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<1>
Accession Number
623114963
Author
Xaplanteris P.; Fournier S.; Pijls N.H.J.; Fearon W.F.; Barbato E.; Tonino
P.A.L.; Engstrom T.; Kaab S.; Dambrink J.-H.; Rioufol G.; Toth G.G.;
Piroth Z.; Witt N.; Frobert O.; Kala P.; Linke A.; Jagic N.; Mates M.;
Mavromatis K.; Samady H.; Irimpen A.; Oldroyd K.; Campo G.; Rothenbuhler
M.; Juni P.; De Bruyne B.
Institution
(Xaplanteris, Fournier, Barbato, Toth, De Bruyne) Cardiovascular Center
Aalst, Onze-Lieve-Vrouw Clinic, Moorselbaan 164, Aalst B-9300, Belgium
(Pijls, Tonino) Department of Cardiology, Eindhoven University of
Technology, Catharina Hospital, Eindhoven, Netherlands
(Dambrink) Isala Klinieken, Zwolle, Netherlands
(Fearon) Stanford University Medical Center and Palo Alto Veterans Affairs
(VA) Health Care Systems, Stanford, CA, United States
(Engstrom) Rigshospitalet University Hospital, D-Copenhagen, Germany
(Kaab) Klinikum Der Universitat Munchen-Campus-Innenstadt, Munich, Germany
(Linke) Heart Center Leipzig, Leipzig, Germany
(Linke) Heart Center Dresden, Dresden, Germany
(Rioufol) Cardiovascular Hospital, Lyon, France
(Toth, Piroth) Gottsegen Hungarian Institute of Cardiology, Budapest,
Hungary
(Witt) Karolinska Institutet at Sodersjukhuset, Stockholm, Sweden
(Frobert) Orebro University Hospital, Orebro, Sweden
(Kala) Masaryk University and University Hospital, Brno, Czech Republic
(Mates) Na Homolce Hospital, Prague, Czech Republic
(Jagic) Clinical Center Kragujevac, Kragujevac, Serbia
(Mavromatis) Atlanta VA Medical Center, Decatur, United States
(Samady) Emory University School of Medicine, G-Atlanta, Georgia
(Irimpen) Vascular Institute, Tulane University Heart, New Orleans, United
States
(Oldroyd) Golden Jubilee National Hospital, Glasgow, United Kingdom
(Campo) Gruppo Villa Maria Care and Research, Cardiology Unit, Azienda
Ospedalieria Universitaria di Ferrara, Maria Cecilia Hospital, Ferrara,
Cotignola, Italy
(Rothenbuhler) Clinical Trials Unit Bern, University of Bern, Bern,
Switzerland
(Juni) Applied Health Research Centre, Department of Medicine and
Institute of Health Policy, Management, and Evaluation, University of
Toronto, Li Ka Shing Knowledge Institute of St. Michael's Hospital,
Toronto, Canada
Title
Five-year outcomes with PCI guided by fractional flow reserve.
Source
New England Journal of Medicine. 379 (3) (pp 250-259), 2018. Date of
Publication: 19 Jul 2018.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND We hypothesized that fractional flow reserve (FFR)-guided
percutaneous coronary intervention (PCI) would be superior to medical
therapy as initial treatment in patients with stable coronary artery
disease. METHODS Among 1220 patients with angiographically significant
stenoses, those in whom at least one stenosis was hemodynamically
significant (FFR, <=0.80) were randomly assigned to FFR-guided PCI plus
medical therapy or to medical therapy alone. Patients in whom all stenoses
had an FFR of more than 0.80 received medical therapy and were entered
into a registry. The primary end point was a composite of death,
myocardial infarction, or urgent revascularization. RESULTS A total of 888
patients underwent randomization (447 patients in the PCI group and 441 in
the medical-therapy group). At 5 years, the rate of the primary end point
was lower in the PCI group than in the medical-therapy group (13.9% vs.
27.0%; hazard ratio, 0.46; 95% confidence interval [CI], 0.34 to 0.63;
P<0.001). The difference was driven by urgent revascularizations, which
occurred in 6.3% of the patients in the PCI group as compared with 21.1%
of those in the medical-therapy group (hazard ratio, 0.27; 95% CI, 0.18 to
0.41). There were no significant differences between the PCI group and the
medical-therapy group in the rates of death (5.1% and 5.2%, respectively;
hazard ratio, 0.98; 95% CI, 0.55 to 1.75) or myocardial infarction (8.1%
and 12.0%; hazard ratio, 0.66; 95% CI, 0.43 to 1.00). There was no
significant difference in the rate of the primary end point between the
PCI group and the registry cohort (13.9% and 15.7%, respectively; hazard
ratio, 0.88; 95% CI, 0.55 to 1.39). Relief from angina was more pronounced
after PCI than after medical therapy. CONCLUSIONS In patients with stable
coronary artery disease, an initial FFR-guided PCI strategy was associated
with a significantly lower rate of the primary composite end point of
death, myocardial infarction, or urgent revascularization at 5 years than
medical therapy alone. Patients without hemodynamically significant
stenoses had a favorable long-term outcome with medical therapy alone.
(Funded by St. Jude Medical and others; FAME 2 ClinicalTrials.gov number,
NCT01132495.)<br/>Copyright &#xa9; 2018 Massachusetts Medical Society.

<2>
Accession Number
623126927
Author
Elsheshtawy M.O.; Mahmoud A.N.; Abdelghany M.; Suen I.H.; Sadiq A.; Shani
J.
Institution
(Elsheshtawy, Sadiq, Shani) Division of Cardiovascular Medicine,
Department of Medicine, Maimonides Medical Center, Brooklyn, NY, United
States
(Elsheshtawy, Suen) Division of Cardiovascular Medicine, Department of
Medicine, Coney Island Hospital, Brooklyn, NY, United States
(Mahmoud) Division of Cardiovascular Medicine, Department of Medicine,
University of Florida, Gainesville, FL, United States
(Abdelghany) Division of Cardiovascular Medicine, Department of Medicine,
State University of New York, Upstate Medical University, Syracuse, NY,
United States
Title
Left ventricular aneurysms in hypertrophic cardiomyopathy with
midventricular obstruction: A systematic review of literature.
Source
PACE - Pacing and Clinical Electrophysiology. 41 (7) (pp 854-865), 2018.
Date of Publication: July 2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Hypertrophic cardiomyopathy (HCM) with or without left
ventricular apical aneurysm (LVA) had been studied in the past.
Midventricular obstruction associated with HCM and LVA is a unique entity
that has not been distinguished previously as a separate phenotypic
disease in HCM patients. Methods: A systematic review of Pubmed and Google
Scholar was conducted from inception until September 2017 for all
observational studies conducted on HCM with midventricular obstruction and
LVA. Results: A total of 94 patients from 39 studies were included in our
analysis. The mean age of the patients was 58.05 +/- 11.76 years with
59.6% being males. The most common electrocardiographic finding was T wave
inversion occurring in 13.8% of the cases followed by ST elevation (9.5%).
Maximal left ventricle (LV) wall thickness was reported 18.89 +/- 5.19 mm
on transthoracic echocardiography and paradoxical jet flow was detected in
29.8% of patients. Beta-blockers (58.5%) were the most common drug therapy
at baseline and amiodarone (10.6%) was the most common antiarrhythmic used
for ventricular tachycardia (VT). The most common complication, VT,
occurred in 39.3% of cases and the incidence of all-cause mortality was
13.8 % over 16 +/- 20.1 months follow-up. Implantable cardioverter
defibrillator (ICD) was used in 37.2% of patients; 25.7% of patients with
ICD received appropriate shock therapy. Conclusion: HCM with LVA and
midventricular obstruction is a unique entity that appears to be
associated with high incidence of morbidity and mortality. Thus, early
diagnosis and therapeutic intervention is recommended for management of
this condition.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<3>
Accession Number
619492656
Author
Zochios V.; Klein A.A.; Gao F.
Institution
(Zochios) University Hospitals Birmingham NHS Foundation Trust, Department
of Critical Care Medicine, Queen Elizabeth Hospital Birmingham, Edgbaston,
Birmingham, United Kingdom
(Zochios, Gao) Perioperative Critical Care and Trauma Trials Group,
Institute of Inflammation and Ageing, Centre of Translational Inflammation
Research, University of Birmingham, Birmingham, United Kingdom
(Klein) Department of Cardiothoracic Anesthesia and Critical Care
Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard,
Cambridge, United Kingdom
(Gao) The 2nd Affiliated Hospital and Yuying Children's Hospital, Wenzhou
Medical University, Wenzhou, China
Title
Protective Invasive Ventilation in Cardiac Surgery: A Systematic Review
With a Focus on Acute Lung Injury in Adult Cardiac Surgical Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (4) (pp 1922-1936),
2018. Date of Publication: August 2018.
Publisher
W.B. Saunders

<4>
Accession Number
619934147
Author
Kang F.; Tang C.; Han M.; Chai X.; Huang X.; Li J.
Institution
(Kang, Tang, Han, Chai, Huang, Li) Department of Anesthesiology, Anhui
Provincial Hospital Affiliated to Anhui Medical University, Anhui
Province, China
Title
Effects of Dexmedetomidine-Isoflurane versus Isoflurane Anesthesia on
Brain Injury After Cardiac Valve Replacement Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (4) (pp 1581-1586),
2018. Date of Publication: August 2018.
Publisher
W.B. Saunders
Abstract
Objectives: To compare dexmedetomidine combined with isoflurane versus
isoflurane anesthesia on brain injury after cardiac surgery. Design: A
prospective, randomized, single-blind study. Setting: University hospital.
Participants: Adult patients undergoing elective valve replacement
surgery. Interventions: Ninety-seven patients scheduled for valve
replacement surgery were randomly divided into 2 groups: dexmedetomidine
and isoflurane (Dex-Iso, n = 50) and isoflurane alone (Iso, n = 47).
Dexemedetomidine was infused at 0.6 mug/kg as a bolus, followed with 0.2
mug/kg/h until the end of surgery. Measurements and Main Results: Jugular
blood samples were drawn for analysis of matrix metalloproteinase-9
(MMP-9) and glial fibrillary acidic protein (GFAP) levels on time points
of: T1 (before induction); T2 (5 minutes after cardiopulmonary bypass
[CPB] onset); T3 (after CPB off); T4 (the first day after operation); T5
(the second day after operation). Plasma lactate levels in arterial and
jugular venous blood also were quantified. The difference between arterial
and jugular bulb venous blood lactate levels (AVDL) was calculated. An
antisaccadic eye movement (ASEM) test was carried out on the day before
the operation and the seventh day postoperatively. In both groups, serum
MMP-9 and GFAP concentrations increased after CPB, with the peak values
occurring after CPB. At time point T5, MMP-9 and GFAP levels were close to
those at T1. MMP-9 concentrations in the Dex-Iso group were lower than the
Iso group at T3 and T4. GFAP concentrations in the Dex-Iso group were
lower at T3 but were higher than the Iso group at T2. No significant
differences were found in AVDL between the 2 groups perioperatively except
at T2. The ASEM scores decreased significantly postoperatively. There was
no significant difference in the ASEM scores between the 2 treatment
groups before and after the operation. Conclusions: The use of
dexmedetomidine decreased the biochemical markers of brain injury but did
not improve the neuropsychological test result after cardiac
surgery.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<5>
Accession Number
620208406
Author
Biancari F.; Kinnunen E.-M.; Kiviniemi T.; Tauriainen T.; Anttila V.;
Airaksinen J.K.E.; Brascia D.; Vasques F.
Institution
(Biancari, Brascia) Department of Surgery, University of Turku, Turku,
Finland
(Biancari, Kinnunen, Tauriainen) Department of Surgery, University of
Oulu, Oulu, Finland
(Biancari, Kiviniemi, Anttila, Airaksinen) Heart Center, Turku University
Hospital and University of Turku, Turku, Finland
(Vasques) Department of Anesthesia, Padua University Hospital, Padua,
Italy
Title
Meta-analysis of the Sources of Bleeding after Adult Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (4) (pp 1618-1624),
2018. Date of Publication: August 2018.
Publisher
W.B. Saunders
Abstract
Objective: The aim of this study was to pool data on the proportion and
prognostic impact of sources of bleeding in patients requiring
re-exploration after adult cardiac surgery. Design: Systematic review of
the literature and meta-analysis. Setting: Multistitutional study.
Measurements and Main Results: A literature review was performed to
identify studies published since 1990 evaluating the outcome after
reoperation for bleeding or tamponade after adult cardiac surgery.
Eighteen studies including 5,1497 patients fulfilled the selection
criteria. Reoperation for bleeding/tamponade was performed in 2,455
patients (4.6%; 95% confidence interval [CI] 3.9%-5.2%, I²
92%). These had a significantly higher risk of in-hospital/30-day
mortality compared with patients not reoperated for bleeding (pooled
rates: 9.3% v 2.3%; risk ratio 3.30; 95% CI 2.52-4.32; I² 47%;
8 studies; 25,463 patients). Surgical sites of bleeding were identified in
65.7% of cases (95% CI 58.3%-73.2%; I² 94%), cardiac site
bleeding in 40.9% of cases (95% CI 29.7%-52.0%; I² 94%), and
mediastinal/sternum site bleeding in 27.0% of cases (95% CI 16.8%-37.3%;
I² 94%). The main sites of bleeding were the body of the graft
(20.2%), the sternum (17.0%), vascular sutures (12.5%), the internal
mammary artery harvest site (13.0%), and anastomoses (9.9%). In
metaregression, surgical site bleeding was associated with a lower risk of
in-hospital/30-day mortality compared with diffuse bleeding (p = 0.003).
Conclusions: Surgical site bleeding is identified in two-thirds of
patients undergoing re-exploration after adult cardiac surgery. Meticulous
surgical technique and systematic intraoperative checking of potential
surgical sites of bleeding at the time of the original cardiac surgery may
reduce the risk of such a severe complication.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<6>
Accession Number
623190925
Author
Tewari K.; Tewari V.V.; Datta S.K.
Institution
(Tewari, Datta) Department of Anaesthesia and Critical Care, Cardiology,
Base Hospital, New Delhi, India
(Tewari) Department of Paediatrics, Army Hospital (Referral and Research),
New Delhi, India
Title
Dexmedetomidine-propofol vs ketamine-propofol anaesthesia in paediatric
and young adult patients undergoing device closure procedures in cardiac
catheterisation laboratory: An open label randomised trial.
Source
Indian Journal of Anaesthesia. 62 (7) (pp 531-537), 2018. Date of
Publication: July 2018.
Publisher
Indian Society of Anaesthetists (Flat No 12/1A K Point, 68-BAPC Roy Road,
Kolkata 700009, India)
Abstract
Background and Aims: Several drug combinations have been tried in patients
with acyanotic congenital heart disease (ACHD) undergoing transcatheter
device closure in the cardiac catheterisation laboratory (CCL). Adequate
sedation, analgesia, akinesia, cardiorespiratory stability, and prompt
recovery are key requirements. Ketamine with propofol is used for this
purpose. Dexmedetomidine carries a shorter recovery time. This study
compared dexmedetomidine-propofol (DP) with ketamine-propofol (KP) in
patients in the CCL. Methods: This was an open label randomised trial at a
CCL over a 2-year period from August 2012 to August 2014. Fifty-six
paediatric and 44 young adults with ACHD underwent device closure and were
randomised to receive DP or KP. The primary outcome studied was time to
regain full consciousness, airway and motor recovery. Results: Baseline
characteristics were similar in the study groups. In the DP arm as
compared to the KP arm, the time to recovery of consciousness (mean +/-
SD) was significantly faster in both paediatric patients [30 +/- 15 vs. 58
+/- 13 min (P < 0.001)] and in young adult patients [22 +/- 10 vs. 35 +/-
12 min (P < 0.001)]. There was significantly faster motor recovery also
(mean +/- SD) [paediatric: 25 +/- 05 vs. 40 +/- 14 (P < 0.001); young
adult: 10 +/- 05 vs. 22 +/- 10 min (P < 0.001)]. Conclusion: Procedural
anaesthesia with DP in paediatric and young adult patients with ACHD
undergoing device closure in the CCL resulted in faster recovery of
consciousness and motor recovery compared to KP.<br/>Copyright &#xa9; 2018
Indian Journal of Anaesthesia.

<7>
Accession Number
623271009
Author
Bagur R.; Martin G.P.; Nombela-Franco L.; Doshi S.N.; George S.;
Toggweiler S.; Sponga S.; Cotton J.M.; Khogali S.S.; Ratib K.; Kinnaird
T.; Anderson R.A.; Chu M.W.A.; Kiaii B.; Biagioni C.; Schofield-Kelly L.;
Loretz L.; Torracchi L.; Sekar B.; Kwok C.S.; Sperrin M.; Ludman P.F.;
Mamas M.A.
Institution
(Bagur, Chu, Kiaii) Heart Team, London Health Sciences Centre, London, ON,
Canada
(Bagur) Department of Epidemiology and Biostatistics, Schulich School of
Medicine and Dentistry, Western University, London, ON, Canada
(Bagur, Ratib, Kwok, Mamas) Keele Cardiovascular Research Group, Centre
for Prognosis Research, Institute for Primary Care and Health Sciences,
Keele University, Stoke-on-Trent, United Kingdom
(Martin, Sperrin, Mamas) Farr Institute, Faculty of Biology, Medicine and
Health, University of Manchester, Manchester Academic Health Science
Centre, Manchester, United Kingdom
(Nombela-Franco, Biagioni) Cardiovascular Institute, Hospital Clinico San
Carlos, Madrid, Spain
(Doshi, George, Ludman) Cardiology Department, Queen Elizabeth Hospital,
Birmingham, United Kingdom
(Toggweiler, Loretz) Cardiology Division, Heart Center Lucerne, Lucerne,
Switzerland
(Sponga, Torracchi) Cardiothoracic Department, University Hospital of
Udine, Udine, Italy
(Cotton, Khogali, Schofield-Kelly) Heart and Lung Centre, Royal
Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
(Kinnaird, Anderson, Sekar) Department of Cardiology, University Hospital
of Wales, Cardiff, United Kingdom
Title
Association of comorbid burden with clinical outcomes after transcatheter
aortic valve implantation.
Source
Heart. (no pagination), 2018. Date of Publication: 20 Jul 2018.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives: To investigate the association of the CharlsonComorbidity
Index (CCI) with clinical outcomes after transcatheter aortic valve
implantation (TAVI). Background: Patients undergoing TAVI have high
comorbid burden; however, there is limited evidence of its impact on
clinical outcomes. Methods: Data from 1887 patients from the UK, Canada,
Spain, Switzerland and Italy were collected between 2007 and 2016. The
association of CCI with 30-day mortality, Valve Academic Research
Consortium-2 (VARC-2) composite early safety, long-term survival and
length of stay (LoS) was calculated using logistic regression and Cox
proportional hazard models, as a whole cohort and at a country level,
through a two-stage individual participant data (IPD) random effect
meta-analysis. Results: Most (60%) of patients had a CCI >=3. A weak
correlation was found between the total CCI and four different
preoperative risks scores (=0.16 to 0.29), and approximately 50% of
patients classed as low risk from four risk prediction models still
presented with a CCI >=3. Per-unit increases in total CCI were not
associated with increased odds of 30-day mortality (OR 1.09, 95% CI 0.96
to 1.24) or VARC-2 early safety (OR 1.04, 95% CI 0.96 to 1.14) but were
associated with increased hazard of long-term mortality (HR 1.10, 95% CI
1.05 to 1.16). The two-stage IPD meta-analysis indicated that CCI was not
associated with LoS (HR 0.97, 95% CI 0.93 to 1.02). Conclusion: In this
multicentre international study, patients undergoing TAVI had significant
comorbid burden. We found a weak correlation between the CCI and
well-established preoperative risks scores. The CCI had a moderate
association with long-term mortality up to 5 years
post-TAVI.<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2018. No
commercial re-use. See rights and permissions. Published by BMJ.

<8>
Accession Number
622796742
Author
Harmel E.K.; Reichenspurner H.; Girdauskas E.
Institution
(Harmel, Reichenspurner, Girdauskas) Department of Cardiothoracic Surgery,
University Heart Center Hamburg, Hamburg, Germany
Title
Subannular reconstruction in secondary mitral regurgitation: A
meta-analysis.
Source
Heart. (no pagination), 2018. Date of Publication: 13 Mar 2018.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: Mitral valve repair using an undersized complete annuloplasty
ring in secondary mitral regurgitation with restricted leaflet motion
during systole (Carpentier's surgical classification of mitral valve
pathology: type IIIb) only inadequately addresses the underlying left
ventricular disease. This may lead to an ongoing ventricular remodelling
and progressive papillary muscle displacement with increasing leaflet
tethering. Several subannular techniques have been proposed to counteract
the reoccurrence of mitral regurgitation after mitral valve repair. We
aimed to evaluate the potential additive effect of such subannular
techniques on the late reoccurrence rate of secondary mitral
regurgitation. Methods: Systematic literature review and meta-analysis
were performed on PubMed, Embase and Google Scholar for studies published
up to March 2016 and reporting late reoccurrence of mitral regurgitation
after mitral valve repair using standard annuloplasty (control group)
versus annuloplasty with subannular correction (study group) cohorts.
Primary endpoint was late reoccurrence of mitral regurgitation >=2 after
surgical mitral valve repair, as defined by follow-up echocardiography.
Results: The cumulative number of 1093 patients in 12 included studies
served as our study population. A total of 743 patients underwent combined
mitral valve repair including annuloplasty and subannular manoeuvre (ie,
study group), while the remaining 350 patients underwent an isolated ring
annuloplasty (ie, control group). Secondary mitral regurgitation was
caused by ischaemic heart disease in 733/743 patients in the study group
and 334/350 patients in the control group. Mean echocardiographic
follow-up was 42.7+/-13.9 months. Pooled outcome analysis demonstrated
that the combination of subannular repair with ring annuloplasty was
associated with a significantly lower reoccurrence rate of mitral
regurgitation >=2 as compared with annuloplasty alone (OR 0.27, 95% CI
0.19 to 0.38, P=0.0001). Conclusion: The combination of subannular
reconstruction and mitral valve annuloplasty is associated with a lower
late reoccurrence of mitral regurgitation after surgical mitral valve
repair, as compared with annuloplasty alone.<br/>Copyright &#xa9; Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2018. All rights reserved. No commercial use is permitted unless
otherwise expressly granted.

<9>
Accession Number
623265249
Author
Kanjanahattakij N.; Horn B.; Vutthikraivit W.; Biso S.M.; Ziccardi M.R.;
Lu M.L.R.; Rattanawong P.
Institution
(Kanjanahattakij, Horn, Biso, Ziccardi, Lu) Department of Medicine,
Einstein Medical Center, Philadelphia, PA, United States
(Vutthikraivit) Department of Medicine, Texas Tech University Health
Sciences Center, Lubbock, TX, United States
(Rattanawong) University of Hawaii Internal Medicine Residency Program,
Honolulu, HI, United States
Title
Comparing outcomes after transcatheter aortic valve replacement in
patients with stenotic bicuspid and tricuspid aortic valve: A systematic
review and meta-analysis.
Source
Clinical Cardiology. 41 (7) (pp 896-902), 2018. Date of Publication: July
2018.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has become an
alternative treatment to surgery in patients with severe aortic stenosis.
However, patients with bicuspid aortic stenosis (BAV) are usually excluded
from major TAVR studies. The aim of this study is to reexamine current
evidence of TAVR in patients with severe aortic stenosis and BAV compared
with tricuspid aortic valve (TAV). Hypothesis: There might be differences
in outcomes post TAVR between patients with BAV comparing to TAV. Method:
Databases were systematically searched for relevant articles featuring
cohort studies that included patients with BAV and TAV who underwent TAVR
studies, of which reported outcomes of interest included mortality and
complications in both groups. Pooled effect size was calculated with a
random-effect model and weighted for the inverse of variance, to compare
outcomes post-TAVR between BAV and TAV. Results: Nine studies were
included in the meta-analysis. There was no difference in 30-day mortality
rate in patients with BAV compared with TAV (OR: 1.27, 95% CI: 0.84-1.93,
I² = 0). Patients with BAV were more likely to have a moderate
to severe paravalvular leak (9 studies; OR: 1.42, 95% CI: 1.08-1.87,
I² = 0) and conversion to surgery (5 studies; OR: 5.48, 95% CI:
1.74-17.27, I² = 0), and less likely to have device success
compared with patients with TAV (5 studies; OR: 0.57, 95% CI: 0.40-0.81,
I² = 0%). Conclusions: There was no difference in mortality
post-TAVR in patients with BAV compared with TAV. Further randomized
studies should be done in newer-generation prostheses to assess this
association.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<10>
Accession Number
623274683
Author
Jackson J.C.; Mozaffarian D.; Graves A.J.; Brown N.J.; Marchioli R.; Kiehl
A.L.; Ely E.W.
Institution
(Jackson, Kiehl, Ely) Department of Medicine, Divisions of Allergy,
Pulmonary and Critical Care Medicine, Nashville, TN, United States
(Graves) Division of Urologic Surgery, Vanderbilt University School of
Medicine, Nashville, TN, United States
(Brown) Division of Pharmacology, Vanderbilt University School of
Medicine, Nashville, TN, United States
(Jackson) Department of Psychiatry, Vanderbilt University School of
Medicine, Nashville, TN, United States
(Jackson, Kiehl, Ely) Center for Health Services Research, Vanderbilt
University School of Medicine, Nashville, TN, United States
(Jackson) Research Service, Department of Veterans Affairs Medical Center,
Tennessee Valley Healthcare System, Nashville, TN, United States
(Jackson, Ely) Geriatric Research Education and Clinical Center (GRECC),
Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare
System, Nashville, TN, United States
(Mozaffarian) Friedman School of Nutrition Science and Policy, Tufts
University, Boston, MA, United States
(Marchioli) Therapeutic Science and Strategy Unit (TSSU), Quintiles,Milan,
Italy
Title
Fish oil supplementation does not affect cognitive outcomes in cardiac
surgery patients in the omega-3 fatty acids for prevention of
post-operative atrial fibrillation (OPERA) trial.
Source
Journal of Nutrition. 148 (3) (pp 472-479), 2018. Date of Publication: 01
Mar 2018.
Publisher
Oxford University Press
Abstract
Background: Cognitive decline has been reported following cardiac surgery,
leading to great interest in interventions to minimize its occurrence.
Long-chain n-3 (omega-3) polyunsaturated fatty acids (PUFAs) have been
associated with less cognitive decline in observational studies, yet no
trials have tested the effects of n-3 PUFAs on cognitive decline after
surgery. Objective:We sought to determine whether perioperative n-3 PUFA
supplementation reduces postoperative cognitive decline in patients
postcardiac surgery. Methods: The study comprised a randomized,
double-blind, placebo-controlled, multicenter, clinical trial conducted on
cardiac surgery recipients at 9 tertiary care medical centers across the
United States. Patients were randomly assigned to receive fish oil (1-g
capsules containing >=840 mg n-3 PUFAs as ethyl esters) or placebo, with
preoperative loading of 8-10 g over 2-5 d followed postoperatively by 2
g/d until hospital discharge or postoperative day 10, whichever came
first. Global cognition was assessed using in-person testing over 30 d
with the Repeatable Battery for the Assessment of Neuropsychological
Status (RBANS) (primary outcome), Mini-Mental State Exam (secondary
outcome), and Trails A and B (secondary outcome) tests. All end pointswere
prespecified. Statistical methodswere employed, including descriptive
statistics, logistic regression, and various sensitivity analyses.
Results: A total of 320 US patients were enrolled in the Omega-3 Fatty
Acids for Prevention of Post-Operative Atrial Fibrillation (OPERA)
Cognitive Trial (OCT), a substudy of OPERA. The median age was 62 y (IQR
53, 70 y). No differences in global cognition were observed between
placebo and fish oil groups at day 30 (P = 0.32) for the primary outcome,
a composite neuropsychological RBANS score. The population demonstrated
resolution of initial 4-d cognitive decline back to baseline function by
30 d on the RBANS. Conclusion: Perioperative supplementation with n-3
PUFAs in cardiac surgical patients did not influence cognition <=30 d
after discharge. Modern anesthetic, surgical, and postoperative care may
be mitigating previously observed long-term declines in cognitive function
following cardiac surgery. This trial was registered at clinicaltrials.gov
as NCT00970489. J Nutr 2018;148:472-479.<br/>Copyright &#xa9;2018 American
Society for Nutrition.

<11>
Accession Number
623274739
Author
Makki N.; Lilly S.M.
Institution
(Makki, Lilly) Department of Cardiology Ohio State University Wexner
Medical Center Columbus, Ohio
Title
Advanced chronic kidney disease: Relationship to outcomes post-TAVR, a
meta-analysis.
Source
Clinical Cardiology. (no pagination), 2018. Date of Publication: 2018.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Chronic kidney disease (CKD) is associated with worse outcomes in
high-surgical-risk patients undergoing transcatheter aortic valve
replacement (TAVR). However, it is unclear whether this relationship is
apparent in lower-surgical-risk patients. We sought to analyze existing
literature to assess whether or not advanced CKD is associated with
increased mortality or a greater incidence of adverse events (specifically
major stroke, bleeding, and vascular complications). We searched PubMed
and Embase (2008-2017) for relevant studies. Studies with <1 year
follow-up and those not evaluating advanced CKD or outcomes post-TAVR were
excluded. Our co-primary endpoints were the incidence of short-term
mortality (defined as in-hospital or 30-day mortality) and long-term
mortality (1 year). Our secondary endpoints included incidence of major
stroke, life-threatening bleeding, and major vascular complications.
Eleven observational studies with a total population of 10709 patients met
the selection criteria. Among patients with CKD there was an increased
risk of short- and long-term mortality in high-surgical-risk patients who
underwent TAVR (hazard ratio [HR]: 1.51, 95% confidence interval [CI]:
1.22-1.88 and HR: 1.56, 95% CI: 1.38-1.77, respectively; P < 0.01).
However, there was no association between CKD and mortality in low- to
intermediate-risk patients (HR: 1.35, 95% CI: 0.98-1.84, P = 0.06 in
short-term and HR: 1.08, 95% CI: 0.92-1.27, P = 0.34 in long-term). In
low- to intermediate-risk TAVR patients, advanced CKD is not associated
with increased mortality or poorer safety outcomes. These findings should
be factored into the clinical decision-making process regarding TAVR
candidacy.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<12>
Accession Number
623266566
Author
Tam D.Y.; Vo T.X.; Wijeysundera H.C.; Dvir D.; Friedrich J.O.; Fremes S.E.
Institution
(Tam, Fremes) Division of Cardiac Surgery, Department of SurgerySchulich
Heart Centre, Sunnybrook Health Sciences Centre, University of
TorontoToronto Canada
(Tam, Wijeysundera, Fremes) Institute of Health Policy, Management and
Evaluation, University of TorontoToronto Canada
(Vo) Division of Cardiac Surgery, Department of SurgeryUniversity of
Ottawa Heart Institute, University of OttawaOttawa Canada
(Wijeysundera) Division of Cardiology, Department of MedicineSchulich
Heart Centre, Sunnybrook Health Sciences Centre, University of
TorontoToronto Canada
(Dvir) Division of Cardiology Department of MedicineUniversity of
Washington Medical CentreSeattle, Washington
(Friedrich) Critical Care and Medicine DepartmentsSt. Michael's Hospital
University of TorontoToronto Canada
Title
Transcatheter valve-in-valve versus redo surgical aortic valve replacement
for the treatment of degenerated bioprosthetic aortic valve: A systematic
review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2018.
Date of Publication: 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: To determine the safety and efficacy of valve-in-valve
transcatheter aortic valve replacement (ViV) versus redo surgical aortic
valve replacement (SAVR) for the treatment of previously failed aortic
bioprostheses. Background: Valve-in-valve has emerged as a treatment
option for patients with a failed aortic bioprosthesis. Evidence for
safety and efficacy remains limited to small studies. Methods: Medline and
Embase were searched to 2017 for studies that directly compared ViV to
redo SAVR. A random effects meta-analysis was performed. Results: Four
unadjusted (n=298) and two propensity-matched (n=200) observational
studies were included. Valve-in-valve patients were 2.85-years older
(P=0.03) and were 23% higher in predicted mortality risk (ratio of means:
1.23, 95% confidence interval (95%CI): 1.02-1.48). There was no difference
in peri-operative mortality (4.4% vs. 5.7%, P=0.83;I²=0%) or
late mortality, reported at median one year follow-up (incident rate ratio
(IRR) 0.93, 95%CI: 0.74-1.16, P=0.51, I²=0%) between ViV and
redo SAVR. The incidence of permanent pacemaker implantation (8.3% vs
14.6%; P=0.05;I²=0%) and dialysis (3.2% vs. 10.3%; P=0.03;
I²=0%) were lower in ViV. There was a reduction in the
incidence of severe patient-prosthesis mismatch (3.3% vs 13.5%; P=0.03;
I²=0%) and mild or greater paravalvular leak (5.5% vs 21.1%;
P=0.03; I²=37%) in the redo SAVR group compared to ViV.
Conclusions: Despite higher predicted surgical risk of ViV patients, there
was no difference in mortality but less permanent pacemaker implantation
and dialysis compared to redo SAVR. Choice of treatment must be
individualized for both anatomical and patient risk factors; in high risk
patients with favorable previous prosthesis size, valve-in-valve may be
preferred.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<13>
Accession Number
623266506
Author
Zochios V.; Collier T.; Blaudszun G.; Butchart A.; Earwaker M.; Jones N.;
Klein A.A.
Institution
(Zochios) Department of Intensive Care Medicine University Hospitals
Birmingham National Health Service Foundation Trust Queen Elizabeth
Hospital Birmingham University of Birmingham UK
(Collier) Medical Statistics Department London School of Hygiene and
Tropical Medicine LondonUK
(Blaudszun) Department of Anaesthesia, Pharmacology and Intensive Care
Medicine Geneva University Hospitals GeneveSwitzerland
(Butchart, Jones, Klein) Department of Cardiothoracic Anaesthesia and
Intensive Care Medicine Royal Papworth Hospital National Health Service
Foundation Trust CambridgeUK
(Earwaker) Research and Development Department Royal Papworth Hospital
National Health Service Foundation Trust CambridgeUK
(Jones, Klein) Department of Anaesthesia and Intensive Care Royal Papworth
Hospital National Health Service Foundation Trust Cambridge UK
Title
The effect of high-flow nasal oxygen on hospital length of stay in cardiac
surgical patients at high risk for respiratory complications: A randomised
controlled trial.
Source
Anaesthesia. (no pagination), 2018. Date of Publication: 2018.
Publisher
Blackwell Publishing Ltd
Abstract
There has been increased interest in the prophylactic and therapeutic use
of high-flow nasal oxygen in patients with, or at risk of, non-hypercapnic
respiratory failure. There are no randomised trials examining the efficacy
of high-flow nasal oxygen in high-risk cardiac surgical patients. We
sought to determine whether routine administration of high-flow nasal
oxygen, compared with standard oxygen therapy, leads to reduced hospital
length of stay after cardiac surgery in patients with pre-existing
respiratory disease at high risk for postoperative pulmonary
complications. Adult patients with pre-existing respiratory disease
undergoing elective cardiac surgery were randomly allocated to receive
high-flow nasal oxygen (n = 51) or standard oxygen therapy (n = 49). The
primary outcome was hospital length of stay and all analyses were carried
out on an intention-to-treat basis. Median (IQR [range]) hospital length
of stay was 7 (6-9 [4-30]) days in the high-flow nasal oxygen group and 9
(7-16 [4-120]) days in the standard oxygen group (p=0.012). Geometric mean
hospital length of stay was 29% lower in the high-flow nasal group (95%CI
11-44%, p = 0.004). High-flow nasal oxygen was also associated with fewer
intensive care unit re-admissions (1/49 vs. 7/45; p = 0.026). When
compared with standard care, prophylactic postoperative high-flow nasal
oxygen reduced hospital length of stay and intensive care unit
re-admission. This is the first randomised controlled trial examining the
effect of prophylactic high-flow nasal oxygen use on patient-centred
outcomes in cardiac surgical patients at high risk for postoperative
respiratory complications. 2018<br/>Copyright &#xa9; The Association of
Anaesthetists.

<14>
Accession Number
621583733
Author
Godai K.; Hasegawa-Moriyama M.; Matsunaga A.; Kanmura Y.
Institution
(Godai, Hasegawa-Moriyama, Matsunaga, Kanmura) Department of
Anesthesiology and Critical Care Medicine, Graduate School of Medical and
Dental Sciences, Kagoshima University, Kagoshima, Japan
Title
Phenylephrine does not improve oxygenation during one-lung ventilation: A
randomized, double-blind, cross-over study.
Source
PLoS ONE. 13 (4) (no pagination), 2018. Article Number: e0195576. Date of
Publication: April 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Phenylephrine is an alpha<inf>1</inf> adrenergic receptor
agonist that causes pulmonary vasoconstriction, and so may effectively
enhance hypoxic pulmonary vasoconstriction (HPV). However, there is little
evidence that phenylephrine augments HPV in clinical situations. This
study aimed to evaluate the clinical effects of phenylephrine infusion on
oxygenation during one-lung ventilation (OLV) in patients undergoing
thoracic surgery. Methods This was a prospective, randomized,
double-blind, cross-over study. Included patients were those undergoing
elective thoracic surgery in the lateral decubitus position with OLV.
Patients were randomly allocated to two groups. The N-P group initially
had OLV with normal saline infusion for 30 minutes; after a 10 minute
interval, OLV was then maintained with phenylephrine infusion for 30
minutes. The P-N group had the drug-infusion in the reverse order. The
primary outcome was arterial partial pressure of oxygen. Secondary
outcomes were mean arterial pressure, heart rate, pulse pressure
variation, perfusion index, and difference between bladder and skin
temperature. Statistical analysis was performed using the student t-test,
Fisher's exact test, and ANOVA for Cross-over design. P <; 0.05 was
considered statistically significant. Results Twenty-nine patients were
analyzed. Although phenylephrine infusion significantly increased mean
arterial pressure (P <; 0.001), arterial partial pressure of oxygen did
not differ between the two timepoints (P = 0.19). There was no carryover
effect in arterial partial pressure of oxygen (P = 0.14). Phenylephrine
infusion significantly decreased heart rate (P = 0.02) and pulse pressure
variation (P <; 0.001). Conclusions Phenylephrine infusion did not improve
oxygenation during OLV. The present results indicate that phenylephrine
does not have clinically meaningful effects on HPV.<br/>Copyright &#xa9;
2018 Godai et al. This is an open access article distributed under the
terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.

<15>
[Use Link to view the full text]
Accession Number
619925093
Author
Baystrukov V.I.; Kretov E.I.; Boukhris M.; Osiev A.G.; Grazhdankin I.O.;
Biryukov A.V.; Najjar H.; Verin V.V.; Zubarev D.D.; Naryshkin I.A.;
Bogachev-Prokophiev A.V.; Mashayekhi K.; Galassi A.R.; Prokhorikhin A.A.
Institution
(Baystrukov, Kretov, Grazhdankin, Zubarev, Naryshkin, Bogachev-Prokophiev,
Prokhorikhin) E.N. Meshalkin Siberian Federal Biomedical Research Center,
Novosibirsk 630090, Russian Federation
(Osiev) Moscow Regional Research and Clinical Institute ('Moniki'),
Moscow, Russian Federation
(Biryukov) Pavlov First Saint Petersburg State Medical University, Saint
Petersburg, United States
(Verin) Primorskiy Regional Hospital No. 1, Vladivostok, Russian
Federation
(Mashayekhi) Division of Cardiology and Angiology II, University Heart
Center Freiburg, Bad Krozingen, Germany
(Galassi) Department of Clinical and Experimental Medicine, University of
Catania, Catania, Italy
(Galassi) Department of Cardiology, University Heart Center, University
Hospital Zurich, Zurich, Switzerland
(Boukhris, Najjar) Department of Cardiology, Abderrahmen Mami Hospital,
Ariana, Tunisia
(Boukhris, Najjar) Faculty of Medicine of Tunis, University Tunis El
Manar, Tunis, Tunisia
Title
A randomized trial of bifurcation stenting technique in chronic total
occlusions percutaneous coronary intervention.
Source
Coronary Artery Disease. 29 (1) (pp 30-38), 2018. Date of Publication:
2018.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background The optimal strategy to treat bifurcation lesions (BFLs) in a
percutaneous coronary intervention (PCI) for chronic total occlusions
(CTOs) remains unknown. Aims We sought to assess whether T-provisional or
mini-crush is appropriate for BFLs within CTO vessels. Patients and
methods From January 2011 to December 2013, patients who underwent
successful CTO guidewire crossing and with a BFL within the CTO target
vessel were enrolled prospectively and assigned randomly to either
T-provisional stenting or the mini-crush technique for BFL treatment.
One-year clinical follow-up was performed. Major adverse cardiac and
cerebrovascular events (MACCE) were defined as the composite of
cardiovascular death, myocardial infarction, target vessel
revascularization, and stroke. Results The prevalence of BFLs was 54.3%. A
total of 146 patients with BFLs within CTO vessel were enrolled
prospectively and assigned randomly to either T-provisional stenting
(N=73) or the mini-crush technique (N=73). Angiographic and clinical
success rates were similar in the two groups: 91.8 versus 97.2% (P=0.27)
and 91.8 versus 94.5% (P=0.67), respectively. Although T-provisional
stenting was associated with a nonsignificantly lower incidence of MACCE
in case of BFLs located far from the CTO (9.3 vs. 22.2%; P=0.426), the
mini-crush technique resulted in higher MACCE-free survival at 1 year in
the presence of BFLs within the CTO body or close to the proximal or the
distal cap (89.1 vs. 64.9%; P=0.007). Conclusion The mini-crush technique
appeared to be associated with improved 1-year clinical and angiographic
outcomes, particularly when used to treat BFLs located within the CTO body
or close to the proximal or the distal cap.<br/>Copyright &#xa9; 2017
Wolters Kluwer Health, Inc. All rights reserved.

<16>
[Use Link to view the full text]
Accession Number
619543893
Author
O'Lynn C.; Cooper A.; Blackwell L.
Institution
(O'Lynn, Blackwell) Chamberlain University, Joanna Briggs Institute
Affiliated Group, Chamberlain University College of Nursing, Chicago, IL,
United States
(Cooper) UCSF Centre for Evidence Synthesis and Implementation, Joanna
Briggs Institute Center of Excellence, San Francisco, CA, United States
Title
Perceptions, experiences and preferences of patients receiving a
clinician's touch during intimate care and procedures: A qualitative
systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 15 (11) (pp
2707-2722), 2017. Date of Publication: 01 Nov 2017.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Background Clinical practice frequently involves the practitioner touching
patients' bodies in areas that are highly personal. If inappropriately
performed, such intimate touch may result in much anxiety, confusion and
misinterpretation. Examination of evidence is necessary to guide practice
in this area to mitigate risks and foster optimal clinicianpatient
relations and care. Objectives The objective of this qualitative
systematic review was to identify and synthesize findings on the
perceptions, experiences and preferences of patients receiving a
clinician's touch during intimate care and procedures Inclusion criteria
Types of participants The current review considered studies that included
patients who had received a clinician's touch during intimate care and
procedures. Phenomena of interest The current review considered
qualitative studies that evaluated patients' perceptions, experiences and
preferences of a clinician's touch during intimate care and procedures.
Types of studies The current review considered studies that collected
qualitative data and included studies using designs such as phenomenology,
grounded theory, ethnography, action research, qualitative description,
focus group methodology and feminist research. In the absence of research
studies, other text such as opinion papers and reports were considered.
Context The current review considered studies that included patients'
perceptions, experiences and preferences of a clinician's touch during
intimate care and procedures. Intimate care is likely to occur in any
clinical setting where patients need assistance with personal care, where
physical examinations occur, or in settings were gynecologic,
genitourinary, lower intestinal, dermatologic, cardiac or other procedures
involving highly personal areas of the body are performed. Search strategy
A three-step search strategy was used to find published and unpublished
studies in English from 1970 to 2016, searching various databases which
included searches of reference lists of studies selected for appraisal.
Methodological quality Included studies were assessed for methodological
quality independently by two reviewers using the Joanna Briggs Institute
Qualitative Assessment and Review Instrument (JBI-QARI) prior to
inclusion. Of the two studies included in the review, one did not discuss
ontological and epistemological assumptions, and the other did not include
the personal assumptions and role of the researcher. Data extraction Data
were extracted using the data extraction tool from the JBI-QARI. The data
extracted included details about the phenomenon of interest, populations
and study methods. Data synthesis Qualitative findings were synthesized
using JBI-QARI. Results Two studies were included in this review. Seven
findings were organized into three categories and one synthesized finding,
"clinician respect". The finding suggests that clients prefer engaged and
meaningful communication prior to and during an intimate touch encounter,
expect autonomy over their bodies and desire shared decision making
relative to how and by whom intimate touch is provided. Conclusion The
synthesized finding from this review suggests that: Healthcare educators
introduce clinician respect as an approach to care activities that involve
intimate touch. (Grade B) Clinicians practice with overall respect toward
their patients by communicating clearly, honoring patients' concerns and
preferences, and engaging patients in decision making to improve patients'
comfort with intimate touch. (Grade B) More research is needed to explore
the perceptions and preferences for intimate touch among diverse
populations, generations, cultures and contexts. Particular exploration is
needed for populations with additional vulnerabilities to
misunderstandings, anxiety and abuse, such as pediatric and geriatric
patients, and patients with physical, mental and cognitive
impairments.<br/>Copyright &#xa9; 2017 The Joanna Briggs Institute.

<17>
Accession Number
619021090
Author
Wang Y.; Xiao L.; Mu W.; Yu H.-L.; Zhang S.; Tian G.-H.; Shang H.-C.
Institution
(Wang) Department of Chinese Medicine, People's Hospital of the Inner
Mongolia Autonomous Region, Hohhot 010017, China
(Xiao) Department of Emergency, The First Affiliated Hospital of Tianjin
University of Traditional Chinese Medicine, Tianjin 300193, China
(Mu) Department of Clinical Pharmacology, The Second Affiliated Hospital
of Tianjin University of Traditional Chinese Medicine, Tianjin 300150,
China
(Yu) Department of Encephalopathy Rehabilitation, The First Affiliated
Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin
300193, China
(Zhang) Department of Integrated Traditional Chinese and Western Medicine,
Metabolic Diseases Hospital of Tianjin Medical University, Tianjin 300070,
China
(Tian) Department of Massage Pain, Dongzhimen Hospital, Beijing University
of Chinese Medicine, Beijing 100700, China
(Shang) Key Laboratory of Chinese Internal Medicine of Ministry of
Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese
Medicine, Beijing 100700, China
Title
A summary and evaluation of current evidence for myocardial infarction
with Chinese medicine.
Source
Chinese Journal of Integrative Medicine. 23 (12) (pp 948-955), 2017. Date
of Publication: 01 Dec 2017.
Publisher
Chinese Journal of Integrated Traditional and Western Medicine Press
(E-mail: cjim@jia.net)
Abstract
Objective: To provide evidence-based recommendations for clinical
application and provoke thoughts for future researchers by conducting a
comprehensive summary and evaluation of the current evidence profile for
the role of Chinese medicine (CM) in treating myocardial infarction (MI).
Methods: Online databases including PubMed, EMBase, Cochrane Library,
Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical
Medicine (CBM), VIP Journal Integration Platform, and Wanfang database
were systematically searched for literatures on CM in treating MI. After
screening, studies were categorized into 5 types, i.e. systematic review
(SR), randomized controlled trial (RCT), observational study, case report
and basic research. General information was abstracted, and the quality
levels of these studies and their conclusions were summarized and
assessed. Results: A total of 452 studies including 10 SRs, 123 RCTs, 47
observational studies, 28 case reports, and 244 basic researches were
selected. Clinical studies centered primarily on herbal decoction and
mostly were not rigorously performed. High-quality studies were
predominantly on Chinese patent medicines (CPMs) such as Danshen Injection
(), Shenmai Injection (), Shengmai Injection () and Qishen Yiqi Dripping
Pills (). The most frequently observed pattern of drug combination was
decoction plus injection. Results of SRs and clinical studies showed that
CM may reduce mortality, decrease risk of complication, reduce myocardial
injury, improve cardiac function and inhibit ventricular remodeling.
Findings from basic researches also supported the positive role of CM in
reducing infarct size and myocardial injury, promoting angiogenesis,
preventing ventricular remodeling and improving cardiac function.
According to the current evidence body, CM has proven effects in the
prevention and treatment of MI. It is also found that the effects of CPMs
vary with indications. For instance, Shenmai Injection has been found to
be especially effective for reducing the incidence of acute clinical
events, while CPMs with qi-nourishing and bloodcirculating properties have
been proven to be effective in inhibiting ventricular remodeling. High
quality evidence supports the use of CM injection for acute MI and CPM for
secondary prevention. Reports on adverse events and other safety outcomes
associated with CM for MI are scarce. Conclusions: Sufficient evidence
supported the use of CM as an adjuvant to Western medicine for preventing
and treating MI. The choice of drug use varies with disease stage and
treatment objective. However, the quality of the evidence body remains to
be enhanced.<br/>Copyright &#xa9; 2017, Chinese Association of the
Integration of Traditional and Western Medicine and Springer-Verlag GmbH
Germany, part of Springer Nature.

<18>
Accession Number
620790240
Author
Nardin M.; Verdoia M.; Barbieri L.; Schaffer A.; Suryapranata H.; De Luca
G.
Institution
(Nardin, Verdoia, Barbieri, Schaffer, De Luca) Division of Cardiology,
Azienda Ospedaliera-Universitaria "Maggiore della Carita", Eastern
Piedmont University, Novara, Italy
(Nardin) Division of Internal Medicine, ASST "Spedali Civili" Brescia,
University of Brescia, Italy
(Suryapranata) Department of Cardiology, UMC St Radboud, Nijmegen,
Netherlands
Title
Radial vs femoral approach in acute coronary syndromes: A meta-analysis of
randomized trials.
Source
Current Vascular Pharmacology. 16 (1) (pp 79-92), 2018. Date of
Publication: 01 Jan 2018.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Substantial improvements have been achieved with percutaneous
coronary intervention (PCI) for the treatment of Acute Coronary Syndromes
(ACS). Nevertheless, bleeding still affects outcomes. The radial approach
for PCI has shown important benefits on access site complications, but is
still not achieving universal consensus as first choice in acute settings.
Therefore, we performed a comprehensive meta-analysis of randomized trials
comparing radial vs femoral approach in PCI for ACS. Methods: The
literature and main scientific session abstracts were scanned for
randomized studies comparing radial vs femoral approach for PCI in ACS.
Primary endpoint was mortality within 30-days. Secondary endpoints were:
1) Major Adverse Cardiovascular Events (MACE), 2) major bleeding, and, 3)
vascular complications. Results: We included 17 randomized trials,
enrolling 19325 patients. A total of 9635 patients were randomized to the
radial approach and 9690 to the femoral approach. The radial approach was
associated with a significant reduction in mortality (1.8 vs 2.5%, odds
ratio, OR [95% CI] = 0.72 [0.59,0.88], p = 0.001,
p<inf>heterogeneity</inf> = 0.31) and in major bleeding complications
compared with the femoral approach (1.5 vs 2.6%, OR [95% CI] = 0.57 [0.47,
0.71], p < 0.00001, p<inf>heterogeneity</inf> = 0.59), with similar
advantages observed for both ST-elevation myocardial infarction and non-ST
segment elevation ACS. MACE occurrence and vascular complications were
also reduced with the radial approach (OR [95% CI] = 0.82 [0.74, 0.92], p
= 0.0005, and OR [95% CI] = 0.52 [0.47, 0.58], p < 0.00001, respectively).
Our results were not influenced by patient risk profile or the
antithrombotic strategy applied. Conclusion: Our meta-analysis shows that
among ACS patients undergoing PCI, the radial approach is associated with
a significant reduction in mortality, major bleeding complications, MACE
and vascular complication compared with the femoral
approach.<br/>Copyright &#xa9; 2018 Bentham Science Publishers.

<19>
Accession Number
623140912
Author
Li W.; Chen Z.; Dai Z.; Liu R.; Yin Q.; Wang H.; Hao Y.; Han Y.; Qiu Z.;
Xiong Y.; Sun W.; Zi W.; Xu G.; Liu X.
Institution
(Li, Chen, Liu, Yin, Wang, Hao, Han, Xiong, Sun, Zi, Xu, Liu) Department
of Neurology, Jinling Hospital, Southern Medical University, Nanjing,
China
(Li) Department of Neurology, Third Affiliated Hospital of Guangzhou
Medical University, Guangzhou, China
(Dai) Department of Neurology, Wuxi People's Hospital, Jiangsu, China
(Qiu) Department of Neurology, 117th hospital of the people's liberation
army, Hangzhou, China
Title
Management of acute tandem occlusions: Stent-retriever thrombectomy with
emergency stenting or angioplasty.
Source
Journal of International Medical Research. 46 (7) (pp 2578-2586), 2018.
Date of Publication: 01 Jul 2018.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: To compare outcomes following intracranial stent
retriever-based intracranial thrombectomy (SRT) with emergency
extracranial internal carotid artery (EICA) stenting or angioplasty alone
in patients presenting with acute stroke due to tandem occlusions of the
ICA. Methods: Consecutive patients with acute anterior tandem occlusion
who received an endovascular intervention within 6h of symptom onset
between January 2013 and June 2016 were included in this prospective
study. Demographic, radiological, procedural and clinical outcome data
were compared between the stenting and the angioplasty alone groups.
Results: Of the 37 patients eligible for the study, 18 had angioplasty
alone and 19 underwent stent placement. Successful recanalization rate was
statistically significantly higher in the stenting group than in
angioplasty alone group (74% vs. 39%) and although not statistically
significant, more patients in the stenting group than in the angioplasty
alone group had favourable outcomes (63% vs. 50%). There was no
significant difference between groups in rates of symptomatic intracranial
haemorrhage (SICH), cerebral herniation or mortality. Conclusion: This
study in a small sample size suggests that among patients with acute
anterior tandem occlusion, SRT with EICA stenting tended to achieve higher
recanalization and improved clinical outcomes at three months compared
with SRT and angioplasty alone with a similar rate of SICH and
mortality.<br/>Copyright &#xa9; The Author(s) 2018.

<20>
Accession Number
623247796
Author
Ueshima D.; Nai Fovino L.; Mojoli M.; Napodano M.; Fraccaro C.; Tarantini
G.
Institution
(Ueshima, Nai Fovino, Mojoli, Napodano, Fraccaro, Tarantini) Cardiology
Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of
Padua Medical SchoolPadua Italy
Title
The interplay between permanent pacemaker implantation and mortality in
patients treated by transcatheter aortic valve implantation: A systematic
review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2018.
Date of Publication: 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Previous implantation of a permanent pacemaker (PPM) is common
among patients undergoing transcatheter aortic valve implantation (TAVI).
Moreover, onset of conduction disturbances needing new PPM implantation
after TAVI is frequent. The interplay of pre-existing and new-PPM on
mortality after TAVI remains controversial. Methods: We performed a
systematic review and study-level meta-analysis on the influence of PPM on
mortality after TAVI. Patients were divided into 3 groups: pre-existing
PPM, new-PPM (implantation within 30 days after TAVI) and no-PPM (without
PPM up to 30 days after TAVI). Outcomes were compared using pairwise and
network meta-analysis. Results: A total of 28 studies including 40,016
subjects were eligible. Patients of the no-PPM group had a lower mortality
outcome compared to the rest of the study population (relative risk [RR]
0.76, 95% confidence interval [CI] 0.68-0.85, P<0.0001) at median follow
up of 16.3 months. In particular, patients with a pre-existing PPM (RR
1.43, 95% CI 1.26-1.62, P<0.0001), but not those with a newly implanted
PPM (RR 1.08, 95% CI 0.99-1.18, P=0.10), had a significantly higher
mortality compared to patients of the no-PPM group. Moreover,
meta-regression analysis showed that the transapical approach rate had a
detrimental interaction with pre-existing PPM on mortality (P=0.03).
Conclusion: Compared to patients without PPM, those with a pre-existing
PPM before TAVI had higher mortality, in particular if treated by the
transapical approach. New-PPM implantation did not have a negative
relation on mid-term outcome.<br/>Copyright &#xa9; 2018 Wiley Periodicals,
Inc.

<21>
Accession Number
2000821714
Author
Zellweger M.; Abdelnour-Berchtold E.; Krueger T.; Ris H.-B.; Perentes
J.Y.; Gonzalez M.
Institution
(Zellweger, Abdelnour-Berchtold, Krueger, Ris, Perentes, Gonzalez)
Division of Thoracic Surgery, Centre Hospitalier Vaudois (CHUV), Lausanne,
Switzerland
Title
Surgical treatment of pulmonary metastasis in colorectal cancer patients:
Current practice and results.
Source
Critical Reviews in Oncology/Hematology. 127 (pp 105-116), 2018. Date of
Publication: July 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Colorectal cancer (CRC) is a frequently occurring disease, yet diagnosed
at a local stage in only 40% of cases. Lung metastases (LM) appear in
5-15% of patients and, left untreated, carry a very poor prognosis. Some
CRC patients may benefit from a potentially curative LM resection, but
success and benefit are difficult to predict. We discuss prognostic
factors of survival after lung metastasectomy in CRC patients under
several scenarios (with/ without prior liver metastases; repetitive
pulmonary resections). We reviewed all studies (2005-2015) about pulmonary
metastases surgical management with curative intent in CRC patients, with
a minimum threshold on the number of patients reported (without prior
liver metastases: n >= 100; with prior resection of liver metastases: n >=
50; repetitive thoracic surgery: n >= 30). The picture of the prognostic
factors of survival is nuanced: surgical management demonstrates clear
successes and steady progress, yet there is no single success criterion;
stratification of patients and selection bias impact the conclusions.
Surgical management of liver and lung metastases may prolong life or cure
CRC patients, provided the lesions are fully resected and patients
carefully selected. Repeat lung metastasectomy is a safe approach to treat
patients in selected cases. In conclusion, there is no standard for
surgical management in CRC patients with pulmonary metastases. Patients
with isolated unilateral lung metastasis with normal CEA level and no
lymph node involvement benefit the most from surgery. Most series report
good results in highly selected patients, but instances of long-term
disease-free survival remain exceptional.<br/>Copyright &#xa9; 2018
Elsevier B.V.

<22>
Accession Number
621677283
Author
Chiam E.; Bellomo R.; Churilov L.; Weinberg L.
Institution
(Chiam, Weinberg) Department of Surgery, University of Melbourne, Austin
Hospital, Heidelberg, VIC, Australia
(Bellomo) Department of Intensive Care, Austin Hospital, Heidelberg, VIC,
Australia
(Churilov) Florey Institute of Neuroscience and Mental Health, Melbourne
Brain Centre, Heidelberg, VIC, Australia
(Weinberg) Anesthesia, Perioperative and Pain Medicine, University of
Melbourne, Victoria, Australia
Title
The hemodynamic effects of intravenous paracetamol (acetaminophen) vs
normal saline in cardiac surgery patients: A single center placebo
controlled randomized study.
Source
PLoS ONE. 13 (4) (no pagination), 2018. Article Number: e0195931. Date of
Publication: April 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
The hemodynamic effects of intravenous (IV) paracetamol in patients
undergoing cardiac surgery are unknown. We performed a prospective single
center placebo controlled randomized study with parallel group design in
adult patients undergoing elective cardiac surgery. Participants received
paracetamol (1 gram) IV or placebo (an equal volume of 0.9% saline)
preoperatively followed by two postoperative doses 6 hours apart. The
primary endpoint was the absolute change in systolic (SBP) 30 minutes
after the preoperative infusion, analysed using an ANCOVA model. Secondary
endpoints included absolute changes in mean arterial pressure (MAP) and
diastolic blood pressure (DPB), and other key hemodynamic variables after
each infusion. All other endpoints were analysed using random-effect
generalized least squares regression modelling with individual patients
treated as random effects. Fifty participants were randomly assigned to
receive paracetamol (n = 25) or placebo (n = 25). Post preoperative
infusion, paracetamol decreased SBP by a mean (SD) of 13 (18) mmHg, p =
0.02, compared to a mean (SD) of 1 (11) mmHg with saline. Paracetamol
decreased MAP and DBP by a mean (SD) of 9 (12) mmHg and 8 (9) mmHg (p =
0.01 and 0.02), respectively, compared to a mean (SD) of 1 (8) mmHg and 0
(6) mmHg with placebo. Postoperatively, there were no significant
differences in pressure or flow based hemodynamic parameters in both
groups. This study provides high quality evidence that the administration
of IV paracetamol in patients undergoing cardiac surgery causes a
transient decrease in preoperative blood pressure when administered before
surgery but no adverse hemodynamic effects when administered in the
postoperative setting.<br/>Copyright &#xa9; 2018 Chiam et al. This is an
open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<23>
Accession Number
618505139
Author
Essex M.N.; Cheung R.; Li C.; Xie L.
Institution
(Essex, Cheung) Global Medical Affairs Pfizer Inc., 235 East 42nd St, New
York, NY 10017, United States
(Li) Biostatistics and Analysis Pfizer Inc., 1 Giralda Farms, Madison, NJ
07940, United States
(Xie) China Medical Affairs, Pfizer Investment Co. Ltd, 3-7 Chaoyangmen
North Avenue Dongcheng District, Beijing 100010, China
Title
Safety of parecoxib when used for more than 3 days for the management of
postoperative pain.
Source
Pain Management. 7 (5) (pp 383-389), 2017. Date of Publication: September
2017.
Publisher
Future Medicine Ltd. (E-mail: info@futuremedicine.com)
Abstract
Aim: To assess parecoxib safety when used for >3 days for postoperative
pain management. Methods: Treatment-emergent adverse event (TEAE)
occurrence after day 3 was examined in a pooled analysis of three
placebo-controlled trials of parecoxib following general or gynecologic
surgery, or total hip arthroplasty. A total of 358 patients received
parecoxib, and 318 placebo. Results: Mean treatment duration was similar
between treatment groups. The overall frequency of all TEAEs after day 3
was also similar between treatment groups. Most TEAEs occurred in <1% of
patients after day 3; frequencies were similar between treatment groups.
Most TEAEs were considered mild or moderate in severity. Conclusion: TEAE
occurrence in patients receiving parecoxib for >3 days was low and similar
to placebo after treatment day 3.<br/>Copyright &#xa9; 2017 Future
Medicine Ltd.

<24>
Accession Number
619566363
Author
Bigna J.J.; Noubiap J.J.; Nansseu J.R.; Aminde L.N.
Institution
(Bigna) Department of Epidemiology and Public Health, Centre Pasteur of
Cameroon, Yaounde, Cameroon
(Bigna) University of Paris Sud XI, Faculty of Medicine, Le Kremlin
Bicetre, France
(Noubiap) Groote Schuur Hospital and University of Cape Town, Department
of Medicine, Cape Town, South Africa
(Nansseu) University of Yaounde 1, Department of Public Health, Faculty of
Medicine and Biomedical Sciences, Yaounde, Cameroon
(Nansseu) Sickle Cell Disease Unit, Mother and Child Centre of the Chantal
Biya Foundation, Yaounde, Cameroon
(Nansseu) Ministry of Public Health, Department of Disease, Epidemics and
Pandemics Control, Yaounde, Cameroon
(Aminde) Clinical Research Education, Networking and Consultancy (CRENC),
Douala, Cameroon
(Aminde) University of Queensland, School of Public Health, Faculty of
Medicine and Biomedical Sciences, Brisbane, Australia
Title
Prevalence and etiologies of pulmonary hypertension in Africa: A
systematic review and meta-analysis.
Source
BMC Pulmonary Medicine. 17 (1) (no pagination), 2017. Article Number: 183.
Date of Publication: 08 Dec 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Despite the recent increasing worldwide attention towards
pulmonary hypertension (PH), its epidemiology remains poorly described in
Africa. Accordingly, we performed a systematic review and meta-analysis of
PH prevalence, incidence and etiologies in Africa. Methods: We searched
PubMed, EMBASE, African Journals Online, and Africa Index Medicus.
Published observational studies until September 20, 2017, including adult
participants residing in Africa were considered. Two review authors
independently selected studies, assessed included studies for
methodological quality, and extracted data. A random-effects model was
used for meta-analysis. Heterogeneity was evaluated by the chi
² test on Cochrane's Q statistic which is quantified by
I² values. Using Newcastle-Ottawa Scale, we considered a score
of 0-4, 5-7, and 8-10 as indicative of high, moderate, and low risk of
bias in included studies, respectively. Results: Of 1611 entries, 25
studies were retained. Twelve (48%), seven (28%), and six (24%) papers had
respectively a low, moderate and high risk of bias. The prevalence of PH
widely varied across different populations: 9.8% (95% confidence interval:
3.2-19.3; I²=99.4%; 6 studies) in 11,163 people presenting with
cardiac complaints; 10.6% (4.3-19.1; I²=90.3%; 4 studies) in
937 HIV-infected people; 32.9% (17.6-50.4; I²=97.2%; 3 studies)
in 2077 patients with heart failure; 23.2% (15.2-32.2;
I²=59.4%; 3 studies) in 248 patients on hemodialysis; 12.9%
(11.8-14.0; I²=79.7%; 2 studies) in 3750 patients with
rheumatic heart disease; 36.9% (29.7-44.3; I²=79.7; 2 studies)
in 79 patients with sickle cell disease; 62.7% (49.0-74.7; 1 study) in 51
patients with chronic obstructive pulmonary disease; 25.4% (16.3-37.3; 1
study) in 63 patients with systemic lupus erythematous; 68.7% (62.8-74.1;
1 study) in 259 patients with cardiac surgery; and 7.4% (4.6-11.9; 1
study) in 202 patients with systemic sclerosis. No study reported PH
incidence. From one international study (n=209), PH etiologies were: left
heart disease (68.9%), pulmonary arterial hypertension (15.8%), lung
disease and/or hypoxia (12.0%), chronic thromboembolic PH (1.9%) and
unclear/multifactorial PH (15.8%). Conclusion: The prevalence of PH is
relatively high in some populations in Africa, perhaps mainly driven by
left heart diseases, highlighting the need for context-specific
interventions.<br/>Copyright &#xa9; 2017 The Author(s).

<25>
Accession Number
618683581
Author
Greenberg J.W.; Lancaster T.S.; Schuessler R.B.; Melby S.J.
Institution
(Greenberg, Lancaster, Schuessler, Melby) Barnes-Jewish Hospital, Division
of Cardiothoracic Surgery, Washington University School of Medicine, St.
Louis, MO, United States
Title
Postoperative atrial fibrillation following cardiac surgery: A persistent
complication.
Source
European Journal of Cardio-thoracic Surgery. 52 (4) (pp 665-672), 2017.
Date of Publication: 01 Oct 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Postoperative atrial fibrillation (POAF) is a common, expensive and
potentially morbid complication following cardiac surgery. POAF occurs in
around 35% of cardiac surgery cases and has a peak incidence on
postoperative day 2. Patients who develop POAF incur on average $10
000-$20 000 in additional hospital treatment costs, 12-24 h of prolonged
ICU time, and an additional 2 to 5 days in the hospital. POAF has been
identified as an independent predictor of numerous adverse outcomes,
including a 2- to 4-fold increased risk of stroke, reoperation for
bleeding, infection, renal or respiratory failure, cardiac arrest,
cerebral complications, need for permanent pacemaker placement, and a
2-fold increase in all-cause 30-day and 6-month mortality. The
pathogenesis of POAF is incompletely understood but likely involves
interplay between pre-existing physiological components and local and
systemic inflammation. POAF is associated with numerous risk factors
including advanced age, pre-existing conditions that cause cardiac
remodelling and certain non-cardiovascular conditions. Clinical management
of POAF includes both prophylactic and therapeutic measures, although the
efficacy of many interventions remains in question. This review provides a
comprehensive and up-to-date summary of the pathogenesis of POAF, outlines
current clinical guidelines for POAF prophylaxis and management, and
discusses new avenues for further investigation.<br/>Copyright &#xa9; 2017
The European Society of Cardiology.

<26>
Accession Number
623196340
Author
Ghimire L.V.; Chou F.-S.
Institution
(Ghimire) Section of Pediatrics and Section of Cardiology, Department of
Medicine, Lakes Region General Hospital, Laconia, NH, United States
(Ghimire) Department of Clinical Pediatrics, University of New England,
Biddeford, ME, United States
(Chou) Division of Neonatology, Children's Mercy Kansas City, Kansas City,
MO, United States
(Chou) Department of Pediatrics, University of Missouri-Kansas City,
Kansas City, MO, United States
(Chou) Department of Pediatrics, University of Kansas Medical Center,
Kansas City, KS, United States
Title
Efficacy of prophylactic dexmedetomidine in preventing postoperative
junctional ectopic tachycardia in pediatric cardiac surgery patients: A
systematic review and meta-analysis.
Source
Paediatric Anaesthesia. 28 (7) (pp 597-606), 2018. Date of Publication:
July 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Junctional ectopic tachycardia is a serious tachyarrhythmic
complication following pediatric cardiac surgery. It is difficult to
manage and is associated with significant morbidity and mortality.
Conventional nonpharmacological and pharmacological measures have shown
limited effects. Dexmedetomidine is an alpha2 agonist which has recently
been shown in multiple studies to be effective. Aims: The aim of this
systematic review with meta-analysis was to evaluate the efficacy of
prophylactic dexmedetomidine administration in the prevention of
junctional ectopic tachycardia in pediatric patients following cardiac
surgeries. Methods: We searched MEDLINE, EMBASE, Cochrane, Web of Science,
and relevant references published in English before December 20, 2017 and
performed meta-analysis on the selected studies, with one group receiving
prophylactic perioperative dexmedetomidine administration and another
group receiving placebo. The primary outcome was the incidence of
junctional ectopic tachycardia, secondary outcomes included bradycardia,
hypotension, intensive care unit stay, total hospital stay, inotropic
scores, and total mechanical ventilation time. Odds ratio or mean
difference with 95% confidence intervals were calculated using a random
effect model. Results: Seven studies (5 prospective randomized studies and
2 retrospective case-controlled studies) with a total of 1616 patients
were analyzed. The incidence of junctional ectopic tachycardia in the
dexmedetomidine group was significantly reduced compared to placebo.
Similarly, intensive care unit stay, inotropic scores, and total
mechanical ventilation time were also significantly decreased in the
dexmedetomidine group. No significant increases in adverse events were
found. Mortality was low in both groups. Conclusion: Prophylactic
dexmedetomidine is effective in reducing the incidence of postoperative
junctional ectopic tachycardia without significant increases in adverse
events in pediatric patients undergoing surgery for congenital heart
diseases.<br/>Copyright &#xa9; 2018 John Wiley & Sons Ltd

<27>
Accession Number
623169785
Author
Mohammadi N.; Pooria A.; Yarahmadi S.; Tarrahi M.J.; Najafizadeh H.;
Abbasi P.; Moradi B.
Institution
(Mohammadi) Department of Critical Care Nursing, Nursing and Midwifery
Faculty, Centre for Nursing Care Research, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Pooria) Department of Cardiac Surgery, Lorestan University of Medical
Sciences, Khorramabad, Iran, Islamic Republic of
(Yarahmadi, Najafizadeh, Moradi) Social Determinants of Health Research
Center, Lorestan University of Medical Sciences, Khorramabad, Iran,
Islamic Republic of
(Tarrahi) Department of Bio-statistics and Epidemiology, School of Health,
Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Abbasi) Chronic Respiratory Diseases Research Center, National Research
Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Effects of cold application on chest tube removal pain in heart surgery
patients.
Source
Tanaffos. 17 (1) (pp 29-36), 2018. Date of Publication: 2018.
Publisher
Shaheed Beheshti University of Medical Sciences and Health Services
(E-mail: info@tanaffosjournal.ir)
Abstract
Background: Chest tube removal is considered a painful technique, which
may not respond well to palliative therapies. There are no standard
procedures or guidelines to manage the pain associated with chest tube
removal. This study aimed to examine the effects of cold application on
pain reduction during and after chest tube removal. Materials and Methods:
This randomized controlled trial was conducted on 90 hospitalized
patients, undergoing heart bypass surgery at the intensive care units
where at least a pleural chest tube was inserted. The patients were
randomly divided into two groups (45 samples per group). In the cold
application group, an ice bag was placed at the designated point for 20
minutes before chest tube removal, while only routine interventions were
applied for chest tube removal in the control group. Pain severity was
measured in the groups before, during, and 15 minutes after chest tube
removal, using the visual analogue scale. Repeated measures ANOVA test was
applied for data analysis. Results: There was no significant difference in
the baseline pain score between the groups (P= 0.18). However, there was a
significant difference in terms of pain severity score between the cold
application (3.58+/-1.09) and control (4.73+/-0.86) groups during chest
tube removal (P< 0.001). On the other hand, there was no significant
difference between the groups regarding the score of pain severity at 15
minutes after chest tube removal (P= 0.38). Conclusion: Cold application,
as a nonpharmacological intervention, may contribute to the alleviation of
cryotherapy-related pain.<br/>Copyright &#xa9; 2018 NRITLD, National
Research Institute of Tuberculosis and Lung Disease, Iran.

<28>
[Use Link to view the full text]
Accession Number
619152932
Author
Thiagarajan K.; Jeevanantham V.; Van Ham R.; Gleason T.G.; Badhwar V.;
Chang Y.; Thirumala P.D.
Institution
(Thiagarajan, Chang, Thirumala) Departments of Neurological Surgery,
University of Pittsburgh Medical, 200 Lothrop Street, Pittsburgh, PA
15213, United States
(Gleason) Departments of Cardiothoracic Surgery, Division of Cardiac
Surgery, University of Pittsburgh Medical Center, United States
(Van Ham, Thirumala) University of Pittsburgh, School of Medicine,
Pittsburgh, PA, United States
(Jeevanantham) Saint Anthony Hospital, Oklahoma City, OK, United States
(Badhwar) Division of Cardiothoracic Surgery, West Virginia University,
Morgantown, WV, United States
Title
Perioperative Stroke and Mortality after Surgical Aortic Valve
Replacement.
Source
Neurologist. 22 (6) (pp 227-233), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: Perioperative stroke rate after surgical aortic valve
replacement (SAVR) varies between 1.3% and 6.2%, whereas the operative
mortality ranges between 1% and 16.4%. The aim of this study was to
determine whether perioperative stroke is a risk factor for operative
mortality after SAVR by performing a meta-analysis of relevant studies.
Materials and Methods: PubMed, EMBASE, and Web of Science databases were
searched to retrieve relevant literature. Screening of the articles was
done independently on the basis of predetermined criteria. Data from the
relevant studies were extracted and a random effects model was used to
calculate the odds of mortality among patients with perioperative strokes
after aortic valve replacement compared with those without such strokes.
Subgroup analyses of patients (1) aged above and below 70 years and (2)
undergoing isolated valve replacement procedure were performed.
Metaregression to check for association of effect estimate and (1) sex,
(2) mechanical valve replacement, (3) New York Heart Association class
III/IV, (4) left ventricle ejection fraction <30%, and (5) preoperative
atrial fibrillation was performed. Results: Statistical analyses using a
random effects model showed that patients with perioperative strokes had
4.74 times greater odds for operative mortality after SAVR, independent of
the following covariates: (1) sex, (2) mechanical valve replacement, (3)
New York Heart Association class III/IV, (4) left ventricle ejection
fraction <30%, and (5) preoperative atrial fibrillation. Conclusions:
Patients with perioperative strokes after SAVR have nearly 5 times greater
odds of experiencing operative mortality compared with those without.
Thus, perioperative strokes are associated with increased risk of early
mortality and require further examination of preventive
strategies.<br/>Copyright &#xa9; 2017 Wolters Kluwer Health, Inc.

<29>
Accession Number
619359373
Author
Efremov S.; Lomivorotov V.; Stoppe C.; Shilova A.; Shmyrev V.; Deryagin
M.; Karaskov A.
Institution
(Efremov, Lomivorotov, Shmyrev, Deryagin, Karaskov) Department of
Anesthesiology and Intensive Care, E. Meshalkin National Medical Research
Center, Novosibirsk 630055, Russian Federation
(Stoppe) Department of Intensive Care Medicine, University Hospital, RWTH
Aachen University, Aachen 52074, Germany
(Shilova) Laboratory Diagnostics Department, E. Meshalkin National Medical
Research Center, Novosibirsk 630055, Russian Federation
Title
Standard vs. Calorie-dense immune nutrition in haemodynamically
compromised cardiac patients: A prospective randomized controlled pilot
study.
Source
Nutrients. 9 (11) (no pagination), 2017. Article Number: 1264. Date of
Publication: 20 Nov 2017.
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland)
Abstract
Background. The aim of study was to test the hypothesis that early enteral
nutrition (EN) with calorie-dense and protein rich enteral formula
improves enteral energy and protein delivery in critically ill cardiac
patients. Methods. Prospective randomized pilot study of 40 ventilated
adult patients undergoing elective cardiac surgery with use of
cardiopulmonary bypass receiving inotropic support postoperatively.
Patients were to receive either standard isocaloric (1000 Kcal/L and 38
g/L protein) early EN (n = 20) or calorie-dense and protein-rich (1300
Kcal/L and 66.7 g/L protein) early EN (n = 20). Results. The mean time to
EN initiation was 27 +/- 11 h. Early EN with the calorie-dense formula
provided significantly more energy and protein enteral delivery on the
2nd, (p < 0.0001), 5th (p = 0.036), and 7th days (p = 0.024), and was
associated with higher levels of prealbumin concentration on the 14th day
(0.13 +/- 0.01 g/L and 0.21 +/- 0.1 g/L; p = 0.04) and significantly
increased levels of transferrin on the 3rd, 5th, and 7th day (p < 0.05)
after surgery. Conclusion. Present findings support hypothesis that early
EN using a calorie-dense and protein rich formula leads to better enteral
energy and protein delivery and higher levels of short-lived serum
proteins.<br/>Copyright &#xa9; 2017 by the authors. Licensee MDPI, Basel,
Switzerland.

<30>
Accession Number
2000896646
Author
Martin Gutierrez E.; Martinez Comendador J.M.; Gualis Cardona J.; Maiorano
P.; Castillo Pardo L.; Cuellas Ramon C.; Fernandez Vazquez F.; Castano
Ruiz M.
Institution
(Martin Gutierrez, Martinez Comendador, Gualis Cardona, Maiorano, Castillo
Pardo, Castano Ruiz) Servicio de Cirugia Cardiaca, Hospital Universitario
de Leon, CAULE, Leon, Spain
(Cuellas Ramon, Fernandez Vazquez) Servicio de Cardiologia, Hospital
Universitario de Leon, CAULE, Leon, Spain
Title
Transcatheter aortic valve implantation versus aortic valve replacement in
intermediate surgical risk patients. Review of literature and
meta-analysis.
Source
Cirugia Cardiovascular. 25 (4) (pp 191-203), 2018. Date of Publication:
July - August 2018.
Publisher
Elsevier Doyma
Abstract
Introduccion y objetivos: El implante valvular aortico transcateter (TAVI)
ha mostrado resultados excelentes, constituyendo una alternativa
terapeutica a la sustitucion valvular aortica para pacientes de riesgo
quirurgico alto o excesivo. Sin embargo, no existe un claro consenso sobre
los beneficios del TAVI en pacientes con riesgo quirurgico intermedio.
Realizamos una revision sistematica de la literatura y el consiguiente
metaanalisis considerando resultados periprocedimiento y en el seguimiento
maximo disponible. Metodos: Se realizo una busqueda bibliografica
combinando 3 grupos de palabras clave: <<TAVR/TAVI/transcatheter aortic
valve implantation/transcatheter aortic valve replacement>> AND
<<intermediate risk>> AND <<aortic valve replacement/AVR/surgery>>. Fueron
considerados los trabajos publicados en los ultimos 6 anos. Resultados:
Fueron seleccionados 21 trabajos: 4 estudios prospectivos aleatorizados y
17 estudios observacionales, 13 de ellos ajustados por analisis de
propensiones. No existieron diferencias significativas en la mortalidad
(RR = 1; IC95%: 0,99-1,02) o incidencia de accidente cerebrovascular (RR =
0,96; IC95%: 0,77-1,20) en el seguimiento maximo (1-3 anos). La lesion
vascular (accidente cerebrovascular) grave fue significativamente mayor en
el grupo TAVI (RR = 4,39; IC95%: 2,17-8,91), asi como la necesidad de
implante de marcapasos permanente (RR = 2,96; IC95%: 2-4,36) y la
incidencia de fuga paravalvular significativa (>= 2+; RR = 6,83; IC95%:
4,64-10,05). Tanto la incidencia de fibrilacion auricular (RR = 0,39;
IC95%: 0,25-0,61) como de fallo renal (RR = 0,45; IC95%: 0,28-0,72) fueron
superiores en el grupo quirurgico. Conclusiones: Tras comparar TAVI frente
a la sustitucion valvular aortica en pacientes con riesgo quirurgico
intermedio mediante metaanalisis, no se han identificado diferencias
significativas en terminos de mortalidad o accidente cerebrovascular a lo
largo del seguimiento. Sin embargo, el diferente perfil de complicaciones
de cada una de las tecnicas deberia guiar la seleccion de pacientes
realizada por el Heart-Team para reducir la morbilidad posprocedimiento.
Introduction and objectives: Transcatheter aortic valve implantation
(TAVI) has shown excellent results, and is a therapeutic alternative to
aortic valve replacement for high or excessive surgical risk patients.
However, there is no clear consensus about the benefits of TAVI for
patients with intermediate surgical risk. A systematic review of
literature and subsequent meta-analysis was carried out considering
outcomes after the procedure and during the maximum available follow-up.
Methods: A systematic review of literature was performed, combining three
clusters of Keywords: "TAVR/TAVI/transcatheter aortic valve
implantation/transcatheter aortic valve replacement "AND "intermediate
risk" AND "aortic valve replacement/AVR/surgery". Studies published in the
last 6 years were considered for analysis. Results: A total of 21 studies
were included in the analysis, of which 4 were randomised controlled
trials and 17 were observation studies, with 13 of them being
propensity-score adjusted. No differences were found in terms of mortality
(RR = 1.00, 95% CI: 0.99-1.02) or incidence of cerebrovascular accident
(RR = 0.96, 95% CI: 0.77-1.20) during the maximum follow-up (1-3 years). A
major vascular lesion (cerebrovascular accident) (RR = 4.39, 95% CI:
2.17-8.91), need of permanent pacemaker implantation (RR = 2.96, 95% CI:
2.00-4.36), and residual significant paravalvular leak (>= 2+; RR = 6.83,
95% CI: 4.64-10.05) were significantly higher in TAVI group. The incidence
of atrial fibrillation (RR = 0.39, 95% CI: 0.25-0.61) and kidney failure
(RR = 0,45, 95% CI: 0.28-0.72) were higher in the surgical group.
Conclusions: After comparing TAVI and aortic valve replacement in patients
with intermediate surgical risk using meta-analysis, no significatant
differences were identified in terms of mortality or cerebrovascular
accident during follow-up. However, the different profile of complications
of each technique should guide patient selection by the Heart-Team in
order to reduce post-procedural morbidity.<br/>Copyright &#xa9; 2018
Sociedad Espanola de Cirugia Toracica-Cardiovascular

<31>
Accession Number
623206890
Author
Malik V.; Kiran U.; Chauhan S.; Makhija N.
Institution
(Malik, Kiran, Chauhan, Makhija) Department of Cardiac Anaesthesia,
Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari
Nagar, New Delhi 110 029, India
Title
Transcutaneous nerve stimulation for pain relief during chest tube removal
following cardiac surgery.
Source
Journal of Anaesthesiology Clinical Pharmacology. 34 (2) (pp 216-220),
2018. Date of Publication: April-June 2018.
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background and Aims: In patients undergoing open heart surgery, chest
tubes are removed postoperatively when patients are well awake and stable.
Pain during chest tube removal can be moderate to severe and can be the
worst experience of hospitalization. Various modalities of pain relief
during chest tube removal have been tried with variable results. We sought
to examine the effect of transcutaneous electrical nerve stimulation
(TENS) as an intervention for pain relief during chest tube removal after
cardiac surgery. Material and Methods: In a tertiary care center, fifty
patients undergoing open heart surgery were randomized into two groups.
Group TENS (n = 25) received TENS from 30 min before and continued up to
30 min after chest tube removal. Control Group (n = 25) did not receive
TENS. In both the groups, additional analgesic medication was provided on
demand, besides the standard analgesic regime which was injection
ketorolac 30 mg intramuscularly every 8 h. Patients were studied for pain
during chest drain removal and pain related nausea, vomiting, and sense of
well-being. Results: Mean visual analog pain score assessed for chest tube
removal was significantly less 4.1 +/- 1.2 (P < 0.05) in TENS Group as
compared to 6.1 +/- 0.8 in Control Group. Significantly greater number of
patients (n = 14) (P < 0.05) in Control Group demanded additional
analgesia as compared to TENS Group (n = 5). Feeling of well-being,
improvement in appetite, and sleep was better in TENS Group as compared to
Control Group. Conclusion: We conclude that TENS might not replace the
conventional analgesics but has definite adjuvant role in decreasing pain
scores and improves sense of well-being during chest tube removal after
cardiac surgery.<br/>Copyright &#xa9; 2018 Medknow. All rights reserved.

<32>
Accession Number
623141018
Author
Fukui M.; Cavalcante J.L.
Institution
(Fukui, Cavalcante) Structural Cardiovascular Imaging and Core Lab, Heart
& Vascular Institute - UPMC University of Pittsburgh, 200 Lothrop Street,
South Tower, E353.9, Pittsburgh, PA 15213, United States
Title
Strain Evaluation in TAVR-Current Evidence, Knowledge Gaps, and Future
Directions.
Source
Current Cardiovascular Imaging Reports. 11 (9) (no pagination), 2018.
Article Number: 22. Date of Publication: 01 Sep 2018.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: Transcatheter aortic valve replacement (TAVR) has been
a paradigm shift for the treatment of patients with severe aortic stenosis
(AS). Subclinical cardiac changes in myocardial deformation, not reflected
by left ventricular ejection fraction (LVEF), are often present and can be
measured by strain imaging. This manuscript will review the current
literature and discuss the importance of strain evaluation in TAVR
patients. Recent Findings: Strain measurement, especially global
longitudinal strain (GLS), has been shown to be associated with outcomes
in patients with AS. In addition, GLS assessment prior to and after TAVR
appears to correlate with LV functional recovery, symptoms, and the
prognosis in these patients; however, evidence is limited to small
studies. Summary: With a better understanding of strain evaluation in TAVR
patients, this important imaging modality could emerge as a powerful
bedside tool to aid in determining the timing of intervention and further
improving outcomes.<br/>Copyright &#xa9; 2018, Springer Science+Business
Media, LLC, part of Springer Nature.

<33>
Accession Number
623222438
Author
Patlolla S.H.; Sandhyavenu H.; Vallabhajosyula S.; Barsness G.W.; Dunlay
S.M.; Greason K.L.; Holmes D.R.; Eleid M.F.
Institution
(Vallabhajosyula, Patlolla, Sandhyavenu, Vallabhajosyula, Barsness,
Dunlay, Holmes, Eleid) Departments of Cardiovascular Medicine, Mayo
Clinic, Rochester, MN, United States
(Greason) Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United
States
Title
Periprocedural cardiopulmonary bypass or venoarterial extracorporeal
membrane oxygenation during transcatheter aortic valve replacement: A
systematic review.
Source
Journal of the American Heart Association. 7 (14) (no pagination), 2018.
Article Number: e009608. Date of Publication: 01 Jul 2018.
Publisher
American Heart Association Inc.
Abstract
Background-There are limited data on the use of venoarterial
extracorporeal membrane oxygenation (VA-ECMO) or cardiopulmonary bypass
(CPB) to provide hemodynamic support periprocedurally during transcatheter
aortic valve replacement. This study sought to evaluate patients receiving
transcatheter aortic valve replacement with concomitant use of
CPB/VA-ECMO. Methods and Results-We systematically reviewed the published
literature from 2000 to 2018 for studies evaluating adult patients
requiring CPB/VA-ECMO periprocedurally during transcatheter aortic valve
replacement. Studies reporting short-term and long-term mortality were
included. Given the significant methodological and statistical differences
between published studies, meta-analysis of the association of CPB/VA-ECMO
with mortality was not performed. Of the 537 studies identified, 9 studies
representing 5191 patients met our inclusion criteria. Median ages were
between 75 and 87 years with 33% to 75% male patients. Where reported, the
Edwards SAPIENTM transcatheter heart valve was the most frequently used. A
total of 203 (3.9%) patients received periprocedural hemodynamic support
with CPB/VA-ECMO. Common indications for CPB/VA-ECMO included left
ventricular or aortic annular rupture, rapid hemodynamic deterioration,
aortic regurgitation, cardiac arrest, and left main coronary artery
obstruction. The use of CPB/VA-ECMO was predominantly an emergent strategy
and was used for durations of 1 to 2 hours. Short-term mortality
(in-hospital and 30-day) was 29.8%, and 1-year mortality was 52.4%. Major
complications such as bleeding, vascular injury, tamponade, stroke, and
renal failure were noted in 10% to 50% of patients.
Conclusions-CPB/VA-ECMO was used in 4% in the early experience of patients
undergoing transcatheter aortic valve replacement, most commonly for
periprocedural complications. There are limited data on preprocedural
planned use of VA-ECMO, and the characteristics of this population remain
poorly defined.<br/>Copyright &#xa9; 2018 The Authors.

<34>
Accession Number
2000979562
Author
Shavelle D.M.; Banerjee S.; Maini B.; Schreiber T.L.; Kapasi N.; O'Neill
W.W.; Popma J.; Matthews R.V.
Institution
(Shavelle, Kapasi, Matthews) Division of Cardiovascular Medicine,
University of Southern California, Los Angeles, California, United States
(Banerjee) Veterans Affairs North Texas Health Care System and University
of Texas Southwestern Medical Center, Dallas, Texas, United States
(Maini) Florida Atlantic University, Boca Raton, Florida, United States
(Schreiber) Detroit Medical Center, Cardiovascular Institute, Detroit,
Michigan, United States
(O'Neill) Henry Ford Hospital, Detroit, Michigan, United States
(Popma) Beth Israel Deaconess Medical Center, Boston, Massachusetts,
United States
Title
Comparison of Outcomes of Percutaneous Coronary Intervention on Native
Coronary Arteries Versus on Saphenous Venous Aorta Coronary Conduits in
Patients With Low Left Ventricular Ejection Fraction and Impella Device
Implantation Achieved or Attempted (from the PROTECT II Randomized Trial
and the cVAD Registry).
Source
American Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients with prior coronary artery bypass grafting (CABG) represent a
high-risk cohort given associated medical conditions and worse outcome of
saphenous vein graft compared with native vessel percutaneous coronary
intervention (PCI). The goal of the current analysis was to compare
clinical outcomes in 591 patients with and without prior CABG and
multivessel coronary artery disease or unprotected left main disease and
severely reduced left ventricular systolic function underwent Impella
supported PCI from the PROTECT II randomized trial and the cVAD Registry.
Patients with prior CABG surgery (n = 201) were compared with those
without prior CABG surgery (n = 390). The primary end point of this
analysis was overall mortality at 30 days. Patients with prior CABG
surgery had greater Society of Thoracic Surgery mortality score compared
with patients without prior CABG surgery, 7.6 +/- 6.4 versus 5.1 +/- 5.5,
respectively, p <0.001. Saphenous vein graft PCI was performed in 17% of
patients with prior CABG surgery. Number of vessels treated was lower in
patients with prior CABG surgery compared with patients without prior CABG
surgery, 1.66 +/- 0.56 versus 1.89 +/- 0.64, respectively, p <0.001.
Achievement of TIMI 3 flow post PCI and overall PCI success was similar in
the two groups. Overall mortality at 30 days was similar in patients with
prior CABG surgery compared with patients without prior CABG surgery,
6.75% versus 6.61%, respectively, p = 1.0. In conclusion, in this
high-risk cohort of patients underwent hemodynamically supported PCI,
prior CABG surgery was not associated with worse outcome. The use of
hemodynamic support appears to mitigate the increased risk of PCI
associated with prior CABG.<br/>Copyright &#xa9; 2018

<35>
Accession Number
623220176
Author
Stopyra J.P.; Riley R.F.; Hiestand B.C.; Russell G.B.; Hoekstra J.W.;
Lefebvre C.W.; Nicks B.A.; Cline D.M.; Askew K.L.; Elliott S.B.;
Herrington D.M.; Burke G.L.; Miller C.D.; Mahler S.A.
Institution
(Stopyra, Hiestand, Hoekstra, Lefebvre, Nicks, Cline, Askew, Elliott,
Miller, Mahler) Department of Emergency Medicine Wake Forest School of
Medicine Winston-Salem, NC
(Russell, Herrington) Department of Biostatistical Sciences Wake Forest
School of Medicine Winston-Salem, NC
(Burke) Department of Internal Medicine Division of Cardiology Wake Forest
School of Medicine Winston-Salem, NC
(Burke) Public Health Sciences Wake Forest School of Medicine
Winston-Salem, NC
(Mahler) Departments of Implementation Science and Epidemiology and
Prevention Wake Forest School of Medicine Winston-Salem, NC
(Riley) The Christ Hospital Heart and Vascular Center and Lindner Center
for Research and Education Cincinnati, OH
Title
The HEART Pathway Randomized Controlled Trial One-year Outcomes.
Source
Academic Emergency Medicine. (no pagination), 2018. Date of Publication:
2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: The objective was to determine the impact of the HEART Pathway
on health care utilization and safety outcomes at 1 year in patients with
acute chest pain. Methods: Adult emergency department (ED) patients with
chest pain (N = 282) were randomized to the HEART Pathway or usual care.
In the HEART Pathway arm, ED providers used the HEART score and troponin
measures (0 and 3 hours) to risk stratify patients. Usual care was based
on American College of Cardiology/American Heart Association guidelines.
Major adverse cardiac events (MACE-cardiac death, myocardial infarction
[MI], or coronary revascularization), objective testing (stress testing or
coronary angiography), and cardiac hospitalizations and ED visits were
assessed at 1 year. Randomization arm outcomes were compared using
Fisher's exact tests. Results: A total of 282 patients were enrolled, with
141 randomized to each arm. MACE at 1 year occurred in 10.6% (30/282):
9.9% in the HEART Pathway arm (14/141; 10 MIs, four revascularizations
without MI) versus 11.3% in usual care (16/141; one cardiac death, 13 MIs,
two revascularizations without MI; p = 0.85). Among low-risk HEART Pathway
patients, 0% (0/66) had MACE, with a negative predictive value (NPV) of
100% (95% confidence interval = 93%-100%). Objective testing through 1
year occurred in 63.1% (89/141) of HEART Pathway patients compared to
71.6% (101/141) in usual care (p = 0.16). Nonindex cardiac-related
hospitalizations and ED visits occurred in 14.9% (21/141) and 21.3%
(30/141) of patients in the HEART Pathway versus 10.6% (15/141) and 16.3%
(23/141) in usual care (p = 0.37, p = 0.36). Conclusions: The HEART
Pathway had a 100% NPV for 1-year safety outcomes (MACE) without
increasing downstream hospitalizations or ED visits. Reduction in 1-year
objective testing was not significant.<br/>Copyright &#xa9; 2018 Society
for Academic Emergency Medicine.

<36>
Accession Number
623215729
Author
Ma W.-Q.; Sun X.-J.; Wang Y.; Han X.-Q.; Zhu Y.; Liu N.-F.
Institution
(Ma, Sun, Wang, Han, Zhu, Liu) Department of Cardiology, Zhongda Hospital,
School of Medicine Southeast University 87 Dingjiaqiao Nanjing China
Title
Does body mass index truly affect mortality and cardiovascular outcomes in
patients after coronary revascularization with percutaneous coronary
intervention or coronary artery bypass graft? A systematic review and
network meta-analysis.
Source
Obesity Reviews. (no pagination), 2018. Date of Publication: 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Obesity, a comorbid medical condition, is usually observed in
patients with established coronary artery disease. Paradoxically, patients
with a higher body mass index (BMI) usually have better clinical outcomes
after coronary revascularization. Methods: We searched five online
databases through December 2017. We identified studies reporting the rate
of all-cause mortality or cardiovascular-related outcomes among patients
after coronary revascularization with percutaneous coronary intervention
or coronary artery bypass graft based on various BMI categories. Network
meta-analysis was performed using Bayesian methods. Results: Sixty-five
records involving 865,774 participants were included in our study. A
U-shaped association was observed across BMI categories for all-cause
mortality. Using normal weight as the reference, all-cause mortality was
increased for (relative risk [RR]: 2.4; 95% credibility interval [CrI]:
2.1-2.7) patients with underweight, whereas it was lowered in patients
with overweight, obese, and severely obese. This association remained
significant in many subgroups. We also observed that the risk of major
adverse cardiovascular events (MACE) was lowest among patients with
overweight. Furthermore, patients with underweight were associated with
greater risks of myocardial infarction (RR: 1.9; 95% CrI: 1.4-2.5),
cardiovascular-related mortality (RR: 2.8; 95% CrI: 1.6-4.7), stroke (RR:
2.0; 95% CrI: 1.3-3.3) and heart failure (RR: 1.7; 95% CrI: 1.1-2.7)
compared with normal weight patients; no significant association was
observed among individuals with higher BMI. Conclusions: The 'obesity
paradox' does exist in patients after coronary revascularization,
especially for patients with post-percutaneous coronary intervention.
All-cause mortality in patients with high BMI is significantly lower
compared with patients with normal weight. Furthermore, patients with
underweight experience higher rates of cardiovascular outcomes compared
with patients with normal weight.<br/>Copyright &#xa9; 2018 World Obesity
Federation.

<37>
Accession Number
622820855
Author
Dimitriu I.; Voiculescu D.; Lacraru A.; Sinescu C.
Institution
(Dimitriu, Voiculescu, Lacraru, Sinescu) University of Medicine and
Pharmacy Carol Davila, Bucharest, Romania
Title
Importance of NT pro BNP in management of chronic ischemic patient to
prevent heart failure.
Source
European Journal of Clinical Investigation. Conference: 52nd Annual
Scientific Meeting of the European Society for Clinical Investigation.
Spain. 48 (Supplement 1) (pp 123), 2018. Date of Publication: May 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Background: To prove the importance of NTproBNP for preventing heart
failure at ischemic patients. Materials and methods: We included 196
patients who were presented at hospital during 2 years, with myocardial
infarction, angioplasty or aortocoronary bypass in their medical history.
We excluded patients who are already diagnosed with heart failure or who
had current symptoms of heart failure. We randomized patients into 2 equal
groups: a control group and an intervention group. NTproBNP value was
determined for all patients. In the intervention group patients were
treated according to the NTproBNP. Patients with NTproBNP < 125 pg/dL (54
patients) received standard treatment for their symptoms. Patients with
NTproBNP > 125 pg/dL (44 patients) were the ones on which we intervened to
prevent heart failure. They were investigated by cardiac ultrasound and
other tests and they received specific treatment. Patients in the control
group received standard treatment regardless of the NTproBNP value.
Results: After 2 years, the end points were: diagnosis of heart failure
left ventricular dysfunction, death from any cause, the rate of
hospitalizations for cardiovascular pathology. After 2 years in the
control group were twentyone (21 8%) patients who developed heart failure
compared to fourteen (14 2%) patients in the intervention group. Fifty
four (59 1%) patients were diagnosed with left ventricular systolic
dysfunction, compared to thirty-nine (39 7%) in the intervention group.
Also, and rate of admissions for cardiovascular pathology was higher in
the control group thirtytwo (22 4%) vs nine (9, 18%) in the intervention
group. Conclusions: Patients in the intervention group, in which the value
of NTproBNP was used in choosing therapeutic management, had lower rate of
incidence of heart failure or cardiovascular events than patients in the
control group. The NTproBNP value in ischemic patients without heart
failure can detect patients at risk of developing heart failure. And more,
medical intervention guided by NTproBNP can prevent or delay heart
failure.

<38>
Accession Number
622663959
Author
Lee S.; Binte Said N.; Ho R.; Singh G.; Tang S.; Sanjeeva R.; Moshi G.; Ng
B.; Tan L.
Institution
(Lee, Ho, Moshi, Tan) Department of Laboratory Medicine, Singapore
(Binte Said) Department of Oncology Nursing, Singapore
(Singh) Department of Orthopaedic Surgery, Singapore
(Tang) Department of Surgery, Singapore
(Sanjeeva, Ng) Department of Anaesthesia, National University Hospital,
Singapore, Singapore
Title
Multifaceted patient blood management measures reduce red cell transfusion
in surgery.
Source
Vox Sanguinis. Conference: 35th International Congress of the
International Society of Blood Transfusion, ISBT 2018. Canada. 113
(Supplement 1) (pp 303), 2018. Date of Publication: June 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Patient Blood Management (PBM) is a multidisciplinary,
evidence-based approach to optimizing the care of patients who might need
a blood transfusion. National recommendations were instituted in the last
several years, which all hospitals were encouraged to adopt. Aims: This
study aims to examine the impact of PBM implementation on red cell (RBC)
transfusion rates in surgeries performed in a tertiary hospital. Methods:
Perioperative RBC transfusions rates (number of cases transfused/total
number of cases x 100%) occurring between 3 days pre-operation to 3 days
post-operation for six surgeries, coronary artery bypass grafting (CABG),
total knee arthroplasty (TKA), total hip arthroplasty (THA), nephrectomy,
colectomy and hys-terectomy, were studied. Baseline transfusion rates
before intensive implementation of PBM were measured in June 2016.
Post-implementation transfusion rates were measured in a randomly selected
two-month period in 2017. PBM planning phase occurred from 2014 and 2015,
and these measures were intensively implemented from July 2016 onwards:
(1) early pre-operative screening for anemia, (2) rapid access
pre-operative anemia management clinic, (3) use of tranexamic acid when
indicated, (4) use of Intraoperative Cell Salvage for high blood loss
surgeries, (5) introducing reminders of evidence-based transfusion
guidelines into the electronic ordering system at the time of RBC
ordering, (6) hospital-wide audit of appropriateness of RBC transfusions.
Extensive engagement with surgeons and anaesthetists occurred through
talks and meetings to raise awareness of PBM. To measure the take up rate
of PBM, two indicators were recorded: (i) proportion of patients whose
pre-operative anemia was managed, (ii) mean pre-transfusion hemoglobin of
post-operative transfusions as a surrogate of adoption of evidence-based
transfusion thresh-olds. Results: The number of surgeries in the
baseline/post-implementation periods were 33/40 CABG, 26/48 TKA, 12/11
THA, 4/9 nephrectomies, 7/11 colectomies, 27/50 hysterectomies.
Transfusion rates for CABG and THA were significantly lower
post-implementation compared to baseline (CABG: 57.5 vs 87.9%, 95% CI of
difference 9.74-47.36, P = 0.005; THA: 18.2 vs 66.7%, 95% CI of difference
8.08-71.97, P = 0.022). TKA, nephrectomies and hysterectomies all showed
trends towards lower transfusion rates post-implementation compared to
baseline, i.e. 2.1 vs 11.5%, 11.1 vs 25.0%, 6.0 vs 14.8%. Transfusion rate
for colectomies increased from 14.3% to 36.4%, but sample size was small.
All surgeries combined, the proportion whose preoperative anemia was
managed increased from baseline 6.1% to 50.0% post-imple-mentation (95% CI
of difference 24.48-58.73, P < 0.0001) and mean pre-transfusion hemoglobin
decreased from baseline 8.4 g/dl to 7.8 g/dl post-implementation (95% CI
of difference-0.59 +/- 0.21, P = 0.0061). For CABG, these differences
remained significant: proportion whose pre-operative anemia was managed
increased (0% vs 35.7%; P = 0.015), while mean pre-transfusion hemoglobin
decreased (8.4 g/dl vs 7.7 g/dl; P = 0.003) and mean number of RBC units
transfused per transfused patient decreased (4.3 vs 3.3).
Summary/Conclusions: Implementation of multifaceted PBM is able to reduce
transfusion rates across different types of surgery. Proportion of
pre-operative anemia managed increased and mean pre-transfusion hemoglobin
decreased, reflecting adoption of PBM measures. The next phase would focus
on ensuring as many patients as possible are managed accordingly, and to
study outcomes such as infection rates and resource utilization.

<39>
Accession Number
622663899
Author
Gilchrist P.; Coopersmith A.; Li M.; Woroniak V.; Ditto B.
Institution
(Gilchrist) Public Health and Primary Care, University of Cambridge,
Cambridge, United Kingdom
(Coopersmith, Li, Woroniak, Ditto) Psychology, McGill University,
Montreal, Canada
Title
Standing enhances vasovagal symptoms elicited by stimuli associated with
blood but not other emotional stressors.
Source
Vox Sanguinis. Conference: 35th International Congress of the
International Society of Blood Transfusion, ISBT 2018. Canada. 113
(Supplement 1) (pp 144), 2018. Date of Publication: June 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Various stimuli (orthostatic stress, blood-related stimuli,
fear, haemorrhage, etc.) are capable of triggering a vasovagal response
(VVR). It remains unclear to what extent these represent identical or just
similar physiological reactions. Aims: This study examined the specificity
of VVR in response to stimuli involving Blood/Injury when compared to
other emotional stimuli, and built upon the idea of 'simulated' blood loss
by hypothesizing that VVR are based on the prevention of excessive blood
loss and thus triggered by stimuli that suggest as well as produce actual
loss. As a result, the effects of certain emotional, blood-related
stressors should interact with certain postural stressors. Methods: 48
healthy young adults completed a questionnaire assessing medical fears
(Medical Fears Survey-MFS-SF; Olatunji et al., 2012) and watched five
5-min-ute stimulus videos with different emotional content. All
participants watched the Neutral video followed by 4 subsequent videos
presented in counter-balanced orders: a Blood/Injury video depicting an
open heart surgery, and three additional videos (Medical, Chase/Fear, and
Loss/Sadness). Participants were randomly assigned to watch the videos
either standing or sitting in an arm-chair. Vasovagal symptoms, blood
pressure (BP), and heart rate (HR) were assessed during each video.
Results: The primary analyses were 2 Posture (sitting/standing) x 4 Video
(Loss/Chase/Medical/Blood-Injury) x Medical Fear (treated as a continuous
measure) repeated-measure general linear models (GLMs) with sex and a
Neutral video value as covariates. As predicted, there was a significant
Posture x Video interaction, F(3, 129) = 3.53, P = 0.040,
T)²<inf>p</inf>= 0.076, due to a specific enhancement of
symptoms during the Blood/Injury video by standing. This effect was
moderated by fearfulness leading to a significant Posture x Video X
Medical Fear interaction, F(3, 129) = 5.30, P = 0.010,
g²<inf>p</inf>= 0.11. Standing significantly increased symptoms
experienced by more fearful participants during Blood/Injury but not other
videos. This pattern was corroborated by SBP and HR with significant
Posture x Film interaction effects, F(3, 117) = 2.84, P = 0.048,
g²<inf>p</inf>= 0.068, and F(3, 117) = 4.20, P = 0.011,
g²<inf>p</inf>= 0.097, respectively. As expected, this was due
to notable decreases among those who watched the surgery film while
standing. Summary/Conclusions: Blood-related fears play a key role in
eliciting VVR and orthostatic stress enhances this effect. These findings
provide support for the theory that VVR may have developed as a means to
facilitate the survival of animals who were injured and experiencing
significant blood loss. Clinical implications include the management or
reduction of blood-related stimuli for blood donors.

<40>
Accession Number
622663888
Author
Ng M.S.; Hay K.; Middelburg R.; Suen J.; Tung J.; Fraser J.
Institution
(Ng, Suen, Fraser) Critical Care Research Group, Faculty of Medicine,
University of Queensland, Australia
(Ng, Tung) Research and Development, Australian Red Cross Blood Service,
Australia
(Hay) QIMR Berghofer Medical Research Institute, Brisbane, Australia
(Middelburg) Centre for Clinical Transfusion Research, Sanquin Research,
Leiden, Netherlands
Title
Fresh frozen plasma storage duration associated with small increased
in-hopsital mortality risk.
Source
Vox Sanguinis. Conference: 35th International Congress of the
International Society of Blood Transfusion, ISBT 2018. Canada. 113
(Supplement 1) (pp 301), 2018. Date of Publication: June 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Storage-induced changes in fresh frozen plasma (FFP) have been
posited to lead to decreased transfusion efficacy and safety. To date, the
effects of FFP storage duration on mortality has only been investigated in
one study of cardiac surgery patients (Van Straten, J Thorac Cardiovasc
Surg, 2011). Aims: This study aimed to determine the relationship between
FFP storage duration and in-hospital mortality. Methods: Secondary
analyses were conducted on patient level data previously collected for an
individual meta-analysis studying the effects of packed red blood cell
storage duration. Studies reporting FFP storage duration were included in
the analysis. Two-stage meta-analyses were performed to derive pooled
effect estimates of FFP storage duration on mortality. Patient-level mixed
effects logistic regression models were also fitted. Models were adjusted
for age, gender and volume of FFP transfused. Results: The FFP storage
duration analysis included 3625 patients across 4 studies, conducted in
orthopaedic surgery, acute medicine, intensive care and cardiac surgery
patients. Each additional month of FFP storage was associated with a small
enhanced risk of in-hospital mortality (OR 1.05, 95% CI 1.01-1.08, P =
0.01). Effect estimates from the patient-level mixed effects model were
consistent, but did not remain significant at the 5% level (OR 1.03, 95%
CI 1.00-1.06; P = 0.09). Summary/Conclusions: This study updates existing
information on the clinical FFP storage duration effects by including a
wide range of patient subtypes. There was an increased risk of in-hospital
mortality with longer storage of FFPs. Before considering FFP shelf life
alterations, further investigation is warranted to address potential
confounding factors such as patient subgroup, country and recruitment
year. Acknowledgements: Australian governments fund the Australian Red
Cross Blood Service for the provision of blood, blood products and
services to the Australian community. This project was partially funded by
The Prince Charles Hospital Foundation.

<41>
Accession Number
622663716
Author
Simon G.; Craswell A.; Thom O.; Fung L.
Institution
(Simon, Fung) School of Sport and Health Sciences, Australia
(Craswell) School of Nursing, Midwifery and Paramedicine, USC Australia,
Sippy Downs, Australia
(Thom) Department of Emergency Medicine, Sunshine Coast Hospital and
Health Service, Birtinya, Australia
Title
Questioning the benefit of restrictive transfusion practice in older
adults.
Source
Vox Sanguinis. Conference: 35th International Congress of the
International Society of Blood Transfusion, ISBT 2018. Canada. 113
(Supplement 1) (pp 17), 2018. Date of Publication: June 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Background: In recent years, randomised controlled trials (RCTs) have
published findings comparing patient outcomes associated with liberal
versus restrictive transfusion strategies. RCT evidence has challenged
some assumptions generated by earlier observational studies. Guidelines
based on RCTs promote restrictive transfusion practice, except for
specific patient groups where there is insufficient evidence to make
recommendations. Most adult studies enrol patients across a broad age
range, with very few studies focussed on patients aged 65 years and above.
Patients aged 65 years and above are the highest consumers of red cells.
Aims: To examine evidence regarding restrictive and liberal transfusion
strategies in older adults; and to examine pathophysiological changes
associated with ageing that may impact tolerance of anaemia and
transfusion outcomes. Methods: The Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. We
first identified RCTs that focussed on transfusion evidence in adults aged
65 years and above. As only three RCTs met this condition, inclusion
criteria were widened to incorporate additional studies that had a mean
patient age of at least 64 years. The identified RCTs comparing liberal
versus restrictive transfusion strategies were subjected to meta-analysis.
Literature related to the pathophysiology of aging was examined for
factors that impact circulation and oxygen transport. Results: A total of
nine RCTs, with mean patient ages ranging from 64 to 87 years, were
included. Meta-analysis of evidence from the RCTs supported liberal
transfusion strategies for older adults with respect to mortality and
cardiac outcomes. Infection risk and hospital length of stay were
equivocal between restrictive and liberal transfusion strategies. After
publication of these findings, the Transfusion Requirements in Cardiac
Surgery (TRICS III) study report, including analysis of older patient
sub-groups, was released. It found that a restrictive strategy in
moderate-to-high risk patients was non-inferior to a liberal strategy,
including in older sub-groups of patients. Differences in Hb thresholds
were noted between the studies. In our meta-analysis, liberal Hb
thresholds for the RCTs restricted to patients aged 65 and above ranged
from 100 to 113! g/l. TRICS III, however, applied lower liberal thresholds
of 85 g/l for non-ICU and 90 g/l for ICU patients. Pathophysiological
changes of ageing occur at cellular and systemic levels, negatively
impacting the rate of oxygen delivery relative to haemoglobin level.
Summary/Conclusions: Recent RCTs have provided valuable new information
and challenged some observational study evidence regarding associations
between blood transfusion, infections and length of stay. However,
findings from RCT and meta-ana-lysis regarding transfusion outcomes in
older adults are conflicted. Differences in RCT Hb triggers complicate
interpretation, and consequently the inference of the terms 'liberal' and
'restrictive' transfusion. This paper will critically analyse differences
in study approaches and outcomes, with the intent of highlighting
challenges that need to be considered and addressed. Age-related
pathophysiological changes may explain differences in outcome associated
with the various Hb triggers used in RCTs. Avenues for further research
will be discussed, particularly in the context of informing PBM guideline
development for older adults, the largest cohort of blood recipients.

<42>
Accession Number
622663572
Author
Khalaf Adeli E.
Institution
(Khalaf Adeli) Blood Transfusion Research Center, High Institute for
Research and Education in Transfusion Medicine, Tehran, Iran, Tehran,
Iran, Islamic Republic of
Title
Impact of pre-operative supplemental of fibrinogen concentrate on bleeding
and transfusion requirements in cardiac surgery.
Source
Vox Sanguinis. Conference: 35th International Congress of the
International Society of Blood Transfusion, ISBT 2018. Canada. 113
(Supplement 1) (pp 296), 2018. Date of Publication: June 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Cardiopulmonary bypass (CPB) induces a multifactorial
coagulopathy due to an extensive consumption of coagulation factors
especially fibrinogen. There are contradictory reports about effects of
preoperative supplemental fibrinogen in patients without
hypofibrinogenemia. Aims: The aim of this study was to investigate the
effect of pre-operative supplemental of fibrinogen concentrate on bleeding
and transfusion requirements in car-diac surgery. Methods: Totally 78
patients scheduled elective CABG or valvular surgery, were included in a
clinical trial study between March 2017 and November 2017. Patients were
randomly assigned to the fibrinogen and control groups. In the fibrinogen
group patients received 2 grams of fibrinogen dissolved in 50 mL of normal
saline over a 15 min period 30 min after induction of anesthesia. In the
control group the patients were received the same volume of normal saline
during the same period of time. Post-operative bleeding was recorded as
the overall mediastinal drainage or other drain in surgical site during 24
H after surgery. Amount of transfused packed red blood cells, fresh frozen
plasma, and platelets during first post-surgery day were also documented.
Results: The mean volume of bleeding was significantly lower in fibrinogen
group compared with control group (168 +/- 12 ml vs 344 +/- 37 ml) (P =
0.001). Furthermore, the mean volume of FFP and platelet concentrate which
used in fibrinogen group was significantly lower in fibrinogen group
compared with control group (P < 0.05). However, we didn't found any
significant differences in RBC consumption between groups
Summary/Conclusions: Preoperative supplementation with fibrinogen results
in reduction in postoperative blood loss and transfusion requirements
during cardiac surgery.

<43>
Accession Number
622663544
Author
Reade M.C.
Institution
(Reade) Faculty of Medicine, University of Queensland, Brisbane, Australia
(Reade) Joint Health Command, Australian Defence Force, Canberra,
Australia
Title
Frozen platelets: Current practice, evidence, evidence gaps and clinical
research programs underway.
Source
Vox Sanguinis. Conference: 35th International Congress of the
International Society of Blood Transfusion, ISBT 2018. Canada. 113
(Supplement 1) (pp 48), 2018. Date of Publication: June 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Platelets are essential for haemostasis. Liquid-stored platelets have a
shorter shelf life (5 days) than other blood components (42 days for red
cells and 12 months for fresh frozen plasma), so outer metropolitan
hospitals, rural hospitals and deployed military hospitals usually cannot
justify maintaining platelet units on-site, as this would inevitably waste
a resource in high demand elsewhere. In response, the Netherlands Military
Blood Bank built on earlier US Navy research to refine a process to freeze
(using dimethylsulfoxide as a cryopreservative), store (for up to 2 years)
and reconstitute (in plasma) platelets for use in military operations.
Experience with 1,143! cry-opreserved platelet units transfused into 349
patients in Afghanistan suggests they were both safe and effective in
treating active bleeding (Noorman et al., 2016), although no comparisons
with liquid-stored platelets or whole blood were made. There are also
several instances in civilian practice in which the ability to transfuse
platelets has been judged to outweigh any unquantified risk associated
with the cry-opreserved product, including in Poland, the Czech Republic,
France and the United States. However, while extensive preclinical
assessments and one phase I human study of cryopreserved platelets have
been performed, to date there has only been one clinical trial involving
bleeding patients published. This US Navy-sponsored study (Khuri et al.,
1999) randomised 73 patients to cryopreserved or liquid-stored platelets
for treatment of bleeding after cardiac surgery. No adverse effects were
observed in the 24 patients who received cryopreserved platelets. Blood
loss with cryopreserved platelets was significantly less, despite lower
post-transfusion platelet increments and a tendency towards decreased
platelet survival. While uniformly encouraging, this evidence base is
insufficient to justify regulatory approval. Several international trial
groups are seeking to address this deficiency, including the Czech
military and the US Department of Defense/Dartmouth University. In 2015
the Australian Red Cross Blood Service and the Australian Defence Force
commenced a clinical trial program, the Cryopreserved vs. Liquid Platelet
trial (CLIP), designed to evaluate the effectiveness, safety and
cost-effectiveness of cryopreserved platelets in comparison to
liquid-stored platelets. The Australian pilot trial ceased enrolment in
December 2017, with a New Zealand variant of the protocol due to run
through 2018. In the Australian pilot, 121 high-risk cardiac surgical
patients were ran-domised, of whom 42 were transfused platelets. Study
groups were well-balanced at baseline. There were no adverse events
attributed to platelet transfusion. Medical complications that might have
been related to cryopreserved platelet transfusion, but which are also
common after high-risk cardiac surgery, such as fever, infection, acute
respiratory distress syndrome, and deep venous thrombosis, were present in
similar proportions in the two trial groups. There were non-statistically
significant trends to superiority in several bleeding-related outcomes,
including blood loss, requirement for red cell transfusion, and need to
return to the operating theatre for bleeding. The results justify
progression to a definitive phase III trial, CLIP-II.

<44>
Accession Number
622663066
Author
Yates J.; Perelman I.; Khair S.; Taylor J.; Lampron J.; Tinmouth A.;
Saidenberg E.
Institution
(Yates, Lampron, Tinmouth, Saidenberg) Ottawa Hospital, Canada
(Perelman, Khair, Taylor) University of Ottawa, Canada
(Perelman, Tinmouth, Saidenberg) Ottawa Hospital Research Institute,
Ottawa, Canada
Title
Exclusion criteria and adverse events in peri-operative cardiac surgery
tranexamic acid trials: A systematic review and meta-analysis.
Source
Vox Sanguinis. Conference: 35th International Congress of the
International Society of Blood Transfusion, ISBT 2018. Canada. 113
(Supplement 1) (pp 323), 2018. Date of Publication: June 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Cardiac surgeries are often associated with substantial blood
loss, putting patients at increased risk for blood transfusions. The use
of tranexamic acid (TXA), an anti-fibrinolytic agent, as a blood
conservation strategy has gained popularity in many surgical specialties,
and it has been shown to be both an effective and safe therapy. However,
TXA remains underutilized, largely due to fear of potential thromboembolic
events, which are of concern in cardiac surgery. Another possible
contributing factor to the under-use of TXA is the lack of evidence-based
guidelines outlining which patient groups should not receive TXA due to
risks outweighing the benefits. Aims: We conducted a systematic review to
determine which patients were excluded from clinical trials of TXA in
cardiac surgery to help determine if there are patient groups in whom the
risk of TXA therapy cannot be estimated. As a secondary objective, we
assessed the safety of systemic TXA. We hope the findings of this review
will enable the development of evidence-informed exclusion criteria for
TXA use in patients undergoing cardiac surgeries. Methods: The databases
Medline, EMBASE, and the Cochrane Central Register of Controlled Trials
were searched from inception until September 2017. Eligible studies were
randomized controlled trials (RCTs) administering systemic TXA
peri-operatively to patients undergoing any cardiac surgery. Comparator
groups of placebo, no intervention, or an active comparator were accepted.
Our primary outcome was a description of the exclusion criteria for each
RCT, and as a secondary endpoint we assessed the rate of adverse events
associated with TXA use. A descriptive synthesis was performed to
synthesize study characteristics and analyze the exclusion criteria. TXA
safety was assessed with meta-analysis using a random effects model.
Results: 70 eligible RCTs were included in this systematic review. A
variety of cardiac surgeries were included, the most common one being
coronary artery bypass graft surgery (45.7% of studies). The two most
common reasons for excluding patients from TXA trials in cardiac surgery
were major hepatic, renal, or cardiac comorbidities (75.7% of studies),
and the use of medications affecting coagulation (55.7% of studies). Other
patient groups frequently excluded from these trials were those with
coagulopathy (41.4% of studies), known allergy to TXA (3!5.7%), an
abnormal coagulation profile (32.9% of studies), a previous history of
arterial or venous thromboembolic events (27.1% of studies), and anemia
(20.0% of studies). Meta-analysis showed that systemic TXA did not
increase the risk of adverse events compared to placebo or no intervention
(RR = 0.97, 95% CI: 0.88, 1.07). Summary/Conclusions: Systemic TXA is safe
to use peri-operatively in cardiac surgery, and evidence-based guidelines
for its use in surgery can be developed for many patient populations.
Regarding the patient groups commonly excluded from TXA trials in cardiac
surgery, some of the exclusions may not be warranted based on current
evidence. However, due to frequent exclusion from RCTs, there may be
limited efficacy and safety data on TXA in these populations, and further
research on TXA in these patient groups may be warranted.

<45>
Accession Number
622663051
Author
Perelman I.; Khair S.; Dermer E.; Tinmouth A.; Saidenberg E.; Fergusson D.
Institution
(Perelman, Tinmouth, Saidenberg, Fergusson) Clinical Epidemiology, Ottawa
Hospital Research Institute, Canada
(Perelman, Khair, Dermer, Fergusson) University of Ottawa, Canada
(Tinmouth, Saidenberg) Ottawa Hospital, Ottawa, Canada
Title
The epidemiology of multiple blood component transfusion: A systematic
review.
Source
Vox Sanguinis. Conference: 35th International Congress of the
International Society of Blood Transfusion, ISBT 2018. Canada. 113
(Supplement 1) (pp 304), 2018. Date of Publication: June 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Patient care and blood product allocation within the hospital
can be optimized by better understanding the prevalence of patients that
receive co-transfusions of multiple blood products (multi-transfusions),
as well as the characteristics and outcomes of these multi-transfusion
recipients. However, there is a lack of literature describing the
epidemiology of multi-transfusion, as most studies concentrate on a
particular blood product and its utilization. Aims: The purpose of this
systematic review was to describe the prevalence of multi-transfusion, and
as a secondary objective, to determine any patient characteristics and
outcomes associated with multi-transfusion. Methods: The databases
Medline, EMBASE, and the Cochrane Library of Systematic Reviews were
searched. Observational cohort and cross-sectional studies of adult or
pediatric hospital patients that reported on multi-transfusion incidence
or prevalence, or on patient characteristics and outcomes associated with
multi-transfusion, were included. A descriptive synthesis of studies was
performed. Results: A total of 37 studies were identified and included, of
which 34 (92%) reported on multi-transfusion prevalence. It was found that
multi-transfusion prevalence varied greatly by patient population and by
the specific combination of blood products given in the multi-transfusion,
but changed little over time. Multi-transfused patients included those
with burns, cardiac surgery, liver transplant, cancer, infectious
diseases, trauma, patients requiring massive blood transfusions, and ICU
patients. Five studies found associations between multi-transfusion and
adverse health outcomes for cardiac surgery and liver transplant patients;
however, these findings are likely confounded by indication. The overall
quality of evidence was very low, given a fair-to-poor individual study
quality, inconsistent multi-transfu-sion estimates, and significant
confounding by indication. Summary/Conclusions: A knowledge of
multi-transfusion trends and of multi-transfusion recipients is needed to
help improve patient care and patient blood man-agement. Physician
awareness of the risks and benefits of multi-transfusion can help optimize
transfusion decision-making, leading to appropriate transfusion practice
and avoidance of unnecessary transfusions. Our research showed that in
certain patient groups, as many as 99% of patients are multi-transfused.
Yet, little is really known about these patients. Further research is
needed in several areas to gain a better understanding of the epidemiology
of multi-transfusion, including more studies on multi-transfusion in
hematologic cancer patients, and studies looking for patient
characteristics that can better predict the need for multi-transfusion.

<46>
[Use Link to view the full text]
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.

<47>
[Use Link to view the full text]
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.

<48>
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

<49>
[Use Link to view the full text]
Accession Number
623124810
Author
Zhu X.; Chen Y.; Xiang L.; You T.; Jiao Y.; Xu W.; Chen J.
Institution
(Zhu, Chen, Xiang, You, Jiao, Xu, Chen) Department of Cardiology, Second
Affiliated Hospital, Soochow University, 1055 Sanxiang Road, Suzhou,
Jiangsu Province 215004, China
Title
The long-term prognostic significance of high-sensitive C-reactive protein
to in-stent restenosis.
Source
Medicine (United States). 97 (27) (no pagination), 2018. Article Number:
e10679. Date of Publication: 01 Jul 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: In the current meta-analysis, we aim to assess the effect of
high-sensitive C-reactive protein (hs-CRP) on in-stent restenosis (ISR)
outcome in patients receiving stent implantation. Methods: Embase, PubMed,
and Cochrane databases were searched through October 2016 using the
keywords "high-sensitive C-reactive protein," "in-stent restenosis." An
odds ratio (OR) of on ISR endpoints among patients receiving stent
implantation was calculated using random-effects models. Results: In the
meta-analysis of 6 prospective observational studies, there are 1156
coronary heart disease (CHD) patients, a total of 885 stents were
implanted and 194 ISR events had been followed up for 6 to 12 months;
high-sensitive C-reactive protein levels are associated with the
prediction of in-stent restenosis among patients receiving stent
implantation. The OR of hs-CRP for ISR was 1.16 [95% confidence interval
(CI), 1.01-1.30, P<.05]. Conclusions: This meta-analysis shows that higher
levels of hs-CRP are associated with an increased risk of ISR and indicate
a poorer prognosis in CHD patients after stent implantation.<br/>Copyright
&#xa9; 2018 the Author(s). Published by Wolters Kluwer Health, Inc.

<50>
Accession Number
2000971783
Author
van Dongen I.M.; Kolk M.Z.H.; Elias J.; Meijborg V.M.F.; Coronel R.; de
Bakker J.M.T.; Claessen B.E.P.M.; Delewi R.; Ouweneel D.M.; Scheunhage
E.M.; van der Schaaf R.J.; Suttorp M.-J.; Bax M.; Marques K.M.; Postema
P.G.; Wilde A.A.M.; Henriques J.P.S.
Institution
(van Dongen, Kolk, Elias, Meijborg, Coronel, de Bakker, Claessen, Delewi,
Ouweneel, Scheunhage, Postema, Wilde, Henriques) Academic Medical Center -
University of Amsterdam, Amsterdam, Netherlands
(van der Schaaf) Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
(Suttorp) Sint Antonius Ziekenhuis, Nieuwegein, Netherlands
(Bax) Haga Teaching Hospital, The Hague, Netherlands
(Marques) Free University Medical Center, Amsterdam, Netherlands
Title
The effect of revascularization of a chronic total coronary occlusion on
electrocardiographic variables. A sub-study of the EXPLORE trial.
Source
Journal of Electrocardiology. 51 (5) (pp 906-912), 2018. Date of
Publication: September - October 2018.
Publisher
Churchill Livingstone Inc.
Abstract
Introduction: Chronic total coronary occlusions (CTOs) have been
associated with a higher prevalence of ventricular arrhythmias compared to
patients without a CTO. We evaluated the effect of CTO revascularization
on electrocardiographic (ECG) variables. Methods: We studied a selection
of ST-elevation myocardial infarction patients with a concomitant CTO
enrolled in the EXPLORE trial. ECG variables and cardiac function were
analysed at baseline and at 4 months follow-up. Results: Patients were
randomized to percutaneous coronary intervention (PCI) of their CTO (n =
77) or to no-CTO PCI (n = 81). At follow-up, median QT dispersion was
significantly lower in the CTO PCI group compared to the no-CTO PCI group
(46 ms [33-58] vs. 54 ms [37-68], P = 0.043). No independent association
was observed between ECG variables and cardiac function. Conclusion:
Revascularization of a CTO after STEMI significantly shortened QT
dispersion at 4 months follow-up. These findings support the hypothesis
that CTO revascularization reduces the pro-arrhythmic substrate in CTO
patients.<br/>Copyright &#xa9; 2018

<51>
Accession Number
2000975905
Author
Krishna S.N.; Chauhan S.; Bhoi D.; Kaushal B.; Hasija S.; Sangdup T.;
Bisoi A.K.
Institution
(Krishna, Chauhan, Kaushal, Hasija) Department of Cardiac Anesthesiology,
Cardio and Neurosciences Center, All India Institute of Medical Sciences,
New Delhi, India
(Bhoi) Department of Anesthesiology, Pain Medicine and Critical Care, All
India Institute of Medical Sciences, New Delhi, India
(Sangdup, Bisoi) Department of Cardiothoracic and Vascular Surgery, Cardio
and Neurosciences Center, All India Institute of Medical Sciences, New
Delhi, India
Title
Bilateral Erector Spinae Plane Block for Acute Post-Surgical Pain in Adult
Cardiac Surgical Patients: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Publisher
W.B. Saunders
Abstract
Objectives: To examine the analgesic efficacy of bilateral erector spinae
plane (ESP) block compared with conventional treatment for pain after
cardiac surgery in adult patients. Design: A prospective, randomized,
controlled, single-blinded study. Setting: Single-center tertiary teaching
hospital. Participants: One hundred and six adult patients undergoing
elective cardiac surgery with cardiopulmonary bypass. Interventions:
Patients were randomized into 2 groups. Patients in group 1 (ESP block
group, n = 53) received ultrasound-guided bilateral ESP block with 3 mg/kg
of 0.375% ropivacaine before anesthesia induction at the T6 transverse
process level. Patients in group 2 (paracetamol and tramadol group, n =
53) received paracetamol (1 gm every 6 hours) and tramadol (50 mg every 8
hours) intravenously in the postoperative period. The primary study
outcome was to evaluate pain at rest using an 11-point numeric rating
scale (NRS). Mann-Whitney U test was used for comparing NRS scores.
Measurements and Main Results: The postoperative pain level after
extubation and duration of analgesia during which NRS was < 4 of 10 was
compared between the groups. The median pain score at rest after
extubation in group 1 was 0 of 10 until hour 6, 3 of 10 at hour 8, and 4
of 10 at hours 10 and 12 postextubation. These were significantly less in
comparison with group 2 (p = 0.0001). Patients in group 1 had a
significantly higher mean duration of analgesia (8.98 +/- 0.14 hours),
during which NRS was < 4 of 10, compared with group 2 (4.60 +/- 0.12
hours) (p = 0.0001). Conclusion: ESP block safely provided significantly
better pain relief at rest for longer duration as compared to intravenous
paracetamol and tramadol.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<52>
Accession Number
615868878
Author
Nazer R.I.; Albarrati A.M.
Institution
(Nazer) Department of Cardiac Science, King Fahad Cardiac Center, College
of Medicine, King Saud University, Riyadh, Saudi Arabia
(Albarrati) Department of Rehabilitation Science, College of Applied
Medical Science, King Saud University, Riyadh, Saudi Arabia
Title
Topical Ice Slush Adversely Affects Sniff Nasal Inspiratory Force After
Coronary Bypass Surgery.
Source
Heart Lung and Circulation. 27 (3) (pp 371-376), 2018. Date of
Publication: March 2018.
Publisher
Elsevier Ltd
Abstract
Background: Topical cooling with ice slush as an adjunct for myocardial
protection during cardiac surgery has been shown to cause freezing injury
of the phrenic nerves. This can cause diaphragmatic dysfunction and
respiratory complications. Methods: Twenty (n = 20) male patients between
the ages of 40 and 60 years were equally randomised to undergo elective
coronary artery bypass grafting (CABG) with either cold cardioplegic
arrest with topical ice slush cooling or cold cardioplegic arrest without
the use of ice slush. The sniff nasal inspiratory force (SNIF) was used to
compare inspiratory muscle strength. Results: There was no difference in
the preoperative SNIF in the two randomised groups. In the immediate
postoperative period, the ice slush group had worse SNIF (33.5 +/- 9.6 cm
H2O versus 47.8 +/- 12.2 cm H2O; p = 0.009). The pre-home discharge SNIF
was still significantly lower for the ice slush group despite a noted
improvement in SNIF recovery in both groups (38.3 +/- 10.6 cm H2O versus
53.5 +/- 13.2 cm H2O; p = 0.011). Two patients in the ice slush group had
left diaphragmatic dysfunction with none in the control group. Conclusion:
The use of topical ice slush is associated with freezing injury of the
phrenic nerves. This will adversely affect the inspiratory muscle force
which may lead to respiratory complications after surgery.<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)

<53>
Accession Number
619169404
Author
Thein P.M.; White K.; Banker K.; Lunny C.; Mirzaee S.; Nasis A.
Institution
(Thein) Department of Medicine, Monash Medical Centre, Monash Health,
Melbourne, Vic, Australia
(Thein, White, Banker) Monash University, School of Public Health and
Preventive Medicine, Melbourne, Vic, Australia
(Lunny) Department of Epidemiology and Preventive Medicine, School of
Public Health and Preventive Medicine, Cochrane Australia, Melbourne, Vic,
Australia
(Mirzaee, Nasis) MonashHeart, Monash Cardiovascular Research Centre,
Monash Health Department of Medicine (MMC), Monash University, Melbourne,
Vic, Australia
Title
Preoperative Use of Oral Beta-Adrenergic Blocking Agents and the Incidence
of New-Onset Atrial Fibrillation After Cardiac Surgery. A Systematic
Review and Meta-Analysis.
Source
Heart Lung and Circulation. 27 (3) (pp 310-321), 2018. Date of
Publication: March 2018.
Publisher
Elsevier Ltd
Abstract
Background: Current epidemiological data suggests that postoperative
atrial fibrillation or atrial flutter (POAF) causes significant morbidity
and mortality after cardiac surgery. The literature for prophylactic
management of POAF is limited, resulting in the lack of clear guidelines
on management recommendations. Aim: To examine the efficacy of
prophylactic rate control agents in reducing the incidence of new-onset
POAF in patients undergoing elective cardiac surgery. Methods: Cochrane
Central Register of Controlled Trials (CENTRAL), Embase, and Medline were
systematically searched for blinded randomised controlled studies (RCT)
evaluating adults with no history of atrial fibrillation randomised to a
pharmacological agent (either beta blocker, calcium channel blocker or
digoxin), compared to placebo. Utilising Cochrane guidance, three
reviewers screened, extracted and the quality of the evidence was
assessed. We used a random effects meta-analysis to compare a rate-control
agent with placebo. Results: Five RCTs (688 subjects, mean age 61 +/- 8.9,
69% male) were included. Beta blocker administration prior to elective
cardiac surgery significantly reduced the incidence of POAF (OR 0.43,
95%Cl [0.30-0.61], I² = 0%) without significant impact on
ischaemic stroke (OR 0.49, 95%Cl [0.10-2.44], I² = 0%),
non-fatal myocardial infarction (OR 0.76, 95%Cl [0.08-7.44], I²
= 0%), overall mortality (OR 0.83, 95%Cl [0.19-3.66], I² = 0%),
or length of stay (mean -0.96 days 95%Cl [-1.49 to -0.42], I² =
0%). An increased rate of bradycardic episodes was observed (OR 3.53,
95%Cl [1.22-10.23], I² = 0%). Conclusions: This review suggests
that selective administration of prophylactic oral beta blockers prior to
elective cardiac surgery is safe and may reduce the incidence of
POAF.<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)

<54>
Accession Number
619883515
Author
Goldstein B.H.; Goldstein S.L.; Devarajan P.; Zafar F.; Kwiatkowski D.M.;
Marino B.S.; Morales D.L.S.; Krawczeski C.D.; Cooper D.S.
Institution
(Goldstein, Goldstein, Zafar, Morales, Cooper) Heart Institute, Cincinnati
Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2003,
Cincinnati, OH 45229, United States
(Goldstein, Devarajan, Cooper) Center for Acute Care Nephrology,
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United
States
(Kwiatkowski, Krawczeski) Division of Cardiology, Stanford University
School of Medicine, Palo Alto, California, United States
(Marino) Division of Cardiology, Northwestern University Feinberg School
of Medicine and Lurie Children's Hospital, Chicago, Illinois, United
States
Title
First-stage palliation strategy for univentricular heart disease may
impact risk for acute kidney injury.
Source
Cardiology in the Young. 28 (1) (pp 93-100), 2018. Date of Publication: 01
Jan 2018.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Objective Norwood palliation for patients with single ventricle heart
disease is associated with a significant risk for acute kidney injury,
which portends a worse prognosis. We sought to investigate the impact of
hybrid stage I palliation (Hybrid) on acute kidney injury risk. Design
This study is a single-centre prospective case-control study of seven
consecutive neonates with single ventricle undergoing Hybrid palliation.
Levels of serum creatinine and four novel urinary biomarkers, namely
neutrophil gelatinase-associated lipocalin, interleukin-18, liver fatty
acid-binding protein, and kidney injury molecule-1, were obtained before
and after palliation. Acute kidney injury was defined as a 50% increase in
serum creatinine within 48 hours after the procedure. Data were compared
with a contemporary cohort of 12 neonates with single ventricle who
underwent Norwood palliation. Results Patients who underwent Hybrid were
more likely to be high-risk candidates (86 versus 25%, p=0.01) compared
with those who underwent Norwood. Despite similar preoperative serum
creatinine levels, there was a trend towards higher levels of
postoperative peak serum creatinine (0.7 [0.63, 0.94] versus 0.56 [0.47,
0.74], p=0.06) and rate of acute kidney injury (67 versus 29%, p=0.17) in
the Norwood cohort. Preoperative neutrophil gelatinase-associated
lipocalin (58.4 [11, 86.3] versus 6.3 [5, 16.2], p=0.07) and
interleukin-18 (30.6 [9.6, 167.2] versus 6.3 [6.3, 16.4], p=0.03) levels
were higher in the Hybrid cohort. Nevertheless, longitudinal mixed-effect
models demonstrated Hybrid palliation to be a protective factor against
increased postoperative levels of neutrophil gelatinase-associated
lipocalin (estimate -1.8 [-3.0, -9.0], p<0.001) and liver fatty
acid-binding protein (-49.3 [-89.7, -8.8], p=0.018). Conclusions In this
single-centre case-control study, postoperative acute kidney injury risk
did not differ significantly by single ventricle stage I treatment
strategy; however, postoperative elevation in novel urinary biomarkers,
consistent with subclinical kidney injury, was encountered in the Norwood
cohort but not in the Hybrid cohort.<br/>Copyright &#xa9; Cambridge
University Press 2017.

<55>
Accession Number
614411455
Author
Kirmani B.H.; Jones S.G.; Datta S.; McLaughlin E.K.; Hoschtitzky A.J.
Institution
(Kirmani, Datta, McLaughlin, Hoschtitzky) Department of Cardiothoracic
Surgery, Manchester Royal Infirmary, Manchester, United Kingdom
(Kirmani, Jones) Department of Cardiothoracic Surgery, Liverpool Heart and
Chest Hospital, Thomas Drive, Liverpool L14 3PE, United Kingdom
Title
A meta-analysis of platelet gel for prevention of sternal wound infections
following cardiac surgery.
Source
Blood Transfusion. 15 (1) (pp 57-65), 2017. Date of Publication: January
2017.
Publisher
SIMTI Servizi Sri (E-mail: luisa.stea@bloodtransfusion.it)
Abstract
Deep sternal wound infection and bleeding are devastating complications
following cardiac surgery, which may be reduced by topical application of
autologous platelet gel. Systematic review identified seven comparative
studies involving 4,692 patients. Meta-analysis showed significant
reductions in all sternal wound infections (odds ratio 3.48 [1.08-11.23],
p=0.04) and mediastinitis (odds ratio 2.69 [1.20-6.06], p=0.02) but not
bleeding. No adverse events relating to the use of topical platelet-rich
plasma were reported. The use of autologous platelet gel in cardiac
surgery appears to provide significant reductions in serious sternal wound
infections, and its use is unlikely to be associated with significant
risk.<br/>Copyright &#xa9; SIMTI Servizi Srl.

<56>
Accession Number
617548707
Author
Yi B.; Wang J.; Yi D.; Zhu Y.; Jiang Y.; Li Y.; Mo S.; Liu Y.; Rong J.
Institution
(Yi) Department of Cardiothoracic Surgery, Heart Center, the First
Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on
Assisted Circulation, Ministry of Health, Guangzhou, China
(Yi, Zhu, Jiang, Li, Mo, Rong) Department of Extracorporeal Circulation,
Heart Center, the First Affiliated Hospital, Sun Yat-Sen University, and
Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou,
China
(Wang) Department of Anesthesiology, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Disease, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
(Yi) Department of Cardiac Surgery, the Second Xiangya Hospital, Central
South University, Changsha, China
(Liu) Department of Anesthesiology, the First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China
Title
Remote Ischemic Preconditioning and Clinical Outcomes in On-Pump Coronary
Artery Bypass Grafting: A Meta-Analysis of 14 Randomized Controlled
Trials.
Source
Artificial Organs. 41 (12) (pp 1173-1182), 2017. Date of Publication:
December 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
The purpose of this article is to perform the first pooled analysis on
remote ischemic preconditioning (RIPC) used for the improvement of
clinical outcomes of patients only undergoing on-pump coronary artery
bypass grafting (CABG) in randomized controlled trials (RCTs). A
systematic search was performed using PubMed, the Cochrane Library, and
the Web of Science to identify studies that described the effect of RIPC
on postoperative mortality in patients only undergoing on-pump CABG. The
outcomes included postoperative mortality, postoperative morbidity
(including incidence of myocardial infarction, atrial fibrillation,
stroke, acute kidney injury, and renal replacement therapy), mechanical
ventilation (MV), intensive care unit length of stay (ICU LOS), and
hospital length of stay (HLOS). A total of 14 RCTs (2830 participants)
were included. Our meta-analysis found that RIPC failed to reduce the
postoperative mortality in patients only undergoing on-pump CABG compared
with control individuals (odds ratio, 0.81; 95% confidence interval,
[0.40, 1.64]; P = 0.55; I² = 25%). Moreover, there were no
differences in postoperative morbidity, ICU LOS, and HLOS between the two
groups. However, MV in the RIPC group was shorter than that in control
individuals (standard mean difference, -0.41; 95% confidence interval,
[-0.80, -0.01]; P = 0.04; I² = 73%). The present meta-analysis
found that RIPC failed to improve most of clinical outcomes in patients
only undergoing on-pump CABG; however, MV was reduced. Adequately powered
trials are warranted to provide more evidence in the future.<br/>Copyright
&#xa9; 2017 International Center for Artificial Organs and Transplantation
and Wiley Periodicals, Inc.

<57>
Accession Number
618521129
Author
Zhang L.; Zheng X.; Long Y.; Wu M.; Chen Y.; Yang J.; Liu Z.; Zhang Z.
Institution
(Zhang, Chen, Yang, Liu, Zhang) Department of Clinical Laboratory and
Pathology, Wuhan Asia Heart Hospital, Wuhan University, Wuhan, China
(Zheng) Laboratory of Molecular Cardiology, Wuhan Asia Heart Hospital,
Wuhan University, Wuhan, China
(Long, Wu) Heart Center, Wuhan Asia Heart Hospital, Wuhan University,
Wuhan, China
Title
D-dimer to guide the intensity of anticoagulation in Chinese patients
after mechanical heart valve replacement: a randomized controlled trial.
Source
Journal of Thrombosis and Haemostasis. 15 (10) (pp 1934-1941), 2017. Date
of Publication: October 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Essentials Low anticoagulation intensity reduces bleeding but increases
thrombosis during warfarin therapy. Elevated D-dimer level is associated
with increased thrombosis events. D-dimer can be used to find potential
thrombosis in those receiving low intensity therapy. D-dimer-guided
therapy may be the optimal strategy for those with mechanical heart valve
replacement. Summary: Background Controversies remain regarding the
optimal anticoagulation intensity for Chinese patients after mechanical
heart valve replacement despite guidelines having recommended a standard
anticoagulation intensity. Objectives To investigate whether D-dimer could
be used to determine the optimal anticoagulation intensity in Chinese
patients after mechanical heart valve replacement. Patients/Methods This
was a prospective, randomized controlled clinical study. A total of 748
patients following mechanical heart valve replacement in Wuhan Asia Heart
Hospital were randomized to three groups at a ratio of 1 : 1 : 1. Patients
in two control groups received warfarin therapy based on constant standard
intensity (international normalized ratio [INR], 2.5-3.5; n = 250) and low
intensity (INR, 1.8-2.6; n = 248), respectively. In the experimental group
(n = 250), warfarin therapy was initiated at low intensity, then those
with elevated D-dimer levels were adjusted to standard intensity. All
patients were followed-up for 24 months until the occurrence of endpoints,
including bleeding events, thrombotic events and all-cause mortality.
Results A total of 718 patients were included in the analysis. Fifty-three
events occurred during follow-up. There was less hemorrhage (3/240 vs.
16/241; hazard ratio [HR], 0.18; 95% confidence interval [CI], 0.07-0.45)
and all-cause mortality (4/240 vs. 12/241; HR, 0.33; 95% CI, 0.12-0.87)
observed in the D-dimer-guided group than in the standard-intensity group.
A lower incidence of thrombotic events was also observed in the
D-dimer-guided group when compared with the low-intensity group (5/240 vs.
14/237; HR, 0.35; 95% CI, 0.14-0.85). Overall, the total events were less
in the D-dimer-guided group (9/240) when compared with the other two
control groups (24/241, 20/237; HR, 0.37, 0.44; 95% CI, 0.19-0.72,
0.21-0.90. Conclusions The D-dimer-guided adjustment of anticoagulation
intensity could reduce adverse events in Chinese patients after mechanical
heart valve replacement. Trial Registry: NCT01996657;
ClinicalTrials.gov.<br/>Copyright &#xa9; 2017 International Society on
Thrombosis and Haemostasis

<58>
Accession Number
619321567
Author
Ghaffary S.; Ghaeli P.; Talasaz A.H.; Karimi A.; Noroozian M.; Salehiomran
A.; Jalali A.
Institution
(Ghaffary) Hematology and Oncology Research Center, Tabriz University of
Medical Sciences, Tabriz, Iran, Islamic Republic of
(Ghaeli, Talasaz) Departments of Pharmacotherapy, Faculty of Pharmacy,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Talasaz, Karimi, Salehiomran, Jalali) Tehran Heart Center, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Noroozian) Memory and Behavioral Neurology Department, Roozbeh Hospital,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Effect of memantine on post-operative cognitive dysfunction after cardiac
surgeries: A randomized clinical trial.
Source
DARU, Journal of Pharmaceutical Sciences. 25 (1) (no pagination), 2017.
Article Number: 24. Date of Publication: 21 Nov 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Post-operative cognitive dysfunction (POCD) is an important
complication of cardiac surgeries. Glutamate plays a critical role in
physiologic and pathologic conditions in the brain. Due to the role of
glutamate in ischemia, this study is designed to identify the effect of
memantine in prevention of POCD early and late after cardiac surgeries.
Methods: In this randomized clinical trial, 172 patients with ages 45-75
years old who underwent elective cardiac surgery were enrolled. For
patients in memantine group, 5 mg of memantine per day administered at
least 48 h before surgery and increased to 10 mg per day during the first
24 h after surgery and continued for 3 months. A brief Wechsler memory
test (WMT) was administered before, three to 5 days after, and 3 months
after surgery for both groups. Results: Both groups demonstrate standard
pattern of cognitive dysfunction after surgery and in follow up. Pre- and
post-operative WMT score showed significant improvement in memantine
compared to control group (P < 0.001) both in unadjusted and adjusted with
confounding factor analysis. Unadjusted pre-, post-operative, and follow
up WMT score improved significantly after 3 months in memantine group (P =
0.006). Conclusion: Pre-operative administration of memantine protects
patients from POCD following cardiac surgeries. In addition, it improves
cognitive function 3 months after surgery. Trial registration: The trial
was registered in the Iranian Registry of Clinical Trials (registration
number: IRCT201303168698N12). Graphical abstract: Memantin effect on
POCD.<br/>Copyright &#xa9; 2017 The Author(s).

<59>
Accession Number
611106970
Author
Balogh A.L.; Petak F.; Fodor G.H.; Tolnai J.; Csorba Z.; Babik B.; Asai T.
Institution
(Balogh, Csorba, Babik) Department of Anaesthesiology and Intensive
Therapy, University of Szeged, 6 Semmelweis u. H-6725, Szeged, Hungary
(Balogh, Petak, Fodor, Tolnai) Department of Medical Physics and
Informatics, University of Szeged, 9 Koranyi fasor, Szeged H-6720, Hungary
Title
Capnogram slope and ventilation dead space parameters: Comparison of
mainstream and sidestream techniques.
Source
British Journal of Anaesthesia. 117 (1) (pp 109-117), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Oxford University Press
Abstract
Background Capnography may provide useful non-invasive bedside information
concerning heterogeneity in lung ventilation, ventilation-perfusion
mismatching and metabolic status. Although the capnogram may be recorded
by mainstream and sidestream techniques, the capnogram indices furnished
by these approaches have not previously been compared systematically.
Methods Simultaneous mainstream and sidestream time and volumetric
capnography was performed in anaesthetized, mechanically ventilated
patients undergoing elective heart surgery. Time capnography was used to
assess the phase II (S<inf>II,T</inf>) and III slopes (S<inf>III,T</inf>).
The volumetric method was applied to estimate phase II (S<inf>II,V</inf>)
and III slopes (S<inf>III,V</inf>), together with the dead space values
according to the Fowler (V<inf>DF</inf>), Bohr (V<inf>DB</inf>), and
Enghoff (V<inf>DE</inf>) methods and the volume of CO<inf>2</inf>
eliminated per breath (VCO2). The partial pressure of end-tidal
CO<inf>2</inf> (PETCO2) was registered. Results Excellent correlation and
good agreement were observed in S<inf>III,T</inf> measured by the
mainstream and sidestream techniques [ratio=1.05 (sem 0.16),
R²=0.92, P<0.0001]. Although the sidestream technique
significantly underestimated VCO2 and overestimated S<inf>III,V</inf>
[1.32 (0.28), R²=0.93, P<0.0001], V<inf>DF</inf>,
V<inf>DB</inf>, and V<inf>DE</inf>, the agreement between the mainstream
and sidestream techniques in the difference between V<inf>DE</inf> and
V<inf>DB</inf>, reflecting the intrapulmonary shunt, was excellent [0.97
(0.004), R²=0.92, P<0.0001]. The PETCO2 exhibited good
correlation and mild differences between the mainstream and sidestream
approaches [0.025 (0.005) kPa]. Conclusions Sidestream capnography
provides adequate quantitative bedside information about uneven alveolar
emptying and ventilation-perfusion mismatching, because it allows reliable
assessments of the phase III slope, PETCO2 and intrapulmonary shunt.
Reliable measurement of volumetric parameters (phase II slope, dead
spaces, and eliminated CO<inf>2</inf> volumes) requires the application of
a mainstream device.<br/>Copyright &#xa9; 2016 The Author 2016. Published
by Oxford University Press on behalf of the British Journal of
Anaesthesia. All rights reserved.

<60>
Accession Number
622994754
Author
D'Amico G.; Basile M.; Tarantini G.; Marchese A.
Institution
(D'Amico, Tarantini) Unit of Cardiology, Department of Cardiac, Thoracic,
and Vascular Sciences, University of Padua Medical School, Gallucci Heart
Center, Clinic of Cardiology, Via Giustiniani 2, Padua 35128, Italy
(Basile, Marchese) Unit of Cardiology, GVM Care and Research, Anthea
Hospital, Bari, Italy
Title
Revascularization strategies in STEMI with multivessel disease: When and
how.
Source
Minerva Cardioangiologica. 66 (4) (pp 429-441), 2018. Date of Publication:
August 2018.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Acute ST-segment elevation myocardial infarction (STEMI) typically arises
from total occlusion of an epicardial coronary artery, most often due to
atherosclerotic plaque rupture/erosion and subsequent thrombus formation.
Granted this, important angiographic information for patients presenting
with STEMI is not only about the status of infarct-related artery (IRA)
but also about the atherosclerotic disease burden and disease severity of
non-IRA vessels. Previous studies have reported that multivessel coronary
artery disease is found in approximately 50% of patients with STEMI
undergoing primary percutaneous coronary intervention (PCI). Primary PCI
is now considered the gold standard in the treatment for patients with
STEMI; however, the optimal reperfusion strategy in patients with STEMI
and multivessel disease (MVD) remains uncertain. In this review, we
summarize the available evidence on treatment options for patients with
STEMI and MVD and highlight current guideline recommendations on this
topic.<br/>Copyright &#xa9; 2018 EDIZIONI MINERVA MEDICA.

<61>
Accession Number
621208986
Author
Touw H.R.; Parlevliet K.L.; Beerepoot M.; Schober P.; Vonk A.; Twisk J.W.;
Elbers P.W.; Boer C.; Tuinman P.R.
Institution
(Touw, Parlevliet, Beerepoot, Elbers, Tuinman) Department of Intensive
Care Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Infection and
Immunity Institute, VU University Medical Center Amsterdam, Netherlands
(Touw, Schober, Boer) Department of Anaesthesiology, Amsterdam
Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU
University Medical Center Amsterdam, Netherlands
(Vonk) Department of Cardiothoracic Surgery, Amsterdam Cardiovascular
Sciences, Amsterdam Infection and Immunity Institute, VU University
Medical Center Amsterdam, Netherlands
(Twisk) Department of Epidemiology and Biostatistics, Amsterdam
Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU
University Medical Center Amsterdam, Netherlands
Title
Lung ultrasound compared with chest X-ray in diagnosing postoperative
pulmonary complications following cardiothoracic surgery: a prospective
observational study.
Source
Anaesthesia. 73 (8) (pp 946-954), 2018. Date of Publication: August 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Postoperative pulmonary complications are common after cardiothoracic
surgery and are associated with adverse outcomes. The ability to detect
postoperative pulmonary complications using chest X-rays is limited, and
this technique requires radiation exposure. Little is known about the
diagnostic accuracy of lung ultrasound for the detection of postoperative
pulmonary complications after cardiothoracic surgery, and we therefore
aimed to compare lung ultrasound with chest X-ray to detect postoperative
pulmonary complications in this group of patients. We performed this
prospective, observational, single-centre study in a tertiary intensive
care unit treating adult patients who had undergone cardiothoracic
surgery. We recorded chest X-ray findings upon admission and on
postoperative days 2 and 3, as well as rates of postoperative pulmonary
complications and clinically-relevant postoperative pulmonary
complications that required therapy according to the treating physician as
part of their standard clinical practice. Lung ultrasound was performed by
an independent researcher at the time of chest X-ray. We compared lung
ultrasound with chest X-ray for the detection of postoperative pulmonary
complications and clinically-relevant postoperative pulmonary
complications. We also assessed inter-observer agreement for lung
ultrasound, and the time to perform both imaging techniques. Subgroup
analyses were performed to compare the time to detection of
clinically-relevant postoperative pulmonary complications by both
modalities. We recruited a total of 177 patients in whom both lung
ultrasound and chest X-ray imaging were performed. Lung ultrasound
identified 159 (90%) postoperative pulmonary complications on the day of
admission compared with 107 (61%) identified with chest X-ray (p < 0.001).
Lung ultrasound identified 11 out of 17 patients (65%) and chest X-ray 7
out of 17 patients (41%) with clinically-relevant postoperative pulmonary
complications (p < 0.001). The clinically-relevant postoperative pulmonary
complications were detected earlier using lung ultrasound compared with
chest X-ray (p = 0.024). Overall inter-observer agreement for lung
ultrasound was excellent (kappa = 0.907, p < 0.001). Following
cardiothoracic surgery, lung ultrasound detected more postoperative
pulmonary complications and clinically-relevant postoperative pulmonary
complications than chest X-ray, and at an earlier time-point. Our results
suggest lung ultrasound may be used as the primary imaging technique to
search for postoperative pulmonary complications after cardiothoracic
surgery, and will enhance bedside decision making.<br/>Copyright &#xa9;
2018 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf
of Association of Anaesthetists of Great Britain and Ireland

<62>
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

<63>
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.

<64>
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

<65>
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.

<66>
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

<67>
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

<68>
Accession Number
623165898
Author
Wang T.K.M.; Wang M.T.M.
Institution
(Wang, Wang) Auckland City Hospital, Auckland, New Zealand
(Wang, Wang) University of Auckland, Auckland, New Zealand
Title
Repair versus replacement of isolated tricuspid valve disease: A
meta-analysis.
Source
Heart Lung and Circulation. Conference: Cardiac Society of Australia and
New Zealand Annual Scientific Meeting 2018. New Zealand. 27 (Supplement 1)
(pp S35-S36), 2018. Date of Publication: 2018.
Publisher
Elsevier Ltd
Abstract
Aims: Tricuspid valve surgery is rarely performed in isolation and has
high operative risk compared to other single-valve operations. There is
sparse literature on the best surgical approach for isolated tricuspid
valve disease although guidelines consensus suggests valve repair. We
meta-analysed the outcomes of isolated tricuspid valve repair versus
replacement. Methods: Two authors independently searched MEDLINE, Embase,
Scopus and Cochrane from January 1980 to December 2017 for studies which
report outcomes for both isolated tricuspid valve repair and replacement,
and excluding congenital tricuspid valve aetiologies. Data were extracted
and pooled using random-effects models. Results: The search yielded 734
articles, with 28 full-texts obtained from abstract screening and 6
observational studies included, totalling 2,465 repairs and 3,271
replacements. Mean age were 52+/-17 and 55+/-15 years p = 0.11, and
females made up 54% and 60% p = 0.34 respectively. Pooled repair and
replacement event rates and odds ratios (95% confidence intervals) for
operative mortality was 8% versus 10%, 0.72 (0.60-0.87) in 6 studies, and
late mortality 14% versus23%, 0.64 (0.25-1.64) in 5 studies. Other odds
ratios (95% confidence intervals) for repair compared to replacement were
in-hospital renal complications 0.56 (0.30-1.04), cardiac complications
0.51 (0.22-1.20) and permanent pacemaker implantation 0.55 (0.28-1.07),
and redo operations during follow-up 1.19 (0.39-3.64). Conclusion:
Isolated tricuspid valve repair was associated with significantly reduced
operative mortality, and trend towards reduction in renal complications
and permanent pacemaker implantation, but no differences in longer term
outcomes mortality or redo operations. Valvular repair is therefore
recommended where feasible for isolated tricuspid disease.

<69>
Accession Number
623165869
Author
Lesiawan E.; Stewart R.; Webster M.
Institution
(Lesiawan, Stewart) University of Auckland, Auckland, New Zealand
(Lesiawan, Stewart, Webster) Greenlane Cardiovascular Services, Auckland
City Hospital, Auckland, New Zealand
Title
Impact of outcome measure and duration of follow-up on the reliability of
clinical trials assessing the efficacy and safety of coronary artery
stents.
Source
Heart Lung and Circulation. Conference: Cardiac Society of Australia and
New Zealand Annual Scientific Meeting 2018. New Zealand. 27 (Supplement 1)
(pp S10), 2018. Date of Publication: 2018.
Publisher
Elsevier Ltd
Abstract
Aim: Advances in coronary stent design have reduced rates of coronary
restenosis and the need for further revascularisation. However, compared
with second-generation(2ndGen) drug-eluting stents(DES),
first-generation(1stGen) DES and bioresorbable coronary scaffolds(BVS)
have an increased risk of stent thrombosis which may not be adequately
assessed in individual studies. A meta-analysis was undertaken to evaluate
the best choice of endpoint and follow-up duration to detect any increased
risk of stent or scaffold thrombosis(ST). Methods: Medline, Embase and
Central were searched for randomised coronary stent trials involving>=100
patients and reporting clinical outcomes for >=12months. Meta-analyses
compared 1stGenDES with bare metal stents(BMS), 2ndGen- DES with BMS,
2ndGenDES with 1stGenDES, 2ndGenDES with BVS. Landmark analysis evaluated
clinical outcomes <=1 year and >1 year. Results: 75 trials were analysed
involving 78,491 patients. Compared with BMS, 1stGenDES decreased
revascularisation[ OR0.36(95%CI 0.25,0.53)] and myocardial infarction(
MI)[OR0.65(95%CI 0.52,0.82)] <=1 year, but increased ST[OR1.66(95%CI
1.21,2.29)] and MI[OR1.41(95%CI 1.07,1.87)] >1 year. 2ndGenDES vs BMS
decreased revascularisation[ OR0.51(95%CI 0.44,0.58)], MI[OR0.70(95%CI
0.58,0.85)], and ST[OR0.48(95%CI 0.31,0.72)], at <=1 year with little
impact on other and later end-points. Compared with 1stGenDES and BVS,
2ndGenDES reduced ST and MI at >1 year. Coronary revascularisation, and
composite endpoints including death and revascularisation, did not
reliably identify ST-related risk. Conclusion: Revascularisation rates
<=12 months can evaluate the efficacy of stents on reducing restenosis.
Long-term safety can only be assessed in large study populations followed
for several years, with the best endpoint a combination of MI and ST. A
two-phased approach is required to evaluate the next generation of
coronary stents and scaffolds.

<70>
Accession Number
623167956
Author
Tekkesin N.; Avci G.S.
Institution
(Tekkesin) Sisli Memorial Hospital, Central Biohemistry Laboratory,
Istanbul, Turkey
(Avci) Sisli Memorial Hospital, Cardiology Department, Istanbul, Turkey
Title
Effect of enhanced external counterpulsation on oxidative sress capacity.
Source
FEBS Open Bio. Conference: 43rd FEBS Congress. Czech Republic. 8
(Supplement 1) (pp 294), 2018. Date of Publication: July 2018.
Publisher
Wiley Blackwell
Abstract
Although, the mechanisms responsible for anti-ischemic benefits of
enhanced external counterpulsation (EECP) remain unknown, we hypothesize
that improvements in oxidative stress (OS) capacity and other extracardiac
parameters are valuable markers to see the efficiency. So, the current
study was designed to evaluate a new OS capacity test under the control of
EECP theraphy in order to trace the extracardiac effects of EECP.
Seventeen symptomatic patients with coronary artery disease were
randomized to thirty-five 1-hour sessions of either EECP (n = 17) or sham
EECP (n = 10). Plasma levels of OS capacity, HDL-cholesterol,
LDL-cholesterol, Glycated hemoglobin (HbA1c), insulin resistance
(HOMA-IR), high-sensitivity C-reactive protein (hsCRP) and NtproBNP were
measured. Measurement of OS capacity includes Free Oxygen Radical Test
(FORT) and the Free Oxygen Radical Defence (FORD). There were no
differences between the two groups at study entry with respect to blood
pressure, drug therapy, prior cardiovascular history and/or procedures, or
cardiovascular risk factors. Following the intervention, patients that
received EECP demonstrated an improvement in FORT (417 U vs 322 U, P <
0.05) and FORD (1.04 vs 2.11, P < 0.01). Except HbA1c and HOMA-IR, there
were also significant beneficial changes in HDL-cholesterol,
LDL-cholesterol, hsCRP and NtproBNP (P < 0.05). Our findings provide a
novel evidence that the beneficial clinical effect of EECP could be also
evaluated by a new OS capacity test. We report that the use of this test
is practical, but studies involving a larger sample size are necessary to
confirm our findings.

<71>
Accession Number
2000972670
Author
Murakami C.; Kawano H.; Kinoshita M.; Kondo A.; Inoue M.
Institution
(Murakami, Kawano, Kinoshita, Kondo, Inoue) Department of Anesthesiology,
Tokushima Prefectural Central Hospital, Tokushima, Japan
Title
Effects of Nicorandil Versus Nitroglycerin on Arterial Oxygenation During
Two-Lung Ventilation and One-Lung Ventilation in Patients With Risk
Factors for Myocardial Ischemia: A Prospective, Randomized, Double-Blind
Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Publisher
W.B. Saunders
Abstract
Objectives: To compare the effects of nicorandil and nitroglycerin on
arterial oxygenation during two-lung ventilation (TLV) and one-lung
ventilation (OLV) in patients with risk factors for myocardial ischemia.
Design: A prospective, randomized, double-blind study. Setting: A tertiary
care hospital. Participants: Fifty-six patients scheduled for elective
video-assisted thoracic surgery were assigned randomly to either the
nicorandil group or the nitroglycerin group. Interventions: Patients in
the nicorandil group received a bolus dose of nicorandil, 0.08 mg/kg,
during induction of anesthesia, followed by a continuous infusion at a
rate of 0.08 mg/kg/h. Patients in the nitroglycerin group received a
continuous infusion of nitroglycerin at a rate of 1 micro&#32;g/kg/min
from the induction of anesthesia. Measurements and Main Results: Arterial
blood gas analysis was performed at the following points: before induction
of anesthesia; during TLV; at 5, 10, 20, and 30 minutes after the
initiation of OLV. PaO<inf>2</inf> at TLV (479.7 +/- 57.1 v 408.2 +/- 70.9
mmHg, p < 0.001); and at 5 minutes (344.8 +/- 85.1 v 282.6 +/- 85.8 mmHg,
p = 0.012), 20 minutes (215.7 +/- 103.0 v 158.2 +/- 74.5 mmHg, p = 0.027),
and 30 minutes (198.8 +/- 103.5 v 147.5 +/- 64.1 mmHg, p = 0.039) after
OLV was significantly higher in the nicorandil group than in the
nitroglycerin group. Conclusion: This study demonstrated that oxygenation
during TLV and OLV was significantly higher in patients receiving
nicorandil than in those receiving nitroglycerin.<br/>Copyright &#xa9;
2018 Elsevier Inc.

<72>
Accession Number
623175250
Author
Khan S.U.; Talluri S.; Rahman H.; Lekkala M.; Khan M.S.; Riaz H.; Shah H.;
Kaluski E.; Sattur S.
Institution
(Khan, Talluri, Rahman, Lekkala, Shah, Kaluski, Sattur) Guthrie Clinic,
Robert Packer Hospital, United States
(Khan) Cook County Hospital, United States
(Riaz) Cleveland Clinic, United States
Title
Meta-analysis of efficacy and safety of dual antiplatelet therapy versus
aspirin monotherapy after coronary artery bypass grafting.
Source
European Journal of Preventive Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)