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<1>
Accession Number
619180949
Title
Multidetector Computed Tomography Angiography (MD-CTA) of Coronary Artery
Bypass Grafts - Update 2017.
Source
RoFo Fortschritte auf dem Gebiet der Rontgenstrahlen und der Bildgebenden
Verfahren. 190 (3) (pp 237-249), 2018. Date of Publication: 01 Mar 2018.
Author
Jungmann F.; Emrich T.; Mildenberger P.; Emrich A.L.; Duber C.; Kreitner
K.F.
Institution
(Jungmann, Emrich, Mildenberger, Duber, Kreitner) Department of Diagnostic
and Interventional Radiology, University Medical Center, Johannes
Gutenberg University Mainz, Germany
(Emrich) Department of Cardiothoracic and Vascular Surgery, University
Medical Center, Johannes Gutenberg University Mainz, Germany
(Jungmann) Radiologie, Johannes Gutenberg-Universitat Mainz, Klinik und
Poliklinik fur Diagnostische und Interventionelle Radiologie -Str
Langenbeckstr. 1, Mainz 55131, Germany
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
BackgroundCoronary artery bypass grafting (CABG) is still an important
therapeutic approach in the treatment especially of advanced coronary
artery disease. In this study, we elucidate the current role of
multidetector computed tomography angiography (MD-CTA) in imaging patients
after CABG surgery. MethodThis study is based on recent reports in the
literature (2007-2016) on imaging of CABG using 64-slice MD-CT scanners
and beyond. We included 13 reports that compared ECG-gated MD-CTA with
conventional invasive coronary angiography (ICA) as the reference standard
for the assessment of graft patency and for the detection of >50%
stenoses. These studies had to provide absolute values for true-positive,
true-negative, false-positive and false-negative results or at least allow
calculation of these numbers. In total, 1002 patients with 2521 bypass
grafts were the basis for this review. Results and ConclusionThe
sensitivity and specificity for the assessment of graft patency or the
detection of >50% graft stenosis were 97.2% and 97.5%, respectively. The
negative and positive predictive values were 93.6% and 99%, respectively.
By using prospective ECG-gating and an increasing pitch factor, the
radiation dose exposure declined to 2.4mSv in the latest reports.
ECG-gated MD-CTA provides a fast and reliable, noninvasive method for
assessing patients after CABG. The most substantial benefit of the newest
CT scanner generations is a remarkable reduction of radiation dose
exposure while maintaining a still excellent diagnostic accuracy during
recent years. Key Points MD-CTA using 64-slice MDCT scanners and beyond is
a reliable, noninvasive method for evaluating CABGs. Technical advances
such as prospective ECG-gating, iterative reconstruction algorithms and
high-pitch scanning lead to a remarkable drop-down in radiation dose
exposures as low as 2.4mSv. Despite significant dose reductions, MD-CTA
could maintain a high diagnostic accuracy in evaluating CABGs in recent
years. Citation Format Jungmann F, Emrich T, Mildenberger P etal.
Multidetector Computed Tomography Angiography (MD-CTA) of Coronary Artery
Bypass Grafts - Update 2017. Fortschr Rontgenstr 2018; 190:
237-249.<br/>Copyright &#xa9; Georg Thieme Verlag KG, Stuttgart.New York.

<2>
Accession Number
623345069
Title
The application of mitraclip in the treatment of mitral regurgitation: A
clinical policy.
Source
Shiraz E Medical Journal. 19 (6) (no pagination), 2018. Article Number:
e64244. Date of Publication: June 2018.
Author
Mobinizadeh M.; Olyaeemanesh A.; Zargar S.; Ghiasvand H.; Akbarisari A.
Institution
(Mobinizadeh, Olyaeemanesh) National Institute of Health Research and
Health Equity Research Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Zargar) Department of Health Management and Economics, School of
Medicine, AJA University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Ghiasvand) Social Determinants of Health Research Center, University of
Social Welfare and Rehabilitation Sciences, Tehran, Iran, Islamic Republic
of
(Akbarisari) Department of Health Management and Economics, School of
Public Health, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
Publisher
Shiraz University of Medical Sciences (School of Medicine, 8th floor,
Shiraz, Iran, Islamic Republic of)
Abstract
Context: The mitral valve conducts blood flow from the left atrium to the
left ventricle. Mitral regurgitation occurs when the valve couldn't be
closed properly at the end of ventricular filling. Mitraclip, a
catheter-based device that can reduce mitral regurgitation without
requiring open surgery, is routinely used for patients with unacceptable
risk of conventional mitral valve repair or replacement. The purpose of
this study is assessing the safety, efficacy, and economic aspects of
Mitraclip treatment for mitral regurgitation. Evidence Acquisition: The
Cochrane Library, the TRIP database, and Google Scholar have been searched
through appropriate strategies. Seven studies were included in the final
phase based on the inclusion and exclusion criteria. Data collected from
these studies were analyzed based on four main themes; applications,
safety, efficacy, and economic evaluation. Results: The most potential
side effects were related to an improper transfer of catheters and low
durability of the device. One of the included studies showed that improved
outcomes of the New York Heart Association (NYHA) was more in the clip
group with better quality of life that were observed after 1 to 12 months
in 192 patients and also one-year mortality rate after using clip ranged
between 10% and 24%. This included study found that 72% to 100% of
patients with Mitraclip have been successfully treated and the duration of
hospital stays in these patients was between 5 to 10 days. The
cost-effectiveness of the procedure still needs more robust evidence.
Conclusions: Given the lack of high quality evidence and relatively high
cost of Mitraclip, it seems that until further robust evidence is
produced; it should be used in research and in high risk patients selected
after detailed examination with strict indications and appropriate
opinions of cardiologists.<br/>Copyright &#xa9; 2018, Shiraz E-Medical
Journal.

<3>
Accession Number
615137620
Title
Proposal for the rapid reversal of coagulopathy in patients with
nonoperative head injuries on anticoagulants and/or antiplatelet agents: A
case study and literature review.
Source
Neurosurgery. 81 (6) (pp 899-909), 2017. Date of Publication: 01 Dec 2017.
Author
Watson V.L.; Louis N.; Seminara B.V.; Paul Muizelaar J.; Alberico A.
Institution
(Watson, Seminara, Paul Muizelaar, Alberico) Department of Neurosurgery,
Marshall University's Joan C. Edwards School of Medicine, 1600 Medical
Center Drive, Huntington, WV, United States
(Louis) Universidad Autonoma de Guadalajara, 110 Gallery Circle, San
Antonio, TX, United States
Publisher
Oxford University Press (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Emergency room physicians, trauma teams, and neurosurgeons are
seeing increasing numbers of head-injured patients on anticoagulants, many
of whom are nonoperative. Head injury and anticoagulation can lead to
devastating consequences. These patients need immediate evaluation and
often reversal of anticoagulation in order to decrease their high rates of
morbidity and mortality. OBJECTIVE: To review data on the prevalence,
risks, treatment, and complications of head-injured anticoagulated
patients and provide a proposal for their anticoagulant management, and
imaging requirements. METHODS: A PubMed database search was performed for
articles on the prevalence, risks, treatment, and complications of
patients who have sustained a head injury while on anticoagulant or
antiplatelet agents. RESULTS: A total of 1877 articles were found, of
which 64 were selected for use based on direct relevance, information
quality, and contribution of the article to the current understanding of
anticoagulated head injury patients. CONCLUSION: There are very few
guidelines for the management of nonoperative head-injured patients. Rapid
reversal guided by international normalized ratio values, Platelet
Function Assays, computed tomography imaging of the head, and physical
exam is suggested. The proposal presented in this paper enables patient
management to begin quickly in a systematic approach, with the goal of
achieving a significant decrease in the morbidity and mortality for the
anticoagulated head-injured patient. Rapid reversal can potentially
decrease mortality by as much as 38%.<br/>Copyright &#xa9; 2017 by the
Congress of Neurological Surgeons.

<4>
Accession Number
2001005129
Title
Meta-Analysis Comparing the Frequency of Stroke After Transcatheter Versus
Surgical Aortic Valve Replacement.
Source
American Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Author
Shah K.; Chaker Z.; Busu T.; Badhwar V.; Alqahtani F.; Alvi M.; Adcock A.;
Alkhouli M.
Institution
(Shah, Alqahtani, Alkhouli) Division of Cardiology, West Virginia School
of Medicine, Morgantown, WV, United States
(Chaker, Busu) Department of Medicine, West Virginia School of Medicine,
Morgantown, WV, United States
(Badhwar) Department of Cardiothoracic Surgery, West Virginia School of
Medicine, Morgantown, WV, United States
(Alvi, Adcock) Department of Neurology, West Virginia School of Medicine,
Morgantown, WV, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Stroke is one of the most feared complications of aortic valve
replacement. Although the outcomes of transcatheter aortic valve
implantation (TAVI) improved substantially over time, concerns remained
about a potentially higher incidence of stroke with TAVI compared with
surgical replacement (SAVR). However, comparative data are sparse. We
performed a meta-analysis comparing the incidence of stroke among patients
undergoing TAVI versus SAVR. Of the 5067 studies screened, 28 eligible
studies (22 propensity-score matched studies and 6 randomized trials) were
analyzed. Primary endpoints were 30-day stroke and disabling stroke.
Secondary endpoints were 1-year stroke and disabling stroke. A total of
23,587 patients were included, of whom 47.27% underwent TAVI and 52.72%
underwent SAVR. For each endpoint, pooled estimates of odds ratio (OR)
with 95% confidence interval (CI) were calculated. The pooled estimates
for stroke (2.7% vs 3.1%, OR 0.86; 95% CI 0.72 to 1.02; p=0.08) and
disabling stroke (2.5% vs 2.9%, OR 0.96; 95% CI 0.57 to 1.62; p=0.89) were
comparable following TAVI versus SAVR at 30 days. Similarly, the pooled
estimates for stroke (5.0% vs 4.6%, OR 1.01; 95% CI 0.79 to 1.28; p=0.96)
and disabling stroke (4.1% vs 4.5%, OR 0.92; 95% CI 0.92 to 1.39; p=0.71)
were similar at 1 year. A sensitivity analysis including only RCTs yielded
similar results. Our meta-analysis documents comparable rates of strokes
and disabling strokes following TAVI or SAVR both at 30 days and 1
year.<br/>Copyright &#xa9; 2018

<5>
Accession Number
2001003267
Title
Prognostic value of late gadolinium enhancement on CMR in patients with
severe aortic valve disease: a systematic review and meta-analysis.
Source
Clinical Radiology. (no pagination), 2018. Date of Publication: 2018.
Author
Chen H.; Zeng J.; Liu D.; Yang Q.
Institution
(Chen, Zeng, Liu, Yang) Department of Radiology, The Yongchuan Affiliated
Hospital, Chongqing Medical University, Xuan hua Road, Yongchuan District,
Chongqing 402160, China
Publisher
W.B. Saunders Ltd
Abstract
Aim: To evaluate the predictive value of late gadolinium enhancement (LGE)
on cardiac magnetic resonance (CMR) in patients with severe aortic valve
disease. Materials and methods: PubMed, EMBASE, and Web of Science were
searched for studies applying LGE-CMR to assess prognostic significance in
patients with severe aortic valve disease and to measure myocardial
fibrosis (MF). The association of LGE with outcomes was estimated for each
study by an odds ratio (OR) along with its 95% confidence interval (CI).
Pooled estimates of ORs were calculated using a Mantel-Haenszel
fixed-effects model. Results: Six studies including 626 patients were
included in the meta-analysis. The follow-up period was from 0.5 to 5.7
years. The pooled OR was 3.28 (95% CI: 2.02-5.32; p<0.001) for LGE (+)
versus LGE (-) in predicting patients with aortic valve disease in
all-cause mortality. The presence of LGE was associated with
cardiovascular mortality (pooled OR: 3.10, 95% CI: 1.73-5.56; p<0.001).
The presence of LGE was associated with all-cause mortality in patients
with severe aortic stenosis after aortic valve replacement (pooled OR:
2.30, 95% CI: 1.06-4.99; p=0.036). CONCLUSION: LGE on CMR is a promising
risk stratification method, as it could predict all-cause mortality and
cardiovascular mortality in patients with aortic valve disease, especially
for aortic stenosis. LGE-CMR also has significant prognostic value in
patients after aortic valve replacement.<br/>Copyright &#xa9; 2018 The
Royal College of Radiologists

<6>
Accession Number
621928180
Title
Association between baseline LDL-C level and total and cardiovascular
mortality after LDL-C lowering a systematic review and meta-analysis.
Source
JAMA - Journal of the American Medical Association. 319 (15) (pp
1566-1579), 2018. Date of Publication: 17 Apr 2018.
Author
Navarese E.P.; Robinson J.G.; Kowalewski M.; Kolodziejczak M.; Andreotti
F.; Bliden K.; Tantry U.; Kubica J.; Raggi P.; Gurbel P.A.
Institution
(Navarese, Bliden, Tantry, Gurbel) Interventional Cardiology and
Cardiovascular Medicine Research, Inova Center for Thrombosis Research and
Drug Development, Inova Heart and Vascular Institute, Falls Church, VA,
United States
(Navarese, Kowalewski, Kolodziejczak, Andreotti, Gurbel) Systematic
Investigation and Research on Interventions and Outcomes (SIRIO), MEDICINE
Cardiovascular Research Network, United States
(Navarese, Kolodziejczak, Kubica) Cardiovascular Institute, Ludwik
Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz,
Poland
(Robinson) Prevention Intervention Center, Department of Epidemiology and
Medicine, University of Iowa, S455 CPHB, 145 N Riverside Dr, Iowa City, IA
52242, United States
(Kowalewski) Department of Cardiac Surgery, Cardiovascular Institute, Dr
Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
(Andreotti) Institute of Cardiology, Catholic University, Medical School,
Rome, Italy
(Raggi) Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, AB, Canada
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: Effects on specific fatal and nonfatal end points appear to
vary for low-density lipoprotein cholesterol (LDL-C)-lowering drug trials.
OBJECTIVE: To evaluate whether baseline LDL-C level is associated with
total and cardiovascular mortality risk reductions. DATA SOURCESAND STUDY
SELECTION: Electronic databases (Cochrane, MEDLINE, EMBASE, TCTMD,
ClinicalTrials.gov, major congress proceedings) were searched through
February 2, 2018, to identify randomized clinical trials of statins,
ezetimibe, and PCSK9-inhibiting monoclonal antibodies. DATA EXTRACTION AND
SYNTHESIS: Two investigators abstracted data and appraised risks of bias.
Intervention groups were categorized as "more intensive" (more potent
pharmacologic intervention) or "less intensive" (less potent, placebo, or
control group). MAIN OUTCOMES AND MEASURES: The coprimary end points were
total mortality and cardiovascular mortality. Random-effects
meta-regression and meta-analyses evaluated associations between baseline
LDL-C level and reductions in mortality end points and secondary end
points including major adverse cardiac events (MACE). RESULTS: In 34
trials, 136 299 patients received more intensive and 133 989 received less
intensive LDL-C lowering. All-cause mortality was lower for more vs less
intensive therapy (7.08% vs 7.70%; rate ratio [RR], 0.92 [95% CI, 0.88 to
0.96]), but varied by baseline LDL-C level. Meta-regression showed more
intensive LDL-C lowering was associated with greater reductions in
all-cause mortality with higher baseline LDL-C levels (change in RRs per
40-mg/dL increase in baseline LDL-C, 0.91 [95% CI, 0.86 to 0.96]; P =.001;
absolute risk difference [ARD], -1.05 incident cases per 1000 person-years
[95% CI, -1.59 to -0.51]), but only when baseline LDL-C levels were 100
mg/dL or greater (P <.001 for interaction) in a meta-analysis.
Cardiovascular mortality was lower for more vs less intensive therapy
(3.48% vs 4.07%; RR, 0.84 [95% CI, 0.79 to 0.89]) but varied by baseline
LDL-C level. Meta-regression showed more intensive LDL-C lowering was
associated with a greater reduction in cardiovascular mortality with
higher baseline LDL-C levels (change in RRs per 40-mg/dL increase in
baseline LDL-C, 0.86 [95% CI, 0.80 to 0.94]; P <.001; ARD, -1.0 incident
cases per 1000 person-years [95% CI, -1.51 to -0.45]), but only when
baseline LDL-C levels were 100 mg/dL or greater (P <.001 for interaction)
in a meta-analysis. Trials with baseline LDL-C levels of 160 mg/dL or
greater had the greatest reduction in all-cause mortality (RR, 0.72 [95%
CI, 0.62 to 0.84]; P <.001; 4.3 fewer deaths per 1000 person-years) in a
meta-analysis. More intensive LDL-C lowering was also associated with
progressively greater risk reductions with higher baseline LDL-C level for
myocardial infarction, revascularization, and MACE. CONCLUSIONS AND
RELEVANCE: In these meta-analyses and meta-regressions, more intensive
compared with less intensive LDL-C lowering was associated with a greater
reduction in risk of total and cardiovascular mortality in trials of
patients with higher baseline LDL-C levels. This association was not
present when baseline LDL-C level was less than 100 mg/dL, suggesting that
the greatest benefit from LDL-C-lowering therapy may occur for patients
with higher baseline LDL-C levels.<br/>Copyright &#xa9; 2018 American
Medical Association. All rights reserved.

<7>
Accession Number
622109408
Title
Transcatheter aortic valve implantation for aortic stenosis in high
surgical risk patients: A systematic review and meta-analysis.
Source
PLoS ONE. 13 (5) (no pagination), 2018. Article Number: e0196877. Date of
Publication: May 2018.
Author
Liu Z.; Kidney E.; Bem D.; Bramley G.; Bayliss S.; De Belder M.A.; Cummins
C.; Duarte R.
Institution
(Liu) Nuffield Department of Population Health, University of Oxford,
Oxford, United Kingdom
(Kidney, Bem, Bramley, Bayliss, Cummins) Institute of Applied Health
Research, University of Birmingham, Birmingham, United Kingdom
(De Belder) James Cook University Hospital, Middlesbrough, United Kingdom
(Duarte) Liverpool Reviews and Implementation Group, University of
Liverpool, Liverpool, United Kingdom
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: Symptomatic aortic stenosis has a poor prognosis. Many
patients are considered inoperable or at high surgical risk for surgical
aortic valve replacement (SAVR), reflecting their age, comorbidities and
frailty. The clinical effectiveness and safety of TAVI have not been
reviewed systematically for these high levels of surgical risk. This
systematic review compares mortality and other important clinical outcomes
up to 5 years post treatment following TAVI or other treatment in these
risk groups. Methods A systematic review protocol was registered on the
PROSPERO database (CRD42016048396). The Cochrane Library, Centre for
Reviews and Dissemination Databases, MEDLINE, EMBASE, and ZETOC were
searched from January 2002 to August 2016. Clinical trials or matched
studies comparing TAVI with other treatments for AS in patients surgically
inoperable or operable at a high risk were included. Data extraction and
quality assessment were conducted by two reviewers. Data were pooled using
random-effects meta-analysis. The main outcomes were all-cause mortality,
efficacy and major complications. Results Three good quality randomised
controlled trials (RCTs) were included. Patients' mean age ranged from
83-85 years, around half were female and New York Heart Association (NYHA)
functional class III or IV ranged from 83.8% to 94.2% with frequent
comorbidities. In 358 surgically inoperable patients from one RCT, TAVI
was superior to medical therapy for all-cause mortality at 1 year (hazard
ratio (HR) 0.58, 95% confidence interval (CI) 0.36 -0.92), 2 years (HR
0.50, 95% CI 0.39-0.65), 3 years (HR 0.53, 95% CI 0.41to 0.68) and 5 years
(HR 0.50, 95% CI 0.39-0.65), and NYHA class III or IV at 2 years (TAVI
16.8% (16/ 95), medical therapy 57.5% (23/40), p<0.001), quality of life
and re-hospitalisation. TAVI had higher risks of major bleeding up to 1
year, of stroke up to 3 years (at one year 11.2% versus 5.5%, p = .06; HR
at 2 years 2.79, 95% CI 1.25-6.22; HR at 3 years 2.81; 95% CI 1.26-6.26)
and of major vascular complication at 3 years (HR 8.27, 95% CI
2.92-23.44). Using the GRADE tool, this evidence was considered to be of
moderate quality. In a meta-analysis including 1,494 high risk surgically
operable patients from two non-inferiority RCTs TAVI showed no significant
differences from SAVR in all-cause mortality at two years (HR 1.03, 95% CI
0.82-1.29) and up to 5 years (HR 0.83, 95% CI 0.83-1.12). There were no
statistically significant differences in major vascular complications and
myocardial infarction at any time point, discrepant results for major
bleeding on variable definitions and no differences in stroke rate at any
time point. Using the GRADE tool, this evidence was considered of low
quality. Conclusions Symptomatic aortic stenosis can be lethal without
intervention but surgical resection is contraindicated for some patients
and high risk for others. We found that all-cause mortality up to 5 years
of follow-up did not differ significantly between TAVI and SAVR in
patients surgically operable at a high risk, but favoured TAVI over
medical therapy in patients surgically inoperable. TAVI is a viable
life-extending treatment option in these surgical high risk
groups.<br/>Copyright &#xa9; 2018 Liu 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.

<8>
Accession Number
622425319
Title
Effects of erythropoietin on the clinical outcomes of patients with acute
ST segment elevation myocardial infarction after percutaneous coronary
intervention: A meta-analysis.
Source
International Journal of Clinical Pharmacology and Therapeutics. 56 (6)
(pp 277-279), 2018. Date of Publication: 2018.
Author
Yang H.-T.; Xiu W.-J.; Zheng Y.-Y.; Ma Y.-T.; Xie X.
Institution
(Yang, Xiu, Zheng, Ma, Xie) Heart Center, First Affiliated Hospital,
Xinjiang Medical University, No. 137 Liyushan Road, Urumqi, Xinjiang
830011, China
Publisher
Dustri-Verlag Dr. Karl Feistle (Bajuwarenring 4, Oberhaching 82041,
Germany. E-mail: marina.rottner@dustri.de)
Abstract
Aims: To investigate the effects of erythropoietin (EPO) on the clinical
outcomes of patients with acute ST segment elevation myocardial infarction
(STEMI) after percutaneous coronary intervention (PCI). Material and
methods: We collected randomized controlled studies conducted before April
15, 2017, and performed a metaanalysis using RevMan5.3 software. Results:
Compared with the conventional revascularization group, mortality (RR =
0.79; 95% Cl, 0.42 - 1.50; p = 0.47), stroke events (RR = 2.63; 95% Cl,
0.70 - 9.85; p = 0.15), recurrent myocardial infarction (RR = 0.99; 95%
Cl, 0.44 - 2.20; p = 0.98), and other clinical endpoints were not
significantly different in the EPO group. However, subgroup analysis
showed a marginally significant difference between the high-dose EPO group
and the control group (MD = 1.29; 95% CI, 0.02 - 2.56; p = 0.05) in
ejection fraction. Conclusion: The administration of EPO has no effects on
the clinical outcomes of patients with acute STEMI after PCI, whilst a
high dose of EPO may increase patients' ejection fraction.<br/>Copyright
&#xa9; 2018 Dustri-Verlag Dr. K. Feistle.

<9>
Accession Number
619531049
Title
Paclitaxel-eluting stents versus everolimus-eluting coronary stents in a
diabetic population: Two-year follow-up of the TUXEDO-India trial.
Source
EuroIntervention. 13 (10) (pp 1194-1201), 2017. Date of Publication:
November 2017.
Author
Kaul U.; Bhagwat A.; Pinto B.; Goel P.K.; Jagtap P.; Sathe S.; Wander
G.S.; Arambam P.; Bangalore S.
Institution
(Kaul) Department of Cardiology, Fortis Escorts Heart Institute, Okhla
Road, New Delhi, Delhi 110025, India
(Bhagwat) Department of Interventional Cardiology, Kamalnayan Bajaj
Hospital, Aurangabad, India
(Pinto) Department of Cardiology, Holy Family Hospital - Diagnostic
Services, Mumbai, India
(Goel) Department of Cardiology, Sanjay Gandhi Post Graduate Institute of
Medical Sciences, Lucknow, India
(Jagtap) Department of Interventional Cardiology, Wockhardt Heart
Hospital, Nagpur, India
(Sathe) Department of Cardiology, Deenanath Mangeshkar Hospital and
Research Centre, Pune, India
(Wander) Department of Cardiology, Dayanand Medical College and Hospital,
Ludhiana, India
(Arambam) Academics and Research Department, Fortis Escorts Heart
Institute, New Delhi, India
(Bangalore) Division of Cardiology, Department of Medicine, New York
University School of Medicine, New York, NY, United States
Publisher
EuroPCR
Abstract
Aims: The aim of this study was to report whether the superiority of the
everolimus-eluting stent (EES) vs. the paclitaxel-eluting stent (PES) at
one-year follow-up in the Taxus Element versus Xience Prime in a Diabetic
Population (TUXEDO)-India trial was sustained at longer-term follow-up.
Methods and results: One thousand eight hundred and thirty (1, 830)
patients with diabetes mellitus and coronary artery disease were
randomised to EES vs. PES. Follow-up data up to two years were available
in 1, 701 (92.9%) patients. The primary endpoint was target vessel failure
(TVF), defined as the composite of cardiac death, target vessel myocardial
infarction (TV-MI), or ischaemia-driven target vessel revascularisation
(TVR). Treatment with EES had a lower two-year rate of TVF (4.3% vs. 6.6%,
p=0.03). Of the secondary endpoints, EES significantly reduced any MI
(1.6% vs. 3.5%, p=0.01), TV-MI (0.7% vs. 3.1%, p=0.0001), ST (0.4% vs.
2.2%, p=0.001), cardiac death or target vessel MI (2.9% vs. 4.8%, p=0.04)
and TLR (1.9% vs. 3.7%, p=0.02), compared with PES. Between one year and
two years, no significant differences in the clinical outcomes were
observed (pinteraction >0.05). Conclusions: In this adequately powered
trial, the benefits of EES vs. PES in a diabetic population seen at one
year were maintained at two years. Trial registration ctri.nic.in.
Identifier: CTRI/2011/06/001830.<br/>Copyright &#xa9; Europa Digital &
Publishing 2017. All rights reserved.

<10>
Accession Number
618319605
Title
A randomized trial of restarting warfarin at maintenance versus loading
doses following an elective procedure.
Source
Journal of Thrombosis and Thrombolysis. 44 (4) (pp 507-515), 2017. Date of
Publication: 01 Nov 2017.
Author
Bungard T.J.; Mutch J.; Ritchie B.
Institution
(Bungard) EPICORE Centre, Division of Cardiology, 362 Heritage Medical
Research Centre, University of Alberta, Edmonton, AB T6G 2S2, Canada
(Mutch) Alberta Health Services, University of Alberta, 0G1.01, 8440 112
Street NW, Edmonton, AB T6G 2B7, Canada
(Ritchie) Division of Hematology, University of Alberta, 4-71 Medical
Sciences Building, Edmonton, AB T6G 2B6, Canada
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Guidelines suggest restarting warfarin at known maintenance doses,
although this may result in a delay to achieving therapeutic
anticoagulation. As such, we compared the time to achieve an INR >= 2.0
between those restarting warfarin maintenance vs loading doses after
transient interruption, and the impact on protein C, S and factor II
levels. Patients requiring interruption of warfarin for elective
procedures without hospitalization were randomized 1:1 to receive warfarin
maintenance or loading doses (1.5 times the maintenance dose for 3 days
followed by pre-procedural warfarin maintenance dosing). Protein C, S and
Factor II were drawn at baseline (prior to warfarin interruption), 7 and
14 days after restarting warfarin. Among 19 patients randomized to
maintenance and 20 to loading doses, nearly half in each group had
mechanical heart valves with gastrointestinal endoscopic procedures most
commonly performed (41%). The median number of days to reach an INR >= 2.0
was 7.8 days in the loading and 9.0 in the maintenance group (difference
between medians 1.2 days, 95% CI -3.1 to 4.9; P = 0.19). Although levels
of protein C, S and factor II were lower in the loading vs maintenance
dose group, all remained above that of baseline. Warfarin resumption with
loading doses shortened the time to achieve a therapeutic INR by a median
of 1.2 days. Prompt warfarin dose escalation should be done in response to
the INR. Protein C and S remained above pre-warfarin interruption levels,
implying a lack of depletion with restarting warfarin.<br/>Copyright
&#xa9; 2017, Springer Science+Business Media, LLC.

<11>
Accession Number
618299532
Title
Single versus dual anti-platelet therapy post transcatheter aortic valve
implantation: a meta-analysis of randomized controlled trials.
Source
Journal of Thrombosis and Thrombolysis. 44 (4) (pp 448-456), 2017. Date of
Publication: 01 Nov 2017.
Author
Ando T.; Takagi H.; Briasoulis A.; Afonso L.
Institution
(Ando, Afonso) Division of Cardiovascular Disease, Department of Internal
Medicine, Harper hospital, Wayne State University, Detroit, United States
(Takagi) Division of Cardiovascular Surgery, Department of Surgery,
Shizuoka Medical Center, Shizuoka, Japan
(Briasoulis) Division of Cardiovascular Disease, Department of Internal
Medicine, Mayo Clinic, Rochester, MN, United States
(Ando) Division of Cardiology, Detroit Medical Center, 3990, John R,
Detroit, MI 48201, United States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The purpose of this systematic review and meta-analysis was to assess the
30-days safety (bleeding and vascular events) and efficacy (reduction in
major stroke, myocardial infarction and mortality) of single anti-platelet
(SAPT) versus dual anti-platelet (DAPT) after transcatheter aortic valve
implantation (TAVI). We used a meta-analytic method with Mantel-Haenszel
methods to calculate the odds ratio (OR) and 95% confidence interval (CI).
Only randomized clinical trials that compared 30-days safety and efficacy
based on Valve Academic Research Consortium criteria were included.
Studies that included patients on anticoagulants were excluded. Our
analysis included three studies with a total of 421 patients (210 SAPT and
211 DAPT). Life-threatening and major bleeding as well as major vascular
complications was similar between SAPT and DAPT. Similarly, major stroke,
myocardial infarction and mortality was also comparable between the two
groups. The combined outcomes of 30-day mortality, life-threatening and
major bleeding showed tendency toward lower event rates in SAPT compared
to DAPT (9.5 vs. 15.6%, OR 0.57; 95% CI 0.31-1.03, p = 0.06). In
conclusion, SAPT provided similar safety without adding incremental
efficacy compared to DAPT but showed tendency of lower combined endpoints
of 30-day mortality, life-threatening and major bleeding.<br/>Copyright
&#xa9; 2017, Springer Science+Business Media, LLC.

<12>
Accession Number
610671104
Title
Efficacy and safety of intravenous lidocaine for postoperative analgesia
and recovery after surgery: A systematic review with trial sequential
analysis.
Source
British Journal of Anaesthesia. 116 (6) (pp 770-783), 2016. Date of
Publication: 19 Jun 2016.
Author
Weibel S.; Jokinen J.; Pace N.L.; Schnabel A.; Hollmann M.W.; Hahnenkamp
K.; Eberhart L.H.J.; Poepping D.M.; Afshari A.; Kranke P.
Institution
(Weibel, Jokinen, Schnabel, Kranke) Department of Anaesthesia and Critical
Care, University Hospitals of Wuerzburg, Oberduerrbacher Str. 6, Wuerzburg
97080, Germany
(Pace) Department of Anaesthesiology, University of Utah, Salt Lake City,
UT, United States
(Hollmann) Department of Anaesthesiology, Academic Medical Centre (AMC),
University of Amsterdam, Amsterdam, Netherlands
(Hahnenkamp) Department of Anaesthesiology, Intensive Care, Emergency and
Pain Medicine, University Medicine, Greifswald, Germany
(Eberhart) Department of Anaesthesiology and Intensive Care Medicine,
Philipps-University Marburg, Marburg, Germany
(Poepping) Department of Anaesthesiology, Intensive Care and Pain
Medicine, University Hospital Muenster, Muenster, Germany
(Afshari) Department of Anaesthesia, Juliane Marie Centre, Copenhagen
University Hospital, Rigshospitalet, Copenhagen, Denmark
Publisher
Oxford University Press
Abstract
Background Improvement of postoperative pain and other perioperative
outcomes remain a significant challenge and a matter of debate among
perioperative clinicians. This systematic review aims to evaluate the
effects of perioperative i.v. lidocaine infusion on postoperative pain and
recovery in patients undergoing various surgical procedures. Methods
CENTRAL, MEDLINE, EMBASE, and CINAHL databases and ClinicalTrials.gov, and
congress proceedings were searched for randomized controlled trials until
May 2014, that compared patients who did or did not receive continuous
perioperative i.v. lidocaine infusion. Results Forty-five trials (2802
participants) were included. Meta-analysis suggested that lidocaine
reduced postoperative pain (visual analogue scale, 0 to 10 cm) at 1-4 h
(MD -0.84, 95% CI -1.10 to -0.59) and at 24 h (MD -0.34, 95% CI -0.57 to
-0.11) after surgery, but not at 48 h (MD -0.22, 95% CI -0.47 to 0.03).
Subgroup analysis and trial sequential analysis suggested pain reduction
for patients undergoing laparoscopic abdominal surgery or open abdominal
surgery, but not for patients undergoing other surgeries. There was
limited evidence of positive effects of lidocaine on postoperative
gastrointestinal recovery, opioid requirements, postoperative nausea and
vomiting, and length of hospital stay. There were limited data available
on the effect of systemic lidocaine on adverse effects or surgical
complications. Quality of evidence was limited as a result of
inconsistency (heterogeneity) and indirectness (small studies).
Conclusions There is limited evidence suggesting that i.v. lidocaine may
be a useful adjuvant during general anaesthesia because of its beneficial
impact on several outcomes after surgery.<br/>Copyright &#xa9; 2016 The
Author 2016. Published by Oxford University Press on behalf of the British
Journal of Anaesthesia. All rights reserved.

<13>
Accession Number
613253848
Title
Thoracic paravertebral blocks in abdominal surgery - A systematic review
of randomized controlled trials.
Source
British Journal of Anaesthesia. 117 (3) (pp 297-308), 2016. Date of
Publication: 01 Sep 2016.
Author
El-Boghdadly K.; Madjdpour C.; Chin K.J.
Institution
(El-Boghdadly, Chin) Department of Anesthesia, Toronto Western Hospital,
University of Toronto, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
(Madjdpour) Anaesthetics Department, Northumbria Healthcare NHS Foundation
Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and
Wear NE29 8NH, United Kingdom
Publisher
Oxford University Press
Abstract
Thoracic paravertebral blocks (TPVBs) have an extensive evidence base as
part of a multimodal analgesic strategy for thoracic and breast surgery
and have gained popularity with the advent of ultrasound guidance.
However, this role is poorly defined in the context of abdominal surgery.
We performed a systematic review of randomized controlled trials, to
clarify the impact of TPVB on perioperative analgesic outcomes in adult
abdominal surgery. We identified 20 published trials involving a total of
1044 patients that met inclusion criteria; however there was significant
heterogeneity in terms of type of surgery, TPVB technique, comparator
groups and study quality. Pain scores and opioid requirements in the early
postoperative period were generally improved when compared with systemic
analgesia, but there was insufficient evidence for any definitive
conclusions regarding comparison with epidural analgesia or other
peripheral block techniques, or the benefit of continuous TPVB techniques.
The reported primary block failure rate was 2.8% and the incidence of
complications was 1.2% (6/504); there were no instances of pneumothorax.
TPVB therefore appears to be a promising analgesic technique for abdominal
surgery in terms of efficacy and safety. But further well-designed and
adequately powered studies are needed to confirm its utility, particularly
with respect to other regional anaesthesia techniques.<br/>Copyright
&#xa9; The Author 2016. Published by Oxford University Press on behalf of
the British Journal of Anaesthesia.

<14>
Accession Number
612718593
Title
A randomized, prospective pilot comparison of 3 atrial appendage
elimination techniques: Internal ligation, stapled excision, and surgical
excision.
Source
Journal of Thoracic and Cardiovascular Surgery. 152 (4) (pp 1075-1080),
2016. Date of Publication: 01 Oct 2016.
Author
Lee R.; Vassallo P.; Kruse J.; Malaisrie S.C.; Rigolin V.; Andrei A.-C.;
McCarthy P.
Institution
(Lee) Center for Comprehensive Cardiovascular Care, Saint Louis
University, St Louis, Mo, United States
(Vassallo, Kruse, Malaisrie, Rigolin, Andrei, McCarthy) Bluhm
Cardiovascular Institute, Northwestern University, Chicago, Ill, United
States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Elimination of the left atrial appendage (LAA) attempts to
reduce stroke in patients with atrial fibrillation (AF). A retrospective
review suggests that various surgical techniques are often unsuccessful
and may leave a stump or gap. In a pilot study, we prospectively evaluated
3 surgical techniques with long-term follow up to define effectiveness.
Methods At a single institution, 28 patients undergoing concomitant AF
surgery were randomized prospectively into 1 of 3 techniques of LAA
elimination: internal suture ligation (IL), external stapled excision
(StEx), and surgical excision (SxEx). The success of LAA elimination was
assessed by transesophageal echocardiography (TEE) in all patients at the
time of surgery. Failure of LAA closure consisted of either a stump
(residual appendage tissue >1 cm in maximum length) or a gap (persistent
flow between the left atrium [LA] and the LAA). Failure was treated
intraoperatively when recognized. Late follow-up was obtained using a TEE
at a mean of 0.4 years in 21/28 (75%) of patients. Results Early failure
was recognized and treated in 1 patient in the IL group (13%), 6 patients
in the StEx group (60%), and 2 patients in the SxEx group (20%) (P = .06).
On follow-up TEE, 4 of 7 patients in the IL group (57%) had developed
gaps, 3 of whom (43%) with greater than mild flow. No patients in the StEx
or SxEx groups had a gap (P = .03). In late follow-up, 1 of 7 patients in
the IL group (14%) had a stump, compared with 2 of 8 (25%) in the StEx
group and 3 of 6 (50%) in the SxEx group (P = .35). The overall failure
rate was 57%: 5 of 8 (63%) in the IL group, 6 of 10 (60%) in the StEx
group, and 5 of 10 (50%) in the SxEx group (P = .85). No patient had a
stroke at any time during follow-up. Conclusions LAA elimination is often
incomplete and goes undetected. If the LAA is eliminated at the time of
surgery, then TEE should be used intraoperatively to assess effectiveness
and reintervention performed if warranted. Late assessment for
completeness of closure should be considered before cessation of
anticoagulation until more effective LAA techniques can be
developed.<br/>Copyright &#xa9; 2016 The American Association for Thoracic
Surgery

<15>
Accession Number
612718521
Title
Right internal thoracic artery versus radial artery as the second best
arterial conduit: Insights from a meta-analysis of propensity-matched data
on long-term survival.
Source
Journal of Thoracic and Cardiovascular Surgery. 152 (4) (pp
1083-1091.e15), 2016. Date of Publication: 01 Oct 2016.
Author
Benedetto U.; Gaudino M.; Caputo M.; Tranbaugh R.F.; Lau C.; Di Franco A.;
Ng C.; Girardi L.N.; Angelini G.D.
Institution
(Benedetto, Caputo, Angelini) Bristol Heart Institute, University of
Bristol, School of Clinical Sciences, Bristol, United Kingdom
(Gaudino, Tranbaugh, Lau, Di Franco, Girardi) Department of Cardiothoracic
Surgery, Weill Cornell Medical College, New York, NY, United States
(Ng) National University of Singapore, Singapore
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective(s) We conducted a meta-analysis of propensity score-matching
(PSM) studies comparing long-term survival of patients receiving right
internal thoracic artery (RITA) versus radial artery (RA) as a second
arterial conduit for coronary artery bypass grafting. Methods A literature
search was conducted using MEDLINE, EMBASE, and Web of Science to identify
relevant articles. Primary endpoint was long-term mortality. Secondary
endpoints were operative mortality, incidence of sternal wound infection,
and repeat revascularization. Binary events were pooled using the
DerSimonian and Laird method. For time-to-event outcomes, estimates of log
hazard ratio (HR) and standard errors obtained were combined using the
generic inverse-variance method. Results A total of 8 PSM studies were
finally selected including 15,374 patients (RITA, 6739; RA, 8635) with
2992 matched pairs for final comparison. Mean follow-up time ranged from
45 to 168 months. When compared with RA, RITA was associated with a lower
risk reduction of late death (HR, 0.75; 95% confidence interval [CI],
0.58-0.97; P = .028) and repeat revascularization (HR, 0.37; 95% CI,
0.16-0.85; P = .03). On the other hand, RITA did not increase operative
mortality (odds ratio [OR], 1.53; 95% CI, 0.97-2.39; P = .07). RITA was
associated with an increased risk of sternal wound complication when
pedicled harvesting was used (OR, 3.18; 95% CI, 1.34-7.57), but not with
skeletonized harvesting (OR, 1.07; 95% CI, 0.67-1.71). Conclusions The
present PSM data meta-analysis suggests that the use of RITA compared with
RA was associated with superior long-term survival and freedom from repeat
revascularization, with similar operative mortality and incidence of
sternal wound complication when the skeletonized harvesting technique was
used.<br/>Copyright &#xa9; 2016 The American Association for Thoracic
Surgery

<16>
Accession Number
613300045
Title
Modern hydroxyethyl starch and acute kidney injury after cardiac surgery:
A prospective multicentre cohort.
Source
British Journal of Anaesthesia. 117 (4) (pp 458-463), 2016. Date of
Publication: 01 Oct 2016.
Author
Vives M.; Callejas R.; Duque P.; Echarri G.; Wijeysundera D.N.; Hernandez
A.; Sabate A.; Bes-Rastrollo M.; Monedero P.
Institution
(Vives) Anaesthesia and Intensive Care, Hospital Universitari Bellvitge,
Universitat de Barcelona, C/ Feixa Llarga, s/n. Hospitalet, Barcelona
08907, Spain
(Callejas, Duque, Echarri, Monedero) Anesthesiology and Critical Care,
Clinica Universidad de Navarra, Avenida Pio 12, 36, Pamplona 31008, Spain
(Wijeysundera) Department of Anesthesia and Pain Management, Toronto
General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
(Wijeysundera) Department of Anesthesia and Institute of Health Policy
Management and Evaluation, University of Toronto, Toronto, Canada
(Wijeysundera) Li Ka Shing Knowledge Institute of St. Michael's Hospital,
Toronto, Canada
(Hernandez) Department of Anesthesiology and Critical Care, University
Hospital of South Manchester, Southmoor Rd, Wythenshawe, Manchester M23
9LT, United Kingdom
(Sabate) Department of Anesthesiology and Critical Care, Bellvitge
University Hospital, C/ Feixa Llarga, s/n. Hospitalet, Barcelona 08907,
Spain
(Bes-Rastrollo) Department Preventive Medicine and Public Health,
University of Navarra, Av. Pio XII, 36, Pamplona 31008, Spain
(Bes-Rastrollo) CIBERobn, Instituto de Salud Carlos III, Spain
(Bes-Rastrollo) IDISNA, Navarra's Health Research Institute, Spain
Publisher
Oxford University Press
Abstract
Background Recent trials have shown hydroxyethyl starch (HES) solutions
increase the risk of acute kidney injury (AKI) in critically ill patients.
It is uncertain whether these adverse effects also affect surgical
patients. We sought to determine the renal safety of modern tetrastarch
(6% HES 130/0.4) use in cardiac surgical patients. Methods In this
multicentre prospective cohort study, 1058 consecutive patients who
underwent cardiac surgery from 15th September 2012 to 15th December 2012
were recruited in 23 Spanish hospitals. Results We identified 350 patients
(33%) administered 6% HES 130/0.4 intraoperatively and postoperatively,
and 377 (36%) experienced postoperative AKI (AKI Network criteria).
In-hospital death occurred in 45 (4.2%) patients. Patients in the non-HES
group had higher Euroscore and more comorbidities including unstable
angina, preoperative cardiogenic shock, preoperative intra-aortic balloon
pump use, peripheral arterial disease, and pulmonary hypertension. The
non-HES group received more intraoperative vasopressors and had longer
cardiopulmonary bypass times. After multivariable risk-adjustment, 6% HES
130/0.4 use was not associated with significantly increased risks of AKI
(adjusted odds ratio 1.01, 95% CI 0.71-1.46, P=0.91). These results were
confirmed by propensity score-matched pairs analyses. Conclusions The
intraoperative and postoperative use of modern hydroxyethyl starch 6% HES
130/0.4 was not associated with increased risks of AKI and dialysis after
cardiac surgery in our multicentre cohort.<br/>Copyright &#xa9; 2016 The
Author 2016. Published by Oxford University Press on behalf of the British
Journal of Anaesthesia. All rights reserved. For Permissions, please
email: journals.permissions@oup.com.

<17>
Accession Number
613300025
Title
Sodium bicarbonate does not prevent postoperative acute kidney injury
after off-pump coronary revascularization: A double-blinded randomized
controlled trial.
Source
British Journal of Anaesthesia. 117 (4) (pp 450-457), 2016. Date of
Publication: 01 Oct 2016.
Author
Soh S.; Song J.W.; Shim J.K.; Kim J.H.; Kwak Y.L.
Institution
(Soh, Song, Shim, Kwak) Department of Anaesthesiology and Pain Medicine,
South Korea
(Song, Shim, Kwak) Anaesthesia and Pain Research Institute, Yonsei
Cardiovascular Hospital, Yonsei University College of Medicine, 50
Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
(Kim) Department of Anaesthesiology and Pain Medicine, National Health
Insurance Service Ilsan Hospital, Goyang City, Gyeonggi-do 410-719, South
Korea
Publisher
Oxford University Press
Abstract
Background Acute kidney injury (AKI) is a common morbidity after off-pump
coronary revascularization. We investigated whether perioperative
administration of sodium bicarbonate, which might reduce renal injury by
alleviating oxidative stress in renal tubules, prevents postoperative AKI
in off-pump coronary revascularization patients having renal risk factors.
Methods Patients (n=162) having at least one of the following AKI risk
factors were enrolled: (i) age >70 yr; (ii) diabetes mellitus; (iii)
chronic renal disease; (iv) congestive heart failure or left ventricular
ejection fraction <35%; and (v) reoperation or emergency. Patients were
evenly randomized to receive either sodium bicarbonate (0.5 mmol
kg^-1 for 1 h upon induction of anaesthesia followed by 0.15
mmol kg^-1 h^-1 for 23 h) or 0.9% saline. Acute kidney
injury within 48 h after surgery was assessed using the Acute Kidney
Injury Network criteria. Results The incidences of AKI were 21 and 26% in
the bicarbonate and control groups, respectively (P=0.458). Serially
measured serum creatinine concentrations and perioperative fluid balance
were also comparable between the groups. The length of postoperative
hospitalization and incidence of morbidity end points were similar between
the groups, whereas significantly more patients in the bicarbonate group
required prolonged mechanical ventilation (>24 h) relative to the control
group (20 vs 6, P=0.003). Conclusions Perioperative sodium bicarbonate
administration did not decrease the incidence of AKI after off-pump
coronary revascularization in high-risk patients and might even be
associated with a need for prolonged ventilatory care. Clinical trial
registration NCT01840241.<br/>Copyright &#xa9; 2016 The Author 2016.
Published by Oxford University Press on behalf of the British Journal of
Anaesthesia. All rights reserved. For Permissions, please email:
journals.permissions@oup.com.

<18>
Accession Number
613300007
Title
Impact of balanced tetrastarch raw material on perioperative blood loss: A
randomized double blind controlled trial.
Source
British Journal of Anaesthesia. 117 (4) (pp 442-449), 2016. Date of
Publication: 01 Oct 2016.
Author
Joosten A.; Tircoveanu R.; Arend S.; Wauthy P.; Gottignies P.; Van Der
Linden P.
Institution
(Joosten) Department of Anesthesiology and Perioperative Care, Erasme
University Hospital, Universit Libre de Bruxelles, Brussels, Belgium
(Tircoveanu, Arend, Van Der Linden) Department of Anesthesiology and
Perioperative Care, CHU Brugmann, Universit Libre de Bruxelles, Brussels,
Belgium
(Wauthy) Department of Cardiac Surgery, CHU Brugmann, Universit Libre de
Bruxelles, Brussels, Belgium
(Gottignies) Department of Intensive Care, CHU Brugmann, Universit Libre
de Bruxelles, Brussels, Belgium
Publisher
Oxford University Press
Abstract
Background As 6% hydroxyethyl starch (HES) 130/0.40 or 130/0.42 can
originate from different vegetable sources, they might have different
clinical effects. The purpose of this prospective, randomized,
double-blind controlled trial was to compare two balanced tetrastarch
solutions, one maize-derived and one potato-derived, on perioperative
blood loss in patients undergoing cardiac surgery with cardiopulmonary
bypass (CPB). Methods We randomly assigned 118 patients undergoing
elective cardiac surgery into two groups, to receive either a maize- or a
potato-derived HES solution. Study fluids were administered
perioperatively (including priming of CPB) until the second postoperative
day (POD#2) using a goal directed algorithm. The primary outcome was
calculated postoperative blood loss up to POD#2. Secondary outcomes
included short-term incidence of acute kidney injury (AKI), and long-term
effect (up to one yr) on renal function. Results Preoperative and
intraoperative characteristics of the subjects were similar between
groups. Similar volumes of HES were administered (1950 ml [1250-2325] for
maize-HES and 2000 ml [1500-2700] for potato-HES; P=0.204). Calculated
blood loss (504 ml [413-672] for maize-HES vs 530 ml [468-705] for
potato-HES; P=0.107) and the need for blood components were not different
between groups. The incidence of AKI was similar in both groups (P=0.111).
Plasma creatinine concentration and glomerular filtration rates did vary
over time, although changes were minimal. Conclusions Under our study
conditions, HES 130/0.4 or 130/0.42 raw material did not have a
significant influence on perioperative blood loss. Moreover, we did not
find any effect of tetrastarch raw material composition on short and
long-term renal function. Clinical trial registration EudraCT number:
2011-005920-16.<br/>Copyright &#xa9; 2016 The Author 2016. Published by
Oxford University Press on behalf of the British Journal of Anaesthesia.
All rights reserved. For Permissions, please email:
journals.permissions@oup.com.

<19>
Accession Number
613204495
Title
The IMPACT-CABG trial: A multicenter, randomized clinical trial of
CD133⁺ stem cell therapy during coronary artery bypass grafting
for ischemic cardiomyopathy.
Source
Journal of Thoracic and Cardiovascular Surgery. 152 (6) (pp 1582-1588.e2),
2016. Date of Publication: 01 Dec 2016.
Author
Noiseux N.; Mansour S.; Weisel R.; Stevens L.-M.; Der Sarkissian S.; Tsang
K.; Crean A.M.; Larose E.; Li S.-H.; Wintersperger B.; Vu M.Q.; Prieto I.;
Li R.-K.; Roy D.C.; Yau T.M.
Institution
(Noiseux, Stevens, Prieto) Division of Cardiac Surgery, Centre Hospitalier
de l'Universite de Montreal (CHUM), Montreal, Quebec, Canada
(Mansour) Division of Cardiology, Centre Hospitalier de l'Universite de
Montreal (CHUM), Montreal, Quebec, Canada
(Noiseux, Mansour, Stevens, Der Sarkissian, Vu) Centre Hospitalier de
l'Universite de Montreal Research Center (CRCHUM), Montreal, Quebec,
Canada
(Noiseux, Stevens, Der Sarkissian, Prieto, Roy) Department of Surgery,
Universite de Montreal, Montreal, Quebec, Canada
(Mansour) Department of Medicine, Universite de Montreal, Montreal,
Quebec, Canada
(Larose) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec City, Quebec, Canada
(Weisel, Tsang, Crean, Li, Wintersperger, Li, Yau) Peter Munk Cardiac
Centre, University Health Network, Toronto, Ontario, Canada
(Weisel, Tsang, Li, Li, Yau) Division of Cardiovascular Surgery,
Department of Surgery, University of Toronto, Toronto, Ontario, Canada
(Crean, Wintersperger) Division of Medical Imaging, University of Toronto,
Toronto, Ontario, Canada
(Roy) Department of Hematology, Hopital Maisonneuve-Rosemont (HMR),
Montreal, Quebec, Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives The IMPACT-CABG trial is the first North American multicenter
phase II randomized study of intramyocardial delivery of autologous
CD133⁺ stem cells in patients with chronic ischemic
cardiomyopathy undergoing coronary artery bypass grafting. The primary
objective was to demonstrate safety, including freedom from major adverse
cardiac events. The secondary objective was to evaluate feasibility of
same-day autologous cell preparation. Although the trial was not powered
to evaluate LV function, exploratory data were collected. Methods After 7
open-label patients who received cells, patients randomly received stem
cells or placebo (N = 40 total, 20 per center). After completion of
coronary anastomoses, up to 10 million CD133⁺,
CD34⁺, CD45⁺ triple-positive cells or placebo were
injected into the infarct and border zones. Patients were followed up
clinically and underwent magnetic resonance imaging preoperatively and
after 6 months. Results There were no procedural complications from bone
marrow isolation and cell injection, no in-hospital mortality, and no
protocol-related complications. Four patients had transient renal
insufficiency, with 1 death during 6-month follow-up. Magnetic resonance
imaging revealed that left ventricular volumes and ejection fractions
improved in all patients (no difference between groups). Conclusions The
trial successfully met both primary and secondary objectives,
demonstrating that same-day isolation and autologous CD133⁺
cell delivery with coronary artery bypass grafting is safe and feasible.
The positive findings support a larger randomized, multicenter trial, with
higher numbers of transplanted cells to demonstrate beneficial effects.
The upcoming IMPACT-CABG II trial will evaluate higher cell doses and
pharmacologic enhancement to determine whether these cells improve
perfusion and myocardial function.<br/>Copyright &#xa9; 2016 The American
Association for Thoracic Surgery

<20>
Accession Number
611440464
Title
Effect of diastolic dysfunction on postoperative outcomes after
cardiovascular surgery: A systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 152 (4) (pp 1142-1153),
2016. Date of Publication: 01 Oct 2016.
Author
Kaw R.; Hernandez A.V.; Pasupuleti V.; Deshpande A.; Nagarajan V.; Bueno
H.; Coleman C.I.; Ioannidis J.P.A.; Bhatt D.L.; Blackstone E.H.
Institution
(Kaw) Department of Hospital Medicine, Medicine Institute, Cleveland
Clinic, Cleveland, Ohio, United States
(Kaw) Department of Outcomes Research, Anesthesiology Institute, Cleveland
Clinic, Cleveland, Ohio, United States
(Hernandez) Health Outcomes and Clinical Epidemiology Section, Department
of Quantitative Health Sciences, Lerner Research Institute, Cleveland
Clinic, Cleveland, Ohio, United States
(Deshpande) Medicine Institute Center for Value Based Care Research,
Cleveland Clinic, Cleveland, Ohio, United States
(Blackstone) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, Ohio, United States
(Hernandez) School of Medicine, Universidad Peruana de Ciencias Aplicadas
(UPC), Lima, Peru
(Pasupuleti) Department of Medicine, Case Western Reserve University,
Cleveland, Ohio, United States
(Nagarajan) Department of Cardiovascular Medicine, University of Virginia,
Charlottesville, Va, United States
(Bueno) Centro Nacional de Investigaciones Cardiovasculares (CNIC),
Madrid, Spain
(Bueno) Department of Cardiology, Hospital Universitario 12 de Octubre,
Madrid, Spain
(Bueno) University of Connecticut School of Pharmacy, Storrs, Conn, United
States
(Coleman) Universidad Complutense de Madrid, Madrid, Spain
(Ioannidis) Department of Medicine, Stanford Prevention Research Center,
Stanford University School of Medicine, Stanford, Calif, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center and Harvard
Medical School, Boston, Mass, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective The objective of this study was to investigate the effect of
preoperative diastolic dysfunction on postoperative mortality and
morbidity after cardiovascular surgery. Methods We systematically searched
for articles that assessed the prognostic role of diastolic dysfunction on
cardiovascular surgery in PubMed, Cochrane Library, Web of Science,
Embase, and Scopus until February 2016. Twelve studies (n = 8224) met our
inclusion criteria. Because of the scarcity of outcome events,
fixed-effects meta-analysis was performed via the Mantel-Haenszel method.
Results Preoperative diagnosis of diastolic dysfunction was associated
with greater postoperative mortality (odds ratio [OR], 2.41; 95%
confidence interval [CI], 1.54-3.71; P < .0001), major adverse cardiac
events (OR, 2.07; 95% CI, 1.55-2.78; P <= .0001), and prolonged mechanical
ventilation (OR, 2.08; 95% CI, 1.04-4.16; P = .04) compared with patients
without diastolic dysfunction among patients who underwent cardiovascular
surgery. The odds of postoperative myocardial infarction (OR, 1.29; 95%
CI, 0.82-2.05; P = .28) and atrial fibrillation (OR, 2.67; 95% CI,
0.49-14.43; P = .25) did not significantly differ between the 2 groups.
Severity of preoperative diastolic dysfunction was associated with
increased postoperative mortality (OR, 21.22; 95% CI, 3.74-120.33; P =
.0006) for Grade 3 diastolic dysfunction compared with patients with
normal diastolic function. Inclusion of left ventricular ejection fraction
(LVEF) <40% accompanying diastolic dysfunction did not further impact
postoperative mortality (P = .27; I² = 18%) compared with
patients with normal LVEF and diastolic dysfunction. Conclusions Presence
of preoperative diastolic dysfunction was associated with greater
postoperative mortality and major adverse cardiac events, regardless of
LVEF. Mortality was significantly greater in grade III diastolic
dysfunction.<br/>Copyright &#xa9; 2016 The American Association for
Thoracic Surgery

<21>
Accession Number
623206890
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.
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
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.

<22>
Accession Number
623265249
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.
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
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.

<23>
Accession Number
620586659
Title
Effect-site concentration of remifentanil required to blunt haemodynamic
responses during tracheal intubation: A randomized comparison between
single-and double-lumen tubes.
Source
Journal of International Medical Research. 46 (1) (pp 430-439), 2018. Date
of Publication: 01 Jan 2018.
Author
Kim T.K.; Hong D.M.; Lee S.H.; Paik H.; Min S.H.; Seo J.-H.; Jung C.-W.;
Bahk J.-H.
Institution
(Kim, Hong, Lee, Paik, Min, Seo, Jung, Bahk) Department of Anaesthesiology
and Pain Medicine, Seoul National University Hospital, Seoul National
University College of Medicine, Seoul, South Korea
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: To investigate the effect-site concentration of remifentanil
required to blunt haemodynamic responses during tracheal intubation with a
single-lumen tube (SLT) or a double-lumen tube (DLT). Methods: Patients
scheduled for thoracic surgery requiring one-lung ventilation were
randomly allocated to either the SLT or DLT group. All patients received a
target-controlled infusion of propofol and a predetermined concentration
of remifentanil. Haemodynamic parameters during intubation were recorded.
The effect-site concentration of remifentanil was determined using a
delayed up-and-down sequential allocation method. Results: A total of 92
patients were enrolled in the study. The effective effect-site
concentrations of remifentanil required to blunt haemodynamic responses in
50% of patients (EC<inf>50</inf>) estimated by isotonic regression with
bootstrapping was higher in the DLT than the SLT group (8.5 ng/ml [95%
confidence interval (CI) 8.0-9.5 ng/ml] versus 6.5 ng/ml [95% CI 5.6-6.7
ng/ml], respectively). Similarly, the effective effect-site concentrations
of remifentanil in 95% of patients in the DLT group was higher than the
SLT group (9.9 ng/ml [95% CI 9.8-10.0 ng/ml] versus 7.0 ng/ml [95% CI 6.9-
7.0 ng/ml], respectively). Conclusions: This study demonstrated that a
DLTrequires a 30% higher EC<inf>50</inf> of remifentanil than does an SLT
to blunt haemodynamic responses during tracheal intubation when combined
with a target-controlled infusion of propofol.<br/>Copyright &#xa9; The
Author(s) 2017.

<24>
Accession Number
2000985879
Title
Left Main Revascularization With PCI or CABG in Patients With Chronic
Kidney Disease: EXCEL Trial.
Source
Journal of the American College of Cardiology. 72 (7) (pp 754-765), 2018.
Date of Publication: 14 August 2018.
Author
Giustino G.; Mehran R.; Serruys P.W.; Sabik J.F.; Milojevic M.; Simonton
C.A.; Puskas J.D.; Kandzari D.E.; Morice M.-C.; Taggart D.P.; Gershlick
A.H.; Genereux P.; Zhang Z.; McAndrew T.; Redfors B.; Ragosta M.; Kron
I.L.; Dressler O.; Leon M.B.; Pocock S.J.; Ben-Yehuda O.; Kappetein A.P.;
Stone G.W.
Institution
(Giustino, Mehran) The Zena and Michael A. Wiener Cardiovascular
Institute, Icahn School of Medicine at Mount Sinai, New York, New York,
United States
(Giustino, Mehran, Genereux, Zhang, McAndrew, Redfors, Dressler, Leon,
Ben-Yehuda, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, New York, United States
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland,
Ohio, United States
(Milojevic, Kappetein) Erasmus University Medical Center, Rotterdam,
Netherlands
(Simonton) Abbott Vascular, Santa Clara, California, United States
(Puskas) Mount Sinai Heart at Mount Sinai St. Luke's, New York, New York,
United States
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Morice) Ramsay Generale de Sante Hopital Prive Jacques Cartier, Massy,
France
(Taggart) Department Cardiac Surgery, John Radcliffe Hospital, Oxford,
United Kingdom
(Gershlick) University Hospitals of Leicester, Leicester, United Kingdom
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, New Jersey, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
(Ragosta, Kron) Division of Cardiovascular Medicine, University of
Virginia Health System, Charlottesville, Virginia, United States
(Leon, Ben-Yehuda, Stone) New York-Presbyterian Hospital/Columbia
University Medical Center, New York, New York, United States
(Pocock) London School of Hygiene and Tropical Medicine, London, United
Kingdom
Publisher
Elsevier USA
Abstract
Background: The optimal revascularization strategy for patients with left
main coronary artery disease (LMCAD) and chronic kidney disease (CKD)
remains unclear. Objectives: This study investigated the comparative
effectiveness of percutaneous coronary intervention (PCI) versus coronary
artery bypass graft (CABG) surgery in patients with LMCAD and low or
intermediate anatomical complexity according to baseline renal function
from the multicenter randomized EXCEL (Evaluation of XIENCE Versus
Coronary Artery Bypass Surgery for Effectiveness of Left Main
Revascularization) trial. Methods: CKD was defined as an estimated
glomerular filtration rate <60 ml/min/1.73 m² using the CKD
Epidemiology Collaboration equation. Acute renal failure (ARF) was defined
as a serum creatinine increase >=5.0 mg/dl from baseline or a new
requirement for dialysis. The primary composite endpoint was the composite
of death, myocardial infarction (MI), or stroke at 3-year follow-up.
Results: CKD was present in 361 of 1,869 randomized patients (19.3%) in
whom baseline estimated glomerular filtration rate was available. Patients
with CKD had higher 3-year rates of the primary endpoint compared with
those without CKD (20.8% vs. 13.5%; hazard ratio [HR]: 1.60; 95%
confidence interval [CI]: 1.22 to 2.09; p = 0.0005). ARF within 30 days
occurred more commonly in patients with compared with those without CKD
(5.0% vs. 0.8%; p < 0.0001), and was strongly associated with the 3-year
risk of death, stroke, or MI (50.7% vs. 14.4%; HR: 4.59; 95% CI: 2.73 to
7.73; p < 0.0001). ARF occurred less commonly after revascularization with
PCI compared with CABG both in patients with CKD (2.3% vs. 7.7%; HR: 0.28;
95% CI: 0.09 to 0.87) and in those without CKD (0.3% vs. 1.3%; HR: 0.20;
95% CI: 0.04 to 0.90; p<inf>interaction</inf> = 0.71). There were no
significant differences in the rates of the primary composite endpoint
after PCI and CABG in patients with CKD (23.4% vs. 18.1%; HR: 1.25; 95%
CI: 0.79 to 1.98) and without CKD (13.4% vs. 13.5%; HR: 0.97; 95% CI: 0.73
to 1.27; p<inf>interaction</inf> = 0.38). Conclusions: Patients with CKD
undergoing revascularization for LMCAD in the EXCEL trial had increased
rates of ARF and reduced event-free survival. ARF occurred less frequently
after PCI compared with CABG. There were no significant differences
between PCI and CABG in terms of death, stroke, or MI at 3 years in
patients with and without CKD. (EXCEL Clinical Trial [EXCEL];
NCT01205776)<br/>Copyright &#xa9; 2018 American College of Cardiology
Foundation

<25>
Accession Number
619531068
Title
A randomised comparison of biodegradable polymer-and permanent
polymer-coated platinum-chromium everolimuseluting coronary stents in
China: The EVOLVE China study.
Source
EuroIntervention. 13 (10) (pp 1210-1217), 2017. Date of Publication:
November 2017.
Author
Han Y.; Yang Y.; Zhang J.; Xu K.; Fu G.; Su X.; Jiang T.; Pang W.; Chen
J.; Yuan Z.; Li H.; Wang H.; Hong T.; Liu H.; Sun F.; Allocco D.J.; Zhang
M.; Dawkins K.D.
Institution
(Han, Liu, Xu) Department of Cardiology, General Hospital of Shenyang
Military Region, 83 Wenhua Road, Shenyang 10016, China
(Yang) Cardiovascular Institute, Fu Wai Hospital, Beijing, China
(Zhang) TEDA International Cardiovascular Hospital, Tianjin, China
(Fu) Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University,
Hangzhou, Zhejiang Province, China
(Su) Wuhan Asia Heart Hospital, Wuhan, China
(Jiang) Affiliated Hospital of Medical College of Chinese People's Armed
Police Force, Tianjin, China
(Pang) Shengjing Hospital of China Medical University, Shenyang, China
(Chen) Guangdong General Hospital, Guangzhou, China
(Yuan) First Affiliated Hospital of Medical College of Xi'an Jiaotong
University, Xi'an, China
(Li) Daqing Oilfield General Hospital, Daqing, China
(Wang) First Affiliated Hospital of the Fourth Military Medical
University, Xi'an, China
(Hong) Peking University First Hospital, Beijing, China
(Liu) Beijing Affiliated Hospital of Armed Police Medical College,
Beijing, China
(Sun) Beijing Hospital of the Ministry of Health, Beijing, China
(Allocco, Zhang, Dawkins) Boston Scientific Corporation, Marlborough, MA,
United States
Publisher
EuroPCR
Abstract
Aims: The EVOLVE China randomised study sought to evaluate the clinical
safety and effectiveness of the SYNERGY bioabsorbable polymer-coated
everolimus-eluting stent (EES) for the treatment of patients with coronary
heart disease in China. Methods and results: Eligible patients with de
novo native coronary artery lesions were randomised (1:1) to receive the
SYNERGY or PROMUS Element Plus stent. The primary endpoint was in-stent
late loss at nine months. Secondary endpoints included death, MI,
revascularisation, and stent thrombosis up to 12 months. A total of 412
subjects were randomised (205 SYNERGY; 207 PROMUS Element Plus) at 14
sites in China from October 2013 to July 2014. SYNERGY was non-inferior to
PROMUS Element Plus for the primary endpoint of nine-month in-stent late
loss: SYNERGY 0.20+/-0.33 mm vs. PROMUS Element Plus 0.17+/-0.38 mm with
an upper one-sided 97.5% confidence interval of the difference (0.10 mm),
significantly less than the non-inferiority margin (0.15 mm; p<0.0008).
Clinical adverse event rates were low and not significantly different
between groups at nine and 12 months (all p>0.05). Conclusions: In the
EVOLVE China trial, the SYNERGY bioabsorbable polymer-coated EES was
noninferior to the PROMUS Element Plus permanent polymer-coated EES for
the primary endpoint of late loss at nine months.<br/>Copyright &#xa9;
Europa Digital & Publishing 2017. All rights reserved.

<26>
Accession Number
622796742
Title
Subannular reconstruction in secondary mitral regurgitation: A
meta-analysis.
Source
Heart. (no pagination), 2018. Date of Publication: 13 Mar 2018.
Author
Harmel E.K.; Reichenspurner H.; Girdauskas E.
Institution
(Harmel, Reichenspurner, Girdauskas) Department of Cardiothoracic Surgery,
University Heart Center Hamburg, Hamburg 20251, Germany
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.

<27>
Accession Number
622950773
Title
Fentanyl Delays the Platelet Inhibition Effects of Oral Ticagrelor: Full
Report of the PACIFY Randomized Clinical Trial.
Source
Thrombosis and Haemostasis. 118 (8) (pp 1409-1418), 2018. Date of
Publication: 01 Aug 2018.
Author
Ibrahim K.; Shah R.; Goli R.R.; Kickler T.S.; Clarke W.A.; Hasan R.K.;
Blumenthal R.S.; Thiemann D.R.; Resar J.R.; Schulman S.P.; McEvoy J.W.
Institution
(Ibrahim, Hasan, Blumenthal, Thiemann, Resar, Schulman, McEvoy) Division
of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Heart
Disease, Johns Hopkins University, School of Medicine, 600 N. Wolfe
Street, Baltimore, MD 21287, United States
(Shah, Goli) Department of Medicine, Johns Hopkins University, School of
Medicine, Baltimore, MD, United States
(Kickler, Clarke) Department of Pathology, Johns Hopkins University,
School of Medicine, Baltimore, MD, United States
(Blumenthal) Ciccarone Center for the Prevention of Heart Disease, Johns
Hopkins University, School of Medicine, Baltimore, MD, United States
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Morphine delays oral P2Y <inf>12</inf> platelet inhibitor absorption and
is associated with adverse outcomes after myocardial infarction.
Consequently, many physicians and first responders are now considering
fentanyl as an alternative. We conducted a single-centre trial randomizing
cardiac patients undergoing coronary angiography to intravenous fentanyl
or not. All participants received local anaesthetic and intravenous
midazolam. Those requiring percutaneous coronary intervention (PCI) with
stenting received 180 mg oral ticagrelor intra-procedurally. The primary
outcome was area under the ticagrelor plasma concentration-time curve (AUC
<inf>0-24 hours</inf>). The secondary outcomes were platelet function
assessed at 2 hours after loading, measured by P2Y <inf>12</inf> reaction
units (PRUs) and light transmission platelet aggregometry. Troponin-I was
measured post-PCI using a high-sensitivity troponin-I assay (hs-TnI). All
participants completed a survey of pain and anxiety. Of the 212
randomized, 70 patients required coronary stenting and were loaded with
ticagrelor. Two participants in the no-fentanyl arm crossed over to
receive fentanyl for pain. In as-treated analyses, ticagrelor
concentrations were higher in the no-fentanyl arm (AUC <inf>0-24
hours</inf> 70% larger, p = 0.03). Platelets were more inhibited by 2
hours in the no-fentanyl arm (71 vs. 113 by PRU, p = 0.03, and 25% vs. 41%
for adenosine diphosphate response by platelet aggregation, p < 0.01).
Mean hs-TnI was higher with fentanyl at 2 hours post-PCI (11.9 vs. 7.0
ng/L, p = 0.04) with a rate of enzymatic myocardial infarction of 11% for
fentanyl and 0% for no-fentanyl (p = 0.08). No statistical differences in
self-reported pain or anxiety were found. In conclusion, fentanyl
administration can impair ticagrelor absorption and delay platelet
inhibition, resulting in mild excess of myocardial damage. This newly
described drug interaction should be recognized by physicians and suggests
that the interaction between opioids and oral P2Y <inf>12</inf> platelet
inhibitors is a drug class effect associated with all opioids. Clinical
Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02683707
(NCT02683707).<br/>Copyright &#xa9; 2018 Georg Thieme Verlag KG Stuttgart
New York.

<28>
Accession Number
623322613
Title
Trigemino-cardiac reflex: A case report of intra-operative asystole in
response to manipulation of the temporalis muscle.
Source
Canadian Journal of Neurological Sciences. Conference: 53rd Annual
Congress of the Canadian Neurological Sciences Federation. Canada. 45
(Supplement 2) (pp S47), 2018. Date of Publication: June 2018.
Author
Shakil H.; Wang A.; Reddy K.
Institution
(Shakil, Wang, Reddy) HamiltonCanada
Publisher
Cambridge University Press
Abstract
Background: The trigemino-cardiac reflex (TCR) is a sudden onset of
bradycardia, hypotension, apnea or gastric hypermotility during
stimulation of the trigeminal nerve. Methods: We conducted a MEDLINE
search for surgical cases of TCR and herein describe a case seen recently
at our institution. Results: A 60 year-old female underwent a left
orbitozygomatic craniotomy for resection of a skull-base tumor.
Pre-operative anesthesia evaluation was unremarkable and negative for a
history of cardiovascular disease. Intraoperatively, retraction with
moderate force of the temporalis muscle consistently produced asystole.
Cessation of retraction resulted in immediate return of sinus rhythm.
Otherwise, intra-operative heart rate was 60-90 BPM. Post-operatively,
vital signs and clinical course were unremarkable. The patient experienced
a similar phenomenon during an operation 6 years earlier, when
manipulation of tumor near cranial nerves IX/X resulted in bradycardia.
TCR is the result of a polysynaptic brainstem network involving the
afferent trigeminal sensory nucleus, the reticular formation, and the
efferent vagal motor nucleus. Conclusions: This is a case of exaggerated
vagal response following manipulation of the temporalis muscle. Our report
emphasizes the importance for neurosurgeons and anesthesiologists alike to
be wary of TCR in order to avoid deleterious consequences when operating
on structures associated with the trigeminal nerve.

<29>
Accession Number
623332719
Title
Gender difference in clinical outcomes of the patients with coronary
artery disease after percutaneous coronary intervention: A systematic
review and meta-analysis.
Source
Medicine. 97 (30) (pp e11644), 2018. Date of Publication: 01 Jul 2018.
Author
Guo Y.; Yin F.; Fan C.; Wang Z.
Institution
(Guo, Yin, Fan) First Medical Clinical College of Lanzhou University
(Wang) Department of Cardiology, First Hospital of Lanzhou University,
Lanzhou, Gansu, China
Abstract
BACKGROUND AND OBJECTIVES: Previous researches have reported the
controversial results regarding the gender difference in clinical outcomes
of patients with coronary artery disease after percutaneous coronary
intervention. Hence, this systematic review and meta-analysis was designed
to investigate whether gender difference existed in patients with coronary
artery disease after percutaneous coronary intervention.
METHODS: PubMed, Embase, and the Cochrane Library database were searched
up to February 10, 2018. Studies comparing the gender-specific effect on
clinical outcomes of patients with coronary artery disease after
percutaneous coronary intervention were identified, to analyze mortality,
major adverse cardiovascular events (MACE) and revascularization.
Statistical software RevMan was utilized in this meta-analysis.
RESULTS: A total of 49 studies, involving 1,032,828 patients (774,115
males and 258,713 females) reporting gender-specific outcomes, were
included in this study. The in-hospital mortality, 30-day mortality,
1-year mortality, and at least 2-years mortality in male patients with
coronary artery disease after percutaneous coronary intervention were
significantly lower than those of females (odds ratio [OR] 0.58 95%
confidence interval [CI] 0.52-0.63, P < .001; OR 0.64, 95% CI 0.61-0.66, P
= .04; OR 0.67, 95% CI 0.60-0.75, P < .001 and OR 0.71, 95% CI 0.63-0.79,
P = .005, respectively). The MACE was significantly decreased in male
subjects after initial percutaneous coronary intervention compared with
females in <1-year or at least 1-year (OR 0.67, 95% CI 0.56-0.80, P < .001
and OR 0.84, 95% CI 0.76-0.93, P < .001). The male patients after
percutaneous coronary intervention harbored higher rate of
revascularization compared with females for at least 1-year (OR 1.17, 95%
CI 1.00-1.36, P < .001), while the rate of revascularization in male
patients for < 1-year was lower than that of females (OR 0.93, 95% CI
0.69-1.26, P < .001).
CONCLUSIONS: The systematic review and meta-analysis suggests that the
prognosis of male patients with coronary artery disease after percutaneous
coronary intervention is better than that of females, except for long-term
revascularization.

<30>
Accession Number
623313983
Title
Efficacy of bilateral pectoralis nerve block for ultrafast tracking and
postoperative pain management in cardiac surgery.
Source
Annals of Cardiac Anaesthesia. 21 (3) (pp 333-338), 2018. Date of
Publication: July-September 2018.
Author
Kumar K.N.; Kalyane R.N.; Singh N.G.; Nagaraja P.S.; Krishna M.; Babu B.;
Varadaraju R.; Sathish N.; Manjunatha N.
Institution
(Kumar, Singh, Nagaraja, Krishna, Babu, Sathish, Manjunatha) Departments
of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular
Sciences and Research, Bengaluru, Karnataka 560 069, India
(Kalyane, Varadaraju) Cardiaothoracic and Vascular Surgery, Sri Jayadeva
Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka,
India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: Good postoperative analgesia in cardiac surgical patients
helps in early recovery and ambulation. An alternative to parenteral,
paravertebral, and thoracic epidural analgesia can be pectoralis nerve
(Pecs) block, which is novel, less invasive regional analgesic technique.
Aims: We hypothesized that Pecs block would provide superior postoperative
analgesia for patients undergoing cardiac surgery through midline
sternotomy compared to parenteral analgesia. Materials and Methods: Forty
adult patients between the age groups of 25 and 65 years undergoing
coronary artery bypass grafting or valve surgeries through midline
sternotomy under general anesthesia were enrolled in the study. Patients
were randomly allocated into two groups with 20 in each group. Group 1
patients did not receive Pecs block, whereas Group 2 patients received
bilateral Pecs block postoperatively. Patients were extubated once they
fulfilled extubation criteria. Ventilator duration was recorded. Patients
were interrogated for pain by visual analog scale (VAS) scoring at rest
and cough. Inspiratory flow rate was assessed using incentive spirometry.
Results: Pecs group patients required lesser duration of ventilator
support (P < 0.0001) in comparison to control group. Pain scores at rest
and cough were significantly low in Pecs group at 0, 3, 6, 12, and 18 h
from extubation (P < 0.05). At 24 h, VAS scores were comparable between
two groups. Peak inspiratory flow rates were higher in Pecs group as
compared to control group at 0, 3, 6, 12, 18, and 24 h (P < 0.05).
Thirty-four episodes of rescue analgesia were given in control group,
whereas in Pecs group, there were only four episodes of rescue analgesia.
Conclusion: Pecs block is technically simple and effective technique and
can be used as part of multimodal analgesia in postoperative cardiac
surgical patients for better patient comfort and outcome.<br/>Copyright
&#xa9; 2018 Medknow Publications. All rights reserved.

<31>
Accession Number
623313980
Title
Inhaled levosimendan versus intravenous levosimendan in patients with
pulmonary hypertension undergoing mitral valve replacement.
Source
Annals of Cardiac Anaesthesia. 21 (3) (pp 328-332), 2018. Date of
Publication: July-September 2018.
Author
Kundra T.S.; Nagaraja P.S.; Bharathi K.S.; Kaur P.; Manjunatha N.
Institution
(Kundra, Nagaraja, Bharathi, Manjunatha) Department of Cardiac
Anaesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and
Research, Bengaluru, Karnataka, India
(Kaur) Department of Critical Care, Sir Ganga Ram Hospital, New Delhi,
India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Context: Inhaled levosimendan may act as selective pulmonary vasodilator
and avoid systemic side effects of intravenous levosimendan, which include
decrease in systemic vascular resistance (SVR) and systemic hypotension,
but with same beneficial effect on pulmonary artery pressure (PAP) and
right ventricular (RV) function. Aim: The aim of this study was to compare
the effect of inhaled levosimendan with intravenous levosimendan in
patients with pulmonary hypertension undergoing mitral valve replacement.
Settings and Design: The present prospective randomized comparative study
was conducted in a tertiary care hospital. Subjects and Methods: Fifty
patients were randomized into two groups (n = 25). Group A: Levosimendan
infusion was started immediately after coming-off of cardiopulmonary
bypass and continued for 24 h at 0.1 mcg/kg/min. Group B: Total dose of
levosimendan which would be given through intravenous route over 24 h was
calculated and then divided into four equal parts and administered through
inhalational route 6^th hourly over 24 h. Hemodynamic profile
(pulse rate, mean arterial pressure, pulmonary artery systolic pressure
[PASP], SVR) and RV function were assessed immediately after shifting, at
1, 8, 24, and 36 h after shifting to recovery. Statistical Analysis Used:
Intragroup analysis was done using paired student t-test, and unpaired
student t-test was used for analysis between two groups. Results: PASP and
RV-fractional area change (RV-FAC) were comparable in the two groups at
different time intervals. There was a significant reduction in PASP and
significant improvement in RV-FAC with both intravenous and inhalational
levosimendan. SVR was significantly decreased with intravenous
levosimendan, but no significant decrease in SVR was observed with
inhalational levosimendan. Conclusions: Inhaled levosimendan is a
selective pulmonary vasodilator. It causes decrease in PAP and improvement
in RV function, without having a significant effect on SVR.<br/>Copyright
&#xa9; 2018 Medknow Publications. All rights reserved.

<32>
Accession Number
623313977
Title
Comparison of continuous thoracic epidural analgesia with bilateral
erector spinae plane block for perioperative pain management in cardiac
surgery.
Source
Annals of Cardiac Anaesthesia. 21 (3) (pp 323-327), 2018. Date of
Publication: July-September 2018.
Author
Nagaraja P.S.; Ragavendran S.; Singh N.G.; Asai O.; Bhavya G.; Manjunath
N.; Rajesh K.
Institution
(Nagaraja, Ragavendran, Singh, Asai, Bhavya, Manjunath) Departments of
Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences
and Research, Bengaluru, Karnataka, India
(Rajesh) CTVS, Sri Jayadeva Institute of Cardiovascular Sciences and
Research, Bengaluru, Karnataka, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Objective: Continuous thoracic epidural analgesia (TEA) is compared with
erector spinae plane (ESP) block for the perioperative pain management in
patients undergoing cardiac surgery for the quality of analgesia,
incentive spirometry, ventilator duration, and intensive care unit (ICU)
duration. Methodology: A prospective, randomized comparative clinical
study was conducted. A total of 50 patients were enrolled, who were
randomized to either Group A: TEA (n = 25) or Group B: ESP block (n = 25).
Visual analog scale (VAS) was recorded in both the groups during rest and
cough at the various time intervals postextubation. Both the groups were
also compared for incentive spirometry, ventilator, and ICU duration.
Statistical analysis was performed using the independent Student's t-test.
A value of P < 0.05 was considered statistically significant. Results: C
omparable VAS scores were revealed at 0 h, 3 h, 6 h, and 12 h (P > 0.05)
at rest and during cough in both the groups. Group A had a statistically
significant VAS score than Group B (P <= 0.05) at 24 h, 36 h, and 48 h but
mean VAS in either of the Group was <=4 both at rest and during cough.
Incentive spirometry, ventilator, and ICU duration were comparable between
the groups. Conclusion: ESP block is easy to perform and can serve as a
promising alternative to TEA in optimal perioperative pain management in
cardiac surgery.<br/>Copyright &#xa9; 2018 Medknow Publications. All
rights reserved.

<33>
Accession Number
623313928
Title
Sedation effects by dexmedetomidine versus propofol in decreasing duration
of mechanical ventilation after open heart surgery.
Source
Annals of Cardiac Anaesthesia. 21 (3) (pp 235-242), 2018. Date of
Publication: July-September 2018.
Author
Elgebaly A.S.; Sabry M.
Institution
(Elgebaly) Department of Anesthesia and PSIC, Faculty of Medicine, Tanta
University, Tanta, Gharbia 31111, Egypt
(Sabry) Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta
University Hospital, Tanta, Gharbia 31111, Egypt
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Objective: The objective of this study was to compare the suitability
(efficacy and safety) of dexmedetomidine versus propofol for patients
admitted to the intensive care unit (ICU) after the cardiovascular surgery
for the postoperative sedation before weaning from mechanical ventilation.
Background: Sedation is prescribed in patients admitted to the ICU after
cardiovascular surgery to reduce the patient discomfort, ventilator
asynchrony, to make mechanical ventilation tolerable, prevent accidental
device removal, and to reduce metabolic demands during respiratory and
hemodynamic instability. Careful drug selection for sedation by the ICU
team, postcardiovascular surgery should be done so that patients can be
easily weaned from mechanical ventilation after sedation is stopped to
achieve a shorter duration of mechanical ventilation and decreased the
length of stay in ICU. Methods: A total of 50 patients admitted to the ICU
after cardiovascular surgery, aged from 18 to 55 years and requiring
mechanical ventilation on arrival to the ICU were enrolled in a
prospective and comparative study. They were randomly divided into two
groups as follows: Group D patients (n = 25) received dexmedetomidine in a
maintenance infusion dose of 0.8 mug/kg/h and Group P patients (n = 25)
received propofol in a maintenance infusion dose of 1.5 mg/kg/h. The
patients were assessed for 12 h postoperatively, and dosing of the study
drug was adjusted based on sedation assessment performed with the Richmond
Agitation-Sedation Scale (RASS). The patients were required to be within
the RASS target range of -2 to +1 at the time of study drug initiation. At
every 4 h, the following information was recorded from each patient such
as heart rate (HR), mean arterial pressure (MAP), arterial blood gases
(ABG), tidal volume (TV), exhaled TV, maximum inspiratory pressure,
respiratory rate and the rapid shallow breathing index, duration of
mechanical ventilation, midazolam and fentanyl dose requirements, and
financial costs. Results: The study results showed no statistically
significant difference between both groups with regard to age and body
mass index. Group P patients were more associated with lower MAP and HR
than Group D patients. There was no statistically significant difference
between groups with regard to ABG findings, oxygenation, ventilation, and
respiratory parameters. There was significant difference between both the
groups in midazolam and fentanyl dose requirement and financial costs with
a value of P < 0.05. Conclusion: Dexmedetomidine is safer and equally
effective agent for the sedation of mechanically ventilated patients
admitted to the ICU after cardiovascular surgery compared to the patients
receiving propofol, with good hemodynamic stability, and equally rapid
extubation time.<br/>Copyright &#xa9; 2018 Medknow Publications. All
rights reserved.

<34>
Accession Number
2000995909
Title
Prevention of deep sternal wound infection in cardiac surgery: a
literature review.
Source
Journal of Hospital Infection. (no pagination), 2018. Date of Publication:
2018.
Author
Vos R.J.; Van Putte B.P.; Kloppenburg G.T.L.
Institution
(Vos, Van Putte, Kloppenburg) Department of Cardiothoracic Surgery, St.
Antonius Hospital, Nieuwegein, Netherlands
(Vos, Van Putte) Department of Cardiothoracic Surgery, Academic Medical
Center, Amsterdam, Netherlands
Publisher
W.B. Saunders Ltd
Abstract
Background: Deep sternal wound infection (DSWI) is a dreaded complication
of cardiac surgery with considerable consequences in terms of mortality,
morbidity and treatment costs. In addition to standard surgical site
infection prevention guidelines, multiple specific measures in the
prevention of DSWI have been developed and evaluated in the past decades.
This review focuses on these specific measures to prevent DSWI. Methods:
An extensive literature search was performed to assess interventions in
the prevention of DSWI. Articles describing results of a randomized
controlled trial were categorized by type of intervention. Results were
yielded and, if possible, pooled. Results: From a total of 743 articles
found, 48 randomized controlled trials were selected. Studies were divided
into 12 categories, containing pre-, peri- and postoperative preventive
measures. Specific measures shown to be effective were: antibiotic
prophylaxis with a first-generation cephalosporin for at least 24 h,
application of local gentamicin before chest closure, sternal closure with
figure-of-eight steel wires, and postoperative chest support using a
corset or vest. Conclusion: This study identified several measures that
prevent DSWI after cardiac surgery that are not frequently applied in
current practice. It is recommended that the guidelines on prevention of
surgical site infection in cardiac surgery should be
updated.<br/>Copyright &#xa9; 2018 The Healthcare Infection Society

<35>
Accession Number
2000995801
Title
Culprit-Only Versus Complete Coronary Revascularization After ST-Segment
Elevation Myocardial Infarction- A Systematic Review and Analysis of
Clinical Outcomes.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Author
Lamelas P.; Winter J.; Villablanca P.A.; Mehta S.; Ramakrishna H.
Institution
(Lamelas, Mehta) Population Health Research Institute, McMaster
University, Hamilton, Ontario, Canada
(Lamelas, Winter, Mehta) Interventional Cardiology, McMaster University,
Hamilton, Ontario, Canada
(Villablanca) Division of Cardiology, New York University School of
Medicine, New York, NY, United States
(Ramakrishna) Division of Cardiovascular and Thoracic Anesthesiology,
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic,
Phoenix, AZ, United States
Publisher
W.B. Saunders

<36>
Accession Number
623114963
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.
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
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.

<37>
Accession Number
619678566
Title
Relative hyperglycemia is associated with complications following an acute
myocardial infarction: A post-hoc analysis of HI-5 data.
Source
Cardiovascular Diabetology. 16 (1) (no pagination), 2017. Article Number:
157. Date of Publication: 12 Dec 2017.
Author
Lee T.F.; Burt M.G.; Heilbronn L.K.; Mangoni A.A.; Wong V.W.; McLean M.;
Cheung N.W.
Institution
(Lee, Burt, Mangoni) Flinders University, School of Medicine, Adelaide,
Australia
(Lee, Burt) Repatriation General Hospital, Southern Adelaide Diabetes and
Endocrine Services, Daw Park, Adelaide, SA 5041, Australia
(Heilbronn) The University of Adelaide, Adelaide, Australia
(Wong, McLean, Cheung) Westmead Hospital, Centre for Diabetes and
Endocrinology Research, Sydney, Australia
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Hyperglycemia is associated with increased morbidity and
mortality in patients with an acute myocardial infarction (AMI). We
evaluated whether complications after AMI are associated with absolute or
relative glycemia. Methods: A total of 192 patients with AMI were
randomized to intensive or conventional insulin therapy. Absolute glycemia
was defined as mean blood glucose level (BGL) during the first 24 h
following randomization. Relative glycemia was defined by the stress
hyperglycaemia ratio (SHR), calculated as mean BGL divided by average
glucose concentration over the prior 3 months estimated from glycosylated
haemoglobin. The primary endpoint was a "complicated AMI", defined as an
AMI complicated by death, congestive cardiac failure, arrhythmia, cardiac
arrest, reinfarction, cardiogenic shock, inotrope use or emergency
revascularization. Results: There was not a significant association
between mean BGL and complicated AMI (odds ratio (OR) 1.05 per mmol/L
glucose increment, 95% confidence intervals (CI) 0.93-1.19). In contrast,
SHR was positively associated with a complicated myocardial infarction (OR
1.22 per 0.1 SHR increment, 95% CI 1.06-1.42), and individual
complications of death (OR 1.55, 95% CI 1.14-2.11), congestive cardiac
failure (OR 1.27, 95% CI 1.05-1.54), arrhythmia (OR 1.31, 95% CI
1.12-1.54) and cardiogenic shock (OR 1.42, 95% CI 1.03-1.97). The
relationship between SHR and a complicated AMI was independent of diabetic
status, intensive insulin therapy, sex and hypoglycemia. Conclusions:
Relative, but not absolute, glycemia during insulin treatment is
independently associated with complications after an AMI. Future studies
should investigate whether basing therapeutic glycaemic targets on
relative glycemia improves patient outcomes.<br/>Copyright &#xa9; 2017 The
Author(s).

<38>
Accession Number
619763064
Title
Intraoperative oxygen concentration and neurocognition after cardiac
surgery: Study protocol for a randomized controlled trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 600. Date of
Publication: 19 Dec 2017.
Author
Shaefi S.; Marcantonio E.R.; Mueller A.; Banner-Goodspeed V.; Robson S.C.;
Spear K.; Otterbein L.E.; O'Gara B.P.; Talmor D.S.; Subramaniam B.
Institution
(Shaefi, Mueller, Banner-Goodspeed, O'Gara, Talmor, Subramaniam) Beth
Israel Deaconess Medical Center, Harvard Medical School, Department of
Anesthesia, Critical Care and Pain Medicine, 330 Brookline Ave, Boston, MA
02215, United States
(Marcantonio) Beth Israel Deaconess Medical Center, Harvard Medical
School, Division of General Medicine and Primary Care, 330 Brookline Ave,
Boston, MA 02215, United States
(Robson) Beth Israel Deaconess Medical Center, Harvard Medical School,
Division of Gastroenterology, 3 Blackfan Circle, Boston, MA 02215, United
States
(Spear) Beth Israel Deaconess Medical Center, Harvard Medical School,
Division of Cardiothoracic Surgery, 330 Brookline Ave, Boston, MA 02215,
United States
(Otterbein) Beth Israel Deaconess Medical Center, Harvard Medical School,
Division of Transplant Surgery, Center for Life Sciences, Boston, MA
02215, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative cognitive dysfunction (POCD) is a common
complication of cardiac surgery. Studies have identified potentially
injurious roles for cardiopulmonary bypass (CPB) and subsequent
reperfusion injury. Cognitive dysfunction has also been linked to the
deleterious effects of hyperoxia following ischemia-reperfusion injuries
in several disease states, but there has been surprisingly little study
into the role of hyperoxia in reperfusion injury after CPB. The potential
for tightly regulated intraoperative normoxia to ameliorate the
neurocognitive decline following cardiac surgery has not been investigated
in a prospective manner. We hypothesize that the use of a protocolized
management strategy aimed towards maintenance of an intraoperative
normoxic level of oxygen, as opposed to hyperoxia, will reduce the
incidence of POCD in older patients undergoing cardiac surgery.
Methods/Design: One hundred patients aged 65 years and older undergoing
non-emergency coronary artery bypass grafting surgery on cardiopulmonary
bypass will be enrolled in this prospective, randomized, controlled trial.
Subjects will be randomized to receive a fraction of inspired oxygen of
either 35% or 100% while under general anesthesia throughout the
intraoperative period. The primary outcome measure will be the incidence
of POCD in the acute postoperative phase and up to 6 months. The
assessment of neurocognition will be undertaken by trained personnel,
blinded to study group, with the telephone Montreal Cognitive Assessment
(t-MoCA) tool. Secondary outcome measures will include assessment of
delirium using the Confusion Assessment Method (CAM and CAM-ICU), as well
as time to extubation, days of mechanical ventilation, length of ICU and
hospital stay and mortality at 6 months. With the aim of later identifying
mechanistic aspects of the effect of oxygen tension, blood, urine, and
atrial tissue specimens will be taken at various time points during the
perioperative period and later analyzed. Discussion: This trial will be
one of the first randomized controlled studies to prospectively assess the
relationship between intraoperative oxygen levels and postoperative
neurocognition in cardiac surgery. It addresses a promising biological
avenue of intervention in this vulnerable aging population. Trial
registration: ClinicalTrials.gov Identifier: NCT02591589 , registered
February 13, 2015.<br/>Copyright &#xa9; 2017 The Author(s).

<39>
Accession Number
619682114
Title
Posterior Left pericardiotomy for the prevention of postoperative Atrial
fibrillation after Cardiac Surgery (PALACS): Study protocol for a
randomized controlled trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 593. Date of
Publication: 13 Dec 2017.
Author
Abouarab A.A.; Leonard J.R.; Ohmes L.B.; Lau C.; Rong L.Q.; Ivascu N.S.;
Pryor K.O.; Munjal M.; Crea F.; Massetti M.; Sanna T.; Girardi L.N.;
Gaudino M.
Institution
(Crea, Massetti, Sanna) Catholic University, Department of Cardiovascular
Sciences, Rome, Italy
(Abouarab, Leonard, Ohmes, Lau, Rong, Ivascu, Pryor, Munjal, Girardi,
Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525
East 68th St, New York, NY 10065, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative atrial fibrillation (POAF) is a common
complication following cardiac surgery. POAF is associated with increased
morbidity and hospital costs. We herein describe the protocol for a
randomized controlled trial to determine if performing a posterior left
pericardiotomy prevents POAF after cardiac surgery. Methods/design: All
patients submitted to cardiac surgery at our institution will be screened
for inclusion into the study. The study will consist of two parallel arms
with random allocation between groups to either receive a posterior left
pericardiotomy or serve as a control. Masking will be done in a
single-blinded fashion to the patient. Patients will be continuously
monitored postoperatively for the occurrence of atrial fibrillation until
discharge. At the follow-up clinic visit (15-30 days after surgery), the
primary endpoint (atrial fibrillation) and other secondary endpoints, such
as pleural or pericardial effusion, will be assessed. A total sample size
of 350 subjects will be recruited. Discussion: POAF is associated with
increased morbidity, prolonged hospital stay, and increased costs after
cardiac surgery. Several strategies aimed at reducing the incidence of
POAF have been investigated, including beta-blockers, amiodarone, and
statins, all with suboptimal results. Posterior left pericardiotomy has
been associated with a reduction of POAF in previous series. However,
these studies had limited sample sizes and suboptimal methodology, so that
the efficacy of posterior pericardiotomy in preventing POAF remains to be
definitively proven. Our randomized trial aims to determine the effect of
a posterior left pericardiotomy on the incidence of POAF. Trial
registration: ClinicalTrials.gov, ID: NCT02875405 , protocol record
1502015867. Registered on July 2016.<br/>Copyright &#xa9; 2017 The
Author(s).

<40>
Accession Number
614976448
Title
Transfemoral TAVI is superior to SAVR in elderly high-risk patients with
symptomatic severe aortic stenosis!.
Source
European Heart Journal. 37 (47) (pp 3513-3514), 2016. Date of Publication:
01 Dec 2016.
Author
Moat N.; Brecker S.
Institution
(Moat) Cardiovascular BRU, Royal Brompton and Harefield NHS Trust, London,
United Kingdom
(Brecker) Department of Cardiology, Cardiology Clinical Academic Group,
St. George's Hospital, St. George's University of London, Blackshaw Road,
London SW17 0QT, United Kingdom
Publisher
Oxford University Press

<41>
Accession Number
623274683
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.
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
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.

<42>
Accession Number
623305694
Title
Effects of N-acetyl cysteine and melatonin on early reperfusion injury in
patients undergoing coronary artery bypass grafting: A randomized,
open-labeled, placebo-controlled trial.
Source
Medicine. 97 (30) (pp e11383), 2018. Date of Publication: 01 Jul 2018.
Author
Shafiei E.; Bahtoei M.; Raj P.; Ostovar A.; Iranpour D.; Akbarzadeh S.;
Shahryari H.; Anvaripour A.; Tahmasebi R.; Netticadan T.; Movahed A.
Institution
(Shafiei, Iranpour, Akbarzadeh, Shahryari, Anvaripour) Department of
Cardiology, Denmark
(Bahtoei) Department of Internal Medicine, Faculty of Medicine, Egypt
(Raj, Netticadan) Physiology and Pathophysiology, University of Manitoba,
Switzerland
(Raj, Netticadan) Canadian Center for Agri-food Research in Health and
Medicine, Winnipeg, Manitoba, Canada
(Ostovar, Tahmasebi, Movahed) Biochemistry Group, Persian Gulf Tropical
Medicine Research Center, Bushehr University of Medical Sciences, Bushehr,
Iran, Islamic Republic of
Abstract
OBJECTIVES: This study assessed the efficacy of oral consumption of
N-acetyl cysteine (NAC) and melatonin (ML) in reducing early reperfusion
injury and acute oxidative stress in patients undergoing coronary artery
bypass grafting (CABG) with respect to the measurements of cardiac
troponin I, lactate, malondealdehyde (MDA), and tumor necrosis
factor-alpha (TNF-alpha) levels in the blood.
METHODS: This study was a randomized, open-label, placebo-controlled
trial. Eighty eight patients, aged between 39 to 76 years and eligible for
CABG, were recruited and randomly assigned into 3 intervention groups
through a simple randomization method and underwent CABG surgery. Blood
samples were withdrawn from arterial line, before the induction of
anesthesia (before the start of surgery), after incision (before aortic
cross-clamping), during global ischemia (during aortic cross-clamping),
after aortic cross-clamping (on set of reperfusion), 15 minutes after
reperfusion, and after recovery at the intense care unit. The blood
samples were analyzed for troponin I, lactate, MDA and TNF-alpha levels.
RESULTS: There was no significant difference in influencing variables
among the groups at the baseline. Overall mean troponin I, lactate, and
TNF- alpha levels were significantly different between the intervention
groups (all P < .001) at the recovery phase. Post-hoc pairwise comparisons
showed that the differences of mean serum levels between ML and control
groups were statistically significant for MDA, TNF- alpha, lactate, and
troponin I (P < .001, P = .001, and P = .001, respectively). The
differences between NAC and control groups and between ML and NAC groups
were only significant for mean lactate level (P < .001).
CONCLUSION: The current study revealed that ML and NAC are potent
antioxidants with similar efficacy in terms of reducing CABG related
cardiac injury and oxidative stress with the dosage employed for the
intervention.

<43>
Accession Number
620231205
Title
Health-related quality of life in older patients with acute coronary
syndrome randomised to an invasive or conservative strategy. The After
Eighty randomised controlled trial.
Source
Age and Ageing. 47 (1) (pp 42-47), 2018. Date of Publication: 01 Jan 2018.
Author
Tegn N.; Abdelnoor M.; Aaberge L.; Ranhoff A.H.; Endresen K.; Gjertsen E.;
Skardal R.; Gullestad L.; Bendz B.
Institution
(Tegn, Aaberge, Endresen, Skardal, Gullestad, Bendz) Department of
Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
(Tegn, Gullestad, Bendz) Faculty of Medicine, University of Oslo, Norway
(Abdelnoor) Centre for Biostatistics and Epidemiology, Oslo University
Hospital, Ulleval, Oslo, Norway
(Ranhoff) Diakonhjemmet Hospital and Department of Clinical Science,
University of Bergen, Bergen, Norway
(Gjertsen) Department of Cardiology, Drammen Hospital, Drammen, Norway
Publisher
Oxford University Press
Abstract
Objective: in the After Eighty study (ClinicalTrials.gov.number,
NCT01255540), patients aged 80 years or more, with non-ST-elevation
myocardial infarction (NSTEMI), and unstable angina pectoris (UAP), were
randomised to either an invasive or conservative management approach. We
sought to compare the effects of these management strategies on health
related quality of life (HRQOL) after 1 year.Methods: the After Eighty
study was a prospective randomised controlled multicenter trial. In total,
457 patients aged 80 or over, with NSTEMI or UAP, were randomised to
either an invasive strategy (n = 229, mean age: 84.7 years), involving
early coronary angiography, with immediate evaluation for percutaneous
coronary intervention, coronary artery bypass graft, optimal medical
therapy, or to a conservative strategy (n = 228, mean age: 84.9 years).
The Short Form 36 health survey (SF-36) was used to assess HRQOL at
baseline, and at the 1-year follow-up.Results: baseline SF-36 completion
was achieved for 208 and 216 patients in the invasive and conservative
groups, respectively. A total of 137 in the invasive group and 136
patients in the conservative group completed the SF-36 form at follow-up.
When comparing the changes from follow-up to baseline (delta) no
significant changes in quality-of-life scores were observed between the
two strategies in any of the domains, expect for a small but statistically
significant difference in bodily pain. This difference in only one of the
SF-36 subscales may not necessarily be clinically significant.Conclusion:
from baseline to the 1 year follow-up, only minor differences in change of
HRQOL as measured by SF-36 were seen by comparing an invasive and
conservative strategy.<br/>Copyright &#xa9; The Author 2017.

<44>
Accession Number
619679635
Title
FFR-guided multivessel stenting reduces urgent revascularization compared
with infarct-related artery only stenting in ST-elevation myocardial
infarction: A meta-analysis of randomized controlled trials.
Source
International Journal of Cardiology. 252 (pp 63-67), 2018. Date of
Publication: 01 Feb 2018.
Author
Gupta A.; Bajaj N.S.; Arora P.; Arora G.; Qamar A.; Bhatt D.L.
Institution
(Gupta, Bajaj, Qamar, Bhatt) Heart and Vascular Center, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
(Arora, Arora) Division of Cardiovascular Disease, Department of Medicine,
The University of Alabama at Birmingham, Birmingham, AL, United States
(Arora) Section of Cardiology, Birmingham Veterans Affairs Medical Center,
Birmingham, AL, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background Randomized controlled trials (RCTs) have shown fractional flow
reserve-guided (FFR) multivessel stenting to be superior to
infarct-related artery (IRA) only stenting in patients with ST-elevation
myocardial infarction (STEMI) and multivessel disease. This effect was
mainly driven by a reduction in overall repeat revascularization. However,
the ability to assess the effect of this strategy on urgent
revascularization or reinfarction was underpowered in individual trials.
Methods We searched Pubmed, EMBASE, Cochrane CENTRAL, and Web of Science
for RCTs of FFR-guided multivessel stenting versus IRA-only stenting in
STEMI with multivessel disease. The outcomes of interest were death,
reinfarction, urgent, and non-urgent repeat revascularization. Risk ratios
(RR) were pooled using the DerSimonian and Laird random-effects model.
Results After review of 786 citations, 2 RCTs were included. The pooled
results demonstrated a significant reduction in the composite of death,
reinfarction, or revascularization in the FFR-guided multivessel stenting
group versus IRA-only stenting group (RR [95%, Confidence Interval]: 0.49
[0.33-0.72], p < 0.001). This risk reduction was driven mainly by a
reduction in repeat revascularization, both urgent (0.41 [0.24-0.71], p =
0.002) and non-urgent revascularization (0.31 [0.19-0.50], p < 0.001).
Pooled RR for reinfarction was lower in the FFR-guided strategy, but was
not statistically significant (0.71[0.39-1.31], p = 0.28). Conclusions
This systematic review and meta-analysis suggests that a strategy of
FFR-guided multivessel stenting in STEMI patients reduces not only overall
repeat revascularization but also urgent revascularization. The effect on
reinfarction needs to be evaluated in larger trials.<br/>Copyright &#xa9;
2017 Elsevier Ireland Ltd

<45>
Accession Number
619449789
Title
Ultrasound-guided radial artery catheterisation increases the success rate
among anaesthesiology residents: A randomised study.
Source
Journal of Vascular Access. 18 (6) (pp 546-551), 2017. Date of
Publication: November-December 2017.
Author
Gopalasingam N.; Hansen M.A.; Thorn S.; Sloth E.; Juhl-Olsen P.
Institution
(Gopalasingam, Hansen, Thorn, Sloth, Juhl-Olsen) Department of
Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus N,
Denmark
Publisher
Wichtig Publishing Srl (E-mail: jean.jones@wichtig.com)
Abstract
Introduction: The palpation technique is generally used for radial artery
catheterisation, but is associated with a high rate of failure and
complications. Dynamic needle tip positioning (DNTP) is a new
ultrasound-guided technique. We aimed to compare the traditional palpation
technique with DNTP performed by four anaesthesiology residents. Methods:
The study was a randomised, controlled, patient-blinded, crossover study.
Fourty patients underwent bilateral radial artery catheterisation using
both techniques. The primary endpoint was the first attempt success rate.
The secondary endpoints were: 1) number of skin perforations, 2) number of
needle retractions, 3) needle manipulation time, 4) total time, 5)
attempts lasting >180 seconds, 6) number of catheters used, 7) frequency
of aborted attempts or crossovers, and 8) pain scores (VAS). Results: The
first attempt success rate was significantly higher in the DNTP group
compared with the palpation group (36/40 vs. 28/40, p = 0.022). The
palpation technique group required a higher number of skin perforations
(44 vs. 60, p = 0.016), needle retractions (p = 0.001) and catheters (42
vs. 52, p = 0.011) compared with the DNTP group. Neither the total time
required for arterial catheterisation, the needle manipulation time nor
the VAS scores were significantly different between the groups (all
p>0.407). Aborted attempts were only seen in the palpation group (7/40, p
= 0.016). Conclusions: Ultrasound-guided arterial catheterisation using
the DNTP technique is superior to the standard palpation technique. This
study favours the ultrasound-guided DNTP technique as the first choice
rather than merely being viewed as a rescue procedure.<br/>Copyright
&#xa9; 2017 Wichtig Publishing.

<46>
Accession Number
619406774
Title
Transcatheter vs surgical aortic-valve replacement in low- to
intermediate-surgical-risk candidates: A meta-analysis and systematic
review.
Source
Clinical Cardiology. 40 (11) (pp 974-981), 2017. Date of Publication:
November 2017.
Author
Khan S.U.; Lone A.N.; Saleem M.A.; Kaluski E.
Institution
(Khan, Lone, Kaluski) Department of Internal Medicine, Guthrie
Clinic/Robert Packer Hospital, Sayre, PA, United States
(Saleem) Department of Family Medicine, Mercy Health, Janesville, WI,
United States
(Kaluski) Department of Cardiology, Rutgers Medical School, Newark, NJ,
United States
(Kaluski) The Commonwealth Medical College, Scranton, PA, United States
(Kaluski) Department of Cardiology, Guthrie Clinic/Robert Packer Hospital,
Sayre, PA, United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
The American and European expert documents recommend transcatheter aortic
valve replacement (TAVR) for inoperable or high-surgical-risk patients
with severe aortic stenosis. In comparison, efficacy of TAVR is relatively
less studied in low- to intermediate-surgical-risk patients. We sought to
discover whether TAVR can be as effective as surgical aortic valve
replacement (SAVR) in low- to intermediate-surgical-risk candidates. Four
randomized clinical trials (RCTs) and 8 prospective matched studies were
selected using PubMed/MEDLINE, Embase, and Cochrane Library (inception:
March 2017). Results were reported as random-effects odds ratio (OR) with
95% confidence interval (CI). Among 9851 patients, analyses of RCTs showed
that all-cause mortality was comparable between TAVR and SAVR (short term,
OR: 1.19, 95% CI: 0.86-1.64, P = 0.30; mid-term, OR: 0.97, 95% CI:
0.75-1.26, P = 0.84; and long term, OR: 0.97, 95% CI: 0.81-1.16, P =
0.76). The analysis restricted to matched studies showed similar outcomes.
In the analysis stratified by study design, no significant differences
were noted in the RCTs for stroke, whereas TAVR was better than SAVR in
matched studies at short term only (OR: 0.46, 95% CI: 0.33-0.65, P <
0.001). TAVR is associated with reduced risk of acute kidney injury and
new-onset atrial fibrillation (P < 0.05). However, increased incidence of
permanent pacemaker implantation and paravalvular leaks was observed with
TAVR. TAVR can provide similar mortality outcome compared with SAVR in
low- to intermediate-surgical-risk patients with critical aortic stenosis.
However, both procedures are associated with their own array of adverse
events.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<47>
Accession Number
618297611
Title
Comparison of mid- to long-term clinical outcomes between anatomical
testing and usual care in patients with suspected coronary artery disease:
A meta-analysis of randomized trials.
Source
Clinical Cardiology. 40 (11) (pp 1129-1138), 2017. Date of Publication:
November 2017.
Author
Hwang I.-C.; Choi S.J.; Choi J.E.; Ko E.-B.; Suh J.K.; Choi I.; Kang
H.-J.; Kim Y.-J.; Kim J.Y.
Institution
(Hwang, Kang, Kim) Cardiovascular Center and Department of Internal
Medicine, Seoul National University Hospital, Seoul, South Korea
(Choi, Choi, Ko, Suh, Choi, Kim) National Evidence-Based Healthcare
Collaborating Agency, Seoul, South Korea
(Ko) Department of Health Administration, Yonsei University Graduate
School, Wonju, South Korea
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Controversies remain regarding clinical outcomes following
initial strategies of coronary computed tomography angiography (CCTA) vs
usual care with functional testing in patients with suspected coronary
artery disease (CAD). Hypothesis: CCTA as initial diagnostic strategy
results in better mid- to long-term outcomes than usual care in patients
with suspected CAD. Methods: We searched PubMed, Embase, and Cochrane
Library for randomized controlled trials comparing clinical outcomes
during >=6 months' follow-up between initial anatomical testing by CCTA vs
usual care with functional testing in patients with suspected CAD.
Occurrence of all-cause mortality, nonfatal myocardial infarction (MI),
and major adverse cardiovascular events (MACE), and use of invasive
coronary angiography and coronary revascularization, were compared between
the 2 diagnostic strategies. Results: Twelve trials were included (20 014
patients; mean follow-up, 20.5 months). Patients undergoing CCTA as
initial noninvasive testing had lower risk of nonfatal MI compared with
those treated with usual care (risk ratio [RR]: 0.70, 95% confidence
interval [CI]: 0.52-0.94, P = 0.02). There was a tendency for reduced MACE
following initial CCTA strategy, but not for risk of all-cause mortality.
Compared with functional testing, the CCTA strategy increased use of
invasive coronary angiography (RR: 1.53, 95% CI: 1.12-2.09, P = 0.007) and
coronary revascularization (RR: 1.49, 95% CI: 1.11-2.00, P = 0.007).
Conclusions: Anatomical testing with CCTA as the initial noninvasive
diagnostic modality in patients with suspected CAD resulted in lower risk
of nonfatal MI than usual care with functional testing, at the expense of
more frequent use of invasive procedures.<br/>Copyright &#xa9; 2017 Wiley
Periodicals, Inc.

<48>
Accession Number
614901062
Title
The effect of reverse trendelenburg position on incidence of hypotension
after spinal anesthesia for cesarean section.
Source
Journal of the Medical Association of Thailand. 99 (12) (pp 1322-1327),
2016. Date of Publication: December 2016.
Author
Keesakul C.; Sae-Ngow P.; Euaraksakul P.; Karnjanarachata C.
Institution
(Keesakul, Sae-Ngow, Euaraksakul, Karnjanarachata) Department of
Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand
Publisher
Medical Association of Thailand (E-mail: math@loxinfo.co.th)
Abstract
Objective: To prove if 10-degree head-up tilt position during conduction
of spinal anesthesia and continue through the operation will reduce the
incidence of hypotension comparing to horizontal position in elective
cesarean section parturient. Material and Method: In this randomized
double-blind controlled trial. Forty-four parturient were equally
allocated into 10-degree head-up tilt and horizontal position during
conduction of spinal anesthesia and continue during the operation. Blood
pressure, heart rate, incidence of hypotension, ephedrine consumption, and
anesthesia level were compared. Results: Incidence of hypotension and
percentage of parturient that required ephedrine were comparable in
control and study groups (72.73% vs. 45.45%, p = 0.066) but lower before
cord clamping in the study group (68.18% vs. 36.36%, p = 0.03). The
sensory block levels were identical but more parturient in the study group
required reposition in order to gain the required anesthetic level.
Conclusion: Ten-degree head-up tilt position during conduction and
maintenance of spinal anesthesia for cesarean section reduced incidence of
hypotension and ephedrine consumption without any adverse effect in both
parturient and newly-born babies.<br/>Copyright &#xa9; 2016, Medical
Association of Thailand. All rights reserved.

<49>
Accession Number
610888427
Title
Evaluation of right ventricular function after cardiac surgery: The
importance of tricuspid annular plane systolic excursion and right
ventricular ejection fraction.
Source
Journal of Thoracic and Cardiovascular Surgery. 152 (2) (pp 613-620),
2016. Date of Publication: 01 Aug 2016.
Author
Garcia Gigorro R.; Renes Carreno E.; Mayordomo S.; Marin H.; Perez Vela
J.L.; Corres Peiretti M.A.; Montejo Gonzalez J.C.
Institution
(Garcia Gigorro, Renes Carreno, Perez Vela, Corres Peiretti) Intensive
Care Medicine Department, Cardiac Intensive Care Unit Division, Madrid,
Spain
(Mayordomo) Cardiology Department, Hospital Universitario 12 de Octubre,
Madrid, Spain
(Marin, Montejo Gonzalez) Intensive Care Medicine Department, Hospital
Universitario 12 de Octubre, Madrid, Spain
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective The evaluation of right ventricular systolic function is
essential to the hemodynamic management of critically ill cardiac
patients. Nevertheless, assessment of right ventricular function remains
problematic. We sought to analyze the correlation between tricuspid
annular plane systolic excursion (TAPSE) and right ventricular ejection
fraction (RVEF) in the assessment of global and regional right ventricular
function, respectively. Methods This was a prospective study of 61 cardiac
surgical patients. TAPSE was measured with transthoracic echocardiography
and RVEF was obtained by a thermodilution pulmonary artery catheter. Both
measurements were estimated simultaneously during the early postoperative
period. Patients with previously identified severe tricuspid insufficiency
were excluded from the study to avoid confounding results. Results The
etiologies for cardiac surgery were surgical pulmonary
thromboendarterectomy in 19 patients, valve replacement in 17 patients,
heart transplant in 13 patients, and coronary artery bypass graft in 9
patients. Mean RVEF and TAPSE were 26.2% +/- 9.7% and 11.4 +/- 4 mm,
respectively. RVEF and TAPSE showed a significant correlation (r = 0.73, P
< .001). Weak reverse relationships between TAPSE or RVEF with afterload
hemodynamic parameters, mean pulmonary artery pressure, or pulmonary
vascular resistance were elucidated. Conclusions TAPSE is a robust measure
of right ventricular function that correlates with RVEF assessed by
pulmonary artery catheter. A noninvasive method such as echocardiography
can guide and support invasive monitoring of right ventricular function in
cardiac surgical patients.<br/>Copyright &#xa9; 2016 The American
Association for Thoracic Surgery

<50>
Accession Number
617639333
Title
Outcome after percutaneous edge-to-edge mitral repair for functional and
degenerative mitral regurgitation: A systematic review and meta-analysis.
Source
Heart. 104 (4) (pp 306-312), 2018. Date of Publication: 01 Feb 2018.
Author
Chiarito M.; Pagnesi M.; Martino E.A.; Pighi M.; Scotti A.; Biondi-Zoccai
G.; Latib A.; Landoni G.; Mario C.D.; Margonato A.; Maisano F.; Feldman
T.; Alfieri O.; Colombo A.; Godino C.
Institution
(Chiarito) Interventional Cardiology Unit, Humanitas Clinical and Research
Center, Rozzano, Italy
(Pagnesi, Scotti, Latib, Margonato, Colombo, Godino) Interventional
Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina 60,
Milan 20132, Italy
(Martino, Landoni) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Pighi, Mario) Department of Cardiology, NIHR Biomedical Research Unit,
Royal Brompton Hospital, London, United Kingdom
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Roma, Department of
AngioCardioNeurology, Pozzilli, Latina, Italy
(Latib, Colombo) Interventional Cardiology Unit, EMO-GVM Centro Cuore
Columbus, Milan, Italy
(Landoni, Margonato, Alfieri, Colombo) Vita-Salute San Raffaele
University, Milan, Italy
(Maisano) Universitats Spital Zurich, University Heart Center, Zurich,
Switzerland
(Feldman) NorthShore University HealthSystem, Evanston, IL, United States
(Alfieri) Cardiac Surgery Unit, San Raffaele Hospital, Milan, Italy
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives Differences in terms of safety and efficacy of percutaneous
edge-to-edge mitral repair between patients with functional and
degenerative mitral regurgitation (MR) are not well established. We
performed a systematic review and meta-analysis to clarify these
differences. Methods PubMed, EMBASE, Google scholar database and
international meeting abstracts were searched for all studies about
MitraClip. Studies with <25 patients or where 1-year results were not
delineated between MR aetiology were excluded. This study is registered
with PROSPERO. Results A total of nine studies investigating the mid-term
outcome of percutaneous edge-to-edge repair in patients with functional
versus degenerative MR were included in the meta-analysis (n=2615). At 1
year, there were not significant differences among groups in terms of
patients with MR grade<=2 (719/1304 vs 295/504; 58% vs 54%; risk ratio
(RR) 1.12; 95% CI: 0.86 to 1.47; p=0.40), while there was a significantly
lower rate of mitral valve re-intervention in patients with functional MR
compared with those with degenerative MR (77/1770 vs 80/818; 4% vs 10%; RR
0.60; 95% CI: 0.38 to 0.97; p=0.04). One-year mortality rate was 16%
(408/2498) and similar among groups (RR 1.26; 95% CI: 0.90 to 1.77;
p=0.18). Functional MR group showed significantly higher percentage of
patients in New York Heart Association class III/IV (234/1480 vs 49/583;
16% vs 8%; p<0.01) and re-hospitalisation for heart failure (137/605 vs
31/220; 23% vs 14%; p=0.03). No differences were found in terms of single
leaflet device attachment (25/969 vs 20/464; 3% vs 4%; p=0.81) and device
embolisation (no events reported in both groups) at 1 year. Conclusions
This meta-analysis suggests that percutaneous edge-to-edge repair is
likely to be an efficacious and safe option in patients with both
functional and degenerative MR. Large, randomised studies are ongoing and
awaited to fully assess the clinical impact of the procedure in these two
different MR aetiologies.<br/>Copyright &#xa9; Article author(s) (or their
employer(s) unless otherwise stated in the text of the article) 2018.

<51>
Accession Number
623222438
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.
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
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.

<52>
Accession Number
2000990587
Title
Patient-Controlled Paravertebral Block for Video-Assisted Thoracic
Surgery: A Randomized Trial.
Source
Annals of Thoracic Surgery. (no pagination), 2018. Date of Publication:
2018.
Author
Wu Z.; Fang S.; Wang Q.; Wu C.; Zhan T.; Wu M.
Institution
(Wu, Fang, Wang, Zhan, Wu) Department of Thoracic Surgery, the Second
Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou,
China
(Wu) Department of Medical Quality Management, the Women's Hospital,
Zhejiang University School of Medicine, Hangzhou, China
Publisher
Elsevier USA
Abstract
Background: Paravertebral block (PVB) has been proven to be an efficient
way to control postoperative pain in patients who have undergone a
thoracotomy. This study explored whether the use of a patient-controlled
PVB can provide benefits over intravenous patient-controlled analgesia
(PCA) for 3-port single-intercostal video-assisted thoracic surgery.
Methods: From May 2015 to December 2016, patients who had solitary
pulmonary nodules or spontaneous pneumothorax and underwent
single-intercostal video-assisted thoracic surgery were randomly allocated
to receive patient-controlled PVB or intravenous PCA. Intramuscular
dezocine (10 mg) was used as a rescue medication. None of the surgeons,
patients, or investigators assessing outcomes or analyzing the data were
blinded to the group assignments. Pain level was measured by the visual
analog score. Results: There were 86 patients assigned to the PVB group
and 85 patients assigned to the PCA group. The difference in the mean
visual analog score between these two groups was not significant (p =
0.115). For patients who needed rescue medication, the cumulative dezocine
dose in the PVB group was significantly lower than that in the PCA group
(21.7 mg vs 30.9 mg, p = 0.001) throughout the 4 postoperative days. The
frequencies of severe vomiting (p = 0.003) and hypotension (p = 0.005)
were significantly lower in the PVB group. Conclusions: PVB, which
resulted in lower cumulative dezocine doses and produced fewer side
effects than PCA, can provide effective pain relief for patients
undergoing video-assisted thoracic surgery.<br/>Copyright &#xa9; 2018 The
Society of Thoracic Surgeons

<53>
Accession Number
2000990084
Title
Effect of Dexmedetomidine Infusion on Sublingual Microcirculation in
Patients Undergoing On-Pump Coronary Artery Bypass Graft Surgery: A
Prospective Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Author
Mohamed H.; Hosny H.; Tawadros, MD P.; Elayashy, MD, DESA, FCAI M.;
El-Ashmawi, MD H.
Institution
(Mohamed, Hosny, Tawadros, MD, Elayashy, MD, DESA, FCAI, El-Ashmawi, MD)
Department of Anesthesia and Intensive Care, Kasr Al-Ainy Faculty of
Medicine, Cairo University, London, United Kingdom
(Hosny) Department of Cardiothoracic Anaesthesia, Royal Brompton Hospital,
Sydney Street, London, United Kingdom
Publisher
W.B. Saunders
Abstract
Objectives: Cardiac surgery is characterized by attenuation of
microcirculatory perfusion. Dexmedetomidine has been proved to attenuate
the microcirculatory derangements evoked by experimental sepsis. The
authors investigated the effects of dexmedetomidine infusion on sublingual
microcirculation in patients undergoing on-pump coronary artery bypass
graft (CABG) surgery. Design: Prospective, randomized blinded study.
Settings: Tertiary university hospital. Participants: A total of 70 adults
undergoing elective on-pump CABG surgery. Intervention: After a standard
general anesthesia, participants were allocated randomly to receive either
propofol continuous intravenous infusion, 50 to 70 micro&#32;g/kg/min, or
propofol infusion, 50 to 70 micro&#32;g/kg/min plus dexmedetomidine
infusion, 0.5 micro&#32;g/kg/h, during cardiopulmonary bypass.
Microcirculation was studied with side-stream dark field imaging at 3
times: immediately before starting bypass (T0), 30 minutes after
initiation of bypass (T1), and 30 minutes after weaning from bypass (T2).
Measurements and Main Results: Microvascular flow index was significantly
higher in the dexmedetomidine group at T2 compared to the control group
(2.20 +/- 0.29 and 1.47 +/- 0.30, respectively; p = 0.001). The perfused
vessel density was significantly higher in the dexmedetomidine group at T2
compared to the control group (6.1 [3-8.9] mm/mm2 and 3.3 [2.2-4.3] mm/mm2
respectively; p = 0.01). The total vascular density was significantly
higher in the dexmedetomidine group compared to the control group at T1
and T2 (9.9 [7.8-12.6] mm/mm2 v 7.4 [6.1-9] mm/mm2 p = 0.005; and 9.27 +/-
2.27 mm/mm2 v 7.24 +/- 1.66 mm/mm2 p = 0.003, respectively). Conclusion:
This trial demonstrated that dexmedetomidine infusion improved sublingual
microcirculation indices in patients undergoing on-pump CABG
surgery.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<54>
Accession Number
2000989446
Title
Mini-Stern Trial: A randomized trial comparing mini-sternotomy to full
median sternotomy for aortic valve replacement.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Author
Nair S.K.; Sudarshan C.D.; Thorpe B.S.; Singh J.; Pillay T.; Catarino P.;
Valchanov K.; Codispoti M.; Dunning J.; Abu-Omar Y.; Moorjani N.; Matthews
C.; Freeman C.J.; Fox-Rushby J.A.; Sharples L.D.
Institution
(Nair, Sudarshan, Catarino, Valchanov, Codispoti, Dunning, Abu-Omar,
Moorjani, Matthews, Freeman) Department of Cardiothoracic Surgery,
Papworth Hospital, Cambridge, United Kingdom
(Nair, Pillay) Freeman Hospital, Newcastle upon Tyne, United Kingdom
(Thorpe) Leeds Institute of Clinical Trials Research, University of Leeds,
Leeds, United Kingdom
(Singh, Fox-Rushby) Health Economics Research Group, Brunel University
London, London, United Kingdom
(Sharples) London School of Hygiene and Tropical Medicine, Keppel Street,
London, United Kingdom
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Aortic valve replacement (AVR) can be performed either through
full median sternotomy (FS) or upper mini-sternotomy (MS). The Mini-Stern
trial aimed to establish whether MS leads to quicker postoperative
recovery and shorter hospital stay after first-time isolated AVR. Methods:
This pragmatic, open-label, parallel randomized controlled trial (RCT)
compared MS with FS for first-time isolated AVR in 2 United Kingdom
National Health Service hospitals. Primary endpoints were duration of
postoperative hospital stay and the time to fitness for discharge from
hospital after AVR, analyzed in the intent-to-treat population. Results:
In this RCT, 222 patients were recruited and randomized (n = 118 in the MS
group; n = 104 in the FS group). Compared with the FS group, the MS group
had a longer hospital length of stay (mean, 9.5 days vs 8.6 days) and took
longer to achieve fitness for discharge home (mean, 8.5 days vs 7.5 days).
Adjusting for valve type, sex, and surgeon, hazard ratios (HRs) from Cox
models did not show a statistically significant effect of MS (relative to
FS) on either hospital stay (HR, 0.874; 95% confidence interval [CI],
0.668-1.143; P =.3246) or time to fitness for discharge (HR, 0.907; 95%
CI, 0.688-1.197; P value =.4914). During a mean follow-up of 760 days (745
days for the MS group and 777 days for the FS group), 12 patients (10%) in
the MS group and 7 patients (7%) in the FS group died (HR, 1.871; 95% CI,
0.723-4.844; P =.1966). Average extra cost for MS was 1714 during the
first 12 months after AVR. Conclusions: Compared with FS for AVR, MS did
not result in shorter hospital stay, faster recovery, or improved survival
and was not cost-effective. The MS approach is not superior to FS for
performing AVR.<br/>Copyright &#xa9; 2018 The American Association for
Thoracic Surgery

<55>
Accession Number
2000988720
Title
Double-Blind, Randomized, Placebo-Controlled Trial Comparing the Effects
of Antithrombin Versus Placebo on the Coagulation System in Infants with
Low Antithrombin Undergoing Congenital Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Author
Jooste E.H.; Scholl R.; Wu Y.-H.; Jaquiss R.D.B.; Lodge A.J.; Ames W.A.;
Homi H.M.; Machovec K.A.; Greene N.H.; Donahue B.S.; Shah N.; Benkwitz C.
Institution
(Jooste, Scholl, Ames, Homi, Machovec, Greene) Pediatric Anesthesiology,
Department of Anesthesiology, Duke University Medical Center, Durham, NC,
United States
(Wu) Department of Biostatistics and Bioinformatics, Duke University
Medical Center, Durham, NC, United States
(Jaquiss) Department of Cardiovascular and Thoracic Surgery, UT
Southwestern Medical Center and Children's Medical Center, Dallas, TX,
United States
(Lodge) Division of Congenital Cardiac Surgery, Department of
Cardiothoracic Surgery, Duke University Medical Center, Durham, United
States
(Donahue) Division of Pediatric Cardiac Anesthesiology, Monroe Carell Jr
Children's Hospital, Vanderbilt University Medical Center, Nashville, TN,
United States
(Shah) Division of Pediatric Hematology/Oncology, Duke University Medical
Center, Durham, NC, United States
(Benkwitz) Department of Anesthesia and Perioperative Care, UCSF Benioff
Children's Hospital, San Francisco, CA, United States
Publisher
W.B. Saunders
Abstract
Objectives: To determine whether precardiopulmonary bypass (CPB)
normalization of antithrombin levels in infants to 100% improves heparin
sensitivity and anticoagulation during CPB and has beneficial effects into
the postoperative period. Design: Randomized, double-blinded,
placebo-controlled prospective study. Setting: Multicenter study performed
in 2 academic hospitals. Participants: The study comprised 40 infants
younger than 7 months with preoperative antithrombin levels <70%
undergoing CPB surgery. Interventions: Antithrombin levels were increased
with exogenous antithrombin to 100% functional level intraoperatively
before surgical incision. Measurements and Main Results: Demographics,
clinical variables, and blood samples were collected up to postoperative
day 4. Higher first post-heparin activated clotting times (sec) were
observed in the antithrombin group despite similar initial heparin dosing.
There was an increase in heparin sensitivity in the antithrombin group.
There was significantly lower 24-hour chest tube output (mL/kg) in the
antithrombin group and lower overall blood product unit exposures in the
antithrombin group as a whole. Functional antithrombin levels (%) were
significantly higher in the treatment group versus placebo group until
postoperative day 2. D-dimer was significantly lower in the antithrombin
group than in the placebo group on postoperative day 4. Conclusion:
Supplementation of antithrombin in infants with low antithrombin levels
improves heparin sensitivity and anticoagulation during CPB without
increased rates of bleeding or adverse events. Beneficial effects may be
seen into the postoperative period, reflected by significantly less
postoperative bleeding and exposure to blood products and reduced
generation of D-dimers.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<56>
Accession Number
623277154
Title
Effects of lowest-dose vs. highest-dose pitavastatin on coronary
neointimal hyperplasia at 12-month follow-up in type 2 diabetic patients
with non-ST elevation acute coronary syndrome: an optical coherence
tomography analysis.
Source
Heart and Vessels. (no pagination), 2018. Date of Publication: 2018.
Author
Lim J.W.; Jeong H.S.; Hong S.J.; Kim H.J.; Kim Y.C.; Kang B.G.; Jeon S.M.;
Cho J.Y.; Lee S.H.; Joo H.J.; Park J.H.; Yu C.W.
Institution
(Lim, Jeong, Hong, Kim, Kim, Kang, Jeon, Cho, Lee, Joo, Park, Yu)
Department of Cardiology, Cardiovascular Center, Korea University Anam
Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul 136-705, South Korea
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Current ACC/AHA guidelines recommend high-dose statin therapy after
coronary stenting, especially in diabetic patients; however, pitavastatin
4 mg or pitavastatin 1 mg are frequently used after coronary stenting in
Asia, even in patients with acute coronary syndrome. We compared the
effects of highest-dose and lowest-dose pitavastatin therapy on coronary
neointimal hyperplasia at 12-month follow-up in diabetic patients with
non-ST-elevation acute coronary syndrome (NSTE-ACS) using optical
coherence tomography. A total of 72 diabetic patients with NSTE-ACS were
randomized to lowest-dose pitavastatin [1 mg (n = 36)] or highest-dose
pitavastatin [4 mg (n = 36)] after everolimus-eluting stent implantation.
The primary endpoint was to compare the normalized neointimal volume at
12-month follow-up. Normalized neointimal volume was significantly lower
in the pitavastatin 4 mg group (4.00 +/- 2.80 vs. 8.24 +/- 2.83
mm³/mm, p < 0.01) at 12-month follow-up. There was also
significant difference in neointimal area between the pitavastatin 4 mg
group and pitavastatin 1 mg group (0.41 +/- 0.28 vs. 0.74 +/- 0.23
mm², p < 0.01). Improvement of brachial artery flow-mediated
dilation (baFMD) was significantly higher in the pitavastatin 4 mg group
than in pitavastatin 1 mg group (0.15 +/- 0.15 vs. - 0.03 +/- 0.19 mm, p <
0.001). In addition, the improvement of adiponectin levels was
significantly greater in the pitavastatin 4 mg group than in the
pitavastatin 1 mg group (2.97 +/- 3.98 vs. 0.59 +/- 2.80 mug/mL, p <
0.05). Pitavastatin 4 mg significantly improved inflammatory cytokines and
lipid profiles compared to pitavastatin 1 mg during the 12-month
follow-up, contributing to the reduction of neointimal hyperplasia and to
the improvement of baFMD in diabetic patients with NSTE-ACS requiring
coronary stenting. Thus, the administration of pitavastatin 4 mg can be
safely and effectively used in high-risk patients requiring coronary
stenting. Trial registration NCT02545231 (Clinical Trial registration
information:
https://clinicaltrials.gov/ct2/show/NCT02545231).<br/>Copyright &#xa9;
2018, Springer Japan KK, part of Springer Nature.