EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
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Accession Number
623433971
Title
Percutaneous coronary intervention for treating de-novo lesions in small
coronary vessels: Initial experience with the Essential paclitaxel-coated
balloon.
Source
Coronary Artery Disease. 29 (6) (pp 477-481), 2018. Date of Publication:
01 Sep 2018.
Author
Abellas-Sequeiros R.A.; Benezet J.; Agarrado Luna A.; Oneto Otero J.; Dery
J.-P.; Cieza T.; Delarochelliere R.; Duocastella L.; Gomez A.; Molina M.;
Asmarats L.; Pelletier-Beaumont E.; Puri R.; Rodes-Cabau J.
Institution
(Abellas-Sequeiros, Dery, Cieza, Delarochelliere, Asmarats,
Pelletier-Beaumont, Puri, Rodes-Cabau) Quebec Heart and Lung Institute,
Laval University, 2725 Chemin Ste-Foy, Quebec City, QC, Canada
(Benezet, Agarrado Luna, Oneto Otero) Department of Cardiology, Hospital
de Jerez de la Frontera, Jerez de la Frontera Cadiz, Spain
(Duocastella, Gomez, Molina) IVascular, Barcelona, Spain
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background Paclitaxel-coated balloon (PCB) coronary angioplasty is an
alternative treatment for de-novo coronary lesions in small vessels. This
study with the new Essential PCB aimed to evaluate early and mid-Term
clinical outcomes following angioplasty with the Essential PCB in the
treatment of de-novo lesions in small vessels. Patients and methods We
included all patients who underwent PCB angioplasty for treating de-novo
coronary lesions in small vessels (reference diameter <2.5 mm) between
October 2015 and June 2016 in 2 centres. The primary endpoint was the
12-month target lesion failure (TLF) rate: A composite of cardiac death,
target vessel-related myocardial infarction, and target lesion
revascularization. The secondary endpoints were rates of target vessel
failure and global major adverse cardiac events (MACE). Results A total of
71 patients (comprising 71 lesions) were included, with a mean age of
66+/-11 years. A 56% were diabetic and 70% had an acute coronary syndrome
as an indication for coronary revascularization. The mean vessel diameter
and lesion length were 2.21+/-0.41 and 20.7+/-9.2 mm, respectively.
Predilatation was performed in 85.9% of patients. The median diameter,
length, and inflation pressure of the Essential balloon were 2.0
[interquartile range (IQR): 2.0-2.5] mm, 20 (IQR: 15-30) mm, and 12+/-2
atmospheres, respectively. Angiographic success was achieved in 97.2% of
cases, and bail-out stenting was required in nine (12.7%) cases. The
incidence of TLF at the 12-month follow-up was 4.2%, with a target lesion
revascularization rate of 4.2%. Target vessel failure and global MACE
rates were 4.2 and 9.9%, respectively. Conclusion Use of the Essential PCB
for treating de-novo coronary lesions in small vessels was safe, with low
TLF and MACE rates at the 12-month follow-up.<br/>&#xa9; Copyright 2018
Wolters Kluwer Health, Inc. All rights reserved.

<2>
Accession Number
623428402
Title
A review of combination antimicrobial therapy for enterococcus faecalis
bloodstream infections and infective endocarditis.
Source
Clinical Infectious Diseases. 67 (2) (pp 303-309), 2018. Date of
Publication: 02 Jul 2018.
Author
Beganovic M.; Luther M.K.; Rice L.B.; Arias C.A.; Rybak M.J.; Laplante
K.L.
Institution
(Beganovic, Luther, Laplante) College of Pharmacy, University of Rhode
Island, 7 Greenhouse Rd, Ste 295A, Kingston, RI 02881, United States
(Beganovic, Luther, Laplante) Infectious Diseases Research Program,
Providence Veterans Affairs Medical Center, Providence, RI, United States
(Luther, Laplante) Center of Innovation in Long-Term Services and
Supports, Providence Veterans Affairs Medical Center, Providence, RI,
United States
(Rice) Rhode Island Hospital, Providence, Rhode Island, Providence, RI,
United States
(Rice, Laplante) Warren Alpert Medical School of Brown University,
Division of Infectious Diseases, Providence, RI, United States
(Arias) Center for Antimicrobial Resistance and Microbial Genomics,
Division of Infectious Diseases, Department of Internal Medicine,
Department of Microbiology and Molecular Genetics, University of Texas
Health Science Center at Houston (UTHealth), McGovern Medical School,
Bogota, Colombia
(Arias) Center for Infectious Diseases, UTHealth School of Public Health,
Bogota, Colombia
(Arias) Molecular Genetics and Antimicrobial Resistance Unit,
International Center for Microbial Genomics, Universidad El Bosque,
Bogota, Colombia
(Rybak) Anti-Infective Research Laboratory, Department of Pharmacy
Practice, Eugene Applebaum College of Pharmacy and Health Sciences,
Michigan, United States
(Rybak) Department of Medicine, Division of Infectious Diseases, School of
Medicine, Wayne State University, Michigan, United States
(Rybak) Department of Pharmacy Services, Detroit Receiving Hospital,
Michigan, United States
Publisher
Oxford University Press
Abstract
Enterococci, one of the most common causes of hospital-associated
infections, are responsible for substantial morbidity and mortality.
Enterococcus faecalis, the more common and virulent species, causes
serious high-inoculum infections, namely infective endocarditis, that are
associated with cardiac surgery and mortality rates that remained
unchanged for the last 30 years. The best cures for these infections are
observed with combination antibiotic therapy; however, optimal treatment
has not been fully elucidated. It is the purpose of this review to
highlight treatment options and their limitations, and provide direction
for future investigative efforts to aid in the treatment of these severe
infections. While ampicillin plus ceftriaxone has emerged as a preferred
treatment option, mortality rates continue to be high, and from a safety
standpoint, ceftriaxone, unlike other cephalosporins, promotes
colonization with vancomycin resistant-enterococci due to high biliary
concentrations. More research is needed to improve patient outcomes from
this high-mortality disease.<br/>Copyright &#xa9; Published by Oxford
University Press for the Infectious Diseases Society of America 2018.

<3>
Accession Number
623324833
Title
Platelet storage duration and its clinical and transfusion outcomes: A
systematic review.
Source
Critical Care. 22 (1) (no pagination), 2018. Article Number: 185. Date of
Publication: 05 Aug 2018.
Author
Aubron C.; Flint A.W.J.; Ozier Y.; McQuilten Z.
Institution
(Aubron) Centre Hospitalier et Universitaire de Brest - Universite de
Bretagne Occidentale, The Medical Intensive Care Unit, Bvd Tanguy Prigent,
Brest Cedex 29609, France
(Aubron, Flint, McQuilten) Monash University, The Australian and New
Zealand Intensive Care Research Centre, Department of Epidemiology and
Preventive Medicine, Melbourne, Australia
(McQuilten) Monash University, The Transfusion Research Unit, Department
of Epidemiology and Preventive Medicine, Melbourne, Australia
(Flint) Royal Australian Navy, Australian Defence Force, Canberra,
Australia
(Ozier) Centre Hospitalier et Universitaire de Brest - Universite de
Bretagne Occidentale, The Department of Anesthesiology, Brest, France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Platelets (PLTs) are usually stored for up to 5days prior to
transfusion, although in some blood services the storage period is
extended to 7days. During storage, changes occur in both PLT and storage
medium, which may lead to PLT activation and dysfunction. The clinical
significance of these changes remains uncertain. Methods: We performed a
systematic review to assess the association between PLT storage time and
clinical or transfusion outcomes in patients receiving allogeneic PLT
transfusion. We searched studies published in English between January 2000
and July 2017 identified from MEDLINE, Embase, PubMed and the Cochrane
Libraries. Results: Of the 18 studies identified, five included 4719
critically ill patients (trauma, post-cardiac surgery and a heterogeneous
population of critically ill patients) and 13 included 8569 haematology
patients. The five studies in critically ill patients were retrospective
and did not find any association between PLT storage time when PLTs were
stored for up to 5days and mortality. There was also no association
between older PLTs and sepsis in the two largest studies (n=4008
patients). Of the 13 studies in haematology patients, seven analysed
prolonged storage time up to 6.5 or 7days. Administration of fresh PLTs
(less than 2 or 3days) was associated with a significant increase in
corrected count increment (CCI) compared to older PLTs in seven of the
eight studies analysing this outcome. One single centre retrospective
study found an increase in bleeding events in patients receiving older
PLTs. Conclusions: PLT storage time does not appear to be associated with
clinical outcomes, including bleeding, sepsis or mortality, in critically
ill patients or haematology patients. The freshest PLTs (less than 3days)
were associated with a better CCI, although there was no impact on
bleeding events, questioning the clinical significance of this
association. However, there is an absence of evidence to draw definitive
conclusions, especially in critically ill patients.<br/>Copyright &#xa9;
2018 The Author(s).

<4>
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Accession Number
614962304
Title
Effects of methods used to achieve hemostasis on radial artery occlusion
following percutaneous coronary procedures: A systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 15 (3) (pp
738-764), 2017. Date of Publication: 01 Mar 2017.
Author
Fernandez R.S.; Lee A.
Institution
(Fernandez) Centre for Evidence Based Initiatives in Health Care, Joanna
Briggs Institute Centre of Excellence, Australia
(Fernandez) School of Nursing, University of Wollongong, Wollongong,
Australia
(Fernandez) Centre for Research in Nursing and Health, St George Hospital,
Sydney, Australia
(Lee) Wollongong Hospital, Wollongong, Australia
(Lee) School of Medicine, University of Wollongong, Wollongong, Australia
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Background Transradial access to percutaneous coronary procedures is
becoming the preferred access route, and it is being increasingly used for
emergent and elective procedures. However, radial artery occlusion (RAO)
continues to remain an adverse occurrence following sheath removal or in
the first 24 hours following sheath removal due to the smaller diameter of
the artery. Objectives The overall objective of this study was to
synthesize the best available research evidence related to the effects of
methods used to achieve hemostasis on RAO rates after percutaneous
coronary procedures. Inclusion criteria Types of participants The current
review considered trials that included adult patients (18 years and over)
who have had a coronary angiography or coronary re-vascularization
intervention via the radial artery. Types of intervention(s) The
interventions of interest were the use of various hemostatic methods
compared to traditional interventions to prevent RAO. Types of studies All
randomized and quasi-randomized controlled trials evaluating the effect of
various hemostatic methods on RAO rates after percutaneous coronary
procedures were included in the review. Outcomes The primary outcome of
interest was the incidence of RAO at the time of discharge and persistent
occlusion at the time of follow-up. Search strategy The search aimed to
find published and unpublished trials through electronic databases,
reference lists and key reports. An extensive search was undertaken for
the following databases - CINAHL, Embase, PubMed and the Cochrane Central
Register of Controlled Trials (CENTRAL). Databases were searched up to May
2016. The search for unpublished trials included Dissertation Abstracts
International, World Cat, Clinicaltrials.gov, ProQuest Dissertation and
Theses and MedNar. Methodological quality Methodological quality was
assessed independently by two reviewers using the Joanna Briggs Institute
Meta- Analysis of Statistics Assessment and Review Instrument
(JBI-MAStARI) checklist. Disagreements that arose between the reviewers
were resolved through discussion. Data extraction Quantitative data were
extracted from papers included in the review by one reviewer using the
standardized data extraction tool from JBI-MAStARI. The data extracted
were checked by a second reviewer. Disagreements that arose between the
reviewerswere resolved through discussion. All resultswere subject to
double data entry in ReviewManager. Data synthesis Statistical pooling of
the data was not possible due to the heterogeneity of the trials;
therefore, the findings are presented in narrative form. However, figures
have been used to illustrate the results. Results A total of seven trials
were included in the review. One trial demonstrated a significant
reduction in RAO rates in patients who had a mean arterial pressure
(MAP)-guided TR band to a standard TR band (odds ratio [OR] 0.08; 95%
confidence interval [CI] 0.02, 0.37). A statistically significant
reduction in the incidence of RAO was observed among patients who received
a biopolymer dressing (Chitosen) compared to those who received the TR
band (OR 2.20; 95% CI 1.20, 4.02). No statistically significant difference
in the incidence of RAO was reported between those who received the TR
band and those who received either the elastic bandage (P1/40.08) or T
band (P1/40.76). Similarly, no statistically significant difference in
rates of RAO among patients was reported among those who had pro-coagulant
dressings compared to those who had short or long manual compression. One
trial that compared the TR band to a MAP-guided TR band demonstrated no
statistically significant difference in the time taken to obtain
hemostasis between the two groups (P1/40.61). A statistically significant
reduction in the time taken to obtain hemostasis was observed among
patients who received the hemostatic biopolymer dressing compared to the
TR band. No statistically significant difference in the incidence of
hematoma was identified among patients who received pneumatic compression
or traditional compression to achieve hemostasis. Conclusion There is
limited evidence to support the use of any single hemostatic method to
prevent RAO rates after percutaneous coronary procedures. Although used
extensively, there is evidence of no effect of the pneumatic compression
method using the TR band on the incidence of RAO at discharge or
follow-up, the time taken to obtain hemostasis and the incidence of
hematoma. The MAP-guided compression method and the Biopolymer dressing
(Chitosen) were superior to the TR band compression method, and patent
hemostasis was superior to hemoband in the prevention of RAO. However,
these results are based on single trials and should be interpreted with
caution. The evidence obtained from the review does not provide a concrete
base for the development of practice guidelines. Until more robust
evidence is available, practices will continue to be dictated by local
preferences and available resources.<br/>Copyright &#xa9; 2017 The Joanna
Briggs Institute.

<5>
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Accession Number
620970795
Title
The use of therapeutic magnesium for neuroprotection during global
cerebral ischemia associated with cardiac arrest and cardiac surgery in
adults: A systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 15 (1) (pp
86-118), 2017. Date of Publication: 2017.
Author
Pearce A.; Lockwood C.; Van Den Heuvel C.; Pearce J.
Institution
(Pearce, Lockwood, Pearce) Joanna Briggs Institute, Faculty of Health and
Medical Sciences, University of Adelaide, Adelaide, Australia
(Van Den Heuvel) School of Medical Sciences, Faculty of Health and Medical
Sciences, University of Adelaide, Adelaide, Australia
(Pearce) School of Nursing, Midwifery and Paramedicine, Australian
Catholic University, Canberra, Australia
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Background: Global cerebral ischemia occurs due to reduced blood supply to
the brain. This is commonly caused by a cessation of myocardial activity
associated with cardiac arrest and cardiac surgery. Survival is not the
only important outcome because neurological dysfunction impacts on quality
of life, reducing independent living. Magnesium has been identified as a
potential neuroprotective agent; however, its role in this context is not
yet clear. Objectives: The objective of this review was to present the
best currently available evidence related to the neuroprotective effects
of magnesium during a period of global cerebral ischemia in adults with
cardiac arrest or cardiac surgery. Inclusion criteria Types of
participants: The current review considered adults aged over 18 years who
were at risk of global cerebral ischemia associated with cardiac arrest or
cardiac surgery. Studies of patients with existing neurological deficits
or under the age of 18 years were excluded from the review. Types of
intervention(s)/phenomena of interest: The intervention of interest was
magnesium administered in doses of at least of 2 g compared to placebo to
adult patients within 24 hours of cardiac arrest or cardiac surgery. Types
of studies: The current review considered experimental designs including
randomized controlled trials, non-randomized controlled trials and
quasi-experimental designs. Outcomes: The outcome of interest were
neurological recovery post-cardiac arrest or cardiac surgery, as measured
by objective scales, such as but not limited to, cerebral performance
category, brain stem reflexes, Glasgow Coma Score and independent living
or dependent living status. To enable assessment of the available data,
neuroprotection was examined by breaking down neurological outcomes into
three domains - functional neurological outcomes, neurophysiological
outcomes and neuropsychological outcomes. Search strategy: The search
strategy aimed to find both published and unpublished studies between
January 1980 and August 2014, utilizing the Joanna Briggs Institute (JBI)
three-step search strategy. Databases searched included PubMed, Embase,
CINAHL, Cochrane Central Register of Controlled Trials, Australian
Clinical Trials Register, Australian and New Zealand Clinical Trials
Register, Clinical Trials, European Clinical Trials Register and ISRCTN
Registry.<br/>Copyright &#xa9; 2017 THE JOANNA BRIGGS INSTITUTE.

<6>
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Accession Number
616277624
Title
Effectiveness of haloperidol prophylaxis in critically ill patients with a
high risk of delirium: A systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 15 (5) (pp
1440-1472), 2017. Date of Publication: 01 May 2017.
Author
Santos E.; Cardoso D.; Neves H.; Cunha M.; Rodrigues M.; Apostolo J.
Institution
(Santos, Cardoso, Neves, Rodrigues, Apostolo) Health Sciences Research
Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence
Based Practice, Joanna Briggs Institute Centre of Excellence, Australia
(Santos) Emergency Department, Centro Hospitalar e Universitario de
Coimbra (CHUC), Coimbra, Portugal
(Cunha) Research and Development Unit, Centre of Studies in Education,
Health and Technology, Viseu, Portugal
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
EXECUTIVE SUMMARYBackground Delirium is associated with increased
intensive care unit and hospital length of stay, prolonged duration of
mechanical ventilation, unplanned removal of tubes and catheters, and
increased morbidity and mortality. Prophylactic treatment with low-dose
haloperidol may have beneficial effects for critically ill patients with a
high risk of delirium. Objectives To identify the effectiveness of
haloperidol prophylaxis in critically ill patients with a high risk for
delirium. Inclusion criteria Types of participants Patients with a
predicted high risk of delirium, aged 18 years or over, and in intensive
care units. Patients with a history of concurrent antipsychotic medication
use were excluded. Types of intervention(s)/phenomena of interest
Haloperidol prophylaxis for preventing delirium. Types of studies
Experimental and epidemiological study designs. Outcomes Primary outcome
is the incidence of delirium. Secondary outcomes are duration of
mechanical ventilation, incidence of re-intubation, incidence of
unplanned/accidental removal of tubes/lines and catheters, intensive care
unit and hospital length of stay, and re-admissions to both settings.
Search strategy An initial search of MEDLINE and CINAHL was undertaken,
followed by a second search for published and unpublished studies from
January 1967 to September 2015 in major healthcare-related electronic
databases. Studies in English, Spanish and Portuguese were included.
Methodological quality Two independent reviewers assessed the
methodological quality of five studies using the standardized critical
appraisal instrument from the Joanna Briggs Institute Meta-Analysis of
Statistics Assessment and Review Instrument. There was general agreement
among the reviewers to exclude one relevant study due to methodological
quality. Data extraction Data were extracted using the JBI data extraction
form for experimental studies and included details about the
interventions, populations, study methods and outcomes of significance to
the review questions. Data synthesis Significant differences were found
between participants, interventions, outcome measures (clinical
heterogeneity) and designs (methodological heterogeneity). For these
reasons, we were unable to perform a meta-analysis. Therefore, the results
have been described in a narrative format. Results Five studies met the
inclusion criteria. One of these studies was excluded due to poor
methodological quality. The remaining four original studies (total of 1142
patients) were included in this review. Three studies were randomized
controlled trials and one was a cohort study. Two studies confirmed the
effectiveness of haloperidol prophylaxis in critically ill patients with a
high risk of delirium. These studies showed that short-term prophylactic
administration of low-dose intravenous haloperidol significantly decreased
the incidence of delirium in elderly patients admitted to intensive care
units after non-cardiac surgery and in general intensive care unit
patients with a high risk of delirium. However, the two remaining studies
showed contradictory results in mechanically ventilated critically ill
adults, revealing that the administration of haloperidol reduced delirium
prevalence, delayed its occurrence, and/or shorten its duration.
Conclusions The evidence related to the effectiveness of haloperidol
prophylaxis in critically ill patients with a high risk of delirium is
contradictory. However, balancing the benefits and low side effects
associated with haloperidol prophylaxis, this preventive intervention may
be useful to reduce the incidence of delirium in critically ill adults in
intensive care units.<br/>Copyright &#xa9; 2017 THE JOANNA BRIGGS
INSTITUTE.

<7>
Accession Number
621774423
Title
Efficacy of corticosteroids in prevention of acute kidney injury in
neonates undergoing cardiac surgery-A randomized controlled trial.
Source
Acta Anaesthesiologica Scandinavica. 62 (8) (pp 1072-1079), 2018. Date of
Publication: September 2018.
Author
Jahnukainen T.; Keski-Nisula J.; Tainio J.; Valkonen H.; Patila T.;
Jalanko H.; Suominen P.
Institution
(Jahnukainen, Tainio, Jalanko) Department of Pediatric Nephrology and
Transplantation, Children's Hospital, University of Helsinki and Helsinki
University Hospital, Helsinki, Finland
(Keski-Nisula, Valkonen, Suominen) Department of Anesthesia and Intensive
Care, Children's Hospital, University of Helsinki and Helsinki University
Hospital, Helsinki, Finland
(Patila) Department of Pediatric Surgery, Children's Hospital, University
of Helsinki and Helsinki University Hospital, Helsinki, Finland
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Heart surgery requiring cardiopulmonary bypass (CPB) causes an
inflammatory response which may further induce acute kidney injury (AKI).
In the present randomized controlled study we evaluated whether
corticosteroids can prevent CPB related AKI in neonates undergoing heart
surgery. Methods: Forty neonates were randomized to receive 2 mg/kg
methylprednisolone followed by hydrocortisone infusion 0.2 mg/kg/h
perioperatively with tapering doses for 5 days, or placebo administered in
a similar fashion. The primary outcome was the inflammatory response
(plasma concentrations of interleukins 6 and 10). The correspondence of
the interleukin concentrations with AKI was analysed as secondary outcome.
In addition, plasma and urine neutrophil gelatinase-associated lipocalin
(NGAL), plasma cystatin C, and urine kidney injury molecule-1 (KIM-1)
levels were measured. Results: Six patients (15%) developed post-operative
AKI. No significant difference in the AKI occurrence between the treatment
(n = 2) and the placebo (n = 4) groups could be found (risk ratio 2.00,
95% confidence interval 0.41-9.71; P =.661) despite significant reduction
in inflammatory response in the treatment group. One patient in the
treatment group and two patients in the placebo group required acute
peritoneal dialysis. Plasma creatinine and cystatin C or urine NGAL and
KIM-1 concentrations did not differ between the treatment and the placebo
group. Conclusions: Significantly reduced inflammatory reaction induced by
corticosteroid treatment in neonates undergoing cardiac surgery did not
reduce the incidence of AKI defined by KDIGO classification or decrease
the rise of AKI biomarkers.<br/>Copyright &#xa9; 2018 The Acta
Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons
Ltd

<8>
Accession Number
623429449
Title
An HIV-positive status and short term perioperative mortality-a systematic
review.
Source
Southern African Journal of Infectious Diseases. 32 (1) (pp 12-16), 2017.
Date of Publication: 23 Mar 2017.
Author
Moodley Y.; Govender K.
Institution
(Moodley) Discipline of Anaesthesiology and Critical Care Medicine,
University of KwaZulu-Natal, Durban, South Africa
(Govender) Nelson R. Mandela School of Medicine, University of
KwaZulu-Natal, Durban, South Africa
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Background: A contemporary summary describing the impact of an
HIV-positive status on short term perioperative mortality is lacking.
Objective: To collate and summarise published data related to short term
perioperative mortality from studies comparing HIV-positive and
HIV-negative patient groups. Method: We conducted a systematic review of
the published literature by performing structured searches of two medical
literature databases. Pre-defined inclusion/exclusion criteria were used
to identify potentially relevant manuscripts. Further screening of the
reference lists of eligible manuscripts, as well as a prior systematic
review was also performed to identify any additional manuscripts that may
have been relevant. Data retrieved from eligible manuscripts included,
amongst other variables: study and population descriptions, surgical
category (cardiac or noncardiac surgery), as well the incidence of short
term perioperative mortality. Crude odds ratios were calculated for each
eligible manuscript to describe the association between HIV status and
short term perioperative mortality. Results: Our systematic review
consisted of 12 manuscripts describing 12 studies. The majority of
manuscripts described studies conducted in countries with a low burden of
HIV infection. Most manuscripts described findings from a noncardiac
surgery setting. Crude associations between an HIV-positive status and a
higher odds of short term perioperative mortality were noted for data from
2 of the 12 manuscripts, while the association was unclear in the
remaining 10 manuscripts. Conclusion: Evidence supporting a higher odds of
short term perioperative mortality in patients with an HIV-positive status
is unconvincing. Further research is required to adequately investigate
this.<br/>Copyright &#xa9; 2017, &#xa9; 2017 The Author(s). Open Access
article distributed under the terms of the Creative Commons License [CC
BY-NC 3.0].

<9>
Accession Number
2001011185
Title
Meta-Analysis of the Prognostic Value of Psoas-Muscle Area on Mortality in
Patients Undergoing Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Author
Takagi H.; Hari Y.; Kawai N.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit,
Michigan, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
We performed a meta-analysis of currently available studies assessing
prognostic value of psoas-muscle area (PMA) on mortality in patients who
underwent transcatheter aortic valve implantation (TAVI). MEDLINE and
EMBASE were searched through May 2018 to identify studies reporting
>=1-year all-cause mortality in PMA-stratified TAVI patients. A hazard
ratio of follow-up (including early) mortality for "lowest-quantile"
versus "higher-quantiles" PMA was extracted from each study.
Study-specific estimates were combined in the random-effects model. Our
search identified 6 eligible studies enrolling a total of 1,237 TAVI
patients with 1-year to 2-year (midterm) follow-up. A primary
meta-analysis pooling all hazard ratios for "lowest-quantile versus
higher-quantiles" PMA demonstrated significantly higher mortality in
"lowest-quantile" than "higher-quantiles" patients (p <0.0001). A subgroup
meta-analysis indicated no significant difference in mortality between
"<50th- and >=50th-percentile" patients (p = 0.95), but significantly
higher mortality in "lowest-tertile" than "higher-tertiles" patients (p =
0.0009) and in "lowest-quartile" than "higher-quartiles" patients (p =
0.0003). A secondary meta-analysis revealed significantly higher mortality
in "lowest-tertile" than "mid-tertile" patients (p = 0.01) and in
"lowest-tertile" than "highest-tertile" patients (p = 0.01). A
gender-stratified meta-analysis showed significantly higher mortality in
"lowest-quantile" than "higher-quantiles" patients in both men (p =
0.0008) and women (p = 0.01). In conclusion, low PMA, especially
"lowest-tertile/quartile" PMA, is a predictor of high all-cause mortality
at midterm follow-up after TAVI for both men and women. However, PMA
categorization into 50th percentiles may be invalid to predict
mortality.<br/>Copyright &#xa9; 2018

<10>
Accession Number
622459795
Title
Effects of levosimendan on mortality in patients undergoing cardiac
surgery: A systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. 33 (6) (pp 322-329), 2018. Date of
Publication: June 2018.
Author
Chen P.; Wu X.; Wang Z.; Li Z.; Tian X.; Wang J.; Yan T.
Institution
(Chen) Department of Intensive Care, First People's Hospital of Shangqiu,
Shangqiu, China
(Wu, Wang, Tian, Wang, Yan) Department of Urology, Henan Provincial
People's Hospital, Zhengzhou, China
(Li) Department of Ultrasound, Zhengzhou Central Hospital, Zhengzhou,
China
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Purpose: We sought to determine the impact of levosimendan on mortality
following cardiac surgery based on large-scale randomized controlled
trials (RCTs). Methods: We searched PubMed, Web of Science, Cochrane
databases, and ClinicalTrials.gov for RCTs published up to December 2017,
on levosimendan for patients undergoing cardiac surgery. Results: A total
of 25 RCTs enrolling 2960 patients met the inclusion criteria; data from
15 placebo-controlled randomized trials were included for meta-analysis.
Pooled analysis showed that the all-cause mortality rate was 6.4% (71 of
1106) in the levosimendan group and 8.4% (93 of 1108) in the placebo group
(odds ratio [OR], 0.76; 95% confidence interval [CI], 0.55-1.04; P =
0.09). There were no significant differences between the two groups in the
rates of myocardial infarction (OR: 0.91; 95% CI, 0.68-1.21; P = 0.52),
serious adverse events (OR: 0.84; 95% CI, 0.66-1.07; P = 0.17),
hypotension (OR: 1.69; 95% CI, 0.94-3.03; P = 0.08), and low cardiac
output syndrome (OR: 0.47; 95% CI, 0.22-1.02; P = 0.05). Conclusion:
Levosimendan did not result in a reduction in mortality in adult cardiac
surgery patients. Well designed, adequately powered, multicenter trials
are necessary to determine the role of levosimendan in adult cardiac
surgery.<br/>Copyright &#xa9; 2018 The Authors. Journal of Cardiac Surgery
Published by Wiley Periodicals Inc.

<11>
Accession Number
2000461742
Title
Mortality after coronary artery bypass grafting versus percutaneous
coronary intervention with stenting for coronary artery disease: a pooled
analysis of individual patient data.
Source
The Lancet. 391 (10124) (pp 939-948), 2018. Date of Publication: 10 - 16
March 2018.
Author
Head S.J.; Milojevic M.; Daemen J.; Ahn J.-M.; Boersma E.; Christiansen
E.H.; Domanski M.J.; Farkouh M.E.; Flather M.; Fuster V.; Hlatky M.A.;
Holm N.R.; Hueb W.A.; Kamalesh M.; Kim Y.-H.; Makikallio T.; Mohr F.W.;
Papageorgiou G.; Park S.-J.; Rodriguez A.E.; Sabik J.F.; Stables R.H.;
Stone G.W.; Serruys P.W.; Kappetein A.P.
Institution
(Head, Milojevic, Papageorgiou, Kappetein) Department of Cardiothoracic
Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
(Daemen, Boersma) Department of Cardiology, Erasmus University Medical
Center, Rotterdam, Netherlands
(Papageorgiou) Department of Biostatistics, Erasmus University Medical
Center, Rotterdam, Netherlands
(Ahn, Kim, Park) Department of Cardiology, University of Ulsan College of
Medicine, Asan Medical Center, Seoul, South Korea
(Christiansen, Holm) Department of Cardiology, Aarhus University Hospital,
Skejby, Aarhus, Denmark
(Domanski, Farkouh, Fuster) Icahn School of Medicine at Mount Sinai, New
York, NY, United States
(Domanski, Farkouh) Peter Munk Cardiac Centre and the Heart and Stroke
Richard Lewar Centre, University of Toronto, Toronto, ON, Canada
(Flather) Norwich Medical School University of East Anglia and Norfolk and
Norwich University Hospital, Norwich, United Kingdom
(Hlatky) Stanford University School of Medicine, Stanford, CA, United
States
(Hueb) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Kamalesh) Richard L Roudebush VA Medical Center, Indianapolis, IN, United
States
(Makikallio) Department of Cardiology, Oulu University Hospital, Oulu,
Finland
(Mohr) Department of Cardiac Surgery, Herzzentrum Universitat Leipzig,
Leipzig, Germany
(Rodriguez) Cardiac Unit, Otamendi Hospital, Buenos Aires, Argentina
(Sabik) Department Surgery, University Hospitals Cleveland Medical Center,
Cleveland, OH, United States
(Stables) Institute of Cardiovascular Medicine and Science, Liverpool
Heart and Chest Hospital, Liverpool, United Kingdom
(Stone) Columbia University Medical Center and the Center for Clinical
Trials, Cardiovascular Research Foundation, New York, NY, United States
(Serruys) Imperial College London, London, United Kingdom
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Numerous randomised trials have compared coronary artery
bypass grafting (CABG) with percutaneous coronary intervention (PCI) for
patients with coronary artery disease. However, no studies have been
powered to detect a difference in mortality between the revascularisation
strategies. Methods: We did a systematic review up to July 19, 2017, to
identify randomised clinical trials comparing CABG with PCI using stents.
Eligible studies included patients with multivessel or left main coronary
artery disease who did not present with acute myocardial infarction, did
PCI with stents (bare-metal or drug-eluting), and had more than 1 year of
follow-up for all-cause mortality. In a collaborative, pooled analysis of
individual patient data from the identified trials, we estimated all-cause
mortality up to 5 years using Kaplan-Meier analyses and compared PCI with
CABG using a random-effects Cox proportional-hazards model stratified by
trial. Consistency of treatment effect was explored in subgroup analyses,
with subgroups defined according to baseline clinical and anatomical
characteristics. Findings: We included 11 randomised trials involving 11
518 patients selected by heart teams who were assigned to PCI (n=5753) or
to CABG (n=5765). 976 patients died over a mean follow-up of 3.8 years (SD
1.4). Mean Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX)
score was 26.0 (SD 9.5), with 1798 (22.1%) of 8138 patients having a
SYNTAX score of 33 or higher. 5 year all-cause mortality was 11.2% after
PCI and 9.2% after CABG (hazard ratio [HR] 1.20, 95% CI 1.06-1.37;
p=0.0038). 5 year all-cause mortality was significantly different between
the interventions in patients with multivessel disease (11.5% after PCI vs
8.9% after CABG; HR 1.28, 95% CI 1.09-1.49; p=0.0019), including in those
with diabetes (15.5% vs 10.0%; 1.48, 1.19-1.84; p=0.0004), but not in
those without diabetes (8.7% vs 8.0%; 1.08, 0.86-1.36; p=0.49). SYNTAX
score had a significant effect on the difference between the interventions
in multivessel disease. 5 year all-cause mortality was similar between the
interventions in patients with left main disease (10.7% after PCI vs 10.5%
after CABG; 1.07, 0.87-1.33; p=0.52), regardless of diabetes status and
SYNTAX score. Interpretation: CABG had a mortality benefit over PCI in
patients with multivessel disease, particularly those with diabetes and
higher coronary complexity. No benefit for CABG over PCI was seen in
patients with left main disease. Longer follow-up is needed to better
define mortality differences between the revascularisation strategies.
Funding: None.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<12>
Accession Number
620255431
Title
Peri-operative chest physiotherapy for paediatric cardiac patients: a
systematic review and meta-analysis.
Source
Physiotherapy (United Kingdom). 104 (3) (pp 251-263), 2018. Date of
Publication: September 2018.
Author
Beningfield A.; Jones A.
Institution
(Beningfield, Jones) Discipline of Physiotherapy, College of Healthcare
Sciences, James Cook University, Townsville, Australia
Publisher
Elsevier Ltd
Abstract
Background: Chest physiotherapy (CPT) is implemented before and after
congenital heart disease (CHD) surgery in paediatrics to prevent and treat
postoperative pulmonary complications (PPC). Currently, there are no
systematic reviews or meta-analyses on the efficacy of CPT in this
population. Objective: To conduct a systematic review and meta-analysis to
determine whether peri-operative CPT is safe and effective for paediatric
patients with CHD. Data sources: A literature search was conducted on
PEDro, MEDLINE, CINAHL, Informit, The Cochrane Library and Scopus in March
and April 2016. Eligibility criteria: English peer-reviewed articles that
utilised CPT before or after cardiac surgery for paediatric CHD.
Systematic reviews were excluded. Data extraction and synthesis: Completed
by two independent researchers using the Crowe Critical Appraisal Tool.
Data were collated using a piloted data extraction tool. Mix Version
2.0.1.4 was used for meta-analysis, and data were extracted using an odds
ratio (with a random effects model). Results: Eleven studies met the
inclusion criteria for the systematic review. Variable results were found
regarding the effect of CPT on peripheral oxygen saturation and pain.
Meta-analysis showed that CPT did not prevent pneumonia (odds ratio (OR)
2.01; 95% confidence interval (CI) 0.80 to 5.05; P = 0.13), and did not
prevent or treat atelectasis (OR 1.27; 95% CI 0.18 to 8.87; P = 0.81).
Limitations: There was a lack of high-quality studies. The included
studies were comprised of heterogeneous treatment, limiting external
validity. Conclusion: Active therapies such as mobilisation, deep
breathing and incentive spirometry were more effective than passive
treatment. Percussion led to oxygen desaturation, and percussion,
vibration and suctioning increased the risk of developing atelectasis.
Systematic review registration number CRD42015024768.<br/>Copyright &#xa9;
2017 Chartered Society of Physiotherapy

<13>
Accession Number
620554491
Title
The radial artery: Results and technical considerations.
Source
Journal of Cardiac Surgery. 33 (5) (pp 213-218), 2018. Date of
Publication: May 2018.
Author
Leonard J.R.; Abouarab A.A.; Tam D.Y.; Girardi L.N.; Gaudino M.F.L.;
Fremes S.E.
Institution
(Leonard, Abouarab, Girardi, Gaudino) Department of Cardiothoracic
Surgery, Weill Cornell Medicine, New York, NY, United States
(Tam, Fremes) Division of Cardiac Surgery, Schulich Heart Centre,
Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON,
Canada
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The radial artery (RA) is a frequently used conduit for
coronary artery bypass graft (CABG). We review the results of the use of
the RA in CABG patients and discuss the unique technical considerations
when using this conduit. Methods: A literature search was performed in
PubMed through December 2017 on the comparative efficacy of the RA to
other conduits and technical considerations for the use of the RA in CABG
surgery. Results: When compared to the saphenous vein graft, the RA proved
to be superior in graft patency in multiple randomized clinical trials.
The RA was associated with better clinical outcomes in observational
studies. The debate over the second best arterial conduit remains
unresolved between the RA and the right internal thoracic artery.
Preoperative evaluation of the patient's coronary anatomy and the quality
of the RA is imperative to achieve the best clinical outcome with RA
grafting. Conclusion: With careful preoperative planning and attention to
technical details, the RA is an excellent choice as the second conduit for
CABG surgery.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<14>
Accession Number
618962345
Title
The efficacy of probucol combined with hydration in preventing
contrast-induced nephropathy in patients with coronary heart disease
undergoing percutaneous coronary intervention: a multicenter, prospective,
randomized controlled study.
Source
International Urology and Nephrology. 50 (1) (pp 105-112), 2018. Date of
Publication: 01 Jan 2018.
Author
Fu N.; Yang S.; Zhang J.; Zhang P.; Liang M.; Cong H.; Lin W.; Tian F.; Lu
C.
Institution
(Fu, Yang, Zhang, Zhang, Cong) Department of Cardiology, Tianjin Chest
Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin
300222, China
(Liang) Tianjin Medical University, Tianjin, China
(Lin) Department of Cardiology, Teda International Cardiovascular
Hospital, Tianjin, China
(Tian) Department of Cardiology, Tianjin Fourth Central Hospital, Tianjin,
China
(Lu) Department of Cardiology, Tianjin First Central Hospital, Tianjin,
China
Publisher
Springer Netherlands (E-mail: rbk@louisiana.edu)
Abstract
Purpose: To investigate the preventive effect of probucol combined with
hydration on contrast-induced nephropathy (CIN) in patients with coronary
heart disease undergoing percutaneous coronary intervention (PCI).
Methods: A total of 641 patients undergoing PCI were randomly assigned to
either a probucol group (probucol 500 mg twice daily and hydration; n =
321) or a control group (hydration only; n = 320). The primary endpoint
was the incidence of CIN, defined as an increase in serum creatinine (Scr)
by >= 44.2 mumol/L or >= 25% within 72 h after the administration of
contrast agent. Secondary endpoints were changes in Scr, cystatin-C
(Cys-C), creatinine clearance rate (Ccr), C-reactive protein (CRP),
superoxide dismutase (SOD), and glutathione (GSH) within 72 h, and major
adverse events during hospitalization or the 14-day follow-up period.
Results: The incidence of CIN was 4.0% (13/321) in the probucol group and
10.9% (35/320) in the control group. The probucol group had lower Cys-C
and higher Ccr at 48 and 72 h after PCI compared with the control group.
At 48 and 72 h following the operation, Cys-C and CRP were lower in the
probucol group compared with the control group, but Ccr, SOD, and GSH were
higher. There were no differences in the incidence of major adverse events
during hospitalization or the 14-day follow-up between the groups.
Multivariate logistic regression analysis showed that probucol was an
independent protective factor for CIN. Conclusions: Probucol combined with
hydration more effectively decreased the incidence of CIN in patients with
coronary heart disease undergoing PCI compared with hydration
alone.<br/>Copyright &#xa9; 2017, Springer Science+Business Media B.V.

<15>
Accession Number
618947562
Title
The diagnosis of microorganism involved in infective endocarditis (IE) by
polymerase chain reaction (PCR) and real-time PCR: A systematic review.
Source
Kaohsiung Journal of Medical Sciences. 34 (2) (pp 71-78), 2018. Date of
Publication: February 2018.
Author
Faraji R.; Behjati-Ardakani M.; Moshtaghioun S.M.; Kalantar S.M.;
Namayandeh S.M.; Soltani M.; Emami M.; Zandi H.; Firoozabadi A.D.;
Kazeminasab M.; Ahmadi N.; Sarebanhassanabadi M.
Institution
(Faraji, Behjati-Ardakani, Namayandeh, Soltani, Emami, Firoozabadi,
Ahmadi, Sarebanhassanabadi) Yazd Cardiovascular Research Center, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Moshtaghioun) Department of Biology, Faculty of Science, Yazd University,
Yazd, Iran, Islamic Republic of
(Kalantar) Medical Genetic Research and Clinical Centre for Infertility,
Shahid Sadoughi University of Medical Sciences, Yazd, Iran, Islamic
Republic of
(Zandi) Department of Microbiology, Faculty of Medicine, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Kazeminasab) Student Research Committee, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran, Islamic Republic of
Publisher
Elsevier (Singapore) Pte Ltd (3 Killiney Road, 08-01, Winsland House I,
Singapore 239519, Singapore)
Abstract
Broad-range bacterial rDNA polymerase chain reaction (PCR) followed by
sequencing may be identified as the etiology of infective endocarditis
(IE) from surgically removed valve tissue; therefore, we reviewed the
value of molecular testing in identifying organisms' DNA in the studies
conducted until 2016. We searched Google Scholar, Scopus, ScienceDirect,
Cochrane, PubMed, and Medline electronic databases without any time
limitations up to December 2016 for English studies reporting
microorganisms involved in infective endocarditis microbiology using PCR
and real-time PCR. Most studies were prospective. Eleven out of 12 studies
used valve tissue samples and blood cultures while only 1 study used whole
blood. Also, 10 studies used the molecular method of PCR while 2 studies
used real-time PCR. Most studies used 16S rDNA gene as the target gene.
The bacteria were identified as the most common microorganisms involved in
infective endocarditis. Streptococcus spp. and Staphylococcus spp. were,
by far, the most predominant bacteria detected. In all studies, PCR and
real-time PCR identified more pathogens than blood and tissue cultures;
moreover, the sensitivity and specificity of PCR and real-time PCR were
more than cultures in most of the studies. The highest sensitivity and
specificity were 96% and 100%, respectively. The gram positive bacteria
were the most frequent cause of infective endocarditis. The molecular
methods enjoy a greater sensitivity compared to the conventional blood
culture methods; yet, they are applicable only to the valve tissue of the
patients undergoing cardiac valve surgery.<br/>Copyright &#xa9; 2017

<16>
Accession Number
619495358
Title
An "alternative finger" in robotic-assisted thoracic surgery:
Intraoperative ultrasound localization of pulmonary nodules.
Source
Medical Ultrasonography. 19 (4) (pp 374-379), 2017. Date of Publication:
2017.
Author
Zhou Z.; Wang Z.; Zheng Z.; Cao J.; Zhang C.; He Z.; Lv W.; Hu J.
Institution
(Zhou, Wang, Cao, Zhang, He, Lv, Hu) Department of Thoracic Surgery, The
First Affiliated Hospital, College of Medicine, Zhejiang University,
Hangzhou, China
(Zheng) Department of Ultrasound Imaging, The First Affiliated Hospital,
College of Medicine, Zhejiang University, Hangzhou, China
Publisher
Societatea Romana de Ultrasonografie in Medicina si Biologie (E-mail:
dfodor@ymail.com)
Abstract
Aim: Robotic-assisted thoracic surgery (RATS) has become a promising
treatment for pulmonary neoplasms. During RATS, intraoperative
ultrasonography can act as an "alternative finger" to "touch" and locate
lesions, especially pulmonary nodules. This study was aimed to investigate
the efficacy of intraoperative ultrasonographic localization during da
Vinci RATS procedures. Material and methods: Patients with pulmonary
nodules were randomly divided into an Experimental Group and Control Group
in which nodules were respectively located using intraoperative
ultrasonography or by the surgeon's anatomic knowledge. The success rates
and relevant localization factors were compared between the groups and
analyzed to conclude the efficacy of intraoperative ultrasonography.
Additionally, the intraoperative ultrasonography learning curve was
analyzed to evaluate each surgeon's ability to independently perform
intraoperative ultrasonography. Results: Thirty-four patients were
included in the study (n = 17/group). Respectively, the Experimental Group
and Control Group comprised 41.2% and 58.9% women (p= 0.937), and had
average ages of 55.5 and 55.8 years. In the Experimental group,
ultrasonographic localization for mixed ground-glass nodules with CT
values of -500 to -100 Hounsfield units had an efficacy of 87.5%. By
contrast, the localization efficacy in Control Group was 20.0% (p=0.032).
A single surgeon without prior experience performed intraoperative
ultrasonography in 20 cases, and the latter 10 procedures required
significantly less time relative to the former 10 procedures (p=0.000).
Conclusions: During RATS, the use of intraoperative ultrasonography as an
"alternative finger" to "touch" and find the accurate location of
pulmonary nodules, especially mixed ground-glass nodules, is warranted.

<17>
Accession Number
614121262
Title
Early vs late coronary angiography and intervention following thrombolytic
therapy; a cohort study.
Source
Emergency. 5 (1) (no pagination), 2017. Article Number: e32. Date of
Publication: 2017.
Author
Feizi B.; Taghdisi S.; Etemadi J.; Feizi A.H.; Asgarzadeh S.; Kamal S.
Institution
(Feizi, Taghdisi, Feizi, Kamal) Clinical Research Development Center,
Bouali Hospital, Islamic Azad University, Tehran Medical Sciences Branch,
Tehran, Iran, Islamic Republic of
(Etemadi) Cardiology Department, Imam Hossein Hospital, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Asgarzadeh) Clinical Research Development Center, Amir-almomenin
Hospital, Islamic Azad University, Tehran Medical Sciences Branch, Tehran,
Iran, Islamic Republic of
Publisher
Shahid Beheshti University of Medical Sciences (E-mail:
emamhadi@yahoo.com)
Abstract
Introduction: The precise time of using percutaneous coronary intervention
(PCI) after fibrinolytic therapy for maximum efficiency and minimumside
effects is still undetermined. Therefore, the present study was designed
to compare the outcome of myocardial infarction (MI) patients who
underwent surgical intervention (angiography and PCI) within 48 hours of
thrombolytic therapy or after that. Methods: The present study is a
prospective cohort study aiming to compare the occurrence of no-reflow
phenomenon, unstable angina, bleeding during intervention, and one month
major adverse cardiac outcomes (recurrent MI, need for repeating surgical
intervention, andmortality) between MI patents undergoing surgical
intervention within the first 48 hours of or after 48 hours of
thrombolytic therapy. Results: 90 patients with the mean age of 54.97 +/-
10.54 were studied (86.67% male). 50 (56%) patients underwent surgical
intervention within 48 hours and 40 (44%) after that. The 2 groups were
not significantly different regarding baseline characteristics. No-reflow
phenomenon in the < 48 hours group was about twice the > 48 hours group
(OR = 0.35; 95% confidence interval: 0.14 - 0.92; p = 0.03), other
outcomes were not significantly different. No case of mortality was seen
in the 1 month follow up. Conclusion: Based on the results of the present
study, it seems that no-reflow phenomenon rate is significantly lower in
patients undergoing surgical intervention after 48 hours of fibrinolytic
therapy. The difference between the two groups regarding prevalence
ofmajor adverse cardiac outcomes was not statistically
significant.<br/>Copyright &#xa9; (2016) Shahid Beheshti University
ofMedical Sciences.

<18>
Accession Number
615758096
Title
Comparative Analysis of Simulated versus Live Patient-Based FAST (Focused
Assessment With Sonography for Trauma) Training.
Source
Journal of Surgical Education. 74 (6) (pp 1012-1018), 2017. Date of
Publication: November 2017.
Author
Juo Y.-Y.; Quach C.; Hiatt J.; Hines O.J.; Tillou A.; Burruss S.
Institution
(Juo, Quach, Hiatt, Hines, Tillou) Department of Surgery, David Geffen
School of Medicine at the University of California, Los Angeles,
California, United States
(Juo) Center for Advanced Surgical and Interventional Technology,
University of California, Los Angeles, California, United States
(Burruss) Department of Surgery, Loma Linda University Medical Center,
Loma Linda, California, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective To investigate whether simulated patient (SP)-based training has
comparable efficacy as live patient (LP)-based training in teaching
Focused Abdominal Sonography for Trauma (FAST) knowledge and skill
competencies to surgical residents. Design A randomized
pretest/intervention/posttest controlled study design was employed to
compare the participants' performance in written and practical
examinations regarding FAST examination after SP-based versus LP-based
training. Setting University-based general residency program at a single
institution. Participants A total of 29 general surgery residents of
various training levels and sonographic experience were recruited by
convenience sampling. Results There was no correlation between subjects'
baseline training level or sonographic experience with either the
posttest-pretest score difference or the percentage of subjects getting
all 4 windows with adequate quality. There was no significant difference
between the improvement in written posttest-pretest scores for SP and LP
group, which were 33 +/- 9.6 and 31 +/- 6.8 (p = 0.40), respectively. With
regard to performance-based learning efficacy, a statistically higher
proportion of subjects were able to obtain all 4 windows with adequate
quality among the LP than the SP group (6/8 vs 1/8, p = 0.01). Conclusion
SP- and LP-based FAST training for surgical residents were associated with
similar knowledge-based competency acquisition, but residents receiving
LP-based training were better at acquiring adequate FAST windows on live
patients. Simulation training appeared to be a valid adjunct to LP
practice but cannot replace LP training. Future investigations on how to
improve simulation fidelity and its training efficacy for skill-based
competencies are warranted.<br/>Copyright &#xa9; 2017 Association of
Program Directors in Surgery

<19>
Accession Number
613174223
Title
Troponin elevations after non-cardiac, non-vascular surgery are predictive
of major adverse cardiac events and mortality: A systematic review and
meta-analysis.
Source
British Journal of Anaesthesia. 117 (5) (pp 559-568), 2016. Date of
Publication: 01 Nov 2016.
Author
Ekeloef S.; Alamili M.; Devereaux P.J.; Gogenur I.
Institution
(Ekeloef, Alamili, Gogenur) Department of Surgery, Center for Surgical
Science, Zealand University Hospital, Koege and Roskilde, Denmark
(Devereaux) Department of Clinical Epidemiology and Biostatistics,
McMaster University, Hamilton, ON, Canada
(Devereaux) Department of Medicine, McMaster University, Hamilton, ON,
Canada
Publisher
Oxford University Press
Abstract
Background: Patients undergoing non-cardiac, non-vascular surgery are at
risk of major cardiovascular complications. In non-cardiac surgery,
troponin elevation has previously been shown to be an independent
predictor of major adverse cardiac events and postoperative mortality;
however, a majority of studies have focused on vascular surgery patients.
The aim of this meta-analysis was to determine whether troponin elevation
is a predictor of major adverse cardiac events and mortality within 30
days and 1 yr after non-cardiac, non-vascular surgery. Methods: A
systematic review and meta-analysis was conducted in January 2016
according to the Meta-analysis Of Observational Studies in Epidemiology
guidelines. Both interventional and observational studies measuring
troponin within the first 4 days after surgery were eligible. A systematic
search was performed in PubMed, EMBASE, Scopus, and the Cochrane Central
Register of Controlled Trials. Results: Eleven eligible clinical studies
(n=2193) were identified. A postoperative troponin elevation was a
predictor of 30 day mortality, odds ratio (OR) 3.52 [95% confidence
interval (CI) 2.21-5.62; I²=0%], and an independent predictor
of 1 yr mortality, adjusted OR 2.53 (95% CI 1.20-5.36; I²=26%).
A postoperative troponin elevation was associated with major adverse
cardiac events at 30 days, OR 5.92 (95% CI 1.67-20.96; I²=86%),
and 1 yr after surgery, adjusted OR 3.00 (95% CI 1.43-6.29;
I²=21%). Conclusions: Postoperative myocardial injury is an
independent predictor of major adverse cardiac events and mortality within
30 days and 1 yr after non-cardiac, non-vascular surgery. The
meta-analysis provides evidence that supports troponin monitoring as a
cardiovascular risk stratification tool.<br/>Copyright &#xa9; 2016 The
Author. Published by Oxford University Press on behalf of the British
Journal of Anaesthesia. All rights reserved.

<20>
Accession Number
610516576
Title
Intravenous acetaminophen analgesia after cardiac surgery: A randomized,
blinded, controlled superiority trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 152 (3) (pp 881-889),
2016. Date of Publication: 2016.
Author
Mamoun N.F.; Lin P.; Zimmerman N.M.; Mascha E.J.; Mick S.L.; Insler S.R.;
Sessler D.I.; Duncan A.E.
Institution
(Mamoun, Insler, Duncan) Department of Cardiothoracic Anesthesia,
Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, United States
(Mamoun, Lin, Zimmerman, Mascha, Insler, Sessler, Duncan) Department of
Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland,
Ohio, United States
(Zimmerman, Mascha) Department of Quantitative Health Sciences, Cleveland
Clinic, Cleveland, Ohio, United States
(Mick) Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland,
Ohio, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Pain after cardiac surgery traditionally has been controlled by
intravenous opioids and nonsteroidal antiinflammatory drugs. An
intravenous analgesic with fewer adverse effects is needed. Therefore, we
tested the primary hypothesis that intravenous acetaminophen is more
effective than placebo for pain management, which was defined a priori as
superior on either pain intensity score and/or opioid consumption and not
worse on either. Methods In this single-center, double-blind trial, 147
patients having cardiac surgery via median sternotomy were randomized to
receive either 1 g of intravenous acetaminophen (73 patients) every 6
hours for 24 hours or comparable placebo (74 patients) starting in the
operating room after sternal closure. Cumulative opioid consumption (in
morphine equivalents) and pain intensity scores (on a 0-10 Numeric Rating
Scale) were measured at 4, 6, 8, 12, 16, 20, and 24 hours after surgery.
We estimated ratio of mean opioid consumption by using multivariable
linear regression (noninferiority delta = 1.15) and pain score difference
by using repeated measures regression (noninferiority delta = 1). Results
Acetaminophen was superior to placebo on mean pain intensity scores and
noninferior on opioid consumption, with estimated difference in mean pain
(95% confidence interval) of -0.90 (-1.39, -0.42), P < .001 (superior),
and estimated ratio of means in opioid consumption (90% confidence
interval) of 0.89 (0.73-1.10), P = .28 (noninferior; not superior).
Conclusions Intravenous acetaminophen reduced pain after cardiac surgery,
but not opioid consumption. Intravenous acetaminophen can be an effective
analgesic adjunct in patients recovering from median
sternotomy.<br/>Copyright &#xa9; 2016 The American Association for
Thoracic Surgery

<21>
Accession Number
2000795289
Title
Prospective observational study of the effect of dual antiplatelet therapy
with tranexamic acid treatment on platelet function and bleeding after
cardiac surgery.
Source
British Journal of Anaesthesia. 117 (6) (pp 749-757), 2016. Date of
Publication: December 2016.
Author
Amour J.; Garnier M.; Szymezak J.; Le Manach Y.; Helley D.; Bertil S.;
Ouattara A.; Riou B.; Gaussem P.
Institution
(Amour, Garnier, Szymezak, Le Manach, Helley, Bertil, Ouattara, Riou,
Gaussem) Universite Pierre et Marie Curie, Assistance Publique-Hopitaux de
Paris (APHP), Department of Anaesthesiology and Critical Care, UMRS
INSERM, IHU ICAN, CHU Pitie-Salpetriere, Paris, 1166, France; Assistance
Publique-Hopitaux de Paris (APHP), Department of Biological Hematology,
Hopital Europeen Georges Pompidou, Inserm UMR-S1140, Faculte de Pharmacie,
Descartes University, Sorbonne Paris Cite Paris, France; Departments of
Anaesthesia and Clinical Epidemiology and Biostatistics, Michael DeGroote
School of Medicine, Faculty of Health Sciences, McMaster University,
Canada; Department of Anaesthesiology and Critical Care, Groupe
Hospitalier Sud, Pessac, Bordeaux; Universite Pierre et Marie Curie,
Assistance Publique-Hopitaux de Paris (APHP), Department of Emergency
Medicine and Surgery, UMRS INSERM 1166, IHU ICAN, CHU Pitie-Salpetriere,
Assistance Publique-Hopitaux de Paris (APHP), Paris, France
Publisher
Elsevier Ltd
Abstract
Background: The bleeding impact of dual antiplatelet therapy (DAPT),
aspirin and clopidogrel, maintained until coronary artery bypass graft
surgery (CABG), is still a matter of debate. The lack of preoperative
antiplatelet activity measurement and heterogeneity of antifibrinolytic
protocols in prior studies make the conclusions questionable. The aim of
this prospective study was to determine, after preoperative antiplatelet
activity measurement, if the maintenance of DAPT until CABG increases
bleeding in patients treated with tranexamic acid (TA). Methods: This
observational study included 150 consecutive patients, 89 treated with
aspirin and 61 treated with DAPT, undergoing a first-time planned on-pump
CABG with TA treatment. Antiplatelet activity was measured with platelet
aggregation tests and quantification of VASP phosphorylation.
Postoperative bleeding at 24 h was recorded and propensity score analysis
was performed. Results: Based on VASP assay, 54% of patients showed high
on-clopidogrel platelet activity inhibition. Postoperative bleeding at 24
h increased by 22% in the DAPT group, compared with the aspirin group (680
[95% CI: 360-1670] vs 558 [95%CI: 267-1270] ml, P < 0.01), consistent with
increased blood transfusion (21% vs 7%, P = 0.01); a higher incidence of
mediastinitis did not reach statistical significance (15% vs 4%, P =
0.05). Bleeding correlated with the extent of clopidogrel antiplatelet
effect, with the best correlation for the VASP assay. Conclusions:
Maintenance of DAPT until the day of CABG in patients treated with TA,
increased postoperative bleeding at 24 h in parallel with preoperative
antiplatelet activity induced by clopidogrel.<br/>Copyright &#xa9; 2016
The Author(s)

<22>
Accession Number
623367267
Title
Prospective, randomized un-blinded three arm controlled study in coronary
artery revascularization with Minimal Invasive Extracorporeal Circulation
Systems (MiECC): surrogate parameter analysis of biocompatibility.
Source
Heart Surgery Forum. 21 (3) (pp E179-E186), 2018. Date of Publication:
April 2018.
Author
Kiessling A.H.; Keller H.; Moritz A.
Institution
(Keller, Moritz) University Hospital, Department of Thoracic and
Cardiovascular Surgery, Frankfurt/Main, Germany
(Kiessling) Medical School Berlin, Department of Clinical Research,
Calandrelli Strasse 1-9, Berlin D-12247, Germany
Publisher
Forum Multimedia Publishing LLC (E-mail: motis@cjp.com)
Abstract
Objectives: Minimal extracorporeal circulation techniques and systems
(MiECC) may reduce the negative side effects of conventional
extracorporeal circulation (ECC). However, it is still unclear as to what
this is caused by, the reduced priming volume and hemodilution, or the
avoidance of blood-air contact and dispersion of mediastinal debris into
the systemic circulation. The aim of the trial was the comparison of MiECC
to an open ECC setup (openECC) or a system with reduced blood air and
debris interaction (closeECC). Methods: In a prospective randomized trial,
72 patients (73 +/- 5.3 years; 83% male) referred for coronary artery
bypass graft (CABG) were randomly assigned either to MiECC (priming volume
550mL), closeECC, or openECC (priming volume 1250mL). The laboratory
surrogate endpoints (renal function, inflammatory response, ischemia,
coagulation, and hemolysis) and clinical data were measured at six
different time points (T1-6). Results: Patients were comparable for all
preoperative variables. The operation times (MiECC 261 +/- 79min; openECC
264 +/- 75min; closeECC 231 +/- 68min) and perfusion times (MiECC 115 +/-
49min; openECC353 107 +/- 37min; closeECC 99 +/- 22min) revealed a trend
of faster performance in the closeECC group (P < .05). Pro-inflammatory
cytokines, ischemia, and coagulation markers were significantly elevated
postoperatively in all cardiopulmonary bypass types, and decreased to
pre-baseline levels at discharge (T5) without identifiable statistical
differences between the three study groups. Free-hemoglobin was not
significantly increased by centrifugal pump or cell saver procedures.
Significant intra-operative hemodilution effects due to the different
priming volumes were demonstrated only at the end of operation (T2) (MiECC
Hb 9.6 +/- 1.1g/dL; openECC Hb 9.0 +/- 0.8g/dL; closeECC Hb 8.7 +/- 1g/dL;
P =. 01). Conclusion: Neither the hemodilution, suction technique (MiECC),
nor blood-air interface (closeECC) could show sustainable benefits in this
underpowered study, compared to conventional ECC systems (openECC) in a
high volume series of surrogate parameters.<br/>Copyright &#xa9; 2018
Forum Multimedia Publishing, LLC.

<23>
Accession Number
623387581
Title
Epicardial left atrial appendage AtriClip occlusion reduces the incidence
of stroke in patients with atrial fibrillation undergoing cardiac surgery.
Source
Europace. 20 (7) (pp e105-e114), 2018. Date of Publication: 01 Jul 2018.
Author
Caliskan E.; Sahin A.; Yilmaz M.; Seifert B.; Hinzpeter R.; Alkadhi H.;
Cox J.L.; Holubec T.; Reser D.; Falk V.; Grunenfelder J.; Genoni M.;
Maisano F.; Salzberg S.P.; Emmert M.Y.
Institution
(Caliskan, Sahin, Yilmaz, Holubec, Reser, Genoni, Maisano, Emmert) Clinic
for Cardiovascular Surgery, University Hospital Zurich, University of
Zurich, Raemistrasse 100, Zurich, Switzerland
(Caliskan, Falk) Department of Cardiovascular Surgery, Charite
Universitatsmedizin Berlin, Chariteplatz 1, Berlin, Germany
(Caliskan, Falk) Department of Cardiothoracic and Vascular Surgery, German
Heart Institute Berlin, Augustenburger Platz 1, Berlin, Germany
(Seifert) Department of Biostatistics, Epidemiology, Biostatistics and
Prevention Institute, University of Zurich, Hirschengraben 84, Zurich,
Switzerland
(Hinzpeter, Alkadhi) Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich, Raemistrasse 100,
Zurich, Switzerland
(Cox) Feinberg School of Medicine, Northwestern University, Arthur J.
Rubloff Building, 420 East Superior Street, Chicago, IL, United States
(Grunenfelder, Salzberg) HeartClinic, Hirslanden Hospital,
Witellikerstrasse 40, Zurich, Switzerland
Publisher
Oxford University Press
Abstract
Aims Left atrial appendage (LAA) occlusion has emerged as an interesting
alternative to oral anticoagulation (OAC) for stroke prevention in
patients with atrial fibrillation (AF). We report the safety, efficacy,
and durability of concomitant device-enabled epicardial LAA occlusion
during open-heart surgery. In addition to long-term follow-up, we evaluate
the impact on stroke risk in this selected population. Methods and results
A total of 291 AtriClip devices were deployed epicardially in patients
(mean CHA2DS2-VASc-Score: 3.1+/- 1.5) undergoing open-heart surgery
(including isolated coronary artery bypass grafting, valve, or combined
procedures) comprising of forty patients from a first-in-man device trial
(NCT00567515) and 251 patients from a consecutive institutional registry
thereafter. In all patients (n= 291), the LAA was successfully excluded
and overall mean follow-up (FU) was 36+/- 23months (range: 1?97months). No
device-related complications were detected throughout the FU period.
Longterm imaging work-up (computed tomography) in selected patients
>5years post-implant (range: 5.1?8.1 years) displayed complete LAA
occlusion with no signs of residual reperfusion or significant LAA stumps.
Subgroup analysis of patients with discontinued OAC during FU (n= 166)
revealed a relative risk reduction of 87.5% with an observed ischaemic
stroke-rate of 0.5/100 patient-years compared with what would have been
expected in a group of patients with similar CHA2DS2-VASc scores (expected
rate of 4.0/100 patient-years). No strokes occurred in the subgroup with
OAC. Conclusion The long-term results from our first-in-man prospective
human trial plus our institutional registry of epicardial LAA occlusion
with the AtriClip in patients with AF undergoing cardiac surgery
demonstrate the safety and durability of the procedure. In addition, our
data are suggestive for the potential efficacy of LAA occlusion in
reducing the incidence of stroke. If validated in future large randomized
trials, routine LAA occlusion in patients undergoing cardiac surgery (with
contraindications to treatment with oral anticoagulants) may represent a
reasonable adjunct procedure to reduce the risk of future
stroke.<br/>Copyright &#xa9;The Author(s) 2018.

<24>
Accession Number
623386398
Title
Benefits of Using High-Volume-Low-Pressure Tracheal Tube in Children
Undergoing Congenital Cardiac Surgery: Evidence From a Prospective
Randomized Study.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 22 (3) (pp 300-305),
2018. Date of Publication: 01 Sep 2018.
Author
Chand R.; Roy Chowdhury S.; Rupert E.; Mandal C.K.; Narayan P.
Institution
(Chand, Roy Chowdhury, Rupert, Mandal, Narayan) NH Rabindranath Tagore
International Institute of Cardiac Sciences, Kolkata, India
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background. In the past 2 decades, usage of high-volume-low-pressure
microcuffed tracheal tubes in smaller children has increased. However,
there is paucity of evidence of its usage in smaller children undergoing
congenital cardiac surgery. The aim of this study was to assess if
microcuff endotracheal tubes in neonates and younger children undergoing
congenital cardiac surgery is associated with better outcomes than
uncuffed tubes. Methods. We carried out this single-center, prospective,
randomized study between June and November 2016. Eighty patients were
randomized into those receiving microcuff tracheal tubes and conventional
uncuffed tubes. Primary outcome was stridor postextubation. Secondary
outcomes measured included number of tube changes, volume of anesthetic
gases required, and cost incurred. Results. The 2 groups were comparable
in terms of baseline characteristics and duration of intubation. Incidence
of stridor was significantly higher in conventional uncuffed tubes (12
[30%] vs 4 [10%]; P =.04) and so was the number of tube changes required
(17/40 [42.5%] vs 2/40 [5%]; P <=.001). Tube change was associated with
more than 3-fold risk of stridor (odds ratio = 3.92; 95% confidence
interval = 1.23-12.43). Isoflurane (29.14 +/- 7.01 mL vs19.2 +/- 4.81 mL;
P <.0001) and oxygen flow requirement (P <.0001) and the resultant cost
(7.46 +/- 1.4 vs 5.77 +/- 1.2 US$; P <.0001) were all significantly higher
in the conventional uncuffed group. Conclusion. Microcuff pediatric
tracheal tube is associated with significantly lower incidence of stridor,
tube changes, and anesthetic gas requirement. This leads to significant
cost reduction that offsets the higher costs associated with usage of a
microcuff tracheal tube.<br/>Copyright &#xa9; The Author(s) 2018.

<25>
Accession Number
613995063
Title
Efficacy of N-Acetylcysteine in Preventing Acute Kidney Injury After
Cardiac Surgery: A Meta-Analysis Study.
Source
Journal of Investigative Surgery. (pp 1-10), 2017. Date of Publication: 06
Jan 2017.
Author
Mei M.; Zhao H.-W.; Pan Q.-G.; Pu Y.-M.; Tang M.-Z.; Shen B.-B.
Institution
(Mei, Zhao, Pan, Pu, Tang, Shen) Department of Kidney, Southwest Hospital,
Third Military Medical University, Chongqing 400038, P.R. China
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Purpose: To evaluate whether perioperative N-acetylcysteine (NAC)
administration reduces the risk of cardiac surgery associated acute kidney
injury (CSA-AKI). Materials and Methods: A systematic literature review
(Medline, PubMed, Cochrane, Biomedical central, Google Scholar) identified
10 studies (1391 patients; 695 NAC and 696 placebo) that compared the
efficacy and adverse effects of perioperative NAC administration for
CSA-AKI prevention in adults undergoing elective cardiac surgery.
Meta-analysis was performed using Comprehensive Meta-Analysis statistical
software. Results: Patients in the NAC-treated and placebo groups had
similar rate of CSA-AKI occurrence, change in creatinine levels, as well
as the in-hospital mortality rate (RR = 0.841, 95% CI = 0.691 to 1.023, p
= 0.083; pooled difference in means = -0.328, 95% CI = -0.712 to 0.056, p
= 0.094; RR = 0.741, 95% CI = 0.388 to 1.418, p = 0.366, respectively).
Conclusions: Our study does not support perioperative NAC administration
as a mean to reduce the risk of CSA-AKI.<br/>Copyright &#xa9; 2017 Taylor
& Francis Group, LLC

<26>
Accession Number
623415291
Title
Assessment of impact of preprocedural pulmonary hypertension to the
clinical outcomes in patients undergoing transcatheter aortic valve
replacement; A single center experience.
Source
Cardiology (Switzerland). Conference: 23rd World Congress on Heart Disease
International Academy of Cardiology Annual Scientific Sessions 2018.
United States. 140 (Supplement 1) (pp 57), 2018. Date of Publication:
2018.
Author
Farhoud M.; Banga S.; Bhardwaj C.
Institution
(Farhoud, Banga, Bhardwaj) OSF SFMC, Peoria, IL, United States
Publisher
S. Karger AG
Abstract
Objective: Patients with severe aortic stenosis pre-procedural pulmonary
hypertension undergoing transcatheter aortic valve replacement (TAVR)
experience decrease in Pulmonary Artery Hypertension (PAH) post procedure.
We studied the relationship of pre-procedural PAH to their clinical
outcomes. Method: This is a single center retrospective chart review of
patients who underwent TAVR from December, 2012 to August, 2016 using
pooled data from electronic medical records. The patients were divided
into two groups: Group A with no or mild PAH (<=50 mm Hg) versus Group B
with moderate/severe PAH (>50 mm Hg). The post procedure echocardiogram
was done within 6 months post TAVR. The clinical outcomes were compared in
two groups in terms of 30 days and 1 year morality, MACE (acute myocardial
infarction, stroke and death). Statistical analysis was performed using
both paired and independent two-sample student t tests, as well as linear
regression. Results: Of the total 244 patient enrolled, we had complete
data on 213 patients, There were 159 patients in group A with average age
of 82.5 +/- 7.6 years and 61% of males versus 54 patients in the group B
with average age of 83+/-9 years and 41% of males. The average PAH in
Group A pre-procedure was 36.1+/-9.1 mmHg while the Group B had 59.8+/-8.1
mmHg. The 30-day (3% vs 0%, p <0.001) and 1-year mortality (8%vs0%, p
<0.001) was higher in patients with mild or no PAH versus none in moderate
to high PAH. Similar trend was seen in Group B in regards to MACE events
with lower in Group B with 1.9% patents versus in 15% in Group A with no
or mild PAH pre-procedure. In multivariate analysis, systolic pulmonary
artery pressure and chronic lung disease were identified as independent
predictors for mortality at 1 year. Conclusion: PAH has a common co-morbid
association with severe aortic stenosis in patients undergoing TAVR.
Significantly elevated pulmonary artery pressures at baseline are a poor
prognostic factor and should be considered while performing pre-procedural
assessment of the patients. In our case surprisingly low or no PAH had
poor outcomes.

<27>
Accession Number
623415259
Title
Cardiovascular outcomes of amlodipine-based combination therapies in
high-risk hypertensive patients.
Source
Cardiology (Switzerland). Conference: 23rd World Congress on Heart Disease
International Academy of Cardiology Annual Scientific Sessions 2018.
United States. 140 (Supplement 1) (pp 107), 2018. Date of Publication:
2018.
Author
Lu P.P.; Meng X.; Hu A.H.; Wang W.; Ma L.Y.; Zhang Y.Q.; Zhang X.Z.; Ma
L.H.; Liu L.S.; Zhou X.L.
Institution
(Lu, Meng, Ma, Zhang, Ma, Zhou) Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, Bei Jing, China
(Hu, Wang, Zhang, Liu) Beijing Hypertension League Institute, Chinese
Hypertension League, Bei Jing, China
Publisher
S. Karger AG
Abstract
Objective: To evaluate the treatment efficacy with the combination of a
dihydropyridine calcium-channel blocker amlodipine with diuretics or
angiotensin II receptor blocker on reducing the rate of cardiovascular
events. Methods: In a randomized, open-label, blinded-endpoint trial,
hypertensive patients at high risk for cardiovascular events from 180
clinical centers in China were assigned to receive treatment with either
amlodipine plus amiloride/hydrochlorothiazide (n=6776) or telmisartan
(n=6766). The primary outcome was the composite of nonfatal stroke,
nonfatal myocardial infarction or death from cardiovascular causes.
Results: The median follow-up was 41 months. No between-group difference
was observed in the mean BP lowering. However, the primary-outcome events
were reduced by 23.7% in the amlodipine-diuretics group compared with the
amlodipine-telmisartan group (hazard ratio [HR], 0.76; p=0.006). Of note,
amlodipine-diuretics treatment significantly lowered the risk of
cardiovascular death (HR, 0.64; p=0.035) and fatal and nonfatal stroke
(HR, 0.78; p=0.037) relative to amlodipine-telmisartan combination. Both
treatments were safe and well tolerated. Conclusion: The
amlodipine-diuretics combination was more efficacious in reducing
cardiovascular events than the amlodipine-telmisartan combination in
hypertensive patients with high risk for such events, independent of blood
pressure reduction. (ClinicalTrials.gov number, NCT01011660) Table 1:
Hazard ratios for primary, secondary and other outcomes.
Amlodipine-Diuretics Amlodipine-Telmisartan Hazard Ratio P Outcome-no. (%)
Group (N=6776) Group (N=6766) (95% CI) value Primary outcome 179 (2.6) 235
(3.5) 0.76 (0.63, 0.93) 0.006 Fatal and nonfatal stroke 127 (1.9) 163
(2.4) 0.78 (0.62, 0.99) 0.037 Death from cardiovascular 37 (0.5) 58 (0.9)
0.64 (0.43, 0.97) 0.035 causes Fatal and nonfatal myocardial 35 (0.5) 38
(0.6) 0.93 (0.59, 1.47) 0.747 infarction Hospitalization for unstable 49
(0.7) 60 (0.9) 0.82 (0.56,1.20) 0.312 angina Coronary revascularization 33
(0.5) 48 (0.7) 0.69 (0.44,1.08) 0.104 Hospitalization for 6 (0.1) 16 (0.2)
0.38 (0.15, 0.97) 0.042 congestive heart failure Composite of
cardiovascular 192 (2.8) 243 (3.6) 0.79 (0.66, 0.96) 0.016 events Death
from any cause 110 (1.6) 98 (1.4) 1.13 (0.86, 1.48) 0.385.

<28>
Accession Number
623415246
Title
Permanent pacemaker (PPM) insertion in patients with conduction
abnormalities post transcatheter aortic valve replacement (TAVR): A review
and proposed guidelines.
Source
Cardiology (Switzerland). Conference: 23rd World Congress on Heart Disease
International Academy of Cardiology Annual Scientific Sessions 2018.
United States. 140 (Supplement 1) (pp 54), 2018. Date of Publication:
2018.
Author
Nanda A.S.; Bob-Manuel T.; Chinta V.; Sharma A.; Ashraf U.; Kelly J.;
Pour-Ghaz I.; Khouzam R.N.
Institution
(Nanda, Bob-Manuel, Chinta, Sharma, Ashraf, Kelly, Pour-Ghaz, Khouzam)
University of Tennessee, Memphis, TN, United States
Publisher
S. Karger AG
Abstract
Background: Conduction abnormalities are a common complication of TAVR
with established predictive factors. Current guidelines are not concrete,
leaving several questions unanswered about PPM implantation post-TAVR. A
small subset of these patients are PPM dependent at one year post-TAVR,
while patients are still at a hemodynamic disadvantage. It is incumbent to
develop guidelines for risk stratification, procedure selection,
monitoring and recommending PPM implantation post-TAVR. Methods: 60
peer-reviewed articles including American College of Cardiology (ACC) and
European Society of Cardiology (ESC) guidelines, prospective randomized
trials, retrospective studies, meta-analyses and expert opinion articles
published from 1999-2017 were researched using SCOPUS, EMBASE and MEDLINE.
Studies reporting pathophysiology, predictors and clinical implications of
conduction abnormalities post-TAVR were reviewed. Results: The highest
risk of persistent complete heart block (CHB) is linked to pre-existing
right bundle branch block (RBBB), heavily calcified left ventricular
outflow tract (LVOT) and a short membranous septum. Increasing TAVR to
aortic annulus oversizing ratios is associated with an increase in PPM
implantation. TAVR depth less than 6 mm and placement higher in the LVOT
shows a lower trend in conduction abnormalities. Risk is higher with
self-expanding valves compared to balloon expandable valves (BEV). While
no ACC guidelines exist, the ESC recommends that PPM implants be
considered only in patients with CHB and high grade atrio-ventricular
block that persist 7 days post-TAVR. The predictive ability of
electrophysiology (EP) testing in those with new left bundle branch block
(LBBB) post-TAVR is under utilized. Conclusions: We propose pre-procedure
risk stratification and post-procedure monitoring in high-risk patients.
We propose procedural modification such as using the BEV and a high depth
of implantation. Cardiac EP testing in patients with new onset LBBB should
be used to determine the risk of persistent CHB. Early discharge with
leadless temporary pacemaker and continuous monitoring in high risk
patients post-TAVR will minimize unwanted PPM implantation.

<29>
Accession Number
623415171
Title
Placebo: Power of non-specific treatment effects.
Source
Cardiology (Switzerland). Conference: 23rd World Congress on Heart Disease
International Academy of Cardiology Annual Scientific Sessions 2018.
United States. 140 (Supplement 1) (pp 348), 2018. Date of Publication:
2018.
Author
Barsness G.
Institution
(Barsness) Mayo Clinic, Rochester, MN, United States
Publisher
S. Karger AG
Abstract
Background: The potential impact of placebo has been recognized for
centuries and used to varying degrees of success in the treatment of a
variety of disorders, including pain syndromes and angina pectoris. In
modern medical practice, placebo has alternately been embraced and
dismissed depending on audience and expertise, but the observation of a
substantial non-specific placebo (beneficial) or nocebo (harmful) effect
attendant to directed interventions remains consistent. Methods and
Results: While often conflated with a disease's natural history, the
Hawthorne effect or regression to the mean, apparent therapeutic effects
of presumably inert or inactive pills or procedures has been labeled the
"placebo effect." A wide range of blinded clinical investigations
utilizing sham or inactive controls have documented a beneficial effect
associated with these interventions, often accounting for nearly half of
the therapeutic effect noted in the "active" intervention cohorts.
Recently, clinical trials in cardiology and vascular disease have
highlighted the impact of these non-specific, placebo effects on patient
outcome. Randomized experiences in stroke prevention with PFO closure,
laser myocardial revascularization, headache prophylaxis and percutaneous
coronary intervention for stable angina have demonstrated a consistent
benefit in patients undergoing sham treatment that approaches or equals
the effect noted in patients receiving "active" treatment. Conclusions:
Recognition of the potential impact of non-specific placebo treatment
effects is increasingly important in an age of rapidly evolving medical
and complex surgical practice. Robust clinical trial design is imperative
in quantifying incremental benefits attributable to therapeutic
interventions in the setting of potentially substantial associated placebo
effects.

<30>
Accession Number
623415140
Title
A review of racial disparities in transcatheter aortic valve replacement
(TAVR).
Source
Cardiology (Switzerland). Conference: 23rd World Congress on Heart Disease
International Academy of Cardiology Annual Scientific Sessions 2018.
United States. 140 (Supplement 1) (pp 395), 2018. Date of Publication:
2018.
Author
Sharma A.; Bob-Manuel T.; Nanda A.; Ashraf U.; Kelly J.; Pour-Ghaz I.;
Khouzam R.N.
Institution
(Sharma, Bob-Manuel, Nanda, Ashraf, Kelly, Pour-Ghaz, Khouzam) University
of Tennessee Health Science Center, Memphis, TN, United States
Publisher
S. Karger AG
Abstract
Objective: To review racial disparities in the accessibility, referrals,
and performance of Transcatheter Aortic Valve Replacement (TAVR).
Background: While the number of TAVR procedures has been increasing
annually at an almost 100% rate, the percentage of African American (AA)
patients who receive this therapy has remained the same at 3.8%. This is
not proportionate to their percentage in the population. Several factors
can explain this disparity. Method: We performed a Pubmed and Medline
search for this topic and found 56 studies suitable for review. Results:
Racial Differences in the Prevalence of Aortic Stenosis (AS): AA patients
have been found to be at a significantly lower risk of developing severe
AS compared to Caucasians (0.3% vs 0.9%). Studies have shown AAs with
calcified aortic valves are less likely to progress to AS. Socioeconomic
and health insurance disparities: There is a higher number of uninsured AA
patients compared to their Caucasian counterparts. Many older minorities
have Medicare, which has stringent reimbursement requirements and multiple
exclusions for approval of TAVR. In comparison, patients with a
combination of private and Medicare insurance have been shown to get the
procedure more often. Disparities in specialist referrals: It has been
shown that AA patients with severe AS are less likely to be referred to
cardiology, more likely to decline an intervention, or be lost to
follow-up. Limited Inclusion in Clinical Trials: The Partner Trials that
pioneered the use of TAVR in high risk AS patients had limited inclusion
of AA patients. Access of AAs to Tertiary Care Centers is limited.
Cultural Perception towards disease and procedure: AA patients are
significantly more likely to refuse AVR compared to Caucasians. Medical
decisions are often reached from a group decision by family members who
may dissuade the patient without a full understanding of the procedure.
Conclusion: Racial disparities in TAVR implantation result from multiple
complex factors. A holistic multidisciplinary approach is required to
improve TAVR access in African Americans.

<31>
Accession Number
623415301
Title
Hemodynamic consequences following surgical aortic valve replacement
versus transcatheter aortic valve implantation-a randomized study.
Source
Acta Anaesthesiologica Scandinavica. Conference: 33rd Congress of the
Scandinavian Society of Anaesthesiology and Intensive Care Medicine, SSAI
2015. Iceland. 59 (Supplement 121) (pp 11), 2015. Date of Publication:
June 2015.
Author
Ryhammer P.K.; Greisen J.; Jakobsen C.-J.
Institution
(Ryhammer, Greisen, Jakobsen) Department of Anaesthesiology and Intensive
Care, Aarhus University Hospita, Denmark
Publisher
Blackwell Munksgaard
Abstract
Introduction: The trans-apical aortic valve replacement (a-TAVI) and the
surgical aortic valve replacement (SAVR) are two different methods of
treating severe aortic valve stenosis. The purpose of this study was to
compare perioperative haemodynamics in patients going through either
procedure to evaluate the anaesthetic and surgical impact. Methods: The
present study is a subset of a multicentre trial comparing the two methods
in patients with valvular aortic stenosis (AS), who were eligible for
either procedure, and thus were randomized to one of them. 58 patients
from our institution were included and all available data on haemodynamics
as well as arterial blood gases and s-creatinine were gathered and
compared. All patients were monitored invasively during anaesthesia and
recovery. Results: The SAVR group had lower cardiac index (CI) and stroke
volume index (SVI) (P < 0.001). At the end of surgery the SAVR group had a
higher pO2 (P < 0.0001), a higher s-lactate (P = 0.003) and a lower
haematocrit (P = 0.045) than the TAVI. The SAVR group received more fluids
(P < 0.0001) and a more pronounced increase in s-creatinine (P = 0.034)
was seen in the TAVI group. No differences in the perioperative use of
inotropes, vasoconstrictors or vasodilators Conclusions: The main finding
in the present study was that the surgical and anaesthesiological
management of a-TAVI resulted in a more stable haemodynamic situation both
per-and postoperatively compared to SAVR patients. The haemodynamic
changes during anaesthesia and SAVR operation may potentially lead to
hypoperfusion of organs. The advantages may be even more pronounced now as
TAVI today is a treatment that is well established.

<32>
Accession Number
623415333
Title
Ambient sevoflurane concentration during inhaled sedation in the Intensive
Care Unit.
Source
Acta Anaesthesiologica Scandinavica. Conference: 33rd Congress of the
Scandinavian Society of Anaesthesiology and Intensive Care Medicine, SSAI
2015. Iceland. 59 (Supplement 121) (pp 12), 2015. Date of Publication:
June 2015.
Author
Hellstrom J.; Ovall A.; Sackey P.V.
Institution
(Hellstrom, Ovall, Sackey) Department of Cardiothoracic Anesthesia and
Intensive Care, Karolinska University Hospital, Stockholm, Sweden
Publisher
Blackwell Munksgaard
Abstract
Background: Occupational exposure to sevoflurane without the use of
scavenging-only relying on air changes for sevoflurane clearance-vs.
passive scavenging to an adsorbing filter has not been well compared when
the anesthetic conserving device is used for inhaled sedation in the
intensive care unit1-2 (ICU). Methods: Ten patients gave consent to be
sevoflurane sedated in a non-blinded observational study following cardiac
surgery. Patients were randomized to be treated without scavenging (n = 5)
or with scavenging (n = 5) from all breathing air outlets to a
CONTRAfluranTM adsorbing cylinder. The study took place in a single-bed
ICU room with six air changes per hour. A closed suction system was used
in the latter group. Nurses exposure was sampled with dosimeters. Infrared
spectrophotometer was used to measure on-line concentration in the room,
inside outlets of breathing air and near the patient during procedures
involving disconnected breathing circuit. Results: Nurses exposure to
sevoflurane sampled with dosimeters was below the Swedish Occupational
Exposure Limit (OEL) of 10 ppm in both groups; median exposure with
scavenging was 0.67 ppm (range <= 0.50-0.77) and without 2.08 ppm (range
1.83-2.81) (P = 0.008). On-line concentration near the patient following 2
h sedation was <= 1 ppm with scavenging and 4-6 ppm without. Extubation
resulted in the highest peaks (range 4-10 ppm). Conclusions: Sevoflurane
exposure in a moderately ventilated ICU room was below OEL even without
scavenging. However, scavenging with CONTRAfluranTM and the use of a
closed suction system is an effective way of reducing occupational
exposure and should be advocated.

<33>
Accession Number
623347714
Title
New-onset arrhythmias following transcatheter aortic valve implantation: A
systematic review and meta-analysis.
Source
Heart. 104 (14) (pp 1208-1215), 2018. Date of Publication: 01 Jul 2018.
Author
Siontis G.C.M.; Praz F.; Lanz J.; Vollenbroich R.; Roten L.; Stortecky S.;
Raber L.; Windecker S.; Pilgrim T.
Institution
(Siontis, Praz, Lanz, Vollenbroich, Roten, Stortecky, Raber, Windecker,
Pilgrim) Department of Cardiology, Swiss Cardiovascular Center Bern,
University of Bern, Bern, Switzerland
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: To evaluate the prevalence and clinical impact of new-onset
arrhythmias in patients following transcatheter aortic valve implantation
(TAVI). Method: We systematically identified studies reporting new-onset
arrhythmias after TAVI other than atrioventricular conduction
disturbances. We summarised monitoring strategies, type and prevalence of
arrhythmias and estimated their effect on risk of death or cerebrovascular
events by using random-effects meta-analysis. The study is registered with
International prospective register of systematic reviews (PROSPERO)
(CRD42017058053). Results: Sixty-five studies (43 506 patients) reported
new-onset arrhythmias following TAVI. The method of arrhythmia detection
was specified only in 31 studies (48%). New-onset atrial fibrillation
(NOAF) (2641 patients), bradyarrhythmias (182 patients), supraventricular
arrhythmias (29 patients), ventricular arrhythmias (28 patients) and
non-specified major arrhythmias (855 patients) were reported. In most
studies (52 out of 65), new-onset arrhythmia detection was limited to the
first month following TAVI. The most frequently documented arrhythmia was
NOAF with trend of increasing summary prevalence of 11%, 14%, 14% and 25%
during inhospital, 30-day, 1-year and 2-year follow-ups, respectively (P
for trend=0.011). Summary prevalence estimates of NOAF at 30-day follow-up
differ significantly between studies of prospective and retrospective
design (8% and 21%, respectively, P=0.002). New episodes of
bradyarrhythmias were documented with a summary crude prevalence of 4% at
1-year follow-up. NOAF increased the risk of death (relative risk 1.61,
95% CI 1.35 to 1.98, I 2 =47%) and cerebrovascular events (1.79, 95% CI
1.24 to 2.64, I 2 =0%). No study commented on therapeutic modifications
following the detection of new-onset arrhythmias. Conclusions: Systematic
identification of new-onset arrhythmias following TAVI may have
considerable impact on subsequent therapeutic management and long-term
prognosis in this patient population.<br/>Copyright &#xa9; 2018 Article
author(s). All rights reserved.

<34>
Accession Number
623327016
Title
The effect of inhalation aromatherapy with lavender essential oil on pain
severity of patients after coronary artery bypass surgery: A single-blind
randomised clinical trial.
Source
Journal of Clinical and Diagnostic Research. 12 (7) (pp LC01-LC05), 2018.
Date of Publication: 01 Jul 2018.
Author
Seifi Z.; Bikmoradi A.; Bazrafshan M.-R.; Poorolajal J.; Araghchian M.;
Kashfi S.H.; Kavi E.; Jokar M.
Institution
(Seifi, Bazrafshan, Kashfi, Kavi) Department of Nursing, School of
Nursing, Larestan University of Medical Sciences, Larestan, Iran, Islamic
Republic of
(Bikmoradi) Department of Health Economic and Management, School of Public
Health, Hamadan University of Medical Sciences, Hamadan, Iran, Islamic
Republic of
(Poorolajal) Modeling of No communicable Diseases Research Center,
Department of Epidemiology and Biostatistics, School of Public Health,
Hamadan University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Araghchian) Department of Pharmacology, School of Medicine, Hamadan
University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Jokar) Department of Operating Room, School of Nursing and Midwifery,
Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of
Publisher
Journal of Clinical and Diagnostic Research (No 3, 1/9 Roop Nagar,GT
Karnal Road, Delhi 110007, India)
Abstract
Introduction: Pain control and management are the most important issues of
human basic needs and healthcare. The use of aromatherapy to relieve pain
has grown substantially compared with other supplementary therapies. Aroma
molecules convert to nervous signals in the olfactory bulb, amygdala and
the limbic system and produce therapeutic effects by causing the release
of a variety of neurotransmitters such as encephalin, endorphins and
serotonin. Aim: This study aimed to investigate the effects of inhalation
aromatherapy with lavender essential oil on pain severity of patients
after coronary artery bypass surgery. Materials and Methods: A
single-blinded randomised clinical trial was conducted with 60 patients
after coronary artery bypass surgeries that were recruited during 2013
from Ekbatan Therapeutic Center of Hamadan, Iran. The intervention
continued for two days for pain management. The intervention group inhaled
two drops of 2% lavender essential oil, while the control group used the
same amount of distilled water for 20 minutes on the second and third
postoperative days. Pain was measured at baseline and 5, 30, and 60
minutes following the intervention via vital sign tests and Visual
Analogue Scale (VAS). Independent t-test and ANOVA were performed to
measure continuous variables, while chi-square was conducted for the
analysis of categorical variables, using stata version 11.0. Results: The
mean chest pain score decreased significantly in both groups after surgery
however, there were significant differences between the aromatherapy and
control groups before and after intervention only at the 30^th
minute (p=0.001) and 60^th minute (p=0.012) on the second day
after surgery. Conclusion: Inhalational aromatherapy with lavender
essential oil could relief pain of patients in the first days following
coronary artery bypass surgery.<br/>Copyright &#xa9; 2018, Journal of
Clinical and Diagnostic Research. All rights reserved.

<35>
Accession Number
622035548
Title
Revascularization versus medical management of coronary artery disease in
prerenal transplant patients: A meta-analysis.
Source
CardioRenal Medicine. 8 (3) (pp 192-198), 2018. Date of Publication: 01
Jul 2018.
Author
Kamran H.; Kupferstein E.; Sharma N.; Singh G.; Sowers J.R.;
Whaley-Connell A.; Yacoub M.; Marmur J.D.; Salifu M.O.; McFarlane S.I.
Institution
(Kamran, Kupferstein, Sharma, Singh, Marmur, Salifu, McFarlane) Divisions
of Cardiovascular Medicine, Nephrology and Endocrinology, Department of
Medicine, State University of New York Downstate Medical Center, 450
Clarkson Avenue, Brooklyn, NY 11203, United States
(Sowers, Whaley-Connell) Divisions of Nephrology and Endocrinology,
Department of Medicine, University of Missouri, Columbia, MO, United
States
(Yacoub) Department of Cardiology, Northside Hospital, St. Petersburg,
Florida, United States
Publisher
S. Karger AG
Abstract
Introduction: End-stage renal disease requiring renal transplantation
comprises a growing patient population at risk for cardiovascular disease
(CVD) morbidity and mortality in large part due to accelerated
atherosclerosis. Consequently, these patients are at even higher risk of
major surgical CVD mortality. A paucity of research has addressed the
posttransplantation CVD outcomes related to different treatment strategies
in this patient population and therefore, there are no specific
preoperative guidelines regarding management of coronary artery disease in
this high-risk population undergoing renal transplantation. Objective:
Through meta-analysis we compare coronary revascularization to medical
management prior to renal transplantation in patients who are found to
have significant obstructive coronary artery disease. Results: A total of
6 studies were deemed suitable out of 777 articles reviewed. This included
260 patients who received medical management and 338 who received coronary
revascularization. There were 36 events in the revascularization and 57
events in the medical management group. One study only reported hazard
ratios but no CVD outcomes. Comprehensive Meta-Analysis software was used
to calculate pooled odds ratio with 95% confidence intervals (CI) for the
fixed effects. The data is presented as forest plots. The pooled odds
ratio with 95% CI for the fixed effects was 1.415 (95% CI 0.885-2.263), p
= 0.147, indicating that there is no difference in CVD outcomes between
pretransplant treatment strategy. This observation suggests that the CVD
outcomes posttransplantation are not affected when optimal medical therapy
is used instead of coronary revascularization.<br/>&#xa9; 2018 S. Karger
AG, Basel. Copyright: All rights reserved.

<36>
Accession Number
617340530
Title
Modified Single-Patch Technique Versus Two-Patch Technique for the Repair
of Complete Atrioventricular Septal Defect: A Meta-Analysis.
Source
Pediatric Cardiology. 38 (7) (pp 1456-1464), 2017. Date of Publication: 01
Oct 2017.
Author
Li D.; Fan Q.; Iwase T.; Hirata Y.; An Q.
Institution
(Li, Fan, An) Department of Cardiovascular Surgery, West China Hospital,
Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China
(Li, Iwase, Hirata) Department of Cardiac Surgery, The University of Tokyo
Hospital, Tokyo, Japan
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Technical selection for surgical repair of complete atrioventricular
septal defect (CAVSD) still remains controversial. This meta-analysis
aimed to compare the modified single-patch (MP) technique with the
two-patch (TP) technique for patients with CAVSD. Relevant studies
comparing the MP technique with the TP technique were identified through a
literature search using MEDLINE, EMBASE, Google Scholar, Cochrane Library,
and the China National Knowledge Infrastructure databases. The variables
were ventricular septal defect (VSD) size, cardiopulmonary bypass (CBP)
time, aortic cross-clamp (ACC) time, intensive care unit stay, hospital
stay, and other outcomes involving mortality, left ventricular outflow
tract obstruction, atrioventricular valve regurgitation, residual septal
shunt, atrioventricular block, and reoperation. A
random-effect/fixed-effect model was used to summarize the estimates of
mean difference/odds ratio with 95% confidence interval. Subgroup analysis
stratified by region was performed. Fifteen publications involving 1034
patients were included. This meta-analysis demonstrated that (1) VSD size
in the MP group was significantly smaller; (2) CBP time, ACC time, and
hospital stay in the MP group experienced improvement; (3) Other
postoperative outcomes showed no significant differences between two
groups; and (4) The trends in China and other countries were close. The MP
and TP techniques had comparable outcomes; however, the MP technique was
performed with significantly shorter CBP and ACC times in patients with
smaller VSDs. Given this limitation of data, the results of comparison of
the two techniques in patients with larger VSDs remain unknown. Further
studies are needed.<br/>Copyright &#xa9; 2017, Springer Science+Business
Media, LLC.

<37>
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.

<38>
Accession Number
623384199
Title
Heights and pitfalls of mitral valve repair versus replacement: Review of
literature.
Source
Clujul Medical. Conference: Medicalis 2017. Romania. 90 (Supplement 3) (pp
S99), 2017. Date of Publication: 2017.
Author
Luana-Andreea B.; Karina B.; Gabriela P.C.; Radu N.
Publisher
Universitatea de Medicina si Farmacie Iuliu Hatieganu
Abstract
Introduction. Mitral regurgitation is frequently caused by degenerative
changes of the valvular tissue, associated with other risk factors. Left
untreated, this affection has a bad prognosis and can lead to myocardial
infarction and pathological heart rhythms. The surgical treatment can be
done either by Mitral Plasty or Replacement. However, choosing between the
two procedures might be a challenge. Through this review, we summarized
the available data regarding clinical outcomes of Mitral Valve Repair and
Replacement, aiming to highlight the advantages and disadvantages of both
techniques. Material and methods. We systemized the information from two
databases of Duke Clinical Research Institute and made a retrospective
analysis with reference to all the procedures of Mitral Valve Replacement
and Mitral Valve Repair performed on 266 patients, over a period of 3
years. We examined the mortality rate in both types of surgery and,
considering the demographics, associated comorbidities and also the past
surgical interventions, we made a detailed comparison between the two
surgical techniques. The data was independently extracted by the two
reviewers and metaanalyzed based on the predefined criteria of study.
Results. In comparison with patients that underwent Mitral Valve
Replacement, those operated on for Mitral Valve Repair had a lower rate of
operative and post- operative mortality, which demonstrates significantly
reduced risks. Recurrence of at least mild mitral regurgitation was
greater in Mitral Valve Repair, but the percentage of re-intervention was
borderline similar. Conclusion. To conclude, in the current analysis, it
is demonstrated that although Mitral Valve Replacement is a durable
solution rarely followed by a second intervention, Mitral Valve Repair is
the elective procedure due to the low morbidity. However, a thorough
anamnesis is compulsory for guidance towards the correct surgical
treatment.

<39>
Accession Number
623324391
Title
Early initiation of post-sternotomy cardiac rehabilitation exercise
training (SCAR): Study protocol for a randomised controlled trial and
economic evaluation.
Source
BMJ Open. 8 (3) (no pagination), 2018. Date of Publication: 2018.
Author
Ennis S.; Lobley G.; Worrall S.; Powell R.; Kimani P.K.; Khan A.J.;
Banerjee P.; Barker T.; McGregor G.
Institution
(Ennis, Lobley, Worrall, Powell, McGregor) Department of Cardiac
Rehabilitation, Centre for Exercise and Health, University Hospital,
Coventry, United Kingdom
(Ennis) Cardiff Centre for Exercise and Health, Cardiff Metropolitan
University, Cardiff, United Kingdom
(Kimani) Statistics and Epidemiology, Division of Health Sciences, Warwick
Medical School, University of Warwick, Coventry, United Kingdom
(Khan, Banerjee, McGregor) Health and Life Sciences Research Centre,
Coventry University, Coventry, United Kingdom
(Banerjee) Department of Cardiology, University Hospitals, Coventry,
United Kingdom
(Barker) Department of Cardiothoracic Surgery, University Hospital,
Coventry, United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Current guidelines recommend abstinence from supervised
cardiac rehabilitation (CR) exercise training for 6 weeks post-sternotomy.
This practice is not based on empirical evidence, thus imposing
potentially unnecessary activity restrictions. Delayed participation in CR
exercise training promotes muscle atrophy, reduces cardiovascular fitness
and prolongs recovery. Limited data suggest no detrimental effect of
beginning CR exercise training as early as 2 weeks post-surgery, but
randomised controlled trials are yet to confirm this. The purpose of this
trial is to compare CR exercise training commenced early (2 weeks
post-surgery) with current usual care (6 weeks post-surgery) with a view
to informing future CR guidelines for patients recovering from sternotomy.
Methods and analysis In this assessor-blind randomised controlled trial,
140 cardiac surgery patients, recovering from sternotomy, will be assigned
to 8 weeks of twiceweekly supervised CR exercise training commencing at
either 2 weeks (early CR) or 6 weeks (usual care CR) post-surgery. Usual
care exercise training will adhere to current UK recommendations.
Participants in the early CR group will undertake a highly individualised
2-3 week programme of functional mobility, strength and cardiovascular
exercise before progressing to a usual care CR programme. Outcomes will be
assessed at baseline (inpatient), pre-CR (2 or 6 weeks post-surgery),
post-CR (10 or 14 weeks post-surgery) and 12 months. The primary outcome
will be change in 6 min walk distance. Secondary outcomes will include
measures of functional fitness, quality of life and cost-effectiveness.
Ethics and dissemination Recruitment commenced on July 2017 and will
complete by December 2019. Results will be disseminated via national
governing bodies, scientific meetings and peer-reviewed
journals.<br/>Copyright &#xa9; 2018 BMJ Publishing Group. All rights
reserved.

<40>
Accession Number
2001012917
Title
Current Readings: Single vs Bilateral Internal Mammary Artery in Coronary
Artery Bypass Grafting.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Author
Ejiofor J.I.; Kaneko T.; Aranki S.F.
Institution
(Ejiofor, Kaneko, Aranki) Division of Cardiac Surgery, Brigham and Women's
Hospital, Harvard Medical School, Boston, Massachusetts, United States
Publisher
W.B. Saunders
Abstract
There is strong retrospective data demonstrating that bilateral internal
mammary artery (BIMA) grafting leads to better long-term survival as
compared to left internal mammary artery grafting. However, this survival
advantage was not corroborated by the interim results of the Arterial
Revascularization Trial. Today, there are barriers to widespread adoption
of BIMA grafting. One of the main disadvantages of the use of BIMA grafts
is the higher risk of deep sternal wound infection. Deep sternal wound
infections can be minimized by skeletonized harvesting of the internal
mammary artery grafts, which preserve blood flow to the sternum. Also,
utilizing the BIMA graft as a "Y" graft may lead to more complete
revascularization compared to its in situ use. BIMA grafting on average
takes 25 minutes longer operating time with a higher in-hospital costs. We
eagerly await the 10-year results of the Arterial Revascularization Trial
to determine the truly unbiased randomized long-term effectiveness of BIMA
grafting.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<41>
Accession Number
2001012556
Title
The Effect of Inhaled Milrinone Versus Inhaled Levosimendan in Pulmonary
Hypertension Patients Undergoing Mitral Valve Surgery-A Randomized
Double-Blind Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Author
Kundra T.S.; Prabhakar V.; Kaur P.; Manjunatha N.; Gandham R.
Institution
(Kundra, Prabhakar, Manjunatha) Department of Cardiac Anaesthesia, Sri
Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore,
India, India
(Kaur) Department of Critical Care, Sir Ganga Ram Hospital, New Delhi,
India, India
(Gandham) Department of Anaesthesiology, Apollo Hospital, Vishakhapatnam,
India, India
Publisher
W.B. Saunders
Abstract
Objective: To compare the effects of inhaled milrinone and levosimendan on
pulmonary and systemic hemodynamics in patients with pulmonary
hypertension. Design: Prospective, double-blind, randomized controlled
study. Setting: Tertiary care cardiac institute with 650 beds.
Participants: The study comprised 150 adult patients with pulmonary
hypertension undergoing mitral valve surgery. Interventions: Patients were
assigned randomly into 1 of the following 3 groups: milrinone (M),
levosimendan (L), or control (C); n = 50 per group. In group M, inhaled
milrinone (50 micro&#32;g/kg); in group L, inhaled levosimendan (24
micro&#32;g/kg); and in group C, normal saline was administered when the
patient arrived in the recovery room. Pre-inhalation and post-inhalation
hemodynamics (mean arterial pressure [MAP], pulse rate, and systemic
vascular resistance [SVR]) were noted until 24 hours of inhalation of the
drug. The change in pulmonary artery pressures (pulmonary artery systolic
pressure [PASP] and mean pulmonary artery pressure [MPAP]) and the
duration for which they remained decreased compared with the control
group, were noted. Measurements and Main Results: MAP, pulse rate, and SVR
were comparable in the 3 groups at various time intervals. PASP and MPAP
decreased comparably after inhalation of levosimendan and milrinone.
However, they reached levels near the control group values after 2.5 to 3
hours in group L and after 0.5 hours in group M. Conclusions: Because
inhaled levosimendan causes a decrease in PASP and MPAP without causing a
decrease in SVR and MAP, the authors conclude that inhaled levosimendan is
a selective pulmonary vasodilator. It is as effective as milrinone in
reducing pulmonary artery pressures. In addition, it has advantage over
inhaled milrinone because it is has a longer duration of
action.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<42>
Accession Number
620193774
Title
The Perspective of the Intensivist on Inotropes and Postoperative Care
Following Pediatric Heart Surgery: An International Survey and Systematic
Review of the Literature.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 9 (1) (pp
10-21), 2018. Date of Publication: 01 Jan 2018.
Author
Roeleveld P.P.; de Klerk J.C.A.
Institution
(Roeleveld) Department of Pediatric Intensive Care, Leiden University
Medical center, Leiden, Netherlands
(de Klerk) Department of Neonatal Intensive Care, Erasmus MC-Sophia
Children's Hospital, Rotterdam, Netherlands
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Introduction: Inotropes are frequently being used in children undergoing
heart surgery to prevent or treat low cardiac output syndrome (LCOS).
There is only limited evidence that inotropes actually positively
influence postoperative outcome. Our aim was to describe the current
international practice variation in the use of inotropes following
congenital heart surgery. Methods: We developed an online survey regarding
the postoperative use of inotropes. We sent an invitation to all 197
registered members of the Pediatric Cardiac Intensive Care Society (PCICS)
to participate in the survey. We also performed a systematic review of the
literature. Results: Ninety-eight people (50%) responded, representing 62
international centers. Milrinone is routinely used perioperatively by 90
respondents (97%). Adrenaline/epinephrine is routinely used by 43%,
dopamine by 36%, dobutamine by 11%, and levosimendan by 6%. Steroids are
used routinely by 54% before initiating cardiopulmonary bypass.
Vasopressin is used by 44% of respondents. The development of LCOS is
monitored with lactate in 99% of respondents, physical examination (98%),
intermittent mixed venous saturation (76%), continuous mixed venous
saturation (13%), echocardiography (53%), core-peripheral temperature gap
(29%), near-infrared spectrometry (25%), and 4% use cardiac output
monitors (PiCCO, USCOM). To improve cardiac output, 42% add/increase
milrinone, 37% add adrenaline, and 15% add dopamine. Rescue therapy is
titrated individually, based on the patients' pathophysiology. A
systematic review of the literature failed to show compelling evidence
with regard to the benefit of inotropes. Conclusions: Despite the lack of
sufficient evidence, milrinone is used by the vast majority of caregivers
following congenital heart surgery.<br/>Copyright &#xa9; 2017, &#xa9; The
Author(s) 2017.

<43>
Accession Number
621773546
Title
Is fibre-optic bronchoscopy necessary to confirm the position of
rigid-angled endobronchial blockers before thoracic surgery? A randomized
controlled trial.
Source
European Journal of Cardio-thoracic Surgery. 53 (1) (pp 241-246), 2018.
Date of Publication: January 2018.
Author
Wang M.-L.; Wang Y.-P.; Hung M.-H.; Hsu H.-H.; Chen J.-S.; Yang F.-S.;
Cheng Y.-J.
Institution
(Wang, Wang, Hung, Yang, Cheng) Department of Anesthesiology, National
Taiwan University Hospital, National Taiwan University College of
Medicine, Taipei, Taiwan (Republic of China)
(Wang, Hung) Graduate Institute of Clinical Medicine, National Taiwan
University College of Medicine, Taipei, Taiwan (Republic of China)
(Hsu, Chen) Department of Surgery, National Taiwan University Hospital,
National Taiwan University College of Medicine, Taipei, Taiwan (Republic
of China)
(Chen) Department of Traumatology, National Taiwan University Hospital,
National Taiwan University College of Medicine, Taipei, Taiwan (Republic
of China)
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: To determine the success rate of blind insertion and the
usefulness of fibre-optic bronchoscopy for directing rigid-angled
endobronchial blockers (EBs) to the correct side and achieving
satisfactory surgical fields. METHODS: A randomized trial was designed to
determine the extent to which the Coopdech Endobronchial Blocker Tube
(Daiken Medical Co., Ltd) could successfully be placed through either
auscultation (n = 57) or fibre-optic bronchoscopy (n = 55) in patients
scheduled for thoracic surgery. The placement time was recorded and
quality of the thoracoscopic operation field was determined by the
thoracic surgeon. Anaesthesiologists with varying thoracic experience
levels were enrolled. RESULTS: The success rates of insertion through
auscultation were 100% (32 of 32) for the right side and 88% (22 of 25)
for the left side. Placement through auscultation was faster than that
through bronchoscopy (mean 89.6 vs 141.1 s, P = 0.008) in the right-sided
procedure but non-significant in the left-sided procedure (mean 138.5 vs
130 s, P = 0.795). Surgical grading of the operation field was not
significantly different between both techniques (P = 0.502). Experienced
anaesthesiologists took less time to position EBs (mean 91.0 vs 138.0 s, P
= 0.015). Surgical grading was comparable between specialists and
residents (P = 0.058). CONCLUSIONS: Once an EB was correctly inserted and
confirmed through auscultation, the corresponding surgical satisfaction
was comparable to that through bronchoscopy. In the majority of cases,
bronchoscopy is unnecessary for correct and efficient EB positioning.
However, bronchoscopy is still mandatory in left-sided EB insertion and in
patients with deviated tracheobronchial anatomy.<br/>Copyright &#xa9; The
Author 2017.

<44>
Accession Number
620559155
Title
Life After Surviving Fontan Surgery: A Meta-Analysis of the Incidence and
Predictors of Late Death.
Source
Heart Lung and Circulation. 27 (5) (pp 552-559), 2018. Date of
Publication: May 2018.
Author
Poh C.L.; d'Udekem Y.
Institution
(Poh, d'Udekem) Department of Cardiac Surgery, The Royal Children's
Hospital, Melbourne, Vic, Australia
(Poh, d'Udekem) Department of Paediatrics, University of Melbourne,
Melbourne, Vic, Australia
(Poh, d'Udekem) Heart Research, The Murdoch Childrens Research Institute,
Melbourne, Vic, Australia
Publisher
Elsevier Ltd
Abstract
Aim: We now know that 20-40% of patients with a single ventricle will
develop heart failure after the second decade post-Fontan surgery.
However, we remain unable to risk-stratify the cohort to identify patients
at highest risk of late failure and death. We conducted a systematic
review of all reported late outcomes for patients with a Fontan
circulation to identify predictors of late death. Methods: We searched
MEDLINE, Embase and PubMed with subject terms ("single ventricle"
"Hypoplastic left heart syndrome" "congenital heart defects" or "Fontan
procedure") AND ("heart failure" "post-operative complications" "death"
"cause of death" "transplantation" or "follow-up studies") for relevant
studies between January 1990 and December 2015. Variables identified as
significant predictors of late death on multivariate analysis were
collated for meta-analysis. Survival data was extrapolated from
Kaplan-Meier survival curves to generate a distribution-free summary
survival curve. Results: Thirty-four relevant publications were
identified, with a total of 7536 patients included in the analysis. Mean
follow-up duration was 114 months (range 24-269 months). There were 688
(11%) late deaths. Predominant causes of death were late Fontan failure
(34%), sudden death (19%) and perioperative death (16%). Estimated mean
survival at 5, 10 and 20 years post Fontan surgery were 95% (95%CI 93-96),
91% (95%CI 89-93) and 82% (95%CI 77-85). Significant predictors of late
death include prolonged pleural effusions post Fontan surgery (HR1.18,
95%CI 1.09-1.29, p < 0.001), protein losing enteropathy (HR2.19, 95%CI
1.69-2.84, p < 0.001), increased ventricular end diastolic volume (HR1.03
per 10 ml/BSA increase, 95%CI 1.02-1.05, p < 0.001) and having a permanent
pacemaker (HR12.63, 95%CI 6.17-25.86, p < 0.001). Conclusions: Over 80% of
patients who survive Fontan surgery will be alive at 20 years. Developing
late sequelae including protein losing enteropathy, ventricular
dysfunction or requiring a pacemaker predict a higher risk of late
death.<br/>Copyright &#xa9; 2017 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<45>
Accession Number
619926361
Title
Efficacy of amiodarone and lidocaine for preventing ventricular
fibrillation after aortic cross-clamp release in open heart surgery: a
meta-analysis of randomized controlled trials.
Source
Journal of Zhejiang University: Science B. 18 (12) (pp 1113-1122), 2017.
Date of Publication: 01 Dec 2017.
Author
Zheng Y.; Gu Q.; Chen H.-W.; Peng H.-M.; Jia D.-Y.; Zhou Y.; Xiang M.-X.
Institution
(Zheng, Zhou, Xiang) Department of Cardiology, the Second Affiliated
Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
(Zheng, Zhou, Xiang) Cardiovascular Key Lab of Zhejiang Province, the
Second Affiliated Hospital, School of Medicine, Zhejiang University,
Hangzhou 310009, China
(Gu) Department of Anesthesiology, the First Affiliated Hospital, School
of Medicine, Zhejiang University, Hangzhou 310003, China
(Chen) Cardiology Division, the First Affiliated Hospital of Nanjing
Medical University, Nanjing 210029, China
(Peng) Department of Respiratory, Tinhu People's Hospital, Yancheng
224001, China
(Jia) Department of Biology, Georgia Southern University, Statesboro
30460, United States
Publisher
Zhejiang University Press (Hangzhou Post Bureau, Hangzhou 310000, China)
Abstract
Objective: The relative preventative efficacy of amiodarone and lidocaine
for ventricular fibrillation (VF) after release of an aortic cross-clamp
(ACC) during open heart surgery has not been determined. This
meta-analysis was designed to systematically evaluate the influence of
amiodarone, lidocaine, or placebo on the incidence of VF after ACC.
Methods: Prospective randomized controlled trials (RCTs) that compared the
VF-preventative effects of amiodarone with lidocaine, or amiodarone or
lidocaine with placebo were included. PubMed, EMBASE, and the Cochrane
Library were searched for relevant RCTs. Fixed or randomized effect models
were applied according to the heterogeneity of the data from the selected
studies. Results: We included eight RCTs in the analysis. Pooled results
suggested that the preventative effects of amiodarone and lidocaine were
comparable (relative risk (RR)=1.12, 95% confidence interval (CI): 0.70 to
1.80, P=0.63), but both were superior to the placebo (amiodarone, RR=0.71,
95% CI: 0.51 to 1.00, P=0.05; lidocaine, RR=0.63, 95% CI: 0.46 to 0.88,
P=0.006). The percentage of patients requiring electric defibrillation
counter shocks (DCSs) did not differ significantly among patients
administered amiodarone (RR=0.21, 95% CI: 0.04 to 1.19, P=0.08), lidocaine
(RR=2.44, 95% CI: 0.13 to 44.02, P=0.55), or the placebo (RR=0.56, 95% CI:
0.25 to 1.25, P=0.16). Conclusions: Amiodarone and lidocaine are
comparably effective in preventing VF after ACC, but the percentage of
patients who subsequently require DCSs does not differ among those
administered amiodarone, lidocaine, or placebo.<br/>Copyright &#xa9; 2017,
Zhejiang University and Springer-Verlag GmbH Germany, part of Springer
Nature.

<46>
Accession Number
619534264
Title
Protease-Activated receptor PAR-4: An inducible switch between thrombosis
and vascular inflammation?.
Source
Thrombosis and Haemostasis. 117 (11) (pp 2013-2025), 2017. Date of
Publication: 2017.
Author
Fender A.C.; Rauch B.H.; Geisler T.; Schror K.
Institution
(Fender, Schror) Institut for Pharmakologie and Klinische Pharmakologie,
Klinikum der Heinrich-Heine-Universitat Dosseldorf, Mendelstr. 11, Monster
48149, Germany
(Fender) Experimentelle Hamostaseologie, Klinik for Anasthesiologie,
Universitatsklinikum Monster, Monster, Germany
(Rauch) Center of Drug Absorption and Transport (C-DAT), Institut for
Pharmakologie, Universitatsmedizin Greifswald, Greifswald, Germany
(Geisler) Medizinische Klinik III, Kardiologie Klinikum der
Eberhard-Karls-Universitat Tobingen, Tobingen, Germany
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Thrombin triggers activation of platelets through protease-Activated
receptor 1 (PAR-1) and PAR-4. Both receptors are widely expressed and
exert multiple platelet-independent functions. PAR signalling contributes
to healing responses after injury, by promoting cytokine activity and
cellular growth and mobility. Uncontrolled PAR activation, however, can
prevent timely resolution of inflammation, enhance thrombogenic
endothelial function and drive adverse remodelling. The specific role of
PAR-4 in thromboinflammatory vascular disease has been largely
underestimated, given the relatively limited expression of PAR-4 in
non-platelet cells under healthy conditions. However, unlike PAR-1, PAR-4
expression adapts dynamically to numerous stimuli associated with
thromboinflammation, including thrombin, angiotensin II,
sphingosine-1-phosphate (S1P), high glucose and redox stress, suggesting
expression is switched on 'at need'. Prostacyclin negatively regulates
PAR-4 expression at the post-Transcriptional level, which may serve to
fine-Tune thrombin responses and limit these to the injury site. PAR-4
elicits inflammatory, mitogenic and proliferative actions not only in
response to thrombin but also to numerous other inflammatory proteases,
and can cross-Talk with other receptor systems such as S1P and adenosine
receptors. Accordingly, PAR-4 has emerged as a candidate player in vessel
disease and cardiac post-infarction remodelling. Currently, PAR-4 is a
particularly promising target for safer anti-Thrombotic therapies. Recent
studies with the PAR-4 antagonist BMS-986120 lend support to the concept
that selective antagonism of PAR-4 may offer both an effective and safe
anti-Thrombotic therapy in the acute thrombotic setting as well as an
anti-inflammatory strategy to prevent long-Term progressive
atherosclerotic disease in high-risk cardiovascular
patients.<br/>Copyright &#xa9; 2017 Schattauer.

<47>
Accession Number
611107092
Title
Randomized evaluation of fibrinogen vs placebo in complex cardiovascular
surgery (REPLACE): A double-blind phase III study of haemostatic therapy.
Source
British Journal of Anaesthesia. 117 (1) (pp 41-51), 2016. Date of
Publication: 01 Jul 2016.
Author
Rahe-Meyer N.; Levy J.H.; Mazer C.D.; Schramko A.; Klein A.A.; Brat R.;
Okita Y.; Ueda Y.; Schmidt D.S.; Ranganath R.; Gill R.
Institution
(Rahe-Meyer) Clinic for Anesthesiology and Intensive Care Medicine,
Franziskus Hospital, Kiskerstrase 26, Bielefeld D-33615, Germany
(Levy) Duke University School of Medicine, Durham, NC, United States
(Mazer) St Michael's Hospital University of Toronto, Toronto, ON, Canada
(Schramko) Helsinki University Hospital, Helsinki, Finland
(Klein) Papworth Hospital, Cambridge, United Kingdom
(Brat) Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
(Okita) Kobe University Hospital, Kobe, Japan
(Ueda) Nagoya University Graduate School of Medicine, Nagoya, Japan
(Schmidt) CSL Behring, Marburg, Germany
(Ranganath) CSL Behring, King of Prussia, PA, United States
(Gill) University Hospital of Southampton, Southampton, United Kingdom
Publisher
Oxford University Press
Abstract
Background Single-dose human fibrinogen concentrate (FCH) might have
haemostatic benefits in complex cardiovascular surgery. Methods Patients
undergoing elective aortic surgery requiring cardiopulmonary bypass were
randomly assigned to receive FCH or placebo. Study medication was
administered to patients with a 5 min bleeding mass of 60-250 g after
separation from bypass and surgical haemostasis. A standardized algorithm
for allogeneic blood product transfusion was followed if bleeding
continued after study medication. Results 519 patients from 34 centres
were randomized, of whom 152 (29%) met inclusion criteria for study
medication. Median (IQR) pretreatment 5 min bleeding mass was 107 (76-138)
and 91 (71-112) g in the FCH and placebo groups, respectively (P=0.13).
More allogeneic blood product units were administered during the first 24
h after FCH, 5.0 (2.0-11.0), when compared with placebo, 3.0 (0.0-7.0),
P=0.026. Fewer patients avoided transfusion in the FCH group (15.4%)
compared with placebo (28.4%), P=0.047. The FCH immediately increased
plasma fibrinogen concentration and fibrin-based clot strength. Adverse
event rates were comparable in each group. Conclusions Human fibrinogen
concentrate was associated with increased allogeneic blood product
transfusion, an unexpected finding contrary to previous studies. Human
fibrinogen concentrate may not be effective in this setting when
administered according to 5-minute bleeding mass. Low bleeding rates and
normal-range plasma fibrinogen concentrations before study medication, and
variability in adherence to the complex transfusion algorithm, may have
contributed to these results. Clinical trial registration
ClinicalTrials.gov identifier no. NCT01475669; EudraCT trial no.
2011-002685-20.<br/>Copyright &#xa9; 2016 The Author 2016. Published by
Oxford University Press on behalf of the British Journal of Anaesthesia.
All rights reserved.

<48>
Accession Number
611107030
Title
Beneficial effects of levosimendan on survival in patients undergoing
extracorporeal membrane oxygenation after cardiovascular surgery.
Source
British Journal of Anaesthesia. 117 (1) (pp 52-58), 2016. Date of
Publication: 01 Jul 2016.
Author
Distelmaier K.; Roth C.; Schrutka L.; Binder C.; Steinlechner B.; Heinz
G.; Lang I.M.; Maurer G.; Koinig H.; Niessner A.; Hulsmann M.; Speidl W.;
Goliasch G.
Institution
(Distelmaier, Roth, Schrutka, Binder, Heinz, Lang, Maurer, Niessner,
Hulsmann, Speidl, Goliasch) Department of Internal Medicine II, Medical
University of Vienna, Waehringer Guertel 18-20, Vienna A-1090, Austria
(Steinlechner) Division of Cardiothoracic and Vascular Anaesthesia and
Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel
18-20, Vienna A-1090, Austria
(Koinig) Department of Anaesthesia and Intensive Care Medicine, University
Hospital Krems, Karl Landsteiner University of Health Sciences, Krems,
Austria
Publisher
Oxford University Press
Abstract
Background The impact of levosimendan treatment on clinical outcome in
patients undergoing extracorporeal membrane oxygenation (ECMO) support
after cardiovascular surgery is unknown. We hypothesized that the
beneficial effects of levosimendan might improve survival when adequate
end-organ perfusion is ensured by concomitant ECMO therapy. We therefore
studied the impact of levosimendan treatment on survival and failure of
ECMO weaning in patients after cardiovascular surgery. Methods We enrolled
a total of 240 patients undergoing veno-arterial ECMO therapy after
cardiovascular surgery at a university-affiliated tertiary care centre
into our observational single-centre registry. Results During a median
follow-up period of 37 months (interquartile range 19-67 months), 65% of
patients died. Seventy-five per cent of patients received levosimendan
treatment within the first 24 h after initiation of ECMO therapy. Cox
regression analysis showed an association between levosimendan treatment
and successful ECMO weaning [adjusted hazard ratio (HR) 0.41; 95%
confience interval (CI) 0.22-0.80; P=0.008], 30 day mortality (adjusted HR
0.52; 95% CI 0.30-0.89; P=0.016), and long-term mortality (adjusted HR
0.64; 95% CI 0.42-0.98; P=0.04). Conclusions These data suggest an
association between levosimendan treatment and improved short- and
long-term survival in patients undergoing ECMO support after
cardiovascular surgery.<br/>Copyright &#xa9; 2016 The Author 2016.
Published by Oxford University Press on behalf of the British Journal of
Anaesthesia. All rights reserved.

<49>
Accession Number
611106985
Title
Predictors of difficult videolaryngoscopy with GlideScope or
C-MAC with D-blade: Secondary analysis from a large comparative
videolaryngoscopy trial.
Source
British Journal of Anaesthesia. 117 (1) (pp 118-123), 2016. Date of
Publication: 01 Jul 2016.
Author
Aziz M.F.; Bayman E.O.; Van Tienderen M.M.; Todd M.M.; Brambrink A.M.;
Asai T.; Abrons R.O.; Cattano D.; Swanson D.E.; Hagberg C.A.
Institution
(Aziz, Van Tienderen, Brambrink) Oregon Health and Science University,
Mail Code KPV 5A, 3181 SW Sam Jackson Park Road, Portland, OR 97239,
United States
(Bayman, Todd) University of Iowa Hospitals and Clinics, 200 Hawkins
Drive, Iowa City, IA 52242, United States
Publisher
Oxford University Press
Abstract
Background Tracheal intubation using acute-angle videolaryngoscopy
achieves high success rates, but is not without difficulty. We aimed to
determine predictors of 'difficult videolaryngoscopy'. Methods We
performed a secondary analysis of a data set (n=1100) gathered from a
multicentre prospective randomized controlled trial of patients for whom
difficult direct laryngoscopy was anticipated and who were intubated with
one of two videolaryngoscopy devices (GlideScope or
C-MAC with D-blade). 'Difficult videolaryngoscopy' was defined
as 'first intubation time >60 s' or 'first attempt intubation failure'. A
multivariate logistic regression model along with stepwise model selection
techniques was performed to determine independent predictors of difficult
videolaryngoscopy. Results Of 1100 patients, 301 were identified as
difficult videolaryngoscopies. By univariate analysis, head and neck
position, provider, type of surgery, and mouth opening were associated
with difficult videolaryngoscopy (P<0.05). According to the multivariate
logistic regression model, characteristics associated with greater risk
for difficult videolaryngoscopy were as follows: (i) head and neck
position of 'supine sniffing' vs 'supine neutral' {odds ratio (OR) 1.63,
95% confidence interval (CI) [1.14, 2.31]}; (ii) undergoing
otolaryngologic or cardiac surgery vs general surgery (OR 1.89, 95% CI
[1.19, 3.01] and OR 6.13, 95% CI [1.85, 20.37], respectively); (iii)
intubation performed by an attending anaesthestist vs a supervised
resident (OR 1.83, 95% CI [1.14, 2.92]); and (iv) small mouth opening (OR
1.18, 95% CI [1.02, 1.36]). Conclusion This secondary analysis of an
existing data set indicates four covariates associated with difficult
acute-angle videolaryngoscopy, of which patient position and provider
level are modifiable.<br/>Copyright &#xa9; 2016 The Author 2016. Published
by Oxford University Press on behalf of the British Journal of
Anaesthesia. All rights reserved.

<50>
Accession Number
621769611
Title
CHA<inf>2</inf>DS<inf>2</inf>-VASc risk factors as predictors of stroke
after acute coronary syndrome: A systematic review and meta-analysis.
Source
European Heart Journal: Acute Cardiovascular Care. 7 (3) (pp 264-274),
2018. Date of Publication: 01 Apr 2018.
Author
Guerra F.; Scappini L.; Maolo A.; Campo G.; Pavasini R.; Shkoza M.;
Capucci A.
Institution
(Guerra, Scappini, Maolo, Shkoza, Capucci) Cardiology and Arrhythmology
Clinic, Marche Polytechnic University, University Hospital 'Ospedali
Riuniti', Italy
(Campo, Pavasini) Cardiology Department, Universita degli Studi di
Ferrara, Ospedale Sant'Anna, Italy
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Stroke is a rare but serious complication of acute coronary
syndrome. At present, no specific score exists to identify patients at
higher risk. The aim of the present study is to test whether each clinical
variable included in the CHA<inf>2</inf>DS<inf>2</inf>-VASc score retains
its predictive value in patients with recent acute coronary syndrome,
irrespective of atrial fibrillation. Methods: The meta-analysis was
conducted according to the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational
Studies in Epidemiology (MOOSE) guidelines. All clinical trials and
observational studies presenting data on the association between
stroke/transient ischemic attack incidence and at least one
CHA<inf>2</inf>DS<inf>2</inf>-VASc item in patients with a recent acute
coronary syndrome were considered in the analysis. Atrial fibrillation
diagnosis was also considered. Results: The whole cohort included 558,193
patients of which 7108 (1.3%) had an acute stroke and/or transient
ischemic attack during follow-up (median nine months;
1^st-3^rd quartile 1-12 months). Age and previous
stroke had the highest odds ratios (odds ratio 2.60; 95% confidence
interval 2.21-3.06 and odds ratio 2.74; 95% confidence interval 2.19-3.42
respectively), in accordance with the two-point value given in the
CHA<inf>2</inf>DS<inf>2</inf>-VASc score. All other factors were
positively associated with stroke, although with lower odds ratios. Atrial
fibrillation, while present in only 11.2% of the population, confirmed its
association with an increased risk of stroke and/or transient ischemic
attack (odds ratio 2.04; 95% confidence interval 1.71-2.44). Conclusions:
All risk factors included in the CHA<inf>2</inf>DS<inf>2</inf>-VASc score
are associated with stroke/ transient ischemic attack in patients with
recent acute coronary syndrome, and retain similar odds ratios to what
already seen in atrial fibrillation. The utility of
CHA<inf>2</inf>DS<inf>2</inf>-VASc score for risk stratification of stroke
in patients with acute coronary syndrome remains to be
determined.<br/>Copyright &#xa9; 2016, &#xa9; The European Society of
Cardiology 2016.

<51>
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.

<52>
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.

<53>
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.

<54>
Accession Number
619027754
Title
Lung segmentectomy: Does it offer a real functional benefit over
lobectomy?.
Source
European Respiratory Review. 26 (146) (no pagination), 2017. Article
Number: 170079. Date of Publication: 31 Dec 2017.
Author
Charloux A.; Quoix E.
Institution
(Charloux) Physiology and Functional Explorations Dept, University
Hospital, Strasbourg, France
(Charloux) EA 3072, Federation of Translational Medicine, Strasbourg
University, Strasbourg, France
(Quoix) Pulmonology Dept, University Hospital, Strasbourg, France
Publisher
European Respiratory Society (E-mail: info@ersnet.org)
Abstract
Anatomical segmentectomy has been developed to offer better pulmonary
function preservation than lobectomy, in stage IA lung cancer. Despite the
retrospective nature of most of the studies and the lack of randomised
studies, a substantial body of literature today allows us to evaluate to
what extent lung function decreases after segmentectomy and whether
segmentectomy offers a real functional benefit over lobectomy. From the
available series, it emerges that the mean decrease in forced expiratory
volume in 1 s (FEV<inf>1</inf>) is low, ranging from -9% to -24% of the
initial value within 2 months and -3 to-13% 12 months after segmentectomy.
This reduction in lung function is significantly lower than that induced
by lobectomy, but saves only a few per cent of pre-operative
FEV<inf>1</inf>. Moreover, the published results do not firmly establish
the functional benefit of segmentectomy over lobectomy in patients with
poor lung function. Some issues remain to be addressed, including whether
video-assisted thoracic surgery (VATS) segmentectomy may preserve lung
function better than VATS lobectomy in patients with poor lung function,
especially within the early days after surgery, and whether this may
translate to lowering the functional limit for surgery. Eventually, trials
comparing stereotactic ablative body radiotherapy, radiofrequency ablation
and segmentectomy functional consequences are warranted.<br/>Copyright
&#xa9; ERS 2017.

<55>
Accession Number
619721330
Title
Outcomes in Coronary artery disease patients with sleepy obstructive sleep
apnoea on CPAP.
Source
European Respiratory Journal. 50 (6) (no pagination), 2017. Article
Number: 1700749. Date of Publication: 01 Dec 2017.
Author
Peker Y.; Thunstrom E.; Glantz H.; Wegscheider K.; Eulenburg C.
Institution
(Peker) Dept of Pulmonary Medicine, Faculty of Medicine, Marmara
University, Pendik Education and Research Hospital, Sleep Medicine Center,
Pendik, Istanbul 34899, Turkey
(Peker, Thunstrom) Dept. of Molecular and Clinical Medicine/Cardiology,
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
(Thunstrom) Dept of Cardiology, Sahlgrenska University Hospital/Ostra,
Gothenburg, Sweden
(Glantz) Dept of Internal Medicine, Skaraborg Hospital, Lidkoping, Sweden
(Wegscheider) Dept of Medical Biometry and Epidemiology, University
Medical Center Hamburg-Eppendorf, Hamburg, Germany
(Eulenburg) Medical Statistics and Decision Making, Dept of Epidemiology,
University Medical Center Groningen, Groningen, Netherlands
Publisher
European Respiratory Society (E-mail: info@ersnet.org)
Abstract
Coronary artery disease (CAD) patients with obstructive sleep apnoea (OSA)
have increased risk for major adverse cardiovascular and cerebrovascular
events (MACCEs) compared with CAD patients without OSA. We aimed to
address if the risk is similar in both groups when OSA patients are
treated. This study was a parallel observational arm of the RICCADSA
randomised controlled trial, conducted in Sweden between 2005 and 2013.
Patients with revascularised CAD and OSA (apnoea-hypopnoea index (AHI)
>=15 events.h-1) with daytime sleepiness (Epworth Sleepiness Scale score
>=10) were offered continuous positive airway pressure (CPAP) (n=155); CAD
patients with no OSA (AHI <5 events.h-1) acted as controls (n=112), as a
randomisation of sleepy OSA patients to no treatment would not be
ethically feasible. The primary end-point was the first event of MACCEs.
Median follow-up was 57 months. The incidence of MACCEs was 23.2% in OSA
patients versus 16.1% in those with no OSA (adjusted hazard ratio 0.96,
95% CI 0.40-2.31; p=0.923). Age and previous revascularisation were
associated with increased risk for MACCEs, whereas coronary artery bypass
grafting at baseline was associated with reduced risk. We conclude that
the risk for MACCEs was not increased in CAD patients with sleepy OSA on
CPAP compared with patients without OSA.<br/>Copyright &#xa9; ERS 2017.

<56>
Accession Number
620129627
Title
Staging classification of aortic stenosis based on the extent of cardiac
damage.
Source
European Heart Journal. 38 (45) (pp 3351-3358), 2017. Date of Publication:
2017.
Author
Genereux P.; Pibarot P.; Redfors B.; Mack M.J.; Makkar R.R.; Jaber W.A.;
Svensson L.G.; Kapadia S.; Tuzcu E.M.; Thourani V.H.; Babaliaros V.;
Herrmann H.C.; Szeto W.Y.; Cohen D.J.; Lindman B.R.; McAndrew T.; Alu
M.C.; Douglas P.S.; Hahn R.T.; Kodali S.K.; Smith C.R.; Miller D.C.; Webb
J.G.; Leon M.B.
Institution
(Genereux, Redfors, McAndrew, Hahn, Kodali, Leon) Clinical Trials Center,
Cardiovascular Research Foundation, New York, NY, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Universite de Montreal,
Montreal, QC, Canada
(Pibarot) Pulmonary Hypertension and Vascular Biology Research Group,
Laval University, Quebec, Canada
(Redfors) Sahlgrenska University Hospital, Gothenburg, Sweden
(Mack) Baylor Scott and White Health, Plano, TX, United States
(Makkar) Interventional Technologies in the Heart Institute, Cedars-Sinai
Medical Center, Los Angeles, CA, United States
(Jaber, Svensson, Kapadia, Tuzcu) Heart and Vascular Institute, Cleveland
Clinic, Cleveland, OH, United States
(Thourani, Babaliaros) Emory University School of Medicine, Atlanta, GA,
United States
(Herrmann, Szeto) Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, PA, United States
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Lindman) Vanderbilt University Medical Center, Nashville, TN, United
States
(Alu, Hahn, Kodali, Smith, Leon) Columbia University Medical Center, 161
Ft. Washington Avenue, New York, NY 10032, United States
(Douglas) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC, United States
(Miller) Stanford University, Stanford, CA, United States
(Webb) University of British Columbia, St. Paul's Hospital, Vancouver, BC,
Canada
Publisher
Oxford University Press
Abstract
Aims In patients with aortic stenosis (AS), risk stratification for aortic
valve replacement (AVR) relies mainly on valverelated factors, symptoms
and co-morbidities. We sought to evaluate the prognostic impact of a
newly-defined staging classification characterizing the extent of
extravalvular (extra-aortic valve) cardiac damage among patients with
severe AS undergoing AVR. Methods and results Patients with severe AS from
the PARTNER 2 trials were pooled and classified according to the presence
or absence of cardiac damage as detected by echocardiography prior to AVR:
no extravalvular cardiac damage (Stage 0), left ventricular damage (Stage
1), left atrial or mitral valve damage (Stage 2), pulmonary vasculature or
tricuspid valve damage (Stage 3), or right ventricular damage (Stage 4).
One-year outcomes were compared using Kaplan- Meier techniques and
multivariable Cox proportional hazards models were used to identify 1-year
predictors of mortality. In 1661 patients with sufficient
echocardiographic data to allow staging, 47 (2.8%) patients were
classified as Stage 0, 212 (12.8%) as Stage 1, 844 (50.8%) as Stage 2, 413
(24.9%) as Stage 3, and 145 (8.7%) as Stage 4. Oneyear mortality was 4.4%
in Stage 0, 9.2% in Stage 1, 14.4% in Stage 2, 21.3% in Stage 3, and 24.5%
in Stage 4 (Ptrend < 0.0001). The extent of cardiac damage was
independently associated with increased mortality after AVR (HR 1.46 per
each increment in stage, 95% confidence interval 1.27-1.67, P < 0.0001).
Conclusion This newly described staging classification objectively
characterizes the extent of cardiac damage associated with AS and has
important prognostic implications for clinical outcomes after
AVR.<br/>Copyright &#xa9; 2017 The Author.

<57>
Accession Number
620129078
Title
Mechanical aortic valve replacement in non-elderly adults: Meta-analysis
and microsimulation.
Source
European Heart Journal. 38 (45) (pp 3370-3377), 2017. Date of Publication:
2017.
Author
Korteland N.M.; Etnel J.R.G.; Arabkhani B.; Mokhles M.M.; Mohamad A.;
Roos-Hesselink J.W.; Bogers A.J.J.C.; Takkenberg J.J.M.
Institution
(Korteland, Etnel, Arabkhani, Mokhles, Bogers, Takkenberg) Department of
Cardiothoracic Surgery, Erasmus MC, PO Box 2040, Rotterdam 3000 CA,
Netherlands
(Mohamad) Department of Radiology, Erasmus MC, PO Box 2040, Rotterdam 3000
CA, Netherlands
(Roos-Hesselink) Department of Cardiothoracic Cardiology, Erasmus MC, PO
Box 2040, Rotterdam 3000 CA, Netherlands
Publisher
Oxford University Press
Abstract
Aims To support decision-making regarding prosthetic valve selection in
non-elderly adults, we aim to provide a detailed overview of outcome after
contemporary mechanical aortic valve replacement (AVR). Methods and
results A systematic review was conducted for papers reporting clinical
outcome after AVR with bileaflet mechanical valves with a mean patient age
>=18 and <=55 years, published between 1 January 1995 and 31 December
2015. Through meta-analysis outcomes were pooled and entered into a
microsimulation model to calculate (event-free) life expectancy and
lifetime event risk. Twenty-nine publications, encompassing a total of
5728 patients with 32 515 patient-years of follow-up (pooled mean
follow-up: 5.7 years), were included. Pooled mean age at surgery was 48.0
years. Pooled early mortality risk was 3.15% (95% confidence interval
(CI):2.37-4.23), late mortality rate was 1.55%/year (95%CI:1.25-1.92);
38.7% of late deaths were valve-related. Pooled thromboembolism rate was
0.90%/year (95%CI:0.68-1.21), major bleeding 0.85%/year (95%CI:0.65-1.12),
nonstructural valve dysfunction 0.39%/year (95%CI:0.21-0.76), endocarditis
0.41%/year (95%CI:0.29-0.57), valve thrombosis 0.14%/year
(95%CI:0.08-0.25), structural valve deterioration 0.00%/year (zero events
observed), and reintervention 0.51%/year (95%CI:0.37-0.71), mostly due to
nonstructural valve dysfunction and endocarditis. For a 45-year-old, for
example, this translated to an estimated life expectancy of 19 years
(general population: 34 years) and lifetime risks of thromboembolism,
bleeding and reintervention of 18%, 15%, and 10%, respectively. Conclusion
This study demonstrates that outcome after mechanical AVR in non-elderly
adults is characterized by suboptimal survival and considerable lifetime
risk of anticoagulation-related complications, but also reoperation.
Non-elderly adult patients who are facing prosthetic valve selection are
entitled to conveyance of evidence-based estimates of the risks and
benefits of both mechanical and biological valve options in a shared
decision-making process.<br/>Copyright &#xa9; 2017 The Author.

<58>
Accession Number
623374721
Title
Effectiveness of colchicine for the prevention of recurrent pericarditis
and post-pericardiotomy syndrome: an updated meta-analysis of randomized
clinical data.
Source
European heart journal. Cardiovascular pharmacotherapy. 1 (2) (pp
117-125), 2015. Date of Publication: 01 Apr 2015.
Author
Agarwal S.K.; Vallurupalli S.; Uretsky B.F.; Hakeem A.
Institution
(Agarwal, Vallurupalli) Department of Cardiovascular Medicine, University
of Arkansas for Medical Sciences, Slot # 5324301 West Markham Street ,Mail
Slot #532, Little Rock, AR 72205, United States
(Uretsky, Hakeem) Department of Cardiovascular Medicine, University of
Arkansas for Medical Sciences, USA Central Arkansas Veterans Affair Health
System, Slot # 5324301 West Markham Street ,Mail Slot #532, Little Rock,
AR 72205, United States
Abstract
The aim of this study is to assess the safety and efficacy of colchicine
in prevention of recurrence, symptom reduction, and complications in
patients with pericarditis. Pericarditis is an important cause of chest
pain leading to frequent emergency room visits and reduced quality of
life. Pericarditis has traditionally been treated symptomatically with
anti-inflammatory drugs, but growing evidence suggests the use of
colchicine for both first episode and recurrent pericarditis in the
prevention of recurrences and reducing symptoms. PubMed, EMBASE, and the
Cochrane Central register of controlled trials (CENTRAL) databases were
searched and the studies were selected using the Preferred Reporting Items
for Systematic Reviews and Meta-Analyses (PRISMA) checklist. All
randomized clinical trials with head-to-head comparison between colchicine
and standard of care were included. A total of five studies were included
in the primary analysis of pericarditis and three in the analysis for
prevention of post-pericardiotomy syndrome (PPS). Colchicine reduced the
incidence rate of recurrent pericarditis in patients with both the first
episode and recurrent pericarditis, compared with placebo [16.7 vs. 36.8%;
risk ratio (RR) 0.46; 95% confidence interval (CI) 0.36-0.58; P < 0.00001;
I(2) = 0%], with a significant increase in adverse effects (12.5 vs. 8.5%,
RR 1.45; 95% CI 1.09-1.95; P = 0.01; I(2) = 0%) and drug withdrawal rate
(10.8 vs. 8.5%; RR 1.44; 95% CI 1.01-2.05; P = 0.04; I(2) = 14%). In
addition, colchicine decreased symptom duration in patients with recurrent
pericarditis (63.1 vs. 78.6%; RR 0.58; 95% CI 0.39-0.87; P = 0.02; I(2) =
65%), but had no significant effect on symptom duration in patients with
an initial episode of pericarditis (RR 0.91; 95% CI 0.65-1.28; P = 0.57;
I(2) = 0%). Colchicine was superior to placebo in the prevention of PPS at
1 year (13.2 vs. 25.8%, RR 0.56, 95% CI 0.42-0.76; P < 0.01). In this
quantitative analysis of randomized clinical data, colchicine demonstrated
superior clinical efficacy compared with standard therapy for the
prevention of recurrent pericarditis and PPS at the cost of a small
increase in the incidence rate of side effects. <br/>Copyright Published
on behalf of the European Society of Cardiology. All rights reserved.
&#xa9; The Author 2015. For permissions please email:
journals.permissions@oup.com.

<59>
Accession Number
2001007539
Title
Surgical Management of Tricuspid Valve Infective Endocarditis: A
Systematic Review and Meta-Analysis.
Source
Annals of Thoracic Surgery. (no pagination), 2018. Date of Publication:
2018.
Author
Yanagawa B.; Elbatarny M.; Verma S.; Hill S.; Mazine A.; Puskas J.D.;
Friedrich J.O.
Institution
(Yanagawa, Elbatarny, Verma, Hill, Mazine) Division of Cardiac Surgery,
St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
(Puskas) Department of Cardiothoracic Surgery, Mount Sinai Hospital, New
York, New York, United States
(Friedrich) Department of Critical Care and Medicine, St. Michael's
Hospital, University of Toronto, Toronto, Ontario, Canada
Publisher
Elsevier USA
Abstract
Background: This meta-analysis compares the early and late outcomes of
valve repair versus replacement, the primary surgical strategies for
tricuspid valve infective endocarditis (IE). Methods: We searched MEDLINE
and EMBASE databases until 2016 for studies comparing tricuspid valve
repair and replacement. Results: The main outcomes were mortality,
recurrent IE, and need for reoperation. There were 12 unmatched
retrospective observational studies with 1,165 patients (median follow-up
3.8 years, interquartile range: 2.1 to 5.0). The most common indications
for surgery were septic pulmonary embolism, left-sided IE, right-side
heart failure, and persistent bacteremia. Median repair proportion was 59%
and replacement was 41% among studies. The primary repair strategies are
vegetectomy, De Vega procedure, annuloplasty ring, bicuspidization, and
leaflet patch augmentation. Of valve replacements, 83% were bioprosthetic
and 17% mechanical prostheses. There were no differences in perioperative
mortality between tricuspid valve repair versus replacement (relative risk
[RR] 0.62, 95% confidence interval [CI]: 0.26 to 1.46, p = 0.3). Long-term
all-cause mortality was not different (RR 0.61, 95% CI: 0.22 to 1.72, p =
0.4). Valve repair was associated with lower recurrent IE (RR 0.17, 95%
CI: 0.05 to 0.57, p = 0.004) and need for reoperation (RR 0.26, 95% CI:
0.07 to 0.92, p = 0.04) but a trend toward greater risk of moderate to
severe tricuspid regurgitation (RR 4.14, 95% CI: 0.80 to 21.34, p = 0.09).
Furthermore, tricuspid valve repair is associated with lower need for
permanent pacemaker (RR 0.20, 95% CI: 0.11 to 0.35, p < 0.001).
Conclusions: Tricuspid valve repair and replacement offer similar
long-term survival. Valve repair may offer greater freedom from recurrent
IE and reoperation as well as freedom from pacemaker and should be the
preferred approach for patients with tricuspid valve IE.<br/>Copyright
&#xa9; 2018 The Society of Thoracic Surgeons