EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2001024416
Title
Oral thyroxin supplementation in infants undergoing cardiac surgery: A
double-blind placebo-controlled randomized clinical trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (3) (pp 1209-1217.e3),
2018. Date of Publication: September 2018.
Author
Talwar S.; Bhoje A.; Khadagawat R.; Chaturvedi P.; Sreenivas V.; Makhija
N.; Sahu M.; Choudhary S.K.; Airan B.
Institution
(Talwar, Bhoje, Khadagawat, Chaturvedi, Sreenivas, Makhija, Sahu,
Choudhary, Airan) Cardiothoracic Center, All India Institute of Medical
Sciences, New Delhi, India
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Decreases in serum total thyroxin and total triiodothyronine
occurs after cardiopulmonary bypass, and is reflected as poor immediate
outcome. We studied effects of oral thyroxin supplementation in infants
who underwent open-heart surgery. Methods: In this prospective study, 100
patients were randomized into 2 groups: 50 in the thyroxin group (TH) and
50 in the placebo group (PL). Patients in the TH group received oral
thyroxin (5 mug/kg) 12 hours before surgery and once daily for the
remainder of their intensive care unit (ICU) stay. Data on intraoperative
and postoperative variables were recorded. Cardiac index (CI) was
measured. Perioperative serum thyroid hormone levels and serum
interleukin-6 and tumor necrosis factor-alpha were measured. Secondary
analysis was performed by dividing patients into simple and complex
subcategories. Results: Results of the primary analysis indicated a higher
CI in the TH compared with the PL. In the complex category, the mean
duration of mechanical ventilation was 3.85 +/- 0.93 and 4.66 +/- 1.55
days in the TH and PL, respectively (P =.001). Mean ICU stay was 6.79 +/-
2.26 and 8.33 +/- 3.09 days (P =.03), and mean hospital stay was 15.70 +/-
4.77 and 18.90 +/- 4.48 days (P =.01) in the TH and PL, respectively.
There were no significant differences between the TH and the PL in the
simple category. CI was higher in the TH at all time points (P =.004). The
average therapeutic intervention scoring system scores for the first 2
days were higher in the PL in the complex category. Conclusions: Oral
thyroxin supplementation improves the CI and reduces the inotropic
requirement. In addition, it reduces the duration of mechanical
ventilation, ICU and hospital stay, and therapeutic intervention scoring
system in infants after surgery for complex congenital heart
defects.<br/>Copyright &#xa9; 2018 The American Association for Thoracic
Surgery

<2>
Accession Number
2000823087
Title
Lower versus upper leg saphenous vein composite grafts based on the left
internal thoracic artery: A randomized study.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (3) (pp 986-994.e2),
2018. Date of Publication: September 2018.
Author
Chang H.W.; Hwang H.Y.; Seo J.-W.; Kim K.-B.
Institution
(Chang) Department of Thoracic and Cardiovascular Surgery, Sejong General
Hospital, Bucheon-si, Gyeonggi-do, South Korea
(Hwang, Kim) Department of Thoracic and Cardiovascular Surgery, Seoul
National University Hospital, Seoul National University College of
Medicine, Seoul, South Korea
(Seo) Department of Pathology, Seoul National University Hospital, Seoul
National University College of Medicine, Seoul, South Korea
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: The "lower versus upper leg saphenous vein (SV) composite
graft based on the left internal thoracic artery (ITA) for coronary artery
bypass grafting" trial was designed to compare the histologic,
immunohistochemical, and angiographic findings of lower versus upper leg
SV composite grafts. Methods: Twenty-six patients with multivessel
coronary artery disease were prospectively randomized to undergo
revascularization using a lower leg (n = 13) or upper leg (n = 13) SV
composite graft based on the in situ left ITA. The SV was harvested with a
"no-touch" technique, and 2 excess segments were removed from the distal
and proximal portions of each SV conduit. Another proximal segment was
removed from the reversed SV composite graft, which had been dilated by
the native ITA pressure. Hematoxylin and eosin staining,
immunohistochemistry, and early and 1-year postoperative angiographic
results were compared. Results: The histologic study showed that the
proximal and dilated proximal SV conduit lumen diameters were smaller in
the lower leg group than in the upper leg group (proximal, 623 +/- 143 mum
vs 858 +/- 266 mum; P =.008; dilated proximal, 1138 +/- 419 mum vs 1477
+/- 353 mum; P =.047). However, there were no differences in the lumen
diameters of the distal SV segments in terms of immunohistochemical
comparisons, diameters, patency rates, or filling frame counts of the SV
conduits on early and 1-year postoperative angiograms between the 2
groups. Conclusions: Although the proximal segment luminal diameters were
smaller in the lower leg SV, there were no differences in the
immunohistochemical results or patency rates on early and 1-year
postoperative angiograms between the lower and upper leg "no-touch" SV
conduits.<br/>Copyright &#xa9; 2018 The American Association for Thoracic
Surgery

<3>
Accession Number
621249026
Title
Induction immunosuppressive therapy in cardiac transplantation: a
systematic review and meta-analysis.
Source
Heart Failure Reviews. 23 (5) (pp 641-649), 2018. Date of Publication: 01
Sep 2018.
Author
Briasoulis A.; Inampudi C.; Pala M.; Asleh R.; Alvarez P.; Bhama J.
Institution
(Briasoulis, Inampudi, Pala, Alvarez, Bhama) Division of Cardiovascular
Diseases, Section of Heart Failure and Transplant, University of Iowa
Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242, United States
(Asleh) Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN,
United States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Approximately 50% of heart transplant programs currently employ a strategy
of induction therapy (IT) with either interleukin-2 receptor antagonists
(IL2RA) or polyclonal anti-thymocyte antibodies (ATG) during the early
postoperative period. However, the overall utility of such therapy is
uncertain and data comparing induction protocols are limited. The authors
searched PubMed, the Cochrane Central Register of Controlled Trials, and
ClinicalTrials.gov through January 2018 for randomized controlled trials
(RCTs) or observational controlled studies of IT vs no IT and IL2RA vs
ATG. Inverse variance fixed effects models with odds ratio (OR) as the
effect measure were used for primary analyses. Main outcomes include
moderate and severe rejection, all-cause mortality, infection, and cancer.
The authors' search retrieved 2449 studies, of which 11 met criteria for
inclusion (8 RCTs and 3 observational case-control studies). Quality of
evidence for RCTs was moderate to high. Overall, patients receiving IT had
similar risk of moderate-to-severe rejection, all-cause death, infection,
and cancer with patients who did not receive IT. The use of IL2RA was
associated with significantly higher risk of moderate-to-severe rejection
than ATG (OR 3.4; 95% CI 1.4 to 8.1), but similar risk of death,
infections, and cancer. The use of IT was not associated with any benefits
or harms compared with no IT. Moderate-to-severe rejection may be reduced
by ATG compared with IL2RA.<br/>Copyright &#xa9; 2018, Springer
Science+Business Media, LLC, part of Springer Nature.

<4>
Accession Number
2000990587
Title
Patient-Controlled Paravertebral Block for Video-Assisted Thoracic
Surgery: A Randomized Trial.
Source
Annals of Thoracic Surgery. 106 (3) (pp 888-894), 2018. Date of
Publication: September 2018.
Author
Wu Z.; Fang S.; Wang Q.; Wu C.; Zhan T.; Wu M.
Institution
(Wu, Fang, Wang, Zhan, Wu) Department of Thoracic Surgery, the Second
Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou,
China
(Wu) Department of Medical Quality Management, the Women's Hospital,
Zhejiang University School of Medicine, Hangzhou, China
Publisher
Elsevier USA
Abstract
Background: Paravertebral block (PVB) has been proven to be an efficient
way to control postoperative pain in patients who have undergone a
thoracotomy. This study explored whether the use of a patient-controlled
PVB can provide benefits over intravenous patient-controlled analgesia
(PCA) for 3-port single-intercostal video-assisted thoracic surgery.
Methods: From May 2015 to December 2016, patients who had solitary
pulmonary nodules or spontaneous pneumothorax and underwent
single-intercostal video-assisted thoracic surgery were randomly allocated
to receive patient-controlled PVB or intravenous PCA. Intramuscular
dezocine (10 mg) was used as a rescue medication. None of the surgeons,
patients, or investigators assessing outcomes or analyzing the data were
blinded to the group assignments. Pain level was measured by the visual
analog score. Results: There were 86 patients assigned to the PVB group
and 85 patients assigned to the PCA group. The difference in the mean
visual analog score between these two groups was not significant (p =
0.115). For patients who needed rescue medication, the cumulative dezocine
dose in the PVB group was significantly lower than that in the PCA group
(21.7 mg vs 30.9 mg, p = 0.001) throughout the 4 postoperative days. The
frequencies of severe vomiting (p = 0.003) and hypotension (p = 0.005)
were significantly lower in the PVB group. Conclusions: PVB, which
resulted in lower cumulative dezocine doses and produced fewer side
effects than PCA, can provide effective pain relief for patients
undergoing video-assisted thoracic surgery.<br/>Copyright &#xa9; 2018 The
Society of Thoracic Surgeons

<5>
Accession Number
2000920365
Title
Exercise prehabilitation in elective intra-cavity surgery: A role within
the ERAS pathway? A narrative review.
Source
International Journal of Surgery. 56 (pp 328-333), 2018. Date of
Publication: August 2018.
Author
Orange S.T.; Northgraves M.J.; Marshall P.; Madden L.A.; Vince R.V.
Institution
(Orange, Northgraves, Marshall, Vince) Sport, Health and Exercise Science,
School of Life Sciences, University of Hull, Hull, United Kingdom
(Northgraves) Department of Health Sciences, University of York, York,
United Kingdom
(Madden) Centre of Biomedical Research, School of Life Sciences,
University of Hull, Hull, United Kingdom
Publisher
Elsevier Ltd
Abstract
The Enhanced Recovery after Surgery (ERAS) model integrates several
elements of perioperative care into a standardised clinical pathway for
surgical patients. ERAS programmes aim to reduce the rate of
complications, improve surgical recovery, and limit postoperative length
of hospital stay (LOHS). One area of growing interest that is not
currently included within ERAS protocols is the use of exercise
prehabilitation (PREHAB) interventions. PREHAB refers to the systematic
process of improving functional capacity of the patient to withstand the
upcoming physiological stress of surgery. A number of recent systematic
reviews have examined the role of PREHAB prior to elective intra-cavity
surgery. However, the results have been conflicting and a definitive
conclusion has not been obtained. Furthermore, a summary of the research
area focussing exclusively on the therapeutic potential of exercise prior
to intra-cavity surgery is yet to be undertaken. Clarification is required
to better inform perioperative care and advance the research field.
Therefore, this "review of reviews" provides a critical overview of
currently available evidence on the effect of exercise PREHAB in patients
undergoing i) coronary artery bypass graft surgery (CABG), ii) lung
resection surgery, and iii) gastrointestinal and colorectal surgery. We
discuss the findings of systematic reviews and meta-analyses and
supplement these with recently published clinical trials. This article
summarises the research findings and identifies pertinent gaps in the
research area that warrant further investigation. Finally, studies are
conceptually synthesised to discuss the feasibility of PREHAB in clinical
practice and its potential role within the ERAS pathway.<br/>Copyright
&#xa9; 2018 IJS Publishing Group Ltd

<6>
Accession Number
2001007539
Title
Surgical Management of Tricuspid Valve Infective Endocarditis: A
Systematic Review and Meta-Analysis.
Source
Annals of Thoracic Surgery. 106 (3) (pp 708-714), 2018. Date of
Publication: September 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

<7>
Accession Number
623534985
Title
Prophylactic amiodarone vs dronedarone for prevention of perioperative
arrhythmias in offpump coronary artery bypass grafting: A pilot randomized
controlled trial.
Source
Journal of perioperative practice. 27 (1-2) (pp 9-14), 2017. Date of
Publication: 01 Jan 2017.
Author
Som A.; Sen C.; Goswami A.
Institution
(Som) Department of Anaesthesiology, Pain Medicine and Critical Care,
AIIMS, New Delhi, India
(Sen, Goswami) Department of Cardiac Anaesthesiology, Institute of Post
Graduate Medical Education and Research, Kolkata, India
Abstract
The aim of this study was to compare the effects of prophylactic
dronedarone and amiodarone in prevention of arrhythmias during and
following off-pump coronary artery bypass grafting (OPCAB). This
randomized, controlled, double-blinded, parallel-group study was carried
out on 36 adult male patients aged 30-70 years, with modified Parsonnet
score 0-10 undergoing offpump coronary artery bypass grafting. After
obtaining approval from the institutional ethics committee and informed
consent, the patients were randomly allocated to two equal groups (n=18).
In one group, patients were given inj. amiodarone 3mg/kg in 100ml of
normal saline prior to skin incision intravenously over 20 minutes. In the
second group patients received tablet dronedarone 400mg orally twice
daily, commencing three days prior to the date of surgery. Patients in the
amiodarone group received placebo tablet while patients in the dronedarone
group received placebo infusion for the sake of blinding. The frequency
and profile of arrhythmias intraoperatively and 24 hours postoperatively
were studied. Intraoperative arrhythmias occurred in 50% of patients
receiving amiodarone and 16.67% of patients receiving dronedarone. Maximum
ventricular rate during atrial fibrillation was significantly lower in the
dronedarone group (121 beats per min) than in the amiodarone group (168
beats per min). The study concludes that dronedarone appears to be at
least as effective as amiodarone in prophylaxis of intraoperative and
postoperative arrhythmias in patients undergoing OPCAB, with a better
control of ventricular response.<br/>Copyright the Association for
Perioperative Practice.

<8>
Accession Number
623537832
Title
Levosimendan for perioperative cardioprotection: Myth or reality?.
Source
Current Cardiology Reviews. 14 (3) (pp 142-152), 2018. Date of
Publication: 2018.
Author
Santillo E.; Migale M.; Massini C.; Incalzi R.A.
Institution
(Santillo, Migale) Geriatric-Rehabilitative Department, Italian National
Research Center on Aging (INRCA), Fermo, Italy
(Massini) Cardiac, Thoracic and Vascular Surgery Ward, Salus Hospital-GVM
Care & Research, Reggio Emilia, Italy
(Incalzi) Chair of Geriatrics, Biomedic Campus University, Via Alvaro del
Portillo 21, Rome, Italy
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Levosimendan is a calcium sensitizer drug causing increased
contractility in the myocardium and vasodilation in the vascular system.
It is mainly used for the therapy of acute decompensated heart failure.
Several studies on animals and humans provided evidence of the
cardioprotective properties of levosimendan including preconditioning and
anti-apoptotic. In view of these favorable effects, levosimendan has been
tested in patients undergoing cardiac surgery for the prevention or
treatment of low cardiac output syndrome. However, initial positive
results from small studies have not been confirmed in three recent large
trials. Aim: To summarize levosimendan mechanisms of action and clinical
use and to review available evidence on its perioperative use in a cardiac
surgery setting. Methods: We searched two electronic medical databases for
randomized controlled trials studying levosimendan in cardiac surgery
patients, ranging from January 2000 to August 2017. Meta-analyses,
consensus documents and retrospective studies were also reviewed. Results:
In the selected interval of time, 54 studies on the use of levosimendan in
heart surgery have been performed. Early small size studies and
meta-analyses have suggested that perioperative levosimendan infusion
could diminish mortality and other adverse outcomes (i.e. intensive care
unit stay and need for inotropic support). Instead, three recent large
randomized controlled trials (LEVO-CTS, CHEETAH and LICORN) showed no
significant survival benefits from levosimendan. However, in LEVO-CTS
trial, prophylactic levosimendan administration significantly reduced the
incidence of low cardiac output syndrome. Conclusions: Based on most
recent randomized controlled trials, levosimendan, although effective for
the treatment of acute heart failure, can't be recommended as standard
therapy for the management of heart surgery patients. Further studies are
needed to clarify whether selected subgroups of heart surgery patients may
benefit from perioperative levosimendan infusion.<br/>Copyright &#xa9;
2018 Bentham Science Publishers.

<9>
Accession Number
2001039483
Title
A Systemic Review and Meta-Analysis of Sutureless Aortic Valve Replacement
Versus Transcatheter Aortic Valve Implantation.
Source
Annals of Thoracic Surgery. 106 (3) (pp 924-929), 2018. Date of
Publication: September 2018.
Author
Shinn S.H.; Altarabsheh S.E.; Deo S.V.; Sabik J.H.; Markowitz A.H.; Park
S.J.
Institution
(Shinn) Department of Thoracic and Cardiovascular Surgery, Cheju Halla
General Hospital, Jeju, Republic of Korea, South Korea
(Altarabsheh) Department of Cardiovascular Surgery, Queen Alia Heart
Institute, Amman, Jordan
(Deo, Sabik, Markowitz, Park) Division of Cardiac Surgery, Harrington
Heart and Vascular Institute, Case Western University Hospital, Cleveland,
Ohio, United States
Publisher
Elsevier USA
Abstract
Background: Sutureless aortic valve replacement (SU-AVR) and transcatheter
aortic valve implantation (TAVI) are increasingly adopted methods to treat
high-risk patients with severe aortic valve stenosis. We conducted a
systematic review and meta-analysis to compare the clinical outcomes
between these two recent methods to treat aortic valve disease. Methods:
We systematically searched multiple databases (January 2000 to October
2016) to identify original studies comparing clinical outcome between
SU-AVR and TAVI. End points studied were early mortality, development of
paravalvular leak, early stroke, bleeding events, and the need for
pacemaker insertion. A random-effect inverse-variance weighted analysis
was performed. Event rates were compared as odds ratio (OR) and 95%
confidence interval (CI). Results: The meta-analysis included seven
observational studies comprising 617 SU-AVR and 621 TAVI patients. Early
mortality was 2.5% and 5% in the SU-AVR and TAVI cohorts, respectively
(OR, 0.52; 95% CI, 0.30 to 0.90; p = 0.02; I² = 2%).
Postprocedural significant paravalvular leak was much lower after SU-AVR
(OR, 0.18l; 95% CI, 0.11 to 0.30; p < 0.0001). Postprocedural stroke (OR,
0.71; 95% CI, 0.24 to 2.08; p = 0.53) and the need for pacemaker insertion
(OR, 0.884; 95% CI, 0.364 to 2.18; p = 0.7) were comparable between the
two cohorts. Conclusions: Our meta-analysis of observational studies
demonstrates that early mortality is lower after SU-AVR than after TAVI in
selected patients. The rates of stroke and pacemaker implant are
comparable between procedures; however, the incidence of paravalvular leak
is higher after TAVI.<br/>Copyright &#xa9; 2018 The Society of Thoracic
Surgeons

<10>
Accession Number
2001037327
Title
Cardiovascular Outcomes Assessment of the MitraClip in Patients with Heart
Failure and Secondary Mitral Regurgitation: Design and rationale of the
COAPT trial.
Source
American Heart Journal. 205 (pp 1-11), 2018. Date of Publication: November
2018.
Author
Mack M.J.; Abraham W.T.; Lindenfeld J.; Bolling S.F.; Feldman T.E.;
Grayburn P.A.; Kapadia S.R.; McCarthy P.M.; Lim D.S.; Udelson J.E.; Zile
M.R.; Gammie J.S.; Gillinov A.M.; Glower D.D.; Heimansohn D.A.; Suri R.M.;
Ellis J.T.; Shu Y.; Kar S.; Weissman N.J.; Stone G.W.
Institution
(Mack) Heart Hospital Baylor Plano, Baylor HealthCare System, Dallas, TX,
United States
(Abraham) Departments of Medicine, Physiology, and Cell Biology, Division
of Cardiovascular Medicine, Davis Heart & Lung Research Institute, The
Ohio State University, Columbus, OH, United States
(Lindenfeld) Advanced Heart Failure, Vanderbilt Heart and Vascular
Institute, Nashville, TN, United States
(Bolling) Department of Cardiac Surgery, University of Michigan Health
System, Ann Arbor, MI, United States
(Feldman) Evanston Hospital Cardiology Division, Northshore University
Health System, Evanston, IL, United States
(Grayburn) Baylor University Medical Center, Baylor Heart and Vascular
Institute, Dallas, TX, United States
(Kapadia) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, OH, United States
(McCarthy) Division of Cardiac Surgery, Department of Surgery,
Northwestern University Feinberg School of Medicine, Northwestern
University, Chicago, IL, United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville, VA,
United States
(Udelson) Division of Cardiology and the CardioVascular Center, Tufts
Medical Center, Boston, MA, United States
(Zile) Medical University of South Carolina and Ralph H. Johnson Veterans
Administration Medical Center, Charleston, SC, United States
(Gammie) Division of Cardiac Surgery, University of Maryland School of
Medicine, Baltimore, MD, United States
(Gillinov) Department of Thoracic and Cardiovascular Surgery, Heart and
Vascular Institute, Cleveland Clinic, Cleveland, OH, United States
(Glower) Division of Cardiology, Duke University Medical Center, Durham,
NC, United States
(Heimansohn) Department of Cardiothoracic Surgery, St Vincent Heart
Center, Indianapolis, IN, United States
(Suri) Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation,
Cleveland, OH, United States
(Ellis, Shu) Abbott, Santa Clara, CA, United States
(Kar) Cedars Sinai Heart Institute, Cedars Sinai Medical Center, Los
Angeles, CA, United States
(Weissman) MedStar Health Research Institute, Hyattsville, MD, United
States
(Stone) New York Presbyterian Hospital, Columbia University Medical
Center, The Cardiovascular Research Foundation, New York, NY, United
States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Patients with heart failure (HF) and symptomatic secondary
mitral regurgitation (SMR) have a poor prognosis, with morbidity and
mortality directly correlated with MR severity. Correction of isolated SMR
with surgery is not well established in this population, and medical
management remains the preferred approach in most patients. The
Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy
for Heart Failure Patients with Functional Mitral Regurgitation (COAPT)
trial was designed to determine whether transcatheter mitral valve (MV)
repair with the MitraClip device is safe and effective in patients with
symptomatic HF and clinically significant SMR. Study design: The COAPT
trial is a prospective, randomized, parallel-controlled, open-label
multicenter study of the MitraClip device for the treatment of
moderate-to-severe (3+) or severe (4+) SMR (as verified by an independent
echocardiographic core laboratory) in patients with New York Heart
Association class II-IVa HF despite treatment with maximally tolerated
guideline-directed medical therapy (GDMT) who have been determined by the
site's local heart team as not appropriate for MV surgery. A total of 614
eligible subjects were randomized in a 1:1 ratio to MV repair with the
MitraClip plus GDMT versus GDMT alone. The primary effectiveness end point
is recurrent HF hospitalizations through 24 months, analyzed when the last
subject completes 12-month follow-up, powered to demonstrate superiority
of MitraClip therapy. The primary safety end point is a composite of
device-related complications at 12 months compared to a performance goal.
Follow-up is ongoing, and the principal results are expected in late 2018.
Conclusions: HF patients with clinically significant SMR who continue to
be symptomatic despite optimal GDMT have limited treatment options and a
poor prognosis. The randomized COAPT trial was designed to determine the
safety and effectiveness of transcatheter MV repair with the MitraClip in
symptomatic HF patients with moderate-to-severe or severe
SMR.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<11>
Accession Number
2001037363
Title
Outcomes of Patients Receiving Downstream Revascularization After Initial
Medical Management for Non-ST-Segment Elevation Acute Coronary Syndromes
(From the TRILOGY ACS Trial).
Source
American Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Author
Hinohara T.T.; Roe M.T.; White H.D.; Fox K.A.A.; Bhatt D.L.; Hamm C.;
Gurbel P.A.; Aylward P.E.; Wiviott S.D.; Huber K.; Neely M.L.; Ohman E.M.
Institution
(Hinohara) Division of General Internal Medicine, Duke University School
of Medicine, Durham, North Carolina, United States
(Roe, Ohman) Division of Cardiology, Department of Medicine, Duke
University School of Medicine, Durham, North Carolina, United States
(Roe, Neely, Ohman) Duke Clinical Research Institute, Duke University
School of Medicine, Durham, North Carolina, United States
(White) Green Lane Cardiovascular Service, Auckland City Hospital, New
Zealand
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, United Kingdom
(Bhatt, Wiviott) Cardiovascular Division, Brigham and Women's Hospital,
Harvard Medical School, Boston, Massachusetts, United States
(Bhatt) VA Boston Healthcare System, Boston, Massachusetts, United States
(Hamm) Kerckhoff Heart and Thoraxcenter, Bad Nauheim, Germany
(Gurbel) Sinai Center for Thrombosis Research, Sinai Hospital of
Baltimore, Baltimore, Maryland, United States
(Aylward) South Australian Health and Medical Research Institute, Flinders
University Medical Centre, Adelaide, SA, Australia
(Huber) Third Department of Medicine, Cardiology and Intensive Care
Medicine, Wilhelminenhospital, and Sigmund Freud University, Medical
School, Vienna, Austria
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS)
are sometimes treated with medical management alone rather than an
invasive strategy. Among those medically managed without revascularization
and discharged, a proportion will require revascularization later on, but
little is known about this population. In TRILOGY ACS, 9,326 patients with
NSTE ACS who were selected for medical management alone were randomized to
treatment with prasugrel or clopidogrel and discharged without
revascularization. Patient characteristics and ischemic and bleeding
outcomes through 30 months were compared between patients who underwent
downstream revascularization after the index hospitalization and those who
did not. A total of 662 patients (7.1%) underwent later revascularization
by percutaneous coronary intervention (73.1%), coronary artery bypass
graft surgery (26.4%), or the two (0.5%). Median time to revascularization
was 121 days (twenty-fifth, seventy-fifth percentiles: 41, 326).
Revascularized patients were younger, more likely to be male, and had
higher rates of hyperlipidemia, diabetes mellitus, prior myocardial
infarction, and prior revascularization compared with those not
revascularized. Europe and North America had the highest rates of
revascularization. During the follow-up period, those who underwent
revascularization had a higher rate of the composite outcome of
cardiovascular death, myocardial infarction, or stroke occurring after
revascularization compared with those not revascularized (hazard ratio
[HR] 2.73 [95% confidence interval {CI} 2.21 to 3.38], p < 0.001) as well
as a higher rate of each of the individual outcomes. Major bleeding was
also higher in those who underwent revascularization (GUSTO severe or
life-threatening: HR 2.61 [95% CI 1.02 to 6.67], p = 0.045; TIMI major: HR
2.24 [95% CI 1.12 to 4.48], p = 0.022). There was no evidence that
bleeding and ischemic outcomes varied by treatment with clopidogrel versus
prasugrel. In conclusion, among patients initially medically managed after
NSTE ACS, a small proportion later require revascularization and have a
high rate of ischemic and major bleeding outcomes compared with those not
requiring downstream revascularization.<br/>Copyright &#xa9; 2018

<12>
Accession Number
2001031886
Title
A randomized clinical trial evaluating negative pressure therapy to
decrease vascular groin incision complications.
Source
Journal of Vascular Surgery. (no pagination), 2018. Date of Publication:
2018.
Author
Kwon J.; Staley C.; McCullough M.; Goss S.; Arosemena M.; Abai B.;
Salvatore D.; Reiter D.; DiMuzio P.
Institution
(Kwon, Staley, McCullough, Goss, Arosemena, Abai, Salvatore, Reiter,
DiMuzio) Division of Vascular and Endovascular Surgery, Thomas Jefferson
University Hospital, Philadelphia, Pa, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Vascular groin incision complications contribute significantly
to patients' morbidity and rising health care costs. Negative pressure
therapy over the closed incision decreases the infection rate in cardiac
and orthopedic procedures. This study prospectively evaluated negative
pressure therapy as a means to decrease wound complications and associated
health care costs. Methods: This was a randomized, prospective,
single-institution study of 119 femoral incisions closed primarily after
elective vascular surgery including both inflow (eg, aortofemoral) and
outflow (eg, femoral-popliteal bypass) procedures. Incisions were
categorized as high risk for wound complications on the basis of body mass
index >30 kg/m², pannus, reoperation, prosthetic graft, poor
nutrition, immunosuppression, or hemoglobin A<inf>1c</inf> >8% and
randomized 1:1 to standard gauze (n = 60) dressing vs negative pressure
therapy (Prevena [Acelity, San Antonio, Tex], n = 59). Wound complication
rate, length of stay (LOS), reoperation, readmission, and variable
hospital costs were determined during 30 days. Statistical analysis was
performed using chi² test along with a two-sample unpaired
t-test for continuous variables. Results: There were no significant
demographic differences (age, sex, risk factors for wound complication)
between the two high-risk groups. In low-risk controls, the major wound
complication rate was 4.8% (involving one infection in 21 incisions),
resulting in a 3.8-day LOS, 4.8% reoperation, 4.8% readmission rate, and
$17,599 in average variable cost. For high-risk controls, there was a
significant increase in major wound complications to 25% (including all 12
infections in 60 incisions), LOS (10.6 days), reoperation (18.3%),
readmission (16.7%), and costs ($36,537). Finally, negative pressure
therapy significantly reduced major wound complications to 8.5% (including
five of six infections in 59 incisions; P < .001), reoperation (8.5%; P <
.05), and readmission (6.8%; P < .04) but not LOS (10.6 days). The average
variable cost was reduced ($30,492), yielding an average savings of $6045
per patient (P = .11). Conclusions: This study suggests that negative
pressure therapy significantly reduces the major wound complication,
reoperation, and readmission rates for patients at high risk for groin
wound complications. Furthermore, this therapy may lead to a reduction in
hospital costs. Negative pressure therapy for all groin incisions
considered at high risk for wound complications is
recommended.<br/>Copyright &#xa9; 2018 Society for Vascular Surgery

<13>
Accession Number
620635428
Title
Single Versus Multi-Incisional Video-Assisted Thoracic Surgery: A
Systematic Review and Meta-analysis.
Source
Journal of Laparoendoscopic and Advanced Surgical Techniques. 28 (2) (pp
174-185), 2018. Date of Publication: February 2018.
Author
Abouarab A.A.; Rahouma M.; Kamel M.; Ghaly G.; Mohamed A.
Institution
(Abouarab) Department of Surgery, Division of Cardiothoracic Surgery,
University of Alabama at Birmingham, Birmingham, AL, United States
(Rahouma, Kamel, Ghaly, Mohamed) Surgical Oncology Department, National
Cancer Institute, Cairo University, 1st Fom Elkhaleeg Square, Masr
ElKadema, Cairo 11796, Egypt
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
Background: Video-Assisted Thoracic Surgery (VATS) is conventionally
performed through multiple small incisions (C-VATS). Recent studies have
reported encouraging results with the single-incision VATS (S-VATS) over
the conventional technique. However, these studies were either small in
size, unfocused, nonuniform, retrospective, lacking follow-up information,
or focused on pain. We aim to validate previously reported results in a
single large meta-analysis, including only the best evidence studies
available. Methods: Systematic review of the PubMed archive was conducted
to include only full English articles with Newcastle Ottawa Scale score
>=7. The primary outcome was the complications rate while secondary
outcomes were operative time, resected lymph nodes (LNs), chest tube
duration, estimated blood loss, length of postoperative stay (LOS), and
postoperative pain on day 1 after surgery. Odds ratio and standard mean
difference were used as effect estimates. Random model and leave-one-out
analysis were used. Results: A total of 39 studies were included with 4635
patients (1686 S-VATS versus 2949 C-VATS). S-VATS has resulted in
significantly less postoperative pain (P < .001), blood loss (P = .006),
LOS (P < .001), and chest tube duration (P < .001). In lung cancer
patients, the number of retrieved LNs was similar to that of C-VATS (P >
.05). Subgroup comparison of the rate of complications between lung
resections versus other intrathoracic procedures, lung cancer versus
pneumothorax, and lung cancer versus other lung-only lesions did not show
any significant differences between the groups. Conclusion: Performing
S-VATS technique has shown superior postoperative outcomes over the C-VATS
technique in the treatment of thoracic disorders. Substantial benefit was
confirmed in terms of less postoperative pain, blood loss, drainage time,
and postoperative hospital stay.<br/>&#xa9; Copyright 2018, Mary Ann
Liebert, Inc. 2018.

<14>
Accession Number
619859984
Title
Systematic Literature Review on the Incidence and Prevalence of Heart
Failure in Children and Adolescents.
Source
Pediatric Cardiology. 39 (3) (pp 415-436), 2018. Date of Publication: 01
Mar 2018.
Author
Shaddy R.E.; George A.T.; Jaecklin T.; Lochlainn E.N.; Thakur L.; Agrawal
R.; Solar-Yohay S.; Chen F.; Rossano J.W.; Severin T.; Burch M.
Institution
(Shaddy) Children's Hospital Los Angeles, 4650 Sunset Blvd. MS#126, Los
Angeles, CA 90027, United States
(George, Thakur, Agrawal) Novartis Healthcare Pvt. Ltd., Hyderabad, India
(Jaecklin) Shire International GmbH, Global Clinical Development,
Zahlerweg 10, Zug 6300, Switzerland
(Lochlainn, Severin) Novartis Pharma AG, Basel, Switzerland
(Solar-Yohay, Chen) Novartis Pharmaceuticals Corporation, East Hanover,
NJ, United States
(Rossano) Children's Hospital of Philadelphia, University of Pennsylvania
Perelman School of Medicine, Philadelphia, PA, United States
(Burch) Cardiorespiratory Division, Great Ormond Street Hospital for
Children, London, United Kingdom
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
While the epidemiology of adult heart failure has been extensively
researched, this systematic review addresses the less well characterized
incidence and prevalence of pediatric HF. The search strategy used
Cochrane methodology and identified 83 unique studies for inclusion.
Studies were categorized according to whether the HF diagnosis was
reported as primary (n = 10); associated with other cardiovascular
diseases (CVDs) (n = 49); or associated with non-CVDs (n = 24). A
narrative synthesis of the evidence is presented. For primary HF, the
incidence ranged from 0.87/100,000 (UK and Ireland) to 7.4/100,000
(Taiwan). A prevalence of 83.3/100,000 was reported in one large
population-based study from Spain. HF etiology varied across regions with
lower respiratory tract infections and severe anemia predominating in
lower income countries, and cardiomyopathies and congenital heart disease
major causes in higher income countries. Key findings for the other
categories included a prevalence of HF associated with cardiomyopathies
ranging from 36.1% (Japan) to 79% (US); associated with congenital heart
disease from 8% (Norway) to 82.2% (Nigeria); associated with rheumatic
heart diseases from 1.5% (Turkey) to 74% (Zimbabwe); associated with renal
disorders from 3.8% (India) to 24.1% (Nigeria); and associated with HIV
from 1% (US) to 29.3% (Brazil). To our knowledge, this is the first
systematic review of the topic and strengthens current knowledge of
pediatric HF epidemiology. Although a large body of research was
identified, heterogeneity in study design and diagnostic criteria limited
the ability to compare regional data. Standardized definitions of
pediatric HF are required to facilitate cross-regional comparisons of
epidemiological data.<br/>Copyright &#xa9; 2017, The Author(s).

<15>
Accession Number
623417945
Title
Comparing the effect of lidocaine-magnesium sulfate combination with
amiodarone-magnesium sulfate combination in preventing ventricular
fibrillation after aortic artery crossclamp removal during coronary artery
bypass graft surgery.
Source
Iranian Red Crescent Medical Journal. 20 (5) (no pagination), 2018.
Article Number: e59107. Date of Publication: May 2018.
Author
Kashani S.; Jarineshin H.; Fekrat F.; Moradi Shahdadi M.; Soltani
Shahabadi N.
Institution
(Kashani, Jarineshin, Fekrat, Moradi Shahdadi, Soltani Shahabadi) Research
Center for Anesthesiology, Critical Care, and Pain Management, Hormozgan
University of Medical Sciences, Bandar Abass, Iran, Islamic Republic of
Publisher
Kowsar Medical Publishing Company (E-mail: library@kowsarpub.com)
Abstract
Background: The prevalence of ventricular fibrillation after removal of
the aortic cross-clamp in patients undergoing coronary artery bypass
surgery is about 74%-96% cross-clamp. Defibrillation shock and different
types of agents are used to treat ventricular fibrillation (VF).
Objectives: This study was aimed to compare the effects of combining
lidocaine lidocaine + magnesium sulfate sulfate with amiodarone +
magnesium sulfate sulfate in the prevention of reperfusion-induced
ventricular fibrillation. Methods: This randomized, double-blinded
clinical study included 74 ASA class II and III patients undergoing
coronary artery bypass grafting (CABG) in a university-affiliated
hospital, Bandar Abbas, Iran, in the years 2015-2016. Patients were
divided into two groups based on a random sample table of block. Both
groups received magnesium sulfate through the cardiopulmonary
cardiopulmonary bypass pump. lidocaine 2% (100 mg) and amiodarone (300 mg)
were injected respectively to group lidocaine + magnesium sulfate (LM) and
group amiodarone + magnesium sulfate (AM) patients before aortic
cross-clamp release. The incidences of arrhythmias were recorded within 30
minutes after release of the aortic sross-clamp (ACC). Additionally, the
defibrillation shocks (frequency and level of joules delivered), amount of
inotrope agent, and the hemodynamic and arterial blood gas parameters were
recorded up to 24 hours post-operatively. Results: There was no
significant difference between the two groups in terms of demographic
characteristics, ejection fraction, and ASA class. The prevalence of
ventricular fibrillation (VF) and atrial fibrillation (Af) 30 minutes
after ACC release were 46.7% and 53.3% (P = 0.240) vs. 33.3% and 66.7% (P
> 0.999); while, up to 24 hours post-operatively were 60% and 20.0% vs.
0.0% and 0.0% in groups LM and AM respectively. The number of
defibrillations in the lidocaine + magnesium sulfate group was
significantly higher 57.9% vs. 25% in groups LM and AM respectively (P =
0.004). Conclusions: The use of amiodarone + magnesium sulfate reduces the
number of defibrillation following the release of the Aortic cross-clamp
compared with lidocaine + magnesium sulfate.<br/>Copyright &#xa9; 2018,
Author(s).

<16>
Accession Number
623525743
Title
Anomalies and anatomical variations of the thoracic great vessels in dogs.
Source
Journal of Veterinary Internal Medicine. Conference: 26th European
Congress of Veterinary Internal Medicine for Companion Animals, ECVIM-CA
Congress. Sweden. 31 (1) (pp 205), 2017. Date of Publication: January -
February 2017.
Author
Sebastian P.; Warren-Smith C.; Fonfara S.; Borgeat K.; Casamian D.
Institution
(Sebastian, Warren-Smith, Casamian) Langford Veterinary Services, School
of Veterinary Science, University of Bristol, Bristol, United Kingdom
(Fonfara) Ontario Veterinary College, Universityog Guelph, Guelph, Canada
(Borgeat) Highcroft Veterinary Referrals, Bristol, United Kingdom
Publisher
Blackwell Publishing Inc.
Abstract
Well-known congenital thoracic cardiovascular anomalies in the dog are
patent ductus arteriosus and persistent right aortic arch. These
cardiovascular anomalies are clinically significant and their prevalence
has been reported in veterinary medicine. Contrary to these, developmental
anomalies of thoracic vessels that may not cause clinical signs are
usually not detected or are identified as incidental findings, and their
prevalence is unknown. However, these might be of importance as
interference with thoracic surgery, interventional procedures, or
interpretation of thoracic imaging is possible. The aim of the study was
therefore to determine the prevalence of anatomical variations of the
great thoracic vessels. The CT thoracic studies of 878 dogs carried out
between 2011 to 2014 at Langford Veterinary Services (University of
Bristol) were reviewed. Poor quality CTs or those of young dogs with
clinical evidence of congenital cardiac disease or regurgitation were
excluded. A total of 802 studies met the inclusion criteria. A panel of
three boarded cardiologists and one boarded diagnostic imager reviewed the
abnormalities. Overall 8 dogs (1%) showed an anatomic anomaly. The most
common anomaly was an aberrant retroesophageal right subclavian artery (n
= 7, 0.8%). One dog showed a dilated azygos vein associated with
coarctation of the caudal vena cava. None of the dogs had a persistent
left cranial vena cava. Anatomical variations observed included three
types of branching of the common carotid arteries: both arteries arising
at the same point (type I present in 68.5% of dogs, n = 506/739), the
arteries arising separated (type II, identified in 28.7% of dogs, n =
212/739) or from a common trunk ("Bicarotid Trunk", type III, in 2.8% of
dogs, n = 21/739). In 92.1% of cases (n = 739) the azygos vein drained
into the cranial vena cava, in 1.9% (n = 15) into the right atrium and in
6% (n = 48) the drainage site was equivocal. Incidental anatomical
anomalies of the thoracic great vessels appear to be rare in dogs. Only 1%
(n = 8) of dogs undergoing thoracic CTs showed an anomaly. Of these, an
aberrant retroesophageal right subclavian artery was the most common
abnormality. A persistent left cranial vena cava appears to be very
uncommon, as it was not detected in any of the 802 dogs of the present
population. Three different branching patterns of the common carotid
artery were identified and type I (both carotids arising from the same
point of the brachyocephalic trunk) was the most frequent.

<17>
Accession Number
623527355
Title
Rationale for administering beta-blocker therapy to patients undergoing
coronary artery bypass surgery: a systematic review.
Source
Expert Opinion on Drug Safety. 17 (8) (pp 805-813), 2018. Date of
Publication: 03 Aug 2018.
Author
Thaper A.; Kulik A.
Institution
(Thaper, Kulik) Lynn Heart and Vascular Institute, Boca Raton Regional
Hospital, and Charles E. Schmidt College of Medicine, Florida Atlantic
University, Boca Raton, FL, United States
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Introduction: Secondary preventative therapies are essential for patients
undergoing coronary artery bypass graft (CABG) surgery to optimize
perioperative and long-term outcomes. Beta-blockers are commonly used to
treat patients with coronary artery disease and congestive heart failure
(CHF), but their role for CABG patients remains unclear. The goal of this
systematic review was to evaluate the rationale for administering
beta-blockers to the CABG population and to assess their efficacy before
and after coronary surgical revascularization. Areas covered: A systematic
literature review was performed to retrieve relevant articles from the
PubMed database published between 1985 and 2017. Expert opinion: Outside
of the surgical field, strong evidence supports the use of beta-blockers
for patients with a history of previous myocardial infarction (MI) or CHF.
For the CABG population, studies have suggested that perioperative
beta-blocker therapy is beneficial, with an associated reduction in
mortality, particularly among those with a history of previous MI or CHF.
Beta-blocker administration has also clearly been shown to lower the rate
of new-onset postoperative atrial fibrillation after CABG. Among the
different types of beta-blockers, perioperative carvedilol appears to be
the most beneficial. In the absence of contraindications, nearly all CABG
patients are candidates for perioperative beta-blocker
therapy.<br/>Copyright &#xa9; 2018, &#xa9; 2018 Informa UK Limited,
trading as Taylor & Francis Group.

<18>
Accession Number
622389214
Title
An audit of chronic pain after breast cancer surgery with perioperative
thoracic paravertebral block.
Source
British Journal of Pain. Conference: 51st Annual Scientific Meeting of the
British Pain Society, BPS 2018. United Kingdom. 12 (2 Supplement 1) (pp
37), 2018. Date of Publication: May 2018.
Author
Reddi D.; Fung M.; Mofeez A.
Institution
(Reddi, Mofeez) University College London Hospital, United Kingdom
(Fung) Royal Free Hospital, United Kingdom
Publisher
SAGE Publications Ltd
Abstract
Background Chronic pain after surgery is increasingly recognized as a
cause of post-operative morbidity. Rates of chronic pain after breast
surgery have been estimated at 20-30%, with severe pain affecting 5-10%
(Kehlet 2010). A Cochrane review suggested that thoracic paravertebral
block (TPVB) reduces persistent pain after surgery compared to
conventional analgesia, with a number needed to treat of 5 (Andreae 2012).
Aims The aim of our retrospective audit was to quantify rates of chronic
pain after breast surgery in patients receiving TPVB, and to assess for
the presence of neuropathic pain. Methods Women who had undergone breast
cancer surgery with TPVB at least 3 months ago were identified from a
single centre database of patients between 23/10/2014 and 25/02/2016.
Patients were excluded if they were unable to speak English due to the
follow up being carried out by telephone. Written records were accessed
where details from the database were unclear. Patients were telephoned and
pain was assessed using the Brief Pain Inventory and self-report Leeds
Assessment of Neuropathic Symptoms and Signs (S-LANSS). If patients could
not be contacted on the initial phone call then 2 further attempts were
made. Patients with post-operative complications such as infection were
also excluded. results Thirty-seven women eligible for inclusion were
identified and 25 were contacted. Eleven women could not be contacted by
telephone. One patient did not speak English and was excluded. Seven
patients reported ongoing discomfort related to surgery. Using the BPI,
the worst pain ranged from 0-8/10, the least pain 0-5/10 and average pain
ranged from 0-8/10 over the last 24 hours. Some patients had not had pain
in the last 24 hours. One patient was using analgesia specifically for the
post-surgical pain and reported 40% pain relief. Two patients reported
interference with activity, mood, walking, relationships or enjoyment of
life. Pain affected work in 3 cases and in 3 cases pain affected sleep. On
further questioning using the S-LANSS in patients reporting persistent
pain 5 of 7 patients had a score consistent with a neuropathic pain. The
mean duration of follow up was 241 days, range 105-407 days. conclusion
Our findings demonstrate chronic pain in 7/25 (28%) of patients undergoing
breast cancer surgery with TPVB, although it was only moderate or severe
in 2 patients and mild in the other 5 patients. Of the women with chronic
pain 5/7 (83%) experienced pain with a S-LANSS score suggestive of
neuropathic pain (12/20). Chronic pain after breast cancer surgery has
been reported as being predominantly neuropathic in nature and our
findings are consistent with this. This audit was a small retrospective
study. Further work should focus on a randomized controlled trial,
comparing TPVB against standard multimodal analgesia.

<19>
Accession Number
622470290
Title
Timing, incidence, and prognostic impact of atrial fibrillation after
percutaneous or surgical revascularization for left main disease: Analysis
from the excel trial.
Source
Heart Rhythm. Conference: 39th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2018. United States. 15 (5 Supplement 1) (pp
S36), 2018. Date of Publication: May 2018.
Author
Kosmidou I.; Redfors B.; Chen S.; Kappetein A.P.; Serruys P.W.; Gersh
B.J.; Puskas J.D.; Kandzari D.A.; Taggart D.P.; Morice M.-C.; Buszman
P.E.; Bochenek A.; Schampaert E.; Page P.; Sabik J.; Thomas M.; Ben-Yehuda
O.; Stone G.W.
Institution
(Kosmidou, Redfors, Chen, Kappetein, Serruys, Gersh, Puskas, Kandzari,
Taggart, Morice, Buszman, Bochenek, Schampaert, Page, Sabik, Thomas,
Ben-Yehuda, Stone) St Francis Hospital and Cardiovascular Research
Foundation, New York, NY, Cardiovascular Research Foundation, New York,
NY, Thoraxcenter, Erasmus MC, Rotterdam, Netherlands, Imperial College of
Science, Technology and Medicine, London, United Kingdom, Mayo Clinic,
Cardiovascular Div, Rochester, MN, Icahn School of Medicine at Mount
Sinai, New York, NY, Piedmont Heart Institute, Atlanta, GA, Ramsay
Generale deSante, Hopital Prive Jacques Cartier, Massy, France, Medical
University of Silesia, Katowice, Poland, Cardiovascular Research
Foundation, Katowice, Poland, Hopital du Sacre-Coeur de Montreal, Quebec,
QC, Canada, Universite De Montreal, Hopital Du Sacre-Coeur De Montreal,
Montreal, QC, Canada, Department of Surgery, UH Cleveland Medical Cente,
Cleveland, OH
Publisher
Elsevier B.V.
Abstract
Background: There is limited data on the frequency and prognostic impact
of atrial fbrillation or futter (AF) following percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG) for left
main coronary artery disease (LMCAD). Objective: The study sought to
determine the frequency and impact of AF on cardiovascular outcomes in
patients with LMCAD treated with PCI or CABG. Methods: In the EXCEL trial,
1905 patients with LMCAD and low or intermediate SYNTAX scores were
randomized to PCI with everolimus-eluting stents versus CABG. We analyzed
the incidence and timing of AF following PCI or CABG and its multivariable
time-adjusted association with death, cardiovascular death, stroke and the
composite endpoint of death, stroke or myocardial infarction (MI) at 3
years. Results: 1,812 patients without AF at baseline were included in the
analysis. A total of 229 episodes of AF [31 (13.5%) in the PCI arm and 198
(86.5%) in the CABG arm, P<0.0001] during 3-year follow-up; 166 (72.2%) AF
episodes were perioperative (POAF, occurring intraoperatively or during
the index hospitalization) and 63 (27.8%) occurred post-discharge. By 3
years AF had occurred in 26 PCI and 198 CABG patients (2.9% vs. 20.3%
respectively, P<0.0001); multiple episodes during follow-up occurred in 17
patients (9.4%) with AF. Greater age and reduced left ventricular ejection
fraction (LVEF) were major predictors of AF; POAF and greater age were
major predictors of post-discharge AF. By multivariable analysis, AF was
an independent predictor of 3-year death (HR 3.66, 95% CI 2.03-6.60,
P<0.0001), stroke (HR 7.90, 95% CI 2.96-21.12, P<0.0001) and the composite
of death, stroke or MI (HR 3.72, 95% CI 1.86-7.45, P=0.0009). Both POAF
and post-discharge AF were independent predictors of 3-year death, stroke
and the composite endpoint of death, stroke or MI. Conclusion: The
peri-procedural and 3-year incidence of AF is signifcantly greater after
CABG compared to PCI for LMCAD, and is strongly associated with increased
mortality, stroke and composite adverse outcomes. Heightened surveillance,
prophylaxis and treatment of AF may improve cardiovascular outcomes in
this high-risk patient population.

<20>
Accession Number
622469582
Title
Safete: Stroke and atrial fibrillation evaluation of therapy
electronically.
Source
Heart Rhythm. Conference: 39th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2018. United States. 15 (5 Supplement 1) (pp
S564), 2018. Date of Publication: May 2018.
Author
Thomas G.R.; Mariano Z.; Aves T.; Mangat I.; Dorian P.; Angaran P.
Institution
(Thomas, Mariano, Aves, Mangat, Dorian, Angaran) University of Toronto,
Toronto, ON, Canada, St. Michael's Hospital, Toronto, ON, Canada
Publisher
Elsevier B.V.
Abstract
Background: Oral anticoagulants (OACs) decrease stroke rates in atrial
fbrillation (AF) by 70%, but large outpatient registry studies have not
demonstrated a signifcant improvement in actual OAC use over the past
decade The pattern of OAC use in teaching hospitals is poorly understood
and relies on data from administrative coding. Objective: We assessed the
rate of OAC use for AF at our institution using an automated method for
data extraction directly from the electronic medical record (EMR).
Secondly, we aimed to gain perspective on why some patients, who met
guideline indications, were not on an OAC. Methods: This is a
retrospective study of 3,915 inpatients at an academic hospital (January
2010-December 2014) with at least one 12-lead ECG showing AF. We excluded
patients with the following characteristics: i) <65 years old, ii)
prosthetic valves, iii) death during admission, iv) absence of discharge
summary, and vi) intensive care unit admission at the time of ECG. Patient
data was electronically extracted from the Cerner Soarian and GE Muse
databases A sample of 133 patients, randomly selected and equally
distributed over the study period, was manually reviewed to validate the
accuracy of the automated data extraction and to subsequently investigate
reasons for not anticoagulating patients. Results: On average, 50.9+/-2.3%
of patients were discharged on a systemic anticoagulant from 2010-2014.
This was corroborated by the manual review that showed a mean OAC rate of
56.0% The remaining patients were on ASA alone (33.1%) or no stroke
prevention therapy (16.0%) The most common reasons for not prescribing an
OAC included: i) most responsible physicians not recognizing AF on ECG,
ii) neglecting stroke prevention in AF management, and iii) deferring OAC
decisions to primary care providers. OAC rates were lowest among patients
admitted to surgical services (21.7%) and highest on cardiology (64.4%)
and neurology (69.2%). Conclusion: Anticoagulation rates in inpatients
with AF remain suboptimal. Our approach allowed for an automated,
feasible, and accurate review of a large population over a period of time.

<21>
Accession Number
622461661
Title
Use of preoperative thoracic epidural and the prevention of chronic pain
in patients undergoing open thoracotomy.
Source
Pain Medicine (United States). Conference: 60th Annual Meeting of the
American Association of Physicists in Medicine, AAPM 2018. United States.
19 (4) (pp 837-838), 2018. Date of Publication: April 2018.
Author
Ibrahim M.; Patel M.
Institution
(Ibrahim, Patel) University of Florida Health Jacksonville, Jacksonville,
FL, United States
Publisher
Oxford University Press
Abstract
Introduction: Regional anesthesia has been used in the pre-operative
period with the intention to reduce acute post-operative pain after
surgical interventions. This is a literature review to determine if the
use of preoperative thoracic epidural placement affects the development of
chronic pain in patients undergoing open thoracotomy. Methods: The review
was performed by searching PubMed for studies utilizing pre-operative
epidurals compared to post-operative epidural utilization, cryotherapy of
intercostal nerves, or intravenous patient controlled analgesia in
patients undergoing open thoracotomy. Studies were analyzed and graded in
terms of quality of data based on the Agency for Healthcare Research and
Quality (AHRQ) and given a respective grade of High, Moderate, Low or
Insufficient. Results: There were four randomized control studies and one
meta-analysis that fit the criteria. Three studies provided a high-grade
level of evidence and two provided a moderate grade level of evidence. All
of the high-grade studies and one of the moderate grade studies concluded
that pre-operative placement and utilization of thoracic epidurals
significantly reduced the incidence of chronic pain in patients who
underwent open thoracotomy. One of the moderate grade studies concluded no
difference between preoperative and post-operative utilization of thoracic
epidurals and the development of chronic pain in open thoracotomy
patients. Conclusions: Pre-operative initiation of thoracic epidurals
prior to surgical incision in patients undergoing open thoracotomies seems
to prevent the development of chronic pain when compared to patients who
were provided post-operative thoracic epidurals, cryoablation of
intercostal nerves, or postoperative intravenous patient controlled
analgesia.

<22>
Accession Number
623487752
Title
Mitochondrial and contractile function of human right atrial tissue in
response to remote ischemic conditioning.
Source
Journal of the American Heart Association. 7 (15) (no pagination), 2018.
Article Number: e009540. Date of Publication: 01 Aug 2018.
Author
Kleinbongard P.; Gedik N.; Kirca M.; Stoian L.; Frey U.; Zandi A.;
Thielmann M.; Jakob H.; Peters J.; Kamler M.; Heusch G.
Institution
(Kleinbongard, Gedik, Kirca, Stoian, Heusch) Institut fur
Pathophysiologie, Westdeutsches Herz- und Gefaszentrum,
Universitatsklinikum Essen, Germany
(Frey, Peters) Klinik fur Anasthesiologie und Intensivmedizin,
Universitatsklinikum Essen, Germany
(Zandi, Kamler) Klinik fur Herzchirurgie Essen-Huttrop, Westdeutsches
Herz- und Gefaszentrum, Universitatsklinikum Essen, Germany
(Thielmann, Jakob) Klinik fur Thorax- und Kardiovaskulare Chirurgie,
Westdeutsches Herz- und Gefaszentrum, Universitatsklinikum Essen, Germany
Publisher
American Heart Association Inc.
Abstract
Background-Remote ischemic preconditioning (RIPC) by repeated brief cycles
of limb ischemia/reperfusion attenuates myocardial ischemia/reperfusion
injury. We aimed to identify a functional parameter reflecting the
RIPC-induced protection in human. Therefore, we measured mitochondrial
function in right atrial tissue and contractile function of isolated right
atrial trabeculae before and during hypoxia/reoxygenation from patients
undergoing coronary artery bypass grafting with RIPC or placebo,
respectively. Methods and Results-One hundred thirty-seven patients under
isoflurane anesthesia underwent RIPC (3x5 minutes blood pressure cuff
inflation on the left upper arm/5 minutes deflation, n=67) or placebo
(cuff uninflated, n=70), and right atrial appendages were harvested before
ischemic cardioplegic arrest. Myocardial protection by RIPC was assessed
from serum troponin I/T concentrations over 72 hours after surgery. Atrial
tissue was obtained for isolation of mitochondria (RIPC/placebo: n=10/10).
Trabeculae were dissected for contractile function measurements at
baseline and after hypoxia/reoxygenation (60 min/30 min) and for western
blot analysis after hypoxia/reoxygenation (RIPC/placebo, n=57/60).
Associated with cardioprotection by RIPC (26% decrease in the area under
the curve of troponin I/T), mitochondrial adenosine diphosphate-stimulated
complex I respiration (+10%), adenosine triphosphate production (+46%),
and calcium retention capacity (+37%) were greater, whereas reactive
oxygen species production (-24%) was less with RIPC than placebo.
Contractile function was improved by RIPC (baseline, +7%; reoxygenation,
+24%). Expression and phosphorylation of proteins, which have previously
been associated with cardioprotection, were not different between RIPC and
placebo. Conclusions-Cardioprotection by RIPC goes along with improved
mitochondrial and contractile function of human right atrial
tissue.<br/>Copyright &#xa9; 2018 The Authors.

<23>
Accession Number
2000626507
Title
Concomitant surgical closure of left atrial appendage: A systematic review
and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (3) (pp 1071-1080.e2),
2018. Date of Publication: September 2018.
Author
Ando M.; Funamoto M.; Cameron D.E.; Sundt T.M.
Institution
(Ando, Funamoto, Cameron, Sundt) Division of Cardiac Surgery,
Massachusetts General Hospital and Harvard Medical School, Boston, Mass,
United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Although percutaneous closure of the left atrial appendage is
supported as a potential alternative to lifelong anticoagulation in
patients with atrial fibrillation, comprehensive evidence on surgical left
atrial appendage closure in heart surgery is limited. Methods: We
conducted a meta-analysis of studies comparing patients who underwent open
cardiac surgery with or without left atrial appendage closure. A
literature search was performed on PubMed, Embase, and Cochrane Trials
databases. Outcomes of interest were 30-day/in-hospital mortality and
cerebrovascular accident. I² statistics were used to evaluate
heterogeneity, and publication bias was evaluated by Begg's and Egger's
tests. Results: We reviewed 1284 articles and selected for main analysis 7
articles including 3897 patients (1963 in the left atrial appendage
closure group and 1934 in the non-left atrial appendage closure group).
Among the 7 studies, 3 were randomized-controlled studies, 3 were
propensity-matched studies, and 1 was a case-matching study. At
30-day/in-hospital follow-up, left atrial appendage closure was
significantly associated with decreased risk of mortality and
cerebrovascular accident (odds ratio, 0.384, 95% confidence interval,
0.233-0.631 for mortality, and odds ratio, 0.622, 95% confidence interval,
0.388-0.998 for cerebrovascular accident). Stratified analysis
demonstrated that this association was more prominent in preoperative
atrial fibrillation strata. Conclusions: Concomitant surgical left atrial
appendage closure should be considered at the time of open cardiac
surgery, particularly among those in atrial fibrillation preoperatively.
The benefit of left atrial appendage closure for patients not in atrial
fibrillation and for those undergoing nonvalvular surgery is still
unclear. Further prospective investigations are indicated.<br/>Copyright
&#xa9; 2018 The American Association for Thoracic Surgery

<24>
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.

<25>
Accession Number
623402804
Title
Painful Recall in Elective Electrical Cardioversion with Propofol and the
Need for Additional Analgesia.
Source
Cardiology Research and Practice. 2018 (no pagination), 2018. Article
Number: 2363062. Date of Publication: 2018.
Author
Van Winden D.F.M.; Westra A.; Dennesen P.J.W.; Monnink S.H.J.; Verdouw
B.C.; Le Kluse R.
Institution
(Van Winden, Westra) Department of Emergency Medicine, Reinier de Graaf
Hospital, Delft, Netherlands
(Dennesen) Department of Intensive Care, Haaglanden Medical Center, The
Hague, Netherlands
(Monnink, Le Kluse) Department of Cardiology, Reinier de Graaf Hospital,
Delft, Netherlands
(Verdouw) Department of Anaesthesiology, Reinier de Graaf Hospital, Delft,
Netherlands
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Introduction. Electrical cardioversion (ECV) is a short but painful
procedure for treating cardiac dysrhythmias. There is a wide variation
regarding the medication strategy to facilitate this procedure. Many
different sedative techniques for ECV are described. Currently, the
optimal medication strategy to prevent pain in ECV has yet to be
established. The role for additional analgesic agents to prevent pain
during the procedure remains controversial, and evidence is limited.
Methods. We conducted a prospective multicenter study to determine the
incidence of painful recall in ECV with propofol as a sole agent for
sedation, in order to assess the indication for additional opioids. In all
patients, sedation was induced with propofol titrated till loss of eyelash
reflex and nonresponsiveness to stimuli, corresponding to Ramsay Sedation
Score level 5-6. ECV was performed with extracardiac biphasic electrical
shocks. The primary outcome was painful recall of the procedure, defined
as numeric pain rating scale (NRS) >= 1. NRS >= 4 is considered
inadequately treated pain. Secondary outcome parameters were pain at the
side of the defipads and muscle pain after ECV. Results. A total of 232
patients were enrolled in this study. Six patients were excluded due to
missing data or violation of study protocol. Three patients reported
recall of the procedure, and one patient (0.4%) reported recall of severe
pain during the procedure with NRS 7. Two patients (0.9%) reported recall
of mild pain with NRS 1-3. Complete amnesia was observed in 223 patients
(98.7%), with NRS 0. The mean of the total dose of propofol was 1.1 mg/kg.
Fifteen patients (6.6%) experienced pain at the side of the defipads, and
six patients (2.7%) complained of muscle pain after the procedure.
Conclusions. In this prospective multicenter study, propofol as a sole
agent provided good conditions for ECV with a low incidence of recall.
Effective sedation and complete amnesia was achieved in 98.7% of the
patients, 0.4% of patients reported recall of severe pain during the
procedure, and 0.9% of patients experienced mild pain during the
ECV.<br/>Copyright &#xa9; 2018 D. F. M. van Winden et al.

<26>
Accession Number
2000873413
Title
A double-blind, randomized controlled trial of gabapentin vs. placebo for
acute pain management in critically ill patients with rib fractures.
Source
Injury. 49 (9) (pp 1693-1698), 2018. Date of Publication: September 2018.
Author
Moskowitz E.E.; Garabedian L.; Harden K.; Perkins-Pride E.; Asfaw M.;
Preslaski C.; Liasia K.N.; Lawless R.; Burlew C.C.; Pieracci F.
Institution
(Moskowitz, Garabedian, Harden, Perkins-Pride, Asfaw, Preslaski, Liasia,
Lawless, Burlew, Pieracci) Denver Health Medical Center, University of
Colorado School of Medicine, United States
Publisher
Elsevier Ltd
Abstract
Introduction: Achieving adequate pain control for rib fractures remains
challenging; prescription of alternatives to narcotics is imperative to
curtail the current opioid epidemic. Although gabapentin has shown promise
following elective thoracic procedures, its efficacy in patients with rib
fractures remains unstudied. We hypothesized that gabapentin, as compared
to placebo, would both improve acute pain control and decrease narcotic
use among critically ill patients with rib fractures. Materials and
Methods: Adult patients admitted to the trauma surgery service from
November 2016 - November 2017 at an urban, Level I trauma center with one
or more rib fractures were randomized to either gabapentin 300 mg thrice
daily or placebo for one month following their injury. Daily numeric pain
scores, opioid consumption, oxygen requirement, respiratory rate, and
incentive spirometry recordings during the index admission, as well as and
one-month quality of life survey data were abstracted. Results: Forty
patients were randomized. The groups were well matched with respect to
age, gender, prior narcotic use, tobacco use, and prior respiratory
disease. Although the median RibScore did not differ between groups, the
gabapentin group had a higher median number of ribs fractured as compared
to the placebo group (7 vs. 5, respectively). Degree of pulmonary
contusion and injury severity score were similar between groups. Use of
loco-regional anesthetic modalities did not differ between groups. Daily
numeric pain scores, opioid consumption, oxygen requirement, respiratory
rate, and incentive spirometry recordings were similar between both
groups. No benefit was observed when adding gabapentin to a multi-modal
analgesic regimen for rib fractures. There were no instances of pneumonia,
respiratory failure, or mortality in either group. Hospital and intensive
care unit length of stay were similar between groups. Both overall and
chest-specific quality of life was equivalent between groups at one month
follow-up. Conclusions: In this group of critically ill patients with rib
fractures, gabapentin did not improve acute outcomes for up to one month
of treatment.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<27>
Accession Number
2001028524
Title
Intensive versus moderate statin therapy and early graft occlusion after
coronary bypass surgery: The Aggressive Cholesterol Therapy to Inhibit
Vein Graft Events randomized clinical trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Author
Kulik A.; Abreu A.M.; Boronat V.; Ruel M.
Institution
(Kulik, Abreu, Boronat) Lynn Heart and Vascular Institute, Boca Raton
Regional Hospital, and Charles E. Schmidt College of Medicine, Florida
Atlantic University, Boca Raton, Fla, United States
(Ruel) University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Statins prevent saphenous vein graft (SVG) disease and improve
outcomes after coronary artery bypass graft surgery. However, the optimal
postoperative statin dose remains unclear. The Aggressive Cholesterol
Therapy to Inhibit Vein Graft Events trial was undertaken to evaluate
whether early postoperative high-dose statin therapy reduces SVG occlusion
compared with conventional moderate-dose therapy. Methods: In this pilot,
multicenter, double-blind randomized trial, 173 patients who had coronary
artery bypass graft surgery with SVG were randomized to receive 10 mg or
80 mg atorvastatin daily for 1 year. The primary outcome was SVG occlusion
at 1 year. Secondary outcomes were SVG stenosis and major adverse
cardiovascular events. Results: During trial enrollment, patients
randomized to 80 mg atorvastatin achieved significantly lower low-density
lipoprotein cholesterol levels (P < .00001). One-year graft assessment was
performed in 145 patients (83.8%). The primary outcome, SVG occlusion at 1
year, did not significantly differ between the 2 groups (12.9% vs 11.4%
for 10 mg atorvastatin vs 80 mg atorvastatin; P = .85). The incidence of
vein graft stenosis also did not significantly differ between the groups
(P = .54). However, there was a trend toward fewer patients developing
vein graft disease (either occlusion or stenosis) in the 80 mg
atorvastatin group (29.2% vs 19.2%, 10 mg atorvastatin vs 80 mg
atorvastatin; P = .18). Freedom from major adverse cardiovascular events
at 1 year was similar between the groups (P = .27). Conclusions: Compared
with 10 mg atorvastatin, 80 mg atorvastatin did not significantly reduce
vein graft occlusion 1 year after coronary artery bypass graft surgery in
this pilot trial.<br/>Copyright &#xa9; 2018 The American Association for
Thoracic Surgery

<28>
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].

<29>
Accession Number
622631915
Title
Local anaesthetics and regional anaesthesia versus conventional analgesia
for preventing persistent postoperative pain in adults and children.
Source
Cochrane Database of Systematic Reviews. 2018 (6) (no pagination), 2018.
Article Number: CD007105. Date of Publication: 20 Jun 2018.
Author
Weinstein E.J.; Levene J.L.; Cohen M.S.; Andreae D.A.; Chao J.Y.; Johnson
M.; Hall C.B.; Andreae M.H.
Institution
(Weinstein, Levene) Albert Einstein College of Medicine of Yeshiva
University, 1300 Morris Park Ave, Bronx, NY 10461, United States
(Cohen, Chao) Montefiore Medical Center, Albert Einstein College of
Medicine, Department of Anesthesiology, 111 E 210 Street, Bronx, NY
#N4-005, United States
(Andreae) Milton S Hershey Medical Center, Department of Allergy/
Immunology, 500 University Dr, Hershey, PA 17033, United States
(Johnson) Teachers College, Columbia University, Human Development, New
York, NY 10027, United States
(Hall) Albert Einstein College of Medicine, Division of Biostatistics,
Department of Epidemiology and Population Health, 1300 Morris Park Avenue,
Bronx, NY 10461, United States
(Andreae) Milton S Hershey Medical Centre, Department of Anesthesiology
and Perioperative Medicine, 500 University Drive, H187, Hershey, PA 17033,
United States
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Regional anaesthesia may reduce the rate of persistent
postoperative pain (PPP), a frequent and debilitating condition. This
review was originally published in 2012 and updated in 2017. Objectives:
To compare local anaesthetics and regional anaesthesia versus conventional
analgesia for the prevention of PPP beyond three months in adults and
children undergoing elective surgery. Search methods: We searched CENTRAL,
MEDLINE, and Embase to December 2016 without any language restriction. We
used a combination of free text search and controlled vocabulary search.
We limited results to randomized controlled trials (RCTs). We updated this
search in December 2017, but these results have not yet been incorporated
in the review. We conducted a handsearch in reference lists of included
studies, review articles and conference abstracts. We searched the
PROSPERO systematic review registry for related systematic reviews.
Selection criteria: We included RCTs comparing local or regional
anaesthesia versus conventional analgesia with a pain outcome beyond three
months after elective, non-orthopaedic surgery. Data collection and
analysis: At least two review authors independently assessed trial quality
and extracted data and adverse events. We contacted study authors for
additional information. We presented outcomes as pooled odds ratios (OR)
with 95% confidence intervals (95% CI), based on random-effects models
(inverse variance method). We analysed studies separately by surgical
intervention, but pooled outcomes reported at different follow-up
intervals. We compared our results to Bayesian and classical (frequentist)
models. We investigated heterogeneity. We assessed the quality of evidence
with GRADE. Main results: In this updated review, we identified 40 new
RCTs and seven ongoing studies. In total, we included 63 RCTs in the
review, but we were only able to synthesize data on regional anaesthesia
for the prevention of PPP beyond three months after surgery from 39
studies, enrolling a total of 3027 participants in our inclusive analysis.
Evidence synthesis of seven RCTs favoured epidural anaesthesia for
thoracotomy, suggesting the odds of having PPP three to 18 months
following an epidural for thoracotomy were 0.52 compared to not having an
epidural (OR 0.52 (95% CI 0.32 to 0.84, 499 participants, moderate-quality
evidence). Simlarly, evidence synthesis of 18 RCTs favoured regional
anaesthesia for the prevention of persistent pain three to 12 months after
breast cancer surgery with an OR of 0.43 (95% CI 0.28 to 0.68, 1297
participants, low-quality evidence). Pooling data at three to 8 months
after surgery from four RCTs favoured regional anaesthesia after caesarean
section with an OR of 0.46, (95% CI 0.28 to 0.78; 551 participants,
moderate-quality evidence). Evidence synthesis of three RCTs investigating
continuous infusion with local anaesthetic for the prevention of PPP three
to 55 months after iliac crest bone graft harvesting (ICBG) was
inconclusive (OR 0.20, 95% CI 0.04 to 1.09; 123 participants, low-quality
evidence). However, evidence synthesis of two RCTs also favoured the
infusion of intravenous local anaesthetics for the prevention of PPP three
to six months after breast cancer surgery with an OR of 0.24 (95% CI 0.08
to 0.69, 97 participants, moderate-quality evidence). We did not
synthesize evidence for the surgical subgroups of limb amputation, hernia
repair, cardiac surgery and laparotomy. We could not pool evidence for
adverse effects because the included studies did not examine them
systematically, and reported them sparsely. Clinical heterogeneity,
attrition and sparse outcome data hampered evidence synthesis. High risk
of bias from missing data and lack of blinding across a number of included
studies reduced our confidence in the findings. Thus results must be
interpreted with caution. Authors' conclusions: We conclude that there is
moderate-quality evidence that regional anaesthesia may reduce the risk of
developing PPP after three to 18 months after thoracotomy and three to 12
months after caesarean section. There is low-quality evidence that
regional anaesthesia may reduce the risk of developing PPP three to 12
months after breast cancer surgery. There is moderate evidence that
intravenous infusion of local anaesthetics may reduce the risk of
developing PPP three to six months after breast cancer surgery. Our
conclusions are considerably weakened by the small size and number of
studies, by performance bias, null bias, attrition and missing data.
Larger, high-quality studies, including children, are needed. We caution
that except for breast surgery, our evidence synthesis is based on only a
few small studies. On a cautionary note, we cannot extend our conclusions
to other surgical interventions or regional anaesthesia techniques, for
example we cannot conclude that paravertebral block reduces the risk of
PPP after thoracotomy. There are seven ongoing studies and 12 studies
awaiting classification that may change the conclusions of the current
review once they are published and incorporated.<br/>Copyright &#xa9; 2018
The Cochrane Collaboration.

<30>
Accession Number
623499324
Title
An initial investigation into normal values and the effects of sampling
handling on viscoelastic dynamic coagulometery in healthy adult horses.
Source
Journal of Veterinary Emergency and Critical Care. Conference:
International Veterinary Emergency and Critical Care Symposium, IVECCS
2015. United States. 25 (Supplement 1) (pp S17), 2015. Date of
Publication: September 2015.
Author
Jamieson C.; Holbrook T.; Hanzlicek A.; Payton M.
Institution
(Jamieson, Holbrook, Hanzlicek, Payton) Oklahoma State University,
Stillwater, OK, United States
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: Viscoelastic coagulometry such as the Sonoclot Coagulation
Analyzer is a relatively new technique in veterinary coagulation analysis
that allows for dynamic, close to real time assessment of all phases of
the clotting cascade from initial activation through clot retraction. In
human medicine this is used in many critical care settings from monitoring
of anticoagulant therapy to prediction of transfusion need in trauma and
cardiac surgery patients, and while horses experience many critical
illnesses that alter coagulation, the currently available PT and aPTT are
poor measures of coagulation status as a whole. Methods: This is a pilot
study including 16 healthy horses. Each horse was confirmed healthy with a
physical examination, CBC, and biochemistry panel. For each horse, 4 tubes
of 3.8% sodium citrate were filled at a 9:1 ratio (blood to sodium
citrate) via Vacutainer. Tubes were randomly allocated to four handling
groups- non-agitated run at 30 (N30) and 240 (N240) minutes and agitated
run at 30 (A30) and 240 (A240) minutes. Descriptive statistics were
presented as mean ( +/- SD). Results: Mean activated clotting time (ACT)
for N30, N240, A30, A240 was 279.2 (126.0), 293 (112.3), 169.1 (32.8), and
183.2 (46.2) seconds, respectively. Mean clot rate (CR) was 11.1 (10.9),
9.1 (4.9), 47.0 (24.1), 39.7 (23.2), respectively. Mean platelet function
(PF) was 4.0 (0.78), 4.1 (0.69), 3.7 (0.88), 3.5 (1.2), respectively. Mean
timeto-peak was 13.5 (4.04), 12.8 (2.64), 8.08 (1.90), 8.46 (1.88)
minutes, respectively. Conclusion: This initial data suggests that sample
handling has a profound effect on values obtained for Activated Clot Time
and Clot Rate and time to peak, but less effect on Platelet Function.
Samples handled optimally have statistically significantly higher
activated clot times than agitated samples. Clot rate appears elevated in
agitated samples compared to rested ones however platelet function appears
minimally effected by sample handling. This initial data suggests that
sample handling can have a profound effect on overall clot signature
although some parameters remain unaffected, while time from sampling
appears to have little effect. Larger samples numbers would provide
reliable significance and a projected sample size of 60 horses will
provide this.

<31>
Accession Number
2001022665
Title
Dual versus triple therapy in patients on oral anticoagulants and
undergoing coronary stent implantation: A systematic review and
meta-analysis.
Source
International Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Author
Fortuni F.; Ferlini M.; Leonardi S.; Angelini F.; Crimi G.; Somaschini A.;
Cornara S.; Potenza A.; De Servi S.; Oltrona Visconti L.; De Ferrari G.M.
Institution
(Fortuni, Leonardi, Somaschini, Cornara, De Ferrari) Coronary Care Unit
and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS
Policlinico San Matteo, Pavia, Italy
(Fortuni, Somaschini, Cornara, De Ferrari) Department of Molecular
Medicine, University of Pavia, Pavia, Italy
(Ferlini, Crimi, Potenza, Oltrona Visconti) Division of Cardiology,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(Angelini) Division of Cardiology, University of Torino, Citta della
Salute e della Scienza Hospital, Italy
(De Servi) IRCCS Multimedica, Sesto San Giovanni, Milan, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims: There is contrasting evidence regarding the optimal
antithrombotic regimen after percutaneous coronary stent implantation in
patients on oral anticoagulants. A systematic review and meta-analysis was
performed to explore the comparative efficacy and safety of dual (an
antiplatelet plus an oral anticoagulant) versus triple therapy (dual
antiplatelet therapy plus an oral anticoagulant). Methods: We searched the
literature for randomized controlled trials (RCTs) or observational
studies (OSs) addressing this issue. The efficacy outcomes were all-cause
mortality, cardiovascular mortality, myocardial infarction and stent
thrombosis. The safety outcomes were major bleeding events and all
bleeding events. The analyses were stratified by type of anticoagulant and
of antiplatelet used in dual therapy. Results: Four RCTs and ten OSs met
our inclusion criteria including a total of 10,126 patients. 5671 patients
received triple therapy whereas 4455 received dual therapy. Median follow
up was 12 months. There was no difference between dual therapy and triple
therapy regarding efficacy outcomes. Dual therapy significantly reduced
the risk of major bleeding (RR 0.66; CI 95% 0.52-0.83; P = 0.0005) and of
all bleeding events (RR 0.67, CI 95% 0.55-0.80; P < 0.0001). The effect
was consistent regardless of the type of antiplatelet and anticoagulant
used in dual therapy. Conclusion: Dual antithrombotic therapy after
coronary stenting in anticoagulated patients significantly reduces
bleeding events compared with triple therapy. Dual therapy might be
considered in this setting especially when bleeding risk outweighs
ischemic risk, although our study was not sufficiently powered to detect a
difference in ischemic endpoints.<br/>Copyright &#xa9; 2018

<32>
Accession Number
613340806
Title
Assessment of a Drug-Eluting Balloon for the Treatment of de novo Coronary
Lesions Guided by Optical Coherence Tomography: Study Protocol for a
Randomized Controlled Trial.
Source
Cardiology (Switzerland). 136 (4) (pp 252-257), 2017. Date of Publication:
01 Mar 2017.
Author
Li B.; Ding Y.; Tian F.; Chen W.; Han T.; Chen Y.
Institution
(Li, Ding, Tian, Chen, Han, Chen) Department of Cardiology, Chinese PLA
General Hospital, 28 Fuxing Road, Beijing 100853, China
Publisher
S. Karger AG
Abstract
Background: The drug-eluting balloon (DEB) is a promising tool to prevent
restenosis after coronary angioplasty. However, data on the outcomes of
DEB in de novo lesions are scarce. Vessel recoil and constrictive
remodeling are the dominant causes of restenosis after angioplasty. The
use of cutting balloons (CB) may effectively reduce elastic recoil after
balloon dilation. In this study, we evaluate the efficacy and safety of
DEB in treating de novo coronary artery lesions, using a predilation
strategy with cutting balloon (CB) dilation before DEB angioplasty.
Methods/Design: We present the design of a prospective, single-center,
open-label, randomized, 2-arm clinical trial aiming to assess whether or
not the strategy of CB dilation before DEB angioplasty reduces the primary
end point of late lumen loss (LLL) compared with drug-eluting stent (DES)
implantation alone for de novo coronary artery lesions. A total of 120
patients will be randomly enrolled into the DEB or DES group (1:1 ratio).
The primary end point is insegment LLL at 12 months as measured by optical
coherence tomography (OCT). Secondary end points include procedural
success, such as angiographic success and device success, and clinical
outcomes including all-cause death, myocardial infarction, target vessel
revascularization, target lesion revascularization, and stent thrombosis.
Discussion: The study will evaluate the clinical efficacy, angiographic
outcomes, and safety of DEB after CB dilation compared with DES for the
treatment of de novo coronary artery lesions guided by OCT.<br/>Copyright
&#xa9; 2016 S. Karger AG, Basel.

<33>
Accession Number
617340620
Title
Incidence and Causes for Early Ticagrelor Discontinuation: A "real-World"
Dutch Registry Experience.
Source
Cardiology (Switzerland). 138 (3) (pp 164-168), 2017. Date of Publication:
01 Nov 2017.
Author
Bergmeijer T.O.; Janssen P.W.A.; Van Oevelen M.; Van Rooijen D.; Godschalk
T.C.; Kelder J.C.; Deneer V.H.M.; Serebruany V.L.; Ten Berg J.M.
Institution
(Bergmeijer, Janssen, Van Oevelen, Van Rooijen, Godschalk, Kelder, Ten
Berg) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Deneer) Department of Clinical Pharmacy, St. Antonius Hospital,
Nieuwegein, Netherlands
(Serebruany) Johns Hopkins University, Baltimore, MD, United States
(Ten Berg) St. Antonius Hospital Nieuwegein, PO Box 2500, EM Nieuwegein
NL-3432, Netherlands
Publisher
S. Karger AG
Abstract
Objectives: The PLATO trial revealed superiority of ticagrelor over
clopidogrel for the prevention of atherothrombotic events in patients with
acute coronary syndrome. However, adverse events such as bleeding,
dyspnea, and bradycardia were frequently reported, potentially leading to
excess early ticagrelor discontinuation (ETD), later confirmed in the
PEGASUS trial. We here evaluated the incidence and causes for ETD in a
real-world patient cohort in a high-volume nonacademic percutaneous
coronary intervention center in the Netherlands. Methods: In a
retrospective single-center registry, all patients discharged from the
hospital with a new ticagrelor prescription were screened for ETD.
Follow-up data were obtained using the hospital electronic patient file
records and confirmed by telephone contact with the patient and/or general
practitioner, if necessary, to complement the data. Results: Ticagrelor
was prescribed in 354 patients between December 2011 and December 2012.
The follow-up data were available in 301 patients with a mean follow-up
duration of 330 days. ETD or switching to another antiplatelet agent
occurred in 73 patients (24.3%), mostly due to dyspnea (11.6%), bleeding
(3.7%), or planned major surgery (2.7%). Conclusions: Almost one quarter
of ticagrelor patients were discontinued prematurely or switched to
another antiplatelet agent within 1 year, mostly due to dyspnea or
bleeding.<br/>Copyright &#xa9; 2017 S. Karger AG, Basel.

<34>
Accession Number
615794052
Title
Three-Year Clinical Outcome of Patients with Coronary Disease and
Increased Event Risk Treated with Newer-Generation Drug-Eluting Stents:
From the Randomized Dutch PEERS Trial.
Source
Cardiology (Switzerland). 137 (4) (pp 207-217), 2017. Date of Publication:
01 Jul 2017.
Author
Van Der Heijden L.C.; Kok M.M.; Lowik M.M.; Danse P.W.; Jessurun G.A.J.;
Hartmann M.; Stoel M.G.; Van Houwelingen K.G.; Hautvast R.W.M.; Linssen
G.C.; Doggen C.J.M.; Von Birgelen C.
Institution
(Van Der Heijden, Kok, Lowik, Hartmann, Stoel, Van Houwelingen, Von
Birgelen) Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum
Twente, Enschede, Netherlands
(Danse) Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
(Jessurun) Department of Cardiology, Treant Zorggroep, Emmen, Netherlands
(Hautvast) Department of Cardiology, Medical Center Alkmaar, Alkmaar,
Netherlands
(Linssen) Department of Cardiology, Ziekenhuisgroep Twente, Netherlands
(Doggen, Von Birgelen) Department of Health Technology and Services
Research, MIRA, Institute for Biomedical Technology and Technical
Medicine, University of Twente, Koningsplein 1, Enschede NL-7512,
Netherlands
Publisher
S. Karger AG
Abstract
Objective: Limited data is available on the long-term outcome of patients
with increased cardiovascular event risk, treated with newer-generation
durable polymer drug-eluting stents (DES). Methods: We therefore assessed
3-year follow-up data of high-risk versus low-to intermediate-risk
patients of the randomized DUTCH PEERS trial (NCT01331707). In both risk
groups we also compared patients treated with Resolute Integrity versus
Promus Element DES. Patients were categorized as "high-risk" if they met
>=1 of the following criteria: (1) diabetes (17.9%); (2) previous
myocardial infarction (21.9%); (3) previous coronary revascularization
(25.8%); (4) chronic renal failure (3.5%); (5) left ventricular ejection
fraction <=30% (1.5%); and (6) age >=75 years (17.3%). Results: At the
3-year follow-up, the incidence of the composite endpoint target vessel
failure (TVF) (13.2 vs. 7.5%; logrank p < 0.001) and 2 of its
components-cardiac death (4.7 vs. 1.5%; logrank p < 0.001) and target
vessel revascularization (7.3 vs. 4.7%; logrank p = 0.03)-was higher in
high-risk (n = 957) versus low-to intermediate-risk patients (n = 854).
Among high-risk patients, treatment with Resolute Integrity (n = 481) and
Promus Element stents (n = 476) was similarly safe and efficacious (TVF:
13.3 vs. 13.1%; logrank p = 0.95; definite-or-probable stent thrombosis:
1.7 vs. 1.7%; logrank p = 1.00). Conclusions: The newer-generation
Resolute Integrity and Promus Element stents showed similar results in
terms of safety and efficacy for treating high-risk patients, who had
significantly higher event rates than patients with low-to-intermediate
risk.<br/>Copyright &#xa9; 2017 S. Karger AG, Basel.

<35>
Accession Number
619776295
Title
Acute kidney injury post-transcatheter aortic valve replacement.
Source
Clinical Cardiology. 40 (12) (pp 1357-1362), 2017. Date of Publication:
December 2017.
Author
Ram P.; Mezue K.; Pressman G.; Rangaswami J.
Institution
(Ram, Mezue, Rangaswami) Department of Internal Medicine, Einstein Medical
Center, Philadelphia, PA, United States
(Pressman) Heart and Vascular Institute, Division of Cardiology, Einstein
Medical Center, Philadelphia, PA, United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Transcatheter aortic valve replacement (TAVR) is a treatment option in
high-risk patients with severe aortic stenosis who are not surgical
candidates. In light of emerging evidence, it is being increasingly
performed even in intermediate-risk patients in recent years. Patients who
develop acute kidney injury (AKI) following TAVR are known to have worse
outcomes. The objective of this concise review was to identify the
prevalence and the impact of AKI following TAVR on patient outcomes by
including the most recent literature in our search. After a thorough
search on MEDLINE, Google Scholar, and PubMed, we included all literature
relevant to AKI following TAVR. We found that AKI was caused by a variety
of reasons, such as hemodynamic instability during rapid pacing, blood
transfusion, periprocedural embolization, and use of contrast medium, to
name a few. In patients who developed AKI following TAVR, 30-day and
1-year mortality were increased. Further, in these patients, length and
cost of hospital stay were increased as well. Preventive measures such as
optimal periprocedural hydration, careful contrast use, and techniques to
prevent embolization during device implantation have been tried with
limited success. Given that TAVR is expected to be increasingly performed,
this review aimed to summarize the rapidly expanding currently available
literature in an effort to reduce procedural complications and thereby
improve patient outcomes.<br/>Copyright &#xa9; 2017 Wiley Periodicals,
Inc.

<36>
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.