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<1>
Accession Number
619493686
Title
Cardiac troponin and adverse outcomes in atrial fibrillation: A
meta-analysis.
Source
Clinica Chimica Acta. 477 (pp 48-52), 2018. Date of Publication: February
2018.
Author
Fan Y.; Zhao X.; Li X.; Li N.; Hu X.
Institution
(Fan, Zhao, Li, Li, Hu) Department of Vascular and Thyroid Surgery, The
First Affiliated Hospital, China Medical University, Shenyang 110001,
China
Publisher
Elsevier B.V.
Abstract
Background The prognostic value of cardiac troponin elevation in atrial
fibrillation (AF) is unclear. Objective To investigate the association of
cardiac troponin elevation with adverse outcomes in AF by conducting a
meta-analysis. Methods We systematically searched the PubMed and Embase
databases until April 2017 for studies assessing the association of
cardiac troponin-T (cTnT) or troponin-I (cTnI) elevation with adverse
outcomes in AF. The outcome measures were all-cause mortality and major
adverse cardiac events (MACEs: death, stroke, myocardial infarction,
pulmonary embolism, major bleeding, or revascularization). Results Six
studies involving 22,697 AF patients were identified. Meta-analysis showed
that AF with elevated cardiac troponin was independently associated with
increased risk of all-cause mortality (HR 2.04; 95% CI 1.56-2.67) and
MACEs (HR 1.93; 95% CI 1.61-2.30). Furthermore, the prognostic value of
cardiac troponin elevation was consistently found irrespective of method
determination, type of troponin measured, sample size, and study quality
subgroup. Conclusions AF with cardiac troponin elevation was independently
associated with increased risk of all-cause mortality and MACEs.
Therefore, determination of troponin should be considered for risk
stratification in AF.<br/>Copyright &#xa9; 2017

<2>
Accession Number
621243862
Title
A comparison of outcomes between Canada and the United States in patients
recovering from hip fracture repair: Secondary analysis of the FOCUS
trial.
Source
International Journal for Quality in Health Care. 30 (2) (pp 97-103),
2018. Date of Publication: 01 Mar 2018.
Author
Beaupre L.A.; Wai E.K.; Hoover D.R.; Noveck H.; Roffey D.M.; Cook D.R.;
Magaziner J.S.; Carson J.L.
Institution
(Beaupre) Department of Physical Therapy, University of Alberta, Edmonton,
AB, Canada
(Wai, Roffey) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, 725 Parkdale Avenue, Ottawa, ON K1Y 4E9, Canada
(Wai) Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa,
ON K1H 8M5, Canada
(Wai) Division of Orthopaedic Surgery, Department of Surgery, The Ottawa
Hospital, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada
(Hoover) Department of Statistics and Biostatistics, Rutgers University,
The State University of New Jersey, 473 Hill Center, Campus Rutgers Univ.
110 Frelinghuysen Rd, Piscataway, NJ 08854-8019, United States
(Noveck, Carson) Division of General Internal Medicine, Rutgers Robert
Wood Johnson Medical School, Rutgers Biomedical and Health Sciences,
Rutgers, The State University of New Jersey, 125 Paterson St, New
Brunswick, NJ 08901, United States
(Cook) Division of General Internal Medicine, Cumming School of Medicine,
University of Calgary, FMC North Tower, 1403 29th Street NW, Calgary, AB
T2N 2T9, Canada
(Magaziner) Department of Epidemiology and Public Health, University of
Maryland School of Medicine, Suite 200, Howard Hall, 660 West Redwood
Street, Baltimore, MD 21201, United States
Publisher
Oxford University Press
Abstract
Objective: To determine if adjusted mortality, walking ability or return
home differed after hip fracture surgery between Canada and the USA.
Design: Secondary analysis of the Functional Outcomes in Cardiovascular
Patients Undergoing Surgical Hip Fracture Repair (FOCUS) trial data.
Setting: Data were collected from 47 American and Canadian hospitals.
Participants: Overall, 2016 subjects with a hip fracture (USA = 1222
(60.6%); Canada = 794 (39.4%)) were randomized to a liberal or restrictive
transfusion strategy. Subjects were 50 years and older, with
cardiovascular disease and/or risk factors and hemoglobin <100 g/L within
3 days post-surgery. The average age was 82 years and 1527(76%) subjects
were females. Intervention: Demographics, health status and health
services data were collected up to 60 days post-surgery and mortality to a
median of 3 years post-surgery. Main outcomes: Mortality, inability to
walk and return home. Results: US subjects had higher adjusted mortality
than Canadians at 30 days (odds ratio = 1.78; 95% confidence interval:
1.09-2.90), 60 days (1.53; 1.02-2.29) and up to 3 years (hazard ratio =
1.25; 1.07-1.45). There were no differences in adjusted outcomes for
walking ability or return home at 30 or 60 days post-surgery. Median
hospital length of stay was longer (P < 0.0001) in Canada (9 days;
interquartile range: 5-18 days) than the US (3 days; 2-5 days). US
subjects (52.9%) were more likely than Canadians (16.8%) to be discharged
to nursing homes for rehabilitation (P < 0.001). Conclusions: Adjusted
survival favored Canadians post hip fracture while walking ability and
return home were not different between countries. The reason(s) for
mortality differences warrant further investigation.<br/>Copyright &#xa9;
The Author(s) 2018. Published by Oxford University Press in association
with the International Society for Quality in Health Care. All rights
reserved.

<3>
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.

<4>
Accession Number
613120360
Title
Percutaneous Intervention for Concurrent Chronic Total Occlusions in
Patients With STEMI: The EXPLORE Trial.
Source
Journal of the American College of Cardiology. 68 (15) (pp 1622-1632),
2016. Date of Publication: 11 Oct 2016.
Author
Hoebers L.P.; Barbato E.; Nijveldt R.; van Rossum A.C.; Elias J.; van
Dongen I.M.; Claessen B.E.P.M.; Tijssen J.G.; van der Schaaf R.; Tijssen
J.G.P.; Zijlstra F.; de Boer M.-J.; Michels R.; Agostoni P.; van
Houwelingen K.G.; Verberne H.J.; Hirsch A.; Henriques J.P.S.; Piek J.J.;
de Winter R.J.; Koch K.T.; Vis M.M.; Baan J.; Wykrzykowska J.; Ramunddal
T.; Ioanes D.; Laanmets P.; van der Schaaf R.J.; Slagboom T.; Amoroso G.;
Eriksen E.; Tuseth V.; Bax M.; Schotborgh C.E.; Suttorp M.J.; Strauss
B.H.; Marques K.M.; Bertrand O.; Meuwissen M.; van der Ent M.; Koolen J.
Institution
(Henriques, Hoebers, Elias, van Dongen, Claessen, Tijssen) Academic
Medical Center, University of Amsterdam, Amsterdam, Netherlands
(Ramunddal, Ioanes) Sahlgrenska University Hospital, Gothenburg, Sweden
(Laanmets) North Estonia Medical Center, Tallinn, Estonia
(Eriksen) Haukeland University Hospital, Bergen, Norway
(Bax) Haga Teaching Hospital, The Hague, Netherlands
(Suttorp) Sint Antonius Ziekenhuis, Nieuwegein, Netherlands
(Strauss) Sunnybrook Health Sciences Centre, Toronto, Canada
(Barbato) Onze Lieve Vrouwe Ziekenhuis, Aalst, Belgium
(Nijveldt, van Rossum, Marques) VU University Medical Center, Amsterdam,
Netherlands
(van der Schaaf) Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
Publisher
Elsevier USA
Abstract
Background In 10% to 15% of patients with ST-segment elevation myocardial
infarction (STEMI), concurrent coronary chronic total occlusion (CTO) in a
non-infarct-related artery is present and is associated with increased
morbidity and mortality. Objectives The EXPLORE (Evaluating Xience and
Left Ventricular Function in Percutaneous Coronary Intervention on
Occlusions After ST-Elevation Myocardial Infarction) trial evaluated
whether patients with STEMI and concurrent CTO in a non-infarct-related
artery benefit from additional percutaneous coronary intervention (PCI) of
CTO shortly after primary PCI. Methods From November 2007 through April
2015, we enrolled 304 patients with acute STEMI who underwent primary PCI
and had concurrent CTO in 14 centers in Europe and Canada. A total of 150
patients were randomly assigned to early PCI of the CTO (CTO PCI), and 154
patients were assigned to conservative treatment without PCI of the CTO
(no CTO PCI). Primary outcomes were left ventricular ejection fraction
(LVEF) and left ventricular end diastolic volume (LVEDV) on cardiac
magnetic resonance imaging after 4 months. Results The
investigator-reported procedural success rate in the CTO PCI arm of the
trial was 77%, and the adjudicated success rate was 73%. At 4 months, mean
LVEF did not differ between the 2 groups (44.1 +/- 12.2% vs. 44.8 +/-
11.9%, respectively; p = 0.60). Mean LVEDV at 4 months was 215.6 +/- 62.5
ml in the CTO PCI arm versus 212.8 +/- 60.3 ml in the no-CTO PCI arm (p =
0.70). Subgroup analysis revealed that patients with CTO located in the
left anterior descending coronary artery who were randomized to the CTO
PCI strategy had significantly higher LVEF compared with patients
randomized to the no-CTO PCI strategy (47.2 +/- 12.3% vs. 40.4 +/- 11.9%;
p = 0.02). There were no differences in terms of 4-month major adverse
coronary events (5.4% vs. 2.6%; p = 0.25). Conclusions Additional CTO PCI
within 1 week after primary PCI for STEMI was feasible and safe. In
patients with STEMI and concurrent CTO, we did not find an overall benefit
for CTO PCI in terms of LVEF or LVEDV. The finding that early CTO PCI in
the left anterior descending coronary artery subgroup was beneficial
warrants further investigation. (Evaluating Xience and Left Ventricular
Function in Percutaneous Coronary Intervention on Occlusions After
ST-Segment Elevation Myocardial Infarction; NTR1108)<br/>Copyright &#xa9;
2016 American College of Cardiology Foundation

<5>
Accession Number
608764719
Title
Agreement of treatment effects for mortality from routinely collected data
and subsequent randomized trials: Meta-epidemiological survey.
Source
BMJ (Online). 352 (no pagination), 2016. Article Number: i493. Date of
Publication: 08 Feb 2016.
Author
Hemkens L.G.; Contopoulos-Ioannidis D.G.; Ioannidis J.P.A.
Institution
(Hemkens, Ioannidis) Stanford Prevention Research Center, Department of
Medicine, Stanford University School of Medicine, Stanford, CA 94305,
United States
(Hemkens) Basel Institute for Clinical Epidemiology and Biostatistics,
University Hospital Basel, Basel, Switzerland
(Contopoulos-Ioannidis) Department of Pediatrics, Division of Infectious
Diseases, Stanford University School of Medicine, Stanford, CA, United
States
(Contopoulos-Ioannidis, Ioannidis) Meta-Research Innovation Center at
Stanford (METRICS), Stanford University School of Medicine, Stanford, CA,
United States
(Ioannidis) Department of Health Research and Policy, Stanford University
School of Medicine, Stanford, CA, United States
(Ioannidis) Department of Statistics, Stanford University School of
Humanities and Sciences, Stanford, CA, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To assess differences in estimated treatment effects for
mortality between observational studies with routinely collected health
data (RCD; that are published before trials are available) and subsequent
evidence from randomized controlled trials on the same clinical question.
Design Meta-epidemiological survey. Data sources PubMed searched up to
November 2014. Methods Eligible RCD studies were published up to 2010 that
used propensity scores to address confounding bias and reported
comparative effects of interventions for mortality. The analysis included
only RCD studies conducted before any trial was published on the same
topic. The direction of treatment effects, confidence intervals, and
effect sizes (odds ratios) were compared between RCD studies and
randomized controlled trials. The relative odds ratio (that is, the
summary odds ratio of trial(s) divided by the RCD study estimate) and the
summary relative odds ratio were calculated across all pairs of RCD
studies and trials. A summary relative odds ratio greater than one
indicates that RCD studies gave more favorable mortality results. Results
The evaluation included 16 eligible RCD studies, and 36 subsequent
published randomized controlled trials investigating the same clinical
questions (with 17 275 patients and 835 deaths). Trials were published a
median of three years after the corresponding RCD study. For five (31%) of
the 16 clinical questions, the direction of treatment effects differed
between RCD studies and trials. Confidence intervals in nine (56%) RCD
studies did not include the RCT effect estimate. Overall, RCD studies
showed significantly more favorable mortality estimates by 31% than
subsequent trials (summary relative odds ratio 1.31 (95% confidence
interval 1.03 to 1.65; I²=0%)). Conclusions Studies of
routinely collected health data could give different answers from
subsequent randomized controlled trials on the same clinical questions,
and may substantially overestimate treatment effects. Caution is needed to
prevent misguided clinical decision making.<br/>Copyright &#xa9; BMJ
Publishing Group Ltd 2015.

<6>
Accession Number
623585944
Title
Association of body mass index with short-term outcomes after cardiac
surgery: Retrospective study and meta-analysis.
Source
Medicina (Argentina). 78 (3) (pp 171-179), 2018. Date of Publication: June
2018.
Author
Borracci R.A.; Ingino C.A.; Miranda J.M.
Institution
(Borracci) Departamento de Cirugia Cardiaca, Hospital de Clinicas,
Facultad de Medicina, Universidad de Buenos Aires, Argentina
(Borracci, Ingino, Miranda) Departamento de Cardiologia y Cirugia
Cardiaca, ENERI-Sagrada Familia, Buenos Aires, Argentina
Publisher
Instituto de Investigaciones Medicas (E-mail: revmed@intramed.net.ar)
Abstract
The relationship between higher body mass index (BMI), decreased morbidity
and mortality is known as the "obesity paradox", and has been described in
cohorts of patients with hypertension, diabetes, heart failure, coronary
and peripheral artery diseases, non-cardiac surgery, and end-stage renal
disease. Here we investigated the relationship between BMI and short-term
outcomes after adult cardiac surgery to explore the existence of an
obesity paradoxical effect. A secondary objective was to perform an
updated systematic review to further analyze the association between BMI
and 30-day in-hospital mortality after cardiac surgery. A retrospective
analysis was performed from a consecutive series of 1823 adult patients
who underwent cardiac surgery, that were assigned to five BMI groups:
normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), class I obese
(30-34.9 kg/m2), class II obese (35-39.9 kg/m2), and class III obese or
morbidly obese (40-49.9 kg/m2). A systematic review search was performed
including controlled trials and observational studies identified in
MEDLINE, Embase, SCOPUS, and the Cochrane library (to the end of June
2017). In the present series, overweight and obese patients had similar or
slightly lower in-hospital mortality rates after cardiac surgery compared
with normal-weight individuals. Conversely, postoperative complication
rates increased with higher BMI levels. Most studies included in the
review showed that overweight and obese patients had at least the same
mortality rate as normal-weight patients, or even a lower death risk.
Pooled-data of the meta-analysis provided evidence on the association
between higher BMI levels and a lower all-cause in-hospital mortality rate
after cardiac surgery.<br/>Copyright &#xa9; 2018, Instituto de
Investigaciones Medicas. All rights reserved.

<7>
Accession Number
620774816
Title
Use of an alternating inflatable head pad in patients undergoing open
heart surgery.
Source
Medical Science Monitor. 24 (pp 970-976), 2018. Date of Publication: 16
Feb 2018.
Author
Huang W.; Zhu Y.; Qu H.
Institution
(Huang) Yantai Yuhuangding Hospital, Eastern Operating Room, Yantai,
Shandong, China
(Zhu, Qu) Department of Nursing, Yantai Yuhuangding Hospital, Yantai,
Shandong, China
Publisher
International Scientific Information, Inc. (E-mail:
iza.pranga@isl-science.com)
Abstract
Background: Preoperative symptoms like occipital pressure ulcers and
alopecia areata (AA) significantly lowered patient quality of life.
Therefore, preoperative nursing was in need of investigation. This study
aimed to compare effects of an alternating inflatable head pad and a gel
pad on occurrence of postoperative pressure ulcers and AA in patients
undergoing open heart surgery. Material/Methods: This was a prospective
study. We allocated randomly 120 patients undergoing surgery (3-7 h) in
the Yantai Yuhuangding Hospital affiliated to Qingdao University, China
from January to October 2015 to the control (gel head pad) or the
experimental (alternating inflatable head pad) group (n=60 per group). The
incidence and severity of occipital pressure ulcer were graded by the
classification system of the European Pressure Ulcer Advisory Panel
(EPUAP). The degree of occipital alopecia was measured by hair pull test.
This study used the t test and chi-square analysis. All statistics were
analyzed by SPSS 21.0. Results: Compared with the control group, there was
a significantly lower incidence and severity of occipital pressure ulcer
and alopecia in the experimental group (9 cases/60 cases vs. 1 case/60
cases, P<0.01). Moreover, multivariate analysis showed the risk of
developing occipital pressure ulcer after surgery was also obviously lower
in the experimental group (OR 1.449-120.798; P<0.005). Hair pull test
revealed that fewer patients in the experimental group had a hair loss
over 10%. Conclusions: The alternating inflatable head pad was effective
in reducing the incidence and severity of occipital pressure ulcer and
alopecia associated with surgery, which benefited the postoperative
nursing and improved patient quality of life.<br/>Copyright &#xa9; Med Sci
Monit, 2018.

<8>
Accession Number
623215729
Title
Does body mass index truly affect mortality and cardiovascular outcomes in
patients after coronary revascularization with percutaneous coronary
intervention or coronary artery bypass graft? A systematic review and
network meta-analysis.
Source
Obesity Reviews. 19 (9) (pp 1236-1247), 2018. Date of Publication:
September 2018.
Author
Ma W.-Q.; Sun X.-J.; Wang Y.; Han X.-Q.; Zhu Y.; Liu N.-F.
Institution
(Ma, Sun, Wang, Han, Zhu, Liu) Department of Cardiology, Zhongda Hospital,
School of Medicine, Southeast University 87 Dingjiaqiao, Nanjing, China
Publisher
Blackwell Publishing Ltd
Abstract
Background: Obesity, a comorbid medical condition, is usually observed in
patients with established coronary artery disease. Paradoxically, patients
with a higher body mass index (BMI) usually have better clinical outcomes
after coronary revascularization. Methods: We searched five online
databases through December 2017. We identified studies reporting the rate
of all-cause mortality or cardiovascular-related outcomes among patients
after coronary revascularization with percutaneous coronary intervention
or coronary artery bypass graft based on various BMI categories. Network
meta-analysis was performed using Bayesian methods. Results: Sixty-five
records involving 865,774 participants were included in our study. A
U-shaped association was observed across BMI categories for all-cause
mortality. Using normal weight as the reference, all-cause mortality was
increased for (relative risk [RR]: 2.4; 95% credibility interval [CrI]:
2.1-2.7) patients with underweight, whereas it was lowered in patients
with overweight, obese, and severely obese. This association remained
significant in many subgroups. We also observed that the risk of major
adverse cardiovascular events (MACE) was lowest among patients with
overweight. Furthermore, patients with underweight were associated with
greater risks of myocardial infarction (RR: 1.9; 95% CrI: 1.4-2.5),
cardiovascular-related mortality (RR: 2.8; 95% CrI: 1.6-4.7), stroke (RR:
2.0; 95% CrI: 1.3-3.3) and heart failure (RR: 1.7; 95% CrI: 1.1-2.7)
compared with normal weight patients; no significant association was
observed among individuals with higher BMI. Conclusions: The 'obesity
paradox' does exist in patients after coronary revascularization,
especially for patients with post-percutaneous coronary intervention.
All-cause mortality in patients with high BMI is significantly lower
compared with patients with normal weight. Furthermore, patients with
underweight experience higher rates of cardiovascular outcomes compared
with patients with normal weight.<br/>Copyright &#xa9; 2018 World Obesity
Federation

<9>
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.

<10>
Accession Number
623511011
Title
Smoking resumption after heart or lung transplantation: A systematic
review and suggestions for screening and management.
Source
Journal of Thoracic Disease. 10 (7) (pp 4609-4618), 2018. Date of
Publication: 01 Jul 2018.
Author
Hofmann P.; Benden C.; Kohler M.; Schuurmans M.M.
Institution
(Hofmann, Benden, Kohler, Schuurmans) Division of Pulmonology, University
Hospital Zurich, Zurich, Switzerland
(Kohler, Schuurmans) University of Zurich, Zurich, Switzerland
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Smoking remains the leading cause of preventable disease and death in the
developed world and kills half of all long-term users. Smoking resumption
after heart or lung transplantation is associated with allograft
dysfunction, higher incidence of cancer, and reduced overall survival.
Although self-reporting is considered an unreliable method for tobacco use
detection, implementing systematic cotinine-based screening has proven
challenging. This review examines the prevalence of smoking resumption in
thoracic transplant patients, explores the risk factors associated with a
post-transplant smoking resumption and discusses the currently available
smoking cessation interventions for transplant patients.<br/>Copyright
&#xa9;Journal of Thoracic Disease.

<11>
Accession Number
623510941
Title
Short-term and 1-year outcomes after MitraClip therapy in functional
versus degenerative mitral regurgitation patients: A systematic review and
meta-analysis.
Source
Journal of Thoracic Disease. 10 (7) (pp 4156-4168), 2018. Date of
Publication: 01 Jul 2018.
Author
Liu X.-H.; Shi J.-Y.; Feng X.-J.; Feng D.-C.; Wang L.; Pang H.-Y.; Xie
H.-Z.; Wang F.-F.; Hsu J.; Jia F.-W.; Chen W.
Institution
(Liu, Feng, Feng, Xie, Wang, Hsu, Jia, Chen) Department of Cardiology,
Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
and Peking Union Medical College, Beijing 100730, China
(Shi) Department of Cardiology, Affiliated Hospital of Nantong University,
Medical School of Nantong University, Jiangsu 226001, China
(Wang) Division of Cardiac imaging, St. Francis Hospital Heart Center,
Long Island, NY, United States
(Pang) Institute of Basic Medical Sciences, Chinese Academy of Medical
Sciences, School of Basic Medicine,Peking Union Medical College, Beijing
100730, China
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Differences in short-term and 1-year outcomes of percutaneous
edge-to-edge mitral repair between patients with functional and
degenerative mitral regurgitation (MR) remain unclear. We performed a
systematic review and meta-analysis to investigate the safety and efficacy
of MitraClip (MC) in patients with different MR etiologies. Methods: This
study systematically searched three common databases for studies on MC
therapy until November 2017. The studies meeting the standard inclusion
criteria were included. The data at baseline, short-term and 1-year
clinical and echocardiographic outcomes were obtained and analyzed. All
data were checked by another reviewer. Results: Thirteen studies totalling
2,351 patients investigating the short-term and 1-year outcomes of MC in
patients with functional MR (FMR) versus degenerative MR (DMR) were
included for further analysis. FMR patients presented a higher risk
profile at baseline. There was no difference in short-term outcomes
between DMR and FMR for post-procedural MR grade 0-2 (76.8% vs. 77.1%;
P=0.428), mean trans-mitral gradient (3.92 vs. 3.50 mmHg; P=0.098), 30-day
mortality rate (0.05% vs. 0.03%; P=0.118) and 30-day NYHA I-II (85.3% vs.
78.7%; P=0.211). FMR patients had a higher rate of acute procedural
success compared to the DMR patient group (91.2% vs. 95.2%; P=0.016). A
greater portion of DMR patients implanted two or more MCs than the FMR
patients (41.4% vs. 35.7%; P=0.043). For the 1-year outcomes, no
difference was found in the mortality rate (13.0% vs. 15.2%; P=0.268) and
proportion of patients with post-procedural MR grades 0-2 (75.0% vs.
80.7%; P=0.106). Conclusions: Despite a higher risk profile in FMR
patients, the short-term and 1-year outcomes were not significantly
different. We conclude that MC therapy is similar between FMR and DMR
patients until 1-year follow-up. Large randomized trials are warranted to
fully and further assess the clinical impact of the procedure in these two
MR etiologies over a longer period of time.<br/>Copyright &#xa9;Journal of
Thoracic Disease.

<12>
Accession Number
618297890
Title
Platelet reactivity-adjusted antiplatelet therapy in patients with
percutaneous coronary intervention: a meta-analysis of randomized
controlled trials.
Source
Platelets. 29 (6) (pp 589-595), 2018. Date of Publication: 18 Aug 2018.
Author
Xing Z.; Tang L.; Zhu Z.; Huang J.; Peng X.; Hu X.
Institution
(Xing, Tang, Zhu, Huang, Peng, Hu) Department of Cardiovascular Medicine,
The Second Xiangya Hospital, Central South University, Changsha, Hunan,
China
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Numerous number of evidences show that high on-treatment platelet
reactivity is a well-known risk factor for adverse events in patients
after percutaneous coronary intervention (PCI). Controversial situations
still exist regarding the effectiveness of tailoring antiplatelet therapy
according to platelet function monitoring. The PubMed, Embase, and
Cochrane Central databases were searched for randomized trials comparing
platelet reactivity-adjusted antiplatelet therapy with conventional
antiplatelet therapy in patients undergoing PCI. The primary end point was
all-cause mortality, major adverse cardiac events (MACE) including
cardiovascular (CV) death, nonfatal myocardial infarction (MI),
definite/probable stent thrombosis (ST), revascularization, and stroke or
transient ischemic attack (TIA). The safety end point was defined as major
bleeding events. We derived pooled risk ratios (RRs) with fixed-effect
models. Six studies enrolling 6347 patients were included. Compared with
conventional treatment, tailoring antiplatelet failed to reduce all-cause
mortality (RR: 0.89, 95% confidence interval [CI]: 0.63-1.24, P = 0.48),
MACE (RR: 1.02, 95% CI: 0.92-1.14, P = 0.69), MI (RR: 1.07, 95% CI:
0.95-1.21, P = 0.24), CV death (RR: 0.69, 95% CI: 0.40-1.19, P = 0.09), ST
(RR: 0.83, 95% CI: 0.50-1.38, P = 0.23), stroke or TIA (RR: 1.08, 95% CI:
0.55-2.12, P = 0.83), revascularization (RR: 0.96, 95% CI: 0.69-1.33, P =
0.79), and major bleeding events (RR: 0.79, 95% CI: 0.53-1.17, P = 0.24).
Compared with traditional antiplatelet treatment, tailoring antiplatelet
therapy according to platelet reactivity testing failed to reduce
all-cause mortality, MACE, and major bleeding events in patients
undergoing PCI.<br/>Copyright &#xa9; 2018, &#xa9; 2018 Taylor & Francis.

<13>
[Use Link to view the full text]
Accession Number
623482183
Title
Myocardial protection by glucose-insulin-potassium in moderate-to
high-risk patients undergoing elective on-pump cardiac surgery: A
randomized controlled trial.
Source
Anesthesia and Analgesia. 126 (4) (pp 1133-1141), 2018. Date of
Publication: April 2018.
Author
Ellenberger C.; Sologashvili T.; Kreienbuhl L.; Cikirikcioglu M.; Diaper
J.; Licker M.
Institution
(Ellenberger, Diaper, Licker) Department of Anesthesiology, Pharmacology
and Intensive Care, University Hospital of Geneva, Faculty of Medicine,
Geneva CH-1206, Switzerland
(Sologashvili, Cikirikcioglu) Division of Cardiovascular Surgery,
University Hospital of Geneva, Geneva, Switzerland
(Kreienbuhl) Department of Anesthesiology and Intensive Care Medicine,
Campus Charite Mitte, Campus Virchow-Klinikum, Charite-Universitatsmedizin
Berlin, Berlin, Germany
(Licker) Faculty of Medicine, University of Geneva, Geneva, Switzerland
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Low cardiac output syndrome is a main cause of death after
cardiac surgery. We sought to assess the impact of
glucose.insulin.potassium (GIK) to enhance myocardial protection in
moderate-to high-risk patients undergoing on-pump heart surgery. METHODS:
A randomized controlled trial was performed in adult patients
(Bernstein.Parsonnet score >7) scheduled for elective aortic valve
replacement and/or coronary artery bypass surgery. Patients were
randomized to GIK (20 IU of insulin, 10 mEq of potassium chloride in 50 mL
of glucose 40%) or saline infusion given over 60 minutes on anesthetic
induction. The primary end point was postcardiotomy ventricular
dysfunction (PCVD), defined as new/worsening left ventricular dysfunction
requiring inotropic support (>=120 minutes). Secondary end points were the
intraoperative changes in left ventricular function as assessed by
transoesophageal echocardiography, postoperative troponin levels,
cardiovascular and respiratory complications, and intensive care unit and
hospital length of stay. RESULTS: From 224 randomized patients, 222 were
analyzed (112 and 110 in the placebo and GIK groups, respectively). GIK
pretreatment was associated with a reduced occurrence of PCVD (risk ratio
[RR], 0.41; 95% confidence interval [CI], 0.25.0.66). In GIK-treated
patients, the left systolic ventricular function was better preserved
after weaning from bypass, plasma troponin levels were lower on the first
postoperative day (2.9 ng EmL.1 [interquartile range {IQR}, 1.5.6.6] vs
4.3 ng EmL.1 [IQR, 2.4.8.2]), and cardiovascular (RR, 0.69; 95% CI,
0.50.0.89) and respiratory complications (RR, 0.5; 95% CI, 0.38.0.74) were
reduced, along with a shorter length of stay in intensive care unit (3
days [IQR, 2.4] vs 3.5 days [IQR, 2.7]) and in hospital (14 days [IQR,
11.18.5] vs 16 days [IQR, 12.5.23.5]), compared with placebo-treated
patients. CONCLUSIONS: GIK pretreatment was shown to attenuate PCVD and to
improve clinical outcome in moderate-to high-risk patients undergoing
on-pump cardiac surgery.<br/>Copyright &#xa9; 2018 International
Anesthesia Research Society.

<14>
Accession Number
623488501
Title
Intravenous ivabradine versus placebo in patients with low cardiac output
syndrome treated by dobutamine after elective coronary artery bypass
surgery: A phase 2 exploratory randomized controlled trial.
Source
Critical Care. 22 (1) (no pagination), 2018. Article Number: 193. Date of
Publication: 17 Aug 2018.
Author
Nguyen L.S.; Squara P.; Amour J.; Carbognani D.; Bouabdallah K.; Thierry
S.; Apert-Verneuil C.; Moyne A.; Cholley B.
Institution
(Nguyen, Squara) Critical Care Medicine, CMC Ambroise Pare,
Neuilly-sur-Seine, France
(Amour) Hopital de la Pitie-Salpetriere, AP-HP, Universite Pierre et Marie
Curie, Anesthesiology and Critical Care Medicine, Paris, France
(Carbognani, Bouabdallah) Institut Mutualiste Monsouris, Anesthesiology
and Critical Care Medicine, Paris, France
(Thierry) Centre Cardiologique du Nord, Anesthesiology and Critical Care
Medicine, Saint-Denis, France
(Apert-Verneuil, Moyne) Institut de Recherches Internationales Servier,
Suresnes, France
(Cholley) Hopital Europeen Georges Pompidou, AP-HP, Universite Paris
Descartes-Sorbonne Paris Cite, Anesthesiology and Critical Care Medicine
Department, Paris, France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Low cardiac output syndrome (LCOS) is a severe condition which
can occur after cardiac surgery, especially among patients with
pre-existing left ventricular dysfunction. Dobutamine, its first-line
treatment, is associated with sinus tachycardia. This study aims to assess
the ability of intravenous ivabradine to decrease sinus tachycardia
associated with dobutamine infused for LCOS after coronary artery bypass
graft (CABG) surgery. Methods: In a phase 2, multi-center, single-blind,
randomized controlled trial, patients with left ventricular ejection
fraction below 40% presenting sinus tachycardia of at least 100 beats per
minute (bpm) following dobutamine infusion for LCOS after CABG surgery
received either intravenous ivabradine or placebo (three ivabradine for
one placebo). Treatment lasted until dobutamine weaning or up to 48 h. The
primary endpoint was the proportion of patients achieving a heart rate
(HR) in the 80- to 90-bpm range. Secondary endpoints were invasive and
non-invasive hemodynamic parameters and arrhythmia events. Results:
Nineteen patients were included. More patients reached the primary
endpoint in the ivabradine than in the placebo group (13 (93%) versus 2
(40%); P = 0.04). Median times to reach target HR were 1.0 h in the
ivabradine group and 5.7 h in the placebo group. Ivabradine decreased HR
(112 to 86 bpm, P <0.001) while increasing cardiac index (P = 0.02),
stroke volume (P <0.001), and systolic blood pressure (P = 0.03). In the
placebo group, these parameters remained unchanged from baseline. In the
ivabradine group, five patients (36%) developed atrial fibrillation (AF)
and one (7%) was discontinued for sustained AF; two (14%) were
discontinued for bradycardia. Conclusion: Intravenous ivabradine achieved
effective and rapid correction of sinus tachycardia in patients who
received dobutamine for LCOS after CABG surgery. Simultaneously, stroke
volume and systolic blood pressure increased, suggesting a beneficial
effect of this treatment on tissue perfusion.<br/>Copyright &#xa9; 2018
The Author(s).

<15>
[Use Link to view the full text]
Accession Number
623482717
Title
Effect of xenon anesthesia compared to sevoflurane and total intravenous
anesthesia for coronary artery bypass graft surgery on postoperative
cardiac troponin release an international, multicenter, phase 3,
single-blinded, randomized noninferiority trial.
Source
Anesthesiology. 127 (6) (pp 918-933), 2017. Date of Publication: 2017.
Author
Hofland J.; Ouattara A.; Fellahi J.-L.; Gruenewald M.; Hazebroucq J.;
Ecoffey C.; Joseph P.; Heringlake M.; Steib A.; Coburn M.; Amour J.; Rozec
B.; De Liefde I.; Meybohm P.; Preckel B.; Hanouz J.-L.; Tritapepe L.;
Tonner P.; Benhaoua H.; Roesner J.P.; Bein B.
Institution
(Hofland, Bein) Sector Cardiothoracic Anesthesiology, Torax Centre,
Rotterdam, Netherlands
(Ouattara, Ecoffey, Coburn, Amour) Service d'Anesthesiereanimation II,
Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
(Fellahi, Heringlake, Steib, Rozec) Louis Pradel University Hospital,
Lyon, France
(Meybohm, Tritapepe) Department of Anesthesiology and Intensive Care
Medicine, Inserm U1060, Faculty of Medicine, Claude Bernard Lyon 1
University, Lyon, France
(Preckel) UniversitatsKlinikum Schleswig-Holstein, Klinik fur
Anasthesiologie und Operative Intensivmedizin, Campus Kiel, Kiel, Germany
(Hanouz) Air Liquide Sante International, Jouy-en-Josas, France
(Hanouz) Department of Anesthesia, Hopital Pontchaillou, Centre
Hospitalier Universitaire de Rennes, Rennes, France
(Joseph, Tonner) Department of Anesthesia and Intensive Care, Hopital
Cardiovasculaire et Pneumologique Louis Pradel, Bron, France
(Benhaoua) Department of Anesthesiology and Intensive Care Medicine,
University of Lubeck, Lubeck, Germany
(Tonner, Roesner) Service d'Anesthesie Reanimation Chirurgicale, Hopitaux
Universitaire de Strasbourg, Strasbourg, France
(De Liefde) Department of Anesthesiology, University Hospital RWTH Aachen,
Aachen, Germany
(Tritapepe) Department of Anesthesia and Intensive Care, Institut de
Cardiologie, Hopital Pitie Salpetriere, Paris, France
(Preckel) Service d'Anesthesie et Reanimation Chirurgicale, Hopital G and
R Laennec, Centre Hospitalier Universitaire de Nantes, Nantes, France
(De Liefde) Clinic of Anesthesiology, Intensive Care Medicine and Pain
Terapy, University Hospital Frankfurt Am Main, Frankfurt am Main, Germany
(Coburn) Department of Anesthesiology, Academic Medical Center, University
of Amsterdam, Amsterdam, Netherlands
(Ecoffey) Service d'Anesthesie et Reanimation Chirurgicale, Centre
Hospitalier Universitaire de Caen, Caen, France
(Heringlake) Department of Anesthesia and Intensive Care, Policlinico
Umberto i, La Sapienza University of Rome, Rome, Italy
(Steib) Department of Anesthesiology and Intensive Care, Klinikum Links
der Weser GGmbH, Bremen, Germany
(Hazebroucq) Chirurgie Cardiovasculaire-Service de Reanimation, Centre
Hospitalier Regional Universitaire, Hospitalier de Rangueil, Toulouse,
France
(Gruenewald) Clinic for Anesthesia and Critical Care Medicine, University
Hospital of Rostock, Rostock, Germany
(Hofland) Radboud University Medical Center, P.O. Box 9109, HB Nijmegen
6500, Netherlands
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Ischemic myocardial damage accompanying coronary artery bypass
graft surgery remains a clinical challenge. We investigated whether xenon
anesthesia could limit myocardial damage in coronary artery bypass graft
surgery patients, as has been reported for animal ischemia models.
Methods: In 17 university hospitals in France, Germany, Italy, and Te
Netherlands, low-risk elective, on-pump coronary artery bypass graft
surgery patients were randomized to receive xenon, sevoflurane, or
propofol-based total intravenous anesthesia for anesthesia maintenance. Te
primary outcome was the cardiac troponin I concentration in the blood 24h
postsurgery. Te noninferiority margin for the mean diflerence in cardiac
troponin I release between the xenon and sevoflurane groups was less than
0.15ng/ml. Secondary outcomes were the safety and feasibility of xenon
anesthesia. Results: Te frst patient included at each center received
xenon anesthesia for practical reasons. For all other patients, anesthesia
maintenance was randomized (intention-to-treat: n = 492;
per-protocol/without major protocol deviation: n = 446). Median 24-h
postoperative cardiac troponin I concentrations (ng/ml [interquartile
range]) were 1.14 [0.76 to 2.10] with xenon, 1.30 [0.78 to 2.67] with
sevoflurane, and 1.48 [0.94 to 2.78] with total intravenous anesthesia
[per-protocol]). Te mean diflerence in cardiac troponin I release between
xenon and sevoflurane was-0.09ng/ml (95% CI,-0.30 to 0.11; per-protocol: P
= 0.02). Postoperative cardiac troponin I release was signifcantly less
with xenon than with total intravenous anesthesia (intention-to-treat: P =
0.05; perprotocol: P = 0.02). Perioperative variables and postoperative
outcomes were comparable across all groups, with no safety concerns.
Conclusions: In postoperative cardiac troponin I release, xenon was
noninferior to sevoflurane in low-risk, on-pump coronary artery bypass
graft surgery patients. Only with xenon was cardiac troponin I release
less than with total intravenous anesthesia. Xenon anesthesia appeared
safe and feasible.<br/>Copyright &#xa9; 2017, the American Society of
Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved.

<16>
[Use Link to view the full text]
Accession Number
623482511
Title
Persistent postoperative pain after cardiac surgery: A systematic review
with meta-analysis regarding incidence and pain intensity.
Source
Pain. 158 (10) (pp 1869-1885), 2017. Date of Publication: October 2017.
Author
Guimaraes-Pereira L.; Reis P.; Abelha F.; Azevedo L.F.; Castro-Lopes J.M.
Institution
(Guimaraes-Pereira, Reis, Abelha) Department of Anesthesiology, Centro
Hospitalar de Sao Joao, Alameda Prof. Hernani Monteiro, Porto 4200-319,
Portugal
(Guimaraes-Pereira, Reis, Azevedo) Department of Health Information and
Decision Sciences (CIDES), Portugal
(Abelha) Department of Surgery, Faculty of Medicine, University of Porto,
Porto, Portugal
(Azevedo) CINTESIS-Centre for Health Technology and Services Research,
University of Porto, Porto, Portugal
(Azevedo, Castro-Lopes) National Observatory of Pain-NOPain (OBSERVDOR),
Faculty of Medicine, University of Porto, Porto, Portugal
(Castro-Lopes) Department of Experimental Biology, Faculty of Medicine,
University of Porto, Porto, Portugal
(Castro-Lopes) IBMC-Institute for Molecular and Cell Biology, University
of Porto, Porto, Portugal
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Persistent postoperative pain (PPP) has been described as a complication
of cardiac surgery (CS). We aimed to study PPP after CS (PPPCS) by
conducting a systematic review of the literature regarding its incidence,
intensity, location, and the presence of neuropathic pain, according to
the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
The review comprised 3 phases: a methodological assessment of 6 different
databases identifying potential articles and screening for inclusion
criteria by 2 independent reviewers; data extraction; and study quality
assessment. Meta-analysis was used to estimate the pooled incidence rates
using a random effects model. We have identified 442 potentially relevant
studies through database searching. A total of 23 studies (involving
11,057 patients) met our inclusion criteria. Persistent postoperative pain
affects 37% patients in the first 6 months after CS, and it remains
present more than 2 years after CS in 17%. The reported incidence of PPP
during the first 6 months after CS increased in recent years. Globally,
approximately half of the patients with PPPCS reported moderate to severe
pain. Chest is the main location of PPPCS followed by the leg; neuropathic
pain is present in the majority of the patients. This is the first
systematic review and meta-analysis to provide estimates regarding
incidence and intensity of PPPCS, which elucidates its relevance. There is
an urgent need for adequate treatment and follow-up in patients with
PPPCS.<br/>Copyright &#xa9; 2017 International Association for the Study
of Pain.

<17>
Accession Number
2000922101
Title
Statin therapy improved long-term prognosis in patients with major
non-cardiac vascular surgeries: a systematic review and meta-analysis.
Source
Vascular Pharmacology. 109 (pp 1-16), 2018. Date of Publication: October
2018.
Author
Yu W.; Wang B.; Zhan B.; Li Q.; Li Y.; Zhu Z.; Yan Z.
Institution
(Yu, Wang, Li, Li, Zhu, Yan) The Center for Hypertension and Metabolic
Diseases, Department of Hypertension and Endocrinology, Daping Hospital,
Third Military Medical University, Chongqing Institute of Hypertension,
Chongqing 400042, China
(Yu, Zhan) The Thirteenth People's Hospital of Chongqing, The Chongqing
Geriatric Hospital, Chongqing 400053, China
(Wang) Department of Nephrology, Chinese PLA General Hospital, Chinese PLA
Institute of Nephrology, Beijing Key Laboratory of Kidney Disease,
National Clinical Research Center for Kidney Diseases, Fuxing Road 28,
Beijing 100853, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: To investigate whether statin intervention will improve the
long-term prognosis of patients undergoing major non-cardiac vascular
surgeries. Methods: Major database searches for clinical trials enrolling
patients undergoing major non-cardiac vascular surgeries, including lower
limb revascularization, carotid artery surgeries, arteriovenous fistula,
and aortic surgeries, were performed. Subgroup analyses, stratified by
surgical types or study types, were employed to obtain statistical results
regarding survival, patency rates, amputation, and cardiovascular and
stroke events. Odds ratio (ORs) and 95% confidence intervals (CIs) were
calculated by Review Manager 5.3. Sensitivity analysis, publication bias
and meta-regression were conducted by Stata 14.0. Results: In total, 34
observational studies, 8 prospective cohort studies and 4 randomized
controlled clinical trials (RCTs) were enrolled in the present analysis.
It was demonstrated that statin usage improved all-cause mortality in
lower limb, carotid, aortic and mixed types of vascular surgery subgroups
compared with those in which statins were not used. Additionally, the
employment of statins efficiently enhanced the primary and secondary
patency rates and significantly decreased the amputation rates in the
lower limb revascularization subgroup. Furthermore, for other
complications, statin intervention decreased cardiovascular events in
mixed types of vascular surgeries and stroke incidence in the carotid
surgery subgroup. No significant publication bias was observed. The
meta-regression results showed that the morbidity of cardiovascular
disease or the use of aspirin might affect the overall estimates in
several subgroups. Conclusions: This meta-analysis demonstrated that
statin therapy was associated with improved survival rates and patency
rates and with reduced cardiovascular or stroke morbidities in patients
who underwent non-cardiac vascular surgeries.<br/>Copyright &#xa9; 2018
Elsevier Inc.

<18>
Accession Number
623629672
Title
The combined effects of cold therapy and music therapy on pain following
chest tube removal among patients with cardiac bypass surgery.
Source
Complementary therapies in clinical practice. 31 (pp 71-75), 2018. Date of
Publication: 01 May 2018.
Author
Yarahmadi S.; Mohammadi N.; Ardalan A.; Najafizadeh H.; Gholami M.
Institution
(Yarahmadi, Najafizadeh, Gholami) School of Nursing and Midwifery,
Lorestan University of Medical Sciences, Khorramabad, Iran, Islamic
Republic of
(Mohammadi) Department of Critical Care Nursing, Nursing and Midwifery
Faculty, Centre for Nursing Care Research, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Ardalan) 563 Hampshire Rd, Apt 273, Westlake Village, CA 91361, USA
Abstract
BACKGROUND: Chest tube removal is an extremely painful procedure and
patients may not respond well to palliative therapies. This study aimed to
examine the effect of cold and music therapy individually, as well as a
combination of these interventions on reducing pain following chest tube
removal.
METHODS: A factorial randomized-controlled clinical trial was performed on
180 patients who underwent cardiac surgery. Patients were randomized into
four groups of 45. Group A used ice packs for 20 minutes prior to chest
tube removal. Group B was assigned to listen to music for a total length
of 30 minutes which started 15 minutes prior to chest tube removal. Group
C received a combination of both interventions; and Group D received no
interventions. Pain intensity was measured in each group every 15 minutes
for a total of 3 readings. Analysis of variance, Tukey and Bonferroni post
hoc tests, as well as repeated measures ANOVA were employed for data
analysis.
RESULTS: Cold therapy and combined method intervention effectively reduced
the pain caused by chest tube removal (P<0.001). Additionally, there were
no statistically significant difference in pain intensity scores between
groups at 15 minutes following chest tube removal (P=0.07).
CONCLUSION: Cold and music therapy can be used by nursing staff in
clinical practice as a combined approach to provide effective pain control
following chest tube removal.<br/>Copyright &#xa9; 2018 Elsevier Ltd. All
rights reserved.

<19>
Accession Number
623631763
Title
Impact of renin-angiotensin system inhibitors on clinical outcomes and
ventricular remodelling after transcatheter aortic valve implantation:
rationale and design of the RASTAVI randomised multicentre study.
Source
BMJ open. 8 (2) (pp e020255), 2018. Date of Publication: 13 Feb 2018.
Author
Amat-Santos I.J.; Catala P.; Diez Del Hoyo F.; Fernandez-Diaz J.A.;
Alonso-Briales J.H.; Del Trigo M.; Regueiro A.; Juan-Salvadores P.; Serra
V.; Gutierrez-Ibanes E.; Munoz-Garcia A.J.; Nombela-Franco L.; Sabate M.;
Jimenez-Diaz V.A.; Garcia Del Blanco B.; Lopez J.; Varela-Falcon L.H.;
Sevilla T.; Arnold R.; Revilla A.; San Roman J.A.
Institution
(Amat-Santos, Lopez, Varela-Falcon, Sevilla, Arnold, Revilla, San Roman)
Cardiology Department, Hospital Clinico Universitario, Valladolid, Spain
(Catala) Cardiology Department, Hospital Clinico Universitario,
Valladolid, Spain
(Diez Del Hoyo, Gutierrez-Ibanes) Cardiology Department, Hospital General
Universitario Gregorio Maranon, Madrid, Spain
(Fernandez-Diaz) Cardiology Department, Hospital Puerta de Hierro, Madrid,
Spain
(Alonso-Briales, Munoz-Garcia) Cardiology Department, Hospital Virgen de
la Victoria, Malaga, Spain
(Del Trigo, Nombela-Franco) Cardiology Department, Hospital Clinico San
Carlos, Madrid, Spain
(Regueiro, Sabate) Cardiology Department, Hospital Clinic de Barcelona,
Barcelona, Spain
(Juan-Salvadores, Jimenez-Diaz) Cardiology Department, Hospital
Universitario Alvaro Cunqueiro, EOXI de Vigo, Vigo, Spain
(Serra, Garcia Del Blanco) Cardiology Department, Hospital Val d'Hebron,
Barcelona, Spain
Abstract
INTRODUCTION: Transcatheter aortic valve implantation (TAVI) as a
treatment in severe aortic stenosis (AS) is an excellent alternative to
conventional surgical replacement. However, long-term outcomes are not
benign. Renin-angiotensin system (RAS) blockade has shown benefit in terms
of adverse remodelling in severe AS and after surgical replacement.
METHODS AND ANALYSIS: The RAS blockade after TAVI (RASTAVI) trial aims to
detect if there is a benefit in clinical outcomes and ventricular
remodelling with this therapeutic strategy following the TAVI procedure.
The study has been designed as a randomised 1:1 open-label study that will
be undertaken in 8 centres including 336 TAVI recipients. All patients
will receive the standard treatment. The active treatment group will
receive ramipril as well. Randomisation will be done before discharge,
after signing informed consent. All patients will be followed up for 3
years. A cardiac magnetic resonance will be performed initially and at
1year to assess ventricular remodelling, defined as ventricular
dimensions, ejection fraction, ventricular mass and fibrosis. Recorded
events will include cardiac death, admission due to heart failure and
stroke. The RASTAVI Study will improve the management of patients after
TAVI and may help to increase their quality of life, reduce readmissions
and improve long-term survival in this scenario.
ETHICS AND DISSEMINATION: All authors and local ethics committees have
approved the study design. All patients will provide informed consent.
Results will be published irrespective of whether the findings are
positive or negative.
TRIAL REGISTRATION NUMBER: NCT03201185.<br/>Copyright &#xa9; Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2018. All rights reserved. No commercial use is permitted unless
otherwise expressly granted.

<20>
[Use Link to view the full text]
Accession Number
623628262
Title
Hybrid coronary revascularization versus conventional coronary artery
bypass grafting: Systematic review and meta-analysis.
Source
Medicine. 97 (33) (pp e11941), 2018. Date of Publication: 01 Aug 2018.
Author
Reynolds A.C.; King N.
Institution
(Reynolds) School of Biomedical and Healthcare Sciences, University of
Plymouth, Plymouth, United Kingdom
Abstract
BACKGROUND: Hybrid coronary revascularization (HCR) combining minimally
invasive grafting of the left internal mammary artery to the left anterior
descending artery with percutaneous coronary intervention has become a
viable option for treating coronary artery disease. The aim of this
meta-analysis was to compare HCR with conventional coronary artery bypass
grafting (CABG) in a range of clinical outcomes and hospital costs.
METHODS: To identify potential studies, systematic searches were carried
out in various databases. The key search terms included "hybrid
revascularization" AND "coronary artery bypass grafting" OR "HCR" OR
"CABG." This was followed by a meta-analysis investigating the need for
blood transfusion, hospital costs, ventilation time, hospital stay,
cerebrovascular accident, myocardial infarction, mortality, postoperative
atrial fibrillation, renal failure, operation duration, and ICU stay.
RESULTS: The requirement for blood transfusion was significantly lower for
HCR: odds ratio 0.38 (95% confidence intervals [CIs] 0.31-0.46, P <
.00001) as was the hospital stay: mean difference (MD) -1.48 days (95% CI,
-2.61 to -0.36, P = 0.01) and the ventilation time: MD -8.99 hours (95%
CI, -15.85 to -2.13, P = .01). On the contrary, hospital costs were more
expensive for HCR: MD $3970 (95% CI, 2570-5370, P < .00001). All other
comparisons were insignificant.
CONCLUSIONS: In the short-term, HCR is as safe as conventional CABG and
may offer certain benefits such as a lower requirement for blood
transfusion and shorter hospital stays. However, HCR is more expensive
than conventional CABG.

<21>
Accession Number
623616530
Title
Intensive care after cardiac surgery.
Source
Indian Journal of Forensic Medicine and Toxicology. 12 (3) (pp 172-177),
2018. Date of Publication: July-September 2018.
Author
Vardanjani M.M.; Mardani D.; Hormoz N.; Kalvandi N.
Institution
(Vardanjani) Department of Medical Surgical Nursing, School of Nursing and
Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran, Islamic
Republic of
(Mardani) Member of Chamran Heart Center, Isfahan University of Medical
Sciences, Isfahan, Iran, Islamic Republic of
(Hormoz, Kalvandi) Hamadan University of Medical Scinces, Hamadan, Iran,
Islamic Republic of
Publisher
Indian Journal of Forensic Medicine and Toxicology (E-mail:
ijfmt@hotmail.com)
Abstract
Post-surgical cardiac surgery is one of the most critical therapeutic
courses in patients undergoing cardiovascular surgery. Complications such
as bleeding, heart failure, arrhythmias, organ failure, neurological
disorders, respiratory failure, infection, and hemodynamic disorders are
some of the most prominent and life-threatening events in this period. The
management and treatment of these patients is done in partnership with a
team that plays a key role for nurses. A prospective review article is an
integrated review of the articles which have been evaluated and analyzed
during three stages of the search of texts. Searching for texts in valid
databases was searched using the keywords "nursing care", "heart surgery",
"nursing" and "cardiac surgery complications", subject to their
publication period from 2000 to 2016. The data extracted from the reviewed
articles is analyzed and categorized. Among the critical nursing practices
in the management of this critical period, one can explore and identify
people at risk, heart rate monitoring and monitoring, hemodynamic
monitoring, correction of hypertension disorders, diagnosis and treatment
of hemodynamic disorders, and prevention and treatment of neurological
disorders. Be The forthcoming review study attempts to explain and explain
the nurses' responsibilities to specialized care units during
post-operative heart surgery by systematically reviewing nursing
texts.<br/>Copyright &#xa9; 2018, Indian Journal of Forensic Medicine and
Toxicology. All rights reserved.

<22>
Accession Number
623636713
Title
Comparison of propofol-based versus volatile-based anaesthesia and
postoperative sedation in cardiac surgical patients: A prospective,
randomized, study.
Source
Anaesthesiology Intensive Therapy. 50 (3) (pp 200-209), 2018. Date of
Publication: 17 Aug 2018.
Author
Wasowicz M.; Jerath A.; Luksun W.; Sharma V.; Mitsakakis N.; Meineri M.;
Katznelson R.; Yau T.; Rao V.; Beattie W.S.
Institution
(Wasowicz, Jerath, Luksun, Sharma, Meineri, Katznelson, Beattie)
Department of Anesthesia, University of Toronto, Toronto, Canada
(Mitsakakis) Institute for Health Policy, Management and Evaluation,
University of Toronto, Biostatistics Research Unit, University Health
Network, Toronto, Canada
(Yau, Rao) Division of Cardiac Surgery, Peter Munk Cardiac Centre,
University Health Network, Department of Surgery, University of Toronto,
Toronto, Canada
(Wasowicz, Jerath, Luksun, Sharma, Meineri, Katznelson, Beattie)
Department of Anesthesia and Pain Management, Toronto General Hospital,
University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4,
Canada
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Clinical trials have shown conflicting results regarding the
use of volatile anaesthesia before or after an ischaemic insult in cardiac
surgical patients and its effect on myocardial injury. This may be
attributable to the failure of continuing volatile agents into the early
postoperative period. We hypothesised that combined volatile-based
anaesthesia and postoperative sedation would decrease the extent of
myocardial injury after coronary artery bypass grafting (CABG) when
compared with an intravenous, propofol-based approach. This study aimed to
assess the feasibility of the perioperative protocol and investigate
whether volatile anaesthesia provides cardioprotection in patients
undergoing CABG. Methods: Randomized, controlled trial enrolling 157
patients with preserved left ventricular function scheduled for elective
or urgent on-pump CABG. Patients received either volatile- or
propofol-based anaesthesia and postoperative sedation. Volatile sedation
in the ICU was provided with the use of the AnaConDa device
(Sedana Medical, Uppsala, Sweden). The primary outcome was myocardial
injury measured by serial troponin measurement at the beginning of
surgery, 2, 4 and 12-16 h after ICU admission. The secondary outcome was
cardiac performance expressed as cardiac index (CI) and the need for
inotropic and vasopressor drug support. The peak postoperative troponin
level was defined as the highest level at any time in the first 16 h after
surgery. Results: 127 patients completed the study protocol, 60 patients
in the volatile group and 67 patients in the propofol group. Troponin
levels were similar between groups at all of the measured time points.
There were no differences in cardiac index or vasoactive drug support
except for the immediate post- cardiopulmonary bypass (CPB) period when
patients in the volatile group had low systemic vascular resistance, high
CI and required more vasopressors. There was no difference in
postoperative kidney function, intensive care unit discharge or hospital
discharge time. Conclusions: The use of volatile-based anaesthesia and
postoperative sedation did not confer any cardioprotection compared with
propofol-based anaesthesia and sedation in patients who had good left
ventricular function and were undergoing CABG.

<23>
Accession Number
623632474
Title
Prehabilitation in thoracic surgery.
Source
Journal of Thoracic Disease. 10 (Supplement22) (pp S2593-S2600), 2018.
Date of Publication: 01 Aug 2018.
Author
Sanchez-Lorente D.; Navarro-Ripoll R.; Guzman R.; Moises J.; Gimeno E.;
Boada M.; Molins L.
Institution
(Sanchez-Lorente, Guzman, Boada, Molins) General Thoracic Surgery
Department, Clinical Respiratory Institute, Hospital Clinic of Barcelona,
Barcelona, Spain
(Navarro-Ripoll) Department of Anesthesiology, Clinical Respiratory
Institute, Hospital Clinic of Barcelona, Barcelona, Spain
(Moises, Gimeno) Department of Pneumology, Clinical Respiratory Institute,
Hospital Clinic of Barcelona, Barcelona, Spain
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Surgical resection remains the best treatment option for patients with
early stage of non-small cell lung cancer (NSCLC). However, it may be
responsible of postoperative complication and mortality, especially in
patients with impaired pulmonary function. Enhanced recovery after surgery
(ERAS) programs have been focused mainly in minimal invasive surgery
approach during lung resection and respiratory rehabilitation after
surgery. Preoperative exercise-based intervention (prehabilitation) has
demonstrated reduction of morbi-mortality in other surgeries but in
thoracic surgery continues to be under discussion. Cardio-pulmonary
exercise test (CPET) is the gold standard technique to predict
postoperative morbimortality. The implementation of a preoperative
respiratory rehabilitation could optimize patient's physical capacity
before surgery and improve outcomes and enhance recovery. The aim of this
systematic review of the literature is to identify the effectiveness and
safety of prehabilitation programs in thoracic surgery, the type of
exercise and its duration, and the group of patients with best benefit.
Prehabilitation is a safe intervention without side effects in patients.
High-intensity interval training (HIT) with duration of 2 to 6 weeks seems
to be the best exercise programme in a prehabilitation intervention but it
exists heterogeneity in terms of intensity and duration. Prehabilitation
increase exercise capacity and significantly enhances pulmonary function.
But the reduction of postoperative complication and mortality has not been
clearly demonstrated. Different criteria selection, type of intervention
and small sample size, in addition to no randomization, could justify
disparate results. It seems that not all patients can benefit from
prehabilitation and it could be indicated only in patients with impaired
lung function. Further randomized clinical trials with enough patients,
correct duration of HIT (2 to 6 weeks) and focused in COPD patients are
needed to clarify the suitability of prehabilitation. Meanwhile, safety of
prehabilitation and good results of some studies support this intervention
in high-risk patients.<br/>Copyright &#xa9; Journal of Thoracic Disease.

<24>
Accession Number
623587020
Title
Cardiovascular events in patients under age fifty with early findings of
elevated lipid and glucose levels - The AMORIS study.
Source
PLoS ONE. 13 (8) (no pagination), 2018. Article Number: e0201972. Date of
Publication: August 2018.
Author
Ivert T.; Malmstrom H.; Hammar N.; Carlsson A.C.; Wandell P.E.; Holzmann
M.J.; Jungner I.; Arnlov J.; Walldius G.
Institution
(Ivert) Department of Molecular Medicine and Surgery, Karolinska
Institutet and Heart and Vascular Theme, Karolinska University Hospital,
Stockholm, Sweden
(Malmstrom, Hammar, Jungner, Walldius) Unit of Epidemiology, Institute of
Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
(Malmstrom) Biostatistics, Data Management and Medical Writing, Research
and Development, Swedish Orphan Biovitrum (Sobi), Stockholm, Sweden
(Hammar) Medical Evidence and Observational Research, Global Medical
Affairs, AstraZeneca, Molndal, Sweden
(Carlsson, Wandell, Arnlov) Division of Family Medicine and Primary Care,
Department of Neurobiology, Care Sciences and Society, Karolinska
Institutet, Huddinge, Sweden
(Carlsson) Department of Medical Sciences, Uppsala University Hospital,
Uppsala, Sweden
(Holzmann) Department of Emergency Medicine, Karolinska University
Hospital, Huddinge, Sweden
(Holzmann) Department of Internal Medicine, Karolinska Institutet, Solna,
Sweden
(Arnlov) School of Health and Social Studies, Dalarna University, Falun,
Sweden
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background The long-term trajectories of lipid and glucose levels in
subjects who experience a major cardiovascular (CV) event at a young age
has not been well studied. Our objective was to investigate lipid,
lipoprotein, apolipoprotein (apo), and glucose levels in individuals
experiencing a CV event before 50 years of age. Methods and findings A
first CV event [non-fatal myocardial infarction (MI), coronary
revascularisation, or CV related death] before age 50 was recorded in
2,939 (cumulative incidence 1.2% in males and 0.3% in females) of 361,353
individuals included in the prospective Swedish AMORIS
(Apolipoprotein-related MOrtality RISk) study with health examinations
1985-1996 and follow-up through 2011. In a nested case-control analysis,
cases with a CV event were matched to randomly selected controls.
Population risk factor trajectories were calculated up to 20 years prior
to an event. Total cholesterol (TC), triglyceride (TG), and glucose levels
were higher in cases than in controls as early as 20 years prior to the
event with differences increasing over time. Low density lipoprotein,
apoB, and the apoB/apoA-1 ratio were higher and increased over time, while
HDL and apoA-1 were lower in cases compared to controls. The odds ratio
was 2.5 (95% confidence interval 1.6-3.7) for TC 5 mmol/L and TG 1.7
mmol/L in cases versus controls. The adjusted population-attributable
fractions including lipids, glucose, diabetes, smoking, hypertension, and
obesity indicated that about 50% of CV events before age 50 may be
associated with elevated lipid and glucose levels. Conclusions Elevated
TC, TG, LDL, apoB, and glucose levels and high apoB/apo A-1 ratio
documented two decades before a CV event in subjects younger than 50 years
may account for about half of CV events before age 50, which calls for
early recognition and possibly treatment of modifiable CV risk factors in
young individuals.<br/>Copyright &#xa9; 2018 Ivert et al. This is an open
access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<25>
Accession Number
623625466
Title
Anesthesia using target-controlled infusion of propofol during elective
pediatric surgery: Kataria versus Paedfusor pharmacokinetic model.
Source
Anaesthesia, Pain and Intensive Care. 22 (2) (pp 207-211), 2018. Date of
Publication: April-June 2018.
Author
Hassan W.M.N.W.; Mansor A.; Zaini R.H.M.
Institution
(Hassan, Mansor, Zaini) Department of Anesthesiology and Intensive Care,
School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu,
Kelantan 16150, Malaysia
Publisher
Faculty of Anaesthesia, Pain and Intensive Care, AFMS (E-mail:
tariqhayatkhan@hotmail.com)
Abstract
Background and Aim: Propofol and sevoflurane, both meet the criteria of
rapid smooth induction, hemodynamic stability, rapid recovery with minimal
side effects. The present study investigated the hemodynamic stability and
recovery profile while maintaining anesthesia with sevoflurane as
inhalational agent versus propofol as total intravenous anesthesia during
laparoscopic surgeries. Methodology: This was a prospective study
conducted for one year at our hospital. Using convenient sampling
technique, a total of 50 adult patients of American Society of
Anesthesiologists (ASA) physical status I or II, aged between 18-60 years,
of either sex, who were scheduled for elective day care surgeries of less
than 2-hour duration under general anesthesia were selected for the study
after informed consent. All the patients were randomly allocated into one
of the two groups using computer generated random number table. Group-S
received induction with propofol and maintenance with sevoflurane, while
Group-P was induced and maintained with propofol only. Hemodynamic and
recovery profiles were then compared. The differences between two groups
were analyzed using unpaired t-test while categorical variables were
analyzed using chi-square test. All the statistical tests were performed
in Epi Info 3.5.1 software by CDC, USA.6 p < 0.05was considered as
statistically significant while p < 0.01 was considered as statistically
highly significant. Results: The baseline demographic analysis showed that
the two groups did not differ significantly in age, weight, sex, ASA grade
and operative times. During the course of surgery, heart rate was
significantly low in Group-P at 45 to 60 min than in Group-S. Systolic and
diastolic blood pressures were significantly low during maintenance of
anesthesia with propofol as compared to sevoflurane. Group-S showed
significantly shorter time for spontaneous eye opening and recalling names
and recognizing surroundings. Post-operative nausea and vomiting was
significantly low in Group-P. Conclusion: The present study concludes that
patients in both groups were hemodynamically stable. Sevoflurane has the
added advantage of providing rapid emergence and recovery of cognitive
function. Hence it can be considered as a useful alternative to propofol
for maintenance of anesthesia.<br/>Copyright &#xa9; Anaesthesia, Pain &
Intensive Care, 2010-2013.

<26>
Accession Number
623625417
Title
Comparison of hemodynamic stability and recovery profile with sevoflurane
as inhalational agent versus propofol as total intravenous anesthesia
during laparoscopic surgeries.
Source
Anaesthesia, Pain and Intensive Care. 22 (2) (pp 212-218), 2018. Date of
Publication: April-June 2018.
Author
Shah J.; Varma N.
Institution
(Shah, Varma) Department of Anesthesiology, GMERS Medical College, 225,
Sola Rd, Shenbhai Nagar, Sola, Ahmedabad, Gujarat 380081, India
Publisher
Faculty of Anaesthesia, Pain and Intensive Care, AFMS (E-mail:
tariqhayatkhan@hotmail.com)
Abstract
Background and Aim: Propofol and sevoflurane, both meet the criteria of
rapid smooth induction, hemodynamic stability, rapid recovery with minimal
side effects. The present study investigated the hemodynamic stability and
recovery profile while maintaining anesthesia with sevoflurane as
inhalational agent versus propofol as total intravenous anesthesia during
laparoscopic surgeries. Methodology: This was a prospective study
conducted for one year at our hospital. Using convenient sampling
technique, a total of 50 adult patients of American Society of
Anesthesiologists (ASA) physical status I or II, aged between 18-60 years,
of either sex, who were scheduled for elective day care surgeries of less
than 2-hour duration under general anesthesia were selected for the study
after informed consent. All the patients were randomly allocated into one
of the two groups using computer generated random number table. Group-S
received induction with propofol and maintenance with sevoflurane, while
Group-P was induced and maintained with propofol only. Hemodynamic and
recovery profiles were then compared. The differences between two groups
were analyzed using unpaired t-test while categorical variables were
analyzed using chi-square test. All the statistical tests were performed
in Epi Info 3.5.1 software by CDC, USA.6 p < 0.05was considered as
statistically significant while p < 0.01 was considered as statistically
highly significant. Results: The baseline demographic analysis showed that
the two groups did not differ significantly in age, weight, sex, ASA grade
and operative times. During the course of surgery, heart rate was
significantly low in Group-P at 45 to 60 min than in Group-S. Systolic and
diastolic blood pressures were significantly low during maintenance of
anesthesia with propofol as compared to sevoflurane. Group-S showed
significantly shorter time for spontaneous eye opening and recalling names
and recognizing surroundings. Post-operative nausea and vomiting was
significantly low in Group-P. Conclusion: The present study concludes that
patients in both groups were hemodynamically stable. Sevoflurane has the
added advantage of providing rapid emergence and recovery of cognitive
function. Hence it can be considered as a useful alternative to propofol
for maintenance of anesthesia.<br/>Copyright &#xa9; Anaesthesia, Pain &
Intensive Care, 2010-2013.

<27>
Accession Number
623636185
Title
A comparison of haemostatic biomarkers during low-risk patients undergoing
cardiopulmonary bypass using either conventional centrifugal cell salvage
or the HemoSep device.
Source
Perfusion (United Kingdom). (no pagination), 2018. Date of Publication:
2018.
Author
Boyle G.; Kuffel A.; Parmar K.; Gibson K.; Smith M.; Grehan A.; Hunt B.J.;
Chambers D.J.
Institution
(Boyle, Grehan) Clinical Perfusion Department, Guy's and St Thomas, NHS
Foundation Trust, St Thomas' Hospital, United Kingdom
(Kuffel, Parmar, Hunt) Thrombosis & Vascular Biology Group, The Rayne
Institute, United Kingdom
(Gibson, Smith) Cardiovascular Research, Guy's and St Thomas' NHS
Foundation Trust, St Thomas' Hospital, United Kingdom
(Hunt) Thrombosis & Haemophilia, Guy's & St Thomas' NHS Foundation Trust,
St Thomas' Hospital, United Kingdom
(Chambers) Cardiothoracic Surgery/Cardiac Surgical Research, The Rayne
Institute, Guy's and St Thomas, NHS Foundation Trust, St Thomas' Hospital,
United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Cardiac surgery using cardiopulmonary bypass (CPB) is
associated with a coagulopathy due to haemodilution, thrombocytopenia and
platelet dysfunction and the activation of coagulation and fibrinolysis,
despite the use of large doses of unfractionated heparin. Conventional red
cell salvage may exacerbate post-operative bleeding as plasma containing
haemostatic factors is discarded. We hypothesized that a novel cell
salvage device (HemoSep) may attenuate haemostatic changes associated with
red cell salvage. We studied haemostatic markers following autologous
transfusion from conventional cell salvage or the HemoSep device. Methods:
This randomised, controlled trial compared haemostatic markers in patients
undergoing coronary artery bypass grafting or aortic valve replacement who
received autologous blood returned from cell salvage (control) or HemoSep
(study). Blood samples were taken pre-operatively, end of CPB,
post-transfusion of salvaged blood and 3 hours post-operatively and
analysed for full blood count (FBC), prothrombin time (PT), activated
partial thromboplastin time (aPTT), fibrinogen, D-dimer and endogenous
thrombin potential (ETP). Results: Fifty-four patients were recruited
(n=28 control, n=26 study). Processed blood volume for transfusion was
significantly (p<0.001) higher in the HemoSep group. In the HemoSep group,
the PT was shorter (18.7+/-0.3 vs 19.9+/-0.3 sec; p<0.05) post-operatively
and the aPTT was longer (48.6+/-3.8 vs 37.3+/-1.0 sec; p<0.01) following
autologous transfusion. In the control group, D-dimer and ETP levels were
higher (1903+/-424 vs.1088+/-151; p<0.05 and 739+/-46 vs. 394+/-60;
p<0.001, respectively) following autologous transfusion. Conclusions:
Although centrifuged cell salvage is known to adequately haemoconcentrate
and remove unwanted substrates and bacteriological contamination, the
process can exacerbate coagulopathy. The HemoSep device demonstrated some
increase in haemostatic markers when used in low-risk cardiac surgery
patients.<br/>Copyright &#xa9; The Author(s) 2018.

<28>
Accession Number
623610440
Title
Antithrombotic therapy after mitral valve repair: VKA or aspirin?.
Source
Journal of Thrombosis and Thrombolysis. (no pagination), 2018. Date of
Publication: 2018.
Author
van der Wall S.J.; Olsthoorn J.R.; Heuts S.; Klautz R.J.M.; Tomsic A.;
Jansen E.K.; Vonk A.B.A.; Sardari Nia P.; Klok F.A.; Huisman M.V.
Institution
(van der Wall, Klok, Huisman) Department of Thrombosis and Hemostasis,
Leiden University Medical Centre, Albinusdreef 2, Leiden 2300 RC,
Netherlands
(Olsthoorn, Heuts, Sardari Nia) Department of Cardio-Thoracic Surgery,
Maastricht University Medical Centre, Maastricht, Netherlands
(Klautz, Tomsic) Department of Cardio-Thoracic Surgery, Leiden University
Medical Centre, Leiden, Netherlands
(Jansen, Vonk) Department of Cardio-Thoracic Surgery, VU University
Medical Centre, Amsterdam, Netherlands
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The optimal antithrombotic therapy following mitral valve repair (MVr) is
still a matter of debate. Therefore, we evaluated the rate of
thromboembolic and bleeding complications of two antithrombotic prevention
strategies: vitamin K antagonists (VKA) versus aspirin. Consecutive
patients who underwent MVr between 2004 and 2016 at three Dutch hospitals
were evaluated for thromboembolic and bleeding complications during three
postoperative months. The primary endpoint was the combined incidence of
thromboembolic and bleeding complications to determine the net clinical
benefit of VKA strategy as compared with aspirin. Secondary objectives
were to evaluate both thromboembolic and bleeding rates separately and to
identify predictors for both complications. A total of 469 patients were
analyzed, of whom 325 patients (69%) in the VKA group and 144 patients
(31%) in the aspirin group. Three months postoperatively, the cumulative
incidence of the combined end point of the study was 9.2% (95%CI 6.1-12)
in the VKA group and 11% (95%CI 6.0-17) in the aspirin group [adjusted
hazard ratio (HR) 1.6, 95%CI 0.83-3.1]. Moreover, no significant
differences were observed in thromboembolic rates (adjusted HR 0.82, 95%CI
0.16-4.2) as well as in major bleeding rates (adjusted HR 1.89, 95%CI
0.90-3.9). VKA and aspirin therapy showed a similar event rate of 10%
during 3 months after MVr in patients without prior history of AF. In both
treatment groups thromboembolic event rate was low and major bleeding
rates were comparable. Future prospective, randomized trials are warranted
to corroborate our findings.<br/>Copyright &#xa9; 2018, The Author(s).

<29>
Accession Number
623617071
Title
Evaluation of 24-hour automatic stop order impact on albumin use.
Source
Journal of Pharmacy Practice. Conference: 57th Annual Assembly of the New
York State Council of Health-system Pharmacists, NYSCHP 2018. United
States. 31 (4) (pp 414), 2018. Date of Publication: August 2018.
Author
Gross K.; Prashar P.; Kersten B.; Zammit K.
Institution
(Gross, Prashar, Kersten, Zammit) Buffalo General Medical Center, Buffalo,
NY, United States
Publisher
SAGE Publications Inc.
Abstract
Introduction/Background: The optimal choice of fluid for volume
resuscitation in hospitalized patients remains uncertain. Albumin is
commonly chosen for its potential to provide rapid volume expansion with
minimal risk of pulmonary edema. However, randomized trials fail to
demonstrate clinically significant benefits of albumin compared with more
economical crystalloid alternatives. Objective(s): To describe the impact
of a hospital-wide 24-hour automatic stop order on albumin dose, duration,
and utilization. Methods: This was a retrospective, before and after study
evaluating 100 randomly selected patients who received at least one dose
of albumin. Data was collected during the 3 months prior and subsequent to
implementation of the 24-hour automatic stop on all albumin orders in
April 2017. Both pre-and post-implementation groups included a
pre-specified 50 patients consisting of 50% cardiothoracic surgery, 25%
general surgery, and 25% all other patients. The primary endpoint was
total dose of albumin administered per patient per hospitalization.
Secondary endpoints included total duration and cost of administration.
This study was approved by the Pharmacy and Therapeutic Committee at
Buffalo General Medical Center. Results: The median total dose and
duration of albumin use in the pre-implementation group were 75 grams [IQR
37.5, 100] and 24 hours (24-192), respectively. The median total dose and
duration in the post-implementation group were 75 grams [IQR 25, 100] and
24 hours (24-96), respectively. The economic impact resulting from the
automatic stop order was a 13% decrease in spending on albumin.
Conclusions: A 24-hour automatic stop may be an effective way to reduce
prolonged administration of albumin products.

<30>
Accession Number
616869226
Title
Remote ischemic preconditioning of transplant recipients to reduce graft
ischemia and reperfusion injuries: A systematic review.
Source
Transplantation Reviews. 32 (1) (pp 10-15), 2018. Date of Publication:
January 2018.
Author
Farooqui W.; Pommergaard H.C.; Rasmussen A.
Institution
(Farooqui) Department of Surgery, Nordsjaellands Hospital, Dyrehavevej 29,
Hillerod 3400, Denmark
(Pommergaard, Rasmussen) Department of Surgical Gastroenterology and
Transplantation, Abdominal Centre, Rigshospitalet, Blegdamsvej 9,
Kobehnavn O 2100, Denmark
Publisher
W.B. Saunders
Abstract
Background Solid organ transplantation is an accepted treatment for
end-stage solid organ diseases. During the procedure, ischemia and
reperfusion injury may affect graft and patient outcomes. Remote ischemic
preconditioning (rIC) has been shown to reduce ischemia and reperfusion
injury and can be performed safely. Thus, rIC may potentially improve
outcomes after solid organ transplantation. Traditionally, the focus of
rIC has been on the donor. However, preconditioning the recipient may be a
more suitable approach in transplant settings. The current review analyzed
previously published studies where rIC was performed on transplant
recipients. Methods PubMed and EMBASE databases were searched for eligible
clinical and animal studies evaluating rIC of recipients. Articles were
analyzed and compared qualitatively. Risk of bias was assessed using the
Cochrane Collaboration's tool for interventional clinical studies and
SYRCLEs risk of bias tool for animal studies. Results A total of 12
studies were included. Overall, these studies were heterogeneous due to
differences in populations and intervention set-up. Some of the studies
suggested improvement of graft function, while other studies did not show
any effect. The quality of the 12 included studies was predominantly low.
Conclusion Due to the heterogeneity and quality of the included studies
the result, that rIC may be beneficial in transplantation of some organs,
should be interpreted with caution. The result must be confirmed by
further clinical studies.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<31>
Accession Number
623367267
Title
Prospective, randomized un-blinded three arm controlled study in coronary
artery revascularization with Minimal Invasive Extracorporeal Circulation
Systems (MiECC): surrogate parameter analysis of biocompatibility.
Source
Heart Surgery Forum. 21 (3) (pp E179-E186), 2018. Date of Publication:
April 2018.
Author
Kiessling A.H.; Keller H.; Moritz A.
Institution
(Keller, Moritz) University Hospital, Department of Thoracic and
Cardiovascular Surgery, Frankfurt/Main, Germany
(Kiessling) Medical School Berlin, Department of Clinical Research,
Calandrelli Strasse 1-9, Berlin D-12247, Germany
Publisher
Forum Multimedia Publishing LLC (E-mail: motis@cjp.com)
Abstract
Objectives: Minimal extracorporeal circulation techniques and systems
(MiECC) may reduce the negative side effects of conventional
extracorporeal circulation (ECC). However, it is still unclear as to what
this is caused by, the reduced priming volume and hemodilution, or the
avoidance of blood-air contact and dispersion of mediastinal debris into
the systemic circulation. The aim of the trial was the comparison of MiECC
to an open ECC setup (openECC) or a system with reduced blood air and
debris interaction (closeECC). Methods: In a prospective randomized trial,
72 patients (73 +/- 5.3 years; 83% male) referred for coronary artery
bypass graft (CABG) were randomly assigned either to MiECC (priming volume
550mL), closeECC, or openECC (priming volume 1250mL). The laboratory
surrogate endpoints (renal function, inflammatory response, ischemia,
coagulation, and hemolysis) and clinical data were measured at six
different time points (T1-6). Results: Patients were comparable for all
preoperative variables. The operation times (MiECC 261 +/- 79min; openECC
264 +/- 75min; closeECC 231 +/- 68min) and perfusion times (MiECC 115 +/-
49min; openECC353 107 +/- 37min; closeECC 99 +/- 22min) revealed a trend
of faster performance in the closeECC group (P < .05). Pro-inflammatory
cytokines, ischemia, and coagulation markers were significantly elevated
postoperatively in all cardiopulmonary bypass types, and decreased to
pre-baseline levels at discharge (T5) without identifiable statistical
differences between the three study groups. Free-hemoglobin was not
significantly increased by centrifugal pump or cell saver procedures.
Significant intra-operative hemodilution effects due to the different
priming volumes were demonstrated only at the end of operation (T2) (MiECC
Hb 9.6 +/- 1.1g/dL; openECC Hb 9.0 +/- 0.8g/dL; closeECC Hb 8.7 +/- 1g/dL;
P =. 01). Conclusion: Neither the hemodilution, suction technique (MiECC),
nor blood-air interface (closeECC) could show sustainable benefits in this
underpowered study, compared to conventional ECC systems (openECC) in a
high volume series of surrogate parameters.<br/>Copyright &#xa9; 2018
Forum Multimedia Publishing, LLC.

<32>
Accession Number
616899496
Title
Off-pump versus on-pump coronary surgery in patients with chronic kidney
disease: a meta-analysis.
Source
Clinical and Experimental Nephrology. 22 (1) (pp 99-109), 2018. Date of
Publication: 01 Feb 2018.
Author
Wang Y.; Zhu S.; Gao P.; Zhou J.; Zhang Q.
Institution
(Wang, Zhou, Zhang) Department of Cardiology, West China Hospital, Sichuan
University, 37 Guoxue Street, Chengdu, Sichuan 610041, China
(Zhu) Department of Epidemiology and Biostatistics, School of Public
Health, Sichuan University, Chengdu, Sichuan, China
(Gao) Department of Nephrology, West China Hospital, Sichuan University,
Chengdu, Sichuan, China
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Background: Patients with chronic kidney disease (CKD) have worse adverse
cardiovascular outcomes after coronary artery bypass grafting (CABG).
However, the adverse cardiovascular outcomes between off-pump coronary
artery bypass grafting (OPCAB) versus on-pump coronary artery bypass
grafting (ONCAB) in these patients have been a subject of debate. Methods:
We undertook a comprehensive literature search of PubMed, Embase, and the
Cochrane Library database to identify all relevant studies comparing
techniques between OPCAB and ONCAB in CKD patients. We pooled the odds
ratios (ORs) and hazard ratios (HRs) from individual studies and conducted
heterogeneity, quality assessment, and publication bias analyses. Results:
This meta-analysis includes 17 studies with 201,889 patients. In CKD
patients, OPCAB was associated with significantly lower early mortality as
compared to ONCAB (OR 0.88; 95% CI 0.82-0.93; p < 0.0001). OPCAB was
associated with decreased risk of atrial fibrillation (OR 0.57; 95% CI
0.34-0.97; p = 0.04), cerebrovascular accident (OR 0.46; 95% CI 0.22-0.95;
p = 0.04), blood transfusion (OR 0.20; 95% CI 0.08-0.49; p = 0.0005),
pneumonia, prolonged ventilation, and shorter hospital stays. No
difference was found regarding long-term survival (HR 1.08; 95% CI
0.86-1.36; p = 0.51) or myocardial infarction (OR 0.65; 95% CI 0.30-1.38;
p = 0.26). Conclusions: Compared with ONCAB, OPCAB is associated with
superior postoperative morbidity and the early mortality in CKD patients.
Long-term survival is comparable between the two surgical
revascularizations.<br/>Copyright &#xa9; 2017, Japanese Society of
Nephrology.

<33>
Accession Number
616322435
Title
Cost analysis of pulmonary lobectomy procedure: Comparison of stapler
versus precision dissection and sealant.
Source
ClinicoEconomics and Outcomes Research. 9 (pp 201-206), 2017. Date of
Publication: 03 Apr 2017.
Author
Droghetti A.; Marulli G.; Vannucci J.; Giovanardi M.; Bottoli M.C.; Ragusa
M.; Muriana G.
Institution
(Droghetti, Giovanardi, Bottoli, Muriana) Thoracic Surgery Division, Carlo
Poma Hospital, Mantova, Italy
(Marulli) Thoracic Surgery Division, University of Padova, Padova, Italy
(Vannucci, Ragusa) Thoracic Surgery Division, University of Perugia,
Perugia, Italy
Publisher
Dove Medical Press Ltd (PO Box 300-008, Albany, 44 Corinthian Drive,
Albany,Auckland 0752, New Zealand. E-mail: angela@dovepress.com)
Abstract
Objective: We aimed to evaluate the direct costs of pulmonary lobectomy
hospitalization, comparing surgical techniques for the division of
interlobar fissures: stapler (ST) versus electrocautery and hemostatic
sealant patch (ES). Methods: The cost comparison analysis was based on the
clinical pathway and drawn up by collecting the information available from
the Thoracic Surgery Division medical team at Mantova Hospital. Direct
resource consumption was derived from a previous randomized controlled
trial including 40 patients. Use and maintenance of technology, equipment
and operating room; administrative plus general costs; and 30-day use of
postsurgery hospital resources were considered. The analysis was conducted
from the hospital perspective. Results: On the average, a patient
submitted to pulmonary lobectomy costs 9,744.29. This sum could vary from
9,027 (using ES) to 10,460 (using ST). The overall lower incidence (50% vs
95%, P=0.0001) and duration of air leakage (1.7 days vs 4.5 days,
P=0.0001) in the ES group significantly affects the mean time of hospital
stay (11.0 days vs 14.3 days) and costs. Cost saving in the ES group was
also driven by the lower incidence of complications. The main key cost
driver was staff employment (42%), then consumables (34%) and operating
room costs (12%). Conclusion: There is an overall saving of around
1,432.90 when using ES patch for each pulmonary lobectomy. Among patients
undergoing this surgical procedure, ES can significantly reduce air
leakage incidence and duration, as well as decrease hospitalization rates.
However, further multicenter research should be developed considering
different clinical and managerial settings.<br/>Copyright &#xa9; 2017
Droghetti et al.

<34>
Accession Number
621384471
Title
Pharmacological interventions for preventing post-operative atrial
fibrillation in patients undergoing cardiac surgery: A network
metaanalysis protocol.
Source
BMJ Open. 7 (12) (no pagination), 2017. Article Number: e018544. Date of
Publication: 2017.
Author
Wang X.; Yao L.; Ge L.; Li L.; Liang F.; Zhou Q.; Chen Y.; Wang Y.; Yang
K.
Institution
(Wang, Ge, Chen, Yang) Evidence Based Medicine Centre, School of Basic
Medical Sciences, Lanzhou University, Lanzhou, China
(Wang, Ge, Chen, Yang) Key Laboratory of Evidence Based Medicine and
Knowledge Translation of Gansu Province, Lanzhou, China
(Wang, Ge, Chen, Yang) Chinese GRADE Centre, Lanzhou University, Lanzhou,
China
(Yao) Clinical Research and Evidence Based Medicine Institute, People's
Hospital of Gansu Province, Lanzhou, Gansu, China
(Li) Xiangya Hospital of Central South University, Lanzhou, China
(Liang, Zhou) First Hospital of Lanzhou University, Lanzhou, China
(Wang) Gansu University of Chinese Medicine, Lanzhou, China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Postoperative atrial fibrillation (POAF) is the most common
complication following cardiac surgery, and randomised clinical trials
(RCTs) and systematic reviews have been conducted to compare and evaluate
different pharmacological interventions for preventing POAF. This study
aimed to explore the effect of different pharmacological interventions for
prophylaxis against POAF after cardiac surgery using network meta-analysis
(NMA). Methods and analysis A systematic search will be performed in
PubMed, EMBASE and the Cochrane Library to identify RCTs, systematic
reviews, metaanalyses or NMA of different pharmacological interventions
for POAF. We will evaluate the risk of bias of the included RCTs according
to the Cochrane Handbook V.5.1.0, and use GRADE to assess the quality of
evidence. Standard pairwise meta-analysis, trial sequential analysis and
Bayesian network metaanalysis will be used to compare the efficacy of
different pharmacological interventions. Ethics and dissemination Ethics
approval and patient consent are not required as this study is a
meta-analysis based on published studies. The results of this NMA and
trial sequential analysis will be submitted to a peerreviewed journal for
publication.<br/>Copyright &#xa9; Article author(s) (or their employer(s)
unless otherwise stated in the text of the article) 2017. All rights
reserved.

<35>
Accession Number
613005953
Title
A randomised, controlled, double-blind trial of ultrasound-guided phrenic
nerve block to prevent shoulder pain after thoracic surgery.
Source
Anaesthesia. 71 (12) (pp 1441-1448), 2016. Date of Publication: 01 Dec
2016.
Author
Blichfeldt-Eckhardt M.R.; Laursen C.B.; Berg H.; Holm J.H.; Hansen L.N.;
Ording H.; Andersen C.; Licht P.B.; Toft P.
Institution
(Blichfeldt-Eckhardt, Berg, Holm, Hansen, Andersen, Toft) Department of
Anesthesiology and Intensive Care, Odense University Hospital, Odense,
Denmark
(Laursen) Department of Respiratory Medicine, Odense University Hospital,
Odense, Denmark
(Licht) Department of Cardiothoracic Surgery, Odense University Hospital,
Odense, Denmark
(Ording) Department of Anaesthesiology, Vejle Hospital, Vejle, Denmark
Publisher
Blackwell Publishing Ltd
Abstract
Moderate to severe ipsilateral shoulder pain is a common complaint
following thoracic surgery. In this prospective, parallel-group study at
Odense University Hospital, 76 patients (aged > 18 years) scheduled for
lobectomy or pneumonectomy were randomised 1:1 using a computer-generated
list to receive an ultrasound-guided supraclavicular phrenic nerve block
with 10 ml ropivacaine or 10 ml saline (placebo) immediately following
surgery. A nerve catheter was subsequently inserted and treatment
continued for 3 days. The study drug was pharmaceutically pre-packed in
sequentially numbered identical vials assuring that all participants,
healthcare providers and data collectors were blinded. The primary outcome
was the incidence of unilateral shoulder pain within the first 6 h after
surgery. Pain was evaluated using a numeric rating scale. Nine of 38
patients in the ropivacaine group and 26 of 38 patients in the placebo
group experienced shoulder pain during the first 6 h after surgery
(absolute risk reduction 44% (95% CI 22-67%), relative risk reduction 65%
(95% CI 41-80%); p = 0.00009). No major complications, including
respiratory compromise or nerve injury, were observed. We conclude that
ultrasound-guided supraclavicular phrenic nerve block is an effective
technique for reducing the incidence of ipsilateral shoulder pain after
thoracic surgery.<br/>Copyright &#xa9; 2016 The Association of
Anaesthetists of Great Britain and Ireland

<36>
Accession Number
623047623
Title
Serum Calcification Propensity and Fetuin-A: Biomarkers of Cardiovascular
Disease in Kidney Transplant Recipients.
Source
American Journal of Nephrology. 48 (1) (pp 21-31), 2018. Date of
Publication: 01 Aug 2018.
Author
Bostom A.; Pasch A.; Madsen T.; Roberts M.B.; Franceschini N.; Steubl D.;
Garimella P.S.; Ix J.H.; Tuttle K.R.; Ivanova A.; Shireman T.; Gohh R.;
Merhi B.; Jarolim P.; Kusek J.W.; Pfeffer M.A.; Liu S.; Eaton C.B.
Institution
(Bostom, Roberts, Eaton) Center for Primary Care and Prevention, Memorial
Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860, United
States
(Pasch) University of Bern, Bern, Switzerland
(Madsen) Department of Emergency Medicine, Rhode Island Hospital,
Providence, RI, United States
(Franceschini, Ivanova) Department of Epidemiology, Gillings School of
Public Health, University of North Carolina at Chapel Hill, Chapel Hill,
NC, United States
(Steubl) Klinikum Rechts der Isar, Technische Universitat, Munich, Germany
(Garimella, Ix) Department of Medicine, Division of
Nephrology-Hypertension, University of California, San Diego, CA, United
States
(Tuttle) Providence Medical Research Center, University of Washington,
Spokane, WA, United States
(Shireman) Center for Gerontology and Healthcare Research, Brown
University, Providence, RI, United States
(Gohh, Merhi) Department of Medicine, Division of Hypertension and Kidney
Diseases, Rhode Island Hospital, Providence, RI, United States
(Jarolim) Department of Pathology, Brigham and Women's Hospital, Boston,
MA, United States
(Kusek) National Institute of Diabetes, Digestive, and Kidney Diseases,
National Institutes of Health, Bethesda, MD, United States
(Pfeffer) Division of Cardiovascular Medicine, Brigham and Women's
Hospital, Boston, MA, United States
(Liu) Department of Epidemiology, School of Public Health, Brown
University, Providence, RI, United States
(Eaton) Department of Family Medicine, Warren Alpert Medical School, Brown
University, Providence, RI, United States
Publisher
S. Karger AG
Abstract
Background: "T50," shortened transformation time from primary to secondary
calciprotein particles may reflect deranged mineral metabolism
predisposing to vascular calcification and cardiovascular disease (CVD).
The glycoprotein fetuin-A is a major T50 determinant. Methods: The Folic
Acid For Vascular Outcome Prevention In Transplantation (FAVORIT) cohort
is a completed, large, multiethnic controlled clinical trial cohort of
chronic, stable kidney transplant recipients (KTRs). We conducted a
longitudinal case-cohort analysis using a randomly selected subcohort of
patients, and all individual cases who developed CVD. Serum T50 and
fetuin-A were determined in this total of n = 685 FAVORIT trial
participants at randomization. Results: During a median surveillance of
2.18-years, 311 incident or recurrent CVD events occurred. Shorter T50
(minutes) or reduced fetuin-A concentrations (g/L) were associated with
CVD after adjustment for treatment assignment, systolic blood pressure,
age, sex, race, preexisting CVD and diabetes, smoking, body mass index,
total cholesterol/HDL cholesterol, kidney allograft vintage and type,
calcineurin inhibitor, or lipid-lowering drug use, estimated glomerular
filtration rate, and urinary albumin/creatinine: tertile 1 (lowest) to
tertile 3 (highest) comparisons, T50, (hazard ratio [HR] 1.86; 95% CI
1.20-2.89); fetuin-A, (HR 2.25; 95% CI 1.38-3.69). Elevated high
sensitivity c-reactive protein (hsCRP) was an effect modifier of both
these associations. Conclusions: Shortened T50, as well as reduced
fetuin-A levels, ostensible promoters of vascular calcification, remained
associated with greater risk for CVD outcomes, after adjustment for major
CVD risk factors, measures of kidney function and damage, and KTR clinical
characteristics and demographics, in a large, multiethnic cohort of
long-term KTRs. Increased hsCRP was an effect modifier of these CVD risk
associations.<br/>&#xa9; 2018 S. Karger AG, Basel. Copyright: All rights
reserved.

<37>
Accession Number
623492820
Title
Dietary Nitrate Supplementation Reduces Circulating Platelet-Derived
Extracellular Vesicles in Coronary Artery Disease Patients on Clopidogrel
Therapy: A Randomised, Double-Blind, Placebo-Controlled Study.
Source
Thrombosis and Haemostasis. 118 (1) (pp 112-122), 2018. Date of
Publication: 01 Jan 2018.
Author
Burnley-Hall N.; Abdul F.; Androshchuk V.; Morris K.; Ossei-Gerning N.;
Anderson R.; Rees D.A.; James P.E.
Institution
(Burnley-Hall, Abdul, Androshchuk) Department of Biomedical Science,
School of Medicine, Cardiff University, Cardiff, United Kingdom
(Morris, James) Department of Biomedical Science, Cardiff School of Health
Sciences, Cardiff Metropolitan University, Cardiff CF5 2SG, United Kingdom
(Ossei-Gerning, Anderson) Department of Cardiology, University Hospital of
Wales, Heath Park, Cardiff, United Kingdom
(Rees) Neurosciences and Mental Health Research Institute, School of
Medicine, Cardiff University, Cardiff, United Kingdom
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Extracellular vesicles (EVs) are implicated in the pathogenesis of
cardiovascular disease (CVD). Specifically, platelet-derived EVs are
highly pro-coagulant, promoting thrombin generation and fibrin clot
formation. Nitrate supplementation exerts beneficial effects in CVD, via
an increase in nitric oxide (NO) bioavailability. Clopidogrel is capable
of producing NO-donating compounds, such as S-nitrosothiols (RSNO) in the
presence of nitrite and low pH. The aim of this study was to assess the
effect of nitrate supplementation with versus without clopidogrel therapy
on circulating EVs in coronary artery disease (CAD) patients. In this
randomized, double-blind, placebo-controlled study, CAD patients with (n =
10) or without (n = 10) clopidogrel therapy received a dietary nitrate
supplement (SiS nitrate gel) or identical placebo. NO metabolites and
platelet activation were measured using ozone-based chemiluminescence and
multiple electrode aggregometry. EV concentration and origin were
determined using nanoparticle tracking analysis and time-resolved
fluorescence. Following nitrate supplementation, plasma RSNO was elevated
(4.7 +/- 0.8 vs 0.2 +/- 0.5 nM) and thrombin-receptor mediated platelet
aggregation was reduced (-19.9 +/- 6.0 vs 4.0 +/- 6.4 U) only in the
clopidogrel group compared with placebo. Circulating EVs were
significantly reduced in this group (-1.183e ¹¹ +/- 3.15e
¹⁰ vs -9.93e ⁹ +/- 1.84e ¹⁰ EVs/mL),
specifically the proportion of CD41+ EVs (-2,120 +/- 728 vs 235 +/- 436
RFU [relative fluorescence unit]) compared with placebo. In vitro
experiments demonstrated clopidogrel-SNO can reduce platelet-EV directly
(6.209e ¹⁰ +/- 4.074e ⁹ vs 3.94e ¹¹ +/-
1.91e ¹⁰ EVs/mL). In conclusion, nitrate supplementation
reduces platelet-derived EVs in CAD patients on clopidogrel therapy,
increasing patient responsiveness to clopidogrel. Nitrate supplementation
may represent a novel approach to moderating the risk of thrombus
formation in CAD patients.<br/>Copyright &#xa9; 2018 Schattauer.

<38>
Accession Number
623584769
Title
Extending inferences from randomized participants to all eligible
individuals using clinical trials nested within cohorts.
Source
Value in Health. Conference: 23rd Annual Meeting of the International
Society for Pharmacoeconomics and Outcomes Research, ISPOR 2018. United
States. 21 (Supplement 1) (pp S214), 2018. Date of Publication: May 2018.
Author
Robertson S.E.; Dahabreh I.J.; Stuart E.A.; Hernan M.A.
Institution
(Robertson, Dahabreh) Brown University, Providence, RI, United States
(Stuart) John Hopkins University, Baltimore, MD, United States
(Hernan) Harvard University, Boston, MA, United States
Publisher
Elsevier Ltd
Abstract
Objectives: To propose methods for extending inferences from randomized
trial participants to the population of all eligible individuals using
clinical trials nested within cohorts of trial-eligible individuals,
including those who refuse randomization. Methods: We show that the data
from clinical trials nested within cohorts can be used to identify the
average treatment effect in the super-population of eligible individuals.
We examine three classes of estimators of the average treatment effect:
(1) outcome model-based; (2) probability of trial participation-based; and
(3) doubly robust. We assess the finite-sample performance of different
estimators in a simulation study. Lastly, we demonstrate the
implementation of the methods using data from the Coronary Artery Surgery
Study of 2099 eligible patients with coronary artery disease, of whom 780
were randomized into coronary revascularization surgery or medical therapy
and 1319 refused randomization and self-selected into treatment. Results:
In the simulation study, when all models were correctly specified, all
estimators were approximately unbiased. The outcome-model based estimator
had the lowest variance, followed closely by the two doubly robust
estimators. The probability of trial participation based estimator had
substantially larger variance than all other estimators. All methods
produced similar results when applied to the Coronary Artery Surgery
Study. Conclusions: We propose methods for extending inferences from trial
participants to the population of all trial-eligible patients, while
avoiding confounding of the treatment effect among eligible individuals
who refuse randomization. These methods are appropriate for clinical
trials embedded in large healthcare systems.

<39>
Accession Number
623584194
Title
Comparison of video-assisted thoracic surgery segmentectomy (VATS-S)
versus video-assisted thoracic surgery lobectomy (VATS-L) for stage I
non-small cell lung cancer (NSCLC-I) in Chinese patients: A systemic
review and meta-analysis.
Source
Value in Health. Conference: 23rd Annual Meeting of the International
Society for Pharmacoeconomics and Outcomes Research, ISPOR 2018. United
States. 21 (Supplement 1) (pp S18), 2018. Date of Publication: May 2018.
Author
Yin C.; Zhao M.; Roy S.; Metz L.
Institution
(Yin, Metz) Johnson and Johnson Medical Asia Pacific, Singapore, Singapore
(Zhao) China Pharmaceutical University, NanJing, China
(Roy) Ethicon Inc, Somerville, NJ, United States
Publisher
Elsevier Ltd
Abstract
Objectives: VATS-S is a newly introduced surgical technique in the
treatment of stage I NSCLC. However, owing to small sample sizes of
relevant clinical studies, there is no conclusive evidence of the relative
benefit between the outcomes of VATS-S and VATS-L in Chinese patients.
This meta-analysis offers the first robust comparative assessment of the
safety and clinical outcomes of VATS-S versus VATS-L in Chinese patients
with NSCLC-I. Methods: A thorough search of major electronic databases was
conducted to identify surgical studies on Chinese patients with NSCLC-I
till September 2017. Random-effects meta-analysis was used to estimate
risk ratios (RRs, 95% CI) and mean differences (MD, 95% CI) for
dichotomous and continuous variables, respectively. The main outcomes and
measures were operating room time (ORT), intraoperative blood loss (BL),
number of lymph nodes resected (LNRN), total volume of chest tube drainage
postoperatively (TVCTD), chest tube duration (CTD), length of stay (LOS),
post-operative complications (POC), overall cancer recurrence rate (ORR),
local cancer recurrence rate (LRR) and distal cancer recurrence rate
(DRR). Results: 7 studies, with 762 NSCLC-I patients (229 VATS-S, 533
VATS-L), were included. Patient characteristic baselines were matched
between 2 groups, including age (p= 0.22), gender (p= 0.67) and
comorbidity rate (p= 0.37). The average follow-up time was 10.2 to 27
months. VATS-S group was associated with a reduction in TVCTD by 224.42 ml
(MD:-224.42, 95%CI (-345.06,-103.79), p= 0.0003); a reduction of CTD by
0.73 days (-1.42,-0.03; p= 0.04); and a reduction of LOS by 0.58 days
(-1.04,-0.11; p= 0.02). There was no significant difference between the
groups in BL, LNRN, POC, ORT, ORR, LRR, and DRR. Conclusions: VATS-S is a
less invasive surgical technique which is associated with less chest tube
drainage volume, shorter chest tube duration, and shorter length of stay
compared to VATS-L in the treatment of Chinese patients with stage I
NSCLC.

<40>
Accession Number
623584577
Title
Postoperative complication rate of three different surgeries in the
treatment of lung cancer in Chinese patients: Literature review and
single-arm meta-analysis.
Source
Value in Health. Conference: 23rd Annual Meeting of the International
Society for Pharmacoeconomics and Outcomes Research, ISPOR 2018. United
States. 21 (Supplement 1) (pp S20), 2018. Date of Publication: May 2018.
Author
Yin C.; Zhao M.; Roy S.; Metz L.
Institution
(Yin, Metz) Johnson and Johnson Medical Asia Pacific, Singapore, Singapore
(Zhao) China Pharmaceutical University, NanJing, China
(Roy) Ethicon Inc, Somerville, NJ, United States
Publisher
Elsevier Ltd
Abstract
Objectives: Video-assisted thoracic surgery (VATS), hybrid VATS (hVATS)
and thoracotomy (TH) are three major approaches for lung cancer surgery in
China, involving an increasing order of invasiveness and trauma. The
objective of this meta-analysis is to assess the relative clinical
evidence of postoperative complications (POC) among the three surgical
approaches. Methods: A thorough search of major electronic databases was
conducted to identify studies through September 2017 reporting POC in
Chinese population undergoing lung cancer surgery. Randomeffects
meta-analysis was conducted using non-comparative binary data in RevMan
software to estimate mean (95% CI) for POC rate. Results: 58 studies, with
a total of 7,813 patients (4,403 VATS, 531 hVATS, and 2,879 TH), were
included. The overall POC rate was 14.5% (12.3%-16.7%). TH had the highest
POC rate (21.9%, 18.0%-25.9%), followed by hVATS (11.5%, 6.5%-18.7%), and
VATS (10.7%, 9.1%-13.8%). Overall among the three approaches, major POCs
were air leak (3.8%, 2.9%-5.7%), arrhythmia (3.8%, 2.9%-5.7%), pneumonia
(3.8%, 2.9%-5.7%), pneumothorax (2.9%, 2.0%-5.7%) and surgical site
infection (SSI) (2.9%, 2.0%-3.8%). However, top POCs varied by approach,
as follows: VATS-arrhythmia (5.7%, 4.8%-6.5%), air leaks (3.8%,
2.0%-5.7%), atelectasis (3.8%, 2.9%-5.7%), pleural effusion (3.8%,
1.0%-9.1%), and pneumonia (2.9%, 2.0%-4.8%); hVATS-pleural effusion (5.7%,
2.0%-16.7%), pneumonia (5.7%, 3.8%-9.9%), air leaks (3.8%, 2.0%-9.1%), SSI
(3.8%, 2.0%-9.1%), and arrhythmia (3.8%, 2.0%-7.4%); and TH-air leak
(5.7%, 2.9%-9.1%), pneumonia (5.7%, 3.8%-8.3%), arrhythmia (5.7%,
3.8%-8.3%), pneumothorax (5.7%, 2.9%-9.9%), and SSI (4.8%,3.8%-6.5%).
Postoperative bleeding was the lowest in VATS (1.0%, 1.0%-2.9%), followed
by hVATS 2.9% (0%-1.9%), and the highest in TH (3.8%, 2.0%-7.4%).
Conclusions: Postoperative complications in surgical treatment of lung
cancer in China is still very high. This analysis suggests that less
traumatic procedures are associated with reduced postoperative
complication rates, and may be considered for broader adoption.

<41>
Accession Number
623584448
Title
Caregiver burden among individuals providing informal caregiving to
survivors of Major Adverse Cardiac Event (MACE): A systematic review.
Source
Value in Health. Conference: 23rd Annual Meeting of the International
Society for Pharmacoeconomics and Outcomes Research, ISPOR 2018. United
States. 21 (Supplement 1) (pp S67), 2018. Date of Publication: May 2018.
Author
Bhattacharjee S.; Gallo T.; Patel J.; Harrison D.J.; Rane P.B.
Institution
(Bhattacharjee, Gallo) University of Arizona, Tucson, AZ, United States
(Patel, Harrison, Rane) Amgen Inc., Thousand Oaks, CA, United States
Publisher
Elsevier Ltd
Abstract
Objectives: To conduct a systematic literature review (SLR) of informal
caregiver burden (ICB) among caregivers of adults with Major Adverse
Cardiac Events (MACE). Methods: A SLR was conducted in six electronic
databases [PubMed, CINAHL, Embase, Dissertation Abstracts
International/Proquest, Scopus, and PsycINFO] along with cross-referencing
from included studies using search-terms tailored for each database. Per
PRISMA guidelines, a-priori study inclusion criteria included published
and unpublished English language studies from 01/01/2000-11/28/2017of
randomized controlled trials or observational studies of adults (>= 18
years) with MACE (myocardial infarction (MI)/stroke/hospitalization due to
unstable angina/coronary revascularization) and their caregivers. Informal
caregivers included close family members, relatives, or friends who did
not receive reimbursement and did not have any organizational affiliations
or certifications for caregiving. Final study selection,
quality-assessment, and data abstraction were conducted independently by
two reviewers with disagreements resolved through consensus. Results: Only
two of the included studies (N= 143) were conducted in MI survivors; the
remaining were in stroke survivors. Most (95.1%) studies were
observational and conducted in US (28.67%). No consistent measure of ICB
was found and the burden was reported in terms of hours spent in
caregiving, ICB opportunity costs, and impact on quality of life of
caregiver assessed using the EQ-5D, and other caregiving burden scales.
Mean number of hours spent in ICB ranged from 58-108 per week. Cost varied
based on study methodology and the country of origin; ranging from
US$3,700-US$7,900/year for stroke patients with/without complications, and
total US economic ICB ranging from US$4.2-26.8 billion annually. Few
(2.8%) studies reported EQ-5D (mean scores ranging 0.5-0.8). Posttraumatic
growth and higher mortality rates were reported in terms of MI ICB.
Conclusions: This comprehensive SLR underscores the high ICB among
caregivers for individuals with MACE. Studies that omit this important
component underestimate the true burden of MACE and potentially the value
of CV risk reduction.

<42>
Accession Number
623596468
Title
Patient blood management as a standard of care.
Source
Blood Transfusion. Conference: 43rd National Conference of Transfusion
Medicine Studies. Italy. 16 (Supplement 1) (pp s61-s63), 2018. Date of
Publication: May 2018.
Author
Shander A.
Institution
(Shander) Department of Anesthesiology, Critical Care and Hyperbaric
Medicine, Englewood Hospital and Medical Center, TeamHealth Research
Institute, Englewood, NJ, United States
Publisher
Edizioni SIMTI
Abstract
The pace of progress in the field of medicine has been staggering with new
frontiers being reached and newer horizons being opened every day. Thanks
to the advancement in technologies such as genomics and proteomics, we are
gaining a far better understanding of the pathophysiological basis of
diseases, with the development of many safer, more effective and targeted
therapies within grasp. While transfusion medicine should be no exception
to this general trend, improving the transfusion practices has been
somewhat more complicated as the relationship between humans and blood has
often been emotional and mixed with myths throughout the history of many
cultures and civilizations1. Nonetheless, there is no doubt that this
discipline has gained in both knowledge and safety despite some lagging.
Patient Blood Management (PBM) is defined as "the timely application of
evidence-based medical and surgical concepts designed to maintain
hemoglobin concentration, optimize hemostasis and minimize blood loss in
an effort to improve patient outcome [What is PBM From the Society for the
Advancement of Blood Management (SABM), available at
http://www.sabm.org/]1. As described in the definition, Patient Blood
Management underscores a fundamental shift from a product-centered
approach to a patient-centric approach. In this concept, allogeneic blood
transfusion is not viewed as the treatment of default for anemic or
bleeding patients, but one among many treatment modalities that should be
weighed based on its merits-potentials risks and benefits-for the
individual patient in the context of other alternatives2. At the heart of
the matter is the diagnosis and management of patients with anemia. Anemia
remains a global health issue. It is estimated that one out of every three
to four human beings across the world meets the WHO definition of anemia
(hemoglobin <13 g/dL in adult men and 12 g/dL in adult nonpregnant women).
Anemia is often multifactorial and various causes including nutritional
deficiencies (iron, vitamin B12 and folic acid), inflammatory processes
and blood loss (acute or chronic) usually play a role to some degree. The
overall prevalence of anemia in surgical patients is believed to be higher
than general population3. The omnipresent nature of anemia and the
assumption that a quick and easy treatment is always available (blood
transfusion) might lead some to think it is a simple and even acceptable
condition. This notion lacks validity because anemia is not just a simple
laboratory diagnosis and certainly not a so-called innocent bystander4.
The pernicious nature of anemia has been documented in numerous studies
over the years, with more evidence continuing to emerge. A recent
meta-analysis summarized the effects of anemia on the surgical population
and concluded that it was associated with an increase in mortality, acute
kidney injuries, strokes, and myocardial infarctions. These issues may be
the result of the anemia as an independent risk factor that can be
compounded by the underlying causes of the anemia as well as the risks
associated with the treatments given for anemia5. The pace of progress in
the field of medicine has been staggering with new frontiers being reached
and newer horizons being opened every day. Thanks to the advancement in
technologies such as genomics and proteomics, we are gaining a far better
understanding of the pathophysiological basis of diseases, with the
development of many safer, more effective and targeted therapies within
grasp. While transfusion medicine should be no exception to this general
trend, improving the transfusion practices has been somewhat more
complicated as the relationship between humans and blood has often been
emotional and mixed with myths throughout the history of many cultures and
civilizations1. Nonetheless, there is no doubt that this discipline has
gained in both knowledge and safety despite some lagging. Patient Blood
Management (PBM) is defined as "the timely application of evidence-based
medical and surgical concepts designed to maintain hemoglobin
concentration, optimize hemostasis and minimize blood loss in an effort to
improve patient outcome [What is PBM From the Society for the Advancement
of Blood Management (SABM), available at http://www.sabm.org/]1. As
described in the definition, Patient Blood Management underscores a
fundamental shift from a product-centered approach to a patient-centric
approach. In this concept, allogeneic blood transfusion is not viewed as
the treatment of default for anemic or bleeding patients, but one among
many treatment modalities that should be weighed based on its
merits-potentials risks and benefits-for the individual patient in the
context of other alternatives2. At the heart of the matter is the
diagnosis and management of patients with anemia. Anemia remains a global
health issue. It is estimated that one out of every three to four human
beings across the world meets the WHO definition of anemia (hemoglobin <13
g/dL in adult men and 12 g/dL in adult nonpregnant women). Anemia is often
multifactorial and various causes including nutritional deficiencies
(iron, vitamin B12 and folic acid), inflammatory processes and blood loss
(acute or chronic) usually play a role to some degree. The overall
prevalence of anemia in surgical patients is believed to be higher than
general population3. The omnipresent nature of anemia and the assumption
that a quick and easy treatment is always available (blood transfusion)
might lead some to think it is a simple and even acceptable condition.
This notion lacks validity because anemia is not just a simple laboratory
diagnosis and certainly not a so-called innocent bystander4. The
pernicious nature of anemia has been documented in numerous studies over
the years, with more evidence continuing to emerge. A recent meta-analysis
summarized the effects of anemia on the surgical population and concluded
that it was associated with an increase in mortality, acute kidney
injuries, strokes, and myocardial infarctions. These issues may be the
result of the anemia as an independent risk factor that can be compounded
by the underlying causes of the anemia as well as the risks associated
with the treatments given for anemia5. For years, blood transfusion has
been, and continues to be, the default treatment of anemic surgical
patients. Its seemingly innocuous (perhaps even "sacred") nature,
perceived availability, assumed low cost, ease of ordering, and the
ability to observe the treatment effect immediately in terms of increased
hemoglobin level have all contributed to its widespread use. Allogeneic
blood transfusion has become the most commonly performed procedure in the
hospitals in the United States4. Nonetheless, few physicians will argue
against the statement that blood transfusions carry certain risks. The
evidence for the harmful effects of allogeneic blood transfusion is indeed
overwhelming. Several studies have shown that the patients who are
transfused often have worse outcomes, including increased risk of
mortality, morbidities (including stroke, renal injury, atrial
fibrillation, thromboembolic events, infections, respiratory failure, and
prolonged need for ventilatory support), and prolonged hospital stay. The
proposed reasons for harmful effects of blood are many, but one key
consideration is that allogeneic blood transfusion is a live tissue
transplant with farreaching immunologic and inflammatory effects4. Several
randomized controlled trials have shown that more restrictive transfusion
strategies are safe and effective in various patient population compared
with more liberal use of blood. In a recent Cochrane meta-analysis by
Brunskill and colleagues, data from 2,722 patients undergoing surgery for
hip fracture from 6 trials comparing liberal transfusion strategies
(usually target hemoglobin threshold of 10 g/dL) versus restrictive
transfusion strategies (8 g/dL hemoglobin threshold) were pooled and
analyzed. Despite a large number of patients having a history of
cardiovascular disease, there was no significant difference in
postoperative mortality between the liberal and restrictive transfusion
strategies, a finding that casts doubt on the justification of liberal use
of transfusion in these high-risk patients. These findings are supported
by other recent trials in surgical populations, including those with
higher baseline risk4. Most of the salient debate in the literature
centers on the benefits/risk ratio of blood component therapy. Besieged
with repeated studies on restrictive vs. liberal transfusion, the
clinician is left with only one treatment modality for the patient, with
the key question remaining whether to transfuse at hemoglobin level X or
Y. By centering on transfusion, other more effective or less
risk-associated therapies are ignored. This is problematic, as
transfusions may prove to be associated with risks higher than those posed
by the anemia, especially if there is no clinical or physiological
justification for transfusion5. There is growing body of research evidence
supporting that the successful implementation of PBM reduces perioperative
blood loss and transfusion needs, perioperative morbidity, mortality,
length of hospital stay and costs6. In a before-and-after study,
implementation of a PBM program in cardiac surgery service was associated
with approximately 25% reduction in blood loss, and 50% reduction in RBC
transfusion rates (and similar reduction in rate of transfusion of other
blood components). On the other hand, the length of hospital stay
decreased by 15% and the direct cost of care decreased by about 8.5%,
while clinical outcomes such as mortality remained unaffected.

<43>
Accession Number
623585265
Title
Cost-effectiveness of transcathether aortic valve implantation with the
new repositionable self-expandable evolut R versus corevalve system in
inoperable patients with severe aortic stenosis in Mexico.
Source
Value in Health. Conference: 23rd Annual Meeting of the International
Society for Pharmacoeconomics and Outcomes Research, ISPOR 2018. United
States. 21 (Supplement 1) (pp S170), 2018. Date of Publication: May 2018.
Author
Guitierrez M.; Munoz P.; Lemus F.; Flores B.; Gryzbowski E.; Valencia J.
Institution
(Guitierrez, Munoz, Lemus, Flores) Pharmamanagement EAS S de RL de CV,
Cuidad de Mexico, Mexico
(Gryzbowski) Medtronic, Ciudad de Mexico, Mexico
(Valencia) Medtronic, Miami, FL, United States
Publisher
Elsevier Ltd
Abstract
Objectives: To assess the cost-effectiveness of the transcathether aortic
valve implantation with the new repositionable self-expandable Evolut R
versus CoreValve system, for patients with severe aortic stenosis and high
surgical risk in Mexico Methods: After a systematic review on MEDLINE,
EMBASE, The Cochrane Library, Health Technology Assessment (HTA), Database
of Abstracts of Reviews of Effects (DARE) and NHS Economic Evaluation
Database (EED), a single paper was identified as the main input. We
developed a cost-effectiveness evaluation, through a decision tree model,
from the public-sector perspective. A post-surgery time horizon (in-
hospital days after surgery) was considered. Health effect was measured
based on the probability of in-hospital survival; with a scenario
sensitivity analysis (SSA) at 30 and 365 days. We estimated direct medical
costs (intervention and adverse events) from official sources
(diagnosis-related group and unit costs from "Instituto Mexicano de la
Seguridad Social"). Deterministic sensitivity analysis (DSA) and
probabilistic sensitivity analysis (PSA) was performed to evaluate
uncertainty levels. Results: Our model show Evolut TM R as a dominant
option vs CoreValve TM, with an incremental effectiveness of 0.023 extra
survival probability (ESP) and cost savings of $3,653.00 USD ($ 68,712.98
MXN) for the post-surgery scenario; in SSA at 30 and 365 days ESP were
0.062 and 0.061 respectively. The most influential variables in the
incremental cost effectiveness ratio (ICER) at DSA are the price of Evolut
TM R and the moderate or severe paravalvular leak. PSA through 1000
iterations illustrate that in 90% of them, Evolut TM R remains as a
cost-effective option. Conclusions: In a Life-threatening disease, as an
inoperable patient with severe aortic stenosis, E Evolut TM R provided
meaningful clinical benefits and cost savings, compared with CoreValve,
with incremental costs considered within acceptable threshold by Mexico
authorities.

<44>
Accession Number
623585198
Title
Testosterone replacement therapy reduces cardiovascular events in men with
chronic kidney disease.
Source
Value in Health. Conference: 23rd Annual Meeting of the International
Society for Pharmacoeconomics and Outcomes Research, ISPOR 2018. United
States. 21 (Supplement 1) (pp S104-S105), 2018. Date of Publication: May
2018.
Author
Chen J.; Adjei Boakye E.; McKee A.M.; Dhindsa S.S.
Institution
(Chen, Adjei Boakye) Saint Louis University, Center for Outcomes Research,
Saint Louis, MO, United States
(McKee, Dhindsa) Saint Louis University, School of Medicine, Saint Louis,
MO, United States
Publisher
Elsevier Ltd
Abstract
Objectives: This study aims to examine whether testosterone replacement
therapy (TRT) can affect the incidence of cardiovascular events in men
with chronic kidney disease (CKD). Methods: A retrospective cohort study
was conducted using a national administrative claims data from 2007 to
2014 on adult males with diabetes and CKD stage 4 or 5. Men with
panhypopituitarism, use of non-testosterone androgenic drugs, HIV/AIDS,
and malignancy were excluded. Treatment group was composed of patients who
received testosterone prescription or were administered testosterone as
injection. The primary outcome was defined as the combined incidence of
myocardial infarction (MI) and stroke. Secondary outcomes included
incidences of congestive heart failure (CHF), coronary artery stents,
coronary artery bypass surgery, secondary polycythemia, and prostate
cancer. Multivariate Cox regression analyses were performed for each
outcome adjusting for baseline demographic and clinical covariates.
Results: Of the eligible 225,720 adult men with CKD, 14% patients received
testosterone treatment. Median follow up time was 1,296 days for men on
TRT and 722 days for men who did not receive TRT. After controlling for
baseline covariates, the combined incidence of MI and stroke was 31% lower
in men who received TRT (aHR: 0.69, 95%CI: 0.66-0.73). The incidences of
CHF (aHR: 0.72, 95% CI: 0.70-0.74), coronary artery stents (aHR: 0.80, 95%
CI: 0.65-0.99), and coronary artery bypass surgery (aHR: 0.76, 95% CI:
0.62-0.95) were also lower in men who received TRT. The incidence of
secondary polycythemia did not statistically differ between the study
groups (aHR 1.18, 95% CI: 0.93-1.49). No men were diagnosed with incident
prostate cancer during the follow-up period. Conclusions: The study
suggests that TRT may decrease cardiovascular events in men with CKD
stages 4 and 5. Randomized controlled trials of testosterone replacement
in men with CKD are needed to establish the cardiovascular effects of TRT
in these men.

<45>
Accession Number
623605507
Title
Efficacy and Safety of Pleurodesis Using Platelet-Rich Plasma and Fibrin
Glue in Management of Postoperative Chylothorax After Esophagectomy.
Source
World journal of surgery. 42 (4) (pp 1046-1055), 2018. Date of
Publication: 01 Apr 2018.
Author
Alamdari D.H.; Asadi M.; Rahim A.N.; Maddah G.; Azizi S.; Shahidsales S.;
Mehrabibahar M.
Institution
(Alamdari) Stem Cell and Regenerative Medicine Research Group, Department
of Biochemistry, Stem Cell Laboratory, Faculty of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Asadi, Mehrabibahar) Surgical Oncology Research Center, Faculty of
Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
(Rahim, Azizi) Department of Surgery, Faculty of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Maddah) Endoscopic and Minimally Invasive Surgery Research Center,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Shahidsales) Cancer Research Center, Faculty of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Abstract
MATERIALS AND METHODS: We randomly allocated 52 consecutive esophageal
cancer patients with postoperative chylothorax who did not respond to
conservative management to either PRP fibrin glue pleurodesis or surgical
thoracic duct ligation. 26 patients in each group were treated with PRP
fibrin glue pleurodesis or surgical thoracic duct ligation in order to
control chylothorax. Perioperative data, including success rate and
complications of both interventions, were analyzed.
INTRODUCTION: Chylothorax is by definition a collection of lymphatic
fluids in the pleural cavity because of leakage from main thoracic duct or
its tributaries. It is an uncommon but serious postoperative complication
in esophageal cancer patients. There is no standard therapeutic algorithm
for chylothorax because no prospective or randomized trials have yet been
performed to evaluate the available treatment options. The aim of this
study was to evaluate the efficacy of pleurodesis with a combination of
platelet-rich plasma (PRP) and fibrin glue to the treatment of chylothorax
after trans-hiatal esophagectomy.
RESULTS: Two groups were similar in terms of patients' demographics and
tumor characteristics. All 26 patients in pleurodesis group (100%) and 20
patients in surgery group (76.9%) were successfully treated (p = 0.009).
Seven patients (26.92%) in pleurodesis group required a second application
of PRP fibrin glue after a week. The mean length of hospital stay was
53.50 +/- 16.662 days in surgery group and 36.04 +/- 8.224 days in
pleurodesis group (p < 0.001). Although mortality rate in surgery group
was higher than pleurodesis group, it was not statistically significant (p
= 0.1621). There was no significant difference in complications between
two groups either. No serious side effect occurred with PRP fibrin glue
application.
CONCLUSION: In conclusion, pleurodesis using PRP and fibrin glue for
chylothorax after trans-hiatal esophagectomy was associated with
significantly increased success rate, decreased ICU stay, decreased
overall hospital stay, and decreased mortality compared with surgical
thoracic duct ligation. No patient after PRFG required additional
intervention including surgery. Thus, given the improved outcomes with
PRFG pleurodesis, this technique may be considered in all patients with
postoperative chylothorax after or during conservative management and
before proceeding to more invasive interventions.

<46>
[Use Link to view the full text]
Accession Number
623482539
Title
The society of thoracic surgeons, the society of cardiovascular
anesthesiologists, and the American society of extracorporeal technology:
Clinical practice guidelines - Anticoagulation during cardiopulmonary
bypass.
Source
Anesthesia and Analgesia. 126 (2) (pp 413-424), 2018. Date of Publication:
2018.
Author
Shore-Lesserson L.; Baker R.A.; Ferraris V.A.; Greilich P.E.; Fitzgerald
D.; Roman P.; Hammon J.W.
Institution
(Shore-Lesserson) Department of Anesthesiology, Northshore University
Hospital, 300 Community Dr, Manhasset, NY 11030, United States
(Baker) Cardiac Surgery Research and Perfusion, Flinders University and
Flinders Medical Center, Adelaide, SA, Australia
(Ferraris) Division of Cardiovascular and Thoracic Surgery, University of
Kentucky, Lexington, KY, United States
(Greilich) Department of Anesthesiology and Pain Management, University of
Texas-Southwestern Medical Center, Dallas, TX, United States
(Fitzgerald) Division of Cardiovascular Perfusion, Medical University of
South Carolina, Charleston, SC, United States
(Roman) Department of Anesthesiology, Saint Anthony Hospital, Lakewood,
CO, United States
(Hammon) Department of Cardiothoracic Surgery, Wake Forest University
School of Medicine, Winston-Salem, NC, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Despite more than a half century of "safe" cardiopulmonary bypass (CPB),
the evidence base surrounding the conduct of anticoagulation therapy for
CPB has not been organized into a succinct guideline. For this and other
reasons, there is enormous practice variability relating to the use and
dosing of heparin, monitoring heparin anticoagulation, reversal of
anticoagulation, and the use of alternative anticoagulants. To address
this and other gaps, The Society of Thoracic Surgeons, the Society of
Cardiovascular Anesthesiologists, and the American Society of
Extracorporeal Technology developed an Evidence Based Workgroup. This was
a group of interdisciplinary professionals gathered to summarize the
evidence and create practice recommendations for various aspects of CPB.
To date, anticoagulation practices in CPB have not been standardized in
accordance with the evidence base. This clinical practice guideline was
written with the intent to fill the evidence gap and to establish best
practices in anticoagulation therapy for CPB using the available
evidence.To identify relevant evidence, a systematic review was outlined
and literature searches were conducted in PubMed using standardized
medical subject heading (MeSH) terms from the National Library of Medicine
list of search terms. Search dates were inclusive of January 2000 to
December 2015. The search yielded 833 abstracts, which were reviewed by
two independent reviewers. Once accepted into the full manuscript review
stage, two members of the writing group evaluated each of 286 full papers
for inclusion eligibility into the guideline document. Ninety-six
manuscripts were included in the final review. In addition, 17 manuscripts
published before 2000 were included to provide method, context, or
additional supporting evidence for the recommendations as these papers
were considered sentinel publications. Members of the writing group wrote
and developed recommendations based on review of the articles obtained and
achieved more than two thirds agreement on each recommendation. The
quality of information for a given recommendation allowed assessment of
the level of evidence as recommended by the American College of Cardiology
Foundation/American Heart Association Task Force on Practice Guidelines.
Recommendations were written in the three following areas: (1) heparin
dosing and monitoring for initiation and maintenance of CPB; (2) heparin
contraindications and heparin alternatives; and (3) reversal of
anticoagulation during cardiac operations. It is hoped that this guideline
will serve as a resource and will stimulate investigators to conduct more
research and to expand on the evidence base on the topic of
anticoagulation therapy for CPB.<br/>Copyright &#xa9; 2017 International
Anesthesia Research Society.

<47>
[Use Link to view the full text]
Accession Number
623482459
Title
Efficacy of ultrasound-guided serratus plane block on postoperative
quality of recovery and analgesia after video-assisted thoracic surgery: A
randomized, triple-blind, placebo-controlled study.
Source
Anesthesia and Analgesia. 126 (4) (pp 1353-1361), 2018. Date of
Publication: April 2018.
Author
Kim D.-H.; Oh Y.J.; Lee J.G.; Ha D.; Chang Y.J.; Kwak H.J.
Institution
(Kim, Oh) Departments of Anesthesiology and Pain Medicine, Anesthesia and
Pain Research Institute, South Korea
(Lee) Departments of Thoracic and Cardiovascular Surgery, South Korea
(Ha) Anesthesiology and Pain Medicine, Yonsei University College of
Medicine, Seoul, South Korea
(Chang, Kwak) Department of Anesthesiology and Pain Medicine, Gil Medical
Center, Gachon University, 1198 Guwol-dong, Namdong-gu, Incheon 405-760,
South Korea
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: The optimal regional technique for analgesia and improved
quality of recovery after video-assisted thoracic surgery (a procedure
associated with considerable postoperative pain) has not been established.
The main objective in this study was to compare quality of recovery in
patients undergoing serratus plane block (SPB) with either ropivacaine or
normal saline on the first postoperative day. Secondary outcomes were
analgesic outcomes, including postoperative pain intensity and opioid
consumption. METHODS: Ninety patients undergoing video-assisted thoracic
surgery were randomized to receive ultrasound-guided SPB with 0.4 mL/kg of
either 0.375% ropivacaine (SPB group) or normal saline (control group)
after anesthetic induction. The primary outcome was the 40-item Quality of
Recovery (QoR-40) score at 24 hours after surgery. The QoR-40
questionnaire was completed by patients the day before surgery and on
postoperative days 1 and 2. Pain scores, opioid consumption, and adverse
events were assessed for 2 days postoperatively. RESULTS: Eighty-five
patients completed the study: 42 in the SPB group and 43 in the control
group. The global QoR-40 scores on both postoperative days 1 and 2 were
significantly higher in the SPB group than in the control group (estimated
mean difference 8.5, 97.5% confidence interval [CI], 2.1-15.0, and P =
.003; 8.5, 97.5% CI, 2.0-15.1, and P = .004, respectively). The overall
mean difference between the SPB and control groups was 8.5 (95% CI,
3.3-13.8; P = .002). Pain scores at rest and opioid consumption were
significantly lower up to 6 hours after surgery in the SPB group than in
the control group. Cumulative opioid consumption was significantly lower
up to 24 hours postoperatively in the SPB group. CONCLUSIONS:
Single-injection SPB with ropivacaine enhanced the quality of recovery for
2 days postoperatively and improved postoperative analgesia during the
early postoperative period in patients undergoing video-assisted thoracic
surgery.<br/>Copyright &#xa9; 2018 International Anesthesia Research
Society.

<48>
[Use Link to view the full text]
Accession Number
623481878
Title
Medical management of rheumatic heart disease: A systematic review of the
evidence.
Source
Cardiology in Review. 26 (4) (pp 187-195), 2018. Date of Publication:
2018.
Author
Anne Russell E.; Walsh W.F.; Costello B.; McLellan A.J.A.; Brown A.; Reid
C.M.; Tran L.; Maguire G.P.
Institution
(Anne Russell, Costello, McLellan, Maguire) Clinical Research Domain,
Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC 3004,
Australia
(Anne Russell, Reid, Tran, Maguire) School of Epidemiology and Preventive
Medicine, Monash University, Melbourne, Australia
(Walsh) Department of Cardiology, Prince of Wales Hospital, Randwick,
Australia
(Costello, McLellan) Department of Cardiovascular Medicine/Heart Centre,
Alfred Hospital, Melbourne, Australia
(McLellan) Department of Cardiology, St Vincent's Hospital, Melbourne,
Australia
(Brown) Wardliparingga Aboriginal Research Unit, South Australia Health
and Medical Research Institute, Adelaide, Australia
(Brown) School of Population Health, University of South Australia,
Adelaide, Australia
(Reid) School of Public Health, Curtin University, Perth, Australia
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Rheumatic heart disease (RHD) is an important cause of heart disease
globally. Its management can encompass medical and procedural (catheter
and surgical) interventions. Literature pertaining to the medical
management of RHD from PubMed 1990-2016 and via selected article reference
lists was reviewed. Areas included symptom management, left ventricular
dysfunction, rate control in mitral stenosis, atrial fibrillation,
anticoagulation, infective endocarditis prophylaxis, and management in
pregnancy. Diuretics, angiotensin blockade and beta-blockers for left
ventricular dysfunction, and beta-blockers and If inhibitors for rate
control in mitral stenosis reduced symptoms and improved left ventricular
function, but did not alter disease progression. Rhythm control for atrial
fibrillation was preferred, and where this was not possible, rate control
with beta-blockers was recommended. Anticoagulation was indicated where
there was a history of cardioembolism, atrial fibrillation, spontaneous
left atrial contrast, and mechanical prosthetic valves. While warfarin
remained the agent of choice for mechanical valve implantation,
non-Vitamin K antagonist oral anticoagulants may have a role in
RHD-related AF, particularly with valvular regurgitation. Evidence for
anticoagulation after bioprosthetic valve implantation or mitral valve
repair was limited. RHD patients are at increased risk of endocarditis,
but the evidence supporting antibiotic prophylaxis before procedures that
may induce bacteremia is limited and recommendations vary. The management
of RHD in pregnancy presents particular challenges, especially regarding
decompensation of previously stable disease, the choice of
anticoagulation, and the safety of medications in both pregnancy and
breast feeding.<br/>Copyright &#xa9; 2017 Wolters Kluwer Health, Inc. All
rights reserved.

<49>
Accession Number
623538873
Title
Intravenous versus inhalational maintenance of anaesthesia for
postoperative cognitive outcomes in elderly people undergoing non-cardiac
surgery.
Source
Cochrane Database of Systematic Reviews. 2018 (8) (no pagination), 2018.
Article Number: CD012317. Date of Publication: 21 Aug 2018.
Author
Miller D.; Lewis S.R.; Pritchard M.W.; Schofield-Robinson O.J.; Shelton
C.L.; Alderson P.; Smith A.F.
Institution
(Miller) North Cumbria University Hospitals, Academic Unit, Cumberland
Infirmary, Newtown Road, Carlisle CA2 7HY, United Kingdom
(Lewis, Pritchard, Schofield-Robinson) Royal Lancaster Infirmary,
Lancaster Patient Safety Research Unit, Pointer Court 1, Ashton Road,
Lancaster LA1 4RP, United Kingdom
(Shelton) Lancaster University, Lancaster Medical School, Lancaster,
United Kingdom
(Alderson) National Institute for Health and Care Excellence, Level 1A,
City Tower, Piccadilly Plaza, Manchester M1 4BD, United Kingdom
(Smith) Royal Lancaster Infirmary, Department of Anaesthesia, Ashton Road,
Lancaster, Lancashire LA1 4RP, United Kingdom
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: The use of anaesthetics in the elderly surgical population
(more than 60 years of age) is increasing. Postoperative delirium, an
acute condition characterized by reduced awareness of the environment and
a disturbance in attention, typically occurs between 24 and 72 hours after
surgery and can affect up to 60% of elderly surgical patients.
Postoperative cognitive dysfunction (POCD) is a new-onset of cognitive
impairment which may persist for weeks or months after surgery.
Traditionally, surgical anaesthesia has been maintained with inhalational
agents. End-tidal concentrations require adjustment to balance the risks
of accidental awareness and excessive dosing in elderly people. As an
alternative, propofol-based total intravenous anaesthesia (TIVA) offers a
more rapid recovery and reduces postoperative nausea and vomiting. Using
TIVA with a target controlled infusion (TCI) allows plasma and effect-site
concentrations to be calculated using an algorithm based on age, gender,
weight and height of the patient. TIVA is a viable alternative to
inhalational maintenance agents for surgical anaesthesia in elderly
people. However, in terms of postoperative cognitive outcomes, the optimal
technique is unknown. Objectives: To compare maintenance of general
anaesthesia for elderly people undergoing non-cardiac surgery using
propofol-based TIVA or inhalational anaesthesia on postoperative cognitive
function, mortality, risk of hypotension, length of stay in the
postanaesthesia care unit (PACU), and hospital stay. Search methods: We
searched the Cochrane Central Register of Controlled Trials (CENTRAL;
2017, Issue 11), MEDLINE (1946 to November 2017), Embase (1974 to November
2017), PsycINFO (1887 to November 2017). We searched clinical trials
registers for ongoing studies, and conducted backward and forward citation
searching of relevant articles. Selection criteria: We included randomized
controlled trials (RCTs) with participants over 60 years of age scheduled
for non-cardiac surgery under general anaesthesia. We planned to also
include quasi-randomized trials. We compared maintenance of anaesthesia
with propofol-based TIVA versus inhalational maintenance of anaesthesia.
Data collection and analysis: Two review authors independently assessed
studies for inclusion, extracted data, assessed risk of bias, and
synthesized findings. Main results: We included 28 RCTs with 4507
randomized participants undergoing different types of surgery
(predominantly cardiovascular, laparoscopic, abdominal, orthopaedic and
ophthalmic procedures). We found no quasi-randomized trials. Four studies
are awaiting classification because we had insufficient information to
assess eligibility. All studies compared maintenance with propofol-based
TIVA versus inhalational maintenance of anaesthesia. Six studies were
multi-arm and included additional TIVA groups, additional inhalational
maintenance or both. Inhalational maintenance agents included sevoflurane
(19 studies), isoflurane (eight studies), and desflurane (three studies),
and was not specified in one study (reported as an abstract). Some studies
also reported use of epidural analgesia/anaesthesia, fentanyl and
remifentanil. We found insufficient reporting of randomization methods in
many studies and all studies were at high risk of performance bias because
it was not feasible to blind anaesthetists to study groups. Thirteen
studies described blinding of outcome assessors. Three studies had a high
of risk of attrition bias, and we noted differences in the use of
analgesics between groups in six studies, and differences in baseline
characteristics in five studies. Few studies reported clinical trials
registration, which prevented assessment of risk of selective reporting
bias. We found no evidence of a difference in incidences of postoperative
delirium according to type of anaesthetic maintenance agents (odds ratio
(OR) 0.59, 95% confidence interval (CI) 0.15 to 2.26; 321 participants;
five studies; very low-certainty evidence); we noted during sensitivity
analysis that using different time points in one study may influence
direction of this result. Thirteen studies (3215 participants) reported
POCD, and of these, six studies reported data that could not be pooled; we
noted no difference in scores of POCD in four of these and in one study,
data were at a time point incomparable to other studies. We excluded one
large study from meta-analysis because study investigators had used
non-standard anaesthetic management and this study was not
methodologically comparable to other studies. We combined data for seven
studies and found low-certainty evidence that TIVA may reduce POCD (OR
0.52, 95% CI 0.31 to 0.87; 869 participants). We found no evidence of a
difference in mortality at 30 days (OR 1.21, 95% CI 0.33 to 4.45; 271
participants; three studies; very low-certainty evidence). Twelve studies
reported intraoperative hypotension. We did not perform meta-analysis for
11 studies for this outcome. We noted visual inconsistencies in these
data, which may be explained by possible variation in clinical management
and medication used to manage hypotension in each study (downgraded to
low-certainty evidence); one study reported data in a format that could
not be combined and we noted little or no difference between groups in
intraoperative hypotension for this study. Eight studies reported length
of stay in the PACU, and we did not perform meta-analysis for seven
studies. We noted visual inconsistencies in these data, which may be
explained by possible differences in definition of time points for this
outcome (downgraded to very low-certainty evidence); data were unclearly
reported in one study. We found no evidence of a difference in length of
hospital stay according to type of anaesthetic maintenance agent (mean
difference (MD) 0 days, 95% CI -1.32 to 1.32; 175 participants; four
studies; very low-certainty evidence). We used the GRADE approach to
downgrade the certainty of the evidence for each outcome. Reasons for
downgrading included: study limitations, because some included studies
insufficiently reported randomization methods, had high attrition bias, or
high risk of selective reporting bias; imprecision, because we found few
studies; inconsistency, because we noted heterogeneity across studies.
Authors' conclusions: We are uncertain whether maintenance with
propofol-based TIVA or with inhalational agents affect incidences of
postoperative delirium, mortality, or length of hospital stay because
certainty of the evidence was very low. We found low-certainty evidence
that maintenance with propofol-based TIVA may reduce POCD. We were unable
to perform meta-analysis for intraoperative hypotension or length of stay
in the PACU because of heterogeneity between studies. We identified 11
ongoing studies from clinical trials register searches; inclusion of these
studies in future review updates may provide more certainty for the review
outcomes.<br/>Copyright &#xa9; 2018 The Cochrane Collaboration.

<50>
Accession Number
2001043455
Title
Thoracic Epidurals are Associated With Decreased Opioid Consumption
Compared to Surgical Infiltration of Liposomal Bupivacaine Following
Video-Assisted Thoracoscopic Surgery for Lobectomy: A Retrospective Cohort
Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Author
Sztain J.F.; Gabriel R.A.; Said E.T.
Institution
(Sztain, Gabriel, Said) Department of Anesthesiology, Division of Regional
Anesthesia and Acute Pain, University of California, San Diego, La Jolla,
CA, United States
(Gabriel) Department of Medicine, Division of Biomedical Informatics,
University of California, San Diego, La Jolla, CA, United States
Publisher
W.B. Saunders
Abstract
Objective: Thoracic epidural analgesia (TEA) is considered the gold
standard for postoperative pain control in thoracic surgery, however it is
associated with the undesirable risks of hypotension urinary retention,
and bleeding. Recently, surgical site infiltration with liposomal
bupivicaine (LB) has been suggested as a comparable alternative to TEA.
The authors compared total opioid consumption in patients who received
either TEA or LB undergoing video-assisted thorascopic surgery (VATS) for
lobectomy. Design: Retrospective cohort study. Setting: University
hospital. Participants: Patients undergoing VATS for lobectomy.
Interventions: TEA versus LB Measurements and Main Results: The primary
outcome was POD 0 to 2 total opioid requirements, measured in intravenous
morphine equivalents (mg). Wilcoxon rank sum test was used to calculate
the significant differences in the primary outcome. The 25 - 75%
interquartile range (IQR) was reported with each median value. Forty-five
patients were included in the analysis, in which 14 (31.1%) were in the LB
group. Between the TEA and LB group, there were no differences in age,
sex, or body mass. The median (25 - 75% IQR) total opioid consumption
during POD 0 - 2 in the TEA and LB group were 28.0 mg (12.0 - 52.0 mg) and
49.5 mg (35.0 - 70.5 mg), respectively (p = 0.03), in which the median
difference was 22.5 mg (95% CI 0.60 - 38.0 mg). Conclusions: VATs
lobectomy patients consumed 43.4% less opioids on POD 0-2 with TEA when
compared to surgical site infiltration of LB. Further prospective
randomized controlled trials are required to demonstrate superior
analgesia of TEA in this surgical population.<br/>Copyright &#xa9; 2018
Elsevier Inc.

<51>
Accession Number
622859329
Title
Mitral valve repair or replacement in native valve endocarditis?
Systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. 33 (7) (pp 364-371), 2018. Date of
Publication: July 2018.
Author
Harky A.; Hof A.; Garner M.; Froghi S.; Bashir M.
Institution
(Harky, Garner, Bashir) Department of Cardiac Surgery, Barts Heart Centre,
St. Bartholomew's Hospital, London, United Kingdom
(Harky) Department of Vascular Surgery, Countess of Chester Hospital,
Chester, United Kingdom
(Hof) Department of Cardiovascular Surgery, Heinrich-Heine-University,
Medical Faculty, Dusseldrof, Germany
(Froghi) Department of Surgery, Imperial College NHS Trust, Hammersmith
Hospital, London, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: The objective of this study is to review the morbidity and
mortality associated with mitral valve repair versus replacement in
infective endocarditis patients. Methods: A comprehensive search was
undertaken among the four major databases (PubMed, Embase, Scopus, and
Ovid) to identify all available data comparing mitral valve repair or
replacement in infective endocarditis. Databases were evaluated and
assessed to March 2017. Data were analyzed using meta-analytical
techniques including odds ratio and mean weighted difference. Results: A
total of 8978 patients were analyzed in a total of 14 articles. The
average age of the cohort was 53 years. Results revealed a shorter CPB
time in the mitral valve (MV) repair compared to replacement group (P =
0.05). Postoperative outcomes (30 days/in hospital events) such as
bleeding (P = 0.0047) and recurrence of infective endocarditis (IE) (P =
0.004) were significantly lower in the MV repair group. Beyond 30 days,
recurrence of IE was higher in the MV replacement than the repair group (P
< 0.0001). Additionally, there were significantly less reoperations in the
repair group (P = 0.0021). The MV repair group had significantly better
survival at 1 and 5 years postop (P < 0.0001, P < 0.0001). Conclusion:
This meta-analysis shows that mitral valve repair has good clinical
outcomes both in-hospital and at 1 and 5 years of follow-up. Mitral valve
repair should be attempted in those patients in whom sufficient valve
tissue is present for reconstruction after all infectious tissue has been
resected.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<52>
Accession Number
622859320
Title
Should the mitral valve be repaired for moderate ischemic mitral
regurgitation at the time of revascularization surgery?.
Source
Journal of Cardiac Surgery. 33 (7) (pp 374-384), 2018. Date of
Publication: July 2018.
Author
Salmasi M.Y.; Harky A.; Chowdhury M.F.; Abdelnour A.; Benjafield A.; Suker
F.; Hubbard S.; Vohra H.A.
Institution
(Salmasi, Chowdhury) Department of Cardiothoracic Surgery, University
Hospitals of Leicester, Leicester, United Kingdom
(Harky) Department of Cardiac Surgery, St Bartholemew's Hospital, London,
United Kingdom
(Abdelnour) Department of Cardiac Surgery, Royal Hospitals, Belfast,
United Kingdom
(Benjafield) Department of Cardiac Surgery, Royal Brompton Hospital,
London, United Kingdom
(Suker) Department of Medical Sciences, University of Nottingham,
Nottingham, United Kingdom
(Hubbard) Department of Health Sciences, University of Leicester,
Leicester, United Kingdom
(Vohra) Bristol Heart Institute, Bristol Royal Infirmary, Bristol, United
Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Ischemic mitral regurgitation (IMR) is associated with
increased mortality and recurrent congestive heart failure following
coronary artery bypass graft (CABG) surgery. While mitral surgery should
be undertaken for severe MR during CABG, the treatment of moderate IMR
remains controversial. We conducted a meta-analysis to determine the
outcomes of CABG alone and combine with mitral valve repair (MVr) in
moderate IMR. Methods: A literature search was conducted by Pubmed, Ovid,
and Embase, which included 643 articles. Eleven studies (seven
observational studies and four randomized controlled trials) with a total
of 1406 patients were included (CABG alone = 864 and CABG plus MVr = 542).
Results: There was no difference in operative mortality (odds ratio 1.56,
95% confidence interval [CI] 0.92-2.71) or long-term survival at 1 or 5
years (hazard ratio 0.98, 95%CI 0.71-1.35, P = 0.49) between the two
groups, and little evidence of heterogeneity was found in the studies
(I² = 0.0, P = 0.562). There was significantly greater
improvement in MR grade (weighted mean difference [WMD] -1.15, 95%CI -1.67
to -0.064, P = < 0.001) and left ventricular systolic diameter (WMD -3.02,
95%CI -4.85 to -1.18, P = 0.001) following CABG and MVr compared to CABG
alone. No difference in postoperative functional class or ejection
fraction was found. Conclusions: Our results show that in the presence of
moderate IMR, adding MVr to revascularization reduces MR grade on
follow-up echocardiography and promotes ventricular remodeling, with no
improvement in long-term survival or functional class.<br/>Copyright
&#xa9; 2018 Wiley Periodicals, Inc.

<53>
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

<54>
Accession Number
2001007544
Title
Is the Venner-PneuX Endotracheal Tube System a Cost-Effective Option for
Post Cardiac Surgery Care?.
Source
Annals of Thoracic Surgery. 106 (3) (pp 757-763), 2018. Date of
Publication: September 2018.
Author
Andronis L.; Oppong R.A.; Manga N.; Senanayake E.; Gopal S.; Charman S.;
Giri R.; Luckraz H.
Institution
(Andronis) Population, Evidence and Technologies Group, Division of Health
Sciences, University of Warwick, Coventry, United Kingdom
(Oppong) Health Economics Unit, Institute of Applied Health Research,
University of Birmingham, Birmingham, United Kingdom
(Manga) RTI Health Solutions, Manchester, United Kingdom
(Senanayake, Luckraz) Cardiothoracic Surgery, Heart and Lung Centre, New
Cross Hospital, Wolverhampton, United Kingdom
(Gopal) Intensive Care Unit, New Cross Hospital, Wolverhampton, United
Kingdom
(Charman) Department of Health Services Research & Policy, London School
of Hygiene and Tropical Medicine, London, United Kingdom
(Giri) Cardiothoracic Anaesthesiology, Heart and Lung Centre, New Cross
Hospital, Wolverhampton, United Kingdom
Publisher
Elsevier USA
Abstract
Background: Ventilator-associated pneumonia (VAP) is common and costly. In
a recent randomized controlled trial, the Venner-PneuX (VPX) endotracheal
tube system (Qualitech Healthcare Limited, Maidenhead, United Kingdom) was
found to be superior to standard endotracheal tubes (SET) in preventing
VAP. However, VPX is considerably more expensive. We evaluated the costs
and benefits of VPX to determine whether replacing SET with VPX is a
cost-effective option for intensive care units. Methods: We developed a
decision analytic model to compare intubation with VPX or SET for patients
requiring mechanical ventilation after cardiac operations. The model was
populated with existing evidence on costs, effectiveness, and quality of
life. Cost-effectiveness and cost-utility analyses were conducted from a
National Health Service hospital perspective. Uncertainty was assessed
through deterministic and probabilistic sensitivity analyses. Results:
Compared with SET, VPX is associated with an expected cost saving of 738
per patient. VPX led to a small increase in quality-adjusted life years,
indicating that the device is overall less costly and more effective than
SET. The probability of VPX being cost-effective at 30,000 per
quality-adjusted life year is 97%. VPX would cease to be cost-effective if
(1) it led to a risk reduction smaller than 0.02 compared with SET, (2)
the acquisition cost of VPX was as high as 890, or (3) the cost of
treating a case of VAP was lower than 1,450. Conclusions: VPX resulted in
improved outcomes and savings that far offset the cost of the device,
suggesting that replacing SET with VPX is overall beneficial. Findings
were robust to extreme values of key variables.<br/>Copyright &#xa9; 2018
The Society of Thoracic Surgeons

<55>
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

<56>
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

<57>
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

<58>
Accession Number
619376948
Title
The effect of pleasant olfactory mental imagery on the incidence and
extent of atelectasis in patients after open heart surgery.
Source
Complementary Therapies in Medicine. 36 (pp 33-37), 2018. Date of
Publication: February 2018.
Author
Rezaei-Nodehi M.; Shorofi S.A.; Bagheri-Nesami M.; Ghafari R.;
Yazdani-Charati J.; Darbeheshti M.
Institution
(Rezaei-Nodehi) Student Research Committee, School of Nursing and
Midwifery, Addiction Institute, Mazandaran University of Medical Sciences,
Sari, Iran, Islamic Republic of
(Shorofi) Traditional and Complementary Medicine Research Center,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Shorofi) Adjunct Research Fellow, Flinders University, Adelaide,
Australia
(Bagheri-Nesami) Traditional and Complementary Medicine Research Center,
Addiction Institute, Mazandaran University of Medical Sciences, Sari,
Iran, Islamic Republic of
(Ghafari) Department of Cardiac Surgery, School of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Yazdani-Charati) Health Sciences Research Center, Mazandaran University
of Medical Science, Sari, Iran, Islamic Republic of
(Darbeheshti) Department of Radiology, Mazandaran Cardiac Surgery Center,
Sari, Iran, Islamic Republic of
Publisher
Churchill Livingstone
Abstract
Background and purpose Atelectasis is the most common pulmonary
complication after open heart surgery. This study was intended to examine
the effects of pleasant olfactory mental imagery on postoperative
atelectasis in patients undergoing open heart surgery. Materials and
methods This is a randomized controlled clinical trial. The sample
consisted of 80 patients who were randomly assigned to either practice
olfactory mental imagery (test group) or receive routine care (control
group). A card with the image of roses was given to patients and they were
asked to look at the image, visualize the scent of roses in the mind, and
then sniff as much as possible, hold their breath for 2 s and eventually
exhale slowly through the nose. This procedure was consecutively repeated
five times. After a fifteen-minute break, patients proceeded to practice
olfactory mental imagery with other fruit images (banana, apple, and
lemon). The test group executed the olfactory mental imagery for two hours
in the morning and two hours in the afternoon on postoperative days 1 and
2. The control group received the routine ICU care. A questionnaire
collected information on sociodemographic characteristics and clinical
parameters. Chest radiographs were used to diagnose atelectasis, which
were evaluated by the hospital radiologist. Results No statistically
significant differences were observed between the two groups regarding
sociodemographic, medical and surgical information. The incidence of
atelectasis in the test group (40%, n = 16) was significantly lower than
in the control group (67.5%, n = 27) on postoperative day 2 (p = 0.02).
Conclusion Our findings suggest that olfactory mental imagery can improve
respiratory function and reduce the risk of atelectasis in patients with
cardiac surgery.<br/>Copyright &#xa9; 2017

<59>
Accession Number
620245810
Title
Dexmedetomidine prevents acute kidney injury after adult cardiac surgery:
A meta-analysis of randomized controlled trials.
Source
BMC Anesthesiology. 18 (1) (no pagination), 2018. Article Number: 7. Date
of Publication: 15 Jan 2018.
Author
Liu Y.; Sheng B.; Wang S.; Lu F.; Zhen J.; Chen W.
Institution
(Liu, Sheng, Wang, Lu, Zhen, Chen) Capital Medical University, Department
of Intensive care unit, Beijing Shijitan Hospital, No. 10, Tieyi Road,
Haidian District, Beijing 100038, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Dexmedetomidine has been shown to confer direct renoprotection
by stabilizing the sympathetic system, exerting anti-inflammatory effects
and attenuating ischemia/reperfusion (I/R) injury in preclinical studies.
Results from clinical trials of dexmedetomidine on acute kidney injury
(AKI) following adult cardiac surgery are controversial. Methods: We
searched EMBASE, PubMed, and Cochrane CENTRAL databases for randomized
controlled trials (RCTs) comparing the renal effect of dexmedetomidine
versus placebo or other anesthetic drugs in adult patients undergoing
cardiac surgery. The primary outcome was the incidence of AKI. The
secondary outcomes were mechanical ventilation (MV) duration, intensive
care unit (ICU) stay and hospital length of stay(LOS), and postoperative
mortality (in-hospital or within 30 days). Results: Ten trials with a
total of 1575 study patients were selected. Compared with controls,
dexmedetomidine significantly reduced the incidence of postoperative AKI
[68/788 vs 97/787; odds ratio(OR), 0.65; 95% confidence interval (CI),
0.45-0.92; P = 0.02; I² = 0.0%], and there was no difference
between groups in postoperative mortality (4/487 vs 11/483; OR, 0.43; 95%
CI, 0.14-1.28; P = 0.13; I² = 0.0%), MV duration [in days; n =
1229; weighted mean difference(WMD), -0.22; 95% CI, -2.04 to 1.70; P =
0.81], ICU stay (in days; n = 1363; WMD, -0.85; 95% CI, -2.14 to 0.45; P =
0.20), and hospital LOS (in days; n = 878; WMD, -0.24; 95% CI, -0.71 to
0.23; P = 0.32). Conclusions: Perioperative administration of
dexmedetomidine in adult patients undergoing cardiac surgery may reduce
the incidence of postoperative AKI. Future trials are needed to determine
the dose and timing of dexmedetomidine in improving outcomes, especially
in patients with decreased baseline kidney function.<br/>Copyright &#xa9;
2018 The Author(s).

<60>
Accession Number
623487362
Title
ABO-incompatible kidney transplant outcomes: A meta-analysis.
Source
Clinical Journal of the American Society of Nephrology. 13 (8) (pp
1234-1243), 2018. Date of Publication: 07 Aug 2018.
Author
de Weerd A.E.; Betjes M.G.H.
Institution
(de Weerd, Betjes) Department of Nephrology and Kidney Transplantation,
Erasmus Medical Center, Rotterdam, Netherlands
Publisher
American Society of Nephrology (E-mail: email@asn-online.org)
Abstract
Background and objectives ABO blood group-incompatible kidney
transplantation is considered a safe procedure, with noninferior outcomes
in large cohort studies. Its contribution to living kidney transplantation
programs is substantial and growing. Outcomes compared with center-matched
ABO blood group-compatible control patients have not been ascertained.
Design, setting, participants, & measurements Comprehensive searches were
conducted in Embase, Medline, Cochrane, Web-of-Science, and Google
Scholar. Meta-analyses Of Observational Studies in Epidemiology study
guidelines for observational studies and Newcastle Ottawa bias scale were
implemented to assess studies. Meta-analysis was performed using Review
Manager 5.3. A subgroup analysis on antibody removal technique was
performed. Results After identifying 2728 studies addressing
ABO-incompatible kidney transplantation, 26 studies were included,
describing 1346 unique patients who were ABO-incompatible and 4943
ABO-compatible controls. Risk of bias was low (all studies >=7 of 9
stars). Baseline patient characteristics revealed no significant
differences in immunologic risk parameters. Statistical heterogeneity of
studies was low (I² 0% for graft and patient survival).
One-year uncensored graft survival of patients who were ABO-incompatible
was 96% versus 98% in ABO compatible controls (relative risk, 0.97; 95%
confidence interval, 0.96 to 0.98; P<0.001). Forty-nine percent of
reported causes of death in patients who were ABO-incompatible were of
infectious origin, versus only 13% in patients who were ABO-compatible
(P=0.02). Antibody-mediated rejection (3.86; 95%confidence interval, 2.05
to 7.29; P<0.001), severe nonviral infection (1.44; 95%confidence
interval, 1.13 to 1.82; P=0.003), and bleeding (1.92; 95%confidence
interval, 1.36 to 2.72; P<0.001) were also more common after
ABO-incompatible transplantation. Conclusions ABO-incompatible kidney
transplant recipients have good outcomes, albeit inferior to center
matched ABO-compatible control patients.<br/>Copyright &#xa9; 2018 by the
American Society of Nephrology.

<61>
Accession Number
623467896
Title
A randomized multicentre trial to compare revascularization with optimal
medical therapy for the treatment of chronic total coronary occlusions.
Source
European Heart Journal. 39 (26) (pp 2484-2493), 2018. Date of Publication:
07 Jul 2018.
Author
Werner G.S.; Martin-Yuste V.; Hildick-Smith D.; Boudou N.; Sianos G.;
Gelev V.; Rumoroso J.R.; Erglis A.; Christiansen E.H.; Escaned J.; Di
Mario C.; Hovasse T.; Teruel L.; Bufe A.; Lauer B.; Bogaerts K.; Goicolea
J.; Spratt J.C.; Gershlick A.H.; Galassi A.R.; Louvard Y.
Institution
(Werner) Klinikum Darmstadt GmbH, Medizinische Klinik i, Grafenstrasse 9,
Darmstadt D-64283, Germany
(Martin-Yuste) Hospital Clinic, Seccion de Hemodinamica Cardiaca,
Villaroel 170, Barcelona 08036, Spain
(Hildick-Smith) Royal Sussex County Hospital, Sussex Cardiac Centre,
Eastern Road, Brighton BN2 5 BE, United Kingdom
(Boudou) Hopital de Rangueil, CHU Toulouse, Department of Cardiology, 1
avenue Jean Poulhes, Toulouse Cedex 9 31059, France
(Sianos) AHEPA University Hospital, 1st Department of Cardiology,
Stilponos Kyriakidi 1, Thessaloniki 54636, Greece
(Gelev) Cardiology Clinic, MHAT, Tokuda Hospital Sofia, 51B Nikola
Vaptsarov Blvd., Sofia 1407, Bulgaria
(Rumoroso) Hospital Galdakao-Usansolo, Seccion de Hemodinamica, barrio de
labeaga s/n, Galdakao 48960, Spain
(Erglis) Pauls Stradins Clinical University Hospital, Institute of
Cardiology and Regenerative Medicine, 13 Pilsonu street, Riga LV-1002,
Latvia
(Christiansen) Aarhus University Hospital, Department of Cardiology B,
Skejby Aarhus N 8200, Denmark
(Escaned) Hospital Clinico San Carlos, Unidad de Cardiologia
Intervencionista, Profesor Martin Lagos s/n, Madrid 28040, Spain
(Di Mario) University Hospital Careggi, Division of Structural
Interventional Cardiology, Largo Brambilla 3, Florence 50139, Italy
(Hovasse, Louvard) Institut Jacques Cartier, 6 avenue Noyer Lambert, Massy
91300, France
(Teruel) Bellvitge University Hospital, Unidad de Hemodinamica y
Cardiologia, L'Hospitalet de Llobregat, C/ Feixa Llarga s/n, Barcelona
08907, Spain
(Bufe) HELIOS Klinik Krefeld, Medizinische Klinik i, Lutherplatz 40,
Krefeld 47805, Germany
(Lauer) Zentralklinik Bad Berka, Klinik fur Kardiologie, Robert-Koch-Allee
9, Bad Berka 99437, Germany
(Bogaerts) Leuven Biostatistics and Statistical Bioinformatics Centre,
L-BioStat. Kapucijnenvoer 35, Leuven 3000, Belgium
(Goicolea) Hospital Universitario Puerta de Hierro, Servicio de
Hemodinamica y Arritmias, Joaquin Rodrigo, 2, Majadahonda 28222, Spain
(Spratt) Royal Infirmary of Edinburgh, Department of Cardiology, 51 Little
France Crescent, Edinburgh EH16 4SA, United Kingdom
(Gershlick) Glenfield Hospital, Leicester Cardiovascular Biomedical
Research Unit, Groby Road, Leicester LE3 9 QP, United Kingdom
(Galassi) Department of Clinical and Experimental Medicine, University of
Catania, Via Antonello da Messina 75, Catania 95021, Italy
Publisher
Oxford University Press
Abstract
Aims The clinical value of percutaneous coronary intervention (PCI) for
chronic coronary total occlusions (CTOs) is not established by randomized
trials. This study should compare the benefit of PCI vs. optimal medical
therapy (OMT) on the health status in patients with at least one CTO.
Method and results Three hundred and ninety-six patients were enrolled in
a prospective randomized, multicentre, open-label, and controlled clinical
trial to compare the treatment by PCI with OMT with a 2:1 randomization
ratio. The primary endpoint was the change in health status assessed by
the Seattle angina questionnaire (SAQ) between baseline and 12months
follow-up. Fifty-two percent of patients have multi-vessel disease in whom
all significant non-occlusive lesions were treated before randomization.
An intention-to-treat analysis was performed including 13.4% failed
procedures in the PCI group and 7.3% cross-overs in the OMT group. At
12months, a greater improvement of SAQ subscales was observed with PCI as
compared with OMT for angina frequency [5.23, 95% confidence interval (CI)
1.75; 8.71; P= 0.003], and quality of life (6.62, 95% CI 1.78-11.46; P =
0.007), reaching the prespecified significance level of 0.01 for the
primary endpoint. Physical limitation (P= 0.02) was also improved in the
PCI group. Complete freedom from angina was more frequent with PCI 71.6%
than OMT 57.8% (P = 0.008). There was no periprocedural death or
myocardial infarction. At 12months, major adverse cardiac events were
comparable between the two groups. Conclusion Percutaneous coronary
intervention leads to a significant improvement of the health status in
patients with stable angina and a CTO as compared with OMT
alone.<br/>Copyright &#xa9; The Author(s) 2018.

<62>
Accession Number
2000566937
Title
Cost-effectiveness of a management strategy based on exercise
echocardiography versus exercise electrocardiography in patients
presenting with suspected angina during long term follow up: A randomized
study.
Source
International Journal of Cardiology. 259 (pp 1-7), 2018. Date of
Publication: 15 May 2018.
Author
Gurunathan S.; Zacharias K.; Akhtar M.; Ahmed A.; Mehta V.; Karogiannis
N.; Vamvakidou A.; Khattar R.; Senior R.
Institution
(Gurunathan, Zacharias, Akhtar, Ahmed, Mehta, Karogiannis, Vamvakidou,
Senior) Department of Cardiology, Northwick park Hospital, Harrow, United
Kingdom
(Gurunathan, Vamvakidou, Khattar, Senior) Department of Cardiology, Royal
Brompton Hospital, United Kingdom
(Gurunathan, Vamvakidou, Khattar, Senior) Biomedical Research Unit,
National Heart and Lung Institute, Imperial College, London, United
Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Introduction: Exercise ECG (Ex-ECG) is advocated by guidelines for
patients with low - intermediate probability of coronary artery disease
(CAD). However, there are no randomized studies comparing Ex-ECG with
exercise stress echocardiography (ESE) evaluating long term
cost-effectiveness of each management strategy. Methods: Accordingly, 385
patients with no prior CAD and low-intermediate probability of CAD (mean
pre-test probability 34%), were randomized to undergo either Ex-ECG (194
patients) or ESE (191 patients). The primary endpoint was clinical
effectiveness defined as the positive predictive value (PPV) for the
detection of CAD of each test. Cost-effectiveness was derived using the
cumulative costs incurred by each diagnostic strategy during a mean of
follow up of 3.0 years. Results: The PPV of ESE and Ex-ECG were 100% and
64% (p = 0.04) respectively for the detection of CAD. There were fewer
clinic (31 vs 59, p < 0.01) and emergency visits (14 vs 30, p = 0.01) and
lower number of hospital bed days (8 vs 29, p < 0.01) in the ESE arm, with
fewer patients undergoing coronary angiography (13.4% vs 6.3%, p = 0.02).
The overall cumulative mean costs per patient were 796 for Ex-ECG and 631
for ESE respectively (p = 0.04) equating to a >20% reduction in cost with
an ESE strategy with no difference in the combined end-point of death,
myocardial infarction, unplanned revascularization and hospitalization for
chest pain between ESE and Ex-ECG (3.2% vs 3.7%, p = 0.38). Conclusion: In
patients with low to intermediate pretest probability of CAD and suspected
angina, an ESE management strategy is cost-effective when compared with
Ex-ECG during long term follow up.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<63>
Accession Number
623560317
Title
Effects of foot reflexology on anxiety and physiological parameters in
patients undergoing coronary artery bypass graft surgery: A clinical
trial.
Source
Complementary therapies in clinical practice. 31 (pp 220-228), 2018. Date
of Publication: 01 May 2018.
Author
Abbaszadeh Y.; Allahbakhshian A.; Seyyedrasooli A.; Sarbakhsh P.;
Goljarian S.; Safaei N.
Institution
(Abbaszadeh, Allahbakhshian, Seyyedrasooli, Sarbakhsh, Safaei) Master of
medical-surgical nursing student, Faculty of Nursing and Midwifery, Tabriz
University of Medical Sciences, Tabriz, Iran; Assistant Professor,
Department of Medical-Surgical, Faculty of Nursing and Midwifery, Tabriz
University of Medical Sciences, Tabriz, Iran; Lecture, Department of
Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz
University of Medical Sciences, Tabriz, Iran; Assistant Professor,
Department of Statistics and Epidemiology, School of Public Health, Tabriz
University of Medical Sciences, Tabriz, Iran; Assistant Professor,
Department of physiotherapy, Faculty of Rehabilitation, Tabriz University
of Medical Sciences, Tabriz, Iran; Professor, Department of Cardiac
Surgery, Cardiovascular Research Center, Tabriz University of Medical
Sciences, Tabriz, Iran
(Goljarian) Master of medical-surgical nursing student, Faculty of Nursing
and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran;
Assistant Professor, Department of Medical-Surgical, Faculty of Nursing
and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran;
Lecture, Department of Medical-Surgical Nursing, Faculty of Nursing and
Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran; Assistant
Professor, Department of Statistics and Epidemiology, School of Public
Health, Tabriz University of Medical Sciences, Tabriz, Iran; Assistant
Professor, Department of physiotherapy, Faculty of Rehabilitation, Tabriz
University of Medical Sciences, Tabriz, Iran; Professor, Department of
Cardiac Surgery, Cardiovascular Research Center, Tabriz University of
Medical Sciences, Tabriz, Iran. Electronic address: Goljaryan@tbzmed.ac.ir
Abstract
INTRODUCTION: This study aimed to investigate the effect of foot
reflexology on anxiety and physiological parameters in patients after CABG
surgery.
METHOD: This was a single-blind, three-arm, parallel-group, randomized
controlled trial with three groups of 40 male patients undergoing CABG.
Participants were placed in three groups, named intervention, placebo, and
control. Physiological parameters were measured including systolic and
diastolic blood pressure, mean arterial pressure, heart rate, respiratory
rate, percutaneous oxygen saturation, and anxiety of participants.
RESULTS: Results showed a statistically significant difference between
intervention and control groups in terms of the level of anxiety (p<0.05).
Also, results showed a statistically significant effect on all
physiological parameters except heart rate (p<0.05).
CONCLUSION: This study indicated that foot reflexology may be used by
nurses as an adjunct to standard ICU care to reduce anxiety and stabilize
physiological parameters such as systolic, diastolic, mean arterial
pressure, and heart rate.<br/>Copyright &#xa9; 2018 Elsevier Ltd. All
rights reserved.