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<1>
Accession Number
623687180
Title
Perioperative diltiazem or nitroglycerin in on-pump coronary artery
bypass: A systematic review and network meta-analysis.
Source
PLoS ONE. 13 (8) (no pagination), 2018. Article Number: e0203315. Date of
Publication: August 2018.
Author
Hu Y.; Yang X.; Zhang L.; Wu X.; Liu A.Y.; Boscarino J.A.; Kirchner H.L.;
Casale A.S.; Zhang X.
Institution
(Hu, Yang, Kirchner) Biomedical and Translational Informatics, Geisinger
Medical Center, Danville, PA, United States
(Zhang, Wu, Zhang) Division of Anesthesiology, Geisinger Medical Center,
Danville, PA, United States
(Liu) Department of Cell and Systems Biology, University of Toronto,
Toronto, Canada
(Boscarino) Department of Epidemiology and Health Services Research,
Geisinger Medical Center, Danville, PA, United States
(Casale) Geisinger Heart Institute, Geisinger Wyoming Valley Medical
Center, Wilkes Barre, PA, United States
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Arterial graft spasm is a severe complication after coronary
artery bypass graft (CABG). Among numerous potential antispasmodic agents,
systemic application of diltiazem and nitroglycerin had been investigated
most frequently over the past three decades. However, it remains
inconclusive if either or both agents could improve patient outcomes by
preventing graft spasm when applied perioperatively, and, if so, which one
would be a better choice. The current systematic review and network
meta-analysis aims to summarize the data from all available randomized
clinical trials of perioperative continuous intravenous infusion of
diltiazem and/or nitroglycerin in patients undergoing on-pump CABG in
order to define and compare their roles in graft spasm prevention and
their impacts on perioperative outcomes. Methods We searched Ovid Medline,
PubMed, CINAHL, Google Scholar and Cochrane Center for randomized
controlled trials that reported outcome effects of perioperative
continuous intravenous infusion of diltiazem and/or nitroglycerin in
patients undergoing elective on-pump CABG. Conventional meta-analyses were
conducted to evaluate the pairwise comparisons (diltiazem vs. placebo;
nitroglycerin vs. placebo; diltiazem vs. nitroglycerin) on perioperative
outcomes. Network meta-analyses were implemented to compare the three
regimens through direct and indirect comparison. Results Twenty-seven
studies involving 1,660 patients were included. Pairwise and network
meta-analyses found no significant difference in mortality among the
groups. There are four studies that reported blood flow measurements of
internal mammary artery grafts intraopera-tively after dissecting or
immediately after distal anastomosis while patients were on continuous
intravenous infusion of diltiazem and nitroglycerin. Although insufficient
for data synthesis, the measured results from all four studies suggest
that both diltiazem and nitroglycerin significantly increased blood flow
of arterial grafts compared to placebo. For other perioperative outcomes,
compared to diltiazem, patients that received nitroglycerin had higher
odds of postoperative atrial fibrillation (OR = 2.67, 95% CI: 1.15 to
6.24) and higher peak serum cardiac enzymes. Patients that received
placebo had higher odds of atrial fibrillation (OR = 3.00, 95% CI: 1.18 to
7.63) and lower odds of requiring inotrope support (OR = 0.19, 95% CI:
0.04 to 0.73) compared to diltiazem. Data from the network meta-analysis
indicated that diltiazem had significantly lower odds of postoperative
atrial fibrillation compared to nitroglycerin (OR = 0.39, 95% CI: 0.18 to
0.85). In fact, the rank from highest to lowest rates of postoperative
atrial fibrillation was placebo>nitroglycerin>diltiazem. The rank from
highest to lowest odds of requiring inotropic support is nitroglycerin>
diltiazem>pla-cebo. However, placebo had significantly higher odds of
postoperative myocardial infarction than diltiazem (OR = 4.51, 95% CI:
1.34 to 15.25). The rank from highest to lowest odds of postoperative
myocardial infarction, transient cardiac ischemic event and atrial
fibrillation is placebo>nitroglycerin>diltiazem. Conclusion Compared to
nitroglycerin and placebo, perioperative continuous intravenous infusion
of diltiazem had stronger protective effects against postoperative
ischemic cardiac injuries and atrial fibrillation although patients may
need more inotropic support. The increased blood flow from diltiazem use
in arterial grafts may potentially contribute to the drug's outcome
benefits.<br/>Copyright &#xa9; 2018 Hu 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.

<2>
Accession Number
623686393
Title
Normal values for Doppler echocardiographic assessment of prosthetic valve
function after transcatheter aortic valve replacement: A systematic review
and meta-analysis.
Source
European Heart Journal Cardiovascular Imaging. 19 (4) (pp 361-368), 2018.
Date of Publication: April 2018.
Author
Winter M.-P.; Zbiral M.; Kietaibl A.; Sulzgruber P.; Kastner J.; Rosenhek
R.; Binder T.; Lang I.M.; Goliasch G.
Institution
(Winter, Zbiral, Kietaibl, Sulzgruber, Kastner, Rosenhek, Binder, Lang,
Goliasch) Department of Internal medicine II, Division of cardiology,
Medical University of Vienna, Waehringerguertel 18-20, Vienna A-1090,
Austria
Publisher
Oxford University Press
Abstract
Transcatheter aortic valve replacement has emerged as valuable treatment
modality for patients with severe aortic stenosis and an unacceptable
risk/benefit ratio for open heart surgery, but particularities specific to
TAVR and a rapidly growing number of available TAVR prosthesis make
post-procedural assessment of valve function challenging. Aim of the
present analysis was to collect and pool all available data currently in
the literature regarding normal doppler values for transcatheter
prosthetic heart valves and to provide a comprehensive overview. A PRISMA
checklist-guided systematic review and meta-analysis of prospective
observational studies or national and device specific registries or
randomized clinical trials was conducted. Studies were identified by
searching PUBMED, SCOPUS, Cochrane Central Register of Controlled Trials
and LILACs from January 2000 to March 2017. Out of 240 abstracts, 155
studies reporting echocardiographic parameter for twelve different valves
prosthesis in a total of 27,159 patients were in included in this
meta-analysis. The means and standard deviations of peak velocity, peak
gradient, mean gradient and effective orifice were extracted and pooled
from the included studies. The pooled means and standard deviations for
all available TAVR prosthesis were classified according to implanted valve
size and time since implantation. The present study firstly describes a
pooled analysis of normal values for all available TAVR prosthesis in
order to empower treating physicians with a reliable tool to perform
follow-up echocardiographic assessment in TAVR patients and to safely
identify patients with prostheses dysfunction.<br/>Copyright &#xa9; The
Author 2017.

<3>
Accession Number
623713797
Title
Adverse clinical outcomes associated with double dose clopidogrel compared
to the other antiplatelet regimens in patients with coronary artery
disease: A systematic review and meta-analysis.
Source
BMC Pharmacology and Toxicology. 19 (1) (no pagination), 2018. Article
Number: 54. Date of Publication: 03 Sep 2018.
Author
Zhuo X.; Zhuo B.; Ouyang S.; Niu P.; Xiao M.
Institution
(Zhuo, Ouyang, Niu, Xiao) Affiliated Changsha Hospital of Hunan Normal
University, The Fourth Hospital of Changsha, Department of Cardiology,
Changsha, Hunan 410006, China
(Zhuo) People's Hospital of Laibin, Department of Pharmacology, Laibin,
Guangxi 546100, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Recently, several newer antiplatelet treatment strategies have
been used in patients with coronary artery disease (CAD). Apart from the
dual antiplatelet therapy (DAPT) consisting of aspirin and clopidogrel,
double dose clopidogrel (DDC), triple antiplatelet therapy (TAPT)
consisting of aspirin, clopidogrel and cilostazol and other newer
antiplatelet agents have shown to be effective in different ways. In this
analysis, we aimed to systematically compare the adverse clinical outcomes
and the bleeding events which were observed when DDC was compared to the
other antiplatelet regimens in patients with CAD. Methods: English
publications comparing DDC with other antiplatelet regimens were searched
from MEDLARS/MEDLINE, EMBASE, www.ClinicalTrials.gov and Google Scholar.
Adverse cardiovascular outcomes and bleeding events were the study
endpoints. Statistical analysis was carried out by the RevMan 5.3 software
whereby odds ratios (OR) with 95% confidence intervals (CIs) were
calculated. Results: A total number of 23,065 participants were included.
Results of this analysis showed major adverse cardiac events (MACEs),
all-cause mortality, cardiac death, stroke, stent thrombosis,
revascularization and myocardial infarction (MI) to have been similarly
manifested in patients who were treated with DDC versus the control group
with OR: 0.98, 95% CI: 0.78-1.22; p = 0.83, OR: 0.95, 95% CI: 0.77-1.17; p
= 0.62, OR: 0.97, 95% CI: 0.79-1.20; p = 0.81, OR: 0.98, 95% CI:
0.65-1.48; p = 0.94, OR: 0.84, 95% CI: 0.40-1.75; p = 0.64, OR: 0.88, 95%
CI: 0.52-1.49; p = 0.63, and OR: 0.89, 95% CI: 0.65-1.21; p = 0.45
respectively. Any minor and major bleedings were also similarly
manifested. When DDC was compared to DAPT, no significant difference was
observed in any bleeding event with OR: 1.58, 95% CI: 0.86-2.91; p = 0.14.
Even when DDC was compared with either ticagrelor or prasugrel or TAPT,
still no significant difference was observed in terms of bleeding
outcomes. Conclusions: In patients with CAD, adverse clinical outcomes
were not significantly different when DDC was compared to the other
antiplatelet regimens. In addition, bleeding events were also similarly
manifested when DDC was compared to DAPT, TAPT or
ticagrelor/prasugrel.<br/>Copyright &#xa9; 2018 The Author(s).

<4>
Accession Number
620733772
Title
Three-dimensional printing in congenital heart disease: A systematic
review.
Source
Journal of Medical Radiation Sciences. 65 (3) (pp 226-236), 2018. Date of
Publication: September 2018.
Author
Lau I.; Sun Z.
Institution
(Lau, Sun) Department of Medical Radiation Sciences, Curtin University,
Perth, Australia
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Three-dimensional (3D) printing has shown great promise in medicine with
increasing reports in congenital heart disease (CHD). This systematic
review aims to analyse the main clinical applications and accuracy of 3D
printing in CHD, as well as to provide an overview of the software tools,
time and costs associated with the generation of 3D printed heart models.
A search of different databases was conducted to identify studies
investigating the application of 3D printing in CHD. Studies based on
patient's medical imaging datasets were included for analysis, while
reports on in vitro phantom or review articles were excluded from the
analysis. A total of 28 studies met selection criteria for inclusion in
the review. More than half of the studies were based on isolated case
reports with inclusion of 1-12 cases (61%), while 10 studies (36%) focused
on the survey of opinion on the usefulness of 3D printing by healthcare
professionals, patients, parents of patients and medical students, and the
remaining one involved a multicentre study about the clinical value of 3D
printed models in surgical planning of CHD. The analysis shows that
patient-specific 3D printed models accurately replicate complex cardiac
anatomy, improve understanding and knowledge about congenital heart
diseases and demonstrate value in preoperative planning and simulation of
cardiac or interventional procedures, assist surgical decision-making and
intra-operative orientation, and improve patient-doctor communication and
medical education. The cost of 3D printing ranges from USD 55 to USD 810.
This systematic review shows the usefulness of 3D printed models in
congenital heart disease with applications ranging from accurate
replication of complex cardiac anatomy and pathology to medical education,
preoperative planning and simulation. The additional cost and time
required to manufacture the 3D printed models represent the limitations
which need to be addressed in future studies.<br/>Copyright &#xa9; 2018
The Authors. Journal of Medical Radiation Sciences published by John Wiley
& Sons Australia, Ltd on behalf of Australian Society of Medical Imaging
and Radiation Therapy and New Zealand Institute of Medical Radiation
Technology.

<5>
Accession Number
2000917472
Title
Meta-analysis of the Impact of Avoiding Balloon Predilation in
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 122 (3) (pp 477-482), 2018. Date of
Publication: 1 August 2018.
Author
Banerjee K.; Kandregula K.; Sankaramangalam K.; Anumandla A.; Kumar A.;
Parikh P.; Kerrigan J.; Khubber S.; Krishnaswamy A.; Mick S.; White J.;
Svensson L.; Kapadia S.
Institution
(Banerjee, Sankaramangalam, Kerrigan, Krishnaswamy, Mick, White, Svensson,
Kapadia) Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio,
United States
(Kandregula) Department of Internal Medicine, Drexel University,
Philadelphia, Pennsylvania, United States
(Anumandla, Parikh, Khubber) Department of Internal Medicine, Cleveland
Clinic, Cleveland, Ohio, United States
(Kumar) Department of Cardiology, Emory University, Atlanta, Georgia,
Georgia
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Balloon predilation (BPD) has been an integral part of transcatheter
aortic valve implantation (TAVI) since inception. We sought to investigate
the effect of avoiding BPD on outcomes of TAVI across different valve
types. Articles were included if outcomes of TAVI without BPD were
reported. Pooled meta-analysis used a random effects model and reported
odds ratios (ORs). Twenty-one studies with 10,752 patients were pooled for
analysis. Age and gender were well matched between NoBPD and BPD groups.
There was no difference in mortality, stroke, bleeding, and acute kidney
injury. NoBPD showed lower pacemaker rates (OR 0.84, 95% confidence
interval [CI] 0.72 to 0.97), vascular complications (OR 0.77, 95% CI 0.62
to 0.95), and early safety at 30 days (OR 0.81, 95% CI 0.66 to 0.99). For
balloon-expandable valves, lower rates of aortic regurgitation (OR 0.73,
95% CI 0.53 to 0.99) and early safety (OR 0.68, 95% CI 0.55 to 0.85) were
seen. Self-expanding valves showed lower pacemaker (OR 0.80, 95% CI 0.66
to 0.97) and vascular complications (OR 0.70, 95% CI 0.50 to 0.99), with a
trend toward higher postdilation (OR 1.51, 95% CI 0.85 to 2.67). TAVI
without BPD is safe and effective. NoBPD is associated with fewer vascular
complications, less aortic regurgitation, and fewer pacemaker requirements
and composite early safety end points.<br/>Copyright &#xa9; 2018

<6>
Accession Number
2000888541
Title
Meta-Analysis Comparing Outcomes and Need for Renal Replacement Therapy of
Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve
Replacement.
Source
American Journal of Cardiology. 122 (3) (pp 468-476), 2018. Date of
Publication: 1 August 2018.
Author
Siddiqui W.J.; Alvarez C.; Aslam M.; Bakar A.; Khan M.H.; Aslam A.; Hanif
M.O.; Hasni S.F.; Ranganna K.; Eisen H.; Aggarwal S.
Institution
(Siddiqui, Hanif, Hasni, Ranganna, Eisen, Aggarwal) Drexel University
College of Medicine, Philadelphia, Pennsylvania, United States
(Siddiqui, Hanif, Hasni, Ranganna, Eisen, Aggarwal) Hahnemann University
Hospital, Philadelphia, Pennsylvania, United States
(Alvarez) Seton Hall University, St. Francis Medical Center, Trenton, New
Jersey, United States
(Aslam, Bakar) Department of Medicine, Dow University of Health Sciences,
Karachi, Pakistan
(Khan) Aga Khan University Medical College, Karachi, Pakistan
(Aslam) Department of Medicine, Beth Israel Deaconess Medical Center,
Harvard University, Boston, Massachusetts, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Acute kidney injury (AKI) is commonly associated with aortic valve
replacement. Surgical aortic valve replacement (SAVR) is a known risk
factor for AKI but little is known about the short- and long-term effects
of transcatheter aortic valve implantation (TAVI). The purpose of our
analysis is to identify the short- and long-term effect of TAVI on renal
outcomes. We searched Medline and PUBMED from January 1, 2000 to November
6, 2017 for randomized control trials (RCTs) comparing TAVI to SAVR in
patients with severe aortic stenosis. Three hundred sixty-nine trials were
identified, 6 RCTs were included in our analysis. RevMan version 5.3 was
used for statistical analysis. Heterogeneity is calculated using
I² statistics. Primary outcomes were AKI within 30 days and 1
year of TAVI, and requirement for renal replacement therapy. We included
5,536 patients (2,796 in TAVI and 2,740 in SAVR arm) from 6 RCTs. Baseline
characteristics were similar. There was reduced incidence of AKI at 30
days of TAVI compared with SAVR, 57 versus 133 (odds ratio [OR] 0.40,
confidence interval [CI] 0.28 to 0.56, p <0.00001, I² = 7%)
with no difference at 1 year (OR 0.65, CI 0.32 to 1.32, p = 0.23,
I² = 76%) and need for renal replacement therapy OR 0.95, CI
0.50 to 1.80, p = 0.87, I² = 0%). Permanent pacemaker was more
frequent in the TAVI arm compared with SAVR arm, 379 versus 110, (OR 3.75,
CI 1.67 to 8.42, p = 0.001, I² = 89%). In conclusion, TAVI is
associated with a reduction in AKIs at 30 days despite the exposure to
contrast and higher incidence of new permanent pacemaker
placement.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<7>
Accession Number
623811221
Title
Challenges with conducting a trial of opioid administration during
anesthesia in pediatric patients undergoing cardiac surgery.
Source
Clinical Trials. Conference: 39th Annual Meeting Society for Clinical
Trials, SCT 2018. United States. 15 (Supplement 2) (pp 131-132), 2018.
Date of Publication: August 2018.
Author
Waberski A.; Braffett B.
Institution
(Waberski) Children's National Medical Center, United States
(Braffett) George Washington University, United States
Publisher
SAGE Publications Ltd
Abstract
Background Postoperative high dose opioid strategies can result
inrespiratory depression, ileus, opioid tolerance, and fluctuations in
analgesia. Methadone administered duringanesthesia has been shown to
reduce postoperativeopioid requirement in adults, however, little is
knownabout the effects in children undergoing high risk cardiac bypass
surgery. Furthermore, the pediatric population has a different set of
requirements pre-andpostoperatively related to patient safety and
positiveoutcomes and the interpretation of adequate analgesiaand control
of agitation in the postoperative period isdifficult in critically ill
pediatric patients. Therefore,conducting a randomized, double-blinded
controlledanesthesia trial in this specialized population poses itsown set
of challenges.MethodsThe objective of the Methadone vs.
FentanylAdministration on Postoperative Pain Control inPediatric Patients
Undergoing Cardiac Surgery(MFAPP-PP) study is to evaluate if
administration ofmethadone vs. fentanyl in pediatric patients (2-8
yearsold, weight.6 kg) undergoing cardiac surgeryimproves postoperative
opioid requirements for paincontrol during the first 24 hours, and to
evaluate anypotential side effects. Continuous pain assessments
aremeasured postoperatively and daily and total opioidconsumption are
recorded. Respiratory support, inotropic support, and discharge times are
included in thepostoperative measurements.ResultsTo date, 25 of the
anticipated 152 patients have beenenrolled in the study. Numerous families
have deniedresearch consent due to the overwhelming nature
andunfamiliarity with pediatric cardiac anesthesia. Amongthose who enroll,
several factors routine to pediatricanesthesia care are challenging to
ascertain and collectconsistently across patients during a research
protocol.Examples include anxiety and agitation which are common
postoperative sequelae for pediatric patients however difficult to
distinguish from inadequate analgesia.Furthermore, clinical and parental
assessments of pain,which routinely dictate the administration of
opioidsbased on scaled scores, are difficult to ascertain.Additional
challenges include tolerance to opioids administered in the newborn or
infant period. We utilized awell documented postoperative balanced
analgesicapproach, including acetaminophen and NSAIDs, whichmay have
additional varying degrees of effect and influence on patient's pain.
Variability among anesthesia andintensive care providers results in
additional challengesto proper standardization of the study protocol
acrosspatients, this includes postoperative extubation criteria,inotropic
support, and discharge criteria. ConclusionThe analgesic picture for
pediatric patients undergoingcongenital heart surgery is often difficult
to diagnoseand treat. We rely heavily on signs rather than symptoms for
interpretation of pain control in children lessthan eight years old.
Providing a well balanced anesthetic technique to include a long acting
opioid maybenefit analgesia and agitation for pediatric patientsfollowing
cardiac bypass surgery. It is the goal of thistrial to optimize opioid
analgesic strategies for pediatriccardiac bypass surgery patients.

<8>
Accession Number
623811119
Title
Imbalanced.
Source
Clinical Trials. Conference: 39th Annual Meeting Society for Clinical
Trials, SCT 2018. United States. 15 (Supplement 2) (pp 185), 2018. Date of
Publication: August 2018.
Author
Chandereng T.; Chappell R.; McDaniel L.
Institution
(Chandereng, Chappell) University of Wisconsin Madison, United States
(McDaniel) Louisiana State University, United States
Publisher
SAGE Publications Ltd
Abstract
Randomization is a common technique used in clinicaltrials to eliminate
potential bias and confounders in apatient population. Randomization
eliminates a systematic difference between subjects in treatment groups
inducing approximate balance with respect to covariates, bothobserved and
unobserved. Equal allocation to treatmentsgroups is the standard due to
its high efficiency in manycases. Statistical efficiencies are directly
related to statistical power. Thus, increasing statistical efficiencies
improvesthe likelihood of correctly rejecting the null hypothesiswhen the
alternative is true. However, in certain scenarios,unequal allocation can
improve efficiency. In superioritytrials with more than two groups, the
optimal randomization is not always a balanced randomization.
Non-inferiority trials are clinical trials designed to establish a
newtreatment that is not much worse than the current treatment or control.
A margin? is introduced to allow a smallloss in efficacy in the new
treatment compared to the control treatment. The margin of? could be
additive or multiplicative and it is important in obtaining the
efficientrandomization ratio. In non-inferiority trials, additivemargin
with equal variance is the only instance withbalanced randomization. The
Cardiovascular PatientOutcomes Research Team (CPORT), which is a
multicenter trial conducted to compare fatality rate betweenpresence of
on-site cardiac surgery in performing angioplasty, serves as a motivation
to this research. Patientswere randomized 1:3 (with and without onsite
cardiac surgery) due to several constraints, therefore reducing the
statistical efficiency and statistical power for the same samplesize (N)
compared to the optimal randomization ratio.This paper describes each case
and computes the optimalrandomization ratio and efficiency gains compared
to abalanced randomization.

<9>
Accession Number
623811100
Title
Design of the teammate trial for children with heart transplant and
development of a novel efficient endpoint.
Source
Clinical Trials. Conference: 39th Annual Meeting Society for Clinical
Trials, SCT 2018. United States. 15 (Supplement 2) (pp 183), 2018. Date of
Publication: August 2018.
Author
Sleeper L.; Daly K.; Rossano J.; Desai M.; Auerbach S.; Bock D.M.;
Castleberry C.; Fenton M.; Hollander S.; Lal A.; Pahl E.; Almond C.
Institution
(Sleeper, Daly) Boston Children's Hospital, Harvard Medical School, United
States
(Rossano) Children's Hospital of Philadelphia, United States
(Desai) Stanford University School of Medicine, United States
(Auerbach) Children's Hospital Colorado, University of Colorado, United
States
(Bock) Loma Linda University, United States
(Castleberry) Washington University School of Medicine, United States
(Fenton) Great Ormond Street Hospital, United States
(Hollander, Almond) Lucile Packard Children's Hospital, Stanford
University School of Medicine, United States
(Lal) Primary Children's Hospital, University of Utah, United States
(Pahl) Ann and Robert H. Lurie Children's Hospital of Chicago, United
States
Publisher
SAGE Publications Ltd
Abstract
Background Clinical research in pediatric heart transplant has
historically been conducted to assess short-term outcomesat single
centers. Efficient approaches are needed to testhypotheses related to
long-term outcome.Median survival after pediatric heart transplantationis
only 15 years in the current era, due to the occurrence of late
complications after heart transplant, mostof which stem from the
medications used to suppressthe immune system in order to prevent graft
rejection.While graft survival has improved significantly with thecurrent
standard of care, tacrolimus (TAC) and mycophenolate mofetil (MMF), most
of the improvementhas come from a reduction in early mortality.
Latemortality is driven by 6 major adverse transplant events(MATE): acute
cellular rejection (ACR), antibodymediated rejection, coronary artery
vasculopathy(CAV), post-transplant lymphoproliferative disorder,infection,
and chronic kidney disease (CKD). In recentyears, everolimus (EVL), a
proliferation signal inhibitor, in combination with low-dose
tacrolimus(LDTAC), has emerged as a potential treatment thatmay improve
longer-term survival by reducing the riskof CAV, CKD and ACR, as well as
cytomegalovirusinfection.The ChallengeEvaluation of an immunosuppressive
regimen to reducethe rate of long-term complications of transplant is
hindered by a large sample size requirement and lengthyfollow-up in order
to achieve sufficient power to detecttreatment differences. The MATE Score
was developedby a network of pediatric heart transplant investigators;it
was validated against long-term registry outcomesand then approved by the
FDA, paving the way forimplementation of an efficient trial
design.DesignThe FDA-regulated, multicenter randomizedTEAMMATE Trial
network infrastructure was built in2017 and launched enrollment in 2018.
The trial is ledby a Clinical Coordinating Center at StanfordUniversity
and a Data Coordinating Center at BostonChildren's Hospital. Innovations
include the MATEscore and the use of a central IRB for over 20 sites
tofacilitate efficient trial start-up. The target of 210patients will be
randomized to either the standardTAC/MMF or EVL/LDTAC at 6 months
post-transplant. The primary efficacy and safety endpoints aretwo forms of
the MATE score. Follow-up is 2.5 yearsper subject. Central adjudication of
clinical MATEevents and a core laboratory for angiogram interpretation are
in place to minimize variance.ConclusionsLeveraging the cumulative burden
of multiple complications into a single, continuous validated
endpointenables the TEAMMATE trial to test a hypothesisregarding long-term
outcome with relatively short follow-up. This talk will highlight trial
endpoint development, statistical power considerations, and the
logisticsof efficiently launching a complex multicenter trial withmultiple
stakeholders. We anticipate that theTEAMMATE trial will result in FDA
approval of thefirst immunosuppression regimen for pediatric
hearttransplantation and that the trial infrastructure willfacilitate the
development of a sustainable clinicalresearch network for the pediatric
heart transplantfield.

<10>
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Accession Number
623815984
Title
A randomized controlled trial investigating the effect of high-energy
formula on weight gain and gastrointestinal tolerance in postoperative
infants with congenital heart disease.
Source
Pediatric Critical Care Medicine. Conference: 9th Congress of the World
Federation of Pediatric Intensive and Critical Care Societies, WFPICCS
2018. Singapore. 19 (6 Supplement 1) (pp 13), 2018. Date of Publication:
June 2018.
Author
Zhang H.; Gu Y.; Mi Y.; Jin Y.; Fu W.; Latour J.
Institution
(Zhang) Children's Hospital of Fudan University, PICU, Shanghai, China
(Gu) Children's Hospital of Fudan University, Nursing Department,
Shanghai, China
(Mi, Jin, Fu) Children's Hospital of Fudan University, Cardiac Intensive
Unit, Shanghai, China
(Latour) Plymouth University, School of Nursing and Midwifery, Plymouth,
United Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
Aims & Objectives: To investigate the effect of high-energy formula (HF)
on weight gain and gastrointestinal tolerance in postoperative infants
with congenital heart disease. Methods A double-blinded randomized
controlled trial at a cardiac intensive care unit in a Chinese children's
hospital. Participants were infants <1 year of age after cardiac surgery
and were randomly assigned to intervention group (n=32) or control group
(n=32). The intervention group received HF (100 kcal/100 mL) and the
control group standard formula (67 kcal/100 mL) for 7 postoperative days.
Primary outcomes were weight gain and gastrointestinal intolerance;
secondary outcomes were prealbumin, energy intake and standard intensive
care characteristics. Final analysis included 30 infants in intervention
and 29 infants in control group. Trial registration at ClinicalTrials. gov
is #NCT02389491. Results Infants who received HF (n=30) showed greater
weight gain than those in the control group (n=29) (-0.09 +/- 0.18kg/7days
versus-0.30 +/- 0.22kg/7days, p<0.0001). Gastrointestinal intolerance was
observed in the intervention group with abdominal tympany (n=1), gastric
retention (n=2), and diarrhea (n=1), while the control group had no
problems. The prealnumin showed significant differences at day 7
(p=0.037). Enteral energy intake in the intervention group showed higher
than control group from day 3(Figure 1). We observed no significant
differences in secondary outcomes of ICU characteristics (Table 1).
Conclusions Postoperative infants with congenital heart disease receiving
HF gained more weight and experienced some gastrointestinal problems than
those infants receiving standard formula. We suggest infants receiving HF
were safe and effective, also need more studies to confirm it. (Figure
prsented). (Table presented).

<11>
Accession Number
623815431
Title
Prevention of post-cardiac surgery vitamin d deficiency in children with
congenital heart disease: Results of a pilot dose evaluation randomized
controlled trial.
Source
Pediatric Critical Care Medicine. Conference: 9th Congress of the World
Federation of Pediatric Intensive and Critical Care Societies, WFPICCS
2018. Singapore. 19 (6 Supplement 1) (pp 44), 2018. Date of Publication:
June 2018.
Author
McNally D.; O'Hearn K.; Lougheed J.; Fergusson D.; Maharajh G.; Weiler H.;
Jones G.; Khamessan A.; Redpath S.; Geier P.; McIntyre L.; Doherty D.R.;
Lawson M.; Menon K.
Institution
(McNally, Lougheed, Redpath, Geier, Lawson, Menon) Children's Hospital of
Eastern Ontario, Pediatrics, Ottawa, Canada
(O'Hearn) Children's Hospital of Eastern Ontario Research Institute,
Research, Ottawa, Canada
(Fergusson) Ottawa Hospital Research Institute, Clinical Epidemiology,
Ottawa, Canada
(Maharajh) University of Ottawa, Division of Cardiovascular Surgery,
Ottawa, Canada
(Weiler) McGill University, School of Human Nutrition, Montreal, Canada
(Jones) Queen's University, Biomedical and Molecular Sciences, Kingston,
Canada
(Khamessan) Euro-Pharm International Canada Inc., Ottawa, Canada
(McIntyre) Ottawa Hospital, Critical Care, Ottawa, Canada
(Doherty) Children's University Hospital, Pediatric Intensive Care Unit,
Dublin, Ireland
Publisher
Lippincott Williams and Wilkins
Abstract
Aims & Objectives: Associations between post-operative vitamin D status
and illness severity suggest that optimization could improve outcome
following pediatric congenital heart disease (CHD) surgery. Methods
Two-arm, double blind RCT in children requiring cardiopulmonary bypass for
CHD at a Canadian tertiary care center. Eligible patients were randomized
to receive either usual care (UC, < 1 year = 400 IU/day, > 1 year=600
IU/day) or high dose (HD) vitamin D supplementation approximating the
Institute of Medicine recommended Tolerable Upper Intake Level (< 1 year =
1600 IU/day, > 1 year = 2400 IU/day). The primary outcome was vitamin D
status, assessed using blood 25-hydroxyvitamin D (25OHD). Results
Forty-six children were randomized (24 HD, 22 UC). Five withdrew, leaving
41 children for analysis (21 HD, 20 UC). Compared to UC, the HD group had
higher 25OHD concentrations immediately preoperatively (81.5 +/- 36.5 vs.
55.5 +/- 13.8 nmol/L, p=0.005) and at time of PICU admission (52.0 +/-
23.3 vs. 34.8 +/- 12.0 nmol/L, p =0.006). The post-operative rate for
25OHD <50 nmol/L was significantly lower in the HD arm (84% vs. 43%, p =
0.009). Multivariate regression demonstrated longer periods between
enrollment and surgery to be associated with higher post-operative 25OHD
concentrations (+0.73 nmol/L per week, p=0.02). No vitamin D related
adverse events were observed. Conclusions Pre-operative daily high-dose
supplementation safely improved post-operative vitamin D status compared
to usual care. Findings suggest that an alternative loading dose
supplementation strategy may be required to optimize post-operative
vitamin D status in children with short intervals between presentation,
diagnosis and surgery.

<12>
Accession Number
623771658
Title
Maintaining intraoperative normothermia reduces blood loss in patients
undergoing major operations: A pilot randomized controlled clinical trial.
Source
BMC Anesthesiology. 18 (1) (no pagination), 2018. Article Number: 126.
Date of Publication: 08 Sep 2018.
Author
Yi J.; Liang H.; Song R.; Xia H.; Huang Y.
Institution
(Yi, Liang, Song, Xia, Huang) Chinese Academy of Medical Science,
Department of Anesthesia, Peking Union Medical College Hospital, 1
Shuaifuyuan, Dongcheng District, Beijing 100730, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Inadvertent intraoperative hypothermia (core
temperature<36degreeC) is a common but preventable adverse event. This
study aimed to determine whether active intraoperative warming reduced
bleeding in patients undergoing major operations: open thoracic surgery
and hip replacement surgery. Methods/Design: The study was a pilot,
prospective, parallel two-arm randomized controlled trial. Eligible
patients were randomly allocated to two groups: passive warming (PW), with
application of a cotton blanket (thermal insulation), or active warming
(AW), with a forced-air warming system. The primary endpoint was
intraoperative blood loss, and secondary endpoints were surgical-site
infection, cardiovascular events, and length of stay in the
post-anesthesia care unit, intensive care unit, and hospital. Results:
Sixty-two patients were enrolled. Forced-air active warming maintained
intraoperative normothermia in all AW subjects, whereas intraoperative
hypothermia occurred in 21/32 (71.8%) of PW patients (p=0.000). The volume
of blood loss was more in the PW group (682+/-426ml) than in the AW group
(464+/-324ml) (p<0.021), and the perioperative hemoglobin value declined
more in the PW group (28.6+/-17.5g/L) than in the AW group (21.0+/-9.9g/L)
(p=0.045). However, there were no difference in other clinical outcomes
between two groups. Conclusion: Intraoperative active warming is
associated with less blood loss than passive warming in open thoracic and
hip replacement operations in this pilot study.<br/>Copyright &#xa9; 2018
The Author(s).

<13>
Accession Number
623743755
Title
Effects of epidural anesthesia combined with inhalation anesthesia or
intravenous anesthesia on intrapulmonary shunt and oxygenation in patients
undergoing long term single lung ventilation.
Source
Pakistan Journal of Medical Sciences. 34 (4) (pp 799-803), 2018. Date of
Publication: July-August 2018.
Author
Zheng X.; Lv Z.; Yin K.; Peng M.
Institution
(Zheng, Lv, Yin, Peng) Department of Anesthesiology, Yongchuan Hospital of
Chongqing Medical University, Chongqing 402160, China
Publisher
Professional Medical Publications (Raja Ghazanfar Ali Road, Saddar,
Karachi, Pakistan)
Abstract
Objective: To investigate the effect of epidural anesthesia combined with
inhalation or intravenous anesthesia on intrapulmonary shunt and
oxygenation in patients undergoing long term single lung ventilation.
Methods: Eighty patients, aged 35-75, American Society of Anesthesiology
(ASA) classification of I-III, undergoing thoracic surgery with one lung
ventilation more than three hour, were randomly divided into propofol
group (group Pro), propofol combined with epidural anesthesia group (group
Pro+Epi), isoflurane group (group Iso) and isoflurane combined with
epidural anesthesia group (group Iso+ Epi), 20 patients in each group.
Arterial blood and mixed venous blood were taken for blood gas analysis,
and hemodynamic data were recorded at following time points: before
induction in supine position (T<inf>1</inf>), 30min after bilateral lung
ventilation (T<inf>2</inf>), 15min after one lung ventilation
(T<inf>3</inf>), 30min after one lung ventilation (T4), 60min after one
lung ventilation (T5), 180min after one lung ventilation (T6),
intrapulmonary shunt (Qs/Qt) was calculated according to the correlation
formula. Results: Qs/Qt values at T<inf>2-6</inf> in four groups were
significantly higher than that of T<inf>1</inf>, and Qs/Qt values at
T<inf>3-6</inf> was significantly higher than that of T<inf>2</inf> (P<
0.05); PaO2 at T<inf>2-6</inf> were significantly higher than that of
T<inf>1</inf>, with PaO2 at T<inf>3-6</inf> were significantly lower than
T<inf>2</inf> (P< 0.05). Between groups, Qs/Qt values in group Iso were
significantly higher than that of group Pro, Pro+Epi and Iso+Epi at
T<inf>3-5</inf> (P< 0.05). There was no significant difference in
PaO<inf>2</inf> between groups (P> 0.05). CI at T3-6 in group Iso and
Iso+Epi were significantly higher than that of T<inf>1</inf> (P<0.05), and
were significantly higher than that of propofol group (P<0.05). MAP at
T<inf>3-6</inf> in group Pro+Epi and Iso+Epi were significantly lower than
that at T<inf>1</inf> (P <0.05). Heart rate at T<inf>4-6</inf> in group
Iso were significantly higher than T<inf>1</inf>, and higher than group
Pro and group Iso+Epi (P <0.05). Conclusion: One lung ventilation may
predispose to increase of intrapulmonary shunt and decrease in arterial
partial pressure of oxygen; isoflurane inhalation anesthesia is more
likely to cause intrapulmonary shunt, but no changes in arterial partial
pressure of oxygen.<br/>Copyright &#xa9; 2018, Professional Medical
Publications. All rights reserved.

<14>
Accession Number
2001081212
Title
The 2018 ISHLT/APM/AST/ICCAC/STSW recommendations for the psychosocial
evaluation of adult cardiothoracic transplant candidates and candidates
for long-term mechanical circulatory support.
Source
Psychosomatics. (no pagination), 2018. Date of Publication: 2018.
Author
Dew M.A.; DiMartini A.F.; Dobbels F.; Grady K.L.; Jowsey-Gregoire S.G.;
Kaan A.; Kendall K.; Young Q.-R.; Abbey S.E.; Butt Z.; Crone C.C.; De
Geest S.; Doligalski C.T.; Kugler C.; McDonald L.; Ohler L.; Painter L.;
Petty M.G.; Robson D.; Schloglhofer T.; Schneekloth T.D.; Singer J.P.;
Smith P.J.; Spaderna H.; Teuteberg J.J.; Yusen R.D.; Zimbrean P.C.
Institution
(Dew, DiMartini) University of Pittsburgh School of Medicine and Medical
Center, Pittsburgh, Pennsylvania, United States
(Dobbels, De Geest) Katholieke Universiteit Leuven, Leuven, Belgium
(Grady, Butt) Northwestern University Feinberg School of Medicine,
Chicago, Illinois, United States
(Jowsey-Gregoire, Schneekloth) Mayo Clinic, Rochester, Minnesota, United
States
(Kaan, Young) St. Paul's Hospital, Vancouver, British Columbia, Canada
(Kendall) Cleveland Clinic, Cleveland, Ohio, United States
(Abbey) University of Toronto and University Health Network, Toronto,
Ontario, Canada
(Crone) INOVA Hospitals, Fairfax, Virginia, United States
(De Geest) University of Basel, Basel, Switzerland
(Doligalski) Tampa General Hospital, Tampa, Florida, United States
(Kugler) University of Freiburg, Freiburg, Germany
(McDonald) University of North Carolina, Chapel Hill, North Carolina,
United States
(Ohler) George Washington University, Washington, DC, United States
(Painter) Auckland City Hospital, Auckland, New Zealand
(Petty) University of Minnesota, Minneapolis, Minnesota, United States
(Robson) St. Vincent's Hospital, Sydney, New South Wales, Australia
(Schloglhofer) Medical University of Vienna, Vienna, Austria
(Singer) University of California at San Francisco, San Francisco,
California, United States
(Smith) Duke University, Durham, North Carolina, United States
(Spaderna) Trier University, Trier, Germany
(Teuteberg) Stanford University, Stanford, California, United States
(Yusen) Washington University, St. Louis, Missouri, United States
(Zimbrean) Yale University, New Haven, Connecticut, United States
(Doligalski) University of North Carolina, Chapel Hill, NC, United States
(Ohler) New York University Medical Center, New York, NY, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The psychosocial evaluation is well-recognized as an important component
of the multifaceted assessment process to determine candidacy for heart
transplantation, lung transplantation, and long-term mechanical
circulatory support (MCS). However, there is no consensus-based set of
recommendations for either the full range of psychosocial domains to be
assessed during the evaluation, or the set of processes and procedures to
be used to conduct the evaluation, report its findings, and monitor
patients' receipt of and response to interventions for any problems
identified. This document provides recommendations on both evaluation
content and process. It represents a collaborative effort of the
International Society for Heart and Lung Transplantation (ISHLT) and the
Academy of Psychosomatic Medicine, American Society of Transplantation,
International Consortium of Circulatory Assist Clinicians, and Society for
Transplant Social Workers. The Nursing, Health Science and Allied Health
Council of the ISHLT organized a Writing Committee composed of
international experts representing the ISHLT and the collaborating
societies. This Committee synthesized expert opinion and conducted a
comprehensive literature review to support the psychosocial evaluation
content and process recommendations that were developed. The
recommendations are intended to dovetail with current ISHLT guidelines and
consensus statements for the selection of candidates for cardiothoracic
transplantation and MCS implantation. Moreover, the recommendations are
designed to promote consistency across programs in the performance of the
psychosocial evaluation by proposing a core set of content domains and
processes that can be expanded as needed to meet programs' unique needs
and goals.<br/>Copyright &#xa9; 2018 The Authors

<15>
Accession Number
623824864
Title
Sentinel node navigation surgery in esophageal cancer.
Source
Annals of Gastroenterological Surgery. (no pagination), 2018. Date of
Publication: 2018.
Author
Takeuchi H.; Kitagawa Y.
Institution
(Takeuchi) Department of Surgery, Hamamatsu University School of Medicine,
Hamamatsu, Japan
(Kitagawa) Department of Surgery, Keio University School of Medicine,
Tokyo, Japan
Publisher
Wiley-Blackwell Publishing Ltd (E-mail: info@royensoc.co.uk)
Abstract
Over the last 20 years, the sentinel node (SN) concept has been widely
applied to the surgical staging of both breast cancer and melanoma.
However, the validity of this concept has been controversial for
esophageal cancer, because SN mapping for esophageal cancer is not
considered to be technically easy because of the complicated
multidirectional lymphatic networks of the esophagus and mediastinum.
Nevertheless, studies including meta-analyses indicated that SN mapping
may be feasible in early esophageal cancer. Transthoracic esophagectomy
with three-field lymphadenectomy was developed as a potential curative
procedure for thoracic esophageal cancer. However, this highly invasive
procedure might increase morbidity and reduce patients' quality of life
(QOL) after esophagectomy. Although further validation based on
multicenter trials using the standard protocol of SN mapping for
esophageal cancer is required, SN navigation surgery would enable us to
carry out personalized and limited lymph node dissection which might
reduce morbidity and maintain patients' QOL.<br/>Copyright &#xa9; 2018 The
Authors. Annals of Gastroenterological Surgery published by John Wiley &
Sons Australia, Ltd on behalf of The Japanese Society of
Gastroenterological Surgery

<16>
Accession Number
623824303
Title
Risk of heart failure in a population with type 2 diabetes versus a
population without diabetes with and without coronary heart disease.
Source
Diabetes, Obesity and Metabolism. (no pagination), 2018. Date of
Publication: 2018.
Author
Chen H.-F.; Ho C.-A.; Li C.-Y.
Institution
(Chen) Department of Endocrinology, Far Eastern Memorial Hospital, New
Taipei City, Taiwan (Republic of China)
(Chen) School of Medicine, Fujen Catholic University, New Taipei City,
Taiwan (Republic of China)
(Ho) Department of Surgery, Catholic Mercy Hospital, Hsinchu County,
Taiwan (Republic of China)
(Li) Department of Public Health, College of Medicine, National Cheng Kung
University, Tainan City, Taiwan (Republic of China)
(Li) Department of Public Health, College of Public Health, China Medical
University, Taichung City, Taiwan (Republic of China)
Publisher
Blackwell Publishing Ltd
Abstract
Aims: To conduct a population-based study comparing age- and sex-specific
risk estimates of heart failure (HF) between people with type 2 diabetes
and people without diabetes, and to investigate the risks of HF in
association with type 2 diabetes in people with various coronary heart
diseases (CHDs). Materials and methods: We used a nationally
representative sample (one million people) selected from Taiwan's National
Health Insurance (NHI) system. A total of 34 291 patients with type 2
diabetes were identified from ambulatory care claims in 2000, and the same
number of age- and sex-matched controls were randomly selected from the
registry of NHI beneficiaries in the same year. All study subjects were
linked to inpatient claims (2000-2013) to identify the possible admissions
for HF. Using a Cox proportional hazard regression model, we compared the
relative hazards of HF in relation to type 2 diabetes according to various
age and sex stratifications. We also compared the relative hazard of HF
between type 2 diabetes and controls, with and without histories of
various CHDs and coronary revascularization procedures. Results: Compared
with absence of diabetes (control group), type 2 diabetes was
significantly associated with an increased hazard of HF (adjusted hazard
ratio [aHR] 1.47, 95% confidence interval [CI] 1.40-1.54]. In both sexes,
those with type 2 diabetes aged <45 years had the highest increased hazard
of HF, with an aHR of 2.54 (95% CI 1.62-3.98) and 4.12 (95% CI 2.35-7.23)
for men and women, respectively. Compared with the control subjects
without any CHD, people with type 2 diabetes without prior CHD had
increased hazards of HF (aHR 1.54, 95% CI 1.41-1.68, in men and aHR 1.56,
95% CI 1.43-1.71, in women), which were similar to the aHRs for people
without diabetes who had histories of heart diseases (aHR 1.60 and 1.55
for men and women, respectively). Conclusions: Diabetes mellitus may
increase the risk of HF in both men and women, as well as in all age
groups, especially in young people. People with type 2 diabetes without
CHD had a similarly increased risk of HF to that of control subjects with
CHD. Certain coronary revascularization procedures and CHDs, including
percutaneous transluminal coronary angiography, coronary artery bypass
surgery and acute myocardial infarction, were found to greatly increase
risk of HF in people with type 2 diabetes.<br/>Copyright &#xa9; 2018 John
Wiley & Sons Ltd

<17>
Accession Number
623816674
Title
Ross Procedure vs Mechanical Aortic Valve Replacement in Adults: A
Systematic Review and Meta-analysis.
Source
JAMA Cardiology. (no pagination), 2018. Date of Publication: 2018.
Author
Mazine A.; Rocha R.V.; El-Hamamsy I.; Ouzounian M.; Yanagawa B.; Bhatt
D.L.; Verma S.; Friedrich J.O.
Institution
(Mazine, Rocha) Division of Cardiac Surgery, Department of Surgery,
University of Toronto, Toronto, ON, Canada
(El-Hamamsy) Department of Cardiac Surgery, Montreal Heart Institute,
Montreal, QC, Canada
(Ouzounian) Department of Cardiac Surgery, Toronto General Hospital,
Toronto, ON, Canada
(Yanagawa, Verma) Department of Cardiac Surgery, St Michael's Hospital,
Toronto, ON, Canada
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Friedrich) Department of Critical Care Medicine, St Michael's Hospital,
30 Bond St, Toronto, ON M5B 1W8, Canada
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: The ideal aortic valve substitute in young and middle-aged
adults remains unknown. Objective: To compare long-term outcomes between
the Ross procedure and mechanical aortic valve replacement in adults. Data
Sources: The Ovid versions of MEDLINE and EMBASE classic (January 1, 1967,
to April 26, 2018; search performed on April 27, 2018) were screened for
relevant studies using the following text word search in the title or
abstract: ("Ross" OR "autograft") AND ("aortic" OR "mechanical"). Study
Selection: All randomized clinical trials and observational studies
comparing the Ross procedure to the use of mechanical prostheses in adults
undergoing aortic valve replacement were included. Studies were included
if they reported any of the prespecified primary or secondary outcomes.
Studies were excluded if no clinical outcomes were reported or if data
were published only as an abstract. Citations were screened in duplicate
by 2 of the authors, and disagreements regarding inclusion were reconciled
via consensus. Data Extraction and Synthesis: This meta-analysis was
conducted in accordance with the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses and Meta-analysis of Observational Studies in
Epidemiology guidelines. Data were independently abstracted by 3 reviewers
and pooled using a random-effects model. Main Outcomes and Measures: The
prespecified primary outcome was all-cause mortality. Results: The search
identified 2919 reports, of which 18 studies (3516 patients) met inclusion
criteria, including 1 randomized clinical trial and 17 observational
studies, with a median average follow-up of 5.8 (interquartile range,
3.4-9.2) years. Analysis of the primary outcome showed a 46% lower
all-cause mortality in patients undergoing the Ross procedure compared
with mechanical aortic valve replacement (incidence rate ratio [IRR],
0.54; 95% CI, 0.35-0.82; P =.004; I² = 28%). The Ross procedure
was also associated with lower rates of stroke (IRR, 0.26; 95% CI,
0.09-0.80; P =.02; I² = 8%) and major bleeding (IRR, 0.17; 95%
CI, 0.07-0.40; P <.001; I² = 0%) but higher rates of
reintervention (IRR, 1.76; 95% CI, 1.16-2.65; P =.007; I² =
0%). Conclusions and Relevance: Data from primarily observational studies
suggest that the Ross procedure is associated with lower all-cause
mortality compared with mechanical aortic valve replacement. These
findings highlight the need for a large, prospective randomized clinical
trial comparing long-term outcomes between these 2
interventions.<br/>Copyright &#xa9; 2018 American Medical Association. All
rights reserved.

<18>
[Use Link to view the full text]
Accession Number
622570819
Title
Sex-Specific Outcomes after Transcatheter Aortic Valve Replacement: A
Review of the Literature.
Source
Cardiology in Review. 26 (2) (pp 73-81), 2018. Date of Publication: 2018.
Author
Azarbaijani Y.; O'Callaghan K.; Sanders W.E.; Wu C.; Laschinger J.;
Marinac-Dabic D.; Strauss D.G.; Canos D.A.; Zusterzeel R.
Institution
(Azarbaijani, O'Callaghan, Sanders, Wu, Laschinger, Marinac-Dabic,
Strauss, Canos, Zusterzeel) US Food and Drug Administration, 10903 New
Hampshire Ave, Silver Spring, MD 20993-0002, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Transcatheter aortic valve replacement (TAVR) is a safe and effective
therapy for aortic valve replacement in patients ineligible for or at high
risk for surgery. However, outcomes after TAVR based on an individual's
sex remain to be fully elucidated. We searched PUBMED and EMBASE using the
keywords: "transcatheter aortic valve replacement," "transcatheter aortic
valve implantation," "sex differences," "gender," "sex characteristics"
and collected information on baseline features, procedural
characteristics, and postprocedural outcomes in women. Inclusion/exclusion
resulted in 23 publications. Women had less preexisting comorbidities than
men. Most studies reported better survival in women (range of hazard ratio
[95% CI] = 0.27 [0.09-0.84] to 0.91 [0.75-1.10]). At 30 days, women also
had more vascular complications (6-20% vs 2-14%) and higher bleeding rates
(10-44% vs 8-25%). Stroke rates were similar at 30 days (women, 1-7%; men,
1-5%). This literature review showed better survival in women than men
after TAVR. However, women had more vascular complications and bleeding;
stroke rates were similar. These findings may partly be explained by fewer
baseline comorbidities in women. These results should be interpreted with
caution as most measures only include unadjusted
percentages.<br/>Copyright &#xa9; 2018 Wolters Kluwer Health, Inc. All
rights reserved.

<19>
[Use Link to view the full text]
Accession Number
620924588
Title
Evaluation and Management of Maternal Congenital Heart Disease: A Review.
Source
Obstetrical and Gynecological Survey. 73 (2) (pp 116-124), 2018. Date of
Publication: 01 Feb 2018.
Author
Hopkins M.K.; Goldstein S.A.; Ward C.C.; Kuller J.A.
Institution
(Hopkins, Kuller) Division of Maternal-Fetal Medicine, Department of
Obstetrics and Gynecology, Duke University, Durham, NC, United States
(Goldstein, Ward) Division of Cardiology, Department of Internal Medicine,
Duke University, Durham, NC, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective Congenital heart defects represent the most common major
congenital anomalies. The objective of this review was to define the most
common forms of congenital heart disease (CHD) in pregnancy, outline
preconception counseling, discuss the associated morbidity and mortality
of each lesion, and review current recommendations for management of CHD
in pregnancy. Evidence Acquisition A MEDLINE search of "congenital heart
disease in pregnancy" and specific conditions in pregnancy including
"ventricular septal defect," "atrial septal defect," "left outflow
obstruction," "right outflow obstruction," "tetralogy of Fallot," and
"transposition of the great vessels" was performed. Results The evidence
included in the review contains 18 retrospective studies, 8 meta-analyses
or systematic reviews or expert opinions, 5 case reports including
surgical case reports, 2 prospective studies, and 2 clinical texts.
Conclusions Given advances in surgical and medical management, women with
a history of congenital cardiac defects are more frequently reaching
childbearing age and requiring obstetric care. Many women with CHD can
have successful pregnancies, although there are a few conditions that
confer significant maternal risk, and pregnancy may even be
contraindicated. Appropriate care for women with CHD requires a knowledge
of cardiac physiology in pregnancy, the common lesions of CHD, and
coordinated care from cardiology and maternal-fetal medicine specialists.
Target Audience Obstetricians and gynecologists, family physicians.
Learning Objectives After completing this activity, the learner should be
better able to compare pregnancy risks among varying types of the most
common maternal CHD; apply criteria of relative and absolute
contraindications to pregnancy when performing preconception counseling to
women with CHD; interpret for patients and other health providers the
prognosis, management, and expectations of pregnancies with women with the
most common types of CHD; and select relevant imaging studies, tests, and
appropriate consultations and referrals when caring for women with
maternal CHD.<br/>Copyright &#xa9; Wolters Kluwer Health, Inc. All rights
reserved.

<20>
Accession Number
623175183
Title
Study Design of the Graft Patency After FFR-Guided Versus
Angiography-Guided CABG Trial (GRAFFITI).
Source
Journal of Cardiovascular Translational Research. 11 (4) (pp 269-273),
2018. Date of Publication: 01 Aug 2018.
Author
Toth G.G.; De Bruyne B.; Kala P.; Ribichini F.L.; Casselman F.; Ramos R.;
Piroth Z.; Fournier S.; Van Mieghem C.; Penicka M.; Mates M.; Van Praet
F.; Degriek I.; Barbato E.
Institution
(Toth) Department of Cardiology, University Heart Center Graz, Medical
University of Graz, Graz, Austria
(Toth, De Bruyne, Casselman, Fournier, Van Mieghem, Penicka, Van Praet,
Degriek, Barbato) Cardiovascular Research Center Aalst, OLV Clinic, OLV
Hospital, Moorselbaan, 164, Aalst B-9300, Belgium
(Kala) Department of Cardiology and Internal Medicine, University Hospital
Brno and Medical Faculty of Masaryk University, Brno, Czech Republic
(Ribichini) Division of Cardiology, Department of Medicine, University of
Verona, Verona, Italy
(Ramos) Hospital Santa Marta - Centro Hospitalar Lisboa Central, Lisbon,
Portugal
(Piroth) Hungarian Institute of Cardiology, Budapest, Hungary
(Mates) Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic
(Barbato) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University, Naples, Italy
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Clinical benefit of invasive functionally guided revascularization has
been mostly investigated and proven for percutaneous coronary
intervention. It has never been prospectively evaluated whether a
systematic fractional flow reserve (FFR) assessment is also beneficial in
guiding coronary artery bypass graft surgery (CABG). The objective of the
GRAft patency after FFR-guided versus angiography-guIded CABG (GRAFFITI)
trial was to compare an FFR-guided revascularization strategy to the
traditional angiography-guided revascularization strategy for patients
undergoing CABG. Patients were enrolled with significantly diseased left
anterior descending or left main stem and at least one major coronary
artery with angiographically intermediate stenosis (30-90% diameter
stenosis) that was assessed by FFR. Thereafter, while the FFR values were
kept concealed, cardiac surgeons decided their intended procedural
strategy based on the coronary angiography alone. At this point, patients
underwent 1:1 randomization to either an FFR-guided or an
angiography-guided CABG strategy. In case the patient was randomized to
angiography-guided arm, cardiac surgeons kept their intended procedural
strategy, i.e., CABG was guided solely on the basis of the coronary
angiography. In case the patient was randomized to the FFR-guided arm, FFR
values were disclosed to the surgeons who revised the surgical protocol
according to the functional significance of each coronary stenosis. The
primary endpoint of the trial was the rate of graft occlusion at 12
months, assessed by coronary computed tomography or coronary angiography.
The secondary endpoints were (1) length of postoperative hospital stay;
(2) changes in surgical strategy depending upon FFR results (in FFR-guided
group only); and (3) rate of major adverse cardiac and cerebrovascular
events, i.e., composite of death, myocardial infarction, stroke, and any
revascularization during the follow-up period. This study is the first
prospective randomized trial investigating potential clinical benefits,
associated with FFR-guided surgical revascularization. Trial registration:
NCT01810224.<br/>Copyright &#xa9; 2018, Springer Science+Business Media,
LLC, part of Springer Nature.

<21>
Accession Number
623769495
Title
Rejuvenation of allogenic red cells: benefits and risks.
Source
Vox Sanguinis. 113 (6) (pp 509-529), 2018. Date of Publication: August
2018.
Author
Aujla H.; Wozniak M.; Kumar T.; Murphy G.J.; Cardigan R.; Deary A.; Hodge
R.; Smethurst P.; Braund R.; Mellor P.; Edmondson D.; Collett D.;
Griffiths A.; New H.; Landrigan M.; Gray A.
Institution
(Aujla, Wozniak, Kumar, Murphy) Department of Cardiovascular Sciences and
NIHR Leicester Biomedical Research Centre - Cardiovascular Theme,
Glenfield General Hospital, University of Leicester, Leicester, United
Kingdom
National Health Service Blood and Transplant, Cambridge, United Kingdom
Department of Haematology, Cambridge Biomedical Campus, University of
Cambridge, Cambridge, United Kingdom
National Health Service Blood and Transplant, Filton, Bristol, United
Kingdom
National Health Service Blood and Transplant, Stoke Gifford, Bristol,
United Kingdom
National Health Service Blood and Transplant, Colindale, London, United
Kingdom
Zimmer Biomet, Warsaw, IN, United States
Citra Labs, A Zimmer Biomet Company, Braintree, MA, United States
Publisher
Blackwell Publishing Ltd
Abstract
Background and objectives: To review preclinical and clinical studies that
have evaluated the effects of red cell rejuvenation in vivo and in vitro
and to assess the potential risks and benefits from their clinical use.
Materials and methods: A systematic review and narrative synthesis of the
intervention of red cell rejuvenation using a red cell processing solution
containing inosine, pyruvate, phosphate and adenine. Outcomes of interest
in vitro were changes in red cell characteristics including adenosine
triphosphate (ATP), 2,3-diphosphoglycerate (2,3-DPG), deformability and
the accumulation of oxidized lipids and other reactive species in the red
cell supernatant. Outcomes in vivo were 24-h post-transfusion survival and
the effects on oxygen delivery, organ function and inflammation in
transfused recipients. Results: The literature search identified 49
studies evaluating rejuvenated red cells. In vitro rejuvenation restored
cellular properties including 2,3-DPG and ATP to levels similar to freshly
donated red cells. In experimental models, in vivo transfusion of
rejuvenated red cells improved oxygen delivery and myocardial, renal and
pulmonary function when compared to stored red cells. In humans, in vivo
24-h survival of rejuvenated red cells exceeded 75%. In clinical studies,
rejuvenated red cells were found to be safe, with no reported adverse
effects. In one adult cardiac surgery trial, transfusion of rejuvenated
red cells resulted in improved myocardial performance. Conclusion:
Transfusion of rejuvenated red cells reduces organ injury attributable to
the red cell storage lesion without adverse effects in experimental
studies in vivo. The clinical benefits of this intervention remain
uncertain.<br/>Copyright &#xa9; 2018 International Society of Blood
Transfusion

<22>
Accession Number
623684675
Title
Cardiovascular magnetic resonance in heart transplant patients: Diagnostic
value of quantitative tissue markers: T2 mapping and extracellular volume
fraction, for acute rejection diagnosis.
Source
Journal of Cardiovascular Magnetic Resonance. 20 (1) (no pagination),
2018. Article Number: 59. Date of Publication: 27 Aug 2018.
Author
Vermes E.; Pantaleon C.; Auvet A.; Cazeneuve N.; Machet M.C.; Delhommais
A.; Bourguignon T.; Aupart M.; Brunereau L.
Institution
(Vermes, Pantaleon, Auvet, Bourguignon, Aupart) Department of
Cardiothoracic Surgery, University Francois Rabelais, Tours, France
(Vermes, Cazeneuve, Delhommais, Brunereau) Department of Radiology,
University Francois Rabelais, Tours, France
(Machet) Department of Anatomopathology, University Francois Rabelais,
Tours, France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The diagnosis of acute rejection in cardiac transplant
recipients requires invasive technique with endomyocardial biopsy (EMB)
which has risks and limitations. Cardiovascular magnetic resonance imaging
(CMR) with T2 and T1 mapping is a promising technique for characterizing
myocardial tissue. The purpose of the study was to evaluate T2, T1 and
extracellular volume fraction (ECV) quantification as novel tissue markers
to diagnose acute rejection. Methods: CMR was prospectively performed in
20 heart transplant patients providing 31 comparisons EMB-CMR. CMR was
performed close to EMB. Images were acquired on a 1.5 Tesla scanner
including T2 mapping (T2 prepared balanced steady state free precession)
and T1 mapping (modified Look-Locker inversion recovery sequences: MOLLI)
at basal, mid and apical level in short axis view. Global and segmental T2
and T1 values were measured before and 15 min (for T1 mapping) after
contrast administration. Results: Acute rejection was diagnosed in seven
patients: six cellular rejections (4 grade IR, 2 grade 2R) and one
antibody mediated rejection. Patients with acute rejection had
significantly higher global T2 values at 3 levels: 58.5 ms [55.0-60.3] vs
51.3 ms [49.5-55.2] (p = 0.007) at basal; 55.7 ms [54.0-59.7] vs 51.8 ms
[50.1-53.6] (p = 0.002) at median and 58.2 ms [54.0-63.7] vs 53.6 ms
[50.8-57.4] (p = 0.026) at apical level. The area under the curve (AUC)
for each level was 0.83, 0.79 and 0.78 respectively. Patients with acute
rejection had significantly higher ECV at basal level: 34.2% [32.8-37.4]
vs 27.4% [24.6-30.6] (p = 0.006). The AUC for basal level was 0.84. The
sensitivity, specificity and diagnosis accuracy for basal T2 (cut off:
57.7 ms) were 71, 96 and 90% respectively; and for basal ECV: (cut off
32%) were 86, 85 and 85% respectively. Combining basal T2 and basal ECV
allowed diagnosing all acute rejection and avoiding 63% of EMB.
Conclusions: In heart transplant patients, a combined CMR approach using
T2 mapping and ECV quantification provides a high diagnostic accuracy for
acute rejection diagnosis and could potentially decrease the number of
routine EMB.<br/>Copyright &#xa9; 2018 The Author(s).

<23>
Accession Number
622796865
Title
Long-term impact of chronic total occlusion recanalisation in patients
with ST-elevation myocardial infarction.
Source
Heart. 104 (17) (pp 1432-1438), 2018. Date of Publication: 01 Sep 2018.
Author
Elias J.; Van Dongen I.M.; Ramunddal T.; Laanmets P.; Eriksen E.;
Meuwissen M.; Michels H.R.; Bax M.; Ioanes D.; Suttorp M.J.; Strauss B.H.;
Barbato E.; Marques K.M.; Claessen B.E.P.M.; Hirsch A.; Van Der Schaaf
R.J.; Tijssen J.G.P.; Henriques J.P.S.; Hoebers L.P.
Institution
(Elias, Van Dongen, Claessen, Tijssen, Henriques, Hoebers) Department of
Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam
1105 AZ, Netherlands
(Ramunddal, Ioanes) Sahlgrenska University Hospital, Gothenburg, Sweden
(Laanmets) North-Estonia Medical Centre, Talinn, Estonia
(Eriksen) Haukeland University Hospital, Bergen, Norway
(Meuwissen) Department of Cardiology, Amphia Hospital, Breda, Netherlands
(Michels) Catharina Hospital, Eindhoven, Netherlands
(Bax) Department of Cardiology, Haga Teaching Hospital, The Hague,
Netherlands
(Suttorp) Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein,
Netherlands
(Strauss) Sunnybrook Health Sciences Centre, Toronto, Canada
(Barbato) Cardiovascular Center, Onze Lieve Vrouwe Ziekenhuis, Aalst,
Belgium
(Marques) VU University Medical Center, Amsterdam, Netherlands
(Hirsch) Erasmus Medical Center, Rotterdam, Netherlands
(Van Der Schaaf) Department of Cardiology, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background During primary percutaneous coronary intervention (PCI), a
concurrent chronic total occlusion (CTO) is found in 10% of patients with
ST-elevation myocardial infarction (STEMI). Long-term benefits of CTO-PCI
have been suggested; however, randomised data are lacking. Our aim was to
determine mid-term and long-term clinical outcome of CTO-PCI versus CTO-No
PCI in patients with STEMI with a concurrent CTO. Methods The Evaluating
Xience and left ventricular function in PCI on occlusiOns afteR STEMI
(EXPLORE) was a multicentre randomised trial that included 302 patients
with STEMI after successful primary PCI with a concurrent CTO. Patients
were randomised to either CTO-PCI or CTO-No PCI. The primary end point of
the current study was occurrence of major adverse cardiac events (MACE):
cardiac death, coronary artery bypass grafting and MI. Other end points
were 1-year left ventricular function (LVF); LV-ejection fraction and LV
end-diastolic volume and angina status. Results The median long-term
follow-up was 3.9 (2.1-5.0) years. MACE was not significantly different
between both arms (13.5% vs 12.3%, HR 1.03, 95% CI 0.54 to 1.98; P=0.93).
Cardiac death was more frequent in the CTO-PCI arm (6.0% vs 1.0%, P=0.02)
with no difference in all-cause mortality (12.9% vs 6.2%, HR 2.07, 95% CI
0.84 to 5.14; P=0.11). One-year LVF did not differ between both arms.
However, there were more patients with freedom of angina in the CTO-PCI
arm at 1 year (94% vs 87%, P=0.03). Conclusions In this randomised trial
involving patients with STEMI with a concurrent CTO, CTO-PCI was not
associated with a reduction in long-term MACE compared to CTO-No PCI.
One-year LVF was comparable between both treatment arms. The finding that
there were more patients with freedom of angina after CTO-PCI at 1-year
follow-up needs further investigation. Clinical trial registration EXPLORE
trial number NTR1108 www.trialregister.nl.<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.

<24>
Accession Number
620675740
Title
Shed-blood-separation and cell-saver: an integral Part of MiECC?
Shed-blood-separation and its influence on the perioperative inflammatory
response during coronary revascularization with minimal invasive
extracorporeal circulation systems - a randomized controlled trial.
Source
Perfusion (United Kingdom). 33 (2) (pp 136-147), 2018. Date of
Publication: 01 Mar 2018.
Author
Bauer A.; Hausmann H.; Schaarschmidt J.; Scharpenberg M.; Troitzsch D.;
Johansen P.; Nygaard H.; Eberle T.; Hasenkam J.M.
Institution
(Bauer, Schaarschmidt) MediClin Heart Centre Coswig, Department of
Cardiovascular Perfusion, Coswig, Saxony-Anhalt, Germany
(Bauer, Eberle) MediClin Heart Centre Coswig, Department of Anaesthesia
and Intensive Care Medicine, Coswig, Saxony-Anhalt, Germany
(Hausmann) MediClin Heart Centre Coswig, Department of Cardiothoracic and
Vascular Surgery, Coswig, Saxony-Anhalt, Germany
(Scharpenberg) University of Bremen, Competence Center for Clinical
Trials, Bremen, Germany
(Troitzsch) Zoll Lifebridge, Ampfing, Bayern, Germany
(Johansen) Department of Engineering, Aarhus University, Jutland, Denmark
(Nygaard, Hasenkam) Aarhus University, Department of Cardio Thoracic and
Vascular Surgery, Aarhus University Hospital and Department of Clinical
Medicine, Aarhus, Jutland, Denmark
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: The postoperative systemic inflammatory response after
cardiopulmonary bypass (CPB) is still an undesirable side-effect after
cardiac surgery. It is most likely caused by blood contact with foreign
surfaces and by the surgical trauma itself. However, the recirculation of
activated shed mediastinal blood is another main cause of blood cell
activation and cytokine release. Minimal invasive extracorporeal
circulation (MiECC) comprises a completely closed circuit, coated surfaces
and the separation of suction blood. We hypothesized that MiECC, with
separated cell saved blood, would induce less of a systemic inflammatory
response than MiECC with no cell-saver. The aim of this study was,
therefore, to investigate the impact of cell washing shed blood from the
operating field versus direct return to the ECC on the biomarkers for
systemic inflammation. Material and methods: In the study, patients with
MiECC and cell-saver were compared with the control group, patients with
MiECC and direct re-transfusion of the drawn blood shed from the surgical
field. Results: High amounts of TNF-alpha (+ 120% compared to serum blood)
were found in the shed blood itself, but a significant reduction was
demonstrated with the use of a cell-saver (TNF-alpha ng/l post-ECC 10 min:
9.5+/-3.5 vs. 19.7+/-14.5, p<0.0001). The values for procalcitonin were
not significantly increased in the control group (6h: 1.07+/-3.4 vs.
2.15+/-9.55, p=0.19) and lower for C-reactive protein (CRP) (24h:
147.1+/-64.0 vs.134.4+/-52.4 p=0.28). Conclusion: The use of a cell-saver
and the processing of shed blood as an integral part of MiECC
significantly reduces the systemic cytokine load. We, therefore, recommend
the integration of cell-saving devices in MiECC to reduce the
perioperative inflammatory response.<br/>Copyright &#xa9; 2017, &#xa9; The
Author(s) 2017.

<25>
Accession Number
619188996
Title
Frailty and Clinical Outcomes in Advanced Heart Failure Patients
Undergoing Left Ventricular Assist Device Implantation: A Systematic
Review and Meta-analysis.
Source
Journal of the American Medical Directors Association. 19 (3) (pp
255-261.e1), 2018. Date of Publication: March 2018.
Author
Tse G.; Gong M.; Wong S.H.; Wu W.K.K.; Bazoukis G.; Lampropoulos K.; Wong
W.T.; Xia Y.; Wong M.C.S.; Liu T.; Woo J.
Institution
(Tse, Wong, Woo) Department of Medicine and Therapeutics, Faculty of
Medicine, Chinese University of Hong Kong, Hong Kong, SAR, Hong Kong
(Tse, Wong, Wu) Li Ka Shing Institute of Health Sciences, Faculty of
Medicine, Chinese University of Hong Kong, Hong Kong, SAR, Hong Kong
(Gong, Liu) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Wu) Department of Anaesthesia and Intensive Care, State Key Laboratory of
Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong
Kong
(Bazoukis, Lampropoulos) Second Department of Cardiology, Laboratory of
Cardiac Electrophysiology, Evangelismos General Hospital of Athens,
Athens, Greece
(Wong) School of Life Sciences, The Chinese University of Hong Kong, Hong
Kong, Hong Kong
(Xia) Department of Cardiology, First Affiliated Hospital of Dalian
Medical University, Dalian, China
(Wong) JC School of Public Health and Primary Care, The Chinese University
of Hong Kong, Hong Kong, Hong Kong
(Wong) State Key Laboratory of Digestive Disease, Chinese University of
Hong Kong, Hong Kong
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Frailty has been identified as a risk factor for adverse
clinical outcomes after cardiac intervention or surgery. However, whether
it increases the risk of adverse outcomes in patients undergoing left
ventricular assist device (LVAD) therapy has been controversial.
Therefore, we conducted a systematic review and meta-analysis of the
frailty measures and clinical outcomes of length of stay and mortality in
this setting. Methods: PubMed and Embase were searched until September 11,
2017, for studies evaluating the association between frailty and clinical
outcomes in advanced heart failure patients undergoing LVAD implantation.
Results: A total of 46 and 79 entries were retrieved from our search
strategy. A total of 13 studies involving 3435 patients were included in
the final meta-analysis (mean age: 57.7 +/- 15.3 years; 79% male,
follow-up duration was 13 +/- 14 months). Compared to nonfrail patients (n
= 2721), frail patients (n = 579) had significantly longer
time-to-extubation (n = 3; mean difference: 45 +/- 6 hours; I²:
0%) and hospital length of stay (n = 4; mean difference: 2.9 +/- 1.2 days;
P =.001; I²: 21%). Frailty was not a predictor of inpatient or
short-term mortality [n = 3; hazard ratio (HR): 1.22, 95% confidence
interval (CI): 0.66-2.26; P >.05; I²: 0%] but predicted
long-term mortality (n = 7; HR: 1.44, 95% CI: 1.15-1.80; P =.001;
I²: 0%). Conclusions: Frailty leads to significantly longer
time to extubation, hospital length of stay, and long-term mortality in
advanced heart failure patients who have undergone LVAD implantation.
Older patients being considered for LVAD implantation should therefore be
assessed for frailty status. The risk and benefit of the procedure should
be explained to the patient, emphasizing that frailty increases the
likelihood of adverse clinical outcomes.<br/>Copyright &#xa9; 2017 AMDA -
The Society for Post-Acute and Long-Term Care Medicine

<26>
Accession Number
619130547
Title
The Effect of a 2-Year Intervention Consisting of Diet, Physical Exercise,
Cognitive Training, and Monitoring of Vascular Risk on Chronic
Morbidity-the FINGER Randomized Controlled Trial.
Source
Journal of the American Medical Directors Association. 19 (4) (pp
355-360.e1), 2018. Date of Publication: April 2018.
Author
Marengoni A.; Rizzuto D.; Fratiglioni L.; Antikainen R.; Laatikainen T.;
Lehtisalo J.; Peltonen M.; Soininen H.; Strandberg T.; Tuomilehto J.;
Kivipelto M.; Ngandu T.
Institution
(Marengoni) Department of Clinical and Experimental Sciences, University
of Brescia, Brescia, Italy
(Marengoni, Rizzuto, Fratiglioni, Kivipelto) Aging Research Center,
Department of Neurobiology, Care Sciences and Society, Karolinska
Institutet, Stockholm University, Stockholm, Sweden
(Fratiglioni) Stockholm Gerontology Research Center, Stockholm, Sweden
(Antikainen, Strandberg) Center for Life Course Health
Research/Geriatrics, University of Oulu, Oulu, Finland
(Antikainen, Strandberg) Medical Research Center Oulu, Oulu University
Hospital, Oulu, Finland
(Antikainen) Oulu City Hospital, Oulu, Finland
(Laatikainen, Lehtisalo, Peltonen, Tuomilehto, Kivipelto, Ngandu)
Department of Public Health Solutions, Chronic Disease Prevention Unit,
National Institute for Health and Welfare, Helsinki, Finland
(Laatikainen) Institute of Public Health and Clinical Nutrition,
University of Eastern Finland, Kuopio, Finland
(Laatikainen) Joint municipal authority for North Karelia social and
health services, Joensuu, Finland
(Lehtisalo, Tuomilehto) Department of Public Health, University of
Helsinki, Helsinki, Finland
(Soininen, Kivipelto) Institute of Clinical Medicine/Neurology, University
of Eastern Finland, Kuopio, Finland
(Strandberg) University of Helsinki, Helsinki University Hospital,
Helsinki, Finland
(Tuomilehto) South Ostrobothnia Central Hospital, Seinajoki, Finland
(Tuomilehto) Dasman Diabetes Institute, Dasman, Kuwait
(Tuomilehto) Diabetes Research Group, King Abdulaziz University, Jeddah,
Saudi Arabia
(Kivipelto, Ngandu) Division of Clinical Geriatrics, Center for Alzheimer
Research, Department of Neurobiology, Care Sciences and Society,
Karolinska Institutet, Stockholm, Sweden
(Kivipelto) Stockholms Sjukhem, Research & Development unit, Stockholm,
Sweden
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: To verify whether a multidomain intervention lowers the risk of
developing new chronic diseases in older adults. Methods: Multicenter,
double-blind randomized controlled trial started in October 2009, with
2-year follow-up. A total of 1260 people aged 60 to 77 years were enrolled
in the Finnish Geriatric Intervention Study to Prevent Cognitive
Impairment and Disability (FINGER). Participants were randomly assigned in
a 1:1 ratio to a 2-year multidomain intervention (n = 631) (nutritional
guidance, exercise, cognitive training, and management of metabolic and
vascular risk factors) or a control group (n = 629) (general health
advice). Data on most common chronic diseases were collected by a
physician at baseline and 2 years later. Results: At 2-year follow-up, the
average number of new chronic diseases was 0.47 [standard deviation (SD)
0.7] in the intervention group and 0.58 (SD 0.8) in the control group (P
<.01). The incidence rate per 100 person-years for developing 1+ new
disease(s) was 17.4 [95% confidence interval (CI) = 15.1-20.1] in the
intervention group and 20.5 (95% CI = 18.0-23.4) in the control group; for
developing 2+ new diseases, 4.9 (95% CI = 3.7-6.4) and 6.1 (95% CI =
4.8-7.8); and for 3+ new diseases, 0.7 (95% CI = 0.4-1.5) and 1.8 (95% CI
= 1.1-2.8), respectively. After adjustment for age, sex, education,
current smoking, alcohol intake, and the number of chronic diseases at
baseline, the intervention group had a hazard ratio ranging from 0.80
(0.66-0.98) for developing 1+ new chronic disease(s) to 0.38 (0.16-0.88)
for developing 3+ new chronic diseases compared to the control group.
Conclusions: Findings from this randomized controlled trial suggest that a
multidomain intervention could reduce the risk of developing new chronic
diseases in older people.<br/>Copyright &#xa9; 2017 AMDA - The Society for
Post-Acute and Long-Term Care Medicine

<27>
Accession Number
622706299
Title
Systolic mitral annulus velocity is a sensitive index for changes in left
ventricular systolic function during inotropic therapy in patients with
acute heart failure.
Source
European Heart Journal: Acute Cardiovascular Care. 7 (4) (pp 321-329),
2018. Date of Publication: 01 Jun 2018.
Author
Husebye T.; Eritsland J.; Bjornerheim R.; Andersen G.O.
Institution
(Husebye, Eritsland, Bjornerheim, Andersen) Department of Cardiology, Oslo
University Hospital Ulleval, Norway
(Husebye, Eritsland, Bjornerheim, Andersen) Centre for Heart Failure
Research, University of Oslo, Norway
(Husebye) Faculty of Medicine, University of Oslo, Norway
(Andersen) Centre for Clinical Heart Research, Oslo University Hospital
Ulleval, Norway
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Echocardiography is recommended for assessment of left
ventricular systolic function in patients with acute heart failure but few
randomised trials have validated techniques like tissue Doppler (TDI) and
speckle tracking (STE) in patients with acute heart failure following
ST-elevation myocardial infarction. Methods: This was a substudy from the
LEAF (LEvosimendan in Acute heart Failure following myocardial infarction)
trial (NCT00324766), which randomised 61 patients developing acute heart
failure, including cardiogenic shock, within 48 hours after ST-elevation
myocardial infarction, double-blind to a 25-hour infusion of levosimendan
or placebo. TDI-derived systolic mitral annulus velocity (S'), STE-derived
global longitudinal strain (S<inf>l</inf>) and strain rate
(SR<inf>l</inf>) were measured at baseline, day 1, day 5 and after 42
days. Results: Datasets rejected for analyses were 2% (TDI) and 17% (STE).
S' increased by 23% in the levosimendan group versus 8% in the placebo
group from baseline to day 1 (p= 0.011) and by 30% vs. 3% from baseline to
day 5 (p <0.0005). Significant, but less pronounced, improvements in
global S<inf>l</inf> (p = 0.025 and p = 0.032) and in global
SR<inf>l</inf> (p = 0.046 and p = 0.001) in favour of levosimendan were
also present. Conclusion: S' by TDI and STE-derived S<inf>l</inf> and
SR<inf>l</inf> were sensitive indices for changes in left ventricular
systolic function related to treatment with levosimendan. However, S' by
TDI was more feasible and sensitive and might be preferred for assessment
of changes in left ventricular systolic function in critically ill
patients with acute heart failure receiving inotropic
therapy.<br/>Copyright &#xa9; 2017, The European Society of Cardiology
2017.

<28>
Accession Number
620719225
Title
Comparative evaluation of blood salvage techniques in patients undergoing
cardiac surgery with cardiopulmonary bypass.
Source
Perfusion (United Kingdom). 33 (2) (pp 105-109), 2018. Date of
Publication: 01 Mar 2018.
Author
Gunaydin S.; Robertson C.; Budak A.B.; Gourlay T.
Institution
(Gunaydin, Budak) Department of Cardiovascular Surgery, Numune Training &
Research Hospital, Ankara, Turkey
(Robertson, Gourlay) Department of Biomedical Engineering, University of
Strathclyde, Glasgow, United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: The primary objective of this study was to test and compare
the efficacy of currently available intraoperative blood salvage systems
via a demonstration of the level of increase in percentage concentration
of red blood cells (RBC), white blood cells 9WBC) and platelets (Plt) in
the end product. Methods: In a prospective, randomized study, data of 80
patients undergoing elective cardiac surgery with cardiopulmonary bypass
in a 6-month period was collected, of which the volume aspirated from the
surgical field was processed by either the HemoSep Novel Collection Bag
(Advancis Surgical, Kirkby-in-Ashfield, Notts, UK) (N=40) (Group 1) or a
cell- saver (C.A.T.S Plus Autotransfusion System, Fresenius Kabi, Bad
Homburg, Germany) (N=40) (Group 2). Results: Hematocrit levels increased
from 23.05%+/-2.7 to 43.02%+/-12 in Group 1 and from 24.5+/-2 up to
55.2+/-9 in Group 2 (p=0.013). The mean number of platelets rose to
225200+/-47000 from 116400 +/-40000 in the HemoSep and decreased from
125200+/-25000 to 96500+/-30000 in the cell-saver group (p=0.00001). The
leukocyte count was concentrated significantly better in Group 1 (from
10100+/-4300 to 18120+/-7000; p=0.001). IL-6 levels (pg/dL) decreased from
223+/-47 to 83+/-21 in Group 1 and from 219+/-40 to 200+/-40 in Group 2
(p=0.001). Fibrinogen was protected significantly better in the HemoSep
group (from 185+/-35 to 455+/-45; p=0.004). Conclusions: Intraoperative
blood salvage systems functioned properly and the resultant blood product
was superior in terms of red blood cell species. The HemoSep group had
significantly better platelet and leukocyte concentrations and fibrinogen
content.<br/>Copyright &#xa9; 2017, &#xa9; The Author(s) 2017.

<29>
Accession Number
621085186
Title
Preoperative inspiratory muscle training prevents pulmonary complications
after cardiac surgery - a systematic review.
Source
Danish Medical Journal. 65 (3) (no pagination), 2018. Article Number:
A5450. Date of Publication: March 2018.
Author
Karanfil E.O.T.; Moller A.M.
Publisher
Danish Medical Association
Abstract
INTRODUCTION: Post-operative pulmonary complications are a common cause of
morbidity and mortality in patients undergoing heart surgery. The aim of
this systematic review was to determine if preoperative inspiratory muscle
training could prevent the development of pneumonia and atelectasis in
patients undergoing coronary artery bypass grafting (CABG) or heart valve
surgery. METHODS:Systematic searches were performed in MED-LINE, Embase
and the Cochrane Library. The included studies compared the development of
pneumonia and atelectasis in CABG patients or heart valve surgery patients
who were prescribed either preoperative inspiratory muscle training or
usual care. The quality of the studies was assessed using the Cochrane
Risk of Bias Tool. RESULTS: The search yielded 2,479 records. The
inclusion criteria were fulfilled by five studies. All the studies were
randomised controlled trials. We found that the development of both
pneumonia and atelectasis was significantly reduced among patients who
received inspiratory muscle training preoperatively compared with patients
treated with usual care. CONCLUSIONS: Preoperative inspiratory muscle
training may reduce the risk of developing pneumonia and atelectasis.
However, more trials are needed to support and strengthen the evidence
found in this systematic review before routine implementation of this kind
of training preoperatively.<br/>Copyright &#xa9; 2018, Danish Medical
Association. All rights reserved.

<30>
Accession Number
623723709
Title
Odyssey outcomes: Clinical study: Implications for us.
Source
Cardiology Letters. 27 (2) (pp 76-86), 2018. Date of Publication: 2018.
Author
Murin J.; Caprnda M.; Kasperova V.
Institution
(Murin, Caprnda, Kasperova) Comenius University Faculty of Medicine, 1th
Department of Internal Medicine, University Hospital, Bratislava, Slovakia
Publisher
SYMEKARD s.r.o. (E-mail: gk@symekard.sk)
Abstract
Patients suffering acute coronary syndrome (ACS), even with optimal
treatment of ACS and optimal secondary prevention treatment afterwards,
still have a very high cardiovascular (CV) risk of morbidity and
mortality. More intensive treatment of dyslipidemia, with further
reduction of serum LDL-Ch levels, to improve the prognosis of these
patients - was the hypothesis of this study, with alirocumab (PCSK9
inhibitor) treatment versus placebo treatment. There were 18 924 patients
in this study, randomized for the mentioned treatment in the time period
of 1 - 12 months after ACS. In the active arm treatment there was a
further reduction of serum LDL-Ch level (from 2.62 to 1.37 mmol/l,
reduction of 54.7%). This serum LDL-Ch reduction contributed to a
reduction of primary end-point (coronary mortality/nonfatal myocardial
infarction and stroke/hospitalization for unstable angina pectoris) of 15%
(significantly, S), but also components of this end-point were
successfully reduced, and all-cause mortality too by 15% (S). The best
benefit was in the subgroup of patients with the highest serum level of
LDL-Ch, >= 2.6 mmol/l: the primary end-point was reduced by 29% (S) and CV
mortality by 31% (S). The treatment was safe. The message of this study is
the great reduction of CV events (mortality, nonfatal myocardial
infarctions and strokes, unstable angina pectoris) in patients with an ACS
treated by alirocumab; and all patients had an excellent standard
treatment of this with strong and high doses of statins included. Patients
with the highest basal serum LDL-Ch levels (>= 2.6 mmol/l) profited the
most. Fig. 7, Tab. 1, Ref. 21, online full text (Free, PDF),
www.cardiologyletters.sk.<br/>Copyright &#xa9; 2018, SYMEKARD s.r.o. All
rights reserved.

<31>
Accession Number
623694335
Title
Red blood cell transfusion in patients with ST-elevation myocardial
infarction-a meta-analysis of more than 21,000 patients.
Source
Netherlands Heart Journal. 26 (9) (pp 454-460), 2018. Date of Publication:
01 Sep 2018.
Author
Mincu R.I.; Rassaf T.; Totzeck M.
Institution
(Mincu, Rassaf, Totzeck) Medical Faculty, West German Heart and Vascular
Center, Department of Cardiology and Vascular Medicine, University
Hospital Essen, Essen, Germany
(Mincu) University and Emergency Hospital, Cardiac Research Unit, 'Carol
Davila' University of Medicine and Pharmacy, Bucharest, Romania
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Background: Red blood cell transfusion remains controversial in patients
with acute coronary syndromes and particularly in patients with
ST-elevation myocardial infarction (STEMI). Methods: We systematically
searched PubMed, Cochrane, EMBASE, and Web of Science for studies
published until January 2017 describing the outcomes in patients with
STEMI who received red blood cell transfusion, compared with patients who
did not. Results: A total of 21,770 patients with STEMI from 5 cohort
studies were included in the meta-analysis, 984 (4.5%) received red blood
cell transfusion and 20,786 (95.4%) did not. Red blood cell transfusion
was associated with a higher risk of in-hospital and long-term mortality,
emergency repeated percutaneous coronary intervention (PCI), reinfarction
rate, stroke rate, and heart failure. The group with red blood cell
transfusion had a slightly higher incidence of diabetes mellitus and
hypertension, but a lower incidence of smoking. The two groups had the
same incidence of prior myocardial infarction, prior coronary artery
bypass graft surgery and malignancy. Prior heart failure, prior stroke and
prior PCI were more frequent in the group that had received red blood cell
transfusion. The mean nadir haemoglobin was 8.5+/- 0.1g/dl in the group
with red blood cell transfusion and 12.5+/- 0.4g/dl in the control group,
p< 0.001. Conclusions: Red blood cell transfusion increases the morbidity
and mortality in patients with STEMI. This difference could not be
explained by the higher morbidity in the red blood cell transfusion group
alone. Further randomised controlled trials are required to provide a
reliable haemoglobin threshold for these patients.<br/>Copyright &#xa9;
2018, The Author(s).

<32>
Accession Number
623664113
Title
Long-term use of carvedilol in patients with ST-segment elevation
myocardial infarction treated with primary percutaneous coronary
intervention.
Source
PLoS ONE. 13 (8) (no pagination), 2018. Article Number: e0199347. Date of
Publication: August 2018.
Author
Watanabe H.; Ozasa N.; Morimoto T.; Shiomi H.; Bingyuan B.; Suwa S.;
Nakagawa Y.; Izumi C.; Kadota K.; Ikeguchi S.; Hibi K.; Furukawa Y.; Kaji
S.; Suzuki T.; Akao M.; Inada T.; Hayashi Y.; Nanasato M.; Okutsu M.;
Kametani R.; Sone T.; Sugimura Y.; Kawai K.; Abe M.; Kaneko H.; Nakamura
S.; Kimura T.
Institution
(Watanabe, Ozasa, Shiomi, Bingyuan, Kimura) Department of Cardiovascular
Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
(Morimoto) Department of Clinical Epidemiology, Hyogo College of Medicine,
Hyogo, Japan
(Suwa) Division of Cardiology, Juntendo University Shizuoka Hospital,
Izunokuni, Japan
(Nakagawa, Izumi) Division of Cardiology, Tenri Hospital, Nara, Japan
(Kadota) Division of Cardiology, Kurashiki Central Hospital, Kurashiki,
Japan
(Ikeguchi) Division of cardiology, Shiga General Hospital, Moriyama, Japan
(Hibi) Division of Cardiology, Yokohama City University Medical Center,
Yokohama, Japan
(Furukawa, Kaji) Division of Cardiology, Kobe City Medical Center General
Hospital, Kobe, Japan
(Suzuki) Division of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
(Akao) Department of Cardiology, National Hospital Organization Kyoto
Medical Center, Kyoto, Japan
(Inada) Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
(Hayashi) Division of Cardiology, Tsuchiya General Hospital, Hiroshima,
Japan
(Nanasato) Cardiovascular Center, Nagoya Daini Red Cross Hospital, Nagoya,
Japan
(Okutsu) Division of Cardiology, Nozaki Tokushukai Hospital, Osaka, Japan
(Kametani) Division of Cardiology, Nagoya Tokushukai General Hospital,
Kasugai, Japan
(Sone) Division of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
(Sugimura) Division of Cardiology, Kawakita General Hospital, Tokyo, Japan
(Kawai) Division of Cardiology, Chikamori Hospital, Kochi, Japan
(Abe) Division of Cardiology, Yotsuba Circulation Clinic, Matsuyama, Japan
(Kaneko) Division of Cardiology, Hoshi General Hospital, Koriyama, Japan
(Nakamura) Division of Cardiology, New Tokyo Hospital, Chiba, Japan
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Despite its recommendation by the current guidelines, the role
of long-term oral beta-blocker therapy has never been evaluated by
randomized trials in uncomplicated ST-segment elevation myocardial
infarction (STEMI) patients without heart failure, left ventricular
dysfunction or ventricular arrhythmia who underwent primary percutaneous
coronary intervention (PCI). Methods and results In a multi-center,
open-label, randomized controlled trial, STEMI patients with successful
primary PCI within 24 hours from the onset and with left ventricular
ejection fraction (LVEF) 40% were randomly assigned in a 1-to-1 fashion
either to the carvedilol group or to the no beta-blocker group within 7
days after primary PCI. The primary endpoint is a composite of all-cause
death, myocardial infarction, hospitalization for heart failure, and
hospitalization for acute coronary syndrome. Between August 2010 and May
2014, 801 patients were randomly assigned to the carvedilol group (N =
399) or the no beta-blocker group (N = 402) at 67 centers in Japan. The
carvedilol dose was up-titrated from 3.4+/-2.1 mg at baseline to 6.3
+/-4.3 mg at 1-year. During median follow-up of 3.9 years with 96.4%
follow-up, the cumulative 3-year incidences of both the primary endpoint
and any coronary revascularization were not significantly different
between the carvedilol and no beta-blocker groups (6.8% and 7.9%, P =
0.20, and 20.3% and 17.7%, P = 0.65, respectively). There also was no
significant difference in LVEF at 1-year between the 2 groups (60.9+/-8.4%
and 59.6+/-8.8%, P = 0.06) Conclusion Long-term carvedilol therapy added
on the contemporary evidence-based medications did not seem beneficial in
selected STEMI patients treated with primary PCI. Trial registration
CAPITAL-RCT (Carvedilol Post-Intervention Long-Term Administration in
Large-scale Randomized Controlled Trial) ClinicalTrials.gov.number, NCT
01155635.<br/>Copyright &#xa9; 2018 Watanabe 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.

<33>
Accession Number
623657393
Title
Single-dose intravenous diclofenac for acute postoperative pain in adults.
Source
Cochrane Database of Systematic Reviews. 2018 (8) (no pagination), 2018.
Article Number: CD012498. Date of Publication: 28 Aug 2018.
Author
Mcnicol E.D.; Ferguson M.C.; Schumann R.
Institution
(Mcnicol, Schumann) Tufts Medical Center, Department of Anesthesiology and
Perioperative Medicine, Boston, MA, United States
(Mcnicol) Tufts Medical Center, Department of Pharmacy, Boston, MA, United
States
(Mcnicol) Tufts University School of Medicine, Pain Research, Education
and Policy (PREP) Program, Department of Public Health and Community
Medicine, Boston, MA, United States
(Ferguson) Southern Illinois University Edwardsville, Pharmacy Practice,
Edwardsville, United States
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Postoperative administration of non-steroidal
anti-inflammatory drugs (NSAIDs) reduces patient opioid requirements and,
in turn, reduces the incidence and severity of opioid-induced adverse
events (AEs). Objectives: To assess the analgesic efficacy and adverse
effects of single-dose intravenous diclofenac, compared with placebo or an
active comparator, for moderate to severe postoperative pain in adults.
Search methods: We searched the following databases without language
restrictions: the Cochrane Central Register of Controlled Trials (Cochrane
Register of Studies Online), MEDLINE, and Embase on 22 May 2018. We
checked clinical trials registers and reference lists of retrieved
articles for additional studies. Selection criteria: We included
randomized trials that compared a single postoperative dose of intravenous
diclofenac with placebo or another active treatment, for treating acute
postoperative pain in adults following any surgery. Data collection and
analysis: We used standard methodological procedures expected by Cochrane.
Two review authors independently considered trials for review inclusion,
assessed risk of bias, and extracted data. Our primary outcome was the
number of participants in each arm achieving at least 50% pain relief over
a four- and six-hour period. Our secondary outcomes were time to, and
number of participants using rescue medication; withdrawals due to lack of
efficacy, AEs, and for any cause; and number of participants experiencing
any AE, serious AEs (SAEs), and NSAID-related AEs. We performed a post hoc
analysis of opioid-related AEs, to enable indirect comparisons with other
analyses of postoperative analgesics. For subgroup analysis, we planned to
analyze different doses and formulations of parenteral diclofenac
separately. We assessed the overall quality of the evidence for each
outcome using GRADE and created two 'Summary of findings' tables. Main
results: We included eight studies, involving 1756 participants undergoing
various surgeries (dental, mixed minor, abdominal, and orthopedic), with
20 to 175 participants receiving intravenous diclofenac in each study.
Mean study population ages ranged from 24.5 years to 54.5 years.
Intravenous diclofenac doses varied among and within studies, ranging from
3.75 mg to 75 mg. Five studies assessed newer formulations of parenteral
diclofenac that could be administered as an undiluted intravenous bolus.
Most studies had an unclear risk of bias for several domains and a high
risk of bias due to small sample size. The overall quality of evidence for
each outcome was generally low for reasons including unclear risk of bias
in studies, imprecision, and low event numbers. Primary outcome Three
studies (277 participants) produced a number needed to treat for an
additional beneficial outcome (NNTB) for at least 50% of maximum pain
relief versus placebo of 2.4 (95% confidence interval (CI) 1.9 to 3.1)
over four hours (low-quality evidence). Four studies (436 participants)
produced an NNTB of 3.8 versus placebo (95% CI 2.9 to 5.9) over six hours
(low-quality evidence). No studies provided data for the comparison of
intravenous diclofenac with another NSAID over four hours. At six hours
there was no difference between intravenous diclofenac and another NSAID
(low-quality evidence). Secondary outcomes For secondary efficacy
outcomes, intravenous diclofenac was generally superior to placebo and
similar to other NSAIDs. For time to rescue medication, comparison of
intravenous diclofenac versus placebo demonstrated a median of 226 minutes
for diclofenac versus 80 minutes for placebo (5 studies, 542 participants,
low-quality evidence). There were insufficient data for pooled analysis
for comparisons of diclofenac with another NSAID (very low-quality
evidence). For the number of participants using rescue medication, two
studies (235 participants) compared diclofenac with placebo. The number
needed to treat to prevent one additional harmful event (NNTp) (here, the
need for rescue medication) compared with placebo was 3.0 (2.2 to 4.5,
low-quality evidence). The comparison of diclofenac with another NSAID
included only one study (98 participants). The NNTp was 4.5 (2.5 to 33)
for ketorolac versus diclofenac (very low-quality evidence). The numbers
of participants withdrawing were generally low and inconsistently reported
(very low-quality evidence). Participant withdrawals were: 6% (8/140)
diclofenac versus 5% (7/128) placebo, and 9% (8/87) diclofenac versus 7%
(6/82) another NSAID for lack of efficacy; 2% (4/211) diclofenac versus 0%
(0/198) placebo, and 3% (4/138) diclofenac versus 2% (2/129) another NSAID
due to AEs; and 11% (21/191) diclofenac versus 17% (30/179) placebo, and
18% (21/118) diclofenac versus 15% (17/111) another NSAID for any cause.
Overall adverse event rates were similar between intravenous diclofenac
and placebo (71% in both groups, 2 studies, 296 participants) and between
intravenous diclofenac and another NSAID (55% and 58%, respectively, 2
studies, 265 participants) (low-quality evidence for both comparisons).
Serious and specific AEs were rare, preventing meta-analysis. There were
sufficient data for a dose-effect analysis for our primary outcome for
only one alternative dose, 18.75 mg. Analysis of the highest dose employed
in each study demonstrated a relative benefit compared with placebo of 1.9
(1.4 to 2.4), whereas for the group receiving 18.75 mg, the relative
benefit versus placebo was 1.6 (1.2 to 2.1, 2 studies). Compared to
another NSAID, the high-dose analysis demonstrated a relative benefit of
0.9 (0.8 to 1.1), for the group receiving 18.75 mg, the relative benefit
was 0.78 (0.65 to 0.93). For direct comparison of high dose versus 18.75
mg, the proportion of participants with at least 50% pain relief was 66%
(90/137) for the high-dose arm versus 57% (77/135) in the low-dose arm.
There were insufficient data for subgroup meta-analysis of different
diclofenac formulations. Authors' conclusions: The amount and quality of
evidence for the use of intravenous diclofenac as a treatment for
postoperative pain is low. The available evidence indicates that
postoperative intravenous diclofenac administration offers good pain
relief for the majority of patients, but further research may impact this
estimate. Adverse events appear to occur at a similar rate to other
NSAIDs. Insufficient information is available to assess whether
intravenous diclofenac has a different rate of bleeding, renal
dysfunction, or cardiovascular events versus other NSAIDs. There was
insufficient information to evaluate the efficacy and safety of newer
versus traditional formulations of intravenous diclofenac. There was a
lack of studies in major and cardiovascular surgeries and in elderly
populations, which may be at increased risk for adverse
events.<br/>Copyright &#xa9; 2018 The Cochrane Collaboration.

<34>
Accession Number
623653093
Title
Adverse side effects of dexamethasone in surgical patients.
Source
Cochrane Database of Systematic Reviews. 2018 (8) (no pagination), 2018.
Article Number: CD011940. Date of Publication: 28 Aug 2018.
Author
Polderman J.A.W.; Farhang-Razi V.; Van Dieren S.; Kranke P.; Devries J.H.;
Hollmann M.W.; Preckel B.; Hermanides J.
Institution
(Polderman, Farhang-Razi, Van Dieren, Hollmann, Preckel, Hermanides)
Academic Medical Center (AMC) University of Amsterdam, Department of
Anaesthesiology, Meibergdreef 9, Amsterdam 1105 AZ, Netherlands
(Kranke) University of Wurzburg, Department of Anaesthesia and Critical
Care, Oberdurrbacher Str. 6, Wurzburg 97080, Germany
(Devries) Academic Medical Centre, Department of Internal Medicine, PO Box
22700, Amsterdam 1100 DE, Netherlands
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: In the perioperative period, dexamethasone is widely and
effectively used for prophylaxis of postoperative nausea and vomiting
(PONV), for pain management, and to facilitate early discharge after
ambulatory surgery. Long-term treatment with steroids has many side
effects, such as adrenal insufficiency, increased infection risk,
hyperglycaemia, high blood pressure, osteoporosis, and development of
diabetes mellitus. However, whether a single steroid load during surgery
has negative effects during the postoperative period has not yet been
studied. Objectives: To assess the effects of a steroid load of
dexamethasone on postoperative systemic or wound infection, delayed wound
healing, and blood glucose change in adult surgical patients (with planned
subgroup analysis of patients with and without diabetes). Search methods:
We searched MEDLINE, Embase, the Cochrane Central Register of Controlled
Trials (CENTRAL), in the Cochrane Library, and the Web of Science for
relevant articles on 29 January 2018. We searched without language or date
restriction two clinical trial registries to identify ongoing studies, and
we handsearched the reference lists of relevant publications to identify
all eligible trials. Selection criteria: We searched for randomized
controlled trials comparing an incidental steroid load of dexamethasone
versus a control intervention for adult patients undergoing surgery. We
required that studies include a follow-up of 30 days for proper assessment
of the number of postoperative infections, delayed wound healing, and the
glycaemic response. Data collection and analysis: Two review authors
independently screened studies for eligibility, extracted data from
relevant studies, and assessed all included studies for bias. We resolved
differences by discussion and pooled included studies in a meta-analysis.
We calculated Peto odds ratios (ORs) for dichotomous outcomes and mean
differences (MDs) for continuous outcomes. Our primary outcomes were
postoperative systemic or wound infection, delayed wound healing, and
glycaemic response within 24 hours. We created a funnel plot for the
primary outcome postoperative (wound or systemic) infection. We used GRADE
to assess the quality of evidence for each outcome. Main results: We
included in the meta-analysis 38 studies that included adults undergoing a
large variety of surgical procedures (i.e. abdominal surgery, cardiac
surgery, neurosurgery, and orthopaedic surgery). Age range of participants
was 18 to 80 years. There is probably little or no difference in the risk
of postoperative (wound or systemic) infection with dexamethasone compared
with no treatment, placebo, or active control (ramosetron, ondansetron, or
tropisetron) (Peto OR 1.01, 95% confidence interval (CI) 0.80 to 1.27;
4931 participants, 27 studies; I2 = 27%; moderate-quality evidence). The
effects of dexamethasone on delayed wound healing are unclear because the
wide confidence interval includes both meaningful benefit and harm (Peto
OR 0.99, 95% CI 0.28 to 3.43; 1072 participants, eight studies; I2 = 0%;
low-quality evidence). Dexamethasone may produce a mild increase in
glucose levels among participants without diabetes during the first 12
hours after surgery (MD 13 mg/dL, 95% CI 6 to 21; 10 studies; 595
participants; I2 = 50%; low-quality evidence). We identified two studies
reporting on glycaemic response after dexamethasone in participants with
diabetes within 24 hours after surgery (MD 32 mg/dL, 95% CI 15 to 49; 74
participants; I2 = 0%; very low-quality evidence). Authors' conclusions: A
single dose of dexamethasone probably does not increase the risk for
postoperative infection. It is uncertain whether dexamethasone has an
effect on delayed wound healing in the general surgical population owing
to imprecision in trial results. Participants with increased risk for
delayed wound healing (e.g. participants with diabetes, those taking
immunosuppressive drugs) were not included in the randomized studies
reporting on delayed wound healing included in this meta-analysis;
therefore our findings should be extrapolated to the clinical setting with
caution. Furthermore, one has to keep in mind that dexamethasone induces a
mild increase in glucose. For patients with diabetes, very limited
evidence suggests a more pronounced increase in glucose. Whether this
influences wound healing in a clinically relevant way remains to be
established. Once assessed, the three studies awaiting classification and
two that are ongoing may alter the conclusions of this
review.<br/>Copyright &#xa9; 2018 The Cochrane Collaboration.

<35>
Accession Number
623685003
Title
Prophylactic corticosteroids for paediatric heart surgery with
cardiopulmonary bypass.
Source
Cochrane Database of Systematic Reviews. 2018 (8) (no pagination), 2018.
Article Number: CD013101. Date of Publication: 30 Aug 2018.
Author
Gibbison B.; Villalobos Lizardi J.C.; Aviles Martinez K.I.; Fudulu D.P.;
Medina Andrade M.A.; Perez-Gaxiola G.; Schadenberg A.W.L.; Stoica S.C.;
Lightman S.L.; Angelini G.D.; Reeves B.C.
Institution
(Gibbison) Bristol Heart Institute/University Hospitals Bristol NHS FT,
Department of Cardiac Anaesthesia and Intensive Care, Bristol Royal
Infirmary, 7th Floor Queens Building, Bristol BS2 8HW, United Kingdom
(Villalobos Lizardi, Aviles Martinez) Hospital Civil de Guadalajara Fray
Antonio Alcalde, Emergency Pediatric Department, Hospital 278. El Retiro,
Guadalajara, Jalisco 44280, Mexico
(Fudulu, Angelini) University Hospital Bristol NHS Trust, Department of
Cardiac Surgery, Bristol, United Kingdom
(Medina Andrade) Hospital Civil Fray Antonio Alcalde de Guadalajara,
Thoracic and Cardiovascular Department, Guadalajara, Mexico
(Perez-Gaxiola) Hospital Pediatrico de Sinaloa, Evidence-Based Medicine
Department, Blvd. Constitucion s/n, Col. Almada. 80200, Culiacan, Sinaloa
80200, Mexico
(Schadenberg) University Hospital Bristol NHS Trust, Department of
Paediatric Intensive Care, Bristol, United Kingdom
(Stoica) University Hospital Bristol NHS Trust, Department of Paediatric
Cardiac Surgery, Bristol, United Kingdom
(Lightman) University of Bristol, Henry Wellcome Laboratories for
Integrative Metabolism and Neuroscience, Whitson Street, Bristol BS1 3NY,
United Kingdom
(Reeves) University of Bristol, School of Clinical Sciences, Bristol Royal
Infirmary, Level 7, Marlborough Street, Bristol BS2 8HW, United Kingdom
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives
are as follows: To assess the benefits and harms of prophylactic
corticosteroids in children between birth and 18 years of age undergoing
cardiac surgery with cardiopulmonary bypass.<br/>Copyright &#xa9; 2018 The
Cochrane Collaboration.

<36>
Accession Number
620280776
Title
Novel oral anticoagulants in the preoperative period: a meta-analysis.
Source
Journal of Thrombosis and Thrombolysis. (pp 1-11), 2018. Date of
Publication: 17 Jan 2018.
Author
He H.; Ke B.; Li Y.; Han F.; Li X.; Zeng Y.
Institution
(He, Ke, Li, Li, Zeng) Department of Emergency Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Anzhen Road Second, Chaoyang
District, Beijing 100029, China
(Han) Department of Epidemiology, Beijing Anzhen Hospital, Beijing
Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical
University, Beijing 100029, China
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The purpose of this study is to evaluate the efficacy and safety of novel
oral anticoagulant (NOAC) versus warfarin therapy in patients undergoing
different operations. We performed a systematic review of MEDLINE, EMBASE,
Cochrane Controlled Trials Register, and reports presented at scientific
meetings. The efficacy and safety of NOACs during the perioperative period
was compared to that using warfarin. Of the 2652 studies initially
reviewed, we identified 9 that included 15,880 patients for the
meta-analysis. Compared to warfarin, dabigatran increased the risk of
major bleeding (RR 1.37, 95% CI 1.06-1.78, P = 0.02). Apixaban (RR 0.63,
95% CI 0.40-0.99, P = 0.04) reduced thrombotic events. NOAC therapy
decreased thrombotic events in patients undergoing non-cardiac surgery (RR
0.68, 95% CI 0.50-0.92, P = 0.02). Compared to warfarin, the
administration of NOACs in the perioperative period has the same risk of
thromboembolism and major bleeding. But patients undergoing non-cardiac
surgery may benefit more from perioperative NOAC therapy. Apixaban may
reduce thrombotic events and dabigatran increases the risk of major
bleeding during the perioperative period.<br/>Copyright &#xa9; 2018
Springer Science+Business Media, LLC, part of Springer Nature

<37>
[Use Link to view the full text]
Accession Number
623787449
Title
Off-pump versus on-pump complete coronary artery bypass grafting:
Comparison of the effects on the renal damage in patients with renal
dysfunction.
Source
Medicine. 97 (35) (pp e12146), 2018. Date of Publication: 01 Aug 2018.
Author
Arslan U.; Calik E.; Tekin A.I.; Erkut B.
Institution
(Arslan, Calik, Erkut) Department of Cardiovascular Surgery, Ataturk
University, Erzurum
(Tekin) Department of Cardiovascular Surgery, Health Science University,
Kayseri Training and Research Hospital, Kayseri, Turkey
Abstract
BACKGROUND: We aimed to compare off-pump technique with on-pump technique
on renal function in patients with nondialysis-dependent renal dysfunction
who underwent coronary artery bypass grafting.
METHODS: The 94 patients with renal dysfunction undergoing isolated
coronary artery bypass grafting were retrospectively analyzed. No patient
was receiving dialysis. Patients were randomly assigned to conventional
revascularization with cardiopulmonary bypass and beating heart. Both
groups were compared in terms of renal dysfunction parameters and dialysis
requirement. The logistic regression models were constructed to identify
risk factors associated with dialysis requirement.
RESULTS: Renal dysfunction requiring dialysis developed in 9 patients in
the on-pump group. The measures analysis of variance was performed on the
data that showed worsening of renal function in the on-pump group compared
with the off-pump group. Cardiopulmonary bypass is significant as
independent predictor for the development of postoperative dialysis.
CONCLUSION: These results suggest that off-pump coronary revascularization
offers a superior renal protection and has a significantly lower risk for
renal complications in patients with nondialysis-dependent renal
dysfunction when compared with conventional coronary revascularization
with cardiopulmonary bypass.

<38>
Accession Number
623779007
Title
Inotropic and lusitropic effects of levosimendan and milrinone assessed by
strain echocardiography-A randomised trial.
Source
Acta Anaesthesiologica Scandinavica. 62 (9) (pp 1246-1254), 2018. Date of
Publication: October 2018.
Author
Fredholm M.; Jorgensen K.; Houltz E.; Ricksten S.-E.
Institution
(Fredholm, Jorgensen, Houltz, Ricksten) Department of Anesthesiology and
Intensive Care Medicine at the Sahlgrenska Academy, University of
Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: We compared the direct inotropic and lusitropic effects of two
inodilators, milrinone and levosimendan in patients after aortic valve
replacement for aortic stenosis. Methods: In this randomised, blinded
study, 31 patients with normal LV function, were randomised to either
levosimendan (0.1 and 0.2 mug/kg/min, n = 15) or milrinone (0.4 and 0.8
mug/kg/min, n = 16) after aortic valve replacement. The effects on LV
performance, LV strain, systolic (SR-S) and early diastolic (SR-E) strain
rate were assessed by a pulmonary artery catheter and transoesophageal
two-dimensional speckle tracking echocardiography of the LV inferior wall.
To circumvent the inodilator-induced hemodynamic changes on LV systolic
and diastolic deformation, central venous pressure (CVP), systolic artery
pressure (SAP), and heart rate were maintained constant by colloid
infusion, phenylephrine-induced vasoconstriction and atrial pacing,
respectively, during drug infusion. Results: Both inotropic agents induced
a dose-dependent increase in cardiac index and stroke volume index by
approximately 20% at the highest infusion rates with no differences
between groups (P =.139 and.249, respectively). CVP, pulmonary capillary
wedge pressure, SAP and heart rate were maintained constant in both
groups. LV strain and SR-S increased with both agents, dose-dependently,
by 17%-18% and 25%-30%, respectively, at the highest infusion rates, with
no difference between groups (P =.434 and.284, respectively). Both agents
improved early LV relaxation with no differences between groups (P =.637).
At the higher doses, both agents increased SR-E by 30%. Conclusions: At
clinically relevant infusion rates and a certain increase in LV
performance the direct inotropic and lusitropic of milrinone and
levosimendan were comparable.<br/>Copyright &#xa9; 2018 The Acta
Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons
Ltd

<39>
[Use Link to view the full text]
Accession Number
2001072974
Title
Impact of Isolyte Versus 0.9% Saline on Postoperative Event of Acute
Kidney Injury Assayed by Urinary [TIMP-2]x[IGFBP7] in Patients Undergoing
Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Author
Lee N.M.; Deriy L.; Petersen T.R.; Shah V.O.; Hutchens M.P.; Gerstein N.S.
Institution
(Lee, Deriy, Petersen, Gerstein) Department of Anesthesiology and Critical
Care Medicine, University of New Mexico School of Medicine, Albuquerque,
N, United States
(Shah) Department of Internal Medicine, Division of Nephrology, University
of New Mexico School of Medicine, Albuquerque, NM, United States
(Hutchens) Department of Anesthesiology and Perioperative Medicine, Oregon
Health & Science University, Portland, OR, United States
Publisher
W.B. Saunders
Abstract
Objective: Administration of excess chloride in 0.9% normal saline (NS)
decreases renal perfusion and glomerular filtration rate, thereby
increasing the risk for acute kidney injury (AKI). In this study, the
effect of NS versus Isolyte use during cardiac surgery on urinary levels
of tissue inhibitor of metalloproteinase 2 and insulin-like growth
factor-binding protein 7 [TIMP-2] x [IGFBP7] and postoperative risk of AKI
were examined. Design: Prospective, randomized, and single-blinded trial.
Setting: Single university medical center. Participants: Thirty patients
over 18 years without chronic renal insufficiency or recent AKI undergoing
elective cardiac surgery. Interventions: Subjects were randomized to
receive either NS or Isolyte during the intraoperative period.
Measurements and Main Results: The primary outcome was the change in
urinary levels of [TIMP2] x [IGFBP7] from before surgery to 24 hours
postoperatively. Secondary outcomes included serum creatinine pre- and
postoperatively at 24 and 48 hours, serum chloride pre- and
postoperatively at 24 and 48 hours, need for dialysis prior to discharge,
and arterial pH measured 24 hours postoperatively. Sixteen patients
received NS and 14 patients received Isolyte. Three patients developed AKI
within the first 3 postoperative days, all in the NS group. The authors
found increases in [TIMP-2] x [IGFBP7] in both groups. However, the
difference in this increase between study arms was not significant (p =
0.92; -0.097 to 0.107). Conclusion: The authors observed no change in
urinary [TIMP-] x [IGFBP7] levels in patients receiving NS versus Isolyte
during cardiac surgery. Future larger studies in patients at higher risk
for AKI are recommended to evaluate the impact of high- versus
lower-chloride solutions on the risk of postoperative AKI after cardiac
surgery.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<40>
Accession Number
2001063536
Title
Automated Titanium Fasteners Versus Hand-Tied Knots: A Randomized
Controlled Trial.
Source
Annals of Thoracic Surgery. (no pagination), 2018. Date of Publication:
2018.
Author
Etiwy M.; Javadikasgari H.; Houghtaling P.; Gillinov M.
Institution
(Etiwy, Javadikasgari, Gillinov) Department of Thoracic and Cardiovascular
Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio,
United States
(Houghtaling) Department of Quantitative Health Sciences, Research
Institute, Cleveland Clinic, Cleveland, Ohio, United States
Publisher
Elsevier USA
Abstract
Background: The relative benefits of automated titanium fasteners (LSI
Solutions, Victor, NY) have not been examined in patients undergoing
sternotomy. The aim of this study was to assess the time and cost required
for suture fixation with the automated device versus conventional hand
tying in sternotomy for mitral or tricuspid ring annuloplasty. Methods:
Fifty patients scheduled to undergo primary mitral or tricuspid, or both,
ring annuloplasty-based valve repair operation by a single surgeon were
randomly assigned to receive either conventional hand-tied knots or
automated titanium fasteners, with 25 patients in each group. The primary
outcome variable was the time required to affix the annuloplasty device to
the valve annulus. Results: The times taken to affix a mitral annuloplasty
band or ring were 6.1 +/- 0.9 min for manual tying versus 3.1 +/- 0.4 min
for automated fasteners (p < 0.0001); when calculated per annuloplasty
stitch, the values were 22 +/- 2 s versus 12 +/- 1.1 s, respectively (p <
0.0001). The corresponding values for tricuspid annuloplasty were 4.2 +/-
1.2 min (hand tying) versus 2.2 +/- 0.3 min (automated fasteners) (p =
0.0005), and the times for each suture were 20 +/- 2.1 s versus 13 +/- 2
s, respectively (p = 0.0004). The use of the automated fastener had no
significant impact on aortic cross-clamp time or cardiopulmonary bypass
duration. Total cost associated with annuloplasty fixation with automated
titanium fasteners (device cost in addition to operating room time cost)
was significantly higher than with hand tying ($1,190 +/- 374 vs $164 +/-
60; p < 0.0001). Conclusions: Using the automated fastener to facilitate
annuloplasty fixation through a sternotomy resulted in a small procedural
time savings (average of 10 s/stitch) that had no overall impact on
cardiopulmonary bypass or cross-clamp times but added an average cost of
$1,026 to the operation.<br/>Copyright &#xa9; 2018 The Society of Thoracic
Surgeons

<41>
Accession Number
623774886
Title
Evaluation of patient and staff exposure with state of the art X-ray
technology in cardiac catheterization: A randomized controlled trial.
Source
Journal of Interventional Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Author
Buytaert D.; Eloot L.; Mauti M.; Drieghe B.; Gheeraert P.; Taeymans Y.;
Bacher K.
Institution
(Buytaert, Eloot, Bacher) Department of Basic Medical Sciences, Ghent
University, Ghent, Belgium
(Mauti) Philips Healthcare, Best, Netherlands
(Drieghe, Gheeraert, Taeymans) Heart Centre, Ghent University Hospital,
Ghent, Belgium
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Introduction: Cardiac catheterization procedures result in high patient
radiation exposure and corresponding staff doses are reported to be among
the highest for medical staff. The purpose of current randomized
controlled study was to quantify the potential radiation dose reduction
for both patient and staff, enabled by recent X-ray technology. This
technology is equipped with advanced image processing algorithms,
real-time dose monitoring, and an acquisition chain optimized for cardiac
catheterization applications. Methods: A total of 122 adult patients were
randomly assigned to one of two cath labs, either the reference X-ray
modality (Allura Xper FD10, Philips Healthcare, the Netherlands) or the
new X-ray system (AlluraClarity FD20/10 Philips Healthcare, the
Netherlands). Exposure parameters and staff dosimeter readings were
recorded for each exposure. Technical measurements were performed to
define the radiation scatter behavior. Results: With the newer equipment,
patient radiation dose is reduced (as total dose-area product) by 67%
based on geometric means with 95%CI of 53%, 77% for diagnostic and
interventional procedures. The C-arm and leg dosimeter readings were both
reduced with 65% (P < 0.001), while for the collar and chest dosimeter
readings no statistically significant reduction was noticed. Conclusion:
The new x-ray and image processing technology, significantly reduces
patient dose in coronary angiographies, and PCIs by 67%. In general,
scatter dose was also reduced, yet for some dosimeters the reduction was
limited and not statistically significant. This study clearly indicates
that the scatter behavior is highly dependent on C-arm rotation, operator
movement and height, dosimeter position, beam filtration, clinical
procedure type and system geometry.<br/>Copyright &#xa9; 2018 Wiley
Periodicals, Inc.

<42>
Accession Number
623770577
Title
Efficacy and Safety of Further Lowering of Low-Density Lipoprotein
Cholesterol in Patients Starting with Very Low Levels: A Meta-Analysis.
Source
JAMA Cardiology. (no pagination), 2018. Date of Publication: 2018.
Author
Sabatine M.S.; Wiviott S.D.; Im K.; Murphy S.A.; Giugliano R.P.
Institution
(Sabatine, Wiviott, Im, Murphy, Giugliano) TIMI Study Group, Division of
Cardiovascular Medicine, Brigham and Women's Hospital, 60 Fenwood Rd, 7th
Floor, Boston, MA 02115, United States
(Sabatine) JAMA Cardiology, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: In the Cholesterol Treatment Trialists Collaboration (CTTC),
in patients starting with low-density lipoprotein cholesterol (LDL-C)
levels of approximately 3.4 mmol/L (131.5 mg/dL), there was a 22%
reduction in major vascular events per 1-mmol/L (38.7-mg/dL) lowering of
LDL-C. The magnitude of clinical benefit of further LDL-C lowering in
patients already with very low LDL-C levels remains debated. Objective: To
evaluate efficacy and safety of further lowering LDL-C levels in patient
populations presenting with median LDL-C levels of 1.8 mmol/L (70 mg/dL)
or less. Data Sources and Study Selection: The CTTC was used for statin
data. For nonstatin therapy, Medline database was searched (2015-April
2018). Key inclusion criteria were a randomized, double-blind, controlled
cardiovascular outcome trial of LDL-C lowering with data in populations
starting with LDL-C levels averaging 1.8 mmol/L (70 mg/dL) or less. Data
Extraction and Synthesis: Two authors independently extracted data into
standardized data sheets, and data were analyzed using meta-Analysis. Main
Outcomes and Measures: The risk ratio (RR) of major vascular events (a
composite of coronary heart death, myocardial infarction, ischemic stroke,
or coronary revascularization) per 1-mmol/L (38.7-mg/dL) reduction in
LDL-C level. Results: In the subgroup of patients from the CTTC
meta-Analysis of statins with a mean LDL-C in the control arm of 1.7
mmol/L (65.7 mg/dL), 1922 major vascular events occurred and the RR for
major vascular events per 1-mmol/L (38.7-mg/dL) reduction in LDL-C was
0.78 (95% CI, 0.65-0.94). For 3 trials of nonstatin LDL-C-lowering
therapies added to statins, there were 50627 patients, the median LDL-C in
the control arms ranged from 1.6 mmol/L to 1.8 mmol/L (63 mg/dL to 70
mg/dL), and 9570 major vascular events occurred. Nonstatin therapy lowered
LDL-C by 0.3 to 1.2 mmol/L (11 mg/dL to 45 mg/dL), and the RR for major
vascular events per 1-mmol/L (38.7-mg/dL) reduction in LDL-C was 0.79 (95%
CI, 0.70-0.88). For statins and nonstatins combined, the RR was 0.79 (95%
CI, 0.71-0.87; P <.001). Low-density lipoprotein cholesterol lowering was
not associated with an increased risk of serious adverse events, myalgias
and/or myositis, elevation in the level of aminotransferases, new-onset
diabetes, hemorrhagic stroke, or cancer. Conclusions and Relevance: There
is a consistent relative risk reduction in major vascular events per
change in LDL-C in patient populations starting as low as a median of 1.6
mmol/L (63 mg/dL) and achieving levels as low as a median of 0.5 mmol/L
(21 mg/dL), with no observed offsetting adverse effects. These data
suggest further lowering of LDL-C beyond the lowest current targets would
further reduce cardiovascular risk.<br/>Copyright &#xa9; 2018 American
Medical Association. All rights reserved.

<43>
Accession Number
618786136
Title
Selective BET Protein Inhibition with Apabetalone and Cardiovascular
Events: A Pooled Analysis of Trials in Patients with Coronary Artery
Disease.
Source
American Journal of Cardiovascular Drugs. 18 (2) (pp 109-115), 2018. Date
of Publication: 01 Apr 2018.
Author
Nicholls S.J.; Ray K.K.; Johansson J.O.; Gordon A.; Sweeney M.; Halliday
C.; Kulikowski E.; Wong N.; Kim S.W.; Schwartz G.G.
Institution
(Nicholls, Kim) South Australian Health and Medical Research Institute,
University of Adelaide, PO Box 11060, Adelaide, SA 5001, Australia
(Ray) School of Public Health, Imperial College London, London, United
Kingdom
(Johansson, Gordon, Sweeney, Halliday, Kulikowski, Wong) Resverlogix
Corporation, Denver, CO, United States
(Schwartz) University of Colorado School of Medicine, Denver, CO, United
States
Publisher
Springer International Publishing
Abstract
Background: Inhibition of bromodomain and extra-terminal (BET) proteins
can modulate lipoprotein and inflammatory factors that mediate
atherosclerosis. The impact of the BET inhibitor, apabetalone, on
cardiovascular events is unknown. Objective: Our objective was to
investigate the impact of apabetalone on cardiovascular event rates in a
pooled analysis of clinical studies in patients with established coronary
artery disease. Methods: We conducted a pooled analysis of patients (n =
798) with coronary artery disease who participated in clinical trials
(ASSERT, ASSURE, SUSTAIN) that evaluated the impact of 3-6 months of
treatment with apabetalone on lipid parameters and coronary
atherosclerosis. The incidence of major adverse cardiovascular events
(death, myocardial infarction, coronary revascularization, hospitalization
for cardiovascular causes) in the treatment groups was evaluated. Results:
At baseline, patients treated with apabetalone were more likely to be
Caucasian, have a history of dyslipidemia, and be undertreated with
s-blocker and anti-platelet agents. Treatment with apabetalone produced
the following dose-dependent changes compared with placebo: increases in
apolipoprotein A-I (apoA-I) of up to 6.7% (P < 0.001), increases in
high-density lipoprotein cholesterol (HDL-C) of up to 6.5% (P < 0.001),
increases in large HDL particles of up to 23.3% (P < 0.001), and decreases
in high-sensitivity C-reactive protein (hsCRP) of - 21.1% (P = 0.04).
Apabetalone treatment did not affect atherogenic lipoproteins compared
with placebo. Patients treated with apabetalone experienced fewer major
adverse cardiovascular events than those treated with placebo (5.9 vs.
10.4%; P = 0.02), a finding that was more prominent in patients with
diabetes (5.4 vs. 12.7%; P = 0.02), with baseline HDL-C < 39 mg/dl (5.5
vs. 12.8%; P = 0.01), or with elevated hsCRP levels (5.4 vs. 14.2%; P =
0.02). Conclusion: Pooled analysis of short-term studies demonstrated
fewer cardiovascular events among patients treated with the BET protein
inhibitor, apabetalone, than among those treated with placebo. BET protein
inhibition warrants further investigation as a novel approach to
cardiovascular risk reduction.<br/>Copyright &#xa9; 2017, Springer
International Publishing AG.

<44>
Accession Number
622339513
Title
Primary prevention of post-pericardiotomy syndrome using corticosteroids:
a systematic review.
Source
Expert Review of Cardiovascular Therapy. 16 (6) (pp 405-412), 2018. Date
of Publication: 03 Jun 2018.
Author
Wamboldt R.; Bisleri G.; Glover B.; Haseeb S.; Tse G.; Liu T.; Baranchuk
A.
Institution
(Wamboldt, Glover, Haseeb, Baranchuk) Division of Cardiology, Kingston
Health Science Center, Queen's University, Kingston, Canada
(Bisleri) Division of Cardiovascular Surgery, Kingston Health Science
Center, Queen's University, Kingston, Canada
(Tse) Department of Medicine, Chinese University of Hong Kong, Hong Kong
(Liu) Department of Cardiology, Tianjin Institute of Cardiology Second
Hospital of Tianjin Medical University, Tianjin, China
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Post-pericardiotomy syndrome is a well-recognized
inflammatory phenomenon that commonly occurs in patients following cardiac
surgery. Due to the increased morbidity and resource utilization
associated with this condition, research has recently focused on ways of
preventing its prevention this condition; primarily using colchicine,
NSAIDs and corticosteroids. Areas covered: This systematic review
summarizes the three clinical studies that have used corticosteroids for
PPS primary prevention in the perioperative period. Due to the
heterogeneity amongst these three studies in terms of population (both
pediatric and adult patients), surgical procedure, administration regimen
and results (only 1/3 studies reporting a positive effect), the
effectiveness of corticosteroids remains unproven. Expert commentary:
Corticosteroids have shown to be useful in the treatment of PPS but have
thus far have shown mixed results as a primary prevention method. Research
on patients taking corticosteroids pre-operatively have shown a
significant reduction in the risk of developing PPS. Further research is
required to determine if corticosteroids are helpful in preventing PPS in
patient undergoing cardiac surgery, before any recommendations regarding
their use in cardiovascular surgery can be made.<br/>Copyright &#xa9; 2018
Informa UK Limited, trading as Taylor & Francis Group.

<45>
Accession Number
622069197
Title
The revolution of transcatheter aortic valve implantation.
Source
Journal of Cardiovascular Surgery. 59 (3) (pp 368-369), 2018. Date of
Publication: June 2018.
Author
Tchetche D.
Institution
(Tchetche) Groupe Cardiovasculaire Interventionnel, Clinique Pasteur,
Toulouse, France
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)

<46>
Accession Number
618003838
Title
Clinical outcomes associated with sarcomere mutations in hypertrophic
cardiomyopathy: a meta-analysis on 7675 individuals.
Source
Clinical Research in Cardiology. 107 (1) (pp 30-41), 2018. Date of
Publication: 01 Jan 2018.
Author
Sedaghat-Hamedani F.; Kayvanpour E.; Tugrul O.F.; Lai A.; Amr A.; Haas J.;
Proctor T.; Ehlermann P.; Jensen K.; Katus H.A.; Meder B.
Institution
(Sedaghat-Hamedani, Kayvanpour, Tugrul, Lai, Amr, Haas, Ehlermann, Katus,
Meder) Institute for Cardiomyopathy, Department of Medicine III,
University of Heidelberg, INF 410, Heidelberg 69120, Germany
(Sedaghat-Hamedani, Kayvanpour, Tugrul, Amr, Haas, Katus, Meder) DZHK
(German Centre for Cardiovascular Research), Berlin, Germany
(Proctor, Jensen) Institute of Medical Biometry and Informatics,
University of Heidelberg, Heidelberg, Germany
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Hypertrophic cardiomyopathy (HCM) is the most common genetic
cardiovascular disease, which goes along with increased risk for sudden
cardiac death (SCD). Despite the knowledge about the different causal
genes, the relationship between individual genotypes and phenotypes is
incomplete. Methods and results: We retrieved PubMed/Medline literatures
on genotype-phenotype associations in patients with HCM and mutations in
MYBPC3, MYH7, TNNT2, and TNNI3. Altogether, 51 studies with 7675 HCM
patients were included in our meta-analysis. The average frequency of
mutations in MYBPC3 (20%) and MYH7 (14%) was higher than TNNT2 and TNNI3
(2% each). The mean age of HCM onset for MYH7 mutation positive patients
was the beginning of the fourth decade, significantly earlier than
patients without sarcomeric mutations. A high male proportion was observed
in TNNT2 (69%), MYBPC3 (62%) and mutation negative group (64%). Cardiac
conduction disease, ventricular arrhythmia and heart transplantation (HTx)
rate were higher in HCM patients with MYH7 mutations in comparison to
MYBPC3 (p < 0.05). Furthermore, SCD was significantly higher in patients
with sarcomeric mutations (p < 0.01). Conclusion: A pooled dataset and a
comprehensive genotype-phenotype analysis show that the age at disease
onset of HCM patients with MYH7 is earlier and leads to a more severe
phenotype than in patient without such mutations. Furthermore, patients
with sarcomeric mutations are more susceptible to SCD. The present study
further supports the clinical interpretation of sarcomeric mutations in
HCM patients.<br/>Copyright &#xa9; 2017, Springer-Verlag GmbH Germany.

<47>
Accession Number
368854579
Title
Oral azithromycin in extended dosage schedule for chronic, subclinical
Chlamydia pneumoniae infection causing coronary artery disease: A probable
cure in sight? Results of a controlled preliminary trial.
Source
International Journal of General Medicine. 5 (pp 505-509), 2012. Date of
Publication: 2012.
Author
Dogra J.
Institution
(Dogra) Poly Clinic, Central Government Health Scheme, Jaipur, Rajasthan,
India
Publisher
Dove Medical Press Ltd.
Abstract
Purpose: Two mega trials have raised the question as to whether the
hypothesis that infection plays a role in atherosclerosis is still
relevant. This controlled preliminary trial investigated an extended dose
of azithromycin in the treatment of Chlamydia pneumoniae infection causing
coronary artery disease (CAD). Patients and methods: Forty patients with
documentary evidence of CAD were screened for immunoglobulin G titers
against C. pneumoniae and grouped into either the study group (patients
with positive titer, n = 32) or control group (patients with negative
titer, n = 8). Cases who met inclusion criteria could not have had
coronary artery bypass graft surgery or percutaneous coronary intervention
in the preceding 6 months. Informed consent was obtained from every
patient. Baseline blood samples were analyzed for red blood cell indices,
serum creatinine, and liver function tests, and repeated every 2 months. A
primary event was defined as the first occurrence of death by any cause,
recurrent myocardial infarction, coronary revascularization procedure, or
hospitalization for angina. Patients in the study group received 500 mg of
oral azithromycin once daily for 5 days, which was then repeated after a
gap of 10 days (total of 24 courses in the 1-year trial period). The
control group did not have azithromycin added to their standard CAD
treatment. Results: In the study group, 30 patients completed the trial.
Two patients had to undergo percutaneous coronary intervention in the
initial first quarter of the 1-year trial period. In the control group,
one patient died during the trial, one had to undergo coronary artery
bypass graft surgery, and one had percutaneous coronary intervention.
Conclusion: The patients tolerated the therapy well and there was a
positive correlation between azithromycin and secondary prevention of CAD.
&#xa9; 2012 Dogra, publisher and licensee Dove Medical Press Ltd.

<48>
Accession Number
622474694
Title
Effect of preoperative warming on intraoperative hypothermia: a
randomized-controlled trial.
Source
Canadian Journal of Anesthesia. 65 (9) (pp 1029-1040), 2018. Date of
Publication: 01 Sep 2018.
Author
Lau A.; Lowlaavar N.; Cooke E.M.; West N.; German A.; Morse D.J.; Gorges
M.; Merchant R.N.
Institution
(Lau, Lowlaavar, Cooke, West, Gorges, Merchant) Department of
Anesthesiology, Pharmacology, & Therapeutics, University of British
Columbia, Vancouver, BC, Canada
(German) Graduate School of Medicine, University of Wollongong,
Wollongong, Australia
(Morse) 3M Infection Prevention Division, 3M Corporation, St. Paul, MN,
United States
(Gorges) Research Institute, BC Children's Hospital, Vancouver, BC, Canada
(Merchant) Department of Anesthesia and Perioperative Medicine, Royal
Columbian Hospital, Fraser Health Authority, New Westminster, BC, Canada
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: The purpose of this study was to evaluate the effects of
preoperative forced-air warming on intraoperative hypothermia. Methods: In
this randomized-controlled trial, adult patients scheduled for elective,
non-cardiac surgery under general anesthesia were stratified by scheduled
surgical duration (< 2.5 hr or >= 2.5 hr) and then randomized to a
pre-warming group using a BairPawsTM forced-air warming system for at
least 30 min preoperatively or to a control group with warmed blankets on
request. All patients were warmed intraoperatively via convective
forced-air warming blankets. Perioperative temperature was measured using
the SpotOnTM temperature system consisting of a single-use disposable
sensor applied to the participant's forehead. The primary outcome was the
magnitude of intraoperative hypothermia calculated as the area under the
time-temperature curve for core temperatures < 36degreeC between induction
of general anesthesia and leaving the operating room. Secondary outcomes
included surgical site infections, packed red blood cell requirements, and
24 hr postoperative opioid consumption. Results: Two hundred participants
were analyzed (101 control; 99 pre-warmed). Pre-warmed participants had a
lower median [interquartile range] magnitude of hypothermia than controls
(0.00 [0.00-0.12] degreeC.hr^-1vs 0.05 [0.00-0.36]
degreeC.hr^-1, respectively; median difference,
-0.01degreeC.hr^-1; 95% confidence interval, -0.04 to
0.00degreeC.hr^-1; P = 0.005). There were no between-group
differences in the secondary outcomes. Conclusion: A minimum of 30 min of
preoperative forced-air convective warming decreased the overall
intraoperative hypothermic exposure. While redistribution hypothermia
still occurs despite pre- and intraoperative forced-air warming, their
combined application results in greater preservation of intraoperative
normothermia compared with intraoperative forced-air warming alone. Trial
registration: www.clinicaltrials.gov (NCT02177903). Registered 25 June
2014.<br/>Copyright &#xa9; 2018, Canadian Anesthesiologists' Society.

<49>
Accession Number
623762823
Title
Effect of Cardiac Rehabilitation Dose on Mortality and Morbidity: A
Systematic Review and Meta-regression Analysis.
Source
Mayo Clinic Proceedings. 92 (11) (pp 1644-1659), 2017. Date of
Publication: November 2017.
Author
Santiago de Araujo Pio C.; Marzolini S.; Pakosh M.; Grace S.L.
Institution
(Santiago de Araujo Pio, Grace) York University, School of Kinesiology and
Health Science, Toronto, Ontario, Canada
(Marzolini, Pakosh, Grace) University Health Network-University of
Toronto, Toronto, Ontario, Canada
Publisher
Elsevier Ltd
Abstract
Objective To ascertain the effect of cardiac rehabilitation (CR) dose (ie,
duration x frequency/wk; categorized as low [<12 sessions], medium [12-35
sessions], or high [>=36 sessions]) on mortality and morbidity. Methods
The Cochrane, CINAHL, EMBASE, PsycINFO, and MEDLINE databases were
systematically searched from inception through November 30, 2015.
Inclusion criteria included randomized or nonrandomized studies with a
minimum CR dose of 4 or higher and presence of a control/comparison group.
Citations were considered for inclusion, and data were extracted in
included studies independently by 2 investigators. Studies were pooled
using random-effects meta-analysis and meta-regression where warranted
(covariates included study quality, country, publication year, and
diagnosis). Results Of 4630 unique citations, 33 trials were included
comparing CR to usual care (ie, no dose). In meta-regression, greater dose
was significantly related to lower all-cause mortality (high: -0.77; SE,
0.22; P<.001; medium: -0.80; SE, 0.21; P<.001) when compared with low
dose. With regard to morbidity, meta-analysis revealed that dose was
significantly associated with fewer percutaneous coronary interventions
(high: relative risk, 0.65; 95% CI, 0.50-0.84; medium/low: relative risk,
1.04; 95% CI, 0.74-1.48; between subgroup difference P=.03). This
reduction was also significant in meta-regression (high vs medium/low:
-0.73; SE, 0.20; P<.001). Publication bias was not evident. No
dose-response association was found for cardiovascular mortality,
all-cause hospitalization, coronary artery bypass graft surgery, or
myocardial infarction. Conclusion A minimum of 36 CR sessions may be
needed to reduce percutaneous coronary interventions. Future studies
should examine the effect of actual dose of CR, and trials are needed
comparing different doses. PROSPERO Registration
CRD42016036029.<br/>Copyright &#xa9; 2017 Mayo Foundation for Medical
Education and Research

<50>
Accession Number
623755779
Title
Comparing the effect of oral clonidine and tranexamic acid on bleeding and
surgical field quality during functional endoscopic sinus surgery.
Source
Iranian Journal of Otorhinolaryngology. 30 (5) (pp 255-260), 2018. Date of
Publication: 2018.
Author
Ghorbani J.; Arastou S.; Naeini A.S.; Raad N.; Galougahi M.K.;
Jahangirifard A.; Dilmaghani N.A.
Institution
(Ghorbani) Chronic Respiratory Disease Research Center, National Research
Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Arastou) Department of Rhinology, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Naeini, Raad, Galougahi) Tracheal Research Center, National Research
Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Jahangirifard) Lung Transplantation Research Center, National Research
Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Dilmaghani) Hearing Disorders Research Center, Shahid Beheshti University
of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Mashhad University of Medical Sciences (E-mail: IJO@mums.ac.ir)
Abstract
Introduction: Bleeding during functional endoscopic sinus surgery (FESS)
is an important issue for both anesthesiologists and surgeons as it can
affect the safety and efficiency of the procedure. We compared the
efficacy of tranexamic acid (TXA) and clonidine in reducing blood loss and
improving surgical field visualization during FESS. Materials and Methods:
In a double-blind, randomized, clinical trial, 52 patients, American
Society of Anesthesiologists (ASA) physical status 1-2, aged 13-75 years,
suffering from rhinosinusitis with or without polyposis, and who were
candidates for FESS, were enrolled. The first group received intravenous
TXA 15 mg/kg diluted in 100 ml normal saline, administered during 10-min
infusion after induction. In the second group, 0.2 mg oral clonidine was
given 1 to 1.5 hours before surgery. Duration of surgery, hemoglobin
level, heart rate, blood pressure, and quality of surgical field based on
Boezzart's scale and surgeon satisfaction based on Likert's scale were
recorded in both groups. Results: In total, 52 patients, 27 (51.9%) males
and 25 (48.07%) females were studied. Twenty-two (42.3%) and 30 (57.7%)
were in the TXA and clonidine groups, respectively. The mean pre- and
post-surgical hemoglobin level showed no meaningful difference between the
two groups. The same result was obtained for blood pressure and heart rate
at different time points (P > 0.05). Mean anesthesia time (P=0.859), mean
surgical time (P=0.880), surgeon's satisfaction of the surgical field
(P=0.757) and surgical field quality at different time points revealed no
significant difference between the two groups. Conclusion: Premedication
with oral clonidine and intravenous TXA has the same effect on bleeding
during FESS, surgical field visualization, and surgeon
satisfaction.<br/>Copyright &#xa9; 2018, Mashhad University of Medical
Sciences.

<51>
Accession Number
623751668
Title
Preoperative rehabilitation in lung cancer patients: Yoga approach.
Source
Advances in Experimental Medicine and Biology. 1096 (pp 19-29), 2018. Date
of Publication: 2018.
Author
Barassi G.; Bellomo R.G.; Di Iulio A.; Lococo A.; Porreca A.; Di Felice
P.A.; Saggini R.
Institution
(Barassi, Porreca, Di Felice, Saggini) Department of Medical Oral and
Biotechnological Science, "Gabriele d'Annunzio" University,
Chieti-Pescara, Italy
(Bellomo) Department of Biomolecular Sciences, 'Carlo Bo' University,
Urbino, Italy
(Di Iulio, Lococo) Division of Thoracic Surgery, Santo Spirito Hospital of
Pescara, Pescara, Italy
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Lung cancer is one of the leading causes of cancer death worldwide.
Surgical removal remains the best option for most tumors of this type.
Reduction of cigarette consumption in patients with lung cancer candidates
for the surgery could limit the impact of tobacco on postsurgical
outcomes. Breathing exercises appear to help combat cigarette cravings.
Yoga exercise benefits have been studied in lung cancer survivors, rather
than in the preoperative setting. In this study, we have recruited 32
active smokers affected by lung cancer and being candidates for pulmonary
surgery. The patients were randomly assigned to two groups: one treated by
standard breathing and the other treated by yoga breathing (YB). The
groups were evaluated at times T0 (baseline) and T1 (after 7 days of
treatment) to compare the effects of the two breathing treatments on
pulmonary performance in a presurgery setting. Pulmonary and
cardiocirculatory functions have been tested using a self-calibrating
computerized spirometer and a portable pulse oximetry device. The findings
demonstrate appreciable short-term improvement in lung function assessed
by spirometry. We conclude that yoga breathing can be a beneficial
preoperative support for thoracic surgery.<br/>Copyright &#xa9; 2018,
Springer International Publishing AG, part of Springer Nature.

<52>
Accession Number
2001065927
Title
Levosimendan use in patients with preoperative low ejection fraction
undergoing cardiac surgery: A systematic review with meta-analysis and
trial sequential analysis.
Source
Journal of Clinical Anesthesia. 52 (pp 37-47), 2019. Date of Publication:
February 2019.
Author
Ng K.T.; Chan X.L.; Tan W.; Wang C.Y.
Institution
(Ng, Wang) Department of Anaesthesiology, Faculty of Medicine, University
of Malaya, Jalan Universiti, Kuala Lumpur 50603, Malaysia
(Chan, Tan) School of Medicine, University of Bristol, Bristol, United
Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: Patients with preoperative low left ventricular ejection
fraction (LVEF) are known to be associated with high morbidities and
mortality in cardiac surgery. The primary aim of this review was to
examine the clinical outcomes of levosimendan versus placebo in patients
with preoperative low LVEF <= 50% undergoing cardiac surgery. Data
sources: MEDLINE, EMBASE, PubMed and CENTRAL were searched systematically
from their inception until June 2018. Review methods: All the randomised
clinical trials (RCTs) were included. Results: Twelve trials were eligible
(n = 1867) for inclusion in the data synthesis. In comparison to the
placebo cohort, the levosimendan cohort showed a significant reduction in
mortality (TSA = inconclusive; rho = 0.002; I² = 0%; FEM: OR
0.56; 95% CI 0.39, 0.80), especially in the subgroups of preoperative
severe low LVEF <= 30% (rho = 0.003; OR 0.33; 95% CI 0.16, 0.69),
preoperative administering of levosimendan (rho = 0.001; OR 0.46; 95% CI
0.29, 0.74) and patients who had bolus followed by infusion of
levosimendan (rho = 0.005; OR 0.50; 95% CI 0.30, 0.81). However, the
effect on mortality was not significant in the subgroup analysis of high
quality trials (rho = 0.14; OR 0.73; 95% CI 0.47, 1.12). The levosimendan
cohort showed a significantly lower incidence of
low-cardiac-output-syndrome (rho < 0.001; OR 0.58; 95% CI 0.46, 0.74) and
lesser need for mechanical support of cardiac assist devices (rho = 0.02;
OR 0.39; 95% CI 0.18, 0.86). Conclusions: Given the low level of evidence
and inconclusive TSA, the results of this meta-analysis neither support
nor oppose the use of levosimendan in cardiac patients with preoperative
low LVEF <= 50%. Therefore, multi-centre, adequately powered, randomised
controlled trials are warranted. PROSPERO registration:
CRD42017067572.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<53>
Accession Number
621400230
Title
Assessment of renal and hepatic tissue-protective effects of
n-acetylcysteine via ammonia metabolism: A prospective randomized study.
Source
Medical Science Monitor. 24 (pp 1540-1546), 2018. Article Number: 908172.
Date of Publication: 15 Mar 2018.
Author
Onk D.; Ozcelik F.; Onk O.A.; Gunay M.; Ayazoglu T.A.; Unver E.
Institution
(Onk) Department of Anesthesiology, Faculty of Medicine, Erzincan
University, Erzincan, Turkey
(Ozcelik) Department of Medical Biochemistry, Sultan Abdulhamid Han
Training Hospital, University of Health Sciences, Istanbul, Turkey
(Onk) Department of Cardiovascular Surgery, Faculty of Medicine, Erzincan
University, Erzincan, Turkey
(Gunay) Department of Biochemistry, Faculty of Medicine, Erzincan
University, Erzincan, Turkey
(Ayazoglu) Department of Anesthesiology, Goztepe Training and Research
Hospital, Istanbul, Turkey
(Unver) Department of Chest Diseases, Faculty of Medicine, Erzincan
University, Erzincan, Turkey
Publisher
International Scientific Information, Inc. (E-mail:
iza.pranga@isl-science.com)
Abstract
Background: The present study sought to assess the renal and liver
protective effect of N-acetylcysteine through NH3 and urea metabolism in
patients with chronic obstructive pulmonary disease who were scheduled for
coronary artery bypass grafting surgery. Material/Methods: Patients with
chronic obstructive pulmonary disease (COPD) who were scheduled for
coronary artery bypass grafting were divided into 2 groups so as to
receive (Group 1, n=35) or not receive (Group 2, n=35) 900 mg/day of
n-acetylcysteine for 7 days before the operation starting from their
admission to the service by a pulmon-ologist with the purpose of treating
COPD until the day of surgery. Both groups were subjected to the same
anesthesia protocol. Blood samples were taken preoperatively, within the
first 15^th minute following cessation of the cardiopulmonary
bypass, at postoperative 24^th hour, and at postoperative
48^th hour. Blood tests included ammonia (NH3), lactate, blood
urea nitrogen, creatinine, aspartate transaminase (AST), alanine
transaminase (ALT), alkaline phosphatase (ALP), troponin I (Tn I), and
creatinine kinase-muscle brain (CKMB). Results: There was a significant
difference between the groups' NH3 and lactate levels after
cardiopulmonary bypass, postoperative 24^th hour, and
postoperative 48^th hour (respectively, NH3: 39.0+/-8.8 vs.
55.4+/-19.6 and 40.1+/-8.4 vs. 53.2+/-20.2 mcg/dl, lactate: 1.7+/-0.9 vs.
2.1+/-1.2 and 1.2+/-0.5 vs. 1.8+/-1.4 mmol/L; p<0.01). Creatinine and BUN
levels in Group 2 were found to be significantly higher at the
postoperative 48^th hour compared to the levels of Group 1
(P<0.05). Conclusions: N-acetylcysteine pretreatment appears to improve
renal and hepatic functions through regulation of ammonia and nitrogen
metabolism and reduction of lactate in patients with chronic obstructive
pulmonary disease who undergo coronary artery bypass grafting surgery. We
found that N-acetylcysteine improved kidney and/or liver
functions.<br/>Copyright &#xa9; Med Sci Monit.

<54>
Accession Number
623740753
Title
Randomized controlled trial of a self-administered five-day antiseptic
bundle versus usual disinfectant soap showers for preoperative eradication
of Staphylococcus aureus colonization.
Source
Infection Control and Hospital Epidemiology. (no pagination), 2018. Date
of Publication: 2018.
Author
Kline S.E.; Neaton J.D.; Lynfield R.; Ferrieri P.; Kulasingam S.; Dittes
K.; Glennen A.; Jawahir S.; Kaizer A.; Menk J.; Johnson J.R.
Institution
(Kline, Dittes, Johnson) University of Minnesota Medical School,
Department of Medicine, Division of Infectious Diseases, Minneapolis, MN,
United States
(Neaton) Division of Biostatistics, University of Minnesota School of
Public Health, Minneapolis, MN, United States
(Lynfield, Glennen, Jawahir) Minnesota Department of Health, St Paul, MN,
United States
(Ferrieri) Department of Laboratory Medicine and Pathology, University of
Minnesota Medical School, Minneapolis, MN, United States
(Kulasingam) Division of Epidemiology, University of Minnesota, School of
Public Health, Minneapolis, MN, United States
(Kaizer, Menk) Biostatistical Design and Analysis Center, University of
Minnesota, Minneapolis, MN, United States
(Johnson) Veterans Affairs Medical Center, Minneapolis, MN, United States
Publisher
Cambridge University Press (E-mail: subscriptions@press.uchicago.edu)
Abstract
ObjectiveTo determine the efficacy in eradicating Staphylococcus aureus
(SA) carriage of a 5-day preoperative decolonization bundle compared to 2
disinfectant soap showers, with both regimens self-administered at
home.DesignOpen label, single-center, randomized clinical
trial.SettingAmbulatory orthopedic, urologic, neurologic, colorectal,
cardiovascular, and general surgery clinics at a tertiary-care referral
center in the United States.ParticipantsPatients at the University of
Minnesota Medical Center planning to have elective surgery and not on
antibiotics.MethodsConsenting participants were screened for SA
colonization using nasal, throat, axillary, and perianal swab cultures.
Carriers of SA were randomized, stratified by methicillin resistance
status, to a decolonization bundle group (5 days of nasal mupirocin,
chlorhexidine gluconate [CHG] bathing, and CHG mouthwash) or control group
(2 preoperative showers with antiseptic soap). Colonization status was
reassessed preoperatively. The primary endpoint was absence of SA at all 4
screened body sites.ResultsOf 427 participants screened between August 31,
2011, and August 9, 2016, 127 participants (29.7%) were SA carriers. Of
these, 121 were randomized and 110 were eligible for efficacy analysis (57
decolonization bundle group, 53 control group). Overall, 90% of evaluable
participants had methicillin-susceptible SA strains. Eradication of SA at
all body sites was achieved for 41 of 57 participants (71.9%) in the
decolonization bundle group and for 13 of 53 participants (24.5%) in the
control group, a difference of 47.4% (95% confidence interval [CI],
29.1%-65.7%; P<.0001).ConclusionAn outpatient preoperative antiseptic
decolonization bundle aimed at 4 body sites was significantly more
effective in eradicating SA than the usual disinfectant showers (ie, the
control).Trial RegistrationClinicalTrials.gov identifier.<br/>Copyright
&#xa9; 2018 by The Society for Healthcare Epidemiology of America. All
rights reserved.

<55>
Accession Number
623738041
Title
The incremental predictive value of frailty measures in elderly patients
undergoing cardiac surgery: A systematic review.
Source
Clinical Cardiology. (no pagination), 2018. Date of Publication: 2018.
Author
Li Z.; Ding X.
Institution
(Li) Department of Epidemiology & Biostatistics, Western University,
London, ON, Canada
(Ding) Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing, China
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Emerging evidence demonstrates that frailty measures can predict adverse
outcomes after cardiac procedures. Our objectives were to examine whether
the inclusion of frailty measures adds incremental predictive value to
existing surgical risk prediction models in patients undergoing cardiac
surgery and to evaluate the reporting and methods of studies that
investigated the prediction of frailty measures in cardiology. The
inclusion of frailty measures adds incremental predictive value on
existing perioperative risk-scoring systems. We systematically searched
the EMBASE, MEDLINE, and Web of Science databases for relevant studies.
Studies were included according to predefined inclusion criteria. The
quality of included studies was appraised using the QUADAS-2 tool. Data
were extracted and synthesized according to predefined methods. Twelve
studies were included in the analysis. Included studies demonstrated the
incremental predictive value of frailty measures on existing surgical risk
models for mortality, but the predictive value of frailty measures alone
was not consistent across literature. Few studies that investigated the
predictive ability of frailty measures reported all important model
performance measures. When comparing the predictive value of frailty
measures with existing models, few studies reported if the frailty
measurement was separately performed from the existing perioperative risk
assessment. The addition of frailty measures to the existing perioperative
risk models improved the prediction performance for mortality, but the
incorporation of frailty assessment into perioperative risk assessment
requires further evidence before making health policy
recommendations.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<56>
Accession Number
623736830
Title
Unequal intra-group variance in trajectory classification.
Source
Statistics in Medicine. (no pagination), 2018. Date of Publication: 2018.
Author
Klich A.; Ecochard R.; Subtil F.
Institution
(Klich, Ecochard, Subtil) Service de Biostatistique-Bioinformatique, Pole
Sante Publique, Hospices Civils de Lyon, Lyon, France
(Klich, Ecochard, Subtil) Universite de Lyon, Universite Lyon 1, CNRS,
Laboratoire de Biometrie et Biologie Evolutive UMR 5558, Villeurbanne,
France
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Classifying patients into groups according to longitudinal series of
measurements (ie, trajectory classification) has become frequent in
clinical research. Most classification models suppose an equal intra-group
variance across groups. This assumption is sometimes inappropriate because
measurements in diseased subjects are often more heterogeneous than in
healthy ones. We developed a new classification model for trajectories
that uses unequal intra-group variance across groups and evaluated its
impact on classification using simulations and a clinical study. The
classification and typical trajectories were estimated using the
classification Expectation Maximization (EM) algorithm to maximize the
classification likelihood, the log-likelihood being profiled during the
Maximization (M) step of the algorithm. The simulations showed that
assuming equal intra-group variance resulted in a high misclassification
rate (up to 50%) when the real intra-group variances were different. This
rate was greatly reduced by allowing intra-group variances to be
different. Similar classification was obtained when the real intra-group
variances were equal, except when the total sample size and the number of
repeated measurements were small. In a randomized trial that compared the
effect of low vs standard cyclosporine A dose on creatinine levels after
cardiac transplantation, the classification model with unequal intra-group
variance led to more meaningful groups than with equal intra-group
variance and showed distinct benefits of low dose. In conclusion, we
recommend the use of a classification model for trajectories that allows
for unequal intra-group variance across groups except when the number of
repeated measurements and total sample size are small.<br/>Copyright
&#xa9; 2018 John Wiley & Sons, Ltd.