EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
623616530
Title
Intensive care after cardiac surgery.
Source
Indian Journal of Forensic Medicine and Toxicology. 12 (3) (pp 172-177),
2018. Date of Publication: July-September 2018.
Author
Vardanjani M.M.; Mardani D.; Hormoz N.; Kalvandi N.
Institution
(Vardanjani) Department of Medical Surgical Nursing, School of Nursing and
Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran, Islamic
Republic of
(Mardani) Member of Chamran Heart Center, Isfahan University of Medical
Sciences, Isfahan, Iran, Islamic Republic of
(Hormoz, Kalvandi) Hamadan University of Medical Scinces, Hamadan, Iran,
Islamic Republic of
Publisher
Indian Journal of Forensic Medicine and Toxicology (E-mail:
ijfmt@hotmail.com)
Abstract
Post-surgical cardiac surgery is one of the most critical therapeutic
courses in patients undergoing cardiovascular surgery. Complications such
as bleeding, heart failure, arrhythmias, organ failure, neurological
disorders, respiratory failure, infection, and hemodynamic disorders are
some of the most prominent and life-threatening events in this period. The
management and treatment of these patients is done in partnership with a
team that plays a key role for nurses. A prospective review article is an
integrated review of the articles which have been evaluated and analyzed
during three stages of the search of texts. Searching for texts in valid
databases was searched using the keywords "nursing care", "heart surgery",
"nursing" and "cardiac surgery complications", subject to their
publication period from 2000 to 2016. The data extracted from the reviewed
articles is analyzed and categorized. Among the critical nursing practices
in the management of this critical period, one can explore and identify
people at risk, heart rate monitoring and monitoring, hemodynamic
monitoring, correction of hypertension disorders, diagnosis and treatment
of hemodynamic disorders, and prevention and treatment of neurological
disorders. Be The forthcoming review study attempts to explain and explain
the nurses' responsibilities to specialized care units during
post-operative heart surgery by systematically reviewing nursing
texts.<br/>Copyright &#xa9; 2018, Indian Journal of Forensic Medicine and
Toxicology. All rights reserved.

<2>
Accession Number
621493019
Title
Do selective serotonin reuptake inhibitors increase the risk of bleeding
or mortality following coronary artery bypass graft surgery? A
meta-analysis of observational studies.
Source
Perfusion (United Kingdom). 33 (6) (pp 415-422), 2018. Date of
Publication: 01 Sep 2018.
Author
Eckersley M.J.; Sepehripour A.H.; Casula R.; Punjabi P.; Athanasiou T.
Institution
(Eckersley, Sepehripour, Casula, Punjabi, Athanasiou) Department of
Surgery and Cancer, Imperial College London, London, United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: Depressive illness has a high prevalence in patients
undergoing coronary artery bypass graft surgery (CABG). The first line
treatment for depression are selective serotonin reuptake inhibitors
(SSRIs) which inhibit serotonin reuptake in the presynaptic neuronal
membrane and uptake by platelets, inhibiting subsequent serotonin-mediated
platelet activation. This presents a theoretically increased risk of
bleeding and subsequent postoperative mortality. This review aims to
investigate the effects of SSRIs on postoperative bleeding, defined as the
need for transfusions and re-operation for bleeding, as well as 30-day
mortality in patients undergoing CABG. Method: Four hundred and
thirty-seven papers were screened with seven meeting the full inclusion
criteria. Results: Meta-analysis demonstrated that SSRI use increased the
risk of red blood cell transfusion (odds ratio (OR) = 1.15; 95% confidence
interval (CI): 1.06-1.26), but resulted in no difference in the rate of
re-operation for bleeding (OR = 1.07; 95% CI: 0.66-1.74). SSRI use had no
effect on the rates of platelet (OR = 0.93; 95% CI: 0.79-1.09) or fresh
frozen plasma (OR = 0.96; 95% CI: 0.74-1.24) transfusion nor on the
mortality rate (OR =1.03; 95 CI: 0.90-1.17). Conclusion: This review
demonstrates that SSRIs are largely safe in cardiac surgery as no increase
in mortality was observed. However, there is a significantly raised chance
of red blood cell transfusion. The heterogeneous nature of the current
evidence base highlights the need for further research into SSRIs and
whether any effect on patient outcomes in cardiac surgery
occurs.<br/>Copyright &#xa9; The Author(s) 2018.

<3>
Accession Number
623644612
Title
Prognostic indicators for heart failure hospitalization in acute coronary
syndrome patients: An observational study under the influenza vaccination
trial.
Source
Journal of the Medical Association of Thailand. 101 (8) (pp 1043-1049),
2018. Date of Publication: August 2018.
Author
Sribhutorn A.; Phrommintikul A.; Wongcharoen W.; Chaikledkaew U.;
Eakanunkul S.; Patumanond J.; Sukonthasarn A.
Institution
(Sribhutorn) Faculty of Medicine, Chiang Mai University, Thailand
(Sribhutorn) Department of Pharmacy Practice, School of Pharmaceutical
Sciences, University of Phayao, Phayao, Thailand
(Phrommintikul, Wongcharoen, Sukonthasarn) Cardiology Division, Department
of Internal Medicine, Faculty of Medicine, Chiang Mai University, Thailand
(Chaikledkaew) Social and Administrative Pharmacy Excellence Research
(SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol
University, Bangkok, Thailand
(Eakanunkul) Department of Pharmaceutical Sciences, Faculty of Pharmacy,
Chiang Mai University, Thailand
(Patumanond) Department of Clinical Epidemiology and Clinical Statistics,
Clinical Research Center, Faculty of Medicine, Thammasat University,
Pathum Thani, Thailand
Publisher
Medical Association of Thailand (E-mail: math@loxinfo.co.th)
Abstract
Background: Heart failure [HF] is described as a consequence from tissue
injury in myocardial infarction through finally organ failure. Therefore,
HF prevention through forecasting clinical predictors is useful for
closely HF monitoring and management. Objective: To explore prognostic
indicators for HF hospitalization in Acute coronary syndrome [ACS]
patients through the influenza vaccination trial. Materials and Methods:
These observational data were collected from 439 ACS patients of
Phrommintikul et al. The inactivated influenza vaccine was injected
intramuscularly as a single dose in the vaccination group. The HF
hospitalization outcome was determined through one-year follow-up time.
The multivariable Cox's regression model was performed to explore the
prognostic values. Results: The significant prognostic indicators were
female (HR 4.05, 95% CI 1.25 to 13.19, p = 0.020), dyslipidemia (HR 7.44,
95% CI 1.88 to 29.40, p = 0.004), elevated SCr (HR = 5.46, 95% CI 1.39 to
21.41, p = 0.015), impaired LVEF (HR 9.55, 95% CI 2.55 to 35.81, p =
0.001), and influenza vaccination (HR 0.25, 95% CI 0.07 to 0.86, p =
0.028). Conclusion: ACS patients who were female with dyslipidemia,
elevated SCr, and impaired LVEF should be closely monitored for HF. The
influenza vaccination had a significant protective effect for HF in ACS.
Therefore, the benefit of influenza vaccine should be considered in
practice for ACS patients.<br/>Copyright &#xa9; 2018, Medical Association
of Thailand. All rights reserved.

<4>
Accession Number
620676488
Title
Is the use of hydroxyethyl starch as priming solution during cardiac
surgery advisable? A randomized, single-center trial.
Source
Perfusion (United Kingdom). 33 (6) (pp 483-489), 2018. Date of
Publication: 01 Sep 2018.
Author
Svendsen O.S.; Farstad M.; Mongstad A.; Haaverstad R.; Husby P.; Kvalheim
V.L.
Institution
(Svendsen, Farstad, Husby) Department of Anesthesia and Intensive Care,
Haukeland University Hospital, Bergen, Norway
(Mongstad, Haaverstad, Kvalheim) Section for Cardiothoracic Surgery,
Department for Heart Disease, Haukeland University Hospital, Bergen,
Norway
(Haaverstad, Kvalheim) Department of Clinical Science, Faculty of
Medicine, University of Bergen, Bergen, Norway
(Husby) Department of Clinical Medicine, Faculty of Medicine, University
of Bergen, Bergen, Norway
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: The use of cardiopulmonary bypass (CPB) leads to increased
fluid filtration and edema. The use of artificial colloids to counteract
fluid extravasation during cardiac surgery is controversial. Beneficial
effects on global fluid loading, leading to better cardiac performance and
hemodynamics, have been claimed. However, renal function and coagulation
may be adversely affected, with unfavorable impact on outcome following
cardiac surgery. Methods: Forty patients were randomly allocated to study
groups receiving either acetated Ringer's solution (CT group) or
hydroxyethyl starch (HES group, Tetraspan) as CPB priming
solution. Fluid balance, bleeding and hemodynamics, including cardiac
output, were followed postoperatively. The occurrence of acute kidney
injury was closely registered. Results: Two patients were excluded from
further analyzes due to surgical complications. Fluid accumulation was
attenuated in the HES group (3374 (883) ml) compared with the CT group
(4328 (1469) ml) (p=0.024). The reduced perioperative fluid accumulation
was accompanied by an increased cardiac index immediately after surgery
(2.7 (0.4) L/min/m² in the HES group and 2.1 (0.3)
L/min/m² in the CT group (p<0.001)). No increase in bleeding
could be demonstrated in the HES group. Three patients, all of them in the
HES group, experienced acute kidney injury postoperatively. Conclusions:
CPB priming with HES solution lowers fluid loading during bypass and
improves cardiac function in the early postoperative period. The
manifestation of acute kidney injury exclusively in the HES group of
patients raises doubts about the use of HES products in conjunction with
cardiac surgery.
(https://clinicaltrials.gov/ct2/show/NCT01511120).<br/>Copyright &#xa9;
The Author(s) 2017.

<5>
Accession Number
2001061078
Title
EdoxabaN Versus standard of care and theIr effectS on clinical outcomes in
pAtients havinG undergonE Transcatheter Aortic Valve Implantation in
Atrial Fibrillation-Rationale and design of the ENVISAGE-TAVI AF trial.
Source
American Heart Journal. 205 (pp 63-69), 2018. Date of Publication:
November 2018.
Author
Van Mieghem N.M.; Unverdorben M.; Valgimigli M.; Mehran R.; Boersma E.;
Baber U.; Hengstenberg C.; Shi M.; Chen C.; Saito S.; Veltkamp R.; Vranckx
P.; Dangas G.D.
Institution
(Van Mieghem) Department of Cardiology, Thoraxcenter, Erasmus Medical
Center, Rotterdam, Netherlands
(Unverdorben, Chen) Global Medical Affairs, Daiichi Sankyo, Inc, Basking
Ridge, NJ, United States
(Valgimigli, Boersma) Swiss Cardiovascular Center, Inselspital, Bern,
Switzerland
(Mehran, Baber, Dangas) Zena and Michael A. Wiener Cardiovascular
Institute, Mount Sinai Hospital, New York, NY, United States
(Hengstenberg) Division of Cardiology, Department of Internal Medicine II,
Medical University of Vienna, Vienna, Austria
(Shi) Biostatistics, Daiichi Sankyo Pharma Development, Basking Ridge, NJ,
United States
(Saito) Department of Cardiovascular Medicine, Shonan Kamakura General
Hospital, Kanagawa, Japan
(Veltkamp) Imperial College, London, United Kingdom
(Veltkamp) Department of Neurology, Alfried-Krupp Krankenhaus, Essen,
Germany
(Vranckx) Hartcentrum Hasselt, Hasselt, Belgium
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Transcatheter aortic valve implantation, also called transcatheter aortic
valve replacement (TAVR), is the treatment of choice for patients with
severe aortic stenosis and intermediate to high operative risk. A
significant portion of TAVR patients have atrial fibrillation (AF)
requiring chronic oral anticoagulation. In moderate- to high-risk AF
patients, the direct factor Xa inhibitor edoxaban is noninferior to
vitamin K antagonists (VKAs) for prevention of stroke or systemic embolism
with less bleeding and cardiovascular deaths. ENVISAGE-TAVI AF
(NCT02943785) is a multinational, multicenter, prospective, randomized,
open-label, blinded end point evaluation study comparing edoxaban to
VKA-based therapy in approximately 1,400 patients with an indication for
chronic oral anticoagulation after successful transfemoral TAVR. The
coprimary end points are to assess the differential effects of the 2
treatments (a) on net adverse clinical events (the composite of all-cause
death, myocardial infarction, ischemic stroke, systemic thromboembolism,
valve thrombosis, and major bleeding events) and (b) on major bleeding.
Twelve hours to 5 days after successful TAVR, patients will be randomized
to 60 mg daily oral edoxaban or any VKA (international normalized ratio:
2.0-3.0 or 1.6-2.6 [numbers inclusive] in Japan if age >= 70 years).
Antiplatelet therapy may be administered per physician's discretion.
Randomization will be stratified by edoxaban dose reduction (per local
label). Treatment duration will be up to 36 months. The study is powered
(80%) to detect noninferiority (margin for the hazard ratio: 1.38) for the
composite primary end points, followed by superiority
testing.<br/>Copyright &#xa9; 2018

<6>
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.

<7>
Accession Number
623694321
Title
Short versus conventional hydration for prevention of kidney injury during
pre-TAVI computed tomography angiography.
Source
Netherlands Heart Journal. 26 (9) (pp 425-432), 2018. Date of Publication:
01 Sep 2018.
Author
van Mourik M.S.; van Kesteren F.; Planken R.N.; Stoker J.; Wiegerinck
E.M.A.; Piek J.J.; Tijssen J.G.; Koopman M.G.; Henriques J.P.S.; Baan J.;
Vis M.M.
Institution
(van Mourik, van Kesteren, Wiegerinck, Piek, Tijssen, Henriques, Baan,
Vis) Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC,
University of Amsterdam, Amsterdam, Netherlands
(van Kesteren, Planken, Stoker) Department of Radiology, Amsterdam UMC,
University of Amsterdam, Amsterdam, Netherlands
(Koopman) Department of Nephrology, Amsterdam UMC, University of
Amsterdam, Amsterdam, Netherlands
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Background: Computed tomography angiography (CTA) is required in the
work-up for transcatheter aortic valve implantation (TAVI). However, CTA
may cause contrast-induced acute kidney injury (CI-AKI). We hypothesised
that a short (1h, 3ml/kg/h sodium bicarbonate) hydration protocol is not
inferior to conventional (24h, 1ml/kg/h saline) hydration in avoiding a
decline in renal function in patients with impaired renal function.
Methods and results: Single-centre randomised non-inferiority trial in
patients with impaired renal function who underwent pre-TAVI CTA. Patients
were randomised on a 1:1 ratio to short hydration (SHORT; 1h sodium
bicarbonate, 3ml/kg/h) or conventional hydration (CONV; 24h saline,
1ml/kg/h). Outcomes included percentage change in serum creatinine until
2-6 days after CTA with a non-inferiority margin of 10% and an increase on
the Borg dyspnoea scale >=1 point. Seventy-four patients were included.
Increase in creatinine was 6micro&#32;mol/l (95% CI 2.5-9.3) in the SHORT
versus 2micro&#32;mol/l (95% CI-1.4 to 6.3) in the CONV arm (p= 0.167).
The percentage change was 4.6% (95% CI 2.0-7.3%) in the SHORT arm versus
2.5% (95% CI: 0.8 to 5.8%) in the CONV arm. The difference in percentage
increase in creatinine between the two arms was 2.1% (95% CI: 2.0-6.2%;
p-value non-inferiority: <0.001). CI-AKI and a need for dialysis were not
observed. An increase of >=1 point on the Borg scale (dyspnoea scale
ranging from 1 (lowest) to 10 (highest)) was seen in 1 patient in the
SHORT arm versus 5 patients in the CONV arm (2.9% vs 16.1%, p= 0.091).
Conclusion: For patients with impaired renal function undergoing pre-TAVI
CTA, a short 1-h, low-volume hydration protocol with sodium bicarbonate is
not inferior to conventional 24-h, high-volume saline
hydration.<br/>Copyright &#xa9; 2018, The Author(s).

<8>
Accession Number
623717497
Title
Cardioplegia practice in paediatric cardiac surgery: a UK & Ireland
survey.
Source
Perfusion (United Kingdom). (no pagination), 2018. Date of Publication:
2018.
Author
Drury N.E.; Horsburgh A.; Bi R.; Willetts R.G.; Jones T.J.
Institution
(Drury, Horsburgh, Bi, Willetts, Jones) Department of Paediatric Cardiac
Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
(Drury) Institute of Cardiovascular Sciences, University of Birmingham,
Birmingham, United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: Many techniques are available for cardioplegic arrest in
children, but there is a lack of late phase clinical trials to guide
practice. We surveyed paediatric cardiac surgeons and perfusionists to
establish current practice and willingness to change within a clinical
trial. Methods: An online survey was sent to all consultant paediatric
cardiac surgeons and chief perfusionists in paediatric centres in the UK
and Ireland. Information was sought on cardioplegia type, composition,
temperature, topical cooling, dosing for induction and maintenance,
interval between doses, whether practice changed with patient age or
complexity and whether respondents would be willing and able to use
different cardioplegia solutions within a randomised trial. Results:
Responses were obtained from 32 (78.0%) surgeons and 12 (100%)
perfusionists. Twenty-seven (84.4%) surgeons use blood cardioplegia in
infants, with St. Thomas' Harefield preparation the most popular (19,
59.4%), used routinely in eight (66.7%) centres. Twenty-two (68.8%)
administer at 4-6degreeC, 18 (56.3%) use topical cooling, 18 (56.3%) give
30 ml/kg induction and 15 ml/kg maintenance, with 23 (71.9%) re-dosing
every 20-25 minutes. Thirty (93.8%) surgeons were open to randomising
patients in a trial, with del Nido (29, 90.6%) the most popular.
Conclusions: This survey demonstrates heterogeneity in cardioplegia
practice. Whilst most surgeons use blood cardioplegia, there is variation
in type, temperature, topical cooling, dosing and intervals. Combined with
a lack of evidence from late phase trials, our findings support the
presence of clinical equipoise. Surgeons are willing to change practice,
suggesting that a pragmatic, multi-centre, randomised, controlled trial of
cardioplegia in children is feasible.<br/>Copyright &#xa9; The Author(s)
2018.

<9>
Accession Number
623717234
Title
Computed tomography-guided pericardiocentesis: a systematic review
concerning contemporary evidence and future perspectives.
Source
Therapeutic Advances in Cardiovascular Disease. (no pagination), 2018.
Date of Publication: 2018.
Author
Vilela E.M.; Ruivo C.; Guerreiro C.E.; Silva M.P.; Ladeiras-Lopes R.;
Caeiro D.; Morais G.P.; Primo J.; Braga P.; Ferreira N.; Nunes J.P.L.;
Ribeiro V.G.
Institution
(Vilela) Cardiology Department, Vila Nova de Gaia / Espinho Hospital
Center EPE, Rua Conceicao Fernandes, Vila Nova de Gaia 4434-520, Portugal
(Ruivo) Leiria Hospital Center, Leiria, Portugal
(Guerreiro, Silva, Ladeiras-Lopes, Caeiro, Morais, Primo, Braga, Ferreira,
Ribeiro) Cardiology Department, Vila Nova de Gaia / Espinho Hospital
Center, Gaia, Portugal
(Nunes) Sao Joao Hospital Center, Porto, Portugal
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Pericardial effusion (PE) can develop in several pathological
scenarios, and is often initially evaluated by means of echocardiography.
Computed tomography (CT) has been used as an aid in the management of
patients presenting with PE, in selected cases. The role of CT-guided
pericardiocentesis in contemporary practice, however, remains not fully
ascertained. We aimed at presenting a systematic review concerning the
state-of-the-art of this technique. Methods: A systematic review of
published data on the use of CT for guiding pericardiocentesis was carried
out (search performed on PubMed, ISI Web of Knowledge and Scopus
databases). Results: From title and abstract analysis, 14 articles were
included that met the prespecified criteria. After full-text analysis, six
articles were excluded. The eight articles under analysis included a total
of 635 procedures performed in 571 patients. CT guidance was mostly used
in a postoperative setting (364 procedures). Most procedures were done
mainly for therapeutic purposes (528 procedures). Success rates ranged
from 94% to 100%. Complications ranged from 0% to 7.8%. Conclusion:
CT-guided pericardiocentesis is a useful technique in the approach to PE,
in several clinical scenarios. Its use can be especially relevant in the
postoperative period, as well as in individuals with suboptimal image
quality (as assessed by echocardiography, for the moment the first choice
in the approach to most cases of PE).<br/>Copyright &#xa9; The Author(s),
2018.

<10>
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

<11>
Accession Number
620127219
Title
Remote Ischemic Preconditioning has a Cardioprotective Effect in Children
in the Early Postoperative Phase: A Meta-Analysis of Randomized Controlled
Trials.
Source
Pediatric Cardiology. 39 (3) (pp 617-626), 2018. Date of Publication: 01
Mar 2018.
Author
Tan W.; Zhang C.; Liu J.; Li X.; Chen Y.; Miao Q.
Institution
(Tan, Zhang, Liu, Li, Chen, Miao) Department of Cardiac Surgery, Peking
Union Medical College Hospital, Chinese Academy of Medical Sciences and
Peking Union Medical College, Beijing 100730, China
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
In this updated meta-analysis, we assessed the cardioprotective effect of
remote ischemic preconditioning (RIPC) in pediatric patients undergoing
congenital heart surgery. A total of 9 randomized controlled trials (RCTs)
involving 793 pediatric patients under 18 years old were identified. RIPC
obviously reduced the release of troponin I at 6 h after surgery [standard
mean difference (SMD) -0.59, 95% confidence interval (CI) -1.14 to -0.04;
p = 0.03], mitigated the inotropic scores within 4-6 h (SMD -0.43, 95% CI
-0.72 to -0.14; p = 0.004) and within 12 h (SMD -0.26, 95% CI -0.50 to
-0.02; p = 0.03) and shortened the ventilator support time (SMD -0.28, 95%
CI -0.49 to -0.07; p = 0.01) as well as the duration of intensive care
unit (ICU) stay (SMD -0.21, 95% CI -0.35 to -0.06; p = 0.004). Our
meta-analysis determined that RIPC had cardioprotective effects in the
early postoperative phase. Additional RCTs focused on the cardiac benefits
from RIPC in pediatric patients are warranted.<br/>Copyright &#xa9; 2018,
Springer Science+Business Media, LLC, part of Springer Nature.

<12>
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

<13>
Accession Number
621323224
Title
Early Outcomes of Hypoplastic Left Heart Syndrome Infants: Meta-Analysis
of Studies Comparing the Hybrid and Norwood Procedures.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 9 (2) (pp
224-233), 2018. Date of Publication: 01 Mar 2018.
Author
Cao J.Y.; Lee S.Y.; Phan K.; Ayer J.; Celermajer D.S.; Winlaw D.S.
Institution
(Cao, Lee, Phan, Ayer, Celermajer, Winlaw) Sydney Medical School,
University of Sydney, Sydney, NSW, Australia
(Phan) NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private
Hospital, Sydney, NSW, Australia
(Ayer, Winlaw) Heart Centre for Children, The Children's Hospital at
Westmead, Sydney, NSW, Australia
(Celermajer) Cardiology, Royal Prince Alfred Hospital, Sydney, NSW,
Australia
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
The hybrid strategy is an alternative to the traditional Norwood procedure
for initial palliation of infants with hypoplastic left heart syndrome
(HLHS) who are deemed to be at high surgical risk. Numerous single-center
studies have compared the two procedures, showing similar early outcomes,
although the cohort sizes are likely insufficiently powered to detect
significant differences. The current meta-analysis aims to explore the
early morbidity and mortality associated with the hybrid compared to the
Norwood procedure. MEDLINE, Cochrane Libraries, and Embase were
systematically searched, and 14 studies were included for statistical
synthesis, comprising 263 hybrid and 426 Norwood patients. Early mortality
was significantly higher in the hybrid patients (relative risk [RR] =
1.54, P <.05, 95% confidence interval [CI]: 1.02-2.34), whereas interstage
mortality was comparable between the two groups (RR = 0.88, P >.05, 95%
CI: 0.46-1.70). Six-month (RR = 0.89, P <.05, 95% CI: 0.80-1.00) and
one-year (RR = 0.88, P <.05, 95% CI: 0.78-1.00) transplant-free survival
was also inferior among the hybrid patients. Furthermore, the hybrid
patients required more reinterventions following initial surgical
palliation (RR = 1.48, P <.05, 95% CI: 1.09-2.01), although the two groups
had comparable length of hospital and intensive care unit stay
postoperatively. In conclusion, our results suggest that the hybrid
procedure is associated with worse early survival compared to the
traditional Norwood when used for initial palliation of infants with HLHS.
However, due to the hybrid being used preferentially for high-risk
patients, definitive conclusions regarding the efficacy of the procedure
cannot be drawn.<br/>Copyright &#xa9; 2018, &#xa9; The Author(s) 2018.

<14>
Accession Number
614744919
Title
In-hospital mortality in propensity-score matched low-risk patients
undergoing routine isolated surgical or transfemoral transcatheter aortic
valve replacement in 2014 in Germany.
Source
Clinical Research in Cardiology. 106 (8) (pp 610-617), 2017. Date of
Publication: 01 Aug 2017.
Author
Frerker C.; Bestehorn K.; Schluter M.; Bestehorn M.; Hamm C.W.; Mollmann
H.; Katus H.A.; Kuck K.-H.
Institution
(Frerker, Kuck) Department of Cardiology, Asklepios Klinik St. Georg,
Lohmuhlenstr. 5, Hamburg 20099, Germany
(Bestehorn) Technische Universitat Dresden, Dresden, Germany
(Schluter) Asklepios Proresearch, Hamburg, Germany
(Bestehorn) ProMedCon GmbH, Ebenhausen, Germany
(Hamm) Department of Medical Clinic I, University of Giessen, Giessen,
Germany
(Hamm) Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim,
Germany
(Mollmann) Department of Cardiology, St. Johannes Hospital, Dortmund,
Dortmund, Germany
(Katus) Center for Internal Medicine, Heidelberg University Hospital,
Heidelberg, Germany
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Aims: Recent randomized trials have documented the superiority of
TAVR-particularly via transfemoral access-over SAVR in patients with
severe aortic stenosis considered to have a high or intermediate operative
risk of death. We sought to assess in-hospital outcomes of patients with
severe aortic stenosis and a low risk of operative mortality undergoing
routine surgical aortic valve replacement (SAVR) or transcatheter aortic
valve replacement (TAVR). Methods and results: We performed a
propensity-score matched comparison of all patients undergoing first-time
treatment by SAVR or transfemoral TAVR (TF-TAVR) in 2014 in Germany who
had a logistic EuroSCORE (logES) <= 10%, considered to reflect low
surgical risk. The primary endpoint of our analysis was in-hospital
mortality. Of 7624 SAVR and 9969 TF-TAVR procedures, 6844 (89.8%) and 2751
patients (27.6%), respectively, were considered low risk with a logES
between 1.505 and 10.0%. Matching yielded 805 TF-TAVR/SAVR patient pairs
with identical propensity scores and no difference in pertinent baseline
characteristics, except for the logES, which was significantly higher in
TF-TAVR patients (6.8 +/- 1.7 vs. 4.2 +/- 1.3% in SAVR patients, P <
0.001). Observed in-hospital mortalities were 1.7% (95% confidence
interval, 1.1-3.0%) in SAVR and 2.0% (1.3-3.3%) in TF-TAVR patients (P =
0.85). Conclusion: Our finding of no difference in in-hospital mortality
in propensity-score matched low-surgical-risk patients treated by SAVR or
TF-TAVR in a routine clinical setting indicates that TF-TAVR can be
offered safely to individual patients, despite their operative risk being
low. This finding needs to be confirmed in a randomized
trial.<br/>Copyright &#xa9; 2017, Springer-Verlag Berlin Heidelberg.

<15>
Accession Number
614484465
Title
Implantable cardioverter/defibrillators for primary prevention in dilated
cardiomyopathy post-DANISH: an updated meta-analysis and systematic review
of randomized controlled trials.
Source
Clinical Research in Cardiology. 106 (7) (pp 501-513), 2017. Date of
Publication: 01 Jul 2017.
Author
Wolff G.; Lin Y.; Karathanos A.; Brockmeyer M.; Wolters S.; Nowak B.;
Furnkranz A.; Makimoto H.; Kelm M.; Schulze V.
Institution
(Wolff, Lin, Karathanos, Brockmeyer, Wolters, Furnkranz, Makimoto, Kelm,
Schulze) Division of Cardiology, Pulmonology and Vascular Medicine,
Department of Internal Medicine, Heinrich-Heine-University, Moorenstr. 5,
Dusseldorf 40225, Germany
(Nowak, Furnkranz) Cardioangiologisches Centrum Bethanien, Frankfurt am
Main, Germany
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Sudden cardiac death (SCD) is frequent in patients with heart
failure due to dilated cardiomyopathy (DCM). Implantable
cardioverter/defibrillator (ICD) device therapy is currently used for
primary prevention. However, publication of the DANISH trial has recently
given reason for doubt, showing no significant improvement in all-cause
mortality in comparison to contemporary medical therapy. Methods: We
performed a meta-analysis of all randomized controlled trials comparing
ICD therapy to medical therapy (MT) for primary prevention in DCM. The
primary outcome was all-cause mortality; secondary analyses were performed
on sudden cardiac death, cardiovascular death and non-cardiac death.
Results: Five trials including a total of 2992 patients were included in
the pooled analysis. Compared to contemporary medical treatment there was
a significant mortality reduction with ICD device therapy [odds ratio (OR)
0.77, 95% confidence interval (CI) 0.64-0.93; p = 0.006]. SCD was
decreased significantly (OR 0.43, CI 0.27-0.69; p = 0.0004), while
cardiovascular death and non-cardiac death showed no differences.
Sensitivity analyses showed no influence of amiodarone therapy on overall
results. Analysis of MT details revealed the DANISH population to adhere
the most to current guideline recommendations. In addition, it was the
only study including a substantial amount of CRT devices (58%).
Conclusions: Our meta-analysis of all available randomized evidence shows
a survival benefit of ICD therapy for primary prevention in DCM. DANISH
results suggest an attenuation of this ICD advantage when compared to
contemporary medical and cardiac resynchronization therapy. Until larger
trials have confirmed this finding, ICD therapy should remain the
recommendation for primary prevention of SCD in DCM.<br/>Copyright &#xa9;
2017, Springer-Verlag Berlin Heidelberg.

<16>
Accession Number
623683616
Title
Off-pump coronary artery bypass grafting: 30 years of debate.
Source
Journal of the American Heart Association. 7 (16) (no pagination), 2018.
Article Number: e009934. Date of Publication: 01 Aug 2018.
Author
Gaudino M.; Angelini G.D.; Antoniades C.; Bakaeen F.; Benedetto U.;
Calafiore A.M.; Franco A.D.; Mauro M.D.; Fremes S.E.; Girardi L.N.;
Glineur D.; Grau J.; He G.-W.; Patrono C.; Puskas J.D.; Ruel M.; Schwann
T.A.; Tam D.Y.; Tatoulis J.; Tranbaugh R.; Vallely M.; Zenati M.A.; Mack
M.; Taggart D.P.
Institution
(Gaudino, Franco, Girardi, Tranbaugh) Department of Cardiothoracic
Surgery, Weill Cornell Medicine, New York, NY, United States
(Angelini, Benedetto) Bristol Heart Institute, University of Bristol,
United Kingdom
(Antoniades, Taggart) University of Oxford, United Kingdom
(Bakaeen) Cleveland Clinic, Cleveland, OH, United States
(Calafiore) Cardiac Surgery, Pope John Paul II Foundation, Campobasso,
Italy
(Mauro) Cardiovascular Disease Institute, University of L'Aquila, Italy
(Fremes, Tam) Schulich Heart Centre, Sunnybrook Health Science, University
of Toronto, Canada
(Glineur, Grau) Division of Cardiac Surgery, Ottawa Heart Institute,
Ottawa, Canada
(He) TEDA International Cardiovascular Hospital, Chinese Academy of
Medical Sciences & Peking Union Medical College, Tianjin, China
(Patrono) Department of Pharmacology, Catholic University School of
Medicine, Rome, Italy
(Puskas) Department of Cardiovascular Surgery, Icahn School of Medicine at
Mount Sinai, New York City, NY, United States
(Ruel) University of Ottawa Heart Institute, Ottawa, Canada
(Schwann) University of Toledo College of Medicine, Toledo, OH, United
States
(Tatoulis) Department of Surgery, University of Melbourne, Parkville,
Australia
(Vallely) Sydney Medical School, The University of Sydney, Australia
(Zenati) Harvard Medical School, Boston, MA, United States
(Mack) The Heart Hospital Baylor Plano, Plano, TX, United States
Publisher
American Heart Association Inc.

<17>
Accession Number
2001057077
Title
Early Versus Standard Discharge After Transcatheter Aortic Valve
Replacement: A Systematic Review and Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 11 (17) (pp 1759-1771), 2018. Date of
Publication: 10 September 2018.
Author
Kotronias R.A.; Teitelbaum M.; Webb J.G.; Mylotte D.; Barbanti M.; Wood
D.A.; Ballantyne B.; Osborne A.; Solo K.; Kwok C.S.; Mamas M.A.; Bagur R.
Institution
(Kotronias, Kwok, Mamas, Bagur) Keele Cardiovascular Research Group,
Institute for Applied Clinical Science and Centre for Prognosis Research,
Institute of Primary Care and Health Sciences, University of Keele,
Stoke-on-Trent, United Kingdom
(Kotronias) Oxford University Clinical Academic Graduate School, Oxford
University, Oxford, United Kingdom
(Teitelbaum, Ballantyne, Osborne, Bagur) London Health Sciences Centre,
London, Ontario, Canada
(Webb, Wood) Centre for Heart Valve Innovation, St. Paul's Hospital,
University of British Columbia, Vancouver, British Columbia, Canada
(Mylotte) Galway University Hospitals, National University of Ireland,
Galway, Ireland
(Barbanti) Division of Cardiology, Cardio-Thoracic-Vascular Department,
University of Catania, Catania, Italy
(Solo, Bagur) Department of Epidemiology and Biostatistics, Schulich
School of Medicine & Dentistry, Western University, London, Ontario,
Canada
(Kwok, Mamas) The Heart Centre, Royal Stoke Hospital, University Hospital
of North Midlands Trust, Stoke-on-Trent, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to assess the clinical outcomes of patients
undergoing transcatheter aortic valve replacement (TAVR) with early
discharge (ED) versus standard discharge (SD) pathways. Background:
Minimalist approaches for TAVR have been developed targeting different
aspects of the procedure such as local anesthesia or sedation,
intraprocedural imaging, vascular access, post-operative monitoring and
care, and discharge planning. Their incorporation into routine clinical
practice aims to reduce length of hospital stay and health care cost
utilization without adversely affecting outcomes when compared with
standard approaches. Methods: The authors conducted a search of MEDLINE
and EMBASE to identify studies that investigated ED (<=3 days) versus SD
in TAVR patients. Random-effects meta-analyses were used to estimate the
effect of ED compared with SD with regard to 30-day mortality after
discharge, 30-day readmission rate, and need for permanent pacemaker
implantation (PPI) following discharge. Results: Eight studies including
1,775 participants (ED, n = 642) fulfilled the inclusion criteria. The
mean age was 82.4 years and STS score was 6.7. Meta-analyses evaluating
discharge to 30-day mortality (odds ratio [OR]: 0.65; 95% confidence
interval [CI]: 0.23 to 1.82; I² = 0%) and discharge to 30-day
new PPI (OR: 1.61; 95% CI: 0.19 to 13.71; I² = 40%) showed no
significant difference in an ED compared with a SD strategy. Notably, ED
patients were less likely to be readmitted after ED when compared with SD
patients (OR: 0.63; 95% CI: 0.41 to 0.98; p = 0.04, I² = 0%).
Conclusions: ED following uncomplicated TAVR is safe in terms of discharge
to 30-day mortality or need for PPI following discharge. Moreover, ED
patients experienced a lower rate of readmissions. These data support the
safety of programs aiming an ED pathway in selected TAVR patients.
Institutional protocols with the input from different members of the
multidisciplinary heart team should be devised to optimize discharge
processes to improve health care resource utilization.<br/>Copyright
&#xa9; 2018 American College of Cardiology Foundation

<18>
Accession Number
619562411
Title
Applicability of the Cleveland clinic scoring system for the risk
prediction of acute kidney injury after cardiac surgery in a South Asian
cohort.
Source
Indian Heart Journal. 70 (4) (pp 533-537), 2018. Date of Publication: July
- August 2018.
Author
Rao S.N.; Shenoy M P.; Gopalakrishnan M.; Kiran B A.
Institution
(Rao, Kiran B) Deptartment of Nephrology, K.S.Hegde Medical Academy,
Derlakatte, Mangalore, Karnataka, India
(Shenoy M, Gopalakrishnan) Department of Cardiothoracic Surgery, K.S.Hegde
Medical Academy, Derlakatte, Mangalore, Karnataka, India
Publisher
Elsevier B.V.
Abstract
Background: Acute kidney injury (AKI) after cardiac surgery is a frequent
post-operative complication associated with an increased risk of
mortality, morbidity and hospital costs. Preoperative risk scores such as
the Cleveland Clinic Scoring Tool (CCST) have been validated in Western
population group to identify patients at higher risk of AKI and may
facilitate preventive strategies. However, the scoring tool has not been
validated systematically in a South Asian cohort. We aimed to evaluate the
applicability of the CCST in prediction of AKI after open cardiac surgery
in a South-Indian tertiary care center. Materials and methods: A
retrospective study of all patients who underwent elective open cardiac
surgery over a 4 year period from Jan 2012 to Dec 2015 at a single centre
were included and relevant details extracted from a comprehensive chart
review. The primary outcome was AKI as defined by the Kidney Disease
Improving Global Outcomes (KDIGO) criteria. Patients were risk stratified
as per the CCST to assess for prediction of AKI into low risk (0-2),
intermediate risk (3-5) and high risk (>6) groups. Results: A total of 276
patients underwent open cardiac surgery with mean age of 51.5 +/- 13.06
yrs. This included 177 (64.1%) males and 99 females (35.8%). Overall
incidence of AKI was 6.88%. Mean age, gender, BMI, preoperative serum
creatinine, diabetes mellitus, chronic obstructive pulmonary disease,
cardiopulmonary bypass time was similar in patients who developed AKI vs
those who did not have AKI postoperatively. The mean CCST scores were 1.6
in those without AKI, 1.5 in stage 1, 3.0 in stage 2 and 3.4 in stage 3
AKI. Higher risk scores predicted greater risk of AKI. A total of 106
patients (38.4%) were on ACE/ARB, 119 patients (43.1%) received
beta-blockers, 110 (39.8%) received diuretics while 144(52.1%) had
received preoperative statins. Comparison of drug use between the two
groups revealed that preoperative use of ACEI/ARB was associated with
highest risk of AKI (p = 0.006). Mortality rate was also high at 15.7% in
those with AKI compared to 3.1% in non-AKI group (p = 0.04). Conclusion:
The modified CCST was valid in risk identification of patients with severe
stage of AKI but did not have strong discrimination for early AKI stages.
Preoperative statin use did not protect against AKI in our study, however
preoperative ARB/ACEI use was significantly associated with occurrence of
postoperative AKI.<br/>Copyright &#xa9; 2017

<19>
Accession Number
621383492
Title
Study rationale, design, and pretransplantation alloantibody status: A
first report of Clinical Trials in Organ Transplantation in Children-04
(CTOTC-04) in pediatric heart transplantation.
Source
American Journal of Transplantation. 18 (9) (pp 2135-2147), 2018. Date of
Publication: September 2018.
Author
Zuckerman W.A.; Zeevi A.; Mason K.L.; Feingold B.; Bentlejewski C.;
Addonizio L.J.; Blume E.D.; Canter C.E.; Dipchand A.I.; Hsu D.T.; Shaddy
R.E.; Mahle W.T.; Demetris A.J.; Briscoe D.M.; Mohanakumar T.; Ahearn
J.M.; Ikle D.N.; Armstrong B.D.; Morrison Y.; Diop H.; Odim J.; Webber
S.A.
Institution
(Zuckerman, Addonizio) Division of Pediatric Cardiology, Columbia
University Medical Center, New York, NY, United States
(Zeevi, Bentlejewski, Demetris) Department of Pathology, University of
Pittsburgh Medical Center, Pittsburgh, PA, United States
(Mason, Ikle, Armstrong) Rho Inc., Federal Systems Division, Chapel Hill,
NC, United States
(Feingold) Department of Pediatrics and Clinical and Translational
Science, University of Pittsburgh School of Medicine, Pittsburgh, PA,
United States
(Blume) Department of Pediatric Cardiology, Boston Children's Hospital,
Boston, MA, United States
(Canter) Division of Pediatric Cardiology, Washington University School of
Medicine, St. Louis, MO, United States
(Dipchand) Labatt Family Heart Center, Department of Paediatrics, Hospital
for Sick Children, Toronto, ON, Canada
(Hsu) Division of Pediatric Cardiology, Children's Hospital at Montefiore,
Bronx, NY, United States
(Shaddy) Division of Pediatric Cardiology, Children's Hospital of
Philadelphia, Philadelphia, PA, United States
(Mahle) Division of Pediatric Cardiology, Children's Healthcare of
Atlanta, Atlanta, GA, United States
(Briscoe) Transplant Research Program, Division of Pediatric Nephrology,
Harvard Medical School, Boston, MA, United States
(Mohanakumar) Norton Thoracic Institute, Saint Joseph Hospital and Medical
Center, Phoenix, AZ, United States
(Ahearn) Department of Medicine, Allegheny Health Network, Pittsburgh, PA,
United States
(Morrison, Diop, Odim) Transplantation Branch, National Institute of
Allergy and Infectious Diseases, National Institutes of Health, Bethesda,
MD, United States
(Webber) Division of Pediatric Cardiology, Monroe Carrell Jr. Children's
Hospital at Vanderbilt, Nashville, TN, United States
Publisher
Blackwell Publishing Ltd
Abstract
Anti-HLA donor-specific antibodies are associated with worse outcomes
after organ transplantation. Among sensitized pediatric heart candidates,
requirement for negative donor-specific cytotoxicity crossmatch increases
wait times and mortality. However, transplantation with positive
crossmatch may increase posttransplantation morbidity and mortality. We
address this clinical challenge in a prospective, multicenter,
observational cohort study of children listed for heart transplantation
(Clinical Trials in Organ Transplantation in Children-04 [CTOTC-04]).
Outcomes were compared among sensitized recipients who underwent
transplantation with positive crossmatch, nonsensitized recipients, and
sensitized recipients without positive crossmatch. Positive crossmatch
recipients received antibody removal and augmented immunosuppression,
while other recipients received standard immunosuppression with
corticosteroid avoidance. This first CTOTC-04 report summarizes study
rationale and design and relates pretransplantation sensitization status
using solid-phase technology. Risk factors for sensitization were
explored. Of 317 screened patients, 290 were enrolled and 240 underwent
transplantation. Core laboratory evaluation demonstrated that more than
half of patients were anti-HLA sensitized. Greater than 80% of sensitized
patients had class I (with or without class II) HLA antibodies, and
one-third of sensitized patients had at least 1 HLA antibody with median
fluorescence intensity of >=8000. Logistic regression models demonstrated
male sex, weight, congenital heart disease history, prior allograft, and
ventricular assist device are independent risk factors for
sensitization.<br/>Copyright &#xa9; 2018 The American Society of
Transplantation and the American Society of Transplant Surgeons

<20>
[Use Link to view the full text]
Accession Number
623701928
Title
Mandela study results at 18 months after heart transplantation: Superior
renal function with CNI-FREE everolimus over standard CNI-based regimen-a
randomized, multi-center trial in de novo heart transplant recipients.
Source
Transplantation. Conference: 27th International Congress of The
Transplantation Society, TTS 2018. Spain. 102 (7 Supplement 1) (pp S362),
2018. Date of Publication: July 2018.
Author
Barten M.J.; Hirt S.W.; Garbade J.; Bara C.; Doesch A.; Knosalla C.;
Grinninger C.; Stypmann J.; Sieder C.; Junge M.; Schulz U.
Institution
(Barten, Hirt, Garbade, Bara, Doesch, Knosalla, Grinninger, Stypmann,
Schulz) Mandela, Study, Group, Germany
(Sieder, Junge) Novartis, Pharma, GmbH, Germany
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose: The MANDELA study (NCT00862979) was designed to assess the
benefit on renal function of either CNI-free or CNI-minimized EVR-based
regimen after early conversion of de novo heart transplant recipients
(HTxR). Methods: MANDELA is a multi-center, randomized, controlled,
open-label, 12 month study. In total 232 de novo HTxR were enrolled 3
months post Tx, of whom 162 could be randomized (1:1) to receive either
EVR (C0-h 5-10ng/mL) with reduced CNI (TAC C0-h 3-8ng/mL or CsA C0-h
50-150ng/mL) and steroids (<=0.3mg/kg) or EVR (C0-h 5-10ng/mL) with
mycophenolic acid (EC-MPSmax. 2880mg/day orMMF max. 3g/day) and steroids
(<=0.3mg/kg). The primary objective was superiority of cGFR (MDRD) 12
months after randomization for CNI-free over CNI-reduced EVR treatment.
Key secondary objectives included efficacy (composite of BPAR ISHLT1990
grade >=3A/ ISHLT2004 grade >=2R, graft loss/re-transplant, death or loss
to follow-up) and assessment of safety profiles including infections.
Results: Primary endpoint for superior renal function in CNI-free EVR arm
was met with high significance with a difference of +11.2 ml/min in favor
of CNI-free EVR arm vs CNI-reduced group (p<0.0001) [cGFR (ml/min)MDRD;
LS-mean ANCOVA with LOCF] (Figure 1: course of mean+/-SD cGFR; MDRD). Per
protocol analysis showed a difference of +19.0 ml/min in favor of CNI-free
EVR arm (p<0.0001) [cGFR (ml/min) from MDRD formula; LS-mean from ANCOVA
model]. Occurrence of MACE and BPAR was in line with international
standards and the safety profile was according to the patient population
and the treatment compounds investigated herein. Data from full analysis
will be available for presentation at TTS-2018 meeting. Conclusion:
TheMANDELA study showed that improved renal function can be achieved by
early conversion to an everolimus based CNI-free regimen in HTxR without
compromising safety and efficacy.

<21>
[Use Link to view the full text]
Accession Number
623701834
Title
Prevalence and predictors of hypertension among heart transplant
recipients: An analysis of Russian national medical research centre of
transplantology and artificial organs registry.
Source
Transplantation. Conference: 27th International Congress of The
Transplantation Society, TTS 2018. Spain. 102 (7 Supplement 1) (pp S425),
2018. Date of Publication: July 2018.
Author
Shevchenko A.; Koloskova N.N.; Nikitina E.A.; Orlov V.; Gautier S.V.
Institution
(Shevchenko, Koloskova, Nikitina) Cardiology, Russian National Research
Centre of Transplantology and Artificial Organs, Moscow, Russian
Federation
(Shevchenko) Advanced Heart Failure Centre, Russian National Research
Centre of Transplantology and Artificial Organs, Moscow, Russian
Federation
(Orlov, Gautier) Transplant Surgery, Russian National Research Centre of
Transplantology and Artificial Organs, Moscow, Russian Federation
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Post-transplant arterial hypertension (AH) is an important
modifiable risk factor for the development of cardiovascular events and
renal dysfunction. Objectives: The study was aimed to assess prevalence
and risk factors for the development of AH in heart transplant recipients.
Patients and Methods: End-stage heart failure patients who received
cardiac transplant between 01.01.2013 and 31.12.2016 in the Russian
National Research Centre of Transplantology and Artificial Organs (Moscow)
and survived 3 months were included and followed-up for 999.4+/-774.3
(108-1587) days. Young patients (<18 y/o) and patients after repeated
(n=18) or multiorgan transplantation (n=3) were excluded. Results: 353
cardiac recipients aged 45.6+/-1.6 years (64 females and 289 males) were
enrolled to the study. AH prevalence was 17.6%, 42.8%, 62.3%, and 71.4% in
the pre-transpalnt anamnesis, 3 months, 1 year, and 3+ years after the
transplantation, respectively. The risk of developing post-transplant
hypertension was independent of age, sex, initial diagnosis, mean
tacrolimus levels and the number of acute cellular rejections.
Post-transplant AH was significantly related to the initial body mass
index (p=0.026), serum creatinine (p<0.001), preexisting hypertension
(RR=1.36, p=0.022) and renal failure, as well as donor heart posterior
wall thickness (p=0.034), post-transplant dialysis (RR=1.85, p<0.001), and
antibody mediated rejection episodes (OP=1.7, p=0.001). Conclusions:
Hypertension is highly prevalent among our population of cardiac
recipients. Combination of various etiologic mechanisms, multiplex therapy
and subjective factors demand the careful individual patient management.
Controlled clinical trials are required to determine target blood pressure
levels and assess the impact of various antihypertensive medications on
long-term prognosis.

<22>
[Use Link to view the full text]
Accession Number
623701747
Title
Lower rates of death in heart recipients with secondary antibody
deficiency and severe infection after therapy with intravenous
immunoglobulin.
Source
Transplantation. Conference: 27th International Congress of The
Transplantation Society, TTS 2018. Spain. 102 (7 Supplement 1) (pp S359),
2018. Date of Publication: July 2018.
Author
Carbone J.; Fernandez-Yanez J.; Montanchez J.; Sousa I.; Zatarain E.;
Navarro J.; Munoz P.; Hortal J.; Barrio J.; Sarmiento E.
Institution
(Carbone, Montanchez, Navarro, Sarmiento) Transplant Immunology Group.
Immunology Department, Hospital General Universitario Gregorio Maranon,
Madrid, Spain
(Fernandez-Yanez, Sousa, Zatarain) Cardiology Department, Hospital General
Universitario Gregorio Maranon, Madrid, Spain
(Munoz) Microbiology and Infectious Diseases Department, Hospital General
Universitario Gregorio Maranon, Madrid, Spain
(Hortal, Barrio) Anesthesiology Department, Hospital General Universitario
Gregorio Maranon, Madrid, Spain
(Carbone) Immunology, Oftalmology and ORL Department, Complutense
University, Madrid, Spain
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Secondary antibody deficiency defined as IgG
hypogammaglobulinemia (HGG) is a risk factor of severe infection in heart
recipients. Single center studies (distinct induction protocols; various
centers around the world); a multicenter prospective study; evaluation of
reproducibility of IgG testing among centers and a metanalysis support the
usefulness of this biomarker. Interventional studies evaluating the effect
of the modification of the risk factor are necessary.We evaluated the
impact of therapeutic intervention of intravenous immunoglobulin (IVIG) in
heart recipients with severe infections and HGG on clinical outcomes.
Methods: Retrospective analysis of prospectively collected data of 233
patients in a single center. 91 patients that developed severe infections
in the post-heart transplantation period andwere found to
haveHGG(serumIgG<600mg/dL), received non-specific 5%IVIG in addition to
conventional antimicrobial therapy with the aims of contributing to
control of infection (secondary prevention of reinfection) and
normalization of IgG (IgG>750 mg/dL). IVIG was administered at a dose of
300-400 mg/kg/month up to three months after infectionswere resolved
(negative bacterial culture or CMV DNAmia). 142 heart recipients from the
same center that where not treated with IVIG, were analyzed as controls.
Results: Severe infections included non pneumonic bacterial infection
(30%), bacterial pneumonia (18%), CMV disaese + bacterial infection (12%),
CMV disease + severe fungal infection (12%). Mean IgG level at the time of
infection was 481 mg/dL (198-599 mg/dL). Mean time to the first IVIG
infusion was 65.4 days (7-180 days). Normalization of IgG levels was
obtained in 75 of 91 patients (82.4%) after addition of IVIG. Both groups
were comparable in terms of demographic and clinical variables.
IVIGtreated recipients disclosed a lower rate of death (p=0.006). In
multivariate regression analysis, IVIG use (RH 0.27, 95%CI 0.09-0.82,
p=0.017), use of noncytolitic induction (anti-CD25) vs cytolitic (ATG) (RH
0.28, 95%CI 0.09-0.82, p=0.017) and number of episodes of acute rejection
(per each increase, RH 2.17, 95% CI 1.25-3.78, p=0.0062) remained in the
final regression model as protective factors and risk factors
respectively. Conclusions: Personalized immunoguided intervention of IVIG
in heart recipients with severe infections and HGG is associated with a
lower rate of death during long termfollow-up after heart transplantation.
Amulticenter randomized clinical trial is in due course in Spain to
further evaluate this new IVIG indication.

<23>
[Use Link to view the full text]
Accession Number
623701361
Title
Mediterranean and low-fat diets reduce cardiovascular disease after both
heart and lung transplantation: Results from a randomised trial with 12
month follow up.
Source
Transplantation. Conference: 27th International Congress of The
Transplantation Society, TTS 2018. Spain. 102 (7 Supplement 1) (pp S65),
2018. Date of Publication: July 2018.
Author
Entwistle T.; Miura K.; Keevil B.G.; Morris J.; Critchley W.R.; Yonan N.;
Venkateswaran R.; Pohl M.; Green A.C.; Fildes J.E.
Institution
(Entwistle, Critchley, Yonan, Venkateswaran, Fildes) Transplant Centre,
Manchester University Hospitals NHS Foundation Trust, Manchester, United
Kingdom
(Miura, Green) Cancer and Population Studies Group, QIMR Berghofer Medical
Research Institute, Queensland, Australia
(Critchley, Fildes) Manchester Collaborative Centre for Inflammation
Research (MCCIR), University of Manchester, Manchester, United Kingdom
(Pohl) Igelosa Life Science AB, Igelosa 373. 225 94, Lund, Sweden
(Keevil) Department of Clinical Biochemistry, University Hospital
SouthManchester NHS Foundation Trust, Manchester, United Kingdom
(Morris) Department of Medical Statistics, University Hospital of South
Manchester, University of Manchester, Manchester, United Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Cardiovascular disease (CVD) reduces survival following
cardiothoracic transplantation. In a randomised trial we compared
feasibility and effectiveness ofMediterranean and low-fat dietary
interventions in decreasing CVD severity. Methods: Adult cardiothoracic
transplant recipientswere randomly allocated to a Mediterranean or low-fat
diet for 12 months. Feasibility was measured by participation and
retention rates, adherence and acceptability of each diet to patients and
families. Weight, blood pressure (BP), blood glucose and lipids, and
prednisolone dosewere assessed at baseline, intervention mid-point and
cessation. Similar outcomes were collected retrospectively from eligible
patients who declined participation (surrogate controls). Results: Of
those approached, 21 of 56 heart transplant recipients and 20 of 60 lung
recipients were recruited (45%) and randomised to Mediterranean (n=21) or
low-fat (n=20) diets. All but one from each group completed the study
(95%). In both groups dietary adherence was high and family members
approved. No adverse events related to the intervention were reported.
Respective clinical changes in the Mediterranean and low-fat diet groups
were: weight (kg), -1.8, -0.2; BMI (kg/m²), -0.5, 0.0;
systolic/diastolic BP (mmHg), 0.5/0.1, -4.4/-3.5, and corresponding
cardiometabolic changes were: fasting glucose (mmol/L) -0.26, -0.27; total
cholesterol (mmol/L) -0.56, -0.40; triglycerides (mmol/L) -0.17, -0.44.
Prednisolone doses were reduced in both groups in the 12-month study
period. In contrast all routinely recorded CVD risk factors increased
among surrogate controls. Conclusions: High retention, adherence and
family satisfaction indicated that both dietary interventions are
feasible. Improved CVD outcomes suggest both are highly beneficial
compared with no intervention.

<24>
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.

<25>
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.

<26>
Accession Number
623698432
Title
Syphilitic aortic aneurysm.
Source
Zeitschrift fur Rheumatologie. (no pagination), 2018. Date of Publication:
2018.
Author
Yuan S.-M.
Institution
(Yuan) Department of Cardiothoracic Surgery, The First Hospital of Putian,
Teaching Hospital, Fujian Medical University, 389 Longdejing Street,
Chengxiang District, Putian, Fujian Province 351100, China
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
The aim of this study was to outline the clinical features of syphilitic
aortic aneurysm. The study materials were based on a comprehensive
literature review of publications on syphilitic aortic aneurysm published
between 2000 and 2017. Syphilitic aortic aneurysm occurred most commonly
in the ascending aorta in either a saccular or a fusiform shape.
Syphilitic aortic aneurysm was often complicated by aortic valve
insufficiency (in almost half of the patients), and by a coronary
artery/ostium lesion in 16.5% of the patients. Aortic valve operation was
necessary in one fourth, and coronary artery surgery accounted for less
than one fifth of patients warranting a surgical treatment. Although there
was no difference in the survival rates between the surgically and
conservatively treated patients, an aggressive treatment should be
performed when diagnosis is made due to the potential risks of aneurysm
rupture and sudden death.<br/>Copyright &#xa9; 2018, Springer Medizin
Verlag GmbH, ein Teil von Springer Nature.

<27>
Accession Number
617936119
Title
Comparative Efficacy of Drugs for Preventing Acute Kidney Injury after
Cardiac Surgery: A Network Meta-Analysis.
Source
American Journal of Cardiovascular Drugs. 18 (1) (pp 49-58), 2018. Date of
Publication: 01 Feb 2018.
Author
Chen X.; Huang T.; Cao X.; Xu G.
Institution
(Chen, Cao) Grade 2013, The Second Clinical Medical College of Nanchang
University, Nanchang, Jiangxi, China
(Huang, Xu) Department of Nephrology, The Second Affiliated Hospital of
Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi
330006, China
Publisher
Springer International Publishing
Abstract
Background: Acute kidney injury (AKI) occurs frequently after cardiac
surgery and has been associated with increased hospital length of stay,
mortality, and costs. Objective: We aimed to evaluate the efficacy of
pharmacologic strategies for preventing AKI after cardiac surgery.
Methods: We searched PubMed, Embase, the Cochrane Central Register of
Controlled Trials (CENTRAL) up to 6 May 2017 and the reference lists of
relevant articles about trials. The outcome was the occurrence of AKI.
This is the first network meta-analysis of the different prevention
strategies using Bayesian methodology. Results: The study included 63
articles with 19,520 participants and evaluated the effect of ten
pharmacologic strategies to prevent AKI in patients undergoing cardiac
surgery. Compared with placebo, the odds ratio (OR) for the occurrence of
AKI was 0.24 [95% confidence interval (CI) 0.16-0.34] with natriuretic
peptide, 0.33 (95% CI 0.14-0.70) with fenoldopam, 0.54 (95% CI 0.31-0.84)
with dexmedetomidine, 0.56 (95% CI 0.29-0.95) with low-dose
erythropoietin, 0.63 (95% CI 0.43-0.88) with levosimendan, 0.76 (95% CI
0.52-1.10) with steroids, 0.83 (95% CI 0.48-1.40) with high-dose
erythropoietin, 0.85 (95% CI 0.64-1.14) with N-acetylcysteine, 0.96 (95%
CI 0.69-1.29) with sodium bicarbonate, and 1.05 (95% CI 0.70-1.41) with
statins. The surface under the cumulative ranking curve probabilities
indicated that natriuretic peptide was the best treatment therapy and that
fenoldopam ranked second. Conclusions: Natriuretic peptide is probably the
preferred pharmacologic strategy to prevent AKI in adult patients
undergoing cardiac surgery, especially in those at high risk of
AKI.<br/>Copyright &#xa9; 2017, Springer International Publishing AG.

<28>
Accession Number
623636713
Title
Comparison of propofol-based versus volatile-based anaesthesia and
postoperative sedation in cardiac surgical patients: A prospective,
randomized, study.
Source
Anaesthesiology Intensive Therapy. 50 (3) (pp 200-209), 2018. Date of
Publication: 17 Aug 2018.
Author
Wasowicz M.; Jerath A.; Luksun W.; Sharma V.; Mitsakakis N.; Meineri M.;
Katznelson R.; Yau T.; Rao V.; Beattie W.S.
Institution
(Wasowicz, Jerath, Luksun, Sharma, Meineri, Katznelson, Beattie)
Department of Anesthesia, University of Toronto, Toronto, Canada
(Mitsakakis) Institute for Health Policy, Management and Evaluation,
University of Toronto, Biostatistics Research Unit, University Health
Network, Toronto, Canada
(Yau, Rao) Division of Cardiac Surgery, Peter Munk Cardiac Centre,
University Health Network, Department of Surgery, University of Toronto,
Toronto, Canada
(Wasowicz, Jerath, Luksun, Sharma, Meineri, Katznelson, Beattie)
Department of Anesthesia and Pain Management, Toronto General Hospital,
University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4,
Canada
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Clinical trials have shown conflicting results regarding the
use of volatile anaesthesia before or after an ischaemic insult in cardiac
surgical patients and its effect on myocardial injury. This may be
attributable to the failure of continuing volatile agents into the early
postoperative period. We hypothesised that combined volatile-based
anaesthesia and postoperative sedation would decrease the extent of
myocardial injury after coronary artery bypass grafting (CABG) when
compared with an intravenous, propofol-based approach. This study aimed to
assess the feasibility of the perioperative protocol and investigate
whether volatile anaesthesia provides cardioprotection in patients
undergoing CABG. Methods: Randomized, controlled trial enrolling 157
patients with preserved left ventricular function scheduled for elective
or urgent on-pump CABG. Patients received either volatile- or
propofol-based anaesthesia and postoperative sedation. Volatile sedation
in the ICU was provided with the use of the AnaConDa device
(Sedana Medical, Uppsala, Sweden). The primary outcome was myocardial
injury measured by serial troponin measurement at the beginning of
surgery, 2, 4 and 12-16 h after ICU admission. The secondary outcome was
cardiac performance expressed as cardiac index (CI) and the need for
inotropic and vasopressor drug support. The peak postoperative troponin
level was defined as the highest level at any time in the first 16 h after
surgery. Results: 127 patients completed the study protocol, 60 patients
in the volatile group and 67 patients in the propofol group. Troponin
levels were similar between groups at all of the measured time points.
There were no differences in cardiac index or vasoactive drug support
except for the immediate post- cardiopulmonary bypass (CPB) period when
patients in the volatile group had low systemic vascular resistance, high
CI and required more vasopressors. There was no difference in
postoperative kidney function, intensive care unit discharge or hospital
discharge time. Conclusions: The use of volatile-based anaesthesia and
postoperative sedation did not confer any cardioprotection compared with
propofol-based anaesthesia and sedation in patients who had good left
ventricular function and were undergoing CABG.

<29>
Accession Number
623632474
Title
Prehabilitation in thoracic surgery.
Source
Journal of Thoracic Disease. 10 (Supplement22) (pp S2593-S2600), 2018.
Date of Publication: 01 Aug 2018.
Author
Sanchez-Lorente D.; Navarro-Ripoll R.; Guzman R.; Moises J.; Gimeno E.;
Boada M.; Molins L.
Institution
(Sanchez-Lorente, Guzman, Boada, Molins) General Thoracic Surgery
Department, Clinical Respiratory Institute, Hospital Clinic of Barcelona,
Barcelona, Spain
(Navarro-Ripoll) Department of Anesthesiology, Clinical Respiratory
Institute, Hospital Clinic of Barcelona, Barcelona, Spain
(Moises, Gimeno) Department of Pneumology, Clinical Respiratory Institute,
Hospital Clinic of Barcelona, Barcelona, Spain
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Surgical resection remains the best treatment option for patients with
early stage of non-small cell lung cancer (NSCLC). However, it may be
responsible of postoperative complication and mortality, especially in
patients with impaired pulmonary function. Enhanced recovery after surgery
(ERAS) programs have been focused mainly in minimal invasive surgery
approach during lung resection and respiratory rehabilitation after
surgery. Preoperative exercise-based intervention (prehabilitation) has
demonstrated reduction of morbi-mortality in other surgeries but in
thoracic surgery continues to be under discussion. Cardio-pulmonary
exercise test (CPET) is the gold standard technique to predict
postoperative morbimortality. The implementation of a preoperative
respiratory rehabilitation could optimize patient's physical capacity
before surgery and improve outcomes and enhance recovery. The aim of this
systematic review of the literature is to identify the effectiveness and
safety of prehabilitation programs in thoracic surgery, the type of
exercise and its duration, and the group of patients with best benefit.
Prehabilitation is a safe intervention without side effects in patients.
High-intensity interval training (HIT) with duration of 2 to 6 weeks seems
to be the best exercise programme in a prehabilitation intervention but it
exists heterogeneity in terms of intensity and duration. Prehabilitation
increase exercise capacity and significantly enhances pulmonary function.
But the reduction of postoperative complication and mortality has not been
clearly demonstrated. Different criteria selection, type of intervention
and small sample size, in addition to no randomization, could justify
disparate results. It seems that not all patients can benefit from
prehabilitation and it could be indicated only in patients with impaired
lung function. Further randomized clinical trials with enough patients,
correct duration of HIT (2 to 6 weeks) and focused in COPD patients are
needed to clarify the suitability of prehabilitation. Meanwhile, safety of
prehabilitation and good results of some studies support this intervention
in high-risk patients.<br/>Copyright &#xa9; Journal of Thoracic Disease.

<30>
Accession Number
2001054350
Title
Comparison of International Guidelines for Assessment of Suspected Stable
Angina: Insights From the PROMISE and SCOT-HEART.
Source
JACC: Cardiovascular Imaging. 11 (9) (pp 1301-1310), 2018. Date of
Publication: September 2018.
Author
Adamson P.D.; Newby D.E.; Hill C.L.; Coles A.; Douglas P.S.; Fordyce C.B.
Institution
(Adamson, Newby) British Heart Foundation Centre for Cardiovascular
Science, University of Edinburgh, Edinburgh, United Kingdom
(Hill, Coles, Douglas) Duke Clinical Research Institute, Duke University
School of Medicine, Durham, North Carolina, United States
(Fordyce) Division of Cardiology, University of British Columbia,
Vancouver, British Columbia, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to compare the performance of major
guidelines for the assessment of stable chest pain including risk-based
(American College of Cardiology/American Heart Association and European
Society of Cardiology) and symptom-focused (National Institute for Health
and Care Excellence) strategies. Background: Although noninvasive testing
is not recommended in low-risk individuals with stable chest pain,
guidelines recommend differing approaches to defining low-risk patients.
Methods: Patient-level data were obtained from the PROMISE (Prospective
Multicenter Imaging Study for Evaluation of Chest Pain) and SCOT-HEART
(Scottish Computed Tomography of the Heart) trials. Pre-test probability
was determined and patients dichotomized into low-risk and
intermediate-high-risk groups according to each guideline's definitions.
The primary endpoint was obstructive coronary artery disease on coronary
computed tomography angiography. Secondary endpoints were coronary
revascularization at 90 days and cardiovascular death or nonfatal
myocardial infarction up to 3 years. Results: In total, 13,773 patients
were included of whom 6,160 had coronary computed tomography angiography.
The proportions of patients identified as low risk by the American College
of Cardiology/American Heart Association, European Society of Cardiology,
and National Institute for Health and Care Excellence guidelines,
respectively, were 2.5%, 2.5%, and 10.0% within PROMISE, and 14.0%, 19.8%,
and 38.4% within SCOT-HEART. All guidelines identified lower rates of
obstructive coronary artery disease in low- versus intermediate-high-risk
patients with a negative predictive value of >=0.90. Compared with
low-risk groups, all intermediate-high-risk groups had greater risks of
coronary revascularization (odds ratio [OR]: 2.2 to 24.1) and clinical
outcomes (OR: 1.84 to 5.8). Conclusions: Compared with risk-based
guidelines, symptom-focused assessment identifies a larger group of
low-risk chest pain patients potentially deriving limited benefit from
noninvasive testing. (Scottish Computed Tomography of the Heart Trial
[SCOT-HEART]; NCT01149590; Prospective Multicenter Imaging Study for
Evaluation of Chest Pain [PROMISE]; NCT01174550)<br/>Copyright &#xa9; 2018
The Authors

<31>
Accession Number
622224611
Title
Effects of perioperative statins on patient outcomes after noncardiac
surgery: a meta-analysis.
Source
Annals of Medicine. 50 (5) (pp 402-409), 2018. Date of Publication: 04 Jul
2018.
Author
Ma B.; Sun J.; Diao S.; Zheng B.; Li H.
Institution
(Ma, Sun, Diao, Zheng) Department of Cardiology, The Affiliated Hospital
of Binzhou Medical University, Binzhou, Shandong, China
(Li) Department of Oncology, The Affiliated Hospital of Binzhou Medical
University, Binzhou, Shandong, China
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Background: Cardiovascular complications are strongly correlated with a
higher risk of mortality during follow-up after noncardiac surgery.
However, controversy remains regarding whether perioperative
administration of hydroxymethylglutaryl-CoA reductase inhibitors (statins)
has a beneficial effect on patient outcomes. Objective: We performed a
meta-analysis to validate the hypothesis that perioperative statins
improve patient outcomes after noncardiac surgery. Methods: Electronic
databases (PubMed, Web of Science, EMBASE, and the Cochrane Library) were
searched for randomized controlled trials (RCTs) published up to 10
November 2017. RCTs were eligible for inclusion if they compared
perioperative statin treatment with control treatment in patients
scheduled for noncardiac surgery and reported data pertaining to clinical
outcomes. Results: Twelve RCTs involving 4707 patients (2371 in the
perioperative statin group and 2336 in the control group) were ultimately
included in this meta-analysis. The incidences of postoperative myocardial
infarction, composite of death/myocardial infarction/stroke and new cases
of atrial fibrillation were all lower in patients treated with statins
than in control group patients, as shown by the fixed-effects model (odds
ratio (OR) = 0.460, 95% confidence interval (CI) = 0.324-0.653, p = 0 for
myocardial infarction; OR = 0.617, 95% CI = 0.476-0.801, p = 0 for
composite of death/myocardial infarction/stroke; OR = 0.406, 95% CI =
0.247-0.666, p = 0 for new atrial fibrillation). No significant
differences in the incidences of stroke or transient ischemic attack,
all-cause mortality and cardiovascular mortality were observed between the
statin and control arms. Conclusions: This meta-analysis supports the
hypothesis that perioperative statins effectively reduce the incidences of
postoperative myocardial infarction, composite of death/myocardial
infarction/stroke and new cases of atrial fibrillation in patients
undergoing noncardiac surgery.Key Messages Cardiovascular complications
are strongly correlated with a higher risk of mortality during follow-up
after noncardiac surgery. We performed a meta-analysis to confirm the
hypothesis that perioperative statins improve patient outcomes after
noncardiac surgery.<br/>Copyright &#xa9; 2018, &#xa9; 2018 Informa UK
Limited, trading as Taylor & Francis Group.

<32>
Accession Number
2001022620
Title
Genetic association between HLA-G 14-bp polymorphism and diseases: A
systematic review and meta-analysis.
Source
Human Immunology. 79 (10) (pp 724-735), 2018. Date of Publication: October
2018.
Author
de Almeida B.S.; Muniz Y.C.N.; Prompt A.H.; Castelli E.C.; Mendes-Junior
C.T.; Donadi E.A.
Institution
(de Almeida, Donadi) Divisao de Imunologia Clinica, Departamento de
Clinica Medica, Faculdade de Medicina de Ribeirao Preto (FMRP),
Universidade de Sao Paulo (USP), Ribeirao Preto, SP 14049-900, Brazil
(de Almeida) Laboratorio Multiusuario de Estudos em Biologia, Centro de
Ciencias Biologicas, Universidade Federal de Santa Catarina (UFSC),
Florianopolis, Brazil
(Muniz, Prompt) Departamento de Biologia Celular, Embriologia e Genetica,
Centro de Ciencias Biologicas, Universidade Federal de Santa Catarina
(UFSC), Florianopolis, Brazil
(Castelli) Departamento de Patologia, Faculdade de Medicina de Botucatu,
Unesp - Univ. Estadual Paulista, Botucatu, SP 18618-970, Brazil
(Mendes-Junior) Faculdade de Filosofia Ciencias e Letras de Ribeirao Preto
(FFCLRP), Universidade de Sao Paulo (USP), Ribeirao Preto, SP 14049-900,
Brazil
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: HLA-G is an immune checkpoint molecule. Since a differential
molecule expression has been reported even for healthy individuals, many
studies have focused on polymorphisms at HLA-G regulatory regions,
particularly the 3' untranslated region (3'UTR). The presence/absence of a
14-bp sequence was the first polymorphism described and it is the most
studied in association between HLA-G and disorders. Methods: In this
study, we performed a systematic review and meta-analysis of all
association studies published regarding the HLA-G 14-bp. Results: We
verified association between 14-bp alleles and diseases in the following
situations: (1) presence of 14-bp (insertion) conferred susceptibility to
preeclampsia (child alleles evaluated) and systemic lupus erythematosus
(OR = 1.42; 95%CI = 1.04-1.93; p = 0.026 and OR = 1.13; 95%CI = 1.01-1.27,
p = 0.028); (2) 14-bp absence (deletion) was associated with increased
risk to breast cancer (OR = 1.23; 95%CI = 1.06-1.43; p = 0.006) and human
Cytomegalovirus infection (OR = 2.06; 95%CI = 1.60-2.64; p < 0.0001); and
(3) a risk association was observed between the group of reproductive
disorders and the 14-bp insertion (OR = 1.12; 95%CI = 1.01-1.24; p =
0.034). Conclusions: Considering that others 14-bp associations were
inconclusive and that other variation sites observed at HLA-G 3'UTR
exhibit a proven role on post-transcriptional regulation of HLA-G
expression, the complete 3'UTR segment should be analyzed in terms of
disease susceptibility, instead of a single polymorphism.<br/>Copyright
&#xa9; 2018

<33>
Accession Number
623696451
Title
Age and Surgical Complexity impact on Renoprotection by Remote Ischemic
Preconditioning during Adult Cardiac Surgery: A Meta analysis.
Source
Scientific reports. 7 (1) (pp 215), 2017. Date of Publication: 16 Mar
2017.
Author
Zhou C.; Bulluck H.; Fang N.; Li L.; Hausenloy D.J.
Institution
(Zhou, Fang) Department of Anesthesiology, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Disease, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing 100037, China
(Bulluck, Hausenloy) Hatter Cardiovascular Institute, University College
London, 67 Chenies Mews, London WC1E 6HX, United Kingdom
(Bulluck, Hausenloy) National Institute of Health Research University
College London Hospitals Biomedical Research Centre, London, United
Kingdom
(Bulluck, Hausenloy) National Heart Research Institute Singapore, National
Heart Centre Singapore, Singapore
(Li) Department of Anesthesiology, State Key Laboratory of Cardiovascular
Disease, Fuwai Hospital, National Center for Cardiovascular Disease,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing 100037, China
(Hausenloy) Cardiovascular and Metabolic Disorders Program, Duke-National
University of Singapore, Singapore
Abstract
We aimed to conduct an up-to-date meta-analysis to comprehensively assess
the renoprotective effect of remote ischemic preconditioning (RIPC) in
patients undergoing adult cardiac surgery. 21 randomized controlled trials
(RCTs) with a total of 6302 patients were selected and identified.
Compared with controls, RIPC significantly reduced the incidence of acute
kidney injury (AKI) [odds ratio (OR)=0.79; P=0.02; I2=38%], and in
particular, AKI stage I (OR=0.65; P=0.01; I2=55%). RIPC significantly
shortened mechanical ventilation (MV) duration [weighted mean difference
(WMD)=-0.79hours; P=0.002; I2=53%), and reduced intensive care unit (ICU)
stay (WMD=-0.23 days; P=0.07; I2=96%). Univariate meta-regression analyses
showed that the major sources of heterogeneity for AKI stage I were age
(coefficient=0.06; P=0.01; adjusted R2=0.86) and proportion of complex
surgery (coefficient=0.02; P=0.03; adjusted R2=0.81). Subsequent
multivariate regression and subgroup analyses also confirmed these
results. The present meta-analysis suggests that RIPC reduces the
incidence of AKI in adults undergoing cardiac surgery and this benefit was
more pronounced in younger patients undergoing non-complex cardiac
surgery. RIPC may also shorten MV duration and ICU stay. Future RCTs
tailored for those most likely to benefit from RIPC warrants further
investigation.

<34>
Accession Number
623674865
Title
Network meta-analysis comparing iFR versus FFR versus coronary angiography
to drive coronary revascularization.
Source
Journal of Interventional Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Author
Verardi R.; Fioravanti F.; Barbero U.; Conrotto F.; Omede P.; Montefusco
A.; Moretti C.; D'Amico M.; Rinaldi M.; Escaned J.; D'Ascenzo F.
Institution
(Verardi, Fioravanti, Barbero, Conrotto, Omede, Montefusco, Moretti,
D'Amico, Rinaldi, D'Ascenzo) Division of Cardiology, Department of Medical
Sciences, University of Torino, Torino, Italy
(Escaned) Cardiovascular Institute, Hospital Clinico San Carlos, Madrid,
Spain
(Escaned) Centro Nacional de Investigaciones Cardiovasculares Carlos III,
Madrid, Spain
(Escaned) Faculty of Medicine, Complutense University of Madrid, Madrid,
Spain
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Aims: Instantaneous free-wave ratio (iFR) has been recently demonstrated
non-inferior to fractional flow reserve (FFR) to drive coronary
revascularization; however, no study has compared iFR versus coronary
angiography (CA). We performed a network meta-analysis to evaluate
efficacy and safety of iFR- versus CA-guided strategy. Methods and
Results: We searched for randomized trials and studies with propensity
score matching in The Cochrane Collaboration Central Register of
Controlled Trials, EMBASE, and MEDLINE/Pubmed. CA, FFR, and iFR were the
three competitive arms, MACE (a composite endpoint of death, myocardial
infarction [MI], and target vessel revascularization [TVR]) was the
primary endpoint, while its single components the secondary ones. Subgroup
analysis was performed for patients presenting with stable coronary artery
disease. Eight studies were selected: 4126 patients were evaluated with
FFR, 2160 with iFR, and 2214 with CA, acute coronary syndrome (ACS) was
the most frequent admission diagnosis. After 12 months, rates of MACE and
all-cause death did not differ between groups (respectively OR 1.04 and OR
0.86 for iFR vs FFR). Both FFR and iFR reduced TVR compared to CA
(respectively OR 0.68 and OR 0.70). In patients with stable CAD both FFR
and iFR reduced risk of subsequent MI compared to CA (respectively OR 0.66
and OR 0.79). Conclusion: Compared to CA alone, both FFR and iFR are safe
and effective in guiding coronary revascularization at 12 months. In
patients with stable CAD, both FFR and iFR-guided revascularization reduce
the risk of subsequent MI at 12 months.<br/>Copyright &#xa9; 2018 Wiley
Periodicals, Inc.

<35>
Accession Number
621796319
Title
Myocardial protection following del Nido cardioplegia in pediatric cardiac
surgery.
Source
Asian Cardiovascular and Thoracic Annals. 26 (4) (pp 267-272), 2018. Date
of Publication: 01 May 2018.
Author
Panigrahi D.; Roychowdhury S.; Guhabiswas R.; Rupert E.; Das M.; Narayan
P.
Institution
(Panigrahi, Roychowdhury, Guhabiswas, Rupert) Department of Cardiac
Anesthesia, NH Rabindranath Tagore International Institute of Cardiac
Sciences, Kolkata, India
(Das, Narayan) Department of Cardiac Surgery, NH Rabindranath Tagore
International Institute of Cardiac Sciences, Kolkata, India
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: This study was designed to compare myocardial protection with
del Nido cardioplegia and conventional blood cardioplegia in children
undergoing cardiac surgery in Risk Adjustment for Congenital Heart Surgery
categories 1 and 2. Methods: Sixty patients were randomized into 2 groups
receiving del Nido cardioplegia solution or conventional blood
cardioplegia. Myocardial injury was assessed using biochemical markers
(troponin I and creatine kinase-MB). Vasoactive-inotropic scores were
calculated to compare inotropic requirements. Results: Demographic
characteristics, cardiopulmonary bypass time, and aortic crossclamp time
were comparable in the 2 groups. Time-related changes in troponin I and
creatine kinase-MB were similar in both groups. Statistically significant
differences were seen in total cardioplegia volume requirement (p <
0.0001), number of cardioplegia doses given (p < 0.0001), packed red cell
volume usage during cardiopulmonary bypass (p < 0.02), and time taken to
restore spontaneous regular rhythm (p < 0.0001). Vasoactive-inotropic
scores on transfer to the intensive care unit (p < 0.040) and at 24 h (p <
0.030) were significantly lower in the del Nido group. Duration of
mechanical ventilation, intensive care unit stay, and hospital stay were
comparable in the 2 groups. Conclusions: Our results show that del Nido
cardioplegia solution is as safe as conventional blood cardioplegia.
Moreover, it provides the benefits of reduced dose requirement, lower
consumption of allogenic blood on cardiopulmonary bypass, quicker
resumption of spontaneous regular cardiac rhythm, and less inotropic
support requirement on transfer to the intensive care unit and at 24 h,
compared to conventional blood cardioplegia.<br/>Copyright &#xa9; 2018,
&#xa9; The Author(s) 2018.

<36>
Accession Number
619905965
Title
New Targets for the Prevention of Chronic Rejection after Thoracic Organ
Transplantation.
Source
Thoracic and Cardiovascular Surgeon. 66 (1) (pp 20-30), 2018. Date of
Publication: 01 Jan 2018.
Author
Heim C.; Gocht A.; Weyand M.; Ensminger S.
Institution
(Heim, Gocht, Weyand) Department of Cardiac Surgery, University of
Erlangen-Nuremberg, Erlangen, Germany
(Ensminger) Department of Thoracic and Cardiovascular Surgery, Heart and
Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
The gold standard for the treatment of terminal heart failure and
irreversible lung diseases includes thoracic organ transplantation. The
major obstacle for long-term survival after successful transplantation is
chronic rejection, an ongoing immunomodulatory disease so far without
effective therapy. Therefore, the aim of this review is to elucidate
scientific efforts targeting different new mechanisms of cardiac allograft
vasculopathy (CAV) and chronic lung allograft dysfunction (CLAD). For this
purpose, we performed a systematic review of the literature to assess
recent strategies in transplant immunology research. We searched MEDLINE
from 2015 up to date for articles addressing the following keywords: CAV,
transplant vasculopathy, transplant arteriosclerosis, CLAD, bronchiolitis
obliterans transplant, and obliterative bronchiolitis transplant. All
articles including experimental models in the field of transplant
immunology addressing new aspects for the prevention of chronic rejection
after heart and lung transplantation were included in this review. The
prevention of chronic rejection would clearly improve the survival of
patients after heart and lung transplantation. Interesting targets were
addressed in recent research, but further research is necessary to
effectively treat this life-threatening disease in transplant
recipients.<br/>Copyright &#xa9; 2018 Georg Thieme Verlag KG Stuttgart,
New York.

<37>
Accession Number
619949956
Title
Comparison of Arndt-endobronchial blocker plus laryngeal mask airway with
left-sided double-lumen endobronchial tube in one-lung ventilation in
thoracic surgery in the morbidly obese.
Source
Brazilian Journal of Medical and Biological Research. 51 (2) (no
pagination), 2018. Article Number: e6825. Date of Publication: 2018.
Author
Zhang Z.J.; Zheng M.L.; Nie Y.; Niu Z.Q.
Institution
(Zhang, Zheng, Nie, Niu) Department of Anesthesiology, The Cangzhou
Central Hospital, Cangzhou, Hebei, China
Publisher
Associacao Brasileira de Divulgacao Cientifica (E-mail:
bjournal@fmrp.usp.br)
Abstract
This study aimed to evaluate the feasibility and performance of
Arndt-endobronchial blocker (Arndt) combined with laryngeal mask airway
(LMA) compared with left-sided double-lumen endobronchial tube (L-DLT) in
morbidly obese patients in one-lung ventilation (OLV). In a prospective,
randomized double-blind controlled clinical trial, 80 morbidly obese
patients (ASA I-III, aged 20-70) undergoing general anesthesia for
elective thoracic surgeries were randomly allocated into groups Arndt
(n=40) and L-DLT (n=40). In group Arndt, a LMATM Proseal was placed
followed by an Arndt-endobronchial blocker. In group L-DLT, patients were
intubated with a left-sided double-lumen endotracheal tube. Primary
endpoints were the airway establishment, ease of insertion, oxygenation,
lung collapse and surgical field exposure. Results showed similar ease of
airway establishment and tube/device insertion between the two groups.
Oxygen arterial pressure (PaO<inf>2</inf>) of patients in the Arndt group
was significantly higher than L-DLT (154+/-46 vs 105+/-52 mmHg; P<0.05).
Quality of lung collapse and surgical field exposure in the Arndt group
was significantly better than L-DLT (effective rate 100 vs 90%; P<0.05).
Duration of surgery and anesthesia were significantly shorter in the Arndt
group (2.4+/-1.7 vs 3.1+/-1.8 and 2.8+/-1.9 vs 3.8+/-1.8 h, respectively;
P<0.05). Incidence of hoarseness of voice and incidence and severity of
throat pain at the post-anesthesia care unit and 12, 24, 48, and 72 h
after surgery were significantly lower in the Arndt group (P<0.05).
Findings suggested that Arndt-endobronchial blocker combined with LMA can
serve as a promising alternative for morbidly obese patients in OLV in
thoracic surgery.<br/>Copyright &#xa9; 2018, Associacao Brasileira de
Divulgacao Cientifica. All rights reserved.

<38>
Accession Number
614710300
Title
Systematic review of model-based economic evaluations of heart valve
implantations.
Source
European Journal of Health Economics. 19 (2) (pp 241-255), 2018. Date of
Publication: 01 Mar 2018.
Author
Huygens S.A.; Takkenberg J.J.M.; Rutten-van Molken M.P.M.H.
Institution
(Huygens, Takkenberg) Department of Cardiothoracic Surgery, Erasmus
University Medical Center, PO Box 2040, Rotterdam 3000 CA, Netherlands
(Huygens, Rutten-van Molken) Department of Health Policy and
Management/Institute for Medical Technology Assessment, Erasmus University
Rotterdam, Bayle Building, Campus Woudestein, PO Box 1738, Rotterdam 3000
DR, Netherlands
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Objective: To review the evidence on the cost-effectiveness of heart valve
implantations generated by decision analytic models and to assess their
methodological quality. Methods: A systematic review was performed
including model-based cost-effectiveness analyses of heart valve
implantations. Study and model characteristics and cost-effectiveness
results were extracted and the methodological quality was assessed using
the Philips checklist. Results: Fourteen decision-analytic models
regarding the cost-effectiveness of heart valve implantations were
identified. In most studies transcatheter aortic valve implantation (TAVI)
was cost-effective compared to standard treatment (ST) in inoperable or
high-risk operable patients (ICER range 18,421-120,779 ) and in all
studies surgical aortic valve replacement (SAVR) was cost-effective
compared to ST in operable patients (ICER range 14,108-40,944 ), but the
results were not consistent on the cost-effectiveness of TAVI versus SAVR
in high-risk operable patients (ICER range: dominant to dominated by
SAVR). Mechanical mitral valve replacement (MVR) had the lowest costs per
success compared to mitral valve repair and biological MVR. The
methodological quality of the studies was moderate to good. Conclusion:
This review showed that improvements can be made in the description and
justification of methods and data sources, sensitivity analysis on
extrapolation of results, subgroup analyses, consideration of
methodological and structural uncertainty, and consistency (i.e. validity)
of the models. There are several opportunities for future
decision-analytic models of the cost-effectiveness of heart valve
implantations: considering heart valve implantations in other valve
positions besides the aortic valve, using a societal perspective, and
developing patient-simulation models to investigate the impact of patient
characteristics on outcomes.<br/>Copyright &#xa9; 2017, The Author(s).

<39>
Accession Number
621062672
Title
Role of terminal warm blood cardioplegia in complex congenital heart
surgery.
Source
Asian Cardiovascular and Thoracic Annals. 26 (3) (pp 196-202), 2018. Date
of Publication: 01 Mar 2018.
Author
Busro P.W.; Romolo H.; Sastroasmoro S.; Rachmat J.; Sadikin M.; Santoso
A.; Boom C.E.; Suwarto S.; Jusuf A.A.
Institution
(Busro, Romolo) Department of Pediatric Cardiac Surgery, Rumah Sakit
Jantung dan Pembuluh Darah Nasional Harapan Kita, Jakarta, Indonesia
(Sastroasmoro) Department of Pediatrics, Rumah Sakit Cipto Mangunkusumo,
Jakarta, Indonesia
(Rachmat) Department of Pediatric Cardiac Surgery, Rumah Sakit Cipto
Mangunkusumo, Jakarta, Indonesia
(Sadikin) Department of Biochemistry, Faculty of Medicine, Universitas
Indonesia, Jakarta, Indonesia
(Santoso) Department of Cardiology, Rumah Sakit Jantung dan Pembuluh Darah
Nasional Harapan Kita, Jakarta, Indonesia
(Boom) Department of Anesthesiology, Rumah Sakit Jantung dan Pembuluh
Darah Nasional Harapan Kita, Jakarta, Indonesia
(Suwarto) Department of Internal Medicine, Rumah Sakit Cipto Mangunkusumo,
Jakarta, Indonesia
(Jusuf) Department of Histology, Faculty of Medicine, Universitas
Indonesia, Jakarta, Indonesia
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Introduction: Myocardial protection is vital to ensure successful open
heart surgery. Cardioplegic solution is one method to achieve good
myocardial protection. Inevitably, ischemia-reperfusion injury occurs with
aortic crossclamping. Histidine-tryptophan-ketoglutarate solution is a
frequently used cardioplegia for complex congenital heart surgery. We
postulated that addition of terminal warm blood cardioplegia before
removal of the aortic crossclamp might improve myocardial protection.
Method: A randomized controlled trial was conducted on 109 cyanotic
patients aged, 1 to 5 years who underwent complex biventricular repair.
They were divided into a control group of 55 patients who had
histidine-tryptophan-ketoglutarate only and a treatment group of 54 who
had histidine-tryptophan-ketoglutarate with terminal warm blood
cardioplegia. Endpoints were clinical parameters, troponin I levels, and
caspase-3 as an apoptosis marker. Results: The incidence of low cardiac
output syndrome was 34%, with no significant difference between groups
(35.2% vs. 33.3%, p = 0.84). The incidence of arrhythmias in our treatment
group was lower compared to the control group (36% vs. 12%, p = 0.005).
Troponin I and caspase-3 results did not show any significant differences
between groups. For cases with Aristotle score >= 10, weak expression of
caspase-3 in the treatment group post-cardiopulmonary bypass was lower
compared to the control group. Conclusion: For complex congenital cardiac
surgery, the addition of terminal warm blood cardioplegia does not
significantly improve postoperative clinical or metabolic
markers.<br/>Copyright &#xa9; 2018, &#xa9; The Author(s) 2018.

<40>
Accession Number
618804123
Title
Real-world use and modeled impact of glucose-lowering therapies evaluated
in recent cardiovascular outcomes trials: An NCDR Research to Practice
project.
Source
European Journal of Preventive Cardiology. 24 (15) (pp 1637-1645), 2017.
Date of Publication: 01 Oct 2017.
Author
Arnold S.V.; Inzucchi S.E.; Tang F.; McGuire D.K.; Mehta S.N.; Maddox
T.M.; Goyal A.; Sperling L.S.; Einhorn D.; Wong N.D.; Khunti K.; Lam
C.S.P.; Kosiborod M.
Institution
(Arnold, Tang, Kosiborod) Saint Luke's Mid America Heart Institute,
University of Missouri-Kansas City, 4401 Wornall Road, Kansas City, MO
64111, United States
(Inzucchi) Yale School of Medicine, New Haven, CT, United States
(McGuire) University of Texas, Southwestern Medical Center, Dallas, TX,
United States
(Mehta) Joslin Diabetes Center, Boston, MA, United States
(Maddox) Washington University, School of Medicine, Saint Louis, MO,
United States
(Goyal, Sperling) Emory University, School of Medicine, Atlanta, GA,
United States
(Einhorn) University of California, San Diego School of Medicine, San
Diego, CA, United States
(Wong) University of California, Irvine School of Medicine, Irvine, CA,
United States
(Khunti) University of Leicester, Leicester, United Kingdom
(Lam) Duke-National University of Singapore, National Heart Centre,
Singapore
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Aims Recent trials (EMPA-REG OUTCOME and Liraglutide Effect and Action in
Diabetes: Evaluation of Cardiovascular Outcome Results [LEADER]) have
shown improved cardiovascular (CV) mortality with specific currently
available glucose-lowering medications (empagliflozin and liraglutide,
respectively), but were limited to selected patient populations. We sought
to evaluate the current use and potential real-world impact of
empagliflozin (and other sodium-glucose co-transporter 2 inhibitors
[SGLT2is]) and liraglutide (and other glucagonlike peptide-1 receptor
agonist [GLP-1 RAs]) among patients in the Diabetes Collaborative Registry
(DCR). Methods and results We evaluated 182,525 patients from the DCR - a
large, US-based outpatient registry of individuals with type 2 diabetes
from 313 sites that included cardiology, endocrinology and primary care
practices. Among these patients, 26.2% met major eligibility criteria for
EMPA-REG OUTCOME and 48.0% met major eligibility criteria for LEADER. Of
these potentially eligible patients, only a small minority were actually
prescribed these agents: 5.2% on an SGLT2i and 6.0% on a GLP-1 RA,
respectively. Patients receiving these studied medications or medication
classes, in general, had lower CV disease burden compared with those not
on these agents. Assuming similar risk reductions as in the clinical
trials, if all potentially trial-eligible patients in the DCR were treated
for 1 year with empagliflozin (or other SGLT2is, assuming a class effect)
or liraglutide (or other GLP-1 RAs, assuming a class effect), this may
have prevented 354 CV deaths, 231 heart failure hospitalizations, 329 CV
deaths and 247 myocardial infarctions, respectively. Conclusion In a
large, US-based outpatient registry, we found a significant number of
patients would have been potentially eligible for glucose-lowering agents
that demonstrated CV benefit in recent clinical trials. In view of these
findings, a broader and better-targeted use of these medications in
evidence-based patient populations should be considered.<br/>Copyright
&#xa9; European Society of Cardiology.

<41>
Accession Number
618804044
Title
A systematic review of cardiac rehabilitation registries.
Source
European Journal of Preventive Cardiology. 24 (15) (pp 1596-1609), 2017.
Date of Publication: 01 Oct 2017.
Author
Poffley A.; Thomas E.; Grace S.L.; Neubeck L.; Gallagher R.; Niebauer J.;
O'Neil A.
Institution
(Poffley) UNC Gillings School of Global Public Health, University of North
Carolina, United States
(Thomas, O'Neil) Melbourne School of Population and Global Health,
University of Melbourne, VIC, Australia
(Grace) Faculty of Health, York University, University Health Network,
Canada
(Neubeck) School of Health and Social Care, Edinburgh Napier University,
United Kingdom
(Gallagher) Sydney Nursing School, University of Sydney, Australia
(Niebauer) Institute of Sports Medicine, Prevention, and Rehabilitation,
Paracelsus Medical University, Austria
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Introduction Despite cardiac rehabilitation being recommended in clinical
practice guidelines internationally these services are underutilised,
programmes are not standardised and quality improvement methods and
outcomes are rarely published. National registries are an important
strategy to characterise service delivery, quality and outcomes, yet the
number, type and components of national cardiac rehabilitation registries
have not been reported. Aims To identify and describe national and
international cardiac rehabilitation registries, and summarise their key
features. Methods We systematically reviewed the literature reporting on
cardiac rehabilitation registries at a national and international level. A
search of four databases was conducted in July 2016, with two reviewers
independently screening titles/abstracts and full texts for inclusion.
Data were extracted from included studies, independently checked by a
second reviewer and synthesised qualitatively. Results Eleven articles
were included in the review comprising seven national registries and one
international registry (of 12 European countries) for a total sample of
265,608 patients. Data were most commonly provided to the registry by a
web-based application, and included individual-level data (i.e.
sociodemographic characteristics, medical history, and clinical
measurements). When reported, service-level data most commonly included
wait times, programme enrolment and completion. The overarching
governance, funding modes (e.g. industry (n = 2), government (n = 1)), and
incentives for registry participation (e.g. benchmarking, financial
reimbursement, or mandatory requirement) varied widely. Conclusion The use
of national and international registries for characterising cardiac
rehabilitation and providing a benchmark for quality improvement is in its
early stages but shows promise for national and global
benchmarking.<br/>Copyright &#xa9; European Society of Cardiology.

<42>
Accession Number
612256226
Title
Validation of the Ability of SYNTAX and Clinical SYNTAX Scores to Predict
Adverse Cardiovascular Events after Stent Implantation: A Systematic
Review and Meta-Analysis.
Source
Angiology. 67 (9) (pp 820-828), 2016. Date of Publication: 01 Oct 2016.
Author
Chen J.; Tang B.; Lin Y.; Ru Y.; Wu M.; Wang X.; Chen Q.; Chen Y.; Wang J.
Institution
(Chen, Lin, Ru, Wu, Chen, Wang) Department of Cardiology, Sun Yat-sen
Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
(Chen, Lin, Ru, Wu, Chen, Wang) Guangdong Province Key Laboratory of
Arrhythmia and Electrophysiology, Guangzhou, China
(Tang, Wang, Chen) Intelligent Computing Research Center, Harbin Institute
of Technology, Shenzhen Graduate School, Shenzhen, China
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
To compare the predicative ability of SYNTAX (Synergy between PCI with
Taxus and Cardiac Surgery) and clinical SYNTAX scores for major adverse
cardiac events (MACEs) after stent implantation in patients with coronary
artery disease (CAD). Studies were identified by electronic and manual
searches. Twenty-six studies were included in the meta-analysis. The
pooled C-statistics of SYNTAX score for 1- and 5-year all-cause mortality
(ACM) were 0.65 (95% confidence interval [CI]: 0.61-0.68) and 0.62 (95%
CI: 0.59-0.65), respectively, with weak heterogeneity. The 1- and 5-year
ACM pooled C-statistics for clinical SYNTAX scores were significantly
higher at 0.77 and 0.71, respectively (Ps <.05). Both scoring systems
predicted 1- and 5-year MACE equally well. The pooled risk ratio of the
SYNTAX score for predicting 1-year ACM per unit was 1.04 (95% CI:
1.03-1.05). Calibration analysis indicated SYNTAX scores overestimated the
risk of major adverse cardiac and cerebrovascular events in each risk
stratum. The SYNTAX score demonstrated minimal discrimination in
predicting 1- or 5-year adverse cardiovascular events after percutaneous
coronary intervention in patients with CAD. The clinical SYNTAX score
could further improve the predictive capability for ACM but not
MACE.<br/>Copyright &#xa9; The Author(s) 2015.

<43>
Accession Number
613239042
Title
A randomised controlled trial comparing the effects of propofol with
isoflurane in patients with diastolic dysfunction undergoing coronary
artery bypass graft surgery.
Source
Anaesthesia. 71 (11) (pp 1308-1316), 2016. Date of Publication: 01 Nov
2016.
Author
Ammar A.; Mahmoud K.; Elkersh A.; Kasemy Z.
Institution
(Ammar, Mahmoud, Elkersh, Kasemy) Statistics and Community Medicine,
Minoufiya Faculty of Medicine, Shebin Elkoam, Egypt
Publisher
Blackwell Publishing Ltd
Abstract
There is a strong association between pre-operative diastolic dysfunction
and difficulty in weaning from cardiopulmonary bypass. We compared the
effects of propofol and isoflurane on left ventricular diastolic function
in patients with pre-existing diastolic dysfunction undergoing coronary
artery bypass grafting. We randomly allocated 60 patients to receive
either propofol or isoflurane anaesthesia, and assessed left ventricular
diastolic function using transoesophageal echocardiography. We measured
early (E), late (A) diastolic velocities, E/A ratio, A-wave duration and
deceleration time using pulsed wave Doppler, and early (Em), late (Am)
diastolic velocities of the mitral annulus, Em/Am ratio and isovolumetric
relaxation time using tissue Doppler. We measured pulmonary venous flow
velocity and recorded values for the peak systolic flow velocity (S), peak
diastolic flow velocity (D), S/D ratio, peak reverse atrial flow velocity
and duration of reverse atrial flow. All data were recorded immediately
after tracheal intubation as a baseline, 5 min before sternotomy
(T<inf>1</inf>), 5 min before aortic cannulation (T<inf>2</inf>) and 15
min after weaning from cardiopulmonary bypass (T<inf>3</inf>). Both
propofol and isoflurane improved left ventricular diastolic function as
evidenced by significant increases in E/A ratios, and significant
decreases in deceleration time and isovolumetric relaxation time; the
improvement was greater in the isoflurane group (between groups, p = 0.001
for both E/A ratio and deceleration time at T<inf>1</inf> and
T<inf>2</inf> and p = 0.006 for isovolumetric relaxation time at both
T<inf>1</inf> and T<inf>2</inf>). Furthermore, Em/Am ratio, S, D and S/D
ratios were significantly better in the isoflurane group. The
administration of isoflurane during cardiac surgery improves diastolic
function comparatively more than propofol.<br/>Copyright &#xa9; 2016 The
Association of Anaesthetists of Great Britain and Ireland

<44>
Accession Number
2000922101
Title
Statin therapy improved long-term prognosis in patients with major
non-cardiac vascular surgeries: a systematic review and meta-analysis.
Source
Vascular Pharmacology. 109 (pp 1-16), 2018. Date of Publication: October
2018.
Author
Yu W.; Wang B.; Zhan B.; Li Q.; Li Y.; Zhu Z.; Yan Z.
Institution
(Yu, Wang, Li, Li, Zhu, Yan) The Center for Hypertension and Metabolic
Diseases, Department of Hypertension and Endocrinology, Daping Hospital,
Third Military Medical University, Chongqing Institute of Hypertension,
Chongqing 400042, China
(Yu, Zhan) The Thirteenth People's Hospital of Chongqing, The Chongqing
Geriatric Hospital, Chongqing 400053, China
(Wang) Department of Nephrology, Chinese PLA General Hospital, Chinese PLA
Institute of Nephrology, Beijing Key Laboratory of Kidney Disease,
National Clinical Research Center for Kidney Diseases, Fuxing Road 28,
Beijing 100853, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: To investigate whether statin intervention will improve the
long-term prognosis of patients undergoing major non-cardiac vascular
surgeries. Methods: Major database searches for clinical trials enrolling
patients undergoing major non-cardiac vascular surgeries, including lower
limb revascularization, carotid artery surgeries, arteriovenous fistula,
and aortic surgeries, were performed. Subgroup analyses, stratified by
surgical types or study types, were employed to obtain statistical results
regarding survival, patency rates, amputation, and cardiovascular and
stroke events. Odds ratio (ORs) and 95% confidence intervals (CIs) were
calculated by Review Manager 5.3. Sensitivity analysis, publication bias
and meta-regression were conducted by Stata 14.0. Results: In total, 34
observational studies, 8 prospective cohort studies and 4 randomized
controlled clinical trials (RCTs) were enrolled in the present analysis.
It was demonstrated that statin usage improved all-cause mortality in
lower limb, carotid, aortic and mixed types of vascular surgery subgroups
compared with those in which statins were not used. Additionally, the
employment of statins efficiently enhanced the primary and secondary
patency rates and significantly decreased the amputation rates in the
lower limb revascularization subgroup. Furthermore, for other
complications, statin intervention decreased cardiovascular events in
mixed types of vascular surgeries and stroke incidence in the carotid
surgery subgroup. No significant publication bias was observed. The
meta-regression results showed that the morbidity of cardiovascular
disease or the use of aspirin might affect the overall estimates in
several subgroups. Conclusions: This meta-analysis demonstrated that
statin therapy was associated with improved survival rates and patency
rates and with reduced cardiovascular or stroke morbidities in patients
who underwent non-cardiac vascular surgeries.<br/>Copyright &#xa9; 2018
Elsevier Inc.

<45>
[Use Link to view the full text]
Accession Number
623481878
Title
Medical management of rheumatic heart disease: A systematic review of the
evidence.
Source
Cardiology in Review. 26 (4) (pp 187-195), 2018. Date of Publication:
2018.
Author
Anne Russell E.; Walsh W.F.; Costello B.; McLellan A.J.A.; Brown A.; Reid
C.M.; Tran L.; Maguire G.P.
Institution
(Anne Russell, Costello, McLellan, Maguire) Clinical Research Domain,
Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC 3004,
Australia
(Anne Russell, Reid, Tran, Maguire) School of Epidemiology and Preventive
Medicine, Monash University, Melbourne, Australia
(Walsh) Department of Cardiology, Prince of Wales Hospital, Randwick,
Australia
(Costello, McLellan) Department of Cardiovascular Medicine/Heart Centre,
Alfred Hospital, Melbourne, Australia
(McLellan) Department of Cardiology, St Vincent's Hospital, Melbourne,
Australia
(Brown) Wardliparingga Aboriginal Research Unit, South Australia Health
and Medical Research Institute, Adelaide, Australia
(Brown) School of Population Health, University of South Australia,
Adelaide, Australia
(Reid) School of Public Health, Curtin University, Perth, Australia
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Rheumatic heart disease (RHD) is an important cause of heart disease
globally. Its management can encompass medical and procedural (catheter
and surgical) interventions. Literature pertaining to the medical
management of RHD from PubMed 1990-2016 and via selected article reference
lists was reviewed. Areas included symptom management, left ventricular
dysfunction, rate control in mitral stenosis, atrial fibrillation,
anticoagulation, infective endocarditis prophylaxis, and management in
pregnancy. Diuretics, angiotensin blockade and beta-blockers for left
ventricular dysfunction, and beta-blockers and If inhibitors for rate
control in mitral stenosis reduced symptoms and improved left ventricular
function, but did not alter disease progression. Rhythm control for atrial
fibrillation was preferred, and where this was not possible, rate control
with beta-blockers was recommended. Anticoagulation was indicated where
there was a history of cardioembolism, atrial fibrillation, spontaneous
left atrial contrast, and mechanical prosthetic valves. While warfarin
remained the agent of choice for mechanical valve implantation,
non-Vitamin K antagonist oral anticoagulants may have a role in
RHD-related AF, particularly with valvular regurgitation. Evidence for
anticoagulation after bioprosthetic valve implantation or mitral valve
repair was limited. RHD patients are at increased risk of endocarditis,
but the evidence supporting antibiotic prophylaxis before procedures that
may induce bacteremia is limited and recommendations vary. The management
of RHD in pregnancy presents particular challenges, especially regarding
decompensation of previously stable disease, the choice of
anticoagulation, and the safety of medications in both pregnancy and
breast feeding.<br/>Copyright &#xa9; 2017 Wolters Kluwer Health, Inc. All
rights reserved.

<46>
Accession Number
623625466
Title
Anesthesia using target-controlled infusion of propofol during elective
pediatric surgery: Kataria versus Paedfusor pharmacokinetic model.
Source
Anaesthesia, Pain and Intensive Care. 22 (2) (pp 207-211), 2018. Date of
Publication: April-June 2018.
Author
Hassan W.M.N.W.; Mansor A.; Zaini R.H.M.
Institution
(Hassan, Mansor, Zaini) Department of Anesthesiology and Intensive Care,
School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu,
Kelantan 16150, Malaysia
Publisher
Faculty of Anaesthesia, Pain and Intensive Care, AFMS (E-mail:
tariqhayatkhan@hotmail.com)
Abstract
Background and Aim: Propofol and sevoflurane, both meet the criteria of
rapid smooth induction, hemodynamic stability, rapid recovery with minimal
side effects. The present study investigated the hemodynamic stability and
recovery profile while maintaining anesthesia with sevoflurane as
inhalational agent versus propofol as total intravenous anesthesia during
laparoscopic surgeries. Methodology: This was a prospective study
conducted for one year at our hospital. Using convenient sampling
technique, a total of 50 adult patients of American Society of
Anesthesiologists (ASA) physical status I or II, aged between 18-60 years,
of either sex, who were scheduled for elective day care surgeries of less
than 2-hour duration under general anesthesia were selected for the study
after informed consent. All the patients were randomly allocated into one
of the two groups using computer generated random number table. Group-S
received induction with propofol and maintenance with sevoflurane, while
Group-P was induced and maintained with propofol only. Hemodynamic and
recovery profiles were then compared. The differences between two groups
were analyzed using unpaired t-test while categorical variables were
analyzed using chi-square test. All the statistical tests were performed
in Epi Info 3.5.1 software by CDC, USA.6 p < 0.05was considered as
statistically significant while p < 0.01 was considered as statistically
highly significant. Results: The baseline demographic analysis showed that
the two groups did not differ significantly in age, weight, sex, ASA grade
and operative times. During the course of surgery, heart rate was
significantly low in Group-P at 45 to 60 min than in Group-S. Systolic and
diastolic blood pressures were significantly low during maintenance of
anesthesia with propofol as compared to sevoflurane. Group-S showed
significantly shorter time for spontaneous eye opening and recalling names
and recognizing surroundings. Post-operative nausea and vomiting was
significantly low in Group-P. Conclusion: The present study concludes that
patients in both groups were hemodynamically stable. Sevoflurane has the
added advantage of providing rapid emergence and recovery of cognitive
function. Hence it can be considered as a useful alternative to propofol
for maintenance of anesthesia.<br/>Copyright &#xa9; Anaesthesia, Pain &
Intensive Care, 2010-2013.

<47>
Accession Number
623357582
Title
Implantable cardioverter defibrillator in nonischemic cardiomyopathy: A
systematic review and meta-analysis.
Source
Journal of Arrhythmia. 34 (1) (pp 4-10), 2018. Date of Publication: 01 Feb
2018.
Author
Khan S.U.; Ghimire S.; Talluri S.; Rahman H.; Khan M.U.; Nasir F.; Kaluski
E.
Institution
(Khan, Ghimire, Talluri, Rahman, Khan, Nasir, Kaluski) Guthrie
Clinic/Robert Packer Hospital, Sayre, PA, United States
(Kaluski) Rutgers Medical School, Newark, NJ, United States
(Kaluski) Geisinger Commonwealth School of Medicine, Scranton, PA, United
States
Publisher
Wiley-Blackwell (E-mail: info@wiley.com)
Abstract
The evidence to support implantable cardioverter defibrillator (ICD) in
subjects with nonischemic cardiomyopathy (NICM) for primary prevention of
sudden cardiac death (SCD) is not robust. This meta-analysis intends to
assess the impact of routine ICD implantation for primary prevention of
mortality due to SCD in NICM based on all the published randomized
clinical trials (RCTs). Six RCTs were selected using PubMed/Medline,
EMBASE, and CENTRAL from inception to December 2016. Outcomes were
calculated as random-effects relative risk (RR) and risk difference (RD)
with 95% confidence interval (CI). Patients were randomized to ICD arm and
control arm (usual care, medical treatment, and anti-arrhythmic drugs).
ICD significantly reduced all-cause mortality in NICM patients (RR, 0.74,
95% CI, 0.56-0.97, P =.03, I² = 40). Mortality benefit was
achieved due to a significant reduction in sudden cardiac death (SCD) (RR,
0.47, 95% CI, 0.30-0.73, P <.001, I² = 0). There were no
statistical differences between two groups with regard to risk of
noncardiac mortality, non-SCD, cardiac arrest, cardiac transplant,
sustained ventricular tachycardia (VT), and VT requiring medical
treatment. Our results support efficacy of ICDs at reducing all-cause
mortality due to a reduction in SCD.<br/>Copyright &#xa9; 2017 The
Authors.

<48>
[Use Link to view the full text]
Accession Number
623482539
Title
The society of thoracic surgeons, the society of cardiovascular
anesthesiologists, and the American society of extracorporeal technology:
Clinical practice guidelines - Anticoagulation during cardiopulmonary
bypass.
Source
Anesthesia and Analgesia. 126 (2) (pp 413-424), 2018. Date of Publication:
2018.
Author
Shore-Lesserson L.; Baker R.A.; Ferraris V.A.; Greilich P.E.; Fitzgerald
D.; Roman P.; Hammon J.W.
Institution
(Shore-Lesserson) Department of Anesthesiology, Northshore University
Hospital, 300 Community Dr, Manhasset, NY 11030, United States
(Baker) Cardiac Surgery Research and Perfusion, Flinders University and
Flinders Medical Center, Adelaide, SA, Australia
(Ferraris) Division of Cardiovascular and Thoracic Surgery, University of
Kentucky, Lexington, KY, United States
(Greilich) Department of Anesthesiology and Pain Management, University of
Texas-Southwestern Medical Center, Dallas, TX, United States
(Fitzgerald) Division of Cardiovascular Perfusion, Medical University of
South Carolina, Charleston, SC, United States
(Roman) Department of Anesthesiology, Saint Anthony Hospital, Lakewood,
CO, United States
(Hammon) Department of Cardiothoracic Surgery, Wake Forest University
School of Medicine, Winston-Salem, NC, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Despite more than a half century of "safe" cardiopulmonary bypass (CPB),
the evidence base surrounding the conduct of anticoagulation therapy for
CPB has not been organized into a succinct guideline. For this and other
reasons, there is enormous practice variability relating to the use and
dosing of heparin, monitoring heparin anticoagulation, reversal of
anticoagulation, and the use of alternative anticoagulants. To address
this and other gaps, The Society of Thoracic Surgeons, the Society of
Cardiovascular Anesthesiologists, and the American Society of
Extracorporeal Technology developed an Evidence Based Workgroup. This was
a group of interdisciplinary professionals gathered to summarize the
evidence and create practice recommendations for various aspects of CPB.
To date, anticoagulation practices in CPB have not been standardized in
accordance with the evidence base. This clinical practice guideline was
written with the intent to fill the evidence gap and to establish best
practices in anticoagulation therapy for CPB using the available
evidence.To identify relevant evidence, a systematic review was outlined
and literature searches were conducted in PubMed using standardized
medical subject heading (MeSH) terms from the National Library of Medicine
list of search terms. Search dates were inclusive of January 2000 to
December 2015. The search yielded 833 abstracts, which were reviewed by
two independent reviewers. Once accepted into the full manuscript review
stage, two members of the writing group evaluated each of 286 full papers
for inclusion eligibility into the guideline document. Ninety-six
manuscripts were included in the final review. In addition, 17 manuscripts
published before 2000 were included to provide method, context, or
additional supporting evidence for the recommendations as these papers
were considered sentinel publications. Members of the writing group wrote
and developed recommendations based on review of the articles obtained and
achieved more than two thirds agreement on each recommendation. The
quality of information for a given recommendation allowed assessment of
the level of evidence as recommended by the American College of Cardiology
Foundation/American Heart Association Task Force on Practice Guidelines.
Recommendations were written in the three following areas: (1) heparin
dosing and monitoring for initiation and maintenance of CPB; (2) heparin
contraindications and heparin alternatives; and (3) reversal of
anticoagulation during cardiac operations. It is hoped that this guideline
will serve as a resource and will stimulate investigators to conduct more
research and to expand on the evidence base on the topic of
anticoagulation therapy for CPB.<br/>Copyright &#xa9; 2017 International
Anesthesia Research Society.

<49>
[Use Link to view the full text]
Accession Number
623482459
Title
Efficacy of ultrasound-guided serratus plane block on postoperative
quality of recovery and analgesia after video-assisted thoracic surgery: A
randomized, triple-blind, placebo-controlled study.
Source
Anesthesia and Analgesia. 126 (4) (pp 1353-1361), 2018. Date of
Publication: April 2018.
Author
Kim D.-H.; Oh Y.J.; Lee J.G.; Ha D.; Chang Y.J.; Kwak H.J.
Institution
(Kim, Oh) Departments of Anesthesiology and Pain Medicine, Anesthesia and
Pain Research Institute, South Korea
(Lee) Departments of Thoracic and Cardiovascular Surgery, South Korea
(Ha) Anesthesiology and Pain Medicine, Yonsei University College of
Medicine, Seoul, South Korea
(Chang, Kwak) Department of Anesthesiology and Pain Medicine, Gil Medical
Center, Gachon University, 1198 Guwol-dong, Namdong-gu, Incheon 405-760,
South Korea
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: The optimal regional technique for analgesia and improved
quality of recovery after video-assisted thoracic surgery (a procedure
associated with considerable postoperative pain) has not been established.
The main objective in this study was to compare quality of recovery in
patients undergoing serratus plane block (SPB) with either ropivacaine or
normal saline on the first postoperative day. Secondary outcomes were
analgesic outcomes, including postoperative pain intensity and opioid
consumption. METHODS: Ninety patients undergoing video-assisted thoracic
surgery were randomized to receive ultrasound-guided SPB with 0.4 mL/kg of
either 0.375% ropivacaine (SPB group) or normal saline (control group)
after anesthetic induction. The primary outcome was the 40-item Quality of
Recovery (QoR-40) score at 24 hours after surgery. The QoR-40
questionnaire was completed by patients the day before surgery and on
postoperative days 1 and 2. Pain scores, opioid consumption, and adverse
events were assessed for 2 days postoperatively. RESULTS: Eighty-five
patients completed the study: 42 in the SPB group and 43 in the control
group. The global QoR-40 scores on both postoperative days 1 and 2 were
significantly higher in the SPB group than in the control group (estimated
mean difference 8.5, 97.5% confidence interval [CI], 2.1-15.0, and P =
.003; 8.5, 97.5% CI, 2.0-15.1, and P = .004, respectively). The overall
mean difference between the SPB and control groups was 8.5 (95% CI,
3.3-13.8; P = .002). Pain scores at rest and opioid consumption were
significantly lower up to 6 hours after surgery in the SPB group than in
the control group. Cumulative opioid consumption was significantly lower
up to 24 hours postoperatively in the SPB group. CONCLUSIONS:
Single-injection SPB with ropivacaine enhanced the quality of recovery for
2 days postoperatively and improved postoperative analgesia during the
early postoperative period in patients undergoing video-assisted thoracic
surgery.<br/>Copyright &#xa9; 2018 International Anesthesia Research
Society.

<50>
Accession Number
623640701
Title
Are children hospitalized for congenital heart disease surgery at risk of
pressure ulcers?.
Source
European Journal of Cardiovascular Nursing. Conference: EuroHeartCare 2018
Annual Congress of the Council on Cardiovascular Nursing and Allied
Professionals, CCNAP 2018. Ireland. 17 (1 Supplement 1) (pp 106-107),
2018. Date of Publication: August 2018.
Author
Hansen L.
Institution
(Hansen) Rigshospitalet, Copenhagen University Hospital, Thoracic Surgery
Department 3043, Copenhagen, Denmark
Publisher
SAGE Publications Inc.
Abstract
Background: Pediatric patients in general are at risk of pressure ulcers
(PU) during hospitalization. Approximately 250 children undergo surgery
for congenital heart disease (CHD) at Copenhagen University Hospital
yearly. Purpose: The purpose was to examine the risk of PU in children
hospitalized for CHD surgery. Method: A systematic review of the
literature was conducted in the PubMed database. An observational study of
pre-and postoperative skin status was carried out in children undergoing
CHD surgery. Age, weight, diagnoses, duration of surgery and extra
corporal circulation (ECC) was documented. Results: Children hospitalized
for CHD surgery are at risk of PU due to critical illness, prolonged
surgery time, stay at intensive care unit, compromised circulation and
nutrition, and lack of repositioning guidelines. 39 children were included
in the observational study. 5% developed PU during their hospitalization.
10% had alterations in their skin (considered early signs of PU)
postoperatively. Findings included severe diagnoses, prolonged surgery and
ECC time, and a weight-for-age below average. Conclusion: This study
documents a risk of PU among children hospitalized for CHD surgery, and
shows the need for further research and preventive measures.

<51>
Accession Number
623640604
Title
The efficacy and safety of simvastatin-fenofibrate fixed-dose combination
in patients undergoing percutaneous coronary intervention.
Source
European Journal of Cardiovascular Nursing. Conference: EuroHeartCare 2018
Annual Congress of the Council on Cardiovascular Nursing and Allied
Professionals, CCNAP 2018. Ireland. 17 (1 Supplement 1) (pp 71), 2018.
Date of Publication: August 2018.
Author
Elmurodov S.; Alyavi A.; Narziev B.; Madaliev A.
Institution
(Elmurodov, Alyavi, Narziev, Madaliev) Tashkent Medical Academy,
Cardiology, Tashkent, Uzbekistan
Publisher
SAGE Publications Inc.
Abstract
Background: Dyslipidemia management situation in patients with high risk
and very high risk has been demonstrated very low, despite the wide use of
statins. Purpose: The aim of this study was to evaluate the efficacy and
safety of combination therapy with simvastatin and fenofibrate in patients
after coronary artery stenting. Methods: A total of 153 patients after
coronary artery stenting were randomly assigned to receive 10 mg
simvastatin (n = 71) and a combination of 10 mg simvastatin plus 200 mg
fenofibrate (n = 82) for 1 months. In order to evaluate the clinical
effects on lipids-lowering, systemic inflammation response and clinical
safety, the follow-up of all patients was carried out at day 10th and 30th
after treatment. Results: Combination treatment was more effective in
normalizing lipid profile than monotherapy. The level of low-density
lipoprotein cholesterol (LDL-C) in combination group and statins group was
1.89 0.42 and 2.34 0.65 mmol/L at day 10th, 1.55 0.31 and 1.96 0.49 mmol/L
at day 30th, respectively. The control rates of LDL-C level in the
combination group and the statins group were 76% and 45% at day 30th,
respectively. There was no significant improvement on high-density
lipoprotein cholesterol (HDL-C) level during follow-up. The triglyceride
(TG) levels were significantly reduced in both groups, while no obvious
difference was observed between two groups. No significant difference on
serum high-sensitivity C-reactive protein (hs-CRP) level between two
groups was observed. Moreover, we did not observe any significant
correlation between serum lipids levels and serum hs-CRP level during
follow-up. The liver dysfunction and muscle related side effects (MRSE),
creatine kinase (CK) and myopathy were not observed in both groups.
Conclusion: The results of this study demonstrated that combination
therapy with fenofibrate and simvastatin is more effective than
monotherapy in patients after coronary artery revasculirisation, and is
generally safe and well tolerated.

<52>
Accession Number
623640501
Title
Functional capacity and health-related quality of life outcomes post
transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
European Journal of Cardiovascular Nursing. Conference: EuroHeartCare 2018
Annual Congress of the Council on Cardiovascular Nursing and Allied
Professionals, CCNAP 2018. Ireland. 17 (1 Supplement 1) (pp 92), 2018.
Date of Publication: August 2018.
Author
Straiton N.; Jin K.; Bhindi R.; Gallagher R.
Institution
(Straiton, Jin, Gallagher) University of Sydney, Sydney, Australia
(Bhindi) Royal North Shore Hospital, Sydney, Australia
Publisher
SAGE Publications Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) provides
prognostic benefit for high surgical-risk patients with severe aortic
stenosis (AS), however impact to patient outcomes is far less understood.
Method: A systematic review and meta-analysis to evaluate functional
capacity and health-related quality of life (HRQoL) outcomes for patients
up to 12 months post TAVR. A total of 20 eligible publications, comprising
randomised-controlled trials, observational studies and a registry study
were identified from databases, including MEDLINE, EMBASE, Cochrane
Library and others (inception to February 2017). Results: Total sample was
2775 with a mean age of 81.82.1 years, 52% were female and of high
surgicalrisk mean STS 9.64.3% (Society of Thoracic Surgeons). Post TAVR,
patients had significant improvement in functional capacity of >40m in the
6-minute walk test (6MWT) (95% confidence interval (CI) 9.69-73.28) and a
clinically meaningful increase in ability to perform daily physical-based
tasks (Duke Activity Status Index (DASI), mean difference (MD) increase
5.42 points, 95% CI 3.16-7.68). HRQoL improved consistently following TAVR
regardless of measure used, with significant increases in the physical
component scores. Conclusion: Despite evolving patient selection criteria,
functional capacity and HRQoL improved substantially post procedure, thus
TAVR continues to provide a directly beneficial option for severe AS
patients.

<53>
[Use Link to view the full text]
Accession Number
623645011
Title
Repair or replacement for severe ischemic mitral regurgitation: A
meta-analysis.
Source
Medicine. 97 (31) (pp e11546), 2018. Date of Publication: 01 Aug 2018.
Author
Wang X.; Zhang B.; Zhang J.; Ying Y.; Zhu C.; Chen B.
Institution
(Wang) Department of Thoracic and Cardiovascular Surgery, Affiliated
Taizhou Hospital of Wenzhou Medical University, Taizhou, China
Abstract
BACKGROUND: The best surgical option for severe ischemic mitral
regurgitation (IMR) is still controversial. The aim of this study was to
perform a meta-analysis to compare the clinical outcomes of mitral valve
repair (MVP) with replacement (MVR).
METHODS: A literature search was conducted in PubMed, Embase, and Medline
using the terms "ischemic mitral regurgitation" and "repair or
annuloplasty or reconstruction" and "replacement" in the title/abstract
field. The primary outcomes of interest were perioperative mortality and
long-term survival. Secondary outcomes were mitral regurgitation (MR)
recurrence and reoperation.
RESULTS: Of 276 studies, 13 studies met the inclusion and exclusion
criteria. A total of 1993 patients were included in these studies,
consisting of 1259 (63%) repair cases, and 734 (37%) replacement cases.
Perioperative mortality was lower with MVP compared with MVR [OR 0.61;
(95% CI, 0.43-0.87; P < .05)]. There was no difference with respect to
long-term survival [HR 0.75; (95% CI, 0.52-1.09; P = .14)] and reoperation
[OR 0.77; (95% CI, 0.38-1.57; P = .47)]. MVP is associated with a higher
recurrence of MR [OR = 4.09; (95% CI, 1.82-9.19; P < .001)].
CONCLUSION: MVP is associated with a lower perioperative mortality but a
higher recurrence of MR compared with MVR for severe IMR. No differences
were found with respect to long-term survival and reoperation.

<54>
Accession Number
623639375
Title
Optimal time for pharmacological treatment of abdominal aortic aneurysm.
Source
Current Drug Targets. 19 (11) (pp 1297-1301), 2018. Date of Publication:
2018.
Author
Iida Y.; Sawa S.; Shimizu H.
Institution
(Iida, Shimizu) Department of Cardiovascular Surgery, Keio University,
Tokyo, Japan
(Iida, Sawa) Department of Cardiovascular Surgery, Ogi-kubo Hospital,
Tokyo, Japan
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Abdominal aortic aneurysm (AAA), if left untreated, poses the
main risks of progressive expansion, rupture, and hemorrhage, leading to
death. Large AAA with a risk of rupture is usually treated by graft
replacement or endovascular aneurysm repair. Nonsurgical treatment is not
an alternative for large AAA, but is potentially beneficial for small AAA
which usually requires a watchful waiting approach with medication.
Objective: We introduce current clinical research regarding the
pharmacological treatment of small AAA and assess the optimal time for
starting the treatment. Results: Data from current clinical researches on
pharmacological treatment of AAA investigating the efficacy of
pharmacological treatment to limit AAA growth were presented and
introduced the medicines currently evaluated by randomized controlled
trials for their efficacy for AAA. Conclusion: The optimal time to
administer pharmacological treatment for AAA is during the stage wherein
its diameter is still small. To detect early small-diameter AAA, screening
tests are mandatory in high-risk patients. For pharmacological treatment,
the drug that shows acceptable results in clinical tests and is the most
effective for the patient's condition should be carefully selected.
Lifestyle changes should also accompany pharmacological
treatment.<br/>Copyright &#xa9; 2018 Bentham Science Publishers.