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<1>
Accession Number
2000811503
Title
Sonolysis in risk reduction of symptomatic and silent brain infarctions
during coronary stenting (SONOREDUCE): Randomized, controlled trial.
Source
International Journal of Cardiology. 267 (pp 62-67), 2018. Date of
Publication: 15 September 2018.
Author
Viszlayova D.; Brozman M.; Langova K.; Herzig R.; Skoloudik D.
Institution
(Viszlayova, Brozman) Department of Neurology, Faculty Hospital Nitra and
Constantine Philosopher University, Nitra, Slovakia
(Viszlayova) Department of Neurology, Faculty of Medicine and Dentistry,
Palacky University, Olomouc, Czech Republic
(Viszlayova) Department of Neurology, Charles University Faculty of
Medicine, Hradec Kralove, Czech Republic
(Langova, Skoloudik) Centre for Research and Science, Faculty of Health
Sciences, Palacky University, Olomouc, Czech Republic
(Langova) Department of Biophysics, Faculty of Medicine and Dentistry,
Palacky University, Olomouc, Czech Republic
(Herzig) Department of Neurology, Comprehensive Stroke Center, Charles
University Faculty of Medicine and University Hospital Hradec Kralove,
Hradec Kralove, Czech Republic
Publisher
Elsevier Ireland Ltd
Abstract
Background: Silent brain infarcts can be detected on magnetic resonance
imaging (MRI) in ~22% of patients after coronary angioplasty and stenting
(CS). The effect of periprocedural sonolysis on the risk of new brain
infarcts during CS was examined. Methods: Patients undergoing elective CS
were allocated randomly to a bilateral sonolysis group (70 patients, 58
men; mean age, 59.9 years) or a control group (74 patients, 45 men; mean
age, 65.5 years). Neurologic examination, cognitive function tests, and
brain MRI were performed prior to intervention and at 24 h after CS.
Neurologic examination and cognitive function tests were repeated at 30
days after CS. Results: No significant differences were observed in the
number of patients with new infarcts (25.7 vs. 18.9%, P = 0.423), the
number of lesions (1.3 +/- 1.0 vs. 2.9 +/- 5.3, P = 0.493), lesion volume
(0.16 +/- 0.34 vs. 0.28 +/- 0.60 mL, P = 0.143), and the number of
patients with new ischemic lesions in the insonated MCA territories
(18.6vs. 17.6%, P = 0.958) between the sonolysis group and the control
group. There were no cases of stroke, transient ischemic attack,
myocardial infarction, or death in the two groups. Intracranial bleeding
was reported only in 1 patient in the control group (0 vs. 1.4%, P =
0.888). Clock-drawing test scores at 30 days were significantly higher in
the sonolysis group than in the control group (median 3.0 vs. 2.5, P =
0.031). Conclusions: Sonolysis does not reduce the risk of new brain
infarcts after CS. The effect of sonolysis on number and volume of
ischemic lesions and cognitive function should be assessed in further
studies.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<2>
Accession Number
2001037363
Title
Outcomes of Patients Receiving Downstream Revascularization After Initial
Medical Management for Non-ST-Segment Elevation Acute Coronary Syndromes
(From the TRILOGY ACS Trial).
Source
American Journal of Cardiology. 122 (8) (pp 1322-1329), 2018. Date of
Publication: 15 October 2018.
Author
Hinohara T.T.; Roe M.T.; White H.D.; Fox K.A.A.; Bhatt D.L.; Hamm C.;
Gurbel P.A.; Aylward P.E.; Wiviott S.D.; Huber K.; Neely M.L.; Ohman E.M.
Institution
(Hinohara) Division of General Internal Medicine, Duke University School
of Medicine, Durham, NC, United States
(Roe, Ohman) Division of Cardiology, Department of Medicine, Duke
University School of Medicine, Durham, NC, United States
(Roe, Neely, Ohman) Duke Clinical Research Institute, Duke University
School of Medicine, Durham, NC, United States
(White) Green Lane Cardiovascular Service, Auckland City Hospital, New
Zealand
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, United Kingdom
(Bhatt, Wiviott) Cardiovascular Division, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Bhatt) VA Boston Healthcare System, Boston, MA, United States
(Hamm) Kerckhoff Heart and Thoraxcenter, Bad Nauheim, Germany
(Gurbel) Sinai Center for Thrombosis Research, Sinai Hospital of
Baltimore, Baltimore, MD, United States
(Aylward) South Australian Health and Medical Research Institute, Flinders
University Medical Centre, Adelaide, SA, Australia
(Huber) Third Department of Medicine, Cardiology and Intensive Care
Medicine, Wilhelminenhospital, and Sigmund Freud University, Medical
School, Vienna, Austria
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS)
are sometimes treated with medical management alone rather than an
invasive strategy. Among those medically managed without revascularization
and discharged, a proportion will require revascularization later on, but
little is known about this population. In TRILOGY ACS, 9,326 patients with
NSTE ACS who were selected for medical management alone were randomized to
treatment with prasugrel or clopidogrel and discharged without
revascularization. Patient characteristics and ischemic and bleeding
outcomes through 30 months were compared between patients who underwent
downstream revascularization after the index hospitalization and those who
did not. A total of 662 patients (7.1%) underwent later revascularization
by percutaneous coronary intervention (73.1%), coronary artery bypass
graft surgery (26.4%), or the two (0.5%). Median time to revascularization
was 121 days (twenty-fifth, seventy-fifth percentiles: 41, 326).
Revascularized patients were younger, more likely to be male, and had
higher rates of hyperlipidemia, diabetes mellitus, prior myocardial
infarction, and prior revascularization compared with those not
revascularized. Europe and North America had the highest rates of
revascularization. During the follow-up period, those who underwent
revascularization had a higher rate of the composite outcome of
cardiovascular death, myocardial infarction, or stroke occurring after
revascularization compared with those not revascularized (hazard ratio
[HR] 2.73 [95% confidence interval {CI} 2.21 to 3.38], p < 0.001) as well
as a higher rate of each of the individual outcomes. Major bleeding was
also higher in those who underwent revascularization (GUSTO severe or
life-threatening: HR 2.61 [95% CI 1.02 to 6.67], p = 0.045; TIMI major: HR
2.24 [95% CI 1.12 to 4.48], p = 0.022). There was no evidence that
bleeding and ischemic outcomes varied by treatment with clopidogrel versus
prasugrel. In conclusion, among patients initially medically managed after
NSTE ACS, a small proportion later require revascularization and have a
high rate of ischemic and major bleeding outcomes compared with those not
requiring downstream revascularization.<br/>Copyright &#xa9; 2018

<3>
Accession Number
621231985
Title
Performance of TCI Propofol Using the Schnider Model for Cardiac Surgery
on Cardiopulmonary Bypass-A Pilot Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (2) (pp 723-730),
2018. Date of Publication: April 2018.
Author
Lee A.K.Y.; Kong A.Y.H.; Kong C.F.
Institution
(Lee, Kong, Kong) Department of Anaesthesiology, Singapore General
Hospital, Singapore
Publisher
W.B. Saunders
Abstract
Objective: This pilot study aimed to evaluate the performance of
target-controlled infusion (TCI) of propofol using the Schnider
pharmacokinetic model in patients undergoing cardiac surgery requiring
cardiopulmonary bypass. Design: This was a prospective pharmacokinetic
study. Setting: A tertiary care hospital. Participants: This study is
comprised of 10 patients, aged between 46 and 81, who underwent elective
cardiac surgery requiring the use of cardiopulmonary bypass.
Interventions: Anesthetic technique was standardized. Hypnosis was
maintained using TCI of propofol, titrated to achieve a bispectral index
of 30 to 60. Calculated plasma propofol concentrations were recorded at 5
time points in total, before, during, and after cardiopulmonary bypass.
Blood propofol concentration was measured at each of these time points.
Measurements and Main Results: The prediction errors and absolute
prediction errors were calculated for each sample. From these, the median
prediction error (MDPE) and its absolute value (MDAPE) were derived.
Agreement between predicted and measured propofol concentrations was
assessed using a Bland-Altman plot. Mean prediction errors were also
compared pre-, on, and post-bypass using the generalized linear latent and
mixed model. The MDPE and MDAPE were both found to be 45%, indicating
significant bias toward under-prediction in the Schnider pharmacokinetic
model. This bias was increased at an average propofol concentration of 4.5
mug/mL and above. A significant decrease in mean prediction error was
noted while on bypass (45.6%, 95% confidence intervals 9.2-82.1).
Conclusions: The performance of the Schnider pharmacokinetic model for TCI
propofol was poor, with a tendency toward under-prediction of blood
propofol concentration, especially at higher average concentrations of
propofol. While mitigating the risk of awareness, the risk of other
adverse effects like hypotension and cardiorespiratory depression is
increased. Patients should therefore be adequately monitored, and
predicted plasma propofol concentrations taken in context with other
patient parameters. A lower target concentration of propofol is probably
sufficient to maintain an adequate depth of anesthesia as measured by
BIS.<br/>Copyright &#xa9; 2017 Elsevier Ltd

<4>
Accession Number
621231973
Title
Effects of Positive Airway Pressure and Mechanical Ventilation of the
Lungs During Cardiopulmonary Bypass on Pulmonary Adverse Events After
Cardiac Surgery: A Systematic Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (2) (pp 748-759),
2018. Date of Publication: April 2018.
Author
Wang Y.-C.; Huang C.-H.; Tu Y.-K.
Institution
(Wang, Huang) Department of Anaesthesiology, National Taiwan University
Hospital, Taipei, Taiwan (Republic of China)
(Tu) Institute of Epidemiology & Preventive Medicine, College of Public
Health, National Taiwan University, Taipei, Taiwan (Republic of China)
Publisher
W.B. Saunders
Abstract
Objective: To investigate whether different ventilation strategies during
cardiopulmonary bypass (CPB) can improve outcomes in adult cardiac surgery
patients. Design: Systematic review of randomized controlled trials with
meta-analyses. Setting: Clinical trials for human studies up to July 2016
were obtained from electronic databases (Medline, Embase, PubMed, and the
Cochrane Central Register of Controlled Trials) and reference lists of
relevant randomized trials and review articles. Participants: Adult
patients undergoing cardiac surgery. Interventions: Patients who underwent
cardiac surgery with CPB and ventilation or continuous positive airway
pressure (CPAP). Measurements and Main Results: Fifteen randomized
controlled trials with 748 patients were analyzed. In cardiac surgery,
CPAP use during CPB was associated with an improved alveolar-arterial
oxygen gradient difference compared with no CPAP (weighted mean difference
[WMD] = 4.11 kPa; 95% confidence interval [CI] = 0.85-7.37; I²
= 28.8%). Ventilation during CPB did not improve the postoperative
hypoxemia score (WMD = 30.94; 95% CI = -20.76 to 82.63; I² =
61%) or diffusion capacity compared with the apnea group (WMD = 2.59 kPa;
95% CI = -2.49 to 7.67; I² = 81.3%). Neither CPAP nor
ventilation during CPB was associated with a shorter mechanical
ventilation time or hospital stay. Conclusions: CPAP during CPB improved
the alveolar-arterial oxygen gradient difference compared with apnea, but
ventilation during CPB did not. Neither CPAP nor ventilation during CPB
demonstrated evidence of improving clinical outcomes in low- or
intermediate-risk patients for elective cardiac surgery. The findings are
inconclusive because of heterogeneity and small sample
sizes.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<5>
Accession Number
620537856
Title
Phosphocreatine in Cardiac Surgery Patients: A Meta-Analysis of Randomized
Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (2) (pp 762-770),
2018. Date of Publication: April 2018.
Author
Mingxing F.; Landoni G.; Zangrillo A.; Monaco F.; Lomivorotov V.V.; Hui
C.; Novikov M.; Nepomniashchikh V.; Fominskiy E.
Institution
(Mingxing, Hui) Department of Intensive Care, The Third Hospital, Hebei
Medical University, Shijiazhuang, Hebei Province, China
(Landoni, Zangrillo, Monaco, Fominskiy) Department of Anesthesia and
Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
(Landoni, Zangrillo) Vita-Salute San Raffaele University of Milan, Milan,
Italy
(Lomivorotov, Nepomniashchikh, Fominskiy) Department of Anesthesia and
Intensive Care, Siberian Biomedical Research Center of the Ministry of
Health, Novosibirsk, Russian Federation
(Novikov) Department of Anesthesia and Intensive Care, Medical Center of
Saint-Petersburg State University, Saint-Petersburg, Russian Federation
Publisher
W.B. Saunders
Abstract
Objective: There is experimental evidence that phosphocreatine (PCr) can
decrease ischemia/reperfusion injury of the heart. The authors
investigated if PCr would improve heart performance as compared with
standard treatment in cardiac surgery. Design: Meta-analysis of randomized
controlled trials. Setting: Hospitals. Participants: Adult and pediatric
patients undergoing cardiac surgery. Interventions: The ability of PCr to
improve cardiac outcomes as compared with standard treatment was
investigated. Measurements and Main Results: PubMed/Medline, Embase,
Scopus, Cochrane Library, China National Knowledge Infrastructure,
WANGFANG DATA, and VIP Paper Check System were searched to March 1 2017.
The authors included 26 randomized controlled trials comprising 1,948
patients. Random and fixed-effects models were used to estimate odds ratio
(OR) and mean difference (MD) with 95% confidence interval (CI). PCr use
was associated with reduced rates of intraoperative inotropic support (27%
v 44%; OR 0.47, 95% CI 0.35-0.61; p < 0.001), major arrhythmias (16% v
28%; OR 0.44, 95% CI 0.27-0.69; p < 0.001), as well as increased
spontaneous recovery of the cardiac rhythm immediately after aortic
declamping (50% v 34%; OR 2.45, 95% CI 1.82-3.30; p < 0.001) as compared
with standard treatment. The use of PCr decreased myocardial damage and
augmented left ventricular ejection fraction in the postoperative period;
however, MD for these outcomes were small and do not seem to be clinically
significant. Conclusions: In randomized trials, PCr administration was
associated with reduced rates of intraoperative inotropic support and
major arrhythmias, and increased spontaneous recovery of the cardiac
rhythm after aortic declamping. Large multicenter evidence is needed to
validate these findings.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<6>
Accession Number
619185339
Title
Lower Dose of Sufentanil Does Not Enhance Fast Track Significantly-A
Randomized Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (2) (pp 731-738),
2018. Date of Publication: April 2018.
Author
Bhavsar R.; Ryhammer P.K.; Greisen J.; Jakobsen C.-J.
Institution
(Bhavsar, Ryhammer, Greisen, Jakobsen) Department of Anaesthesiology and
Intensive Care, Aarhus University Hospital, Aarhus, Denmark
Publisher
W.B. Saunders
Abstract
Objective: Adjustment in the doses of opioids has been a focus of interest
for achieving better fast-track conditions in cardiac anesthesia, but
relatively sparse information exists on the potential effect of
psychologic and behavioral factors, such as stress, anxiety, and type of
personality, on anesthesia requirements and patient turnover in the
cardiac recovery unit (CRU); to the authors' knowledge, this particular
focus has not been systematically investigated. In this randomized study,
the authors tested the hypothesis that low-dose sufentanil, compared with
a standard dose, can improve fast-track parameters and the overall quality
of recovery. Opioid requirements related to personality type, pain
sensitivity, and preoperative stress and anxiety also were assessed.
Design: A randomized, prospective study. Participants: The study comprised
60 patients scheduled for elective coronary artery bypass grafting with or
without aortic valve replacement. Setting: A university hospital.
Interventions: Patients were randomly assigned to receive either a
standard dose (bolus 0.5 micro&#32;g/kg) or low dose (bolus 0.25
micro&#32;g/kg) of sufentanil combined with propofol. Measurements and
Main Results: The primary outcome variables were ventilation time and
eligible time to discharge from the CRU. The secondary objective was to
evaluate the relationship between opioid requirements and personality
type, pain sensitivity, and preoperative stress and anxiety. The groups
were comparable in selected demographics and perioperative parameters.
There was no difference between groups in ventilation time (low dose: 191
[163-257] v standard dose: 205 [139-279] min; p = 0.405); eligible CRU
discharge time (10.3 +/- 5.0 v 10.3 +/- 4.2 h; p = 0.978); or
administration of postoperative morphine (25 [11-34) v 27 [10-39] g; p =
0.790). There was no difference between groups in total sufentanil
administration and various preoperative psychologic and behavioral test
levels nor in the time to reach bispectral index <50 during induction,
except that personality type A demonstrated a longer induction time of 10
(8-12) minutes versus 6 (4-8) minutes in low-score patients. Conclusion: A
lower dose of sufentanil, compared with a standard dose, does not enhance
fast-track conditions significantly.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<7>
Accession Number
2001108334
Title
Remote ischaemic conditioning for prevention of acute kidney injury after
valvular heart surgery: a randomised controlled trial.
Source
British Journal of Anaesthesia. 121 (5) (pp 1034-1040), 2018. Date of
Publication: November 2018.
Author
Song J.W.; Lee W.K.; Lee S.; Shim J.K.; Kim H.J.; Kwak Y.L.
Institution
(Song, Lee, Shim, Kim, Kwak) Department of Anaesthesiology and Pain
Medicine, Yonsei University College of Medicine, Seoul, South Korea
(Song, Shim, Kwak) Anaesthesia and Pain Research Institute, Yonsei
University College of Medicine, Seoul, South Korea
(Lee) Department of Cardiovascular Surgery, Yonsei University College of
Medicine, Seoul, South Korea
Publisher
Elsevier Ltd
Abstract
Background: Repeated remote ischaemic conditioning (RIC) during weaning
from cardiopulmonary bypass and in the early postoperative period may
confer protection against acute kidney injury (AKI). We evaluated the
effect of repeated RIC on the incidence of AKI in patients undergoing
valvular heart surgery. Methods: Patients were randomised into either the
RIC (n=120) or control (n=124) group. A pneumatic tourniquet was placed on
each patient's thigh. Upon removal of the aortic cross-clamp, three cycles
of inflation for 5 min at 250 mm Hg (with 5 min intervals) were applied in
the RIC group. Additionally, three cycles of RIC were repeated at
postoperative 12 and 24 h. AKI was diagnosed based on the Kidney Disease:
Improving Global Outcomes guideline. The incidences of renal replacement
therapy, permanent stroke, sternal wound infection, newly developed atrial
fibrillation, mechanical ventilation >24 h, and reoperation for bleeding
during hospitalisation were recorded. Results: The incidences of AKI were
not significantly different between the control (19.4%) and RIC (15.8%)
groups (a difference of 3.5 percentage points; 95% confidence interval:
-6.8%-13.9%; P=0.470). Perioperative serum creatinine concentrations were
similar in the control and RIC groups (P=0.494). Fluid balance, urine
output, blood loss, transfusion, and vasopressor/inotropic requirements
were not significantly different between the groups (all P>0.05). The
occurrences of a composite of morbidity and mortality endpoints were not
significantly different between the control (46.0%) and RIC (39.2%) groups
(a difference of 6.8 percentage points; 95% confidence interval:
-6.4%-20.0%; P=0.283). Conclusions: The results of our study do not
support repeated RIC to decrease the incidence of AKI after valvular heart
surgery. Clinical trial registration: NCT02720549.<br/>Copyright &#xa9;
2018 British Journal of Anaesthesia

<8>
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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.

<9>
Accession Number
2000625675
Title
A narrative overview: Have clinical trials of PCI vs medical therapy
addressed the right question?.
Source
International Journal of Cardiology. 267 (pp 35-40), 2018. Date of
Publication: 15 September 2018.
Author
Morrone D.; Marzilli M.; Panico R.A.; Kolm P.; Weintraub W.S.
Institution
(Morrone, Kolm, Weintraub) Christiana Care Health System, Newark, DE,
United States
(Morrone, Marzilli, Panico) Surgery Pathology, Medical, Molecular and
Critic Area Department-Cardiovascular Disease Section, Pisa University,
Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background: In RCTs about revascularization, the terms "coronary artery
disease" and "ischemic heart disease" are sometimes used interchangeably.
This can create confusion concerning inclusion and exclusion criteria,
which may lead to uncertain results. Objective: Our purpose is to
investigate whether the study populations in randomized controlled trials
(RCTs) which compared percutaneous coronary revascularization to medical
therapy for stable ischemic heart disease specifically enrolled patients
with demonstrable ischemia, and how many patients were included in trials
with evidence of coronary atherosclerosis but without evidence of
ischemia. Methods: Trial published data were obtained from ACME I, ACME
II, RITA I, RITA II, MASS I, MASS II, AVERT, ACIP, COURAGE and FAME2.
Published data were used to calculate the number of patients included in
the trials with a negative stress test but significant coronary artery
stenosis and the number of patients excluded from the trials with a
positive stress test or angina, but without significant coronary artery
stenosis at the time of angiography. Results: A total of 196,433 patients
were screened between 1998 and 2011. Overall about 30% of patients were
excluded if they did not meet the angiographic criteria, even though the
presence of inducible ischemia or angina, and, about 20% of patients were
included without inducible ischemia. Conclusion: RCTs have contributed to
the confusion between coronary artery disease and ischemic heart disease.
This may limit the ability to interpret the results and apply them in
practice.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<10>
Accession Number
621614120
Title
Critical developments of 2017: a review of the literature from selected
topics in transfusion. A committee report from the AABB Clinical
Transfusion Medicine Committee.
Source
Transfusion. 58 (4) (pp 1065-1075), 2018. Date of Publication: April 2018.
Author
Friedman D.F.; Goel R.; Heddle N.M.; Hopkins C.K.; Karp J.K.; Pagano M.B.;
Perumbeti A.; Ramsey G.; Roback J.D.; Schwartz J.; Shaz B.H.; Spinella
P.C.; Cohn C.S.; Cushing M.M.; Kelley J.; Klapper E.
Institution
(Cushing, Goel, Cushing) Department of Pathology, Weill Cornell Medicine,
New York, NY, United States
(Kelley, Kelley) Department of Laboratory Medicine, The University of
Texas MD Anderson Cancer Center, Houston, TX, United States
(Klapper, Klapper) Department of Pathology and Laboratory Medicine,
Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Friedman) Blood Bank and Transfusion Medicine Department, Children's
Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA,
United States
(Heddle) McMaster Center for Transfusion Research, McMaster University,
Hamilton, ON, Canada
(Hopkins) Blood Systems Inc., Scottsdale, AZ, United States
(Karp) Department of Pathology, Anatomy, and Cell Biology, Thomas
Jefferson University Hospitals, Philadelphia, PA, United States
(Pagano) Transfusion Medicine Division, Department of Laboratory Medicine,
University of Washington, Seattle, WA, United States
(Perumbeti) Department of Pathology and Laboratory Medicine, Children's
Hospital Los Angeles, Los Angeles, CA, United States
(Ramsey) Department of Pathology, Feinberg School of Medicine,
Northwestern University, Chicago, IL, United States
(Roback) Department of Pathology and Laboratory Medicine, Emory University
School of Medicine, Atlanta, GA, United States
(Schwartz) Department of Pathology and Cell Biology, Columbia University
Medical Center and the New York-Presbyterian Hospital, United States
(Shaz) New York Blood Center, New York, NY, United States
(Spinella) Department of Pediatrics, Division of Pediatric Critical Care,
Washington University School of Medicine, St Louis, MO, United States
(Cohn, Cohn) Department of Laboratory Medicine and Pathology, University
of Minnesota, Minneapolis, MN, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: The AABB compiles an annual synopsis of the published
literature covering important developments in the field of Transfusion
Medicine. For the first time, an abridged version of this work is being
made available in TRANSFUSION, with the full-length report available as an
Appendix S1 (available as supporting information in the online version of
this paper). STUDY DESIGN AND METHODS: Papers published in 2016 and early
2017 are included, as well as earlier papers cited for background.
Although this synopsis is comprehensive, it is not exhaustive, and some
papers may have been excluded or missed. RESULTS: The following topics are
covered: duration of red blood cell storage and clinical outcomes, blood
donor characteristics and patient outcomes, reversal of bleeding in
hemophilia and for patients on direct oral anticoagulants, transfusion
approach to hemorrhagic shock, pathogen inactivation, pediatric
transfusion medicine, therapeutic apheresis, and extracorporeal support.
CONCLUSION: This synopsis may be a useful educational tool.<br/>Copyright
&#xa9; 2018 AABB

<11>
Accession Number
620396891
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
Annals of Thoracic Surgery. 105 (2) (pp 650-662), 2018. Date of
Publication: February 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, Zucker School of Medicine
at Hofstra Northwell, Hempstead, New York, United States
(Baker) Cardiac Surgery Research and Perfusion, Flinders University and
Flinders Medical Center, Adelaide, South Australia, Australia
(Ferraris) Division of Cardiovascular and Thoracic Surgery, University of
Kentucky, Lexington, Kentucky, United States
(Greilich) Department of Anesthesiology and Pain Management, University of
Texas-Southwestern Medical Center, Dallas, Texas, United States
(Fitzgerald) Division of Cardiovascular Perfusion, Medical University of
South Carolina, Charleston, South Carolina, United States
(Roman) Department of Anesthesiology, Saint Anthony Hospital, Lakewood,
Colorado, United States
(Hammon) Department of Cardiothoracic Surgery, Wake Forest University
School of Medicine, Winston-Salem, North Carolina, United States
Publisher
Elsevier USA
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; 2018 The Society of
Thoracic Surgeons, International Anesthesia Research Society, and the
American Society of ExtraCorporeal Technology

<12>
Accession Number
621625870
Title
Surgical chylothorax in neonates: management and outcomes.
Source
World Journal of Pediatrics. 14 (2) (pp 110-115), 2018. Date of
Publication: 01 Apr 2018.
Author
Costa K.M.; Saxena A.K.
Institution
(Costa, Saxena) Department of Pediatric Surgery, Chelsea Children's
Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial
College London, London, United Kingdom
(Costa, Saxena) Ribeirao Preto Medical School, University of Sao Paulo,
Ribeirao Preto, Brazil
Publisher
Institute of Pediatrics of Zhejiang University (E-mail: wjpch@zju.edu.cn)
Abstract
Background: Postoperative chylothorax occurs due to trauma to lymphatic
vessels and can occur after any thoracic procedure. This study reviewed
recent literature to evaluate the management and outcomes of surgical
chylothorax in neonates. Methods: PubMed database was searched for
articles in English, Portuguese and Spanish from 2000 to 2016. Data were
collected for surgery, chylothorax management, complications, mortality
and length of hospital stay (LOS). Results: Twenty studies offered 107
neonates: congenital diaphragmatic hernia (CDH) (n = 76, 71%), cardiac
malformations (n = 25, 23.4%), esophageal atresia (n = 5, 4.7%) and CDH +
extralobar sequestration (n = 1, 0.9%). Medium-chain triglycerides (MCT)
was the initial treatment in 52 neonates (48.6%), prednisolone + MCT in
one (0.9%), total parenteral nutrition in 51 patients (47.7%), and three
patients (2.8%) did not require any treatment. Octreotide and somatostatin
were used as second or third line treatment in 25 neonates (23.4%), and 15
neonates (14%) underwent 17 surgeries, including thoracic duct ligation
(TDL) (n = 9); pleurodesis (n = 3) (2 patients required TDL); TDL +
pleurodesis (n = 2), and TDL + placement of hemostat (n = 1).
Complications due to the chylothorax were reported in 27 neonates (25.2%):
hypoalbuminemia + hyponatremia (n = 18), hypoalbuminemia (n = 4),
hypoalbuminemia with cutaneous flushing as colateral effect of
somatostatin (n = 1), loose stool after somatostatin use (n = 1),
pneumonia (n = 1), congestive heart failure + hypernatremia (n = 1), and
hyponatremia (n = 1). There were 21 deaths (19.6%) and median LOS was 53.4
days (30-93.1 days). Conclusions: Conservative management is appropriate
as initial treatment for neonatal postsurgical chylothorax. Octreotide and
somatostatin are safe in neonates and surgical approach should be
considered in prolonged leaks.<br/>Copyright &#xa9; 2018, Children's
Hospital, Zhejiang University School of Medicine.

<13>
Accession Number
2000774397
Title
Goal-directed perfusion to reduce acute kidney injury: A randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (5) (pp 1918-1927.e2),
2018. Date of Publication: November 2018.
Author
Ranucci M.; Johnson I.; Willcox T.; Baker R.A.; Boer C.; Baumann A.;
Justison G.A.; de Somer F.; Exton P.; Agarwal S.; Parke R.; Newland R.F.;
Haumann R.G.; Buchwald D.; Weitzel N.; Venkateswaran R.; Ambrogi F.;
Pistuddi V.
Institution
(Ranucci, Pistuddi) Department of Cardiothoracic and Vascular Anesthesia
and Intensive Care Unit, Istituto di Ricovero e Cura a Carattere
Scientifico, Policlinico San Donato, San Donato Milanese, Milan, Italy
(Johnson, Agarwal) Department of Perfusion, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Johnson, Agarwal) Department of Anesthesia, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Willcox, Parke) Green Lane Cardiothoracic Unit and Cardiothoracic and
Vascular Intensive Care, Auckland City Hospital, Auckland, New Zealand
(Willcox, Parke) Department of Anaesthesiology, Faculty of Medical and
Health Sciences, University of Auckland, Auckland, New Zealand
(Baker, Newland) Cardiac Research and Perfusion, Cardiac and Thoracic
Surgical Unit, Flinders Medical Centre and Flinders University, Adelaide,
South Australia, Australia
(Boer, Haumann) Department of Anesthesiology, Institute for Cardiovascular
Research, VU University Medical Center, Amsterdam, Netherlands
(Boer, Haumann) Department of Cardiothoracic Surgery, Institute for
Cardiovascular Research, VU University Medical Center, Amsterdam,
Netherlands
(Baumann, Buchwald) Department of Anaesthesiology, Intensive Care,
Palliative Care and Pain Medicine, BG University Hospital Bergmannsheil,
Ruhr University, Bochum, Germany
(Baumann, Buchwald) Department of Cardiac and Thoracic Surgery, BG
University Hospital Bergmannsheil, Ruhr University, Bochum, Germany
(Justison, Weitzel) Department of Perfusion, University of Colorado
Denver, Aurora, Colo, United States
(Justison, Weitzel) Department of Anesthesiology, University of Colorado
Denver, Aurora, Colo, United States
(de Somer) Heart Centre, University Hospital Ghent, Ghent, Belgium
(Exton, Venkateswaran) Department of Cardiothoracic Surgery, University
Hospital of South Manchester National Health Service Foundation Trust,
Manchester, United Kingdom
(Ambrogi) Department of Clinical Sciences and Community Health, University
of Milan, and IRCCS Policlinico San Donato, Milan, Italy
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: To determine whether a goal-directed perfusion (GDP) strategy
aimed at maintaining oxygen delivery (DO<inf>2</inf>) at >=280
mL.min^-1.m^-2 reduces the incidence of acute kidney
injury (AKI). Methods: This multicenter randomized trial enrolled a total
of 350 patients undergoing cardiac surgery in 9 institutions. Patients
were randomized to receive either GDP or conventional perfusion. A total
of 326 patients completed the study and were analyzed. Patients in the
treatment arm were treated with a GDP strategy during cardiopulmonary
bypass (CPB) aimed to maintain DO<inf>2</inf> at >=280
mL.min^-1.m^-2. The perfusion strategy for patients in
the control arm was factored on body surface area and temperature. The
primary endpoint was the rate of AKI. Secondary endpoints were intensive
care unit length of stay, major morbidity, red blood cell transfusions,
and operative mortality. Results: Acute Kidney Injury Network (AKIN) stage
1 was reduced in patients treated with GDP (relative risk [RR], 0.45; 95%
confidence interval [CI], 0.25-0.83; P =.01). AKIN stage 2-3 did not
differ between the 2 study arms (RR, 1.66; 95% CI, 0.46-6.0; P =.528).
There were no significant differences in secondary outcomes. In a
prespecified analysis of patients with a CPB time between 1 and 3 hours,
the differences in favor of the treatment arm were more pronounced, with
an RR for AKI of 0.49 (95% CI, 0.27-0.89; P =.017). Conclusions: A GDP
strategy is effective in reducing AKIN stage 1 AKI. Further studies are
needed to define perfusion interventions that may reduce more severe
levels of renal injury (AKIN stage 2 or 3).<br/>Copyright &#xa9; 2018 The
American Association for Thoracic Surgery

<14>
Accession Number
620929942
Title
Red blood cells treated with the amustaline (S-303) pathogen reduction
system: a transfusion study in cardiac surgery.
Source
Transfusion. 58 (4) (pp 905-916), 2018. Date of Publication: April 2018.
Author
Brixner V.; Kiessling A.-H.; Madlener K.; Muller M.M.; Leibacher J.;
Dombos S.; Weber I.; Pfeiffer H.-U.; Geisen C.; Schmidt M.; Henschler R.;
North A.; Huang N.; Mufti N.; Erickson A.; Ernst C.; Rico S.; Benjamin
R.J.; Corash L.M.; Seifried E.
Institution
(Brixner, Muller, Leibacher, Dombos, Weber, Pfeiffer, Geisen, Schmidt,
Seifried) Institute for Transfusion Medicine and Immunohematology of
Johann Wolfgang Goethe University and German Red Cross Blood Donor
Service, Frankfurt am Main, Germany
(Kiessling) Department of Thoracic and Cardiovascular Surgery, Johann
Wolfgang Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
(Madlener) Department of Haemostaseology and Transfusion Medicine,
Kerckhoff-Klinik, Bad Nauheim, Germany
(Henschler) Blood Center Zurich, Swiss Red Cross, Schlieren, Switzerland
(Henschler) Red Cross Blood Service Graubunden, Chur, Switzerland
(North, Huang, Mufti, Erickson, Ernst, Rico, Benjamin, Corash) Cerus
Corporation, Concord, CA, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Nucleic acid-targeted pathogen inactivation technology using
amustaline (S-303) and glutathione (GSH) was developed to reduce the risk
of transfusion-transmitted infectious disease and transfusion-associated
graft-versus-host disease with red blood cell (RBC) transfusion. STUDY
DESIGN AND METHODS: A randomized, double-blind, controlled study was
performed to assess the in vitro characteristics of amustaline-treated
RBCs (test) compared with conventional (control) RBCs and to evaluate
safety and efficacy of transfusion during and after cardiac surgery. The
primary device efficacy endpoint was the postproduction hemoglobin (Hb)
content of RBCs. Exploratory clinical outcomes included renal and hepatic
failure, the 6-minute walk test (a surrogate for cardiopulmonary
function), adverse events (AEs), and the immune response to
amustaline-treated RBCs. RESULTS: A total of 774 RBC unis were produced.
Mean treatment difference in Hb content was -2.27 g/unit (95% confidence
interval, -2.61 to -1.92 g/unit), within the prespecified equivalence
margins (+/-5 g/unit) to declare noninferiority. Amustaline-treated RBCs
met European guidelines for Hb content, hematocrit, and hemolysis.
Fifty-one (25 test and 26 control) patients received study RBCs. There
were no significant differences in RBC usage or other clinical outcomes.
Observed AEs were within the spectrum expected for patients of similar age
undergoing cardiovascular surgery requiring RBCs transfusion. No patients
exhibited an immune response specific to amustaline-treated RBCs.
CONCLUSION: Amustaline-treated RBCs demonstrated equivalence to control
RBCs for Hb content, have appropriate characteristics for transfusion, and
were well tolerated when transfused in support of acute anemia. Renal
impairment was characterized as a potential efficacy endpoint for pivotal
studies of RBC transfusion in cardiac surgery.<br/>Copyright &#xa9; 2018
The Authors Transfusion published by Wiley Periodicals, Inc. on behalf of
AABB

<15>
Accession Number
2001189109
Title
Meta-Analysis Comparing Dual Antiplatelet Therapy Versus Single
Antiplatelet Therapy Following Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 122 (8) (pp 1401-1408), 2018. Date of
Publication: 15 October 2018.
Author
Siddamsetti S.; Balasubramanian S.; Yandrapalli S.; Vij A.; Joshi U.; Tang
G.; Kodumuri V.
Institution
(Siddamsetti, Balasubramanian, Yandrapalli, Vij, Joshi, Tang, Kodumuri)
Division of Cardiology, John H. Stroger Jr. Hospital of Cook County,
Chicago, IL, United States
(Yandrapalli) Westchester Medical Center/New York Medical Center,
Valhalla, NY, United States
(Tang) Icahn School of Medicine at Mount Sinai Hospital, New York, NY,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The present American College of Cardiology/American Heart Association
guidelines (Grade IIb, level of evidence C) recommend dual antiplatelet
therapy (DAPT) with aspirin and clopidogrel for 6 months followed by
lifelong aspirin after transcathter aortic valve implantation (TAVI).
However, studies that have compared DAPT to single antiplatelet therapy
(SAPT) after TAVI have questioned this recommendation as DAPT has been
associated with more bleeding events compared with SAPT. We performed a
meta-analysis of all the trials that compared DAPT to SAPT in patients who
underwent TAVI. Three randomized trials and 4 nonrandomized studies were
included. The primary endpoint was the rate of ischemic stroke. Secondary
end points were the rates of myocardial infarction, life threatening
bleeding (LTB), significant bleeding (LTB and major bleeding), and death.
The Mantel-Haenszel random effects model was used to calculate the
combined odds ratios (OR) and 95% confidence intervals (CI) for outcomes
at 30 days and up to 6 to 12 months follow-up. The LTB (OR 2.73, 95% CI
1.31 to 5.69, p = 0.007) and significant bleeding rates (OR 2.76, 95% CI
1.57 to 4.85, p = 0.0004) were significantly higher in DAPT arm at 30
days. Significant bleeding (OR 2.24, 95% CI 1.33 to 3.79, p = 0.002) was
still significantly higher in the DAPT arm but there was only a
nonsignificant trend toward higher LTB (OR 1.93 95% CI 0.61 to 6.03, p =
0.26) at 6 to 12 month follow up. There was no difference in mortality,
ischemic stroke and myocardial infarction at 30 days or 6 to 12 month
follow up. In conclusion, our meta-analysis shows that DAPT after TAVI
does not confer any additional benefit over SAPT in TAVI.<br/>Copyright
&#xa9; 2018

<16>
Accession Number
619504651
Title
Is the use of renin-angiotensin systeminhibitors in patients with aortic
valve stenosis safe and of prognostic benefit? A systematic review and
meta-analysis.
Source
European Heart Journal - Cardiovascular Pharmacotherapy. 3 (1) (pp 21-27),
2017. Date of Publication: 2017.
Author
Andersson C.; Abdulla J.
Institution
(Andersson, Abdulla) Department of Internal Medicine, Glostrup Hospital,
University of Copenhagen, Nordre Ringvej 57, Glostrup 2600, Denmark
Publisher
Oxford University Press
Abstract
Aortic valve stenosis (AVS) is associated with significant morbidity and
mortality, especially in the presence of symptoms and echocardiographic
signs of left ventricular remodelling (i.e. increase in left ventricular
mass, left ventricular dilation, and systolic dysfunction). Renin-
angiotensin system inhibitors (RASi) attenuate cardiac remodelling in
various conditions, but the safety and efficacy of RASi in AVS is unsure.
We performed a systematic review and meta-analysis to address these
issues. We identified three smaller randomized clinical trials and five
observational studies eligible for inclusion (PubMed, EMBASE, and Cochrane
library search criteria: Aortic stenosis, aortic valve,
angiotensin-converting enzyme inhibitor in different combinations,
published in English at any time up to 1 April 2016). Our analyses
suggested that use of RASi was safe, with no observed increase in
mortality risk [576/3389 patients receiving RASi vs. 1118/4384 controls
died; relative risk 0.93 (95% confidence interval 0.78-1.11), P=0.44]. Use
of RASi was also observed to lower the risk of aortic valve replacement
(AVR) surgery [67/2913 patients with RASi vs. 154/3666 controls underwent
AVR; relative risk 0.68 (95% confidence interval 0.51-0.91), P=0.01]. In
current clinical practice (based on published literature; mainly
observational studies), use of RASi appears to be safe in patients with
AVS and may reduce the need for AVR, but the evidence is overall weak.
Large-scale randomized clinical trials are warranted to address whether
prescription of RASi to treatment-naive patients may prevent disease
progression, delay AVR surgery need, and lower the risk of
mortality.<br/>Copyright &#xa9; The Author 2016.

<17>
Accession Number
619032645
Title
Survival and cardiovascular outcomes of patients with secondary mitral
regurgitation: A systematic review and meta-analysis.
Source
JAMA Cardiology. 2 (10) (pp 1130-1139), 2017. Date of Publication: October
2017.
Author
Sannino A.; Smith R.L.; Schiattarella G.G.; Trimarco B.; Esposito G.;
Grayburn P.A.
Institution
(Sannino, Grayburn) Division of Cardiology, Department of Medicine, Baylor
University Medical Center, Baylor Heart and Vascular Hospital, Dallas, TX,
United States
(Sannino, Schiattarella) Division of Cardiology, Department of Medicine,
Universita Degli Studi di Napoli Federico II, Naples, Italy
(Smith) Department of Cardiothoracic Surgery, Heart Hospital Baylor Plano,
Plano, TX, United States
(Schiattarella) Division of Cardiology, Department of Medicine, University
of Texas Southwestern Medical Center, Dallas, United States
(Trimarco, Esposito) Division of Cardiology, Department of Medicine,
Universita Degli Studi di Napoli Federico II, Naples, Italy
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: The outcomes of patients with left ventricular (LV)
dysfunction and secondary mitral regurgitation (SMR) are still
controversial. OBJECTIVE: To clarify the role of SMR in the outcomes of
patients with ischemic or idiopathic cardiomyopathies. DATA SOURCES:
MEDLINE, ISI Web of Science, and Scopus databases were searched for
studies published up to March 2017. STUDY SELECTION: Studies reporting
data on outcomes in patients with SMR were included. Duplicate publication
data, studies lacking data on SMR grade and its correlation with outcomes,
mixed data on SMR and primary mitral regurgitation, studies not clearly
reporting the outcome of interest, and studies with fewer than 100
patients were excluded. Of the initial 3820 articles identified, 1.4% were
finally included. DATA EXTRACTION AND SYNTHESIS: The study met PRISMA
requirements. Two of us independently screened articles for fulfillment of
inclusion criteria. MAIN OUTCOMES AND MEASURES: The primary outcome, set
after data collection, was the incidence of all-cause mortality in
patients with and without SMR. Secondary outcomes included hospitalization
for heart failure (HF), cardiac mortality, and a composite end point of
death, HF hospitalization, and cardiac transplant. RESULTS: Fifty-three
studies and 45 900 patients were included in the meta-analysis. The mean
(SD) length of follow-up was 40.8 (22.2) months. In 26 of 36 studies
reporting LV function by SMR grade, increasing SMR severity was associated
with worse LV function. When SMR was categorized as present or absent,
all-cause mortality was significantly higher in the patients with SMR (17
studies, 26 359 patients; risk ratio [RR],1.79; 95% CI, 1.47-2.18; P <
.001, I² = 85%); when SMR was qualitatively graded, the
incidence of all-cause mortality was significantly increased in patients
having any degree of SMR compared with patients not having SMR (21
studies, 21 081 patients; RR, 1.96; 95% CI, 1.67-2.31; P < .001,
I² = 74%). Finally, when SMR was quantitatively graded, it
remained associated with an increased all-cause mortality rate (9 studies,
3649 patients; RR, 1.97; 95% CI, 1.71-2.27; P < .001, I² = 0%).
Moreover, SMR was associated with an increased risk of hospitalization for
HF (16 studies, 10 171 patients; RR, 2.26; 95% CI, 1.92-2.67; P < .001,
I² = 41%), cardiac mortality (12 studies, 11 896 patients; RR,
2.62; 95% CI, 1.87-3.69; P < .001, I² = 74%), and death, HF,
and transplant (11 studies, 8256 patients; RR, 1.63; 95% CI, 1.33-1.99; P
< .001, I² = 78%). CONCLUSIONS AND RELEVANCE: To our knowledge,
this study is the first meta-analysis to date to demonstrate that SMR,
even when mild, correlates with adverse outcomes in patients with ischemic
or idiopathic cardiomyopathies. Because SMR is an intrinsic consequence of
LV dysfunction, causality between SMR and mortality should not be
implied.<br/>Copyright &#xa9; 2017 American Medical Association. All
rights reserved.

<18>
Accession Number
619032639
Title
Percutaneous coronary intervention vs coronary artery bypass grafting in
patients with left main coronary artery stenosis: A systematic review and
meta-analysis.
Source
JAMA Cardiology. 2 (10) (pp 1079-1088), 2017. Date of Publication: October
2017.
Author
Giacoppo D.; Colleran R.; Cassese S.; Frangieh A.H.; Wiebe J.; Joner M.;
Schunkert H.; Kastrati A.; Byrne R.A.
Institution
(Giacoppo, Colleran, Cassese, Frangieh, Wiebe, Joner, Schunkert, Kastrati,
Byrne) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich, Germany
(Joner, Schunkert, Kastrati, Byrne) German Centre for Cardiovascular
Research, Partner Site Munich Heart Alliance, Munich, Germany
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: In patients with left main coronary artery (LMCA) stenosis,
coronary artery bypass grafting (CABG) has been the standard therapy for
several decades. However, some studies suggest that percutaneous coronary
intervention (PCI) with drug-eluting stents may be an acceptable
alternative. OBJECTIVE: To compare the long-term safety of PCI with
drug-eluting stent vs CABG in patients with LMCA stenosis. DATA SOURCES:
PubMed, Scopus, EMBASE, Web of Knowledge, and ScienceDirect databases were
searched from December 18, 2001, to February 1, 2017. Inclusion criteria
were randomized clinical trial, patients with LMCA stenosis, PCI vs CABG,
exclusive use of drug-eluting stents, and clinical follow-up of 3 or more
years. DATA EXTRACTION AND SYNTHESIS: Trial-level hazard ratios (HRs) and
95% CIs were pooled by fixed-effect and random-effects models with inverse
variance weighting. Time-to-event individual patient data for the primary
end point were reconstructed. Sensitivity analyses according to
drug-eluting stent generation and coronary artery disease complexity were
performed. MAIN OUTCOMES AND MEASURES: The primary end point was a
composite of all-cause death, myocardial infarction, or stroke at
long-term follow-up. Secondary end points included repeat
revascularization and a composite of all-cause death, myocardial
infarction, stroke, or repeat revascularization at long-term follow-up.
RESULTS: A total of 4 randomized clinical trials were pooled; 4394
patients were included in the analysis. Of these, 3371 (76.7%) were men;
pooled mean age was 65.4 years. According to Grading of Recommendations,
Assessment, Development and Evaluation, evidence quality with respect to
the primary composite end point was high. Percutaneous coronary
intervention and CABG were associated with a comparable risk of all-cause
death, myocardial infarction, or stroke both by fixed-effect (HR, 1.06;
95% CI, 0.90-1.24; P = .48) and random-effects (HR, 1.06; 95% CI,
0.85-1.32; P = .60) analysis. Sensitivity analyses according to low to
intermediate Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX)
score (random-effects: HR, 1.02; 95% CI, 0.74-1.41; P = .89) and
drug-eluting stent generation (first generation: HR, 0.90; 95% CI,
0.68-1.20; P = .49; second generation: HR, 1.19; 95% CI, 0.82-1.73; P =
.36) were consistent. Kaplan-Meier curve reconstruction did not show
significant variations over time between the techniques, with a 5-year
incidence of all-cause death, myocardial infarction, or stroke of 18.3%
(319 events) in patients treated with PCI and 16.9% (292 events) in
patients treated with CABG. However, repeat revascularization after PCI
was increased (HR, 1.70; 95% CI, 1.42-2.05; P < .001). Other individual
secondary end points did not differ significantly between groups. Finally,
pooled estimates of trials with LMCA stenosis tended overall to differ
significantly from those of trials with multivessel coronary artery
disease without left main LMCA stenosis. CONCLUSIONS AND RELEVANCE:
Percutaneous coronary intervention and CABG show comparable safety in
patients with LMCA stenosis and low to intermediate-complexity coronary
artery disease. However, repeat revascularization is more common after
PCI.<br/>Copyright &#xa9; 2017 American Medical Association. All rights
reserved.

<19>
Accession Number
2001011185
Title
Meta-Analysis of the Prognostic Value of Psoas-Muscle Area on Mortality in
Patients Undergoing Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 122 (8) (pp 1394-1400), 2018. Date of
Publication: 15 October 2018.
Author
Takagi H.; Hari Y.; Kawai N.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
We performed a meta-analysis of currently available studies assessing
prognostic value of psoas-muscle area (PMA) on mortality in patients who
underwent transcatheter aortic valve implantation (TAVI). MEDLINE and
EMBASE were searched through May 2018 to identify studies reporting
>=1-year all-cause mortality in PMA-stratified TAVI patients. A hazard
ratio of follow-up (including early) mortality for "lowest-quantile"
versus "higher-quantiles" PMA. Study-specific estimates were combined in
the random-effects model. Our search identified 6 eligible studies
enrolling a total of 1,237 TAVI patients with 1-year to 2-year (midterm)
follow-up. A primary meta-analysis pooling all hazard ratios for
"lowest-quantile versus higher-quantiles" PMA demonstrated significantly
higher mortality in "lowest-quantile" than "higher-quantiles" patients (p
<0.0001). A subgroup meta-analysis indicated no significant difference in
mortality between "<50th- and >=50th-percentile" patients (p = 0.95), but
significantly higher mortality in "lowest-tertile" than "higher-tertiles"
patients (p = 0.0009) and in "lowest-quartile" than "higher- quartiles"
patients (p = 0.0003). A secondary meta-analysis revealed significantly
higher mortality in "lowest-tertile" than "mid-tertile" patients (p =
0.01) and in "lowest-tertile" than "highest-tertile" patients (p = 0.01).
A gender-stratified meta-analysis showed significantly higher mortality in
"lowest-quantile" than "higher-quantiles" patients in both men (p =
0.0008) and women (p = 0.01). In conclusion, low PMA, especially
"lowest-tertile/quartile" PMA, is a predictor of high all-cause mortality
at midterm follow-up after TAVI for both men and women. However, PMA
categorization into 50th percentiles may be invalid to predict
mortality.<br/>Copyright &#xa9; 2018

<20>
Accession Number
619144063
Title
Drug-eluting stents in elderly patients with coronary artery disease
(SENIOR): a randomised single-blind trial.
Source
The Lancet. 391 (10115) (pp 41-50), 2018. Date of Publication: 6 - 12
January 2018.
Author
Varenne O.; Cook S.; Sideris G.; Kedev S.; Cuisset T.; Carrie D.; Hovasse
T.; Garot P.; El Mahmoud R.; Spaulding C.; Helft G.; Diaz Fernandez J.F.;
Brugaletta S.; Pinar-Bermudez E.; Mauri Ferre J.; Commeau P.; Teiger E.;
Bogaerts K.; Sabate M.; Morice M.-C.; Sinnaeve P.R.
Institution
(Varenne) Hopital Cochin, Assistance Publique-Hopitaux de Paris, Paris,
France
(Varenne) Cardiology Department, Universite Paris Descartes, Sorbonne
Paris-Cite, Paris, France
(Cook) Cardiology Department, University and Hospital Fribourg, Fribourg,
Switzerland
(Sideris) Service de Cardiologie-Institut national de la sante et de la
recherche medicale U942, Hopital Lariboisiere, Assistance Publique -
Hopitaux de Paris, Universite Paris Diderot, Paris, France
(Kedev) Cardiology Department, University St Cyril and Methodius, Skopje,
Macedonia
(Cuisset) Departement de Cardiologie, Centre hospitalier universitaire
Timone, Marseille, France
(Carrie) Service de Cardiologie, Centre hospitalier universitaire Toulouse
Rangueil, Universite Paul Sabatier, Toulouse, France
(Hovasse, Garot) Institut Cardiovasculaire Paris-Sud, Ramsay Generale de
Sante, Massy and Quincy, France
(El Mahmoud) Hopital Ambroise Pare Assistance Publique-Hopitaux de Paris,
Universite Versailles-Saint Quentin en Yvelines, Versailles, France
(Spaulding) Service de Cardiologie, Hopital Europeen Georges Pompidou,
Assistance Publique-Hopitaux de Paris, Paris Descartes University and
Sudden Death Expert Center, Institut national de la sante et de la
recherche medicale U990, Paris, France
(Helft) Institut de Cardiologie, Hopital Pitie-Salpetriere, Assistance
Publique-Hopitaux de Paris, Universite Pierre et Marie Curie et Institut
hospitalo-universitaire, Institute of Cardiometabolism and Nutrition,
Hopital Pitie-Salpetriere, Paris, France
(Diaz Fernandez) Juan Ramon Jimenez University Hospital, Huelva, Spain
(Brugaletta) Cardiovascular Institute, Hospital Clinic, Institut
d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
(Pinar-Bermudez) Hospital Universitario Virgen de la Arrixaca, Murcia,
Spain
(Mauri Ferre) Hospital Universitari Germans Trias i Pujol, Badalona, Spain
(Commeau) Departement de Cardiologie Interventionnelle, Polyclinique Les
Fleurs, Ollioules, France
(Teiger) Service de Cardiologie, Hopital Henri Mondor Assistance
Publique-Hopitaux de Paris, Universite Paris Est Creteil, Creteil, France
(Bogaerts) Interuniversity Institute for Biostatistics and Statistical
Bioinformatics (I-BioStat), Department of Public Health and Primary Care,
Katholieke Universiteit Leuven, Leuven, Belgium
(Bogaerts) Interuniversity Institute for Biostatistics and Statistical
Bioinformatics (I-BioStat), University Hasselt, Hasselt, Belgium
(Sabate) Interventional Cardiology Unit, Cardiovascular Institute,
Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer,
Barcelona, Spain
(Morice) Cardiovascular European Research Center, Massy, France
(Sinnaeve) Department of Cardiovascular Medicine, University Hospitals
Leuven, Leuven, Belgium
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Elderly patients regularly receive bare-metal stents (BMS)
instead of drug-eluting stents (DES) to shorten the duration of double
antiplatelet therapy (DAPT). The aim of this study was to compare outcomes
between these two types of stents with a short duration of DAPT in such
patients. Methods: In this randomised single-blind trial, we recruited
patients from 44 centres in nine countries. Patients were eligible if they
were aged 75 years or older; had stable angina, silent ischaemia, or an
acute coronary syndrome; and had at least one coronary artery with a
stenosis of at least 70% (>=50% for the left main stem) deemed eligible
for percutaneous coronary intervention (PCI). Exclusion criteria were
indication for myocardial revascularisation by coronary artery bypass
grafting; inability to tolerate, obtain, or comply with DAPT; requirement
for additional surgery; non-cardiac comorbidities with a life expectancy
of less than 1 year; previous haemorrhagic stroke; allergy to aspirin or
P2Y<inf>12</inf> inhibitors; contraindication to P2Y<inf>12</inf>
inhibitors; and silent ischaemia of less than 10% of the left myocardium
with a fractional flow reserve of 0.80 or higher. After the intended
duration of DAPT was recorded (1 month for patients with stable
presentation and 6 months for those with unstable presentation), patients
were randomly allocated (1:1) by a central computer system (blocking used
with randomly selected block sizes [two, four, eight, or 16]; stratified
by site and antiplatelet agent) to either a DES or similar BMS in a
single-blind fashion (ie, patients were masked), but those assessing
outcomes were masked. The primary outcome was to compare major adverse
cardiac and cerebrovascular events (ie, a composite of all-cause
mortality, myocardial infarction, stroke, or ischaemia-driven target
lesion revascularisation) between groups at 1 year in the
intention-to-treat population, assessed at 30 days, 180 days, and 1 year.
This trial is registered with ClinicalTrials.gov, number NCT02099617.
Findings: Between May 21, 2014, and April 16, 2016, we randomly assigned
1200 patients (596 [50%] to the DES group and 604 [50%] to the BMS group).
The primary endpoint occurred in 68 (12%) patients in the DES group and 98
(16%) in the BMS group (relative risk [RR] 0.71 [95% CI 0.52-0.94];
p=0.02). Bleeding complications (26 [5%] in the DES group vs 29 [5%] in
the BMS group; RR 0.90 [0.51-1.54]; p=0.68) and stent thrombosis (three
[1%] vs eight [1%]; RR 0.38 [0.00-1.48]; p=0.13) at 1 year were infrequent
in both groups. Interpretation: Among elderly patients who have PCI, a DES
and a short duration of DAPT are better than BMS and a similar duration of
DAPT with respect to the occurrence of all-cause mortality, myocardial
infarction, stroke, and ischaemia-driven target lesion revascularisation.
A strategy of combination of a DES to reduce the risk of subsequent repeat
revascularisations with a short BMS-like DAPT regimen to reduce the risk
of bleeding event is an attractive option for elderly patients who have
PCI. Funding: Boston Scientific.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<21>
Accession Number
623717234
Title
Computed tomography-guided pericardiocentesis: a systematic review
concerning contemporary evidence and future perspectives.
Source
Therapeutic Advances in Cardiovascular Disease. 12 (11) (pp 299-307),
2018. Date of Publication: 01 Nov 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.

<22>
Accession Number
2001191425
Title
Rationale and design of the Pemafibrate to Reduce Cardiovascular Outcomes
by Reducing Triglycerides in Patients with Diabetes (PROMINENT) study.
Source
American Heart Journal. 206 (pp 80-93), 2018. Date of Publication:
December 2018.
Author
Pradhan A.D.; Paynter N.P.; Everett B.M.; Glynn R.J.; Amarenco P.; Elam
M.; Ginsberg H.; Hiatt W.R.; Ishibashi S.; Koenig W.; Nordestgaard B.G.;
Fruchart J.-C.; Libby P.; Ridker P.M.
Institution
(Pradhan) Division of Cardiovascular Medicine, VA Boston Medical Center,
Boston, MA, United States
(Pradhan, Paynter, Everett, Glynn, Ridker) Division of Preventive
Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston,
MA, United States
(Amarenco) Paris-Diderot Sorbonne University, Paris, France
(Elam) Division of Cardiovascular Medicine, VA Memphis Medical Center,
Memphis, TN, United States
(Ginsberg) Columbia University Vagellos College of Physicians and
Surgeons, New York, NY, United States
(Hiatt) University of Colorado School of Medicine, Division of Cardiology
and CPC Clinical Research, Aurora, CO, United States
(Ishibashi) Division of Endocrinology and Metabolism, Department of
Internal Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen and
German Centre for Cardiovascular Research, Partner Site Munich Heart
Alliance, Munich, Germany
(Nordestgaard) Herlev and Gentofte Hospital, Copenhagen University
Hospital, University of Copenhagen, Copenhagen, Denmark
(Fruchart) The R3i Foundation, Basel, Switzerland
(Everett, Libby, Ridker) Division of Cardiovascular Medicine Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Observational, genetic, and experimental data indicate that triglyceride
rich lipoproteins (TRLs) likely participate causally in atherothrombosis.
Yet, robust clinical trial evidence that triglyceride (TG) lowering
therapy reduces cardiovascular events remains elusive. The selective
peroxisome proliferator-activated receptor alpha modulator (SPPARM-alpha),
pemafibrate, will be used to target residual cardiovascular risk remaining
after treatment to reduce low-density lipoprotein cholesterol (LDL-C) in
individuals with the dyslipidemia of type 2 diabetes mellitus (T2). The
PROMINENT study will randomly allocate approximately 10,000 participants
with T2D, mild-to-moderate hypertriglyceridemia (TG: 200- 499 mg/dl; 2.26-
5.64 mmol/l) and low high-density lipoprotein cholesterol levels (HDL-C:
<=40 mg/dl; 1.03 mmol/l) to either pemafibrate (0.2 mg twice daily) or
matching placebo with an average expected follow-up period of 3.75 years
(total treatment phase 5 years; 24 countries). At study entry,
participants must be receiving either moderate-to-high intensity statin
therapy or meet specified LDL-C criteria. The study population will be
one-third primary and two-thirds secondary prevention (established
cardiovascular disease). The primary endpoint is a composite of nonfatal
myocardial infarction, nonfatal ischemic stroke, hospitalization for
unstable angina requiring urgent coronary revascularization, and
cardiovascular death. This event-driven study will complete when 1092
adjudicated primary endpoints have accrued with at least 200 occurring in
women. Statistical power is at least 90% to detect an 18% reduction in the
primary endpoint. Pre-specified secondary and tertiary endpoints include
all-cause mortality, hospitalization for heart failure, new or worsening
peripheral artery disease, new or worsening diabetic retinopathy and
nephropathy, and change in biomarkers including select lipid and non-lipid
biomarkers, inflammatory and glycemic parameters.<br/>Copyright &#xa9;
2018

<23>
Accession Number
624320431
Title
Predictors of ischaemic mitral regurgitation recurrence in patients
undergoing combined surgery: Additional value of cardiovascular magnetic
resonance imaging.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (2) (pp 222-228),
2018. Date of Publication: August 2018.
Author
Glaveckaite S.; Uzdavinyte-Gateliene E.; Petrulioniene Z.; Palionis D.;
Valeviciene N.; Kalinauskas G.; Serpytis P.; Laucevicius A.
Institution
(Glaveckaite, Uzdavinyte-Gateliene, Petrulioniene, Serpytis, Laucevicius)
Clinic of Cardiovascular Diseases, Centre of Cardiology and Angiology,
Vilnius University, Vilnius, Lithuania
(Palionis, Valeviciene) Department of Radiology, Nuclear Medicine and
Medical Physics, Centre of Radiology and Nuclear Medicine, Vilnius,
Lithuania
(Kalinauskas) Clinic of Cardiovascular Diseases, Centre of Heart Surgery,
Vilnius University, Vilnius, Lithuania
Publisher
Oxford University Press
Abstract
OBJECTIVES: We aimed to evaluate (i) the effectiveness of combined surgery
(coronary artery bypass grafting with restrictive mitral valve
annuloplasty) and (ii) the late gadolinium enhancement cardiovascular
magnetic resonance-based predictors of ischaemic mitral regurgitation
(IMR) recurrence. METHODS: The prospective analysis included 40 patients
with multivessel coronary artery disease, IMR >IIdegree and left
ventricular (LV) dysfunction undergoing combined surgery. The degree of
IMR and LV parameters were assessed preoperatively by transthoracic
echocardiography, 3D transoesophageal echocardiography and cardiovascular
magnetic resonance and postoperatively by transthoracic echocardiography.
The effective mitral valve repair group (n = 30) was defined as having
recurrent ischaemic mitral regurgitation (RIMR) <IIdegree at the end of
follow-up (25 +/- 11 months). RESULTS: The surgery was effective: freedom
from RIMR >IIdegree at 1 and 2 years after surgery was 80% and 75%,
respectively. Using multivariable logistic regression, 2 independent
predictors of RIMR >IIdegree were identified: >3 non-viable LV segments
(odds ratio 22, P = 0.027) and >1 non-viable segment in the LV posterior
wall (odds ratio 11, P = 0.026). Using classification trees, the best
combinations of cardiovascular magnetic resonance-based and 3D
transoesophageal echocardiography-based predictors for RIMR >IIdegree were
(i) posterior mitral valve leaflet angle >40degree and LV end-systolic
volume index >45 ml/m2 (sensitivity 100%, specificity 89%) and (ii) scar
transmurality >68% in the inferior LV wall and EuroSCORE II >8
(sensitivity 83%, specificity 78%). CONCLUSIONS: There is a clear
relationship between the amount of non-viable LV segments, especially in
the LV posterior and inferior walls, and the recurrence of IMR after the
combined surgery.<br/>Copyright &#xa9; The Author(s) 2018.

<24>
Accession Number
623693383
Title
Echocardiographic evaluation of velocity ratio, velocity time integral
ratio, and pulmonary valve area in dogs with pulmonary valve stenosis.
Source
Journal of Veterinary Internal Medicine. 32 (5) (pp 1570-1578), 2018. Date
of Publication: September/October 2018.
Author
Nishimura S.; Visser L.C.; Belanger C.; Oldach M.S.; Gunther-Harrington
C.T.; Stern J.A.
Institution
(Nishimura, Visser, Belanger, Oldach, Gunther-Harrington, Stern)
Department of Medicine and Epidemiology, School of Veterinary Medicine,
University of California, Davis, Davis, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Velocity ratio, velocity time integral (VTI) ratio, and
pulmonary valve area indexed to body surface area (iPVA) are methods of
assessment of pulmonary valve stenosis (PS) severity that are less
dependent on blood flow. Studies evaluating these methods are limited.
Objectives: To determine the effects of butorphanol, atenolol, and balloon
valvuloplasty (BV) on velocity ratio, VTI ratio, iPVA, mean PG, and max
PG. Animals: Twenty-seven dogs with PS (max PG >50 mm Hg). Methods:
Prospective study. All dogs underwent an echocardiogram at baseline,
5-minutes after administration of butorphanol (0.2-0.25 mg/kg IV), and
2-to-4 weeks after atenolol (1-1.5 mg/kg q12h). Twenty-one of these were
evaluated 24-hours after BV. Results: There were no significant
differences (P >.05) amongst any of the methods of assessment of PS
severity after butorphanol. After atenolol, mean (SD) of mean (57.0 [21.0]
mm Hg) and max PG (93.1 [33.8] mm Hg) were significantly decreased (P
<=.047) compared with baseline (65.2 [26.2] mm Hg and 108 [44.4] mm Hg,
respectively). After atenolol, there were no significant (P >=.12)
differences in velocity ratio (0.29 [0.09]), VTI ratio (0.18 [0.05]), or
iPVA (0.43 [0.16] cm²/m²) compared with baseline
(0.30 [0.09], 0.19 [0.09], 0.44 [0.17] cm²/m²,
respectively). Conclusions and Clinical Importance: Atenolol might reduce
mean and max PG but does not alter less flow-dependent methods of
assessment of PS severity (velocity ratio, VTI ratio, and iPVA) in dogs
with PS. Results support an integrative approach to assessment of PS
severity that includes less flow-dependent methods, particularly in states
of altered flow or right ventricular function.<br/>Copyright &#xa9; 2018
The Authors. Journal of Veterinary Internal Medicine published by Wiley
Periodicals, Inc. on behalf of the American College of Veterinary Internal
Medicine.

<25>
Accession Number
623691250
Title
The cortisol stress response induced by surgery: A systematic review and
meta-analysis.
Source
Clinical Endocrinology. 89 (5) (pp 554-567), 2018. Date of Publication:
November 2018.
Author
Prete A.; Yan Q.; Al-Tarrah K.; Akturk H.K.; Prokop L.J.; Alahdab F.;
Foster M.A.; Lord J.M.; Karavitaki N.; Wass J.A.; Murad M.H.; Arlt W.;
Bancos I.
Institution
(Prete, Karavitaki, Arlt) Institute of Metabolism and Systems Research,
University of Birmingham, Birmingham, United Kingdom
(Prete, Karavitaki, Arlt) Centre for Endocrinology, Diabetes and
Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
(Yan) Department of Surgery, Mayo Clinic, Rochester, MN, United States
(Al-Tarrah, Foster, Lord) Institute of Inflammation and Ageing, University
of Birmingham, Birmingham, United Kingdom
(Akturk) Barbara Davis Center for Diabetes, University of Colorado School
of Medicine, Aurora, CO, United States
(Prokop) Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, United States
(Alahdab, Murad) Evidence-based Practice Center, Mayo Clinic, Rochester,
MN, United States
(Foster) NIHR Surgical Reconstruction and Microbiology Research Centre,
Queen Elizabeth Hospital Birmingham & Royal Centre for Defence Medicine,
Birmingham, United Kingdom
(Wass) Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill
Hospital, Oxford, United Kingdom
(Bancos) Division of Endocrinology, Metabolism and Nutrition, Department
of Internal Medicine, Mayo Clinic, Rochester, MN, United States
Publisher
Blackwell Publishing Ltd
Abstract
Objective: Surgery is a stressor that can be categorized by duration and
severity and induces a systemic stress response that includes increased
adrenal cortisol production. However, the precise impact of surgical
stress on the cortisol response remains to be defined. Design: We
performed a systematic review and meta-analysis to assess the cortisol
stress response induced by surgery and to stratify this response according
to different parameters. Methods: We conducted a comprehensive search in
several databases from 1990 to 2016. Pairs of reviewers independently
selected studies, extracted data and evaluated the risk of bias. Cortisol
concentrations were standardized, pooled in meta-analysis and plotted over
time. Results: We included 71 studies reporting peri-operative serum
cortisol measurements in 2953 patients. The cortisol response differed
substantially between moderately/highly invasive and minimally invasive
surgical procedures. Minimally invasive procedures did not show a
peri-operative cortisol peak, whereas more invasive surgeries caused a
cortisol surge that was more pronounced in older subjects, women and
patients undergoing open surgery and general anaesthesia. The duration of
the procedure and the use of etomidate for induction of anaesthesia did
not affect the cortisol response. Conclusions: The peri-operative cortisol
stress response is dynamic and influenced by patient-specific, surgical
and anaesthetic features. However, the available evidence is derived from
highly heterogeneous studies, with only two of 71 studies measuring
cortisol by mass spectrometry, which currently prevents a precise and
reproducible definition of this response.<br/>Copyright &#xa9; 2018 John
Wiley & Sons Ltd.

<26>
Accession Number
2001206526
Title
Baseline and on-statin treatment lipoprotein(a) levels for prediction of
cardiovascular events: individual patient-data meta-analysis of statin
outcome trials.
Source
The Lancet. 392 (10155) (pp 1311-1320), 2018. Date of Publication: 13 - 19
October 2018.
Author
Willeit P.; Ridker P.M.; Nestel P.J.; Simes J.; Tonkin A.M.; Pedersen
T.R.; Schwartz G.G.; Olsson A.G.; Colhoun H.M.; Kronenberg F.; Drechsler
C.; Wanner C.; Mora S.; Lesogor A.; Tsimikas S.
Institution
(Willeit) Department of Neurology, Medical University of Innsbruck,
Innsbruck, Austria
(Willeit) Department of Public Health and Primary Care, University of
Cambridge, Cambridge, United Kingdom
(Ridker, Mora) Brigham and Women's Hospital, Harvard Medical School,
Boston, MA, United States
(Nestel) Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
(Simes) NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW,
Australia
(Tonkin) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Vic, Australia
(Pedersen) Oslo University Hospital, Ulleval, and Medical Faculty,
University of Oslo, Oslo, Norway
(Schwartz) Division of Cardiology, VA Medical Center and University of
Colorado School of Medicine, Denver, CO, United States
(Olsson) Department of Medicine and Care, Faculty of Health Sciences,
University of Linkoping, Linkoping, Sweden
(Colhoun) MRC Human Genetics Unit, Centre for Genomic and Experimental
Medicine, MRC Institute of Genetics & Molecular Medicine, Edinburgh,
United Kingdom
(Kronenberg) Division of Genetic Epidemiology, Department of Medical
Genetics, Molecular and Clinical Pharmacology, Medical University of
Innsbruck, Innsbruck, Austria
(Drechsler, Wanner) Division of Nephrology, Department of Internal
Medicine 1 and Comprehensive Heart Failure Centre, University Hospital of
Wurzburg, Wurzburg, Germany
(Lesogor) Novartis Pharma AG, Basel, Switzerland
(Tsimikas) Vascular Medicine Program, Sulpizio Cardiovascular Center,
Division of Cardiology, Department of Medicine, University of California
San Diego, La Jolla, CA, United States
(Tsimikas) Vascular Medicine Program, Sulpizio Cardiovascular Center,
University of California San Diego, La Jolla, CA 92093, United States
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Elevated lipoprotein(a) is a genetic risk factor for
cardiovascular disease in general population studies. However, its
contribution to risk for cardiovascular events in patients with
established cardiovascular disease or on statin therapy is uncertain.
Methods: Patient-level data from seven randomised, placebo-controlled,
statin outcomes trials were collated and harmonised to calculate hazard
ratios (HRs) for cardiovascular events, defined as fatal or non-fatal
coronary heart disease, stroke, or revascularisation procedures. HRs for
cardiovascular events were estimated within each trial across predefined
lipoprotein(a) groups (15 to <30 mg/dL, 30 to <50 mg/dL, and >=50 mg/dL,
vs <15 mg/dL), before pooling estimates using multivariate random-effects
meta-analysis. Findings: Analyses included data for 29 069 patients with
repeat lipoprotein(a) measurements (mean age 62 years [SD 8]; 8064 [28%]
women; 5751 events during 95 576 person-years at risk). Initiation of
statin therapy reduced LDL cholesterol (mean change -39% [95% CI -43 to
-35]) without a significant change in lipoprotein(a). Associations of
baseline and on-statin treatment lipoprotein(a) with cardiovascular
disease risk were approximately linear, with increased risk at
lipoprotein(a) values of 30 mg/dL or greater for baseline lipoprotein(a)
and 50 mg/dL or greater for on-statin lipoprotein(a). For baseline
lipoprotein(a), HRs adjusted for age and sex (vs <15 mg/dL) were 1.04 (95%
CI 0.91-1.18) for 15 mg/dL to less than 30 mg/dL, 1.11 (1.00-1.22) for 30
mg/dL to less than 50 mg/dL, and 1.31 (1.08-1.58) for 50 mg/dL or higher;
respective HRs for on-statin lipoprotein(a) were 0.94 (0.81-1.10), 1.06
(0.94-1.21), and 1.43 (1.15-1.76). HRs were almost identical after further
adjustment for previous cardiovascular disease, diabetes, smoking,
systolic blood pressure, LDL cholesterol, and HDL cholesterol. The
association of on-statin lipoprotein(a) with cardiovascular disease risk
was stronger than for on-placebo lipoprotein(a) (interaction p=0.010) and
was more pronounced at younger ages (interaction p=0.008) without
effect-modification by any other patient-level or study-level
characteristics. Interpretation: In this individual-patient data
meta-analysis of statin-treated patients, elevated baseline and on-statin
lipoprotein(a) showed an independent approximately linear relation with
cardiovascular disease risk. This study provides a rationale for testing
the lipoprotein(a) lowering hypothesis in cardiovascular disease outcomes
trials. Funding: Novartis Pharma AG.<br/>Copyright &#xa9; 2018 Elsevier
Ltd

<27>
Accession Number
623034687
Title
Association between albumin administration and survival in cardiac
surgery: a retrospective cohort study.
Source
Canadian Journal of Anesthesia. 65 (11) (pp 1218-1227), 2018. Date of
Publication: 01 Nov 2018.
Author
Kingeter A.J.; Raghunathan K.; Munson S.H.; Hayashida D.K.; Zhang X.;
Iyengar S.; Bunke M.; Shaw A.D.
Institution
(Kingeter) Department of Anesthesiology, Vanderbilt University Medical
Center, 1211 21st Avenue South MAB 422, Nashville, TN 37232-5614, United
States
(Raghunathan) Duke University Medical Center and Durham VA Medical Center,
Durham, NC, United States
(Munson, Hayashida, Zhang, Iyengar) Boston Strategic Partners, Inc.,
Boston, MA, United States
(Bunke) Grifols, Inc., Research Triangle Park, NC, United States
(Shaw) University of Alberta, Edmonton, AB, Canada
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Albumin is widely used during and after on-pump cardiac surgery,
although it is unclear whether this therapy improves clinical outcomes.
Methods: This observational study utilized the Cerner Health Facts
database (a large HIPAA-compliant clinical-administrative database
maintained by Cerner Inc., USA) to identify a cohort of 6,188 adults that
underwent on-pump cardiac surgery for valve and/or coronary artery
procedures between January 2001 and March 2013. Of these, 1,095 patients
who received 5% albumin with crystalloid solutions and 1,095 patients who
received crystalloids alone on the day of or the day following cardiac
surgery were selected by propensity-score matching. The primary outcome
was all-cause in-hospital mortality. Three secondary outcomes analyzed
include acute kidney injury severity, major morbidity composite, and
all-cause 30-day readmissions. Results: In the propensity-score matched
cohort, receipt of perioperative 5% albumin was associated with decreased
risk of in-hospital mortality (odds ratio [OR], 0.5; 95% confidence
interval [CI], 0.3 to 0.9; P = 0.02) and lower all-cause 30-day
readmission rates (OR, 0.7; 98.3% CI, 0.5 to 0.9; P < 0.01). Albumin
therapy was not associated with differences in overall major morbidity
(OR, 0.9; 98.3% CI, 0.7 to 1.2; P = 0.39; composite) or acute kidney
injury severity (OR, 0.9; 98.3% CI, 0.6 to 1.4; P = 0.53) compared with
therapy with crystalloid solutions. Conclusions: In this large
retrospective study, use of 5% albumin solution was associated with
significantly decreased odds of in-hospital mortality and all-cause 30-day
readmission rate compared with administration of crystalloids alone in
adult patients undergoing on-pump cardiac surgery. These results warrant
further studies to examine fluid receipt, including 5% albumin, in
surgical populations via randomized-controlled trials.<br/>Copyright
&#xa9; 2018, Canadian Anesthesiologists' Society.

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

<29>
[Use Link to view the full text]
Accession Number
624466122
Title
The clinical and economic consequences of practice style variations in
common surgical interventions: A protocol for systematic review.
Source
Medicine. 97 (42) (pp e12439), 2018. Date of Publication: 01 Oct 2018.
Author
Nouhi M.; Hadian M.; Olyaeemanesh A.
Institution
(Nouhi, Hadian) School of Health Management and Information Sciences, Iran
University of Medical Sciences, Iran, Islamic Republic of
(Olyaeemanesh) National Institute of Health Research, United Kingdom
(Olyaeemanesh) Health Equity Research Center, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: Surgical intervention is one of the common therapeutic
interventions applied to a vast class of diseases. Unwarranted variation
in practice style in different locations is considered as practice style
variations (PSVs), which cause undesirable effects on patient health
status and economic consequences. The magnitude of the variations in
surgical interventions and its effects on clinical outcomes of patients
and also utilization of resources have been investigated in recent years.
But the findings show considerable heterogeneities in magnitude and
consequences. We develop a protocol to systematically review the current
literature of PSV to explain the magnitude of PSV and its clinical and
economic consequences.
METHOD: This systematic review will include observational and experimental
studies to investigate magnitude and consequences of PSV in common
surgical interventions, cardiovascular disease, urological, and
ophthalmological diseases. Source of information is scientific databases,
theses, clinical trials registrations website, and grey literature. A
comprehensive electronic search will be conducted through PubMed, Web of
Science, EBSCO, EMBASE, and Scopus databases. Studies are assessed
systematically by 2 investigators. Methodological quality of the included
studies is evaluated by the STROBE and CONSORT checklists. In case of data
availability, we will pool findings of included studies by meta-analysis
techniques in the CMA software. Subgroup analyses are based on the type of
the interventions and selected diseases.
RESULTS: This study has ethical approval from ethical committee of Iran
University of Medical Sciences, ethic code: IR.IUMS.REC1395.9221504203.
The results will be published in a peer-reviewed journal.
CONCLUSION: A systematic review is considered as an appropriate scientific
method for reaching a consensus on magnitude as well as consequences of
PSV. Results of this study will help clinical experts to attain more
knowledge about PSV and encourage them to use some tools such as clinical
guidelines and shared decision making to alleviate its consequences.

<30>
[Use Link to view the full text]
Accession Number
624465695
Title
Sevoflurane is an effective adjuvant to propofol-based total intravenous
anesthesia for attenuating cough reflex in nonintubated video-assisted
thoracoscopic surgery.
Source
Medicine. 97 (42) (pp e12927), 2018. Date of Publication: 01 Oct 2018.
Author
Lai H.-C.; Huang T.-W.; Tseng W.-C.; Lin W.-L.; Chang H.; Wu Z.-F.
Institution
(Lai, Tseng, Lin, Wu) Department of Anesthesiology, Netherlands
(Huang, Chang) Division of Chest Surgery, Department of Surgery,
Tri-Service General Hospital and National Defense Medical Center, Republic
of China, Taipei, Taiwan (Republic of China)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Nonintubated video-assisted thoracic surgery (VATS) has been
widely developed during the recent years. Cough reflex is an inevitably
encountered problem while approaching lung lesions, and it may induce
major bleeding. Sevoflurane anesthesia may attenuate cough reflex by
inhibiting the pulmonary irritant receptors. However, the incidence of
postoperative nausea and vomiting (PONV) in inhalational anesthesia is
higher than in the propofol-based total intravenous anesthesia (TIVA). We
investigated the effect of sevoflurane combination with propofol-based
TIVA on cough reflex and PONV in nonintubated VATS.
METHODS: Ninety patients undergoing nonintubated VATS with laryngeal mask
airway (LMA) and spontaneous breathing were randomly assigned for TIVA or
propofol/sevoflurane anesthesia. In the TIVA group (n = 45), anesthesia
was induced and maintained with propofol and fentanyl; in the
propofol/sevoflurane (P/S) group (n = 45), 1% sevoflurane anesthesia was
added to propofol and fentanyl anesthesia. The primary outcome
measurements were cough reflex. In addition, the incidence of PONV and
extubation time were investigated.
RESULTS: Patients with cough reflex were significantly fewer in the P/S
group than in the TIVA group (10/45 vs 34/45; P < .001). The cough
severity (35/5/5/0 vs 11/17/17/0; P < .001) and limb movement (40/5/0/0 vs
28/17/0/0; P < .001) were lower in the P/S group than in the TIVA group.
Besides, incremental fentanyl bolus for cough reflex was 5 (0 [0-1]) in
the P/S group and 17 (0 [0-3]) in the TIVA group (P < .05). And there was
no conversion to general anesthesia, postoperative hemorrhage, aspiration
pneumonia, or PONV in the 2 groups. Besides, there was no significant
difference in extubation time (TIVA: 5.04 +/- 2.88 vs P/S: 4.44 +/- 2.98
minutes; P = .33).
CONCLUSION: Sevoflurane attenuated cough reflex under propofol-based TIVA
and did not increase the incidence of PONV and extubation time in
nonintubated VATS.

<31>
Accession Number
624473412
Title
CELEB trial: Comparative Effectiveness of Lung volume reduction surgery
for Emphysema and Bronchoscopic lung volume reduction with valve
placement: a protocol for a randomised controlled trial.
Source
BMJ open. 8 (10) (pp e021368), 2018. Date of Publication: 17 Oct 2018.
Author
Buttery S.; Kemp S.V.; Shah P.L.; Waller D.; Jordan S.; Lee J.T.; Banya
W.; Steiner M.C.; Hopkinson N.S.
Institution
(Buttery, Kemp, Shah, Jordan, Banya, Hopkinson) NIHR Respiratory Disease,
Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation
Trust, Imperial College London, London, United Kingdom
(Waller) Thorax Centre, Barts Health NHS Trust, London, United Kingdom
(Lee) School of Public Health, National University of Singapore, Singapore
(Steiner) Leicester Respiratory Biomedical Research Unit, University
Hospitals of Leicester NHS Foundation Trust, Leicester, United Kingdom
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Although lung volume reduction surgery and bronchoscopic
lung volume reduction with endobronchial valves have both been shown to
improve lung function, exercise capacity and quality of life in
appropriately selected patients with emphysema, there are no direct
comparison data between the two procedures to inform clinical
decision-making.
METHODS AND ANALYSIS: We describe the protocol of the CELEB study, a
randomised controlled trial which will compare outcomes at 1year between
the two procedures, using a composite disease severity measure, the iBODE
score, which includes body mass index, airflow obstruction, dyspnoeaand
exercise capacity (incremental shuttle walk test).
ETHICS AND DISSEMINATION: Ethical approval to conduct the study has been
obtained from the Fulham Research Ethics Committee, London (16/LO/0286).
The outcome of this trial will provide information to guide treatment
choices in this population and will be presented at national and
international meetings and published in peer-reviewed journals. We will
also disseminate the main results to all participants in a letter.
TRIAL REGISTRATION NUMBER: ISRCTN19684749; Pre-results.<br/>Copyright
&#xa9; Author(s) (or their employer(s)) 2018. Re-use permitted under CC
BY. Published by BMJ.

<32>
Accession Number
624329304
Title
Comparison of graft patency following coronary artery bypass grafting in
the left versus the right coronary artery systems: A systematic review and
meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 54 (2) (pp 221-228), 2018.
Date of Publication: 2018.
Author
Pinho-Gomes A.-C.; Azevedo L.; Antoniades C.; Taggart D.P.
Institution
(Pinho-Gomes, Taggart) Department of Cardiac Surgery, Oxford University
Hospitals NHS Trust, John Radcliffe Hospital, Oxford OX39DU, United
Kingdom
(Azevedo) Department of Community Medicine, Information and Health
Decision Sciences, Faculty of Medicine, Center for Health Technology and
Services Research, University of Porto, Porto, Portugal
(Antoniades, Taggart) Division of Cardiovascular Medicine, University of
Oxford, Oxford, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Although coronary artery bypass grafting has been the standard of care for
patients with complex coronary artery disease for over 50 years, the
evolution of graft patency over time in the left versus the right coronary
systems remains poorly documented. This systematic review and
meta-analysis aimed to characterize the evolution of graft patency over
time comparing the left (excluding left anterior descending artery) and
right coronary systems, with an emphasis on the comparison of venous
versus arterial grafts and symptomatic versus asymptomatic patients. We
searched the Cochrane Central Register of Controlled Trials (CENTRAL) and
MEDLINE from inception to August 2016. We also searched clinical trials
registers and reference lists of relevant studies. We included randomized
clinical trials and observational studies comparing graft patency in the
left versus the right coronary systems. Our outcome was graft patency
defined as a binary variable according to whether grafts were reported as
patent or failed at the time of angiogram. Data collection and analysis
were performed according to the methodological recommendations of the
Cochrane Collaboration. From a total 2275 papers, 52 studies were included
in the qualitative analysis and 48 studies (including 36 006 grafts) in
the meta-analysis. There was a 3.3% significant difference between the
left-sided and rightsided graft patency, and the difference appeared to
increase over time. Furthermore, patency of arterial grafts was higher in
the left coronary system, while venous grafts performed similarly
irrespective of the coronary circulation. Symptom recurrence also seemed
related to a higher failure rate in the right coronary circulation.
However, the high degree of heterogeneity precluded drawing definite
conclusions. This metaanalysis suggested that graft patency might be
better for left-sided vessels and that this difference might be driven by
the better performance of arterial grafts in the left coronary system.
However, evidence currently available is limited, and further research is
warranted to understand whether certain grafts achieve better patency in
the right versus the left coronary circulations.<br/>Copyright &#xa9; 2018
The Author(s).

<33>
Accession Number
624320448
Title
Does minimally invasive coronary artery bypass improve outcomes compared
to off-pump coronary bypass via sternotomy in patients undergoing coronary
artery bypass grafting?.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (3) (pp 357-364),
2018. Date of Publication: 2018.
Author
Florisson D.S.; DeBono J.A.; Davies R.A.; Newcomb A.E.
Institution
(Florisson, DeBono, Davies, Newcomb) Department of Cardiothoracic Surgery,
St Vincent's Public Hospital, 41 Victoria Parade, Melbourne, VIC 3065,
Australia
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'In patients undergoing
off-pump coronary artery bypass grafting, for single or multivessel
disease, does minimally invasive direct coronary artery bypass (MIDCAB) or
off-pump coronary artery bypass (OPCAB) provide the superior outcome
including a reduction in morbidity and mortality?'. A total of 187 papers
were found using the reported search, of which 12 represented the best
evidence to answer the clinical question. The authors, date, journal and
country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. It was found that
compared to OPCAB, MIDCAB surgery can offer decreased intensive care unit
length of stay (4.5-57.4 h vs 5.2-52.7 h) and total hospital length of
stay (4.5-8.5 days vs 5.2-12 days), with 1 paper showing a decrease in
mortality at 1 year (3% vs 14%). However, there were several papers that
showed significant risks with MIDCAB surgery in patients with either
single or multivessel disease. These include increased risk of incomplete
revascularization (29% vs 0%), significant early complications (22.5 vs
0%), urgent reintervention (16% vs 0%), repeat revascularization events
(12.2% vs 3.7%), progression of native disease (4.8% vs 0.9%),
rehospitalization by 3 months (20% vs 2%) and postoperative infarction
(2.9% vs 1.45%). These risks did not translate to an increase in early
mortality (01% vs 0-1.6%) or late mortality (0-3% vs 0-14%) in papers that
included mid-Term follow up. However, they do represent significant
potential risks that cannot be overlooked when considering the use of
MIDCAB. We conclude that MIDCAB is associated with greater morbidity and
reintervention compared to OPCAB via sternotomy, but both techniques are
equivalent in terms of operative and mid-Term mortality.<br/>Copyright
&#xa9; The Author(s) 2018. Published by Oxford University Press on behalf
of Entomological Society of America.

<34>
Accession Number
620401046
Title
Systematic detection of polyvascular disease combined with aggressive
secondary prevention in patients presenting with severe coronary artery
disease: The randomized AMERICA Study.
Source
International Journal of Cardiology. 254 (pp 36-42), 2018. Date of
Publication: 01 Mar 2018.
Author
Collet J.-P.; Cayla G.; Ennezat P.-V.; Leclercq F.; Cuisset T.; Elhadad
S.; Henry P.; Belle L.; Cohen A.; Silvain J.; Barthelemy O.; Beygui F.;
Diallo A.; Vicaut E.; Montalescot G.
Institution
(Collet, Silvain, Barthelemy, Montalescot) Sorbonne Universite Paris 6,
ACTION Study Group, Institut de Cardiologie Hopital Pitie-Salpetriere
(APHP), INSERM UMRS, Paris 1166, France
(Cayla) ACTION Study Group, Cardiologie, CHU Caremeau, Universite de
Montpellier, Nimes, France
(Ennezat) Cardiologie, Pole Thorax et Vaisseaux, CHU La Tronche, Grenoble,
France
(Leclercq) Cardiologie, Hopital Arnaud de Villeneuve-CHU Montpellier,
France
(Cuisset) Department of Cardiology, CHU Timone and Aix-Marseille Univ,
INSERM UMR1062, INRA UMR1260, Nutrition, Obesity and Risk of Thrombosis,
Faculty of Medicine, Marseille F-13385, France
(Elhadad) Cardiologie, CH de Lagny-Marne la Vallee, Jossigny, France
(Henry) Cardiologie, CHU Lariboisiere (APHP), Paris, France
(Belle) Cardiologie, Centre Hospitalier d'Annecy, France
(Cohen) Cardiologie, CHU Saint-Antoine (APHP), Paris, France
(Beygui) Cardiologie, Hopital de la Cote de Nacre, Caen, France
(Diallo, Vicaut) ACTION Study Group, Unite de Recherche Clinique-Hopital
Lariboisiere (APHP), France and Universite Denis Diderot, Paris, France
Publisher
Elsevier Ireland Ltd
Abstract
Background: The prevalence and associated-risk of asymptomatic multisite
artery disease (MSAD) in high risk coronary patients are unknown. Whether
systematic identification and aggressive management of asymptomatic MSAD
is clinically relevant in high risk coronary patients has not been
evaluated. Methods: We randomly assigned 521 high risk coronary patients
defined by the presence of three-vessel coronary disease (n = 304) or
recent acute coronary syndrome beyond the age of 75 years (n = 215) to
either a strategy of systematic detection of asymptomatic MSAD combined
with an aggressive secondary prevention (n = 263) or to a more
conventional strategy based on treatment of coronary artery disease only
with standard of care (n = 258). The primary end point was the time to
first occurrence of death, any organ failure or ischemic event leading to
re-hospitalization through two years of follow-up. Results: The pro-active
strategy identified asymptomatic MSAD in 21.7% of patients with few
revascularizations (3.6%); the pro-active pharmacological secondary
prevention was obtained in > 85% of patients and life-style changes in <
60% of patients. At 2-year follow-up, the primary end point occurred in
44.9% of patients in the pro-active group and 43.0% of patients in the
conventional group (HR 1.03; 95% confidence interval [CI], 0.80 to 1.34].
The rate of major bleeding did not differ significantly between groups
(4.6% vs 5.0%; HR, 0.97; 95% CI, 0.40 to 1.91). Conclusion: In high risk
coronary patients, there is no apparent benefit of a systematic detection
of asymptomatic extra-coronary atherothrombotic disease and intensified
treatment over a 2-year follow-up period. (Funded by the Academic Allies
in Cardiovascular Trials Initiatives and Organized Networks and Institut
de l'Atherothrombose; AMERICA ClinicalTrials.gov number,
NCT00445835).<br/>Copyright &#xa9; 2017 Elsevier Ireland Ltd

<35>
Accession Number
620027237
Title
Fulminant giant-cell myocarditis on mechanical circulatory support:
Management and outcomes of a French multicentre cohort.
Source
International Journal of Cardiology. 253 (pp 105-112), 2018. Date of
Publication: 15 Feb 2018.
Author
Montero S.; Aissaoui N.; Tadie J.-M.; Bizouarn P.; Scherrer V.; Persichini
R.; Delmas C.; Rolle F.; Besnier E.; Le Guyader A.; Combes A.; Schmidt M.
Institution
(Montero, Combes, Schmidt) Medical Intensive Care Unit, iCAN, Institute of
Cardiometabolism and Nutrition, Hopital de la Pitie-Salpetriere,
Assistance Publique-Hopitaux de Paris, Paris, France
(Aissaoui) Intensive Care Unit, U970, European Georges-Pompidou Hospital,
Paris Descartes University, Paris, France
(Tadie) Infectious Diseases and Intensive Care Unit, Pontchaillou
University Hospital, Rennes, France
(Bizouarn) Cardiac Intensive Care Department, CHU Nantes, Nantes, France
(Scherrer, Besnier) Rouen University Hospital, Department of
Anaesthesiology and Critical Care, Rouen, France
(Persichini) Medical-Surgical Intensive Care Unit, CHU de La Reunion,
Felix-Guyon Hospital, Saint Denis, La Reunion, France
(Delmas) Medical Intensive Care Unit, Rangueil Hospital, Toulouse, France
(Rolle, Le Guyader) Thoracic and Cardiac Surgery Department, CHU Limoges,
Limoges, France
(Montero) Acute and Intensive Cardiovascular Care Unit, Department of
Cardiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research
Institute IIB-Sant Pau, Barcelona, Spain
Publisher
Elsevier Ireland Ltd
Abstract
Aims Giant-cell myocarditis (GCM) is a rare and often fatal form of
myocarditis. Only a few reports have focused on fulminant forms. We
describe the clinical characteristics, management and outcomes of GCM
patients rescued by mechanical circulatory support (MCS). Methods and
results The clinical features, diagnoses, treatments and outcomes of
MCS-treated patients in refractory cardiogenic shock secondary to
fulminant GCM admitted to eight French intensive care units (2002-2016)
were analysed. We also conducted a systematic review of this topic.
Thirteen patients (median age 44 [range 21-76] years, Simplified Acute
Physiology Score II 55 [40-79]) in severe cardiogenic shock (median
[range] left ventricular ejection fraction 15% [15-35%] and blood lactate
4 mmol/L) were placed on MCS 4 [0-28] days after hospital admission.
Severe arrhythmic disturbances were frequent (77%), with six (46%)
patients experiencing an electrical storm prior to MCS. Venoarterial
extracorporeal membrane oxygenation was the first MCS option for 11 (85%)
patients. GCM was diagnosed in five (38%) patients before transplant or
death and treated with immunosuppressants; infections were the main
complication (80%). Four patients died on MCS and no patient presented
long-term survival free from heart transplant (nine patients, 69%). All
transplanted patients were alive 1 year later and no GCM recurrence was
reported after median follow-up of 42 [12-145] months. Conclusion Outcomes
of fulminant GCMs may differ from those of milder forms. In this context,
heart transplant might likely be the only long-term survival
option.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<36>
Accession Number
619924238
Title
A meta-analysis of transcatheter device closure of perimembranous
ventricular septal defect.
Source
International Journal of Cardiology. 254 (pp 75-83), 2018. Date of
Publication: 01 Mar 2018.
Author
Santhanam H.; Yang L.; Chen Z.; Tai B.-C.; Rajgor D.D.; Quek S.-C.
Institution
(Santhanam, Yang, Rajgor, Quek) Department of Paediatrics, Yong Loo Lin
School of Medicine, National University of Singapore, Singapore
(Santhanam, Yang, Rajgor, Quek) Khoo Teck Puat-National University
Children's Medical Institute, National University Health System, Singapore
(Chen) Investigational Medicine Unit, National University Health System,
Singapore
(Tai) Saw Swee Hock School of Public Health, National University of
Singapore, Singapore, Singapore
Publisher
Elsevier Ireland Ltd
Abstract
Background: While transcatheter device closure of ventricular septal
defects (VSDs) is gaining popularity, concerns remain about adverse
events; particularly heart block in peri-membranous VSDs (pmVSDs). The aim
of this study is to ascertain outcomes of transcatheter device closure of
pmVSDs through a meta-analysis of current literature. Methods: A PubMed
and Scopus search for studies in English on device closure of pmVSDs
published till end-February 2017 was performed. Exclusion criteria
included case series already included in multi-centre studies, sample size
< 5, and VSD acquired following myocardial infarction. Pooled estimates of
success and complications was obtained using the random effects model.
Results: A total of 54 publications comprising 6762 patients with pmVSDs
were included. The mean age of patients ranged from 1.6 to 37.4 years. The
pooled estimate of successful device implantation is 97.8% (95% CI: 96.8
to 98.6). The most common complication is residual shunt (15.9%; 95% CI:
10.9 to 21.5). Other complications include arrhythmias (10.3%; 95% CI: 8.3
to 12.4) and valvular defects (4.1%; 95% CI: 2.4 to 6.1). The pooled
estimate of complete atrioventricular block (cAVB) is 1.1% (95% CI: 0.5 to
1.9). Conclusion: Our meta-analysis suggests that device closure of pmVSDs
is a safe and effective procedure. The complication of cAVB is low but
significant. The risk is expected to further reduce with newer devices
which are less stiff with improved profiles. Further studies validating
this will be useful in formulating guidelines for device closure of
pmVSDs.<br/>Copyright &#xa9; 2017 Elsevier Ireland Ltd

<37>
Accession Number
620572455
Title
Predictors of 1-year mortality in heart transplant recipients: A
systematic review and meta-analysis.
Source
Heart. 104 (2) (pp 151-160), 2018. Date of Publication: January 2018.
Author
Foroutan F.; Alba A.C.; Guyatt G.; Posada J.D.; Hing N.N.F.; Arseneau E.;
Meade M.; Hanna S.; Badiwala M.; Ross H.
Institution
(Foroutan, Alba, Posada, Hing, Badiwala, Ross) Cardiology, Toronto General
Hospital, University Health Network, Toronto, ON, Canada
(Foroutan, Guyatt, Arseneau, Meade, Hanna) Clinical Epidemiology and
Biostatistics, McMaster University, Hamilton, ON, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective A systematic summary of the observational studies informing
heart transplant guideline recommendations for selection of candidates and
donors has thus far been unavailable. We performed a metaanalysis to
better understand the impact of such known risk factors. Methods We
systematically searched and metaanalysed the association between known
pretransplant factor and 1-year mortality identified by multivariable
regression models. Our review used the Grading of Recommendations,
Assessment, Development and Evaluation for assessing the quality of
assessment. We pooled risk estimates by using random effects models.
Results Recipient variables including age (HR 1.16 per 10-year increase,
95% CI 1.10-1.22, high quality), congenital aetiology (HR 2.35, 95% CI
1.62 to 3.41, moderate quality), diabetes (HR 1.37, 95% CI 1.15 to 1.62,
high quality), creatinine (HR 1.11 per 1 mg/dL increase, 95% CI 1.06 to
1.16, high quality), mechanical ventilation (HR 2.46, 95% CI 1.48 to 4.09,
low quality) and short-term mechanical circulatory support (MCS) (HR 2.47,
95% CI 1.04 to 5.87, low quality) were significantly associated with
1-year mortality. Donor age (HR 1.20 per 10-year increase, 95% CI 1.14 to
1.26, high quality) and female donor to male recipient sex mismatch (HR
1.38, 95% CI 1.06 to 1.80, high quality) were significantly associated
with 1-year mortality. None of the operative factors proved significant
predictors. Conclusion High-quality and moderate-quality evidence
demonstrates that recipient age, congenital aetiology, creatinine,
pulsatile MCS, donor age and female donor to male recipient sex mismatch
are associated with 1-year mortality post heart transplant. The results of
this study should inform future guideline and predictive model
development.<br/>Copyright &#xa9; 2018 Article author(s).

<38>
Accession Number
620572435
Title
Evaluation of aortic regurgitation with cardiac magnetic resonance
imaging: A systematic review.
Source
Heart. 104 (2) (pp 103-110), 2018. Date of Publication: January 2018.
Author
Lee J.C.; Branch K.R.; Hamilton-Craig C.; Krieger E.V.
Institution
(Lee, Branch, Hamilton-Craig, Krieger) Division of Cardiology, Department
of Medicine, University of Washington, Seattle, WA, United States
(Hamilton-Craig) Centre for Advanced Imaging, University of Queensland,
Brisbane, QLD, Australia
(Hamilton-Craig) Department of Cardiology, Heart and Lung Institute,
Prince Charles Hospital, Brisbane, QLD, Australia
(Krieger) Seattle Adult Congenital Heart Service, University of
Washington, School of Medicine, Seattle, WA 98195, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
This review summaries the utility, application and data supporting use of
cardiac magnetic resonance imaging (CMR) to evaluate and quantitate aortic
regurgitation. We systematically searched Medline and PubMed for original
research articles published since 2000 that provided data on the
quantitation of aortic regurgitation by CMR and identified 11 articles for
review. Direct aortic measurements using phase contrast allow quantitation
of volumetric flow across the aortic valve and are highly reproducible and
accurate compared with echocardiography. However, this technique requires
diligence in prescribing the correct imaging planes in the aorta.
Volumetric analytic techniques using differences in ventricular volumes
are also highly accurate but less than phase contrast techniques and only
accurate when concomitant valvular disease is absent. Comparison of both
aortic and ventricular data for internal data verification ensures
fidelity of aortic regurgitant data. CMR data can be applied to many types
of aortic valve regurgitation including combined aortic stenosis with
regurgitation, congenital valve diseases and post-transcatheter valve
placement. CMR also predicts those patients who progress to surgery with
high overall sensitivity and specificity. Future studies of CMR in
patients with aortic regurgitation to quantify the incremental benefit
over echocardiography as well as prediction of cardiovascular events are
warranted.<br/>Copyright &#xa9; Article author(s) (or their employer(s)
unless otherwise stated in the text of the article) 2018.

<39>
Accession Number
2000787779
Title
Our modified technique of combined antegrade-vein graft cardioplegia
infusion versus conventional antegrade method in coronary artery bypass
grafting. A randomized clinical trial.
Source
International Journal of Surgery. 55 (pp 53-59), 2018. Date of
Publication: July 2018.
Author
Sharifi M.; Mousavi S.R.; Rafiei M.
Institution
(Sharifi) Cardiovascular Surgery, Department of Cardiovascular Surgery,
Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran,
Islamic Republic of
(Mousavi) Vascular Surgery, Department of Vascular Surgery, Faculty of
Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Rafiei) Biostatistics, Department of Biostatistics and Epidemiology,
Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran,
Islamic Republic of
Publisher
Elsevier Ltd
Abstract
Background: To determine the efficacy of antegrade cardioplegia
supplemented with venous graft perfusion in patients scheduled for
coronary artery bypass grafting (CABG). Methods: 223 consecutive patients
scheduled for isolated CABG were randomized to receive either continuous
crystalloid cardioplegia via vein grafts on completion of each distal
anastomosis plus intermittent blood cardioplegia through aortic root
(group 1, n = 110) or antegrade blood cardioplegia alone (group 2, n =
113). Two groups were similar in terms of preoperative patients' and
procedural characteristics. The primary end-points were low output
syndrome (LOS) variables. Results: The inotrope and intra-aortic balloon
pump demand during weaning were significantly higher in the control group
(31.8% vs. 20%, p = 0.043 and 7.9% vs. 1.8%, p = 0.034 respectively).
Postoperative level of potassium and arterial base excess (BE), stood in
the normal range in both groups, despite significant inter-group
differences. Peak serum level of myocardial injury biomarkers (CK, CK-MB,
and cTnI) at 12 h following operation, though markedly greater in the
group 2, did not reach the cut-off point of myocardial necrosis.
Postoperative arrhythmia was more commonly encountered in the control
group (p = 0.045). The duration of ventilation and hospital stay were
considerably longer in the group 2. In a subgroup with LVEF<30%, the
length of ICU stay was more prolonged in the control group, as well (p =
0.0145). The significant differences among groups regarding LOS parameters
were more remarkable in the two high-risk subgroups (LVEF<30%, left main
coronary stenosis). Conclusions: Given the better postoperative cardiac
performance, we recommend this method to all CABG candidates, particularly
in higher-risk patients.<br/>Copyright &#xa9; 2018 IJS Publishing Group
Ltd

<40>
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.

<41>
Accession Number
623829514
Title
Whole lung irradiation in patients with osteosarcoma and ewing sarcoma.
Source
Anticancer Research. 38 (9) (pp 4977-4985), 2018. Date of Publication:
September 2018.
Author
Ronchi L.; Buwenge M.; Cortesi A.; Ammendolia I.; Frakulli R.; Abate M.E.;
Arcelli A.; Donati C.M.; Macchia G.; Morganti A.G.; Cammelli S.
Institution
(Ronchi, Buwenge, Ammendolia, Frakulli, Arcelli, Donati, Morganti,
Cammelli) Radiation Oncology Center, Department of Experimental,
Diagnostic and Speciality Medicine -DIMES, S. Orsola-Malpighi Hospital,
University of Bologna, via Giuseppe Massarenti 9, Bologna 40138, Italy
(Cortesi) Istituto Scientifico Romagnolo per lo Studio e la Cura dei
Tumori (I.R.S.T.) S.r.l., Sede Legale, Meldola, Italy
(Abate) Chemotherapy Section, Istituto Ortopedico Rizzoli, Bologna, Italy
(Macchia) Radiotherapy Unit, Department of Oncology, Giovanni Paolo II
Foundation, Catholic University of Sacred Heart, Campobasso, Italy
Publisher
International Institute of Anticancer Research (1st km Kapandritiou -
Kalamou Rd., P.O. Box 22, Kapandriti, Attica GR-19014, Greece. E-mail:
subscriptions@iiar-anticancer.org)
Abstract
Background/Aim: Whole lung irradiation (WLI) represents standard therapy
for patients with pulmonary metastases from Ewing sarcoma although the
impact on clinical outcomes and toxicity is still unclear. The aim of this
study was to evaluate toxicity after WLI in patients with Ewing sarcoma
and osteosarcoma as well as overall survival (OS) and event-free survival
(EFS). Materials and Methods: A systematic review of studies on bilateral
pulmonary irradiation treatments for prophylactic or curative therapy was
performed based on PRISMA methodology. Data base searches on PubMed and
Cochrane Library from the earliest time possible through 31st March 2018
were carried out. Combination with other treatments, such as chemotherapy
and surgery were allowed. Only articles published in English were
considered. Results: Toxicity was evaluated in 13 of the 14 analyzed
studies (640 patients). Reported lung acute toxicity grade >=3 ranged
between 0.0 and 12.2%. Three studies reported 12 cases (1.8%) of severe
pneumonitis. Grade >=2 late toxicity was mainly recorded in patients who
received boost irradiation, previous thoracic surgery, chemotherapy or who
were smokers. Lack of a significant impact of WLI on OS was reported in
comparative studies although patients treated with WLI showed higher
survival in most individual studies. Conclusion: Although the rate of
severe toxicity was very low, the real impact of WLI on patients' outcomes
remains unproven, probably due to the narrow dose limits that can be
delivered to the whole lung parenchyma. New strategies to prevent or treat
lung metastases in these patients should be tested. Ultra-fractionated
radiotherapy concurrent with modern chemotherapy protocols could be tested
in this setting due to the chemo-sensitizing effect and negligible
radio-induced toxicity of fraction doses <0.5 Gy.<br/>Copyright &#xa9;
2018 International Institute of Anticancer Research. All rights reserved.

<42>
Accession Number
623657393
Title
Single-dose intravenous diclofenac for acute postoperative pain in adults.
Source
Cochrane Database of Systematic Reviews. 2018 (8) (no pagination), 2018.
Article Number: CD012498. Date of Publication: 28 Aug 2018.
Author
Mcnicol E.D.; Ferguson M.C.; Schumann R.
Institution
(Mcnicol, Schumann) Tufts Medical Center, Department of Anesthesiology and
Perioperative Medicine, Boston, MA, United States
(Mcnicol) Tufts Medical Center, Department of Pharmacy, Boston, MA, United
States
(Mcnicol) Tufts University School of Medicine, Pain Research, Education
and Policy (PREP) Program, Department of Public Health and Community
Medicine, Boston, MA, United States
(Ferguson) Southern Illinois University Edwardsville, Pharmacy Practice,
Edwardsville, United States
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Postoperative administration of non-steroidal
anti-inflammatory drugs (NSAIDs) reduces patient opioid requirements and,
in turn, reduces the incidence and severity of opioid-induced adverse
events (AEs). Objectives: To assess the analgesic efficacy and adverse
effects of single-dose intravenous diclofenac, compared with placebo or an
active comparator, for moderate to severe postoperative pain in adults.
Search methods: We searched the following databases without language
restrictions: the Cochrane Central Register of Controlled Trials (Cochrane
Register of Studies Online), MEDLINE, and Embase on 22 May 2018. We
checked clinical trials registers and reference lists of retrieved
articles for additional studies. Selection criteria: We included
randomized trials that compared a single postoperative dose of intravenous
diclofenac with placebo or another active treatment, for treating acute
postoperative pain in adults following any surgery. Data collection and
analysis: We used standard methodological procedures expected by Cochrane.
Two review authors independently considered trials for review inclusion,
assessed risk of bias, and extracted data. Our primary outcome was the
number of participants in each arm achieving at least 50% pain relief over
a four- and six-hour period. Our secondary outcomes were time to, and
number of participants using rescue medication; withdrawals due to lack of
efficacy, AEs, and for any cause; and number of participants experiencing
any AE, serious AEs (SAEs), and NSAID-related AEs. We performed a post hoc
analysis of opioid-related AEs, to enable indirect comparisons with other
analyses of postoperative analgesics. For subgroup analysis, we planned to
analyze different doses and formulations of parenteral diclofenac
separately. We assessed the overall quality of the evidence for each
outcome using GRADE and created two 'Summary of findings' tables. Main
results: We included eight studies, involving 1756 participants undergoing
various surgeries (dental, mixed minor, abdominal, and orthopedic), with
20 to 175 participants receiving intravenous diclofenac in each study.
Mean study population ages ranged from 24.5 years to 54.5 years.
Intravenous diclofenac doses varied among and within studies, ranging from
3.75 mg to 75 mg. Five studies assessed newer formulations of parenteral
diclofenac that could be administered as an undiluted intravenous bolus.
Most studies had an unclear risk of bias for several domains and a high
risk of bias due to small sample size. The overall quality of evidence for
each outcome was generally low for reasons including unclear risk of bias
in studies, imprecision, and low event numbers. Primary outcome Three
studies (277 participants) produced a number needed to treat for an
additional beneficial outcome (NNTB) for at least 50% of maximum pain
relief versus placebo of 2.4 (95% confidence interval (CI) 1.9 to 3.1)
over four hours (low-quality evidence). Four studies (436 participants)
produced an NNTB of 3.8 versus placebo (95% CI 2.9 to 5.9) over six hours
(low-quality evidence). No studies provided data for the comparison of
intravenous diclofenac with another NSAID over four hours. At six hours
there was no difference between intravenous diclofenac and another NSAID
(low-quality evidence). Secondary outcomes For secondary efficacy
outcomes, intravenous diclofenac was generally superior to placebo and
similar to other NSAIDs. For time to rescue medication, comparison of
intravenous diclofenac versus placebo demonstrated a median of 226 minutes
for diclofenac versus 80 minutes for placebo (5 studies, 542 participants,
low-quality evidence). There were insufficient data for pooled analysis
for comparisons of diclofenac with another NSAID (very low-quality
evidence). For the number of participants using rescue medication, two
studies (235 participants) compared diclofenac with placebo. The number
needed to treat to prevent one additional harmful event (NNTp) (here, the
need for rescue medication) compared with placebo was 3.0 (2.2 to 4.5,
low-quality evidence). The comparison of diclofenac with another NSAID
included only one study (98 participants). The NNTp was 4.5 (2.5 to 33)
for ketorolac versus diclofenac (very low-quality evidence). The numbers
of participants withdrawing were generally low and inconsistently reported
(very low-quality evidence). Participant withdrawals were: 6% (8/140)
diclofenac versus 5% (7/128) placebo, and 9% (8/87) diclofenac versus 7%
(6/82) another NSAID for lack of efficacy; 2% (4/211) diclofenac versus 0%
(0/198) placebo, and 3% (4/138) diclofenac versus 2% (2/129) another NSAID
due to AEs; and 11% (21/191) diclofenac versus 17% (30/179) placebo, and
18% (21/118) diclofenac versus 15% (17/111) another NSAID for any cause.
Overall adverse event rates were similar between intravenous diclofenac
and placebo (71% in both groups, 2 studies, 296 participants) and between
intravenous diclofenac and another NSAID (55% and 58%, respectively, 2
studies, 265 participants) (low-quality evidence for both comparisons).
Serious and specific AEs were rare, preventing meta-analysis. There were
sufficient data for a dose-effect analysis for our primary outcome for
only one alternative dose, 18.75 mg. Analysis of the highest dose employed
in each study demonstrated a relative benefit compared with placebo of 1.9
(1.4 to 2.4), whereas for the group receiving 18.75 mg, the relative
benefit versus placebo was 1.6 (1.2 to 2.1, 2 studies). Compared to
another NSAID, the high-dose analysis demonstrated a relative benefit of
0.9 (0.8 to 1.1), for the group receiving 18.75 mg, the relative benefit
was 0.78 (0.65 to 0.93). For direct comparison of high dose versus 18.75
mg, the proportion of participants with at least 50% pain relief was 66%
(90/137) for the high-dose arm versus 57% (77/135) in the low-dose arm.
There were insufficient data for subgroup meta-analysis of different
diclofenac formulations. Authors' conclusions: The amount and quality of
evidence for the use of intravenous diclofenac as a treatment for
postoperative pain is low. The available evidence indicates that
postoperative intravenous diclofenac administration offers good pain
relief for the majority of patients, but further research may impact this
estimate. Adverse events appear to occur at a similar rate to other
NSAIDs. Insufficient information is available to assess whether
intravenous diclofenac has a different rate of bleeding, renal
dysfunction, or cardiovascular events versus other NSAIDs. There was
insufficient information to evaluate the efficacy and safety of newer
versus traditional formulations of intravenous diclofenac. There was a
lack of studies in major and cardiovascular surgeries and in elderly
populations, which may be at increased risk for adverse
events.<br/>Copyright &#xa9; 2018 The Cochrane Collaboration.

<43>
Accession Number
2000546852
Title
Does the Use of a Pulmonary Artery Catheter Make a Difference During or
After Cardiac Surgery?.
Source
Heart Lung and Circulation. 27 (8) (pp 952-960), 2018. Date of
Publication: August 2018.
Author
Joseph C.; Garrubba M.; Smith J.A.; Melder A.
Institution
(Joseph, Garrubba, Smith, Melder) Monash Health, Melbourne, Vic, Australia
(Smith) Department of Surgery (School of Clinical Sciences at Monash
Health), Monash University, Melbourne, Vic, Australia
Publisher
Elsevier Ltd
Abstract
Pulmonary artery catheters (PACs) were introduced in 1970. Since then,
their use has steadily increased. However, there have been questions
raised regarding their efficacy for multiple clinical scenarios. The
purpose of this systematic review was to determine the safety and
effectiveness of routine use of PACs post cardiac surgery on mortality,
complications, days in intensive care unit, days in hospital, and costs in
patients undergoing cardiac surgery, or patients who end up in an
intensive care unit. Methods: Medline, All EBM, EMBASE and Cumulative
Index to Nursing and Allied Health Literature (CINAHL) databases were
searched using predetermined search terms. Google, British Medical Journal
(BMJ) Best Practice, and the National Institute for Clinical Excellence
(NICE) were also searched. All searches were from 2012 to current to
update a previous review from 2013. Studies were included if they involved
adult cardiac surgery patients, or intensive care unit (ICU) patients
requiring haemodynamic monitoring. All other surgical patients were
excluded. Results: Six articles were included in this review. Of the six
articles, five were randomised or observational studies, and one was an
expert recommendation. For all cardiac surgery patients and patients
having coronary artery bypass grafting, there was no difference in
mortality. There was an increase in mortality in high-risk cardiac surgery
patients, who had a PAC. For patients following coronary artery bypass
grafting, there was no difference in ICU length of stay (LOS) but for
patients following cardiac surgery total length of hospital stay >30 days
was greater in patients with a PAC. For patients following coronary artery
bypass grafting, in-hospital costs for the entire hospitalisation were
higher in patients with a PAC and, there was no difference in
complications between PAC and a central venous catheter use. Overall, PACs
were not a predictor of worse outcomes. Conclusion: This review revealed
that PAC use was associated with a poorer outcome in a small subset of
cardiac surgical patients but in the majority of patients PAC use made no
difference to outcome. Further studies are required to confirm the true
safety and efficacy of PAC use in cardiac surgery.<br/>Copyright &#xa9;
2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<44>
Accession Number
624045530
Title
The Impact of Public Performance Reporting on Market Share, Mortality, and
Patient Mix Outcomes Associated with Coronary Artery Bypass Grafts and
Percutaneous Coronary Interventions (2000-2016).
Source
Medical Care. 56 (11) (pp 956-966), 2018. Date of Publication: 01 Nov
2018.
Author
Dunt D.; Prang K.-H.; Sabanovic H.; Kelaher M.
Institution
(Dunt, Prang, Sabanovic, Kelaher) Centre for Health Policy, Melbourne
School of Population and Global Health, University of Melbourne,
Parkville, VIC 3010, Australia
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: Public performance reporting (PPR) of coronary artery bypass
graft (CABG) and percutaneous coronary intervention (PCI) outcomes aim to
improve the quality of care in hospitals, surgeons and to inform consumer
choice. Past CABG and PCI studies have showed mixed effects of PPR on
quality and selection. The aim of this study was to undertake a systematic
review and meta-analysis of the impact of PPR on market share, mortality,
and patient mix outcomes associated with CABG and PCI. Methods: Six online
databases and 8 previous reviews were searched for the period 2000-2016.
Data extraction, quality assessment, systematic critical synthesis, and
meta-analysis (where possible) were carried out on included studies.
Results: In total, 22 relevant articles covering mortality (n=19), patient
mix (n=14), and market share (n=6) outcomes were identified. Meta-analyses
showed that PPR led to a near but not significant reduction in short-term
mortality for both CABG and PCI. PPR on CABG showed a positive effect on
market share for hospitals (3 of 6 studies) and low-performing surgeons (2
of 2 studies). Five of 6 PCI studies found that high-risk patients were
less likely to be treated in States with PPR. Conclusions: There is some
evidence that PPR reduces mortality rates in CABG/PCI-treated patients.
The significance of there being no strong evidence, in the period
2000-2016, should be considered. There is need for both further
development of PPR practice and further research into the intended and
unintended consequences of PPR.<br/>Copyright &#xa9; 2018 The Author(s).
Published by Wolters Kluwer Health, Inc.

<45>
Accession Number
622796742
Title
Subannular reconstruction in secondary mitral regurgitation: A
meta-analysis.
Source
Heart. 104 (21) (pp 1783-1790), 2018. Date of Publication: 01 Nov 2018.
Author
Harmel E.K.; Reichenspurner H.; Girdauskas E.
Institution
(Harmel, Reichenspurner, Girdauskas) Department of Cardiothoracic Surgery,
University Heart Center Hamburg, Hamburg 20251, Germany
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Mitral valve repair using an undersized complete annuloplasty
ring in secondary mitral regurgitation with restricted leaflet motion
during systole (Carpentier's surgical classification of mitral valve
pathology: type IIIb) only inadequately addresses the underlying left
ventricular disease. This may lead to an ongoing ventricular remodelling
and progressive papillary muscle displacement with increasing leaflet
tethering. Several subannular techniques have been proposed to counteract
the reoccurrence of mitral regurgitation after mitral valve repair. We
aimed to evaluate the potential additive effect of such subannular
techniques on the late reoccurrence rate of secondary mitral
regurgitation. Methods Systematic literature review and meta-analysis were
performed on PubMed, Embase and Google Scholar for studies published up to
March 2016 and reporting late reoccurrence of mitral regurgitation after
mitral valve repair using standard annuloplasty (control group) versus
annuloplasty with subannular correction (study group) cohorts. Primary
endpoint was late reoccurrence of mitral regurgitation >=2 after surgical
mitral valve repair, as defined by follow-up echocardiography. Results The
cumulative number of 1093 patients in 12 included studies served as our
study population. A total of 743 patients underwent combined mitral valve
repair including annuloplasty and subannular manoeuvre (ie, study group),
while the remaining 350 patients underwent an isolated ring annuloplasty
(ie, control group). Secondary mitral regurgitation was caused by
ischaemic heart disease in 733/743 patients in the study group and 334/350
patients in the control group. Mean echocardiographic follow-up was
42.7+/-13.9 months. Pooled outcome analysis demonstrated that the
combination of subannular repair with ring annuloplasty was associated
with a significantly lower reoccurrence rate of mitral regurgitation >=2
as compared with annuloplasty alone (OR 0.27, 95% CI 0.19 to 0.38,
P=0.0001). Conclusion The combination of subannular reconstruction and
mitral valve annuloplasty is associated with a lower late reoccurrence of
mitral regurgitation after surgical mitral valve repair, as compared with
annuloplasty alone.<br/>Copyright &#xa9; 2018 Article author(s) (or their
employer(s) unless otherwise stated in the text of the article). All
rights reserved. No commercial use is permitted unless otherwise expressly
granted.

<46>
Accession Number
624425903
Title
Association between Bariatric Surgery and Macrovascular Disease Outcomes
in Patients with Type 2 Diabetes and Severe Obesity.
Source
JAMA - Journal of the American Medical Association. 320 (15) (pp
1570-1582), 2018. Date of Publication: 16 Oct 2018.
Author
Fisher D.P.; Johnson E.; Haneuse S.; Arterburn D.; Coleman K.J.; O'Connor
P.J.; O'Brien R.; Bogart A.; Theis M.K.; Anau J.; Schroeder E.B.; Sidney
S.
Institution
(Fisher, O'Brien) Permanente Medical Group, Kaiser Permanente Northern
California, Oakland, United States
(Johnson, Arterburn, Theis, Anau) Kaiser Permanente Washington Health
Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA 98101, United
States
(Haneuse) Department of Biostatistics, Harvard T.H. Chan School of Public
Health, Boston, MA, United States
(Coleman) Department of Research and Evaluation, Kaiser Permanente
Southern California, Pasadena, United States
(O'Connor) HealthPartners Institute, HealthPartners, Minneapolis, MN,
United States
(Bogart) RAND Corporation, Santa Monica, CA, United States
(Schroeder) Institute for Health Research, Kaiser Permanente Colorado,
Aurora, United States
(Sidney) Division of Research, Kaiser Permanente Northern California,
Oakland, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Macrovascular disease is a leading cause of morbidity and
mortality for patients with type 2 diabetes, and medical management,
including lifestyle changes, may not be successful at lowering risk.
Objective: To investigate the relationship between bariatric surgery and
incident macrovascular (coronary artery disease and cerebrovascular
diseases) events in patients with severe obesity and type 2 diabetes.
Design, Setting, and Participants: In this retrospective, matched cohort
study, patients with severe obesity (body mass index >=35) aged 19 to 79
years with diabetes who underwent bariatric surgery from 2005 to 2011 in 4
integrated health systems in the United States (n = 5301) were matched to
14934 control patients on site, age, sex, body mass index, hemoglobin
A<inf>1c</inf>, insulin use, observed diabetes duration, and prior health
care utilization, with follow-up through September 2015. Exposures:
Bariatric procedures (76% Roux-en-Y gastric bypass, 17% sleeve
gastrectomy, and 7% adjustable gastric banding) were compared with usual
care for diabetes. Main Outcomes and Measures: Multivariable-adjusted Cox
regression analysis investigated time to incident macrovascular disease
(defined as first occurrence of coronary artery disease [acute myocardial
infarction, unstable angina, percutaneous coronary intervention, or
coronary artery bypass grafting] or cerebrovascular events [ischemic
stroke, hemorrhagic stroke, carotid stenting, or carotid endarterectomy]).
Secondary outcomes included coronary artery disease and cerebrovascular
outcomes separately. Results: Among a combined 20235 surgical and
nonsurgical patients, the mean (SD) age was 50 (10) years; 76% of the
surgical and 75% of the nonsurgical patients were female; and the baseline
mean (SD) body mass index was 44.7 (6.9) and 43.8 (6.7) in the surgical
and nonsurgical groups, respectively. At the end of the study period,
there were 106 macrovascular events in surgical patients (including 37
cerebrovascular and 78 coronary artery events over a median of 4.7 years;
interquartile range, 3.2-6.2 years) and 596 events in the matched control
patients (including 227 cerebrovascular and 398 coronary artery events
over a median of 4.6 years; interquartile range, 3.1-6.1 years). Bariatric
surgery was associated with a lower composite incidence of macrovascular
events at 5 years (2.1% in the surgical group vs 4.3% in the nonsurgical
group; hazard ratio, 0.60 [95% CI, 0.42-0.86]), as well as a lower
incidence of coronary artery disease (1.6% in the surgical group vs 2.8%
in the nonsurgical group; hazard ratio, 0.64 [95% CI, 0.42-0.99]). The
incidence of cerebrovascular disease was not significantly different
between groups at 5 years (0.7% in the surgical group vs 1.7% in the
nonsurgical group; hazard ratio, 0.69 [95% CI, 0.38-1.25]). Conclusions
and Relevance: In this observational study of patients with type 2
diabetes and severe obesity who underwent surgery, compared with those who
did not undergo surgery, bariatric surgery was associated with a lower
risk of macrovascular outcomes. The findings require confirmation in
randomized clinical trials. Health care professionals should engage
patients with severe obesity and type 2 diabetes in a shared decision
making conversation about the potential role of bariatric surgery in the
prevention of macrovascular events.<br/>Copyright &#xa9; 2018 American
Medical Association. All rights reserved.

<47>
Accession Number
2001193009
Title
Ultrathin-strut, biodegradable-polymer, sirolimus-eluting stents versus
thin-strut, durable-polymer, everolimus-eluting stents for percutaneous
coronary revascularisation: 5-year outcomes of the BIOSCIENCE randomised
trial.
Source
The Lancet. 392 (10149) (pp 737-746), 2018. Date of Publication: 1 - 7
September 2018.
Author
Pilgrim T.; Piccolo R.; Heg D.; Roffi M.; Tuller D.; Muller O.; Moarof I.;
Siontis G.C.M.; Cook S.; Weilenmann D.; Kaiser C.; Cuculi F.; Hunziker L.;
Eberli F.R.; Juni P.; Windecker S.
Institution
(Pilgrim, Siontis, Hunziker, Windecker) Department of Cardiology,
Inselspital, University of Bern, Bern, Switzerland
(Heg) Institute of Social and Preventive Medicine, Inselspital, University
of Bern, Bern, Switzerland
(Heg) Clinical Trials Unit, Inselspital, University of Bern, Bern,
Switzerland
(Piccolo) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University, Naples, Italy
(Roffi) Department of Cardiology, Geneva University Hospital, Geneva,
Switzerland
(Tuller, Eberli) Department of Cardiology, Triemlispital, Zurich,
Switzerland
(Muller) Department of Cardiology, Lausanne University Hospital, Lausanne,
Switzerland
(Moarof) Department of Cardiology, Kantonsspital Aarau, Aarau, Switzerland
(Cook) Department of Cardiology, University and Hospital Fribourg,
Fribourg, Switzerland
(Weilenmann) Department of Cardiology, Kantonsspital St Gallen, St Gallen,
Switzerland
(Kaiser) Department of Cardiology, University Hospital Basel, Basel,
Switzerland
(Cuculi) Department of Cardiology, Luzerner Kantonsspital, Luzern,
Switzerland
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St Michael's Hospital, Department of Medicine and Institute of Health
Policy, Management and Evaluation, University of Toronto, Toronto, ON,
Canada
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Drug-eluting stents combining an ultrathin cobalt-chromium
stent platform with a biodegradable polymer eluting sirolimus have been
shown to be non-inferior or superior to thin-strut, durable-polymer,
everolimus-eluting stents in terms of 1 year safety and efficacy outcomes.
Methods: In the randomised, single-blind, multicentre, non-inferiority
BIOSCIENCE trial, we compared biodegradable-polymer sirolimus-eluting
stents with durable-polymer everolimus-eluting stents in patients with
chronic stable coronary artery disease or acute coronary syndromes. Here,
we assess the final 5-year clinical outcomes of BIOSCIENCE with regards to
the primary clinical outcome of target lesion failure, which was a
composite of cardiac death, target vessel myocardial infarction, and
clinically indicated target lesion revascularisation. The primary analysis
was done by intention to treat. The BIOSCIENCE trial is registered with
ClinicalTrials.gov, number NCT01443104. Findings: 2008 (95%) of 2119
patients recruited between March 1, 2012, and May 31, 2013, completed 5
years of follow-up. Target lesion failure occurred in 198 patients
(cumulative incidence 20.2%) treated with biodegradable-polymer
sirolimus-eluting stents and in 189 patients (18.8%) treated with
durable-polymer everolimus-eluting stents (rate ratio [RR] 1.07, 95% CI
0.88-1.31; p=0.487). All-cause mortality was significantly higher in
patients treated with biodegradable-polymer sirolimus-eluting stents than
in those treated with durable-polymer everolimus-eluting stents (14.1% vs
10.3%; RR 1.36, 95% CI 1.06-1.75; p=0.017), driven by a difference in
non-cardiovascular deaths. We observed no difference between groups in
cumulative incidence of definite stent thrombosis at 5 years (1.6% in both
groups; 1.02, 0.51-2.05; p=0.950). Interpretation: 5-year risk of target
lesion failure among all-comer patients undergoing percutaneous coronary
intervention is similar after implantation of ultrathin-strut,
biodegradable-polymer, sirolimus-eluting stents or thin-strut,
durable-polymer, everolimus-eluting stents. Higher incidences of all-cause
and non-cardiovascular mortality in patients treated with
biodegradable-polymer stents eluting sirolimus than in those treated with
durable-polymer stents eluting everolimus warrant careful observation in
ongoing clinical trials. Funding: Clinical Trials Unit of the University
of Bern and Biotronik.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<48>
Accession Number
624005634
Title
A radiological and anatomic examination of intralaminar screws in the
thoracic spine-a theoretical feasibility study.
Source
Acta Neurochirurgica. 160 (11) (pp 2229-2236), 2018. Date of Publication:
01 Nov 2018.
Author
Muller J.; Muller J.-U.; Koppe T.; Nowak S.; Schroeder H.W.S.; Baldauf J.
Institution
(Muller, Muller, Nowak, Schroeder, Baldauf) Department of Neurosurgery,
E.-M.-Arndt University, Greifswald, Germany
(Koppe) Institute of Anatomy and Cell Biology, E.-M.-Arndt University,
Greifswald, Germany
Publisher
Springer-Verlag Wien (E-mail: michaela.bolli@springer.at)
Abstract
Background: Failure of pedicle screws and anatomical variations which
prevent pedicle screw implantation make the search for an alternative to
pedicle screws in thoracic spine surgery necessary. To date, published
data have shown that intralaminar screws could be a possible way of
fixation. Object of this study is a systematic examination of the
feasibility of lamina screws in the whole thoracic spine. Methods: Fifty
females and 50 males (age 20 to 60 years) who underwent a polytrauma CT
from 2010 to 2012 were randomly selected. Patients with injury of the
thoracic spine, trauma-independent deformity, or dysplasia of the thoracic
spine were excluded. A three-dimensional reconstruction of the thoracic
spine was performed from the data set. The anatomical data of the lamina
were measured under consideration of the potential trajectory of a laminar
screw. The caliber of the corresponding pedicle was measured as well.
Results: The diameters of the lamina show a decline in superior-inferior
direction (0.66 cm in T1 to 0.60 cm in T12 in males, 0.62 to 0.56 cm in
females). Diameters of pedicle and lamina show no correlation. Twenty
percent of the pedicles have a hypoplasia with a diameter of less than 0.5
cm. However, in these vertebrae, 62.3% of the laminae would be suitable
for 0.4-cm lamina screws. Only in 2.75% of the vertebral bodies, there was
no possibility for intralaminar or pedicle screws. Conclusions: This study
shows that it is possible to use intralaminar screws in the thoracic spine
in most of patients.<br/>Copyright &#xa9; 2018, Springer-Verlag GmbH
Austria, part of Springer Nature.

<49>
Accession Number
619230288
Title
Rivaroxaban with or without aspirin in patients with stable coronary
artery disease: an international, randomised, double-blind,
placebo-controlled trial.
Source
The Lancet. 391 (10117) (pp 205-218), 2018. Date of Publication: 20 - 26
January 2018.
Author
Connolly S.J.; Eikelboom J.W.; Bosch J.; Dagenais G.; Dyal L.; Lanas F.;
Metsarinne K.; O'Donnell M.; Dans A.L.; Ha J.-W.; Parkhomenko A.N.; Avezum
A.A.; Lonn E.; Lisheng L.; Torp-Pedersen C.; Widimsky P.; Maggioni A.P.;
Felix C.; Keltai K.; Hori M.; Guzik T.J.; Bhatt D.L.; Branch K.R.H.; Cook
Bruns N.; Berkowitz S.D.; Anand S.S.; Varigos J.D.; Fox K.A.A.; Yusuf S.;
SALA J.; CARTASEGNA L.U.I.S.; VICO M.; HOMINAL M.A.; HASBANI E.; CACCAVO
A.; ZAIDMAN C.; VOGEL D.; HRABAR A.; SCHYGIEL P.O.; CUNEO C.; LUQUEZ
H.U.G.O.; MACKINNON I.J.; AHUAD GUERRERO R.A.; COSTABEL J.P.; BARTOLACCI
I.P.; MONTANA O.; BARBIERI M.; GOMEZ VILAMAJO O.; GARCIA DURAN R.O.;
SCHIAVI L.B.; GARRIDO M.; INGARAMO A.; BORDONAVA A.P.; PELAGAGGE M.J.;
NOVARETTO L.; ALBISU DI GENNERO J.P.; IBANEZ SAGGIA L.M.; ALVAREZ M.; VITA
N.A.; MACIN S.M.; DRAN R.D.; CARDONA M.; GUZMAN L.U.I.S.; SARJANOVICH
R.J.; CUADRADO J.; NANI S.; LITVAK BRUNO M.R.; CHACON C.; MAFFEI L.E.;
GRINFELD D.; VENSENTINI N.; MAJUL C.R.; LUCIARDI H.L.; GONZALEZ COLASO
P.D.C.; FERRE PACORA F.A.; VAN DEN HEUVEL P.A.U.L.; VERHAMME P.; ECTOR
B.A.V.O.; DEBONNAIRE P.; VAN DE BORNE P.; LEROY J.E.A.N.; SCHROE H.;
VRANCKX P.; ELEGEERT I.V.A.N.; HOFFER E.; DUJARDIN K.A.R.L.; INDIO DO
BRASIL C.; PRECOMA D.; ABRANTES J.A.; MANENTI E.; REIS G.; SARAIVA
J.O.S.E.; MAIA L.; HERNANDES M.; ROSSI P.; ROSSI DOS SANTOS F.; ZIMMERMANN
S.L.; RECH R.; ABIB JR E.; LEAES P.; BOTELHO R.; DUTRA O.; SOUZA W.;
BRAILE M.; IZUKAWA N.I.L.O.; NICOLAU J.C.; TANAJURA L.F.; SERRANO JUNIOR
C.V.; MINELLI C.; NASI L.A.; OLIVEIRA L.; DE CARVALHO CANTARELLI M.J.;
TYTUS R.; PANDEY S.; LONN E.V.A.; CHA J.; VIZEL S.A.U.L.; BABAPULLE M.;
LAMY A.; SAUNDERS K.; BERLINGIERI J.; KIAII B.O.B.; BHARGAVA R.; MEHTA P.;
HILL L.; FELL D.; LAM A.N.D.Y.; AL-QOOFI F.; BROWN C.; PETRELLA R.; RICCI
J.A.; GLANZ A.; NOISEUX N.; BAINEY K.; MERALI F.; HEFFERNAN M.; DELLA
SIEGA A.; DAGENAIS G.R.; DAGENAIS F.; BRULOTTE S.; NGUYEN M.; HARTLEIB M.;
GUZMAN R.; BOURGEOIS R.; RUPKA D.; KHAYKIN Y.; GOSSELIN G.; HUYNH
T.H.A.O.; PILON C.; CAMPEAU J.E.A.N.; PICHETTE F.; DIAZ A.; JOHNSTON J.;
SHUKLE P.; HIRSCH G.; RHEAULT P.A.U.L.; CZARNECKI W.; ROY A.; NAWAZ
S.H.A.H.; FREMES S.; SHUKLA D.; JANO G.; COBOS J.L.; CORBALAN R.; MEDINA
M.; NAHUELPAN L.; RAFFO C.; PEREZ L.U.I.S.; POTTHOFF S.; STOCKINS B.;
SEPULVEDA P.; PINCETTI C.; VEJAR M.; TIAN H.; WU X.; KE Y.; JIA K.; YIN
P.; WANG Z.; YU L.; WU S.; WU Z.; LIU S.W.; BAI X.J.; ZHENG Y.A.N.G.; YANG
P.I.N.G.; YANG Y.M.; ZHANG J.; GE J.; CHEN X.P.; HU T.H.; ZHANG R.; ZHENG
Z.H.E.; CHEN X.I.N.; TAO L.; LI J.; HUANG W.; FU G.; LI C.; DONG Y.; WANG
C.; ZHOU X.; KONG Y.E.; SOTOMAYOR A.; ACCINI MENDOZA J.L.; CASTILLO H.;
URINA M.; AROCA G.; PEREZ M.; MOLINA DE SALAZAR D.I.; SANCHEZ VALLEJO G.;
FERNANDO M.J.; GARCIA H.; GARCIA L.H.; ARCOS E.; GOMEZ J.U.A.N.; CUERVO
MILLAN F.; TRUJILLO DADA F.A.; VESGA B.; MORENO SILGADO G.A.; ZIDKOVA
E.V.A.; LUBANDA J.-C.; KALETOVA M.; KRYZA R.; MARCINEK G.; RICHTER M.;
SPINAR J.; MATUSKA J.I.R.I.; TESAK M.; MOTOVSKA Z.; BRANNY M.; MALY
J.I.R.I.; MALY M.; WIENDL M.; FOLTYNOVA CAISOVA L.; SLABY J.; VOJTISEK
P.E.T.R.; PIRK J.A.N.; SPINAROVA L.; BENESOVA M.; CANADYOVA J.; HOMZA M.;
FLORIAN J.; POLASEK R.; COUFAL Z.; SKALNIKOVA V.; BRAT R.; BRTKO M.;
JANSKY P.E.T.R.; LINDNER J.; MARCIAN P.; STRAKA Z.; TRETINA M.; DUARTE
Y.C.; POW CHON LONG F.; SANCHEZ M.; LOPEZ J.O.S.E.; PERUGACHI C.; MARMOL
R.; TRUJILLO F.; TERAN P.; TUOMILEHTO J.; TUOMILEHTO H.; TUOMINEN M.-L.;
KANTOLA I.; STEG G.; ABOYANS V.; LECLERCQ F.; FERRARI E.; BOCCARA F.;
MESSAS E.; MISMETTI P.; SEVESTRE M.A.; CAYLA G.; MOTREFF P.; STOERK S.;
DUENGEN H.A.N.S.-D.I.R.K.; STELLBRINK C.; GUEROCAK O.; KADEL C.;
BRAUN-DULLAEUS R.; JESERICH M.; OPITZ C.; VOEHRINGER H.-F.; APPEL K.-F.;
WINKELMANN B.; DORSEL T.; NIKOL S.; DARIUS H.; RANFT J.; SCHELLONG S.;
JUNGMAIR W.; DAVIERWALA P.; VORPAHL M.A.R.C.; BAJNOK L.; LASZLO Z.; NOORI
E.; VERESS G.; VERTES A.; ZSARY A.; KIS E.R.N.O.; KORANYI L.; BAKAI J.;
BODA Z.; POOR F.; JARAI Z.; KEMENY V.; BARTON J.O.H.N.; MCADAM B.; MURPHY
A.; CREAN P.; MAHON N.; CURTIN R.; MACNEILL B.; DINNEEN S.E.A.N.; HALABI
M.; ZIMLICHMAN R.; ZELTSER D.; TURGEMAN Y.O.A.V.; KLAINMAN E.; LEWIS B.;
KATZ A.M.O.S.; ATAR S.; NIKOLSKY E.; BOSI S.; NALDI M.; FAGGIANO P.; ROBBA
D.; MOS L.; SINAGRA G.; COSMI F.; OLTRONA VISCONTI L.; CARMINE D.M.; DI
PASQUALE G.; DI BIASE M.; MANDORLA S.A.R.A.; BERNARDINANGELI M.; PICCINNI
G.C.; GULIZIA M.M.; GALVANI M.; VENTURI F.; MOROCUTTI G.; BALDIN M.G.;
OLIVIERI C.; PERNA G.P.; CIRRINCIONE V.; KANNO T.; DAIDA H.; OZAKI Y.;
MIYAMOTO N.; HIGASHIUE S.; DOMAE H.; HOSOKAWA S.; KOBAYASHI H.; KURAMOCHI
T.; FUJII K.; MIZUTOMI K.; SAKU K.; KIMURA K.; HIGUCHI Y.; ABE M.; OKUDA
H.; NODA T.; MITA T.; HIRAYAMA A.; ONAKA H.; INOKO M.; HIROKAMI M.; OKUBO
M.; AKATSUKA Y.; IMAMAKI M.; KAMIYA H.; MANITA M.; HIMI T.; UENO H.;
HISAMATSU Y.U.J.I.; AKO J.; NISHINO Y.; KAWAKAMI H.; YAMADA Y.; KORETSUNE
Y.; YAMADA T.; YOSHIDA T.; SHIMOMURA H.; KINOSHITA N.; TAKAHASHI A.;
YUSOFF K.; WAN AHMAD W.A.; ABU HASSAN M.R.; KASIM S.; ABDUL RAHIM A.A.;
MOHD ZAMRIN D.; MACHIDA M.; HIGASHINO Y.; UTSU N.; NAKANO A.; NAKAMURA S.;
HASHIMOTO T.; ANDO K.; SAKAMOTO T.; PRINS F.J.; LOK D.I.R.K.; MILHOUS
J.G.-J.; VIERGEVER E.R.I.C.; WILLEMS F.; SWART H.E.N.K.; ALINGS M.;
BREEDVELD R.O.B.; DE VRIES K.E.E.S.-J.A.N.; VAN DER BORGH R.; OEI F.;
ZOET-NUGTEREN S.; KRAGTEN H.A.N.S.; HERRMAN J.P.; VAN BERGEN P.A.U.L.;
GOSSELINK M.; HOEKSTRA E.; ZEGERS E.; RONNER E.; DEN HARTOG F.; BARTELS
G.; NIEROP P.; VAN DER ZWAAN C.O.E.N.; VAN ECK J.; VAN GORSELEN E.;
GROENEMEIJER B.; HOOGSLAG P.; DE GROOT M.R.; LOYOLA A.; SULIT D.J.; REY
N.; ABOLA M.T.; MORALES D.; PALOMARES E.; ABAT M.E.; ROGELIO G.; CHUA P.;
DEL PILAR J.C.; ALCARAZ J.D.; EBO G.; TIRADOR L.; CRUZ J.; ANONUEVO
J.O.H.N.; PITARGUE A.; JANION M.; GUZIK T.; GAJOS G.; ZABOWKA M.;
RYNKIEWICZ A.; BRONCEL M.; SZUBA A.; CZARNECKA D.; MAGA P.; STRAZHESKO I.;
VASYUK Y.U.R.Y.; SIZOVA Z.; POZDNYAKOV Y.U.R.Y.; BARBARASH O.L.G.A.;
VOEVODA M.; POPONINA T.; REPIN A.; OSIPOVA I.; EFREMUSHKINA A.N.N.A.;
NOVIKOVA N.I.N.A.; AVERKOV O.L.E.G.; ZATEYSHCHIKOV D.; VERTKIN A.; AUSHEVA
A.Z.A.; COMMERFORD P.; SEEDAT S.; VAN ZYL L.; ENGELBRECHT J.A.N.; MAKOTOKO
E.M.; PRETORIUS C.E.; MOHAMED Z.A.I.D.; HORAK A.; MABIN T.; KLUG E.R.I.C.;
BAE J.A.N.G.-H.O.; KIM C.; KIM C.H.O.N.G.-J.I.N.; KIM D.O.N.G.-S.O.O.; KIM
Y.J.; JOO S.; HA J.O.N.G.-W.O.N.; PARK C.S.; KIM J.Y.; KIM
Y.O.U.N.G.-K.W.O.N.; JARNERT C.; MOOE T.; DELLBORG M.; TORSTENSSON I.;
ALBERTSSON P.E.R.; JOHANSSON L.A.R.S.; AL-KHALILI F.; ALMROTH H.;
ANDERSSON T.; PANTEV E.M.I.L.; TENGMARK B.E.N.G.T.-O.L.O.V.; LIU B.O.;
RASMANIS G.; WAHLGREN C.-M.; MOCCETTI T.; PARKHOMENKO A.; TSELUYKO
V.I.R.A.; VOLKOV V.; KOVAL O.; KONONENKO L.; PROKHOROV O.; VDOVYCHENKO V.;
BAZYLEVYCH A.; RUDENKO L.; VIZIR V.; KARPENKO O.; MALYNOVSKY Y.; KOVAL V.;
STOROZHUK B.; COTTON J.; VENKATARAMAN A.S.O.K.; MORIARTY A.; CONNOLLY D.;
DAVEY P.; SENIOR R.O.X.Y.; BIRDI I.; CALVERT J.O.H.N.; DONNELLY P.;
TREVELYAN J.; CARTER J.; PEACE A.; AUSTIN D.; KUKREJA N.; HILTON T.;
SRIVASTAVA S.; WALSH R.; FIELDS R.; HAKAS J.; PORTNAY E.; GOGIA H.;
SALACATA A.; HUNTER J.J.; BACHARACH J.M.; SHAMMAS N.; SURESH D.; SCHNEIDER
R.; GURBEL P.A.U.L.; BANERJEE S.; GRENA P.A.U.L.; BEDWELL N.O.E.L.; SLOAN
S.; LUPOVITCH S.; SONI A.; GIBSON K.; SANGRIGOLI R.; MEHTA R.; I-HSUAN
TSAI P.; GILLESPIE E.V.E.; DEMPSEY S.; HAMROFF G.; BLACK R.; LADER E.;
KOSTIS J.B.; BITTNER V.E.R.A.; MCGUINN W.; BRANCH K.; MALHOTRA V.;
MICHAELSON S.; VACANTE M.; MCCORMICK M.; ARIMIE R.; CAMP A.L.A.N.; DAGHER
G.; KOSHY N.M.; THEW S.; COSTELLO F.; HEIMAN M.A.R.K.; CHILTON R.; MORAN
M.; ADLER F.; COMEROTA A.; SEIWERT A.; FRENCH W.; SEROTA H.; HARRISON R.;
BAKAEEN F.; OMER S.; CHANDRA L.; WHELAN A.L.A.N.; BOYLE A.;
ROBERTS-THOMSON P.; ROGERS J.; CARROLL P.; COLQUHOUN D.; SHAW J.; BLOMBERY
P.; AMERENA J.O.H.N.; HII C.; ROYSE A.; SINGH B.; SELVANAYAGAM J.; JANSEN
S.; LO W.; HAMMETT C.; POULTER R.; NARASIMHAN S.; WIGGERS H.; NIELSEN H.;
GISLASON G.; KOBER L.A.R.S.; HOULIND K.I.M.; BOENELYKKE SOERENSEN V.;
DIXEN U.; REFSGAARD J.E.N.S.; ZEUTHEN E.; SOEGAARD P.; HRANAI M.; GASPAR
L.; PELLA D.; HATALOVA K.; DROZDAKOVA E.; COMAN I.O.A.N.; DIMULESCU D.;
VINEREANU D.; CINTEZA M.; SINESCU C.; ARSENESCU C.; BENEDEK I.M.R.E.;
BOBESCU E.; DOBREANU D.A.N.; GAITA D.A.N.; IANCU A.; ILIESIU A.; LIGHEZAN
D.; PETRESCU L.; PIRVU O.; TEODORESCU I.; TESLOIANU D.A.N.; VINTILA M.M.;
CHIONCEL O.
Institution
(Connolly, Eikelboom, Dyal, Lonn, Anand, Yusuf) Population Health Research
Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON,
Canada
(Bosch) School of Rehabilitation Science, McMaster University, Hamilton,
ON, Canada
(Dagenais) Institut Universitaire de Cardiologie et Pneumologie de Quebec,
Quebec, QC, Canada
(Lanas) Universidad de la Frontera, Temuco, Chile
(Metsarinne) Department of Medicine, Turku University Central Hospital and
Turku University, Turku, Finland
(O'Donnell) Department of Medicine, National University of Ireland,
Galway, Ireland
(Dans) Department of Medicine, University of Philippines, Manila,
Philippines
(Ha) Yonsei University College of Medicine, Seoul, South Korea
(Parkhomenko) Institute of Cardiology, Kiev, Ukraine
(Avezum) Instituto Dante Pazzanese de Cardiologia & University Santo
Amaro, Sao Paulo, Brazil
(Lisheng) FuWai Hospital, CAMS, Beijing, China
(Torp-Pedersen) University of Aalborg, Aalborg, Denmark
(Widimsky) Charles University, Prague, Czech Republic
(Maggioni) ANMCO Research Center, Florence, Italy
(Felix) Universidad Tecnologica Equinoccial, Facultad de Ciencias de la
Salud Eugenio, Espejo, Quito, Ecuador
(Keltai) Department of Medicine, Semmelweis University, Budapest, Hungary
(Hori) Osaka International Cancer Institute, Osaka, Japan
(Yusoff) Universiti Teknologi Mara, Selangor, Malaysia
(Guzik) Collegium Medicum Jagiellonian University, Krakow, Poland
(Guzik) University of Glasgow, Glasgow, United Kingdom
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center and Harvard
Medical School, Boston, MA, United States
(Branch) Department of Medicine, University of Washington Medical Centre,
Seattle, WA, United States
(Cook Bruns) Bayer AG, Wuppertal, Germany
(Berkowitz) Bayer AG, Parsippany, NJ, United States
(Varigos) Monash University, Melbourne, VIC, Australia
(Fox) Department of Medicine, University of Edinburgh, Edinburgh, United
Kingdom
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Coronary artery disease is a major cause of morbidity and
mortality worldwide, and is a consequence of acute thrombotic events
involving activation of platelets and coagulation proteins. Factor Xa
inhibitors and aspirin each reduce thrombotic events but have not yet been
tested in combination or against each other in patients with stable
coronary artery disease. Methods: In this multicentre, double-blind,
randomised, placebo-controlled, outpatient trial, patients with stable
coronary artery disease or peripheral artery disease were recruited at 602
hospitals, clinics, or community centres in 33 countries. This paper
reports on patients with coronary artery disease. Eligible patients with
coronary artery disease had to have had a myocardial infarction in the
past 20 years, multi-vessel coronary artery disease, history of stable or
unstable angina, previous multi-vessel percutaneous coronary intervention,
or previous multi-vessel coronary artery bypass graft surgery. After a
30-day run in period, patients were randomly assigned (1:1:1) to receive
rivaroxaban (2.5 mg orally twice a day) plus aspirin (100 mg once a day),
rivaroxaban alone (5 mg orally twice a day), or aspirin alone (100 mg
orally once a day). Randomisation was computer generated. Each treatment
group was double dummy, and the patients, investigators, and central study
staff were masked to treatment allocation. The primary outcome of the
COMPASS trial was the occurrence of myocardial infarction, stroke, or
cardiovascular death. This trial is registered with ClinicalTrials.gov,
number NCT01776424, and is closed to new participants. Findings: Between
March 12, 2013, and May 10, 2016, 27 395 patients were enrolled to the
COMPASS trial, of whom 24 824 patients had stable coronary artery disease
from 558 centres. The combination of rivaroxaban plus aspirin reduced the
primary outcome more than aspirin alone (347 [4%] of 8313 vs 460 [6%] of
8261; hazard ratio [HR] 0.74, 95% CI 0.65-0.86, p<0.0001). By comparison,
treatment with rivaroxaban alone did not significantly improve the primary
outcome when compared with treatment with aspirin alone (411 [5%] of 8250
vs 460 [6%] of 8261; HR 0.89, 95% CI 0.78-1.02, p=0.094). Combined
rivaroxaban plus aspirin treatment resulted in more major bleeds than
treatment with aspirin alone (263 [3%] of 8313 vs 158 [2%] of 8261; HR
1.66, 95% CI 1.37-2.03, p<0.0001), and similarly, more bleeds were seen in
the rivaroxaban alone group than in the aspirin alone group (236 [3%] of
8250 vs 158 [2%] of 8261; HR 1.51, 95% CI 1.23-1.84, p<0.0001). The most
common site of major bleeding was gastrointestinal, occurring in 130 [2%]
patients who received combined rivaroxaban plus aspirin, in 84 [1%]
patients who received rivaroxaban alone, and in 61 [1%] patients who
received aspirin alone. Rivaroxaban plus aspirin reduced mortality when
compared with aspirin alone (262 [3%] of 8313 vs 339 [4%] of 8261; HR
0.77, 95% CI 0.65-0.90, p=0.0012). Interpretation: In patients with stable
coronary artery disease, addition of rivaroxaban to aspirin lowered major
vascular events, but increased major bleeding. There was no significant
increase in intracranial bleeding or other critical organ bleeding. There
was also a significant net benefit in favour of rivaroxaban plus aspirin
and deaths were reduced by 23%. Thus, addition of rivaroxaban to aspirin
has the potential to substantially reduce morbidity and mortality from
coronary artery disease worldwide. Funding: Bayer AG.<br/>Copyright &#xa9;
2018 Elsevier Ltd

<50>
Accession Number
2001192509
Title
Statin Therapy Improved Long-Term Prognosis in Patients With Major
Non-Cardiac Vascular Surgeries: A Systematic Review and Meta-Analysis.
Source
Journal of Vascular Surgery. Conference: VEITHsymposium. United States. 68
(5) (pp 1608), 2018. Date of Publication: November 2018.
Author
Yu W.; Wang B.; Zhan B.; Li Q.; Li Y.; Zhu Z.
Publisher
Mosby Inc.
Abstract
Study design: Major database searches using Embase, Medline (PubMed),
Cochrane library, and unpublished studies from www.clinicaltrials.gov
reviewed 34 observational studies, 8 prospective cohort studies, and 4
randomized controlled clinical trials between January 1991 and April 2018.
Key findings: Statin usage (1) improved all-cause mortality in lower limb,
carotid, and aortic subgroups, (2) enhanced patency rates and decreased
amputation rates in the lower limb revascularization subgroup, and (3)
decreased stroke in the carotid surgery and stent subgroup. Conclusion:
Statin therapy was associated with improved long-term survival, patency
and limb salvage rates, and reduced cardiovascular and stroke events in
patients who underwent vascular surgeries. Commentary: LetaTMs keep it
simple a"all patients undergoing vascular interventions, whether carotid,
aortic, or peripheral arterial, and whether surgical or endovascular
procedures, should be placed on statins (and aspirin or Plavix) before,
during, and after the procedures. All of us need to be sure this is being
done for all of our patients and not just pay lip service to these
recommendations. Do you have a strategy in place where you or your office
staff ensure that your patients are taking statins and antiplatelet agents
before you intervene? NuffaTM said.<br/>Copyright &#xa9; 2018

<51>
Accession Number
624451768
Title
Right minithoracotomy versus median sternotomy for reoperative mitral
valve surgery: a systematic review and meta-analysis of observational
studies.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 54 (5) (pp 817-825),
2018. Date of Publication: 01 Nov 2018.
Author
Daemen J.H.T.; Heuts S.; Olsthoorn J.R.; Maessen J.G.; Sardari Nia P.
Institution
(Daemen, Heuts, Olsthoorn, Maessen, Sardari Nia) Department of
Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+),
Maastricht, Netherlands
(Heuts, Maessen, Sardari Nia) Faculty of Health, Medicine and Life
Sciences, Cardiovascular Research Institute Maastricht (CARIM),
Maastricht, Netherlands
Publisher
NLM (Medline)
Abstract
Reoperative mitral valve surgery (MVS) through a median sternotomy
(ST-MVS) can be particularly challenging due to dense adhesions and is
known to carry a substantial risk of injuries to vascular structures.
These injuries occur in 7-9% of cases and are associated with increased
mortality rates. A valid alternative that could avoid the risks associated
with redo ST-MVS is the right anterolateral minithoracotomy (MT-MVS)
approach. The aim of this study was to quantify the effects of MT-MVS
compared with those of ST-MVS on morbidity and mortality among patients
who underwent prior cardiac surgery through a sternotomy. The MEDLINE and
EMBASE databases were searched through 1 November 2017. Data regarding
mortality, stroke, reoperation for bleeding and length of hospital stay
were extracted and submitted to a meta-analysis using random effects
modelling and the I2-test for heterogeneity. Six retrospective
observational studies were included, enrolling a total of 777 patients. In
a pooled analysis, MT-MVS demonstrated reduced mortality rates compared to
a standard sternotomy [odds ratio (OR) 0.41, 95% confidence interval (CI)
0.18-0.96; P=0.04]. MT-MVS was, moreover, associated with reduced length
of hospital stay [difference between the means was -3.81, 95% CI -5.53 to
-2.08; P<0.0001) and reoperation for bleeding (OR 0.32, 95% CI 0.10-0.99;
P=0.0488). The incidence of stroke was similar (OR 1.51, 95% CI 0.65-3.54;
P=0.34), all in the absence of heterogeneity. In conclusion, reoperative
minimally invasive MVS through a minithoracotomy is a safe alternative to
standard sternotomy, with reduced mortality rates, length of hospital stay
and reoperations for bleeding and a comparable risk of stroke. However,
because the existing literature provided limited, low-quality evidence,
more methodologically rigorous randomized controlled trials are needed.

<52>
Accession Number
2000707429
Title
Baroreflex activation therapy for the treatment of heart failure with
reduced ejection fraction in patients with and without coronary artery
disease.
Source
International Journal of Cardiology. 266 (pp 187-192), 2018. Date of
Publication: 1 September 2018.
Author
Halbach M.; Abraham W.T.; Butter C.; Ducharme A.; Klug D.; Little W.C.;
Reuter H.; Schafer J.E.; Senni M.; Swarup V.; Wachter R.; Weaver F.A.;
Wilks S.J.; Zile M.R.; Muller-Ehmsen J.
Institution
(Halbach, Reuter) Department of Internal Medicine III, University Hospital
of Cologne, Cologne, Germany
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, OH, United States
(Butter) Department of Cardiology, Immanuel Heart Center Bernau - Medical
School Brandenburg, Bernau, Germany
(Ducharme) Montreal Heart Institute, University of Montreal, Montreal,
Quebec, Canada
(Klug) Department of Cardiology A, University Hospital, Lille, France
(Little) Division of Cardiology, University of Mississippi Medical Center,
Jackson, MS, United States
(Schafer) Department of Statistics, NAMSA, Inc., Minneapolis, MN, United
States
(Senni) Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo,
Italy
(Swarup) Department of Electrophysiology, Arizona Heart Hospital, Phoenix,
AZ, United States
(Wachter) Clinic and Policlinic for Cardiology, University Hospital
Leipzig, Leipzig, Germany
(Weaver) Division of Vascular Surgery and Endovascular Therapy, Keck
School of Medicine, University of Southern California, Los Angeles, CA,
United States
(Wilks) Department of Research, CVRx, Inc., Minneapolis, MN, United States
(Zile) Medical University of South Carolina, Charleston, SC, United States
(Muller-Ehmsen) Department of Medicine, Asklepios Klinik Altona, Hamburg,
Germany
(Zile) Ralph H. Johnson Department of Veterans Affairs Medical Center,
Charleston, SC, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: In a randomized trial, baroreflex activation therapy (BAT)
improved exercise capacity, quality of life and NT-proBNP in patients with
heart failure with reduced ejection fraction (HFrEF). In view of different
mechanisms underlying HFrEF, we performed a post-hoc subgroup analysis of
efficacy and safety of BAT in patients with and without coronary artery
disease (CAD). Methods and results: Patients with left ventricular
ejection fraction <35% and NYHA Class III were randomized 1:1 to
guideline-directed medical and device therapy alone or plus BAT. Patients
with a history of CAD, prior myocardial infarction or coronary artery
bypass graft were assigned to the CAD group with all others assigned to
the no-CAD group. Of 71 BAT treated patients, 52 had CAD and 19 had no
CAD. In the control group, 49 of 69 patients had CAD and 20 had no CAD.
The system- or procedure-related major adverse neurological or
cardiovascular event rate was 3.8% in the CAD group vs. 0% in the no-CAD
group (p = 1.0). In the whole cohort, NYHA Class, Minnesota Living with
Heart Failure score, 6-minute hall walk distance and NTproBNP were
improved in BAT treated patients compared with controls. Statistical
analyses revealed no interaction between the presence of CAD and effect of
BAT (all p > 0.05). Conclusion: No major differences were found in BAT
efficacy or safety between patients with and without CAD, indicating that
BAT improves exercise capacity, quality of life and NTproBNP in patients
with ischemic and non-ischemic cardiomyopathy. ClinicalTrials.gov
identifier NCT01471860 and NCT01720160.<br/>Copyright &#xa9; 2018 Elsevier
B.V.

<53>
Accession Number
620719429
Title
GLP-1 Receptor Agonists and Cardiovascular Disease: a Meta-Analysis of
Recent Cardiac Outcome Trials.
Source
Cardiovascular Drugs and Therapy. 32 (1) (pp 65-72), 2018. Date of
Publication: 01 Feb 2018.
Author
Jia X.; Alam M.; Ye Y.; Bajaj M.; Birnbaum Y.
Institution
(Jia, Alam, Birnbaum) The Section of Cardiology, Department of Medicine,
Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United
States
(Ye) The Department of Biochemistry and Molecular Biology, University of
Texas Medical Branch, Galveston, TX, United States
(Bajaj) Endocrinology and Diabetes Division, Department of Medicine,
Baylor College of Medicine, Houston, TX, United States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: The aim of this study is to examine the cardioprotective
properties of Glucagon-like peptide-1 receptor agonist, a class of
antihyperglycemic therapy, via meta-analysis of four recently published
cardiovascular outcomes trials. Methods: Meta-analysis was performed
pooling data from the ELIXA, LEADER, SUSTAIN-6 and EXSCEL trials. A random
effects model was used to generate risk ratio with 95% confidence interval
for cardiovascular and safety outcomes. Results: A total of 33,457
patients were included in the meta-analysis. Based on the study, GLP-1R
agonists significantly reduced all-cause mortality (RR 0.89; 95% CI 0.82
to 0.96) and cardiovascular mortality (RR 0.88; 95% CI 0.80 to 0.97) when
compared to placebo. When long-acting agents were analyzed alone,
reduction in major adverse cardiac events (RR 0.88; 95% CI 0.81 to 0.97)
and non-fatal strokes (RR 0.87; 95% CI 0.76 to 0.99) also showed
significance. Conclusion: Overall, GLP-1R agonists appear to have
cardioprotective properties likely via modification of metabolic
parameters such as glycemic control, weight loss, and improvement in blood
pressure. Additional studies are warranted to compare cardiovascular
outcomes among the different agents.<br/>Copyright &#xa9; 2018, Springer
Science+Business Media, LLC, part of Springer Nature.

<54>
Accession Number
621803933
Title
Risks of restrictive red blood cell transfusion strategies in patients
with cardiovascular disease (CVD): a meta-analysis.
Source
Transfusion Medicine. 28 (5) (pp 335-345), 2018. Date of Publication:
October 2018.
Author
Cortes-Puch I.; Wiley B.M.; Sun J.; Klein H.G.; Welsh J.; Danner R.L.;
Eichacker P.Q.; Natanson C.
Institution
(Cortes-Puch, Wiley, Sun, Danner, Eichacker, Natanson) Critical Care
Medicine Department, Clinical Center, National Institutes of Health,
Bethesda, MD, United States
(Wiley) Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN,
United States
(Klein) Department of Transfusion Medicine, Clinical Center, National
Institutes of Health, Bethesda, MD, United States
(Welsh) National Institutes of Health Library, National Institutes of
Health, Bethesda, MD, United States
Publisher
Blackwell Publishing Ltd
Abstract
Aim: To evaluate the risks of restrictive red blood cell transfusion
strategies (haemoglobin 7-8 g dL^-1) in patients with and
without known cardiovascular disease (CVD). Background: Recent guidelines
recommend restrictive strategies for CVD patients hospitalised for non-CVD
indications, patients without known CVD and patients hospitalised for CVD
corrective procedures. Methods/Materials: Database searches were conducted
through December 2017 for randomised clinical trials that enrolled
patients with and without known CVD, hospitalised either for
CVD-corrective procedures or non-cardiac indications, comparing effects of
liberal with restrictive strategies on major adverse coronary events
(MACE) and death. Results: In CVD patients not undergoing cardiac
interventions, a liberal strategy decreased (P = 0.01) the relative risk
(95% CI) (RR) of MACE [0.50 (0.29-0.86)] (I² = 0%). Among
patients without known CVD, the incidence of MACE was lower (1.7 vs 3.9%),
and the effect of a liberal strategy on MACE [0.79, (0.39-1.58)] was
smaller and non-significant but not different from CVD patients (P =
0.30). Combining all CVD and non-CVD patients, a liberal strategy
decreased MACE [0.59, (0.39-0.91); P = 0.02]. Conversely, among studies
reporting mortality, a liberal strategy decreased mortality in CVD
patients (11.7% vs.13.3%) but increased mortality (19.2% vs 18.0%) in
patients without known CVD [interaction P = 0.05; ratio of RR 0.73,
(0.53-1.00)]. A liberal strategy also did not benefit patients undergoing
cardiac surgery; data were insufficient for percutaneous cardiac
procedures. Conclusions: In patients hospitalised for non-cardiac
indications, liberal transfusion strategies are associated with a
decreased risk of MACE in both those with and without known CVD. However,
this only provides a survival benefit to CVD patients not admitted for
CVD-corrective procedures.<br/>Copyright Published 2018. This article is a
U.S. Government work and is in the public domain in the USA

<55>
Accession Number
619411693
Title
Anesthesia and sleep apnea.
Source
Sleep Medicine Reviews. 40 (pp 79-92), 2018. Date of Publication: August
2018.
Author
Tamisier R.; Fabre F.; O'Donoghue F.; Levy P.; Payen J.-F.; Pepin J.-L.
Institution
(Tamisier, O'Donoghue, Levy, Pepin) Laboratoire HP2, Inserm 1042,
Universitee Grenoble Alpes, Grenoble F-38042, France
(Tamisier, Levy, Pepin) Laboratoire EFCR et Sommeil, Pole Thorax et
Vaisseaux, Grenoble Alpes University Hospital, Grenoble 38043, France
(Fabre, Payen) Pole Anesthesie-reanimation - Hopital Michallon, Grenoble
Alpes University Hospital, Grenoble F-38000, France
(O'Donoghue) Institute for Breathing and Sleep, Austin Health, Heidelberg,
Victoria 3084, Australia
(O'Donoghue) The University of Melbourne, Parkville, Victoria 3010,
Australia
(Payen) Grenoble Institut des Neurosciences, Univ. Grenoble Alpes,
Grenoble F-38000, France
(Payen) INSERM, U1216, Grenoble F-38000, France
Publisher
W.B. Saunders Ltd
Abstract
Due to its low rate of diagnosis, in the general population over half of
those experiencing obstructive sleep apnea (OSA) are unaware that they
have the condition. However, any acute medical event may exacerbate OSA
and could have serious health consequences. In this context the management
of the perioperative period, from anesthesia through the surgery itself
and into the postoperative period, is more problematic for patients with
sleep disordered breathing than for others. There is prolific literature
in this area although large randomized trials are few due to the high
sample size needed and possible ethical difficulties of withholding OSA
treatment in the perioperative period. In 2014 the American Society of
Anesthesiologists published an updated set of recommendations to guide OSA
management during the perioperative period. In this present review we
provide an overview of the different issues that practitioners face with
regard to OSA, from the initial consultation with the anesthesiologist to
the extended post-operative period. There is considerable evidence that
OSA patients are at high risk of perioperative complications, though the
inherent risks from OSA per se and its comorbidities remain difficult to
discern. Nevertheless, appropriate screening and management allow
clinicians to minimize OSA associated risk.<br/>Copyright &#xa9; 2017
Elsevier Ltd

<56>
Accession Number
617911834
Title
Clinical Impact of Changes in Hemodynamic Indices of Contractile Function
During Treatment of Acute Decompensated Heart Failure.
Source
Journal of Cardiac Failure. 24 (1) (pp 43-50), 2018. Date of Publication:
January 2018.
Author
Bilchick K.C.; Mejia-Lopez E.; McCullough P.; Breathett K.; Kennedy J.L.;
Tallaj J.; Bergin J.; Pamboukian S.; Abuannadi M.; Mazimba S.
Institution
(Bilchick, Mejia-Lopez, Kennedy, Bergin, Abuannadi, Mazimba) University of
Virginia Health System, Charlottesville, Virginia, United States
(McCullough) Baylor Heart and Vascular Institute, Dallas, Texas, United
States
(Breathett) University of Colorado, Denver, Colorado, United States
(Tallaj, Pamboukian) University of Alabama, Birmingham, Alabama, United
States
Publisher
Churchill Livingstone Inc.
Abstract
Background The objective of this work was to determine the impact of
improving right ventricular versus left ventricular stroke work indexes
(RVSWI vs LVSWI) during therapy for acute decompensated heart failure
(ADHF). Methods and Results Cox proportional hazards regression and
logistic regression were used to analyze key factors associated with
outcomes in 175 patients (mean age 56.7 +/- 13.6 years, 29.1% female) with
hemodynamic data from the Evaluation Study of Congestive Heart Failure and
Pulmonary Artery Catheterization Effectiveness trial. In this cohort,
28.6% and 69.7%, respectively, experienced the outcomes of death,
transplantation, or ventricular assist device implantatation (DVADTX) and
DVADTX or HF rehospitalization (DVADTXHF) during 6 months of follow-up.
Increasing RVSWI (DELTARVSWI) from baseline to discharge was associated
with a decrease in DVADTXHF (hazard ratio [HR] 0.923, 95% confidence
interval [CI] 0.871-0.979) per 0.1 mm HgLm^-2 increase);
however, increasing LVSWI (DELTALVSWI) had only a nonsignificant
association with decreased DVADTXHF (P =.11) In a multivariable model,
patients with DELTARVSWI <=1.07 mm HgLm^-2 and DELTALVSWI <=4.57
mm HgLm^-2 had a >2-fold risk of DVADTXHF (HR 2.05, 95% CI
1.23-3.41; P =.006). Conclusion Compared with left ventricular stroke
work, increasing right ventricular stroke work during treatment of ADHF
was associated with better outcomes. The results promise to inform optimal
hemodynamic targets for ADHF.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<57>
Accession Number
2000542159
Title
Changes in resting pulmonary function testing over time after the Nuss
procedure: A systematic review and meta-analysis.
Source
Journal of Pediatric Surgery. 53 (11) (pp 2299-2306), 2018. Date of
Publication: November 2018.
Author
Wang Q.; Fan S.; Wu C.; Jin X.; Pan Z.; Hong D.
Institution
(Wang, Wu, Jin, Pan) Cardiothoracic surgery of hildren's Hospital of
Chongqing Medical University; Ministry of Education Key Laboratory of
Child Development and Disorders; China international Science and
Technology Cooperation base of Child development and Critical Disorders;
Chongqing Key Laboratory of Pediatrics, Chongqing, China
(Fan, Hong) Renal Division and Institute of Nephrology, Sichuan Academy of
Medical Science & Sichuan Provincial People's Hospital, School of
Medicine, University of Electronic Science and Technology of China,
Chengdu, China
(Hong) ChengduChina
Publisher
W.B. Saunders
Abstract
Background: Pectus excavatum, the most common congenital chest wall
deformity in pediatric patients, leads to pulmonary dysfunction. There is
no consensus regarding the effectiveness of the Nuss procedure for
recovering pulmonary function. In this meta- analysis, we focused on the
changes that occur in pulmonary function after the Nuss procedure.
Methods: We performed a literature search in the MEDLINE, Embase, Cochrane
library and PubMed databases. The included studies were required to
contain pulmonary function tests with results adjusted to predicted values
both before and after the Nuss procedure. The key outcomes of interest in
this analysis were pulmonary function measured as forced expiratory volume
in 1 s (FEV1) and forced vital capacity (FVC). Subgroup analyses were
performed based on time since surgery and the mean ages of the patients
when they underwent surgery by forest plots and meta-regressions. Results:
Thirteen studies involving 465 participants were included in this review.
The standard mean difference (SMD) observed in FEV1 and FVC after surgery
were 0.17 (95% CI, 0.01-0.33, p = 0.04) and - 0.18 (95% CI, - 0.41-0.06, p
= 0.14), respectively. The overall meta-regression SMD of FEV1 and FVC by
time since surgery were 1.21 (95% CI, 1.04-1.41, p = 0.020) and 1.38 (95%
CI, 1.05-1.83, p = 0.027), respectively. We found evidence of a temporal
relationship between time at which pulmonary function tests were performed
after surgery and predicted FEV1 and FVC values. The SMD of FEV1 (0.26, p
= 0.012) was slightly higher in group evaluated more than 2 year after
initial surgery. Conclusions: Abnormal resting pulmonary functions tests
performed prior to surgery showed an initial depression after surgery. The
FEV1 of patients slightly increased at 2 year post surgery compared with
the baseline. Further studies with longer term follow-up are still needed
to determine if pulmonary function could improve to normal after surgery.
Levels of Evidence: Level of evidence: 4 (based on lowest level of article
analyzed in meta-analysis/systematic review).<br/>Copyright &#xa9; 2018

<58>
Accession Number
2000574321
Title
Dual antiplatelet therapy versus single antiplatelet therapy after
transaortic valve replacement: Meta-analysis.
Source
Cardiovascular Revascularization Medicine. 19 (6 Supplement) (pp 47-52),
2018. Date of Publication: September 2018.
Author
Alrifai A.; Soud M.; Kabach A.; Jobanputra Y.; Masrani A.; El Dassouki S.;
Alraies M.C.; Fanari Z.
Institution
(Alrifai, Jobanputra) University of Miami/JFK Medical Center, Atlantis,
FL, United States
(Soud) MedStar Heart and Vascular Institute, MedStar Washington Hospital
Center, Washington, DC, United States
(Kabach) Creighton University, School of Medicine, Omaha, NE, United
States
(Masrani) Mallinckrodt Institute of Radiology, Washington University in St
Louis, St Louis, MO, United States
(El Dassouki) Jackson Memorial Hospital/University of Miami, Miller School
of Medicine, Division of Cardiovascular Medicine, Miami, FL, United States
(Alraies) Wayne State University, Detroit Medical Center, Detroit, MI,
United States
(Fanari) Heartland Cardiology/Wesley Medical Center, University of Kansas
School of Medicine, Wichita, KS, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The current guidelines recommend empirical therapy with DAPT
of aspirin and clopidogrel for six months after TAVR. This recommendation
is based on expert consensus only. Giving the lack of clear consensus on
treatment strategy following TAVR. Goal of this meta-analysis is to assess
the efficacy and safety of mono-antiplatelet therapy (MAPT) versus dual
antiplatelet therapy (DAPT) following transcatheter aortic valve
replacement (TAVR). Methods and Materials: We performed a meta-analysis
from randomized clinical trials (RCTs) and prospective studies that tested
DAPT vs. MAPT for all-cause mortality and major bleeding of 603 patients.
The primary efficacy outcomes were 30 days mortality and stroke. The
primary safety outcomes were major bleeding and major vascular
complications. Results: We included 603 patients from 4 studies. The use
of MAPT was associated with similar mortality rate (5.9% vs. 6.6%; RR =
0.92; 95% CI 0.49-1.71; P = 0.68) and stroke rate compared with DAPT (1.3%
vs. 1.3%; RR 1.04; 95% CI 0.27 to 4.04; P = 0.81). There was no difference
in major vascular complication (4.2% vs. 8.9%; RR 0.52; 95% CI 0.23 to
1.18; P = 0.17) or minor vascular complication (4.2% vs. 7.3%; RR 0.58;
95% CI 0.25 to 1.34; P = 0.14). However, MAPT was associated with
significantly less risk of major bleeding (4.9% vs. 14.5%; RR 0.37; 95% CI
0.20 to 0.70; P < 0.01) but no difference in minor bleeding (4.2% vs.
3.6%; RR 1.16; 95% CI 0.43 to 3.10; P = 0.85). Conclusion: MAPT use after
TAVR is associated with lower rates of major bleeding compared with DAPT
with no significant difference in mortality, stroke or vascular
complications.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<59>
Accession Number
624281684
Title
Challenges in Aortic Stenosis: Review of Antiplatelet/Anticoagulant
Therapy Management with Transcatheter Aortic Valve Replacement (TAVR):
TAVR with Recent PCI, TAVR in the Patient with Atrial Fibrillation, and
TAVR Thrombosis Management.
Source
Current Cardiology Reports. 20 (12) (no pagination), 2018. Article Number:
130. Date of Publication: 01 Dec 2018.
Author
Sherwood M.W.; Vora A.N.
Institution
(Sherwood) Inova Heart and Vascular Institute, 3300 Gallows Rd. 1st floor
Suite 1225, Falls Church, VA 22042, United States
(Vora) Duke Clinical Research Institute, 2400 Pratt Street, P.O. Box
17969, Durham, NC 27715, United States
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: This review aims to describe the current evidence and
consensus recommendations around antiplatelet and anticoagulant management
in three common clinical scenarios in transcatheter aortic valve
replacement (TAVR): (1) recent percutaneous coronary intervention (PCI)
preceding TAVR, (2) atrial fibrillation (AF) management in patients
undergoing TAVR, and (3) bioprosthetic valve thrombosis management in
TAVR. Recent Findings: Several small clinical trials have evaluated the
use of single vs. dual antiplatelet therapy in patients undergoing TAVR,
with most recent data favoring single antiplatelet therapy. There are
several trials currently enrolling and in follow-up that evaluate the use
of anticoagulants in combination with single and dual antiplatelet therapy
for patients with AF undergoing TAVR, but as yet, there is no data to
support a clear strategy. The use of DAPT after PCI continues to
potentially shorten in patients undergoing elective PCI, thus prolonged
DAPT may not be necessary post TAVR for the sake of PCI. Bioprosthetic
valve thrombosis occurs more commonly than previously thought, but has
uncertain clinical significance. In observational studies, antiplatelet
therapy has little effect on bioprosthetic valve thrombosis, whereas
anticoagulation is effective in both prevention and treatment of
thrombosis. Summary: DAPT is currently recommended for 1-6 months for all
patients without an indication for oral anticoagulation who undergo TAVR;
however, there is a growing amount of evidence for single antiplatelet
therapy. In the special situation of patients who have recently undergone
PCI, the length of DAPT will depend on stent selection (BMS vs. DES), but
may not be significantly prolonged unless the patient experienced an acute
coronary syndrome prior to TAVR. There is no clear, optimal antithrombotic
strategy for patients with AF who undergo TAVR, but avoidance of triple
therapy by using OAC and low-dose ASA seems to be reasonable. OAC, not
DAPT, is now known to prevent bioprosthetic valve thrombosis in TAVR and
SAVR patients; however, the optimal therapy remains unknown. For patients
who develop bioprosthetic valve thrombosis, OAC for 3-6 months, and repeat
imaging is recommended to document resolution.<br/>Copyright &#xa9; 2018,
Springer Science+Business Media, LLC, part of Springer Nature.

<60>
Accession Number
624260365
Title
Differential immunological profiles herald magnetic resonance
imaging-defined perioperative cerebral infarction.
Source
Therapeutic Advances in Neurological Disorders. 11 (no pagination), 2018.
Date of Publication: 01 Jan 2018.
Author
Fanning J.P.; See Hoe L.E.; Passmore M.R.; Barnett A.G.; Rolfe B.E.;
Millar J.E.; Wesley A.J.; Suen J.; Fraser J.F.
Institution
(Fanning) Critical Care Research Group, Level 3 Clinical Sciences
Building, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD
4032, Australia
(See Hoe, Passmore, Millar, Suen, Fraser) Critical Care Research Group,
The Prince Charles Hospital, Brisbane, QLD, Australia
(Barnett) School of Public Health and Social Work, Queensland University
of Technology, Brisbane, QLD, Australia
(Rolfe) Australian Institute for Bioengineering and Nanotechnology, The
University of Queensland, Brisbane, QLD, Australia
(Wesley) Metro North Hospital and Health Service District, QLD, Australia
(See Hoe, Passmore, Millar, Suen, Fraser) Faculty of Medicine, The
University of Queensland, Brisbane, QLD, Australia
(Millar) Wellcome-Wolfson Centre For Experimental edicine, Queen's
University, Belfast, United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: The perioperative period is associated with a high risk for
human ischaemic stroke. Although inflammatory mechanisms are known to have
an important role in cerebral infarction in the nonoperative setting,
their role in modulating perioperative risk remains unclear. Methods: In
this prospective case-control study, we compared 10 patients (cases) who
developed magnetic resonance imaging (MRI) evidence of cerebral infarction
following transcatheter aortic valve implantation with 10 patients
(controls) who underwent the same procedure without neurological
complication. Blood sampling was performed preoperatively (baseline) and
at 24 h, 48 h and 72 h postoperatively and analysed for specific
cytokines, chemokines and complement factors. Results: Baseline serum
assessments identified significant differences between the two cohorts for
levels of complement C3, complement C4b, granulocyte-macrophage
colony-stimulating factor, interleukin-15 and macrophage inflammatory
protein-1beta. Longitudinal regression analysis and best-fit polynomial
curves of postoperative analyte profiles identified significantly higher
levels of complement C3 and matrix metalloproteinase-9, and lower levels
of interferon-gamma and macrophage inflammatory protein-1beta levels in
cases versus controls. Conclusions: These results support a potentially
important role for inflammatory mechanisms in MRI-defined perioperative
stroke and reveal a potentially important role for complement components
in this process.<br/>Copyright &#xa9; The Author(s), 2018.

<61>
Accession Number
622088151
Title
Infective endocarditis following transcatheter edge-to-edge mitral valve
repair: A systematic review.
Source
Catheterization and Cardiovascular Interventions. 92 (3) (pp 583-591),
2018. Date of Publication: 01 Sep 2018.
Author
Asmarats L.; Rodriguez-Gabella T.; Chamandi C.; Bernier M.; Beaudoin J.;
O'Connor K.; Dumont E.; Dagenais F.; Paradis J.-M.; Rodes-Cabau J.
Institution
(Asmarats, Rodriguez-Gabella, Chamandi, Bernier, Beaudoin, O'Connor,
Dumont, Dagenais, Paradis, Rodes-Cabau) Quebec Heart and Lung Institute,
Laval University, Quebec City, QC, Canada
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To assess the clinical characteristics, management, and
outcomes of patients diagnosed with infective endocarditis (IE) after
edge-to-edge mitral valve repair with the MitraClip device. Background:
Transcatheter edge-to-edge mitral valve repair has emerged as an
alternative to surgery in high-risk patients. However, few data exist on
IE following transcatheter mitral procedures. Methods: Four electronic
databases (PubMed, Google Scholar, Embase, and Cochrane Library) were
searched for original published studies on IE after edge-to-edge
transcatheter mitral valve repair from 2003 to 2017. Results: A total of
10 publications describing 12 patients with definitive IE (median age 76
years, 55% men) were found. The mean logistic EuroSCORE/EuroSCORE II were
41% and 45%, respectively. The IE episode occurred early (within 12 months
post-procedure) in nine patients (75%; within the first month in five
patients). Staphylococcus aureus was the most frequent (60%) causal
microorganism, and severe mitral regurgitation was present in all cases
but one. Surgical mitral valve replacement (SMVR) was performed in most
(67%) patients, and the mortality associated with the IE episode was high
(42%). Conclusions: IE following transcatheter edge-to-edge mitral valve
repair is a rare but life-threatening complication, usually necessitating
SMVR despite the high-risk profile of the patients. These results
highlight the importance of adequate preventive measures and a prompt
diagnosis and treatment of this serious complication.<br/>Copyright &#xa9;
2018 Wiley Periodicals, Inc.

<62>
Accession Number
623247796
Title
The interplay between permanent pacemaker implantation and mortality in
patients treated by transcatheter aortic valve implantation: A systematic
review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 92 (3) (pp E159-E167),
2018. Date of Publication: 01 Sep 2018.
Author
Ueshima D.; Nai Fovino L.; Mojoli M.; Napodano M.; Fraccaro C.; Tarantini
G.
Institution
(Ueshima, Nai Fovino, Mojoli, Napodano, Fraccaro, Tarantini) Cardiology
Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of
Padua Medical School, Padua, Italy
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Previous implantation of a permanent pacemaker (PPM) is common
among patients undergoing transcatheter aortic valve implantation (TAVI).
Moreover, onset of conduction disturbances needing new PPM implantation
after TAVI is frequent. The interplay of pre-existing and new-PPM on
mortality after TAVI remains controversial. Methods: We performed a
systematic review and study-level meta-analysis on the influence of PPM on
mortality after TAVI. Patients were divided into 3 groups: pre-existing
PPM, new-PPM (implantation within 30 days after TAVI) and no-PPM (without
PPM up to 30 days after TAVI). Outcomes were compared using pairwise and
network meta-analysis. Results: A total of 28 studies including 40,016
subjects were eligible. Patients of the no-PPM group had a lower mortality
outcome compared to the rest of the study population (relative risk [RR]
0.76, 95% confidence interval [CI] 0.68-0.85, P < 0.0001) at median follow
up of 16.3 months. In particular, patients with a pre-existing PPM (RR
1.43, 95% CI 1.26-1.62, P < 0.0001), but not those with a newly implanted
PPM (RR 1.08, 95% CI 0.99-1.18, P = 0.10), had a significantly higher
mortality compared to patients of the no-PPM group. Moreover,
meta-regression analysis showed that the transapical approach rate had a
detrimental interaction with pre-existing PPM on mortality (P = 0.03).
Conclusion: Compared to patients without PPM, those with a pre-existing
PPM before TAVI had higher mortality, in particular if treated by the
transapical approach. New-PPM implantation did not have a negative
relation on mid-term outcome.<br/>Copyright &#xa9; 2018 Wiley Periodicals,
Inc.

<63>
Accession Number
624279160
Title
Effect of Shenmai injection on cognitive function after cardiopulmonary
bypass in cardiac surgical patients: A randomized controlled trial.
Source
BMC Anesthesiology. 18 (1) (no pagination), 2018. Article Number: 142.
Date of Publication: 11 Oct 2018.
Author
Chen L.; Wang L.; Zhuo Q.; Zhang Q.; Chen F.; Li L.; Lin L.
Institution
(Chen, Wang, Zhang, Chen, Li, Lin) Department of Anesthesiology, First
Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang
Province, China
(Zhuo) Wenzhou People's Hospital, Wenzhou, Zhejiang Province, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative cognitive dysfunction (POCD) is a common
complication after cardiac surgery that influences the clinical outcomes
and quality of life of patients. This study aimed to evaluate the effects
of Shenmai injection (SMI) on POCD of patients who underwent cardiac valve
replacement under cardiopulmonary bypass (CPB). Methods: This prospective,
randomized, controlled trial was conducted from September 2014 to January
2017. Eighty-eight patients receiving cardiac valve replacement under CPB
were randomized into the control (C) or the SMI (S) group. SMI (0.6 mL/kg)
was administered intravenously from the time of anesthesia induction to
the beginning of CPB. Cognitive function was assessed at 3 days before
surgery and 3 days, 7 days, and 1 month after surgery using the Beijing
version of the Montreal Cognitive Assessment (MoCA-BJ) score. The serum
levels of neuroglobin (Ngb), hypoxia-inducible factor-1alpha (HIF-1alpha),
and neuron-specific enolase (NSE) were measured at 30 min after induction
(T<inf>0</inf>), immediately after the endonasal temperature rewarmed to
36 degreeC (T<inf>1</inf>), and 1 h (T<inf>2</inf>), 6 h (T<inf>3</inf>),
24 h (T<inf>4</inf>), 48 h (T<inf>5</inf>), and 72 h (T<inf>6</inf>) after
CPB. Results: Compared with the baseline values at T<inf>0</inf>, the
serum Ngb levels in group C were significantly decreased at
T<inf>1-2</inf> and then increased at T<inf>3-6</inf>, while the levels in
group S were decreased at T<inf>1-2</inf> and increased at
T<inf>4-6</inf>, compared to group C (p < 0.05). The serum HIF-1alpha
levels at T<inf>1-4</inf> and the serum NSE levels at T<inf>1-6</inf> were
significantly increased in both groups (p < 0.05). The serum levels of Ngb
at T<inf>3</inf>, HIF-1alpha at T<inf>1-3</inf>, and NSE at
T<inf>3-4,6</inf> were lower in group S, compared to group C (p < 0.01).
The MoCA-BJ scores were decreased at 3 and 7 days after surgery in both
groups, and the MoCA-BJ scores in group S were higher than those in group
C at 3 and 7 days after surgery (p < 0.01). Conclusion: Cognitive function
is impaired postoperatively in patients who have undergone cardiac valve
replacement under CPB. In addition, treatment with the traditional Chinese
medicine SMI decreases the serum levels of Ngb, HIF-1alpha, and NSE as
well as attenuates cognitive dysfunction. Trial registration: This trial
was registered with Clinicaltrials.gov as ChiCTR-TRC-14004373 on March 11,
2014.<br/>Copyright &#xa9; 2018 The Author(s).

<64>
Accession Number
618953137
Title
Clinical and procedural outcomes with the SAPIEN 3 versus the SAPIEN XT
prosthetic valves in transcatheter aortic valve replacement: A systematic
review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 92 (3) (pp E149-E158),
2018. Date of Publication: 01 Sep 2018.
Author
Tummala R.; Banerjee K.; Sankaramangalam K.; Mick S.; Krishnaswamy A.;
White J.; Fares M.; Mehta A.; Popovic Z.; Svensson L.G.; Kapadia S.R.
Institution
(Tummala) Department of Internal Medicine, St. Vincent Charity Medical
Center, An Affiliate of Case Western Reserve University, Cleveland, OH,
United States
(Banerjee, Sankaramangalam, Mick, Krishnaswamy, White, Fares, Mehta,
Popovic, Svensson, Kapadia) Heart and Vascular Institute, Cleveland
Clinic, Cleveland, OH, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: The SAPIEN 3 valve (S3V) was designed to overcome the
shortcomings of its predecessor, the SAPIEN XT (SXT) valve. We conducted a
meta-analysis to compare their clinical outcomes and procedural
characteristics. Methods: PUBMED, EMBASE, and Cochrane CENTRAL were
searched by two independent reviewers. The clinical outcomes of interest
were paravalvular leakage (PVL), major vascular complications (MVC),
bleeding, acute kidney injury (AKI), device success, need for post
dilation all-cause mortality and procedural details. Results: Fifteen
observational cohort studies were included in the analysis involving a
total of 4,496 patients. Of these, 1,700 were S3V recipients and 2,796
were SXT recipients. The S3V group showed fewer complications compared to
the SXT group with respect to PVL (5.58% vs. 19.35%, OR: 0.27, P: 0.000),
MVC (4.07% vs. 9.13%, OR: 0.44, P: 0.002), bleeding (6.40% vs. 12.03%, OR:
0.50, P: 0.003), 30-day mortality (3.29% vs. 5.68%, OR: 0.51, P: 0.000),
and stroke (1.48% vs. 2.86%, OR: 0.49, P: 0.014). Device success was
higher in the S3V (98.18% vs. 93.76%, OR: 3.14, P: 0.000). Cardiovascular
mortality, myocardial infarction, AKI and post-dilatation were not
significantly different. Permanent pacemaker implantation (PPI) was higher
in S3V recipients (13.29% vs. 9.23%, OR: 1.58, P: 0.000). Procedure time
was shorter for the S3V (71.94 vs. 86.85, P: 0.016) and used less contrast
volume (129.36 vs. 161.18, P: 0.049). Conclusions: Patients receiving the
S3V had lower risk of PVL, MVC, bleeding, mortality, and stroke. PPI was
somewhat higher in the S3V group. S3V implantation was faster and used
less contrast.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<65>
Accession Number
624287429
Title
Perioperative hyperglycemia and neurocognitive outcome after surgery: A
systematic review.
Source
Minerva Anestesiologica. 84 (10) (pp 1178-1188), 2018. Date of
Publication: October 2018.
Author
Hermanides J.; Qeva E.; Preckel B.; Bilotta F.
Institution
(Qeva, Bilotta) Department of Anesthesiology, Critical Care and Pain,
Sapienza University of Rome, Rome, Italy
(Hermanides, Preckel) Department of Anesthesiology, Academic Medical
Centre, Meibergdreef 9, Amsterdam 1105 AZ, Netherlands
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
introDUction: Preliminary evidence suggest a possible relationship between
perioperative hyperglycemia, postoperative delirium (PoD) or cognitive
dysfunction (PocD). We aim to present the available clinical evidence
related to chronic (i.e. diabetes mellitus) or acute perioperative
hyperglycemia as risk factors for PoD/PocD. eviDence acQUisition: a
literature search of eMBase (via ovid, 1974-present) online medical
database and MeDline (via PubMed or ovid, 1946-present) was performed. all
types of clinical studies including randomized controlled trials,
prospective, as well as retrospective cohort studies were screened.
clinical studies that reported original information on the relationship
between diabetes mellitus (DM) and/or acute perioperative abnormal glucose
levels and PoD or PocD were selected. reviews and editorials (i.e.
articles not presenting original preclinical or clinical research) were
excluded and case-reports were not considered for analysis. eviDence
sYntHesis: our search resulted in 2356 papers for screening, from which we
selected 29 studies that met our inclusion criteria. DM was investigated
in 24 observational papers, acute perioperative hyperglycemia in six
observational studies and two randomized controlled trials examined the
effect of perioperative glucose lowering on PoD/PocD. Diabetes was
associated with PoD or PocD in 18/24 observational studies and 6/6 of the
included observational studies found that perioperative hyperglycemia was
associated with PoD/PocD, independent of diabetes. the two randomized
controlled trials had a different trial design and reported conflicting
results. conclUsions: according to the available evidence, DM and acute
perioperative hyperglycemia may be associated with an increased risk for
PoD/PocD. these conclusions are based mostly on observational studies and
deserve more and dedicated research. this systematic review may direct the
design of future studies.<br/>Copyright &#xa9; 2018 Edizioni Minerva
Medica.

<66>
Accession Number
624341050
Title
Effects of dexmedetomidine infusion on inflammatory responses and injury
of lung tidal volume changes during one-lung ventilation in thoracoscopic
surgery: A randomized controlled trial.
Source
Mediators of Inflammation. 2018 (no pagination), 2018. Article Number:
2575910. Date of Publication: 2018.
Author
Wu C.-Y.; Lu Y.-F.; Wang M.-L.; Chen J.-S.; Hsu Y.-C.; Yang F.-S.; Cheng
Y.-J.
Institution
(Wu, Wang, Hsu, Yang, Cheng) Anesthesiology Department, National Taiwan
University Hospital, Taiwan (Republic of China)
(Lu) Anesthesiology Department, National Taiwan University Hospital,
Hsinchu Branch, Taiwan (Republic of China)
(Chen) Surgery Department, National Taiwan University Hospital, Taipei,
Taiwan (Republic of China)
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
One-lung ventilation in thoracic surgery provokes profound systemic
inflammatory responses and injury related to lung tidal volume changes. We
hypothesized that the highly selective a2-adrenergic agonist
dexmedetomidine attenuates these injurious responses. Sixty patients were
randomly assigned to receive dexmedetomidine or saline during
thoracoscopic surgery. There is a trend of less postoperative medical
complication including that no patients in the dexmedetomidine group
developed postoperative medical complications, whereas four patients in
the saline group did (0% versus 13.3%, p = 0 1124). Plasma inflammatory
and injurious biomarkers between the baseline and after resumption of
two-lung ventilation were particularly notable. The plasma highmobility
group box 1 level decreased significantly from 51.7 (58.1) to 33.9 (45.0)
ng.ml^-1 (p < 0 05) in the dexmedetomidine group, which was not
observed in the saline group. Plasma monocyte chemoattractant protein 1
[151.8 (115.1) to 235.2 (186.9) pg.ml^-1, p < 0 05] and
neutrophil elastase [350.8 (154.5) to 421.9 (106.1) ng.ml^-1, p
< 0 05] increased significantly only in the saline group. In addition,
plasma interleukin-6 was higher in the saline group than in the
dexmedetomidine group at postoperative day 1 [118.8 (68.8) versus 78.5
(58.8) pg.ml^-1, p = 0 0271]. We conclude that dexmedetomidine
attenuates one-lung ventilation-associated inflammatory and injurious
responses by inhibiting alveolar neutrophil recruitment in thoracoscopic
surgery.<br/>Copyright &#xa9; 2018 Chun-Yu Wu et al.

<67>
Accession Number
624431335
Title
Novel association between non-metastatic carcinoid tumors arising in the
gastrointestinal tract and the presence of aortic root dilatation.
Source
Journal of Gastroenterology and Hepatology. Conference:
Gastroenterological Society of Australia, GESA and Australian
Gastroenterology Week, AGW "Gut Matters". Australia. 33 (Supplement 2) (pp
20-21), 2018. Date of Publication: September 2018.
Author
Kentwell S.; Khokhar A.; Gupta R.; Wu H.; Ishwariah H.; Thomas J.; Hodgson
R.; West M.; Rahman T.
Institution
(Kentwell, Khokhar, Gupta, Wu, Ishwariah, Thomas, Hodgson) Departments of
Gastroenterology and Hepatology, Australia
(West, Rahman) Cardiology, Prince Charles Hospital, Brisbane, QLD,
Australia
Publisher
ACT Publishing Group Liminted
Abstract
Background: Non-metastatic carcinoid originating in the gastrointestinal
tract is not commonly associated with carcinoid heart disease. Vasoactive
substances released from the tumor drain through the portal venous system
to the liver, where they are inactivated by monoamine oxidases. Carcinoid
heart disease is typically seen in cases of carcinoid tumor that
metastasizes to the liver. If hepatic metastases are present, the
vasoactive substances can reach the heart because they drain directly from
the liver into the systemic venous circulation and avoid inactivation. We
report the first series of cases of non-metastatic carcinoid demonstrating
the presence of left-sided cardiac abnormalities, particularly aortic root
enlargement. Methods: We conducted a literature search on PubMed using
search pa-rameters of carcinoid and (i) aortic, (ii) cardiac, (iii)
left-sided, and (iv) right-sided. Results were examined and noted. The
Prince Charles Hospital (TPCH) Auscare (histopathology) and ESSIS database
was then analyzed for patients with carcinoid diagnosed at time of
colonoscopy or endoscopy. Additionally, two cases were identified at bowel
surgery. Simultaneously, the TPCH echocardiography database was
cross-referenced. Thus, echo-cardiography results for each
gastrointestinal carcinoid patient were examined. If results did not
exist, this was requested for them. Demographic, biochemical,
histopathological, and endoscopic locations were recorded. Once
cross-referencing, both databases was completed, the data were ratified,
and patients were offered a hospital outpatient appointment to discuss the
findings. Results: Results are presented in Table 1 (above). Conclusion:
We report a novel relationship between non-metastatic carcinoid tumors and
aortic root dilatation identified by echocardiography. Although the
pathogenesis and development of carcinoid heart plaques are incompletely
understood, there is evidence that suggests serotonin (5-HT) plays a key
role. Carcinoid heart disease requires ongoing echocardio-graphic
surveillance and can ultimately result in the requirement for valve
replacement surgery. This case series suggests that it may be useful to
screen all patients diagnosed with non-metastatic carcinoid tumors with
echocardiography, as well as highlighting a potential area of future
research.

<68>
[Use Link to view the full text]
Accession Number
624133756
Title
Neurocognitive Function after Cardiac Surgery: From Phenotypes to
Mechanisms.
Source
Anesthesiology. 129 (4) (pp 829-851), 2018. Date of Publication: 01 Oct
2018.
Author
Berger M.; Terrando N.; Smith S.K.; Browndyke J.N.; Newman M.F.; Mathew
J.P.
Institution
(Berger) From the Department of Anesthesiology (M.B., N.T., S.K.S.,
M.F.N., J.P.M.) Division of Geriatric Behavioral Health, Department of
Psychiatry and Behavioral Sciences (J.N.B), Duke University Medical
Center, Durham, North Carolina
Publisher
NLM (Medline)
Abstract
For half a century, it has been known that some patients experience
neurocognitive dysfunction after cardiac surgery; however, defining its
incidence, course, and causes remains challenging and controversial.
Various terms have been used to describe neurocognitive dysfunction at
different times after cardiac surgery, ranging from "postoperative
delirium" to "postoperative cognitive dysfunction or decline." Delirium is
a clinical diagnosis included in the Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition (DSM-5). Postoperative cognitive
dysfunction is not included in the DSM-5 and has been heterogeneously
defined, though a recent international nomenclature effort has proposed
standardized definitions for it. Here, the authors discuss
pathophysiologic mechanisms that may underlie these complications, review
the literature on methods to prevent them, and discuss novel approaches to
understand their etiology that may lead to novel treatment strategies.
Future studies should measure both delirium and postoperative cognitive
dysfunction to help clarify the relationship between these important
postoperative complications.

<69>
Accession Number
624401726
Title
Effect of Sustained Use of Aspirin until the Time of Surgery on Outcomes
following Coronary Artery Bypass Grafting: A Randomized Clinical Trial.
Source
The Thoracic and cardiovascular surgeon. 66 (6) (pp 442-451), 2018. Date
of Publication: 01 Sep 2018.
Author
Sharifi M.; Kamali A.; Ghandi Y.
Institution
(Sharifi) Department of Cardiovascular Surgery, Faculty of Medicine, Arak
University of Medical Sciences, Arak, Iran, Islamic Republic of
(Kamali) Department of Anesthesiology, Faculty of Medicine, Arak
University of Medical Sciences, Arak, Iran, Islamic Republic of
(Ghandi) Department of Pediatric Cardiology, Faculty of Medicine, Arak
University of Medical Sciences, Arak, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: The topic of aspirin (acetylsalicylic acid, ASA) use in
coronary artery disease patients planned for coronary artery bypass
grafting during perioperative period is among the most disputed issues in
cardiac surgery. We designed a study to weigh the risks and benefits of
continued ASA ingestion until the time of surgery.
METHODS: In this randomized double-blind clinical trial, 206 consecutive
patients scheduled for isolated coronary artery bypass surgery (CABG) were
randomly stratified into two groups. In group 1 (104 cases), patients were
given 80 mg ASA per day until the day of surgery. In group 2 (102
patients), ASA (80 mg per day) was stopped 4 days before the operation.
Patients in these two groups were similar in terms of preoperative patient
and procedural characteristics. ASA was resumed 24 hours after the surgery
in all patients.
RESULTS: The rates of bleeding and reexploration within 24 hours of
surgery were significantly higher in group 1 (824.3 vs. 492.1 mL, p<0.001
and 5.7% vs. 0, p=0.0138, respectively). The amount of intra- and
postoperative packed red blood cell (PRBC) transfusion was considerably
greater in group 1 (mean: 1.83 vs. 0.71 units, p<0.001). The rate of
hospital mortality was similar (1.9% in both the groups, p=0.98). Patients
in group 1 had significantly longer mean hospital stay than patients in
group 2 (8 vs. 5.1 days, p<0.001). Again the time interval between weaning
from heart-lung machine and closing the sternum was strikingly longer in
group 1 (mean: 32.1 vs. 14.5 minutes, p<0.001). The incidence of adverse
postoperative outcomes such as myocardial infarction, stroke, and renal
failure was not statistically different between the two groups.
CONCLUSION: Sustained ASA use until the day of surgery in patients planned
for elective isolated CABG can result in excessive bleeding, increased
rate of reexploration, and need for more PRBC transfusion without any
proven beneficial effect on reducing unfavorable postoperative outcomes.
Hence, we recommend discontinuing ASA between 3 and 5 days before
non-urgent CABG while keeping it on in nonelective
circumstances.<br/>Copyright Georg Thieme Verlag KG Stuttgart . New York.

<70>
Accession Number
624128985
Title
Atrial fibrillation and ischemic events with rivaroxaban in patients with
stable coronary artery disease (AFIRE): Protocol for a multicenter,
prospective, randomized, open-label, parallel group study.
Source
International journal of cardiology. 265 (pp 108-112), 2018. Date of
Publication: 15 Aug 2018.
Author
Yasuda S.; Kaikita K.; Ogawa H.; Akao M.; Ako J.; Matoba T.; Nakamura M.;
Miyauchi K.; Hagiwara N.; Kimura K.; Hirayama A.; Matsui K.
Institution
(Yasuda) Department of Cardiovascular Medicine, National Cerebral and
Cardiovascular Center Hospital, 5-7-1 Fujishiro-dai, Suita, Osaka
565-8565, Japan. Electronic address: afire@jcvrf.jp
(Kaikita) Department of Cardiovascular Medicine, Graduate School of
Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto
860-8556, Japan
(Ogawa) National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai,
Suita, Osaka 565-8565, Japan
(Akao) Department of Cardiology, National Hospital Organization Kyoto
Medical Center, Fukakusa, 1-1 Mukaihata-cho, Fushimi-ku, Kyoto 612-8555,
Japan
(Ako) Department of Cardiovascular Medicine, Kitasato University School of
Medicine, 1-15-1 KitasatoSagamihara 252-0373, Minami-ku, Japan
(Matoba) Department of Cardiovascular Medicine, Kyushu University
Hospital, 3-1-1 Maidashi, Fukuoka 812-8582, Japan
(Nakamura) Division of Cardiovascular Medicine, Toho University Ohashi
Medical Center, 2-17-6, Ohashi, Meguro-ku, Tokyo 153-8515, Japan
(Miyauchi) Department of Cardiology, Juntendo University School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
(Hagiwara) Department of Cardiology, Tokyo Women's Medical University,
Kawada-cho ,Shinjuku-ku, Tokyo 162-8666, Japan
(Kimura) Department of Cardiology, Yokohama City University Medical
Center, 4-57, Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
(Hirayama) Division of Cardiology, Nihon University School of Medicine,
30-1 Ohyaguchi Kamicho, Tokyo 173-8610, Japan
(Matsui) Department of Community, Family, and General Medicine, Kumamoto
University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
Publisher
NLM (Medline)
Abstract
BACKGROUND: In atrial fibrillation (AF) patients with coronary artery
disease (CAD), anticoagulants are commonly used in combination with
antiplatelet drugs. However, dual therapy can increase the risk of
bleeding, and the potential therapeutic benefits must be weighed against
this. Therefore, it is recommended that dual therapy is only used for a
limited time, and that monotherapy with anticoagulants should start from
1year after percutaneous coronary intervention (PCI). However, there is a
lack of evidence on the use of monotherapy, in particular with direct oral
anticoagulants, in this group of patients.
METHODS: The AFIRE Study is a multicenter, prospective, randomized,
open-label, parallel group study conducted in patients aged >=20years with
non-valvular AF (NVAF) and CAD. Patients who have undergone PCI or
coronary artery bypass graft at least 1year prior to enrollment, or those
without significant coronary lesions requiring PCI (>=50% stenosis), will
be included. Approximately 2200 participants will be randomized to receive
either rivaroxaban monotherapy or rivaroxaban plus an antiplatelet drug
(aspirin, clopidogrel, or prasugrel). The primary efficacy endpoints are
the composite of cardiovascular events (stroke, non-central nervous system
embolism, myocardial infarction, and unstable angina pectoris requiring
revascularizations) and all-cause mortality. The primary safety endpoint
is major bleeding as defined by the International Society on Thrombosis
and Haemostasis criteria.
CONCLUSIONS: This study will be the first to assess the efficacy and
safety of rivaroxaban monotherapy in NVAF patients with stable
CAD.<br/>Copyright &#xa9; 2018. Published by Elsevier B.V.

<71>
Accession Number
624123536
Title
Outcomes associated with mammalian target of rapamycin (mTOR) inhibitors
in heart transplant recipients: A meta-analysis.
Source
International journal of cardiology. 265 (pp 71-76), 2018. Date of
Publication: 15 Aug 2018.
Author
Jennings D.L.; Lange N.; Shullo M.; Latif F.; Restaino S.; Topkara V.K.;
Takeda K.; Takayama H.; Naka Y.; Farr M.; Colombo P.; Baker W.L.
Institution
(Jennings) Department of Pharmacy, Columbia University Medical Center, New
York, NY, United States. Electronic address: dj2414@cumc.columbia.edu
(Lange) Department of Pharmacy, Columbia University Medical Center, New
York, NY, United States
(Shullo) WVU Medicine, West Virginia Health System, Morgantown, WV, United
States
(Latif, Restaino, Topkara, Farr, Colombo) Division of Cardiology,
Department of Medicine, Columbia University Medical Center, New York, NY,
United States
(Takeda, Takayama, Naka) Division of Cardiovascular Surgery, Department of
Surgery, Columbia University Medical Center, New York, NY, United States
(Baker) Department of Pharmacy Practice, University of Connecticut,
Storrs, CT, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Data evaluating mTOR inhibitor use heart transplant (HT)
patients comes from relatively small studies and controversy exists
regarding their specific role. We performed a meta-analysis of randomized
trials to evaluate the efficacy and safety of mTOR inhibitors in HT
patients.
METHODS: We performed a systematic literature search of Medline and Embase
through July 2017 identifying studies evaluating mTOR inhibitors in HT
patients reporting effects on coronary allograft vasculopathy (CAV), renal
function, acute cellular rejection (ACR), cytomegalovirus (CMV) infection,
and discontinuation due to adverse drug events (ADE). Data were pooled
using a random-effects model producing a mean difference (MD; for
continuous data) or odds ratio (OR; for dichotomous data) and 95%
confidence interval (CI).
RESULTS: 14 trials reported at least one outcome of interest. Change in
mean maximal intimal thickness was significantly reduced with mTOR (-0.04
[-0.07 to -0.02]) compared to calcineurin inhibitor/mycophenolate mofetil
(CNI/MMF). Rates of CMV infection were also significantly reduced (0.26;
[0.2 to 0.32]) with mTOR regimens compared to CNI/MMF therapy. ACR was
more frequent with CNI-sparing regimens 6.46 [1.55 to 26.95]). eGFR was
significantly improved with CNI-sparing therapies (mean difference
12.09mL/min [2.43 to 21.74]), but was similar between CNI/mTOR versus
CNI/MMF regimens (p>0.05). Rates of discontinuation due to ADE were higher
in mTOR-containing regimens (OR 2.15 [1.28 to 3.60], p=0.01), while
mortality rates were similar (OR 0.91 [0.61 to 1.37], p=0.62).
CONCLUSIONS: mTOR-containing regimens can attenuate CAV and CMV risk in HT
recipients. A mTOR/MMF combination preserves renal function but increases
the risk of ACR.<br/>Copyright &#xa9; 2018 Elsevier B.V. All rights
reserved.

<72>
Accession Number
624127331
Title
Efficacy of forced-air warming for preventing perioperative hypothermia
and related complications in patients undergoing laparoscopic surgery: A
randomized controlled trial.
Source
International journal of nursing practice. 24 (5) (pp e12660), 2018. Date
of Publication: 01 Oct 2018.
Author
Su S.-F.; Nieh H.-C.
Institution
(Su) Department of Nursing, National Taichung University of Science and
Technology, Taichung, Taiwan (Republic of China)
(Nieh) Department of Nursing, Taichung Veterans General Hospital,
Taichung, Taiwan (Republic of China)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Perioperatively, unexpected hypothermia may cause adverse
surgical outcomes. However, few studies have explored the efficacy of
forced-air warming in patients undergoing laparoscopic surgery.
AIM/OBJECTIVE: To determine the efficacy of forced-air warming for
preventing perioperative hypothermia and complications in patients
undergoing laparoscopic surgery.
METHODS: A total of 127 participants undergoing laparoscopic thoracic or
abdominal surgery were recruited between January and November 2015.
Participants were randomly allocated to intervention (forced-air warming,
n = 64) and control groups (passive insulation, n = 63). Oesophageal core
temperature was measured during surgery, whilst tympanic core temperature
was measured every 30 minutes preoperatively and in the postanaesthesia
care unit. Levels of shivering and pain, amount of bleeding, and adverse
cardiac events were measured before the transfer from the postanaesthesia
care unit. The generalized estimating equation was used for data analysis.
RESULTS: The intervention group had better warming efficacy than the
control group between 90 and 330 minutes during surgery. The intervention
group had fewer complications than the control group in terms of
intraoperative bleeding, time to rewarm to 36degreeC, pain levels, and
shivering levels in the postanaesthesia care unit.
CONCLUSION: Forced-air warming can increase warming efficacy and reduce
complications of perioperative hypothermia in patients undergoing
laparoscopic surgery.<br/>Copyright &#xa9; 2018 John Wiley & Sons
Australia, Ltd.

<73>
[Use Link to view the full text]
Accession Number
624402730
Title
Effect of high-flow nasal cannula oxygen therapy vs conventional oxygen
therapy on adult postcardiothoracic operation: A meta-analysis.
Source
Medicine. 97 (41) (pp e12783), 2018. Date of Publication: 01 Oct 2018.
Author
Wu X.; Cao W.; Zhang B.; Wang S.
Institution
(Wu) Department of Pulmonary and Critical Care Medicine, First Affiliated
Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
Publisher
NLM (Medline)
Abstract
INTRODUCTION: The effect of high-flow nasal cannula (HFNC) on adult post
cardiothoracic operation remains controversial. We conducted a
meta-analysis of randomized controlled trials to evaluate the effect of
HFNC and conventional oxygen therapy (COT) on postcardiothoracic surgery.
METHODS: A search was conducted in Embase, MEDLINE, Ovid, and Cochrane
databases until December, 2017 for all the controlled study to compare
HFNC with COT in adult postcardiothoracic surgery. Two authors extracted
data and assessed the quality of each study independently. The
meta-analysis was performed by using RevMan 5.3. The primary outcome was
the rate of escalation of respiratory support rate and pulmonary
complications; secondary outcome included the length of intensive care
unit (ICU) stay and length of hospital stay and the rate of intubation.
RESULTS: Four studies that involved 649 patients were included in the
analysis. No significant heterogeneity was found in outcome measures.
Compared with COT, HFNC were associated with a significant reduction in
the escalation of respiratory support (odds ratio [OR] = 0.44, 95%
confidence interval [CI] = 0.29-0.66, P < .001) and pulmonary
complications (OR = 0.28, 95% CI = 0.13-0.6, P = .001). There were no
significant differences in the reintubation rate (OR = 0.33, 95% CI =
0.02-5.39, P = .43), length of ICU stay (weighted mean difference = 0.11;
95% CI = -0.44 -0.26, P = .14) or length of hospital stay (weighted mean
difference = -0.15, 95% CI = -0.46 -0.17, P = .36) between the 2 groups.
No severe complications were reported in either group.
CONCLUSION: The HFNC could reduce respiratory support and pulmonary
complications, and it could be safely administered for adult
postcardiothoracic surgery. Further large-scale, randomized, and
controlled trials are needed to update this finding.

<74>
Accession Number
624400614
Title
Impact of an ultraviolet air sterilizer on cardiac surgery patients, a
randomized clinical trial.
Source
Medicina clinica. 151 (8) (pp 299-307), 2018. Date of Publication: 23 Oct
2018.
Author
Heredia-Rodriguez M.; Alvarez-Fuente E.; Bustamante-Munguira J.;
Poves-Alvarez R.; Fierro I.; Gomez-Sanchez E.; Gomez-Pesquera E.;
Lorenzo-Lopez M.; Eiros J.M.; Alvarez F.J.; Tamayo E.
Institution
(Heredia-Rodriguez, Alvarez-Fuente, Gomez-Sanchez, Gomez-Pesquera,
Lorenzo-Lopez) Department of Anaesthesiology, Hospital Clinico
Universitario, Valladolid, Spain; BioCritic, Group for Biomedical Research
in Critical Care Medicine, Valladolid, Spain
(Bustamante-Munguira) Department of Cardiovascular Surgery, Hospital
Universitario de La Princesa, Madrid, Spain
(Poves-Alvarez) Department of Anaesthesiology, Hospital Clinico
Universitario, Valladolid, Spain; BioCritic, Group for Biomedical Research
in Critical Care Medicine, Valladolid, Spain. Electronic address:
rpoves@saludcastillayleon.es
(Fierro) Department of Health Sciences, European University Miguel de
Cervantes, Valladolid, Spain
(Eiros) Department of Microbiology, Hospital Rio Hortega, Valladolid,
Spain
(Alvarez) Department of Pharmacology, University of Valladolid,
Valladolid, Spain
(Tamayo) Department of Pharmacology, University of Valladolid, Valladolid,
Spain; BioCritic, Group for Biomedical Research in Critical Care Medicine,
Valladolid, Spain
Publisher
NLM (Medline)
Abstract
BACKGROUND: Numerous studies have evaluated the use of ultraviolet-C
devices for terminal disinfection in hospitals, however, to date there is
little information about the device's final impact on patients. We
investigated the effect of an ultraviolet air sterilizer (UVAS) on the
clinical outcomes of cardiac surgery patients.
MATERIALS AND METHODS: This random, prospective and non-interventional
study included 1097 adult patients undergoing elective cardiac surgery:
522 stayed in an ICU room with UVAS (Medixair) and 575 patients ICU room
without UVAS and were used as a control. The primary outcome measure was
to evaluate the effect of a UVAS on the overall prevalence of nosocomial
infections in postoperative cardiac patients in ICUs.
RESULTS: No significant differences in ventilator-associated pneumonia
(4.6% vs. 5.0%, p=0.77) and total infection (14.0% vs. 15.5%, p=0.45)
rates were detected in patients with and without the UVAS. The length of
stay in the intensive care unit and at the hospital was similar in both
groups, UVAS (4.6 (8.2) days and 18.3 (5.5) days) and without UVAS (4.6
(7.3) days and 19.2 (18.6) days). The 30-day in-hospital mortality rate
was 5.3%, no significant differences between groups were observed
(p=0.053).
CONCLUSION: Novel ultraviolet-C technology has not been shown to
significantly reduce nosocomial infections or mortality rates in cardiac
surgery patients.<br/>Copyright &#xa9; 2018 Elsevier Espana, S.L.U. All
rights reserved.

<75>
Accession Number
624132825
Title
Operative strategies to reduce cerebral embolic events during on- and
off-pump coronary artery bypass surgery: A stratified, prospective
randomized trial.
Source
The Journal of thoracic and cardiovascular surgery. 154 (4) (pp
1278-1285), 2017. Date of Publication: 01 Oct 2017.
Author
Halkos M.E.; Anderson A.; Binongo J.N.G.; Stringer A.; Lasanajak Y.;
Thourani V.H.; Lattouf O.M.; Guyton R.A.; Baio K.T.; Sarin E.; Keeling
W.B.; Cook N.R.; Carssow K.; Neill A.; Glas K.E.; Puskas J.D.
Institution
(Halkos, Thourani, Lattouf, Guyton, Baio, Keeling, Cook, Carssow, Neill)
Division of Cardiothoracic Surgery, Emory University School of Medicine,
Atlanta, Ga, United States
(Anderson) Department of Neurology, Emory University School of Medicine,
Atlanta, Ga, United States
(Binongo, Lasanajak) Rollins School of Public Health, Emory University
School of Medicine, Atlanta, Ga, United States
(Stringer) Department of Rehabilitation Medicine, Emory University School
of Medicine, Atlanta, Ga, United States
(Sarin) Department of Cardiothoracic Surgery, Inova Fairfax Healthcare
System, Falls Church, Va, United States
(Glas) Department of Anesthesiology, Emory University School of Medicine,
Atlanta, Ga, United States
(Puskas) Department of Cardiothoracic Surgery, Mount Sinai University
School of Medicine, New York, NY
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To determine the impact of different aortic clamping strategies
on the incidence of cerebral embolic events during coronary artery bypass
grafting (CABG).
METHODS: Between 2012 and 2015, 142 patients with low-grade aortic disease
(epiaortic ultrasound grade I/II) undergoing primary isolated CABG were
studied. Those undergoing off-pump CABG were randomized to a partial clamp
(n = 36) or clampless facilitating device (CFD; n = 36) strategy. Those
undergoing on-pump CABG were randomized to a single-clamp (n = 34) or
double-clamp (n = 36) strategy. Transcranial Doppler ultrasonography (TCD)
was performed to identify high-intensity transient signals (HITS) in the
middle cerebral arteries during periods of aortic manipulation.
Neurocognitive testing was performed at baseline and 30-days
postoperatively. The primary endpoint was total number of HITS detected by
TCD. Groups were compared using the Mann-Whitney U test.
RESULTS: In the off-pump group, the median number of total HITS were
higher in the CFD subgroup (30.0; interquartile range [IQR], 22-43)
compared with the partial clamp subgroup (7.0; IQR, 0-16; P < .0001). In
the CFD subgroup, the median number of total HITS was significantly lower
for patients with 1 CFD compared with patients with >1 CFD (12.5 [IQR,
4-19] vs 36.0 [IQR, 25-47]; P = .001). In the on-pump group, the median
number of total HITS was 10.0 (IQR, 3-17) in the single-clamp group,
compared with 16.0 (IQR, 4-49) in the double-clamp group (P = .10). There
were no differences in neurocognitive outcomes across the groups.
CONCLUSIONS: For patients with low-grade aortic disease, the use of CFDs
was associated with an increased rate of cerebral embolic events compared
with partial clamping during off-pump CABG. A single-clamp strategy during
on-pump CABG did not significantly reduce embolic events compared with a
double-clamp strategy.<br/>Copyright &#xa9; 2017 The American Association
for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

<76>
Accession Number
624425119
Title
Normothermic versus hypothermic cardiopulmonary bypass in low-risk
paediatric heart surgery: A randomised controlled trial.
Source
Heart. (no pagination), 2018. Date of Publication: 2018.
Author
Caputo M.; Pike K.; Baos S.; Sheehan K.; Selway K.; Ellis L.; Stoica S.;
Parry A.; Clayton G.; Culliford L.; Angelini G.D.; Pandey R.; Rogers C.A.
Institution
(Caputo, Sheehan, Selway, Stoica, Parry, Pandey) Bristol Royal Hospital
for Children, University Hospitals Bristol NHS Foundation Trust, Bristol,
United Kingdom
(Pike, Baos, Ellis, Clayton, Culliford, Rogers) Clinical Trials and
Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol,
United Kingdom
(Angelini) Bristol Heart Institute, University of Bristol, Bristol, United
Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: To compare normothermic (35degreeC-36degreeC) versus
hypothermic (28degreeC) cardiopulmonary bypass (CPB) in paediatric
patients undergoing open heart surgery to test the hypothesis that
normothermic CPB perfusion maintains the functional integrity of major
organ systems leading to faster recovery. Methods: Two single-centre,
randomised controlled trials (known as Thermic-1 and Thermic-2,
respectively) were carried out to compare the effectiveness and
acceptability of normothermic versus hypothermic CPB in children with
congenital heart disease undergoing open heart surgery. In both studies,
the co-primary clinical outcomes were duration of inotropic support,
intubation time and postoperative hospital stay. Results: In total, 200
participants were recruited; 59 to the Thermic-1 study and 141 to the
Thermic-2 study. 98 patients received normothermic CPB and 102 patients
received hypothermic CPB. There were no significant differences between
the treatment groups for any of the co-primary outcomes: inotrope duration
HR=1.01, 95% CI (0.72 to 1.41); intubation time HR=1.14, 95% CI (0.86 to
1.51); postoperative hospital stay HR=1.06, 95% CI (0.80 to 1.40).
Differences favouring normothermia were found in urea nitrogen at 2 days
geometric mean ratio (GMR)=0.86 95% CI (0.77 to 0.97); serum creatinine at
3 days GMR=0.89, 95% CI (0.81 to 0.98); urinary albumin at 48 hours
GMR=0.32, 95% CI (0.14 to 0.74) and neutrophil gelatinase-associated
lipocalin at 4 hours GMR=0.47, 95% CI (0.22 to 1.02), but not at other
postoperative time points. Conclusions: Normothermic CPB is as safe and
effective as hypothermic CPB and can be routinely adopted as a perfusion
strategy in low-risk infants and children undergoing open heart surgery.
Trial registration number: ISRCTN93129502.<br/>Copyright &#xa9; Author(s)
(or their employer(s)) 2018. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ.

<77>
Accession Number
624424788
Title
A prospective study of patients' pain intensity after cardiac surgery and
a qualitative review: Effects of examiners' gender on patient reporting.
Source
Scandinavian Journal of Pain. (no pagination), 2018. Date of Publication:
2018.
Author
Meyer-Friessem C.H.; Szalaty P.; Zahn P.K.; Pogatzki-Zahn E.M.
Institution
(Meyer-Friesem, Szalaty, Zahn) Department of Anaesthesiology, Intensive
Care Medicine, Palliative Care and Pain Medicine, Medical Faculty of
Ruhr-University, BG-Universitatsklinikum Bergmannsheil GGmbH,
Burkle-de-la-Camp-Platz 1, Bochum 44789, Germany
(Pogatzki-Zahn) Department of Anaesthesiology, Intensive Care and Pain
Medicine, University Hospital of Muenster, Munster, Germany
Publisher
De Gruyter (E-mail: peter.golla@degruyter.com)
Abstract
As indicated by experimental studies, reports of pain intensity may depend
on the examiner's gender. Until now, it is unclear whether this is
relevant in clinical routine. This study investigated prospectively
whether the gender of assessor plays a role in patients' pain reports and
whether this role differs in male and female patients. 165 patients (66.4
years+/-0.63; 118 males) scheduled for heart surgery were allocated
consecutively to one examiner out of four students of both genders: two
females and two males (aged 24.3 years+/-1.7). Therefore, the following
study groups were defined: Group 1: female assessors-female patients, 2:
female-male; 3: male-female, 4: male-male. Using a standardized analgesic
scheme, patients were asked to rank their pain intensity on a numeric
rating scale (NRS: 0-10), postoperatively. Statistics: Kruskal-Wallis,
Mann-Whitney; p<0.05. Additionally, a qualitative literature review of the
databases Medline and CENTRAL was performed focusing on experimental and
clinical studies on experimenter gender bias. Due to the review, this
prospective clinical study was designed to investigate whether patients
after surgery report lower pain intensities when assessed by a female
compared to a male assessor. Summarizing all patients, pain intensity on
POD-1 was rated 4.0+/-2.4 on NRS and decreased on POD-2 to 3.0+/-2.1
[H(3)=37.941, p=0.000]. On average, pain intensity did not differ between
males and females (NRS: 3.5 vs. 3.6). Only on the second postoperative
day, more intense pain was reported in front of female assessors and less
intense pain in front of male assessors (NRS: 3.4 vs. 2.4; p=0.000). A
main effect for the four groups was seen (p=0.003): male patients reported
higher pain scores to female assessors (NRS: 3.5 vs. 2.3; p=0.000).
Together, contrary to the expectations, patients after cardiac surgery
reported a higher pain intensity in front of a female and a lower pain
intensity in front of a male assessor. In particular, female caregivers
may heighten the reported pain intensity up to 1.2 NRS-points; this bias
seems to be more relevant for male patients. Therefore, despite some
methodological weakness, our data suggest that attention should be paid to
a rather small, but somehow significant and consistent examiner gender
bias after cardiac surgery especially in male patients. Further clinical
studies are needed to show the true extent of clinical relevance and exact
mechanisms underlying these gender reporting bias.<br/>Copyright &#xa9;
2018 Scandinavian Association for the Study of Pain. Published by Walter
de Gruyter GmbH, Berlin/Boston. All rights reserved.

<78>
Accession Number
624408421
Title
Relationship between intra-operative vein graft treatment with DuraGraft
or saline and clinical outcomes after coronary artery bypass grafting.
Source
Expert Review of Cardiovascular Therapy. (no pagination), 2018. Date of
Publication: 2018.
Author
Haime M.; McLean R.R.; Kurgansky K.E.; Emmert M.Y.; Kosik N.; Nelson C.;
Gaziano M.J.; Cho K.; Gagnon D.R.
Institution
(Haime, Gaziano, Cho) VA Boston Healthcare System, Harvard Medical School,
West Roxbury, MA, United States
(McLean) Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA,
United States
(McLean) Department of Medicine, Beth Israel Deaconess Medical Center and
Harvard Medical School, Boston, MA, United States
(McLean, Kurgansky, Kosik, Nelson, Gaziano, Cho) Massachusetts Veterans
Epidemiology Research and Information Center (MAVERIC), VA Boston
Healthcare System, Boston, MA, United States
(Emmert) Clinic for Cardiovascular Surgery, University Hospital of Zurich,
Zurich, Switzerland
(Gaziano, Cho, Gagnon) Division of Aging, Brigham and Women's Hospital,
Boston, MA, United States
(Gagnon) Department of Biostatistics, Boston University School of Public
Health, Boston, MA, United States
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Background: Saphenous vein grafts (SVGs) remain the most often used
conduits for coronary bypass grafting (CABG). Progressive intimal
hyperplasia contributes to vein-graft disease and vein-graft failure
(VGF). We compared the impact of intraoperative preservation of SVGs in a
storage solution (DuraGraft) versus heparinized saline on VGF-related
outcomes after CABG. Methods: From 1996 to 2004, 2436 patients underwent
isolated CABG with >= 1 SVG. SVGs were consecutively treated with
DuraGraft in 1036 patients (2001-2004) and heparinized saline in 1400
patients (1996-1999). Short- (< 30 days) and long-term (>= 1000 days)
outcomes were assessed using repeat revascularization (primary end point),
and major adverse cardiac events (MACE) consisting of the composite of
death, nonfatal myocardial infarction, or repeat revascularization.
Results: Mean follow-up in the DuraGraft group was 8.5 +/- 4.2 years and
9.9 +/- 5.6 years in controls. Short-term event rates were low and
generally did not differ between groups. DuraGraft was associated with a
45% lower occurrence of nonfatal myocardial infarction after 1000 days
(hazard ratio 0.55, 95% CI 0.41-0.74; P < 0.0001). There was 35% and 19%
lower long-term risk for revascularization (HR 0.65, 95% CI 0.44-0.97; P =
0.037) and MACE (HR 0.81, 95% CI 0.70-0.94; P = 0.0051), respectively,
after DuraGraft. Mortality was comparable between both groups at 1, 5, and
10 years. There was no statistically significant association between
DuraGraft exposure and time to death starting at 30 or 1000 days (HR 0.91,
95% CI 0.76-1.09; P = 0.29). Conclusion: In this study, intraoperative
treatment of SVGs with DuraGraft was associated with a lower risk of
long-term adverse events suggesting that efficient intraoperative SVG
treatment may reduce VGF-related complications post-CABG. These data
warrant randomized clinical trials to validate these
findings.<br/>Copyright &#xa9; 2018, &#xa9; 2018 Informa UK Limited,
trading as Taylor & Francis Group.

<79>
Accession Number
2000795963
Title
Impact of an ultraviolet air sterilizer on cardiac surgery patients, a
randomized clinical trial.
Source
Medicina Clinica. 151 (8) (pp 299-307), 2018. Date of Publication: 23
October 2018.
Author
Heredia-Rodriguez M.; Alvarez-Fuente E.; Bustamante-Munguira J.;
Poves-Alvarez R.; Fierro I.; Gomez-Sanchez E.; Gomez-Pesquera E.;
Lorenzo-Lopez M.; Eiros J.M.; Alvarez F.J.; Tamayo E.
Institution
(Heredia-Rodriguez, Alvarez-Fuente, Poves-Alvarez, Gomez-Sanchez,
Gomez-Pesquera, Lorenzo-Lopez) Department of Anaesthesiology, Hospital
Clinico Universitario, Valladolid, Spain
(Heredia-Rodriguez, Alvarez-Fuente, Poves-Alvarez, Gomez-Sanchez,
Gomez-Pesquera, Lorenzo-Lopez, Tamayo) BioCritic, Group for Biomedical
Research in Critical Care Medicine, Valladolid, Spain
(Bustamante-Munguira) Department of Cardiovascular Surgery, Hospital
Universitario de La Princesa, Madrid, Spain
(Fierro) Department of Health Sciences, European University Miguel de
Cervantes, Valladolid, Spain
(Alvarez, Tamayo) Department of Pharmacology, University of Valladolid,
Valladolid, Spain
(Eiros) Department of Microbiology, Hospital Rio Hortega, Valladolid,
Spain
Publisher
Ediciones Doyma, S.L.
Abstract
Background: Numerous studies have evaluated the use of ultraviolet-C
devices for terminal disinfection in hospitals, however, to date there is
little information about the device's final impact on patients. We
investigated the effect of an ultraviolet air sterilizer (UVAS) on the
clinical outcomes of cardiac surgery patients. Materials and methods: This
random, prospective and non-interventional study included 1097 adult
patients undergoing elective cardiac surgery: 522 stayed in an ICU room
with UVAS (Medixair) and 575 patients ICU room without UVAS and
were used as a control. The primary outcome measure was to evaluate the
effect of a UVAS on the overall prevalence of nosocomial infections in
postoperative cardiac patients in ICUs. Results: No significant
differences in ventilator-associated pneumonia (4.6% vs. 5.0%, p = 0.77)
and total infection (14.0% vs. 15.5%, p = 0.45) rates were detected in
patients with and without the UVAS. The length of stay in the intensive
care unit and at the hospital was similar in both groups, UVAS (4.6 (8.2)
days and 18.3 (5.5) days) and without UVAS (4.6 (7.3) days and 19.2 (18.6)
days). The 30-day in-hospital mortality rate was 5.3%, no significant
differences between groups were observed (p = 0.053). Conclusion: Novel
ultraviolet-C technology has not been shown to significantly reduce
nosocomial infections or mortality rates in cardiac surgery
patients.<br/>Copyright &#xa9; 2018 Elsevier Espana, S.L.U.

<80>
Accession Number
620676580
Title
Prognostic efficacy of circulating asymmetric dimethylarginine in patients
with peripheral arterial disease: A meta-analysis of prospective cohort
studies.
Source
Vascular. 26 (3) (pp 322-330), 2018. Date of Publication: 01 Jun 2018.
Author
Chu R.; Yu D.; Chu J.; Lin M.; Yu H.
Institution
(Chu, Yu, Chu, Yu) Department of Interventional Radiology, Wendeng
Osteopathy Hospital, Weihai, China
(Lin) Department of Radiology, Wendeng Osteopathy Hospital, Weihai, China
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Asymmetric dimethylarginine is suggested to be a marker of
poor prognosis in patients with atherosclerosis. However, the predictive
role of circulating asymmetric dimethylarginine for clinical outcome in
patients with peripheral arterial disease has not been determined. Aims:
To quantitatively assess the predictive value of circulating asymmetric
dimethylarginine for clinical outcome in patients with peripheral arterial
disease in a meta-analysis of prospective cohort studies. Methods:
Relevant studies were identified by systematically searching of PubMed and
Embase databases. A random-effect model was used to synthesize the
results. Sensitivity analyses by omitting one study at a time were
performed to evaluate the robustness of the results. Results: Six studies
with 2535 peripheral arterial disease patients were included. Patients
with higher circulating asymmetric dimethylarginine at baseline were
associated with higher risk of all-cause mortality (adjusted hazard ratio:
1.63, 95% confidence interval: 1.28-2.06, I² = 16%), and major
adverse cardiovascular events (adjusted hazard ratio: 2.01, 95% confidence
interval: 1.08-3.73, I² = 78%) as compared with those with
lower circulating asymmetric dimethylarginine at baseline. Specifically,
every increment of 0.1 micro&#32;mol/l of asymmetric dimethylarginine was
associated with 18% (adjusted hazard ratio: 1.18, 95% confidence interval:
1.06-1.31) increased risk for all-cause mortality and 14% (adjusted hazard
ratio: 1.14, 95% confidence interval: 1.04-1.25) increased risk for major
adverse cardiovascular disease. Sensitivity analyses by omitting one study
at a time did not significantly change the results. Conclusion: Higher
circulating asymmetric dimethylarginine at baseline may be associated with
higher incidence of cardiovascular events and mortality in patients with
peripheral arterial disease.<br/>Copyright &#xa9; 2017, &#xa9; The
Author(s) 2017.

<81>
Accession Number
2001132716
Title
Radial versus femoral access and bivalirudin versus unfractionated heparin
in invasively managed patients with acute coronary syndrome (MATRIX):
final 1-year results of a multicentre, randomised controlled trial.
Source
The Lancet. 392 (10150) (pp 835-848), 2018. Date of Publication: 8 - 14
September 2018.
Author
Valgimigli M.; Frigoli E.; Leonardi S.; Vranckx P.; Rothenbuhler M.;
Tebaldi M.; Varbella F.; Calabro P.; Garducci S.; Rubartelli P.; Briguori
C.; Ando G.; Ferrario M.; Limbruno U.; Garbo R.; Sganzerla P.; Russo F.;
Nazzaro M.; Lupi A.; Cortese B.; Ausiello A.; Ierna S.; Esposito G.;
Ferrante G.; Santarelli A.; Sardella G.; de Cesare N.; Tosi P.; van 't Hof
A.; Omerovic E.; Brugaletta S.; Windecker S.; Heg D.; Juni P.; Campo G.;
Uguccioni L.; Tamburino C.; Presbitero P.; Zavalloni-Parenti D.; Ferrari
F.; Ceravolo R.; Tarantino F.; Pasquetto G.; Casu G.; Mameli S.; Stochino
M.L.; Mazzarotto P.; Cremonesi A.; Saia F.; Saccone G.; Abate F.; Picchi
A.; Violini R.; Colangelo S.; Boccuzzi G.; Guiducci V.; Vigna C.;
Zingarelli A.; Gagnor A.; Zaro T.; Tresoldi S.; Vandoni P.; Contarini M.;
Liso A.; Dellavalle A.; Curello S.; Mangiacapra F.; Evola R.; Palmieri C.;
Falcone C.; Liistro F.; Creaco M.; Colombo A.; Chieffo A.; Perkan A.; De
Servi S.; Fischetti D.; Rigattieri S.; Sciahbasi A.; Pucci E.; Romagnoli
E.; Moretti C.; Moretti L.; De Caterina R.; Caputo M.; Zimmarino M.;
Bramucci E.; Di Lorenzo E.; Turturo M.; Bonmassari R.; Penzo C.; Loi B.;
Mauro C.; Petronio A.S.; Gabrielli G.; Micari A.; Belloni F.; Amico F.;
Comeglio M.; Fresco C.; Klinieken I.; Van Mieghem N.; Diletti R.; Regar
E.; Sabate M.; Gomez Hospital J.A.; Diaz Fernandez J.F.; Mainar V.; de la
Torre Hernandez J.M.
Institution
(Valgimigli, Windecker) Inselspital, Bern University Hospital, University
of Bern, Bern, Switzerland
(Frigoli, Rothenbuhler, Heg) Clinical Trials Unit, University of Bern,
Bern, Switzerland
(Leonardi, Ferrario) UOC Cardiologia, Dipartimento CardioToracoVascolare,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
(Tebaldi) University Hospital of Ferrara, Ferrara, Italy
(Varbella) Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3,
Turin, Italy
(Calabro) Division of Clinical Cardiology, "Sant'Anna e San Sebastiano"
Hospital, Caserta, Italy
(Calabro) Department of Translational Medical Sciences, University of
Campania "Luigi Vanvitelli", Naples, Italy
(Garducci) A.O. Ospedale Civile di Vimercate, Vimercate, Italy
(Rubartelli) Department of Cardiology, ASL3 Ospedale Villa Scassi, Genoa,
Italy
(Briguori) Clinica Mediterranea, Naples, Italy
(Ando) Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino",
University of Messina, Messina, Italy
(Limbruno) UO Cardiologia, ASL 9 Grosseto, Grosseto, Italy
(Garbo) San Giovanni Bosco Hospital, Turin, Italy
(Sganzerla) AO Ospedale Treviglio-Caravaggio, Treviglio, Italy
(Russo) Azienda Ospedaliera Sant'Anna, Como, Italy
(Nazzaro) San Camillo-Forlanini, Roma, Italy
(Lupi) Division of Cardiology, ASL VCO, Verbania, Italy
(Cortese) Ospedale FatebeneFratelli, Milano, Italy
(Ausiello) Casa di Cura Villa Verde, Taranto, Italy
(Ierna) Ospedale Sirai, Carbonia, Carbonia, Italy
(Esposito) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University of Naples, Naples, Italy
(Ferrante) IRCCS Humanitas, Milan, Italy
(Santarelli) Cardiovascular Department, Infermi Hospital, Rimini, Italy
(Sardella) Policlinico Umberto I, "Sapienza" University of Rome, Rome,
Italy
(de Cesare) Policlinico San Marco, Zingonia, Italy
(Tosi) Mater Salutis Hospital, Legnago, Italy
(van 't Hof) Department of Cardiology, Maastricht University Medical
Center (MUMC+), Maastricht, Netherlands
(Omerovic) Sahlgrenska University Hospital, Gothenburg, Sweden
(Brugaletta) Hospital Clinic, University of Barcelona, Thorax Institute,
Department of Cardiology, Barcelona, Spain
(Juni) Applied Health Research Centre (AHRC), Li Ka Shing Knowledge
Institute of St Michael's Hospital, Department of Medicine and Institute
of Health Policy, Management and Evaluation, University of Toronto,
Toronto, ON, Canada
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: The Minimizing Adverse Haemorrhagic Events by Transradial
Access Site and Systemic Implementation of Angiox (MATRIX) programme was
designed to assess the comparative safety and effectiveness of radial
versus femoral access and of bivalirudin versus unfractionated heparin
with optional glycoprotein IIb/IIIa inhibitors in patients with the whole
spectrum of acute coronary syndrome undergoing invasive management. Here
we describe the prespecified final 1-year outcomes of the entire
programme. Methods: MATRIX was a programme of three nested, randomised,
multicentre, open-label, superiority trials in patients with acute
coronary syndrome in 78 hospitals in Italy, the Netherlands, Spain, and
Sweden. Patients with ST-elevation myocardial infarction were
simultaneously randomly assigned (1:1) before coronary angiography to
radial or femoral access and to bivalirudin, with or without
post-percutaneous coronary intervention infusion or unfractionated heparin
(one-step inclusion). Patients with non-ST-elevation acute coronary
syndrome were randomly assigned (1:1) before coronary angiography to
radial or femoral access and, only if deemed eligible to percutaneous
coronary intervention after angiography (two-step inclusion), entered the
antithrombin type and treatment duration programmes. Randomisation
sequences were computer generated, blocked, and stratified by intended new
or current use of P2Y12 inhibitor (clopidogrel vs ticagrelor or
prasugrel), and acute coronary syndrome type (ST-elevation myocardial
infarction, troponin-positive, or troponin-negative non-ST-elevation acute
coronary syndrome). Bivalirudin was given as a bolus of 0.75 mg/kg,
followed immediately by an infusion of 1.75 mg/kg per h until completion
of percutaneous coronary intervention. Heparin was given at 70-100 units
per kg in patients not receiving glycoprotein IIb/IIIa inhibitors, and at
50-70 units per kg in patients receiving glycoprotein IIb/IIIa inhibitors.
Clinical follow-up was done at 30 days and 1 year. Co-primary outcomes for
MATRIX access and MATRIX antithrombin type were major adverse
cardiovascular events, defined as the composite of all-cause mortality,
myocardial infarction, or stroke up to 30 days; and net adverse clinical
events, defined as the composite of non-coronary artery bypass
graft-related major bleeding, or major adverse cardiovascular events up to
30 days. The primary outcome for MATRIX treatment duration was the
composite of urgent target vessel revascularisation, definite stent
thrombosis, or net adverse clinical events up to 30 days. Analyses were
done according to the intention-to-treat principle. This trial is
registered with ClinicalTrials.gov, number NCT01433627. Findings: Between
Oct 11, 2011, and Nov 7, 2014, we randomly assigned 8404 patients to
receive radial (4197 patients) or femoral (4207 patients) access. Of these
8404 patients, 7213 were included in the MATRIX antithrombin type study
and were randomly assigned to bivalirudin (3610 patients) or heparin (3603
patients). Patients assigned to bivalirudin were included in the MATRIX
treatment duration study, and were randomly assigned to post-procedure
infusion (1799 patients) or no post-procedure infusion (1811 patients). At
1 year, major adverse cardiovascular events did not differ between
patients assigned to radial access compared with those assigned to femoral
access (14.2% vs 15.7%; rate ratio 0.89, 95% CI 0.80-1.00; p=0.0526), but
net adverse clinical events were fewer with radial than with femoral
access (15.2% vs 17.2%; 0.87, 0.78-0.97; p=0.0128). Compared with heparin,
bivalirudin was not associated with fewer major adverse cardiovascular
(15.8% vs 16.8%; 0.94, 0.83-1.05; p=0.28) or net adverse clinical events
(17.0% vs 18.4%; 0.91, 0.81-1.02; p=0.10). The composite of urgent target
vessel revascularisation, stent thrombosis, or net adverse clinical events
did not differ with or without post-procedure bivalirudin infusion (17.4%
vs 17.4%; 0.99, 0.84-1.16; p=0.90). Interpretation: In patients with acute
coronary syndrome, radial access was associated with lower rates of net
adverse clinical events compared with femoral access, but not major
adverse cardiovascular events at 1 year. Bivalirudin with or without
post-procedure infusion was not associated with lower rates of major
adverse cardiovascular events or net adverse clinical events. Radial
access should become the default approach in acute coronary syndrome
patients undergoing invasive management. Funding: Italian Society of
Invasive Cardiology, The Medicines Company, Terumo, amd Canada Research
Chairs Programme.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<82>
Accession Number
623995489
Title
Cardiovascular safety of lorcaserin in overweight or obese patients.
Source
New England Journal of Medicine. 379 (12) (pp 1107-1117), 2018. Date of
Publication: 20 Sep 2018.
Author
Bohula E.A.; Wiviott S.D.; McGuire D.K.; Inzucchi S.E.; Kuder J.; Im K.A.;
Fanola C.L.; Qamar A.; Brown C.; Budaj A.; Garcia-Castillo A.; Gupta M.;
Leiter L.A.; Weissman N.J.; White H.D.; Patel T.; Francis B.; Miao W.;
Perdomo C.; Dhadda S.; Bonaca M.P.; Ruff C.T.; Keech A.C.; Smith S.R.;
Sabatine M.S.; Scirica B.M.
Institution
(Bohula, Wiviott, Kuder, Im, Qamar, Bonaca, Ruff, Sabatine, Scirica)
Thrombolysis in Myocardial Infarction (TIMI) Study Group, Division of
Cardiovascular Medicine, Brigham and Women's Hospital, 60 Fenwood Rd.,
Boston, MA 02115, United States
(McGuire) Cardiovascular Division, University of Texas Southwestern
Medical Center, Dallas, United States
(Inzucchi) Section of Endocrinology, Yale School of Medicine, New Haven,
CT, United States
(Fanola) Department of Medicine, University of Minnesota, Minneapolis,
United States
(Brown) Partners Clinical Research Centre, Nassau, Bahamas
(Budaj) Department of Cardiology, Postgraduate Medical School, Grochowski
Hospital, Warsaw, Poland
(Garcia-Castillo) Cardiolink Clinical Trials, Monterrey, Mexico
(Gupta) McMaster University, Brampton, ON, Canada
(Leiter) Division of Endocrinology and Metabolism, St. Michael's Hospital,
University of Toronto, Toronto, Canada
(Weissman) MedStar Health Research Institute, Hyattsville, MD, United
States
(White) Cardiology Department, Auckland City Hospital, Auckland, New
Zealand
(Patel, Francis, Miao, Perdomo, Dhadda) Eisai, Woodcliff Lake, NJ, United
States
(Keech) National Health and Medical Research Council Clinical Trials
Centre, University of Sydney, Sydney, Australia
(Smith) Translational Research Institute for Metabolism and Diabetes,
Florida Hospital and the Sanford-Burnham Institute, Winter Park, United
States
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Lorcaserin, a selective serotonin 2C receptor agonist that
modulates appetite, has proven efficacy for weight management in
overweight or obese patients. The cardiovascular safety and efficacy of
lorcaserin are undefined. METHODS We randomly assigned 12,000 overweight
or obese patients with atherosclerotic cardiovascular disease or multiple
cardiovascular risk factors to receive either lorcaserin (10 mg twice
daily) or placebo. The primary safety outcome of major cardiovascular
events (a composite of cardiovascular death, myocardial infarction, or
stroke) was assessed at an interim analysis to exclude a noninferiority
boundary of 1.4. If noninferiority was met, the primary cardiovascular
efficacy outcome (a composite of major cardiovascular events, heart
failure, hospitalization for unstable angina, or coronary
revascularization [extended major cardiovascular events]) was assessed for
superiority at the end of the trial. RESULTS At 1 year, weight loss of at
least 5% had occurred in 1986 of 5135 patients (38.7%) in the lorcaserin
group and in 883 of 5083 (17.4%) in the placebo group (odds ratio, 3.01;
95% confidence interval [CI], 2.74 to 3.30; P<0.001). Patients in the
lorcaserin group had slightly better values with respect to cardiac risk
factors (including blood pressure, heart rate, glycemic control, and
lipids) than those in the placebo group. During a median follow-up of 3.3
years, the rate of the primary safety outcome was 2.0% per year in the
lorcaserin group and 2.1% per year in the placebo group (hazard ratio,
0.99; 95% CI, 0.85 to 1.14; P<0.001 for noninferiority); the rate of
extended major cardiovascular events was 4.1% per year and 4.2% per year,
respectively (hazard ratio, 0.97; 95% CI, 0.87 to 1.07; P = 0.55). Adverse
events of special interest were uncommon, and the rates were generally
similar in the two groups, except for a higher number of patients with
serious hypoglycemia in the lorcaserin group (13 vs. 4, P = 0.04).
CONCLUSIONS In a high-risk population of overweight or obese patients,
lorcaserin facilitated sustained weight loss without a higher rate of
major cardiovascular events than that with placebo.<br/>Copyright &#xa9;
2018 Massachusetts Medical Society.

<83>
Accession Number
619499363
Title
Effect of Sustained Use of Aspirin until the Time of Surgery on Outcomes
following Coronary Artery Bypass Grafting: A Randomized Clinical Trial.
Source
Thoracic and Cardiovascular Surgeon. 66 (6) (pp 442-451), 2018. Date of
Publication: 24 Nov 2018.
Author
Sharifi M.; Kamali A.; Ghandi Y.
Institution
(Sharifi) Department of Cardiovascular Surgery, Amir-Almomenin Training
and Research Hospital, Arak University of Medical Sciences, Arak
3848176941, Iran, Islamic Republic of
(Kamali) Department of Anesthesiology, Faculty of Medicine, Arak
University of Medical Sciences, Arak, Iran, Islamic Republic of
(Ghandi) Department of Pediatric Cardiology, Faculty of Medicine, Arak
University of Medical Sciences, Arak, Iran, Islamic Republic of
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background The topic of aspirin (acetylsalicylic acid, ASA) use in
coronary artery disease patients planned for coronary artery bypass
grafting during perioperative period is among the most disputed issues in
cardiac surgery. We designed a study to weigh the risks and benefits of
continued ASA ingestion until the time of surgery. Methods In this
randomized double-blind clinical trial, 206 consecutive patients scheduled
for isolated coronary artery bypass surgery (CABG) were randomly
stratified into two groups. In group 1 (104 cases), patients were given 80
mg ASA per day until the day of surgery. In group 2 (102 patients), ASA
(80 mg per day) was stopped 4 days before the operation. Patients in these
two groups were similar in terms of preoperative patient and procedural
characteristics. ASA was resumed 24 hours after the surgery in all
patients. Results The rates of bleeding and reexploration within 24 hours
of surgery were significantly higher in group 1 (824.3 vs. 492.1 mL, p <
0.001 and 5.7% vs. 0, p = 0.0138, respectively). The amount of intra- and
postoperative packed red blood cell (PRBC) transfusion was considerably
greater in group 1 (mean: 1.83 vs. 0.71 units, p < 0.001). The rate of
hospital mortality was similar (1.9% in both the groups, p = 0.98).
Patients in group 1 had significantly longer mean hospital stay than
patients in group 2 (8 vs. 5.1 days, p < 0.001). Again the time interval
between weaning from heart-lung machine and closing the sternum was
strikingly longer in group 1 (mean: 32.1 vs. 14.5 minutes, p < 0.001). The
incidence of adverse postoperative outcomes such as myocardial infarction,
stroke, and renal failure was not statistically different between the two
groups. Conclusion Sustained ASA use until the day of surgery in patients
planned for elective isolated CABG can result in excessive bleeding,
increased rate of reexploration, and need for more PRBC transfusion
without any proven beneficial effect on reducing unfavorable postoperative
outcomes. Hence, we recommend discontinuing ASA between 3 and 5 days
before non-urgent CABG while keeping it on in nonelective
circumstances.<br/>Copyright &#xa9; 2018 Georg Thieme Verlag KG Stuttgart.
New York.

<84>
Accession Number
615136925
Title
Coronary Artery Bypass Surgery in Diffuse Advanced Coronary Artery
Disease: 1-Year Clinical and Angiographic Results.
Source
Thoracic and Cardiovascular Surgeon. 66 (6) (pp 477-482), 2018. Date of
Publication: 18 Feb 2018.
Author
Dourado L.O.C.; Bittencourt M.S.; Pereira A.C.; Poppi N.T.; Dallan L.A.O.;
Krieger J.E.; Cesar L.A.M.; Gowdak L.H.W.
Institution
(Dourado, Pereira, Poppi, Dallan, Krieger, Cesar, Gowdak) Cardiopneumology
Department, Heart Institute (InCor), University of Sao Paulo Medical
School, Sao Paulo, Brazil
(Bittencourt) Division of Internal Medicine, Center for Clinical and
Epidemiological Research, University Hospital, University of Sao Paulo,
Sao Paulo, Brazil
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background Proper treatment of patients with diffuse, severe coronary
artery disease (CAD) is a challenge due to its complexity. Thus, data on
the outcomes after coronary artery bypass graft (CABG) in this population
is scarce. In this study, we aimed to determine the impact of CABG on the
clinical and functional status, as well as graft patency in those
individuals. Methods Patients with severe and diffuse CAD who underwent
incomplete CABG due to complex anatomy or extensive distal coronary
involvement were evaluated preoperatively and 1 year after surgery.
Postoperative coronary angiography was performed to evaluate graft
patency. Graft occlusion was defined as the complete absence of
opacification of the target vessel. Stratified analysis of graft occlusion
was performed by graft type and territories, defined as left anterior
descending artery (LAD), the left circumflex branch, and the right
coronary artery territories; the latter two, grouped, were further
classified as non-LAD territory. Results A total of 57 patients were
included, in whom 131 grafts were placed. There was a significant
improvement in Canadian Cardiovascular Society angina symptom severity (Z
= -6.1; p < 0.001) and maximum oxygen uptake (p < 0.001), with a
corresponding decrease in the use of long-acting nitrates (p < 0.001). The
overall graft occlusion rate was 19.1%, with no significant difference
between LAD and non-LAD territories (p = 0.08). However, a significantly
lower occlusion rate was noted for the internal mammary artery (IMA)
grafts when compared with saphenous vein grafts (p = 0.01), though this
difference was only significant in the LAD territory (p = 0.04). Overall,
the use of venous graft was the only predictor occlusion at 1 year (odds
ratio: 4.03; p = 0.016). Conclusion In patients with diffuse CAD,
incomplete CABG surgery resulted in a significant clinical improvement,
with acceptable graft occlusion rates at 1 year, particularly for IMA
grafts to the LAD territory.<br/>Copyright &#xa9; 2018 Georg Thieme Verlag
KG Stuttgart. New York.

<85>
Accession Number
618502170
Title
Ischemic Conditioning as a Hemostatic Intervention in Surgery and Cardiac
Procedures: A Systematic Review.
Source
Seminars in Thrombosis and Hemostasis. 43 (7) (pp 716-731), 2017. Date of
Publication: 01 Oct 2017.
Author
Krag A.E.; Hvas A.-M.
Institution
(Krag, Hvas) Department of Clinical Biochemistry, Center for Hemophilia
and Thrombosis, Aarhus University Hospital, Palle Juul-Jensens Boulevard
99, Aarhus N 8200, Denmark
Publisher
Thieme Medical Publishers, Inc. (E-mail: custserv@thieme.com)
Abstract
Ischemic conditioning induced by nonlethal cycles of tissue ischemia and
reperfusion attenuates ischemia-reperfusion injury. The objective of this
study is to systematically review the effects of local and remote ischemic
conditioning on laboratory parameters of hemostasis and the clinical
outcomes of thromboembolism or bleeding in patients undergoing surgery or
cardiac procedures. PubMed and Embase were searched for relevant human
trials published in English between January 1, 1986, and September 7,
2016, and additional studies were identified from reference lists. Data on
laboratory parameters of hemostasis, thromboembolism, and bleeding were
extracted for qualitative synthesis. In total, 69 studies were included;
of these, 53 were randomized controlled trials (RCTs) and 11 were
meta-analyses. Local and remote ischemic conditioning reduced platelet
activation in patients undergoing cardiac procedures. Local ischemic
conditioning did not reduce the thromboembolic risk in patients undergoing
surgery or cardiac procedures. Remote ischemic conditioning reduced the
incidence of arterial thromboembolism after surgery or cardiac procedures
in 3 out of 28 RCTs and 4 out of 5 meta-analyses. Local and remote
ischemic conditioning did not increase operative bleeding. In conclusion,
ischemic conditioning reduced platelet activity without increasing the
risk of bleeding in patients undergoing surgery or cardiac procedures.
Limited evidence supports the proposal that ischemic conditioning reduces
the incidence of arterial thromboembolism in patients undergoing surgery
or cardiac procedures.

<86>
Accession Number
624279753
Title
Provocative biomarker stress test: Stress-delta N-terminal pro-B type
natriuretic peptide.
Source
Open Heart. 5 (2) (no pagination), 2018. Article Number: e000847. Date of
Publication: 01 Oct 2018.
Author
Limkakeng A.T.; Leahy J.C.; Griffin S.M.; Lokhnygina Y.; Jaffa E.;
Christenson R.H.; Newby L.K.
Institution
(Limkakeng, Leahy, Griffin, Jaffa) Division of Emergency Medicine, Duke
University School of Medicine, Durham, NC, United States
(Lokhnygina) Department of Biostatistics and Bioinformatics, Duke
University School of Medicine, Durham, NC, United States
(Christenson) Department of Pathology, University of Maryland School of
Medicine, Baltimore, United States
(Newby) Division of Cardiology, Department of Medicine, Duke Clinical
Research Institute, Durham, NC, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Stress testing is commonly performed in emergency department
(ED) patients with suspected acute coronary syndrome (ACS). We
hypothesised that changes in N-terminal pro-B type natriuretic peptide
(NT-proBNP) concentrations from baseline to post-stress testing
(stress-delta values) differentiate patients with ischaemic stress tests
from controls. Methods We prospectively enrolled 320 adult patients with
suspected ACS in an ED-based observation unit who were undergoing exercise
stress echocardiography. We measured plasma NT-proBNP concentrations at
baseline and at 2 and 4hours post-stress and compared stress-delta
NT-proBNP between patients with abnormal stress tests versus controls
using non-parametric statistics (Wilcoxon test) due to skew. We calculated
the diagnostic test characteristics of stress-delta NT-proBNP for
myocardial ischaemia on imaging. Results Among 320 participants, the
median age was 51 (IQR 44-59) years, 147 (45.9%) were men, and 122 (38.1%)
were African-American. Twenty-six (8.1%) had myocardial ischaemia. Static
and stress-deltas NT-proBNP differed at all time points between groups.
The median stress-deltas at 2hours were 10.4 (IQR 6.0-51.7) ng/L vs 1.7
(IQR -0.4 to 8.7) ng/L, and at 4hours were 14.8 (IQR 5.0-22.3) ng/L vs 1.0
(-2.0 to 10.3) ng/L for patients with ischaemia versus those without.
Areas under the receiver operating curves were 0.716 and 0.719 for 2-hour
and 4-hour stress-deltas, respectively. After adjusting for baseline
NT-proBNP levels, the 4-hour stress-delta NT-proBNP remained significantly
different between the groups (p=0.009). Conclusion Among patients with
ischaemic stress tests, static and 4-hour stress-delta NT-proBNP values
were significantly higher. Further study is needed to determine if
stress-delta NT-proBNP is a useful adjunct to stress
testing.<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2018.
Re-use permitted under CC BY-NC. No commercial re-use. See rights and
permissions. Published by BMJ.

<87>
Accession Number
624351625
Title
Positive impact of retrograde autologous priming in adult patients
undergoing cardiac surgery: a randomized clinical trial.
Source
Journal of cardiothoracic surgery. 13 (1) (pp 50), 2018. Date of
Publication: 21 May 2018.
Author
Hofmann B.; Kaufmann C.; Stiller M.; Neitzel T.; Wienke A.; Silber R.-E.;
Treede H.
Institution
(Hofmann, Kaufmann, Stiller, Neitzel, Silber, Treede) Department of
Cardiac Surgery, University Hospital Halle, Ernst-Grube-Strasse 40, Halle
06120, Germany
(Wienke) Institute of Medical Epidemiology, Biostatistics and Informatics,
Martin-Luther-University Halle-Wittenberg, Halle 06097, Germany
Abstract
BACKGROUND: Adult cardiac surgery with extracorporeal circulation is known
to be associated with increased risk of blood transfusion leading to
adverse outcomes. Procedures like retrograde autologous priming (RAP) may
reduce these negative side effects. This randomized prospective study was
initiated to assess whether RAP using specifically designed RAP bag
(Terumo) has immediate effects on patient outcome.
METHODS: One hundred eighteen adults undergoing elective CABG or elective
aortic valve replacement were randomly assigned by a computer program into
two groups: the RAP group (n=54) in which the retrograde autologous
priming was applied and the non-RAP (n=64) group in which the same setting
was used without the possibility to save priming volume. Patient
demographics, preoperative characteristics and postoperative outcomes were
analyzed for both groups.
RESULTS: The primary endpoint defined as rate of intraoperative blood
transfusion was significantly reduced in the RAP-group (p=0.04). The
absolute risk reduction for RAP managed patients was 13.5 percent points.
There were no significant differences in operation time and blood loss. No
deaths and no myocardial infarctions were observed. The number of patients
needed to treat to prevent at least one red blood cell transfusion was
around 8 (NNT=7.42).
CONCLUSIONS: Retrograde autologous priming is a safe and less invasive
procedure which achieves clear benefits for adult cardiac surgery
patients. In the light of increasing red blood cell transfusion risks and
costs and the wish of patients to avoid a transfusion implementation of
retrograde autologous priming is an interesting option.
TRIAL REGISTRATION: German Clinical Trials Register ID: DRKS00013512 ,
registered 04 December 2017.

<88>
[Use Link to view the full text]
Accession Number
624384002
Title
Effectiveness of Nurse's Intentional Presence as a Holistic Modality on
Depression, Anxiety, and Stress of Cardiac Surgery Patients.
Source
Holistic nursing practice. 32 (6) (pp 296-306), 2018. Date of Publication:
01 Nov 2018.
Author
Khajian Gelogahi Z.; Aghebati N.; Mazloum S.R.; Mohajer S.
Institution
(Khajian Gelogahi) Evidence-Based Research Center (Dr Aghebati, Medical
Surgical Department (Ms Gelogahi, Dr Aghebati, School of Nursing and
Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
Publisher
NLM (Medline)
Abstract
One of the important aspects of recovering after bypass surgery is mental
disorders of patients. Despite the importance of intentional presence in
interpersonal interactive space in holistic nursing, a few experimental
and clinical trial studies are conducted on this subject. This study
determines the effect of intentional presence of a holistic nurse on
anxiety, stress, and depression in patients undergoing coronary artery
bypass graft surgery. The study used a randomized clinical trial conducted
on 80 patients referred to heart surgery department from March 2016 to
June 2017, who were allocated to the control and intervention groups
randomly. DASS 21 (Depression, Anxiety, Stress scale) questionnaire and a
checklist to determine stressor resources were used to measure the
variables. Four 30- to 45-minute sessions of nursing intentional presence
were conducted for each patient individually in the intervention group.
The results showed homogeneity between 2 groups in demographic variables
(P > .05). But there was heterogeneity between 2 groups (P < .05) for some
stressors. By using analysis of covariance and excluding the effect of
stressors and the first scores before the intervention, statistics
represented a significant decrease in stress, anxiety, and depression
scores in the intervention group compared with the control group (P <
.0001). The results of this study indicated that the intentional presence
of a nurse as an effective nursing procedure can reduce the depression,
stress, and anxiety of the patients undergoing coronary artery bypass
surgery.

<89>
Accession Number
624196937
Title
Six-Month Outcomes after Restrictive or Liberal Transfusion for Cardiac
Surgery.
Source
The New England journal of medicine. 379 (13) (pp 1224-1233), 2018. Date
of Publication: 27 Sep 2018.
Author
Mazer C.D.; Whitlock R.P.; Fergusson D.A.; Belley-Cote E.; Connolly K.;
Khanykin B.; Gregory A.J.; de Medicis E.; Carrier F.M.; McGuinness S.;
Young P.J.; Byrne K.; Villar J.C.; Royse A.; Grocott H.P.; Seeberger M.D.;
Mehta C.; Lellouche F.; Hare G.M.T.; Painter T.W.; Fremes S.; Syed S.;
Bagshaw S.M.; Hwang N.-C.; Royse C.; Hall J.; Dai D.; Mistry N.; Thorpe
K.; Verma S.; Juni P.; Shehata N.
Institution
(Mazer, Whitlock, Fergusson, Belley-Cote, Connolly, Khanykin, Gregory, de
Medicis, Carrier, McGuinness, Young, Byrne, Villar, Royse, Grocott,
Seeberger, Mehta, Lellouche, Hare, Painter, Fremes, Syed, Bagshaw, Hwang,
Royse, Hall, Dai, Mistry, Thorpe, Verma, Juni, Shehata) From the
Department of Anesthesia (C.D.M., G.M.T.H., N.M.) and the Department of
Surgery, Division of Cardiac Surgery (S.V.), St. Michael's Hospital,
Keenan Research Centre for Biomedical Science, the Li Ka Shing Knowledge
Institute of St. Michael's Hospital (C.D.M., G.M.T.H., K.T., S.V., P.J.),
Applied Health Research Centre (J.H., D.D., K.T., S.V., P.J.), Sunnybrook
Health Sciences Centre (S.F.), Division of Hematology, Mount Sinai
Hospital (N.S.), the Departments of Medicine (P.J., N.S.), Physiology
(C.D.M., G.M.T.H), and Laboratory Medicine and Pathobiology (N.S.), Dalla
Lana School of Public Health (K.T.), and Institute of Health Policy,
Management and Evaluation, University of Toronto, and Canadian Blood
Services (N.S.), Toronto, the Population Health Research Institute
(R.P.W., E.B.-C.), Hamilton Health Sciences Center (R.P.W., E.B.-C., K.C.,
S.S.), McMaster University (R.P.W., E.B.-C., K.C., S.S.), Hamilton, ON,
the Ottawa Hospital Research Institute, University of Ottawa, Ottawa
(D.A.F.), the Cumming School of Medicine and Libin Cardiovascular
Institute, University of Calgary, Calgary (A.J.G.), and the Department of
Critical Care Medicine, Faculty of Medicine and Dentistry, University of
Alberta, Edmonton (S.M.B.), CHUS-Centre Hospitalier Universitaire de
Sherbrooke, Sherbrooke (E.M.), and the Department of Anesthesiology and
Critical Care Medicine, Institut Universitaire de Cardiologie et de
Pneumologie de Quebec, Laval University, Laval (F.L.), QC, the Departments
of Anesthesia and Medicine, Division of Critical Care, Centre Hospitalier
de l'Universite de Montreal, Montreal (F.M.C.), and the Department of
Anesthesia, Perioperative and Pain Medicine, St. Boniface Hospital,
University of Manitoba, Winnipeg (H.P.G.) - all in Canada; the Department
of Cardiothoracic Anesthesia, Rigshospitalet, Copenhagen University
Hospital, Copenhagen (B.K.); Medical Research Institute of New Zealand,
Wellington (S.M., P.J.Y.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: We reported previously that, in patients undergoing cardiac
surgery who were at moderate-to-high risk for death, a restrictive
transfusion strategy was noninferior to a liberal strategy with respect to
the composite outcome of death from any cause, myocardial infarction,
stroke, or new-onset renal failure with dialysis by hospital discharge or
28 days after surgery, whichever came first. We now report the clinical
outcomes at 6 months after surgery.
METHODS: We randomly assigned 5243 adults undergoing cardiac surgery to a
restrictive red-cell transfusion strategy (transfusion if the hemoglobin
concentration was <7.5 g per deciliter intraoperatively or
postoperatively) or a liberal red-cell transfusion strategy (transfusion
if the hemoglobin concentration was <9.5 g per deciliter intraoperatively
or postoperatively when the patient was in the intensive care unit [ICU]
or was <8.5 g per deciliter when the patient was in the non-ICU ward). The
primary composite outcome was death from any cause, myocardial infarction,
stroke, or new-onset renal failure with dialysis occurring within 6 months
after the initial surgery. An expanded secondary composite outcome
included all the components of the primary outcome as well as emergency
department visit, hospital readmission, or coronary revascularization
occurring within 6 months after the index surgery. The secondary outcomes
included the individual components of the two composite outcomes.
RESULTS: At 6 months after surgery, the primary composite outcome had
occurred in 402 of 2317 patients (17.4%) in the restrictive-threshold
group and in 402 of 2347 patients (17.1%) in the liberal-threshold group
(absolute risk difference before rounding, 0.22 percentage points; 95%
confidence interval [CI], -1.95 to 2.39; odds ratio, 1.02; 95% CI, 0.87 to
1.18; P=0.006 for noninferiority). Mortality was 6.2% in the
restrictive-threshold group and 6.4% in the liberal-threshold group (odds
ratio, 0.95; 95% CI, 0.75 to 1.21). There were no significant
between-group differences in the secondary outcomes.
CONCLUSIONS: In patients undergoing cardiac surgery who were at
moderate-to-high risk for death, a restrictive strategy for red-cell
transfusion was noninferior to a liberal strategy with respect to the
composite outcome of death from any cause, myocardial infarction, stroke,
or new-onset renal failure with dialysis at 6 months after surgery.
(Funded by the Canadian Institutes of Health Research and others; TRICS
III ClinicalTrials.gov number, NCT02042898 .).

<90>
Accession Number
624196546
Title
The effect of tranexamic acid to reduce blood loss and transfusion on
off-pump coronary artery bypass surgery: A systematic review and
cumulative meta-analysis.
Source
Journal of clinical anesthesia. 44 (pp 23-31), 2018. Date of Publication:
01 Feb 2018.
Author
Dai Z.; Chu H.; Wang S.; Liang Y.
Institution
(Dai, Chu, Wang, Liang) Department of Anesthesiology, Affiliated Hospital
of Qingdao University, 16 Jiangsu Road, Qingdao 276000, China
Publisher
NLM (Medline)
Abstract
STUDY OBJECTIVE: To assess the safety and efficacy of tranexamic acid (TA)
on off-pump coronary artery bypass (OPCAB) surgery.
DESIGN: Meta-analysis.
SETTING: Operating room, OPCAB surgery, all surgeries were elective
measurements. Searching the following data sources respectively:
PubMed/MEDLINE, the Cochrane Library, EMBASE and reference lists of
identified articles, we performed a meta-analysis of postoperative 24h
blood loss, postoperative allogeneic transfusion, re-operation for massive
bleeding, postoperative mortality, and postoperative thrombotic
complications.
MAIN RESULTS: Using electronic databases, we selected 15 randomized
control trials (RCTs), carried out between 2003 and 2016, with a total of
1250 patients for our review. TA significantly reduced the postoperative
24h blood loss (mean difference -213.32ml, 95% confidence intervals,
-247.20ml to -179.43ml; P<0.0001). And, TA also significantly reduced the
risk of packed red blood cell (PRBCs) transfusion (risk ratio 0.62; 95%
confidence intervals 0.51 to 0.76; P<0.0001) and fresh frozen plasma (FFP)
transfusion (0.65; 0.52 to 0.81; P<0.001). There were no statistical
significance on platelet transfusion (risk difference -0.00, 95%
confidence interval -0.02 to 0.02; P=0.73) and re-operation (0.00, -0.02
to 0.02; P=1.00). No association was found between TA and morbility (risk
difference -0.00, 95% confidence interval -0.02 to 0.02; P=0.99) and
thrombotic complications (-0.01, -0.01 to 0.02; P=0.70).
CONCLUSIONS: TA reduced the probability of receiving a PRBCs and FFP
transfusion during OPCAB surgery. And no association with postoperative
death and thrombotic events was found. However, further trials with an
appropriate sample size are required to confirm TA safety in OPCAB
surgery.<br/>Copyright &#xa9; 2017 Elsevier Inc. All rights reserved.

<91>
Accession Number
622615859
Title
Red blood cell distribution width as a predictor of atrial fibrillation.
Source
Journal of Clinical Laboratory Analysis. 32 (5) (no pagination), 2018.
Article Number: e22378. Date of Publication: June 2018.
Author
Shao Q.; Korantzopoulos P.; Letsas K.P.; Tse G.; Hong J.; Li G.; Liu T.
Institution
(Shao, Li, Liu) Department of Cardiology, Tianjin Institute of Cardiology,
Second Hospital of Tianjin Medical University, Tianjin Key Laboratory of
Ionic-Molecular Function of Cardiovascular disease, Tianjin, China
(Korantzopoulos) First Department of Cardiology, University Hospital of
Ioannina, Ioannina, Greece
(Letsas) Second Department of Cardiology, Laboratory of Cardiac
Electrophysiology, "Evangelismos" General Hospital of Athens, Athens,
Greece
(Tse) Department of Medicine and Therapeutics, Chinese University of Hong
Kong, Hong Kong
(Tse) Li Ka Shing Institute of Health Sciences, Chinese University of Hong
Kong, Hong Kong
(Hong) Department of Internal Medicine, Shanghai First People's Hospital,
Shanghai Jiao Tong University, Shanghai, China
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Current evidence suggests that a higher red blood cell
distribution width (RDW) may be associated with increased risk of atrial
fibrillation (AF) development. Given that some controversial results have
been published, we conducted a systematic review of the current literature
along with a comprehensive meta-analysis to evaluate the association
between RDW and AF development. Methods: We performed a systematic search
of the literature using electronic databases (PubMed, Ovid, Embase, and
Web of Science) to identify studies reporting on the association between
RDW and AF development published until June 2016. We used both fix-effects
and random-effects models to calculate the overall effect estimate. An
I² > 50% indicates at least moderate statistical heterogeneity.
A sensitivity analysis and subgroup analysis were performed to find the
origin of heterogeneity. Results: A total of 12 studies involving 2721
participants were included in this meta-analysis. The standardized mean
difference in the RDW levels between patients with and those without AF
development was 0.66 units (P <.05; 95% confidence interval 0.44-0.88). A
significant heterogeneity between the individual studies was observed (P
<.05; I² = 80.4%). A significant association between the
baseline RDW levels and AF occurrence or recurrence following cardiac
procedure or surgery was evident (SMD: 0.61; 95% confidence interval
0.33-0.88; P <.05) with significant heterogeneity across the studies
(I² = 80.7%; P <.01). Conclusions: Our comprehensive
meta-analysis suggests that higher levels of RDW are associated with an
increased risk of AF in different populations.<br/>Copyright &#xa9; 2018
Wiley Periodicals, Inc.

<92>
Accession Number
618808988
Title
Remote Ischemic Preconditioning in High-risk Cardiovascular Surgery
Patients: A Randomized-controlled Trial.
Source
Seminars in Thoracic and Cardiovascular Surgery. 30 (1) (pp 26-33), 2018.
Date of Publication: Spring 2018.
Author
Coverdale N.S.; Hamilton A.; Petsikas D.; McClure R.S.; Malik P.; Milne
B.; Saha T.; Zelt D.; Brown P.; Payne D.M.
Institution
(Coverdale, Hamilton, Petsikas, Zelt, Brown, Payne) Department of Surgery,
Queen's University and Kingston General Hospital, Kingston, Ontario,
Canada
(McClure) Department of Surgery, Libin Cardiovascular Institute of
Alberta, Foothills Medical Center, University of Calgary, Calgary,
Alberta, Canada
(Malik) Department of Medicine, Queen's University and Kingston General
Hospital, Kingston, Ontario, Canada
(Milne, Saha) Department of Anesthesiology and Perioperative Medicine,
Queen's University and Kingston General Hospital, Kingston, Ontario,
Canada
Publisher
W.B. Saunders
Abstract
Remote ischemic preconditioning (RIPC) may reduce biomarkers of ischemic
injury after cardiovascular surgery. However, it is unclear whether RIPC
has a positive impact on clinical outcomes. We performed a blinded,
randomized controlled trial to determine if RIPC resulted in fewer adverse
clinical outcomes after cardiac or vascular surgery. The intervention
consisted of 3 cycles of RIPC on the upper limb for 5 minutes alternated
with 5 minutes of rest. A sham intervention was performed on the control
group. Patients were recruited who were undergoing (1) high-risk cardiac
or vascular surgery or (2) cardiac or vascular surgery and were at high
risk of ischemic complications. The primary end point was a composite
outcome of mortality, myocardial infarction, stroke, renal failure,
respiratory failure, and low cardiac output syndrome, and the secondary
end points included the individual outcome parameters that made up this
score, as well as troponin-I values. A total of 436 patients were
randomized and analysis was performed on 215 patients in the control group
and on 213 patients in the RIPC group. There were no differences in the
composite outcome between the 2 groups (RIPC: 67 [32%] and control: 72
[34%], relative risk [0.94 {0.72-1.24}]) or in any of the individual
components that made up the composite outcome. Additionally, we did not
observe any differences between the groups in troponin-I values, the
length of intensive care unit stay, or the total hospital stay. RIPC did
not have a beneficial effect on clinical outcomes in patients who had
cardiovascular surgery.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<93>
Accession Number
623266621
Title
Transcatheter mitral valve implantation for degenerated mitral
bioprostheses or failed surgical annuloplasty rings: A systematic review
and meta-analysis.
Source
Journal of Cardiac Surgery. 33 (9) (pp 508-519), 2018. Date of
Publication: September 2018.
Author
Hu J.; Chen Y.; Cheng S.; Zhang S.; Wu K.; Wang W.; Zhou Y.
Institution
(Hu, Chen, Cheng, Zhang, Wu, Wang, Zhou) Department of
Thoracic-Cardiovascular Surgery, Tongji Hospital, Tongji University School
of Medicine, Shanghai, China
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Transcatheter mitral valve-in-valve (TMVIV) and valve-in-ring
(TMVIR) implantation for degenerated mitral bioprostheses and failed
annuloplasty rings have recently emerged as treatment options for patients
deemed unsuitable for repeat surgery. Methods: A systematic literature
review was conducted to summarize the data regarding the baseline
characteristics and clinical outcomes of patients undergoing TMVIV and
TMVIR procedures. Results: A total of 245 patients (172 patients who
underwent TMVIV surgery and 73 patients who underwent TMVIR surgery) were
included in the study; 93.5% of patients experienced successful TMVIV or
TMVIR implantation. The mortality rates at discharge, 30 days, and 6
months were 5.7%, 8.1%, and 23.4%, respectively. The transapical (TA)
access route was used in most procedures (55.2%). The TA and transseptal
(TS) access routes resulted in similar outcomes. No significant
differences were observed in the short-term outcomes between the patients
who developed mitral stenosis versus mitral regurgitation as the mode of
failure. Conclusions: TMVIV and TMVIR implantation for degenerated mitral
bioprostheses and failed annuloplasty rings are safe and effective. Both
procedures, via TA or TS access, can result in excellent short-term
clinical outcomes in patients with mitral stenosis or regurgitation, but
long-term follow-up data are currently lacking to determine the durability
of these procedures.<br/>Copyright &#xa9; 2018 The Authors. Journal of
Cardiac Surgery Published by Wiley Periodicals, Inc.

<94>
Accession Number
618567714
Title
Randomized Trial of Carnitine for the Prevention of Perioperative Atrial
Fibrillation.
Source
Seminars in Thoracic and Cardiovascular Surgery. 30 (1) (pp 7-13), 2018.
Date of Publication: Spring 2018.
Author
Dastan F.; Talasaz A.H.; Mojtahedzadeh M.; Karimi A.; Salehiomran A.; Bina
P.; Jalali A.
Institution
(Dastan) School of Pharmacy, ShahidBeheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Talasaz, Mojtahedzadeh) School of Pharmacy, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Karimi, Salehiomran, Bina, Jalali) Tehran Heart Center, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
W.B. Saunders
Abstract
Atrial fibrillation (AF) is one of the most common complications in
patients who undergo coronary artery bypass graft surgery (CABG). The aim
of this study was to evaluate the effect of L-carnitine administration on
postoperative AF and the levels of C-reactive protein (CRP) following
CABG. The effects of L-carnitine on the incidence of acute kidney injury
after CABG were also assessed. One hundred thirty-four patients undergoing
elective CABG, without a history of AF or previous L-carnitine treatment,
were randomly assigned to an L-carnitine group (3000 mg/d L-carnitine) or
a control group. CRP levels, as a biomarker of inflammation, were assessed
in all the patients before surgery as baseline levels and 48 hours
postoperatively. Neutrophil gelatinase-associated lipocalin, as a kidney
biomarker, was also measured in the patients before surgery and 2 hours
thereafter. The incidence of AF was 13.4% in our population. The incidence
of AF was decreased in the L-carnitine group (7.5% in the L-carnitine
group vs 19.4% in the control group; P = 0.043) and the postoperative CRP
level (8.79 +/- 6.9 in the L-carnitine group, and 10.83 +/- 5.7 in the
control group; P = 0.021). The postoperative neutrophil
gelatinase-associated lipocalin concentration demonstrated no significant
rise after surgery compared with the preoperative concentration (72.54 +/-
20.30 in the L-carnitine group vs 67.68 +/- 22.71 in the placebo group; P
= 0.19). Our study showed that L-carnitine administration before CABG
might inhibit and reduce the incidence of AF after CABG. It seems that a
rise in the CRP level, as an inflammation marker, may be associated with
the incidence of AF. Inflammation as measured by CRP was also reduced in
the carnitine group, compared with the control group.<br/>Copyright &#xa9;
2017 Elsevier Inc.

<95>
Accession Number
622577863
Title
Quality Measurement and Improvement Study of Surgical Coronary
Revascularization: Medication Adherence (MISSION-2).
Source
Chinese Medical Journal. 131 (12) (pp 1480-1489), 2018. Date of
Publication: 20 Jun 2018.
Author
Liu C.-Y.; Du J.-Z.; Rao C.-F.; Zhang H.; Liu H.-N.; Zhao Y.; Yang L.-M.;
Li X.; Li J.; Wang J.; Wang H.-S.; Liu Z.-G.; Cheng Z.-Y.; Zheng Z.
Institution
(Liu, Du, Rao, Zhang, Liu, Zhao, Li, Zheng) National Clinical Research
Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular
Disease, Fuwai Hospital, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences, Peking Union Medical College, 167
Beilishi Road, Beijing 100073, China
(Rao, Zhang, Liu, Yang, Li, Zheng) Department of Cardiovascular Surgery,
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese
Academy of Medical Sciences, Peking Union Medical College, Beijing 100073,
China
(Wang) Department of Thoracic and Cardiovascular Surgery, First Affiliated
Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
(Wang) Department of Cardiovascular Surgery, General Hospital of Shenyang
Military Region, Shenyang, Liaoning 110016, China
(Liu) Department of Cardiovascular Surgery, TEDA International
Cardiovascular Hospital, Peking Union Medical College, Chinese Academy of
Medical Science, Tianjin 300457, China
(Cheng) Department of Cardiovascular Surgery, Henan Provincial People's
Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan
450003, China
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: Secondary preventive therapies play a key role in the
prevention of adverse outcomes after coronary artery bypass grafting
(CABG). However, medication adherence after CABG is often poor, and
conventional interventions for improving adherence have limited success.
With increasing penetration of smartphones, health-related smartphone
applications might provide an opportunity to improve adherence. Carefully
designed trials are needed to provide reliable evidence for the use of
these applications in patients after CABG. Methods: The Measurement and
Improvement Studies of Surgical Coronary Revascularization: Medication
Adherence (MISSION-2) study is a multicenter randomized controlled trial,
aiming to randomize 1000 CABG patients to the intervention or control
groups in a 1:1 ratio. We developed the multifaceted, patient-centered,
smartphone-based Heart Health Application to encourage medication
adherence in the intervention group through a health self-management
program initiated during hospital admission for CABG. The application
integrated daily scheduled reminders to take the discharge medications,
cardiac educational materials, a dynamic dashboard to review
cardiovascular risk factors and secondary prevention targets, and weekly
questionnaires with interactive feedback. The primary outcome was
secondary preventive medication adherence measured by the Chinese version
of the 8-item Morisky Medication Adherence Scale at 6 months after
randomization. Secondary outcomes included all-cause death, cardiovascular
rehospitalization, and a composite of death, myocardial infarction,
stroke, and repeat revascularization. Discussion: Findings will not only
provide evidence regarding the feasibility and effectiveness of the
described intervention for improving adherence to CABG secondary
preventive therapies but also explore a model for outpatient health
self-management that could be translated to various chronic diseases and
widely disseminated across resource-limited settings. Trial Registration:
https://clinicaltrials.gov (NCT02432469).<br/>Copyright &#xa9; 2018
Chinese Medical Journal. Produced by Wolters Kluwer Medknow.

<96>
Accession Number
619469955
Title
A Stopping Guideline for Pulmonary Heart Valve Premarket Approval Studies.
Source
Seminars in Thoracic and Cardiovascular Surgery. 30 (1) (pp 81-84), 2018.
Date of Publication: Spring 2018.
Author
Li H.-F.; Wu Y.; Wang M.; Grunkemeier G.L.
Institution
(Li, Wu, Wang, Grunkemeier) Medical Data Research Center, Providence
Health and Service, Portland, Oregon, United States
Publisher
W.B. Saunders

<97>
Accession Number
623736705
Title
Clinical pharmacodynamics and long-term efficacy of Talcom vs. Plavix in
patients undergoing coronary stent implantation: a randomized study with
5-year follow-up.
Source
European Journal of Clinical Pharmacology. 74 (11) (pp 1397-1403), 2018.
Date of Publication: 01 Nov 2018.
Author
Li J.; Fan Y.; Zhu T.; Chen J.; Kong D.; Meng H.; Zhang J.; Xu K.; Ye S.;
Ji Y.; Li C.
Institution
(Li, Fan, Meng, Zhang, Xu, Ye, Ji, Li) Department of Cardiology, The First
Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road,
Nanjing, Jiangsu 210029, China
(Li) Department of Cardiology, Suqian Hospital Affiliated of Xuzhou
Medical University, Suqian, Jiangsu 223800, China
(Zhu) Department of Cardiology, The Affiliated Jiangning Hospital of
Nanjing Medical University, Nanjing, Jiangsu 210029, China
(Chen) Department of Cardiology, People's Hospital of Maanshan, Maanshan,
Anhui 243000, China
(Kong) Department of Cardiology, Jining First People's Hospital, Jining,
Shandong 272011, China
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Form II clopidogrel bisulfate (Plavix) has been extensively used
in patients with acute coronary syndrome. However, the efficacy of form I
clopidogrel bisulfate (Talcom) was less investigated. The aim of this
study was to investigate the efficacy and safety of Talcom compared with
Plavix. Method: Two hundred and forty-eight patients were recruited after
receiving percutaneous coronary intervention (PCI). Participants were
randomly assigned to Talcom or Plavix group, and administered with Talcom
or Plavix 75 mg od respectively in combination with aspirin 100 mg od for
12 months. Primary endpoints were set as levels of adenosine
diphosphate-induced platelet aggregation (PL<inf>ADP</inf>) on the 5th day
and at 1 month after randomization. Patients were followed-up for 5 years.
Bleeding events and major adverse cardiovascular events (MACE) including
cardiac death, non-fatal myocardial infarction, ischemic stroke, target
lesion revascularization (TLR), and cardiogenic re-admission were
recorded. Results: On the 5th day and at 1 month after randomization, the
antiplatelet effect of Talcom was non-inferior to that of Plavix
[PL<inf>ADP</inf> (5th day): 30% (22%, 43%) vs. 33% (22%, 44%), p = 0.007;
PL<inf>ADP</inf> (1 month): 29% (19%, 43%) vs. 31% (22%, 43%), p = 0.005].
A total of 208 patients completed the follow-up, the incidences of MACE
and bleeding were both comparable, and the MACE-free survival did not
differ between the two groups. However, the expenditure was 32% lower for
Talcom compared to Plavix during the treatment period. Conclusions: The
antiplatelet effect of Talcom is non-inferior to Plavix, and the clinical
efficacy and safety of Talcom and Plavix at 5 years were not significantly
different in this study.<br/>Copyright &#xa9; 2018, Springer-Verlag GmbH
Germany, part of Springer Nature.

<98>
Accession Number
624357719
Title
Effect of aspirin in vascular surgery in patients from a randomized
clinical trial (POISE-2).
Source
The British journal of surgery. 105 (12) (pp 1591-1597), 2018. Date of
Publication: 01 Nov 2018.
Author
Biccard B.M.; Sigamani A.; Chan M.T.V.; Sessler D.I.; Kurz A.; Tittley
J.G.; Rapanos T.; Harlock J.; Szalay D.; Tiboni M.E.; Popova E.; Vasquez
S.M.; Kabon B.; Amir M.; Mrkobrada M.; Mehra B.R.; El Beheiry H.; Mata E.;
Tena B.; Sabate S.; Zainal Abidin M.K.; Shah V.R.; Balasubramanian K.;
Devereaux P.J.
Institution
(Biccard) Department of Anaesthesia and Perioperative Medicine, Groote
Schuur Hospital and University of Cape Town, Cape Town, South Africa
(Sigamani) Narayana Hrudayalaya Limited, Bangalore, India
(Chan) Department of Anaesthetics, Chinese University of Hong Kong, Hong
Kong, China
(Sessler) Department of Outcomes Research, Cleveland Clinic, Cleveland,
OH, United States
(Kurz) Department of General Anesthesiology, Anesthesiology Institute,
Cleveland Clinic, Cleveland, OH, United States
(Tittley, Rapanos, Harlock, Szalay) Division of Vascular Surgery, McMaster
University, Hamilton, ON, Canada
(Tiboni) Department of Medicine, McMaster University, Hamilton, ON, Canada
(Popova) Biomedical Research Institute (IIB - Sant Pau), Barcelona, Spain
(Vasquez) Grupo de Cardiologia Preventiva Universidad Autonoma de
Bucaramanga, Bucaramanga, Colombia
(Kabon) Department of Anaesthesiology, Medical University of Vienna,
Vienna, Austria
(Amir) Department of Surgery, Shifa International Hospital/Shifa
Tameer-e-Millat University, Islamabad, Pakistan
(Mrkobrada) Department of Medicine, Schulich School of Medicine and
Dentistry, Western University, London, ON, Canada
(Mehra) Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
(El Beheiry) University of Toronto, Trillium Health Partners, Toronto, ON,
Canada
(Mata) Hospital Universitario La Princesa, Madrid, Spain
(Tena) Department of Anaesthesiology, Hospital Clinic, Barcelona, Spain
(Sabate) Department of Anaesthesiology, Fundacio Puigvert (IUNA),
Barcelona, Spain
(Zainal Abidin) Department of Anaesthesiology and Intensive Care, Sarawak
General Hospital, Kuching, Sarawak, Malaysia
(Shah) Viroc Hospital, Vadodara, India
(Balasubramanian, Devereaux) Population Health Research Institute,
Hamilton, ON, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: In the POISE-2 (PeriOperative ISchemic Evaluation 2) trial,
perioperative aspirin did not reduce cardiovascular events, but increased
major bleeding. There remains uncertainty regarding the effect of
perioperative aspirin in patients undergoing vascular surgery. The aim of
this substudy was to determine whether there is a subgroup effect of
initiating or continuing aspirin in patients undergoing vascular surgery.
METHODS: POISE-2 was a blinded, randomized trial of patients having
non-cardiac surgery. Patients were assigned to perioperative aspirin or
placebo. The primary outcome was a composite of death or myocardial
infarction at 30days. Secondary outcomes included: vascular occlusive
complications (a composite of amputation and peripheral arterial
thrombosis) and major or life-threatening bleeding.
RESULTS: Of 10010 patients in POISE-2, 603 underwent vascular surgery, 319
in the continuation and 284 in the initiation stratum. Some 272 patients
had vascular surgery for occlusive disease and 265 had aneurysm surgery.
The primary outcome occurred in 13.7 per cent of patients having aneurysm
repair allocated to aspirin and 9.0 per cent who had placebo (hazard ratio
(HR) 1.48, 95 per cent c.i. 0.71 to 3.09). Among patients who had surgery
for occlusive vascular disease, 15.8 per cent allocated to aspirin and
13.6 per cent on placebo had the primary outcome (HR 1.16, 0.62 to 2.17).
There was no interaction with the primary outcome for type of surgery
(P=0.294) or aspirin stratum (P=0.623). There was no interaction for
vascular occlusive complications (P=0.413) or bleeding (P=0.900) for
vascular compared with non-vascular surgery.
CONCLUSION: This study suggests that the overall POISE-2 results apply to
vascular surgery. Perioperative withdrawal of chronic aspirin therapy did
not increase cardiovascular or vascular occlusive complications.
Registration number: NCT01082874 (
http://www.clinicaltrials.gov).<br/>Copyright &#xa9; 2018 BJS Society Ltd
Published by John Wiley & Sons Ltd.

<99>
[Use Link to view the full text]
Accession Number
624349556
Title
The ROMA trial: why it is needed.
Source
Current opinion in cardiology. 33 (6) (pp 622-626), 2018. Date of
Publication: 01 Nov 2018.
Author
Gaudino M.F.L.; Taggart D.P.; Fremes S.E.
Institution
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York City, NY, United States
(Taggart) University of Oxford, Oxford, United Kingdom
(Fremes) Schulich Heart Centre, Sunnybrook Health Science, University of
Toronto, Toronto, ON, Canada
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: We herein summarize the current evidence on the
clinical outcome associated with the use of single and multiple arterial
grafts for coronary bypass surgery and the role and importance of the
Randomized comparison of the clinical Outcome of single versus Multiple
Arterial grafts (ROMA) trial.
RECENT FINDINGS: Observational evidence suggests that the use of multiple
arterial grafts is associated with better clinical outcomes compared to
the use of a single arterial graft. Randomized evidence is inconclusive;
the 5-year interim analysis of the largest randomized trial on the topic
did not show any clinical benefit associated with the use of bilateral
versus single internal thoracic arteries, whereas a pooled analysis of the
trials comparing the radial artery and the saphenous vein as a second
graft showed a significant reduction in follow-up cardiac events using the
radial artery. Hidden confounders and treatment allocation biases as well
as methodological flaws are the most likely explanation of this
contradiction.
SUMMARY: ROMA was conceived based on the lessons learned from a critical
analysis of the existing randomized and observational evidence with the
aim to provide a definitive answer to the question of the potential
clinical benefit of multiple arterial grafts for coronary bypass.

<100>
Accession Number
624362802
Title
A meta-analysis of >=5-year mortality in randomized controlled trials of
off-pump versus on-pump coronary artery bypass grafting.
Source
Journal of Cardiac Surgery. (no pagination), 2018. Date of Publication:
2018.
Author
Takagi H.; Hari Y.; Mitta S.; Kawai N.; Ando T.
Institution
(Takagi, Hari, Mitta, Kawai) Department of Cardiovascular Surgery,
Shizuoka Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: We sought to determine whether off-pump coronary artery bypass
grafting (CABG) increases long-term mortality, by performing a
meta-analysis of randomized controlled trials (RCTs) of off-pump versus
on-pump CABG with >=5-year follow-up. Methods: MEDLINE and EMBASE, and the
Cochrane Central Register of Controlled Trials were searched through July
2018. Hazard, risk, or odds ratios (HRs, RRs, or ORs) of long-term
(>=5-year) mortality for off-pump versus on-pump CABG were extracted from
each individual trial. Study-specific estimates were combined using
inverse variance-weighted averages of logarithmic HRs in the
random-effects model. Results: Our search identified eight medium- to
large-size RCTs at low risk of bias with long-term follow-up of off-pump
versus on-pump CABG enrolling a total of 8780 patients. Combining four
RCTs reporting actual HRs generated a statistically significant result
favoring on-pump CABG (HR, 1.21; P = 0.02). A pooled analysis of all eight
RCTs demonstrated a statistically significant increase in mortality with
off-pump CABG (HR/RR, 1.19; P = 0.01). There was no evidence of
significant publication bias in the meta-analysis of all eight RCTs. In a
sensitivity analysis, extracting RRs or ORs from all eight RCTs and
pooling them demonstrated a statistically significant increase in
mortality with off-pump CABG (RR, 1.17; P = 0.01; OR, 1.20; P = 0.007).
Eliminating 2 RRs and combining six HRs still generated a statistically
significant result favoring on-pump CABG (HR, 1.19; P = 0.05).
Conclusions: Off-pump CABG increases long-term (>=5-year) mortality
compared with on-pump CABG.<br/>Copyright &#xa9; 2018 Wiley Periodicals,
Inc.