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<1>
Accession Number
2000461742
Title
Mortality after coronary artery bypass grafting versus percutaneous
coronary intervention with stenting for coronary artery disease: a pooled
analysis of individual patient data.
Source
The Lancet. 391 (10124) (pp 939-948), 2018. Date of Publication: 10 - 16
March 2018.
Author
Head S.J.; Milojevic M.; Daemen J.; Ahn J.-M.; Boersma E.; Christiansen
E.H.; Domanski M.J.; Farkouh M.E.; Flather M.; Fuster V.; Hlatky M.A.;
Holm N.R.; Hueb W.A.; Kamalesh M.; Kim Y.-H.; Makikallio T.; Mohr F.W.;
Papageorgiou G.; Park S.-J.; Rodriguez A.E.; Sabik J.F.; Stables R.H.;
Stone G.W.; Serruys P.W.; Kappetein A.P.
Institution
(Head, Milojevic, Papageorgiou, Kappetein) Department of Cardiothoracic
Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
(Daemen, Boersma) Department of Cardiology, Erasmus University Medical
Center, Rotterdam, Netherlands
(Papageorgiou) Department of Biostatistics, Erasmus University Medical
Center, Rotterdam, Netherlands
(Ahn, Kim, Park) Department of Cardiology, University of Ulsan College of
Medicine, Asan Medical Center, Seoul, South Korea
(Christiansen, Holm) Department of Cardiology, Aarhus University Hospital,
Skejby, Aarhus, Denmark
(Domanski, Farkouh, Fuster) Icahn School of Medicine at Mount Sinai, New
York, NY, United States
(Domanski, Farkouh) Peter Munk Cardiac Centre and the Heart and Stroke
Richard Lewar Centre, University of Toronto, Toronto, ON, Canada
(Flather) Norwich Medical School University of East Anglia and Norfolk and
Norwich University Hospital, Norwich, United Kingdom
(Hlatky) Stanford University School of Medicine, Stanford, CA, United
States
(Hueb) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Kamalesh) Richard L Roudebush VA Medical Center, Indianapolis, IN, United
States
(Makikallio) Department of Cardiology, Oulu University Hospital, Oulu,
Finland
(Mohr) Department of Cardiac Surgery, Herzzentrum Universitat Leipzig,
Leipzig, Germany
(Rodriguez) Cardiac Unit, Otamendi Hospital, Buenos Aires, Argentina
(Sabik) Department Surgery, University Hospitals Cleveland Medical Center,
Cleveland, OH, United States
(Stables) Institute of Cardiovascular Medicine and Science, Liverpool
Heart and Chest Hospital, Liverpool, United Kingdom
(Stone) Columbia University Medical Center and the Center for Clinical
Trials, Cardiovascular Research Foundation, New York, NY, United States
(Serruys) Imperial College London, London, United Kingdom
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Numerous randomised trials have compared coronary artery
bypass grafting (CABG) with percutaneous coronary intervention (PCI) for
patients with coronary artery disease. However, no studies have been
powered to detect a difference in mortality between the revascularisation
strategies. Methods: We did a systematic review up to July 19, 2017, to
identify randomised clinical trials comparing CABG with PCI using stents.
Eligible studies included patients with multivessel or left main coronary
artery disease who did not present with acute myocardial infarction, did
PCI with stents (bare-metal or drug-eluting), and had more than 1 year of
follow-up for all-cause mortality. In a collaborative, pooled analysis of
individual patient data from the identified trials, we estimated all-cause
mortality up to 5 years using Kaplan-Meier analyses and compared PCI with
CABG using a random-effects Cox proportional-hazards model stratified by
trial. Consistency of treatment effect was explored in subgroup analyses,
with subgroups defined according to baseline clinical and anatomical
characteristics. Findings: We included 11 randomised trials involving 11
518 patients selected by heart teams who were assigned to PCI (n=5753) or
to CABG (n=5765). 976 patients died over a mean follow-up of 3.8 years (SD
1.4). Mean Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX)
score was 26.0 (SD 9.5), with 1798 (22.1%) of 8138 patients having a
SYNTAX score of 33 or higher. 5 year all-cause mortality was 11.2% after
PCI and 9.2% after CABG (hazard ratio [HR] 1.20, 95% CI 1.06-1.37;
p=0.0038). 5 year all-cause mortality was significantly different between
the interventions in patients with multivessel disease (11.5% after PCI vs
8.9% after CABG; HR 1.28, 95% CI 1.09-1.49; p=0.0019), including in those
with diabetes (15.5% vs 10.0%; 1.48, 1.19-1.84; p=0.0004), but not in
those without diabetes (8.7% vs 8.0%; 1.08, 0.86-1.36; p=0.49). SYNTAX
score had a significant effect on the difference between the interventions
in multivessel disease. 5 year all-cause mortality was similar between the
interventions in patients with left main disease (10.7% after PCI vs 10.5%
after CABG; 1.07, 0.87-1.33; p=0.52), regardless of diabetes status and
SYNTAX score. Interpretation: CABG had a mortality benefit over PCI in
patients with multivessel disease, particularly those with diabetes and
higher coronary complexity. No benefit for CABG over PCI was seen in
patients with left main disease. Longer follow-up is needed to better
define mortality differences between the revascularisation strategies.
Funding: None.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<2>
Accession Number
622271742
Title
Short-term and mid-term clinical outcomes following hybrid coronary
revascularization versus off-pump coronary artery bypass: A meta-analysis.
Source
Arquivos Brasileiros de Cardiologia. 110 (4) (pp 321-330), 2018. Date of
Publication: April 2018.
Author
Dong L.; Kang Y.-K.; An X.-G.
Institution
(Dong, Kang, An) Heart Center & Beijing Key Laboratory of Hypertension,
Beijing Chaoyang Hospital, Capital Medical University, Beijng, China
Publisher
Arquivos Brasileiros de Cardiologia (E-mail: arquivos@cardiol.br)
Abstract
Background: Off-pump coronary artery bypass grafting (OPCAB) is one of the
standard treatments for coronary artery disease (CAD) while hybrid
coronary revascularization (HCR) represents an evolving revascularization
strategy. However, the difference in outcomes between them remains
unclear. Objective: We performed a meta-analysis to compare the short-term
and mid-term outcomes of HCR versus OPCAB for the treatment of multivessel
or left main CAD. Methods: We searched the PubMed, EMBASE, Web of Science
and Cochrane databases to identify related studies and a routine
meta-analysis was conducted. Results: Nine studies with 6121 patients were
included in the analysis. There was no significant difference in
short-term major adverse cardiac and cerebrovascular event (MACCE) rate
(RR: 0.55, 95% CI: 0.30-1.03, p = 0.06) or mortality (RR: 0.51, 95% CI:
0.17-1.48, p = 0.22). HCR required less ventilator time (SMD: -0.36, 95%
CI: -0.55- -0.16, p < 0.001), ICU stay (SMD: -0.35, 95% CI: -0.58 - -0.13,
p < 0.01), hospital stay (SMD: -0.29, 95% CI: -0.50- -0.07, p < 0.05) and
blood transfusion rate (RR: 0.57, 95% CI: 0.49-0.67, p < 0.001), but
needed more operation time (SMD: 1.29, 95% CI: 0.54-2.05, p < 0.001) and
hospitalization costs (SMD: 1.06, 95% CI: 0.45-1.66, p < 0.001). The HCR
group had lower mid-term MACCE rate (RR: 0.49, 95% CI: 0.26-0.92, p <
0.05) but higher rate in mid-term target vessel revascularization (TVR,
RR: 2.20, 95% CI: 1.32-3.67, p < 0.01). Conclusions: HCR had similar
short-term mortality and morbidity comparing to OPCAB. HCR decreased the
ventilator time, ICU stay, hospital stay, blood transfusion rate and
increased operation time and hospitalization costs. HCR has a lower
mid-term MACCE rate while OPCAB shows better in mid-term
TVR.<br/>Copyright &#xa9; 2018, Arquivos Brasileiros de Cardiologia. All
rights reserved.

<3>
Accession Number
618792253
Title
Levosimendan for patients with severely reduced left ventricular systolic
function and/or low cardiac output syndrome undergoing cardiac surgery: A
systematic review and meta-analysis.
Source
Critical Care. 21 (1) (no pagination), 2017. Date of Publication: 19 Oct
2017.
Author
Sanfilippo F.; Knight J.B.; Scolletta S.; Santonocito C.; Pastore F.;
Lorini F.L.; Tritapepe L.; Morelli A.; Arcadipane A.
Institution
(Sanfilippo, Knight, Santonocito, Pastore, Arcadipane) Department of
Anesthesia and Intensive Care, Istituto Mediterraneo per i Trapianti e
Terapie ad alta specializzazione (IRCCS-ISMETT), Via Tricomi 5, Palermo
90127, Italy
(Knight) University of Pittsburgh Medical Center, Department of
Anesthesiology, Pittsburgh, PA, United States
(Scolletta) Azienda Ospedaliera Universitaria Senese, Unit of Anesthesia
and Critical Care Medicine, Department of Medical Biotechnologies, Siena,
Italy
(Lorini) Department of Anaesthesia and Intensive Care, Papa Giovanni XXIII
Hospital, Bergamo, Italy
(Tritapepe) Sapienza University of Rome, Department of Cardiovascular,
Respiratory, Nephrological, Anaesthetic and Geriatric Sciences, Rome,
Italy
(Morelli) Policlinico Umberto 1, Sapienza University of Rome, Department
of Anesthesiology and Intensive Care, Rome, Italy
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Previous studies have shown beneficial effects of levosimendan
in high-risk patients undergoing cardiac surgery. Two large randomized
controlled trials (RCTs), however, showed no advantages of levosimendan.
Methods: We performed a systematic review and meta-analysis (MEDLINE and
Embase from inception until March 30, 2017), investigating whether
levosimendan offers advantages compared with placebo in high-risk cardiac
surgery patients, as defined by preoperative left ventricular ejection
fraction (LVEF) <= 35% and/or low cardiac output syndrome (LCOS). The
primary outcomes were mortality at longest follow-up and need for
postoperative renal replacement therapy (RRT). Secondary postoperative
outcomes investigated included myocardial injury, supraventricular
arrhythmias, development of LCOS, acute kidney injury (AKI), duration of
mechanical ventilation, intensive care unit and hospital lengths of stay,
and incidence of hypotension during drug infusion. Results: Six RCTs were
included in the meta-analysis, five of which investigated only patients
with LVEF <= 35% and one of which included predominantly patients with
LCOS. Mortality was similar overall (OR 0.64 [0.37, 1.11], p = 0.11) but
lower in the subgroup with LVEF < 35% (OR 0.51 [0.32, 0.82], p = 0.005).
Need for RRT was reduced by levosimendan both overall (OR 0.63 [0.42,
0.94], p = 0.02) and in patients with LVEF < 35% (OR 0.55 [0.31, 0.97], p
= 0.04). Among secondary outcomes, we found lower postoperative LCOS in
patients with LVEF < 35% receiving levosimendan (OR 0.49 [0.27, 0.89], p =
0.02), lower overall AKI (OR 0.62 [0.42, 0.92], p = 0.02), and a trend
toward lower mechanical support, both overall (p = 0.07) and in patients
with LVEF < 35% (p = 0.05). Conclusions: Levosimendan reduces mortality in
patients with preoperative severely reduced LVEF but does not affect
overall mortality. Levosimendan reduces the need for RRT after high-risk
cardiac surgery.<br/>Copyright &#xa9; 2017 The Author(s).

<4>
Accession Number
618780251
Title
Effect of levosimendan on prognosis in adult patients undergoing cardiac
surgery: A meta-analysis of randomized controlled trials.
Source
Critical Care. 21 (1) (no pagination), 2017. Date of Publication: 17 Oct
2017.
Author
Chen Q.-H.; Zheng R.-Q.; Lin H.; Shao J.; Yu J.-Q.; Wang H.-L.
Institution
(Chen, Zheng, Lin, Shao, Yu, Wang) Yangzhou University, Department of
Critical Care Medicine, Subei People's Hospital, School of Medicine, 98
Nantong West Road, Yangzhou, Jiangsu 225001, China
(Wang) Yangzhou University, Department of Cardiology, Subei People's
Hospital, School of Medicine, 98 Nantong West Road, Yangzhou 225001, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Small trials suggest that levosimendan is associated with a
favorable outcome in patients undergoing cardiac surgery. However,
recently published larger-scale trials did not provide evidence for a
similar benefit from levosimendan. We performed a meta-analysis to assess
the survival benefits of levosimendan in patients undergoing cardiac
surgery and to investigate its effects in subgroups of patients with
preoperative low-ejection fraction (EF). Methods: We identified randomized
clinical trials through 20 April 2017 that investigated levosimendan
therapy versus control in patients undergoing cardiac surgery. Individual
patient data from each study were compiled. Meta-analyses were performed
for primary outcomes, secondary outcomes and serious adverse events, and
subgroup analyses according to the preoperative EF of enrolled patients
were also conducted. The risk of bias was assessed using the Cochrane
risk-of-bias tool. Results: Seventeen studies involving a total of 2756
patients were included. Levosimendan therapy was associated with a
significant reduction in 30-day mortality (RR 0.67; 95% CI, 0.49 to 0.93;
p = 0.02) and reduced the risk of death in single-center trials (RR 0.49;
95% CI, 0.30 to 0.79; p = 0.004) and in subgroup trials of inferior
quality (RR 0.39; 95% CI, 0.17 to 0.92; p = 0.02); however, in multicenter
and in high-quality subgroup-analysis trials, no significant difference in
mortality was observed between patients who received levosimendan therapy
and controls (p > 0.05). However, in high-quality subgroup trials,
levosimendan therapy was associated with reduced mortality in patients in
a preoperative low-EF subgroup (RR 0.58; 95% CI, 0.38 to 0.88; p = 0.01).
Similarly, only patients in the preoperative low-EF subgroup benefited in
terms of reduced risk of renal replacement therapy (RR 0.54; 95% CI, 0.34
to 0.85; p = 0.007). Furthermore, levosimendan therapy was associated with
a significant reduction in intensive care unit (ICU) length of stay (MDR
-17.19; 95% CI, -34.43 to -2.94; p = 0.02). Conclusions: In patients
undergoing cardiac surgery, the benefit of levosimendan in terms of
survival was not shown in multicenter or in high-quality trials; however,
levosimendan therapy was associated with reduced mortality in patients
with preoperative ventricular systolic dysfunction.<br/>Copyright &#xa9;
2017 The Author(s).

<5>
Accession Number
618044503
Title
Clinical efficacy and safety of achieving very low LDL-cholesterol
concentrations with the PCSK9 inhibitor evolocumab: a prespecified
secondary analysis of the FOURIER trial.
Source
The Lancet. 390 (10106) (pp 1962-1971), 2017. Date of Publication: 28
October - 3 November 2017.
Author
Giugliano R.P.; Pedersen T.R.; Park J.-G.; De Ferrari G.M.; Gaciong Z.A.;
Ceska R.; Toth K.; Gouni-Berthold I.; Lopez-Miranda J.; Schiele F.; Mach
F.; Ott B.R.; Kanevsky E.; Pineda A.L.; Somaratne R.; Wasserman S.M.;
Keech A.C.; Sever P.S.; Sabatine M.S.
Institution
(Giugliano, Park, Kanevsky, Sabatine) TIMI Study Group, Division of
Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, United
States
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Oslo, Norway
(De Ferrari) Department of Molecular Medicine, University of Pavia and
Cardiac Intensive Care Unit and Laboratories for Experimental Cardiology,
IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
(Gaciong) Department of Internal Medicine, Hypertension and Vascular
Diseases, The Medical University of Warsaw, Warsaw, Poland
(Ceska) Center of Preventive Cardiology, 3rd Department Internal Medicine,
University General Hospital and 1st Medical Faculty, Prague, Czech
Republic
(Toth) 1st Department of Medicine, University of Pecs, Pecs, Hungary
(Gouni-Berthold) Polyclinic for Endocrinology, Diabetes, and Preventive
Medicine, University of Cologne, Cologne, Germany
(Lopez-Miranda) Lipids and Atherosclerosis Unit, Maimonides Biomedical
Research Institute of Cordoba, Reina Sofia University Hospital, University
of Cordoba, CIBEROBN, Cordoba, Spain
(Schiele) University Hospital Center Besancon, Besancon, France
(Mach) Hopital Cantonal, Hopitaux Universitaires de Geneva, Geneva,
Switzerland
(Ott) Rhode Island Hospital, Department of Neurology, Alpert Medical
School of Brown University, Providence, RI, United States
(Pineda, Somaratne, Wasserman) Amgen, Thousand Oaks, CA, United States
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Centre, University of Sydney, Sydney, NSW,
Australia
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: LDL cholesterol is a well established risk factor for
atherosclerotic cardiovascular disease. How much one should or safely can
lower this risk factor remains debated. We aimed to explore the
relationship between progressively lower LDL-cholesterol concentrations
achieved at 4 weeks and clinical efficacy and safety in the FOURIER trial
of evolocumab, a monoclonal antibody to proprotein convertase
subtilisin-kexin type 9 (PCSK9). Methods: In this prespecified secondary
analysis of 25 982 patients from the randomised FOURIER trial, the
relationship between achieved LDL-cholesterol concentration at 4 weeks and
subsequent cardiovascular outcomes (primary endpoint was the composite of
cardiovascular death, myocardial infarction, stroke, coronary
revascularisation, or unstable angina; key secondary endpoint was the
composite of cardiovascular death, myocardial infarction, or stroke) and
ten prespecified safety events of interest was examined over a median of
2.2 years of follow-up. We used multivariable modelling to adjust for
baseline factors associated with achieved LDL cholesterol. This trial is
registered with ClinicalTrials.gov, number NCT01764633. Findings: Between
Feb 8, 2013, and June 5, 2015, 27 564 patients were randomly assigned a
treatment in the FOURIER study. 1025 (4%) patients did not have an LDL
cholesterol measured at 4 weeks and 557 (2%) had already had a primary
endpoint event or one of the ten prespecified safety events before the
week-4 visit. From the remaining 25 982 patients (94% of those randomly
assigned) 13 013 were assigned evolocumab and 12 969 were assigned
placebo. 2669 (10%) of 25 982 patients achieved LDL-cholesterol
concentrations of less than 0.5 mmol/L, 8003 (31%) patients achieved
concentrations between 0.5 and less than 1.3 mmol/L, 3444 (13%) patients
achieved concentrations between 1.3 and less than 1.8 mmol/L, 7471 (29%)
patients achieved concentrations between 1.8 to less than 2.6 mmol/L, and
4395 (17%) patients achieved concentrations of 2.6 mmol/L or higher. There
was a highly significant monotonic relationship between low
LDL-cholesterol concentrations and lower risk of the primary and secondary
efficacy composite endpoints extending to the bottom first percentile
(LDL-cholesterol concentrations of less than 0.2 mmol/L; p=0.0012 for the
primary endpoint, p=0.0001 for the secondary endpoint). Conversely, no
significant association was observed between achieved LDL cholesterol and
safety outcomes, either for all serious adverse events or any of the other
nine prespecified safety events. Interpretation: There was a monotonic
relationship between achieved LDL cholesterol and major cardiovascular
outcomes down to LDL-cholesterol concentrations of less than 0.2 mmol/L.
Conversely, there were no safety concerns with very low LDL-cholesterol
concentrations over a median of 2.2 years. These data support further
LDL-cholesterol lowering in patients with cardiovascular disease to well
below current recommendations. Funding: Amgen.<br/>Copyright &#xa9; 2017
Elsevier Ltd

<6>
Accession Number
612240265
Title
School-based anti-smoking intervention for physiotherapy students: A
three-year non-randomized trial.
Source
Journal of Preventive Medicine and Hygiene. 57 (2) (pp E91-E94), 2016.
Date of Publication: 2016.
Author
Mipatrini D.; Mannocci A.; Pizzi C.; La Torre G.
Institution
(Mipatrini, Mannocci, La Torre) Department of Public Health and Infectious
Diseases, 'Sapienza' University of Rome, Piazzale Aldo Moro 5, Rome 00185,
Italy
(Pizzi) School of Pharmacy and Medicine, 'Sapienza' University of Rome,
Italy
(Pizzi) S. Camillo-Forlanini Hospital, Rome, Italy
Publisher
Pacini Editore S.p.A. (Via A. Gherardesca 1, Ospedaletto (Pisa) 56121,
Italy. E-mail: journal@jpsychopathol.it)
Abstract
Introduction. The aim of the study was to assess the efficacy of a
school-based intervention for reducing tobacco consumption among
physiotherapy students. Materials and methods. This controlled trial
involved two groups of physiotherapy students: a treatment group (A) and a
control group (B). Treatment consisted of a seminar on smoking-related
diseases (3 hours) and training (at least 10 months) in a respiratory
diseases or thoracic surgery unit. The control group (B) did not undergo
any treatment. The main outcome was the prevalence of smokers. Follow-up
lasted 3 years. Results. Groups A and B comprised 78 and 72 students,
respectively. The two groups did not differ in terms of gender
distribution, mean age, prevalence of smokers and nicotine dependence. In
group A, the prevalence of smoking declined from 36% to 33% between T0 and
T1 (3 years), the relative risk (RR) at T1 being 0.93 (95% CI: 0.6-1.44).
In group B, the prevalence increased from 28% to 35% between T0 and T1,
with a RR at T1 of 1.26 (0.76- 2.11). The prevalence reduction
"attributable" to the intervention in group A 7.7%, while a 27.8% increase
in prevalence "attributable" to the absence of intervention was found in
group B. However, the differences were not statistically significant.
Conclusions. School-based interventions seem to be effective in reducing
the prevalence of smoking among healthcare students. Further studies on
larger samples and with standardized methodology are required in order to
confirm these preliminary findings.

<7>
Accession Number
2000778981
Title
Steroids and Survival in Critically Ill Adult Patients: A Meta-analysis of
135 Randomized Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2252-2260),
2018. Date of Publication: October 2018.
Author
Martino E.A.; Baiardo Redaelli M.; Sardo S.; Lembo R.; Giordano V.F.;
Winterton D.; Ruggeri L.; Hajjar L.A.; Zangrillo A.; Landoni G.
Institution
(Martino, Baiardo Redaelli, Lembo, Giordano, Winterton, Ruggeri,
Zangrillo, Landoni) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Sardo) Department of Medical Sciences "M. Aresu, " University of
Cagliari, Cagliari, Italy
(Hajjar) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Zangrillo, Landoni) Vita-Salute San Raffaele University, Milan, Italy
Publisher
W.B. Saunders
Abstract
Objective: Corticosteroids have important effects on intermediate outcomes
in critically ill patients, but their effect on survival is unknown. The
objective of this meta-analysis was to analyze the effect on mortality of
corticosteroids in critical and perioperative settings. Design: A
meta-analysis of randomized trials. Setting: PubMed, Embase, BioMed
Central, Google Scholar, and the Cochrane Central Register of Controlled
Trials were searched to February 1, 2018, for randomized trials comparing
corticosteroids with placebo or standard care. Participants: Critically
ill or surgical adult patients. Interventions: Corticosteroids compared
with placebo or standard care. Measurements and Main Results: A total of
44,553 patients from 135 studies were included. Overall, mortality in the
corticosteroid group and in the control group were similar (16% v 16%; p =
0.9). Subanalyses identified a beneficial effect of corticosteroids on
survival in patients with respiratory system diseases (9% v 13%; p <
0.001) and bacterial meningitis (28% v 32%; p= 0.04), and a detrimental
effect on survival in patients with traumatic brain injury (22% v 19%; p <
0.001). No differences in mortality were found in patients with cardiac
diseases (7% v 6%; p = 0.7), in patients undergoing cardiac surgery (2.8%
v 3.2% p = 0.14), and when treatment duration or patient age were
considered. Conclusions: This meta-analysis documents the safety of
corticosteroids in the overall critically ill population with the notable
exception of brain injury patients, a setting where the authors confirmed
their detrimental effect on survival. A possible beneficial effect of
corticosteroids on survival was found among patients with respiratory
diseases and in patients with bacterial meningitis.<br/>Copyright &#xa9;
2018 Elsevier Inc.

<8>
Accession Number
2000571932
Title
Effect of Levosimendan on Renal Outcome in Cardiac Surgery Patients With
Chronic Kidney Disease and Perioperative Cardiovascular Dysfunction: A
Substudy of a Multicenter Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2152-2159),
2018. Date of Publication: October 2018.
Author
Zangrillo A.; Alvaro G.; Belletti A.; Pisano A.; Brazzi L.; Calabro M.G.;
Guarracino F.; Bove T.; Grigoryev E.V.; Monaco F.; Boboshko V.A.;
Likhvantsev V.V.; Scandroglio A.M.; Paternoster G.; Lembo R.; Frassoni S.;
Comis M.; Pasyuga V.V.; Navalesi P.; Lomivorotov V.V.
Institution
(Zangrillo, Belletti, Calabro, Bove, Monaco, Scandroglio, Lembo, Frassoni)
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Zangrillo) Vita-Salute San Raffaele University, Milan, Italy
(Alvaro, Navalesi) Department of Anesthesia and Intensive Care, AOU Mater
Domini Germaneto, Catanzaro, Italy
(Pisano) Division of Cardiac Anesthesia and Intensive Care Unit, AORN dei
Colli - Monaldi Hospital, Naples, Italy
(Brazzi) Department of Anesthesia and Intensive Care, AOU Citta della
Salute e della Scienza, Turin, Italy
(Brazzi) Department of Surgical Sciences, University of Turin, Turin,
Italy
(Guarracino) Division of Cardiothoracic Anesthesia and Intensive Care,
Department of Anesthesia and Critical Care Medicine, AOU Pisana, Pisa,
Italy
(Grigoryev) Department of Anesthesiology and Intensive Care, State
Research Institute for Complex Issues of Cardiovascular Disease, Kemerovo,
Russian Federation
(Boboshko, Lomivorotov) Department of Anesthesiology and Intensive Care,
E. Meshalkin National Medical Research Center, Novosibirsk, Russian
Federation
(Likhvantsev) Department of Anesthesiology and Intensive Care, Moscow
Regional Clinical and Research Institute, Moscow, Russian Federation
(Paternoster) Department of Anesthesia and Intensive Care, San Carlo
Hospital, Potenza, Italy
(Comis) Department of Cardiovascular Anesthesia and Intensive Care, AO
Ordine Mauriziano, Turin, Italy
(Pasyuga) Department of Anesthesiology and Intensive Care, Federal Center
for Cardiovascular Surgery Astrakhan, Astrakhan, Russian Federation
(Navalesi) Department of Medical and Surgical Sciences, Magna Graecia
University, Catanzaro, Italy
Publisher
W.B. Saunders
Abstract
Objective: Acute kidney injury (AKI) occurs frequently after cardiac
surgery. Levosimendan might reduce the incidence of AKI in patients
undergoing cardiac surgery. The authors investigated whether levosimendan
administration could reduce AKI incidence in a high-risk cardiac surgical
population. Design: Post hoc analysis of a multicenter randomized trial.
Setting: Cardiac surgery operating rooms and intensive care units of 14
centers in 3 countries. Participants: The study comprised 90 patients who
underwent mitral valve surgery with an estimated glomerular filtration
rate <60 mL/min/1.73 m² and perioperative myocardial
dysfunction. Interventions: Patients were assigned randomly to receive
levosimendan (0.025-0.2 mug/kg/min) or placebo in addition to standard
inotropic treatment. Measurements and Main Results: Forty-six patients
were assigned to receive levosimendan and 44 to receive placebo.
Postoperative AKI occurred in 14 (30%) patients in the levosimendan group
versus 23 (52%) in the placebo group (absolute difference -21.8; 95%
confidence interval -41.7 to -1.97; p = 0.035). The incidence of major
complications also was lower (18 [39%]) in the levosimendan group versus
that in the placebo group (29 [66%]) (absolute difference -26.8 [-46.7 to
-6.90]; p = 0.011). A trend toward lower serum creatinine at intensive
care unit discharge was observed in the levosimendan group (1.18
[0.99-1.49] mg/dL) versus that in the placebo group (1.39 [1.05-1.76]
mg/dL) (95% confidence interval -0.23 [-0.49 to 0.01]; p = 0.07).
Conclusions: Levosimendan may improve renal outcome in cardiac surgery
patients with chronic kidney disease undergoing mitral valve surgery who
develop perioperative myocardial dysfunction. Results of this exploratory
analysis should be investigated in future properly designed randomized
controlled trials.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<9>
Accession Number
2000741576
Title
Vasopressin in Cardiac Surgery: A Meta-analysis of Randomized Controlled
Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2225-2232),
2018. Date of Publication: October 2018.
Author
Dunser M.W.; Bouvet O.; Knotzer H.; Arulkumaran N.; Hajjar L.A.; Ulmer H.;
Hasibeder W.R.
Institution
(Dunser) Department of Anesthesiology and Intensive Care Medicine, Kepler
University Hospital and Johannes Kepler University Linz, Linz, Austria
(Bouvet) Amomed Pharma GmbH, Vienna, Austria
(Knotzer) Department of Anesthesiology and Critical Care Medicine II,
Klinikum Wels, Wels, Austria
(Arulkumaran) Department of Critical Care, University College of London
Hospital, London, United Kingdom
(Hajjar) Department of Cardiopneumology, InCor, University of Sao Paulo,
Sao Paulo, Brazil
(Ulmer) Institute of Medical Statistics, Informatics and Health Economics,
Innsbruck Medical University, Innsbruck, Austria
(Hasibeder) Department of Anesthesiology and Critical Care Medicine,
Krankenhaus St. Vinzenz in Zams, Zams, Austria
Publisher
W.B. Saunders
Abstract
Objective: To summarize the results of randomized controlled trials on the
use of vasopressin as a vasopressor agent in cardiac surgery. Design:
Meta-analysis. Participants: Six-hundred-twenty-five adult patients
undergoing elective or emergency cardiac surgery. Interventions: Arginine
vasopressin infusion (n = 313) or control/standard therapy (n = 312).
Measurements and Main Results: The rates of perioperative complications
and postoperative mortality were used as primary and secondary endpoints,
respectively. Fixed and/or random effects models were used to compare
pooled odds ratios. Arginine vasopressin reduced the pooled odds ratio
(OR) of perioperative complications (OR, 0.33; 95% confidence interval
[CI], 0.2-0.54; p < 0.0001). A sensitivity analysis excluding the largest
trial showed an unchanged reduction in perioperative complications (OR,
0.35; 95% CI, 0.18-0.69; p = 0.002). When analyzing each perioperative
complication separately, vasopressin reduced the pooled OR of vasodilatory
shock (OR, 0.4; 95% CI, 0.16-0.97; p = 0.04) and new-onset atrial
fibrillation (OR, 0.42; 95% CI, 0.21-0.82; p = 0.01). The pooled OR of
postoperative death was not different between patients treated with
arginine vasopressin and those receiving standard therapy or placebo (OR,
0.83; 95% CI, 0.45-1.53; p = 0.55). The funnel plot for the primary
endpoint suggested a relevant publication bias. All included trials
suffered from a high risk of bias. Conclusion: Our meta-analysis suggests
that arginine vasopressin may reduce the rate of perioperative
complications in patients undergoing elective or emergency cardiac
surgery. No difference in postoperative mortality was observed. An
adequately powered multicenter trial is required for reliable estimation
of the effects of arginine vasopressin on perioperative complication rates
and mortality in cardiac surgical patients.<br/>Copyright &#xa9; 2018
Elsevier Inc.

<10>
Accession Number
2001012556
Title
The Effect of Inhaled Milrinone Versus Inhaled Levosimendan in Pulmonary
Hypertension Patients Undergoing Mitral Valve Surgery - A Pilot Randomized
Double-Blind Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2123-2129),
2018. Date of Publication: October 2018.
Author
Kundra T.S.; Prabhakar V.; Kaur P.; Manjunatha N.; Gandham R.
Institution
(Kundra, Prabhakar, Manjunatha) Department of Cardiac Anaesthesia, Sri
Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore,
India, India
(Kaur) Department of Critical Care, Sir Ganga Ram Hospital, New Delhi,
India, India
(Gandham) Department of Anaesthesiology, Apollo Hospital, Vishakhapatnam,
India, India
Publisher
W.B. Saunders
Abstract
Objective: To compare the effects of inhaled milrinone and levosimendan on
pulmonary and systemic hemodynamics in patients with pulmonary
hypertension. Design: Prospective, double-blind, randomized controlled
study. Setting: Tertiary care cardiac institute with 650 beds.
Participants: The study comprised 150 adult patients with pulmonary
hypertension undergoing mitral valve surgery. Interventions: Patients were
assigned randomly into 1 of the following 3 groups: milrinone (M),
levosimendan (L), or control (C); n = 50 per group. In group M, inhaled
milrinone (50 micro&#32;g/kg); in group L, inhaled levosimendan (24
micro&#32;g/kg); and in group C, normal saline was administered when the
patient arrived in the recovery room. Pre-inhalation and post-inhalation
hemodynamics (mean arterial pressure [MAP], pulse rate, and systemic
vascular resistance [SVR]) were noted until 24 hours of inhalation of the
drug. The change in pulmonary artery pressures (pulmonary artery systolic
pressure [PASP] and mean pulmonary artery pressure [MPAP]) and the
duration for which they remained decreased compared with the control
group, were noted. Measurements and Main Results: MAP, pulse rate, and SVR
were comparable in the 3 groups at various time intervals. PASP and MPAP
decreased comparably after inhalation of levosimendan and milrinone.
However, they reached levels near the control group values after 2.5 to 3
hours in group L and after 0.5 hours in group M. Conclusions: Because
inhaled levosimendan causes a decrease in PASP and MPAP without causing a
decrease in SVR and MAP, the authors conclude that inhaled levosimendan is
a selective pulmonary vasodilator. It is as effective as milrinone in
reducing pulmonary artery pressures. In addition, it has advantage over
inhaled milrinone because it is has a longer duration of
action.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<11>
[Use Link to view the full text]
Accession Number
624068468
Title
Hyperinsulinemic Normoglycemia during Cardiac Surgery Reduces a Composite
of 30-day Mortality and Serious In-hospital Complications: A Randomized
Clinical Trial.
Source
Anesthesiology. 128 (6) (pp 1125-1139), 2018. Date of Publication: 01 Jun
2018.
Author
Duncan A.E.; Sessler D.I.; Sato H.; Sato T.; Nakazawa K.; Carvalho G.;
Hatzakorzian R.; Codere-Maruyama T.; Abd-Elsayed A.; Bose S.; Said T.;
Mendoza-Cuartas M.; Chowdary H.; Mascha E.J.; Yang D.; Gillinov A.M.;
Schricker T.
Institution
(Duncan) Departments of Cardiothoracic Anesthesia and Outcomes Research,
Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave-J4, Cleveland,
OH 44195, United States
(Sessler, Abd-Elsayed, Bose, Said, Mendoza-Cuartas, Chowdary, Mascha,
Yang) Outcomes Research, United States
(Mascha, Yang) Quantitative Health Sciences, United States
(Gillinov) Thoracic and Cardiovascular Surgery, Cleveland Clinic,
Cleveland, OH, United States
(Sato, Sato, Nakazawa, Carvalho, Hatzakorzian, Codere-Maruyama, Schricker)
Department of Anesthesia, Royal Victoria Hospital, McGill University,
Montreal, Canada
(Abd-Elsayed) Department of Anesthesiology, University of Wisconsin,
School of Medicine and Public Health, Madison, WI, United States
(Bose) Department of Anesthesia and Critical Care, Beth Israel Deaconess
Medical Center, Boston, MA, United States
(Said) Departments of Family Medicine and Geriatric Medicine, Metro Health
Medical Center, Cleveland, OH, United States
(Mendoza-Cuartas) Southern Arizona Anesthesia, Tucson, AZ, United States
(Chowdary) Department of Anesthesiology, University of Cincinnati,
Cincinnati, OH, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Hyperinsulinemic normoglycemia augments myocardial glucose
uptake and utilization. We tested the hypothesis that hyperinsulinemic
normoglycemia reduces 30-day mortality and morbidity after cardiac
surgery. Methods: This dual-center, parallel-group, superiority trial
randomized cardiac surgical patients between August 2007 and March 2015 at
the Cleveland Clinic, Cleveland, Ohio, and Royal Victoria Hospital,
Montreal, Canada, to intraoperative glycemic management with (1)
hyperinsulinemic normoglycemia, a fixed high-dose insulin and concomitant
variable glucose infusion titrated to glucose concentrations of 80 to 110
mg . dl^-1; or (2) standard glycemic management, low-dose
insulin infusion targeting glucose greater than 150 mg . dl^-1.
The primary outcome was a composite of 30-day mortality, mechanical
circulatory support, infection, renal or neurologic morbidity. Interim
analyses were planned at each 12.5% enrollment of a maximum 2,790
patients. Results: At the third interim analysis (n = 1,439;
hyperinsulinemic normoglycemia, 709, standard glycemic management, 730;
52% of planned maximum), the efficacy boundary was crossed and study
stopped per protocol. Time-weighted average glucose concentration (means
+/- SDs) with hyperinsulinemic normoglycemia was 108 +/- 20 versus 150 +/-
33 mg . dl^-1 with standard glycemic management, P < 0.001. At
least one component of the composite outcome occurred in 49 (6.9%)
patients receiving hyperinsulinemic normoglycemia versus 82 (11.2%)
receiving standard glucose management (P < efficacy boundary 0.0085);
estimated relative risk (95% interim-adjusted CI) 0.62 (0.39 to 0.97), P =
0.0043. There was a treatment-by-site interaction (P = 0.063); relative
risk for the composite outcome was 0.49 (0.26 to 0.91, P = 0.0007, n =
921) at Royal Victoria Hospital, but 0.96 (0.41 to 2.24, P = 0.89, n =
518) at the Cleveland Clinic. Severe hypoglycemia (less than 40 mg .
dl^-1) occurred in 6 (0.9%) patients. Conclusions:
Intraoperative hyperinsulinemic normoglycemia reduced mortality and
morbidity after cardiac surgery. Providing exogenous glucose while
targeting normoglycemia may be preferable to simply normalizing glucose
concentrations.<br/>Copyright &#xa9; 2018, the American Society of
Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved.

<12>
Accession Number
624050339
Title
Association of perioperative red blood cell transfusions with venous
thromboembolism in a North American Registry.
Source
JAMA Surgery. 153 (9) (pp 826-833), 2018. Date of Publication: September
2018.
Author
Goel R.; Patel E.U.; Cushing M.M.; Frank S.M.; Ness P.M.; Takemoto C.M.;
Vasovic L.V.; Sheth S.; Nellis M.E.; Shaz B.; Tobian A.A.R.
Institution
(Goel, Cushing, Vasovic) Division of Transfusion Medicine, Department of
Pathology, New York Presbyterian Hospital, Weill Cornell Medicine, New
York, United States
(Goel, Sheth) Division of Pediatric Hematology/Oncology, Department of
Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, New
York, United States
(Patel, Ness, Tobian) Division of Transfusion Medicine, Department of
Pathology, Johns Hopkins University, Baltimore, MD, United States
(Frank) Department of Anesthesiology and Critical Care Medicine, Johns
Hopkins Medical Institutions, Baltimore, MD, United States
(Takemoto) Division of Pediatric Hematology, Johns Hopkins University,
Baltimore, MD, United States
(Nellis) Division of Pediatric Critical Care Medicine, Department of
Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, New
York, United States
(Shaz) New York Blood Center, New York, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Increasing evidence supports the role of red blood cells (RBCs)
in physiological hemostasis and pathologic thrombosis. Red blood cells are
commonly transfused in the perioperative period; however, their
association with postoperative thrombotic events remains unclear.
OBJECTIVE To examine the association between perioperative RBC
transfusions and postoperative venous thromboembolism (VTE) within 30 days
of surgery. DESIGN, SETTING, AND PARTICIPANTS This analysis used
prospectively collected registry data from the American College of Surgery
National Surgical Quality Improvement Program (ACS-NSQIP) database, a
validated registry of 525 teaching and nonteaching hospitals in North
America. Participants included patients in the ACS-NSQIP registry who
underwent a surgical procedure from January 1 through December 31, 2014.
Data were analyzed from July 1, 2016, through March 15, 2018. MAIN
OUTCOMES AND MEASURES Risk-adjusted odds ratios (aORs) were estimated
using multivariable logistic regression. The primary outcome was the
development of postoperative VTE (deep venous thrombosis [DVT] and
pulmonary embolism [PE]) within 30 days of surgery that warranted
therapeutic intervention; DVT and PE were also examined separately as
secondary outcomes. Subgroup analyses were performed by surgical subtypes.
Propensity score matching was performed for sensitivity analyses. RESULTS
Of 750 937 patients (56.8% women; median age, 58 years; interquartile
range, 44-69 years), 47 410 (6.3%) received at least 1 perioperative RBC
transfusion. Postoperative VTE occurred in 6309 patients (0.8%) (DVT in
4336 [0.6%]; PE in 2514 [0.3%]; both DVT and PE in 541 [0.1%]).
Perioperative RBC transfusion was associated with higher odds of VTE (aOR,
2.1; 95% CI, 2.0-2.3), DVT (aOR, 2.2; 95% CI, 2.1-2.4), and PE (aOR, 1.9;
95% CI, 1.7-2.1), independent of various putative risk factors. A
significant dose-response effect was observed with increased odds of VTE
as the number of intraoperative and/or postoperative RBC transfusion
events increased (aOR, 2.1 [95% CI, 2.0-2.3] for 1 event; 3.1 [95% CI,
1.7-5.7] for 2 events; and 4.5 [95% CI, 1.0-19.4] for 3 events vs no
intraoperative or postoperative RBC transfusion; P < .001 for trend). In
subgroup analyses, the association between any perioperative RBC
transfusion and postoperative VTE remained statistically significant
across all surgical subspecialties analyzed. The association between any
perioperative RBC transfusion and the development of postoperative VTE
also remained robust after 1:1 propensity score matching (47 142 matched
pairs; matched OR, 1.9; 95% CI, 1.8-2.1). CONCLUSIONS AND RELEVANCE The
results of this study suggest that perioperative RBC transfusions may be
significantly associated with the development of new or progressive
postoperative VTE, independent of several putative confounders. These
findings, if validated, should reinforce the importance of rigorous
perioperative management of blood transfusion practices.<br/>Copyright
&#xa9; 2018 American Medical Association. All rights reserved.

<13>
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.

<14>
Accession Number
617595285
Title
TIMP-2*IGFBP7 (Nephrocheck) Measurements at Intensive Care Unit Admission
after Cardiac Surgery are Predictive for Acute Kidney Injury Within 48
Hours.
Source
Kidney and Blood Pressure Research. 42 (3) (pp 456-467), 2017. Date of
Publication: 2017.
Author
Stork T.; Heuschmann P.U.; Leyh R.G.; Wagner M.
Institution
(Oezkur, Magyar, Thomas, Stork, Bening, Leyh) Klinik und Poliklinik Fur
Thorax, Herz- und Thorakale Gefaschirugie, Uniklinikum Wurzburg,
Oberdurrbacherstrasse 6, Wurzburg 97078, Germany
(Oezkur, Magyar, Thomas, Stork, Heuschmann, Wagner) Institute of Clinical
Epidemiology and Biometry, University of Wurzburg, Germany
(Schneider, Wagner) Div. of Nephrology, Dept. of Medicine i, University
Hospital Wurzburg, Germany
(Stork, Heuschmann, Wagner) Comprehensive Heart Failure Center, University
of Wurzburg, Germany
(Stork) Divof Cardiology, Dept. of Medicine i, University Hospital
Wurzburg, Germany
(Heuschmann) Clinical Trial Center Wurzburg, University Hospital Wurzburg,
Wurzburg, Germany
Publisher
S. Karger AG
Abstract
Aims: Acute kidney injury (AKI) is a postoperative complication after
cardiac surgery with a high impact on mortality and morbidity. Nephrocheck
[TIMP-2*IGFBP7] determines markers of tubular stress, which occurs prior
to tubular damage. It is unknown at which time-point [TIMP-2*IGFBP7]
measurement should be performed to ideally predict AKI. We investigated
the association of [TIMP-2*IGFBP7] at various time-points with the
incidence of AKI in patients undergoing elective cardiac surgery including
cardio-pulmonary bypass. Methods: In a prospective cohort study, serial
blood and urine samples were collected from 150 patients: pre-operative,
at ICU-admission, 24h and 48h post-surgery. AKI was defined as
Serum-Creatinine rise >0.3 mg/dl within 48hrs. Urinary [TIMP-2*IGFBP7] was
measured at pre-operative, ICU-admission and 24h post-surgery; medical
staff was kept blinded to these results. Results: A total of 35 patients
(23.5%) experienced AKI, with a higher incidence in those with high
[TIMP-2*IGFBP7] values at ICU admission (57.1% vs. 10.1%, p<0.001). In
logistic regression [TIMP-2*IGFBP7] at ICU admission was independently
associated with the occurrence of AKI (Odds Ratio 11.83; p<0.001,
C-statistic= 0.74) after adjustment for EuroSCORE II and CBP-time.
Conclusions: Early detection of elevated [TIMP-2*IGFBP7] at ICU admission
was strongly predictive for postoperative AKI and appeared to be more
precise as compared to subsequent measurements.<br/>Copyright &#xa9; 2017
&#xa9; 2017 The Author(s). Published by S. Karger AG, Basel.

<15>
Accession Number
624094679
Title
STS/SCA/AmSECT clinical practice guidelines: Anticoagulation during
cardiopulmonary bypass.
Source
Journal of Extra-Corporeal Technology. 50 (1) (pp 5-18), 2018. Date of
Publication: 2018.
Author
Shore-Lesserson L.; Baker R.A.; Ferraris V.; Greilich P.E.; Fitzgerald D.;
Roman P.; Hammon J.
Institution
(Shore-Lesserson) Department of Anesthesiology, Hofstra Northwell School
of Medicine, New Hyde Park, 300 Community Drive, Manhasset, NY 11030,
United States
(Baker) Cardiac Surgery Research and Perfusion, Flinders University and
Flinders Medical Centre, Adelaide, SA, Australia
(Ferraris) Division of Cardiovascular and Thoracic Surgery, University of
Kentucky, Lexington, KY, United States
(Greilich) Department of Anesthesiology and Pain Management, University of
Texas-Southwestern Medical Center, Dallas, TX, United States
(Fitzgerald) Division of Cardiovascular Perfusion, Medical University of
South Carolina, Charleston, SA, United States
(Roman) Department of Anesthesiology, Saint Anthony Hospital, Lakewood,
CO, United States
(Hammon) Department of Cardiothoracic Surgery, Wake Forest University,
School of Medicine, Winston-Salem, NC, United States
Publisher
American Society of Extra-Corporeal Technology (E-mail: donna@amsect.org)
Abstract
Despite more than a half century of "safe" cardio-pulmonary bypass (CPB),
the evidence base surrounding the conduct of anticoagulation 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 (STS), the Society of Cardiovascular
Anesthesiologists (SCA), and the American Society of Extracorporeal
Technology (AmSECT) developed an Evidence Based Workgroup. This was a
group of interdisciplinary professionals gathered together 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 for CPB using the available evidence. To
identify relevant evidence a systematic review was outlined and literature
searches were conducted in PubMed using standardized 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 prior to 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 AHA/ACCF 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, 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 expand upon the
evidence base on the topic of anticoagulation for CPB.<br/>Copyright
&#xa9; 2018 American Society of Extra-Corporeal Technology. All Rights
Reserved.

<16>
[Use Link to view the full text]
Accession Number
624093793
Title
Utility of Perioperative Lung Ultrasound in Pediatric Cardiac Surgery: A
Randomized Controlled Trial.
Source
Anesthesiology. 128 (4) (pp 718-727), 2018. Date of Publication: 01 Apr
2018.
Author
Song I.-K.; Kim E.-H.; Lee J.-H.; Kang P.; Kim H.-S.; Kim J.-T.
Institution
(Song) Department of Anesthesiology and Pain Medicine, Asan Medical
Center, University of Ulsan, College of Medicine, Seoul, South Korea
(Kim, Lee, Kang, Kim, Kim) Department of Anesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul National University College of
Medicine, #101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Pediatric cardiac patients are at risk for perioperative
respiratory insufficiency. The objective of this study was to assess the
utility of perioperative lung ultrasound examination in pediatric cardiac
surgery. Methods: In this randomized, controlled trial, children (5 yr old
or younger) undergoing cardiac surgery were allocated into a control (n =
61) or intervention (n = 61) group. The control group received only lung
ultrasound examinations at the end of surgery and 6 to 12 h after surgery.
The intervention group received lung ultrasound examinations and an
ultrasound-guided recruitment maneuver depending on ultrasound findings
after inducing anesthesia, at the end of surgery, and 6 to 12 h after
surgery. Primary outcomes were incidences of intra-and postoperative
desaturation, and postoperative pulmonary complications. Multiple
comparisons were corrected (P <= 0.017) in the primary outcome analysis.
Results: Of the 120 children included in the analysis, postoperative
desaturation (64% vs. 27%; P < 0.001; odds ratio [OR], 0.210; 95% CI,
0.097 to 0.456) occurred more in the control group. The incidences of
intraoperative desaturation (36% vs. 19%; P = 0.033; OR, 0.406; 95% CI,
0.176 to 0.939) and postoperative pulmonary complications (12% vs. 3%; P =
0.093; OR, 0.271; 95% CI, 0.054 to 1.361) were similar between the groups.
Lung ultrasound scores were better in the intervention group than in the
control group. Duration of mechanical ventilation was longer in the
control group than in the intervention group (38 +/- 43 vs. 26 +/- 25 h;
95% CI of mean difference, 0 to 25; P = 0.048). Conclusions: Perioperative
lung ultrasound examination followed by ultrasound-guided recruitment
maneuver helped decrease postoperative desaturation events and shorten the
duration of mechanical ventilation in pediatric cardiac
patients.<br/>Copyright &#xa9; 2018, the American Society of
Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved.

<17>
[Use Link to view the full text]
Accession Number
624093791
Title
Cyclosporine before Coronary Artery Bypass Grafting Does Not Prevent
Postoperative Decreases in Renal Function: A Randomized Clinical Trial.
Source
Anesthesiology. 128 (4) (pp 710-717), 2018. Date of Publication: 01 Apr
2018.
Author
Ederoth P.; Dardashti A.; Grins E.; Bronden B.; Metzsch C.; Erdling A.;
Nozohoor S.; Mokhtari A.; Hansson M.J.; Elmer E.; Algotsson L.; Jovinge
S.; Bjursten H.
Institution
(Ederoth, Dardashti, Grins, Bronden, Metzsch, Erdling, Algotsson)
Departments of Anesthesiology and Intensive Care, Sweden
(Nozohoor, Mokhtari, Bjursten) Departments of Cardiothoracic Surgery,
Clinical Sciences, Lund University, Skane University Hospital, Lund 221
85, Sweden
(Hansson, Elmer) Department of Mitochondrial Medicine Clinical Sciences,
Lund University, Lund, Sweden
(Jovinge) Frederik Meijer Heart and Vascular Institute, Spectrum Health,
Grand Rapids, MI, United States
(Jovinge) Van Andel Institute, Grand Rapids, MI, United States
(Jovinge) Cardiovascular Institute, Stanford University, Stanford, CA,
United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Acute kidney injury is a common complication after cardiac
surgery, leading to increased morbidity and mortality. One suggested cause
for acute kidney injury is extracorporeal circulation-induced
ischemia-reperfusion injury. In animal studies, cyclosporine has been
shown to reduce ischemia-reperfusion injury in the kidneys. We
hypothesized that administering cyclosporine before extracorporeal
circulation could protect the kidneys in patients undergoing cardiac
surgery. Methods: The Cyclosporine to Protect Renal Function in Cardiac
Surgery (CiPRICS) study was an investigator-initiated, double-blind,
randomized, placebo-controlled, single-center study. The primary objective
was to assess if cyclosporine could reduce acute kidney injury in patients
undergoing coronary artery bypass grafting surgery with extracorporeal
circulation. In the study, 154 patients with an estimated glomerular
filtration rate of 15 to 90 ml . min^-1 . 1.73 m^-2
were enrolled. Study patients were randomized to receive 2.5 mg/kg
cyclosporine or placebo intravenously before surgery. The primary endpoint
was relative plasma cystatin C changes from the preoperative day to
postoperative day 3. Secondary endpoints included biomarkers of kidney,
heart, and brain injury. Results: All enrolled patients were analyzed. The
cyclosporine group (136.4 +/- 35.6%) showed a more pronounced increase
from baseline plasma cystatin C to day 3 compared to placebo (115.9 +/-
30.8%), difference, 20.6% (95% CI, 10.2 to 31.2%, P < 0.001). The same
pattern was observed for the other renal markers. The cyclosporine group
had more patients in Risk Injury Failure Loss End-stage (RIFLE) groups R
(risk), I (injury), or F (failure; 31% vs. 8%, P < 0.001). There were no
differences in safety parameter distribution between groups. Conclusions:
Administration of cyclosporine did not protect coronary artery bypass
grafting patients from acute kidney injury. Instead, cyclosporine caused a
decrease in renal function compared to placebo that resolved after 1
month.<br/>Copyright &#xa9; 2018, the American Society of
Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved.

<18>
Accession Number
622125360
Title
Impact of ultra-thin struts on restenosis after chronic total occlusion
recanalization: Insights from the randomized PRISON IV trial.
Source
Journal of Interventional Cardiology. 31 (5) (pp 580-587), 2018. Date of
Publication: October 2018.
Author
Zivelonghi C.; Teeuwen K.; Agostoni P.; van der Schaaf R.J.; Ribichini F.;
Adriaenssens T.; Kelder J.C.; Tijssen J.G.P.; Henriques J.P.S.; Suttorp
M.J.
Institution
(Zivelonghi, Agostoni, Kelder, Suttorp) Department of Cardiology, Sint
Antonius Ziekenhuis, Nieuwegein, Netherlands
(Zivelonghi, Ribichini) Department of Cardiology, University of Verona,
Verona, Italy
(Teeuwen) Department of Cardiology, Catharina Hospital, Eindhoven,
Netherlands
(van der Schaaf) Department of Cardiology, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
(Adriaenssens) Department of Cardiology, University Hospital Leuven,
Belgium
(Tijssen, Henriques) Department of Cardiology, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: The PRISON-IV trial showed inferior outcome in patients with
chronic total occlusions (CTOs) treated with the ultrathin-struts (60 mum
for stent diameter <=3 mm, 81mum >3 mm) hybrid-sirolimus eluting stents
(SES) compared with everolimus eluting stents (EES, 81 mum). The aim of
this study is to investigate if the use of smaller stents (<=3 mm) was
responsible for the inferior outcome reported in the trial. Methods: In
the PRISON-IV trial 330 patients with CTO lesion were randomized 1:1 to
receive either hybrid-SES or EES. The hybrid-SES failed to reach the
non-inferiority primary endpoint of in-segment late lumen loss (LLL) at
9-month angiographic follow-up. In this sub-analysis, we divided the
population according to the different size of stents implanted in those
receiving only stents with diameter <=3 mm (Group-A, 178 patients), only
stents >3 mm (Group-B, 59 patients), and those receiving stents of both
sizes (Group-C, 93 patients). Results: Baseline and procedural
characteristics were comparable in the three groups. At angiographic
follow-up, most of the adverse outcomes occurred in Group A, with higher
incidence of binary restenosis in the Hybrid-SES versus EES (10.3% vs
1.3%, P = 0.03) and augmented in-stent diameter stenosis (26.04 +/- 18.59%
vs 21.24 +/- 12.84, P = 0.06). Similarly, optical coherence tomography
(OCT), which was performed in 60 patients at follow-up, documented a mild
trend toward lower values of minimum in stent area in Hybrid-SES arm of
Group A (4.4 +/- 1.02mm² vs 5.0 +/- 1.28mm2, respectively, P =
0.16). Conclusions: The present analysis suggests that the inferior
performance of the ultra-thin hybrid-SES in CTO-PCI is particularly
pronounced when smaller stent (<=3 mm diameter) are adopted, if compared
with EES.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<19>
Accession Number
623337475
Title
Meta-analysis of the impact of successful chronic total occlusion
percutaneous coronary intervention on left ventricular systolic function
and reverse remodeling.
Source
Journal of Interventional Cardiology. 31 (5) (pp 562-571), 2018. Date of
Publication: October 2018.
Author
Megaly M.; Saad M.; Tajti P.; Burke M.N.; Chavez I.; Gossl M.; Lips D.;
Mooney M.; Poulose A.; Sorajja P.; Traverse J.; Wang Y.; Kohl L.P.;
Bradley S.M.; Brilakis E.S.
Institution
(Megaly, Tajti, Burke, Chavez, Gossl, Lips, Mooney, Poulose, Sorajja,
Traverse, Wang, Bradley, Brilakis) Minneapolis Heart Institute, Abbott
Northwestern Hospital, Minneapolis, MN, United States
(Megaly, Kohl) Division of Cardiology, Department of Medicine, Hennepin
County Medical Center, Minneapolis, MN, United States
(Saad) Department of Cardiovascular Medicine, University of Arkansas,
Little Rock, AR, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: We sought to examine the impact of coronary chronic total
occlusion (CTO) percutaneous coronary intervention (PCI) on left
ventricular (LV) function. Methods: We performed a systematic review and
meta-analysis of studies published between January 1980 and November 2017
on the impact of successful CTO PCI on LV function. Results: A total of 34
observational studies including 2735 patients were included in the
meta-analysis. Over a weighted mean follow-up of 7.9 months, successful
CTO PCI was associated with an increase in LV ejection fraction by 3.8%
(95%CI 3.0-4.7, P < 0.0001, I² = 45%). In secondary analysis of
15 studies (1248 patients) that defined CTOs as occlusions of at least
3-month duration and reported follow-up of at least 3-months after the
procedure, successful CTO PCI was associated with improvement in LV
ejection fraction by 4.3% (95%CI [3.1, 5.6], P < 0.0001). In the 10
studies (502 patients) that reported LV end-systolic volume, successful
CTO PCI was associated with a decrease in LV end-systolic volume by 4 mL,
(95%CI -6.0 to -2.1, P < 0.0001, I² = 0%). LV end-diastolic
volume was reported in 9 studies with 403 patients and did not
significantly change after successful CTO PCI (-2.3 mL, 95%CI -5.7 to 1.2
mL, P = 0.19, I² = 0%). Conclusions: Successful CTO PCI is
associated with a statistically significant improvement in LV ejection
fraction and decrease in LV end-systolic volume, that may reflect a
beneficial effect of CTO recanalization on LV remodeling. The clinical
implications of these findings warrant further
investigation.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<20>
Accession Number
621919035
Title
Pooled diagnostic accuracy of resting distal to aortic coronary pressure
referenced to fractional flow reserve: The importance of resting coronary
physiology.
Source
Journal of Interventional Cardiology. 31 (5) (pp 588-598), 2018. Date of
Publication: October 2018.
Author
Maini R.; Moscona J.; Sidhu G.; Katigbak P.; Fernandez C.; Irimpen A.;
Mogabgab O.; Ward C.; Samson R.; LeJemtel T.
Institution
(Maini, Moscona, Katigbak, Irimpen, Mogabgab, Ward, Samson, LeJemtel)
Division of Cardiology, Department of Medicine, Tulane University, New
Orleans, LA, United States
(Sidhu) The Wright Center for Graduate Medical Education, Scranton, PA,
United States
(Fernandez) Division of Precision Medicine, HeartGEN Institute, Boston,
MA, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Introduction: Both resting and hyperemic physiologic methods to guide
coronary revascularization improve cardiovascular outcomes compared with
angiographic guidance alone. Fractional flow reserve (FFR) remains
underutilized due to concerns regarding hyperemia, prompting study of
resting distal to aortic coronary pressure (Pd/Pa). Pd/Pa is a
vasodilator-free resting index unlike FFR. While Pd/Pa is similar to
another resting index, instantaneous wave-free ratio (iFR), it is a
whole-cycle measurement not limited to the wave-free diastolic period.
Pd/Pa is not validated clinically although multiple accuracy studies have
been performed. Our meta-analysis examines the overall diagnostic accuracy
of Pd/Pa referenced to FFR, the accepted invasive standard of ischemia.
Methods: We searched PubMed, EMBASE, Central, ProQuest, and Web of Science
databases for full text articles published through August 9, 2017
addressing the diagnostic accuracy of Pd/Pa referenced to FFR < 0.80. The
following keywords were used: "distal coronary artery pressure" OR "Pd/Pa"
AND "fractional flow reserve" OR "FFR.". Results: In total, 14 studies
comprising 7004 lesions were identified. Pooled diagnostic accuracy
estimates of Pd/Pa versus FFR < 0.80 were: sensitivity, 0.77 (95% CI,
0.75-0.78); specificity, 0.82 (0.81-0.83); positive likelihood ratio, 4.7
(3.3-6.6); negative likelihood ratio, 0.29 (0.24-0.34); diagnostic odds
ratio, 18.1 (14.4-22.6); area under the summary receiver-operating
characteristic curve of 0.88; and diagnostic accuracy of 0.80 (0.76-0.83).
Conclusions: Pd/Pa shows adequate agreement with FFR as a resting index of
coronary stenosis severity without the undesired effects and cost of
hyperemic agents. Pd/Pa has the potential to guide coronary
revascularization with easier application and availability compared with
iFR and FFR.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<21>
Accession Number
622333460
Title
Polymer-free versus permanent polymer-coated drug eluting stents for the
treatment of coronary artery disease: A meta-analysis of randomized
trials.
Source
Journal of Interventional Cardiology. 31 (5) (pp 608-616), 2018. Date of
Publication: October 2018.
Author
Nogic J.; Baey Y.-W.; Nerlekar N.; Ha F.J.; Cameron J.D.; Nasis A.; West
N.E.J.; Brown A.J.
Institution
(Nogic, Baey, Nerlekar, Ha, Cameron, Nasis, Brown) Monash Cardiovascular
Research Centre, Monash University and Monash Heart, Monash Health,
Melbourne, VIC, Australia
(West) Department of Interventional Cardiology, Papworth Hospital NHS
Trust, Cambridge, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Polymer-free drug eluting stents (PF-DES) were developed, in
part, to overcome risk of late ischemic events observed with permanent
polymer-coated DES (PP-DES). However, trial results are inconsistent with
longer-term safety and efficacy of PF-DES remaining unknown. We performed
a meta-analysis of randomized trials assessing outcomes of patients
receiving PF-DES versus PP-DES for treatment of coronary artery disease
(CAD). Methods: Electronic searches were performed for randomized trials
comparing outcomes between PF-DES and PP-DES. Trials reporting major
adverse cardiovascular events (MACE), myocardial infarction (MI), stent
thrombosis (ST), all-cause death, target lesion/vessel revascularization
(TLR/TVR), and late lumen loss (LLL) were included. Analyses were
performed at longest follow-up and landmarked beyond 1-year. Results:
Twelve trials (6,943 patients) were included. There was no significant
difference in MACE between PF-DES and PP-DES at longest follow-up (Odds
Ratio [OR] 0.96, 95%CI 0.85-1.10, P = 0.59) or landmark analysis beyond
1-year (OR 0.96, 95%CI 0.76-1.20, P = 0.70). Although PF-DES were
associated with a significant reduction in all-cause death (OR 0.85, 95%CI
0.72-1.00, P < 0.05), this effect was not present on landmark analysis
beyond 1-year (OR 0.89, 95%CI 0.73-1.10, P = 0.30). There were no
differences observed for MI (OR 1.00, 95%CI 0.77-1.28, P = 0.99) or ST (OR
0.95, 95%CI 0.54-1.68, P = 0.86), with similar efficacy outcomes including
TVR (OR 1.07, 95%CI 0.91-1.26, P = 0.42), TLR (OR 1.03, 95%CI 0.88-1.21, P
= 0.68) and angiographic LLL (pooled mean difference 0.01 mm, 95%CI -0.08
to 0.11, P = 0.76). Conclusions: PF-DES are as safe and efficacious as
PP-DES for the treatment of patients with CAD, but do not significantly
reduce late ischemic complications.<br/>Copyright &#xa9; 2018 Wiley
Periodicals, Inc.

<22>
Accession Number
622321968
Title
Valve in valve transcatheter aortic valve implantation (ViV-TAVI) versus
redo-Surgical aortic valve replacement (redo-SAVR): A systematic review
and meta-analysis.
Source
Journal of Interventional Cardiology. 31 (5) (pp 661-671), 2018. Date of
Publication: October 2018.
Author
Nalluri N.; Atti V.; Munir A.B.; Karam B.; Patel N.J.; Kumar V.; Vemula
P.; Edla S.; Asti D.; Paturu A.; Gayam S.; Spagnola J.; Barsoum E.;
Maniatis G.A.; Tamburrino F.; Kandov R.; Lafferty J.; Kliger C.
Institution
(Nalluri, Munir, Karam, Spagnola, Barsoum, Maniatis, Tamburrino, Kandov,
Lafferty) Department of Cardiology, Staten Island University Hospital,
Northwell Health, Staten Island, New York City, NY, United States
(Atti) Department of Internal Medicine, Michigan State University, Sparrow
Hospital, East Lansing, MI, United States
(Patel) Department of Cardiology, University of Miami, Jackson Memorial
Hospital, Miami, FL, United States
(Kumar) Department of Cardiology, Mount Sinai St. Luke's Roosevelt
Hospital, New York City, NY, United States
(Vemula) Department of Internal Medicine, Sparrow Health System, Lansing,
MI, United States
(Edla) Department of Cardiology, St. John Hospital and Medical Center,
Detroit, MI, United States
(Asti, Kliger) Department of Interventional Cardiology, Lenox Hill
Hospital, Northwell Health, Manhattan, New York City, NY, United States
(Paturu) Department of Internal Medicine, NRI Medical College, Guntur,
India
(Gayam) Department of Internal Medicine, KVG Medical College, Sullia,
Karnataka, India
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Bioprosthetic (BP) valves have been increasingly used for
aortic valve replacement over the last decade. Due to their limited
durability, patients presenting with failed BP valves are rising. Valve in
Valve - Transcatheter Aortic Valve Implantation (ViV-TAVI) emerged as an
alternative to the gold standard redo-Surgical Aortic Valve Replacement
(redo-SAVR). However, the utility of ViV-TAVI is poorly understood.
Methods: A systematic electronic search of the scientific literature was
done in PubMed, EMBASE, SCOPUS, Google Scholar, and ClinicalTrials.gov.
Only studies which compared the safety and efficacy of ViV-TAVI and
redo-SAVR head to head in failed BP valves were included. Results: Six
observational studies were eligible and included 594 patients, of whom 255
underwent ViV- TAVI and 339 underwent redo-SAVR. There was no significant
difference between ViV-TAVI and redo- SAVR for procedural, 30 day and 1
year mortality rates. ViV-TAVI was associated with lower risk of permanent
pacemaker implantation (PPI) (OR: 0.43, CI: 0.21-0.89; P = 0.02) and a
trend toward increased risk of paravalvular leak (PVL) (OR: 5.45, CI:
0.94-31.58; P = 0.06). There was no significant difference for stroke,
major bleeding, vascular complications and postprocedural aortic valvular
gradients more than 20 mm-hg. Conclusion: Our results reiterate the safety
and feasibility of ViV-TAVI for failed aortic BP valves in patients deemed
to be at high risk for surgery. VIV-TAVI was associated with lower risk of
permanent pacemaker implantation with a trend toward increased risk of
paravalvular leak.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<23>
Accession Number
623984871
Title
Variation in definition of prolonged mechanical ventilation.
Source
Respiratory Care. 62 (10) (pp 1324-1332), 2017. Date of Publication: 01
Oct 2017.
Author
Rose L.; McGinlay M.; Amin R.; Burns K.E.; Connolly B.; Hart N.; Jouvet
P.; Katz S.; Leasa D.; Mawdsley C.; McAuley D.F.; Schultz M.J.; Blackwood
B.
Institution
(Rose) Department of Critical Care Medicine, Sunnybrook Health Sciences
Centre, The Lawrence S Bloomberg, Faculty of Nursing and the
Interdepartmental Division of Critical Care Medicine, University of
Toronto, Provincial Centre of Weaning Excellence, Toronto East General
Hospital, Toronto, ON, Canada
(McGinlay) Royal Victoria Hospital, Belfast, United Kingdom
(Amin) SickKids Hospital and the Division of Respirology, University of
Toronto, Toronto, ON, Canada
(Burns) Saint Michael's Hospital, the Li Ka Shing Knowledge Institute,
Interdepartmental Division of Critical Care Medicine, University of
Toronto, Toronto, ON, Canada
(Connolly) Lane Fox Respiratory Unit, St Thomas's Hospital, Guy's and St
Thomas's NHS Foundation Trust, London, United Kingdom
(Hart) Lane Fox Respiratory Unit, St Thomas's Hospital, Guy's and St
Thomas's NHS Foundation Trust, King's College London, London, United
Kingdom
(Jouvet) Pediatric Intensive Care Unit, Department of Pediatrics,
Sainte-Justine Hospital, University of Montreal, Montreal, QC, Canada
(Katz) Department of Respirology, Children's Hospital of Eastern Ontario,
CHEO Research Institute, Faculty of Medicine, University of Ottawa,
Ottawa, ON, Canada
(Leasa) Critical Care Western and London Health Sciences Centre and
Western University, Ottawa, ON, Canada
(Mawdsley) Critical Care Western and London Health Sciences Centre,
London, ON, Canada
(McAuley) Royal Victoria Hospital and the Centre for Experimental
Medicine, Queen's University, Belfast, United Kingdom
(Schultz) Laboratory of Experimental Intensive Care and Anesthesiology,
Academic Medical Center, University of Amsterdam, Amsterdam-Zuidoost,
Netherlands
(Blackwood) Centre for Experimental Medicine, Queen's University, Belfast,
United Kingdom
Publisher
American Association for Respiratory Care
Abstract
Consistency of definitional criteria for terminology applied to describe
subject cohorts receiving mechanical ventilation within ICU and post-acute
care settings is important for understanding prevalence, risk
stratification, effectiveness of interventions, and projections for
resource allocation. Our objective was to quantify the application and
definition of terms for prolonged mechanical ventilation. We conducted a
scoping review of studies (all designs except single-case study) reporting
a study population (adult and pediatric) using the term prolonged
mechanical ventilation or a synonym. We screened 5,331 references,
reviewed 539 full-text references, and excluded 120. Of the 419 studies
(representing 38 countries) meeting inclusion criteria, 297 (71%) reported
data on a heterogeneous subject cohort, and 66 (16%) included surgical
subjects only (46 of those 66, 70% cardiac surgery). Other studies
described COPD (16, 4%), trauma (22, 5%), neuromuscular (17, 4%), and
sepsis (1, 0.2%) cohorts. A total of 741 terms were used to refer to the
419 study cohorts. The most common terms were: prolonged mechanical
ventilation (253, 60%), admission to specialized unit (107, 26%), and
long-term mechanical ventilation (79, 19%). Some authors (282, 67%)
defined their cohorts based on duration of mechanical ventilation, with
154 studies (55%) using this as the sole criterion. We identified 37
different durations of ventilation ranging from 5 h to 1 y, with > 21 d
being the most common (28 of 282, 7%). For studies describing a surgical
cohort, minimum ventilation duration required for inclusion was >= 24 h
for 20 of 66 studies (30%). More than half of all studies (237, 57%) did
not provide a reason/rationale for definitional criteria used, with only
28 studies (7%) referring to a consensus definition. We conclude that
substantial variation exists in the terminology and definitional criteria
for cohorts of subjects receiving prolonged mechanical ventilation.
Standardization of terminology and definitional criteria is required for
study data to be maximally informative.<br/>Copyright &#xa9; 2017 Daedalus
Enterprises.

<24>
Accession Number
621249873
Title
Comparison between intravenous boluses versus infusion of tranexamic acid
(TXA) to reduce bleeding in paediatric cyanotic congenital heart disease
(CHD) surgeries.
Source
Journal of the College of Physicians and Surgeons Pakistan. 28 (3) (pp
180-183), 2018. Date of Publication: 01 Mar 2018.
Author
Junejo F.; Akhtar M.I.; Hamid M.; Ahmed S.S.; Minai F.; Amanullah M.
Institution
(Junejo, Akhtar, Hamid, Ahmed, Minai, Amanullah) Department of
Anaesthesia, The Aga Khan University Hospital, Karachi, Pakistan
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Objective: To compare the intravenous boluses and intravenous continuous
infusion of tranexamic acid (TXA) to reduce postoperative bleeding in
cyanotic congenital heart disease surgeries. Study Design: Single-blinded
randomised clinical trial. Place and Duration of Study: Anaesthesia
Department, The Aga Khan University Hospital, Karachi, from July 2016 to
April 2017. Methodology: Sixty patients of cyanotic congenital heart
disease, undergoing either palliative or corrective surgery involving
cardiopulmonary bypass (CPB), were recruited. These 60 patients were
divided randomly into two groups. The infusion group received intravenous
infusion of TXA at 5 mg/kg/hour while the bolus group received three
intravenous boluses of 10 mg/kg after induction, after going to bypass and
after protamine reversal. Data was collected through predesigned proforma.
There were two primary outcomes: postoperative bleeding in the first 24
hours, and chest closure time. Results: Postoperative bleeding was 13.94
(10.27-20.18) ml/kg in the first 24 hours in infusion group and 15.05
(9.04- 23.50) ml/kg in the bolus group. Chest closure time was 38.5
(25-45) in infusion group and 30 (20-46.25) minutes in the bolus group.
There was no statistically significant and clinical difference between
both groups regarding postoperative bleeding in the first 24 hours and
chest closure time. Conclusion: These infusion and bolus groups had
comparable postoperative bleeding and chest closure time.<br/>Copyright
&#xa9; Journal of the College of Physicians and Surgeons Pakistan 2018.

<25>
Accession Number
618536171
Title
Blood conservation in cardiac surgery.
Source
Transfusion Medicine. 28 (2) (pp 168-180), 2018. Date of Publication:
April 2018.
Author
Blaudszun G.; Butchart A.; Klein A.A.
Institution
(Blaudszun, Butchart, Klein) Department of Anaesthesia and Intensive Care,
Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
Publisher
Blackwell Publishing Ltd
Abstract
This article aims at reviewing the currently available evidence about
blood conservation strategies in cardiac surgery. Pre-operative anaemia
and perioperative allogeneic blood transfusions are associated with worse
outcomes after surgery. In addition, transfusions are a scarce and costly
resource. As cardiac surgery accounts for a significant proportion of all
blood products transfused, efforts should be made to decrease the risk of
perioperative transfusion. Pre-operative strategies focus on the detection
and treatment of anaemia. The management of haematological abnormalities,
most frequently functional iron deficiency, is a matter for debate.
However, iron supplementation therapy is increasingly commonly
administered. Intra-operatively, antifibrinolytics should be routinely
used, whereas the cardiopulmonary bypass strategy should be adapted to
minimise haemodilution secondary to circuit priming. There is less
evidence to recommend minimally invasive surgery. Cell salvage and
point-of-care tests should also be a part of the routine care.
Post-operatively, any unnecessary iatrogenic blood loss should be
avoided.<br/>Copyright &#xa9; 2017 British Blood Transfusion Society

<26>
Accession Number
620739796
Title
Comparative Effectiveness and Harms of Intraoperative Transesophageal
Echocardiography in Noncardiac Surgery: A Systematic Review.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 22 (2) (pp 122-136),
2018. Date of Publication: 01 Jun 2018.
Author
Fayad A.; Shillcutt S.; Meineri M.; Ruddy T.D.; Ansari M.T.
Institution
(Fayad) University of Ottawa, Ottawa, ON, Canada
(Shillcutt) University of Nebraska Medical Center, Omaha, NE, United
States
(Meineri) University of Toronto, Toronto, ON, Canada
(Ruddy) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Ansari) School of Epidemiology and Public Health, University of Ottawa,
Ottawa, ON, Canada
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Intraoperative use of transesophageal echocardiography (TEE) has become
commonplace in high-risk noncardiac surgeries but the balance of benefits
and harms remains unclear. This systematic review investigated the
comparative effectiveness and harms of intraoperative TEE in noncardiac
surgery. We searched Ovid MEDLINE, PubMed, EMBASE, and the Cochrane
Library from 1946 to March 2017. Two reviewers independently screened the
literature for eligibility. Studies were assessed for the risk of
selection bias, confounding, measurement bias, and reporting bias. Three
comparative and 13 noncomparative studies were included. Intraoperative
TEE was employed in a total of 1912 of 3837 patients. Studies had
important design limitations. Data were not amenable to quantitative
synthesis due to clinical and methodological diversity. Reported incidence
of TEE complications ranged from 0% to 1.7% in patients undergoing various
procedures (5 studies, 540 patients). No serious adverse events were
observed for mixed surgeries (2 studies, 197 patients). Changes in
surgical or medical management attributable to the use of TEE were noted
in 17% to 81% of patients (7 studies, 558 patients). The only randomized
trial of intraoperative TEE was grossly underpowered to detect meaningful
differences in 30-day postoperative outcomes. There is lack of
high-quality evidence of effectiveness and harms of intraoperative TEE in
the management of non-cardiac surgeries. Evidence, however, indicates
timely evaluation of cardiac function and structure, and hemodynamics.
Future studies should be comparative evaluating confounder-adjusted impact
on both intraoperative and 30-day postoperative clinical
outcomes.<br/>Copyright &#xa9; 2018, &#xa9; The Author(s) 2018.

<27>
Accession Number
618044514
Title
Population screening and intervention for vascular disease in Danish men
(VIVA): a randomised controlled trial.
Source
The Lancet. 390 (10109) (pp 2256-2265), 2017. Date of Publication: 18 - 24
November 2017.
Author
Lindholt J.S.; Sogaard R.
Institution
(Lindholt) Department of Cardiothoracic and Vascular Surgery, Odense
University Hospital, Odense, Denmark
(Lindholt) Vascular Research Unit, Viborg Hospital, Viborg, Denmark
(Sogaard) Department of Public Health and Department of Clinical Medicine,
Aarhus University, Aarhus, Denmark
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Abdominal aortic aneurysm is the only cardiovascular disease
targeted by population screening. In this study, we test the effect of
screening and subsequent intervention for abdominal aortic aneurysm,
peripheral arterial disease, and hypertension combined. Methods In this
randomised controlled trial, we randomly allocated (1:1) all men aged
65-74 years living in the Central Denmark Region to screening for
abdominal aortic aneurysm, peripheral arterial disease, and hypertension,
or to no screening. We based allocation on computer-generated random
numbers from 1 to 100 in blocks of 1067 to 4392, stratified by 19
municipalities. Only the non-screening group and the investigator
assessing outcomes were masked. We invited participants who were found to
have abdominal aortic aneurysm or peripheral arterial disease back for
confirmation and eventual initiation of relevant pharmacological therapy.
We further offered participants with abdominal aortic aneurysm annual
control or surgical repair. We referred participants with suspected
hypertension to their general practitioner. The primary outcome was
all-cause mortality, assessed 5 years after randomisation, analysed in all
randomly allocated participants except for those who had incorrect person
identification numbers. This trial is registered at ClinicalTrials.gov,
number NCT00662480. Findings Between Oct 8, 2008, and Jan 11, 2011, we
randomly allocated 50 156 participants, with 25 078 (50%) each in the
screening and non-screening groups. Four (<1%) participants in the
screening group were lost to follow-up. After a median follow-up of 4.4
years (IQR 3.9-4.8), 2566 (10.2%) of 25 074 participants in the screening
group and 2715 (10.8%) of 25 078 in the non-screening group had died. This
finding resulted in a significant hazard ratio of 0.93 (95% CI 0.88-0.98;
p=0.01), an absolute risk reduction of 0.006 (0.001-0.011), and a number
needed to invite of 169 (89-1811). Incidences of diabetes (3995 per 100
000 person-years in the screening group vs 4129 per 100 000 person-years
in the non-screening group), intracerebral haemorrhage (146 vs 140), renal
failure (612 vs 649), cancer (3578 vs 3719), or 30 day mortality after
cardiovascular surgery (44.57 vs 39.33) did not differ between groups.
Interpretation The observed reduction of mortality risk from abdominal
aortic aneurysm, peripheral arterial disease, and hypertension has never
been seen before in the population screening literature and can be linked
primarily to initiation of pharmacological therapy. Health policy makers
should consider implementing combined screening whether no screening or
isolated abdominal aortic aneurysm screening is currently offered. Funding
The 7th European Framework Programme, Central Denmark Region, Viborg
Hospital, and the Danish Council for Independent Research.<br/>Copyright
&#xa9; 2017 Elsevier Ltd

<28>
Accession Number
618030176
Title
Ultrathin, bioresorbable polymer sirolimus-eluting stents versus thin,
durable polymer everolimus-eluting stents in patients undergoing coronary
revascularisation (BIOFLOW V): a randomised trial.
Source
The Lancet. 390 (10105) (pp 1843-1852), 2017. Date of Publication: 21 - 27
October 2017.
Author
Kandzari D.E.; Mauri L.; Koolen J.J.; Massaro J.M.; Doros G.;
Garcia-Garcia H.M.; Bennett J.; Roguin A.; Gharib E.G.; Cutlip D.E.;
Waksman R.
Institution
(Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Mauri) Divison of Cardiovascular Medicine, Brigham and Women's Hospital,
Boston, MA, United States
(Koolen) Catharina Hospital, Eindhoven, Netherlands
(Massaro, Doros) Department of Biostatistics and Epidemiology, Boston
University School of Public Health, Boston, MA, United States
(Doros) Baim Institute for Clinical Research, Boston, MA, United States
(Garcia-Garcia, Waksman) Division of Interventional Cardiology, MedStar
Cardiovascular Research Network, MedStar Washington Hospital Center,
Washington, DC, United States
(Bennett) Department of Cardiovascular Medicine, University Hospitals
Leuven, Leuven, Belgium
(Roguin) Department of Cardiology, Rambam Medical Center, Haifa, Israel
(Gharib) Charleston Area Medical Center, Charleston, WV, United States
(Cutlip) Beth Israel Deaconess Medical Center, Baim Institute for Clinical
Research, Boston, MA, United States
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background The development of coronary drug-eluting stents has included
use of new metal alloys, changes in stent architecture, and use of
bioresorbable polymers. Whether these advancements improve clinical safety
and efficacy has not been shown in previous randomised trials. We aimed to
examine the clinical outcomes of a bioresorbable polymer sirolimus-eluting
stent compared with a durable polymer everolimus-eluting stent in a broad
patient population undergoing percutaneous coronary intervention. Methods
BIOFLOW V was an international, randomised trial done in patients
undergoing elective and urgent percutaneous coronary intervention in 90
hospitals in 13 countries (Australia, Belgium, Canada, Denmark, Germany,
Hungary, Israel, the Netherlands, New Zealand, South Korea, Spain,
Switzerland, and the USA). Eligible patients were those aged 18 years or
older with ischaemic heart disease undergoing planned stent implantation
in de-novo, native coronary lesions. Patients were randomly assigned (2:1)
to either an ultrathin strut (60 mum) bioresorbable polymer
sirolimus-eluting stent or to a durable polymer everolimus-eluting stent.
Randomisation was via a central web-based data capture system (mixed
blocks of 3 and 6), and stratified by study site. The primary endpoint was
12-month target lesion failure. The primary non-inferiority comparison
combined these data from two additional randomised trials of bioresorbable
polymer sirolimus-eluting stent and durable polymer everolimus-eluting
stent with Bayesian methods. Analysis was by intention to treat. The trial
is registered with ClinicalTrials.gov, number NCT02389946. Findings
Between May 8, 2015, and March 31, 2016, 4772 patients were recruited into
the study. 1334 patients met inclusion criteria and were randomly assigned
to treatment with bioresorbable polymer sirolimus-eluting stents (n=884)
or durable polymer everolimus-eluting stents (n=450). 52 (6%) of 883
patients in the bioresorbable polymer sirolimus-eluting stent group and 41
(10%) of 427 patients in the durable polymer everolimus-eluting stent
group met the 12-month primary endpoint of target lesion failure (95% CI
-6.84 to -0.29, p=0.0399), with differences in target vessel myocardial
infarction (39 [5%] of 831 patients vs 35 [8%] of 424 patients, p=0.0155).
The posterior probability that the bioresorbable polymer sirolimus-eluting
stent is non-inferior to the durable polymer everolimus-eluting stent was
100% (Bayesian analysis, difference in target lesion failure frequency
-2.6% [95% credible interval -5.5 to 0.1], non-inferiority margin 3.85%,
n=2208). Interpretation The outperformance of the ultrathin, bioresorbable
polymer sirolimus-eluting stent over the durable polymer
everolimus-eluting stent in a complex patient population undergoing
percutaneous coronary intervention suggests a new direction in improving
next generation drug-eluting stent technology. Funding
BIOTRONIK.<br/>Copyright &#xa9; 2017 Elsevier Ltd

<29>
Accession Number
623930596
Title
Commentary: The Long and Winding Road.
Source
Journal of Endovascular Therapy. 25 (5) (pp 608-610), 2018. Date of
Publication: 01 Oct 2018.
Author
Lorenzoni R.; Roffi M.
Institution
(Lorenzoni) Diagnostic and Interventional Cardiology Unit, Department of
Cardiology, San Luca Hospital, Lucca, Tuscany, Italy
(Roffi) Interventional Cardiology Unit, University Hospitals, Geneva,
Switzerland
Publisher
SAGE Publications Inc. (E-mail: setac@allenpress.com)

<30>
Accession Number
623882467
Title
Transradial Approach for Aortoiliac and Femoropopliteal Interventions: A
Systematic Review and Meta-analysis.
Source
Journal of Endovascular Therapy. 25 (5) (pp 599-607), 2018. Date of
Publication: 01 Oct 2018.
Author
Meertens M.M.; Ng E.; Loh S.E.K.; Samuel M.; Mees B.M.E.; Choong A.M.T.L.
Institution
(Meertens, Ng, Loh, Samuel, Choong) SingVaSC, Singapore Vascular Surgical
Collaborative, Singapore
(Meertens, Mees) Department of Vascular Surgery, Maastricht University
Medical Center, Maastricht, Netherlands
(Meertens, Mees) European Vascular Center Aachen-Maastricht, Aachen,
Germany
(Ng) Department of Vascular Surgery, Westmead Hospital, Westmead, NSW,
Australia
(Loh) Department of Diagnostic Imaging, National University Hospital,
Singapore
(Samuel) Systematic Review Unit, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
(Choong) Division of Vascular Surgery, National University Heart Centre,
Singapore
(Choong) Department of Surgery, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
Publisher
SAGE Publications Inc. (E-mail: setac@allenpress.com)
Abstract
Purpose: To present a systematic review and meta-analysis comparing the
transradial approach for aortoiliac and femoropopliteal interventions to
the traditional transfemoral access. Methods: A search of the public
domain databases MEDLINE, SCOPUS, Web of Science, and Cochrane Library
Databases was performed to identify studies related to the use of the
transradial approach for infra-aortic procedures. Meta-analysis was used
to compare the transradial to the transfemoral route in terms of procedure
success, complications, procedure parameters, and hospital length of stay.
Results are presented as the odds ratio (OR) and 95% confidence interval
(CI). Results: Nineteen studies containing 638 patients with transradial
access for lower limb interventions were selected. Lesions were treated
from the aortic bifurcation down to the popliteal artery. The mean
technical success rate was 90.9%, conversion to a transfemoral approach
was necessary in 9.9%, and complications were reported in 1.9%. The
meta-analysis included 4 comparative studies involving 114 transradial and
208 transfemoral procedures. There was no significant advantage of either
approach in terms of procedure success (OR 5.0, 95% CI 0.49 to 50.83,
p=0.17), but the risk of developing a complication was significantly lower
(OR 0.25, 95% CI 0.07 to 0.86, p=0.03) with the transradial approach.
Conclusion: Transradial access for lower limb endovascular interventions
can be performed with comparable technical success and a lower overall
complication profile compared to transfemoral access.<br/>Copyright &#xa9;
The Author(s) 2018.

<31>
Accession Number
619415895
Title
Comparison of left atrial pressure monitoring with dedicated catheter
versus steerable guiding catheter during transcatheter mitral valve
repair.
Source
Catheterization and Cardiovascular Interventions. 92 (2) (pp 374-378),
2018. Date of Publication: 01 Aug 2018.
Author
Eleid M.F.; Reeder G.S.; Rihal C.S.
Institution
(Eleid, Reeder, Rihal) Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: The objective of this study was to determine the accuracy of
left atrial pressure (LAP) measurement through the manufacturer provided
steerable guiding catheter (SGC) during transcatheter mitral valve repair
(TMVR). Background: LAP measurement during TMVR has been shown to be
associated with clinical improvement when measured through a dedicated
catheter. Methods: Simultaneous LAP was performed in consecutive patients
using an independent fluid-filled 4F multipurpose catheter and compared to
LAP waveforms measured through the manufacturer-provided MitraClip SGC
during TMVR (Abbott, Santa Clara, CA). Results: Mean age of 10 consecutive
subjects with primary mitral regurgitation undergoing TMVR was 83 +/- 3
years (60% female). Left atrial v wave and mean pressures through the
dedicated catheter were 42 +/- 7 and 24 +/- 3 mmHg vs. 35 +/- 7 and 23 +/-
3 mmHg through the SGC (P < 0.001 and P = 0.23, respectively). Mean
differences in v wave and mean LAP were 8 +/- 4 and 1.0 +/- 2.4 mmHg
(percent difference 19 and 3%), respectively. SGC waveform overdamping was
observed in all cases. Conclusions: Left atrial v wave pressure
measurement through a dedicated catheter with sideholes during TMVR has
superior accuracy compared to the manufacturer provided SGC, which results
in waveform overdamping and a significant underestimation of v wave
pressure. These data have important implications for clinical
practice.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<32>
Accession Number
621755580
Title
Percutaneous Versus Surgical Revascularization for Left Main or
Multivessel Coronary Artery Disease: Results From a Large-Scale
Meta-Analysis in the Era of Drug-Eluting Stents.
Source
Angiology. 69 (9) (pp 812-824), 2018. Date of Publication: 01 Oct 2018.
Author
Verdoia M.; Barbieri L.; Kedhi E.; Suryapranata H.; De Luca G.
Institution
(Verdoia, Barbieri, De Luca) Division of Cardiology, Azienda
Ospedaliera-Universitaria "Maggiore della Carita," Eastern Piedmont
University, Novara, Italy
(Barbieri) Presidio Ospedaliero S. Andrea, Vercelli, Italy
(Kedhi) Department of Cardiology, Isala Hospital, Zwolle, Netherlands
(Kedhi, Suryapranata) UMC St Radboud, Nijmegen, Netherlands
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
The best treatment options for left main (LM) or multivessel coronary
disease (MVD) are still debated. We performed a meta-analysis of
randomized trials comparing percutaneous versus surgical revascularization
for LM or MVD. Primary end point was overall mortality. Secondary end
points were major adverse cardiovascular events, recurrent myocardial
infarction, repeated revascularization, or stroke. A total of 8 randomized
trials were included, involving 8694 patients, 50% undergoing percutaneous
coronary intervention (PCI). At a mean follow-up of 39.7 months, mortality
was 8.2% with no difference for PCI versus coronary artery bypass grafting
(CABG; odds ratio [OR] 95% confidence interval [CI] = 1.18 [0.90-1.55]; P
=.24, P for heterogeneity [P<inf>het</inf>] =.01). However, CABG was
slightly favored for MVD (OR [95% CI] = 1.54 [1.12-2.13]; P =.008,
P<inf>het</inf> =.14 for PCI) whereas noninferior for LM disease (OR [95%
CI] = 0.88 [0.60-1.29]; P =.50, P<inf>het</inf> =.10, P interaction =.03).
A similar benefit with CABG was also observed in terms of repeated
coronary revascularization, whereas PCI significantly reduced stroke. This
meta-analysis shows that surgical coronary revascularization still offers
advantages in survival and recurrent ischemic events compared to PCI using
drug-eluting stents (DES) in MVD although burdened by an increased risk of
stroke. In LM disease, CABG did not provide outcome benefits but was
associated with a higher risk of stroke compared to PCI. Additional
randomized trials are certainly needed with new-generation
DES.<br/>Copyright &#xa9; The Author(s) 2018.

<33>
Accession Number
620454145
Title
Transcatheter versus surgical aortic valve replacement in patients at low
surgical risk: A meta-analysis of randomized trials and propensity score
matched observational studies.
Source
Catheterization and Cardiovascular Interventions. 92 (2) (pp 408-416),
2018. Date of Publication: 01 Aug 2018.
Author
Witberg G.; Lador A.; Yahav D.; Kornowski R.
Institution
(Witberg, Lador, Kornowski) Department of Cardiology, Rabin medical
center, Petach, Tikva, Israel
(Witberg, Lador, Yahav, Kornowski) Sackler Faculty of Medicine, Tel-Aviv
university, Tel, Aviv, Israel
(Yahav) Infectious diseases unit, Rabin medical center, Petach, Tikva,
Israel
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Although transcatheter aortic valve replacement (TAVR) is
officially indicated for high risk aortic stenosis (AS) patients, the
procedure is increasingly being performed in patients who are not at high
surgical risk, including a substantial number of low risk patients.
However, data on the benefit of TAVR in this patient population is
limited. Methods: We conducted a systematic review and meta-analysis of
randomized controlled trials (RCTs) and observational studies with
propensity score matching (PSM) of TAVR versus surgical aortic valve
replacement (SAVR) in patients who are at low surgical risk. The primary
outcome was all-cause mortality. The secondary outcomes included stroke,
myocardial infarction, bleeding, and various procedural complications.
Results: Six studies (2 RCTs and 4 PSM studies) totaling 3,484 patients
were included. Follow-up ranged from 3 months to 3 years (median 2 years).
The short-term mortality was similar with either TAVR or SAVR (2.2% for
TAVR and 2.6% for SAVR, RR 0.89, 95% CI 0.56-1.41, P = 0.62), however,
TAVR was associated with increased risk for intermediate-term mortality
(17.2% for TAVR and 12.7% for SAVR, RR 1.45, 95% CI 1.11-1.89, P = 0.006).
In terms of periprocedural complications, TAVR was associated with reduced
risk for bleeding and renal failure and an increase in vascular
complications and Pacemaker implantation. Conclusions: In patients who are
at low surgical risk, TAVR seems to be associated with increased mortality
risk. Until more data in this population is available, SAVR should remain
the treatment of choice for these patients.<br/>Copyright &#xa9; 2018
Wiley Periodicals, Inc.

<34>
Accession Number
620453952
Title
Long-term survival after transcatheter versus surgical aortic valve
replacement for aortic stenosis: A meta-analysis of observational
comparative studies with a propensity-score analysis.
Source
Catheterization and Cardiovascular Interventions. 92 (2) (pp 419-430),
2018. Date of Publication: 01 Aug 2018.
Author
Takagi H.; Mitta S.; Ando T.
Institution
(Takagi, Mitta) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To synthesize evidence regarding long-term survival after
transcatheter aortic valve implantation (TAVI) versus surgical aortic
valve replacement (SAVR) for severe aortic stenosis (AS) from real-world
clinical practice, we performed a meta-analysis of observational studies
with a propensity-score analysis and >=3-year follow-up. Methods:
Databases including MEDLINE and EMBASE were searched through April 2017
using PubMed and OVID. Eligible studies were observational comparative
studies with a propensity-score analysis of TAVI versus SAVR enrolling
patients with severe AS and reporting >=3-year all-cause mortality as an
outcome. A hazard ratio (HR) with its 95% confidence interval (CI) of
follow-up (including early) mortality for TAVI versus SAVR was extracted
from each individual study. Results: Our search identified 14 eligible
studies enrolling a total of 4,197 patients. A pooled analysis of all the
14 studies demonstrated a statistically significant 54% increase in
mortality with TAVI relative to SAVR (HR, 1.54; 95% CI, 1.31-1.81; P for
effect < 0.00001; P for heterogeneity = 0.14; I² = 30%).
Several sensitivity analyses did not substantially change the
statistically significant benefit for SAVR. There was no evidence of
significant publication bias. Conclusions: On the basis of a meta-analysis
of 14 observational comparative studies with a propensity-score analysis
including a total of >=4,000 patients, TAVI is associated with worse
>=3-year overall survival than SAVR.<br/>Copyright &#xa9; 2018 Wiley
Periodicals, Inc.

<35>
Accession Number
623812170
Title
Novel oral anticoagulants in the preoperative period: A meta-analysis.
Source
Journal of Thrombosis and Thrombolysis. 45 (3) (pp 386-396), 2018. Date of
Publication: 17 Jan 2018.
Author
He H.; Ke B.; Li Y.; Han F.; Li X.; Zeng Y.
Institution
(He, Ke, Li, Li, Zeng) Department of Emergency Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Anzhen Road Second, Chaoyang
District, Beijing 100029, China
(Han) Department of Epidemiology, Beijing Anzhen Hospital, Beijing
Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical
University, Beijing 100029, China
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The purpose of this study is to evaluate the efficacy and safety of novel
oral anticoagulant (NOAC) versus warfarin therapy in patients undergoing
different operations. We performed a systematic review of MEDLINE, EMBASE,
Cochrane Controlled Trials Register, and reports presented at scientific
meetings. The efficacy and safety of NOACs during the perioperative period
was compared to that using warfarin. Of the 2652 studies initially
reviewed, we identified 9 that included 15,880 patients for the
meta-analysis. Compared to warfarin, dabigatran increased the risk of
major bleeding (RR 1.37, 95% CI 1.06-1.78, P = 0.02). Apixaban (RR 0.63,
95% CI 0.40-0.99, P = 0.04) reduced thrombotic events. NOAC therapy
decreased thrombotic events in patients undergoing non-cardiac surgery (RR
0.68, 95% CI 0.50-0.92, P = 0.02). Compared to warfarin, the
administration of NOACs in the perioperative period has the same risk of
thromboembolism and major bleeding. But patients undergoing non-cardiac
surgery may benefit more from perioperative NOAC therapy. Apixaban may
reduce thrombotic events and dabigatran increases the risk of major
bleeding during the perioperative period.<br/>Copyright &#xa9; Springer
Science+Business Media, LLC, part of Springer Nature 2018.

<36>
Accession Number
623989466
Title
A comparison of an ultrathin-strut biodegradable polymer sirolimus-eluting
stent with a durable polymer everolimus-eluting stent for patients with
acute ST-segment elevation myocardial infarction undergoing primary
percutaneous coronary intervention: Rationale and design of the BIOSTEMI
trial.
Source
EuroIntervention. 14 (6) (pp 692-699), 2018. Date of Publication: August
2018.
Author
Iglesias J.F.; Muller O.; Zaugg S.; Roffi M.; Kurz D.J.; Vuilliomenet A.;
Weilenmann D.; Kaiser C.; Tapponnier M.; Heg D.; Valgimigli M.; Eeckhout
E.; Juni P.; Windecker S.; Pilgrim T.
Institution
(Iglesias, Roffi) Cardiology Division, University Hospital, Lausanne,
Switzerland
(Muller, Eeckhout) Cardiology Department, Lausanne University Hospital,
Rue du Bugnon 46, Lausanne 1011, Switzerland
(Zaugg, Heg) Clinical Trials Unit Bern, Institute of Social and Preventive
Medicine, University of Bern, Bern, Switzerland
(Kurz) Cardiology Department, Triemli Hospital, Zurich, Switzerland
(Vuilliomenet) Cardiology Department, Kantonsspital, Aarau, Switzerland
(Weilenmann) Cardiology Department, Kantonsspital, St Gallen, Switzerland
(Kaiser) Cardiology Department, University Hospital, Basel, Switzerland
(Tapponnier) Cardiology Department, Hopital du Valais, Sion, Switzerland
(Valgimigli, Windecker, Pilgrim) Cardiology Department, Swiss
Cardiovascular Center, University Hospital, Bern, Switzerland
(Juni) Applied Health Research Centre, St. Michael's Hospital, University
of Toronto, Toronto, Canada
Publisher
EuroPCR
Abstract
Aims: A novel ultrathin-strut biodegradable polymer sirolimus-eluting
stent (BP-SES) (Orsiro; Biotronik, Bulach, Switzerland) was shown to be
superior to a thin-strut durable polymer everolimus-eluting stent (DP-EES)
(XIENCE Xpedition/Alpine; Abbott Vascular, Santa Clara, CA, USA) with
respect to the primary endpoint of target lesion failure (TLF) at 12
months in the pre-specified subgroup of patients with ST-segment elevation
myocardial infarction (STEMI) included in the BIOSCIENCE trial. We
designed a large-scale, randomised, clinical trial to assess the clinical
superiority of ultrathin-strut BP-SES over thin-strut DP-EES among
patients with STEMI undergoing primary percutaneous coronary intervention
(PPCI). Methods and results: BIOSTEMI (NCT02579031) is a prospective,
multicentre, randomised, controlled, superiority trial that will randomly
assign 1,250 patients with STEMI undergoing PPCI to treatment with BP-SES
or DP-EES. The primary endpoint of TLF, a composite of cardiac death,
target vessel reinfarction, and clinically indicated target lesion
revascularisation within 12 months, will be analysed with Bayesian models
applied to the BIOSTEMI data set (n=1,250) using robust historical priors
to incorporate historical information from the BIOSCIENCE STEMI subgroup
(n=407). Conclusions: The BIOSTEMI trial will determine whether
ultrathin-strut BP-SES are superior to thin-strut DP-EES with respect to
TLF in patients with STEMI undergoing PPCI.<br/>Copyright &#xa9; Europa
Digital & Publishing 2018. All rights reserved.

<37>
Accession Number
623989453
Title
One-year clinical outcome of early administration of intravenous
beta-blockers in patients with ST-segment elevation myocardial infarction
before primary percutaneous coronary reperfusion.
Source
EuroIntervention. 14 (6) (pp 688-691), 2018. Date of Publication: August
2018.
Author
Roolvink V.; Ottervanger J.P.; Ibanez B.; Dambrink J.H.; Gosselink M.;
Kedhi E.; Van Royen N.; Lipsic E.; Remkes W.; Piek J.; Fuster V.; van't
Hof A.
Institution
(Roolvink, Ottervanger, Dambrink, Gosselink, Kedhi, Remkes, van't Hof)
Heart Centre, Isala Hospital, Dr van Heesweg 2, Zwolle 8025 AB,
Netherlands
(Ibanez) Centro Nacional de Investigaciones Cardiovasculares Carlos III
(CNIC), Madrid, Spain
(Van Royen) Department of Cardiology, VU University Medical Center,
Amsterdam, Netherlands
(Lipsic) Department of Cardiology, University Medical Center Groningen,
Groningen, Netherlands
(Piek) Department of Cardiology, Academic Medical Center, Amsterdam,
Netherlands
(Fuster) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, New York, NY, United States
(van't Hof) Department of Cardiology, Maastricht University Medical
Center, Maastricht, Netherlands
(van't Hof) Department of Cardiology, Zuyderland Medical Center, Heerlen,
Netherlands
Publisher
EuroPCR

<38>
Accession Number
2000979562
Title
Comparison of Outcomes of Percutaneous Coronary Intervention on Native
Coronary Arteries Versus on Saphenous Venous Aorta Coronary Conduits in
Patients With Low Left Ventricular Ejection Fraction and Impella Device
Implantation Achieved or Attempted (from the PROTECT II Randomized Trial
and the cVAD Registry).
Source
American Journal of Cardiology. 122 (6) (pp 966-972), 2018. Date of
Publication: 15 September 2018.
Author
Shavelle D.M.; Banerjee S.; Maini B.; Schreiber T.L.; Kapasi N.; O'Neill
W.W.; Popma J.; Matthews R.V.
Institution
(Shavelle, Kapasi, Matthews) Division of Cardiovascular Medicine,
University of Southern California, Los Angeles, CA, United States
(Banerjee) Veterans Affairs North Texas Health Care System and University
of Texas Southwestern Medical Center, Dallas, TX, United States
(Maini) Florida Atlantic University, Boca Raton, FL, United States
(Schreiber) Detroit Medical Center, Cardiovascular Institute, Detroit, MI,
United States
(O'Neill) Henry Ford Hospital, Detroit, MI, United States
(Popma) Beth Israel Deaconess Medical Center, Boston, MA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients with prior coronary artery bypass grafting (CABG) represent a
high-risk cohort given associated medical conditions and worse outcome of
saphenous vein graft compared with native vessel percutaneous coronary
intervention (PCI). The goal of the current analysis was to compare
clinical outcomes in 591 patients with and without prior CABG and
multivessel coronary artery disease or unprotected left main disease and
severely reduced left ventricular systolic function underwent Impella
supported PCI from the PROTECT II randomized trial and the cVAD Registry.
Patients with prior CABG surgery (n = 201) were compared with those
without prior CABG surgery (n = 390). The primary end point of this
analysis was overall mortality at 30 days. Patients with prior CABG
surgery had greater Society of Thoracic Surgery mortality score compared
with patients without prior CABG surgery, 7.6 +/- 6.4 versus 5.1 +/- 5.5,
respectively, p <0.001. Saphenous vein graft PCI was performed in 17% of
patients with prior CABG surgery. Number of vessels treated was lower in
patients with prior CABG surgery compared with patients without prior CABG
surgery, 1.66 +/- 0.56 versus 1.89 +/- 0.64, respectively, p <0.001.
Achievement of TIMI 3 flow post PCI and overall PCI success was similar in
the two groups. Overall mortality at 30 days was similar in patients with
prior CABG surgery compared with patients without prior CABG surgery,
6.75% versus 6.61%, respectively, p = 1.0. In conclusion, in this
high-risk cohort of patients underwent hemodynamically supported PCI,
prior CABG surgery was not associated with worse outcome. The use of
hemodynamic support appears to mitigate the increased risk of PCI
associated with prior CABG.<br/>Copyright &#xa9; 2018

<39>
Accession Number
2000790595
Title
Transcaval approach for endovascular aortic interventions: A systematic
review.
Source
Journal of Cardiology. 72 (5) (pp 369-376), 2018. Date of Publication:
November 2018.
Author
Wee I.J.Y.; Syn N.; Choong A.M.T.L.
Institution
(Wee, Syn, Choong) SingVaSC, Singapore Vascular Surgical Collaborative,
Singapore
(Wee) Yong Loo Lin School of Medicine, National University of Singapore,
Singapore
(Choong) Cardiovascular Research Institute, National University of
Singapore, Singapore
(Choong) Department of Surgery, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
(Choong) Division of Vascular Surgery, National University Heart Centre,
Singapore
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
The caval-aortic path is a novel access route for endovascular aortic
interventions in aortic interventions, particularly for patients
unsuitable for traditional access routes including femoral, subclavian,
transapical, and aortic. A systematic review was conducted as per the
PRISMA guidelines utilizing three electronic databases: Medline, Embase,
and Cochrane database. There were 10 studies identified, including 7
retrospective studies, 1 prospective cohort study, and 2 case reports.
Data on 209 patients (mean age 79.5 +/- 5.1 years; 51.2% male) were
abstracted including preoperative work-up, technical procedure details,
and outcomes. The overall technical success rate for all procedures is
96.2%, with a 4.3% mortality rate and a mean follow up of 17.9 +/- 19.8
months. Individually in the various interventions, the technical success
rate of transcaval endoleak repair and transcatheter aortic valve
implantation (TAVI) was 94.4% and 97.5% respectively, with a low 30-day
mortality rate of 7.6% in the TAVI intervention. There is encouraging
evidence regarding the rates of mortality and complications in the
transcaval approach for endovascular aortic interventions. It presents a
feasible alternative for a judiciously select group of patients who are
not suitable for other access routes.<br/>Copyright &#xa9; 2018 Japanese
College of Cardiology

<40>
Accession Number
2000953232
Title
Efficacy and safety of alirocumab in patients with or without prior
coronary revascularization: Pooled analysis of eight ODYSSEY phase 3
trials.
Source
Atherosclerosis. 277 (pp 211-218), 2018. Date of Publication: October
2018.
Author
Kereiakes D.J.; Lepor N.E.; Gerber R.; Veronica Lee L.; Elassal J.;
Thompson D.; Michael Gibson C.
Institution
(Kereiakes) The Christ Hospital, Heart and Vascular Center/The Lindner
Research Center, Cincinnati, OH, United States
(Lepor) Cedars-Sinai Medical Center/Westside Medical Associates of Los
Angeles, Beverly Hills, CA, United States
(Gerber) Department of Cardiology, East Sussex Healthcare NHS Trust,
Hastings, United Kingdom
(Veronica Lee) Sanofi, Bridgewater, NJ, United States
(Elassal, Thompson) Regeneron Pharmaceuticals Inc., Tarrytown, NY, United
States
(Michael Gibson) Beth Israel Deaconess Medical Center, Boston, MA, United
States
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims: Patients with atherosclerotic cardiovascular disease
(ASCVD) and prior revascularization are at high risk of further
cardiovascular events and may require additional lipid-lowering therapies
beyond maximally tolerated statin therapy. We assessed the efficacy and
safety of alirocumab, a proprotein convertase subtilisin/kexin type 9
(PCSK9) inhibitor, in patients with ASCVD, with or without prior coronary
revascularization (percutaneous coronary intervention [PCI] or coronary
artery bypass graft [CABG]). Methods: Data from eight controlled
(placebo/ezetimibe) phase 3 ODYSSEY trials were pooled and stratified by
trial design: alirocumab 150 mg or 75 mg with possible dose increase to
150 mg (75/150 mg) every 2 weeks (Q2W) versus placebo, and alirocumab
75/150 mg Q2W versus ezetimibe. Most patients received background
maximally tolerated statin therapy. Results: Among 4629 randomized
patients with hypercholesterolemia, 3382 had ASCVD including 2191 with
prior revascularization. Although baseline characteristics were comparable
between alirocumab and control groups, revascularized patients were more
likely to be male, have had prior myocardial infarction/stroke, have
higher lipoprotein (a) and PCSK9 levels, and were more often treated with
high-intensity statin therapy. Alirocumab significantly reduced
low-density lipoprotein cholesterol (LDL-C; primary endpoint; p < 0.0001),
lipoprotein (a), non-high-density lipoprotein cholesterol, and
apolipoprotein B levels from baseline to week 24 (vs. control), regardless
of stratified treatment group or revascularization status. On-treatment
LDL-C levels with alirocumab ranged from 45.6 to 64.8 mg/dL. Alirocumab
had a similar safety profile regardless of revascularization status, and
higher rates of injection-site reactions versus controls. Conclusions:
Alirocumab is generally well-tolerated and effective with a similar safety
profile in high-risk patients with or without prior revascularization
(PCI/CABG).<br/>Copyright &#xa9; 2018 The Authors

<41>
Accession Number
2000602256
Title
Long term outcomes of new generation drug eluting stents versus coronary
artery bypass grafting for multivessel and/or left main coronary artery
disease. A Bayesian network meta-analysis of randomized controlled trials.
Source
Cardiovascular Revascularization Medicine. 19 (6) (pp 671-678), 2018. Date
of Publication: September 2018.
Author
Mina G.S.; Watti H.; Soliman D.; Shewale A.; Atkins J.; Reddy P.; Dominic
P.
Institution
(Mina, Watti, Reddy, Dominic) Department of Cardiology, LSUHSC-Shreveport,
1501 Kings Hwy, Shreveport, LA 71103, United States
(Soliman) LSUHSC-Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, United
States
(Shewale) Division of Pharmaceutical Evaluation & Policy, University of
Arkansas for Medical Sciences, Little Rock, AR, United States
(Atkins) Department of Medicine, LSUHSC-Shreveport, 1501 Kings Hwy,
Shreveport, LA 71103, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Most data guiding revascularization of multivessel disease
(MVD) and/or left main disease (LMD) favor coronary artery bypass grafting
(CABG) over percutaneous coronary intervention (PCI). However, those data
are based on trials comparing CABG to bare metal stents (BMS) or old
generation drug eluting stents (OG-DES). Hence, it is essential to
outcomes of CABG to those of new generation drug eluting stents (NG-DES).
Methods: We searched PUBMED and Cochrane database for trials evaluating
revascularization of MVD and/or LMD with CABG and/or PCI. A Bayesian
network meta-analysis was performed to calculate odds ratios (OR) and 95%
credible intervals (CrI). Primary outcome was major adverse cardiovascular
events (MACE) at 3-5 years. Secondary outcomes were mortality,
cerebrovascular accidents (CVA), myocardial infarction (MI) and repeat
revascularization. Results: We included 10 trials with a total of 9287
patients. CABG was associated with lower MACE when compared to BMS or
OG-DES. However, MACE was not significantly different between CABG and
NG-DES (OR 0.79, CrI 0.45-1.40). Moreover, there were no significant
differences between CABG and NG-DES in mortality (OR 0.78, CrI 0.45-1.37),
CVA (OR 0.93 CrI 0.35-2.2) or MI (OR 0.6, CrI 0.17-2.0). On the other
hand, CABG was associated with lower repeat revascularization (OR 0.55,
CrI 0.36-0.84). Conclusions: Our study suggests that NG-DES is an
acceptable alternative to CABG in patients with MVD and/or LMD. However,
repeat revascularization remains to be lower with CABG than with
PCI.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<42>
Accession Number
623738041
Title
The incremental predictive value of frailty measures in elderly patients
undergoing cardiac surgery: A systematic review.
Source
Clinical Cardiology. 41 (8) (pp 1103-1110), 2018. Date of Publication:
August 2018.
Author
Li Z.; Ding X.
Institution
(Li) Department of Epidemiology & Biostatistics, Western University,
London, ON, Canada
(Ding) Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing, China
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Emerging evidence demonstrates that frailty measures can predict adverse
outcomes after cardiac procedures. Our objectives were to examine whether
the inclusion of frailty measures adds incremental predictive value to
existing surgical risk prediction models in patients undergoing cardiac
surgery and to evaluate the reporting and methods of studies that
investigated the prediction of frailty measures in cardiology. The
inclusion of frailty measures adds incremental predictive value on
existing perioperative risk-scoring systems. We systematically searched
the EMBASE, MEDLINE, and Web of Science databases for relevant studies.
Studies were included according to predefined inclusion criteria. The
quality of included studies was appraised using the QUADAS-2 tool. Data
were extracted and synthesized according to predefined methods. Twelve
studies were included in the analysis. Included studies demonstrated the
incremental predictive value of frailty measures on existing surgical risk
models for mortality, but the predictive value of frailty measures alone
was not consistent across literature. Few studies that investigated the
predictive ability of frailty measures reported all important model
performance measures. When comparing the predictive value of frailty
measures with existing models, few studies reported if the frailty
measurement was separately performed from the existing perioperative risk
assessment. The addition of frailty measures to the existing perioperative
risk models improved the prediction performance for mortality, but the
incorporation of frailty assessment into perioperative risk assessment
requires further evidence before making health policy
recommendations.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<43>
Accession Number
2000848811
Title
Impact of treatment strategies on outcomes in patients with stable
coronary artery disease and type 2 diabetes mellitus according to
presenting angina severity: A pooled analysis of three federally-funded
randomized trials.
Source
Atherosclerosis. 277 (pp 186-194), 2018. Date of Publication: October
2018.
Author
Mancini G.B.J.; Boden W.E.; Brooks M.M.; Vlachos H.; Chaitman B.R.; Frye
R.; Bittner V.; Hartigan P.M.; Dagenais G.R.
Institution
(Mancini) University of British Columbia, Vancouver, British Columbia,
Canada
(Boden) Clinical Trials Network and Massachusetts Veterans Epidemiology,
Research, and Informatics Center (MAVERIC), Veterans Affairs New England
Healthcare System, Boston, MA, United States
(Brooks, Vlachos) University of Pittsburgh, Graduate School of Public
Health, Pittsburgh, PA, United States
(Chaitman) St. Louis University School of Medicine, St. Louis, MO, United
States
(Frye) Mayo Clinic, Rochester, MN, United States
(Bittner) University of Alabama at Birmingham, Birmingham, AL, United
States
(Hartigan) West Haven Veterans Administration Coordinating Center, West
Haven, CT, United States
(Dagenais) Quebec Heart and Lung University Institute, Quebec City,
Quebec, Canada
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims: The impact of treatment strategies on outcomes in
patients with stable coronary artery disease (CAD) and type 2 diabetes
mellitus (T2DM) according to presenting angina has not been rigorously
assessed. Methods: We performed a patient-level pooled-analysis (n = 5027)
of patients with stable CAD and T2DM randomized to optimal medical therapy
[OMT], percutaneous coronary intervention [PCI] + OMT, or coronary artery
bypass grafting [CABG] + OMT. Endpoints were death/myocardial infarction
(MI)/stroke, post-randomization revascularization (both over 5 years), and
angina control at 1 year. Results: Increasing severity of baseline angina
was associated with higher rates of death/MI/stroke (p = 0.009) and
increased need for post-randomization revascularization (p = 0.001); after
multivariable adjustment, only association with post-randomization
revascularization remained significant. Baseline angina severity did not
influence the superiority of CABG + OMT to reduce the rate of
death/MI/stroke and post-randomization revascularization compared to other
strategies. CABG + OMT was superior for angina control at 1 year compared
to both PCI + OMT and OMT alone but only in patients with >= Class II
severity at baseline. Comparisons between PCI + OMT and OMT were neutral
except that PCI + OMT was superior to OMT for reducing the rate of
post-randomization revascularization irrespective of presenting angina
severity. Conclusions: Presenting angina severity did not influence the
superiority of CABG + OMT with respect to 5-year rates of death/MI/stroke
and need for post-randomization revascularization. Presenting angina
severity minimally influenced relative benefits for angina control at 1
year.<br/>Copyright &#xa9; 2018 The Authors

<44>
Accession Number
623274739
Title
Advanced chronic kidney disease: Relationship to outcomes post-TAVR, a
meta-analysis.
Source
Clinical Cardiology. 41 (8) (pp 1091-1096), 2018. Date of Publication:
August 2018.
Author
Makki N.; Lilly S.M.
Institution
(Makki, Lilly) Department of Cardiology, Ohio State University Wexner
Medical Center, Columbus, OH, United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Chronic kidney disease (CKD) is associated with worse outcomes in
high-surgical-risk patients undergoing transcatheter aortic valve
replacement (TAVR). However, it is unclear whether this relationship is
apparent in lower-surgical-risk patients. We sought to analyze existing
literature to assess whether or not advanced CKD is associated with
increased mortality or a greater incidence of adverse events (specifically
major stroke, bleeding, and vascular complications). We searched PubMed
and Embase (2008-2017) for relevant studies. Studies with <1 year
follow-up and those not evaluating advanced CKD or outcomes post-TAVR were
excluded. Our co-primary endpoints were the incidence of short-term
mortality (defined as in-hospital or 30-day mortality) and long-term
mortality (1 year). Our secondary endpoints included incidence of major
stroke, life-threatening bleeding, and major vascular complications.
Eleven observational studies with a total population of 10709 patients met
the selection criteria. Among patients with CKD there was an increased
risk of short- and long-term mortality in high-surgical-risk patients who
underwent TAVR (hazard ratio [HR]: 1.51, 95% confidence interval [CI]:
1.22-1.88 and HR: 1.56, 95% CI: 1.38-1.77, respectively; P < 0.01).
However, there was no association between CKD and mortality in low- to
intermediate-risk patients (HR: 1.35, 95% CI: 0.98-1.84, P = 0.06 in
short-term and HR: 1.08, 95% CI: 0.92-1.27, P = 0.34 in long-term). In
low- to intermediate-risk TAVR patients, advanced CKD is not associated
with increased mortality or poorer safety outcomes. These findings should
be factored into the clinical decision-making process regarding TAVR
candidacy.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<45>
Accession Number
623770577
Title
Efficacy and safety of further lowering of low-density lipoprotein
cholesterol in patients starting with very low levels: A meta-analysis.
Source
JAMA Cardiology. 3 (9) (pp 823-828), 2018. Date of Publication: September
2018.
Author
Sabatine M.S.; Wiviott S.D.; Im K.; Murphy S.A.; Giugliano R.P.
Institution
(Sabatine, Wiviott, Im, Murphy, Giugliano) TIMI Study Group, Division of
Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical
School, Hale Bldg for Transformative Medicine, 60 Fenwood Rd, Boston, MA
02115, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE In the Cholesterol Treatment Trialists Collaboration (CTTC), in
patients starting with low-density lipoprotein cholesterol (LDL-C) levels
of approximately 3.4 mmol/L (131.5mg/dL), there was a 22%reduction in
major vascular events per 1-mmol/L (38.7-mg/dL) lowering of LDL-C. The
magnitude of clinical benefit of further LDL-C lowering in patients
already with very low LDL-C levels remains debated. OBJECTIVE To evaluate
efficacy and safety of further lowering LDL-C levels in patient
populations presenting with median LDL-C levels of 1.8 mmol/L (70mg/dL) or
less. DATA SOURCES AND STUDY SELECTION The CTTCwas used for statin data.
For nonstatin therapy, Medline database was searched (2015-April 2018).
Key inclusion criteria were a randomized, double-blind, controlled
cardiovascular outcome trial of LDL-C lowering with data in populations
starting with LDL-C levels averaging 1.8 mmol/L (70mg/dL) or less. DATA
EXTRACTION AND SYNTHESIS Two authors independently extracted data into
standardized data sheets, and data were analyzed using meta-analysis. MAIN
OUTCOMES AND MEASURES The risk ratio (RR) of major vascular events (a
composite of coronary heart death,myocardial infarction, ischemic stroke,
or coronary revascularization) per 1-mmol/L (38.7-mg/dL) reduction in
LDL-C level. RESULTS In the subgroup of patients from the CTTC
meta-analysis of statins with a mean LDL-C in the control arm of 1.7
mmol/L (65.7mg/dL), 1922 major vascular events occurred and the RR for
major vascular events per 1-mmol/L (38.7-mg/dL) reduction in LDL-C was
0.78 (95%CI, 0.65-0.94). For 3 trials of nonstatin LDL-C-lowering
therapies added to statins, there were 50 627 patients, the median LDL-C
in the control arms ranged from 1.6 mmol/L to 1.8 mmol/L (63mg/dL to
70mg/dL), and 9570 major vascular events occurred. Nonstatin therapy
lowered LDL-C by 0.3 to 1.2 mmol/L (11mg/dL to 45mg/dL), and the RR for
major vascular events per 1-mmol/L (38.7-mg/dL) reduction in LDL-C was
0.79 (95%CI, 0.70-0.88). For statins and nonstatins combined, the RR was
0.79 (95%CI, 0.71-0.87; P < .001). Low-density lipoprotein cholesterol
lowering was not associated with an increased risk of serious adverse
events,myalgias and/ormyositis, elevation in the level of
aminotransferases, new-onset diabetes, hemorrhagic stroke, or cancer.
CONCLUSIONS AND RELEVANCE There is a consistent relative risk reduction in
major vascular events per change in LDL-C in patient populations starting
as low as a median of 1.6 mmol/L (63mg/dL) and achieving levels as low as
a median of 0.5 mmol/L (21mg/dL), with no observed offsetting adverse
effects. These data suggest further lowering of LDL-C beyond the lowest
current targets would further reduce cardiovascular risk.<br/>Copyright
&#xa9; 2018 American Medical Association. All rights reserved.

<46>
Accession Number
623882844
Title
Total cardiovascular events analysis of the EXAMINE trial in patients with
type 2 diabetes and recent acute coronary syndrome.
Source
Clinical Cardiology. 41 (8) (pp 1022-1027), 2018. Date of Publication:
August 2018.
Author
Cavender M.A.; White W.B.; Liu Y.; Massaro J.M.; Bergenstal R.M.; Mehta
C.R.; Zannad F.; Heller S.; Cushman W.C.; Cannon C.P.
Institution
(Cavender) Department of Medicine, University of North Carolina, Chapel
Hill, NC, United States
(Cavender, Liu, Cannon) Baim Institute for Clinical Research, Boston, MA,
United States
(White) Calhoun Cardiology Center, University of Connecticut School of
Medicine, Farmington, CT, United States
(Massaro) Department of Biostatistics, Boston University School of Public
Health, Boston, MA, United States
(Bergenstal) Department of Endocrinology, Park Nicollet Clinic,
Minneapolis, MN, United States
(Mehta) Department of Biostatistics, Harvard School of Public Health,
Boston, MA, United States
(Zannad) Department of Medicine, INSERM 1143, Universite de Lorraine,
Nancy, France
(Heller) Department of Medicine, University of Sheffield and Sheffield
Teaching Hospitals National Health Service Foundation Trust, Sheffield,
United Kingdom
(Cushman) Department of Medicine, Memphis Veterans Affairs Medical Center
and University of Tennessee Health Science Center, Memphis, TN, United
States
(Cannon) Department of Medicine, Brigham and Women's Hospital, Boston, MA,
United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Alogliptin, a dipeptidyl peptidase-4 inhibitor, is approved for the
treatment of patients with type 2 diabetes (T2DM). EXAMINE was a
randomized controlled clinical trial designed to demonstrate the
cardiovascular (CV) safety of alogliptin. In the trial, 5380 patients with
established T2DM who had a recent acute coronary syndrome event (between
15 and 90 days) were randomized to treatment with either alogliptin or
placebo. To better understand and describe the CV safety of alogliptin, we
analyzed data from the EXAMINE trial to determine whether treatment with
alogliptin affected recurrent and total CV events. Poisson regression
analysis compared the total number of occurrences of CV death, MI, stroke,
unstable angina, and coronary revascularization between all patients
randomized to alogliptin vs placebo groups. Patients with recurrent CV
events were older and more likely to have renal disease and history of
heart failure. There were 1100 first CV events and an additional 666
recurrent events over a median of 18 months of follow-up. There were no
significant differences with regard to total number of events in patients
treated with alogliptin (n = 873) or placebo (n = 893; P = 0.52).
Furthermore, there were no differences in the types of events seen in
patients treated with alogliptin or placebo. Alogliptin did not increase
the risk of either first or recurrent CV events when compared with placebo
in patients with T2DM and recent acute coronary syndrome. These data
support the CV safety of alogliptin in patients who are at increased risk
of future CV events.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<47>
Accession Number
624070709
Title
Assessing the changes in albumin utilization over a 10-year period: A
single centre retrospective study.
Source
Transfusion. Conference: American Association of Blood Banks Annual
Meeting, AABB 2018. United States. 58 (Supplement 2) (pp 132A), 2018. Date
of Publication: October 2018.
Author
Tinmouth A.; Chasse M.; Murphy M.; McIntyre L.; Fergusson D.A.; Kumanan W.
Institution
(Tinmouth) Ottawa Hospital, Canada
(Tinmouth, Murphy, McIntyre, Fergusson, Kumanan) Ottawa Hospital Research
Institute, Canada
(Chasse) Centre Hospitalier de l' Universite de Montreal, Canada
Publisher
Blackwell Publishing Inc.
Abstract
Background/Case Studies: Albumin is a commonly prescribed fraction-ated
blood product, but many of the indications are not supported by strong
clinical evidence. The alternatives to albumin include crystalloid fluids
and colloid fluids. However, recent studies suggest possible harms
associated with the use hydroxyethyl starches, an alternative colloid
solution, which may have impacted the use of albumin. In this study, we
describe the use of albumin in a tertiary academic centre over a 10-year
period. Study Design/Method: This was a 10-year retrospective cohort study
of a large tertiary care hospital in Ontario, Canada. The Ottawa Hospital
Data Warehouse was queried for all inpatient and outpatient encounters
where albumin was transfused between January 2006 and December 2016.
Albumin use over the study period was reported, including number of
hospital encounters, total amount of albumin administered (normalized for
concentration of albumin), concentration of albumin, and attending
medical/service. Patient encounters associated with albumin transfusion
were compared to a randomly selected cohort of patients not receiving
albumin. Results/Finding: At the Ottawa Hospital, 15,927 patients received
albumin from 2006-2016. There were 25,851 encounters where albumin was
transfused, 68.3% of the albumin was administered to inpatients and 30.2%
was administered to outpatients. Overall, the annual number of patients
receiving albumin more than doubled from 1,153 to 2,359 during the period
of study and the total amount of albumin transfused increased by from
255,413 to 384,545 grams. The number of patient encounters with an albumin
infusion and the total amount of albumin transfused was stable from 2007
to 20011 and then increase dramatically between 2011 and 2014. The largest
patient groups receiving albumin were cardiac surgery (19.3%), internal
medicine (13.5%), intensive care (11.8%) and hematology (10.4%). In the
patient encounters with albumin transfusion, the increase in the
pro-portion of cardiac surgery patients and intensive care patients was
greatest as compared to patient encounters with no albumin transfusions.
Conclusion: The number of patients receiving albumin and the total amount
of albumin transfused at the Ottawa Hospital increased from 220 to 2016.
The increases were mostly seen between 2011 and 2014, which may be have
been related to clinical studies demonstrating possible harm associated
with use of alternative colloid fluids. Further analysis will be performed
to understand the changes in the indications for the use of albumin as
well as differences in clinical outcomes among patients who receive
albumin and those that do not.

<48>
Accession Number
624070630
Title
Influence of blood storage age on immune and coagulation parameters in
critically ill or cardiac surgery patients receiving transfusion.
Source
Transfusion. Conference: American Association of Blood Banks Annual
Meeting, AABB 2018. United States. 58 (Supplement 2) (pp 45A-46A), 2018.
Date of Publication: October 2018.
Author
Norris P.J.; Schechtman K.; Sniecinski R.; Trachten-Berg F.; Ranganathan
G.; Adelman A.; Keating S.; Cohen M.; Szlam F.; Levy J.; Assmann S.;
Steiner M.E.; Lacroix J.; Spinella P.C.
Institution
(Norris, Keating) Blood Systems Research Institute, United States
(Schechtman, Adelman, Spinella) Washington University School of Medicine,
United States
(Sniecinski, Szlam) Department of Anesthe-siology, Emory University School
of Medicine, United States
(Trachten-Berg, Ranganathan, Assmann) New England Research Institute,
United Kingdom
(Cohen) University of California, San Francisco, United States
(Levy) Duke University Medical Center, United States
(Steiner) University of Minnesota, United States
(Lacroix) Ste. Justine Hospital, United States
Publisher
Blackwell Publishing Inc.
Abstract
Background/Case Studies: Two large, randomized controlled trials of RBC
storage age were conducted in North America and Europe, the RECESS and
ABLE studies. These studies did not show a significant difference in
outcome between recipients of RBC units stored for short vs. long periods.
Our group collected longitudinal blood samples from the trial participants
to determine if there were changes in a wide array of coagulation and
immunological parameters. Study Design/Method: Samples were collected
pre-surgery or transfusion and at days 2, 6, 28, and 180 thereafter. Whole
blood samples were shipped to a central lab overnight for PBMC processing,
and plasma was separated at clinical sites and stored frozen for batch
shipping. 90 subjects from the RECESS trial and 100 subjects from the ABLE
trial were enrolled and studied. Levels of 16 coagulation parameters,
regulatory and functional T cells, 25 cytokines, and 16 markers of
extracellular vesicles (EVs) were determined using commercial assays for
coagulation and cytokine testing and flow cytometry for T cell and EV
characterization. Results/Finding: In the RECESS ancillary study 35
subjects received fresh, 28 aged RBCs, and 27 were not transfused. Of the
parameters tested, only 4 showed a significant difference early
post-transfusion between study arms: the ability of CD8+T cells to secrete
IFN-gamma and plasma IL-6 were higher and plasma endothelial growth factor
levels and the concentration of extracellular vesicles (EVs) bearing the B
cell marker CD19 were lower in recipients of fresh vs. aged RBCs. Multiple
parameters showed significant modulation post-surgery and transfusion.
Most analytes that changed after surgery did not differ based on
transfusion status. Several EV markers, including two associated with
platelets (CD41a and CD62P), decreased in transfused subjects but not in
those who underwent surgery without transfusion. For the ABLE ancillary
study 49 subjects received fresh and 51 aged RBCs. Changes from baseline
in levels of protein C, factor V, and EVs expressing phosphatidyl serine
and CTLA-4 differed between recipients of fresh and aged RBC units, with
the vast majority of coagulation and EV markers and all cytokines tested
showing no difference between study arms. Although most analytes showed no
difference between subjects in the fresh and aged arms of the study, 6
coagulation parameters, 15 cytokines, and 7 EV parameters changed
significantly in the period post-transfusion. Conclusion: Transfusion of
fresh vs. aged RBCs does not result in substantial changes in hemostasis
or immune parameters in recipients. It is possible that transfusion
modulates the level of platelet-derived EVs, which will require further
studies in patients randomized to receipt of transfusion.

<49>
Accession Number
624070587
Title
Donor characteristics do not influence the risk for onset of
transfusion-related acute lung injury in a secondary analysis of two
case-control studies.
Source
Transfusion. Conference: American Association of Blood Banks Annual
Meeting, AABB 2018. United States. 58 (Supplement 2) (pp 205A), 2018. Date
of Publication: October 2018.
Author
Van De Weerdt E.; Peters A.-L.; Prinsze F.; De Korte D.; Juffermans N.;
Vlaar A.
Institution
(Van De Weerdt, Vlaar) Department of Intensive Care Medicine, Academic
Medical Center, Netherlands
(Van De Weerdt, Peters) Laboratory of Experimental Intensive Care and
Anesthesia, Academic Medical Center, Netherlands
(Peters) Department of Intensive Care, Medical Center, Netherlands
(Prinsze) Department of Donor Studies, Sanquin Research, Netherlands
(De Korte) Department of Blood Cell Research, Sanquin Research and
Landsteiner Laboratory, Netherlands
(Juffermans) Laboratory for Experimental Intensive Care and
Anesthesiology, Academic Medical Center, Netherlands
Publisher
Blackwell Publishing Inc.
Abstract
Background/Case Studies: Transfusion-related acute lung injury (TRALI) is
a potentially fatal complication of transfusion. In pre-clinical studies
and several clinical studies, TRALI has been related to loss of product
quality during red blood cell storage, called the "storage lesion". Donor
characteristics, as for example age, genetics and sex influence this
"storage lesion". We investigated the relation between donor
characteristics and onset of TRALI. We hypothesized that donor sex, age
and blood type is related to TRALI incidence. Study Design/Method: We
performed a secondary analysis on the donor data from two cohort studies,
which combine to one of the largest cohorts of TRALI patients to date. The
first cohort consisted of a retrospective nested case control study in ICU
patients, the second cohort consisted of a prospective case control study
in cardiac surgery patients. Suspected TRALI was defined by using the
consensus definition of ALI. We obtained donor sex, age and blood type
from the national blood bank. We used krus-kal-wallis testing to compare
the number of transfused products and chi-square testing to compare
proportions of TRALI patients and transfused control. Results/Finding: The
retrospective cohort consisted of 109 patients that fulfilled the
diagnostic criteria for TRALI (64% male, median age 62 [IQR 47-71],
massive transfusion 37% +/-33). 109 patients that received transfusion,
but did not develop TRALI, were randomly selected to serve as control
patients (66% male, median age 57 [IQR 49-72], massive transfusion 37%
+/-33). TRALI patients received more products than controls (chi-square
test p< 0.0001). There was no relation between TRALI incidence and donor
sex (chi square test p>0.5). Both TRALI patients and transfused controls
received mainly products from donors over 41 years old (chi square test
p<0.05), but donor age did not influence TRALI risk (chi square test
p>0.5). Both TRALI and control patients received more blood products from
blood type 0 and A (p<0.0001). TRALI was not related to blood group
matched or blood type compatible transfusion (fisher-exact test p = 0.41).
In the prospective case control study in cardiac surgery patients, 16
patients developed TRALI (75% male, median age 74, IQR 71-79). 32 patients
were randomly selected as controls (63% male, median age 69, IQR 62-75).
This cohort confirmed the results of retrospective study for donor blood
type, donor sex and blood type-compatible and blood type-matched products.
In this cohort, both groups received mainly products from males, and TRALI
patients did not receive more transfusions.(chi square test p< 0.00001).
Conclusion: We conclude that in two cohorts of TRALI patients, donor blood
type, donor age, donor sex and the transfusion of blood type-compatible
and blood type-matched products were not associated with an increased risk
for TRALI.

<50>
Accession Number
624070523
Title
Sex-mismatched red blood cell transfusions and mortality: A systematic
review and meta-analysis.
Source
Transfusion. Conference: American Association of Blood Banks Annual
Meeting, AABB 2018. United States. 58 (Supplement 2) (pp 127A-128A), 2018.
Date of Publication: October 2018.
Author
Zeller M.P.; Rochwerg B.; Hillis C.; Runciman R.J.R.; Lane S.; Jamula E.;
Li N.; Arnold D.M.; Heddle N.M.
Institution
(Zeller, Li, Arnold) McMaster Centre for Transfusion Research, Canada
(Zeller) Canadian Blood Services, Canada
(Rochwerg) Department of Medicine, Division of Critical Care, McMaster
University, Canada
(Hillis, Runciman, Lane, Jamula) McMaster Centre for Transfusion Research,
McMaster University, Canada
(Hillis) Department of Oncology, McMaster University, Canada
(Heddle) McMaster University, Canada
Publisher
Blackwell Publishing Inc.
Abstract
Background/Case Studies: Selection of a compatible red blood cell (RBC)
unit does not include matching for donor sex. This systematic review and
meta-analysis aims to summarize the evidence examining the impact of
sex-mismatched RBC transfusion on recipient mortality. Study
Design/Method: Ovid MEDLINE, Ovid EMBASE, CINAHL, PubMed, Web of Science,
and the Cochrane Database of Systematic Reviews were searched up to
January 12, 2018 to identify randomized control trials (RCTs) and
observational studies examining the impact of donor sex on recipient
outcomes. A meta-analysis was conducted on eligible studies and generated
pooled hazard ratios (HRs) using a random-effects model. A three-level
meta-analytic model was applied to emphasize the unknown dependence among
the effect sizes. Prespecified analysis was done on the subgroup of
cardiac surgery patients. Study quality was in duplicate using the ROBINS
tool and certainty of the evidence for all outcomes was assessed using
GRADE. Results/Finding: Five retrospective observational studies (n =
86,737) were included, no RCTs were found. Sex-mismatched RBC transfusions
were associated with a higher risk of death compared with sex-matched
transfusions (pooled hazard ratio [HR] 1.13; 95% confidence interval [CI]
1.02-1.24) (See Figure). In the subgroup of cardiovascular surgery (n =
57,712), there was no significant increase in mortality with
sex-mismatched transfusions (pooled HR 1.08; 95% CI 0.95-1.22). The data
were prone to confounding, selection bias and reporting bias. Certainty of
the evidence was very low. Conclusion: Sex-mismatched RBC transfusions
were associated with an increased risk of death in this pooled analysis.
However, the certainty of the evidence was very low from observational
studies. There is a pressing need to further study the impact of donor sex
because of its potential widespread impact.

<51>
Accession Number
624070317
Title
The fibres study: A pragmatic, randomised, active-control,
non-inferiority, phase 3 trial comparing a new fibrinogen concentrate vs.
cryoprecipitate for the treatment of acquired hypofibrinogenaemia in
bleeding cardiac surgical patients.
Source
Transfusion. Conference: American Association of Blood Banks Annual
Meeting, AABB 2018. United States. 58 (Supplement 2) (pp 81A-82A), 2018.
Date of Publication: October 2018.
Author
Karkouti K.; Callum J.; Carroll J.; Grewal D.; Armali C.
Institution
(Karkouti, Carroll, Grewal) University Health Network, United States
(Karkouti, Callum) University of Toronto, Canada
(Callum, Armali) Sun-nybrook Health Sciences Centre, Canada
Publisher
Blackwell Publishing Inc.
Abstract
Background/Case Studies: Coagulopathic bleeding is a serious complication
of cardiac surgery. A key contributor is acquired hypofibrinogenaemia
(plasma fibrinogen < 1.5-2.0 g/L), the standard treatment for which is
cryo-precipitate. Purified fibrinogen concentrate is also used, but few
comparative data exist and randomised trials are needed. The primary
objective of the FIBrinogen REplenishment in Surgery (FIBRES) study is to
demonstrate that a new fibrinogen concentrate (Octafibrin/Fibryga,
Octapharma) is non-inferior to cryoprecipitate. Study Design/Method: This
is a pragmatic, multi-centre, active-control, randomised (1:1),
single-blinded, non-inferiority, phase 3 trial in adult cardiac surgical
patients with clinically significant bleeding due to acquired
hypofibrinogenaemia. Patients undergoing cardiopulmonary bypass (CPB) for
whom fibrinogen supplementation is ordered within 24 hours will be
randomised to receive 4 g fibrinogen concentrate or 10 units
cryoprecipitate (dose equivalent). Research personnel obtaining outcome
assessments will be blinded to treatment allocation. All randomised
patients will receive fibrinogen supplementation according to clinical
need. Patient consent at randomisation is waived, with written informed
consent obtained as soon as possible therafter. Primary outcome is
combined red cell, platelet and plasma transfusions within 24 hours of
CPB. Secondary outcomes include blood products used within 7 days, major
bleeding within 24 hours, fibrinogen levels and adverse events. Enrolment
of 1,200 patients will provide > 90% power to demonstrate non-inferiority,
based on a 20% non-inferiority margin, > 550 patients/group and ~10%
drop-out rate. Safety reviews by the DSMB will be performed every 100
patients. An interim analysis will be performed at 600 patients with
pre-specified stopping rules for futility and overwhelming efficacy. The
pragmatic design and treatment algorithm align with standard practice,
aiding adherence and generalizability. [Table Presented] Compare
allogeneic transfusions; adverse outcomes; fibrinogen levels
Results/Finding: This is the largest randomised study of fibrinogen
con-centrate versus cryoprecipitate in adult cardiac surgical patients
conducted at 11 Canadian centers. Expected completion is late 2018, with
results available in early 2019. Four-hundred of 1200 patients have been
randomized as of April 2018 with no safety issue so far as assessed by the
DSMB. Conclusion: Non-inferiority of the new fibrinogen concentrate
compared to cryoprecipitate would support its use in cardiac surgical
patients experiencing significant bleeding due to hypofibrinogenaemia, an
under-studied yet high-risk bleeding population.

<52>
Accession Number
624069989
Title
Indications and dosing of cryoprecipitate in neonates.
Source
Transfusion. Conference: American Association of Blood Banks Annual
Meeting, AABB 2018. United States. 58 (Supplement 2) (pp 113A), 2018. Date
of Publication: October 2018.
Author
Desimone R.A.; Cushing M.M.; Sharma A.V.; Perlman J.M.; Kasdorf E.; Hsu
Y.-M.S.; Vasovic L.V.; Nellis M.E.; Goel R.
Institution
(Desimone, Cushing, Sharma, Perlman, Kasdorf, Hsu, Vasovic, Nellis) Weill
Cornell Medicine, United States
(Goel) Depart-ment of Pediatrics, New York Presbyterian Hospital, Weill
Cornell Medicine, United States
Publisher
Blackwell Publishing Inc.
Abstract
Background/Case Studies: Cryoprecipitate (Cryo) is a source of
high-molecular weight plasma proteins, including factor VIII, von
Willebrand factor, factor XIII, fibrinogen and fibronectin. It is produced
from the cold insoluble fraction of FFP. The dose and indications for Cryo
are not well-defined, but today Cryo is largely given to replace
fibrinogen. No randomized controlled trials exist to evaluate its
indications and there is limited information on patterns of Cryo use in
neonates. Study Design/Method: Data was retrospectively collected from
neonates admitted to our NICU and transfused with Cryo from May 2013-May
2017, including clinical scenario, indications, dose, fibrinogen levels
pre-and post-transfusion and other components transfused on the same day
as Cryo. Our institutional recommended Cryo dose in pediatric patients is
1 single, non-pooled unit per 10kg (approximately 1.5mL/kg). AABB
recommends 1-2 units/10kg (with a maximum unit volume of 15mL).
Results/Finding: Twenty-one neonates were transfused 65 doses of Cryo over
4 years. The median age of recipients at first Cryo transfusion was 10
days (range: 0-76 days). Five patients (24%) were transfused
prophylac-tically, and the remainder (76%) were transfused in the setting
of bleeding or surgery. The most common indication for Cryo transfusion
was in the setting of bleeding in open heart surgery with bypass for
repair of congenital heart disease (15/21, 71%). Remaining patients were
transfused in the context of DIC (3/21, 14%), intraoperatively during
exploratory laparotomy (1/21, 5%) and coagulopathy (prolonged PT and aPTT)
not meeting clinical criteria for DIC (1/21, 5%). One patient (1/21, 5%)
with hemophagocytic lymphohistiocytosis and renal failure received 42
doses of Cryo for uremic bleeding over 3 months duration. While Cryo was
often transfused for bleeding, pre-and post-transfusion fibrinogen levels
were assessed in only 9/65 (14%) and 8/65 (12%), respectively.
Viscoelastic testing was not utilized. The median dose of Cryo transfused
was 6.5mL/kg (IQR: 4.6-20.7mL/kg). Excluding the patient receiving 42
doses, the median dose was 10.3mL/kg (IQR: 8.1-15mL/kg). Components
transfused concurrently included platelets (55/65, 85%), RBCs (33/65, 51%)
and plasma (19/65, 29%). No transfusion reactions were reported following
Cryo. Conclusion: The majority of neonatal Cryo transfusions were in the
setting of bleeding or surgery, with the most common being cardiac surgery
and DIC. Pre-or post-transfusion fibrinogen levels were not routinely
assessed. The median Cryo dose administered was higher than our
institutional and AABB guidelines. Further study of Cryo utilization,
dosing and associated outcomes is warranted in neonates, especially in
cardiac surgery cases, to standardize transfusions and dosing decisions.

<53>
Accession Number
624069975
Title
Cryopreserved platelets for surgical bleeding: Protocol for the clip-II
trial based on clip-I pilot data.
Source
Transfusion. Conference: American Association of Blood Banks Annual
Meeting, AABB 2018. United States. 58 (Supplement 2) (pp 8A), 2018. Date
of Publication: October 2018.
Author
Reade M.; Marks D.C.; McQuilten Z.K.; Johnson L.; Wood E.M.
Institution
(Reade) Joint Health Command, Australian Defence Force, Australia
(Reade) Faculty of Medicine, University of Queensland, Australia
(Marks, Johnson) Research and Development, Australian Red Cross Blood
Service, Australia
(McQuilten, Wood) Department of Epidemiology and Preventive Medicine,
Monash University, Australia
Publisher
Blackwell Publishing Inc.
Abstract
Background/Case Studies: Platelets are essential for optimal haemostasis
and to preserve the endothelial glycocalyx in resuscitation from shock.
However, the 5-7 day shelf-life of conventional room-temperature stored
platelets means they are usually not available outside large hospitals.
Cryo-preservation at-80C in dimethylsuphoxide extends shelf-life to 2-4
years, with reconstitution in plasma requiring minimal time, specialised
equipment or training. However, despite encouraging preclinical and phase
I data, only one phase II trial, in which only 24 patients received
cryopreserved platelets, has been published. The CLIP trial program is
seeking to provide sufficient phase III trial data for regulatory
approval. Study Design/Method: Between July 2015 and December 2017 in 4
hospitals, we enrolled cardiac surgical patients at particularly high risk
of periop-erative bleeding (identified using the TRUST criteria (Alghamdi
et al., Transfusion, 2006)) in the CLIP-I pilot trial
(ACTRN12612001261808). Patients were randomised 1:1 to receive either
cryopreserved or liquid-stored platelets if their treating clinicians
decided a platelet transfusion was indicated. Cryopreserved platelets were
prepared by the Australian Red Cross Blood Service using a method based on
that of the Netherlands Military Blood Bank, a modification of the
original protocol described by the US Navy. Results/Finding: In total, 121
patients were randomised, of whom 42 (35%) received a platelet
transfusion. Study groups were well-matched at baseline. There were no
significant differences in any effectiveness outcome, but there was a
trend for the cryopreserved group to require fewer red blood cell units
transfused (median [IQR] 2.5 [1-5] vs. 4 [3-5] units, p=0.18). There was a
trend towards the cryopreserved group having less blood in their chest
drains at 24hr (median [IQR] 712 [540-825] vs. 805 [591-1080]ml, p=0.27).
For the composite outcome defined by the Bleeding Academic Research
Consortium (BARC), there was a trend to superiority in the cryopreserved
platelet group (27.3% vs. 55.6%, p=0.07). There were no clinically
important differences in any measured adverse events. Conclusion: In this
pilot trial, cryopreserved platelets were associated with no evidence of
harm and small non-significant trends to reduced requirement for red cell
transfusion and reduced postoperative blood loss. In the light of this
data and the clear logistic advantages of cryopreservation, a definitive
study with a non-inferiority design testing volume of postoperative
bleeding as the primary outcome is warranted. Improved identification of
patients at high risk for a platelet transfusion using a platelet-specific
transfusion risk prediction score will increase the efficiency of the
phase III trial.

<54>
Accession Number
624073088
Title
Thymectomy for myasthenia gravis.
Source
Journal of Neuromuscular Diseases. Conference: 15th International Congress
on Neuromuscular Diseases, ICNMD 2018. Austria. 5 (Supplement 1) (pp
S38-S39), 2018. Date of Publication: 2018.
Author
Barohn R.J.
Institution
(Barohn) Neurology, University of Kansas Medical Center, Kansas City, KS,
United States
Publisher
IOS Press
Abstract
Thymectomy has a central role in the treatment of MG. In thymomatous MG,
the tumor should be removed. Along with thymoma, the entirety of the
thymus tissue should be removed. Improvement in myasthenic symptoms may or
may not follow. A systematic review of the existing thymectomy literature
emphasized this knowledge gap and recommended the MG field perform a
randomized, controlled trial. (Gronseth and Barohn, 2000) However, owing
to the difficulty of performing controlled trials involving thoracic
surgery in a rare disease, high-quality evidence about thymectomy had been
lacking. A recently completed landmark international, randomized,
rater-blinded clinical trial controlling for medical treatment was
designed to address this uncertainty. One hundred twenty-six recently
diagnosed patients, ages 18 through 65 with AChR antibody-positive
generalized MG were randomized to receive either extended transsternal
thymectomy plus prednisone versus medical management with prednisone. Over
a 3-year follow-up period, the time-weighted average QMG score was lower
in the patients who underwent thymectomy (6.15 vs 8.99; P<.001) Similarly,
the thymectomy group had a lower time-weighted alternate-day prednisone
dose requirement (initially reported at 44 mg vs 60 mg; P<.001), which was
later corrected to 32 mg versus 54 mg (95% confidence interval, 12-32 mg;
P<.001). Also in the thymectomy group, there were fewer patients requiring
additional immunosuppression, fewer adverse events, and fewer admissions
for myasthenic crises. These data provide support for thymectomy as a
first-line treatment modality that can improve MG status and decrease the
required dose and duration of immunotherapy in generalized MG.
(Surprisingly, the effects of the thymectomy could be observed as early as
3 to 4 months and were maintained for the entire 3-year study.) Patients
with persistent bulbar, respiratory, or limb weakness should be treated
with PLEX before surgery. Thymectomy in MuSK, LRP4, and agrin
antibody-positive patients is not supported by current evidence. Patients
with MG with MuSK antibodies were not included in the recent thymectomy
study. Nevertheless, MuSK and "double-negative" antibody patients have
undergone thymectomy and anecdotally have done well. Similarly, there is
limited evidence to support thymectomy in patients with ocular MG,
although if the patient is AChR antibody positive, it may be considered in
refractory cases. The recently completed thymectomy trial mandated a
sternalsplitting procedure. Several new less invasive procedures are now
being used for thymus removal. Video-assisted thoracoscopic surgery and
robotic approaches to thymectomy such as robotic videoassisted
thoracoscopic surgery offer shorter hospital durations of stay and limited
morbidity haveemerged as alternatives to the classic transsternal
approach. There are no trials comparing these surgical techniques,
however, and available reports suggest comparable results.

<55>
Accession Number
624085461
Title
Effects of Peer-Facilitated, Video-Based and Combined Peer-and-Video
Education on Anxiety Among Patients Undergoing Coronary Angiography:
Randomised controlled trial.
Source
Sultan Qaboos University medical journal. 18 (1) (pp e61-e67), 2018. Date
of Publication: 01 Feb 2018.
Author
Habibzadeh H.; Milan Z.D.; Radfar M.; Alilu L.; Cund A.
Institution
(Habibzadeh, Milan, Radfar, Alilu) Department of Nursing, Faculty of
Nursing & Midwifery, Urmia University of Medical Sciences, Urmia, Iran,
Islamic Republic of
(Cund) School of Health, Nursing & Midwifery, University of the West of
Scotland, Paisley, United Kingdom
Abstract
Objectives: Coronary angiography can be stressful for patients and
anxiety-caused physiological responses during the procedure increase the
risk of dysrhythmia, coronary artery spasms and rupture. This study
therefore aimed to investigate the effects of peer, video and combined
peer-and-video training on anxiety among patients undergoing coronary
angiography.
Methods: This single-blinded randomised controlled clinical trial was
conducted at two large educational hospitals in Iran between April and
July 2016. A total of 120 adult patients undergoing coronary angiography
were recruited. Using a block randomisation method, participants were
assigned to one of four groups, with those in the control group receiving
no training and those in the three intervention groups receiving either
peer-facilitated training, video-based training or a combination of both.
A Persian-language validated version of the State-Trait Anxiety Inventory
was used to measure pre- and post-intervention anxiety.
Results: There were no statistically significant differences in mean
pre-intervention anxiety scores between the four groups (F = 0.31; P =
0.81). In contrast, there was a significant reduction in post-intervention
anxiety among all three intervention groups compared to the control group
(F = 27.71; P <0.01); however, there was no significant difference in
anxiety level in terms of the type of intervention used.
Conclusion: Peer, video and combined peer-and-video education were equally
effective in reducing angiography-related patient anxiety. Such techniques
are recommended to reduce anxiety amongst patients undergoing coronary
angiography in hospitals in Iran.

<56>
Accession Number
2001133547
Title
Cardiac Resynchronization Therapy in Inotrope-Dependent Heart Failure
Patients: A Systematic Review and Meta-Analysis.
Source
JACC: Heart Failure. 6 (9) (pp 734-742), 2018. Date of Publication:
September 2018.
Author
Hernandez G.A.; Blumer V.; Arcay L.; Monge J.; Viles-Gonzalez J.F.;
Lindenfeld J.; Goldberger J.J.; Chaparro S.
Institution
(Hernandez, Lindenfeld) Division of Advanced Heart Failure and Transplant
Cardiology, Vanderbilt University Medical Center, Nashville, TN, United
States
(Blumer, Arcay, Monge) Internal Medicine, Department of Medicine, Miller
School of Medicine, University of Miami, Miami, FL, United States
(Viles-Gonzalez) Cardiovascular Division, Department of Medicine, Tulane
University, New Orleans, LA, United States
(Goldberger, Chaparro) Cardiovascular Division, Department of Medicine,
Miller School of Medicine, University of Miami, Miami, FL, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The purpose of this study was to evaluate outcomes after
cardiac resynchronization therapy (CRT) in inotrope-dependent patients
with heart failure (HF) to ascertain the viability of CRT in these
patients. Background: During the last decade, significant numbers of
trials have demonstrated the beneficial effect of CRT in the treatment of
patients with HF and systolic dysfunction, prolonged QRS complex duration,
and New York Heart Association functional class III or IV. However, it is
currently undetermined whether CRT may benefit patients who require
inotropic support. Methods: The authors systematically searched Medline,
Embase, Scopus, and the Cochrane Library through March 2017 for studies
evaluating outcomes after CRT in inotrope-dependent patients with HF. The
study analyzed 8 studies including 151 patients. Most of the patients were
in New York Heart Association functional class IV (80.1%), and all had
severe systolic HF, with a left ventricular ejection fraction <30% and a
significant intraventricular conduction delay in their surface
electrocardiogram (QRS complex duration >130 ms). Results: The pooled
analysis demonstrated that 93% of the reported patients (95% confidence
interval: 86% to 100%) were weaned from inotropic support after CRT, and
the overall 12-month survival rate was 69% (95% confidence interval: 56%
to 83%). Conclusions: This study suggests that rescue CRT may be
considered a viable therapeutic option in inotrope-dependent patients with
HF. In these patients, rescue CRT may allow them to be weaned from
inotropic therapy, improve their quality of life, and decrease the rate of
mortality; furthermore, rescue CRT may serve as a possible bridge to
cardiac transplantation or left ventricular assist device
therapy.<br/>Copyright &#xa9; 2018 American College of Cardiology
Foundation

<57>
[Use Link to view the full text]
Accession Number
624068499
Title
Reduced left ventricular global longitudinal strain predicts prolonged
hospitalization: A cohort analysis of patients having aortic valve
replacement surgery.
Source
Anesthesia and Analgesia. 126 (5) (pp 1484-1493), 2018. Date of
Publication: 01 May 2018.
Author
Sonny A.; Alfirevic A.; Sale S.; Zimmerman N.M.; You J.; Marc Gillinov A.;
Sessler D.I.; Duncan A.E.
Institution
(Sonny, Alfirevic, Sale) Department of Cardiothoracic Anesthesia,
Cleveland Clinic, Cleveland, OH, United States
(Zimmerman, You) Quantitative Health Sciences and Outcomes Research,
Cleveland Clinic, Cleveland, OH, United States
(Marc Gillinov) Thoracic and Cardiovascular Surgery, Cleveland Clinic,
Cleveland, OH, United States
(Sessler) Outcomes Research, Cleveland Clinic, Cleveland, OH, United
States
(Duncan) Cardiothoracic Anesthesia and Outcomes Research, Cleveland
Clinic, Cleveland, OH, United States
(Duncan) Departments of Cardiothoracic Anesthesia and Outcomes Research,
Cleveland Clinic, 9500 Euclid Ave/J4, Cleveland, OH 44195, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Left ventricular ejection fraction (LVEF) is often preserved
in patients with aortic stenosis and thus cannot distinguish between
normal myocardial contractile function and subclinical dysfunction. Global
longitudinal strain and strain rate (SR), which measure myocardial
deformation, are robust indicators of myocardial function and can detect
subtle myocardial dysfunction that is not apparent with conventional
echocardiographic measures. Strain and SR may better predict postoperative
outcomes than LVEF. The primary aim of our investigation was to assess the
association between global longitudinal strain and serious postoperative
outcomes in patients with aortic stenosis having aortic valve replacement.
Secondarily, we also assessed the associations between global longitudinal
SR and LVEF and the outcomes. METHODS: In this post hoc analysis of data
from a randomized clinical trial (NCT01187329), we examined the
association between measures of myocardial function and the following
outcomes: (1) need for postoperative inotropic/vasopressor support; (2)
prolonged hospitalization (>7 days); and (3) postoperative atrial
fibrillation. Standardized transesophageal echocardiographic examinations
were performed after anesthetic induction. Myocardial deformation was
measured using speckle-tracking echocardiography. Multivariable logistic
regression was used to assess associations between measures of myocardial
function and outcomes, adjusted for potential confounding factors. The
predictive ability of global longitudinal strain, SR, and LVEF was
assessed as area under receiver operating characteristics curves (AUCs).
RESULTS: Of 100 patients enrolled in the clinical trial, 86 patients with
aortic stenosis had acceptable images for global longitudinal strain
analysis. Primarily, worse intraoperative global longitudinal strain was
associated with prolonged hospitalization (odds ratio [98.3% confidence
interval], 1.22 [1.01-1.47] per 1% decrease [absolute value] in strain; P
= .012), but not with other outcomes. Secondarily, worse global
longitudinal SR was associated with prolonged hospitalization (odds ratio
[99.7% confidence interval], 1.68 [1.01-2.79] per 0.1 second^-1
decrease [absolute value] in SR; P = .003), but not other outcomes. LVEF
was not associated with any outcomes. Global longitudinal SR was the best
predictor for prolonged hospitalization (AUC, 0.72), followed by global
longitudinal strain (AUC, 0.67) and LVEF (AUC, 0.62). CONCLUSIONS: Global
longitudinal strain and SR are useful predictors of prolonged
hospitalization in patients with aortic stenosis having an aortic valve
replacement. (Anesth Analg 2018;126:1484-93.<br/>Copyright &#xa9; 2017
International Anesthesia Research Society.

<58>
[Use Link to view the full text]
Accession Number
624067435
Title
Hemodynamic and echocardiographic comparison of the lotus and corevalve
transcatheter aortic valves in patients with high and extreme surgical
risk: An analysis from the REPRISE III randomized controlled trial.
Source
Circulation. 137 (24) (pp 2557-2567), 2018. Date of Publication: 12 Jun
2018.
Author
Asch F.M.; Vannan M.A.; Singh S.; Khandheria B.; Little S.H.; Allocco
D.J.; Meredith I.T.; Feldman T.E.; Reardon M.J.; Weissman N.J.
Institution
(Asch, Weissman) MedStar Health Research Institute, MedStar Washington
Hospital Center, 100 Irving St, NW, Suite EB 5123, Washington, DC 20010,
United States
(Vannan) Piedmont Marcus Heart Valve Center, Piedmont Heart Institute,
Atlanta, GA, United States
(Singh) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Khandheria) Aurora St. Luke's Medical Center, Milwaukee, WI, United
States
(Little, Reardon) Houston Methodist DeBakey Heart and Vascular Center, TX,
United States
(Allocco, Meredith) Boston Scientific Corporation, Marlborough, MA, United
States
(Feldman) Evanston Hospital Cardiology Division, Northshore University
Health System, IL, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Comparative echocardiographic data on transcatheter aortic
valve replacement systems from randomized trials are limited. The REPRISE
III trial (Repositionable Percutaneous Replacement of Stenotic Aortic
Valve through Implantation of Lotus Valve System - Randomized Clinical
Evaluation) is a multicenter, randomized comparison of a mechanically
expanded (Lotus) versus self-expanding (CoreValve) transcatheter aortic
valve replacement device. This analysis rigorously assesses
Doppler-derived valve hemodynamics and the impact on outcomes at 1 year in
patients with extreme/high surgical risk treated with Lotus and CoreValve
from REPRISE III. Methods: REPRISE III includes patients with extreme- and
high-risk aortic stenosis. Patients were enrolled at 55 centers. All
transthoracic echocardiograms with Doppler were obtained following a
standard protocol up to 12 months postimplant and analyzed by a core
laboratory. Valve size, mean gradient, aortic valve area, and Doppler
velocity index and their impact on clinical outcomes are reported.
Additional parameters including paravalvular leak were evaluated using a
multiparametric approach. Results: A total of 912 patients were randomly
assigned (2:1 ratio; 607 Lotus:305 CoreValve). Median age was 84 years,
51% of the patients were women, and the Society of Thoracic Surgeons score
was 6.8+/-4.1. CoreValve demonstrated lower gradients and larger aortic
valve area and Doppler velocity index than Lotus at discharge; the
difference decreased in subsequent follow-up up to a year (all P<0.01).
Lotus had lower rates of paravalvular leak that persisted over time
(P<0.05). Similar outcomes were seen when comparing each valve type by
size group (small, medium, large). The hemodynamic differences between
valves did not translate into worse clinical outcomes. All-cause mortality
was not different between the 2 groups in any of the 3 valve sizes. When
comparing patients with normal valve gradients (<20 mm Hg, n=780) with
those with abnormal gradients (>20 mm Hg, n=48) in the entire patient
population, all-cause mortality was not different. This was also not
significant when evaluating each valve type separately. Similarly, there
were no differences for aortic valve area >1.1 cm² or <1.1
cm² and for Doppler velocity index >0.35 or <0.35 (all P=not
significant). Conclusions: Lotus had significantly greater freedom from
moderate or severe paravalvular leak and smaller valve area and higher
gradients than CoreValve. The hemodynamic differences were not associated
with any clinical differences in the composite end point of mortality,
disabling stroke, and moderate paravalvular leak or with quality of life
at 1 year of follow-up. Clinical Trial Registration: URL:
https://www.clinicaltrials.gov. Unique identifier:
NCT02202434.<br/>Copyright &#xa9;2018 American Heart Association, Inc.

<59>
[Use Link to view the full text]
Accession Number
624066407
Title
Effect of losartan on right ventricular dysfunction: Results from the
Double-Blind, Randomized REDEFINE Trial (Right Ventricular Dysfunction in
Tetralogy of Fallot: Inhibition of the Renin-Angiotensin-Aldosterone
System) in Adults with Repaired Tetralogy of Fallot.
Source
Circulation. 137 (14) (pp 1463-1471), 2018. Date of Publication: 03 Apr
2018.
Author
Bokma J.P.; Winter M.M.; Van Dijk A.P.; Vliegen H.W.; Van Melle J.P.;
Meijboom F.J.; Post M.C.; Berbee J.K.; Boekholdt S.M.; Groenink M.;
Zwinderman A.H.; Mulder B.J.M.; Bouma B.J.
Institution
(Bokma, Winter, Boekholdt, Groenink, Mulder, Bouma) Department of
Cardiology, Academic Medical Center Amsterdam, Rm B2-256, Meibergdreef 9,
Amsterdam 1105 AZ, United States
(Bokma, Mulder, Bouma) Netherlands Heart Institute, Utrecht, Netherlands
(Van Dijk) Department of Cardiology, Radboud University Medical Center,
Nijmegen, Netherlands
(Vliegen) Department of Cardiology, Leiden University Medical Center,
Netherlands
(Van Melle) Department of Cardiology, Groningen University Medical Center,
Netherlands
(Meijboom) Department of Cardiology, Utrecht University Medical Center,
Netherlands
(Post) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Berbee) Department of Hospital Pharmacy, Academic Medical Center
Amsterdam, Netherlands
(Zwinderman) Department of Clinical Epidemiology and Biostatistics,
Academic Medical Center Amsterdam, Netherlands
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The effect of angiotensin II receptor blockers on right
ventricular (RV) function is still unknown. Angiotensin II receptor
blockers are beneficial in patients with acquired left ventricular
dysfunction, and recent findings have suggested a favorable effect in
symptomatic patients with systemic RV dysfunction. The current study aimed
to determine the effect of losartan, an angiotensin II receptor blocker,
on subpulmonary RV dysfunction in adults after repaired tetralogy of
Fallot. Methods: The REDEFINE trial (Right Ventricular Dysfunction in
Tetralogy of Fallot: Inhibition of the Renin-Angiotensin-Aldosterone
System) is an investigator-initiated, multicenter, prospective, 1:1
randomized, double-blind, placebo-controlled study. Adults with repaired
tetralogy of Fallot and RV dysfunction (RV ejection fraction [EF] <50%)
but without severe valvular dysfunction were eligible. Patients were
randomly assigned between losartan (150 mg daily) and placebo with target
treatment duration between 18 and 24 months. The primary outcome was RV EF
change, determined by cardiovascular MRI in intention-to-treat analysis.
Results: Of 95 included patients, 47 patients received 150 mg losartan
daily (age, 38.0+/-12.4 years; 74% male), and 48 patients received placebo
(age, 40.6+/-11.4 years; 63% male). Overall, RV EF did not change in
patients allocated to losartan (n=42) (44.4+/-5.1% to 45.2+/-5.0%) and
placebo (n=46) (43.2+/-6.3% to 43.6+/-6.9%). Losartan did not
significantly improve RV EF in comparison with placebo (+0.51%; 95%
confidence interval, -1.0 to +2.0; P=0.50). No significant treatment
effects were found on secondary outcomes: left ventricular EF, peak
aerobic exercise capacity, and N-terminal pro-brain natriuretic peptide
(P>0.30 for all). In predefined subgroup analyses, losartan did not have a
statistically significant impact on RV EF in subgroups with symptoms,
restrictive RV, RV EF<40%, pulmonary valve replacement, or QRS
fragmentation. However, in a post hoc analysis, losartan was associated
with improved RV EF in a subgroup (n=30) with nonrestrictive RV and
incomplete remodeling (QRS fragmentation and previous pulmonary valve
replacement) (+2.7%; 95% confidence interval, +0.1 to +5.4; P=0.045).
Conclusions: Losartan had no significant effect on RV dysfunction or
secondary outcome parameters in repaired tetralogy of Fallot. Future
larger studies may determine whether there might be a role for losartan in
specific vulnerable subgroups. Clinical Trial Registration: URL:
https://www.clinicaltrials.gov. Unique identifier:
NCT02010905.<br/>Copyright &#xa9; 2017 American Heart Association, Inc.

<60>
Accession Number
624066358
Title
Impact of the MitraClip Procedure on Left Atrial Strain and Strain Rate.
Source
Circulation: Cardiovascular Imaging. 11 (3) (no pagination), 2018. Article
Number: 006553. Date of Publication: 01 Mar 2018.
Author
Ipek E.G.; Singh S.; Viloria E.; Feldman T.; Grayburn P.; Foster E.; Qasim
A.
Institution
(Ipek, Singh, Viloria, Foster, Qasim) Department of Cardiology, University
of California San Francisco Medical Center, 720 W Oak St, 505 Parnassus
Avenue, San Francisco, CA 94143, United States
(Feldman) Department of Cardiology, Evanston Hospital, IL, United States
(Grayburn) Department of Cardiology, Baylor Heart and Vascular Institute,
Dallas, TX, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Although reverse remodeling of the left atrium (LA) has been
shown after MitraClip placement in degenerative mitral regurgitation (MR),
changes in LA strain and strain rate have not been evaluated in these
patients or compared with surgical mitral valve repair. Methods and
Results - We included 87 subjects (mean age 59.7+/-12.3 years) with
degenerative MR enrolled in the randomized EVEREST II trial (Endovascular
Valve Edge-to-Edge Repair Study II). Baseline peak positive LA strain ()
and strain rates along with longitudinal left ventricular strain (LV )
were compared with 12-month follow-up measures. At 12 months, all 38
mitral valve repair subjects had <=2+ MR, and 31 of the 49 MitraClip had
<=2+ MR. Baseline LA strain and strain rate values were similar in
MitraClip and mitral valve repair groups. Of the strain rate measures,
only peak early diastolic strain rate was consistently decreased in all
treatment arms. In patients with reduced baseline LA , no significant
change in LA occurred in either the MitraClip or mitral valve repair
group despite significant MR and LA volume reduction. However, in patients
with normal or high baseline , successful MR reduction by either method
resulted in return of LA to normative values. There was a significant
correlation between LA , LV values, and change in LA and LV over time.
Conclusions - Changes seen in LA seem to depend on baseline LA and LV
function. Changes in LA after MR reduction may reflect a decrease in LA
expansion but may also be influenced by the degree of pre-existing LA
dysfunction.<br/>Copyright &#xa9; 2018 American Heart Association, Inc.

<61>
Accession Number
624058326
Title
Perioperative statin therapy in cardiac and non-cardiac surgery: a
systematic review and meta-analysis of randomized controlled trials.
Source
Annals of Intensive Care. 8 (1) (no pagination), 2018. Article Number: 95.
Date of Publication: 01 Dec 2018.
Author
Putzu A.; de Carvalho e Silva C.M.P.D.; de Almeida J.P.; Belletti A.;
Cassina T.; Landoni G.; Hajjar L.A.
Institution
(Putzu) Division of Anesthesiology, Department of Anesthesiology,
Pharmacology and Intensive Care Medicine, Geneva University Hospitals,
Geneva, Switzerland
(de Carvalho e Silva, de Almeida) Division of Anesthesia and Intensive
Care, InCor, Instituto do Cancer, Universidade de Sao Paulo, Sao Paulo,
Brazil
(Belletti, Landoni) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Cassina) Department of Cardiovascular Anesthesia and Intensive Care,
Cardiocentro Ticino, Lugano, Switzerland
(Landoni) Vita-Salute San Raffaele University, Milan, Italy
(Hajjar) Department of Cardiopneumology, InCor, Universidade de Sao Paulo,
Sao Paulo, Brazil
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Background: The effects of perioperative statin therapy on clinical
outcome after cardiac or non-cardiac surgery are controversial. We aimed
to assess the association between perioperative statin therapy and
postoperative outcome. Methods: Electronic databases were searched up to
May 1, 2018, for randomized controlled trials of perioperative statin
therapy versus placebo or no treatment in adult cardiac or non-cardiac
surgery. Postoperative outcomes were: myocardial infarction, stroke, acute
kidney injury (AKI), and mortality. We calculated risk ratio (RR) or odds
ratio (OR) and 95% confidence interval (CI) using fixed-effects
meta-analyses. We performed meta-regression and subgroup analyses to
assess the possible influence of statin therapy regimen on clinical
outcomes and trial sequential analysis to evaluate the risk of random
errors and futility. Results: We included data from 35 RCTs involving 8200
patients. Perioperative statin therapy was associated with lower incidence
of postoperative myocardial infarction in non-cardiac surgery (OR = 0.44
[95% CI 0.30-0.64], p < 0.0001), but not in cardiac surgery (OR = 0.93
[95% CI 0.70-1.24], p = 0.61) (p<inf>subgroup</inf> = 0.002). Higher
incidence of AKI was present in cardiac surgery patients receiving
perioperative statins (RR = 1.15 [95% CI 1.00-1.31], p = 0.05),
nonetheless not in non-cardiac surgery (RR = 1.52 [95% CI 0.71-3.26], p =
0.28) (p<inf>subgroup</inf> = 0.47). No difference in postoperative stroke
and mortality was present in either cardiac or non-cardiac surgery.
However, low risk of bias trials performed in cardiac surgery showed a
higher mortality with statins versus placebo (OR = 3.71 [95% CI
1.03-13.34], p = 0.04). Subgroup and meta-regression analyses failed to
find possible relationships between length of statin regimens and clinical
outcomes. Trial sequential analysis suggested no firm conclusions on the
topic. Conclusions: Perioperative statins appear to be protective against
postoperative myocardial infarction in non-cardiac surgery and associated
with higher AKI in cardiac surgery. Possible positive or even negative
effects on mortality could not be excluded and merits further
investigations. Currently, no randomized evidence supports the systematic
administration of statins in surgical patients.<br/>Copyright &#xa9; 2018,
The Author(s).

<62>
Accession Number
2001129963
Title
Evaluating the use of dexmedetomidine for the reduction of delirium: An
integrative review.
Source
Heart and Lung. (no pagination), 2018. Date of Publication: 2018.
Author
Pavone K.J.; Cacchione P.Z.; Polomano R.C.; Winner L.; Compton P.
Institution
(Pavone, Cacchione, Polomano, Winner, Compton) University of Pennsylvania,
School of Nursing, 418 Curie Blvd, PhiladelphiaP 19104 A, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Delirium, an acute change in cognition and attention not secondary to a
pre-existing condition or dementia, affects nearly 40,000 hospitalized
older adults in the United States every day. Delirium is associated with
increased healthcare costs of $16,303 to $64,421 per patient. To date, no
single pharmacological intervention is effective in preventing or treating
delirium in critically ill patients. Evidence suggests the alpha-2
agonist, dexmedetomidine, may reduce or prevent delirium. An integrative
review examined whether dexmedetomidine was associated with a lower
incidence of delirium compared to other analgesic and sedation strategies.
PRISMA (Preferred Reporting Items for Systematic Reviews and
Meta-Analyses) guided this review and 16 publications met quality criteria
for inclusion. These studies support that postoperative administration of
dexmedetomidine may reduce delirium in patients, particularly following
cardiac surgery. Further research is needed to determine the benefits of
dexmedetomidine in patients on mechanical ventilation and optimal timing
and duration of administration.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<63>
Accession Number
624061876
Title
Total artificial heart implantation as a bridge to transplantation: a
viable model for the future?.
Source
Expert Review of Medical Devices. (no pagination), 2018. Date of
Publication: 2018.
Author
Beaupre R.A.; Frazier O.H.; Morgan J.A.
Institution
(Beaupre) Department of Thoracic Surgery, University of Cincinnati Medical
Center, Cincinnati, OH, United States
(Frazier) Center for Cardiac Support, Texas Heart Institute, Houston, TX,
United States
(Morgan) Division of Mechanical Circulatory Support and Cardiac
Transplantation, Baylor College of Medicine, Houston, TX, United States
(Morgan) Department of Cardiothoracic Surgery, Texas Heart Institute,
Houston, TX, United States
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Since the first total artificial heart (TAH) surgery in a
human patient performed in 1969, over 1300 devices have been implanted
worldwide. Patients are benefiting from increased lengths of durable
support and indications have expanded beyond biventricular failure
including allograft failure, severe restrictive disease, and complex
congenital anomalies. Areas covered: The role of the TAH in biventricular
failure, rates of successful bridge-to-transplant (BTT), and survival
compared with biventricular assist devices (BiVADs) are discussed and
differences between TAH and LVAD patient populations are highlighted. The
device's niche role in physiologies not amenable to single ventricle
support is further described. New developments such as the 50cc Syncardia,
continuous flow mechanisms (BiVACOR and Cleveland Clinic CF-TAH), and a
bioprosthetic model (CARMAT) are discussed. Literature review was
conducted utilizing the PubMed database selecting published research,
database analyses, and case reports under 'total artificial heart'
relevant to the paper's aims. Expert commentary: TAH patients have high
rates of successful BTT and survival on par with BiVAD-supported patients.
Ongoing developments including decreased device size, continuous flow
mechanisms, and use of bioprosthetic materials will ensure that the TAH
will have an increasing role in advanced heart failure with increased
device longevity and decreased post-implant complications.<br/>Copyright
&#xa9; 2018, &#xa9; 2018 Informa UK Limited, trading as Taylor & Francis
Group.

<64>
Accession Number
624061380
Title
Efficacy of dexmedetomidine in prevention of junctional ectopic
tachycardia and acute kidney injury after pediatric cardiac surgery: A
meta-analysis.
Source
Congenital Heart Disease. (no pagination), 2018. Date of Publication:
2018.
Author
Li X.; Zhang C.; Dai D.; Liu H.; Ge S.
Institution
(Li, Zhang, Dai, Liu, Ge) Department of Cardiovascular Surgery, The First
Affiliated Hospital of Anhui Medical University, Hefei, China
Publisher
Blackwell Publishing Ltd
Abstract
Objective: We conducted a meta-analysis to evaluate the effects of
prophylactic perioperative dexmedetomidine administration on postoperative
junctional ectopic tachycardia (JET) and acute kidney injury (AKI) in
pediatric patients having undergone cardiac surgery. Design: This
systematic review was registered with PROSPERO (CRD42017083880). Databases
including PubMed, Cochrane Central Register of Controlled Trials, and Web
of Science were searched for randomized controlled trials (RCTs) and
observational cohort studies from its inception to March 2018. Two
reviewers independently screened literature, extracted data, and assessed
the quality of included studies using the Jadad scale and Newcastle-Ottawa
score. Meta-analysis was then conducted by RevMan 5.3 and Stata 12.0
software. Pvalue <.05 was considered significant. Results: A total of nine
eligible studies (5 RCTs and 4 observational studies) comprising 1851
patients were selected for the final analysis. The results of
meta-analysis showed that dexmedetomidine significantly reduced the
incidence of postoperative JET (OR =0.35, 95% CI: 0.22 to 0.53, P
<.00001), but there was no significant difference between groups in AKI
(OR =0.44, 95% CI: 0.19 to 1.04, P =.06) and all-cause mortality (OR
=0.87, 95% CI: 0.35 to 2.14, P =.77). Conclusions: The administration of
perioperative dexmedetomidine effectively prevents JET in pediatric
patients undergoing cardiac surgery but has no significant effect on
postoperative renal function. However, the quality of evidence for these
findings is low; thus, future larger scale randomized studies are needed
to verify the real clinical effects of dexmedetomidine prophylaxis in
pediatric patients.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<65>
Accession Number
624056769
Title
Amiodarone plus Ranolazine for Conversion of Post-Cardiac Surgery Atrial
Fibrillation: Enhanced Effectiveness in Reduced Versus Preserved Ejection
Fraction Patients.
Source
Cardiovascular Drugs and Therapy. (no pagination), 2018. Date of
Publication: 2018.
Author
Simopoulos V.; Hevas A.; Hatziefthimiou A.; Dipla K.; Skoularigis I.;
Tsilimingas N.; Aidonidis I.
Institution
(Simopoulos, Hevas, Tsilimingas) Department of Thoracic & Cardiovascular
Surgery, University Hospital of Larissa, Larissa, Greece
(Hatziefthimiou, Aidonidis) Department of Physiology, School of Medicine,
University of Thessaly, Larissa Medical School, Larissa 41500, Greece
(Dipla) Department of Physical Education and Sports Science at Serres,
Aristotle University of Thessaloniki, Thessaloniki, Greece
(Skoularigis) Department of Cardiology, University General Hospital of
Larissa, Larissa, Greece
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Ranolazine (RAN) added to amiodarone (AMIO) has been shown to
accelerate termination of postoperative atrial fibrillation (POAF)
following coronary artery bypass surgery in patients without heart failure
(HF). This study aimed to investigate if treatment efficacy with AMIO or
AMIO + RAN differs between patients with concomitant HF with reduced or
preserved ejection fraction (HFrEF or HFpEF). Methods: Patients with POAF
and HFrEF (n = 511, 446 males; 65 +/- 9 years) and with HFpEF (n = 301,
257 males; 66 +/- 10 years) were enrolled. Onset of AF occurred 2.15 +/-
1.0 days after cardiac surgery, and patients within each group were
randomly assigned to receive either AMIO monotherapy (300 mg in 30 min +
1125 mg in 36 h iv) or AMIO+RAN combination (500 mg po + 375 mg, after 6 h
and 375 mg twice daily thereafter). Primary endpoint was the time to
conversion of POAF within 36 h after initiation of treatment. Results:
AMIO restored sinus rhythm earlier in HFrEF vs. in HFpEF patients (24.3
+/- 4.6 vs. 26.8 +/- 2.8 h, p < 0.0001). AMIO + RAN converted POAF faster
than AMIO alone in both HFrEF and HFpEF groups, with conversion times 10.4
+/- 4.5 h in HFrEF and 12.2 +/- 1.1 h in HFpEF patients (p < 0.0001). Left
atrial diameter was significantly greater in HFrEF vs. HFpEF patients
(48.2 +/- 2.6 vs. 35.2 +/- 2.9 mm, p < 0.0001). No serious adverse drug
effects were observed during AF or after restoration to sinus rhythm in
any of the patients enrolled. Conclusion: AMIO alone or in combination
with RAN converted POAF faster in patients with reduced EF than in those
with preserved EF. Thus, AMIO + RAN seems to be a valuable alternative
treatment for terminating POAF in HFrEF patients.<br/>Copyright &#xa9;
2018, Springer Science+Business Media, LLC, part of Springer Nature.

<66>
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): A Systematic Review and
Meta-Analysis.
Source
Medical Care. (no pagination), 2018. Date of Publication: 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, 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.

<67>
Accession Number
624045517
Title
Timing of Loading Dose of Atorvastatin in Patients Undergoing Percutaneous
Coronary Intervention for Acute Coronary Syndromes: Insights from the
SECURE-PCI Randomized Clinical Trial.
Source
JAMA Cardiology. (no pagination), 2018. Date of Publication: 2018.
Author
Lopes R.D.; De Barros E Silva P.G.M.; De Andrade Jesuino I.; Santucci
E.V.; Barbosa L.M.; Damiani L.P.; Nakagawa Santos R.H.; Laranjeira L.N.;
Dall Orto F.T.C.; Beraldo De Andrade P.; De Castro Bienert I.R.; Alexander
J.H.; Granger C.B.; Berwanger O.
Institution
(Lopes, De Barros E Silva, Barbosa) Brazilian Clinical Research Institute,
Sao Paulo, Brazil
(Lopes, Alexander, Granger) Duke Clinical Research Institute, Durham, NC,
United States
(De Barros E Silva, De Andrade Jesuino, Santucci, Damiani, Nakagawa
Santos, Laranjeira, Berwanger) Research Institute-Heart Hospital, Sao
Paulo, Brazil
(Dall Orto) Hospital Do Coracao de Pocos de Caldas, Pocos de Caldas,
Brazil
(Beraldo De Andrade) Santa Casa de Marilia, Marilia, Brazil
(De Castro Bienert) Hospital das Clinicas da Faculdade de Medicina de
Marilia, Marilia, Brazil
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Loading doses of atorvastatin did not show reduction on
clinical outcomes in the overall population of patients with acute
coronary syndrome (ACS) enrolled in the Statins Evaluation in Coronary
Procedures and Revascularization (SECURE-PCI) trial, but a potential
benefit was identified in patients who subsequently underwent percutaneous
coronary intervention (PCI). Objectives: To determine whether
periprocedural loading doses of atorvastatin are associated with decreased
30-day major adverse cardiovascular events (MACE) in patients with ACS
undergoing PCI according to type of ACS and timing of atorvastatin
administration before PCI. Design, Setting, and Participants: Secondary
analysis of a multicenter, double-blind, placebo-controlled, randomized
clinical trial conducted at 53 sites that enrolled 4191 patients with ACS
intended to be treated with PCI between April 18, 2012, and October 06,
2017. Interventions: Patients were randomized to 2 loading doses of 80 mg
of atorvastatin or matching placebo before and 24 hours after a planned
PCI. By protocol, all patients (regardless of treatment group) received 40
mg of atorvastatin for 30 days starting 24 hours after the second dose of
study medication. Main Outcomes and Measures: The primary outcome was MACE
through 30 days, composed by all-cause mortality, myocardial infarction,
stroke, and unplanned coronary revascularization. Cox regression models
adjusting for key baseline characteristics were used to assess the
association between atorvastatin and MACE in patients undergoing PCI.
Results: From the overall trial population, 2710 (64.7%) underwent PCI
(650 women [24.0%]; mean [SD] age, 62 [11.3] years). Loading atorvastatin
was associated with reduced MACE at 30 days by 28% in the PCI group
(adjusted hazard ratio [HR], 0.72; 95% CI 0.54-0.97; P =.03). Loading dose
of atorvastatin was administered less than 12 hours before PCI in 2548
patients (95.3%) (45.1% < 2 hours and 54.3% between 2 and 12 hours). There
was no significant interaction between treatment effect and timing of
study drug administration. The treatment effect of loading atorvastatin
was more pronounced in patients with ST-segment elevation myocardial
infarction than in patients with non-ST-segment elevation ACS (adjusted
HR, 0.59; 95% CI, 0.38-0.92; P =.02; HR, 0.85; 95% CI, 0.58-1.27; P =.43,
respectively). Conclusions and Relevance: In patients with ACS undergoing
PCI, periprocedural loading doses of atorvastatin appeared to reduce the
rate of MACE at 30 days, primarily in patients with ST-segment elevation
myocardial infarction. This beneficial effect seemed to be preserved and
consistent, regardless of timing of atorvastatin administration, including
within 2 hours before PCI. Trial Registration: clinicaltrials.gov
Identifier: NCT01448642.<br/>Copyright &#xa9; 2018 American Medical
Association. All rights reserved.

<68>
Accession Number
621431082
Title
Evaluation of potential antiplatelet effects of CSL112 (Apolipoprotein A-I
[Human]) in patients with atherosclerosis: results from a phase 2a study.
Source
Journal of Thrombosis and Thrombolysis. 45 (4) (pp 469-476), 2018. Date of
Publication: 01 May 2018.
Author
Gurbel P.A.; Tantry U.S.; D'Andrea D.; Chung T.; Alexander J.H.; Bliden
K.P.; Wright S.D.; Tricoci P.
Institution
(Gurbel, Tantry, Bliden) Inova Center for Thrombosis Research and Drug
Development, Inova Heart and Vascular Institute, 3300 Gallows Rd, Falls
Church, VA 22042, United States
(D'Andrea, Chung, Wright) CSL Behring, King of Prussia, PA, United States
(Alexander, Tricoci) Duke Clinical Research Institute, Durham, NC, United
States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
CSL112 (Apolipoprotein A-I [Human]), an infusible, plasma-derived
apolipoprotein A-I, is being developed to reduce cardiovascular events
following acute myocardial infarction (AMI). A predecessor compound
(CSL111) demonstrated a potential antiplatelet effect. A phase 2a
multicentre, randomised, single-ascending dose study in patients with
stable atherosclerotic disease receiving dual antiplatelet therapy (DAPT)
assessed the potential additive effects of CSL112 administration on
platelet function and increase bleeding risk in the subacute period after
AMI. Patients (n = 44) on aspirin (75-325 mg/day) and either clopidogrel
(75 mg/day, n = 37) or prasugrel (10 mg/day, n = 7) for > 30 days
alongside standard-of-care therapy were randomised to a single dose of
placebo or CSL112: 1.7, 3.4, or 6.8 g. Light transmission aggregometry was
used to assess platelet aggregation in response to 2 mM arachidonic acid,
5 and 20 micro&#32;M adenosine diphosphate, and 4 micro&#32;g/mL collagen,
pre-dose (baseline) and up to 48 h post-dosing. Compared to placebo,
CSL112 had no clinically meaningful time- or dose-dependent effects on
maximum platelet aggregation in response to any agonist, by either dose or
renal function subgroup (p > 0.05). Coagulation parameters showed little
variation over time or between treatment groups (p > 0.05). CSL112, when
co-administered with standard DAPT, did not significantly influence
platelet aggregation in response to agonists and is, therefore, not
expected to significantly increase bleeding risk when administered with
antiplatelet therapies.<br/>Copyright &#xa9; 2018, The Author(s).

<69>
Accession Number
617605577
Title
Dexmedetomidine as a promising prevention strategy for cardiac
surgery-associated acute kidney injury: A meta-analysis.
Source
Critical Care. 21 (1) (no pagination), 2017. Article Number: 198. Date of
Publication: 03 Aug 2017.
Author
Shi R.; Tie H.-T.
Institution
(Shi) The First Affiliated Hospital of Chongqing Medical University,
Department of Cardiology, Chongqing 400016, China
(Tie) The First Affiliated Hospital of Chongqing Medical University,
Department of Cardiothoracic Surgery, Chongqing 400016, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)

<70>
Accession Number
612793078
Title
Microcirculation measured by vascular occlusion test during
desflurane-remifentanil anesthesia is superior to that in
propofol-remifentanil anesthesia in patients undergoing thoracic surgery:
subgroup analysis of a prospective randomized study.
Source
Journal of Clinical Monitoring and Computing. 31 (5) (pp 989-997), 2017.
Date of Publication: 01 Oct 2017.
Author
Cho Y.J.; Bae J.; Kim T.K.; Hong D.M.; Seo J.-H.; Bahk J.-H.; Jeon Y.
Institution
(Cho, Bae, Kim, Hong, Seo, Bahk, Jeon) Department of Anesthesiology and
Pain Medicine, Seoul National University Hospital, 101 Daehak-ro,
Jongno-gu, Seoul 03080, South Korea
Publisher
Springer Netherlands (E-mail: rbk@louisiana.edu)
Abstract
General anesthesia can affect microcirculatory properties. However,
differential effects on the microcirculation according to the anesthetic
technique used during thoracoscopic surgery have not been well documented.
We conducted a randomized clinical trial in which the effects of
desflurane and propofol, both with remifentanil, on systemic arterial
oxygenation during one-lung ventilation were compared in patients
undergoing thoracoscopic surgery. As a subgroup analysis, we compared the
effects of two commonly used anesthetic techniques,
desflurane-remifentanil (n = 52) and propofol-remifentanil (n = 48), on
tissue oxygen saturation using a vascular occlusion test in patients
undergoing thoracoscopic surgery. Tissue oxygen saturation was higher in
the desflurane than the propofol group (mean +/- standard deviation, 83
+/- 6 vs. 80 +/- 9, 84 +/- 6 vs. 76 +/- 10, and 87 +/- 7 vs. 77 +/- 10 %
at 30 and 60 min of one-lung ventilation and at two-lung ventilation;
adjusted p = 0.026, <0.001, and <0.001, respectively). The recovery slope
during the vascular occlusion test, reflecting microvascular reperfusion
adequacy, was higher in the desflurane than the propofol group during
surgery (mean difference, 0.5 %/s; 95 % CI 0.0-0.9 %/s; p = 0.037).
Desflurane-remifentanil anesthesia is associated with better
microcirculation than propofol-remifentanil anesthesia in patients
undergoing thoracoscopic surgery.<br/>Copyright &#xa9; 2016, Springer
Science+Business Media Dordrecht.

<71>
Accession Number
611533009
Title
Central venous catheter tip migration due to tracheal extubation: a
prospective randomized study.
Source
Journal of Clinical Monitoring and Computing. 31 (5) (pp 951-959), 2017.
Date of Publication: 01 Oct 2017.
Author
Struck M.F.; Junemann T.; Reinhart K.; Schummer W.
Institution
(Struck) Department of Anaesthesiology and Intensive Care Medicine,
University Hospital Leipzig, Liebigstr. 20, Leipzig 04103, Germany
(Junemann) Department of Anaesthesiology and Intensive Care Medicine, SRH
Wald-Klinikum Gera, Strase des Friedens 122, Gera 07548, Germany
(Reinhart, Schummer) Department of Anaesthesiology and Intensive Care
Medicine, University Hospital Jena, Erlanger Allee 101, Jena 07747,
Germany
Publisher
Springer Netherlands (E-mail: rbk@louisiana.edu)
Abstract
Considerable numbers of patients undergo central venous catheterization
(CVC) under mechanical ventilation. We hypothesized that the return of
spontaneous breathing and tracheal extubation could be associated with
distal CVC tip migration towards intracardiac positions due to decreasing
intrathoracic pressures and subsequent readjustment of mediastinal organs.
Patients scheduled for cardiac surgery were randomized for right or left
internal jugular vein (IJV) CVC placement under general anesthesia and
mechanical ventilation. CVC tips were positioned at the cavoatrial
junction and measured at the time of placement, postoperatively under
mechanical ventilation, and after tracheal extubation until 48 h after
surgery. Measurement methods included intravascular electrocardiography
(ECG) P-wave amplitude, transesophageal echocardiography, and chest
radiography (CXR). Out of 70 patients, 60 were eligible for final
statistical analysis (31 right and 29 left IJV CVC). According to ECG
interpretation, CVC tip positions remained below the pericardiac
reflection point in the distal superior vena cava over the course of the
three measurement intervals. The ECG revealed significant proximal
migration of CVC tips from the time of placement to the time of tracheal
extubation (1.19 +/- 0.55 vs. 0.62 +/- 0.31 mV; P < 0.001). A CXR using
CVC tip to carina distances revealed no significant tip migrations in the
time between postoperative assessment and following tracheal extubation
(5.1 +/- 1.7 vs. 5.3 +/- 1.5 cm; P = 0.196). In patients with CVCs
positioned at the cavoatrial junction, tracheal extubation was not
associated with significant postoperative CVC tip malposition, but tended
to undergo proximal migration. This trend should be considered
particularly in left-sided thoracocervical puncture approaches to avoid
unfavorable CVC tip positions.<br/>Copyright &#xa9; 2016, Springer
Science+Business Media Dordrecht.

<72>
Accession Number
2001110854
Title
Intraoperative hypotension is not associated with postoperative cognitive
dysfunction in elderly patients undergoing general anesthesia for surgery:
results of a randomized controlled pilot trial.
Source
Journal of Clinical Anesthesia. 52 (pp 111-118), 2019. Date of
Publication: February 2019.
Author
Langer T.; Santini A.; Zadek F.; Chiodi M.; Pugni P.; Cordolcini V.;
Bonanomi B.; Rosini F.; Marcucci M.; Valenza F.; Marenghi C.; Inglese S.;
Pesenti A.; Gattinoni L.
Institution
(Langer, Zadek, Chiodi, Pugni, Cordolcini, Valenza, Pesenti, Gattinoni)
Department of Pathophysiology and Transplantation, University of Milan,
Milan, Italy
(Langer, Santini, Valenza, Marenghi, Pesenti, Gattinoni) Department of
Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda
Ospedale Maggiore Policlinico, Milan, Italy
(Bonanomi, Rosini, Marcucci, Inglese) Geriatric Unit, Department of
Medical Sciences and Community Health, University of Milan, Italy
(Marcucci) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada
(Rosini, Marcucci, Inglese) Fondazione IRCCS Ca' Granda Ospedale Maggiore
Policlinico, Milan, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: To assess the effect of different intraoperative blood
pressure targets on the development of POCD and test the feasibility of a
larger trial. Design: Randomized controlled pilot trial. Setting:
Perioperative care in a tertiary care teaching hospital with outpatient
follow-up. Patients: One hundred one patients aged >=75 years with ASA
physical status <4, undergoing elective, non-cardiac surgery under general
anesthesia and 33 age-matched healthy controls. Interventions:
Randomization to a personalized intraoperative blood pressure target, mean
arterial pressure (MAP) >= 90% of preoperative values (Target group), or
to a more liberal intraoperative blood pressure management (No-Target
group). Strategies to reach intraoperative blood pressure target were at
discretion of anesthesiologists. Measurements: An experienced
neuropsychologist performed a validated battery of neurocognitive tests
preoperatively and 3 months after surgery. Incidence of POCD at three
months and postoperative delirium were assessed. Intraoperative time spent
with MAP >= 90% of preoperative values, recruitment and drop-out rate at 3
months were feasibility outcomes. Main results: The Target group spent a
higher percentage of intraoperative time with MAP >=90% of preoperative
values (65 +/- 25% vs. 49 +/- 28%, p < 0.01). Incidence of POCD (11% vs.
7%, relative risk 1.52; 95% CI, 0.41 to 6.3; p = 0.56) and delirium (6%
vs. 14%, relative risk, 0.44; 95% CI, 0.12 to 1.60; p = 0.21) did not
differ between groups. No correlation was found between intraoperative
hypotension and postoperative cognitive performance (p = 0.75) or delirium
(p = 0.19). Recruitment rate was of 6 patients/month (95% confidential
interval (CI), 5 to 7) and drop-out rate at 3 months was 24% (95% CI, 14
to 33%). Conclusions: Intraoperative hypotension did not correlate with
postoperative cognitive dysfunction or delirium occurrence in elderly
patients undergoing general anesthesia for non-cardiac surgery. A
multicenter randomized controlled trial is needed in order to confirm the
effect of intraoperative blood pressure on the development of POCD. Trial
registration number: NCT02428062 www.clinicaltrials.gov.<br/>Copyright
&#xa9; 2018

<73>
Accession Number
619931835
Title
Heart Failure With Preserved Ejection Fraction-A Systematic Review and
Analysis of Perioperative Outcomes.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2423-2434),
2018. Date of Publication: October 2018.
Author
Mohananey D.; Heidari-Bateni G.; Villablanca P.A.; Iturrizaga Murrieta
J.C.; Vlismas P.; Agrawal S.; Bhatia N.; Mookadam F.; Ramakrishna H.
Institution
(Mohananey) Division of Hospital Medicine, Cleveland Clinic, Cleveland,
OH, United States
(Heidari-Bateni) Department of Internal Medicine, Saint Louis University
Hospital, St. Louis, MO, United States
(Villablanca) Division of Cardiovascular Diseases, NYU Langone Medical
Center, New York, NY, United States
(Iturrizaga Murrieta, Vlismas) Department of Internal Medicine, Montefiore
Medical Center, Bronx, NY, United States
(Agrawal) Department of Cardiovascular Medicine, St. Lukes University
Health Network, Bethlehem, PA, United States
(Bhatia) Division of Cardiovascular Medicine, Vanderbilt Heart and
Vascular Institute, Nashville, TN, United States
(Mookadam) Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale,
AZ, United States
(Ramakrishna) Division of Cardiovascular and Thoracic Anesthesiology, Mayo
Clinic, Phoenix, AZ, United States
Publisher
W.B. Saunders

<74>
Accession Number
623740753
Title
Randomized controlled trial of a self-administered five-day antiseptic
bundle versus usual disinfectant soap showers for preoperative eradication
of Staphylococcus aureus colonization.
Source
Infection Control and Hospital Epidemiology. 39 (9) (pp 1049-1057), 2018.
Date of Publication: 01 Sep 2018.
Author
Kline S.E.; Neaton J.D.; Lynfield R.; Ferrieri P.; Kulasingam S.; Dittes
K.; Glennen A.; Jawahir S.; Kaizer A.; Menk J.; Johnson J.R.
Institution
(Kline, Dittes, Johnson) University of Minnesota Medical School,
Department of Medicine, Division of Infectious Diseases, 420 Delaware St
SE, MMC# 250, Minneapolis, MN 55455, United States
(Neaton) Division of Biostatistics, University of Minnesota School of
Public Health, Minneapolis, MN, United States
(Lynfield, Glennen, Jawahir) Minnesota Department of Health, St Paul, MN,
United States
(Ferrieri) Department of Laboratory Medicine and Pathology, University of
Minnesota Medical School, Minneapolis, MN, United States
(Kulasingam) Division of Epidemiology, University of Minnesota School of
Public Health, Minneapolis, MN, United States
(Kaizer, Menk) Biostatistical Design and Analysis Center, University of
Minnesota, Minneapolis, MN, United States
(Johnson) Veterans Affairs Medical Center, Minneapolis, MN, United States
Publisher
Cambridge University Press (E-mail: subscriptions@press.uchicago.edu)
Abstract
Objective To determine the efficacy in eradicating Staphylococcus aureus
(SA) carriage of a 5-day preoperative decolonization bundle compared to 2
disinfectant soap showers, with both regimens self-administered at
home.Design Open label, single-center, randomized clinical trial.Setting
Ambulatory orthopedic, urologic, neurologic, colorectal, cardiovascular,
and general surgery clinics at a tertiary-care referral center in the
United States.Participants Patients at the University of Minnesota Medical
Center planning to have elective surgery and not on antibiotics.Methods
Consenting participants were screened for SA colonization using nasal,
throat, axillary, and perianal swab cultures. Carriers of SA were
randomized, stratified by methicillin resistance status, to a
decolonization bundle group (5 days of nasal mupirocin, chlorhexidine
gluconate [CHG] bathing, and CHG mouthwash) or control group (2
preoperative showers with antiseptic soap). Colonization status was
reassessed preoperatively. The primary endpoint was absence of SA at all 4
screened body sites.Results Of 427 participants screened between August
31, 2011, and August 9, 2016, 127 participants (29.7%) were SA carriers.
Of these, 121 were randomized and 110 were eligible for efficacy analysis
(57 decolonization bundle group, 53 control group). Overall, 90% of
evaluable participants had methicillin-susceptible SA strains. Eradication
of SA at all body sites was achieved for 41 of 57 participants (71.9%) in
the decolonization bundle group and for 13 of 53 participants (24.5%) in
the control group, a difference of 47.4% (95% confidence interval [CI],
29.1%-65.7%; P<.0001).Conclusion An outpatient preoperative antiseptic
decolonization bundle aimed at 4 body sites was significantly more
effective in eradicating SA than the usual disinfectant showers (ie, the
control).Trial Registration ClinicalTrials.gov identifier:
NCT02182115<br/>Copyright &#xa9; 2018 by The Society for Healthcare
Epidemiology of America. All rights reserved.

<75>
Accession Number
2000925758
Title
Saphenous vein versus right internal thoracic artery as a Y-composite
graft: Five-year angiographic and clinical results of a randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (4) (pp 1424-1433.e1),
2018. Date of Publication: October 2018.
Author
Kim M.-S.; Hwang H.Y.; Kim J.S.; Oh S.J.; Jang M.-J.; Kim K.-B.
Institution
(Kim, Hwang, Kim, Oh, Kim) Department of Thoracic and Cardiovascular
Surgery, Seoul National University Hospital, Seoul, South Korea
(Jang) Medical Research Collaborating Center, Seoul National University
Hospital, Seoul, South Korea
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: We compared the 5-year graft occlusion rates and midterm
clinical outcomes of saphenous vein composite grafts with those of right
internal thoracic artery composite grafts in patients who were enrolled in
the SAphenous VEin versus Right Internal Thoracic Artery as a Y-Composite
Graft trial. Methods: Of 224 eligible patients with multivessel coronary
artery disease who were randomized to undergo off-pump revascularization
using the saphenous vein (saphenous vein group, n = 112) or right internal
thoracic artery (right internal thoracic artery group, n = 112) as
Y-composite grafts based on the in situ left internal thoracic artery from
September 2008 to October 2011, 219 patients (saphenous vein group, n =
109; right internal thoracic artery group, n = 110) entered the analysis.
A third limb conduit to lengthen the graft limb for complete
revascularization was used in 47 patients (saphenous vein group vs right
internal thoracic artery group, 8 vs 39). Postoperative 5-year (61.7 +/-
5.2 months) angiograms were performed in 186 patients (84.9%; saphenous
vein group = 95; right internal thoracic artery group = 91). Follow-up was
complete in 97.7% (214/219) of patients with a median follow-up of 80.7
months. Results: The overall graft occlusion rate was 3.6% at 5 years
(3.5% in the saphenous vein group vs 3.7% in the right internal thoracic
artery group, P =.910). The 5-year occlusion rate of the second limb
conduits in the saphenous vein group was 4.3% and was noninferior to that
of the right internal thoracic artery group (2.4%) within the 95% 2-sided
confidence interval of -1.4% to 5.2% (P <.001 for noninferiority). No
statistically significant differences were found in the overall survival
(P =.439) and the freedom from major adverse cardiac and cerebrovascular
event rates (P =.354) at 5 and 8 years between the 2 groups. Conclusions:
The saphenous vein composite grafts were noninferior to the right internal
thoracic artery composite grafts in terms of 5-year graft occlusion rates
and midterm clinical outcomes.<br/>Copyright &#xa9; 2018 The American
Association for Thoracic Surgery

<76>
Accession Number
623937687
Title
The efficacy and safety of dexmedetomidine in cardiac surgery patients: A
systematic review and meta-analysis.
Source
PLoS ONE. 13 (9) (no pagination), 2018. Article Number: e0202620. Date of
Publication: September 2018.
Author
Wang G.; Niu J.; Li Z.; Lv H.; Cai H.
Institution
(Wang, Niu, Li, Lv, Cai) Department of Surgical Intensive Care Unit, First
Affiliated Hospital, Medical College, Zhejiang University, Hangzhou,
Zhejiang, China
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
This study aimed to evaluate the efficacy and safety of dexmedetomidine
versus any other treatment without dexmedetomidine in patients who have
undergone cardiac surgery. Electronic databases including PubMed, Embase,
and Cochrane Library were systematically searched without limitations of
language and publication time. Randomized controlled trials (RCTs) aiming
to evaluate the efficacy and safety of dexmedetomidine versus any other
treatment without dexmedetomidine in patients that have undergone cardiac
surgery were selected. Endpoints such as hemodynamic indexes and adverse
events in eligible studies were extracted by two researchers,
independently. The data was analyzed using RevMan 5.3 and Stata 11.0
software. A total of 18 RCTs met the inclusion criteria, involving 1730
patients. Compared to control (any treatment without dexmedetomidine),
dexmedetomidine showed a pooled mean difference (MD) of -14.46 [95%
confidence interval(CI): -24.69, -4.23; p<0.01] for systolic arterial
pressure, a standardized mean difference (SMD) of -1.74 for mean arterial
blood pressure (95% CI: -2.80, -0.68; P < 0.01), -2.12 (95%CI: -3.23,
-1.00; p<0.01) for heart rate, and combined odds ratio (OR) of 0.22
(95%CI: 0.11, 0.44; p<0.01) for tachycardia, 3.44 (95%CI: 1.95, 5.96;
p<0.01) for bradycardia, 0.74 (95%CI: 0.49, 1.12; p>0.05) for atrial
fibrillation, and 0.99 (95%CI: 0.51, 1.90; p>0.05) for hypotension. In
addition, dexmedetomidine could reduce time of surgery and stay in
intensive care units, improve delirium with good safety. Our study shows
clinical application of dexmedetomidine in cardiac surgery patients can
reduce risks of abnormal hemodynamics with good safety.<br/>Copyright
&#xa9; 2018 Wang et al. This is an open access article distributed under
the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.

<77>
Accession Number
2000669038
Title
Clinical Outcomes of Adult Patients Who Receive Extracorporeal Membrane
Oxygenation for Postcardiotomy Cardiogenic Shock: A Systematic Review and
Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2087-2093),
2018. Date of Publication: October 2018.
Author
Wang L.; Wang H.; Hou X.
Institution
(Wang, Wang, Hou) Center for Cardiac Intensive Care, Capital Medical
University Affiliated Anzhen Hospital, Beijing, China
Publisher
W.B. Saunders
Abstract
Objective: To investigate the clinical outcomes of adult patients
receiving extracorporeal membrane oxygenation (ECMO) for postcardiotomy
cardiogenic shock (PCS). Design: Meta-analysis of 20 observational
studies. Setting: Hospitals that perform cardiac surgery. Participants:
The study included 2,877 PCS patients undergoing ECMO from 20
observational studies. Interventions: ECMO use. Measurements and Main
Results: Twenty observational studies were selected for final analysis.
The pooled survival rate to hospital discharge was 34.0% (30.0%-38.0%) in
PCS patients receiving ECMO. The pooled 1-year survival rate was 24.0%
(19.05%-30.0%). The pooled midterm survival rate was 18.0% (11.0%-27.0%).
The pooled rate of leg ischemia was 14.0% (10.0%-20.0%). The pooled rate
of redo surgery was 50.0% (32.0%-68.0%). The pooled rate of renal failure
was 57.0% (47.0%-66.0%). The pooled rate of neurologic complications was
16.0% (13.0%-20.0%). The pooled rate of infection was 31.0% (22.0%-41.0%).
Most of the included studies commonly revealed that age >65 years,
pre-ECMO or post-ECMO blood lactate, renal insufficiency, a longer
duration of ECMO, and neurologic complications were risk factors of
in-hospital mortality in PCS patients undergoing ECMO. Conclusions: The
short-term and midterm survival rates of PCS patients treated with ECMO
were disappointingly low, and post-ECMO complication rates were relatively
high.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<78>
Accession Number
2000755235
Title
Prospective, randomized, controlled trial of polymer cable ties versus
standard wire closure of midline sternotomy.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (4) (pp 1589-1595.e1),
2018. Date of Publication: October 2018.
Author
Marasco S.F.; Fuller L.; Zimmet A.; McGiffin D.; Seitz M.; Ch'ng S.;
Gangahanumaiah S.; Bailey M.
Institution
(Marasco, Zimmet, McGiffin, Seitz, Ch'ng, Gangahanumaiah) CJOB
Cardiothoracic Surgery Department, The Alfred Hospital, Melbourne,
Victoria, Australia
(Marasco, McGiffin) Department of Surgery, The Alfred Hospital, Monash
University, Melbourne, Victoria, Australia
(Fuller) Physiotherapy Department, The Alfred Hospital, Melbourne,
Victoria, Australia
(Bailey) Australian and New Zealand Intensive Care Research Centre, Monash
University, Melbourne, Victoria, Australia
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Midline sternotomy remains the most common access incision for
cardiac operations. Traditionally, the sternum is closed with stainless
steel wires. Wires are well known to stretch and break, however, leading
to pain, nonunion, and potential deep sternal wound infection. We
hypothesized that biocompatible plastic cable ties would achieve a more
rigid sternal fixation, reducing postoperative pain and analgesia
requirements. Methods: A prospective, randomized study compared the ZIPFIX
(De Puy Synthes, West Chester, Pa) sternal closure system (n = 58) with
standard stainless steel wires (n = 60). Primary outcomes were pain and
analgesia requirements in the early postoperative period. Secondary
outcome was sternal movement, as assessed by ultrasound at the
postoperative follow-up visit. Results: Groups were well matched in
demographic and operative variables. There were no significant differences
between groups in postoperative pain, analgesia, or early ventilatory
requirements. Patients in the ZIPFIX group had significantly more movement
in the sternum and manubrium on ultrasound at 4 weeks. Conclusions: ZIPFIX
sternal cable ties provide reliable closure but no demonstrable benefit in
this study in pain or analgesic requirements relative to standard wire
closure after median sternotomy.<br/>Copyright &#xa9; 2018

<79>
Accession Number
2001075224
Title
Preoperative STOP-BANG Scores and Postoperative Delirium and Coma in
Thoracic Surgery Patients.
Source
Annals of Thoracic Surgery. 106 (4) (pp 966-972), 2018. Date of
Publication: October 2018.
Author
Wang S.; Sigua N.L.; Manchanda S.; Gradney S.; Khan S.H.; Perkins A.;
Kesler K.; Khan B.
Institution
(Wang) Department of Psychiatry, Indiana University School of Medicine,
Indiana University Health Neuroscience Center, Indianapolis, Indiana,
United States
(Wang, Khan) Sandra Eskenazi Center for Brain Care Innovation, Eskenazi
Hospital, Indianapolis, Indiana, United States
(Sigua, Manchanda, Gradney, Khan, Khan) Division of Pulmonary, Critical
Care, Sleep and Occupational Medicine, Department of Internal Medicine,
Indiana University School of Medicine, Indianapolis, Indiana, United
States
(Khan, Khan) Indiana University Center for Aging Research, Regenstrief
Institute, Indianapolis, Indiana, United States
(Perkins) Department of Biostatistics, Indiana University School of
Medicine, Indianapolis, Indiana, United States
(Kesler) Department of Cardiothoracic Surgery, Indiana University School
of Medicine, Indianapolis, Indiana, United States
Publisher
Elsevier USA
Abstract
Background: Obstructive sleep apnea (OSA) is associated with higher rates
of postoperative delirium. The relationship between preoperative OSA risk
and postoperative delirium and coma in thoracic surgery patients
hospitalized in the intensive care unit (ICU) is not well understood. This
study tests the hypothesis that thoracic surgery patients hospitalized in
ICU with a higher preoperative risk for OSA are more likely to develop
postoperative delirium and coma, resulting in longer hospital stays.
Methods: Preoperative OSA risk was measured using the STOP-BANG
questionnaire. STOP-BANG scores of greater than or equal to 3 were defined
as intermediate-high risk for OSA; 128 patients who underwent major
thoracic surgery completed the STOP-BANG questionnaire preoperatively. The
Richmond Agitation and Sedation Scale was used to assess level of
consciousness. The Confusion Assessment Method for the ICU was used to
assess for delirium. Linear regression was used to assess the relationship
between risk of OSA and outcome measures. Results were adjusted for age,
sex, body mass index, Charlson Comorbidity Index, instrumental activities
of daily living, and surgery type. Results: A total of 96 of 128 patients
(76%) were in the intermediate-high-risk OSA group. Adjusted analyses
showed that the intermediate-high-risk OSA group had a longer duration of
postoperative ICU delirium and coma compared with the low-risk OSA group
(1.4 +/- 1.3 days versus 0.9 +/- 1.4 days; P = 0.04). Total number of
hospital days was not significantly different. Conclusions: Higher
preoperative risk for OSA in thoracic surgery patients was associated with
a longer duration of postoperative delirium and coma.<br/>Copyright &#xa9;
2018 The Society of Thoracic Surgeons

<80>
Accession Number
2001063536
Title
Automated Titanium Fasteners Versus Hand-Tied Knots: A Randomized
Controlled Trial.
Source
Annals of Thoracic Surgery. 106 (4) (pp 1160-1163), 2018. Date of
Publication: October 2018.
Author
Etiwy M.; Javadikasgari H.; Houghtaling P.; Gillinov M.
Institution
(Etiwy, Javadikasgari, Gillinov) Department of Thoracic and Cardiovascular
Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio,
United States
(Houghtaling) Department of Quantitative Health Sciences, Research
Institute, Cleveland Clinic, Cleveland, Ohio, United States
Publisher
Elsevier USA
Abstract
Background: The relative benefits of automated titanium fasteners (LSI
Solutions, Victor, NY) have not been examined in patients undergoing
sternotomy. The aim of this study was to assess the time and cost required
for suture fixation with the automated device versus conventional hand
tying in sternotomy for mitral or tricuspid ring annuloplasty. Methods:
Fifty patients scheduled to undergo primary mitral or tricuspid, or both,
ring annuloplasty-based valve repair operation by a single surgeon were
randomly assigned to receive either conventional hand-tied knots or
automated titanium fasteners, with 25 patients in each group. The primary
outcome variable was the time required to affix the annuloplasty device to
the valve annulus. Results: The times taken to affix a mitral annuloplasty
band or ring were 6.1 +/- 0.9 min for manual tying versus 3.1 +/- 0.4 min
for automated fasteners (p < 0.0001); when calculated per annuloplasty
stitch, the values were 22 +/- 2 s versus 12 +/- 1.1 s, respectively (p <
0.0001). The corresponding values for tricuspid annuloplasty were 4.2 +/-
1.2 min (hand tying) versus 2.2 +/- 0.3 min (automated fasteners) (p =
0.0005), and the times for each suture were 20 +/- 2.1 s versus 13 +/- 2
s, respectively (p = 0.0004). The use of the automated fastener had no
significant impact on aortic cross-clamp time or cardiopulmonary bypass
duration. Total cost associated with annuloplasty fixation with automated
titanium fasteners (device cost in addition to operating room time cost)
was significantly higher than with hand tying ($1,190 +/- 374 vs $164 +/-
60; p < 0.0001). Conclusions: Using the automated fastener to facilitate
annuloplasty fixation through a sternotomy resulted in a small procedural
time savings (average of 10 s/stitch) that had no overall impact on
cardiopulmonary bypass or cross-clamp times but added an average cost of
$1,026 to the operation.<br/>Copyright &#xa9; 2018 The Society of Thoracic
Surgeons

<81>
Accession Number
616588801
Title
Oropharyngeal Decontamination with Antiseptics to Prevent
Ventilator-Associated Pneumonia: Rethinking the Benefits of Chlorhexidine.
Source
Seminars in Respiratory and Critical Care Medicine. 38 (3) (pp 381-390),
2017. Article Number: 01282. Date of Publication: 01 Jun 2017.
Author
Klompas M.
Institution
(Klompas) Department of Population Medicine, Harvard Medical School,
Harvard Pilgrim Health Care Institute, 401 Park Street, Suite 401, Boston,
MA 02215, United States
(Klompas) Department of Medicine, Brigham and Women's Hospital, Boston,
Massachusetts, United States
Publisher
Thieme Medical Publishers, Inc. (E-mail: custserv@thieme.com)
Abstract
Daily oral care with chlorhexidine for mechanically ventilated patients is
ubiquitous in contemporary intensive care practice. The practice is
predicated upon meta-analyses suggesting that adding chlorhexidine to
daily oral care regimens can reduce ventilator-associated pneumonia (VAP)
rates by up to 40%. Close analysis, however, raises three concerns: (1)
the meta-analyses are dominated by studies in cardiac surgery patients in
whom average duration of mechanical ventilation is < 1 day and thus their
risk of VAP is very different from other populations, (2) diagnosing VAP
is subjective and nonspecific yet the meta-analyses gave equal weight to
blinded and nonblinded studies, potentially biasing them in favor of
chlorhexidine, and (3) there is circularity between diagnostic criteria
for VAP and chlorhexidine; as an antiseptic, chlorhexidine may decrease
the frequency of positive respiratory cultures but fewer cultures does not
necessarily mean fewer pneumonias. It is therefore important to look at
other outcomes for corollary evidence on whether or not oral chlorhexidine
benefits patients. An updated meta-analysis restricted to double-blinded
studies in noncardiac surgery patients showed no impact on VAP rates,
duration of mechanical ventilation, or intensive care unit length of stay.
Instead, there was a possible signal that oral chlorhexidine may increase
mortality rates. Observational data have raised similar concerns. This
article will review the theoretical basis for adding chlorhexidine to oral
care regimens, delineate potential biases in randomized controlled trials
comparing oral care regimens with and without chlorhexidine, explore the
unexpected mortality signal associated with oral chlorhexidine, and
provide practical recommendations.<br/>Copyright &#xa9; Thieme Medical
Publishers333 Seventh Avenue, New York, NY 10001, USA.

<82>
Accession Number
624033562
Title
Interleukin-6 blockade ameliorates the effect of exercise on cardiac fat
in abdominally obese individuals.
Source
Diabetologia. Conference: 54th Annual Meeting of the European Association
for the Study Diabetes, EASD 2018. Germany. 61 (Supplement 1) (pp S52),
2018. Date of Publication: October 2018.
Author
Christensen R.; Lang Lehrskov L.; Wedell-Neergaard A.-S.; Krogh-Madsen R.;
Karstoft K.; Ellingsgaard H.; Rosenmeier J.; Pedersen B.K.
Institution
(Christensen, Lang Lehrskov, Wedell-Neergaard, Krogh-Madsen, Karstoft,
Ellingsgaard, Pedersen) Capital Hospital of Denmark, Copenhagen, Denmark
(Rosenmeier) Bispebjerg Hospital, Copenhagen, Denmark
Publisher
Springer Verlag
Abstract
Background and aims: Excessive cardiac adipose tissue has been associated
with the incidence and severity of type 2 diabetes and cardiovascular
disease. Exercise training reduces cardiac adipose tissue and may
therefore be a strategy to prevent type 2 diabetes and coronary heart
disease. The underlying mechanisms for exercise-mediated adaptations of
cardiac fat are unclear, but may involve actions of interleukin-6 (IL-6).
IL-6 is a myokine which is released in response to exercise and it has
been shown to increase lipolysis in adipose tissue. Whether this mechanism
is operative in cardiac adipose is unknown. Therefore, the aim of this
study was to investigate whether blocking of IL-6 can ameliorate the
effects of exercise on cardiac fat volume. Materials and methods: This was
a 12-week, double-blinded, randomised, placebo-controlled exercise and
drug intervention trial. 52 abdominally obese participants were enrolled
to endurance exercise (3 x sessions per week of interval-based
high-intensity training of 70-85% of VO2 max) or no exercise groups
combined with IL-6 blockade (Tocilizumab, 8 mg/kg, toci) or placebo
(saline). Cardiac fat volume was assessed byMRI at baseline and post
intervention. Data is expressed as mean +/- SD. A 2-way ANCOVA was used to
assess whether IL-6 blockade influenced the effect of exercise on cardiac
fat. Results: 13 (25%) were men, with an age average of 44 +/- 13 years.
Baseline mean cardiac fat was 203 +/- 111 ml. There were no differences in
baseline cardiac fat levels between participants (p = 0.07). Cardiac fat
was reduced by 16% (95% CI -31; -1, p = 0.041) after 12 weeks of endurance
exercise compared to no exercise (Figure 1). The reduction in cardiac fat
was ameliorated in the group that exercised and received IL-6 blockade (p
= 0.021). IL-6 blockade alone did not lead to any significant changes on
cardiac fat in groups that did not exercise (p = 0.083) (Figure 1).
Conclusion: In a randomised placebo-controlled exercise and drug
intervention we found that IL-6 blockade can ameliorate the effects of
exercise on cardiac fat in abdominally obese individuals. These data
suggest IL-6 is required to mediate the adipose reducing effects of
exercise specifically on cardiac adipose tissue. (Figure Presented).

<83>
Accession Number
624032856
Title
Effects of liraglutide on cardiovascular events in patients with type 2
diabetes and polyvascular disease: Results of the LEADER trial.
Source
Diabetologia. Conference: 54th Annual Meeting of the European Association
for the Study Diabetes, EASD 2018. Germany. 61 (Supplement 1) (pp
S555-S556), 2018. Date of Publication: October 2018.
Author
Zinman B.; Verma S.; Bhatt D.L.; Bain S.C.; Mann J.; Nauck M.A.; Pratley
R.E.; Michelsen M.M.; Monk Fries T.; Rasmussen S.; Leiter L.A.
Institution
(Zinman) Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital,
University of Toronto, Toronto, Canada
(Verma, Leiter) Li Ka Shing Knowledge Institute, St. Michael's Hospital,
University of Toronto, Toronto, Canada
(Bhatt) Brigham and Women's Hospital Heart, Vascular Center and Harvard
Medical School, Boston, United States
(Bain) Institute of Life Science, Swansea University, Swansea, United
Kingdom
(Mann) Friedrich Alexander University of Erlangen, Erlangen, Germany
(Nauck) Diabetes Center Bochum-Hattingen, St. Josef-Hospital
(Ruhr-University Bochum), Bochum, Germany
(Pratley) Florida Hospital Translational Research Institute, Orlando,
United States
(Michelsen, Monk Fries, Rasmussen) Novo Nordisk A/S, Soborg, Denmark
Publisher
Springer Verlag
Abstract
Background and aims: Polyvascular disease can predict cardiovascular (CV)
events. In LEADER, liraglutide significantly reduced major adverse
CVevents (MACE) vs placebo. In a post hoc analysis, we assessed CV
outcomes by history of single or polyvascular disease at baseline.
Materials and methods: In LEADER, 9340 patients with type 2 diabetes (T2D)
and high CV risk were randomised 1:1 to liraglutide vs placebo, both as
add on to standard of care (median follow-up = 3.8 years). The primary
outcome (MACE) was a composite of CV death, nonfatal myocardial
infarction, or nonfatal stroke. The secondary outcome (expanded MACE) also
included hospitalisation for unstable angina, coronary revascularisation,
or hospitalisation for heart failure. Cox regression was used to compare
CVoutcomes in patient risk groups stratified by number of atherosclerotic
vascular territories (coronary, cerebrovascular and/or peripheral artery
disease). Polyvascular disease was defined as >=2 and single vascular
disease as 1 atherosclerotic vascular territory. Results: In LEADER, 6775
patients (72.5%) had documented atherosclerotic CV disease (ASCVD). Of
these, 1536 patients (23%) had polyvascular and 5239 (77%) had single
vascular disease. Patients with polyvascular disease had a higher risk of
CV outcomes than those with single vascular disease (MACE: HR 1.52, 95% CI
1.33-1.73; expanded MACE: HR 1.45, 95% CI 1.31-1.62, CV death: HR 1.41,
95% CI 1.13- 1.75). Liraglutide reduced MACE consistently in patients with
polyvascular (HR 0.82, 95% CI 0.66-1.02) and single vascular disease (HR
0.82, 95% CI 0.71-0.95) vs placebo. In patients without ASCVD at baseline,
the HR for liraglutide vs placebo for MACE was 1.08 (95% CI 0.84-1.38).
Results were similar for expanded MACE and CV death (Table). No
significant interactions were found across risk groups for CVoutcomes
(Table), with the exception of expanded MACE (p interaction = 0.03).
Conclusion: In patients with T2D, polyvascular disease was associated with
greater risk of CVoutcomes vs single vascular disease. Liraglutide
appeared to reduce consistently CVoutcomes in patients with single and
polyvascular disease vs placebo. A trend towards a neutral response was
observed in patients without ASCVD.

<84>
Accession Number
624031006
Title
Effect of liraglutide on cardiovascular outcomes in elderly patients in
the LEADER trial.
Source
Diabetologia. Conference: 54th Annual Meeting of the European Association
for the Study Diabetes, EASD 2018. Germany. 61 (Supplement 1) (pp
S368-S369), 2018. Date of Publication: October 2018.
Author
Gilbert M.P.; Bain S.C.; Franek E.; Jodar-Gimeno E.; Nauck M.A.; Pratley
R.E.; Rea R.; Saraiva J.; Rasmussen S.; Tornoe K.; Von Scholten B.; Buse
J.
Institution
(Gilbert) Robert Larner, M.D. College of Medicine, University of Vermont,
South Burlington, United States
(Bain) Institute of Life Science, Swansea University, Swansea, United
Kingdom
(Franek) Mossakowski Medical Research Centre, Polish Academy of Sciences,
Warsaw, Poland
(Jodar-Gimeno) Quironsalud Madrid University Hospital, Madrid, Spain
(Nauck) Diabetes Center Bochum- Hattingen, St. Josef-Hospital
(Ruhr-Universitat Bochum), Bochum, Germany
(Pratley) Florida Hospital Translational Research Institute, Orlando,
United States
(Rea) Clinical Hospital of the Federal University of Parana (SEMPR),
Curitiba, Brazil
(Saraiva) Pontificia Universidade Catolica De Campinas, Campinas, Brazil
(Rasmussen, Tornoe, Von Scholten) Novo Nordisk A/S, Soborg, Denmark
(Buse) University of North Carolina, School of Medicine, Chapel Hill,
United States
Publisher
Springer Verlag
Abstract
Background and aims: The burden of chronic diseases such as type 2
diabetes (T2D) and associated comorbidities increases with ageing, making
the elderly more vulnerable to potential side effects of medical
treatment. Information about the effect of antihyperglycaemic therapy on
cardiovascular (CV) events in the elderly is limited. Liraglutide reduced
the risk of CVevents in the LEADER trial compared with placebo, and this
post hoc analysis assesses risk of CV events and all-cause mortality in
elderly patients with T2D. Materials and methods: In the LEADER trial,
9340 patients with T2D at high risk for CVevents were randomised 1:1 to
liraglutide or placebo, both on top of standard of care, and followed for
up to 5 years. The primary composite outcome was defined as time to first
occurrence of death from CV causes, nonfatal myocardial infarction (MI) or
non-fatal stroke. Secondary outcomes included the expanded composite
outcome and all-cause mortality. In this analysis, outcomes were assessed
in patients aged >=75 years. Results: Among those aged >=75 years,
baseline characteristics were well matched between treatment arms (N = 418
for both treatment arms). Compared with placebo, liraglutide significantly
reduced the risk of the primary composite outcome, expanded composite
outcome, non-fatal MI, coronary revascularisation, death fromany cause and
death from non-CV causes (Table). Conclusion: In the LEADER trial,
liraglutide treatment reduced the risk of CVevents and all-cause mortality
in elderly patients with T2D. (Table Presented).

<85>
Accession Number
624031383
Title
HbA1c coefficient of variation is an independent risk factor for chronic
complications in type 2 diabetes in the FIELD study.
Source
Diabetologia. Conference: 54th Annual Meeting of the European Association
for the Study Diabetes, EASD 2018. Germany. 61 (Supplement 1) (pp S519),
2018. Date of Publication: October 2018.
Author
Scott E.S.; Januszewski A.S.; O'Connell R.; Colagiuri S.; Fulcher G.R.;
Keech A.; Jenkins A.J.
Institution
(Scott, Januszewski, O'Connell, Keech, Jenkins) NHMRC Clinical Trials
Centre, Sydney, Australia
(Scott, Fulcher) Department of Endocrinology and Diabetes, Royal North
Shore Hospital, Sydney, Australia
(Januszewski, Jenkins) Department of Medicine, St Vincent's, University of
Melbourne, Melbourne, Australia
(Colagiuri) Boden Institute, University of Sydney, Sydney, Australia
(Fulcher) Northern Clinical School, University of Sydney, Sydney,
Australia
Publisher
Springer Verlag
Abstract
Background and aims: Glycaemic variability (GV) is implicated in the
pathogenesis of chronic diabetes complications. GV can be measured long-
and short-term by fluctuations in HbA1c or fasting plasma glucose
respectively. Study aims were to assess whether GVis associated with the
development of micro- and macrovascular complications in the Fenofibrate
Intervention and Event Lowering In Diabetes (FIELD) study, and to
determine what baseline factors predict GV. Materials and methods: The
FIELD study randomised 9795 individuals to fenofibrate 200 mg daily or
placebo and followed the development of vascular complications for a
median of 5-years. GV was calculated as coefficient of variation (CV) and
standard deviation (SD) of HbA1c and fasting plasma glucose (measured at
baseline, annually and at study-end). We assessed whether GV was a
predictor of microvascular and/or macrovascular complications from study
year-2 onward using logistic and Cox proportional hazards regressions with
adjustment for significant covariates. The primary composite endpoint was
the development of microvascular disease (defined as presence of either
retinopathy, albuminuria, neuropathy and/or microvascular amputations),
and subsidiary composite endpoints: macrovascular disease (cardiovascular
mortality, myocardial infarction, stroke, coronary and carotid
revascularization), total mortality and individual vascular complications.
Results: A logistic regression model with adjustment for age, gender,
glycaemic control, baseline complications and treatment allocation
demonstrated that HbA1c CV was an independent risk factor for the
development of microvascular complications (OR 1.13 95% CI (1.04-1.22) P =
0.002). All other GV parameters had similar effects. Although HbA1c CV was
significantly associated with the macrovascular outcome in univariate Cox
proportional hazards regression (P = 0.002), significance was lost in
multivariate analysis. Multiple logistic regression demonstrated that
HbA1c CV (quartiles Q1 = reference) was significantly associated with the
development of nephropathy at 2-years (Q2: OR 1.24 (95% CI 0.97-1.59), Q3:
OR 1.43 (1.12-1.82), Q4: OR 1.77 (1.38-2.25) P < 0.001). HbA1c CV
(quartiles) was significantly associated in Cox proportional hazards
multiple regression with the development of stroke (Q2: OR 1.48 (95% CI
0.93-2.35), Q3: OR 1.52 (0.96-2.41), Q4: 1.99 (1.27- 3.14) P = 0.02) and
totalmortality (Q2: OR 0.97 (95%CI 0.73-1.28), Q3: 1.24 (0.95-1.62), Q4:
OR 1.66 (1.29-2.14) (P < 0.001)). In subjects randomised to fenofibrate
HbA1c CV increased compared to placebo across the study (HbA1c CV 8.98
(5.13) vs 8.58 (5.06) (P < 0.001, (Diff 0.39, 95% CI 0.19-0.60).
Conclusion: In Type 2 diabetes HbA1c CV is an independent risk factor for
microvascular complications, stroke and total mortality. Despite higher
HbA1c CV in individuals randomised to fenofibrate, fenofibrate therapy
significantly reduced total cardiovascular events and all microvascular
outcomes in the FIELD study.

<86>
Accession Number
624032396
Title
Liraglutide reduces major cardiovascular events in patients with chronic
kidney disease: Results from the LEADER trial.
Source
Diabetologia. Conference: 54th Annual Meeting of the European Association
for the Study Diabetes, EASD 2018. Germany. 61 (Supplement 1) (pp
S38-S39), 2018. Date of Publication: October 2018.
Author
Poulter N.; Mann J.; Fonseca V.; Mosenzon O.; Raz I.; Frimer-Larsen H.;
Von Scholten B.; Idorn T.
Institution
(Poulter) Imperial College London, London, United Kingdom
(Mann) KfH Kidney Center, Munich, Germany
(Fonseca) Tulane University Health Sciences Center, School of Medicine,
New Orleans, United States
(Mosenzon, Raz) Hadassah Hebrew University Hospital, Jerusalem, Israel
(Frimer-Larsen, Von Scholten, Idorn) Novo Nordisk A/S, Soborg, Denmark
Publisher
Springer Verlag
Abstract
Background and aims: People with type 2 diabetes (T2D) and chronic kidney
disease (CKD) are at high risk of cardiovascular (CV) events. We analysed
the effect of liraglutide vs placebo (PBO) on CV outcomes in patients with
T2D and CKD in the LEADER trial. Materials and methods: LEADER was a
randomised, double-blind, multicentre, CVoutcome trial with liraglutide
1.8 mg/day vs PBO, both in addition to standard of care for 3.5-5 years,
in 9340 patients with T2D and high CV risk. The primary composite outcome
was defined as first occurrence of death from CV causes, non-fatal
myocardial infarction, or non-fatal stroke. The expanded composite CV
outcome additionally included coronary revascularisation, and
hospitalisation for unstable angina pectoris or hospitalisation for heart
failure (HF). In this analysis, CV outcomes were assessed in patients with
CKD based on estimated GFR (eGFR) (<60 and >=60 mL/min/1.73 m²)
and on albuminuria (>=30 mg/g: micro/macroalbuminuria and <30 mg/g:
normoalbuminuria). Results: The mean eGFR in patientswith baseline eGFR
<60 (n = 2158) and >=60 mL/min/1.73m² (n = 7182) was 45.7 +/-
10.9 and 90.8 +/- 21.6mL/ min/1.73 m², respectively. Versus
PBO, liraglutide was associated with reductions in the risk of the primary
composite outcome: HR 0.69 (CI 0.57; 0.85) for the eGFR <60 subgroup and
HR 0.94 (CI 0.83; 1.07) in the eGFR >=60 subgroup. Equivalent reductions
in the expanded composite CVoutcome were observed (Figure). In the eGFR
<60 mL/min/1.73 m² subgroup, liraglutide significantly reduced
the risk of CV death, non-fatal stroke and hospitalisation for HF vs PBO
(Figure). Liraglutide also reduced the risk of the primary composite
outcome, the expanded composite CVoutcome and CV death in the
micro/macroalbuminuria subgroup vs PBO (Figure). Conclusion: In LEADER,
there was a significant reduction of major CV events in patients with CKD.
(Table Presented).

<87>
Accession Number
624031968
Title
Glycaemic efficacy and safety of linagliptin compared to basal bolus
insulin regimen in non-cardiac surgical patients with type 2 diabetes:
Linagliptin-Surgery trial.
Source
Diabetologia. Conference: 54th Annual Meeting of the European Association
for the Study Diabetes, EASD 2018. Germany. 61 (Supplement 1) (pp
S377-S378), 2018. Date of Publication: October 2018.
Author
Umpierrez G.; Vellanki P.; Rasouli N.; Baldwin D.; Alexanian S.; Anzola
I.; Urrutia M.; Gomez P.; Cardona S.; Wang H.; Pasquel F.
Institution
(Umpierrez, Vellanki, Anzola, Urrutia, Gomez, Cardona, Wang, Pasquel)
Emory University, School of Medicine, Atlanta, United States
(Rasouli) Medicine, University of Colorado, Denver, United States
(Baldwin) Rush University, Chicago, United States
(Alexanian) Medicine, Boston Universty, Boston, United States
Publisher
Springer Verlag
Abstract
Background and aims: Effective hospital and post-discharge regimens are
needed for the management of general surgery patients with type 2
diabetes. We compared the safety and efficacy of linagliptin with a
basalbolus insulin regimen in the hospital, and determine the efficacy of
an HbA1c-based algorithm to guide post-discharge diabetes therapy.
Materials and methods: This prospective, multicenter open-label study
enrolled non-cardiac surgery patients with type 2 diabetes, blood glucose
(BG) between 7.8-22.2 mmol/l and treated with diet, oral agents, or
insulin at a total daily dose (TDD) <=0.5 units/kg. Subjects were
randomized to either linagliptin 5 mg daily (n = 128) or basal-bolus
insulin regimen (n =122). Insulin treated subjects were started at a TDD
of 0.4 U/kg/day or 0.5 U/kg/ day for randomization BG between 7.8 11.1
mmol/l or >11.1-22.1 mmol/l, respectively. If GFR <45 ml/min/1.73
m², TDD was reduced by 50%. Both groups received correction
doses of rapid-acting insulin for BG >7.8 mmol/l before meals or every 6
hours if NPO. The discharge algorithm was based on admission HbA1c. If
HbA1c <7% (<53 mmol/mol), 221 subjects were discharged on linagliptin or
preadmission oral agents; patients with HbA1c 7% and 9% and those >9% were
discharged on linagliptin with glargine at 50% or 80% of the hospital
daily dose, respectively. The primary outcome was difference in mean
hospital daily BG between groups. Secondary outcomes were inpatient
hypoglycaemia and changes in HbA1c at 3 months after discharge. Results:
Difference in mean daily hospital BG between groups was 0.6 mmol/l.
Linagliptin resulted in fewer hypoglycemic events (1.6% vs.11%, p = 0.001,
relative risk reduction of 86%) and in lower number of daily insulin
injections (2.0 +/- 3.3 vs 3.1 +/- 3.3, p < 0.001) compared to
basal-bolus. In patients with a randomization BG <11.1 mmo/l (observed in
63% of overall cohort), linagliptin resulted in similar mean daily BG (8.9
+/- 2.3 vs. 8.7 +/- 2.3 mmol/l, p = 0.43); however, patients with BG
>=11.1 mmol/l treated with linagliptin had higher BG compared to
basalbolus (10.9 +/- 2.6 vs. 9.2 +/- 2.2 mmo/l, p <0.001). There were no
differences in length of hospital stay or in the rate of perioperative
complications between treatment groups. Three months after discharge,
HbA1c decreased from 7.9 +/- 2.0% to 7.1 +/- 1.5%, p < 0.0001 using the
discharge algorithm. Conclusion: Linagliptin is an effective alternative
to basal-bolus insulin regimen in general surgery patients with type 2
diabetes with mild to moderate hyperglycemia. Our results indicate that in
patients with BG <11.1 mmol/l, treatment with linagliptin resulted in
similar improvement in glycemic control and in significantly lower rates
of hypoglycemia compared to the basal-bolus insulin regimen. However,
basal-bolus insulin regimen was superior to linagliptin in patients with
BG >=11.1 mmol/l. The proposed HbA1c-based hospital discharge algorithm
with the use of linagliptin, with or without basal insulin, showed
efficacious glycemic control after discharge.

<88>
Accession Number
624031967
Title
Effect of empagliflozin on cardiovascular events including recurrent
events in the EMPA-REG OUTCOME trial.
Source
Diabetologia. Conference: 54th Annual Meeting of the European Association
for the Study Diabetes, EASD 2018. Germany. 61 (Supplement 1) (pp
S324-S325), 2018. Date of Publication: October 2018.
Author
Lund S.S.; McGuire D.K.; Zinman B.; Inzucchi S.E.; Anker S.D.; Wanner C.;
Kaspers S.; George J.T.; Elsasser U.; Woerle H.J.; Fitchett D.
Institution
(Lund, Kaspers, George, Elsasser, Woerle) Boehringer Ingelheim
International GmbH, Ingelheim, Germany
(McGuire) University of Texas, Southwestern Medical Center, Dallas, United
States
(Zinman) Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital,
University of Toronto, Toronto, Canada
(Inzucchi) Section of Endocrinology, Yale University, School of Medicine,
New Haven, United States
(Anker) Division of Cardiology and Metabolism - Heart Failure, Cachexia
and Sarcopenia; Department of Cardiology (Campus CVK), Berlin-Brandenburg
Center for Regenerative Therapies (BCRT), Berlin, Germany
(Wanner) Wurzburg University Clinic, Wurzburg, Germany
(Fitchett) St Michael's Hospital, Division of Cardiology, University of
Toronto, Toronto, Canada
Publisher
Springer Verlag
Abstract
Background and aims: In the EMPA-REG OUTCOME trial in patients with type 2
diabetes and established CV disease, empagliflozin reduced the risk of
3-point MACE (composite of CV death, MI, or stroke) by 14%, CV death by
38% and hospitalisation for heart failure (HHF) by 35% vs placebo in
analyses of time to first event. We assessed the effect of empagliflozin
on all (first and recurrent) CVevents. Materials and methods: Patients
were randomised to receive empagliflozin 10 mg, empagliflozin 25 mg, or
placebo in addition to standard of care. We assessed the effects of
empagliflozin pooled vs placebo based on all adjudicated CVevents using a
negative binomial model with confidence intervals based on robust error
variance estimators to account for within-subject correlation. Results: A
total of 7020 patients were treated (mean [SD] age 63 [9] years, 71% male,
47% with history of MI, 23% with history of stroke, 10% with HF). In
analyses including all events, the event rate ratio (95% CI) with
empagliflozin vs placebo was 0.78 (0.67, 0.91; p = 0.0020) for 3-point
MACE, 0.79 (0.620, 0.998; p = 0.0486) for MI, 1.10 (0.82, 1.49; p =
0.5248) for stroke, 0.58 (0.42, 0.81; p = 0.0012) for HHF, 0.56 (0.45,
0.69; p < 0.0001) for the composite of CV death or HHF, and 0.80 (0.67,
0.95; p = 0.0119) for the composite of MI or coronary revascularisation.
Results were consistent with analyses of first events (Figure).
Conclusion: Analyses of all (first and recurrent) CVevents in the EMPAREG
OUTCOME trial complement previous analyses and confirm the consistency of
the results. (Table Presented) .

<89>
Accession Number
622107434
Title
Therapeutic options for functional mitral regurgitation in chronic heart
failure.
Source
Expert Review of Medical Devices. 15 (5) (pp 357-365), 2018. Date of
Publication: 04 May 2018.
Author
Lowry J.E.; Fichtlscherer S.; Witte K.K.
Institution
(Lowry, Witte) Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom
(Fichtlscherer) Department of Internal Medicine, Division of Cardiology,
University Hospital Frankfurt, Frankfurt am Main, Germany
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Mitral regurgitation is a common finding in patients with
chronic heart failure and is associated with a progressive worsening of
symptoms, reduced survival and increased cost of care. However, the use of
mitral valve surgery for these patients remains controversial and has not
been shown to improve survival. Consequently, research has been
increasingly directed towards the nonsurgical management of this important
co-morbidity of heart failure. Areas covered: The present review will
describe the relevance of mitral regurgitation in people with chronic
heart failure, the current options for percutaneous treatment and the
evidence base for each of these. Expert commentary: Although at present
there are few solid data to guide heart teams in deciding what degree of
mitral regurgitation to treat, in which patients, and with what, this
situation is likely to change over the next two years with the release of
the first large randomised trials of percutaneous
interventions.<br/>Copyright &#xa9; 2018 Informa UK Limited, trading as
Taylor & Francis Group.

<90>
Accession Number
621102968
Title
Short-Term Outcome after Left Main Interventions in Patients Presenting
with Acute Coronary Syndrome.
Source
Journal of Invasive Cardiology. 30 (3) (pp 98-104), 2018. Date of
Publication: March 2018.
Author
Obeid S.; Yousif N.; Schelldorfer A.; Shahin M.; Raber L.; Gencer B.; Mach
F.; Roffi M.; Matter C.M.; Windecker S.; Luscher T.F.
Institution
(Luscher) Royal Brompton and Harefield Hospital, Imperial College, London
SW3 6NP, United Kingdom
(Obeid, Yousif, Schelldorfer, Shahin, Raber, Gencer, Mach, Roffi, Matter,
Windecker) Department of Cardiology, University Heart Center, University
Hospital Zurich, Switzerland
Publisher
HMP Communications
Abstract
OBJECTIVE: To assess the efficacy and safety of coronary left main (LM)
disease interventions in patients with acute coronary syndromes (ACS) as
compared to those without LM coronary artery disease. METHODS: A total of
2899 patients with ACS, enrolled in the prospective Swiss Program
University Medicine ACS (SPUM-ACS) cohort, were included. The primary
endpoints of independently adjudicated major adverse cardiovascular and
cerebrovascular event (MACCE) and net adverse clinical event (NACE) were
determined at 30-day follow-up. RESULTS: Seventy-one (2.0%) of the 2899
ACS patients had significant LM disease. At 30-day follow-up, the primary
outcomes of MACCE and NACE occurred in 140 patients (4.8%) and 272
patients (9.4%), respectively. Compared to those without LM disease,
patients in the LM group were significantly older (P<.001), had a higher
incidence of hypertension (P<.001) and diabetes (P<=.013), and more often
had a history of coronary artery bypass graft (CABG) surgery (P<.001).
Analyses on non-matched populations showed a nearly significant trend
toward a higher incidence of MACCE (P<=.06) and NACE (P<=.10) in patients
with LM disease compared to those without LM disease. This trend, however,
disappeared after matching the populations for all significant confounding
variables on a 3:1 basis. This subanalysis showed MACCE rates of 10.0% in
the LM group and 7.3% in the non-LM group (P<=.61). Notably, the matched
patients with LM disease treated with percutaneous coronary intervention
had a lower NACE incidence when compared to those undergoing urgent CABG
surgery (P<.01). CONCLUSIONS: In ACS patients with LM disease,
revascularization with PCI is feasible and safe, with short-term outcomes
comparable to ACS patients without significant LM disease.<br/>Copyright
&#xa9; 2018 HMP Communications. All rights reserved.

<91>
Accession Number
621915915
Title
Clinical effectiveness and versatility of a sealing hemostatic patch
(HEMOPATCH) in multiple surgical specialties.
Source
Expert Review of Medical Devices. 15 (5) (pp 367-376), 2018. Date of
Publication: 04 May 2018.
Author
Lewis K.M.; Ikeme S.; Olubunmi T.; Kuntze C.E.
Institution
(Lewis, Ikeme, Kuntze) Global Medical Affairs, Baxter Healthcare
Corporation, Deerfield, IL, United States
(Olubunmi) Global Medical Affairs, Magni Consulting Group, Woodland Hills,
CA, United States
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Intraoperative surgical sealants and hemostatic agents have
been shown to reduce postoperative complications, transfusions, and
hospital resource utilization. Despite availability of these agents, the
incidence and burden of bleeding remains high and surgeons' requirements
for hemostatic control continue to evolve. A burgeoning class of
hemostatic agents are hemostatic patches, which offer package-to-patient
readiness and direct application. In addition, hemostatic patches may
provide tissue sealing capabilities. Areas covered: This review focuses on
the clinical effectiveness, versatility, and surgical efficiency of
HEMOPATCH as a surgical sealant and hemostatic agent in various surgical
specialties including: cardiac, digestive (hepatic, gastrointestinal,
pancreatic), urological, neurological, and endocrine. Expert commentary:
Among hemostatic patches, HEMOPATCH is a valuable tool to stop bleeding
without adverse events across various surgical specialties. Clinical
evidence demonstrates the safety, clinical effectiveness, and versatility
of HEMOPATCH as a unique surgical adjunct in patients undergoing complex
and routine surgical procedures. Larger randomized-controlled clinical
studies, or clinical registries, will continue to be used to evaluate its
performance and versatility, particularly for sealing tissues and closing
the dura. In the current field of surgical sealing and hemostasis,
however, HEMOPATCH represents the next step in improving patient
outcomes.<br/>Copyright &#xa9; 2018 Informa UK Limited, trading as Taylor
& Francis Group.

<92>
Accession Number
619240293
Title
Dual Versus Single Antiplatelet Regimen With or Without Anticoagulation in
Transcatheter Aortic Valve Replacement: Indirect Comparison and
Meta-analysis.
Source
Revista Espanola de Cardiologia. 71 (4) (pp 257-266), 2018. Date of
Publication: April 2018.
Author
Verdoia M.; Barbieri L.; Nardin M.; Suryapranata H.; De Luca G.
Institution
(Verdoia, Barbieri, Nardin, De Luca) Division of Cardiology, Azienda
Ospedaliera-Universitaria "Maggiore della Carita", Eastern Piedmont
University, Novara, Italy
(Barbieri) Department of Cardiology, Ospedale S. Andrea, Vercelli, Italy
(Nardin) Department of Medicine, ASST "Spedali Civili", University of
Brescia, Brescia, Italy
(Suryapranata) Department of Cardiology, University Medical Centre St
Radboud, Nijmegen, Netherlands
Publisher
Ediciones Doyma, S.L.
Abstract
Introduction and objectives: There is uncertainty on the correct
management of antithrombotic therapies after transcatheter aortic valve
replacement (TAVR), with dual antiplatelet therapy (DAPT) being currently
recommended on an empirical basis. The aim of the present meta-analysis
was to assess the safety and effectiveness of DAPT in patients undergoing
TAVR. Methods: Studies comparing different antithrombotic regimens after
TAVR were included. The primary endpoint was 30-day overall mortality.
Results: We included 9 studies, 5 comparing DAPT with aspirin monotherapy
and 4 comparing DAPT with monoantiplatelet therapy (MAPT) + oral
anticoagulation. Among 7991 patients, 72% were on DAPT. The median
follow-up was 3.5 months. Mortality was significantly lower in the DAPT
group (12.2% vs 14.4%; OR, 0.81; 95%CI, 0.70-0.93; P =.003;
P<inf>het</inf> =.93), with similar benefits compared with aspirin
monotherapy (OR, 0.80; 95%CI, 0.69-0.93; P =.004; P<inf>het</inf> =.60),
which were not statistically significant when compared with MAPT + oral
anticoagulation (OR, 0.86; 95%CI, 0.55-1.35; P =.51; P<inf>het</inf>
=.97). A similar trend for DAPT was observed for stroke (OR, 0.83 95%CI,
0.63-1.10; P =.20; P<inf>het</inf> =.67), with no increase in the rate of
major bleedings (OR, 1.69; 95%CI, 0.86-3.31; P =.13;
P<inf>het</inf><.0001). On indirect comparison analysis, no benefit in
survival, stroke, or bleedings was identified for additional oral
anticoagulation. Conclusions: The present meta-analysis supports the use
of DAPT after TAVR, reducing mortality and offering slight benefits in
stroke, with no increase in major bleedings compared with MAPT. The
strategy of aspirin + oral anticoagulation did not provide significant
benefits compared with MAPT or DAPT. Full English text available from:
www.revespcardiol.org/en<br/>Copyright &#xa9; 2017 Sociedad Espanola de
Cardiologia

<93>
Accession Number
617421439
Title
2-year outcomes with the Absorb bioresorbable scaffold for treatment of
coronary artery disease: a systematic review and meta-analysis of seven
randomised trials with an individual patient data substudy.
Source
The Lancet. 390 (10096) (pp 760-772), 2017. Date of Publication: 19 - 25
August 2017.
Author
Ali Z.A.; Serruys P.W.; Kimura T.; Gao R.; Ellis S.G.; Kereiakes D.J.;
Onuma Y.; Simonton C.; Zhang Z.; Stone G.W.
Institution
(Ali, Stone) New York Presbyterian Hospital, Columbia University Medical
Center and the Cardiovascular Research Foundation, New York, NY, United
States
(Serruys) International Centre for Cardiovascular Health, Imperial
College, London, London, United Kingdom
(Kimura) Kyoto University Hospital, Kyoto, Japan
(Gao) Fu Wai Hospital, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences, Beijing, China
(Ellis) Cleveland Clinic, Cleveland, OH, United States
(Kereiakes) The Christ Hospital, Heart and Vascular Center, Lindner
Research Center, Cincinnati, OH, United States
(Onuma) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Simonton, Zhang) Abbott Vascular, Santa Clara, CA, United States
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Bioresorbable vascular scaffolds (BVS) offer the potential to
improve long-term outcomes of percutaneous coronary intervention after
their complete bioresorption. Randomised trials have shown non-inferiority
between BVS and metallic drug-eluting stents at 1 year in composite safety
and effectiveness outcomes, although some increases in rates of target
vessel-related myocardial infarction and device thrombosis were
identified. Outcomes of BVS following the first year after implantation
are unknown. We sought to ascertain whether BVS are as safe and effective
as drug-eluting stents within 2 years after implantation and between 1 and
2 years. Methods We did a systematic review and meta-analysis of
randomised trials in which patients were randomly assigned to
everolimus-eluting Absorb BVS or metallic everolimus-eluting stents (EES)
and followed up for at least 2 years. We searched MEDLINE, the Cochrane
database, TCTMD, ClinicalTrials.gov, Clinical Trial Results, CardioSource,
and abstracts and presentations from major cardiovascular meetings up to
April 1, 2017, to identify relevant studies. The primary efficacy outcome
measure was the device-oriented composite endpoint (cardiac mortality,
target vessel-related myocardial infarction, or ischaemia-driven target
lesion revascularisation) and the primary safety outcome measure was
definite or probable device thrombosis. Individual patient data from the
four ABSORB trials were used for landmark and subgroup analysis and
multivariable modelling. Findings We identified seven randomised trials in
which 5583 patients were randomly assigned to Absorb BVS (n=3261) or
metallic EES (n=2322) and followed up for 2 years. BVS had higher 2-year
relative risks of the device-oriented composite endpoint than did EES
(9.4% [304 of 3217] vs 7.4% [169 of 2299]; relative risk [RR] 1.29 [95% CI
1.08-1.56], p=0.0059). These differences were driven by increased rates of
target vessel-related myocardial infarction (5.8% [187 of 3218] vs 3.2%
[74 of 2299]; RR 1.68 [95% CI 1.29-2.19], p=0.0003) and ischaemia-driven
target lesion revascularisation (5.3% [169 of 3217] vs 3.9% [90 of 2300];
1.40 [1.09-1.80], p=0.0090) with BVS, with non-significant differences in
cardiac mortality. The cumulative 2-year incidence of device thrombosis
was higher with BVS than with EES (2.3% [73 of 3187] vs 0.7% [16 of 2281];
RR 3.35 [95% CI 1.96-5.72], p<0.0001). Landmark analysis between 1 and 2
years also showed higher rates of the device-oriented composite endpoint
(3.3% [69 of 2100] vs 1.9% [23 of 1193]; RR 1.64 [95% CI 1.03-2.61],
p=0.0376) and device thrombosis (0.5% [11 of 2085] vs none [0 of 1183],
p<0.0001) in BVS-treated patients than in EES-treated patients.
Interpretation BVS was associated with increased rates of composite
device-oriented adverse events and device thrombosis cumulatively at 2
years and between 1 and 2 years of follow-up compared with EES. Funding
Abbott Vascular.<br/>Copyright &#xa9; 2017 Elsevier Ltd

<94>
[Use Link to view the full text]
Accession Number
614895927
Title
Lung recruitment improves right ventricular performance after
cardiopulmonary bypass A randomised controlled trial.
Source
European Journal of Anaesthesiology. 34 (2) (pp 66-74), 2017. Date of
Publication: 01 Feb 2017.
Author
Longo S.; Siri J.; Acosta C.; Palencia A.; Echegaray A.; Chiotti I.;
Parisi A.; Ricci L.; Natal M.; Suarez-Sipmann F.; Tusman G.
Institution
(Longo, Siri, Tusman) Department of Anesthesia, Hospital Privado de
Comunidad, Mar del Plata, Argentina
(Chiotti) Department of Intensive Care, Spain
(Acosta, Palencia) Department of Cardiovascular Surgery, Hospital Privado
Universitario de Cordoba, Cordoba, Spain
(Acosta, Tusman) Department of Anesthesia, Hospital Privado de Comunidad,
Argentina
(Ricci, Natal) Department of Mathematics, Facultad de Ciencias Exactas,
Universidad Nacional de Mar Del Plata, Mar del Plata, Argentina
(Echegaray, Parisi) Department of Surgical Sciences, Section of Anesthesia
and Critical Care, Uppsala University Hospital, Sweden
(Suarez-Sipmann) Hedenstierna Laboratory, Uppsala, Sweden
(Suarez-Sipmann) CIBERES, Madrid, Spain
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background Atelectasis after cardiopulmonary bypass (CPB) can affect right
ventricular (RV) performance by increasing its outflow impedance.
OBJECTIVE The aim of this study was to determine whether a lung
recruitment manoeuvre improves RV function by reaerating the lung after
CPB. DESIGN Randomised controlled study. SETTING Single-institution study,
community hospital, Co rdoba, Argentina. PATIENTS Forty anaesthetised
patients with New York Heart Association class I or II, preoperative left
ventricular ejection fraction at least 50% and Euroscore 6 or less
scheduled for cardiac surgery with CPB. INTERVENTIONS Patients were
assigned to receive either standard ventilation with 6 cmH<inf>2</inf>O of
positive end-expiratory pressure (PEEP; group C, n = 20) or standard
ventilation with a recruitment manoeuvre and 10 cmH2O of PEEP after
surgery (group RM, n = 20). RV function, left ventricular cardiac index
(CI) and lung aeration were assessed by transoesophageal echocardiography
(TOE) before, at the end of surgery and 30 min after surgery. MAIN OUTCOME
MEASURES RV function parameters and atelectasis assessed by TOE. RESULTS
Haemodynamic data and atelectasis were similar between groups before
surgery. At the end of surgery, CI had decreased from 2.9-1.1 to 2.6-0.9 l
min^-1 m^-2 in group C (P = 0.24) and from 2.8-1.0 to
2.6-0.8 l min^-1 m^-2 in group RM (P = 0.32).
TOE-derived RV function parameters confirmed a mild decrease in RV
performance in 95% of patients, without significant differences between
groups (multivariate Hotelling t-test P = 0.16). Atelectasis was present
in 18 patients in group C and 19 patients in group RM (P = 0.88). After
surgery, CI decreased further from 2.6 to 2.4 l min^-1
m^-2 in group C (P = 0.17) but increased from 2.6 to 3.7 l
min^-1 m^-2 in group RM (P < 0.001). TOE-derived RV
function parameters improved only in group RM (Hotelling ttest P < 0.001).
Atelectasis was present in 100% of patients in group C but only in 10% of
those in group RM (P < 0.001). CONCLUSION Atelectasis after CPB impairs RV
function but this can be resolved by lung recruitment using 10
cmH<inf>2</inf>O of PEEP.<br/>Copyright &#xa9; 2017 European Society of
Anaesthesiology. All rights reserved.

<95>
[Use Link to view the full text]
Accession Number
614895925
Title
Bilateral sternal infusion of ropivacaine and length of stay in ICU after
cardiac surgery with increased respiratory risk A randomised controlled
trial.
Source
European Journal of Anaesthesiology. 34 (2) (pp 56-65), 2017. Date of
Publication: 01 Feb 2017.
Author
Eljezi V.; Imhoff E.; Bourdeaux D.; Pereira B.; Farhat M.; Schoeffler P.;
Azarnoush K.; Duale C.
Institution
(Eljezi, Imhoff, Schoeffler) CHU Clermont-Ferrand, Medecine
Peri-Operatoire, CHU Clermont-Ferrand, France
(Bourdeaux) Pharmacie Centrale, Hopital Gabriel-Montpied, France
(Pereira) CHU ClermontFerrand, Direction de la Recherche Clinique et des
Innovations, CHU Clermont-Ferrand, France
(Farhat, Azarnoush) Pole Cardiologie, Chirurgie Cardio-Vasculaire, Univ
Clermont1, France
(Schoeffler, Azarnoush, Duale) Fac Medecine, CHU Clermont-Ferrand, France
(Duale) Centre de Pharmacologie Clinique, Inserm, CIC1405, U1107
Neuro-Dol, 58 rue Montalembert, ClermontFerrand Cedex 1 63003, France
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background The continuous bilateral infusion of a local anaesthetic
solution around the sternotomy wound (bilateral sternal) is an innovative
technique for reducing pain after sternotomy. OBJECTIVE To assess the
effects of the technique on the need for intensive care in cardiac
patients at increased risk of respiratory complications. DESIGN
Randomised, observer-blind controlled trial. SETTING Single centre, French
University Hospital. PATIENTS In total, 120 adults scheduled for
open-heart surgery, with one of the following conditions: age more than 75
years, BMI >30 kg m^-2, chronic obstructive pulmonary disease,
active smoking habit. INTERVENTION Either a bilateral sternal infusion of
0.2% ropivacaine (3 ml h^-1 through each catheter;
'intervention' group), or standardised care only ('control' group).
Analgesia was provided with paracetamol and self-administered intravenous
morphine. MAIN OUTCOME MEASURES The length of time to readiness for
discharge from ICU, blindly assessed by a committee of experts. RESULTS No
effect was found between groups for the primary outcome (P = 0.680,
intention to treat); the median values were 42.4 and 37.7 h, respectively
for the control and intervention groups (P = 0.873). Similar
nonsignificant trends were noted for other postoperative delays.
Significant effects favouring the intervention were noted for dynamic
pain, patient satisfaction, occurrence of nausea and vomiting, occurrence
of delirium or mental confusion and occurrence of pulmonary complications.
In 12 patients, although no symptoms actually occurred, the total
ropivacaine plasma level exceeded the lowest value for which neurological
symptoms have been observed in healthy volunteers. CONCLUSION Because of a
small size effect, and despite significant analgesic effects, this
strategy failed to reduce the time spent in ICU.<br/>Copyright &#xa9; 2017
European Society of Anaesthesiology. All rights reserved.

<96>
Accession Number
623904994
Title
A method for addressing right upper lobe obstruction with right-sided
double-lumen endobronchial tubes during surgery: A randomized controlled
trial.
Source
BMC Anesthesiology. 18 (1) (no pagination), 2018. Article Number: 130.
Date of Publication: 18 Sep 2018.
Author
Yu W.; Wang Z.; Gao D.; Zhang W.; Jin W.; Ma X.; Qi S.
Institution
(Yu, Wang, Gao, Zhang, Jin, Ma, Qi) Department of Anaesthesiology, Fourth
Affiliated Hospital, Harbin Medical University, 37 Yiyuan Road, Harbin
Heilongjiang Province 150001, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: A right-sided double-lumen tube (R-DLT) tends to obstruct the
right upper lobe intraoperatively due to anatomical distortion during
surgery. If the R-DLT is poorly matched with the patient's airway anatomy,
it will not be possible to correctly replace the tube with a fiberoptic
bronchoscope (FOB). In our study, we aimed to explore an efficient method
for difficult repositioning caused by right upper lobe occlusion during
surgery: repositioning the R-DLT from the right main bronchus into the
left main bronchus. The current study was designed to assess the efficacy
and safety of this method. Methods: Sixty adult patients scheduled to
undergo left-sided thoracic surgery were randomly assigned to two groups.
With the patient in the right lateral position during surgery, the R-DLT
was pulled back to the trachea while being rotated 90degree clockwise; it
was then either rotated 90degree clockwise for placement into the left
main bronchus (Group L) or rotated 90degree anticlockwise and returned to
the right main bronchus (Group R) using FOB guidance. The primary outcomes
included clinical performance, which was measured by intubation time, and
the quality of lung collapse. A secondary outcome was safety, which was
determined according to bronchial injury and vocal cord injury. Results:
The median intubation time (IQR [range]) required for placement of a R-DLT
into the left main bronchus was shorter than the time required for
placement into the right main bronchus (15.0 s [IQR, 12.0 to 20.0 s]) vs
23.5 s [IQR, 14.5 to 65.8 s], P = 0.005). The groups showed comparable
overall results for the quality of lung collapse during the total period
of one-lung ventilation (P = 1.000). The numbers of patients with
bronchial injuries or vocal cord injuries were also comparable between
groups (Group R, 11/30 vs. Group L 8/30, P = 0.580 for bronchus injuries;
Group R, 15/30 vs. Group L 13/30, P = 0.796 for vocal cord injuries).
Conclusions: Repositioning a R-DLT from the right main bronchus into the
left main bronchus had good clinical performance without causing
additional injury. This may be an efficient method for the difficult
repositioning of a R-DLT due to right upper lobe occlusion during surgery.
Trial registration: Chinese Clinical Trial Registry, ChiCTR-IPR-15006933,
registered on 15 August 2015.<br/>Copyright &#xa9; 2018 The Author(s).

<97>
Accession Number
2001098587
Title
Unexpected perioperative cardiac arrest.
Source
Trends in Anaesthesia and Critical Care. 21 (pp 33-37), 2018. Date of
Publication: August 2018.
Author
Krawczyk P.; Andres J.
Institution
(Krawczyk, Andres) Department of Anesthesiology and Intensive Care
Medicine, Jagiellonian University Medical College, Kopernika 17, Krakow
31-501, Poland
Publisher
Churchill Livingstone
Abstract
Patient safety is the first priority of any medical activity.
Anesthesiology is a medical discipline with imprinted critical events
including perioperative cardiac arrest (POCA). Nevertheless, despite
advances in modern perioperative medicine, there are still factors that
may either provoke adverse reactions or negatively influence the treatment
process. Negative sequelae may result if the problem is not avoided or
managed sufficiently. Anesthesiology focuses on strategies aimed at
prevention, the early recognition of problems, and actions to avoid or
solve critical events. This review considers recently published evidence
on the occurrence, recognition, and management of POCA and future research
in this field of anesthetic practice.<br/>Copyright &#xa9; 2018 Elsevier
Ltd

<98>
[Use Link to view the full text]
Accession Number
616769485
Title
Glidescope versus Airtraq DL for double-lumen tracheal tube insertion in
patients with a predicted or known difficult airway.
Source
European Journal of Anaesthesiology. 34 (7) (pp 456-463), 2017. Date of
Publication: 01 Jul 2017.
Author
Belze O.; Lepage E.; Bazin Y.; Kerourin P.; Fusciardi J.; Remerand F.;
Espitalier F.
Institution
(Belze, Lepage) Department of Anaesthesia, Hopital Foch, Suresnes, France
(Bazin, Kerourin, Fusciardi, Remerand, Espitalier) Department of
Anaesthesia, Pole Anesthesie Reanimation, Universite Francois-Rabelais,
CHRU de Tours, Tours Cedex 09, France
(Belze) Service d'Anesthe sie, Hopital Foch, 40, rue Worth, Suresnes
92151, France
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND Double-lumen tracheal tube (DLT) insertion can be managed with
videolaryngoscopes such as the Glidescope or indirect laryngoscopes like
the Airtraq DL. No study has compared both devices when a difficult
intubation is predicted. OBJECTIVE Our hypothesis was that the Glidescope
is superior to the Airtraq for double-lumen tube insertion in patients
with a predicted or known difficult airway. DESIGN Randomised study.
PATIENTS Adults scheduled for thoracic elective surgery, requiring
one-lung ventilation with a predicted difficult intubation score of at
least 7 (Arne risk index). INTERVENTION Between March 2014 and March 2015,
adult patients, scheduled for elective thoracic surgery, requiring
double-lumen tracheal tube placement, and with a predicted risk (evaluated
preoperatively using the Arne score) or a history of difficult intubation,
were allocated to a Glidescope or an Airtraq group. MAIN OUTCOME MEASURES
The primary outcome was the overall success rate of tracheal intubation
after two attempts. Secondary outcomes were success rates on the first
attempt, duration of intubation, need for laryngeal pressure, Cormack and
Lehane grade and side-effects. RESULTS Of 277 patients, 78 were predicted
to have a difficult airway. Finally, 72 patients were enrolled. Neither
the overall success rates of tracheal intubation [Glidescope group 31/36
(86%) versus Airtraq group 34/36 (94%), P = 0.43] nor the side-effects
differed between groups. There was no difference concerning visualisation
of the glottis using the Cormack and Lehane grade (P = 0.18) or intubation
time [Glidescope group 67 s (49 to 90) versus Airtraq group 81 s (59 to
101), P = 0.28]. All patients with a previous history of difficult
intubation were intubated successfully. CONCLUSION There is no difference
in success rates of tracheal intubation with a double-lumen tube in
patients with a predicted or known difficult airway when using either a
Glidescope or Airtraq device. TRIAL REGISTRATION National register of the
French National Agency for Medicines and Health Products Safety
No.<br/>Copyright &#xa9; 2016 European Society of Anaesthesiology. All
rights reserved.

<99>
Accession Number
620128456
Title
Preoperative Intraaortic Balloon Pump Improves Early Outcomes Following
High-Risk Coronary Artery Bypass Graft Surgery: A Meta-Analysis of
Randomized Trials and Prospective Study Design.
Source
Journal of Invasive Cardiology. 30 (1) (pp 2-9), 2018. Date of
Publication: January 2018.
Author
Rampersad P.P.; Udell J.A.; Zawi R.; Ouzounian M.; Overgaard C.B.; Sharma
V.; Rao V.; Farkouh M.E.; Dzavik V.
Institution
(Rampersad, Udell, Overgaard, Sharma, Farkouh, Dzavik) Division of
Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University
Health Network, 6-246 en Toronto General Hospital, 200 Elizabeth Street,
Toronto, ON M5G 2C4, Canada
(Udell, Zawi) Women's College Research Institution, Cardiovascular
Division, Department of Medicine, Women's College Hospital, Peter Munk
Cardiac Centre, Toronto General Hospital, University of Toronto, 76
Grenville Street, Toronto, ON M5S 1B1, Canada
(Ouzounian, Rao) Division of Cardiac Surgery, Peter Munk Cardiac Centre,
University Health Network, Toronto, ON, Canada
(Farkouh) Heart and Stroke Richard Lewar Centre of Excellence in
Cardiovascular Research, Toronto, ON, Canada
(Udell, Zawi, Ouzounian, Overgaard, Sharma, Rao, Farkouh, Dzavik)
University of Toronto, Toronto, ON, Canada
Publisher
HMP Communications
Abstract
BACKGROUND: Despite widespread use, evidence to support preemptive
intraaortic balloon pump (IABP) insertion for patients undergoing
high-risk coronary artery bypass graft (CABG) surgery remains sparse, and
in need of a well-defined clinical trial. To inform the design of a
prospective trial, we sought to review outcomes in randomized controlled
trials (RCTs) of anticipatory IABP use vs control in patients undergoing
high-risk CABG through meta-analysis. The primary endpoint was all-cause
mortality within 30 days of surgery. The secondary endpoint was major
adverse cardiac and cerebrovascular event (MACCE), a composite of death,
myocardial infarction, stroke, or repeat revascularization. METHODS: Using
Ovid MEDLINE, we systematically reviewed all RCTs comparing preoperative
IABP with control in patients undergoing high-risk CABG, defined as: left
ventricular ejection fraction (LVEF) <=40%, left main stenosis >=70%,
unstable angina, recent myocardial infarction, or prior myocardial
revascularization undergoing elective or emergent CABG on or off pump.
RESULTS: Of 950 articles assessed for eligibility, 10 RCTs of 1261
subjects (mean age, 65.0 years; 21.8% women; mean LVEF, 35%) were
included. Mortality was significantly lower in patients receiving IABP
compared with control (relative risk [RR], 0.48; 95% confidence interval
[CI], 0.30-0.76; P<.01). The risk of MACCE was also lower with IABP (RR,
0.67; 95% CI, 0.54-0.84; P<.001). No significant differences in major
bleeding events (RR, 1.27; 95% CI, 0.44-3.72) or vascular complications
(RR, 1.13; 95% CI, 0.42-3.06) were detected. CONCLUSIONS: A strategy of
routine prophylactic IABP use may reduce short-term mortality and MACCE in
high-risk CABG patients. A definitive, adequately powered, prospective,
randomized trial is warranted to confirm these results.

<100>
Accession Number
624033255
Title
The effect of self-care interventions on sleep quality in post coronary
artery bypass graft surgery patients.
Source
Journal of Sleep Research. Conference: 24th Congress of the European Sleep
Research Society, ESRS 2018. Switzerland. 27 (Supplement 1) (pp 208-209),
2018. Date of Publication: September 2018.
Author
Ghavami H.; Safarzadeh F.; Ghare Aghaji R.
Institution
(Ghavami, Safarzadeh, Ghare Aghaji) Nursing and Midwifery School, Urmia
University of Medical Sciences, Urmia, Iran, Islamic Republic of
Publisher
Blackwell Publishing Ltd
Abstract
Objectives/Introduction: Adequate amount and good quality of sleep are
basic human needs. Studies in adults have shown that inadequate sleep is
associated with metabolic syndrome, diabetes and with cardio-metabolic
risk factors,including weight status, cholesterol, and blood pressure.
Also, studies show that poor sleep quality is common among patients after
coronary artery bypass graft surgery. So, the aim of the current study was
to examine the effect of self-care interventions (based on sleep hygiene
practices, nutrition and physical activity) on sleep quality in post
coronary artery bypass graft surgery (CABG) patients. Methods: This
randomized controlled trial study included a total of 160 post CABG
patients. They were divided into two groups randomly; 80 patients were
randomized to the self-care interventions group, and 80 to the usual care
group. Those in the selfcare interventions group had 6 educative sessions
on sleep hygiene practice, aerobic exercises, and dietary training and
then they had individual consultant sessions about these self-care items
monthly three times. Those in the usual care group were instructed to
continue their normal life. The patient characteristics form and The
Pittsburgh Sleep Quality Index (PSQI) were used for data collection.
Results: Based on Independent Samples T Test; the mean PSQI score in the
self-care interventions group decreased to 7.13 +/- 2.26 after the
application of the self-care intervention, while it increased to 9.54 +/-
2.14 in the control group. There were not any baseline difference between
the two groups in terms of the mean PSQI score p = 0.91 before the start
of this study, but the difference between the mean PSQI scores in the two
groups was statistically high after the application of the self-care
interventions (p =< 0.001). Conclusions: Post CABG patients may benefit
from participating in self-care interventions for improving their quality
of sleep. Additional research in self-care interventions along with
cognitive behavioral therapy also may be beneficial.

<101>
Accession Number
624030564
Title
Constrictive pericarditis as the first presentation of systemic lupus
erythematosus: A case report and literature review.
Source
Lupus Science and Medicine. Conference: 11th European Lupus Meeting.
Germany. 5 (Supplement 1) (pp A126-A127), 2018. Date of Publication: March
2018.
Author
Jethwa H.; Rana M.; Kitt J.; Democratis J.; Menzies S.; Steuer A.; Gindea
S.
Institution
(Jethwa, Rana, Democratis, Menzies, Steuer, Gindea) Wexham Park Hospital,
Slough, United Kingdom
(Kitt) South Buckinghamshire Trust, South Buckinghamshire, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Objective Although fibrinous and exudative pericarditis is a common
feature of Systemic lupus erythematosus (SLE), found in 62% of lupus
patients on autopsy, very few cases progress to (effusive) - constrictive
pericarditis. We describe the unusual occurrence of constrictive
pericarditis (CP) in a patient with Systemic Lupus Erythematosus. Methods
This is a chart review- based report of a lupus patient who had
constrictive pericarditis as a presenting feature and a systematic
literature review of previously published cases. We searched the English
medical literature from 1963 to 2016 using PubMed, for terms: 'systemic
lupus erythematosus' and 'constrictive pericarditis'. Results A 49 year
old African man presented with several weeks of malaise, weight loss,
cough, breathlessness, peripheral oedema and hepatomegaly suggestive of
right ventricular failure. An echocardiogram demonstrated features of
effusive-constrictive pericarditis. The patient was initially treated for
suspected tuberculosis; his symptoms progressed in spite of treatment.
Further investigations confirmed positive lupus serology (ANA, anti-dsDNA
Ab and anti-Sm Ab, low complement levels) and a raised urine protein:
creatinine ratio of 177 mg/mmol. A diagnosis of SLE was established and
treatment with Hydroxychloroquine and Prednisolone was initiated. However,
the CP was refractory to medical management eventually requiring
Pericardiectomy. A literature review identified six other cases of lupus
patients with CP. Of these, four patients were male and average age was 38
years. CP was the presenting feature in four cases and TB was part of the
differential diagnosis in five cases. The progression from exudative to
constrictive pericarditis ranged from one week to six months. Pericardial
biopsies performed in four cases showed non-specific chronic inflammation
and fibrosis. CP resolved with corticosteroid treatment alone in one case;
pericardectomy was necessary in the other five cases for symptom
resolution. Conclusions SLE should be included in differential diagnosis
of constrictive pericarditis, especially in 'idiopathic' cases and in the
context of poor response to tuberculosis treatment. Pericardial biopsy
remains a crucial test in excluding an infectious or malignant aetiology,
although the histological findings are typically non-specific for a
diagnosis of lupusrelated pericarditis. Pericardectomy is likely to be
required for definitive treatment.