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<1>
Accession Number
2000828202
Title
Do surgeons and patients/parents value shared decision-making in pediatric
surgery? A systematic review.
Source
Journal of Surgical Research. 231 (pp 49-53), 2018. Date of Publication:
November 2018.
Author
Carlisle E.M.; Shinkunas L.A.; Kaldjian L.C.
Institution
(Carlisle) Department of Surgery, University of Iowa Hospitals and
Clinics, Iowa City, Iowa, United States
(Shinkunas, Kaldjian) Program in Bioethics and Humanities, University of
Iowa Carver College of Medicine, Iowa City, Iowa, United States
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Background: Shared decision-making (SDM) is touted as the preferred
approach to clinical counseling. However, few data exist regarding whether
patients prefer SDM over surgeon-guided discussions for complex surgical
decision-making. Even fewer data exist regarding surgeon preferences. Such
issues may be especially pronounced in pediatric surgery given the complex
decision-making triad between patients/parents and surgeons. The objective
of this systematic review was to evaluate patient/parent and surgeon
attitudes toward SDM in pediatric surgery. Methods: A systematic review of
English language articles in Medline, EMBASE, and Cochrane databases was
performed. Inclusion and exclusion criteria were predefined. Text
screening and data abstraction were performed by two investigators.
Results: Seven thousand five hundred eighty-four articles were screened.
Title/abstract review excluded 7544 articles, and full-text review
excluded four articles. Thirty-six articles were identified as addressing
patient/parent or surgeon preferences toward SDM in pediatric surgery.
Subspecialties included Otolaryngology (33%), General Surgery (30%),
Plastics (14%), Cardiac (11%), Urology (8%), Neurosurgery (6%),
Orthopedics (6%), and Gynecology (3%). Most studies (94%) evaluated
elective/nonurgent procedures. The majority (97%) concentrated on
patient/parent preferences, whereas only 22% addressed surgeon
preferences. Eleven percent of studies found that surgeons favored SDM,
and 73% demonstrated that patients/parents favored SDM. Conclusions:
Despite recommendations that SDM is the preferred approach to clinical
counseling, our systematic literature review shows that few studies
evaluate patient/parent and surgeon attitudes toward SDM in pediatric
surgery. Of these studies, very few focus on complex, urgent/emergent
decision-making. Further research is needed to understand whether
patients/parents, as well as surgeons, may prefer a more surgeon-guided
approach to decision-making, especially when surgery is complex or taking
place in urgent/emergent settings.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<2>
Accession Number
2000570647
Title
Clinical Outcomes after Pulmonary Cryoablation with the Use of a Triple
Freeze Protocol.
Source
Journal of Vascular and Interventional Radiology. 29 (5) (pp 714-721),
2018. Date of Publication: May 2018.
Author
Lyons G.R.; Askin G.; Pua B.B.
Institution
(Lyons, Pua) Department of Radiology, NewYork-Presbyterian Hospital/Weill
Cornell Medicine, 525 East 68th Street, New York, NY 10065, United States
(Askin) Department of Biostatistics and Epidemiology, NewYork-Presbyterian
Hospital/Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Purpose: To elucidate clinical variables associated with safety and
efficacy in patients after cryoablation of pulmonary tumors with the use
of a triple freeze protocol. Materials and Methods: Percutaneous
cryoablation of pulmonary tumors was performed using Galil Medical
cryoprobes (Arden Hills, Minnesota) with a triple freeze protocol: 67
nodules in 42 patients were treated at a single institution from 2012 to
2016. Average nodule diameter was 1.6 cm (range 0.4-5.9); 13 nodules
(19.4%) were pathologically determined to be a primary lung malignancy,
whereas 54 (80.6%) were metastatic nodules of extrapulmonary origin.
Average patient age was 68.1 years (range 39.6-89.6), and the male-female
ratio was 1.3:1. Ipsilateral thoracic surgery, intervention, or
radiotherapy had been performed before the first cryoablation in 18
patients (42.9%). Mean imaging follow-up was 326 days (range 9-1,152).
Results: Pneumothorax occurred in 19 cases (33.9%), 7 (12.5%) requiring
chest tube, the likelihood of which was significantly greater in patients
with 3 or more cryoprobes (P <.01). Local tumor recurrence/residual
disease occurred in 6 cases (9.0%). Local tumor recurrence was not seen
after ablation of nodules measuring <1.0 cm at the time of procedure, a
significant difference from the recurrence ratee of 14.3% for nodules
measuring >=1.0 cm (P <.05). Likelihood of tumor recurrence/residual
disease did not correlate with tumor pathology, tumor location, or
procedural factors. The estimated marginal probabilities of local
recurrence were 11.4%, 11.4%, and 38.1% at 1, 2, and 3 years after
ablation, respectively. Conclusions: Cryoablation of pulmonary tumors with
the use of a triple freeze protocol is a viable modality with low
recurrence and complication rates.<br/>Copyright &#xa9; 2018 SIR

<3>
Accession Number
624077339
Title
Six-month outcomes after restrictive or liberal transfusion for cardiac
surgery.
Source
New England Journal of Medicine. 379 (13) (pp 1224-1233), 2018. Date of
Publication: 27 Sep 2018.
Author
Mazer C.D.; Whitlock R.P.; Fergusson D.A.; Belley-Cote E.; Connolly K.;
Khanykin B.; Gregory A.J.; De Medicis E.; Carrier F.M.; McGuinness S.;
Young P.J.; Byrne K.; Villar J.C.; Royse A.; Grocott H.P.; Seeberger M.D.;
Mehta C.; Lellouche F.; Hare G.M.T.; Painter T.W.; Fremes S.; Syed S.;
Bagshaw S.M.; Hwang N.-C.; Royse C.; Hall J.; Dai D.; Mistry N.; Thorpe
K.; Verma S.; Juni P.; Shehata N.
Institution
(Mazer, Hare, Mistry) Department of Anesthesia, St. Michael's Hospital,
University of Toronto, 30 Bond St., Toronto, ON M5B 1W8, Canada
(Verma) Department of Surgery, Division of Cardiac Surgery, Keenan
Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute of
St. Michael's Hospital, Canada
(Mazer, Hare, Thorpe, Verma, Juni) St. Michael's Hospital, Keenan Research
Centre for Biomedical Science, Li Ka Shing Knowledge Institute of St.
Michael's Hospital, Canada
(Hall, Dai, Thorpe, Verma, Juni) Applied Health Research Centre,
University of Toronto, Canadian Blood Services, Toronto, Canada
(Fremes) Sunnybrook Health Sciences Centre, University of Toronto,
Canadian Blood Services, Toronto, Canada
(Shehata) Division of Hematology, Mount Sinai Hospital, University of
Toronto, Canadian Blood Services, Toronto, Canada
(Juni, Shehata) Department of Medicine, University of Toronto, Canadian
Blood Services, Toronto, Canada
(Mazer, Hare) Department of Physiology, University of Toronto, Canadian
Blood Services, Toronto, Canada
(Shehata) Laboratory Medicine and Pathobiology, University of Toronto,
Canadian Blood Services, Toronto, Canada
(Thorpe) Dalla Lana School of Public Health, University of Toronto,
Canadian Blood Services, Toronto, Canada
(Shehata) Institute of Health Policy, Management and Evaluation,
University of Toronto, Canadian Blood Services, Toronto, Canada
(Whitlock, Belley-Cote) Population Health Research Institute, Hamilton,
ON, Canada
(Whitlock, Belley-Cote, Connolly, Syed) Hamilton Health Sciences Center,
Hamilton, ON, Canada
(Whitlock, Belley-Cote, Connolly, Syed) McMaster University, Hamilton, ON,
Canada
(Fergusson) Ottawa Hospital Research Institute, University of Ottawa,
Ottawa, Canada
(Gregory) Cumming School of Medicine, Libin Cardiovascular Institute,
University of Calgary, Calgary, Canada
(Bagshaw) Department of Critical Care Medicine, Faculty of Medicine and
Dentistry, University of Alberta, Edmonton, Canada
(De Medicis) CHUS-Centre Hospitalier Universitaire de Sherbrooke,
Sherbrooke, Canada
(Lellouche) Department of Anesthesiology and Critical Care Medicine,
Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Laval
University, Laval, QC, Canada
(Carrier) Departments of Anesthesia and Medicine, Division of Critical
Care, Centre Hospitalier de L'Universite de Montreal, Montreal, Canada
(Grocott) Department of Anesthesia, Perioperative and Pain Medicine, St.
Boniface Hospital, University of Manitoba, Winnipeg, Canada
(Khanykin) Department of Cardiothoracic Anesthesia, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Canada
(McGuinness, Young) Medical Research Institute of New Zealand, Wellington,
New Zealand
(Byrne) Waikato Hospital, Hamilton, New Zealand
(Villar) Fundacion Cardioinfantil-Instituto de Cardiologia, Universidad
Autonoma de Bucaramanga, Bucaramanga, Colombia
(Royse, Royse) Department of Surgery, University of Melbournel, Melbourne,
VIC, Australia
(Royse) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, VIC, Australia
(Painter) Department of Anaesthesia, Royal Adelaide Hospital, Discipline
of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
(Seeberger) University of Basel, Department of Anesthesia, Surgical
Intensive Care, Prehospital Emergency Medicine and Pain Therapy,
University Hospital Basel, Basel, Switzerland
(Seeberger) Klinik Hirslanden Zurich, Zurich, Switzerland
(Mehta) Heart Care Associates, SAL Hospital, Gujarat, India
(Hwang) Department of Cardiothoracic Anaesthesia, National Heart Center,
Singapore, Singapore
(Hwang) Department of Anaesthesiology, Singapore General Hospital,
Singapore, Singapore
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND We reported previously that, in patients undergoing cardiac
surgery who were at moderate-to-high risk for death, a restrictive
transfusion strategy was noninferior to a liberal strategy with respect to
the composite outcome of death from any cause, myocardial infarction,
stroke, or new-onset renal failure with dialysis by hospital discharge or
28 days after surgery, whichever came first. We now report the clinical
outcomes at 6 months after surgery. METHODS We randomly assigned 5243
adults undergoing cardiac surgery to a restrictive red-cell transfusion
strategy (transfusion if the hemoglobin concentration was <7.5 g per
deciliter intraoperatively or postoperatively) or a liberal red-cell
transfusion strategy (transfusion if the hemoglobin concentration was <9.5
g per deciliter intraoperatively or postoperatively when the patient was
in the intensive care unit [ICU] or was <8.5 g per deciliter when the
patient was in the non-ICU ward). The primary composite outcome was death
from any cause, myocardial infarction, stroke, or newonset renal failure
with dialysis occurring within 6 months after the initial surgery. An
expanded secondary composite outcome included all the components of the
primary outcome as well as emergency department visit, hospital
readmission, or coronary revascularization occurring within 6 months after
the index surgery. The secondary outcomes included the individual
components of the two composite outcomes. RESULTS At 6 months after
surgery, the primary composite outcome had occurred in 402 of 2317
patients (17.4%) in the restrictive-threshold group and in 402 of 2347
patients (17.1%) in the liberal-threshold group (absolute risk difference
before rounding, 0.22 percentage points; 95% confidence interval [CI],
-1.95 to 2.39; odds ratio, 1.02; 95% CI, 0.87 to 1.18; P = 0.006 for
noninferiority). Mortality was 6.2% in the restrictive-threshold group and
6.4% in the liberal-threshold group (odds ratio, 0.95; 95% CI, 0.75 to
1.21). There were no significant between-group differences in the
secondary outcomes. CONCLUSIONS In patients undergoing cardiac surgery who
were at moderate-to-high risk for death, a restrictive strategy for
red-cell transfusion was noninferior to a liberal strategy with respect to
the composite outcome of death from any cause, myocardial infarction,
stroke, or new-onset renal failure with dialysis at 6 months after
surgery.<br/>Copyright &#xa9; 2018 Massachusetts Medical Society.

<4>
Accession Number
618813138
Title
Coronary artery bypass grafting versus percutaneous coronary intervention
in patients with noninsulin treated type 2 diabetes mellitus: A
meta-analysis of randomized controlled trials.
Source
Diabetes/Metabolism Research and Reviews. 34 (1) (no pagination), 2018.
Article Number: e2951. Date of Publication: January 2018.
Author
Wang Y.; Wen M.; Zhou J.; Chen Y.; Zhang Q.
Institution
(Wang, Wen, Zhou, Chen, Zhang) Department of Cardiology, West China
Hospital, Sichuan University, Chengdu, China
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: The outcomes and prognosis of revascularization by either
coronary artery bypass grafting (CABG) surgery or percutaneous coronary
intervention (PCI) in patients with noninsulin-treated type 2 diabetes
mellitus (NITDM) have not yet been well established. Methods: Randomized
controlled trials (RCTs) were identified by searching Pubmed, EMBASE, and
Cochrane library from inception until May 2016. Heterogeneity was
evaluated, and the pooled hazard ratio (HR) was calculated by using a
fixed-effect model. A random-effect model was used when statistically
significant heterogeneity was observed (I² >= 50%). All data
analyses were carried out by using RevMan 5.3 and STATA software 12.0.
Results: A total of 4 RCTs involving 5 studies, consisting of 2270
patients with noninsulin-treated type 2 diabetes mellitus, were
identified. Compared with CABG-treated patients, PCI-treated patients had
significantly higher all-cause mortality (HR 1.39; 95% CI 1.01 to 1.91; P
=.04), myocardial infarction (HR 2.14; 95% CI 1.40 to 3.27; P =.0004),
repeated revascularization (HR 2.52; 95% CI 1.77 to 3.57; P <.00001), and
major adverse cardiovascular and cerebrovascular events (HR 1.50; 95% CI
1.20-1.87; P =.0004). However, PCI was associated with lower incidence of
stoke (HR 0.47; 95% CI 0.24 to 0.90; P =.02). Conclusions: In NITDM
patients, our study suggests that CABG surgery is associated with reduced
risk of mortality and morbidity, although with increased incidence of
stroke compared with percutaneous coronary intervention. The decision if
to have percutaneous coronary intervention or CABG surgery should factor
the risk for stroke of the patients when considering CABG over
percutaneous coronary intervention. Adequately powered RCTs are needed to
confirm the results of this meta-analysis.<br/>Copyright &#xa9; 2017 John
Wiley & Sons, Ltd.

<5>
Accession Number
619342048
Title
The role of platelet reactivity assessment in dual antiplatelet
prophylaxis after transcatheter aortic valve implantation.
Source
Archives of Cardiovascular Diseases. 111 (4) (pp 233-245), 2018. Date of
Publication: April 2018.
Author
Czerwinska-Jelonkiewicz K.; Witkowski A.; Dabrowski M.; Piotrowski W.;
Hryniewiecki T.; Stepinska J.
Institution
(Czerwinska-Jelonkiewicz, Stepinska) Intensive Cardiac Therapy Department,
Institute of Cardiology, Warsaw, Poland
(Witkowski, Dabrowski) Department of Cardiology and Interventional
Angiology, Institute of Cardiology, Warsaw, Poland
(Piotrowski) Department of Epidemiology, Institute of Cardiology, Warsaw,
Poland
(Hryniewiecki) Department of Acquired Valvular Heart Disease, Institute of
Cardiology, Warsaw, Poland
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background: Dual antiplatelet therapy (DAPT) is recommended prophylaxis
after transcatheter aortic valve implantation (TAVI). The usefulness of
platelet reactivity (PLTR) tests in predicting the safety of
periprocedural DAPT in the TAVI population is unknown. Aim: To analyze the
value of aspirin/clopidogrel PLTR testing in predicting the risk of
in-hospital TAVI-related bleeding. Methods: PLTR, expressed as
P2Y<inf>12</inf>/aspirin reaction units (PRU/ARU), was performed using
optical aggregometry with the VerifyNow device, in the 24 h
before and on the sixth day after TAVI. Follow-up was by telephone.
Bleeding was defined according to VARC-2, and comprised in-hospital, major
and life-threatening events. Results: Overall, 100 patients undergoing
TAVI were included; 30 (30%) had bleeding. Clopidogrel PLTR before TAVI
(area under the curve [AUC] 0.686, 95% confidence interval [CI]
0.542-0.808; P = 0.02) and after TAVI (AUC 0.970, 95% CI 0.904-0.995; P <
0.001) correlated with bleeding, with PRU cut-off values of <=204 and
<=124 as bleeding predictors, respectively. A significant periprocedural
decrease in clopidogrel PLTR was noted, with a PRU drop of >78 as bleeding
predictor (AUC 0.851, 95% CI 0.725-0.935; P < 0.001). Only postprocedural
aspirin PLTR was associated with bleeding (AUC 0.697, 95% CI 0.585-0.794;
P = 0.008). Follow-up (359 +/- 73 days after TAVI) included 85 patients
(85%) (after exclusion for in-hospital death [n = 4] and lack of contact
[n = 11]). Major bleeding was noted in four patients (4.7%), all on
combined prophylaxis. Conclusions: TAVI-related bleeding occurs mainly
during the procedure or in the early postprocedural period. Testing of
periprocedural clopidogrel PLTR, but not aspirin PLTR, seems useful
because of its predictive value for TAVI-related bleeding. PLTR testing
suggests that premedication with clopidogrel, enhanced response to
clopidogrel early after TAVI and significant periprocedural drop in
clopidogrel PLTR might increase the risk of TAVI-related
bleeding.<br/>Copyright &#xa9; 2017 Elsevier Masson SAS

<6>
Accession Number
619074939
Title
The effect of tranexamic acid to reduce blood loss and transfusion on
off-pump coronary artery bypass surgery: A systematic review and
cumulative meta-analysis.
Source
Journal of Clinical Anesthesia. 44 (pp 23-31), 2018. Date of Publication:
January 2018.
Author
Dai Z.; Chu H.; Wang S.; Liang Y.
Institution
(Dai, Chu, Wang, Liang) Department of Anesthesiology, The Affiliated
Hospital of Qingdao University, 16 Jiangsu Road, Qingdao 276000, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study Objective To assess the safety and efficacy of tranexamic acid (TA)
on off-pump coronary artery bypass (OPCAB) surgery. Design Meta-analysis.
Setting Operating room, OPCAB surgery, all surgeries were elective
measurements. Searching the following data sources respectively:
PubMed/MEDLINE, the Cochrane Library, EMBASE and reference lists of
identified articles, we performed a meta-analysis of postoperative 24 h
blood loss, postoperative allogeneic transfusion, re-operation for massive
bleeding, postoperative mortality, and postoperative thrombotic
complications. Main results Using electronic databases, we selected 15
randomized control trials (RCTs), carried out between 2003 and 2016, with
a total of 1250 patients for our review. TA significantly reduced the
postoperative 24 h blood loss (mean difference - 213.32 ml, 95% confidence
intervals, - 247.20 ml to - 179.43 ml; P < 0.0001). And, TA also
significantly reduced the risk of packed red blood cell (PRBCs)
transfusion (risk ratio 0.62; 95% confidence intervals 0.51 to 0.76; P <
0.0001) and fresh frozen plasma (FFP) transfusion (0.65; 0.52 to 0.81; P <
0.001). There were no statistical significance on platelet transfusion
(risk difference - 0.00, 95% confidence interval - 0.02 to 0.02; P = 0.73)
and re-operation (0.00, - 0.02 to 0.02; P = 1.00). No association was
found between TA and morbility (risk difference - 0.00, 95% confidence
interval - 0.02 to 0.02; P = 0.99) and thrombotic complications (- 0.01, -
0.01 to 0.02; P = 0.70). Conclusions TA reduced the probability of
receiving a PRBCs and FFP transfusion during OPCAB surgery. And no
association with postoperative death and thrombotic events was found.
However, further trials with an appropriate sample size are required to
confirm TA safety in OPCAB surgery.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<7>
Accession Number
622281712
Title
Anticancer Drug-Related Nonvalvular Atrial Fibrillation: Challenges in
Management and Antithrombotic Strategies.
Source
Seminars in Thrombosis and Hemostasis. 44 (4) (pp 388-396), 2018. Date of
Publication: 01 Jun 2018.
Author
Tufano A.; Galderisi M.; Esposito L.; Trimarco V.; Sorriento D.; Gerusalem
G.; Picardi M.; Lancellotti P.; Pane F.
Institution
(Tufano, Picardi, Pane) Department of Clinical Medicine and Surgery,
Regional Reference Centre for Coagulation Disorders, Federico II
University Hospital, Via S. Pansini, 5, Naples 80131, Italy
(Galderisi, Esposito, Sorriento) Dipartimento di Scienze Biomediche
Avanzate, Universita Federico II, Napoli, Italy
(Trimarco) Dipartimento di Neuroscienze e Scienze Riproduttive Ed
Odontostomatologiche, Universita Federico II, Napoli, Italy
(Gerusalem) Department of Medical Oncology, CHU Sart Tilman Liege, Liege
University, Liege, Belgium
(Lancellotti) University of Liege Hospital, GIGA Cardiovascular Sciences,
Department of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liege,
Belgium
(Lancellotti) Gruppo Villa Maria Care and Research, Anthea, Hospital,
Bari, Italy
Publisher
Thieme Medical Publishers, Inc. (E-mail: custserv@thieme.com)
Abstract
Cancer patients may experience nonvalvular atrial fibrillation (AF) as a
manifestation of cardiotoxicity. AF may be a direct effect of a neoplasm
or, more often, appear as a postsurgical complication, especially after
thoracic surgery. AF may also develop as a consequence of anticancer
therapy (chemotherapy or radiotherapy), a condition probably
underestimated. Cancer patients with AF require a multidisciplinary
approach involving oncologists/hematologists, cardiologists, and
coagulation experts. An echocardiogram should be performed to detect
possible abnormalities of left ventricular systolic and diastolic
function, as well as left atrial dilation and the existence of valvular
heart disease, to determine pretest probability of sinus rhythm
restoration, and identify the best treatment. The choice of antiarrhythmic
treatment in cancer patients may be difficult because scanty information
is available on the interactions between anticancer agents and
antiarrhythmic drugs. A careful evaluation of the antithrombotic strategy
with the best efficacy/safety ratio is always needed. The use of vitamin K
antagonists (VKAs) may be problematic because of the unpredictable
therapeutic response and high bleeding risk in patients with active cancer
who are undergoing chemotherapy and who may experience thrombocytopenia
and changes in renal or hepatic function. Low molecular weight heparins
(in particular for short and intermediate periods) and non-VKA oral
anticoagulants (NOACs) should be preferred. However, the possible
pharmacological interactions of NOACs with both anticancer and
antiarrhythmic drugs should be considered. Based on all these
considerations, antiarrhythmic and anticoagulant therapy for AF should be
tailored individually for each patient.<br/>&#xa9; Copyright 2018 by
Thieme Medical Publishers, Inc.

<8>
Accession Number
622279321
Title
Levosimendan in Patients with Left Ventricular Dysfunction Undergoing
Cardiac Surgery: An Update Meta-Analysis and Trial Sequential Analysis.
Source
BioMed Research International. 2018 (no pagination), 2018. Article Number:
7563083. Date of Publication: 2018.
Author
Wang B.; He X.; Gong Y.; Cheng B.
Institution
(Wang, Gong, Cheng) Department of Anesthesiology, Critical Care and Pain
Medicine, Second Affiliated Hospital, Yuying Children's Hospital of
Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
(He) School of Ophthalmology and Optometry and Eye Hospital, Wenzhou
Medical University, Wenzhou, Zhejiang 325000, China
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Background. Recent studies suggest that levosimendan does not provide
mortality benefit in patients with low cardiac output syndrome undergoing
cardiac surgery. These results conflict with previous findings. The aim of
the current study is to assess whether levosimendan reduces postoperative
mortality in patients with impaired left ventricular function (mean EF <=
40%) undergoing cardiac surgery. Methods. We conducted a comprehensive
search of PubMed, EMBASE, and Cochrane Library Database through November
20, 2017. Inclusion criteria were random allocation to treatment with at
least one group receiving levosimendan and another group receiving placebo
or other treatments and cardiac surgery patients with a left ventricular
ejection fraction of 40% or less. The primary endpoint was postoperative
mortality. Secondary outcomes were cardiac index, pulmonary capillary
wedge pressure (PCWP), length of intensive care unit (ICU) stay,
postoperative atrial fibrillation, and postoperative renal replacement
therapy. We performed trial sequential analysis (TSA) to evaluate the
reliability of the primary endpoint. Results. Data from 2,152 patients in
15 randomized clinical trials were analyzed. Pooled results demonstrated a
reduction in postoperative mortality in the levosimendan group [RR = 0.53,
95% CI (0.38-0.73), I2=0]. However, the result of TSA showed that the
conclusion may be a false positive. Secondary outcomes demonstrated that
PCWP, postoperative renal replacement therapy, and length of ICU stay were
significantly reduced. Cardiac index was greater in the levosimendan
group. No difference was found in the rate of postoperative atrial
fibrillation. Conclusions. Levosimendan reduces the rate of death and
other adverse outcomes in patients with low ejection fraction who were
undergoing cardiac surgery, but results remain inconclusive. More
large-volume randomized clinical trials (RCTs) are
warranted.<br/>Copyright &#xa9; 2018 Benji Wang et al.

<9>
Accession Number
618872541
Title
Shifting transcatheter aortic valve implantation to low-risk patients: A
pilgrimage with no shortcuts.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 3 (4) (pp
258-261), 2017. Date of Publication: 01 Oct 2017.
Author
Alfonso F.; Trillo R.; Moris C.
Institution
(Alfonso) Department of Cardiology, Hospital Universitario de la Princesa,
Instituto de Investigacion Sanitaria Princesa, Universidad Autonoma de
Madrid, IIS-IP, Diego de Leon 62, Madrid 28006, Spain
(Trillo) Department of Cardiology, Hospital Universitario de Santiago de
Compostela, La Coruna, Spain
(Moris) Department of Cardiology, Hospital Universitario Central de
Asturias, Oviedo, Spain
Publisher
Oxford University Press

<10>
Accession Number
624073315
Title
Effects of methylprednisolone on blood-brain barrier and cerebral
inflammation in cardiac surgery - A randomized trial 11 Medical and Health
Sciences 1103 Clinical Sciences 11 Medical and Health Sciences 1109
Neurosciences.
Source
Journal of Neuroinflammation. 15 (1) (no pagination), 2018. Article
Number: 283. Date of Publication: 27 Sep 2018.
Author
Danielson M.; Reinsfelt B.; Westerlind A.; Zetterberg H.; Blennow K.;
Ricksten S.-E.
Institution
(Danielson, Reinsfelt, Westerlind, Ricksten) Department of Anesthesiology
and Intensive Care Medicine, Sahlgrenska University Hospital, University
of Gothenburg, Gothenburg SE-413 45, Sweden
(Zetterberg, Blennow) Deparment of Anesthesiology and Intensive Care
Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University
of Gothenburg, Gothenburg SE-41345, Sweden
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Cognitive dysfunction is a frequent complication to open-heart
surgery. Cerebral inflammation caused by blood-brain barrier (BBB)
dysfunction due to a systemic inflammatory response is considered a
possible etiology. The effects of the glucocorticoid, methylprednisolone,
on cerebrospinal fluid (CSF) markers of BBB function, neuroinflammation,
and brain injury in patients undergoing cardiac surgery with
cardiopulmonary bypass were studied. Methods: In this prospective,
randomized, blinded study, 30 patients scheduled for elective surgical
aortic valve replacement were randomized to methylprednisolone 15 mg/kg (n
= 15) or placebo (n = 15) as a bolus dose administered after induction of
anesthesia. CSF and blood samples were obtained the day before and 24 h
after surgery for assessment of systemic and brain inflammation
(interleukin-6, interleukin-8, tumor necrosis factor-alpha), axonal injury
(total-tau, neurofilament light chain protein), neuronal injury
(neuron-specific enolase), astroglial injury (S-100B, glial fibrillary
acidic protein), and the BBB integrity (CSF/serum albumin ratio). Results:
In the control group, there was a 54-fold and 17-fold increase in serum
interleukin-6 and interleukin-8, respectively. This systemic activation of
the inflammatory cytokines was clearly attenuated by methylprednisolone (p
< 0.001). The increase of the CSF levels of the astroglial markers was not
affected. A postoperative BBB dysfunction was seen in both groups as the
CSF/serum albumin ratio increased from 6.4 +/- 8.0 to 8.0 in the placebo
group (p < 0.01) and from 5.6 +/- 2.3 to 7.2 in the methylprednisolone
group (p < 0.01) with no difference between groups (p = 0.98). In the CSF,
methylprednisolone attenuated the interleukin-6 release (p < 0.001), which
could be explained by the fall in systemic interleukin-6, and the serum to
CSF gradient of IL-6 seen both at baseline and after surgery. In the CSF,
methylprednisolone enhanced the interleukin-8 release (p < 0.001) but did
not affect postoperative changes in CSF levels of tumor necrosis factor
alpha. Serum levels of S-100B and neuron-specific enolase increased in
both groups with no difference between groups. CSF levels of total tau,
neurofilament light chain protein, and neuron-specific enolase were not
affected in any of the groups. Conclusions: Preventive treatment with
high-dose methylprednisolone attenuated the systemic inflammatory response
to open-heart surgery with cardiopulmonary bypass, but did not prevent or
attenuate the increase in BBB permeability or the neuroinflammatory
response. Trial registration: Clinical Trials, Identifier: NCT01755338,
registered 24 December 2012<br/>Copyright &#xa9; 2018 The Author(s).

<11>
Accession Number
2000822917
Title
A role for very low-dose recombinant activated factor VII in refractory
bleeding after cardiac surgery: Lessons from an observational study.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (4) (pp 1564-1573.e8),
2018. Date of Publication: October 2018.
Author
Hoffmann T.; Assmann A.; Dierksen A.; Roussel E.; Ullrich S.; Lichtenberg
A.; Albert A.; Sixt S.
Institution
(Hoffmann, Roussel) Transfusion Medicine and Clinical Haemostaseology,
United States
(Assmann, Dierksen, Lichtenberg, Albert) Department of Cardiovascular
Surgery, United States
(Ullrich) .05 Statistics Consultants, Life Science Centre, Duesseldorf,
Germany
(Sixt) Department of Anaesthesiology Heinrich Heine University, Medical
Faculty, Duesseldorf, Germany
(Assmann) Biomaterials Innovation Research Center, Brigham and Women's
Hospital, Department of Medicine, Harvard Medical School, Boston, Mass,
United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Although off-label use of recombinant activated factor VII
against refractory bleeding is incorporated in current guideline
recommendations, safety concerns persist predominantly with respect to
thromboembolic complications. We analyzed the safety and efficacy of
recombinant activated factor VII at a very low dose in cardiosurgical
patients with refractory bleeding. Methods: This prospective study
includes 1180 cardiosurgical patients at risk of bleeding. Goal-directed
substitution was based on real-time laboratory testing and clinical
scoring of the bleeding intensity. All patients who fulfilled the criteria
for enhanced risk of bleeding (n = 281) were consequently included in the
present analysis. Patients in whom refractory bleeding developed despite
substitution with specific hemostatic compounds (n = 167) received a
single shot of very low-dose recombinant activated factor VII (<=20
mug/kg). Mortality and risk of thromboembolic complications, and freedom
from stroke and acute myocardial infarction in particular, were analyzed
(vs patients without recombinant activated factor VII) by multivariable
logistic and Cox regression analyses, as well as Kaplan-Meier estimates.
Results: There was no increase in rates of mortality (30-day mortality
4.2% vs 7.0% with P =.418; follow-up survival 85.6% at 13.0 [interquartile
range, 8.4-15.7] months vs 80.7% at 10.2 [interquartile range, 7.2-16.1]
months with P =.151), thromboembolic complications (6.6% vs 9.6% with P
=.637), renal insufficiency, need for percutaneous coronary intervention,
duration of ventilation, duration of hospital stay, or rehospitalization
in patients receiving very low-dose recombinant activated factor VII
compared with patients not receiving recombinant activated factor VII.
Complete hemostasis without any need for further hemostatic treatment was
achieved after very low-dose recombinant activated factor VII
administration in the majority of patients (up to 88.6% vs 0% with P
<.001). The key results were confirmed after adjustment by propensity
score-based analyses. Conclusions: When combined with early and specific
restoration of hemostatic reserves after cardiac surgery, very low-dose
recombinant activated factor VII treatment of refractory bleeding is
effective and not associated with any apparent increase in adverse
events.<br/>Copyright &#xa9; 2018 The American Association for Thoracic
Surgery

<12>
Accession Number
2001003267
Title
Prognostic value of late gadolinium enhancement on CMR in patients with
severe aortic valve disease: a systematic review and meta-analysis.
Source
Clinical Radiology. 73 (11) (pp 983.e7-983.e14), 2018. Date of
Publication: November 2018.
Author
Chen H.; Zeng J.; Liu D.; Yang Q.
Institution
(Chen, Zeng, Liu, Yang) Department of Radiology, The Yongchuan Affiliated
Hospital, Chongqing Medical University, Xuan hua Road, Yongchuan District,
Chongqing 402160, China
Publisher
W.B. Saunders Ltd
Abstract
Aim: To evaluate the predictive value of late gadolinium enhancement (LGE)
on cardiac magnetic resonance (CMR) in patients with severe aortic valve
disease. Materials and methods: PubMed, EMBASE, and Web of Science were
searched for studies applying LGE-CMR to assess prognostic significance in
patients with severe aortic valve disease and to measure myocardial
fibrosis (MF). The association of LGE with outcomes was estimated for each
study by an odds ratio (OR) along with its 95% confidence interval (CI).
Pooled estimates of ORs were calculated using a Mantel-Haenszel
fixed-effects model. Results: Six studies including 626 patients were
included in the meta-analysis. The follow-up period was from 0.5 to 5.7
years. The pooled OR was 3.28 (95% CI: 2.02-5.32; p<0.001) for LGE (+)
versus LGE (-) in predicting patients with aortic valve disease in
all-cause mortality. The presence of LGE was associated with
cardiovascular mortality (pooled OR: 3.10, 95% CI: 1.73-5.56; p<0.001).
The presence of LGE was associated with all-cause mortality in patients
with severe aortic stenosis after aortic valve replacement (pooled OR:
2.30, 95% CI: 1.06-4.99; p=0.036). CONCLUSION: LGE on CMR is a promising
risk stratification method, as it could predict all-cause mortality and
cardiovascular mortality in patients with aortic valve disease, especially
for aortic stenosis. LGE-CMR also has significant prognostic value in
patients after aortic valve replacement.<br/>Copyright &#xa9; 2018 The
Royal College of Radiologists

<13>
Accession Number
624089161
Title
Cerebral monitoring of anaesthesia on reducing cognitive dysfunction and
postoperative delirium: a systematic review.
Source
Journal of International Medical Research. 46 (10) (pp 4100-4110), 2018.
Date of Publication: 01 Oct 2018.
Author
Luo C.; Zou W.
Institution
(Luo) Department of Neurology, The People's Hospital of Yongchuan
District, Chongqing, China
(Zou) Department of Neurology, Yongchuan Hospital of Traditional Chinese
Medicine, Chongqing, China
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: To assess the efficacy of cerebrally monitoring the depth of
anaesthesia in reducing postoperative cognitive dysfunction and
postoperative delirium (POD). Methods: MEDLINE, EMBASE, and Cochrane
Library databases were searched following PRISMA statement guidelines. We
included randomized clinical trials (RCTs) comparing
electroencephalogram-based and routine care-guided titration of
anaesthesia in a systematic review. The risk estimate from each RCT was
pooled in a meta-analysis. The primary outcome was POD and long-term
cognitive dysfunction. Subgroup analyses were conducted for the subtypes
of intervention group and surgery. We identified five RCTs with a total
sample size of 2,868 and with bispectral index (BIS) or auditory evoked
potential (AEP) as interventions. Results: The odds ratio (OR) for POD and
long-term cognitive decline was 0.51 (95%CI: 0.35-0.76) and 0.69 (95%CI:
0.49-0.97), respectively. Significant heterogeneity was identified in the
POD data. There was no significant difference between BIS- and AEP-based
titration of anaesthesia in reducing the risk of POD. Extensive
heterogeneity for cardiac and thoracic surgery was identified in the study
population, and significant publication bias was found among the POD
results. Conclusions: BIS- and AEP-guided anaesthesia are associated with
significantly reduced risk of POD and long-term cognitive
dysfunction.<br/>Copyright &#xa9; The Author(s) 2018.

<14>
Accession Number
624103523
Title
Reassessing Coronary Artery Bypass Surgery Versus Percutaneous Coronary
Intervention in Patients with Type 2 Diabetes Mellitus: A Brief Updated
Analytical Report (2015-2017).
Source
Diabetes Therapy. 9 (5) (pp 2163-2171), 2018. Date of Publication: 01 Oct
2018.
Author
Dai X.; Luo Z.-C.; Zhai L.; Zhao W.-P.; Huang F.
Institution
(Dai, Zhai, Zhao) Department of Endocrinology, The First Affiliated
Hospital of Guangxi Medical University, Guangxi, China
(Luo) Department of Internal Medicine Education, The First Affiliated
Hospital of Guangxi Medical University, Guangxi, China
(Huang) Institute of Cardiovascular Diseases and Guangxi Key Laboratory
Base of Precision Medicine in Cardio-cerebrovascular Disease Control and
Prevention and Guangxi Clinical Research Center for Cardio-cerebrovascular
Diseases, The First Affiliated Hospital of Guangxi Medical University,
Guangxi, China
Publisher
Springer Healthcare (E-mail: kathleen.burke@springer.com)
Abstract
Introduction: In this analysis, we aimed to systematically compare
percutaneous coronary intervention (PCI) versus coronary artery bypass
surgery (CABG) in terms of adverse outcomes utilizing data from a recent
(2015-2017) population of patients with type 2 diabetes mellitus (T2DM).
Methods: An electronic search of recent studies (2015-2017) was carried
out using 'diabetes mellitus,' 'coronary artery bypass surgery,' and
'percutaneous coronary intervention' as the main search terms.
Uncomplicated T2DM patients with stable coronary artery disease (CAD),
left main CAD, and multi-vessel disease were included. RevMan software
(version 5.3) was used to calculate odds ratios (OR) and 95% confidence
intervals (CIs). Results: Among a total of 13,114 T2DM patients, CABG and
PCI patients did not differ significantly in their rates of mortality (OR
0.90, 95% CI 0.61-1.31; P = 0.57) and cardiac death (OR 1.00, 95% CI
0.78-1.30; P = 0.98). However, rates of major adverse events, repeat
revascularization, and myocardial infarction were significantly higher in
the PCI group. Stroke rates did not significantly differ between the two
groups. Conclusion: Mortality (1-5 years) did not significantly differ
between the CABG and PCI patients with T2DM. However, rates of other major
adverse events were significantly higher in the PCI patients, suggesting
that CABG is more advantageous than PCI in patients with
T2DM.<br/>Copyright &#xa9; 2018, The Author(s).

<15>
[Use Link to view the full text]
Accession Number
624135335
Title
The five-year clinical and angiographic follow-up outcomes of
intracoronary transfusion of circulation-derived cd34+ cells for patients
with end-stage diffuse coronary artery disease unsuitable for coronary
intervention - Phase i clinical trial.
Source
Critical Care Medicine. 46 (5) (pp e411-e418), 2018. Date of Publication:
01 May 2018.
Author
Sung P.-H.; Lee F.-Y.; Tong M.-S.; Chiang J.Y.; Pei S.-N.; Ma M.-C.; Li
Y.-C.; Chen Y.-L.; Wu C.-J.; Sheu J.-J.; Lee M.S.; Yip H.-K.
Institution
(Sung, Tong, Li, Chen, Wu, Yip) Division of Cardiology, Department of
Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung
University College of Medicine, Kaohsiung, Taiwan (Republic of China)
(Sung, Yip) Center for Shockwave Medicine and Tissue Engineering,
Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Republic of
China)
(Lee, Sheu) Division of Thoracic and Cardiovascular Surgery, Department of
Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University
College of Medicine, Kaohsiung, Taiwan (Republic of China)
(Chiang) Department of Computer Science and Engineering, National Sun
Yat-sen University, Kaohsiung, Taiwan (Republic of China)
(Chiang) Department of Healthcare Administration and Medical Informatics,
Kaohsiung Medical University, Kaohsiung, Taiwan (Republic of China)
(Pei, Ma) Division of Hema-Oncology, Department of Internal Medicine,
Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of
Medicine, Kaohsiung, Taiwan (Republic of China)
(Lee) Department of Orthopedics, Kaohsiung Chang Gung Memorial Hospital,
Chang Gung University, College of Medicine, Kaohsiung, Taiwan (Republic of
China)
(Yip) Institute for Translational Research in Biomedicine, Kaohsiung Chang
Gung Memorial Hospital, Chang Gung University, College of Medicine,
Kaohsiung, Taiwan (Republic of China)
(Yip) Department of Medical Research, China Medical University Hospital,
China Medical University, Taichung, Taiwan (Republic of China)
(Yip) Department of Nursing, Asia University, Taichung, Taiwan (Republic
of China)
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: This study investigated the clinical and angiographic
long-term outcomes of intracoronary transfusion of circulation-derived
CD34+ cells for patients with end-stage diffuse coronary artery disease
unsuitable for coronary intervention. Design and Setting: A single-center
prospective randomized double-blinded phase I clinical trial. Thirty-eight
patients undergoing CD34+ cell therapy were allocated into groups 1 (1.0 x
10 7 cells/each vessel; n = 18) and 2 (3.0 x 10 7 cells/each vessel; n =
20). Patients: Those with end-stage diffuse coronary artery disease were
unsuitable for percutaneous and surgical coronary revascularization.
Interventions: Intracoronary delivery of circulation-derived CD34+ cells.
Measurements and Main Results: We prospectively evaluated long-term
clinical and echocardiographic/angiographic outcomes between survivors and
nonsurvivors. By the end of 5-year follow-up, the survival rate and major
adverse cardio/cerebrovascular event were 78.9% (30/38) and 36.8% (14/38),
respectively. During follow-up period, 31.6% patients (12/38) received
coronary stenting for reason of sufficient target vessel size grown-up
after the treatment. Endothelial function was significantly reduced in the
nonsurvivors than the survivors (p = 0.039). Wimasis image analysis of
angiographic findings showed that the angiogenesis was significantly and
progressively increased from baseline to 1 and 5 years (all p < 0.001).
The 3D echocardiography showed left ventricular ejection fraction
increased from baseline to 1 year and then remained stable up to 5 years,
whereas left ventricular chamber diameter exhibited an opposite pattern to
left ventricular ejection fraction among the survivors. The clinical
scores for angina and heart failure were significantly progressively
reduced from baseline to 1 and 5 years (all p < 0.001). Conclusions: CD34+
cell therapy for end-stage diffuse coronary artery disease patients might
contribute to persistently long-term effects on improvement of left
ventricular function, angina/heart failure, and amelioration of left
ventricular remodeling.<br/>Copyright &#xa9; 2018 by the Society of
Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights
Reserved.

<16>
Accession Number
624193340
Title
Fluid resuscitation associated with elevated angiopoietin-2 and length of
mechanical ventilation after cardiac surgery.
Source
Critical care and resuscitation : journal of the Australasian Academy of
Critical Care Medicine. 20 (3) (pp 198-208), 2018. Date of Publication: 01
Sep 2018.
Author
Parke R.; Bihari S.; Dixon D.-L.; Gilder E.; Cavallaro E.; McGuinness S.;
Bersten A.D.
Institution
(Parke, Gilder, McGuinness) Cardiothoracic and Vascular Intensive Care
Unit, Auckland City Hospital, Auckland, New Zealand
(Bihari, Dixon, Bersten) Intensive and Critical Care Unit, Flinders
Medical Centre, Adelaide, SA, Australia
(Cavallaro) Critical Care Medicine, College of Medicine and Public Health,
Flinders University, Adelaide, SA, Australia
Abstract
BACKGROUND: Fluid restriction in patients with acute respiratory distress
syndrome increases ventilator-free days while lowering plasma
angiopoietin-2 (Ang-2), a marker of pulmonary endothelial injury. We
hypothesised that fluid resuscitation may lead to endothelial injury after
cardiac surgery and analysed Ang-2, angiopoietin-1 (Ang-1) and
phospholipase A2 (PLA2) levels and the impact of fluid management on
ventilation time.
METHODS: Patients enrolled in a single-centre, prospectively randomised
interventional study of liberal or conservative fluid resuscitation
strategy had plasma Ang-2, Ang-1 and PLA2 levels measured at baseline
(pre-operative), 6 and 24 hours after commencement of cardiopulmonary
bypass, and analysed by linear mixed models as liberal v conservative
(intention to treat) or high v low fluid group (actual treatment, >= 3250
mL of fluid administered), and further subclassified as EuroSCORE
(European System for Cardiac Operative Risk Evaluation) II >= 0.9 or <
0.9.
RESULTS: Over 9 months, 144 patients were randomly allocated to either
liberal (n =74) or conservative (n =70) fluid. Patients in the liberal
fluid arm tended to an increased Ang-2 (P =0.12) and had higher PLA2
levels (P =0.03). Based on actual fluid administered, Ang-2 levels were
higher, the Ang-1/Ang-2 ratio lower, and the length of mechanical
ventilation and intensive care unit (ICU) stay was longer in the high
fluid group (P < 0.001). The highest levels of Ang- 2 and corresponding
lowest Ang-1/Ang-2 ratio, along with longest length of mechanical
ventilation and ICU stay, were found with both the liberal and high fluid
groups in patients with a EuroSCORE II >= 0.9 (P < 0.01).
CONCLUSION: Liberal fluid resuscitation after cardiac surgery was
associated with both pulmonary endothelial injury and prolonged length of
mechanical ventilation.
CLINICAL TRIAL REGISTRATION: ACTRN12612000754842.

<17>
Accession Number
624193253
Title
Design and statistical analysis plan for a trial comparing a conservative
fluid management strategy with usual care in patients after cardiac
surgery: the FAB study.
Source
Critical care and resuscitation : journal of the Australasian Academy of
Critical Care Medicine. 20 (3) (pp 190-197), 2018. Date of Publication: 01
Sep 2018.
Author
Parke R.; Gilder E.; Gillham M.; Walker L.; Bailey M.; McGuinness S.
Institution
(Parke, Gilder, Gillham, Walker, McGuinness) Auckland City Hospital,
Auckland, New Zealand
(Bailey) Australian and New Zealand Intensive Care Research Centre, Monash
University, Melbourne, Australia
Abstract
BACKGROUND: Cardiac surgery is one of the most frequently performed major
surgical procedures. Following surgery, haemodynamic instability and
prevention of organ dysfunction may be treated in the intensive care unit
(ICU) with intravenous fluid, inotropes and vasopressors. In other
surgical groups, liberal intravenous fluid administration and a positive
fluid balance have been associated with adverse outcomes and increased
risk of morbidity and mortality. There is a paucity of evidence to guide
intravenous fluid administration in cardiac surgery patients. We have
previously shown that a protocol-guided strategy avoiding unnecessary
fluid administration significantly reduces fluid loading.
OBJECTIVE: To present the design and statistical analysis plan for a
randomised controlled trial comparing a conservative fluid management
strategy to usual care in patients after cardiac surgery.
METHODS: We designed a prospective, multicentre, parallel-group,
randomised controlled trial - the FAB (Fluids After Bypass) study. A total
of 700 patients undergoing cardiac surgery using cardiopulmonary bypass
who have a European System for Cardiac Operative Risk Evaluation
(EuroSCORE) II >= 0.9 will be enrolled in this study and randomly
allocated to a protocol-guided strategy using stroke volume variation to
guide administration of bolus fluid or to usual care fluid administration
in a 1:1 ratio, stratified by centre. Study treatment will be administered
from post-operative admission to the ICU until de-sedation or for a
24-hour period (whichever is shorter). The primary outcome is ICU length
of stay. Secondary endpoints include quality of life and disability-free
survival at 3 and 6 months after surgery, and process-of-care,
physiological and safety measures.
CONCLUSION: This trial aims to determine whether a protocol-guided
strategy that avoids unnecessary fluid administration reduces ICU length
of stay and improves outcomes in higher-risk adults undergoing cardiac
surgery.

<18>
Accession Number
2001161758
Title
Reclassification of Treatment Strategy With Instantaneous Wave-Free Ratio
and Fractional Flow Reserve: A Substudy From the iFR-SWEDEHEART Trial.
Source
JACC: Cardiovascular Interventions. 11 (20) (pp 2084-2094), 2018. Date of
Publication: 22 October 2018.
Author
Andell P.; Berntorp K.; Christiansen E.H.; Gudmundsdottir I.J.; Sandhall
L.; Venetsanos D.; Erlinge D.; Frobert O.; Koul S.; Reitan C.; Gotberg M.
Institution
(Andell, Berntorp, Erlinge, Koul, Reitan, Gotberg) Department of
Cardiology, Clinical Sciences, Lund University, Skane University Hospital,
Lund, Sweden
(Christiansen) Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark
(Gudmundsdottir) Department of Cardiology, University Hospital of Iceland,
Reykjavik, Iceland
(Sandhall) Departments of Cardiology and Radiology, Helsingborg Hospital,
Helsingborg, Sweden
(Venetsanos) Departments of Cardiology and of Medical and Health Sciences,
Linkoping University, Linkoping, Sweden
(Frobert) Department of Cardiology, Faculty of Health, Orebro University,
Orebro, Sweden
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The authors sought to compare reclassification of treatment
strategy following instantaneous wave-free ratio (iFR) and fractional flow
reserve (FFR). Background: iFR was noninferior to FFR in 2 large
randomized controlled trials in guiding coronary revascularization.
Reclassification of treatment strategy by FFR is well-studied, but similar
reports on iFR are lacking. Methods: The iFR-SWEDEHEART (Instantaneous
Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable
Angina Pectoris or Acute Coronary Syndrome Trial) study randomized 2,037
participants with stable angina or acute coronary syndrome to treatment
guided by iFR or FFR. Interventionalists entered the preferred treatment
(optimal medical therapy [OMT], percutaneous coronary intervention [PCI],
or coronary artery bypass grafting [CABG]) on the basis of coronary
angiograms, and the final treatment decision was mandated by the iFR/FFR
measurements. Results: In the iFR/FFR (n = 1,009/n = 1,004) populations,
angiogram-based treatment approaches were similar (p = 0.50) with respect
to OMT (38%/35%), PCI of 1 (37%/39%), 2 (15%/16%), and 3 vessels (2%/2%)
and CABG (8%/8%). iFR and FFR reclassified 40% and 41% of patients,
respectively (p = 0.78). The majority of reclassifications were conversion
of PCI to OMT in both the iFR/FFR groups (31.4%/29.0%). Reclassification
increased with increasing number of lesions evaluated (odds ratio per
evaluated lesion for FFR: 1.46 [95% confidence interval: 1.22 to 1.76] vs.
iFR 1.37 [95% confidence interval: 1.18 to 1.59]). Reclassification rates
for patients with 1, 2, and 3 assessed vessels were 36%, 52%, and 53% (p <
0.01). Conclusions: Reclassification of treatment strategy of intermediate
lesions was common and occurred in 40% of patients with iFR or FFR. The
most frequent reclassification was conversion from PCI to OMT regardless
of physiology modality. Irrespective of the physiological index
reclassification of angiogram-based treatment strategy increased with the
number of lesions evaluated.<br/>Copyright &#xa9; 2018 American College of
Cardiology Foundation

<19>
Accession Number
624183007
Title
Amaze: A randomized controlled trial of adjunct surgery for atrial
fibrillation.
Source
European Journal of Cardio-thoracic Surgery. 54 (4) (pp 729-737), 2018.
Date of Publication: 01 Oct 2018.
Author
Nashef S.A.M.; Fynn S.; Abu-Omar Y.; Spyt T.J.; Mills C.; Everett C.C.;
Fox-Rushby J.; Singh J.; Dalrymple-Hay M.; Sudarshan C.; Codispoti M.;
Braidley P.; Wells F.C.; Sharples L.D.
Institution
(Nashef, Abu-Omar, Sudarshan, Codispoti, Wells) Department of Surgery,
Papworth Hospital, Cambridge CB23 3RE, United Kingdom
(Fynn) Department of Cardiology, Papworth Hospital, Cambridge, United
Kingdom
(Spyt) Department of Cardiothoracic Surgery, Glenfield Hospital,
Leicester, United Kingdom
(Mills) Research and Development, Papworth Hospital, Cambridge, United
Kingdom
(Everett) Clinical Trials Unit, University of Leeds, Leeds, United Kingdom
(Fox-Rushby, Singh) Department of Health Economics, Brunel University,
London, United Kingdom
(Dalrymple-Hay) Department of Cardiothoracic Surgery, Plymouth Hospital,
Derriford Hospital, Plymouth, United Kingdom
(Braidley) Department of Cardiothoracic Surgery, Northern General
Hospital, Sheffield, United Kingdom
(Sharples) Department of Medical Statistics, London School of Hygiene and
Tropical Medicine, London, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES Atrial fibrillation (AF) reduces survival and quality of life
(QoL). It can be treated at the time of major cardiac surgery using
ablation procedures ranging from simple pulmonary vein isolation to a full
maze procedure. The aim of this study is to evaluate the impact of adjunct
AF surgery as currently performed on sinus rhythm (SR) restoration,
survival, QoL and cost-effectiveness. METHODS In a multicentre, Phase III,
pragmatic, double-blinded, parallel-armed randomized controlled trial, 352
cardiac surgery patients with >3 months of documented AF were randomized
to surgery with or without adjunct maze or similar AF ablation between
2009 and 2014. Primary outcomes were SR restoration at 1 year and
quality-adjusted life years at 2 years. Secondary outcomes included SR at
2 years, overall and stroke-free survival, medication, QoL,
cost-effectiveness and safety. RESULTS More ablation patients were in SR
at 1 year [odds ratio (OR) 2.06, 95% confidence interval (CI) 1.20-3.54; P
= 0.009]. At 2 years, the OR increased to 3.24 (95% CI 1.76-5.96).
Quality-adjusted life years were similar at 2 years (ablation - control
-0.025, P = 0.6319). Significantly fewer ablation patients were
anticoagulated from 6 months postoperatively. Stroke rates were 5.7%
(ablation) and 9.1% (control) (P = 0.3083). There was no significant
difference in stroke-free survival [hazard ratio (HR) = 0.99, 95% CI
0.64-1.53; P = 0.949] nor in serious adverse events, operative or overall
survival, cardioversion, pacemaker implantation, New York Heart
Association, EQ-5D-3L and SF-36. The mean additional ablation cost per
patient was 3533 (95% CI 1321-5746). Cost-effectiveness was not
demonstrated at 2 years. CONCLUSIONS Adjunct AF surgery is safe and
increases SR restoration and costs but not survival or QoL up to 2 years.
A continued follow-up will provide information on these outcomes in the
longer term. Study registration ISRCTN82731440 (project number
07/01/34).<br/>Copyright &#xa9; The Author(s) 2018. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.

<20>
Accession Number
624181500
Title
Is administration of dual-antiplatelet therapy beneficial for patients
following off-pump coronary artery bypass grafting?.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (4) (pp 548-554),
2018. Date of Publication: 01 Oct 2018.
Author
Peksa M.; Aboul-Hassan S.S.; Marczak J.; Cichon R.
Institution
(Peksa, Aboul-Hassan, Marczak) Department of Cardiac Surgery, MEDINET
Heart Center Ltd., Chalubinskiego 7 street, Nowa Sol 67-100, Poland
(Marczak) Department of Cardiac Surgery, Wroclaw Medical University,
Wroclaw, Poland
(Cichon) Department of Cardiac Surgery, Warsaw Medical University, Warsaw,
Poland
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether administration of
dual-antiplatelet therapy (DAPT) following off-pump coronary artery bypass
grafting (OPCAB) would improve postoperative clinical outcomes or minimize
the incidence of postoperative graft failure. In total, 101 papers were
found using the reported search, 14 of which represented the best evidence
to answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. One meta-analysis and 3 randomized
controlled trials showed that DAPT following OPCAB is associated with
decreased incidence of saphenous vein graft occlusion. One randomized
controlled trial and 4 observational studies showed no effect of DAPT on
mortality following OPCAB, whereas 3 observational studies showed that
DAPT decreased mortality. One meta-analysis and 4 observational studies
showed that DAPT reduced the incidence of cardiac events following OPCAB.
One randomized controlled trial and 4 observational studies showed that
DAPT did not increase the incidence of major or minor bleeding
complications following OPCAB. The results presented suggest that
administration of DAPT in patients following OPCAB for at least 3 months
improves saphenous vein graft patency and could be protective against
recurrence of cardiac events, especially acute coronary syndrome, in
comparison with aspirin monotherapy. The administration of DAPT following
OPCAB is safe and is not associated with increased incidence of major or
minor bleeding complications when compared with aspirin
alone.<br/>Copyright &#xa9; The Author(s) 2018. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<21>
Accession Number
624175919
Title
The association between blood pressure and long-term outcomes of patients
with ischaemic cardiomyopathy with and without surgical revascularization:
An analysis of the STICH trial.
Source
European Heart Journal. 39 (37) (pp 3464-3471), 2018. Date of Publication:
01 Oct 2018.
Author
Andersson B.; She L.; Tan R.-S.; Jeemon P.; Mokrzycki K.; Siepe M.;
Romanov A.; Favaloro L.E.; Djokovic L.T.; Raju P.K.; Betlejewski P.;
Racine N.; Ostrzycki A.; Nawarawong W.; Das S.; Rouleau J.L.; Sopko G.;
Lee K.L.; Velazquez E.J.; Panza J.A.
Institution
(Andersson) Department of Cardiology, Bla Straket 3, Sahlgrenska
University Hospital, Gothenburg, Sweden
(She, Lee, Velazquez) Duke Clinical Research Institute, 2400 Pratt Street,
Durham, NC, United States
(Tan) National Heart Centre, 5 Hospital Drive, Singapore, Singapore
(Jeemon) Achutha Menon Centre for Health Science Studies, Sree Chitra
Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011,
India
(Mokrzycki) Department of Cardiac Surgery, SPSK-2, Pomeranian Medical
University, Powsta.,cow Wielkopolskich 72, Szczecin, Poland
(Siepe) Klinik fur Herz-und Gefasschirurgie, Universitats Herzzentrum
Freiburg Bad Krozingen, Sudring 15, Bad Krozingen, Germany
(Romanov) Arrhythmia Department and Electrophysiology Laboratory, State
Research Institute of Circulation Pathology, Rechkunovskaya 15,
Novosibirsk, Russian Federation
(Favaloro) Hospital Universitario Fundacion Favaloro, Av. Belgrano 1782
(C1093AAS), Ciudad Autonoma de Buenos Aires, Argentina
(Djokovic) Dedinje Cardiovascular Institute, Heroja Milana Tepia br. 1,
Belgrade, Serbia
(Raju) Care Hospitals, Care Op Center, Road Number 10, Zahara Nagar,
Hyderabad, Telangana, India
(Betlejewski) Klinika Kardiochirurgii, Instytut Kardiologii, Wileska 44,
Gdask, Poland
(Racine, Rouleau) Universite de Montreal, Montreal Heart Institute, 5000
Belanger est, Montreal, QC, Canada
(Ostrzycki) National Institute of Cardiology, Alpejska 42, Warsaw, Poland
(Nawarawong) Department of Surgery, Chiang Mai University, Su Thep, Mueang
Chiang Mai District, Chiang Mai, Thailand
(Das) Centre for Chronic Disease Conrol, C1/52 2nd Floor, Safdarjung
Development Area, New Delhi, India
(Sopko) National Heart Lung, and Blood Institute, National Institutes of
Health, 6701 Rockledge Dr, Bethesda, MD, United States
(Lee) Department of Biostatistics and Bioinformatics, Duke University
School of Medicine, Durham, NC, United States
(Velazquez) Department of Internal Medicine, Section of Cardiovascular
Medicine, Yale School of Medicine, New Haven, CT, United States
(Panza) Cardiology, Westchester Medical Center, WMC Health Network, New
York Medical College, Macy Pavilion, 100 Woods Road, Valhalla, NY, United
States
Publisher
Oxford University Press
Abstract
Aims Hypertension (HTN) is a well-known contributor to cardiovascular
disease, including heart failure (HF) and coronary artery disease, and is
the leading risk factor for premature death world-wide. A J-or U-shaped
relationship has been suggested between blood pressure (BP) and clinical
outcomes in different studies. However, there is little information about
the significance of BP on the outcomes of patients with coronary artery
disease and left ventricular dysfunction. This study aimed to determine
the relationship between BP and mortality outcomes in patients with
ischaemic cardiomyopathy. Methods and results The influence of BP during a
median follow-up of 9.8 years was studied in a total of 1212 patients with
ejection fraction <=35% and coronary disease amenable to coronary artery
bypass grafting (CABG) who were randomized to CABG or medical therapy
alone (MED) in the STICH (Surgical Treatment for Ischaemic Heart Failure)
trial. Landmark analyses were performed starting at 1, 2, 3, 4, and 5
years after randomization, in which previous systolic BP values were
averaged and related to subsequent mortality through the end of follow-up
with a median of 9.8 years. Neither a previous history of HTN nor baseline
BP had any significant influence on long-term mortality outcomes, nor did
they have a significant interaction with MED or CABG treatment. The
landmark analyses showed a progressive U-shaped relationship that became
strongest at 5 years (I ++ 2 and P-values: 7.08, P = 0.069; 8.72, P =
0.033; 9.86; P = 0.020; 8.31, P = 0.040; 14.52, P = 0.002; at 1, 2, 3, 4,
and 5-year landmark analyses, respectively). The relationship between
diastolic BP (DBP) and outcomes was similar. The most favourable outcomes
were observed in the SBP range 120-130, and DBP 75-85 mmHg, whereas lower
and higher BP were associated with worse outcomes. There were no
differences in BP-lowering medications between groups. Conclusion A strong
U-shaped relationship between BP and mortality outcomes was evident in
ischaemic HF patients. The results imply that the optimal SBP might be in
the range 120-130 mmHg after intervention, and possibly be subject to
pharmacologic action regarding high BP. Further, low BP was a marker of
poor outcomes that might require other interactions and treatment
strategies. Clinical Trial Registration URL:
http://www.clinicaltrials.gov. Unique identifier:
NCT00023595.<br/>Copyright &#xa9; 2018 The Author(s).

<22>
Accession Number
624089140
Title
Cognitive function in patients with coronary artery disease: A literature
review.
Source
Journal of International Medical Research. 46 (10) (pp 4019-4031), 2018.
Date of Publication: 01 Oct 2018.
Author
Burkauskas J.; Lang P.; Bunevicius A.; Neverauskas J.;
Buciute-Jankauskiene M.; Mickuviene N.
Institution
(Burkauskas, Neverauskas, Buciute-Jankauskiene, Mickuviene) Behavioral
Medicine Institute, Lithuanian University of Health Sciences, Vyduno Str.
4/J. Sliupo Str. 7, Palanga LT-00135, Lithuania
(Lang) Harvard Medical School, Laboratory of Clinical & Experimental
Psychopathology, Dr. John C. Corrigan Mental Health Center, Harvard
Medical School, 49 Hillside Street, Fall River, MA 02720, United States
(Bunevicius) Laboratory of Clinical Research, Neuroscience Institute,
Lithuanian University of Health Sciences, Eiveniu st. 4, Kaunas LT-50161,
Lithuania
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: Cognitive function impairment is a well-documented complication
of cerebrovascular disease (CBVD). Less is known about what factors affect
the deterioration of cognitive function in patients with coronary artery
disease (CAD). The aim of this review is to explore recent studies
investigating factors associated with cognitive function in patients with
CAD. Methods: Studies published from 2010 to 2016 were identified through
a systematic search of MEDLINE/PubMed and were included if they addressed
factors affecting cognitive function in the CAD population. Results: Of
the 227 publications identified, 32 were selected for the review. Five
factors tentatively affecting cognitive function in patients with CAD were
identified: coronary artery bypass grafting (CABG) surgery, apolipoprotein
E4 (APOE4) genotype, left ventricular ejection fraction (LVEF), medication
use, and various hormones and biomarkers. Conclusion: New techniques in
CABG surgery have proven to alleviate postoperative cognitive decline.
Researchers are still debating the effects of APOE4 genotype, LVEF, and
the use of cardiovascular medications on cognitive function. Thyroid
hormones and biomarkers are associated with cognitive function, but the
exact nature of the association is debatable. Longitudinal studies should
clarify those associations. In addition, cross-sectional studies
addressing other causes of cognitive decline in patients with CAD are
warranted.<br/>Copyright &#xa9; The Author(s) 2018.

<23>
Accession Number
624173922
Title
Safety and efficacy of transcatheter aortic valve replacement for native
aortic valve regurgitation: A systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2018.
Date of Publication: 2018.
Author
Rawasia W.F.; Khan M.S.; Usman M.S.; Siddiqi T.J.; Mujeeb F.A.; Chundrigar
M.; Kalra A.; Alkhouli M.; Kavinsky C.J.; Bhatt D.L.
Institution
(Rawasia, Alkhouli) Division of Cardiology, School of Medicine, West
Virginia University, Morgantown, WV, United States
(Khan) Department of Internal Medicine, Cook County Hospital, Chicago, IL,
United States
(Usman, Siddiqi, Mujeeb) Department of Internal Medicine, Dow Medical
College, Dow University of Health Sciences, Karachi, Pakistan
(Chundrigar) Department of Internal Medicine, The Aga Khan University -
Medical College, Karachi, Pakistan
(Kalra) Division of Cardiovascular Medicine, Case Western Reserve
University School of Medicine, University Hospitals Cleveland Medical
Center, Cleveland, OH, United States
(Kalra) Department of Medicine, Case Western Reserve University School of
Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH,
United States
(Kavinsky) Division of Cardiology, Rush University Medical Center,
Chicago, IL, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Harvard University, Boston, MA, 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 analyze the available
literature on using transcatheter aortic valve replacement (TAVR) for
native aortic regurgitation (AR). Background: Surgical aortic valve
replacement is the gold standard therapy for native AR. TAVR has emerged
as an alternative approach in high-risk patients. Methods: MEDLINE,
Scopus, and Cochrane CENTRAL were searched for reports of at least 5
patients undergoing TAVR for native AR. Outcomes included 30-day
mortality, myocardial infarction, stroke, major bleeding, postprocedural
moderate to severe AR, and device success. Pooled estimates were
calculated using a random-effects model. Subgroup analysis and a
meta-regression were performed to study the effects of study level
covariates on outcomes. Results: Nineteen studies (n =998 patients) were
included. The rate of procedural success per Valve Academic Research
Consortium - 2 (VARC-2) criteria was 86.2% (78.8%-92.2%]. Thirty-day
mortality was 11.9% (9.4%-14.7%). Subgroup analysis showed the use of new
generation valves was associated with lower 30-day mortality (P = 0.02)
and higher device success (P = 0.009) compared with early generation
valves. There was no significant difference (P = 0.13) in the rate of
30-day mortality between patients receiving purpose-specific [8.2%
(4.3%-13.1%); I2 = 0%] and nonpurpose specific valves [13.0% (8.2%-18.6%);
I2 = 25%]. However, device success was higher (P = 0.02) in patients who
received purpose-specific valves [96.3% (92.2%-98.9%); I2 = 0%] compared
with nonpurpose specific valves [84.4% (75%-91.9%); I2 =46%]. Conclusion:
TAVR for native AR is associated with acceptable procedural success but
increased early mortality. However, the safety and the efficacy of the
procedure increased with newer valves.<br/>Copyright &#xa9; 2018 Wiley
Periodicals, Inc.

<24>
Accession Number
618231986
Title
Impact of Discontinuation of Antiplatelet Therapy Prior to Isolated Valve
and Combined Coronary Artery Bypass Graft and Valve Procedures on Short
and Intermediate Term Outcomes.
Source
Heart Lung and Circulation. 27 (7) (pp 878-884), 2018. Date of
Publication: July 2018.
Author
Meneguzzi J.; Kilpin M.; Zhu Y.Y.; Doi A.; Reid C.; Tran L.; Hayward P.;
Smith J.
Institution
(Meneguzzi, Kilpin, Doi) The Alfred Hospital, Melbourne, Vic, Australia
(Zhu, Hayward) The Austin Hospital, Melbourne, Vic, Australia
(Reid, Tran) The Alfred Centre, Melbourne, Vic, Australia
(Smith) Monash University, Melbourne, Vic, Australia
Publisher
Elsevier Ltd
Abstract
Background: A change in cardiac surgery practice over the past decade has
seen an increase in urgent or inpatient referrals for surgery, with
antiplatelet therapy often continued up until surgery. This study aims to
identify the optimal timing for administration of aspirin to minimise risk
of perioperative morbidity and mortality. Methods: From a prospectively
compiled database collected by the Australian and New Zealand Society of
Cardiac and Thoracic Surgeons, we identified 8294 patients undertaking
combined CABG and valve or isolated valve procedures while discontinuing
aspirin. Time points for cessation of antiplatelet therapy were
categorised as follows: <2 days, 3-7 days or >7 days preoperatively. We
evaluated the association of adverse in-hospital events and intermediate
term survival in each time category. Results: Discontinuing aspirin 3 to 7
days from surgery decreased rates of perioperative MI (HR = 0.300, p =
0.027), return to theatre (HR = 0.560, p = 0.002) reduced drain output (HR
= 0.757, p = 0.000) and red blood cell and platelet transfusions (HR =
0.719, p = 0.000 and HR = 0.604, p = 0.000 respectively) compared to
patients continuing aspirin until <2 days from the procedure. Stopping
aspirin <2 days from the date of surgery increased risk of perioperative
MI (HR = 5.919, p = 0.000), reoperation for bleeding (HR = 2.076, p =
0.001), returning to theatre (HR = 1.781, p = 0.000), ICC drain losses (HR
= 1.337, p = 0.000) and transfusion demands for red blood cells (HR =
1.381, p = 0.000) and platelets (HR = 1.450, p = 0.000) when compared to
those discontinuing aspirin >7 days from surgery. Conclusion: Late
discontinuation of aspirin before combined coronary artery bypass graft
and valve procedures results in greater rates of bleeding and transfusion
requirements. Earlier discontinuation of aspirin results in no benefit in
intermediate term survival.<br/>Copyright &#xa9; 2017

<25>
[Use Link to view the full text]
Accession Number
372489522
Title
Setting individualized positive end-expiratory pressure level with a
positive end-expiratory pressure decrement trial after a recruitment
maneuver improves oxygenation and lung mechanics during one-lung
ventilation.
Source
Anesthesia and Analgesia. 118 (3) (pp 657-665), 2014. Date of Publication:
March 2014.
Author
Ferrando C.; Mugarra A.; Gutierrez A.; Carbonell J.A.; Garcia M.; Soro M.;
Tusman G.; Belda F.J.
Institution
(Ferrando, Mugarra, Gutierrez, Carbonell, Garcia, Soro, Belda)
Anesthesiology and Critical Care Department, Hospital Clinico
Universitario of Valencia, Av. Blasco Ibanez, 17, Valencia, CP: 46010,
Spain
(Tusman) Department of Anesthesiology, Hospital Privado de Comunidad, Mar
de Plata, Argentina
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND:: We investigated whether individualized positive
end-expiratory pressure (PEEP) improves oxygenation, ventilation, and lung
mechanics during one-lung ventilation compared with standardized PEEP.
METHODS:: Thirty patients undergoing thoracic surgery were randomly
allocated to the study or control group. Both groups received an alveolar
recruitment maneuver at the beginning and end of one-lung ventilation.
After the alveolar recruitment maneuver, the control group had their lungs
ventilated with a 5 cm.H2O PEEP, while the study group had their lungs
ventilated with an individualized PEEP level determined by a PEEP
decrement trial. Arterial blood samples, lung mechanics, and volumetric
capnography were recorded at multiple timepoints throughout the procedure.
RESULTS:: The individualized PEEP values in study group were higher than
the standardized PEEP values (10 +/- 2 vs 5 cm.H2O; P < 0.001). In both
groups, arterial oxygenation decreased when bilateral-lung ventilation was
switched to one-lung ventilation and increased after the alveolar
recruitment maneuver. During one-lung ventilation, oxygenation was
maintained in the study group but decreased in the control group. After
one-lung ventilation, arterial oxygenation was significantly higher in the
study group (306 vs 231 mm.Hg, P = 0.007). Static compliance decreased in
both groups when bilateral-lung ventilation was switched to one-lung
ventilation. Static compliance increased significantly only in the study
group (P < 0.001) after the alveolar recruitment maneuver and optimal PEEP
adjustment. The alveolar recruitment maneuver did not decrease cardiac
index in any patient. CONCLUSIONS:: During one-lung ventilation, the
improvements in oxygenation and lung mechanics after an alveolar
recruitment maneuver were better preserved by ventilation by using
individualized PEEP with a PEEP decrement trial than with a standardized 5
cm.H2O of PEEP. &#xa9; 2013 International Anesthesia Research Society.

<26>
Accession Number
623945377
Title
Patent foramen ovale and atrial fibrillation as causes of cryptogenic
stroke: is treatment with surgery superior to device closure and
anticoagulation? A review of the literature.
Source
Acta Radiologica Open. 7 (9) (no pagination), 2018. Date of Publication:
01 Sep 2018.
Author
Kjeld T.; Jorgensen T.S.; Fornitz G.; Roland J.; Arendrup H.C.
Institution
(Kjeld, Arendrup) Department of 53146 Cardiothoracic Surgery, University
of Copenhagen, Rigshospitalet, Copenhagen, Denmark
(Jorgensen) Department of Cardiology, University of Copenhagen, Amager
Hospital, Copenhagen, Denmark
(Fornitz, Roland) Department of Cardiology, University of Zealand,
Slagelse Hospital, Slagelse, Denmark
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Closure of persistent foramen ovale (PFO) to avoid cryptogenic strokes is
performed globally with enthusiasm but lacks prove of efficacy. We present
a 79-year-old man who had had a PFO device introduced nine years
previously because of cryptogenic strokes presenting as syncopes. The
patient was referred from his general practitioner with two new syncopes.
Transthoracic echocardiography revealed no cardiac causes of embolism.
Transesophageal echocardiography (TEE) revealed a misplaced device like an
umbrella in a storm, but no septum defects. Holter revealed seconds-long
episodes of atrial fibrillation (AF). The patient was successfully treated
with anticoagulation. A literature review showed that: (i) the efficacy of
PFO closure devices has not been proven in any trial, but was demonstrated
in a meta-analysis comparing three different devices; (ii) PFO devices are
rarely controlled by TEE during or after insertion; (iii) residual shunts
are detected in up to 45% of cases; (iv) there is an increased rate of
post-arrhythmic complications; (v) the risk of AF in congenital heart
disease increases with increasing age, with a 13% risk of transient
ischemic attacks and stroke; and (vi) surgical treatment of PFO was found
to have a 4.1% risk of complications including stroke. The question to be
asked is whether device closure of PFO should be avoided, considering that
PFO is a congenital heart defect with risks of AF and (cryptogenic)
stroke? Heart surgery should be a treatment option for symptomatic
PFO.<br/>Copyright &#xa9; The Foundation Acta Radiologica 2018.

<27>
Accession Number
2001012216
Title
Usefulness and Safety of Rivaroxaban in Patients Following Isolated Mitral
Valve Replacement With a Mechanical Prosthesis.
Source
American Journal of Cardiology. 122 (6) (pp 1047-1050), 2018. Date of
Publication: 15 September 2018.
Author
Duraes A.R.; Bitar Y.D.S.L.; Lima M.L.G.; Santos C.C.; Schonhofen I.S.;
Filho J.A.L.; Roever L.
Institution
(Duraes, Bitar, Lima, Santos, Schonhofen, Filho) General Hospital Roberto
Santos, Salvador, Brazil
(Roever) Leonardo Roever: Uberlandia Federal University, Uberlandia,
Brazil
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Rivaroxaban has previously been tested in experimental and animal models
with encouraging results. We prospectively selected seven patients between
May 2017 and January 2018 who underwent isolated mitral valve replacement
with a mechanical prosthesis and had unstable INR control at least 3
months after surgery. An intervention of rivaroxaban 15 mg was then
administered twice daily for a period of 90 days. No patient presented
intracardiac thrombus, reversible ischemic neurological deficit, ischemic
or hemorrhagic stroke, and hospitalization or death during 3 months of
follow-up. Two patients eradicated the presence of spontaneous echo
contrast. Mean and peak pressure gradients, peak velocity, effective
orifice area, and PHT were similar before and after the intervention. In
conclusion, the use of rivaroxaban for 90 days in seven patients after
replacement of mitral valve with the mechanical prosthesis did not present
thromboembolic or bleeding events (NCT02894307).<br/>Copyright &#xa9; 2018
Elsevier Inc.

<28>
Accession Number
624108235
Title
Angiotensin receptor neprilysin inhibitor in Japanese patients with heart
failure and reduced ejection fraction: Baseline characteristics and
treatment of PARALLEL-HF trial.
Source
Circulation Journal. 82 (10) (pp 2575-2583), 2018. Date of Publication:
2018.
Author
Tsutsui H.; Momomura S.-I.; Saito Y.; Ito H.; Yamamoto K.; Ohishi T.;
Okino N.; Kitamura T.; Guo W.
Institution
(Tsutsui) Department of Cardiovascular Medicine, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan
(Momomura) Cardiovascular Division, Jichi Medical University, Saitama
Medical Center, Saitama, Japan
(Saito) First Department of Internal Medicine, Nara Medical University,
Kashihara, Japan
(Ito) Department of Cardiovascular Medicine, Okayama University Graduate
School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
(Yamamoto) Department of Molecular Medicine and Therapeutics, Tottori
University, Yonago, Japan
(Ohishi, Okino, Kitamura) Novartis Pharma K.K., Tokyo, Japan
(Guo) Novartis Pharmaceutical Corporation, East Hanover, NJ, United States
Publisher
Japanese Circulation Society
Abstract
Background: The objective of the present analyses was to describe the
baseline characteristics and treatment of the Japanese patients with HFrEF
in THE PARALLEL-HF study. Methods and Results: Key demographic, clinical
and laboratory findings, along with treatment, were reported and compared
with patients enrolled in the PARADIGM-HF trial and other contemporary
randomized clinical trials and registries of Japanese patients with HFrEF.
In addition, the MAGGIC and EMPHASIS-HF risk scores were calculated. A
total of 225 Japanese patients were randomized in PARALLEL-HF with a mean
age of 67.9 years and the majority of the patients being male (85.8%) and
in NYHA Class II (93.8%). Key baseline characteristics in PARALLEL-HF were
generally comparable with PARADIGM-HF, and other contemporary clinical
trials and registries of Japanese HFrEF patients. Patients enrolled in
PARALLEL-HF were well treated with conventional evidence-based therapy at
baseline (angiotensin-converting enzyme inhibitor inhibitor/angiotensin
receptor blocker, 62.7%/37.3%; beta-blockers, 94.7%; mineralocorticoid
receptor antagonist, 59.1%). Despite the evidence-based treatment and most
patients being in NYHA Class II, these patients had a low LVEF (mean
28.1%) and were at high risk of cardiovascular mortality and morbidity as
assessed by the MAGGIC and EMPHASIS-HF risk scores. Conclusions: Overall,
the patients in PARALLEL-HF were largely representative of contemporary
ambulatory patients with HFrEF who are well treated with evidence-based
therapies. PARALLEL-HF will determine whether sacubitril/valsartan
provides similar improvements in clinical outcomes in Japanese HFrEF
patients as observed in the PARADIGM-HF study.<br/>Copyright &#xa9; 2018,
Japanese Circulation Society. All rights reserved.

<29>
[Use Link to view the full text]
Accession Number
624068322
Title
Impact of Cardiac Progenitor Cells on Heart Failure and Survival in Single
Ventricle Congenital Heart Disease.
Source
Circulation Research. 122 (7) (pp 994-1005), 2018. Date of Publication: 30
Mar 2018.
Author
Sano T.; Ousaka D.; Goto T.; Ishigami S.; Hirai K.; Kasahara S.; Ohtsuki
S.; Sano S.; Oh H.
Institution
(Sano, Ousaka, Goto, Kasahara) Department of Cardiovascular Surgery,
Okayama University Graduate School of Medicine, Dentistry, and
Pharmaceutical Sciences, Japan
(Hirai, Ohtsuki) Department of Pediatrics, Okayama University Graduate
School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
(Oh) Department of Regenerative Medicine, Center for Innovative Clinical
Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama
700-8558, Japan
(Ishigami, Sano) Department of Pediatric Cardiothoracic Surgery,
University of California, San Francisco, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Rationale: Intracoronary administration of cardiosphere-derived cells
(CDCs) in patients with single ventricles resulted in a short-term
improvement in cardiac function. Objective: To test the hypothesis that
CDC infusion is associated with improved cardiac function and reduced
mortality in patients with heart failure. Methods and Results: We
evaluated the effectiveness of CDCs using an integrated cohort study in
101 patients with single ventricles, including 41 patients who received
CDC infusion and 60 controls treated with staged palliation alone. Heart
failure with preserved ejection fraction (EF) or reduced EF was stratified
by the cardiac function after surgical reconstruction. The main outcome
measure was to evaluate the magnitude of improvement in cardiac function
and all-cause mortality at 2 years. Animal studies were conducted to
clarify the underlying mechanisms of heart failure with preserved EF and
heart failure with reduced EF phenotypes. At 2 years, CDC infusion
increased ventricular function (stage 2: +8.4+/-10.0% versus +1.6+/-6.4%,
P=0.03; stage 3: +7.9+/-7.5% versus -1.1+/-5.5%, P<0.001) compared with
controls. In all available follow-up data, survival did not differ between
the 2 groups (log-rank P=0.225), whereas overall patients treated by CDCs
had lower incidences of late failure (P=0.022), adverse events (P=0.013),
and catheter intervention (P=0.005) compared with controls. CDC infusion
was associated with a lower risk of adverse events (hazard ratio, 0.411;
95% CI, 0.179-0.942; P=0.036). Notably, CDC infusion reduced mortality
(P=0.038) and late complications (P<0.05) in patients with heart failure
with reduced EF but not with heart failure with preserved EF. CDC-treated
rats significantly reversed myocardial fibrosis with differential collagen
deposition and inflammatory responses between the heart failure
phenotypes. Conclusions: CDC administration in patients with single
ventricles showed favorable effects on ventricular function and was
associated with reduced late complications except for all-cause mortality
after staged procedures. Patients with heart failure with reduced EF but
not heart failure with preserved EF treated by CDCs resulted in
significant improvement in clinical outcome. Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01273857 and
NCT01829750.<br/>Copyright &#xa9; 2018 American Heart Association, Inc.

<30>
Accession Number
623984852
Title
Clinical effectiveness of incentive spirometry for the prevention of
postoperative pulmonary complications.
Source
Respiratory Care. 63 (3) (pp 347-352), 2018. Date of Publication: 01 Mar
2018.
Author
Eltorai A.E.M.; Szabo A.L.; Antoci V.; Ventetuolo C.E.; Elias J.A.;
Daniels A.H.; Hess D.R.
Institution
(Eltorai, Antoci, Ventetuolo, Elias, Daniels) Warren Alpert Medical School
of Brown University, Providence, RI, United States
(Szabo) The Cleveland Clinic, Cleveland, OH, United States
(Hess) Massachusetts General Hospital, Boston, MA, United States
Publisher
American Association for Respiratory Care
Abstract
Incentive spirometry (IS) is commonly prescribed to reduce pulmonary
complications, despite limited evidence to support its benefits and a lack
of consensus on optimal protocols for its use. Although numerous studies
and meta-analyses have examined the effects of IS on patient outcomes,
there is no clear evidence establishing its benefit to prevent
postoperative pulmonary complications. Clinical practice guidelines advise
against the routine use of IS in postoperative care. Until evidence of
benefit from well-designed clinical trials becomes available, the routine
use of IS in postoperative care is not supported by high levels of
evidence.<br/>Copyright &#xa9; 2018 Daedalus Enterprises.

<31>
Accession Number
2001005129
Title
Meta-Analysis Comparing the Frequency of Stroke After Transcatheter Versus
Surgical Aortic Valve Replacement.
Source
American Journal of Cardiology. 122 (7) (pp 1215-1221), 2018. Date of
Publication: 1 October 2018.
Author
Shah K.; Chaker Z.; Busu T.; Badhwar V.; Alqahtani F.; Alvi M.; Adcock A.;
Alkhouli M.
Institution
(Shah, Alqahtani, Alkhouli) Division of Cardiology, West Virginia School
of Medicine, Morgantown, WV, United States
(Chaker, Busu) Department of Medicine, West Virginia School of Medicine,
Morgantown, WV, United States
(Badhwar) Department of Cardiothoracic Surgery, West Virginia School of
Medicine, Morgantown, WV, United States
(Alvi, Adcock) Department of Neurology, West Virginia School of Medicine,
Morgantown, WV, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Stroke is one of the most feared complications of aortic valve
replacement. Although the outcomes of transcatheter aortic valve
implantation (TAVI) improved substantially over time, concerns remained
about a potentially higher incidence of stroke with TAVI compared with
surgical replacement (SAVR). However, comparative data are sparse. We
performed a meta-analysis comparing the incidence of stroke among patients
undergoing TAVI versus SAVR. Of the 5067 studies screened, 28 eligible
studies (22 propensity-score matched studies and 6 randomized trials) were
analyzed. Primary endpoints were 30-day stroke and disabling stroke.
Secondary endpoints were 1-year stroke and disabling stroke. A total of
23,587 patients were included, of whom 47.27% underwent TAVI and 52.72%
underwent SAVR. For each endpoint, pooled estimates of odds ratio (OR)
with 95% confidence interval (CI) were calculated. The pooled estimates
for stroke (2.7% vs 3.1%, OR 0.86; 95% CI 0.72 to 1.02; p=0.08) and
disabling stroke (2.5% vs 2.9%, OR 0.96; 95% CI 0.57 to 1.62; p=0.89) were
comparable following TAVI versus SAVR at 30 days. Similarly, the pooled
estimates for stroke (5.0% vs 4.6%, OR 1.01; 95% CI 0.79 to 1.28; p=0.96)
and disabling stroke (4.1% vs 4.5%, OR 0.92; 95% CI 0.92 to 1.39; p=0.71)
were similar at 1 year. A sensitivity analysis including only RCTs yielded
similar results. Our meta-analysis documents comparable rates of strokes
and disabling strokes following TAVI or SAVR both at 30 days and 1
year.<br/>Copyright &#xa9; 2018

<32>
Accession Number
623952303
Title
Cardiac surgery for Chagas disease.
Source
Journal of Cardiac Surgery. 33 (10) (pp 597-602), 2018. Date of
Publication: October 2018.
Author
Magarakis M.; Macias A.E.; Tompkins B.A.; Reis V.; Loebe M.; Batista R.;
Salerno T.A.
Institution
(Magarakis, Reis) Jackson Memorial Hospital-University of Miami Miller
School of Medicine, Department of Surgery, Division of Cardiothoracic
Surgery, Cardiac Surgery section, Miami, FL, United States
(Macias) Department of Surgery, University of Medicine and Health
Sciences, Miami, FL, United States
(Tompkins) Department of Surgery, Jackson Memorial Hospital-University of
Miami Miller School of Medicine, Miami, FL, United States
(Loebe) Jackson Memorial Hospital-University of Miami Miller School of
Medicine, Department of Surgery, Division of Transplant Surgery, Miami,
FL, United States
(Batista) Fundacao Vilela Batista, Curitiba, Brazil
(Salerno) Jackson Memorial Hospital-University of Miami Miller School of
Medicine, Department of Surgery, Division of Cardiothoracic Surgery,
Miami, FL, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Although Chagas disease is a rare entity in North America, it is
associated with significant cardiac morbidity. It is estimated that 20-30%
of those who are infected will eventually develop cardiovascular disease
secondary to Chagas disease. We review the literature and share our
experience on the surgical management of this challenging patient
population.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<33>
Accession Number
624158528
Title
Comparison of arterial and venous coagulation parameters measured with the
quantratm system in cardiac surgery.
Source
Research and Practice in Thrombosis and Haemostasis. Conference: 26th
International Society on Thrombosis and Haemostasis Congress, ISTH 2017.
Germany. 1 (Supplement 1) (pp 1390), 2017. Date of Publication: July 2017.
Author
Viola F.; Winegar D.; Fernandez L.; Groves D.; Huffmyer J.
Institution
(Viola, Winegar) HemoSonics LLC, Charlottesville, United States
(Fernandez, Groves, Huffmyer) University of Virginia, Anesthesiology,
Charlottesville, United States
Publisher
Wiley-Blackwell Publishing Ltd
Abstract
Background: Coagulation testing is often performed in cardiac surgery and
other major procedures to aid in the management of perioperative bleeding.
Although reference ranges are obtained in venous samples, perioperative
testing is often performed with arterial samples. Limited studies have
been published on the effects of sampling site on coagulation testing.
Aims: To compare coagulation parameters determined by the Quantra System
(HemoSonics LLC) for venous and arterial blood samples. Methods: The
Quantra is a novel cartridge-based viscoelastic analyzer that measures
changes in clot stiffness during coagulation using ultrasound detection of
resonance. A cohort of 25 patients undergoing cardiopulmonary bypass
surgery were enrolled in this study. For each patient, arterial and venous
samples were obtained in citrated tubes in close temporal sequence.
Sampling was randomized at two of the following three time points:
baseline, during bypass, or after protamine administration. Measurements
were performed on a research use only (RUO) version of the Quantra and
included Clot Time (CT), Heparinase Clot Time (CTH), Clot Stiffness (CS),
Fibrinogen (FCS) and Platelet (PCS) Contributions to clot stiffness.
Results: Paired t-tests were performed on matched arterial vs venous
samples. Data is summarized in Table I. CS, FCS and PCS were similar
between arterial and venous samples. CT and CTH demonstrated a
statistically significant difference. Venous clot times were prolonged
relative to the arterial ones with an average bias of 0. 24 min and 0. 21
min, respectively. Conclusions: This pilot study demonstrates that Quantra
clot stiffness based parameters (CS, FCS, PCS) are unaffected by sampling
site, whereas the clot time based parameters (CT and CTH) show good
correlation in the presence of a small bias.

<34>
Accession Number
624157063
Title
Does remote ischemic preconditioning increase fibr inolysis in head and
neck cancer surgery? preliminary results from a randomized controlled
trial.
Source
Research and Practice in Thrombosis and Haemostasis. Conference: 26th
International Society on Thrombosis and Haemostasis Congress, ISTH 2017.
Germany. 1 (Supplement 1) (pp 628), 2017. Date of Publication: July 2017.
Author
Krag A.E.; Kiil B.J.; Hvas C.L.; Hvas A.-M.
Institution
(Krag, Hvas) Aarhus University Hospital, Center for Hemophilia and
Thrombosis, Department of Clinical Biochemistry, Aarhus, Denmark
(Krag, Kiil) Aarhus University Hospital, Department of Plastic Surgery and
Breast Surgery, Aarhus, Denmark
(Hvas) Aarhus University Hospital, Department of Anesthesiology and
Intensive Care, Aarhus, Denmark
Publisher
Wiley-Blackwell Publishing Ltd
Abstract
Background: Cancer induces abnormal coagulation and fibrinolysis leading
to an increased risk of thromboembolism. Large head and neck tumors are
primarily treated by surgical resection and reconstruction of the defect
by transfer of the patient's own tissue. Thrombosis in the transferred
tissue or the patient's circulation is a life-threatening complication in
head and neck cancer surgery. Remote ischemic preconditioning (RIPC)
attenuates ischemia-reperfusion injury and reduces subsequent thrombotic
events in cardiovascular procedures. Aims: The aim of the trial is to
investigate if RIPC increases fibrinolysis in head and neck cancer
patients undergoing surgery. Methods: The local Ethics Committee has
approved this trial, and informed consent is obtained before study
inclusion. We aim to randomize 60 patients undergoing head and neck cancer
surgery to RIPC or sham intervention. RIPC is induced with an inflatable
tourniquet and administered intraoperatively by four 5-minute cycles of
upper extremity ischemia and reperfusion. Blood samples are collected
preoperatively, intraoperatively, and in the postoperative phase. An
inhouse clot lysis assay, tissue plasminogen activator (tPA), plasminogen
activator inhibitor-1 (PAI-1), and fibrin D-dimer will be measured.
Results: Until now, 35 patients have been included in the trial.
Preliminary results show reduced clot lysis area under the curve and 50%
lysis time, reduced PAI-1, and increased tPA measured postoperatively in
the RIPC group. No difference is found in postoperative fibrin D-dimer
between the groups. Conclusions: Preliminary results indicate that RIPC
increases fibrinolysis in head and neck cancer patients undergoing
surgery, which may reduce the risk of postoperative thromboembolism.
Despite increased fibrinolysis, postoperative fibrin D-dimer was similar
in the two groups. We expect to present data from at least 40 patients at
the congress.

<35>
Accession Number
624155715
Title
Tranexamic acid blocks fibrinolysis but not overall plasmin generation and
modulates the immune response in patients undergoing coronary artery
surgery. A sub-study of the "aspirin and tranexamic acid for coronary
artery surgery" (ATACAS) trial.
Source
Research and Practice in Thrombosis and Haemostasis. Conference: 26th
International Society on Thrombosis and Haemostasis Congress, ISTH 2017.
Germany. 1 (Supplement 1) (pp 484), 2017. Date of Publication: July 2017.
Author
Draxler D.F.; Hanafi G.; Zahra S.; Vorontsov S.; Niego B.; Ho H.; DagIas
M.; Goncalves I.; Tran H.; Wallace S.; Plebanski M.; Myles P.; Medcalf
R.L.
Institution
(Draxler, Hanafi, Zahra, Vorontsov, Niego, Ho, DagIas, Goncalves, Tran,
Medcalf) Monash University, Australian Centre for Blood Diseases,
Melbourne, Australia
(Goncalves, Tran) Alfred Hospital, Department of Clinical Haematology,
Melbourne, Australia
(Wallace, Myles) Alfred Hospital, Department of Anaesthesia and
Perioperative Medicine, Melbourne, Australia
(Plebanski) Monash University, Department of Immunology, Melbourne,
Australia
Publisher
Wiley-Blackwell Publishing Ltd
Abstract
Background: Cardiac surgery is associated with increased fibrinolysis
resulting in enhanced bleeding, and immunosuppression making patients
susceptible to infection. We reported that plasmin inhibits the ability of
dendritic cells (DCs) to mediate an allogeneic response. Hence,
anti-fibrinolytic agents (tranexamic acid; TXA) used to reduce blood loss,
might also modulate the immune response. Aims: To evaluate the temporal
effects of TXA on plasmin generation, fibrinolysis and the immune response
after cardiac surgery. Methods: Blood was taken from 41 cardiac surgery
patients randomised to TXA in the ATACAS trial. Plasma obtained prior to
surgery, post-operatively, 24 and 72 h was tested for D-dimer,
plasmin-antiplasmin complex (PAP) and by clot lysis assays (CLA). Flow
cytometry was performed for functional markers of myeloid and lymphoid
cell populations. Multiplex ELISAs were used to detect cytokine levels.
The effects of TXA (1 g, oral) was also determined in 10 healthy
volunteers. Results: TXA completely inhibited fibrinolysis (reduced
D-dimer and CLA) in all patients (n=22) at the post-OP and 24h time
points. However, PAP levels were increased at the same time points. As TXA
inhibits lysine-dependent plasmin generation, these data indicate that
lysine-independent mechanisms exist for plasmin formation in the cardiac
surgery setting. Flow cytometry showed that TXA significantly increased
expression of the activation marker CD83 on both classical monocytes and
DCs, suggesting enhanced immune competence. Baseline levels of
pro-inflammatory cytokines TNF-alpha and IL-6 were significantly reduced
by TXA in healthy volunteers, indicating a role for lysine- dependent
plasmin formation for controlling cytokine expression. Conclusions: TXA
effectively blocks fibrinolysis and modulates the immune system in healthy
volunteers and cardiac surgery patients. Plasmin formation still occurs
via lysine-independent mechanisms and the consequences of this finding
remain to be determined.

<36>
Accession Number
624123323
Title
Impact of a Nurse Intervention to Improve Sleep Quality in Intensive Care
Units: Results From a Randomized Controlled Trial.
Source
Dimensions of critical care nursing : DCCN. 37 (6) (pp 310-317), 2018.
Date of Publication: 01 Nov 2018.
Author
Diaz-Alonso J.; Smith-Plaza A.M.; Suarez-Mier B.; Lana A.
Institution
(Diaz-Alonso) Julian Diaz-Alonso, RN, is a registered nurse specialized in
critical care and with extensive formation in emergencies at the Intensive
Care Unit, Asturias Central University Hospital, Oviedo, Spain. He is
currently a PhD candidate at the University of Oviedo. Andrea M.
Smith-Plaza, RN, is a registered nurse specialized in family and community
health at the Preventive Medicine and Public Health Department, School of
Medicine and Health Sciences, Oviedo, Spain. She is also junior researcher
in the Department of Medicine at the University of Oviedo. Belen
Suarez-Mier, RN, is a senior clinical researcher and a preventive medicine
nurse at the Preventive Medicine Unit, Asturias Central University
Hospital, Oviedo, Spain. Furthermore, she is a nursing assistant professor
at the University of Oviedo. Alberto Lana, PhD, is senior researcher at
the University of Oviedo. He has extensively published on several health
related topics, including nursing practice
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients of adult intensive care units (ICUs) often suffer
from a lack of sleep. Reducing anxiety by promoting adaptation to the ICU
prior to admission may be an appropriate way to increase sleep quality.
OBJECTIVE: The aim of this study was to evaluate the impact on sleep
quality of a brief nurse intervention.
METHODS: This was a pilot randomized controlled trial in Spain. Forty
patients admitted in hospital for valve cardiac surgery were randomly
allocated to (1) control group (n = 20), receiving usual care, and to (2)
experimental group (EG, n = 20), receiving a nurse intervention the day
before surgery and admission in the ICU. The intervention was based on Roy
Adaptation Model. A trained nurse anticipated the stressful stimulus to
patients in order to develop functional adaptive behaviors. A set of
photographs and videos was used to illustrate the environment and
assistance in the ICU. Sleep quality in the ICU was measured with the
Richards-Campbell Sleep Questionnaire and usual sleep quality with the
Pittsburgh Sleep Quality Index.
RESULTS: After the intervention, sleep quality was lower in the EG
compared with the control group (-4 points in Richards-Campbell Sleep
Questionnaire, P = .69). Adjustment for main confounders led this
reduction to -1.9 points (P = .87) among patients in EG. Stratified
analyses shown a positive impact for people who usually slept well (+5.2
points, P = .77), but negative for those who had previous poor sleep
quality (-20.0 points, P = .24).
CONCLUSION: A nurse intervention prior to ICU admission did not increase
patients' sleep quality. In addition, the intervention could have
incremented anxiety over the patients who used to sleep poorly at their
homes.

<37>
Accession Number
2001156838
Title
Open-labeled randomized controlled trial to evaluate the 1-year clinical
outcomes of polymer-free sirolimus-eluting coronary stents as compared
with biodegradable polymer-based sirolimus-eluting coronary stents.
Source
Indian Heart Journal. (no pagination), 2018. Date of Publication: 2018.
Author
Viswanathan S.; Gopinath K.; Koshy G.; Gupta P.N.; Velappan P.
Institution
(Viswanathan, Gopinath, Koshy, Gupta, Velappan) Department of Cardiology,
Government Medical College and Hospital, Thiruvananthapuram, Kerala
695011, India
Publisher
Elsevier B.V.
Abstract
Background: Head to head trials of clinical outcomes of sirolimus eluting
polymer free vs. biodegradable polymer stents are lacking. Methods: Single
centre prospective open labeled randomised controlled clinical trial.
Basis for sample size calculation was the rate of MACE from the ISAR TEST
3 trial in which the absolute difference was 10.25% with a standard
deviation of 0.24. Assuming null hypothesis, 80% power and 5% alpha error,
to detect a 10% difference, adjusting for 10% loss of follow up, sample
size was 204. Inclusion criteria: Patients with stable coronary artery
disease or recent acute coronary syndrome (>1 week from the date of
STEMI), being taken up for elective angioplasty. End points: Primary end
point was MACE at 1 year and secondary end points at the end of 1 year
were cardiac death, urgent target lesion revascularization, acute coronary
syndrome, stroke and in-stent re-stenosis. Results: 204 patients were
enrolled between January 2013 to July 2014, 91 in the polymer-free group
and 113 in the biodegradable polymer group. Baseline characteristics were
comparable between both groups. 21 patients (10.29%), were lost to follow
up. MACE at 1 year were comparable in both the groups 3 of 85(3.52%) in
the polymer-free group and 3 of 98(3.06%) in the biodegradable polymer
group, p = 0.859. The secondary end points were also comparable between
the two groups- Death- 1 of 85(1.17%) vs. 2 of 98(2.04%), p = 0.646,
Stroke 0 of 85 vs. 2 of 98(2.04%), p = 0.185 and acute coronary syndrome -
2 of 85(2.35%) vs. 1 of 98(1.02%), p = 0.204. There were no instances of
urgent target lesion re-vascularisation or definite stent thrombosis in
either groups. In stent re-stenosis was found in 7 of 85(8.2%) in the
polymer-free group vs. 6 of 98(6.12%) in the biodegradable polymer group.
Conclusion: The 1 year MACE rates are comparable in patients who underwent
elective coronary revascularization using sirolimus eluting polymer-free
and biodegradable polymer stents.<br/>Copyright &#xa9; 2018 Cardiological
Society of India

<38>
Accession Number
2001135853
Title
Comparing Combined Short-Axis and Long-Axis Ultrasound-Guided Central
Venous Catheterization With Conventional Short-Axis Out-of-Plane
Approaches.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Author
Takeshita J.; Nishiyama K.; Fukumoto A.; Shime N.
Institution
(Takeshita) Department of Intensive Care Medicine, Osaka Prefectural
Hospital Organization, Osaka Women's and Children's Hospital, Izumi,
Osaka, Japan
(Nishiyama) Department of Emergency and Critical Care Medicine, National
Hospital Organization, Kyoto Medical Center, Fushimi-ku, Kyoto, Japan
(Fukumoto) Department of Cardiovascular Surgery, Rakuwakai Otowa Hospital,
Yamashina-ku, Kyoto, Japan
(Shime) Department of Emergency and Critical Care Medicine, Institute of
Biomedical and Health Sciences, Hiroshima University, Minami-ku,
Hiroshima, Japan
Publisher
W.B. Saunders
Abstract
Objective: Visualizing the needle tip using the short-axis out-of-plane
(SA-OOP) ultrasound-guided central venous catheterization approach is
difficult and results in posterior wall puncture (PWP). To improve needle
tip visualization in the long-axis view, combining the SA-OOP and the
long-axis in-plane approaches has been suggested. The authors, who
previously reported on the utility of this technique using a manikin
model, examined the feasibility of this novel method (referred to as the
combined short-axis and long-axis [CSLA] approach) and compared the CSLA
approach with the SA-OOP approach in humans for the present study. Design:
Prospective observational study. Setting: Single institution, Rakuwakai
Otowa Hospital. Participants: Patients undergoing cardiac or vascular
surgeries. Interventions: The CSLA and SA-OOP approaches were used for
ultrasound-guided right jugular venous puncture. The puncturing procedures
were determined arbitrarily preoperatively without consideration of the
patient's neck anatomy and were based on the operator's preference without
randomization. Measurements and Main Results: The study comprised 100
patients. Successful guidewire insertion without PWP was performed in 48
patients (96%) in the CSLA approach group and 33 (66%) in the SA-OOP
approach group; the rate was significantly higher in the CSLA approach
group (p = 0.0001). The procedural durations were 27.5 (range 17.0-122.0)
seconds in the CSLA approach group and 25.0 (range 15.0-158.0) seconds in
the SA-OOP approach group (p = 0.19). Conclusions: This study showed that
the CSLA approach to ultrasound-guided central venous catheterization
might help prevent PWP.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<39>
Accession Number
2001063980
Title
Effect of Baseline Aortic Regurgitation on Mortality in Patients Treated
With Transcatheter or Surgical Aortic Valve Replacement (from the
CoreValve US Pivotal Trial).
Source
American Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Author
Grayburn P.A.; Oh J.K.; Reardon M.J.; Popma J.J.; Deeb G.M.; Boulware M.;
Huang J.; Stoler R.C.
Institution
(Grayburn, Stoler) Department of Cardiology and Cardiovascular Surgery,
Baylor Heart and Vascular Hospital, Dallas, Texas, United States
(Oh) Department of Echocardiography, Mayo Clinic, Rochester, Minnesota,
United States
(Reardon) Department of Cardiac Surgery, Houston-Methodist-Debakey Heart
and Vascular Center, Houston, Texas, United States
(Popma) Department of Internal Medicine (Cardiovascular Division), Beth
Israel Deaconess Medical Center, Boston, Massachusetts, United States
(Deeb) University of Michigan Hospitals, Ann Arbor, Michigan, United
States
(Boulware, Huang) Medtronic Clinical and Statistical Services,
Minneapolis, Minnesota, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
This study was performed to determine if baseline aortic regurgitation
(AR) affects the deleterious effects of postprocedure paravalvular leak
following transcatheter aortic valve implantation (TAVI). We evaluated the
effect of baseline AR on mortality in a large cohort of patients
randomized to transcatheter or surgical aortic valve replacement (SAVR).
The analysis cohort comprised 739 patients who underwent attempted TAVI (n
= 386) or SAVR (n = 353) in the CoreValve US Pivotal High Risk Trial and
had baseline AR measurements. Patients were stratified by the severity of
baseline AR into those with none and/or trace and those with >=mild AR.
Echocardiographic measurements were assessed by an independent core
laboratory. Of the 386 TAVI patients, 204 (52.9%) had none and/or trace at
baseline AR; 182 (47.2%) had >=mild AR. Of the 353 SAVR patients, 169
(47.9%) had none and/or trace and 184 (52.1%) >=mild AR. The presence of
>=mild baseline AR was associated with lower all-cause mortality at 1 year
following TAVI (9.4% vs 18.6%, p = 0.008) or SAVR (13.3% vs 24.4%, p =
0.009). Mortality remained lower in the >=mild baseline AR patients at 3
years after SAVR (p = 0.011), but not TAVI. In conclusion, baseline AR
appears to provide a protective effect on survival and quality of life in
both TAVI and SAVR patients at 1 year; this effect persists out to 3 years
in SAVR patients.<br/>Copyright &#xa9; 2018

<40>
Accession Number
624144809
Title
Assessment of omega-3 carboxylic acids in statin-treated patients with
high levels of triglycerides and low levels of high-density lipoprotein
cholesterol: Rationale and design of the STRENGTH trial.
Source
Clinical Cardiology. (no pagination), 2018. Date of Publication: 2018.
Author
Nicholls S.J.; Lincoff A.M.; Bash D.; Ballantyne C.M.; Barter P.J.;
Davidson M.H.; Kastelein J.J.P.; Koenig W.; McGuire D.K.; Mozaffarian D.;
Pedersen T.R.; Ridker P.M.; Ray K.; Karlson B.W.; Lundstrom T.; Wolski K.;
Nissen S.E.
Institution
(Nicholls) South Australian Health and Medical Research Institute,
University of Adelaide, Adelaide, Australia
(Lincoff, Bash, Wolski, Nissen) Department of Cardiovascular Medicine and
Cleveland Clinic Coordinating Center for Clinical Research, Cleveland
Clinic, Cleveland, OH, United States
(Ballantyne) Baylor College of Medicine, Houston, TX, United States
(Barter) University of New South Wales, Sydney, Australia
(Davidson) University of Chicago, Chicago, IL, United States
(Kastelein) Academic Medical Center, Amsterdam, Netherlands
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
and DZHK (German Centre for Cardiovascular Research), partner site Munich
Heart Alliance, Munich, Germany
(McGuire) Division of Cardiology, University of Texas Southwestern Medical
Center, Dallas, TX, United States
(Mozaffarian) Friedman School of Nutrition Science and Policy, Tufts
University, Boston, MA, United States
(Pedersen) Oslo University Hospital, Oslo, Norway
(Ridker) Harvard Medical School, Boston, MA, United States
(Ray) Imperial College of London, London, United Kingdom
(Karlson, Lundstrom) Department of Molecular and Clinical Medicine,
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden
(Karlson, Lundstrom) AstraZeneca Pharmaceuticals, Gothenburg, Sweden
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
It is uncertain whether omega-3 fatty acids are beneficial in
statin-treated patients. Epanova is a mix of omega-3 free fatty acids, not
requiring co-ingestion with food, which can lower triglycerides by up to
31%. STRENGTH will examine whether Epanova 4 g daily reduces the rate of
cardiovascular events in statin-treated patients with hypertriglyceridemia
and low levels of HDL-C at high risk for developing cardiovascular events.
STRENGTH is a randomized, double-blind, placebo-controlled trial. Patients
had a triglyceride level >= 180 to <500 mg/dL and HDL-C < 42 mg/dL (men)
or < 47 mg/dL (women) in the presence of either (1) established
atherosclerotic cardiovascular disease, (2) diabetes with one additional
risk factor, or (3) were other high-risk primary prevention patients,
based on age and risk factor assessment. Patients should be treated with a
statin, for >4 weeks, and have LDL-C < 100 mg/dL, but were also eligible
if LDL-C was >=100 mg/dL while on maximum tolerated statin therapy. The
study will extend from October 30, 2014 to October 30, 2019. 13 086
patients were randomized to Epanova 4 g or placebo daily in addition to
standard medical therapy. The primary efficacy outcome is time to first
event of cardiovascular death, myocardial infarction, stroke, coronary
revascularization or hospitalization for unstable angina. The trial will
continue until 1600 patients reach the primary endpoint, with a median
duration of therapy of 3 years. STRENGTH will determine whether Epanova 4
g daily will reduce cardiovascular events in statin-treated high-risk
patients with hypertriglyceridemia and low HDL-C levels.<br/>Copyright
&#xa9; 2018 Wiley Periodicals, Inc.

<41>
Accession Number
624144220
Title
Clinical complete response after chemoradiotherapy for carcinoma of
thoracic esophagus: Is esophagectomy always necessary? A systematic review
and meta-analysis.
Source
Thoracic Cancer. (no pagination), 2018. Date of Publication: 2018.
Author
Wang J.; Qin J.; Jing S.; Liu Q.; Cheng Y.; Wang Y.; Cao F.
Institution
(Wang, Jing, Liu, Cheng, Wang, Cao) Department of Radiation Oncology, The
Fourth Hospital of Hebei Medical University, Shijiazhuang, China
(Qin) Department of Thoracic Surgery, Cancer Hospital of Chinese Academy
of Medical Sciences, Beijing, China
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Although a clinical complete response (cCR) after
chemoradiotherapy (CRT) could lead to a better prognosis, the choice of a
following strategy, such as surgical or non-surgical approach, remains
controversial. Methods: All articles relevant to a comparison of surgical
and non-surgical treatment (including further definitive chemoradiotherapy
or active surveillance) for esophageal carcinoma patients with a cCR after
CRT were retrieved for meta-analysis. The final date for data retrieval
was 30 June 2018. Results: Four retrospective studies including 648
patients met the inclusion criteria: 620 with squamous cell carcinoma and
28 with adenocarcinoma. The CRT + surgery group had an advantage over the
non-surgery group in regard to two-year disease-free survival (DFS);
however, the two groups showed similar results in five-year DFS. The CRT +
surgery group had an advantage over the non-surgery group in two-year
overall survival (OS); nevertheless, the two groups showed similar results
in five-year OS. Conclusions: Based on the available evidence, the
addition of surgery to thoracic locally advanced esophageal carcinoma
patients with a cCR after neoadjuvant CRT provided no advantage to
long-term survival. As an exception, the two-year DFS and OS could be
improved. This research conclusion might be more suitable to patients with
squamous cell carcinoma.<br/>Copyright &#xa9; 2018 The Authors. Thoracic
Cancer published by China Lung Oncology Group and John Wiley & Sons
Australia, Ltd

<42>
Accession Number
620844538
Title
Perioperative Management of Cardiovascular Medications.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2289-2302),
2018. Date of Publication: October 2018.
Author
Lomivorotov V.V.; Efremov S.M.; Abubakirov M.N.; Belletti A.; Karaskov
A.M.
Institution
(Lomivorotov, Efremov, Abubakirov) Department of Anaesthesiology and
Intensive Care, E. Meshalkin National Medical Research Center,
Novosibirsk, Russian Federation
(Belletti) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Karaskov) Department of Cardiac Surgery, E. Meshalkin National Medical
Research Center, Novosibirsk, Russian Federation
Publisher
W.B. Saunders

<43>
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.

<44>
Accession Number
620538852
Title
Incidence, predictors, and long term clinical outcome of angiographic
definite stent thrombosis in real world scenario - A prospective cohort
study.
Source
Cardiovascular Revascularization Medicine. 19 (6) (pp 666-670), 2018. Date
of Publication: September 2018.
Author
Singh B.; Ramesh B.; Rajendran R.; Singh Y.; Singla V.; Kolhari V.B.;
Goyal A.; Mohan B.; Aslam N.; Chhabra S.T.; Wander G.S.; Nanjappa M.C.
Institution
(Singh, Goyal, Mohan, Aslam, Chhabra, Wander) Department of Cardiology,
Dayanand Medical College and Hospital, Ludhiana, Punjab, India
(Ramesh, Rajendran, Singh, Singla, Kolhari, Nanjappa) Department of
Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research,
Karnataka, India
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The occurrence of stent thrombosis (ST) in real world scenario
is far different from that mentioned in the literature. Our study
identifies the various parameters of ST. Methods: This is a prospective
observational-cohort study where-in consecutive patients who received
successful percutaneous transluminal angioplasty (PTCA) over the study
period of 1-year was included and were followed for 1-year from the
primary procedure. Results: The overall incidence of definite ST was 1.4%
and 1.7% at 30 days and 1 year respectively. The most common mode of
presentation of ST was ST-elevation myocardial infarction (82.6%). The
history of prior PTCA, multi-vessel disease, emergent PTCA, acute coronary
syndrome and type B2/C lesions were found to be the independent predictors
for definite ST. The incidence of late ST was significantly higher with
bare metal stent (BMS) than drug-eluting stent (DES) (OR-2.4, 95%
CI:1.3-4.5). At mean follow-up of 13.9 months after ST, the overall
mortality was 36.9%. The independent predictors of mortality after ST were
post-PTCA thrombolysis in myocardial infarction (TIMI) flow grade < 3, and
cardiogenic shock at the time of presentation. Conclusion: The overall
incidence of definite ST is high in the real world scenario and the DES
fared better than BMS. ST carries a bad prognosis especially so if the
patients present in cardiogenic shock, or unable to achieve TIMI-3 flow
after PTCA.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<45>
Accession Number
621224934
Title
Postoperative Vasoplegic Syndrome Is Associated With Impaired Endothelial
Vasomotor Response in Cardiac Surgery: A Prospective, Observational Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2218-2224),
2018. Date of Publication: October 2018.
Author
Abou-Arab O.; Martineau L.; Bar S.; Huette P.; Amar A.B.; Caus T.; Dupont
H.; Kamel S.; Guinot P.-G.; Lorne E.
Institution
(Abou-Arab, Martineau, Bar, Huette, Amar, Dupont, Lorne) Department of
Anaesthesiology and Critical Care Medicine, Amiens Picardy University
Hospital, Amiens, France
(Caus) Department of Cardiac Surgery, Amiens Picardy University Hospital,
Amiens, France
(Kamel) Jules Verne University of Picardy, Amiens, France
(Guinot) Department of Anaesthesiology and Critical Care Medicine, Dijon
University Hospital, Dijon, France
Publisher
W.B. Saunders
Abstract
Objectives: Vasoplegic syndrome (VS) affects up to 30% of cardiac surgery
patients. Onset of VS may be associated with overproduction of nitric
oxide (NO). The response of the brachial artery to NO can be assessed
using flow-mediated vasodilation (FMD). The aim of this study was to
assess brachial artery diameter and FMD response immediately after cardiac
surgery. Design: Prospective, observational study. Setting: Single-center
study in a tertiary teaching hospital. Patients: Patients older than 18
years undergoing elective cardiac surgery with cardiopulmonary bypass who
provided informed consent. Interventions: Brachial artery diameter and FMD
response were measured before cardiac surgery and just after surgery on
admission to the intensive care unit. Patients were screened for VS for
the following 48 hours. Results: Eleven (39%) of the 28 patients included
in the study developed VS. Brachial artery diameter and FMD differed
between VS and non-VS patients. On intensive care unit admission, mean
(+/- standard deviation) brachial artery diameter was greater in VS
patients than in non-VS patients (3.9 +/- 0.7 mm v 3.0 +/- 0.8 mm,
respectively; p = 0.002). Similarly, the FMD response after surgery was
greater in VS patients than in non-VS patients (42% +/- 8% v 31% +/- 1%,
respectively; p = 0.014). Brachial artery diameter and FMD response after
surgery were both predictive of VS, with an area under the curve (95%
confidence interval) of 0.850 (0.705-0.995) (p = 0.002) and 0.755
(0.56-0.95) (p = 0.047), respectively. Conclusion: Cardiac surgery with
cardiopulmonary bypass appears to alter the NO-mediated endothelial
vasomotor response.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<46>
Accession Number
2000844102
Title
Revascularization strategies in cardiogenic shock complicating acute
myocardial infarction: A systematic review and meta-analysis.
Source
Cardiovascular Revascularization Medicine. 19 (6) (pp 647-654), 2018. Date
of Publication: September 2018.
Author
Rahman H.; Khan S.U.; Lone A.N.; Kaluski E.
Institution
(Rahman, Khan, Lone, Kaluski) Guthrie Health System/Robert Packer
Hospital, Sayre, PA, United States
(Kaluski) Rutgers New Jersey Medical School, Newark, NJ, United States
(Kaluski) The Geisinger Commonwealth Medical College, Scranton, PA, United
States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The optimal revascularization strategy in patients with
multi-vessel disease (MVD) presenting with acute myocardial infarction
(AMI) and cardiogenic shock (CS) remains unclear. Objective: To
investigate the comparative differences between culprit-only
revascularization (COR) versus instant multi-vessel revascularization
(IMVR) in AMI and CS. Methods: 13 studies were selected using MEDLINE,
EMBASE and the CENTRAL (Inception - 31 November2017). Outcomes were
assessed at short-term (in-hospital or <=30 days duration) and long-term
duration (>=6 months). Estimates were reported as random effects relative
risk (RR) with 95% confidence interval (CI). Results: In analysis of 7311
patients, COR significantly reduced the relative risk of short-term
all-cause mortality (RR: 0.87; 95% CI, 0.77-0.97; p = 0.01, I²
= 50%) and renal failure (RR: 0.75; 95% CI, 0.61-0.94; p = 0.01,
I² = 7%) compared with IMVR. There were no significant
differences between both the strategies in terms of reinfarction (RR:
1.25; 95% CI, 0.59-2.63; p = 0.56, I² = 0%), major bleeding
(RR: 0.88; 95% CI, 0.75-1.04; p = 0.14, I² = 0%) and stroke
(RR: 0.77; 95% CI, 0.50-1.17; p = 0.22, I² = 0%) at short term
duration. Similarly, no significant differences were observed between both
groups regarding all-cause mortality (RR; 1.01; 95% CI, 0.85-1.20; p =
0.93, I² = 61%) and reinfarction (RR: 0.71; 95% CI, 0.34-1.47;
p = 0.35, I² = 26%) at long term duration. Conclusion: In MVD
patients presenting with AMI and CS, IMVR was comparable to COR in terms
of all-cause mortality at long term follow up duration. These results are
predominantly derived from observational data and more randomized
controlled trials are required to validate this impression.<br/>Copyright
&#xa9; 2018 Elsevier Inc.

<47>
[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.

<48>
[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.

<49>
Accession Number
2001137546
Title
Prevalence and Outcomes of Percutaneous Coronary Interventions for Ostial
Chronic Total Occlusions: Insights From a Multicenter Chronic Total
Occlusion Registry.
Source
Canadian Journal of Cardiology. 34 (10) (pp 1264-1274), 2018. Date of
Publication: October 2018.
Author
Tajti P.; Burke M.N.; Karmpaliotis D.; Alaswad K.; Jaffer F.A.; Yeh R.W.;
Patel M.; Mahmud E.; Choi J.W.; Doing A.H.; Datilo P.; Toma C.; Smith
A.J.C.; Uretsky B.; Holper E.; Garcia S.; Krestyaninov O.; Khelimskii D.;
Koutouzis M.; Tsiafoutis I.; Moses J.W.; Lembo N.J.; Parikh M.; Kirtane
A.J.; Ali Z.A.; Doshi D.; Jaber W.; Samady H.; Rangan B.V.; Xenogiannis
I.; Ungi I.; Banerjee S.; Brilakis E.S.
Institution
(Tajti, Burke, Xenogiannis, Brilakis) Minneapolis Heart Institute, Abbott
Northwestern Hospital, Minneapolis, MN, United States
(Tajti, Ungi) University of Szeged, Division of Invasive Cardiology,
Department of Second Internal Medicine and Cardiology Center, Szeged,
Hungary
(Karmpaliotis, Moses, Lembo, Ali, Doshi) Columbia University, New York,
NY, United States
(Alaswad, Parikh, Kirtane) Henry Ford Hospital, Detroit, MI, United States
(Jaffer) Massachusetts General Hospital, Boston, MA, United States
(Yeh) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Patel, Mahmud) VA San Diego Healthcare System and University of
California San Diego, La Jolla, CA, United States
(Choi) Baylor Heart and Vascular Hospital, Dallas, TX, United States
(Doing, Datilo) Medical Center of the Rockies, Loveland, CO, United States
(Toma, Smith) University of Pittsburgh Medical Center, Pittsburgh, PA,
United States
(Uretsky) VA Central Arkansas Healthcare System, Little Rock, AR, United
States
(Holper) The Heart Hospital Baylor Plano, Plano, TX, United States
(Garcia) VA Minneapolis Healthcare System and University of Minnesota,
Minneapolis, MN, United States
(Krestyaninov, Khelimskii) Meshalkin Siberian Federal Biomedical Research
Center, Ministry of Health of Russian Federation, Novosibirsk, Russian
Federation
(Koutouzis, Tsiafoutis) Korgialeneio-Benakeio Hellenic Red Cross General
Hospital of Athens, Athens, Greece
(Jaber, Samady) Emory University Hospital Midtown, Atlanta, GA, United
States
(Rangan, Banerjee) VA North Texas Health Care System and University of
Texas Southwestern Medical Center, Dallas, TX, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Ostial chronic total occlusions (CTOs) can be challenging to
recanalize. Methods: We sought to examine the prevalence, angiographic
presentation, and procedural outcomes of ostial (side-branch ostial and
aorto-ostial) CTOs among 1000 CTO percutaneous coronary interventions
(PCIs) performed in 971 patients between 2015 and 2017 at 14 centres in
the US, Europe, and Russia. Results: Ostial CTOs represented 16.9% of all
CTO PCIs: 9.6% were aorto-ostial, and 7.3% were side-branch ostial
occlusions. Compared with nonostial CTOs, ostial CTOs were longer (44 +/-
33 vs 29 +/- 19 mm, P < 0.001) and more likely to have proximal-cap
ambiguity (55% vs 33%, P < 0.001), moderate/severe calcification (67% vs
45%, P < 0.001), a diffusely diseased distal vessel (41% vs 26%, P <
0.001), interventional collaterals (64% vs 53%, P = 0.012), and previous
coronary artery bypass graft surgery (CABG) (51% vs 27%, P < 0.001). The
retrograde approach was used more often in ostial CTOs (54% vs 29%, P <
0.001) and was more often the final successful crossing strategy (30% vs
18%, P = 0.003). Technical (81% vs 84%, P = 0.280), and procedural (77% vs
83%, P = 0.112) success rates and the incidence of in-hospital major
complication were similar (4.8% vs 2.2%, P = 0.108), yet in-hospital
mortality (3.0% vs 0.5%, P = 0.010) and stroke (1.2% vs 0.0%, P = 0.030)
were higher in the ostial CTO PCI group. In multivariable analysis, ostial
CTO location was not independently associated with higher risk for
in-hospital major complications (adjusted odds ratio 1.27, 95% confidence
intervals 0.37 to 4.51, P = 0.694). Conclusions: Ostial CTOs can be
recanalized with similar rates of success as nonostial CTOs but are more
complex, more likely to require retrograde crossing and may be associated
with numerically higher risk for major in-hospital
complications.<br/>Copyright &#xa9; 2018 Canadian Cardiovascular Society

<50>
Accession Number
2001133235
Title
Impact of Coronary Artery Chronic Total Occlusion on Arrhythmic and
Mortality Outcomes: A Systematic Review and Meta-Analysis.
Source
JACC: Clinical Electrophysiology. 4 (9) (pp 1214-1223), 2018. Date of
Publication: September 2018.
Author
Chi W.K.; Gong M.; Bazoukis G.; Yan B.P.; Letsas K.P.; Liu T.; Baranchuk
A.; Nombela-Franco L.; Dong M.; Tse G.
Institution
(Chi, Yan, Tse) Department of Medicine and Therapeutics, Faculty of
Medicine, Chinese University of Hong Kong, Hong Kong, SAR, Hong Kong
(Chi, Tse) Li Ka Shing Institute of Health Sciences, Faculty of Medicine,
Chinese University of Hong Kong, Hong Kong, SAR, Hong Kong
(Gong, Liu) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular Disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Bazoukis, Letsas) Second Department of Cardiology, Laboratory of Cardiac
Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
(Baranchuk) Department of Medicine, Kingston General Hospital, Queen's
University, Kingston, Ontario, Canada
(Nombela-Franco) Cardiology Department, Instituto Cardiovascular, Hospital
Clinico San Carlos, IdISSC, Madrid, Spain
(Dong) Department of Cardiology, Yantai Yuhuangding Hospital Affiliated to
Qingdao University, Yantai, Shandong Province, China
(Tse) Department of Medicine and Therapeutics, Faculty of Medicine, The
Chinese University of Hong Kong, Room 114043, 9/F, Lui Che Woo Clinical
Sciences Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong, Hong
Kong
Publisher
Elsevier Inc
Abstract
Objectives: This study aimed to examine the relationship between chronic
coronary artery total occlusion (CTO) status and the occurrence of
ventricular tachycardia (VT)/ventricular fibrillation (VF) or appropriate
implantable cardioverter-defibrillator (ICD) therapy. Background: CTO is a
significant problem in patients with ischemic heart disease. However, the
extent to which it predisposes affected individuals to VT/VF and whether
these arrhythmic events could be prevented by revascularization are
unclear. Therefore, a systematic review and meta-analysis were conducted
to examine the relationship between CTO status and the occurrence of VT/VF
or appropriate ICD therapy. Methods: PubMed and Embase databases were
searched until November 16, 2017, identifying 137 studies. Results:
Seventeen studies involving 54,594 subjects (mean age, 61 +/- 21 years of
age, 81% male) with a mean follow-up of 43 +/- 31 months were included.
The presence of CTO was associated with higher risk of VT/VF or
appropriate ICD therapy (adjusted hazard ratio [aHR]: 1.99; 95% confidence
interval (CI): 1.53 to 2.59; p < 0.0001, I² = 3%) but not in
cardiac mortality (aHR: 2.59; 95% CI: 0.64 to 10.59; p = 0.18,
I² = 86%) or in all-cause mortality (aHR: 1.70; 95% CI: 0.84 to
3.46; p = 0.14; I² = 64%). Compared to patients with
non-infarct-related CTOs, those with infarct-related CTOs have a higher
risk of VT/VF or appropriate ICD therapy (aHR: 2.47; 95% CI: 1.76 to 3.46;
p < 0.0001; I² = 14%), cardiac mortality (aHR: 2.73; 95% CI:
1.02 to 7.30; p < 0.05; I² = 79%) and higher all-cause
mortality (aHR: 1.69; 95% CI: 1.19 to 2.40; p < 0.01; I² =
40%). Nonrevascularization of CTOs tended to be associated with an
increased risk of all-cause mortality compared to successful
revascularization (unadjusted HR: 1.52; 95% CI: 0.96 to 2.43; p = 0.08;
I² = 76). Conclusions: CTOs, especially infarct-related, are
associated with high risk of VT/VF or appropriate ICD therapy and
mortality. ICD implantation could be beneficial. However, it is not clear
that revascularization has an impact on the outcome of patients with
CTOs.<br/>Copyright &#xa9; 2018 American College of Cardiology Foundation

<51>
Accession Number
2001133016
Title
A Randomized Study of Distal Filter Protection Versus Conventional
Treatment During Percutaneous Coronary Intervention in Patients With
Attenuated Plaque Identified by Intravascular Ultrasound.
Source
JACC: Cardiovascular Interventions. 11 (16) (pp 1545-1555), 2018. Date of
Publication: 27 August 2018.
Author
Hibi K.; Kozuma K.; Sonoda S.; Endo T.; Tanaka H.; Kyono H.; Koshida R.;
Ishihara T.; Awata M.; Kume T.; Tanabe K.; Morino Y.; Tsukahara K.; Ikari
Y.; Fujii K.; Yamasaki M.; Yamanaka T.; Kimura K.; Isshiki T.
Institution
(Hibi, Kimura) Division of Cardiology, Yokohama City University Medical
Center, Yokohama, Japan
(Kozuma, Kyono) Division of Cardiology, Teikyo University School of
Medicine, Tokyo, Japan
(Sonoda) Second Department of Internal Medicine, School of Medicine,
University of Occupational and Environmental Health, Kitakyushu, Japan
(Endo) Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital,
Yokohama, Japan
(Tanaka) Department of Cardiology, Tokyo Metropolitan Tama Medical Center,
Fuchu, Japan
(Koshida) Tokeidai Memorial Hospital Cardiovascular Center, Sapporo, Japan
(Ishihara) Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
(Awata) Cardiovascular Division, Osaka National Hospital, Osaka, Japan
(Kume) Department of Cardiology, Kawasaki Medical School, Okayama, Japan
(Tanabe) Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(Morino) Division of Cardiology, Department of Internal Medicine, Iwate
Medical University School of Medicine, Morioka, Japan
(Tsukahara) Division of Cardiology, Fujisawa City Hospital, Fujisawa,
Japan
(Ikari) Department of Cardiology, Tokai University, Kanagawa, Japan
(Fujii) Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka,
Japan
(Yamasaki) Department of Cardiology, NTT Medical Center Tokyo, Tokyo,
Japan
(Yamanaka) Department of Biostatistics, Yokohama City University,
Yokohama, Japan
(Isshiki) Division of Cardiology, Ageo Central General Hospital, Saitama,
Japan
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to evaluate the utility of distal
protection during percutaneous coronary intervention (PCI) in patients
with acute coronary syndromes at high risk for distal embolization.
Background: The results of previous clinical trials indicated that the
routine use of distal protection in patients with ST-segment elevation
myocardial infarction did not improve clinical outcomes. However,
selective use of distal protection by means of a filter-based distal
protection system has not been evaluated. Methods: Two hundred patients
with acute coronary syndromes who had native coronary artery lesions and
attenuated plaque with longitudinal length >=5 mm on pre-PCI intravascular
ultrasound were randomly assigned to undergo PCI with distal protection or
conventional treatment. Results: The primary endpoint (no-reflow
phenomenon) occurred in 26 patients (26.5%) in the distal protection group
and 39 patients (41.7%) in the conventional treatment group (p = 0.026),
and the corrected TIMI (Thrombolysis In Myocardial Infarction) frame count
after revascularization was significantly lower in the distal protection
group (23 vs. 30.5; p = 0.0003). The incidence of cardiac death, cardiac
arrest, cardiogenic shock after revascularization requiring
defibrillation, cardiopulmonary resuscitation, or extracorporeal membrane
oxygenation was significantly lower in the distal protection group than in
the conventional treatment group (0% vs. 5.2%; p = 0.028). Conclusions:
The use of distal embolic protection applied with a filter device
decreased the incidence of the no-reflow phenomenon and was associated
with fewer serious adverse cardiac events after revascularization than
conventional PCI in patients with acute coronary syndromes with attenuated
plaque >=5 mm in length. (Assessment of Distal Protection Device in
Patients at High Risk for Distal Embolism in Acute Coronary Syndrome [ACS]
[VAMPIRE3]; NCT01460966)<br/>Copyright &#xa9; 2018 American College of
Cardiology Foundation

<52>
Accession Number
2001132716
Title
Radial versus femoral access and bivalirudin versus unfractionated heparin
in invasively managed patients with acute coronary syndrome (MATRIX):
final 1-year results of a multicentre, randomised controlled trial.
Source
The Lancet. 392 (10150) (pp 835-848), 2018. Date of Publication: 8 - 14
September 2018.
Author
Valgimigli M.; Frigoli E.; Leonardi S.; Vranckx P.; Rothenbuhler M.;
Tebaldi M.; Varbella F.; Calabro P.; Garducci S.; Rubartelli P.; Briguori
C.; Ando G.; Ferrario M.; Limbruno U.; Garbo R.; Sganzerla P.; Russo F.;
Nazzaro M.; Lupi A.; Cortese B.; Ausiello A.; Ierna S.; Esposito G.;
Ferrante G.; Santarelli A.; Sardella G.; de Cesare N.; Tosi P.; van 't Hof
A.; Omerovic E.; Brugaletta S.; Windecker S.; Heg D.; Juni P.; Campo G.;
Uguccioni L.; Tamburino C.; Presbitero P.; Zavalloni-Parenti D.; Ferrari
F.; Ceravolo R.; Tarantino F.; Pasquetto G.; Casu G.; Mameli S.; Stochino
M.L.; Mazzarotto P.; Cremonesi A.; Saia F.; Saccone G.; Abate F.; Picchi
A.; Violini R.; Colangelo S.; Boccuzzi G.; Guiducci V.; Vigna C.;
Zingarelli A.; Gagnor A.; Zaro T.; Tresoldi S.; Vandoni P.; Contarini M.;
Liso A.; Dellavalle A.; Curello S.; Mangiacapra F.; Evola R.; Palmieri C.;
Falcone C.; Liistro F.; Creaco M.; Colombo A.; Chieffo A.; Perkan A.; De
Servi S.; Fischetti D.; Rigattieri S.; Sciahbasi A.; Pucci E.; Romagnoli
E.; Moretti C.; Moretti L.; De Caterina R.; Caputo M.; Zimmarino M.;
Bramucci E.; Di Lorenzo E.; Turturo M.; Bonmassari R.; Penzo C.; Loi B.;
Mauro C.; Petronio A.S.; Gabrielli G.; Micari A.; Belloni F.; Amico F.;
Comeglio M.; Fresco C.; Klinieken I.; Van Mieghem N.; Diletti R.; Regar
E.; Sabate M.; Gomez Hospital J.A.; Diaz Fernandez J.F.; Mainar V.; de la
Torre Hernandez J.M.
Institution
(Valgimigli, Windecker) Inselspital, Bern University Hospital, University
of Bern, Bern, Switzerland
(Frigoli, Rothenbuhler, Heg) Clinical Trials Unit, University of Bern,
Bern, Switzerland
(Leonardi, Ferrario) UOC Cardiologia, Dipartimento CardioToracoVascolare,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
(Tebaldi) University Hospital of Ferrara, Ferrara, Italy
(Varbella) Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3,
Turin, Italy
(Calabro) Division of Clinical Cardiology, "Sant'Anna e San Sebastiano"
Hospital, Caserta, Italy
(Calabro) Department of Translational Medical Sciences, University of
Campania "Luigi Vanvitelli", Naples, Italy
(Garducci) A.O. Ospedale Civile di Vimercate, Vimercate, Italy
(Rubartelli) Department of Cardiology, ASL3 Ospedale Villa Scassi, Genoa,
Italy
(Briguori) Clinica Mediterranea, Naples, Italy
(Ando) Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino",
University of Messina, Messina, Italy
(Limbruno) UO Cardiologia, ASL 9 Grosseto, Grosseto, Italy
(Garbo) San Giovanni Bosco Hospital, Turin, Italy
(Sganzerla) AO Ospedale Treviglio-Caravaggio, Treviglio, Italy
(Russo) Azienda Ospedaliera Sant'Anna, Como, Italy
(Nazzaro) San Camillo-Forlanini, Roma, Italy
(Lupi) Division of Cardiology, ASL VCO, Verbania, Italy
(Cortese) Ospedale FatebeneFratelli, Milano, Italy
(Ausiello) Casa di Cura Villa Verde, Taranto, Italy
(Ierna) Ospedale Sirai, Carbonia, Carbonia, Italy
(Esposito) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University of Naples, Naples, Italy
(Ferrante) IRCCS Humanitas, Milan, Italy
(Santarelli) Cardiovascular Department, Infermi Hospital, Rimini, Italy
(Sardella) Policlinico Umberto I, "Sapienza" University of Rome, Rome,
Italy
(de Cesare) Policlinico San Marco, Zingonia, Italy
(Tosi) Mater Salutis Hospital, Legnago, Italy
(van 't Hof) Department of Cardiology, Maastricht University Medical
Center (MUMC+), Maastricht, Netherlands
(Omerovic) Sahlgrenska University Hospital, Gothenburg, Sweden
(Brugaletta) Hospital Clinic, University of Barcelona, Thorax Institute,
Department of Cardiology, Barcelona, Spain
(Juni) Applied Health Research Centre (AHRC), Li Ka Shing Knowledge
Institute of St Michael's Hospital, Department of Medicine and Institute
of Health Policy, Management and Evaluation, University of Toronto,
Toronto, ON, Canada
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: The Minimizing Adverse Haemorrhagic Events by Transradial
Access Site and Systemic Implementation of Angiox (MATRIX) programme was
designed to assess the comparative safety and effectiveness of radial
versus femoral access and of bivalirudin versus unfractionated heparin
with optional glycoprotein IIb/IIIa inhibitors in patients with the whole
spectrum of acute coronary syndrome undergoing invasive management. Here
we describe the prespecified final 1-year outcomes of the entire
programme. Methods: MATRIX was a programme of three nested, randomised,
multicentre, open-label, superiority trials in patients with acute
coronary syndrome in 78 hospitals in Italy, the Netherlands, Spain, and
Sweden. Patients with ST-elevation myocardial infarction were
simultaneously randomly assigned (1:1) before coronary angiography to
radial or femoral access and to bivalirudin, with or without
post-percutaneous coronary intervention infusion or unfractionated heparin
(one-step inclusion). Patients with non-ST-elevation acute coronary
syndrome were randomly assigned (1:1) before coronary angiography to
radial or femoral access and, only if deemed eligible to percutaneous
coronary intervention after angiography (two-step inclusion), entered the
antithrombin type and treatment duration programmes. Randomisation
sequences were computer generated, blocked, and stratified by intended new
or current use of P2Y12 inhibitor (clopidogrel vs ticagrelor or
prasugrel), and acute coronary syndrome type (ST-elevation myocardial
infarction, troponin-positive, or troponin-negative non-ST-elevation acute
coronary syndrome). Bivalirudin was given as a bolus of 0.75 mg/kg,
followed immediately by an infusion of 1.75 mg/kg per h until completion
of percutaneous coronary intervention. Heparin was given at 70-100 units
per kg in patients not receiving glycoprotein IIb/IIIa inhibitors, and at
50-70 units per kg in patients receiving glycoprotein IIb/IIIa inhibitors.
Clinical follow-up was done at 30 days and 1 year. Co-primary outcomes for
MATRIX access and MATRIX antithrombin type were major adverse
cardiovascular events, defined as the composite of all-cause mortality,
myocardial infarction, or stroke up to 30 days; and net adverse clinical
events, defined as the composite of non-coronary artery bypass
graft-related major bleeding, or major adverse cardiovascular events up to
30 days. The primary outcome for MATRIX treatment duration was the
composite of urgent target vessel revascularisation, definite stent
thrombosis, or net adverse clinical events up to 30 days. Analyses were
done according to the intention-to-treat principle. This trial is
registered with ClinicalTrials.gov, number NCT01433627. Findings: Between
Oct 11, 2011, and Nov 7, 2014, we randomly assigned 8404 patients to
receive radial (4197 patients) or femoral (4207 patients) access. Of these
8404 patients, 7213 were included in the MATRIX antithrombin type study
and were randomly assigned to bivalirudin (3610 patients) or heparin (3603
patients). Patients assigned to bivalirudin were included in the MATRIX
treatment duration study, and were randomly assigned to post-procedure
infusion (1799 patients) or no post-procedure infusion (1811 patients). At
1 year, major adverse cardiovascular events did not differ between
patients assigned to radial access compared with those assigned to femoral
access (14.2% vs 15.7%; rate ratio 0.89, 95% CI 0.80-1.00; p=0.0526), but
net adverse clinical events were fewer with radial than with femoral
access (15.2% vs 17.2%; 0.87, 0.78-0.97; p=0.0128). Compared with heparin,
bivalirudin was not associated with fewer major adverse cardiovascular
(15.8% vs 16.8%; 0.94, 0.83-1.05; p=0.28) or net adverse clinical events
(17.0% vs 18.4%; 0.91, 0.81-1.02; p=0.10). The composite of urgent target
vessel revascularisation, stent thrombosis, or net adverse clinical events
did not differ with or without post-procedure bivalirudin infusion (17.4%
vs 17.4%; 0.99, 0.84-1.16; p=0.90). Interpretation: In patients with acute
coronary syndrome, radial access was associated with lower rates of net
adverse clinical events compared with femoral access, but not major
adverse cardiovascular events at 1 year. Bivalirudin with or without
post-procedure infusion was not associated with lower rates of major
adverse cardiovascular events or net adverse clinical events. Radial
access should become the default approach in acute coronary syndrome
patients undergoing invasive management. Funding: Italian Society of
Invasive Cardiology, The Medicines Company, Terumo, amd Canada Research
Chairs Programme.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<53>
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

<54>
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).

<55>
[Use Link to view the full text]
Accession Number
624014832
Title
Individualized Biventricular Epicardial Augmentation Technology in a
Drug-Induced Porcine Failing Heart Model.
Source
ASAIO Journal. 64 (4) (pp 480-488), 2018. Date of Publication: 2018.
Author
Jagschies L.; Hirschvogel M.; Matallo J.; Maier A.; Mild K.; Brunner H.;
Hinkel R.; Gee M.W.; Radermacher P.; Wildhirt S.M.; Hafner S.
Institution
(Jagschies, Hirschvogel, Gee) Mechanics and High Performance Computing
Group, Technical University of Munich, Garching, Germany
(Maier, Wildhirt) AdjuCor GmbH, Garching, Germany
(Mild, Brunner) Klinik fur Diagnostische und Interventionelle Radiologie,
Universitatsklinikum Ulm, Ulm, Germany
(Hinkel) Institute for Cardiovascular Prevention (IPEK), LMU, Munich,
Germany
(Hinkel) . Medizinische Klinik, Klinikum Rechts der Isar, TUM, Munich,
Germany
(Hinkel) DZHK (German Center for Cardiovascular Research), Partner Site
Munich Heart Alliance, Munich, Germany
(Hafner) Klinik fur Anasthesiologie, Universitatsklinikum Ulm, Ulm,
Germany
(Matallo, Hafner) Institut fur Anasthesiologische Pathophysiologie und
Verfahrensentwicklung, Universitatsklinikum Ulm, Helmholtzstrasse 8-1, Ulm
89081, Germany
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
For treatment of advanced heart failure, current strategies include
cardiac transplantation or blood-contacting pump technology associated
with complications, including stroke and bleeding. This study investigated
an individualized biventricular epicardial augmentation technology in a
drug-induced porcine failing heart model. A total of 11 pigs were used,
for the assessment of hemodynamics and cardiac function under various
conditions of support pressures and support durations (n = 4), to assess
device positioning and function by in vivo computer tomographic imaging (n
= 3) and to investigate a minimally invasive implantation on the beating
heart (n = 4). Support pressures of 20-80 mm Hg gradually augmented
cardiac function parameters in this animal model as indicated by increased
left ventricular stroke volume, end-systolic pressures, and decreased
end-diastolic pressures. Strong evidence was found regarding the necessity
of mechanical synchronization of support end with the isovolumetric
relaxation phase of the heart. In addition, the customized,
self-expandable implant enabled a marker-guided minimally invasive
implantation through a 4 cm skin incision using fluoroscopy. Correct
positioning was confirmed in computer tomographic images. Continued
long-term survival investigations will deliver preclinical evidence for
further development of this concept. ASAIO Journal 2018;
64:480-488.<br/>Copyright &#xa9; 2017 by the ASAIO.

<56>
Accession Number
624001621
Title
Sex Differences in the Management of Advanced Heart Failure.
Source
Current Treatment Options in Cardiovascular Medicine. 20 (11) (no
pagination), 2018. Article Number: 88. Date of Publication: 01 Nov 2018.
Author
Crousillat D.R.; Ibrahim N.E.
Institution
(Crousillat, Ibrahim) Massachusetts General Hospital, 55 Fruit Street
GRB-800, Boston, MA 02114, United States
(Ibrahim) Harvard Medical School, Boston, MA, United States
Publisher
Springer Healthcare
Abstract
Purpose of review: Heart failure (HF) is prevalent among women and remains
a leading cause of morbidity and mortality in the United States.
Currently, 3 million women live with HF and the prevalence is projected to
continue to increase. The purpose of this review is to highlight sex
differences in the use and response to evidence-based pharmacological,
device, and advanced HF therapies, as well as explore emerging areas of
research in sex differences in the treatment of HF. Recent findings:
Under-representation of women in clinical HF trials has limited our
understanding of sex-related differences in the treatment and outcomes of
HF. Summary: Important sex differences exist in the use of evidence-based
HF therapies and clinical response among women with HF. In general, women
tend to obtain the same clinical benefit from evidence-based HF drug and
device therapies, but the utilization rates of guideline-directed medical
therapies remain poor compared to men. Future research efforts should
focus on increasing the enrollment of women in HF trials to help gain
helpful insight into sex-specific differences in treatment effects and
subsequent clinical outcomes.<br/>Copyright &#xa9; 2018, Springer
Science+Business Media, LLC, part of Springer Nature.

<57>
Accession Number
624140407
Title
Spinal anaesthesiavs general anaesthesia for lumbar microdisc surgery.
Source
Regional Anesthesia and Pain Medicine. Conference: 37th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2018.
Ireland. 43 (7 Supplement 1) (pp e102), 2018. Date of Publication: October
2018.
Author
Morina Q.; Morina A.; Bunjaku D.; Matoshi D.; Kelmendi F.
Institution
(Morina, Bunjaku, Matoshi) University Clinical Center of Kosova, Clinic of
Anaesthesia and Intensive Care Unit, Prishtina, Serbia
(Morina, Kelmendi) University Clinical Center of Kosova, Clinic of
Neurosurgery, Prishtina, Serbia
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Aims: Aim of this study was to compare the relative
morbidities associated with SAvs GA for LMS regarding to intraoperative
and early postoperative side-effects. Methods: Forty-three ASAI-II
patients were randomized in two-groups. The exclusion criteria for SA,
that is, patient refusal, local infection, bleeding diathesis. Group of
the patients receiving SA -19 were given a single injection of bupivacaine
0.25%plus 50mug of fentanyl. The injection performed one level higher or
at the same level of the surgery in both positions regarding the patients
wish. Patients receiving GA n=24 were induced with propofol, fentanyl,
midazolam, and atracurium. For maintaining the anesthesia, combination of
N2O/O2 with a propofol followed by a maintenance infusion. The recorded
data during surgery were heart rate, systolic, diastolic, MABP, oxygen
saturation, and blood loss. Postoperatively, occurrence of nausea,
vomiting and pain intensity was evaluated by using VAS. Results: The mean
intraoperative blood pressure and HR was significantly higher in the GA
group as compared with the SA group. In the SA group at the beginning of
surgery, there were hypotension and bradycardia in 23% of patients, which
needed atropine or ephedrine injection. The mean intraoperative blood loss
was significantly lower in the SA group in comparison with that of GA
group (P = 0.002). The mean pain scores in SA group was significantly
lower in comparison with that ofGAgroup (P < 0.01). Patientswith SAhad
significantly less nausea and vomiting. Conclusions: SA has some
advantages over GA regarding intraoperative hemodynamic stability,
prolonged postoperative analgesia, and significantly fewer postoperative
side effects.

<58>
Accession Number
624140262
Title
Con: Neuraxial.
Source
Regional Anesthesia and Pain Medicine. Conference: 37th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2018.
Ireland. 43 (7 Supplement 1) (pp e37-e38), 2018. Date of Publication:
October 2018.
Author
Kessler P.
Institution
(Kessler) Orthopaedic University Hospital, Anaesthesiology and Intensive
Care Medicine, Frankfurt, Germany
Publisher
Lippincott Williams and Wilkins
Abstract
Surgeries on the thorax are among the most painful procedures performed
and belong to the group of medical interventionswith the highest risk of
chronic pain. Surgical access (minimal vs. open) and cutting technique
(posterolateral vs. muscle sparing vs. sternotomy) have a major influence
on pain intensity. The increasingly used video-assisted thoracoscopic
surgery (VATS) carries a markedly reduced post-operative pain intensity
compared to open thoracotomies. It also applies to thoracic surgery that
multimodal analgesia is the most effective strategy to improve pain relief
and reduce side effects. Multimodal analgesia is based on the use of a
variety of analgesic agents and/or techniques that target different
nociceptive mechanisms. Regional techniques are among the cornerstones of
a multimodal pain concept in thoracic surgery. Various regional analgesia
concepts (intercostal, paravertebral, interpleural and epidural and
truncal blocks with local anaesthesia and opiates) have proven their
effectiveness in pain management in thoracic surgery. As a sole technique
for thoracic surgery without general anaesthesia, so far only the thoracic
epidural anaesthesia and the thoracic paravertebral blockade in the
context of VATS are suitable. Performing awake thoracic surgery (ATS) can
result in a greater benefit for the patient due to avoidance of
complications of intubation and prolonged mechanical ventilation, while
providing better hemodynamics and possibly superior postoperative
analgesia. Thoracic epidural anaesthesia (TEA): TEA is currently
considered the gold standard in treatment of thoracotomy pain. In many
comparative studies with systemic opiates, TEAwas proven to be superior.
TEA has also been used exclusively in selected surgical procedures. Beside
the excellent analgesic properties of TEA, the sympathetic blockade by
local anaesthetics has significant beneficial effects on several organ
systems: increased gastrointestinal motility and perfusion, decreased
myocardial ischemia and systemic stress response. In addition to a failure
rate of about 10%, it is mainly the fear of an epidural haematoma that
limits the use of TEA. The risk of bleeding complications after TEA is not
known, but a rare event. Nevertheless, the possibility of developing an
epidural haematoma is the main cause for concern amongst
anaesthesiologists. Many of the patients undergoing thoracic surgery today
are old, have impaired renal function, and take anticoagulants and/or
antithrombotic agents. As a result, a TEA is out of the question for many
patients. Awide variety of thoracic surgical procedures have been
performed as ATS using only TEA: resection of pulmonary nodules and
solitary metastases, management of pneumothorax, lung volume reduction
surgery and even major thoracic procedures like thoracotomy and median
sternotomy. ATS under TEA is not just possible; the few comparative
studies show that specific patient collectives benefit from this
procedure, especially in VATS. Thoracic paravertebral blockade (tPVB):
Among the alternative regional anaesthesia procedures, thoracic
paravertebral blockade (tPVB) plays the biggest role in treatment of
intra- and postoperative pain in thoracic surgery next to TEA. The
effectiveness of tPVB in thoracic surgery meanwhile has been sufficiently
proven. For thoracic surgery tPVB is considered equivalent in its
analgesic properties to TEA, although with a more favorable side effect
profile. The application of local anesthetic into the paravertebral
compartment generates an ipsilateral somatic and sympathetic nerve
blockade across several thoracic dermatomes. Standard techniques use
surface landmarks or ultrasound (US). As an alternative, paravertebral
catheters can be very reliably inserted under direct vision by the surgeon
during thoracotomy. A multitude of comparative prospective randomized
studies have investigated the efficiency of tPVB compared to TEA in
thoracic surgery. The various studies were re-examined in a meta-analysis
and two systemic reviews reaching the conclusion that tPVB can be at least
as effective as epidural analgesia. It also has a better side-effect
profile and a reduced rate of complications than epidural analgesia. As
the location of puncture in tPVB is close to the spinal canal, which may
cause complications if bleeding occurs, the same safety time intervals
regarding application of anticoagulants as for neuraxial procedures are
required for puncture or removal of the catheter. So far no case
concerning haematoma-related damage of the spinal column in association
with a tPVB has been published. Intercostal nerve blockade (ICNB): ICNB
seems to be the most frequently used technique worldwide for
post-thoracotomy pain control. It is easy, less time-consuming and,
perhaps, a safer technique compared to TEA or PVB. Where these techniques
are not possible, or are contraindicated, an ICNB is recommended despite
insufficient duration of analgesia, which requires the use of
supplementary systemic analgesia. Both the single-shot technique and the
continuous infusion are possible, but only the latter seems effective
after thoracic surgery. Serratus anterior plane block (SAPB): The SAPB was
originally proposed for breast surgery but its applications have later
been extended, and is nowoften used in thoracic surgery. It is an
ultrasound-guided thoracic wall nerve block that covers the lateral
cutaneous branch of the intercostal nerves from T2 to T9. The few case
reports published so far show that after thoracotomy a SAPB can potentiate
opioid-based PCA and reduce pain and opioid consumption in the first 24 h
after intervention. Due to the low invasiveness and a pure somatic
analgesia, the SAPB can be considered as an option for VATS or as a second
choice for thoracotomy whenever the TEA or tPVB are not feasible. Erector
spinae plane block (ESPB): The ESPB is a newly described technique for
providing thoracic analgesia. Under ultrasound guidance, about 20 mL of
local anesthetic are injected 3 cm beside the interspinous line at T5
level deep to the trapezius, rhomboid and erector spinae muscles. ESPB has
been proposed for thoracic neuropathic pain, rib fractures and thoracic
procedures mainly VATS. The ESPB can be used as a single-shot or catheter
technique. Discussions continue whether the ESPB is a modified tPVB and
the local anaesthetic penetrates the paravertebral space and thus
additionally blocks the sympathetic nerve fibers producing a visceral
analgesia. Currently, the lack of experience with this technique does not
allowto define its role in the treatment of pain after thoracic
procedures. Summary: Regional techniques for thoracic surgery are mainly
used for postoperative, not so much intraoperative analgesia. The only
really validated regional techniques are the TEA and the tPVB. All other
peripheral blockades such as ICNB, SAPB and ESPB show in case reports that
they are effective in the less painful VATS. Therefore, they are indicated
for minor thoracic procedures or when TEA/ tPVB cannot be performed due to
contraindications. Only TEA and tPVB can be considered as regional
anaesthetic techniques for thoracic procedures without general
anaesthesia.

<59>
Accession Number
624140153
Title
Analgesic efficacy of caudal dexamethasone combined with bupivacaine in
ilioinguinal pediatric surgery: prospective randomized controlled trial.
Source
Regional Anesthesia and Pain Medicine. Conference: 37th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2018.
Ireland. 43 (7 Supplement 1) (pp e95), 2018. Date of Publication: October
2018.
Author
Abid A.; Elleuch S.; Choura D.; Grati F.; Abdelmoula M.; Jarraya A.; Kolsi
K.
Institution
(Abid, Elleuch, Choura, Grati, Abdelmoula, Jarraya, Kolsi) Hedi Chaker
University Hospital, Anesthesiology Department, Sfax, Tunisia
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Aims: Caudal analgesia is the most commonly used technique
providing intra- and postoperative analgesia for various pediatric
infraumbilical surgical procedures but with the disadvantage of short
duration of action after single injection. Caudal dexamethasone could
offer significant analgesic benefits. Methods: The aim of the study was to
assess the efficacy of caudal dexamethasonewith bupivacaine 0.25%for
postoperative pain relief in children undergoing sub-umbilical surgical
procedures. In this prospective randomized double blind study, 56 children
of ASA-I class aged from 1 to 5 years scheduled for sub-umbilical surgical
procedures were randomly allocated to two groups: - Group I received
caudal block with: bupivacaine 0.25%(1 ml/kg) with placebo. - Group II
received caudal block with: bupivacaine 0.25% (1 ml/kg) with dexamethasone
0.1 mg/ml. Results: Postoperatively patients were assessed for analgesia
and side effects. Demographic parameters (age, weight, size, sex) and per
operative heart rate and blood pressure were similar in both groups.
Significantly high levels and prolonged duration of post-operative
analgesia was observed from the 6th to the 24th postoperative hours in
group II (P<0.005) with no increased side effects. Conclusions: Caudal
dexamethasone may safely improve and prolongs postoperative analgesia for
sub-umblical surgical procedures in children.

<60>
Accession Number
624140112
Title
Is thoracic interfascial block needed for breast lumpectomy surgery? yes.
Source
Regional Anesthesia and Pain Medicine. Conference: 37th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2018.
Ireland. 43 (7 Supplement 1) (pp e93-e94), 2018. Date of Publication:
October 2018.
Author
Youn S.K.; Hong B.; Jo Y.; Kim Y.; Ko Y.
Institution
(Youn, Hong, Jo, Kim, Ko) Chungnam National University Hospital,
Anesthesiology and Pain Medicine, Daejeon, South Korea
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Aims: Breast Lumpectomy involves resection of some
subcutaneous tissues and may include sentinel lymph node biopsy or
axillary lymph node dissection. Because the extent of lumpectomy are
smaller than in other breast surgery, most patients tend not to undergo
aggressive pain control after surgery. However, inadequate pain control
may increase opioid consumption, and cause opioid related side effect. We
therefore investigated whether the thoracic interfascial plane block is
effective in postoperative pain management after lumpectomy. Methods: A
total of 46 patients (20-80 years, female, ASA I-III) with breast cancer
scheduled to undergo lumpectomy were randomly assigned to two groups.
Postoperative pain control in the control group consisted only of
intravenous patient controlled analgesia (IV-PCA). In the block group,
IV-PCA was used after modified pecs 2 (below serratus anterior muscle,
0.375% 20cc) and pectointercostal plane (0.375% ropivacaine 20cc) block
after surgery. The primary outcome was the 24 hours cumulative
postoperative fentanyl consumption. Pain severity, additional rescue
analgesics requirement, side effect, patients satisfaction were also
evaluated. Results: Postoperative fentanyl consumption in block group was
significantly reduced compared with control group (88.8 [48.0;167.6] vs
155.2 [88.8;249.2], p=0.022). The postoperative numeric rating scale pain
scores were significantly lower in the block group only at PACU (2.9 +/-
1.8 vs 4.3 +/- 2.3, p=0.022). There was no differences in the incidence of
PONVand in requirement of additional analgesics. Satisfaction score was
significantly higher in block group. Conclusions: Even after lumpectomy
that with relatively low pain score after surgery, thoracic interfascial
block reduced opioid usage and increased patient satisfaction. (Figure
Presented).

<61>
Accession Number
624139985
Title
Regional anaesthesia/analgesia for thoracic surgery: Current update.
Source
Regional Anesthesia and Pain Medicine. Conference: 37th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2018.
Ireland. 43 (7 Supplement 1) (pp e14-e15), 2018. Date of Publication:
October 2018.
Author
Moka E.
Institution
(Moka) Creta InterClinic Hospital, Anaesthesiology Department, Heraklion-
Crete, Greece
Publisher
Lippincott Williams and Wilkins
Abstract
Thoracic surgery is considered one of the most painful surgical procedures
and, despite our increased-detailed knowledge in the pathophysiology and
pharmacology of nociception, unsurpisingly, patients can and sometimes do
suffer considerable postoperative pain of moderate to severe intensity,
lasting for 48h or even more, if analgesia is not managed appropriately.
Of all incision types, posterolateral thoracotomy, is the most painful
one, with referred VAS scores coming up to almost 9 in a scale of 10,
whereas, less invasive methods (VATS) are categorized amongst the least
painful thoracic surgery interventions. The pathogenetic mechanisms of
acute postoperative pain following thoracic surgery, are rather
complicated, due to the complexity of the surgical procedure itself.
Nociceptive receptors are stimulated by the skin incision, muscles
division and retraction, as well as retraction and sometimes fracture of
ribs. Additionally, ligaments may be stretched, intercostal nerves can be
injured, and costochondral joints may be dislocated, causing further pain.
The whole neurovascular intercostal bundle is usually damaged, with a
particular injury of intercostal nerves. Also, the incised pleura is
frequently irritated, by partial surgical stripping, chest drains and
residual pleural blood. As such, the resulting inflammatory responses
further activate nociceptors. CNS transmission of these multiple
nociceptive signals, amplifies pain transmission and increases pain
perception through central sensitization. It is well understood that
multiple components contribute to acute pain after thoracic surgery,
including: 1. Parietal Pain form thoracotomy itself and the drains
placement 2. Visceral Pain attributed to parietal pleura inflammation 3.
Dynamic Pain due to respiratory movements 4. Referred Pain to either the
anterior chest wall, due tomajor bronchus transection, or to ipsilateral
shoulder (75%), because of diaphragm & phrenic nerve irritation, or
position-related mechanical stress of the shoulder Pain after thoracic
surgery, generated from multiple structures, is transmitted via a number
of afferent pathways, and induces a variety of neuroplastic processes.
Factors that can influence postoperative pain can be divided into:
-Patients Factors (age, gender-specific characteristics, genetic factors,
psychosocial influence values & opioid tolerance) -Surgical Technique
-Selected Analgesic Plan Multimodal Analgesia, administered preemptively,
or even better in a preventive & protective mode against CNS
sensitization, seems to be of paramount importance in reducing the
majority of aforementioned complications. Analgesic options are multiple,
including systemic analgesia, analgesic adjuvants & RA techniques (TEA,
Intrathecal Opioids, PVBs, ICBs, Intrapleural Analgesia, Continuous Would
Infiltration). However, no single RA technique is ideal, with each one
possessing its own advantages and disadvantages. Starting with TEA, which
has a long track record, it represents the most widely utilized analgesic
mode following thoracic surgery, and has been regarded as the gold
standard against which other modalities are compared, not only due to its
excellent analgesic effects, but also because of reduced stress response
to surgery and a favorable homeostatic milieu, resulting in beneficial
actions on multiple organ functions, and in reduced complication rates
from various systems (respiratory, CV, GI) with the additional potential
effects on some oncological aspects & possibly on postoperative mortality
& outcome. In reference to TEA technical aspects, first, the level of
puncture depends on the surgical incision site, although it is usually
performed between T3-T7. Secondly, catheters are sited at a level
corresponding approximately with the midpoint of the dermatomal
distribution of the skin incision. The required analgesia level is between
T2-T12, and this can be achieved by an analgesic mixture combining
LAs+opioids (continuous infusion, PCEA, or a combination of both). The
role of LAs in TEA analgesic mixtures is really important, since LAs
enhance the bioavailability of opioids in CSF, and increase their binding
to mu receptors in the dorsal horns of SC. Multiple studies confirm the
TEA analgesic efficacy versus opioid iv PCA. A meta-analysis, involving
more than 3.000 patients, was published by the group of Wu and, according
to the authors results, all forms of TEA (both continuous & PCEA) provided
significantly superior postoperative analgesia in thoracic surgery & lower
overall VAS scores versus systemic opioids. In addition, according to a
systematic review of 2008, evaluating RA for Post-Thoracotomy Analgesia, a
quantitative analysis of available data has shown, aWMD ofVAS that favours
TEA over systemic opioids, thus, reflecting significant reductions in pain
scores for 3 days postoperatively, in patients receiving TEA, with the
combination of LAs+opioids (fentanyl, sufentanyl, morphine), versus
parenteral opioid administration alone. Furthermore, in reference to
analgesia quality after thoracotomy, according to the results of a survey
on almost 19.000 consecutive patients, and the consequent database
analysis of the prospectively raised data, both resting and dynamic pain
scores were significantly reduced, in patients receiving PCEAversus iv
PCA. And it is in favour of TEA-PCEA to see that in these patients,
dynamic VAS scores were well below 30 in a scale of a hundred in the
immediately postoperative period in the recovery room, also being
maintained below 20 the 1st postoperative day, and around 10 for 4 days
after surgery. Moreover, according to the results of a RC study published
in 2010, TEA with LAs+opioids delivers better analgesia, but also improves
QoL, compared with iv PCA in patients undergoing major thoracic surgery.
According to the study results, mean pain scores were significantly lower
in the TEA group at most time points, whereas physical and mental scores
in the TEAgroupwere significantly better than the PCA one, for both SF-8
and SF-36 QoL health surveys. As far as protective effects of TEA on
Pulmonary Complications after Thoracic Surgery, according to the results
of this meta analysis published in 2008, involving almost 6000 patients,
extracted from 58 RCTs, existing in literature from 1996 till 2006, from a
comparison between TEA & systemic opioids, cumulative meta-analysis of
data favors epidurals over iv opioids, with OR of pneumonia being
decreased when TEAwas applied, independently of analgesia duration or the
selected regimen. Similar results have appeared in literature from
multiple RCTs and have been very nicely summarized in a concise review
article of El Tahan MR, that appeared online in September 2016, in an
effort to involve all available data until beginning of 2016. According to
the author conclusions TEA, improves postoperative lung function, by
increasing VC, FEV1 and by reducing PaCO2. It also reduces atelectasis and
related pulmonary complications (eg, infections, pneumonia), decreases
bronchial reactivity by LAs systemic effects, maintains cough reflex, does
not increase Paw in patients with COPD, and preserves HPV during OLV,
without exerting any effect on pulmonary shunt fraction. Additionally, the
author of this big review further highlighted other positive effects of
TEA in Thoracic Surgery, such as possible GA effects due to volatile
anaesthetics sparing effects, reduced rates of postoperative AF during
lung cancer surgery in the elderly, earlier recovery of bowel function,
and, decreased rates of chronic postsurgical pain after thoracotomy.
Regarding Chronic Post Thoracotomy Pain Syndrome (CPTPS) and the potential
positive role of TEA, unfortunately, not many evidence - based data are
available in literature. However, according to a meta-analysis of almost
500 patients, published more than 10 years ago, it seems that preemptive
TEA is more efficacious, when outcome is defined as the number of patients
that are pain free at six months postoperatively. Moreover, addition of iv
ketamine further potentiates protective effect of TEA on CPTP, since,
according to a RCT study results, the numerical rating scale scores for
baseline pain, 1 and 3 months after thoracotomy, were significantly lower
in the ketamine group.

<62>
Accession Number
624139929
Title
Pro.
Source
Regional Anesthesia and Pain Medicine. Conference: 37th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2018.
Ireland. 43 (7 Supplement 1) (pp e10-e11), 2018. Date of Publication:
October 2018.
Author
Rawal N.
Institution
(Rawal) Orebro University, Department of Anaesthesiolog, Sweden
Publisher
Lippincott Williams and Wilkins
Abstract
Postoperative pain has been managed poorly for decades. Recent surveys
from US and Europe do not show any improvement. In spite of the growing
awareness of benefits of multimodal analgesic regimens, opioid monotherapy
remains the mainstay of pain management (1). This was reinforced by an
editorial in the latest issue of RAPM commenting that ". most
perioperative patients in the United States and many other countries still
receive nonmultimodal, nonregional, opioid-based analgesic regimens"(2).
In the US over-prescription of opioids for perioperative pain is believed
to have contributed to an 'opioid epidemic' (3). Although this is
predominantly a US problem, other countries will be impacted too. There is
a risk of the pendulum swinging back to the days of 'opiophobia' when
restrictive opioid policies were associated with widespread poor pain
relief in patients, including those with cancer. The use of nonopioid
modalities can be expected to increase and regional analgesia techniques
are well-placed to play an important role. This abstract will make the
case for the use of infiltrative regional techniques because of their
evidence-based efficacy and also for their simplicity and safety. Choice
of regional analgesic techniques: Regional anaesthesia techniques remain
the most effective methods to treat pain after surgery. There is
overwhelming evidence that these techniques are superior to opioids.
However, though opioids are grossly overused, regional techniques remain
grossly underused. Current evidence shows that the role of epidural
technique is diminishing. The advantages of epidural technique are not as
impressive as previously believed and the risks are greater than estimated
in the past. The risk-benefit equation has shifted away from epidural and
in favour of less invasive but equally effective and safer regional
anaesthesia techniques. Epidural can no longer be considered the gold
standard as a routine method for the management of postoperative pain (4).
Perineural techniques are highly effective to manage pain. Several
adjuvants have shown to be effective in prolonging the analgesia after
single dose blocks. Catheter techniques can prolong the duration of
analgesia for almost unlimited time. In ambulatory surgery, catheter
techniques have been in use for over 20 years for pain management at home
(5). However, the use of perineural techniques is embarrassingly low. A
recent database study of nearly 13 million outpatient surgeries showed
that the overall frequency of use of peripheral nerve blocks was reported
in only 3.3% of patients considered amenable to such blocks (6). Recent
interest in use of ultrasound-guided nerve blocks has reduced failure
rates and encouraged more anaesthesiologists to use such techniques.
Nevertheless, the routine use of these techniques, though increasing,
remains restricted to a relatively small percentage of institutions. For
example, a US database study of almost a million patients undergoing total
hip (THA) and total knee (TKA) replacements showed that during the period
from 2006 to 2013 the use of peripheral nerve blocks increased from 6,5%
to 8,7% for THA and from 10.3% to 20.4% for TKA (7). In short, inspite of
their well-documented efficacy, the increase in use of perineural
techniques even for self-evident indications is still excruciatingly slow.
In day surgery patients, perineural catheter techniques are feasible but
will most likely remain restricted to even fewer institutions because of
safety concerns in the medically unsupervised patient at home(1).
Infiltrative techniques- the evidence: In recent years, several
infiltrative techniques have received increasing attention as simple and
less invasive local anaesthesia-based alternatives, either alone or as
part of multimodal regimens, to manage postoperative pain. Simple
surgeon-delivered or surgeon-assisted techniques such as wound
infiltration, preperitoneal/intraperitoneal administration, Transversus
Abdominis Plane (TAP) block and Local Infiltration Analgesia (LIA) as
single administration or through catheters placed under direct vision in
collaboration with anaesthesiologists can play a significant role in
improvement of postoperative care. Wound catheter infusions (WCI): Several
recent studies and meta-analyses have demonstrated that this technique
provides effective analgesia after almost all types of surgeries. A
systematic review of WCI from 2006 reported consistent evidence of
analgesic efficacy across a wide range of surgical procedures, location of
catheters, and dosing regimens. (8). Since then several other systematic
reviews and metaanalyses have appeared in the literature. A meta-analysis
by Ventham et al reported that wound infiltration techniques provided
prolonged and effective analgesia and improved recovery in patients
undergoing colorectal surgery (9). In another meta-analysis the same group
compared WCI with epidural technique in patients undergoing major
abdominal procedures and concluded that WCI was equally effective but
epidural was associated with high incidence of urinary retention (10).
Raines et al evaluated the role of ropivacaine for CWI infusions in a
meta-analysis and concluded that ropivacaine is effective for awide range
of surgical procedures (cardiothoracic, major abdominal, major
orthopaedic, urological etc). The evidence was considered robust with
meaningful outcomes and no major adverse effects (11). Wound infiltration
is recommended for management of postoperative pain as part of multimodal
analgesia regimens bymany national and international societies including
the American Society of Anesthesiologists (1). Local Infiltration
Analgesia (LIA) for hip and knee joint replacement: LIA is a major recent
development in lower extremity joint replacement surgery. In spite of its
name, the LIA technique is not just infiltration of local anaesthetic but
a multicomponent optimisation package. The details of the technique are
described elsewhere (1). Several studies have shown the efficacy of this
technique after knee and hip replacement. In many institutions it has been
a game changer (1) In a systematic review of 27 RCTs (17 RCTs TKA, n=888
and 10 RCTs THA, n=756), Andersen and Kehlet concluded that LIAwas more
effective or equally effective when compared with epidural technique,
intrathecal morphine and femoral block. This review also reported that
intraarticular catheters provided prolonged analgesia and a reduction of
LOS in most (but not all) studies. There was also limited evidence for
increased range of motion (ROM), no complications were reported (12).
Similar results were reported with 3 other, more recent, meta-analyses
(13,14,15). There is robust evidence of lack of complications with WCI and
LIA techniques. Transversus Abdominis Plane (TAP) block: These
infiltrative blocks have been demonstrated to be effective in many major
abdominal procedures such as open prostatectomy, bowel resection,
appendectomy, c. section, and abdominal hysterectomy. Lateral, subcostal,
and posterior approaches have been described. The safety and efficacy of
TAP blocks has been shown in a Cochrane review and at least 5
meta-analyses (1). In recent years several newer infiltrative techniques
have been reported, especially with ultrasound guidance. For postoperative
pain management following abdominal wall surgeries the following fascial
plane blocks have been described: * Rectus sheath block (hernia repair,
laparoscopic cholecystectomy, laparoscopic appendectomy) * Quadratus
Lumborum (QL) block, at least 5 variations described including anterior,
posterior, lateral, transmuscular, and intramuscular approaches. * Erector
Spinae Plane (ESP) block (open abdominal surgery, bariatric surgery) *
Transversalis fascial plane block * Thoracolumbar interfascial plane block
For postoperative analgesia after chest wall surgeries, the following
fascial plane blocks have been described: * Pectoral nerve block (PECS 1)
(superficial procedures such as breast expanders) * Pectoral nerve block
(PECS 2)(mastectomy, axillary dissection) * Erector Spinae (ESP)
(post-thoracotomy pain, chest wall trauma) * Serratus Anterior Plane (SAP)
block (radical mastectomy) * Latissimus Dorsi (LD) block * PECS
intercostal fascial (PIFB) block Most authors advocate a combination of
blocks to cover analgesia over whole chest wall, axilla and shoulder (16).

<63>
Accession Number
2001061650
Title
Comparison of Health Related Quality of Life in Transcatheter Versus
Surgical Aortic Valve Replacement: A Meta-Analysis.
Source
Heart Lung and Circulation. (no pagination), 2018. Date of Publication:
2018.
Author
Ando T.; Takagi H.; Briasoulis A.; Grines C.L.; Afonso L.
Institution
(Ando, Afonso) Division of Cardiology, Wayne State University/Detroit
Medical Center, Detroit, MI, United States
(Takagi) Division of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Briasoulis) Division of Cardiology, University of Iowa Hospitals and
Clinics, IA, United States
(Grines) Division of Cardiology, North Shore University Hospital, Hofstra
Northwell School of Medicine, Manhasset, NY, United States
Publisher
Elsevier Ltd
Abstract
Background: Data on the effects of transcatheter aortic valve replacement
(TAVR) compared to surgical aortic valve replacement (SAVR) on
health-related quality of life (HRQOL) outcomes are limited. To assess the
comparative HRQOL outcomes between TAVR and SAVR, we performed a
systematic review and meta-analysis. Methods: PubMed and EMBASE databases
were searched for articles that compared the HRQOL scores, Kansas City
Cardiomyopathy Questionnaire (KCCQ), Medical Outcomes Study Short-Form
Health Survey 12 or 36 (SF-12/36), or the EuroQoL 5 Dimension score
(EQ-5D) at 30 days and 1 year between TAVR and SAVR. Mean difference (MD)
and 95% confidence interval (CI) was calculated with inverse variance
statistical method and random-effects model. Results: A total of four
studies with 4125 patients (1268 transfemoral [TF]-TAVR, 1261 Non-TF TAVR
[transsubclavian, transapical or transaortic], and 1596 SAVR) were
included in the studies. KCCQ overall summary scores and its subscales,
SF-12/36, and EQ-5D were significantly higher in TF-TAVR compared to SAVR
but were similar in non-TF TAVR vs. SAVR at 30 days. At 1 year follow-up,
TF-TAVR and non-TF TAVR conferred similar HRQOL scores in KCCQ overall
summary and subscales scores, SF-12/36, and EQ-5D compared to SAVR.
Conclusions: Transfermoral-TAVR achieved better HRQOL at 30 days but
similar HRQOL at 1 year compared to SAVR. Non-TF TAVR resulted in similar
improvements in HRQOL at both 30 days and 1 year compared with
SAVR.<br/>Copyright &#xa9; 2018

<64>
Accession Number
2000753024
Title
Atrial fibrillation and ischemic events with rivaroxaban in patients with
stable coronary artery disease (AFIRE): Protocol for a multicenter,
prospective, randomized, open-label, parallel group study.
Source
International Journal of Cardiology. 265 (pp 108-112), 2018. Date of
Publication: 15 August 2018.
Author
Yasuda S.; Kaikita K.; Ogawa H.; Akao M.; Ako J.; Matoba T.; Nakamura M.;
Miyauchi K.; Hagiwara N.; Kimura K.; Hirayama A.; Matsui K.
Institution
(Yasuda) Department of Cardiovascular Medicine, National Cerebral and
Cardiovascular Center Hospital, 5-7-1 Fujishiro-dai, Suita, Osaka
565-8565, Japan
(Kaikita) Department of Cardiovascular Medicine, Graduate School of
Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto
860-8556, Japan
(Ogawa) National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai,
Suita, Osaka 565-8565, Japan
(Akao) Department of Cardiology, National Hospital Organization Kyoto
Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555,
Japan
(Ako) Department of Cardiovascular Medicine, Kitasato University School of
Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0373, Japan
(Matoba) Department of Cardiovascular Medicine, Kyushu University
Hospital, 3-1-1 Maidashi, Fukuoka 812-8582, Japan
(Nakamura) Division of Cardiovascular Medicine, Toho University Ohashi
Medical Center, 2-17-6, Ohashi, Meguro-ku, Tokyo 153-8515, Japan
(Miyauchi) Department of Cardiology, Juntendo University School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
(Hagiwara) Department of Cardiology, Tokyo Women's Medical University,
8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
(Kimura) Department of Cardiology, Yokohama City University Medical
Center, 4-57, Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
(Hirayama) Division of Cardiology, Nihon University School of Medicine,
30-1 Ohyaguchi Kamicho, Itabashi-ku, Tokyo 173-8610, Japan
(Matsui) Department of Community, Family, and General Medicine, Kumamoto
University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
Publisher
Elsevier Ireland Ltd
Abstract
Background: In atrial fibrillation (AF) patients with coronary artery
disease (CAD), anticoagulants are commonly used in combination with
antiplatelet drugs. However, dual therapy can increase the risk of
bleeding, and the potential therapeutic benefits must be weighed against
this. Therefore, it is recommended that dual therapy is only used for a
limited time, and that monotherapy with anticoagulants should start from 1
year after percutaneous coronary intervention (PCI). However, there is a
lack of evidence on the use of monotherapy, in particular with direct oral
anticoagulants, in this group of patients. Methods: The AFIRE Study is a
multicenter, prospective, randomized, open-label, parallel group study
conducted in patients aged >=20 years with non-valvular AF (NVAF) and CAD.
Patients who have undergone PCI or coronary artery bypass graft at least 1
year prior to enrollment, or those without significant coronary lesions
requiring PCI (>=50% stenosis), will be included. Approximately 2200
participants will be randomized to receive either rivaroxaban monotherapy
or rivaroxaban plus an antiplatelet drug (aspirin, clopidogrel, or
prasugrel). The primary efficacy endpoints are the composite of
cardiovascular events (stroke, non-central nervous system embolism,
myocardial infarction, and unstable angina pectoris requiring
revascularizations) and all-cause mortality. The primary safety endpoint
is major bleeding as defined by the International Society on Thrombosis
and Haemostasis criteria. Conclusions: This study will be the first to
assess the efficacy and safety of rivaroxaban monotherapy in NVAF patients
with stable CAD.<br/>Copyright &#xa9; 2018

<65>
Accession Number
2000824091
Title
Outcomes following the surgical management of left ventricular outflow
tract obstruction; A systematic review and meta-analysis.
Source
International Journal of Cardiology. 265 (pp 62-70), 2018. Date of
Publication: 15 August 2018.
Author
Collis R.A.; Rahman M.S.; Watkinson O.; Guttmann O.P.; O'Mahony C.;
Elliott P.M.
Institution
(Collis, Watkinson, Guttmann, O'Mahony, Elliott) Institute of
Cardiovascular Science, University College London, Gower Street, London
WC1E 6BT, United Kingdom
(Collis, Watkinson, Guttmann, O'Mahony, Elliott) Barts Heart Centre, St
Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom
(Rahman) Institute of Statistical Research and Training (ISRT), University
of Dhaka, Dhaka, Bangladesh
Publisher
Elsevier Ireland Ltd
Abstract
Background: Left ventricular outflow tract obstruction (LVOTO) causes
exertional symptoms in two thirds of patients with hypertrophic
cardiomyopathy (HCM). Consensus guidelines recommend surgical intervention
in patients with drug refractory symptoms. The primary aim of this study
was to perform a systematic review and meta-analysis to determine
morbidity and mortality after surgery. Methods: Study Selection: Studies
reporting outcomes following surgical intervention for symptomatic LVOTO
in HCM. Data Extraction: Articles from searching two scientific databases
(PubMed and Web of Science) were reviewed and data were extracted by two
investigators. Meta-analysis of data was performed with heterogeneity
assessed using I² statistic. Results: 85 studies were included
in the systematic review and 35 studies in the meta-analysis. Contemporary
early (<30 days) and late (>30 days) mortality following septal myectomy
were 1.4% (CI 0.8, 2.4) I² 9.0%, p = 0.36 and 0.7% (CI 0.3,
1.2) I² 70.7%, p < 0.05 respectively. Sixty-eight studies (80%)
reported perioperative complications. The contemporary rate of a
perioperative ventricular septal defect was 1.4% (0.8, 2.3) I²
0%, p < 0.05. Late morbidities including atrial fibrillation, stroke,
heart failure and transplant were reported in fewer than 22% of studies
and few studies compared mortality and clinical outcomes using different
surgical approaches to LVOTO. The incidence rate (IR) of reintervention
with a further surgical procedure was 0.3% (CI 0.2, 0.4) I²
52.5%, p < 0.05. Conclusions: Contemporary surgical management of LVOTO is
associated with low operative mortality rates but further studies are
needed to investigate the impact of surgical therapy on non-fatal early
and late complications.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<66>
Accession Number
623819120
Title
Coronary CT angiography and 5-year risk of myocardial infarction.
Source
New England Journal of Medicine. 379 (10) (pp 924-933), 2018. Date of
Publication: 06 Sep 2018.
Author
Newby D.E.; Adamson P.D.; Berry C.; Boon N.A.; Dweck M.R.; Flather M.;
Forbes J.; Hunter A.; Lewis S.; MacLean S.; Mills N.L.; Norrie J.; Roditi
G.; Shah A.S.V.; Timmis A.D.; Van Beek E.J.R.; Williams M.C.
Institution
(Newby, Adamson, Boon, Dweck, Hunter, Lewis, Mills, Norrie, Shah, Van
Beek, Williams) University of Edinburgh, Edinburgh, United Kingdom
(Berry, Roditi) University of Glasgow, Glasgow, United Kingdom
(Flather) University of East Anglia, Norwich, United Kingdom
(MacLean) NHS Fife, Kirkcaldy, United Kingdom
(Timmis) Queen Mary University, London, United Kingdom
(Forbes) University of Limerick, Limerick, Ireland
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Although coronary computed tomographic angiography (CTA)
improves diagnostic certainty in the assessment of patients with stable
chest pain, its effect on 5-year clinical outcomes is unknown. METHODS In
an open-label, multicenter, parallel-group trial, we randomly assigned
4146 patients with stable chest pain who had been referred to a cardiology
clinic for evaluation to standard care plus CTA (2073 patients) or to
standard care alone (2073 patients). Investigations, treatments, and
clinical outcomes were assessed over 3 to 7 years of follow-up. The
primary end point was death from coronary heart disease or nonfatal
myocardial infarction at 5 years. RESULTS The median duration of follow-up
was 4.8 years, which yielded 20,254 patientyears of follow-up. The 5-year
rate of the primary end point was lower in the CTA group than in the
standard-care group (2.3% [48 patients] vs. 3.9% [81 patients]; hazard
ratio, 0.59; 95% confidence interval [CI], 0.41 to 0.84; P = 0.004).
Although the rates of invasive coronary angiography and coronary
revascularization were higher in the CTA group than in the standard-care
group in the first few months of follow-up, overall rates were similar at
5 years: invasive coronary angiography was performed in 491 patients in
the CTA group and in 502 patients in the standard- care group (hazard
ratio, 1.00; 95% CI, 0.88 to 1.13), and coronary revascularization was
performed in 279 patients in the CTA group and in 267 in the standard-care
group (hazard ratio, 1.07; 95% CI, 0.91 to 1.27). However, more preventive
therapies were initiated in patients in the CTA group (odds ratio, 1.40;
95% CI, 1.19 to 1.65), as were more antianginal therapies (odds ratio,
1.27; 95% CI, 1.05 to 1.54). There were no significant between-group
differences in the rates of cardiovascular or noncardiovascular deaths or
deaths from any cause. CONCLUSIONS In this trial, the use of CTA in
addition to standard care in patients with stable chest pain resulted in a
significantly lower rate of death from coronary heart disease or nonfatal
myocardial infarction at 5 years than standard care alone, without
resulting in a significantly higher rate of coronary angiography or
coronary revascularization. (Funded by the Scottish Government Chief
Scientist Office and others; SCOT-HEART ClinicalTrials.gov number,
NCT01149590.).<br/>Copyright &#xa9; 2018 Massachusetts Medical Society.

<67>
Accession Number
621806878
Title
Urinary biomarkers predict advanced acute kidney injury after
cardiovascular surgery.
Source
Critical Care. 22 (1) (no pagination), 2018. Article Number: 108. Date of
Publication: 26 Apr 2018.
Author
Wang J.-J.; Chi N.-H.; Huang T.-M.; Connolly R.; Chen L.W.; Chueh S.-C.J.;
Kan W.-C.; Lai C.-C.; Wu V.-C.; Fang J.-T.; Chu T.-S.; Wu K.-D.
Institution
(Wang) Chi Mei Medical Center, Division of Nephrology, Department of
Internal Medicine, Liouying, Tainan, Taiwan (Republic of China)
(Wang, Huang, Wu, Chu, Wu) NSARF group (National Taiwan University
Hospital Study Group of ARF), Taipei, Taiwan (Republic of China)
(Chi, Chen) National Taiwan University Hospital, Department of Surgery,
Taipei, Taiwan (Republic of China)
(Huang, Wu, Chu, Wu) National Taiwan University Hospital, Division of
Nephrology, Department of Internal Medicine, Taipei, Taiwan (Republic of
China)
(Connolly) Dublin City University, School of Biotechnology, Glasnevin,
Dublin 9, Ireland
(Chueh) Cleveland Clinic Lerner College of Medicine, Glickman Urological
and Kidney Institute, Cleveland Clinic, Cleveland, United States
(Kan) Chi-Mei Medical Center, Division of Nephrology, Department of
Internal Medicine, Tainan, Taiwan (Republic of China)
(Lai) Chi Mei Medical Center, Department of Intensive Care Medicine,
Liouying, Tainan, Taiwan (Republic of China)
(Fang) Chang Gung University College of Medicine, Taoyuan, Taiwan
(Republic of China)
(Fang) Chang Gung Memorial Hospital, Kidney Research Center, Department of
Nephrology, Taoyuan City, Taiwan (Republic of China)
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Acute kidney injury (AKI) after cardiovascular surgery is a
serious complication. Little is known about the ability of novel
biomarkers in combination with clinical risk scores for prediction of
advanced AKI. Methods: In this prospectively conducted multicenter study,
urine samples were collected from 149 adults at 0, 3, 6, 12 and 24 h after
cardiovascular surgery. We measured urinary hemojuvelin (uHJV), kidney
injury molecule-1 (uKIM-1), neutrophil gelatinase-associated lipocalin
(uNGAL), alpha-glutathione S-transferase (ualpha-GST) and pi-glutathione
S-transferase (upi-GST). The primary outcome was advanced AKI, under the
definition of Kidney Disease: Improving Global Outcomes (KDIGO) stage 2, 3
and composite outcomes were KDIGO stage 2, 3 or 90-day mortality after
hospital discharge. Results: Patients with advanced AKI had significantly
higher levels of uHJV and uKIM-1 at 3, 6 and 12 h after surgery. When
normalized by urinary creatinine level, uKIM-1 in combination with uHJV at
3 h post-surgery had a high predictive ability for advanced AKI and
composite outcome (AUC=0.898 and 0.905, respectively). The combination of
this biomarker panel (normalized uKIM-1, uHJV at 3 h post-operation) and
Liano's score was superior in predicting advanced AKI (AUC=0.931,
category-free net reclassification improvement of 1.149, and p< 0.001).
Conclusions: When added to Liano's score, normalized uHJV and uKIM-1
levels at 3 h after cardiovascular surgery enhanced the identification of
patients at higher risk of progression to advanced AKI and composite
outcomes.<br/>Copyright &#xa9; 2018 The Author(s).

<68>
Accession Number
622465249
Title
Biatrial versus Isolated Left Atrial Ablation in Atrial Fibrillation: A
Systematic Review and Meta-Analysis.
Source
BioMed Research International. 2018 (no pagination), 2018. Article Number:
3651212. Date of Publication: 2018.
Author
Li H.; Lin X.; Ma X.; Tao J.; Zou R.; Yang S.; Liu H.; Hua P.
Institution
(Li, Liu) Department of Cardiovascular Surgery, Quanzhou First Hospital,
Fujian Medical University, Quanzhou 362000, China
(Lin, Tao, Zou, Hua) Department of Cardiovascular Surgery, Sun Yat-sen
Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
(Ma) Guangzhou Women and Children's Medical Center, Guangzhou 510623,
China
(Yang) Biobank of Sun Yat-sen Memorial Hospital, Sun Yat-sen University,
Guangzhou 510120, China
(Yang) Guangdong Province Key Laboratory of Brain Function and Disease,
Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080,
China
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Objective. The outcomes of biatrial ablation (BA) and isolated left atrial
ablation (LA) in atrial fibrillation remain inconclusive. In this
meta-analysis, we assess the currently available evidence to compare
outcomes between BA and LA. Methods. Electronic searches were performed
from database inception to December 2016, and relevant studies were
accessed. Odds ratios and weight mean differences with 95% confidence
intervals are reported. Twenty-one studies comprising 3609 patients were
included in the present meta-analysis. Results. The prevalence of sinus
rhythm in the BA cohort was similar to that in the LA cohort at discharge,
at 12 months, and after more than 1 year of follow-up. However, at 6
months, the prevalence of sinus rhythm was higher in the BA cohort than in
the LA cohort. The rate of permanent pacemaker implantation was higher in
the BA cohort than in the LA cohort. However, 30-day and late mortality
and neurological events were similar between the BA and LA groups.
Conclusion. There was no significant difference in the rate of restored
sinus rhythm, the risk of death, and cerebrovascular events between BA and
LA, but BA had a higher rate of permanent pacemaker
implantation.<br/>Copyright &#xa9; 2018 Hongmu Li et al.

<69>
Accession Number
2000611624
Title
Outcomes associated with mammalian target of rapamycin (mTOR) inhibitors
in heart transplant recipients: A meta-analysis.
Source
International Journal of Cardiology. 265 (pp 71-76), 2018. Date of
Publication: 15 August 2018.
Author
Jennings D.L.; Lange N.; Shullo M.; Latif F.; Restaino S.; Topkara V.K.;
Takeda K.; Takayama H.; Naka Y.; Farr M.; Colombo P.; Baker W.L.
Institution
(Jennings, Lange) Department of Pharmacy, Columbia University Medical
Center, New York, NY, United States
(Shullo) WVU Medicine, West Virginia Health System, Morgantown, WV, United
States
(Latif, Restaino, Topkara, Farr, Colombo) Division of Cardiology,
Department of Medicine, Columbia University Medical Center, New York, NY,
United States
(Takeda, Takayama, Naka) Division of Cardiovascular Surgery, Department of
Surgery, Columbia University Medical Center, New York, NY, United States
(Baker) Department of Pharmacy Practice, University of Connecticut,
Storrs, CT, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Data evaluating mTOR inhibitor use heart transplant (HT)
patients comes from relatively small studies and controversy exists
regarding their specific role. We performed a meta-analysis of randomized
trials to evaluate the efficacy and safety of mTOR inhibitors in HT
patients. Methods: We performed a systematic literature search of Medline
and Embase through July 2017 identifying studies evaluating mTOR
inhibitors in HT patients reporting effects on coronary allograft
vasculopathy (CAV), renal function, acute cellular rejection (ACR),
cytomegalovirus (CMV) infection, and discontinuation due to adverse drug
events (ADE). Data were pooled using a random-effects model producing a
mean difference (MD; for continuous data) or odds ratio (OR; for
dichotomous data) and 95% confidence interval (CI). Results: 14 trials
reported at least one outcome of interest. Change in mean maximal intimal
thickness was significantly reduced with mTOR (-0.04 [-0.07 to -0.02])
compared to calcineurin inhibitor/mycophenolate mofetil (CNI/MMF). Rates
of CMV infection were also significantly reduced (0.26; [0.2 to 0.32])
with mTOR regimens compared to CNI/MMF therapy. ACR was more frequent with
CNI-sparing regimens 6.46 [1.55 to 26.95]). eGFR was significantly
improved with CNI-sparing therapies (mean difference 12.09 mL/min [2.43 to
21.74]), but was similar between CNI/mTOR versus CNI/MMF regimens (p >
0.05). Rates of discontinuation due to ADE were higher in mTOR-containing
regimens (OR 2.15 [1.28 to 3.60], p = 0.01), while mortality rates were
similar (OR 0.91 [0.61 to 1.37], p = 0.62). Conclusions: mTOR-containing
regimens can attenuate CAV and CMV risk in HT recipients. A mTOR/MMF
combination preserves renal function but increases the risk of
ACR.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<70>
Accession Number
620804174
Title
Hemodynamic effects of acute hyperoxia: Systematic review and
meta-analysis.
Source
Critical Care. 22 (1) (no pagination), 2018. Article Number: 45. Date of
Publication: 25 Feb 2018.
Author
Smit B.; Smulders Y.M.; van der Wouden J.C.; Oudemans-van Straaten H.M.;
Spoelstra-de Man A.M.E.
Institution
(Smit, Oudemans-van Straaten, Spoelstra-de Man) VU University Medical
Center, Department of Intensive Care, De Boelelaan 1117, Amsterdam MB
1007, Netherlands
(Smulders) VU University Medical Center, Department of Internal Medicine,
Amsterdam, Netherlands
(van der Wouden) VU University Medical Center, Department of General
Practice and Elderly Care Medicine, Amsterdam Public Health research
institute, Amsterdam, Netherlands
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: In clinical practice, oxygen is generally administered to
patients with the intention of increasing oxygen delivery. Supplemental
oxygen may, however, cause arterial hyperoxia, which is associated with
hemodynamic alterations. We performed a systematic review and
meta-analysis of the literature to determine the effect of hyperoxia on
central hemodynamics and oxygen delivery in healthy volunteers and
cardiovascular-compromised patients. Methods: PubMed and EMBASE were
searched up to March 2017. Studies with adult humans investigating changes
in central hemodynamics or oxygen delivery induced by acute normobaric
hyperoxia were included. Studies focusing on lung, retinal, or brain
parameters were not included. We extracted subject and oxygen exposure
characteristics, indexed and unindexed values for heart rate, stroke
volume, cardiac output, mean arterial pressure (MAP), systemic vascular
resistance, and oxygen delivery during normoxia and hyperoxia. For
quantitative synthesis of the data, a random-effects ratio of means (RoM)
model was used. Results: We identified 33 studies with 42 datasets. Study
categories included healthy volunteers (n = 22 datasets), patients with
coronary artery disease (CAD; n = 6), heart failure (HF; n = 6), coronary
artery bypass graft (CABG; n = 3) and sepsis (n = 5). Hyperoxia (arterial
oxygen tension of 234-617 mmHg) reduced cardiac output (CO) by 10-15% in
both healthy volunteers (-10.2%, 95% confidence interval (CI) -12.9% to
-7.3%) and CAD (-9.6%, 95% CI -12.3% to -6.9%) or HF patients (-15.2%, 95%
CI -21.7% to -8.2%). No significant changes in cardiac output were seen in
CABG or septic patients (-3%). Systemic vascular resistance increased
remarkably in patients with heart failure (24.6%, 95% CI 19.3% to 30.1%).
In healthy volunteers, and those with CAD and CABG, the effect was smaller
(11-16%) and was virtually absent in patients with sepsis (4.3%, 95% CI
-3.2% to 12.3%). No notable effect on MAP was found in any group (2-3%).
Oxygen delivery was not altered by hyperoxia. Considerable heterogeneity
existed between study results, likely due to methodological differences.
Conclusions: Hyperoxia may considerably decrease cardiac output and
increase systemic vascular resistance, but effects differ between patient
categories. Heart failure patients were the most sensitive while no
hemodynamic effects were seen in septic patients. There is currently no
evidence supporting the notion that oxygen supplementation increases
oxygen delivery.<br/>Copyright &#xa9; 2018 The Author(s).

<71>
Accession Number
617408818
Title
Operative strategies to reduce cerebral embolic events during on- and
off-pump coronary artery bypass surgery: A stratified, prospective
randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (4) (pp 1278-1285.e1),
2017. Date of Publication: October 2017.
Author
Halkos M.E.; Anderson A.; Binongo J.N.G.; Stringer A.; Lasanajak Y.;
Thourani V.H.; Lattouf O.M.; Guyton R.A.; Baio K.T.; Sarin E.; Keeling
W.B.; Cook N.R.; Carssow K.; Neill A.; Glas K.E.; Puskas J.D.
Institution
(Halkos, Thourani, Lattouf, Guyton, Baio, Keeling, Cook, Carssow, Neill)
Division of Cardiothoracic Surgery, Emory University School of Medicine,
Atlanta, Ga, United States
(Anderson) Department of Neurology, Emory University School of Medicine,
Atlanta, Ga, United States
(Stringer) Department of Rehabilitation Medicine, Emory University School
of Medicine, Atlanta, Ga, United States
(Glas) Department of Anesthesiology, Emory University School of Medicine,
Atlanta, Ga, United States
(Binongo, Lasanajak) Rollins School of Public Health, Emory University
School of Medicine, Atlanta, Ga, United States
(Sarin) Department of Cardiothoracic Surgery, Inova Fairfax Healthcare
System, Falls Church, Va, United States
(Puskas) Department of Cardiothoracic Surgery, Mount Sinai University
School of Medicine, New York, NY, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective To determine the impact of different aortic clamping strategies
on the incidence of cerebral embolic events during coronary artery bypass
grafting (CABG). Methods Between 2012 and 2015, 142 patients with
low-grade aortic disease (epiaortic ultrasound grade I/II) undergoing
primary isolated CABG were studied. Those undergoing off-pump CABG were
randomized to a partial clamp (n = 36) or clampless facilitating device
(CFD; n = 36) strategy. Those undergoing on-pump CABG were randomized to a
single-clamp (n = 34) or double-clamp (n = 36) strategy. Transcranial
Doppler ultrasonography (TCD) was performed to identify high-intensity
transient signals (HITS) in the middle cerebral arteries during periods of
aortic manipulation. Neurocognitive testing was performed at baseline and
30-days postoperatively. The primary endpoint was total number of HITS
detected by TCD. Groups were compared using the Mann-Whitney U test.
Results In the off-pump group, the median number of total HITS were higher
in the CFD subgroup (30.0; interquartile range [IQR], 22-43) compared with
the partial clamp subgroup (7.0; IQR, 0-16; P <.0001). In the CFD
subgroup, the median number of total HITS was significantly lower for
patients with 1 CFD compared with patients with >1 CFD (12.5 [IQR, 4-19]
vs 36.0 [IQR, 25-47]; P =.001). In the on-pump group, the median number of
total HITS was 10.0 (IQR, 3-17) in the single-clamp group, compared with
16.0 (IQR, 4-49) in the double-clamp group (P =.10). There were no
differences in neurocognitive outcomes across the groups. Conclusions For
patients with low-grade aortic disease, the use of CFDs was associated
with an increased rate of cerebral embolic events compared with partial
clamping during off-pump CABG. A single-clamp strategy during on-pump CABG
did not significantly reduce embolic events compared with a double-clamp
strategy.<br/>Copyright &#xa9; 2017 The American Association for Thoracic
Surgery

<72>
Accession Number
620675644
Title
Better platelet function, less fibrinolysis and less hemolysis in
re-transfused residual pump blood with the Ringer's chase technique - a
randomized pilot study.
Source
Perfusion (United Kingdom). 33 (3) (pp 185-193), 2018. Date of
Publication: 01 Apr 2018.
Author
Olsson A.; Alfredsson J.; Ramstrom S.; Svedjeholm R.; Kenny D.; Hakansson
E.; Berglund J.S.; Berg S.
Institution
(Olsson, Berglund) Blekinge Institute of Technology, Department of Health
Science, Karlskrona, Sweden
(Olsson) Department of Medical and Health Sciences, Linkoping University,
Linkoping, Sweden
(Olsson) Department of Cardio-Thoracic Surgery, Blekinge Hospital,
Karlskrona, Sweden
(Alfredsson) Department of Cardiology and Department of Medical and Health
Sciences, Linkoping University, Linkoping, Sweden
(Ramstrom) Department of Clinical and Experimental Medicine, Linkoping
University, Linkoping, Sweden
(Svedjeholm, Hakansson, Berg) Department of Cardio-Thoracic and Vascular
Surgery and Department of Medical and Health Sciences, Linkoping
University, Linkoping, Sweden
(Kenny) Clinical Research Centre, Royal College of Surgeons in Ireland,
Dublin, Ireland
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: Residual pump blood from the cardiopulmonary bypass (CPB)
circuit is often collected into an infusion bag (IB) and re-transfused. An
alternative is to chase the residual blood into the circulation through
the arterial cannula with Ringer's acetate. Our aim was to assess possible
differences in hemostatic blood quality between these two techniques.
Methods: Forty adult patients undergoing elective coronary artery bypass
graft surgery with CPB were randomized to receive the residual pump blood
by either an IB or through the Ringer's chase (RC) technique. Platelet
activation and function (impedance aggregometry), coagulation and
hemolysis variables were assessed in the re-transfused blood and in the
patients before, during and after surgery. Results are presented as median
(25-75 quartiles). Results: Total hemoglobin and platelet levels in the
re-transfused blood were comparable with the two methods, as were soluble
platelet activation markers P-selectin and soluble glycoprotein VI (GPVI).
Platelet aggregation (U) in the IB blood was significantly lower compared
to the RC blood, with the agonists adenosine diphosphate (ADP) 24 (10-32)
vs 46 (33-65), p<0.01, thrombin receptor activating peptide (TRAP) 50
(29-73) vs 69 (51-92), p=0.04 and collagen 24 (17-28) vs 34 (26-59),
p<0.01. The IB blood had higher amounts of free hemoglobin (mg/L) (1086
(891-1717) vs 591(517-646), p<0.01) and D-dimer 0.60 (0.33-0.98) vs 0.3
(0.3-0.48), p<0.01. Other coagulation variables showed no difference
between the groups. Conclusions: The handling of blood after CPB increases
hemolysis, impairs platelet function and activates coagulation and
fibrinolysis. The RC technique preserved the blood better than the
commonly used IB technique.<br/>Copyright &#xa9; 2017, &#xa9; The
Author(s) 2017.

<73>
Accession Number
624046596
Title
Short-term outcome of cardiac surgery under cardiopulmonary bypass in
patients who refuse transfusion: A controlled study.
Source
Journal of Cardiovascular Surgery. 59 (5) (pp 729-736), 2018. Date of
Publication: October 2018.
Author
Reyes Garcia A.; Vega Gonzalez G.; Andino Ruiz R.
Institution
(Reyes Garcia, Vega Gonzalez, Andino Ruiz) Unit of Intensive Care,
Hospital Universitario de la Princesa, Instituto de Investigacion La
Princesa, Alfredo Marquerie 1, Madrid 28034, Spain
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Background: Although bloodless cardiac surgery has been successfully
performed for many years, studies with controls permitting transfusion are
few and their results inconclusive. This study compares the outcome of
cardiac surgery on Jehovah's Witnesses (JW) refusing transfusion, with
that of controls permitting transfusion if required. Methods: Data from
172 operations in 162 JW were compared with 172 matched controls. Risk
factors, preoperative, operative, 48 hour postoperative variables, outcome
data and transfusions were recorded. Results: Preoperative and operative
variables were similar in both groups except for more previous cardiac
operations, and more frequent use of cell saver and aprotinin in JW, who
bled less and had higher hemoglobin concentrations at all periods.
Thirty-day mortality was higher in JW (9.9% vs. 3.5%; P=0.03) (Risk
difference 6.4%; CI95%: 2.7-10.1). Nevertheless operative mortality was
similar in both groups (9.9% vs. 7.6%; P=0.44). Mortality in low-risk
subjects was higher in JW (8.9% vs. 1.0%; P=0.02) (Risk difference 7.9%;
CI95%: 2.7-13.2). Moreover, death associated with hemorrhage and anemia
tended to be more frequent in JW. Mortality of transfused controls (14.1%)
and their matched JW (13.0%) was similar. In contrast, mortality of
non-transfused controls was zero versus 6.3% in their matched JW
(P=0.059). Conclusions: Low-risk JW had significantly higher mortality
than controls. Bleeding related deaths tended to be more frequent in JW.
Blood-sparing maneuvers should be intensively implemented in both JW and
patients permitting transfusion in order to reduce bleeding and the need
for transfusion with its harmful effects.<br/>Copyright &#xa9; 2015
Edizioni Minerva Inervainerva Medica.

<74>
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.

<75>
Accession Number
623881396
Title
Rationale and design of the Virginia Commonwealth University-Anakinra
Remodeling Trial-3 (VCU-ART3): A randomized, placebo-controlled,
double-blinded, multicenter study.
Source
Clinical Cardiology. 41 (8) (pp 1004-1008), 2018. Date of Publication:
August 2018.
Author
Van Tassell B.W.; Lipinski M.J.; Appleton D.; Roberts C.S.; Kontos M.C.;
Abouzaki N.; Melchior R.; Mueller G.; Garnett J.; Canada J.; Carbone S.;
Buckley L.F.; Wohlford G.; Kadariya D.; Trankle C.R.; Oddi Erdle C.;
Sculthorpe R.; Puckett L.; DeWilde C.; Shah K.; Angiolillo D.J.; Vetrovec
G.; Biondi-Zoccai G.; Arena R.; Abbate A.
Institution
(Van Tassell, Roberts, Kontos, Abouzaki, Melchior, Mueller, Canada,
Carbone, Kadariya, Trankle, Oddi Erdle, Shah, Vetrovec, Abbate) VCU Pauley
Heart Center, Virginia Commonwealth University, Richmond, VA, United
States
(Van Tassell, Buckley, Wohlford) Department of Pharmacotherapy and
Outcomes Science, Virginia Commonwealth University, Richmond, VA, United
States
(Van Tassell, Puckett, DeWilde, Abbate) VCU Johnson Center for Pulmonary
and Critical Care Research, Virginia Commonwealth University, Richmond,
VA, United States
(Lipinski) Medstar Heart and Vascular Institute, MedStar Washington
Hospital Center, Washington, DC, United States
(Appleton, Melchior, Mueller, Garnett, Puckett) Virginia Cardiovascular
Specialists, Richmond, United States
(Canada) Department of Kinesiology and Health Sciences, Virginia
Commonwealth University, Richmond, VA, United States
(Sculthorpe) Investigational Pharmacy, Virginia Commonwealth University,
Richmond, VA, United States
(Biondi-Zoccai) Department of Medical and Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, and Department of
AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
(Arena) Department of Physical Therapy, College of Applied Health
Sciences, University of Illinois at Chicago, Chicago, IL, United States
(Angiolillo) Division of Cardiology, University of Florida, Jacksonville,
FL, United States
(Abbate) Kenneth and Dianne Wright Center for Clinical and Translational
Research, Virginia Commonwealth University, Richmond, VA, United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
There is clear association between the intensity of the acute inflammatory
response during acute myocardial infarction (AMI) and adverse prognosis
after AMI. Interleukin-1 (IL-1) is a pro-inflammatory cytokine released
during AMI and involved in adverse remodeling and heart failure (HF). We
describe a study to evaluate the safety and efficacy of IL-1 blockade
using an IL-1 receptor antagonist (anakinra) during the acute phase of
ST-segment elevation myocardial infarction (STEMI). The Virginia
Commonwealth University-Anakinra Remodeling Trial-3 (VCU-ART3;
http://www.ClinicalTrials.gov NCT01950299) is a phase 2, multicenter,
double-blinded, randomized, placebo-controlled clinical trial comparing
anakinra 100 mg once or twice daily vs matching placebo (1:1:1) for 14
days in 99 patients with STEMI. Patients who present to the hospital with
STEMI within 12 hours of symptom onset will be eligible for enrollment.
Patients will be excluded for a history of HF (functional class III-IV),
severe valvular disease, severe kidney disease (stage 4-5), active
infection, recent use of immunosuppressive drugs, active malignancy, or
chronic autoimmune/auto-inflammatory diseases. We will measure the
difference in the area under the curve for C-reactive protein between
admission and day 14, separately comparing each of the anakinra groups
with the placebo group. The P value will be considered significant if
<0.025 to adjust for multiple comparisons. Patients will also be followed
for up to 12 months from enrollment to evaluate cardiac remodeling
(echocardiography), cardiac function (echocardiography), and major adverse
cardiovascular outcomes (cardiovascular death, MI, revascularization, and
new onset of HF).<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<76>
[Use Link to view the full text]
Accession Number
624071697
Title
Unraveling the Underlying Arrhythmia Mechanism in Persistent Atrial
Fibrillation: Results from the STARLIGHT Study.
Source
Circulation: Arrhythmia and Electrophysiology. 11 (6) (no pagination),
2018. Article Number: e005897. Date of Publication: 01 Jun 2018.
Author
Child N.; Clayton R.H.; Roney C.H.; Laughner J.I.; Shuros A.; Neuzil P.;
Petru J.; Jackson T.; Porter B.; Bostock J.; Niederer S.A.; Razavi R.S.;
Rinaldi C.A.; Taggart P.; Wright M.J.; Gill J.
Institution
(Child, Roney, Jackson, Porter, Niederer, Razavi) Department of Imaging
Sciences and Biomedical Engineering, King's College London, United Kingdom
(Clayton) INSIGNEO Institute for in Silico Medicine, University of
Sheffield, United Kingdom
(Laughner, Shuros) Boston Scientific Corp, St. Paul, MN, United States
(Neuzil, Petru) Department of Cardiology, Na Holmolce Hospital, Prague,
Czech Republic
(Child, Bostock, Rinaldi, Wright, Gill) Department of Cardiology, Guy's
and St Thomas' Hospital, London SE1 7EH, United Kingdom
(Taggart) University College London, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The mechanisms that initiate and sustain persistent atrial
fibrillation are not well characterized. Ablation results remain
significantly worse than in paroxysmal atrial fibrillation in which the
mechanism is better understood and subsequent targeted therapy has been
developed. The aim of this study was to characterize and quantify patterns
of activation during atrial fibrillation using contact mapping. Methods:
Patients with persistent atrial fibrillation (n=14; mean age, 61+/-8
years; ejection fraction, 59+/-10%) underwent simultaneous biatrial
contact mapping with 64 electrode catheters. The atrial electrograms were
transformed into phase, and subsequent spatiotemporal mapping was
performed to identify phase singularities (PSs). Results: PSs were located
in both atria, but we observed more PSs in the left atrium compared with
the right atrium (779+/-302, 552+/-235; P=0.015). Although some PSs of
duration sufficient to complete >1 rotation were detected, the maximum PS
duration was only 1150 ms, and the vast majority (97%) of PSs persisted
for too short a period to complete a full rotation. Although in selected
patients there was evidence of PS local clustering, overall, PSs were
distributed globally throughout both chambers with no clear anatomic
predisposition. In a subset of patients (n=7), analysis was repeated using
an alternative established atrial PS mapping technique, which confirmed
our initial findings. Conclusions: No sustained rotors or localized
drivers were detected, and instead, the mechanism of arrhythmia
maintenance was consistent with the multiple wavelet hypothesis, with
passive activation of short-lived rotational activity.<br/>Copyright
&#xa9;2018 American Heart Association, Inc.

<77>
[Use Link to view the full text]
Accession Number
624066425
Title
Angiography versus hemodynamics to predict the natural history of coronary
stenoses: Fractional flow reserve versus angiography in multivessel
evaluation 2 substudy.
Source
Circulation. 137 (14) (pp 1475-1485), 2018. Date of Publication: 03 Apr
2018.
Author
Ciccarelli G.; Barbato E.; Toth G.G.; Gahl B.; Xaplanteris P.; Fournier
S.; Milkas A.; Bartunek J.; Vanderheyden M.; Pijls N.; Tonino P.; Fearon
W.F.; Juni P.; De Bruyne B.
Institution
(Ciccarelli, Barbato, Xaplanteris, Fournier, Milkas, Bartunek,
Vanderheyden, De Bruyne) Cardiovascular Center, OLV Hospital, Moorselbaan,
Aalst 9300, Belgium
(Barbato) Department of Advanced Biomedical Sciences, University of Naples
Federico II, Italy
(Toth) University Heart Centre Graz, Austria
(Gahl) Department of Clinical Research, CTU Bern, University of Bern,
Switzerland
(Pijls) Department of Cardiology, Catharina Hospital, Eindhoven,
Netherlands
(Tonino) Stanford University Medical Center, CA, United States
(Fearon) Applied Health Research Centre, Li Ka Shing Knowledge Institute
of St Michael's Hospital, Toronto, ON, Canada
(Juni) Department of Medicine, University of Toronto, ON, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Among patients with documented stable coronary artery disease
and in whom no revascularization was performed, we compared the respective
values of angiographic diameter stenosis (DS) and fractional flow reserve
(FFR) in predicting natural history. Methods: The present analysis
included the 607 patients from the FAME 2 trial (Fractional Flow Reserve
Versus Angiography in Multivessel Evaluation 2) in whom no
revascularization was performed. FFR varied from 0.20 to 1.00 (average
0.74+/-0.16), and DS (by quantitative coronary analysis) varied from 8% to
98% (average 53+/-15). The primary end point, defined as vessel-oriented
clinical end point (VOCE) at 2 years, was a composite of prospectively
adjudicated cardiac death, vessel-related myocardial infarction,
vessel-related urgent, and not urgent revascularization. The stenoses were
divided into 4 groups according to FFR and %DS values: positive
concordance (FFR<=0.80; DS>=50%), negative concordance (FFR>0.80; DS<50%),
positive mismatch (FFR<=0.80; DS<50%), and negative mismatch (FFR>0.80;
DS>=50%). Results: The rate of VOCE was highest in the positive
concordance group (log rank: X 2 =80.96; P=0.001) and lowest in the
negative concordance group. The rate of VOCE was higher in the positive
mismatch group than in the negative mismatch group (hazard ratio, 0.38;
95% confidence interval, 0.21-0.67; P=0.001). There was no significant
difference in VOCE between the positive concordance and positive mismatch
groups (FFR<=0.80; hazard ratio, 0.77; 95% confidence interval, 0.57-1.09;
P=0.149) and no significant difference in rate of VOCE between the
negative mismatch and negative concordance groups (FFR>0.80; hazard ratio,
1.89; 95% confidence interval, 0.96-3.74; P=0.067). Conclusions: In
patients with stable coronary disease, physiology (FFR) is a more
important determinant of the natural history of coronary stenoses than
anatomy (DS). Clinical Trial Registration: URL:
https://clinicaltrials.gov. Unique identifier: NCT01132495.<br/>Copyright
&#xa9; 2017 American Heart Association, Inc.

<78>
[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.

<79>
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.

<80>
Accession Number
624065560
Title
Incidence, Predictors, and Outcomes Associated with Hypotensive Episodes
among Heart Failure Patients Receiving Sacubitril/Valsartan or Enalapril:
The PARADIGM-HF Trial (Prospective Comparison of Angiotensin Receptor
Neprilysin Inhibitor with Angiotensin-Converting Enzyme Inhibitor to
Determine Impact on Global Mortality and Morbidity in Heart Failure).
Source
Circulation: Heart Failure. 11 (4) (no pagination), 2018. Article Number:
e004745. Date of Publication: 01 Apr 2018.
Author
Vardeny O.; Claggett B.; Kachadourian J.; Pearson S.M.; Desai A.S.; Packer
M.; Rouleau J.; Zile M.R.; Swedberg K.; Lefkowitz M.; Shi V.; McMurray
J.J.V.; Solomon S.D.
Institution
(Vardeny) Minneapolis VA Health Care System, University of Minnesota,
United States
(Pearson) University of Colorado, Aurora, United States
(Claggett, Desai, Solomon) Brigham and Women's Hospital, Harvard
University, Cardiovascular Division, 75 Francis St, Boston, MA 02115,
United States
(Kachadourian, Lefkowitz, Shi) Novartis Pharmaceuticals Corporation, East
Hanover, NJ, United States
(McMurray) University of Glasgow, United Kingdom
(Packer) Baylor University Medical Center, Dallas, TX, United States
(Rouleau) Universite de Montreal, Canada
(Zile) Medical University of South Carolina, Charleston, United States
(Swedberg) University of Gothenburg, Sweden
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: In PARADIGM-HF (Prospective Comparison of Angiotensin Receptor
Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to
Determine Impact on Global Mortality and Morbidity in Heart Failure),
heart failure treatment with sacubitril/valsartan reduced the primary
composite outcome of cardiovascular death or heart failure hospitalization
compared with enalapril but resulted in more symptomatic hypotension.
Concern on hypotension may be limiting use of sacubitril/valsartan in
appropriate patients. Methods and Results: We characterized patients in
PARADIGM-HF by whether they reported hypotension during study run-in
periods (enalapril, followed by sacubitril/valsartan) and after
randomization and assessed whether hypotension modified the efficacy of
sacubitril/valsartan. Of the 10 513 patients entering the enalapril
run-in, 136 (1.3%) experienced hypotension and 93 (68%) were unable to
continue to the next phase; of 9419 patients entering the
sacubitril/valsartan run-in period, 228 (2.4%) patients experienced
hypotension and 51% were unable to successfully complete the run-in. After
randomization, 388 (9.2%) participants had 501 hypotensive events with
enalapril, and 588 (14.0%) participants had 803 hypotensive events with
sacubitril/valsartan (P<0.001). There was no difference between randomized
treatment groups in the number of participants who discontinued therapy
because of hypotension. Individuals with a hypotensive event in either
group were older, had lower blood pressure at randomization, and were more
likely to have an implantable cardioverter defibrillator. Participants
with hypotensive events during run-in who were ultimately randomized
derived similar efficacy from sacubitril/valsartan compared with enalapril
as those without hypotensive events (P interaction>0.90). Conclusions:
Hypotension was more common with sacubitril/valsartan relative to
enalapril in PARADIGM-HF but did not differentially affect permanent
discontinuations. Patients with hypotension during run-in derived similar
benefit from sacubitril/valsartan compared with enalapril as those who did
not experience hypotension.<br/>Copyright &#xa9; 2018 American Heart
Association, Inc.

<81>
Accession Number
617433519
Title
Evaluation of flow after transcatheter aortic valve replacement in
patients with low-flow aortic stenosis: A secondary analysis of the
PARTNER randomized clinical trial.
Source
JAMA Cardiology. 1 (5) (pp 481-489), 2016. Date of Publication: August
2016.
Author
Anjan V.Y.; Herrmann H.C.; Pibarot P.; Stewart W.J.; Kapadia S.; Tuzcu
E.M.; Babaliaros V.; Thourani V.H.; Szeto W.Y.; Bavaria J.E.; Kodali S.;
Hahn R.T.; Williams M.; Miller D.C.; Douglas P.S.; Leon M.B.
Institution
(Anjan, Herrmann) Cardiovascular Division, Hospital of the University of
Pennsylvania, 9038 Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104,
United States
(Pibarot) Department of Medicine, Laval University, Quebec City, QC,
Canada
(Stewart, Kapadia, Tuzcu) Department of Cardiovascular Medicine, Cleveland
Clinic, Cleveland, OH, United States
(Babaliaros) Department of Medicine, Emory University, Atlanta, GA, United
States
(Thourani) Department of Surgery, Emory University, Atlanta, GA, United
States
(Szeto, Bavaria) Division of Cardiothoracic Surgery, University of
Pennsylvania, Philadelphia, PA, United States
(Kodali, Hahn, Leon) Department of Medicine, Columbia University Medical
Center, New York, NY, United States
(Williams) Division of Cardiac Surgery, New York University Langone
Medical Center, New York, NY, United States
(Miller) Department of Cardiothoracic Surgery, Stanford University,
Stanford, CA, United States
(Douglas) Department of Medicine, Duke Clinical Research Institute, Duke
University Medical Center, Durham, NC, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Low-flow (LF) severe aortic stenosis (AS) is an independent
predictor of mortality in patients undergoing aortic valve replacement
(AVR). Little is known about improvement in flow after AVR and its effects
on survival. Objective: To determine whether higher flow (left-ventricular
stroke volume index [LVSVI]) after transcatheter AVR (TAVR) would indicate
better clinical outcomes in this at-risk population. Design, Setting, and
Participants: A substudy analysis of data from the Placement of Aortic
Transcatheter Valves (PARTNER) randomized clinical trial and
continued-access registry was conducted. A total of 984 participants with
evaluable echocardiograms and baseline LF AS (LVSVI<=35 mL/m²)
were included. The trial was conducted at 26 sites in the United States
and Canada. Patients were stratified after TAVR into tertiles by discharge
LVSVI status (severe low flow [SLF], moderate low flow [MLF], and normal
flow [(NF]). The present study was conducted from May 11, 2007, to January
9, 2012, with data analysis performed from April 25, 2014, to January 21,
2016. Main Outcomes and Measures: The primary end pointwas all-cause
mortality at 1 year. Results: Baseline characteristics of 984 patients
with LF AS included mean (SD) age, 84 (7) years; 582 (59.1%) men; mean
Society of Thoracic Surgeons (STS) score, 11.4%(4.0%); and mean LVSVI,
27.6 (5.0) mL/m². The discharge LVSVI values by group were SLF,
23.1 (3.5) mL/m²; MLF, 31.7 (2.2) mL/m²; and NF,
43.1 (7.0). All-cause mortality at 1 year was SLF, 26.5%; MLF, 20.1%; and
NF, 19.6%(P = .045). Mean LVSVI normalized by 6 months in the MLF (35.9
[9.3] mL/m²) and NF (38.8 [11.1] mL/m²) groups, but
remained low in the SLF group at 6 months and 1 year (31.4 [8.4] and 33.0
[8.3] mL/m²], respectively) (P < .001 for all groups). Reported
as multivariate hazard ratio, mortality at 1 year was higher in the SLF
group compared with the other groups (1.61; 95%CI, 1.17-2.23; P = .004).
In addition to SLF, sex (1.59; 95%CI, 1.18-2.13; P = .002), presence of
atrial fibrillation (1.41; 95%CI, 1.06-1.87; P = .02), STS score (1.03;
95%CI, 1.01-1.06; P = .02), presence of moderate or severe mitral
regurgitation at discharge (1.65; 95%CI, 1.21-2.26; P = .001), pre-TAVR
mean transvalvular gradient (0.98; 95%CI, 0.97-0.99; P = .004), and
effective orifice area index (1.87; 95%CI, 1.09-3.19; P = .02) were
independent predictors of 1-year mortality. Conclusions and Relevance:
Severe LF at discharge is associated with an increased risk of mortality
following TAVR in patients with severe AS and preexisting LF. The
identification of remedial causes of persistent LF after TAVR may
represent an opportunity to improve the outcome of these
patients.<br/>Copyright &#xa9; 2016 American Medical Association. All
rights reserved.

<82>
Accession Number
624126045
Title
Outcome of prenatally diagnosed fetal heterotaxy: systematic review and
meta-analysis.
Source
Ultrasound in obstetrics & gynecology : the official journal of the
International Society of Ultrasound in Obstetrics and Gynecology. 51 (3)
(pp 323-330), 2018. Date of Publication: 01 Mar 2018.
Author
Buca D.I.P.; Khalil A.; Rizzo G.; Familiari A.; Di Giovanni S.; Liberati
M.; Murgano D.; Ricciardulli A.; Fanfani F.; Scambia G.; D'Antonio F.
Institution
(Buca, Di Giovanni, Liberati, Murgano, Ricciardulli, Fanfani) Department
of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio
University of Chieti-Pescara, Chieti, Italy
(Khalil) University of London & St George's University Hospitals NHS
Foundation Trust Molecular and Clinical Sciences Research Institute, St
George's, London, United Kingdom
(Rizzo) Department of Obstetrics and Gynaecology, Universita di Roma Tor
Vergata, Rome, Italy
(Familiari, Scambia) Department of Obstetrics and Gynaecology, Catholic
University of the Sacred Heart, Rome, Italy
(D'Antonio) Department of Clinical Medicine, Faculty of Health Sciences,
UiT - The Arctic University of Norway, Tromso, Norway
(D'Antonio) Department of Obstetrics and Gynaecology, University Hospital
of Northern Norway, Tromso, Norway
Abstract
OBJECTIVES: The main aim of this systematic review was to evaluate the
prevalence and type of associated anomalies in fetuses with heterotaxy
diagnosed prenatally on ultrasound; the perinatal outcome of these fetuses
was also studied.
METHODS: An electronic search of MEDLINE, EMBASE and CINAHL databases was
performed. Only studies reporting the prenatal diagnosis of isomerism were
included. Outcomes observed included associated cardiac and extracardiac
anomalies, fetal arrhythmia, abnormal karyotype, type of surgical repair
and perinatal mortality. The analysis was stratified according to the type
of heterotaxy syndrome (left (LAI) or right (RAI) atrial isomerism).
Meta-analyses of proportions were used to combine data. Quality assessment
of the included studies was performed using the Newcastle-Ottawa Scale for
cohort studies.
RESULTS: Sixteen studies (647 fetuses) were included in the analysis.
Atrioventricular septal defect was the most common associated major
cardiac anomaly found both in fetuses with LAI (pooled proportion (PP),
59.3% (95% CI, 44.0-73.7%)), with obstructive lesions of the right outflow
tract occurring in 35.5% of these cases, and in fetuses with RAI (PP,
72.9% (95% CI, 60.4-83.7%)). Fetal arrhythmias occurred in 36.7% (95% CI,
26.9-47.2%) of cases with LAI and were mainly represented by complete
atrioventricular block, while this finding was uncommon in cases with RAI
(PP, 1.3% (95% CI, 0.2-3.2%)). Abnormal stomach and liver position were
found, respectively, in 59.4% (95% CI, 38.1-79.0%) and 32.5% (95% CI,
11.9-57.6%) of cases with LAI, and in 54.5% (95% CI, 38.5-70.1%) and 45.9%
(95% CI, 11.3-83.0%) of cases with RAI, while intestinal malrotation was
detected in 14.2% (95% CI, 2.5-33.1%) of LAI and 27.1% (95% CI, 7.9-52.0%)
of RAI cases. Hydrops developed in 11.8% (95% CI, 2.9-25.6%) of fetuses
diagnosed prenatally with LAI. Biventricular repair was accomplished in
78.2% (95% CI, 64.3-89.4%) of cases with LAI, while univentricular repair
or palliation was needed in 17.0% (95% CI, 9.7-25.9%); death during or
after surgery occurred in 26.8% (95% CI, 4.6-58.7%) of LAI cases. Most
children with RAI had univentricular repair and 27.8% (95% CI, 15.5-42.1%)
died during or after surgery.
CONCLUSIONS: Fetal heterotaxy is associated with a high prevalence of
cardiac and extracardiac anomalies. Approximately one quarter of fetuses
with heterotaxy died during or after surgery. Abnormal heart rhythm,
especially heart block, is common in fetuses with LAI, while this finding
is uncommon in RAI. Biventricular repair was common in LAI while
univentricular repair was required in the majority of children affected by
RAI. Copyright &#xa9; 2017 ISUOG. Published by John Wiley & Sons Ltd.

<83>
Accession Number
624130644
Title
Effects of Dexmedetomidine Infusion on Inflammatory Responses and Injury
of Lung Tidal Volume Changes during One-Lung Ventilation in Thoracoscopic
Surgery: A Randomized Controlled Trial.
Source
Mediators of inflammation. 2018 (pp 2575910), 2018. Date of Publication:
2018.
Author
Wu C.-Y.; Lu Y.-F.; Wang M.-L.; Chen J.-S.; Hsu Y.-C.; Yang F.-S.; Cheng
Y.-J.
Institution
(Wu, Wang, Hsu, Yang, Cheng) Anesthesiology Department, National Taiwan
University Hospital, Taiwan (Republic of China)
(Lu) Anesthesiology Department, National Taiwan University Hospital,
Hsinchu Branch, Taiwan (Republic of China)
(Chen) Surgery Department, National Taiwan University Hospital, Taipei,
Taiwan (Republic of China)
Abstract
One-lung ventilation in thoracic surgery provokes profound systemic
inflammatory responses and injury related to lung tidal volume changes. We
hypothesized that the highly selective a2-adrenergic agonist
dexmedetomidine attenuates these injurious responses. Sixty patients were
randomly assigned to receive dexmedetomidine or saline during
thoracoscopic surgery. There is a trend of less postoperative medical
complication including that no patients in the dexmedetomidine group
developed postoperative medical complications, whereas four patients in
the saline group did (0% versus 13.3%, p = 0.1124). Plasma inflammatory
and injurious biomarkers between the baseline and after resumption of
two-lung ventilation were particularly notable. The plasma high-mobility
group box 1 level decreased significantly from 51.7 (58.1) to 33.9 (45.0)
ng.ml-1 (p < 0.05) in the dexmedetomidine group, which was not observed in
the saline group. Plasma monocyte chemoattractant protein 1 [151.8 (115.1)
to 235.2 (186.9) pg.ml-1, p < 0.05] and neutrophil elastase [350.8 (154.5)
to 421.9 (106.1) ng.ml-1, p < 0.05] increased significantly only in the
saline group. In addition, plasma interleukin-6 was higher in the saline
group than in the dexmedetomidine group at postoperative day 1 [118.8
(68.8) versus 78.5 (58.8) pg.ml-1, p = 0.0271]. We conclude that
dexmedetomidine attenuates one-lung ventilation-associated inflammatory
and injurious responses by inhibiting alveolar neutrophil recruitment in
thoracoscopic surgery.

<84>
Accession Number
624131974
Title
PREVENTION OF HEART FAILURE PATIENTS WITH DECREASED EJECTION FRACTION IN
NON-CARDIAC SURGERY: LEVOSIMENDAN OR ANESTHETIC CARDIOPROTECTION?.
Source
Anesteziologiia i reanimatologiia. 61 (6) (pp 411-417), 2016. Date of
Publication: 01 Nov 2016.
Author
Likhvantsev V.V.; Marchenko D.N.; Grebenshchikov O.A.; Ubasev Y.V.;
Zabelina T.S.; Timoshin S.S.; Skripkin Y.V.; Ovezov A.M.; Lar'kov R.N.;
Philippovskaya Z.S.; Sungurov V.A.
Abstract
ENDPOINTS: the primary endpoint of the trial is the need and the maximum
dose of inotropic drugs in the perioperative period; secondary point: the
length of stay in the ICU, composite outcome, the dynamics of SI, FI, the
content ofNT-proBNP and TnT Materials and methods: A randomized study was
performed in three groups of patients during reconstructive operations on
infrarenal part of aorta: control (traditional methodfor prevention of
decompensation of CHF were used) - 31 patients; the group with the
anesthetic cardioprotectivei - 31 patients; the group with a preoperative
preparing with levosimendan - 30 patients.
RESULTS: The incidence of heart failure (estimated by need to use
inotropic drugs - IS) was 83% of control group patients and 75% of the
patients of the group "VIMA" (p = 0,65). The number ofpatients needing the
use of dobutamine in LS-group was significantly below, 50% (p = 0,02
relative to control group and p = 0,08 compared to the group VIMA). IS in
the control group was 8 [6, 9] mug xkg-1 - xmin-1 ; group VIMA 8 [3; 9] mg
xkg -1 xmin-1 , whereas in the LS group only 2 [0; 7] mg -1 xkg-1 xmin-1 .
Differences between groups credible, given the Bonferroni correction (p =
0,0015). In our study, was not identified significant differences in
30-day mortality: in the control group it was 3,4%; in the group VIMA of
3,1%; in the group of LS - 0% (p > 0,017); however, a composite outcome
(number of adverse events (heart attack+stroke+mortality) were slightly
better in the LS group - 17%, against 34% in the control group (p =
0,043).
CONCLUSION: Preoperative preparation with levosimendan in patients with
reduced fraction left ventricle ejection when performing reconstructive
operations on the descending aorta reduces the incidence of episodes of
decompensation of heart failure compared with the control group to 39,8%
(p < 0,05). The use of this technique improves the composite outcome of
operations on the infrarenal aorta. The study has not shown the influence
of anesthetic cardioprotection in terms of hospitalization and composite
outcome of surgical treatment.
BACKGROUND: Chronic heart failure (CHF) significantly worsens the
prognosis of surgical treatment in noncardiac surgery, doubling mortality
in compared with patients with coronary artery disease. Modern
anesthesiology has at least two methods that potentially can improve the
results in noncardiac surgery: anesthetic cardioprotection and the
prevention of CHF decompensation with levosimendan.
THE AIM: to study the efficacy of anesthetic cardioprotection
andpreoperative preparation with levosimendan for the prevention of CHF
decompensation in patients with reduced left ventricular ejectionfraction
in noncardiac surgery.

<85>
Accession Number
2001149927
Title
Transcatheter aortic valve replacement outcomes in bicuspid compared to
trileaflet aortic valves.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2018. Date of
Publication: 2018.
Author
Nagaraja V.; Suh W.; Fischman D.L.; Banning A.; Martinez S.C.; Potts J.;
Kwok C.S.; Ratib K.; Nolan J.; Bagur R.; Mamas M.A.
Institution
(Nagaraja, Potts, Kwok, Ratib, Nolan, Bagur, Mamas) Keele Cardiovascular
Research Group, Centre for Prognosis Research, Institute of Primary Care
and Health Sciences, Keele University, United Kingdom
(Nagaraja, Potts, Ratib, Nolan, Bagur, Mamas) Academic Dept of Cardiology,
Royal Stoke Hospital, United Kingdom
(Nagaraja) Department of Cardiology, Prince of Wales Hospital and
Community Health Services, Randwick, New South Wales, Australia
(Suh) Division of Cardiology, University of California Los Angeles Medical
Center, David Geffen School of Medicine at UCLA, United States
(Fischman) Department of Medicine (Cardiology), Thomas Jefferson
University Hospital, Philadelphia, PA, United States
(Banning) Oxford Heart Centre, Oxford University Hospitals NHS Trust
Foundation, Oxford, United Kingdom
(Martinez) Division of Cardiology, Providence St. Peter Hospital, Olympia,
WA, United States
(Kwok) Department of Cardiology, University Hospital of North Midlands,
United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Aim: TAVR in patients with bicuspid aortic valves (BAV) is more
challenging compared to individuals with trileaflet aortic valves (TAV).
BAV have been excluded from the large randomized clinical trials assessing
transcatheter aortic valve replacements (TAVR) and has been considered as
a relative contraindication to TAVR. To report the outcomes of TAVR in BAV
and compare them to TAV in the National Inpatient Sample (NIS). Methods
and results: TAVR procedures were identified between 2011 and 2014 in the
NIS dataset. Endpoints assessed included in-hospital mortality,
periprocedural complications, length of stay and cost. Of 40,604
identified TAVR procedures, 407 (1%) were BAV and the 40,197 (99%) were
TAV. Patients with BAV were younger and had a lower comorbidity burden. In
hospital mortality (4.89% vs 4.17%, OR: 1.71, 95%CI: 0.57-5.12, P = 0.21),
AMI (3.49% vs 3.58%, OR: 1.12, 95%CI: 0.36-3.54, P = 0.85), stroke and TIA
(2.49% vs 3.55%, OR: 0.75, 95%CI: 0.18-3.16, P = 0.70), vascular
complications (2.39% vs 5.58%, OR:0.47, 95%CI: 0.11-1.93, P = 0.29), major
bleeding (16.96% vs 23.50%, OR: 0.63, 95%CI: 0.34-1.17, P = 0.15) and
rates of permanent pacemaker (PPM) (9.88% vs 10.88%, OR: 1.19, 95%CI:
0.57-2.51, P = 0.64) were similar in both cohorts. Conclusions: With
multimodality imaging and further improvement in technology, our study
demonstrates off-label TAVR should not be considered prohibitive and can
be successfully performed for BAV with similar peri-procedural outcomes
compared to those with TAV. However, there is a need for robust large
prospective studies.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<86>
Accession Number
2001137367
Title
Perioperative Right Ventricular Pressure Monitoring in Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Author
Raymond M.; Gronlykke L.; Couture E.J.; Desjardins G.; Cogan J.; Cloutier
J.; Lamarche Y.; L'Allier P.L.; Ravn H.B.; Couture P.; Deschamps A.;
Chamberland M.-E.; Ayoub C.; Lebon J.-S.; Julien M.; Taillefer J.; Rochon
A.; Denault A.Y.
Institution
(Raymond, Desjardins, Cogan, Couture, Deschamps, Chamberland, Ayoub,
Lebon, Julien, Taillefer, Rochon) Department of Anesthesiology, Montreal
Heart Institute, Universite de Montreal, Montreal, Quebec, Canada
(Gronlykke, Ravn) Department of Cardiothoracic Anaesthesia,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Couture) Intensive Care Program, Montreal Heart Institute, Universite de
Montreal, Montreal, Quebec, Canada
(Cloutier) Department of Anesthesiology, Saint John Regional Hospital,
Saint John, New Brunswick, Canada
(Lamarche) Department of Cardiac Surgery, Montreal Heart Institute,
Universite de Montreal, Montreal, Quebec, Canada
(L'Allier) Department of Cardiology, Montreal Heart Institute, Universite
de Montreal, Montreal, Quebec, Canada
(Denault) Department of Anesthesiology and Cardiac Surgical Intensive Care
Department, Montreal Heart Institute, Universite de Montreal, Montreal,
Quebec, Canada
Publisher
W.B. Saunders
Abstract
Right ventricular (RV) dysfunction is a cause of increased morbidity and
mortality in both cardiac surgery and noncardiac surgery and in the
intensive care unit. Early diagnosis of this condition still poses a
challenge. The diagnosis of RV dysfunction traditionally is based on a
combination of echocardiography, hemodynamic measurements, and clinical
symptoms. This review describes the method of using RV pressure waveform
analysis to diagnose and grade the severity of RV dysfunction. The authors
describe the technique, optimal use, and pitfalls of this method, which
has been used at the Montreal Heart Institute since 2002, and review the
current literature on this method. The RV pressure waveform is obtained
using a pulmonary artery catheter with the capability of measuring RV
pressure by connecting a pressure transducer to the pacemaker port. The
authors describe how RV pressure waveform analysis can facilitate the
diagnosis of systolic and diastolic RV dysfunction, the evaluation of
RV-arterial coupling, and help diagnose RV outflow tract obstruction. RV
pressure waveform analysis also can be used to guide pharmacologic
treatment and fluid resuscitation strategies for RV
dysfunction.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<87>
Accession Number
624107209
Title
Treatment of Candida sternal infection following cardiac surgery-a review
of literature.
Source
Infectious Diseases. (no pagination), 2018. Date of Publication: 2018.
Author
Arikan A.A.; Omay O.; Kanko M.; Horuz E.; Yagli G.; Kagan E.Y.; Agir H.
Institution
(Arikan) Department of Cardiovascular Surgery, Mus State Hospital, Mus,
Turkey
(Omay, Kanko, Yagli) Kocaeli University Medical Faculty, Department of
Cardiovascular Surgery, Kocaeli, Turkey
(Horuz) Department of Infectious Diseases and Clinical Microbiology,
Zonguldak Hospital for Obstetrics and Pediatric Diseases, Zonguldak,
Turkey
(Kagan) Department of Plastic and Reconstructive Surgery, Kocaeli
University Medical Faculty, Kocaeli, Turkey
(Agir) Department of Plastic and Reconstructive Surgery, Altunizade
Acibadem Hospital, Istanbul, Turkey
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Background:Candida sternal wound infections (SWIs) following cardiac
surgery are rare but are associated with a high mortality rate. Guidelines
on this topic either propose no suggestions for management or offer
recommendations based on a small number of reports. Methods: This paper
presents a case of a Candida SWI and its successful treatment with
debridement using a burr, negative pressure vacuum therapy (NPVT) and
dermal grafting. To investigate different methods of treating Candida SWIs
following cardiac surgery, a review was completed using the MEDLINE
database. Reports without English abstracts and without defined outcomes
of therapy for individual patients were excluded. Results: Seventy-seven
cases of Candida SWIs following cardiac surgery were identified in 20
articles published since 1999, including our case. Treatment strategies
are identified: omentum flap; muscle flap; debridement and secondary wound
healing with or without NPVT; debridement and primary closure; incision
and drainage; only medical therapy. Patients documented in the articles
were classified based on the following outcomes: cured (n = 41 patients
[including the present case]), relapse infection (n = 25 patients) and
death (n = 11 patients). The various methods used to treat patients were
analysed. Conclusions: Delayed closure reoperation with surgical
debridement and NPVT have favourable outcomes. In the presence of
widespread osteomyelitis, the use of omental flaps is advocated. Treatment
with muscle flaps has a high rate of relapse. Debridement and secondary
healing or conservative management with antifungals alone can be
considered in the treatment of relapsing infection.<br/>Copyright &#xa9;
2018, &#xa9; 2018 Society for Scandinavian Journal of Infectious Diseases.