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<1>
Accession Number
2000795963
Title
Impact of an ultraviolet air sterilizer on cardiac surgery patients, a
randomized clinical trial.
Source
Medicina Clinica. 151 (8) (pp 299-307), 2018. Date of Publication: 23
October 2018.
Author
Heredia-Rodriguez M.; Alvarez-Fuente E.; Bustamante-Munguira J.;
Poves-Alvarez R.; Fierro I.; Gomez-Sanchez E.; Gomez-Pesquera E.;
Lorenzo-Lopez M.; Eiros J.M.; Alvarez F.J.; Tamayo E.
Institution
(Heredia-Rodriguez, Alvarez-Fuente, Poves-Alvarez, Gomez-Sanchez,
Gomez-Pesquera, Lorenzo-Lopez) Department of Anaesthesiology, Hospital
Clinico Universitario, Valladolid, Spain
(Heredia-Rodriguez, Alvarez-Fuente, Poves-Alvarez, Gomez-Sanchez,
Gomez-Pesquera, Lorenzo-Lopez, Tamayo) BioCritic, Group for Biomedical
Research in Critical Care Medicine, Valladolid, Spain
(Bustamante-Munguira) Department of Cardiovascular Surgery, Hospital
Universitario de La Princesa, Madrid, Spain
(Fierro) Department of Health Sciences, European University Miguel de
Cervantes, Valladolid, Spain
(Alvarez, Tamayo) Department of Pharmacology, University of Valladolid,
Valladolid, Spain
(Eiros) Department of Microbiology, Hospital Rio Hortega, Valladolid,
Spain
Publisher
Ediciones Doyma, S.L.
Abstract
Background: Numerous studies have evaluated the use of ultraviolet-C
devices for terminal disinfection in hospitals, however, to date there is
little information about the device's final impact on patients. We
investigated the effect of an ultraviolet air sterilizer (UVAS) on the
clinical outcomes of cardiac surgery patients. Materials and methods: This
random, prospective and non-interventional study included 1097 adult
patients undergoing elective cardiac surgery: 522 stayed in an ICU room
with UVAS (Medixair) and 575 patients ICU room without UVAS and
were used as a control. The primary outcome measure was to evaluate the
effect of a UVAS on the overall prevalence of nosocomial infections in
postoperative cardiac patients in ICUs. Results: No significant
differences in ventilator-associated pneumonia (4.6% vs. 5.0%, p = 0.77)
and total infection (14.0% vs. 15.5%, p = 0.45) rates were detected in
patients with and without the UVAS. The length of stay in the intensive
care unit and at the hospital was similar in both groups, UVAS (4.6 (8.2)
days and 18.3 (5.5) days) and without UVAS (4.6 (7.3) days and 19.2 (18.6)
days). The 30-day in-hospital mortality rate was 5.3%, no significant
differences between groups were observed (p = 0.053). Conclusion: Novel
ultraviolet-C technology has not been shown to significantly reduce
nosocomial infections or mortality rates in cardiac surgery
patients.<br/>Copyright &#xa9; 2018 Elsevier Espana, S.L.U.

<2>
Accession Number
623266621
Title
Transcatheter mitral valve implantation for degenerated mitral
bioprostheses or failed surgical annuloplasty rings: A systematic review
and meta-analysis.
Source
Journal of Cardiac Surgery. 33 (9) (pp 508-519), 2018. Date of
Publication: September 2018.
Author
Hu J.; Chen Y.; Cheng S.; Zhang S.; Wu K.; Wang W.; Zhou Y.
Institution
(Hu, Chen, Cheng, Zhang, Wu, Wang, Zhou) Department of
Thoracic-Cardiovascular Surgery, Tongji Hospital, Tongji University School
of Medicine, Shanghai, China
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Transcatheter mitral valve-in-valve (TMVIV) and valve-in-ring
(TMVIR) implantation for degenerated mitral bioprostheses and failed
annuloplasty rings have recently emerged as treatment options for patients
deemed unsuitable for repeat surgery. Methods: A systematic literature
review was conducted to summarize the data regarding the baseline
characteristics and clinical outcomes of patients undergoing TMVIV and
TMVIR procedures. Results: A total of 245 patients (172 patients who
underwent TMVIV surgery and 73 patients who underwent TMVIR surgery) were
included in the study; 93.5% of patients experienced successful TMVIV or
TMVIR implantation. The mortality rates at discharge, 30 days, and 6
months were 5.7%, 8.1%, and 23.4%, respectively. The transapical (TA)
access route was used in most procedures (55.2%). The TA and transseptal
(TS) access routes resulted in similar outcomes. No significant
differences were observed in the short-term outcomes between the patients
who developed mitral stenosis versus mitral regurgitation as the mode of
failure. Conclusions: TMVIV and TMVIR implantation for degenerated mitral
bioprostheses and failed annuloplasty rings are safe and effective. Both
procedures, via TA or TS access, can result in excellent short-term
clinical outcomes in patients with mitral stenosis or regurgitation, but
long-term follow-up data are currently lacking to determine the durability
of these procedures.<br/>Copyright &#xa9; 2018 The Authors. Journal of
Cardiac Surgery Published by Wiley Periodicals, Inc.

<3>
Accession Number
622615859
Title
Red blood cell distribution width as a predictor of atrial fibrillation.
Source
Journal of Clinical Laboratory Analysis. 32 (5) (no pagination), 2018.
Article Number: e22378. Date of Publication: June 2018.
Author
Shao Q.; Korantzopoulos P.; Letsas K.P.; Tse G.; Hong J.; Li G.; Liu T.
Institution
(Shao, Li, Liu) Department of Cardiology, Tianjin Institute of Cardiology,
Second Hospital of Tianjin Medical University, Tianjin Key Laboratory of
Ionic-Molecular Function of Cardiovascular disease, Tianjin, China
(Korantzopoulos) First Department of Cardiology, University Hospital of
Ioannina, Ioannina, Greece
(Letsas) Second Department of Cardiology, Laboratory of Cardiac
Electrophysiology, "Evangelismos" General Hospital of Athens, Athens,
Greece
(Tse) Department of Medicine and Therapeutics, Chinese University of Hong
Kong, Hong Kong
(Tse) Li Ka Shing Institute of Health Sciences, Chinese University of Hong
Kong, Hong Kong
(Hong) Department of Internal Medicine, Shanghai First People's Hospital,
Shanghai Jiao Tong University, Shanghai, China
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Current evidence suggests that a higher red blood cell
distribution width (RDW) may be associated with increased risk of atrial
fibrillation (AF) development. Given that some controversial results have
been published, we conducted a systematic review of the current literature
along with a comprehensive meta-analysis to evaluate the association
between RDW and AF development. Methods: We performed a systematic search
of the literature using electronic databases (PubMed, Ovid, Embase, and
Web of Science) to identify studies reporting on the association between
RDW and AF development published until June 2016. We used both fix-effects
and random-effects models to calculate the overall effect estimate. An
I² > 50% indicates at least moderate statistical heterogeneity.
A sensitivity analysis and subgroup analysis were performed to find the
origin of heterogeneity. Results: A total of 12 studies involving 2721
participants were included in this meta-analysis. The standardized mean
difference in the RDW levels between patients with and those without AF
development was 0.66 units (P <.05; 95% confidence interval 0.44-0.88). A
significant heterogeneity between the individual studies was observed (P
<.05; I² = 80.4%). A significant association between the
baseline RDW levels and AF occurrence or recurrence following cardiac
procedure or surgery was evident (SMD: 0.61; 95% confidence interval
0.33-0.88; P <.05) with significant heterogeneity across the studies
(I² = 80.7%; P <.01). Conclusions: Our comprehensive
meta-analysis suggests that higher levels of RDW are associated with an
increased risk of AF in different populations.<br/>Copyright &#xa9; 2018
Wiley Periodicals, Inc.

<4>
Accession Number
618808988
Title
Remote Ischemic Preconditioning in High-risk Cardiovascular Surgery
Patients: A Randomized-controlled Trial.
Source
Seminars in Thoracic and Cardiovascular Surgery. 30 (1) (pp 26-33), 2018.
Date of Publication: Spring 2018.
Author
Coverdale N.S.; Hamilton A.; Petsikas D.; McClure R.S.; Malik P.; Milne
B.; Saha T.; Zelt D.; Brown P.; Payne D.M.
Institution
(Coverdale, Hamilton, Petsikas, Zelt, Brown, Payne) Department of Surgery,
Queen's University and Kingston General Hospital, Kingston, Ontario,
Canada
(McClure) Department of Surgery, Libin Cardiovascular Institute of
Alberta, Foothills Medical Center, University of Calgary, Calgary,
Alberta, Canada
(Malik) Department of Medicine, Queen's University and Kingston General
Hospital, Kingston, Ontario, Canada
(Milne, Saha) Department of Anesthesiology and Perioperative Medicine,
Queen's University and Kingston General Hospital, Kingston, Ontario,
Canada
Publisher
W.B. Saunders
Abstract
Remote ischemic preconditioning (RIPC) may reduce biomarkers of ischemic
injury after cardiovascular surgery. However, it is unclear whether RIPC
has a positive impact on clinical outcomes. We performed a blinded,
randomized controlled trial to determine if RIPC resulted in fewer adverse
clinical outcomes after cardiac or vascular surgery. The intervention
consisted of 3 cycles of RIPC on the upper limb for 5 minutes alternated
with 5 minutes of rest. A sham intervention was performed on the control
group. Patients were recruited who were undergoing (1) high-risk cardiac
or vascular surgery or (2) cardiac or vascular surgery and were at high
risk of ischemic complications. The primary end point was a composite
outcome of mortality, myocardial infarction, stroke, renal failure,
respiratory failure, and low cardiac output syndrome, and the secondary
end points included the individual outcome parameters that made up this
score, as well as troponin-I values. A total of 436 patients were
randomized and analysis was performed on 215 patients in the control group
and on 213 patients in the RIPC group. There were no differences in the
composite outcome between the 2 groups (RIPC: 67 [32%] and control: 72
[34%], relative risk [0.94 {0.72-1.24}]) or in any of the individual
components that made up the composite outcome. Additionally, we did not
observe any differences between the groups in troponin-I values, the
length of intensive care unit stay, or the total hospital stay. RIPC did
not have a beneficial effect on clinical outcomes in patients who had
cardiovascular surgery.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<5>
Accession Number
619469955
Title
A Stopping Guideline for Pulmonary Heart Valve Premarket Approval Studies.
Source
Seminars in Thoracic and Cardiovascular Surgery. 30 (1) (pp 81-84), 2018.
Date of Publication: Spring 2018.
Author
Li H.-F.; Wu Y.; Wang M.; Grunkemeier G.L.
Institution
(Li, Wu, Wang, Grunkemeier) Medical Data Research Center, Providence
Health and Service, Portland, Oregon, United States
Publisher
W.B. Saunders

<6>
Accession Number
618567714
Title
Randomized Trial of Carnitine for the Prevention of Perioperative Atrial
Fibrillation.
Source
Seminars in Thoracic and Cardiovascular Surgery. 30 (1) (pp 7-13), 2018.
Date of Publication: Spring 2018.
Author
Dastan F.; Talasaz A.H.; Mojtahedzadeh M.; Karimi A.; Salehiomran A.; Bina
P.; Jalali A.
Institution
(Dastan) School of Pharmacy, ShahidBeheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Talasaz, Mojtahedzadeh) School of Pharmacy, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Karimi, Salehiomran, Bina, Jalali) Tehran Heart Center, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
W.B. Saunders
Abstract
Atrial fibrillation (AF) is one of the most common complications in
patients who undergo coronary artery bypass graft surgery (CABG). The aim
of this study was to evaluate the effect of L-carnitine administration on
postoperative AF and the levels of C-reactive protein (CRP) following
CABG. The effects of L-carnitine on the incidence of acute kidney injury
after CABG were also assessed. One hundred thirty-four patients undergoing
elective CABG, without a history of AF or previous L-carnitine treatment,
were randomly assigned to an L-carnitine group (3000 mg/d L-carnitine) or
a control group. CRP levels, as a biomarker of inflammation, were assessed
in all the patients before surgery as baseline levels and 48 hours
postoperatively. Neutrophil gelatinase-associated lipocalin, as a kidney
biomarker, was also measured in the patients before surgery and 2 hours
thereafter. The incidence of AF was 13.4% in our population. The incidence
of AF was decreased in the L-carnitine group (7.5% in the L-carnitine
group vs 19.4% in the control group; P = 0.043) and the postoperative CRP
level (8.79 +/- 6.9 in the L-carnitine group, and 10.83 +/- 5.7 in the
control group; P = 0.021). The postoperative neutrophil
gelatinase-associated lipocalin concentration demonstrated no significant
rise after surgery compared with the preoperative concentration (72.54 +/-
20.30 in the L-carnitine group vs 67.68 +/- 22.71 in the placebo group; P
= 0.19). Our study showed that L-carnitine administration before CABG
might inhibit and reduce the incidence of AF after CABG. It seems that a
rise in the CRP level, as an inflammation marker, may be associated with
the incidence of AF. Inflammation as measured by CRP was also reduced in
the carnitine group, compared with the control group.<br/>Copyright &#xa9;
2017 Elsevier Inc.

<7>
Accession Number
622577863
Title
Quality Measurement and Improvement Study of Surgical Coronary
Revascularization: Medication Adherence (MISSION-2).
Source
Chinese Medical Journal. 131 (12) (pp 1480-1489), 2018. Date of
Publication: 20 Jun 2018.
Author
Liu C.-Y.; Du J.-Z.; Rao C.-F.; Zhang H.; Liu H.-N.; Zhao Y.; Yang L.-M.;
Li X.; Li J.; Wang J.; Wang H.-S.; Liu Z.-G.; Cheng Z.-Y.; Zheng Z.
Institution
(Liu, Du, Rao, Zhang, Liu, Zhao, Li, Zheng) National Clinical Research
Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular
Disease, Fuwai Hospital, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences, Peking Union Medical College, 167
Beilishi Road, Beijing 100073, China
(Rao, Zhang, Liu, Yang, Li, Zheng) Department of Cardiovascular Surgery,
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese
Academy of Medical Sciences, Peking Union Medical College, Beijing 100073,
China
(Wang) Department of Thoracic and Cardiovascular Surgery, First Affiliated
Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
(Wang) Department of Cardiovascular Surgery, General Hospital of Shenyang
Military Region, Shenyang, Liaoning 110016, China
(Liu) Department of Cardiovascular Surgery, TEDA International
Cardiovascular Hospital, Peking Union Medical College, Chinese Academy of
Medical Science, Tianjin 300457, China
(Cheng) Department of Cardiovascular Surgery, Henan Provincial People's
Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan
450003, China
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Secondary preventive therapies play a key role in the
prevention of adverse outcomes after coronary artery bypass grafting
(CABG). However, medication adherence after CABG is often poor, and
conventional interventions for improving adherence have limited success.
With increasing penetration of smartphones, health-related smartphone
applications might provide an opportunity to improve adherence. Carefully
designed trials are needed to provide reliable evidence for the use of
these applications in patients after CABG. Methods: The Measurement and
Improvement Studies of Surgical Coronary Revascularization: Medication
Adherence (MISSION-2) study is a multicenter randomized controlled trial,
aiming to randomize 1000 CABG patients to the intervention or control
groups in a 1:1 ratio. We developed the multifaceted, patient-centered,
smartphone-based Heart Health Application to encourage medication
adherence in the intervention group through a health self-management
program initiated during hospital admission for CABG. The application
integrated daily scheduled reminders to take the discharge medications,
cardiac educational materials, a dynamic dashboard to review
cardiovascular risk factors and secondary prevention targets, and weekly
questionnaires with interactive feedback. The primary outcome was
secondary preventive medication adherence measured by the Chinese version
of the 8-item Morisky Medication Adherence Scale at 6 months after
randomization. Secondary outcomes included all-cause death, cardiovascular
rehospitalization, and a composite of death, myocardial infarction,
stroke, and repeat revascularization. Discussion: Findings will not only
provide evidence regarding the feasibility and effectiveness of the
described intervention for improving adherence to CABG secondary
preventive therapies but also explore a model for outpatient health
self-management that could be translated to various chronic diseases and
widely disseminated across resource-limited settings. Trial Registration:
https://clinicaltrials.gov (NCT02432469).<br/>Copyright &#xa9; 2018
Chinese Medical Journal. Produced by Wolters Kluwer Medknow.

<8>
Accession Number
2001108334
Title
Remote ischaemic conditioning for prevention of acute kidney injury after
valvular heart surgery: a randomised controlled trial.
Source
British Journal of Anaesthesia. 121 (5) (pp 1034-1040), 2018. Date of
Publication: November 2018.
Author
Song J.W.; Lee W.K.; Lee S.; Shim J.K.; Kim H.J.; Kwak Y.L.
Institution
(Song, Lee, Shim, Kim, Kwak) Department of Anaesthesiology and Pain
Medicine, Yonsei University College of Medicine, Seoul, South Korea
(Song, Shim, Kwak) Anaesthesia and Pain Research Institute, Yonsei
University College of Medicine, Seoul, South Korea
(Lee) Department of Cardiovascular Surgery, Yonsei University College of
Medicine, Seoul, South Korea
Publisher
Elsevier Ltd
Abstract
Background: Repeated remote ischaemic conditioning (RIC) during weaning
from cardiopulmonary bypass and in the early postoperative period may
confer protection against acute kidney injury (AKI). We evaluated the
effect of repeated RIC on the incidence of AKI in patients undergoing
valvular heart surgery. Methods: Patients were randomised into either the
RIC (n=120) or control (n=124) group. A pneumatic tourniquet was placed on
each patient's thigh. Upon removal of the aortic cross-clamp, three cycles
of inflation for 5 min at 250 mm Hg (with 5 min intervals) were applied in
the RIC group. Additionally, three cycles of RIC were repeated at
postoperative 12 and 24 h. AKI was diagnosed based on the Kidney Disease:
Improving Global Outcomes guideline. The incidences of renal replacement
therapy, permanent stroke, sternal wound infection, newly developed atrial
fibrillation, mechanical ventilation >24 h, and reoperation for bleeding
during hospitalisation were recorded. Results: The incidences of AKI were
not significantly different between the control (19.4%) and RIC (15.8%)
groups (a difference of 3.5 percentage points; 95% confidence interval:
-6.8%-13.9%; P=0.470). Perioperative serum creatinine concentrations were
similar in the control and RIC groups (P=0.494). Fluid balance, urine
output, blood loss, transfusion, and vasopressor/inotropic requirements
were not significantly different between the groups (all P>0.05). The
occurrences of a composite of morbidity and mortality endpoints were not
significantly different between the control (46.0%) and RIC (39.2%) groups
(a difference of 6.8 percentage points; 95% confidence interval:
-6.4%-20.0%; P=0.283). Conclusions: The results of our study do not
support repeated RIC to decrease the incidence of AKI after valvular heart
surgery. Clinical trial registration: NCT02720549.<br/>Copyright &#xa9;
2018 British Journal of Anaesthesia

<9>
Accession Number
2000542159
Title
Changes in resting pulmonary function testing over time after the Nuss
procedure: A systematic review and meta-analysis.
Source
Journal of Pediatric Surgery. 53 (11) (pp 2299-2306), 2018. Date of
Publication: November 2018.
Author
Wang Q.; Fan S.; Wu C.; Jin X.; Pan Z.; Hong D.
Institution
(Wang, Wu, Jin, Pan) Cardiothoracic surgery of hildren's Hospital of
Chongqing Medical University; Ministry of Education Key Laboratory of
Child Development and Disorders; China international Science and
Technology Cooperation base of Child development and Critical Disorders;
Chongqing Key Laboratory of Pediatrics, Chongqing, China
(Fan, Hong) Renal Division and Institute of Nephrology, Sichuan Academy of
Medical Science & Sichuan Provincial People's Hospital, School of
Medicine, University of Electronic Science and Technology of China,
Chengdu, China
(Hong) ChengduChina
Publisher
W.B. Saunders
Abstract
Background: Pectus excavatum, the most common congenital chest wall
deformity in pediatric patients, leads to pulmonary dysfunction. There is
no consensus regarding the effectiveness of the Nuss procedure for
recovering pulmonary function. In this meta- analysis, we focused on the
changes that occur in pulmonary function after the Nuss procedure.
Methods: We performed a literature search in the MEDLINE, Embase, Cochrane
library and PubMed databases. The included studies were required to
contain pulmonary function tests with results adjusted to predicted values
both before and after the Nuss procedure. The key outcomes of interest in
this analysis were pulmonary function measured as forced expiratory volume
in 1 s (FEV1) and forced vital capacity (FVC). Subgroup analyses were
performed based on time since surgery and the mean ages of the patients
when they underwent surgery by forest plots and meta-regressions. Results:
Thirteen studies involving 465 participants were included in this review.
The standard mean difference (SMD) observed in FEV1 and FVC after surgery
were 0.17 (95% CI, 0.01-0.33, p = 0.04) and - 0.18 (95% CI, - 0.41-0.06, p
= 0.14), respectively. The overall meta-regression SMD of FEV1 and FVC by
time since surgery were 1.21 (95% CI, 1.04-1.41, p = 0.020) and 1.38 (95%
CI, 1.05-1.83, p = 0.027), respectively. We found evidence of a temporal
relationship between time at which pulmonary function tests were performed
after surgery and predicted FEV1 and FVC values. The SMD of FEV1 (0.26, p
= 0.012) was slightly higher in group evaluated more than 2 year after
initial surgery. Conclusions: Abnormal resting pulmonary functions tests
performed prior to surgery showed an initial depression after surgery. The
FEV1 of patients slightly increased at 2 year post surgery compared with
the baseline. Further studies with longer term follow-up are still needed
to determine if pulmonary function could improve to normal after surgery.
Levels of Evidence: Level of evidence: 4 (based on lowest level of article
analyzed in meta-analysis/systematic review).<br/>Copyright &#xa9; 2018

<10>
Accession Number
623737388
Title
Donor derived Mycobacterium tuberculosis infection after solid-organ
transplantation: A comprehensive review.
Source
Transplant Infectious Disease. 20 (5) (no pagination), 2018. Article
Number: e12971. Date of Publication: October 2018.
Author
Abad C.L.R.; Razonable R.R.
Institution
(Abad) Section of Infectious Diseases, Department of Medicine, Philippine
General Hospital, University of the Philippines-Manila, Manila,
Philippines
(Razonable) Division of Infectious Diseases, Department of Medicine, The
William J Von Liebig Center for Transplantation and Clinical Regeneration,
Mayo Clinic College of Medicine and Sciences, Rochester, MN, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Mycobacterium tuberculosis may be transmitted via the
allograft to cause a morbid and potentially fatal infection after solid
organ transplantation (SOT). We reviewed all reported cases of
donor-derived tuberculosis (DDTB) to provide an update on its
epidemiology, clinical course, and outcome after SOT. Methods: MEDLINE,
OVID, and EMBASE were reviewed from its inception until December 31, 2016
using key words donor-derived infection, tuberculosis and solid organ
transplant or transplantation. Results: We retrieved 36 cases of proven (n
= 17), probable (n = 8), and possible (n = 11) DDTB among 16 lung, 13
kidney, 6 liver, and 1 heart recipients. Most patients were male (21/35,
60%) with median age of 48 (range 23-68) years. Median time to clinical
presentation or diagnosis was 2.7 months (range 0.2-29). The most common
donor risk factor was residence in a TB-endemic area (13/28, 46.4%). Fever
was the most frequent presenting symptom (20/36, 56.5%). Diagnosis of
tuberculosis was mostly made via AFB smear or mycobacterial culture
(30/36, 83.3%). Allograft involvement was expectedly common; there were
almost equal proportions of pulmonary (36%), extra-pulmonary (28%) and
disseminated (36%) cases. All cases of pulmonary TB were identified only
among lung transplant recipients. The median duration of TB treatment was
10.5 (range 3-24) months. Graft loss occurred in four (4/22, 18.2%)
patients. All-cause mortality was 25% (9/36); four of nine deaths were
attributed to TB. Conclusions: Donor-derived TB presents early after SOT,
most commonly as fever, and carries a high mortality risk. Donors should
be screened, with particular attention to TB risk factors. Fever during
the early post-operative period should prompt a thorough evaluation for
DDTB in endemic regions and among patients with "at-risk"
donors.<br/>Copyright &#xa9; 2018 John Wiley & Sons A/S. Published by John
Wiley & Sons Ltd

<11>
Accession Number
2001165939
Title
Association between transcatheter aortic valve implantation or replacement
and mortality, and major adverse events after coronary artery bypass
grafting.
Source
IJC Heart and Vasculature. 21 (pp 57-63), 2018. Date of Publication:
December 2018.
Author
Zheng Y.; Li T.
Institution
(Zheng) The Third Central Clinical College of Tianjin Medical University,
Tianjin 300170, China
(Li) The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong
District, Tianjin 300170, China
(Zheng, Li) Tianjin Key Laboratory of Artificial Cell, China
(Zheng, Li) Artificial Cell Engineering Technology Research Center of
Public Health Ministry, Tianjin, China
(Zheng, Li) Tianjin Institute of Hepatobiliary Disease, Tianjin, China
Publisher
Elsevier Ireland Ltd (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background: In recent years, many people are opting for minimally invasive
surgery in China. Patients undergoing transcatheter aortic valve
implantation or replacement (TAVIR) with previous coronary artery bypass
grafting (CABG) have higher risks of death and major complications.
Materials/methods: PubMed and Embase were searched for all comparison
studies between TAVIR with and without prior CABG and mortality as a
primary outcome, irrespective of surgical risk, to investigate whether
patients with prior CABG can undergo TAVIR. Randomized controlled trials
and propensity-score-matched cohort studies were eligible for inclusion.
The outcomes of interest included 30-day, 6-month, and 1-year mortality
and 30-day complications. If significant heterogeneity was found in the
random-effects meta-analyses, a sensitivity analysis that individually
removed each study was conducted. Results: Five studies reported results
on patients undergoing TAVIR with or without prior CABG. Compared with the
non-CABG cohort, the CABG cohort showed no significant difference in the
30-day, 6-month, and 1-year mortality and the 30-day risk of major
complications, except life-threatening bleeding. However, for the 30-day
risk of life-threatening bleeding, the morbidity of CABG cohort was
significantly lower than that of the non-CABG cohort (risk ratio 0.555;
95% confidence interval 0.35-0.85; P = 0.006; I² = 0%).
Conclusions: Patients with prior CABG can undergo TAVIR. Patients
undergoing TAVIR without prior CABG need more attention because of a
higher risk of life-threatening bleeding.<br/>Copyright &#xa9; 2018

<12>
Accession Number
624162936
Title
Physical Activity after Cardiac EventS (PACES) - A group education
programme with subsequent text-message support designed to increase
physical activity in individuals with diagnosed coronary heart disease:
Study protocol for a randomised controlled trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 537. Date of
Publication: 04 Oct 2018.
Author
Herring L.Y.; Dallosso H.; Chatterjee S.; Bodicoat D.; Schreder S.; Khunti
K.; Yates T.; Seidu S.; Hudson I.; Davies M.J.
Institution
(Herring, Dallosso, Schreder) Leicester Diabetes Centre, University
Hospitals of Leicester, Leicester General Hospital, Leicester LE5 4PR,
United Kingdom
(Chatterjee, Bodicoat, Khunti, Yates, Seidu, Davies) Diabetes Research
Centre, College of Medicine, Biological Sciences and Psychology,
University of Leicester, Leicester LE5 4PW, United Kingdom
(Khunti) NIHR Collaboration for Leadership in Applied Health Research and
Care - East Midlands, University of Leicester, Leicester, United Kingdom
(Yates, Davies) NIHR Leicester Biomedical Research Centre, University of
Leicester, Leicester, United Kingdom
(Hudson) Department of Cardiology, Glenfield Hospital, Leicester LE3 9QP,
United Kingdom
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Coronary heart disease (CHD) represents approximately 13% of
deaths worldwide and is the leading cause of death in the UK with
considerable associated health care costs. After a CHD event, timely
cardiac rehabilitation optimises patient outcomes. However, a high
percentage of these services do not meet necessary performance indicators
such as course length and follow-up attendance. Uptake of such services is
only 50% in UK patients and support provided 12 months after an event is
often limited. To delay and prevent further CHD events leading to
hospitalisation, supplementary self-management strategies such as group
education, are necessary. Methods: This is a single-centre, randomised
controlled trial (RCT) recruiting participants (n = 290) aged >=18 years
who are 12 to 48 months post diagnosis of a CHD-related cardiac event
(myocardial infarction, angina and any other acute coronary syndrome). The
study aims to implement a structured education programme, with
text-message support over 12 months, and identify whether delivery of the
programme, to individuals who have a history of a cardiac event, would be
an effective and cost-effective strategy for increasing walking. The
primary outcome, objectively measured average daily physical activity,
specifically step count through walking activity, is assessed using the
wrist-worn GENEActiv accelerometer at baseline, 6 and 12 months. Secondary
outcomes at 12 months include cardiovascular risk factors such as smoking
status, blood pressure, lipid profile, glycated haemoglobin (HbA1c),
obesity, self-efficacy, quality of life, physical activity and physical
function. Participants are randomised to either the control group
receiving standard care and a physical activity information leaflet, or
the intervention group whose partcipants receive the leaflet and are
invited to attend two group-based structured education sessions. These
encourage participants to adopt and maintain healthy behaviours and
self-manage their lifestyle. They are delivered approximately 2 weeks
apart by trained facilitators and reinforced via subsequent text-message
support. Discussion: To our knowledge, this is the first trial designed to
assess the effectiveness of a group education programme 12 to 48 months
after a CHD event diagnosis. If successful, the PACES programme could be
translated into effective post-operative cardiac care and complement the
current post-operative services available. Trial registration: ISRCTN, ID:
ISRCTN91163727. The trial was registered on 27 February
2017.<br/>Copyright &#xa9; 2018 The Author(s).

<13>
Accession Number
624138201
Title
Six months versus 12 months dual antiplatelet therapy after drug-eluting
stent implantation in ST-elevation myocardial infarction (DAPT-STEMI):
Randomised, multicentre, non-inferiority trial.
Source
BMJ (Online). 363 (no pagination), 2018. Article Number: k3793. Date of
Publication: 2018.
Author
Kedhi E.; Fabris E.; Van Der Ent M.; Buszman P.; Von Birgelen C.; Roolvink
V.; Zurakowski A.; Schotborgh C.E.; Hoorntje J.C.A.; Eek C.H.; Cook S.;
Togni M.; Meuwissen M.; Van Royen N.; Van Vliet R.; Wedel H.; Delewi R.;
Zijlstra F.
Institution
(Kedhi, Fabris, Roolvink) Isala Hartcentrum, Isala Klinieken, Zwolle,
Netherlands
(Fabris) Cardiovascular Department, University of Trieste, Trieste, Italy
(Van Der Ent, Van Vliet) Maasstad Ziekenhuis, Rotterdam, Netherlands
(Buszman) American Heart of Poland, Ustro, Poland
(Buszman) Medical University of Silesia, Katowice, Poland
(Von Birgelen, Zijlstra) Thoraxcenter, Erasmus Medisch Centrum, Rotterdam,
Netherlands
(Von Birgelen) University of Twente, Enschede, Netherlands
(Zurakowski) American Heart of Poland, Chrzanow, Poland
(Schotborgh) Haga Hospital, The Hague, Netherlands
(Hoorntje) Zuyderland Medical Centre, Heerlen, Netherlands
(Eek) Department of Cardiology, Oslo Academic University, Oslo, Norway
(Cook, Togni) Department of Cardiology, University and Hospital, Fribourg,
Switzerland
(Meuwissen) Department of Cardiology, Amphia Hospital, Breda, Netherlands
(Van Royen) Department of Cardiology, Radboud University Medical Centre,
Nijmegen, Netherlands
(Wedel) Sahlgrenska Academy, University of Gothenburg, Nordic School of
Public Health, Gothenburg, Sweden
(Delewi) Heart Centre, Academic Medical Centre, University of Amsterdam,
Amsterdam, Netherlands
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To show that limiting dual antiplatelet therapy (DAPT) to six
months in patients with event-free ST-elevation myocardial infarction
(STEMI) results in a non-inferior clinical outcome versus DAPT for 12
months. Design Prospective, randomised, multicentre, non-inferiority
trial. Setting Patients with STEMI treated with primary percutaneous
coronary intervention (PCI) and second generation zotarolimus-eluting
stent. Participants Patients with STEMI aged 18 to 85 that underwent a
primary PCI with the implantation of second generation drug-eluting stents
were enrolled in the trial. Patients that were event-free at six months
after primary PCI were randomised at this time point. Interventions
Patients that were taking DAPT and were event-free at six months were
randomised 1:1 to single antiplatelet therapy (SAPT) (ie, aspirin only) or
to DAPT for an additional six months. All patients that were randomised
were then followed for another 18 months (ie, 24 months after the primary
PCI). Main outcome measures The primary endpoint was a composite of all
cause mortality, any myocardial infarction, any revascularisation, stroke,
and thrombolysis in myocardial infarction major bleeding at 18 months
after randomisation. Results A total of 1100 patients were enrolled in the
trial between 19 December 2011 and 30 June 2015. 870 were randomised: 432
to SAPT versus 438 to DAPT. The primary endpoint occurred in 4.8% of
patients receiving SAPT versus 6.6% of patients receiving DAPT (hazard
ratio 0.73, 95% confidence interval 0.41 to 1.27, P=0.26). Non-inferiority
was met (P=0.004 for non-inferiority), as the upper 95% confidence
interval of 1.27 was smaller than the prespecified non-inferiority margin
of 1.66. Conclusions DAPT to six months was non-inferior to DAPT for 12
months in patients with event-free STEMI at six months after primary PCI
with second generation drug-eluting stents. Trial registration
Clinicaltrials.gov NCT01459627.<br/>Copyright &#xa9; Published by the BMJ
Publishing Group Limited. For permission to use (where not already granted
under a licence) please go to.

<14>
Accession Number
622796742
Title
Subannular reconstruction in secondary mitral regurgitation: A
meta-analysis.
Source
Heart. 104 (21) (no pagination), 2018. Date of Publication: 01 Nov 2018.
Author
Harmel E.K.; Reichenspurner H.; Girdauskas E.
Institution
(Harmel, Reichenspurner, Girdauskas) Department of Cardiothoracic Surgery,
University Heart Center Hamburg, Hamburg 20251, Germany
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: Mitral valve repair using an undersized complete annuloplasty
ring in secondary mitral regurgitation with restricted leaflet motion
during systole (Carpentier's surgical classification of mitral valve
pathology: type IIIb) only inadequately addresses the underlying left
ventricular disease. This may lead to an ongoing ventricular remodelling
and progressive papillary muscle displacement with increasing leaflet
tethering. Several subannular techniques have been proposed to counteract
the reoccurrence of mitral regurgitation after mitral valve repair. We
aimed to evaluate the potential additive effect of such subannular
techniques on the late reoccurrence rate of secondary mitral
regurgitation. Methods: Systematic literature review and meta-analysis
were performed on PubMed, Embase and Google Scholar for studies published
up to March 2016 and reporting late reoccurrence of mitral regurgitation
after mitral valve repair using standard annuloplasty (control group)
versus annuloplasty with subannular correction (study group) cohorts.
Primary endpoint was late reoccurrence of mitral regurgitation >=2 after
surgical mitral valve repair, as defined by follow-up echocardiography.
Results: The cumulative number of 1093 patients in 12 included studies
served as our study population. A total of 743 patients underwent combined
mitral valve repair including annuloplasty and subannular manoeuvre (ie,
study group), while the remaining 350 patients underwent an isolated ring
annuloplasty (ie, control group). Secondary mitral regurgitation was
caused by ischaemic heart disease in 733/743 patients in the study group
and 334/350 patients in the control group. Mean echocardiographic
follow-up was 42.7+/-13.9 months. Pooled outcome analysis demonstrated
that the combination of subannular repair with ring annuloplasty was
associated with a significantly lower reoccurrence rate of mitral
regurgitation >=2 as compared with annuloplasty alone (OR 0.27, 95% CI
0.19 to 0.38, P=0.0001). Conclusion: The combination of subannular
reconstruction and mitral valve annuloplasty is associated with a lower
late reoccurrence of mitral regurgitation after surgical mitral valve
repair, as compared with annuloplasty alone.<br/>Copyright &#xa9; Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2018. All rights reserved. No commercial use is permitted unless
otherwise expressly granted.

<15>
Accession Number
624281682
Title
Asymptomatic Severe Aortic Valve Stenosis-When to Intervene: a Review of
the Literature, Current Trials, and Guidelines.
Source
Current Cardiology Reports. 20 (12) (no pagination), 2018. Article Number:
129. Date of Publication: 01 Dec 2018.
Author
Pineda A.M.; Kiefer T.L.
Institution
(Pineda) Division of Cardiology - ACC Building 5th floor, University of
Florida College of Medicine - Jacksonville, 655 West 8th Street,
Jacksonville, FL 32209, United States
(Kiefer) Division of Cardiology, Duke University Hospital, Durham, NC,
United States
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: The optimal treatment for asymptomatic patients with
severe aortic valve stenosis (AS) is not clearly known. Here, we review
the available data on the management of such patients. Recent Findings:
Half of patients with severe AS are asymptomatic at the time of diagnosis,
and are at risk for adverse events, including sudden cardiac death. A
significant proportion of these patients develop AS-related symptoms
within 1 or 2 years. Clinical and echocardiographic characteristics are
predictors of poor outcomes and can guide treatment decisions. Several
non-randomized studies and meta-analyses have suggested benefit from early
AVR for asymptomatic severe AS, including improved all-cause,
cardiovascular, and valve-related mortality. Based on the available
information, current guidelines suggest aortic valve replacement in the
presence of specific characteristic, including left ventricular
dysfunction and very severe AS with significantly elevated gradients.
Summary: Although the available data suggests early AVR improves the
clinical outcomes of these patients, most patients in current practice are
managed conservatively. Six randomized trials are ongoing to better
elucidate the ideal management of asymptomatic severe AS
patients.<br/>Copyright &#xa9; 2018, Springer Science+Business Media, LLC,
part of Springer Nature.

<16>
Accession Number
624279160
Title
Effect of Shenmai injection on cognitive function after cardiopulmonary
bypass in cardiac surgical patients: A randomized controlled trial.
Source
BMC Anesthesiology. 18 (1) (no pagination), 2018. Article Number: 142.
Date of Publication: 11 Oct 2018.
Author
Chen L.; Wang L.; Zhuo Q.; Zhang Q.; Chen F.; Li L.; Lin L.
Institution
(Chen, Wang, Zhang, Chen, Li, Lin) Department of Anesthesiology, First
Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang
Province, China
(Zhuo) Wenzhou People's Hospital, Wenzhou, Zhejiang Province, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative cognitive dysfunction (POCD) is a common
complication after cardiac surgery that influences the clinical outcomes
and quality of life of patients. This study aimed to evaluate the effects
of Shenmai injection (SMI) on POCD of patients who underwent cardiac valve
replacement under cardiopulmonary bypass (CPB). Methods: This prospective,
randomized, controlled trial was conducted from September 2014 to January
2017. Eighty-eight patients receiving cardiac valve replacement under CPB
were randomized into the control (C) or the SMI (S) group. SMI (0.6 mL/kg)
was administered intravenously from the time of anesthesia induction to
the beginning of CPB. Cognitive function was assessed at 3 days before
surgery and 3 days, 7 days, and 1 month after surgery using the Beijing
version of the Montreal Cognitive Assessment (MoCA-BJ) score. The serum
levels of neuroglobin (Ngb), hypoxia-inducible factor-1alpha (HIF-1alpha),
and neuron-specific enolase (NSE) were measured at 30 min after induction
(T<inf>0</inf>), immediately after the endonasal temperature rewarmed to
36 degreeC (T<inf>1</inf>), and 1 h (T<inf>2</inf>), 6 h (T<inf>3</inf>),
24 h (T<inf>4</inf>), 48 h (T<inf>5</inf>), and 72 h (T<inf>6</inf>) after
CPB. Results: Compared with the baseline values at T<inf>0</inf>, the
serum Ngb levels in group C were significantly decreased at
T<inf>1-2</inf> and then increased at T<inf>3-6</inf>, while the levels in
group S were decreased at T<inf>1-2</inf> and increased at
T<inf>4-6</inf>, compared to group C (p < 0.05). The serum HIF-1alpha
levels at T<inf>1-4</inf> and the serum NSE levels at T<inf>1-6</inf> were
significantly increased in both groups (p < 0.05). The serum levels of Ngb
at T<inf>3</inf>, HIF-1alpha at T<inf>1-3</inf>, and NSE at
T<inf>3-4,6</inf> were lower in group S, compared to group C (p < 0.01).
The MoCA-BJ scores were decreased at 3 and 7 days after surgery in both
groups, and the MoCA-BJ scores in group S were higher than those in group
C at 3 and 7 days after surgery (p < 0.01). Conclusion: Cognitive function
is impaired postoperatively in patients who have undergone cardiac valve
replacement under CPB. In addition, treatment with the traditional Chinese
medicine SMI decreases the serum levels of Ngb, HIF-1alpha, and NSE as
well as attenuates cognitive dysfunction. Trial registration: This trial
was registered with Clinicaltrials.gov as ChiCTR-TRC-14004373 on March 11,
2014.<br/>Copyright &#xa9; 2018 The Author(s).

<17>
Accession Number
623717234
Title
Computed tomography-guided pericardiocentesis: a systematic review
concerning contemporary evidence and future perspectives.
Source
Therapeutic Advances in Cardiovascular Disease. (no pagination), 2018.
Date of Publication: 2018.
Author
Vilela E.M.; Ruivo C.; Guerreiro C.E.; Silva M.P.; Ladeiras-Lopes R.;
Caeiro D.; Morais G.P.; Primo J.; Braga P.; Ferreira N.; Nunes J.P.L.;
Ribeiro V.G.
Institution
(Vilela) Cardiology Department, Vila Nova de Gaia / Espinho Hospital
Center EPE, Rua Conceicao Fernandes, Vila Nova de Gaia 4434-520, Portugal
(Ruivo) Leiria Hospital Center, Leiria, Portugal
(Guerreiro, Silva, Ladeiras-Lopes, Caeiro, Morais, Primo, Braga, Ferreira,
Ribeiro) Cardiology Department, Vila Nova de Gaia / Espinho Hospital
Center, Gaia, Portugal
(Nunes) Sao Joao Hospital Center, Porto, Portugal
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Pericardial effusion (PE) can develop in several pathological
scenarios, and is often initially evaluated by means of echocardiography.
Computed tomography (CT) has been used as an aid in the management of
patients presenting with PE, in selected cases. The role of CT-guided
pericardiocentesis in contemporary practice, however, remains not fully
ascertained. We aimed at presenting a systematic review concerning the
state-of-the-art of this technique. Methods: A systematic review of
published data on the use of CT for guiding pericardiocentesis was carried
out (search performed on PubMed, ISI Web of Knowledge and Scopus
databases). Results: From title and abstract analysis, 14 articles were
included that met the prespecified criteria. After full-text analysis, six
articles were excluded. The eight articles under analysis included a total
of 635 procedures performed in 571 patients. CT guidance was mostly used
in a postoperative setting (364 procedures). Most procedures were done
mainly for therapeutic purposes (528 procedures). Success rates ranged
from 94% to 100%. Complications ranged from 0% to 7.8%. Conclusion:
CT-guided pericardiocentesis is a useful technique in the approach to PE,
in several clinical scenarios. Its use can be especially relevant in the
postoperative period, as well as in individuals with suboptimal image
quality (as assessed by echocardiography, for the moment the first choice
in the approach to most cases of PE).<br/>Copyright &#xa9; The Author(s),
2018.

<18>
Accession Number
624186268
Title
The effects of perioperative angiotensin converting enzyme inhibitors and
angiotensin receptor blockers on acute kidney injury in major elective
non-cardiac surgery. A multicentre, prospective cohort study.
Source
Colorectal Disease. Conference: 13th Scientific and Annual Meeting of the
European Society of Coloproctology. France. 20 (Supplement 4) (pp 79),
2018. Date of Publication: September 2018.
Author
Anonymous
Publisher
Blackwell Publishing Ltd
Abstract
Aim: This study aimed to investigate if withholding angiotensin converting
enzyme inhibitors or angiotensin receptor blockers (ACEi/ARBs)
perioperatively reduces the risk of postoperative acute kidney injury
(AKI). Method: Consecutive patients undergoing elective major
gastrointestinal or liver surgery were included. The primary outcome was
AKI within 7 days of index operation. Mortality at thirty postoperative
days was also assessed. Adjusted multilevel models were used to account
for centre level effects and propensity score matching was used to reduce
the effects of selection bias between treatment groups. Results: A total
of 963 patients were prospectively included across 160 centres, of whom
579 had ACEi/ARB withheld perioperatively. The AKI rate was 18.1%; there
was no difference between patients who had their ACEi/ARB continued or
withheld (17.7% versus 18.5%). After adjusting for confounding factors,
withholding ACEi/ARB did not reduce the risk of AKI (OR = 0.99, 95%CI =
0.69-1.40, P = 0.935) or death (OR = 1.15, 95%CI = 0.33-4.00, P = 0.825).
Following propensity matching, withholding ACEi/ARB did not demonstrate a
protective effect against AKI (OR = 1.16, 95%CI = 0.79-1.71, P = 0.458).
Conclusion: Withholding ACEi/ARB perioperatively did not reduce the odds
of sustaining AKI. Large, randomised trials are required to definitively
evaluate whether perioperative ACEi/ARB administration affects the
development of AKI.

<19>
Accession Number
624325918
Title
Effect of a training program on satisfaction of caregivers of patients
with coronary artery bypass graft.
Source
Journal of Mazandaran University of Medical Sciences. 28 (165) (pp 87-97),
2018. Date of Publication: October 2018.
Author
Shoushi F.; Shafipour V.; Mousavinasab S.N.; Jannati Y.
Institution
(Shoushi) Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Shafipour) Department of Medical-Surgical Nursing, Nasibeh Faculty of
Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari,
Iran, Islamic Republic of
(Mousavinasab) Department of Biostatistics, Faculty of Health, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Jannati) Psychiatry and Behavioral Sciences Research Center, Addiction
Institute, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
Publisher
Mazandaran University of Medical Sciences (E-mail: jmums@mazums.ac.ir)
Abstract
Background and purpose: Satisfaction of caregivers of hospitalized
patients is one of the pillars of good quality in patient care. Providing
appropriate trainings on this issue could lead to improvements in patient
recovery. The present study was conducted to investigate the effects of a
training program on satisfaction of caregivers of patients who had
Coronary Artery Bypass Grafting. Materials and methods: An interventional
study was done in 69 caregivers of hospitalized patients in intensive care
unit in Sari Fatemeh Zahra Hospital. The samples were randomly allocated
into intervention and control groups. In the intervention group, the
caregivers of the hospitalized patients alongside routine information
received training starting one day before their patient's surgery until 24
hr before discharge. The Family Satisfaction in the Intensive Care Unit
(FSICU) was administered to measure the satisfaction of caregivers in both
groups, 24 hr before discharge. Data were analyzed using Mann-Whitney,
Independent t-test, and Chi-square. Results: Compared to the control
group, a significant difference was found between the mean score for
satisfaction in intervention group after the training program
(58.3+/-11.56 vs. 81.28+/-6.08), (P<0.001). Caregivers reported highest
level of satisfaction with medical personnel performance and the lowest
with making decisions about patients. Conclusion: According to the
findings, nurses can increase caregivers' satisfaction from nursing care
by providing them with training programs and improve patient care after
heart surgery.<br/>Copyright &#xa9; 2018, Mazandaran University of Medical
Sciences. All rights reserved.

<20>
Accession Number
624341231
Title
Synchronous or Staged Carotid Endarterectomy and Coronary Artery Bypass
Grafting? Propensity score matched study.
Source
The heart surgery forum. 21 (5) (pp E359-E364), 2018. Date of Publication:
17 Aug 2018.
Author
Hempe S.; Moza A.; Goetzenich A.; Tewarie L.; Bleilevens C.; Autschbach
R.; Schnoering H.; Zayat R.
Institution
(Hempe) Department of Thoracic and Cardiovascular Surgery, University
Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: The optimal treatment strategy in patients presenting with
hemodynamically significant carotid artery disease who are to undergo
cardiac surgery, remains controversial. In this study, we retrospectively
analyzed the outcome data of patients receiving synchronous or staged
coronary artery bypass graft (CABG) surgery and carotid endarterectomy
(CEA).
METHODS: Between 2011 and 2016, 3173 patients underwent CABG surgery in
our institution, of whom 323 received CABG and CEA either as synchronous
(N = 307) or as staged (N = 16) procedures. Patients' characteristics,
peri- and postoperative data were collected from our digital medical
database. Propensity score matching was used to match each patient from
the staged group to two appropriate patients (1:2 matching) from the
synchronous group (synchronousmatched).
RESULTS: The overall incidence of ischemic stroke (IS) and transitory
ischemic attack (TIA) was 4.9% and 5.6%, respectively. No hemorrhagic
stroke was noted in both groups. Incidence of IS did not differ
significantly between matched groups (P = 1.000). Significantly higher
rates of postoperative neurological complications, such as TIA and
delirium, were found in the synchronousmatched group (P = .041 and P =
.043, respectively) compared with the staged group. Additionally, there
were more postoperative respiratory insufficiencies in the
synchronousmatched group (P = .043). Thirty days mortality did not differ
significantly between the matched groups.
CONCLUSION: In this experience combined with the data given in literature,
our findings suggest a possible superiority of the staged CABG/CEA
approach. Large, randomized studies are required to verify our findings
and to establish applicable guidelines.

<21>
Accession Number
624234432
Title
Lung protection strategies during cardiopulmonary bypass affect the
composition of bronchoalveolar fluid and lung tissue in cardiac surgery
patients.
Source
Metabolites. 8 (4) (no pagination), 2018. Article Number: 54. Date of
Publication: December 2018.
Author
Maltesen R.G.; Buggeskov K.B.; Andersen C.B.; Plovsing R.; Wimmer R.; Ravn
H.B.; Rasmussen B.S.
Institution
(Maltesen, Rasmussen) Department of Anesthesia and Intensive Care
Medicine, Aalborg University Hospital, Aalborg 9000, Denmark
(Buggeskov, Ravn) Department of Cardiothoracic Anesthesia, Heart Centre,
Rigshospitalet, Copenhagen 2100, Denmark
(Andersen) Department of Forensic Medicine, University of Copenhagen,
Copenhagen 2100, Denmark
(Plovsing) Department of Intensive Care, Rigshospitalet, University of
Copenhagen, Copenhagen 2100, Denmark
(Plovsing) Department of Anesthesiology, Hvidovre Hospital, University of
Copenhagen, Hvidovre 2650, Denmark
(Wimmer) Department of Chemistry and Bioscience, Aalborg University,
Aalborg 9220, Denmark
(Rasmussen) Department of Clinical Medicine, School of Medicine and
Health, Aalborg University, Aalborg 9220, Denmark
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Pulmonary dysfunction is among the most frequent complications to cardiac
surgeries. Exposure of blood to the cardiopulmonary bypass (CPB) circuit
with subsequent lung ischemia-reperfusion leads to the production of
inflammatory mediators and increases in microvascular permeability. The
study aimed to elucidate histological, cellular, and metabolite changes
following two lung protective regimens during CPB with
Histidine-Tryptophan-Ketoglutarate (HTK) enriched or warm oxygenated blood
pulmonary perfusion compared to standard regimen with no pulmonary
perfusion. A total of 90 patients undergoing CPB were randomized to
receiving HTK, oxygenated blood or standard regimen. Of these,
bronchoalveolar lavage fluid (BALF) and lung tissue biopsies were obtained
before and after CPB from 47 and 25 patients, respectively.
Histopathological scores, BALF cell counts and metabolite screening were
assessed. Multivariate and univariate analyses were performed. Profound
histological, cellular, and metabolic changes were identified in all
patients after CPB. Histological and cellular changes were similar in the
three groups; however, some metabolite profiles were different in the HTK
patients. While all patients presented an increase in inflammatory cells,
metabolic acidosis, protease activity and oxidative stress, HTK patients
seemed to be protected against severe acidosis, excessive fatty acid
oxidation, and inflammation during ischemia-reperfusion. Additional
studies are needed to confirm these findings.<br/>Copyright &#xa9; 2018 by
the authors.

<22>
Accession Number
624327165
Title
A meta-analysis of valve-in-valve and valve-in-ring transcatheter mitral
valve implantation.
Source
Journal of Interventional Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Author
Takagi H.; Hari Y.; Kawai N.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
Japan
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: We performed a meta-analysis of transcatheter mitral valve
implantation (TMVI) for deteriorated bioprosthetic valves (valve-in-valve
[VIV]-TMVI) and/or failed annuloplasty rings (valve-in-ring [VIR]-TMVI),
comparing observed early (30-day) mortality with predicted operative
mortality. Background: It remains unclear whether VIV/VIR-TMVI reduces
mortality as compared with redo MVS. Methods: MEDLINE and EMBASE were
searched current through 24 July 2018 using Web-based search engines
(PubMed and OVID) to identify studies including >=10 patients undergoing
VIV/VIR-TMVI. For each study, data regarding observed 30-day mortality and
predicted operative mortality (Society of Thoracic Surgeons Predicted Risk
of Mortality [STS-PROM]) were used to generate risk ratios (RRs) and 95%
confidence intervals (CIs). Study-specific estimates were combined using
the inverse variance-weighted average of logarithmic RRs in the
random-effects model. One-group meta-analyses of 30-day/late (including
30-day) mortality rates were also performed in the random-effects model.
Results: Of 270 potentially relevant articles screened initially, 17
eligible studies including a total of 1017 patients undergoing
VIV/VIR-TMVI were identified. In all but four studies, the STS-PROM was
available and varied from 7.7% to 22.0% (weighted mean, 11.5%). Pooled
analyses of all VIV/VIR-TMVI studies demonstrated the 30-day mortality
rate of 5.4% (95%CI, 4.0-6.8%), the midterm (1- to 5-year) mortality rate
of 13.7% (95%CI, 9.0-18.5%), and significantly lower observed 30-day
mortality than predicted operative mortality (RR, 0.67; 95%CI, 0.49-0.91;
P = 0.01). Conclusions: VIV/VIR-TMVI brought about relatively low early
and midterm (1- to 5-year) mortality, and observed 30-day mortality was
significantly lower than predicted operative mortality.<br/>Copyright
&#xa9; 2018, Wiley Periodicals, Inc.

<23>
Accession Number
624327081
Title
Cognitive Outcomes After Heart Valve Surgery: A Systematic Review and
Meta-Analysis.
Source
Journal of the American Geriatrics Society. (no pagination), 2018. Date of
Publication: 2018.
Author
Oldham M.A.; Vachon J.; Yuh D.; Lee H.B.
Institution
(Oldham, Lee) Department of Psychiatry, University of Rochester Medical
Center, Rochester, NY, United States
(Vachon) Oncology Department, Ingram School of Nursing, McGill University,
Montreal, QC, Canada
(Yuh) Department of Surgery, Stamford Hospital, Stamford, CT, United
States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To summarize evidence on cognitive outcomes after heart valve
surgery; secondary aim, to examine whether aortic and mitral valve surgery
are associated with different cognitive outcomes. Design: Preferred
Reporting Items for Systematic Reviews and Meta-Analyses systematic review
and meta-analysis. Setting: Cardiac surgery. Participants: Individuals
undergoing heart valve surgery. Measurements: We searched MEDLINE, EMBASE,
and PsycINFO for peer-reviewed reports of individuals undergoing heart
valve surgery who underwent pre- and postoperative cognitive assessment.
Our initial search returned 1,475 articles, of which 12 were included.
Postoperative cognitive results were divided into those from 1 week to 1
month (early outcomes, n<inf>pooled</inf> = 450) and from 2 to 6 months
(intermediate outcomes; n<inf>pooled</inf> = 722). No studies with
longer-term outcomes were identified. Results: Subjects had moderate early
cognitive decline from baseline (Becker mean gain effect size (ES)=-0.39
+/- 0.27) that improved slightly by 2 to 6 months (ES=-0.25 +/- 0.38).
Individuals undergoing aortic valve surgery-who were older on average than
those undergoing mitral valve surgery (68 vs 57)-had greater early
cognitive decline than those undergoing mitral valve surgery (ES=-0.68 vs
-0.12), but both cohorts had similar decline 2 to 6 months postoperatively
(ES=-0.27 vs -0.20). Conclusions: Heart valve surgery is associated with
cognitive decline over the 6 months after surgery, but outcomes beyond 6
months are unclear. These findings highlight the cognitive vulnerability
of this population, especially older adults with aortic stenosis. &#xa9;
2018 American Geriatrics Society and Wiley Periodicals, Inc.<br/>&#xa9;
2018, Copyright the Author Journal compilation &#xa9; 2018, The American
Geriatrics Society

<24>
Accession Number
624326601
Title
Rivaroxaban versus Warfarin in Patients with Mechanical Heart Valve:
Rationale and Design of the RIWA Study.
Source
Drugs in R and D. (no pagination), 2018. Date of Publication: 2018.
Author
Duraes A.R.; de Souza Lima Bitar Y.; Filho J.A.L.; Schonhofen I.S.; Camara
E.J.N.; Roever L.; Cardoso H.E.D.P.; Akrami K.M.
Institution
(Duraes, Filho, Schonhofen, Cardoso) General Hospital Roberto Santos,
Salvador, Bahia, Brazil
(Duraes, de Souza Lima Bitar, Camara) Federal University of Bahia, Medical
School-UFBA/FAMEB, XV de novembro Square, s/n-Largo do Terreiro de Jesus,
Salvador, BA 40025-010, Brazil
(Roever) Federal University of Uberlandia, Uberlandia, Minas Gerais,
Brazil
(Akrami) Division of Infectious Disease, Department of Medicine,
University of California, San Diego, San Diego, CA, United States
Publisher
Springer International Publishing
Abstract
Introduction: Mechanical heart valves (MHV) are extremely durable, but
they require permanent use of anticoagulation to prevent thromboembolic
events. The only approved therapeutic options are vitamin K antagonists
(VKAs), such as warfarin. As a drug class, clinical management is
difficult, therefore new alternatives need to be evaluated. Methods: RIWA
is a phase II/III, prospective, open-label, randomized, pilot study
designed to investigate oral rivaroxaban 15 mg twice daily compared with
dose-adjusted warfarin for the prevention of stroke (ischemic or
hemorrhagic) and systemic embolism in patients with MHV, from August 2018
to December 2019. Patients will undergo transesophageal echocardiography
at the beginning and the end of the study (follow-up time 90 days). On an
explanatory basis, all events will be analyzed, including stroke,
peripheral systemic embolism, valve thrombosis, significant bleeding and
death. Discussion: Warfarin and similar VKAs are standard therapy for
patients with an MHV. Even with the appropriate use of therapy, the
incidence of thromboembolic events is high at 1-4% per year. Furthermore,
bleeding risk is significant, ranging from 2 to 9% per year. The new
frontier to be overcome in relation to use of the new oral anticoagulants
is undoubtedly in patients with MHV. A significant portion of people with
MHV worldwide will benefit if noninferiority of these new agents is
confirmed. Trial Registration: ClinicalTrials.gov identifier: NCT03566303.
Recruitment Status: Recruiting. First Posted: 25 June 2018. Last Update
Posted: 25 June 2018.<br/>Copyright &#xa9; 2018, The Author(s).

<25>
Accession Number
623937687
Title
The efficacy and safety of dexmedetomidine in cardiac surgery patients: A
systematic review and meta-analysis.
Source
PLoS ONE. 13 (9) (no pagination), 2018. Article Number: e0202620. Date of
Publication: September 2018.
Author
Wang G.; Niu J.; Li Z.; Lv H.; Cai H.
Institution
(Wang, Niu, Li, Lv, Cai) Department of Surgical Intensive Care Unit, First
Affiliated Hospital, Medical College, Zhejiang University, Hangzhou,
Zhejiang, China
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
This study aimed to evaluate the efficacy and safety of dexmedetomidine
versus any other treatment without dexmedetomidine in patients who have
undergone cardiac surgery. Electronic databases including PubMed, Embase,
and Cochrane Library were systematically searched without limitations of
language and publication time. Randomized controlled trials (RCTs) aiming
to evaluate the efficacy and safety of dexmedetomidine versus any other
treatment without dexmedetomidine in patients that have undergone cardiac
surgery were selected. Endpoints such as hemodynamic indexes and adverse
events in eligible studies were extracted by two researchers,
independently. The data was analyzed using RevMan 5.3 and Stata 11.0
software. A total of 18 RCTs met the inclusion criteria, involving 1730
patients. Compared to control (any treatment without dexmedetomidine),
dexmedetomidine showed a pooled mean difference (MD) of -14.46 [95%
confidence interval(CI): -24.69, -4.23; p<0.01] for systolic arterial
pressure, a standardized mean difference (SMD) of -1.74 for mean arterial
blood pressure (95% CI: -2.80, -0.68; P < 0.01), -2.12 (95%CI: -3.23,
-1.00; p<0.01) for heart rate, and combined odds ratio (OR) of 0.22
(95%CI: 0.11, 0.44; p<0.01) for tachycardia, 3.44 (95%CI: 1.95, 5.96;
p<0.01) for bradycardia, 0.74 (95%CI: 0.49, 1.12; p>0.05) for atrial
fibrillation, and 0.99 (95%CI: 0.51, 1.90; p>0.05) for hypotension. In
addition, dexmedetomidine could reduce time of surgery and stay in
intensive care units, improve delirium with good safety. Our study shows
clinical application of dexmedetomidine in cardiac surgery patients can
reduce risks of abnormal hemodynamics with good safety.<br/>Copyright
&#xa9; 2018 Wang et al. This is an open access article distributed under
the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.

<26>
Accession Number
2001003305
Title
The efficacy of a novel peristaltic feeding tube (PFT) in reducing reflux
and aspiration of gastric contents in mechanically ventilated patients.
Source
Clinical Nutrition Experimental. 21 (pp 1-8), 2018. Date of Publication:
October 2018.
Author
Biderman P.; van Heerden P.V.; Avitzur Y.; Iakobishvili Z.; Singer P.
Institution
(Biderman) Intensive Care Unit, Assuta Medical Center, Ashdod, Israel
(van Heerden) General Intensive Care Unit, Hadassah Medical Center,
Jerusalem, Israel
(Avitzur) Intestinal Rehabilitation and Transplantation, Division of
Gastroenterology Hepatology and Nutrition, Hospital for Sick Kids,
Toronto, Canada
(Iakobishvili) Department of Community Cardiology, Clalit Health Services,
Tel Aviv District, Israel
(Singer) General Intensive Care Unit, Rabin Medical Center, Petah Tikvah,
Israel
Publisher
Elsevier Ltd
Abstract
Gastro-esophageal reflux (GER) is common in ventilated patients and is a
cause of ventilator associated pneumonia (VAP). The novel persistaltic
feeding tube (PFT) uses simulated peristalsis to seal the esophagus to
fluid moving in a retrograde manner, whilst allowing normal drainage of
fluid and secretions moving in an ante-grade manner. This study describes
the first trial of the PFT in ventilated patients. Methods: There were 10
subjects in the treatment (PFT) group and 10 patients in the control
group, who had all undergone elective cardiac surgery and were ventilated
in the intensive care unit (ICU) afterwards. The PFT was placed on
admission to the ICU. In the control group a standard nasogastric tube
(NGT) was inserted. Specimens were collected by suctioning from the
oropharynx and from above the tracheal tube balloon every hour and from
the trachea twice per 8 h shift. Samples were analyzed by ELISA for Pepsin
A, as a marker for secretions of gastric origin. Esophageal pressure
monitoring (as a measure of pleural pressure), which is an intrinsic
ability of the PFT device, was also noted throughout the study - for
future integration in mechanical ventilation strategies. Results: The two
groups were comparable with regard to demographics and duration of
ventilation. There was a larger number of specimens positive for Pepsin A
in the control group in the oropharynx (p < 0.0001) and above the ETT cuff
(p = 0.0001), but not in the trachea (p = 0.0603), using the Wald
Chi-squared test. However, when comparing mean concentrations of Pepsin at
the three sites, there was a statistically higher concentration in the
control group in the oropharynx, above the ETT and in the trachea,
compared to the PFT group. Conclusion: The PFT reduced the amount of GER
in ventilated patients. A larger study is required to determine whether
this translates to a reduction in VAP. Australian New Zealand Clinical
Trials Registry (ANZCTR): ACTRN12618000669291.<br/>Copyright &#xa9; 2018
The Authors

<27>
Accession Number
624230408
Title
Comparative evaluation of analgesic sparing efficacy between
dexmedetomidine and clonidine used as adjuvant to ropivacaine in thoracic
paravertebral block for patients undergoing breast cancer surgery: A
prospective, randomized, double-blind study.
Source
Saudi Journal of Anaesthesia. 12 (4) (pp 548-554), 2018. Date of
Publication: October-December 2018.
Author
Mukherjee A.; Das A.; Mayur N.; Bhattacharyya C.; Biswas H.; Mitra T.;
Roybasunia S.; Mandal S.K.
Institution
(Mukherjee, Das, Mayur, Bhattacharyya, Biswas, Mitra, Roybasunia, Mandal)
Department of Anaesthesiology, NRS Medical College, 174, Gorakshabashi
Road, Royal Plaza Apartment, Nagerbazar, Kolkata, West Bengal 700 028,
India
(Das, Mayur, Biswas, Mandal) Department of Anaesthesiology, College of
Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
(Bhattacharyya) Department of Anaesthesiology, IPGMER, Kolkata, West
Bengal, India
(Mitra, Roybasunia) Department of Anaesthesiology, Murshidabad Medical
College, Berhampore, West Bengal, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Introduction: Thoracic paravertebral block (TPVB) is an effective method
for intra- and post-operative pain management in thoracic surgeries. For a
long time, various adjuvants have been tried for prolonging the duration
of TPVB. Objective: In this prospective study, we have compared the
analgesic sparing efficacy of dexmedetomidine and clonidine, two
alpha<inf>2</inf> adrenergic agonists, administered along with ropivacaine
for TPVB for breast cancer surgery patients. Materials and Methods:
Forty-four breast cancer surgery patients undergoing general anesthesia
(GA) were randomly divided into Group C and Group D (n = 44 each)
receiving preoperative TPVB at T<inf>3-5</inf> level with 0.5% ropivacaine
solution admixture with clonidine and dexmedetomidine, respectively.
Cancer surgery was performed under GA. Intraoperative fentanyl and
propofol requirement was compared. Visual analogue scale was used for pain
assessment. Total dose and mean time to administration of first rescue
analgesic diclofenac sodium was noted. Side effects and hemodynamic
parameters were also noted. Results: Intraoperative fentanyl and propofol
requirement was significantly less in dexmedetomidine group than
clonidine. The requirement of diclofenac sodium was also significantly
less and later in Group D than Group C. Hemodynamics, and side effects
were comparable among two groups. Conclusion: Dexmedetomidine provided
better intraoperative as well as postoperative analgesia than clonidine
when administered with ropivacaine in TPVB before breast cancer surgery
patients without producing remarkable side effects.<br/>Copyright &#xa9;
2018 Saudi Journal of Anesthesia <br/> Published by Wolters Kluwer -
Medknow.

<28>
Accession Number
618953137
Title
Clinical and procedural outcomes with the SAPIEN 3 versus the SAPIEN XT
prosthetic valves in transcatheter aortic valve replacement: A systematic
review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 92 (3) (pp E149-E158),
2018. Date of Publication: 01 Sep 2018.
Author
Tummala R.; Banerjee K.; Sankaramangalam K.; Mick S.; Krishnaswamy A.;
White J.; Fares M.; Mehta A.; Popovic Z.; Svensson L.G.; Kapadia S.R.
Institution
(Tummala) Department of Internal Medicine, St. Vincent Charity Medical
Center, An Affiliate of Case Western Reserve University, Cleveland, OH,
United States
(Banerjee, Sankaramangalam, Mick, Krishnaswamy, White, Fares, Mehta,
Popovic, Svensson, Kapadia) Heart and Vascular Institute, Cleveland
Clinic, Cleveland, OH, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: The SAPIEN 3 valve (S3V) was designed to overcome the
shortcomings of its predecessor, the SAPIEN XT (SXT) valve. We conducted a
meta-analysis to compare their clinical outcomes and procedural
characteristics. Methods: PUBMED, EMBASE, and Cochrane CENTRAL were
searched by two independent reviewers. The clinical outcomes of interest
were paravalvular leakage (PVL), major vascular complications (MVC),
bleeding, acute kidney injury (AKI), device success, need for post
dilation all-cause mortality and procedural details. Results: Fifteen
observational cohort studies were included in the analysis involving a
total of 4,496 patients. Of these, 1,700 were S3V recipients and 2,796
were SXT recipients. The S3V group showed fewer complications compared to
the SXT group with respect to PVL (5.58% vs. 19.35%, OR: 0.27, P: 0.000),
MVC (4.07% vs. 9.13%, OR: 0.44, P: 0.002), bleeding (6.40% vs. 12.03%, OR:
0.50, P: 0.003), 30-day mortality (3.29% vs. 5.68%, OR: 0.51, P: 0.000),
and stroke (1.48% vs. 2.86%, OR: 0.49, P: 0.014). Device success was
higher in the S3V (98.18% vs. 93.76%, OR: 3.14, P: 0.000). Cardiovascular
mortality, myocardial infarction, AKI and post-dilatation were not
significantly different. Permanent pacemaker implantation (PPI) was higher
in S3V recipients (13.29% vs. 9.23%, OR: 1.58, P: 0.000). Procedure time
was shorter for the S3V (71.94 vs. 86.85, P: 0.016) and used less contrast
volume (129.36 vs. 161.18, P: 0.049). Conclusions: Patients receiving the
S3V had lower risk of PVL, MVC, bleeding, mortality, and stroke. PPI was
somewhat higher in the S3V group. S3V implantation was faster and used
less contrast.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<29>
Accession Number
621803933
Title
Risks of restrictive red blood cell transfusion strategies in patients
with cardiovascular disease (CVD): a meta-analysis.
Source
Transfusion Medicine. 28 (5) (pp 335-345), 2018. Date of Publication:
October 2018.
Author
Cortes-Puch I.; Wiley B.M.; Sun J.; Klein H.G.; Welsh J.; Danner R.L.;
Eichacker P.Q.; Natanson C.
Institution
(Cortes-Puch, Wiley, Sun, Danner, Eichacker, Natanson) Critical Care
Medicine Department, Clinical Center, National Institutes of Health,
Bethesda, MD, United States
(Wiley) Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN,
United States
(Klein) Department of Transfusion Medicine, Clinical Center, National
Institutes of Health, Bethesda, MD, United States
(Welsh) National Institutes of Health Library, National Institutes of
Health, Bethesda, MD, United States
Publisher
Blackwell Publishing Ltd
Abstract
Aim: To evaluate the risks of restrictive red blood cell transfusion
strategies (haemoglobin 7-8 g dL^-1) in patients with and
without known cardiovascular disease (CVD). Background: Recent guidelines
recommend restrictive strategies for CVD patients hospitalised for non-CVD
indications, patients without known CVD and patients hospitalised for CVD
corrective procedures. Methods/Materials: Database searches were conducted
through December 2017 for randomised clinical trials that enrolled
patients with and without known CVD, hospitalised either for
CVD-corrective procedures or non-cardiac indications, comparing effects of
liberal with restrictive strategies on major adverse coronary events
(MACE) and death. Results: In CVD patients not undergoing cardiac
interventions, a liberal strategy decreased (P = 0.01) the relative risk
(95% CI) (RR) of MACE [0.50 (0.29-0.86)] (I² = 0%). Among
patients without known CVD, the incidence of MACE was lower (1.7 vs 3.9%),
and the effect of a liberal strategy on MACE [0.79, (0.39-1.58)] was
smaller and non-significant but not different from CVD patients (P =
0.30). Combining all CVD and non-CVD patients, a liberal strategy
decreased MACE [0.59, (0.39-0.91); P = 0.02]. Conversely, among studies
reporting mortality, a liberal strategy decreased mortality in CVD
patients (11.7% vs.13.3%) but increased mortality (19.2% vs 18.0%) in
patients without known CVD [interaction P = 0.05; ratio of RR 0.73,
(0.53-1.00)]. A liberal strategy also did not benefit patients undergoing
cardiac surgery; data were insufficient for percutaneous cardiac
procedures. Conclusions: In patients hospitalised for non-cardiac
indications, liberal transfusion strategies are associated with a
decreased risk of MACE in both those with and without known CVD. However,
this only provides a survival benefit to CVD patients not admitted for
CVD-corrective procedures.<br/>Copyright Published 2018. This article is a
U.S. Government work and is in the public domain in the USA

<30>
Accession Number
622088151
Title
Infective endocarditis following transcatheter edge-to-edge mitral valve
repair: A systematic review.
Source
Catheterization and Cardiovascular Interventions. 92 (3) (pp 583-591),
2018. Date of Publication: 01 Sep 2018.
Author
Asmarats L.; Rodriguez-Gabella T.; Chamandi C.; Bernier M.; Beaudoin J.;
O'Connor K.; Dumont E.; Dagenais F.; Paradis J.-M.; Rodes-Cabau J.
Institution
(Asmarats, Rodriguez-Gabella, Chamandi, Bernier, Beaudoin, O'Connor,
Dumont, Dagenais, Paradis, Rodes-Cabau) Quebec Heart and Lung Institute,
Laval University, Quebec City, QC, Canada
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To assess the clinical characteristics, management, and
outcomes of patients diagnosed with infective endocarditis (IE) after
edge-to-edge mitral valve repair with the MitraClip device. Background:
Transcatheter edge-to-edge mitral valve repair has emerged as an
alternative to surgery in high-risk patients. However, few data exist on
IE following transcatheter mitral procedures. Methods: Four electronic
databases (PubMed, Google Scholar, Embase, and Cochrane Library) were
searched for original published studies on IE after edge-to-edge
transcatheter mitral valve repair from 2003 to 2017. Results: A total of
10 publications describing 12 patients with definitive IE (median age 76
years, 55% men) were found. The mean logistic EuroSCORE/EuroSCORE II were
41% and 45%, respectively. The IE episode occurred early (within 12 months
post-procedure) in nine patients (75%; within the first month in five
patients). Staphylococcus aureus was the most frequent (60%) causal
microorganism, and severe mitral regurgitation was present in all cases
but one. Surgical mitral valve replacement (SMVR) was performed in most
(67%) patients, and the mortality associated with the IE episode was high
(42%). Conclusions: IE following transcatheter edge-to-edge mitral valve
repair is a rare but life-threatening complication, usually necessitating
SMVR despite the high-risk profile of the patients. These results
highlight the importance of adequate preventive measures and a prompt
diagnosis and treatment of this serious complication.<br/>Copyright &#xa9;
2018 Wiley Periodicals, Inc.

<31>
Accession Number
623247796
Title
The interplay between permanent pacemaker implantation and mortality in
patients treated by transcatheter aortic valve implantation: A systematic
review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 92 (3) (pp E159-E167),
2018. Date of Publication: 01 Sep 2018.
Author
Ueshima D.; Nai Fovino L.; Mojoli M.; Napodano M.; Fraccaro C.; Tarantini
G.
Institution
(Ueshima, Nai Fovino, Mojoli, Napodano, Fraccaro, Tarantini) Cardiology
Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of
Padua Medical School, Padua, Italy
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Previous implantation of a permanent pacemaker (PPM) is common
among patients undergoing transcatheter aortic valve implantation (TAVI).
Moreover, onset of conduction disturbances needing new PPM implantation
after TAVI is frequent. The interplay of pre-existing and new-PPM on
mortality after TAVI remains controversial. Methods: We performed a
systematic review and study-level meta-analysis on the influence of PPM on
mortality after TAVI. Patients were divided into 3 groups: pre-existing
PPM, new-PPM (implantation within 30 days after TAVI) and no-PPM (without
PPM up to 30 days after TAVI). Outcomes were compared using pairwise and
network meta-analysis. Results: A total of 28 studies including 40,016
subjects were eligible. Patients of the no-PPM group had a lower mortality
outcome compared to the rest of the study population (relative risk [RR]
0.76, 95% confidence interval [CI] 0.68-0.85, P < 0.0001) at median follow
up of 16.3 months. In particular, patients with a pre-existing PPM (RR
1.43, 95% CI 1.26-1.62, P < 0.0001), but not those with a newly implanted
PPM (RR 1.08, 95% CI 0.99-1.18, P = 0.10), had a significantly higher
mortality compared to patients of the no-PPM group. Moreover,
meta-regression analysis showed that the transapical approach rate had a
detrimental interaction with pre-existing PPM on mortality (P = 0.03).
Conclusion: Compared to patients without PPM, those with a pre-existing
PPM before TAVI had higher mortality, in particular if treated by the
transapical approach. New-PPM implantation did not have a negative
relation on mid-term outcome.<br/>Copyright &#xa9; 2018 Wiley Periodicals,
Inc.

<32>
Accession Number
624061876
Title
Total artificial heart implantation as a bridge to transplantation: a
viable model for the future?.
Source
Expert Review of Medical Devices. 15 (10) (pp 701-706), 2018. Date of
Publication: 03 Oct 2018.
Author
Beaupre R.A.; Frazier O.H.; Morgan J.A.
Institution
(Beaupre) Department of Thoracic Surgery, University of Cincinnati Medical
Center, Cincinnati, OH, United States
(Frazier) Center for Cardiac Support, Texas Heart Institute, Houston, TX,
United States
(Morgan) Division of Mechanical Circulatory Support and Cardiac
Transplantation, Baylor College of Medicine, Houston, TX, United States
(Morgan) Department of Cardiothoracic Surgery, Texas Heart Institute,
Houston, TX, United States
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Since the first total artificial heart (TAH) surgery in a
human patient performed in 1969, over 1300 devices have been implanted
worldwide. Patients are benefiting from increased lengths of durable
support and indications have expanded beyond biventricular failure
including allograft failure, severe restrictive disease, and complex
congenital anomalies. Areas covered: The role of the TAH in biventricular
failure, rates of successful bridge-to-transplant (BTT), and survival
compared with biventricular assist devices (BiVADs) are discussed and
differences between TAH and LVAD patient populations are highlighted. The
device's niche role in physiologies not amenable to single ventricle
support is further described. New developments such as the 50cc Syncardia,
continuous flow mechanisms (BiVACOR and Cleveland Clinic CF-TAH), and a
bioprosthetic model (CARMAT) are discussed. Literature review was
conducted utilizing the PubMed database selecting published research,
database analyses, and case reports under 'total artificial heart'
relevant to the paper's aims. Expert commentary: TAH patients have high
rates of successful BTT and survival on par with BiVAD-supported patients.
Ongoing developments including decreased device size, continuous flow
mechanisms, and use of bioprosthetic materials will ensure that the TAH
will have an increasing role in advanced heart failure with increased
device longevity and decreased post-implant complications.<br/>Copyright
&#xa9; 2018, &#xa9; 2018 Informa UK Limited, trading as Taylor & Francis
Group.

<33>
Accession Number
2000859042
Title
Endocarditis in the Mediterranean Basin.
Source
New Microbes and New Infections. 26 (Supplement 1) (pp S43-S51), 2018.
Date of Publication: November 2018.
Author
Gouriet F.; Chaudet H.; Gautret P.; Pellegrin L.; de Santi V.P.; Savini
H.; Texier G.; Raoult D.; Fournier P.-E.
Institution
(Gouriet, Raoult) UMR MEPHI, France
(Chaudet, Gautret, Pellegrin, de Santi, Savini, Texier, Fournier) UMR
VITROME, Aix-Marseille Universite, IRD, Service de Sante des Armees,
Assistance Publique-Hopitaux de Marseille, Institut
Hospitalo-Universitaire Mediterranee-Infection, France
(Pellegrin, de Santi, Texier) Forces Centre for Epidemiology and Public
Health, French Forces Health Services, France
(Savini) Military Teaching Hospital Laveran, Department of Infectious
Diseases and Tropical Medicine, French Forces Health Services, Marseille,
France
Publisher
Elsevier Ltd
Abstract
Infective endocarditis is a severe disease with high mortality. Despite a
global trend towards an increase in staphylococcal aetiologies, in older
patients and a decrease in viridans streptococci, we have observed in
recent studies great epidemiologic disparities between countries. In order
to evaluate these differences among Mediterranean countries, we performed
a PubMed search of infective endocarditis case series for each country.
Data were available for 13 of the 18 Mediterranean countries. Despite
great differences in diagnostic strategies, we could classify countries
into three groups. In northern countries, patients are older (>50 years
old), have a high rate of prosthetic valves or cardiac electronic
implantable devices and the main causative agent is Staphylococcus aureus.
In southern countries, patients are younger (<40 years old), rheumatic
heart disease remains a major risk factor (45-93%), viridans streptococci
are the main pathogens, zoonotic and arthropod-borne agents are frequent
and blood culture-negative endocarditis remains highly prevalent. Eastern
Mediterranean countries exhibit an intermediate situation: patients are 45
to 60 years old, the incidence of rheumatic heart disease ranges from 8%
to 66%, viridans streptococci play a predominant role and zoonotic and
arthropod-borne diseases, in particular brucellosis, are identified in up
to 12% of cases.<br/>Copyright &#xa9; 2018 The Author(s)

<34>
Accession Number
624304972
Title
Outcomes of vocal fold motion impairment and dysphagia following
congenital heart surgery: Systematic review.
Source
Otolaryngology - Head and Neck Surgery (United States). Conference: Annual
Meeting of the American Academy of Otolaryngology-Head and Neck Surgery
Foundation and OTO Experience, AAO-HNSF 2018. United States. 159 (1
Supplement 1) (pp P308), 2018. Date of Publication: October 2018.
Author
Orzell S.C.; Joseph R.; Ongkasuwan J.; Bedwell J.R.; Raol N.P.
Publisher
SAGE Publications Inc.
Abstract
Objectives: Vocal fold motion impairment (VFMI) is a wellknown cause of
morbidity following congenital heart surgery (CHS). The objective of this
study was to systematically review the literature regarding swallowing
function and VFMI in children following CHS. Methods: This was a
systematic review. PubMed, EMBASE, Medline, CINAHL, and Cochrane library
were searched from inception to June 30, 2017. Manual searches of
bibliographies were also completed. Studies that described recovery of
VFMI and swallowing function following CHS were included. Demographic and
additional outcome data, including length of stay (LOS) and overall
mortality, were also collected. Because of the heterogeneity of the data,
a qualitative analysis of the data was performed. Results: A total of 1371
studies were identified, and 7 met the inclusion criteria. The inability
to maintain an oral diet was present in 14% to 100% of subjects with VFMI
and 11% to 61% of subjects without VFMI following surgery. Moreover, 66%
to 75% of subjects with VFMI and 88% to 100% of subjects without VFMI were
able to tolerate an oral diet without tube feeding at 23.6 days to 3.2
years of follow-up. VMFI was present in 8% to 59% of subjects, and rates
of recovery ranged from 9% to 96% at 6 months to 6 years of follow-up.
Limited data suggest that time to extubation is longer in VFMI subjects,
but overall hospital LOS and mortality are not affected by VFMI status.
Conclusions: Data evaluating dysphagia and VFMI after CHS are limited.
Most studies suggest significant improvement in swallowing function, while
rate of recovery of VFMI is variable.

<35>
Accession Number
624314631
Title
Three-dimensional transesophageal echocardiography is an attractive
alternative to cardiac multi-detector computed tomography for aortic
annular sizing: Systematic review and meta-analysis.
Source
Echocardiography (Mount Kisco, N.Y.). 35 (10) (pp 1626-1634), 2018. Date
of Publication: 01 Oct 2018.
Author
Elkaryoni A.; Nanda N.C.; Baweja P.; Arisha M.J.; Zamir H.; Elgebaly A.;
Altibi A.M.; Sharma R.
Institution
(Elkaryoni, Zamir, Sharma) Division of Internal Medicine, University of
Missouri Kansas City, Kansas City, MO, United States
(Nanda, Arisha) Division of Cardiovascular Disease, University of Alabama
at Birmingham, Birmingham, AL, United States
(Baweja) Division of Cardiovascular Disease, University of Missouri Kansas
City, Kansas City, MO, United States
(Elgebaly) Faculty of Medicine, Al Azhar University, Cairo, Egypt
(Altibi) University of Pittsburgh Medical Center, Pittsburgh, PA, United
States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiac imaging is the cornerstone of the pretranscatheter
aortic valve replacement (TAVR) assessment. Multi-detector computed
tomography (MDCT) is considered the conventional imaging modality.
However, there is still no definitive gold standard. Targeted cohort of
inoperable high-risk patients with underlying comorbidities, particularly
renal impairment, makes apparent the need for MDCT alternative. We aimed
to demonstrate the correlation extent between MDCT and three-dimensional
transesophageal echocardiography (3DTEE) aortic annular area measures and
to answer the question: Is 3DTEE a good alternative to MDCT?
METHODS: A systematic literature search and meta-analysis were conducted
to evaluate the degree of correlation and agreement between 3DTEE and MDCT
aortic annular sizing. A thorough assessment of EMBASE, PubMed, and
Cochrane Central Register of Controlled Trials (CENTRAL) was performed.
All studies comparing 3DTEE and MDCT in relation to aortic annular sizing
were included.
RESULTS: Thirteen studies were included (N = 1228 patients). A strong
linear correlation was found between 3DTEE and MDCT measurements of aortic
annulus area (r = 0.84, P < 0.001), mean perimeter (r = 0. 0.85, P <
0.001), and mean diameter (r = 0.80, P < 0.001). Bland-Altman plots
revealed smaller mean 3DTEE values in comparison to MDCT for aortic
annular area, the mean difference being -2.22 mm2 with 95% limits of
agreement -12.79 to 8.36.
CONCLUSION: Aortic annulus measurements obtained by 3DTEE demonstrated a
high level of correlation with those evaluated by MDCT. This makes 3DTEE a
feasible choice for aortic annulus assessment, with advantage of real time
assessment, lack of contrast, and no radiation exposure.<br/>Copyright
&#xa9; 2018 Wiley Periodicals, Inc.

<36>
Accession Number
624320313
Title
The ACURATE neo transcatheter aortic valve system.
Source
Expert Review of Medical Devices. 15 (10) (pp 693-699), 2018. Date of
Publication: 03 Oct 2018.
Author
Choudhury T.; Solomonica A.; Bagur R.
Institution
(Choudhury, Solomonica, Bagur) London Health Sciences Centre, London,
Canada
(Bagur) Keele Cardiovascular Research Group, Centre for Prognosis
Research, Institute of Primary Care and Health Sciences, University of
Keele, Stoke-on-Trent, United Kingdom
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: The field of transcatheter aortic valve implantation (TAVI)
has seen an exponential expansion in TAVI devices for the treatment of
severe symptomatic aortic stenosis. Areas covered: The ACURATE neo (Boston
Scientific, MA, USA) is a second-generation self-expanding transcatheter
aortic valve system. The valve presents a supra-annular design, and
comprises three stabilization arches for axial alignment, an upper-crown
for capping the aortic annulus, and a lower-crown that is opened over the
native aortic valve for full deployment. This device minimally protrudes
into the left ventricular outflow-tract, thereby minimizing the risk of
conduction abnormalities. The ACURATE neo can be delivered by transfemoral
and transapical approaches with a unique 'top-down' deployment.
Information was gathered from published manuscripts obtained using
standard databases (MEDLINE) and trial data presented at conferences.
Expert commentary: Data from observational series show that TAVI with the
ACURATE neo is associated with low rates of all-cause mortality,
paravalvular leak, and permanent pacemaker requirement. Randomized data
comparing the ACURATE neo valve with contemporary valves and long-term
durability data are awaited. Continuing modifications in device and
delivery system design are anticipated with a view to further reduction in
paravalvular leak.<br/>Copyright &#xa9; 2018, &#xa9; 2018 Informa UK
Limited, trading as Taylor & Francis Group.

<37>
Accession Number
624050339
Title
Association of perioperative red blood cell transfusions with venous
thromboembolism in a North American Registry.
Source
JAMA Surgery. 153 (9) (pp 826-833), 2018. Date of Publication: September
2018.
Author
Goel R.; Patel E.U.; Cushing M.M.; Frank S.M.; Ness P.M.; Takemoto C.M.;
Vasovic L.V.; Sheth S.; Nellis M.E.; Shaz B.; Tobian A.A.R.
Institution
(Goel, Cushing, Vasovic) Division of Transfusion Medicine, Department of
Pathology, New York Presbyterian Hospital, Weill Cornell Medicine, New
York, United States
(Goel, Sheth) Division of Pediatric Hematology/Oncology, Department of
Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, New
York, United States
(Patel, Ness, Tobian) Division of Transfusion Medicine, Department of
Pathology, Johns Hopkins University, Baltimore, MD, United States
(Frank) Department of Anesthesiology and Critical Care Medicine, Johns
Hopkins Medical Institutions, Baltimore, MD, United States
(Takemoto) Division of Pediatric Hematology, Johns Hopkins University,
Baltimore, MD, United States
(Nellis) Division of Pediatric Critical Care Medicine, Department of
Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, New
York, United States
(Shaz) New York Blood Center, New York, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Increasing evidence supports the role of red blood cells (RBCs)
in physiological hemostasis and pathologic thrombosis. Red blood cells are
commonly transfused in the perioperative period; however, their
association with postoperative thrombotic events remains unclear.
OBJECTIVE To examine the association between perioperative RBC
transfusions and postoperative venous thromboembolism (VTE) within 30 days
of surgery. DESIGN, SETTING, AND PARTICIPANTS This analysis used
prospectively collected registry data from the American College of Surgery
National Surgical Quality Improvement Program (ACS-NSQIP) database, a
validated registry of 525 teaching and nonteaching hospitals in North
America. Participants included patients in the ACS-NSQIP registry who
underwent a surgical procedure from January 1 through December 31, 2014.
Data were analyzed from July 1, 2016, through March 15, 2018. MAIN
OUTCOMES AND MEASURES Risk-adjusted odds ratios (aORs) were estimated
using multivariable logistic regression. The primary outcome was the
development of postoperative VTE (deep venous thrombosis [DVT] and
pulmonary embolism [PE]) within 30 days of surgery that warranted
therapeutic intervention; DVT and PE were also examined separately as
secondary outcomes. Subgroup analyses were performed by surgical subtypes.
Propensity score matching was performed for sensitivity analyses. RESULTS
Of 750 937 patients (56.8% women; median age, 58 years; interquartile
range, 44-69 years), 47 410 (6.3%) received at least 1 perioperative RBC
transfusion. Postoperative VTE occurred in 6309 patients (0.8%) (DVT in
4336 [0.6%]; PE in 2514 [0.3%]; both DVT and PE in 541 [0.1%]).
Perioperative RBC transfusion was associated with higher odds of VTE (aOR,
2.1; 95% CI, 2.0-2.3), DVT (aOR, 2.2; 95% CI, 2.1-2.4), and PE (aOR, 1.9;
95% CI, 1.7-2.1), independent of various putative risk factors. A
significant dose-response effect was observed with increased odds of VTE
as the number of intraoperative and/or postoperative RBC transfusion
events increased (aOR, 2.1 [95% CI, 2.0-2.3] for 1 event; 3.1 [95% CI,
1.7-5.7] for 2 events; and 4.5 [95% CI, 1.0-19.4] for 3 events vs no
intraoperative or postoperative RBC transfusion; P < .001 for trend). In
subgroup analyses, the association between any perioperative RBC
transfusion and postoperative VTE remained statistically significant
across all surgical subspecialties analyzed. The association between any
perioperative RBC transfusion and the development of postoperative VTE
also remained robust after 1:1 propensity score matching (47 142 matched
pairs; matched OR, 1.9; 95% CI, 1.8-2.1). CONCLUSIONS AND RELEVANCE The
results of this study suggest that perioperative RBC transfusions may be
significantly associated with the development of new or progressive
postoperative VTE, independent of several putative confounders. These
findings, if validated, should reinforce the importance of rigorous
perioperative management of blood transfusion practices.<br/>Copyright
&#xa9; 2018 American Medical Association. All rights reserved.

<38>
Accession Number
621200762
Title
To fly as a pilot after cardiac surgery.
Source
European Journal of Cardio-thoracic Surgery. 53 (3) (pp 505-511), 2018.
Date of Publication: 01 Mar 2018.
Author
Syburra T.; Nicol E.; Mitchell S.; Bron D.; Rosendahl U.; Pepper J.
Institution
(Syburra) Department of Cardiac Surgery, Luzerner Kantonsspital, Luzern,
Switzerland
(Nicol) Department of Cardiology, Royal Brompton Hospital, London, United
Kingdom
(Mitchell) Civil Aviation Authority, Gatwick Airport, United Kingdom
(Bron) Aeromedical Centre, Swiss Air Force, Dubendorf, Switzerland
(Rosendahl, Pepper) Department of Cardiothoracic Surgery, Royal Brompton
Hospital, London, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Aircrew are responsible for safe and reliable aircraft operations.
Cardiovascular disease accounts for 50% of all pilot licences declined or
withdrawn for medical reasons in Western Europe and is the most common
cases of sudden incapacitation in flight. Aircrew retirement age is
increasing (up to age 65) in a growing number of airlines and the burden
of subclinical, but potentially significant, coronary atherosclerosis is
unknown in qualified pilots above age 40. Safety considerations are
paramount in aviation medicine, and the most dreaded cardiovascular
complications are thromboembolic events and rhythm disturbances due to
their potential for sudden incapacitation. In aviation, the current
consensus risk threshold for an acceptable level of controlled risk of
acute incapacitation is 1% (for dual pilot commercial operations), a
percentage calculated using engineering principles to ensure the incidence
of a fatal air accident is no greater than 1 per 107 h of flying. This is
known as the '1% safety rule'. To fly as a pilot after cardiac surgery is
possible; however, special attention to perioperative planning is
mandatory. Choice of procedure is crucial for license renewal. Licensing
restrictions are likely to apply and the postoperative follow-up requires
a tight scheduling. The cardiac surgeon should always liaise and
communicate with the pilot's aviation medicine examiner prior to and
following cardiac surgery.<br/>Copyright &#xa9; The Author 2017. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<39>
Accession Number
621200759
Title
Comparative performance of transcatheter aortic valve-in-valve
implantation versus conventional surgical redo aortic valve replacement in
patients with degenerated aortic valve bioprostheses: Systematic review
and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 53 (3) (pp 495-504), 2018.
Date of Publication: 01 Mar 2018.
Author
Gozdek M.; Raffa G.M.; Suwalski P.; Kolodziejczak M.; Anisimowicz L.;
Kubica J.; Navarese E.P.; Kowalewski M.
Institution
(Gozdek, Anisimowicz, Kowalewski) Department of Cardiac Surgery,
Cardiovascular Institute, Dr Antoni Jurasz Memorial University Hospital,
Bydgoszcz, Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy
(Suwalski) Clinical Department of Cardiac Surgery, Central Clinical
Hospital of the Ministry of Interior, Warsaw, Poland
(Suwalski) Pulaski University of Technology and Humanities, Radom, Poland
(Kolodziejczak) Cardiovascular Institute, Collegium Medicum in Bydgoszcz,
University of Nicolaus Copernicus, Torun, Poland
(Kubica) Department of Cardiology and Internal Medicine, Cardiovascular
Institute, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz,
Poland
(Navarese) Inova Center for Thrombosis Research and Drug Development,
Inova Heart and Vascular Institute, Fairfax, VA, United States
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
The objective of this report was to directly compare, by means of a
systematic review and meta-analysis, redo surgical aortic valve
replacement (re-sAVR) with valve-in-valve transcatheter aortic valve
implantation (ViV TAVI) for patients with failed degenerated aortic
bioprostheses. Multiple databases were screened for all available reports
comparing ViV TAVI with re-sAVR in patients with failing degenerated
aortic bioprostheses. The primary outcome was all-cause mortality
determined from the longest available survival data. Five observational
studies (n = 342) were included in the meta-analysis; patients in the ViV
TAVI group were older and had a higher baseline risk compared to those in
the re-sAVR group. Although there was no statistical difference in
procedural mortality [risk ratio (RR) 0.74, 95% confidence interval (CI)
0.18-2.97; P = 0.67], 30-day mortality (RR 1.29, 95% CI 0.44-3.78; P =
0.64) and cardiovascular mortality (RR 0.91, 95% CI 0.30-2.70; P = 0.86)
at a mean follow-up period of 18 months, cumulative survival analysis
favoured surgery with borderline statistical significance (ViV TAVI versus
re-sAVR: hazard ratio 1.91, 95% CI 1.03-3.57; P = 0.039). ViV TAVI was
associated with a significantly lower rate of permanent pacemaker
implantations (RR 0.37, 95% CI 0.20-0.68; P = 0.002) and shorter intensive
care unit (P < 0.001) and hospital stays (P = 0.020). In contrast, re-sAVR
offered superior echocardiographic outcomes: lower incidence of
patient-prosthesis mismatch (P = 0.008), fewer paravalvular leaks (P =
0.023) and lower mean postoperative aortic valve gradients in the
prespecified analysis (P = 0.017). The ViV TAVI approach is a safe and
feasible alternative to re-sAVR that may offer an effective, less invasive
treatment for patients with failed surgical aortic valve bioprostheses who
are inoperable or at high risk. Re-sAVR should remain the standard of
care, particularly in the low-risk population, because it offers superior
haemodynamic outcomes with low mortality rates.<br/>Copyright &#xa9; The
Author 2017. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<40>
Accession Number
620208406
Title
Meta-analysis of the Sources of Bleeding after Adult Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (4) (pp 1618-1624),
2018. Date of Publication: August 2018.
Author
Biancari F.; Kinnunen E.-M.; Kiviniemi T.; Tauriainen T.; Anttila V.;
Airaksinen J.K.E.; Brascia D.; Vasques F.
Institution
(Biancari, Brascia) Department of Surgery, University of Turku, Turku,
Finland
(Biancari, Kinnunen, Tauriainen) Department of Surgery, University of
Oulu, Oulu, Finland
(Biancari, Kiviniemi, Anttila, Airaksinen) Heart Center, Turku University
Hospital and University of Turku, Turku, Finland
(Vasques) Department of Anesthesia, Padua University Hospital, Padua,
Italy
Publisher
W.B. Saunders
Abstract
Objective: The aim of this study was to pool data on the proportion and
prognostic impact of sources of bleeding in patients requiring
re-exploration after adult cardiac surgery. Design: Systematic review of
the literature and meta-analysis. Setting: Multistitutional study.
Measurements and Main Results: A literature review was performed to
identify studies published since 1990 evaluating the outcome after
reoperation for bleeding or tamponade after adult cardiac surgery.
Eighteen studies including 5,1497 patients fulfilled the selection
criteria. Reoperation for bleeding/tamponade was performed in 2,455
patients (4.6%; 95% confidence interval [CI] 3.9%-5.2%, I²
92%). These had a significantly higher risk of in-hospital/30-day
mortality compared with patients not reoperated for bleeding (pooled
rates: 9.3% v 2.3%; risk ratio 3.30; 95% CI 2.52-4.32; I² 47%;
8 studies; 25,463 patients). Surgical sites of bleeding were identified in
65.7% of cases (95% CI 58.3%-73.2%; I² 94%), cardiac site
bleeding in 40.9% of cases (95% CI 29.7%-52.0%; I² 94%), and
mediastinal/sternum site bleeding in 27.0% of cases (95% CI 16.8%-37.3%;
I² 94%). The main sites of bleeding were the body of the graft
(20.2%), the sternum (17.0%), vascular sutures (12.5%), the internal
mammary artery harvest site (13.0%), and anastomoses (9.9%). In
metaregression, surgical site bleeding was associated with a lower risk of
in-hospital/30-day mortality compared with diffuse bleeding (p = 0.003).
Conclusions: Surgical site bleeding is identified in two-thirds of
patients undergoing re-exploration after adult cardiac surgery. Meticulous
surgical technique and systematic intraoperative checking of potential
surgical sites of bleeding at the time of the original cardiac surgery may
reduce the risk of such a severe complication.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<41>
Accession Number
621344135
Title
High-intensity interval training in heart transplant recipients: A
systematic review with meta-analysis.
Source
Arquivos Brasileiros de Cardiologia. 110 (2) (pp 188-194), 2018. Date of
Publication: February 2018.
Author
Perrier-Melo R.J.; Figueira F.A.M.S.; Guimaraes G.V.; Costa M.C.
Institution
(Perrier-Melo, Costa) Universidade de Pernambuco (UPE), Recife, PE, Brazil
(Figueira) Instituto de Medicina Integral Professor Fernando Figueira,
Recife, PE, Brazil
(Guimaraes) Universidade de Sao Paulo, Sao Paulo, SP, Brazil
Publisher
Arquivos Brasileiros de Cardiologia (E-mail: arquivos@cardiol.br)
Abstract
Heart transplantation (HTx) is considered an efficient and gold-standard
procedure for patients with end-stage heart failure. After surgery,
patients have lower aerobic power (VO<inf>2</inf> max) and compensatory
hemodynamic responses. The aim of the present study was to assess through
a systematic review with meta-analysis whether high-intensity interval
training (HIIT) can provide benefits for those parameters. This is a
systematic review with meta-analysis, which searched the databases and
data portals PubMed, Web of Science, Scopus, Science Direct and Wiley
until December 2016 (pairs). The following terms and descriptors were
used: "heart recipient" OR "heart transplant recipient" OR "heart
transplant" OR "cardiac transplant" OR "heart graft". Descriptors via DeCS
and Mesh were: "heart transplantation'' OR "cardiac transplantation". The
words used in combination (AND) were: "exercise training" OR "interval
training" OR "high intensity interval training" OR "high intensity
training" OR "anaerobic training" OR "intermittent training" OR "sprint
training". The initial search identified 1064 studies. Then, only those
studies assessing the influence of HIIT on the post-HTx period were added,
resulting in three studies analyzed. The significance level adopted was
0.05. Heart transplant recipients showed significant improvement in
VO<inf>2</inf>peak, heart rate and peak blood pressure in 8 to 12 weeks of
intervention.<br/>Copyright &#xa9; 2018, Arquivos Brasileiros de
Cardiologia. All rights reserved.

<42>
Accession Number
619934147
Title
Effects of Dexmedetomidine-Isoflurane versus Isoflurane Anesthesia on
Brain Injury After Cardiac Valve Replacement Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (4) (pp 1581-1586),
2018. Date of Publication: August 2018.
Author
Kang F.; Tang C.; Han M.; Chai X.; Huang X.; Li J.
Institution
(Kang, Tang, Han, Chai, Huang, Li) Department of Anesthesiology, Anhui
Provincial Hospital Affiliated to Anhui Medical University, Anhui
Province, China
Publisher
W.B. Saunders
Abstract
Objectives: To compare dexmedetomidine combined with isoflurane versus
isoflurane anesthesia on brain injury after cardiac surgery. Design: A
prospective, randomized, single-blind study. Setting: University hospital.
Participants: Adult patients undergoing elective valve replacement
surgery. Interventions: Ninety-seven patients scheduled for valve
replacement surgery were randomly divided into 2 groups: dexmedetomidine
and isoflurane (Dex-Iso, n = 50) and isoflurane alone (Iso, n = 47).
Dexemedetomidine was infused at 0.6 mug/kg as a bolus, followed with 0.2
mug/kg/h until the end of surgery. Measurements and Main Results: Jugular
blood samples were drawn for analysis of matrix metalloproteinase-9
(MMP-9) and glial fibrillary acidic protein (GFAP) levels on time points
of: T1 (before induction); T2 (5 minutes after cardiopulmonary bypass
[CPB] onset); T3 (after CPB off); T4 (the first day after operation); T5
(the second day after operation). Plasma lactate levels in arterial and
jugular venous blood also were quantified. The difference between arterial
and jugular bulb venous blood lactate levels (AVDL) was calculated. An
antisaccadic eye movement (ASEM) test was carried out on the day before
the operation and the seventh day postoperatively. In both groups, serum
MMP-9 and GFAP concentrations increased after CPB, with the peak values
occurring after CPB. At time point T5, MMP-9 and GFAP levels were close to
those at T1. MMP-9 concentrations in the Dex-Iso group were lower than the
Iso group at T3 and T4. GFAP concentrations in the Dex-Iso group were
lower at T3 but were higher than the Iso group at T2. No significant
differences were found in AVDL between the 2 groups perioperatively except
at T2. The ASEM scores decreased significantly postoperatively. There was
no significant difference in the ASEM scores between the 2 treatment
groups before and after the operation. Conclusions: The use of
dexmedetomidine decreased the biochemical markers of brain injury but did
not improve the neuropsychological test result after cardiac
surgery.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<43>
Accession Number
620608858
Title
Effect of cone reconstruction on right ventricular function in patients
with Ebstein's anomaly: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (2) (pp 301-306),
2018. Date of Publication: 01 Feb 2018.
Author
Li D.; Hirata Y.; Zhou X.; Masuzawa A.; Ono M.; An Q.
Institution
(Li, An) Department of Cardiovascular Surgery, West China Hospital,
Sichuan University, No. 37 Guo Xue Xiang, Sichuan 610041, China
(Li, Hirata, Masuzawa, Ono) Department of Cardiac Surgery, University of
Tokyo, Tokyo, Japan
(Zhou) Evidence-Based Medicine Research Center, School of Basic Medical
Sciences, Jiangxi University of Traditional Chinese Medicine, Jiangxi,
China
Publisher
Oxford University Press
Abstract
OBJECTIVES Cone reconstruction (CR) is a novel technique for surgically
treating the tricuspid valve and right ventricle (RV) in patients with
Ebstein's anomaly. However, precise changes in the RV function after CR
remain unclear. This study aimed to evaluate the RV size and New York
Heart Association (NYHA) functional class by conducting a meta-analysis of
reported data. METHODS The MEDLINE, EMBASE, Cochrane Library and China
National Knowledge Infrastructure databases were searched for relevant
studies. The variables were RV measurements, NYHA functional classes and
tricuspid valve regurgitation grades. A fixed/random effects model was
used to summarize the estimates of mean difference with standard error.
Sensitivity analysis was conducted to ascertain the primary origin of the
heterogeneity. RESULTS Nine studies that involved 210 patients were
included. The results demonstrated that after CR, the functional RV volume
significantly decreased, NYHA functional class improved and tricuspid
valve regurgitation grade decreased. CONCLUSIONS Thus, CR appeared to be a
positive approach for Ebstein's anomaly, with good results being obtained
for the RV size and NYHA functional class. Because some limitations could
not be overcome, studies with more data on RV and longer follow-ups are
required to confirm our study results.<br/>Copyright &#xa9; 2017 The
Author.

<44>
Accession Number
622142159
Title
BK virus: A cause for concern in thoracic transplantation?.
Source
Annals of Transplantation. 23 (pp 310-321), 2018. Date of Publication: 11
May 2018.
Author
Barten M.J.; Zuckermann A.
Institution
(Barten) University Heart Center, University Hospital Hamburg-Eppendorf,
Hamburg, Germany
(Zuckermann) Department of Cardiac Surgery, Medical University of Vienna,
Vienna, Austria
Publisher
International Scientific Information, Inc. (E-mail:
office@isl-science.com)
Abstract
Human BK polyomavirus (BKV) infection is poorly documented in heart and
lung transplant patients. BK viruria and viremia have been estimated to
affect 19% and 5% of heart transplant recipients, respectively. Data are
limited, especially for lung transplantation, but the proportion of
patients progressing from BK viruria to viremia or BKV-related nephropathy
(BKVN) appears lower than in kidney transplantation. Nevertheless, a
number of cases of BKVN have been reported in heart and lung transplant
patients, typically with late diagnosis and generally poor outcomes. Risk
factors for BKV infection or BKVN in this setting are unclear but may
include cytomegalovirus infection and anti-rejection treatment. The
relative infrequency of BKVN or other BK-related complications means that
routine BKV surveillance in thoracic transplantation is not warranted, but
a diagnostic workup for BKV infection may be justified for progressive
renal dysfunction with no readily-identifiable cause; after anti-rejection
therapy; and for renal dysfunction in patients with cytomegalovirus
infection or hypogammaglobulinemia. Treatment strategies in heart or lung
transplant recipients rely on protocols developed in kidney
transplantation, with reductions in immunosuppression tailored to match
the higher risk status of thoracic transplant patients.<br/>Copyright
&#xa9; 2018, Ann Transplant.

<45>
Accession Number
621224479
Title
Rationale, design, and baseline characteristics of the CArdiovascular
safety and Renal Microvascular outcomE study with LINAgliptin
(CARMELINA): A randomized, double-blind, placebo-controlled
clinical trial in patients with type 2 diabetes and high cardio-renal
risk.
Source
Cardiovascular Diabetology. 17 (1) (no pagination), 2018. Article Number:
39. Date of Publication: 14 Mar 2018.
Author
Rosenstock J.; Perkovic V.; Alexander J.H.; Cooper M.E.; Marx N.; Pencina
M.J.; Toto R.D.; Wanner C.; Zinman B.; Baanstra D.; Pfarr E.; Mattheus M.;
Broedl U.C.; Woerle H.-J.; George J.T.; von Eynatten M.; McGuire D.K.
Institution
(Rosenstock) Dallas Diabetes Research Center at Medical City, 7777 Forest
Lane, Suite C-685, Dallas, TX 75230, United States
(Perkovic) University of New South Wales, The George Institute for Global
Health, Faculty of Medicine, Sydney, NSW, Australia
(Alexander, Pencina) Duke Clinical Research Institute, Duke Health,
Durham, NC, United States
(Cooper) Monash University, Head of Diabetes, Melbourne, VIC, Australia
(Marx) RWTH Aachen University, Department of Internal Medicine I,
University Hospital Aachen, Aachen, Germany
(Toto) University of Texas Southwestern Medical Center, Dallas, TX, United
States
(Wanner) Wurzburg Univ Clinic, Dept of Medicine, Wurzburg, Germany
(Zinman) Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute,
Toronto, Canada
(Zinman) University of Toronto, Toronto, Canada
(Baanstra) Boehringer Ingelheim bv, Alkmaar, Netherlands
(Pfarr, Mattheus, Broedl, George, von Eynatten) Boehringer Ingelheim
Pharma GmbH and Co. KG, Ingelheim, Germany
(Woerle) Ulm University, Ulm, Germany
(McGuire) University of Texas Southwestern Medical Center, Division of
Cardiology, Department of Internal Medicine, Dallas, TX, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Cardiovascular (CV) outcome trials in type 2 diabetes (T2D)
have underrepresented patients with chronic kidney disease (CKD), leading
to uncertainty regarding their kidney efficacy and safety. The
CARMELINA trial aims to evaluate the effects of linagliptin, a
DPP-4 inhibitor, on both CV and kidney outcomes in a study population
enriched for cardio-renal risk. Methods: CARMELINA is a
randomized, double-blind, placebo-controlled clinical trial conducted in
27 countries in T2D patients at high risk of CV and/or kidney events.
Participants with evidence of CKD with or without CV disease and HbA1c
6.5-10.0% (48-86 mmol/mol) were randomized 1:1 to receive linagliptin once
daily or matching placebo, added to standard of care adjusted according to
local guidelines. The primary outcome is time to first occurrence of CV
death, non-fatal myocardial infarction, or non-fatal stroke. The key
secondary outcome is a composite of time to first sustained occurrence of
end-stage kidney disease, >= 40% decrease in estimated glomerular
filtration rate (eGFR) from baseline, or renal death. CV and kidney events
are prospectively adjudicated by independent, blinded clinical event
committees. CARMELINA was designed to continue until at least
611 participants had confirmed primary outcome events. Assuming a hazard
ratio of 1.0, this provides 90% power to demonstrate non-inferiority of
linagliptin versus placebo within the pre-specified non-inferiority margin
of 1.3 at a one-sided alpha-level of 2.5%. If non-inferiority of
linagliptin for the primary outcome is demonstrated, then its superiority
for both the primary outcome and the key secondary outcome will be
investigated with a sequentially rejective multiple test procedure.
Results: Between July 2013 and August 2016, 6980 patients were randomized
and took >= 1 dose of study drug (40.6, 33.1, 16.9, and 9.4% from Europe,
South America, North America, and Asia, respectively). At baseline, mean
+/- SD age was 65.8 +/- 9.1 years, HbA1c 7.9 +/- 1.0%, BMI 31.3 +/- 5.3
kg/m², and eGFR 55 +/- 25 mL/min/1.73 m². A total of
5148 patients (73.8%) had prevalent kidney disease (defined as eGFR < 60
mL/min/1.73 m² or macroalbuminuria [albumin-to-creatinine ratio
> 300 mg/g]) and 3990 patients (57.2%) had established CV disease with
increased albuminuria; these characteristics were not mutually exclusive.
Microalbuminuria (n = 2896 [41.5%]) and macroalbuminuria (n = 2691
[38.6%]) were common. Conclusions: CARMELINA will add important
information regarding the CV and kidney disease clinical profile of
linagliptin by including an understudied, vulnerable cohort of patients
with T2D at highest cardio-renal risk.<br/>Copyright &#xa9; 2018 The
Author(s).

<46>
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

<47>
Accession Number
619492656
Title
Protective Invasive Ventilation in Cardiac Surgery: A Systematic Review
With a Focus on Acute Lung Injury in Adult Cardiac Surgical Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (4) (pp 1922-1936),
2018. Date of Publication: August 2018.
Author
Zochios V.; Klein A.A.; Gao F.
Institution
(Zochios) University Hospitals Birmingham NHS Foundation Trust, Department
of Critical Care Medicine, Queen Elizabeth Hospital Birmingham, Edgbaston,
Birmingham, United Kingdom
(Zochios, Gao) Perioperative Critical Care and Trauma Trials Group,
Institute of Inflammation and Ageing, Centre of Translational Inflammation
Research, University of Birmingham, Birmingham, United Kingdom
(Klein) Department of Cardiothoracic Anesthesia and Critical Care
Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard,
Cambridge, United Kingdom
(Gao) The 2nd Affiliated Hospital and Yuying Children's Hospital, Wenzhou
Medical University, Wenzhou, China
Publisher
W.B. Saunders

<48>
Accession Number
621928180
Title
Association between baseline LDL-C level and total and cardiovascular
mortality after LDL-C lowering a systematic review and meta-analysis.
Source
JAMA - Journal of the American Medical Association. 319 (15) (pp
1566-1579), 2018. Date of Publication: 17 Apr 2018.
Author
Navarese E.P.; Robinson J.G.; Kowalewski M.; Kolodziejczak M.; Andreotti
F.; Bliden K.; Tantry U.; Kubica J.; Raggi P.; Gurbel P.A.
Institution
(Navarese, Bliden, Tantry, Gurbel) Interventional Cardiology and
Cardiovascular Medicine Research, Inova Center for Thrombosis Research and
Drug Development, Inova Heart and Vascular Institute, Falls Church, VA,
United States
(Navarese, Kowalewski, Kolodziejczak, Andreotti, Gurbel) Systematic
Investigation and Research on Interventions and Outcomes (SIRIO), MEDICINE
Cardiovascular Research Network, United States
(Navarese, Kolodziejczak, Kubica) Cardiovascular Institute, Ludwik
Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz,
Poland
(Robinson) Prevention Intervention Center, Department of Epidemiology and
Medicine, University of Iowa, S455 CPHB, 145 N Riverside Dr, Iowa City, IA
52242, United States
(Kowalewski) Department of Cardiac Surgery, Cardiovascular Institute, Dr
Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
(Andreotti) Institute of Cardiology, Catholic University, Medical School,
Rome, Italy
(Raggi) Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, AB, Canada
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: Effects on specific fatal and nonfatal end points appear to
vary for low-density lipoprotein cholesterol (LDL-C)-lowering drug trials.
OBJECTIVE: To evaluate whether baseline LDL-C level is associated with
total and cardiovascular mortality risk reductions. DATA SOURCESAND STUDY
SELECTION: Electronic databases (Cochrane, MEDLINE, EMBASE, TCTMD,
ClinicalTrials.gov, major congress proceedings) were searched through
February 2, 2018, to identify randomized clinical trials of statins,
ezetimibe, and PCSK9-inhibiting monoclonal antibodies. DATA EXTRACTION AND
SYNTHESIS: Two investigators abstracted data and appraised risks of bias.
Intervention groups were categorized as "more intensive" (more potent
pharmacologic intervention) or "less intensive" (less potent, placebo, or
control group). MAIN OUTCOMES AND MEASURES: The coprimary end points were
total mortality and cardiovascular mortality. Random-effects
meta-regression and meta-analyses evaluated associations between baseline
LDL-C level and reductions in mortality end points and secondary end
points including major adverse cardiac events (MACE). RESULTS: In 34
trials, 136 299 patients received more intensive and 133 989 received less
intensive LDL-C lowering. All-cause mortality was lower for more vs less
intensive therapy (7.08% vs 7.70%; rate ratio [RR], 0.92 [95% CI, 0.88 to
0.96]), but varied by baseline LDL-C level. Meta-regression showed more
intensive LDL-C lowering was associated with greater reductions in
all-cause mortality with higher baseline LDL-C levels (change in RRs per
40-mg/dL increase in baseline LDL-C, 0.91 [95% CI, 0.86 to 0.96]; P =.001;
absolute risk difference [ARD], -1.05 incident cases per 1000 person-years
[95% CI, -1.59 to -0.51]), but only when baseline LDL-C levels were 100
mg/dL or greater (P <.001 for interaction) in a meta-analysis.
Cardiovascular mortality was lower for more vs less intensive therapy
(3.48% vs 4.07%; RR, 0.84 [95% CI, 0.79 to 0.89]) but varied by baseline
LDL-C level. Meta-regression showed more intensive LDL-C lowering was
associated with a greater reduction in cardiovascular mortality with
higher baseline LDL-C levels (change in RRs per 40-mg/dL increase in
baseline LDL-C, 0.86 [95% CI, 0.80 to 0.94]; P <.001; ARD, -1.0 incident
cases per 1000 person-years [95% CI, -1.51 to -0.45]), but only when
baseline LDL-C levels were 100 mg/dL or greater (P <.001 for interaction)
in a meta-analysis. Trials with baseline LDL-C levels of 160 mg/dL or
greater had the greatest reduction in all-cause mortality (RR, 0.72 [95%
CI, 0.62 to 0.84]; P <.001; 4.3 fewer deaths per 1000 person-years) in a
meta-analysis. More intensive LDL-C lowering was also associated with
progressively greater risk reductions with higher baseline LDL-C level for
myocardial infarction, revascularization, and MACE. CONCLUSIONS AND
RELEVANCE: In these meta-analyses and meta-regressions, more intensive
compared with less intensive LDL-C lowering was associated with a greater
reduction in risk of total and cardiovascular mortality in trials of
patients with higher baseline LDL-C levels. This association was not
present when baseline LDL-C level was less than 100 mg/dL, suggesting that
the greatest benefit from LDL-C-lowering therapy may occur for patients
with higher baseline LDL-C levels.<br/>Copyright &#xa9; 2018 American
Medical Association. All rights reserved.

<49>
Accession Number
2001056198
Title
Ramipril and left ventricular diastolic function in stable patients with
pulmonary regurgitation after repair of tetralogy of Fallot.
Source
International Journal of Cardiology. 272 (pp 64-69), 2018. Date of
Publication: 1 December 2018.
Author
Krupickova S.; Li W.; Cheang M.H.; Rigby M.L.; Uebing A.; Davlouros P.;
Dimopoulos K.; Di Salvo G.; Fraisse A.; Swan L.; Alonso-Gonzalez R.;
Kempny A.; Pennell D.J.; Senior R.; Gatzoulis M.A.; Babu-Narayan S.V.
Institution
(Krupickova, Rigby, Uebing, Davlouros, Dimopoulos, Di Salvo, Fraisse,
Swan, Alonso-Gonzalez, Kempny, Pennell, Senior, Gatzoulis, Babu-Narayan)
Royal Brompton Hospital, London, United Kingdom
(Li, Dimopoulos, Di Salvo, Fraisse, Kempny, Pennell, Senior, Gatzoulis,
Babu-Narayan) National Heart and Lung Institute, Imperial College London,
United Kingdom
(Pennell, Gatzoulis, Babu-Narayan) Cardiovascular Research Unit, Royal
Brompton & Harefield NHS Foundation Trust, Imperial College London, United
Kingdom
(Cheang) UCL Institute of Cardiovascular Science, University College
London, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: Measures of left ventricular (LV) systolic and diastolic
function are known predictors of mortality after repair of tetralogy of
Fallot. We aimed to characterise LV reverse remodelling achievable with
ramipril therapy. Methods and results: A blinded post-hoc analysis of
baseline and 6-month follow-up echocardiograms from the APPROPRIATE
(ISRCTN: 97515585) randomised double-blinded placebo-controlled trial of
ramipril therapy was performed in 64 patients: 32 in ramipril and 32 in
placebo group. Tissue Doppler systolic and diastolic myocardial
velocities, mitral inflow velocities and time intervals were measured.
Left atrial area and left atrial emptying fraction were calculated. There
was significant increase in long axis shortening mean (standard
deviation); MAPSE [1.9 (4.2) mm vs -0.2 (3.7) mm; p = 0.030], peak lateral
systolic velocity; S' lateral [1.0 (2.0) cm/s vs -0.3 (2.2) cm/s; p =
0.025], peak lateral early diastolic velocity; E' lateral [0.57 (2.4) cm/s
vs -3.3 (3.9) cm/s; p < 0.001], transmitral to lateral mitral annular
early diastolic velocity ratio; E/E' lateral [-0.7 (1.9) vs 1.5 (1.9); p <
0.001] over the study period in the ramipril compared to the placebo
group. Significantly higher measurements were observed in the ramipril arm
of the subgroup of patients with right ventricular restrictive physiology
in terms of peak late diastolic velocity; A [5.9 (13.5) cm/s vs -5.8
(12.5) cm/s; p = 0.041] and early to late diastolic transmitral velocity
ratio; E/A [-0.18 (0.42) vs 0.23 (0.48); p = 0.037]. Conclusion: Six
months' ramipril treatment appears to limit progression of both diastolic
and systolic LV function in adults late after tetralogy of Fallot repair.
With increased appreciation that even subtle LV disease predicts tetralogy
of Fallot outcomes, further clinical trials of drug therapies are
justified.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<50>
Accession Number
619998937
Title
Bronchial Blocker Versus Left Double-Lumen Endotracheal Tube for One-Lung
Ventilation in Right Video-Assisted Thoracoscopic Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 297-301),
2018. Date of Publication: February 2018.
Author
Lu Y.; Dai W.; Zong Z.; Xiao Y.; Wu D.; Liu X.; Chun Wong G.T.
Institution
(Lu, Dai, Zong, Xiao, Liu) Department of Anesthesiology, First Affiliated
Hospital of Anhui Medical University, Hefei, China
(Wu) Department of Anesthesiology, Affiliated Fuyang Hospital of Anhui
Medical University, Hefei, China
(Chun Wong) Department of Anesthesiology, University of Hong Kong, Hong
Kong SAR, Hong Kong
Publisher
W.B. Saunders
Abstract
Objective: The aim of this study was to compare the quality of lung
deflation of a left-sided double-lumen endotracheal tube (DLT) with a
bronchial blocker (BB) for one-lung ventilation in video-assisted thoracic
surgery (VATS). Design: A prospective, randomized, clinical study.
Setting: A university-affiliated teaching hospital. Participants:
Forty-five adult patients undergoing esophageal tumor surgery using VATS
with right lung deflation. Interventions: Patients were assigned by a
computer-generated randomization sequence to either the left-sided DLT or
BB group. The correct positioning of the airway device was confirmed using
fiberoptic bronchoscopy. Measurements and Main Results: The variables
assessed included: (1) time required to correctly place the devices and to
achieve lung collapse; (2) the number of times the device malpositioned;
(3) the quality of lung deflation as rated by the surgeon; (4) blood
pressure and heart rate at baseline (T<inf>1</inf>), immediately before
(T<inf>2</inf>) and after (T<inf>3</inf>) and 1 minute (T<inf>4</inf>)
after intubation; (5) the number of patients with hypoxemia
(SpO<inf>2</inf> < 90%) during the one-lung ventilation (OLV) period; and
(6) postoperative hoarseness of voice, sore throat, or pulmonary
infection. Of the 45 patients approached for the study, 21 patients in the
DLT group and 19 patients in the BB group were analyzed. The time required
to place the device in the correct position was similar between the 2
groups. The time to achieve right lung collapse in the BB group was
significantly longer (mean difference: 3.232, 95% confidence interval
[CI]: 1.993-4.471; p = 0.003). The quality of lung collapse, OLV duration,
number of patients with device malposition, and hypoxemia in both groups
were similar. There were more patients suffering hoarseness (odds ratio
[OR]: 4.85, 95% CI: 1.08-21.76; p = 0.034) or sore throat (OR: 4.29, 95%
CI: 1.14-16.18; p = 0.030) in the DLT group, while no patients developed
postoperative lung infection in either group. Compared to T<inf>1</inf>,
systolic blood pressure (sBP), diastolic BP (dBP), and heart rate (HR) at
T<inf>2</inf> in both groups were higher (p < 0.05) in the DLT group.
Then, compared to T<inf>2</inf>, sBP and dBP at T<inf>3</inf> and
T<inf>4</inf> and HR at T<inf>3</inf> in the DLT group were higher (p <
0.05). Conclusions: The results of this study showed that BB is an
effective alternative for left one-lung ventilation in right VATS, but
requires a longer time to achieve complete lung collapse. Moreover, the
use of BB caused less hemodynamic perturbation and can reduce
postoperative hoarseness and sore throat.<br/>Copyright &#xa9; 2018
Elsevier Inc.

<51>
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.

<52>
Accession Number
618536171
Title
Blood conservation in cardiac surgery.
Source
Transfusion Medicine. 28 (2) (pp 168-180), 2018. Date of Publication:
April 2018.
Author
Blaudszun G.; Butchart A.; Klein A.A.
Institution
(Blaudszun, Butchart, Klein) Department of Anaesthesia and Intensive Care,
Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
Publisher
Blackwell Publishing Ltd
Abstract
This article aims at reviewing the currently available evidence about
blood conservation strategies in cardiac surgery. Pre-operative anaemia
and perioperative allogeneic blood transfusions are associated with worse
outcomes after surgery. In addition, transfusions are a scarce and costly
resource. As cardiac surgery accounts for a significant proportion of all
blood products transfused, efforts should be made to decrease the risk of
perioperative transfusion. Pre-operative strategies focus on the detection
and treatment of anaemia. The management of haematological abnormalities,
most frequently functional iron deficiency, is a matter for debate.
However, iron supplementation therapy is increasingly commonly
administered. Intra-operatively, antifibrinolytics should be routinely
used, whereas the cardiopulmonary bypass strategy should be adapted to
minimise haemodilution secondary to circuit priming. There is less
evidence to recommend minimally invasive surgery. Cell salvage and
point-of-care tests should also be a part of the routine care.
Post-operatively, any unnecessary iatrogenic blood loss should be
avoided.<br/>Copyright &#xa9; 2017 British Blood Transfusion Society

<53>
[Use Link to view the full text]
Accession Number
618680162
Title
Effects of dexamethasone on early cognitive decline after cardiac surgery;
A randomised controlled trial.
Source
European Journal of Anaesthesiology. 34 (11) (pp 776-784), 2017. Date of
Publication: 01 Nov 2017.
Author
Glumac S.; Kardum G.; Sodic L.; Supe-Domic D.; Karanovic N.
Institution
(Glumac, Karanovic) Clinical Department of Anaesthesiology, Intensive
Care, University Hospital of Split, Spinciceva 1, Split 21000, Croatia
(Kardum) Department of Psychology, Faculty of Humanities and Social
Sciences, University of Split, Croatia
(Sodic) Clinical Department of Neurology, Croatia
(Supe-Domic) Department of Medical Laboratory Diagnostics, University
Hospital of Split, Croatia
(Karanovic) Department of Anaesthesiology and Intensive Medicine, School
of Medicine, University of Split, Split, Croatia
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND Postoperative cognitive decline (POCD), a very common
complication after cardiac surgery, is characterised by impairment of both
memory function and intellectual ability as well as being associated with
increased use of healthcare resources. The investigators focused on the
role of the inflammatory response to a surgical procedure as a potential
factor involved in the pathogenesis of POCD. OBJECTIVE The use of
prophylactic dexamethasone to attenuate the inflammatory response was
hypothesised to reduce the risk of POCD. DESIGN Randomised controlled
study. SETTING Single university teaching hospital, from March 2015 to
January 2016. PATIENTS A total of 169 patients scheduled for elective
cardiac surgery were enrolled, and 161 patients were included in the
analyses. INTERVENTION Patients were randomised to receive a single
intravenous bolus of 0.1mgkg -1 dexamethasone (n=85) or placebo (n=84) 10h
before the surgery. MAIN OUTCOME MEASURES The primary outcome measure in
both groups was the incidence of POCD on the 6th day after surgery. The
investigators also evaluated the effect of dexamethasone on the incidence
of systemic inflammatory response syndrome, postoperative C-reactive
protein levels and postoperative serum S100beta protein levels. RESULTS
Compared to the placebo group, the dexamethasone group showed
statistically significant reductions in the incidence of POCD (relative
risk, 0.43; 95% confidence interval, 0.21 to 0.89; P=0.02), the incidence
of systemic inflammatory response syndrome (30.0 versus 58.0%, P<0.001)
and postoperative C-reactive protein levels (P<0.001). Postoperative
S100beta levels were insignificantly lower (P=0.56) in the dexamethasone
group. CONCLUSION Preoperative administration of dexamethasone reduced the
inflammatory response and thereby decreased the risk of early POCD after
cardiac surgery. TRIAL REGISTRATION Clinicaltrials.gov identifier:
NCT02767713.<br/>&#xa9; Copyright2017 European Society of Anaesthesiology.
All rights reserved.

<54>
[Use Link to view the full text]
Accession Number
618680119
Title
Evaluation of preoperative oral carbohydrate administration on insulin
resistance in off-pump coronary artery bypass patients: A randomised
trial.
Source
European Journal of Anaesthesiology. 34 (11) (pp 740-747), 2017. Date of
Publication: 01 Nov 2017.
Author
Lee B.; Soh S.; Shim J.-K.; Kim H.Y.; Lee H.; Kwak Y.-L.
Institution
(Lee, Soh, Shim, Kim, Lee, Kwak) Department of Anaesthesiology and Pain
Medicine, Anaesthesia and Pain Research Institute, Yonsei Cardiovascular
Hospital, Yonsei University College of Medicine, 50 Yonsei-ro,
Seodaemun-Gu, Seoul 03722, South Korea
(Shim, Kwak) Yonsei Cardiovascular Hospital, Yonsei University College of
Medicine, Seoul, South Korea
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND In fasting cardiac surgery patients, preoperative carbohydrate
(CHO) drink intake attenuated insulin resistance and improved cardiac
metabolism, although its beneficial effects were not evident after cardiac
surgery possibly due to cardiopulmonary bypass-related extreme systemic
inflammation. OBJECTIVE We aimed to evaluate whether preoperative CHO
intake affected insulin resistance and free-fatty acid (FFA)
concentrations in off-pump coronary revascularisation. DESIGN A randomised
controlled trial. SETTING Primary care in a university hospital in Korea
from January 2015 to July 2016. PATIENTS Sixty patients who underwent
elective multi-vessel off-pump coronary revascularisation were randomised
into two groups. Three patients were excluded from analysis and 57
patients completed study. INTERVENTION The CHO group received oral CHO
(400ml) the prior evening and 2 to 3h before surgery, and the control
group was fasted from food and water according to standard protocol. MAIN
OUTCOME MEASURES Insulin resistance was assessed twice, after anaesthetic
induction and after surgery via short insulin tolerance test. FFA,
C-reactive protein and creatine kinase-myocardial band concentrations were
determined serially for 48h after surgery. RESULTS Insulin sensitivity was
greater (P=0.002) and plasma FFA concentrations were lower (P=0.001) after
anaesthetic induction in the CHO group compared with the Control group,
although there were no intergroup differences after surgery. The
postoperative peak creatine kinase-myocardial band concentration was
significantly lower in the CHO group compared with the Control group [8.8
(5.4 to 18.2) vs. 6.4 (3.5 to 9.7)ngml -1, P=0.031]. CONCLUSION A
preoperative CHO supplement significantly reduced insulin resistance and
FFA concentrations compared with fasting at the beginning of the surgery,
but these benefits were lost after off-pump coronary revascularisation.
Despite their transient nature, these beneficial effects resulted in less
myocardial injury, mandating further studies focused on the impact of
preoperative CHO on myocardial ischaemia and cardiac function after
coronary revascularisation. TRIAL REGISTRATION Clinicaltrials.gov
identifier: NCT 02330263.<br/>&#xa9; Copyright2017 European Society of
Anaesthesiology. All rights reserved.

<55>
Accession Number
608566081
Title
Deferral vs. performance of percutaneous coronary intervention of
functionally non-significant coronary stenosis: 15-year follow-up of the
DEFER trial.
Source
European Heart Journal. 36 (45) (pp 3182-3188), 2015. Date of Publication:
2015.
Author
Zimmermann F.M.; Ferrara A.; Johnson N.P.; Van Nunen L.X.; Escaned J.;
Albertsson P.; Erbel R.; Legrand V.; Gwon H.-C.; Remkes W.S.; Stella P.R.;
Van Schaardenburgh P.; Jan Willem Bech G.; De Bruyne B.; Pijls N.H.J.
Institution
(Zimmermann, Van Nunen, Pijls) Department of Cardiology, Catharina
Hospital Eindhoven, Michelangelolaan 2, Eindhoven 5623 EJ, Netherlands
(Ferrara, De Bruyne) Cardiovascular Center, Aalst, Belgium
(Johnson) Weatherhead PET Center for Preventing and Reversing
Atherosclerosis, Division of Cardiology, Department of Medicine,
University of Texas Medical, School and Memorial Hermann Hospital,
Houston, TX, United States
(Van Nunen, Pijls) Department of Biomedical Engineering, Eindhoven
University of Technology, Eindhoven, Netherlands
(Escaned) Hospital Clinico San Carlos, Faculty of Medicine, Complutense
University of Madrid, Centro Nacional de Investigaciones Cardiovasculares
Carlos III (CNIC), Madrid, Spain
(Albertsson) Department of Cardiology, Sahlgrenska University Hospital
Gothenburg, Sweden
(Erbel) Department of Cardiology, West-German Heart and Vascular Centre,
University Hospital of Essen, Essen, Germany
(Legrand) Department of Cardiology, University Hospital of Liege, Liege,
Belgium
(Gwon) Division of Cardiology, Cardiac and Vascular Center, Samsung
Medical Center, Sungkyunkwan University School of Medicine, Seoul, South
Korea
(Remkes) Department of Cardiology, Isala Klinieken, Zwolle, Netherlands
(Stella) Department of Interventional Cardiology, University Medical
Center Utrecht, Utrecht, Netherlands
(Van Schaardenburgh) Department of Cardiology, VieCuri, Venlo, Netherlands
(Jan Willem Bech) Department of Cardiology, HagaZiekenhuis, The Hague,
Netherlands
(Jan Willem Bech) Reinier de Graaf Groep, Delft, Netherlands
Publisher
Oxford University Press
Abstract
Aims Stenting an angiographically intermediate but functionally
non-significant stenosis is controversial. Nevertheless, it has been
questioned if deferral of a functionally non-significant lesion on the
basis of fractional flow reserve (FFR) measurement, is safe, especially on
the long term. Five-year follow-up of the DEFER trial showed that outcome
after deferral of percutaneous coronary intervention (PCI) of an
intermediate coronary stenosis based on FFR = 0.75 is excellent and was
not improved by stenting. The aim of this study was to investigate the
validity of this position on the very long term. Met hods and resul ts In
325 patients scheduled for PCI of an intermediate stenosis, FFR was
measured just before the planned intervention. If FFR was = 0.75, patients
were randomly assigned to deferral (Defer group; n = 91) or performance
(Perform group; n = 90) of PCI. If FFR was, 0.75, PCI was performed as
planned (Reference group; n = 144). Clinical follow-up was 15 years. There
were no differences in baseline clinical characteristics between the
randomized groups. Complete 15-year follow-up was obtained in 92% of
patients. After 15 years of follow-up, the rate of death was not different
between the three groups: 33.0% in the Defer group, 31.1% in the Perform
group, and 36.1% in the Reference group (Defer vs. Perform, RR 1.06, 95%
CI: 0.69 1.62, P = 0.79). The rate of myocardial infarction was
significantly lower in the Defer group (2.2%) compared with the Perform
group (10.0%), RR 0.22, 95% CI: 0.05 0.99, P = 0.03. Conclusion Deferral
of PCI of a functionally non-significant stenosis is associated with a
favourable very long-term follow-up without signs of late 'catch-up'
phenomenon.<br/>Copyright &#xa9; 2015 The Author.

<56>
Accession Number
624181533
Title
Advanced image processing with fusion and calcification enhancement in
transcatheter aortic valve implantation: Impact on radiation exposure.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (4) (pp 512-519),
2018. Date of Publication: 01 Oct 2018.
Author
Overtchouk P.; Sudre A.; Delhaye C.; Juthier F.; Van Belle E.; Coisne A.;
Koussa M.; Mylotte D.; Modine T.
Institution
(Overtchouk, Sudre, Delhaye, Juthier, Van Belle, Coisne, Koussa, Modine)
Department of Cardiology and Cardiovascular Surgery, Institut Coeur
Poumon, Centre Hospitalier Regional et Universitaire de Lille (CHRU de
Lille), 2 Avenue Oscar Lambret, Lille 59037, France
(Juthier, Van Belle, Coisne) INSERM UMR 1011, Lille, France
(Juthier, Van Belle, Coisne) Faculte de Medecine, Universite de Lille 2,
Lille, France
(Coisne) Institut Pasteur de Lille, Lille, France
(Coisne) European Genomic Institute for Diabetes (E.G.I.D), Lille, France
(Coisne) CHU Lille, Department of Clinical Physiology and
Echocardiography, Lille, France
(Mylotte) Department of Cardiology, Galway University Hospital, Galway,
Ireland
Publisher
Oxford University Press
Abstract
OBJECTIVES Radiation exposure is a concern for both patients and operators
during transcatheter aortic valve implantation (TAVI). Efforts to reduce
radiation dose are warranted. We aimed at investigating if per-operative
advanced image processing can reduce patient and operator irradiation use
during TAVI. METHODS We performed a prospective single-centre
observational study comparing patient and operator radiation exposure
using standard fluoroscopy (control group) or a novel technology of live
advanced fluoroscopic image processing (test group) among consecutive
patients undergoing TAVI between August 2015 and April 2016. Patient
irradiation (dose-area product, effective dose and air kerma), contrast
media volume and clinical outcomes were assessed. RESULTS Among 152
elderly [median age (interquartile range): 83 (78-87)] patients (n = 76
per group) undergoing TAVI, baseline clinical characteristics were similar
between the control and test groups, except for a higher median EuroSCORE
II (2.8% vs 2.3%, P = 0.02) and higher rate of TAVI for failing surgical
bioprosthesis (11.8% vs 2.6%, P = 0.03) in the control group. The
dose-area product was reduced in the test group: mean reduction of -27.5
Gy x cm² [95% confidence intervals (CIs): 15.9-39.1, P <
0.001]. Furthermore, effective dose [mean reduction -6.5 (95% CI: 5.9-7.2)
mSv, P < 0.001] and air kerma [mean reduction -167.5 (95% CI 163.4-177.3)
mGy, P < 0.001] were lower in the test group. Fluoroscopy time, contrast
volume and clinical outcomes were similar. CONCLUSIONS Patient radiation
exposure was significantly reduced using a novel live advanced fluoroscopy
image processing with calcification enhancement and fusion of the virtual
aortic annulus without compromising patient safety.<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.

<57>
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.

<58>
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.

<59>
Accession Number
624150801
Title
Meta-Analysis of Potent P2Y12-ADP Receptor Antagonist Therapy Compared to
Clopidogrel Therapy in Acute Coronary Syndrome Patients with Chronic
Kidney Disease.
Source
Thrombosis and Haemostasis. 118 (10) (pp 1839-1846), 2018. Date of
Publication: 2018.
Author
Bonello L.; Laine M.; Lemesle G.; Puymirat E.; Dabry T.; Thuny F.;
Paganelli F.; Aradi D.; Frere C.; Burtey S.; Sibbing D.; Mancini J.
Institution
(Bonello, Laine, Dabry, Thuny, Paganelli) Service de Cardiologie, Centre
Hospitalier Universitaire de Marseille, Hopital NORD, Aix-Marseille
Universite, Hopital Nord, MARS Cardio, INSERM UMRS 1076, Chemin des
Bourrely, Marseille 13015, France
(Bonello, Burtey) Vascular Research Center of Marseille, Aix-Marseille
Universite, Marseille, France
(Lemesle) Departement de Cardiologie, Hopital Universitaire de Lille,
Lille, France
(Puymirat) Departement de Cardiologie, Hopital Europeen Georges Pompidou,
Assistance Publique des Hopitaux de Paris, Paris, France
(Aradi) Heart Center Balatonfured, Semmelweis University Budapest,
Budapest, Hungary
(Frere) Department of Haematology, Assistance Publique Hopitaux de Paris,
Pitie-Salpetriere Hospital, Paris, France
(Burtey) Centre de Nephrologie et Transplantation Renale, Hopital de la
Conception, Marseille, France
(Sibbing) Department of Cardiology, German Center for Cardiovascular
Research, Ludwig-Maximilians-Universitat, Munchen, Germany
(Mancini) Department of Public Health (BIOSTIC), Aix-Marseille University,
Hopital de la Timone, Marseille, France
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background ?The clinical benefit of anti-platelet agents in patients with
chronic kidney disease (CKD) is uncertain. In addition, the risk-benefit
ratio of potent oral P2Y12-adenosine diphosphate (ADP) receptor
antagonists (PPAs), namely, prasugrel and ticagrelor, compared with
clopidogrel in CKD patients suffering from acute coronary syndrome (ACS)
remains unknown. Objective ?We performed a meta-analysis of all studies
comparing the clinical outcomes of PPA and clopidogrel therapy in CKD
patients suffering from ACS. Methods ?We searched PubMed, the Cochrane
library, Google Scholar, Clinical trial.org and the abstracts of
international cardiology congresses from April 2000 to October 2017.
Clinical studies comparing PPA with clopidogrel in ACS patients with CKD
were selected. Our literature research identified five studies which were
included in the meta-analysis. The primary endpoint was a composite of
major adverse cardiovascular events (MACEs) at the latest follow-up
available. Secondary endpoint included bleedings. Results ?We included
data from three sub-group analysis of randomized clinical trials and two
prospective observational studies (n = 31,234). Overall, PPAs were
associated with lower rates of major cardiovascular events, with a pooled
hazard ratio (pHR) of 0.88 (95% confidence interval [CI]: 0.79-0.99; p =
0.03), without increased bleedings (pHR = 1.10) (95% CI: 0.95-1.27; p =
0.18). In a sensitivity analysis restricted to studies enrolling
invasively managed patients, the benefit of PPA on MACE was maintained
(pHR = 0.85) (95% CI: 0.77-0.93; p < 0.001), including a reduction in
mortality (pHR = 0.82) (95% CI: 0.7-0.96; p = 0.016). Conclusion ?Compared
with clopidogrel, PPAs were associated with a reduced rate of MACE without
increased bleedings in CKD patients with ACS. Among invasively managed
patients, this benefit from PPA included a reduction in
mortality.<br/>Copyright &#xa9; 2018 Georg Thieme Verlag KG Stuttgart .
New York.

<60>
Accession Number
624202716
Title
Impact of bariatric surgery on cardiovascular and renal complications of
diabetes: a focus on clinical outcomes and putative mechanisms.
Source
Expert Review of Endocrinology and Metabolism. 13 (5) (pp 251-262), 2018.
Date of Publication: 03 Sep 2018.
Author
Martin W.P.; Docherty N.G.; Le Roux C.W.
Institution
(Martin, Docherty, Le Roux) Diabetes Complications Research Centre, Conway
Institute of Biomolecular and Biomedical Research, School of Medicine,
University College Dublin, Dublin, Ireland
(Docherty, Le Roux) Department of Gastrosurgical Research and Education,
Institute of Clinical Sciences, Sahlgrenska Academy, University of
Gothenburg, Gothenburg, Sweden
(Le Roux) Division of Investigative Science, Imperial College London,
London, United Kingdom
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Cardiovascular and renal disease accounts for a substantial
proportion of the morbidity and mortality associated with obesity and type
2 diabetes mellitus (T2DM). Bariatric surgery is associated with improved
long-term cardiovascular and renal outcomes. Areas covered: All major
case-control, cohort, and randomized controlled trial studies of bariatric
surgery in adults with T2DM were screened and data on prespecified
cardiovascular and renal outcomes collated. Bariatric surgery reduces
all-cause mortality and risk of cardiovascular disease, albuminuria and
progressive chronic kidney disease. Patients with poorer glycemic control
and established microvascular disease preoperatively may stand to benefit
the most from the surgical approach. Reduced sympathetic drive, remission
of glomerular hypertension, enhanced natriuresis, gut microbiota shifts,
reduced systemic and renal inflammation, improved lipoprotein profiles,
and reductions in chronic cardiac remodeling may all be implicated. Expert
commentary: Ongoing RCTs of bariatric surgery selectively recruiting
patients with class 1 obesity and established microvascular complications
of diabetes will help to better characterize which subgroups of patients
benefit most from this effective therapy.<br/>Copyright &#xa9; 2018,
&#xa9; 2018 Informa UK Limited, trading as Taylor & Francis Group.

<61>
Accession Number
2000954269
Title
Intestinal Involvement in Kawasaki Disease.
Source
Journal of Pediatrics. 202 (pp 186-193), 2018. Date of Publication:
November 2018.
Author
Colomba C.; La Placa S.; Saporito L.; Corsello G.; Ciccia F.; Medaglia A.;
Romanin B.; Serra N.; Di Carlo P.; Cascio A.
Institution
(Colomba, La Placa, Saporito, Corsello, Medaglia, Romanin, Di Carlo,
Cascio) Department of Sciences for Health Promotion and Mother and Child
Care, University of Palermo, Palermo, Italy
(Ciccia) Biomedical Department of Internal and Specialist Medicine,
University of Palermo, Palermo, Italy
(Serra) Department of Pediatrics, School of Medicine, Federico II
University, Naples, Italy
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: To describe a case of Kawasaki disease with intestinal
involvement and to analyze other published reports to define clinical
characteristics, diagnostic issues, and therapeutic approaches of
gastrointestinal involvement in Kawasaki disease. Study design: A
computerized search without language restriction was conducted using
PubMed and SCOPUS. An article was considered eligible for inclusion in the
systematic review if it reported data on patient(s) with intestinal
involvement in Kawasaki disease. Our case was also included in the
analysis. Results: Thirty-three articles reporting 48 cases of Kawasaki
disease with intestinal involvement were considered. Fever, abdominal
pain, and vomiting were the most frequent symptoms observed and typical
Kawasaki disease signs and symptoms appeared after intestinal complaints
in all cases. Plain radiographs, ultrasonography, and computed tomography
showed pseudo-obstruction as the most frequent sign of gastrointestinal
involvement; 25 patients underwent surgery. Cardiac involvement was
documented in 21 cases. All but three patients received medical treatment
with immunoglobulin intravenous or aspirin. The outcome was good in 28
patients; 7 patients showed persistence of coronary artery abnormalities;
1 patient developed cyanosis, and later, left hand and forefoot gangrene;
3 patients died. Conclusions: The diagnosis and treatment of Kawasaki
disease might be delayed if intestinal symptoms appear before the
characteristic clinical features of Kawasaki disease, thus, increasing the
risk of cardiac complications. Furthermore, patients may undergo
unnecessary invasive procedures. Pediatricians and pediatric surgeons,
therefore, should consider Kawasaki disease among diagnoses in children
with fever, abdominal symptoms, and radiologic findings of
pseudo-obstruction.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<62>
Accession Number
2000574321
Title
Dual antiplatelet therapy versus single antiplatelet therapy after
transaortic valve replacement: Meta-analysis.
Source
Cardiovascular Revascularization Medicine. 19 (6 Supplement) (pp 47-52),
2018. Date of Publication: September 2018.
Author
Alrifai A.; Soud M.; Kabach A.; Jobanputra Y.; Masrani A.; El Dassouki S.;
Alraies M.C.; Fanari Z.
Institution
(Alrifai, Jobanputra) University of Miami/JFK Medical Center, Atlantis,
FL, United States
(Soud) MedStar Heart and Vascular Institute, MedStar Washington Hospital
Center, Washington, DC, United States
(Kabach) Creighton University, School of Medicine, Omaha, NE, United
States
(Masrani) Mallinckrodt Institute of Radiology, Washington University in St
Louis, St Louis, MO, United States
(El Dassouki) Jackson Memorial Hospital/University of Miami, Miller School
of Medicine, Division of Cardiovascular Medicine, Miami, FL, United States
(Alraies) Wayne State University, Detroit Medical Center, Detroit, MI,
United States
(Fanari) Heartland Cardiology/Wesley Medical Center, University of Kansas
School of Medicine, Wichita, KS, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The current guidelines recommend empirical therapy with DAPT
of aspirin and clopidogrel for six months after TAVR. This recommendation
is based on expert consensus only. Giving the lack of clear consensus on
treatment strategy following TAVR. Goal of this meta-analysis is to assess
the efficacy and safety of mono-antiplatelet therapy (MAPT) versus dual
antiplatelet therapy (DAPT) following transcatheter aortic valve
replacement (TAVR). Methods and Materials: We performed a meta-analysis
from randomized clinical trials (RCTs) and prospective studies that tested
DAPT vs. MAPT for all-cause mortality and major bleeding of 603 patients.
The primary efficacy outcomes were 30 days mortality and stroke. The
primary safety outcomes were major bleeding and major vascular
complications. Results: We included 603 patients from 4 studies. The use
of MAPT was associated with similar mortality rate (5.9% vs. 6.6%; RR =
0.92; 95% CI 0.49-1.71; P = 0.68) and stroke rate compared with DAPT (1.3%
vs. 1.3%; RR 1.04; 95% CI 0.27 to 4.04; P = 0.81). There was no difference
in major vascular complication (4.2% vs. 8.9%; RR 0.52; 95% CI 0.23 to
1.18; P = 0.17) or minor vascular complication (4.2% vs. 7.3%; RR 0.58;
95% CI 0.25 to 1.34; P = 0.14). However, MAPT was associated with
significantly less risk of major bleeding (4.9% vs. 14.5%; RR 0.37; 95% CI
0.20 to 0.70; P < 0.01) but no difference in minor bleeding (4.2% vs.
3.6%; RR 1.16; 95% CI 0.43 to 3.10; P = 0.85). Conclusion: MAPT use after
TAVR is associated with lower rates of major bleeding compared with DAPT
with no significant difference in mortality, stroke or vascular
complications.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<63>
Accession Number
624268832
Title
Intravenous iron transfusion in patients having in house urgent cardiac
surgery: Does it have an effect?.
Source
Anaesthesia. Conference: Annual Congress of the Association of
Anaesthetists of Great Britain and Ireland, AAGBI 2018. Ireland. 73
(Supplement 4) (pp 69), 2018. Date of Publication: September 2018.
Author
Sandhu M.; Law S.; Brand J.; McDonald A.; Akowuah E.; Mellor A.
Institution
(Sandhu, Law, Brand, McDonald, Akowuah, Mellor) James Cook University
Hospital, Middlesbrough, United Kingdom
Publisher
Blackwell Publishing Ltd
Abstract
While there are data that show potential benefits of intravenous (i.v.)
iron transfusion in patients undergoing elective cardiac surgery [1], the
effect of i.v. iron in anaemic in-house urgent (IHU) patients has not
previously been published. This study set out to observe a cohort of IHU
patients who are anaemic and were treated with i.v. iron. We investigated
the feasibility of giving i.v. iron and the effect of i.v. iron on
haematocrit (Hct) and blood transfusion. Methods This study was performed
as part of a service evaluation at The James Cook University Hospital. One
hundred patients referred for IHU cardiac surgery were included. Anaemic
patients (haemoglobin < 120 g.l^-1 for women and < 130
g.l^-1 for men) were treated with i.v. iron. Data on haematinic
parameters, blood transfusion postoperatively, 30-day mortality and length
of stay were recorded. They were compared to an historic anaemic cohort of
IHU patients. Results Of 100 patients, one had percutaneous intervention.
Thirty five patients were anaemic (36.4%). Of these, 28 patients (77.8%)
received i.v. iron prior to their procedure. The controls were 24 anaemic
IHU patients. The average Euroscore II was 4.5% (i.v.) and 4.85%
(control). The mean time of receiving iron before procedure was 4.57 days
(SD 3.02). Baseline Hct was 34.0% (i.v.) and 33.0% (control). The mean Hct
from the first pre-operative arterial blood gas was significantly higher
in the i.v. iron cohort, 33.3% (i.v.) and 30.5% (control) (p = 0.016). The
proportion of patients receiving blood transfusion in the i.v. iron group
was less (i.v. 61% (n = 17) vs. control 75% (n = 18), but did not reach
statistical significance. The mean number of units of blood received
during admission was less in the i.v. group than in the control group
(1.75 units (SD 1.76) vs. 3.08 units (SD 3.20)); but, again, did not reach
statistical significance. There were no adverse events encountered with
administration of i.v. iron. Discussion The proportion of IHU patients
with pre-operative anaemia requiring blood transfusion is high as observed
in previous studies [2]. We demonstrated that it is safe and feasible to
offer i.v. iron before urgent heart surgery. Administration of i.v. iron
resulted in a significantly higher Hct prior to sternotomy. There was a
non-significant trend to reduced blood transfusion after surgery. A larger
trial is required to determine if i.v. iron could lead to decreased
transfusion [3].

<64>
Accession Number
2001178529
Title
Factor VII and thromboembolism.
Source
Trends in Anaesthesia and Critical Care. 22 (pp 33-40), 2018. Date of
Publication: October 2018.
Author
Cardoso T.; Saracoglu A.
Institution
(Saracoglu) Department of Anesthesiology and Reanimation, University of
Marmara Medical School, Istanbul, Turkey
(Cardoso) University of Algarve Medical School, Faro, Portugal
Publisher
Churchill Livingstone
Abstract
Recombinant activated factor VIIa (rFVIIa) is a potent hemostatic agent
originally developed for the treatment of haemophilia patients with
inhibitors against factor FVIII or FIX. In approved indications, the
safety profile of rFVIIa is favourable without major concerns. The
prevalence of thromboembolic (TE) complications is less than 4/100.000
with fatal events being extremely rare. Also, the majority of reported
events occurred in elderly patients with predisposing factors for TE
complications. Currently, off-label use of rFVIIa has become much more
common with intracerebral haemorrhage and major surgical procedures being
one of the most investigated areas. However, the literature had
controversial results with a dubious safety profile. While in
intracerebral haemorrhage and cardiac surgery the administration of rFVIIa
appears to increase the risk for TE adverse events, in trauma patients,
variceal bleeding and liver transplantation the risk doesn't seem to be
higher. Besides, no significant difference was reported in mortality
rates. Moreover, a close monitoring for signs and symptoms of TE episodes
is essential in patients treated with rFVIIa, especially the elderly and
other patients with predisposing risk factors for thrombosis. In this
opinion article, we aimed to review the current literature about the
potential TE adverse events of rFVIIa in different clinical and surgical
scenarios.<br/>Copyright &#xa9; 2018

<65>
Accession Number
2001173105
Title
Off-pump coronary artery bypass surgery: The long and winding road.
Source
International Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Author
Farina P.; Gaudino M.; Angelini G.D.
Institution
(Farina) Cardiothoracic Surgery, Mater Misericordiae University Hospital,
Dublin, Ireland
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York, NY, United States
(Angelini) Bristol Heart Institute, Bristol University, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
After more than thirty years, a hundred randomized studies and dozens of
meta-analyses, there is still controversy on the results and benefits of
off-pump coronary artery bypass grafting. The present review summarizes
the most relevant evidence, the relation of outcomes with surgeon's and
institution's experience, addresses regional variations in popularity of
the technique, and the need for structural training.<br/>Copyright &#xa9;
2018 Elsevier B.V.

<66>
Accession Number
624272167
Title
Postoperative Delirium in Individuals Undergoing Transcatheter Aortic
Valve Replacement: A Systematic Review and Meta-Analysis.
Source
Journal of the American Geriatrics Society. (no pagination), 2018. Date of
Publication: 2018.
Author
Abawi M.; Pagnesi M.; Agostoni P.; Chiarito M.; van Jaarsveld R.C.; van
Dongen C.S.; Slooter A.J.C.; Colombo A.; Kooistra N.H.M.; Doevendans
P.A.F.M.; Latib A.; Stella P.R.
Institution
(Abawi, Agostoni, van Jaarsveld, van Dongen, Kooistra, Doevendans, Stella)
Department of Cardiology, University Medical Center Utrecht, Utrecht
University, Utrecht, Netherlands
(Pagnesi, Colombo, Latib) Interventional Cardiology Unit San Raffaele
Scientific Institute, Milan, Italy
(Agostoni) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Chiarito) Cardio Center Humanitas Research Hospital, Rozzano Milan, Italy
(Slooter) Department of Intensive Care Medicine and Brain Center Rudolf
Magnus, University Medical Center Utrecht, Utrecht University, Utrecht,
Netherlands
(Doevendans) Netherlands Heart Institute, Utrecht, Netherlands
(Colombo, Latib) Interventional Cardiology Unit EMO-GVM Centro Cuore
Columbus, Milan, Italy
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To evaluate the incidence of in-hospital postoperative
delirium (IHPOD) after transcatheter aortic valve replacement (TAVR).
Design: Systematic review and meta-analysis. Setting: Elective procedures.
Participants: Individuals undergoing TAVR. Measurements: A literature
search was conducted in PubMed, Embase, BioMedCentral, Google Scholar, and
the Cochrane Central Register of Controlled Trials (up to December 2017).
All observational studies reporting the incidence of IHPOD after TAVR
(sample size > 25) were included in our meta-analysis. The reported
incidence rates were weighted to obtain a pooled estimate rate with 95%
confidence interval (CI). Results: Of 96 potentially relevant articles, 31
with a total of 32,389 individuals who underwent TAVR were included in the
meta-analysis. The crude incidence of IHPOD after TAVR ranged from 0% to
44.6% in included studies, with a pooled estimate rate of 8.1% (95%
CI=6.7-9.4%); heterogeneity was high (Q = 449; I = 93%;
p<inf>heterogeneity</inf> <.001). The pooled estimate rate of IHPOD was
7.2% (95% CI=5.4-9.1%) after transfemoral (TF) TAVR and 21.4% (95%
CI=10.3-32.5%) after non-TF TAVR. Conclusion: Delirium occurs frequently
after TAVR and is more common after non-TF than TF procedures.
Recommendations are made with the aim of standardizing future research to
reduce heterogeneity between studies on this important healthcare
problem.<br/>&#xa9; 2018, Copyright the Author Journal compilation &#xa9;
2018, The American Geriatrics Society

<67>
Accession Number
624271718
Title
Cardiopulmonary exercise testing for evaluation of a randomized exercise
training intervention following aortic valve replacement.
Source
Clinical Physiology and Functional Imaging. (no pagination), 2018. Date of
Publication: 2018.
Author
Nilsson H.; Nylander E.; Borg S.; Tamas E.; Hedman K.
Institution
(Nilsson, Nylander, Hedman) Department of Clinical Physiology and
Department of Medical and Health Sciences, Linkoping University,
Linkoping, Sweden
(Borg) Department of Cardiology and Department of Medical and Health
Sciences, Linkoping University, Linkoping, Sweden
(Tamas) Department of Cardiothoracic and Vascular Surgery and Department
of Cardiovascular Medicine, Linkoping University, Linkoping, Sweden
Publisher
Blackwell Publishing Ltd
Abstract
Aortic valve surgery is the definitive treatment for aortic stenosis (AS).
No specific recommendation is available on how exercise training should be
conducted and evaluated after aortic valve replacement (AVR). This study
aimed to examine the effect of aerobic exercise training on exercise
capacity following AVR. In addition to our primary outcome variable, peak
oxygen uptake (peakVO<inf>2</inf>), the effect on submaximal
cardiopulmonary variables including oxygen uptake kinetics (tau), oxygen
uptake efficiency slope (OUES) and ventilatory efficiency
(VE/VCO<inf>2</inf> slope) was evaluated. Following AVR due to AS, 12
patients were randomized to either a group receiving 12 weeks of
supervised aerobic exercise training (EX) or a control group (CON).
Exercise capacity was assessed by a maximal cardiopulmonary exercise test
(CPET). There was a significant increase in peak load (+28%, P = 0.031)
and in peakVO<inf>2</inf> (+23%, P = 0.031) in EX, corresponding to an
increase in achieved percentage of predicted peakVO<inf>2</inf> from 88 to
104% (P = 0.031). For submaximal variables, there were only
non-statistically significant trends in improvement between CPETs in EX.
In CON, there were no significant differences in any maximal or submaximal
variable between CPETs. We conclude that 12 weeks of supervised aerobic
exercise training induces significant adaptations in cardiopulmonary
function following AVR, especially in regard to maximal variables
including peakVO<inf>2</inf>. In addition, we provide novel data on the
effect on several submaximal variables following exercise training in this
group of patients.<br/>Copyright &#xa9; 2018 The Authors. Clinical
Physiology and Functional Imaging published by John Wiley & Sons Ltd on
behalf of Scandinavian Society of Clinical Physiology and Nuclear Medicine

<68>
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

<69>
Accession Number
622056132
Title
Is MRI equivalent to CT in the guidance of TAVR? A pilot study.
Source
European Radiology. 28 (11) (pp 4625-4634), 2018. Date of Publication: 01
Nov 2018.
Author
Mayr A.; Klug G.; Reinstadler S.J.; Feistritzer H.-J.; Reindl M.; Kremser
C.; Kranewitter C.; Bonaros N.; Friedrich G.; Feuchtner G.; Metzler B.
Institution
(Mayr, Kremser, Kranewitter, Feuchtner) University Clinic of Radiology,
Medical University of Innsbruck, Anichstrase 35, Innsbruck A-6020, Austria
(Klug, Reinstadler, Feistritzer, Reindl, Friedrich, Metzler) University
Clinic of Internal Medicine III, Cardiology and Angiology, Medical
University of Innsbruck, Anichstrase 35, Innsbruck A-6020, Austria
(Bonaros) University Clinic of Cardiac Surgery, Medical University of
Innsbruck, Anichstrase 35, Innsbruck A-6020, Austria
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Objectives: To compare a comprehensive cardiovascular magnetic resonance
imaging (MRI) protocol with contrast-enhanced computed tomography
angiography (CTA) for guidance in transcatheter aortic valve replacement
(TAVR) evaluation. Methods and results: Non-contrast three-dimensional
(3D) 'whole heart' MRI imaging for aortic annulus sizing and measurements
of coronary ostia heights, contrast-enhanced MRI angiography (MRA) for
evaluation of transfemoral routes as well as aortoiliofemoral-CTA were
performed in 16 patients referred for evaluation of TAVR. Aortic annulus
measurements by MRI and CTA showed a very strong correlation (r=0.956,
p<0.0001; effective annulus area for MRI 430+/-74 vs. 428+/-78
mm² for CTA, p=0.629). Regarding decision for valve size there
was complete consistency between MRI and CTA. Moreover, vessel luminal
diameters and angulations of aortoiliofemoral access as measured by MRA
and CTA showed overall very strong correlations (r= 0.819 to 0.996, all
p<0.001), the agreement of minimal vessel diameter between the two
modalities revealed a bias of 0.02 mm (upper and lower limit of agreement:
1.02 mm and -0.98 mm). Conclusions: In patients referred for TAVR, MRI
measurements of aortic annulus and minimal aortoiliofemoral diameters
showed good to excellent agreement. Decisions based on MRI measurements
regrading prosthesis sizing and transfemoral access would not have
modified TAVR-strategy as compared to a CTA-based choice. Key Points: *
'Whole heart' MRI and CTA measurements of aortic annulus correlate very
strongly. * MRI- and CTA-based prostheses sizing are in excellent
agreement. * MRA and CTA equally guide TAVR access strategy.<br/>Copyright
&#xa9; 2018, European Society of Radiology.

<70>
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

<71>
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.

<72>
Accession Number
624182982
Title
Left ventricular assist device implantation with and without concomitant
tricuspid valve surgery: A systematic review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 54 (4) (pp 644-651), 2018.
Date of Publication: 01 Oct 2018.
Author
Veen K.M.; Muslem R.; Soliman O.I.; Caliskan K.; Kolff M.E.A.; Dousma D.;
Manintveld O.C.; Birim O.; Bogers A.J.J.C.; Takkenberg J.J.M.
Institution
(Veen, Muslem, Kolff, Dousma, Birim, Bogers, Takkenberg) Thoraxcenter,
Department of Cardiothoracic Surgery, Erasmus University Medical Centre,
Rotterdam, Netherlands
(Muslem, Soliman, Caliskan, Manintveld) Thoraxcenter, Department of
Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES Moderate-to-severe tricuspid regurgitation is common in
end-stage heart disease and is associated with an impaired survival after
left ventricular assist device (LVAD) surgery. Controversy remains whether
concomitant tricuspid valve surgery (TVS) during LVAD implantation is
beneficial. We aimed to provide a contemporary overview of outcomes in
patients who underwent LVAD surgery with or without concomitant TVS.
METHODS A systematic literature search was performed for articles
published between January 2005 and March 2017. Studies comparing patients
undergoing isolated LVAD implantation and LVAD + TVS were included. Early
outcomes were pooled in risk ratios using random effects models, and late
survival was visualized by a pooled Kaplan-Meier curve. RESULTS Eight
publications were included in the meta-analysis, including 562 undergoing
isolated LVAD implantation and 303 patients with LVAD + TVS. Patients
undergoing LVAD + TVS had a higher tricuspid regurgitation grade, central
venous pressure and bilirubin levels at baseline and were more often
female. We found no significant differences in early mortality and late
mortality, early right ventricular failure and late right ventricular
failure, acute kidney failure, early right ventricular assist device
implantation or length of hospital stay. Cardiopulmonary bypass time was
longer in patients undergoing additional TVS [mean difference +35 min 95%
confidence interval (16-55), P = 0.001]. CONCLUSIONS Adding TVS during
LVAD implantation is not associated with worse outcome. Adding TVS,
nevertheless, may be beneficial, as baseline characteristics of patients
undergoing LVAD + TVS were suggestive of a more progressive underlying
disease, but with comparable short-term outcome and long-term outcome with
patients undergoing isolated LVAD.<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.

<73>
Accession Number
624182978
Title
Systematic bilateral internal mammary artery grafting: Lessons learned
from the CATHolic University EXtensive BIMA Grafting Study.
Source
European Journal of Cardio-thoracic Surgery. 54 (4) (pp 702-707), 2018.
Date of Publication: 01 Oct 2018.
Author
Gaudino M.; Glieca F.; Luciani N.; Pragliola C.; Tsiopoulos V.; Bruno P.;
Farina P.; Bonalumi G.; Pavone N.; Nesta M.; Cammertoni F.; Munjal M.; Di
Franco A.; Massetti M.
Institution
(Gaudino, Glieca, Luciani, Pragliola, Tsiopoulos, Bruno, Farina, Bonalumi,
Pavone, Nesta, Cammertoni, Di Franco, Massetti) Department of
Cardiovascular Sciences, Catholic University, Rome, Italy
(Munjal) Department of Cardiothoracic Surgery, Cornell Medicine, New York,
NY, United States
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES Despite claims of feasibility, to date no study has examined
the effect of systematic bilateral internal mammary artery (BIMA) use in a
large cohort of real-world unselected patients. The CATHolic University
EXtensive BIMA Grafting Study (CATHEXIS) registry was designed to assess
the feasibility and safety of systematic BIMA grafting. METHODS The
CATHEXIS was a single-centre, prospective, observational,
propensity-matched study. The study was supposed to include 2 arms of 500
patients each: a prospective arm and a retrospective arm. The prospective
arm included almost all patients referred for coronary artery bypass
grafting (CABG) at our institution after the start of the CATHEXIS with
very few exceptions. BIMA would have been used in all these patients. The
retrospective arm included patients submitted to CABG before the start of
the CATHEXIS and propensity matched to the prospective group (average BIMA
use 50%; the radial artery was extensively used). Safety analyses were
scheduled after enrolment of 200, 300 and 400 BIMA patients. RESULTS After
the first 226 patients, the BIMA use percentage was 88.5% (200 of 226). In
178 (89%) patients, mammary arteries were used as Y graft. Postoperative
mortality was 2%, and incidence of perioperative myocardial infarction,
graft failure and sternal complications were 3.5%, 3% and 5.5%,
respectively. No perioperative stroke occurred. The incidence of major
adverse cardiac events (particularly graft failure and sternal
complications) in the BIMA arm were significantly higher than those in the
propensity-matched cohort; the study was stopped for safety. CONCLUSIONS
In a real world setting the systematic use of BIMA was associated with a
higher incidence of perioperative adverse events (particularly sternal
complications). Individualization of the revascularization strategy and
use of alternative arterial conduits are probably preferable to systematic
use of BIMA.<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.

<74>
Accession Number
624182891
Title
Prospective multicentre evaluation of a novel, low-profile transapical
delivery system for self-expandable transcatheter aortic valve
implantation: 6-month outcomes.
Source
European Journal of Cardio-thoracic Surgery. 54 (4) (pp 762-767), 2018.
Date of Publication: 01 Oct 2018.
Author
Conradi L.; Hilker M.; Kempfert J.; Borgermann J.; Treede H.; Holzhey
D.M.; Schrofel H.; Kim W.-K.; Schaefer U.; Walther T.
Institution
(Conradi) Department of Cardiovascular Surgery, University Heart Center
Hamburg, Hamburg 20251, Germany
(Hilker) Department of Cardiothoracic Surgery, University Medical Center
Regensburg, Regensburg, Germany
(Kempfert) Department of Cardiac Surgery, German Heart Center, Berlin,
Germany
(Borgermann) Clinic for Thoracic and Cardiovascular Surgery, Heart and
Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
(Treede) Department of Cardiac Surgery, Mid-German Heart Center,
University Hospital Halle, Halle, Germany
(Holzhey) Department of Cardiac Surgery, Heart Center Leipzig University,
Leipzig, Germany
(Schrofel) Department of Cardiovascular Surgery, Heart Center Freiburg,
Bad Krozingen, Germany
(Kim) Department of Cardiology, Kerckhoff Heart and Lung Center, Bad
Nauheim, Germany
(Kim, Walther) Department of Cardiac Surgery, Kerckhoff Heart and Lung
Center, Bad Nauheim, Germany
(Schaefer) Department of Cardiology, University Heart Center Hamburg,
Hamburg, Germany
(Walther) Department of Thoracic and Cardiovascular Surgery, University
Hospital Frankfurt, Frankfurt am Main, Germany
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES We assessed the safety and efficacy of a novel low-profile,
22-Fr transapical delivery system together with the ACURATE neoTM
resheathable transcatheter heart valve. METHODS This prospective,
single-arm, multicentre study enrolled 60 patients with severe symptomatic
aortic stenosis and high surgical risk ineligible for transfemoral access.
Primary end points were 6-month mortality and procedural success. RESULTS
The mean age of patients was 79.8 +/- 4.7 years, and the patients had
severe comorbidities including coronary artery disease (71.7%), diabetes
(38.3%), atrial fibrillation (30.0%) and chronic obstructive pulmonary
disease (21.7%); logistic EuroSCORE-I, -II and the Society of Thoracic
Surgeons (STS) scores were 20.9 +/- 8.9%, 6.1 +/- 5.0% and 4.3 +/- 2.9%,
respectively. A non-rib spreading approach using soft tissue retractors
only was used in 88.3% of patients (n = 53). Resheathing and repositioning
of transcatheter heart valve were performed in 6.7% of cases (n = 4); the
device implantation time was 3 +/- 2 min. Apical access site complications
occurred in 1.7% (n = 1). Procedural success was 98.3% (n = 59), and
procedural success in the absence of major adverse cardiac and
cerebrovascular events at 30 days was 90.0% (n = 54). At 30 days,
cardiovascular and overall mortality were 8.3% (n = 5), stroke rate was
1.7% (n = 1), and 17.2% of patients (n = 10) received a permanent
pacemaker implant. No paravalvular leakage >=2+ was observed, and the mean
transvalvular gradient was 5.9 +/- 2.7 mmHg. At 6 months, survival was
84.3% with sustained haemodynamic results. CONCLUSIONS This study
indicates safety and efficacy of transapical aortic valve implantation
using a novel low-profile delivery system. High procedural success, short
implantation times and a low rate of apical access site complications
underline the favourable safety profile and ease of use. Clinical trial
registration ClinicalTrials.gov: NCT02950428.<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.

<75>
[Use Link to view the full text]
Accession Number
618233017
Title
Microvascular reactivity monitored with near-infrared spectroscopy is
impaired after induction of anaesthesia in cardiac surgery patients.
Source
European Journal of Anaesthesiology. 34 (10) (pp 688-694), 2017. Date of
Publication: 01 Oct 2017.
Author
Vandenbulcke L.; Lapage K.G.; Vanderstraeten K.V.; De Somer F.M.; De Hert
S.G.; Moerman A.T.
Institution
(Vandenbulcke, Lapage, De Hert, Moerman) Department of Anaesthesiology,
Ghent University Hospital, De Pintelaan 185, Gent 9000, Belgium
(De Somer) Department of Cardiac Surgery, Ghent University Hospital, Gent,
Belgium
(Vanderstraeten) Faculty of Medicine and Health Sciences, Ghent
University, Gent, Belgium
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND Induction of anaesthesia causes significant macrohaemodynamic
changes, but little is known about its effects on the microcirculation.
However, alterations in microvascular perfusion are known to be associated
with impaired tissue oxygenation and organ dysfunction. Microvascular
reactivity can be assessed with vascular occlusion testing, which
evaluates the response of tissue oxygen saturation to transient ischaemia
and reperfusion. OBJECTIVE The aim of the current study was to evaluate
the effects of an opioid-based anaesthesia induction on microvascular
reactivity. We hypothesised that despite minimal blood pressure changes,
microvascular function would be impaired. DESIGN Prospective,
observational study. SETTING Single-centre, tertiary university teaching
hospital, Belgium. PATIENTS Thirty-five adult patients scheduled for
elective coronary artery bypass grafting surgery. INTERVENTION
Microvascular reactivity was assessed before and 30 min after anaesthesia
induction by means of vascular occlusion testing and near-infrared
spectroscopy. MAIN OUTCOME MEASURES Tissue oxygen saturations,
desaturation rate, recovery time (time from release of cuff to the maximum
value) and rate of recovery were determined. RESULTS Data are expressed as
median (minimum to maximum). Tissue oxygen saturation was higher after
induction of anaesthesia [70 (54 to 78) vs. 73 (55 to 94)%, P = 0.015].
Oxygen consumption decreased after induction, appreciable by the higher
minimum tissue oxygen saturation [45 (29 to 69) vs. 53 (28 to 81)%, P <
0.001] and the slower desaturation rate [11 (4 to 18) vs. 9 (5 to 16)% min
-1, P < 0.001]. After induction of anaesthesia, recovery times were longer
[40 (20 to 120) vs. 48 (24 to 356) s, P = 0.004] and the rate of recovery
was lower [114 (12 to 497) vs. 80 (3 to 271)% min -1, P < 0.001].
CONCLUSION After induction of anaesthesia, oxygen consumption was
decreased. The longer recovery times and slower rates of recovery indicate
impaired microvascular reactivity after induction of anaesthesia. TRIAL
REGISTRATION The research project was registered at ClinicalTrials.gov
(NCT02034682).<br/>Copyright &#xa9; 2017 European Society of
Anaesthesiology. All rights reserved.

<76>
Accession Number
624240093
Title
Sutureless technique versus conventional surgery in the primary treatment
of total anomalous pulmonary venous connection: a systematic review and
meta-analysis.
Source
Journal of cardiothoracic surgery. 13 (1) (pp 69), 2018. Date of
Publication: 15 Jun 2018.
Author
Wu Y.; Wu Z.; Zheng J.; Li Y.; Zhou Y.; Kuang H.; Jin X.; Wu C.
Institution
(Wu, Li, Zhou, Jin) Department of Cardiothoracic Surgery, Children's
Hospital of Chongqing Medical University, No.136 Zhongshan Second Road
,Yuzhong District, Chongqing 400014, China
(Wu, Li, Zhou, Kuang, Jin) Ministry of Education Key Laboratory of Child
Development and Disorders, Chongqing 400014, China
(Wu, Li, Zhou, Kuang, Jin) China International Science and Technology
Cooperation Base of Child Development and Critical Disorders, Chongqing
400014, China
(Wu, Li, Zhou, Kuang, Jin) Chongqing Key Laboratory of Pediatrics,
Chongqing 400014, China
(Wu, Zheng) Department of Cardiovascular Surgery, Sun Yat-Sen Memorial
Hospital, Sun Yat-Sen University, Yuexiu District, No.107 Yanjiang West
Road, Guangzhou 510120, China
(Kuang) Department of Cardiology, Children's Hospital of Chongqing Medical
University, Chongqing 400014, China
(Wu) Department of Cardiothoracic Surgery, Children's Hospital of
Chongqing Medical University, No.136 Zhongshan Second Road ,Yuzhong
District, Chongqing 400014, China
(Wu) Ministry of Education Key Laboratory of Child Development and
Disorders, Chongqing 400014, China
(Wu) China International Science and Technology Cooperation Base of Child
Development and Critical Disorders, Chongqing 400014, China
(Wu) Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
Abstract
BACKGROUD: A meta-analysis was performed to compare the differences in
outcomes between sutureless technique and conventional surgery for primary
repair of Total Anomalous Pulmonary Venous Connection(TAPVC).
METHODS: Electronic databases, including PubMed, EMbase, Medline, CNKI,
Wanfang Data and Weipu Data were searched systematically for the
literature aimed mainly at comparing the therapeutic effects for primary
repair of TAPVC administered by sutureless technique and conventional
surgery. Corresponding data sets were extracted and two reviewers
independently assessed the methodological quality.
RESULTS: Seven studies meeting the inclusion criteria were included,
involving a total of 1293 subjects. It was observed that sutureless
technique entailed a lower occurrence rate of post-operative Pulmonary
Veins Obstruction (PVO) (OR, 0.52 95%CI, 0.32-0.86; P=0.01) and
re-operation due to PVO (OR, 0.28;95%CI, 0.09-0.87; P=0.03). However,
meta-analyses of hospitalization time (WMD, 5.92; 95%CI, -7.97-19.80;
P=0.40) and post-operative mortality (OR, 0.65; 95%CI, 0.41-1.04; P=0.07)
showed no significant differences between sutureless technique and
conventional surgery. Meta-analysis of Cardiopulmonary Bypass (CPB) time
and aortic cross-clamp time also showed no significant differences between
the two surgical approaches (WMD, 5.07; 95%CI, -9.29-19.42; P=0.49); (WMD,
5.73; 95%CI, -7.76-19.23; P=0.40), but the result remained inconclusive
due to pooling result changes after sensitivity analysis.
CONCLUSIONS: Compared with conventional surgery, a lower occurrence rate
of post-operative PVO and re-operation due to PVO were associated with
sutureless technique. Meanwhile, hospitalization time and post-operative
mortality were not statistically different between the two surgical
approaches. Pooling result of CPB and aortic cross-clamp time between the
two groups remained inconclusive.

<77>
Accession Number
2001168660
Title
TAVR in patients with a low STS score: A cohort study with a mean follow
up of 2years.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2018. Date of
Publication: 2018.
Author
Al-Shaibi K.; Ahmed W.; Abukhudair W.; Nosir Y.; Al-Shaibi A.; Kateb R.;
Alasnag M.
Institution
(Al-Shaibi, Ahmed, Abukhudair, Nosir, Kateb, Alasnag) King Fahd Armed
Forces Hospital, Jeddah, Saudi Arabia
(Al-Shaibi) King Abdulaziz University, Jeddah, Saudi Arabia
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Partner 2 and SURTAVI trials (mean STS score of 5.8 and 4.5)
support extending TAVR into the intermediate risk group. We present our
results of TAVR in a group with mean STS score of 2.9 and 2 year follow
up. Methods: This is a prospective cohort study of 46 consecutive patients
undergoing TAVR between 2011 and 2016. All patients had severe symptomatic
AS. Age, functional status, coronary disease, co-morbidity and imaging
parameters were assessed. Patients were followed up for 12-60 months.
Results: 46 patients with a mean age of 75 years were enrolled. Mean EF
56%, mean MG 52 mm Hg and mean PG 87 mm Hg. The mean STS score was 2.9.
Forty-two underwent transfemoral and 4 transaortic TAVR. Forty-five of 46
valves were implanted successfully. One patient had moderate perivalvular
regurgitation (PVR). Post-procedure mean MG was 11 mm Hg. There was one
procedure related stroke and one intraprocedural death. Five patients
(10.8%) required a permanent pacemaker. 30-day mortality was 2 of 46
(4.3%). Mean follow up was 28 months. Mean MG at 2 years was 12 mm Hg.
Late cardiac mortality occurred in 1 patient. Conclusion: TAVR in this
group with a low STS score was successful with excellent valve
performance. Although the STS score identifies intermediate and high risk
patients, it does not account for the overall frailty and limited mobility
of many elderly patients placing them at a higher surgical risk despite
their low STS scores. A scoring system that captures all such factors is
required. Finally, a large scale randomized trial with long term follow up
determining the validity of TAVR in truly low risk individuals is
necessary.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<78>
Accession Number
2001161926
Title
Meta-Analysis Comparing Outcomes of Drug Eluting Stents Versus Single and
Multiarterial Coronary Artery Bypass Grafting.
Source
American Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Author
Gaudino M.; Rahouma M.; Abouarab A.; Tam D.Y.; Di Franco A.; Leonard J.;
Benedetto U.; Iannaccone M.; D'Ascenzo F.; Biondi-Zoccai G.; Vallely M.;
Girardi L.N.; Fremes S.E.; Taggart D.P.
Institution
(Gaudino, Rahouma, Abouarab, Di Franco, Leonard, Girardi) Department of
Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United
States
(Tam, Fremes) Schulich Heart Centre, Sunnybrook Health Science, University
of Toronto, Toronto, Ontario, Canada
(Benedetto) School of Clinical Sciences, Bristol Heart Institute,
University of Bristol, Bristol, United Kingdom
(Iannaccone, D'Ascenzo) Citta della Scienza e della Salute, Department of
Cardiology, University of Turin, Torino, Italy
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University, Rome, Italy
(Biondi-Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed,
Pozzilli, Italy
(Vallely) Sydney Medical School, The University of Sydney, Sydney, New
South Wales, Australia
(Taggart) University of Oxford, Oxford, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Relative benefits of coronary artery bypass (CABG) using single and
multiple arterial grafting (SAG, MAG) and drug eluting stent (DES) in
multivessel coronary disease remain uncertain. We compared SAG, MAG, and
DES in a pairwise and network meta-analysis. Randomized trials and
adjusted observational studies comparing CABG versus DES were included
(primary end point: long-term mortality; secondary end points: operative
mortality, perioperative stroke, and follow-up repeated revascularization
[RR]). Studies with >=1.7 arterial grafts and/or patient were classified
as MAG. Bayesian network meta-analyses and random-model pairwise
meta-analyses were performed. A total of 53,239 patients (8 randomized, 17
observational studies) were included (26,306 DES; 26,933 CABG). In
pairwise comparison (mean follow-up: 5.42 years), CABG (MAG + SAG) was
associated with lower long-term mortality (incident rate ratio [IRR] 0.77,
95% confidence interval [CI] 0.66 to 0.90), lower RR (IRR 0.37, 95% CI
0.27 to 0.51), increased perioperative stroke (odds ratio [OR] 3.18, 95%
CI 1.70 to 5.97), and similar operative mortality (OR 1.04, 95% CI 0.64 to
1.70) compared with DES. There was a nonsignificant trend toward lower
long-term mortality for studies with higher mean number of arterial
grafts. In network meta-analyses, compared with DES, MAG was associated
with lower long-term mortality (IRR 0.72, 95% credible interval [CrI] 0.57
to 0.92) and late RR (IRR 0.32, 95% CrI 0.21 to 0.49), SAG was associated
with lower long-term mortality and RR (IRR 0.80, 95% CrI 0.66 to 0.97 and
IRR 0.42, 95% CrI 0.29 to 0.61, respectively). In conclusion, CABG was
associated with reduced 5-year mortality and need for RR compared with
DES. MAG was ranked as the best treatment for the primary and all
secondary outcomes.<br/>Copyright &#xa9; 2018

<79>
Accession Number
624252536
Title
Impact of Atrial Fibrillation on the Outcomes after MitraClip: A
Meta-Analysis.
Source
Structural Heart. (no pagination), 2018. Date of Publication: 2018.
Author
Megaly M.; Abraham B.; Saad M.; Omer M.; Elbadawi A.; Tawadros M.; Khalil
C.; Nairoz R.; Almomani A.; Sengupta J.; Kalra A.; Brilakis E.; Gafoor S.
Institution
(Megaly, Sengupta, Brilakis) Minneapolis Heart Institute, Abbott
Northwestern Hospital, Minneapolis, MN, United States
(Megaly) Division of Cardiology, Department of Medicine, Hennepin County
Medical Center, Minneapolis, MN, United States
(Abraham) Department of Medicine, St. John Providence Hospital, Detroit,
MI, United States
(Saad, Almomani) Department of Cardiovascular Medicine, University of
Arkansas, Little Rock, AR, United States
(Saad) Division of Cardiology, Ain Shams University, Cairo, Egypt
(Omer) Cardiology Division, Saint Luke's Hospital, Kansas City, MO, United
States
(Elbadawi) Division of Cardiology, Rochester General Hospital, Rochester,
NY, United States
(Tawadros) Department of Cardiology, Ain Shams University Medical School,
Cairo, Egypt
(Khalil) Department of Internal Medicine, University of Buffalo, Buffalo,
NY, United States
(Nairoz) Division of Cardiology, University of South California, Los
Angeles, CA, United States
(Kalra) Division of Cardiology, Case Western Reserve University School of
Medicine, Cleveland, OH, United States
(Gafoor) Division of Cardiology, Swedish Medical Center, Seattle, WA,
United States
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: Atrial fibrillation (AF) has been associated with worse
outcomes in patients undergoing mitral valve surgery for mitral
regurgitation. The impact of preexisting AF on the outcomes after
transcatheter mitral valve repair with MitraClip (Abbott Vascular, Santa
Clara, CA, USA) has not been well studied. Methods: An electronic search
was performed until December 2017 for studies reporting outcomes after
MitraClip in patients with AF versus those with no AF. Outcomes of
interest included all-cause mortality, stroke and major adverse
cardiovascular events (MACE) defined as the composite outcome of death,
stroke, and myocardial infarction at the longest follow-up reported.
Results: A total of four studies including 1473 patients (AF n = 697; no
AF n = 776) were included. There was no difference in procedural success
or procedural time between patients with AF versus those without AF. AF
was associated with increased mortality after MitraClip compared with
patients with no AF (OR 1.54, 95% CI (1.16, 2.04), p = 0.003,
I² = 0%) over a mean follow-up period of 10.2 months. In a
sensitivity analysis excluding early postoperative (30-day) outcomes, AF
remained associated with higher mortality (OR 1.53, 95% CI (1.15, 2.03), p
= 0.003, I² = 19%). AF was associated with a higher incidence
of MACE after MitraClip (OR 1.46, 95% CI (1.03, 2.07), p = 0.03,
I² = 13%). No difference was observed in the risk of stroke
between patients with versus without AF after MitraClip (OR 1.13, 95%CI
(0.36, 3.56), p = 0.84, I² = 37%). Conclusions: Compared with
patients without AF, patients with preexisting AF are at higher risk of
death and MACE after MitraClip.<br/>Copyright &#xa9; 2018, &#xa9; 2018
Cardiovascular Research Foundation.

<80>
Accession Number
624224548
Title
Zero-Balance Ultrafiltration of Priming Blood Attenuates Procalcitonin and
Improves the Respiratory Function in Infants After Cardiopulmonary Bypass:
A Randomized Controlled Trial.
Source
Artificial Organs. (no pagination), 2018. Date of Publication: 2018.
Author
Gholampour Dehaki M.; Niknam S.; Azarfarin R.; Bakhshandeh H.; Mahdavi M.
Institution
(Gholampour Dehaki, Niknam, Azarfarin, Bakhshandeh, Mahdavi) Rajaie
Cardiovascular, Medical & Research Center-Perfusion, Tehran Province,
Tehran, Iran, Islamic Republic of
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Blood priming is needed for cardiopulmonary bypass (CPB) in neonates and
infants to avoid exceeding hemodilution; however, transfusion-related
inflammation affects post-CPB outcomes in infant open-heart surgery.
Procalcitonin, a newly detected inflammatory moderator and a sensitive
parameter for predicting pulmonary dysfunction secondary to CPB, rises
after CPB. We hypothesized that the hemofiltration of priming blood before
CPB might decrease inflammatory mediators in the blood and post-CPB
inflammatory replications, thereby improving the respiratory function
after CPB in infants. Sixty infants with a weight below 10 kg were divided
randomly into two equal groups of CPB with the zero-balance
ultrafiltration (Z-BUF) of priming blood and CPB without it. The
procalcitonin level was measured before anesthesia, after admission to the
intensive care unit (ICU), and 24 h afterward. The respiratory index and
pulmonary compliance were measured after anesthesia, at the end of CPB,
and 2 h after admission to the ICU. Additionally, time to extubation was
recorded. The Z-BUF of priming blood maintained electrolytes within a
physiologic level, and procalcitonin had a slighter rise in the Z-BUF
Group at 24 h after admission to the ICU (P = 0.05). The respiratory index
was decreased in the Z-BUF Group, but the difference with the control
group did not reach statistical significance (P > 0.05). The change in
pulmonary compliance was significantly increased in the cyanotic patients
in the intervention group, but there was no significant difference between
the two groups. The time to extubation and the ICU stay were shorter in
the Z-BUF Group (P < 0.05). A positive correlation was found between the
peak procalcitonin concentration and the time to extubation directly and
pulmonary compliance reversely. These results suggest that the Z-BUF of
priming blood may have some beneficial clinical effects such as improved
respiratory function and attenuated procalcitonin.<br/>Copyright &#xa9;
2018 International Center for Artificial Organs and Transplantation and
Wiley Periodicals, Inc.

<81>
Accession Number
624211899
Title
Management and outcomes of left ventricular assist device related
endocarditis: A systematic review and meta-analysis.
Source
ASAIO Journal. Conference: 64th Annual Conference of the American Society
for Artificial Internal Organs, ASAIO 2018. United States. 64 (Supplement
1) (pp 71), 2018. Date of Publication: May - June 2018.
Author
Patel S.; Luc J.G.; Choi J.; Horan D.P.; Weber M.P.; Moncho Escriva E.;
Rizvi S.A.; Qureshi A.; Entwistle J.W.; Morris R.J.; Aburjania N.; Massey
H.T.; Tchantchaleishvili V.
Institution
(Patel, Choi, Horan, Weber, Rizvi, Entwistle, Morris, Massey,
Tchantchaleishvili) Division of Cardiac Surgery, Thomas Jefferson
University, Philadelphia, PA, United States
(Luc) Faculty of Medicine and Dentistry, University of Alberta, Edmonton,
AB, Canada
(Moncho Escriva) University of Granada, Granada, Spain
(Qureshi) Division of Cardiology, Thomas Jefferson University,
Philadelphia, PA, United States
(Aburjania) Division of Infectious Diseases, Thomas Jefferson University,
Philadelphia, PA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Study: Left ventricular assist device (LVAD) related endocarditis remains
poorly studied. The aim of this systemic review was to assess the outcomes
of LVAD related endocarditis. Methods: Electronic search was performed to
identify all studies in the English literature on endocarditis in patients
with LVADs. Identified articles were systematically assessed for inclusion
and exclusion criteria. Results: 16 studies were included for analysis,
with a total of 26 patients of which 7 had a continuous-flow (CF-LVAD) and
19 had a pulsatile-flow device (p-LVAD). Time to development of
endocarditis following LVAD implantation was 91 days [CF-LVAD 152 (IQR
91-1422) days; p-LVAD 65 (IQR 55-153) days, p=0.05]. 11/25 (44%) patients
were treated with antibiotics only with the remainder undergoing
additional surgical intervention including heart transplantation (n=6),
LVAD exchange (n=5), LVAD explantation (n=1), inflow-outflow valve
exchange (n=1), and outflow graft repair (n=1). At a follow up time of 344
days [CF-LVAD 395 (IQR 350-1551) days; p-LVAD 266 (IQR 103-859) days,
p=0.10], there was no difference in mortality between CF-LVAD and p-LVAD
related endocarditis (57% vs. 42%, p=0.81). Patients who underwent
surgical intervention had superior survival (71%) as compared to those
treated with antimicrobials only (27%); however the Kaplan-Meier analysis
was underpowered to detect statistical significance (p=0.17) (Figure).
Compared to p-LVAD, CF-LVADs appeared to be resistant to early development
of LVAD related endocarditis. A possible survival advantage of surgical
intervention vs medical therapy alone deserves further exploration to
determine its applicability in the CF-LVAD cohort.

<82>
Accession Number
2001142297
Title
Laparoscopic vs. open left lateral sectionectomy: an update systematic
review and meta-analysis of randomized and non-randomized controlled
trials.
Source
HPB. Conference: Abstract of the 13th World Congress of the International
Hepato-Pancreato-Biliary Association. Switzerland. 20 (Supplement 2) (pp
S438), 2018. Date of Publication: September 2018.
Author
Macacari R.L.; Coelho F.F.; Bernardo W.M.B.; Kruger J.A.P.; Jeismann V.B.;
Fonseca G.M.; Cesconetto D.M.; Cecconello I.; Herman P.
Institution
(Macacari, Coelho, Bernardo, Kruger, Jeismann, Fonseca, Cesconetto,
Cecconello, Herman) Department of Digestive Surgery and Coloproctology,
Sao Paulo University / School of Medicine, Brazil
Publisher
Elsevier B.V.
Abstract
Background: Left lateral sectionectomy (LLS) is considered the most
suitable anatomical liver resection to be performed laparoscopically.
Laparoscopic LLS has been increasingly performed, however studies
specifically comparing laparoscopic and open LLS are mostly retrospective
with small sample size. Only recently prospective trials were reported.
The aim of this study was to perform an update systematic review and
meta-analysis of studies comparing perioperative outcomes of laparoscopic
vs. open LLS. Methods: A systematic review was performed in Medline,
EMBASE, Cochrane Library Central and Scielo/LILACS. Randomized and
observational studies comparing perioperative results between laparoscopic
and open LLS were included. The latest date for the search was December
31^st, 2017. Treatment outcomes, including conversion rate,
estimated blood loss, transfusion rate, operative time, hospital stay,
morbidity and mortality were evaluated. Results: A total of 2566 articles
were initially evaluated, and 20 studies included in the meta-analysis (18
observational and 2 randomized trials). Conversion rate was 8.7%.
Laparoscopic LLS showed shorter hospital stay [mean difference
(MD)=-2.19days; 95%CI -2.70-(-1.67); I²=78%, P=< 0.001;
N=3116]; lower blood loss [MD=-119.81ml; 95%CI -127.90-(-111.72);
I²=32%; P=< 0.001, N=618]; lower transfusion rate [risk
difference [RD]=-0.06; 95%CI -0.08-(-0.04); P=< 0.001; I²=12%;
N=2924]; marginal decrease in overall morbidity [RD=-0.03; 95%CI
-0.06-(-0.00); P=0.07; I²=0%; N=3224]; and lower perioperative
mortality [RD=-0.02; 95%CI -0.02-(-0.01); P=0.01; I²=0%;
N=3288]. There was no difference regarding operative time, cardiac and
pulmonary complications and reoperation rate between the groups.
Conclusion: Laparoscopic had better perioperative results than open
approach and should be recommended as the gold-standard approach for
LLS.<br/>Copyright &#xa9; 2018

<83>
Accession Number
624231998
Title
Effect of anti-arrhythmic medication drug interactions on thrombotic and
bleeding outcomes in patients with atrial fibrillation.
Source
Research and Practice in Thrombosis and Haemostasis. Conference: 64th
Annual Meeting of the Scientific Standardization Committee of the
International Society on Thrombosis and Haemostasis. Ireland. 2
(Supplement 1) (pp 221), 2018. Date of Publication: July 2018.
Author
Wanat M.; Wang X.; Abughosh S.; Chen H.; Johnson M.; Fleming M.
Institution
(Wanat, Wang) University of Houston, Department of Pharmacy Practice and
Translational Research, Houston, United States
(Abughosh, Chen, Johnson, Fleming) University of Houston, Department of
Pharmaceutical Health Outcomes and Policy, Houston, United States
Publisher
Wiley-Blackwell Publishing Ltd
Abstract
Background: Optimizing anticoagulant therapy in patients with atrial
fibrillation (AF) is essential to reduce the risk of thromboembolic events
and improve quality of life. No real world studies have addressed the
effect of antiarrhythmic medications (AADs) on outcomes in patients with
non-valvular atrial fibrillation (NVAF). Aims: To evaluate thrombosis and
bleeding in patients receiving apixaban versus warfarin, and a concomitant
anti-arrhythmic medication. Methods: This was a retrospective cohort study
using a large electronic medical record (2012-2016). Patients aged 18
years with a diagnosis of NVAF and on warfarin or apixaban, in addition to
an AAD were included. Select exclusion criteria included venous
thromboembolism and cardiac surgery during the 12 months prior to the
index date. The primary endpoint was a composite of stroke (ischemic or
hemorrhagic) or systemic embolism. The primary safety endpoint was major
bleeding (ISTH definition). Patients were matched using propensity
scoring. Univariate survival analyses were conducted using the log-rank
test and Kaplan-Meier survival curves. A Cox Proportional Hazards Model
was used to estimate the risk-adjusted effect of treatment on time until
outcome. Results: 3,774 patients met inclusion criteria, and 2,496 were
included in the propensity matching. There were no differences in baseline
characteristics with respect to age, comorbidities, CHADS2-Vasc score, and
concurrent medications. The most commonly used AAD was amiodarone (54.41%
vs. 56.17%, P=0.9062).The primary endpoint occurred in 1.04% (n=13) of
patients in the apixaban group compared to 1.36% (n=17) in the warfarin
group (HR=0.5, P=0.4236). Major bleeding occurred at a similar between the
apixaban group (5.29%, n=66) and the warfarin group (6.89%, n=86)
(P=0.0763). Conclusions: There was no difference in thrombotic or bleeding
outcomes in patients with NVAF on apixaban or warfarin, and a concomitant
AAD. Further randomized controlled trials should be performed to assess
the effect of drug interactions.

<84>
Accession Number
624231866
Title
Risk of thrombosis and bleeding in patients treated with warfarin or
apixaban for non-valvular atrial fibrillation: A large, national,
retrospective study.
Source
Research and Practice in Thrombosis and Haemostasis. Conference: 64th
Annual Meeting of the Scientific Standardization Committee of the
International Society on Thrombosis and Haemostasis. Ireland. 2
(Supplement 1) (pp 216), 2018. Date of Publication: July 2018.
Author
Wanat M.; Wang X.; Abughosh S.; Chen H.; Johnson M.; Fleming M.
Institution
(Wanat) University of Houston, Department of Pharmacy Practice and
Translational Research, Houston, United States
(Wang, Abughosh, Chen, Johnson, Fleming) University of Houston, Department
of Pharmaceutical Health Outcomes and Policy, Houston, United States
Publisher
Wiley-Blackwell Publishing Ltd
Abstract
Background: Optimizing anticoagulant therapy in patients with atrial
fibrillation (AF) is essential to reduce the risk of thromboembolic events
and improve quality of life. Limited real world (phase IV) data is
available comparing anticoagulant outcomes. Aims: To evaluate thrombotic
and bleeding endpoints in patients with non-valvular atrial fibrillation.
Methods: A retrospective cohort study was conducted using a large United
States electronic medical record (2012-2016). Patients aged 18 years with
a diagnosis of NVAF and on warfarin or apixaban were included. Select
exclusion criteria included previous venous thromboembolism and recent
cardiac surgery. The primary endpoint was a composite of stroke (ischemic
or hemorrhagic) or systemic embolism. The primary safety endpoint was
major bleeding using the ISTH definition. Patients were matched using
propensity scoring. Univariate survival analyses were conducted by using
the log-rank test and Kaplan-Meier survival curves. A Cox Proportional
Hazards Model was used to estimate the risk-adjusted effect of treatment
on time until outcome. Outcomes were defined as time to first event.
Results: A total of 332,100 patients with NVAF were identified, of which
31,612 patients met inclusion criteria, and 20,378 were included in the
propensity matching analysis. There were no differences in baseline
characteristics with respect to age, comorbidities, CHADS2-Vasc score, and
concurrent medications. The primary endpoint occurred in 122 (1.2%)
patients in the apixaban group compared to 166 (1.63%) patients in the
warfarin group (HR 0.84, P<0.0001). Major bleeding occurred at a lower
rate in the apixaban group (n=600 5.89%) compared to the warfarin group
(n=887 8.71%) (OR 1.54, P<0.00001). Conclusions: There was a statistically
significant reduction in thrombotic and bleeding outcomes seen with
apixaban compared to warfarin. Further randomized controlled trials should
be performed to assess the real world effectiveness of oral
anticoagulants.

<85>
Accession Number
624231405
Title
Benefits of a community cardiac rehabilitation program in stable angina.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. Conference: 2016
Annual Scientific Meeting of the Canadian Association of Cardiovascular
Prevention and Rehabilitation. Canada. 36 (5) (pp 387), 2016. Date of
Publication: September - October 2016.
Author
Yeung C.; Firth W.; Giacomantonio N.
Institution
(Yeung, Firth, Giacomantonio) Dalhousie University, Halifax, NS, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Cardiac Rehabilitation (CR) has been shown to reduce morbidity
and mortality in multiple controlled clinical trials in patients with
ischemic heart disease, and is recommended in cardiovascular society
guidelines. There are numerous indications for CR, including acute
coronary syndromes (ACS), stable angina, chronic heart failure, or
post-procedure following several cardiovascular interventions. Despite
ample evidence supporting CR, there remains a paucity of research
evaluating CR specifically for stable angina. OBJECTIVE: This
retrospective study aims to examine the effects of a 12-week community CR
program on patients with stable angina. METHODS: Subjects enrolled and
completing the Community Cardiovascular Hearts in Motion (CCHIM) CR
program in Halifax, Nova Scotia, between 2010-2014, were included for
analysis. CR patients with a referral diagnosis of known chronic stable
angina or coronary artery disease were compared with patients referred
following ACS, percutaneous coronary intervention (PCI), or coronary
artery bypass graft (CABG) surgery. Analysis includes descriptive
statistics of demographic and clinical characteristics, and comparison of
longitudinal anthropomorphic, physiologic, and laboratory outcome data
using matched-pairs t-test analysis. RESULTS: Of patients completing the
CCHIM CR program, 95 were referred with chronic stable angina or coronary
artery disease and 199 were referred with ACS, PCI, or CABG surgery. In
both groups of patients, statistically significant reductions at 3-months
follow-up post-program were observed in body mass index (BMI), weight,
waist circumference, and systolic blood pressure. In the stable angina
group, improvements remained significant at 12-months follow-up for BMI (p
= 0.0039) and weight (p = 0.0014). Both groups demonstrated significantly
improved cardiovascular fitness at both 3- and 12-months follow-up. Lipid
profile trends improved longitudinally, with significant improvements in
calculated high-density lipoprotein levels after 12 months for both
groups. In the stable angina group, calculated lowdensity lipoprotein
levels decreased significantly after 3 months (p = 0.024) and 12 months (p
= 0.019). CONCLUSION: Following completion of a community cardiac
rehabilitation program, numerous benefits were observed in stable angina
and ischemic heart disease patients. The study of CR in stable angina
merits ongoing attention to further support strong guideline
recommendations and associated morbidity and mortality benefit.

<86>
Accession Number
624231402
Title
Assessing the impact of accelerometry device use on exercise motivation
and clinical outcomes in patients attending cardiac rehabilitation
following percutaneous coronary intervention or cardiac surgery.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. Conference: 2016
Annual Scientific Meeting of the Canadian Association of Cardiovascular
Prevention and Rehabilitation. Canada. 36 (5) (pp 386), 2016. Date of
Publication: September - October 2016.
Author
Mundle J.S.; MacLeod J.B.; Hassan A.; Lutchmedial S.
Institution
(Mundle, MacLeod, Hassan, Lutchmedial) Cardiovascular Research New
Brunswick, Saint John, NB, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: An accelerometer, like a pedometer, is a device used to
measure human activity but with more advanced features. Accelerometer
device use (ADU) has been shown in the general population to increase
caloric expenditure through better selfawareness of daily exertion. Little
is known, however, regarding the effect of ADU in patients with
cardiovascular disease. The primary objectives of this study were: (1) to
assess the impact of ADU on six-month clinical and biochemical
characteristics of patients attending cardiac rehabilitation who had
recently undergone percutaneous coronary intervention (PCI) or cardiac
surgery; and (2) to determine if ADU resulted in an overall increase in
physical activity in these patients. METHODS: Patients having undergone
PCI or cardiac surgery and attending a 10-week cardiac rehabilitation
program at the New Brunswick Heart Centre at the time of the study were
approached for recruitment. Consenting participants were matched according
to age (above or below 65 years) and gender and then randomized to the
"accelerometer" (study) group or the "no accelerometer" (control) group.
Participants in the study group were instructed to wear their
accelerometer device a minimum of 10 hours per day and for 3 days per week
up to a maximum of 30 days. Participants in both groups were asked to
self-report daily estimates of their physical activity via a
questionnaire. Groups were compared on the basis of baseline and six-month
clinical characteristics (physical function, anxiety, depression, blood
pressure), biochemical characteristics (lipid profile, cholesterol,
fasting blood sugar, glycated hemoglobin, creatinine) and self-reported
daily activity (sedentary, light-moderate, vigorous). RESULTS: A total of
50 participants were included in the final analysis (study: n = 30;
control: n = 20). Of these, 39 (78%) completed their six-month assessment.
There were no differences between the two groups in terms of baseline and
6-month clinical and biochemical characteristics. Self-reported daily
activity were also similar between the study and control groups in terms
of mean estimated time spent in sedentary (424.2 +/- 144.3 vs. 424.2 mean
+/- 155.1, p = 0.999); light-moderate (172.4 +/- 145.2 vs. 166.2 +/-
137.9, p = 0.88); and vigorous activity (3.4 +/- 8.5 vs. 9.5 +/- 28.9, p =
0.37). CONCLUSION: In patients attending cardiac rehabilitation following
PCI or cardiac surgery, ADU was not associated with improved clinical or
biochemical outcomes or increased activity levels. Based on these results,
ADU in patients attending cardiac rehabilitation following PCI or cardiac
surgery cannot be recommended.

<87>
Accession Number
624231536
Title
Women's health care use following cardiac rehabilitation.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. Conference: 2015
Annual Scientific Meeting of the Canadian Association of Cardiovascular
Prevention and Rehabilitation. Canada. 35 (5) (pp 374), 2015. Date of
Publication: September - October 2015.
Author
Midence L.; Oh P.; Grace S.L.
Institution
(Midence, Grace) York University, Toronto, ON, Canada
(Oh, Grace) University Health Network, Toronto, ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Cardiac rehabilitation (CR) participation is associated with
significantly lower morbidity, even among women who may have poorer
outcomes. This may be due to less recurrent events requiring
re-hospitalization, and/or appropriate outpatient followup with healthcare
providers. The objectives of this study were to: describe women's cardiac
healthcare use during CR, and follow-up care by primary practitioners, and
whether these differed by the program model they attended. METHODS:
Secondary analysis of a single-blind randomized controlled trial with 3
parallel arms was undertaken. Low-risk coronary artery disease patients
were recruited from 6 hospitals in Ontario. Consenting participants
completed pre-program surveys and clinical data were extracted from
charts. Eligible women were randomized, and referred to CR at 1 of 3
sites. Six months later, participants were asked to complete post-program
surveys assessing healthcare use. RESULTS: 264 (26.3%) patients consented,
of which 169 (64.0%) were randomized. 144 (87.8%) enrolled in CR, of which
99 (68.8%) attended their randomized model. The 116 (68.6%) participants
retained at post-test were older, less likely to provide care to someone
in their home, and had higher CR program adherence than those lost to
followup. During CR, participants saw a family doctor a mean of
4.60+/-4.09 times, a heart specialist 2.20+/-2.06 times, went to the
emergency department 0.48+/-1.08 times, and been admitted to the hospital
for heart-related symptoms 0.38+/-0.79 times. 86 (77.5%) had not
experienced any heart problems. 15 (13.8%) had angina, 14 (12.6%)
percutaneous coronary intervention, 5 (4.5%) each a myocardial infarction,
bypass+/-valve surgery, 2 (1.8%) peripheral vascular disease, and 1 (0.9%)
each heart failure, heart transplant, cardiac rhythm device insertion, or
stroke. 55 (57.9%) had an appointment with their general practitioner
post-CR. Of these, 14 (25.5%) said their healthcare provider had
correspondence from the CR program at their appointment, 16 (29.1%) did
not, and 25 (45.5%) did not know. Of these participants, 21 (38.2%)
discussed their experiences and health changes from the CR program with
their healthcare provider, and 33 (60.0%) did not. Participants attending
home-based CR (5.9%) were less likely than those attending mixed-sex
(30.4%) CR to have a doctor's appointment post-CR (p<.001). These
associations sustained adjustment for the retention differences identified
above. No other differences were observed. CONCLUSION: Many women
experienced interim events which may impact their course of CR, and
continuity of care post-CR with general practitioners is inconsistent.
There is an opportunity for improved care integration in the community.