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<1>
Accession Number
620550659
Title
Right ventricular systolic function in patients undergoing transcatheter
aortic valve implantation: A systematic review and meta-analysis.
Source
International Journal of Cardiology. 257 (pp 40-45), 2018. Date of
Publication: 15 Apr 2018.
Author
Ren B.; Spitzer E.; Geleijnse M.L.; Zijlstra F.; de Jaegere P.P.T.; Van
Mieghem N.M.; Tijssen J.G.
Institution
(Ren, Spitzer, Geleijnse, Zijlstra, de Jaegere, Van Mieghem) Department of
Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
(Tijssen) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
Publisher
Elsevier Ireland Ltd
Abstract
Background: Right ventricular (RV) systolic dysfunction is associated with
worse survival in patients undergoing surgical aortic valve replacement
(SAVR), yet it is not included in traditional risk scores of transcatheter
aortic valve implantation (TAVI) candidates. We aimed to evaluate the
prognostic value of RV systolic function on clinical outcomes in patients
undergoing TAVI at one year follow-up; and, echocardiographic changes of
RV systolic function up to 12 months after TAVI and compared with SAVR
when possible. Methods and results: This systematic review and
meta-analysis is registered in PROSPERO (CRD42017065761). Studies
investigating RV systolic function with echocardiography in TAVI cohorts
were identified from Medline, Embase and Cochrane databases. We used
random-effects models to assess differences in primary outcomes.
Twenty-one studies were identified, where RV systolic function and
clinical outcomes were assessed in eight (4016 patients) and RV systolic
function changes were evaluated in 14 (1709 patients). For the primary
outcome of all-cause death at one year, RV systolic dysfunction was
associated with a significant 78% relative risk increase (risk ratio[95%
confidence interval (CI)]) = 1.78[1.37, 2.31], P < 0.01), albeit
significant heterogeneity (I² = 64%, P < 0.01). RV systolic
function was unchanged after TAVI throughout follow-up as shown with
tricuspid annular plane systolic excursion (TAPSE)(mean difference[95%
CI]pre-discharge = 0.03 [-0.92,0.99]mm,1-3 months =
-0.09[-0.89,0.71]mm,6-12 months = 0.52 [-0.29,1.32] mm, all P = NS), while
TAPSE was significantly reduced after SAVR (pre-discharge =
-10.17[-13.11,-7.24]mm, P < 0.01;1-3 months = -7.3[-8.17,-6.44]mm, P <
0.01;6-12 months = -5.99[-7.95,-4.03]mm, P < 0.01). Conclusions: RV
systolic dysfunction was associated with a significant increase in
all-cause mortality at one year after TAVI. RV systolic function was
unchanged after TAVI up to 12 months, whereas deteriorated significantly
after SAVR.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<2>
Accession Number
619209390
Title
Feasibility of the Use of Transesophageal Echocardiography as a Surface
Probe for Puncturing and Catheterization of the Internal Jugular Vein: A
Randomized Controlled Pilot Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 363-369),
2018. Date of Publication: February 2018.
Author
Teng Y.; Ou M.; Yu H.
Institution
(Teng, Ou, Yu) Department of Anaesthesiology, West China Hospital, Sichuan
University, Chengdu, Sichuan, China
Publisher
W.B. Saunders
Abstract
Objective: To compare the transesophageal echocardiography (TEE) probe as
a surface probe with the vascular probe for guiding internal jugular vein
(IJV) catheterization. Design: Prospective, randomized, controlled pilot
study. Setting: University hospital. Participants: One hundred cardiac
surgery patients, including 50 adult and 50 pediatric patients.
Interventions: Patients in the TEE probe group received right IJV
catheterization using the TEE probe, while the vascular probe group used
the vascular probe for catheterization. Measurements and Main Results: The
puncture time, first-attempt success rate, quality of the imaging with
needle tip positioning, wire positioning, and catheter positioning were
recorded. The incidence of complication or any adverse event also was
observed. Adult patients: In the vascular probe group, the success rate
for first attempt IJV catheterization was 24/25 (96%), while in the TEE
probe group, the success rate for first attempt IJV catheterization was
25/25 (100%). There was no statistical difference in the puncture time,
image quality, needle tip positioning, wire positioning, and catheter
positioning between groups (p > 0.05). Pediatric patients: The success
rate for first-attempt IJV catheterization was 100% in both groups, and
there were no statistical differences in the puncture time, image quality,
and positioning between the 2 groups (p > 0.05). No complications or
adverse events were observed in either group. Conclusion: The TEE probe,
used as a surface probe, can be used to guide IJV puncturing and
catheterization in cardiac surgery patients with favorable feasibility and
safety.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<3>
Accession Number
620505345
Title
Prophylaxis of postoperative nausea and vomiting after cardiac surgery in
high-risk patients: A randomized controlled study.
Source
Annals of Cardiac Anaesthesia. 21 (1) (pp 8-14), 2018. Date of
Publication: January-March 2018.
Author
Champion S.; Zieger L.; Hemery C.
Institution
(Champion, Zieger, Hemery) Intensive Care Unit, Parly 2 Clinic, Ramsay
Generale de Sante, Le Chesnay 78150, France
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Context: The role of prophylaxis for postoperative nausea and vomiting
(PONV) in cardiac surgery is under debate. Aims: To study the risk factors
for PONV after cardiac surgery and the role of betamethasone with or
without droperidol for its prevention. Setting and Design: Randomized
open-label controlled study comparing standard care with PONV prophylaxis
from February to November 2016. Methods: Five hundred and two patients
with planned nonemergent cardiac surgery were included. Interventions: In
the intervention arm, PONV prophylaxis (4 mg betamethasone with/without
0.625 mg droperidol) was administered in high-risk patients (two or more
risk factors). Patients in the control arm were treated as per routine
hospital practices. Results: Female sex, past history of PONV, and
migraines were associated with a significantly increased risk of PONV,
while motion sickness, smoking status, and volatile anesthetics were not.
Pain and treatment with nefopam or ketoprofen were associated with an
increased risk of PONV. PONV was less frequent in the active arm compared
to controls (45.5% vs. 54.0%, P = 0.063; visual analogic scale 10.9 vs.
15.3 mm, P = 0.043). Among the 180 patients (35.6%) with >=2 risk factors,
prophylaxis was associated with reduced PONV (intention-to-treat: 46.8%
vs. 67.8%, P = 0.0061; per-protocol: 39.2% vs. 69%, P = 0.0002). In
multivariate analysis, prophylaxis was independently associated with PONV
(odds ratio [OR]: 0.324, 95% confidence interval: 0.167-0.629, P =
0.0009), as were female sex, past history of PONV, and migraines (OR:
3.027, 3.031, and 2.160 respectively). No drug-related side effects were
reported. Conclusion: Betamethasone with/without droperidol was effective
in decreasing PONV in high risk cardiac surgical patients without any side
effect.<br/>Copyright &#xa9; 2018 Annals of Cardiac Anaesthesia, Published
by Wolters Kluwer- Medknow.

<4>
Accession Number
620505314
Title
A randomized controlled trial comparing the myocardial protective effects
of isoflurane with propofol in patients undergoing elective coronary
artery bypass surgery on cardiopulmonary bypass, assessed by changes in
N-terminal brain natriuretic peptide.
Source
Annals of Cardiac Anaesthesia. 21 (1) (pp 34-40), 2018. Date of
Publication: January-March 2018.
Author
Kuppuswamy B.; Davis K.; Sahajanandan R.; Ponniah M.
Institution
(Kuppuswamy, Davis, Sahajanandan, Ponniah) Department of Anaesthesia,
Christian Medical College, Vellore, Tamil Nadu, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Objective: The objective of the study is to compare the myocardial
protective effects of isoflurane with propofol in patients undergoing
elective coronary artery bypass surgery on cardiopulmonary bypass (CPB),
the cardio protection been assessed by changes in N-terminal brain
natriuretic peptide (NT proBNP). Methodology and Design: This study is
designed as a participant blinded, prospective randomized clinical trial.
Setting: Christian Medical College Hospital, Vellore, India. Participants:
Patients undergoing elective coronary artery bypass surgery on CPB.
Intervention: Anesthesia was maintained with 0.8-1.2 end tidal
concentrations of isoflurane in the isoflurane group and in the propofol
group, anesthesia was maintained with propofol infusion as described by
Roberts et al. Measurements: Hemodynamic data were recorded at frequent
intervals during the surgery and up to 24 h in the Intensive Care Unit
(ICU). The other variables that were measured include duration of
mechanical ventilation, dose and duration of inotropes in ICU, (inotrope
score), duration of ICU stay, NT proBNP levels before induction and 24 h
postoperatively, creatine kinase-MB levels in the immediate postoperative,
first and second day. Results: Mean heart rate was significantly higher in
propofol group during sternotomy, (P = 0.021). Propofol group had a
significantly more number of patients requiring nitroglycerine in the
prebypass period (P = 0.01). The increase in NT proBNP from preoperative
to postoperative value was lesser in the isoflurane group compared to
propofol even though the difference was not statistically significant. The
requirement of phenylephrine to maintain mean arterial pressure within 20%
of baseline, mechanical ventilation duration, inotrope use, duration of
ICU stay and hospital stay were found to be similar in both groups.
Conclusion: Propofol exhibit comparable myocardial protective effect like
that of isoflurane in patients undergoing coronary artery bypass graft
surgery. Considering the unproven mortality benefit of isoflurane and the
improved awareness of green OT concept, propofol may be the ideal
alternative to volatile anesthetics, at least in patients with good left
ventricular function.<br/>Copyright &#xa9; 2018 Annals of Cardiac
Anaesthesia, Published by Wolters Kluwer- Medknow.

<5>
Accession Number
620505305
Title
Dexmedetomidine for prevention of skeletal muscle ischaemia-reperfusion
injury in patients with chronic limb ischaemia undergoing aortobifemoral
bypass surgery: A prospective double-blind randomized controlled study.
Source
Annals of Cardiac Anaesthesia. 21 (1) (pp 22-25), 2018. Date of
Publication: January-March 2018.
Author
Kundra T.S.; Thimmarayappa A.; Dhananjaya M.; Manjunatha N.
Institution
(Kundra, Thimmarayappa, Dhananjaya, Manjunatha) Department of Cardiac
Anaesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and
Research, Bengaluru, Karnataka, India
(Kundra) Kothi No. 184, Phase 4, Mohali, Punjab, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: Dexmedetomidine is a selective alpha-2 agonist used for
sedation. It has also been shown to have myocardial protective effect and
prevent ischemia-reperfusion injury in off-pump coronary artery bypass
patients. The aim of our study was to assess the effect of dexmedetomidine
for prevention of skeletal muscle ischemia-reperfusion injury in patients
undergoing aortobifemoral bypass surgery. Methodology: Sixty adult
patients (Group dexmedetomidine n = 30, Group normal saline n = 30)
undergoing aortobifemoral bypass surgery were recruited over 3 months.
Randomization was done using a computer-generated random table. The
attending anesthesiologist would be blinded to whether the drug/normal
saline was being administered. He would consider each unlabeled syringe as
containing dexmedetomidine and calculate the volume to be infused via a
syringe pump accordingly. Dexmedetomidine infusion (1 mcg/kg) over 15
minutes was given as a loading dose, followed by maintenance infusion of
0.5 mcg/kg/h till 2 h postprocedure in Group dexmedetomidine (D) while the
same volume of normal saline was given in the control Group C till 2 h
postprocedure. Creatine phosphokinase (CPK) values were noted at baseline
(T0), 6 h (T1), 12 h (T2), and 24 h (T3) after the procedure. Hemodynamic
variables (heart rate [HR] and mean blood pressure [MAP]) were recorded at
T0, T1, T2, and T3. Results were analyzed using unpaired Student's t-test,
P < 0.05 was considered statistically significant. Results: MAP and HR
significantly decreased in Group D as compared to control group (P <
0.05). However, the decrease was never <20% of the baseline. The CPK
values at 6, 12, and 24 h were statistically significant between the two
groups. Conclusion: Dexmedetomidine prevents skeletal muscle
ischemia-reperfusion injury in patients undergoing aortobifemoral bypass
surgery.<br/>Copyright &#xa9; 2018 Annals of Cardiac Anaesthesia,
Published by Wolters Kluwer- Medknow.

<6>
Accession Number
2001191290
Title
The East-West late lumen loss study: Comparison of angiographic late lumen
loss between Eastern and Western drug-eluting stent study cohorts.
Source
American Heart Journal. 206 (pp 61-71), 2018. Date of Publication:
December 2018.
Author
Harrison R.W.; Radhakrishnan V.; Allen J.C.; Lam P.S.; Allocco D.J.; Brar
S.; Fahy M.; Zhang Z.; Fisher R.; Ikeno F.; Genereux P.; Kimura T.; Liu
M.; Lye W.K.; Nagai H.; Suzuki Y.; White R.; Krucoff M.W.
Institution
(Harrison, Radhakrishnan, Fisher, White, Krucoff) Duke University Medical
Center/Duke Clinical Research Institute, Durham, NC, United States
(Allen, Lye) Duke-NUS Medical School Singapore, Singapore
(Lam, Allocco) Boston Scientific Corporation, Marlborough, MA, United
States
(Brar, Fahy, Liu) Medtronic, Inc., Santa Rosa, CA, United States
(Zhang) Abbott Vascular, Santa Clara, CA, United States
(Ikeno) Stanford University, Stanford, CA, United States
(Genereux) Cardiovascular Research Foundation, New York, NY, United States
(Kimura) Kyoto University, Kyoto, Japan
(Nagai) Terumo Corporation, Tokyo, Japan
(Suzuki) Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Regulatory decisions approving new coronary drug-eluting stent
(DES) require mechanistic observations of angiographic late lumen loss
(LLL). Patient safety and device approval times could be enhanced if
angiographic follow-up data were found to be generalizable across
jurisdictions and geographies. The objectives were to assess the
comparability of in-segment LLL in Eastern and Western DES populations
using the world's largest compilation of follow-up quantitative coronary
angiography data. Methods: Data from 4 manufacturers involving 29 DES
clinical trials in Eastern and Western hemispheres were compiled. "East"
and "West" cohorts were defined by trial location. Independent core
laboratories quantified in-segment LLL for all studies. East and West were
compared before and after adjustment for clinical and anatomic covariates
known to correlate with LLL via conditioning on propensity score
quintiles. An international panel of experts and regulators prospectively
established a clinically meaningful difference between East and West mean
in-segment LLL of +/-0.40 mm. Results: The data set comprised 2,047 East
and 4,456 West patients. Unadjusted mean +/- SD for West and East
in-segment LLL (mm) was 0.25 +/- 0.46 and 0.12 +/- 0.42, respectively
(difference 0.13 mm; 95% CI 0.11-0.16). Propensity score-adjusted
in-segment LLL East and West least squares means were 0.11 and 0.26 mm,
respectively (difference 0.15 mm; 95% CI 0.13-0.18). Conclusions: In the
world's largest compilation of DES protocol 8- to 13-month angiographic
follow-up data, clinically meaningful comparability of in-segment LLL by
independent core laboratory quantitative coronary angiography in East and
West cohorts was demonstrated in both unadjusted and adjusted comparisons.
These findings suggest that DES LLL, once characterized, could be
generalized across regulatory jurisdictions over the course of global
registration efforts.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<7>
[Use Link to view the full text]
Accession Number
624266263
Title
Early post-operative cognitive dysfunction after closed-loop versus manual
target controlled-infusion of propofol and remifentanil in patients
undergoing elective major non-cardiac surgery: Protocol of the randomized
controlled single-blind POCD-ELA trial.
Source
Medicine. 97 (40) (pp e12558), 2018. Date of Publication: 01 Oct 2018.
Author
Besch G.; Vettoretti L.; Claveau M.; Boichut N.; Mahr N.; Bouhake Y.; Liu
N.; Chazot T.; Samain E.; Pili-Floury S.
Institution
(Besch, Vettoretti, Claveau, Boichut, Mahr, Bouhake, Samain, Pili-Floury)
Department of Anesthesiology and Intensive Care Medicine, University
Hospital of Besancon, University of Franche-Comte, Besancon
(Liu, Chazot) Department of Anesthesia, Foch Hospital, Suresnes, France,
and Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Post-operative cognitive dysfunction (POCD) is frequent in
patients older than 60 years undergoing major non-cardiac surgery, and
increases both morbidity and mortality. Anesthetic drugs may exert
neurotoxic effects and contribute to the genesis of POCD. The hypothesis
of the POCD-ELA trial was that closed-loop target-controlled infusion of
propofol and remifentanil could reduce the occurrence of POCD by
decreasing the risk of excessive depth of anesthesia and the dose of
anesthetic drugs.
METHODS AND ANALYSIS: We designed a single-center, single-blind,
randomized, controlled, parallel trial and aim to include 204 patients
aged >60 years undergoing elective major non-cardiac surgery. Patients
will be randomized to receive closed-loop versus manual target-controlled
infusion of propofol and remifentanil guided by bispectral index
monitoring. Cognitive assessment will be performed the day before surgery
(baseline) and within 72 hours after surgery, using a battery of validated
neuropsychological tests. The primary outcome is the incidence of POCD
within 72 hours after surgery. POCD is defined as a Z-score value > 1.96
for at least 2 different tests or a Z-score composite value >1.96. The
calculation of the Z-score is based on data from an age-matched control
population who did not undergo surgery or general anesthesia.
ETHICS AND DISSEMINATION: This study was approved by the Ethics Committee
(Comite de Protection des Personnes Est-II) and authorized by the French
Health Products Agency (Agence Nationale de Securite des Medicaments,
Saint-Denis, France). The University Hospital of Besancon is the trial
sponsor and the holder of all data and publication rights. Results of the
study will be submitted for publication in a peer-review international
medical journal and for presentation in abstract (oral or poster) in
international peer-reviewed congresses.
REGISTRATION: The trial is registered with ClinicalTrials.gov (Identifier:
NCT02841423, principal investigator: Prof Emmanuel Samain, date of
registration: July 22, 2016). Last amendment of protocol: version 8.0
April 2018.

<8>
[Use Link to view the full text]
Accession Number
624265361
Title
Comparison of transcatheter closure, mini-invasive closure, and open-heart
surgical repair for treatment of perimembranous ventricular septal defects
in children: A PRISMA-compliant network meta-analysis of randomized and
observational studies.
Source
Medicine. 97 (40) (pp e12583), 2018. Date of Publication: 01 Oct 2018.
Author
Yi K.; You T.; Ding Z.-H.; Hou X.-D.; Liu X.-G.; Wang X.-K.; Tian J.-H.
Institution
(Yi, You, Hou, Liu, Wang) Department of Cardiovascular Surgery, Gansu
Provincial Hospital, China
(Yi, You) International Congenital Heart Disease Diagnosis and Treatment
Regional Center
(Ding) Nursing Department, Gansu Provincial Hospital, China
(Tian) Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China
Publisher
NLM (Medline)
Abstract
METHODS: Five databases were systematically searched including Chinese
Biomedical Literature Database, China National Knowledge Infrastructure,
PubMed, EMBASE.com, and the Cochrane Central Register of Controlled Trials
from the starting date of each database to February 2017. Tools for
assessing the risk of bias in nonrandomized studies of interventions
(ROBINS-I) were used to evaluate the risk of bias in observational studies
and Cochrane Handbook version 5.1.0 was used for randomized controlled
trials (RCTs). Data were analyzed using R-3.4.0 software and Review
Manager 5.2.
RESULTS: Three RCTs and 24 observational studies were included in our
study. Network meta-analysis result demonstrated that transcatheter
closure was the most effective treatment in terms of operative time
[standardized mean difference (SMD) = -2.02, 95% confidence interval (CI):
-3.92 to -0.12], major complications [odds ratio (OR) = 0.52, 95% CI =
0.30-0.91], ICU stay (SMD = -1.11, 95% CI = -2.13 to -0.08), and hospital
stay (SMD = -1.81, 95% CI = -2.24 to -1.39). However, open-heart surgical
repair showed a higher success rate of the procedure than transcatheter
closure (OR = 0.36, 95% CI = 0.17-0.77).Statistical analysis result
demonstrated that transcatheter closure had the best potential to lessen
major complications, ICU stay, hospital stay, operative time, and
significant residual shunt.
CONCLUSIONS: Transcatheter closure has more benefit than mini-invasive
closure and open-heart surgical repair to treat pmVSDs.
OBJECTIVE: Our study was aimed to comprehensively compare the relative
efficacy, safety, and the cost of transcatheter closure, mini-invasive
closure, and open-heart surgical repair to treat perimembranous
ventricular septal defects (pmVSDs) in children using network
meta-analysis method.

<9>
Accession Number
622495957
Title
Early negative fluid balance is associated with lower mortality after
cardiovascular surgery.
Source
Perfusion (United Kingdom). 33 (8) (pp 630-637), 2018. Date of
Publication: 01 Nov 2018.
Author
Li C.; Wang H.; Liu N.; Jia M.; Zhang H.; Xi X.; Hou X.
Institution
(Li, Wang, Liu, Jia, Hou) Center for Cardiac Intensive Care, Beijing
Anzhen Hospital, Capital Medical University, Beijing, China
(Zhang) Department of Cardiovascular Surgery, National Center for
Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing, China
(Xi) Intensive Care Unit, Fuxing Hospital, Capital Medical University,
Beijing, China
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Early fluid expansion could prevent postoperative organ
hypoperfusion. However, excessive fluid resuscitation adversely influences
multiple organ systems. This retrospective, observational study aimed to
investigate the relationship between early negative fluid balance and
postoperative mortality in critically ill adult patients following
cardiovascular surgery. Methods: In total, 567 critically ill patients who
had undergone cardiovascular surgery and whose intensive care unit length
of stay (LOS) was more than 24 hours were enrolled. The baseline
characteristics, daily fluid balance and cumulative fluid balance were
obtained. Patients were followed until discharge or day 28. Multivariate
logistic regressions adjusted by propensity score were used to analyze the
relationship between early negative fluid balance and postoperative
mortality. Results: Overall, postoperative mortality was 6.2% (35/567).
Acute Physiology and Chronic Health Evaluation II on admission (odd ratios
[OR] 1.110), acute kidney injury stage (OR 1.639) and renal replacement
therapy received (OR 3.922) were the independent risk factors of
postoperative mortality, whereas negative daily fluid balance at day 2 (OR
0.411) was the protective factor. Patients with a negative daily fluid
balance at day 2 had lower postoperative mortality (3.4% vs. 12.2% in the
positive fluid balance group), lower acute kidney injury (AKI) stage, were
less likely to receive renal replacement therapy (RRT) and experienced
shorter hospital LOS compared with those with a daily positive fluid
balance. Conclusion: This retrospective, observational study indicates
that early negative fluid balance is associated with lower postoperative
mortality in critically ill patients following cardiovascular surgery.
Further prospective, randomized trials are needed to prove the benefits
from the restrictive fluid management strategy.<br/>Copyright &#xa9; The
Author(s) 2018.

<10>
Accession Number
624611984
Title
Sleep patterns at hospital discharge in infants undergoing cardiac
surgery.
Source
Journal of Sleep Research. Conference: 30th ASM of Australasian Sleep
Association and Australasian Sleep Technologists Association, Sleep
DownUnder 2018. Australia. 27 (Supplement 2) (no pagination), 2018. Date
of Publication: October 2018.
Author
Boynton A.; Pearson K.; Long D.; Chawla J.
Institution
(Boynton, Pearson, Long, Chawla) Lady Cilento Children's Hospital,
Brisbane, Australia
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: There is minimal existing literature regarding the role of
sleep as a modulator of outcomes in critically ill children both within
the PICU environment and after discharge. Studies of adults admitted to
the ICU demonstrate a number of sleep difficulties including decreased
sleep efficiency and an increase in arousal frequency. Furthermore poor
sleep quality has been shown to persist even after discharge from ICU.
Infants undergoing heart surgery for congenital heart disease undergo a
significant period of sedation, mechanical ventilation and prolonged
hospital admission. The aim of this study was to evaluate sleep in these
infants at the point of hospital discharge. Methods: The Cardiac Baby
SPICE study is a blinded randomised controlled trial comparing 2 sedation
protocols in infants undergoing cardiac surgery on bypass at <12 months of
age. As a secondary outcome measures, sleep patterns were assessed in
these infants at hospital discharge and at 6 and 12 months follow up.
Infants underwent actigraphy and parents completed the Brief Infant Sleep
Questionnaire (BISQ) each time. Results: Baseline sleep data from the BISQ
was available for 24 patients in this study who were an average age of 7
months at the time of hospital discharge (range 1-23 months). Infants
slept an average of 7.36hrs at night (5-10 hrs) and 4.37hrs during the day
(1.30-9.30 hrs), giving an overall average sleep time of 12hrs. The
average number of awakenings overnight was reported to be 2, with the
average amount of time awake at night 74mins.11/24 infants fell asleep
whilst being held and only 5 infants fell asleep in bed alone. Most
infants slept supine (n=13) but there were 4 infants who slept prone. Only
8/24 parents felt their infant had a sleep problem and in all cases this
was reported as a small problem only. Actigraphy data was also available
for a subset of patients (n=9). Discussion: Whilst parents did not feel
sleep problems were prevalent in this group of infants, this study found
the average sleep quantity to be at the lower end of recommended normal
for this age group (12-16hrs) and almost half the infants needed to be
held by parents to fall asleep. It is possible that this is related to
their prolonged hospital stay at birth and practices used for sleep during
this time. Longitudinal data will be important to determine if circadian
patterns are altered long-term in this population of infants.

<11>
Accession Number
624607032
Title
Rct comparing the LNG-IUS versus endometrial ablation in women with heavy
menstrual bleeding (MIRA).
Source
International Journal of Gynecology and Obstetrics. Conference: 22nd FIGO
World Congress of Gynecology and Obstetrics. Brazil. 143 (Supplement 3)
(pp 318-319), 2018. Date of Publication: October 2018.
Author
Beelen P.; Van Den Brink M.J.; Geomini P.M.A.J.; Dekker J.H.; Herman M.C.;
Duijnhoven R.G.; Mol B.W.J.; Berger M.Y.; Bongers M.Y.
Institution
(Beelen, Geomini, Herman) Department of Obstetrics and Gynaecology, Maxima
Medical Center, Veldhoven, Netherlands
(Van Den Brink, Dekker, Berger) Department of General Practice, University
Medical Center Groningen, Groningen, Netherlands
(Duijnhoven) Department of Obstetrics and Gynaecology, Academic Medical
Center, Amsterdam, Netherlands
(Mol) Department of Obstetrics and Gynaecology, Monash University,
Melbourne, Australia
(Bongers) Department of Obstetrics and Gynaecology, Maxima Medical Center,
Maastricht University Medical Center Veldhoven, Maastricht, Netherlands
Publisher
John Wiley and Sons Ltd.
Abstract
Objectives: Heavy menstrual bleeding (HMB) is an important health problem,
negatively affecting the physical functioning and social well-being of
many women. The levonorgestrel intrauterine system (LNG-IUS) and
endometrial ablation (EA) are two frequently applied treatments in women
with HMB. At present, large randomised controlled trials directly
comparing LNG-IUS with endometrial ablation in women with HMB are lacking.
We assessed the non-inferiority of a strategy starting with LNG-IUS
compared with endometrial ablation in a multicentre randomised controlled
trial (NTR 2984). Method: We performed a multicentre randomised controlled
non-inferiority trial in both general practices and gynaecological
practices in the Netherlands. Women with HMB, >=34 years old, without
intracavitary pathology and not planning future pregnancies were
randomised to either the LNG-IUS (Mirena) or EA (NovaSure). The primary
outcome was mean blood loss at 24 months, measured with a Pictorial Blood
Assessment Chart (PBAC) score. The non-inferiority margin was set at 25
points. Secondary outcomes included re-intervention rates, patient
satisfaction, quality of life and sexual function. Results: Between July
2012 and December 2015, we randomised 270 women to an initial treatment
with LNG-IUS (N=132, baseline PBAC 616) or EA (N=138, baseline PBAC 630).
91.5% of the women completed the 24-month follow up. At 24 months mean
PBAC scores were 64.8 in the LNG-IUS group and 14.2 in the EA group (diff
50.5 95% CI -2.7 to 197.5). The surgical re-intervention rate (EA or
hysterectomy) was 23.5% in the LNG-IUS group compared to 9.4% in the EA
group (RR 2.49, 95% CI 1.37 to 4.55). In the LNG-IUS group, 73.5% of the
women were satisfied compared to 84.3% in the EA group. Conclusions: Our
study did not demonstrate the non-inferiority of the LNG-IUS. However,
both LNG-IUS and endometrial ablation are effective treatments in reducing
HMB. Women in the endometrial ablation group had less surgical
re-interventions and seemed to be more satisfied compared to the LNG-IUS
group. The results of this study can be used in the process of shared
decision making in women suffering from HMB.

<12>
Accession Number
624613842
Title
Transcatheter repair of functional mitral regurgitation in heart failure
patients: A meta-analysis of 23 studies on mitraclip implantation.
Source
Circulation Journal. 82 (11) (pp 2800-2810), 2018. Date of Publication:
2018.
Author
De Rosa R.; Silverio A.; Baldi C.; Di Maio M.; Prota C.; Radano I.; Rey
J.; Herrmann E.; Citro R.; Piscione F.; Galasso G.
Institution
(De Rosa, Silverio, Baldi, Prota, Radano, Citro, Piscione, Galasso)
Cardiology Unit, Cardiovascular and Thoracic Department, University
Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
(Di Maio) Division of Cardiology, Department of Cardiothoracic and
Respiratory Sciences, University of Campania "Luigi Vanvitelli", Monaldi
Hospital, AORN "Ospedali dei Colli", Naples, Italy
(Rey, Herrmann) Department of Medicine, Institute of Biostatistics and
Mathematical Modelling, Goethe University Frankfurt, Frankfurt, Germany
Publisher
Japanese Circulation Society
Abstract
Background: The aim of this study was to investigate long-term survival,
clinical status, and echocardiographic findings of patients with severe
functional mitral regurgitation (FMR) undergoing MitraClip (MC) treatment
and to explore the role of baseline features on outcome. Methods and
Results: Randomized and observational studies of FMR patients undergoing
MC treatment were collected to evaluate the overall survival, New York
Heart Association (NYHA) class and echocardiographic changes after MC
treatment. Baseline parameters associated with mortality and
echocardiographic changes were also investigated. Across 23 studies
enrolling 3,253 patients, the inhospital death rate was 2.31%, whereas the
mortality rate was 5.37% at 1 month, 11.87% at 6 months, 18.47% at 1 year
and 31.08% at 2 years. Mitral regurgitation Grade <3+ was observed in
92.76% patients at discharge and in 83.36% patients at follow-up. At
follow-up, 76.63% of patients NYHA Class I-II and there were significant
improvements in left ventricular (LV) volume, ejection fraction, and
pulmonary pressure. Atrial fibrillation (AF) had a significant negative
effect on 1-year survival (beta=0.18+/-0.06; P=0.0047) and on the
reduction in LV end-diastolic and end-systolic volumes (beta=-1.05+/-0.47
[P=0.0248] and beta=-2.60+/-0.53 [P=0.0024], respectively). Conclusions:
MC results in durable reductions in mitral regurgitation associated with
significant clinical and echocardiographic improvements in heart failure
patients. AF negatively affects LV reverse remodeling and 1-year survival
after MC treatment.<br/>Copyright &#xa9; 2018, Japanese Circulation
Society. All rights reserved.

<13>
Accession Number
624465199
Title
Surgical ablation of atrial fibrillation: A systematic review
andmeta-analysis of randomized controlled trials.
Source
Europace. 20 (9) (pp 1442-1450), 2018. Date of Publication: 2018.
Author
McClure G.R.; Belley-Cote E.P.; Jaffer I.H.; Dvirnik N.; An K.R.; Fortin
G.; Spence J.; Healey J.; Singal R.K.; Whitlock R.P.
Institution
(McClure, An) Michael G. DeGroote School of Medicine, McMaster University,
1280 Main St W, Hamilton, ON L8S 4L8, Canada
(McClure, Belley-Cote, Dvirnik, Spence, Whitlock) Department of Clinical
Epidemiology and Biostatistics, McMaster University, 1280 Main St W,
Hamilton, ON L8S 4L8, Canada
(Belley-Cote, Healey) Department of Medicine, McMaster University, 1280
Main St W, Hamilton, ON L8S 4L8, Canada
(Belley-Cote, Dvirnik, Healey, Whitlock) Population Health Research
Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
(Belley-Cote, Fortin) Department of Medicine, Universite de Sherbrooke,
2500 Boulevard de l'Universite, Sherbrooke, QC J1K 2R1, Canada
(Jaffer) Thrombosis and Atherosclerosis Research Institute (TaARI),
McMaster University, 20 Copeland Ave, Hamilton, ON L8L 2X2, Canada
(Jaffer, Dvirnik, Whitlock) Department of Cardiac Surgery, McMaster
University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
(Spence) Department of Anesthesia, McMaster University, 1280 Main St W,
Hamilton, ON L8S 4L8, Canada
(Singal) Department of Surgery, University of Manitoba, 66 Chancellors
Cir, Winnipeg, MB R3T 2N2, Canada
(Singal) I.H. Asper Clinical Research Institute, St. Boniface General
Hospital, 69 Tache Avenue, Winnipeg, MB R2H 2A6, Canada
Publisher
Oxford University Press
Abstract
Aims: The aim of this review was to assess the effect of concomitant
surgical atrial fibrillation (AF) ablation on postoperative freedom from
AF and patient-important outcomes. Methods and results: We searched
Cochrane CENTRAL, MEDLINE, and EMBASE databases from inception to May 2016
for randomized controlled trials (RCTs) evaluating surgical AF ablation
using any lesion set vs. no surgical AF ablation in adults with AF
undergoing cardiac surgery. We performed screening, risk-of-bias
evaluation, and data collection independently and in duplicate. We
evaluated risk of bias with the modified Cochrane tool, quality of
evidence using GRADE framework, and pooled data with a random-effects
model. Of the 23 included studies, only one was considered at low risk of
bias. Surgical AF ablation was associated with more freedom from AF at 12
months [relative risk (RR) = 2.32, 95% confidence interval (CI) 1.92-2.80;
P < 0.001, low quality]. However, no significant difference was seen in
mortality (RR = 1.07, 95% CI 0.72-1.52; P = 0.41, moderate quality),
stroke (RR = 1.19, 95% CI 0.59-2.39; P = 0.63, moderate quality), or
pacemaker implantation (RR = 1.28, 95% CI 0.85-1.95; P = 0.24, high
quality). Comparing biatrial and left-sided lesion sets showed no
difference in mortality (P-interaction = 0.60) or stroke (Pinteraction =
0.12). At 12 months, biatrial procedures led to more freedom from AF (RR =
2.80, 95% CI 2.13-3.68; P < 0.0001) when compared with left-sided ablation
(RR = 2.00, 95% CI 1.68-2.39; P < 0.0001) (P-interaction = 0.04) Biatrial
procedures appear to increase the risk for pacemaker (RR = 2.68, 95% CI
1.41-5.11; P = 0.002) compared with no ablation while left-sided ablation
does not (RR = 1.08, 95% CI 0.67-1.74; P = 0.76) (P-interaction = 0.03).
Conclusion: Surgical AF ablation during cardiac surgery improves freedom
from AF. However, impact on patient-important outcomes including mortality
and stroke has not shown statistical significance in current RCT evidence.
Biatrial compared with left-sided lesion sets showed no difference in
mortality or stroke but were associated with significantly increased
freedom from AF and risk for pacemaker requirement.<br/>Copyright &#xa9;
2017 The Author(s).

<14>
Accession Number
2001226742
Title
Bibliometric Analysis of the Top 100 Most Cited Articles in the First 50
Years of Heart Transplantation.
Source
American Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Author
Kolkailah A.A.; Fugar S.; Vondee N.; Hirji S.A.; Okoh A.; Ayoub A.;
Al-Ogaili A.; Paz Rios L.H.; Kumar S.K.; Camacho M.T.; Rich J.D.; Golzar
Y.
Institution
(Kolkailah, Ayoub, Al-Ogaili, Paz Rios) Department of Medicine, John H.
Stroger, Jr. Hospital of Cook County, Chicago, IL, United States
(Fugar) Division of Cardiology, Rush University Medical Center, Chicago,
IL, United States
(Vondee) Department of Medicine, St. Vincent Charity Medical Center,
Cleveland, OH, United States
(Hirji) Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Okoh, Camacho) Cardiology and Cardiac Surgery Research Unit, Newark Beth
Israel Medical Center, Newark, NJ, United States
(Kumar) Division of Advanced Heart Failure and Transplant Cardiology,
Tampa General Hospital, Tampa, FL, United States
(Rich) Division of Advanced Heart Failure and Transplant Cardiology,
Northwestern Memorial Hospital, Chicago, IL, United States
(Golzar) Division of Cardiology, John H. Stroger, Jr. Hospital of Cook
County, Chicago, IL, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The world celebrates over 50 years since the first human-to-human heart
transplant. Bibliometric analysis is a statistical concept that has
recently evolved, enabling scientists to study citation patterns and
identify characteristics of highly cited scholarly work in different
fields. Although it has been widely utilized, such analyses have not been
conducted to date on heart transplant literature. We sought to assess the
characteristics of the top 100 most referenced citations in the field of
heart transplantation. We searched the Scopus database (www.scopus.com) to
identify all articles relating to heart transplantation. The articles were
arranged in descending order from most cited to least cited and selected
articles were scrutinized for data extraction. One hundred articles were
included in the final list. Of the total 40,660 citations identified,
3,210 (8.0%) were self-citations, which impacted the final rank order. The
articles were published in 25 different journals between 1960 and 2013.
The most productive 5-year time period was between 2000 and 2005, when 24
of the 100 most cited publications were produced. There was no correlation
between the journal impact factor and the number of articles produced per
journal. The presence and type of funding were not associated with the
number of citations. Over 85% of first and senior investigators were men.
In conclusion, our study highlights key features of the most highly cited
scientific literature on heart transplantation and provides insights into
trends of published work in this field. Additionally, this work may serve
as a useful guide to researchers and funding bodies by highlighting the
most prolific areas of cardiac transplant research to date.<br/>Copyright
&#xa9; 2018

<15>
Accession Number
622926655
Title
Effect of breviscapine on recovery of viable myocardium and left
ventricular remodeling in chronic total occlusion patients after
revascularization: Rationale and design for a randomized controlled trial.
Source
Medical Science Monitor. 24 (pp 4602-4609), 2018. Date of Publication: 04
Jul 2018.
Author
Wang M.; Zhang W.-B.; Song J.-L.; Luan Y.; Jin C.-Y.
Institution
(Wang, Zhang, Song, Luan, Jin) Department of Cardiology, Biomedical
Research (Therapy) Center, Sir Run Run Shaw Hospital, School of Medicine,
Zhejiang University, Hangzhou, Zhejiang, China
Publisher
International Scientific Information, Inc. (E-mail:
iza.pranga@isl-science.com)
Abstract
Background: How to speed the recovery of viable myocardium in chronic
total occlusion (CTO) patients after revascularization is still an
unsolved problem. Breviscapine is widely used in cardiovascular diseases.
However, there has been no study focused on the effect of breviscapine on
viable myocardium recovery and left ventricular remodeling after CTO
revascularization. Material/Methods: We propose to recruit 78 consecutive
coronary artery disease (CAD) patients with CTO during a period of 12
months. They will be randomly assigned to receive either breviscapine (40
mg) or placebo in the following 12 months. Blood tests, electrocardiogram,
and Major Adverse Cardiac Events (MACE) will be collected at baseline and
the follow-up visits at 1, 3, 6, 9, and 12 months. Low-dose dobutamine MRI
will be applied for the assessment of viable myocardium, microcirculation
perfusion, and left ventricular remodeling, and the concentrations of
angiogenic cytokine, vascular endothelial growth factor (VEGF), and basic
fibroblast growth factor (bFGF) will be investigated at baseline and at
1-and 12-month follow-up. The recovery of viable myocardium after
revascularization in CTO patients was the primary endpoint. Improvement of
microcirculation perfusion, left ventricular remodeling, peripheral
concentrations of VEGF and bFGF as well as MACE will be the secondary
endpoints. Results: Breviscapine treatment obviously improve the recovery
of viable myocardium, myocardial microcirculation perfusion, and left
ventricular remodeling after revascularization in CTO patients, and reduce
the occurrence of MACE. We also will determine if breviscapine increases
the peripheral blood angiogenic cytokine concentrations of VEGF and bFGF.
Conclusions: This study will aim to demonstrate the effect of breviscapine
on the recovery of viable myocardium and left ventricular remodeling in
CTO patients after revascularization.<br/>Copyright &#xa9; Med Sci Monit,
2018.

<16>
Accession Number
622347418
Title
Sole and combined vitamin C supplementation can prevent postoperative
atrial fibrillation after cardiac surgery: A systematic review and
meta-analysis of randomized controlled trials.
Source
Clinical Cardiology. 41 (6) (pp 871-878), 2018. Date of Publication: June
2018.
Author
Shi R.; Li Z.-H.; Chen D.; Wu Q.-C.; Zhou X.-L.; Tie H.-T.
Institution
(Shi, Chen, Wu, Tie) Department of Cardiothoracic Surgery, the First
Affiliated Hospital of Chongqing Medical University, Chongqing, China
(Shi, Zhou) Department of Cardiology, the First Affiliated Hospital of
Chongqing Medical University, Chongqing, China
(Li) Department of Metabolism and Endocrinology, Shanghai East Hospital,
Tongji University School of Medicine, Shanghai, China
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
We undertook a systematic review and meta-analysis to evaluate the effect
of vitamin C supplementation (vitamin C solely or as adjunct to other
therapy) on prevention of postoperative atrial fibrillation (POAF) in
patients after cardiac surgery. PubMed, Embase, Web of Science, and
Cochrane Library were systematically searched to identify randomized
controlled trials assessing the effect of vitamin C supplementation in
adult patients undergoing cardiac surgery, and the meta-analysis was
performed with a random-effects model. Thirteen trials involving 1956
patients were included. Pooling estimate showed a significantly reduced
incidence of POAF (relative risk [RR]: 0.68, 95% confidence interval [CI]:
0.54 to 0.87, P = 0.002) both in vitamin C alone (RR: 0.75, 95% CI: 0.63
to 0.90, P = 0.002) and as an adjunct to other therapy (RR: 0.32, 95% CI:
0.20 to 0.53, P < 0.001). The results remain stable and robust in subgroup
and sensitivity analyses, and trial sequential analysis also confirmed
that the evidence was sufficient and conclusive. Additionally, vitamin C
could significantly decrease intensive care unit length of stay (weighted
mean difference: -0.24 days, 95% CI: -0.45 to -0.03, P = 0.023), hospital
length of stay (weighted mean difference: -0.95 days, 95% CI: -1.64 to
-0.26, P = 0.007), and risk of adverse events (RR: 0.45, 95% CI: 0.21 to
0.96, P = 0.039). Use of vitamin C alone and as adjunct to other therapy
can prevent POAF in patients undergoing cardiac surgery and should be
recommended for patients receiving cardiac surgery for prevention of
POAF.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<17>
Accession Number
621555172
Title
Repair versus replacement for the surgical correction of tricuspid
regurgitation: A meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 53 (4) (pp 748-755), 2018.
Date of Publication: 01 Apr 2018.
Author
Choi J.W.; Jang M.-J.; Kim K.H.; Hwang H.Y.
Institution
(Choi, Kim, Hwang) Department of Thoracic and Cardiovascular Surgery,
Seoul National University Hospital, Seoul National University College of
Medicine, Seoul, South Korea
(Jang) Medical Research Collaborating Center, Seoul National University
Hospital, Seoul National University College of Medicine, Seoul, South
Korea
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Tricuspid valve repair (TVr) has both a theoretical advantage
in preserving right ventricular function and disadvantages such as a
higher risk of repair failure in the long-term compared with tricuspid
valve replacement (TVR). This study was conducted to compare the results
of TVr with those of TVR to find an optimal treatment option. METHODS: A
literature search of 5 databases was performed. The primary outcome was
all-cause mortality. Secondary outcomes were tricuspid reoperation and
valve-related events. Subgroup analyses were performed according to the
risk of bias, year of publication and proportions of patients with
tricuspid regurgitation Grade >= 3, functional aetiology and isolated
tricuspid valve surgery. Publication bias was explored using the funnel
plot and Egger's test. RESULTS: Seventeen retrospective studies involving
4561 patients (TVr group = 3432 patients and TVR group = 1129 patients)
were included. A pooled analysis showed that the risk of all-cause
mortality was significantly higher in the TVR group than in the TVr group
[hazard ratio (95% confidence interval) 1.59 (1.26-2.00)]. There were no
significant differences in tricuspid valve reoperation in 6 studies and
valve-related events in 5 studies between the TVR and TVr groups [hazard
ratio (95% confidence interval) 1.30 (0.88-1.91) and 1.47 (0.91- 2.38),
respectively]. None of the subgroup analyses demonstrated a significant
difference in the hazard ratio of all-cause mortality. No publication bias
was identified for the primary and secondary outcomes. CONCLUSIONS: This
meta-analysis indicates that TVr is more beneficial compared with TVR in
terms of all-cause mortality. From the available data, TVr is not
associated with an increased risk of tricuspid reoperation compared with
TVR.<br/>Copyright &#xa9; The Author 2017. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<18>
Accession Number
621555156
Title
Randomized controlled trials in children's heart surgery in the 21st
century: A systematic review.
Source
European Journal of Cardio-thoracic Surgery. 53 (4) (pp 724-731), 2018.
Date of Publication: 01 Apr 2018.
Author
Drury N.E.; Patel A.J.; Oswald N.K.; Chong C.-R.; Stickley J.; Barron
D.J.; Jones T.J.
Institution
(Drury, Patel, Oswald, Stickley, Barron, Jones) Department of Paediatric
Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United
Kingdom
(Drury) Institute of Cardiovascular Sciences, University of Birmingham,
Birmingham, United Kingdom
(Chong) Department of Physiology, Anatomy and Genetics, University of
Oxford, Oxford, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Randomized controlled trials are the gold standard for
evaluating health care interventions, yet are uncommon in children's heart
surgery. We conducted a systematic review of clinical trials in paediatric
cardiac surgery to evaluate the scope and quality of the current
international literature. METHODS: We searched MEDLINE, CENTRAL and
LILACS, and manually screened retrieved references and systematic reviews
to identify all randomized controlled trials reporting the effect of any
intervention on the conduct or outcomes of heart surgery in children
published in any language since January 2000; secondary publications and
those reporting inseparable adult data were excluded. Two reviewers
independently screened studies for eligibility and extracted data; the
Cochrane Risk of Bias tool was used to assess for potential biases.
RESULTS: We identified 333 trials from 34 countries randomizing 23 902
children. Most were early phase (313, 94.0%), recruiting few patients
(median 45, interquartile range 28-82), and only 11 (3.3%) directly
evaluated a surgical intervention. One hundred and nine (32.7%) trials
calculated a sample size, 52 (15.6%) reported a CONSORT diagram, 51
(15.3%) were publicly registered and 25 (7.5%) had a Data Monitoring
Committee. The overall risk of bias was low in 22 (6.6%), high in 69
(20.7%) and unclear in 242 (72.7%). CONCLUSIONS: The recent literature in
children's heart surgery contains few late-phase clinical trials. Most
trials did not conform to the accepted standards of reporting, and the
overall risk of bias was low in few studies. There is a need for
high-quality, multicentre clinical trials to provide a robust evidence
base for contemporary paediatric cardiac surgical practice.<br/>Copyright
&#xa9; The Author 2017. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<19>
Accession Number
622658895
Title
Sleep study-guided multidisciplinary therapy (SGMT) for patients with
acute coronary syndrome: Trial rationale and design.
Source
Clinical Cardiology. 41 (6) (pp 721-728), 2018. Date of Publication: June
2018.
Author
Chua A.-P.; Koo C.-Y.; Kristanto W.; Parot M.V.J.M.; Tan E.S.-J.; Koh
E.H.-T.; Abd Gani M.B.; Kojodjojo P.; Han T.-O.; Chan S.-P.; Chong
J.P.-C.; Frampton C.; Richards A.M.; Lee C.-H.
Institution
(Chua, Parot) Division of Respiratory Medicine, Department of Medicine, Ng
Teng Fong General Hospital, Singapore
(Koo, Tan, Kojodjojo, Richards, Lee) Department of Cardiology, National
University Heart Centre Singapore, Singapore
(Kristanto, Kojodjojo) Division of Cardiology, Department of Medicine, Ng
Teng Fong General Hospital, Singapore
(Koh, Abd Gani, Han) Clinical Research Unit, Ng Teng Fong General
Hospital, Singapore
(Chan, Chong, Richards, Lee) Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
(Chan, Chong, Richards, Lee) Cardiovascular Research Institute, National
University of Singapore, Singapore
(Frampton, Richards) Department of Medicine, University of Otago,
Christchurch, New Zealand
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Obstructive sleep apnea (OSA) is an emerging risk marker for acute
coronary syndrome (ACS). This randomized trial aims to determine the
effects of sleep study-guided multidisciplinary therapy (SGMT) comprising
overnight sleep study, continuous positive airway pressure, and behavioral
therapy for OSA during the subacute phase of ACS. We hypothesize that SGMT
will reduce (1) the plasma levels of N-terminal pro brain natriuretic
peptide and suppression of tumorigenicity 2; (2) the estimated 10-year
risk of cardiovascular mortality as measured by the European Systematic
Coronary Risk Evaluation (SCORE) algorithm; and (3) the cardiovascular
event rate during a 3-year follow-up, compared with standard therapy. In
the SGMT trial, 180 patients presenting with ACS will be randomly assigned
to SGMT (n = 90) and standard therapy (n = 90) groups. Both groups will
receive guideline-mandated treatment for ACS. Those assigned to SGMT will
additionally undergo a sleep study and, if OSA is diagnosed, attend a
multidisciplinary OSA clinic where they will receive personalized
treatment including continuous positive airway pressure and
behavioral/lifestyle counseling. The primary endpoint is the plasma
N-terminal pro brain natriuretic peptide concentration at 7-month
follow-up. This report presents the baseline characteristics of 117
patients (SGMT group: n =54; standard therapy group: n =63) who had been
enrolled into the study as of August 31, 2017. The results of this trial
will help us to understand whether active OSA diagnosis and treatment will
improve the physiologic and clinical cardiovascular outcomes of this group
of patients.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<20>
Accession Number
2000566937
Title
Cost-effectiveness of a management strategy based on exercise
echocardiography versus exercise electrocardiography in patients
presenting with suspected angina during long term follow up: A randomized
study.
Source
International Journal of Cardiology. 259 (pp 1-7), 2018. Date of
Publication: 15 May 2018.
Author
Gurunathan S.; Zacharias K.; Akhtar M.; Ahmed A.; Mehta V.; Karogiannis
N.; Vamvakidou A.; Khattar R.; Senior R.
Institution
(Gurunathan, Zacharias, Akhtar, Ahmed, Mehta, Karogiannis, Vamvakidou,
Senior) Department of Cardiology, Northwick park Hospital, Harrow, United
Kingdom
(Gurunathan, Vamvakidou, Khattar, Senior) Department of Cardiology, Royal
Brompton Hospital, United Kingdom
(Gurunathan, Vamvakidou, Khattar, Senior) Biomedical Research Unit,
National Heart and Lung Institute, Imperial College, London, United
Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Introduction: Exercise ECG (Ex-ECG) is advocated by guidelines for
patients with low - intermediate probability of coronary artery disease
(CAD). However, there are no randomized studies comparing Ex-ECG with
exercise stress echocardiography (ESE) evaluating long term
cost-effectiveness of each management strategy. Methods: Accordingly, 385
patients with no prior CAD and low-intermediate probability of CAD (mean
pre-test probability 34%), were randomized to undergo either Ex-ECG (194
patients) or ESE (191 patients). The primary endpoint was clinical
effectiveness defined as the positive predictive value (PPV) for the
detection of CAD of each test. Cost-effectiveness was derived using the
cumulative costs incurred by each diagnostic strategy during a mean of
follow up of 3.0 years. Results: The PPV of ESE and Ex-ECG were 100% and
64% (p = 0.04) respectively for the detection of CAD. There were fewer
clinic (31 vs 59, p < 0.01) and emergency visits (14 vs 30, p = 0.01) and
lower number of hospital bed days (8 vs 29, p < 0.01) in the ESE arm, with
fewer patients undergoing coronary angiography (13.4% vs 6.3%, p = 0.02).
The overall cumulative mean costs per patient were 796 for Ex-ECG and 631
for ESE respectively (p = 0.04) equating to a >20% reduction in cost with
an ESE strategy with no difference in the combined end-point of death,
myocardial infarction, unplanned revascularization and hospitalization for
chest pain between ESE and Ex-ECG (3.2% vs 3.7%, p = 0.38). Conclusion: In
patients with low to intermediate pretest probability of CAD and suspected
angina, an ESE management strategy is cost-effective when compared with
Ex-ECG during long term follow up.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<21>
Accession Number
621231977
Title
Chest Computed Tomography Image for Accurately Predicting the Optimal
Insertion Depth of Left-Sided Double-Lumen Tube.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (2) (pp 855-859),
2018. Date of Publication: April 2018.
Author
Liu Z.; Zhao L.; Jia Q.; Yang X.; Liang S.J.; He W.
Institution
(Liu, Jia, Yang, Liang, He) Department of Anesthesiology, First Hospital
of Qinhuangdao, Qinhuangdao, Hebei, China
(Zhao) Department of Emergency, First Hospital of Qinhuangdao,
Qinhuangdao, Hebei, China
Publisher
W.B. Saunders
Abstract
Objective: The main objective of this study was to assess the feasibility
and accuracy of measuring the distance between the vocal cord and carina
using chest computer tomography (CT) as a guide for the intubation of a
left-sided double-lumen tube (LDLT). Design: Single-center, prospective,
randomized study. Setting: Local hospital in China. Participants: Sixty
adult patients undergoing elective thoracic surgery requiring an LDLT for
one lung ventilation were enrolled in this study. Interventions: Patients
were randomly allocated to the following 2 groups: blind intubation group
(B group, n = 30) or chest computed tomography-guided group (C group, n =
30). The placement of the LDLT was accomplished using 1 of the 2
intubation methods. After intubation, an independent anesthesiologist
evaluated the position of the LDLT and carina and bronchial injuries using
fiber optic bronchoscopy. The number of optimal positions, the time for
LDLT intubation, the time for fiber optic bronchoscope confirmation, and
carina and bronchial injuries were recorded. Results: Sixteen of 30
intubations in the B group were in optimal position, whereas 27 of 30
intubations in the C group were in optimal position; the difference was
statistically significant (p < 0.01). The time for intubation of the LDLT
took 118.0 +/- 26.2 seconds in the B group and 71.5 +/- 8.7 seconds in the
C group (p < 0.01). The time for position confirmation using fiber optic
bronchoscope took 40.8 +/- 15.8 seconds in the B group and 18.7 +/- 7.9
seconds in the C group (p < 0.05). The incidences of carina and bronchial
injuries were obviously lower in the C group (occurred in 3 of 30 cases)
than in the B group (11 of 30 cases) p < 0.05. The incidences of
postoperative sore throat and hoarseness showed no significant differences
between the 2 groups (p > 0.05). Conclusion: This study demonstrated that
the method of measuring the distance between the vocal cord and carina
according to the chest CT as a guide for the intubation of LDLT is more
effective and more accurate than the blind intubation
method.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<22>
Accession Number
620160644
Title
Intramyocardial dissecting hematoma: Two case reports and a meta-analysis
of the literature.
Source
Echocardiography. 35 (2) (pp 260-266), 2018. Date of Publication:
Februaryy 2018.
Author
Leitman M.; Tyomkin V.; Sternik L.; Copel L.; Goitein O.; Vered Z.
Institution
(Tyomkin, Vered) Department of Cardiology, Assaf Harofeh Medical Center,
Zerifin, Israel
(Leitman, Sternik, Copel, Goitein, Vered) Sackler School of Medicine, Tel
Aviv University, Zerifin, Israel
(Sternik) Department of Cardiac Surgery, Sheba Medical Center, Tel
Hashomer, Israel
(Copel) Department of Radiology, Assaf Harofeh Medical Center, Zerifin,
Israel
(Goitein) Department of Radiology, Sheba Medical Center, Tel Hashomer,
Israel
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Until recently, diagnosis of intramyocardial dissecting hematoma (IDH) was
performed during necropsy or at surgery. During the recent years,
echocardiography has permitted clinical suspicion, which usually needed
confirmation with magnetic resonance imaging (MRI). In this study, we
tried to define clinical and imaging features of IDH and predictors of
mortality. We searched the literature for proven cases of IDH and analyzed
them together with 2 of our cases. A total of 40 cases of IDH (2 our
original and 38 literature cases) were included. Mean age was 60. In 32
cases, IDH was a complication of myocardial infarction (MI), in 66%
anterior, a mean time from symptoms to diagnosis was 9 days. Thirty-eight
% underwent surgery. In-hospital mortality was 23%. Multivariate analysis
showed that the strongest independent predictor of mortality (42%) was EF
< 35%; in patients with age >60, mortality risk was 44%; and in the
presence of MI or late diagnosis (>24 hours since symptoms started),
mortality risk was 50%. In summary, IDH is a diagnostic challenge. A high
level of suspicion is needed for prompt diagnosis. Management of these
patients is based on individual clinical and imaging parameters. Low EF,
age > 60, and late diagnosis, all are predictors of in-hospital
mortality.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<23>
[Use Link to view the full text]
Accession Number
624071697
Title
Unraveling the Underlying Arrhythmia Mechanism in Persistent Atrial
Fibrillation: Results from the STARLIGHT Study.
Source
Circulation: Arrhythmia and Electrophysiology. 11 (6) (no pagination),
2018. Article Number: e005897. Date of Publication: 01 Jun 2018.
Author
Child N.; Clayton R.H.; Roney C.H.; Laughner J.I.; Shuros A.; Neuzil P.;
Petru J.; Jackson T.; Porter B.; Bostock J.; Niederer S.A.; Razavi R.S.;
Rinaldi C.A.; Taggart P.; Wright M.J.; Gill J.
Institution
(Child, Roney, Jackson, Porter, Niederer, Razavi) Department of Imaging
Sciences and Biomedical Engineering, King's College London, United Kingdom
(Clayton) INSIGNEO Institute for in Silico Medicine, University of
Sheffield, United Kingdom
(Laughner, Shuros) Boston Scientific Corp, St. Paul, MN, United States
(Neuzil, Petru) Department of Cardiology, Na Holmolce Hospital, Prague,
Czech Republic
(Child, Bostock, Rinaldi, Wright, Gill) Department of Cardiology, Guy's
and St Thomas' Hospital, London SE1 7EH, United Kingdom
(Taggart) University College London, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The mechanisms that initiate and sustain persistent atrial
fibrillation are not well characterized. Ablation results remain
significantly worse than in paroxysmal atrial fibrillation in which the
mechanism is better understood and subsequent targeted therapy has been
developed. The aim of this study was to characterize and quantify patterns
of activation during atrial fibrillation using contact mapping. Methods:
Patients with persistent atrial fibrillation (n=14; mean age, 61+/-8
years; ejection fraction, 59+/-10%) underwent simultaneous biatrial
contact mapping with 64 electrode catheters. The atrial electrograms were
transformed into phase, and subsequent spatiotemporal mapping was
performed to identify phase singularities (PSs). Results: PSs were located
in both atria, but we observed more PSs in the left atrium compared with
the right atrium (779+/-302, 552+/-235; P=0.015). Although some PSs of
duration sufficient to complete >1 rotation were detected, the maximum PS
duration was only 1150 ms, and the vast majority (97%) of PSs persisted
for too short a period to complete a full rotation. Although in selected
patients there was evidence of PS local clustering, overall, PSs were
distributed globally throughout both chambers with no clear anatomic
predisposition. In a subset of patients (n=7), analysis was repeated using
an alternative established atrial PS mapping technique, which confirmed
our initial findings. Conclusions: No sustained rotors or localized
drivers were detected, and instead, the mechanism of arrhythmia
maintenance was consistent with the multiple wavelet hypothesis, with
passive activation of short-lived rotational activity.<br/>Copyright
&#xa9;2018 American Heart Association, Inc.

<24>
Accession Number
622436734
Title
The REACH protocol: An innovative strategy for home management of infants
with complex CHD.
Source
Cardiology in the Young. 28 (7) (pp 961-967), 2018. Date of Publication:
01 Jul 2018.
Author
Fleck D.A.; Marino B.S.; Costello J.M.; Ravishankar C.; Torowicz D.; Alden
C.; Van'T Hof K.; Medoff-Cooper B.
Institution
(Fleck) School of Nursing, University of Pennsylvania, Claire M Fagin
Hall, 418 Curie Boulevard, Philadelphia, PA 19104-4217, United States
(Fleck, Ravishankar, Torowicz, Medoff-Cooper) Cardiac Center, Children's
Hospital of Philadelphia, Philadelphia, PA, United States
(Marino, Costello, Alden, Van'T Hof) Ann and Robert H. Lurie Children's
Hospital of Chicago, Chicago, IL, United States
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Approximately 32,000 infants are born with CHDs each year in the United
States of America. Of every 1000 live births, 2.3 require surgical or
transcatheter intervention in the first year of life. There are few more
stressful times for parents than when their neonate receives a diagnosis
of complex CHD requiring surgery. The stress of caring for these infants
is often unrelenting and may last for weeks, months, and often years,
placing parents at risk for developing post-Traumatic stress disorder, as
well as a drastic decrease in quality of life. Anxiety often peaks in the
days and weeks after discharge from the hospital as families no longer
have immediate access to nursing and medical staff. The purpose of this
paper is to describe the methods of a randomised controlled trial that was
designed to determine whether REACH would favourably affect parental and
infant outcomes by decreasing parental stress, improve parental quality of
life, increase infant stability, and decrease resource utilisation in
infants with complex CHD.<br/>Copyright &#xa9; Cambridge University Press
2018.

<25>
Accession Number
622436681
Title
Left ventricular function and exercise capacity after arterial switch
operation for transposition of the great arteries: A systematic review and
meta-Analysis.
Source
Cardiology in the Young. 28 (7) (pp 895-902), 2018. Date of Publication:
01 Jul 2018.
Author
Van Wijk S.W.; Driessen M.M.; Meijboom F.J.; Doevendans P.A.; Schoof P.H.;
Breur H.M.; Takken T.
Institution
(Van Wijk, Meijboom, Breur) Department of Paediatric Cardiology,
Wilhelmina Children's Hospital, University Medical Centre Utrecht,
Lundlaan 6, Utrecht 3584 EA, Netherlands
(Driessen, Meijboom, Doevendans) Department of Cardiology, University
Medical Centre Utrecht, Netherlands
(Doevendans) ICIN-Netherlands Heart Institute, Utrecht, Netherlands
(Schoof) Paediatric Cardiothoracic Surgery, Wilhelmina Children's
Hospital, University Medical Centre Utrecht, Netherlands
(Takken) Paediatric Clinical Exercise Physiology, Wilhelmina Children's
Hospital, University Medical Centre Utrecht, Netherlands
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Background The arterial switch operation for transposition of the great
arteries was initially believed to be an anatomical correction. Recent
evidence shows reduced exercise capacity and left ventricular function in
varying degrees in the long term after an arterial switch
operation.Objective To perform a meta-Analysis on long-Term exercise
capacity and left ventricular ejection fraction after an arterial switch
operation.Methods A literature search was performed to cover all studies
on patients who had undergone a minimum of 6 years of follow-up that
reported either left ventricular ejection fraction, peak oxygen uptake,
peak workload, and/or peak heart rate. A meta-Analysis was performed if
more than three studies reported the outcome of interest.Results A total
of 21 studies reported on the outcomes of interest. Oxygen uptake was
consistently lower in patients who had undergone an arterial switch
operation compared with healthy controls, with a pooled average peak
oxygen uptake of 87.5+/-2.9% of predicted. The peak heart rate was also
lower compared with that of controls, at 92+/-2% of predicted. Peak
workload was significantly reduced in two studies. Pooled left ventricular
ejection fraction was normal at 60.7+/-7.2%.Conclusion Exercise capacity
is reduced and left ventricular ejection fraction is preserved in the long
term after an arterial switch operation for transposition of the great
arteries.<br/>Copyright &#xa9; Cambridge University Press 2018.

<26>
Accession Number
621862076
Title
Treatment of malignant pleural mesothelioma: American society of clinical
oncology clinical practice guideline.
Source
Journal of Clinical Oncology. 36 (13) (pp 1343-1373), 2018. Date of
Publication: 01 May 2018.
Author
Kindler H.L.; Ismaila N.; Armato S.G.; Bueno R.; Hesdorffer M.; Jahan T.;
Jones C.M.; Miettinen M.; Pass H.; Rimner A.; Rusch V.; Sterman D.; Thomas
A.; Hassan R.
Institution
(Kindler, Armato) University of Chicago, Chicago, IL, United States
(Ismaila) American Society of Clinical Oncology, Alexandria, VA, United
States
(Hesdorffer) Mesothelioma Applied Research Foundation, Alexandria, VA,
United States
(Bueno) Harvard Medical School, Boston, MA, United States
(Jahan) University of California San Francisco, San Francisco, CA, United
States
(Jones) Baptist Cancer Center Physicians Foundation, Memphis, TN, United
States
(Miettinen, Thomas, Hassan) Center for Cancer Research, National Cancer
Institute, Bethesda, MD, United States
(Pass, Sterman) New York University Langone Medical Center, New York, NY,
United States
(Rimner, Rusch) Memorial Sloan Kettering Cancer Center, New York, NY,
United States
Publisher
American Society of Clinical Oncology (E-mail: jcoservice@asco.org)
Abstract
Purpose To provide evidence-based recommendations to practicing physicians
and others on the management of malignant pleural mesothelioma. Methods
ASCO convened an Expert Panel of medical oncology, thoracic surgery,
radiation oncology, pulmonary, pathology, imaging, and advocacy experts to
conduct a literature search, which included systematic reviews,
meta-analyses, randomized controlled trials, and prospective and
retrospective comparative observational studies published from 1990
through 2017. Outcomes of interest included survival, disease-free or
recurrence-free survival, and quality of life. Expert Panel members used
available evidence and informal consensus to develop evidence-based
guideline recommendations. Results The literature search identified 222
relevant studies to inform the evidence base for this guideline.
Recommendations Evidence-based recommendations were developed for
diagnosis, staging, chemotherapy, surgical cytoreduction, radiation
therapy, and multimodality therapy in patients with malignant pleural
mesothelioma.<br/>Copyright &#xa9; 2018 American Society of Clinical
Oncology. All rights reserved.

<27>
Accession Number
2000632947
Title
Pre-Angioplasty Instantaneous Wave-Free Ratio Pullback Predicts
Hemodynamic Outcome In Humans With Coronary Artery Disease: Primary
Results of the International Multicenter iFR GRADIENT Registry.
Source
JACC: Cardiovascular Interventions. 11 (8) (pp 757-767), 2018. Date of
Publication: 23 April 2018.
Author
Kikuta Y.; Cook C.M.; Sharp A.S.P.; Salinas P.; Kawase Y.; Shiono Y.;
Giavarini A.; Nakayama M.; De Rosa S.; Sen S.; Nijjer S.S.; Al-Lamee R.;
Petraco R.; Malik I.S.; Mikhail G.W.; Kaprielian R.R.; Wijntjens G.W.M.;
Mori S.; Hagikura A.; Mates M.; Mizuno A.; Hellig F.; Lee K.; Janssens L.;
Horie K.; Mohdnazri S.; Herrera R.; Krackhardt F.; Yamawaki M.; Davies J.;
Takebayashi H.; Keeble T.; Haruta S.; Ribichini F.; Indolfi C.; Mayet J.;
Francis D.P.; Piek J.J.; Di Mario C.; Escaned J.; Matsuo H.; Davies J.E.
Institution
(Kikuta, Cook, Shiono, Sen, Nijjer, Al-Lamee, Petraco, Malik, Mikhail,
Kaprielian, Mayet, Francis, Davies) Imperial College London and
Hammersmith Hospital NHS Trust, London, United Kingdom
(Kikuta, Hagikura, Takebayashi, Haruta) Fukuyama Cardiovascular Hospital,
Fukuyama, Japan
(Sharp) Royal Devon and Exeter Hospital and University of Exeter, Exeter,
United Kingdom
(Salinas, Herrera, Escaned) Hospital Clinico San Carlos, Faculty of
Medicine, Complutense University, Madrid, Spain
(Kawase, Matsuo) Gifu Heart Center, Gifu, Japan
(Giavarini, Di Mario) Royal Brompton Hospital and Harefield Trust, London,
United Kingdom
(Nakayama) Toda Central General Hospital, Toda, Japan
(De Rosa, Indolfi) Universita degli Studi Magna Graecia di Catanzaro,
Catanzaro, Italy
(Wijntjens, Piek) Academic Medical Centre, Amsterdam, Netherlands
(Mori, Yamawaki) Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
(Mates) Na Homolce Hospital, Prague, Czech Republic
(Mizuno) St Luke's International Hospital, Tokyo, Japan
(Hellig) Sunninghill Hospital, Johannesburg, University of Cape Town,
South Africa
(Lee) United Lincolnshire Hospital, Lincoln, United Kingdom
(Janssens) Imelda Hospital, Bonheiden, Belgium
(Horie) Sendai Kousei Hospital, Sendai, Japan
(Mohdnazri, Davies, Keeble) Essex Cardiothoracic Centre, Basildon and
Anglia Ruskin University, Chelmsford, Essex, United Kingdom
(Krackhardt) Charite-Universitatsmedizin Campus Virchow, Berlin, Germany
(Ribichini) University of Verona, Verona, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The authors sought to evaluate the accuracy of instantaneous
wave-Free Ratio (iFR) pullback measurements to predict post-percutaneous
coronary intervention (PCI) physiological outcomes, and to quantify how
often iFR pullback alters PCI strategy in real-world clinical settings.
Background: In tandem and diffuse disease, offline analysis of continuous
iFR pullback measurement has previously been demonstrated to accurately
predict the physiological outcome of revascularization. However, the
accuracy of the online analysis approach (iFR pullback) remains untested.
Methods: Angiographically intermediate tandem and/or diffuse lesions were
entered into the international, multicenter iFR GRADIENT (Single
instantaneous wave-Free Ratio Pullback Pre-Angioplasty Predicts
Hemodynamic Outcome Without Wedge Pressure in Human Coronary Artery
Disease) registry. Operators were asked to submit their procedural
strategy after angiography alone and then after iFR-pullback measurement
incorporating virtual PCI and post-PCI iFR prediction. PCI was performed
according to standard clinical practice. Following PCI, repeat iFR
assessment was performed and the actual versus predicted post-PCI iFR
values compared. Results: Mean age was 67 +/- 12 years (81% male). Paired
pre- and post-PCI iFR were measured in 128 patients (134 vessels). The
predicted post-PCI iFR calculated online was 0.93 +/- 0.05; observed
actual iFR was 0.92 +/- 0.06. iFR pullback predicted the post-PCI iFR
outcome with 1.4 +/- 0.5% error. In comparison to angiography-based
decision making, after iFR pullback, decision making was changed in 52
(31%) of vessels; with a reduction in lesion number (-0.18 +/- 0.05
lesion/vessel; p = 0.0001) and length (-4.4 +/- 1.0 mm/vessel; p <
0.0001). Conclusions: In tandem and diffuse coronary disease, iFR pullback
predicted the physiological outcome of PCI with a high degree of accuracy.
Compared with angiography alone, availability of iFR pullback altered
revascularization procedural planning in nearly one-third of
patients.<br/>Copyright &#xa9; 2018 The Authors

<28>
Accession Number
622501256
Title
Role of the tricuspid regurgitation after mitraclip and transcatheter
aortic valve implantation: A systematic review and meta-Analysis.
Source
European Heart Journal Cardiovascular Imaging. 19 (6) (pp 654-659), 2018.
Date of Publication: 01 Jun 2018.
Author
Pavasini R.; Ruggerini S.; Grapsa J.; Biscaglia S.; Tumscitz C.; Serenelli
M.; Boriani G.; Squeri A.; Campo G.
Institution
(Pavasini, Biscaglia, Tumscitz, Serenelli, Campo) Cardiology Unit, Azienda
Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy
(Ruggerini, Boriani) Division of Cardiology, Department of Diagnostics,
University of Modena and Reggio Emilia, Policlinico d Modena, Italy
(Grapsa) Heart and Vascular Institute, Cleaveland Clinic, Cleaveland,
United States
(Squeri) Cardiology Unit, Maria Cecilia Hospital, GVM Care and Research,
Cotignola, Italy
(Campo) Maria Cecilia Hospital, GVM Care and Research, E.S.: Health
Science Foundation, Cotignola, Italy
Publisher
Oxford University Press
Abstract
Aims Treatment of tricuspid regurgitation (TR) is common after surgery for
mitral and/or aortic valves. The prognostic role of moderate to severe TR
in patients undergoing mitraclip or transcatheter aortic valve
implantation (TAVI) is not well-defined. Thus, the aim of this article is
to perform a systematic review and meta-Analysis of articles valuing the
prognostic role of TR for patients undergoing mitraclip and TAVI. Methods
and results Articles were searched in Pubmed, Cochrane Library, Google
Scholar and Biomed Central in September 2016. Inclusion criteria:
observational or randomized clinical trials with data on the prognostic
role of TR in patients undergoing mitraclip or TAVI. Primary outcome was
all-cause mortality expressed as hazard ratio (HR). Six articles fulfilled
inclusion criteria, three were on mitraclip and three on TAVI. A total of
2329 patients were analysed (mean age was 78.38 (3.09), 63% male): 1328
treated with TAVI and 1001 with mitraclip. The HR for all-cause mortality
of moderate to severe TR was 2.0 (95% CI 1.57-2.55, I 2 = 0%). Data were
confirmed also after subgroup analysis for mitraclip vs. TAVI. None of the
factor considered in meta-regression analyses was affecting the primary
outcome. Conclusions The current meta-Analysis suggests that the presence
of moderate to severe TR in patients undergoing mitraclip or TAVI might be
a major determinant of all-cause mortality. New studies are needed to
confirm it and to plan possible intervention in order to reduce its
impact.<br/>Copyright &#xa9; The Author 2017.

<29>
Accession Number
623824565
Title
A randomized clinical trial of age and genotype-guided tacrolimus dosing
after pediatric solid organ transplantation.
Source
Pediatric Transplantation. 22 (7) (no pagination), 2018. Article Number:
e13285. Date of Publication: November 2018.
Author
Min S.; Papaz T.; Lafreniere-Roula M.; Nalli N.; Grasemann H.; Schwartz
S.M.; Kamath B.M.; Ng V.; Parekh R.S.; Manlhiot C.; Mital S.
Institution
(Min, Papaz, Lafreniere-Roula, Grasemann, Kamath, Parekh, Mital)
Department of Pediatrics, Hospital for Sick Children, University of
Toronto, Toronto, ON, Canada
(Nalli) Department of Pharmacy, Hospital for Sick Children, University of
Toronto, Toronto, ON, Canada
(Schwartz) Department of Cardiac Critical Care Medicine, Hospital for Sick
Children, University of Toronto, Toronto, ON, Canada
(Ng) Transplant and Regenerative Medicine Centre, Department of
Pediatrics, Hospital for Sick Children, University of Toronto, Toronto,
ON, Canada
(Parekh) Division of Nephrology, Department of Medicine, University Health
Network and University of Toronto, Toronto, ON, Canada
(Parekh) Child Health Evaluative Sciences Program, SickKids Research
Institute, Toronto, ON, Canada
(Manlhiot) Cardiovascular Data Management Centre (CVDMC) Hospital for Sick
Children, University of Toronto, Toronto, ON, Canada
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Tacrolimus pharmacokinetics are influenced by age and CYP3A5
genotype with CYP3A5 expressors (CYP3A5*1/*1 or *1/*3) being fast
metabolizers. However, the benefit of genotype-guided dosing in pediatric
solid organ transplantation has been understudied. Objective: To determine
whether age and CYP3A5 genotype-guided starting dose of tacrolimus result
in earlier attainment of therapeutic drug concentrations. Setting: Single
hospital-based transplant center. Methods: This was a randomized,
semi-blinded, 30-day pilot trial. Between 2012 and 2016, pediatric
patients listed for solid organ transplant were consented and enrolled
into the study. Participants were categorized as expressors, CYP3A5*1/*1
or CYP3A5*1/*3, and nonexpressors, CYP3A5*3/*3. Patients were stratified
by age (<= or > 6 years) and randomized (2:1) after transplant to receive
genotype-guided (n = 35) or standard (n = 18) starting dose of tacrolimus
for 36-48 hours and were followed for 30 days. Results: Median age at
transplant in the randomized cohort was 2.1 (0.75-8.0) years; 24 (45%)
were male. Participants in the genotype-guided arm achieved therapeutic
concentrations earlier at a median (IQR) of 3.4 (2.5-6.6) days compared to
those in the standard dosing arm of 4.7 (3.5-8.6) days (P = 0.049), and
had fewer out-of-range concentrations [OR (95% CI) = 0.60 (0.44, 0.83), P
= 0.002] compared to standard dosing, with no difference in frequency of
adverse events between the two groups. Conclusions: CYP3A5 genotype-guided
dosing stratified by age resulted in earlier attainment of therapeutic
tacrolimus concentrations and fewer out-of-range
concentrations.<br/>Copyright &#xa9; 2018 The Authors. Pediatric
Transplantation Published by Wiley Periodicals, Inc.

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

<31>
Accession Number
624534942
Title
Definitions and clinical impact of revascularization completeness.
Source
Minerva Cardioangiologica. 66 (5) (pp 594-599), 2018. Date of Publication:
October 2018.
Author
Aurigemma C.; Burzotta F.; Russo G.; Previ L.; Trani C.
Institution
(Aurigemma, Burzotta, Russo, Previ, Trani) Institute of Cardiology,
Catholic University of the Sacred Heart, Largo A. Gemelli 1, Rome 00168,
Italy
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
The completeness of revascularization in patients with multivessel
coronary artery disease (CAD) remains an unanswered question. Despite 20
years of investigation there are still major doubts in this topic,
reaching as far as to the lack of a standardized definition. The
employment of different definition and the multiplicity of confounding
variables that in general favor patients who receive a complete
revascularization (CR) are the reason of difficult comparisons between
studies. The complexity of coronary anatomy diseases and the clinical
features play important role in the revascularization strategy. However,
the clinical impact of CR is different in particular clinical subsets,
such as diabetes, ST-segment elevation myocardial infarction, cardiogenic
shock, ischemic heart failure. The CR is a desirable objective, but it is
not mandatory and sometimes a reasonable incomplete revascularization (IR)
offers comparable results. Clinical variables, including patient's age,
life expectancy, the severity of symptoms at presentation, comorbidities
(particularly diabetes mellitus), left ventricular function and myocardial
viability, as well as coronary anatomy should be considered in the
decision making whether to attempt CR or to follow a reasonable IR
strategy, for both percutaneous coronary intervention and coronary artery
bypass graft surgery, in patients with multivessel CAD.<br/>Copyright
&#xa9; 2018 EDIZIONI MINERVA MEDICA.

<32>
Accession Number
624534928
Title
High-risk percutaneous coronary intervention: How to define it today?.
Source
Minerva Cardioangiologica. 66 (5) (pp 576-593), 2018. Date of Publication:
October 2018.
Author
De Marzo V.; D'Amario D.; Galli M.; Vergallo R.; Porto I.
Institution
(De Marzo, D'Amario, Galli, Vergallo, Porto) Unit of Interventional
Cardiology, Department of Cardiovascular Sciences, Catholic University of
the Sacred Heart, Rome, Italy
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Before the percutaneous era, the mortality rate of patients with coronary
heart disease not suitable for cardiac surgery was extremely high. This
limit has been progressively exceeded with the advent of minimally
invasive approaches, which, although initially intended exclusively for
low risk scenarios, was then employed in complex patients often too
compromised to undergo cardiac surgery. We are currently witnessing,
however, a sudden expansion in percutaneous coronary interventions (PCI)
in extreme cases, perceived as high-risk by operators, imposing an
important burden of human and economic resources on interventional
cardiology as a whole. In this review, the literature regarding the
current definition of high-risk PCI and its implications has been
reviewed. In summary, all proposed definitions of high risk PCI combine
features related to three main clinical areas: 1) patient risk factors and
comorbidities (incorporating those which preclude surgical or percutaneous
revascularization such as diabetes, chronic obstructive pulmonary disease,
chronic kidney disease, lung disease, frailty, advanced age); 2) location
of the disease and complexity of coronary anatomy (including multi-vessel
disease, left main disease, chronic total occlusion, bifurcations); 3)
hemodynamic clinical status (ventricular dysfunction, concomitant valvular
disease or unstable characteristics). Importantly, encouraging results in
terms of efficacy and gains in health status of PCI in (variously defined)
high-risk, as compared to the low-risks patients, are reported. Thus,
treating high-risk patients is becoming increasingly relevant, to the
point that current guidelines now particularly highlight the
appropriateness of percutaneous interventions in this
setting.<br/>Copyright &#xa9; 2018 EDIZIONI MINERVA MEDICA.

<33>
Accession Number
621176178
Title
Comparison of single versus dual antiplatelet therapy after TAVR: A
systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 92 (4) (pp 783-791),
2018. Date of Publication: 01 Oct 2018.
Author
Raheja H.; Garg A.; Goel S.; Banerjee K.; Hollander G.; Shani J.; Mick S.;
White J.; Krishnaswamy A.; Kapadia S.
Institution
(Raheja, Banerjee, Mick, White, Krishnaswamy, Kapadia) Department of
Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland,
OH, United States
(Garg) Department of Cardiology, Newark Beth Israel Medical Center,
Newark, NJ, United States
(Goel, Hollander, Shani) Department of Cardiology, Maimonides Medical
Center, Brooklyn, NY, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: We aim to evaluate the efficacy of dual versus single
anti-platelet therapy (SAPT) after TAVR through a systematic review and
meta-analysis of published research. Background: Dual antiplatelet therapy
(DAPT) with aspirin and clopidogrel is a commonly practiced strategy after
transcatheter aortic valve replacement (TAVR). However, there is lack of
sufficient evidence supporting this approach. Method: We searched PubMed,
EMBASE, the Cochrane Central Register of Controlled trials, and the
clinical trial registry maintained at clinicaltrials.gov for randomized
control trials (RCT) and observational studies comparing DAPT with SAPT
post TAVR. Event rates were compared using a forest plot of relative risk
with 95% confidence intervals using a random-effects model assuming
inter-study heterogeneity. Results: A total of six studies (3 RCTs and 3
observational studies, n = 840) were included in the final analysis.
Compared to SAPT, DAPT was associated with increased risk of significant
bleeding (life threatening and major) [RR = 2.52 (95% CI 1.62-3.92, P <
0.0001)] with the number needed to harm for major or life-threatening
bleeding calculated to be 10.4. There was no significant difference in the
incidence of stroke [RR = 1.06 (95% CI, 0.43-2.60, P = 0.90)], spontaneous
myocardial infarction [RR = 2.08 (95% CI, 0.56-7.70, P = 0.27)] and
all-cause mortality [RR = 1.18 (95% CI, 0.68-2.05, P = 0.56] in the DAPT
and SAPT groups. Conclusion: In this small meta-analysis of DAPT versus
SAPT after TAVR, DAPT did not prevent stroke, myocardial infarction or
death while the risk of bleeding was higher. Results from ongoing trials
are awaited to determine the best anti-thrombotic approach after
TAVR.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<34>
Accession Number
622977011
Title
The therapeutic role of ivabradine in heart failure.
Source
Therapeutic Advances in Chronic Disease. 9 (11) (pp 199-207), 2018. Date
of Publication: 01 Nov 2018.
Author
Badu-Boateng C.; Jennings R.; Hammersley D.
Institution
(Badu-Boateng, Jennings) Department of Medicine, Frimley Park Hospital,
Frimley, Camberley, United Kingdom
(Hammersley) Department of Cardiology, Kings College Hospital NHS
Foundation Trust, Denmark Hill, London SE5 9RS, United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Heart failure represents a major global cause of morbidity and mortality.
Ivabradine is a selective funny current (I<inf>f</inf>) inhibitor, which
acts on the sinoatrial node, resulting in a reduction in heart rate.
Ivabradine is currently licensed for use in patients with symptomatic
heart failure with reduced ejection fraction and a heart rate persistently
at least 70 beats per minute in spite of otherwise optimal prognostic
heart failure pharmacotherapy. In this review article, we examine the
mechanism of action of ivabradine, evaluate the clinical trials
underpinning its application in heart failure and discuss its current
recommended clinical use in this capacity.<br/>Copyright &#xa9; The
Author(s), 2018.

<35>
[Use Link to view the full text]
Accession Number
624597743
Title
Unselected Use of Ultrathin Strut Biodegradable Polymer Sirolimus-Eluting
Stent Versus Durable Polymer Everolimus-Eluting Stent for Coronary
Revascularization.
Source
Circulation. Cardiovascular interventions. 11 (9) (pp e006741), 2018. Date
of Publication: 01 Sep 2018.
Author
Yamaji K.; Zanchin T.; Zanchin C.; Stortecky S.; Koskinas K.C.; Hunziker
L.; Praz F.; Blochlinger S.; Moro C.; Moschovitis A.; Seiler C.;
Valgimigli M.; Billinger M.; Pilgrim T.; Heg D.; Windecker S.; Raber L.
Institution
(Yamaji, Zanchin, Zanchin, Stortecky, Koskinas, Hunziker, Praz,
Blochlinger, Moro, Moschovitis, Seiler, Valgimigli, Billinger, Pilgrim,
Windecker, Raber) Swiss Cardiovascular Center Bern, Department of
Cardiology, Bern University Hospital, S.S., F.P., S.B., C.M., C.S., S.W.,
A.M., M.B, Canada
(Heg) Institute of Social and Preventive Medicine and Clinical Trials
Unit, University of Bern, Czech Republic
Publisher
NLM (Medline)
Abstract
METHODS AND RESULTS: Among 7640 consecutive patients who underwent
percutaneous coronary intervention between March 2011 and June 2015, 4638
patients were exclusively treated with BP-SES (N=1896; 3137 lesions) or
DP-EES (N=2742; 4468 lesions). After propensity score matching within
strata of clinical indications, the final study population consisted of
2902 matched patients (BP-SES 2406 lesions and DP-EES 2368 lesions). The
primary device-oriented composite end point (DOCE) included cardiac death,
target vessel myocardial infarction, and target lesion revascularization
at 1 year. BP-SES (6.9%) was noninferior to DP-EES (8.0%) with respect to
device-oriented composite end point (hazard ratio [HR], 0.85; 95% CI,
0.65-1.11; P for noninferiority <0.001; P for superiority=0.24). No
differences in cardiac death (BP-SES, 2.3% versus DP-EES, 3.0%; HR, 0.76;
95% CI, 0.49-1.20; P=0.25), myocardial infarction (BP-SES, 4.6% versus
DP-EES, 4.6%; HR, 1.00; 95% CI, 0.71-1.40; P=0.99), or target lesion
revascularization (BP-SES, 2.8% versus DP-EES, 2.5%; HR, 1.11; 95% CI,
0.71-1.74; P=0.65) were observed. The rate of periprocedural myocardial
infarction was comparable between the 2 groups (2.1% versus 2.2%; HR,
0.97; 95% CI, 0.59-1.58; P=0.89). The rate of definite stent thrombosis
was similarly low throughout 1 year (BP-SES, 0.8% versus DP-EES, 0.8%; HR,
1.00; 95% CI, 0.45-2.22; P=1.00).
CONCLUSIONS: In a consecutively enrolled percutaneous coronary
intervention population reflecting routine clinical practice, BP-SES was
noninferior to DP-EES for device-oriented composite end point at 1 year.
CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique
identifier: NCT02241291.
BACKGROUND: Biodegradable polymer sirolimus-eluting stents (BP-SESs) have
been reported to be noninferior compared with durable polymer
everolimus-eluting stents (DP-EES) in a randomized clinical trial. We
sought to compare the efficacy and safety of an ultrathin strut BP-SES
with a DP-EES in an all-comers population.

<36>
[Use Link to view the full text]
Accession Number
624594890
Title
Benefit and Risk of Prolonged DAPT After Coronary Stenting in Women.
Source
Circulation. Cardiovascular interventions. 11 (8) (pp e005308), 2018. Date
of Publication: 01 Aug 2018.
Author
Berry N.C.; Kereiakes D.J.; Yeh R.W.; Steg P.G.; Cutlip D.E.; Jacobs A.K.;
Abbott J.D.; Hsieh W.-H.; Massaro J.M.; Mauri L.
Institution
(Berry, Mauri) Department of Cardiovascular Medicine, Brigham and Women's
Hospital, Boston, United Kingdom
(Berry, Yeh, Cutlip, Mauri) Harvard Medical School, L.M., D.E.C., Boston,
United Kingdom
(Berry, Yeh, Cutlip, Hsieh, Massaro, Mauri) Baim Institute for Clinical
Research, L.M., D.E.C., Boston, United Kingdom
(Kereiakes) Christ Hospital Heart and Vascular Center and The Lindner
Center for Research and Education, Cincinnati, United States
(Yeh) Smith Center for Outcomes Research in Cardiology (R.W.Y.), Beth
Israel Deaconess Medical Center, Boston, MA, United States
(Steg) Universite Paris-Diderot, Departement Hospitalo-Universitaire
Fibrosis Inflammation Remodeling, Hopital Bichat, Assistance
Publique-Hopitaux de Paris, Sorbonne Paris Cite
(Steg) National Heart and Lung Institute, Institute of Cardiovascular
Medicine and Science, Royal Brompton Hospital, Imperial College, United
Kingdom (P.G.S.), London, Canada
(Cutlip) Division of Cardiology, Department of Medicine (D.E.C.)
(Jacobs) Boston University School of Medicine, Boston, United Kingdom
(Abbott) Rhode Island Hospital, Brown University School of Medicine
(J.D.A.)
(Massaro) Boston University School of Public Health, United States
Publisher
NLM (Medline)
Abstract
METHODS AND RESULTS: The DAPT study was a randomized double-blind,
placebo-controlled trial comparing continued thienopyridine versus placebo
beyond 12 months after coronary stenting. We compared rates of myocardial
infarction, stent thrombosis, major adverse cardiovascular and
cerebrovascular events, and bleeding by sex and randomized treatment. Of
11648 patients, women (N=2925) were older, with higher prevalence of
diabetes mellitus and lower rates of acute coronary syndrome than men. At
12 to 30 months, women had similar adjusted ischemic and bleeding events
as men. The effects of continued thienopyridine therapy did not differ
significantly by sex for stent thrombosis (women: hazard ratio [HR], 0.54;
95% confidence interval [CI], 0.22-1.36; men: HR, 0.26; 95% CI, 0.15-0.44;
interaction P=0.17), myocardial infarction (women: HR, 0.75; 95% CI,
0.50-1.14; men: HR, 0.46; 95% CI, 0.36-0.60; interaction P=0.052), major
adverse cardiovascular and cerebrovascular events (women: HR, 0.87; 95%
CI, 0.62-1.22; men: HR, 0.70; 95% CI, 0.58-0.85; interaction P=0.26), and
bleeding (women: HR, 1.45; 95% CI, 0.88-2.40; men: HR, 1.78; 95% CI,
1.28-2.49; interaction P=0.50).
BACKGROUND: Women may derive differential benefit from prolonged DAPT
(dual antiplatelet therapy) after coronary stenting than men. We assessed
whether the risks/benefits of prolonged DAPT differ between women and men.
CONCLUSIONS: Women had similar late risks of ischemia and bleeding as men
after coronary stent procedures.
CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique
identifier: NCT00977938.

<37>
Accession Number
624333094
Title
Frailty and Exercise Training: How to Provide Best Care after Cardiac
Surgery or Intervention for Elder Patients with Valvular Heart Disease.
Source
BioMed research international. 2018 (pp 9849475), 2018. Date of
Publication: 2018.
Author
Tamuleviciute-Prasciene E.; Drulyte K.; Jurenaite G.; Kubilius R.;
Bjarnason-Wehrens B.
Institution
(Tamuleviciute-Prasciene, Jurenaite, Kubilius) Rehabilitation Department,
Lithuanian University of Health Sciences, Eiveniu g. 2, Kaunas LT-50161,
Lithuania
(Drulyte) Faculty of Medicine, Lithuanian University of Health Sciences,
A. Mickeviciaus g. 9, Kaunas LT-44307, Lithuania
(Bjarnason-Wehrens) Institute of Cardiology and Sports Medicine,
Department Preventive and Rehabilitative Sport and Exercise Medicine,
German Sport University Cologne, Am Sportpark Muengersdorf 6, Cologne
50933, Germany
Publisher
NLM (Medline)
Abstract
The aim of this literature review was to evaluate existing evidence on
exercise-based cardiac rehabilitation (CR) as a treatment option for
elderly frail patients with valvular heart disease (VHD). Pubmed database
was searched for articles between 1980 and January 2018. From 2623
articles screened, 61 on frailty and VHD and 12 on exercise-based training
for patients with VHD were included in the analysis. We studied and
described frailty assessment in this patient population. Studies reporting
results of exercise training in patients after surgical/interventional VHD
treatment were analyzed regarding contents and outcomes. The tools for
frailty assessment included fried phenotype frailty index and its
modifications, multidimensional geriatric assessment, clinical frailty
scale, 5-meter walking test, serum albumin levels, and Katz index of
activities of daily living. Frailty assessment in CR settings should be
based on functional, objective tests and should have similar components as
tools for risk assessment (mobility, muscle mass and strength,
independence in daily living, cognitive functions, nutrition, and anxiety
and depression evaluation). Participating in comprehensive exercise-based
CR could improve short- and long-term outcomes (better quality of life,
physical and functional capacity) in frail VHD patients. Such CR program
should be led by cardiologist, and its content should include (1) exercise
training (endurance and strength training to improve muscle mass,
strength, balance, and coordination), (2) nutrition counseling, (3)
occupational therapy (to improve independency and cognitive function), (4)
psychological counseling to ensure psychosocial health, and (5) social
worker counseling (to improve independency). Comprehensive CR could help
to prevent, restore, and reduce the severity of frailty as well as to
improve outcomes for frail VHD patients after surgery or intervention.

<38>
[Use Link to view the full text]
Accession Number
624601028
Title
Outcomes Among Patients Undergoing Distal Left Main Percutaneous Coronary
Intervention.
Source
Circulation. Cardiovascular interventions. 11 (10) (pp e007007), 2018.
Date of Publication: 01 Oct 2018.
Author
Kandzari D.E.; Gershlick A.H.; Serruys P.W.; Leon M.B.; Morice M.-C.;
Simonton C.A.; Lembo N.J.; Banning A.P.; Merkely B.; van Boven A.J.; Ungi
I.; Kappetein A.P.; Sabik J.F.; Genereux P.; Dressler O.; Stone G.W.
Institution
(Kandzari) Piedmont Heart Institute, Atlanta, United States
(Gershlick) Leicester Biomedical Research Centre, University Hospitals of
Leicester, University of Leicester, United Kingdom (A.H.G.)
(Serruys) Imperial College of Science, Technology and Medicine, United
Kingdom (P.W.S.), London, Canada
(Leon, Lembo, Stone) Center for Interventional Vascular Therapy, Division
of Cardiology, New York-Presbyterian Hospital/Columbia University Medical
Center (M.B.L.
(Leon, Lembo, Genereux, Dressler, Stone) Clinical Trials Center,
Cardiovascular Research Foundation, O.D., NY, United States
(Morice) Ramsay Generale de Sante, Hopital Prive Jacques Cartier, Massy,
France
(Simonton) Abbott Vascular, Inc, Santa Clara, Cuba
(Banning) John Radcliffe Hospital, United Kingdom (A.P.B.), Oxford, Canada
(Merkely) Heart and Vascular Center, Semmelweis University, Hungary
(B.M.), Budapest, Hungary
(van Boven) Medisch Centrum Leeuwarden, Netherlands
(Ungi) Cardiology Center, University of Szeged, Hungary (I.U.)
(Kappetein) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Sabik) Department of Surgery, UH Cleveland Medical Center
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center
(Genereux) Hopital du Sacre-Coeur de Montreal, Quebec, Canada
Publisher
NLM (Medline)
Abstract
METHODS AND RESULTS: The clinical and angiographic characteristics,
procedural methods and outcomes, and clinical events through 3-year
follow-up were compared in patients undergoing distal LM PCI with a
1-stent provisional versus planned 2-stent technique in the EXCEL trial
(Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for
Effectiveness of Left Main Revascularization). Among 529 patients
undergoing planned distal LM PCI, 344 (65.0%) and 185 (35.0%) were treated
with intended 1-stent provisional and planned 2-stent techniques,
respectively. The primary composite end point rate of death, myocardial
infarction, or stroke at 3 years was significantly lower in patients
treated with the provisional 1-stent versus planned 2-stent method (14.1%
versus 20.7%; adjusted hazard ratio, 0.55; 95% CI, 0.35-0.88; P=0.01),
driven by differences in cardiovascular death (3.3% versus 8.3%, P=0.01)
and myocardial infarction (7.7% versus 12.8%, P=0.06). The 3-year rate of
ischemia-driven revascularization of the LM complex was also lower in the
provisional group (7.2% versus 16.3%, P=0.001). In 342 patients with
distal LM bifurcation disease that did not involve both major side branch
vessels, the 3-year primary end point was lower with a provisional 1-stent
versus planned 2-stent technique (13.8% versus 23.3%, P=0.04), whereas no
significant difference was present in 182 patients with distal LM
bifurcation disease that did involve both side branch vessels (14.3%
versus 19.2%, P=0.36).
CONCLUSIONS: Among patients with distal LM bifurcation disease in the
EXCEL trial randomized to PCI, 3-year adverse outcomes were worse with
planned 2-stent treatment compared with a provisional 1-stent approach, a
difference that was confined to patients without major involvement of both
LM side branch vessels.
BACKGROUND: Distal left main (LM) coronary artery bifurcation disease
increases percutaneous coronary intervention (PCI) procedural complexity
and is associated with worse outcomes than isolated ostial/shaft disease.
The optimal treatment strategy for distal LM disease is undetermined. We
sought to determine whether outcomes after PCI of LM distal bifurcation
lesions are influenced by treatment with a provisional 1-stent versus
planned 2-stent technique, and if so, whether such differences are
conditioned by the complexity of the LM bifurcation lesion.
CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique
identifier: NCT01205776.

<39>
[Use Link to view the full text]
Accession Number
624600752
Title
Non-Vitamin K Antagonist Oral Anticoagulants for Mechanical Heart Valves.
Source
Circulation. 138 (13) (pp 1356-1365), 2018. Date of Publication: 25 Sep
2018.
Author
Aimo A.; Giugliano R.P.; De Caterina R.
Institution
(Aimo) Cardiology Division, University Hospital of Pisa, Italy
(Giugliano) Brigham and Women's Hospital, Harvard Medical School, Boston,
United Kingdom
(De Caterina) G. d'Annunzio University, Chieti-Pescara and Center of
Excellence on Aging
Publisher
NLM (Medline)
Abstract
The estimated prevalence of mitral or aortic valvular heart disease is
=2.5% in the general population of Western countries, and is expected to
rise with population aging. A substantial proportion of patients with
valvular heart disease undergoes surgical valve replacement. Mechanical
heart valves are much more durable than bioprostheses, and are thus
preferentially implanted in patients with a longer life expectancy, but
have the major drawback of requiring lifelong anticoagulation to prevent
valve thrombosis because of their higher thrombogenicity. The non-vitamin
K antagonist oral anticoagulants (NOACs) are replacing vitamin K
antagonists in many settings, including bioprostheses, because of their
favorable safety and efficacy profiles. However, mechanical heart valves
currently pose an absolute contraindication to NOACs based on the results
of a single phase II study comparing dabigatran and warfarin (RE-ALIGN
[Randomized, Phase II Study to Evaluate the Safety and Pharmacokinetics of
Oral Dabigatran Etexilate in Patients after Heart Valve Replacement]).
That trial was stopped prematurely because of an excess of both stroke and
bleeding with the dabigatran doses tested. Because of such negative
findings, research in this area has been halted. We believe that several
aspects of both the preclinical studies and the RE-ALIGN trial should be
critically reevaluated. In our opinion, 1 single trial with a single NOAC
does not represent sufficient evidence for dismissing a therapeutic
strategy, anticoagulation with NOACs, that has shown better safety and at
least similar efficacy as warfarin in the setting of atrial fibrillation
and venous thromboembolism,. Herein, we reevaluate this topic to identify
the patient profile that has the greatest likelihood of benefit from some
of the NOACs, with a focus on factor Xa inhibitors, thus providing some
perspectives for basic and translational research.

<40>
[Use Link to view the full text]
Accession Number
624600751
Title
Effect of Everolimus Initiation and Calcineurin Inhibitor Elimination on
Cardiac Allograft Vasculopathy in De Novo Heart Transplant Recipients.
Source
Circulation. Heart failure. 11 (9) (pp e004050), 2018. Date of
Publication: 01 Sep 2018.
Author
Arora S.; Andreassen A.K.; Karason K.; Gustafsson F.; Eiskjaer H.; Botker
H.E.; Radegran G.; Gude E.; Ioanes D.; Solbu D.; Dellgren G.; Ueland T.;
Aukrust P.; Gullestad L.
Institution
(Arora, Andreassen, Gude, Gullestad) Department of Cardiology, Oslo
University Hospital, E.G., Rikshospitalet
(Arora) Center for Heart Failure Research, University of Oslo and Faculty
of Medicine, University of Oslo, Germany
(Karason, Ioanes) Department of Cardiology, Sahlgrenska University
Hospital, Gothenburg, Germany
(Gustafsson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Eiskjaer, Botker) Department of Cardiology, Aarhus University Hospital,
Sweden
(Radegran) Section for Heart Failure and Valvular Disease, VO Heart and
Lung Medicine, Skane University Hospital and Department of Clinical
Sciences, Lund University, Denmark
(Solbu) Novartis Norge AS, Oslo, Norway
(Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Germany
(Ueland, Aukrust) Research Institute of Internal Medicine, Oslo University
Hospital, Rikshospitalet, Norway
(Ueland, Aukrust) K.G. Jebsen Inflammatory Research Center, Faculty of
Medicine, University of Oslo, Germany
(Ueland, Aukrust) K. G. Jebsen Thrombosis Research and Expertise Center,
University of Tromso
(Ueland, Aukrust, Gullestad) Faculty of Medicine, University of Oslo, P.A,
United States
(Aukrust) Section of Clinical Immunology and Infectious Diseases, Oslo
University Hospital, Rikshospitalet, Norway
Publisher
NLM (Medline)
Abstract
Background Cardiac allograft vasculopathy (CAV) limits survival after
heart transplantation, and the effect of different immunosuppressive
regimens on CAV is not fully understood. The randomized SCHEDULE trial
(Scandinavian Heart Transplant Everolimus De Novo Study With Early
Calcineurin Inhibitors Avoidance) evaluated whether initiation of the
proliferation signal inhibitor everolimus and early cyclosporine
elimination can reduce CAV development. Methods and Results The SCHEDULE
trial was a multicenter Scandinavian trial, where 115 de novo heart
transplantation recipients were randomized to everolimus with complete
cyclosporine withdrawal 7 to 11 weeks after heart transplantation or
standard cyclosporine-based immunosuppression. Seventy-six (66%) patients
had matched intravascular ultrasound examinations at baseline and 12 and
36 months. Intravascular ultrasound analysis evaluated maximal intimal
thickness, percent atheroma volume, and total atheroma volume. Qualitative
plaque analysis using virtual histology assessed fibrous, fibrofatty, and
calcified tissue as well as necrotic core. Serum inflammatory markers were
measured in parallel. The everolimus group (n=37) demonstrated
significantly reduced CAV progression as compared with the cyclosporine
group (n=39) at 36 months (DELTA maximal intimal thickness, 0.09+/-0.05
versus 0.15+/-0.16 mm [ P=0.03]; DELTA percent atheroma volume, 5.3+/-2.8%
versus 7.6+/-5.9% [ P=0.03]; and DELTA total atheroma volume, 33.9+/-71.2
versus 54.2+/-96.0 mm3 [ P=0.34], respectively]. At 36 months the number
of everolimus patients with rejection graded >=2R was 15 (41%) as compared
with 5 (13%) in the cyclosporine group ( P=0.01). Everolimus did not
affect CAV morphology or immune marker activity during the follow-up
period. Conclusions The SCHEDULE trial demonstrates that everolimus
initiation and early cyclosporine elimination significantly reduces CAV
progression at 12 months, and this beneficial effect is clearly sustained
at 36 months. Clinical trial registration URL:
https://www.clinicaltrials.gov . Unique identifier: NCT01266148.

<41>
[Use Link to view the full text]
Accession Number
624592342
Title
LPA Variants Are Associated With Residual Cardiovascular Risk in Patients
Receiving Statins.
Source
Circulation. 138 (17) (pp 1839-1849), 2018. Date of Publication: 23 Oct
2018.
Author
Wei W.-Q.; Li X.; Feng Q.; Kubo M.; Kullo I.J.; Peissig P.L.; Karlson
E.W.; Jarvik G.P.; Lee M.T.M.; Shang N.; Larson E.A.; Edwards T.; Shaffer
C.M.; Mosley J.D.; Maeda S.; Horikoshi M.; Ritchie M.; Williams M.S.;
Larson E.B.; Crosslin D.R.; Bland S.T.; Pacheco J.A.; Rasmussen-Torvik
L.J.; Cronkite D.; Hripcsak G.; Cox N.J.; Wilke R.A.; Stein C.M.; Rotter
J.I.; Momozawa Y.; Roden D.M.; Krauss R.M.; Denny J.C.
Institution
(Wei, Mosley, Denny) Department of Biomedical Informatics (W.-Q.W.,
Vanderbilt University Medical Center, Nashville, TN, United States
(Li, Rotter) Institute for Translational Genomics and Population Sciences,
Departments of Pediatrics and Medicine, Los Angeles Biomedical Research
Institute at Harbor-UCLA Medical Center, Torrance, United States
(Feng, Shaffer, Mosley, Stein, Roden) Division of Clinical Pharmacology
(Q.F., C.S., C.M.S., Vanderbilt University Medical Center, Nashville, TN,
United States
(Kubo, Maeda, Horikoshi, Momozawa) Japan (M.K., M.H., RIKEN Center for
Integrative Medical Sciences, Yokohama, Japan
(Kullo) Department of Cardiovascular Diseases, Mayo Clinic, Rochester,
United Kingdom
(Peissig) Center for Precision Medicine Research, Marshfield Clinic
Research Institute
(Karlson) Division of Rheumatology, Immunology and Allergy, Brigham &
Women's Hospital and Harvard Medical School, Boston, United Kingdom
(Jarvik, Cronkite) Departments of Medicine (Medical Genetics) and Genome
Sciences (G.P.J., University of Washington, Seattle, United States
(Lee, Williams) Genomic Medicine Institute, Geisinger, Danville, PA
(M.T.M.L., M.S.W.)
(Shang, Hripcsak) Department of Biomedical Informatics, Columbia
University, NY, United States
(Larson, Wilke) Sanford School of Medicine, University of South Dakota,
United States
(Edwards, Cox) Vanderbilt Genetics Institute and the Division of Genetic
Medicine, Vanderbilt University, Nashville, United States
(Maeda) Department of Advanced Genomic and Laboratory Medicine, Graduate
School of Medicine, University of the Ryukyus, Japan (S.M.), Nishihara
(Maeda) Division of Clinical Laboratory and Blood Transfusion, University
of the Ryukyus Hospital, Japan (S.M.), Nishihara
(Ritchie) Center for Translational Bioinformatics, Institute for
Biomedical Informatics, Center for Precision Medicine, University of
Pennsylvania, Australia
(Larson, Cronkite) Kaiser Permanente Washington Health Research Institute
(Crosslin) Department of Biomedical Informatics and Medical Education
(D.R.C.), University of Washington, Seattle, United States
(Bland) Vanderbilt Institute for Clinical and Translational Research
(S.T.B.), Vanderbilt University Medical Center, Nashville, TN, United
States
(Pacheco, Rasmussen-Torvik) Feinberg School of Medicine, Northwestern
University, Chicago, United States
(Stein, Roden, Denny) Department of Medicine (C.M.S., D.M.R., Vanderbilt
University Medical Center, Nashville, TN, United States
(Krauss) Children's Hospital Oakland Research Institute
Publisher
NLM (Medline)
Abstract
BACKGROUND: Coronary heart disease (CHD) is a leading cause of death
globally. Although therapy with statins decreases circulating levels of
low-density lipoprotein cholesterol and the incidence of CHD, additional
events occur despite statin therapy in some individuals. The genetic
determinants of this residual cardiovascular risk remain unknown.
METHODS: We performed a 2-stage genome-wide association study of CHD
events during statin therapy. We first identified 3099 cases who
experienced CHD events (defined as acute myocardial infarction or the need
for coronary revascularization) during statin therapy and 7681 controls
without CHD events during comparable intensity and duration of statin
therapy from 4 sites in the Electronic Medical Records and Genomics
Network. We then sought replication of candidate variants in another 160
cases and 1112 controls from a fifth Electronic Medical Records and
Genomics site, which joined the network after the initial genome-wide
association study. Finally, we performed a phenome-wide association study
for other traits linked to the most significant locus.
RESULTS: The meta-analysis identified 7 single nucleotide polymorphisms at
a genome-wide level of significance within the LPA/PLG locus associated
with CHD events on statin treatment. The most significant association was
for an intronic single nucleotide polymorphism within LPA/PLG (rs10455872;
minor allele frequency, 0.069; odds ratio, 1.58; 95% confidence interval,
1.35-1.86; P=2.6x10-10). In the replication cohort, rs10455872 was also
associated with CHD events (odds ratio, 1.71; 95% confidence interval,
1.14-2.57; P=0.009). The association of this single nucleotide
polymorphism with CHD events was independent of statin-induced change in
low-density lipoprotein cholesterol (odds ratio, 1.62; 95% confidence
interval, 1.17-2.24; P=0.004) and persisted in individuals with
low-density lipoprotein cholesterol <=70 mg/dL (odds ratio, 2.43; 95%
confidence interval, 1.18-4.75; P=0.015). A phenome-wide association study
supported the effect of this region on coronary heart disease and did not
identify noncardiovascular phenotypes.
CONCLUSIONS: Genetic variations at the LPA locus are associated with CHD
events during statin therapy independently of the extent of low-density
lipoprotein cholesterol lowering. This finding provides support for
exploring strategies targeting circulating concentrations of
lipoprotein(a) to reduce CHD events in patients receiving statins.

<42>
Accession Number
2001225026
Title
A Review of Coronary Artery Bypass Grafting in the Indigenous Australian
Population.
Source
Heart Lung and Circulation. (no pagination), 2018. Date of Publication:
2018.
Author
Wiemers P.D.; Fraser J.F.; Marney L.; Yadav S.; Tam R.
Institution
(Wiemers, Marney, Yadav, Tam) Department of Cardiothoracic Surgery, The
Townsville Hospital, Townsville, Australia
(Wiemers, Fraser) University of Queensland School of Medicine, Brisbane,
Australia
(Fraser) Critical Care Research Group, The Prince Charles Hospital,
Brisbane, Australia
(Tam) James Cook University, College of Medicine and Dentistry,
Townsville, Australia
(Wiemers) Royal Brisbane & Women's Hospital Herston, Australia
Publisher
Elsevier Ltd
Abstract
Introduction: Indigenous Australians experience poorer health outcomes
than non-Indigenous Australians. Ischaemic heart disease is a leading
contributor to the mortality gap which exists between Indigenous and
non-Indigenous Australians. Methods: We reviewed the literature in regards
to Indigenous Australians undergoing coronary artery bypass grafting
(CABG) for management of ischaemic heart disease. Results: Younger
patients with higher rates of preventable risk factors constitute the
Indigenous Australian CABG population. Indigenous Australian females are
over-represented in series to date. High rates of left ventricular
dysfunction are seen in the Indigenous CABG cohorts potentially reflecting
barriers to medical care or the influence of high rates of diabetes
observed in the Indigenous Australian population. The distribution of
coronary artery disease appears to differ between Indigenous Australian
and non-Indigenous CABG cohorts likely reflecting a difference in the
referral patterns of the two population groups with diabetes again likely
influencing management decisions. Reduced utilisation of arterial conduits
in Indigenous Australian cohorts has been identified in a number of
series. This is of particular concern given the younger age structure of
the Indigenous Australian cohorts. Indigenous Australian patients suffer
excess morbidity and mortality in the longer term after undergoing CABG.
Ventricular dysfunction and excess comorbidities in the Indigenous
Australian CABG population appear largely responsible for this.
Conclusion: Excess morbidity and mortality endured by Indigenous
Australians in the longer term following CABG appears largely contributed
to by higher rates of ventricular dysfunction and comorbidities in the
Indigenous Australian CABG population. Maximising internal mammary artery
use and continued focus on strategies to reduce the impact of diabetes,
renal impairment and heart failure in the Indigenous Australian population
is essential to reduce the mortality gap experienced by Indigenous
Australians secondary to ischaemic heart disease.<br/>Copyright &#xa9;
2018

<43>
Accession Number
624586004
Title
Effect of intraoperative dexmedetomidine on renal function after
cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a
randomized, placebo-controlled trial.
Source
International Journal of Hyperthermia. (no pagination), 2018. Date of
Publication: 2018.
Author
Song Y.; Kim D.-H.; Kwon T.D.; Han D.W.; Baik S.H.; Jung H.H.; Kim J.Y.
Institution
(Song, Kim, Kwon, Han, Jung, Kim) Department of Anesthesiology and Pain
Medicine, Yonsei University College of Medicine, Seoul, South Korea
(Song, Kim, Kwon, Han, Kim) Anesthesia and Pain Research Institute, Yonsei
University College of Medicine, Seoul, South Korea
(Baik) Department of Surgery, Yonsei University College of Medicine,
Seoul, South Korea
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Introduction: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal
chemotherapy (HIPEC) predispose to postoperative renal dysfunction.
Dexmedetomidine is an alpha<inf>2</inf> adrenoreceptor agonist, which has
renoprotective effects after cardiac surgery. Objective: To assess the
effect of dexmedetomidine on renal function after CRS and HIPEC.
Materials: Thirty-eight patients undergoing CRS and HIPEC were randomized
to receive dexmedetomidine (dexmedetomidine group, n = 19, loading 1
mug/kg over 20 min followed by infusion at 0.5 mug/kg/h) or 0.9% sodium
chloride (control group, n = 19) during surgery. Creatinine clearance
(CrCl) was assessed daily until postoperative day 7. Urine neutrophil
gelatinase-associated lipocalin (NGAL) and kidney injury molecule (KIM)-1
were measured for 24 h after surgery. Results: There was no difference in
the lowest CrCl value during the first 7 days postoperatively, but the %
change from baseline to the lowest value was lower in the dexmedetomidine
group than in the control group (p =.037). Urine NGAL and KIM-1 levels
were increased over time in both groups, but the increases were
significantly less in the dexmedetomidine group (p =.018 and 0.038,
respectively). In the dexmedetomidine group, the length of intensive care
unit stay was shorter (p =.034). Conclusions: Intraoperative
dexmedetomidine infusion did not improve renal function in terms of serum
Cr-related indices following CRS and HIPEC. However, as the decrease in
CrCl was attenuated and early tubular-injury markers were lower in the
dexmedetomidine group, dexmedetomidine may have protective effects against
early tubular injury in CRS and HIPEC. Clinical Trials
Registry:http://clinicaltrials.gov (NCT02641938).<br/>Copyright &#xa9;
2018, &#xa9; 2018 The Author(s). Published by Informa UK Limited, trading
as Taylor & Francis Group.

<44>
Accession Number
611367901
Title
Impact of standard-pressure and low-pressure pneumoperitoneum on shoulder
pain following laparoscopic cholecystectomy: a randomised controlled
trial.
Source
Surgical Endoscopy. 31 (3) (pp 1287-1295), 2017. Date of Publication: 01
Mar 2017.
Author
Bhattacharjee H.K.; Jalaludeen A.; Bansal V.; Krishna A.; Kumar S.;
Subramanium R.; Ramachandran R.; Misra M.
Institution
(Bhattacharjee, Jalaludeen, Bansal, Krishna, Kumar, Misra) Department of
Surgical Disciplines, All India Institute of Medical Sciences, New Delhi,
India
(Subramanium, Ramachandran) Department of Anaesthesiology, All India
Institute of Medical Sciences, New Delhi, India
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: The incidence of shoulder pain (SP) following laparoscopic
cholecystectomy (LC) varies between 21 and 80 %. A few randomised
controlled trials and meta-analysis have shown lesser SP in LC performed
under low-pressure carbon dioxide pneumoperitoneum (LPCP) than under
standard-pressure carbon dioxide pneumoperitoneum (SPCP). However, the
possible compromise in adequate exposure and effective working space
during LPCP has negatively influenced its uniform adoption for LC.
Materials and methods: All consecutive patients undergoing elective LC for
gallstone disease who met the inclusion and exclusion criteria were
enroled. Fourty patients were randomised to SPCP group (pressure of 14
mmHg) and 40 to LPCP group (pressure of 9-10 mmHg). Primary outcome
measured was incidence of SP and its severity on visual analogue scale
(VAS) at 4, 8, 24 h and 7 days after LC. Secondary outcomes measured were
procedural time, technical difficulty, surgeons' satisfaction score on
exposure and working space, intra-operative changes in heart rate and
blood pressure, abdominal pain and analgesic requirement. Analyses were
performed using Stata software. Results: There was no conversion to open
surgery, bile duct injury or need to increase intra-abdominal pressure on
either group. Twenty-three patients (57.5 %) in SPCP group and nine
patients (22.5 %) in LPCP group had SP (p = 0.001). The severity of SP was
significantly more in SPCP group at 8 and 24 h (p = 0.009 and 0.005,
respectively). Both the groups had similar procedural time, surgeons'
satisfaction score, intra-operative changes in heart rate and blood
pressure. Conclusion: The incidence and severity of SP following LC
performed at LPCP are significantly less compared to that in SPCP. The
safety, efficacy and surgeons' satisfaction appear to be comparable in
both the groups. Hence, a routine practice of low-pressure carbon dioxide
pneumoperitoneum may be recommended in selected group of patients
undergoing laparoscopic cholecystectomy. Clinical trial registration
number: CTRI/2016/02/006590.<br/>Copyright &#xa9; 2016, Springer
Science+Business Media New York.

<45>
Accession Number
610189145
Title
One-port video-assisted thoracic surgery versus three-port video-assisted
thoracic surgery for primary spontaneous pneumothorax: a meta-analysis.
Source
Surgical Endoscopy. 31 (1) (pp 17-24), 2017. Date of Publication: 01 Jan
2017.
Author
Xu W.; Wang Y.; Song J.; Mo L.; Jiang T.
Institution
(Xu, Wang, Song, Jiang) Department of Respiratory Medicine, The First
Affiliated Hospital of Chongqing Medical University, Chongqing 400016,
China
(Mo) Department of Respiratory Medicine, Dazu District People's Hospital,
Chongqing 400016, China
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Objective: To further understand the effects of video-assisted thoracic
surgery (VATS) with one-port versus three-port VATS for primary
spontaneous pneumothorax (PSP). Methods: In this study, we searched
information from the PubMed, Cochrane Library, Embase, ScienceDirect, Web
of Science, China National Knowledge Infrastructure (CNKI), and Wanfang
Data databases from inception to September 2015 to collect data of
randomized controlled trials (RCTs) and cohort studies about one-port VATS
versus three-port VATS for PSP. Two independent authors were committed to
screen literature, extract data, and assess the risk of bias of related
studies. Then, we used the RevMan 5.20 software for a meta-analysis of
one-port VATS versus three-port VATS for PSP. Results: Six cohort studies
involving 310 patients were finally selected in this meta-analysis. The
results of our study indicate that one-port VATS had a shorter hospital
stay (SMD = -0.39, 95 % CI -0.69 to 0.09, P = 0.01), lower VAS score of
24-h post-operative pain (SMD = -0.78, 95 % CI -1.40 to -0.52, P <
0.00001), shorter chest drainage time (SMD = -0.68, 95 % CI -1.15 to
-0.22, P = 0.004), and lower incidence of post-operative paraesthesia (OR
= 0.13, 95 % CI 0.06 to 0.29, P < 0.00001) compared with three-port VATS.
However, one-port VATS had a lower patient satisfaction score at 24 h (SMD
= -0.65, 95 % CI -0.95 to -0.35, P < 0.0001) and 48 h (SMD = -0.46, 95 %
CI -0.71 to -0.21, P = 0.0002). No differences in the recurrence of
pneumothorax (OR = 0.58, 95 % CI 0.20 to 1.67, P = 0.32), the operation
time (SMD = 1.01, 95 % CI -4.63 to 2.60, P = 0.58), and the satisfaction
score at 72 h (SMD = -0.11, 95 % CI -0.44 to 0.22, P < 0.00001) were noted
between the groups. Conclusion: Current evidence suggests that one-port
VATS may have certain advantages over three-port VATS for PSP. More
large-scale and high-quality studies are needed for
authentication.<br/>Copyright &#xa9; 2016, Springer Science+Business Media
New York.

<46>
Accession Number
605254074
Title
Impact of single-incision laparoscopic cholecystectomy (SILC) versus
conventional laparoscopic cholecystectomy (CLC) procedures on surgeon
stress and workload: a randomized controlled trial.
Source
Surgical Endoscopy. 30 (3) (pp 1205-1211), 2016. Date of Publication: 01
Mar 2016.
Author
Abdelrahman A.M.; Bingener J.; Yu D.; Lowndes B.R.; Mohamed A.; McConico
A.L.; Hallbeck M.S.
Institution
(Abdelrahman, Yu, Lowndes, Hallbeck) Robert D. and Patricia E. Kern Center
for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN,
United States
(Bingener, Mohamed, McConico, Hallbeck) Department of Surgery, Mayo
Clinic, Rochester, MN, United States
(Abdelrahman, Yu, Lowndes, Mohamed, Hallbeck) Division of Health Care
Policy and Research, Department of Health Sciences Research, Mayo Clinic,
200 First Street SW, Rochester, MN 55905, United States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Introduction: Single-incision laparoscopic cholecystectomy (SILC) may lead
to higher patient satisfaction; however, SILC may expose the surgeon to
increased workload. The goal of this study was to compare surgeon stress
and workload between SILC and conventional laparoscopic cholecystectomy
(CLC). Methods: During a double-blind randomized controlled trial
comparing patient outcomes for SILC versus CLC (NCT0148943), surgeon
workload was assessed by four measures: surgery task load index
questionnaire (Surg-TLX), maximum heart rate, salivary cortisol level, and
instruments usability survey. The maximum heart rate and salivary cortisol
levels were sampled from the surgeon before the random assignment of the
surgical procedure, intraoperatively after the cystic duct was clipped,
and at skin closure. After each procedure, the surgeon completed the
Surg-TLX and an instrument usability survey. Student's t tests, Wilcoxon
rank sum test, and Kruskal-Wallis nonparametric ANOVAs on the dependent
variables by the technique (SILC vs. CLC) were performed with alpha =
0.05. Results: Twenty-three SILC and 25 CLC procedures were included in
the intent-to-treat analysis. No significant differences were observed
between SILC and CLC for patient demographics and procedure duration. SILC
had significantly higher post-surgery surgeon maximum heart rates than CLC
(p < 0.05). SILC also had significantly higher mean change in the maximum
heart rate between during and post-procedure (p < 0.05) than CLC. Salivary
cortisol level was significantly higher during SILC than CLC (p < 0.01).
Awkward manipulation of the instruments and limited fine motions were
reported significantly more frequently with SILC than CLC (p < 0.01). In
the surgeon-reported Surg-TLX, subscale of physical demand was
significantly more demanding for SILC than CLC (p < 0.05). Conclusions:
Surgeon heart rate, salivary cortisol level, instrument usability, and
Surg-TLX ratings indicate that SILC is significantly more stressful and
physically demanding than the CLC. Surgeon stress and workload may impact
patients' outcomes; thus, ergonomic improvement on SILC is
necessary.<br/>Copyright &#xa9; 2015, The Author(s).

<47>
Accession Number
52964726
Title
Simulation-based training for thoracoscopic lobectomy: A randomized
controlled trial: Virtual-reality versus black-box simulation.
Source
Surgical Endoscopy. 28 (6) (pp 1821-1829), 2014. Date of Publication: June
2014.
Author
Jensen K.; Ringsted C.; Hansen H.J.; Petersen R.H.; Konge L.
Institution
(Jensen, Hansen, Petersen) Department of Cardiothoracic Surgery,
University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100
Copenhagen, Denmark
(Ringsted) Wilson Centre, University of Toronto, University Health
Network, Toronto, ON, Canada
(Konge) Centre for Clinical Education, University of Copenhagen,
Copenhagen, Denmark
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Video-assisted thoracic surgery is gradually replacing
conventional open thoracotomy as the method of choice for the treatment of
early-stage non-small cell lung cancers, and thoracic surgical trainees
must learn and master this technique. Simulation-based training could help
trainees overcome the first part of the learning curve, but no
virtual-reality simulators for thoracoscopy are commercially available.
This study aimed to investigate whether training on a laparoscopic
simulator enables trainees to perform a thoracoscopic lobectomy. Methods:
Twenty-eight surgical residents were randomized to either virtual-reality
training on a nephrectomy module or traditional black-box simulator
training. After a retention period they performed a thoracoscopic
lobectomy on a porcine model and their performance was scored using a
previously validated assessment tool. Results: The groups did not differ
in age or gender. All participants were able to complete the lobectomy.
The performance of the black-box group was significantly faster during the
test scenario than the virtual-reality group: 26.6 min (SD 6.7 min) versus
32.7 min (SD 7.5 min). No difference existed between the two groups when
comparing bleeding and anatomical and non-anatomical errors. Conclusion:
Simulation-based training and targeted instructions enabled the trainees
to perform a simulated thoracoscopic lobectomy. Traditional black-box
training was more effective than virtual-reality laparoscopy training.
Thus, a dedicated simulator for thoracoscopy should be available before
establishing systematic virtual-reality training programs for trainees in
thoracic surgery. &#xa9; 2014 Springer Science+Business Media.

<48>
Accession Number
52463902
Title
A prospective study comparing three-port video-assisted thoracoscopy with
the single-incision laparoscopic surgery (SILS) port and instruments for
the video thoracoscopic approach: A pilot study.
Source
Surgical Endoscopy. 27 (7) (pp 2557-2560), 2013. Date of Publication: July
2013.
Author
Mier J.M.; Chavarin A.; Izquierdo-Vidal C.; Fibla J.J.; Molins L.
Institution
(Mier, Chavarin, Izquierdo-Vidal, Fibla, Molins) Hospital Universitari
Sagrat Cor, c/Viladomat 288, 08029 Barcelona, Spain
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Single-incision laparoscopic surgery (SILS) has proved its
advantages in several procedures, mainly a shorter hospital stay, improved
aesthetic results, and less postoperative pain. The authors have used this
approach for several thoracic surgical procedures. Methods: This
prospective study compared 20 cases between standard three-port
video-assisted thoracic surgery (VATS) and the single-incision approach
using a standard abdominal SILS system. In both groups, postsurgical
analgesia was provided with 15 ml of bupivacaine 0.5% at 3 h intervals via
a paravertebral catheter. The hospital length of stay and chest drain
duration (in hours) were recorded as well as postoperative pain using an
analogic visual pain scale (AVPS). A telephone survey was conducted for
all the outpatients. The Mann-Whitney U test was used for statistical
analysis. Results: This study of 20 procedures included 11 lung biopsies,
6 pneumothorax procedures, 2 mediastinic cystectomies, and 1 catamenial
pneumothorax procedure. No statistically significant difference was
reported in hospital length of stay or chest drain duration between the
two groups. However, postoperative pain at 24 h was significantly less in
the SILS group (AVPS, 4.40) than in the VATS group (AVPS, 6.20) (p =
0.035). The SILS group reported two minor surgical wound complications and
one catamenial pneumothorax recurrence that did not require drainage. The
VATS group reported one case of skin rash with no identifiable cause.
Conclusions: The use of the SILS port in thoracic surgery results in less
postoperative pain. This is related to the port's protective effect over
the periostium and the intercostal nerve, relieving them of direct contact
with surgical instruments. However, the findings showed a higher incidence
of surgical wound complications with the SILS port, which can be
attributed to increased pressure on the skin and soft tissues surrounding
the port and to the fact that this same incision was used for chest drain
placement, thus increasing the risk for complications. &#xa9; 2013
Springer Science+Business Media New York.

<49>
Accession Number
51420314
Title
A modified two-port thoracoscopic technique versus axillary
minithoracotomy for the treatment of recurrent spontaneous pneumothorax: A
prospective randomized study.
Source
Surgical Endoscopy. 26 (3) (pp 607-614), 2012. Date of Publication: March
2012.
Author
Foroulis C.N.; Anastasiadis K.; Charokopos N.; Antonitisis P.;
Halvatzoulis H.V.; Karapanagiotidis G.T.; Grosomanidis V.;
Papakonstantinou C.
Institution
(Foroulis, Anastasiadis, Charokopos, Antonitisis, Halvatzoulis,
Karapanagiotidis, Papakonstantinou) Department of Thoracic and
Cardiovascular Surgery, Aristotle University Medical School, AHEPA
University Hospital, Stilponos Kiriakidi Street, Thessaloniki 54636,
Greece
(Grosomanidis) Department of Anaesthesiology and Intensive Care, Aristotle
University Medical School, AHEPA University Hospital, Thessaloniki, Greece
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Currently, most thoracic surgeons perform surgical pleurodesis
for recurrent spontaneous pneumothorax (RSP) by video-assisted thoracic
surgery (VATS). However, the superiority of VATS over axillary
minithoracotomy is not been established in prospective studies to date. A
modified two-port VATS technique and axillary minithoracotomy were
prospectively evaluated for possible differences in the short- and
long-term outcome for patients. Methods: In this study, 66 consecutive
patients underwent surgical pleurodesis for RSP through either a modified
two-port VATS procedure (group A, 33 patients) or axillary minithoracotomy
(group B, 33 patients). According to the study design (NCT01192217), the
patients were randomly assigned to the two groups, which were similar in
terms of age and body mass index. One-lung ventilation time, histology of
the available lung parenchyma specimens, early postoperative
complications, length of chest tube drainage and hospital stay, recurrence
rate, and a score for patient satisfaction with treatment based on the sum
of postoperative pain, dependent-arm mobilization, and return to full
activity subscores were evaluated. The follow-up period varied from 3 to
53 months (median, 30 months). Results: The one-lung ventilation and
operating times were significantly longer (p < 0.001) in group A than in
group B. The overall detection of blebs, bulla, or both was 51.5% in group
A and 63.8% in group B. The recurrence rate, complication rate,
postoperative chest tube drainage duration, postoperative hospital stay,
and incidence of chronic pain did not differ between the two groups. The
score for patient satisfaction with treatment was significantly higher in
group A than in group B (p < 0.001) according the subscores for better
dependent-arm mobilization and return to full activity. Conclusions:
Axillary minithoracotomy and VATS are equally effective for the treatment
of RSP, although the rate for resection of blebs, bulla, or both is higher
with the axillary minithoracotomy procedure. Although VATS is more time
consuming, it offers to the patient more satisfaction with treatment.
&#xa9; 2011 Springer Science+Business Media, LLC.

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

<51>
Accession Number
624459600
Title
Oral anticoagulant use in cardiovascular disorders: a perspective on
present and potential indications for rivaroxaban.
Source
Current Medical Research and Opinion. 34 (11) (pp 1945-1957), 2018. Date
of Publication: 02 Nov 2018.
Author
Camm A.J.; Fox K.A.A.
Institution
(Camm) Cardiovascular and Cell Sciences Research Institute, St George's,
University of London and Imperial College, London, United Kingdom
(Fox) Centre for Cardiovascular Science, University of Edinburgh and Royal
Infirmary of Edinburgh, Edinburgh, United Kingdom
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Background: Four non-vitamin-K-antagonist oral anticoagulants (NOACs) have
been approved for use in various cardiovascular indications. The direct
thrombin inhibitor dabigatran and the direct factor Xa inhibitors
apixaban, edoxaban and rivaroxaban are now increasingly used in clinical
practice. For some of these agents, available data from real-world studies
support the efficacy and safety data in phase III clinical trials.
Objectives: This review aims to summarize the current status of trials and
observational studies of oral anticoagulant use over the spectrum of
cardiovascular disorders (excluding venous thrombosis), provide a
reference source beyond stroke prevention for atrial fibrillation (AF) and
examine the potential for novel applications in the cardiovascular field.
Methods: We searched the recent literature for data on completed and
upcoming trials of oral anticoagulants with a particular focus on
rivaroxaban. Results: Recent data in specific patient subgroups, such as
patients with AF undergoing catheter ablation or cardioversion, have led
to an extended approval for rivaroxaban, whereas the other NOACs have
ongoing or recently completed trials in this setting. However, there are
unmet medical needs for several arterial thromboembolic-related
conditions, including patients with: AF and acute coronary syndrome, AF
and coronary artery disease undergoing elective percutaneous coronary
intervention, coronary artery disease and peripheral artery disease,
implanted cardiac devices, and embolic stroke of unknown source.
Conclusion: NOACs may provide alternative treatment options in areas of
unmet need, and numerous studies are underway to assess their benefit-risk
profiles in these settings.<br/>Copyright &#xa9; 2018, &#xa9; 2018 Informa
UK Limited, trading as Taylor & Francis Group.

<52>
Accession Number
624459567
Title
Antiplatelet Effect of Ketorolac in Children After Congenital Cardiac
Surgery.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 9 (6) (pp
651-658), 2018. Date of Publication: 01 Nov 2018.
Author
Kim J.S.; Kaufman J.; Patel S.S.; Manco-Johnson M.; Di Paola J.; da Cruz
E.M.
Institution
(Kim, Kaufman, Patel, da Cruz) Department of Pediatrics, Heart Institute,
Children's Hospital Colorado, University of Colorado Denver School of
Medicine, Aurora, CO, United States
(Manco-Johnson, Di Paola) Department of Pediatrics, Hemophilia and
Thrombosis Center, Children's Hospital Colorado, University of Colorado
Denver School of Medicine, Aurora, CO, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Ketorolac is used for pediatric analgesia after surgery
despite its known platelet inhibition via the arachidonic acid (AA)
pathway. The degree of platelet inhibitory effect after cardiac surgery is
not well characterized. Thromboelastography with platelet mapping (TEG-PM)
is emerging as a frequently used test to evaluate platelet inhibition via
the AA pathway. Methods: Post hoc analysis of a data set collected in a
prospective observational cohort study evaluating platelet inhibition in
children after congenital heart surgery with cardiopulmonary bypass (CPB).
Categorization into two groups: (1) received ketorolac and (2) did not
receive ketorolac for analgesia after surgery. The TEG-PM was evaluated at
two time points (prior to surgery and 12-48 hours after CPB). Results:
Fifty-three children were studied; mean age was 6.6 (range: 0.07-16.7)
years and 45% (n = 24) were female. Participants were distributed into two
groups by ketorolac use, 41 within the ketorolac group and 12 in the no
ketorolac group. All 41 participants who received ketorolac had platelet
inhibition and 11 (91.7%) of 12 participants who did not receive ketorolac
had normal platelet function after surgery (P <.0001). There was no
difference in patient characteristics or clinical data between the two
groups. Conclusions: Ketorolac use in a cohort of children after
congenital cardiac surgery was associated with platelet inhibition via the
AA pathway when evaluated by TEG-PM.<br/>Copyright &#xa9; The Author(s)
2018.

<53>
Accession Number
624508370
Title
Medical treatment or revascularisation as the best approach for
spontaneous coronary artery dissection: A systematic review and
meta-analysis.
Source
European Heart Journal: Acute Cardiovascular Care. 7 (7) (pp 614-623),
2018. Date of Publication: 01 Oct 2018.
Author
Martins J.L.; Afreixo V.; Santos L.; Costa M.; Santos J.; Goncalves L.
Institution
(Martins, Santos, Santos) Department of Cardiology, Baixo Vouga Hospital
Centre, Portugal
(Afreixo) CIDMA/IBIMED/Department of Mathematics, University of Aveiro,
Portugal
(Costa, Goncalves) Department of Cardiology, Coimbra Hospital and
Universitary Centre - General Unit, Portugal
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Introduction: Patients presenting with spontaneous coronary artery
dissection (SCAD) may receive either conservative medical management or a
revascularisation strategy. There is still a lack of consensus with
respect to the best treatment approach for SCAD. Objectives: We sought to
determine whether outcomes differ between the first-line treatment
approaches (conservative versus revascularisation) in patients with SCAD.
Methods: We searched Medline, EMBASE and the Cochrane Library for studies
published from January 1990 to November 2016 that compared first-line
treatments for patients with SCAD. We conducted a pooled risk ratio
meta-analysis for four main outcomes: mortality, myocardial infarction
(MI), SCAD recurrence and target vessel revascularisation (TVR). Results:
We identified 11 non-randomised studies that included a total of 631
patients. A pooled meta-analysis showed no significant difference between
conservative management and revascularisation approaches in mortality
(risk difference [RD] = 0.01; 95% confidence interval [CI] = -0.01 to
0.04; I² = 0%; p = 1), MI (RD = -0.01; 95% CI = -0.04 to 0.03;
I² = 0%; p = 0.5) or SCAD recurrence (RD = -0.01; 95% CI =
-0.06 to 0.05; I² = 0%; p = 0.74). Revascularisation as an
initial first-line approach was associated with an estimated additional
risk of TVR of 6.3% (RD = 0.06; 95% CI = 0.01-0.11; I² = 0%; p
= 0.96). Conclusion: The results demonstrate an increased risk of TVR when
revascularisation was used as the initial first-line treatment approach.
The treatment decision must be individualised and be based on both
clinical and angiographic factors, but conservative therapy should prevail
in most cases.<br/>Copyright &#xa9; The European Society of Cardiology
2017.

<54>
Accession Number
624502290
Title
Prospective randomized evaluation of preoperative angiotensin-converting
enzyme inhibition (PREOP-ACEI).
Source
Journal of Hospital Medicine. 13 (10) (pp 661-667), 2018. Date of
Publication: October 2018.
Author
Shiffermiller J.F.; Monson B.J.; Vokoun C.W.; Beachy M.W.; Smith M.P.;
Sullivan J.N.; Vasey A.J.; Guda P.; Lyden E.R.; Ellis S.J.; Pang H.;
Thompson R.E.
Institution
(Shiffermiller, Vokoun, Beachy, Smith, Thompson) Section of Hospital
Medicine, University of Nebraska Medical Center, Omaha, NE, United States
(Monson, Guda) Department of Internal Medicine, University of Nebraska
Medical Center, Omaha, NE, United States
(Sullivan, Ellis, Pang) Department of Anesthesiology, University of
Nebraska Medical Center, Omaha, NE, United States
(Vasey) Division of General Internal Medicine, University of Nebraska
Medical Center, Omaha, NE, United States
(Lyden) Department of Biostatistics, University of Nebraska Medical
Center, Omaha, NE, United States
Publisher
Society of hospital medicine (E-mail: jhospitalmedicine@jjeditorial.com)
Abstract
BACKGROUND: Intraoperative hypotension is associated with an increased
risk of end organ damage and death. The transient preoperative
interruption of angiotensin-converting enzyme inhibitor (ACEI) therapy
prior to cardiac and vascular surgeries decreases the occurrence of
intraoperative hypotension. OBJECTIVE: We sought to compare the effect of
two protocols for preoperative ACEI management on the risk of
intraoperative hypotension among patients undergoing noncardiac,
nonvascular surgeries. DESIGN: Prospective, randomized study. SETTING:
Midwestern urban 489-bed academic medical center. PATIENTS: Patients
taking an ACEI for at least six weeks preoperatively were considered for
inclusion. INTERVENTIONS: Randomization of the final preoperative ACEI
dose to omission (n = 137) or continuation (n = 138). MEASUREMENTS: The
primary outcome was intraoperative hypotension, which was defined as any
systolic blood pressure (SBP) < 80 mm Hg. Postoperative hypotensive (SBP <
90 mm Hg) and hypertensive (SBP > 180 mm Hg) episodes were also recorded.
Outcomes were compared using Fisher's exact test. RESULTS: Intraoperative
hypotension occurred less frequently in the omission group (76 of 137
[55%]) than in the continuation group (95 of 138 [69%]) (RR: 0.81, 95% CI:
0.67 to 0.97, P = .03, NNH 7.5). Postoperative hypotensive events were
also less frequent in the ACEI omission group (RR: 0.49, 95% CI: 0.28 to
0.86, P = .02) than in the continuation group. However, postoperative
hypertensive events were more frequent in the omission group than in the
continuation group (RR: 1.95, 95%: CI: 1.14 to 3.34, P = .01). CONCLUSION:
The transient preoperative interruption of ACEI therapy is associated with
a decreased risk of intraoperative hypotension. REGISTRATION:
ClinicalTrials.gov: NCT01669434.<br/>Copyright &#xa9; 2018 Society of
Hospital Medicine.

<55>
Accession Number
624399324
Title
Does oesophageal stenosis have any impact on survival of oesophageal
cancer patients?.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (3) (pp 384-386),
2018. Date of Publication: 2018.
Author
Deng H.-Y.; Li G.; Luo J.
Institution
(Deng) Lung Cancer Center, West China Hospital, Sichuan University, No. 37
Guoxue Alley, Chengdu, Sichuan 610041, China
(Deng, Li, Luo) Department of Thoracic Surgery, West China Hospital,
Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan 610041, China
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'Does oesophageal stenosis
have any impact on survival of oesophageal cancer patients?'. A total of
542 papers were found using the reported search, of which 8 cohort studies
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.
Most of these studies defined stenosis as failure to cross the tumour at
endoscopic ultrasonography. Seven studies demonstrated that oesophageal
cancer patients with stenosis had significantly poorer survival than those
without, while 2 studies found that oesophageal stenosis was also a
predictor of poor recurrence-free survival. We conclude that oesophageal
stenosis is a predictor of poor prognosis in patients with oesophageal
cancer.<br/>Copyright &#xa9; 2018 The Author(s). Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<56>
Accession Number
624377409
Title
Randomized trial of the Carpentier-Edwards supra-annular prosthesis versus
the Medtronic Mosaic aortic prosthesis: 10-year results.
Source
European Journal of Cardio-thoracic Surgery. 54 (2) (pp 281-287), 2018.
Date of Publication: 2018.
Author
Zibdeh O.; Bugg I.; Patel S.; Twine G.; Unsworth-White J.
Institution
(Zibdeh, Bugg, Patel) Plymouth University, Peninsula School of Medicine,
Plymouth, United Kingdom
(Twine, Unsworth-White) South West Cardiothoracic Unit, Derriford
Hospital, Plymouth PL6 8DH, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: We performed a prospective randomized study comparing the
clinical performance of the Carpentier-Edwards supraannular valve (CE-SAV)
(Edwards Lifesciences, Irvine, CA, USA) and the newer Mosaic (Medtronic
Corporation, Minneapolis, MN, USA) porcine bioprostheses in the aortic
position over a 10-year period. METHODS: Between January 2001 and March
2005, 394 patients undergoing bioprosthetic aortic valve replacement were
randomized to receive either the CE-SAV (n = 191) or the Mosaic (n = 203)
prosthesis. The preoperative demographics, EuroSCORE and intraoperative
characteristics concerning cardiopulmonary bypass of the 2 groups were
comparable. All patients were followed annually for 10 years. RESULTS:
There were 77 (40.3%) deaths in the CE-SAV group and 93 (45.8%) deaths in
the Mosaic group. The 10-year survival rate in the 2 groups was 59.7% and
54.2%, respectively (P = 0.27). There were no statistically significant
differences between the 2 groups in terms of structural valve
deterioration (P = 0.08), endocarditis (P = 0.95), thromboembolism (P =
0.06) and major bleeds (P = 0.09). However, the incidence of paravalvular
leaks and valve-related reoperations were higher in the Mosaic group, with
5 leaks and 6 reoperations when compared to none in the CE-SAV group,
(P=0.02) and (P = 0.01) respectively. CONCLUSIONS: At 10 years after
implantation, freedom from reoperation was greater in the CE-SAV group
with no incidences of paravalvular leaks. There were no other
statistically significant differences between CE-SAV and Mosaic aortic
prostheses.<br/>Copyright &#xa9; The Author(s) 2018.

<57>
Accession Number
624377360
Title
A systemic review and meta-analysis: Long-term results of the Bentall
versus the David procedure in patients with Marfan syndrome.
Source
European Journal of Cardio-thoracic Surgery. 54 (3) (pp 411-419), 2018.
Date of Publication: 2018.
Author
Burgstaller J.M.; Held U.; Mosbahi S.; Stak D.; Steurer J.; Eckstein F.;
Berdajs D.A.
Institution
(Burgstaller, Held, Steurer) Horten Center for Patient-Oriented Research
and Knowledge Transfer, University of Zurich, Zurich, Switzerland
(Mosbahi) Department of General Surgery, County Hospital Freiburg,
Freiburg im Breisgau, Switzerland
(Stak) Department of Cardiac Surgery, Triemli City Hospital, Zurich,
Switzerland
(Eckstein, Berdajs) Department of Cardiac Surgery, University Hospital
Basel, Spitalstrasse 21, Basel 4031, Switzerland
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
This systemic review of the literature and meta-analysis aimed to evaluate
the current state of the evidence for and against reimplantation of the
aortic valve (RAV) versus the composite valve graft (CVG) intervention in
patients with Marfan syndrome. Random effects metaregression was performed
across the study arms with logit-transformed proportions of in-hospital
deaths as an outcome measure when possible. Results are presented as odds
ratios with 95% confidence intervals (CIs) and P-values. Other outcomes
are summarized with medians, interquartile ranges (IQR) and ranges and the
numbers of patients at risk. Twenty retrospective studies that included a
combined 2156 patients with long-term follow-up were identified for
analysis after a literature search. The in-hospital mortality rate
favoured the RAV procedure with an odds ratio of 0.23 [95% CI 0.09-0.55, P
= 0.001]. The survival rate at mid-term for the RAV cohort was 96.7% (CI
94.2-98.5) vs. 86.4% (CI 82.8-89.6) for the CVG group and 93.1% (CI
66.4-100) for the RAV group vs. 82.6% (CI 74.9-89.2) for the CVG group for
the long term. Freedom from valve-related reintervention (median
percentages) for the long term was 97.6% (CI 90.3-100%) for the RAV
procedure and 88.6% (CI 79.1-95.5) for a CVG. This systematic review of
the literature stresses the advantages of the RAV procedure in patients
with Marfan syndrome in regard to long- and short-term results as the
treatment of choice in aortic root surgery. The RAV procedure reduces
in-hospital as well as long-term deaths and protects against aortic valve
reintervention.<br/>Copyright &#xa9; 2018 The Author(s). Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<58>
Accession Number
624298258
Title
Efficacy of bilateral continuous paravertebral block for off pump coronary
artery bypass surgery.
Source
Journal of Cardiovascular Disease Research. 9 (2) (pp 59-62), 2018. Date
of Publication: April-June 2018.
Author
Venkataswamy M.; Ramakrishna P.S.; Nagaraja P.S.; Singh N.G.; Adoni P.J.
Institution
(Venkataswamy, Ramakrishna, Nagaraja, Singh, Adoni) Department of Cardiac
Anesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and
Research, Bangalore, Karnataka, India
(Adoni) Near Ambekar Stadium, A.D.halli, #308, Bluejay Aston, 13th cross,
Bangalore-79, Karnataka, India
Publisher
EManuscript Technologies (E-mail: journals@emanuscript.in)
Abstract
Aims and Objectives: The purpose of the study is to prospectively
evaluate. 1.The feasibility and efficacy of bilateral continuous
Paravertebral block for off pump coronary artery bypass surgery. 2.Time
taken for extubation following cardiac surgery. 3.Hemodynamic parameters.
Methodology: This was a prospective randomised study which included 60
patients, 30 each in Group A (PVB) and 30 patients in Group B (control).
Group A had catheter inserted on either side of the spine in the
paravertebral space at T3- T4 or T4-T5 level and a bolus of 0.25
mlkg^-1 Inj Bupivacaine 0.25% was given followed by an infusion
of Inj Bupivacaine 0.125% at the rate of 0.15 mlkg^-1
hr^-1 throughout the surgery and continued postoperatively. In
Group B Inj Fentanyl 1micro&#32;gkg^-1hr^-1 IV
infusion was given intraoperatively and Inj Tramadol 1mg/kg TID IV post
operatively. Parameters evaluated included hemodynamic parameters, visual
analogue scale pain score (pain severity- 0-3=mild, 4-7=moderate,
>7=severe) at rest and deep breathing, rescue analgesia at 0 hr, 4 hr, 8
hr, 12hr, 24hr and 36 hr, ICU and hospital stay. Unpaired t-test and
chi-square test were used to compare values between 2 groups. Results: The
severity of pain in group B was statistically significant at 0 and 8hr at
rest and statistically significant at 0, 8, 12 and 24hr with deep
breathing as compared with Group A. A less requirement of rescue analgesia
was observed in Group A vs Group B (0.27+/- 0.72 vs 2.0+/-0.926). Group A
had more stable haemodynamic parameters in post-operative period. Compared
with the group B, the length of ICU and hospital stay in group A was
numerically lower but not statistically significant (p=0.439 and p=0.560,
respectively). Conclusion: Bilateral continuous Paravertebral block is
feasible, provides good hemodynamic stability, excellent analgesia and
allows early extubation.<br/>Copyright &#xa9; 2018 EManuscript
Technologies.

<59>
Accession Number
624329304
Title
Comparison of graft patency following coronary artery bypass grafting in
the left versus the right coronary artery systems: A systematic review and
meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 54 (2) (pp 221-228), 2018.
Date of Publication: 2018.
Author
Pinho-Gomes A.-C.; Azevedo L.; Antoniades C.; Taggart D.P.
Institution
(Pinho-Gomes, Taggart) Department of Cardiac Surgery, Oxford University
Hospitals NHS Trust, John Radcliffe Hospital, Oxford OX39DU, United
Kingdom
(Azevedo) Department of Community Medicine, Information and Health
Decision Sciences, Faculty of Medicine, Center for Health Technology and
Services Research, University of Porto, Porto, Portugal
(Antoniades, Taggart) Division of Cardiovascular Medicine, University of
Oxford, Oxford, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Although coronary artery bypass grafting has been the standard of care for
patients with complex coronary artery disease for over 50 years, the
evolution of graft patency over time in the left versus the right coronary
systems remains poorly documented. This systematic review and
meta-analysis aimed to characterize the evolution of graft patency over
time comparing the left (excluding left anterior descending artery) and
right coronary systems, with an emphasis on the comparison of venous
versus arterial grafts and symptomatic versus asymptomatic patients. We
searched the Cochrane Central Register of Controlled Trials (CENTRAL) and
MEDLINE from inception to August 2016. We also searched clinical trials
registers and reference lists of relevant studies. We included randomized
clinical trials and observational studies comparing graft patency in the
left versus the right coronary systems. Our outcome was graft patency
defined as a binary variable according to whether grafts were reported as
patent or failed at the time of angiogram. Data collection and analysis
were performed according to the methodological recommendations of the
Cochrane Collaboration. From a total 2275 papers, 52 studies were included
in the qualitative analysis and 48 studies (including 36 006 grafts) in
the meta-analysis. There was a 3.3% significant difference between the
left-sided and rightsided graft patency, and the difference appeared to
increase over time. Furthermore, patency of arterial grafts was higher in
the left coronary system, while venous grafts performed similarly
irrespective of the coronary circulation. Symptom recurrence also seemed
related to a higher failure rate in the right coronary circulation.
However, the high degree of heterogeneity precluded drawing definite
conclusions. This metaanalysis suggested that graft patency might be
better for left-sided vessels and that this difference might be driven by
the better performance of arterial grafts in the left coronary system.
However, evidence currently available is limited, and further research is
warranted to understand whether certain grafts achieve better patency in
the right versus the left coronary circulations.<br/>Copyright &#xa9; 2018
The Author(s).

<60>
Accession Number
623352675
Title
Efficacy of Xuebijing Injection () on Cardiopulmonary Bypass-Associated
Pulmonary Injury: A Prospective, Single-center, Randomized, Double Blinded
Trial.
Source
Chinese Journal of Integrative Medicine. 24 (11) (pp 815-821), 2018. Date
of Publication: 01 Nov 2018.
Author
Gao W.; Li N.; Cui X.-G.
Institution
(Gao, Li, Cui) Department of Anesthesiology, the Second Affiliated
Hospital of Harbin Medical University, Harbin 150081, China
Publisher
Chinese Journal of Integrated Traditional and Western Medicine Press
(E-mail: cjim@jia.net)
Abstract
Objective: To evaluate the efficacy of Xuebijing Injection (, XBJ) on the
lung injury induced by cardiopulmonary bypass (CPB). Methods: Fifty
patients undergoing CPB were randomized to either the saline group or XBJ
group according to a random number table (25 cases in each group). The
patients in the saline group received saline and patients in XBJ group
received XBJ at 12 h prior to the operation, at the beginning of the
operation, and at 12 h after the second injection. The
PaO<inf>2</inf>/FiO<inf>2</inf> at extubation 3 days post-operation,
duration of ventilation in the intensive care unit (ICU), and lengths of
stay in the ICU and hospital were recorded. The levels of inflammatory
mediators including interleukin (IL)-1beta, IL-8, IL-10, and C-reactive
protein (CRP) in bronchoalveolar lavage fluid (BALF) and plasma were
measured. The neutrophil count and elastase neutrophil elastase in BALF
were also measured. In addition, adverse events were monitored. Results:
The PaO<inf>2</inf>/FiO<inf>2</inf> in the XBJ group was higher than that
in the saline group from 12 to 72 h post-operation (all P<0.05). The blood
levels of IL-1beta, IL-8, and CRP in the XBJ group from 12 to 72 h were
all significantly lower than those in the saline group (all P<0.05). In
contrast, the level of the anti-inflammatory cytokine IL-10 was
significantly higher in the XBJ group than in the saline group (P<0.05).
In addition, 4 patients presented with atelectasis in the saline group and
none in the XBJ group. Ten patients experienced mild acute respiratory
distress syndrome (ARDS) during hospitalization, and 5 patients with mild
ARDS were in the XBJ group (P<0.05). Conclusion: XBJ shows protective
potential against lung injury in patients who undergo CPB surgery,
possibly through the downregulation of inflammatory mediators, reduction
in neutrophil infiltration, and upregulation of IL-10 (Trial registry:
ChiCTR-TRC-14004628).<br/>Copyright &#xa9; 2018, Chinese Association of
the Integration of Traditional and Western Medicine.

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

<62>
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.

<63>
Accession Number
620608825
Title
Sutureless aortic valve replacement versus transcatheter aortic valve
implantation: A meta-analysis of comparative matched studies using
propensity score matching.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (2) (pp 207-209),
2018. Date of Publication: 01 Feb 2018.
Author
Meco M.; Miceli A.; Montisci A.; Donatelli F.; Cirri S.; Ferrarini M.; Lio
A.; Glauber M.
Institution
(Meco) Cardiac Centre, Humanitas Gavazzeni Hospital, Bergamo, Italy
(Miceli, Montisci, Donatelli, Cirri, Ferrarini, Lio, Glauber)
Cardiothoracic Center, Istituto Clinico sant'Ambrogio, Gruppo Ospedaliero
San Donato, Via G. Faravelli 16, Milan 20149, Italy
(Miceli) Department of Clinical Science at South Bristol, University of
Bristol, Bristol, United Kingdom
(Donatelli) Department of Cardiac Surgery, University of Milan, Milan,
Italy
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: The aim of this meta-analysis was to compare outcomes of
patients undergoing transcatheter aortic valve implantation (TAVI) with
those undergoing surgical aortic valve replacement using sutureless
valves. METHODS: A systematic review and meta-analysis in accordance with
the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) statement was performed. RESULTS: No randomized controlled trials
were identified. Six comparative studies using propensity score matching
met the inclusion criteria. This meta-analysis identified 1462 patients in
that 731 patients underwent surgical aortic valve replacement using
sutureless valves (SU) and 731 patients underwent a TAVI. The 30-day or
in-hospital mortality was lower in the SU group [odds ratio (OR) 0.54, 95%
confidence interval (CI) 0.36-0.80; P = 0.003]. In the TAVI group, the
incidence of postoperative stroke was higher (OR 0.36, 95% CI 0.17-0.79; P
= 0.01). The incidence of moderate or severe paravalvular regurgitation
was higher in the TAVI group (OR 0.22, 95% CI 0.14-0.35; P = 0.001). There
were neither differences in the postoperative renal failure (OR 1.44, 95%
CI 0.46-4.58; P = 0.53) nor in the number of patients requiring
postoperative pacemaker implantation (OR 1.06, 95% CI 0.54-2.08; P =
0.86). Patients in the SU group required more transfusions (OR 4.47, 95%
CI 2.77-7.21; P = 0.0001), whereas those in the TAVI group had higher
major vascular complications (OR 0.06, 95% CI 0.01-0.25; P = 0.0001).
Intensive care unit stay was not different (mean difference 0.99, 95%
CI-1.22 to 1.40; P = 0.53). One-year survival was better in the SU group
(Peto OR 0.35, 95% CI 0.18-0.67; P = 0.001), as was the 2-year survival
(Peto OR 0.38, 95% CI 0.17-0.86; P = 0.001). CONCLUSIONS: Surgical aortic
valve replacement using sutureless valves is associated with better early
and mid-term outcomes compared with TAVI in high-or intermediate-risk
patients.<br/>Copyright &#xa9; 2017 The Author.

<64>
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).

<65>
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.

<66>
Accession Number
624549192
Title
A prospective, randomized, comparison study on effect of perioperative use
of chloride liberal intravenous fluids versus chloride restricted
intravenous fluids on postoperative acute kidney injury in patients
undergoing off-pump coronary artery bypass grafting surgeries.
Source
Annals of Cardiac Anaesthesia. 21 (4) (pp 413-418), 2018. Date of
Publication: October-December 2018.
Author
Bhaskaran K.; Arumugam G.; Vinay Kumar P.V.
Institution
(Bhaskaran, Arumugam) Department of Anaesthesia, Apollo Hospitals,
Chennai, Tamil Nadu, India
(Vinay Kumar) Department of Anaesthesia, Sri Siddhartha Medical College,
Tumakur, Karnataka, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Context and Aims: Off-pump coronary artery bypass graft (OPCABG) is a form
of CABG surgery. It is performed without the use of cardiopulmonary bypass
machine as a surgical treatment for coronary heart disease. Acute kidney
injury (AKI) is one of the common postoperative complications of OPCABG.
Previous studies suggest important differences related to intravenous
fluid (IVF) chloride content and renal function. We hypothesize that
perioperative use of chloride restricted IVFs may decrease incidence and
severity of postoperative AKI in patients undergoing OPCABG. Methods: Six
hundred patients were randomly divided into two groups of 300 each. In
Group A (n = 300), chloride liberal IVFs, namely, hydroxyethyl starch
(130/0.4) in 0.9% normal saline (Voluven), 0.9% normal saline, and
Ringer's lactate were used for perioperative fluid management. In Group B
(n = 300), chloride-restricted IVFs, namely, hydroxyethyl starch (130/0.4)
in balanced colloid solution (Volulyte) and balanced salt crystalloid
solution (PlasmaLyte A), were used for perioperative fluid management.
Serum creatinine values were taken preoperatively, postoperatively at 24 h
and at 48 h. Postoperative AKI was determined by AKI network (AKIN)
criteria. Results: In Group A, 9.2% patients and in Group B 4.6% patients
developed Stage-I AKI determined by AKIN criteria which was statistically
significant (P < 0.05). Conclusion: Perioperative use of chloride
restricted IVF was found to decrease incidence of postoperative AKI. The
use of chloride liberal IVF was associated with hyperchloremic metabolic
acidosis.<br/>Copyright &#xa9; 2018 Annals of Cardiac Anaesthesia <br/>
Published by Wolters Kluwer-Medknow.

<67>
Accession Number
624549189
Title
Evaluation of local intra-pleural application of tranexamic acid on
postoperative blood loss in lung decortication surgery, a prospective,
randomized, double-blind, placebo-controlled study.
Source
Annals of Cardiac Anaesthesia. 21 (4) (pp 409-412), 2018. Date of
Publication: October-December 2018.
Author
Sabry M.M.; Sallam A.A.; Elgebaly A.S.; Abdelwahab A.A.
Institution
(Sabry, Sallam, Elgebaly, Abdelwahab) Department of Cardiothoracic
Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: During decortication surgery, fibrous peel over the lung was
removed to allow expansion of the lung and therefore, wide raw area was
created with surface oozing. The phenomenon of fibrinolysis usually
activated after such procedure, resulting in increasing the postoperative
bleeding. Tranexamic acid is one of antifibrinolytic therapies that could
be used topically and to targets directly the source of bleeding and
reducing the local activation of the fibrinolytic process and consequently
reducing the postoperative bleeding. Patients and Methods: A total of 70
patients underwent lung decortication surgery in Cardiothoracic Surgery
Department at Tanta University Hospital from January 2015 to May 2017.
Patients were randomly allocated into two groups, Group I (35 patients)
receiving 3 g of tranexamic acid in 100 ml of saline solution and Group II
(35 patients) receiving 100 ml of saline solution as placebo. At the end
of the operation and before closing the chest, in both groups, drug or
placebo solution was distributed locally all over the pleural cavity.
Comparison between the groups was done regarding the amount of
postoperative bleeding, postoperative hemoglobin in the first 24 and 48 h
postoperatively, blood transfusion, Intensive Care Unit (ICU) stay, and
hospital stay. Results: Both groups were comparable regarding demographic
and surgical data. Group I patients had the significantly lesser amount of
postoperative blood loss than Group II during the first postoperative 48
h, and hence, the need of postoperative blood transfusion was
significantly lower in Group I with better postoperative hemoglobin level
than Group II. However, there was no difference in overall ICU and
hospital stay. Conclusion: The local intrapleural use of tranexamic acid
after decortication surgery of the lung is safe and significantly reduces
the amount of postoperative blood loss and in consequence reduces the
amount of postoperative blood transfusion.<br/>Copyright &#xa9; 2018
Annals of Cardiac Anaesthesia <br/> Published by Wolters Kluwer-Medknow.

<68>
Accession Number
624549155
Title
The efficacy of different modes of analgesia in postoperative pain
management and early mobilization in postoperative cardiac surgical
patients: A systematic review.
Source
Annals of Cardiac Anaesthesia. 21 (4) (pp 371-375), 2018. Date of
Publication: October-December 2018.
Author
Nachiyunde B.; Lam L.
Institution
(Nachiyunde) Department of Health Sciences, School of Nursing and
Midwifery, University of South Australia, City East Campus, Adelaide, SA
5001, Australia
(Lam) School of Nursing and Healthcare Professions, Federation University
Australia, Offce 1121, Building 903, Berwick Campus, PO Box 859, Berwick,
VIC 3806, Australia
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Cardiac surgery induces severe postoperative pain and impairment of
pulmonary function, increases the length of stay (LOS) in hospital, and
increases mortality and morbidity; therefore, evaluation of the evidence
is needed to assess the comparative benefits of different techniques of
pain management, to guide clinical practice, and to identify areas of
further research. A systematic search of the Cochrane Central Register of
Controlled Trials, DARE database, Joanna Briggs Institute, Google scholar,
PUBMED, MEDLINE, EMBASE, Academic OneFile, SCOPUS, and Academic search
premier was conducted retrieving 1875 articles. This was for pain
management postcardiac surgery in intensive care. Four hundred and
seventy-one article titles and 266 abstracts screened, 52 full text
articles retrieved for critical appraisal, and ten studies were included
including 511 patients. Postoperative pain (patient reported),
complications, and LOS in intensive care and the hospital were evaluated.
Anesthetic infiltrations and intercostal or parasternal blocks are
recommended the immediate postoperative period (4-6 h), and
patient-controlled analgesia (PCA) and local subcutaneous anesthetic
infusions are recommended immediate postoperative and 24-72 h postcardiac
surgery. However, the use of mixed techniques, that is, PCA with opioids
and local anesthetic subcutaneous infusions might be the way to go in pain
management postcardiac surgery to avoid oversedation and severe nausea and
vomiting from the narcotics. Adequate studies in the use of ketamine for
pain management postcardiac surgery need to be done and it should be used
cautiously.<br/>Copyright &#xa9; 2018 Annals of Cardiac Anaesthesia <br/>
Published by Wolters Kluwer-Medknow.

<69>
Accession Number
624545848
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. 35 (10) (pp 1626-1634), 2018. Date of Publication:
October 2018.
Author
Elkaryoni A.; Nanda N.C.; Baweja P.; Arisha M.J.; Zamir H.; Elgebaly A.;
Altibi A.M.A.; 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
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
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.

<70>
Accession Number
2001208623
Title
Meta-Analysis of Unplanned Readmissions Following Thoracoscopic Versus
Open Lung Cancer Resection.
Source
Journal of Thoracic Oncology. Conference: IASLC 19th World Conference on
Lung Cancer. Canada. 13 (10 Supplement) (pp S642), 2018. Date of
Publication: October 2018.
Author
Kowalewski J.; Dancewicz M.; Kowalewski M.
Institution
(Kowalewski, Dancewicz) Department of Thoracic Surgery and Tumors.
Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun,
Bydgoszcz, Poland
(Kowalewski) Cardiothoracic Research Centre, Collegium Medicum Umk, Torun,
Bydgoszcz, Poland
Publisher
Elsevier Inc.
Abstract
Background: Approximately 7.4% of patients experience unplanned
readmission within 30 days following pulmonary resection. Although
video-assisted thoracic surgery (VATS) is able to improve short-term
outcomes in both cancer patients and noncancer patients, surprisingly,
several recent big registry studies showed significantly increased
readmission rates. Method: We performed a systematic review and
meta-analysis according to PRISMA (Preferred Items Reporting for
Systematic Reviews and Meta-Analyses) guidelines. The search process
covered a period until 31st of March 2018. Search keywords were: VATS,
lobectomy, segmentectomy, open, thoracotomy, readmission*, readmit*.
Studies were to compare VATS vs open thoracotomy and reporting 30-90 days
readmission rates. Only reports in English were included and retrieved as
full-txts. Data were pooled in DerSimmonian and Laird Inverse Variance
random effects model and reported as Risk Ratios (RR) with corresponding
95% Confidence Intervals (CIs). Result: A systematic search yielded 16
potentially elegible reports, of which 5 were further excluded because
they did not report crude readmission rates across VATS vs open
thoracotomy. Eleven studies remained enrolling 60,146 patients undergoing
VATS (39.3%) and open thoracotomy (60.7%). Unplanned readmissions followed
in 7.8% (1,843/23,632) and 8.1% (2,944/36,514) of patienst undergoing VATS
and open thoracotomy respectively; there was no statistical differences
between two appraoches: RR (95%CIs): 0.94 (0.75-1.19); p=0.63. Substantial
heterogeneity was present (p<0.001, I²=87%) in the analysis
though. No single study influenced direction nor magnitude of the
estimates in number of sensitivity analyses. In meta-regression analyses
we demonstrated that patients' age, disease's local advancement and centre
volume did not influence the results (p>0.05). On the other hand number of
complications across single study pooled n. of patients was negatively
correlated with readmissions. Conclusion: There was no apparent difference
between VATS and open thoracotomy with regard to number of unplanned
readmissions. Future studies should focus on reducing complication rates
in the open thoacotomy group rather than reducing readmission rates after
VATS. [Figure presented]<br/>Copyright &#xa9; 2018

<71>
Accession Number
2001208607
Title
E-Cigarettes - What Do Lung Cancer Advocates Need to Know?.
Source
Journal of Thoracic Oncology. Conference: IASLC 19th World Conference on
Lung Cancer. Canada. 13 (10 Supplement) (pp S257), 2018. Date of
Publication: October 2018.
Author
Peters M.
Institution
(Peters) Faculty of Medicine and Health Sciences, Macquarie University,
Macquarie Park, NSW, Australia
Publisher
Elsevier Inc.
Abstract
Since the release of the IASLC Statement on e-cigarettes in 2014(1),
opinion in relation to their role has become more not less polarised.
E-cigarettes are not going away as an issue and advocates should be aware
of the state of knowledge generally and of reputable information to which
they can refer. Lung cancer advocates and patient supporters should have
enough knowledge to assist individual patients to make an informed
decision, to educate if that is their role and to advocate for the best
care environment for those who have lung cancer or are at elevated risk
for the development of lung cancer in the future. Some scenarios are
worthy of consideration. The smoker who needs surgical resection: Smoking
cessation is standard-of-care before thoracic surgery. Cessation reduces
respiratory and cardiac morbidity and improves wound healing. Almost all
smokers in this situation quit easily. Limited studies suggest an adverse
effect of e-cigarettes on wound healing that is similar to smoking. More
disturbingly, a bronchoscopy study found severe bronchial inflammation
(2). There is sufficient, reasonable concern about impaired healing of the
bronchial stump and compromised sputum clearance to explicitly recommend
against the use of e-cigarettes before surgery even if smoking cessation
is achieved. Patients with advanced lung cancer: Advanced lung cancer is
no longer rapidly and uniformly fatal. In the previous era, before recent
treatment advances, with targeted small molecules and immunotherapy, it
was difficult to show a survival advantage but continued smoking was
associated with impaired quality of life and longer periods in hospital
stay in cancer patients. There are no similar data for the complete
substitution of smoking for e-cigarettes. Cessation should still be the
aim. There are also practical problems with few health-care providers
permitting e-cigarette use in enclosed spaces. NRT in contrast can be used
in any location. Current smokers involved in lung cancer screening
programs or with incidental nodules: This is unquestionably a high value
group for effective smoking cessation intervention. The considerations are
those for the availability and recommendation for e-cigarettes in the
community generally. What is the benefit of e-cigarettes in promoting
cessation: In its report, NASEM concluded that there is limited evidence
that e-cigarettes are effective aids to promote smoking cessation,
moderate evidence from randomized controlled trials that e-cigarettes with
nicotine are more effective than e-cigarettes without nicotine and that
There is insufficient evidence from randomized controlled trials about the
effectiveness of e-cigarettes as cessation aids compared with no treatment
or FDA-approved smoking cessation treatments(3). Since that report was
released, the largest RCT of e-cigarettes vs other treatment options
published in NEJM found no benefit for e-cigarettes (4). What are the
harms especially long-term when long term use is encouraged: There are
probably few harms of a short-course (6 weeks or less) of e-cigarette use
but a statistically significant decline in lung function is detected at 3
months. Airway inflammation is also seen rapidly. Some Much attention has
been focussed on the claim that e-cigarettes are 95% safer than smoking.
This claim is supported by no evidence. It is true that tobacco smoke
contains putative cancer-causing chemicals that are at low levels in
e-cigarette vapour but the real situation is more complex. In the
bronchoscopy study looking at airway protein levels, there was a cluster
of adverse changes seen only with smoking, another seen with smoking and
e-cigarette use and a third seen only with e-cigarette vapour(2). Whether
these are from the base chemicals, nicotine or flavourings is uncertain.
Long-term studies are few. Use of e-cigarettes for two years in a study
sponsored by a tobacco-company subsidiary detected very rapid (5%/year)
loss of lung function (6). There are no meaningful long-term studies for
CV risk and smoking-related cancers. What are the wider harms in promoting
smoking in youths and young adults? The NASEM report concludes that there
is "substantial evidence that e-cigarette use increases risk of ever using
combustible tobacco cigarettes among youth and young adults." Based on a
meta-analysis, after adjustment for all reasonable confounders the risk is
about 3-fold. It is inevitable that promotion amongst children and young
adults will occur generating concerns as now seen with the JUUL product.
Where is the role of e-cigarettes at the present time as a smoking
cessation aid? E-cigarettes represent an intuitive solution for some
smokers and there is a wealth of non-evidence-based information accessible
on the internet. It is challenging for health advocates to accede to the
use of a treatment that appears to be ineffective yet having this
evidence-based approach is seen by many wedded to harm reduction as
negative. Subject to the regulatory environment in each country, it may be
reasonable to tolerate, under supervision, e-cigarette use where an
individual will only attempt smoking cessation with e-cigarette use. This
should be time-limited to perhaps 6-8 weeks with cessation of e-cigarettes
if smoking continues; leading to a consideration of other options. If
cessation is achieved, e-cigarette use should be withdrawn. There should
be no compromise on the question of concurrent smoking/e-cigarette use
that offers no health benefit and is unstable with many patients reverting
to smoking. References: 1. Cummings KM, Dresler CM, Field JK et al.
E-cigarettes and cancer patients. J Thorac Oncol. 2014; 9: 438-41 2. Ghosh
A, Coakley RC, Mascenik T et al. Chronic E-Cigarette Exposure Alters the
Human Bronchial Epithelial Proteome. Am Rev Resp Crit Care Med 2018; 198:
67-76. 3. National Academies of Sciences and Engineering and Medicine.
Public health consequences of e-cigarettes. Washington. DC: The National
Academies Press, 2018. 4. Halpern SD, Harhay MO, Saulsgiver K, et al. A
Pragmatic Trial of E-Cigarettes, Incentives, and Drugs for Smoking
Cessation. N Engl J Med 2018; 378:2302-2310 5. McNeill A, Brose LS, Calder
R et al. Evidence review of e-cigarettes and heated tobacco products 2018.
A report commissioned by Public Health England. London: Public Health
England. 6. Walele T, Bush J, Koch A et al. Evaluation of the safety
profile of an electronic vapour product used for two years by smokers in a
real-life setting. Regulatory Toxicology and Pharmacology 2018;
92:226-238. Keywords: smoking, electronic cigarettes<br/>Copyright &#xa9;
2018

<72>
Accession Number
2001208473
Title
The Introduction of Robotic Lobectomy for Non-Small Cell Lung Cancer in
South East Asia: A 5-Year Single Centre Study.
Source
Journal of Thoracic Oncology. Conference: IASLC 19th World Conference on
Lung Cancer. Canada. 13 (10 Supplement) (pp S846), 2018. Date of
Publication: October 2018.
Author
Ong K.; Fazuludeen A.A.; Aneez D.
Institution
(Ong, Fazuludeen, Aneez) Division of Thoracic Surgery, Department of
General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
Publisher
Elsevier Inc.
Abstract
Background: Over the past decade, minimally invasive robotic-assisted
thoracic surgery has gradually evolved into the preferred platform for
oncological thoracic resection, demonstrating respectable perioperative
and long-term outcomes. The aim of this study is to evaluate the
feasibility of completely portal robotic lobectomy (CPRL4) for non-small
cell lung cancer (NCSLC) at a geographical region that has yet to
assimilate this relatively new platform. Method: This is a 5-year
retrospective review of consecutive patients with NCSLC who underwent
CPRL4 by a single surgeon at our institution from January 2013 - October
2017. Result: A total of 80 patients (female 55%, median age 67 years)
underwent elective completely portal robotic lobectomy CPRL4 for NCSLC.
67.5% were non-smokers. The top 3 co-morbidities were hypertension (60%),
hyperlipidaemia (55%) and diabetes (21.3%). 17.5% had previous non-lung
related malignancies. Median operative time was 202 mins (range 80 - 335
mins). Conversion rate was 12.5%, the vast majority were due to
non-progression of the case. Median ICU/HDU stay, chest tube duration and
length of hospital stay were 1 day (range 0 - 4 days), 3 days (range 1 -
34 days) and 4 days (range 2 - 30 days) respectively. There was no
perioperative (30-day) mortality in this study. The two commonest
complications were prolonged chest tube duration (11.3%) and atrial
fibrillation (3.75%). Median tumour size on histology was 2.3cm (range 0.9
- 7cm). Most were adenocarcinomas (85%), followed by squamous cell
carcinoma (7.5%), adeno-squamous cell carcinomas (2.5%) and other rare
tumours. Final pathological staging distribution was 68.8% stage 1, 15.8%
stage 2, 9.2% stage 3A and 5.3% stage 4. 25% were upstaged after
pathological staging. Median follow up was 2 years (range 0.2-5.33 years).
All lung cancer related mortality at the end of follow-up was 7.8%.
Conclusion: The perioperative and early to mid-term oncologic results of
CRPL4 for NSCLC are promising. With the surge of big data supporting this
platform of oncologic surgery, we are confident that CPRL4 will be the
preferred choice for minimally invasive surgery in lung cancer patients.
However, to establish this body of evidence, further prospective
randomised controlled trials will be necessary. Keywords: Completely
portal robotic lobectomy, non-small cell lung cancer,
Surgery<br/>Copyright &#xa9; 2018

<73>
Accession Number
2001208158
Title
CT Versus Needle Biopsy Assessment Before Resection of Part Solid Nodules.
Source
Journal of Thoracic Oncology. Conference: IASLC 19th World Conference on
Lung Cancer. Canada. 13 (10 Supplement) (pp S265), 2018. Date of
Publication: October 2018.
Author
Kim Y.T.
Institution
(Kim) Thoracic and Cardiovascular Surgery, Seoul National University
Hospital, Seoul, South Korea
Publisher
Elsevier Inc.
Abstract
Increasing number of lung cancer screening program detects pulmonary
ground glass nodules (GGN) and those are frequently found to be an
adenocarcinoma or its precursors, particularly if they are persistent or
increase in size. Preoperative diagnosis of GGNs by trans-bronchial or
trans-thoracic fine-needle aspiration biopsy can be performed with
reasonable diagnostic accuracy ¹. However, they have limitation
for the pathologic confirmation of GGNs as they can fail to sample small
invasive foci ^{2, 3}. In addition, hemoptysis has been reported
to occur more frequently after needle biopsy in GGNs ⁴.
Accordingly, needle biopsy for GGNs are not used in our current practice
and if the suspicion for malignancy is high on CT, surgical biopsy is
performed without preoperative needle biopsy. Recently published
Fleischner recommendations for the management of GGNs may help to make a
clinical decision. During the surgery, especially in minimally invasive
surgery, GGNs are often difficult to palpate. Thus, preoperative marking
techniques have been utilized for localization of the GGNs using various
methods ⁵. That can be done either percutaneously or
transbronchially, using various materials including a dye, colored
collagen, barium, lipiodol, micro coil, metallic wire, or fiducial
⁶. In our center, we have been using various methods for
preoperative localization and but currently, we favor to use
electromangetive navigational bronchoscopy (ENB) guided dye marking
technique. Once surgery is decided, deciding the extent of resection is
another issue. The size of solid portion measured on the CT can be
helpful. If it is less than 5 mm, a simple wide wedge resection can be
performed by which the goal of diagnosis and treatment can be achieved. If
it is larger than 5 mm, the specimen is examined by frozen section and if
the malignancy is confirmed, anatomic lung resection is conducted.However,
the CT findings have not yet proven sufficiently reliable to guide the
management plan. Intraoperative frozen section diagnosis is an alternative
that can guide the extent of the subsequent surgical procedure. The
problem of frozen section is, however, the fact that deflated lung
specimens often makes the correct diagnosis difficult. To obviate this
problem, the technique of inflating the lung specimen with the embedding
medium for frozen section (EMIT) has been used, which allows better
interpretation, and facilitated correct diagnosis in the frozen section
⁷. In our center, we have been using EMIT and found a high
diagnostic accuracy with the concordance rate of 90.6% between EMIT and
permanent pathology. Based on our experience, it is our current practice
to perform a wide wedge resection of the GGNs and send the specimen for
EMIT. If the result of EMIT is pre-invasive lesions (benign, AAH, AIS, or
MIA), we do not perform additional resection. If the invasive
adenocarcinoma is diagnosed, we prefer to proceed anatomic lung resection
with systematic lymph node dissection. Several studies showed that limited
resection could be beneficial, especially in early stage lung
adenocarcinoma, including GGN ⁸. On the contrary, in one
prospective study that reported a long-term outcome, limited resection of
GGNs showed a low disease-control rate. They reported adenocarcinomas
developed in four out of 26 patients in the surrounding area of initial
resection site after more than five years ⁹. However, as GGNs
usually show favorable prognosis, limited resection could be generally
recommended ¹⁰. Additionally, in cases of deeply located GGNs,
where wedge resection is not technically feasible, direct segmentectomy
without wedge biopsy for the purpose of diagnosis and treatment, is
recommended. For the segmentectomy, various technics can be used, but it
is our current practice to use ENB guided dye marking to define an
adequate parenchymal resection margin during the segmentectomy. To
summarize, although there are several CT findings that can differentiate
between pre-invasive and invasive lesions, those findings have not yet
proven sufficiently reliable to guide the management plan for GGNs. In
addition, attempt to sample solid component in GGNs using a biopsy needle
is often not feasible and therefore, not helpful for being used in
clinical decision. Currently, the best practice for the management of GGNs
is to carefully follow the patient with CT, and if malignancy is
suspected, to perform a surgical biopsy with the guide of various
localization methods and/or other innovative methods to differentiate
between pre-invasive versus invasive adenocarcinoma. References: 1.
Yamagami T, Yoshimatsu R, Miura H, et al. Diagnostic performance of
percutaneous lung biopsy using automated biopsy needles under
CT-fluoroscopic guidance for ground-glass opacity lesions. Br J Radiol
2013;86:20120447. 2. Kim TJ, Lee JH, Lee CT, et al. Diagnostic accuracy of
CT-guided core biopsy of ground-glass opacity pulmonary lesions. AJR Am J
Roentgenol 2008;190:234-239. 3. Lu CH, Hsiao CH, Chang YC, et al.
Percutaneous computed tomography-guided coaxial core biopsy for small
pulmonary lesions with ground-glass attenuation. J Thorac Oncol
2012;7:143-150. 4. Choi JW, Park CM, Goo JM, et al. C-arm cone-beam
CT-guided percutaneous transthoracic needle biopsy of small (</= 20 mm)
lung nodules: diagnostic accuracy and complications in 161 patients. AJR
Am J Roentgenol 2012;199:W322-330. 5. Ikeda K, Nomori H, Mori T, et al.
Impalpable pulmonary nodules with ground-glass opacity: Success for making
pathologic sections with preoperative marking by lipiodol. Chest
2007;131:502-506. 6. Zaman M, Bilal H, Woo CY, et al. In patients
undergoing video-assisted thoracoscopic surgery excision, what is the best
way to locate a subcentimetre solitary pulmonary nodule in order to
achieve successful excision? Interactive cardiovascular and thoracic
surgery 2012;15:266-272. 7. Marchevsky AM, Changsri C, Gupta I, et al.
Frozen section diagnoses of small pulmonary nodules: accuracy and clinical
implications. The Annals of thoracic surgery 2004;78:1755-1759. 8. Cao C,
Gupta S, Chandrakumar D, et al. Meta-analysis of intentional sublobar
resections versus lobectomy for early stage non-small cell lung cancer.
Ann Cardiothorac Surg 2014;3:134-141. 9. Nakao M, Yoshida J, Goto K, et
al. Long-term outcomes of 50 cases of limited-resection trial for
pulmonary ground-glass opacity nodules. J Thorac Oncol 2012;7:1563-1566.
10. Shao G, Ren W, Feng Z, et al. The role of video-assisted thoracoscopic
surgery in management of the multiple ground-glass nodules. Indian J
Cancer 2015;52 Suppl 2:e75-79. Keywords: GGN, biopsy,
Adenocarcinoma<br/>Copyright &#xa9; 2018

<74>
Accession Number
2001208048
Title
Exparel vs. Bupivicaine for Postoperative Analgesia After VATS Lung
Resection: Results of a Randomized Control Trial.
Source
Journal of Thoracic Oncology. Conference: IASLC 19th World Conference on
Lung Cancer. Canada. 13 (10 Supplement) (pp S821-S822), 2018. Date of
Publication: October 2018.
Author
Khandhar S.; Collins D.; Schatz C.; Liu C.; Chandy J.
Institution
(Khandhar, Collins, Schatz, Liu) Department of Surgery, Inova Fairfax
Hospital, Falls Church, United States
(Chandy) Fairfax Anesthesiology Associates, Falls Church, United States
Publisher
Elsevier Inc.
Abstract
Background: Postoperative pain control practices are highly variable and
opioid use is of considerable interest to clinicians and patients. This
thoracic surgery program focuses on minimally invasive interventions and
sought an optimal pain control regimen. Previously, tunneled pleural
catheters with a continuous Bupivicaine infusion for 7 days were used. The
shortened length of stay (LOS) and excellent patient satisfaction observed
were attributed to this technique, however a prior randomized controlled
trial (RCT) at this institution showed no differences in opioid use
between catheters or singular injections of Bupivicaine. Exparel
(Liposomal Bupivacaine formulation) reports local anesthesia up to 72
hours. Exparel's emergence removed the catheter burden and compares local
infiltration of Exparel with standard 0.25% Bupivacaine injections into
the subcutaneous space. Method: This RCT compares both injections'
analgesic effects on opioid use. Adult VATS lung resection patients from
2015-2017 were eligible. Patients with: chronic opioid use, pain
medication allergies, liver or renal dysfunction, severe COPD, peptic
ulcerative disease, or pregnancy were excluded. The primary endpoint
measured differences in opioid utilization in postoperative days (POD)
0-7, via chart review and self-reported pain medication use
post-discharge. Hydromorphone equivalents were utilized for opioid
conversions. Wilcoxon rank-sum and Fisher's exact tests compared all
appropriate endpoints. Result: Sample sizes, opioid utilization, and pain
scores are demonstrated in Table 1. No differences were observed for
opioid utilization between groups for all PODs. No differences in pain
scores (except for POD4), 30-day patient satisfaction (98% vs. 90% very
satisfied), or LOS (0 [0-1] vs. 0 [0-1]) were observed Conclusion: These
results suggest clinical equipoise between Exparel and Bupivicaine and
practitioners cannot justify routine use of Exparel in this patient
population for improved postoperative pain control. Appropriate
preoperative preparation and attention to proven evidence-based metrics
designed to decrease morbidity, such as ambulation, should take precedence
over a focus on pain management. Keywords: Exparel (Liposomal
Bupivacaine), Pain Managemnet, VATS Lung Resections. [Figure
presented]<br/>Copyright &#xa9; 2018

<75>
Accession Number
2001207850
Title
The Role of Surgical Resection.
Source
Journal of Thoracic Oncology. Conference: IASLC 19th World Conference on
Lung Cancer. Canada. 13 (10 Supplement) (pp S261-S262), 2018. Date of
Publication: October 2018.
Author
Sepesi B.
Institution
(Sepesi) Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center,
Houston, TX, United States
Publisher
Elsevier Inc.
Abstract
Lung cancer is an aggressive malignancy with low (< 10%) 5-year survival
rates when metastases appear. Historically, surgical resection in
metastatic setting has not been beneficial in term of survival; this was
especially true when options for effective systemic therapy were limited.
It is now recognized that up 50% of patients who presents with metastatic
NSCLC have a limited (up to 5) number of metastases. Common sites of
metastases include brain, lungs, adrenal glands, bones, or liver. In
appropriately selected patients, surgical resection in metastatic lung
cancer may be considered for the control of primary tumor, regional nodal
disease, and metastases present within the same surgical field (example:
metastases in ipsilateral ribs, or another lobe in the same lung as
primary tumor). Surgical resection of selected extra-thoracic metastases
is also possible; however, radiation is more commonly employed in those
circumstances. The main goal of surgery in oligometastatic setting is to
achieve complete disease control. Careful patient selection must account
for the extent and the location of primary tumor and nodal disease,
physiologic status and reserve of the patient, tumor histology,
biomarkers, synchronous or meta-chronous presence of metastases and number
of metastases, previous therapies and planned post-surgical systemic or
other local therapies. Invasive mediastinal staging with either
mediastinoscopy or endobronchial ultrasound is of utmost importance prior
to proceeding with surgery. Long-term outcomes with positive ipsilateral
mediastinal N2 or contralateral N3 lymph nodes are poor as compared to N0
or N1 nodal status; N2 and N3 disease should be considered
contraindication for surgical therapy outside of a clinical trial.
Lobectomy with mediastinal node dissection is a preferred procedure for
primary tumor in oligometastatic circumstances. Pneumonectomy, especially
on the right side should be avoided, and its need should be regarded as a
relative contra-indication. If brain metastases are present, they should
be treated first; other metastatic sites maybe addressed based on
symptoms. Commonly, systemic platinum-based chemotherapy has been
administered as the 1st line therapy for 3-4 cycles to sort out the cancer
biology and response to chemotherapy. Stable or improved disease following
chemotherapy makes proceeding with surgical resection of primary tumor and
control of oligometastases reasonable. However, this paradigm continues to
evolve in the era of immunotherapy and targeted therapy. There are a
number of advantages to surgical resection of lung cancer in
oligometastatic setting, as compared to other local modalities. Complete
resection provides the best chance for prolonged local and regional
disease control. It hypothetically removes all or at least the majority of
cancer clones, it allows for detailed pathological analysis of the tumor
and lymph nodes, and it provides adequate tissue for translational studies
or personalized experimental treatment approaches. With current minimally
invasive approaches such as video assisted or robotic assisted thoracic
surgery recovery from surgical treatment of lung cancer can be
expeditious. With the use of enhanced recovery pathways, even recovery
after thoracotomy mimics recovery after minimally invasive thoracic
surgery. Potential disadvantage of surgical therapy in oligometastatic
lung cancer is the risk of post-operative cardiac or pulmonary
complications, resolution of which may require time and may delay other
necessary therapy. This again highlights the importance of patient
selection for surgical therapy. Surgical Resection of Oligometastatic Lung
Cancer in the Era of Targeted Therapy and Immunotherapy. Within the last
year, immunotherapy has become the frontline treatment modality for
metastatic lung cancer. Response rates, durability of responses, and
toxicity profiles with immunotherapy are all better than with
chemotherapy. Although imperfect, PD-L1 expression and tumor mutation
burden serve as predictive biomarkers for immunotherapy. Many studies of
combined chemo-immune regimens, or combination immune regimens are
underway. These results are encouraging, however, as we improve systemic
disease control, loco-regional lung cancer control will become even more
important. The role and timing of local treatments following immunotherapy
or targeted therapy in oligometastatic setting are currently under study.
While there are reports of radiation therapy potentiating immunotherapy,
evidence is not conclusive and biomarkers are still under investigation.
Surgical therapy and radiation therapy should be considered complementary
modalities in oligometastatic lung cancer. If lobectomy is possible for
primary disease control in an acceptable-risk surgical candidate, it
should not be discarded as an option over radiation. Considering current
operative experience following prolonged immunotherapy, it is hypothesized
that salvage surgical resections for local recurrence following
immune-radio therapy may be difficult and may convert possible routine
early lobectomy to an eventual salvage pneumonectomy. As the therapeutic
options for oligometastastic lung cancer continue to evolve with much
improved systemic options, effective local and regional therapy will
become more important. Novel surgical techniques and enhanced recovery
pathways have decreased the morbidity and sped up patients' surgical
recovery. Surgical resection should therefore continue to play a role in
the multi-modality setting for oligometastatic lung cancer in
appropriately selected patients. References: Gomez DR, Blumenschein GR Jr,
Lee JJ, Hernandez M, Ye R, Camidge DR, Doebele RC, Skoulidis F, Gaspar LE,
Gibbons DL, Karam JA, Kavanagh BD, Tang C, Komaki R, Louie AV, Palma DA,
Tsao AS, Sepesi B, William WN, Zhang J, Shi Q, Wang XS, Swisher SG,
Heymach JV. Local consolidative therapy versus maintenance therapy or
observation for patients with oligometastatic non-small-cell lung cancer
without progression after first-line systemic therapy: a multicentre,
randomised, controlled, phase 2 study. Lancet Oncol. 2016
Dec;17(12):1672-1682. https://doi.org/10.1016/S1470-2045(1630532-0). Epub
2016 Oct 24. Patrini D, Panagiotopoulos N, Bedetti B, Mitsos S, Crisci R,
Solli P, Bertolaccini L, Scarci M. Surgical approach in oligometastatic
non-small cell lung cancer. Ann Transl Med. 2018 Mar;6(5):93.
https://doi.org/10.21037/atm.2018.02.16. Review. Stephens SJ, Moravan MJ,
Salama JK. Managing Patients With Oligometastatic Non-Small-Cell Lung
Cancer. J Oncol Pract. 2018 Jan;14(1):23-31. Keywords: Surgery,
Oligometastases, lung cancer<br/>Copyright &#xa9; 2018

<76>
Accession Number
2001207742
Title
An Early Rehabilitation Intervention for Enhancing Oxygenation From Lung
Cancer Surgery.
Source
Journal of Thoracic Oncology. Conference: IASLC 19th World Conference on
Lung Cancer. Canada. 13 (10 Supplement) (pp S328-S329), 2018. Date of
Publication: October 2018.
Author
Hsiao W.L.
Institution
(Hsiao) National Taiwan University Hospital, Taipei, Taiwan (Republic of
China)
Publisher
Elsevier Inc.
Abstract
Background: The purpose of this study is to test the effects of an early
rehabilitation intervention on oxygenation, postoperative complications,
and recovery from lung cancer surgery. Method: The study uses an
experimental design. Ninety patients scheduled for lung cancer surgeries
was recruited from thoracic surgery units of a medical center in Taiwan.
Patients were randomly assigned to the intervention or the control group.
The intervention includes a 5-day postoperative in-hospital rehabilitation
from post op day 1. The main components of the rehabilitation were aerobic
and strength exercises as well as breathing training by using an incentive
spirometry. Peripheral capillary oxygen saturation (SpO2) was measured in
the morning of the preoperative day and of the 4 consecutive days from
postoperative day one to four by using the NellcorTM OxiMax N-65 Portable
Pulse Oximeter. The SpO2/FiO2 (S/F) ratio was then calculated to assess
patients' oxygenation. Data on postoperative pulmonary compilations and
durations of chest tube drainage were collected from the patients' charts.
Result: The patients' demographics and baseline measures were equivalent
between groups. Results of GEE showed a significant group by time
interaction effect on S/F ratio. As for the parameter estimates, from
postoperative day 1 to day 4, the S/F ratio improvement in the
intervention group was 74.49 (Wald X² = 46.42, p<0.001) more
than in the control group. Result of Chi-square test showed that the
number of postoperative lung complications in the intervention group (n
=1) was significantly less (X² = 8.39, p = 0.004) than it in
the control group (n =10). Result of t- test showed that the duration of
chest tube drainage in the intervention group (2.00+/-1.00 days) was
significantly shorter (t =-2.32, p = 0.022) than it in the control group
(2.56+/-1.25 days). Conclusion: The study results support the effects of
the early rehabilitation intervention on enhancing oxygenation, preventing
complications, and promoting recovery from lung cancer surgery as
indicated by shortened the duration of chest tube drainage. Surgery to
remove the cancer is one of the primary treatment options for non-small
cell lung cancer. However, lung cancer surgery may result in decreasing
lung capacity and expansion; therefore, increase risks for postoperative
pulmonary complications. Pulmonary rehabilitation designed to enhance lung
expansion and ventilation may help to reduce postoperative lung
complications and promote patients' recovery from lung cancer surgery.
Keywords: pulmonary rehabilitation, lung cancer surgery,
oxygenation<br/>Copyright &#xa9; 2018

<77>
Accession Number
2001207631
Title
Robotic Thoracic Surgery in Lung Cancer Resection - A Comprehensive
Review.
Source
Journal of Thoracic Oncology. Conference: IASLC 19th World Conference on
Lung Cancer. Canada. 13 (10 Supplement) (pp S1010), 2018. Date of
Publication: October 2018.
Author
Balakrishnan P.
Institution
(Balakrishnan) Cardiothoracic Department, Wellington Regional Hospital,
Wellington, New Zealand
Publisher
Elsevier Inc.
Abstract
Background: Minimally invasive VATS thoracic surgery is currently the gold
standard approach for most thoracic procedures. It has come a long way
since major maximally invasive thoracotomy approaches. Minimally invasive
thoracic procedures indefinitely has its distinctive positive outcomes and
other secondary benefits to patients and surgeons. Introduction of robotic
technique into thoracic surgery has brought huge advantage to patients and
surgeons as well as maximised treatment modalities more efficiently. In
the review, we will look into the state of art robotic thoracic surgeries
available, feasibility, outcomes, accessibility and costs and the
pitfalls. Method: A extensive literature search was performed using
MEDLINE, OVID and PUBMED search databases in the last 10 years. A
retrospective review and meta- analysis of these papers were conducted
using matched-pair analyses and propensity matched scoring and standard
statistical analysis. A total of 43 papers were reviewed and a
meta-analysis of these studies in terms of feasibility, outcomes,
accessibility and costs and the pitfalls were looked into. A summary
review into the current state of robotic thoracic surgery, with the its
current limitations and future adaptations were also looked into Result:
pending data collection and interpretation. Applied late-breaking abstract
Conclusion: pending -applied late-breaking abstract Keywords: robotic
thoracic surgery, NSCLC, advances in Lung resection<br/>Copyright &#xa9;
2018

<78>
Accession Number
2001207341
Title
Surgical Considerations in OMD.
Source
Journal of Thoracic Oncology. Conference: IASLC 19th World Conference on
Lung Cancer. Canada. 13 (10 Supplement) (pp S200-S201), 2018. Date of
Publication: October 2018.
Author
Donington J.
Institution
(Donington) Surgery, University of Chicago, Chicago, IL, United States
Publisher
Elsevier Inc.
Abstract
Historically, surgery was reserved for palliation in patients with stage
IV NSCLC, but since the 1980s there have been reports of prolonged
survival following complete resection of primary tumors and metastatic
lesions in select patients with low volume metastatic disease. Hellman and
Wechselbaum introduced the term "oligometastasis" to describe an
intermediate spread of disease, prior to widely metastatic disease and
recognized it as a subset where aggressive local treatments were
warranted. Surgery for metastatic NSCLC is increasing in frequency. An
analysis from the National Inpatient Sample uncovered a 5.8% average
annual percent increase resections of NSCLC metastases between 2000 and
2011.¹This increase is attributed to several factors, including
more efficacious and better tolerated chemotherapies including targeted
agents, which have slowed the progression of metastatic spread and altered
patterns of resistance. Simultaneously, there have been significant
improvements in surgical techniques, with increased minimally invasive
approaches, making resection better tolerated and negating long
interruption from systemic treatments. The majority of patients considered
for resection of oligometastatic NSCLC fall into three categories,
isolated metastasis to the brain, adrenal glands, or contralateral lung.
Patients who have previously undergone resection of early stage NSCLC and
subsequently develope isolated oligometastasis and good performance status
should be considered for curative intent resection. Similarly patients
with oliogometastsis de novo should be evaluated for curative resection in
addition to systemic therapy. Isolated Brain Metastasis: Some of the
oldest series on surgical treatment of oligometastatic NSLC relate to
treatment of isolated brain metastasis.^2,3 Up to one quarter of
all patients with stage IV NSCLC harbor brain metastasis. Adenocarcinomas
are associated with higher rates of brain metastasis, but in 10% of
patients with metastatic adenocarcinoma the brain is the only site of
involvement.⁴ Aggressive curative intent treatment of the
primary and metastatic site is encouraged in those with good performance
status and in whom both sites are amenable to complete resection or
ablation. Curative intent local treatments can only be considered after a
thorough search for disease at other sites. Mediastinal lymph node
involvement portends poor prognosis and therefore invasive mediastinal
staging is recommended prior to starting treatment. Brain MRI is
recommended in addition to PET/ CT because of increased sensitivity.
Multiple brain metastasis are not an absolute contraindication to this
aggressive treatment approach, but most recommend three or fewer
lesions.⁵ Treatment of the brain lesion can be by resection or
radiosurgery ablation. Five year survival following definitive treatment
of isolated brain metastasis and primary NSCLC is 15%, and not
significantly impacted by synchronous or metachronous presentation.
Prognosis is improved in patients who are younger, female, have lower
t-stage, and good performance status. Adjuvant whole brain radiation
therapy (WBRT) following resection or radiosurgery is recommended.
Randomized data on WBRT in this setting is limited, but the sole trial
demonstrated a significant decrease brain recurrence.⁶ There is
also no randomized data specifically addressing the use of adjuvant
chemotherapy following complete resection of stage IV disease, but with
strong evidence supporting adjuvant chemotherapy for completely resected
stage II and III, it is recommended. Isolated Adrenal Metastasis: In
well-selected patients with isolated adrenal metastasis from NSCLC,
survival following complete resection is 25%.⁷ Similar to those
with isolated brain metastasis, mediastinal lymph node involvement portend
poor prognosis so invasive staging is recommended. Histology and
laterality appear to have no impact on survival and adjuvant chemotherapy
is recommended. Synchronous and metachronous tumors have similar long-term
survival rates, despite younger age distribution in patients with
synchronous presentation.⁷ Operative mortality is extremely low
in reported series and the majority of patients die of disease
progression. M1a Disease: The appearance of bilateral NSCLC lesions with
the same histology is a staging challenge. In the absence of other disease
it is difficult to distinguish bilateral primary tumors from stage IVa
disease. Analysis of mutational status and genetic clonality difference
are being investigated, but not clinically reliable at this time.The
clinical judgement of an experienced multi-modality team is essential,
⁴ and the criteria described by Martini and Melamed in 1975
remains relevant.⁸ As with isolated brain and adrenal
metastasis, an exhaustive search for additional metastatic disease and
invasive mediastinal staging are recommended prior to considering
resection. Parenchymal sparing resections are typically recommended when
possible in this setting. Conclusion: Most agree that favorable biology is
the primary driver of prognosis in the setting of oligometastasis and the
true impact of local interventions on prognosis is unclear. But in an era
when local treatments carry minimal morbidity and mortality, the lack of
clarity should not translate into a denial of intervention in
well-selected patients, but rather another treatment option to prolong
survival. References: 1. Bartlett EK, Simmons KD, Wachtel H, et al. The
rise in metastasectomy across cancer types over the past decade. Cancer
2014. 2. Wronski M, Arbit E, Burt M, Galicich JH. Survival after surgical
treatment of brain metastases from lung cancer: a follow-up study of 231
patients treated between 1976 and 1991. Journal of neurosurgery
1995;83:605-16. 3. Nakagawa H, Miyawaki Y, Fujita T, et al. Surgical
treatment of brain metastases of lung cancer: retrospective analysis of 89
cases. J Neurol Neurosurg Psychiatry 1994;57:950-6. 4. Kozower BD, Larner
JM, Detterbeck FC, Jones DR. Special treatment issues in non-small cell
lung cancer: Diagnosis and management of lung cancer, 3rd ed: American
College of Chest Physicians evidence-based clinical practice guidelines.
Chest 2013;143:e369S-99S. 5. Fuentes R, Bonfill X, Exposito J. Surgery
versus radiosurgery for patients with a solitary brain metastasis from
non-small cell lung cancer. The Cochrane database of systematic reviews
2006:CD004840. 6. Patchell RA, Tibbs PA, Regine WF, et al. Postoperative
radiotherapy in the treatment of single metastases to the brain: a
randomized trial. Jama 1998;280:1485-9. 7. Tanvetyanon T, Robinson LA,
Schell MJ, et al. Outcomes of adrenalectomy for isolated synchronous
versus metachronous adrenal metastases in non-small-cell lung cancer: a
systematic review and pooled analysis. Journal of clinical oncology:
official journal of the American Society of Clinical Oncology
2008;26:1142-7. 8. Martini N, Melamed MR. Multiple primary lung cancers.
The Journal of thoracic and cardiovascular surgery 1975;70:606-12.
Keywords: surgery, oligometastasis<br/>Copyright &#xa9; 2018

<79>
Accession Number
2001207108
Title
From Surgical Perspective.
Source
Journal of Thoracic Oncology. Conference: IASLC 19th World Conference on
Lung Cancer. Canada. 13 (10 Supplement) (pp S213-S214), 2018. Date of
Publication: October 2018.
Author
Korst R.
Institution
(Korst) Thoracic Surgery, Mount Sinai Health System, New York, NY, United
States
Publisher
Elsevier Inc.
Abstract
The pleural space represents the most common location for recurrence
following resection of thymic epithelial tumors (TET). The rationale to
include surgical resection in the management plan for these patients is
based on small case series and reports, many of which demonstrate long
periods of survival following pleural metastasectomy. Two large,
retrospective series of patients with pleural disease have been recently
published, both of which reflect pooled data from multiple institutions;
one from Europe and the other from Japan^1,2. Despite this,
little prospective data address this issue. In addition, the management
strategy for pleural disease in patients with TET is extrapolated from the
management of primary TET in the mediastinum, where surgical resection
plays an important role. Prognostic factors after surgical resection for
pleural disease mirror those that are most consistently reported for
primary mediastinal TET. Most case series of patients undergoing resection
for pleural disease (either recurrence or initial presentation) suggest
that the ability to completely resect the disease is an important
prognostic factor. Indeed, both of the aforementioned larger series
confirm that complete resection is associated with enhanced
survival^1,2. The Japanese report of 136 cases of pleural
dissemination of thymoma at initial presentation (not recurrence) also
determined that lower disease burden in the pleural space positively
affects survival². Although the large European Society of
Thoracic Surgery (ESTS) Thymic Working Group Project (152 patients with
either pleural recurrence and pleural disease at initial presentation) did
not report disease burden, it confirmed the importance of complete
resection in maximizing survival¹. This later study also
determined that thymic carcinoma patients experienced significantly
shorter survival after resection of pleural disease than patients with
thymoma. Thymic carcinoma, pleural disease burden and the ability to
perform a complete resection can all be considered surrogates for
individual tumor biology, which may be the most important underlying
prognostic factor. Surgical approaches for patients with TET that has
spread to the pleural space include metastasectomy and extrapleural
pneumonectomy (EPP). The surgeon's goal is the complete gross resection of
disease, which is dependent on the burden and location of disease. In
cases of pleural recurrence, the surgical approach is typically through a
lateral thoracotomy since this incision provides the best exposure of the
entire pleural space and the mediastinal tumor has already been resected
at an earlier time. More recently, video assisted thoracic surgery (VATS)
approaches have been used selectively to approach these patients depending
on the expertise of the operator. The surgeon wishes to perform the least
amount of resection possible while still rendering the patient grossly
disease free. Metastasectomy may range from the resection of a single
pleural lesion to an extensive parietal pleurectomy with or without
pulmonary resection(s) for visceral pleural involvement of metastatic
deposits. On occasion, the surgeon may explore the chest of a patient with
the intent of performing metastasectomy, but instead encounters diffuse
innumerable visceral and parietal pleural metastatic deposits. In this
case, EPP may be the only option to render the patient grossly disease
free. The surgeon should always be prepared for this development whenever
operating on a patient for metastatic TET, so that an educated decision
can be made to proceed with EPP at the time of exploration, if necessary.
EPP, however, may not be a good option for patients with thymic carcinoma
that has metastasized to the pleural space given the magnitude of this
approach combined with the significantly worse survival after resection in
patients with metastatic pleural disease, when compared to thymoma.
Pleural treatments used as an adjunct at the time of surgical resection
for patients with pleural metastases from TET are becoming more popular.
Heated intrapleural chemotherapy (HIPC) represents the most commonly used
modality in this regard. After resecting all gross disease, the surgeon
perfuses the hemithorax with heated chemotherapy for a period of time
ranging from one to two hours. This strategy has been demonstrated to be
safe with an acceptable complication rate in several small case series of
patients with TET³. Although survival rates appear to be
encouraging, definitive data demonstrating a survival benefit to HIPC are
lacking. Intrathoracic photodynamic therapy (PDT) has also recently been
reported for patients with TET that has metastasized to the pleural
space⁴. Although the use of neoadjuvant chemotherapy has been
reported in several case series of patients with pleural metastases at the
time of initial presentation⁵, data are lacking specifically in
the scenario of pleural recurrence. The rationale for this approach mimics
that for locally advanced TET in the mediastinum - to reduce the disease
burden in hopes of increasing the likelihood of complete resection. Once
again, this strategy appears to be safe and associated with encouraging
rates of complete resection and survival, but definitive data confirming a
benefit are lacking. In summary, the surgical resection of pleural
recurrence of TET is associated with prolonged survival in selected
patients, as reported in many case series. However, given the lack of
controlled studies, it is unclear if prolonged survival is a direct result
of the surgical approach or simply selection of patients with more
forgiving tumor biology. Despite this, a rational approach may be to
invoke a surgical approach as the initial strategy in patients with
thymoma whose disease appears to be resectable. Once surgical options have
been exhausted, or the disease is clearly unresectable, systemic therapy
and/or radiotherapy can be utilized to achieve further disease control.
References: 1. Moser B, et al. Surgical therapy of thymic tumours with
pleural involvement: an ESTS Thymic Working Group project. Eur J
Cardiothorac Surg 2017;52:346-55. 2. Okuda K, et al. Thymoma patients with
pleural dissemination: Nationwide retrospective study of 136 cases in
Japan. Ann Thorac Surg 2014;97;1743-9. 3. Maury J-M, et al. Intra-thoracic
chemo-hyperthermia for pleural recurrence of thymomas. J Thorac Dis
2017;9:E1137-9. 4. Chen K-C, et al. Pleural photodynamic therapy and
surgery in lung cancer and thymoma patients with pleural spread. PLOS one
2015;10:e0133230. 5. Shapiro M, et al. Surgical Approaches for stage IVa
thymic epithelial tumors. Front Oncol 2014;3:332. Keywords: Thymoma,
Surgical resection, pleural recurrence<br/>Copyright &#xa9; 2018

<80>
Accession Number
624570181
Title
The fibres study: A phase 3, non-inferiority, randomised comparison of A
new fibrinogen concentrate vs. cryoprecipitate for treating acquired
hypofibrinogenaemia in bleeding cardiac surgical patients.
Source
American Journal of Hematology. Conference: 4th Biennial Summit of the
Thrombosis and Hemostasis Societies of North America, THSNA 2018. United
States. 93 (9) (pp E31), 2018. Date of Publication: September 2018.
Author
Karkouti K.
Institution
(Karkouti) Toronto General Hospital, Toronto, ON, Canada
Publisher
Wiley-Liss Inc.
Abstract
Introduction: Cardiac surgery involving cardiopulmonary bypass (CPB) is
associated with coagulopathy and excess bleeding. Acquired
hypofibrinogenaemia (plasma fibrinogen <1.5-2.0 g/L) is A primary
causative factor. Randomised trials evaluating the use of fibrinogen
supplementation with cryoprecipitate vs. fibrinogen concentrate in this
setting are needed. Methods: FIBrinogen REplenishment in Surgery (FIBRES)
is A prospective, multi-centre, randomised (1:1), active-control,
single-blinded, non-inferiority phase 3 trial in adult cardiac surgical
patients with clinically significant bleeding due to acquired
hypofibrinogenaemia (NCT03037424). The primary objective is to determine
if the efficacy of A new fibrinogen concentrate (Octafibrin/Fibryga,
Octapharma) is non-inferior to cryoprecipitate. Patients will receive 4 g
fibrinogen concentrate or 10 units of cryoprecipitate (dose-equivalent to
4 g) each time fibrinogen supplementation is ordered within 24 hours after
CPB; all randomised patients will receive fibrinogen supplementation as
clinically indicated. The primary outcome is total allogeneic blood
products (ABPs; red blood cells, pooled/apheresis platelets, plasma)
administered within 24 hours. Secondary outcomes include ABPs administered
within 7 days, major bleeding within 24 hours, fibrinogen levels, and
adverse events (AEs) and serious AEs within 28 days. Patient consent prior
to treatment is waived, and the study will include 1,200 patients; using A
20% non-inferiority margin and assuming A drop-out rate of ~10% after
randomisation, >=550 patients/group will provide >80% power. Interim
analysis will include 600 patients. The pragmatic study design and
treatment algorithm align with standard practice, aiding adherence and
clinical relevance. Results: FIBRES is expected to complete in late 2018,
with results available in early 2019. Discussion/Conclusion: FIBRES is the
largest randomised comparison of fibrinogen concentrate and
cryoprecipitate in cardiac surgery patients undergoing CPB, an
under-studied, high-risk population. Non-inferiority of the new, highly
purified fibrinogen concentrate would support its use in acquired
hypofibrinogenaemia. The results from FIBRES are likely to improve care
for cardiac surgical patients experiencing significant bleeding.

<81>
Accession Number
624562096
Title
Cytokine removal using the CytoSorb system in combination with extra
corporeal membrane oxygenation: A review of the literature.
Source
ASAIO Journal. Conference: 29th Annual Extracorporeal Life Support
Organization Conference, ELSO 2018. United States. 64 (Supplement 2) (pp
24), 2018. Date of Publication: September - October 2018.
Author
Fischer S.; Akil A.; Ziegeler S.; Rehers S.; Richter L.; Semik M.
Institution
(Fischer, Akil, Richter, Semik) Department of Thoracic Surgery and Lung
Support, Ibbenbueren General Hospital, Grosse Strasse 41, Ibbenbueren
49477, Germany
(Ziegeler, Rehers) Deprtament of Anesthesia and Intensive Care Medicine,
Ibbenbueren General Hospital, Ibbenbueren, Germany
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Extracorporeal membrane oxygenation (ECMO) is an increasingly
applied concept for mechanical support of respiratory and
cardiocirculatory failure with promising results. Excessive systemic
inflammatory response is observed during sepsis and may lead to multiple
organ failure worsening the outcome. Therefore, controlling excessively
increased cytokines and the pre-inflammatory response by hemoadsorption
may have a positive impact on overall mortality. The aim of the present
work is to provide a summary and critical evaluation of the existing
literature. Methods: A Medline search was performed (publication period
1980-2018). All publication formats were considered. The following
keywords were used: Cytosorb, hemoadsorbtion, sepsis, thoracic surgery,
extra corporeal membrane oxygenation. Results: 47 articles were found
about CytoSorb application in several modalities and medical fields. Only
one multi-center study was presented with data available from 20 centers
from four countries provided data for a total of 198 patients. A
single-center prospective study was identified, in which n=20 consecutive
patients with refractory septic shock were included. In n=6 case series
the efficacy of cytokine adsorption was demonstrated for treatment of
patients with severe sepsis and septic shock. Other single cases (n=20)
reported the benefits of the cytokine adsorption therapy, among which n= 7
cases reported the successful combination of ECMO with cytokine removal
therapy in patients with severe sepsis. N= 3 Studies were found evaluating
the effect of adsorption of cytokines using CytoSorb in combination with
cardiopulmonary bypass (CPB) during cardiac surgery. N=3 case series and
n= 5 case reports were identified concerning hemoadsorption treatment of
patients during surgery with CPB. Conclusion: Hemoadsorption therapy using
CytoSorb seems to offer a promising novel option for the treatment of
patients with overwhelming inflammatory response leading to faster
hemodynamic and metabolic stabilization finally resulting in preserved
organ function. Despite the beneficial effects, the results must be
interpreted with caution, since patient numbers are still small; however
the disease severity is remarkably high and suggests that cytokine
modulation by adsorption might be considered as an ultimate treatment in
such life-threatening situations.

<82>
Accession Number
624569980
Title
The value of scoring systems.
Source
Ambulatory Surgery. Conference: 12th International Congress of the
International Association for Ambulatory Surgery, IAAS 2017. China. 23 (2)
(pp 65), 2017. Date of Publication: July 2017.
Author
Skues M.
Institution
(Skues) Ambulatory Surgery, United States
Publisher
International Association for Ambulatory Surgery
Abstract
Scoring systems for Ambulatory Surgery provide an extremely useful
benchmark to establish outcomes. Increasingly, patients are interested in
the likelihood of morbidity or potential complications that may help them
in provision of truly informed consent. This presentation concentrates on
the logical development of scoring systems, evaluating the evidence base
for development and implementation, and then highlighting potential
pitfalls in interpretation and implementation, particularly in relation to
the management of post-operative nausea and vomiting. Any scoring system
will have been developed as a method of classification, diagnosis,
prediction or prognosis for individuals or populations (1). Classification
models might be age or height; diagnostic models include body mass index,
chronic kidney disease, or evaluation for diabetes mellitus. Prediction
models commonly used in anaesthesia include the STOPBANG score for
evaluation of obstructive sleep apnoea, the Mallampati score or the
simplified airway risk index for assessment of the risk of difficult
tracheal intubation, while prognostic models exist for post operative
nausea and vomiting, mortality after surgery, or cardiac risk. The
development of a scoring system relies upon evaluation of the factors
likely to have an effect on prediction. Apfel et al (2) performed this for
PONV factors with a metaanalysis in 2012, highlighting female gender,
previous history of PONV, age and being a non-smoker as principal
indicators, with the use of volatile anaesthetics or nitrous oxide,
post-operative opioids, and duration being secondary factors. He also
estimated that the type of surgery (laparoscopic, gynaecology, ENT, or
cholecystectomy) were more likely to be implicated in the causes of PONV.
Various scoring systems have been developed (3-5), with that of Sinclair
et al (4) being the only study carried out in ambulatory surgery patients.
Given also that the Apfel scale includes the use of post-operative opioids
as a risk factor, it would seem that the Sinclair score may be a better
prediction system for PONV in the outpatient environment. This has been
confirmed in our unit, with a Number Needed to Treat of 1.16 for patients
assessed with the Sinclair system, compared with 4.71 for those assessed
using Apfel's algorithm. Similarly, emetic symptoms after discharge from
an Ambulatory Unit may be over predicted by Apfel's scoring system (6),
suggesting that there may be differences in the characteristics of the
cohorts studied. In conclusion, while scoring systems are useful for
stratification of patient risk, there is value in the calibration of
algorithms to the local population, defining threshold for prophylaxis,
and ensuring that there is a robust rescue therapy pathway.

<83>
Accession Number
624571845
Title
Digging deeper in postoperative modifications of right ventricular
function: impact of pericardial approach and cardioplegia.
Source
European Heart Journal Cardiovascular Imaging. Conference: 20th Annual
Meeting of the European Association of Echocardiography, EUROECHO 2016.
Germany. 17 (Supplement 2) (pp ii258), 2016. Date of Publication: December
2016.
Author
Loardi C.; Saccocci M.; Tamborini G.; Veglia F.; Pepi M.; Alamanni F.;
Zanobini M.
Institution
(Loardi, Saccocci, Tamborini, Veglia, Pepi, Alamanni, Zanobini) Institute
Monzino, Cardiac Surgery, Milan, Italy
Publisher
Oxford University Press
Abstract
Background: After cardiac surgery, the right ventricle appears to
experience an impairment of its longitudinal performance in the absence of
concomitant geometrical functional changes. Factors involved in such
phenomenon and their respective influence are scarcely known. Purpose: The
aim of the study was to analyse the impact of different pericardial
incision types (lateral versus anterior) and of myocardial protection
strategies (Buckberg versus Custodiol) onto postoperative right
ventricular (RV) function by comparing two- (2D) and three-dimensional
(3D) echocardiographic parameters in patients undergoing minimally
invasive or traditional mitral valve repair. Methods: 44 patients (mean
age 54612 years; 34 males) with severe mitral degenerative regurgitation
were prospectively and randomly assigned to one of these groups: 1. Group
A (17 patients): traditional sternotomy operation with Buckberg
cardioplegia 2. Group B (17 patients): mini-invasive surgery with
Custodiol cardioplegia 3.Group C (10 patients): traditional sternotomy
operation with Custodiol cardioplegia Pericardial approach consisted in an
anterior reversed T incision for traditional surgery and in a lateral one
for mini-invasive surgery. 2D transthoracic echocardiography was performed
pre- and 6 months post surgery to evaluate RV function by tricuspid
annular plane systolic excursion (TAPSE). 3D echocardiography was used for
RV volumes, ejection fraction and stroke volume evaluation. Results: All
patients underwent uncomplicated surgery. Preoperative RV function was
normal in all patients. Groups failed to statistically differ in basal 2D
and 3D RV performance and cross-clamping time. A postoperative TAPSE fall
was found in all groups, but mini-invasive patients experienced a
statistically significant less marked variation (21.564.1 post versus
23.564 pre) versus traditional surgery (Group A 14.963 post versus
24.564.8 pre; Group C 19.364.2 post versus 27.465.3 pre), p<0.0001 Group B
vs A, p=0.008 Group B vs C. 3D echocardiography retrieved no significant
inter-group differences in postoperative changes of RV volumes. In
miniinvasive patients, RV ejection fraction slightly augmented after
surgery (60.766.8 post versus 58.566.1 pre), while in Group A and C it
decreased (58.265.4 post versus 62.268.9 pre and 59.566.9 post versus
60.568.2 pre, respectively). Comparison between mini-invasive group versus
sternotomy-Buckberg one was statistically significant (p=0.04).
Conclusion: Mini-invasive mitral repair with lateral pericardial opening
reduces postoperative TAPSE fall while cardioplegia protocol fails to have
an impact onto longitudinal RV function. In our study, the right ventricle
seems to experience a clinically irrelevant geometrical modification too,
whose entity appears to be less evident in case of lateral pericardial
approach.

<84>
Accession Number
624571794
Title
Variability of thoracic aortic diameters according to gender, age and body
surface area. time to forget absolute cut-off values?.
Source
European Heart Journal Cardiovascular Imaging. Conference: 20th Annual
Meeting of the European Association of Echocardiography, EUROECHO 2016.
Germany. 17 (Supplement 2) (pp ii89-ii90), 2016. Date of Publication:
December 2016.
Author
Carrero C.; Altamirano C.; Pipkin M.; Constantin I.; Fava A.; Diaz Babio
G.; Masson Juarez G.; San Miguel J.; Vera Janavel G.; Stutzbach P.
Institution
(Carrero, Altamirano, Pipkin, Constantin, Fava, Diaz Babio, Masson Juarez,
San Miguel, Vera Janavel, Stutzbach) Cardiovascular Institute of San
Isidro (ICSI), Sanatorio Las Lomas, Buenos Aires, Argentina
Publisher
Oxford University Press
Abstract
Background: Thoracic aortic (TA) dilatation require accurate and timely
detection to prevent progression to dissection. Transthoracic
echocardiography (TTE) remains the screening tool. Differences in TA
diameters (TAD) according to gender (G), age (A) and body surface area
(BSA) have been reported. However, the reported ranges of TAD are limited
by small sample size, different measurement sites and heterogeneous
cohorts. Besides, there is scarce locally-sourced information. Moreover,
surgery indication for TA aneurysms is still based mainly on absolute TAD
with no reference to G, A or BSA. Purpose: We aimed to assess the full
spectrum of TAD in both G and their correlations with A and BSA to obtain
reference nomograms in healthy adolescents and adults. Methods: Medical
examination and complete color flow Doppler TTE were performed to exclude
cardiovascular risk factors, TA aneurysm, aortic regurgitation, bicuspid
valve, past history of cardiac surgery or personal/familial aortopathies.
TAD (cm) were assessed and BSA-indexed (TADi, cm/m2) in healthy, >=14 y/o
volunteers at: annulus (TAD1), sinuses of Valsalva (TAD2), sinotubular
junction (TAD3), proximal ascending (TAD4), isthmus (TAD5) and proximal
descending aorta (TAD6). We used paraesternal long axis (TAD1-4) and
suprasternal (TAD5&6) views. TAD1 was measured at mid-systole (inner edge
method) and all other at end-diastole (leading edge method). We stratified
data by G and A (A1: 14-24 y/o, A2: 25-40 y/o, A3: >40 y/o). Afterwards,
we conducted linear regression analyses between dependent (TAD, TADi) and
independent (G, A and BSA) variables with Pearson's least squares method
to obtain coefficients of determination (R2) and 95% prediction intervals.
Group data was compared with unequal variance T-test for independent
samples or Fisher's z transformation for independent correlations. Results
are reported as mean+/-SEM. Significance was set at P<0.05. Results:
Pooled data from all patients (n=485; 35.5% women; 32.3+/-0.7 y/o;
1.82+/-0.01 m2) showed a positive correlation between all TAD and A or BSA
(p<0.001). All TADi were negatively correlated with BSA (p<0.001). Every
TADi was positively correlated with A (p<0.001) except for TADi1
(R2=0.0005; p=NS). Gender comparisons showed group differences between
TAD, TADi, A and BSA (p<0.001), but strongly similar correlations (p=NS).
Nomograms were obtained for A1, A2 and A3 to predict TAD from BSA with no
need of G distinction. Conclusions: In our cohort, BSA was the strongest
predictor of TAD. TAD increased with A, except for the aortic annulus
which depended more on BSA. Women had smaller TAD due to their lower BSA,
but they correlated strongly similar to men. We propose nomograms of TAD
for different A groups without G distinction. Our study provides
applicable reference prediction values for TA dilatation screening
purposes and treatment decision making. BSA and A must be taken into
account when assessing an individual patient. (Table Presented).

<85>
Accession Number
624570905
Title
Utility of speckle tracked strain assessment of the right ventricle
following lung resection.
Source
European Heart Journal Cardiovascular Imaging. Conference: 20th Annual
Meeting of the European Association of Echocardiography, EUROECHO 2016.
Germany. 17 (Supplement 2) (pp ii244), 2016. Date of Publication: December
2016.
Author
Mccall P.J.; Sonecki P.; Kinsella J.; Shelley B.G.
Institution
(Mccall, Sonecki, Shelley) Golden Jubilee National Hospital, Glasgow,
United Kingdom
(Kinsella) University of Glasgow, Glasgow, United Kingdom
Publisher
Oxford University Press
Abstract
Existing studies indicate that right ventricular (RV) dysfunction occurs
following lung resection, predisposing patient to post-operative
complications and prolonged critical care stay. Although widely
hypothesised to result from increased afterload, the mechanisms and extent
of dysfunction remain incompletely understood. Trans thoracic
echocardiographic (TTE) assessment of the RV is challenging in this
population, with the difficulties of RV imaging compounded following
thoracic surgery. Many of the parameters used correlate poorly with each
other and lack validation in this patient group. To further investigate
the RV response to lung resection we performed a prospective observational
cohort study using cardiac magnetic resonance (CMR) imaging and speckle
tracked echocardiography. With ethics approval and informed consent, 27
patients undergoing lobectomy by thoracotomy underwent serial TTE and CMR;
pre-op, on post-operative day 2 (POD 2) and at 2-month follow-up. Global
and RV free wall speckle tracked peak longitudinal strain (RV-GPLS and
RV-FPLS respectively) were determined offline from randomised and
anonymised images (Echopac, GE Healthcare). RV ejection fraction (RVEF)
was calculated offline by dual reported analysis of randomised and
anonymised CMR images (Argus, Siemens). All correlations were assessed
using Pearson's correlation coefficient. Twenty-six patients had TTE
performed on POD 2 with 22 (84.62%) having RVPLS and GPLS calculated. POD
2 RV-GPLS and RV-FPLS (Fig 1.) were unchanged from pre-op values (p = 0.69
and 0.09 respectively, Wilcoxon Signed Rank, Fig. 1). RVEF by CMR, POD 2
RV-GPLS and RV-FPLS correlated with the duration of critical care stay (r
= -0.61, r = 0.60 and r = 0.52 respectively, p < 0.01 for all). RV-GPLS
and RV-FPLS correlated moderately with RVEF by CMR at all peri-operative
time points (r = -0.41, -0.54, -0.52 for RV-GPLS and r = -0.53, -0.51,
-0.55 for RV-FPLS, p < 0.05 for all). This study suggests that speckle
tracked strain assessment of the RV may have utility in patients following
lung resection. Although there was no significant change in RV strain over
time, there is an association with RV function on POD 2 and the duration
of critical care stay. Importantly RV strain correlates with a gold
standard method of assessing RV function, this offers a non-invasive and
bedside method of measuring RV function in this patient group.

<86>
Accession Number
624570802
Title
The appropriate use of transthoracic echocardiography for the exclusion of
infective endocarditis.
Source
European Heart Journal Cardiovascular Imaging. Conference: 20th Annual
Meeting of the European Association of Echocardiography, EUROECHO 2016.
Germany. 17 (Supplement 2) (pp ii76-ii77), 2016. Date of Publication:
December 2016.
Author
Jillott N.; Wilson S.
Institution
(Jillott, Wilson) Addenbrooke's Hospital, Cardiology, Cambridge, United
Kingdom
Publisher
Oxford University Press
Abstract
Infective endocarditis (IE) is a potentially lethal disease, which is
associated with high mortality and severe morbidity. According to the ESC
Guidelines transthoracic echocardiography ( TTE ) is the first imaging
choice for investigation for IE. The major echocardiographic findings for
identifying IE include direct visualization of a vegetation or other
hallmarks of the disease such as pseudoaneurysm or abscess formation.
Sensitivity for the in native and prosthetic valves is 70% and 50%,
respectively for TTE. The modified Duke criteria were proposed as a
standardised method of assessing the likelihood of the presence of IE.
According to this classification, patients can be categorised in three
ways: "definite", "possible", and "rejected". Systematic reviews have
shown that TTE is largely over utilised and often provides little
additional clinical information. In order to review this hypothesis, 680
patients referred for TTE for possible endocarditis from October 2014 to
October 2015 were analysed in a single tertiary referral centre. All
patients over 16 years of age that had been referred as an inpatient TTE
for endocarditis were included. All patients underwent standard TTE with
images and measurements taken according to the British Society of
Echocardiography minimum dataset. Statistical analysis was carried out
using SPSS version 22, with a p value of < 0.05 considered significant. 91
patients were excluded as they were below the age cut off. In the
remaining 589 patients, evidence of IE was seen in 7 (1.18%) patients. The
mean age of the population was 60.8 years (range 16 - 98 years), and 54%
were male. Univariate analysis was performed. The significant independent
predictors for a positive TTE were central venous access, injected drug
use and positive blood cultures. Through strict application of the
modified Duke criteria, 8 cases (1.3%) were classed as 'definite', 14
cases (2.3%) were classed as 'possible', 567 cases (96.4%) were classed as
'rejected'. In the current cost-conscious NHS it seems inappropriate to
use advanced imaging techniques such as TTE if it adds little additional
clinical information in an identifiable patient population. Over 90% of
the TTE referrals in our series could have been avoided by the judicious
use of appropriate clinical criteria. (Table Presented).

<87>
Accession Number
624571119
Title
The impact of right ventricular function from aortic valve replacement: A
randomised study comparing minimally invasive aortic valve surgery and
conventional open heart surgery.
Source
European Heart Journal Cardiovascular Imaging. Conference: 20th Annual
Meeting of the European Association of Echocardiography, EUROECHO 2016.
Germany. 17 (Supplement 2) (pp ii130), 2016. Date of Publication: December
2016.
Author
Hashemi N.; Johnsson J.; Gomez A.; Alam M.; Winter R.
Institution
(Hashemi) Department of Clinical science, Danderyd Hospital, Capio St
Goran Hospital, Stockholm, Sweden
(Johnsson, Winter) Royal Institute of Technology, Stockholm, Sweden
(Gomez) Capio St Goran Hospital, Clinical Physiology, Stockholm, Sweden
(Alam) Karolinska Institute, Danderyds Hospital, Depratment of Cardiology,
Stockholm, Sweden
Publisher
Oxford University Press
Abstract
Background: Reduction in longitudinal displacement of right ventricular
(RV) free wall measured by tricuspid annular plane systolic excursion
(TAPSE), following cardiac surgery is a well known phenomenon. Minimally
invasive aortic valve surgery (MIAVR) is a new technique which might
result in better perioperative clinical outcome. However, the impact of
this new surgical technique on right ventricular function is not well
studied. Purpose: To explore the alteration in TAPSE following minimally
invasive aortic valve surgery in comparison to conventional aortic valve
surgery (AVR). Methods: Fourty patients with severe aortic valve stenosis
were randomised to MIAVR or AVR. Patients with atrial fibrillation,
previous cardiac surgery, coronary artery disease, reduced left
ventricular function and other valvular disease than aorta were excluded.
Echocardiography was performed prior to surgery and 1 month post surgery.
TAPSE was measured using M-mode at the level of the lateral tricuspid
annulus of the RV free wall. Results: The mean age was 69 years in both
groups. In the AVR group TAPSE reduced substantially when comparing pre to
postoperative values (26+/-4.9 mm vs 15.5+/-3.5 mm P<0.0001). TAPSE also
reduced in the MIAVR group but to a lesser extent, comparing values from
pre to post surgery (24.6+/-3.5 mm v.s.19.8+/-3.5 mm P<0.0001). Following
surgery TAPSE reduced by 40.4% in the AVR group comparing to 19.5% in the
MIAVR group. Conclusion: TAPSE reduced substantially following AVR. A
decline in TAPSE was also noticed following MIAVR, however to a much
lesser extent.

<88>
Accession Number
624236808
Title
Hormonal manipulation after surgery for catamenial pneumothorax.
Source
Interactive cardiovascular and thoracic surgery. 26 (2) (pp 319-322),
2018. Date of Publication: 01 Feb 2018.
Author
Garner M.; Ahmed E.; Gatiss S.; West D.
Institution
(Garner, Ahmed, West) Department of Thoracic Surgery, University Hospitals
Bristol, Bristol, United Kingdom
(Gatiss) Department of Obstetrics and Gynaecology, City Hospitals
Sunderland, Sunderland, United Kingdom
Publisher
NLM (Medline)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether hormonal
manipulation with gonadotrophin-releasing hormone analogues reduces the
risk of recurrent catamenial pneumothorax after surgery, compared with
surgery alone. Altogether 819 papers were found using the reported search,
of which 7 represented the best evidence to answer the clinical question.
The authors, date, journal, country of publication, study type, level of
evidence, patient group studied, relevant outcomes and results of these
papers are tabulated. Of the 7 papers selected, 6 demonstrated a reduction
in recurrence of catamenial pneumothorax with the use of
gonadotrophin-releasing hormone analogues, whereas in the single paper
where surgery alone was performed, no evidence of recurrence was
demonstrated. We therefore conclude that, based on very small
retrospective observational studies, gonadotrophin-releasing hormone
analogues used as an adjunct to surgical intervention may reduce the risk
of recurrent pneumothorax, when compared with either no hormonal therapy
or oestrogen-progesterone therapy, but should be initiated and supervised
by gynaecologists who will be familiar with the therapy and the potential
side effects.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<89>
Accession Number
624237211
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 : official journal of the
European Association for 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
NLM (Medline)
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 18months, 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.

<90>
Accession Number
624238175
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: 01 Aug 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, UK; Perioperative Critical Care and Trauma Trials Group,
Institute of Inflammation and Ageing, Centre of Translational Inflammation
Research, University of Birmingham, Birmingham, UK
(Klein) Department of Cardiothoracic Anesthesia and Critical Care
Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard,
Cambridge, UK
(Gao) Perioperative Critical Care and Trauma Trials Group, Institute of
Inflammation and Ageing, Centre of Translational Inflammation Research,
University of Birmingham, Birmingham, UK; The 2nd Affiliated Hospital and
Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
Publisher
NLM (Medline)

<91>
Accession Number
624220347
Title
Cerebral monitoring of anaesthesia on reducing cognitive dysfunction and
postoperative delirium: a systematic review.
Source
The 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, People's Hospital of Yongchuan District,
Chongqing, China
(Zou) Department of Neurology, Yongchuan Hospital of Traditional Chinese
Medicine, Chongqing, China
Publisher
NLM (Medline)
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.

<92>
Accession Number
624220319
Title
Antithrombotic therapy after mitral valve repair: VKA or aspirin?.
Source
Journal of thrombosis and thrombolysis. 46 (4) (pp 473-481), 2018. Date of
Publication: 01 Nov 2018.
Author
van der Wall S.J.; Olsthoorn J.R.; Heuts S.; Klautz R.J.M.; Tomsic A.;
Jansen E.K.; Vonk A.B.A.; Sardari Nia P.; Klok F.A.; Huisman M.V.
Institution
(van der Wall) Department of Thrombosis and Hemostasis, Leiden University
Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
s.j.van_der_wall@lumc.nl
(Olsthoorn, Heuts, Sardari Nia) Department of Cardio-Thoracic Surgery,
Maastricht University Medical Centre, Maastricht, Netherlands
(Klautz, Tomsic) Department of Cardio-Thoracic Surgery, Leiden University
Medical Centre, Leiden, Netherlands
(Jansen, Vonk) Department of Cardio-Thoracic Surgery, VU University
Medical Centre, Amsterdam, Netherlands
(Klok, Huisman) Department of Thrombosis and Hemostasis, Leiden University
Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
Publisher
NLM (Medline)
Abstract
The optimal antithrombotic therapy following mitral valve repair (MVr) is
still a matter of debate. Therefore, we evaluated the rate of
thromboembolic and bleeding complications of two antithrombotic prevention
strategies: vitamin K antagonists (VKA) versus aspirin. Consecutive
patients who underwent MVr between 2004 and 2016 at three Dutch hospitals
were evaluated for thromboembolic and bleeding complications during three
postoperative months. The primary endpoint was the combined incidence of
thromboembolic and bleeding complications to determine the net clinical
benefit of VKA strategy as compared with aspirin. Secondary objectives
were to evaluate both thromboembolic and bleeding rates separately and to
identify predictors for both complications. A total of 469 patients were
analyzed, of whom 325 patients (69%) in the VKA group and 144 patients
(31%) in the aspirin group. Three months postoperatively, the cumulative
incidence of the combined end point of the study was 9.2% (95%CI 6.1-12)
in the VKA group and 11% (95%CI 6.0-17) in the aspirin group [adjusted
hazard ratio (HR) 1.6, 95%CI 0.83-3.1]. Moreover, no significant
differences were observed in thromboembolic rates (adjusted HR 0.82, 95%CI
0.16-4.2) as well as in major bleeding rates (adjusted HR 1.89, 95%CI
0.90-3.9). VKA and aspirin therapy showed a similar event rate of 10%
during 3 months after MVr in patients without prior history of AF. In both
treatment groups thromboembolic event rate was low and major bleeding
rates were comparable. Future prospective, randomized trials are warranted
to corroborate our findings.

<93>
[Use Link to view the full text]
Accession Number
624193115
Title
To transfuse or not transfuse: an intensive appraisal of red blood cell
transfusions in the ICU.
Source
Current opinion in hematology. 25 (6) (pp 468-472), 2018. Date of
Publication: 01 Nov 2018.
Author
Hayes M.M.; Uhl L.
Institution
(Hayes) Harvard Medical School, Beth Israel Deaconess Medical Center
Internal Medicine Residency, Carl J. Shapiro Institute for Education and
Research, Division of Pulmonary, Critical Care, Sleep Medicine, Medical
Intensive Care Unit, France
(Uhl) Harvard Medical School, Laboratory and Transfusion Medicine, Beth
Israel Deaconess Medical Center, Boston, MA, United States
Publisher
NLM (Medline)
Abstract
RECENT FINDINGS: Almost a decade after the TRICC trial, a randomized trial
showing the safety of a restrictive transfusion threshold in critically
ill patients, four large randomized controlled trials have shown that a
restrictive transfusion strategy is safe in pediatric critically ill
patients, patients with acute upper gastrointestinal bleeds, patients with
septic shock and patients undergoing cardiac surgery. A large multicenter
randomized trial is underway to determine the safety of a restrictive
strategy in myocardial infarction.
SUMMARY: A restrictive transfusion threshold is recommended in nearly all
critically ill patients. This is at least noninferior to more liberal
transfusion practice; in addition, a restrictive threshold has shown
improved outcomes in some patients and decreased chances of adverse events
in patients. Judicious use of red cells improves patient outcome and
protects the blood supply, a limited resource. More data are needed to
determine appropriate transfusion threshold recommendations for patients
with traumatic brain injury and acute coronary syndrome.
PURPOSE OF REVIEW: This review is a critical appraisal of the current data
comparing restrictive vs. liberal transfusion strategies for patients who
are critically ill in ICUs. We focus on four subsets of critically ill
patients: pediatric patients, patients with gastrointestinal bleeds,
septic patients and patients undergoing cardiac surgery.

<94>
Accession Number
624248631
Title
Cost-effectiveness analysis of single use negative pressure wound therapy
dressings (sNPWT) compared to standard of care in reducing surgical site
complications (SSC) in patients undergoing coronary artery bypass grafting
surgery.
Source
Journal of cardiothoracic surgery. 13 (1) (pp 103), 2018. Date of
Publication: 03 Oct 2018.
Author
Nherera L.M.; Trueman P.; Schmoeckel M.; Fatoye F.A.
Institution
(Nherera, Trueman) Smith & Nephew Advanced Wound Management, Global Market
Access, 101 Hessle Road, Hull HU3 2BN, United Kingdom
(Schmoeckel) Vascular and Diabetic Centre Department of Heart Surgery,
Asklepios Klinik St. Georg Cardiac, Lohmuhlenstr 5, Hamburg 20099, Germany
(Fatoye) Department of Health Professions, Manchester Metropolitan
University, Manchester, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: There is a growing interest in using negative pressure wound
therapy in closed surgical incision to prevent wound complications which
continue to persist following surgery despite advances in infection
measures.
OBJECTIVES: To estimate the cost-effectiveness of single use negative
pressure wound therapy (sNPWT) compared to standard of care in patients
following coronary artery bypass grafting surgery (CABG) procedure to
reduce surgical site complications (SSC) defined as dehiscence and
sternotomy infections.
METHOD: A decision analytic model was developed from the Germany Statutory
Health Insurance payer's perspective over a 12-week time horizon. Baseline
data on SSC, revision operations, length of stay, and readmissions were
obtained from a prospective observational study of 2621 CABG patients in
Germany. Effectiveness data for sNPWT was taken from a randomised open
label trial conducted in Poland which randomised 80 patients to treatment
with either sNPWT or standard care. Cost data (in Euros) were taken from
the relevant diagnostic related groups and published literature.
RESULTS: The clinical study reported an increase in wounds that healed
without complications 37/40 (92.5%) in the sNPWT compared to 30/40 (75%)
patients in the SC group p=0.03. The model estimated sNPWT resulted in
0.989 complications avoided compared to 0.952 and the estimated quality
adjusted life years were 0.8904 and 0.8593 per patient compared to
standard care. The estimated mean cost per patient was 19,986 for sNPWT
compared to 20,572 for SC resulting in cost-saving of 586. The findings
were robust to a range of sensitivity analyses.
CONCLUSION: The sNPWT can be considered a cost saving intervention that
reduces surgical site complications following CABG surgery compared to
standard care. We however recommend that additional economic studies
should be conducted as new evidence on the use of sNPWT in CABG patients
becomes available to validate the results of this economic analysis.

<95>
[Use Link to view the full text]
Accession Number
624244811
Title
Simvastatin Treatment Protects Myocardium in Noncoronary Artery Cardiac
Surgery by Inhibiting Apoptosis Through miR-15a-5p Targeting.
Source
Journal of cardiovascular pharmacology. 72 (4) (pp 176-185), 2018. Date of
Publication: 01 Oct 2018.
Author
Zhou L.; Liu X.; Wang Z.-Q.; Li Y.; Shi M.-M.; Xu Z.; Ou Z.-J.; Li H.-M.;
Cheng T.-P.; Jian Y.-P.; Zhang W.; Liu C.; Zhang X.; Quon M.J.; Zhang
C.-X.; Xu Y.-Q.; Wang Z.-P.; Ou J.-S.
Institution
(Zhou, Liu, Wang, Li, Shi, Xu, Li, Cheng, Jian, Zhang, Zhang, Xu, Wang,
Ou) Division of Cardiac Surgery, Heart Center, First Affiliated Hospital
of Sun Yat-sen University, Guangzhou, China
(Zhou, Liu, Wang, Li, Shi, Xu, Ou, Li, Cheng, Jian, Zhang, Liu, Zhang, Xu,
Wang, Ou) Key Laboratory of Assisted Circulation, Ministry of Health,
Guangzhou, China
(Liu, Wang, Li, Shi, Ou, Li, Cheng, Jian, Liu, Ou) National and Guangdong
Province Joint Engineering Laboratory for Diagnosis and Treatment of
Vascular Diseases, Guangzhou, China
(Ou) Division of Hypertension and Vascular Diseases, Heart Center, First
Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
(Liu) Department of Cardiology, Heart Center, First Affiliated Hospital of
Sun Yat-sen University, Guangzhou, China
(Quon) Division of Endocrinology, Diabetes, Nutrition, University of
Maryland School of Medicine, Baltimore, MD, United States
(Zhang) Department of Biomedical Engineering, School of Medicine,
University of Alabama at Birmingham, Birmingham, AL, United States
(Ou) Guangdong Provincial Key Laboratory of Brain Function and Disease,
Guangzhou, China
Publisher
NLM (Medline)
Abstract
Simvastatin treatment is cardioprotective in patients undergoing
noncoronary artery cardiac surgery. However, the mechanisms by which
simvastatin treatment protects the myocardium under these conditions are
not fully understood. Seventy patients undergoing noncoronary cardiac
surgery, 35 from a simvastatin treatment group and 35 from a control
treatment group, were enrolled in our clinical study. Simvastatin (20
mg/d) was administered preoperatively for 5-7 days. Myocardial tissue
biopsies were taken before and after surgery. Apoptosis was detected by
TUNEL staining. The expressions of Bcl-2 and Bak in myocardial tissue were
detected by immunoblotting. The expressions of miRNA and Bcl-2 mRNA were
detected by quantitative real-time polymerase chain reaction assays.
Cardiomyocytes were isolated from rat and cultured cells. MiR-15a-5p mimic
was transfected into cardiomyocytes, and the Bcl-2 was detected by
immunoblotting. TUNEL staining showed significantly less myocardial
apoptosis in the simvastatin treatment group when compared with the
control treatment group. Protein expression of Bcl-2 was increased in the
simvastatin treatment group before surgery, and Bak expression was
increased in the control treatment group after surgery. Further
comparisons showed that Bcl-2/Bak ratios were reduced in the control
treatment group but were not significantly changed in the simvastatin
treatment group after surgery. Furthermore, microarray assays revealed
that miR-15a-5p was significantly decreased by simvastatin treatment. This
was validated by quantitative real-time polymerase chain reaction
analysis. MiR-15a-5p was predicted to target Bcl-2 mRNA at nucleotide
positions 2529-2536. This was validated by luciferase binding assays.
Coincident with the change in miR-15a-5p, the mRNA expression of Bcl-2 was
increased in the simvastatin treatment group. MiR-15a-5p mimic
significantly inhibited Bcl-2 expression in cardiomyocytes. Our findings
strongly suggest that simvastatin treatment preoperatively protected the
myocardium in patients undergoing noncoronary artery cardiac surgery, at
least in part, by inhibiting apoptosis via suppressing miR-15a-5p
expression, leading to increasing expression of Bcl-2 and decreasing
expression of Bak.

<96>
Accession Number
624243640
Title
The association between blood pressure and long-term outcomes of patients
with ischaemic cardiomyopathy with and without surgical revascularization:
an analysis of the STICH trial.
Source
European heart journal. 39 (37) (pp 3464-3471), 2018. Date of Publication:
01 Oct 2018.
Author
Andersson B.; She L.; Tan R.-S.; Jeemon P.; Mokrzycki K.; Siepe M.;
Romanov A.; Favaloro L.E.; Djokovic L.T.; Raju P.K.; Betlejewski P.;
Racine N.; Ostrzycki A.; Nawarawong W.; Das S.; Rouleau J.L.; Sopko G.;
Lee K.L.; Velazquez E.J.; Panza J.A.
Institution
(Andersson) Department of Cardiology, Sahlgrenska University Hospital, Bla
Straket 3, Gothenburg, Sweden
(She, Lee, Velazquez) Duke Clinical Research Institute, 2400 Pratt Street
Durham, NC, United States
(Tan) National Heart Centre, 5 Hospital Drive, Singapore
(Jeemon) Achutha Menon Centre for Health Science Studies, Sree Chitra
Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011,
India, and Centre for Chronic Disease Control, New Delhi, India
(Mokrzycki) Department of Cardiac Surgery, SPSK-2, Pomeranian Medical
University, Powstancow Wielkopolskich 72, Szczecin, Poland
(Siepe) Klinik fur Herz- und Gefasschirurgie, Universitats Herzzentrum
Freiburg Bad Krozingen, Sudring 15, Bad Krozingen, Germany
(Romanov) Arrhythmia Department and Electrophysiology Laboratory, State
Research Institute of Circulation Pathology, Rechkunovskaya 15,
Novosibirsk, Russian Federation
(Favaloro) Hospital Universitario Fundacion Favaloro, Ciudad Autonoma de
Buenos Aires, Argentina
(Djokovic) Dedinje Cardiovascular Institute, Heroja Milana Tepica br. 1,
Belgrade, Serbia
(Raju) Care Hospitals, Care op center, Road Number 10 ,Banjara Hills,
Hyderabad, Telangana, India
(Betlejewski) Klinika Kardiochirurgii, Instytut Kardiologii, Wilenska 44,
Gdansk, Poland
(Racine, Rouleau) Montreal Heart Institute, Universite de Montreal5000
Belanger est, Montreal, Quebec, Canada
(Ostrzycki) National Institute of Cardiology, Alpejska 42, Warsaw, Poland
(Nawarawong) Department of Surgery, Chiang Mai University, Su Thep, Chiang
Mai, Thailand
(Das) Centre for Chronic Disease Conrol, Safdarjung Development Area,
C1/52 2nd Floor, New Delhi, India
(Sopko) National Heart, Lung, and Blood Institute, National Institutes of
Health, 6701 Rockledge Dr, Bethesda, MD, USA
(Lee) Department of Biostatistics and Bioinformatics, Duke University
School of Medicine, Durham, NC, United States
(Velazquez) Department of Internal Medicine, Section of Cardiovascular
Medicine, Yale School of Medicine, New Haven, CT, United States
(Panza) Cardiology, Westchester Medical Center and WMC Health Network, New
York Medical College, Room 100 Valhalla, 100 Woods Road ,Macy Pavilion,
NY, United States
Publisher
NLM (Medline)
Abstract
Aims: Hypertension (HTN) is a well-known contributor to cardiovascular
disease, including heart failure (HF) and coronary artery disease, and is
the leading risk factor for premature death world-wide. A J- or U-shaped
relationship has been suggested between blood pressure (BP) and clinical
outcomes in different studies. However, there is little information about
the significance of BP on the outcomes of patients with coronary artery
disease and left ventricular dysfunction. This study aimed to determine
the relationship between BP and mortality outcomes in patients with
ischaemic cardiomyopathy.
Methods and results: The influence of BP during a median follow-up of
9.8years was studied in a total of 1212 patients with ejection fraction
<=35% and coronary disease amenable to coronary artery bypass grafting
(CABG) who were randomized to CABG or medical therapy alone (MED) in the
STICH (Surgical Treatment for Ischaemic Heart Failure) trial. Landmark
analyses were performed starting at 1, 2, 3, 4, and 5years after
randomization, in which previous systolic BP values were averaged and
related to subsequent mortality through the end of follow-up with a median
of 9.8years. Neither a previous history of HTN nor baseline BP had any
significant influence on long-term mortality outcomes, nor did they have a
significant interaction with MED or CABG treatment. The landmark analyses
showed a progressive U-shaped relationship that became strongest at 5years
(chi2 and P-values: 7.08, P=0.069; 8.72, P=0.033; 9.86; P=0.020; 8.31,
P=0.040; 14.52, P=0.002; at 1, 2, 3, 4, and 5-year landmark analyses,
respectively). The relationship between diastolic BP (DBP) and outcomes
was similar. The most favourable outcomes were observed in the SBP range
120-130, and DBP 75-85mmHg, whereas lower and higher BP were associated
with worse outcomes. There were no differences in BP-lowering medications
between groups.
Conclusion: A strong U-shaped relationship between BP and mortality
outcomes was evident in ischaemic HF patients. The results imply that the
optimal SBP might be in the range 120-130mmHg after intervention, and
possibly be subject to pharmacologic action regarding high BP. Further,
low BP was a marker of poor outcomes that might require other interactions
and treatment strategies.
Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique
identifier: NCT00023595.

<97>
Accession Number
624243209
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: 01 Aug 2018.
Author
Kang F.; Tang C.; Han M.; Chai X.; Huang X.; Li J.
Institution
(Kang, Tang, Han, Chai, Huang) Department of Anesthesiology, Anhui
Provincial Hospital Affiliated to Anhui Medical University, Anhui
Province, China
(Li) Department of Anesthesiology, Anhui Provincial Hospital Affiliated to
Anhui Medical University, Anhui Province, China
Publisher
NLM (Medline)
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. All rights
reserved.

<98>
Accession Number
624241867
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: 01 Aug 2018.
Author
Biancari F.; Kinnunen E.-M.; Kiviniemi T.; Tauriainen T.; Anttila V.;
Airaksinen J.K.E.; Brascia D.; Vasques F.
Institution
(Biancari) Department of Surgery, University of Turku, Turku, Finland;
Department of Surgery, University of Oulu, Oulu, Finland; Heart Center,
Turku University Hospital and University of Turku, Turku, Finland
(Kinnunen, Tauriainen) Department of Surgery, University of Oulu, Oulu,
Finland
(Kiviniemi, Anttila, Airaksinen) Heart Center, Turku University Hospital
and University of Turku, Turku, Finland
(Brascia) Department of Surgery, University of Turku, Turku, Finland
(Vasques) Department of Anesthesia, Padua University Hospital, Padua,
Italy
Publisher
NLM (Medline)
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. All rights reserved.

<99>
Accession Number
624430159
Title
Enhanced recovery after surgery pathway for patients undergoing cardiac
surgery: A randomized clinical trial.
Source
European Journal of Cardio-thoracic Surgery. 54 (3) (pp 491-497), 2018.
Date of Publication: 2018.
Author
Li M.; Zhang J.; Gan T.J.; Qin G.; Wang L.; Zhu M.; Zhang Z.; Pan Y.; Ye
Z.; Zhang F.; Chen X.; Lin G.; Huang L.; Luo W.; Guo Q.; Wang E.
Institution
(Li, Zhang, Qin, Wang, Zhu, Zhang, Pan, Ye, Zhang, Guo, Wang) Department
of Anaesthesiology, Xiangya Hospital, Central South University, Changsha,
Hunan 410008, China
(Gan) Department of Anesthesiology, Stony Brook University, Stony Brook,
NY, United States
(Chen, Lin, Huang, Luo) Department of Cardiovascular Surgery, Xiangya
Hospital, Central South University, Changsha, Hunan, China
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Enhanced recovery after surgery (ERAS) pathways have not been
reported in cardiac surgery. The aim of this study was to evaluate the
clinical effectiveness and safety profile of ERAS pathways compared with
routine care for patients undergoing cardiac valvular surgery. METHODS: A
randomized clinical trial was conducted between July 2015 and November
2016. A total of 226 patients who underwent elective valvular surgery were
randomly assigned to the ERAS pathway or routine care (control) group. The
ERAS protocol consisted of an evidence-based systematic optimization
approach for managing perioperative patients. The control group received
routine care. The primary end-point was readiness for hospital discharge.
The secondary outcomes were duration of intensive care unit (ICU) stay,
length of postoperative vasoactive drug support, duration of mechanical
ventilation, time to first bowel movement, removal of surgical drain,
overall medical costs and complication rate. RESULTS: Postoperative time
to readiness for discharge was significantly shorter in the ERAS group
(6.0 (2.014.0) days) than the control group (7.0 (4.016.0) days, P =
0.01), and the duration of ICU stay and duration of mechanical ventilation
were significantly shorter in the ERAS group (20.9 (13.569.3) h, 7.2
(0.022.3) h, respectively) than the control group (22.0 (13.4212.3) h, P =
0.001; 8.8 (3.744.9) h, respectively; P < 0.0001). The overall treatment
cost of the ERAS group (69202 (52089123823) CNY) was significantly lower
than that of the control group (77058 (51390144290) CNY, P = 0.002).
CONCLUSIONS: ERAS pathways reduce the length of ICU and hospital stay,
postoperative complications and cost for patients undergoing cardiac
surgery. Clinical trial registration: ClinicalTrials.gov:
NCT02479581.<br/>Copyright &#xa9; 2018 The Author(s).

<100>
Accession Number
2001217197
Title
Randomized Controlled Trial of Heparin Versus Bivalirudin Anticoagulation
in Acyanotic Children Undergoing Open Heart Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Author
Hasija S.; Talwar S.; Makhija N.; Chauhan S.; Malhotra P.; Chowdhury U.K.;
Krishna N.S.; Sharma G.
Institution
(Hasija, Makhija, Chauhan, Malhotra, Krishna) Department of Cardiac
Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
(Talwar, Chowdhury) Department of Cardiothoracic Vascular Surgery, All
India Institute of Medical Sciences, New Delhi, India
(Sharma) Department of Perfusion Technology, All India Institute of
Medical Sciences, New Delhi, India
Publisher
W.B. Saunders
Abstract
Objective: To determine the safety and efficacy of bivalirudin as an
anticoagulant for pediatric open heart surgery (OHS) and to determine its
appropriate dosage for this purpose. Design: Prospective, randomized
controlled trial. Setting: Tertiary care hospital. Participants: Fifty
acyanotic children aged 1-12 years undergoing OHS. Interventions: The
children were randomized to receive either 4 mg/kg of heparin (n = 25,
group H) or 1 mg/kg of bivalirudin bolus followed by 2.5 mg/kg/h infusion
(n = 25, group B) as the anticoagulant. The doses were adjusted to
maintain activated clotting time (ACT) above 480 seconds. At the
conclusion of surgery, protamine (1.3 mg/100 U of heparin) was
administered to children in group H. Measurements and Main Results: The
children were comparable in both groups with regard to demographic
characteristics. The mean age and weight were 51.5 months and 13.4 kg in
group H, and 59.3 months and 13.4 kg in group B. The dose of anticoagulant
required was 4.0 +/- 0.2 mg/kg in group H and 1.7 +/- 0.2 mg/kg followed
by 3.0 +/- 0.7 mg/kg/h infusion in group B (p < 0.001). One child in group
H required an additional dose compared to 13 (54.2%) children in group B.
Intraoperatively, the ACT achieved was higher in group H compared to group
B (p < 0.05). The ACT returned to baseline value after protamine
administration in group H, but it remained elevated for 2 hours after
termination of cardiopulmonary bypass (CPB) in group B (p < 0.01). The ACT
was higher in group B compared to group H for 6 hours after termination of
CPB (p < 0.05). Heparin prolonged the onset of clotting, decreased the
rate and strength of thrombus formation, and inhibited platelet function
to a greater extent than bivalirudin on viscoelastic coagulation testing.
The total duration of surgery was prolonged in group B. The postoperative
chest tube drainage was similar in group B (4.9 mL/kg) as in group H (5.9
mL/kg) in spite of higher ACT. The transfusion requirements were similar.
No adverse event occurred in any patient. Conclusion: Bivalirudin is a
safe and effective anticoagulant for pediatric OHS. Though it is not
suitable as a routine anticoagulant for this purpose, it may be used as a
heparin alternative in instances when heparin cannot be used. The dose
required to maintain ACT for more than 480 seconds was 1.7 +/- 0.2 mg/kg
followed by 3.0 +/- 0.7 mg/kg/h infusion. The ACT remained elevated for 2
hours after stopping the infusion. Bivalirudin did not increase
postoperative bleeding and transfusion requirement.<br/>Copyright &#xa9;
2018 Elsevier Inc.

<101>
Accession Number
624575453
Title
Comparative pharmacokinetics of tacrolimus in de novo pediatric transplant
recipients randomized to receive immediate- or prolonged-release
tacrolimus.
Source
Pediatric Transplantation. (no pagination), 2018. Article Number: e13289.
Date of Publication: 2018.
Author
Vondrak K.; Dhawan A.; Parisi F.; Grenda R.; Debray D.; Marks S.D.; Webb
N.J.A.; Lachaux A.; Kazeem G.; Undre N.
Institution
(Vondrak) Department of Pediatrics, University Hospital Motol, Second
School of Medicine, Charles University, Prague, Czech Republic
(Dhawan) Paediatric Liver GI and Nutrition Center, King's College
Hospital, London, United Kingdom
(Parisi) Department of Pediatric Cardiology and Cardiac Surgery, Thoracic
Transplant Unit, Osp Pediatrico Bambino Gesu, Rome, Italy
(Grenda) Department of Nephrology and Kidney Transplantation, The
Children's Memorial Health Institute, Warsaw, Poland
(Debray) Pediatric Hepatology Unit, APHP-Hopital Universitaire
Necker-Enfants Malades, Paris, France
(Marks) Department of Paediatric Nephrology, Great Ormond Street Hospital
for Children, NHS Foundation Trust, London, United Kingdom
(Webb) Department of Paediatric Nephrology, Royal Manchester Children's
Hospital, Manchester University Foundation Trust, Manchester, United
Kingdom
(Lachaux) Service d'Hepatologie Pediatrique, Universite Lyon 1 et Hospices
Civils de Lyon, HFME, Bron Cedex, France
(Kazeem, Undre) Astellas Pharma Europe Ltd, Chertsey, United Kingdom
(Kazeem) BENKAZ Consulting Ltd, Cambridge, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Phase 2, parallel-group, multicenter, open-label, 4-week study, comparing
PK of PR-T vs IR-T in de novo pediatric patients undergoing primary
kidney, liver, or heart transplantation. Patients randomized 1:1 to
receive once daily, PR-T-, or twice-daily, IR-T-based regimens; dose
adjustments permitted after Day 1. Twenty-four-hour PK profiles collected
on Days 1, 7, and 28. Primary endpoint: tacrolimus AUC<inf>24</inf>.
Secondary end points included tacrolimus C<inf>24</inf> and
C<inf>max</inf>. Endpoints compared between PR-T and IR-T on Days 1, 7,
and 28. Predefined similarity interval for CIs of LSM ratios: 80%-125%. PK
analysis set comprised 33 patients (PR-T, n = 15; IR-T, n = 18). Overall,
AUC<inf>24</inf> and C<inf>max</inf> were lower on Day 1 vs 7 and 28.
Geometric LSM ratios of PR-T:IR-T on Days 1, 7, and 28 were 66.3%, 92.5%,
99.9%, respectively, for AUC<inf>24</inf>; 66.3%, 82.2%, 90.9% for
C<inf>24</inf>; and 77.3%, 120.3%, 92.2% for C<inf>max</inf>.
AUC<inf>24</inf> 90% CI within predefined similarity interval on Day 28;
other 90% CIs fell outside. Linear relationship was similar between
AUC<inf>24</inf> and C<inf>24</inf>, and between tacrolimus formulations,
suggesting that the same therapeutic drug monitoring method can be used
with both formulations in de novo pediatric allograft
recipients.<br/>Copyright &#xa9; 2018 The Authors. Pediatric
Transplantation published by Wiley Periodicals, Inc

<102>
Accession Number
624573416
Title
A prospective, single-center, randomized study to assess whether automated
coregistration of optical coherence tomography with angiography can reduce
geographic miss.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2018.
Date of Publication: 2018.
Author
Koyama K.; Fujino A.; Maehara A.; Yamamoto M.H.; Alexandru D.; Jennings
J.; Krug P.; Santiago L.M.; Murray M.; Bongiovanni L.; Lee T.; Kim S.-Y.;
Wang X.; Lin Y.; Matsumura M.; Ali Z.A.; Sosa F.; Haag E.; Mintz G.S.;
Shlofmitz R.A.
Institution
(Koyama, Fujino, Maehara, Yamamoto, Lee, Kim, Wang, Lin, Ali) Division of
Cardiology, Department of Medicine, Columbia University Medical Center,
New York, NY, United States
(Koyama, Fujino, Maehara, Yamamoto, Lee, Kim, Wang, Lin, Matsumura, Ali,
Mintz) Clinical Trials Center, Cardiovascular Research Foundation, New
York, NY, United States
(Alexandru, Jennings, Krug, Santiago, Murray, Bongiovanni, Haag,
Shlofmitz) Department of Cardiology, St. Francis Hospital, Roslyn, NY,
United States
(Wang) Beijing Anzhen Hospital, Capital Medical University, Beijing, China
(Lin) Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen
University, Guangzhou, China
(Sosa) Abbott Vascular, Santa Clara, CA, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: We sought to evaluate whether automated coregistration of
optical coherence tomography (OCT) with angiography reduces geographic
miss (GM) during coronary stenting. Background: Previous intravascular
ultrasound or OCT studies have showed that residual disease at the stent
edge or stent edge dissection was associated with stent thrombosis or edge
restenosis. This has been termed GM. Methods: Two hundred de novo coronary
lesions were randomized in a 1:1 ratio to OCT-guided percutaneous coronary
intervention (PCI) with versus without automated coregistration of OCT
with angiography. GM, the primary endpoint, was defined as angiographic
>=type B dissection or diameter stenosis >50% or OCT minimum lumen area
<4.0 mm² with significant residual disease or dissection
(dissection flap >60degree) within 5 mm from the stent edge. Results: The
prevalence of GM was not different comparing OCT-guided PCI with versus
without automated coregistration (27.6% vs 34.0%, P = 0.33). However,
there was a trend toward a reduced prevalence of significant distal stent
edge dissection in lesions with automated coregistration (11.1% vs 20.8%,
P = 0.07). The discrepancy in the distance between planned versus actual
implanted stent location with automated coregistration was significantly
shorter than without coregistration (1.9 +/- 1.6 mm vs 2.6 +/- 2.7 mm, P =
0.03), especially the prevalence of >=5 mm discrepancy that was less
frequent with automated coregistration. Conclusions: Automated
coregistration of OCT with angiography did not reduce the primary endpoint
of GM after stent implantation.<br/>Copyright &#xa9; 2018 Wiley
Periodicals, Inc.

<103>
Accession Number
624556565
Title
Short version of the S3 guideline on screening, diagnosis, therapy and
follow-up of abdominal aortic aneurysms.
Source
Gefasschirurgie. (no pagination), 2018. Date of Publication: 2018.
Author
Debus E.S.; Heidemann F.; Gross-Fengels W.; Mahlmann A.; Muhl E.; Pfister
K.; Roth S.; Stroszczynski C.; Walther A.; Weiss N.; Wilhelmi M.;
Grundmann R.T.
Institution
(Debus, Heidemann) Klinik und Poliklinik fur Gefasmedizin, Universitares
Herzzentrum Hamburg, Hamburg, Germany
(Gross-Fengels) Abteilung Diagnostische und Interventionelle Radiologie,
Asklepios Klinik Harburg, Hamburg, Germany
(Mahlmann, Weiss) Bereich Angiologie, Universitatsgefascentrum,
Universitatsklinikum "Carl Gustav Carus", Technische Universitat Dresden,
Dresden, Germany
(Muhl) Klinik fur Chirurgie, Campus Lubeck, Universitatsklinikum
Schleswig-Holstein, Lubeck, Germany
(Pfister) Abteilung fur Gefaschirurgie, Endovaskulare Chirurgie,
Universitatsklinikum Regensburg, Regensburg, Germany
(Roth) Klinik fur Gefaschirurgie, St. Marienhospital, Hamm, Germany
(Stroszczynski) Institut fur Rontgendiagnostik, Universitatsklinikum
Regensburg, Regensburg, Germany
(Walther) Klinik fur Anasthesiologie und op. Intensivmedizin, Klinikum
Stuttgart, Katharinenhospital, Stuttgart, Germany
(Wilhelmi) Klinik fur Herz-, Thorax-, Transplantations- und Gefaschirurgie
(HTTG), Medizinische Hochschule Hannover, Hanover, Germany
(Grundmann) Deutsches Institut fur Gefasmedizinische Gesundheitsforschung
(DIGG), Deutsche Gesellschaft fur Gefaschirurgie und Gefasmedizin, Berlin,
Germany
(Grundmann) In den Gruben 144, Burghausen 84489, Germany
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
In this article a brief version of the newly developed S3 guidelines on
screening, diagnosis, therapy and follow-up of abdominal aortic aneurysms
(AAA), which was developed under the auspices of the German Society of
Vascular Surgery and VascularMedicine (DGG) is presented. In addition to
the DGG, participating professional societies were the German Radiological
Society (DRG), German Society for Angiology/Society for Vascular Medicine
(DGA), German Interdisciplinary Association for Intensive Care and
Emergency Medicine (DIVI), German Society for Ultrasound in Medicine
(DEGUM), German Vascular League e.V., German Society for Interventional
Radiology (DEGIR), German Society for Anesthesiology and Intensive Care
Medicine (DGAI), German Society for Thoracic and Cardiovascular Surgery
(DGTHG) and the German Society of Surgery (DGCH). The guidelines are based
on a systematic literature search in Medline (PubMed) for the period from
1 January 2000 to 1 January 2017. Important publications from 2017 were
also considered. The selection of evidence was made by a multilevel
screening process. In addition to the evidence, other criteria were
included in the assessment of the recommendation level, such as the
consistency of the study results, the clinical relevance of the endpoints
and effect sizes, the benefit-risk balance, the applicability of the study
results to the patient target group and the care system, the feasibility
of the recommendations in everyday life, patient preferences and ethical
and legal considerations. All recommendations/findings were approved with
strong consensus (approval of >95% of the participating professional
societies/associations). Thus, the present text version of the S3
guidelines on AAA represents the view of all participating
societies.<br/>Copyright &#xa9; 2018, The Author(s).

<104>
Accession Number
624544263
Title
Does No-Touch Technique Better than Conventional or Intermediate Saphenous
Vein Harvest Techniques for Coronary Artery Bypass Graft Surgery: a
Systematic Review and Meta-analysis.
Source
Journal of Cardiovascular Translational Research. (no pagination), 2018.
Date of Publication: 2018.
Author
Elshafay A.; Bendary A.H.; Vuong H.T.; Ahmed A.R.; Mokhtar M.A.; Soliman
A.L.; Vuong N.L.; bestawi I.A.E.; Abdallah N.A.; Vu V.T.; Hirayama K.; Huy
N.T.
Institution
(Elshafay, Bendary, Soliman, bestawi) Faculty of Medicine, Al-Azhar
University, Cairo 11884, Egypt
(Vuong) Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho
Chi Minh City 700000, Vietnam
(Ahmed) Faculty of Pharmacy, Tanta University, Gharbia 13741, Egypt
(Mokhtar) Faculty of Medicine, Sohag University, Sohag 82738, Egypt
(Vuong) Department of Cardiovascular and Thoracic Surgery, Faculty of
Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi
Minh City 70000, Vietnam
(Vuong) Department of Medical statistic and Informatics, Faculty of Public
Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi
Minh City 70000, Vietnam
(Abdallah) Faculty of Medicine, Aswan University, Aswan 81543, Egypt
(Vu) Faculty of Public Health, University of Medicine and Pharmacy at Ho
Chi Minh City, Ho Chi Minh City 700000, Vietnam
(Hirayama) Department of Immunogenetics, Institute of Tropical Medicine
(NEKKEN), Graduate School of Biomedical Sciences, Nagasaki University,
1-12-4 Sakamoto, Nagasaki 852-8523, Japan
(Huy) Evidence Based Medicine Research Group & Faculty of Applied
Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam
(Huy) Department of Clinical Product Development, Institute of Tropical
Medicine (NEKKEN), School of Tropical Medicine and Global Health, Nagasaki
University, Nagasaki, Japan
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Saphenous vein (SV) is a common graft being used in coronary artery bypass
grafting (CABG). Conventional (CON), intermediate (I), and no-touch (NT)
are the most common harvesting techniques of SV for CABG. The aim of this
study is to systematically review the NT versus CON and I techniques in
harvesting SV for CABG. Twelve databases were searched for randomized
controlled trials comparing the CON, I, and NT techniques in harvesting SV
for CABG. Twelve reports of six RCTs were included. Our meta-analysis
showed that with NT technique, patency rate was significantly higher when
compared to I technique up to 18-month follow-up duration. In contrast,
this significant difference was not maintained in terms of minor
complications of leg wounds with both techniques. The NT has significantly
higher patency rate compared to I vein harvesting technique. However, more
RCTs are warranted to confirm these results.<br/>Copyright &#xa9; 2018,
Springer Science+Business Media, LLC, part of Springer Nature.

<105>
Accession Number
619362219
Title
Relationship of C-reactive protein reduction to cardiovascular event
reduction following treatment with canakinumab: a secondary analysis from
the CANTOS randomised controlled trial.
Source
The Lancet. 391 (10118) (pp 319-328), 2018. Date of Publication: 27
January - 2 February 2018.
Author
Ridker P.M.; MacFadyen J.G.; Everett B.M.; Libby P.; Thuren T.; Glynn
R.J.; Kastelein J.; Koenig W.; Genest J.; Lorenzatti A.; Varigos J.;
Siostrzonek P.; Sinnaeve P.; Fonseca F.; Nicolau J.; Gotcheva N.; Yong H.;
Urina-Triana M.; Milicic D.; Cifkova R.; Vettus R.; Anker S.D.; Manolis
A.J.; Wyss F.; Forster T.; Sigurdsson A.; Pais P.; Fucili A.; Ogawa H.;
Shimokawa H.; Veze I.; Petrauskiene B.; Salvador L.; Cornel J.H.; Klemsdal
T.O.; Medina F.; Budaj A.; Vida-Simiti L.; Kobalava Z.; Otasevic P.; Pella
D.; Lainscak M.; Seung K.-B.; Commerford P.; Dellborg M.; Donath M.; Hwang
J.-J.; Kultursay H.; Flather M.; Ballantyne C.; Bilazarian S.; Chang W.;
East C.; Forgosh L.; Harris B.; Ligueros M.
Institution
(Ridker, MacFadyen, Everett, Glynn) Center for Cardiovascular Disease
Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston,
MA, United States
(Ridker, Everett, Libby) Cardiovascular Division, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Thuren) Novartis Pharmaceutical Corporation, East Hanover, NJ, United
States
(Thuren) Novartis Pharmaceutical Corporation, Basel, Switzerland
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Canakinumab, a monoclonal antibody targeting interleukin-1beta
reduces inflammation and cardiovascular event rates with no effect on
lipid concentrations. However, it is uncertain which patient groups
benefit the most from treatment and whether reductions in the inflammatory
biomarker high-sensitivity C-reactive protein (hsCRP) correlate with
clinical benefits for individual patients. Methods: The Canakinumab
Anti-Inflammatory Thrombosis Outcomes Study (CANTOS) used
computer-generated codes to randomly allocate 10 061 men and women with a
history of myocardial infarction to placebo or one of three doses of
canakinumab (50 mg, 150 mg, or 300 mg) given subcutaneously once every 3
months. In a prespecified secondary analysis designed to address the
relationship of hsCRP reduction to event reduction in CANTOS, we evaluated
the effects of canakinumab on rates of major adverse cardiovascular
events, cardiovascular mortality, and all-cause mortality according to
on-treatment concentrations of hsCRP. We used multivariable modelling to
adjust for baseline factors associated with achieved hsCRP and multiple
sensitivity analyses to address the magnitude of residual confounding. The
median follow-up was 3.7 years. The trial is registered with
ClinicalTrials.gov, number NCT01327846. Findings: Baseline clinical
characteristics did not define patient groups with greater or lesser
cardiovascular benefits when treated with canakinumab. However, trial
participants allocated to canakinumab who achieved hsCRP concentrations
less than 2 mg/L had a 25% reduction in major adverse cardiovascular
events (multivariable adjusted hazard ratio [HR^adj]=0.75, 95%
CI 0.66-0.85, p<0.0001), whereas no significant benefit was observed among
those with on-treatment hsCRP concentrations of 2 mg/L or above
(HR^adj=0.90, 0.79-1.02, p=0.11). For those treated with
canakinumab who achieved on-treatment hsCRP concentrations less than 2
mg/L, cardiovascular mortality (HR^adj=0.69, 95% CI 0.56-0.85,
p=0.0004) and all-cause mortality (HR^adj=0.69, 0.58-0.81,
p<0.0001) were both reduced by 31%, whereas no significant reduction in
these endpoints was observed among those treated with canakinumab who
achieved hsCRP concentrations of 2 mg/L or above. Similar differential
effects were found in analyses of the trial prespecified secondary
cardiovascular endpoint (which additionally included hospitalisation for
unstable angina requiring unplanned revascularisation) and in sensitivity
analyses alternatively based on median reductions in hsCRP, on 50% or
greater reductions in hsCRP, on the median percent reduction in hsCRP, in
dose-specific analyses, and in analyses using a causal inference approach
to estimate the effect of treatment among individuals who would achieve a
targeted hsCRP concentration. Interpretation: The magnitude of hsCRP
reduction following a single dose of canakinumab might provide a simple
clinical method to identify individuals most likely to accrue the largest
benefit from continued treatment. These data further suggest that lower is
better for inflammation reduction with canakinumab. Funding: Novartis
Pharmaceuticals.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<106>
Accession Number
2001193010
Title
Targeted therapy with a localised abluminal groove, low-dose
sirolimus-eluting, biodegradable polymer coronary stent (TARGET All
Comers): a multicentre, open-label, randomised non-inferiority trial.
Source
The Lancet. 392 (10153) (pp 1117-1126), 2018. Date of Publication: 29
September - 5 October 2018.
Author
Lansky A.; Wijns W.; Xu B.; Kelbaek H.; van Royen N.; Zheng M.; Morel
M.-A.; Knaapen P.; Slagboom T.; Johnson T.W.; Vlachojannis G.; Arkenbout
K.E.; Holmvang L.; Janssens L.; Ochala A.; Brugaletta S.; Naber C.K.;
Anderson R.; Rittger H.; Berti S.; Barbato E.; Toth G.G.; Maillard L.;
Valina C.; Buszman P.; Thiele H.; Schachinger V.; Baumbach A.
Institution
(Lansky, Baumbach) Yale University School of Medicine, New Haven, CT,
United States
(Lansky, Baumbach) Barts Heart Centre, London and Queen Mary University of
London, London, United Kingdom
(Wijns) The Lambe Institute for Translational Medicine and Curam, National
University of Ireland, Galway and Saolta University Healthcare Group,
University College Hospital Galway, Galway, Ireland
(Xu) Fu Wai Hospital, National Centre for Cardiovascular Diseases, Chinese
Academy of Medical Sciences, Beijing, China
(Kelbaek) Department of Cardiology, Roskilde University Hospital,
Roskilde, Denmark
(van Royen, Knaapen) Department of Cardiology, VU University Medical
Centre, Amsterdam, Netherlands
(Zheng) Shanghai MicroPort Medical (Group), Shanghai, China
(Morel) Cardialysis, Rotterdam, Netherlands
(Slagboom) Amsterdam Department of Interventional Cardiolody, Onze Lieve
Vrouwe Gasthuis, Amsterdam, Netherlands
(Johnson) Bristol Heart Institute, University Hospitals Bristol NHS
Foundation Trust, Bristol, United Kingdom
(Vlachojannis) Department of Cardiology, Maasstad Ziekenhuis, Rotterdam,
Netherlands
(Arkenbout) Department of Cardiology, Tergooi Ziekenhuis, Blaricum,
Netherlands
(Holmvang) Department of Cardiology, Rigshospitalet, Copenhagen University
Hospital, Copenhagen, Denmark
(Janssens) Heart Centre, Imelda Ziekenhuis, Bonheiden, Belgium
(Ochala) Department of Invasive Cardiology, Silesian Medical University,
Katowice, Poland
(Brugaletta) Cardiovascular Institute, Hospital Clinic, Institut
d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona,
Spain
(Naber) Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus, Essen,
Germany
(Anderson) Department of Cardiology, University Hospital of Wales,
Cardiff, United Kingdom
(Rittger) Medizinische Klinik I, Klinikum Furth, University of Erlangen,
Furth, Germany
(Berti) UOC Cardiologia Diagnostica ed Interventistica, Fondazione CNR Reg
Toscana G Monasterio, Ospedale del Cuore, Massa, Italy
(Barbato) Cardiovascular Research Centre Aalst, OLV Hospital, Aalst,
Belgium
(Barbato) Department of Advanced Biomedical Sciences, University of Naples
Federico II, Italy
(Toth) Department of Cardiology, Medical University of Graz, Graz, Austria
(Maillard) Service de Cardiologie, Clinique Axium, Aix-en-Provence, France
(Valina) Klinik fur Kardiologie und Angiologie II,
Universitats-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
(Buszman) American Heart of Poland, Katowice, Poland
(Thiele) Herzzentrum Leipzig, Leipzig, Germany
(Schachinger) Medizinische Klinik I, Herz-Thorax Zentrum, Klinikum Fulda,
Fulda, Germany
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: The FIREHAWK is a drug-eluting stent with a fully
biodegradable sirolimus-containing polymer coating localised to recessed
abluminal grooves on the stent surface. We investigated clinical outcomes
with this targeted, low-dose, biodegradable polymer, sirolimus-eluting
stent compared with XIENCE durable polymer, everolimus-eluting stents in
an all-comers population. Methods: The TARGET All Comers study was a
prospective, multicentre, open-label randomised non-inferiority trial done
at 21 centres in ten European countries. Patients with symptomatic or
asymptomatic coronary artery disease and objective evidence of myocardial
ischaemia who qualified for percutaneous coronary intervention were
randomised 1:1 to undergo implantation of a FIREHAWK or XIENCE.
Randomisation was web-based, with random block allocation and
stratification by centre and ST elevation myocardial infarction. Outcome
assessors were masked to treatment allocation, but treating physicians and
patients were not. The primary endpoint was target lesion failure at 12
months, a composite of cardiac death, target vessel myocardial infarction,
or ischaemia-driven target lesion revascularisation. The control event
rate for XIENCE was assumed to be 7%, the non-inferiority margin was 3.5%,
and the primary analysis was in the intention-to-treat population,
censoring patients who did not have either an event before 365 days or
contact beyond 365 days. Late lumen loss was the primary endpoint of an
angiographic substudy designed to investigate the non-inferiority of the
FIREHAWK compared with the XIENCE stent. This trial is registered with
ClinicalTrials.gov, number NCT02520180. Findings: From Dec 17, 2015, to
Oct 14, 2016, 1653 patients were randomly assigned to implantation of the
FIREHAWK (n=823) or XIENCE (n=830). 65 patients in the FIREHAWK group and
66 in the XIENCE group had insufficient follow-up data and were excluded
from the analyses. At 12 months, target lesion failure occurred in 46
(6.1%) of 758 patients in the FIREHAWK group and in 45 (5.9%) of 764
patients in the XIENCE group (difference 0.2%, 90% CI -1.9 to 2.2,
p<inf>non-inferiority</inf>=0.004, 95% CI -2.2 to 2.6,
p<inf>superiority</inf>=0.88). There were no differences in
ischaemia-driven revascularisation or stent thrombosis rates at 12 months.
176 patients were included in the angiographic substudy, in which in-stent
late lumen loss was 0.17 mm (SD 0.48) in the FIREHAWK group and 0.11 mm
(0.52) in the XIENCE group (p=0.48), with an absolute difference of 0.05
mm (95% CI -0.09 to 0.18, p<inf>non-inferiority</inf>=0.024).
Interpretation: In a broad all-comers population of patients requiring
stent implantation for myocardial ischaemia, the FIREHAWK was non-inferior
to the XIENCE as assessed with the primary endpoint of target lesion
failure at 12 months and in-stent late lumen loss at 13 months. The
FIREHAWK is a safe and effective alternative stent to treat patients with
ischaemic coronary artery disease in clinical practice. Funding: Shanghai
Microport Medical.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<107>
Accession Number
2001081212
Title
The 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for the Psychosocial
Evaluation of Adult Cardiothoracic Transplant Candidates and Candidates
for Long-term Mechanical Circulatory Support.
Source
Psychosomatics. 59 (5) (pp 415-440), 2018. Date of Publication: September
- October 2018.
Author
Dew M.A.; DiMartini A.F.; Dobbels F.; Grady K.L.; Jowsey-Gregoire S.G.;
Kaan A.; Kendall K.; Young Q.-R.; Abbey S.E.; Butt Z.; Crone C.C.; De
Geest S.; Doligalski C.T.; Kugler C.; McDonald L.; Ohler L.; Painter L.;
Petty M.G.; Robson D.; Schloglhofer T.; Schneekloth T.D.; Singer J.P.;
Smith P.J.; Spaderna H.; Teuteberg J.J.; Yusen R.D.; Zimbrean P.C.
Institution
(Dew, DiMartini) University of Pittsburgh School of Medicine and Medical
Center, Pittsburgh, PA, United States
(Dobbels, De Geest) Katholieke Universiteit Leuven, Leuven, Belgium
(Grady, Butt) Northwestern University Feinberg School of Medicine,
Chicago, IL, United States
(Jowsey-Gregoire, Schneekloth) Mayo Clinic, Rochester, MN, United States
(Kaan, Young) St. Paul's Hospital, Vancouver, British Columbia, Canada
(Kendall) Cleveland Clinic, Cleveland, OH, United States
(Abbey) University of Toronto and University Health Network, Toronto,
Ontario, Canada
(Crone) INOVA Hospitals, Fairfax, VA, United States
(De Geest) University of Basel, Basel, Switzerland
(Doligalski) Tampa General Hospital, Tampa, FL, United States
(Kugler) University of Freiburg, Freiburg, Germany
(McDonald) University of North Carolina, Chapel Hill, NC, United States
(Ohler) George Washington University, Washington, DC, United States
(Painter) Auckland City Hospital, Auckland, New Zealand
(Petty) University of Minnesota, Minneapolis, MN, United States
(Robson) St. Vincent's Hospital, Sydney, New South Wales, Australia
(Schloglhofer) Medical University of Vienna, Vienna, Austria
(Singer) University of California at San Francisco, San Francisco, CA,
United States
(Smith) Duke University, Durham, NC, United States
(Spaderna) Trier University, Trier, Germany
(Teuteberg) Stanford University, Stanford, CA, United States
(Yusen) Washington University, St. Louis, MO, United States
(Zimbrean) Yale University, New Haven, CT, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The psychosocial evaluation is well-recognized as an important component
of the multifaceted assessment process to determine candidacy for heart
transplantation, lung transplantation, and long-term mechanical
circulatory support (MCS). However, there is no consensus-based set of
recommendations for either the full range of psychosocial domains to be
assessed during the evaluation, or the set of processes and procedures to
be used to conduct the evaluation, report its findings, and monitor
patients' receipt of and response to interventions for any problems
identified. This document provides recommendations on both evaluation
content and process. It represents a collaborative effort of the
International Society for Heart and Lung Transplantation (ISHLT) and the
Academy of Psychosomatic Medicine, American Society of Transplantation,
International Consortium of Circulatory Assist Clinicians, and Society for
Transplant Social Workers. The Nursing, Health Science and Allied Health
Council of the ISHLT organized a Writing Committee composed of
international experts representing the ISHLT and the collaborating
societies. This Committee synthesized expert opinion and conducted a
comprehensive literature review to support the psychosocial evaluation
content and process recommendations that were developed. The
recommendations are intended to dovetail with current ISHLT guidelines and
consensus statements for the selection of candidates for cardiothoracic
transplantation and MCS implantation. Moreover, the recommendations are
designed to promote consistency across programs in the performance of the
psychosocial evaluation by proposing a core set of content domains and
processes that can be expanded as needed to meet programs' unique needs
and goals.<br/>Copyright &#xa9; 2018 The Authors

<108>
Accession Number
623816674
Title
Ross Procedure vs Mechanical Aortic Valve Replacement in Adults: A
Systematic Review and Meta-analysis.
Source
JAMA Cardiology. 3 (10) (pp 978-987), 2018. Date of Publication: October
2018.
Author
Mazine A.; Rocha R.V.; El-Hamamsy I.; Ouzounian M.; Yanagawa B.; Bhatt
D.L.; Verma S.; Friedrich J.O.
Institution
(Mazine, Rocha) Division of Cardiac Surgery, Department of Surgery,
University of Toronto, Toronto, ON, Canada
(El-Hamamsy) Department of Cardiac Surgery, Montreal Heart Institute,
Montreal, QC, Canada
(Ouzounian) Department of Cardiac Surgery, Toronto General Hospital,
Toronto, ON, Canada
(Yanagawa, Verma) Department of Cardiac Surgery, St Michael's Hospital,
Toronto, ON, Canada
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Friedrich) Department of Critical Care Medicine, St Michael's Hospital,
30 Bond St., Toronto, ON M5B 1W8, Canada
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: The ideal aortic valve substitute in young and middle-aged
adults remains unknown. Objective: To compare long-term outcomes between
the Ross procedure and mechanical aortic valve replacement in adults. Data
Sources: The Ovid versions of MEDLINE and EMBASE classic (January 1, 1967,
to April 26, 2018; search performed on April 27, 2018) were screened for
relevant studies using the following text word search in the title or
abstract: ("Ross" OR "autograft") AND ("aortic" OR "mechanical"). Study
Selection: All randomized clinical trials and observational studies
comparing the Ross procedure to the use of mechanical prostheses in adults
undergoing aortic valve replacement were included. Studies were included
if they reported any of the prespecified primary or secondary outcomes.
Studies were excluded if no clinical outcomes were reported or if data
were published only as an abstract. Citations were screened in duplicate
by 2 of the authors, and disagreements regarding inclusion were reconciled
via consensus. Data Extraction and Synthesis: This meta-analysis was
conducted in accordance with the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses and Meta-analysis of Observational Studies in
Epidemiology guidelines. Data were independently abstracted by 3 reviewers
and pooled using a random-effects model. Main Outcomes and Measures: The
prespecified primary outcome was all-cause mortality. Results: The search
identified 2919 reports, of which 18 studies (3516 patients) met inclusion
criteria, including 1 randomized clinical trial and 17 observational
studies, with a median average follow-up of 5.8 (interquartile range,
3.4-9.2) years. Analysis of the primary outcome showed a 46% lower
all-cause mortality in patients undergoing the Ross procedure compared
with mechanical aortic valve replacement (incidence rate ratio [IRR],
0.54; 95% CI, 0.35-0.82; P =.004; I² = 28%). The Ross procedure
was also associated with lower rates of stroke (IRR, 0.26; 95% CI,
0.09-0.80; P =.02; I² = 8%) and major bleeding (IRR, 0.17; 95%
CI, 0.07-0.40; P <.001; I² = 0%) but higher rates of
reintervention (IRR, 1.76; 95% CI, 1.16-2.65; P =.007; I² =
0%). Conclusions and Relevance: Data from primarily observational studies
suggest that the Ross procedure is associated with lower all-cause
mortality compared with mechanical aortic valve replacement. These
findings highlight the need for a large, prospective randomized clinical
trial comparing long-term outcomes between these 2
interventions.<br/>Copyright &#xa9; 2018 American Medical Association. All
rights reserved.

<109>
[Use Link to view the full text]
Accession Number
624510418
Title
Impact of Donor Core Body Temperature on Graft Survival After Heart
Transplantation.
Source
Transplantation. 102 (11) (pp 1891-1900), 2018. Date of Publication: 01
Nov 2018.
Author
Schnuelle P.; Benck U.; Kramer B.K.; Yard B.A.; Zuckermann A.; Wagner F.;
Szabo G.; Borggrefe M.; Karck M.; Gummert J.
Institution
(Schnuelle) Academic Training Practice, Center for Renal Diseases,
Weinheim, Germany
(Schnuelle, Benck, Kramer, Yard) Vth Department of Medicine, University
Medical Center Mannheim, Mannheim, Germany
(Zuckermann) Department of Cardiac Surgery, Medical University of Vienna,
Vienna, Austria
(Wagner) Department of Cardiac Surgery, Asklepios Clinic St. Georg,
Hamburg, Germany
(Szabo, Karck) Department of Cardiac Surgery, University Hospital
Heidelberg, Heidelberg, Germany
(Borggrefe) Ist Department of Medicine, University Medical Center Mannheim
and German Center for Cardiovascular Research Heidelberg/Mannheim,
Mannheim, Germany
(Gummert) Department of Thoracic and Cardiovascular Surgery, Ruhr
University Bochum, Heart and Diabetes Center North Rhine-Westphalia, Bad
Oeynhausen, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: A previous donor intervention trial found that induction of
mild therapeutic hypothermia in the brain-dead donor reduced the dialysis
requirement after kidney transplantation. Consequences on the performance
of cardiac allografts after transplantation were not explored to date.
METHODS: Cohort study investigating 3-year heart allograft survival
according to spontaneous core body temperature (CBT) assessed on the day
of organ procurement. The study is nested in the database of the
randomized trial of donor pretreatment with low-dose dopamine
(ClinicalTrials.gov identifier: NCT000115115).
RESULTS: Ninety-nine heart transplant recipients who had received a
cardiac allograft from a multiorgan donor enrolled in the dopamine trial
were grouped by tertiles of the donor's CBT assessed by a mere temperature
reading 4 to 20 hours before procurement (lowest, 32.0-36.2degreeC;
middle, 36.3-36.8degreeC; highest, 36.9-38.8degreeC). Baseline
characteristics considering demographics of donors and recipients,
concomitant donor treatments, donor hemodynamic, and respiratory
parameters as well as underlying cardiac diseases in recipients,
pretransplant hemodynamic assessments, including pretransplant
inotropic/mechanical support, urgency, and waiting time were similar. A
lower CBT was associated with inferior heart allograft survival (hazard
ratio, 0.53; 95% confidence interval, 0.31-0.93, per tertile; P = 0.02,
and hazard ratio, 0.68; 95% confidence interval, 0.50-0.93degreeC; P =
0.02) when CBT was included as continuous explanatory variable in the Cox
regression analysis.
CONCLUSIONS: A lower CBT in the brain-dead donor before procurement may
associate with an unfavorable clinical course after heart transplantation.
More research is required, before therapeutic hypothermia can routinely be
used in multiorgan donors when a cardiac transplantation is intended.

<110>
Accession Number
624526297
Title
Influence of 6% Hydroxyethyl Starch 130/0.4 Versus Crystalloid Solution on
Structural Renal Damage Markers After Coronary Artery Bypass Grafting: A
Post Hoc Subgroup Analysis of a Prospective Trial.
Source
Journal of cardiothoracic and vascular anesthesia. 32 (1) (pp 205-211),
2018. Date of Publication: 01 Feb 2018.
Author
Datzmann T.; Hoenicka M.; Reinelt H.; Liebold A.; Gorki H.
Institution
(Datzmann, Reinelt) Department of Cardiac Anesthesiology, University
Hospital Ulm, Ulm, Germany
(Hoenicka, Liebold, Gorki) Department Cardiothoracic and Vascular Surgery,
University Hospital Ulm, Ulm, Germany
Abstract
MEASUREMENTS AND MAIN RESULTS: Functional renal parameters and the
structural biomarkers alpha-glutathione S-transferase, kidney injury
molecule-1, liver fatty acid-binding protein, and neutrophil
gelatinase-associated lipocalin were investigated. Volume balances,
vasopressor dosages, blood losses, and coagulation parameters were
compared. Most functional and structural renal parameters did not differ
between the groups (serum creatinine p = 0.8380). Liver fatty acid-binding
protein was transiently higher in the HES group only at 24 hours
postoperatively (p = 0.0002). No differences in mortality, acute kidney
injury, and need for renal replacement therapy were observed. Blood
coagulation was significantly more compromised in the HES group at
intensive care unit arrival (factor II, p = 0.0012; factor X, p = 0.0031;
thrombocytes, p = 0.0010). Blood losses, and vasopressor dosages tended to
be higher in HES-treated patients without significance.
CONCLUSION: Overall, the values and time courses of the biomarkers used
did not indicate evidence of a mechanism for tubular injury caused by HES.
OBJECTIVE: The restriction of hydroxyethyl starch (HES) has mandated
changes in volume management based on data of critically ill patients.
Reliable data of structural renal damage after HES treatment in cardiac
surgical patients are lacking. The influence of 6% HES 130/0.4 was
investigated in this study.
DESIGN: An exploratory post hoc subgroup analysis of a prospective trial
was performed.
SETTING: The study was carried out at a university hospital.
PARTICIPANTS: Forty-four low-risk cardiac surgical patients were examined.
INTERVENTIONS: Twenty-two patients received only crystalloid solutions,
and 22 were treated with balanced 6% HES 130/0.4.<br/>Copyright &#xa9;
2018 Elsevier Inc. All rights reserved.

<111>
Accession Number
624522092
Title
Is the use of hydroxyethyl starch as priming solution during cardiac
surgery advisable? A randomized, single-center trial.
Source
Perfusion. 33 (6) (pp 483-489), 2018. Date of Publication: 01 Sep 2018.
Author
Svendsen OS.; Farstad M.; Mongstad A.; Haaverstad R.; Husby P.; Kvalheim
V.L.
Institution
(Svendsen, Farstad, Husby) Department of Anesthesia and Intensive Care,
Haukeland University Hospital, Bergen, Norway
(Mongstad, Haaverstad, Kvalheim) Section for Cardiothoracic Surgery,
Department for Heart Disease, Haukeland University Hospital, Bergen,
Norway
(Haaverstad, Kvalheim) Department of Clinical Science, Faculty of
Medicine, University of Bergen, Bergen, Norway
(Husby) Department of Clinical Medicine, Faculty of Medicine, University
of Bergen, Bergen, Norway
Publisher
NLM (Medline)
Abstract
CONCLUSIONS: CPB priming with HES solution lowers fluid loading during
bypass and improves cardiac function in the early postoperative period.
The manifestation of acute kidney injury exclusively in the HES group of
patients raises doubts about the use of HES products in conjunction with
cardiac surgery. ( https://clinicaltrials.gov/ct2/show/NCT01511120 ).
INTRODUCTION: The use of cardiopulmonary bypass (CPB) leads to increased
fluid filtration and edema. The use of artificial colloids to counteract
fluid extravasation during cardiac surgery is controversial. Beneficial
effects on global fluid loading, leading to better cardiac performance and
hemodynamics, have been claimed. However, renal function and coagulation
may be adversely affected, with unfavorable impact on outcome following
cardiac surgery.
METHODS: Forty patients were randomly allocated to study groups receiving
either acetated Ringer's solution (CT group) or hydroxyethyl starch (HES
group, Tetraspan) as CPB priming solution. Fluid balance, bleeding and
hemodynamics, including cardiac output, were followed postoperatively. The
occurrence of acute kidney injury was closely registered.
RESULTS: Two patients were excluded from further analyzes due to surgical
complications. Fluid accumulation was attenuated in the HES group (3374
(883) ml) compared with the CT group (4328 (1469) ml) (p=0.024). The
reduced perioperative fluid accumulation was accompanied by an increased
cardiac index immediately after surgery (2.7 (0.4) L/min/m2 in the HES
group and 2.1 (0.3) L/min/m2 in the CT group (p<0.001)). No increase in
bleeding could be demonstrated in the HES group. Three patients, all of
them in the HES group, experienced acute kidney injury postoperatively.

<112>
Accession Number
624528629
Title
Multilevel Thoracic Paravertebral Block Using Ropivacaine With/Without
Dexmedetomidine in Video-Assisted Thoracoscopic Surgery.
Source
Journal of cardiothoracic and vascular anesthesia. 32 (1) (pp 318-324),
2018. Date of Publication: 01 Feb 2018.
Author
Xu J.; Yang X.; Hu X.; Chen X.; Zhang J.; Wang Y.
Institution
(Xu, Yang, Hu, Zhang, Wang) Department of Anesthesiology, Huashan
Hospital, Fudan University, Shanghai, China
(Chen) Department of Cardiothorcic Surgery, Huashan Hospital, Fudan
University, Shanghai, China
Abstract
OBJECTIVES: Thoracic paravertebral block (TPVB) is reported to have
advantages in postoperative pain management in unilateral thoracic
surgeries. Previous studies have demonstrated that dexmedetomidine could
be used as an adjuvant to local anesthetics, with the aim of prolonging
the duration of neural blockade. However, little is known about whether
such a combination could improve the quality of postoperative analgesia
compared with local anesthetic only when TPVB is used for patients
undergoing video-assisted thoracoscopic surgery (VATS).
DESIGN: A prospective, randomized, controlled study.
SETTING: Single-center university hospital.
PARTICIPANTS: The study included 60 patients undergoing VATS under general
anesthesia.
INTERVENTIONS: The patients were allocated randomly into the following 2
groups: 0.375% ropivacaine, 20 mL only (group R, n = 30), and 0.375%
ropivacaine, 20 mL plus 1 mug/kg of dexmedetomidine (group RD, n = 30). At
the end of surgery, TPVB guided using ultrasound was performed at 4
points-T4-5, T5-6, T6-7, and T7-8-of the surgical side; 5 mL of solution
were injected at each point. Postoperatively, the intravenous nonsteroidal
anti-inflammatory drug flurbiprofen was used as part of multimodal
analgesia.
MEASUREMENTS AND MAIN RESULTS: Pain scores at rest and during coughing
were evaluated by a blinded observer in the postanesthesia care unit
postoperatively at 1, 2, 4, 8, 12, 24, 36, and 48 hours, and the
dermatomal levels of sensory blockade, postoperative requirements for
rescue analgesia, adverse events, and patient satisfaction also were
recorded. There was a significant reduction in postoperative pain scores
at rest starting from the postoperative 8th hour until the 48th hour and
during coughing starting at the postoperative 4th hour until the 48th hour
in the group RD compared with those in group R (p = 0.043). The dermatomal
levels of sensory blockade were comparable in the 2 groups. Patient
satisfaction after surgery was significantly higher in the group RD than
in group R (p < 0.001). Total consumption of the intravenous rescue
analgesic morphine and adverse events were not significantly different
between the 2 groups.
CONCLUSIONS: Compared with ropivacaine only, the addition of
dexmedetomidine, 1 mug/kg, to local anesthetic for multilevel TPVB in
patients undergoing VATS prolonged the duration of postoperative analgesia
and improved patient satisfaction without serious side effects when
combined with postoperative intravenous nonsteroidal anti-inflammatory
drug administration.<br/>Copyright &#xa9; 2018 Elsevier Inc. All rights
reserved.

<113>
Accession Number
624528455
Title
Transfusion Requirements in Cardiac Surgery III (TRICS III): Study Design
of a Randomized Controlled Trial.
Source
Journal of cardiothoracic and vascular anesthesia. 32 (1) (pp 121-129),
2018. Date of Publication: 01 Feb 2018.
Author
Shehata N.; Whitlock R.; Fergusson D.A.; Thorpe K.E.; MacAdams C.; Grocott
H.P.; Rubens F.; Fremes S.; Lellouche F.; Bagshaw S.; Royse A.; Rosseel
P.M.; Hare G.; Medicis E.; Hudson C.; Belley-Cote E.; Bainbridge D.; Kent
B.; Shaw A.; Byrne K.; Syed S.; Royse C.F.; McGuiness S.; Hall J.; Mazer
C.D.
Institution
(Shehata) Departments of Medicine, Laboratory Medicine and Pathobiology,
Institute of Health Policy Management and Evaluation, University of
Toronto, Division of Hematology, Mount Sinai Hospital, Toronto, ON, Canada
(Whitlock) Department of Surgery, Population Health Research Institute,
McMaster University, David Braley Cardiac Vascular and Stroke Research
Institute, Hamilton, ON, Canada
(Fergusson) Ottawa Health Research Institute, University of Ottawa, Ottawa
Hospital, Centre for Practice-Changing Research, General Campus, Ottawa,
ON, Canada
(Thorpe, Hall) Applied Health Research Center, St. Michael's Hospital,
Toronto, ON, Canada
(MacAdams) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, University of Melbourne, Italy
(Grocott) Departments of Anesthesia & Perioperative Medicine and Surgery,
University of Manitoba, St. Boniface General Hospital, Winnipeg, MB,
Canada
(Rubens) Department of Surgery, University of Ottawa, Ottawa Heart
Institute, Ottawa, ON, Canada
(Fremes) Department of Surgery, University of Toronto, Sunnybrook Health
Sciences Centre, Toronto, ON, Canada
(Lellouche) Department of Medicine, University of Laval, Unite de
Recherche en Pneumologie, QC, Canada
(Bagshaw) Department of Critical Care Medicine, Faculty of Medicine and
Dentistry, University of Alberta, Edmonton, AB, Canada
(Royse) Department of Surgery, University of Melbourne, Royal Melbourne
Hospital, Parkville, Victoria, Australia
(Rosseel) Department of Anesthesia, Amphia Hospital, Breda, Netherlands
(Hare, Mazer) Department of Anesthesia, University of Toronto, St.
Michael's Hospital, Toronto, ON, Canada
(Medicis) Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC,
Canada
(Hudson) Department of Anesthesia, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Belley-Cote) Department of Medicine, Population Health Research
Institute, McMaster University, Hamilton, Canada
(Bainbridge) Department of Anaesthesia and Perioperative Medicine, Western
University, London, ON, Canada
(Kent) Department of Anesthesia, Pain Management and Perioperative
Medicine, Dalhousie University, Halifax, NS, Canada
(Shaw) Department of Anesthesia, Vanderbilt University Medical Center,
Nashville, TN, United States
(Byrne) Department of Anesthesia, Waikato Hospital, Hamilton, New Zealand
(Syed) Department of Anesthesia, McMaster University, Hamilton Health
Sciences, Hamilton, ON, Canada
(Royse) Department of Surgery, The University of Melbourne, The Royal
Melbourne Hospital, Parkville, Victoria, Australia; Department of
Cardiothoracic Anaesthesia, Royal Melbourne Hospital, Parkville, Victoria,
Australia
(McGuiness) Medical Research Institute of New Zealand, Auckland City
Hospital, Auckland, New Zealand
Abstract
OBJECTIVES: To determine if a restrictive transfusion threshold is
noninferior to a higher threshold as measured by a composite outcome of
mortality and serious morbidity.
DESIGN: Transfusion Requirements in Cardiac Surgery (TRICS) III was a
multicenter, international, open-label randomized controlled trial of two
commonly used transfusion strategies in patients having cardiac surgery
using a noninferiority trial design (ClinicalTrials.gov number,
NCT02042898).
SETTING: Eligible patients were randomized prior to surgery in a 1:1
ratio.
PARTICIPANTS: Potential participants were 18 years or older undergoing
planned cardiac surgery using cardiopulmonary bypass (CPB) with a
preoperative European System for Cardiac Operative Risk Evaluation
(EuroSCORE I) of 6 or more.
INTERVENTIONS: Five thousand patients; those allocated to a restrictive
transfusion group received a red blood cell (RBC) transfusion if the
hemoglobin concentration (Hb) was less than 7.5 g/dL intraoperatively
and/or postoperatively. Patients allocated to a liberal transfusion
strategy received RBC transfusion if the Hb was less than 9.5 g/dL
intraoperatively or postoperatively in the intensive care unit or less
than 8.5 g/dL on the ward.
MEASUREMENTS AND MAIN RESULTS: The primary outcome was a composite of
all-cause mortality, myocardial infarction, stroke, or new onset renal
dysfunction requiring dialysis at hospital discharge or day 28, whichever
comes first. The primary outcome was analyzed as a per-protocol analysis.
The trial monitored adherence closely as adherence to the transfusion
triggers is important in ensuring that measured outcomes reflect the
transfusion strategy.
CONCLUSION: By randomizing prior to surgery, the TRICS III trial captured
the most acute reduction in hemoglobin during cardiopulmonary
bypass.<br/>Copyright &#xa9; 2018. Published by Elsevier Inc.

<114>
Accession Number
624529312
Title
Omega-3 Polyunsaturated Fatty Acids and Cardiovascular Health: A
Comprehensive Review.
Source
Progress in cardiovascular diseases. 61 (1) (pp 76-85), 2018. Date of
Publication: 01 May 2018.
Author
Elagizi A.; Lavie C.J.; Marshall K.; DiNicolantonio J.J.; O'Keefe J.H.;
Milani R.V.
Institution
(Elagizi) Department of Internal Medicine, Leonard J Chabert Medical
Center, Houma, LA, United States
(Lavie, Milani) Department of Cardiovascular Diseases, John Ochsner Heart
and Vascular Institute, Ochsner Clinical School, University of Queensland
School of Medicine, New Orleans, LA, United States
(Marshall) Director Global Lipid Science and Advocacy for DSM Nutritional
Products, Columbia, MD, United States
(DiNicolantonio, O'Keefe) Mid America Heart Institute at Saint Luke's
Hospital, Kansas City, MO, United States
Publisher
NLM (Medline)
Abstract
The potential cardiovascular (CV) disease (CVD) benefits of Omega-3
Polyunsaturated Fatty Acids (OM3) have been intensely studied and debated
for decades. Initial trials were performed in patients with low use of
maximal medical therapy for CVD, and reported significant mortality
benefits with the use of 1g/day OM3 intervention following myocardial
infarction (MI). More recent studies, including cohorts of patients
receiving modern guideline directed medical therapy for CVD, have often
not shown similar benefits with OM3 use. We conducted a literature review
using PubMed, professional society guidelines, specific journal databases
including New England Journal of Medicine and Journal of the American
College of Cardiology from January 1, 2007 to December 31, 2017.
References from selected articles were also reviewed, as well as key
articles outside of the selected time-frame for their important findings
or historical perspectives. Currently, there are no Class I
recommendations from the American Heart Association (AHA) for the use of
OM3, however, considering the safety of this therapy and beneficial
findings of some modern studies (including patients with current maximal
medical therapy for CVD), the AHA has recently expanded their list of
Class II recommendations, in which treatment with OM3 for CVD benefit is
reasonable. This review discusses the current state of the evidence,
summarizes current professional recommendations, and provides
recommendations for future research.<br/>Copyright &#xa9; 2018 Elsevier
Inc. All rights reserved.

<115>
Accession Number
624529204
Title
Do selective serotonin reuptake inhibitors increase the risk of bleeding
or mortality following coronary artery bypass graft surgery? A
meta-analysis of observational studies.
Source
Perfusion. 33 (6) (pp 415-422), 2018. Date of Publication: 01 Sep 2018.
Author
Eckersley M.J.; Sepehripour A.H.; Casula R.; Punjabi P.; Athanasiou T.
Institution
(Eckersley, Sepehripour, Casula, Punjabi, Athanasiou) Department of
Surgery and Cancer, Imperial College London, London, United Kingdom
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Depressive illness has a high prevalence in patients
undergoing coronary artery bypass graft surgery (CABG). The first line
treatment for depression are selective serotonin reuptake inhibitors
(SSRIs) which inhibit serotonin reuptake in the presynaptic neuronal
membrane and uptake by platelets, inhibiting subsequent serotonin-mediated
platelet activation. This presents a theoretically increased risk of
bleeding and subsequent postoperative mortality. This review aims to
investigate the effects of SSRIs on postoperative bleeding, defined as the
need for transfusions and re-operation for bleeding, as well as 30-day
mortality in patients undergoing CABG.
METHOD: Four hundred and thirty-seven papers were screened with seven
meeting the full inclusion criteria.
RESULTS: Meta-analysis demonstrated that SSRI use increased the risk of
red blood cell transfusion (odds ratio (OR) = 1.15; 95% confidence
interval (CI): 1.06-1.26), but resulted in no difference in the rate of
re-operation for bleeding (OR = 1.07; 95% CI: 0.66-1.74). SSRI use had no
effect on the rates of platelet (OR = 0.93; 95% CI: 0.79-1.09) or fresh
frozen plasma (OR = 0.96; 95% CI: 0.74-1.24) transfusion nor on the
mortality rate (OR =1.03; 95 CI: 0.90-1.17).
CONCLUSION: This review demonstrates that SSRIs are largely safe in
cardiac surgery as no increase in mortality was observed. However, there
is a significantly raised chance of red blood cell transfusion. The
heterogeneous nature of the current evidence base highlights the need for
further research into SSRIs and whether any effect on patient outcomes in
cardiac surgery occurs.

<116>
Accession Number
624526201
Title
Type II Minimal-Invasive Extracorporeal Circuit for Aortic Valve
Replacement: A Randomized Controlled Trial.
Source
Artificial organs. 42 (6) (pp 620-629), 2018. Date of Publication: 01 Jun
2018.
Author
Gygax E.; Kaeser H.-U.; Stalder M.; Gahl B.; Rieben R.; Carrel T.; Erdoes
G.
Institution
(Gygax, Kaeser, Stalder, Carrel) Department of Cardiovascular Surgery,
Inselspital, University of Bern, University Hospital Bern, Bern,
Switzerland
(Gahl) Clinical Trials Unit, Inselspital, University of Bern, University
Hospital Bern, Bern, Switzerland
(Rieben) Department for Biomedical Research, Inselspital, University of
Bern, University Hospital Bern, Bern, Switzerland
(Erdoes) Department of Anesthesiology and Pain Therapy, Inselspital,
University of Bern, University Hospital Bern, Bern, Switzerland
Abstract
Extracorporeal circulation triggers systemic inflammatory response and
coagulation disorders which may lead to unfavorable clinical outcome. A
type II minimally-invasive extracorporeal circuit (MiECC) is a closed
system with markedly reduced artificial surface as compared to
conventional extracorporeal circuits (CECC). The aim of this study was to
investigate and compare inflammatory responses, complement activation and
selected clinical end-points in isolated surgical aortic valve replacement
(SAVR) performed with a type II MiECC circuit or a CECC. Fifty patients
were prospectively randomized to MiECC or CECC perfusion regimen.
Complement activation (sC5b-9), inflammation (IL-6, TNF-alpha,
sCD40-ligand) and activation of the coagulation system (D-dimer,
TAT-complex) were determined before operation, at 2 hours and 24 hours
after surgery. Clinical end-points included perfusion time, transfusion of
allogeneic blood products, postoperative bleeding, sepsis, new onset of
atrial fibrillation, stroke and in-hospital mortality. Patient
characteristics and baseline plasma markers were similar in both groups.
Levels for sC5b-9, TNF-alpha, sCD40 ligand, TAT-complex and D-dimers were
not significantly different between MiECC and CECC at 2 hours and 24 hours
after surgery. The IL-6 plasma concentration was lower in the CECC group
at 24 hours (P=0.026, vs. MiECC). Comparisons of the baseline level to
values at 2 hours and 24 hours, adjusted for the type of oxygenator and
hemoglobin, showed a significantly lower sC5b-9 in MiECC at 2 hours
(P=0.013), but no difference at 24 hours (P=0.990). Compared with CECC,
MiECC patients had a shorter perfusion time (P=0.037) and less transfusion
requirements (P=0.04). In this selected cohort of SAVR patients, the type
II MiECC was not inferior to CECC in terms of inflammatory response and
complement activation. Thus, MiECC might be an alternative perfusion
strategy to conventional.<br/>Copyright &#xa9; 2018 International Center
for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

<117>
Accession Number
624523172
Title
Inspiratory muscle training is effective to reduce postoperative pulmonary
complications and length of hospital stay: a systematic review and
meta-analysis.
Source
Disability and rehabilitation. 40 (8) (pp 864-882), 2018. Date of
Publication: 01 Apr 2018.
Author
Kendall F.; Oliveira J.; Peleteiro B.; Pinho P.; Bastos P.T.
Institution
(Kendall, Pinho, Bastos) Department of Cardiothoracic Surgery, Centro
Hospitalar de Sao Joao, Porto, Portugal
(Kendall) b Polytechnic Health Institute of the North, CESPU, Gandra ,
Paredes , Portugal
(Kendall, Oliveira) Research Center in Physical Activity, Health and
Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
(Peleteiro) EPIUnit - Institute of Public Health, University of Porto,
Porto, Portugal
(Peleteiro) Department of Clinical Epidemiology, Predictive Medicine and
Public Health, Faculty of Medicine, University of Porto, Porto, Portugal
Abstract
PURPOSE: This study systematically review and meta-analyse the
effectiveness of inspiratory muscle training (IMT) to reduce postoperative
pulmonary complications (PPC) and length of hospital stay (LOS), both in
the preoperative and/or postoperative periods of cardiac, pulmonary, and
abdominal surgical patients. Sensitive analysis was performed to examine
which patients benefit more from IMT according to methodological features
(quality of studies and sample size), patient's characteristics (pulmonary
risk stratification, age, and body mass index), type of surgery, period of
training, and training protocols (training doses and level of
supervision).
METHODS: The literature search was made in the electronic databases
PubMed, EBSCO, Web of Science, PEDro and Scopus. Only randomized
controlled trials were included. Data extraction, quality assessment and
meta-analysis were performed.
RESULTS: We included 17 randomized controlled trials in the systematic
review, of which, 12 were included for the PPC meta-analysis and 11 for
the LOS meta-analysis. IMT significantly reduced the risk of PPC (Risk
Ratio (RR)=0.50, 95%CI: 0.39, 0.64, I2=0.0%), and a decrease in LOS (Mean
Difference=-1.41, 95%CI: -2.07, -0.75, I2=0.0%).
CONCLUSION: IMT is effective to reduce PPC and LOS in patients undergoing
surgery. Implications for Rehabilitation Physiotherapy interventions with
inspiratory muscle training (IMT) are effective to reduce postoperative
pulmonary complications (PPC) and length of hospital stay (LOS) after
major surgery, and should start preoperatively. Rehabilitation with IMT is
beneficial at all ages and risk levels, but older and high-risk patients
benefit more, as well as pulmonary surgery patients. IMT is more effective
if it is supervised, and prescription target at least two-week period,
sessions with more than 15minutes, with imposed load increment, and adding
other exercise modes.

<118>
Accession Number
624526815
Title
Metamizole and Platelet Inhibition by Aspirin Following On-Pump Coronary
Artery Bypass Grafting.
Source
Journal of cardiothoracic and vascular anesthesia. 32 (1) (pp 178-186),
2018. Date of Publication: 01 Feb 2018.
Author
Wilczynski M.; Wybraniec M.T.; Sanak M.; Goral J.; Mizia-Stec K.
Institution
(Wilczynski) Department of Cardiac Surgery, Medical University of Lodz,
Lodz, Poland
(Wybraniec, Mizia-Stec) First Department of Cardiology, School of Medicine
in Katowice, Medical University of Silesia, Katowice, Poland; Public
Hospital No 7 in Katowice, Upper Silesia Medical Center
(Sanak) II Department of Internal Medicine, Division of Molecular Biology
and Clinical Genetics, Jagiellonian University Medical College, Krakow,
Poland
(Goral) Department of Laboratory Medicine, Public Hospital No 7 in
Katowice, Upper Silesia Medical Center, Katowice, Poland
Abstract
INTERVENTIONS: Patients were randomized to postoperative intravenous
metamizole +/- opioids (study group; n = 23) or opioids alone (control
group; n = 20). Aspirin was withheld at least 7 days before the surgery
and reinitiated (300 mg) immediately after the procedure prior to
metamizole use, and continued daily thereafter (150 mg). Platelet function
was evaluated using multielectrode impedance aggregometry (acid-induced
platelet activation [ASPI] and collagen-induced platelet activation [COL]
test), P-selectin expression and urinary 11-dehydro-thromboxane B2
(11-DTXB2) level at baseline, postoperative day (POD) 0, POD 1, POD 2, and
POD 6. Residual platelet reactivity (RPR) was defined as ASPI test >400
AU*min.
MEASUREMENTS AND MAIN RESULTS: In all study participants, postoperative
ASPI test value moderately decreased (1058.2 v 966.6 AU*min, p = 0.047),
urinary 11-DTXB2 level increased (923.4 v 4367.3 pg/mg, p < 0.001), and
P-selectin expression and COL test value remained stable postprocedure.
The decreases of ASPI (p = 0.146) and COL test (p = 0.642), and P-selectin
expression (p = 0.318) did not differ between both groups. Patients in the
control group had higher postoperative increase of urinary 11-DTXB2 level
(p = 0.001). The prevalence of RPR was high and comparable between study
and control groups (day 1, 95.6% v 100%, p = 0.535; day 6, 100% v 90%, p =
0.21). Multivariate analysis revealed that metamizole use did not predict
the fluctuations of ASPI and COL test values and P-selectin expression,
yet it independently predicted postoperative change of 11-DTXB2 level (b =
-0.518, p = 0.001).
CONCLUSIONS: Intravenous metamizole preceded by a loading dose of aspirin
did not modify platelet response to aspirin in the postoperative period
after CABG.
PARTICIPANTS: The study comprised 43 patients with multivessel coronary
artery disease undergoing CABG.
DESIGN: Prospective, single-blind, randomized trial.
SETTING: Tertiary referal hospital.
OBJECTIVE: The purpose of the study was to evaluate the impact of
intravenous metamizole on platelet inhibition by aspirin in patients with
coronary artery disease early after on-pump coronary artery bypass
grafting (CABG).<br/>Copyright &#xa9; 2018 Elsevier Inc. All rights
reserved.

<119>
Accession Number
624526782
Title
Transfusion Threshold of Hemoglobin 80 g/L Is Comparable to 100 g/L in
Terms of Bleeding in Cardiac Surgery: A Prospective Randomized Study.
Source
Journal of cardiothoracic and vascular anesthesia. 32 (1) (pp 131-139),
2018. Date of Publication: 01 Feb 2018.
Author
Laine A.; Niemi T.; Schramko A.
Institution
(Laine, Niemi, Schramko) Division of Anesthesiology, Department of
Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki,
Helsinki University Hospital, Helsinki, Finland
Abstract
MEASUREMENTS AND MAIN RESULTS: Rotational thromboelastometry (ROTEM) and
conventional laboratory tests were performed to evaluate coagulation.
There was no significant difference in bleeding or ROTEM parameters
between the groups. Complication rate and Hb concentration after 7-day
follow-up were not different between the groups, but Group 100 g/L had
received twice the amount of RBC transfusions.
CONCLUSION: Hb threshold of 80 g/L for RBC transfusion in cardiac surgery
is comparable to 100 g/L in terms of bleeding and possibly short-term
complications.
OBJECTIVE: Anemia is common after cardiac surgery and, according to some
suggestive evidence, may be associated with increased bleeding, other
morbidity, and mortality. However, transfusion of red blood cells (RBC)
may cause adverse effects and increase cost. The authors hypothesized that
the restrictive hemoglobin threshold (Hb of 80 g/L) may aggravate bleeding
more than the higher Hb threshold (Hb 100 g/L).
DESIGN: Prospective randomized trial.
TYPE OF HOSPITAL: University Hospital of Helsinki, Finland.
PARTICIPANTS: Eighty patients with written informed consent, scheduled for
elective open-heart surgery were randomized in 2 groups.
INTERVENTIONS: Two study groups had RBC transfusion threshold of either Hb
80 g/L or 100 g/L. These triggers were followed for a 24-hour period
postoperatively. A medical follow-up was carried out for 7 days after
surgery.<br/>Copyright &#xa9; 2018 Elsevier Inc. All rights reserved.

<120>
Accession Number
624527145
Title
A Comparison of 3 Videolaryngoscopes for Double-Lumen Tube Intubation in
Humans by Users With Mixed Experience: A Randomized Controlled Study.
Source
Journal of cardiothoracic and vascular anesthesia. 32 (1) (pp 277-286),
2018. Date of Publication: 01 Feb 2018.
Author
El-Tahan M.R.; Khidr A.M.; Gaarour I.S.; Alshadwi S.A.; Alghamdi T.M.;
Al'ghamdi A.
Institution
(El-Tahan) Anesthesiology Department, King Fahd Hospital of Imam
Abdulrahman Bin Faisal University (formerly University of Dammam), Dammam,
Saudi Arabia
(Khidr, Gaarour, Alshadwi, Alghamdi, Al'ghamdi) Anesthesiology Department,
King Fahd Hospital of Imam Abdulrahman Bin Faisal University (formerly
University of Dammam), Dammam, Saudi Arabia
Abstract
MEASUREMENTS AND MAIN RESULTS: The following data were recorded: time
required for achieving successful DLT intubation; glottis visualization;
optimization maneuvers; first-pass success rate; intubation difficulty;
failure to intubate, defined as an attempt taking >150 seconds to perform
or if peripheral oxygen saturation <92% was noted; and postoperative sore
throat and hoarseness were recorded. Compared with GlideScope, the Airtraq
resulted in shorter times for achieving successful DLT intubation (median
times: 21 s [95% confidence interval 23.9-70.8 s] v 57.5 s [95% confidence
interval 46.2-89.1 s], respectively; p = 0.021); a lower score for
difficult intubations (p = 0.023); and fewer optimization maneuvers. The 4
laryngoscopes were associated with comparable glottis visualization;
first-pass success rate (100%, 100%, 94.4%, and 100%, respectively; p =
0.522); incidence of oropharyngeal trauma; postoperative sore throat; and
hoarseness of voice. There were 2 (5.7%) endobronchial intubation failures
using the Airtraq due to the inability to advance the DLT through the
glottis opening. The experience of the anesthesiologists in using the 4
devices had a statistically significant negative correlation with the time
to confirmation of endobronchial intubation (Spearman r -0.392; p <
0.001).
CONCLUSION: When used by operators with mixed experience, the channeled
Airtraq required less time for DLT intubation and was easier to use than
the GlideScope, although failures did occur with the Airtraq, whereas they
did not occur with the other systems.
OBJECTIVES: To test the hypothesis that laryngoscopy using the Airtraq
(Prodol Limited, Viscaya, Spain) or King Vision laryngoscope (KVL) (Ambu
A/S, Ballerup, Denmark) would result in a shorter time for successful
double-lumen endobronchial tube (DLT) intubation by users with mixed
experience than the time required using the Macintosh or GlideScope
(Verathon Inc., Bothell, WA) laryngoscopes.
DESIGN: A randomized, prospective, blind study.
SETTING: A single university hospital.
PARTICIPANTS: The study comprised 133 patients undergoing elective
thoracic surgery.
INTERVENTIONS: Patients were randomly allocated into the following 4
groups of DLTs: Macintosh (n = 32), GlideScope (n = 34), Airtraq (n = 35),
or KVL (n = 32).<br/>Copyright &#xa9; 2017 Elsevier Inc. All rights
reserved.

<121>
Accession Number
624525339
Title
A Randomized Controlled Study of the Use of Video Double-Lumen
Endobronchial Tubes Versus Double-Lumen Endobronchial Tubes in Thoracic
Surgery.
Source
Journal of cardiothoracic and vascular anesthesia. 32 (1) (pp 267-274),
2018. Date of Publication: 01 Feb 2018.
Author
Heir J.S.; Guo S.-L.; Purugganan R.; Jackson T.A.; Sekhon A.K.; Mirza K.;
Lasala J.; Feng L.; Cata J.P.
Institution
(Heir, Purugganan, Jackson, Sekhon, Mirza, Lasala, Cata) Department of
Anesthesiology and Perioperative Medicine, University of Texas MD Anderson
Cancer Center, Houston, TX, United States
(Guo) Department of Anesthesiology, Cathay General Hospital, Taipei,
Taiwan; Department of Anesthesiology, Tri-Service General Hospital and
National Defense Medical Center, Taipei, Taiwan
(Feng) Department of Biostatistics, University of Texas MD Anderson Cancer
Center, Houston, TX, United States
Abstract
OBJECTIVE: To compare the incidence of fiberoptic bronchoscope (FOB) use
(1) during verification of initial placement and (2) for reconfirmation of
correct placement following repositioning, when either a double-lumen tube
(DLT) or video double-lumen tube (VDLT) was used for lung isolation during
thoracic surgery.
DESIGN: A randomized controlled study.
SETTING: Single-center university teaching hospital.
PARTICIPANTS: The study comprised 80 patients who were 18 years or older
requiring lung isolation for surgery.
INTERVENTIONS: After institutional review board approval, patients were
randomized prior to surgery to either DLT or VDLT usage. Attending
anesthesiologists placed the Mallinckrodt DLT or Vivasight (ET View Ltd,
Misgav, Israel) VDLT with conventional laryngoscopy or video laryngoscopy
then verified correct tube position through the view provided with either
VDLT external monitor or FOB.
MEASUREMENTS AND MAIN RESULTS: Data collected included: sex, body mass
index, successful intubation and endobronchial placement, intubation time,
confirmation time of tube position, FOB use, quality of view, dislodgement
of tube, and ability to forewarn dislodgement of endobronchial cuff and
complications. FOB use for verification of final position of the tube
(VDLT 13.2% [5/38] v DLT 100% [42/42], p < 0.0001), need for FOB to
correct the dislodgement (VDLT 7.7% [1/13] v DLT 100% [14/14], p <
0.0001), dislodgement during positioning (VDLT 61.5% [8/13] v DLT 64.3%
[9/14], p = ns), dislodgement during surgery (VDLT 38.5% [5/13] v DLT
21.4% [3/14], p = ns), and ability to forewarn dislodgement of
endobronchial cuff (VDLT 18.4% [7/38] v DLT 4.8% [2/42], p = 0.078).
CONCLUSION: This study demonstrated a reduction of 86.8% in FOB use, which
was a similar reduction found in other published studies.<br/>Copyright
&#xa9; 2018 Elsevier Inc. All rights reserved.

<122>
Accession Number
624525466
Title
A Randomized Controlled Trial Comparing the Utility of Lighted Stylet and
GlideScope for Double-Lumen Endobronchial Intubation.
Source
Journal of cardiothoracic and vascular anesthesia. 32 (1) (pp 290-296),
2018. Date of Publication: 01 Feb 2018.
Author
Chang J.-E.; Kim H.; Min S.-W.; Lee J.-M.; Ryu J.-H.; Yoon S.; Hwang J.-Y.
Institution
(Chang, Kim, Min, Lee) Department of Anesthesiology and Pain Medicine,
SMG-SNU Boramae Medical Center, Seoul, North Korea
(Ryu) Department of Anesthesiology & Pain Medicine, Seoul National
University Bundang Hospital, North Korea
(Yoon) Department of Anesthesiology & Pain Medicine, Seoul National
University Hospital, Seoul, North Korea
(Hwang) Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae
Medical Center, Seoul, North Korea
Abstract
MEASUREMENTS AND MAIN RESULTS: Number of intubation attempts, difficulty
of DLT advancement toward the glottis, time taken for DLT intubation, and
the incidence and severity of postoperative sore throat and hoarseness at
1 and 24 hours after surgery were evaluated. Time taken for DLT intubation
was shorter in the lighted stylet group compared with the GlideScope group
(30 [28-32] s v 45 [38-53] s, median [interquartile range], respectively;
p < 0.001). DLT advancement toward the glottis was easier in the lighted
stylet group than in the GlideScope group (p = 0.016). The success rate of
DLT intubation in the first attempt (96.9% v 90.6% for lighted stylet and
GlideScope, respectively), and the incidence and severity of postoperative
sore throat and hoarseness were not different between the two groups.
CONCLUSIONS: The use of lighted stylet allowed easier advancement of the
DLT toward the glottis in the oropharyngeal space and reduced time for
achieving DLT intubation compared with GlideScope.
DESIGN: A prospective, randomized study.
OBJECTIVE: To compare GlideScope and lighted stylet for double-lumen
endobronchial tube (DLT) intubation in terms of intubation time, success
rate of first attempt at intubation, difficulty in DLT advancement toward
the glottis, and postoperative sore throat and hoarseness.
SETTING: Medical center governed by a university hostpial.
PARTICIPANTS: Sixty-two adult patients undergoing thoracic surgery using
DLT intubation.
INTERVENTION: After the induction of anesthesia, DLT intubation was
performed using GlideScope (n = 32) or lighted stylet (n =
32).<br/>Copyright &#xa9; 2018 Elsevier Inc. All rights reserved.

<123>
Accession Number
624527784
Title
High-intensity Statin Treatments in Clinically Stable Patients on Aspirin
Monotherapy 12 Months After Drug-eluting Stent Implantation: A Randomized
Study.
Source
Revista espanola de cardiologia (English ed.). 71 (6) (pp 423-431), 2018.
Date of Publication: 01 Jun 2018.
Author
Im E.; Cho Y.-H.; Suh Y.; Cho D.-K.; Her A.-Y.; Kim Y.H.; Lee K.; Kang
W.C.; Yun K.H.; Yoo S.-Y.; Cheong S.-S.; Shin D.-H.; Ahn C.-M.; Kim J.-S.;
Kim B.-K.; Ko Y.-G.; Choi D.; Jang Y.; Hong M.-K.
Institution
(Im) Department of Internal Medicine, Yongin Severance Hospital, Yonsei
University Health System, Yongin, South Korea
(Cho, Suh, Cho) Department of Internal Medicine, Myongji Hospital, Goyang,
South Korea
(Her, Kim) Department of Internal Medicine, School of Medicine, Kangwon
National University, Chuncheon, South Korea
(Lee, Kang) Department of Internal Medicine, Gachon University Gil Medical
Center, Incheon, South Korea
(Yun) Department of Internal Medicine, Wonkwang University Hospital,
Iksan, South Korea
(Yoo, Cheong) Department of Internal Medicine, GangNeung Asan Hospital,
GangNeung, South Korea
(Shin, Ahn) Division of Cardiology, Severance Cardiovascular Hospital,
Yonsei University Health System, Seoul, South Korea
(Kim, Kim, Ko, Choi) Division of Cardiology, Severance Cardiovascular
Hospital, Yonsei University Health System, Seoul, Korea; Cardiovascular
Research Institute, Yonsei University College of Medicine, Seoul, Korea
(Jang, Hong) Division of Cardiology, Severance Cardiovascular Hospital,
Yonsei University Health System, Seoul, Korea; Cardiovascular Research
Institute, Yonsei University College of Medicine, Seoul, Korea; Severance
Biomedical Science Institute, Yonsei University College of Medicine,
Seoul, Korea
Abstract
INTRODUCTION AND OBJECTIVES: Current guidelines on the treatment of blood
cholesterol recommend continuous maintenance of high-intensity statin
treatment in drug-eluting stent (DES)-treated patients. However,
high-intensity statin treatment is frequently underused in clinical
practice after stabilization of DES-treated patients. Currently, the
impact of continuous high-intensity statin treatment on the incidence of
late adverse events in these patients is unknown. We investigated whether
high-intensity statin treatment reduces late adverse events in clinically
stable patients on aspirin monotherapy 12 months after DES implantation.
METHODS: Clinically stable patients who underwent DES implantation 12
months previously and received aspirin monotherapy were randomly assigned
to receive either high-intensity (40mg atorvastatin, n = 1000) or
low-intensity (20mg pravastatin, n = 1000) statin treatment. The primary
endpoint was adverse clinical events at 12-month follow-up (a composite of
all death, myocardial infarction, revascularization, stent thrombosis,
stroke, renal deterioration, intervention for peripheral artery disease,
and admission for cardiac events).
RESULTS: The primary endpoint at 12-month follow-up occurred in 25
patients (2.5%) receiving high-intensity statin treatment and in 40
patients (4.1%) receiving low-intensity statin treatment (HR, 0.58; 95%CI,
0.36-0.92; P = .018). This difference was mainly driven by a lower rate of
cardiac death (0 vs 0.4%, P = .025) and nontarget vessel myocardial
infarction (0.1 vs 0.7%, P = .033) in the high-intensity statin treatment
group.
CONCLUSIONS: Among clinically stable DES-treated patients on aspirin
monotherapy, high-intensity statin treatment significantly reduced late
adverse events compared with low-intensity statin treatment.
CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique
identifier: NCT01557075.<br/>Copyright &#xa9; 2017 Sociedad Espanola de
Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

<124>
Accession Number
624527782
Title
Plasma-Lyte 148 vs. Hartmann's solution for cardiopulmonary bypass pump
prime: a prospective double-blind randomized trial.
Source
Perfusion. 33 (4) (pp 310-319), 2018. Date of Publication: 01 May 2018.
Author
Weinberg L.; Chiam E.; Hooper J.; Liskaser F.; Hawkins A.K.; Massie D.;
Ellis A.; Tan C.O.; Story D.; Bellomo R.
Institution
(Weinberg, Hooper, Liskaser, Hawkins, Tan) 1 Department of Anesthesia,
Austin Health, Heidelberg, Victoria, Australia
(Weinberg, Chiam) Department of Surgery, University of Melbourne, Austin
Health, Victoria, Australia
(Massie, Ellis) 3 Department of Clinical Pharmacology & Therapeutics,
Austin Hospital, Heidelberg, Victoria, Australia
(Story) Anesthesia, Perioperative and Pain Medicine Unit, Melbourne
Medical School, University of Melbourne, Victoria, Australia
(Bellomo) Department of Intensive Care, University of Melbourne, Victoria,
Australia
Abstract
BACKGROUND: The mechanisms of acid-base changes during cardiopulmonary
bypass (CPB) remain unclear. We tested the hypothesis that, when used as
CPB pump prime solutions, Plasma-Lyte 148 (PL) and Hartmann's solution
(HS) have differential mechanisms of action in their contribution to
acid-base changes.
METHODS: We performed a prospective, double-blind, randomized trial in
adult patients undergoing elective cardiac surgery with CPB. Participants
received a CPB prime solution of 2000 mL, with either PL or HS. The
primary endpoint was the standard base excess (SBE) value measured at 60
minutes after full CPB flows (SBE60min). Secondary outcomes included
changes in SBE, pH, chloride, sodium, lactate, gluconate, acetate, strong
ion difference and strong ion gap at two (T2min), five (T5min), ten
(T10min), thirty (T30min) and sixty (T60min) minutes on CPB. The primary
outcome was measured using a two-tailed Welch's t-test. Repeated measures
ANOVA was used to test for differences between time points.
RESULTS: Twenty-five participants were randomized to PL and 25 to HS.
Baseline characteristics, EURO and APACHE scores, biochemistry, hematology
and volumes of cardioplegia were similar. Mean (SD) SBE at T60min was -1.3
(1.4) in the PL group and -0.1 (2.7) in the HS group; p=0.55. No
significant differences in SBE between the groups was observed during the
first 60 minutes (p=0.48). During CPB, there was hyperacetatemia and
hypergluconatemia in the PL group and hyperlactatemia and hyperchloremia
in the HS group. No significant difference between the groups in plasma
bicarbonate levels and total weak acid levels were found. Complications
and intensive care unit and hospital length of stays were similar.
CONCLUSIONS: During CPB, PL and HS did not cause a significant metabolic
acidosis. There was hyperacetatemia and hypergluconatemia with PL and
hyperchloremia and hyperlactatemia with HS. These physiochemical effects
appear clinically innocuous.

<125>
Accession Number
624523689
Title
Preprocedural C-Reactive Protein Predicts Outcomes after Primary
Percutaneous Coronary Intervention in Patients with ST-elevation
Myocardial Infarction a systematic meta-analysis.
Source
Scientific reports. 7 (pp 41530), 2017. Date of Publication: 27 Jan 2017.
Author
Mincu R.-I.; Janosi R.A.; Vinereanu D.; Rassaf T.; Totzeck M.
Institution
(Mincu, Janosi, Rassaf, Totzeck) University Hospital Essen, Medical
Faculty, West German Heart and Vascular Center, Department of Cardiology
and Vascular Diseases, Hufelandstr. 55, Essen 45147, Germany
(Mincu, Vinereanu) University of Medicine and Pharmacy Carol Davila -
University and Emergency Hospital, Cardiac Research Unit, Splaiul
Independentei 169, 050098 Bucharest, Romania
Abstract
Risk assessment in patients with acute coronary syndromes (ACS) is
critical in order to provide adequate treatment. We performed a systematic
meta-analysis to assess the predictive role of serum C-reactive protein
(CRP) in patients with ST-segment elevation myocardial infarction (STEMI),
treated with primary percutaneous coronary intervention (PPCI). We
included 7 studies, out of 1,033 studies, with a total of 6,993 patients
with STEMI undergoing PPCI, which were divided in the high or low CRP
group, according to the validated cut-off values provided by the
corresponding CRP assay. High CRP values were associated with increased
in-hospital and follow-up all-cause mortality, in-hospital and follow-up
major adverse cardiac events (MACE), and recurrent myocardial infarction
(MI). The pre-procedural CRP predicted in-hospital target vessel
revascularization (TVR), but was not associated with acute/subacute and
follow-up in-stent restenosis (ISR), and follow-up TVR. Thus,
pre-procedural serum CRP could be a valuable predictor of global
cardiovascular risk, rather than a predictor of stent-related
complications in patients with STEMI undergoing PPCI. This biomarker might
have the potential to improve the management of these high-risk patients.

<126>
Accession Number
624320464
Title
Downsized cryopreserved and standard-sized allografts for right
ventricular outflow tract reconstruction in children: Long-Term
single-institutional experience.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (2) (pp 257-263),
2018. Date of Publication: August 2018.
Author
Romeo J.L.R.; Papageorgiou G.; Van De Woestijne P.C.; Takkenberg J.J.M.;
Westenberg L.E.H.; Van Beynum I.; Bogers A.J.J.C.; Mokhles M.M.
Institution
(Romeo, Papageorgiou, Van De Woestijne, Takkenberg, Bogers, Mokhles)
Department of Cardiothoracic Surgery, Erasmus University Medical Center, s
Gravendijkwal 230, Rotterdam 3015, Netherlands
(Papageorgiou) Department of Biostatistics, Erasmus University Medical
Center, Rotterdam, Netherlands
(Westenberg, Van Beynum) Department of Pediatric Cardiology, Sophia
Children's Hospital, Rotterdam, Netherlands
Publisher
Oxford University Press
Abstract
OBJECTIVES: The objective of this study was to determine long-Term results
with bicuspidalized allografts compared to nonbicuspidalized allografts in
children under 2 years undergoing primary correction of the right
ventricular outflow tract. METHODS: Thirty-five consecutive bicuspidalized
allografts were compared to 45 consecutive non-bicuspidalized allografts
implanted during the same period. Valve-related events were analysed with
Kaplan'Meier and Cox-regression techniques. Mixed-effects modelling was
used to analyse serial echocardiographic measurements of pulmonary
gradient. In addition, a systematic review with meta-Analysis of the
published literature concerning implantation of bicuspidalized allografts
was performed. RESULTS: Perioperative characteristics and in-hospital
mortality [bicuspidalized 5 (14.3%), non-bicuspidalized 6 (13.3%)] were
comparable (P = 0.902). Bicuspidalized allografts were smaller (14.7 vs
16.5 mm, P = 0.023) and always (100%) of pulmonary origin compared to 26
(57.8%) of the standard-sized allografts. There were no differences in
late mortality between the bicuspidalized and non-bicuspidalized group
(6.7% vs 7.7%, P = 0.798) or freedom from allograft replacement at 10
years (82 +/- 10% and 71 ' 8%, for bicuspidalized and nonbicuspidalized
allografts, respectively). Evolution of peak pulmonary gradient (P =
0.273) was comparable between bicuspidalized and non-bicuspidalized
allografts. Meta-Analysis showed a pooled early and late mortality for
bicuspidalized allograft patients of 10.72% [95% confidence interval (CI)
6.13'18.75] and 1.6% per year (95% CI 0.99'2.79), respectively. Pooled
estimated late reintervention and replacement rates were 5.94% per year
(95% CI 3.42'10.30) and 3.78% per year (95% CI 2.69'5.32), respectively.
CONCLUSIONS: Bicuspidalization seems to be a viable alternative to combat
limited supply of small-sized allografts with acceptable survival and
reintervention rates comparable to non-bicuspidalized
allografts.<br/>Copyright &#xa9; The Author(s) 2018.

<127>
Accession Number
2001212006
Title
Does the position of the drains after open heart surgery make a
difference?"A clinical randomized trial".
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. (no
pagination), 2018. Date of Publication: 2018.
Author
Refat A.M.; Abdelsayed A.
Institution
(Refat, Abdelsayed) Department of Cardiothoracic Surgery, Faculty of
Medicine, Zagazig University, Sharqia, Egypt
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Pericardial effusion remains a common clinical problem after
cardiac surgery. Adequate postoperative drainage can be obtained by
posterior pericardial drainage through a posterior tube, along with
conventional drainage of the anterior mediastinum. Methods: Three hundred
patients, who underwent cardiac surgery, were enrolled in a prospectively
randomized study. Group A (150 patients) had two retrosternal drains and
group B (150 patients) had two retrosternal drains, one retrosternal and
one retro-cardiac. Results: Early pericardial effusion developed in 5
(3.4%) patients in group A and 2 (2.9%) in group B (P = 0.76). Early
posterior pericardial effusion occurred in 5 (3.4%) patients of group A
whereas no patients had early posterior pericardial effusion in Group B (P
= 0.024). Fourteen (9.5%) patients from group A had late posterior
pericardial effusion, compared to 1 (0.7%) patient from group B (P =
0.001). Three patients from group A had late posterior cardiac tamponade
whereas no patients from group B had late posterior cardiac tamponade (P =
0.013). Conclusions: The use of a drain placed in the posterior
pericardial cavity is simple and safe and appears to be sufficient for
posterior drainage. This reduces not only the high incidence of late
significant pericardial effusion but also reduce early pericardial
effusion and tamponade.<br/>Copyright &#xa9; 2018 The Egyptian Society of
Cardio-thoracic Surgery

<128>
Accession Number
624533182
Title
Anaemia and mortality in patients with transcatheter aortic valve
replacement: a systematic review and meta-analysis.
Source
Acta Cardiologica. (no pagination), 2018. Date of Publication: 2018.
Author
Kanjanahattakij N.; Rattanawong P.; Krishnamoorthy P.; Sirinvaravong N.;
Chongsathidkiet P.; Lapumnuaypol K.; George J.C.; Witzke C.; Figueredo
V.M.
Institution
(Kanjanahattakij, Sirinvaravong, Lapumnuaypol) Department of Medicine,
Einstein Medical Center, Philadelphia, PA, United States
(Rattanawong) University of Hawaii Internal Medicine Residency Program,
Honolulu, HI, United States
(Krishnamoorthy, George, Witzke, Figueredo) Division of Cardiology,
Department of Medicine, Einstein Medical Center, Philadelphia, PA, United
States
(Chongsathidkiet) Department of Pathology, Duke University Medical Center,
Durham, NC, United States
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Objective: This study was done to determine the relationship between
pre-procedural anaemia and mortality post transcatheter aortic valve
replacement (TAVR). Introduction: TAVR is now a treatment option for
patients with severe aortic stenosis (AS) with high surgical risk. Anaemia
is a common comorbidity in the TAVR population. Small studies have
suggested that anaemia is associated with worse short-term and long-term
mortality in patients who underwent TAVR. However, there are no
meta-analyses to further assess this association. Method: Studies were
systematically searched from electronic databases (EMBASE and MEDLINE).
Inclusion criteria were adult population with aortic stenosis who
underwent TAVR, and number of patients with pre-procedural anaemia
reported. Outcomes were short-term mortality or long-term mortality.
Pooled effect size was calculated with a random-effect model, weighted for
the inverse of variance. Heterogeneity was assessed with I².
Results: Six studies were included in the final analysis. Of these, pooled
analysis of four studies examining association between anaemia and 30-day
mortality did not show a statistically significant relationship. A pooled
analysis of four studies examining the association of anaemia and
long-term mortality after TAVR showed pooled adjusted risk ratio (RR) of
1.43, 95% CI 1.22-1.67 with low heterogeneity (I² = 33%).
Subgroup analysis after exclusion of one smaller study showed that the
association remained significant (RR 1.41, 95% CI 1.27-1.56) with
decreased heterogeneity (I² = 0%). Conclusion: This systematic
review and meta-analysis found an association between pre-procedural
anaemia and increased long-term but not short-term mortality after TAVR.
Further study of the pathophysiology underlying this association is
needed.<br/>Copyright &#xa9; 2018, &#xa9; 2018 Belgian Society of
Cardiology.

<129>
Accession Number
624532740
Title
Clinical impact of baseline chronic kidney disease in patients undergoing
transcatheter or surgical aortic valve replacement.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2018.
Date of Publication: 2018.
Author
Pineda A.M.; Kevin Harrison J.; Kleiman N.S.; Reardon M.J.; Conte J.V.;
O'Hair D.P.; Chetcuti S.J.; Huang J.; Yakubov S.J.; Popma J.J.; Beohar N.
Institution
(Pineda) Division of Cardiology, University of Florida College of
Medicine-Jacksonville, Jacksonville, FL, United States
(Kevin Harrison) Department of Medicine, Duke University Medical Center,
Durham, NC, United States
(Kleiman) Department of Cardiology, Houston Methodist DeBakey Heart and
Vascular Center, Houston, TX, United States
(Reardon) Department of Cardiothoracic Surgery, Houston Methodist DeBakey
Heart and Vascular Center, Houston, TX, United States
(Conte) Division of Cardiac Surgery, Johns Hopkins University, Baltimore,
MD, United States
(O'Hair) Department of Cardiothoracic Surgery, Aurora Healthcare,
Milwaukee, WI, United States
(Chetcuti) Department of Internal Medicine, Division of Cardiology,
University of Michigan, Ann Arbor, MI, United States
(Huang) Coronary and Structural Heart Clinical Department, Mounds View,
MN, United States
(Yakubov) Department of Cardiology, Riverside Methodist Hospital,
Columbus, OH, United States
(Popma) Department of Internal Medicine, Cardiovascular Division, Beth
Israel Deaconess Medical Center, Boston, MA, United States
(Beohar) Division of Cardiology at Mount Sinai Medical Center, Columbia
University, Miami Beach, FL, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To assess the treatment effect of TAVR versus SAVR on clinical
outcomes to 3 years in patients stratified by chronic kidney disease (CKD)
by retrospectively studying patients randomized to TAVR or SAVR.
Background: The impact of CKD on mid-term outcomes of patients undergoing
TAVR versus SAVR is unclear. Methods: Patients randomized to TAVR or SAVR
in the CoreValve US Pivotal High Risk Trial were retrospectively
stratified by eGFR: none/mild or moderate/severe CKD. To evaluate the
impact of baseline CKD in TAVR patients only, all patients undergoing an
attempted TAVR implant in the US Pivotal Trial and CAS were stratified by
baseline eGFR into none/mild, moderate, and severe CKD. The primary
endpoint was major adverse cardiovascular and renal events (MACRE), a
composite of all-cause mortality, myocardial infarction, stroke/TIA, and
new requirement of dialysis. Results: Moderate/severe CKD was present in
62.7% and 60.7% of high-risk patients randomized to TAVR or SAVR,
respectively. Baseline characteristics were similar between TAVR and SAVR
patients in both CKD subgroups, except for higher rates of diabetes and
higher serum creatinine in SAVR patients. Among high-risk patients with
moderate/severe CKD, TAVR provided a lower 3-year MACRE rate compared with
SAVR: 42.1% vs. 51.0, P =.04. Of 3,733 extreme- and high-risk TAVR
patients, 39.9% had none/mild, 53.8% moderate, and 6.4% severe CKD.
Worsening baseline CKD was associated with increased 3-year MACRE rates
[none/mild 51.5%, moderate 54.5%, severe 63.1%, P =.001]. Conclusions:
TAVR results in lower 3-year MACRE versus SAVR in high-risk patients with
moderate/severe CKD. In patients undergoing TAVR, worsening CKD increases
mid-term mortality and MACRE. Randomized trials of TAVR vs. SAVR in
patients with moderate-severe CKD would help elucidate the best treatment
for these complex patients. Trial Registration: CoreValve US Pivotal
Trial: NCT01240902. CoreValve Continued Access Study:
NCT01531374.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<130>
Accession Number
624532513
Title
A Meta-Analysis of Clinical Outcomes of Transcatheter Aortic Valve
Replacement in Patients with End-Stage Renal Disease.
Source
Structural Heart. (no pagination), 2018. Date of Publication: 2018.
Author
Amione-Guerra J.; Mattathil S.; Prasad A.
Institution
(Amione-Guerra, Mattathil, Prasad) Department of Medicine, Division of
Cardiology, University of Texas Health Science Center at San Antonio, San
Antonio, TX, United States
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: End-stage renal disease (ESRD) is associated with an increased
incidence of severe aortic stenosis (AS). For these patients the usual
care has been surgical aortic valve replacement (SAVR). ESRD patients are
at increased surgical risk. Trans-aortic valve replacement (TAVR) may be
an alternative to SAVR for these patients. However, TAVR trials have
excluded patients with ESRD. Methods: MEDLINE, OMBASE and Cochrane
databases were queried for relevant studies. A meta-analysis was performed
on the selected studies. Primary outcome was early all-cause mortality;
secondary outcomes included 1-year mortality, bleeding, neurological
deficits, vascular complications, pacemaker requirement, and myocardial
infarction. Results: A total of 16 studies included 3,499 patients. Most
patients were high risk as demonstrated by Society of Thoracic Surgeons
(STS) scores > 10 in most studies. Post-TAVR early and 1-year mortality
were 10% (95%CI: 7.8-10.5%) and 33% (95%CI: 24.1-36.8%) respectively. Most
common post-procedure complications were bleeding 17% (95%CI: 14.8-20.8%),
pacemaker implant 14% (95%CI: 11.6-17.5%) and vascular complications 7%
(95%CI: 4.3-9.9%). Neurological deficits and myocardial infarction were
less common both at 1.2% (95%CI: 0.4-2.4%, 0.3-2.5% respectively). Three
studies with 2,545 patients compared TAVR versus SAVR, there was no
difference in early mortality (~ 10%, RR:1.0, 95%CI 0.60-1.64, p = 0.9).
TAVR was associated with decreased risk of vascular complications (RR:0.58
95%CI: 0.3-0.8, p = 0.03). Conclusions: These results suggest that TAVR
outcomes in ESRD patients are comparable to those patients considered
extreme surgical risk. Compared to SAVR, there was no difference in early
mortality, but fewer vascular complications. As the ESRD population
continues to grow, future prospective studies should focus on this
particular patient population.<br/>Copyright &#xa9; 2018, &#xa9; 2018
Cardiovascular Research Foundation.

<131>
Accession Number
624531623
Title
Impact of Transcatheter Mitral Valve Repair on Left Ventricular Remodeling
in Secondary Mitral Regurgitation: A Meta-Analysis.
Source
Structural Heart. (no pagination), 2018. Date of Publication: 2018.
Author
Megaly M.; Khalil C.; Abraham B.; Saad M.; Tawadros M.; Stanberry L.;
Kalra A.; Goldsmith S.R.; Bart B.; Bae R.; Brilakis E.S.; Gossl M.;
Sorajja P.
Institution
(Megaly, Stanberry, Bae, Brilakis, Gossl, Sorajja) Valve Science Center,
Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital,
Minneapolis, MN, United States
(Megaly, Goldsmith, Bart) Division of Cardiology, Department of Medicine,
Hennepin Healthcare, Minneapolis, MN, United States
(Khalil) Department of Medicine, University at Buffalo, Buffalo, NY,
United States
(Abraham) St. John Hospital and Medical Center, Detroit, MI, United States
(Saad) Department of Cardiovascular Medicine, University of Arkansas for
Medical Sciences, Little Rock, AR, United States
(Saad) Department of Cardiology, Ain Shams University, Cairo, Egypt
(Tawadros) Faculty of Medicine, Ain Shams University, Cairo, Egypt
(Kalra) Division of Cardiology, Case Western Reserve University School of
Medicine, Cleveland, OH, United States
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: Secondary mitral regurgitation (MR) arises from left
ventricular (LV) dilatation and remodeling, and commonly is treated with
transcatheter mitral valve repair. We examined the impact of MitraClip on
reverse cardiac remodeling in patients with severe, symptomatic secondary
MR. Methods: An electronic search was performed through January 2018 for
studies that reported cardiac chamber dimensions prior to and after
treatment with MitraClip in patients with secondary MR. The mean
difference (MD) with 95% CI was calculated using fixed or random inverse
variance models. Outcomes of interest were changes in LV end-systolic and
end-diastolic volumes (LVESV, LVEDV) and dimensions (LVESD, LVEDD).
Secondary outcomes included left atrial (LA) volume, systolic pulmonary
artery pressure (sPAP) and LV ejection fraction (LVEF). Results: A total
of 16 studies with 1,266 patients were included in the present analysis.
The weighted mean follow-up period (+/-SD) was 11.5 +/- 7.2 months.
MitraClip was associated with significant reduction in LVEDV (-14.24 ml,
95% CI [-22.53, -5.94], p = 0.0008), LVESV (-7.67 ml, CI [-12.30, -3.03],
p = 0.001), LVEDD (-2.92 mm [-3.65, -2.19 mm], p < 0.00001), and LVESD
(-1.92 mm [-2.92, -0.92], p = 0.0002). MitraClip was also associated with
reduction in LA volume (-16.36 ml [23.23, -9.49 ml], p < 0.00001) and sPAP
(-6.93 mmHg [-8.76, -5.10], p < 0.00001), and a significant increase in
LVEF (+ 2.78% [0.91, 4.66], p = 0.004). Conclusions: In patients with
severe symptomatic secondary MR, MitraClip is associated with modest, but
favorable LV and LA reverse remodeling. The impact of these changes on
clinical outcomes deserves further study.<br/>Copyright &#xa9; 2018,
&#xa9; 2018 Cardiovascular Research Foundation.

<132>
Accession Number
618945432
Title
A Randomized Controlled Study of the Use of Video Double-Lumen
Endobronchial Tubes Versus Double-Lumen Endobronchial Tubes in Thoracic
Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 267-274),
2018. Date of Publication: February 2018.
Author
Heir J.S.; Guo S.-L.; Purugganan R.; Jackson T.A.; Sekhon A.K.; Mirza K.;
Lasala J.; Feng L.; Cata J.P.
Institution
(Heir, Purugganan, Jackson, Sekhon, Mirza, Lasala, Cata) Department of
Anesthesiology and Perioperative Medicine, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
(Guo) Department of Anesthesiology, Cathay General Hospital, Taipei,
Taiwan (Republic of China)
(Guo) Department of Anesthesiology, Tri-Service General Hospital and
National Defense Medical Center, Taipei, Taiwan (Republic of China)
(Feng) Department of Biostatistics, The University of Texas MD Anderson
Cancer Center, Houston, TX, United States
Publisher
W.B. Saunders
Abstract
Objective: To compare the incidence of fiberoptic bronchoscope (FOB) use
(1) during verification of initial placement and (2) for reconfirmation of
correct placement following repositioning, when either a double-lumen tube
(DLT) or video double-lumen tube (VDLT) was used for lung isolation during
thoracic surgery. Design: A randomized controlled study. Setting:
Single-center university teaching hospital. Participants: The study
comprised 80 patients who were 18 years or older requiring lung isolation
for surgery. Interventions: After institutional review board approval,
patients were randomized prior to surgery to either DLT or VDLT usage.
Attending anesthesiologists placed the Mallinckrodt DLT or Vivasight (ET
View Ltd, Misgav, Israel) VDLT with conventional laryngoscopy or video
laryngoscopy then verified correct tube position through the view provided
with either VDLT external monitor or FOB. Measurements and Main Results:
Data collected included: sex, body mass index, successful intubation and
endobronchial placement, intubation time, confirmation time of tube
position, FOB use, quality of view, dislodgement of tube, and ability to
forewarn dislodgement of endobronchial cuff and complications. FOB use for
verification of final position of the tube (VDLT 13.2% [5/38] v DLT 100%
[42/42], p < 0.0001), need for FOB to correct the dislodgement (VDLT 7.7%
[1/13] v DLT 100% [14/14], p < 0.0001), dislodgement during positioning
(VDLT 61.5% [8/13] v DLT 64.3% [9/14], p = ns), dislodgement during
surgery (VDLT 38.5% [5/13] v DLT 21.4% [3/14], p = ns), and ability to
forewarn dislodgement of endobronchial cuff (VDLT 18.4% [7/38] v DLT 4.8%
[2/42], p = 0.078). Conclusion: This study demonstrated a reduction of
86.8% in FOB use, which was a similar reduction found in other published
studies.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<133>
Accession Number
620585343
Title
Influence of 6% Hydroxyethyl Starch 130/0.4 Versus Crystalloid Solution on
Structural Renal Damage Markers After Coronary Artery Bypass Grafting: A
Post Hoc Subgroup Analysis of a Prospective Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 205-211),
2018. Date of Publication: February 2018.
Author
Datzmann T.; Hoenicka M.; Reinelt H.; Liebold A.; Gorki H.
Institution
(Datzmann, Reinelt) Department of Cardiac Anesthesiology, University
Hospital Ulm, Ulm, Germany
(Hoenicka, Liebold, Gorki) Department Cardiothoracic and Vascular Surgery,
University Hospital Ulm, Ulm, Germany
Publisher
W.B. Saunders
Abstract
Objective: The restriction of hydroxyethyl starch (HES) has mandated
changes in volume management based on data of critically ill patients.
Reliable data of structural renal damage after HES treatment in cardiac
surgical patients are lacking. The influence of 6% HES 130/0.4 was
investigated in this study. Design: An exploratory post hoc subgroup
analysis of a prospective trial was performed. Setting: The study was
carried out at a university hospital. Participants: Forty-four low-risk
cardiac surgical patients were examined. Interventions: Twenty-two
patients received only crystalloid solutions, and 22 were treated with
balanced 6% HES 130/0.4. Measurements and Main Results: Functional renal
parameters and the structural biomarkers alpha-glutathione S-transferase,
kidney injury molecule-1, liver fatty acid-binding protein, and neutrophil
gelatinase-associated lipocalin were investigated. Volume balances,
vasopressor dosages, blood losses, and coagulation parameters were
compared. Most functional and structural renal parameters did not differ
between the groups (serum creatinine p = 0.8380). Liver fatty acid-binding
protein was transiently higher in the HES group only at 24 hours
postoperatively (p = 0.0002). No differences in mortality, acute kidney
injury, and need for renal replacement therapy were observed. Blood
coagulation was significantly more compromised in the HES group at
intensive care unit arrival (factor II, p = 0.0012; factor X, p = 0.0031;
thrombocytes, p = 0.0010). Blood losses, and vasopressor dosages tended to
be higher in HES-treated patients without significance. Conclusion:
Overall, the values and time courses of the biomarkers used did not
indicate evidence of a mechanism for tubular injury caused by
HES.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<134>
Accession Number
620719044
Title
Plasma-Lyte 148 vs. Hartmann's solution for cardiopulmonary bypass pump
prime: a prospective double-blind randomized trial.
Source
Perfusion (United Kingdom). 33 (4) (pp 310-319), 2018. Date of
Publication: 01 May 2018.
Author
Weinberg L.; Chiam E.; Hooper J.; Liskaser F.; Hawkins A.K.; Massie D.;
Ellis A.; Tan C.O.; Story D.; Bellomo R.
Institution
(Weinberg, Hooper, Liskaser, Hawkins, Tan) Department of Anesthesia,
Austin Health, Heidelberg, VIC, Australia
(Weinberg, Chiam) Department of Surgery, The University of Melbourne,
Austin Health, VIC, Australia
(Massie, Ellis) Department of Clinical Pharmacology & Therapeutics, Austin
Hospital, Heidelberg, VIC, Australia
(Story) Anesthesia, Perioperative and Pain Medicine Unit, Melbourne
Medical School, University of Melbourne, VIC, Australia
(Bellomo) Department of Intensive Care, The University of Melbourne, VIC,
Australia
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: The mechanisms of acid-base changes during cardiopulmonary
bypass (CPB) remain unclear. We tested the hypothesis that, when used as
CPB pump prime solutions, Plasma-Lyte 148 (PL) and Hartmann's solution
(HS) have differential mechanisms of action in their contribution to
acid-base changes. Methods: We performed a prospective, double-blind,
randomized trial in adult patients undergoing elective cardiac surgery
with CPB. Participants received a CPB prime solution of 2000 mL, with
either PL or HS. The primary endpoint was the standard base excess (SBE)
value measured at 60 minutes after full CPB flows (SBE60min). Secondary
outcomes included changes in SBE, pH, chloride, sodium, lactate,
gluconate, acetate, strong ion difference and strong ion gap at two
(T2min), five (T5min), ten (T10min), thirty (T30min) and sixty (T60min)
minutes on CPB. The primary outcome was measured using a two-tailed
Welch's t-test. Repeated measures ANOVA was used to test for differences
between time points. Results: Twenty-five participants were randomized to
PL and 25 to HS. Baseline characteristics, EURO and APACHE scores,
biochemistry, hematology and volumes of cardioplegia were similar. Mean
(SD) SBE at T60min was -1.3 (1.4) in the PL group and -0.1 (2.7) in the HS
group; p=0.55. No significant differences in SBE between the groups was
observed during the first 60 minutes (p=0.48). During CPB, there was
hyperacetatemia and hypergluconatemia in the PL group and hyperlactatemia
and hyperchloremia in the HS group. No significant difference between the
groups in plasma bicarbonate levels and total weak acid levels were found.
Complications and intensive care unit and hospital length of stays were
similar. Conclusions: During CPB, PL and HS did not cause a significant
metabolic acidosis. There was hyperacetatemia and hypergluconatemia with
PL and hyperchloremia and hyperlactatemia with HS. These physiochemical
effects appear clinically innocuous.<br/>Copyright &#xa9; 2017, &#xa9; The
Author(s) 2017.

<135>
Accession Number
621493019
Title
Do selective serotonin reuptake inhibitors increase the risk of bleeding
or mortality following coronary artery bypass graft surgery? A
meta-analysis of observational studies.
Source
Perfusion (United Kingdom). 33 (6) (pp 415-422), 2018. Date of
Publication: 01 Sep 2018.
Author
Eckersley M.J.; Sepehripour A.H.; Casula R.; Punjabi P.; Athanasiou T.
Institution
(Eckersley, Sepehripour, Casula, Punjabi, Athanasiou) Department of
Surgery and Cancer, Imperial College London, London, United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: Depressive illness has a high prevalence in patients
undergoing coronary artery bypass graft surgery (CABG). The first line
treatment for depression are selective serotonin reuptake inhibitors
(SSRIs) which inhibit serotonin reuptake in the presynaptic neuronal
membrane and uptake by platelets, inhibiting subsequent serotonin-mediated
platelet activation. This presents a theoretically increased risk of
bleeding and subsequent postoperative mortality. This review aims to
investigate the effects of SSRIs on postoperative bleeding, defined as the
need for transfusions and re-operation for bleeding, as well as 30-day
mortality in patients undergoing CABG. Method: Four hundred and
thirty-seven papers were screened with seven meeting the full inclusion
criteria. Results: Meta-analysis demonstrated that SSRI use increased the
risk of red blood cell transfusion (odds ratio (OR) = 1.15; 95% confidence
interval (CI): 1.06-1.26), but resulted in no difference in the rate of
re-operation for bleeding (OR = 1.07; 95% CI: 0.66-1.74). SSRI use had no
effect on the rates of platelet (OR = 0.93; 95% CI: 0.79-1.09) or fresh
frozen plasma (OR = 0.96; 95% CI: 0.74-1.24) transfusion nor on the
mortality rate (OR =1.03; 95 CI: 0.90-1.17). Conclusion: This review
demonstrates that SSRIs are largely safe in cardiac surgery as no increase
in mortality was observed. However, there is a significantly raised chance
of red blood cell transfusion. The heterogeneous nature of the current
evidence base highlights the need for further research into SSRIs and
whether any effect on patient outcomes in cardiac surgery
occurs.<br/>Copyright &#xa9; The Author(s) 2018.

<136>
Accession Number
619924382
Title
Transfusion Requirements in Cardiac Surgery III (TRICS III): Study Design
of a Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 121-129),
2018. Date of Publication: February 2018.
Author
Shehata N.; Whitlock R.; Fergusson D.A.; Thorpe K.E.; MacAdams C.; Grocott
H.P.; Rubens F.; Fremes S.; Lellouche F.; Bagshaw S.; Royse A.; Rosseel
P.M.; Hare G.; Medicis E.D.; Hudson C.; Belley-Cote E.; Bainbridge D.;
Kent B.; Shaw A.; Byrne K.; Syed S.; Royse C.F.; McGuiness S.; Hall J.;
Mazer C.D.
Institution
(Shehata) Departments of Medicine, Laboratory Medicine and Pathobiology,
Institute of Health Policy Management and Evaluation, University of
Toronto, Division of Hematology, Mount Sinai Hospital, Toronto, Ontario,
Canada
(Whitlock) Department of Surgery, Population Health Research Institute,
McMaster University, David Braley Cardiac Vascular and Stroke Research
Institute, Hamilton, Ontario, Canada
(Fergusson) Ottawa Health Research Institute, University of Ottawa, The
Ottawa Hospital, General Campus, Centre for Practice-Changing Research,
Ottawa, Ontario, Canada
(Thorpe, Hall) Applied Health Research Center, St. Michael's Hospital,
Toronto, Ontario, Canada
(MacAdams) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, University of Melbourne, Toronto, Ontario, Canada
(Grocott) Departments of Anesthesia & Perioperative Medicine and Surgery,
University of Manitoba, St. Boniface General Hospital, Winnipeg, Manitoba,
Canada
(Rubens) Department of Surgery, University of Ottawa, Ottawa Heart
Institute, Ottawa, Ontario, Canada
(Fremes) Department of Surgery, University of Toronto, Sunnybrook Health
Sciences Centre, Toronto, Ontario, Canada
(Lellouche) Department of Medicine, University of Laval, Unite de
Recherche en Pneumologie, Quebec, Canada
(Bagshaw) Department of Critical Care Medicine, Faculty of Medicine and
Dentistry, University of Alberta, Edmonton, Alberta, Canada
(Royse, Royse) Department of Surgery, The University of Melbourne, The
Royal Melbourne Hospital, Parkville, Victoria, Australia
(Rosseel) Department of Anesthesia, Amphia Hospital, Breda, Netherlands
(Hare, Mazer) Department of Anesthesia, University of Toronto, St.
Michael's Hospital, Toronto, Ontario, Canada
(Medicis) Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke,
Quebec, Canada
(Hudson) Department of Anesthesia, University of Ottawa Heart Institute,
Ottawa, Ontario, Canada
(Belley-Cote) Department of Medicine, Population Health Research
Institute, McMaster University, Hamilton, Canada
(Bainbridge) Department of Anaesthesia and Perioperative Medicine, Western
University, London, Ontario, Canada
(Kent) Department of Anesthesia, Pain Management and Perioperative
Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
(Shaw) Department of Anesthesia, Vanderbilt University Medical Center,
Nashville, TN, United States
(Byrne) Department of Anesthesia, Waikato Hospital, Hamilton, New Zealand
(Syed) Department of Anesthesia, McMaster University, Hamilton Health
Sciences, Hamilton, Ontario, Canada
(Royse) Department of Cardiothoracic Anaesthesia, Royal Melbourne
Hospital, Parkville, Victoria, Australia
(McGuiness) Medical Research Institute of New Zealand, Auckland City
Hospital, Auckland, New Zealand
Publisher
W.B. Saunders
Abstract
Objectives: To determine if a restrictive transfusion threshold is
noninferior to a higher threshold as measured by a composite outcome of
mortality and serious morbidity. Design: Transfusion Requirements in
Cardiac Surgery (TRICS) III was a multicenter, international, open-label
randomized controlled trial of two commonly used transfusion strategies in
patients having cardiac surgery using a noninferiority trial design
(ClinicalTrials.gov number, NCT02042898). Setting: Eligible patients were
randomized prior to surgery in a 1:1 ratio. Participants: Potential
participants were 18 years or older undergoing planned cardiac surgery
using cardiopulmonary bypass (CPB) with a preoperative European System for
Cardiac Operative Risk Evaluation (EuroSCORE I) of 6 or more.
Interventions: Five thousand patients; those allocated to a restrictive
transfusion group received a red blood cell (RBC) transfusion if the
hemoglobin concentration (Hb) was less than 7.5 g/dL intraoperatively
and/or postoperatively. Patients allocated to a liberal transfusion
strategy received RBC transfusion if the Hb was less than 9.5 g/dL
intraoperatively or postoperatively in the intensive care unit or less
than 8.5 g/dL on the ward. Measurements and Main Results: The primary
outcome was a composite of all-cause mortality, myocardial infarction,
stroke, or new onset renal dysfunction requiring dialysis at hospital
discharge or day 28, whichever comes first. The primary outcome was
analyzed as a per-protocol analysis. The trial monitored adherence closely
as adherence to the transfusion triggers is important in ensuring that
measured outcomes reflect the transfusion strategy. Conclusion: By
randomizing prior to surgery, the TRICS III trial captured the most acute
reduction in hemoglobin during cardiopulmonary bypass.<br/>Copyright
&#xa9; 2018

<137>
Accession Number
2000552881
Title
Safety of Stenting and Endarterectomy for Asymptomatic Carotid Artery
Stenosis: A Meta-Analysis of Randomised Controlled Trials.
Source
European Journal of Vascular and Endovascular Surgery. 55 (5) (pp
614-624), 2018. Date of Publication: May 2018.
Author
Cui L.; Han Y.; Zhang S.; Liu X.; Zhang J.
Institution
(Cui, Zhang) Department of Vascular and Thyroid Surgery, The First
Hospital of China Medical University, Shenyang, China
(Han, Liu) Department of General Surgery, Shengjing Hospital of China
Medical University, Shenyang, China
(Zhang) Department of Endovascular Surgery, The First Hospital of
Zhengzhou University, Zhengzhou, China
Publisher
W.B. Saunders Ltd
Abstract
Objective/Background: A meta-analysis of recently published randomised
controlled trials (RCTs) was performed to evaluate the safety of carotid
artery stenting (CAS) versus carotid endarterectomy (CEA) for asymptomatic
carotid stenosis with average risk. Methods: The MEDLINE, Embase, and
Cochrane Library databases were systematically searched for RCTs that
compared CAS with CEA for asymptomatic carotid stenosis. These
publications reported clinical outcomes after revascularisation in
patients with asymptomatic carotid stenosis during their primary
intervention. Trials published in English were searched for on 31 May
2017. End points (composite of ipsilateral stroke, any stroke, major
stroke, minor stroke, myocardial infarction [MI], and death during the
post-procedural period) were extracted from the publications by two
reviewers. The pooled odds ratios (ORs) and 95% confidence intervals (CIs)
were calculated for peri-operative outcomes following CAS and CEA using a
fixed effects model. Results: Five studies involving 3901 patients (1585
with CEA; 2316 with CAS) were included in the meta-analysis. The risk of
any stroke during the peri-procedural period was significantly lower in
patients who underwent CEA than CAS (OR 0.53; 95% CI 0.29-0.96). The
difference between CAS and CEA in the rate of stroke could be driven by
minor stroke (OR 0.50; 95% CI 0.25-1.00). The risk of death, major stroke,
ipsilateral stroke, and MI were not significantly different between the
two interventions (peri-procedural death: OR 1.49 [95% CI 0.26-8.68];
peri-procedural major stroke: OR 0.69 [95% CI 0.20-2.35]; peri-procedural
ipsilateral stroke: OR 0.63 [95% CI 0.27-1.47]; peri-procedural MI: OR
1.75 [95% CI 0.84-3.65]). No robust conclusion could be drawn regarding
mid to long-term complications because of the heterogeneity of the
reported data. The different outcomes precluded any further analysis being
conducted. Conclusion: Among patients with asymptomatic carotid stenosis,
stenting has a significantly higher rate of any peri-procedural stroke and
peri-procedural minor stroke than CEA, and similar risk of peri-procedural
major stroke, peri-procedural ipsilateral stroke, or MI.<br/>Copyright
&#xa9; 2018 European Society for Vascular Surgery

<138>
Accession Number
619467904
Title
Multilevel Thoracic Paravertebral Block Using Ropivacaine With/Without
Dexmedetomidine in Video-Assisted Thoracoscopic Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 318-324),
2018. Date of Publication: February 2018.
Author
Xu J.; Yang X.; Hu X.; Chen X.; Zhang J.; Wang Y.
Institution
(Xu, Yang, Hu, Zhang, Wang) Department of Anesthesiology, Huashan
Hospital, Fudan University, Shanghai, China
(Chen) Department of Cardiothorcic Surgery, Huashan Hospital, Fudan
University, Shanghai, China
Publisher
W.B. Saunders
Abstract
Objectives: Thoracic paravertebral block (TPVB) is reported to have
advantages in postoperative pain management in unilateral thoracic
surgeries. Previous studies have demonstrated that dexmedetomidine could
be used as an adjuvant to local anesthetics, with the aim of prolonging
the duration of neural blockade. However, little is known about whether
such a combination could improve the quality of postoperative analgesia
compared with local anesthetic only when TPVB is used for patients
undergoing video-assisted thoracoscopic surgery (VATS). Design: A
prospective, randomized, controlled study. Setting: Single-center
university hospital. Participants: The study included 60 patients
undergoing VATS under general anesthesia. Interventions: The patients were
allocated randomly into the following 2 groups: 0.375% ropivacaine, 20 mL
only (group R, n = 30), and 0.375% ropivacaine, 20 mL plus 1 mug/kg of
dexmedetomidine (group RD, n = 30). At the end of surgery, TPVB guided
using ultrasound was performed at 4 points-T4-5, T5-6, T6-7, and T7-8-of
the surgical side; 5 mL of solution were injected at each point.
Postoperatively, the intravenous nonsteroidal anti-inflammatory drug
flurbiprofen was used as part of multimodal analgesia. Measurements and
Main Results: Pain scores at rest and during coughing were evaluated by a
blinded observer in the postanesthesia care unit postoperatively at 1, 2,
4, 8, 12, 24, 36, and 48 hours, and the dermatomal levels of sensory
blockade, postoperative requirements for rescue analgesia, adverse events,
and patient satisfaction also were recorded. There was a significant
reduction in postoperative pain scores at rest starting from the
postoperative 8th hour until the 48th hour and during coughing starting at
the postoperative 4th hour until the 48th hour in the group RD compared
with those in group R (p = 0.043). The dermatomal levels of sensory
blockade were comparable in the 2 groups. Patient satisfaction after
surgery was significantly higher in the group RD than in group R (p <
0.001). Total consumption of the intravenous rescue analgesic morphine and
adverse events were not significantly different between the 2 groups.
Conclusions: Compared with ropivacaine only, the addition of
dexmedetomidine, 1 mug/kg, to local anesthetic for multilevel TPVB in
patients undergoing VATS prolonged the duration of postoperative analgesia
and improved patient satisfaction without serious side effects when
combined with postoperative intravenous nonsteroidal anti-inflammatory
drug administration.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<139>
Accession Number
620683046
Title
Type II Minimal-Invasive Extracorporeal Circuit for Aortic Valve
Replacement: A Randomized Controlled Trial.
Source
Artificial Organs. 42 (6) (pp 620-629), 2018. Date of Publication: June
2018.
Author
Gygax E.; Kaeser H.-U.; Stalder M.; Gahl B.; Rieben R.; Carrel T.; Erdoes
G.
Institution
(Gygax, Kaeser, Stalder, Carrel) Department of Cardiovascular Surgery,
Inselspital, University Hospital Bern, University of Bern, Bern,
Switzerland
(Gahl) Clinical Trials Unit, Inselspital, University Hospital Bern,
University of Bern, Bern, Switzerland
(Rieben) Department for Biomedical Research, Inselspital, University
Hospital Bern, University of Bern, Bern, Switzerland
(Erdoes) Department of Anesthesiology and Pain Therapy, Inselspital,
University Hospital Bern, University of Bern, Bern, Switzerland
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Extracorporeal circulation triggers systemic inflammatory response and
coagulation disorders which may lead to unfavorable clinical outcome. A
type II minimally-invasive extracorporeal circuit (MiECC) is a closed
system with markedly reduced artificial surface as compared to
conventional extracorporeal circuits (CECC). The aim of this study was to
investigate and compare inflammatory responses, complement activation and
selected clinical end-points in isolated surgical aortic valve replacement
(SAVR) performed with a type II MiECC circuit or a CECC. Fifty patients
were prospectively randomized to MiECC or CECC perfusion regimen.
Complement activation (sC5b-9), inflammation (IL-6, TNF-alpha,
sCD40-ligand) and activation of the coagulation system (D-dimer,
TAT-complex) were determined before operation, at 2 hours and 24 hours
after surgery. Clinical end-points included perfusion time, transfusion of
allogeneic blood products, postoperative bleeding, sepsis, new onset of
atrial fibrillation, stroke and in-hospital mortality. Patient
characteristics and baseline plasma markers were similar in both groups.
Levels for sC5b-9, TNF-alpha, sCD40 ligand, TAT-complex and D-dimers were
not significantly different between MiECC and CECC at 2 hours and 24 hours
after surgery. The IL-6 plasma concentration was lower in the CECC group
at 24 hours (P = 0.026, vs. MiECC). Comparisons of the baseline level to
values at 2 hours and 24 hours, adjusted for the type of oxygenator and
hemoglobin, showed a significantly lower sC5b-9 in MiECC at 2 hours (P =
0.013), but no difference at 24 hours (P=0.990). Compared with CECC, MiECC
patients had a shorter perfusion time (P = 0.037) and less transfusion
requirements (P = 0.04). In this selected cohort of SAVR patients, the
type II MiECC was not inferior to CECC in terms of inflammatory response
and complement activation. Thus, MiECC might be an alternative perfusion
strategy to conventional.<br/>Copyright &#xa9; 2018 International Center
for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

<140>
Accession Number
620676488
Title
Is the use of hydroxyethyl starch as priming solution during cardiac
surgery advisable? A randomized, single-center trial.
Source
Perfusion (United Kingdom). 33 (6) (pp 483-489), 2018. Date of
Publication: 01 Sep 2018.
Author
Svendsen O.S.; Farstad M.; Mongstad A.; Haaverstad R.; Husby P.; Kvalheim
V.L.
Institution
(Svendsen, Farstad, Husby) Department of Anesthesia and Intensive Care,
Haukeland University Hospital, Bergen, Norway
(Mongstad, Haaverstad, Kvalheim) Section for Cardiothoracic Surgery,
Department for Heart Disease, Haukeland University Hospital, Bergen,
Norway
(Haaverstad, Kvalheim) Department of Clinical Science, Faculty of
Medicine, University of Bergen, Bergen, Norway
(Husby) Department of Clinical Medicine, Faculty of Medicine, University
of Bergen, Bergen, Norway
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: The use of cardiopulmonary bypass (CPB) leads to increased
fluid filtration and edema. The use of artificial colloids to counteract
fluid extravasation during cardiac surgery is controversial. Beneficial
effects on global fluid loading, leading to better cardiac performance and
hemodynamics, have been claimed. However, renal function and coagulation
may be adversely affected, with unfavorable impact on outcome following
cardiac surgery. Methods: Forty patients were randomly allocated to study
groups receiving either acetated Ringer's solution (CT group) or
hydroxyethyl starch (HES group, Tetraspan) as CPB priming
solution. Fluid balance, bleeding and hemodynamics, including cardiac
output, were followed postoperatively. The occurrence of acute kidney
injury was closely registered. Results: Two patients were excluded from
further analyzes due to surgical complications. Fluid accumulation was
attenuated in the HES group (3374 (883) ml) compared with the CT group
(4328 (1469) ml) (p=0.024). The reduced perioperative fluid accumulation
was accompanied by an increased cardiac index immediately after surgery
(2.7 (0.4) L/min/m² in the HES group and 2.1 (0.3)
L/min/m² in the CT group (p<0.001)). No increase in bleeding
could be demonstrated in the HES group. Three patients, all of them in the
HES group, experienced acute kidney injury postoperatively. Conclusions:
CPB priming with HES solution lowers fluid loading during bypass and
improves cardiac function in the early postoperative period. The
manifestation of acute kidney injury exclusively in the HES group of
patients raises doubts about the use of HES products in conjunction with
cardiac surgery.
(https://clinicaltrials.gov/ct2/show/NCT01511120).<br/>Copyright &#xa9;
The Author(s) 2017.

<141>
Accession Number
618981393
Title
Metamizole and Platelet Inhibition by Aspirin Following On-Pump Coronary
Artery Bypass Grafting.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 178-186),
2018. Date of Publication: February 2018.
Author
Wilczynski M.; Wybraniec M.T.; Sanak M.; Goral J.; Mizia-Stec K.
Institution
(Wilczynski) Department of Cardiac Surgery, Medical University of Lodz,
Lodz, Poland
(Wybraniec, Mizia-Stec) First Department of Cardiology, School of Medicine
in Katowice, Medical University of Silesia, Katowice, Poland
(Sanak) II Department of Internal Medicine, Division of Molecular Biology
and Clinical Genetics, Jagiellonian University Medical College, Krakow,
Poland
(Goral) Department of Laboratory Medicine, Public Hospital No 7 in
Katowice, Upper Silesia Medical Center, Katowice, Poland
Publisher
W.B. Saunders
Abstract
Objective: The purpose of the study was to evaluate the impact of
intravenous metamizole on platelet inhibition by aspirin in patients with
coronary artery disease early after on-pump coronary artery bypass
grafting (CABG). Design: Prospective, single-blind, randomized trial.
Setting: Tertiary referal hospital. Participants: The study comprised 43
patients with multivessel coronary artery disease undergoing CABG.
Interventions: Patients were randomized to postoperative intravenous
metamizole +/- opioids (study group; n = 23) or opioids alone (control
group; n = 20). Aspirin was withheld at least 7 days before the surgery
and reinitiated (300 mg) immediately after the procedure prior to
metamizole use, and continued daily thereafter (150 mg). Platelet function
was evaluated using multielectrode impedance aggregometry (acid-induced
platelet activation [ASPI] and collagen-induced platelet activation [COL]
test), P-selectin expression and urinary 11-dehydro-thromboxane
B<inf>2</inf> (11-DTXB<inf>2</inf>) level at baseline, postoperative day
(POD) 0, POD 1, POD 2, and POD 6. Residual platelet reactivity (RPR) was
defined as ASPI test >400 AU*min. Measurements and Main Results: In all
study participants, postoperative ASPI test value moderately decreased
(1058.2 v 966.6 AU*min, p = 0.047), urinary 11-DTXB<inf>2</inf> level
increased (923.4 v 4367.3 pg/mg, p < 0.001), and P-selectin expression and
COL test value remained stable postprocedure. The decreases of ASPI (p =
0.146) and COL test (p = 0.642), and P-selectin expression (p = 0.318) did
not differ between both groups. Patients in the control group had higher
postoperative increase of urinary 11-DTXB<inf>2</inf> level (p = 0.001).
The prevalence of RPR was high and comparable between study and control
groups (day 1, 95.6% v 100%, p = 0.535; day 6, 100% v 90%, p = 0.21).
Multivariate analysis revealed that metamizole use did not predict the
fluctuations of ASPI and COL test values and P-selectin expression, yet it
independently predicted postoperative change of 11-DTXB<inf>2</inf> level
(b = -0.518, p = 0.001). Conclusions: Intravenous metamizole preceded by a
loading dose of aspirin did not modify platelet response to aspirin in the
postoperative period after CABG.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<142>
Accession Number
618847531
Title
A Comparison of 3 Videolaryngoscopes for Double-Lumen Tube Intubation in
Humans by Users With Mixed Experience: A Randomized Controlled Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 277-286),
2018. Date of Publication: February 2018.
Author
El-Tahan M.R.; Khidr A.M.; Gaarour I.S.; Alshadwi S.A.; Alghamdi T.M.;
Al'ghamdi A.
Institution
(El-Tahan, Khidr, Gaarour, Alshadwi, Alghamdi, Al'ghamdi) Anesthesiology
Department, King Fahd Hospital of Imam Abdulrahman Bin Faisal University
(formerly University of Dammam), Dammam, Saudi Arabia
Publisher
W.B. Saunders
Abstract
Objectives: To test the hypothesis that laryngoscopy using the Airtraq
(Prodol Limited, Viscaya, Spain) or King Vision laryngoscope (KVL) (Ambu
A/S, Ballerup, Denmark) would result in a shorter time for successful
double-lumen endobronchial tube (DLT) intubation by users with mixed
experience than the time required using the Macintosh or GlideScope
(Verathon Inc., Bothell, WA) laryngoscopes. Design: A randomized,
prospective, blind study. Setting: A single university hospital.
Participants: The study comprised 133 patients undergoing elective
thoracic surgery. Interventions: Patients were randomly allocated into the
following 4 groups of DLTs: Macintosh (n = 32), GlideScope (n = 34),
Airtraq (n = 35), or KVL (n = 32). Measurements and Main Results: The
following data were recorded: time required for achieving successful DLT
intubation; glottis visualization; optimization maneuvers; first-pass
success rate; intubation difficulty; failure to intubate, defined as an
attempt taking >150 seconds to perform or if peripheral oxygen saturation
<92% was noted; and postoperative sore throat and hoarseness were
recorded. Compared with GlideScope, the Airtraq resulted in shorter times
for achieving successful DLT intubation (median times: 21 s [95%
confidence interval 23.9-70.8 s] v 57.5 s [95% confidence interval
46.2-89.1 s], respectively; p = 0.021); a lower score for difficult
intubations (p = 0.023); and fewer optimization maneuvers. The 4
laryngoscopes were associated with comparable glottis visualization;
first-pass success rate (100%, 100%, 94.4%, and 100%, respectively; p =
0.522); incidence of oropharyngeal trauma; postoperative sore throat; and
hoarseness of voice. There were 2 (5.7%) endobronchial intubation failures
using the Airtraq due to the inability to advance the DLT through the
glottis opening. The experience of the anesthesiologists in using the 4
devices had a statistically significant negative correlation with the time
to confirmation of endobronchial intubation (Spearman r -0.392; p <
0.001). Conclusion: When used by operators with mixed experience, the
channeled Airtraq required less time for DLT intubation and was easier to
use than the GlideScope, although failures did occur with the Airtraq,
whereas they did not occur with the other systems.<br/>Copyright &#xa9;
2017 Elsevier Inc.

<143>
Accession Number
619159136
Title
Nonsurgical Strategies to Reduce Mortality in Patients Undergoing Cardiac
Surgery: An Updated Consensus Process.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 225-235),
2018. Date of Publication: February 2018.
Author
Landoni G.; Lomivorotov V.; Silvietti S.; Nigro Neto C.; Pisano A.; Alvaro
G.; Hajjar L.A.; Paternoster G.; Riha H.; Monaco F.; Szekely A.; Lembo R.;
Aslan N.A.; Affronti G.; Likhvantsev V.; Amarelli C.; Fominskiy E.;
Baiardo Redaelli M.; Putzu A.; Baiocchi M.; Ma J.; Bono G.; Camarda V.;
Covello R.D.; Di Tomasso N.; Labonia M.; Leggieri C.; Lobreglio R.; Monti
G.; Mura P.; Scandroglio A.M.; Pasero D.; Turi S.; Roasio A.; Votta C.D.;
Saporito E.; Riefolo C.; Sartini C.; Brazzi L.; Bellomo R.; Zangrillo A.
Institution
(Landoni, Silvietti, Monaco, Lembo, Affronti, Baiardo Redaelli, Camarda,
Di Tomasso, Leggieri, Monti, Scandroglio, Turi, Votta, Riefolo, Sartini,
Zangrillo) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Landoni, Zangrillo) Vita-Salute San Raffaele University, Milan, Italy
(Lomivorotov, Fominskiy) Department of Anaesthesiology and Intensive Care,
Siberian Biomedical Research Center of the Ministry of Health,
Novosibirsk, Russian Federation
(Nigro Neto) Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
(Pisano) Division of Cardiac Anesthesia and Intensive Care, Azienda
Ospedaliera Dei Colli, Monaldi Hospital, Naples, Italy
(Alvaro, Bono, Labonia, Saporito) Department of Anesthesia and Intensive
Care, Policlinico Universitario Mater Domini, Catanzaro, Italy
(Hajjar) Surgical Intensive Care, Department of Cardiopneumology, InCor,
University of Sao Paulo., Sao Paulo, Brazil
(Paternoster) Department of Cardiovascular Anaesthesia and Intensive Care,
Ospedale San Carlo, Potenza, Italy
(Riha) Cardiothoracic Anaesthesiology and Intensive Care, Department of
Anaesthesiology and Intensive Care Medicine, Institute for Clinical and
Experimental Medicine, Prague, Czech Republic
(Szekely) Department of Anesthesia and Intensive Care, Semmelweis Egyetem,
Budapest, Hungary
(Aslan) Medipol Mega University Hospital, Department of Anesthesiology and
Intensive Care, Istanbul, Turkey
(Likhvantsev) Department of Anesthesia and Intensive Care, Moscow Regional
Clinical and Research Institute, Moscow, Russian Federation
(Amarelli) Department of Cardiovascular Surgery and Transplants, Monaldi
Hospital, Azienda dei Colli, Naples, Italy
(Putzu) Department of Cardiovascular Anesthesia and Intensive Care,
Cardiocentro Ticino, Lugano, Switzerland
(Baiocchi) Department of Anesthesia and Intensive Care, S. Orsola-Malpighi
University Hospital, Bologna, Italy
(Ma) Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Covello) Anesthesia and Intensive Care Unit, Busto Arsizio Hospital, ASST
Valle Olona, Varese, Italy
(Lobreglio, Pasero, Brazzi) Department of Anesthesia and Intensive Care,
A.O.U. Citta della Salute e della Scienza, Turin, Italy
(Mura) Department of Anesthesia and Intensive Care Unit, Policlinico
Duilio Casula AOU Cagliari, Department of Medical Sciences "M. Aresu,
Cagliari, Italy
(Roasio) Department of Anaesthesia and Intensive Care, Ospedale Cardinal
Massaia di Asti, Asti, Italy
(Bellomo) School of Medicine, The University of Melbourne, Parkville,
Melbourne, Australia
(Brazzi) Department of Surgical Sciences, University of Turin, Italy
Publisher
W.B. Saunders
Abstract
Objective: A careful choice of perioperative care strategies is pivotal to
improve survival in cardiac surgery. However, there is no general
agreement or particular attention to which nonsurgical interventions can
reduce mortality in this setting. The authors sought to address this issue
with a consensus-based approach. Design: A systematic review of the
literature followed by a consensus-based voting process. Setting: A
web-based international consensus conference. Participants: More than 400
physicians from 52 countries participated in this web-based consensus
conference. Interventions: The authors identified all studies published in
peer-reviewed journals that reported on interventions with a statistically
significant effect on mortality in the setting of cardiac surgery through
a systematic Medline/PubMed search and contacts with experts. These
studies were discussed during a consensus meeting and those considered
eligible for inclusion in this study were voted on by clinicians
worldwide. Measurements and Main Results: Eleven interventions finally
were selected: 10 were shown to reduce mortality (aspirin, glycemic
control, high-volume surgeons, prophylactic intra-aortic balloon pump,
levosimendan, leuko-depleted red blood cells transfusion, noninvasive
ventilation, tranexamic acid, vacuum-assisted closure, and volatile
agents), whereas 1 (aprotinin) increased mortality. A significant
difference in the percentages of agreement among different countries and a
variable gap between agreement and clinical practice were found for most
of the interventions. Conclusions: This updated consensus process
identified 11 nonsurgical interventions with possible survival
implications for patients undergoing cardiac surgery. This list of
interventions may help cardiac anesthesiologists and intensivists
worldwide in their daily clinical practice and can contribute to direct
future research in the field.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<144>
Accession Number
619146700
Title
Transfusion Threshold of Hemoglobin 80 g/L Is Comparable to 100 g/L in
Terms of Bleeding in Cardiac Surgery: A Prospective Randomized Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 131-139),
2018. Date of Publication: February 2018.
Author
Laine A.; Niemi T.; Schramko A.
Institution
(Laine, Niemi, Schramko) Division of Anesthesiology, Department of
Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki,
Helsinki University Hospital, Helsinki, Finland
Publisher
W.B. Saunders
Abstract
Objective: Anemia is common after cardiac surgery and, according to some
suggestive evidence, may be associated with increased bleeding, other
morbidity, and mortality. However, transfusion of red blood cells (RBC)
may cause adverse effects and increase cost. The authors hypothesized that
the restrictive hemoglobin threshold (Hb of 80 g/L) may aggravate bleeding
more than the higher Hb threshold (Hb 100 g/L). Design: Prospective
randomized trial. Type of Hospital: University Hospital of Helsinki,
Finland. Participants: Eighty patients with written informed consent,
scheduled for elective open-heart surgery were randomized in 2 groups.
Interventions: Two study groups had RBC transfusion threshold of either Hb
80 g/L or 100 g/L. These triggers were followed for a 24-hour period
postoperatively. A medical follow-up was carried out for 7 days after
surgery. Measurements and Main Results: Rotational thromboelastometry
(ROTEM) and conventional laboratory tests were performed to evaluate
coagulation. There was no significant difference in bleeding or ROTEM
parameters between the groups. Complication rate and Hb concentration
after 7-day follow-up were not different between the groups, but Group 100
g/L had received twice the amount of RBC transfusions. Conclusion: Hb
threshold of 80 g/L for RBC transfusion in cardiac surgery is comparable
to 100 g/L in terms of bleeding and possibly short-term
complications.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<145>
Accession Number
623984852
Title
Clinical effectiveness of incentive spirometry for the prevention of
postoperative pulmonary complications.
Source
Respiratory Care. 63 (3) (pp 347-352), 2018. Date of Publication: 01 Mar
2018.
Author
Eltorai A.E.M.; Szabo A.L.; Antoci V.; Ventetuolo C.E.; Elias J.A.;
Daniels A.H.; Hess D.R.
Institution
(Eltorai, Antoci, Ventetuolo, Elias, Daniels) Warren Alpert Medical School
of Brown University, Providence, RI, United States
(Szabo) The Cleveland Clinic, Cleveland, OH, United States
(Hess) Massachusetts General Hospital, Boston, MA, United States
Publisher
American Association for Respiratory Care
Abstract
Incentive spirometry (IS) is commonly prescribed to reduce pulmonary
complications, despite limited evidence to support its benefits and a lack
of consensus on optimal protocols for its use. Although numerous studies
and meta-analyses have examined the effects of IS on patient outcomes,
there is no clear evidence establishing its benefit to prevent
postoperative pulmonary complications. Clinical practice guidelines advise
against the routine use of IS in postoperative care. Until evidence of
benefit from well-designed clinical trials becomes available, the routine
use of IS in postoperative care is not supported by high levels of
evidence.<br/>Copyright &#xa9; 2018 Daedalus Enterprises.

<146>
Accession Number
619216352
Title
A Randomized Controlled Trial Comparing the Utility of Lighted Stylet and
GlideScope for Double-Lumen Endobronchial Intubation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 290-296),
2018. Date of Publication: February 2018.
Author
Chang J.-E.; Kim H.; Min S.-W.; Lee J.-M.; Ryu J.-H.; Yoon S.; Hwang J.-Y.
Institution
(Chang, Kim, Min, Lee, Hwang) Department of Anesthesiology and Pain
Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
(Ryu) Department of Anesthesiology & Pain Medicine, Seoul National
University Bundang Hospital, Gyeonggi-go, South Korea
(Yoon) Department ofDepartment of Anesthesiology & Pain Medicine, Seoul
National University Hospital, Seoul, South Korea
Publisher
W.B. Saunders
Abstract
Objective: To compare GlideScope and lighted stylet for double-lumen
endobronchial tube (DLT) intubation in terms of intubation time, success
rate of first attempt at intubation, difficulty in DLT advancement toward
the glottis, and postoperative sore throat and hoarseness. Design: A
prospective, randomized study. Setting: Medical center governed by a
university hostpial. Participants: Sixty-two adult patients undergoing
thoracic surgery using DLT intubation. Intervention: After the induction
of anesthesia, DLT intubation was performed using GlideScope (n = 32) or
lighted stylet (n = 32). Measurements and Main Results: Number of
intubation attempts, difficulty of DLT advancement toward the glottis,
time taken for DLT intubation, and the incidence and severity of
postoperative sore throat and hoarseness at 1 and 24 hours after surgery
were evaluated. Time taken for DLT intubation was shorter in the lighted
stylet group compared with the GlideScope group (30 [28-32] s v 45 [38-53]
s, median [interquartile range], respectively; p < 0.001). DLT advancement
toward the glottis was easier in the lighted stylet group than in the
GlideScope group (p = 0.016). The success rate of DLT intubation in the
first attempt (96.9% v 90.6% for lighted stylet and GlideScope,
respectively), and the incidence and severity of postoperative sore throat
and hoarseness were not different between the two groups. Conclusions: The
use of lighted stylet allowed easier advancement of the DLT toward the
glottis in the oropharyngeal space and reduced time for achieving DLT
intubation compared with GlideScope.<br/>Copyright &#xa9; 2018 Elsevier
Inc.

<147>
Accession Number
624242679
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: 01 Feb 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, China
Publisher
NLM (Medline)
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 (T1), immediately before (T2) and after (T3) and 1 minute (T4)
after intubation; (5) the number of patients with hypoxemia (SpO2 < 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 T1, systolic blood pressure (sBP),
diastolic BP (dBP), and heart rate (HR) at T2 in both groups were higher
(p < 0.05) in the DLT group. Then, compared to T2, sBP and dBP at T3 and
T4 and HR at T3 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. All
rights reserved.

<148>
Accession Number
2001132716
Title
Radial versus femoral access and bivalirudin versus unfractionated heparin
in invasively managed patients with acute coronary syndrome (MATRIX):
final 1-year results of a multicentre, randomised controlled trial.
Source
The Lancet. 392 (10150) (pp 835-848), 2018. Date of Publication: 8 - 14
September 2018.
Author
Valgimigli M.; Frigoli E.; Leonardi S.; Vranckx P.; Rothenbuhler M.;
Tebaldi M.; Varbella F.; Calabro P.; Garducci S.; Rubartelli P.; Briguori
C.; Ando G.; Ferrario M.; Limbruno U.; Garbo R.; Sganzerla P.; Russo F.;
Nazzaro M.; Lupi A.; Cortese B.; Ausiello A.; Ierna S.; Esposito G.;
Ferrante G.; Santarelli A.; Sardella G.; de Cesare N.; Tosi P.; van 't Hof
A.; Omerovic E.; Brugaletta S.; Windecker S.; Heg D.; Juni P.; Campo G.;
Uguccioni L.; Tamburino C.; Presbitero P.; Zavalloni-Parenti D.; Ferrari
F.; Ceravolo R.; Tarantino F.; Pasquetto G.; Casu G.; Mameli S.; Stochino
M.L.; Mazzarotto P.; Cremonesi A.; Saia F.; Saccone G.; Abate F.; Picchi
A.; Violini R.; Colangelo S.; Boccuzzi G.; Guiducci V.; Vigna C.;
Zingarelli A.; Gagnor A.; Zaro T.; Tresoldi S.; Vandoni P.; Contarini M.;
Liso A.; Dellavalle A.; Curello S.; Mangiacapra F.; Evola R.; Palmieri C.;
Falcone C.; Liistro F.; Creaco M.; Colombo A.; Chieffo A.; Perkan A.; De
Servi S.; Fischetti D.; Rigattieri S.; Sciahbasi A.; Pucci E.; Romagnoli
E.; Moretti C.; Moretti L.; De Caterina R.; Caputo M.; Zimmarino M.;
Bramucci E.; Di Lorenzo E.; Turturo M.; Bonmassari R.; Penzo C.; Loi B.;
Mauro C.; Petronio A.S.; Gabrielli G.; Micari A.; Belloni F.; Amico F.;
Comeglio M.; Fresco C.; Klinieken I.; Van Mieghem N.; Diletti R.; Regar
E.; Sabate M.; Gomez Hospital J.A.; Diaz Fernandez J.F.; Mainar V.; de la
Torre Hernandez J.M.
Institution
(Valgimigli, Windecker) Inselspital, Bern University Hospital, University
of Bern, Bern, Switzerland
(Frigoli, Rothenbuhler, Heg) Clinical Trials Unit, University of Bern,
Bern, Switzerland
(Leonardi, Ferrario) UOC Cardiologia, Dipartimento CardioToracoVascolare,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
(Tebaldi) University Hospital of Ferrara, Ferrara, Italy
(Varbella) Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3,
Turin, Italy
(Calabro) Division of Clinical Cardiology, "Sant'Anna e San Sebastiano"
Hospital, Caserta, Italy
(Calabro) Department of Translational Medical Sciences, University of
Campania "Luigi Vanvitelli", Naples, Italy
(Garducci) A.O. Ospedale Civile di Vimercate, Vimercate, Italy
(Rubartelli) Department of Cardiology, ASL3 Ospedale Villa Scassi, Genoa,
Italy
(Briguori) Clinica Mediterranea, Naples, Italy
(Ando) Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino",
University of Messina, Messina, Italy
(Limbruno) UO Cardiologia, ASL 9 Grosseto, Grosseto, Italy
(Garbo) San Giovanni Bosco Hospital, Turin, Italy
(Sganzerla) AO Ospedale Treviglio-Caravaggio, Treviglio, Italy
(Russo) Azienda Ospedaliera Sant'Anna, Como, Italy
(Nazzaro) San Camillo-Forlanini, Roma, Italy
(Lupi) Division of Cardiology, ASL VCO, Verbania, Italy
(Cortese) Ospedale FatebeneFratelli, Milano, Italy
(Ausiello) Casa di Cura Villa Verde, Taranto, Italy
(Ierna) Ospedale Sirai, Carbonia, Carbonia, Italy
(Esposito) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University of Naples, Naples, Italy
(Ferrante) IRCCS Humanitas, Milan, Italy
(Santarelli) Cardiovascular Department, Infermi Hospital, Rimini, Italy
(Sardella) Policlinico Umberto I, "Sapienza" University of Rome, Rome,
Italy
(de Cesare) Policlinico San Marco, Zingonia, Italy
(Tosi) Mater Salutis Hospital, Legnago, Italy
(van 't Hof) Department of Cardiology, Maastricht University Medical
Center (MUMC+), Maastricht, Netherlands
(Omerovic) Sahlgrenska University Hospital, Gothenburg, Sweden
(Brugaletta) Hospital Clinic, University of Barcelona, Thorax Institute,
Department of Cardiology, Barcelona, Spain
(Juni) Applied Health Research Centre (AHRC), Li Ka Shing Knowledge
Institute of St Michael's Hospital, Department of Medicine and Institute
of Health Policy, Management and Evaluation, University of Toronto,
Toronto, ON, Canada
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: The Minimizing Adverse Haemorrhagic Events by Transradial
Access Site and Systemic Implementation of Angiox (MATRIX) programme was
designed to assess the comparative safety and effectiveness of radial
versus femoral access and of bivalirudin versus unfractionated heparin
with optional glycoprotein IIb/IIIa inhibitors in patients with the whole
spectrum of acute coronary syndrome undergoing invasive management. Here
we describe the prespecified final 1-year outcomes of the entire
programme. Methods: MATRIX was a programme of three nested, randomised,
multicentre, open-label, superiority trials in patients with acute
coronary syndrome in 78 hospitals in Italy, the Netherlands, Spain, and
Sweden. Patients with ST-elevation myocardial infarction were
simultaneously randomly assigned (1:1) before coronary angiography to
radial or femoral access and to bivalirudin, with or without
post-percutaneous coronary intervention infusion or unfractionated heparin
(one-step inclusion). Patients with non-ST-elevation acute coronary
syndrome were randomly assigned (1:1) before coronary angiography to
radial or femoral access and, only if deemed eligible to percutaneous
coronary intervention after angiography (two-step inclusion), entered the
antithrombin type and treatment duration programmes. Randomisation
sequences were computer generated, blocked, and stratified by intended new
or current use of P2Y12 inhibitor (clopidogrel vs ticagrelor or
prasugrel), and acute coronary syndrome type (ST-elevation myocardial
infarction, troponin-positive, or troponin-negative non-ST-elevation acute
coronary syndrome). Bivalirudin was given as a bolus of 0.75 mg/kg,
followed immediately by an infusion of 1.75 mg/kg per h until completion
of percutaneous coronary intervention. Heparin was given at 70-100 units
per kg in patients not receiving glycoprotein IIb/IIIa inhibitors, and at
50-70 units per kg in patients receiving glycoprotein IIb/IIIa inhibitors.
Clinical follow-up was done at 30 days and 1 year. Co-primary outcomes for
MATRIX access and MATRIX antithrombin type were major adverse
cardiovascular events, defined as the composite of all-cause mortality,
myocardial infarction, or stroke up to 30 days; and net adverse clinical
events, defined as the composite of non-coronary artery bypass
graft-related major bleeding, or major adverse cardiovascular events up to
30 days. The primary outcome for MATRIX treatment duration was the
composite of urgent target vessel revascularisation, definite stent
thrombosis, or net adverse clinical events up to 30 days. Analyses were
done according to the intention-to-treat principle. This trial is
registered with ClinicalTrials.gov, number NCT01433627. Findings: Between
Oct 11, 2011, and Nov 7, 2014, we randomly assigned 8404 patients to
receive radial (4197 patients) or femoral (4207 patients) access. Of these
8404 patients, 7213 were included in the MATRIX antithrombin type study
and were randomly assigned to bivalirudin (3610 patients) or heparin (3603
patients). Patients assigned to bivalirudin were included in the MATRIX
treatment duration study, and were randomly assigned to post-procedure
infusion (1799 patients) or no post-procedure infusion (1811 patients). At
1 year, major adverse cardiovascular events did not differ between
patients assigned to radial access compared with those assigned to femoral
access (14.2% vs 15.7%; rate ratio 0.89, 95% CI 0.80-1.00; p=0.0526), but
net adverse clinical events were fewer with radial than with femoral
access (15.2% vs 17.2%; 0.87, 0.78-0.97; p=0.0128). Compared with heparin,
bivalirudin was not associated with fewer major adverse cardiovascular
(15.8% vs 16.8%; 0.94, 0.83-1.05; p=0.28) or net adverse clinical events
(17.0% vs 18.4%; 0.91, 0.81-1.02; p=0.10). The composite of urgent target
vessel revascularisation, stent thrombosis, or net adverse clinical events
did not differ with or without post-procedure bivalirudin infusion (17.4%
vs 17.4%; 0.99, 0.84-1.16; p=0.90). Interpretation: In patients with acute
coronary syndrome, radial access was associated with lower rates of net
adverse clinical events compared with femoral access, but not major
adverse cardiovascular events at 1 year. Bivalirudin with or without
post-procedure infusion was not associated with lower rates of major
adverse cardiovascular events or net adverse clinical events. Radial
access should become the default approach in acute coronary syndrome
patients undergoing invasive management. Funding: Italian Society of
Invasive Cardiology, The Medicines Company, Terumo, amd Canada Research
Chairs Programme.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<149>
Accession Number
624414720
Title
Intra-coronary morphine versus placebo in the treatment of acute
ST-segment elevation myocardial infarction: The MIAMI randomized
controlled trial.
Source
BMC Cardiovascular Disorders. 18 (1) (no pagination), 2018. Article
Number: 193. Date of Publication: 19 Oct 2018.
Author
Le Corvoisier P.; Gallet R.; Lesault P.-F.; Audureau E.; Paul M.; Ternacle
J.; Ghostine S.; Champagne S.; Arrouasse R.; Bitari D.; Mouillet G.;
Dubois-Rande J.-L.; Berdeaux A.; Ghaleh B.; Deux J.-F.; Teiger E.
Institution
(Le Corvoisier, Arrouasse, Bitari) Department VERDI, Inserm, CIC1430,
AP-HP, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny,
Creteil F-94010, France
(Le Corvoisier, Gallet, Dubois-Rande, Berdeaux, Ghaleh, Teiger) Inserm,
U955 Team 3, Creteil F-94010, France
(Gallet, Lesault, Ternacle, Champagne, Mouillet, Teiger) Interventional
Cardiology Unit, AP-HP, Henri Mondor Hospital, Creteil F-94010, France
(Audureau) Department of Public Health and CEPIA EA7376, AP-HP, Henri
Mondor Hospital, Creteil F-94010, France
(Paul) Department of Pharmacy, AP-HP, Henri Mondor Hospital, Creteil
F-94010, France
(Ghostine) Department of Cardiology, Marie-Lannelongue Hospital, Le
Plessis-Robinson F-92350, France
(Dubois-Rande) Department of Cardiology, AP-HP, Henri Mondor Hospital,
Creteil F-94010, France
(Deux) Department of Radiology, AP-HP, Henri Mondor Hospital, Creteil
F-94010, France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Experimental studies suggest that morphine may protect the
myocardium against ischemia-reperfusion injury by activating salvage
kinase pathways. The objective of this two-center, randomized,
double-blind, controlled trial was to assess potential cardioprotective
effects of intra-coronary morphine in patients with ST-segment elevation
myocardial infarction (STEMI) referred for primary percutaneous
intervention. Methods: Ninety-one patients with STEMI were randomly
assigned to intracoronary morphine (1 mg) or placebo at reperfusion of the
culprit coronary artery. The primary endpoint was infarct size/left
ventricular mass ratio assessed by magnetic resonance imaging on day 3-5.
Secondary endpoints included the areas under the curve (AUC) for troponin
T and creatine kinase over three days, left ventricular ejection fraction
assessed by echocardiography on days 1 and 6, and clinical outcomes.
Results: Infarct size/left ventricular mass ratio was not significantly
reduced by intracoronary morphine compared to placebo (27.2% +/- 15.0% vs.
30.5% +/- 10.6%, respectively, p = 0.28). Troponin T and creatine kinase
AUCs were similar in the two groups. Morphine did not improve left
ventricular ejection fraction on day 1 (49.7 +/- 10.3% vs. 49.3 +/- 9.3%
with placebo, p = 0.84) or day 6 (48.5 +/- 10.2% vs. 49.0 +/- 8.5% with
placebo, p = 0.86). The number of major adverse cardiac events, including
stent thrombosis, during the one-year follow-up was similar in the two
groups. Conclusions: Intracoronary morphine at reperfusion did not
significantly reduce infarct size or improve left ventricular systolic
function in patients with STEMI. Presence of comorbidities in some
patients may contribute to explain these results. Trial registration:
ClinicalTrials.gov, NCT01186445 (date of registration: August 23,
2010).<br/>Copyright &#xa9; 2018 The Author(s).

<150>
Accession Number
624341050
Title
Effects of dexmedetomidine infusion on inflammatory responses and injury
of lung tidal volume changes during one-lung ventilation in thoracoscopic
surgery: A randomized controlled trial.
Source
Mediators of Inflammation. 2018 (no pagination), 2018. Article Number:
2575910. Date of Publication: 2018.
Author
Wu C.-Y.; Lu Y.-F.; Wang M.-L.; Chen J.-S.; Hsu Y.-C.; Yang F.-S.; Cheng
Y.-J.
Institution
(Wu, Wang, Hsu, Yang, Cheng) Anesthesiology Department, National Taiwan
University Hospital, Taiwan (Republic of China)
(Lu) Anesthesiology Department, National Taiwan University Hospital,
Hsinchu Branch, Taiwan (Republic of China)
(Chen) Surgery Department, National Taiwan University Hospital, Taipei,
Taiwan (Republic of China)
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
One-lung ventilation in thoracic surgery provokes profound systemic
inflammatory responses and injury related to lung tidal volume changes. We
hypothesized that the highly selective a2-adrenergic agonist
dexmedetomidine attenuates these injurious responses. Sixty patients were
randomly assigned to receive dexmedetomidine or saline during
thoracoscopic surgery. There is a trend of less postoperative medical
complication including that no patients in the dexmedetomidine group
developed postoperative medical complications, whereas four patients in
the saline group did (0% versus 13.3%, p = 0 1124). Plasma inflammatory
and injurious biomarkers between the baseline and after resumption of
two-lung ventilation were particularly notable. The plasma highmobility
group box 1 level decreased significantly from 51.7 (58.1) to 33.9 (45.0)
ng.ml^-1 (p < 0 05) in the dexmedetomidine group, which was not
observed in the saline group. Plasma monocyte chemoattractant protein 1
[151.8 (115.1) to 235.2 (186.9) pg.ml^-1, p < 0 05] and
neutrophil elastase [350.8 (154.5) to 421.9 (106.1) ng.ml^-1, p
< 0 05] increased significantly only in the saline group. In addition,
plasma interleukin-6 was higher in the saline group than in the
dexmedetomidine group at postoperative day 1 [118.8 (68.8) versus 78.5
(58.8) pg.ml^-1, p = 0 0271]. We conclude that dexmedetomidine
attenuates one-lung ventilation-associated inflammatory and injurious
responses by inhibiting alveolar neutrophil recruitment in thoracoscopic
surgery.<br/>Copyright &#xa9; 2018 Chun-Yu Wu et al.

<151>
Accession Number
624482847
Title
Scalp block versus local infiltration anesthesia for skull-pin placement
in DBS surgery: Better hemodynamics and less antihypertensive medication?.
Source
Journal of Neurological Surgery Part A: Central European Neurosurgery.
Conference: Joint Annual Meeting 2018: Swiss Society of Neurosurgery,
Swiss Society of Neuroradiology together with Association of Neurosurgical
Nursing Staff Switzerland. Switzerland. 79 (Supplement 1) (no pagination),
2018. Date of Publication: June 2018.
Author
Krauss P.; Marahori N.A.; Barth F.; Oertel M.F.; Stieglitz L.H.
Institution
(Krauss, Marahori, Barth, Oertel, Stieglitz) Universitatsspital Zurich,
Zurich, Switzerland
Publisher
Georg Thieme Verlag
Abstract
Aim: In awake deep brain stimulation (DBS) surgery, acute high blood
pressure (BP) is a major risk factor for intracranial bleeding. To
minimize pain and hypertensive conditions, sufficient local anesthesia is
mandatory that does not interfere with intraoperative assessments. In this
study, we evaluated whether local instillation of anesthetics (LA) or a
scalp block (SB) prior to frame fixation could improve intraoperative
analgesia and hemodynamics and reduce the dose of analgesics as well as
antihypertensive medication. To our knowledge, this is the first study to
compare both methods during awake DBS surgery. Methods: Intraoperative
cardiovascular parameters and perioperative medication of 47 patients who
underwent DBS surgery were retrospectively analyzed (LA, n = 29; SB, n =
18). Primary study end points were intraoperative systolic BP (means,
peaks >= 160 mm Hg) and heart rate. Secondary end points were use of
intraoperative antihypertensive medication and perioperative analgesics.
Results:: Patients with SB showed significantly lower mean systolic BP
values (LA 153.7 +/- 2.2 mm Hg vs SB 140.7 +/- 3.4 mm Hg; p = 0.001) and
hypertensive peaks >= 160 mm Hg (LA 37.7 +/- 4.6% vs SB 13.4 +/- 3.0%; p =
0.013) during the first 2 hours of surgery when compared with LA patients.
Patients with LA required significantly higher doses of antihypertensive
urapidil to stabilize BP than SB patients (LA 20.5 +/- 3.9 mg/h vs SB 3.4
+/- 0.6 mg/h; p < 0.001). No patients treated with SB had intracranial
bleedings as opposed to two hemorrhage cases in LA patients. The
intraoperative dose of remifentanil was significantly higher in SB
patients (LA 0.0 +/- 0.0 mg/h vs SB 0.04 +/- 0.02 mg/h; p = 0.04), whereas
the doses of paracetamol and metamizole showed no significant difference
between the two groups. When the impulse generator (IPG) was implanted the
same day, SB patients needed significantly less remifentanil during the
second intervention (LA 0.583 +/- 0.049 mg/h vs SB 0.223 +/- 0.044 mg/h; p
= 0.003). Conclusion: Our data suggest that SB might be superior to LA for
DBS surgery with respect to BP control. Intraoperative need for
remifentanil was higher in the SB group during the first procedure and
lower during the second procedure when the IPG was implanted the same day.
Larger prospective, randomized, and controlled studies are needed to
finally confirm the promising present study results.

<152>
Accession Number
624483037
Title
Fibrinogen concentrate: Where and when?.
Source
Transfusion Medicine. Conference: 36th Annual Scientific Meeting of the
British Blood Transfusion Society. United Kingdom. 28 (Supplement 1) (pp
6), 2018. Date of Publication: October 2018.
Author
Curry N.
Institution
(Curry) Oxford Haemophilia and Trombosis Centre, Churchill Hospital,
Oxford and Oxford NIHR BRC Haematology Teme, Oxford, United Kingdom
Publisher
Blackwell Publishing Ltd
Abstract
Fibrinogen is critical for effective haemostasis. Not only is it an
important mediator of platelet aggregation but also, when cleaved by
thrombin, is converted to insoluble fbrin strands which stabilise forming
clots. Observational data support the importance of fbrinogen and have
shown that low fbrinogen levels are an independent predictor of mortality
in trauma 1, as well as bleeding in both trauma and cardiac surgery.
Furthermore, a fbrinogen of 2 g/L or less in pregnant women has been shown
to accurately predict postpartum haemorrhage 2. Despite it being known for
over 20 years that fbrinogen is one of the first clotting factors to fall
to clinically low levels, the central importance of fbrinogen replacement
for effective haemostasis in major bleeding has only recently been
recognised. A growing number of observational studies and randomised
controlled trials (RCTs) have been published in the last 5-10 years
exploring the effectiveness of fbrinogen replacement in major bleeding. A
Cochrane review identified six small elective surgery trials of fbrinogen
concentrate, all of low quality and reported no effect on mortality (2.6%
vs 9.5%, RR 0.28, 95% CI 0.33 to 2.33), but showed a clear reduction in
the incidence of allogeneic transfusions (RR 0.47, 95% CI 0.32 to 0.72)3.
More recently randomised trials evaluating fbrinogen concentrate in trauma
populations (EFIT1, FiiRST) and in postpartum haemorrhage patients
(FIB-PPH, OBS2) have been published and their results will be discussed in
this talk. Tere remain unanswered questions. With our growing
understanding of the coagulation changes associated with major
haemorrhage, that appear to vary across patient groups, it is important
that the effects of fbrinogen therapy are fully evaluated in each patient
setting. Equally important is the design of future studies-for example,
one of the most important clinical outcomes in trauma haemorrhage is a
reduction in early mortality, whereas for cardiac surgery, a reduction in
transfusion requirements is important. Finally, it is unclear whether
fbrinogen replacement in the form of cryoprecipitate or fbrinogen
concentrate is more efcacious and the FIBRES study (NCT03037424) will go
some way to answering that question.

<153>
Accession Number
624483031
Title
Efficacy and safety of inhaled anaesthetic for postoperative sedation
during mechanical ventilation in adult cardiac surgery patients: A
systematic review and meta-analysis.
Source
Canadian Journal of Respiratory Critical Care and Sleep Medicine.
Conference: 10th Annual Canadian Respiratory Conference, CRC 2017. Canada.
1 (3) (pp 159), 2017. Date of Publication: 2017.
Author
Spence J.; Belley-Cote E.; Kan Ma H.; Donald S.; Centofanti J.; Hussain
S.; Gupta S.; Devereaux P.J.; Whitlock R.
Institution
(Spence, Belley-Cote, Kan Ma, Donald, Centofanti, Gupta, Devereaux,
Whitlock) McMaster University, Hamilton, ON, Canada
(Spence, Belley-Cote, Hussain, Gupta, Devereaux, Whitlock) Population
Health Research Institute, Hamilton, ON, Canada
(Hussain) McGill University, Montreal, QC, Canada
Publisher
Taylor and Francis Inc.
Abstract
Purpose: To evaluate the efficacy and safety of volatile anaesthetic for
postoperative sedation in adult cardiac surgery patients through a
systematic review and meta-analysis. Methods: We retrieved randomized
controlled trials from MEDLINE, EMBASE, CENTRAL, Web of Science, clinical
trials registries, conference proceedings, and reference lists of included
articles. Independent reviewers extracted data - including demographics,
type of intraoperative anaesthesia, inhaled anaesthetic used, comparator
sedation, and outcomes of interest - using pre-piloted forms. We assessed
risk of bias using the Cochrane Tool and evaluated strength of the
evidence using the GRADE approach. Results: Eight studies enrolling 610
patients were included. Seven had a high and one a low risk of bias. The
times to extubation after ICU admission and sedation discontinuation were,
respectively, 76 (95% CI -150 to -2, I2=79%) and 74 minutes (95% CI -126
to -23, I2=96%) less in patients who were sedated using volatile
anaesthetic. There was no difference in ICU or hospital LOS. Patients who
received volatile anaesthetic sedation had troponin levels that were 0.71
ng mL^-1 (95% CI 0.23 - 1.2) lower than controls. Reporting on
other outcomes was varied, and not suitable for meta-analysis.
Conclusions: Volatile anaesthetic sedation may be associated with a
shorter time to extubation after cardiac surgery but no change in ICU or
hospital LOS. It is associated with a significantly lower postoperative
troponin level, though the impact of this on adverse cardiovascular
outcomes is uncertain. Blinded randomized trials using intention-to-treat
analysis are required.

<154>
Accession Number
624483268
Title
2017 Canadian Respiratory Conference Abstracts: Part 2: Unmoderated
Posters.
Source
Canadian Journal of Respiratory Critical Care and Sleep Medicine.
Conference: 10th Annual Canadian Respiratory Conference, CRC 2017. Canada.
1 (3) (no pagination), 2017. Date of Publication: 2017.
Author
Anonymous
Publisher
Taylor and Francis Inc.
Abstract
The proceedings contain 46 papers. The topics discussed include:
characteristics of patients with mild to severe asthma in Canada;
association between severe asthma and CFTR mutations; association between
severe asthma and CFTR mutations; development and validation of clinical
scores for diagnosing occupational asthma; effects of endothelial and
inducible NO synthases in a mouse model of sleep apnea; molecular
mechanism of classical transient receptor potential 1 (TRPC1)-regulated
pulmonary vascular remodeling in chronic hypoxia-induced pulmonary
hypertension in mice; a new proteomics approach to profile lung tissue and
bronchoalvelolar lavage fluid; epigenetic control of proteolytic pathways
in the diaphragm during prolonged mechanical ventilation; tuberculosis
diagnostic and treatment availability in 14 highest burden countries;
knowledge of tuberculosis among 6109 patients in a NGO-supported dots
program in India; intrapleural therapy usage in a tertiary health centre;
understanding the process of recovery from critical illness: the patient's
perspective; automation of real-time hypoxemia monitoring in paediatric
ARDS; and efficacy and safety of inhaled anaesthetic for postoperative
sedation during mechanical ventilation in adult cardiac surgery patients:
a systematic review and meta-analysis.

<155>
Accession Number
624508671
Title
Open label study of vasopressors in intensive therapy-survival benefits vs
side effects.
Source
Indian Journal of Critical Care Medicine. Conference: 21st Annual
Conference of Indian Society of Critical Care Medicine, ISCCM 2015. India.
19 (13 Supplement 1) (pp S28-S29), 2015. Date of Publication: March 2015.
Author
Pandey A.; Padhy S.; Mittal A.; Jha R.K.
Publisher
Medknow Publications
Abstract
Background: Physicians have several options to choose from when
instituting vasopressor therapy for patients in shock. Amongst them,
norepinephrine and dopamine are two most frequently used molecules as
first-line therapy. Physiologic models have been proposed, suggesting
superiority of one over the other, but neither has consistently shown to
be advantageous. However, few randomized studies have addressed the issue
of which vasopressor produces better outcomes than the other in management
of shock. Methods: We conducted this study in four intensive care units,
General ICU, Medicine ICU, Surgical ICU and Cardiac ICU for more rational
case mix, at SAMC & PGI, Indore, from 1^st August 2013 to
31^stNovember 2014. Total 1046 patients requiring a vasopressor
were randomized, received either dopamine, started at a dose of 5
mics/kg/min which could be increased incrementally to a maximum dose of 20
mics/kg/min, or Norepinephrine, started at 0.02 mics/kg/min and increased
to a maximum dose of 0.12 mics/kg/min. Both Dopamine and Norepinephrine
solutions were administered from open label. Results After 1, 046
patients, study enrolment was halted because of a predefined stopping rule
that met the criterion for futility (i.e a lack of difference between the
two study drugs for the primary end point of 28-day mortality). The 28-day
mortality in the dopamine group was 51.6%, compared to 47.2% in the
Norepinephrine group (p = 0.10). No significant difference was found in
mortality rates in the ICU, in the hospital, or at 6 or 12 months follow
up. The baseline characteristics of the two groups were similar. The case
mixing of study population was 58% Sepsis & 32% Cardiogenic shock and rest
10% were other distributive, obstructive and Hypovolemic shock. The
baseline characteristics listed amongst the subgroups appear to be
similar. No analysis was conducted to ensure that two potentially
important confounding treatment variables, initiation time of appropriate
antibiotics for patients with septic shock and the rate of use of
thrombolytics for patients with acute myocardial infarction. Accepting
these limitations, those patients with cardiogenic shock had an increased
rate of death if randomized to the dopamine group and were found to have a
significantly increased risk of developing arrhythmias compared to the
Norepinephrine group (26.1 % v. 14.4%; p < 0.001). As well, more people on
vasopressor support were free at 2 weeks in the norepinephrine group than
in the dopamine group (p = 0.01). CONCLUSION The study showed No
significant difference in the primary end point, death at 28 days.
Concerns were addressed about Dopamine therapy due to increased rate of
arrhythmias and increased mortality in the subgroup with cardiogenic
shock.

<156>
Accession Number
624508642
Title
Dexmedetomidine as an adjunct in postoperative pain following cardiac
surgery-A randomized, double-blind study.
Source
Indian Journal of Critical Care Medicine. Conference: 21st Annual
Conference of Indian Society of Critical Care Medicine, ISCCM 2015. India.
19 (13 Supplement 1) (pp S46), 2015. Date of Publication: March 2015.
Author
Singh D.; Priye S.; Sathyanarayan J.; Prakash S.; Bhaskar B.V.; Kadli
C.U.; Reddy D.P.
Institution
(Singh) Dept of Anaesthesiology, India
(Priye, Sathyanarayan, Prakash, Bhaskar, Kadli, Reddy) Vydehi Institute of
Medical Sciences and Research Centre, Bangalore, India
Publisher
Medknow Publications
Abstract
Background: The purpose of this study was to determine the hemodynamic
effects and efficacy of dexmedetomidine used as continuous infusion
without loading dose in post cardiac surgery patients. Methods: Sixty-four
patients scheduled for elective cardiac surgery consented to participate
in the study. Patients with elevated serum creatinine, ejection fraction
less than 40% and diabetes mellitus were excluded. After shifting to post
anaesthesia care unit(PACU) patients were prospectively randomized in a
double-blind fashion into one of two groups. Group A (n=32) received a 12
hour infusion of normal saline and group B (n=32) received a 12 hour
infusion of dexmedetomidine 0.4 ng/kg/hr. All patients received a standard
premedication inj diazepam 0.1mg/kg 45minutes before shifting to operation
room(OR) and anaesthetic consisting of midazolam, fentanyl, propofol and
vecuronium. Postoperative pain was managed with IV fentanyl. Total
fentanyl consumption, hemodynamic monitoring, visual analogue scale (VAS)
pain ratings, Ramsay sedation scale were charted every 6^th
hourly for 24 hours postoperatively and followed up till recovery from
PACU. Results are reported as mean +/- standard deviation. Student's t
test, chi-square/fisher exact test has been used to find the significance
of study parameters on categorical scale between two or more groups.
Results: Dexmedetomidine treated patients had significantly less VAS score
at each level. Total fentanyl consumption in dexmedetomidine group was
128.13+/- 35.78 <br/>xg versus 201.56+/-36.99 ng in saline group (P
<0.001). A statistically significant but clinically unimportant sedation
was noted at 6 and 12 hour (P<0.001, and P=0.046 respectively).Incidence
of delirium was less in dexmedetomidine group (P=0.086+). Hemodynamic
parameters were statistically insignificant. Conclusion: Dexmedetomidine
use by omitting the loading dose is an effective adjunct analgesic, mild
sedative and benefits in reducing delirium without undesirable hemodynamic
effects in cardiac surgery patients.

<157>
Accession Number
624488250
Title
Meta-Analysis Comparing Dual Antiplatelet Therapy Versus Single
Antiplatelet Therapy Following Transcatheter Aortic Valve Implantation.
Source
The American journal of cardiology. 122 (8) (pp 1401-1408), 2018. Date of
Publication: 15 Oct 2018.
Author
Siddamsetti S.; Balasubramanian S.; Yandrapalli S.; Vij A.; Joshi U.; Tang
G.; Kodumuri V.
Institution
(Siddamsetti, Balasubramanian, Vij, Joshi, Kodumuri) Division of
Cardiology, John H. Stroger Jr. Hospital of Cook County, Chicago, IL,
United States
(Yandrapalli) Division of Cardiology, John H. Stroger Jr. Hospital of Cook
County, Chicago, Illinois; Westchester Medical Center/New York Medical
Center, Valhalla, New York
(Tang) Division of Cardiology, John H. Stroger Jr. Hospital of Cook
County, Chicago, Illinois; Icahn School of Medicine at Mount Sinai
Hospital, New York, New York
Publisher
NLM (Medline)
Abstract
The present American College of Cardiology/American Heart Association
guidelines (Grade IIb, level of evidence C) recommend dual antiplatelet
therapy (DAPT) with aspirin and clopidogrel for 6 months followed by
lifelong aspirin after transcathter aortic valve implantation (TAVI).
However, studies that have compared DAPT to single antiplatelet therapy
(SAPT) after TAVI have questioned this recommendation as DAPT has been
associated with more bleeding events compared with SAPT. We performed a
meta-analysis of all the trials that compared DAPT to SAPT in patients who
underwent TAVI. Three randomized trials and 4 nonrandomized studies were
included. The primary endpoint was the rate of ischemic stroke. Secondary
end points were the rates of myocardial infarction, life threatening
bleeding (LTB), significant bleeding (LTB and major bleeding), and death.
The Mantel-Haenszel random effects model was used to calculate the
combined odds ratios (OR) and 95% confidence intervals (CI) for outcomes
at 30days and up to 6 to 12months follow-up. The LTB (OR 2.73, 95% CI 1.31
to 5.69, p = 0.007) and significant bleeding rates (OR 2.76, 95% CI 1.57
to 4.85, p = 0.0004) were significantly higher in DAPT arm at 30days.
Significant bleeding (OR 2.24, 95% CI 1.33 to 3.79, p = 0.002) was still
significantly higher in the DAPT arm but there was only a nonsignificant
trend toward higher LTB (OR 1.93 95% CI 0.61 to 6.03, p = 0.26) at 6 to 12
month follow up. There was no difference in mortality, ischemic stroke and
myocardial infarction at 30days or 6 to 12month follow up. In conclusion,
our meta-analysis shows that DAPT after TAVI does not confer any
additional benefit over SAPT in TAVI.<br/>Copyright &#xa9; 2018. Published
by Elsevier Inc.

<158>
Accession Number
624481602
Title
One-year outcomes of patients with severe aortic stenosis and an STS PROM
of less than three percent in the SURTAVI trial.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
14 (8) (pp 877-883), 2018. Date of Publication: 20 Oct 2018.
Author
Serruys P.W.; Modolo R.; Reardon M.; Miyazaki Y.; Windecker S.; Popma J.;
Chang Y.; Kleiman N.S.; Lilly S.; Amrane H.; Boonstra P.W.; Kappetein
A.P.; Onuma Y.; Sondergaard L.; van Mieghem N.
Institution
(Serruys) International Centre for Circulatory Health, NHLI, Imperial
College London, London, United Kingdom
Publisher
NLM (Medline)
Abstract
AIMS: The indication for transcatheter aortic valve implantation (TAVI)
has evolved from inoperable patients to patients at increased surgical
risk. In low-risk patients, surgical aortic valve replacement (SAVR)
remains the standard of care. The aim of this study was to explore the
outcomes of TAVI and SAVR in patients with a Society of Thoracic Surgeons
(STS) predicted risk of mortality (PROM) score below 3% in the SURTAVI
trial.
METHODS AND RESULTS: In SURTAVI, patients at intermediate surgical risk
based on Heart Team consensus were randomised to TAVI or SAVR. We
stratified the overall patient population into quintiles based on the STS
PROM score; the one-year mortality was correlated with the mean STS PROM
score in each quintile. The quintiles were regrouped into three clinically
relevant categories of STS score: less than 3%, 3 to <5%, and >5%.
All-cause mortality or disabling stroke in each risk stratum was compared
between TAVI and SAVR. Linear regressions between mean values of STS PROM
in each quintile and observed all-cause mortality at one year showed great
association for the global population (r2=0.92), TAVI (r2=0.89) and SAVR
cohorts (r2=0.73). All-cause mortality or disabling stroke of TAVI vs.
SAVR was 1.5% vs. 6.5% (p=0.04), 6.5% vs. 7.6% (p=0.52) and 13.5% vs.
11.0% (p=0.40) in the <3%, 3-5%, and >=5% STS score strata, respectively.
CONCLUSIONS: Among patients at intermediate surgical risk but with an STS
PROM <3%, TAVI may achieve superior clinical outcomes compared to SAVR.
These findings support the need for an adequately powered randomised trial
to compare TAVI with SAVR in patients at low operative risk.

<159>
Accession Number
624481371
Title
Goal-directed perfusion to reduce acute kidney injury: A randomized trial.
Source
The Journal of thoracic and cardiovascular surgery. 156 (5) (pp
1918-1927), 2018. Date of Publication: 01 Nov 2018.
Author
Ranucci M.; Johnson I.; Willcox T.; Baker R.A.; Boer C.; Baumann A.;
Justison G.A.; de Somer F.; Exton P.; Agarwal S.; Parke R.; Newland R.F.;
Haumann R.G.; Buchwald D.; Weitzel N.; Venkateswaran R.; Ambrogi F.;
Pistuddi V.
Institution
(Ranucci) Department of Cardiothoracic and Vascular Anesthesia and
Intensive Care Unit, Istituto di Ricovero e Cura a Carattere Scientifico,
Policlinico San Donato, San Donato Milanese, Milan, Italy
(Johnson, Agarwal) Department of Perfusion, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom; Department of Anesthesia, Liverpool
Heart and Chest Hospital, Liverpool, United Kingdom
(Willcox, Parke) Green Lane Cardiothoracic Unit and Cardiothoracic and
Vascular Intensive Care, Auckland City Hospital, Auckland, New Zealand;
Department of Anaesthesiology, Faculty of Medical and Health Sciences,
University of Auckland, Auckland, New Zealand
(Baker, Newland) Cardiac Research and Perfusion, Cardiac and Thoracic
Surgical Unit, Flinders Medical Centre and Flinders University, Adelaide,
SA, Australia
(Boer, Haumann) Department of Anesthesiology, Institute for Cardiovascular
Research, VU University Medical Center, Amsterdam, The Netherlands;
Department of Cardiothoracic Surgery, Institute for Cardiovascular
Research, VU University Medical Center, Amsterdam, The Netherlands
(Baumann, Buchwald) Department of Anaesthesiology, Intensive Care,
Palliative Care and Pain Medicine, BG University Hospital Bergmannsheil,
Ruhr University, Bochum, Germany; Department of Cardiac and Thoracic
Surgery, BG University Hospital Bergmannsheil, Ruhr University, Bochum,
Germany
(Justison, Weitzel) Department of Perfusion, University of Colorado
Denver, Aurora, Colo; Department of Anesthesiology, University of Colorado
Denver, Aurora, Colo
(de Somer) Heart Centre, University Hospital Ghent, Ghent, Belgium
(Exton, Venkateswaran) Department of Cardiothoracic Surgery, University
Hospital of South Manchester National Health Service Foundation Trust,
Manchester, United Kingdom
(Ambrogi) Department of Clinical Sciences and Community Health, University
of Milan, and IRCCS Policlinico San Donato, Milan, Italy
(Pistuddi) Department of Cardiothoracic and Vascular Anesthesia and
Intensive Care Unit, Istituto di Ricovero e Cura a Carattere Scientifico,
Policlinico San Donato, San Donato Milanese, Milan, Italy
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To determine whether a goal-directed perfusion (GDP) strategy
aimed at maintaining oxygen delivery (DO2) at >=280 mL.min-1.m-2 reduces
the incidence of acute kidney injury (AKI).
METHODS: This multicenter randomized trial enrolled a total of 350
patients undergoing cardiac surgery in 9 institutions. Patients were
randomized to receive either GDP or conventional perfusion. A total of 326
patients completed the study and were analyzed. Patients in the treatment
arm were treated with a GDP strategy during cardiopulmonary bypass (CPB)
aimed to maintain DO2 at >=280 mL.min-1.m-2. The perfusion strategy for
patients in the control arm was factored on body surface area and
temperature. The primary endpoint was the rate of AKI. Secondary endpoints
were intensive care unit length of stay, major morbidity, red blood cell
transfusions, and operative mortality.
RESULTS: Acute Kidney Injury Network (AKIN) stage 1 was reduced in
patients treated with GDP (relative risk [RR], 0.45; 95% confidence
interval [CI], 0.25-0.83; P = .01). AKIN stage 2-3 did not differ between
the 2 study arms (RR, 1.66; 95% CI, 0.46-6.0; P = .528). There were no
significant differences in secondary outcomes. In a prespecified analysis
of patients with a CPB time between 1 and 3 hours, the differences in
favor of the treatment arm were more pronounced, with an RR for AKI of
0.49 (95% CI, 0.27-0.89; P = .017).
CONCLUSIONS: A GDP strategy is effective in reducing AKIN stage 1 AKI.
Further studies are needed to define perfusion interventions that may
reduce more severe levels of renal injury (AKIN stage 2 or
3).<br/>Copyright &#xa9; 2018 The American Association for Thoracic
Surgery. Published by Elsevier Inc. All rights reserved.

<160>
[Use Link to view the full text]
Accession Number
624481303
Title
Transplant-Free Survival and Interventions at 6 Years in the SVR Trial.
Source
Circulation. 137 (21) (pp 2246-2253), 2018. Date of Publication: 22 May
2018.
Author
Newburger J.W.; Sleeper L.A.; Gaynor J.W.; Hollenbeck-Pringle D.; Frommelt
P.C.; Li J.S.; Mahle W.T.; Williams I.A.; Atz A.M.; Burns K.M.; Chen S.;
Cnota J.; Dunbar-Masterson C.; Ghanayem N.S.; Goldberg C.S.; Jacobs J.P.;
Lewis A.B.; Mital S.; Pizarro C.; Eckhauser A.; Stark P.; Ohye R.G.
Institution
(Newburger, Sleeper, Dunbar-Masterson) Boston Children's Hospital and
Harvard Medical School, L.A.S.
(Gaynor) Children's Hospital of Philadelphia and University of
Pennsylvania Medical School
(Hollenbeck-Pringle, Chen, Stark) New England Research Institutes,
Watertown, S.C, United States
(Frommelt, Ghanayem) Children's Hospital of Wisconsin and Medical College
of Wisconsin, United States
(Li) Duke University, North Carolina Consortium, Denmark
(Li) East Carolina University, Greenville, United States
(Li) Wake Forest University, Winston-Salem, Italy
(Mahle) Children's Healthcare of Atlanta and Emory University, United
States
(Williams) Morgan Stanley Children's Hospital of New York-Presbyterian,
Columbia College of Physicians and Surgeons, United States
(Atz) Medical University of South Carolina, Switzerland
(Burns) National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, MD (KM.B.)
(Cnota) Cincinnati Children's Medical Center, United States
(Goldberg, Ohye) University of Michigan Medical School, United States
(Jacobs) Congenital Heart Institute of Florida, St. Petersburg (J.P.J.)
(Lewis) Children's Hospital Los Angeles, United States
(Mital) Hospital for Sick Children, Toronto, ON, Canada
(Pizarro) Nemours Cardiac Center, DE (C.P.), Wilmington, United States
(Eckhauser) Primary Children's Hospital and the University of Utah
Publisher
NLM (Medline)
Abstract
BACKGROUND: In the SVR trial (Single Ventricle Reconstruction), 1-year
transplant-free survival was better for the Norwood procedure with right
ventricle-to-pulmonary artery shunt (RVPAS) compared with a modified
Blalock-Taussig shunt in patients with hypoplastic left heart and related
syndromes. At 6 years, we compared transplant-free survival and other
outcomes between the groups.
METHODS: Medical history was collected annually using medical record
review, telephone interviews, and the death index. The cohort included 549
patients randomized and treated in the SVR trial.
RESULTS: Transplant-free survival for the RVPAS versus modified
Blalock-Taussig shunt groups did not differ at 6 years (64% versus 59%,
P=0.25) or with all available follow-up of 7.1+/-1.6 years (log-rank
P=0.13). The RVPAS versus modified Blalock-Taussig shunt treatment effect
had nonproportional hazards (P=0.009); the hazard ratio (HR) for death or
transplant favored the RVPAS before stage II surgery (HR, 0.66; 95%
confidence interval, 0.48-0.92). The effect of shunt type on death or
transplant was not statistically significant between stage II to Fontan
surgery (HR, 1.36; 95% confidence interval, 0.86-2.17; P=0.17) or after
the Fontan procedure (HR, 0.76; 95% confidence interval, 0.33-1.74;
P=0.52). By 6 years, patients with RVPAS had a higher incidence of
catheter interventions (0.38 versus 0.23/patient-year, P<0.001), primarily
because of more interventions between the stage II and Fontan procedures
(HR, 1.72; 95% confidence interval, 1.00-3.03). Complications did not
differ by shunt type; by 6 years, 1 in 5 patients had had a thrombotic
event, and 1 in 6 had had seizures.
CONCLUSIONS: By 6 years, the hazards of death or transplant and catheter
interventions were not different between the RVPAS versus modified
Blalock-Taussig shunt groups. Children assigned to the RVPAS group had 5%
higher transplant-free survival, but the difference did not reach
statistical significance, and they required more catheter interventions.
Both treatment groups have accrued important complications.
CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique
identifier: NCT00115934.<br/>Copyright &#xa9; 2018 American Heart
Association, Inc.

<161>
Accession Number
624485211
Title
Preferred Revascularization Strategies in Patients with Ischemic Heart
Failure: A Meta-Analysis.
Source
Current medical science. 38 (5) (pp 776-784), 2018. Date of Publication:
01 Oct 2018.
Author
Xiao J.; Xu F.; Yang C.-L.; Chen W.-Q.; Chen X.; Zhang H.; Wei Z.-J.; Liu
J.-P.
Institution
(Xiao, Xu, Chen, Chen, Zhang) Department of Cardiovascular Surgery, Union
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan 430022, China
(Xiao) Department of Cardio-Thoracic Surgery, Ganzhou People's Hospital,
Ganzhou 341000, China
(Yang) Department of Cardiovascular Surgery, Central Hospital of Wuhan,
Wuhan 430022, China
(Wei) Department of Thyroid Surgery, Central Hospital of Wuhan, Wuhan
430022, China
(Liu) Department of Cardiovascular Surgery, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan 430022,
China
Publisher
NLM (Medline)
Abstract
Clinically, coronary artery bypass grafting (CABG) or percutaneous
coronary intervention (PCI) is generally used to treat patients with
ischemic heart failure. However, the optimal treatment strategy remains
unknown. This study examined the efficacy of the two coronary
revascularization strategies for severe ischemic heart failure by using a
meta-analysis. Studies comparing the efficacy of CABG and PCI were
obtained from PubMed, EMBASE, Google Scholar and Cochrane Central Register
of Controlled Trials (CENTRAL). The quality of each eligible article was
evaluated by Newcastle-Ottawa Quality Assessment Scale (NOS), and the
meta-analysis was performed using Stata version 12.0 software. Eventually,
12 studies involving 9248 patients (n=4872 in CABG group; n=4376 in PCI
group) were subject to the meta-analysis for subsequent pooling
calculation. The pooled hazard ratio (HR) [HR=0.83, 95% CI (0.76, 0.90),
P<0.001; heterogeneity, P=0.218, I2=22.9%] of CABG compared with that of
PCI revealed a statistical superiority of CABG to PCI in terms of the
long-term mortality. Furthermore, CABG showed more advantages over PCI
with respect to the incidence of myocardial infarction [HR=0.51, 95% CI
(0.39, 0.67), P<0.001; heterogeneity, P=0.707, I2=0%] and repeat
revascularization [HR=0.40, 95% CI (0.27, 0.59), P<0.001; heterogeneity,
P<0.001, I2=80.1%]. It was concluded that CABG appears to be more
advantageous than PCI for the treatment of ischemic heart failure in the
given clinical setting.

<162>
Accession Number
624484855
Title
Anticoagulation Management in Patients with Valve Replacement.
Source
The Journal of the Association of Physicians of India. 66 (1) (pp 59-74),
2018. Date of Publication: 01 Jan 2018.
Author
Saksena D.; Muralidharan S.; Mishra Y.K.; Kanhere V.; Mohanty B.B.;
Srivastava C.P.; Mange J.; Puranik M.; Nair M.P.; Goel P.; Srivastava P.;
Krishnan R.M.; Nambala S.; Raja V.
Institution
(Saksena) Professor and Head, Dept. of Cardiac Surgery, Bombay Hospital,
Mumbai, Maharashtra, India
(Muralidharan) Chief Cardiothoracic Surgeon, GKNM Hospital, Coimbatore,
Tamil Nadu, India
(Mishra) Director, Department of Cardiovascular Surgery, Fortis Escorts
Heart Centre, New Delhi
(Kanhere) Consultant Cardiothoracic and Vascular Surgeon, Chirayu Health
Centre, Bhopal, Madhya Pradesh, India
(Mohanty) Chief Consultant Cardiothoracic Surgeon, CARE Hospitals,
Bhubaneshwar, Orissa, India
(Srivastava) Chief Consultant Cardiac Surgeon, Narayana Hrudayalaya,
Jaipur, Rajasthan, India
(Mange) Chief Cardiothoracic Surgeon, Shree Mahavir Health and Medical
Relief Society, Surat, Gujarat, India
(Puranik) Consultant Minimally Invasive Cardiac Surgeon, Seth Nandlal
Dhoot Hospital, Aurangabad, Maharashtra, India
(Nair) Senior Consultant, Cardio Vascular Thoracic Surgery, Aster Medcity,
Kochi, Kerala, India
(Goel) Director, Cardiothoracic and Vascular Surgery, Ivy Healthcare,
Amritsar, Punjab, India
(Srivastava) Medical Director and Senior Consultant Cardiac Surgeon,
Divine Heart and Multi-speciality Hospital, Lucknow, Uttar Pradesh, India
(Krishnan) Chief Cardiothoracic Surgeon, Meenakshi Mission Hospital,
Madurai, Tamil Nadu, India
(Nambala) Chief Heart Surgeon, Apollo Hospitals, Bangalore, Karnataka,
India
(Raja) Abbott Healthcare Pvt. Ltd
Publisher
NLM (Medline)
Abstract
Background: Prosthetic valve implantation requires postoperative
prophylactic anticoagulation to preclude thrombotic events. The aim of
this review is to assess the role of anticoagulation therapy in the
management of valve replacement patients.
Methodology: Literature from PubMed, Embase, Medline and Google Scholar
were searched using the terms "valvular heart disease", "anticoagulant",
"mechanical heart valve", "bioprosthesis", "bridging", "Vitamin K
antagonist (VKA)", and "acenocoumarol". A committee comprising leading
cardiothoracic surgeons from India was convened to review the literature
and suggest key practice points.
Results: Prosthetic valve implantation requires postoperative prophylactic
anticoagulation to preclude thrombotic events. A paramount risk of
thromboembolic events is observed during the first three months after
surgery for both mechanical and bioprosthetic devices. The VKA therapy
with individualized target international normalized ratio (INR) is
recommended in patients after prosthetic valve replacement. Therapies for
the management of prosthetic valve complications should be based on the
type of complications. Special care is mandated in distinguished
individuals and those with various co-morbidities.
Conclusion: In patients with prosthetic valve replacement, anticoagulant
therapy with VKA seems to be an effective option. The role for non-VKA
oral anticoagulants in the setting of prosthetic valve replacement has yet
to be established. Furthermore, whether the novel oral anticoagulants are
safe and efficacious in patients after placement of a bioprosthetic valve
remains unanswered.<br/>Copyright &#xa9; Journal of the Association of
Physicians of India 2011.

<163>
Accession Number
624477987
Title
Three-dimensional (3D)- computed tomography bronchography and angiography
combined with 3D-video-assisted thoracic surgery (VATS) versus
conventional 2D-VATS anatomic pulmonary segmentectomy for the treatment of
non-small cell lung cancer.
Source
Thoracic cancer. 9 (2) (pp 305-309), 2018. Date of Publication: 01 Feb
2018.
Author
She X.-W.; Gu Y.-B.; Xu C.; Li C.; Ding C.; Chen J.; Zhao J.
Institution
(She, Xu, Li, Ding, Chen, Zhao) Department of Thoracic Surgery, First
Affiliated Hospital of Soochow University, Suzhou, China
(She) Department of Thoracic Surgery, Nanjing Medical University, Suzhou
Municipal Hospital North District, Suzhou, China
(Gu) Department of Radiology, First Affiliated Hospital of Soochow
University, Suzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Compared to the pulmonary lobe, the anatomical structure of
the pulmonary segment is relatively complex and prone to variation, thus
the risk and difficulty of segmentectomy is increased. We compared
three-dimensional computed tomography bronchography and angiography
(3D-CTBA) combined with 3D video-assisted thoracic surgery (3D-VATS) to
perform segmentectomy to conventional two-dimensional (2D)-VATS for the
treatment of non-small cell lung cancer (NSCLC).
METHODS: We retrospectively reviewed the data of randomly selected
patients who underwent 3D-CTBA combined with 3D-VATS (3D-CTBA-VATS) or
2D-VATS at the Department of Thoracic Surgery, The First Affiliated
Hospital of Soochow University Hospital, from January 2014 to May 2017.
RESULTS: The operative duration of 3D group was significantly shorter than
the 2D group (P < 0.05). There was no significant difference in the number
of dissected lymph nodes between the two groups (P > 0.05). The extent of
intraoperative bleeding and postoperative drainage in the 3D group was
significantly lower than in the 2D group (P < 0.05). Chest tube duration
in the 3D group was shorter than in the 2D group (P < 0.05). Incidences of
pulmonary infection, atelectasis, and arrhythmia were not statistically
different between the two groups (P > 0.05). However, hemoptysis and
pulmonary air leakage (>3d) occurred significantly less frequently in the
3D than in the 2D group (P < 0.05).
CONCLUSION: 3D-CTBA-VATS is a more accurate and smooth technique and leads
to reduced intraoperative and postoperative complications.<br/>Copyright
&#xa9; 2018 The Authors. Thoracic Cancer published by China Lung Oncology
Group and John Wiley & Sons Australia, Ltd.

<164>
Accession Number
624485560
Title
The Society of Thoracic Surgeons, The Society of Cardiovascular
Anesthesiologists, and The American Society of ExtraCorporeal Technology:
Clinical Practice Guidelines-Anticoagulation During Cardiopulmonary
Bypass.
Source
The Annals of thoracic surgery. 105 (2) (pp 650-662), 2018. Date of
Publication: 01 Feb 2018.
Author
Shore-Lesserson L.; Baker R.A.; Ferraris V.A.; Greilich P.E.; Fitzgerald
D.; Roman P.; Hammon J.W.
Institution
(Shore-Lesserson) Department of Anesthesiology, Zucker School of Medicine
at Hofstra Northwell, Hempstead, NY, United States
(Baker) Cardiac Surgery Research and Perfusion, Flinders University and
Flinders Medical Center, Adelaide, SA, Australia
(Ferraris) Division of Cardiovascular and Thoracic Surgery, University of
Kentucky, Lexington, KY, United States
(Greilich) Department of Anesthesiology and Pain Management, University of
Texas-Southwestern Medical Center, Dallas, TX, United States
(Fitzgerald) Division of Cardiovascular Perfusion, Medical University of
South Carolina, Charleston, SC, United States
(Roman) Department of Anesthesiology, Saint Anthony Hospital, Lakewood,
CO, United States
(Hammon) Department of Cardiothoracic Surgery, Wake Forest University
School of Medicine, Winston-Salem, NC, United States
Publisher
NLM (Medline)
Abstract
Despite more than a half century of "safe" cardiopulmonary bypass (CPB),
the evidence base surrounding the conduct of anticoagulation therapy for
CPB has not been organized into a succinct guideline. For this and other
reasons, there is enormous practice variability relating to the use and
dosing of heparin, monitoring heparin anticoagulation, reversal of
anticoagulation, and the use of alternative anticoagulants. To address
this and other gaps, The Society of Thoracic Surgeons, the Society of
Cardiovascular Anesthesiologists, and the American Society of
Extracorporeal Technology developed an Evidence Based Workgroup. This was
a group of interdisciplinary professionals gathered to summarize the
evidence and create practice recommendations for various aspects of CPB.
To date, anticoagulation practices in CPB have not been standardized in
accordance with the evidence base. This clinical practice guideline was
written with the intent to fill the evidence gap and to establish best
practices in anticoagulation therapy for CPB using the available evidence.
To identify relevant evidence, a systematic review was outlined and
literature searches were conducted in PubMed using standardized medical
subject heading (MeSH) terms from the National Library of Medicine list of
search terms. Search dates were inclusive of January 2000 to December
2015. The search yielded 833 abstracts, which were reviewed by two
independent reviewers. Once accepted into the full manuscript review
stage, two members of the writing group evaluated each of 286 full papers
for inclusion eligibility into the guideline document. Ninety-six
manuscripts were included in the final review. In addition, 17 manuscripts
published before 2000 were included to provide method, context, or
additional supporting evidence for the recommendations as these papers
were considered sentinel publications. Members of the writing group wrote
and developed recommendations based on review of the articles obtained and
achieved more than two thirds agreement on each recommendation. The
quality of information for a given recommendation allowed assessment of
the level of evidence as recommended by the American College of Cardiology
Foundation/American Heart Association Task Force on Practice Guidelines.
Recommendations were written in the three following areas: (1) heparin
dosing and monitoring for initiation and maintenance of CPB; (2) heparin
contraindications and heparin alternatives; and (3) reversal of
anticoagulation during cardiac operations. It is hoped that this guideline
will serve as a resource and will stimulate investigators to conduct more
research and to expand on the evidence base on the topic of
anticoagulation therapy for CPB.<br/>Copyright &#xa9; 2018 The Society of
Thoracic Surgeons, International Anesthesia Research Society, and the
American Society of ExtraCorporeal Technology. Published by Elsevier Inc.
All rights reserved.

<165>
Accession Number
624487972
Title
Meta-Analysis of the Prognostic Value of Psoas-Muscle Area on Mortality in
Patients Undergoing Transcatheter Aortic Valve Implantation.
Source
The American journal of cardiology. 122 (8) (pp 1394-1400), 2018. Date of
Publication: 15 Oct 2018.
Author
Takagi H.; Hari Y.; Kawai N.; Ando T.
Institution
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan; Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan. Electronic address:
kfgth973@ybb.ne.jp
(Hari) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan; Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Kawai) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
NLM (Medline)
Abstract
We performed a meta-analysis of currently available studies assessing
prognostic value of psoas-muscle area (PMA) on mortality in patients who
underwent transcatheter aortic valve implantation (TAVI). MEDLINE and
EMBASE were searched through May 2018 to identify studies reporting
>=1-year all-cause mortality in PMA-stratified TAVI patients. A hazard
ratio of follow-up (including early) mortality for "lowest-quantile"
versus "higher-quantiles" PMA. Study-specific estimates were combined in
the random-effects model. Our search identified 6 eligible studies
enrolling a total of 1,237 TAVI patients with 1-year to 2-year (midterm)
follow-up. A primary meta-analysis pooling all hazard ratios for
"lowest-quantile versus higher-quantiles" PMA demonstrated significantly
higher mortality in "lowest-quantile" than "higher-quantiles" patients (p
<0.0001). A subgroup meta-analysis indicated no significant difference in
mortality between "<50th- and >=50th-percentile" patients (p=0.95), but
significantly higher mortality in "lowest-tertile" than "higher-tertiles"
patients (p=0.0009) and in "lowest-quartile" than "higher- quartiles"
patients (p=0.0003). A secondary meta-analysis revealed significantly
higher mortality in "lowest-tertile" than "mid-tertile" patients (p=0.01)
and in "lowest-tertile" than "highest-tertile" patients (p=0.01). A
gender-stratified meta-analysis showed significantly higher mortality in
"lowest-quantile" than "higher-quantiles" patients in both men (p=0.0008)
and women (p=0.01). In conclusion, low PMA, especially
"lowest-tertile/quartile" PMA, is a predictor of high all-cause mortality
at midterm follow-up after TAVI for both men and women. However, PMA
categorization into 50th percentiles may be invalid to predict
mortality.<br/>Copyright &#xa9; 2018. Published by Elsevier Inc.

<166>
Accession Number
624487362
Title
Congenital heart defect repair with ADAPT tissue engineered pericardium
scaffold: An early-stage health economic model.
Source
PloS one. 13 (9) (pp e0204643), 2018. Date of Publication: 2018.
Author
Velickovic V.M.; Borisenko O.; Svensson M.; Spelman T.; Siebert U.
Institution
(Velickovic, Borisenko, Spelman) Synergus AB, Health Economics and
Evidence Synthesis Department, Stockholm, Sweden
(Velickovic, Siebert) Institute of Public Health, Medical Decision Making
and Health Technology Assessment, Department of Public Health, Health
Services Reseaech and Health Technology Assessment, UMIT - University for
Health Sciences, Medical Informatics and Technology, Hall i.T, Austria
(Svensson) Health Metrics, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden
(Spelman) Centre for Population Health, Burnet Institute, Melbourne,
Australia
(Spelman) School of Public Health and Preventive Medicine, Monash
University, Melbourne, Australia
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The objective of this study was to evaluate the cost
effectiveness of tissue engineered bovine tissue pericardium scaffold
(CardioCel) for the repair of congenital heart defects in comparison with
surgery using xenogeneic, autologous, and synthetic patches over a 40-year
time horizon from the perspective of the UK National Health Service.
METHODS: A six-state Markov state-transition model to model natural
history of disease and difference in the interventional effect of
surgeries depending on patch type implanted. Patches differed regarding
their probability of re-operation due to patch calcification, based on a
systematic literature review. Transition probabilities were based on the
published literature, other clinical inputs were based on UK registry
data, and cost data were based on UK sources and the published literature.
Incremental cost-effectiveness ratio (ICER) was determined as incremental
costs per quality adjusted life years (QALY) gained. We used a 40-year
analytic time-horizon and adopted the payer perspective. Comprehensive
sensitivity analyses were performed.
RESULTS: According to the model predictions, CardioCel was associated with
reduced incidence of re-operation, increased QALY, and costs savings
compared to all other patches. Cost savings were greatest compared to
synthetic patches. Estimated cost savings associated with CardioCel were
greatest within atrioventricular septal defect repair and lowest for
ventricular septal defect repair. Based on our model, CardioCel relative
risk for re-operations is 0.938, 0.956and 0.902 relative to xenogeneic,
autologous, and synthetic patches, respectively.
CONCLUSION: CardioCel was estimated to increase health benefits and save
cost when used during surgery for congenital heart defects instead of
other patches.

<167>
Accession Number
624493119
Title
Effect of Baseline Aortic Regurgitation on Mortality in Patients Treated
With Transcatheter or Surgical Aortic Valve Replacement (from the
CoreValve US Pivotal Trial).
Source
The American journal of cardiology. 122 (9) (pp 1527-1535), 2018. Date of
Publication: 01 Nov 2018.
Author
Grayburn P.A.; Oh J.K.; Reardon M.J.; Popma J.J.; Deeb G.M.; Boulware M.;
Huang J.; Stoler R.C.
Institution
(Grayburn, Stoler) Department of Cardiology and Cardiovascular Surgery,
Baylor Heart and Vascular Hospital, Dallas, TX, United States
(Oh) Department of Echocardiography, Mayo Clinic, Rochester, MN, United
States
(Reardon) Department of Cardiac Surgery, Houston-Methodist-Debakey Heart
and Vascular Center, Houston, TX, United States
(Popma) Department of Internal Medicine (Cardiovascular Division), Beth
Israel Deaconess Medical Center, Boston, MA, United States
(Deeb) University of Michigan Hospitals, Ann Arbor, MI, United States
(Boulware, Huang) Medtronic Clinical and Statistical Services,
Minneapolis, MN, United States
Publisher
NLM (Medline)
Abstract
This study was performed to determine if baseline aortic regurgitation
(AR) affects the deleterious effects of postprocedure paravalvular leak
following transcatheter aortic valve implantation (TAVI). We evaluated the
effect of baseline AR on mortality in a large cohort of patients
randomized to transcatheter or surgical aortic valve replacement (SAVR).
The analysis cohort comprised 739 patients who underwent attempted TAVI
(n=386) or SAVR (n=353) in the CoreValve US Pivotal High Risk Trial and
had baseline AR measurements. Patients were stratified by the severity of
baseline AR into those with none and/or trace and those with >=mild AR.
Echocardiographic measurements were assessed by an independent core
laboratory. Of the 386 TAVI patients, 204 (52.9%) had none and/or trace at
baseline AR; 182 (47.2%) had >=mild AR. Of the 353 SAVR patients, 169
(47.9%) had none and/or trace and 184 (52.1%) >=mild AR. The presence of
>=mild baseline AR was associated with lower all-cause mortality at 1 year
following TAVI (9.4% vs 18.6%, p=0.008) or SAVR (13.3% vs 24.4%, p=0.009).
Mortality remained lower in the >=mild baseline AR patients at 3 years
after SAVR (p=0.011), but not TAVI. In conclusion, baseline AR appears to
provide a protective effect on survival and quality of life in both TAVI
and SAVR patients at 1 year; this effect persists out to 3 years in SAVR
patients.<br/>Copyright &#xa9; 2018. Published by Elsevier Inc.

<168>
Accession Number
624492780
Title
A narrative overview: Have clinical trials of PCI vs medical therapy
addressed the right question?.
Source
International journal of cardiology. 267 (pp 35-40), 2018. Date of
Publication: 15 Sep 2018.
Author
Morrone D.; Marzilli M.; Panico R.A.; Kolm P.; Weintraub W.S.
Institution
(Morrone) Christiana Care Health System, Newark, DE, USA; Surgery
Pathology, Medical, Molecular and Critic Area Department-Cardiovascular
Disease Section, Pisa University, Italy
(Marzilli, Panico) Surgery Pathology, Medical, Molecular and Critic Area
Department-Cardiovascular Disease Section, Pisa University, Italy
(Kolm, Weintraub) Christiana Care Health System, Newark, DE, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: In RCTs about revascularization, the terms "coronary artery
disease" and "ischemic heart disease" are sometimes used interchangeably.
This can create confusion concerning inclusion and exclusion criteria,
which may lead to uncertain results.
OBJECTIVE: Our purpose is to investigate whether the study populations in
randomized controlled trials (RCTs) which compared percutaneous coronary
revascularization to medical therapy for stable ischemic heart disease
specifically enrolled patients with demonstrable ischemia, and how many
patients were included in trials with evidence of coronary atherosclerosis
but without evidence of ischemia.
METHODS: Trial published data were obtained from ACME I, ACME II, RITA I,
RITA II, MASS I, MASS II, AVERT, ACIP, COURAGE and FAME2. Published data
were used to calculate the number of patients included in the trials with
a negative stress test but significant coronary artery stenosis and the
number of patients excluded from the trials with a positive stress test or
angina, but without significant coronary artery stenosis at the time of
angiography.
RESULTS: A total of 196,433 patients were screened between 1998 and 2011.
Overall about 30% of patients were excluded if they did not meet the
angiographic criteria, even though the presence of inducible ischemia or
angina, and, about 20% of patients were included without inducible
ischemia.
CONCLUSION: RCTs have contributed to the confusion between coronary artery
disease and ischemic heart disease. This may limit the ability to
interpret the results and apply them in practice.<br/>Copyright &#xa9;
2018 Elsevier B.V. All rights reserved.

<169>
Accession Number
624490998
Title
Sonolysis in risk reduction of symptomatic and silent brain infarctions
during coronary stenting (SONOREDUCE): Randomized, controlled trial.
Source
International journal of cardiology. 267 (pp 62-67), 2018. Date of
Publication: 15 Sep 2018.
Author
Viszlayova D.; Brozman M.; Langova K.; Herzig R.; Skoloudik D.
Institution
(Viszlayova) Department of Neurology, Faculty Hospital Nitra and
Constantine Philosopher University, Nitra, Slovakia; Department of
Neurology, Faculty of Medicine and Dentistry, Palacky University, Olomouc,
Czech Republic; Department of Neurology, Charles University Faculty of
Medicine, Hradec Kralove, Czech Republic
(Brozman) Department of Neurology, Faculty Hospital Nitra and Constantine
Philosopher University, Nitra, Slovakia
(Langova) Centre for Research and Science, Faculty of Health Sciences,
Palacky University, Olomouc, Czech Republic; Department of Biophysics,
Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech
Republic
(Herzig) Department of Neurology, Comprehensive Stroke Center, Charles
University Faculty of Medicine and University Hospital Hradec Kralove,
Hradec Kralove, Czech Republic
(Skoloudik) Centre for Research and Science, Faculty of Health Sciences,
Palacky University, Olomouc, Czech Republic
Publisher
NLM (Medline)
Abstract
BACKGROUND: Silent brain infarcts can be detected on magnetic resonance
imaging (MRI) in ~22% of patients after coronary angioplasty and stenting
(CS). The effect of periprocedural sonolysis on the risk of new brain
infarcts during CS was examined.
METHODS: Patients undergoing elective CS were allocated randomly to a
bilateral sonolysis group (70 patients, 58 men; mean age, 59.9years) or a
control group (74 patients, 45 men; mean age, 65.5years). Neurologic
examination, cognitive function tests, and brain MRI were performed prior
to intervention and at 24h after CS. Neurologic examination and cognitive
function tests were repeated at 30days after CS.
RESULTS: No significant differences were observed in the number of
patients with new infarcts (25.7 vs. 18.9%, P=0.423), the number of
lesions (1.3+/-1.0 vs. 2.9+/-5.3, P=0.493), lesion volume (0.16+/-0.34 vs.
0.28+/-0.60mL, P=0.143), and the number of patients with new ischemic
lesions in the insonated MCA territories (18.6vs. 17.6%, P=0.958) between
the sonolysis group and the control group. There were no cases of stroke,
transient ischemic attack, myocardial infarction, or death in the two
groups. Intracranial bleeding was reported only in 1 patient in the
control group (0 vs. 1.4%, P=0.888). Clock-drawing test scores at 30days
were significantly higher in the sonolysis group than in the control group
(median 3.0 vs. 2.5, P=0.031).
CONCLUSIONS: Sonolysis does not reduce the risk of new brain infarcts
after CS. The effect of sonolysis on number and volume of ischemic lesions
and cognitive function should be assessed in further
studies.<br/>Copyright &#xa9; 2018 Elsevier B.V. All rights reserved.

<170>
Accession Number
624490824
Title
Outcomes of Patients Receiving Downstream Revascularization After Initial
Medical Management for Non-ST-Segment Elevation Acute Coronary Syndromes
(From the TRILOGY ACS Trial).
Source
The American journal of cardiology. 122 (8) (pp 1322-1329), 2018. Date of
Publication: 15 Oct 2018.
Author
Hinohara T.T.; Roe M.T.; White H.D.; Fox K.A.A.; Bhatt D.L.; Hamm C.;
Gurbel P.A.; Aylward P.E.; Wiviott S.D.; Huber K.; Neely M.L.; Ohman E.M.
Institution
(Hinohara) Division of General Internal Medicine, Duke University School
of Medicine, Durham, NC, United States
(Roe, Ohman) Division of Cardiology, Department of Medicine, Duke
University School of Medicine, Durham, North Carolina; Duke Clinical
Research Institute, Duke University School of Medicine, Durham, North
Carolina
(White) Green Lane Cardiovascular Service, Auckland City Hospital, New
Zealand
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, United Kingdom
(Bhatt) Cardiovascular Division, Brigham and Women's Hospital, Harvard
Medical School, Boston, Massachusetts; VA Boston Healthcare System,
Boston, Massachusetts
(Hamm) Kerckhoff Heart and Thoraxcenter, Bad Nauheim, Germany
(Gurbel) Sinai Center for Thrombosis Research, Sinai Hospital of
Baltimore, Baltimore, MD, United States
(Aylward) South Australian Health and Medical Research Institute, Flinders
University Medical Centre, Adelaide, SA, Australia
(Wiviott) Cardiovascular Division, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Huber) Third Department of Medicine, Cardiology and Intensive Care
Medicine, Wilhelminenhospital, Sigmund Freud University, Medical School,
Vienna, Austria
(Neely) Duke Clinical Research Institute, Duke University School of
Medicine, Durham, NC, United States
Publisher
NLM (Medline)
Abstract
Patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS)
are sometimes treated with medical management alone rather than an
invasive strategy. Among those medically managed without revascularization
and discharged, a proportion will require revascularization later on, but
little is known about this population. In TRILOGY ACS, 9,326 patients with
NSTE ACS who were selected for medical management alone were randomized to
treatment with prasugrel or clopidogrel and discharged without
revascularization. Patient characteristics and ischemic and bleeding
outcomes through 30 months were compared between patients who underwent
downstream revascularization after the index hospitalization and those who
did not. A total of 662 patients (7.1%) underwent later revascularization
by percutaneous coronary intervention (73.1%), coronary artery bypass
graft surgery (26.4%), or the two (0.5%). Median time to revascularization
was 121 days (twenty-fifth, seventy-fifth percentiles: 41, 326).
Revascularized patients were younger, more likely to be male, and had
higher rates of hyperlipidemia, diabetes mellitus, prior myocardial
infarction, and prior revascularization compared with those not
revascularized. Europe and North America had the highest rates of
revascularization. During the follow-up period, those who underwent
revascularization had a higher rate of the composite outcome of
cardiovascular death, myocardial infarction, or stroke occurring after
revascularization compared with those not revascularized (hazard ratio
[HR] 2.73 [95% confidence interval {CI} 2.21 to 3.38], p < 0.001) as well
as a higher rate of each of the individual outcomes. Major bleeding was
also higher in those who underwent revascularization (GUSTO severe or
life-threatening: HR 2.61 [95% CI 1.02 to 6.67], p=0.045; TIMI major: HR
2.24 [95% CI 1.12 to 4.48], p=0.022). There was no evidence that bleeding
and ischemic outcomes varied by treatment with clopidogrel versus
prasugrel. In conclusion, among patients initially medically managed after
NSTE ACS, a small proportion later require revascularization and have a
high rate of ischemic and major bleeding outcomes compared with those not
requiring downstream revascularization.<br/>Copyright &#xa9; 2018.
Published by Elsevier Inc.

<171>
Accession Number
624496743
Title
Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting in
Patients With Left Main Coronary Artery Stenosis: A Systematic Review and
Meta-analysis.
Source
JAMA cardiology. 2 (10) (pp 1079-1088), 2017. Date of Publication: 01 Oct
2017.
Author
Giacoppo D.; Colleran R.; Cassese S.; Frangieh A.H.; Wiebe J.; Joner M.;
Schunkert H.; Kastrati A.; Byrne R.A.
Institution
(Giacoppo, Colleran, Cassese, Frangieh, Wiebe, Joner, Schunkert, Kastrati,
Byrne) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich, Germany
(Joner, Schunkert, Kastrati, Byrne) German Centre for Cardiovascular
Research, Partner Site Munich Heart Alliance, Munich, Germany
Publisher
NLM (Medline)
Abstract
Importance: In patients with left main coronary artery (LMCA) stenosis,
coronary artery bypass grafting (CABG) has been the standard therapy for
several decades. However, some studies suggest that percutaneous coronary
intervention (PCI) with drug-eluting stents may be an acceptable
alternative.
Objective: To compare the long-term safety of PCI with drug-eluting stent
vs CABG in patients with LMCA stenosis.
Data Sources: PubMed, Scopus, EMBASE, Web of Knowledge, and ScienceDirect
databases were searched from December 18, 2001, to February 1, 2017.
Inclusion criteria were randomized clinical trial, patients with LMCA
stenosis, PCI vs CABG, exclusive use of drug-eluting stents, and clinical
follow-up of 3 or more years.
Data Extraction and Synthesis: Trial-level hazard ratios (HRs) and 95% CIs
were pooled by fixed-effect and random-effects models with inverse
variance weighting. Time-to-event individual patient data for the primary
end point were reconstructed. Sensitivity analyses according to
drug-eluting stent generation and coronary artery disease complexity were
performed.
Main Outcomes and Measures: The primary end point was a composite of
all-cause death, myocardial infarction, or stroke at long-term follow-up.
Secondary end points included repeat revascularization and a composite of
all-cause death, myocardial infarction, stroke, or repeat
revascularization at long-term follow-up.
Results: A total of 4 randomized clinical trials were pooled; 4394
patients were included in the analysis. Of these, 3371 (76.7%) were men;
pooled mean age was 65.4 years. According to Grading of Recommendations,
Assessment, Development and Evaluation, evidence quality with respect to
the primary composite end point was high. Percutaneous coronary
intervention and CABG were associated with a comparable risk of all-cause
death, myocardial infarction, or stroke both by fixed-effect (HR, 1.06;
95% CI, 0.90-1.24; P=.48) and random-effects (HR, 1.06; 95% CI, 0.85-1.32;
P=.60) analysis. Sensitivity analyses according to low to intermediate
Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score
(random-effects: HR, 1.02; 95% CI, 0.74-1.41; P=.89) and drug-eluting
stent generation (first generation: HR, 0.90; 95% CI, 0.68-1.20; P=.49;
second generation: HR, 1.19; 95% CI, 0.82-1.73; P=.36) were consistent.
Kaplan-Meier curve reconstruction did not show significant variations over
time between the techniques, with a 5-year incidence of all-cause death,
myocardial infarction, or stroke of 18.3% (319 events) in patients treated
with PCI and 16.9% (292 events) in patients treated with CABG. However,
repeat revascularization after PCI was increased (HR, 1.70; 95% CI,
1.42-2.05; P<.001). Other individual secondary end points did not differ
significantly between groups. Finally, pooled estimates of trials with
LMCA stenosis tended overall to differ significantly from those of trials
with multivessel coronary artery disease without left main LMCA stenosis.
Conclusions and Relevance: Percutaneous coronary intervention and CABG
show comparable safety in patients with LMCA stenosis and low to
intermediate-complexity coronary artery disease. However, repeat
revascularization is more common after PCI.

<172>
Accession Number
624496685
Title
Survival and Cardiovascular Outcomes of Patients With Secondary Mitral
Regurgitation: A Systematic Review and Meta-analysis.
Source
JAMA cardiology. 2 (10) (pp 1130-1139), 2017. Date of Publication: 01 Oct
2017.
Author
Sannino A.; Smith R.L.; Schiattarella G.G.; Trimarco B.; Esposito G.;
Grayburn P.A.
Institution
(Sannino, Grayburn) Division of Cardiology, Department of Medicine, Baylor
University Medical Center, Baylor Heart and Vascular Hospital, Dallas, TX,
United States
(Sannino, Schiattarella) Currently with Division of Cardiology, Department
of Medicine, Universita Degli Studi di Napoli Federico II, Naples, Italy
(Smith) Department of Cardiothoracic Surgery, Heart Hospital Baylor Plano,
Plano, TX, United States
(Schiattarella) Division of Cardiology, Department of Medicine, University
of Texas Southwestern Medical Center, Dallas, United States
(Trimarco, Esposito) Division of Cardiology, Department of Medicine,
Universita Degli Studi di Napoli Federico II, Naples, Italy
Publisher
NLM (Medline)
Abstract
Importance: The outcomes of patients with left ventricular (LV)
dysfunction and secondary mitral regurgitation (SMR) are still
controversial.
Objective: To clarify the role of SMR in the outcomes of patients with
ischemic or idiopathic cardiomyopathies.
Data Sources: MEDLINE, ISI Web of Science, and Scopus databases were
searched for studies published up to March 2017.
Study Selection: Studies reporting data on outcomes in patients with SMR
were included. Duplicate publication data, studies lacking data on SMR
grade and its correlation with outcomes, mixed data on SMR and primary
mitral regurgitation, studies not clearly reporting the outcome of
interest, and studies with fewer than 100 patients were excluded. Of the
initial 3820 articles identified, 1.4% were finally included.
Data Extraction and Synthesis: The study met PRISMA requirements. Two of
us independently screened articles for fulfillment of inclusion criteria.
Main Outcomes and Measures: The primary outcome, set after data
collection, was the incidence of all-cause mortality in patients with and
without SMR. Secondary outcomes included hospitalization for heart failure
(HF), cardiac mortality, and a composite end point of death, HF
hospitalization, and cardiac transplant.
Results: Fifty-three studies and 45900 patients were included in the
meta-analysis. The mean (SD) length of follow-up was 40.8 (22.2) months.
In 26 of 36 studies reporting LV function by SMR grade, increasing SMR
severity was associated with worse LV function. When SMR was categorized
as present or absent, all-cause mortality was significantly higher in the
patients with SMR (17 studies, 26359 patients; risk ratio [RR],1.79; 95%
CI, 1.47-2.18; P<.001, I2=85%); when SMR was qualitatively graded, the
incidence of all-cause mortality was significantly increased in patients
having any degree of SMR compared with patients not having SMR (21
studies, 21081 patients; RR, 1.96; 95% CI, 1.67-2.31; P<.001, I2=74%).
Finally, when SMR was quantitatively graded, it remained associated with
an increased all-cause mortality rate (9 studies, 3649 patients; RR, 1.97;
95% CI, 1.71-2.27; P<.001, I2=0%). Moreover, SMR was associated with an
increased risk of hospitalization for HF (16 studies, 10171 patients; RR,
2.26; 95% CI, 1.92-2.67; P<.001, I2=41%), cardiac mortality (12 studies,
11896 patients; RR, 2.62; 95% CI, 1.87-3.69; P<.001, I2=74%), and death,
HF, and transplant (11 studies, 8256 patients; RR, 1.63; 95% CI,
1.33-1.99; P<.001, I2=78%).
Conclusions and Relevance: To our knowledge, this study is the first
meta-analysis to date to demonstrate that SMR, even when mild, correlates
with adverse outcomes in patients with ischemic or idiopathic
cardiomyopathies. Because SMR is an intrinsic consequence of LV
dysfunction, causality between SMR and mortality should not be implied.

<173>
Accession Number
2001211034
Title
Prospective Trial of Low-Fidelity Deliberate Practice of Aortic and
Coronary Anastomoses (TECoG 002).
Source
Journal of Surgical Education. (no pagination), 2018. Date of Publication:
2018.
Author
Spratt J.R.; Brunsvold M.; Joyce D.; Nguyen T.; Antonoff M.; Loor G.
Institution
(Spratt) Department of Surgery, University of Minnesota, Minneapolis, MN,
United States
(Brunsvold) Division of Critical Care/Acute Care Surgery, Department of
Surgery, University of Minnesota, Minneapolis, MN, United States
(Joyce) Division of Cardiothoracic Surgery, Medical College of Wisconsin,
Milwaukee, WI, United States
(Nguyen) Department of Cardiothoracic and Vascular Surgery, University of
Texas Health Science Center at Houston, Houston, TX, United States
(Antonoff) Department of Thoracic and Cardiovascular Surgery, Division of
Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX,
United States
(Loor) Division of Cardiothoracic Surgery, Department of Surgery,
University of Minnesota, Minneapolis, MN, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: We sought to examine the feasibility of a home practice
curriculum of vascular anastomosis in cardiovascular surgery using a
low-fidelity simulation platform and to examine its effectiveness in skill
acquisition in senior surgical trainees. Design: We organized a
multicenter prospective randomized study of senior residents and fellows,
who were oriented to a low-fidelity cardiac simulator and an 8-week
curriculum of independent practice of aortic and coronary anastomosis.
"Treatment" trainees received a simulator and the curriculum. Control
trainees received only their usual operative experience. The groups then
crossed over; all were studied for 16 weeks in total. Video skill
assessments were captured at 0, 8, and 16 weeks and were scored by one
blinded investigator using the Joint Council on Thoracic Surgery Education
Assessment tool. A post-hoc survey was distributed to invited participants
following study completion. Setting: University of Minnesota Department of
Surgery, Mayo Clinic Department of Cardiovascular Surgery, and the
University of Texas Health Science Center at Houston. Participants used
the simulator in offices, call rooms, and their homes. Participants:
Program participation in the study was solicited through the Thoracic
Education Cooperative Group. Four institutions expressed interest and a
total of 29 trainees were invited to the study and randomized. Of these,
12 (38%) completed the curriculum and submitted the requisite 3 sets of
videos (6 treatment, 6 control). All were senior residents and fellows in
general and cardiothoracic surgery. Results: No significant differences
were detected in assessment scores before and after the curriculum nor
before or after the control period in the overall or postgraduate
year-stratified populations. Participant case numbers during the study did
not have a significant effect on assessment scores. Randomized
participants reported strong interest in deliberate practice of technical
skills but identified competing clinical and personal obligations and
significant barriers to simulation. Conclusions: Considerable variability
in performance existed among participants who completed the study, but
overall, the curriculum alone was insufficient to improve simulator Joint
Council on Thoracic Surgery Education scores compared to those not
undergoing the curriculum. Among senior residents and fellows, provision
of a practice curriculum and simulator for repeated practice is feasible
but clinical and personal responsibilities were barriers to repetitive
practice.<br/>Copyright &#xa9; 2018 Association of Program Directors in
Surgery

<174>
Accession Number
2001210542
Title
Temporary autonomic modulation with botulinum toxin type A to reduce
atrial fibrillation after cardiac surgery.
Source
Heart Rhythm. (no pagination), 2018. Date of Publication: 2018.
Author
Waldron N.H.; Cooter M.; Haney J.C.; Schroder J.N.; Gaca J.G.; Lin S.S.;
Sigurdsson M.I.; Fudim M.; Podgoreanu M.V.; Stafford-Smith M.; Milano
C.A.; Piccini J.P.; Mathew J.P.
Institution
(Waldron, Cooter, Sigurdsson, Podgoreanu, Stafford-Smith, Mathew)
Department of Anesthesiology, Duke University Medical Center, Durham, NC,
United States
(Waldron, Fudim, Podgoreanu, Piccini) Duke Clinical Research Institute,
Durham, NC, United States
(Haney, Schroder, Gaca, Lin, Milano) Department of Surgery (Cardiothoracic
Surgery), Duke University Medical Center, Durham, NC, United States
(Lin) Department of Immunology, Duke University Medical Center, Durham,
NC, United States
(Lin) Department of Pathology, Duke University Medical Center, Durham, NC,
United States
(Fudim, Piccini) Department of Medicine (Cardiology), Duke University
Medical Center, Durham, NC, United States
Publisher
Elsevier B.V.
Abstract
Background: Postoperative atrial fibrillation (POAF) frequently
complicates cardiac surgery and is associated with worse outcomes. The
cardiac autonomic nervous system is implicated in the pathogenesis of
POAF. Objective: The purpose of this study was to determine the efficacy
and safety of selective cardiac autonomic modulation in preventing POAF.
Methods: In this randomized, double-blind, placebo-controlled trial,
adults undergoing cardiac surgery were randomized 1:1 to intraoperative
injection of 250 units onabotulinumtoxinA (botulinum toxin type A [BoNTA])
or placebo into epicardial fat pads. The study was powered to detect a 40%
reduction in relative risk of POAF. Time to first episode of in-hospital
POAF was the primary outcome, evaluated in patients receiving injection.
Additionally, incidence of POAF, length of stay (LOS), and adverse events
were examined. Results: The trial assigned 145 patients to injection, 15
of whom were dropped before treatment, leaving 130 patients for analysis.
Overall, 36.5% (23/63) of BoNTA-treated patients developed POAF compared
with 47.8% (32/67) of placebo-treated patients. The time-to-event analysis
revealed a hazard ratio of 0.69 (95% confidence interval 0.41-1.19; P
=.18) for the BoNTA vs placebo arm. There were no significant differences
in postoperative hospital LOS (median [interquartile range] 6.0 [3.4] vs
6.2 [3.7] days; P =.51) or adverse events prolonging LOS (27/63 [42.9%] vs
30/67 [44.8%]; P =.83) in patients receiving BoNTA vs placebo. Conclusion:
Epicardial injection of onabotulinumtoxinA was without discernible adverse
effects, but we failed to detect a significant difference in risk of POAF.
Future large-scale studies of epicardial onabotulinumtoxinA injection as a
potential POAF prevention strategy should be designed to study smaller,
but clinically meaningful, treatment effects.<br/>Copyright &#xa9; 2018
Heart Rhythm Society