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<1>
Accession Number
624362802
Title
A meta-analysis of >=5-year mortality in randomized controlled trials of
off-pump versus on-pump coronary artery bypass grafting.
Source
Journal of Cardiac Surgery. 33 (11) (pp 716-724), 2018. Date of
Publication: November 2018.
Author
Takagi H.; Hari Y.; Mitta S.; Kawai N.; Ando T.
Institution
(Takagi, Hari, Mitta, Kawai) Department of Cardiovascular Surgery,
Shizuoka Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: We sought to determine whether off-pump coronary artery bypass
grafting (CABG) increases long-term mortality, by performing a
meta-analysis of randomized controlled trials (RCTs) of off-pump versus
on-pump CABG with >=5-year follow-up. Methods: MEDLINE and EMBASE, and the
Cochrane Central Register of Controlled Trials were searched through July
2018. Hazard, risk, or odds ratios (HRs, RRs, or ORs) of long-term
(>=5-year) mortality for off-pump versus on-pump CABG were extracted from
each individual trial. Study-specific estimates were combined using
inverse variance-weighted averages of logarithmic HRs in the
random-effects model. Results: Our search identified eight medium- to
large-size RCTs at low risk of bias with long-term follow-up of off-pump
versus on-pump CABG enrolling a total of 8780 patients. Combining four
RCTs reporting actual HRs generated a statistically significant result
favoring on-pump CABG (HR, 1.21; P = 0.02). A pooled analysis of all eight
RCTs demonstrated a statistically significant increase in mortality with
off-pump CABG (HR/RR, 1.19; P = 0.01). There was no evidence of
significant publication bias in the meta-analysis of all eight RCTs. In a
sensitivity analysis, extracting RRs or ORs from all eight RCTs and
pooling them demonstrated a statistically significant increase in
mortality with off-pump CABG (RR, 1.17; P = 0.01; OR, 1.20; P = 0.007).
Eliminating 2 RRs and combining six HRs still generated a statistically
significant result favoring on-pump CABG (HR, 1.19; P = 0.05).
Conclusions: Off-pump CABG increases long-term (>=5-year) mortality
compared with on-pump CABG.<br/>Copyright &#xa9; 2018 Wiley Periodicals,
Inc.

<2>
Accession Number
624144809
Title
Assessment of omega-3 carboxylic acids in statin-treated patients with
high levels of triglycerides and low levels of high-density lipoprotein
cholesterol: Rationale and design of the STRENGTH trial.
Source
Clinical Cardiology. 41 (10) (pp 1281-1288), 2018. Date of Publication:
October 2018.
Author
Nicholls S.J.; Lincoff A.M.; Bash D.; Ballantyne C.M.; Barter P.J.;
Davidson M.H.; Kastelein J.J.P.; Koenig W.; McGuire D.K.; Mozaffarian D.;
Pedersen T.R.; Ridker P.M.; Ray K.; Karlson B.W.; Lundstrom T.; Wolski K.;
Nissen S.E.
Institution
(Nicholls) South Australian Health and Medical Research Institute,
University of Adelaide, Adelaide, Australia
(Lincoff, Bash, Wolski, Nissen) Department of Cardiovascular Medicine and
Cleveland Clinic Coordinating Center for Clinical Research, Cleveland
Clinic, Cleveland, OH, United States
(Ballantyne) Baylor College of Medicine, Houston, TX, United States
(Barter) University of New South Wales, Sydney, Australia
(Davidson) University of Chicago, Chicago, IL, United States
(Kastelein) Academic Medical Center, Amsterdam, Netherlands
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
and DZHK (German Centre for Cardiovascular Research), partner site Munich
Heart Alliance, Munich, Germany
(McGuire) Division of Cardiology, University of Texas Southwestern Medical
Center, Dallas, TX, United States
(Mozaffarian) Friedman School of Nutrition Science and Policy, Tufts
University, Boston, MA, United States
(Pedersen) Oslo University Hospital, Oslo, Norway
(Ridker) Harvard Medical School, Boston, MA, United States
(Ray) Imperial College of London, London, United Kingdom
(Karlson, Lundstrom) Department of Molecular and Clinical Medicine,
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden
(Karlson, Lundstrom) AstraZeneca Pharmaceuticals, Gothenburg, Sweden
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
It is uncertain whether omega-3 fatty acids are beneficial in
statin-treated patients. Epanova is a mix of omega-3 free fatty acids, not
requiring co-ingestion with food, which can lower triglycerides by up to
31%. STRENGTH will examine whether Epanova 4 g daily reduces the rate of
cardiovascular events in statin-treated patients with hypertriglyceridemia
and low levels of HDL-C at high risk for developing cardiovascular events.
STRENGTH is a randomized, double-blind, placebo-controlled trial. Patients
had a triglyceride level >= 180 to <500 mg/dL and HDL-C < 42 mg/dL (men)
or < 47 mg/dL (women) in the presence of either (1) established
atherosclerotic cardiovascular disease, (2) diabetes with one additional
risk factor, or (3) were other high-risk primary prevention patients,
based on age and risk factor assessment. Patients should be treated with a
statin, for >4 weeks, and have LDL-C < 100 mg/dL, but were also eligible
if LDL-C was >=100 mg/dL while on maximum tolerated statin therapy. The
study will extend from October 30, 2014 to October 30, 2019. 13 086
patients were randomized to Epanova 4 g or placebo daily in addition to
standard medical therapy. The primary efficacy outcome is time to first
event of cardiovascular death, myocardial infarction, stroke, coronary
revascularization or hospitalization for unstable angina. The trial will
continue until 1600 patients reach the primary endpoint, with a median
duration of therapy of 3 years. STRENGTH will determine whether Epanova 4
g daily will reduce cardiovascular events in statin-treated high-risk
patients with hypertriglyceridemia and low HDL-C levels.<br/>Copyright
&#xa9; 2018 Wiley Periodicals, Inc.

<3>
Accession Number
624676153
Title
Comparison between two biodegradable polymer-based sirolimus-eluting
stents with differing drug elution and polymer absorption kinetics:
Two-year clinical outcomes of the PANDA III trial.
Source
EuroIntervention. 14 (9) (pp e1029-e1037), 2018. Date of Publication:
October 2018.
Author
Wang J.; Guan C.; Qiao S.; Cao X.; Qin L.; Li Y.; Li Z.; Li X.; Yuan J.;
Gao R.; Xu B.
Institution
(Wang, Guan, Qiao, Yuan, Gao, Xu) Fu Wai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing,
China
(Cao) Chinese PLA 252 Hospital, Baoding, China
(Qin) Kaifeng Central Hospital, Kaifeng, China
(Li) Yunnan St. John's Hospital, Kunming, China
(Li) Liaoning Provincial People's Hospital, Shenyang, China
(Li) Fourth Affiliated Hospital, Harbin Medical University, Harbin, China
Publisher
EuroPCR
Abstract
Aims: In the PANDA III trial, the novel poly-lactide-co-glycolide
polymer-based BuMA sirolimus-eluting stent (SES) was non-inferior to the
polylactide polymer-based Excel SES for the primary endpoint of one-year
target lesion failure (TLF), with a lower incidence of stent thrombosis.
We sought to investigate whether the effectiveness profile of BuMA SES,
with more rapid drug elution and polymer absorption kinetics, would
persist at two years. Methods and results: A total of 2,348 patients (mean
age, 61.2+/-10.6 years; 24.3% diabetics; 31.2% with acute myocardial
infarction within one month) were randomly assigned to receive either BuMA
SES (n=1,174) or Excel SES (n=1,174) in the "all-comer" PANDA III trial.
Two-year clinical follow-up was available for 2,262 (96.3%) patients. The
incidence of TLF and the patient-oriented composite endpoint (PoCE) was
low and similar between the BuMA and Excel groups (7.4% vs. 6.9%, p=0.67,
and 13.1% vs. 10.9%, p=0.11, respectively). The rate of any
revascularisation was significantly higher with the BuMA SES (6.8% vs.
4.6%, p=0.03). Definite and probable thrombosis occurred in 0.7% and 1.4%
of patients in the BuMA and Excel groups, respectively (p=0.10).
Conclusions: Two-year rates of TLF and PoCE events were low and similar
between the two biodegradable polymer-based SES. ClinicalTrials.gov
Identifier: NCT02017275.<br/>Copyright &#xa9; Europa Digital & Publishing
2018. All rights reserved.

<4>
Accession Number
624584304
Title
Preoperative cigarette smoking and short-term morbidity and mortality
after cardiac surgery: A meta-analysis.
Source
Heart Asia. 10 (2) (no pagination), 2018. Article Number: e011069. Date of
Publication: 01 Oct 2018.
Author
Bayfield N.G.R.; Pannekoek A.; Tian D.H.
Institution
(Bayfield, Pannekoek) Department of Clinical Services, Fiona Stanley
Hospital, Murdoch, WA 6150, Australia
(Tian) Collaborative Research (CORE) Group, Macquarie University, Sydney,
Australia
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Currently, the choice of whether or not to electively operate on current
smokers is varied among cardiothoracic surgeons. This meta-analysis aims
to determine whether preoperative current versus ex-smoking status is
related to short-term postoperative morbidity and mortality in cardiac
surgical patients. Systematic literature searches of the PubMed, MEDLINE
and Cochrane databases were carried out to identify all studies in cardiac
surgery that investigated the relationship between smoking status and
postoperative outcomes. Extracted data were analysed by random effects
models. Primary outcomes included 30-day or in-hospital all-cause
mortality and pulmonary morbidity. Overall, 13 relevant studies were
identified, with 34 230 patients in current or ex-smoking subgroups. There
was no difference in mortality (p=0.93). Current smokers had significantly
higher risk of overall pulmonary complications (OR 1.44; 95% CI 1.27 to
1.64; p<0.001) and postoperative pneumonia (OR 1.62; 95%CI 1.27 to 2.06;
p<0.001) as well as lower risk of postoperative renal complications (OR
0.82; 95%CI 0.70 to 0.96; p=0.01) compared with ex-smokers. There was a
trend towards an increased risk of postoperative MI (OR 1.29; 95%CI 0.95
to 1.75; p=0.10). No difference in postoperative neurological
complications (p=0.15), postoperative sternal surgical site infections
(p=0.20) or postoperative length of intensive care unit stay (p=0.86) was
seen. Cardiac surgical patients who are current smokers at the time of
operation do not have an increased 30-day mortality risk compared with
ex-smokers, although they are at significantly increased risk of
postoperative pulmonary complications.<br/>Copyright &#xa9; Author(s) (or
their employer(s)) 2018. No commercial re-use. See rights and permissions.
Published by BMJ.

<5>
Accession Number
2001243438
Title
Aspirin in coronary artery surgery: 1-year results of the Aspirin and
Tranexamic Acid for Coronary Artery Surgery trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Author
Myles P.S.; Smith J.A.; Kasza J.; Silbert B.; Jayarajah M.; Painter T.;
Cooper D.J.; Marasco S.; McNeil J.; Bussieres J.S.; McGuinness S.; Chan
M.T.V.; Wallace S.; Forbes A.
Institution
(Myles, Cooper, Marasco, Wallace) Alfred Hospital, Melbourne, Australia
(Myles, Smith, Kasza, Cooper, Marasco, McNeil, Wallace, Forbes) Monash
University, Melbourne, Australia
(Smith) Monash Medical Centre, Clayton, Australia
(Silbert) St Vincent's Hospital, Fitzroy, Australia
(Jayarajah) South West Cardiac Centre, Derriford Hospital, Plymouth,
United Kingdom
(Painter) Royal Adelaide Hospital and Discipline of Acute Care Medicine,
University of Adelaide, Adelaide, Australia
(Bussieres) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec City, Quebec, Canada
(McGuinness) Auckland City Hospital, Auckland, New Zealand
(Chan) The Chinese University of Hong Kong, Hong Kong, Hong Kong
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Aspirin may reduce the risk of vascular graft thrombosis after
cardiovascular surgery. We previously reported the 30-day results of a
trial evaluating aspirin use before coronary artery surgery. Here we
report the 1-year outcomes evaluating late thrombotic events and
disability-free survival. Methods: Using a factorial design, we randomly
assigned patients undergoing coronary artery surgery to receive aspirin or
placebo and tranexamic acid or placebo. The results of the aspirin
comparison are reported here. The primary 1-year outcome was death or
severe disability, the latter defined as living with a modified Katz
activities of daily living score < 8. Secondary outcomes included a
composite of myocardial infarction, stroke and death from any cause
through to 1 year after surgery. Results: Patients were randomly assigned
to aspirin (1059 patients) or placebo (1068 patients). The rate of death
or severe disability was 4.1% in the aspirin group and 3.5% in the placebo
group (relative risk, 1.17; 95% confidence interval, 0.76-1.81; P =.48).
There was no significant difference in the rates of myocardial infarction
(P =.11), stroke (P =.086), or death (P =.24), or a composite of these
cardiovascular end points (P =.68). With the exception of those with a low
European System for Cardiac Operative Risk Evaluation score (P =.03),
there were no interaction effects on these outcomes with tranexamic acid
(all tests of interaction P >.10). Conclusions: In patients undergoing
coronary artery surgery, preoperative aspirin did not reduce death or
severe disability, or thrombotic events through to 1 year after
surgery.<br/>Copyright &#xa9; 2018

<6>
Accession Number
2001243140
Title
Meta-Analysis of Impact of Anemia and Hemoglobin Level on Survival After
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Author
Takagi H.; Hari Y.; Kawai N.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
To establish evidence whether baseline anemia and decreases in baseline
hemoglobin levels affect survival after transcatheter aortic valve
implantation (TAVI), we performed a meta-analysis of available studies.
Studies considered for inclusion met the following criteria: the design
was a comparative study of patients with baseline anemia versus those
without baseline anemia or a cohort study investigating baseline anemia
(as a dichotomous variable) or baseline hemoglobin levels (as a continuous
variable) as one of prognostic factors of mortality; the study population
was patients who underwent TAVI; and main outcomes included early (30-day
or in-hospital) or late (including early) all-cause mortality.
Study-specific estimates were combined in the random-effects model. Our
search identified 15 eligible studies including a total of 11,657 TAVI
patients. Pooled analysis demonstrated that baseline anemia was associated
with a statistically significant increase in early (p = 0.003) and midterm
mortality (p < 0.0001) and that incremental decreases in baseline
hemoglobin levels were associated with a statistically significant
increase in midterm mortality (p < 0.00001). Pooled analysis of only
adjusted estimates indicated that anemia was independently associated with
a statistically significant increase in early (p = 0.02) and midterm
mortality (p < 0.0001) and that incremental decreases in baseline
hemoglobin levels were independently associated with a statistically
significant increase in midterm mortality (p < 0.00001). In conclusion,
baseline anemia and lower baseline hemoglobin levels may be associated
with increased early and midterm mortality after TAVI.<br/>Copyright
&#xa9; 2018 Elsevier Inc.

<7>
Accession Number
621726140
Title
Systematic review of the cost-effectiveness of transcatheter interventions
for valvular heart disease.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 4 (2) (pp
81-90), 2018. Date of Publication: 01 Apr 2018.
Author
Gialama F.; Prezerakos P.; Apostolopoulos V.; Maniadakis N.
Institution
(Gialama, Maniadakis) Department of Health Services Management, National
School of Public Health, 196 Alexandras Avenue, Athens 115 21, Greece
(Prezerakos) Department of Nursing Studies, University of Peloponnese,
Efstathiou and Stamatikis Valioti and Plateon, Sparti 23100, Greece
(Apostolopoulos) Administration, Athens Medical Group, Filadelfeos and
Kefalariou 1, Square Kefalariou, Kifisia, Athens 14562, Greece
Publisher
Oxford University Press
Abstract
Transcatheter aortic valve implantation (TAVI) and transcatheter mitral
valve repair (TMVR) are increasingly used for managing patients with
valvular heart disease to whom surgery presents a high-risk. As these are
costly procedures, a systematic review of studies concerned with their
economic assessment was undertaken. The search was performed in PubMed and
the Cochrane Library and followed recommended methodological steps.
Studies were screened and their data were retrieved and were synthesized
using a narrative approach. Twenty-four, good to high quality, evaluations
were identified, representing different viewpoints, modelling techniques
and willingness-topay thresholds. Studies show that in high-risk patients
with symptomatic aortic stenosis, TAVI may be cost-effective compared with
medical management (MM) across many health care settings. In contrast,
studies of TAVI compared with surgical aortic valve replacement (SAVR)
yield conflicting and inconclusive results. The limited data available
show that TMVR may also be cost-effective relative to MM in mitral valve
disease. Existing evidence indicates that transcatheter techniques may be
cost-effective options, relative to MM, in high-risk patients with
valvular disease. Nonetheless, more research is needed to establish their
economic value further, to investigate the drives of cost-effectiveness,
and to evaluate surgical with transcatheter techniques in aortic valvular
disease.<br/>Copyright &#xa9; 2018 The Author(s). Published on behalf of
the European Society of Cardiology. All rights reserved.

<8>
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.

<9>
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.

<10>
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.

<11>
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.

<12>
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).

<13>
Accession Number
624464637
Title
The benefit of pacemaker therapy in patients with neurally mediated
syncope and documented asystole: A meta-analysis of implantable loop
recorder studies.
Source
Europace. 20 (8) (pp 1362-1366), 2018. Date of Publication: 2018.
Author
Brignole M.; Deharo J.C.; Menozzi C.; Moya A.; Sutton R.; Tomaino M.;
Ungar A.
Institution
(Brignole) Department of Cardiology, Arrhythmologic Centre, Ospedali del
Tigullio, Via Don Bobbio 25, Lavagna 16033, Italy
(Deharo) Department of Cardiology, Hopital La Timone Adultes, 264 Rue
Saint-Pierre, Marseille Cedex 5 13385, France
(Menozzi) Department of Cardiology, Arcispedale S. Maria Nuova, Viale
Risorgimento 80, Reggio Emilia 42123, Italy
(Moya) Department of Cardiology, Hospital Universitario Vall d'Hebron,
Paseo valle d'Ebron 119-129, Barcelona 08035, Spain
(Sutton) Department of Cardiology, National Heart and Lung Institute,
Imperial College, South Kensington Campus, London SW7 2A2, United Kingdom
(Tomaino) Department of Cardiology, Ospedale di Bolzano, Via Lorenz Bohler
5, Bolzano 39100, Italy
(Ungar) Department of Cardiology, University of Florence, AOU Careggi,
Viale Pieraccini 6, Florence 50141, Italy
Publisher
Oxford University Press
Abstract
Aim: Although the efficacy of cardiac pacing in patients with neurally
mediated syncope (NMS) and documented asystole is established, a more
robust point estimate of the benefit, which is not possible with any
individual study, is lacking. Methods and results: We undertook a
meta-analysis of individual participant data from four studies that
reported follow-up data on syncope recurrence with cardiac pacing in
patients with NMS who had had an electrocardiographic (ECG) documentation
of an asystolic event by means of implantable loop recorder (ILR). Of a
total of 1046 patients, who had ILR implanted, 383 (36.6%) patients had an
ECG documentation of a diagnostic event during mean follow-up of 13+/- 10
months. Of these, 201 (52%) patients, corresponding to 19.2% of the total
ILRs, had an asystolic event of 12.8+/- 11.0 s duration documented and met
the criteria for pacemaker therapy. Follow-up was available in 121 (60%)
of those patients with asystolic events. Syncope recurred after pacing in
18 (14.9%) patients with an actuarial rate of 13% [95% confidence interval
(CI) +/-6] at 1 year, 21% (95%CI +/-10) at 2 years, and 24% (95%CI +/-11)
at 3 years. On multivariable Cox regression analysis, positive tilt test
response was the only significant predictor of syncope recurrence with a
hazard ratio (95% CI) of 4.3 (1.4-13). On the contrary, type of asystolic
event (sinus arrest or atrioventricular block), prodrome, cardiac
abnormalities, number and duration of history of syncope, age, and gender
were not predictors of recurrence of syncope. Conclusion: A long asystolic
pause, suitable for pacemaker therapy, was found in one of five patients
with ILR. After pacemaker implantation, most of these patients remained
free of syncope recurrence for up to 3 years. The benefit of pacemaker was
greater in patients with negative tilt test.<br/>Copyright &#xa9; 2017 The
Author(s).

<14>
Accession Number
621774379
Title
Congenital heart diseases and cardiovascular abnormalities in 22q11.2
deletion syndrome: From well-established knowledge to new frontiers.
Source
American Journal of Medical Genetics, Part A. 176 (10) (pp 2087-2098),
2018. Date of Publication: October 2018.
Author
Unolt M.; Versacci P.; Anaclerio S.; Lambiase C.; Calcagni G.; Trezzi M.;
Carotti A.; Crowley T.B.; Zackai E.H.; Goldmuntz E.; Gaynor J.W.; Digilio
M.C.; McDonald-McGinn D.M.; Marino B.
Institution
(Unolt, Versacci, Anaclerio, Lambiase, Marino) Department of Pediatrics
and Pediatric Neuropsychiatry, "Sapienza" University of Rome, Rome, Italy
(Calcagni, Trezzi, Carotti) Department of Pediatric Cardiology and Cardiac
Surgery, Bambino Gesu Pediatric Hospital, Rome, Italy
(Crowley, Zackai, McDonald-McGinn) Division of Human Genetics, The
Children's Hospital of Philadelphia, Philadelphia, PA, United States
(Goldmuntz, Gaynor) The Cardiac Center, The Children's Hospital of
Philadelphia, Philadelphia, PA, United States
(Digilio) Division of Medical Genetics, Bambino Gesu Pediatric Hospital,
Rome, Italy
Publisher
Wiley-Liss Inc. (E-mail: info@wiley.com)
Abstract
Congenital heart diseases (CHDs) and cardiovascular abnormalities are one
of the pillars of clinical diagnosis of 22q11.2 deletion syndrome
(22q11.2DS) and still represent the main cause of mortality in the
affected children. In the past 30 years, much progress has been made in
describing the anatomical patterns of CHD, in improving their diagnosis,
medical treatment, and surgical procedures for these conditions, as well
as in understanding the underlying genetic and developmental mechanisms.
However, further studies are still needed to better determine the true
prevalence of CHDs in 22q11.2DS, including data from prenatal studies and
on the adult population, to further clarify the genetic mechanisms behind
the high variability of phenotypic expression of 22q11.2DS, and to fully
understand the mechanism responsible for the increased postoperative
morbidity and for the premature death of these patients. Moreover, the
increased life expectancy of persons with 22q11.2DS allowed the expansion
of the adult population that poses new challenges for clinicians such as
acquired cardiovascular problems and complexity related to multisystemic
comorbidity. In this review, we provide a comprehensive review of the
existing literature about 22q11.2DS in order to summarize the knowledge
gained in the past years of clinical experience and research, as well as
to identify the remaining gaps in comprehension of this syndrome and the
possible future research directions.<br/>Copyright &#xa9; 2018 Wiley
Periodicals, Inc.

<15>
Accession Number
624748663
Title
Impact of intravenous exenatide infusion for perioperative blood glucose
control on myocardial ischemia-reperfusion injuries after coronary artery
bypass graft surgery: sub study of the phase II/III ExSTRESS randomized
trial.
Source
Cardiovascular diabetology. 17 (1) (pp 140), 2018. Date of Publication: 01
Nov 2018.
Author
Besch G.; Perrotti A.; Salomon du Mont L.; Puyraveau M.; Ben-Said X.;
Baltres M.; Barrucand B.; Flicoteaux G.; Vettoretti L.; Samain E.; Chocron
S.; Pili-Floury S.
Institution
(Besch, Ben-Said, Baltres, Barrucand, Flicoteaux, Vettoretti, Samain,
Pili-Floury) Department of Anesthesiology and Intensive Care Medicine,
University Hospital of Besancon, University of Franche-Comte, 3 bvd
Alexander Fleming, Besancon 25000, France
(Perrotti) Department of Cardiothoracic Surgery, University of
Franche-Comte, 3 bvd Alexander Fleming, Besancon 25000, France
(Salomon du Mont) Department of Vascular Surgery, University Hospital of
Besancon, and, EA3920, University of Franche-Comte, 3 bvd Alexander
Fleming, 25000, Besancon, France
(Puyraveau) Clinical Methodology Center, University Hospital of Besancon,
University of Franche-Comte, 3 bvd Alexander Fleming, Besancon 25000,
France
(Chocron) Department of Cardiothoracic Surgery, University Hospital of
Besancon, and, EA3920, University of Franche-Comte, 3 bvd Alexander
Fleming, 25000, Besancon, France
Publisher
NLM (Medline)
Abstract
BACKGROUND: The aim of the study was to investigate whether intravenous
(iv) infusion of exenatide, a synthetic GLP-1 receptor agonist, could
provide a protective effect against myocardial ischemia-reperfusion injury
after coronary artery bypass graft (CABG) surgery.
METHODS: A sub study analysis of patients >18 years admitted for elective
CABG and included in the ExSTRESS trial was conducted. Patients were
randomized to receive either iv exenatide (1-h bolus of 0.05 micro&#32;g
min-1 followed by a constant infusion of 0.025 micro&#32;g min-1)
(exenatide group) or iv insulin therapy (control group) for blood glucose
control (target range 100-139 mg dl-1) during the first 48 h after
surgical incision. All serum levels of troponin I measured during routine
care in the Cardiac Surgery ICU were recorded. The primary outcome was the
highest value of plasma concentration of troponin I measured between 12
and 24 h after ICU admission. The proportion of patients presenting an
echocardiographic left ventricular ejection fraction (LVEF) >50% at the
follow-up consultation was compared between the two groups.
RESULTS: Finally, 43 and 49 patients were analyzed in the control and
exenatide groups, respectively {age: 69 [61-76] versus 71 [63-75] years;
baseline LVEF<50%: 6 (14%) versus 16 (32%) patients; on-pump surgery: 29
(67%) versus 33 (67%) patients}. The primary outcome did not significantly
differ between the two groups (3.34 [1.06-6.19] micro&#32;g l-1 versus
2.64 [1.29-3.85] micro&#32;g l-1 in the control and exenatide groups,
respectively; mean difference (MD) [95% confidence interval (95% CI)] 0.16
[-0.25; 0.57], p=0.54). The highest troponin value measured during the
first 72 h in the ICU was 6.34 [1.36-10.90] versus 5.04 [2.39-7.18]
micro&#32;g l-1, in the control and exenatide groups respectively (MD [95%
CI] 0.20 [-0.22; 0.61], p=0.39). At the follow-up consultation, 5 (12%)
versus 8 (16%) patients presented a LVEF<50% in the control and in the
exenatide groups respectively (relative risk [95% CI] 0.68 [0.16; 2.59],
p=0.56).
CONCLUSIONS: Postoperative iv exenatide did not provide any additional
cardioprotective effect compared to iv insulin in low-risk patients
undergoing scheduled CABG surgery. Trial registration ClinicalTrials.gov
Identifier NCT01969149, date of registration: January 7th, 2015; EudraCT
No. 2009-009254-25 A, date of registration: January 6th, 2009.

<16>
Accession Number
624748196
Title
Effect of physical exercise on weight loss and physical function following
bariatric surgery: a meta-analysis of randomised controlled trials.
Source
BMJ open. 8 (10) (pp e023208), 2018. Date of Publication: 31 Oct 2018.
Author
Ren Z.-Q.; Lu G.-D.; Zhang T.-Z.; Xu Q.
Institution
(Ren, Zhang, Xu) School of Nursing, Nanjing Medical University, Nanjing,
China
(Lu) Department of Interventional Radiology, First Affiliated Hospital of
Nanjing Medical University, Nanjing, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: We performed a meta-analysis of all of the available
randomised controlled trials (RCTs) to investigate whether physical
exercise contributes to weight loss or physical function improvement in
adults receiving bariatric surgery.
METHODS: We searched PubMed, Embase, the Cochrane Library, OVID and the
CINAHL up through May 2018. RCTs that assigned adults with obesity to
either an exercise training group or a no-exercise group after bariatric
surgery were included. The primary outcomes were weight loss and physical
function. Study bias was assessed using the Cochrane risk of bias tool,
and the quality of evidence was assessed using GRADEpro.
RESULTS: A total of eight studies met the inclusion criteria (n=347
participants). Most of the studies carried a low risk of bias due to
randomisation and blinding. Compared with those without exercise
intervention after surgery, patients engaging in physical exercise were
associated with greater weight loss (weighted mean difference (WMD)
-1.94kg; 95%CI -3.18 to -0.69; n=8) and longer 6min walk distance (6MWD;
WMD29.67m; 95%CI 25.97 to 33.37; n=2) during follow-up. By subgroup
analyses, the additional weight loss in exercise group was related to the
starting time and type of exercise: patients engaging in exercise 1year or
more after surgery and patients received aerobic-resistance exercise
experienced more weight loss. Besides, patients in exercise training group
also had lower systolic blood pressure and resting heart rate after
surgery. The quality of evidence for these outcomes was moderate to very
low.
CONCLUSIONS: Physical exercise after bariatric surgery provides 1.94kg
additional weight loss and 29.67m longer 6MWD compared with surgery alone.
Moreover, engaging in exercise 1year or more after surgery, and a combined
aerobic and resistance training programme may result in greater weight
loss.<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2018. Re-use
permitted under CC BY-NC. No commercial re-use. See rights and
permissions. Published by BMJ.

<17>
Accession Number
2001243295
Title
Rationale and design of the randomized prospective ATLAS study: Avoid
Transvenous Leads in Appropriate Subjects.
Source
American Heart Journal. 207 (pp 1-9), 2019. Date of Publication: January
2019.
Author
Mondesert B.; Bashir J.; Philippon F.; Dubuc M.; Amit G.; Exner D.; Joza
J.; Birnie D.H.; Lane C.; Tsang B.; Korley V.; Spears D.; Ling A.; Djuric
A.; Crystal E.; Hruczkowski T.; Roux J.-F.; Carroll S.; Essebag V.; Krahn
A.D.; Healey J.S.
Institution
(Mondesert, Dubuc) Department of Medicine, Montreal Heart Institute,
Universite de Montreal, Montreal, Quebec, Canada
(Bashir, Krahn) University of British Columbia, Vancouver, British
Columbia, Canada
(Philippon) Institut Universitaire de cardiologie et de pneumologie de
Quebec, Laval University, Quebec City, Quebec, Canada
(Amit, Ling, Djuric, Carroll, Healey) Population Health Research
Institute, McMaster University, Hamilton, Ontario, Canada
(Exner) Libin Cardiovascular Institute of Alberta, Calgary, Alberta,
Canada
(Joza, Essebag) McGill University Health Centre, Montreal, Quebec, Canada
(Birnie) University of Ottawa Heart Institute, Ottawa, Ontario, Canada
(Lane) Royal Jubilee Hospital, Victoria, British Columbia, Canada
(Tsang) Southlake Regional Health Centre, Newmarket, Ontario, Canada
(Korley) Division of Cardiology, Department of Medicine, St Michael's
Hospital, University of Toronto, Toronto, Ontario, Canada
(Spears) Peter Munk Cardiac Center Toronto General Hospital, University
Health Network, Toronto, Canada
(Crystal) Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health
Sciences Centre, University of Toronto, Toronto, Ontario, Canada
(Hruczkowski) Department of Medicine, Division of Cardiology, University
of Alberta, Edmonton, Canada
(Roux) Cardiology Service, Medicine department, Medicine and Health
sciences university, Sherbrooke university, Sherbrooke, Quebec, Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The defibrillator lead is the weakest part of the transvenous
(TV) implantable cardioverter defibrillation (ICD) system and a frequent
cause of morbidity. Lead dislodgement, cardiac perforation,
insertion-related trauma including pneumothorax and vascular injury, are
common early complications of TV-ICD implantation. Venous occlusion,
tricuspid valve dysfunction, lead fracture and lead insulation failure are
additional, later complications. The introduction of a totally
sub-cutaneous ICD (S-ICD) may reduce these lead-related issues, patient
morbidity, hospitalizations and costs. However, such benefits compared to
the TV-ICD have not been demonstrated in a randomized trial. Design: ATLAS
(Avoid Transvenous Leads in Appropriate Subjects) is a multi-centered,
randomized, open-label, parallel group trial. Patients younger than 60
years are eligible. If older than 60 years, patients are eligible if they
have an inherited heart rhythm disease, or risk factors for ICD-related
complication, such as hemodialysis, a history of ICD or pacemaker
infection, heart valve replacement, or severe pulmonary disease. This
study will determine if using an S-ICD compared to a TV-ICD reduces a
primary composite outcome of perioperative complications including
pulmonary or pericardial perforation, lead dislodgement or dysfunction,
tricuspid regurgitation and ipsilateral venous thrombosis. Five hundred
patients will be enrolled from 14 Canadian hospitals, and data collected
to both early- (at 6 months) and mid-term complications (at 24 months) as
well as mortality and ICD shock efficacy. The ATLAS randomized trial is
comparing early- and mid-term vascular and lead-related complications
among S-ICD versus TV-ICD recipients who are younger or at higher risk of
ICD-related complications.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<18>
Accession Number
624732967
Title
A double-blind randomized controlled trial of the local application of
vancomycin versus ampicillin powder into the operative field for thoracic
and/or lumbar fusions.
Source
Journal of Neurosurgery: Spine. 29 (5) (pp 553-559), 2018. Date of
Publication: November 2018.
Author
Takeuchi M.; Wakao N.; Kamiya M.; Hirasawa A.; Murotani K.; Takayasu M.
Institution
(Takeuchi, Wakao, Kamiya, Hirasawa, Takayasu) Spine Center, Aichi Medical
University Hospital, Nagakute, Japan
(Takeuchi, Takayasu) Department of Neurological Surgery, Aichi Medical
University Hospital, Nagakute, Japan
(Wakao, Kamiya, Hirasawa) Department of Orthopedics Surgery, Aichi Medical
University Hospital, Nagakute, Japan
(Murotani) Division of Biostatistics, Clinical Research Center, Aichi
Medical University Hospital, Nagakute, Japan
(Takeuchi) Department of Spine Surgery, Aichi Spine Hospital, Inuyama,
Aichi, Japan
Publisher
American Association of Neurological Surgeons
Abstract
OBJECTIVE Retrospective studies have reported that the local application
of vancomycin (VCM) powder into the operative field decreases the
incidence of surgical site infection (SSI) in thoracic and/or lumbar
fusion. Authors of the present study prospectively evaluated the effects
of VCM in patients undergoing thoracic and/or lumbar fusion. METHODS In
this randomized double-blind trial, 230 patients undergoing thoracic
and/or lumbar fusion were randomly assigned to the local administration of
VCM (interventional group, 1 g) or ampicillin (AMP; control group, 1 g)
into the surgical field. The primary outcome was SSI results within 1 year
of surgery. RESULTS The trial was prematurely stopped according to
predetermined rules. The results showed one superficial infection (0.9%,
Staphylococcus aureus) and one deep infection (0.9%, S. aureus) in the VCM
group and two superficial infections (1.8%, Staphylococcus epidermidis and
culture negative) and one deep infection (0.9%, methicillin-resistant S.
aureus) in the AMP group. No significant differences in infection rates
were observed between the groups (p = 0.8). CONCLUSIONS This double-blind
randomized controlled trial demonstrated that the local application of VCM
or AMP powder into the operative field in short thoracic and/or lumbar
fusion procedures resulted in a similar incidence of SSI. CLASSIFICATION
OF EVIDENCE Type of question: therapeutic; study design: randomized
controlled trial; evidence: class III. Clinical trial registration no.:
UMIN000009377 (umin.ac.jp/ctr).<br/>Copyright &#xa9; AANS 2018.

<19>
Accession Number
2001101575
Title
Meta-Analysis Comparing Percutaneous Coronary Revascularization Using
Drug-Eluting Stent Versus Coronary Artery Bypass Grafting in Patients With
Left Ventricular Systolic Dysfunction.
Source
American Journal of Cardiology. 122 (10) (pp 1670-1676), 2018. Date of
Publication: 15 November 2018.
Author
Cui K.; Zhang D.; Lyu S.; Song X.; Yuan F.; Xu F.; Zhang M.
Institution
(Cui, Zhang, Lyu, Song, Yuan, Xu, Zhang) Department of Cardiology, Beijing
Anzhen Hospital, Capital Medical University and Beijing Institute of
Heart, Lung and Blood Vessel Diseases, Beijing, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The relative safety and efficacy of percutaneous coronary intervention
(PCI) with drug-eluting stent (DES) and coronary artery bypass grafting
(CABG) in patients with left ventricular (LV) systolic dysfunction remains
controversial; therefore we conducted this meta-analysis to identify the
optimal strategy for such cohorts. A comprehensive search of the
electronic databases including PubMed, EMBASE, and Cochrane Library from
January 1, 2003 to March 1, 2018 was performed to identify the eligible
adjusted observational studies. The primary end point was all-cause death
during the longest follow-up, and the generic inverse variance
random-effect model was used to estimate the pooled hazard ratios (HRs)
with 95% confidence intervals (CIs). Eight adjusted observational studies
involving 10,268 patients were included. Compared with CABG, PCI with DES
was associated with higher risk of all-cause mortality (HR 1.36, 95% CI
1.16 to 1.60), cardiac mortality (HR 2.20, 95% CI 1.63 to 2.95),
myocardial infarction (HR 1.69, 95% CI 1.28 to 2.24), and repeat
revascularization (HR 4.95, 95% CI 3.28 to 7.46) in patients with coronary
artery disease and LV systolic dysfunction. Besides, separate analysis of
patients with LV ejection fraction <35% or left main and/or multivessel
disease obtained similar results compared with the overall analysis.
However, DES and CABG shared similar rates of stroke (HR 0.92, 95% CI 0.67
to 1.26). In conclusion, CABG appears to be superior to PCI with DES for
patients with coronary artery disease and LV systolic dysfunction,
particularly in patients with severe LV systolic dysfunction or those with
left main and/or multivessel disease.<br/>Copyright &#xa9; 2018

<20>
Accession Number
620701991
Title
Quality of life, satisfaction and outcomes after ministernotomy versus
full sternotomy isolated aortic valve replacement (QUALITY-AVR): Study
protocol for a randomised controlled trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 114. Date of
Publication: 17 Feb 2018.
Author
Rodriguez-Caulo E.A.; Guijarro-Contreras A.; Otero-Forero J.; Mataro M.J.;
Sanchez-Espin G.; Guzon A.; Porras C.; Such M.; Ordonez A.; Melero-Tejedor
J.M.; Jimenez-Navarro M.
Institution
(Rodriguez-Caulo, Guijarro-Contreras, Otero-Forero, Mataro, Sanchez-Espin,
Guzon, Porras, Such, Melero-Tejedor, Jimenez-Navarro) UGC Area del
Corazon. Servicio de Cirugia Cardiovascular y Cardiologia. Hospital, Univ.
Virgen de Vic de Malaga, Fund. Publica Andaluza para Invest. de Malaga en
Biomedicina y Salud, Universidad de Malaga. Spain. CIBERCV Enfermedades
Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
(Ordonez) UGC Area del Corazon, Servicio de Cirugia Cardiovascular,
Hospital Universitario Virgen del Rocio de Sevilla, Red de Investigacion
Cardiovascular (RIC), Instituto de Salud Carlos III, Madrid, Spain
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: During the last decade, the use of ministernotomy in cardiac
surgery has increased. Quality of life and patient satisfaction after
ministernotomy have never been compared to conventional full sternotomy in
randomised trials. The aim of the study is to determine if this minimally
invasive approach improves quality of life, satisfaction and clinical
morbimortality outcomes. Methods/design: The QUALITY-AVR trial is a
single-blind, single-centre, independent, and pragmatic randomised
clinical trial comparing ministernotomy ("J" shaped upper hemisternotomy
toward right 4th intercostal space) to full sternotomy in patients with
isolated severe aortic stenosis scheduled for elective aortic valve
replacement. One hundred patients will be randomised in a 1:1
computational fashion. Sample size was determined for the primary end
point with alpha error of 0.05 and with power of 90% in detecting
differences between intervention groups of >=0.10 points in change from
baseline quality of life Questionnaire EuroQOL-index (EQ-5D-5L), measured
at 1, 6 or 12months. Secondary endpoints are: the differences in change
from other baseline EQ-5D-5L utilities (visual analogue scale, Health
Index and Severity Index), cardiac surgery specific satisfaction
questionnaire (SATISCORE), a combined safety endpoint of four major
adverse complications at 1month (all-cause mortality, acute myocardial
infarction, neurologic events and acute renal failure), bleeding through
drains within the first 24h, intubation time, postoperative hospital and
intensive care unit length of stay, transfusion needs during the first 72h
and 1-year survival rates. Clinical follow up is scheduled at baseline, 1,
6, and 12months after randomization. All clinical outcomes are recorded
following the Valve Academic Research Consortium 2 criteria. Discussion:
The QUALITY-AVR trial aims to test the hypothesis that ministernotomy
improves quality of life, satisfaction and clinical outcomes in patients
referred for isolated aortic valve replacement. Statistically significant
differences favouring ministernotomy could modify the surgical "gold
standard" for aortic stenosis surgery, and subsequently the need to change
the control group in transcatheter aortic valve implantation trials.
Recruitment started on 18 March 2016. In November 2017, 75 patients were
enrolled.<br/>Copyright &#xa9; 2018 The Author(s).

<21>
Accession Number
623683616
Title
Off-pump coronary artery bypass grafting: 30 years of debate.
Source
Journal of the American Heart Association. 7 (16) (no pagination), 2018.
Article Number: e009934. Date of Publication: 01 Aug 2018.
Author
Gaudino M.; Angelini G.D.; Antoniades C.; Bakaeen F.; Benedetto U.;
Calafiore A.M.; Franco A.D.; Mauro M.D.; Fremes S.E.; Girardi L.N.;
Glineur D.; Grau J.; He G.-W.; Patrono C.; Puskas J.D.; Ruel M.; Schwann
T.A.; Tam D.Y.; Tatoulis J.; Tranbaugh R.; Vallely M.; Zenati M.A.; Mack
M.; Taggart D.P.
Institution
(Gaudino, Franco, Girardi, Tranbaugh) Department of Cardiothoracic
Surgery, Weill Cornell Medicine, New York, NY, United States
(Angelini, Benedetto) Bristol Heart Institute, University of Bristol,
United Kingdom
(Antoniades, Taggart) University of Oxford, United Kingdom
(Bakaeen) Cleveland Clinic, Cleveland, OH, United States
(Calafiore) Cardiac Surgery, Pope John Paul II Foundation, Campobasso,
Italy
(Mauro) Cardiovascular Disease Institute, University of L'Aquila, Italy
(Fremes, Tam) Schulich Heart Centre, Sunnybrook Health Science, University
of Toronto, Canada
(Glineur, Grau) Division of Cardiac Surgery, Ottawa Heart Institute,
Ottawa, Canada
(He) TEDA International Cardiovascular Hospital, Chinese Academy of
Medical Sciences & Peking Union Medical College, Tianjin, China
(Patrono) Department of Pharmacology, Catholic University School of
Medicine, Rome, Italy
(Puskas) Department of Cardiovascular Surgery, Icahn School of Medicine at
Mount Sinai, New York City, NY, United States
(Ruel) University of Ottawa Heart Institute, Ottawa, Canada
(Schwann) University of Toledo College of Medicine, Toledo, OH, United
States
(Tatoulis) Department of Surgery, University of Melbourne, Parkville,
Australia
(Vallely) Sydney Medical School, The University of Sydney, Australia
(Zenati) Harvard Medical School, Boston, MA, United States
(Mack) The Heart Hospital Baylor Plano, Plano, TX, United States
Publisher
American Heart Association Inc.

<22>
Accession Number
621918721
Title
Tranexamic Acid versus Placebo to Prevent Blood Transfusion during Radical
Cystectomy for Bladder Cancer (TACT): Study Protocol for a Randomized
Controlled Trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 261. Date of
Publication: 02 May 2018.
Author
Breau R.H.; Lavallee L.T.; Cnossen S.; Witiuk K.; Cagiannos I.; Momoli F.;
Bryson G.; Kanji S.; Morash C.; Turgeon A.; Zarychanski R.; Mallick R.;
Knoll G.; Fergusson D.A.
Institution
(Breau, Lavallee, Cnossen, Witiuk, Momoli, Bryson, Kanji, Mallick,
Fergusson) Ottawa Hospital Research Institute, Ottawa, ON, Canada
(Breau, Lavallee, Cagiannos, Morash, Knoll) Division of Urology,
Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
(Bryson) University of Ottawa and Ottawa Hospital, Department of
Anesthesiology and Pain Medicine, Ottawa, ON, Canada
(Turgeon) CHU de Quebec, Universite Laval, Quebec City, QC, Canada
(Zarychanski) University of Manitoba, Department of Internal Medicine,
Section of Medical Oncology and Haematology, Winnipeg, MB, Canada
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Radical cystectomy for bladder cancer is associated with a
high risk of needing red blood cell transfusion. Tranexamic acid reduces
blood loss during cardiac and orthopedic surgery, but no study has yet
evaluated tranexamic acid use during cystectomy. Methods: A randomized,
double-blind (surgeon-, anesthesiologist-, patient-,
data-monitor-blinded), placebo-controlled trial of tranexamic acid during
cystectomy was initiated in June 2013. Prior to incision, the intervention
arm participants receive a 10 mg/kg loading dose of intravenously
administered tranexamic acid, followed by a 5 mg/kg/h maintenance
infusion. In the control arm, the patient receives an identical volume of
normal saline that is indistinguishable from the intervention. The primary
outcome is any blood transfusion from the start of surgery up to 30 days
post operative. There are no strict criteria to mandate the transfusion of
blood products. The decision to transfuse is entirely at the discretion of
the treating physicians who are blinded to patient allocation. Physicians
are allowed to utilize all resources to make transfusion decisions,
including serum hemoglobin concentration and vital signs. To date, 147
patients of a planned 354 have been randomized to the study. Discussion:
This protocol reviews pertinent data relating to blood transfusion during
radical cystectomy, highlighting the need to identify methods for reducing
blood loss and preventing transfusion in patients receiving radical
cystectomy. It explains the clinical rationale for using tranexamic acid
to reduce blood loss during cystectomy, and outlines the study methods of
our ongoing randomized controlled trial.<br/>Copyright &#xa9; 2018 The
Author(s).

<23>
Accession Number
620843382
Title
Baden Prevention and Reduction of Incidence of Postoperative Delirium
Trial (PRIDe): A phase IV multicenter, randomized, placebo-controlled,
double-blind clinical trial of ketamine versus haloperidol for prevention
of postoperative delirium.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 142. Date of
Publication: 26 Feb 2018.
Author
Riegger H.; Hollinger A.; Seifert B.; Toft K.; Blum A.; Zehnder T.;
Siegemund M.
Institution
(Riegger, Hollinger, Blum, Zehnder, Siegemund) University Hospital Basel,
Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency
Medicine and Pain Therapy, Basel, Switzerland
(Seifert) University of Zurich, Epidemiology, Biostatistics and Prevention
Institute, Zurich, Switzerland
(Toft) See-Spital, Horgen and Kilchberg branches, Department for
Anesthesia, Intensive Care and Emergency Medicine, Horgen and Kilchberg,
Switzerland
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Delirium is a neurobehavioural syndrome that frequently
develops in the postoperative setting. The incidence of elderly patients
who develop delirium during hospital stay ranges from 10 to 80% (Schonauer
et al., J Pept Sci. 2017). Delirium was first described more than half a
century ago in the cardiac surgery population (Blachy and Starr, Am J
Psychiatry 121:371-5, 1964), where it was already discovered as a state
that might be accompanied by serious complications such as prolonged ICU
and hospital stay, reduced quality of life and increased mortality.
Furthermore, the duration of delirium is associated with worse long-term
cognitive function in the general ICU population (Sessler et al., Am J
Respir Crit Care Med 166:1338-44, 2002). This long-term experience with
delirium suggests a high socioeconomic burden and has been a focus of many
studies (Nishio et al., Crit Care Med 5:953-7, 1997; Ehlenbach et al.,
JAMA 303:763-70, 2010; Jahangir et al., World J Cardiol 3:383-7, 2011;
Abegunde et al., Lancet 370:1929-1938, 2007; Darmon et al., Intensive Care
Med 43:829-840, 2017; Marino et al., J Nephrol 28:717-24, 2015; Ng LL et
al., J Am Coll Cardiol 69:56-69, 2017; Sezen et al., J Pharmacol Exp Ther
287:238-45, 1998; Kim et al., Ann Lab Med 37:388-97, 2017). Due to the
multifactorial origin of delirium, we have several but no incontestable
options for prevention and symptomatic treatment. Overall, delirium
represents a high burden not only for patient and family members, but also
for the medical care team that aims to prevent postoperative delirium to
avoid serious consequences associated with it. The purpose of this study
is to determine whether postoperative delirium can be prevented by the
combination of established preventive agents. In addition, measured levels
of pre- and postoperative cortisol, neuron specific enolase (NSE) and
S-100beta will be used to investigate dynamics of these parameters in
delirious and non-delirious patients after surgery. Methods/design: The
Baden PRIDe Trial is an investigator-initiated, phase IV, two-centre,
randomised, placebo-controlled, double-blind clinical trial for the
prevention of delirium with haloperidol, ketamine, and the combination of
both vs. placebo in 200 patients scheduled for surgery. We would like to
investigate superiority of one of the three treatment arms (i.e.,
haloperidol, ketamine, combined treatment) to placebo. Discussion: There
is limited but promising evidence that haloperidol and ketamine can be
used to prevent delirium. Clinical care for patients might improve as the
results of this study may lead to better algorithms for the prevention of
delirium.<br/>Copyright &#xa9; 2018 The Author(s).

<24>
Accession Number
621224934
Title
Postoperative Vasoplegic Syndrome Is Associated With Impaired Endothelial
Vasomotor Response in Cardiac Surgery: A Prospective, Observational Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2218-2224),
2018. Date of Publication: October 2018.
Author
Abou-Arab O.; Martineau L.; Bar S.; Huette P.; Amar A.B.; Caus T.; Dupont
H.; Kamel S.; Guinot P.-G.; Lorne E.
Institution
(Abou-Arab, Martineau, Bar, Huette, Amar, Dupont, Lorne) Department of
Anaesthesiology and Critical Care Medicine, Amiens Picardy University
Hospital, Amiens, France
(Caus) Department of Cardiac Surgery, Amiens Picardy University Hospital,
Amiens, France
(Kamel) Jules Verne University of Picardy, Amiens, France
(Guinot) Department of Anaesthesiology and Critical Care Medicine, Dijon
University Hospital, Dijon, France
Publisher
W.B. Saunders
Abstract
Objectives: Vasoplegic syndrome (VS) affects up to 30% of cardiac surgery
patients. Onset of VS may be associated with overproduction of nitric
oxide (NO). The response of the brachial artery to NO can be assessed
using flow-mediated vasodilation (FMD). The aim of this study was to
assess brachial artery diameter and FMD response immediately after cardiac
surgery. Design: Prospective, observational study. Setting: Single-center
study in a tertiary teaching hospital. Patients: Patients older than 18
years undergoing elective cardiac surgery with cardiopulmonary bypass who
provided informed consent. Interventions: Brachial artery diameter and FMD
response were measured before cardiac surgery and just after surgery on
admission to the intensive care unit. Patients were screened for VS for
the following 48 hours. Results: Eleven (39%) of the 28 patients included
in the study developed VS. Brachial artery diameter and FMD differed
between VS and non-VS patients. On intensive care unit admission, mean
(+/- standard deviation) brachial artery diameter was greater in VS
patients than in non-VS patients (3.9 +/- 0.7 mm v 3.0 +/- 0.8 mm,
respectively; p = 0.002). Similarly, the FMD response after surgery was
greater in VS patients than in non-VS patients (42% +/- 8% v 31% +/- 1%,
respectively; p = 0.014). Brachial artery diameter and FMD response after
surgery were both predictive of VS, with an area under the curve (95%
confidence interval) of 0.850 (0.705-0.995) (p = 0.002) and 0.755
(0.56-0.95) (p = 0.047), respectively. Conclusion: Cardiac surgery with
cardiopulmonary bypass appears to alter the NO-mediated endothelial
vasomotor response.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<25>
Accession Number
619931835
Title
Heart Failure With Preserved Ejection Fraction-A Systematic Review and
Analysis of Perioperative Outcomes.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2423-2434),
2018. Date of Publication: October 2018.
Author
Mohananey D.; Heidari-Bateni G.; Villablanca P.A.; Iturrizaga Murrieta
J.C.; Vlismas P.; Agrawal S.; Bhatia N.; Mookadam F.; Ramakrishna H.
Institution
(Mohananey) Division of Hospital Medicine, Cleveland Clinic, Cleveland,
OH, United States
(Heidari-Bateni) Department of Internal Medicine, Saint Louis University
Hospital, St. Louis, MO, United States
(Villablanca) Division of Cardiovascular Diseases, NYU Langone Medical
Center, New York, NY, United States
(Iturrizaga Murrieta, Vlismas) Department of Internal Medicine, Montefiore
Medical Center, Bronx, NY, United States
(Agrawal) Department of Cardiovascular Medicine, St. Lukes University
Health Network, Bethlehem, PA, United States
(Bhatia) Division of Cardiovascular Medicine, Vanderbilt Heart and
Vascular Institute, Nashville, TN, United States
(Mookadam) Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale,
AZ, United States
(Ramakrishna) Division of Cardiovascular and Thoracic Anesthesiology, Mayo
Clinic, Phoenix, AZ, United States
Publisher
W.B. Saunders

<26>
Accession Number
2000776132
Title
Thirty-day readmissions in surgical and transcatheter aortic valve
replacement: A systematic review and meta-analysis.
Source
International Journal of Cardiology. 268 (pp 85-91), 2018. Date of
Publication: 1 October 2018.
Author
Danielsen S.O.; Moons P.; Sandven I.; Leegaard M.; Solheim S.; Tonnessen
T.; Lie I.
Institution
(Danielsen, Lie) Centre for Patient-centered Heart and Lung research,
Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo,
Norway
(Danielsen, Tonnessen) Institute of Clinical Medicine, Faculty of
Medicine, University of Oslo, Oslo, Norway
(Danielsen, Moons) KU Leuven Department of Public Health and Primary Care,
KU Leuven-University of Leuven, Leuven, Belgium
(Moons) Institute of Health and Care Sciences, University of Gothenburg,
Gothenburg, Sweden
(Sandven) Oslo Centre of Biostatistics and Epidemiology, Oslo University
Hospital, Oslo, Norway
(Leegaard) Department of Nursing and Health Promotion, Faculty of Health
Sciences, Oslo Metropolitan University, Oslo, Norway
(Solheim) Center for Clinical Heart Research and Department of Cardiology,
Division of Medicine, Oslo University Hospital, Ulleval, Oslo, Norway
(Tonnessen) Department of Cardiothoracic Surgery, Division of
Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ulleval,
Oslo, Norway
Publisher
Elsevier Ireland Ltd
Abstract
Background: The 30-day all-cause readmission rate after surgical aortic
valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR)
vary substantially. We conducted a systematic review and meta-analysis to
examine the overall incidence, causes, and risk factors of 30-day
all-cause readmission rate after SAVR and TAVR. Methods: Eight medical
research databases were searched; Cochrane, Medline, Embase, UpToDate,
PROSPERO, National Guideline Clearinghouse, SweMed and Oria. We followed
The Preferred Reporting Items for Systematic reviews and Meta-analysis
(PRISMA) for this study. Results: Thirty-three articles were included in
the systematic review, 32 of which were appropriate for the meta-analysis.
Overall, 17% (95% CI: 16-18%) of patients in the SAVR group, and 16% (95%
CI: 15-18%) in the TAVR groups were readmitted within 30 days. Heart
failure, arrhythmia, infection, and respiratory problems were the most
frequent causes of all-cause readmission after SAVR and TAVR. Most
frequent reported prior risk factors for all-cause readmission following
TAVR were diabetes, chronic lung disease/chronic obstructive pulmonary
disease, atrial fibrillation, kidney problems, and transapical
approach/nonfemoral access. For SAVR, no risk factors for 30-day all-cause
readmission were reported in the literature to date. Conclusion: In
conclusion, the overall proportion of 30-day all-cause readmission after
SAVR and TAVR are high. Interventions to prevent avoidable readmissions
ought to be developed and implemented.<br/>Copyright &#xa9; 2018 Elsevier
B.V.

<27>
Accession Number
620844538
Title
Perioperative Management of Cardiovascular Medications.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2289-2302),
2018. Date of Publication: October 2018.
Author
Lomivorotov V.V.; Efremov S.M.; Abubakirov M.N.; Belletti A.; Karaskov
A.M.
Institution
(Lomivorotov, Efremov, Abubakirov) Department of Anaesthesiology and
Intensive Care, E. Meshalkin National Medical Research Center,
Novosibirsk, Russian Federation
(Belletti) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Karaskov) Department of Cardiac Surgery, E. Meshalkin National Medical
Research Center, Novosibirsk, Russian Federation
Publisher
W.B. Saunders

<28>
Accession Number
2000741576
Title
Vasopressin in Cardiac Surgery: A Meta-analysis of Randomized Controlled
Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2225-2232),
2018. Date of Publication: October 2018.
Author
Dunser M.W.; Bouvet O.; Knotzer H.; Arulkumaran N.; Hajjar L.A.; Ulmer H.;
Hasibeder W.R.
Institution
(Dunser) Department of Anesthesiology and Intensive Care Medicine, Kepler
University Hospital and Johannes Kepler University Linz, Linz, Austria
(Bouvet) Amomed Pharma GmbH, Vienna, Austria
(Knotzer) Department of Anesthesiology and Critical Care Medicine II,
Klinikum Wels, Wels, Austria
(Arulkumaran) Department of Critical Care, University College of London
Hospital, London, United Kingdom
(Hajjar) Department of Cardiopneumology, InCor, University of Sao Paulo,
Sao Paulo, Brazil
(Ulmer) Institute of Medical Statistics, Informatics and Health Economics,
Innsbruck Medical University, Innsbruck, Austria
(Hasibeder) Department of Anesthesiology and Critical Care Medicine,
Krankenhaus St. Vinzenz in Zams, Zams, Austria
Publisher
W.B. Saunders
Abstract
Objective: To summarize the results of randomized controlled trials on the
use of vasopressin as a vasopressor agent in cardiac surgery. Design:
Meta-analysis. Participants: Six-hundred-twenty-five adult patients
undergoing elective or emergency cardiac surgery. Interventions: Arginine
vasopressin infusion (n = 313) or control/standard therapy (n = 312).
Measurements and Main Results: The rates of perioperative complications
and postoperative mortality were used as primary and secondary endpoints,
respectively. Fixed and/or random effects models were used to compare
pooled odds ratios. Arginine vasopressin reduced the pooled odds ratio
(OR) of perioperative complications (OR, 0.33; 95% confidence interval
[CI], 0.2-0.54; p < 0.0001). A sensitivity analysis excluding the largest
trial showed an unchanged reduction in perioperative complications (OR,
0.35; 95% CI, 0.18-0.69; p = 0.002). When analyzing each perioperative
complication separately, vasopressin reduced the pooled OR of vasodilatory
shock (OR, 0.4; 95% CI, 0.16-0.97; p = 0.04) and new-onset atrial
fibrillation (OR, 0.42; 95% CI, 0.21-0.82; p = 0.01). The pooled OR of
postoperative death was not different between patients treated with
arginine vasopressin and those receiving standard therapy or placebo (OR,
0.83; 95% CI, 0.45-1.53; p = 0.55). The funnel plot for the primary
endpoint suggested a relevant publication bias. All included trials
suffered from a high risk of bias. Conclusion: Our meta-analysis suggests
that arginine vasopressin may reduce the rate of perioperative
complications in patients undergoing elective or emergency cardiac
surgery. No difference in postoperative mortality was observed. An
adequately powered multicenter trial is required for reliable estimation
of the effects of arginine vasopressin on perioperative complication rates
and mortality in cardiac surgical patients.<br/>Copyright &#xa9; 2018
Elsevier Inc.

<29>
Accession Number
2000669038
Title
Clinical Outcomes of Adult Patients Who Receive Extracorporeal Membrane
Oxygenation for Postcardiotomy Cardiogenic Shock: A Systematic Review and
Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2087-2093),
2018. Date of Publication: October 2018.
Author
Wang L.; Wang H.; Hou X.
Institution
(Wang, Wang, Hou) Center for Cardiac Intensive Care, Capital Medical
University Affiliated Anzhen Hospital, Beijing, China
Publisher
W.B. Saunders
Abstract
Objective: To investigate the clinical outcomes of adult patients
receiving extracorporeal membrane oxygenation (ECMO) for postcardiotomy
cardiogenic shock (PCS). Design: Meta-analysis of 20 observational
studies. Setting: Hospitals that perform cardiac surgery. Participants:
The study included 2,877 PCS patients undergoing ECMO from 20
observational studies. Interventions: ECMO use. Measurements and Main
Results: Twenty observational studies were selected for final analysis.
The pooled survival rate to hospital discharge was 34.0% (30.0%-38.0%) in
PCS patients receiving ECMO. The pooled 1-year survival rate was 24.0%
(19.05%-30.0%). The pooled midterm survival rate was 18.0% (11.0%-27.0%).
The pooled rate of leg ischemia was 14.0% (10.0%-20.0%). The pooled rate
of redo surgery was 50.0% (32.0%-68.0%). The pooled rate of renal failure
was 57.0% (47.0%-66.0%). The pooled rate of neurologic complications was
16.0% (13.0%-20.0%). The pooled rate of infection was 31.0% (22.0%-41.0%).
Most of the included studies commonly revealed that age >65 years,
pre-ECMO or post-ECMO blood lactate, renal insufficiency, a longer
duration of ECMO, and neurologic complications were risk factors of
in-hospital mortality in PCS patients undergoing ECMO. Conclusions: The
short-term and midterm survival rates of PCS patients treated with ECMO
were disappointingly low, and post-ECMO complication rates were relatively
high.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<30>
Accession Number
619290615
Title
Meta-Analysis of the Outcome After Postcardiotomy Venoarterial
Extracorporeal Membrane Oxygenation in Adult Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (3) (pp 1175-1182),
2018. Date of Publication: June 2018.
Author
Biancari F.; Perrotti A.; Dalen M.; Guerrieri M.; Fiore A.; Reichart D.;
Dell'Aquila A.M.; Gatti G.; Ala-Kokko T.; Kinnunen E.-M.; Tauriainen T.;
Chocron S.; Airaksinen J.K.E.; Ruggieri V.G.; Brascia D.
Institution
(Biancari, Kinnunen, Tauriainen, Airaksinen, Brascia) Heart Center, Turku
University Hospital and Department of Surgery, University of Turku, Turku,
Finland
(Biancari, Guerrieri) Department of Surgery, University of Oulu, Oulu,
Finland
(Perrotti, Chocron) Department of Thoracic and Cardio-Vascular Surgery,
University Hospital Jean Minjoz, Besancon, France
(Dalen) Department of Molecular Medicine and Surgery, Department of
Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet,
Karolinska University Hospital, Stockholm, Sweden
(Fiore) Department of Cardiothoracic Surgery, Henri Mondor University
Hospital, AP-HP, Paris-Est University, Creteil, France
(Reichart) Hamburg University Heart Center, Hamburg, Germany
(Dell'Aquila) Department of Cardiothoracic Surgery, University Hospital
Muenster, Muenster, Germany
(Gatti) Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
(Ala-Kokko) Department of Anesthesiology, Division of Intensive Care
Medicine, Oulu University Hospital, Medical Research Center Oulu, Oulu
University, Oulu, Finland
(Ruggieri) Division of Cardiothoracic and Vascular Surgery, Pontchaillou
University Hospital, Rennes, France
Publisher
W.B. Saunders
Abstract
Objective: This study was planned to pool existing data on outcome and to
evaluate the efficacy of postcardiotomy venoarterial extracorporeal
membrane oxygenation (VA-ECMO) in adult patients. Design: Systematic
review of the literature and meta-analysis. Setting: Multi-institutional
study. Participants: Adult patients with acute heart failure immediately
after cardiac surgery. Interventions: VA-ECMO after cardiac surgery.
Studies evaluating only heart transplant patients were excluded from this
analysis. Measurements and Main Results: A literature search was performed
to identify studies published since 2000. Thirty-one studies reported on
2,986 patients (mean age, 58.1 years) who required postcardiotomy VA-ECMO.
The weaning rate from VA-ECMO was 59.5% and hospital survival was 36.1%
(95% CI 31.5-40.8). The pooled rate of reoperation for bleeding was 42.9%,
major neurological event 11.3%, lower limb ischemia 10.8%, deep sternal
wound infection/mediastinitis 14.7%, and renal replacement therapy 47.1%.
The pooled mean number of transfused red blood cell units was 17.7 (95% CI
13.3-22.1). The mean stay in the intensive care unit was 13.3 days (95% CI
10.2-16.4). Survivors were significantly younger (mean, 55.7 v 63.6 years,
p = 0.015) and their blood lactate level before starting VA-ECMO was lower
(mean, 7.7 v 10.7 mmol/L, p = 0.028) than patients who died. One-year
survival rate was 30.9% (95% CI 24.3-37.5). Conclusions: Pooled data
showed that VA-ECMO may salvage one-third of patients unresponsive to any
other resuscitative treatment after adult cardiac surgery.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<31>
Accession Number
2000571932
Title
Effect of Levosimendan on Renal Outcome in Cardiac Surgery Patients With
Chronic Kidney Disease and Perioperative Cardiovascular Dysfunction: A
Substudy of a Multicenter Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2152-2159),
2018. Date of Publication: October 2018.
Author
Zangrillo A.; Alvaro G.; Belletti A.; Pisano A.; Brazzi L.; Calabro M.G.;
Guarracino F.; Bove T.; Grigoryev E.V.; Monaco F.; Boboshko V.A.;
Likhvantsev V.V.; Scandroglio A.M.; Paternoster G.; Lembo R.; Frassoni S.;
Comis M.; Pasyuga V.V.; Navalesi P.; Lomivorotov V.V.
Institution
(Zangrillo, Belletti, Calabro, Bove, Monaco, Scandroglio, Lembo, Frassoni)
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Zangrillo) Vita-Salute San Raffaele University, Milan, Italy
(Alvaro, Navalesi) Department of Anesthesia and Intensive Care, AOU Mater
Domini Germaneto, Catanzaro, Italy
(Pisano) Division of Cardiac Anesthesia and Intensive Care Unit, AORN dei
Colli - Monaldi Hospital, Naples, Italy
(Brazzi) Department of Anesthesia and Intensive Care, AOU Citta della
Salute e della Scienza, Turin, Italy
(Brazzi) Department of Surgical Sciences, University of Turin, Turin,
Italy
(Guarracino) Division of Cardiothoracic Anesthesia and Intensive Care,
Department of Anesthesia and Critical Care Medicine, AOU Pisana, Pisa,
Italy
(Grigoryev) Department of Anesthesiology and Intensive Care, State
Research Institute for Complex Issues of Cardiovascular Disease, Kemerovo,
Russian Federation
(Boboshko, Lomivorotov) Department of Anesthesiology and Intensive Care,
E. Meshalkin National Medical Research Center, Novosibirsk, Russian
Federation
(Likhvantsev) Department of Anesthesiology and Intensive Care, Moscow
Regional Clinical and Research Institute, Moscow, Russian Federation
(Paternoster) Department of Anesthesia and Intensive Care, San Carlo
Hospital, Potenza, Italy
(Comis) Department of Cardiovascular Anesthesia and Intensive Care, AO
Ordine Mauriziano, Turin, Italy
(Pasyuga) Department of Anesthesiology and Intensive Care, Federal Center
for Cardiovascular Surgery Astrakhan, Astrakhan, Russian Federation
(Navalesi) Department of Medical and Surgical Sciences, Magna Graecia
University, Catanzaro, Italy
Publisher
W.B. Saunders
Abstract
Objective: Acute kidney injury (AKI) occurs frequently after cardiac
surgery. Levosimendan might reduce the incidence of AKI in patients
undergoing cardiac surgery. The authors investigated whether levosimendan
administration could reduce AKI incidence in a high-risk cardiac surgical
population. Design: Post hoc analysis of a multicenter randomized trial.
Setting: Cardiac surgery operating rooms and intensive care units of 14
centers in 3 countries. Participants: The study comprised 90 patients who
underwent mitral valve surgery with an estimated glomerular filtration
rate <60 mL/min/1.73 m² and perioperative myocardial
dysfunction. Interventions: Patients were assigned randomly to receive
levosimendan (0.025-0.2 mug/kg/min) or placebo in addition to standard
inotropic treatment. Measurements and Main Results: Forty-six patients
were assigned to receive levosimendan and 44 to receive placebo.
Postoperative AKI occurred in 14 (30%) patients in the levosimendan group
versus 23 (52%) in the placebo group (absolute difference -21.8; 95%
confidence interval -41.7 to -1.97; p = 0.035). The incidence of major
complications also was lower (18 [39%]) in the levosimendan group versus
that in the placebo group (29 [66%]) (absolute difference -26.8 [-46.7 to
-6.90]; p = 0.011). A trend toward lower serum creatinine at intensive
care unit discharge was observed in the levosimendan group (1.18
[0.99-1.49] mg/dL) versus that in the placebo group (1.39 [1.05-1.76]
mg/dL) (95% confidence interval -0.23 [-0.49 to 0.01]; p = 0.07).
Conclusions: Levosimendan may improve renal outcome in cardiac surgery
patients with chronic kidney disease undergoing mitral valve surgery who
develop perioperative myocardial dysfunction. Results of this exploratory
analysis should be investigated in future properly designed randomized
controlled trials.<br/>Copyright &#xa9; 2018 Elsevier Inc.

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

<33>
Accession Number
618954521
Title
An updated meta-analysis of novel oral anticoagulants versus vitamin K
antagonists for uninterrupted anticoagulation in atrial fibrillation
catheter ablation.
Source
Heart Rhythm. 15 (1) (pp 107-115), 2018. Date of Publication: January
2018.
Author
Cardoso R.; Knijnik L.; Bhonsale A.; Miller J.; Nasi G.; Rivera M.; Blumer
V.; Calkins H.
Institution
(Cardoso, Bhonsale, Miller, Calkins) Division of Cardiology, Department of
Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, United
States
(Knijnik, Nasi, Rivera, Blumer) Division of Cardiology, Department of
Medicine, University of Miami-Jackson Memorial Hospital, Miami, Florida,
United States
Publisher
Elsevier B.V.
Abstract
Background: Catheter ablation is recommended as a first- or second-line
rhythm control therapy for selected patients with atrial fibrillation
(AF). There is a wide variability in the periprocedural management of oral
anticoagulation in patients undergoing AF ablation. Objective: We aimed to
perform an updated meta-analysis of novel oral anticoagulants (NOACs) vs
vitamin K antagonists (VKAs) as uninterrupted anticoagulation in patients
undergoing AF ablation. Methods: Databases and conference abstracts were
searched. Studies were excluded if oral anticoagulants were held at any
periprocedural period. The primary outcomes were stroke or transient
ischemic attack (TIA) and major bleeding. Results: Twelve studies and 4962
patients were included. Stroke or TIA was rare (NOAC, 0.08%; VKA, 0.16%)
and not different between groups (odds ratio [OR] 0.66; 95% confidence
interval [CI] 0.19-2.30). The incidence of silent cerebral embolic events
was also not significantly different between NOACs (8%) and VKAs (9.6%)
(OR 0.86; 95% CI 0.42-1.76). Major bleeding was significantly reduced in
the NOAC group (0.9%) as compared with VKA-treated patients (2%) (OR 0.50;
95% CI 0.30-0.84; P <.01). This finding was confirmed in a subgroup
analysis of randomized and cohort studies with matched controls (OR 0.45;
95% CI 0.24-0.83; P =.01). There was no significant difference in the
outcomes of individual NOACs and VKAs, although these analyses may have
been underpowered to detect minor differences in such rare outcomes.
Conclusion: In patients undergoing AF ablation, uninterrupted
periprocedural NOACs are associated with a low incidence of stroke or TIA
and a significant reduction in major bleeding as compared with
uninterrupted VKAs.<br/>Copyright &#xa9; 2017 Heart Rhythm Society

<34>
[Use Link to view the full text]
Accession Number
622304261
Title
Sex difference in patients with ischemic heart failure undergoing surgical
revascularization results from the STICH trial (surgical treatment for
ischemic heart failure).
Source
Circulation. 137 (8) (pp 771-780), 2018. Date of Publication: 2018.
Author
Pina I.L.; Zheng Q.; She L.; Szwed H.; Lang I.M.; Farsky P.S.;
Castelvecchio S.; Biernat J.; Paraforos A.; Kosevic D.; Favaloro L.E.;
Nicolau J.C.; Varadarajan P.; Velazquez E.J.; Pai R.G.; Cyrille N.; Lee
K.L.; Desvigne-Nickens P.
Institution
(Pina, Zheng, Cyrille) Albert Einstein College of Medicine, Montefore
Medical Center, New York, NY, United States
(She) Duke Clinical Research Institute, United States
(Lee) Department of Biostatistics and Bioinformatics, United States
(Velazquez) Department of Medicine, Duke University School of Medicine,
Durham, NC, United States
(Szwed) National Institute of Cardiology, Warsaw, Poland
(Lang) Medical University of Vienna, Austria
(Farsky) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Castelvecchio) Istituti di Ricovero e Cura A Carattere Scientifco
Policlinico San Donato, Milan, Italy
(Biernat) Medical University of Silesia, Katowice, Poland
(Paraforos) Department of Surgery-Cardiac, University of Trier, Germany
(Kosevic) Dedinje Cardiovascular Institute, Belgrade, Serbia
(Favaloro) University Hospital Favaloro Foundation, Buenos Aires,
Argentina
(Nicolau) Heart Institute, University of Sao Paulo Medical School, Brazil
(Varadarajan, Pai) Department of Medicine/Cardiology, University of
California, Riverside School of Medicine, United States
(Desvigne-Nickens) Division of Cardiovascular Sciences, National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda, MD,
United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Female sex is conventionally considered a risk factor for
coronary artery bypass grafting (CABG) and has been included as a poor
prognostic factor in multiple cardiac operative risk evaluation scores. We
aimed to investigate the association of sex and the long-term beneft of
CABG in patients with ischemic left ventricular dysfunction enrolled in
the prospective STICH trial (Surgical Treatment for Ischemic Heart Failure
Study). METHODS: The STICH trial randomized 1212 patients (148 [12%] women
and 1064 [88%] men) with coronary artery disease and left ventricular
ejection fraction =35% to CABG+medical therapy (MED) versus MED alone.
Long-term (10-year) outcomes with each treatment were compared according
to sex. RESULTS: At baseline, women were older (63.4 versus 59.3 years;
P=0.016) with higher body mass index (27.9 versus 26.7 kg/m2; P=0.001).
Women had more coronary artery disease risk factors (diabetes mellitus,
55.4% versus 37.2%; hypertension, 70.9% versus 58.6%; hyperlipidemia,
70.3% versus 58.9%) except for smoking (13.5% versus 21.8%) and had lower
rates of prior CABG (0% versus 3.4%; all P<0.05) than men. Moreover, women
had higher New York Heart Association class (class III/IV, 66.2% versus
57.0%), lower 6-minute walk capacity (300 versus 350 m), and lower Kansas
City Cardiomyopathy Questionnaire overall summary scores (51 versus 63;
all P<0.05). Over 10 years of followup, all-cause mortality (49.0% versus
65.8%; adjusted hazard ratio, 0.67; 95% confdence interval, 0.52-0.86;
P=0.002) and cardiovascular mortality (34.3% versus 52.3%; adjusted hazard
ratio, 0.65; 95% confdence interval, 0.48-0.89; P=0.006) were signifcantly
lower in women compared with men. With randomization to CABG+MED versus
MED treatment, there was no signifcant interaction between sex and
treatment group in all-cause mortality, cardiovascular mortality, or the
composite of all-cause mortality or cardiovascular hospitalization (all
P>0.05). In addition, surgical deaths were not statistically different
(1.5% versus 5.1%; P=0.187) between sexes among patients randomized to
CABG per protocol as initial treatment. CONCLUSIONS: Sex is not associated
with the effect of CABG+MED versus MED on all-cause mortality,
cardiovascular mortality, the composite of death or cardiovascular
hospitalization, or surgical deaths in patients with ischemic left
ventricular dysfunction. Thus, sex should not influence treatment
decisions about CABG in these patients.<br/>Copyright &#xa9; 2017 American
Heart Association, Inc.

<35>
Accession Number
619592181
Title
A comparison between inhalational (Desflurane) and total intravenous
anaesthesia (Propofol and dexmedetomidine) in improving postoperative
recovery for morbidly obese patients undergoing laparoscopic sleeve
gastrectomy: A double-blinded randomised controlled trial.
Source
Journal of Clinical Anesthesia. 45 (pp 6-11), 2018. Date of Publication:
May 2018.
Author
Elbakry A.-E.; Sultan W.-E.; Ibrahim E.
Institution
(Elbakry, Sultan, Ibrahim) Department of Anaesthesia and Intensive Care,
Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective Laparoscopic sleeve gastrectomy is commonly performed
under total intravenous anaesthesia (TIVA) or balanced anaesthesia using
an intravenous and inhalation agent. It is still unclear which anaesthesia
regimen is better for this group of patients. The present study has been
conducted to compare the use of the inhalation anaesthesia technique using
desflurane with the TIVA technique, using propofol and dexmedetomidine.
Design Prospective, randomised, double-blinded study. Setting Menoufia
Univeristy Hospital. Patients This randomised trial was carried out on 100
morbidly obese patients undergoing laparoscopic sleeve gastrectomy. The
patients were randomised into two equally sized groups; one group received
the inhalation anaesthesia technique and the other received the TIVA
technique. Interventions All patients received general anaesthesia, which
was induced by propofol, remifentanil, and rocuronium. Anaesthesia was
maintained using desflurane in oxygen air mixture in the inhalation group,
whilst anaesthesia was maintained by intravenous infusion of propofol and
dexmedetomidine in the TIVA group. Measurements Intra-operative vital
signs, anaesthesia recovery time, postoperative nausea and vomiting, pain
score, post-anaesthetic care unit (PACU) stay time, total first 24 h
post-operative analgesic needs and the onset of first bowel movement were
recorded. Main results The TIVA group had lower intra-operative heart
rates and mean arterial blood pressure (P < 0.0001). The TIVA group also
had a lower post-operative visual analogue score for pain assessment (VAS)
(P < 0.0001), lower total analgesic requirements (P < 0.0001), a lower
incidence of nausea (P = 0.01) and vomiting (P = 0.03), and shorter PACU
stays (P = 0.01). There was no significant difference between groups with
regard to the onset of bowel movement (P = 0.16). Conclusions TIVA using
propofol and dexmedetomidine is a better anaesthetic regimen than
inhalation anaesthesia using desflurane for laparoscopic sleeve
gastrectomy in morbidly obese patients. The TIVA technique provided better
postoperative recovery with fewer postoperative side effects and analgesic
requirements. Clinical trial registery number NCT03029715.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<36>
Accession Number
622950773
Title
Fentanyl Delays the Platelet Inhibition Effects of Oral Ticagrelor: Full
Report of the PACIFY Randomized Clinical Trial.
Source
Thrombosis and Haemostasis. 118 (8) (pp 1409-1418), 2018. Date of
Publication: 01 Aug 2018.
Author
Ibrahim K.; Shah R.; Goli R.R.; Kickler T.S.; Clarke W.A.; Hasan R.K.;
Blumenthal R.S.; Thiemann D.R.; Resar J.R.; Schulman S.P.; McEvoy J.W.
Institution
(Ibrahim, Hasan, Blumenthal, Thiemann, Resar, Schulman, McEvoy) Division
of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Heart
Disease, Johns Hopkins University, School of Medicine, 600 N. Wolfe
Street, Baltimore, MD 21287, United States
(Shah, Goli) Department of Medicine, Johns Hopkins University, School of
Medicine, Baltimore, MD, United States
(Kickler, Clarke) Department of Pathology, Johns Hopkins University,
School of Medicine, Baltimore, MD, United States
(Blumenthal) Ciccarone Center for the Prevention of Heart Disease, Johns
Hopkins University, School of Medicine, Baltimore, MD, United States
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Morphine delays oral P2Y <inf>12</inf> platelet inhibitor absorption and
is associated with adverse outcomes after myocardial infarction.
Consequently, many physicians and first responders are now considering
fentanyl as an alternative. We conducted a single-centre trial randomizing
cardiac patients undergoing coronary angiography to intravenous fentanyl
or not. All participants received local anaesthetic and intravenous
midazolam. Those requiring percutaneous coronary intervention (PCI) with
stenting received 180 mg oral ticagrelor intra-procedurally. The primary
outcome was area under the ticagrelor plasma concentration-time curve (AUC
<inf>0-24 hours</inf>). The secondary outcomes were platelet function
assessed at 2 hours after loading, measured by P2Y <inf>12</inf> reaction
units (PRUs) and light transmission platelet aggregometry. Troponin-I was
measured post-PCI using a high-sensitivity troponin-I assay (hs-TnI). All
participants completed a survey of pain and anxiety. Of the 212
randomized, 70 patients required coronary stenting and were loaded with
ticagrelor. Two participants in the no-fentanyl arm crossed over to
receive fentanyl for pain. In as-treated analyses, ticagrelor
concentrations were higher in the no-fentanyl arm (AUC <inf>0-24
hours</inf> 70% larger, p = 0.03). Platelets were more inhibited by 2
hours in the no-fentanyl arm (71 vs. 113 by PRU, p = 0.03, and 25% vs. 41%
for adenosine diphosphate response by platelet aggregation, p < 0.01).
Mean hs-TnI was higher with fentanyl at 2 hours post-PCI (11.9 vs. 7.0
ng/L, p = 0.04) with a rate of enzymatic myocardial infarction of 11% for
fentanyl and 0% for no-fentanyl (p = 0.08). No statistical differences in
self-reported pain or anxiety were found. In conclusion, fentanyl
administration can impair ticagrelor absorption and delay platelet
inhibition, resulting in mild excess of myocardial damage. This newly
described drug interaction should be recognized by physicians and suggests
that the interaction between opioids and oral P2Y <inf>12</inf> platelet
inhibitors is a drug class effect associated with all opioids. Clinical
Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02683707
(NCT02683707).<br/>Copyright &#xa9; 2018 Georg Thieme Verlag KG Stuttgart
New York.

<37>
Accession Number
2000778981
Title
Steroids and Survival in Critically Ill Adult Patients: A Meta-analysis of
135 Randomized Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2252-2260),
2018. Date of Publication: October 2018.
Author
Martino E.A.; Baiardo Redaelli M.; Sardo S.; Lembo R.; Giordano V.F.;
Winterton D.; Ruggeri L.; Hajjar L.A.; Zangrillo A.; Landoni G.
Institution
(Martino, Baiardo Redaelli, Lembo, Giordano, Winterton, Ruggeri,
Zangrillo, Landoni) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Sardo) Department of Medical Sciences "M. Aresu, " University of
Cagliari, Cagliari, Italy
(Hajjar) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Zangrillo, Landoni) Vita-Salute San Raffaele University, Milan, Italy
Publisher
W.B. Saunders
Abstract
Objective: Corticosteroids have important effects on intermediate outcomes
in critically ill patients, but their effect on survival is unknown. The
objective of this meta-analysis was to analyze the effect on mortality of
corticosteroids in critical and perioperative settings. Design: A
meta-analysis of randomized trials. Setting: PubMed, Embase, BioMed
Central, Google Scholar, and the Cochrane Central Register of Controlled
Trials were searched to February 1, 2018, for randomized trials comparing
corticosteroids with placebo or standard care. Participants: Critically
ill or surgical adult patients. Interventions: Corticosteroids compared
with placebo or standard care. Measurements and Main Results: A total of
44,553 patients from 135 studies were included. Overall, mortality in the
corticosteroid group and in the control group were similar (16% v 16%; p =
0.9). Subanalyses identified a beneficial effect of corticosteroids on
survival in patients with respiratory system diseases (9% v 13%; p <
0.001) and bacterial meningitis (28% v 32%; p= 0.04), and a detrimental
effect on survival in patients with traumatic brain injury (22% v 19%; p <
0.001). No differences in mortality were found in patients with cardiac
diseases (7% v 6%; p = 0.7), in patients undergoing cardiac surgery (2.8%
v 3.2% p = 0.14), and when treatment duration or patient age were
considered. Conclusions: This meta-analysis documents the safety of
corticosteroids in the overall critically ill population with the notable
exception of brain injury patients, a setting where the authors confirmed
their detrimental effect on survival. A possible beneficial effect of
corticosteroids on survival was found among patients with respiratory
diseases and in patients with bacterial meningitis.<br/>Copyright &#xa9;
2018 Elsevier Inc.

<38>
Accession Number
620559023
Title
Guanxinning tablet for patients who switch from dual antiplatelet therapy
to aspirin alone after percutaneous coronary intervention: Study protocol
for a cluster randomized controlled trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 93. Date of
Publication: 07 Feb 2018.
Author
Li J.; Ju J.; Chen Z.; Liu J.; Lu F.; Gao R.; Xu H.
Institution
(Li, Ju) Graduate School, Beijing University of Chinese Medicine, Beijing
100029, China
(Chen, Xu) China Academy of Chinese Medical Sciences, Cardiovascular
Diseases Center, Xiyuan Hospital, XiYuan CaoChang 1, Beijing 100091, China
(Liu) China Academy of Chinese Medical Sciences, Graduate School, Beijing
100700, China
(Lu, Gao) China Academy of Chinese Medical Sciences, Institute of Clinical
Pharmacology, Xiyuan Hospital, XiYuan CaoChang 1, Beijing 100091, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: One-year dual antiplatelet therapy (DAPT), generally aspirin
in combination with a P2Y12 receptor inhibitor, has been a standard
treatment for patients undergoing percutaneous coronary intervention
(PCI). Prolonged DAPT has proven itself effective in further reducing
cardiovascular events, yet with increased risk of bleeding. Thus, it is of
great necessity to find an alternative drug that is as effective but safer
and more economic than the P2Y12 inhibitors after termination of one-year
DAPT. Methods: We will conduct a cluster randomized controlled trial in
3600 eligible post-PCI patients from 36 tertiary hospitals (100 patients
per hospital) across mainland China. The hospitals served as clusters are
randomized in a 2:1 ratio to Guanxinning tablet (GXNT) plus aspirin or
aspirin alone for 12 months, with other conventional treatment applied in
both groups. After the treatment period, all patients will be followed up
for another 12 months. The primary outcome measure is composite
cardiovascular events including cardiovascular death, non-fatal myocardial
infarction, stent thrombosis, revascularization, ischemic stroke, and
re-admission due to unstable angina. Secondary outcome measures are
all-cause mortality, each individual component of the primary outcome
measure, and stopping or reducing the rate of nitroglycerin
administration. Adverse events, including bleeding, will be closely
monitored during the whole trial period. In addition, a cost-effectiveness
study of GXNT for the study population will be conducted along with this
trial. Discussion: This trial aims to determine whether the addition of
GXNT will further improve prognosis without increasing bleeding risk for
patients with coronary artery disease who have switched from DAPT to
aspirin alone after PCI. Completion of this clinical trial might provide a
novel, promising, and safer alternative to P2Y12 inhibitors for prolonged
antiplatelet therapy in post-PCI patients.<br/>Copyright &#xa9; 2018 The
Author(s).

<39>
Accession Number
618389896
Title
Percutaneous coronary intervention vs. coronary artery bypass grafting for
left main revascularization: An updated meta-analysis.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 3 (3) (pp
173-182), 2017. Date of Publication: 2017.
Author
Bajaj N.S.; Patel N.; Kalra R.; Marogil P.; Bhardwaj A.; Arora G.; Arora
P.
Institution
(Bajaj) Division of Cardiovascular Medicine, Department of Radiology,
Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United
States
(Bajaj, Patel, Bhardwaj, Arora, Arora) Division of Cardiovascular
Diseases, Department of Medicine, University of Alabama at Birmingham,
1900 University Boulevard Birmingham, AL 35233, United States
(Kalra) Cardiovascular Division, University of Minnesota, 420 Delaware St
SE, Minneapolis, MN 55455, United States
(Marogil) Department of Internal Medicine, Brookwood Baptist Health, 2010
Brookwood Medical Center Drive Birmingham, AL 35209, United States
(Arora) Section of Cardiology, Birmingham Veterans Affairs Medical Center,
700 19th St S, Birmingham, AL 35233, United States
Publisher
Oxford University Press
Abstract
Aims The optimal revascularization strategy for left main coronary artery
disease (LMD) remains controversial, especially with two recent randomized
controlled trials showing conflicting results. We sought to address this
controversy with our analysis. Methods and results Comprehensive
literature search was performed. We compared percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG) for LMD
revascularization using standard meta-analytic techniques. A 21% higher
risk of long-term major adverse cardiac and cerebrovascular event [MACCE;
composite of death, myocardial infarction (MI), stroke, and repeat
revascularization] was observed in patients undergoing PCI in comparison
with CABG [risk ratio (RR) 1.21, 95% confidence interval (CI) 1.05-1.40].
This risk was driven by higher rate of repeat revascularization in those
undergoing PCI (RR 1.61, 95% CI 1.34-1.95). On the contrary, MACCE rates
at 30 days were lower in PCI when compared with CABG (RR 0.55, 95% CI
0.39-0.76), which was driven by lower rates of stroke in the PCI arm (RR
0.41, 95% CI 0.17-0.98). At 1 year, lower stroke rates (RR 0.21, 95% CI
0.08-0.59) in the PCI arm were balanced by higher repeat revascularization
rates in those undergoing PCI (RR 1.78, 95% CI 1.33-2.37), resulting in a
clinical equipoise in MACCE rates between the two revascularization
strategies. There was no difference in death or MI between PCI when
compared with CABG at any time point. Conclusion Outcomes of CABG vs. PCI
for LMD revascularization vary over time. Therefore, individualized
decisions need to be made for LMD revascularization using the heart team
approach.<br/>Copyright &#xa9; 2017 The Author.

<40>
Accession Number
619544490
Title
The relationship between preoperative frailty and outcomes following
transcatheter aortic valve implantation: A systematic review and
meta-analysis.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 3 (2) (pp
123-132), 2017. Date of Publication: 01 Apr 2017.
Author
Anand A.; Harley C.; Visvanathan A.; Shah A.S.V.; Cowell J.; MacLullich
A.; Shenkin S.; Mills N.L.
Institution
(Anand, Shah, Mills) BHF Centre for Cardiovascular Science, University of
Edinburgh, Room SU305, Chancellor's Building, Edinburgh EH16 4SB, United
Kingdom
(Harley, Visvanathan, Cowell) Department of Geriatric Medicine, NHS
Lothian, Edinburgh, United Kingdom
(MacLullich, Shenkin) Edinburgh Delirium Research Group, Geriatric
Medicine, University of Edinburgh, Edinburgh, United Kingdom
Publisher
Oxford University Press
Abstract
Aims Transcatheter aortic valve implantation (TAVI) is an increasingly
common intervention for patients with aortic stenosis deemed high risk for
major cardiac surgery, but identifying those who will benefit can be
challenging. Frailty reflects physiological reserve and may be a useful
prognostic marker in this population. We performed a systematic review and
meta-analysis of the association between frailty and outcomes after TAVI.
Methods and results Five databases were searched between January 2000 and
May 2015. From 2623 articles screened, 54 were assessed for eligibility.
Ten cohort studies (n = 4592) met the inclusion criteria of reporting a
measure of frailty with early (=30 days) or late (>30 days) mortality and
procedural complications following TAVI as defined by the Valve Academic
Research Consortium (VARC). Frailty was associated with increased early
mortality in four studies (n = 1900) (HR 2.35, 95% CI 1.78-3.09, P <
0.001) and increased late mortality in seven studies (n = 3159) (HR 1.63,
95% CI 1.34-1.97, P < 0.001). Objective frailty tools identified an even
higher risk group for late mortality (HR 2.63, 95% CI 1.87-3.70, P <
0.001). Frail individuals undergoing TAVI have a mortality rate of 34
deaths per 100 patient years, compared with 19 deaths per 100 patient
years in non-frail patients. There was limited reporting of VARC
procedural outcomes in relation to frailty, preventing meta-analysis.
Conclusion Frailty assessment in an already vulnerable TAVI population
identifies individuals at even greater risk of poor outcomes. Use of
objective frailty tools may inform patient selection, but this requires
further assessment in large prospective registries.<br/>Copyright &#xa9;
The Author 2016.

<41>
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.

<42>
Accession Number
624572139
Title
TRACE (Routine posTsuRgical Anesthesia visit to improve patient outComE):
A prospective, multicenter, stepped-wedge, cluster-randomized
interventional study.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 586. Date of
Publication: 26 Oct 2018.
Author
Smit-Fun V.M.; De Korte-De Boer D.; Posthuma L.M.; Stolze A.; Dirksen
C.D.; Hollmann M.W.; Buhre W.F.; Boer C.
Institution
(Smit-Fun, De Korte-De Boer, Buhre) Department of Anaesthesiology and Pain
Medicine, Maastricht University Medical Centre +, P. Debeyelaan 25,
Maastricht 6229 HX, Netherlands
(Posthuma, Hollmann) Department of Anaesthesiology, Academic Medical
Centre Amsterdam, Meibergdreef 9 H1Z-132, Amsterdam 1105 AZ, Netherlands
(Stolze, Boer) Department of Anesthesiology, VU University Medical Centre,
De Boelelaan 1117, Amsterdam 1081 HV, Netherlands
(Dirksen) Department of Clinical Epidemiology and Medical Technology,
Maastricht University Medical Centre+, Maastricht, Netherlands
(Dirksen) Care and Public Health Research Institute (CAPHRI), Maastricht
University, Maastricht, Netherlands
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Perioperative complications occur in 30-40% of non-cardiac
surgical patients and are the leading cause of early postoperative
morbidity and mortality. Regular visits by trained health professionals
may decrease the incidence of complications and mortality through earlier
detection and adequate treatment of complications. Until now, no studies
have been performed on the impact of routine postsurgical anesthesia
visits on the incidence of postoperative complications and mortality.
Methods: TRACE is a prospective, multicenter, stepped-wedge cluster
randomized interventional study in academic and peripheral hospitals in
the Netherlands. All hospitals start simultaneously with a control phase
in which standard care is provided. Sequentially, in a randomized order,
hospitals cross over to the intervention phase in which patients at risk
are routinely followed up by an anesthesia professional at postoperative
days 1 and 3, aiming to detect and prevent or treat postoperative
complications. We aim to include 5600 adult patients who are at high risk
of developing complications. The primary outcome variable is 30-day
postoperative mortality. Secondary outcomes include incidence of
postoperative complications and postoperative quality of life up to one
year following surgery. Statistical analyses will be performed to compare
the control and intervention cohorts with multilevel linear and logistic
regression models, adjusted for temporal trends and for clusters
(hospitals). The time horizon of the economic (cost-effectiveness)
evaluation will be 30 days and one year following surgery. Discussion:
TRACE is the first to study the effects of a routine postoperative visit
by an anesthesia healthcare professional on mortality and
cost-effectiveness of surgical patients. If the intervention proves to be
beneficial for the patient and cost-effective, the stepped-wedge design
ensures direct implementation in the participating hospitals. Trial
registration: Nederlands Trial Register/Netherlands Trial Registration,
NTR5506. Registered on 02 December 2015.<br/>Copyright &#xa9; 2018 The
Author(s).

<43>
Accession Number
2001234428
Title
Cardiovascular Biomarkers after Metabolic Surgery versus Medical Therapy
for Diabetes: Insights from the STAMPEDE Trial.
Source
Surgery for Obesity and Related Diseases. Conference: ASMBS 35th Annual
Meeting at Obesity Week 2018 Abstracts. United States. 14 (11 Supplement)
(pp S11), 2018. Date of Publication: November 2018.
Author
Bhatt D.L.; Kashyap S.; Schauer P.R.; Aminian A.; Kirwan J.P.; Wolski K.;
Brethauer S.A.; Nissen S.E.
Institution
(Bhatt) BostonMAUnited States
(Kashyap, Schauer, Wolski, Brethauer, Nissen) ClevelandOHUnited States
(Aminian) Pepper PikeOHUnited States
(Kirwan) Baton RougeLAUnited States
Publisher
Elsevier Inc.
Abstract
Background: Longitudinal studies have shown that bariatric and metabolic
surgery is associated with significant reduction in cardiovascular events
and mortality. The Surgical Treatment And Medications Potentially
Eradicate Diabetes Efficiently (STAMPEDE) trial showed that 5-years after
randomization, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG)
were superior to intensive medical therapy (IMT) alone in achieving
glycemic control in patients with type 2 diabetes mellitus (T2DM). The aim
of this study was to assess long-term changes in cardiovascular biomarkers
after surgical versus medical treatment of T2DM. Methods: Blood samples
for measurement of 11 cardiovascular biomarkers were available in 100
patients (IMT n=25, RYGB n=39, SG n=36) at baseline and 5-years after
randomization. Percent changes from baseline were compared between the
study groups. Results: Table 1 summarizes the findings. Biomarkers
associated with cardiovascular risk including apolipoprotein A1,
high-sensitivity C-reactive protein, and plasminogen activator inhibitor-1
were significantly improved in both surgical groups at 5 years compared
with the medical group. Furthermore, myeloperoxidase, interleukin-6,
leptin, and uric acid were significantly reduced after RYGB compared with
IMT. Leptin was reduced after RYGB compared with SG. Changes in
apolipoprotein B, lipoprotein (a), homocysteine, and pro B-type
natriuretic peptide were not statistically significant among the study
groups. Conclusions: In patients with T2DM, bariatric surgery is
associated with long-term favorable changes in key cardiovascular
biomarkers compared with IMT. These findings can provide direction for
studies on the possible mechanisms of cardio-protection after metabolic
surgery.<br/>Copyright &#xa9; 2018

<44>
Accession Number
624728563
Title
Coronary computed tomography angiography for heart team decision-making in
multivessel coronary artery disease.
Source
European heart journal. 39 (41) (pp 3689-3698), 2018. Date of Publication:
01 Nov 2018.
Author
Collet C.; Onuma Y.; Andreini D.; Sonck J.; Pompilio G.; Mushtaq S.; La
Meir M.; Miyazaki Y.; de Mey J.; Gaemperli O.; Ouda A.; Maureira J.P.;
Mandry D.; Camenzind E.; Macron L.; Doenst T.; Teichgraber U.; Sigusch H.;
Asano T.; Katagiri Y.; Morel M.-A.; Lindeboom W.; Pontone G.; Luscher
T.F.; Bartorelli A.L.; Serruys P.W.
Institution
(Collet, Asano, Katagiri) Department of Cardiology, Academic Medical
Center, University of Amsterdam, Meibergdreef 9, Netherlands
(Collet, Sonck) Department of Cardiology, Universitair Ziekenhuis Brussel,
Vrije Universiteit Brussel, Laarbeeklaan 101, Jette, Brussel, Belgium
(Onuma, Miyazaki, Morel) Department of Cardiology, Thoraxcenter, Erasmus
Medical Center, Netherlands
(Onuma, Lindeboom) Cardialysis BV, KM Rotterdam, Netherlands
(Andreini, Pompilio, Mushtaq, Pontone, Bartorelli) Centro Cardiologico
Monzino, University of Milan, Via Carlo Parea, Milano, Italy
(La Meir, Gaemperli) Department of Cardiology, University of Zurich,
Ramistrasse 71, Zurich, Switzerland
(de Mey) Department of Radiology, Universitair Ziekenhuis Brussel, Vrije
Universiteit Brussel, Laarbeeklaan 101, Jette, Brussel, Belgium
(Ouda, Luscher) Department of Cardiovascular Surgery, University of
Zurich, Ramistrasse 71, Zurich, Switzerland
(Maureira) Department of Cardiovascular Surgery, CHRU Nancy and University
of Lorraine, Avenue du Marechal de Lattre, Nancy, France
(Mandry) Department of Radiology, CHRU Nancy and University of Lorraine,
Avenue du Marechal de Lattre, Nancy, France
(Camenzind) Department of Cardiology, CHRU Nancy and University of
Lorraine, Avenue du Marechal de Lattre, Nancy, France
(Macron) Department of Cardiology, Centre cardiologique du nord, 36 Rue
des Moulins Gemeaux, Saint-Denis, France
(Doenst) Department of Cardiovascular Surgery, Jena University Hospital,
Friedrich Schiller University of Jena, Furstengraben 1, Jena, Germany
(Teichgraber) Department of Radiology, Jena University Hospital, Friedrich
Schiller University of Jena, Furstengraben 1, Jena, Germany
(Sigusch) Department of Cardiology, Heinrich Braun Klinikum,
Karl-Keil-Strase 35, Zwickau, Germany
(Luscher, Serruys) Department of Cardiology, Royal Brompton and Harefield
Hospitals, Imperial College of London, Kensington, London, UK
(Bartorelli) Department of Biomedical and Clinical Sciences "Luigi Sacco",
University of Milan, Via Festa del Perdono, Milano MI, Italy
Publisher
NLM (Medline)
Abstract
Aims: Coronary computed tomography angiography (CTA) has emerged as a
non-invasive diagnostic method for patients with suspected coronary artery
disease, but its usefulness in patients with complex coronary artery
disease remains to be investigated. The present study sought to determine
the agreement between separate heart teams on treatment decision-making
based on either coronary CTA or conventional angiography.
Methods and results: Separate heart teams composed of an interventional
cardiologist, a cardiac surgeon, and a radiologist were randomized to
assess the coronary artery disease with either coronary CTA or
conventional angiography in patients with de novo left main or
three-vessel coronary artery disease. Each heart team, blinded for the
other imaging modality, quantified the anatomical complexity using the
SYNTAX score and integrated clinical information using the SYNTAX Score II
to provide a treatment recommendations based on mortality prediction at
4years: coronary artery bypass grafting (CABG), percutaneous coronary
intervention (PCI), or equipoise between CABG and PCI. The primary
endpoint was the agreement between heart teams on the revascularization
strategy. The secondary endpoint was the impact of fractional flow reserve
derived from coronary CTA (FFRCT) on treatment decision and procedural
planning. Overall, 223 patients were included. A treatment recommendation
of CABG was made in 28% of the cases with coronary CTA and in 26% with
conventional angiography. The agreement concerning treatment decision
between coronary CTA and conventional angiography was high (Cohen's kappa
0.82, 95% confidence interval 0.74-0.91). The heart teams agreed on the
coronary segments to be revascularized in 80% of the cases. FFRCT was
available for 869/1108 lesions (196/223 patients). Fractional flow reserve
derived from coronary CTA changed the treatment decision in 7% of the
patients.
Conclusion: In patients with left main or three-vessel coronary artery
disease, a heart team treatment decision-making based on coronary CTA
showed high agreement with the decision derived from conventional coronary
angiography suggesting the potential feasibility of a treatment
decision-making and planning based solely on this non-invasive imaging
modality and clinical information.
Trial registration number: NCT02813473.

<45>
Accession Number
624726924
Title
Transcutaneous Electrical Acupoint Stimulation Improves Immunological
Function During the Perioperative Period in Patients With Non-Small Cell
Lung Cancer Undergoing Video-Assisted Thoracic Surgical Lobectomy.
Source
Technology in cancer research & treatment. 17 (pp 1533033818806477), 2018.
Date of Publication: 01 Jan 2018.
Author
Tu Q.; Yang Z.; Gan J.; Zhang J.; Que B.; Song Q.; Wang Y.
Institution
(Tu, Gan) Department of Anesthesiology, Tangshan People's Hospital, North
China University of Science and Technology, Tangshan, China
(Tu) Tangshan, 2 The Graduate School of North China University of Science
and Technology, China
(Tu, Yang) Qing Tu and Zhou Yang contributed equally to this article
(Yang) Sichuan Academy of Medical Sciences, Sichuan Provincial People's
Hospital, 3 Department of Gastrointestinal Surgery, Chengdu, Sichuan,
China
(Zhang) Department of Anesthesiology, Third People's Hospital of Chengdu,
Southwest Jiao Tong University, Chendu, China
(Que) Department of Anesthesiology, Hangzhou Hospital of Traditional
Chinese Medicine, Hangzhou, China
(Song) Department of Cardiology, Tangshan People's Hospital, North China
University of Science and Technology, Tangshan, China
(Wang) Department of Neurology, Tangshan People's Hospital, North China
University of Science and Technology, Tangshan, China
Publisher
NLM (Medline)
Abstract
The immunological function of patients with malignant tumors may be
suppressed during the perioperative period. However, details on the
effects of transcutaneous electrical acupoint stimulation (TEAS) on
immunological function are relatively lacking. We designed this study to
examine the effects of TEAS on the immunological function of patients with
non-small cell lung cancer (NSCLC) during the perioperative period.
Participants (n = 144) were enrolled and randomly assigned into group TEAS
or group sham TEAS. TEAS on bilateral Feishu (BL13), Hegu (L14), and
Zusanli (ST36) was performed continuously throughout the procedure. The
primary outcome was the quantities of natural killer (NK) cells at 30
minutes before induction (T0), 5 minutes after intubation (T1), at the
beginning of the operation (T2), at the beginning of the lobectomy (T3),
at the beginning of the lymphadenectomy (T4), and immediately after
extubation (T5). The secondary outcomes were the serum levels of tumor
necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) at T0 to T5,
the mean arterial pressure (MAP) and heart rate (HR), the intraoperative
consumption of propofol and remifentanil, the incidence of hypoxemia,
postoperative nausea and vomiting (PONV), and the length of hospital stay.
The quantities of NK cells were decreased in group sham TEAS after
intubation compared to that in group TEAS, while the quantities of NK
cells in group TEAS were similar at T0 to T5. Meanwhile, the quantities of
NK cells in group sham TEAS at T1 ( P = .012), T2 ( P < .001), T3 ( P =
.027), T4 ( P = .045), and T5 ( P = .021) were lower than those in group
TEAS. In group TEAS, the serum levels of TNF-alpha were lower at T1 to T5,
while the levels of IL-6 were lower at T2 to T5. Furthermore, the
intraoperative MAP and HR were more stable, the total propofol and
remifentanil consumptions were lower, and the length of hospital stay was
shorter than those in group sham TEAS. The application of TEAS can
effectively reverse the decrease in NK cells, decrease the serum levels of
TNF-alpha and IL-6, maintain hemodynamic stability during the
perioperative period, decrease the consumption of propofol and
remifentanil, and shorten the length of the hospital stay.

<46>
Accession Number
624516354
Title
An innovative panel to assess endothelial integrity of pedicled and
skeletonized internal thoracic artery used as aortocoronary bypass graft:
A randomized comparative histologic and immunohistochemical study.
Source
Journal of Thoracic Disease. 10 (8) (pp 4865-4873), 2018. Date of
Publication: 2018.
Author
Puslecki M.; Buczkowski P.; Nowicki M.; Sujka-Kordowska P.; Ligowski M.;
Misterski M.; Stefaniak S.; Dabrowski M.; Dabrowska A.; Bocianski M.;
Szarpak L.; Ruetzler K.; Jemielity M.; Perek B.
Institution
(Puslecki, Dabrowski, Dabrowska) Department of Medical Rescue, Poznan
University of Medical Sciences, Poznan, Poland
(Puslecki, Buczkowski, Ligowski, Misterski, Stefaniak, Bocianski,
Jemielity, Perek) Department of Cardiac Surgery and Transplantology,
Poznan University of Medical Sciences, Poznan, Poland
(Nowicki, Sujka-Kordowska) Department of Histology and Embryology, Poznan
University of Medical Sciences, Poznan, Poland
(Szarpak) Lazarski University, 43 Swieradowska Str., Warsaw 02-662, Poland
(Ruetzler) Department of General Anesthesiology, Anesthesiology Institute,
Cleveland Clinic, Cleveland, OH, United States
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Optimal preservation of endothelial integrity of the vessels
used as aortocoronary grafts is a crucial determinant of long-term
clinical success of coronary artery bypass grafting (CABG). The purpose of
this study was to evaluate an impact of two common techniques to harvest
left internal thoracic artery (LITA) on endothelial integrity. Methods:
One hundred twenty consecutive patients (84 males and 36 females) with a
mean age of 64.9+/-8.8 years undergoing CABG were randomized to receive
pedicled (group P; n=60) or skeletonized (group S; n=60) LITA grafts.
During surgery LITA was harvested by the same experienced cardiac surgeon.
The most peripheral surplus segments of LITA were obtained and then
analysed histologically under light microscope. Additionally, endothelial
expression of CD31, CD34, CD133 and nitric oxide synthase (eNOS) were
evaluated by means of immunohistochemistry. Results: In both groups, no
cases of major arterial wall damage such as disruption, dissection,
thrombosis or subadventitial hematoma were noted on LITA cross sections.
Immunohistochemical assessment of protein expression revealed no
differences in endothelial expression of CD133, CD34 antigens (markers of
regeneration potential) and eNOS (indicating preserved functional
integrity) between studied groups. Contrary to them, endothelial
immunoreactivity of CD31, a marker of the morphological integrity of the
endothelium, was revealed to be stronger in group P. Conclusions: The
skeletonized method of LITA harvesting may be associated with worse
preservation of morphological integrity of endothelium but without
compromising functional integrity and potential for tissue
regeneration.<br/>Copyright &#xa9; Journal of Thoracic Disease. All rights
reserved.

<47>
Accession Number
624516332
Title
Comparison of different methods of postoperative analgesia after
thoracotomy-a randomized controlled trial.
Source
Journal of Thoracic Disease. 10 (8) (pp 4874-4882), 2018. Date of
Publication: 2018.
Author
Bialka S.; Copik M.; Daszkiewicz A.; Rivas E.; Ruetzler K.; Szarpak L.;
Misiolek H.
Institution
(Bialka, Copik, Daszkiewicz, Misiolek) Department of Anaesthesiology and
Critical Care, School of Medicine, Division of Dentistry in Zabrze,
Medical University of Silesia, Zabrze, Poland
(Rivas, Ruetzler) Department of Outcomes Research, Cleveland Clinic,
Cleveland, OH, United States
(Szarpak) Faculty of Medicine, Lazarski University, Warsaw, Poland
(Szarpak) Department of Emergency Medicine, Warsaw Medical University,
Warsaw, Poland
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Continuous thoracic epidural analgesia (TEA) is a preferred
method of postoperative analgesia in thoracic surgery. Intravenous
patient-controlled analgesia (IVPCA) may be an effective alternative. One
of the most commonly used opioids in PCA is morphine. It has high
antinociceptive efficacy but is associated with many adverse events.
Oxycodone can be an alternative. A small number of scientific reports
comparing morphine and oxycodone in PCA for the treatment of acute
postoperative pain after thoracotomy was the reason to conduct this study.
Methods: Prospective, randomised, observational study. In total of 99
patients scheduled for elective thoracotomy were randomized into three
study groups. TEA group received continuous TEA as a method of
postoperative pain management, morphine (MF) group received morphine
IVPCA, and morphine (OXY) group oxycodone IVPCA. For 48 hours' hemodynamic
parameters, level of pain, sedation and the need for rescue analgesia were
monitored. After 48 hours' patients were asked about their satisfaction
with pain treatment using Likert scale and assessment of opioid related
adverse events via overall benefit of analgesia score (OBAS). Results: The
level of pain in visual analogic score (VAS) and Prince Henry Hospital
Pain Score (PHHPS) scales was significantly lower in TEA group with no
significant difference between groups MF and OXY. Using morphine in PCA
was associated with a significantly higher likelihood of need of rescue
analgesia. The level of sedation in Ramsay scale was significantly higher
in MF compared to OXY and TEA group. There were no significant differences
between groups in OBAS scale. TEA group was characterized by the highest
degree of patient satisfaction. Conclusions: TEA provided superior
anaesthesia compared to PCA in our study group. Use of PCA oxycodone in
postoperative pain management after open thoracotomy provides similar
nociception control compared to morphine but is associated with less
sedation and patients using oxycodone IVPCA require smaller doses of
rescue analgesia compared to systemic morphine IVPCA.<br/>Copyright &#xa9;
Journal of Thoracic Disease. All rights reserved.

<48>
Accession Number
624708343
Title
Remote preconditioning might protect the kidney in heart surgery.
Source
Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dernegi Dergisi. 24 (3) (pp
103-110), 2018. Date of Publication: 2018.
Author
Yildirim F.; Senarslan D.A.; Iskesen I.; Kurdal A.T.; Ozturk T.; Taneli
F.; Cerrahoglu M.
Institution
(Yildirim, Senarslan, Iskesen, Kurdal, Cerrahoglu) Manisa Celal Bayar
Universitesi Tip Fakultesi, Kalp Ve Damar Cerrahisi Anabilim Dali, Hafsa
Sultan Hastanesi, Yunusemre/Manisa 45040, Turkey
(Ozturk) Manisa Celal Bayar Universitesi Tip Fakultesi, Anestezioloji Ve
Reanimasyon Anabilim Dali, Turkey
(Taneli) Manisa Celal Bayar Universitesi Tip Fakultesi, Tibbi Biyokimya
Anabilim Dali, Turkey
Publisher
Turkish Anaesthesiology and Intensive Care Society (Yildiz Posta Caddesi,
Sinan Apt. No; 36 D: 66/67, Gayrettepe-Istanbul 34349, Turkey)
Abstract
Objective: There are conflicting results about renoprotective effects of
remote ischemic preconditioning (RIPC) reported in previous studies. This
study is designed to investigate the effects of this application on renal
function by means of certain deliberate biomarkers during the early
postoperative period in patients undergoing coronary artery bypass graft
(CABG) surgery. Material and Methods: This prospective, randomized, and
blinded study was performed in patients who underwent isolated CABG
surgery together with cardiopulmonary bypass (CPB) after eliminating
factors that may confound biomarkers that indicate renal
ischemiareperfusion injury. The authors randomly assigned patients to RIPC
to the left lower extremity using an inflated (study group) or deflated
(control group). Blood pressure cuff. Renal functions were analyzed by
measuring cystatin C, neutrophil gelatinase-associated lipocalin (NGAL)
and creatinine levels at 3 different time points namely 1 hour (T1) after
CPB and 6 hours (T2) after skin closure, and 24 hours postoperatively
(T3). Results: There were no differences between the two groups in terms
of demographic values and the hemodynamic parameters. Plasma cystatin C
and creatinin levels were significantly higher in the control group than
those of the study group at all time points. Plasma NGAL levels were
higher in the control group than in the study group at two time points,
p=0,001 for time; p=0,243 for group respectively. Conclusion: In low risk
patients with on-pump CABG surgery, RIPC seems to protect renal functions.
Further studies with different risk groups should also be planned to
determine whether this procedure is useful in cardiac surgery
patients.<br/>Copyright &#xa9; 2018 Turkish Anaesthesiology and Intensive
Care Society. All Rights Reserved.

<49>
Accession Number
2001229889
Title
Genotype-Guided Warfarin Dosing in Patients With Mechanical Valves: A
Randomized Controlled Trial.
Source
Annals of Thoracic Surgery. (no pagination), 2018. Date of Publication:
2018.
Author
Xu Z.; Zhang S.-Y.; Huang M.; Hu R.; Li J.-L.; Cen H.-J.; Wang Z.-P.; Ou
J.-S.; Yin S.-L.; Xu Y.-Q.; Wu Z.-K.; Zhang X.
Institution
(Xu, Wang, Ou, Yin, Xu, Wu, Zhang) Division of Cardiac Surgery, Key
Laboratory on Assisted Circulation, Ministry of Health, the First
Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
(Zhang, Huang, Hu, Li) Institute of Clinical Pharmacology, School of
Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
(Cen) Guangzhou Women and Children's Medical Center, Guangzhou Medical
University, Guangzhou, China
Publisher
Elsevier USA
Abstract
Background: The clinical utility of genotype-guided warfarin dosing
remains controversial. The objective of this trial was to evaluate the
efficacy and safety of genotype-guided warfarin dosing in East Asians.
Methods: A double-blind, randomized control trial was performed to compare
a genotype-guided dosing algorithm (CYP2C9, VKORC1, and CYP4F2) with a
clinical-guided one in the initiation treatment for patients with
mechanical heart valves. The primary outcomes included the time to reach a
stable dose and the percentage of time in the therapeutic range (TTR).
Results: Two hundred one patients were randomly assigned to treatment, 101
to control and 100 to study. The major bleeding and thromboembolic
event-free rate in the study group was 97.0% (95% confidence interval:
90.9% to 99.2%). Compared with the control group, the study group
shortened the time to reach a stable dose (mean: 42.09 +/- 23.655 days
versus 33.52 +/- 20.044 days, p = 0.009). The TTRs were 47.257% and
47.461% in the control and study group (p = 0.941), respectively. Patients
with the CYP2C9 *1/*3 genotype had higher international normalized ratio
(INR) variability than patients with the CYP2C9 *1/*1 genotype (p =
0.024). Compared with normal and sensitive responders, the highly
sensitive responders were at increased risk of an INR of 4.0 or greater (p
< 0.05). Conclusions: The genotype-guided warfarin dosing was safe and
might be more efficient for the time to reach a stable dose.
Pharmacogenomic testing might be beneficial to identify the patients with
the CYP2C9 *1/*3 genotype and the highly sensitive responders, who were in
the high-risk subgroup of patients with mechanical heart valves. An
appropriately powered study is needed to further confirm these
findings.<br/>Copyright &#xa9; 2018 The Society of Thoracic Surgeons

<50>
Accession Number
622653312
Title
Dexmedetomidine and intravenous acetaminophen for the prevention of
postoperative delirium following cardiac surgery (DEXACET trial): Protocol
for a prospective randomized controlled trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 326. Date of
Publication: 22 Jun 2018.
Author
Shankar P.; Mueller A.; Packiasabapathy S.; Gasangwa D.; Patxot M.; O'Gara
B.; Shaefi S.; Marcantonio E.R.; Subramaniam B.
Institution
(Shankar, Mueller, Packiasabapathy, Gasangwa, Patxot, O'Gara, Shaefi,
Subramaniam) Beth Israel Deaconess Medical Center, Center for Anesthesia
Research Excellence (CARE), Department of Anesthesia, Critical Care and
Pain Medicine, One Deaconess Road, CC-650, Boston, MA 02215, United States
(Mueller, O'Gara, Shaefi, Marcantonio, Subramaniam) Harvard Medical
School, 25 Shattuck Street, Boston, MA 02215, United States
(Marcantonio) Beth Israel Deaconess Medical Center, Harvard Medical
School, Division of General Medicine and Primary Care, 330 Brookline
Avenue, Boston, MA 02215, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative delirium is common in elderly cardiac surgery
patients. It is multifactorial and is influenced by the patient's baseline
status and the nature of the medical and surgical interventions that the
patient receives. Some of these factors are potentially modifiable,
including postoperative sedation and analgesia protocols. This study has
been designed to evaluate the effectiveness of postoperative intravenous
acetaminophen in conjunction with either dexmedetomidine or propofol in
decreasing the incidence of delirium. Methods: This is a prospective,
randomized, placebo-controlled, double-blinded, factorial trial that
includes patients who are at least 60 years old and who are undergoing
cardiac surgeries involving cardiopulmonary bypass, including coronary
artery bypass graft (CABG) and combined CABG/valve surgeries. Patients are
randomly assigned to receive one of four postoperative analgesic-sedation
regimens: (1) acetaminophen and dexmedetomidine, (2) acetaminophen and
propofol, (3) dexmedetomidine and placebo, or (4) propofol and placebo.
The primary outcome, incidence of delirium, will be assessed with the
Confusion Assessment Method (CAM or CAM-ICU). The secondary outcome,
postoperative cognitive decline, will be assessed with the Montreal
Cognitive Assessment. Additional secondary outcomes, including duration of
delirium, postoperative analgesic requirement, length of stay, and
incidence of adverse events, will also be reported. Data will be analyzed
in 120 randomly assigned patients who received at least one dose of the
study medication(s) on a modified intention-to-treat basis. Discussion:
This study has been approved by the institutional review board at Beth
Israel Deaconess Medical Center, and the trial is currently recruiting.
This study will systematically examine the implications of modification in
postoperative sedative/analgesic protocols after cardiac surgery,
specifically for short- and long-term cognitive outcomes. Any positive
outcomes from this study could direct simple yet effective practice
changes aimed to reduce morbidity. Trial registration: ClinicalTrials.gov
Identifier: NCT02546765 , registered January 13, 2015.<br/>Copyright
&#xa9; 2018 The Author(s).

<51>
Accession Number
621160347
Title
Perioperative aspirin therapy in non-cardiac surgery: A systematic review
and meta-analysis of randomized controlled trials.
Source
International Journal of Cardiology. 258 (pp 59-67), 2018. Date of
Publication: 01 May 2018.
Author
Wolff G.; Navarese E.P.; Brockmeyer M.; Lin Y.; Karathanos A.;
Kolodziejczak M.; Kubica J.; Polzin A.; Zeus T.; Westenfeld R.; Andreotti
F.; Kelm M.; Schulze V.
Institution
(Wolff, Brockmeyer, Lin, Karathanos, Polzin, Zeus, Westenfeld, Kelm,
Schulze) Department of Internal Medicine, Division of Cardiology,
Pulmonology and Vascular Medicine, Heinrich-Heine-University, Dusseldorf,
Germany
(Kolodziejczak, Kubica) Department of Cardiology and Internal Medicine,
Nicolaus Copernicus University, Bydgoszcz, Poland
(Andreotti) Department of Cardiovascular Science, Catholic University of
the Sacred Heart, Rome, Italy
(Wolff, Navarese, Brockmeyer, Lin, Kolodziejczak, Kubica, Kelm, Schulze)
Systematic Investigation and Research on Interventions and Outcomes
(SIRIO)-Medicine Research Network, United States
(Navarese) Interventional Cardiology and Cardiovascular Medicine Research,
Inova Heart And Vascular Institute, Fairfax Medical Campus, Falls Church,
VA, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Aspirin is a key element in prevention of cardiovascular and
thromboembolic events. During non-cardiac surgery however, its balance of
bleeding risks and benefits remains unclear. Methods: A systematic review
and meta-analysis of randomized controlled trials was performed. Online
databases were screened for clinical trials randomizing aspirin to no
aspirin therapy in non-cardiac surgery. Clinical outcomes of all-cause
mortality and cardiovascular mortality, arterial ischemic events, venous
thromboembolic events and bleeding events were separately evaluated.
Results: Seven RCTs comprising 28,302 patients were included. All-cause
mortality (3.7% vs. 3.8%; odds ratio (OR) 0.97, CI 0.86-1.10) and
cardiovascular mortality (2.0% vs. 2.1%, OR 0.92; CI 0.78-1.09) were not
different in aspirin vs. no aspirin groups. Arterial ischemic events
showed no differences, including myocardial infarction (2.5% (aspirin) vs.
2.5% (no aspirin)), cerebrovascular events (0.6% (aspirin) vs. 0.6% (no
aspirin)) and peripheral arterial events (0.2% (aspirin) vs. 0.3% (no
aspirin)). Aspirin significantly reduced the risk for venous
thromboembolic events (VTE; 1.5% (aspirin) vs. 2.0% (no aspirin); OR 0.74,
CI 0.59-0.94, p = 0.02). Perioperative major bleeding was significantly
more frequent in aspirin groups (4.4% vs. 3.7%; OR 1.18, CI 1.05 to 1.33,
p = 0.007). Conclusion: Aspirin remained neutral with respect to overall
survival, cardiovascular mortality and arterial ischemic events. It
reduced venous thromboembolic events at the expense of perioperative major
bleedings. Thus, this analysis supports recommendations against
perioperative aspirin continuation/initiation in cardiovascular disease
patients at intermediate risk, as well as recommendations of aspirin for
VTE prophylaxis in orthopedic patients only.<br/>Copyright &#xa9; 2017
Elsevier B.V.

<52>
Accession Number
619004332
Title
Topical vancomycin to reduce surgical-site infections in neurosurgery:
Study protocol for a multi-center, randomized controlled trial.
Source
Contemporary Clinical Trials. 64 (pp 195-200), 2018. Date of Publication:
January 2018.
Author
Jonokuchi A.J.; Knopman J.; Radwanski R.E.; Martinez M.A.; Taylor B.E.S.;
Rothbaum M.; Sullivan S.; Robison T.R.; Lo E.; Christophe B.R.; Bruce
E.M.; Khan S.; Kellner C.P.; Sigounas D.; Youngerman B.; Bagiella E.;
Angevine P.D.; Lowy F.D.; Sander Connolly E.
Institution
(Jonokuchi, Radwanski, Martinez, Taylor, Robison, Lo, Christophe, Bruce,
Kellner, Youngerman, Angevine, Sander Connolly) Department of Neurological
Surgery, Columbia University College of Physicians and Surgeons, 710 W
168th Street, New York, NY 10032, United States
(Knopman, Rothbaum, Sigounas) Department of Neurological Surgery, Weill
Cornell Medical Center, 525 East 68th Street, Box 99, New York, NY 10065,
United States
(Sullivan, Khan, Lowy) Department of Pathology and Cell Biology, Columbia
University College of Physicians and Surgeons, 630 W 168th Street, New
York, NY 10032, United States
(Bagiella) Center for Biostatistics, Department of Population Health
Science & Policy, Mount Sinai School of Medicine, 1 Gustave L. Levy Place,
New York, NY 10029, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Surgical-site infections (SSIs) account for 20% of all
healthcare-associated infections, are the most common nosocomial infection
among surgical patients, and are a focus of quality improvement
initiatives. Despite implementation of many quality care measures (e.g.
prophylactic antibiotics), SSIs remain a significant cause of morbidity,
mortality, and economic burden, particularly in the field of neurosurgery.
Topical vancomycin is increasingly utilized in instrumented spinal and
cardiothoracic procedures, where it has been shown to reduce the risk of
SSIs. However, a randomized controlled trial assessing its efficacy in the
general neurosurgical population has yet to be done. The principle aim of
"Topical Vancomycin for Neurosurgery Wound Prophylaxis" (NCT02284126) is
to determine whether prophylactic, topical vancomycin reduces the risk of
SSIs in the adult neurosurgical population. This prospective, multicenter,
patient-blinded, randomized controlled trial will enroll patients to
receive the standard of care plus topical vancomycin, or the standard of
care alone. The primary endpoint of this study is a SSI by postoperative
day (POD) 30. Patients must be over 18 years of age. Patients are excluded
for renal insufficiency, vancomycin allergy, and some ineligible
procedures. Univariate analysis and logistic regression will determine the
effect of topical vancomycin on SSIs at 30 days. A randomized controlled
trial is needed to determine the efficacy of this treatment. Results of
this trial are expected to directly influence the standard of care and
prevention of SSIs in neurosurgical patients.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<53>
Accession Number
620505875
Title
Image quality of prospectively ECG-triggered coronary CT angiography in
heart transplant recipients.
Source
American Journal of Roentgenology. 210 (2) (pp 314-319), 2018. Date of
Publication: February 2018.
Author
Bartykowszki A.; Kolossvary M.; Jermendy A.L.; Karady J.; Szilveszter B.;
Karolyi M.; Balogh O.; Sax B.; Merkely B.; Maurovich-Horvat P.
Institution
(Bartykowszki, Kolossvary, Jermendy, Karady, Szilveszter, Karolyi, Sax,
Merkely, Maurovich-Horvat) MTA-SE Cardiovascular Imaging Research Group,
Heart and Vascular Center, Semmelweis University, 68 Varosmajor St,
Budapest H-1122, Hungary
(Balogh) Department of Cardiology, Gottsegen Gyorgy National Cardiology
Institute, Budapest, Hungary
Publisher
American Roentgen Ray Society
Abstract
OBJECTIVE. Cardiac allograft vasculopathy (CAV) is among the top causes of
death 1 year after heart transplantation (HTx). Coronary CT angiography
(CTA) is a potential alternative to invasive imaging in the diagnosis of
CAV. However, the higher heart rate (HR) of HTx recipients prompts the use
of retrospective ECG-gating, which is associated with higher radiation
dose, a major concern in this patient population. Therefore, we sought to
evaluate the feasibility and image quality of low-radiation-dose
prospectively ECG-triggered coronary CTA in HTx recipients. MATERIALS AND
METHODS. In total, 1270 coronary segments were evaluated in 50 HTx
recipients and 50 matched control subjects who did not undergo HTx. The
control subjects were selected from our clinical database and were matched
for age, sex, body mass index, HR, and coronary dominance. Scans were
performed using 256-MDCT with prospective ECG-triggering. The degree of
motion artifacts was evaluated on a per-segment basis on a 4-point
Likert-type scale. RESULTS. The median HR was 74.0 beats/min
(interquartile range [IQR], 67.8-79.3 beats/min) in the HTx group and 73.0
beats/min (IQR, 68.5-80.0 beats/min) in the matched control group (p =
0.58). In the HTx group, more segments had diagnostic image quality
compared with the control group (624/662 [94.3%] vs 504/608 [82.9%]; p <
0.001). The mean effective radiation dose was low in both groups (3.7 mSv
[IQR, 2.4-4.3 mSv] in the HTx group vs 4.3 mSv [IQR, 2.6-4.3 mSv] in the
control group; p = 0.24). CONCLUSION. Prospectively ECG-triggered coronary
CTA examinations of HTx recipients yielded diagnostic image quality with
low radiation dose. Coronary CTA is a promising noninvasive alternative to
routine catheterization during follow-up of HTx recipients to diagnose
CAV.<br/>Copyright &#xa9; American Roentgen Ray Society.

<54>
Accession Number
623487752
Title
Mitochondrial and contractile function of human right atrial tissue in
response to remote ischemic conditioning.
Source
Journal of the American Heart Association. 7 (15) (no pagination), 2018.
Article Number: e009540. Date of Publication: 01 Aug 2018.
Author
Kleinbongard P.; Gedik N.; Kirca M.; Stoian L.; Frey U.; Zandi A.;
Thielmann M.; Jakob H.; Peters J.; Kamler M.; Heusch G.
Institution
(Kleinbongard, Gedik, Kirca, Stoian, Heusch) Institut fur
Pathophysiologie, Westdeutsches Herz- und Gefaszentrum,
Universitatsklinikum Essen, Germany
(Frey, Peters) Klinik fur Anasthesiologie und Intensivmedizin,
Universitatsklinikum Essen, Germany
(Zandi, Kamler) Klinik fur Herzchirurgie Essen-Huttrop, Westdeutsches
Herz- und Gefaszentrum, Universitatsklinikum Essen, Germany
(Thielmann, Jakob) Klinik fur Thorax- und Kardiovaskulare Chirurgie,
Westdeutsches Herz- und Gefaszentrum, Universitatsklinikum Essen, Germany
Publisher
American Heart Association Inc.
Abstract
Background-Remote ischemic preconditioning (RIPC) by repeated brief cycles
of limb ischemia/reperfusion attenuates myocardial ischemia/reperfusion
injury. We aimed to identify a functional parameter reflecting the
RIPC-induced protection in human. Therefore, we measured mitochondrial
function in right atrial tissue and contractile function of isolated right
atrial trabeculae before and during hypoxia/reoxygenation from patients
undergoing coronary artery bypass grafting with RIPC or placebo,
respectively. Methods and Results-One hundred thirty-seven patients under
isoflurane anesthesia underwent RIPC (3x5 minutes blood pressure cuff
inflation on the left upper arm/5 minutes deflation, n=67) or placebo
(cuff uninflated, n=70), and right atrial appendages were harvested before
ischemic cardioplegic arrest. Myocardial protection by RIPC was assessed
from serum troponin I/T concentrations over 72 hours after surgery. Atrial
tissue was obtained for isolation of mitochondria (RIPC/placebo: n=10/10).
Trabeculae were dissected for contractile function measurements at
baseline and after hypoxia/reoxygenation (60 min/30 min) and for western
blot analysis after hypoxia/reoxygenation (RIPC/placebo, n=57/60).
Associated with cardioprotection by RIPC (26% decrease in the area under
the curve of troponin I/T), mitochondrial adenosine diphosphate-stimulated
complex I respiration (+10%), adenosine triphosphate production (+46%),
and calcium retention capacity (+37%) were greater, whereas reactive
oxygen species production (-24%) was less with RIPC than placebo.
Contractile function was improved by RIPC (baseline, +7%; reoxygenation,
+24%). Expression and phosphorylation of proteins, which have previously
been associated with cardioprotection, were not different between RIPC and
placebo. Conclusions-Cardioprotection by RIPC goes along with improved
mitochondrial and contractile function of human right atrial
tissue.<br/>Copyright &#xa9; 2018 The Authors.

<55>
Accession Number
619243123
Title
Comparison of postoperative analgesia with methadone versus morphine in
cardiac surgery.
Source
Brazilian Journal of Anesthesiology. 68 (2) (pp 122-127), 2018. Date of
Publication: March 2018.
Author
Carvalho A.C.; Sebold F.J.G.; Calegari P.M.G.; Oliveira B.H.D.;
Schuelter-Trevisol F.
Institution
(Carvalho) Universidade do Sul de Santa Catarina (Unisul), Curso de
Medicina, Campus Tubarao, Tubarao, SC, Brazil
(Sebold, Calegari, Oliveira) Hospital Nossa Senhora da Conceicao (HNSC),
Anestesiologia, Tubarao, SC, Brazil
(Schuelter-Trevisol) Universidade do Sul de Santa Catarina (Unisul),
Programa de Pos-Graduacao em Ciencias da Saude, Tubarao, SC, Brazil
(Schuelter-Trevisol) Hospital Nossa Senhora da Conceicao (HNSC), Centro de
Pesquisas Clinicas, Tubarao, SC, Brazil
Publisher
Elsevier Editora Ltda
Abstract
Background and objectives: Pain is an aggravating factor of postoperative
morbidity and mortality. The aim of this study was to compare the effects
of methadone versus morphine using the numerical rating scale of pain and
postoperative on-demand analgesia in patients undergoing myocardial
revascularization. Method: A randomized, double-blind, parallel clinical
trial was performed with patients undergoing coronary artery bypass
grafting. The subjects were randomly divided into two groups: Morphine
Group (MoG) and Methadone Group (MeG). At the end of cardiac surgery, 0.1
mg.kg^-1 adjusted body weight of methadone or morphine was
administered intravenously. Patients were referred to the ICU, where the
following was assessed: extubation time, time to first analgesic request,
number of analgesic and antiemetic drug doses within 36 hours, numerical
pain scale at 12, 24, and 36 hours postoperatively, and occurrence of
adverse effects. Results: Each group comprised 50 patients. Methadone
showed 22% higher efficacy than morphine as it yielded a
number-needed-to-treat (NNT) score of 6 and number-needed-to-harm (NNH)
score of 16. The MeG showed a mean score of 1.9 +/- 2.2 according to the
numerical pain scale at 24 hours after surgery, whereas as the MoG showed
a mean score of 2.9 +/- 2.6 (p = 0.029). The MeG required less morphine
(29%) than the MoG (43%) (p = 0.002). However, the time to first analgesic
request in the postoperative period was 145.9 +/- 178.5 minutes in the
MeG, and 269.4 +/- 252.9 in the MoG (p = 0.005). Conclusions: Methadone
was effective for analgesia in patients undergoing coronary artery bypass
grafting without extracorporeal circulation.<br/>Copyright &#xa9; 2017
Sociedade Brasileira de Anestesiologia

<56>
Accession Number
622441087
Title
Acute chest pain evaluation using coronary computed tomography angiography
compared with standard of care: A meta-analysis of randomised clinical
trials.
Source
Heart. 104 (3) (pp 215-221), 2018. Date of Publication: 01 Feb 2018.
Author
Gongora C.A.; Bavishi C.; Uretsky S.; Argulian E.
Institution
(Gongora, Bavishi, Argulian) Mount Sinai Heart, Mount Sinai St Luke's
Hospital, Icahn School of Medicine, Division of Cardiology, New York
10019, United States
(Uretsky) Department of Cardiovascular Medicine, Morristown Medical
Center, Gagnon Cardiovascular Institute, Morristown, NJ, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Coronary CT angiography (CCTA) has certain advantages compared
with stress testing including greater accuracy in identifying obstructive
coronary disease. The aim of the study was to perform a systematical
review and meta-analysis comparing CCTA with other standard-of-care (SOC)
approaches in evaluation of patients with acute chest pain. Methods
Electronic databases were systematically searched to identify randomised
clinical trials of patients with acute chest pain comparing CCTA with SOC
approaches. We examined the following end points: mortality, major adverse
cardiac events (MACE), myocardial infarction (MI), invasive coronary
angiography (ICA) and revascularisation. Pooled risk ratios (RR) and their
95% CIs were calculated using random-effects models. Results Ten trials
with 6285 patients were included. The trials used different definitions
and implementation for SOC but all used physiologic testing. The clinical
follow-up ranged from 1 to 19 months. There were no significant
differences in all-cause mortality (RR 0.48, 95% CI 0.17 to 1.36, p=0.17),
MI (RR 0.82, 95% CI 0.49 to 1.39, p=0.47) or MACE (RR 0.98, 95% CI 0.67 to
1.43, p=0.92) between the groups. However, significantly higher rates of
ICA (RR 1.32, 95% CI 1.07 to 1.63, p=0.01) and revascularisation (RR 1.77,
95% CI 1.35 to 2.31, p<0.0001) were observed in the CCTA arm. Conclusions
Compared with other SOC approaches use of CCTA is associated with similar
major adverse cardiac events but higher rates of revascularisation in
patients with acute chest pain.<br/>Copyright &#xa9; 2018 Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article). All rights reserved.

<57>
Accession Number
622441081
Title
Diagnostic and prognostic benefits of computed tomography coronary
angiography using the 2016 National Institute for Health and Care
Excellence guidance within a randomised trial.
Source
Heart. 104 (3) (pp 207-214), 2018. Date of Publication: 01 Feb 2018.
Author
Adamson P.D.; Hunter A.; Williams M.C.; Shah A.S.V.; McAllister D.A.;
Pawade T.A.; Dweck M.R.; Mills N.L.; Berry C.; Boon N.A.; Clark E.;
Flather M.; Forbes J.; McLean S.; Roditi G.; Van Beek E.J.R.; Timmis A.D.;
Newby D.E.
Institution
(Adamson, Hunter, Williams, Shah, Pawade, Dweck, Mills, Boon, Clark, Van
Beek, Newby) BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh EH16 4SB, United Kingdom
(Williams, Van Beek) Edinburgh Imaging, Queens Medical Research Institute,
University of Edinburgh, Edinburgh, United Kingdom
(McAllister) Institute of Health and Wellbeing, University of Glasgow,
Glasgow, United Kingdom
(Berry, Roditi) Institute of Clinical Sciences, University of Glasgow,
Glasgow, United Kingdom
(Flather) Norwich Medical School, University of East Anglia, Norwich,
United Kingdom
(Forbes) Health Research Institute, University of Limerick, Limerick,
Ireland
(McLean) National Health Service, Fife, United Kingdom
(Timmis) William Harvey Research Institute, Queen Mary University of
London, London, United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives To evaluate the diagnostic and prognostic benefits of CT
coronary angiography (CTCA) using the 2016 National Institute for Health
and Care Excellence (NICE) guidelines for the assessment of suspected
stable angina. Methods Post hoc analysis of the Scottish COmputed
Tomography of the HEART (SCOT-HEART) trial of 4146 participants with
suspected angina randomised to CTCA. Patients were dichotomised into NICE
guideline-defined possible angina and non-anginal presentations. Primary
(diagnostic) endpoint was diagnostic certainty of angina at 6 weeks and
prognostic endpoint comprised fatal and non-fatal myocardial infarction
(MI). Results In 3770 eligible participants, CTCA increased diagnostic
certainty more in those with possible angina (relative risk (RR) 2.22 (95%
CI 1.91 to 2.60), p<0.001) than those with non-anginal symptoms (RR 1.30
(1.11 to 1.53), p=0.002; p interaction <0.001). In the possible angina
cohort, CTCA did not change rates of invasive angiography (p=0.481) but
markedly reduced rates of normal coronary angiography (HR 0.32 (0.19 to
0.52), p<0.001). In the non-anginal cohort, rates of invasive angiography
increased (HR 1.82 (1.13 to 2.92), p=0.014) without reducing rates of
normal coronary angiography (HR 0.78 (0.30 to 2.05), p=0.622). At 3.2
years of follow-up, fatal or non-fatal MI was reduced in patients with
possible angina (3.2% to 1.9%%; HR 0.58 (0.34 to 0.99), p=0.045) but not
in those with non-anginal symptoms (HR 0.65 (0.25 to 1.69), p=0.379).
Conclusions NICE-guided patient selection maximises the benefits of CTCA
on diagnostic certainty, use of invasive coronary angiography and
reductions in fatal and non-fatal myocardial infarction. Patients with
non-anginal chest pain derive minimal benefit from CTCA and increase the
rates of invasive investigation. Trial registration number
ClinicalTrials.gov: NCT01149590;post results.<br/>Copyright &#xa9; Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2018. All rights reserved. No commercial use is permitted unless
otherwise expressly granted.

<58>
Accession Number
622684681
Title
Jugular vs femoral vein for central venous catheterization in pediatric
cardiac surgery (PRECiSE): Study protocol for a randomized controlled
trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 329. Date of
Publication: 25 Jun 2018.
Author
Silvetti S.; Aloisio T.; Cazzaniga A.; Ranucci M.
Institution
(Silvetti, Aloisio, Cazzaniga, Ranucci) IRCCS Policlinico San Donato,
Department of Cardiovascular Anesthesia and Intensive Care, Via Morandi
30, San Donato Milanese, Milan 20097, Italy
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Placement of central venous catheters (CVCs) is essential and
routine practice in the management of children with congenital heart
disease. The purpose of the present protocol is to evaluate the risk for
infectious complications in terms of catheter colonization, catheter
line-associated bloodstream infections, and catheter-related bloodstream
infections (CRBSIs), and the mechanical complications from different
central venous access sites in infants and newborns undergoing cardiac
surgery. Methods: One hundred sixty patients under 1 year of age and
scheduled for cardiac surgery will be included in this randomized
controlled trial (RCT); patients will be randomly allocated to the jugular
or femoral vein arms. CVC insertion will be performed by one of three
selected expert operators. Discussion: The choice of the insertion site
for central venous catheterization can influence the incidence and type of
infectious complications in adults but this is not unanimously evidenced
in the pediatric setting. The experimental hypothesis of this RCT is that
the jugular insertion site is less likely to induce catheter colonization
and CRBSI than the femoral site.<br/>Copyright &#xa9; 2018 The Author(s).

<59>
Accession Number
622870113
Title
The effect of perioperative intravenously administered iron isomaltoside
1000 (Monofer) on transfusion requirements for patients undergoing complex
valvular heart surgery: Study protocol for a randomized controlled trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 350. Date of
Publication: 04 Jul 2018.
Author
Lee S.H.; Shim J.-K.; Soh S.; Song J.W.; Chang B.C.; Lee S.; Kwak Y.-L.
Institution
(Lee, Chang, Lee) Yonsei University Health System, Department of Thoracic
and Cardiovascular Surgery, Severance Cardiovascular Hospital, College of
Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
(Shim, Soh, Song, Kwak) Yonsei University Health System, Department of
Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute,
Yonsei, South Korea
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Anemia is a frequent complication after cardiac surgery
especially following reoperation due to previous prosthetic valve failure
or multiple valve surgery (including combined coronary artery bypass
grafting). This trial explores whether intravenously administered iron
isomaltoside 1000 (Monofer) results in better clinical outcomes in
patients undergoing complex heart valve surgery who are expected to
receive transfusion. Methods/design: In this prospective, single-center,
double-blinded, randomized controlled trial, 214 patients undergoing
reoperation or multiple valve surgery are randomly allocated to either the
iron isomaltoside 1000 (IVFe) or the control group from August 2016 to
August 2018. The IVFe group receives iron isomaltoside 1000 mg (maximum
dose 20 mg/kg) intravenously 3 days before and after the surgery. The
control group receives an equivalent volume of normal saline. The primary
endpoint is transfusion requirement (more than 1 unit of packed
erythrocytes) for postoperative care until discharge and secondary
endpoint are major complications, such as delayed ventilator therapy,
acute kidney injury, and mortality. Reticulocyte count, plasma hepcidin,
iron profiles (serum iron, serum ferritin, total iron-binding capacity,
transferrin, transferrin saturation), coagulation profiles, urinary
analysis, and chemical profiles are measured for three preoperative
baseline-data days and just before surgery, except for hepcidin. After
surgery, daily routine basic laboratory tests are measured just before
discharge and reticulocyte count, iron profiles, and hepcidin are
repeatedly checked for three postoperative days. Discussions: From our
study, we can clarify the following points: the first is the perioperative
IVFe effect on the demand for transfusion, and clinical outcomes in
reoperation or complex valve surgery and the second is the role of
hepcidin in the effect of IVFe on the hemoglobin level
increase.<br/>Copyright &#xa9; 2018 The Author(s).

<60>
Accession Number
622519495
Title
Intravenous morphine versus intravenous paracetamol after cardiac surgery
in neonates and infants: A study protocol for a randomized controlled
trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 318. Date of
Publication: 13 Jun 2018.
Author
Zeilmaker-Roest G.A.; van Rosmalen J.; van Dijk M.; Koomen E.; Jansen
N.J.G.; Kneyber M.C.J.; Maebe S.; van den Berghe G.; Vlasselaers D.;
Bogers A.J.J.C.; Tibboel D.; Wildschut E.D.
Institution
(Zeilmaker-Roest, van Dijk, Tibboel, Wildschut) Erasmus MC-Sophia
Children's Hospital, Department of Pediatric Intensive Care, Rotterdam,
Netherlands
(Zeilmaker-Roest, Bogers) Department of Cardiothoracic Surgery, Erasmus
MC, Rotterdam, Netherlands
(van Rosmalen) Department of Biostatistics, Erasmus MC, Rotterdam,
Netherlands
(Koomen, Jansen) Wilhelmina Children's Hospital, University Medical Center
Utrecht, Department of Pediatric Intensive Care, Utrecht, Netherlands
(Kneyber) Beatrix Children's Hospital, University Medical Center
Groningen, Department of Pediatrics, division of Pediatric Critical Care
Medicine, Groningen, Netherlands
(Maebe, van den Berghe, Vlasselaers) UZ Leuven, Department of Intensive
Care Medicine, Leuven, Belgium
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Morphine is worldwide the analgesic of first choice after
cardiac surgery in children. Morphine has unwanted hemodynamic and
respiratory side effects. Therefore, post-cardiac surgery patients may
potentially benefit from a non-opioid drug for pain relief. A previous
study has shown that intravenous (IV) paracetamol is effective and
opioid-sparing in children after major non-cardiac surgery. The aim of the
study is to test the hypothesis that intermittent IV paracetamol
administration in children after cardiac surgery will result in a
reduction of at least 30% of the cumulative morphine requirement. Methods:
This is a prospective, multi-center, randomized controlled trial at four
level-3 pediatric intensive care units (ICUs) in the Netherlands and
Belgium. Children who are 0-36months old will be randomly assigned to
receive either intermittent IV paracetamol or continuous IV morphine up to
48h post-operatively. Morphine will be available as rescue medication for
both groups. Validated pain and sedation assessment tools will be used to
monitor patients. The sample size (n=208, 104 per arm) was calculated in
order to detect a 30% reduction in morphine dose; two-sided significance
level was 5% and power was 95%. Discussion: This study will focus on the
reduction, or replacement, of morphine by IV paracetamol in children
(0-36months old) after cardiac surgery. The results of this study will
form the basis of a new pain management algorithm and will be implemented
at the participating ICUs, resulting in an evidence-based guideline on
post-operative pain after cardiac surgery in infants who are 0-36months
old.<br/>Copyright &#xa9; 2018 The Author(s).

<61>
Accession Number
620620471
Title
Association between intraoperative hypotension and 30-day mortality, major
adverse cardiac events, and acute kidney injury after non-cardiac surgery:
A meta-analysis of cohort studies.
Source
International Journal of Cardiology. 258 (pp 68-73), 2018. Date of
Publication: 01 May 2018.
Author
Gu W.-J.; Hou B.-L.; Kwong J.S.W.; Tian X.; Qian Y.; Cui Y.; Hao J.; Li
J.-C.; Ma Z.-L.; Gu X.-P.
Institution
(Gu, Hou, Kwong, Qian, Cui, Hao, Li, Ma, Gu) Department of Anesthesiology,
Nanjing Drum Tower Hospital, Medical College of Nanjing University,
Nanjing 210008, China
(Tian) Department of Neurology, The First Affiliated Hospital of Chongqing
Medical University, Chongqing Key Laboratory of Neurology, Chongqing
400016, China
Publisher
Elsevier Ireland Ltd
Abstract
Background: The association between intraoperative hypotension (IOH) and
postoperative outcomes is not fully understood. We performed a
meta-analysis to determine whether IOH is associated with increased risk
of 30-day mortality, major adverse cardiac events (MACEs) and acute kidney
injury (AKI) after non-cardiac surgery. Methods: We searched PubMed and
Embase through May 2016 to identify cohort studies that investigated the
association between IOH and risk of 30-day mortality, MACEs, or AKI in
adult patients after non-cardiac surgery. Ascertainment of IOH and
assessment of outcomes were defined by the individual study. Considering
the level of clinical heterogeneity, adjusted odds ratios (ORs) with 95%
confidence interval (CIs) were pooled using a random-effects model. This
meta-analysis is registered on PROSPERO (CRD42016049405). Results: We
included 14 cohort studies that were heterogeneous in terms of definition
of IOH. IOH alone was associated with increased risk of 30-day mortality
(OR 1.29 [95% CI, 1.19-1.41]), MACEs (OR 1.59 [95% CI, 1.23-2.05]),
especially myocardial injury (OR 1.67 [95% CI, 1.31-2.13]), and AKI (OR
1.39 [95% CI, 1.09-1.77]). Triple low (IOH coincident with low bispectral
index and low minimum alveolar concentration) also predicts increased risk
of 30-day mortality (OR 1.32 [95% CI, 1.03-1.68]). Conclusions: IOH alone
significantly increases the risk of postoperative 30-day mortality, MACEs,
especially myocardial injury, and AKI in adult patients after non-cardiac
surgery. Triple low also predicts increased risk of 30-day mortality after
non-cardiac surgery. These findings provide evidence that IOH should be
recognized as an independent risk factor for postoperative adverse
outcomes after non-cardiac surgery.<br/>Copyright &#xa9; 2018 Elsevier
B.V.

<62>
Accession Number
619892770
Title
Emergency coronary bypass surgery in patients under the influence of dual
antiplatelet therapy: Effects of tranexamic acid and desmopressin acetate.
Source
Turkish Journal of Medical Sciences. 47 (6) (pp 1708-1714), 2017. Date of
Publication: 2017.
Author
Altun G.; Hemsinli D.; Pulathan Z.; Civelek A.
Institution
(Altun, Pulathan) Department of Cardiovascular Surgery, Karadeniz
Technical University, Faculty of Medicine, Trabzon, Turkey
(Hemsinli) Department of Cardiovascular Surgery, Kanuni Education and
Research Hospital, Trabzon, Turkey
(Civelek) Department of Cardiovascular Surgery, Medical Park Hospital,
Ordu, Turkey
Publisher
Turkiye Klinikleri Journal of Medical Sciences (Talapapa Bulvary no. 102,
Hamammonu 1 06230, Turkey)
Abstract
Background/aim: Bleeding in patients undergoing coronary artery bypass
grafting (CABG) while using dual antiplatelet therapy (DAPT) is a cause of
significant morbidity and mortality. The aim of this study is to examine
the perioperative hemostatic effects of tranexamic acid (TnX-A) and
desmopressin acetate (Des) in these patients. Materials and methods: This
clinical study was planned in a prospective and randomized manner.
Fifty-four patients were enrolled and classified into 4 different groups.
They were compared in terms of various bleeding and transfusion
parameters. Results: No significant differences were observed between the
groups in pre/intraoperative data apart from closure times.
Plasmin/alpha-2 antiplasmin complex values in the TnX-A and control groups
were significantly higher than those in the Des and TnX-A+Des groups at
the end of postoperative drug infusion. Mean duration of closure times,
first 3-h and total postoperative amounts of drainage, administered
volumes of erythrocyte suspension/fresh frozen plasma, cost of blood
products, length of intubation, length of stay in the intensive care unit,
and time to discharge were also significantly higher in the Des and
control groups. Conclusion: Des had no significant effect on bleeding
control and even delayed the hemostatic efficacy of TnX-A. Use of TnX-A
infusion alone in these patient groups had a positive effect on
hemostasis-related data.<br/>Copyright &#xa9; TUBITAK.

<63>
Accession Number
619950441
Title
The impact of maintaining serum potassium >=3.6 mEq/L vs >=4.5 mEq/L on
the incidence of new-onset atrial fibrillation in the first 120 hours
after isolated elective coronary artery bypass grafting - study protocol
for a randomised feasibility trial for the proposed Tight K randomized
non-inferiority trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 618. Date of
Publication: 28 Dec 2017.
Author
Campbell N.G.; Allen E.; Sanders J.; Swinson R.; Birch S.; Sturgess J.;
Al-Subaie N.; Elbourne D.; Montgomery H.; O'Brien B.
Institution
(Campbell) Manchester University Foundation NHS Trust, Department of
Cardiology, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT,
United Kingdom
(Allen, Swinson, Sturgess, Elbourne) London School of Hygiene and Tropical
Medicine, Clinical Trials Unit, Keppel Street, London WC1E 7HT, United
Kingdom
(Sanders, Birch, O'Brien) St Bartholomew's Hospital, Barts Health NHS
Trust, Barts Heart Centre, West Smithfield, London EC1A 7BE, United
Kingdom
(Al-Subaie) St George's Hospital, Cardiothoracic Intensive Care Unit,
Blackshaw Road, Tooting, London SW17 0QT, United Kingdom
(Montgomery) UCL Division of Medicine, and Institute for Sport, Exercise
and Health, 1st floor, 170 Tottenham Court Road, London W1T 7HA, United
Kingdom
(Sanders, O'Brien) Queen Mary University of London, William Harvey
Research Institute, Charterhouse Square, London EC1M 6BQ, United Kingdom
(O'Brien) Outcomes Research Consortium, Cleveland, OH, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Atrial fibrillation (AF) occurs in approximately one in three
patients after cardiac surgery, and is associated with increased
short-term and long-term mortality, intensive care unit (ICU) and hospital
stay, and increased cost of care. In an attempt to reduce AF incidence in
these patients, serum potassium (K+) levels are commonly maintained at the
high end of normal (4.5-5.5 mEq/L). However, such potassium
supplementation is without proven benefit, and is not without negative
consequences. It carries clinical risk, negatively impacts patient
experience and is both time-consuming and costly. This protocol describes
a randomised controlled pilot trial to assess the feasibility of a
proposed randomised non-inferiority trial to investigate the impact of
maintaining serum potassium >= 3.6 mEq/L vs >= 4.5 mEq/L on the incidence
of new-onset atrial fibrillation in the first 120 hours after isolated
elective coronary artery bypass grafting. Methods: Design: this is a
randomized feasibility trial as a pilot for a randomized non-inferiority
trial. Participants: are 160 patients undergoing isolated coronary artery
bypass grafting at two centres. Allocation: patients will be randomized
(1:1) to protocols aiming to maintain serum potassium at either >= 3.6
mEq/L ("relaxed control") or >= 4.5 mEq/L ("tight control"). Primary
analytic aim: was to assess the feasibility and acceptability of planning
and delivering the intervention and trial methods to inform a full-scale
non-inferiority trial. Outcome: the primary indicative efficacy outcome
measures being field-tested are feasibility of participant recruitment and
randomization, maintaining a protocol violation rate < 10%, and retaining
90% patient follow up 28 days after surgery. The primary clinical outcome
measure of the future full "Tight K Study" will be incidence of AF after
cardiac surgery. Discussion: The Tight K Pilot will assess the feasibility
of conducting the full trial, which is intended to confirm or refute the
efficacy of current potassium management in preventing AF after cardiac
surgery. Trial registration: ClinicalTrials.gov, NCT03195647. Registered
on 23 May 2017. Last updated 19June 2017.<br/>Copyright &#xa9; 2017 The
Author(s).

<64>
Accession Number
614599465
Title
The effect of two different glycemic management protocols on postoperative
cognitive dysfunction in coronary artery bypass surgery.
Source
Brazilian Journal of Anesthesiology. 67 (3) (pp 258-265), 2017. Date of
Publication: May 2017.
Author
Kurnaz P.; Sungur Z.; Camci E.; Sivrikoz N.; Orhun G.; Senturk M.; Sayin
O.; Tireli E.; Gurvit H.
Institution
(Kurnaz, Sungur, Camci, Sivrikoz, Orhun, Senturk, Sayin) Istanbul
University Istanbul Medical Faculty, Department of Anesthesiology,
Istanbul, Turkey
(Tireli) Istanbul University Istanbul Medical Faculty, Department of
Cardiac Surgery, Istanbul, Turkey
(Gurvit) Istanbul University Istanbul Medical Faculty, Department of
Neurology, Istanbul, Turkey
Publisher
Elsevier Editora Ltda
Abstract
Introduction Postoperative cognitive dysfunction (POCD) is an adverse
outcome of surgery that is more common after open heart procedures. The
aim of this study is to investigate the role of tightly controlled blood
glucose levels during coronary artery surgery on early and late cognitive
decline. Methods 40 patients older than 50 years undergoing elective
coronary surgery were randomized into two groups. In the "Tight Control"
group (GI), the glycemia was maintained between 80 and 120
mg.dL^-1 while in the "Liberal" group (GII), it ranged between
80-180 mg.dL^-1. A neuropsychological test battery was performed
three times: baseline before surgery and follow-up first and 12th weeks,
postoperatively. POCD was defined as a drop of one standard deviation from
baseline on two or more tests. Results At the postoperative first week,
neurocognitive tests showed that 10 patients in the GI and 11 patients in
GII had POCD. The incidence of early POCD was similar between groups.
However the late assessment revealed that cognitive dysfunction persisted
in five patients in the GII whereas none was rated as cognitively impaired
in GI (p = 0.047). Conclusion We suggest that tight perioperative glycemic
control in coronary surgery may play a role in preventing persistent
cognitive impairment.<br/>Copyright &#xa9; 2016 Sociedade Brasileira de
Anestesiologia

<65>
Accession Number
614641045
Title
Perioperative gabapentin and pregabalin in cardiac surgery: a systematic
review and meta-analysis.
Source
Brazilian Journal of Anesthesiology. 67 (3) (pp 294-304), 2017. Date of
Publication: May 2017.
Author
Maitra S.; Baidya D.K.; Bhattacharjee S.; Som A.
Institution
(Maitra, Baidya, Bhattacharjee, Som) All India Institute of Medical
Sciences, Department of Anaesthesiology & Intensive Care, New Delhi, India
Publisher
Elsevier Editora Ltda
Abstract
Objectives Sternotomy for cardiac surgeries causes significant
postoperative pain and when not properly managed may cause significant
morbidity. As neuropathic pain is a significant component here, gabapentin
and pregabalin may be effective in these patients and may reduce
postoperative opioid consumption. The purpose of this systematic review
was to find out efficacy of gabapentin and pregabalin in acute
postoperative pain after cardiac surgery. Methods Published prospective
human randomized clinical trials, which compared preoperative and/or
postoperative gabapentin/pregabalin with placebo or no treatment for
postoperative pain management after cardiac surgery has been included in
this review. Results Four RCTs each for gabapentin and pregabalin have
been included in this systematic review. Three gabapentin and two
pregabalin studies reported decrease in opioid consumption in cardiac
surgical patients while one gabapentin and two pregabalin studies did not.
Three RCTs each for gabapentin and pregabalin reported lower pain scores
both during activity and rest. The drugs are not associated with any
significant complications. Conclusion Despite lower pain scores in the
postoperative period, there is insufficient evidence to recommend routine
use of gabapentin and pregabalin to reduce opioid consumption in the
cardiac surgical patients.<br/>Copyright &#xa9; 2016 Sociedade Brasileira
de Anestesiologia

<66>
[Use Link to view the full text]
Accession Number
614437815
Title
Direct Ora.
Source
Circulation. 135 (7) (pp 714-716), 2017. Date of Publication: 14 Feb 2017.
Author
Siontis K.C.; Yao X.; Gersh B.J.; Noseworthy P.A.
Institution
(Siontis) From Division of Cardiovascular Medicine, University of
Michigan, Ann Arbor, United States
(Yao) Division of Health Care Policy and Research, Department of Health
Sciences Research, United States
(Gersh, Noseworthy) Division of Cardiovascular Diseases, 200 1st St SW,
Mayo Clinic, Rochester, MN 55905, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<67>
Accession Number
624401726
Title
Effect of Sustained Use of Aspirin until the Time of Surgery on Outcomes
following Coronary Artery Bypass Grafting: A Randomized Clinical Trial.
Source
The Thoracic and cardiovascular surgeon. 66 (6) (pp 442-451), 2018. Date
of Publication: 01 Sep 2018.
Author
Sharifi M.; Kamali A.; Ghandi Y.
Institution
(Sharifi) Department of Cardiovascular Surgery, Faculty of Medicine, Arak
University of Medical Sciences, Arak, Iran, Islamic Republic of
(Kamali) Department of Anesthesiology, Faculty of Medicine, Arak
University of Medical Sciences, Arak, Iran, Islamic Republic of
(Ghandi) Department of Pediatric Cardiology, Faculty of Medicine, Arak
University of Medical Sciences, Arak, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: The topic of aspirin (acetylsalicylic acid, ASA) use in
coronary artery disease patients planned for coronary artery bypass
grafting during perioperative period is among the most disputed issues in
cardiac surgery. We designed a study to weigh the risks and benefits of
continued ASA ingestion until the time of surgery.
METHODS: In this randomized double-blind clinical trial, 206 consecutive
patients scheduled for isolated coronary artery bypass surgery (CABG) were
randomly stratified into two groups. In group 1 (104 cases), patients were
given 80 mg ASA per day until the day of surgery. In group 2 (102
patients), ASA (80 mg per day) was stopped 4 days before the operation.
Patients in these two groups were similar in terms of preoperative patient
and procedural characteristics. ASA was resumed 24 hours after the surgery
in all patients.
RESULTS: The rates of bleeding and reexploration within 24 hours of
surgery were significantly higher in group 1 (824.3 vs. 492.1 mL, p<0.001
and 5.7% vs. 0, p=0.0138, respectively). The amount of intra- and
postoperative packed red blood cell (PRBC) transfusion was considerably
greater in group 1 (mean: 1.83 vs. 0.71 units, p<0.001). The rate of
hospital mortality was similar (1.9% in both the groups, p=0.98). Patients
in group 1 had significantly longer mean hospital stay than patients in
group 2 (8 vs. 5.1 days, p<0.001). Again the time interval between weaning
from heart-lung machine and closing the sternum was strikingly longer in
group 1 (mean: 32.1 vs. 14.5 minutes, p<0.001). The incidence of adverse
postoperative outcomes such as myocardial infarction, stroke, and renal
failure was not statistically different between the two groups.
CONCLUSION: Sustained ASA use until the day of surgery in patients planned
for elective isolated CABG can result in excessive bleeding, increased
rate of reexploration, and need for more PRBC transfusion without any
proven beneficial effect on reducing unfavorable postoperative outcomes.
Hence, we recommend discontinuing ASA between 3 and 5 days before
non-urgent CABG while keeping it on in nonelective
circumstances.<br/>Copyright Georg Thieme Verlag KG Stuttgart . New York.

<68>
Accession Number
624400998
Title
Coronary Artery Bypass Surgery in Diffuse Advanced Coronary Artery
Disease: 1-Year Clinical and Angiographic Results.
Source
The Thoracic and cardiovascular surgeon. 66 (6) (pp 477-482), 2018. Date
of Publication: 01 Sep 2018.
Author
Dourado L.O.C.; Bittencourt M.S.; Pereira A.C.; Poppi N.T.; Dallan L.A.O.;
Krieger J.E.; Cesar L.A.M.; Gowdak L.H.W.
Institution
(Dourado, Pereira, Poppi, Dallan, Krieger, Cesar, Gowdak) Cardiopneumology
department, Heart Institute (InCor), University of Sao Paulo Medical
School, Sao Paulo, Brazil
(Bittencourt) Division of Internal Medicine, Center for Clinical and
Epidemiological Research, University Hospital, University of Sao Paulo,
Sao Paulo, Brazil
Publisher
NLM (Medline)
Abstract
BACKGROUND: Proper treatment of patients with diffuse, severe coronary
artery disease (CAD) is a challenge due to its complexity. Thus, data on
the outcomes after coronary artery bypass graft (CABG) in this population
is scarce. In this study, we aimed to determine the impact of CABG on the
clinical and functional status, as well as graft patency in those
individuals.
METHODS: Patients with severe and diffuse CAD who underwent incomplete
CABG due to complex anatomy or extensive distal coronary involvement were
evaluated preoperatively and 1year after surgery. Postoperative coronary
angiography was performed to evaluate graft patency. Graft occlusion was
defined as the complete absence of opacification of the target vessel.
Stratified analysis of graft occlusion was performed by graft type and
territories, defined as left anterior descending artery (LAD), the left
circumflex branch, and the right coronary artery territories; the latter
two, grouped, were further classified as non-LAD territory.
RESULTS: A total of 57 patients were included, in whom 131 grafts were
placed. There was a significant improvement in Canadian Cardiovascular
Society angina symptom severity (Z=-6.1; p<0.001) and maximum oxygen
uptake (p<0.001), with a corresponding decrease in the use of long-acting
nitrates (p<0.001). The overall graft occlusion rate was 19.1%, with no
significant difference between LAD and non-LAD territories (p=0.08).
However, a significantly lower occlusion rate was noted for the internal
mammary artery (IMA) grafts when compared with saphenous vein grafts
(p=0.01), though this difference was only significant in the LAD territory
(p=0.04). Overall, the use of venous graft was the only predictor
occlusion at 1year (odds ratio: 4.03; p=0.016).
CONCLUSION: In patients with diffuse CAD, incomplete CABG surgery resulted
in a significant clinical improvement, with acceptable graft occlusion
rates at 1year, particularly for IMA grafts to the LAD
territory.<br/>Copyright Georg Thieme Verlag KG Stuttgart . New York.

<69>
Accession Number
624484277
Title
Subclavian/Axillary Access for Self-Expanding Transcatheter Aortic Valve
Replacement Renders Equivalent Outcomes as Transfemoral.
Source
The Annals of thoracic surgery. 105 (2) (pp 477-483), 2018. Date of
Publication: 01 Feb 2018.
Author
Gleason T.G.; Schindler J.T.; Hagberg R.C.; Deeb G.M.; Adams D.H.; Conte
J.V.; Zorn G.L.; Hughes G.C.; Guo J.; Popma J.J.; Reardon M.J.
Institution
(Gleason) Department of Cardiothoracic Surgery, University of Pittsburgh
Medical Center Heart and Vascular Institute, University of Pittsburgh
School of Medicine, Pittsburgh, PA, United States
(Schindler) Department of Medicine, University of Pittsburgh Medical
Center Heart and Vascular Institute, University of Pittsburgh School of
Medicine, Pittsburgh, PA, United States
(Hagberg) Department of Cardiac Surgery, University of Michigan Hospitals,
Ann Arbor, MI, United States
(Deeb) Department of Cardiovascular Surgery, Mount Sinai Health System,
NY, United States
(Adams) Division of Cardiac Surgery, Johns Hopkins University, Baltimore,
MD, United States
(Conte) Department of Cardiothoracic Surgery, University of Kansas,
Lawrence, KS, United States
(Zorn) Department of Thoracic and Cardiac Surgery, Duke University Medical
Center, Durham, NC, United States
(Hughes) Statistical Services, Medtronic, Mounds View, MN, United States
(Guo) Cardiovascular Division, Department of Internal Medicine and
Cardiovascular Surgery, Department of Surgery, Beth Israel Deaconess
Medical Center, Boston, MA, United States
(Popma, Reardon) Department of Cardiovascular Surgery, Methodist DeBakey
Heart and Vascular Center, Houston, TX, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Iliofemoral arterial disease can preclude transfemoral (TF)
transcatheter aortic valve replacement (TF-TAVR). Transthoracic access by
direct aortic or a transapical approach imparts a greater risk of
complications and death than TF access. We hypothesized that
subclavian/axillary arterial (SCA) access offers equivalent risks and
outcomes as TF access.
METHODS: The outcomes of 202 patients from the CoreValve (Medtronic,
Minneapolis, MN) United States Pivotal Trial Program treated with SCA
access were propensity matched with patients treated with TF access and
analyzed.
RESULTS: Matching was successful, with no significant baseline differences
in the SCA group and the TF group, except the SCA group had more past or
present smokers (79.2% vs 61.4%, p < 0.001) and fewer patients with anemia
requiring transfusion (18.5% vs 27.5%, p = 0.04). SCA patients experienced
a significantly longer time from enrollment to procedure (8.6 +/- 19.1 vs
5.3 +/- 6.3 days; p = 0.02), likely the result of case planning.
Significant differences in procedural outcomes include less post-TAVR
balloon dilation (17.9% vs 26.7%, p = 0.03) and more general anesthesia
(99.0% vs 89.6%, p < 0.001) for the SCA accesses. There were no
differences in procedure time (57.8 +/- 45.3 vs 57.5 +/- 32.1 min, p =
0.94) or Valve Academic Research Consortium I-defined procedure success
between groups (p = 0.89). Event rates at 30 days or 1 year were similar,
with a trend toward fewer pacemakers with SCA accesses.
CONCLUSIONS: Major morbidity and mortality rates SCA-TAVR are equivalent
to TF-TAVR. The SCA should be the preferred secondary access site for TAVR
because it offers procedural and clinical outcomes comparable to TF-TAVR
and applies to most patients who are not TF candidates.<br/>Copyright
&#xa9; 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc.
All rights reserved.

<70>
[Use Link to view the full text]
Accession Number
624402730
Title
Effect of high-flow nasal cannula oxygen therapy vs conventional oxygen
therapy on adult postcardiothoracic operation: A meta-analysis.
Source
Medicine. 97 (41) (pp e12783), 2018. Date of Publication: 01 Oct 2018.
Author
Wu X.; Cao W.; Zhang B.; Wang S.
Institution
(Wu) Department of Pulmonary and Critical Care Medicine, First Affiliated
Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
Publisher
NLM (Medline)
Abstract
METHODS: A search was conducted in Embase, MEDLINE, Ovid, and Cochrane
databases until December, 2017 for all the controlled study to compare
HFNC with COT in adult postcardiothoracic surgery. Two authors extracted
data and assessed the quality of each study independently. The
meta-analysis was performed by using RevMan 5.3. The primary outcome was
the rate of escalation of respiratory support rate and pulmonary
complications; secondary outcome included the length of intensive care
unit (ICU) stay and length of hospital stay and the rate of intubation.
RESULTS: Four studies that involved 649 patients were included in the
analysis. No significant heterogeneity was found in outcome measures.
Compared with COT, HFNC were associated with a significant reduction in
the escalation of respiratory support (odds ratio [OR] = 0.44, 95%
confidence interval [CI] = 0.29-0.66, P < .001) and pulmonary
complications (OR = 0.28, 95% CI = 0.13-0.6, P = .001). There were no
significant differences in the reintubation rate (OR = 0.33, 95% CI =
0.02-5.39, P = .43), length of ICU stay (weighted mean difference = 0.11;
95% CI = -0.44 -0.26, P = .14) or length of hospital stay (weighted mean
difference = -0.15, 95% CI = -0.46 -0.17, P = .36) between the 2 groups.
No severe complications were reported in either group.
CONCLUSION: The HFNC could reduce respiratory support and pulmonary
complications, and it could be safely administered for adult
postcardiothoracic surgery. Further large-scale, randomized, and
controlled trials are needed to update this finding.
INTRODUCTION: The effect of high-flow nasal cannula (HFNC) on adult post
cardiothoracic operation remains controversial. We conducted a
meta-analysis of randomized controlled trials to evaluate the effect of
HFNC and conventional oxygen therapy (COT) on postcardiothoracic surgery.

<71>
[Use Link to view the full text]
Accession Number
624465695
Title
Sevoflurane is an effective adjuvant to propofol-based total intravenous
anesthesia for attenuating cough reflex in nonintubated video-assisted
thoracoscopic surgery.
Source
Medicine. 97 (42) (pp e12927), 2018. Date of Publication: 01 Oct 2018.
Author
Lai H.-C.; Huang T.-W.; Tseng W.-C.; Lin W.-L.; Chang H.; Wu Z.-F.
Institution
(Lai, Tseng, Lin, Wu) Department of Anesthesiology, Netherlands
(Huang, Chang) Division of Chest Surgery, Department of Surgery,
Tri-Service General Hospital and National Defense Medical Center, Republic
of China, Taipei, Taiwan (Republic of China)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Nonintubated video-assisted thoracic surgery (VATS) has been
widely developed during the recent years. Cough reflex is an inevitably
encountered problem while approaching lung lesions, and it may induce
major bleeding. Sevoflurane anesthesia may attenuate cough reflex by
inhibiting the pulmonary irritant receptors. However, the incidence of
postoperative nausea and vomiting (PONV) in inhalational anesthesia is
higher than in the propofol-based total intravenous anesthesia (TIVA). We
investigated the effect of sevoflurane combination with propofol-based
TIVA on cough reflex and PONV in nonintubated VATS.
METHODS: Ninety patients undergoing nonintubated VATS with laryngeal mask
airway (LMA) and spontaneous breathing were randomly assigned for TIVA or
propofol/sevoflurane anesthesia. In the TIVA group (n = 45), anesthesia
was induced and maintained with propofol and fentanyl; in the
propofol/sevoflurane (P/S) group (n = 45), 1% sevoflurane anesthesia was
added to propofol and fentanyl anesthesia. The primary outcome
measurements were cough reflex. In addition, the incidence of PONV and
extubation time were investigated.
RESULTS: Patients with cough reflex were significantly fewer in the P/S
group than in the TIVA group (10/45 vs 34/45; P < .001). The cough
severity (35/5/5/0 vs 11/17/17/0; P < .001) and limb movement (40/5/0/0 vs
28/17/0/0; P < .001) were lower in the P/S group than in the TIVA group.
Besides, incremental fentanyl bolus for cough reflex was 5 (0 [0-1]) in
the P/S group and 17 (0 [0-3]) in the TIVA group (P < .05). And there was
no conversion to general anesthesia, postoperative hemorrhage, aspiration
pneumonia, or PONV in the 2 groups. Besides, there was no significant
difference in extubation time (TIVA: 5.04 +/- 2.88 vs P/S: 4.44 +/- 2.98
minutes; P = .33).
CONCLUSION: Sevoflurane attenuated cough reflex under propofol-based TIVA
and did not increase the incidence of PONV and extubation time in
nonintubated VATS.

<72>
Accession Number
624196937
Title
Six-Month Outcomes after Restrictive or Liberal Transfusion for Cardiac
Surgery.
Source
The New England journal of medicine. 379 (13) (pp 1224-1233), 2018. Date
of Publication: 27 Sep 2018.
Author
Mazer C.D.; Whitlock R.P.; Fergusson D.A.; Belley-Cote E.; Connolly K.;
Khanykin B.; Gregory A.J.; de Medicis E.; Carrier F.M.; McGuinness S.;
Young P.J.; Byrne K.; Villar J.C.; Royse A.; Grocott H.P.; Seeberger M.D.;
Mehta C.; Lellouche F.; Hare G.M.T.; Painter T.W.; Fremes S.; Syed S.;
Bagshaw S.M.; Hwang N.-C.; Royse C.; Hall J.; Dai D.; Mistry N.; Thorpe
K.; Verma S.; Juni P.; Shehata N.
Institution
(Mazer, Whitlock, Fergusson, Belley-Cote, Connolly, Khanykin, Gregory, de
Medicis, Carrier, McGuinness, Young, Byrne, Villar, Royse, Grocott,
Seeberger, Mehta, Lellouche, Hare, Painter, Fremes, Syed, Bagshaw, Hwang,
Royse, Hall, Dai, Mistry, Thorpe, Verma, Juni, Shehata) From the
Department of Anesthesia (C.D.M., G.M.T.H., N.M.) and the Department of
Surgery, Division of Cardiac Surgery (S.V.), St. Michael's Hospital,
Keenan Research Centre for Biomedical Science, the Li Ka Shing Knowledge
Institute of St. Michael's Hospital (C.D.M., G.M.T.H., K.T., S.V., P.J.),
Applied Health Research Centre (J.H., D.D., K.T., S.V., P.J.), Sunnybrook
Health Sciences Centre (S.F.), Division of Hematology, Mount Sinai
Hospital (N.S.), the Departments of Medicine (P.J., N.S.), Physiology
(C.D.M., G.M.T.H), and Laboratory Medicine and Pathobiology (N.S.), Dalla
Lana School of Public Health (K.T.), and Institute of Health Policy,
Management and Evaluation, University of Toronto, and Canadian Blood
Services (N.S.), Toronto, the Population Health Research Institute
(R.P.W., E.B.-C.), Hamilton Health Sciences Center (R.P.W., E.B.-C., K.C.,
S.S.), McMaster University (R.P.W., E.B.-C., K.C., S.S.), Hamilton, ON,
the Ottawa Hospital Research Institute, University of Ottawa, Ottawa
(D.A.F.), the Cumming School of Medicine and Libin Cardiovascular
Institute, University of Calgary, Calgary (A.J.G.), and the Department of
Critical Care Medicine, Faculty of Medicine and Dentistry, University of
Alberta, Edmonton (S.M.B.), CHUS-Centre Hospitalier Universitaire de
Sherbrooke, Sherbrooke (E.M.), and the Department of Anesthesiology
Publisher
NLM (Medline)
Abstract
METHODS: We randomly assigned 5243 adults undergoing cardiac surgery to a
restrictive red-cell transfusion strategy (transfusion if the hemoglobin
concentration was <7.5 g per deciliter intraoperatively or
postoperatively) or a liberal red-cell transfusion strategy (transfusion
if the hemoglobin concentration was <9.5 g per deciliter intraoperatively
or postoperatively when the patient was in the intensive care unit [ICU]
or was <8.5 g per deciliter when the patient was in the non-ICU ward). The
primary composite outcome was death from any cause, myocardial infarction,
stroke, or new-onset renal failure with dialysis occurring within 6 months
after the initial surgery. An expanded secondary composite outcome
included all the components of the primary outcome as well as emergency
department visit, hospital readmission, or coronary revascularization
occurring within 6 months after the index surgery. The secondary outcomes
included the individual components of the two composite outcomes.
RESULTS: At 6 months after surgery, the primary composite outcome had
occurred in 402 of 2317 patients (17.4%) in the restrictive-threshold
group and in 402 of 2347 patients (17.1%) in the liberal-threshold group
(absolute risk difference before rounding, 0.22 percentage points; 95%
confidence interval [CI], -1.95 to 2.39; odds ratio, 1.02; 95% CI, 0.87 to
1.18; P=0.006 for noninferiority). Mortality was 6.2% in the
restrictive-threshold group and 6.4% in the liberal-threshold group (odds
ratio, 0.95; 95% CI, 0.75 to 1.21). There were no significant
between-group differences in the secondary outcomes.
CONCLUSIONS: In patients undergoing cardiac surgery who were at
moderate-to-high risk for death, a restrictive strategy for red-cell
transfusion was noninferior to a liberal strategy with respect to the
composite outcome of death from any cause, myocardial infarction, stroke,
or new-onset renal failure with dialysis at 6 months after surgery.
(Funded by the Canadian Institutes of Health Research and others; TRICS
III ClinicalTrials.gov number, NCT02042898 .).
BACKGROUND: We reported previously that, in patients undergoing cardiac
surgery who were at moderate-to-high risk for death, a restrictive
transfusion strategy was noninferior to a liberal strategy with respect to
the composite outcome of death from any cause, myocardial infarction,
stroke, or new-onset renal failure with dialysis by hospital discharge or
28 days after surgery, whichever came first. We now report the clinical
outcomes at 6 months after surgery.

<73>
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).

<74>
Accession Number
619197730
Title
Drug-Eluting Stents Versus Coronary Artery Bypass Grafts for Left Main
Coronary Disease: A Meta-Analysis and Review of Randomised Controlled
Trials.
Source
Heart Lung and Circulation. 27 (12) (pp 1437-1445), 2018. Date of
Publication: December 2018.
Author
Moore P.; Burrage M.; Garrahy P.; Lim R.; McCann A.; Camuglia A.
Institution
(Moore, Burrage, Garrahy, Lim, McCann, Camuglia) Department of Cardiology,
Princess Alexandra Hospital, Brisbane, Qld, Australia
(Moore, Burrage, Garrahy, Lim, McCann, Camuglia) School of Medicine,
University of Queensland, Brisbane, Qld, Australia
Publisher
Elsevier Ltd
Abstract
Background: Revascularisation of left main coronary artery (LMCA) disease
can be potentially managed with percutaneous coronary intervention (PCI)
or coronary artery bypass graft surgery (CABG). Recent randomised
controlled trial (RCT) data have added to the literature on this subject
and this meta-analysis aims to assess the state of the data to assist in
guiding patient treatment decisions. Methods: A systematic literature
search of Cochrane Library, EMBASE, OVID, and PubMed Medline was
performed. Randomised controlled trials of patients with LMCA disease
undergoing PCI with drug eluting stents or CABG were included. Clinical
outcomes and adverse events were assessed and analysed. Results: Four
suitable RCTs of adequate quality and follow-up were identified. The
incidence of major adverse cardiac and cerebrovascular events (MACCE) at 3
to 5 years of follow-up was significantly increased with PCI compared to
CABG (23.3% vs 18.2%, OR 1.37; 95% CI: 1.18-1.58; p = < 0.0001;
I² = 0%) and was largely driven by more repeat
revascularisation procedures among patients treated with PCI. There was no
statistically significant difference in rates of mortality, myocardial
infarction or stroke (either individually or when these outcomes were
combined as a composite endpoint). Conclusions: Coronary artery bypass
grafting and PCI both represent reasonable treatment modalities for LMCA
disease in appropriately selected patients. However, where CABG is
feasible it offers superior long-term freedom from repeat
revascularisation. Longer-term follow-up is required to further clarify
the durability of mortality outcomes, especially in patients treated with
PCI.<br/>Copyright &#xa9; 2017 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<75>
Accession Number
624678449
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. 14 (8) (pp 877-883), 2018. Date of Publication: October
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
(Modolo) Department of Cardiology, Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Reardon, Kleiman) Houston Methodist DeBakey Heart and Vascular Center,
Houston, TX, United States
(Miyazaki, Onuma, Van Mieghem) Thoraxcenter, Erasmus Medical Center,
Rotterdam, Netherlands
(Windecker) University Hospital Foundation, Bern, Switzerland
(Popma) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Chang, Kappetein) Medtronic, Minneapolis, MN, United States
(Lilly) Department of Cardiology, Ohio State University, Wexner Medical
Center, Columbus, OH, United States
(Amrane, Boonstra) Department of Cardiothoracic Surgery, Medisch Centrum
Leeuwarden, Leeuwarden, Netherlands
(Onuma) Cardialysis Clinical Trials Management and Core Laboratories,
Rotterdam, Netherlands
(Sondergaard) Heart Center, Rigshospitalet, University of Copenhagen,
Copenhagen, Denmark
Publisher
EuroPCR
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.<br/>Copyright &#xa9; Europa Digital &
Publishing 2018. All rights reserved.

<76>
Accession Number
619197294
Title
A multi-institutional cohort study confirming the risks of Clostridium
difficile infection associated with prolonged antibiotic prophylaxis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Author
Kirkwood K.A.; Gulack B.C.; Iribarne A.; Bowdish M.E.; Greco G.; Mayer
M.L.; O'Sullivan K.; Gelijns A.C.; Fumakia N.; Ghanta R.K.; Raiten J.M.;
Lala A.; Ladowski J.S.; Blackstone E.H.; Parides M.K.; Moskowitz A.J.;
Horvath K.A.
Institution
(Kirkwood, Parides) International Center for Health Outcomes and
Innovation Research (InCHOIR) and Center for Biostatistics in the
Department of Population Health Science and Policy, Icahn School of
Medicine at Mount Sinai, New York, NY
(Greco, O'Sullivan, Gelijns, Moskowitz) International Center for Health
Outcomes and Innovation Research, Department of Population Health Science
and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
(Lala) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine, New York, NY
(Gulack) Division of Cardiovascular and Thoracic Surgery, Department of
Surgery, Duke Health, Durham, NC
(Iribarne) Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon,
NH
(Bowdish) Department of Surgery, Keck School of Medicine of USC,
University of Southern California, Los Angeles, Calif
(Mayer) Division of Cardiovascular Surgery, Department of Surgery,
University of Pennsylvania School of Medicine, Philadelphia, Pa
(Raiten) Department of Anesthesiology and Critical Care, University of
Pennsylvania School of Medicine, Philadelphia, Pa
(Fumakia) Division of Cardiovascular Surgery, Toronto General Hospital,
Toronto, Ontario, Canada
(Ghanta) Michael E. DeBakey Department of Surgery, Baylor College of
Medicine, Houston, Tex
(Ladowski) Indiana Ohio Heart, Fort Wayne, Ind
(Blackstone) Cardiothoracic Research, Cleveland Clinic, Cleveland, Ohio
(Horvath) Clinical Transformation, Association of American Medical
Colleges, Washington, DC
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: The incidence and severity of Clostridium difficile infection
(CDI) have increased rapidly over the past 2 decades, particularly in
elderly patients with multiple comorbidities. This study sought to
characterize the incidence and risks of these infections in cardiac
surgery patients. Methods: A total of 5158 patients at 10 Cardiothoracic
Surgical Trials Network sites in the US and Canada participated in a
prospective study of major infections after cardiac surgery. Patients were
followed for infection, readmission, reoperation, or death up to 65 days
after surgery. We compared clinical and demographic characteristics,
surgical data, management practices, and outcomes for patients with CDI
and without CDI. Results: C difficile was the third most common infection
observed (0.97%) and was more common in patients with preoperative
comorbidities and complex operations. Antibiotic prophylaxis for >2 days,
intensive care unit stay >2 days, and postoperative hyperglycemia were
associated with increased risk of CDI. The median time to onset was 17
days; 48% of infections occurred after discharge. The additional length of
stay due to infection was 12 days. The readmission and mortality rates
were 3-fold and 5-fold higher, respectively, in patients with CDI compared
with uninfected patients. Conclusions: In this large multicenter
prospective study of major infections following cardiac surgery, CDI was
encountered in nearly 1% of patients, was frequently diagnosed
postdischarge, and was associated with extended length of stay and
substantially increased mortality. Patients with comorbidities, longer
surgery time, extended antibiotic exposure, and/or hyperglycemic episodes
were at increased risk for CDI.<br/>Copyright &#xa9; 2017 The American
Association for Thoracic Surgery.

<77>
Accession Number
619713862
Title
The use of del Nido cardioplegia in adult cardiac surgery: A prospective
randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Author
Ad N.; Holmes S.D.; Massimiano P.S.; Rongione A.J.; Fornaresio L.M.;
Fitzgerald D.
Institution
(Ad) Department of Cardiovascular and Thoracic Surgery, West Virginia
University, Morgantown, WVa
(Ad, Massimiano, Rongione) Adventist HealthCare, Takoma Park, Md
(Ad) Inova Fairfax Hospital, Falls Church, Va
(Holmes, Fornaresio) Heart and Vascular Institute, West Virginia
University Medicine, Morgantown, WVa
(Fitzgerald) The Medical University of South Carolina, Charleston, SC
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: The del Nido cardioplegia solution has been used extensively
in congenital heart surgery for more than 20 years and more recently for
adults. This randomized controlled trial examined whether expanding this
technique to adult cardiac surgery confers benefits in surgical workflow
and clinical outcome compared with blood-based cardioplegia. Methods:
Adult first-time coronary artery bypass grafting (CABG), valve, or
CABG/valve surgery patients requiring cardiopulmonary bypass (CPB) were
randomized to del Nido cardioplegia (n = 48) or whole blood cardioplegia
(n = 41). Primary outcomes assessed myocardial preservation. Troponin I
was measured at baseline, 2 hours after CPB termination, 12 and 24 hours
after cardiovascular intensive care unit admission. Alpha was set at P <
.001. Results: Preoperative characteristics were similar between groups,
including age, Society of Thoracic Surgeons risk score, CABG, and valve
procedures. There was no significant difference on CPB time (97 vs 103
minutes; P = .288) or crossclamp time (70 vs 83 minutes; P = .018). The
del Nido group showed higher return to spontaneous rhythm (97.7% vs 81.6%;
P = .023) and fewer patients required inotropic support (65.1% vs 84.2%; P
= .050), but did not reach statistical significance. Incidence of Society
of Thoracic Surgeons-defined morbidity was low, with no strokes,
myocardial infarctions, renal failure, or operative deaths. For del Nido
group patients, troponin levels did not increase as much as for control
patients (P = .040), but statistical significance was not reached.
Conclusions: Evidence from this study suggests del Nido cardioplegia use
in routine adult cases may be safe, result in comparable clinical
outcomes, and streamline surgical workflow. The trend for troponin should
be investigated further because it may suggest superior myocardial
protection with the del Nido solution.<br/>Copyright &#xa9; 2017 The
American Association for Thoracic Surgery.

<78>
Accession Number
624661942
Title
Neurological Complications After Transcatheter Versus Surgical Aortic
Valve Replacement in Intermediate-Risk Patients.
Source
Journal of the American College of Cardiology. 72 (18) (pp 2109-2119),
2018. Date of Publication: 30 Oct 2018.
Author
Durko A.P.; Reardon M.J.; Kleiman N.S.; Popma J.J.; Van Mieghem N.M.;
Gleason T.G.; Bajwa T.; O'Hair D.; Brown D.L.; Ryan W.H.; Chang Y.; De
Leon S.D.; Kappetein A.P.
Institution
(Durko) Department of Cardiothoracic Surgery, Erasmus Medical Center,
Rotterdam, Netherlands
(Reardon, Kleiman) Departments of Cardiology and Cardiovascular Surgery,
Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United
States
(Popma) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Van Mieghem) Department of Cardiology, Erasmus Medical Center, Rotterdam,
Netherlands
(Gleason) Department of Cardiovascular Surgery, University of Pittsburgh
Medical Center, Pittsburgh, PA, United States
(Bajwa, O'Hair) Departments of Cardiology and Cardiac Surgery, St. Luke's
Medical Center/Aurora Health Care, Milwaukee, WI, United States
(Brown, Ryan) Departments of Cardiology and Cardiovascular Surgery, Plano,
TX, United States
(Chang, De Leon) Clinical and Statistical Services, Medtronic,
Minneapolis, MN, United States
(Kappetein) Department of Cardiothoracic Surgery, Erasmus Medical Center,
Rotterdam, Netherlands
Publisher
NLM (Medline)
Abstract
BACKGROUND: Neurological events after aortic valve interventions are
associated with increased mortality and morbidity. Transcatheter aortic
valve replacement (TAVR) is increasingly offered for lower-risk patients
with severe aortic stenosis, previously considered candidates for surgical
aortic valve replacement (SAVR). Differences in post-procedural
neurological events have important implications in treatment allocation.
OBJECTIVES: The authors sought to analyze the neurological events in the
randomized SURTAVI (Surgical Replacement and Transcatheter Aortic Valve
Implantation) trial.
METHODS: Patients with severe, symptomatic aortic stenosis at intermediate
surgical risk were randomized 1:1 to TAVR or SAVR. The rates of
neurological events and quality of life were analyzed at 30 days, and 6
and 12 months post-procedure in a modified intention-to-treat population
(mean age 79.8 +/- 6.2 years; N = 1,660).
RESULTS: The rates of early (30-day) stroke and post-procedural
encephalopathy were higher after SAVR versus TAVR (5.4% vs. 3.3%; p =
0.031; and 7.8% vs. 1.6%; p < 0.001, respectively). At 12 months, the rate
of stroke was not different between SAVR and TAVR (6.9% vs. 5.2%; p =
0.136). Early stroke and early encephalopathy resulted in an elevated
mortality at 12 months in both treatment groups. Quality of life after an
early stroke was significantly lower in SAVR versus TAVR patients at 30
days and was similar at 6 and 12 months.
CONCLUSIONS: The early stroke rate was lower after TAVR than SAVR. In
patients with early strokes, QOL improved earlier after TAVR. At 12-month
follow-up, stroke rates and QOL were not different between TAVR and SAVR
patients. (Surgical Replacement and Transcatheter Aortic Valve
Implantation [SURTAVI]; NCT01586910).<br/>Copyright &#xa9; 2018 American
College of Cardiology Foundation. Published by Elsevier Inc. All rights
reserved.

<79>
Accession Number
624658396
Title
Intestinal Involvement in Kawasaki Disease.
Source
The Journal of pediatrics. 202 (pp 186-193), 2018. Date of Publication: 01
Nov 2018.
Author
Colomba C.; La Placa S.; Saporito L.; Corsello G.; Ciccia F.; Medaglia A.;
Romanin B.; Serra N.; Di Carlo P.; Cascio A.
Institution
(Colomba, La Placa, Saporito, Corsello, Medaglia, Romanin, Di Carlo,
Cascio) Department of Sciences for Health Promotion and Mother and Child
Care, University of Palermo, Palermo, Italy
(Ciccia) Biomedical Department of Internal and Specialist Medicine,
University of Palermo, Palermo, Italy
(Serra) Department of Pediatrics, School of Medicine, Federico II
University, Naples, Italy
Publisher
NLM (Medline)
Abstract
CONCLUSIONS: The diagnosis and treatment of Kawasaki disease might be
delayed if intestinal symptoms appear before the characteristic clinical
features of Kawasaki disease, thus, increasing the risk of cardiac
complications. Furthermore, patients may undergo unnecessary invasive
procedures. Pediatricians and pediatric surgeons, therefore, should
consider Kawasaki disease among diagnoses in children with fever,
abdominal symptoms, and radiologic findings of pseudo-obstruction.
OBJECTIVES: To describe a case of Kawasaki disease with intestinal
involvement and to analyze other published reports to define clinical
characteristics, diagnostic issues, and therapeutic approaches of
gastrointestinal involvement in Kawasaki disease.
STUDY DESIGN: A computerized search without language restriction was
conducted using PubMed and SCOPUS. An article was considered eligible for
inclusion in the systematic review if it reported data on patient(s) with
intestinal involvement in Kawasaki disease. Our case was also included in
the analysis.
RESULTS: Thirty-three articles reporting 48 cases of Kawasaki disease with
intestinal involvement were considered. Fever, abdominal pain, and
vomiting were the most frequent symptoms observed and typical Kawasaki
disease signs and symptoms appeared after intestinal complaints in all
cases. Plain radiographs, ultrasonography, and computed tomography showed
pseudo-obstruction as the most frequent sign of gastrointestinal
involvement; 25 patients underwent surgery. Cardiac involvement was
documented in 21 cases. All but three patients received medical treatment
with immunoglobulin intravenous or aspirin. The outcome was good in 28
patients; 7 patients showed persistence of coronary artery abnormalities;
1 patient developed cyanosis, and later, left hand and forefoot gangrene;
3 patients died.<br/>Copyright &#xa9; 2018 Elsevier Inc. All rights
reserved.

<80>
Accession Number
624691534
Title
New Nano-Film Single-Rivet Patent Ductus Arteriosus Occluders: A
Prospective, Randomized and Double-blind Study.
Source
Current medical science. 38 (1) (pp 85-92), 2018. Date of Publication: 01
Feb 2018.
Author
Shang X.-K.; Liu M.; Li H.-J.; Lu R.; Ding S.-S.; Wang B.; Dong N.-G.;
Chen S.
Institution
(Shang, Wang, Chen) Department of Cardiovascular Surgery, Union Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
Wuhan 430022, China
(Shang) Medical Research Institute, Second Clinical College of Wuhan
University, Wuhan 430071, China
(Liu, Lu) Department of Intensive Care Unit, Wuhan First Hospital, Wuhan
430022, China
(Li) Department of Electroencephalogram, Zhangqiu District Hospital of
Traditional Chinese Medicine, Jinan 250200, China
(Ding) Department of Oncololgy, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan 430022, China
(Dong) Department of Cardiovascular Surgery, Union Hospital, Tongji
Medical College, Huazhong University of Science and Technology, Wuhan
430022, China
Abstract
Nitinol alloy occluders are widely used in the transcatheter intervention
treatment of congenital heart diseases like patent ductus arteriosus
(PDA). However, nitinol alloy contains high levels of nickel, which can
lead to toxic effects in the immune and hematopoietic systems if released
in sufficient quantities. A new type of single-rivet occluder coated with
nano-film has been developed to limit the release of nickel. In total, 23
patients were recruited and randomly assigned to the experimental group
(n=12) with the new nano-film single-rivet occluders or the control group
(n=11) with the traditional occluders. One case in the control group was
lost to follow-up. The remaining 22 cases were followed up at 24 h, 7
days, 1 month, 3 months, and 6 months after the procedure. There were no
statistically significant differences in routine blood test, alanine
aminotransferase, creatinine, and troponin between the experimental and
control groups. Serum nickel concentration in both two groups increased at
24 h after the procedure, peaked at 1 month, and returned to preoperative
levels at 6 months. Serum nickel levels in the experimental group were
significantly lower than in the control group at 24 h, 7 days, 1 month,
and 3 months after the procedure. These data suggested that the nano-film
coating effectively prevented nickel release from the new occluders, and
therefore has a preferable safety profile.

<81>
[Use Link to view the full text]
Accession Number
624687042
Title
Healthcare Resource Use and Cost Implications in the MOMENTUM 3 Long-Term
Outcome Study.
Source
Circulation. 138 (18) (pp 1923-1934), 2018. Date of Publication: 30 Oct
2018.
Author
Mehra M.R.; Salerno C.; Cleveland J.C.; Pinney S.; Yuzefpolskaya M.;
Milano C.A.; Itoh A.; Goldstein D.J.; Uriel N.; Gulati S.; Pagani F.D.;
John R.; Adamson R.; Bogaev R.; Thohan V.; Chuang J.; Sood P.; Goates S.;
Silvestry S.C.
Institution
(Mehra) Brigham and Women's Hospital Heart and Vascular Center and Harvard
Medical School, Boston, United Kingdom
(Salerno) St. Vincent Heart Center, Indianapolis, United States
(Cleveland) University of Colorado School of Medicine, United States
(Pinney) Icahn School of Medicine at Mount Sinai, NY, United States
(Yuzefpolskaya) Columbia University College of Physicians and Surgeons and
New York Presbyterian Hospital, NY, United States
(Milano) Duke Heart Center, Duke University, Durham, Canada
(Itoh) Washington University School of Medicine, St. Louis, United States
(Goldstein) Montefiore Einstein Center for Heart and Vascular Care, NY,
United States
(Uriel) University of Chicago School of Medicine and Medical Center
(Gulati) Carolinas Medical Center, Charlotte, United States
(Pagani) University of Michigan Health System, United States
(John) University of Minnesota Medical Center, Minneapolis (R.J.)
(Adamson) Sharp Memorial Hospital, San Diego, United States
(Bogaev) Bon Secours St. Mary's Hospital, Richmond, Australia
(Thohan) Aurora St. Luke's Medical Center, Milwaukee, United States
(Chuang, Sood, Goates) Abbott, Abbott Park, IL (J.C., P.S., S.G.)
(Silvestry) Florida Hospital
Publisher
NLM (Medline)
Abstract
BACKGROUND: The MOMENTUM 3 trial compares the centrifugal HeartMate 3
(HM3) with the axial HeartMate II (HMII) continuous-flow left ventricular
assist system in patients with advanced heart failure, irrespective of the
intended goal of therapy. The trial's 2-year clinical outcome (n=366)
demonstrated superiority of the HM3 for the primary end point (survival
free of a disabling stroke or reoperation to replace or remove a
malfunctioning pump). This analysis evaluates health resource use and cost
implications of the observed differences between the 2 devices while
patients were enrolled in the trial.
METHODS: We analyzed all hospitalizations and their associated costs
occurring after discharge from the implant hospitalization until censoring
(study withdrawal, heart transplantation, and pump exchange with a
nonstudy device or death). Each adjudicated episode of hospital-based care
was used to calculate costs (device-attributable and
non-device-attributable event costs), estimated by using trial data and
payer administrative claims databases. Cost savings stratified by
subgroups (study outcome [transplant, death, or ongoing on device],
intended goal of therapy, type of insurance, or sex) were also assessed.
RESULTS: In 366 randomly assigned patients, 361 comprised the as-treated
group (189 in the HM3 group and 172 in the HMII group), of whom 337 (177
in the HM3 group and 160 in the HMII group) were successfully discharged
following implantation. The HM3 arm experienced fewer total
hospitalizations per patient-year (HM3: 2.1+/-0.2 versus HMII: 2.7+/-0.2;
P=0.015) and 8.3 fewer hospital days per patient-year on average (HM3:
17.1 days versus HMII: 25.5 days; P=0.003). These differences were driven
by patients hospitalized for suspected pump thrombosis (HM3: 0.6% versus
HMII: 12.5%; P<0.001) and stroke (HM3: 2.8% versus HMII: 11.3%; P=0.002).
Controlled for time spent in the study (average cumulative cost per
patient-year), postdischarge HM3 arm costs were 51% lower than with the
HMII (HM3: $37685+/-4251 versus HMII: $76599+/-11889, P<0.001) and similar
in either bridge to transplant or destination therapy intent.
CONCLUSIONS: In this 2-year outcome economic analysis of the MOMENTUM 3
trial, the HM3 demonstrated a reduction in rehospitalizations, hospital
days spent during rehospitalizations, and a significant cost savings
following discharge in comparison with the HMII left ventricular assist
system, irrespective of the intended goal of therapy.
CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique
identifier: NCT02224755.

<82>
Accession Number
624669161
Title
Oral anticoagulants and atrial fibrillation: A South African perspective.
Source
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.
108 (8) (pp 640-646), 2018. Date of Publication: 25 Jul 2018.
Author
Laas D.J.; Naidoo M.
Institution
(Laas) Discipline of Family Medicine, School of Nursing and Public Health,
College of Health Sciences, University of KwaZulu-Natal, Durban, South
Africa
Publisher
NLM (Medline)
Abstract
This review evaluates the current literature on available oral
anticoagulants and atrial fibrillation with specific relevance to the
South African (SA) public healthcare sector, focusing on the pharmacology
and monitoring of anticoagulants, current guidelines, initiation of
treatment and risk stratification, effectiveness of treatment,
cost-effectiveness and specific costing implications. The direct-acting
oral anticoagulants (DOACs) are superior to warfarin, with dabigatran
being the preferred treatment option in patients with non-valvular atrial
fibrillation (NVAF). Warfarin is still the preferred anticoagulant in
patients with renal failure and prosthetic heart valves and is still the
most cost-effective anticoagulant in the SA public sector setting. There
is a growing body of evidence that demonstrates the advantages of DOACs
over warfarin in NVAF. Warfarin will remain the anticoagulant of choice
until cheaper generic DOACs become available.

<83>
Accession Number
624670341
Title
Topical vancomycin to reduce surgical-site infections in neurosurgery:
Study protocol for a multi-center, randomized controlled trial.
Source
Contemporary clinical trials. 64 (pp 195-200), 2018. Date of Publication:
01 Jan 2018.
Author
Jonokuchi A.J.; Knopman J.; Radwanski R.E.; Martinez M.A.; Taylor B.E.S.;
Rothbaum M.; Sullivan S.; Robison T.R.; Lo E.; Christophe B.R.; Bruce
E.M.; Khan S.; Kellner C.P.; Sigounas D.; Youngerman B.; Bagiella E.;
Angevine P.D.; Lowy F.D.; Sander Connolly E.
Institution
(Jonokuchi, Taylor, Bruce, Kellner, Sander Connolly) Department of
Neurological Surgery, Columbia University College of Physicians and
Surgeons, 710 W 168th Street, New York, NY 10032, United States
(Knopman) Department of Neurological Surgery, Weill Cornell Medical
Center, 525 East 68th Street, Box 99, New York, NY 10065, United States.
Electronic address: jak9030@med.cornell.edu
(Radwanski) Department of Neurological Surgery, Columbia University
College of Physicians and Surgeons, 710 W 168th Street, New York, NY
10032, United States. Electronic address: rer246@cornell.edu
(Martinez) Department of Neurological Surgery, Columbia University College
of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United
States. Electronic address: mm4512@cumc.columbia.edu
(Rothbaum) Department of Neurological Surgery, Weill Cornell Medical
Center, 525 East 68th Street, Box 99, New York, NY 10065, United States.
Electronic address: mir2033@med.cornell.edu
(Sullivan) Department of Pathology and Cell Biology, Columbia University
College of Physicians and Surgeons, 630 W 168th Street, New York, NY
10032, United States. Electronic address: ss4009@cumc.columbia.edu
(Robison) Department of Neurological Surgery, Columbia University College
of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United
States. Electronic address: trr2116@cumc.columbia.edu
(Lo) Department of Neurological Surgery, Columbia University College of
Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United
States. Electronic address: yl3294@cumc.columbia.edu
(Christophe) Department of Neurological Surgery, Columbia University
College of Physicians and Surgeons, 710 W 168th Street, New York, NY
10032, United States. Electronic address: brc2119@cumc.columbia.edu
(Khan) Department of Pathology and Cell Biology, Columbia University
College of Physicians and Surgeons, 630 W 168th Street, New York, NY
10032, United States. Electronic address: sk3782@cumc.columbia.edu
(Sigounas) Department of Neurological Surgery, Weill Cornell Medical
Center, 525 East 68th Street, Box 99, New York, NY 10065, United States
(Youngerman) Department of Neurological Surgery, Columbia University
College of Physicians and Surgeons, 710 W 168th Street, New York, NY
10032, United States. Electronic address: bey2103@cumc.columbia.edu
(Bagiella) Center for Biostatistics, Department of Population Health
Science & Policy, Mount Sinai School of Medicine, 1 Gustave L. Levy Place,
New York, NY 10029, United States
(Angevine) Department of Neurological Surgery, Columbia University College
of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United
States. Electronic address: pda9@cumc.columbia.edu
(Lowy) Department of Pathology and Cell Biology, Columbia University
College of Physicians and Surgeons, 630 W 168th Street, New York, NY
10032, United States. Electronic address: fdl189@cumc.columbia.edu
Publisher
NLM (Medline)
Abstract
Surgical-site infections (SSIs) account for 20% of all
healthcare-associated infections, are the most common nosocomial infection
among surgical patients, and are a focus of quality improvement
initiatives. Despite implementation of many quality care measures (e.g.
prophylactic antibiotics), SSIs remain a significant cause of morbidity,
mortality, and economic burden, particularly in the field of neurosurgery.
Topical vancomycin is increasingly utilized in instrumented spinal and
cardiothoracic procedures, where it has been shown to reduce the risk of
SSIs. However, a randomized controlled trial assessing its efficacy in the
general neurosurgical population has yet to be done. The principle aim of
"Topical Vancomycin for Neurosurgery Wound Prophylaxis" (NCT02284126) is
to determine whether prophylactic, topical vancomycin reduces the risk of
SSIs in the adult neurosurgical population. This prospective, multicenter,
patient-blinded, randomized controlled trial will enroll patients to
receive the standard of care plus topical vancomycin, or the standard of
care alone. The primary endpoint of this study is a SSI by postoperative
day (POD) 30. Patients must be over 18years of age. Patients are excluded
for renal insufficiency, vancomycin allergy, and some ineligible
procedures. Univariate analysis and logistic regression will determine the
effect of topical vancomycin on SSIs at 30days. A randomized controlled
trial is needed to determine the efficacy of this treatment. Results of
this trial are expected to directly influence the standard of care and
prevention of SSIs in neurosurgical patients.<br/>Copyright &#xa9; 2017
Elsevier Inc. All rights reserved.

<84>
[Use Link to view the full text]
Accession Number
624695431
Title
Peri-operative oral caffeine does not prevent postoperative atrial
fibrillation after heart valve surgery with cardiopulmonary bypass: A
randomised controlled clinical trial.
Source
European journal of anaesthesiology. 35 (12) (pp 911-918), 2018. Date of
Publication: 01 Dec 2018.
Author
Lagier D.; Nee L.; Guieu R.; Kerbaul F.; Fenouillet E.; Roux N.; Giorgi
R.; Theron A.; Grisoli D.; Gariboldi V.; Collart F.; Bruder N.; Velly L.;
Guidon C.
Institution
(Lagier) From the Department of Anaesthesia and Intensive Care Medicine
(DL, LN, LV, Department of Biochemistry (RG, Department of Biostatistics
(NR, Department of Cardiac Surgery (AT, La Timone University Hospital,
Aix-Marseille University, Marseille, NB, France
Publisher
NLM (Medline)
Abstract
BACKGROUND: Raised plasma levels of endogenous adenosine after cardiac
surgery using cardiopulmonary bypass (CPB) have been related to the
incidence of postoperative atrial fibrillation (POAF).
OBJECTIVE: We wished to assess if caffeine, an adenosine receptor
antagonist could have a beneficial effect on the incidence of POAF.
DESIGN: A randomised controlled study.
SETTING: Single University Hospital.
PATIENTS: One hundred and ten patients scheduled for heart valve surgery
with CPB.
INTERVENTIONS: We randomly assigned patients to receive peri-operative
oral caffeine (400 mg every 8 h for 2 days) or placebo. Adenosine plasma
concentrations and caffeine pharmacokinetic profile were evaluated in a
subgroup of 50 patients.
MAIN OUTCOME MEASURES: The primary endpoint was the rate of atrial
fibrillation during postoperative hospital stay.
RESULTS: The current study was stopped for futility by the data monitoring
board after an interim analysis. The incidence of atrial fibrillation was
similar in the caffeine and in the placebo group during hospital stay (33
vs. 29%, P = 0.67) and the first 3 postoperative days (18 vs. 15%; P =
0.60). Basal and postoperative adenosine plasma levels were significantly
associated with the primary outcome. Adenosine plasma levels were similar
in the two treatment groups. Caffeine administration was associated with a
higher incidence of postoperative nausea and vomiting (27 vs. 7%, P =
0.005).
CONCLUSION: Oral caffeine does not prevent POAF after heart valve surgery
with CPB but increased the incidence of postoperative nausea and vomiting.
CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, no.: NCT01999829.

<85>
Accession Number
624681940
Title
Levosimendan versus placebo in cardiac surgery: a systematic review and
meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. 27 (5) (pp 677-685),
2018. Date of Publication: 01 Nov 2018.
Author
Tena M.A.; Urso S.; Gonzalez J.M.; Santana L.; Sadaba R.; Juarez P.;
Gonzalez L.; Portela F.
Institution
(Tena, Urso, Portela) Department of Cardiac Surgery, Hospital
Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain
(Gonzalez) Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de
Gran Canaria, Spain
(Santana) Department of Anesthesiology, Hospital Universitario Dr. Negrin,
Las Palmas de Gran Canaria, Spain
(Sadaba) Department of Cardiac Surgery, Complejo Hospitalario de Navarra,
Pamplona, Spain
(Juarez, Gonzalez) Intensive Care Unit, Hospital Universitario Dr. Negrin,
Las Palmas de Gran Canaria, Spain
Publisher
NLM (Medline)
Abstract
The aim of this meta-analysis was to review all published randomized
clinical trials comparing levosimendan versus placebo in patients
undergoing cardiac surgery. PubMed, EMBASE and the Cochrane library
database of clinical trials were searched for prospective randomized
clinical trials investigating the perioperative use of levosimendan versus
placebo in patients undergoing adult cardiac surgery from 1 May 2000 to 10
April 2017. Binary outcomes from individual studies were analysed to
compute individual and pooled risk ratios (RRs) with pertinent 95%
confidence intervals (CIs). Fourteen randomized clinical trials with a
total of 2243 patients were included in this review. Overall meta-analysis
results demonstrated that levosimendan was associated with a significant
reduction in 30-day mortality (RR=0.71, 95% CI=0.53-0.95; P=0.023).
Subgroup analysis showed that this benefit was confined to the moderate
and low ejection fraction studies (RR=0.44, 95% CI=0.27-0.70; P<0.001),
whereas no benefit was observed in the preserved ejection fraction studies
(RR=1.06, 95% CI=0.72-1.56; P=0.78). Levosimendan also reduced the risk of
renal replacement therapy (RR=0.66, 95% CI=0.47-0.92; P=0.015) and low
cardiac output (RR=0.40, 95% CI=0.22-0.73; P=0.003). No significant
differences were detected, between the levosimendan group and the placebo
group, in terms of risk of myocardial injury (RR=0.90, 95% CI=0.69-1.17;
P=0.44), intensive care unit stay (weighted mean differences=-0.57, 95%
CI=-1.15 to 0.01; P=0.055) and the use of ventricular assist device
(RR=0.42, 95% CI=0.07-2.63; P=0.35). In conclusion, levosimendan was
associated with a reduced risk of mortality, renal replacement therapy and
low cardiac output syndrome in patients undergoing cardiac surgery.

<86>
Accession Number
624690402
Title
Acute Effects of Low-Level Laser Therapy on Patients' Functional Capacity
in the Postoperative Period of Coronary Artery Bypass Graft Surgery: A
Randomized, Crossover, Placebo-Controlled Trial.
Source
Photomedicine and laser surgery. 36 (3) (pp 122-129), 2018. Date of
Publication: 01 Mar 2018.
Author
Stein C.; Fernandes R.O.; Miozzo A.P.; Coronel C.C.; Baroni B.M.;
Bello-Klein A.; Plentz R.D.M.
Institution
(Stein, Miozzo, Coronel, Baroni, Plentz) Physical Therapy Department,
Universidade Federal de Ciencias da Saude de Porto Alegre (UFCSPA), Porto
Alegre, RS, Brazil
(Stein, Miozzo, Coronel) Fundacao Universidade de Cardiologia (FUC), 2
Instituto de Cardiologia do Rio Grande do Sul (IC), Porto Alegre, RS,
Brazil
(Fernandes, Bello-Klein) Laboratory of Cardiovascular Physiology,
Institute of Basic Sciences of Health (ICBS), Universidade Federal do Rio
Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
Abstract
METHODS: Fifteen male patients (60+/-9 years) were crossed over during the
experiment, to compare the outcomes after active LLLT and placebo LLLT
treatments. LLLT (850nm, 200mW, 30J to each point, resulting in a total of
240J per quadriceps muscle), using a multidiode cluster (five spots;
6J/spot) in eight points per leg was performed 3min before the ISWT. We
analyzed distance walked, Borg scale of perceived exertion, heart rate,
and brachial arterial blood pressure. Markers of tissue damage [lactate
dehydrogenase (LDH)] and oxidative stress [lipid peroxidation, total thiol
levels, and antioxidant enzyme activity of superoxide dismutase (SOD) and
catalase (CAT)] were also measured in peripheral blood.
RESULTS: Comparison of the distances walked revealed no significant
differences between the LLLT and placebo LLLT groups (p=0.779). Regarding
the Borg scale (p=0.567), heart rate (p=0.506) as well as systolic and
diastolic blood pressure (p=0.164 and p=0.140, respectively), no
differences were observed between LLLT and placebo LLLT groups.
Application of LLLT was not able to change levels of LDH (p=0.214),
oxidative lipid damage (p=0.733), total thiol levels (p=0.925), SOD
(p=0.202), and CAT (p=0.825) enzyme activities.
CONCLUSIONS: Acute LLLT improved neither functional capacity to exercise
nor the markers of oxidation after CABG.
TRIAL REGISTRATION: Registered as a clinical trial (NCT02688426).
OBJECTIVE: The aim of this study was to evaluate the acute effects of
low-level laser therapy (LLLT) on the functional capacity to exercise
tested by incremental shuttle walking test (ISWT) after coronary artery
bypass graft (CABG) surgery.

<87>
Accession Number
624668670
Title
Off- Versus On-Pump Coronary Surgery and the Effect of Follow-Up Length
and Surgeons' Experience: A Meta-Analysis.
Source
Journal of the American Heart Association. 7 (21) (pp e010034), 2018. Date
of Publication: 06 Nov 2018.
Author
Gaudino M.; Benedetto U.; Bakaeen F.; Rahouma M.; Tam D.Y.; Abouarab A.;
Di Franco A.; Leonard J.; Elmously A.; Puskas J.D.; Angelini G.D.; Girardi
L.N.; Fremes S.E.; Taggart D.P.
Institution
(Gaudino, Rahouma, Abouarab, Di Franco, Leonard, Elmously, Girardi)
Department of Cardio-Thoracic Surgery Weill Cornell Medicine New York City
NY
(Benedetto, Angelini) Bristol Heart Institute School of Clinical Sciences
University of Bristol United Kingdom
(Bakaeen) Department of Thoracic and Cardiovascular Surgery Cleveland
Clinic Cleveland OH
(Tam, Fremes) Schulich Heart Centre Sunnybrook Health Science University
of Toronto Canada
(Puskas) Department of Cardiovascular Surgery Icahn School of Medicine at
Mount Sinai New York City NY
(Taggart) Nuffield Department of Surgical Sciences University of Oxford
United Kingdom
Publisher
NLM (Medline)
Abstract
Background The debate on the relative benefits of off-pump and on-pump
coronary artery bypass surgery ( OPCABG and ONCABG ) is still open. We
aimed to provide an updated and complete summary of the evidence on the
differences between OPCABG and ONCABG and to explore whether the length of
the follow-up and the surgeons' experience in OPCABG modify the
comparative results. Methods and Results All randomized clinical trials
comparing OPCABG and ONCABG were included. Primary outcome was follow-up
mortality. Secondary outcomes were operative mortality, perioperative
stroke, perioperative myocardial infarction, and late repeated
revascularization. Subgroup analyses were performed based on the length of
the follow-up and the percentage of crossover from the OPCABG group (used
as a surrogate of surgeon experience with OPCABG ). One hundred four
trials were included (20 627 patients, OPCABG : 10 288; ONCABG : 10 339).
Weighted mean follow-up time was 3.7 years (range 1-7.5 years). OPCABG was
associated with a higher risk of follow-up mortality (incidence rate ratio
1.11, 95% confidence interval 1.00-1.23, P=0.05). The difference was
significant only for trials with mean follow-up of >=3 years and for
studies with a crossover rate of >=10%. There was a trend toward lower
risk of perioperative stroke and higher need for late repeated
revascularization in the OPCABG arm. Conclusions OPCABG is associated with
a higher incidence of incomplete revascularization, an increased need for
repeated revascularization, and decreased midterm survival compared with
ONCABG . Surgeon inexperience in OPCABG is associated with late mortality.

<88>
Accession Number
624668612
Title
Syphilitisches Aortenaneurysma, Syphilitic aortic aneurysm.
Source
Zeitschrift fur Rheumatologie. 77 (8) (pp 741-748), 2018. Date of
Publication: 01 Oct 2018.
Author
Yuan S.-M.
Institution
(Yuan) Department of Cardiothoracic Surgery, First Hospital of Putian,
Teaching Hospital, Fujian Medical University, 389 Longdejing Street,
Putian, Fujian Province 351100, China
Publisher
NLM (Medline)

<89>
Accession Number
624667715
Title
Emergency coronary bypass surgery in patients under the influence of
dualantiplatelet therapy: effects of tranexamic acid and desmopressin
acetate.
Source
Turkish journal of medical sciences. 47 (6) (no pagination), 2017. Date of
Publication: 19 Dec 2017.
Author
Altun G.; Hemsinli D.; Pulathan Z.; Civelek A.
Publisher
NLM (Medline)
Abstract
Background/aim: Bleeding in patients undergoing coronary artery bypass
grafting (CABG) while using dual antiplatelet therapy (DAPT) is a cause of
significant morbidity and mortality. The aim of this study is to examine
the perioperative hemostatic effects of tranexamic acid (TnX-A) and
desmopressin acetate (Des) in these patients. Materials and methods: This
clinical study was planned in a prospective and randomized manner.
Fifty-four patients were enrolled and classified into 4 different groups.
They were compared in terms of various bleeding and transfusion
parameters.Results: No significant differences were observed between the
groups in pre/intraoperative data apart from closure times.
Plasmin/alpha-2 antiplasmin complex values in the TnX-A and control groups
were significantly higher than those in the Des and TnX-A+Des groups at
the end of postoperative drug infusion. Mean duration of closure times,
first 3-h and total postoperative amounts of drainage, administered
volumes of erythrocyte suspension/fresh frozen plasma, cost of blood
products, length of intubation, length of stay in the intensive care unit,
and time to discharge were also significantly higher in the Des and
control groups.Conclusion: Des had no significant effect on bleeding
control and even delayed the hemostatic efficacy of TnX-A. Use of TnX-A
infusion alone in these patient groups had a positive effect on
hemostasis-related data.

<90>
Accession Number
624670599
Title
Do preoperative oral carbohydrates improve postoperative outcomesin
patients undergoing coronary artery bypass grafts?.
Source
Turkish journal of medical sciences. 47 (6) (pp 1681-1686), 2017. Date of
Publication: 19 Dec 2017.
Author
Savluk OF.; Kuscu M.A.; Guzelmeric F.; Gurcu M.E.; Erkilinc A.; Cevirme
D.; Ogus H.; Kocak T.
Publisher
NLM (Medline)
Abstract
Background/aim: The aim of this prospective study was to determine whether
the preoperative oral intake of carbohydrate-rich drinks by patients
undergoing a coronary artery bypass graft attenuates postoperative insulin
requirements, improves postoperative patient discomfort, provides
inotropic support, shortens the length of the ICU stay, and shortens the
duration of postoperative mechanical ventilation. Materials and methods:
This randomized prospective clinical study included 152 patients with
coronary artery disease who were divided into 4 groups. Carbohydrates were
administered to 3 groups at different hours and doses before operation.
The fourth group had an 8-h preoperative fasting period. The inotropic and
vasopressor requirements, ventilation time, and ICU stay time were
recorded for all of the groups. Patient wellbeing, mouth dryness, hunger,
anxiety, and nausea were assessed using VAS scores of 1-10. Results: Mouth
dryness and hunger were significantly higher in the control group (P =
0.03, P = 0.02). The increase in blood glucose level was significantly
higher in the control group (P = 0.04). The exogenous insulin requirement
was significantly higher in the control group than in the other groups (P
= 0.04). Conclusion: The administration of carbohydrates before elective
cardiac surgery reduced insulin resistance. Based on the VAS scores, the
intake of carbohydrates reduced mouth dryness and hunger. Overall,
preoperative oral carbohydrate treatments can improve the postoperative
outcomes of coronary artery bypass graft surgeries.

<91>
Accession Number
624690536
Title
A Role for Photobiomodulation in the Prevention of Myocardial Ischemic
Reperfusion Injury: A Systematic Review and Potential Molecular
Mechanisms.
Source
Scientific reports. 7 (pp 42386), 2017. Date of Publication: 09 Feb 2017.
Author
Liebert A.; Krause A.; Goonetilleke N.; Bicknell B.; Kiat H.
Institution
(Liebert, Bicknell) Australasian Research Institute, Wahroonga, Australia
(Liebert, Goonetilleke) Sydney University, Sydney, Australia
(Krause) Maitland Hospital, Maitland, Australia
(Goonetilleke) Blacktown Hospital, Sydney, Australia
(Bicknell) Australian Catholic University, North Sydney, Australia
(Kiat) University of New South Wales, Kensington, Australia
(Kiat) Macquarie University, Marsfield, Australia
Abstract
Myocardial ischemia reperfusion injury is a negative pathophysiological
event that may result in cardiac cell apoptosis and is a result of
coronary revascularization and cardiac intervention procedures. The
resulting loss of cardiomyocyte cells and the formation of scar tissue,
leads to impaired heart function, a major prognostic determinant of
long-term cardiac outcomes. Photobiomodulation is a novel cardiac
intervention that has displayed therapeutic effects in reducing myocardial
ischemia reperfusion related myocardial injury in animal models. A growing
body of evidence supporting the use of photobiomodulation in myocardial
infarct models has implicated multiple molecular interactions. A
systematic review was conducted to identify the strength of the evidence
for the therapeutic effect of photobiomodulation and to summarise the
current evidence as to its mechanisms. Photobiomodulation in animal models
showed consistently positive effects over a range of wavelengths and
application parameters, with reductions in total infarct size (up to 76%),
decreases in inflammation and scarring, and increases in tissue repair.
Multiple molecular pathways were identified, including modulation of
inflammatory cytokines, signalling molecules, transcription factors,
enzymes and antioxidants. Current evidence regarding the use of
photobiomodulation in acute and planned cardiac intervention is at an
early stage but is sufficient to inform on clinical trials.

<92>
Accession Number
624513621
Title
Diabetes mellitus is an independent prognostic factor for mid-term and
long-term survival following transcatheter aortic valve implantation: A
systematic review and meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (2) (pp 159-168),
2018. Date of Publication: August 2018.
Author
Lv W.; Li S.; Zhao Z.; Liao Y.; Li Y.; Chen M.; Feng Y.
Institution
(Li) Department of Thoracic Surgery, West China Hospital, Sichuan
University, Chengdu, China
(Lv, Zhao, Liao, Li, Chen, Feng) Department of Cardiology, West China
Hospital, Sichuan University, Guoxue Alley No. 37, Chengdu, China
Publisher
Oxford University Press
Abstract
Prior studies have proposed the unfavourable roles of diabetes mellitus
(DM) in surgical populations. For patients who underwent transcatheter
aortic valve implantation, the prognostic value of DM remains
controversial. This review summarizes the effects of DM on short-term,
mid-term and long-term prognosis in patients who undergo transcatheter
aortic valve implantation. We searched the PubMed database to identify
eligible articles. The odds ratio and hazard ratio with the corresponding
95% confidence interval were adopted for synthesizing short-term and
medium- to long-term survival outcomes, respectively. The heterogeneity
level and publication bias between studies were also estimated. Finally,
20 observational studies enrolling 19 260 patients met the eligibility
criteria and, thus, were included in this review. An overall analysis
identified that DM was significantly associated with the poor medium- to
long-term overall survival (hazard ratio 1.21, 95% confidence interval
1.03-1.41; P = 0.019). However, no significant impact of DM on 30-day
mortality was observed (odds ratio 1.10, 95% confidence interval
0.86-1.41; P = 0.46) in patients undergoing transcatheter aortic valve
implantation. Further subgroup analyses indicated that the prognostic
value of DM for medium- to long-term overall survival Remained significant
in the subgroups of multivariable origins of incorporated data, duration
of follow-ups (1-year/<_2-year follow-up), Western populations and
insulin-dependent diabetes mellitus. This meta-analysis demonstrates that
DM is a strongly independent predictor for poor medium- to long-term
overall survival but shows no significant effect of DM on 30-day
mortality. Our findings need to be further verified and modified by more
worldwide studies.<br/>Copyright &#xa9; The Author(s) 2018.

<93>
Accession Number
624440887
Title
Incremental value of right heart metrics and exercise performance to
well-validated risk scores in dilated cardiomyopathy.
Source
European Heart Journal Cardiovascular Imaging. 19 (8) (pp 916-925), 2018.
Date of Publication: 2018.
Author
Moneghetti K.J.; Giraldeau G.; Wheeler M.T.; Kobayashi Y.; Vrtovec B.;
Boulate D.; Kuznetsova T.; Schnittger I.; Wu J.C.; Myers J.; Ashley E.;
Haddad F.
Institution
(Moneghetti, Wheeler, Kobayashi, Vrtovec, Boulate, Kuznetsova, Wu, Haddad)
Stanford Cardiovascular Institute, Stanford, CA, United States
(Moneghetti, Giraldeau, Wheeler, Kobayashi, Schnittger, Wu, Myers, Ashley,
Haddad) Division of Cardiovascular Medicine, Stanford University, School
of Medicine, Stanford, CA, United States
(Wheeler, Ashley) Center for Inherited Cardiovascular Diseases, Stanford
Hospital and Clinics, Stanford, CA, United States
(Myers) Division of Cardiology, Veterans Affairs Palo, Alto Healthcare
System, Palo Alto, CA, United States
Publisher
Oxford University Press
Abstract
Aims Risk stratification in heart failure (HF) relies on several
established clinical risk scores, however, myocardial deformation, right
heart metrics, and exercise performance have not usually been considered.
This study sought to assess the incremental value of advanced
echocardiographic and cardiopulmonary exercise testing (CPX) parameters to
validated risk scores in HF Methods The Meta-Analysis Global Group in
Chronic Heart Failure (MAGGIC) and Metabolic Exercise Test Data and
results Combined with Cardiac and Kidney Indexes (MECKI) scores were
applied to 208 ambulatory patients with dilated cardiomyopathy (DCM) who
completed echocardiography in conjunction with CPX as part of the Stanford
Exercise Testing registry. Patients were followed for the composite end
point of death, heart transplant, left ventricular device implantation,
and hospitalization for acute HF. Mean age, left ventricular ejection
fraction (LVEF), and left ventricular global longitudinal strain (LVGLS)
were 47 +/- 13 years, 33 +/- 13%, and -10.6 +/- 4.4%, respectively, while
right ventricular free-wall longitudinal strain was -18.8 +/- 5.5%.
Partial correlation mapping identified strong correlations between LVEF,
LVGLS, and LV systolic strain rate, with a moderate correlation between
these metrics and peak VO<inf>2</inf>. Over a median follow up of 5.3
years, the composite end point occurred in 60 patients. Cox proportional
hazards identified MAGGIC score [hazard ratio (HR) (2.04 [1.39-3.01], P <
0.01], peak VO<inf>2</inf> HR (0.52 [0.28-0.97], P = 0.04), and right
atrial volume indexed (RAVI) HR (1.31 [1.07-1.61], P < 0.01) as
independent correlates of outcome. RAVI remained an independent correlate
when combined with the MECKI score (2.21 [1.59-3.07]), P < 0.01, RAVI,
1.33 [1.06-1.67], P = 0.01) Conclusion Our study demonstrates that RAVI is
complementary to well-validated HF risk scores and highlights the
importance of exercise performance in DCM.<br/>Copyright Published on
behalf of the European Society of Cardiology. All rights reserved. VC The
Author 2017

<94>
Accession Number
2001229957
Title
High-Versus Low-Dose Warfarin-Related Teratogenicity: A Case Report and
Systematic Review.
Source
Journal of Obstetrics and Gynaecology Canada. 40 (10) (pp 1348-1357),
2018. Date of Publication: October 2018.
Author
Dhillon S.K.; Edwards J.; Wilkie J.; Bungard T.J.
Institution
(Dhillon, Edwards, Wilkie) Alberta Health Services, Edmonton, AB, Canada
(Bungard) Division of Cardiology, Department of Medicine, University of
Alberta, Edmonton, AB, Canada
Publisher
Elsevier Inc
Abstract
Objective: The optimal anticoagulant therapy during pregnancy in women
with mechanical heart valves remains controversial. This study highlights
a case of high-dose warfarin ingestion throughout pregnancy and performed
a systematic review to assess rates of teratogenicity with high versus low
warfarin dosing (<=5 mg daily). Methods: A literature search for all case
reports and available literature was conducted in PubMed, Medline, and
EMBASE up to December 2016 using medical subject heading terms "mechanical
prosthetic valves," "pregnancy," "oral anticoagulants," "warfarin,"
"coumarins," "heparin, low-molecular-weight," and "thromboembolism." To be
included, warfarin had to be administered anytime between 6 and 12 weeks
of gestation with the dose being specified. The Newcastle-Ottawa Scale was
used to assess quality of the cohort data. Results: The woman in the
studied case received the highest reported warfarin doses throughout
pregnancy (14.5-16.5 mg daily) and delivered a baby with no evidence of
teratogenicity to the current age of 5 years. The study identified 23 case
reports, with all demonstrating warfarin teratogenicity regardless of
high-dose (n = 12) or low-dose (n = 11) warfarin. Twelve cohort studies
identified a warfarin teratogenicity rate of 5.0%, with rates of 2.4% and
10.5% with low- and high-dose warfarin, respectively. Risk of bias was
moderate (median Newcastle-Ottawa Scale score of 6) for all of the cohort
studies. Conclusion: Although a lower prevalence of warfarin-induced
teratogenicity is reported with low-dose warfarin, a safe "cut-off" dose
is misleading. Teratogenic risk with warfarin is unpredictable, mandating
individual decisions regardless of the dose.<br/>Copyright &#xa9; 2018
Society of Obstetricians and Gynaecologists of Canada

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

<96>
Accession Number
620572435
Title
Evaluation of aortic regurgitation with cardiac magnetic resonance
imaging: A systematic review.
Source
Heart. 104 (2) (pp 103-110), 2018. Date of Publication: January 2018.
Author
Lee J.C.; Branch K.R.; Hamilton-Craig C.; Krieger E.V.
Institution
(Lee, Branch, Hamilton-Craig, Krieger) Division of Cardiology, Department
of Medicine, University of Washington, Seattle, WA, United States
(Hamilton-Craig) Centre for Advanced Imaging, University of Queensland,
Brisbane, QLD, Australia
(Hamilton-Craig) Department of Cardiology, Heart and Lung Institute,
Prince Charles Hospital, Brisbane, QLD, Australia
(Krieger) Seattle Adult Congenital Heart Service, University of
Washington, School of Medicine, Seattle, WA 98195, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
This review summaries the utility, application and data supporting use of
cardiac magnetic resonance imaging (CMR) to evaluate and quantitate aortic
regurgitation. We systematically searched Medline and PubMed for original
research articles published since 2000 that provided data on the
quantitation of aortic regurgitation by CMR and identified 11 articles for
review. Direct aortic measurements using phase contrast allow quantitation
of volumetric flow across the aortic valve and are highly reproducible and
accurate compared with echocardiography. However, this technique requires
diligence in prescribing the correct imaging planes in the aorta.
Volumetric analytic techniques using differences in ventricular volumes
are also highly accurate but less than phase contrast techniques and only
accurate when concomitant valvular disease is absent. Comparison of both
aortic and ventricular data for internal data verification ensures
fidelity of aortic regurgitant data. CMR data can be applied to many types
of aortic valve regurgitation including combined aortic stenosis with
regurgitation, congenital valve diseases and post-transcatheter valve
placement. CMR also predicts those patients who progress to surgery with
high overall sensitivity and specificity. Future studies of CMR in
patients with aortic regurgitation to quantify the incremental benefit
over echocardiography as well as prediction of cardiovascular events are
warranted.<br/>Copyright &#xa9; Article author(s) (or their employer(s)
unless otherwise stated in the text of the article) 2018.

<97>
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

<98>
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.

<99>
Accession Number
623698432
Title
Syphilitic aortic aneurysm.
Source
Zeitschrift fur Rheumatologie. (no pagination), 2018. Date of Publication:
2018.
Author
Yuan S.-M.
Institution
(Yuan) Department of Cardiothoracic Surgery, The First Hospital of Putian,
Teaching Hospital, Fujian Medical University, 389 Longdejing Street,
Chengxiang District, Putian, Fujian Province 351100, China
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
The aim of this study was to outline the clinical features of syphilitic
aortic aneurysm. The study materials were based on a comprehensive
literature review of publications on syphilitic aortic aneurysm published
between 2000 and 2017. Syphilitic aortic aneurysm occurred most commonly
in the ascending aorta in either a saccular or a fusiform shape.
Syphilitic aortic aneurysm was often complicated by aortic valve
insufficiency (in almost half of the patients), and by a coronary
artery/ostium lesion in 16.5% of the patients. Aortic valve operation was
necessary in one fourth, and coronary artery surgery accounted for less
than one fifth of patients warranting a surgical treatment. Although there
was no difference in the survival rates between the surgically and
conservatively treated patients, an aggressive treatment should be
performed when diagnosis is made due to the potential risks of aneurysm
rupture and sudden death.<br/>Copyright &#xa9; 2018, Springer Medizin
Verlag GmbH, ein Teil von Springer Nature.

<100>
Accession Number
624640992
Title
The relationship between non-invasive endpoints and long-term outcomes in
pulmonary arterial hypertension: Six-minute walk, functional class, and
brain natriuretic peptide.
Source
Journal of Managed Care and Specialty Pharmacy. Conference: Academy of
Managed Care Pharmacy Nexus, AMCP 2018. United States. 24 (10 A) (pp S61),
2018. Date of Publication: October 2018.
Author
Kelley K.; Mordin M.; Wronski S.; Classi P.
Institution
(Kelley) Rx Trusted Advisors, 4502 E Onyx Ave, Phoenix, AZ 85028, United
States
(Mordin, Wronski) RTI-HS, United States
(Classi) United Therapeutics, United States
Publisher
Academy of Managed Care Pharmacy (AMCP)
Abstract
BACKGROUND: Historically, clinical trials in patients (pts) w/pulmonary
arterial hypertension (PAH) evaluate six-minute walk distance (6MWD) as
the primary endpoint to assess exercise capacity. Common secondary
endpoints include functional class (FC) and brain natriuretic peptide
(BNP) to assess PAH disease severity and right heart function,
respectively. Recent PAH studies have employed morbidity and mortality as
a primary endpoint, and while pertinent, require large and lengthy
clinical trials and often cannot be used in clinical practice to monitor
treatment response. OBJECTIVE: To examine the relationship between 3
established noninvasive endpoints and long-term health outcomes in PAH
clinical trials and registries. METHODS: A literature review was performed
using search terminology focused on PAH non-invasive endpoints and related
outcomes. PubMed, MEDLINE, Embase and Cochrane were searched from Jan
1997-Apr 2018. Conference abstracts (2016-2017) were searched from
American Thoracic Society, American College of Chest Physicians and
International Society for Pharmacoeconomics and Outcomes Research. Studies
were selected in accordance with predefined inclusion/ exclusion criteria
based on disease population, interventions, outcomes and study design. The
article selection process included two levels: (1) titles and abstracts
were identified and reviewed (2) full-texts of articles selected at level
1 were obtained and reviewed for relevance. RESULTS: A total of 771 unique
records were retrieved for review from the database search for level 1
screening. Among these, 60 studies and 9 reviews were selected for level 2
screening. Upon review of the fulltext articles, a total of 25 studies
were deemed eligible for inclusion in the report. Literature findings
strongly supported the importance of measuring PAH non-invasive endpoints
in both clinical trials and clinical practice. Baseline and change in 6MWD
was associated with event-free survival including death, heart/lung
transplantation, atrial septostomy, hospital admission due to PAH and
disease worsening. FC and BNP can help identify PAH patients at high risk
for multiple outcomes such as treatment modification, transplantation and
hospitalization. European PAH registry studies show that 6MWD, FC and BNP
are the strongest predictor of outcome and when used in combination can
better determine disease prognosis. CONCLUSIONS: Given their association
with long-term health outcomes and practicality for assessment, 6MWD, FC
and BNP should continue to be assessed in clinics and clinical research.

<101>
Accession Number
2001223921
Title
Changes In Cardiovascular Surgery From a Religious Concept.
Source
Global Heart. Conference: World Congress of Cardiology & Cardiovascular
Health 2018. United Arab Emirates. 13 (4) (pp 442), 2018. Date of
Publication: December 2018.
Author
Santos C.T.; Macedo T.L.D.S.; Anjos I.L.P.B.; Rebello D.M.; Belo G.V.;
Pereira C.M.S.B.; Vilagra M.M.; Vilagra S.M.B.W.; Aragao I.P.B.
Institution
(Santos, Macedo, Anjos, Rebello, Belo, Pereira, Vilagra, Vilagra, Aragao)
Pro-rectory of health sciences, Severino Sombra University, Vassouras,
Brazil
Publisher
Elsevier B.V.
Abstract
Introduction: There are an estimated 8,220,105 Jehovah's Witnesses
worldwide, representing about 0.11% of the world's population. The refusal
of blood challenged a medicine with large studies of cardiovascular
surgery without blood transfusion, which is considered a determinant for a
development of techniques and tolerance towards ideologies. Objectives: To
demonstrate an influence of a religious conception in surgical practice,
as well as the opposite, and reaffirm the concept of patient autonomy
backed by the code of medical ethics. Methods: Systematic review (PUBMED,
EMBASE, SCIELO, LILACS) of the literature on an influence of a religious
conception on cardiovascular surgeries without blood transfusion,
minimally invasive and percutaneous interventions. Results: Open heart
surgery began in 1953 with the closure of interactive and evolutionary
communication to the present day, from transfusion to minimally invasive
methods and percutaneous interventions. A technique to cool the patient to
their oxygen needs during surgery - hypotensive anesthesia - as well as a
use of laser scalpel during the procedure. In 1977, a series of 202 serial
and consecutive experiences of 542 Jehovah's Witness patients ranging from
1 day to 89 years of age were reported. Mortality in 30 days was 9.4%, and
in 362 patients who temporarily required cardiopulmonary bypass, was
10.7%, and in the valve replacement (single or double), 13.5% among 126
patients. The incidence of haemorrhage in the perioperative period was not
higher, as complications were less common in comparison to those who
received. The literature demonstrates that cardiovascular surgeries
without blood transfusion are safe and that has favorably impacted both
religious conception and the general population by reducing surgical time,
decreasing a need for hemotherapy, hospitalization and cost. Conclusion:
The religious concept about the procedure influenced positively in the
perioperative process and vice versa. Cardiovascular surgery progressively
evolves to minimally invasive methods until the percutaneous procedures,
which provide a decrease in morbidity and mortality. Disclosure of
Interest: None declared<br/>Copyright &#xa9; 2018

<102>
Accession Number
2001223914
Title
The Inihibition of PCSK9 In the Decrease of Cardiovascular Events and
Control of Dyslipidemia.
Source
Global Heart. Conference: World Congress of Cardiology & Cardiovascular
Health 2018. United Arab Emirates. 13 (4) (pp 430-431), 2018. Date of
Publication: December 2018.
Author
Santos C.T.; Macedo T.L.S.; Rebello D.M.; Belo G.V.; Anjos I.L.P.B.;
Pereira C.M.S.B.; Fernandes P.C.; Souza B.M.; Aragao A.A.B.; Rocha M.A.;
Rabello E.; Vilagra S.M.B.W.; Vilagra M.M.; Aragao I.P.B.
Institution
(Santos, Macedo, Rebello, Belo, Anjos, Pereira, Fernandes, Souza, Aragao,
Rocha, Rabello, Vilagra, Vilagra, Aragao) Pro-rectory of health sciences,
Severino Sombra University, Vassouras, Brazil
Publisher
Elsevier B.V.
Abstract
Introduction: Dyslipidemia is a cardiovascular (CV) risk factor of high
relevance and its monitoring impacts in the reduction of events. The
proprotein convertase subtilisin/kexin type 9 (PCSK9) decomposes the LDL-c
receptor after internalization in the hepatocits increasing its
availability representing a new approach in conventional hypercholestomia
treatment. Objectives: Analyse the relevance of the inhibition and its
influence in the CV outcomes. Methods: A meta-analysis like sistematic
review was held based on 18 articles, varying from 2010 to 2017, in the
database available on Scielo, Lilacs and PubMed. Results: The SPIRE
randomized multicentric study, with Bococizumabe had 16817 patients on
SPIRE 1 (LDL between 70 and 100 mg/dL) and 10621 on SPIRE 2 (100MG/dL).
The fraction of primary outcome was significantly smaller in the
experimental group (HR 0,79; IC 95% 0,65-0,97; P=0,021). That difference
was not mantained at SPIRE 1 (HR 0,99; IC 95% 0,80-1,09; P=0,94). The
following of the study showed a decrease in the reduction of LDL in 10 to
15% of the patients, leading to the interruption of the trial. The ODYSSEY
study evaluated the use of Alirocumabe in 2341 patients with LDL 70mg/dL,
of which 788 were given placebos. After 24 weeks there was a 61,9%
reduction of the LDL-c levels, contrasting with an increase of 0,8% in the
placebo group and 81% met their their LDL-c reduction goal compared to 9%
(p 0,00001). The reaction in the administrated area led to the suspension
of the drug in 141 patients. On a post-hoc analysis are seen a smaller
rate of events than in the placebo (HR 0,46; IC 95% 0,26-0,82; P 0,01).
The FOURIER study reported the use of Evolucumabe, a totally humanized
monoclonal anti-body, in 27564 patients with stabilished CV disease
treated with statins. The initial basal concentration of LDL was reduced
in 59% (92 mg/dL vs. 30 mf/dL; p 0,00001). The use allowed the reduction
of 15% in the incidence of events (14,6% vs. 12,6%; HR 0,85; IC 95%
0,79-0,92: p 0,001). The rate of coronary revascularization was also
inferior in the group (9,2% vs. 7.0%: HR 0,78; IC 95% 0,71-0,86).
Conclusion: Inhibitors in patients with high CV risk has shown to be an
effective way to reduce new events, providing new perspective in the
conduct to patients who are not controlled with statins. Thus, the advance
of the use of the totally humanized anti-body is highlighted and the
impact of inferior levels of LDL-c is questioned. Disclosure of Interest:
None declared<br/>Copyright &#xa9; 2018

<103>
Accession Number
2001223767
Title
Omentum Transplantation In Lactents and Elders on the Treatment of Post
Operatory Mediastinitis Due to Sternotomy.
Source
Global Heart. Conference: World Congress of Cardiology & Cardiovascular
Health 2018. United Arab Emirates. 13 (4) (pp 502), 2018. Date of
Publication: December 2018.
Author
Santos C.T.; Macedo T.L.S.; Rebello D.M.; Belo G.V.; Anjos I.L.P.B.;
Pereira C.M.S.B.; Fernandes P.C.; Souza B.M.; Aragao A.A.B.; Rocha M.A.;
Vilagra S.M.B.W.; Aragao I.P.B.
Institution
(Santos, Macedo, Rebello, Belo, Anjos, Pereira, Fernandes, Souza, Aragao,
Rocha, Vilagra, Aragao) Pro-rectory of health sciences, Severino Sombra
University, Vassouras, Brazil
Publisher
Elsevier B.V.
Abstract
Introduction: The sternotomy surgery dates back from 1987 and consists of
the surgical opening of the sternum, being the most used way to acess the
heart and the great vasels. With the expansion of the miocardial
revascularization surgery, this procedure is widely used. After cardiac
surgery performed with transternal access, the prevailance of mediastinal
infections varies between 0,2% and 5,0%, and its treatment is often
postergated due to the expectation of its resolution with antibiotics.
Objectives: To evaluate the eficacy of the greater omentum transplant on
the treatment of post operatory mediastinitis due to sternotomy, based on
morbimortality and hospitalar permanency data. Methods: A sistematic
literature review with meta-analysis was held based on nine articles, from
2007 to 2016, based on Scielo, Lilacs and PubMed. Results: The use of the
omentum was applied by Kiricuta for the first time to reconstruct the
toracic wall, after damage caused by mamary neoplasia. Its use for the
treatment in question was first sugested by Lee et al, becoming a largely
used method, with high survival rates. Literature, however, is quite small
when it comes to the transplant in lactents and elders. Pereira NA et al.
described four cases of mediastinitis in lactents treated between july
2010 and august 2014. The transpositiom was done throught
transdiaphragmatic way and all patients received treatment with
antibiotics, being cleared from the ICU with no infection whatsoever. The
mean of post operatory permanency on the ICU was 28,75 days, the highest
being 44 days due to pleural empiema, with the necessity of exploratory
thoracotomy. Another description was made by Moreschi et al. with a total
of 2648 patients that underwent sternotomy, with 81 cases of
mediastinitis. 28 patients, with an average of 60,6 years old, underwent
transplant, fixated by the same way to fill in the dead space. The time of
hospitalar permanency was smaller in comparison to the traditional method,
with only 2 deaths, and also a smaller occurrence of complications in
these group. Conclusion: The benefit of the reported procedure in lactents
and elders is visible even with membranaceous aspect and little volume of
structure. The omentum transplant is effective in the attempt of dealing
with the case, reducing complications and expenses with treatment.
Disclosure of Interest: None declared<br/>Copyright &#xa9; 2018

<104>
Accession Number
2001223627
Title
Percutaneous Approach and Myocardial Revascularization Surgery to Left
Coronary Artery Tron Injury.
Source
Global Heart. Conference: World Congress of Cardiology & Cardiovascular
Health 2018. United Arab Emirates. 13 (4) (pp 416), 2018. Date of
Publication: December 2018.
Author
Santos C.T.; Macedo T.L.S.; Rebello D.M.; Belo G.V.; Anjos I.L.P.B.;
Pereira C.M.S.B.; Fernandes P.C.; Souza B.M.; Aragao A.A.B.; Rocha M.A.;
Vilagra S.M.B.W.; Vilagra M.M.; Aragao I.P.B.; Rabello E.
Institution
(Santos, Macedo, Rebello, Belo, Anjos, Pereira, Fernandes, Souza, Aragao,
Rocha, Vilagra, Vilagra, Aragao, Rabello) Pro-rectory of health sciences,
Severino Sombra University, Vassouras, Brazil
Publisher
Elsevier B.V.
Abstract
Introduction: Cardiovascular atherosclerotic disease is the major cause of
morbidity and mortality in the world with 36% of deaths in adults between
50 and 64 years old and 42% in people older than 65 years. Injuries of the
left coronary artery (ILCA) tend to myocardial revascularization surgery
(MRS) as the main therapeutic alternative. As percutaneous techniques
evolved, the frequency of this method has increased in medical practice,
being also adopted as an option for patients with prohibitive surgical
risk. Objectives: To analyse the singularities between the intervention of
ILCA by MRS and percutaneous intervention (PI). Methods: A sistematic
literature review with meta-analysis was held based on seven articles,
from 2007 to 2017, based on Scielo, Lilacs and PubMed. Results: The
PRECOMBAT study randomized 600 patients with injuries greater than 50% in
the area to receive the two interventions. It was observed that PI was not
inferior to MRS, presenting a composite rate of combined primary events of
8.7 and 6.7%, p = 0.001. The composite events at 24 months had values of
12.2 and 8.1%, p = 0.12 for the respective groups and after that period,
the occurrence of stroke, AMI and death, with rates of 4.4 and 4.7%, p =
0.83 indicating a small difference. The combined analysis with the SYNTAX
trial shows that the incidence of cerebrovascular and cardiac events at
the end of five years was 23% in MRS and 28.3% in PI. PI was associated
with a 67% reduction in cardiac mortality and 60% in all causes as opposed
to surgery. The LEMANS study with 52 patients with PI and 53 with MRS
indicates, at 10 years of follow-up, higher ejection fraction rates for PI
- 54.9 +/- 8.3% and 49.8 +/- 10.3%. Mortality is 21.6 and 30.2%. The
possibility of 14-year survival was similar in both groups, with 74.2% and
67.5%, p = 0.34 and the same was observed with event-free survival, with
34.7% vs. 22.1% p = 0.06. The frequency of heart attacks and strokes, as
well as the need for new revascularizations did not have significant
discrepancies, with values of 8.7% and 10.4%, p = 0.62; 4.3% and 6.3% p =
0.62 and 74.2% and 67.5%, p = 0.34. Conclusion: Although MRS is more
indicated for therapy, the mentioned studies demonstrate the similarity in
results with the percutaneous approach. Patients with ILCA may have
angioplasty as an effective and viable route compared to long-term
surgery, and therefore, it is valid in the group. Disclosure of Interest:
None declared<br/>Copyright &#xa9; 2018

<105>
Accession Number
2001223505
Title
Tools For Implementing Rheumatic Heart Disease Control Programmes 2nd
Edition Update.
Source
Global Heart. Conference: World Congress of Cardiology & Cardiovascular
Health 2018. United Arab Emirates. 13 (4) (pp 520), 2018. Date of
Publication: December 2018.
Author
Wyber R.; Johnson T.; Perkins S.; Watkins D.; La Vincente S.; Mwangi J.;
Carapetis J.; Zuhlke L.
Institution
(Wyber) Office of the Chief Scientist, The George Institute for Global
Health, Sydney, Brazil
(Wyber, Johnson, Carapetis) Telethon Kids Institute, University of Western
Australia, Perth, Australia
(Perkins) University of Cape Town, Cape Town, South Africa
(Watkins) Division of General Internal Medicine, University of Washington,
Seattle, United States
(La Vincente) Telethon Kids Institute, University of Western Australia,
Switzerland
(Mwangi) World Heart Federation, Switzerland
(Mwangi) RhEACH, Telethon Kids Institute, Geneva, Switzerland
(Carapetis) Princess Margaret Hospital for Children, Perth, Australia
(Zuhlke) Faculty of Health Sciences, University of Cape Town, Cape Town,
South Africa
Publisher
Elsevier B.V.
Abstract
Introduction: Tools for Implementing Rheumatic Heart Disease Control
Programmes (TIPs) was first published in 2014. TIPs provides practical
information about the evidence and experience of RHD control in
low-resource settings across 25 domains. TIPs has been widely used to
develop RHD programmes worldwide since the first edition was published.
This increase in RHD initiatives offers new information about how
programmes can be designed and delivered. Objectives: To collate new
evidence and experience relevant to RHD control programmes from 2014-2018.
Methods: References were identified through a systematic literature review
of EMBASE, BIOSIS and PubMed searches from 2014-2018. Additional content
integrates the RHD Action Needs Assessment Tool and the World Heart
Federation Roadmap on RHD. Results: Activities to reduce the burden of RHD
expanded in low and middle-income countries from 2014 onwards. The voice
of people living with RHD and frontline healthcare workers are newly
prominent in these efforts. There is growing emphasis on the need for
comprehensive approaches which address both primary and secondary
prevention. Government engagement and sustained funding remain critical
components of success. Local burden of disease data contributes to both of
these domains which continues to spur interest in echocardiography
screening projects. This has contributed to the rise of telehealth and
task-shifting as trends in RHD control. The role of echocardiography
screening to change clinical outcomes remains unclear. New register data
demonstrate that late presentation of advanced RHD in low-resource
settings is common and that outcomes are poor. Access to cardiac surgery
in these settings remains limited, though best-practice approaches and
models of care are emerging. Preoperative preparation, anticoagulation and
post-operative care continue to be global challenges. New market analysis
about access to benzathine penicillin G has potential to inform solutions.
Integration of RHD control is widely identified as a priority but tangible
examples are still needed. Conclusion: Comprehensive RHD control
programmes necessarily span a wide range of services and activities. They
must be sustained for many years to impact the burden of disease. A
collaborative approach to sharing experiences is needed to amplify
progress by identifying and disseminating best practice. The second
edition of TIPs provides a framework for this ongoing work. Disclosure of
Interest: R. Wyber Grant/ Research support from: This work was completed
while employed through a grant provided by Medtronic Foundation,T. Johnson
Grant/ Research support from: This work was completed while employed
through a grant provided by Medtronic Foundation,S. Perkins Grant/
Research support from: This work was completed while employed through a
grant provided by Medtronic Foundation,D. Watkins Grant/ Research support
from: This work was completed while employed through a grant provided by
Medtronic Foundation,S. La Vincente Grant/ Research support from: This
work was completed while employed through a grant provided by Medtronic
Foundation,J. Mwangi Grant/ Research support from: This work was completed
while employed through a grant provided by Medtronic Foundation,J.
Carapetis: None declared, L. Zuhlke Grant/ Research support from: This
work was completed while employed to work on a grant provided by Medtronic
Foundation<br/>Copyright &#xa9; 2018

<106>
Accession Number
2001208177
Title
Video-Assisted Thoracoscopic Surgery vs. Thoracotomy for Non-Small Cell
Lung Cancer: Oncologic Outcome of a Randomized Trial.
Source
Journal of Thoracic Oncology. Conference: IASLC 19th World Conference on
Lung Cancer. Canada. 13 (10 Supplement) (pp S333-S334), 2018. Date of
Publication: October 2018.
Author
Situ D.; Long H.; Tan Q.; Luo Q.; Wang Z.; Jiang G.; Rong T.
Institution
(Situ, Long) Lung Cancer Research Institute, Sun Yat-Sen University,
Guangzhou, China
(Tan) Thoracic Surgery, Daping Hospital of the Third Military Medical
University, Chongqing, China
(Luo) Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong
University, Shanghai, China
(Wang) Thoracic Surgery, Shenzhen People'S Hospital, Jinan University,
Shenzhen, China
(Jiang) Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University,
Shanghai, China
(Rong) Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou,
China
Publisher
Elsevier Inc.
Abstract
Background: Video-assisted thoracoscopic surgery (VATS) has been widely
used in the treatment of early-stage non-small cell lung cancer (NSCLC).
However, there has not been a robust randomized control trial (RCT) to
conclude VATS has similar oncologic efficacy to open surgery. Therefore, a
large multicenter RCT in China was designed and initialed in order to
verify the role of VATS. Method: A non-inferiority phase 3 RCT was
undertaken at five thoracic surgical centers in China. Patients aged 18-75
years who were diagnosed of clinically early-stage NSCLCs were randomized
in a 1:1 ratio into VATS and thoracotomy groups. Radical lobectomy plus
hilar and mediastinal lymph node dissection was the standard surgical
intervention as per protocol. The long-term oncologic outcomes including
3-year locoregional recurrence rate, overall survival (OS) and
disease-free survival (DFS) would be analyzed and reported here. This
study is registered with the ClinicalTrials.gov, number NCT01102517.
Result: A total of 508 patients were recruited in the trial between
January 2008 and March 2014. And 433 patients were eligible for final
analysis (222 cases in VATS group and 211 cases in thoracotomy group). At
3 years, the locoregional recurrence rates were 4.5% in VATS group and
5.7% in thoracotomy group respectively (P=0.664). Patients who received
VATS procedures had a similar DFS rate to those who underwent open surgery
(66% versus 69%, P=0.925; Fig 1A). Again, the 3-year OS rates were of no
significant difference between VATS and thoracotomy groups (74% versus
73%, P=0.382; Fig 1B). Conclusion: VATS in the treatment of clinically
early-stage NSCLCs was associated with equivalent oncologic efficacy when
compared to open surgery. Keywords: Video-assisted thoracoscopic surgery,
non-small cell lung cancer, thoracotomy [Figure presented]<br/>Copyright
&#xa9; 2018

<107>
Accession Number
624652654
Title
Recovery free of heart failure after acute coronary syndrome and coronary
revascularization.
Source
ESC heart failure. 5 (1) (pp 107-114), 2018. Date of Publication: 01 Feb
2018.
Author
Falkenham A.; Saraswat M.K.; Wong C.; Gawdat K.; Myers T.; Begum J.; Buth
K.J.; Haidl I.; Marshall J.; Legare J.-F.
Institution
(Falkenham, Wong, Gawdat, Legare) Department of Pathology, Dalhousie
University, Halifax, NS, Canada
(Saraswat, Myers, Begum, Buth, Legare) Department of Surgery, Dalhousie
University, Halifax, NS, Canada
(Haidl, Marshall, Legare) Department of Microbiology and Immunology,
Dalhousie University, Halifax, NS, Canada
Abstract
AIMS: Previous studies have examined risk factors for the development of
heart failure (HF) subsequent to acute coronary syndrome (ACS). Our study
seeks to clarify the clinical variables that best characterize patients
who remain free from HF after coronary artery bypass grafting (CABG)
surgery for ACS to determine novel biological factors favouring freedom
from HF in prospective translational studies.
METHODS AND RESULTS: Nova Scotia residents (1995-2012) undergoing CABG
within 3 weeks of ACS were included. The primary outcome was freedom from
readmission to hospital due to HF. Descriptive statistics were generated,
and a Cox proportional hazards model assessed outcome with adjustment for
clinical characteristics. Of 11 936 Nova Scotians who underwent isolated
CABG, 3264 (27%) had a recent ACS and were included. Deaths occurred in
210 (6%) of subjects prior to discharge. A total of 3054 patients were
included in the long-term analysis. During follow-up, HF necessitating
readmission occurred in 688 (21%) subjects with a hazard ratio of 12% at 2
years. The adjusted Cox model demonstrated significantly better freedom
from HF for younger, male subjects without metabolic syndrome and no
history of chronic obstructive pulmonary disease, renal insufficiency,
atrial fibrillation, or HF.
CONCLUSIONS: Our findings have outlined important clinical variables that
predict freedom from HF. Furthermore, we have shown that 12% of patients
undergoing CABG after ACS develop HF (2 years). Our findings support our
next phase in which we plan to prospectively collect blood and tissue
specimens from ACS patients undergoing CABG in order to determine novel
biological mechanism(s) that favour resolution of post-ACS
inflammation.<br/>Copyright &#xa9; 2017 The Authors. ESC Heart Failure
published by John Wiley & Sons Ltd on behalf of the European Society of
Cardiology.

<108>
Accession Number
624646444
Title
Comparison of Angiotensin-Converting Enzyme Inhibitor and Angiotensin
Receptor Blocker Management Strategies Before Cardiac Surgery: A Pilot
Randomized Controlled Registry Trial.
Source
Journal of the American Heart Association. 7 (20) (pp e009917), 2018. Date
of Publication: 16 Oct 2018.
Author
van Diepen S.; Norris C.M.; Zheng Y.; Nagendran J.; Graham M.M.; Gaete
Ortega D.; Townsend D.R.; Ezekowitz J.A.; Bagshaw S.M.
Institution
(van Diepen, Norris, Gaete Ortega, Townsend, Bagshaw) Department of
Critical Care Medicine Faculty of Medicine and Dentistry University of
Alberta Edmonton Alberta Canada
(van Diepen, Graham, Ezekowitz) Division of Cardiology Department of
Medicine University of Alberta Edmonton Alberta Canada
(van Diepen, Zheng, Ezekowitz) Canadian VIGOUR Center University of
Alberta Edmonton Alberta Canada
(Norris, Nagendran) Division of Cardiac Surgery University of Alberta
Hospital Edmonton Alberta Canada
(Norris) Faculty of Nursing University of Alberta Edmonton Alberta Canada
Publisher
NLM (Medline)
Abstract
Background Postoperative clinical outcomes associated with the
preoperative continuation or discontinuation of angiotensin-converting
enzyme inhibitors ( ACEIs ) or angiotensin receptor blockers ( ARBs )
before cardiac surgery remain unclear. Methods and Results In a
single-center, open-label, randomized, registry-based clinical trial,
patients undergoing nonemergent cardiac surgery were assigned to ACEI /
ARB continuation or discontinuation 2 days before surgery. Among the 584
patients screened, 261 met study criteria and 126 (48.3%) patients were
enrolled. In total,121 patients (96% adherence; 60 to continuation and 61
to ACEI / ARB discontinuation) underwent surgery and completed the study
protocol, and follow-up was 100% complete. Postoperative intravenous
vasopressor use (78.3% versus 75.4%, P=0.703), vasodilator use (71.7%
versus 80.3%, P=0.265), vasoplegic shock (31.7% versus 27.9%, P=0.648),
median duration of vasopressor (10 versus 5 hours, P=0.494), and
vasodilator requirements (10 versus 9 hours, P=0.469) were not
significantly different between the continuation and discontinuation arms.
No differences were observed in the incidence of acute kidney injury (1.7%
versus 1.6%, P=0.991), stroke (no events, mortality (1.7% versus 1.6%,
P=0.991), median duration of mechanical ventilation (6 versus 6 hours,
P=0.680), and median intensive care unit length of stay (43 versus 27
hours, P=0.420) between the treatment arms. Conclusions A randomized study
evaluating the routine continuation or discontinuation of ACEIs or ARB s
before cardiac surgery was feasible, and treatment assignment was not
associated with differences in postoperative physiological or clinical
outcomes. These preliminary findings suggest that preoperative ACEI / ARB
management strategies did not affect the postoperative course of patients
undergoing cardiac surgery. Clinical Trial Registration URL :
https://www.clinicaltrials.gov . Unique identifier: NCT 02096406.

<109>
Accession Number
624633612
Title
Mini-extracorporeal circulation technology, conventional bypass and prime
displacement in isolated coronary and aortic valve surgery: A
propensity-matched in-hospital and survival analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (1) (pp 13-19), 2018.
Date of Publication: 01 Jul 2018.
Author
Ariyaratnam P.; McLean L.A.; Cale A.; Chaudhry M.A.; Vijayan A.; Richards
N.; Jarvis M.A.; Haqzad Y.; Ngaage D.; Cowen M.E.; Loubani M.
Institution
(Ariyaratnam) Department of Cardiovascular and Metabolic Research, Hull
York Medical School, York, United Kingdom
(McLean) Department of Cardiac Perfusion, Castle Hill Hospital,
Cottingham, United Kingdom
(Cale, Chaudhry, Richards, Jarvis, Haqzad, Ngaage, Cowen, Loubani)
Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham,
United Kingdom
(Vijayan) Department of Cardiothoracic Anaesthesia, Castle Hill Hospital,
Cottingham, United Kingdom
Publisher
Oxford University Press
Abstract
OBJECTIVES: Conventional cardiopulmonary bypass is the most commonly used
means of artificial circulation in cardiac surgery. However, it suffers
from the effects of haemodilution and activation of
inflammatory/coagulation cascades. Prime displacement (PD) can offset
haemodilution and mini-extracorporeal technology (MIECT) can offset both.
So far, no study has compared all of these modalities together; hence, we
compared the outcomes of these 3 modalities at our institution. METHODS:
This was a retrospective analysis of our cardiac surgical database. A
total of 9626 patients underwent conventional bypass (CB), 3125 patients
underwent a modification of CB, called PD, and 904 underwent MIECT. A 1:1
propensity-matching algorithm was employed using IBM SPSS 24 to match (i)
813 MIECT patients with 813 CB patients and (ii) 717 MIECT patients with
717 PD patients. The patients included coronary artery bypass grafting and
valve surgery. RESULTS: MIECT had significantly (P < 0.05) longer bypass
and cross-clamp times compared to CB and PD. MIECT had significantly
higher rates of postoperative atrial fibrillation associated with it
compared to CB. The mean red cell blood transfusion was significantly
lower in the MIECT group compared to the CB group as was the mean platelet
transfusion and fresh frozen plasma transfusion. The overall 5-year
survival was higher in the MIECT group compared to the CB group (log-rank,
P = 0.018). Between the MIECT and the PD groups, we found the incidence of
renal failure and gastrointestinal complications to be significantly
higher in the PD group compared to the MIECT group. CONCLUSIONS: MIECT has
short-term advantages over CB and PD. However, due to the retrospective
limitations of the study, including calendar time bias, a multicentre
randomized controlled trial comparing all 3 modalities will be beneficial
for the larger cardiac community.<br/>Copyright &#xa9; 2018 Oxford
University Press. All rights reserved.

<110>
Accession Number
624633608
Title
Validity of the Swedish Cardiac Surgery Registry.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (1) (pp 67-74), 2018.
Date of Publication: 01 Jul 2018.
Author
Vikholm P.; Ivert T.; Nilsson J.; Holmgren A.; Freter W.; Ternstrom L.;
Ghaidan H.; Sartipy U.; Olsson C.; Granfeldt H.; Ragnarsson S.; Friberg O.
Institution
(Vikholm) Department of Cardiothoracic Surgery, Uppsala University
Hospital, Uppsala, Sweden
(Ivert, Sartipy, Olsson) Department of Molecular Medicine and Surgery,
Karolinska Institutet and Heart and Vascular Theme, Karolinska University
Hospital, Stockholm, Sweden
(Nilsson, Ragnarsson) Department of Clinical Sciences (Cardiothoracic
Surgery), Skane University Hospital, Lund, Sweden
(Holmgren) Department of Surgery and Perioperative Sciences, Umea
University Hospital, Umea, Sweden
(Freter, Granfeldt) Department of Medical and Health Sciences, Linkoping
University Hospital, Linkoping, Sweden
(Ternstrom) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, S-Gothenburg, Sweden
(Ghaidan) Department of Cardiothoracic Surgery, Blekinge Hospital,
Karlskrona, Sweden
(Friberg) Department of Cardiothoracic Surgery and Vascular Surgery,
Faculty of Medicine and Health, Orebro University Hospital, Orebro, Sweden
Publisher
Oxford University Press
Abstract
OBJECTIVES: Our goal was to validate the Swedish Cardiac Surgery Registry
by reviewing the reported cardiac operations to assess the completeness
and quality of the registered data and the EuroSCORE II variables.
METHODS: A total of 5837 cardiac operations were reported to the Swedish
Cardiac Surgery Registry in Sweden during 2015. A randomly selected sample
of 753 patient records (13%) was scrutinized by 3 surgeons at all 8 units
in Sweden performing open cardiac surgery in adults. RESULTS: Coverage was
excellent with 99% [95% confidence interval (CI) 98-99%] of the performed
procedures found in the registry. Reported waiting times for surgery were
correct in 78% (95% CI 76-79%) of the cases. The main procedural code was
correctly reported in 96% (95% CI 95'97%) of the cases. The correlation
between reported and monitored logistic EuroSCORE II had a coefficient of
0.79 (95% CI 0.76-0.82), and the median difference in EuroSCORE II was 0%
(interquartile range -0.4% to 0.4%). The majority of EuroSCORE II
variables had good agreement and coherence; however, New York Heart
Association functional class, preoperative renal dysfunction, left
ventricular ejection fraction, Canadian Cardiovascular Society Class IV
angina and poor mobility were less robust. Postoperative complications
were rare and in general had a high degree of completeness and agreement.
CONCLUSIONS: The reliability of the variables in the national Swedish
Cardiac Surgery Registry was excellent. Thus, the registry is a valuable
source of data for quality studies and research. Some EuroSCORE II
variables require improved and stricter definitions to obtain uniform
reporting and high validity.<br/>Copyright &#xa9; 2018 Oxford University
Press. All rights reserved.

<111>
Accession Number
624633588
Title
Acute exercise is not cardioprotective and may induce apoptotic signalling
in heart surgery: A randomized controlled trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (1) (pp 95-101), 2018.
Date of Publication: 01 Jul 2018.
Author
Smenes B.T.; Baekkerud F.H.; Slagsvold K.H.; Hassel E.; Wohlwend M.; Pinho
M.; Hoydal M.; Wisloff U.; Rognmo O.; Wahba A.
Institution
(Smenes, Baekkerud, Hassel, Wohlwend, Wisloff, Rognmo, Wahba) Department
of Circulation and Medical Imaging, K.G. Jebsen Center of Exercise in
Medicine, Norwegian University of Science and Technology, Trondheim,
Norway
(Slagsvold, Wahba) Department of Cardiothoracic Surgery, St. Olav's
University Hospital, Norwegian University of Science and Technology,
Prinsesse Kristinas gate 3, Trondheim 7006, Norway
(Hassel) Clinic of Thoracic and Occupational Medicine, St. Olav's
University Hospital, Trondheim, Norway
(Pinho, Hoydal) Group of Molecular and Cellular Cardiology, Department of
Circulation and Medical Imaging, Norwegian University of Science and
Technology, Trondheim, Norway
(Wisloff) School of Human Movement and Nutrition Sciences, University of
Queensland, Australia
Publisher
Oxford University Press
Abstract
OBJECTIVES: During open-heart surgery, the myocardium experiences
ischaemia-reperfusion injury. A single bout of moderate, 30-min exercise
induces preconditioning and protects the heart from ischaemia-reperfusion
injury in rats, but this has never been investigated in humans. We aimed
to investigate whether 1 bout of moderate exercise 24 h prior to surgery
protects against mitochondrial and cardiac damage. METHODS: Patients
scheduled for elective coronary artery bypass were eligible for this pilot
study. Twenty were included and randomized to the treadmill exercise group
(the EX group, n = 10) 24 h preoperatively or to standard presurgical
procedures (control n = 10). Right atrial (RA) and left ventricular (LV)
biopsies were collected immediately before and as long as possible after
aortic cross-clamping to assess the primary outcome of mitochondrial
respiration by respirometry, in addition to reactive oxygen species
production by fluorometry and apoptotic transcripts. Cardiac troponin T
and creatine kinase myocardial brain were measured in plasma at arrival,
before surgery and 6 and 24 h postoperatively. RESULTS: Mitochondrial
respiration was lower in the EX group after surgery in the LV (Complex I
-22%, P < 0.05 and maximal -23%, P < 0.05) and the right atrium (Complex I
-25%, P < 0.05). Transcript level of the apoptosis-related marker caspase
3 was increased 1.5-fold in the LV prior to surgery in the EX group when
compared with the control group, P < 0.05. Cardiac troponin T was 45%
higher in the EX group than in the control group 6 h postoperatively (P =
0.03), although not significant when corrected for aortic cross-clamping
time. CONCLUSIONS: Results indicate that exercise did not precondition the
heart against surgery-related damage. Exercise may render the myocardium
and mitochondria more vulnerable to perioperative damage. Clinical trials
registration number: NCT00218985
(https://clinicaltrials.gov/ct2/show/NCT00218985).<br/>Copyright &#xa9;
2018 Oxford University Press. All rights reserved.

<112>
Accession Number
2001228443
Title
Intraoperative prediction of cardiac surgery-associated acute kidney
injury using urinary biomarkers of cell cycle arrest.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Author
Cummings J.J.; Shaw A.D.; Shi J.; Lopez M.G.; O'Neal J.B.; Billings F.T.
Institution
(Cummings, Shaw, O'Neal, Billings) Division of Cardiothoracic
Anesthesiology, Department of Anesthesiology, Vanderbilt University
Medical Center, Nashville, Tenn, United States
(Lopez, Billings) Division of Critical Care Medicine, Department of
Anesthesiology, Vanderbilt University Medical Center, Nashville, Tenn,
United States
(Shi) Department of Statistics, Walker Bioscience, Carlsbad, Calif, United
States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Tissue inhibitor of metalloproteinases 2 (TIMP-2) and
insulin-like growth factor-binding protein 7 (IGFBP7) are postoperative
urinary biomarkers of renal stress and acute kidney injury (AKI). We
conducted this study to test the hypothesis that intraoperative
concentrations of urinary [TIMP-2].[IGFBP7] are associated with
postoperative AKI. Methods: We measured urinary [TIMP-2].[IGFBP7] at 8
perioperative timepoints in 400 patients who participated in a randomized
controlled trial of atorvastatin for AKI in cardiac surgery. We compared
[TIMP-2].[IGFBP7] between subjects who did and did not develop KDIGO stage
2 or 3 AKI within 48 hours of surgery, adjusted for AKI risk factors.
Results: Fourteen patients (3.5%) met the primary endpoint of stage 2 or 3
AKI within 48 hours of surgery, and an additional 77 patients (19.3%)
developed stage 1 AKI. Patients who developed stage 2 or 3 AKI displayed
bimodal elevations of [TIMP-2].[IGFBP7], with a first elevation (median,
0.45 [ng/mL]²/1000) intraoperatively and a second elevation
(1.45 [ng/mL]²/1000) 6 hours postoperatively. Patients who did
not develop AKI did not have any elevations in [TIMP-2].[IGFBP7]. Each
10-fold increase in intraoperative [TIMP-2].[IGFBP7] was independently
associated with a 290% increase in the odds of stage 2 or 3 AKI (P =.01),
and each 10-fold increase in the 6 hours postoperative [TIMP-2].[IGFBP7]
was independently associated with a 650% increase in the odds of stage 2
or 3 AKI (P <.001). The maximum [TIMP-2].[IGFBP7] between these 2
timepoints provided an area under the receiver operating characteristic
curve of 0.82 (95% confidence interval [CI], 0.73-0.90), 100% sensitivity,
and 100% negative predictive value using the >0.3 cutoff to predict stage
2 or 3 AKI. Conclusions: Intraoperative elevations of [TIMP-2].[IGFBP7]
can predict moderate or severe AKI and could provide an opportunity to
alter postoperative management to prevent kidney injury.<br/>Copyright
&#xa9; 2018