EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
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Accession Number
615007272
Title
Ventilation with High or Low Tidal Volume with PEEP Does Not Influence
Lung Function after Spinal Surgery in Prone Position: A Randomized
Controlled Trial.
Source
Journal of Neurosurgical Anesthesiology. 30 (3) (pp 237-245), 2018. Date
of Publication: 2018.
Author
Soh S.; Shim J.-K.; Ha Y.; Kim Y.-S.; Lee H.; Kwak Y.-L.
Institution
(Soh, Shim, Kwak) Department of Anesthesiology and Pain Medicine,
Anesthesia and Pain Research Institut, Yonsei University College of
Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
(Shim, Kwak) Anesthesia and Pain Research Institute, Severance
Cardiovascular Hospital, United States
(Ha) Departments of and Neurosurgery, United States
(Kim) Internal Medicine, United States
(Lee) Anesthesiology and Pain Medicine, United States
(Ha) Spine and Spinal Cord Institute, Yonsei University College of
Medicine, Seoul, South Korea
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Spinal surgery in the prone position is accompanied by
increased intrathoracic pressure and decreased respiratory compliance.
This study investigated whether intraoperative lung protective mechanical
ventilation improved lung function evaluated with pulmonary function tests
in patients at risk of postoperative pulmonary complications (PPCs) after
major spinal surgery in the prone position. Methods: Seventy-eight
patients at potential risk of PPCs were randomly assigned to the
protective group (tidal volume; 6 mL/kg predicted body weight, 6 cm H 2 O
positive end-expiratory pressure with recruitment maneuvers) or the
conventional group (10 mL/kg predicted body weight, no positive
end-expiratory pressure). The primary efficacy variables were assessed by
pulmonary function tests, performed before surgery, and 3 and 5 days
afterward. Results: Postoperative forced vital capacity (2.17+/-0.1 L vs.
1.91+/-0.1 L, P=0.213) and forced expiratory volume in 1 second
(1.73+/-0.08 L vs. 1.59+/-0.08 L, P=0.603) at postoperative day (POD) 3 in
the protective and conventional groups, respectively, were similar. Trends
of a postoperative decrease in forced vital capacity (P=0.586) and forced
expiratory volume in 1 second (P=0.855) were similar between the groups.
Perioperative blood-gas analysis variables were comparable between the
groups. Patients in the protective and conventional groups showed similar
rates of clinically significant PPCs (8% vs. 10%, P>0.999). Conclusions:
In patients at potential risk of developing PPCs undergoing major spinal
surgery, we did not find evidence indicating any difference between the
lung protective and conventional ventilation in postoperative pulmonary
function and oxygenation.<br/>Copyright &#xa9; 2017 Wolters Kluwer Health,
Inc. All rights reserved.

<2>
Accession Number
623805068
Title
Cardiac rehabilitation and its effects on cognition in patients with
coronary artery disease and heart failure.
Source
Expert Review of Cardiovascular Therapy. 16 (9) (pp 645-652), 2018. Date
of Publication: 02 Sep 2018.
Author
Alagiakrishnan K.; Mah D.; Gyenes G.
Institution
(Alagiakrishnan, Mah, Gyenes) Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, Canada
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Cardiac rehabilitation program is an evidence-based
intervention and established model of exercise delivery following
myocardial infarction and heart failure. Although it forms an important
part of recovery and helps to prevent future events and complications,
there has been little focus on its potential cognitive benefits. Areas
covered: Coronary artery disease and heart failure are common heart
problems associated with significant morbidity and mortality, and
cognitive decline is commonly seen in affected individuals. Cognitive
impairment may influence patient self-management by reducing medication
adherence, rendering patients unable to make lifestyle modifications and
causing missed healthcare visits. Cognitive assessment in cardiac
rehabilitation as an outcome measure has the potential to improve
clinical, functional and behavioral domains as well as help to reduce gaps
in the quality of care in these patients. Expert commentary: Limited
evidence at present has shown that cardiac rehabilitation and exercise has
potential in preventing cognitive decline. Cardiac prehabilitation, a
rehabilitation-like program delivered before cardiac surgery, may also
play a role in preventing postoperative cognitive dysfunction, but needs
future research studies to support it.<br/>Copyright &#xa9; 2018, &#xa9;
2018 Informa UK Limited, trading as Taylor & Francis Group.

<3>
Accession Number
620070112
Title
A randomized trial of an optimism training intervention in patients with
heart disease.
Source
General Hospital Psychiatry. 51 (pp 46-53), 2018. Date of Publication:
March 2018.
Author
Mohammadi N.; Aghayousefi A.; Nikrahan G.R.; Adams C.N.; Alipour A.;
Sadeghi M.; Roohafza H.; Celano C.M.; Huffman J.C.
Institution
(Mohammadi, Aghayousefi, Alipour) Department of Psychology, Payame Noor
University, Tehran, Iran, Islamic Republic of
(Nikrahan) Department of Psychology, University of Isfahan, Isfahan, Iran,
Islamic Republic of
(Adams, Celano, Huffman) Department of Psychiatry, Massachusetts General
Hospital, Boston, MA, United States
(Adams, Celano, Huffman) Department of Psychiatry, Harvard Medical School,
Boston, MA, United States
(Sadeghi) Department of Cardiology, Cardiac Rehabilitation Research
Center, Cardiovascular Research Institute, Isfahan University of Medical
Sciences, Isfahan, Iran, Islamic Republic of
(Roohafza) Department of Psychiatry, Isfahan Cardiovascular Research
Center, Cardiovascular Research Institute, Isfahan University of Medical
Sciences, Isfahan, Iran, Islamic Republic of
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective Optimism is prospectively and independently associated with
superior cardiac outcomes, but there has been minimal study of
optimism-specific interventions in persons with cardiovascular illness. We
aimed to examine the feasibility and impact of an optimism-promoting
program among patients with heart disease in a randomized controlled
trial. Methods Participants (N = 61) were outpatients, age 35-60, with
coronary artery disease who were randomized to an 8-week in-person
group-based optimism training intervention or an attention-matched
educational control condition. Feasibility was assessed via rates of
session attendance and exercise completion, and acceptability was assessed
via weekly participant ratings of exercise ease, utility, and likelihood
of continuation. The impact of the intervention was assessed via
between-group differences in change from baseline optimism (Life
Orientation Test-Revised [LOT-R]) and other psychological self-report
outcomes at 8 weeks (primary time point) and 16 weeks, using random
effects regression models. Results Participants completed a mean of 6.8
(SD 1.2) sessions and 13.9 (SD 2.4) exercises, with mean ratings all >
3.5/5 on measures of acceptability. The intervention was associated with
greater improvement in optimism at 8 weeks (beta = 5.13; 95% confidence
interval [CI] = 3.55, 6.70; p < 0.001) and 16 weeks; the intervention was
also associated with greater improvements in life satisfaction, hope, and
anxiety at both time points, though not with positive or negative affect.
Conclusions A group-based optimism training program was feasible,
acceptable, and associated with improvements in optimism and other
psychological measures in cardiac patients. Future larger studies should
examine effects on major clinical outcomes.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<4>
Accession Number
620609218
Title
Effect of Remote Ischemic Preconditioning on Intestinal
Ischemia-Reperfusion Injury in Adults Undergoing On-Pump CABG Surgery: A
Randomized Controlled Pilot Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (3) (pp 1243-1247),
2018. Date of Publication: June 2018.
Author
Struck R.; Wittmann M.; Muller S.; Meybohm P.; Muller A.; Bagci S.
Institution
(Struck, Wittmann, Muller) Department of Anesthesiology and Intensive Care
Medicine, University Hospital Bonn, Bonn, Germany
(Muller) Department of Anesthesiology and Intensive Care and Emergency
Medicine and Pain Therapy Kemperhof Koblenz, Gemeinschaftsklinikum
Mittelrhein, Koblenz, Germany
(Meybohm) Department of Anesthesiology, Intensive Care Medicine and Pain
Therapy, University Hospital Frankfurt, Frankfurt, Germany
(Muller, Bagci) Neonatology and Pediatric Intensive Care, Children's
Hospital, University of Bonn, Bonn, Germany
Publisher
W.B. Saunders
Abstract
Objective: Cardiopulmonary bypass (CPB) surgery commonly threatens the
heart and remote organs with ischemia-reperfusion injury. Transient
episodes of ischemia to nonvital tissue, known as remote ischemic
preconditioning (RIPC), is thought to help local and remote vital organs
to withstand subsequent ischemic insults. Design: Prospective, randomized,
double-blinded control trial. Setting: Tertiary referral academic teaching
hospital. Participants: Thirty patients undergoing elective CPB surgery
Intervention: RIPC was achieved via three 5-minute cycles of upper limb
ischemia using a blood pressure cuff or control (sham cuff). Measurements
and Main Results: Primary outcome was the occurrence of intestinal injury,
as measured by an increase in intestinal fatty acid binding protein
(I-FABP). Secondary outcomes included incidence of gastrointestinal
complications and duration of intensive care unit (ICU) stay. RIPC did not
affect serum IFABP levels at the end of surgery and on the first
postoperative day (p = 0.697 and p = 0.461, respectively). For all
patients, mean I-FABP levels significantly increased at the end of surgery
and decreased to under baseline levels on the first postoperative day
(from a mean [+/- standard deviation] baseline value of 764 +/- 492 pg/mL
to 2,002 +/- 974 pg/mL and decreased to 568 +/- 319 pg/mL, p < 0.001). All
patients remained clinically absent of gastrointestinal complications
until hospital discharge. Duration of ICU stay was not correlated with
I-FABP levels at the end of surgery. Neither duration of CPB nor duration
of aortic clamping significantly correlated with postoperative I-FABP
levels. Conclusions: These findings suggest that RIPC does not affect
intestinal injury in patients undergoing CPB surgery. In patients
undergoing cardiac surgery, intestinal injury appears to be moderate and
transient without any clinical relevant complication.<br/>Copyright &#xa9;
2017 Elsevier Inc.

<5>
Accession Number
621953266
Title
Augmented reality for the surgeon: Systematic review.
Source
International Journal of Medical Robotics and Computer Assisted Surgery.
14 (4) (no pagination), 2018. Article Number: e1914. Date of Publication:
August 2018.
Author
Yoon J.W.; Chen R.E.; Kim E.J.; Akinduro O.O.; Kerezoudis P.; Han P.K.; Si
P.; Freeman W.D.; Diaz R.J.; Komotar R.J.; Pirris S.M.; Brown B.L.; Bydon
M.; Wang M.Y.; Wharen R.E.; Quinones-Hinojosa A.
Institution
(Yoon, Akinduro, Pirris, Brown, Wharen, Quinones-Hinojosa) Department of
Neurological Surgery, Mayo Clinic, Jacksonville, FL, United States
(Chen) Emory University School of Medicine, Atlanta, GA, United States
(Chen, Han, Si) Georgia Institute of Technology, Atlanta, GA, United
States
(Kim) Baylor College of Medicine, Houston, TX, United States
(Kerezoudis, Bydon) Department of Neurological Surgery, Mayo Clinic,
Rochester, MN, United States
(Freeman) Department of Neurology, Mayo Clinic, Jacksonville, FL, United
States
(Diaz) Department of Neurosurgery and Neurology, Montreal Neurological
Institute and Hospital, McGill University, Montreal, QC, Canada
(Komotar, Wang) Department of Neurological Surgery, University of Miami
Miller School of Medicine, University of Miami Hospital, University of
Miami Brain Tumor Initiative, Miami, FL, United States
(Pirris) St. Vincent's Spine and Brain Institute, Jacksonville, FL, United
States
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Introduction: Since the introduction of wearable head-up displays, there
has been much interest in the surgical community adapting this technology
into routine surgical practice. Methods: We used the keywords augmented
reality OR wearable device OR head-up display AND surgery using PubMed,
EBSCO, IEEE and SCOPUS databases. After exclusions, 74 published articles
that evaluated the utility of wearable head-up displays in surgical
settings were included in our review. Results: Across all studies, the
most common use of head-up displays was in cases of live streaming from
surgical microscopes, navigation, monitoring of vital signs, and display
of preoperative images. The most commonly used head-up display was Google
Glass. Head-up displays enhanced surgeons' operating experience; common
disadvantages include limited battery life, display size and discomfort.
Conclusions: Due to ergonomic issues with dual-screen devices, augmented
reality devices with the capacity to overlay images onto the surgical
field will be key features of next-generation surgical head-up
displays.<br/>Copyright &#xa9; 2018 John Wiley & Sons, Ltd.

<6>
Accession Number
620069745
Title
Comparative Study Between Conventional Fasting Versus Overnight Infusion
of Lipid or Carbohydrate on Insulin and Free Fatty Acids in Obese Patients
Undergoing Elective On-pump Coronary Artery Bypass Grafting. A Prospective
Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (3) (pp 1248-1253),
2018. Date of Publication: June 2018.
Author
Hosny H.; Ibrahim M.; El-Siory W.; Abdel-Monem A.
Institution
(Hosny, Ibrahim, El-Siory, Abdel-Monem) Department of Anesthesia and
Intensive Care, Kasr Al-Ainy Faculty of Medicine, Cairo University, Egypt
(Hosny) Department of Cardiothoracic Anaesthesia, Harefield Hospital,
London, United Kingdom
Publisher
W.B. Saunders
Abstract
Objectives: Postoperative insulin resistance represents a major component
of postoperative metabolic disorder. The authors compared the effects of
preoperative infusion of lipid emulsion or carbohydrate to conventional
preoperative fasting on postoperative insulin and free fatty acid (FFA)
levels. Design: A prospective randomized double-blinded study. Settings:
Tertiary university hospital. Participants: Sixty-three patients
undergoing coronary artery bypass grafting. Intervention: Participants
were randomized into 3 equal groups. Group G received 500 mL of glucose
10% (50 g glucose). Group L received 100 mL of 2% lipid emulsion (soybean
30%, medium chain triglycerides (TG) 30%, olive oil 25%, fish oil 15%, and
20 mg vitamin E). Group C fasted overnight except for clear fluids allowed
until 4 hours preoperatively. Serum insulin at the start of infusion
(T<inf>1</inf>), 1-hour preinduction (T<inf>2</inf>), on admission to the
intensive care unit (T<inf>3</inf>), after 24 hours of admission
(T<inf>4</inf>), and after 48 hours of admission (T<inf>5</inf>), and FFA
at T<inf>1</inf> and T<inf>2</inf> were measured. Serum very-low-density
lipoprotein (VLDL), serum TG, and blood sugar were all measured
(T<inf>1</inf>-T<inf>4</inf>). Bypass time, ischemic time, need for
inotropic support, and length of intensive care unit stay also were
measured. Measurements and Main Results: At the end of infusion FFAs were
significantly lower in the L group (1.1 +/- 0.76 mg/dL) compared with G
(1.64 +/- 0.85 mg/dL) and C groups (1.48 +/- 0.76 mg/dL). Insulin levels
were significantly lower in the L group compared with levels in the G and
C groups at T<inf>2</inf>, T<inf>3</inf>, and T<inf>4</inf>. Also, TG,
VLDL, and random blood sugar levels decreased significantly at
T<inf>2</inf>, T<inf>3</inf>, and T<inf>4</inf> in the L group compared
with the other 2 groups and compared with baseline value within the same
group. Conclusion: Preoperative lipid infusion lowered postoperative FFA,
insulin, TG, VLDL, and random blood sugar in obese patients undergoing
coronary artery bypass grafting surgeries.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<7>
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.

<8>
Accession Number
624329304
Title
Comparison of graft patency following coronary artery bypass grafting in
the left versus the right coronary artery systems: A systematic review and
meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 54 (2) (pp 221-228), 2018.
Date of Publication: 2018.
Author
Pinho-Gomes A.-C.; Azevedo L.; Antoniades C.; Taggart D.P.
Institution
(Pinho-Gomes, Taggart) Department of Cardiac Surgery, Oxford University
Hospitals NHS Trust, John Radcliffe Hospital, Oxford OX39DU, United
Kingdom
(Azevedo) Department of Community Medicine, Information and Health
Decision Sciences, Faculty of Medicine, Center for Health Technology and
Services Research, University of Porto, Porto, Portugal
(Antoniades, Taggart) Division of Cardiovascular Medicine, University of
Oxford, Oxford, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Although coronary artery bypass grafting has been the standard of care for
patients with complex coronary artery disease for over 50 years, the
evolution of graft patency over time in the left versus the right coronary
systems remains poorly documented. This systematic review and
meta-analysis aimed to characterize the evolution of graft patency over
time comparing the left (excluding left anterior descending artery) and
right coronary systems, with an emphasis on the comparison of venous
versus arterial grafts and symptomatic versus asymptomatic patients. We
searched the Cochrane Central Register of Controlled Trials (CENTRAL) and
MEDLINE from inception to August 2016. We also searched clinical trials
registers and reference lists of relevant studies. We included randomized
clinical trials and observational studies comparing graft patency in the
left versus the right coronary systems. Our outcome was graft patency
defined as a binary variable according to whether grafts were reported as
patent or failed at the time of angiogram. Data collection and analysis
were performed according to the methodological recommendations of the
Cochrane Collaboration. From a total 2275 papers, 52 studies were included
in the qualitative analysis and 48 studies (including 36 006 grafts) in
the meta-analysis. There was a 3.3% significant difference between the
left-sided and rightsided graft patency, and the difference appeared to
increase over time. Furthermore, patency of arterial grafts was higher in
the left coronary system, while venous grafts performed similarly
irrespective of the coronary circulation. Symptom recurrence also seemed
related to a higher failure rate in the right coronary circulation.
However, the high degree of heterogeneity precluded drawing definite
conclusions. This metaanalysis suggested that graft patency might be
better for left-sided vessels and that this difference might be driven by
the better performance of arterial grafts in the left coronary system.
However, evidence currently available is limited, and further research is
warranted to understand whether certain grafts achieve better patency in
the right versus the left coronary circulations.<br/>Copyright &#xa9; 2018
The Author(s).

<9>
Accession Number
617639333
Title
Outcome after percutaneous edge-to-edge mitral repair for functional and
degenerative mitral regurgitation: A systematic review and meta-analysis.
Source
Heart. 104 (4) (pp 306-312), 2018. Date of Publication: 01 Feb 2018.
Author
Chiarito M.; Pagnesi M.; Martino E.A.; Pighi M.; Scotti A.; Biondi-Zoccai
G.; Latib A.; Landoni G.; Mario C.D.; Margonato A.; Maisano F.; Feldman
T.; Alfieri O.; Colombo A.; Godino C.
Institution
(Chiarito) Interventional Cardiology Unit, Humanitas Clinical and Research
Center, Rozzano, Italy
(Pagnesi, Scotti, Latib, Margonato, Colombo, Godino) Interventional
Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina 60,
Milan 20132, Italy
(Martino, Landoni) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Pighi, Mario) Department of Cardiology, NIHR Biomedical Research Unit,
Royal Brompton Hospital, London, United Kingdom
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Roma, Department of
AngioCardioNeurology, Pozzilli, Latina, Italy
(Latib, Colombo) Interventional Cardiology Unit, EMO-GVM Centro Cuore
Columbus, Milan, Italy
(Landoni, Margonato, Alfieri, Colombo) Vita-Salute San Raffaele
University, Milan, Italy
(Maisano) Universitats Spital Zurich, University Heart Center, Zurich,
Switzerland
(Feldman) NorthShore University HealthSystem, Evanston, IL, United States
(Alfieri) Cardiac Surgery Unit, San Raffaele Hospital, Milan, Italy
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives Differences in terms of safety and efficacy of percutaneous
edge-to-edge mitral repair between patients with functional and
degenerative mitral regurgitation (MR) are not well established. We
performed a systematic review and meta-analysis to clarify these
differences. Methods PubMed, EMBASE, Google scholar database and
international meeting abstracts were searched for all studies about
MitraClip. Studies with <25 patients or where 1-year results were not
delineated between MR aetiology were excluded. This study is registered
with PROSPERO. Results A total of nine studies investigating the mid-term
outcome of percutaneous edge-to-edge repair in patients with functional
versus degenerative MR were included in the meta-analysis (n=2615). At 1
year, there were not significant differences among groups in terms of
patients with MR grade<=2 (719/1304 vs 295/504; 58% vs 54%; risk ratio
(RR) 1.12; 95% CI: 0.86 to 1.47; p=0.40), while there was a significantly
lower rate of mitral valve re-intervention in patients with functional MR
compared with those with degenerative MR (77/1770 vs 80/818; 4% vs 10%; RR
0.60; 95% CI: 0.38 to 0.97; p=0.04). One-year mortality rate was 16%
(408/2498) and similar among groups (RR 1.26; 95% CI: 0.90 to 1.77;
p=0.18). Functional MR group showed significantly higher percentage of
patients in New York Heart Association class III/IV (234/1480 vs 49/583;
16% vs 8%; p<0.01) and re-hospitalisation for heart failure (137/605 vs
31/220; 23% vs 14%; p=0.03). No differences were found in terms of single
leaflet device attachment (25/969 vs 20/464; 3% vs 4%; p=0.81) and device
embolisation (no events reported in both groups) at 1 year. Conclusions
This meta-analysis suggests that percutaneous edge-to-edge repair is
likely to be an efficacious and safe option in patients with both
functional and degenerative MR. Large, randomised studies are ongoing and
awaited to fully assess the clinical impact of the procedure in these two
different MR aetiologies.<br/>Copyright &#xa9; Article author(s) (or their
employer(s) unless otherwise stated in the text of the article) 2018.

<10>
Accession Number
618297890
Title
Platelet reactivity-adjusted antiplatelet therapy in patients with
percutaneous coronary intervention: a meta-analysis of randomized
controlled trials.
Source
Platelets. 29 (6) (pp 589-595), 2018. Date of Publication: 18 Aug 2018.
Author
Xing Z.; Tang L.; Zhu Z.; Huang J.; Peng X.; Hu X.
Institution
(Xing, Tang, Zhu, Huang, Peng, Hu) Department of Cardiovascular Medicine,
The Second Xiangya Hospital, Central South University, Changsha, Hunan,
China
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Numerous number of evidences show that high on-treatment platelet
reactivity is a well-known risk factor for adverse events in patients
after percutaneous coronary intervention (PCI). Controversial situations
still exist regarding the effectiveness of tailoring antiplatelet therapy
according to platelet function monitoring. The PubMed, Embase, and
Cochrane Central databases were searched for randomized trials comparing
platelet reactivity-adjusted antiplatelet therapy with conventional
antiplatelet therapy in patients undergoing PCI. The primary end point was
all-cause mortality, major adverse cardiac events (MACE) including
cardiovascular (CV) death, nonfatal myocardial infarction (MI),
definite/probable stent thrombosis (ST), revascularization, and stroke or
transient ischemic attack (TIA). The safety end point was defined as major
bleeding events. We derived pooled risk ratios (RRs) with fixed-effect
models. Six studies enrolling 6347 patients were included. Compared with
conventional treatment, tailoring antiplatelet failed to reduce all-cause
mortality (RR: 0.89, 95% confidence interval [CI]: 0.63-1.24, P = 0.48),
MACE (RR: 1.02, 95% CI: 0.92-1.14, P = 0.69), MI (RR: 1.07, 95% CI:
0.95-1.21, P = 0.24), CV death (RR: 0.69, 95% CI: 0.40-1.19, P = 0.09), ST
(RR: 0.83, 95% CI: 0.50-1.38, P = 0.23), stroke or TIA (RR: 1.08, 95% CI:
0.55-2.12, P = 0.83), revascularization (RR: 0.96, 95% CI: 0.69-1.33, P =
0.79), and major bleeding events (RR: 0.79, 95% CI: 0.53-1.17, P = 0.24).
Compared with traditional antiplatelet treatment, tailoring antiplatelet
therapy according to platelet reactivity testing failed to reduce
all-cause mortality, MACE, and major bleeding events in patients
undergoing PCI.<br/>Copyright &#xa9; 2018, &#xa9; 2018 Taylor & Francis.

<11>
Accession Number
621584814
Title
Effect of continuous positive airway pressure on long-term cardiovascular
outcomes in patients with coronary artery disease and obstructive sleep
apnea: A systematic review and meta-analysis.
Source
Respiratory Research. 19 (1) (no pagination), 2018. Article Number: 61.
Date of Publication: 10 Apr 2018.
Author
Wang X.; Zhang Y.; Dong Z.; Fan J.; Nie S.; Wei Y.
Institution
(Wang, Fan, Nie) Capital Medical University, Emergency and Critical Care
Center, Beijing Anzhen Hospital, 2 Anzhen Road, Beijing, Chaoyang District
100029, China
(Zhang, Dong) Capital Medical University, Cardiovascular Center, Beijing
Tongren Hospital, Beijing, China
(Wei) Beijing Anzhen Hospital, Capital Medical University, Department of
Otolaryngology Head and Neck Surgery, 2 Anzhen Road, Beijing, Chaoyang
District 100029, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Obstructive sleep apnea (OSA) is highly prevalent in patients
with coronary artery disease (CAD) and is associated with recurrent
cardiovascular risk. However, whether treatment with continuous positive
airway pressure (CPAP) reduces this risk remains unclear. We performed a
systematic review and meta-analysis to assess the effect of CPAP on
long-term cardiovascular outcomes in patients with concomitant CAD and
OSA. Methods: We searched the PubMed, EMBASE, and Cochrane library from
their inceptions to October 7, 2017. We included observational studies and
randomized controlled trials (RCTs) that described the association of CPAP
treatment with cardiovascular events in patients with CAD and OSA. The
primary outcome of interest was major adverse cardiovascular event (MACE),
including all-cause or cardiovascular death, myocardial infarction,
stroke, repeat revascularization, or hospitalization for heart failure.
Outcomes data were pooled using random effects models and heterogeneity
assessed with the I² statistic. Results: We identified 9
studies (2 RCTs and 7 observational studies) with 1430 participants. The
median follow-up duration was from 36 to 86.5 months. Treatment with CPAP
was associated with a significantly lower risk of MACE in 6 observational
studies (RR 0.61, 95% CI: 0.39-0.94, P = 0.02), but this was not
reproduced in 2 RCTs (RR 0.57, 95% CI: 0.32-1.02, P = 0.06). Similarly,
CPAP significantly reduced the risk of all-cause death (4 observational
studies) and cardiovascular death (3 observational studies), which were
also not confirmed in RCTs. Conclusions: The use of CPAP in patients with
CAD and OSA might prevent subsequent cardiovascular events, which was only
demonstrated in observational studies, but not in RCTs. The value of CPAP
therapy as second prevention for CAD needs further
investigation.<br/>Copyright &#xa9; 2018 The Author(s).

<12>
[Use Link to view the full text]
Accession Number
621052369
Title
Optimizing the Safety Profile of Everolimus by Delayed Initiation in de
Novo Heart Transplant Recipients: Results of the Prospective Randomized
Study EVERHEART.
Source
Transplantation. 102 (3) (pp 493-501), 2018. Date of Publication: 01 Mar
2018.
Author
Potena L.; Pellegrini C.; Grigioni F.; Amarelli C.; Livi U.; MacCherini
M.; Masciocco G.; Faggian G.; Lilla Della Monica P.; Gerosa G.; Marraudino
N.; Corda M.; Boffini M.; De Santo L.S.; Tona F.; Poggio D.; Savini C.;
Ambrogi F.; Bernazzali S.; D'Armini A.M.; Mattiucci G.; Rinaldi M.;
Ribezzo M.; Porcu M.; Musumeci F.; Gambino A.; Maiello C.; Frigerio M.;
Guzzi G.; Forni A.; Capone G.
Institution
(Potena, Grigioni, Savini) Heart and Lung Transplant Program,
Cardiovascular Department, Academic Hospital S. Orsola-Malpighi, Building
21, via Massarenti, 9, Bologna 40138, Italy
(Pellegrini, D'Armini, Mattiucci) Cardiac Surgery Department, University
of Pavia-Hospital Policlinico, San Matteo, Pavia, Italy
(Amarelli, Maiello) Transplant Surgery Department, Hospitals
Colli-Monaldi, Naples, Italy
(Livi, Guzzi) Cardiothoracic Surgery Department, Academic Hospital S.
Maria della Misericordia, Udine, Italy
(MacCherini, Bernazzali) Heart Transplant Surgery Unit, Academic Hospital
Senese, Siena, Italy
(Masciocco, Frigerio) Cardiology 2-Cardiac Insufficiency and
Transplantation Department, Academic Hospital Niguarda, Milan, Italy
(Faggian, Forni) Cardiac Surgery Unit, Academic Hospital Civile Maggiore,
Verona, Italy
(Lilla Della Monica, Musumeci) Cardiac Surgery Unit, Hospital San Camillo
Forlanini, Rome, Italy
(Gerosa, Poggio, Gambino) Cardiac Surgery Unit, Academic Hospital of
Padova, Padua, Italy
(Marraudino, Capone) Cardiac Surgery Unit, Hospital of Bari, Bari, Italy
(Corda, Porcu) Cardiology Unit, Hospital G. Brotzu, San Michele, Cagliari,
Italy
(Boffini, Rinaldi, Ribezzo) Cardiac Surgery Unit, Hospital Molinette,
Turin, Italy
(De Santo) Hospital Monaldi, Naples, Italy
(Tona) Hospital of Monza, Monza, Italy
(Ambrogi) University of Milan, Milan, Italy
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background Although everolimus potentially improves long-term heart
transplantation (HTx) outcomes, its early postoperative safety profile had
raised concerns and needs optimization. Methods This 6-month, open-label,
multicenter randomized trial was designed to compare the cumulative
incidence of a primary composite safety endpoint comprising wound healing
delays, pericardial effusion, pleural effusion needing drainage, and renal
insufficiency events (estimated glomerular filtration rate <=30/mL/min per
1.73 m²) in de novo HTx recipients receiving immediate
everolimus (EVR-I) (<=144 hours post-HTx) or delayed everolimus (EVR-D)
(4-6 weeks post-HTx with mycophenolate mofetil as a bridge) with
reduced-dose cyclosporine A. Cumulative incidence of biopsy-proven
rejection >= 2R, rejection with hemodynamic compromise, graft loss, or
death was the secondary composite efficacy endpoint. Results Overall, 181
patients were randomized to the EVR-I (n = 89) or EVR-D (n = 92) arms.
Incidence of primary safety endpoint was higher for EVR-I than EVR-D arm
(44.9% vs 32.6%; P = 0.191), mainly driven by a higher rate of pericardial
effusion (33.7% vs 19.6%; P = 0.04); wound healing delays, acute renal
insufficiency events, and pleural effusion occurred at similar frequencies
in the study arms. Efficacy failure was not significantly different in
EVR-I arm versus EVR-D arm (37.1% vs 28.3%; P = 0.191). Three patients in
the EVR-I arm and 1 in the EVR-D arm died. Incidence of clinically
significant adverse events leading to discontinuation was higher in EVR-I
arm versus EVR-D arm (P = 0.02). Conclusions Compared with immediate
initiation, delayed everolimus initiation appeared to provide a clinically
relevant early safety benefit in de novo HTx recipients, without
compromising efficacy.<br/>Copyright &#xa9; 2017 The Author(s). Published
by Wolters Kluwer Health, Inc.

<13>
Accession Number
624770347
Title
The Fontan circulation: Contemporary review of ongoing challenges and
management strategies.
Source
Cardiovascular Innovations and Applications. 3 (1) (pp 107-122), 2018.
Date of Publication: 2018.
Author
Kheiwa A.; Agarwal A.; John A.
Institution
(Kheiwa, Agarwal) Division of Cardiology, Department of Medicine,
University of California San Francisco, San Francisco, CA, United States
(John) Division of Cardiology, Department of Pediatrics, Children's
National Health System, George Washington University, 111 Michigan Avenue
Northwest, WW 3rd Floor, Washington, DC 20010, United States
Publisher
Compuscript Ltd (E-mail: m.staunton@compuscript.com)
Abstract
Since its original description, the Fontan operation has been widely used
for the palliation of children with single ventricle physiology and has
resulted in an increasing number of these patients surviving to adulthood.
The Fontan operation is a unique approach to create a circulation in
series without two distinct pumping chambers. Although the Fontan
operation increased the survival rates of patients with single ventricle
physiology, it carries an inevitable risk of long-term morbidities that
impacts the outcomes and quality of life in these patients. In this
review, we discuss the challenges resulting from the unique
pathophysiology of Fontan circulation and propose management
strategies.<br/>Copyright &#xa9; 2018 Cardiovascular Innovations and
Applications.

<14>
Accession Number
624770343
Title
Heart transplantation for adult congenital heart disease: Overview and
special considerations.
Source
Cardiovascular Innovations and Applications. 3 (1) (pp 73-84), 2018. Date
of Publication: 2018.
Author
Gupta D.; Reid J.; Moguillansky D.; Shih R.; Bleiweis M.S.; Fricker F.J.;
Pietra B.A.
Institution
(Gupta, Reid, Moguillansky, Shih, Bleiweis, Fricker, Pietra) Congenital
Heart Center, Department of Pediatrics, UF Health Shands Children's
Hospital, University of Florida, Gainesville, FL, United States
Publisher
Compuscript Ltd (E-mail: m.staunton@compuscript.com)
Abstract
With improvements in their surgical and medical management, the number of
patients with congenital heart disease (CHD) reaching adulthood has
increased over the last decade. As the population of adult CHD patients
continues to rise, an increasing number of these patients will require
evaluation for heart transplantation. It is important to recognize
advanced heart failure and other associated complications early in this
cohort of complex patients for early referral to an adult CHD specialist.
As these patients present with unique challenges because of their multiple
comorbidities and complex anatomy, there needs to be a careful selection
process for transplantation to optimize the utilization of donor
organs.<br/>Copyright &#xa9; 2018 Cardiovascular Innovations and
Applications.

<15>
Accession Number
2001056213
Title
Cost-effectiveness of on-pump and off-pump coronary artery bypass grafting
for patients with coronary artery disease: Results from the MASS III
trial.
Source
International Journal of Cardiology. 273 (pp 63-68), 2018. Date of
Publication: 15 December 2018.
Author
Scudeler T.L.; Hueb W.A.; Farkouh M.E.; Maron D.J.; de Soarez P.C.;
Campolina A.G.; Takiuti M.E.; Rezende P.C.; Godoy L.C.; Hueb A.C.; Lima
E.G.; Garzillo C.L.; Ramires J.A.F.; Kalil Filho R.
Institution
(Scudeler, Hueb, Takiuti, Rezende, Godoy, Hueb, Lima, Garzillo, Ramires,
Kalil Filho) Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP,
Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
(Farkouh, Godoy) Peter Munk Cardiac Centre and the Heart and Stroke
Richard Lewar Centre of Excellence in Cardiovascular Research, University
of Toronto, Toronto, Ontario, Canada
(Maron) Division of Cardiovascular Medicine and Cardiovascular Institute,
Stanford University, Stanford, CA, United States
(de Soarez) Departamento de Medicina Preventiva da Universidade de Sao
Paulo, Sao Paulo, Brazil
(Campolina) Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, Brazil
(Farkouh) 585 University Avenue - 4N474, Toronto, Ontario M5G 2N2, Canada
Publisher
Elsevier Ireland Ltd
Abstract
Background: Recent trials have reported similar clinical outcomes between
on-pump and off-pump coronary artery bypass graft (CABG). However,
long-term cost-effectiveness of these strategies is unknown. Methods: A
prespecified economic study was performed based on the MASS III trial.
Costs were estimated for all patients based on observed healthcare
resource usage over a 5-year follow-up. Health state utilities were
evaluated with the SF-6D questionnaire. Cost-effectiveness was assessed as
cost per quality-adjusted life-year (QALY) gained using a Markov model.
Probabilistic sensitivity analysis with the Monte-Carlo simulation and
cost-effectiveness acceptability curve were used to address uncertainty.
Results: Quality of life improved significantly in both groups during
follow-up compared with baseline. At 5 years, when comparing on-pump and
off-pump CABG groups, no differences were found in cumulative life-years
(4.851 and 4.766 years, P =.319) and QALY gained (4.150 and 4.105 QALYs, P
=.332). Mean cost in US dollars per patient during the trial did not
differ significantly between the on-pump and off-pump groups ($5890.29 and
$5674.75, respectively, P =.409). Over a lifetime horizon, the incremental
cost-effectiveness ratio of on-pump versus off-pump CABG was $12,576 per
QALY gained, which is above the suggested cost-effectiveness threshold
range (from $3210 to 10,122). In the sensitivity analysis, the probability
that on-pump CABG is cost-effective compared to off-pump surgery for a
willingness-to-pay threshold of $3212 per QALY gained was <1%. For the
$10,122 per QALY threshold, the same probability was 35%. Conclusion: This
decision-analytic model suggests that on-pump CABG is not cost-effective
when compared to off-pump CABG from a public health system
perspective.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<16>
Accession Number
2001022665
Title
Dual versus triple therapy in patients on oral anticoagulants and
undergoing coronary stent implantation: A systematic review and
meta-analysis.
Source
International Journal of Cardiology. 273 (pp 80-87), 2018. Date of
Publication: 15 December 2018.
Author
Fortuni F.; Ferlini M.; Leonardi S.; Angelini F.; Crimi G.; Somaschini A.;
Cornara S.; Potenza A.; De Servi S.; Oltrona Visconti L.; De Ferrari G.M.
Institution
(Fortuni, Leonardi, Somaschini, Cornara, De Ferrari) Coronary Care Unit
and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS
Policlinico San Matteo, Pavia, Italy
(Fortuni, Somaschini, Cornara, De Ferrari) Department of Molecular
Medicine, University of Pavia, Pavia, Italy
(Ferlini, Crimi, Potenza, Oltrona Visconti) Division of Cardiology,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(Angelini) Division of Cardiology, University of Torino, Citta della
Salute e della Scienza Hospital, Italy
(De Servi) IRCCS Multimedica, Sesto San Giovanni, Milan, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims: There is contrasting evidence regarding the optimal
antithrombotic regimen after percutaneous coronary stent implantation in
patients on oral anticoagulants. A systematic review and meta-analysis was
performed to explore the comparative efficacy and safety of dual (an
antiplatelet plus an oral anticoagulant) versus triple therapy (dual
antiplatelet therapy plus an oral anticoagulant). Methods: We searched the
literature for randomized controlled trials (RCTs) or observational
studies (OSs) addressing this issue. The efficacy outcomes were all-cause
mortality, cardiovascular mortality, myocardial infarction and stent
thrombosis. The safety outcomes were major bleeding events and all
bleeding events. The analyses were stratified by type of anticoagulant and
of antiplatelet used in dual therapy. Results: Four RCTs and ten OSs met
our inclusion criteria including a total of 10,126 patients. 5671 patients
received triple therapy whereas 4455 received dual therapy. Median follow
up was 12 months. There was no difference between dual therapy and triple
therapy regarding efficacy outcomes. Dual therapy significantly reduced
the risk of major bleeding (RR 0.66; CI 95% 0.52-0.83; P = 0.0005) and of
all bleeding events (RR 0.67, CI 95% 0.55-0.80; P < 0.0001). The effect
was consistent regardless of the type of antiplatelet and anticoagulant
used in dual therapy. Conclusion: Dual antithrombotic therapy after
coronary stenting in anticoagulated patients significantly reduces
bleeding events compared with triple therapy. Dual therapy might be
considered in this setting especially when bleeding risk outweighs
ischemic risk, although our study was not sufficiently powered to detect a
difference in ischemic endpoints.<br/>Copyright &#xa9; 2018

<17>
Accession Number
624788881
Title
A multicenter randomized controlled trial of zephyr endobronchial valve
treatment in heterogeneous emphysema (LIBERATE).
Source
American Journal of Respiratory and Critical Care Medicine. 198 (9) (pp
1151-1164), 2018. Date of Publication: 01 Nov 2018.
Author
Slebos D.-J.; Wiese T.
Institution
(Criner) Department of Thoracic Medicine and Surgery, Lewis Katz School of
Medicine, Temple University, 3501 North Broad Street, Philadelphia, PA
19140, United States
(Sue, Wright) St. Joseph's Hospital and Medical Center, Phoenix, AZ,
United States
(Dransfield) University of Alabama, Birmingham UAB Lung Health Center,
Birmingham, AL, United States
(Rivas-Perez, Wiese) Department of Medicine, University of Louisville,
Louisville, KY, United States
(Sciurba) Division of Pulmonary, Allergy and Critical Care Medicine,
University of Pittsburgh, Pittsburgh, PA, United States
(Shah) Royal Brompton Hospital, Imperial College, London, United Kingdom
(Wahidi) Duke University Medical Center, Duke University, Durham, NC,
United States
(De Oliveira) Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
(Morrissey) Division of Pulmonary Critical Care and Sleep Medicine,
University of California, Davis, Sacramento, CA, United States
(Cardoso) Instituto Do Coracao, Hospital das Clinicas, Universidade de Sao
Paulo, Sao Paulo, Brazil
(Hays) University of California, San Francisco, San Francisco, CA, United
States
(Majid) Interventional Pulmonology, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Pastis) Medical University of South Carolina, Charleston, SC, United
States
(Kopas) Pulmonary Critical Care and Sleep Medicine Consultants, Houston
Methodist, Houston, TX, United States
(Vollenweider) Orlando Health Pulmonary and Sleep Medicine Group, Orlando
Regional Medical Center, Orlando, FL, United States
(McFadden) Keck School of Medicine, University of Southern California, Los
Angeles, CA, United States
(Machuzak) Center for Major Airway Diseases, Cleveland Clinic Foundation,
Respiratory Institute, Cleveland, OH, United States
(Hsia) Los Angeles Biomedical Research Institute, Harbor-University of
California Los Angeles, Torrance, CA, United States
(Sung) Stanford Hospital and Clinics, Stanford, CA, United States
(Jarad) University Hospital Bristol NHS Foundation Trust, Bristol, United
Kingdom
(Kornaszewska) Department of Cardiothoracic Surgery, University Hospital
of Wales, Cardiff, United Kingdom
(Hazelrigg) Division of Cardiothoracic Surgery, Southern Illinois
University, School of Medicine, Springfield, IL, United States
(Krishna) Palo Alto Medical Foundation, El Camino Hospital, Mountain View,
CA, United States
(Armstrong) QST Consultations Ltd., Allendale, MI, United States
(Shargill) Pulmonx Corporation, Redwood City, CA, United States
(Slebos) Department of Pulmonary Diseases, University of Groningen,
University Medical Center Groningen, Groningen, Netherlands
Publisher
American Thoracic Society (E-mail: malexander@thoracic.org)
Abstract
Rationale: This is the first multicenter randomized controlled trial to
evaluate the effectiveness and safety of Zephyr Endobronchial Valve (EBV)
in patients with little to no collateral ventilation out to 12 months.
Objectives: To evaluate the effectiveness and safety of Zephyr EBV in
heterogeneous emphysema with little to no collateral ventilation in the
treated lobe. Methods: Subjects were enrolled with a 2:1 randomization
(EBV/standard of care [SoC]) at 24 sites. Primary outcome at 12 months was
the DELTAEBV-SoC of subjects with a post-bronchodilator FEV<inf>1</inf>
improvement from baseline of greater than or equal to 15%. Secondary
endpoints included absolute changes in postbronchodilator FEV<inf>1</inf>,
6-minute-walk distance, and St. George's Respiratory Questionnaire scores.
Measurements and Main Results: A total of 190 subjects (128 EBV and 62
SoC) were randomized. At 12 months, 47.7% EBV and 16.8% SoC subjects had a
DELTAFEV<inf>1</inf> greater than or equal to 15% (P, 0.001). DELTAEBV-SoC
at 12 months was statistically and clinically significant: For
FEV<inf>1</inf>, 0.106 L (P,0.001); 6-minute-walk distance, 139.31 m (P =
0.002); and St. George's Respiratory Questionnaire, 27.05 points (P =
0.004). Significant DELTAEBV-SoC were also observed in hyperinflation
(residual volume, 2522 ml; P,0.001), modified Medical Research Council
Dyspnea Scale (20.8 points; P,0.001), and the BODE (body mass index,
airflow obstruction, dyspnea, and exercise capacity) index (21.2 points).
Pneumothorax was the most common serious adverse event in the treatment
period (procedure to 45 d), in 34/128 (26.6%) of EBV subjects. Four deaths
occurred in the EBV group during this phase, and one each in the EBV and
SoC groups between 46 days and 12 months. Conclusions: Zephyr EBV provides
clinically meaningful benefits in lung function, exercise tolerance,
dyspnea, and quality of life out to at least 12 months, with an acceptable
safety profile in patients with little or no collateral ventilation in the
target lobe. Clinical trial registered with www.clinicaltrials.gov (NCT
01796392).<br/>Copyright &#xa9; 2018 by the American Thoracic Society.

<18>
Accession Number
2001242422
Title
Comparison of immediate and 6-month follow-up results of percutaneous
transseptal mitral commissurotomy in patients of rheumatic mitral stenosis
in sinus rhythm and atrial fibrillation - An echocardiographic and
haemodynamic study.
Source
Indian Heart Journal. Conference: 70th Annual Conference of Cardiological
Society of India. India. 70 (Supplement 2) (pp S79), 2018. Date of
Publication: November 2018.
Author
P K.; P.K D.
Institution
(P, P.K) Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield,
Bangalore, India
Publisher
Elsevier B.V.
Abstract
Background: The outcomes of percutaneous transseptal mitral commissurotomy
in patients of rheumatic mitral stenosis in atrial fibrillation are
considered to be inferior to outcomes of percutaneous transseptal mitral
commissurotomy in rheumatic mitral stenosis patients in normal sinus
rhythm. Methods: Prospective randomized, open-label,case- control study.
One hundred patients of symptomatic moderate to severe rheumatic mitral
stenosis in sinus rhythm scheduled to undergo percutaneous transseptal
mitral commissurotomy were consecutively recruited and compared with one
hundred patients of symptomatic moderate to severe rheumatic mitral
stenosis in atrial fibrillation scheduled for balloon mitral valvotomy.
Results: 42% patients of patients in sinus rhythm were males and 58 % were
female patients, while in the AF group, there were 47 % male patients to
53 % female patients. The mean Mitral valve area achieved was
significantly higher-1.719+/-0.17 sq cm in the sinus rhythm arm versus
1.383+/-0.21 sq cm in the AF arm (p< 0.001),the mean gradient across the
mitral valve was 4.86+/-0.88 mm Hg in the sinus rhythm arm versus
6.17+/-1.31mm Hg in the AF rhythm arm(p< 0.001). RV systolic pressure was
the same after PTMC in the SR arm (32.47+/-4.92 mm Hg after PTMC versus
54.13+/-9.53 mmHg after PTMC in the AF arm). More patients in the AF arm
returned to "severe" mitral restenosis (MVA -1.251+/-0.15 sq cm in AF arm
at 6 months), as compared to more patients who remained as "mild" mitral
restenosis in the SR arm (avg MVA at 6 months 1.659+/-0.18 sq cm) (p<
0.001). Conclusions: Balloon mitral commissurotomy yields good results in
patients both in sinus rhythm and in atrial fibrillation but both the
immediate and 6-month outcomes are significantly better in patients with
sinus rhythm.The acute gain in valve area is better in patients with sinus
rhythm, and the valve area attrition after 6 months is significantly
lesser in sinus rhythm than in atrial fibrillation.<br/>Copyright &#xa9;
2018

<19>
Accession Number
624832309
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 & circulation. 27 (12) (pp 1437-1445), 2018. Date of
Publication: 01 Dec 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; School of Medicine,
University of Queensland, Brisbane, Qld, Australia
Publisher
NLM (Medline)
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).
Published by Elsevier B.V. All rights reserved.

<20>
Accession Number
624852480
Title
Quality of life in patients with coronary artery disease treated with
coronary artery bypass grafting and hybrid coronary revascularization.
Source
Cardiology journal. 25 (5) (pp 621-627), 2018. Date of Publication: 2018.
Author
Gierszewska K.; Jaworska I.; Skrzypek M.; Gasior M.; Pudlo R.
Institution
(Gierszewska) 3rd Department of Cardiology, School of Medicine with the
Division of Dentistry in Zabrze, Medical University of Silesia, Silesian
Centre for Heart Disease in Zabrze, Katowice, Poland
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients with stable coronary artery disease (CAD) have a
worse quality of life (QoL) in comparison to patients without stable CAD.
Standardized questionnaires are used in evaluation of QoL. Hybrid coronary
revascularization (HCR) is a recently-introduced, minimally invasive
option for patients requiring revascularization for coronary lesions. The
aim of this study was to assess healthrelated quality of life (HRQoL) in
patients with multivessel CAD (MVCAD), according to the mode of
revascularization: coronary artery bypass grafting (CABG) or HCR, using
the generic SF-36 v.2 questionnaire. METHODS: From November 2009 to July
2012, 200 patients from POLMIDES study with diagnosed MVCAD and were
referred for conventional CABG were randomized to HCR (n = 98) or CABG (n
=102) groups in 1:1 ratio. HRQoL were measured at two time points:
hospital admission and 12-month follow up. The primary endpoint was the
difference in HRQoL after the procedure. RESULTS: Both groups showed the
same improvement of HRQoL: in HCR group: 13.5 (3.82-22.34) vs. CABG group:
10.48 (2.46-31.07); p = 0.76. CONCLUSIONS: HRQoL in patients after both
modes of revascularization significantly improved after 12 months in all
domains.

<21>
Accession Number
624819538
Title
High-Versus Low-Dose Warfarin-Related Teratogenicity: A Case Report and
Systematic Review.
Source
Journal of obstetrics and gynaecology Canada : JOGC = Journal
d'obstetrique et gynecologie du Canada : JOGC. 40 (10) (pp 1348-1357),
2018. Date of Publication: 01 Oct 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
NLM (Medline)
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 (<=5mg 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 (14.5-16.5mg 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. Published by
Elsevier Inc. All rights reserved.

<22>
Accession Number
2000985828
Title
Dual versus single antiplatelet therapy after coronary artery bypass graft
surgery: An updated meta-analysis.
Source
International Journal of Cardiology. 269 (pp 80-88), 2018. Date of
Publication: 15 October 2018.
Author
Cardoso R.; Knijnik L.; Whelton S.P.; Rivera M.; Gluckman T.J.; Metkus
T.S.; Blumenthal R.S.; McEvoy J.W.
Institution
(Cardoso, Whelton, Gluckman, Metkus, Blumenthal, McEvoy) Ciccarone Center
for the Prevention of Cardiovascular Disease, Division of Cardiology,
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD,
United States
(Knijnik, Rivera) Division of Cardiology, Department of Medicine,
University of Miami-Jackson Memorial Hospital, Miami, FL, United States
(Gluckman) Center for Cardiovascular Analytics, Research, and Data Science
(CARDS), Providence Heart Institute, Providence St. Joseph Health,
Portland, OR, United States
Publisher
Elsevier Ireland Ltd
Abstract
Introduction: The potential benefit and risks of dual antiplatelet therapy
(DAPT) over single antiplatelet therapy (SAPT) in patients who undergo
coronary artery bypass graft surgery (CABG) is controversial. Methods: We
performed a systematic review and meta-analysis of observational and
randomized clinical trial (RCT) data comparing DAPT to SAPT following
urgent or elective CABG. Subanalyses were performed restricted to: a)
RCTs; b) stable ischemic heart disease (SIHD); c) extended duration DAPT
(>=6 months); and d) follow-up >=2 years. Results: Twenty-two studies
comprising 20,315 patients undergoing CABG were included. Of the
participants studied, 7481 (37%) received postoperative DAPT and 12,834
(63%) received SAPT. Overall, DAPT was associated with a lower
cardiovascular (CV) mortality (OR 0.67; p = 0.02) and a trend towards
lower all-cause mortality (OR 0.78; p = 0.08). There were no differences
in rates of myocardial infarction or stroke. Subanalyses in RCTs, SIHD,
and prolonged follow-up failed to demonstrate improvement in these
outcomes with DAPT. However, in studies with extended duration DAPT,
stroke was significantly reduced in the DAPT group (OR 0.47; p = 0.04).
Saphenous vein graft (SVG) occlusion up to 1 year after CABG was
significantly lower with DAPT overall (OR 0.64; p < 0.01) and in the RCT
subanalysis (OR 0.58; p < 0.01). Major bleeding was significantly higher
with DAPT (OR 1.31; p = 0.03). Conclusion: While DAPT has been associated
with lower CV mortality in observational samples undergoing CABG, such
findings were not replicated in RCTs. Lower rates of SVG occlusion with
DAPT are offset by a higher rate of major bleeding.<br/>Copyright &#xa9;
2018 Elsevier B.V.

<23>
Accession Number
2000720041
Title
Additional Physical Therapy Services Reduce Length of Stay and Improve
Health Outcomes in People With Acute and Subacute Conditions: An Updated
Systematic Review and Meta-Analysis.
Source
Archives of Physical Medicine and Rehabilitation. 99 (11) (pp 2299-2312),
2018. Date of Publication: November 2018.
Author
Peiris C.L.; Shields N.; Brusco N.K.; Watts J.J.; Taylor N.F.
Institution
(Peiris, Shields, Brusco, Taylor) La Trobe University, College of Science,
Health and Engineering, Department of Rehabilitation, Nutrition and Sport,
School of Allied Health(Physiotherapy), Melbourne, Australia
(Shields) Northern Health, Northern Centre for Health Education and
Research, Epping, United Kingdom
(Brusco) Cabrini Health, Physiotherapy, Malvern, United Kingdom
(Watts) Deakin University, School of Health and Social Development,
Faculty of Health, Burwood, Australia
(Taylor) Eastern Health, Eastern Health Clinical Research Office, Box
Hill, Australia
Publisher
W.B. Saunders
Abstract
Objective: To update a previous review on whether additional physical
therapy services reduce length of stay, improve health outcomes, and are
safe and cost-effective for patients with acute or subacute conditions.
Data Sources: Electronic database (AMED, CINAHL, EMBASE, MEDLINE,
Physiotherapy Evidence Database [PEDro], PubMed) searches were updated
from 2010 through June 2017. Study Selection: Randomized controlled trials
evaluating additional physical therapy services on patient health
outcomes, length of stay, or cost-effectiveness were eligible. Searching
identified 1524 potentially relevant articles, of which 11 new articles
from 8 new randomized controlled trials with 1563 participants were
selected. In total, 24 randomized controlled trials with 3262 participants
are included in this review. Data Extraction: Data were extracted using
the form used in the original systematic review. Methodological quality
was assessed using the PEDro scale, and the Grading of Recommendation
Assessment, Development, and Evaluation approach was applied to each
meta-analysis. Data synthesis: Postintervention data were pooled with an
inverse variance, random-effects model to calculate standardized mean
differences (SMDs) and 95% confidence intervals (CIs). There is
moderate-quality evidence that additional physical therapy services
reduced length of stay by 3 days in subacute settings (mean difference
[MD]=-2.8; 95% CI, -4.6 to -0.9; I²=0%), and low-quality
evidence that it reduced length of stay by 0.6 days in acute settings
(MD=-0.6; 95% CI, -1.1 to 0.0; I²=65%). Additional physical
therapy led to small improvements in self-care (SMD=.11; 95% CI,.03-.19;
I²=0%), activities of daily living (SMD=.13; 95% CI,.02-.25;
I²=15%), and health-related quality of life (SMD=.12; 95%
CI,.03-.21; I²=0%), with no increases in adverse events. There
was no significant change in walking ability. One trial reported that
additional physical therapy was likely to be cost-effective in subacute
rehabilitation. Conclusions: Additional physical therapy services improve
patient activity and participation outcomes while reducing hospital length
of stay for adults. These benefits are likely safe, and there is
preliminary evidence to suggest they may be cost-effective.<br/>Copyright
&#xa9; 2018 American Congress of Rehabilitation Medicine

<24>
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)

<25>
Accession Number
2001193010
Title
Targeted therapy with a localised abluminal groove, low-dose
sirolimus-eluting, biodegradable polymer coronary stent (TARGET All
Comers): a multicentre, open-label, randomised non-inferiority trial.
Source
The Lancet. 392 (10153) (pp 1117-1126), 2018. Date of Publication: 29
September - 5 October 2018.
Author
Lansky A.; Wijns W.; Xu B.; Kelbaek H.; van Royen N.; Zheng M.; Morel
M.-A.; Knaapen P.; Slagboom T.; Johnson T.W.; Vlachojannis G.; Arkenbout
K.E.; Holmvang L.; Janssens L.; Ochala A.; Brugaletta S.; Naber C.K.;
Anderson R.; Rittger H.; Berti S.; Barbato E.; Toth G.G.; Maillard L.;
Valina C.; Buszman P.; Thiele H.; Schachinger V.; Baumbach A.
Institution
(Lansky, Baumbach) Yale University School of Medicine, New Haven, CT,
United States
(Lansky, Baumbach) Barts Heart Centre, London and Queen Mary University of
London, London, United Kingdom
(Wijns) The Lambe Institute for Translational Medicine and Curam, National
University of Ireland, Galway and Saolta University Healthcare Group,
University College Hospital Galway, Galway, Ireland
(Xu) Fu Wai Hospital, National Centre for Cardiovascular Diseases, Chinese
Academy of Medical Sciences, Beijing, China
(Kelbaek) Department of Cardiology, Roskilde University Hospital,
Roskilde, Denmark
(van Royen, Knaapen) Department of Cardiology, VU University Medical
Centre, Amsterdam, Netherlands
(Zheng) Shanghai MicroPort Medical (Group), Shanghai, China
(Morel) Cardialysis, Rotterdam, Netherlands
(Slagboom) Amsterdam Department of Interventional Cardiolody, Onze Lieve
Vrouwe Gasthuis, Amsterdam, Netherlands
(Johnson) Bristol Heart Institute, University Hospitals Bristol NHS
Foundation Trust, Bristol, United Kingdom
(Vlachojannis) Department of Cardiology, Maasstad Ziekenhuis, Rotterdam,
Netherlands
(Arkenbout) Department of Cardiology, Tergooi Ziekenhuis, Blaricum,
Netherlands
(Holmvang) Department of Cardiology, Rigshospitalet, Copenhagen University
Hospital, Copenhagen, Denmark
(Janssens) Heart Centre, Imelda Ziekenhuis, Bonheiden, Belgium
(Ochala) Department of Invasive Cardiology, Silesian Medical University,
Katowice, Poland
(Brugaletta) Cardiovascular Institute, Hospital Clinic, Institut
d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona,
Spain
(Naber) Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus, Essen,
Germany
(Anderson) Department of Cardiology, University Hospital of Wales,
Cardiff, United Kingdom
(Rittger) Medizinische Klinik I, Klinikum Furth, University of Erlangen,
Furth, Germany
(Berti) UOC Cardiologia Diagnostica ed Interventistica, Fondazione CNR Reg
Toscana G Monasterio, Ospedale del Cuore, Massa, Italy
(Barbato) Cardiovascular Research Centre Aalst, OLV Hospital, Aalst,
Belgium
(Barbato) Department of Advanced Biomedical Sciences, University of Naples
Federico II, Italy
(Toth) Department of Cardiology, Medical University of Graz, Graz, Austria
(Maillard) Service de Cardiologie, Clinique Axium, Aix-en-Provence, France
(Valina) Klinik fur Kardiologie und Angiologie II,
Universitats-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
(Buszman) American Heart of Poland, Katowice, Poland
(Thiele) Herzzentrum Leipzig, Leipzig, Germany
(Schachinger) Medizinische Klinik I, Herz-Thorax Zentrum, Klinikum Fulda,
Fulda, Germany
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: The FIREHAWK is a drug-eluting stent with a fully
biodegradable sirolimus-containing polymer coating localised to recessed
abluminal grooves on the stent surface. We investigated clinical outcomes
with this targeted, low-dose, biodegradable polymer, sirolimus-eluting
stent compared with XIENCE durable polymer, everolimus-eluting stents in
an all-comers population. Methods: The TARGET All Comers study was a
prospective, multicentre, open-label randomised non-inferiority trial done
at 21 centres in ten European countries. Patients with symptomatic or
asymptomatic coronary artery disease and objective evidence of myocardial
ischaemia who qualified for percutaneous coronary intervention were
randomised 1:1 to undergo implantation of a FIREHAWK or XIENCE.
Randomisation was web-based, with random block allocation and
stratification by centre and ST elevation myocardial infarction. Outcome
assessors were masked to treatment allocation, but treating physicians and
patients were not. The primary endpoint was target lesion failure at 12
months, a composite of cardiac death, target vessel myocardial infarction,
or ischaemia-driven target lesion revascularisation. The control event
rate for XIENCE was assumed to be 7%, the non-inferiority margin was 3.5%,
and the primary analysis was in the intention-to-treat population,
censoring patients who did not have either an event before 365 days or
contact beyond 365 days. Late lumen loss was the primary endpoint of an
angiographic substudy designed to investigate the non-inferiority of the
FIREHAWK compared with the XIENCE stent. This trial is registered with
ClinicalTrials.gov, number NCT02520180. Findings: From Dec 17, 2015, to
Oct 14, 2016, 1653 patients were randomly assigned to implantation of the
FIREHAWK (n=823) or XIENCE (n=830). 65 patients in the FIREHAWK group and
66 in the XIENCE group had insufficient follow-up data and were excluded
from the analyses. At 12 months, target lesion failure occurred in 46
(6.1%) of 758 patients in the FIREHAWK group and in 45 (5.9%) of 764
patients in the XIENCE group (difference 0.2%, 90% CI -1.9 to 2.2,
p<inf>non-inferiority</inf>=0.004, 95% CI -2.2 to 2.6,
p<inf>superiority</inf>=0.88). There were no differences in
ischaemia-driven revascularisation or stent thrombosis rates at 12 months.
176 patients were included in the angiographic substudy, in which in-stent
late lumen loss was 0.17 mm (SD 0.48) in the FIREHAWK group and 0.11 mm
(0.52) in the XIENCE group (p=0.48), with an absolute difference of 0.05
mm (95% CI -0.09 to 0.18, p<inf>non-inferiority</inf>=0.024).
Interpretation: In a broad all-comers population of patients requiring
stent implantation for myocardial ischaemia, the FIREHAWK was non-inferior
to the XIENCE as assessed with the primary endpoint of target lesion
failure at 12 months and in-stent late lumen loss at 13 months. The
FIREHAWK is a safe and effective alternative stent to treat patients with
ischaemic coronary artery disease in clinical practice. Funding: Shanghai
Microport Medical.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<26>
Accession Number
624784122
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) (no pagination), 2018.
Article Number: 009917. Date of Publication: 01 Oct 2018.
Author
van Diepen S.; Norris C.M.; Zheng Y.; Nagendran J.; Graham M.M.; Ortega
D.G.; Townsend D.R.; Ezekowitz J.A.; Bagshaw S.M.
Institution
(van Diepen, Norris, Ortega, Townsend, Bagshaw) Department of Critical
Care Medicine, Faculty of Medicine and Dentistry, University of Alberta,
Edmonton, AB, Canada
(van Diepen, Graham, Ezekowitz) Division of Cardiology, Department of
Medicine, University of Alberta, Edmonton, AB, Canada
(van Diepen, Zheng, Ezekowitz) Canadian VIGOUR Center, University of
Alberta, Edmonton, AB, Canada
(Norris) Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
(Norris, Nagendran) Division of Cardiac Surgery, University of Alberta
Hospital, Edmonton, AB, Canada
(van Diepen, Graham, Ezekowitz) C2 Cardiology Walter MacKenzie Center,
University of Alberta Hospital, 8440-112 St, Edmonton, AB T6G 2B7, Canada
Publisher
American Heart Association Inc.
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 ARBs 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.<br/>Copyright &#xa9; 2018 The Authors.

<27>
Accession Number
624079539
Title
International consensus statement on the peri-operative management of
direct oral anticoagulants in cardiac surgery.
Source
Anaesthesia. 73 (12) (pp 1535-1545), 2018. Date of Publication: December
2018.
Author
Erdoes G.; Martinez Lopez De Arroyabe B.; Bolliger D.; Ahmed A.B.; Koster
A.; Agarwal S.; Boer C.; von Heymann C.
Institution
(Erdoes) Department of Anaesthesiology and Pain Medicine, Inselspital,
University Hospital Bern, University of Bern, Bern, Switzerland
(Martinez Lopez De Arroyabe) Cardiac Anaesthesia Unit, Department of
Emergency, University Hospital of Trieste, Trieste, Italy
(Bolliger) Department of Anaesthesia, Surgical Intensive Care, Prehospital
Emergency Medicine, and Pain Therapy, University Hospital Basel, Basel,
Switzerland
(Ahmed) Department of Anaesthesia, University Hospitals of Leicester NHS
Trust, Leicester, United Kingdom
(Ahmed) Department of Cardiovascular Sciences, University of Leicester,
Leicester, United Kingdom
(Koster) Institute for Anaesthesiology, Heart and Diabetes Centre NRW,
Ruhr-University Bochum, Bad Oeynhausen, Germany
(Agarwal) Department of Anaesthesia, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
(Boer) Department of Anaesthesiology, VU University Medical Centre,
Amsterdam, Netherlands
(von Heymann) Department of Anaesthesia, Intensive Care Medicine,
Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain,
Berlin, Germany
Publisher
Blackwell Publishing Ltd
Abstract
Despite current recommendations on the management of severe peri-operative
bleeding, there is no pragmatic guidance for the peri-operative monitoring
and management of cardiac surgical patients taking direct oral
anticoagulants. Members of the Transfusion and Haemostasis Subcommittee of
the European Association of Cardiothoracic Anaesthesiology, of their own
volition, performed an independent systematic review of peer-reviewed
original research, review articles and case reports and developed the
following consensus statement. This has been endorsed by the European
Association of Cardiothoracic Anaesthesiology. In our opinion, most
patients on direct oral anticoagulant therapy presenting for elective
cardiac surgery can be safely managed in the peri-operative period if the
following conditions are fulfilled: direct oral anticoagulants have been
discontinued two days before cardiac surgery, corresponding to five
elimination half-live periods; in patients with renal or hepatic
impairment or a high risk of bleeding, a pre-operative plasma level of
direct oral anticoagulants has been determined and found to be below 30
ng.ml^-1 (currently only valid for dabigatran, rivaroxaban and
apixaban). In cases where plasma level monitoring is not possible (e.g.
assay was not available), discontinuation for 10 elimination half-live
periods (four days) is required. For FXa inhibitors, a standard
heparin-calibrated anti-Xa level of < 0.1 IU.ml^-1 should be
measured, indicating sufficient reduction in the anticoagulant effect.
Finally, short-term bridging with heparin is not required in the
pre-operative period.<br/>Copyright &#xa9; 2018 Association of
Anaesthetists

<28>
Accession Number
619924372
Title
Med-Score 24: A multivariable prediction model for poststernotomy
mediastinitis 24 hours after admission to the intensive care unit.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (3) (pp 1041-1051.e5),
2018. Date of Publication: March 2018.
Author
Nieto-Cabrera M.; Fernandez-Perez C.; Garcia-Gonzalez I.; Martin-Benitez
J.C.; Ferrero J.; Bringas M.; Carnero M.; Maroto L.; Sanchez-Garcia M.
Institution
(Nieto-Cabrera, Garcia-Gonzalez, Martin-Benitez, Ferrero, Bringas,
Sanchez-Garcia) Critical Care Department, Hospital Clinico San Carlos,
Madrid, Spain
(Fernandez-Perez) Preventive Medicine Service, Hospital Clinico San
Carlos, Madrid, Spain
(Carnero, Maroto) Cardiac Surgery Department, Hospital Clinico San Carlos,
Madrid, Spain
(Fernandez-Perez) Instituto de Investigacion Sanitaria IdISSC, Hospital
Clinico San Carlos, Madrid, Spain
(Nieto-Cabrera, Bringas) Faculty of Medicine, Universidad Alfonso X el
Sabio, Madrid, Spain
(Fernandez-Perez, Martin-Benitez, Sanchez-Garcia) Faculty of Medicine,
Universidad Complutense de Madrid, Madrid, Spain
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Mediastinitis is a serious complication of heart surgery. In
this study, we developed a bedside risk score for poststernotomy
mediastinitis. Methods: Data were prospectively collected from 4625
patients admitted to our intensive care unit after heart surgery (January
2005-June 2011). Mediastinitis was defined according to Centers for
Disease Control and Prevention criteria. A logistic model was constructed
in a randomly selected subgroup of 2618 patients and validated in a second
cohort of 1352, as well as in a prospective cohort of 2615 (June
2011-December 2015). Model discriminatory power was assessed according to
the area under the receiver operating characteristic curve (AUROC). The
beta coefficients of the model were used to define 3 levels of
mediastinitis risk as a score designated Med-Score 24. Its performance to
predict mediastinitis was compared with that of the logistic EuroSCORE and
Society of Thoracic Surgeons score. Results: Ninety-four (2.36%) patients
developed mediastinitis. The risk factors identified as predictive of
mediastinitis (AUROC 0.80) were 4 preoperative variables (age >70 years,
chronic obstructive lung disease, obesity, and antiplatelet therapy) and 3
perioperative variables (prolonged ischemia, emergency reoperation, and
prolonged intubation). AUROCs for the Society of Thoracic Surgeons score
and logistic EuroSCORE were 0.63 and 0.55, respectively, both differing
significantly from the area calculated for Med-Score 24 (P <.001).
Conclusions: The score developed showed excellent predictive power 24
hours after admission to the intensive care unit for mediastinitis risk.
This simple tool helps stratify patients according to this risk, thus
identifying high-risk patients for preventive measures. In our patient
cohort, Med-Score 24 performed better than other scores used for this
purpose.<br/>Copyright &#xa9; 2017 The American Association for Thoracic
Surgery

<29>
Accession Number
619999804
Title
Relation Between Renin-Angiotensin System Blockers and Survival Following
Isolated Aortic Valve Replacement for Aortic Stenosis.
Source
American Journal of Cardiology. 121 (4) (pp 455-460), 2018. Date of
Publication: 15 February 2018.
Author
Magne J.; Guinot B.; Le Guyader A.; Begot E.; Marsaud J.-P.; Mohty D.;
Aboyans V.
Institution
(Magne, Guinot, Begot, Mohty, Aboyans) CHU Limoges, Hopital Dupuytren,
Service Cardiologie, Limoges, France
(Magne, Mohty, Aboyans) INSERM 1094, Faculte de medecine de Limoges,
Limoges, France
(Le Guyader) CHU Limoges, Hopital Dupuytren, Service de Chirurgie
cardiaque, Limoges, France
(Marsaud) CHU Limoges, Hopital Dupuytren, Service de soins critiques
thorax, Limoges, France
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Renin-angiotensin system blockers (RASb) improve cardiac remodeling, but
their clinical utility after surgical aortic valve replacement (SAVR) for
aortic stenosis (AS) is unclear. We aimed to assess the impact of RASb on
short- and long-term survival following isolated SAVR for severe AS. From
January 2005 to January 2014, 508 consecutive patients had isolated SAVR
for severe AS. Patients with RASb (n = 286; 53%) were more often female (p
= 0.039), hypertensive (p < 0.0001), and diabetic (p = 0.004), with higher
body mass index (p < 0.0001) and EuroSCORE II (p = 0.025), and lower mean
aortic pressure gradient (p = 0.011). The 30-day mortality was similar in
both groups (RASb: 3% vs no RASb: 5.8%, p = 0.13), but lower under
angiotensin receptor blockers (ARB) than angiotensin-converting enzyme
inhibitors (ACEi; 0.7% vs 5.6%, p = 0.017). Patients under RASb had a
better 8-year survival than those without RASb (83 +/- 3% vs 52 +/- 5%, p
< 0.0001), confirmed in a propensity score-matched pairs analysis (82 +/-
4% vs 50 +/- 7%, p < 0.0001). Regarding different types of RASb, patients
under ARB had lower mortality than those under ACEi (87 +/- 3% vs 79 +/-
4%, p = 0.028). In multivariate analysis, the use of RASb was associated
with improved survival (hazard ratio = 0.31, 95% confidence interval 0.20
to 0.47, p < 0.0001), with lower mortality under ARB than under ACEi
(hazard ratio = 0.39, 95% confidence interval 0.18 to 0.85, p = 0.018). In
this observational study, the use of RASb was associated with improved
long-term outcome after isolated SAVR for severe AS. A randomized clinical
trial is mandatory.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<30>
Accession Number
623266506
Title
The effect of high-flow nasal oxygen on hospital length of stay in cardiac
surgical patients at high risk for respiratory complications: a randomised
controlled trial.
Source
Anaesthesia. 73 (12) (pp 1478-1488), 2018. Date of Publication: December
2018.
Author
Zochios V.; Collier T.; Blaudszun G.; Butchart A.; Earwaker M.; Jones N.;
Klein A.A.
Institution
(Zochios) Department of Intensive Care Medicine, University Hospitals
Birmingham National Health Service Foundation Trust, Queen Elizabeth
Hospital Birmingham, University of Birmingham, United Kingdom
(Collier) Medical Statistics Department, London School of Hygiene and
Tropical Medicine, London, United Kingdom
(Blaudszun) Department of Anaesthesia, Pharmacology and Intensive Care
Medicine, Geneva University Hospitals, Geneve, Switzerland
(Butchart, Jones, Klein) Department of Cardiothoracic Anaesthesia and
Intensive Care Medicine, Royal Papworth Hospital National Health Service
Foundation Trust, Cambridge, United Kingdom
(Earwaker) Research and Development Department, Royal Papworth Hospital
National Health Service Foundation Trust, Cambridge, United Kingdom
(Jones, Klein) Department of Anaesthesia and Intensive Care, Royal
Papworth Hospital National Health Service Foundation Trust, Cambridge,
United Kingdom
Publisher
Blackwell Publishing Ltd
Abstract
There has been increased interest in the prophylactic and therapeutic use
of high-flow nasal oxygen in patients with, or at risk of, non-hypercapnic
respiratory failure. There are no randomised trials examining the efficacy
of high-flow nasal oxygen in high-risk cardiac surgical patients. We
sought to determine whether routine administration of high-flow nasal
oxygen, compared with standard oxygen therapy, leads to reduced hospital
length of stay after cardiac surgery in patients with pre-existing
respiratory disease at high risk for postoperative pulmonary
complications. Adult patients with pre-existing respiratory disease
undergoing elective cardiac surgery were randomly allocated to receive
high-flow nasal oxygen (n = 51) or standard oxygen therapy (n = 49). The
primary outcome was hospital length of stay and all analyses were carried
out on an intention-to-treat basis. Median (IQR [range]) hospital length
of stay was 7 (6-9 [4-30]) days in the high-flow nasal oxygen group and 9
(7-16 [4-120]) days in the standard oxygen group (p=0.012). Geometric mean
hospital length of stay was 29% lower in the high-flow nasal group (95%CI
11-44%, p = 0.004). High-flow nasal oxygen was also associated with fewer
intensive care unit re-admissions (1/49 vs. 7/45; p = 0.026). When
compared with standard care, prophylactic postoperative high-flow nasal
oxygen reduced hospital length of stay and intensive care unit
re-admission. This is the first randomised controlled trial examining the
effect of prophylactic high-flow nasal oxygen use on patient-centred
outcomes in cardiac surgical patients at high risk for postoperative
respiratory complications.<br/>Copyright &#xa9; 2018 The Authors.
Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of
Anaesthetists.

<31>
Accession Number
2001266142
Title
Randomised trial comparing forced-air warming to the upper or lower body
to prevent hypothermia during thoracoscopic surgery in the lateral
decubitus position.
Source
British Journal of Anaesthesia. 120 (3) (pp 555-562), 2018. Date of
Publication: March 2018.
Author
Min S.-H.; Yoon S.; Yoon S.-H.; Bahk J.-H.; Seo J.-H.
Institution
(Min, Yoon, Yoon, Bahk, Seo) Department of Anaesthesiology and Pain
Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu,
Seoul 03080, South Korea
Publisher
Elsevier Ltd
Abstract
Background: In the supine position, forced-air warming is more effective
on the lower body than on the upper body to prevent intraoperative
hypothermia. However, it is unknown in the lateral decubitus position. We
thus compared forced-air warming on the upper and lower bodies in the
lateral position. Methods: Patients (n=123) were randomised to receive
forced-air warming on the upper body or lower body during thoracoscopic
surgery in the lateral position. We measured the nasopharyngeal
temperature at 0, 30, 60, 90, and 120 min after lateral positioning during
surgery and the infrared tympanic membrane temperature at 0, 30, 60, 90,
and 120 min after surgery. Patients received both upper and lower body
warming at a temperature of <35.5degreeC. The primary outcome was the
incidence of intraoperative hypothermia with a temperature of
<36.0degreeC. Results: Intraoperative hypothermia was less frequent with
the upper body warming than with the lower body warming {21/62 vs 35/61,
risk ratio [95% confidence interval (CI)] 0.6 (0.4-0.9), P=0.011}. The
intraoperative temperature was higher with the upper body warming than
with the lower body warming at 30 (P=0.002), 60 (P<0.001), and 90
(P<0.001) min after lateral positioning, and the postoperative temperature
was higher at 0 (P<0.001) and 30 (P=0.001) min after surgery. Fewer
patients received both upper and lower body warming in the upper body
warming group than in the lower body warming group during surgery (1 vs 7,
P=0.032). Conclusions: Forced-air warming was more effective on the upper
body than on the lower body to prevent hypothermia during thoracoscopic
surgery in the lateral decubitus position. Clinical trial registration:
NCT02993666.<br/>Copyright &#xa9; 2017 British Journal of Anaesthesia

<32>
Accession Number
2001254585
Title
Prophylactic Effect of Amiodarone Infusion on Reperfusion Ventricular
Fibrillation After Release of Aortic Cross-Clamp in Patients with Left
Ventricular Hypertrophy Undergoing Aortic Valve Replacement: A Randomized
Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Author
Mita N.; Kagaya S.; Miyoshi S.; Kuroda M.
Institution
(Mita, Kagaya, Miyoshi) Department of Anesthesiology, Saitama
Cardiovascular and Respiratory Center, Kumagaya City, Saitama, Japan
(Kuroda) Department of Anesthesiology, Saiseikai Utsunomiya Hospital,
Utsunomiya City, Tochigi, Japan
Publisher
W.B. Saunders
Abstract
Objective: To investigate whether prophylactic amiodarone infusion
prevents ventricular fibrillation after aortic cross-clamp release and
attenuates cytokine production in patients with left ventricular
hypertrophy undergoing cardiac surgery. Design: Prospective, randomized
controlled trial. Setting: A public hospital. Participants: The study
comprised 68 patients undergoing aortic valve replacement for severe
aortic stenosis. Interventions: Patients were randomly assigned to receive
a 150 mg bolus then 30 mg/h continuous infusion of amiodarone (amiodarone
group) or a 1 mg/kg bolus then 1 mg/kg/h continuous infusion of lidocaine
(lidocaine group). The primary outcome was the ventricular fibrillation
incidence rate after aortic cross-clamp release. Secondary outcomes
included perioperative serum interleukin-6 and tumor necrosis factor-alpha
levels. Measurements and Main Results: The ventricular fibrillation
incidence rate was significantly lower in the amiodarone than in the
lidocaine group (20.6% v 50%, relative risk 0.41; 95% confidence interval
[CI] 0.20-0.86; p = 0.021). Interleukin-6 levels 1 hour after aortic
cross-clamp release and at intensive care unit admission were
significantly lower in the amiodarone than in the lidocaine group
(geometric mean [95% CI] 117.4 pg/mL [87.1-158.4] v 339.5 pg/mL
[210.6-547.2]; p < 0.01 and 211.1 pg/mL [162.8-73.6] v 434.1 pg/mL
[293.7-641.5]; p < 0.01, respectively). Tumor necrosis factor-alpha levels
1 hour after aortic cross-clamp release were significantly lower in the
amiodarone than in the lidocaine group (geometric mean [95% CI] 1.624
pg/mL [1.359-1.940] v 2.283 pg/mL [1.910-2.731]; p = 0.02). Conclusions:
Amiodarone prevented reperfusion ventricular fibrillation in patients with
left ventricular hypertrophy undergoing aortic valve replacement to a
greater extent than did lidocaine. Furthermore, amiodarone inhibited
postoperative interleukin-6 and tumor necrosis factor-alpha
production.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<33>
Accession Number
622383195
Title
Antiarrhythmic effects of ranolazine used both alone for prevention of
atrial fibrillation and as an add-on to intravenous amiodarone for its
pharmacological cardioversion: A meta-Analysis.
Source
Minerva Cardioangiologica. 66 (3) (pp 349-359), 2018. Date of Publication:
June 2018.
Author
De Vecchis R.; Ariano C.; Giasi A.; Cioppa C.
Institution
(De Vecchis, Ariano, Giasi, Cioppa) Unit of Cardiology, Presidio Sanitario
Intermedio Elena D'Aosta, ASL Napoli 1 Centro, Via P. Gaurico 21, Naples
80125, Italy
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: Recent evidence from relatively small randomized controlled
trials would seem to support a useful role of ranolazine for the
prevention and treatment of atrial fibrillation (AF). The present study is
aimed at providing information about the possible beneficial
anti-Arrhythmic properties of ranolazine. In particular, the meta-Analysis
carried out in this study focuses on the application of ranolazine to
prophylaxis and treatment of atrial fibrillation. EVIDENCE ACQUISITION:
Both methods randomized controlled trials (RCTs) and non-randomized
observational studies concerning the effects of ranolazine on AF were
included in the meta-Analysis. In each of the considered studies, a
comparison was made between a group of patients taking ranolazine and a
second group treated instead with another antiarrhythmic therapy, or
assigned to placebo. Efficacy outcomes were the risk of new-onset AF, the
probability of conversion to sinus rhythm of patients with recent
occurrence (>=48 h) of AF and the time to conversion to sinus rhythm.
Safety endpoints were death, adverse events, QTc prolongation and
hypotension. EVIDENCE SYNTHESIS: Ten studies (8 RCTs and 2 nonrandomized
observational studies) were gathered on the whole. Ranolazine was
effective in preventing the occurrence of AF when compared to controls
(RR=0.60; 95% CI: 0.43-0.83; P=0.002). Subgroup analysis showed a more
pronounced preventive effect of ranolazine against AF in the postoperative
setting of coronary artery bypass grafting (CABG) surgery (RR=0.39; 95%
CI: 0.18-0.83; P=0.02) when compared to non-postoperative AF (RR=0.76; 95%
CI: 0.63-0.92; P=0.04). Ranolazine enhanced the chances of successful
cardioversion when added to intravenous amiodarone compared to amiodarone
alone (RR 1.18; 95% CI: 1.05-1.33; P=0.004) and significantly decreased
the time to cardioversion (SMD=-10.35 h; 95% CI:-18.13 hours to-2.57
hours; P<0.001). Overall risks of death, adverse events, and QTc
prolongation were shown to be similar in the comparison between patients
treated with ranolazine and controls. CONCLUSIONS: Ranolazine given orally
at appropriate doses showed the property to significantly quicken the
conversion of AF to sinus rhythm when combined with the IV amiodarone,
compared to IV amiodarone alone. Furthermore, in patients in sinus rhythm,
ranolazine proved to reduce the frequency of new onset AF as well as of
its recurrences, especially in patients undergone CABG surgery, known to
be at high risk of developing postoperative AF. In addition, ranolazine
use seems to be safe and associated with relatively few adverse
events.<br/>Copyright &#xa9; 2017 EDIZIONI MINERVA MEDICA.

<34>
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.

<35>
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.

<36>
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.

<37>
Accession Number
624713826
Title
Graduated compression stockings for prevention of deep vein thrombosis.
Source
Cochrane Database of Systematic Reviews. 2018 (11) (no pagination), 2018.
Article Number: CD001484. Date of Publication: 03 Nov 2018.
Author
Sachdeva A.; Dalton M.; Lees T.
Institution
(Sachdeva) Newcastle University, Wellcome Centre for Mitochondrial
Research, Cookson Building, Medical School, Framlington Place, Newcastle
upon Tyne NE2 4HH, United Kingdom
(Dalton) Royal Victoria Infirmary, Department of Anaesthetics, Queen
Victoria Road, Newcastle upon Tyne, Tyne and Wear NE1 4LP, United Kingdom
(Lees) NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Hospitalised patients are at increased risk of developing deep
vein thrombosis (DVT) in the lower limb and pelvic veins, on a background
of prolonged immobilisation associated with their medical or surgical
illness. Patients with DVT are at increased risk of developing a pulmonary
embolism (PE). The use of graduated compression stockings (GCS) in
hospitalised patients has been proposed to decrease the risk of DVT. This
is an update of a Cochrane Review first published in 2000, and last
updated in 2014. Objectives: To evaluate the effectiveness and safety of
graduated compression stockings in preventing deep vein thrombosis in
various groups of hospitalised patients. Search methods: For this review
the Cochrane Vascular Information Specialist searched the Cochrane
Vascular Specialised Register, the Cochrane Central Register of Controlled
Trials (CENTRAL), and trials registries on 21 March 2017; and the Cochrane
Vascular Specialised Register, CENTRAL, MEDLINE Ovid, Embase Ovid, CINAHL
Ebsco, AMED Ovid , and trials registries on 12 June 2018. Selection
criteria: Randomised controlled trials (RCTs) involving GCS alone, or GCS
used on a background of any other DVT prophylactic method. We combined
results from both of these groups of trials. Data collection and analysis:
Two review authors (AS, MD) assessed potentially eligible trials for
inclusion. One review author (AS) extracted the data, which a second
review author (MD) cross-checked and authenticated. Two review authors
(AS, MD) assessed the methodological quality of trials with the Cochrane
'Risk of bias' tool. Any disagreements were resolved by discussion with
the senior review author (TL). For dichotomous outcomes, we calculated the
Peto odds ratio and corresponding 95% confidence interval. We pooled data
using a fixed-effect model. We used the GRADE system to evaluate the
overall quality of the evidence supporting the outcomes assessed in this
review. Main results: We included 20 RCTs involving a total of 1681
individual participants and 1172 individual legs (2853 analytic units). Of
these 20 trials, 10 included patients undergoing general surgery; six
included patients undergoing orthopaedic surgery; three individual trials
included patients undergoing neurosurgery, cardiac surgery, and
gynaecological surgery, respectively; and only one trial included medical
patients. Graduated compression stockings were applied on the day before
surgery or on the day of surgery and were worn up until discharge or until
the participants were fully mobile. In the majority of the included
studies DVT was identified by the radioactive I¹²⁵ uptake test.
Duration of follow-up ranged from seven to 14 days. The included studies
were at an overall low risk of bias. We were able to pool the data from 20
studies reporting the incidence of DVT. In the GCS group, 134 of 1445
units developed DVT (9%) in comparison to the control group (without GCS),
in which 290 of 1408 units developed DVT (21%). The Peto odds ratio (OR)
was 0.35 (95% confidence interval (CI) 0.28 to 0.43; 20 studies; 2853
units; high-quality evidence), showing an overall effect favouring
treatment with GCS (P < 0.001). Based on results from eight included
studies, the incidence of proximal DVT was 7 of 517 (1%) units in the GCS
group and 28 of 518 (5%) units in the control group. The Peto OR was 0.26
(95% CI 0.13 to 0.53; 8 studies; 1035 units; moderate-quality evidence)
with an overall effect favouring treatment with GCS (P < 0.001). Combining
results from five studies, all based on surgical patients, the incidence
of PE was 5 of 283 (2%) participants in the GCS group and 14 of 286 (5%)
in the control group. The Peto OR was 0.38 (95% CI 0.15 to 0.96; 5
studies; 569 participants; low-quality evidence) with an overall effect
favouring treatment with GCS (P = 0.04). We downgraded the quality of the
evidence for proximal DVT and PE due to low event rate (imprecision) and
lack of routine screening for PE (inconsistency). We carried out subgroup
analysis by speciality (surgical or medical patients). Combining results
from 19 trials focusing on surgical patients, 134 of 1365 (9.8%) units
developed DVT in the GCS group compared to 282 of 1328 (21.2%) units in
the control group. The Peto OR was 0.35 (95% CI 0.28 to 0.44; high-quality
evidence), with an overall effect favouring treatment with GCS (P <
0.001). Based on results from seven included studies, the incidence of
proximal DVT was 7 of 437 units (1.6%) in the GCS group and 28 of 438
(6.4%) in the control group. The Peto OR was 0.26 (95% CI 0.13 to 0.53;
875 units; moderate-quality evidence) with an overall effect favouring
treatment with GCS (P < 0.001). We downgraded the evidence for proximal
DVT due to low event rate (imprecision). Based on the results from one
trial focusing on medical patients admitted following acute myocardial
infarction, 0 of 80 (0%) legs developed DVT in the GCS group and 8 of 80
(10%) legs developed DVT in the control group. The Peto OR was 0.12 (95%
CI 0.03 to 0.51; low-quality evidence) with an overall effect favouring
treatment with GCS (P = 0.004). None of the medical patients in either
group developed a proximal DVT, and the incidence of PE was not reported.
Limited data were available to accurately assess the incidence of adverse
effects and complications with the use of GCS as these were not routinely
quantitatively reported in the included studies. Authors' conclusions:
There is high-quality evidence that GCS are effective in reducing the risk
of DVT in hospitalised patients who have undergone general and orthopaedic
surgery, with or without other methods of background thromboprophylaxis,
where clinically appropriate. There is moderate-quality evidence that GCS
probably reduce the risk of proximal DVT, and low-quality evidence that
GCS may reduce the risk of PE. However, there remains a paucity of
evidence to assess the effectiveness of GCS in diminishing the risk of DVT
in medical patients.<br/>Copyright &#xa9; 2018 The Cochrane Collaboration.

<38>
Accession Number
2001102320
Title
Meta-Analysis Comparing Complete or Culprit Only Revascularization in
Patients With Multivessel Disease Presenting With Cardiogenic Shock.
Source
American Journal of Cardiology. 122 (10) (pp 1661-1669), 2018. Date of
Publication: 15 November 2018.
Author
Bertaina M.; Ferraro I.; Omede P.; Conrotto F.; Saint-Hilary G.; Cavender
M.A.; Claessen B.E.; Henriques J.P.S.; Frea S.; Usmiani T.; Grosso Marra
W.; Pennone M.; Moretti C.; D'Amico M.; D'Ascenzo F.
Institution
(Bertaina, Ferraro, Omede, Conrotto, Frea, Usmiani, Grosso Marra, Pennone,
Moretti, D'Amico, D'Ascenzo) Department of Cardiology, Citta della Salute
e della Scienza, Molinette Hospital, Turin, Italy
(Saint-Hilary) Department of Mathematical Sciences "G. L. Lagrange,",
Politecnico di Torino, Turin, Italy
(Cavender) Department of Medicine, Division of Cardiology, University of
North Carolina, Chapel Hill, NC, United States
(Claessen, Henriques) Department of Cardiology, Academic Medical Center,
Amsterdam, Netherlands
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The optimal strategy for patients with an acute myocardial infarction (MI)
and multivessel (MV) coronary artery disease complicated by cardiogenic
shock (CS) remains unknown. We conducted a meta-analysis of all randomized
controlled trials and observational studies that reported adjusted effect
measures to evaluate the association of MV-PCI (percutaneous coronary
intervention), compared with culprit only (C)-PCI, with cardiovascular
events in patients admitted for CS and MV disease. We identified 12
studies (n = 1 randomized controlled trials, n = 11 observational) that
included 7,417 patients (n = 1,809 treated with MV-PCI and n = 5,608 with
C-PCI). When compared with C-PCI, MV-PCI was not associated with an
increased risk of short-term death (odds ratio [OR] 1.14, 95% confidence
interval [CI] 0.87 to 1.48, p = 0.35 and adjusted OR [OR<inf>adj</inf>]
1.00, 95% CI 0.70 to 1.43, p = 1.00). In-hospital and/or short-term
mortality tended to be higher with MV-PCI, when compared with C-PCI, for
CS patients needing dialysis (s 0.12, 95% CI from 0.049 to 0.198; p=
0.001), whereas MV-PCI was associated with lower in-hospital and/or
short-term mortality in patients with an anterior MI (s -0.022, 95% CI
-0.03 to -0.01; p <0.001). MV-PCI strategy was associated with a more
frequent need for dialysis or contrast-induced nephropathy after
revascularization (OR 1.36, 95% CI 1.06 to 1.75, p = 0.02). In conclusion,
MV-PCI seems not to increase risk of death during short- or long-term
follow-up when compared with C-PCI in patients admitted for MV coronary
artery disease and MI complicated by CS. Furthermore, it appears a more
favorable strategy in patients with anterior MI, whereas the increased
risk for AKI and its negative prognostic impact should be considered in
decision-making process. Further studies are needed to confirm our
hypothesis on in these subpopulations of CS patients.<br/>Copyright &#xa9;
2018

<39>
[Use Link to view the full text]
Accession Number
624776918
Title
Impact of Donor Core Body Temperature on Graft Survival after Heart
Transplantation.
Source
Transplantation. 102 (11) (pp 1891-1900), 2018. Date of Publication: 01
Nov 2018.
Author
Schnuelle P.; Benck U.; Kramer B.K.; Yard B.A.; Zuckermann A.; Wagner F.;
Szabo G.; Borggrefe M.; Karck M.; Gummert J.
Institution
(Schnuelle) Academic Training Practice, Center for Renal Diseases,
Roentgenstrasse 1, Weinheim D 69469, Germany
(Schnuelle, Benck, Kramer, Yard) Vth Department of Medicine, University
Medical Center Mannheim, Mannheim, Germany
(Zuckermann) Department of Cardiac Surgery, Medical University of Vienna,
Vienna, Austria
(Wagner) Department of Cardiac Surgery, Asklepios Clinic St. Georg,
Hamburg, Germany
(Szabo, Karck) Department of Cardiac Surgery, University Hospital
Heidelberg, Heidelberg, Germany
(Borggrefe) Ist Department of Medicine, University Medical Center Mannheim
and German Center for Cardiovascular Research Heidelberg/Mannheim,
Mannheim, Germany
(Gummert) Department of Thoracic and Cardiovascular Surgery, Ruhr
University Bochum, Heart and Diabetes Center North Rhine-Westphalia, Bad
Oeynhausen, Germany
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background A previous donor intervention trial found that induction of
mild therapeutic hypothermia in the brain-dead donor reduced the dialysis
requirement after kidney transplantation. Consequences on the performance
of cardiac allografts after transplantation were not explored to date.
Methods Cohort study investigating 3-year heart allograft survival
according to spontaneous core body temperature (CBT) assessed on the day
of organ procurement. The study is nested in the database of the
randomized trial of donor pretreatment with low-dose dopamine
(ClinicalTrials.gov identifier: NCT000115115). Results Ninety-nine heart
transplant recipients who had received a cardiac allograft from a
multiorgan donor enrolled in the dopamine trial were grouped by tertiles
of the donor's CBT assessed by a mere temperature reading 4 to 20 hours
before procurement (lowest, 32.0-36.2degreeC; middle, 36.3-36.8degreeC;
highest, 36.9-38.8degreeC). Baseline characteristics considering
demographics of donors and recipients, concomitant donor treatments, donor
hemodynamic, and respiratory parameters as well as underlying cardiac
diseases in recipients, pretransplant hemodynamic assessments, including
pretransplant inotropic/mechanical support, urgency, and waiting time were
similar. A lower CBT was associated with inferior heart allograft survival
(hazard ratio, 0.53; 95% confidence interval, 0.31-0.93, per tertile; P =
0.02, and hazard ratio, 0.68; 95% confidence interval, 0.50-0.93degreeC; P
= 0.02) when CBT was included as continuous explanatory variable in the
Cox regression analysis. Conclusions A lower CBT in the brain-dead donor
before procurement may associate with an unfavorable clinical course after
heart transplantation. More research is required, before therapeutic
hypothermia can routinely be used in multiorgan donors when a cardiac
transplantation is intended.<br/>Copyright &#xa9; 2018 Wolters Kluwer
Health, Inc. All rights reserved.

<40>
Accession Number
2001129963
Title
Evaluating the use of dexmedetomidine for the reduction of delirium: An
integrative review.
Source
Heart and Lung. 47 (6) (pp 591-601), 2018. Date of Publication: November
2018.
Author
Pavone K.J.; Cacchione P.Z.; Polomano R.C.; Winner L.; Compton P.
Institution
(Pavone, Cacchione, Polomano, Winner, Compton) University of Pennsylvania,
School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Delirium, an acute change in cognition and attention not secondary to a
pre-existing condition or dementia, affects nearly 40,000 hospitalized
older adults in the United States every day. Delirium is associated with
increased healthcare costs of $16,303 to $64,421 per patient. To date, no
single pharmacological intervention is effective in preventing or treating
delirium in critically ill patients. Evidence suggests the alpha-2
agonist, dexmedetomidine, may reduce or prevent delirium. An integrative
review examined whether dexmedetomidine was associated with a lower
incidence of delirium compared to other analgesic and sedation strategies.
PRISMA (Preferred Reporting Items for Systematic Reviews and
Meta-Analyses) guided this review and 16 publications met quality criteria
for inclusion. These studies support that postoperative administration of
dexmedetomidine may reduce delirium in patients, particularly following
cardiac surgery. Further research is needed to determine the benefits of
dexmedetomidine in patients on mechanical ventilation and optimal timing
and duration of administration.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<41>
Accession Number
2000877776
Title
Improving informed consent in cardiac surgery by enhancing preoperative
education.
Source
Patient Education and Counseling. 101 (12) (pp 2047-2053), 2018. Date of
Publication: December 2018.
Author
Villanueva C.; Talwar A.; Doyle M.
Institution
(Villanueva, Talwar) Cardiothoracic Surgery Unit, Royal North Shore
Hospital, Sydney, Australia
(Villanueva) Conjoint Lecturer University of New South Wales, Sydney,
Australia
(Doyle) Cardiothoracic Surgery Unit, St George Hospital, Sydney, Australia
Publisher
Elsevier Ireland Ltd
Abstract
Objective: To investigate the effect of enhancing preoperative education
in improving recall and understanding of a surgical procedure and its
application to the informed consent process in cardiac surgery. Methods:
Four electronic database searches were performed from January 2000 to
August 2017. A total of 282 articles were identified from which 22
prospective studies assessing an intervention were selected according to
predefined selection criteria. Results: Most articles that used additional
written information and all that used multimedia presentations to enhance
informed consent showed that their intervention improved risk recall and
patient's understanding of the procedure. A single randomised controlled
trial in cardiac surgery showed that audiotaped consultations improved
patient's knowledge of the operation. Conclusions: Patient recall and
understanding of pre-operative information can significantly improve with
a variety of educational tools. Procedure-specific forms with or without
illustrations as well as interactive multimedia interventions enhance
patient recall and understanding of information. In cardiac surgery
patients, interventions need to meet patients' preferences, be repetitive
on crucial points and consider the nature of the procedure.<br/>Copyright
&#xa9; 2018 Elsevier B.V.

<42>
Accession Number
2001254932
Title
Predictors and Outcomes of Staged Versus One-Time Multivessel
Revascularization in Multivessel Coronary Artery Disease: Insights From
the VA CART Program.
Source
JACC: Cardiovascular Interventions. 11 (22) (pp 2265-2273), 2018. Date of
Publication: 26 November 2018.
Author
Hu P.T.; Jones W.S.; Glorioso T.J.; Baron A.E.; Grunwald G.K.; Waldo S.W.;
Maddox T.M.; Vidovich M.; Banerjee S.; Rao S.V.
Institution
(Hu) Department of Cardiology, Cleveland Clinic, Cleveland, OH, United
States
(Hu, Jones, Rao) Department of Medicine, Duke University Medical Center,
Durham, NC, United States
(Jones, Rao) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC, United States
(Glorioso, Baron, Grunwald, Waldo) Denver Veterans Affairs Medical Center,
Denver, CO, United States
(Glorioso, Baron, Grunwald) Colorado School of Public Health, University
of Colorado Anschutz Medical Campus, Aurora, CO, United States
(Waldo) Section of Cardiology, University of Colorado School of Medicine,
Aurora, CO, United States
(Maddox) Division of Cardiology, Washington University, St. Louis, MO,
United States
(Vidovich) University of Illinois College of Medicine, Chicago, IL, United
States
(Vidovich) Jesse Brown Veterans Affairs Medical Center, Chicago, IL,
United States
(Banerjee) University of Texas Southwestern Medical Center, Dallas, TX,
United States
(Banerjee) Veterans Affairs North Texas Health Care System, Dallas, Texas,
United States
(Rao) Durham Veterans Affairs Medical Center, Durham, NC, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to determine predictors and outcomes
associated with staged percutaneous coronary intervention (PCI) versus
one-time multivessel revascularization (OTMVR) in patients with
multivessel coronary artery disease. Background: Prior observational
studies have not evaluated predictors and outcomes of staged PCI versus
OTMVR in a heterogenous population of patients with multivessel coronary
artery disease who undergo multivessel revascularization. Methods: Data
from the Veterans Affairs (VA) CART (Clinical Assessment, Reporting, and
Tracking) Program were used to evaluate patients who underwent PCI of >2
vessels between October 1, 2007, and September 3, 2014. Associations
between individual factors and the decision to perform staged PCI were
assessed. Additionally, the impact of measured patient and procedural
factors, site factors, and unmeasured site factors on the decision to
perform staged PCI was compared. Cox proportional hazards models were used
to determine the association between staged PCI and mortality. Results: A
total of 7,599 patients at 61 sites were included. The decision to perform
staged PCI was driven by procedural characteristics and unmeasured site
factors. Staged PCI was associated with lower risk-adjusted mortality
compared with OTMVR (adjusted hazard ratio [HR]: 0.78; 95% confidence
interval [CI]: 0.72 to 0.84; p < 0.01). This mortality benefit was
observed among the ST-segment elevation myocardial infarction (HR: 0.31;
95% CI: 0.21 to 0.47; p < 0.01), non-ST-segment elevation myocardial
infarction (HR: 0.74; 95% CI: 0.64 to 0.87; p < 0.01), unstable angina
(HR: 0.75; 95% CI: 0.64 to 0.89; p < 0.01) and stable angina (HR: 0.88;
95% CI: 0.77 to 1.00; p = 0.05) groups. Conclusions: The decision to
pursue staged PCI was driven by procedural characteristics and unmeasured
site variation and was associated with lower mortality compared with
OTMVR. After adjustment, there was an association between staged PCI and
reduced mortality. Given the observational nature of these findings, a
randomized trial comparing the 2 is needed to guide
practice.<br/>Copyright &#xa9; 2018

<43>
Accession Number
624719492
Title
Comparative cost-effectiveness of surgery, angioplasty, or medical therapy
in patients with multivessel coronary artery disease: MASS II trial
ISRCTN66068876 ISRCTN.
Source
Cost Effectiveness and Resource Allocation. 16 (1) (no pagination), 2018.
Article Number: 55. Date of Publication: 03 Nov 2018.
Author
Brandao S.M.G.; Rezende P.C.; Rocca H.-P.B.-L.; Ju Y.T.; De Lima A.C.P.;
Takiuti M.E.; Hueb W.; Bocchi E.A.
Institution
(Brandao, Rezende, Takiuti, Hueb, Bocchi) Instituto Do Coracao (InCor),
Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao
Paulo, Av Dr Eneas de Carvalho Aguiar 44 - Cerqueira Cesar, Sao Paulo, SP
CEP 05403-000, Brazil
(Rocca) Heart Failure Clinic, Department of Cardiology, Maastricht
University Medical Center, Maastricht, Netherlands
(Ju, De Lima) Department of Statistics, Institute of Mathematics and
Statistics, University of Sao Paulo, Sao Paulo, SP, Brazil
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The costs for treating coronary artery disease (CAD) are high
worldwide. We performed a prespecified analyses of cost-effectiveness of
three therapeutic strategies for multivessel CAD. Methods: From May 1995
to May 2000, a total of 611 patients were randomly assigned to coronary
artery bypass graft (CABG), n = 203; percutaneous coronary intervention
(PCI), n = 205; or medical treatment (MT), n = 203. This cost analysis
study was based on the perspective of the Public Health Care System.
Initial procedural and follow-up costs for medications, cardiology
examinations, and hospitalizations for complications were calculated after
randomization. Life-years and quality-adjusted life years (QALYs) were
used as effectiveness measures. Incremental cost-effectiveness ratios
(ICER) were obtained by using nonparametric bootstrapping methods with
5000 resamples. Results: Initial procedural costs were lower for MT.
However, the subsequent 5-year cumulative costs were lower for CABG.
Compared with baseline, the three treatment options produced significant
improvements in QALYs. After 5 years, PCI and CABG had better QALYs
results compared with MT. The ICER results favored CABG and PCI, and
favored PCI over CABG in 61% of the drawings. On the other hand,
sensitivity analysis showed MT as the preferred therapy compared with CABG
and PCI, in the analysis considering higher costs. Conclusions: At 5-year
follow-up, the three treatment options yielded improvements in quality of
life, with comparable and acceptable costs. However, despite higher
initial costs, the comparison of cost-effectiveness after 5 years of
follow-up among the three treatments showed both interventions (CABG and
PCI) to be cost-effective strategies compared with MT. Trial registration
ISRCTN, ISRCTN66068876, Registered 06/10/1994,
http://www.controlled-trials.com/ISRCTN66068876<br/>Copyright &#xa9; 2018
The Author(s).

<44>
Accession Number
624786043
Title
Single versus dual antiplatelet therapy after transcatheter aortic valve
implantation: A systematic review and meta-analysis.
Source
Cardiology (Switzerland). (pp 52-65), 2018. Date of Publication: 2018.
Author
Hu X.; Yang F.-Y.; Wang Y.; Zhang Y.; Chen M.
Institution
(Hu, Yang, Wang, Zhang) West China School of Medicine, West China
Hospital, Sichuan University, Chengdu 610041, China
(Chen) Department of Cardiology, West China Hospital, Sichuan University,
Chengdu, China
Publisher
S. Karger AG
Abstract
Objectives: Although dual antiplatelet therapy (DAPT) with aspirin and
clopidogrel is currently recommended in patients after transcatheter
aortic valve implantation (TAVI), this practice is not supported by
sufficient evidence. This study was performed to compare DAPT to single
antiplatelet therapy (SAPT). Methods: An electronic search was completed
of PubMed, Embase, Ovid Medline, Web of Science, and Cochrane Central
Register of Controlled Trials. Studies comparing DAPT versus SAPT in
patients undergoing TAVI were included. Results: Seven studies
incorporating 1,445 patients were eligible for the present meta-analysis.
There were no significant differences on 30-day all-cause mortality (OR
1.19, 95% CI 0.63-2.25, p = 0.593), 6-month all-cause mortality (OR 1.11,
95% CI 0.49-2.53, p = 0.796), or 1-year all-cause mortality (OR 1.19, 95%
CI 0.63-2.25, p = 0.593). DAPT was associated with an increased risk for
30-day (OR 2.91, 95% CI 1.85-4.58, p < 0.01), 6-month (OR 2.54, 95% CI
1.26-5.10, p < 0.001), and 1-year major and lethal bleeding (OR 2.65, 95%
CI 1.04-6.77, p = 0.041) based on 896, 337, and 583 patients,
respectively, compared to SAPT. Conclusion: Compared to SAPT, DAPT was not
shown to be superior in reducing thrombotic events, but presented an
increased risk of major/life-threatening bleeding. More randomized
controlled trials are needed to provide further evidence.<br/>Copyright
&#xa9; 2018 S. Karger AG, Basel.

<45>
Accession Number
616322435
Title
Cost analysis of pulmonary lobectomy procedure: Comparison of stapler
versus precision dissection and sealant.
Source
ClinicoEconomics and Outcomes Research. 9 (pp 201-206), 2017. Date of
Publication: 03 Apr 2017.
Author
Droghetti A.; Marulli G.; Vannucci J.; Giovanardi M.; Bottoli M.C.; Ragusa
M.; Muriana G.
Institution
(Droghetti, Giovanardi, Bottoli, Muriana) Thoracic Surgery Division, Carlo
Poma Hospital, Mantova, Italy
(Marulli) Thoracic Surgery Division, University of Padova, Padova, Italy
(Vannucci, Ragusa) Thoracic Surgery Division, University of Perugia,
Perugia, Italy
Publisher
Dove Medical Press Ltd (PO Box 300-008, Albany, 44 Corinthian Drive,
Albany,Auckland 0752, New Zealand. E-mail: angela@dovepress.com)
Abstract
Objective: We aimed to evaluate the direct costs of pulmonary lobectomy
hospitalization, comparing surgical techniques for the division of
interlobar fissures: stapler (ST) versus electrocautery and hemostatic
sealant patch (ES). Methods: The cost comparison analysis was based on the
clinical pathway and drawn up by collecting the information available from
the Thoracic Surgery Division medical team at Mantova Hospital. Direct
resource consumption was derived from a previous randomized controlled
trial including 40 patients. Use and maintenance of technology, equipment
and operating room; administrative plus general costs; and 30-day use of
postsurgery hospital resources were considered. The analysis was conducted
from the hospital perspective. Results: On the average, a patient
submitted to pulmonary lobectomy costs 9,744.29. This sum could vary from
9,027 (using ES) to 10,460 (using ST). The overall lower incidence (50% vs
95%, P=0.0001) and duration of air leakage (1.7 days vs 4.5 days,
P=0.0001) in the ES group significantly affects the mean time of hospital
stay (11.0 days vs 14.3 days) and costs. Cost saving in the ES group was
also driven by the lower incidence of complications. The main key cost
driver was staff employment (42%), then consumables (34%) and operating
room costs (12%). Conclusion: There is an overall saving of around
1,432.90 when using ES patch for each pulmonary lobectomy. Among patients
undergoing this surgical procedure, ES can significantly reduce air
leakage incidence and duration, as well as decrease hospitalization rates.
However, further multicenter research should be developed considering
different clinical and managerial settings.<br/>Copyright &#xa9; 2017
Droghetti et al.

<46>
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.

<47>
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.

<48>
Accession Number
624440895
Title
Non-invasive screening for coronary artery disease in asymptomatic
diabetic patients: A systematic review and meta-analysis of randomised
controlled trials.
Source
European Heart Journal Cardiovascular Imaging. 19 (8) (pp 838-846), 2018.
Date of Publication: 2018.
Author
Clerc O.F.; Fuchs T.A.; Stehli J.; Benz D.C.; Grani C.; Messerli M.;
Giannopoulos A.A.; Buechel R.R.; Luscher T.F.; Pazhenkottil A.P.; Kaufmann
P.A.; Gaemperli O.
Institution
(Clerc, Fuchs, Stehli, Benz, Grani, Messerli, Giannopoulos, Buechel,
Luscher, Pazhenkottil, Kaufmann, Gaemperli) University Heart Centre,
University Hospital Zurich, Raemistrasse 100, Zurich CH-8091, Switzerland
Publisher
Oxford University Press
Abstract
It is unclear whether non-invasive screening of asymptomatic diabetic
patients for coronary artery disease (CAD) may improve cardiac outcomes.
Thus, we performed a systematic literature review and meta-analysis of
randomised controlled trials (RCT's) on this topic. We searched
appropriate RCT's in five online databases (PubMed/MEDLINE, Cochrane
Library, Embase, Scopus, and Web of Science) from January 2000 to November
2017 and in 41 recent reviews. Two investigators independently extracted
and assessed study data using standardised forms. Additional unpublished
data were obtained from trial authors. The primary endpoint 'any cardiac
event' was a composite of cardiac death, non-fatal myocardial infarction
(MI), unstable angina (UA), or heart failure (HF) hospitalisation. We
performed a meta-analysis of relative risks (RRs) with 95% confidence
intervals (CI) using the Mantel-Haenszel method. We included five RCT's
with 3299 patients, of which 189 (5.7%) experienced any cardiac event on
follow-up (weighted mean 4.1 years). Non-invasive CAD screening
significantly reduced any cardiac event by 27% [RR 0.73 (95% CI
0.55-0.97), P = 0.028, number needed to screen 56]. This result was driven
by important, albeit non-significant decreases in non-fatal MI [RR 0.65
(95% CI 0.41-1.02), P = 0.062] and HF hospitalisation [RR 0.61 (95% CI
0.33-1.10), P = 0.100]. Non-invasive CAD screening did not significantly
affect cardiac death [RR 0.92 (95% CI 0.53-1.60), P = 0.77] and UA [RR
0.73 (95% CI 0.41-1.31), P = 0.29]. Compared with the standard care,
non-invasive CAD screening reduced cardiac events by 27% in asymptomatic
diabetic patients, largely through reductions in non-fatal MIs, and HF
hospitalisations. The present results justify larger, appropriately
powered trials to potentially revisit current
recommendations.<br/>Copyright Published on behalf of the European Society
of Cardiology. All rights reserved. VC The Author(s) 2018.

<49>
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.

<50>
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).

<51>
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.

<52>
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.

<53>
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

<54>
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.

<55>
[Use Link to view the full text]
Accession Number
624732755
Title
Serum Uric Acid and Atrial Fibrillation: Meta-analysis.
Source
Critical Pathways in Cardiology. 17 (3) (pp 161-166), 2018. Date of
Publication: 01 Sep 2018.
Author
Pak S.; Yatsynovich Y.; Valencia D.; Chen T.
Institution
(Pak, Yatsynovich, Valencia) Department of Medicine, Kettering Medical
Center, Kettering, OH 45429, United States
(Chen) Department of Mathematics and Statistics, Toledo University,
Toledo, OH, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Hyperuricemia has been recently speculated to be associated with the
development of atrial fibrillation (AF). A meta-analysis of observational
studies was conducted to explore the relationship between serum uric acid
(SUA) and AF. We searched the MEDLINE, EMBASE, and CINAHL databases and
performed extensive bibliography search to identify studies with mean SUA
level for patients with and without AF. Key search terms were "atrial
fibrillation" and "uric acid." Under the random-effects model, the pooled
standardized difference in means between patients with and without AF was
calculated. A total of 24 studies with 30,609 patients were included for
quantitative analyzation of the difference in SUA levels between the
patients with and without AF. The SUA level of patients with atrial AF was
found to be significantly higher compared with those without AF
(standardized difference in means = 0.66; 95% confidence interval,
0.43-0.88; P < 0.0001). The mean SUA level of patients with AF
significantly is higher than those without AF.<br/>Copyright &#xa9; 2018
Wolters Kluwer Health, Inc. All rights reserved.

<56>
Accession Number
624756885
Title
Circulating delta-like Notch ligand 1 is correlated with cardiac allograft
vasculopathy and suppressed in heart transplant recipients on
everolimus-based immunosuppression.
Source
American Journal of Transplantation. (no pagination), 2018. Date of
Publication: 2018.
Author
Norum H.M.; Michelsen A.E.; Lekva T.; Arora S.; Otterdal K.; Olsen M.B.;
Kong X.Y.; Gude E.; Andreassen A.K.; Solbu D.; Karason K.; Dellgren G.;
Gullestad L.; Aukrust P.; Ueland T.
Institution
(Norum, Michelsen, Lekva, Otterdal, Olsen, Kong, Aukrust, Ueland) Research
Institute of Internal Medicine, Oslo University Hospital Rikshospitalet,
Oslo, Norway
(Norum, Michelsen, Kong, Gullestad, Aukrust, Ueland) Institute of Clinical
Medicine, Medical Faculty, University of Oslo, Oslo, Norway
(Norum) Division of Emergencies and Critical Care, Department for Research
and Development, Oslo University Hospital, Oslo, Norway
(Arora, Gude, Andreassen, Gullestad) Department of Cardiology, Oslo
University Hospital Rikshospitalet, Oslo, Norway
(Arora) Center for Heart Failure Research, Medical Faculty, University of
Oslo, Oslo, Norway
(Solbu) Novartis Norge AS, Oslo, Norway
(Karason, Dellgren) Sahlgrenska University Hospital, Transplant Institute,
Gothenburg, Sweden
(Karason) Institute of Medicine, University of Gothenburg, Gothenburg,
Sweden
(Dellgren) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, University of Gothenburg, Gothenburg, Sweden
(Dellgren) Department of Molecular and Clinical Medicine, Institute of
Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
(Aukrust) Section of Clinical Immunology and Infectious Diseases, Oslo
University Hospital Rikshospitalet, Oslo, Norway
(Ueland) K.G. Jebsen TREC, University of Tromso, Tromso, Norway
Publisher
Blackwell Publishing Ltd
Abstract
Cardiac allograft vasculopathy (CAV) causes heart failure after heart
transplantation (HTx), but its pathogenesis is incompletely understood.
Notch signaling, possibly modulated by everolimus (EVR), is essential for
processes involved in CAV. We hypothesized that circulating Notch ligands
would be dysregulated after HTx. We studied circulating delta-like Notch
ligand 1 (DLL1) and periostin (POSTN) and CAV in de novo HTx recipients (n
= 70) randomized to standard or EVR-based, calcineurin inhibitor-free
immunosuppression and in maintenance HTx recipients (n = 41). Compared to
healthy controls, plasma DLL1 and POSTN were elevated in de novo (P <.01;
P <.001) and maintenance HTx recipients (P <.001; P <.01). Use of EVR was
associated with a treatment effect for DLL1. For de novo HTx recipients, a
change in DLL1 correlated with a change in CAV at 1 (P =.021) and 3 years
(P =.005). In vitro, activation of T cells increased DLL1 secretion,
attenuated by EVR. In vitro data suggest that also endothelial cells and
vascular smooth muscle cells (VSMCs) could contribute to circulating DLL1.
Immunostaining of myocardial specimens showed colocalization of DLL1 with
T cells, endothelial cells, and VSMCs. Our findings suggest a role of DLL1
in CAV progression, and that the beneficial effect of EVR on CAV could
reflect a suppressive effect on DLL1. Trial registration numbers-SCHEDULE
trial: ClinicalTrials.gov NCT01266148; NOCTET trial: ClinicalTrials.gov
NCT00377962.<br/>Copyright &#xa9; 2018 The American Society of
Transplantation and the American Society of Transplant Surgeons

<57>
Accession Number
624755353
Title
Repetitive levosimendan infusions for patients with advanced chronic heart
failure in the vulnerable post-discharge period.
Source
ESC Heart Failure. (no pagination), 2018. Date of Publication: 2018.
Author
Polzl G.; Allipour Birgani S.; Comin-Colet J.; Delgado J.F.; Fedele F.;
Garcia-Gonzales M.J.; Gustafsson F.; Masip J.; Papp Z.; Stork S.; Ulmer
H.; Vrtovec B.; Wikstrom G.; Altenberger J.
Institution
(Polzl, Allipour Birgani) Department of Internal Medicine III, Medical
University Innsbruck, Innsbruck, Austria
(Comin-Colet) Department of Cardiology, Bellvitge University Hospital and
IDIBELL, University of Barcelona Hospitalet de Llobregat, Barcelona, Spain
(Delgado) Department of Cardiology, University Hospital 12 de Octubre,
CIBERCV, Madrid, Spain
(Fedele) Department of Cardiovascular, Respiratory, Nephrology,
Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome,
Italy
(Garcia-Gonzales) Department of Cardiology, University Hospital Canarias,
San Cristobal de La Laguna, Tenerife, Spain
(Gustafsson) Department of Cardiology, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
(Masip) Intensive Care Department, Consorci Sanitari Integral, University
of Barcelona, Barcelona, Spain
(Masip) Cardiology Department, Hospital Sanitas CIMA, Barcelona, Spain
(Papp) Department of Cardiology, Division of Clinical Physiology, Faculty
of Medicine, University of Debrecen, Debrecen, Hungary
(Stork) Department of Internal Medicine and Comprehensive Heart Failure
Center, University Hospital Wurzburg, Wurzburg, Germany
(Ulmer) Department for Medical Statistics, Informatics and Health
Economics, Medical University Innsbruck, Innsbruck, Austria
(Vrtovec) Department of Cardiology, University Medical Center Ljubljana,
Ljubljana, Slovenia
(Wikstrom) Department of Cardiology, Institute of Medical Sciences,
Uppsala University Hospital, Uppsala, Sweden
(Altenberger) Cardiac Rehabilitation Center Grossgmain,
Pensionsversicherungsanstalt, Teaching Hospital of Paracelsus Medical
Private University, Salzburg, Austria
Publisher
Wiley-Blackwell (E-mail: info@wiley.com)
Abstract
Hospitalization for acute heart failure (HF) is associated with a
substantial morbidity burden and with associated healthcare costs and an
increased mortality risk. However, few if any major medical innovations
have been witnessed in this area in recent times. Levosimendan is a
first-in-class calcium sensitizer and potassium channel opener indicated
for the management of acute HF. Experience in several clinical studies has
indicated that administration of intravenous levosimendan in intermittent
cycles may reduce hospitalization and mortality rates in patients with
advanced HF; however, none of those trials were designed or powered to
give conclusive insights into that possibility. This paper describes the
rationale and protocol of LeoDOR (levosimendan infusions for patients with
advanced chronic heart failure), a randomized, double-blind,
placebo-controlled, international, multicentre trial that will explore the
efficacy and safety of intermittent levosimendan therapy, in addition to
optimized standard therapy, in patients following hospitalization for
acute HF. Salient features of LeoDOR include the use of two treatment
regimens, in order to evaluate the effects of different schedules and
doses of levosimendan during a 12 week treatment phase, and the use of a
global rank primary endpoint, in which all patients are ranked across
three hierarchical groups ranging from time to death or urgent heart
transplantation or implantation of a ventricular assist device to time to
rehospitalization and, lastly, time-averaged proportional change in
N-terminal pro-brain natriuretic peptide. Secondary endpoints include
changes in HF symptoms and functional status at 14 weeks.<br/>Copyright
&#xa9; 2018 The Authors. ESC Heart Failure published by John Wiley & Sons
Ltd on behalf of the European Society of Cardiology.