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<1>
Accession Number
2001155837
Title
Meta-analysis of Prevalence and Risk Factors for Delirium After
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 122 (11) (pp 1917-1923), 2018. Date of
Publication: 1 December 2018.
Author
Tilley E.; Psaltis P.J.; Loetscher T.; Davis D.H.; Harrison S.L.; Kim S.;
Keage H.A.D.
Institution
(Tilley, Loetscher, Keage) Cognitive Ageing and Impairment Neurosciences
Lab, University of South Australia, Adelaide, South Australia, Australia
(Psaltis) School of Medicine, University of Adelaide, Adelaide, South
Australia, Australia
(Psaltis, Kim) Vascular Research Centre, Heart Health Theme, South
Australian Health and Medical Research Institute, SAHMRI, Adelaide, South
Australia, Australia
(Davis) MRC Unit for Lifelong Health and Ageing at UCL, London, United
Kingdom
(Harrison) Department of Rehabilitation, Aged and Extended Care, Flinders
University, Adelaide, South Australia, Australia
(Kim) Flinders Centre for Epidemiology and Biostatistics, College of
Medicine and Public Health, Flinders University, Australia
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Delirium is a severe and common complication following transcatheter
aortic valve implantation (TAVI). We sought to identify the prevalence and
risk factors associated with the development of postprocedural delirium in
patients aged over 60 years who underwent elective TAVI for aortic
stenosis. Overall, 1,051 articles were searched, from which 9 studies were
included. The prevalence of delirium following TAVI was higher in studies
that assessed delirium for a minimum of 3 consecutive days (24.9%)
compared with the studies that did not (2%). There were large effect sizes
(d > 0.8) for 3 risk factors: acute kidney injury (odds ratio [OR] 5, p <
0.001), transapical approach (OR 4, p < 0.001) and carotid artery disease
(OR 4, p < 0.001), whilst small effect sizes were found for a history of
atrial fibrillation, prior stroke/transient ischemic attack, peripheral
artery disease, hypertension, and prior cognitive impairment. In
conclusion, 23% of patients 60 years and over who underwent TAVI
experience delirium, a preventative cause of cognitive impairment and
dementia. Recognition of risk factors for delirium after TAVI, such as a
history of carotid artery disease, development of acute kidney injury, or
use of a transapical approach, provides an opportunity to implement proven
delirium preventative measures. Copyright © 2018

<2>
Accession Number
2000878518
Title
Safety of FFR-guided revascularisation deferral in Anatomically prognostiC
diseasE (FACE: CARDIOGROUP V STUDY): A prospective multicentre study.
Source
International Journal of Cardiology. 270 (pp 107-112), 2018. Date of
Publication: 1 November 2018.
Author
Barbero U.; D'Ascenzo F.; Campo G.; Kleczynski P.; Dziewierz A.; Menozzi
M.; Jimenez Diaz V.A.; Cerrato E.; Raposeiras-Roubin S.; Ielasi A.;
Rognoni A.; Fineschi M.; Kanji R.; Jaguszewski M.J.; Picchi A.; Ando G.;
Soraci E.; Mancone M.; Sardella G.; Calcagno S.; Gallo F.; Huczek Z.;
Krakowian M.; Verardi R.; Montefusco A.; Omede P.; Lococo M.; Moretti C.;
D'Amico M.; Rigattieri S.; Gaita F.; Rinaldi M.; Escaned J.
Institution
(Barbero, D'Ascenzo, Campo, Kleczynski, Dziewierz, Menozzi, Jimenez Diaz,
Cerrato, Raposeiras-Roubin, Ielasi, Rognoni, Fineschi, Kanji, Jaguszewski,
Picchi, Ando, Soraci, Mancone, Sardella, Calcagno, Gallo, Huczek,
Krakowian, Verardi, Montefusco, Omede, Lococo, Moretti, D'Amico,
Rigattieri, Gaita, Rinaldi, Escaned) Division of Cardiology,
Cardio-Thoracic Department, Azienda Ospedaliero-Universitaria Citta della
Salute e della Scienza di Torino, Corso A. M. Dogliotti, 14, Torino 10126,
Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background: FFR-guided coronary intervention is recommended for patients
with intermediate stenoses. However, concerns exist with this approach in
anatomically prognostic disease. Methods: In this prospective, multicentre
study, we consecutively enrolled patients found to have FFR negative
lesions in anatomically significant sites: left main; proximal LAD; last
remaining patent vessel; and multiple vessels with concomitant impaired
left ventricular systolic function (EF < 40%). As per recommendation,
revascularisation was deferred, and patients included into a registry. The
primary endpoint was MACE (death, myocardial infarction and unplanned
target lesion revascularization). Secondary endpoints were the above
individual components. Subgroup analyses were performed for clinical
presentation (stable vs. ACS), localization of lesion (ostial vs. non
ostial) and renal function. Results: The registry included 292 patients
with 297 deferred stenoses. After 1-year, the primary endpoint occurred in
5% of patients, mainly driven by TLR (2.7%). Cardiovascular death occurred
in 0.8% and AMI in 0.8%. During a follow-up of 22.2 +/- 11 months, MACE
occurred in 11.6%. Cardiovascular death occurred in 1.8% and AMI in 2.1%.
After multivariate analysis, impaired renal function (OR 1.99; CI 95%
1.74-5.41; p = 0.046) and ostial disease (OR 2.88; CI 95% 1.04-7.38; p =
0.041) were found to be predictors of MACE. Impaired renal function also
predicted TLR (OR 2.43; CI 95% 1.17-5.02; p = 0.017). Conclusion:
FFR-guided revascularisation deferral is safe in the majority of
anatomically prognostic disease. However, further evaluation is required
in the risk stratification of those patients with ostial disease and renal
disease. Registered on ClinicalTrials, NCT02590926. Copyright ©
2018 Elsevier B.V.

<3>
Accession Number
2001173776
Title
Impact of Baseline Atrial Fibrillation on Outcomes Among Women Who
Underwent Contemporary Transcatheter Aortic Valve Implantation (from the
Win-TAVI Registry).
Source
American Journal of Cardiology. 122 (11) (pp 1909-1916), 2018. Date of
Publication: 1 December 2018.
Author
Guedeney P.; Chieffo A.; Snyder C.; Mehilli J.; Petronio A.S.; Claessen
B.E.; Sartori S.; Lefevre T.; Presbitero P.; Capranzano P.; Tchetche D.;
Iadanza A.; Sardella G.; Van Mieghem N.M.; Chandrasekhar J.; Vogel B.;
Sorrentino S.; Kalkman D.N.; Meliga E.; Dumonteil N.; Fraccaro C.;
Trabattoni D.; Mikhail G.; Ferrer M.C.; Naber C.; Kievit P.; Baber U.;
Sharma S.; Morice M.C.; Mehran R.
Institution
(Guedeney, Snyder, Claessen, Sartori, Chandrasekhar, Vogel, Sorrentino,
Kalkman, Baber, Mehran) Icahn School of Medicine at Mount Sinai, New York
City, NY, United States
(Guedeney) ACTION Study Group, Sorbonne Universite, Institut de
Cardiologie, Departement de Cardiologie, Pitie Salpetriere Hospital
(AP-HP), Paris, France
(Chieffo) San Raffaele Scientific Institute, Milan, Italy
(Mehilli) Munich University Clinic, Ludwig-Maximilians-University and
German Centre for Cardiovascular Research (DZHK), partner site Munich
Heart Alliance, Munich, Germany
(Petronio) AOUP Cisanello, University Hospital, Pisa, Italy
(Lefevre, Morice) Institut Hospitalier Jacques Cartier, Ramsay Generale de
Sante, Massy, France
(Presbitero) Istituto Clinico Humanitas, Milan, Italy
(Capranzano) University of Catania, Catania, Italy
(Tchetche) Clinique Pasteur, Toulouse, France
(Iadanza) Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte,
Siena, Italy
(Sardella) Policlinico "Umberto I", "Sapienza" University of Rome, Rome,
Italy
(Van Mieghem) Erasmus Medical Center, Thorax center, Rotterdam,
Netherlands
(Meliga) Mauriziano Hospital, Turin, Italy
(Dumonteil) Rangueil University Hospital, Toulouse, France
(Fraccaro) University of Padova, Padova, Italy
(Trabattoni) Centro Cardiologico Monzino, Milan, Italy
(Mikhail) Imperial College Healthcare NHS Trust, Hammersmith Hospital,
London, United Kingdom
(Ferrer) Hospital Universitario Miguel Servet, Zaragoza, Spain
(Naber) Contilia Heart and Vascular Centre, Elisabeth Krankenhaus, Essen,
Germany
(Kievit) Department of Cardiology, Radboud University Nijmegen Medical
Center, Nijmegen, Netherlands
(Sharma) Mount Sinai Hospital, New York City, NY, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Pre-existing atrial fibrillation (AF) is common among patients who
underwent transcatheter aortic valve implantation (TAVI) and has been
associated with adverse outcomes. The specific impact of AF at baseline in
women who underwent TAVI, however, remains unknown. The Women's
International Transcatheter Aortic Valve Implantation is a prospective,
multinational registry evaluating the safety and performance of
contemporary TAVI in women in 19 centers between January 2013 and December
2015. Patients with available electrocardiogram at baseline were compared
according to the presence of AF. All events were adjudicated according to
the Valve Academic Research Consortium 2 criteria. Associations between AF
and outcomes were tested using multivariate Cox regression model. Of the
993 women with available baseline electrocardiogram included in the study,
200 (20.1%) presented with AF. Patients with AF at baseline had higher
Euroscore I score values and more frequently had chronic kidney disease or
prior stroke. Patients without AF more frequently had coronary artery
disease. There was no difference regarding in-hospital events between the
two groups aside from longer length of stay for patients with AF (13.3 +/-
11 vs 11.5 +/- 7.1 days, p = 0.01). In multivariate analysis, AF at
baseline was associated with an increase of all-cause and cardiovascular
death at 12 months (<inf>adj</inf>HR 1.67 95%CI 1.11 to 2.50, p = 0.013
and <inf>adj</inf>HR 1.85 95%CI 1.19 to 2.86, p = 0.006 respectively). In
conclusion, in this prospective registry of women who underwent
contemporary TAVI, the presence of AF at baseline was associated with
significantly increased 12-month mortality. Copyright © 2018

<4>
Accession Number
622801072
Title
Closure, anticoagulation, or antiplatelet therapy for cryptogenic stroke
with patent foramen ovale: Systematic review of randomized trials,
sequential meta-analysis, and new insights from the CLOSE study.
Source
Journal of the American Heart Association. 7 (12) (no pagination), 2018.
Article Number: e008356. Date of Publication: 01 Jun 2018.
Author
Chatellier G.; Mas J.-L.; Turc G.; Domigo V.; Guiraud V.; Touze E.; Calvet
D.; Varenne O.; Menacer S.; Sroussi M.; Nana A.; Cabanes L.; Guillon B.;
Schunck A.; Herisson F.; De Gaalon S.; Sevin M.; Langlard J.-M.; Piriou
N.; Jaafar P.; Massardier E.; d'Here B.; Stepowski D.; Bauer F.; Hosseini
H.; Teiger E.; Duval A.-M.; Lim P.; Mechtouff L.; Nighoghossian N.; Derex
L.; Cho T.; Rossi R.; Rioufol G.; Derumeaux G.; Thibaut H.; Barthelet M.;
Thivolet S.; Arquizan C.; Mourand I.; Sportouch C.; Cade S.; Cransac F.;
Giroud M.; Bejot Y.; Eicher J.-C.; L'Huillier I.; Vuillier F.; Moulin T.;
Meneveau N.; Chopard R.; Descotes-Genon V.; Detante O.; Garambois K.;
Bertrand B.; Saunier C.; Mazighi M.; Juliard E.J.-M.; Brochet E.; Guidoux
C.; Meseguer D.; Cabrejo L.; Lavallee P.; Amarenco P.; Messika-Zeitoun;
Lepage L.; Bugnicourt J.-M.; Canaple S.; Lamy C.; Godefroy O.; Leborgne
L.; Guillaumont M.-P.; Trojette F.; Malaquin D.; Vaduva C.; Couvreur G.;
Golfier V.; Plurien F.; Taldir G.; Lucas C.; Cordonnier C.; Henon H.;
Dumont F.; Dequatre-Ponchelle N.; Leys D.; Godart F.; Richardson M.; Polge
A.-S.; Montaigne D.; Coisne A.; Sibon I.; Rouanet F.; Renou P.; Thambo
J.-B.; Reant P.; Laffite S.; Roudaut R.; Garnier P.; Comtet C.; Delsart
D.; Ferrier A.; Bourgois N.; Clavelou P.; Rouhart F.; Timsit S.; Le Cadet
E.; Tirel A.; Mocquard Y.; Guerin P.; Jobic Y.; Le Ven F.; Pouliquen
M.-C.; Milandre L.; Robinet-Borgomano E.; Laksiri N.; Rey C.; Fraisse A.;
Habib G.; Chalvignac V.; Thuny F.; Sablot D.; Runavot G.; Piot C.; Targosz
F.; Chopat P.; Sultan P.; Lacour C.; Richard S.; Ducrocq X.; Marcon F.;
Selton-Suty M.C.; Huttin O.; Bruandet M.; Zuber M.; Tamazyan R.; Antakly
Y.; Garcon P.; Serfaty J.; Favrole P.; Dubois-Rande J.-L.; Hammoudi N.;
Pinel J.-F.; Schleich J.-M.; Donal E.; Lelong B.; Chabanne C.; Viader F.;
Apoil M.; Cogez J.; Labombarda F.; Saloux E.; Reiner P.; Buffon F.; Baudet
M.; Logeart D.; Lefebvre C.; Bataille M.; Godard F.; Biausque F.; Lefetz
Y.; Clement-Dupont M.; Weimar C.; Zegarac V.; Schmitz T.; Plicht B.;
Eissmann M.; Mahabadi A.; Obadia M.; Aubry P.; Iglesias Benyounes N.;
Macian F.; Lusson J.-R.; Darodes N.; Tanguy B.; Mohty D.; Vuillemet F.;
Onea R.; Greciano S.; Roth O.; Neau J.-P.; Quillet L.; Christiaens L.;
Saudeau D.; Patat F.; Singer O.; Fichtlscherer S.; Pico F.; Juliard J.-M.;
Charbonnel C.
Institution
(Turc, Calvet, Mas) Department of Neurology, Hopital Sainte-Anne, Paris,
France
(Turc, Calvet, Sroussi, Chatellier, Mas) Universite Paris Descartes,
Sorbonne Paris Cite, Paris, France
(Turc, Calvet, Mas) INSERM U894, Paris, France
(Turc, Calvet, Mas) DHU Neurovasc, Paris, France
(Guerin) Department of Cardiology, INSERM UMR 915, Institut du Thorax,
Nantes, France
(Guerin) Institut du Thorax, Centre Hospitalier Universitaire de Nantes,
Nantes, France
(Sroussi) Department of Cardiology, Cochin Hospital, India
(Chatellier) Epidemiology and Clinical Research Unit, Georges Pompidou
European Hospital, France
(Chatellier) APHP, Paris, France
(Chatellier) INSERM CIC 1418, Paris, France
(Mas, Turc, Domigo, Guiraud, Touze, Calvet, Lamy, Teiger, Juliard,
Dubois-Rande, Aubry, Varenne, Menacer, Sroussi, Nana, Cabanes) Hopital
Sainte-Anne, Paris, France
(Guillon, Schunck, Herisson, De Gaalon, Sevin, Guerin, Langlard, Piriou,
Jaafar) Hopital Laennec, Nantes, France
(Massardier, Juliard, Aubry, d'Here, Stepowski, Bauer) CHU Rouen, France
(Hosseini, Dubois-Rande, Teiger, Duval, Lim) Hopital Henri Mondor,
Creteil, France
(Mechtouff, Nighoghossian, Derex, Cho, Rossi, Rioufol, Derumeaux, Thibaut,
Barthelet, Thivolet) CHU Pierre Wertheimer, Lyon, France
(Arquizan, Mourand, Piot, Sportouch, Cade, Cransac) Hopital Gui de
Chauliac, Montpellier, France
(Giroud, Bejot, Eicher, Eicher, L'Huillier) CHU Dijon, France
(Vuillier, Moulin, Meneveau, Chopard, Descotes-Genon) CHU Jean Minjoz,
Besancon, France
(Detante, Garambois, Bertrand, Saunier) CHU Grenoble-Alpes, France
(Mazighi, Guidoux, Juliard, Aubry, Brochet, Guidoux, Meseguer, Cabrejo,
Lavallee, Amarenco, Messika-Zeitoun, Lepage) Hopital Bichat, Paris, France
(Bugnicourt, Canaple, Lamy, Godefroy, Rey, Leborgne, Guillaumont,
Trojette, Malaquin) CHU Nord, Amiens, France
(Vaduva, Couvreur, Golfier, Schleich, Plurien, Taldir) Hopital Yves Le
Foll, St-Brieuc, France
(Lucas, Cordonnier, Henon, Dumont, Dequatre-Ponchelle, Leys, Godart, Rey,
Richardson, Polge, Montaigne, Coisne) CHU Salengro, Lille, France
(Sibon, Rouanet, Renou, Thambo, Reant, Laffite, Roudaut) CHU Bordeaux,
France
(Garnier, Lusson, Comtet, Delsart) Hopital Nord, St-Etienne, France
(Ferrier, Bourgois, Clavelou, Lusson, Lusson) CHU Montpied,
Clermont-Ferrand, France
(Rouhart, Timsit, Le Cadet, Tirel, Mocquard, Guerin, Jobic, Le Ven,
Pouliquen) CHU La Cavale Blanche, Brest, France
(Milandre, Robinet-Borgomano, Laksiri, Rey, Fraisse, Habib, Chalvignac,
Thuny) CHU La Timone, Marseille, France
(Sablot, Runavot, Piot, Targosz, Chopat, Sultan) CH Perpignan, France
(Lacour, Richard, Ducrocq, Marcon, Selton-Suty, Huttin) CHU Nancy, France
(Bruandet, Zuber, Tamazyan, Juliard, Aubry, Antakly, Garcon, Serfaty)
Hopital Saint-Joseph, Paris, France
(Favrole, Dubois-Rande, Hammoudi) Hopital Tenon, Paris, France
(Pinel, Schleich, Donal, Lelong, Chabanne) Hopital Pontchaillou, Rennes,
France
(Viader, Apoil, Cogez, Juliard, Labombarda, Saloux) CHU Caen, France
(Reiner, Buffon, Juliard, Baudet, Logeart) Hopital Lariboisiere, Paris,
France
(Lefebvre, Bataille, Godard, Biausque, Lefetz, Clement-Dupont) CH Lens,
France
(Weimar, Zegarac, Schmitz, Plicht, Eissmann, Mahabadi) Essen University
Hospital, Essen, Germany
(Obadia, Juliard, Aubry, Iglesias Benyounes) Fondation Hopital Rothschild,
Paris, France
(Macian, Lusson, Darodes, Tanguy, Mohty) CHU Limoges, France
(Vuillemet, Onea, Greciano, Roth) Hopitaux Civils de Colmar, France
(Neau, Quillet, Christiaens) CHU Poitiers et CHRU Tours, France
(Saudeau, Patat) CHU Bretonneau, Tours, France
(Singer, Fichtlscherer) Goethe University Hospital, Frankfurt, Germany
(Pico, Juliard, Charbonnel) CH Mignot, Versailles, France
Publisher
American Heart Association Inc.
Abstract
Background--We conducted a systematic review and meta-analysis of
randomized controlled trials (RCTs) comparing patent foramen ovale (PFO)
closure, anticoagulation, and antiplatelet therapy to prevent stroke
recurrence in patients with PFO-associated cryptogenic stroke. Methods and
Results--We searched Medline, Cochrane Library, and EMBASE through March
2018. The primary outcome was stroke recurrence. Pooled incidences, hazard
ratios, and risk ratios (RRs) were calculated in random-effects
meta-analyses. PFO closure was associated with a lower risk of recurrent
stroke compared with antithrombotic therapy (antiplatelet therapy or
anticoagulation: 3560 patients from 6 RCTs; RR=0.36, 95% CI: 0.17-0.79;
I2=59%). The effect of PFO closure on stroke recurrence was
larger in patients with atrial septal aneurysm or large shunt (RR=0.27,
95% CI, 0.11-0.70; I2=42%) compared with patients without these
anatomical features (RR=0.80, 95% CI, 0.43-1.47; I2=12%). Major
complications occurred in 2.40% (95% CI, 1.03-4.25; I2=77%) of
procedures. New-onset atrial fibrillation was more frequent in patients
randomized to PFO closure versus antithrombotic therapy (RR=4.33, 95% CI,
2.37-7.89; I2=14%). One RCT compared PFO closure versus
anticoagulation (353 patients; hazard ratio=0.14, 95% CI, 0.00-1.45) and 2
RCTs compared PFO closure versus antiplatelet therapy (1137 patients;
hazard ratio=0.18, 95% CI, 0.05-0.63; I2=12%). Three RCTs
compared anticoagulation versus antiplatelet therapy, with none showing a
significant difference. Conclusions--PFO closure is superior to
antithrombotic therapy to prevent stroke recurrence after cryptogenic
stroke. The annual absolute risk reduction of stroke was low, but it has
to be tempered by a substantial time at risk (at least 5 years) in young
and middle-aged patients. PFO closure was associated with an increased
risk of atrial fibrillation. Copyright © 2018 The Authors.

<5>
Accession Number
619378690
Title
Longitudinal hemodynamics of transcatheter and surgical aortic valves in
the PARTNER Trial.
Source
JAMA Cardiology. 2 (11) (pp 1197-1206), 2017. Date of Publication:
November 2017.
Author
Douglas P.S.; Leon M.B.; Mack M.J.; Svensson L.G.; Webb J.G.; Hahn R.T.;
Pibarot P.; Weissman N.J.; Miller D.C.; Kapadia S.; Herrmann H.C.; Kodali
S.K.; Makkar R.R.; Thourani V.H.; Lerakis S.; Lowry A.M.; Rajeswaran J.;
Finn M.T.; Alu M.C.; Smith C.R.; Blackstone E.H.
Institution
(Douglas, Leon, Hahn) Duke University Medical Center, Durham, NC, United
States
(Leon, Hahn, Kodali, Finn, Alu, Smith) New York Presbyterian Hospital,
Columbia University Medical Center, New York, NY, United States
(Mack) Baylor Scott and White Health, Plano, TX, United States
(Svensson, Kapadia, Lowry, Rajeswaran, Blackstone) Cleveland Clinic,
Cleveland, OH, United States
(Webb) St Paul's Hospital, University of British Columbia, Vancouver, BC,
Canada
(Pibarot) Quebec Heart and Lung Institute, Laval University, Quebec City,
QC, Canada
(Weissman, Miller) MedStar Washington Hospital Center, Washington, DC,
United States
(Miller) Stanford University, Stanford, CA, United States
(Herrmann) University of Pennsylvania Health System, Philadelphia, PA,
United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Thourani, Lerakis) Emory University, Atlanta, GA, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: Use of transcatheter aortic valve replacement (TAVR) for
severe aortic stenosis is growing rapidly. However, to our knowledge, the
durability of these prostheses is incompletely defined. OBJECTIVE: To
determine the midterm hemodynamic performance of balloon-expandable
transcatheter heart valves. DESIGN, SETTING, AND PARTICIPANTS: In this
study, we analyzed core laboratory-generated data from echocardiograms of
all patients enrolled in the Placement of Aortic Transcatheter Valves
(PARTNER) 1 Trial with successful TAVR or surgical AVR (SAVR) obtained
preimplantation and at 7 days, 1 and 6 months, and 1, 2, 3, 4, and 5 years
postimplantation. Patients from continued access observational studies
were included for comparison. INTERVENTIONS: Successful implantation after
randomization to TAVR vs SAVR (PARTNER 1A; TAVR, n = 321; SAVR, n = 313),
TAVR vs medical treatment (PARTNER 1B; TAVR, n = 165), and continued
access (TAVR, n = 1996). Five-year echocardiogram data were available for
424 patients after TAVR and 49 after SAVR. MAIN OUTCOMES AND MEASURES:
Death or reintervention for aortic valve structural indications, measured
using aortic valve mean gradient, effective orifice area, Doppler velocity
index, and evidence of hemodynamic deterioration by reintervention,
adverse hemodynamics, or transvalvular regurgitation. RESULTS: Of 2795
included patients, the mean (SD) age was 84.5 (7.1) years, and 1313
(47.0%) were female. Population hemodynamic trends derived from nonlinear
mixed-effects models showed small early favorable changes in the first few
months post-TAVR, with a decrease of -2.9 mm Hg in aortic valve mean
gradient, an increase of 0.028 in Doppler velocity index, and an increase
of 0.09 cm2 in effective orifice area. There was relative
stability at a median follow-up of 3.1 (maximum, 5) years. Moderate/severe
transvalvular regurgitation was noted in 89 patients (3.7%) after TAVR and
increased over time. Patients with SAVR showed no significant changes. In
TAVR, death/reintervention was associated with lower ejection fraction,
stroke volume index, and aortic valve mean gradient up to 3 years, with no
association with Doppler velocity index or valve area. Reintervention
occurred in 20 patients (0.8%) after TAVR and in 1 (0.3%) after SAVR and
became less frequent over time. Reintervention was caused by structural
deterioration of transcatheter heart valves in only 5 patients. Severely
abnormal hemodynamics on echocardiograms were also infrequent and not
associated with excess death or reintervention for either TAVR or SAVR.
CONCLUSIONS AND RELEVANCE: This large, core laboratory-based study of
transcatheter heart valves revealed excellent durability of the
transcatheter heart valves and SAVR. Abnormal findings in individual
patients, suggestive of valve thrombosis or structural deterioration, were
rare in this protocol-driven database and require further investigation.
TRIAL REGISTRATION: clinicaltrials.gov Identifier:
NCT00530894. Copyright © 2017 American Medical Association. All
rights reserved.

<6>
Accession Number
624895183
Title
Routine angiographic follow-up for left main percutaneous coronary
intervention: Back to the old times?.
Source
Cardiology Journal. 25 (5) (pp 571-573), 2018. Date of Publication: 30 Oct
2018.
Author
Sanmartin M.; Daggubati R.
Institution
(Sanmartin) Hospital Universitario Ramon y Cajal, Carretera Colmenar
Viejo, Madrid, Spain
(Daggubati) Interventional Cardiology Fellowship, NYU Winthrop Hospital,
Mineola, NY, United States
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)

<7>
Accession Number
618263742
Title
Short-term effects of preoperative beta-blocker use for isolated coronary
artery bypass grafting: A systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (2) (pp 620-629.e1),
2018. Date of Publication: February 2018.
Author
Wang L.; Wang H.; Hou X.
Institution
(Wang, Wang, Hou) Center for Cardiac Intensive Care, Capital Medical
University Affiliated Anzhen Hospital, Beijing, China
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The use of preoperative beta-blockers has been used as a
quality standard for patients undergoing coronary artery bypass grafting
(CABG). However, the benefits of beta-blockers use before CABG remain
controversial. We performed a systematic review and meta-analysis to
investigate the short-term effects of preoperative beta-blocker use for
patients undergoing isolated CABG. Methods: We searched PubMed, Embase,
and the Cochrane Library for English articles published from inception to
August 16, 2016. Observational studies comparing preoperative
beta-blockers therapy or non-beta-blockers therapy were considered
eligible for the current study. Results: Six observational studies with
1,231,850 patients were included. The pooled analyses of unadjusted
outcome (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.71-0.95; P
=.007) or risk-adjusted outcome (OR, 0.95; 95% CI, 0.92-0.97; P =.000)
showed slight reduction in operative mortality, whereas an insignificant
difference in mortality rate was observed in pooling postoperative data
from propensity score analysis (OR, 0.97; 95% CI, 0.94-1.00; P =.088).
Removing one study that used propensity-score covariate adjustment,
subgroup analysis of propensity-matched patients (313,417 in each group)
still generated a statistically nonsignificant benefit for preoperative
beta-blocker use (OR, 0.97; 95% CI, 0.94-1.00; P =.093). Furthermore, the
preoperative use of beta-blockers did not reduce the incidence of major
postoperative complications, such as postoperative myocardial infarction,
stroke, atrial fibrillation, reoperation, renal failure, prolonged
ventilation, and sternal wound infection. Conclusions: Our study suggests
that the use of preoperative beta-blockers did not reduce either operative
mortality or the incidence of postoperative complications in patients
undergoing CABG. Copyright © 2017 The American Association for
Thoracic Surgery

<8>
Accession Number
618685470
Title
A prospective randomized trial of the cut-and-sew Maze procedure in
patients undergoing surgery for rheumatic mitral valve disease.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (2) (pp 608-617),
2018. Date of Publication: February 2018.
Author
Wang H.; Han J.; Wang Z.; Yin Z.; Liu Z.; Jin Y.; Han H.
Institution
(Wang, Han, Wang, Yin, Jin, Han) Department of Cardiovascular Surgery,
General Hospital of Shenyang Military Area Command, Shenyang, China
(Liu) TEDA International Cardiovascular Hospital, Tianjin, China
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: To evaluate the safety and efficacy of the addition of the
cut-and-sew Maze III procedure (CSM) for mitral valve replacement (MVR) in
patients with atrial fibrillation (AF) associated with rheumatic mitral
valve disease (RMVD). Methods: A total of 130 patients with persistent or
long-standing persistent AF associated with RMVD were assigned at random
to either the CSM plus MVR (Maze III) group or MVR alone (non-Maze) group.
The primary endpoint was a composite of freedom from stroke and death at 1
year. Results: There were no significant differences between the Maze III
and non-Maze groups in terms of major complications and in-hospital
mortality. One-year freedom from stroke or death was better in the Maze
III group compared with the non-Maze group (P =.0028; hazard ratio,
0.2653; 95% confidence interval, 0.1122 to 0.6270). The risk of AF
recurrence in the Maze III group was 0.002-fold that in non-Maze group (P
=.000). Conclusions: Addition of the CSM to an MVR procedure can decrease
the risk of stroke or death and high sinus rhythm at 1 year without
increasing the operative risk. CSM is a safe and effective approach to
treating AF associated with RMVD. Copyright © 2017 The American
Association for Thoracic Surgery

<9>
Accession Number
623717234
Title
Computed tomography-guided pericardiocentesis: a systematic review
concerning contemporary evidence and future perspectives.
Source
Therapeutic Advances in Cardiovascular Disease. 12 (11) (pp 299-307),
2018. Date of Publication: 01 Nov 2018.
Author
Vilela E.M.; Ruivo C.; Guerreiro C.E.; Silva M.P.; Ladeiras-Lopes R.;
Caeiro D.; Morais G.P.; Primo J.; Braga P.; Ferreira N.; Nunes J.P.L.;
Ribeiro V.G.
Institution
(Vilela) Cardiology Department, Vila Nova de Gaia / Espinho Hospital
Center EPE, Rua Conceicao Fernandes, Vila Nova de Gaia 4434-520, Portugal
(Ruivo) Leiria Hospital Center, Leiria, Portugal
(Guerreiro, Silva, Ladeiras-Lopes, Caeiro, Morais, Primo, Braga, Ferreira,
Ribeiro) Cardiology Department, Vila Nova de Gaia / Espinho Hospital
Center, Gaia, Portugal
(Nunes) Sao Joao Hospital Center, Porto, Portugal
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Pericardial effusion (PE) can develop in several pathological
scenarios, and is often initially evaluated by means of echocardiography.
Computed tomography (CT) has been used as an aid in the management of
patients presenting with PE, in selected cases. The role of CT-guided
pericardiocentesis in contemporary practice, however, remains not fully
ascertained. We aimed at presenting a systematic review concerning the
state-of-the-art of this technique. Methods: A systematic review of
published data on the use of CT for guiding pericardiocentesis was carried
out (search performed on PubMed, ISI Web of Knowledge and Scopus
databases). Results: From title and abstract analysis, 14 articles were
included that met the prespecified criteria. After full-text analysis, six
articles were excluded. The eight articles under analysis included a total
of 635 procedures performed in 571 patients. CT guidance was mostly used
in a postoperative setting (364 procedures). Most procedures were done
mainly for therapeutic purposes (528 procedures). Success rates ranged
from 94% to 100%. Complications ranged from 0% to 7.8%. Conclusion:
CT-guided pericardiocentesis is a useful technique in the approach to PE,
in several clinical scenarios. Its use can be especially relevant in the
postoperative period, as well as in individuals with suboptimal image
quality (as assessed by echocardiography, for the moment the first choice
in the approach to most cases of PE). Copyright © The Author(s),
2018.

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

<11>
Accession Number
619713862
Title
The use of del Nido cardioplegia in adult cardiac surgery: A prospective
randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (3) (pp 1011-1018),
2018. Date of Publication: March 2018.
Author
Ad N.; Holmes S.D.; Massimiano P.S.; Rongione A.J.; Fornaresio L.M.;
Fitzgerald D.
Institution
(Ad) Department of Cardiovascular and Thoracic Surgery, West Virginia
University, Morgantown, WVa, United States
(Ad, Massimiano, Rongione) Adventist HealthCare, Takoma Park, Md, United
States
(Ad) Inova Fairfax Hospital, Falls Church, Va, United States
(Holmes, Fornaresio) Heart and Vascular Institute, West Virginia
University Medicine, Morgantown, WVa, United States
(Fitzgerald) The Medical University of South Carolina, Charleston, SC,
United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: The del Nido cardioplegia solution has been used extensively
in congenital heart surgery for more than 20 years and more recently for
adults. This randomized controlled trial examined whether expanding this
technique to adult cardiac surgery confers benefits in surgical workflow
and clinical outcome compared with blood-based cardioplegia. Methods:
Adult first-time coronary artery bypass grafting (CABG), valve, or
CABG/valve surgery patients requiring cardiopulmonary bypass (CPB) were
randomized to del Nido cardioplegia (n = 48) or whole blood cardioplegia
(n = 41). Primary outcomes assessed myocardial preservation. Troponin I
was measured at baseline, 2 hours after CPB termination, 12 and 24 hours
after cardiovascular intensive care unit admission. Alpha was set at P
<.001. Results: Preoperative characteristics were similar between groups,
including age, Society of Thoracic Surgeons risk score, CABG, and valve
procedures. There was no significant difference on CPB time (97 vs 103
minutes; P =.288) or crossclamp time (70 vs 83 minutes; P =.018). The del
Nido group showed higher return to spontaneous rhythm (97.7% vs 81.6%; P
=.023) and fewer patients required inotropic support (65.1% vs 84.2%; P
=.050), but did not reach statistical significance. Incidence of Society
of Thoracic Surgeons-defined morbidity was low, with no strokes,
myocardial infarctions, renal failure, or operative deaths. For del Nido
group patients, troponin levels did not increase as much as for control
patients (P =.040), but statistical significance was not reached.
Conclusions: Evidence from this study suggests del Nido cardioplegia use
in routine adult cases may be safe, result in comparable clinical
outcomes, and streamline surgical workflow. The trend for troponin should
be investigated further because it may suggest superior myocardial
protection with the del Nido solution. Copyright © 2017 The
American Association for Thoracic Surgery

<12>
Accession Number
2000989446
Title
Mini-Stern Trial: A randomized trial comparing mini-sternotomy to full
median sternotomy for aortic valve replacement.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (6) (pp
2124-2132.e31), 2018. Date of Publication: December 2018.
Author
Nair S.K.; Sudarshan C.D.; Thorpe B.S.; Singh J.; Pillay T.; Catarino P.;
Valchanov K.; Codispoti M.; Dunning J.; Abu-Omar Y.; Moorjani N.; Matthews
C.; Freeman C.J.; Fox-Rushby J.A.; Sharples L.D.
Institution
(Nair, Sudarshan, Catarino, Valchanov, Codispoti, Dunning, Abu-Omar,
Moorjani, Matthews, Freeman) Department of Cardiothoracic Surgery,
Papworth Hospital, Cambridge, United Kingdom
(Nair, Pillay) Freeman Hospital, Newcastle upon Tyne, United Kingdom
(Thorpe) Leeds Institute of Clinical Trials Research, University of Leeds,
Leeds, United Kingdom
(Singh, Fox-Rushby) Health Economics Research Group, Brunel University
London, London, United Kingdom
(Sharples) London School of Hygiene and Tropical Medicine, Keppel Street,
London, United Kingdom
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Aortic valve replacement (AVR) can be performed either through
full median sternotomy (FS) or upper mini-sternotomy (MS). The Mini-Stern
trial aimed to establish whether MS leads to quicker postoperative
recovery and shorter hospital stay after first-time isolated AVR. Methods:
This pragmatic, open-label, parallel randomized controlled trial (RCT)
compared MS with FS for first-time isolated AVR in 2 United Kingdom
National Health Service hospitals. Primary endpoints were duration of
postoperative hospital stay and the time to fitness for discharge from
hospital after AVR, analyzed in the intent-to-treat population. Results:
In this RCT, 222 patients were recruited and randomized (n = 118 in the MS
group; n = 104 in the FS group). Compared with the FS group, the MS group
had a longer hospital length of stay (mean, 9.5 days vs 8.6 days) and took
longer to achieve fitness for discharge home (mean, 8.5 days vs 7.5 days).
Adjusting for valve type, sex, and surgeon, hazard ratios (HRs) from Cox
models did not show a statistically significant effect of MS (relative to
FS) on either hospital stay (HR, 0.874; 95% confidence interval [CI],
0.668-1.143; P =.3246) or time to fitness for discharge (HR, 0.907; 95%
CI, 0.688-1.197; P value =.4914). During a mean follow-up of 760 days (745
days for the MS group and 777 days for the FS group), 12 patients (10%) in
the MS group and 7 patients (7%) in the FS group died (HR, 1.871; 95% CI,
0.723-4.844; P =.1966). Average extra cost for MS was 1714 during the
first 12 months after AVR. Conclusions: Compared with FS for AVR, MS did
not result in shorter hospital stay, faster recovery, or improved survival
and was not cost-effective. The MS approach is not superior to FS for
performing AVR. Copyright © 2018 The American Association for
Thoracic Surgery

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

<14>
Accession Number
624459567
Title
Antiplatelet Effect of Ketorolac in Children After Congenital Cardiac
Surgery.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 9 (6) (pp
651-658), 2018. Date of Publication: 01 Nov 2018.
Author
Kim J.S.; Kaufman J.; Patel S.S.; Manco-Johnson M.; Di Paola J.; da Cruz
E.M.
Institution
(Kim, Kaufman, Patel, da Cruz) Department of Pediatrics, Heart Institute,
Children's Hospital Colorado, University of Colorado Denver School of
Medicine, Aurora, CO, United States
(Manco-Johnson, Di Paola) Department of Pediatrics, Hemophilia and
Thrombosis Center, Children's Hospital Colorado, University of Colorado
Denver School of Medicine, Aurora, CO, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Ketorolac is used for pediatric analgesia after surgery
despite its known platelet inhibition via the arachidonic acid (AA)
pathway. The degree of platelet inhibitory effect after cardiac surgery is
not well characterized. Thromboelastography with platelet mapping (TEG-PM)
is emerging as a frequently used test to evaluate platelet inhibition via
the AA pathway. Methods: Post hoc analysis of a data set collected in a
prospective observational cohort study evaluating platelet inhibition in
children after congenital heart surgery with cardiopulmonary bypass (CPB).
Categorization into two groups: (1) received ketorolac and (2) did not
receive ketorolac for analgesia after surgery. The TEG-PM was evaluated at
two time points (prior to surgery and 12-48 hours after CPB). Results:
Fifty-three children were studied; mean age was 6.6 (range: 0.07-16.7)
years and 45% (n = 24) were female. Participants were distributed into two
groups by ketorolac use, 41 within the ketorolac group and 12 in the no
ketorolac group. All 41 participants who received ketorolac had platelet
inhibition and 11 (91.7%) of 12 participants who did not receive ketorolac
had normal platelet function after surgery (P <.0001). There was no
difference in patient characteristics or clinical data between the two
groups. Conclusions: Ketorolac use in a cohort of children after
congenital cardiac surgery was associated with platelet inhibition via the
AA pathway when evaluated by TEG-PM. Copyright © The Author(s)
2018.

<15>
Accession Number
2001229889
Title
Genotype-Guided Warfarin Dosing in Patients With Mechanical Valves: A
Randomized Controlled Trial.
Source
Annals of Thoracic Surgery. 106 (6) (pp 1774-1781), 2018. Date of
Publication: December 2018.
Author
Xu Z.; Zhang S.-Y.; Huang M.; Hu R.; Li J.-L.; Cen H.-J.; Wang Z.-P.; Ou
J.-S.; Yin S.-L.; Xu Y.-Q.; Wu Z.-K.; Zhang X.
Institution
(Xu, Wang, Ou, Yin, Xu, Wu, Zhang) Division of Cardiac Surgery, Key
Laboratory on Assisted Circulation, Ministry of Health, the First
Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
(Zhang, Huang, Hu, Li) Institute of Clinical Pharmacology, School of
Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
(Cen) Guangzhou Women and Children's Medical Center, Guangzhou Medical
University, Guangzhou, China
Publisher
Elsevier USA
Abstract
Background: The clinical utility of genotype-guided warfarin dosing
remains controversial. The objective of this trial was to evaluate the
efficacy and safety of genotype-guided warfarin dosing in East Asians.
Methods: A double-blind, randomized control trial was performed to compare
a genotype-guided dosing algorithm (CYP2C9, VKORC1, and CYP4F2) with a
clinical-guided one in the initiation treatment for patients with
mechanical heart valves. The primary outcomes included the time to reach a
stable dose and the percentage of time in the therapeutic range (TTR).
Results: Two hundred one patients were randomly assigned to treatment, 101
to control and 100 to study. The major bleeding and thromboembolic
event-free rate in the study group was 97.0% (95% confidence interval:
90.9% to 99.2%). Compared with the control group, the study group
shortened the time to reach a stable dose (mean: 42.09 +/- 23.655 days
versus 33.52 +/- 20.044 days, p = 0.009). The TTRs were 47.257% and
47.461% in the control and study group (p = 0.941), respectively. Patients
with the CYP2C9 *1/*3 genotype had higher international normalized ratio
(INR) variability than patients with the CYP2C9 *1/*1 genotype (p =
0.024). Compared with normal and sensitive responders, the highly
sensitive responders were at increased risk of an INR of 4.0 or greater (p
< 0.05). Conclusions: The genotype-guided warfarin dosing was safe and
might be more efficient for the time to reach a stable dose.
Pharmacogenomic testing might be beneficial to identify the patients with
the CYP2C9 *1/*3 genotype and the highly sensitive responders, who were in
the high-risk subgroup of patients with mechanical heart valves. An
appropriately powered study is needed to further confirm these
findings. Copyright © 2018 The Society of Thoracic Surgeons

<16>
Accession Number
624962467
Title
Outcomes of anticoagulated patients with atrial fibrillation treated with
or without antiplatelet therapy - A pooled analysis from the PREFER in AF
and PREFER in AF PROLONGATON registries.
Source
International journal of cardiology. 270 (pp 160-166), 2018. Date of
Publication: 01 Nov 2018.
Author
Patti G.; Pecen L.; Lucerna M.; Huber K.; Rohla M.; Renda G.;
Siller-Matula J.; Schnabel R.B.; Cemin R.; Kirchhof P.; De Caterina R.
Institution
(Patti) Department of Cardiovascular Sciences, Campus Bio-Medico
University of Rome, Italy
(Pecen) Medical Faculty Pilsen of Charles University, Czech Republic
(Lucerna) Daiichi Sankyo Europe, Munich, Germany
(Huber, Rohla) 3rd Department of Medicine, Cardiology and Intensive Care
Medicine, Wilhelminenhospital, Vienna, Austria; Sigmund Freud University,
Medical School, Vienna, Austria
(Renda) G. d'Annunzio University, Chieti, Italy
(Siller-Matula) Department of Cardiology, Medical University of Vienna,
Austria; 1st Department of Cardiology, Poznan University of Medical
Sciences, Poland
(Schnabel) University Heart Center Hamburg, Clinic for General and
Interventional Cardiology, Hamburg, Germany; DZHK (German Center for
Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany
(Cemin) Department of Cardiology, San Maurizio Regional Hospital of
Bolzano, Italy
(Kirchhof) Institute of Cardiovascular Sciences, University of Birmingham
and SWBH and UHB NHS Trust, Birmingham, United Kingdom
(De Caterina) G. d'Annunzio University, Chieti, Italy; Fondazione G.
Monasterio, Pisa, Italy. Electronic address: rdecater@unich.it
Publisher
NLM (Medline)
Abstract
BACKGROUND: Evidence on whether antiPLT added to OACs is of advantage in
atrial fibrillation (AF) patients with concomitant stable coronary artery
disease (CAD) is limited. We evaluated clinical outcomes with oral
anticoagulant (OAC) monotherapy vs antiplatelet therapy (antiPLT) plus OAC
in patients with AF and stable CAD. METHOD(S): Data on 1058 AF
patients on OACs and history (>1year) of myocardial infarction or coronary
stenting were pooled from the PREFER-in-AF and PREFER-in-AF PROLONGATION
registries. We primarily compared the 1-year incidence of a net composite
endpoint (primary endpoint), including acute coronary syndrome and major
bleeding, with or without antiPLT. RESULT(S): The incidence of the
primary net composite endpoint was significantly higher in patients
receiving OACs+antiPLT (N=348) vs OACs alone (N=710): 7.9 vs 4.2 per
100patients/year; adjusted OR [95% CI] 1.84 [1.01-3.37]; p=0.048. Among
the components of the primary endpoint, the greatest relative difference
was found for major bleeding (OR [95% CI] 2.28 [95% CI 1.00-5.19]), and
especially life-threatening or non-gastrointestinal bleeding. The net
clinical outcome with OACs+antiPLT was poorer irrespective of the type of
CAD (previous infarction or coronary stenting), the type of stent (bare
metal or drug-eluting) or the type of OAC (vitamin K antagonist or
non-vitamin K antagonist OAC). CONCLUSION(S): Among patients with AF
and stable CAD >1-year after the index event, the addition of antiPLT to
OAC does not apparently provide added protection against coronary events,
but increases major bleeding. OAC monotherapy should thus be considered
the antithrombotic therapy of choice for such patients. Copyright
© 2018 Elsevier B.V. All rights reserved.

<17>
[Use Link to view the full text]
Accession Number
624837086
Title
Comparing methods for cardiac output: Intraoperatively doppler-derived
cardiac output measured with 3-dimensional echocardiography is not
interchangeable with cardiac output by pulmonary catheter thermodilution.
Source
Anesthesia and Analgesia. 127 (2) (pp 399-407), 2018. Date of Publication:
2018.
Author
Graeser K.; Zemtsovski M.; Kofoed K.F.; Winther-Jensen M.; Nilsson J.C.;
Kjaergaard J.; Moller-Sorensen H.
Institution
(Graeser, Zemtsovski, Nilsson, Moller-Sorensen) Department of
Cardiothoracic Anaesthesiology, Heart Centre Rigshospitalet, Copenhagen
2200, Denmark
(Graeser) Department of Anaesthesia and Intensive Care, Bispebjerg and
Frederiksberg Hospital, Denmark
(Kofoed, Winther-Jensen, Kjaergaard) Department of Cardiology, Heart
Centre, Denmark
(Kofoed) Department of Radiology, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Estimation of cardiac output (CO) is essential in the
treatment of circulatory unstable patients. CO measured by pulmonary
artery catheter thermodilution is considered the gold standard but carries
a small risk of severe complications. Stroke volume and CO can be measured
by transesophageal echocardiography (TEE), which is widely used during
cardiac surgery. We hypothesized that Doppler-derived CO by 3-dimensional
(3D) TEE would agree well with CO measured with pulmonary artery catheter
thermodilution as a reference method based on accurate measurements of the
cross-sectional area of the left ventricular outflow tract.
 METHOD(S): The primary aim was a systematic comparison of CO with
Doppler-derived 3D TEE and CO by thermodilution in a broad population of
patients undergoing cardiac surgery. A subanalysis was performed comparing
cross-sectional area by TEE with cardiac computed tomography (CT)
angiography. Sixty-Two patients, scheduled for elective heart surgery,
were included; 1 wassubsequently excluded for logistic reasons. Inclusion
criteria were coronary artery bypass surgery (N = 42) and aortic valve
replacement (N = 19). Exclusion criteria were chronic atrial fibrillation,
left ventricular ejection fraction below 0.40 and intracardiac shunts.
Nineteen randomly selected patients had a cardiac CT the day before
surgery. All images were stored for blinded post hoc analyses, and
Bland-Altman plots were used to assess agreement between measurement
methods, defined as the bias (mean difference between methods), limits of
agreement (equal to bias +/- 2 standard deviations of the bias), and
percentage error (limits of agreement divided by the mean of the 2
methods). Precision was determined for the individual methods (equal to 2
standard deviations of the bias between replicate measurements) to
determine the acceptable limits of agreement. RESULT(S): We found a
good precision for Doppler-derived CO measured by 3D TEE, but although the
bias for Doppler-derived CO by 3D compared to thermodilution was only 0.3
L/min (confidence interval, 0.04-0.58), there were wide limits of
agreement (-1.8 to 2.5 L/min) with a percentage error of 55%. Measurements
of cross-sectional area by 3D TEE had low bias of-0.27 cm2 (confidence
interval,-0.45 to-0.08) and a percentage error of 18% compared to cardiac
CT angiography. CONCLUSION(S): Despite low bias, the wide limits of
agreement of Doppler-derived CO by 3D TEE compared to CO by thermodilution
will limit clinical application and can therefore not be considered
interchangeable with CO obtained by thermodilution. The lack of agreement
is not explained by lack of agreement of the 3D technique. (Anesth Analg
2018;127:399-407). Copyright © 2018 International Anesthesia
Research Society.

<18>
Accession Number
2000825445
Title
Dabigatran in patients with myocardial injury after non-cardiac surgery
(MANAGE): an international, randomised, placebo-controlled trial.
Source
The Lancet. 391 (10137) (pp 2325-2334), 2018. Date of Publication: 9 - 15
June 2018.
Author
Rahate P.V.; Chaudhry N.K.; Iglesias P.P.; Eikelboom J.W.; Connolly S.J.;
Devereaux P.J.; Duceppe E.; Bangdiwala S.I.; Connolly S.; Eikelboom J.;
Guyatt G.; Kearon C.; Pettit S.; Pogue J.; Rodseth R.; Sessler D.I.;
Vincent J.; Yusuf S.; Di Diodato S.; Gasic Z.; Mastrangelo L.J.; Molnar
S.H.; Swanson J.L.; Tosh M.L.; Wells J.R.; Botto F.; Diaz R.; Chow C.K.;
Berwanger O.; Gonzales B.; Tandon V.; Villar J.C.; Vasquez S.; Jansky P.;
Dusek R.; Meyhoff C.S.; Coriat P.; Hoeft A.; Wittmann M.; Yonga G.; Xavier
D.; Rao M.; Mathur N.; Franzosi M.G.; Seletti E.; Malaga G.;
Tumanan-Mendoza B.A.; Tagle M.P.A.; Szczeklik W.; Biccard B.M.;
Alonso-Coello P.; Popova E.; Shields M.; Le Manach Y.; Moayyedi P.; van
Zanten S.; Fleischmann E.; Garg A.; Karaye K.; McFalls E.; Sigamani A.;
Belley-Cote E.; Biedron G.; Borges F.; Frosi Stella S.; Haarmark Nielsen
C.; Leong D.P.; Spence J.; Tran A.; Wawrzycka-Adamczyk K.; Yang S.S.; Yung
T.; Wyse D.G.; Cheng D.; Johnstone D.E.; Wells G.A.; Joseph P.; Patel A.;
Gregus K.; Lawrence K.; Doharris L.; Conen D.; Cheung J.; Douketis J.;
Wright D.; Wikkerink S.; Dechert W.; Panju M.; Azzam K.; Rapanos T.; Van
Helder T.; Shroff A.; Hare J.; Kidane B.; Nguyen T.; Leydier L.; Bayaraa
V.; Parlow J.; DuMerton D.A.; Thakrar A.; Shelley J.; Deligne B.; Carling
R.D.; Mrkobrada M.; Dresser G.K.; Jacka M.J.; Hornstein D.; Winkelaar
G.B.; Haider Z.H.; Lanjewar P.P.; Varughese V.; Calton R.; Ahuja H.;
George P.; Sharma A.; Bhatt K.S.; Mangukiya D.O.; Nandaniya K.V.; Parekh
V.V.; Pillai A.B.; Menon V.P.; Desai S.C.; Sidhu R.S.; Gupta S.K.; George
R.K.; Gurunath T.R.; Drummond L.W.; Torborg A.M.; Kusel B.S.; Naidoo P.;
Naidoo D.P.; Rajah C.; Farina Z.; von Rahden R.P.; Gumede S.; Chishala C.;
Coetzee E.; Dyer R.A.; Diedericks J.; Bielanski P.; Kaczmarek B.;
Studzinska D.; Zaniewski M.; Libura M.J.; Zacharias-Nalichowski T.M.; Sega
A.A.S.; Salwa J.; Kozka M.; Gorka J.; Wludarczyk A.; Nowak-Kozka I.;
Grudzien P.S.; Gucwa J.W.; Slowiaczek M.P.; Dobosz P.P.D.; Gogenur I.;
Eriksen J.R.; Borup T.; Kirkegaard T.; Isbye D.; Sonne A.; Rasmussen L.S.;
Troensegaard H.; Duus C.L.; Halle B.M.; Gundel O.N.; Bernholm K.F.;
Martinsen K.R.; Pedersen S.; Itenov T.S.; Camio E.; Vazquez C.; Matarin
S.; Cano E.; Alvarez-Garcia J.; India I.; Gonzalez-Osuna A.; Vives M.;
Rossello E.; Serrano A.B.; Turiel M.; Drago L.; Colombo C.; Marra F.; Mos
L.; Arteni F.; Lembo R.; Ortalda A.; Passarani S.; Mokini Z.; Figueiredo
E.L.; Werner G.F.; Petriz J.L.; Maia L.N.; Bergo R.R.; Precoma D.B.;
Saraiva J.F.K.; Vilamajo O.G.; Allegrini E.; Benzadon M.; Parody M.L.;
Duronto E.A.; Ingaramo A.C.; Parra G.A.; Novoa D.; Miller S.A.; Thomas S.;
Karlapudi S.P.; Bourji M.H.; Banerjee S.; Gupta A.; Opole I.O.; Fischer
M.; Mendoza V.L.; Reyes E.B.; Pierson R.J.; Shields M.O.; Piriou V.;
Zacharowski K.; Rotta-Rotta A.; Paper M.; Srinathan S.K.; Erb J.; Magloire
P.; Neary J.; Rahate P.; Chaudhry N.; Mayosi B.; de Nadal M.; Paniagua
Iglesias P.; Sharma M.; Rao-Melacini P.
Institution
(Devereaux, Duceppe, Guyatt, Kearon, Bangdiwala, Yusuf) Department of
Health Research Methods, Evidence, and Impact, McMaster University,
Hamilton, ON, Canada
(Devereaux, Guyatt, Tandon, Magloire, Neary, Eikelboom, Kearon, Sharma,
Connolly, Yusuf) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Devereaux, Vincent, Pettit, Sharma, Connolly, Bangdiwala, Rao-Melacini,
Yusuf) Population Health Research Institute, Hamilton, ON, Canada
(Duceppe) Department of Medicine, University of Montreal, Montreal, QC,
Canada
(Rodseth) Department of Anaesthesia, University of KwaZulu-Natal,
Pietermaritzburg, South Africa
(Biccard) Department of Anaesthesia and Perioperative Medicine, Groote
Schuur Hospital and University of Cape Town, Cape Town, South Africa
(Mayosi) Department of Medicine, Groote Schuur Hospital and University of
Cape Town, Cape Town, South Africa
(Xavier, Rao) Department of Pharmacology, St John's Medical College and
Research Institute, Bangalore, India
(Szczeklik) Department of Intensive Care and Perioperative Medicine,
Jagiellonian University Medical College, Krakow, Poland
(Meyhoff) Department of Anaesthesia and Intensive Care, Bispebjerg and
Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
(Franzosi) Department of Cardiovascular Research, IRCCS Istituto di
Ricerche Farmacologiche Mario Negri, Milan, Italy
(Srinathan) Department of Surgery, University of Manitoba, Winnipeg, MB,
Canada
(Erb) Department of Anesthesiology and Perioperative Medicine, Queen's
University, Kingston, ON, Canada
(Rahate) Department of Surgery, Rahate Surgical Hospital, Nagpur, India
(Chaudhry) Department of Surgery, Christian Medical College Hospital,
Ludhiana, India
(de Nadal) Department of Anesthesiology, Hospital Universitari Vall
d'Hebron, Barcelona, Spain
(Iglesias) Department of Anesthesiology, Hospital de la Santa Creu i Sant
Pau, Barcelona, Spain
(Berwanger) Instituto de Ensino e Pesquisa do Hospital do Coracao
(IEP-HCor), Sao Paulo, Brazil
(Villar) Departamento de Investigaciones, Fundacion
Cardioinfantil-Instituto de Cardiologia (Bogota) and Facultad de Ciencias
de la Salud, Universidad Autonoma de Bucaramanga, Colombia
(Botto) Estudios Clinicos Latinoamerica (ECLA), Rosario and Hospital
Austral, Pilar, Argentina
(Sessler) Department of Outcomes Research, Cleveland Clinic,
Anesthesiology Institute, Cleveland, OH, United States
(Hoeft) Department of Anesthesiology and Intensive Care Medicine,
University Hospital Bonn, Bonn, Germany
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Myocardial injury after non-cardiac surgery (MINS) increases
the risk of cardiovascular events and deaths, which anticoagulation
therapy could prevent. Dabigatran prevents perioperative venous
thromboembolism, but whether this drug can prevent a broader range of
vascular complications in patients with MINS is unknown. The MANAGE trial
assessed the potential of dabigatran to prevent major vascular
complications among such patients. Methods: In this international,
randomised, placebo-controlled trial, we recruited patients from 84
hospitals in 19 countries. Eligible patients were aged at least 45 years,
had undergone non-cardiac surgery, and were within 35 days of MINS.
Patients were randomly assigned (1:1) to receive dabigatran 110 mg orally
twice daily or matched placebo for a maximum of 2 years or until
termination of the trial and, using a partial 2-by-2 factorial design,
patients not taking a proton-pump inhibitor were also randomly assigned
(1:1) to omeprazole 20 mg once daily, for which results will be reported
elsewhere, or matched placebo to measure its effect on major upper
gastrointestinal complications. Research personnel randomised patients
through a central 24 h computerised randomisation system using block
randomisation, stratified by centre. Patients, health-care providers, data
collectors, and outcome adjudicators were masked to treatment allocation.
The primary efficacy outcome was the occurrence of a major vascular
complication, a composite of vascular mortality and non-fatal myocardial
infarction, non-haemorrhagic stroke, peripheral arterial thrombosis,
amputation, and symptomatic venous thromboembolism. The primary safety
outcome was a composite of life-threatening, major, and critical organ
bleeding. Analyses were done according to the intention-to-treat
principle. This trial is registered with ClinicalTrials.gov, number
NCT01661101. Findings: Between Jan 10, 2013, and July 17, 2017, we
randomly assigned 1754 patients to receive dabigatran (n=877) or placebo
(n=877); 556 patients were also randomised in the omeprazole partial
factorial component. Study drug was permanently discontinued in 401 (46%)
of 877 patients allocated to dabigatran and 380 (43%) of 877 patients
allocated to placebo. The composite primary efficacy outcome occurred in
fewer patients randomised to dabigatran than placebo (97 [11%] of 877
patients assigned to dabigatran vs 133 [15%] of 877 patients assigned to
placebo; hazard ratio [HR] 0.72, 95% CI 0.55-0.93; p=0.0115). The primary
safety composite outcome occurred in 29 patients (3%) randomised to
dabigatran and 31 patients (4%) randomised to placebo (HR 0.92, 95% CI
0.55-1.53; p=0.76). Interpretation: Among patients who had MINS,
dabigatran 110 mg twice daily lowered the risk of major vascular
complications, with no significant increase in major bleeding. Patients
with MINS have a poor prognosis; dabigatran 100 mg twice daily has the
potential to help many of the 8 million adults globally who have MINS to
reduce their risk of a major vascular complication. Funding: Boehringer
Ingelheim and Canadian Institutes of Health Research. Copyright ©
2018 Elsevier Ltd

<19>
Accession Number
622640220
Title
Sex-Specific Outcomes after Transcatheter Aortic Valve Replacement: FDA
Patient-Level Meta-Analysis of Premarket Clinical Trials.
Source
Journal of Women's Health. 27 (6) (pp 808-814), 2018. Date of Publication:
June 2018.
Author
Zusterzeel R.; Mishra N.K.; Beydoun H.; Laschinger J.; Wu C.; Dong L.M.;
Marinac-Dabic D.; Strauss D.G.; Canos D.A.
Institution
(Zusterzeel, Mishra, Beydoun, Laschinger, Wu, Dong, Marinac-Dabic,
Strauss, Canos) U.S. Food and Drug Administration, 10903 New Hampshire
Avenue 64-2014, Silver Spring, MD 20993, United States
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is a less
invasive alternative approach to surgery. Individual randomized clinical
trials evaluating the safety and efficacy of TAVR were mostly underpowered
for conducting separate analyses for women and men. We pooled data from
premarket TAVR clinical trials comparing short (30 days)- and long-term
(~2 years) outcomes by sex. Methods: Patient-level data from the TAVR arms
of six clinical trials were pooled (2515 patients). Random-effects models
for time-to-event outcomes (odds ratios [ORs] for 30-day outcomes and
hazard ratios [HRs] for complete follow-up for mortality, ischemic stroke,
kidney injury, major bleeding, myocardial infarction, and device
migration) and dichotomous outcomes (ORs for reintervention,
rehospitalization, and pacemaker implantation) were then fit to directly
compare outcomes between women and men. Results: Overall, the pattern of
individual comorbidities was more severe in men. There was no difference
in mortality risk at 30 days (female-to-male OR = 1.00 [0.69-1.46]);
however, at follow-up completion (~2 years post-TAVR), women had a 24%
lower mortality risk than men (HR = 0.76 [95% CI: 0.65-0.89]). Women also
had a 30% lower risk of kidney injury at 30 days (OR = 0.70 [0.49-0.98]),
which increased to 33% over the complete follow-up period (HR = 0.67
[0.51-0.87]). Major bleeding was more common in women compared to men at
both 30 days (OR = 1.44 [1.19-1.76]) and long-term follow-up (HR = 1.22
[1.04-1.43]). For dichotomous outcomes, women had a 68% lower risk for
reinterventions (OR = 0.32 [0.18-0.58]). We did not observe any difference
in the risk of ischemic stroke, myocardial infarction, device migration,
rehospitalizations, or pacemaker implantations between sexes. Conclusions:
This patient-level data meta-analysis of six premarket clinical trials
found that women who received TAVR had fewer comorbidities at baseline.
Acute outcomes (30 day) with respect to mortality were similar. Women were
observed to have a lower risk of kidney injury, but higher risk of major
bleeding compared to men receiving TAVR at 30 days. At complete follow-up,
statistically significant advantages for women emerged in improved
survival and lower reintervention risk. No differences in ischemic stroke,
pacemaker implantation, or rehospitalization were observed. That women are
healthier at baseline and develop fewer postprocedural complications than
men may explain their higher survival. © Copyright 2018, Mary Ann
Liebert, Inc. 2018.

<20>
Accession Number
623196340
Title
Efficacy of prophylactic dexmedetomidine in preventing postoperative
junctional ectopic tachycardia in pediatric cardiac surgery patients: A
systematic review and meta-analysis.
Source
Paediatric Anaesthesia. 28 (7) (pp 597-606), 2018. Date of Publication:
July 2018.
Author
Ghimire L.V.; Chou F.-S.
Institution
(Ghimire) Section of Pediatrics and Section of Cardiology, Department of
Medicine, Lakes Region General Hospital, Laconia, NH, United States
(Ghimire) Department of Clinical Pediatrics, University of New England,
Biddeford, ME, United States
(Chou) Division of Neonatology, Children's Mercy Kansas City, Kansas City,
MO, United States
(Chou) Department of Pediatrics, University of Missouri-Kansas City,
Kansas City, MO, United States
(Chou) Department of Pediatrics, University of Kansas Medical Center,
Kansas City, KS, United States
Publisher
Blackwell Publishing Ltd
Abstract
Background: Junctional ectopic tachycardia is a serious tachyarrhythmic
complication following pediatric cardiac surgery. It is difficult to
manage and is associated with significant morbidity and mortality.
Conventional nonpharmacological and pharmacological measures have shown
limited effects. Dexmedetomidine is an alpha2 agonist which has recently
been shown in multiple studies to be effective. Aims: The aim of this
systematic review with meta-analysis was to evaluate the efficacy of
prophylactic dexmedetomidine administration in the prevention of
junctional ectopic tachycardia in pediatric patients following cardiac
surgeries. Methods: We searched MEDLINE, EMBASE, Cochrane, Web of Science,
and relevant references published in English before December 20, 2017 and
performed meta-analysis on the selected studies, with one group receiving
prophylactic perioperative dexmedetomidine administration and another
group receiving placebo. The primary outcome was the incidence of
junctional ectopic tachycardia, secondary outcomes included bradycardia,
hypotension, intensive care unit stay, total hospital stay, inotropic
scores, and total mechanical ventilation time. Odds ratio or mean
difference with 95% confidence intervals were calculated using a random
effect model. Results: Seven studies (5 prospective randomized studies and
2 retrospective case-controlled studies) with a total of 1616 patients
were analyzed. The incidence of junctional ectopic tachycardia in the
dexmedetomidine group was significantly reduced compared to placebo.
Similarly, intensive care unit stay, inotropic scores, and total
mechanical ventilation time were also significantly decreased in the
dexmedetomidine group. No significant increases in adverse events were
found. Mortality was low in both groups. Conclusion: Prophylactic
dexmedetomidine is effective in reducing the incidence of postoperative
junctional ectopic tachycardia without significant increases in adverse
events in pediatric patients undergoing surgery for congenital heart
diseases. Copyright © 2018 John Wiley & Sons Ltd

<21>
Accession Number
620744398
Title
Investigation of Motivational Interviewing and Prevention Consults to
Achieve Cardiovascular Targets (IMPACT) trial.
Source
American Heart Journal. 199 (pp 37-43), 2018. Date of Publication: May
2018.
Author
Gianos E.; Schoenthaler A.; Guo Y.; Zhong J.; Weintraub H.; Schwartzbard
A.; Underberg J.; Schloss M.; Newman J.D.; Heffron S.; Fisher E.A.; Berger
J.S.
Institution
(Gianos, Weintraub, Schwartzbard, Underberg, Schloss, Newman, Heffron,
Fisher, Berger) Department of Medicine, Division of Cardiology, Center for
the Prevention of Cardiovascular Disease, New York University School of
Medicine, New York, NY, United States
(Heffron, Fisher, Berger) Marc and Ruti Bell Program in Vascular Biology,
New York University School of Medicine, New York, NY, United States
(Schoenthaler, Guo, Zhong) Department of Population Health, Center for
Healthful Behavioral Change, New York University School of Medicine, New
York, NY, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Patients undergoing cardiovascular (CV) procedures often have
suboptimal CV risk factor control and may benefit from strategies
targeting healthy lifestyle behaviors and education. Implementation of
prevention strategies may be particularly effective at this point of
heightened motivation. Methods: A prospective, randomized, pilot study was
conducted in 400 patients undergoing a nonurgent CV procedure (cardiac
catheterization +/- revascularization) to evaluate the impact of different
prevention strategies. Patients were randomized in a 1:1:1 fashion to
usual care (UC; group A, n = 134), in-hospital CV prevention consult (PC;
group B, n = 130), or PC plus behavioral intervention program
(telephone-based motivational interviewing and optional tailored text
messages) (group C, n = 133). The primary end point was the DELTA change
in non-high-density lipoprotein cholesterol (non-HDL-C) from baseline to 6
month. Results: The mean age was 64.6 +/- 10.8 years, 23.7% were female,
and 31.5% were nonwhite. After 6 months, the absolute difference in
non-HDL-C for all participants was -19.8 mg/dL (95% CI -24.1 to -15.6, P
<.001). There were no between-group differences in the primary end point
for the combined PC groups (B and C) versus UC, with a DELTA adjusted
between group difference of -5.5 mg/dL (95% CI -13.1 to 2.1, P =.16).
Patients in the PC groups were more likely to be on high-intensity statins
at 6 months (52.9% vs 38.1%, P =.01). After excluding participants with
baseline non-HDL-C <100 mg/dL (initial exclusion criterion), DELTA
non-HDL-C and DELTA low-density lipoprotein cholesterol were improved in
the PC groups compared to UC (non-HDL-C -8.13 mg/dL [-16.00 to -0.27], P
=.04; low-density lipoprotein cholesterol -7.87mg/dL [-15.10 to -0.64], P
=.03). Conclusions: Although non-HDL-C reduction at 6 months following a
nonurgent CV procedure was not significant in the overall cohort, an
increased uptake in high-potency statins may translate into improved
long-term health outcomes and cost reductions. Copyright © 2018

<22>
Accession Number
623738041
Title
The incremental predictive value of frailty measures in elderly patients
undergoing cardiac surgery: A systematic review.
Source
Clinical Cardiology. 41 (8) (pp 1103-1110), 2018. Date of Publication:
August 2018.
Author
Li Z.; Ding X.
Institution
(Li) Department of Epidemiology & Biostatistics, Western University,
London, ON, Canada
(Ding) Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing, China
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Emerging evidence demonstrates that frailty measures can predict adverse
outcomes after cardiac procedures. Our objectives were to examine whether
the inclusion of frailty measures adds incremental predictive value to
existing surgical risk prediction models in patients undergoing cardiac
surgery and to evaluate the reporting and methods of studies that
investigated the prediction of frailty measures in cardiology. The
inclusion of frailty measures adds incremental predictive value on
existing perioperative risk-scoring systems. We systematically searched
the EMBASE, MEDLINE, and Web of Science databases for relevant studies.
Studies were included according to predefined inclusion criteria. The
quality of included studies was appraised using the QUADAS-2 tool. Data
were extracted and synthesized according to predefined methods. Twelve
studies were included in the analysis. Included studies demonstrated the
incremental predictive value of frailty measures on existing surgical risk
models for mortality, but the predictive value of frailty measures alone
was not consistent across literature. Few studies that investigated the
predictive ability of frailty measures reported all important model
performance measures. When comparing the predictive value of frailty
measures with existing models, few studies reported if the frailty
measurement was separately performed from the existing perioperative risk
assessment. The addition of frailty measures to the existing perioperative
risk models improved the prediction performance for mortality, but the
incorporation of frailty assessment into perioperative risk assessment
requires further evidence before making health policy
recommendations. Copyright © 2018 Wiley Periodicals, Inc.

<23>
Accession Number
620405045
Title
Remote Ischaemic PrEconditioning of Human Myocardium (RIPE): Study
protocol for a double-blinded randomised controlled trial.
Source
Kardiologia Polska. 76 (1) (pp 136-143), 2018. Date of Publication: 2018.
Author
Deja M.A.; Wiaderkiewicz R.; Czekaj P.; Czech E.; Malinowski M.; Machej
L.; Weglarzy A.; Kowalowka A.; Piekarska M.; Szurlej B.; Latusek T.
Institution
(Deja, Malinowski, Kowalowka, Piekarska, Szurlej, Latusek) Department of
Cardiac Surgery, School of Medicine in Katowice, Medical University of
Silesia, Katowice, Poland
(Deja, Malinowski, Kowalowka, Piekarska) Department of Cardiac Surgery,
Upper-Silesian Heart Centre, Katowice, Poland
(Wiaderkiewicz, Czekaj, Czech) Department of Histology and Embryology,
School of Medicine in Katowice, Medical University of Silesia, ul. Medykow
18, Katowice 40-752, Poland
(Machej) Department of Anaesthesia and Intensive Care Nursing, School of
Health Sciences, Medical University of Silesia, Katowice, Poland
(Weglarzy) Department of Cardiac Anaesthesia, Upper-Silesian Heart Centre,
Katowice, Poland
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Remote preconditioning has been shown to be a potent
protective phenomenon in many animals. Several studies aimed to
demonstrate it was feasible in humans by trying to show its protective
effect during cardiac surgery. Of these, some small studies and one larger
trial were positive while two other bigger studies showed no effectiveness
of remote preconditioning as assessed by levels of postoperatively
released cardiac markers. Recently, two large clinical trials also failed
to prove the benefit of remote preconditioning in cardiac surgery. No
study showed that remote preconditioning actually increases resistance of
human myocardium to standardised ischaemic and reperfusion stimulus in
experimental settings. In animal studies, remote preconditioning was shown
to improve mitochondrial function and structure, but such data on human
myocardium are scarce. Aim: The aim of the study is to determine whether
remote preconditioning protects human myocardium against
ischaemia-reperfusion injury in both in vivo and in vitro conditions.
Methods: The trial is designed as a single-centre, double-blinded,
sham-controlled trial of 120 patients. We randomise (1:1) patients
referred for coronary artery bypass grafting for stable coronary artery
disease to remote preconditioning or "sham" intervention. The remote
preconditioning is obtained by three cycles of 5 min inflation and 5 min
deflation of a blood pressure cuff on the right arm. Postoperative course
including myocardial enzymes profile will be analysed. Moreover, in the
in-vitro arm the clinically preconditioned myocardium will be assessed for
function, mitochondria structure, and mitochondria-dependent apoptosis.
The informed consent of all patients is obtained before enrolment into the
study by the investigator. The study conforms to the spirit and the letter
of the declaration of Helsinki. Results and conclusions: In case the
effect of remote preconditioning is not measurable in ex-vivo assessment,
any future attempt at implementing this phenomenon in clinical practice
may be futile and should not be continued until the effect can be
confirmed in a controlled experimental setting. The study might therefore
indicate future directions in trials of clinical implementation of remote
preconditioning. Trial Registration: Clinical Trials Register
(Clinicaltrials.gov) identifier: NCT01994707. The study was approved by
Institutional Review Board of the Medical University of Silesia
(KNW/0022/KB1/160/12). Copyright © Polskie Towarzystwo
Kardiologiczne 2018.

<24>
Accession Number
620405039
Title
Haematological indices as predictors of atrial fibrillation following
isolated coronary artery bypass grafting, valvular surgery, or combined
procedures: A systematic review with meta-analysis.
Source
Kardiologia Polska. 76 (1) (pp 107-118), 2018. Date of Publication: 2018.
Author
Weymann A.; Ali-Hasan-Al-Saegh S.; Popov A.-F.; Sabashnikov A.;
Mirhosseini S.J.; Liu T.; Tse G.; Lotfaliani M.; Ghanei A.; Testa L.;
D'Ascenzo F.; Benedetto U.; Dehghan H.; Roever L.; De Oliveira Sa M.P.B.;
Baker W.L.; Yavuz S.; Zeriouh M.; Mashhour A.; Nombela-Franco L.; Jang
J.-S.; Meng L.; Gong M.; Deshmukh A.J.; Palmerini T.; Linde C.; Filipiak
K.J.; Biondi-Zoccai G.; Calkins H.; Stone G.W.
Institution
(Weymann, Mashhour) Department of Cardiac Surgery, University Hospital
Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky
University Oldenburg, Oldenburg, Germany
(Weymann, Popov, Sabashnikov) Department of Cardiothoracic Transplantation
and Mechanical Circulatory Support, Royal Brompton and Harefield NHS
Foundation Trust, Harefield Hospital, Harefield Middlesex, United Kingdom
(Ali-Hasan-Al-Saegh, Popov, Sabashnikov, Mirhosseini) Cardiovascular
Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd,
Iran, Islamic Republic of
(Popov, Sabashnikov) Department of Thoracic and Cardiovascular Surgery,
University Hospital Goethe University Frankfurt, Frankfurt, Germany
(Sabashnikov) Department of Cardiothoracic Surgery, University Hospital of
Cologne, Cologne, Germany
(Liu, Meng, Gong) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular Disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Tse) Department of Medicine and Therapeutics, Li Ka Shing Institute of
Health Sciences, Faculty of Medicine, Chinese University of Hong Kong,
Shatin, Hong Kong
(Lotfaliani) Faculty of Pharmacy, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
(Ghanei) Department of Internal Medicine, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran, Islamic Republic of
(Testa) Department of Cardiology, IRCCS Pol. S. Donato, S. Donato
Milanese, Milan, Italy
(D'Ascenzo) Division of Cardiology, Department of Medical Sciences, Citta
della Salute e della Scienza Hospital, University of Turin, Turin, Italy
(Benedetto) Bristol Heart Institute, University of Bristol, School of
Clinical Sciences, Bristol, United Kingdom
(Dehghan) Department of Health Technology Assessment, Shahid Sadoughi
University of Medical Sciences and Health Services, Yazd, Iran, Islamic
Republic of
(Roever) Department of Clinical Research, Federal University of
Uberlandia, Uberlandia, Brazil
(De Oliveira Sa) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco (PROCAPE), Recife, Brazil
(De Oliveira Sa) University of Pernambuco (UPE), Recife, Brazil
(De Oliveira Sa) Nucleus of Postgraduate and Research in Health Sciences
of Faculty of Medical Sciences and Biological Sciences Institute
(FCM/ICB), Recife, Brazil
(Baker) University of Connecticut/Hartford Hospital Evidence-Based
Practice Centre, Hartford, CT, United States
(Yavuz) Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas
Training and Research Hospital, Bursa, Turkey
(Nombela-Franco) Instituto Cardiovascular, Hospital Universitario Clinico
San Carlos, Madrid, Spain
(Jang) Department of Cardiology, Busan Paik Hospital, Inje University
College of Medicine, Jin-gu, Busan, South Korea
(Deshmukh) Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Mayo
Clinic, Rochester, MN, United States
(Palmerini) Dipartimento Cardio-Toraco-Vascolare, University of Bologna,
Bologna, Italy
(Linde) Department of Cardiology, Karolinska University Hospital,
Karolinska Institutet, Stockholm, Sweden
(Filipiak) 1st Department of Cardiology, Medical University of Warsaw,
Warsaw, Poland
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed,
Pozzilli, Italy
(Calkins) Department of Cardiology, Johns Hopkins Medical Institutions,
Baltimore, MD, United States
(Stone) New York Presbyterian Hospital, Columbia University Medical
Centre, New York, NY, United States
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: New postoperative atrial fibrillation (POAF) is one of the
most critical and common complications after cardiovascular surgery
precipitating early and late morbidities. Complete blood count (CBC) is an
imperative blood test in clinical practice, routinely used in the
examination of cardiovascular diseases. Aim: This systematic review with
meta-analysis aimed to determine the strength of evidence for evaluating
the association of haematological indices in CBC tests with atrial
fibrillation following isolated coronary artery bypass graft (CABG),
isolated valvular surgery, or a combination of these treatments. Methods:
We conducted a meta-analysis of studies evaluating pre- and postoperative
haematological indices in patients with POAF. A comprehensive subgroup
analysis was performed to explore potential sources of heterogeneity.
Results: A literature search of all major databases retrieved 732 studies.
After screening, 22 studies were analysed including a total of 6098
patients. Pooled analysis showed preoperative platelet count (PC)
(weighted mean difference [WMD] = -7.07 x 109/L and p < 0.001),
preoperative mean platelet volume (MPV) (WMD = 0.53 FL and p < 0.001),
preoperative white blood cell count (WBC) (WMD = 0.130 x 109/L
and p < 0.001), preoperative neutrophil-to-lymphocyte ratio (NLR) (WMD =
0.33 and p < 0.001), preoperative red blood cell distribution width (RDW)
(WMD = 0.36% and p < 0.001), postoperative WBC (WMD = 1.36 x
109/L and p < 0.001), and postoperative NLR (WMD = 0.74 and p <
0.001) as associated factors with POAF. Conclusions: Haematological
indices may predict the risk of POAF before surgery. These
easily-performed tests should definitely be taken into account in patients
undergoing isolated CABG, valvular surgery, or combined
procedures. Copyright © Polskie Towarzystwo Kardiologiczne 2018.

<25>
Accession Number
620405038
Title
The effect of intravenous N-acetylcysteine on prevention of atrial
fibrillation after coronary artery bypass graft surgery: A double-blind,
randomised, placebo-controlled trial.
Source
Kardiologia Polska. 76 (1) (pp 99-106), 2018. Date of Publication: 2018.
Author
Soleimani A.; Habibi M.R.; Kiabi F.H.; Alipour A.; Habibi V.; Azizi S.;
Zeydi A.E.; Sohrabi F.B.
Institution
(Soleimani, Habibi, Kiabi) Department of Anaesthesiology, Imam Khomeini
Hospital, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Alipour) Department of Epidemiology, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Habibi) Department of Cardiac Surgery, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Azizi) Department of Pathology, Faculty of Paramedicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Zeydi) Department of Medical-Surgical Nursing, Faculty of Nursing and
Midwifery, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Sohrabi) Mazandaran Heart Centre, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Atrial fibrillation (AF) is one of the most frequently
occurring dysrhythmias after coronary artery bypass graft (CABG) surgery.
Aim: The aim of this study was to evaluate the effect of intravenous
N-acetylcysteine (NAC) on the prevention of AF after CABG surgery.
Methods: In a double-blind, randomised controlled trial, a total of 150
patients who were scheduled for on-pump CABG surgery were randomly
assigned into two groups. In group A, patients received an intravenous NAC
infusion (50 mg/kg) after induction of anaesthesia. These patients
additionally received two intravenous doses of NAC on postoperative days 1
and 2. Patients in group B received normal saline (as a placebo) with the
same volume, during the same time interval. During the first three days
after surgery, postoperative AF (POAF) was assessed by continuous
electrocardiogram monitoring; serum high-sensitivity C-reactive protein
(hsCRP) level was also assessed before and three days after surgery.
Results: During follow-up, 17 patients (17/141, 12.1%) developed POAF.
POAF occurred in four (5.6%) patients in the NAC group and 13 (18.8%)
patients in the placebo group (OR 0.23; 95% CI 0.08-0.82; p = 0.02). In
the multivariable logistic regression analysis, the only predictor of AF
after CABG surgery was the use of NAC (OR 0.21; 95% CI 0.06-0.73; p =
0.01). Also, the hsCRP level trend in the NAC group was different from the
trend in the control group (group time interaction or interaction effect)
(p < 0.001). Conclusions: It seems that perioperative intravenous NAC
therapy can be effectively used to reduce inflammation and the incidence
of POAF after CABG surgery. Copyright © Polskie Towarzystwo
Kardiologiczne 2018.

<26>
Accession Number
618813138
Title
Coronary artery bypass grafting versus percutaneous coronary intervention
in patients with noninsulin treated type 2 diabetes mellitus: A
meta-analysis of randomized controlled trials.
Source
Diabetes/Metabolism Research and Reviews. 34 (1) (no pagination), 2018.
Article Number: e2951. Date of Publication: January 2018.
Author
Wang Y.; Wen M.; Zhou J.; Chen Y.; Zhang Q.
Institution
(Wang, Wen, Zhou, Chen, Zhang) Department of Cardiology, West China
Hospital, Sichuan University, Chengdu, China
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: The outcomes and prognosis of revascularization by either
coronary artery bypass grafting (CABG) surgery or percutaneous coronary
intervention (PCI) in patients with noninsulin-treated type 2 diabetes
mellitus (NITDM) have not yet been well established. Methods: Randomized
controlled trials (RCTs) were identified by searching Pubmed, EMBASE, and
Cochrane library from inception until May 2016. Heterogeneity was
evaluated, and the pooled hazard ratio (HR) was calculated by using a
fixed-effect model. A random-effect model was used when statistically
significant heterogeneity was observed (I2 >= 50%). All data
analyses were carried out by using RevMan 5.3 and STATA software 12.0.
Results: A total of 4 RCTs involving 5 studies, consisting of 2270
patients with noninsulin-treated type 2 diabetes mellitus, were
identified. Compared with CABG-treated patients, PCI-treated patients had
significantly higher all-cause mortality (HR 1.39; 95% CI 1.01 to 1.91; P
=.04), myocardial infarction (HR 2.14; 95% CI 1.40 to 3.27; P =.0004),
repeated revascularization (HR 2.52; 95% CI 1.77 to 3.57; P <.00001), and
major adverse cardiovascular and cerebrovascular events (HR 1.50; 95% CI
1.20-1.87; P =.0004). However, PCI was associated with lower incidence of
stoke (HR 0.47; 95% CI 0.24 to 0.90; P =.02). Conclusions: In NITDM
patients, our study suggests that CABG surgery is associated with reduced
risk of mortality and morbidity, although with increased incidence of
stroke compared with percutaneous coronary intervention. The decision if
to have percutaneous coronary intervention or CABG surgery should factor
the risk for stroke of the patients when considering CABG over
percutaneous coronary intervention. Adequately powered RCTs are needed to
confirm the results of this meta-analysis. Copyright © 2017 John
Wiley & Sons, Ltd.

<27>
Accession Number
620733772
Title
Three-dimensional printing in congenital heart disease: A systematic
review.
Source
Journal of Medical Radiation Sciences. 65 (3) (pp 226-236), 2018. Date of
Publication: September 2018.
Author
Lau I.; Sun Z.
Institution
(Lau, Sun) Department of Medical Radiation Sciences, Curtin University,
Perth, Australia
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Three-dimensional (3D) printing has shown great promise in medicine with
increasing reports in congenital heart disease (CHD). This systematic
review aims to analyse the main clinical applications and accuracy of 3D
printing in CHD, as well as to provide an overview of the software tools,
time and costs associated with the generation of 3D printed heart models.
A search of different databases was conducted to identify studies
investigating the application of 3D printing in CHD. Studies based on
patient's medical imaging datasets were included for analysis, while
reports on in vitro phantom or review articles were excluded from the
analysis. A total of 28 studies met selection criteria for inclusion in
the review. More than half of the studies were based on isolated case
reports with inclusion of 1-12 cases (61%), while 10 studies (36%) focused
on the survey of opinion on the usefulness of 3D printing by healthcare
professionals, patients, parents of patients and medical students, and the
remaining one involved a multicentre study about the clinical value of 3D
printed models in surgical planning of CHD. The analysis shows that
patient-specific 3D printed models accurately replicate complex cardiac
anatomy, improve understanding and knowledge about congenital heart
diseases and demonstrate value in preoperative planning and simulation of
cardiac or interventional procedures, assist surgical decision-making and
intra-operative orientation, and improve patient-doctor communication and
medical education. The cost of 3D printing ranges from USD 55 to USD 810.
This systematic review shows the usefulness of 3D printed models in
congenital heart disease with applications ranging from accurate
replication of complex cardiac anatomy and pathology to medical education,
preoperative planning and simulation. The additional cost and time
required to manufacture the 3D printed models represent the limitations
which need to be addressed in future studies. Copyright © 2018
The Authors. Journal of Medical Radiation Sciences published by John Wiley
& Sons Australia, Ltd on behalf of Australian Society of Medical Imaging
and Radiation Therapy and New Zealand Institute of Medical Radiation
Technology.

<28>
Accession Number
2000646002
Title
Totally endoscopic coronary artery bypass surgery: A meta-analysis of the
current evidence.
Source
International Journal of Cardiology. 261 (pp 42-46), 2018. Date of
Publication: 15 June 2018.
Author
Leonard J.R.; Rahouma M.; Abouarab A.A.; Schwann A.N.; Scuderi G.; Lau C.;
Guy T.S.; Demetres M.; Puskas J.D.; Taggart D.P.; Girardi L.N.; Gaudino M.
Institution
(Leonard, Rahouma, Abouarab, Schwann, Scuderi, Lau, Guy, Girardi, Gaudino)
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York,
NY, United States
(Demetres) Samuel J. Wood Library & C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY, United States
(Puskas) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Taggart) Department of Cardiovascular Surgery, University of Oxford,
United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: Totally endoscopic coronary artery bypass (TECAB) has emerged
as an alternative to other minimally invasive techniques. However, limited
TECAB results are available to date. The purpose of this systematic review
is to examine the existing literature to give an objective estimate of the
outcomes of TECAB using a meta-analytical approach. Methods: A
comprehensive online review was performed in Ovid MEDLINE Ovid EMBASE and
The Cochrane Library from 2000 to July 2017. Eligible studies included
single arm TECAB studies as well as comparative studies (TECAB vs
minimally invasive direct coronary artery bypass (MIDCAB)). Pooled event
rates and odds ratios (ORs) for operative mortality, perioperative
myocardial infarction (MI), perioperative stroke, graft patency and repeat
revascularization were estimated. Single arm and pairwise comparisons were
performed. Results: Seventeen single arm TECAB articles (3721 patients,
weighted mean follow-up 3.3 years) were included. The pooled event rate
was 0.80% (95%CI: 0.60-1.2%) for operative mortality, 2.28% (95%CI:
1.7-3%) for perioperative MI, 1.50% (95%CI: 1.1-2.0%) for perioperative
stroke, 2.99% (95%CI: 1.6-5.4%) for repeat revascularization and 94.8%
(95%CI: 89.3-97.5%) for early graft patency (weighted mean follow-up 10.1
months). On pairwise meta-analysis 376 patients (263 TECAB and 113 MIDCAB)
were included. No difference in operative mortality (OR = 0.25, 95%CI:
0.02-2.83), perioperative MI (OR = 3.09, 95%CI: 0.37-26.12) or
perioperative stroke (OR = 1.33, 95%CI: 0.17-10.26) was found between the
two techniques. Conclusions: TECAB has an acceptably low operative risk
and a good early patency rate. The incidence of perioperative MI requires
further investigation. The dearth of data comparing TECAB to open
approaches compels the need for future comparative trials. Copyright
© 2017 Elsevier Ireland Ltd

<29>
Accession Number
623265249
Title
Comparing outcomes after transcatheter aortic valve replacement in
patients with stenotic bicuspid and tricuspid aortic valve: A systematic
review and meta-analysis.
Source
Clinical Cardiology. 41 (7) (pp 896-902), 2018. Date of Publication: July
2018.
Author
Kanjanahattakij N.; Horn B.; Vutthikraivit W.; Biso S.M.; Ziccardi M.R.;
Lu M.L.R.; Rattanawong P.
Institution
(Kanjanahattakij, Horn, Biso, Ziccardi, Lu) Department of Medicine,
Einstein Medical Center, Philadelphia, PA, United States
(Vutthikraivit) Department of Medicine, Texas Tech University Health
Sciences Center, Lubbock, TX, United States
(Rattanawong) University of Hawaii Internal Medicine Residency Program,
Honolulu, HI, United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has become an
alternative treatment to surgery in patients with severe aortic stenosis.
However, patients with bicuspid aortic stenosis (BAV) are usually excluded
from major TAVR studies. The aim of this study is to reexamine current
evidence of TAVR in patients with severe aortic stenosis and BAV compared
with tricuspid aortic valve (TAV). Hypothesis: There might be differences
in outcomes post TAVR between patients with BAV comparing to TAV. Method:
Databases were systematically searched for relevant articles featuring
cohort studies that included patients with BAV and TAV who underwent TAVR
studies, of which reported outcomes of interest included mortality and
complications in both groups. Pooled effect size was calculated with a
random-effect model and weighted for the inverse of variance, to compare
outcomes post-TAVR between BAV and TAV. Results: Nine studies were
included in the meta-analysis. There was no difference in 30-day mortality
rate in patients with BAV compared with TAV (OR: 1.27, 95% CI: 0.84-1.93,
I2 = 0). Patients with BAV were more likely to have a moderate
to severe paravalvular leak (9 studies; OR: 1.42, 95% CI: 1.08-1.87,
I2 = 0) and conversion to surgery (5 studies; OR: 5.48, 95% CI:
1.74-17.27, I2 = 0), and less likely to have device success
compared with patients with TAV (5 studies; OR: 0.57, 95% CI: 0.40-0.81,
I2 = 0%). Conclusions: There was no difference in mortality
post-TAVR in patients with BAV compared with TAV. Further randomized
studies should be done in newer-generation prostheses to assess this
association. Copyright © 2018 Wiley Periodicals, Inc.

<30>
Accession Number
620600431
Title
Noninvasive cardiac testing vs clinical evaluation alone in acute chest
pain: A secondary analysis of the ROMICAT-II randomized clinical trial.
Source
JAMA Internal Medicine. 178 (2) (pp 212-219), 2018. Date of Publication:
February 2018.
Author
Reinhardt S.W.; Lin C.-J.; Novak E.; Brown D.L.
Institution
(Reinhardt) Department of Internal Medicine, Washington University School
of Medicine, St Louis, MO, United States
(Lin, Novak, Brown) Cardiovascular Division, Washington University School
of Medicine, Campus Box 8086, 660 S Euclid Ave, St Louis, MO 63110, United
States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: The incremental benefit of noninvasive testing in addition to
clinical evaluation (history, physical examination, an electrocardiogram
[ECG], and biomarker assessment) vs clinical evaluation alone for patients
who present to the emergency department (ED) with acute chest pain is
unknown. OBJECTIVE: To examine differences in outcomes with clinical
evaluation and noninvasive testing (coronary computed tomographic
angiography [CCTA] or stress testing) vs clinical evaluation alone.
DESIGN, SETTING, AND PARTICIPANTS: This study was a retrospective analysis
of data from the randomized multicenter Rule Out Myocardial
Ischemia/Infarction by Computer Assisted Tomography (ROMICAT-II) trial.
Data for 1000 patients who presented with chest pain to the EDs at 9
hospitals in the United States were evaluated. INTERVENTIONS: Clinical
evaluation plus noninvasive testing (CCTA or stress test) vs clinical
evaluation alone. MAIN OUTCOMES AND MEASURES: Primary outcomewas length of
stay (LOS). Secondary outcomes included hospital admission, direct ED
discharge, downstream testing, rates of invasive coronary angiography,
revascularization, major adverse cardiac events (MACE), repeated ED visit
or hospitalization for recurrent chest pain at 28 days, and cost. Safety
end points were missed acute coronary syndrome (ACS) and cumulative
radiation exposure during the index visit and follow-up period. RESULTS:
Of the 1000 patients randomized, 118 patients (12%) (mean [SD] age, 53.2
[7.8]; 49 [42%] were female) did not undergo noninvasive testing, whereas
882 (88%) (mean [SD] age, 54.4 [8.14] years; 419 [48%] were female)
received CCTA or stress testing. There was no difference in baseline
characteristics or clinical presentation between groups. Patients who
underwent clinical evaluation alone experienced a shorter LOS (20.3 vs
27.9 hours; P < .001), lower rates of diagnostic testing (P < .001) and
angiography (2%vs 11%; P < .001), lower median costs ($2261.50 vs
$2584.30; P = .009), and less cumulative radiation exposure (0 vs 9.9 mSv;
P < .001) during the 28-day study period. Lack of testing was associated
with a lower rate of diagnosis of ACS (0% vs 9%; P < .001) and less
coronary angiography and percutaneous coronary intervention (PCI) during
the index visit (0% vs 10%; P < .001, and 0% vs 4%; P = .02,
respectively). There was no difference in rates of PCI (2%vs 5%; P = .15),
coronary artery bypass surgery (0% vs 1%; P = .61), return ED visits (5.8%
vs 2.8%; P = .08), or MACE (2%vs 1%; P = .24) in the 28-day follow-up
period. CONCLUSIONS AND RELEVANCE: In patients presenting to the ED with
acute chest pain, negative biomarkers, and a nonischemic ECG result,
noninvasive testing with CCTA or stress testing leads to longer LOS, more
downstream testing, more radiation exposure, and greater cost without an
improvement in clinical outcomes. Copyright © 2017 American
Medical Association. All rights reserved.

<31>
Accession Number
623881396
Title
Rationale and design of the Virginia Commonwealth University-Anakinra
Remodeling Trial-3 (VCU-ART3): A randomized, placebo-controlled,
double-blinded, multicenter study.
Source
Clinical Cardiology. 41 (8) (pp 1004-1008), 2018. Date of Publication:
August 2018.
Author
Van Tassell B.W.; Lipinski M.J.; Appleton D.; Roberts C.S.; Kontos M.C.;
Abouzaki N.; Melchior R.; Mueller G.; Garnett J.; Canada J.; Carbone S.;
Buckley L.F.; Wohlford G.; Kadariya D.; Trankle C.R.; Oddi Erdle C.;
Sculthorpe R.; Puckett L.; DeWilde C.; Shah K.; Angiolillo D.J.; Vetrovec
G.; Biondi-Zoccai G.; Arena R.; Abbate A.
Institution
(Van Tassell, Roberts, Kontos, Abouzaki, Melchior, Mueller, Canada,
Carbone, Kadariya, Trankle, Oddi Erdle, Shah, Vetrovec, Abbate) VCU Pauley
Heart Center, Virginia Commonwealth University, Richmond, VA, United
States
(Van Tassell, Buckley, Wohlford) Department of Pharmacotherapy and
Outcomes Science, Virginia Commonwealth University, Richmond, VA, United
States
(Van Tassell, Puckett, DeWilde, Abbate) VCU Johnson Center for Pulmonary
and Critical Care Research, Virginia Commonwealth University, Richmond,
VA, United States
(Lipinski) Medstar Heart and Vascular Institute, MedStar Washington
Hospital Center, Washington, DC, United States
(Appleton, Melchior, Mueller, Garnett, Puckett) Virginia Cardiovascular
Specialists, Richmond, United States
(Canada) Department of Kinesiology and Health Sciences, Virginia
Commonwealth University, Richmond, VA, United States
(Sculthorpe) Investigational Pharmacy, Virginia Commonwealth University,
Richmond, VA, United States
(Biondi-Zoccai) Department of Medical and Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, and Department of
AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
(Arena) Department of Physical Therapy, College of Applied Health
Sciences, University of Illinois at Chicago, Chicago, IL, United States
(Angiolillo) Division of Cardiology, University of Florida, Jacksonville,
FL, United States
(Abbate) Kenneth and Dianne Wright Center for Clinical and Translational
Research, Virginia Commonwealth University, Richmond, VA, United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
There is clear association between the intensity of the acute inflammatory
response during acute myocardial infarction (AMI) and adverse prognosis
after AMI. Interleukin-1 (IL-1) is a pro-inflammatory cytokine released
during AMI and involved in adverse remodeling and heart failure (HF). We
describe a study to evaluate the safety and efficacy of IL-1 blockade
using an IL-1 receptor antagonist (anakinra) during the acute phase of
ST-segment elevation myocardial infarction (STEMI). The Virginia
Commonwealth University-Anakinra Remodeling Trial-3 (VCU-ART3;
http://www.ClinicalTrials.gov NCT01950299) is a phase 2, multicenter,
double-blinded, randomized, placebo-controlled clinical trial comparing
anakinra 100 mg once or twice daily vs matching placebo (1:1:1) for 14
days in 99 patients with STEMI. Patients who present to the hospital with
STEMI within 12 hours of symptom onset will be eligible for enrollment.
Patients will be excluded for a history of HF (functional class III-IV),
severe valvular disease, severe kidney disease (stage 4-5), active
infection, recent use of immunosuppressive drugs, active malignancy, or
chronic autoimmune/auto-inflammatory diseases. We will measure the
difference in the area under the curve for C-reactive protein between
admission and day 14, separately comparing each of the anakinra groups
with the placebo group. The P value will be considered significant if
<0.025 to adjust for multiple comparisons. Patients will also be followed
for up to 12 months from enrollment to evaluate cardiac remodeling
(echocardiography), cardiac function (echocardiography), and major adverse
cardiovascular outcomes (cardiovascular death, MI, revascularization, and
new onset of HF). Copyright © 2018 Wiley Periodicals, Inc.

<32>
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. Copyright © 2018 Association of
Anaesthetists

<33>
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. Copyright © 2018 The Authors.
Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of
Anaesthetists.

<34>
Accession Number
620124669
Title
Clinical efficacy and safety of evolocumab in high-risk patients receiving
a statin: Secondary analysis of patients with low LDL cholesterol levels
and in those already receiving a maximal-potency statin in a randomized
clinical trial.
Source
JAMA Cardiology. 2 (12) (pp 1385-1391), 2017. Date of Publication:
December 2017.
Author
Giugliano R.P.; Keech A.; Murphy S.A.; Huber K.; Tokgozoglu S.L.; Lewis
B.S.; Ferreira J.; Pineda A.L.; Somaratne R.; Sever P.S.; Pedersen T.R.;
Sabatine M.S.
Institution
(Giugliano, Murphy, Sabatine) TIMI (Thrombolysis in Myocardial Infarction)
Study Office, Cardiovascular Division, Brigham and Women's Hospital,
Harvard Medical School, 60 Fenwood Rd, Ste 7122, Boston, MA 02115, United
States
(Keech) National Health and Medical Research Council Clinical Trials
Centre, Sydney Medical School, University of Sydney, Sydney, Australia
(Huber) Third Department of Medicine, Cardiology, and Intensive Care
Medicine, Faculty of Medicine, Sigmund Freud University, Vienna, Austria
(Tokgozoglu) Department of Cardiology, Hacettepe University Faculty of
Medicine, Ankara, Turkey
(Lewis) Cardiovascular Clinical Research Institute, Lady Davis Carmel
Medical Center, Haifa, Israel
(Ferreira) Department of Cardiology, Hospital de Santa Cruz, Lisbon,
Portugal
(Pineda, Somaratne) Amgen, Inc, Thousand Oaks, CA, United States
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Pedersen) Ulleval and Medical Faculty, Oslo University Hospital,
University of Oslo, Oslo, Norway
(Sabatine) JAMA Cardiology, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Current guidelines for atherosclerotic cardiovascular disease
focus on high-intensity statins and targeting or using a threshold
low-density lipoprotein cholesterol (LDL-C) level of less than 70mg/dL for
the highest-risk patients. Whether further reduction of LDL-C beyond these
boundaries would be beneficial is unknown. OBJECTIVE To compare outcomes
of evolocumab vs placebo in patients with stable atherosclerotic
cardiovascular disease and a baseline LDL-C of less than 70mg/dL and in
those receiving background treatment with a maximal-potency statin.
DESIGN, SETTING, AND PARTICIPANTS This secondary ad hoc analysis of the
Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects
With Elevated Risk (FOURIER) trial compared randomized treatments in 2
subgroups of patients with stable atherosclerotic cardiovascular disease
currently receiving statin. Patientswere classified by a baseline LDL-C of
less than 70 or at least 70mg/dL and by statin intensity (maximal:
atorvastatin calcium, 80mg/d, or rosuvastatin, 40mg/d; submaximal: all
other dosages). Patients with baseline LDL of less than 70mg/dL either had
a final screening LDL-C of at least 70mg/dL or a final screening
non-high-density lipoprotein cholesterol level of at least 100 mg/dL.
Datawere retrieved from 2013 to 2016 and analyzed in 2017 based on
intention to treat. MAIN OUTCOMES AND MEASURES The primary efficacy
endpointwas the composite of cardiovascular death,myocardial infarction,
stroke, hospitalization for unstable angina, or coronary
revascularization. The secondary efficacy endpoint was the composite of
cardiovascular death,myocardial infarction, or stroke. Safety outcomes
included adverse events and events of interest identified in the FOURIER
trial. Interaction testing was used to assess the consistency of results
in patients who did vs did not satisfy the above criteria. RESULTS A total
of 27 564 patients (75.4%men and 24.6%women; mean [SD] age, 62.5 [9.0]
years) were included in the analysis. Of 2034 patients (7.4%) who had a
baseline LDL-C of less than 70mg/dL, evolocumab reduced the risk for the
primary endpoint (hazard ratio [HR], 0.80; 95%CI, 0.60-1.07) to a similar
degree as in the 25 529 patients who had baseline LDL-C of at least
70mg/dL (HR 0.86; 95%CI, 0.79-0.92; P = .65 for interaction; 1 patient was
missing baseline LDL-C data). Of 7533 patients (27.3%) receiving
maximal-potency statins, evolocumab significantly reduced the primary
endpoint (HR, 0.86; 95%CI, 0.75-0.98) to a similar degree as in the 20 031
patients not receiving a maximal-potency statin (HR, 0.85; 95%CI,
0.78-0.93; P = .88 for interaction). The key secondary endpoint was
reduced to a similar degree in both analyses. No major safety concerns
were identified. CONCLUSIONS AND RELEVANCE Evolocumabwas equally effective
in reducing cardiovascular events in patients with stable atherosclerotic
cardiovascular disease regardless of whether the baseline LDL-C was less
than 70 or at least 70mg/dL and whether the background statin was of
maximal or submaximal potency. Copyright © 2017 American Medical
Association. All rights reserved.

<35>
Accession Number
616834912
Title
Intraoperative dexamethasone does not increase the risk of postoperative
wound infection: A propensity score-matched post hoc analysis of the
ENIGMA-II trial (EnDEX).
Source
British Journal of Anaesthesia. 118 (2) (pp 190-199), 2017. Date of
Publication: 01 Feb 2017.
Author
Corcoran T.; Kasza J.; Short T.G.; Chan M.T.V.; Forbes A.; Myles P.;
Wallace S.; Galagher W.; Farrington C.; Ditoro A.; Peyton P.; Baulch S.;
Sidiropoulos S.; Bulach R.; Bryant D.; O'Loughlin E.; Mitteregger V.;
Bolsin S.; Osborne C.; McRae R.; Backstrom M.; Leslie K.; Cotter R.; Paech
M.; March S.; Silbert B.; Said S.; Halliwell R.; Cope J.; Fahlbusch D.;
Crump D.; Thompson G.; Jefferies A.; McCulloch T.; Reeves M.; Buckley N.;
Tidyl T.; Schricker T.; Lattermann R.; Iannuzzi D.; Beattie S.; Carroll
J.; Jacka M.; Bryden C.; Badner N.; Chan M.; Tsang M.; Cheng B.; Fong A.;
Chu L.; Koo E.; Mohd N.; Ming L.E.; Yin Wang C.; Campbell D.; McAllister
D.; Walker S.; Olliff S.; Kennedy R.; Eldawlatly A.; Alzahrani T.; Chua
N.; Haller G.; Pichon I.; Sneyd R.; McMillan H.; Parkinson I.; Rousseau
G.; Brennan A.; Balaji P.; Cupitt J.; Nightingale J.; Kunst G.; Dickinson
M.; Saran T.; Subramaniam B.; Banner-Godspeed V.; Sessler D.; Liu J.; Kurz
A.; Hesler B.; Fu A.; Egan C.; Fiffick A.; Hutcherson M.; Turan A.; Naylor
A.; Obal D.; Cooke E.
Institution
(Corcoran, Paech) Department of Anaesthesia and Pain Medicine, Royal Perth
Hospital, Perth, WA, Australia
(Corcoran, O'Loughlin, Paech) School of Medicine and Pharmacology,
University of Western Australia, Perth, WA, Australia
(Corcoran) Western Australia Health Department, Perth, WA, Australia
(Corcoran, Kasza, Leslie, Forbes, Myles) Department of Epidemiology and
Preventive Medicine, Monash University, Melbourne, VIC, Australia
(Short) Department of Anaesthesia, Auckland City Hospital, Park Road,
Grafton, Auckland, New Zealand
(O'Loughlin) Department of Anaesthesia and Pain Medicine, Fiona Stanley
Hospital, Perth, WA, Australia
(Chan) Department of Anaesthesia and Intensive Care, Chinese University of
Hong Kong, Hong Kong Special Administrative Region, China
(Leslie) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, VIC, Australia
(Leslie) Anaesthesia Perioperative and Pain Medicine Unit, Department of
Pharmacology and Therapeutics, University of Melbourne, Melbourne, VIC,
Australia
(Myles) Department of Anaesthesia and Perioperative Medicine, Alfred
Hospital, Melbourne, VIC, Australia
(Wallace, Galagher, Farrington, Ditoro) AustinAustralia
(Peyton, Baulch, Sidiropoulos) DandenongAustralia
(Bulach, Bryant) Fremantle, Australia
(O'Loughlin, Mitteregger) Geelong Hospital, Australia
(Bolsin, Osborne) Monash Medical Centre, Australia
(McRae, Backstrom) Royal Melbourne Hospital, Australia
(Leslie, Cotter) Royal Perth Hospital, Australia
(Paech, March) St Vincent's Hospital, Australia
(Silbert, Said) Westmead Hospital, Australia
(Halliwell, Cope) Calvary WakefieldAustralia
(Fahlbusch, Crump) Peter MacCallum Cancer Centre, Australia
(Thompson) Western Hospital, Australia
(Jefferies) Royal Prince Alfred, Australia
(McCulloch) North West Regional Hosptial, Australia
(Reeves) McMaster University, Canada
(Buckley, Tidyl) Royal Victoria Hospital, Canada
(Schricker, Lattermann, Iannuzzi) Toronto General Hospital, Canada
(Beattie, Carroll) University of Alberta Hospital, Canada
(Jacka, Bryden) London Health Sciences, Canada
(Badner) Prince of Wales, Hong Kong
(Chan) ANZCA Trials Group Member, Hong Kong
(Tsang) Tuen Mun Hospital, Hong Kong
(Cheng, Fong) ACM Fong, Hong Kong
(Chu, Koo) Nethersole Eastern Hospital, Hong Kong
(Mohd, Ming) Hospital Kuala Lumpur, Malaysia
(Yin Wang) Malaya Medical Centre, Malaysia
(Campbell, McAllister) Auckland Hospital, New Zealand
(Walker, Olliff) Middlemore Hospital, New Zealand
(Kennedy) Christchurch Hospital, New Zealand
(Eldawlatly, Alzahrani) King Saud University Hospital, Saudi Arabia
(Chua) Tan Tock Seng Hospital, Singapore
(Haller, Pichon) Geneva University Hospital, Switzerland
(Sneyd, McMillan) Plymouth NHS Trust, France
(Parkinson) Royal Lancaster Infirmary, United Kingdom
(Rousseau) North Devon District Hospital, United Kingdom
(Brennan) Bradford Teaching Hospital, United Kingdom
(Balaji) Hull Royal Infirmary, United Kingdom
(Cupitt) Blackpool Victoria Hospital, United Kingdom
(Nightingale) Portsmouth Hospital, United Kingdom
(Kunst) King's College Hospital, United Kingdom
(Dickinson) Royal Surrey County Hospital, United Kingdom
(Saran) University Hospitals, Coventry and Warwickshire, United Kingdom
(Subramaniam, Banner-Godspeed) Beth Israel Deaconess Medical Center,
United States
(Sessler, Liu, Kurz, Hesler, Fu, Egan, Fiffick, Hutcherson, Turan, Naylor)
Cleveland Clinic, United States
(Obal, Cooke) Louisville Medical Centre, United States
Publisher
Oxford University Press
Abstract
Background. In a post hoc analysis of the ENIGMA-II trial, we sought to
determine whether intraoperative dexamethasone was associated with adverse
safety outcomes. Methods. Inverse probability weighting with estimated
propensity scores was used to determine the association of dexamethasone
administration with postoperative infection, quality of recovery, and
adverse safety outcomes for 5499 of the 7112 non-cardiac surgery subjects
enrolled in ENIGMA-II. Results. Dexamethasone was administered to 2178
(40%) of the 5499 subjects included in this analysis and was not
associated with wound infection [189 (8.7%) vs 275 (8.3%); propensity
score-adjusted relative risk (RR) 1.10; 95% confidence interval (CI)
0.89-1.34; P=0.38], severe postoperative nausea and vomiting on day 1 [242
(7.3%) vs 189 (8.7%); propensity score-adjusted RR 1.06; 95% CI 0.86-1.30;
P=0.59], quality of recovery score [median 14, interquartile range (IQR)
12-15, vs median 14, IQR 12-16, P=0.10), length of stay in the
postanaesthesia care unit [propensity score-adjusted median (IQR) 2.0
(1.3, 2.9) vs 1.9 (1.3, 3.1), P=0.60], or the primary outcome of the main
trial. Dexamethasone administration was associated with a decrease in
fever on days 1-3 [182 (8.4%) vs 488 (14.7%); RR 0.61; 95% CI 0.5-0.74;
P<0.001] and shorter lengths of stay in hospital [propensity
score-adjusted median (IQR) 5.0 (2.9, 8.2) vs 5.3 (3.1, 9.1), P<0.001].
Neither diabetes mellitus nor surgical wound contamination status altered
these outcomes. Conclusion. Dexamethasone administration to high-risk
non-cardiac surgical patients did not increase the risk of postoperative
wound infection or other adverse events up to day 30, and appears to be
safe in patients either with or without diabetes mellitus. Clinical trial
registration. NCT00430989. Copyright © 2017 The Author.

<36>
Accession Number
614998047
Title
Risk prediction models for delirium in the intensive care unit after
cardiac surgery: A systematic review and independent external validation.
Source
British Journal of Anaesthesia. 118 (3) (pp 391-399), 2017. Date of
Publication: 2017.
Author
Lee A.; Mu J.L.; Joynt G.M.; Chiu C.H.; Lai V.K.W.; Gin T.; Underwood M.J.
Institution
(Lee, Mu, Joynt, Chiu, Lai, Gin) Department of Anaesthesia and Intensive
Care, Chinese University of Hong Kong, Hong Kong, Hong Kong
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery,
Chinese University of Hong Kong, Hong Kong, Hong Kong
Publisher
Oxford University Press
Abstract
Numerous risk prediction models are available for predicting delirium
after cardiac surgery, but few have been directly compared with one
another or been validated in an independent data set.We conducted a
systematic review to identify validated risk prediction models of
delirium(using the Confusion Assessment Method-Intensive Care Unit tool)
after cardiac surgery and assessed the transportability of the risk
prediction models on a prospective cohort of 600 consecutive patients
undergoing cardiac surgery at a university hospital in Hong Kong from July
2013 to July 2015. The discrimination (c-statistic), calibration (GiViTI
calibration belt), and clinical usefulness (decision curve analysis) of
the risk predictionmodels were examined in a stepwisemanner. Three
published high-quality intensive care unit deliriumrisk prediction models
(n5939) were identified: Katznelson, the original PRE-DELIRIC, and the
international recalibrated PRE-DELIRIC model. Deliriumoccurred in 83
patients (13.8%, 95% CI: 11.2-16.9%). After updating the intercept and
regression coefficients in the Katznelsonmodel, there was fair
discrimination (0.62, 95% CI: 0.58-0.66) and good calibration. As the
original PRE-DELIRIC model was already validated externally and
recalibrated in six countries, we performed a logistic calibration on the
recalibrated model and found acceptable discrimination (0.75, 95% CI:
0.72-0.79) and good calibration. Decision curve analysis demonstrated that
the recalibrated PREDELIRIC riskmodel was marginally more clinically
useful than the Katznelsonmodel. Current models predict deliriumrisk in
the intensive care unit after cardiac surgery with only fair to moderate
accuracy and are insufficient for routine clinical use. Copyright
© The Author 2017.

<37>
Accession Number
2001265017
Title
A Randomized Trial to Assess Regional Left Ventricular Function After
Stent Implantation in Chronic Total Occlusion: The REVASC Trial.
Source
JACC: Cardiovascular Interventions. 11 (19) (pp 1982-1991), 2018. Date of
Publication: 8 October 2018.
Author
Mashayekhi K.; Nuhrenberg T.G.; Toma A.; Gick M.; Ferenc M.; Hochholzer
W.; Comberg T.; Rothe J.; Valina C.M.; Loffelhardt N.; Ayoub M.; Zhao M.;
Bremicker J.; Jander N.; Minners J.; Ruile P.; Behnes M.; Akin I.;
Schaufele T.; Neumann F.-J.; Buttner H.J.
Institution
(Mashayekhi, Nuhrenberg, Toma, Gick, Ferenc, Hochholzer, Comberg, Rothe,
Valina, Loffelhardt, Ayoub, Zhao, Bremicker, Jander, Minners, Ruile,
Neumann, Buttner) Department of Cardiology and Angiology II, University
Heart Center Freiburg * Bad Krozingen, Bad Krozingen, Germany
(Behnes, Akin) First Department of Medicine, University Medical Centre
Mannheim, Germany
(Behnes, Akin) DZHK (German Centre for Cardiovascular Research), partner
site Heidelberg/Mannheim, Mannheim, Germany
(Schaufele) Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart,
Germany
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to investigate whether percutaneous
coronary intervention (PCI) of chronic total occlusions (CTOs) improves
left ventricular function. Background: The benefit of PCI in CTOs is still
controversial. Methods: Patients with CTOs who were candidates for PCI
were eligible for the study and were randomized to PCI or no PCI of CTO.
Relevant coexisting non-CTO lesions were treated as indicated. Patients
underwent cardiac magnetic resonance imaging at baseline and at 6 months.
The primary endpoint was the change in segmental wall thickening (SWT) in
the CTO territory. Secondary endpoints were improvement of regional wall
motion and changes in left ventricular volumes and ejection fraction.
Furthermore, major adverse coronary events after 12 months were assessed.
Results: The CTO PCI group comprised 101 patients and the no CTO PCI group
104 patients. The change in SWT did not differ between the CTO PCI (4.1%
[interquartile range: 14.6 to 19.3]) and no CTO PCI (6.0% [interquartile
range: 8.6 to 6.0]) groups (p = 0.57). Similar results were obtained for
other indexes of regional and global left ventricular function. Subgroup
analysis revealed that only in patients without major non-CTO lesions
(basal SYNTAX [Synergy Between Percutaneous Coronary Intervention With
Taxus and Cardiac Surgery] score <=13) CTO PCI was associated with larger
improvement in SWT than no CTO PCI (p for interaction = 0.002). Driven by
repeat intervention, major adverse coronary event rates at 12 months were
significantly lower in the CTO PCI group (16.3% vs. 5.9%; p = 0.02).
Conclusions: No benefit was seen for CTO PCI in terms of the primary
endpoint, SWT, or other indexes of left ventricular function. CTO PCI
resulted in clinical benefit over no CTO PCI, as evidenced by reduced
major adverse coronary event rates at 12 months. Copyright © 2018
American College of Cardiology Foundation

<38>
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. Copyright © 2017 British Journal of Anaesthesia

<39>
Accession Number
624867438
Title
Infectious endocarditis in the case of cirrhosis: Where do we stand?.
Source
European Journal of Gastroenterology and Hepatology. 30 (12) (pp
1406-1410), 2018. Date of Publication: 01 Dec 2018.
Author
Allaire M.; Ollivier-Hourmand I.; Garioud A.; Heng R.; Dao T.; Cadranel
J.-F.D.
Institution
(Allaire, Ollivier-Hourmand, Dao) Department of Hepato-Gastroenterology,
CHU Cote de Nacre, Caen, France
(Allaire) Inserm-U1149, CRI, Paris, France
(Garioud, Heng, Cadranel) Department of Hepato-Gastroenterology, GHPSO,
Hopital Laennec BP 72, Creil 60109, France
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Bacterial infections are common in the case of cirrhosis and represent a
major cause of morbidity and mortality. The most frequent infections are
spontaneous bacterial peritonitis, urinary tract infection, and pneumonia,
but few data on infectious endocarditis are available. Infectious
endocarditis is a rare event, and diagnosis can be made at all stages of
Child-Pugh classification. In the case of cirrhosis, the clinical features
and bacterial ecology are similar to that of the general population (two
males/one female, preferential location on the aortic and mitral valves,
history of heart disease, majority of Gram-positive bacteria), but
in-hospital mortality is higher. The Child-Pugh score and a history of
decompensation have been identified as independent predictive factors for
in-hospital mortality and a Child-Pugh score more than C10 was associated
with a higher risk of death. Less frequent use of aminoglycosides,
rifampin, and cardiac surgery has been described in cirrhotic patients,
probably because of potential toxicity. Nevertheless, as they are a
cornerstone of therapy, prospective studies on the impact of these
therapeutics are warranted to improve outcome in this population of
patients. Copyright © 2018 Wolters Kluwer Health, Inc. All rights
reserved.

<40>
Accession Number
624867106
Title
Blood conservation using tranexamic acid versus epsilon aminocaproic acid
in cardiac surgery: A randomized controlled trial.
Source
Journal of Anesthesia and Perioperative Medicine. 5 (4) (pp 169-175),
2018. Date of Publication: 28 Jul 2018.
Author
Gatling J.; Ramsingh D.; Horricks J.; Lauer R.; Brauer S.; Debooy J.;
Mascetti C.; Applegate R.
Institution
(Gatling, Ramsingh, Horricks, Lauer, Brauer, Debooy, Mascetti, Applegate)
Department of Anesthesiology, Loma Linda University Medical Center, Loma
Linda, CA, United States
Publisher
Evidence Based Communications (E-mail: anhuai.yu@yahoo.com)
Abstract
Background: This study compares the efficacy of tranexamic acid (TXA) to
epsilon aminocaproic acid (EACA) in reducing blood loss in patients
undergoing cardiac surgery. Methods: This was a double-blinded randomized
trial. Patients (n = 100) undergoing cardiac surgery were randomized to
receive either TXA (10 mg/kg bolus followed by an infusion of 1 mg/kg/hr)
or EACA (150 mg/kg bolus followed by an infusion of 20 mg/kg/hr). The
primary outcome measure was a difference in transfusion amounts. Secondary
outcomes measured included: the amount of transfusion during the operative
procedure, calculated Red blood cell (RBC) volume change, postoperative
creatinine, time to extubation, chest tube output and length of ICU stay.
Results: A total of 100 patients consented, of whom 82 completed
participation in the study (EACA arm = 42 patients and TXA arm = 40
patients). There was no difference in patient demographics. Similarly,
there was no difference between the type of cardiac surgery,
cardiopulmonary bypass (CPB) time, intraoperative fluids, and procedure
time. Primary marker comparison showed no difference in the frequency or
amount of transfusion between groups in the operating room, ICU, or in
total. Additionally, there was no difference in hematocrit (Hct), chest
tube output, time to extubation, and length of stay. Post Hoc analysis
indicated that red blood cell volume change through postoperative day 2
was larger in TXA than EACA; P = 0.03). Conclusion: There was no
difference in clinically significant outcome criteria between the TXA and
EACA groups. Given the lower cost of EACA, this study further supports
EACA as an appropriate antifibrinolytic agent for cardiac surgery. (Funded
by the Department of Anesthesiology, Loma Linda University Medical Center;
ClinicalTrials. gov number, NCT01248104. Copyright © 2018 Journal
of Anesthesia and Perioperative Medicine. All rights reserved.

<41>
Accession Number
621915391
Title
PET Imaging Analysis of Vitamin B<inf>1</inf> Kinetics with
[11C]Thiamine and its Derivative [11C]Thiamine
Tetrahydrofurfuryl Disulfide in Rats.
Source
Molecular Imaging and Biology. 20 (6) (pp 1001-1007), 2018. Date of
Publication: 01 Dec 2018.
Author
Nozaki S.; Mawatari A.; Nakatani Y.; Hayashinaka E.; Wada Y.; Nomura Y.;
Kitayoshi T.; Akimoto K.; Ninomiya S.; Doi H.; Watanabe Y.
Institution
(Nozaki, Mawatari, Nakatani, Hayashinaka, Wada, Doi, Watanabe) Division of
Bio-Function Dynamics Imaging, RIKEN Center for Life Science Technologies
(CLST), 6-7-3 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
(Nomura, Kitayoshi, Akimoto, Ninomiya) Takeda Pharmaceutical Company
Limited, 12-10 Nihonbashi 2-Chome, Chuo-ku, Tokyo 103-8668, Japan
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Thiamine is an essential component of glucose metabolism and
energy production. The disulfide derivative, thiamine tetrahydrofurfuryl
disulfide (TTFD), is better absorbed than readily-available water-soluble
thiamine salts because it does not require the rate-limiting transport
system required for thiamine absorption. However, the detailed
pharmacokinetics of thiamine and TTFD under normal and pathological
conditions have not yet been clarified. C-11-labeled thiamine and TTFD
were recently synthesized by our group. In this study, to clarify the
differences in pharmacokinetics and metabolism of these probes, a
quantitative PET imaging study and radiometabolite analysis of
C-11-labeled thiamine and TTFD were performed in the rat heart.
Procedures: Positron emission tomography (PET) imaging with
[11C]thiamine and [11C]TTFD was performed in normal
rats to determine the pharmacokinetics of these probes, and the
radiometabolites of both probes from the blood and heart tissue were
analyzed by thin-layer chromatography. Results: Accumulation of
[11C]TTFD was significantly higher than that of
[11C]thiamine in the rat heart. Moreover, as a result of the
radiometabolite analysis of heart tissue at 15 min after the injection of
[11C]TTFD, thiamine pyrophosphate, which serves as a cofactor
for the enzymes involved in glucose metabolism, was found as the major
radiometabolite and at a significantly higher level than in the
[11C]thiamine-injected group. Conclusions: PET imaging
techniques for visualizing the kinetics and metabolism of thiamine using
[11C]thiamine and [11C]TTFD were developed in this
study. Consequently, noninvasive PET imaging for the pathophysiology of
thiamine-related cardiac function may provide novel information about
heart failure and related disorders. Copyright © 2018, World
Molecular Imaging Society.

<42>
Accession Number
618697474
Title
Effects of glucocorticoids on serum amino acid levels during cardiac
surgery in children.
Source
Clinical Nutrition ESPEN. 23 (pp 212-216), 2018. Date of Publication:
February 2018.
Author
van Zwol A.; Oosterloo N.B.C.; de Betue C.T.; Bogers A.; de Liefde I.I.;
Deutz N.E.P.; Joosten K.F.M.
Institution
(van Zwol, Oosterloo, de Betue, Joosten) Intensive Care and Department of
Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam,
Netherlands
(Bogers, de Liefde) Department of Cardiothoracic Surgery, Erasmus Medical
Centre, Rotterdam, Netherlands
(Deutz) Center of Translation Research in Aging & Longevity, Department of
Health & Kinesiology, Texas A&M University, College Station, TX, United
States
Publisher
Elsevier Ltd
Abstract
Background and aims: Children undergoing cardiac surgery with cardio
pulmonary bypass often receive glucocorticoids to reduce the systemic
inflammatory response. Glucocorticoids stimulate protein breakdown and
increase amino acid availability. We studied whether glucocorticoid
treatment influences the availability of amino acids, specifically those
involved in the nitric oxide pathway. Methods: We prospectively studied 49
children with congenital heart disease undergoing cardiac surgery. Serum
cortisol and amino acid levels were measured in arterial blood sampled
before surgery (t = -5 min), directly after surgery (t = 0 h) and at t =
12 h and t = 24 h after surgery. Serum cortisol and amino acid levels were
compared between children who had received glucocorticoids (G+) and
children who had not (G-). Results: Of 49 patients included ((49% male,
age 1.7 (0.5-8.7) y)), 33 (67%) received glucocorticoids. Baseline
characteristics were not different between groups, except a higher
weighted inotropic score in the G+ group. At t = 0 h, serum cortisol
levels in the G+ group were significantly higher than in the G- group
(7218 vs. 660 nmol/L; (p < 0.05)), but not different at the other time
points. The levels of plasma amino acids had dropped after surgery.
Compared to the G- group, in the G+ group the total amount of amino acids
was significantly higher at t = 12 and t = 24; citrulline levels were
higher at t = 12 and t = 24; and glutamine and arginine levels were higher
at t = 12. Conclusions: Glucocorticoid treatment during cardiac surgery in
children preserves serum amino acid levels post-surgery. The preservation
of glutamine, citrulline and arginine levels might have a beneficial
effect on the related NO metabolism. Copyright © 2017 European
Society for Clinical Nutrition and Metabolism

<43>
Accession Number
2000926704
Title
HVAD: The ENDURANCE Supplemental Trial.
Source
JACC: Heart Failure. 6 (9) (pp 792-802), 2018. Date of Publication:
September 2018.
Author
Milano C.A.; Rogers J.G.; Tatooles A.J.; Bhat G.; Slaughter M.S.; Birks
E.J.; Mokadam N.A.; Mahr C.; Miller J.S.; Markham D.W.; Jeevanandam V.;
Uriel N.; Aaronson K.D.; Vassiliades T.A.; Pagani F.D.
Institution
(Milano, Rogers) Departments of Surgery and Medicine, Duke University
School of Medicine, Durham, NC, United States
(Tatooles, Bhat) Center for Heart Transplant and Assist Devices, Advocate
Christ Medical Center, Oak Lawn, IL, United States
(Slaughter, Birks) Cardiovascular and Thoracic Surgery and Department of
Cardiovascular Medicine, University of Louisville, Louisville, KY, United
States
(Mokadam, Mahr) Divisions of Cardiothoracic Surgery and Cardiology,
University of Washington, Seattle, WA, United States
(Miller, Markham) Departments of Cardiac Surgery and Medicine, St.
Joseph's Hospital of Atlanta, Atlanta, Georgia
(Jeevanandam, Uriel) Heart and Vascular Center, University of Chicago
Medicine, Chicago, IL, United States
(Aaronson, Pagani) Divisions of Cardiovascular Medicine and Cardiothoracic
Surgery, University of Michigan, Ann Arbor, MI, United States
(Vassiliades) Department of Clinical and Medical Affairs, Medtronic
(formerly HeartWare), Framingham, MA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to prospectively evaluate the impact
of blood pressure management on stroke rates in patients receiving the
HeartWare HVAD System. Background: The ENDURANCE trial demonstrated
noninferiority of the HeartWare HVAD System versus control (HeartMate II)
in patients with advanced heart failure ineligible for heart
transplantation. However, stroke was more common in HVAD subjects. Post
hoc analyses demonstrated increased mean arterial blood pressure as a
significant independent risk factor for stroke. Methods: The ENDURANCE
Supplemental Trial was a prospective, multicenter evaluation of 465
patients with advanced heart failure ineligible for transplantation,
randomized 2:1 to HVAD (n = 308) or control (n = 157). The primary
endpoint was the 12-month incidence of transient ischemic attack or stroke
with residual deficit 24 weeks post-event. Secondary endpoints included
the composite of freedom from death, disabling stroke, and need for device
replacement or urgent transplantation, as well as comparisons of stroke or
transient ischemic attack rates in HVAD cohorts in ENDURANCE Supplemental
and ENDURANCE. Results: The enhanced blood pressure protocol significantly
reduced mean arterial blood pressure. The primary endpoint was not
achieved (14.7% with HVAD vs. 12.1% with control, noninferiority [margin
6%] p = 0.14). However, the secondary composite endpoint demonstrated
superiority of HVAD (76.1%) versus control (66.9%) (p = 0.04). The
incidence of stroke in HVAD subjects was reduced 24.2% in ENDURANCE
Supplemental compared with ENDURANCE (p = 0.10), and hemorrhagic
cerebrovascular accident was reduced by 50.5% (p = 0.02). Conclusions: The
ENDURANCE Supplemental Trial failed to demonstrate noninferiority of HVAD
versus control regarding the pre-specified primary endpoint. However, the
trial confirmed that BP management is associated with reduced stroke rates
in HVAD subjects. HVAD subjects, relative to control subjects, more
commonly achieved the composite endpoint (freedom from death, disabling
stroke, and device replacement or urgent transplantation). (A Clinical
Trial to Evaluate the HeartWareTM Ventricular Assist System [ENDURANCE
SUPPLEMENTAL TRIAL] [DT2]; NCT01966458) Copyright © 2018 The
Authors

<44>
Accession Number
624778041
Title
Female sex reduces the risk of hospital-associated acute kidney injury: A
meta-analysis.
Source
BMC Nephrology. 19 (1) (no pagination), 2018. Article Number: 314. Date of
Publication: 08 Nov 2018.
Author
Neugarten J.; Golestaneh L.
Institution
(Neugarten, Golestaneh) Department of Medicine, Nephrology Division,
Montefiore Medical Center, Albert Einstein College of Medicine, 111 E. 210
St, Bronx, NY 10467, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Female sex has been included as a risk factor in models
developed to predict the development of AKI. In addition, the commentary
to the Kidney Disease Improving Global Outcomes Clinical Practice
Guideline for AKI concludes that female sex is a risk factor for
hospital-acquired AKI. In contrast, a protective effect of female sex has
been demonstrated in animal models of ischemic AKI. Methods: To further
explore this issue, we performed a meta-analysis of AKI studies published
between January, 1978 and April, 2018 and identified 83 studies reporting
sex-stratified data on the incidence of hospital-associated AKI among
nearly 240,000,000 patients. Results: Twenty-eight studies (6,758,124
patients) utilized multivariate analysis to assess risk factors for
hospital-associated AKI and provided sex-stratified ORs. Meta-analysis of
this cohort showed that the risk of developing hospital-associated AKI was
significantly greater in men than in women (OR 1.23 (1.11,1.36). Since AKI
is not a single disease but instead represents a heterogeneous group of
disorders characterized by an acute reduction in renal function, we
performed subgroup meta-analyses. The association of male sex with AKI was
strongest among studies of patients who underwent non-cardiac surgery.
Male sex was also associated with AKI in studies which included unselected
hospitalized patients and in studies of critically ill patients who
received care in an intensive care unit. In contrast, cardiac
surgery-associated AKI and radiocontrast-induced AKI showed no sexual
dimorphism. Conclusions: Our meta-analysis contradicts the established
belief that female sex confers a greater risk of AKI and instead suggests
a protective role. Copyright © 2018 The Author(s).

<45>
Accession Number
623736830
Title
Unequal intra-group variance in trajectory classification.
Source
Statistics in Medicine. 37 (28) (pp 4155-4166), 2018. Date of Publication:
10 Dec 2018.
Author
Klich A.; Ecochard R.; Subtil F.
Institution
(Klich, Ecochard, Subtil) Service de Biostatistique-Bioinformatique, Pole
Sante Publique, Hospices Civils de Lyon, Lyon, France
(Klich, Ecochard, Subtil) Universite de Lyon, Universite Lyon 1, CNRS,
Laboratoire de Biometrie et Biologie Evolutive UMR 5558, Villeurbanne,
France
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Classifying patients into groups according to longitudinal series of
measurements (ie, trajectory classification) has become frequent in
clinical research. Most classification models suppose an equal intra-group
variance across groups. This assumption is sometimes inappropriate because
measurements in diseased subjects are often more heterogeneous than in
healthy ones. We developed a new classification model for trajectories
that uses unequal intra-group variance across groups and evaluated its
impact on classification using simulations and a clinical study. The
classification and typical trajectories were estimated using the
classification Expectation Maximization (EM) algorithm to maximize the
classification likelihood, the log-likelihood being profiled during the
Maximization (M) step of the algorithm. The simulations showed that
assuming equal intra-group variance resulted in a high misclassification
rate (up to 50%) when the real intra-group variances were different. This
rate was greatly reduced by allowing intra-group variances to be
different. Similar classification was obtained when the real intra-group
variances were equal, except when the total sample size and the number of
repeated measurements were small. In a randomized trial that compared the
effect of low vs standard cyclosporine A dose on creatinine levels after
cardiac transplantation, the classification model with unequal intra-group
variance led to more meaningful groups than with equal intra-group
variance and showed distinct benefits of low dose. In conclusion, we
recommend the use of a classification model for trajectories that allows
for unequal intra-group variance across groups except when the number of
repeated measurements and total sample size are small. Copyright
© 2018 John Wiley & Sons, Ltd.

<46>
Accession Number
2000882198
Title
The effects of recruitment maneuver during noninvasive ventilation after
coronary bypass grafting: A randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (6) (pp 2170-2177.e1),
2018. Date of Publication: December 2018.
Author
Miura M.C.; Ribeiro de Carvalho C.R.; Yamada da Silveira L.T.; de Moraes
Regenga M.; Petri Damiani L.; Fu C.
Institution
(Miura, de Moraes Regenga) Hospital do Coracao, Sao Paulo-SP, Brazil
(Miura) Department of Physiotherapy, Communication Science & Disorders,
Occupational Therapy, Medical School of the University of Sao Paulo, Sao
Paulo, Brazil
(Miura, Yamada da Silveira, Fu) Cardio-Pulmonary Department-Respiratory
ICU, Pulmonary Division, Heart Institute, Hospital das Clinicas da FMUSP,
University of Sao Paulo, Sao Paulo, Brazil
(Ribeiro de Carvalho) University Hospital, Universidade de Sao Paulo, Sao
Paulo, Brazil
(Petri Damiani) HCor Research Institute, Hospital do Coracao, Sao Paulo,
Brazil
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Pulmonary impairment is a common complication after coronary
artery bypass graft procedure and may be prevented or treated by
noninvasive ventilation. Recruitment maneuvers include sustained airway
pressure with high levels of positive end-expiratory pressure in patients
with hypoxemia, favoring homogeneous pulmonary ventilation and
oxygenation. This study aimed to evaluate whether noninvasive ventilation
with recruitment maneuver could safely improve oxygenation in patients
with atelectasis and hypoxemia who underwent a coronary artery bypass
grafting procedure. Methods: Thirty-four patients admitted to our
intensive care unit undergoing mechanical ventilation after surgery, with
ratio of arterial oxygen partial pressure to fraction of inspired oxygen <
300 and radiologic atelectasis score >=2, were included. The control group
consisted of 16 randomized patients and the recruitment group consisted of
18 patients. After extubation, noninvasive ventilation was applied for 30
minutes 3 times a day with positive end-expiratory pressure of 8 cm
H<inf>2</inf>O. The recruitment group received recruitment maneuver with
positive end-expiratory pressure of 15 cm H<inf>2</inf>O and 20 cm
H<inf>2</inf>O for 2 minutes each during noninvasive ventilation. We
analyzed the arterial oxygen partial pressure in room air, radiologic
atelectasis score, hemodynamic stability, and adverse events from
extubation until discharge. Results: Arterial oxygen partial pressure
increased 12.6% +/- 6.8% in the control group and 23.3% +/- 8.5% in the
recruitment group (P <.001). The radiologic atelectasis score was
completely improved for 94.4% of the recruitment group with no adverse
events, whereas 87.5% of the control group presented some atelectasis (P
<.001). Conclusions: Noninvasive ventilation with recruitment maneuvers is
safe, improves oxygenation, and reduces atelectasis in patients undergoing
coronary artery bypass. Copyright © 2018 The American Association
for Thoracic Surgery

<47>
Accession Number
2000995909
Title
Prevention of deep sternal wound infection in cardiac surgery: a
literature review.
Source
Journal of Hospital Infection. 100 (4) (pp 411-420), 2018. Date of
Publication: December 2018.
Author
Vos R.J.; Van Putte B.P.; Kloppenburg G.T.L.
Institution
(Vos, Van Putte, Kloppenburg) Department of Cardiothoracic Surgery, St.
Antonius Hospital, Nieuwegein, Netherlands
(Vos, Van Putte) Department of Cardiothoracic Surgery, Academic Medical
Center, Amsterdam, Netherlands
Publisher
W.B. Saunders Ltd
Abstract
Background: Deep sternal wound infection (DSWI) is a dreaded complication
of cardiac surgery with considerable consequences in terms of mortality,
morbidity and treatment costs. In addition to standard surgical site
infection prevention guidelines, multiple specific measures in the
prevention of DSWI have been developed and evaluated in the past decades.
This review focuses on these specific measures to prevent DSWI. Methods:
An extensive literature search was performed to assess interventions in
the prevention of DSWI. Articles describing results of a randomized
controlled trial were categorized by type of intervention. Results were
yielded and, if possible, pooled. Results: From a total of 743 articles
found, 48 randomized controlled trials were selected. Studies were divided
into 12 categories, containing pre-, peri- and postoperative preventive
measures. Specific measures shown to be effective were: antibiotic
prophylaxis with a first-generation cephalosporin for at least 24 h,
application of local gentamicin before chest closure, sternal closure with
figure-of-eight steel wires, and postoperative chest support using a
corset or vest. Conclusion: This study identified several measures that
prevent DSWI after cardiac surgery that are not frequently applied in
current practice. It is recommended that the guidelines on prevention of
surgical site infection in cardiac surgery should be
updated. Copyright © 2018 The Healthcare Infection Society

<48>
Accession Number
624935237
Title
Volatile anesthetics versus propofol in the cardiac surgical setting of
remote ischemic preconditioning: A secondary analysis of a Cochrane
Systematic Review.
Source
Minerva Anestesiologica. 84 (11) (pp 1298-1306), 2018. Date of
Publication: November 2018.
Author
Benstoem C.; Goetzenich A.; Autschbach R.; Marx G.; Stoppe C.; Breuer T.
Institution
(Benstoem, Marx, Stoppe, Breuer) Department of Intensive Care Medicine and
Intermediate Care, Medical Faculty, RWTH Aachen University, Pauwelsstr.
30, Aachen D-52074, Germany
(Goetzenich, Autschbach) Department of Thoracic and Cardiovascular
Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: So far, the concept of remote ischemic preconditioning
(RIPC) failed its translation from experimental to clinical studies. In
addition to our Cochrane Systematic Review, we systematically assessed the
use of the intravenous anesthetic propofol, as a potential confounding
factor. EVIDENCEACQUISITION: We searched CENTRAL, MEDLINE, Embase and Web
of Science. We included randomized controlled trials comparing RIPCwith no
RIPCin adult patients scheduled for coronary artery bypass graft surgery
(with or without valve surgery) receiving either exclusively propofol or
exclusively volatile anesthetics. Two authors independently assessed
methodological quality and extracted data. We report odds ratios (ORs)
with 95% confidence intervals as our summary statistics are based on
random-effects models. EVIDENCESYNTHESIS: We included 14 studies involving
4060 participants. We found no difference in treatment effect between the
propofol and volatile anesthetic groups when RIPCor no RIPCis applied on a
composite endpoint (all-cause mortality, non-fatal myocardial infarction
and/or any new stroke), all-cause mortality, non-fatal myocardial
infarction, stroke, or length of stay on ICU. On cardiac markers, RIPCdid
show a treatment effect on cardiac troponin T measured as AUC 72 hours
(SMD -0.80, CI -1.34, -0.25) in the propofol group. However, these
findings have to be interpreted with great caution, to date only a very
limited number of patients received volatile anesthetics in RIPCtrials
(minimum N.=15, maximum N.=232). CONCLUSIONS: Present data do not permit a
final assessment regarding the role of volatile or intravenous anesthetics
as a possible confounding factor in RIPCtrials. Copyright © 2018
EDIZIONIMINERVAMEDICA.

<49>
Accession Number
624935128
Title
Effects of inhalation and intravenous anesthesia on intraoperative
cardiopulmonary function and postoperative complications in patients
undergoing thoracic surgery.
Source
Minerva Anestesiologica. 84 (11) (pp 1287-1297), 2018. Date of
Publication: November 2018.
Author
Pang Q.-Y.; An R.; Liu H.-L.
Institution
(Pang, An, Liu) Department of Anesthesiology, Chongqing Cancer Hospital
and Institute, 181 Hanyu Lu, Shapingba district, Chongqing 400030, China
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: There is a high incidence of postoperative cardiopulmonary
complications after thoracic surgery with one lung ventilation (OLV), the
effect of general anesthetics on intraoperative cardiopulmonary function
and postoperative complications is still unclear. EVIDENCEACQUISITION: We
searched the EMBASE, PubMed, Cochrane Library, Springer, Wiley, CNKI, VIP
and Wanfang databases for randomized controlled trials (RCTs) in which
inhalation anesthesia and intravenous anesthesia were compared;
intraoperative cardiopulmonary function and postoperative complications
were assessed in patients undergoing thoracic surgery with intraoperative
one-lung ventilation (OLV). EVIDENCESYNTHESIS: Twenty-three RCTs with a
total of 1349 patients were included. Compared with intravenous
anesthesia, inhalation anesthesia significantly increased pulmonary shunt
fraction (Qs/Qt) (mean: 5.72, 95% CI: 3.93 to 7.51, P<0.0001), and
improved Cardiac Index (CI) (mean difference [MD]: 0.19, 95% CI: 0.10 to
0.28, P<0.0001), but decreased Oxygenation Index (OI) during OLV
intraoperatively (MD: -27.37, 95% CI: -43.92 to -10.82, P=0.001).
Inhalation anesthesia could reduce postoperative pulmonary complications
(RR: 0.47, 95% CI: 0.33 to 0.66, P<0.0001), but did not reduce
postoperative cardiac adverse events (P>0.05). CONCLUSIONS: Inhalation
anesthesia can preserve intraoperative cardiac function and reduce
postoperative pulmonary complications in patients undergoing thoracic
surgery with OLV; although it decreases intraoperative pulmonary function,
inhalation anesthesia may be superior to intravenous anesthesia in
thoracic surgery. Publication bias existed in some included studies, and
the sample size was not large enough in CIand cardiac adverse
events. Copyright © 2018 EDIZIONIMINERVAMEDICA.

<50>
Accession Number
624947380
Title
Stroke associated with post-operative atrial fibrillation after
non-cardiac surgery: A meta-analysis.
Source
International Journal of Stroke. Conference: 11th World Stroke Congress,
WSC 2018. Canada. 13 (2 Supplement 1) (pp 97), 2018. Date of Publication:
October 2018.
Author
Marafi M.; AlTurki A.; Vieira L.; Proietti R.; Cardinale D.; Blackwell R.;
Bessissow A.; Essebag V.; Healey J.S.; Huynh T.
Institution
(Marafi, Vieira) Montreal Neurological Institute, Neurology, Montreal,
Canada
(AlTurki, Essebag, Huynh) McGill University Health Center, Cardiology,
Montreal, Canada
(Proietti) University of Padua, Cardiac- thoracic and vascular sciences,
Padua, Italy
(Cardinale) European Institute of Oncology, Cardioncology unit, Milan,
Italy
(Blackwell) Loyola University Medical Center, Urology, Maywood, United
States
(Bessissow) McGill University Health Center, Internal Medicine, Montreal,
Canada
(Healey) Population Health Research Institute, McMaster University,
Hamilton, Canada
Publisher
SAGE Publications Inc.
Abstract
Background: Post-operative atrial fibrillation (POAF) is a frequent
occurrence after non-cardiac surgery due to its relatively short duration,
the risk of stroke is unclear. Therefore, we performed a meta-analysis of
randomized controlled studies and observational studies. Method(s):
Electronic databases were searched from inception to December 2016, for
all studies that reported strokes in patients who developed POAF following
non-cardiac surgery. We used random-effects models to summarize the
studies. Two reviewers independently performed the literature search and a
randomeffects model was used to summarize the studies. Result(s): We
retained 15 studies enrolling 1,694,663 patients for the final analyses
including 16,061 patients who had POAF and 1,678,602 patients with no
POAF. There were four randomized controlled studies, three prospective and
eight retrospective cohort studies. At one-month follow-up, POAF was
associated with almost three times increased risk of stroke [odds ratio
(OR): 2.84 (95% Confidence interval (CI): 2.18-3.70); n=8 studies]. In 7
studies with >12 months follow up, POAF was associated with nearly four
times increase in risk of stroke with OR: 3.92 (95% CI: 3.42-4.50). The
risk of stroke was increased after both thoracic (OR: 2.83; 95% CI:
2.08-3.85; p <= 0.001) and non-thoracic (OR: 3.64; 95% CI: 3.01-4.41; p <=
0.001) surgeries. Conclusion(s): POAF was associated with increased
short and long-term risk of stroke after non-cardiac surgery. Future
studies are needed to evaluate the impact of anticoagulation in decreasing
the risk of stroke in these patients.

<51>
Accession Number
624942335
Title
Does dexmedetomidine (vs. propofol) improve outcomes in adult after
cardiac surgery?.
Source
Canadian Journal of Anesthesia. Conference: Critical Care Canada Forum,
CCCF 2017. Canada. 65 (Supplement 2) (pp S38-S39), 2018. Date of
Publication: September 2018.
Author
Asir A.; Amin F.; Al-Hazzani W.
Institution
(Asir) ICU Department, Prince Mohammed Bin Abdulaziz, Riyadh, Saudi Arabia
(Amin, Al-Hazzani) ICU department, McMaster University, Hamilton, Canada
Publisher
Springer New York LLC
Abstract
Introduction: Current guidelines suggest that non-benzodiazepine sedatives
are the preferred sedative agents in mechanically ventilated adults in the
intensive care unit (ICU). Among those agents, it is uncertain whether
dexmedetomidine is better than propofol for sedation in patients after
cardiac surgery. Objective(s): We undertook a systematic review and
meta-analysis of randomized controlled trials (RCTs) to examine the
efficacy and safety of dexmedetomidine, compared to propofol, in adult
patients after cardiac surgery. Method(s): Two reviewers
independently searched PubMed, Embase, OVID Medline, and the Cochrane
Library up to January 31st, 2017. The same reviewers completed abstract
screening, study selection, data abstraction, and risk of bias assessment
using the Cochrane Collaboration's tool for assessing risk of bias. We
used the GRADE approach to assess the quality of evidence. We included
RCTs that enrolled adult post-cardiac surgery patients, comparing
dexmedetomidine to propofol, and reported any of the following outcomes:
delirium, duration of mechanical ventilation, ICU length of stay, opioid
requirements, and mortality. We pooled the estimate of effects across
studies using a random-effects model. The results were summarized as risk
ratio (RR) for binary outcomes, and mean difference (MD) for continuous
outcomes. Result(s): Out of 20 studies that met inclusion criteria,
we included eight RCTs (1002 patients). Dexmedetomidine was associated
with a lower risk of delirium (RR 0.29, 95% confidence interval [CI],
0.09-0.90 p=0.03), shorter duration of mechanical ventilation (hours mean
difference -0.93 95% CI -1.24 to -0.63 p<0.00001), and lower need for
opioids (mg of morphine-equivalents mean difference -14.64, 95% CI -14.80
to -14.47 p<0.00001) compared to propofol. However, there was a higher
incidence of bradycardia (RR 3.21, 95% CI 1.18-8.70 p=0.02), and
hypotension (RR 1.30, 95% CI 1.05-1.62 p=0.02) with dexmedetomidine
compared to propofol. There were no statistically significant differences
in ICU length of stay, mortality, or incidence of atrial fibrillation
between dexmedetomidine and propofol sedation regimens.
 Conclusion(s): Moderate quality evidence revealed that
dexmedetomidine reduces postoperative delirium, shortens the duration of
mechanical ventilation, and lowers opioid requirements after cardiac
surgery, but may increase the incidence of bradycardia and hypotension
compared with propofol.

<52>
Accession Number
624936531
Title
Growth in infants receiving modified fat mother's milk for treatment of
postcardiothoracic surgery chylothorax.
Source
Breastfeeding Medicine. Conference: 19th International Society for
Research in Human Milk and Lactation Conference, ISRHML 2018. Japan. 13
(7) (pp A53-A54), 2018. Date of Publication: September 2018.
Author
DiLauro S.
Institution
(DiLauro) Hospital for Sick Children, Toronto, Canada
Publisher
Mary Ann Liebert Inc.
Abstract
Background: Lacto-engineering may be a promising strategy to facilitate
human milk use among infants with conditions/disorders traditionally
treated with specialty formulas. We have shown use of modified fat breast
milk (MFBM) can facilitate resolution of post-cardiothoracic surgery
chylothorax in infants no differently than high medium chain triglyceride
formula (MCT-formula), however weight-for-age (WAZ) and length-for-age
z-scores (LAZ) declined over the 6-week treatment period.
 Objective(s): To assess two proactive MFBM feeding protocols in
promoting growth in cardiac infants with chylothorax. Method(s): In
this open-label trial, mothers milk-fed infants were randomized to either:
Target Fortification, where protein content of defatted milk was measured
weekly prior to individualized multi-nutrient fortification to provide
3.5g/kg/day of protein (n = 8); or Higher Initial Concentration, where
defatted milk was fortified to a higher initial energy/nutrient level
(80kcal/dL; 2.2g/dL/protein) (n = 8). A third unrandomized group received
MCT-formula (68kcal/dL; 2.3g/dL/protein) (n = 8). Interventions lasted
6weeks after chest tube(s) removal and continued after discharge. Weight,
length and head circumference (HC) were measured weekly. Repeated measures
regression models were used to determine anthropometric differences among
groups over time. Result(s): There were no differences in mean WAZ
(-1.6-0.9, n = 24), LAZ (-1.3-0.8), or HC-for-age (HCZ) (-0.9-1.0) at
enrollment. One Target Fortification infant withdrew at discharge. Changes
in mean WAZ (-0.3-0.9, n = 23), LAZ (0.1-0.6) and HCZ (0.2-0.6) did not
differ among groups over time. There was no difference in chest tube
drainage among groups. Conclusion(s): Use of lacto-engineered MFBM
and proactive feeding protocols facilitate resolution of chylothorax and
support growth in cardiac infants.

<53>
Accession Number
624907942
Title
Value of Myocardial Perfusion Assessment With Coronary Computed Tomography
Angiography in Patients With Recent Acute-Onset Chest Pain.
Source
JACC. Cardiovascular imaging. 11 (11) (pp 1611-1621), 2018. Date of
Publication: 01 Nov 2018.
Author
Sorgaard M.H.; Linde J.J.; Kuhl J.T.; Kelbaek H.; Hove J.D.; Fornitz G.G.;
Jorgensen T.B.S.; Heitmann M.; Kragelund C.; Hansen T.F.; Abdulla J.;
Engstrom T.; Jensen J.S.; Wiegandt Y.T.; Hofsten D.E.; Kober L.V.; Kofoed
K.F.
Institution
(Sorgaard, Linde, Engstrom, Wiegandt, Hofsten, Kober) Department of
Cardiology, Heart Centre, Rigshospitalet, University of Copenhagen,
Copenhagen, Denmark
(Kuhl, Heitmann) Department of Cardiology, Bispebjerg Hospital, University
of Copenhagen, Copenhagen, Denmark
(Kelbaek) Department of Cardiology, Zealand University Hospital, Roskilde,
Denmark
(Hove) Department of Cardiology, Hvidovre Hospital, University of
Copenhagen, Copenhagen, Denmark
(Fornitz, Jorgensen) Department of Cardiology, Amager Hospital, University
of Copenhagen, Copenhagen, Denmark
(Kragelund) Department of Cardiology, Herlev Hospital, University of
Copenhagen, Copenhagen, Denmark
(Hansen, Jensen) Department of Cardiology, Gentofte Hospital, University
of Copenhagen, Copenhagen, Denmark
(Abdulla) Department of Medicine, Division of Cardiology, Glostrup
Hospital, University of Copenhagen, Copenhagen, Denmark
(Kofoed) Department of Cardiology, The Heart Centre, Rigshospitalet,
University of Copenhagen, Copenhagen, Denmark; Department of Radiology,
The Diagnostic Centre, Rigshospitalet, University of Copenhagen,
Copenhagen, Denmark
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The authors sought to perform a randomized controlled trial to
evaluate the clinical efficacy of combined examination with coronary
computed tomography angiography (CTA) and computed tomography perfusion
imaging (CTP) compared to coronary CTA alone. BACKGROUND: Stress
myocardial CTP may increase diagnostic specificity when added to coronary
CTA in patients suspected of having ischemic heart disease.
 METHOD(S): Patients recently hospitalized for acute-onset chest pain,
who had acute coronary syndrome had been ruled out by normal
electrocardiograms, normal troponin levels, and relief of symptoms, and
who had a clinical indication for outpatient noninvasive testing, were
screened for inclusion in the CATCH-2 (CArdiac cT in the treatment of
acute CHest pain 2) trial (NCT02014311). Patients were randomized 1:1 to
examination with coronary CTA or coronary CTA+CTP. The primary endpoint
was the frequency of coronary revascularization among patients referred
for invasive coronary angiography (ICA) based on index computed tomography
evaluation. Secondary endpoints were invasive procedural complications at
index-related ICA, post-index cardiac death, hospital admittance because
of recurrence of chest pain, unstable angina pectoris, or acute myocardial
infarction, ICA, and revascularization. RESULT(S): Among 300 patients
allocated to the coronary CTA+CTP group, 41 (14%) were referred for ICA
compared with 89 (30%) allocated to coronary CTA (p < 0.0001). The primary
endpoint occurred in 50% of coronary CTA+CTP patients versus 48% of
invasively examined patients (p = 0.85). The total number of
revascularizations was significantly lower in the coronary CTA+CTP group
compared to the coronary CTA group (n = 20 [7%] vs. n = 42 [14%]; p =
0.0045). At median follow-up of 1.5 years, the occurrence of secondary
endpoints was similar in the 2 groups. CONCLUSION(S): A
post-discharge diagnostic strategy of coronary CTA+CTP safely reduces the
need for invasive examination and treatment in patients suspected of
having ischemic heart disease. (CArdiac cT in the treatment of acute CHest
pain 2-Myocardial CT Perfusion [CATCH2]; NCT02014311). Copyright
© 2018 American College of Cardiology Foundation. Published by
Elsevier Inc. All rights reserved.

<54>
[Use Link to view the full text]
Accession Number
624903615
Title
Choosing between ticagrelor and clopidogrel following percutaneous
coronary intervention: A systematic review and Meta-Analysis (2007-2017).
Source
Medicine. 97 (43) (pp e12978), 2018. Date of Publication: 01 Oct 2018.
Author
Guan W.; Lu H.; Yang K.
Institution
(Guan) Department of Cardiology, Jingzhou Central Hospital, Second
Clinical Medical College, Yangtze University, Jingzhou, Hubei, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Limitations have been observed with the use of clopidogrel
following percutaneous coronary intervention (PCI) indicating the urgent
need of a more potent anti-platelet agent. We aimed to compare the
efficacy and safety of ticagrelor versus clopidogrel following PCI.
 METHOD(S): Online databases were searched for relevant studies
(published between the years 2007 and 2017) comparing ticagrelor versus
clopidogrel following coronary stenting. Primary outcomes assessed
efficacy whereas secondary outcomes assessed safety. Odds ratios (OR) with
95% confidence intervals (CIs) based on a random effect model were
calculated and the analysis was carried out by the RevMan 5.3 software.
 RESULT(S): A total number of 25,632 patients with acute coronary
syndrome (ACS) [12,992 patients with ST segment elevation myocardial
infarction (STEMI) and 14,215 patients with non-ST segment elevation
myocardial infarction (NSTEMI)] were included in this analysis, of whom
23,714 patients were revascularized by PCI. Results of this analysis did
not show any significant difference in all-cause mortality, major adverse
cardiac events (MACEs), myocardial infarction, stroke and stent thrombosis
observed between ticagrelor and clopidogrel with (OR: 0.83, 95% CI:
0.67-1.03; P = .09), (OR: 0.64, 95% CI: 0.41-1.01; P = .06), (OR: 0.77,
95% CI: 0.57-1.03; P = .08), (OR: 0.85, 95% CI: 0.57-1.26; P = .42) and
(OR: 0.70, 95% CI: 0.47-1.05; P =.09).However, ticagrelor was associated
with a significantly higher minor and major bleeding with (OR: 1.57, 95%
CI: 1.30-1.89; P = .00001) and (OR: 1.52, 95% CI: 1.01-2.29; P = 0.04)
respectively. Dyspnea was also significantly higher in the ticagrelor
group (OR: 2.64, 95% CI: 1.87-3.72; P = .00001). CONCLUSION(S):
Ticagrelor and clopidogrel were comparable in terms of efficacy in these
patients with ACS. However, the safety outcomes of ticagrelor should
further be investigated.

<55>
Accession Number
624903506
Title
Investigation of Motivational Interviewing and Prevention Consults to
Achieve Cardiovascular Targets (IMPACT) trial.
Source
American heart journal. 199 (pp 37-43), 2018. Date of Publication: 01 May
2018.
Author
Gianos E.; Schoenthaler A.; Guo Y.; Zhong J.; Weintraub H.; Schwartzbard
A.; Underberg J.; Schloss M.; Newman J.D.; Heffron S.; Fisher E.A.; Berger
J.S.
Institution
(Gianos, Weintraub, Schwartzbard, Underberg, Schloss, Newman) Department
of Medicine, Division of Cardiology, Center for the Prevention of
Cardiovascular Disease, New York University School of Medicine, New York,
NY
(Schoenthaler, Guo, Zhong) Department of Population Health, Center for
Healthful Behavioral Change, New York University School of Medicine, New
York, NY
(Heffron, Fisher, Berger) Department of Medicine, Division of Cardiology,
Center for the Prevention of Cardiovascular Disease, New York University
School of Medicine, New York, NY; Marc and Ruti Bell Program in Vascular
Biology, New York University School of Medicine, New York, NY
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients undergoing cardiovascular (CV) procedures often have
suboptimal CV risk factor control and may benefit from strategies
targeting healthy lifestyle behaviors and education. Implementation of
prevention strategies may be particularly effective at this point of
heightened motivation. METHOD(S): A prospective, randomized, pilot
study was conducted in 400 patients undergoing a nonurgent CV procedure
(cardiac catheterization +/- revascularization) to evaluate the impact of
different prevention strategies. Patients were randomized in a 1:1:1
fashion to usual care (UC; group A, n = 134), in-hospital CV prevention
consult (PC; group B, n = 130), or PC plus behavioral intervention program
(telephone-based motivational interviewing and optional tailored text
messages) (group C, n = 133). The primary end point was the DELTA change
in non-high-density lipoprotein cholesterol (non-HDL-C) from baseline to 6
month. RESULT(S): The mean age was 64.6 +/- 10.8 years, 23.7% were
female, and 31.5% were nonwhite. After 6 months, the absolute difference
in non-HDL-C for all participants was -19.8 mg/dL (95% CI -24.1 to -15.6,
P < .001). There were no between-group differences in the primary end
point for the combined PC groups (B and C) versus UC, with a DELTA
adjusted between group difference of -5.5 mg/dL (95% CI -13.1 to 2.1, P =
.16). Patients in the PC groups were more likely to be on high-intensity
statins at 6 months (52.9% vs 38.1%, P = .01). After excluding
participants with baseline non-HDL-C <100 mg/dL (initial exclusion
criterion), DELTA non-HDL-C and DELTA low-density lipoprotein cholesterol
were improved in the PC groups compared to UC (non-HDL-C -8.13 mg/dL
[-16.00 to -0.27], P = .04; low-density lipoprotein cholesterol -7.87mg/dL
[-15.10 to -0.64], P = .03). CONCLUSION(S): Although non-HDL-C
reduction at 6 months following a nonurgent CV procedure was not
significant in the overall cohort, an increased uptake in high-potency
statins may translate into improved long-term health outcomes and cost
reductions. Copyright © 2018. Published by Elsevier Inc.

<56>
Accession Number
624903839
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: 01 Dec
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
NLM (Medline)
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. Copyright © 2018 The Authors.
Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of
Anaesthetists.

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Accession Number
624926217
Title
Pilsicainide Poisoning: An Autopsy Case and Review of Literature.
Source
The American journal of forensic medicine and pathology. 39 (4) (pp
357-359), 2018. Date of Publication: 01 Dec 2018.
Author
Fukasawa M.; Ninomiya K.; Kawakami Y.; Fuke C.; Miyazaki T.
Institution
(Fukasawa) From the Department of Legal Medicine, University of the
Ryukyus Graduate School of Medicine, Okinawa, Japan
Publisher
NLM (Medline)
Abstract
We describe an autopsy case of fatal poisoning due to accidental overdose
of pilsicainide, which is a Vaughan Williams class IC antiarrhythmic drug
(a pure sodium channel blocker). A man in his 50s was found dead in his
home at approximately noon. He had ischemic heart disease and insomnia,
and had previously demonstrated improper prescription drug adherence. The
autopsy revealed old coronary artery bypass grafting and mild fibrosis of
myocardium, but no acute myocardial infarction was found in microscopic
examination. Toxicological analysis also identified a high blood
concentration of pilsicainide (femoral vein blood, 14.9 mug/mL), more than
15 times higher than reported therapeutic levels. The blood concentrations
of other drugs were at therapeutic levels, and no alcohol was detected. We
concluded that the cause of death was pilsicainide poisoning, based on the
results of the autopsy and the toxicological examination. This is the
first autopsy report of fatal poisoning due to pilsicainide as a single
agent.

<58>
[Use Link to view the full text]
Accession Number
624926079
Title
The effect of dexmedetomidine on the perioperative hemodynamics and
postoperative cognitive function of elderly patients with hypertension:
Study protocol for a randomized controlled trial.
Source
Medicine. 97 (43) (pp e12851), 2018. Date of Publication: 01 Oct 2018.
Author
Du X.; Yu J.; Mi W.
Institution
(Du, Mi) Department of Anesthesiology, Chinese PLA Medical School/Chinese
PLA General Hospital, Beijing, China
(Yu) Department of Anesthesiology, Affiliated Hospital of Inner Mongolia
Medical University, Hohhot, China
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Cognitive dysfunction after surgery, a common clinical
manifestation of postoperative psychonosema. It usually occurs after heart
surgery, hip replacement, mandibular fractures, and other major
operations. Dexmedetomidine can exert sedative, analgesic, anxiolytic
effect, inhibits the sympathetic activity, maintains hemodynamic balance,
helps reduce the amount of anesthetic agents, and relatively slightly
depresses respiration. Preoperative administration of dexmedetomidine for
sedation has been reported to reduce the incidence of acute postoperative
delirium. But currently there is no study on the effect of dexmedetomidine
on the postoperative cognitive function of elderly patients with essential
hypertension. METHODS/DESIGN: This study is a prospective, single-center,
double-blind controlled clinical trial. Elderly patients aged between 60
and 80 years old, diagnosed with primary hypertension for 1 year or longer
will be included, and randomized into 2 groups. Patients in observational
group will be given a loading dose of dexmedetomidine at 0.8 mug/kg,
pumped for over 10 minutes. Although patients in control group will be
pumped of the same volume of normal saline within 10 minutes, before the
induction of anesthesia. Minimental state examination and levels of
interleukin-6, tumor necrosis factor alpha, and C-reactive protein will be
set as primary endpoints. Baseline characteristics of patients will be
summarized by groups and compared using Chi-square or Fisher exact tests
for categorical variables and 2-sample t tests or Wilcoxon rank sum test
for the continuous variables. Repeated measurement analysis of covariance
model will also be used for the comparison of endpoints between 2 groups.
 CONCLUSION(S): The present study is designed to investigate the
effect of the application of dexmedetomidine on postoperative myocardial
injury and postoperative cognitive dysfunction, also to explore the
association between inflammatory factors and postoperative cognitive
function. With this study, we are expecting to find out an appropriate
anesthesia method for elderly people with hypertension to alleviate the
postoperative adverse effects caused by medical treatments. TRIALS
REGISTRATION: This study was registered on Chinese Clinical Trial Registry
(http://www.chictr.org.cn/) with the ID ChiCTR-IPR-16009156.

<59>
[Use Link to view the full text]
Accession Number
624909547
Title
Pharmacologic prevention of postoperative delirium after on-pump cardiac
surgery: A meta-analysis of randomized trials.
Source
Medicine. 97 (43) (pp e12771), 2018. Date of Publication: 01 Oct 2018.
Author
Tao R.; Wang X.-W.; Pang L.-J.; Cheng J.; Wang Y.-M.; Gao G.-Q.; Liu Y.;
Wang C.
Institution
(Tao, Pang, Cheng, Wang, Gao, Liu, Wang) Department of Substance-Related
Disorders, Division of Psychiatry, Hefei No.4 People's Hospital, Anhui
Mental Health Center, China
(Tao, Pang, Cheng, Wang, Wang) Mental Health Clinical College of Anhui
Medical University, Hefei, China
(Wang) Department of Cardiothoracic Surgery, First Affiliated Hospital of
Chongqing Medical University, Chongqing, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative delirium is a prevalent and disabling mental
disorder in patients undergoing on-pump cardiac surgery. There is some
evidence that the use of pharmacological interventions may reduce the risk
of developing of postoperative delirium. Therefore, the aim of this
meta-analysis was to determine the effect of pharmacologic agents for the
prevention postoperative delirium after cardiac surgery. METHOD(S):
Randomized controlled trials (RCTs) were identified through a systematic
literature search of electronic databases and article references up to
October 2016. End points included incidence of postoperative delirium,
severity of postoperative delirium, cognitive disturbances of
postoperative delirium, duration of postoperative delirium, length of stay
in intensive care unit (ICU) and hospital, and short-term mortality.
 RESULT(S): A total of 14 RCTs with an aggregate of 14,139 patients
were included. The results of the present meta-analysis show that
pharmacologic agents significantly decrease postoperative delirium
[relative risk (RR), 0.83; 95% confidence interval (95% CI), 0.75-0.91, P
< .00001] and duration of postoperative delirium (RR = -0.37, 95% CI =
-0.47 to -0.27, P < .00001) after on-pump cardiac surgery. In addition,
subgroup analysis shows that dexamethasone and dexamethasone were
associated with a trend toward a reduction in postoperative delirium (RR,
0.45; 95% CI, 0.30-0.66, P < .0001; RR, 0.80; 95% CI, 0.68-0.93, P = .003,
respectively). However, our results fail to support the assumption that
pharmacologic prophylaxis is associated with a positively reduction in
short-term mortality, length of ICU, or hospital stay. CONCLUSION(S):
This meta-analysis suggests that the perioperative use of pharmacologic
agents can prevent postoperative delirium development in patients
undergoing cardiac surgery. However, there remain important gaps in the
evidence base on a few small studies with multiple limitations. Further
large-scale, high-quality RCTs are needed in this area.

<60>
Accession Number
624958951
Title
A perioperative surgeon-controlled open-lung approach versus conventional
protective ventilation with low positive end-expiratory pressure in
cardiac surgery with cardiopulmonary bypass (PROVECS): study protocol for
a randomized controlled trial.
Source
Trials. 19 (1) (pp 624), 2018. Date of Publication: 13 Nov 2018.
Author
Lagier D.; Fischer F.; Fornier W.; Fellahi J.-L.; Colson P.; Cholley B.;
Jaber S.; Baumstarck K.; Guidon C.
Institution
(Lagier, Guidon) Department of Cardiovascular Anesthesiology and Critical
Care Medicine, La Timone University Hospital, AP-HM and Aix-Marseille
University, 264 rue saint Pierrecedex 5, Marseille 13005, France
(Fischer) Department of Cardiovascular and Thoracic Anesthesiology, Nouvel
Hopital Civil, Strasbourg, France
(Fornier, Fellahi) Department of Anesthesiology and Critical Care
Medicine, Louis Pradel University Hospital and University Claude Bernard,
28 Avenue du Doyen Lepine, Bron 69677, France
(Colson) Department of Anesthesiology and Critical Care Medicine, Arnaud
de Villeneuve University Hospital, 371 Avenue du Doyen Gaston Giraud,
Montpellier 34295, France
(Cholley) Department of Anesthesiology and Critical Care Medicine, Hopital
Europeen Georges Pompidou, AP-HP and University Paris Descartes-Sorbonne
Paris Cite, 20 Rue Leblanc, Paris 75015, France
(Jaber) Department of Anesthesiology and Critical Care Medicine, Saint
Eloi University Hospital, 80 Avenue Augustin Fliche, Montpellier 34295,
France
(Baumstarck) Unite de Recherche EA3279, Aix-Marseille University, 27 bd
Jean Moulincedex 5, Marseille 13385, France
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative pulmonary complications (PPCs) are frequent
after on-pump cardiac surgery. Cardiac surgery results in a complex
pulmonary insult leading to high susceptibility to perioperative pulmonary
atelectasis. For technical reasons, ventilator settings interact with the
surgical procedure and traditionally, low levels of positive
end-expiratory pressure (PEEP) have been used. The objective is to compare
a perioperative, multimodal and surgeon-controlled open-lung approach with
conventional protective ventilation with low PEEP to prevent PPCs in
patients undergoing cardiac surgery. METHODS/DESIGN: The perioperative
open-lung protective ventilation in cardiac surgery (PROVECS) trial is a
multicenter, two-arm, randomized controlled trial. In total, 494 patients
scheduled for elective cardiac surgery with cardiopulmonary bypass (CPB)
and aortic cross-clamp will be randomized into one of the two treatment
arms. In the experimental group, systematic recruitment maneuvers and
perioperative high PEEP (8 cmH2O) are associated with ultra-protective
ventilation during CPB. In this group, the settings of the ventilator are
controlled by surgeons in relation to standardized protocol deviations. In
the control group, no recruitment maneuvers, low levels of PEEP (2 cmH2O)
and continuous positive airway pressure during CPB (2 cmH2O) are used. Low
tidal volumes (6-8 mL/kg of predicted body weight) are used before and
after CPB in each group. The primary endpoint is a composite of the single
PPCs evaluated during the first 7 postoperative days. DISCUSSION: The
PROVECS trial will be the first multicenter randomized controlled trial to
evaluate the impact of a perioperative and multimodal open-lung
ventilatory strategy on the occurrence of PPCs after on-pump cardiac
surgery. The trial design includes standardized surgeon-controlled
protocol deviations that guarantee a pragmatic approach. The results will
help anesthesiologists and surgeons aiming to optimize ventilatory
settings during cardiac surgery. TRIAL REGISTRATION: Clinical Trials.gov,
NCT 02866578 . Registered on 15 August 2016. Last updated 11 July 2017.

<61>
Accession Number
624920437
Title
Dabigatran in patients with myocardial injury after non-cardiac surgery
(MANAGE): an international, randomised, placebo-controlled trial.
Source
Lancet (London, England). 391 (10137) (pp 2325-2334), 2018. Date of
Publication: 09 Jun 2018.
Author
Devereaux P.J.; Duceppe E.; Guyatt G.; Tandon V.; Rodseth R.; Biccard
B.M.; Xavier D.; Szczeklik W.; Meyhoff C.S.; Vincent J.; Franzosi M.G.;
Srinathan S.K.; Erb J.; Magloire P.; Neary J.; Rao M.; Rahate P.V.;
Chaudhry N.K.; Mayosi B.; de Nadal M.; Iglesias P.P.; Berwanger O.; Villar
J.C.; Botto F.; Eikelboom J.W.; Sessler D.I.; Kearon C.; Pettit S.; Sharma
M.; Connolly S.J.; Bangdiwala S.I.; Rao-Melacini P.; Hoeft A.; Yusuf S.
Institution
(Devereaux) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada; Department of Medicine,
McMaster University, Hamilton, ON, Canada; Population Health Research
Institute, Hamilton, ON, Canada. Electronic address: philipj@mcmaster.ca
(Duceppe) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada; Department of Medicine,
University of Montreal, Montreal, QC, Canada
(Guyatt, Kearon) Department of Health Research Methods, Evidence, and
Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine,
McMaster University, Hamilton, ON, Canada
(Tandon, Magloire, Neary, Eikelboom) Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Rodseth) Department of Anaesthesia, University of KwaZulu-Natal,
Pietermaritzburg, South Africa
(Biccard) Department of Anaesthesia and Perioperative Medicine, Groote
Schuur Hospital and University of Cape Town, Cape Town, South Africa
(Xavier, Rao) Department of Pharmacology, St John's Medical College and
Research Institute, Bangalore, India
(Szczeklik) Department of Intensive Care and Perioperative Medicine,
Jagiellonian University Medical College, Krakow, Poland
(Meyhoff) Department of Anaesthesia and Intensive Care, Bispebjerg and
Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
(Vincent, Pettit, Rao-Melacini) Population Health Research Institute,
Hamilton, ON, Canada
(Franzosi) Department of Cardiovascular Research, IRCCS Istituto di
Ricerche Farmacologiche Mario Negri, Milan, Italy
(Srinathan) Department of Surgery, University of Manitoba, Winnipeg, MB,
Canada
(Erb) Department of Anesthesiology and Perioperative Medicine, Queen's
University, Kingston, ON, Canada
(Rahate) Department of Surgery, Rahate Surgical Hospital, Nagpur, India
(Chaudhry) Department of Surgery, Christian Medical College Hospital,
Ludhiana, India
(Mayosi) Department of Medicine, Groote Schuur Hospital and University of
Cape Town, Cape Town, South Africa
(de Nadal) Department of Anesthesiology, Hospital Universitari Vall
d'Hebron, Barcelona, Spain
(Iglesias) Department of Anesthesiology, Hospital de la Santa Creu i Sant
Pau, Barcelona, Spain
(Berwanger) Instituto de Ensino e Pesquisa do Hospital do Coracao
(IEP-HCor), Sao Paulo, Brazil
(Villar) Departamento de Investigaciones, Fundacion
Cardioinfantil-Instituto de Cardiologia (Bogota) and Facultad de Ciencias
de la Salud, Universidad Autonoma de Bucaramanga, Colombia
(Botto) Estudios Clinicos Latinoamerica (ECLA), Rosario and Hospital
Austral, Pilar, Argentina
(Sessler) Department of Outcomes Research, Cleveland Clinic,
Anesthesiology Institute, Cleveland, OH, United States
(Sharma, Connolly) Department of Medicine, McMaster University, Hamilton,
ON, Canada; Population Health Research Institute, Hamilton, ON, Canada
(Bangdiwala) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada; Population Health Research
Institute, Hamilton, ON, Canada
(Hoeft) Department of Anesthesiology and Intensive Care Medicine,
University Hospital Bonn, Bonn, Germany
(Yusuf) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada; Department of Medicine,
McMaster University, Hamilton, ON, Canada; Population Health Research
Institute, Hamilton, ON, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Myocardial injury after non-cardiac surgery (MINS) increases
the risk of cardiovascular events and deaths, which anticoagulation
therapy could prevent. Dabigatran prevents perioperative venous
thromboembolism, but whether this drug can prevent a broader range of
vascular complications in patients with MINS is unknown. The MANAGE trial
assessed the potential of dabigatran to prevent major vascular
complications among such patients. METHOD(S): In this international,
randomised, placebo-controlled trial, we recruited patients from 84
hospitals in 19 countries. Eligible patients were aged at least 45 years,
had undergone non-cardiac surgery, and were within 35 days of MINS.
Patients were randomly assigned (1:1) to receive dabigatran 110 mg orally
twice daily or matched placebo for a maximum of 2 years or until
termination of the trial and, using a partial 2-by-2 factorial design,
patients not taking a proton-pump inhibitor were also randomly assigned
(1:1) to omeprazole 20 mg once daily, for which results will be reported
elsewhere, or matched placebo to measure its effect on major upper
gastrointestinal complications. Research personnel randomised patients
through a central 24 h computerised randomisation system using block
randomisation, stratified by centre. Patients, health-care providers, data
collectors, and outcome adjudicators were masked to treatment allocation.
The primary efficacy outcome was the occurrence of a major vascular
complication, a composite of vascular mortality and non-fatal myocardial
infarction, non-haemorrhagic stroke, peripheral arterial thrombosis,
amputation, and symptomatic venous thromboembolism. The primary safety
outcome was a composite of life-threatening, major, and critical organ
bleeding. Analyses were done according to the intention-to-treat
principle. This trial is registered with ClinicalTrials.gov, number
NCT01661101. FINDINGS: Between Jan 10, 2013, and July 17, 2017, we
randomly assigned 1754 patients to receive dabigatran (n=877) or placebo
(n=877); 556 patients were also randomised in the omeprazole partial
factorial component. Study drug was permanently discontinued in 401 (46%)
of 877 patients allocated to dabigatran and 380 (43%) of 877 patients
allocated to placebo. The composite primary efficacy outcome occurred in
fewer patients randomised to dabigatran than placebo (97 [11%] of 877
patients assigned to dabigatran vs 133 [15%] of 877 patients assigned to
placebo; hazard ratio [HR] 0.72, 95% CI 0.55-0.93; p=0.0115). The primary
safety composite outcome occurred in 29 patients (3%) randomised to
dabigatran and 31 patients (4%) randomised to placebo (HR 0.92, 95% CI
0.55-1.53; p=0.76). INTERPRETATION: Among patients who had MINS,
dabigatran 110 mg twice daily lowered the risk of major vascular
complications, with no significant increase in major bleeding. Patients
with MINS have a poor prognosis; dabigatran 110 mg twice daily has the
potential to help many of the 8 million adults globally who have MINS to
reduce their risk of a major vascular complication [corrected]. FUNDING:
Boehringer Ingelheim and Canadian Institutes of Health
Research. Copyright © 2018 Elsevier Ltd. All rights reserved.

<62>
Accession Number
624914090
Title
Transcatheter Versus Surgical Aortic Valve Replacement in Patients With
Prior Cardiac Surgery in the Randomized PARTNER 2A Trial.
Source
JACC. Cardiovascular interventions. 11 (21) (pp 2207-2216), 2018. Date of
Publication: 12 Nov 2018.
Author
Chen S.; Redfors B.; Ben-Yehuda O.; Crowley A.; Greason K.L.; Alu M.C.;
Finn M.T.; Vahl T.P.; Nazif T.; Thourani V.H.; Suri R.M.; Svensson L.;
Webb J.G.; Kodali S.K.; Leon M.B.
Institution
(Chen, Ben-Yehuda, Crowley) Cardiovascular Research Foundation, NY, United
States
(Redfors) Cardiovascular Research Foundation, New York, New York;
Department of Cardiology, Sahlgrenska University Hospital, Gothenburg,
Sweden
(Greason) Department of Cardiovascular Surgery, Mayo Clinic, Rochester,
MN, United States
(Alu, Finn, Vahl, Nazif, Kodali) Columbia University Medical
Center/NewYork-Presbyterian Hospital, NY, United States
(Thourani) Medstar Heart & Vascular Institute, Washington, District of
Columbia
(Suri, Svensson) Cleveland Clinic, Cleveland, OH, United States
(Webb) St. Paul's Hospital, University of British Columbia, Vancouver, BC,
Canada
(Leon) Cardiovascular Research Foundation, New York, New York; Columbia
University Medical Center/NewYork-Presbyterian Hospital, New York, New
York
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The aim of this study was to further evaluate clinical
outcomes in patients with and without PCS. BACKGROUND: Prior cardiac
surgery (PCS) is associated with increased surgical risk and
post-operative complications following surgical aortic valve replacement
(SAVR), but whether this risk is similar in transcatheter aortic valve
replacement (TAVR) is unclear. METHOD(S): In the PARTNER 2A
(Placement of Aortic Transcatheter Valve) trial, 2,032 patients with
severe aortic stenosis at intermediate surgical risk were randomized to
TAVR with the SAPIEN XT valve or SAVR. Adverse clinical outcomes at 30
days and 2 years were compared using Kaplan-Meier event rates and
multivariate Cox proportional hazards regression models. The primary
endpoint of the PARTNER 2 trial was all-cause death and disabling stroke.
 RESULT(S): Five hundred nine patients (25.1%) had PCS, mostly (98.2%)
coronary artery bypass grafting. There were no significant differences
between TAVR and SAVR in patients with or without PCS in the rates of the
primary endpoint at 30 days or 2 years. Nevertheless, an interaction was
observed between PCS and treatment arm; whereas no-PCS patients treated
with TAVR had higher rates of 30-day major vascular complications than
patients treated with SAVR (adjusted hazard ratio: 2.66; 95% confidence
interval: 1.68 to 4.22), the opposite was true for patients with PCS
(adjusted hazard ratio: 0.27; 95% confidence interval: 0.11 to 0.66)
(pinteraction <0.0001). A similar interaction was observed for
life-threatening or disabling bleeding. CONCLUSION(S): In the PARTNER
2A trial of intermediate-risk patients with severe aortic stenosis
undergoing SAVR versus TAVR, the relative risk for 2-year adverse clinical
outcomes was similar between TAVR and SAVR in patients with or without
PCS. Copyright © 2018 American College of Cardiology Foundation.
Published by Elsevier Inc. All rights reserved.

<63>
[Use Link to view the full text]
Accession Number
624960156
Title
Prothrombin Complex Concentrates for Perioperative Vitamin K Antagonist
and Non-vitamin K Anticoagulant Reversal.
Source
Anesthesiology. 129 (6) (pp 1171-1184), 2018. Date of Publication: 01 Dec
2018.
Author
Levy J.H.; Douketis J.; Steiner T.; Goldstein J.N.; Milling T.J.
Institution
(Levy) From the Department of Anesthesiology, Cardiothoracic Intensive
Care Unit, Duke University School of Medicine, Durham, North Carolina
(J.H.L.) Department of Medicine, McMaster University, Hamilton, Ontario,
Canada (J.D.) Department of Neurology, Heidelberg University Hospital,
Heidelberg, Germany (T.S.) Department of Emergency Medicine, Massachusetts
General Hospital, Boston, Massachusetts (J.N.G.) the Departments of
Neurology and Surgery and Perioperative Care, Seton Dell Medical School
Stroke Institute, Austin, Texas (T.J.M.)
Publisher
NLM (Medline)
Abstract
Vitamin K antagonist therapy is associated with an increased bleeding
risk, and clinicians often reverse anticoagulation in patients who require
emergency surgical procedures. Current guidelines for rapid
anticoagulation reversal for emergency surgery recommend four-factor
prothrombin complex concentrate and vitamin K coadministration. The
authors reviewed the current evidence on prothrombin complex concentrate
treatment for vitamin K antagonist reversal in the perioperative setting,
focusing on comparative studies and in the context of intracranial
hemorrhage and cardiac surgery. The authors searched Cochrane Library and
PubMed between January 2008 and December 2017 and retrieved 423
English-language papers, which they then screened for relevance to the
perioperative setting; they identified 36 papers to include in this
review. Prothrombin complex concentrate therapy was consistently shown to
reduce international normalized ratio rapidly and control bleeding
effectively. In comparative studies with plasma, prothrombin complex
concentrate use was associated with a greater proportion of patients
achieving target international normalized ratios rapidly, with improved
hemostasis. No differences in thromboembolic event rates were seen between
prothrombin complex concentrate and plasma, with prothrombin complex
concentrate also demonstrating a lower risk of fluid overload events.
Overall, the studies the authors reviewed support current recommendations
favoring prothrombin complex concentrate therapy in patients requiring
vitamin K antagonist reversal before emergency surgery.

<64>
Accession Number
624929129
Title
Tests hemostatiques viscoelastiques au point de service des patients
subissant une chirurgie cardiaque : revue systematique de la litterature
et meta-analyse, Point-of-care viscoelastic hemostatic testing in cardiac
surgery patients: a systematic review and meta-analysis.
Source
Canadian journal of anaesthesia = Journal canadien d'anesthesie. 65 (12)
(pp 1333-1347), 2018. Date of Publication: 01 Dec 2018.
Author
Lodewyks C.; Heinrichs J.; Grocott H.P.; Karkouti K.; Romund G.; Arora
R.C.; Tangri N.; Rabbani R.; Abou-Setta A.; Zarychanski R.
Institution
(Lodewyks, Arora) Department of Surgery, Section of Cardiac Surgery, Max
Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
(Lodewyks, Tangri, Rabbani, Abou-Setta, Zarychanski) Department of
Community Health Sciences, Max Rady College of Medicine, University of
Manitoba, Winnipeg, MB, Canada
(Lodewyks) WinnipegMBR2H 2A6Canada
(Heinrichs, Grocott) Department of Anesthesia and Perioperative Medicine,
Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
(Karkouti) Department of Anesthesia, Institute of Health Policy,
Management, Evaluation, Peter Munk Cardiac Centre, University of Toronto,
Toronto, ON, Canada
(Romund) Neil John Maclean Library, University of Manitoba, Winnipeg, MB,
Canada
(Arora, Tangri, Zarychanski) Department of Internal Medicine, Max Rady
College of Medicine, University of Manitoba, Winnipeg, MB, Canada
(Rabbani, Abou-Setta, Zarychanski) George & Fay Yee Center for Healthcare
Innovation, University of Manitoba/Winnipeg Regional Health Authority,
Winnipeg, MB, Canada
Publisher
NLM (Medline)

<65>
Accession Number
624911361
Title
Clinical Efficacy and Safety of Evolocumab in High-Risk Patients Receiving
a Statin: Secondary Analysis of Patients With Low LDL Cholesterol Levels
and in Those Already Receiving a Maximal-Potency Statin in a Randomized
Clinical Trial.
Source
JAMA cardiology. 2 (12) (pp 1385-1391), 2017. Date of Publication: 01 Dec
2017.
Author
Giugliano R.P.; Keech A.; Murphy S.A.; Huber K.; Tokgozoglu S.L.; Lewis
B.S.; Ferreira J.; Pineda A.L.; Somaratne R.; Sever P.S.; Pedersen T.R.;
Sabatine M.S.
Institution
(Giugliano, Murphy, Sabatine) TIMI (Thrombolysis in Myocardial Infarction)
Study Office, Cardiovascular Division, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Keech) National Health and Medical Research Council Clinical Trials
Centre, Sydney Medical School, University of Sydney, Sydney, Australia
(Huber) Third Department of Medicine, Cardiology, Intensive Care Medicine,
Faculty of Medicine, Sigmund Freud University, Vienna, Austria
(Tokgozoglu) Department of Cardiology, Hacettepe University Faculty of
Medicine, Ankara, Turkey
(Lewis) Cardiovascular Clinical Research Institute, Lady Davis Carmel
Medical Center, Haifa, Israel
(Ferreira) Department of Cardiology, Hospital de Santa Cruz, Lisbon,
Portugal
(Pineda, Somaratne) Amgen, Inc, Thousand Oaks, CA, United States
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Pedersen) Ulleval and Medical Faculty, Oslo University Hospital,
University of Oslo, Oslo, Norway
(Sabatine) Deputy Editor France
Publisher
NLM (Medline)
Abstract
Importance: Current guidelines for atherosclerotic cardiovascular disease
focus on high-intensity statins and targeting or using a threshold
low-density lipoprotein cholesterol (LDL-C) level of less than 70 mg/dL
for the highest-risk patients. Whether further reduction of LDL-C beyond
these boundaries would be beneficial is unknown. Objective(s): To
compare outcomes of evolocumab vs placebo in patients with stable
atherosclerotic cardiovascular disease and a baseline LDL-C of less than
70 mg/dL and in those receiving background treatment with a
maximal-potency statin. Design, Setting, and Participant(s): This
secondary ad hoc analysis of the Further Cardiovascular Outcomes Research
With PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) trial
compared randomized treatments in 2 subgroups of patients with stable
atherosclerotic cardiovascular disease currently receiving statin.
Patients were classified by a baseline LDL-C of less than 70 or at least
70 mg/dL and by statin intensity (maximal: atorvastatin calcium, 80 mg/d,
or rosuvastatin, 40 mg/d; submaximal: all other dosages). Patients with
baseline LDL of less than 70 mg/dL either had a final screening LDL-C of
at least 70 mg/dL or a final screening non-high-density lipoprotein
cholesterol level of at least 100 mg/dL. Data were retrieved from 2013 to
2016 and analyzed in 2017 based on intention to treat. Main Outcomes
and Measures: The primary efficacy endpoint was the composite of
cardiovascular death, myocardial infarction, stroke, hospitalization for
unstable angina, or coronary revascularization. The secondary efficacy
endpoint was the composite of cardiovascular death, myocardial infarction,
or stroke. Safety outcomes included adverse events and events of interest
identified in the FOURIER trial. Interaction testing was used to assess
the consistency of results in patients who did vs did not satisfy the
above criteria. Result(s): A total of 27 564 patients (75.4% men and
24.6% women; mean [SD] age, 62.5 [9.0] years) were included in the
analysis. Of 2034 patients (7.4%) who had a baseline LDL-C of less than 70
mg/dL, evolocumab reduced the risk for the primary endpoint (hazard ratio
[HR], 0.80; 95% CI, 0.60-1.07) to a similar degree as in the 25529
patients who had baseline LDL-C of at least 70 mg/dL (HR 0.86; 95% CI,
0.79-0.92; P=.65 for interaction; 1 patient was missing baseline LDL-C
data). Of 7533 patients (27.3%) receiving maximal-potency statins,
evolocumab significantly reduced the primary endpoint (HR, 0.86; 95% CI,
0.75-0.98) to a similar degree as in the 20031 patients not receiving a
maximal-potency statin (HR, 0.85; 95% CI, 0.78-0.93; P=.88 for
interaction). The key secondary endpoint was reduced to a similar degree
in both analyses. No major safety concerns were identified.
 Conclusions and Relevance: Evolocumab was equally effective in
reducing cardiovascular events in patients with stable atherosclerotic
cardiovascular disease regardless of whether the baseline LDL-C was less
than 70 or at least 70 mg/dL and whether the background statin was of
maximal or submaximal potency.

<66>
Accession Number
624906811
Title
Risk prediction models for delirium in the intensive care unit after
cardiac surgery: a systematic review and independent external validation.
Source
British journal of anaesthesia. 118 (3) (pp 391-399), 2017. Date of
Publication: 01 Mar 2017.
Author
Lee A.; Mu J.L.; Joynt G.M.; Chiu C.H.; Lai V.K.W.; Gin T.; Underwood M.J.
Institution
(Lee, Mu, Joynt, Chiu, Lai, Gin) Department of Anaesthesia and Intensive
Care, Chinese University of Hong Kong, Hong Kong, China
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery,
Chinese University of Hong Kong, Hong Kong, China
Publisher
NLM (Medline)
Abstract
Numerous risk prediction models are available for predicting delirium
after cardiac surgery, but few have been directly compared with one
another or been validated in an independent data set. We conducted a
systematic review to identify validated risk prediction models of delirium
(using the Confusion Assessment Method-Intensive Care Unit tool) after
cardiac surgery and assessed the transportability of the risk prediction
models on a prospective cohort of 600 consecutive patients undergoing
cardiac surgery at a university hospital in Hong Kong from July 2013 to
July 2015. The discrimination (c-statistic), calibration (GiViTI
calibration belt), and clinical usefulness (decision curve analysis) of
the risk prediction models were examined in a stepwise manner. Three
published high-quality intensive care unit delirium risk prediction models
(n=5939) were identified: Katznelson, the original PRE-DELIRIC, and the
international recalibrated PRE-DELIRIC model. Delirium occurred in 83
patients (13.8%, 95% CI: 11.2-16.9%). After updating the intercept and
regression coefficients in the Katznelson model, there was fair
discrimination (0.62, 95% CI: 0.58-0.66) and good calibration. As the
original PRE-DELIRIC model was already validated externally and
recalibrated in six countries, we performed a logistic calibration on the
recalibrated model and found acceptable discrimination (0.75, 95% CI:
0.72-0.79) and good calibration. Decision curve analysis demonstrated that
the recalibrated PRE-DELIRIC risk model was marginally more clinically
useful than the Katznelson model. Current models predict delirium risk in
the intensive care unit after cardiac surgery with only fair to moderate
accuracy and are insufficient for routine clinical use. Copyright
© The Author 2017. Published by Oxford University Press on behalf of
the British Journal of Anaesthesia. All rights reserved. For Permissions,
please email: journals.permissions@oup.com.

<67>
Accession Number
624769495
Title
A prospective case series evaluating use of an in-line air detection and
purging system to reduce air burden during major surgery.
Source
Perioperative Medicine. 7 (1) (no pagination), 2018. Article Number: 23.
Date of Publication: 08 Nov 2018.
Author
Ibrahim Y.M.; Marques N.R.; Garcia C.R.; Salter M.; McQuitty C.; Kinsky
M.; Juan M.; Ludomirsky A.
Institution
(Ibrahim, Marques, Garcia, Salter, McQuitty, Kinsky) Department of
Anesthesiology, University of Texas Medical Branch, Galveston, TX, United
States
(Juan) Department of Anesthesiology, Kadlec Regional Medical Center,
Pasco, WA, United States
(Ludomirsky) Department of Pediatrics, NYU Langone Health, School of
Medicine, New York, NY, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Intravascular air embolism (AE) is a preventable but
potentially catastrophic complication caused by intravenous tubing,
trauma, and diagnostic and surgical procedures. The potentially fatal
risks of arterial AE are well-known, and emerging evidence demonstrates
impact of venous AEs on inflammatory response and coagulation factors. A
novel FDA-approved in-line air detection and purging system was used to
detect and remove air caused by administering a rapid fluid bolus during
surgery. Method(s): A prospective, randomized, case series was
conducted. Subjects were observed using standard monitors, including
transesophageal echocardiography (TEE) in the operating room. After
general anesthesia was induced, an introducer and pulmonary artery
catheter was inserted in the right internal jugular to administer fluids
and monitor cardiac pressures. Six patients undergoing cardiac surgery
were studied. Each patient received four randomized fluid boluses: two
with the in-line air purging device, two without. For each bolus, a bulb
infuser was squeezed three times (10-15 mL) over 5 s. The TEE was
positioned in the mid-esophageal right atrium (RA) to quantify peak air
clearance, and images were video recorded throughout each bolus. Air was
quantified using optical densitometry (OD) from images demonstrating
maximal air in the RA. Result(s): All subjects demonstrated
significantly lower air burden when the air reduction device was used (p =
0.004), and the average time to clear 90% of air was also lower, 3.7 +/-
1.2 s vs. 5.3 +/- 1.3 s (p < 0.001). Conclusion(s): An air purging
system reduced air burden from bolus administration and could consequently
reduce the risk of harmful or fatal AEs during surgery. Copyright
© 2018 The Author(s).

<68>
Accession Number
2001283404
Title
Minimally Invasive Approaches to Surgical Aortic Valve Replacement: A
Meta-Analysis.
Source
Annals of Thoracic Surgery. 106 (6) (pp 1881-1889), 2018. Date of
Publication: December 2018.
Author
Chang C.; Raza S.; Altarabsheh S.E.; Delozier S.; Sharma U.M.; Zia A.;
Khan M.S.; Neudecker M.; Markowitz A.H.; Sabik J.F.; Deo S.V.
Institution
(Chang) School of Medicine, Case Western Reserve University, Cleveland,
OH, United States
(Raza, Delozier, Markowitz, Sabik, Deo) Division of Cardiac Surgery,
Department of Surgery, University Hospitals Cleveland Medical Center,
Cleveland, OH, United States
(Altarabsheh) Department of Cardiac Surgery, Queen Alia Heart Institute,
Amman, Jordan, Jordan
(Sharma) Community Division of Hospital Medicine, Mayo Clinic Health
System, Rochester, MN, United States
(Zia) Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, United
States
(Khan) Division of Internal Medicine, Cook County Hospitals, Chicago, IL,
United States
(Neudecker) Medical Librarian, Core Library, University Hospitals
Cleveland Medical Center, Cleveland, OH, United States
Publisher
Elsevier USA
Abstract
Background: Limited data exist studying the outcomes of the 2 minimally
invasive aortic valve replacement (AVR) strategies-mini-sternotomy
(AVR-st) and right anterior thoracotomy (AVR-th). We conducted an indirect
meta-analysis to compare the outcomes of these minimally invasive
approaches with each other and with conventional AVR (cAVR).
 Method(s): We Searched Medline, PubMed, Embase, and Web of Science in
December 2017 for studies comparing AVR-st, AVR-th, and cAVR. Clinical
outcomes were compared between cohorts with inverse weighted random
effects modeling. Endpoints studied included hospital mortality, stroke,
atrial fibrillation, cardiopulmonary bypass (CPB) time, and length of
stay. Result(s): A total of 19 studies (>10,000 pooled patients) met
the inclusion criteria. Mortality (p = 0.06) and stroke (p = 0.15) were
comparable between minimally invasive and conventional AVR. CPB times were
longer with AVR-th versus cAVR (12.4 minutes [range, 5 to 19]; p < 0.01).
In the AVR-th cohort, CPB duration was weakly inversely related to study
size (p = 0.06). Atrial fibrillation was much less after AVR-th (odds
ratio 0.47 [0.35 to 0.63]; p < 0.001). Hospital stay was significantly
lower after minimally invasive surgery (0.8 [0.4 to 1.3] days; p < 0.01).
AVR-th patients were dismissed 2.1 (1.6 to 2.7) days earlier than cAVR
patients. Conclusion(s): Minimally invasive approaches to AVR yield
excellent outcomes in high-volume centers. They reduce hospital stay and
incidence of postoperative atrial fibrillation, and therefore should be
considered in patients undergoing AVR. The operative approach should be
selected according to surgeon's technical expertise and what is best for
specific patient profile, however. Copyright © 2018 The Society
of Thoracic Surgeons

<69>
Accession Number
624967933
Title
Feasibility of on-table extubation after cardiac surgery with
cardiopulmonary bypass: A randomized clinical trial.
Source
Anesthesiology and Pain Medicine. 8 (5) (no pagination), 2018. Article
Number: e80158. Date of Publication: October 2018.
Author
Totonchi Z.; Azarfarin R.; Jafari L.; Ghavidel A.A.; Baharestani B.;
Alizadehasl A.; Alasti F.M.; Ghaffarinejad M.H.
Institution
(Totonchi, Ghavidel, Baharestani, Ghaffarinejad) Rajaie Cardiovascular
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Azarfarin, Alizadehasl) Echocardiography Research Center, Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Jafari, Alasti) Anesthesiologist, Faculty of Medicine, Iran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Kowsar Medical Publishing Company (E-mail: editor@anesthpain.com)
Abstract
Background: The use of short-acting anesthetics, muscle relaxation, and
anesthesia depth monitoring allows maintaining sufficient anesthesia
depth, fast recovery, and extubation of the patients in the operating room
(OR). We evaluated the feasibility of extubation in the OR in cardiac
surgery. Method(s): This clinical trial was performed on 100 adult
patients who underwent elective noncomplex cardiac surgery using
cardiopulmonary bypass. Additional to the routine monitoring, the
patients' depth of anesthesia and neuromuscular blocked were assessed by
bispectral index and nerve stimulator, respectively. In the on-table
extubation (OTE) group (n = 50), a limited dose of sufentanil (0.15
micro g/kg/h) and inhalational anesthetics were used for early waking.
In the control group (n = 50), the same anesthesia-inducing drugs were
used but the dose of sufentanil during the operation was 0.7-0.8
micro g/kg/h. After the operation, cardiorespiratory parameters and
ICU stay were documented. Result(s): Demographic and clinical
variables were comparable in both study groups. In the OTE group, we
failed to extubate two patients in the OR (success rate of 96%). There
were no significant differences between the two groups in terms of
systolic and diastolic blood pressure at the time of entering the ICU (P >
0.05). Heart rate was lower in the OTE than in the control group at ICU
admission (89.4 +/- 13.1 vs. 97.6 +/- 12.0 bpm; P = 0.008). The ICU stay
time was lower in the OTE group (34 (21.5-44) vs. 48 (44-60) h; P =
0.001). Conclusion(s): Combined inhalational-intravenous anesthesia
along with using multiple anesthesia monitoring systems allows reducing
the dose of total anesthetics and maintaining adequate anesthesia depth
during noncomplex cardiac surgery with cardiopulmonary bypass. Thus,
extubation of the trachea in the OR is feasible in these
patients. Copyright © 2018, Author(s).

<70>
Accession Number
624967922
Title
Effect of acupressure on pain severity in patients undergoing coronary
artery graft: A randomized controlled trial.
Source
Anesthesiology and Pain Medicine. 8 (5) (no pagination), 2018. Article
Number: e82920. Date of Publication: October 2018.
Author
Narimani M.; Jaberi A.A.; Bonabi T.N.; Sadeghi T.
Institution
(Narimani) Department of Medical Surgical Nursing, Students Research
Committee, Faculty of Nursing and Midwifery, Rafsanjan University of
Medical Sciences, Rafsanjan, Iran, Islamic Republic of
(Jaberi) Department of Psychiatric and Mental Health Nursing, Social
Determinants of Health Research Center, Faculty of Nursing and Midwifery,
Rafsanjan University of Medical Sciences, Rafsanjan, Iran, Islamic
Republic of
(Bonabi) Department of Community Health Nursing, Social Determinants of
Health Research Center, Faculty of Nursing and Midwifery, Rafsanjan
University of Medical Sciences, Rafsanjan, Iran, Islamic Republic of
(Sadeghi) Department of Pediatric Nursing, Non-Communicable Disease
Research Center, Faculty of Nursing and Midwifery, Rafsanjan University of
Medical Sciences, Rafsanjan, Iran, Islamic Republic of
Publisher
Kowsar Medical Publishing Company (E-mail: editor@anesthpain.com)
Abstract
Background: Considering the contradictory results on the role of
complementary therapies in correcting post-operative side effects, the aim
of this study was to evaluate the effect of acupressure on pain severity
in patients undergoing coronary artery graft admitted to a coronary care
unit. Method(s): In this double-blind, randomized, clinical trial, 70
patients were selected randomly after coronary artery bypass grafting
(CABG) surgery based on inclusion criteria and then assigned to two groups
(35 in acupressure and 35 in control) randomly by the minimization method.
The intervention group received acupressure at the LI4 point for 20
minutes in 10-second pressure and 2-second resting periods. In the control
group, only touching was applied without any pressure in the same pattern
as the intervention group. Pain severity was measured before, immediately,
and 20 minutes after applying pressure and touch in both groups using the
visual analogue scale. Result(s): The results of repeated measures
analysis of variance (ANOVA) showed a decrease in the pain score in the
intervention group (group effect) during multiple measurements (time
effect) and a reduction in the mean pain score in the various measurements
taking into account the groups (the interaction between time and group; P
= 0.001). Conclusion(s): Acupressure can be used as a complementary
and alternative therapeutic approach to relieve post-operative pain in
CABG patients. Copyright © 2018, Author(s).

<71>
Accession Number
624967894
Title
Nesiritide modulates inflammatory response during cardiac surgery: A pilot
study.
Source
Research in Cardiovascular Medicine. 7 (3) (pp 137-143), 2018. Date of
Publication: July-September 2018.
Author
Beaver T.M.; Cobb J.A.; Koratala A.; Alquadan K.F.; Ejaz A.A.
Institution
(Beaver, Cobb) Division of Thoracic and Cardiovascular Surgery, University
of Florida, Gainesville, FL, United States
(Koratala, Alquadan, Ejaz) Division of Nephrology, Hypertension and Renal
Transplantation, University of Florida, Gainesville, FL, United States
Publisher
KOWSAR Medical Publishing Company (E-mail: editor@archneurosci.com)
Abstract
Objectives: We investigated the effects of nesiritide (NES) on
inflammatory response during cardiac surgery. Material(s) and
Method(s): Twenty-nine cardiac surgery patients were randomized to an
infusion of NES at 0.01 mcg/kg/min for 48 h versus placebo (Ctrl). A panel
of candidate biomarkers and clinical parameters were measured at
predetermined time points. Result(s): There were no significant
differences between the groups with regard to urine neutrophil
gelatinase-associated lipocalin (NES 230.3 + 71.5 ng/mL vs. Ctrl 554.4 +
263.3 ng/mL, P = 0.253) and urine interleukin (IL)-18 (NES 29.9 + 4.8
pg/mL vs. 254.5 + 118.3 pg/mL, P = 0.090), or to the incidence of acute
kidney injury (NES 7.1% vs. Ctrl 13.3%, P = 0.374). A concerted biomarker
kinetic pattern of time-differentiated peak concentrations was observed.
IL-10, inflammatory protein (IP)-10, IL-6, IL-10, IP-10, monocyte IP
(MIP)-1alpha, interferon (IFN)-alpha, IFN-alpha, IL-1a, IL-3, and IL-7
reached peak concentration at 0 h following the end of cardiopulmonary
bypass; tumor necrosis factor (TNF)-alpha, endothelial growth factor
(EGF), granulocyte macrophage-colony-stimulating factor (GM-CSF),
IL-12p40, IL-17, MIP-1alpha, and monocyte chemoattractant protein-1 at 1
h; IL-18, vascular EGF (VEGF), IL-13 and IL-1ra at 2 h, TNF-alpha, G-CSF,
IL-1b, IL-2, IL-4, IL-5, and IL-15 at 4 h; and endothelin (ET)-1 and IL-18
at 6 h. At 0 h, the NES group exhibited significant reduction of peak
concentrations of IL-6 (P = 0.009), IL-10 (P = 0.009), IL-1alpha (P =
0.020), IP-10 (P = 0.001), and IFN-alpha (P = 0.032) compared to the Ctrl
group. Significant reduction in peak concentrations of TNF-alpha (P =
0.007) and MIP1-alpha (P = 0.027) at 1 h and ET-1 (P = 0.020) at 6 h in
the NES group compared to the Ctrl group was noted. Conclusion(s):
NES modulated the concerted inflammatory response in cardiac surgery and
also attenuated ET-1 response, thus suggesting that previously observed
favorable renal effect may be linked to reduced renal
vasoconstriction. Copyright © 2018 Research in Cardiovascular
Medicine Published by Wolters Kluwer-Medknow.

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Accession Number
624837963
Title
Del Nido cardioplegia for myocardial protection in adult cardiac surgery:
A systematic review and meta-analysis.
Source
ASAIO Journal. 64 (3) (pp 360-367), 2018. Date of Publication: 2018.
Author
Li Y.; Lin H.; Zhao Y.; Li Z.; Liu D.; Wu X.; Ji B.; Gao B.
Institution
(Li, Lin, Zhao, Liu, Wu) Department of Cardiac Surgery, Lanzhou University
Second Hospital, Lanzhou University, Lanzhou, China
(Li) Department of Cardiopulmonary Bypass, State Key Laboratory of
Cardiovascular Medicine, Fuwai Hospital, National Center for
Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union
Medical College, Beijing, China
(Li) Department of Cardiopulmonary Bypass, Lanzhou University Second
Hospital, Lanzhou University, Lanzhou, China
(Ji) Department of Cardiopulmonary Bypass, State Key Laboratory of
Cardiovascular Medicine, Fuwai Hospital, National Center for
Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union
Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 10010,
China
(Gao) Department of Cardiac Surgery, Lanzhou University Second Hospital,
No. 80, Cuiyingmen, Chengguan District, Lanzhou 730030, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Cardioplegia is an important strategy for myocardial protection during
cardiac surgery. This meta-analysis was to compare the effects of del Nido
and conventional cardioplegia in adult patients. Systematic searches were
performed to identify studies using PubMed, Embase, the Cochrane Library,
and the International Clinical Trials Registry Platform. A total of nine
studies were included. Cardiopulmonary bypass and cross-clamp time were
significantly shorter in the del Nido than conventional cardioplegia (mean
difference [MD]: -7.52, 95% confidence interval [95% CI]: -14.76 to -0.29,
p = 0.04; MD: -5.74, 95% CI: -10.14 to -1.34, p = 0.01). During the
operation, cardioplegia volume and blood glucose level were lower in the
del Nido group (MD: -522.53, 95% CI: -926.68 to -118.37, p = 0.01;
standardized mean difference [SMD]: -1.11, 95% CI: -1.74 to -0.48, p =
0.0006). Ventilation time and length of intensive care unit were decreased
significantly with del Nido cardioplegia (MD: -1.05, 95% CI: -1.79 to
-0.31, p = 0.006; MD: -0.65, 95% CI: -0.92 to -0.38, p < 0.00001). There
were no differences in myocardial enzyme, postoperative inotropic support,
atrial fibrillation, hospital, and mortality between the two groups. In
adult cardiac surgery, myocardial protection used with the del Nido or
conventional cardioplegia solution yield similar short-term clinical
outcomes. ASAIO Journal 2018; 64:360-367. Copyright © 2017 by the
ASAIO

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Accession Number
624837847
Title
Peer support in critical care: A systematic review.
Source
Critical Care Medicine. 46 (9) (pp 1522-1531), 2018. Date of Publication:
2018.
Author
Haines K.J.; Beesley S.J.; Hopkins R.O.; McPeake J.; Quasim T.; Ritchie
K.; Iwashyna T.J.
Institution
(Haines) Department of Physiotherapy, Western Health, Sunshine Hospital,
St Albans, Melbourne, VIC, Australia
(Haines) Australian and New Zealand Intensive Care Research Centre, School
of Public Health and Preventive Medicine, Monash University, Melbourne,
VIC, Australia
(Beesley, Hopkins) Division of Pulmonary and Critical Care, Department of
Medicine, Intermountain Medical Center, Murray, UT, United States
(Beesley) Division of Pulmonary and Critical Care, Department of Medicine,
University of Utah, Salt Lake City, UT, United States
(Beesley, Hopkins) Center for Humanizing Critical Care, Intermountain
Health Care, Murray, UT, United States
(Hopkins) Department of Psychology, Neuroscience Center, Brigham Young
University, Provo, UT, United States
(McPeake, Quasim) Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde,
United Kingdom
(McPeake, Quasim) School of Medicine, Dentistry and Nursing, University of
Glasgow, United Kingdom
(Ritchie) Library Service, Western Health, Melbourne, VIC, Australia
(Iwashyna) Division of Pulmonary and Critical Care, Department of
Medicine, University of Michigan, Ann Arbor, MI, United States
(Iwashyna) Center for Clinical Management Research, VA Ann Arbor
Healthcare System, Ann Arbor, MI, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: Identifying solutions to improve recovery after critical
illness is a pressing problem. We systematically evaluated studies of peer
support as a potential intervention to improve recovery in critical care
populations and synthesized elements important to peer support model
design. Data Sources: A systematic search of Medical Literature
Analysis and Retrieval System Online, Cumulative Index to Nursing and
Allied Health Literature, PsychINFO, and Excertpa Medica Database was
undertaken May 2017. Prospective Register of Systematic Reviews
identification number: CRD42017070174. Study Selection: Two independent
reviewers assessed titles and abstracts against study eligibility
criteria. Studies were included where 1) patients and families had
experienced critical illness and 2) patients and families had participated
in a peer support intervention. Discrepancies were resolved by consensus
and a third independent reviewer adjudicated as necessary. Data
Extraction: Two independent reviewers assessed study quality with the
Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool, and data were
synthesized according to the Preferred Reporting Items for Systematic
Reviews guidelines and interventions summarized using the Template for
Intervention Description and Replication Checklist. Data Synthesis:
Two-thousand nine-hundred thirty-two studies were screened. Eight were
included, comprising 192 family members and 92 patients including adults
(with cardiac surgery, acute myocardial infarction, trauma), pediatrics,
and neonates. The most common peer support model of the eight studies was
an in-person, facilitated group for families that occurred during the
patients' ICU admission. Peer support reduced psychologic morbidity and
improved social support and self-efficacy in two studies; in both cases,
peer support was via an individual peer-to-peer model. In the remaining
studies, it was difficult to determine the outcomes of peer support as the
reporting and quality of studies was low. Conclusion(s): Peer support
appeared to reduce psychologic morbidity and increase social support. The
evidence for peer support in critically ill populations is limited. There
is a need for well-designed and rigorously reported research into this
complex intervention. Copyright © 2018 by the Society of Critical
Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Accession Number
624837633
Title
Fibrinogen concentrate in cardiovascular surgery: A meta-analysis of
randomized controlled trials.
Source
Anesthesia and Analgesia. 127 (3) (pp 612-621), 2018. Date of Publication:
2018.
Author
Li J.-Y.; Gong J.; Zhu F.; Moodie J.; Newitt A.; Uruthiramoorthy L.; Cheng
D.; Martin J.
Institution
(Li) Department of Anesthesiology, Xiangya Hospital, Central South
University, Changsha, Hunan, China
(Li, Gong, Zhu, Moodie, Newitt, Cheng, Martin) Centre for Medical
Evidence, Decision Integrity and Clinical Impact (MEDICI), Department of
Anesthesia and Perioperative Medicine, University of Western Ontario,
London, ON, Canada
(Gong) Department of Anesthesiology, Fuwai Hospital, Chinese Academy of
Medical Sciences, Peking Union Medical College, Beijing, China
(Uruthiramoorthy, Martin) Department of Epidemiology and Biostatistics,
University of Western Ontario, London, ON, Canada
(Cheng, Martin) Department of Anesthesia and Perioperative Medicine,
Schulich School of Medicine and Dentistry, Western University, University
Hospital, Room C3-412, 339 Windermere Rd., London, ON N6A 5A5, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Postoperative bleeding remains a frequent complication after
cardiovascular surgery and may contribute to serious morbidity and
mortality. Observational studies have suggested a relationship between low
endogenous plasma fibrinogen concentration and increased risk of
postoperative blood loss in cardiac surgery. Although the transfusion of
fibrinogen concentrate has been increasing, potential benefits and risks
associated with perioperative fibrinogen supplementation in cardiovascular
surgery are not fully understood. METHOD(S): PubMed, Cochrane
Library, Ovid MEDLINE, Embase, Web of Science, and China National
Knowledge Infrastructure were searched on January 15, 2017, with automated
updates searched until February 15, 2018, to identify all randomized
controlled trials (RCTs) of fibrinogen concentrate, whether for
prophylaxis or treatment of bleeding, in adults undergoing cardiovascular
surgery. All RCTs comparing fibrinogen infusion versus any other
comparator (placebo/standard of care or another active comparator) in
adult cardiovascular surgery and reporting at least 1 predefined clinical
outcome were included. The random-effects model was used to calculate risk
ratios and weighted mean differences (95% confidence interval [CI]) for
dichotomous and continuous variables, respectively. Subgroup analyses by
fibrinogen dose and by baseline risk for bleeding were preplanned.
 RESULT(S): A total of 8 RCTs of fibrinogen concentrate in adults (n =
597) of mixed risk or high risk undergoing cardiovascular surgery were
included. Compared to placebo or inactive control, perioperative
fibrinogen concentrate did not significantly impact risk of all-cause
mortality (risk ratio, 0.41; 95% CI, 0.12-1.38; I2 = 10%; P
=.15). Fibrinogen significantly reduced incidence of allogeneic red blood
cell transfusion (risk ratio, 0.64; 95% CI, 0.49-0.83; I2 = 0%;
P =.001). No significant differences were found for other clinical
outcomes. Subgroup analyses were unremarkable when analyzed according to
fibrinogen dose, time of infusion initiation, mean cardiopulmonary bypass
time, and rotational thromboelastometry/fibrinogen temogram use (all P
values for subgroup interaction were nonsignificant). CONCLUSION(S):
Current evidence remains insufficient to support or refute routine
perioperative administration of fibrinogen concentrate in patients
undergoing cardiovascular surgery. Fibrinogen concentrate may reduce the
need for additional allogeneic blood product transfusion in cardiovascular
surgery patients at high risk or with evidence of bleeding. However, no
definitive advantage was found for reduction in risk of mortality or other
clinically relevant outcomes. The small number of clinical events within
existing randomized trials suggests that further well-designed studies of
adequate power and duration to measure all-cause mortality, stroke,
myocardial infarction, reoperation, and thromboembolic events should be
conducted. Future studies should also address cost-effectiveness relative
to standard of care. Copyright © 2018 International Anesthesia
Research Society.

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Accession Number
624837589
Title
Inflammatory and cholesterol risk in the FOURIER trial.
Source
Circulation. 138 (2) (pp 131-140), 2018. Date of Publication: 2018.
Author
Bohula E.A.; Giugliano R.P.; Leiter L.A.; Verma S.; Park J.-G.; Sever
P.S.; Pineda A.L.; Honarpour N.; Wang H.; Murphy S.A.; Keech A.; Pedersen
T.R.; Sabatine M.S.
Institution
(Bohula, Giugliano, Park, Murphy, Sabatine) TIMI Study Group,
Cardiovascular Division, Department of Medicine, Brigham and Women's
Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115, United
States
(Leiter, Verma) Li Ka Shing Knowledge Institute, St. Michael's Hospital,
University of Toronto, ON, Canada
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, United Kingdom
(Pineda, Honarpour, Wang) Amgen, Thousand Oaks, CA, United States
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Centre, University of Sydney, Australia
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Norway
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: In the FOURIER trial (Further Cardiovascular Outcomes Research
With PCSK9 Inhibition in Patients With Elevated Risk), the PCSK9
(proprotein convertase subtilisin/kexin type 9) inhibitor evolocumab
reduced low-density lipoprotein cholesterol (LDL-C) and cardiovascular
risk. It is not known whether the efficacy of evolocumab is modified by
baseline inflammatory risk. We explored the efficacy of evolocumab
stratified by baseline high-sensitivity C-reactive protein (hsCRP). We
also assessed the importance of inflammatory and residual cholesterol risk
across the range of on-treatment LDL-C concentrations. METHOD(S):
Patients (n=27 564) with stable atherosclerotic cardiovascular disease and
LDL-C >=70 mg/dL on a statin were randomly assigned to evolocumab versus
placebo and followed for a median of 2.2 years (1.8-2.5). The effects of
evolocumab on the primary end point of cardiovascular death, myocardial
infarction, stroke, hospitalization for unstable angina or coronary
revascularization, and the key secondary end point of cardiovascular
death, myocardial infarction, or stroke were compared across strata of
baseline hsCRP (<1, 1-3, and >3 mg/dL). Outcomes were also assessed across
values for baseline hsCRP and 1-month LDL-C in the entire trial
population. Multivariable models adjusted for variables associated with
hsCRP and 1-month LDL-C were evaluated. RESULT(S): A total of 7981
(29%) patients had a baseline hsCRP<1 mg/L, 11 177 (41%) had a hsCRP 1 to
3 mg/L, and 8337 (30%) had a hsCRP >3 mg/L. Median (interquartile range)
baseline hsCRP was 1.8 (0.9-3.6) mg/L and levels were not altered by
evolocumab (change at 48 weeks of -0.2 mg/dL [-1.0 to 0.4] in both
treatment arms). In the placebo arm, patients in higher baseline hsCRP
categories experienced significantly higher 3-year Kaplan-Meier rates of
the primary and key secondary end points: 12.0%, 13.7%, and 18.1% for the
primary end point (P<inf>trend</inf><0.0001) and 7.4%, 9.1%, and 13.2% for
the key secondary end point (P<inf>trend</inf><0.0001) for categories of
<1, 1 to 3, and >3 mg/dL, respectively. The relative risk reductions for
the primary end point and key secondary end point with evolocumab were
consistent across hsCRP strata (P-interactions>0.15 for both). In
contrast, the absolute risk reductions with evolocumab tended to be
greater in patients with higher hsCRP: 1.6%, 1.8%, and 2.6% and 0.8%,
2.0%, and 3.0%, respectively, for the primary and key secondary end points
across hsCRP strata. In adjusted analyses of the association between LDL-C
and hsCRP levels and cardiovascular risk, both LDL-C and hsCRP were
independently associated with the primary outcome (P<0.0001 for each).
 CONCLUSION(S): LDL-C reduction with evolocumab reduces cardiovascular
events across hsCRP strata with greater absolute risk reductions in
patients with higherbaseline hsCRP. Event rates were lowest in patients
with the lowest hsCRP and LDL-C. Copyright © 2018 American Heart
Association, Inc.

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Accession Number
624836981
Title
Adding sufentanil to ropivacaine in continuous thoracic paravertebral
block fails to improve analgesia after video-assisted thoracic surgery: A
randomised controlled trial.
Source
European Journal of Anaesthesiology. 35 (10) (pp 766-773), 2018. Date of
Publication: 2018.
Author
Bauer C.; Pavlakovic I.; Mercier C.; Maury J.-M.; Koffel C.; Roy P.;
Fellahi J.-L.
Institution
(Bauer, Maury) Hospices Civils de Lyon, Hopital de la Croix Rousse,
Service d'Anesthesie-Reanimation, 103 Grande Rue de la Croix-Rousse, Lyon
69004, France
(Pavlakovic, Koffel, Fellahi) Hospices Civils de Lyon, Hopital
Cardiologique et Pneumologique Louis Pradel, Service
d'Anesthesie-Reanimation, Lyon, France
(Mercier, Roy) Hospices Civils de Lyon, Service de Biostatistique -
Bioinformatique, Lyon, France
(Koffel, Roy, Fellahi) Faculte de Medecine, Universite Claude Bernard Lyon
1, Lyon, France
(Koffel, Roy) CNRS UMR5558, Laboratoire de Biometrie et Biologie
Evolutive, Departement Biostatistiques et Modelisation pour la Sante et
l'Environnement, Equipe Biostatistique-Sante, Lyon, France
(Fellahi) Hospices Civils de Lyon, Hopital Cardiologique et Pneumologique
Louis Pradel, Service de Chirurgie Thoracique, Lyon, France
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND: The benefit of adding opioid to a local anaesthetic for
continuous thoracic paravertebral analgesia after video-assisted thoracic
surgery (VATS) is unclear. OBJECTIVE(S): To analyse the analgesic
efficacy of ropivacaine and sufentanil in combination compared with
ropivacaine alone after VATS. DESIGN: A randomised, double-blinded,
single-centre clinical trial. SETTING: A tertiary university hospital
between March 2010 and April 2014. PATIENTS: Ninety patients were
recruited, two were not included leaving 88 randomised into two groups.
Eighteen patients were excluded from analysis and 70 completed the study.
INTERVENTION: To receive thoracic paravertebral analgesia with either 2 mg
m-1 ropivacaine and 0.25 mug m-1 sufentanil
(ropivacaine R sufentanil group) or 2 mg m-1 ropivacaine alone
(ropivacaine group) for 48 h postoperatively. Infusion rate was set at
0.15 ml kg-1 h-1 in both groups. MAIN OUTCOME
MEASURES: The primary endpoint was the mean total amount of
self-administered morphine by the patients in each group at 48 h
postoperatively. RESULT(S): The mean +/- SD total amount of
self-administered morphine was not significantly different between groups
(53.1+/-27.2mg in the ropivacaine R sufentanil group vs. 58.8+/- 34.3 mg
in the ropivacaine group; P=0.72). No significant differences were found
between the two groups in either pain scores at rest or during movement,
in opioid-related adverse reactions, in patient satisfaction or length of
hospital stay. CONCLUSION(S): Adding 0.25 mugm-1
sufentanil to 2 mg m-1 ropivacaine in continuous thoracic
paravertebral analgesia for VATS did not reduce morphine consumption or
pain scores when compared with ropivacaine alone. We cannot recommend its
use for routine clinical practice. Further studies analysing different
concentrations and infusion rates of sufentanil are needed before a lack
of efficacy can be confirmed. Copyright © 2018 European Society
of Anaesthesiology. All rights reserved.

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Accession Number
624836881
Title
The impact of massage and reading on children's pain and anxiety after
cardiovascular surgery: A pilot study.
Source
Pediatric Critical Care Medicine. 19 (8) (pp 725-732), 2018. Date of
Publication: 2018.
Author
Staveski S.L.; Boulanger K.; Erman L.; Lin L.; Almgren C.; Journel C.;
Roth S.J.; Golianu B.
Institution
(Staveski, Lin) Cincinnati Children's Hospital Medical Center, Research in
Patient Services, Cincinnati, OH, United States
(Staveski) University of Cincinnati, College of Nursing, Cincinnati, OH,
United States
(Boulanger, Erman) Lucile Packard Children's Hospital Stanford, Massage
Therapy Service, Palo Alto, CA, United States
(Almgren, Journel) Lucile Packard Children's Hospital Stanford, Patient
Services - Advanced Practice Nursing, Palo Alto, CA, United States
(Roth) Department of Cardiology and Critical Care, Lucile Packard
Children's Hospital Stanford, Palo Alto, CA, United States
(Roth, Golianu) Department of Pediatrics, Stanford University, School of
Medicine, Palo Alto, CA, United States
(Golianu) Lucile Packard Children's Hospital Stanford, Anesthesiology and
Pain Service, Palo Alto, CA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: The purpose of this pilot study was three-fold: 1) to evaluate
the safety and feasibility of instituting massage therapy in the immediate
postoperative period after congenital heart surgery, 2) to examine the
preliminary results on effects of massage therapy versus standard of care
plus three reading visits on post-operative pain and anxiety, and 3) to
evaluate preliminary effects of opioid and benzodiazepine exposure in
patients receiving massage therapy compared with reading controls.
 Design(s): Prospective, randomized controlled trial. Setting(s):
An academic children's hospital. Subjects: Sixty pediatric heart surgery
patients between ages 6 and 18 years. Intervention(s): Massage
therapy and reading. Measurement and Main Results: There were no adverse
events related to massage or reading interventions in either group. Our
investigation found no statistically significant difference in Pain or
State-Trait Anxiety scores in the initial 24 hours after heart surgery
(T1) and within 48 hours of transfer to the acute care unit (T2) after
controlling for age, gender, and Risk Adjustment for Congenital Heart
Surgery 1 score. However, children receiving massage therapy had
significantly lower State-Trait Anxiety scores after receiving massage
therapy at time of discharge (T3; p = 0.0075) than children receiving
standard of care plus three reading visits. We found no difference in
total opioid exposure during the first 3 postoperative days between groups
(median [interquartile range], 0.80 mg/kg morphine equivalents
[0.29-10.60] vs 1.13 mg/kg morphine equivalents [0.72-6.14]). In contrast,
children receiving massage therapy had significantly lower total
benzodiazepine exposure in the immediate 3 days following heart surgery
(median [interquartile range], 0.002 mg/kg lorazepam equivalents [0-0.03]
vs 0.03 mg/kg lorazepam equivalents [0.02-0.09], p = 0.0253, Wilcoxon
rank-sum) and number of benzodiazepine PRN doses (0.5 [0-2.5] PRN vs 2
PRNs (1-4); p = 0.00346, Wilcoxon rank-sum). Conclusion(s): Our pilot
study demonstrated the safety and feasibility of implementing massage
therapy in the immediate postoperative period in pediatric heart surgery
patients. We found decreased State-Trait Anxiety scores at discharge and
lower total exposure to benzodiazepines. Preventing postoperative
complications such as delirium through nonpharmacologic interventions
warrants further evaluation. Copyright © 2018 by the Society of
Critical Care Medicine and the World Federation of Pediatric Intensive and
Critical Care Societies.

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Accession Number
624836480
Title
Protective ventilation during anaesthesia reduces major postoperative
complications after lung cancer surgery: A double-blind randomised
controlled trial.
Source
European Journal of Anaesthesiology. 35 (10) (pp 727-735), 2018. Date of
Publication: 2018.
Author
Marret E.; Cinotti R.; Berard L.; Piriou V.; Jobard J.; Barrucand B.; Radu
D.; Jaber S.; Bonnet F.
Institution
(Marret, Bonnet) Department of Anaesthesia and Intensive Care Medicine,
American Hospital of Paris, 63 Bd Victor Hugo, Neuilly-sur-Seine, Paris,
France
(Cinotti) Department of Anaesthesia and Intensive Care Medicine, Hotel
Dieu, CHU de Nantes, Nantes Cedex, France
(Berard) Clinical Research Platform (URC-CRC-CRB), AP-HP Hopital
Saint-Antoine, Paris, France
(Berard) INSERM, U-698, UPMC-Paris 06, Paris, France
(Piriou) Critical Care and Anaesthesia Department, CHU Lyon Sud,
University Lyon 1, Lyon, France
(Jobard) Department of Anesthesia and Intensive Care Medicine, Princess
Grace Hospital, Monaco, France
(Barrucand) Department of Anaesthesia and Intensive Care Medicine,
University Hospital of Besancon, Besancon, France
(Radu) Department of Anaesthesia and Intensive Care Medicine, Hotel Dieu,
Cochin University Hospitals, AP-HP, Universite Paris Descartes, Paris,
France
(Jaber) Research Unit, INSERM U1046, Saint Eloi University Hospital,
Montpellier School of Medicine, Montpellier, France
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND Thoracic surgery for lung resection is associated with a high
incidence of postoperative pulmonary complications. Controlled ventilation
with a large tidal volume has been documented to be a risk factor for
postoperative respiratory complications after major abdominal surgery,
whereas the use of low tidal volumes and positive end-expiratory pressure
(PEEP) has a protective effect. OBJECTIVE To evaluate the effects of
ventilation with low tidal volume and PEEP on major complications after
thoracic surgery. DESIGN A double-blind, randomised controlled study.
SETTING A multicentre trial from December 2008 to October 2011. PATIENTS A
total of 346 patients undergoing lobectomy or pneumonectomy for lung
cancer. MAIN OUTCOME MEASURES The primary outcome was the occurrence of
major postoperative complications (pneumonia, acute lung injury, acute
respiratory distress syndrome, pulmonary embolism, shock, myocardial
infarction or death) within 30 days after surgery. INTERVENTIONS Patients
were randomly assigned to receive either lung-protective ventilation (LPV
group) [tidal volume 5 ml kg1 ideal body weight R PEEP between
5 and 8 cmH<inf>2</inf>O] or nonprotective ventilation (control group)
(tidal volume 10 ml kg1 ideal body weight without PEEP) during
anaesthesia. RESULTS The trial was stopped prematurely because of an
insufficient inclusion rate. Major postoperative complications occurred in
23/172 patients in the LPV group (13.4%) vs. 38/ 171 (22.2%) in the
control group (odds ratio 0.54, 95% confidence interval, 0.31 to 0.95, P
1/4 0.03). The incidence of other complications (supraventricular cardiac
arrhythmia, bronchial obstruction, pulmonary atelectasis, hypercapnia,
bronchial fistula and persistent air leak) was also lower in the LPV group
(37.2 vs. 49.4%, odds ratio 0.60, 95% confidence interval, 0.39 to 0.92, P
1/4 0.02).The duration of hospital stay was shorter in the LPV group, 11
[interquartile range, 9 to 15] days vs. 12 [9 to 16] days, P 1/4 0.048.
CONCLUSION Compared with high tidal volume and no PEEP, LPV combining low
tidal volume and PEEP during anaesthesia for lung cancer surgery seems to
improve postoperative outcomes. Copyright © 2018 European Society
of Anaesthesiology. All rights reserved.

<79>
Accession Number
2001271243
Title
The 100 most-cited papers in general thoracic surgery: A bibliography
analysis.
Source
International Journal of Surgery. 53 (pp 230-238), 2018. Date of
Publication: May 2018.
Author
Ding H.; Song X.; Chen L.; Zheng X.; Jiang G.
Institution
(Ding, Song, Chen, Jiang) Department of Thoracic Surgery, Shanghai
Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
(Zheng) Department of Thoracic Surgery, Second Affiliated Hospital,
Lanzhou University, Lanzhou, Gansu Province, China
Publisher
Elsevier Ltd
Abstract
Background: The status of citations can reflect the impact of a paper and
its contribution to surgical practice. The aim of our study was to
identify and review the 100 most-cited papers in general thoracic surgery.
Materials and methods: Relevant papers on general thoracic surgery were
searched through Thomson Reuters Web of Science in the last week of
November 2017. Results were returned in descending order of total
citations. Their titles and abstracts were reviewed to identify whether
they met our inclusion criteria by two thoracic surgeons independently.
Characteristics of the first 100 papers, including title, journal name,
country, first author, year of publication, total citations, citations in
latest 5 years and average citation per year (ACY) were extracted and
analyzed. Results: Of the 100 papers, the mean number of citations was 322
with a range from 184 to 921. 19 journals published the papers from 1956
to 2012. Annals of Surgery had the largest number (29), followed by
Journal of Thoracic and Cardiovascular Surgery (22) and Annals of Thoracic
Surgery (21). The majority of the papers were published in 2000s (48) and
originated from United States of America (62). There were 65 retrospective
studies, 13 RCTs and 11 prospective studies. Orringer MB and Grillo HC
contributed 4 first-author articles respectively. There were 53 papers on
esophagus, 36 on lung, 6 on pleura and 5 on trachea. Conclusions: Our
study identified the most-cited papers in the past several decades and
offered insights into the development and advances of general thoracic
surgery. It can help us understand the evidential basis of clinical
decision-making today in the area. Copyright © 2018

<80>
Accession Number
623950147
Title
Point-of-care viscoelastic hemostatic testing in cardiac surgery patients:
a systematic review and meta-analysis.
Source
Canadian Journal of Anesthesia. 65 (12) (pp 1333-1347), 2018. Date of
Publication: 01 Dec 2018.
Author
Lodewyks C.; Heinrichs J.; Grocott H.P.; Karkouti K.; Romund G.; Arora
R.C.; Tangri N.; Rabbani R.; Abou-Setta A.; Zarychanski R.
Institution
(Lodewyks, Arora) Department of Surgery, Section of Cardiac Surgery, Max
Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
(Lodewyks, Tangri, Rabbani, Abou-Setta, Zarychanski) Department of
Community Health Sciences, Max Rady College of Medicine, University of
Manitoba, Winnipeg, MB, Canada
(Heinrichs, Grocott) Department of Anesthesia and Perioperative Medicine,
Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
(Karkouti) Department of Anesthesia, Institute of Health Policy,
Management, and Evaluation, and Peter Munk Cardiac Centre, University of
Toronto, Toronto, ON, Canada
(Romund) Neil John Maclean Library, University of Manitoba, Winnipeg, MB,
Canada
(Rabbani, Abou-Setta, Zarychanski) George & Fay Yee Center for Healthcare
Innovation, University of Manitoba/Winnipeg Regional Health Authority,
Winnipeg, MB, Canada
(Arora, Tangri, Zarychanski) Department of Internal Medicine, Max Rady
College of Medicine, University of Manitoba, Winnipeg, MB, Canada
(Lodewyks) Y3505-409 Tache Avenue, Winnipeg, MB R2H 2A6, Canada
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Thromboelastography and rotational thromboelastometry are
point-of-care (POC) viscoelastic tests used to help guide blood product
administration. It is unclear whether these tests improve clinical or
transfusion-related outcomes. The objective of this study was to appraise
data from randomized trials evaluating the benefit of POC testing in
cardiac surgery patients. Primary outcomes were the proportion of patients
transfused with blood products and all-cause mortality. Source: Medline
(Ovid), EMBASE (Ovid), CENTRAL (the Cochrane Library-Wiley), Web of
Science, Biosis, Scopus, and CINAHL databases, as well as clinical trial
registries and conference proceedings were queried from inception to
February 2018. Principal findings: We identified 1,917 records, 11 of
which were included in our analysis (8,294 patients). Point-of-care
testing was not associated with a difference in the proportion of patients
transfused with any blood product (risk ratio [RR], 0.90; 95% confidence
interval [CI], 0.79 to 1.02; I2 = 51%; four trials, 7,623
patients), or all-cause mortality (RR, 0.73; 95% CI, 0.47 to 1.13;
I2 = 5%; six trials, 7,931 patients). Nevertheless, POC testing
was weakly associated with a decrease in the proportion of patients
receiving red blood cells (RBC) (RR, 0.91; 95% CI, 0.85 to 0.96;
I2 = 0%; seven trials, 8,029 patients), and heterogeneous
reductions in frozen plasma (FP) (RR, 0.58; 95% CI, 0.34 to 0.99;
I2 = 87%; six trials, 7,989 patients) and platelets (RR, 0.66;
95% CI, 0.49 to 0.90; I2 = 65%; seven trials, 8,029 patients).
Meta-analysis of the number of units of RBCs and FP was not possible due
to heterogeneity in reporting, however POC testing significantly reduced
the units of platelets transfused (standard mean difference, -0.09; 95%
CI, -0.18 to 0.00; four trials, 7,643 patients). Conclusion: Our review
indicates that in cardiac surgery patients, POC viscoelastic hemostatic
testing is not associated with a reduction in the proportion of patients
receiving any blood product or all-cause mortality. However, viscoelastic
testing is weakly associated with a reduction in proportion of patients
transfused with specific blood products. Presently, the benefits
associated with viscoelastic testing in cardiac surgery patients are
insufficiently robust to recommend routine implementation of this
technology. Trial registration: PROSPERO (CRD4201706577). Registered 11
May 2017. Copyright © 2018, Canadian Anesthesiologists' Society.

<81>
Accession Number
2001026578
Title
Cost effectiveness and clinical efficacy of patent foramen ovale closure
as compared to medical therapy in cryptogenic stroke patients: A detailed
cost analysis and meta-analysis of randomized controlled trials.
Source
International Journal of Cardiology. 273 (pp 74-79), 2018. Date of
Publication: 15 December 2018.
Author
Pickett C.A.; Villines T.C.; Resar J.R.; Hulten E.A.
Institution
(Pickett, Villines, Hulten) Uniformed Services University of the Health
Sciences, Bethesda, MD, United States
(Pickett) Brooke Army Medical Center, San Antonio, TX, United States
(Villines) Walter Reed National Military Medical Center, Bethesda, MD,
United States
(Resar) Johns Hopkins Hospital and Johns Hopkins University School of
Medicine, Baltimore, MD, United States
(Hulten) Cardiology Service, Evans Army Hospital, Fort Carson, CO, United
States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Up to half the patients with cryptogenic stroke under the age
of 55 years have been found to have a PFO. Observational studies have
demonstrated a benefit from closure of PFO and several RCTs have shown a
trend toward benefit. The cost and clinical effectiveness of PFO closure
is unclear. Methods and results: We searched for RCTs of PFO closure in
patients with cryptogenic stroke and performed a detailed cost analysis
and meta-analysis of treatment outcomes based on the results of the
meta-analysis. Five RCTs containing 3404 patients with cryptogenic stroke
were included. Of these 1829 underwent PFO closure and 1611 received
medical therapy. Mean follow-up was 4.0 years. PFO closure achieved cost
effectiveness (<$50,000/Quality-adjusted life-year gained) 2.7 years (95%
Confidence Interval (CI) 2.2-3.4) after closure. The incremental cost to
prevent one combined end point (CEP, combined transient ischemic attack
(TIA), stroke, and death) by PFO closure was $535,655(95% CI
$458,329-$642,674). After 55.4 years (95%CI 51.1-60.5) of follow-up, the
per patient total cost of medical therapy exceeded that of PFO closure.
PFO closure demonstrated clinical efficacy with a decreased risk of CEP
(pooled hazard ratio (HR = 0.43(95%CI 0.27-0.59))) and a decreased risk of
stroke (HR = 0.29(95%CI 0.02-0.57)). Conclusions: In comparison to medical
therapy alone, PFO closure appears to be cost-effective and clinically
efficacious. Copyright © 2018 Elsevier B.V.

<82>
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. Copyright
© 2018 Elsevier B.V.

<83>
Accession Number
2000541708
Title
Safety and efficacy of cerebral protection devices in transcatheter aortic
valve replacement: A clinical end-points meta-analysis.
Source
Cardiovascular Revascularization Medicine. Part A. 19 (7) (pp 785-791),
2018. Date of Publication: October 2018.
Author
Mohananey D.; Sankaramangalam K.; Kumar A.; Jobanputra Y.; Villablanca P.;
Krishnaswamy A.; Mick S.; Svensson L.G.; Tuzcu E.M.; Kapadia S.R.
Institution
(Mohananey, Sankaramangalam, Jobanputra, Krishnaswamy, Kapadia) Department
of Cardiovascular Medicine, Cleveland Clinic, OH, United States
(Kumar) Department of Cardiovascular Medicine, Emory University, GA,
United States
(Villablanca) Division of Cardiology, New York University, NY, United
States
(Mick, Svensson) Department of Cardiothoracic surgery, Cleveland Clinic,
OH, United States
(Tuzcu) Department of Cardiovascular Medicine, Cleveland Clinic, Abu
Dhabi, United Arab Emirates
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Stroke after transcatheter aortic valve replacement (TAVR)
occurs with an incidence of 4-11% and is a particularly devastating
adverse event associated with the procedure. Several cerebral protection
devices (CPD) have been developed to prevent cerebrovascular events during
TAVR. While most studies have shown CPD to be associated with decreased
number and volume of lesions on diffusion weighted magnetic resonance
imaging, the clinical benefit of these devices remains uncertain. Methods:
We aimed to use meta-analysis techniques to study the clinical safety and
efficacy of these CPD in prospective randomized and non-randomized
studies. Data was summarized as Mantel-Haenszel relative risk (RR) and 95%
confidence intervals (CI). We used the Higgins' I2 statistic to
evaluate heterogeneity. Results: We found no evidence of difference
between patients with and without CPD [RR 0.70 (95% CI 0.40-1.21)] for the
primary composite outcome of stroke and mortality at 30 days. The two
groups were also comparable in peri-procedural strokes [RR 0.53 (95% CI
0.27-1.07)], stroke at 30 days [RR 0.69(95% CI 0.38-1.26)], mortality [RR
0.59 (95% CI 0.22-1.59) at 30 days, AKI [RR 0.68(95% CI 0.28-1.62)], major
bleeding [RR 0.56 (95% CI 0.26-1.18)], life threating bleeding [0.54 (95%
CI 0.19-1.53)] and major vascular complications [RR 0.80 (95% CI
0.52-1.24)]. The risk of strokes within the first week of TAVR was
significantly lower in the CPD group [0.56(95% CI 0.33-0.96)]. Conclusion:
CPD are associated with a decreased incidence of strokes within 1 week of
follow-up without showing any evidence of increased risk of other
peri-procedural adverse events. Copyright © 2018 Elsevier Inc.

<84>
[Use Link to view the full text]
Accession Number
624892939
Title
A randomized, triple-blind trial of cardiac shock-wave therapy on exercise
tolerance and symptoms in patients with stable angina pectoris.
Source
Coronary Artery Disease. 29 (7) (pp 579-586), 2018. Date of Publication:
01 Nov 2018.
Author
Shkolnik E.; Burneikaite G.; Jakutis G.; Scherbak M.; Zuoziene G.;
Petrauskiene B.; Trush E.; Vasyuk Y.; Laucevicius A.; Celutkiene J.
Institution
(Shkolnik, Scherbak, Trush, Vasyuk) Moscow State University of Medicine
and Dentistry, Moscow, Russian Federation
(Shkolnik) Yale-New Haven Health Bridgeport Hospital, Bridgeport,
Connecticut, United States
(Burneikaite, Jakutis, Zuoziene, Petrauskiene, Celutkiene) Clinic of
Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of
Medicine, Vilnius University, Palangos Street 1/10-3, Vilnius 01117,
Lithuania
(Burneikaite, Zuoziene, Petrauskiene, Celutkiene) Vilnius University
Hospital, Santaros Klinikos, Centre of Cardiology and Angiology, Lithuania
(Laucevicius) Centre of Innovative Medicine, Vilnius, Lithuania
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background Despite major advances in managing coronary artery disease and
continuous research on alternative techniques to enhance myocardial
perfusion and reduce symptoms, coronary artery disease is still one of the
leading causes of adult disability worldwide. Cardiac shockwave therapy
(CSWT) has shown promising results in the amelioration of myocardial
ischemia in experimental studies; however, clinical results are limited to
single-center, mostly uncontrolled and underpowered trials. The current
study aimed to evaluate whether CSWT can improve exercise tolerance and
relieve angina symptoms in addition to optimal medical treatment in
patients with stable angina. Participants and methods A prospective,
randomized, triple blind, sham-procedure-controlled study was carried out.
The primary endpoint was total exercise duration in the modified Bruce
treadmill test at the 6-month follow-up. The secondary endpoints were
changes in ST-segment depression during the treadmill test, angina
symptoms during the treadmill test, number of angina attacks per week,
number of sublingual nitroglycerin consumption per week, Canadian
Cardiovascular Society angina functional class, and the Seattle Angina
Questionnaire score at the 6-month follow-up. Patients were randomized at
a 1 : 1 ratio to optimal medical plus cardiac shock-wave therapy
(OMT+CSWT) and optimal medical therapy with sham procedure (OMT+placebo)
groups. Results The mean exercise time improved in both study arms - CSWT
and placebo treatment - at the 3- and 6-month follow-up, without a
significant difference between groups. The magnitude and frequency of peak
exercise ST-segment depression reduced significantly in the CSWT+OMT group
compared with the OMT+placebo group at the 6-month follow-up (51.4 vs.
90.6%, P=0.001). Percentage of angina-free patients increased
progressively in both groups throughout the study. The Seattle Angina
Questionnaire scores improved significantly in both arms for four of five
domains at the 3- and the 6-month follow-up. Numerically, although
insignificant, the decrease in the number of angina episodes was more
prominent in the OMT+CSWTgroup compared with the OMT+placebo group.
Conclusion The total exercise duration in the modified Bruce treadmill
test at the 6-month follow-up did not differ significantly in patients
treated with CSWT compared with optimal medical therapy alone. In
addition, CSWT exerted a neutral effect on the quality of life and level
of angina. Copyright © 2018 Wolters Kluwer Health, Inc. All
rights reserved.

<85>
Accession Number
624883475
Title
Evaluating the use of dexmedetomidine for the reduction of delirium: An
integrative review.
Source
Heart & lung : the journal of critical care. 47 (6) (pp 591-601), 2018.
Date of Publication: 01 Nov 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
NLM (Medline)
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. Copyright © 2018 Elsevier Inc.
All rights reserved.

<86>
Accession Number
624888052
Title
Self-Management Interventions for Women With Cardiac Pain: A Systematic
Review and Meta-analysis.
Source
The Canadian journal of cardiology. 34 (4) (pp 458-467), 2018. Date of
Publication: 01 Apr 2018.
Author
Parry M.; Bjornnes A.K.; Victor J.C.; Ayala A.P.; Lenton E.; Clarke H.;
Harvey P.; Lalloo C.; McFetridge-Durdle J.; McGillion M.H.; Price J.;
Stinson J.; Watt-Watson J.
Institution
(Parry, Watt-Watson) Lawrence S Bloomberg Faculty of Nursing, University
of Toronto, Toronto, ON, Canada
(Bjornnes) Lawrence S Bloomberg Faculty of Nursing, University of Toronto,
Toronto, Ontario, Canada; Institute of Nursing and Health Promotion, Oslo
and Akershus University College of Applied Sciences, Oslo, Norway
(Victor) Institute of Health Policy, Management and Evaluation, University
of Toronto, Toronto, ON, Canada
(Ayala, Lenton) Gerstein Science Information Centre, University of
Toronto, Toronto, ON, Canada
(Clarke) Pain Research Unit, University Health Network, Toronto, ON,
Canada
(Harvey) Department of Medicine, Women's College Hospital, Toronto, ON,
Canada
(Lalloo) Hospital for Sick Children, Peter Gilgan Centre for Research and
Learning, Toronto, ON, Canada
(McFetridge-Durdle) College of Nursing, Florida State University,
Tallahassee, FL, United States
(McGillion) School of Nursing, McMaster University, Hamilton, ON, Canada
(Price) Women's College Research Institute, Women's College Hospital,
Toronto, ON, Canada
(Stinson) Lawrence S Bloomberg Faculty of Nursing, University of Toronto,
Toronto, Ontario, Canada; The Hospital for Sick Children, The Peter Gilgan
Centre for Research and Learning, Toronto, Ontario, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiac pain is considered the primary indicator of coronary
artery disease (CAD). Existing reviews lack appropriate numbers of women
or sex-based subgroup analyses, or both; thus, the benefits of
self-management (women with cardiac pain actively participating in their
own care and treatment) remain uncertain. METHOD(S): Using methods
described by the Evidence for Policy and Practice Information and
Co-ordinating Centre at the Institute of Education, 7 databases were
systematically searched to examine and synthesize the evidence on
self-management interventions for women with cardiac pain and cardiac pain
equivalents, such as fatigue, dyspnea, and exhaustion. RESULT(S): Our
search yielded 22,402 article titles and abstracts. Of these, 57
randomized controlled trials were included in a final narrative synthesis,
comprising data from 13,047 participants, including 5299 (41%) women.
Self-management interventions targeting cardiac pain in women compared
with a control population reduced (1) cardiac pain frequency and cardiac
pain proportion (obstructive and nonobstructive CAD), (2) fatigue at 12
months, and (3) dyspnea at 2 months. There was no evidence of group
differences in postprocedural (percutaneous coronary intervention or
cardiac surgery) pain. Results indicated that self-management
interventions for cardiac pain were more effective if they included a
greater proportion of women (standardized mean difference [SMD], -0.01;
standard error, 0.003; P = 0.02), goal setting (SMD, -0.26; 95% confidence
interval [CI], -0.49 to -0.03), and collaboration/support from health care
providers (SMD, -0.57; 95% CI, -1.00 to -0.14). CONCLUSION(S): The
results of this review suggest that self-management interventions reduce
cardiac pain and cardiac pain equivalents. Copyright © 2017
Canadian Cardiovascular Society. Published by Elsevier Inc. All rights
reserved.

<87>
Accession Number
620309141
Title
An Invasive vs a Conservative Approach in Elderly Patients with
Non-ST-Segment Elevation Myocardial Infarction: Systematic Review and
Meta-Analysis.
Source
Canadian Journal of Cardiology. 34 (3) (pp 330-332), 2018. Date of
Publication: March 2018.
Author
Saraswat A.; Rahman A.; Singh K.
Institution
(Saraswat, Rahman, Singh) Department of Cardiology, Gold Coast University
Hospital, Gold Coast, Queensland, Australia
(Rahman, Singh) Department of Medicine, Griffith University, Gold Coast,
Queensland, Australia
(Singh) Department of Medicine, University of Adelaide, Adelaide, South
Australia, Australia
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Elderly (>= 75 years) patients form a large sub-group of
non-ST-segment elevation myocardial infarction (NSTEMI) population but are
vastly under-represented in trials. Thus, the benefits of an early
angiography in the elderly remain unclear. In this systematic review, we
compared outcomes of "invasive" and "conservative" strategies of NSTEMI
management in elderly patients. Methods: A comprehensive search of major
databases was performed. We included comparative studies of any design
that enrolled patients >= 75 years, and where outcomes of both strategies
of NSTEMI management were available. Results: Among the included studies
(3 randomized and 6 observational), there were 6340 patients in the
"invasive" group and 13,358 patients in the "conservative" group. The
12-month mortality rate (odds ration [OR], 0.45; p < 0.00001), the 30-day
mortality (OR, 0.50; p = 0.0009), and events of stroke (OR, 0.42; p <
0.00001) were significantly lower in the invasive group. Major bleeding
was higher in the invasive cohort (OR, 1.63; p = 0.03). Analysis of
randomised studies showed lower reinfarction with invasive approach at 12
months (p = 0.0001). Significant heterogeneity was noted among studies
according to study design. Conclusion: The overall benefit with invasive
strategy comes from the data of observational studies that are prone to
selection bias. We believe that there is a need for a large randomized
study in the elderly patients regarding management of
NSTEMI. Copyright © 2017 Canadian Cardiovascular Society

<88>
Accession Number
620775591
Title
Self-Management Interventions for Women With Cardiac Pain: A Systematic
Review and Meta-analysis.
Source
Canadian Journal of Cardiology. 34 (4) (pp 458-467), 2018. Date of
Publication: April 2018.
Author
Parry M.; Bjornnes A.K.; Victor J.C.; Ayala A.P.; Lenton E.; Clarke H.;
Harvey P.; Lalloo C.; McFetridge-Durdle J.; McGillion M.H.; Price J.;
Stinson J.; Watt-Watson J.
Institution
(Parry, Bjornnes, Stinson, Watt-Watson) Lawrence S Bloomberg Faculty of
Nursing, University of Toronto, Toronto, Ontario, Canada
(Bjornnes) Institute of Nursing and Health Promotion, Oslo and Akershus
University College of Applied Sciences, Oslo, Norway
(Victor) Institute of Health Policy, Management and Evaluation, University
of Toronto, Toronto, Ontario, Canada
(Ayala, Lenton) Gerstein Science Information Centre, University of
Toronto, Toronto, Ontario, Canada
(Clarke) Pain Research Unit, University Health Network, Toronto, Ontario,
Canada
(Harvey) Department of Medicine, Women's College Hospital, Toronto,
Ontario, Canada
(Lalloo, Stinson) The Hospital for Sick Children, The Peter Gilgan Centre
for Research and Learning, Toronto, Ontario, Canada
(McFetridge-Durdle) College of Nursing, Florida State University,
Tallahassee, Florida, United States
(McGillion) School of Nursing, McMaster University, Hamilton, Ontario,
Canada
(Price) Women's College Research Institute, Women's College Hospital,
Toronto, Ontario, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Cardiac pain is considered the primary indicator of coronary
artery disease (CAD). Existing reviews lack appropriate numbers of women
or sex-based subgroup analyses, or both; thus, the benefits of
self-management (women with cardiac pain actively participating in their
own care and treatment) remain uncertain. Methods: Using methods described
by the Evidence for Policy and Practice Information and Co-ordinating
Centre at the Institute of Education, 7 databases were systematically
searched to examine and synthesize the evidence on self-management
interventions for women with cardiac pain and cardiac pain equivalents,
such as fatigue, dyspnea, and exhaustion. Results: Our search yielded
22,402 article titles and abstracts. Of these, 57 randomized controlled
trials were included in a final narrative synthesis, comprising data from
13,047 participants, including 5299 (41%) women. Self-management
interventions targeting cardiac pain in women compared with a control
population reduced (1) cardiac pain frequency and cardiac pain proportion
(obstructive and nonobstructive CAD), (2) fatigue at 12 months, and (3)
dyspnea at 2 months. There was no evidence of group differences in
postprocedural (percutaneous coronary intervention or cardiac surgery)
pain. Results indicated that self-management interventions for cardiac
pain were more effective if they included a greater proportion of women
(standardized mean difference [SMD], -0.01; standard error, 0.003; P =
0.02), goal setting (SMD, -0.26; 95% confidence interval [CI], -0.49 to
-0.03), and collaboration/support from health care providers (SMD, -0.57;
95% CI, -1.00 to -0.14). Conclusions: The results of this review suggest
that self-management interventions reduce cardiac pain and cardiac pain
equivalents. Copyright © 2017 Canadian Cardiovascular Society

<89>
Accession Number
621226276
Title
Coronary heart disease, heart failure, and the risk of dementia: A
systematic review and meta-analysis.
Source
Alzheimer's and Dementia. 14 (11) (pp 1493-1504), 2018. Date of
Publication: November 2018.
Author
Wolters F.J.; Segufa R.A.; Darweesh S.K.L.; Bos D.; Ikram M.A.; Sabayan
B.; Hofman A.; Sedaghat S.
Institution
(Wolters, Darweesh, Bos, Hofman) Department of Epidemiology, Harvard T.H.
Chan School of Public Health, Boston, MA, United States
(Wolters, Darweesh, Bos, Ikram, Hofman, Sedaghat) Department of
Epidemiology, Erasmus Medical Centre, Rotterdam, Netherlands
(Wolters, Darweesh, Ikram) Department of Neurology, Erasmus Medical
Centre, Rotterdam, Netherlands
(Segufa, Sabayan) Department of Gerontology and Geriatrics, Leiden
University Medical Centre, Leiden, Netherlands
(Bos, Ikram) Department of Radiology and Nuclear Medicine, Erasmus Medical
Centre, Rotterdam, Netherlands
(Sabayan) Department of Neurology, Feinberg School of Medicine,
Northwestern University, Chicago, IL, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Introduction: Cardiovascular risk factors are closely linked with dementia
risk, but whether heart disease predisposes to dementia is uncertain.
Methods: We systematically reviewed the literature and meta-analyzed risk
estimates from longitudinal studies reporting the association of coronary
heart disease (CHD) or heart failure (HF) with risk of dementia. Results:
We identified 16 studies (1,309,483 individuals) regarding CHD, and seven
studies (1,958,702 individuals) about HF. A history of CHD was associated
with a 27% increased risk of dementia (pooled relative risk [RR] [95%
confidence interval, CI]: 1.27 [1.07-1.50]), albeit with considerable
heterogeneity across studies (I2 = 80%). HF was associated with
60% increased dementia risk (pooled RR 1.60 [1.19-2.13]) with moderate
heterogeneity (I2 = 59%). Among prospective population-based
cohorts, pooled estimates were similar (for CHD, RR 1.26 [1.06-1.49], nine
studies; and HF, RR 1.80 [1.41-2.31], four studies) and highly consistent
(I2 = 0%). Conclusion: CHD and HF are associated with an
increased risk of dementia. Copyright © 2018 the Alzheimer's
Association

<90>
Accession Number
619230288
Title
Rivaroxaban with or without aspirin in patients with stable coronary
artery disease: an international, randomised, double-blind,
placebo-controlled trial.
Source
The Lancet. 391 (10117) (pp 205-218), 2018. Date of Publication: 20 - 26
January 2018.
Author
Connolly S.J.; Eikelboom J.W.; Bosch J.; Dagenais G.; Dyal L.; Lanas F.;
Metsarinne K.; O'Donnell M.; Dans A.L.; Ha J.-W.; Parkhomenko A.N.; Avezum
A.A.; Lonn E.; Lisheng L.; Torp-Pedersen C.; Widimsky P.; Maggioni A.P.;
Felix C.; Keltai K.; Hori M.; Guzik T.J.; Bhatt D.L.; Branch K.R.H.; Cook
Bruns N.; Berkowitz S.D.; Anand S.S.; Varigos J.D.; Fox K.A.A.; Yusuf S.;
SALA J.; CARTASEGNA L.U.I.S.; VICO M.; HOMINAL M.A.; HASBANI E.; CACCAVO
A.; ZAIDMAN C.; VOGEL D.; HRABAR A.; SCHYGIEL P.O.; CUNEO C.; LUQUEZ
H.U.G.O.; MACKINNON I.J.; AHUAD GUERRERO R.A.; COSTABEL J.P.; BARTOLACCI
I.P.; MONTANA O.; BARBIERI M.; GOMEZ VILAMAJO O.; GARCIA DURAN R.O.;
SCHIAVI L.B.; GARRIDO M.; INGARAMO A.; BORDONAVA A.P.; PELAGAGGE M.J.;
NOVARETTO L.; ALBISU DI GENNERO J.P.; IBANEZ SAGGIA L.M.; ALVAREZ M.; VITA
N.A.; MACIN S.M.; DRAN R.D.; CARDONA M.; GUZMAN L.U.I.S.; SARJANOVICH
R.J.; CUADRADO J.; NANI S.; LITVAK BRUNO M.R.; CHACON C.; MAFFEI L.E.;
GRINFELD D.; VENSENTINI N.; MAJUL C.R.; LUCIARDI H.L.; GONZALEZ COLASO
P.D.C.; FERRE PACORA F.A.; VAN DEN HEUVEL P.A.U.L.; VERHAMME P.; ECTOR
B.A.V.O.; DEBONNAIRE P.; VAN DE BORNE P.; LEROY J.E.A.N.; SCHROE H.;
VRANCKX P.; ELEGEERT I.V.A.N.; HOFFER E.; DUJARDIN K.A.R.L.; INDIO DO
BRASIL C.; PRECOMA D.; ABRANTES J.A.; MANENTI E.; REIS G.; SARAIVA
J.O.S.E.; MAIA L.; HERNANDES M.; ROSSI P.; ROSSI DOS SANTOS F.; ZIMMERMANN
S.L.; RECH R.; ABIB JR E.; LEAES P.; BOTELHO R.; DUTRA O.; SOUZA W.;
BRAILE M.; IZUKAWA N.I.L.O.; NICOLAU J.C.; TANAJURA L.F.; SERRANO JUNIOR
C.V.; MINELLI C.; NASI L.A.; OLIVEIRA L.; DE CARVALHO CANTARELLI M.J.;
TYTUS R.; PANDEY S.; LONN E.V.A.; CHA J.; VIZEL S.A.U.L.; BABAPULLE M.;
LAMY A.; SAUNDERS K.; BERLINGIERI J.; KIAII B.O.B.; BHARGAVA R.; MEHTA P.;
HILL L.; FELL D.; LAM A.N.D.Y.; AL-QOOFI F.; BROWN C.; PETRELLA R.; RICCI
J.A.; GLANZ A.; NOISEUX N.; BAINEY K.; MERALI F.; HEFFERNAN M.; DELLA
SIEGA A.; DAGENAIS G.R.; DAGENAIS F.; BRULOTTE S.; NGUYEN M.; HARTLEIB M.;
GUZMAN R.; BOURGEOIS R.; RUPKA D.; KHAYKIN Y.; GOSSELIN G.; HUYNH
T.H.A.O.; PILON C.; CAMPEAU J.E.A.N.; PICHETTE F.; DIAZ A.; JOHNSTON J.;
SHUKLE P.; HIRSCH G.; RHEAULT P.A.U.L.; CZARNECKI W.; ROY A.; NAWAZ
S.H.A.H.; FREMES S.; SHUKLA D.; JANO G.; COBOS J.L.; CORBALAN R.; MEDINA
M.; NAHUELPAN L.; RAFFO C.; PEREZ L.U.I.S.; POTTHOFF S.; STOCKINS B.;
SEPULVEDA P.; PINCETTI C.; VEJAR M.; TIAN H.; WU X.; KE Y.; JIA K.; YIN
P.; WANG Z.; YU L.; WU S.; WU Z.; LIU S.W.; BAI X.J.; ZHENG Y.A.N.G.; YANG
P.I.N.G.; YANG Y.M.; ZHANG J.; GE J.; CHEN X.P.; HU T.H.; ZHANG R.; ZHENG
Z.H.E.; CHEN X.I.N.; TAO L.; LI J.; HUANG W.; FU G.; LI C.; DONG Y.; WANG
C.; ZHOU X.; KONG Y.E.; SOTOMAYOR A.; ACCINI MENDOZA J.L.; CASTILLO H.;
URINA M.; AROCA G.; PEREZ M.; MOLINA DE SALAZAR D.I.; SANCHEZ VALLEJO G.;
FERNANDO M.J.; GARCIA H.; GARCIA L.H.; ARCOS E.; GOMEZ J.U.A.N.; CUERVO
MILLAN F.; TRUJILLO DADA F.A.; VESGA B.; MORENO SILGADO G.A.; ZIDKOVA
E.V.A.; LUBANDA J.-C.; KALETOVA M.; KRYZA R.; MARCINEK G.; RICHTER M.;
SPINAR J.; MATUSKA J.I.R.I.; TESAK M.; MOTOVSKA Z.; BRANNY M.; MALY
J.I.R.I.; MALY M.; WIENDL M.; FOLTYNOVA CAISOVA L.; SLABY J.; VOJTISEK
P.E.T.R.; PIRK J.A.N.; SPINAROVA L.; BENESOVA M.; CANADYOVA J.; HOMZA M.;
FLORIAN J.; POLASEK R.; COUFAL Z.; SKALNIKOVA V.; BRAT R.; BRTKO M.;
JANSKY P.E.T.R.; LINDNER J.; MARCIAN P.; STRAKA Z.; TRETINA M.; DUARTE
Y.C.; POW CHON LONG F.; SANCHEZ M.; LOPEZ J.O.S.E.; PERUGACHI C.; MARMOL
R.; TRUJILLO F.; TERAN P.; TUOMILEHTO J.; TUOMILEHTO H.; TUOMINEN M.-L.;
KANTOLA I.; STEG G.; ABOYANS V.; LECLERCQ F.; FERRARI E.; BOCCARA F.;
MESSAS E.; MISMETTI P.; SEVESTRE M.A.; CAYLA G.; MOTREFF P.; STOERK S.;
DUENGEN H.A.N.S.-D.I.R.K.; STELLBRINK C.; GUEROCAK O.; KADEL C.;
BRAUN-DULLAEUS R.; JESERICH M.; OPITZ C.; VOEHRINGER H.-F.; APPEL K.-F.;
WINKELMANN B.; DORSEL T.; NIKOL S.; DARIUS H.; RANFT J.; SCHELLONG S.;
JUNGMAIR W.; DAVIERWALA P.; VORPAHL M.A.R.C.; BAJNOK L.; LASZLO Z.; NOORI
E.; VERESS G.; VERTES A.; ZSARY A.; KIS E.R.N.O.; KORANYI L.; BAKAI J.;
BODA Z.; POOR F.; JARAI Z.; KEMENY V.; BARTON J.O.H.N.; MCADAM B.; MURPHY
A.; CREAN P.; MAHON N.; CURTIN R.; MACNEILL B.; DINNEEN S.E.A.N.; HALABI
M.; ZIMLICHMAN R.; ZELTSER D.; TURGEMAN Y.O.A.V.; KLAINMAN E.; LEWIS B.;
KATZ A.M.O.S.; ATAR S.; NIKOLSKY E.; BOSI S.; NALDI M.; FAGGIANO P.; ROBBA
D.; MOS L.; SINAGRA G.; COSMI F.; OLTRONA VISCONTI L.; CARMINE D.M.; DI
PASQUALE G.; DI BIASE M.; MANDORLA S.A.R.A.; BERNARDINANGELI M.; PICCINNI
G.C.; GULIZIA M.M.; GALVANI M.; VENTURI F.; MOROCUTTI G.; BALDIN M.G.;
OLIVIERI C.; PERNA G.P.; CIRRINCIONE V.; KANNO T.; DAIDA H.; OZAKI Y.;
MIYAMOTO N.; HIGASHIUE S.; DOMAE H.; HOSOKAWA S.; KOBAYASHI H.; KURAMOCHI
T.; FUJII K.; MIZUTOMI K.; SAKU K.; KIMURA K.; HIGUCHI Y.; ABE M.; OKUDA
H.; NODA T.; MITA T.; HIRAYAMA A.; ONAKA H.; INOKO M.; HIROKAMI M.; OKUBO
M.; AKATSUKA Y.; IMAMAKI M.; KAMIYA H.; MANITA M.; HIMI T.; UENO H.;
HISAMATSU Y.U.J.I.; AKO J.; NISHINO Y.; KAWAKAMI H.; YAMADA Y.; KORETSUNE
Y.; YAMADA T.; YOSHIDA T.; SHIMOMURA H.; KINOSHITA N.; TAKAHASHI A.;
YUSOFF K.; WAN AHMAD W.A.; ABU HASSAN M.R.; KASIM S.; ABDUL RAHIM A.A.;
MOHD ZAMRIN D.; MACHIDA M.; HIGASHINO Y.; UTSU N.; NAKANO A.; NAKAMURA S.;
HASHIMOTO T.; ANDO K.; SAKAMOTO T.; PRINS F.J.; LOK D.I.R.K.; MILHOUS
J.G.-J.; VIERGEVER E.R.I.C.; WILLEMS F.; SWART H.E.N.K.; ALINGS M.;
BREEDVELD R.O.B.; DE VRIES K.E.E.S.-J.A.N.; VAN DER BORGH R.; OEI F.;
ZOET-NUGTEREN S.; KRAGTEN H.A.N.S.; HERRMAN J.P.; VAN BERGEN P.A.U.L.;
GOSSELINK M.; HOEKSTRA E.; ZEGERS E.; RONNER E.; DEN HARTOG F.; BARTELS
G.; NIEROP P.; VAN DER ZWAAN C.O.E.N.; VAN ECK J.; VAN GORSELEN E.;
GROENEMEIJER B.; HOOGSLAG P.; DE GROOT M.R.; LOYOLA A.; SULIT D.J.; REY
N.; ABOLA M.T.; MORALES D.; PALOMARES E.; ABAT M.E.; ROGELIO G.; CHUA P.;
DEL PILAR J.C.; ALCARAZ J.D.; EBO G.; TIRADOR L.; CRUZ J.; ANONUEVO
J.O.H.N.; PITARGUE A.; JANION M.; GUZIK T.; GAJOS G.; ZABOWKA M.;
RYNKIEWICZ A.; BRONCEL M.; SZUBA A.; CZARNECKA D.; MAGA P.; STRAZHESKO I.;
VASYUK Y.U.R.Y.; SIZOVA Z.; POZDNYAKOV Y.U.R.Y.; BARBARASH O.L.G.A.;
VOEVODA M.; POPONINA T.; REPIN A.; OSIPOVA I.; EFREMUSHKINA A.N.N.A.;
NOVIKOVA N.I.N.A.; AVERKOV O.L.E.G.; ZATEYSHCHIKOV D.; VERTKIN A.; AUSHEVA
A.Z.A.; COMMERFORD P.; SEEDAT S.; VAN ZYL L.; ENGELBRECHT J.A.N.; MAKOTOKO
E.M.; PRETORIUS C.E.; MOHAMED Z.A.I.D.; HORAK A.; MABIN T.; KLUG E.R.I.C.;
BAE J.A.N.G.-H.O.; KIM C.; KIM C.H.O.N.G.-J.I.N.; KIM D.O.N.G.-S.O.O.; KIM
Y.J.; JOO S.; HA J.O.N.G.-W.O.N.; PARK C.S.; KIM J.Y.; KIM
Y.O.U.N.G.-K.W.O.N.; JARNERT C.; MOOE T.; DELLBORG M.; TORSTENSSON I.;
ALBERTSSON P.E.R.; JOHANSSON L.A.R.S.; AL-KHALILI F.; ALMROTH H.;
ANDERSSON T.; PANTEV E.M.I.L.; TENGMARK B.E.N.G.T.-O.L.O.V.; LIU B.O.;
RASMANIS G.; WAHLGREN C.-M.; MOCCETTI T.; PARKHOMENKO A.; TSELUYKO
V.I.R.A.; VOLKOV V.; KOVAL O.; KONONENKO L.; PROKHOROV O.; VDOVYCHENKO V.;
BAZYLEVYCH A.; RUDENKO L.; VIZIR V.; KARPENKO O.; MALYNOVSKY Y.; KOVAL V.;
STOROZHUK B.; COTTON J.; VENKATARAMAN A.S.O.K.; MORIARTY A.; CONNOLLY D.;
DAVEY P.; SENIOR R.O.X.Y.; BIRDI I.; CALVERT J.O.H.N.; DONNELLY P.;
TREVELYAN J.; CARTER J.; PEACE A.; AUSTIN D.; KUKREJA N.; HILTON T.;
SRIVASTAVA S.; WALSH R.; FIELDS R.; HAKAS J.; PORTNAY E.; GOGIA H.;
SALACATA A.; HUNTER J.J.; BACHARACH J.M.; SHAMMAS N.; SURESH D.; SCHNEIDER
R.; GURBEL P.A.U.L.; BANERJEE S.; GRENA P.A.U.L.; BEDWELL N.O.E.L.; SLOAN
S.; LUPOVITCH S.; SONI A.; GIBSON K.; SANGRIGOLI R.; MEHTA R.; I-HSUAN
TSAI P.; GILLESPIE E.V.E.; DEMPSEY S.; HAMROFF G.; BLACK R.; LADER E.;
KOSTIS J.B.; BITTNER V.E.R.A.; MCGUINN W.; BRANCH K.; MALHOTRA V.;
MICHAELSON S.; VACANTE M.; MCCORMICK M.; ARIMIE R.; CAMP A.L.A.N.; DAGHER
G.; KOSHY N.M.; THEW S.; COSTELLO F.; HEIMAN M.A.R.K.; CHILTON R.; MORAN
M.; ADLER F.; COMEROTA A.; SEIWERT A.; FRENCH W.; SEROTA H.; HARRISON R.;
BAKAEEN F.; OMER S.; CHANDRA L.; WHELAN A.L.A.N.; BOYLE A.;
ROBERTS-THOMSON P.; ROGERS J.; CARROLL P.; COLQUHOUN D.; SHAW J.; BLOMBERY
P.; AMERENA J.O.H.N.; HII C.; ROYSE A.; SINGH B.; SELVANAYAGAM J.; JANSEN
S.; LO W.; HAMMETT C.; POULTER R.; NARASIMHAN S.; WIGGERS H.; NIELSEN H.;
GISLASON G.; KOBER L.A.R.S.; HOULIND K.I.M.; BOENELYKKE SOERENSEN V.;
DIXEN U.; REFSGAARD J.E.N.S.; ZEUTHEN E.; SOEGAARD P.; HRANAI M.; GASPAR
L.; PELLA D.; HATALOVA K.; DROZDAKOVA E.; COMAN I.O.A.N.; DIMULESCU D.;
VINEREANU D.; CINTEZA M.; SINESCU C.; ARSENESCU C.; BENEDEK I.M.R.E.;
BOBESCU E.; DOBREANU D.A.N.; GAITA D.A.N.; IANCU A.; ILIESIU A.; LIGHEZAN
D.; PETRESCU L.; PIRVU O.; TEODORESCU I.; TESLOIANU D.A.N.; VINTILA M.M.;
CHIONCEL O.
Institution
(Connolly, Eikelboom, Dyal, Lonn, Anand, Yusuf) Population Health Research
Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON,
Canada
(Bosch) School of Rehabilitation Science, McMaster University, Hamilton,
ON, Canada
(Dagenais) Institut Universitaire de Cardiologie et Pneumologie de Quebec,
Quebec, QC, Canada
(Lanas) Universidad de la Frontera, Temuco, Chile
(Metsarinne) Department of Medicine, Turku University Central Hospital and
Turku University, Turku, Finland
(O'Donnell) Department of Medicine, National University of Ireland,
Galway, Ireland
(Dans) Department of Medicine, University of Philippines, Manila,
Philippines
(Ha) Yonsei University College of Medicine, Seoul, South Korea
(Parkhomenko) Institute of Cardiology, Kiev, Ukraine
(Avezum) Instituto Dante Pazzanese de Cardiologia & University Santo
Amaro, Sao Paulo, Brazil
(Lisheng) FuWai Hospital, CAMS, Beijing, China
(Torp-Pedersen) University of Aalborg, Aalborg, Denmark
(Widimsky) Charles University, Prague, Czech Republic
(Maggioni) ANMCO Research Center, Florence, Italy
(Felix) Universidad Tecnologica Equinoccial, Facultad de Ciencias de la
Salud Eugenio, Espejo, Quito, Ecuador
(Keltai) Department of Medicine, Semmelweis University, Budapest, Hungary
(Hori) Osaka International Cancer Institute, Osaka, Japan
(Yusoff) Universiti Teknologi Mara, Selangor, Malaysia
(Guzik) Collegium Medicum Jagiellonian University, Krakow, Poland
(Guzik) University of Glasgow, Glasgow, United Kingdom
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center and Harvard
Medical School, Boston, MA, United States
(Branch) Department of Medicine, University of Washington Medical Centre,
Seattle, WA, United States
(Cook Bruns) Bayer AG, Wuppertal, Germany
(Berkowitz) Bayer AG, Parsippany, NJ, United States
(Varigos) Monash University, Melbourne, VIC, Australia
(Fox) Department of Medicine, University of Edinburgh, Edinburgh, United
Kingdom
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Coronary artery disease is a major cause of morbidity and
mortality worldwide, and is a consequence of acute thrombotic events
involving activation of platelets and coagulation proteins. Factor Xa
inhibitors and aspirin each reduce thrombotic events but have not yet been
tested in combination or against each other in patients with stable
coronary artery disease. Methods: In this multicentre, double-blind,
randomised, placebo-controlled, outpatient trial, patients with stable
coronary artery disease or peripheral artery disease were recruited at 602
hospitals, clinics, or community centres in 33 countries. This paper
reports on patients with coronary artery disease. Eligible patients with
coronary artery disease had to have had a myocardial infarction in the
past 20 years, multi-vessel coronary artery disease, history of stable or
unstable angina, previous multi-vessel percutaneous coronary intervention,
or previous multi-vessel coronary artery bypass graft surgery. After a
30-day run in period, patients were randomly assigned (1:1:1) to receive
rivaroxaban (2.5 mg orally twice a day) plus aspirin (100 mg once a day),
rivaroxaban alone (5 mg orally twice a day), or aspirin alone (100 mg
orally once a day). Randomisation was computer generated. Each treatment
group was double dummy, and the patients, investigators, and central study
staff were masked to treatment allocation. The primary outcome of the
COMPASS trial was the occurrence of myocardial infarction, stroke, or
cardiovascular death. This trial is registered with ClinicalTrials.gov,
number NCT01776424, and is closed to new participants. Findings: Between
March 12, 2013, and May 10, 2016, 27 395 patients were enrolled to the
COMPASS trial, of whom 24 824 patients had stable coronary artery disease
from 558 centres. The combination of rivaroxaban plus aspirin reduced the
primary outcome more than aspirin alone (347 [4%] of 8313 vs 460 [6%] of
8261; hazard ratio [HR] 0.74, 95% CI 0.65-0.86, p<0.0001). By comparison,
treatment with rivaroxaban alone did not significantly improve the primary
outcome when compared with treatment with aspirin alone (411 [5%] of 8250
vs 460 [6%] of 8261; HR 0.89, 95% CI 0.78-1.02, p=0.094). Combined
rivaroxaban plus aspirin treatment resulted in more major bleeds than
treatment with aspirin alone (263 [3%] of 8313 vs 158 [2%] of 8261; HR
1.66, 95% CI 1.37-2.03, p<0.0001), and similarly, more bleeds were seen in
the rivaroxaban alone group than in the aspirin alone group (236 [3%] of
8250 vs 158 [2%] of 8261; HR 1.51, 95% CI 1.23-1.84, p<0.0001). The most
common site of major bleeding was gastrointestinal, occurring in 130 [2%]
patients who received combined rivaroxaban plus aspirin, in 84 [1%]
patients who received rivaroxaban alone, and in 61 [1%] patients who
received aspirin alone. Rivaroxaban plus aspirin reduced mortality when
compared with aspirin alone (262 [3%] of 8313 vs 339 [4%] of 8261; HR
0.77, 95% CI 0.65-0.90, p=0.0012). Interpretation: In patients with stable
coronary artery disease, addition of rivaroxaban to aspirin lowered major
vascular events, but increased major bleeding. There was no significant
increase in intracranial bleeding or other critical organ bleeding. There
was also a significant net benefit in favour of rivaroxaban plus aspirin
and deaths were reduced by 23%. Thus, addition of rivaroxaban to aspirin
has the potential to substantially reduce morbidity and mortality from
coronary artery disease worldwide. Funding: Bayer AG. Copyright ©
2018 Elsevier Ltd

<91>
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. Copyright © 2018 Elsevier B.V.

<92>
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. Copyright © 2018

<93>
Accession Number
613254797
Title
Effect of the type of cardiopulmonary bypass pump flow on postoperative
cognitive function in patients undergoing isolated coronary artery
surgery.
Source
Anatolian Journal of Cardiology. 16 (11) (pp 875-880), 2016. Date of
Publication: 2016.
Author
Ozturk S.; Sacar M.; Baltalarli A.; Ozturk I.
Institution
(Ozturk) Department of Cardiovascular Surgery, Dr. Siyami Ersek
Cardiothoracic and Vascular Surgery Education and Research Hospital,
Istanbul, Turkey
(Sacar) Department of Cardiovascular Surgery, 18 Mart Univesity, Faculty
of Medicine, Canakkale, Turkey
(Baltalarli) Department of Cardiovascular Surgery, Pamukkale Univesity,
Faculty of Medicine, Denizli, Turkey
(Ozturk) Department of Anesthesiology, Goztepe Education and Research
Hospital, Istanbul, Turkey
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: Pulsatile flow, generated by a pump during cardiopulmonary
bypass, has been accepted as more physiological in coronary artery bypass
grafting surgery (CABG). Therefore, we aimed to investigate the effects of
pulsatile and nonpulsatile flow on postoperative cognitive function and to
review relationship with the biomarkers S100beta and neuron-specific
enolase (NSE). Methods: Patients who underwent isolated CABG were included
this prospective, randomized, double-blind study, which was performed
between March 2010 and December 2010. Patients were divided into two
groups: pulsatile (Group I, n=20) and nonpulsatile (Group II, n=20) flow.
Blood samples were collected 1 day before surgery and in the sixth
postoperative hour for the analysis of S100beta and NSE. In addition,
Mini- Mental State Examination (MMSE) was performed during preoperative
period and on third postoperative day. Outcomes were determination of
effects of pump flow type on cognitive function and relationships with
concentrations of S100beta and NSE. Results: Forty patients were included.
No differences were observed between the groups with respect to
complications, mortality, S100beta (Group I: 1.9+/-0.2 mu/L; Group II:
2.0+/-0.2 mu/L), NSE (Group I: 12.5+/-0.8 mu/L; Group II: 12.4+/-0.7
mu/L), MMSE scores [Group I: 25 (23-27); Group II: 25 (23-27)], and
postoperative cognitive dysfunction (POCD) (p>0.05). No correlation was
observed between MMSE scores and concentrations of S100beta (r=-0.032) and
NSE (r=-0.423) (p>0.05). Conclusion: There was no difference between types
of pump flow for POCD and no relationship between cognitive dysfunction
and S100beta and NSE concentrations. Pump flow type does not affect NSE
concentrations. Copyright © 2016 by Turkish Society of
Cardiology.

<94>
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 Copyright © 2018
The Author(s).

<95>
Accession Number
624865208
Title
Effect of cytoadsorbant device on post-cardio-pulmonary bypass
inflammation.
Source
Intensive Care Medicine Experimental. Conference: 31st European Society of
Intensive Care Medicine Annual Congress, ESICM 2018. France. 6 (Supplement
2) (no pagination), 2018. Date of Publication: October 2018.
Author
Poli E.; Bauer-Dorries A.; Marcucci C.; Roumy A.; Kirsch M.; De Stefano
E.; Liaudet L.; Schneider A.
Institution
(Poli, Liaudet, Schneider) Centre Hospitalier Universitaire Vaudois,
Service de Medecine Intensive Adulte, Lausanne, Switzerland
(Bauer-Dorries, Marcucci) Centre Hospitalier Universitaire Vaudois,
Service d'Anesthesiologie, Lausanne, Switzerland
(Roumy, Kirsch, De Stefano) Centre Hospitalier Universitaire Vaudois,
Service de Chirurgie Cardiovasculaire, Lausanne, Switzerland
Publisher
SpringerOpen
Abstract
INTRODUCTION. Cardiopulmonary bypass (CPB) is often associated with
degrees of complex inflammatory response. This inflammatory reaction,
sometimes referred to as "post-pump syndrome", is characterized by
activation of numerous inflammation pathways leading, in severe cases to
systemic hypotension and organ dysfunction [1, 2]. Cytokine Hemoadsorption
(HA) might therefore improve outcomes of patients undergoing cardiac
surgery. OBJECTIVES. In this randomized control trial (NCT02775123), we
aim to evaluate the safety and efficacy of a cytokine HA on post-CPB
inflammatory response in patients undergoing elective cardiac surgery and
at risk of post-operative complications. METHODS. 30 patients undergoing
elective cardiac surgery were randomly assigned either to standard CPB
(control group) or to CPB plus Cytosorb (Cytosorbents, New
Jersey, USA) (Cytosorb group). Our primary outcome was levels of
inflammatory cytokines (IL-1a, IL-1b, IL-2, IL-4, IL-5, IL-6, IL-10,
TNF-alpha, IFN-gamma, MCP-1) were measured at T0 (after induction of
anaesthesia), T2 (end of CPB), T3 (6 hours after CPB initiation) and T4
(24 hours after CPB initiation). Values are presented as median (IQR).
Comparisons were made using chi-square and Wilcoxon signed-rank test. A p
value < 0.05 was considered statistically significant. RESULTS. Baseline
demographics, peri-operative characteristics and procedures are detailed
in Table 1 and 2. There was no difference be-tween the two groups in terms
of need for any vasoconstrictor (p=1.0), mean noradrenaline dose on the
first post-operative day (p=0.87), need for any inotrope (p=0.682),
duration of mechanical ventilation (p=0.305), incidence of AKI (p=1.0),
ICU length of stay (p=1.0), ICU and hospital mortality (both p=1.0).
Cytokine levels are still pending. CONCLUSIONS. There was no difference in
baseline demographics, peri-operative characteristics nor post-operative
outcomes between the two sets of patients. Our primary outcome remains yet
to be determined as cytokine levels are still pending.

<96>
Accession Number
624865145
Title
Intra-and postoperative effects of remifentanil and fentanyl infusion in
patients with elective brain tumour surgery.
Source
Intensive Care Medicine Experimental. Conference: 31st European Society of
Intensive Care Medicine Annual Congress, ESICM 2018. France. 6 (Supplement
2) (no pagination), 2018. Date of Publication: October 2018.
Author
Loncar Stojiljkovic D.; Stojiljkovic M.P.
Institution
(Loncar Stojiljkovic) SGH Jevremova, Belgrade, Serbia
(Stojiljkovic) University of Banja Luka, Faculty of Medicine, Department
of Clinical Pharmacology, Banja Luka, Bosnia and Herzegovina
Publisher
SpringerOpen
Abstract
INTRODUCTION. Patients undergoing brain tumour surgery require proper
level of analgesia and cardiovascular stability during operation and
immediately thereafter. Contemporary anaesthetic techniques use for that
purpose continuous ivinfusion of opioid analgesic (1). OBJECTIVES. Goal of
this randomized clinical study was to compare the effects of two opioid
analgesics, remifentanil and fentanyl, administered as continuous iv
infusion during neurosurgery. METHODS. A total of 32 patients, ASA II-III,
with frontal region brain tumour were included in this single blind,
controlled clinical study.-They were randomised in two similar groups.
Remifentanil (RF) group received RF 1-2 mug/kg of body weight ivbo-lus and
continuously ivat the average infusion rate of 0.44 mug/kg/min, while the
fentanyl (F) group received 100 mug iv bolus, followed by a continuous iv
infusion at an average rate of 0.012 mug/kg/min. The infusion rates were
adjusted according to the sympathetic response to operational stimuli.
Postoperative infusion rates were 0.05mug/kg/min in RF group and 1-2
mug/kg/h in F group. At critical points of anaesthesia and operation
(0-baseline values;-Intubation;-brain manipulation,-end of operation;-1 h
postoperatively;-12 h postoperatively;-24 h postoperatively) haemodynamic
parameters were recorded. Analgesic consumption and adverse effects of
opioids were recorded during one day after the end of surgery. Length of
the operation in RF and F group were 227.5 (165-340) and 212 (175-298)
min, respectively. RESULTS. In almost all the critical points of operation
and immediate postoperative course cardiovascular stability was similar.
RF group showed tendency to lower, yet statistically not significant
values. The only significant difference in heart rate was found during
induction to anesthesia, when average values were lower in F than in RF
group (72 vs 100/min). In RF group in 2 patients there was need for
increase in the analgesic dose and in F group in only one patient. Adverse
effects were found in 7 RF patients (43.75%) and in 2 F patients (12.5 %)
Shivering was most frequent adverse effect found in the RF group, and it
was registered in 4 patients. CONCLUSIONS. There are no significant
differences between the groups in cardiovascular stability. Postoperative
pain control was similar in both groups. Adverse effects were more
frequent in RF than in the F group (7 vs 2). Postoperative shivering was
present in 4 RF patients, which is in accordance with literature data (2).
Shivering can be explained by the development of acute opioid tolerance
after long infusions of a very potent opioid, remifentanil.

<97>
Accession Number
624865113
Title
Lactate-guided therapy after cardiac surgery: A randomized and controlled
trial.
Source
Intensive Care Medicine Experimental. Conference: 31st European Society of
Intensive Care Medicine Annual Congress, ESICM 2018. France. 6 (Supplement
2) (no pagination), 2018. Date of Publication: October 2018.
Author
Souza D.H.D.P.; Almeida J.P.; Fukushima J.T.; Galas F.; Landoni G.; Park
C.; Oliveira G.; Nakamura R.; Mourao M.; Auler J.O.; Kalil-Filho R.;
Hajjar L.A.
Institution
(Souza, Almeida, Fukushima, Galas, Park, Oliveira, Nakamura, Mourao,
Auler, Kalil-Filho, Hajjar) Instituto Do Coracao, Faculdade de Medicina da
USP, Sao Paulo, Brazil
(Landoni) IRCCS San Raffaele Scientific Institute, Milano, Italy
Publisher
SpringerOpen
Abstract
INTRODUCTION. Elevated levels of lactate are associated to poor outcomes
in patients undergoing cardiac surgery, since they may represent anaerobic
metabolism consequent of imbalanced cellular oxygen consumption and
supply. However, whether a lactate-guided resuscitation in the
postoperative of cardiac surgery improves outcomes is still unknown.
OBJECTIVES. We aimed to determine whether a postoperative hemodynamic
therapy based on lactate levels reduces postoperative complications in
patients undergoing cardiac surgery, when compared to a postoperative
hemodynamic therapy which lactate levels were not disclosed to clinicians.
METHODS. We performed a single centre, randomized, double-blind,
controlled-parallel trial between October 2016 to December 2017 at the
Heart Institute of the University of Sao Paulo, Brazil. Patients
undergoing cardiac surgery were randomly assigned to either receive
fluids, vasopressors or inotropes by physicians who were aware of lactate
levels of patients, or to a group which physicians were not in-formed
about patient's lactate levels during the first 8 hours after ICU
admission. Lactate levels were measured every 2h and the aim of the
treatment in the lactate group was to reduce lactate levels at least in
20% if lactate levels were higher than 3 mmol/L. Primary outcome was
defined as acute kidney failure, defined as Acute Kidney Failure Network
(AKIN) score >=1, at postoperative day 7. Secondary outcomes were the
incidence of myocardial ischemia, AKI, require-ment of renal replacement
therapy, length of stay in the ICU and in the hospital, and mortality rate
at 28 days. RESULTS. A total of 280 patients were included. During the
first 8 hours after a ICU admission, patients of the lactate group
received more fluid than patients of control group, 797 mL (standard
deviation[SD] +/-789) vs 583 mL (SD +/-554), P=0.009. There was no
difference regarding lactate levels between groups. At 7 days, 66 of 141
patients (46.8%) in the lactate group and 82 of 139 patients (59.4%) in
the control group presented acute kidney injury (P=0.035). No significant
differences in secondary outcomes were observed between groups.
CONCLUSIONS. Postoperative lactate-guided therapy during the first 8 hours
after ICU admission reduces the incidence of acute kidney injury 7 days
after surgery in patients undergoing cardiac surgery.

<98>
Accession Number
624864874
Title
Desmopressin, as a hemostatic agent, should always be given with
tranexamic acid? A pilot study.
Source
Intensive Care Medicine Experimental. Conference: 31st European Society of
Intensive Care Medicine Annual Congress, ESICM 2018. France. 6 (Supplement
2) (no pagination), 2018. Date of Publication: October 2018.
Author
Spyridakis E.; Fotopoulou G.; Pappa E.; Kalakonas S.
Institution
(Spyridakis, Pappa, Kalakonas) Hygeia Private Hospital, Athens, Greece
(Fotopoulou) National and Kapodistrian University of Athens, 1st
Department of Intensive Care, Athens, Greece
Publisher
SpringerOpen
Abstract
INTRODUCTION. Excessive fibrinolysis remains a major component of acute
coagulopathy in patients undergoing on-pump coronary artery bypass
grafting (CABG). Desmopressin (DDAVP) (1) and tranexamic acid (TXA) (2)
secure the formation of normal blood clots through different pathways
(platelet adhesion and aggregation and inhibition of enzymatic degradation
of fibrin blood clots respectively). OBJECTIVES. The objective of our
study was to evaluate whether the efficacy of DDAVP is major when combined
with TXA. METHODS. We performed a randomized double-blind clinical trial
to investigate the fibrinolytic activity, represented by D-dimers, in 57
patients who underwent primary and isolated on-pump CABG surgery and
admitted in our cardiovascular intensive care unit between December 2017
and March 2018. The patients were randomized in two groups, group D (n=27)
and group B (n=28) according to whether they received DDAVP only (0,6
gamma/kg, divided in two doses, at the beginning and at the end of
surgery) or TXA as well (20 mg/kg at induction of anesthesia,10 mg/kg
during CPB and 30 mg/kg with protamine injection). The two groups were
compared for pre and post-operative levels of D-dimers as well as visible
blood loss defined as intra-and postoperative bleeding during the first 24
hours RESULTS. Median age of the patients included to the study was 66
years and 65% were males. Production of D-dimers and visible blood loss
was significantly lower in group B than group D (0.69 mg/L [+-0.49] vs
3.08 mg/L [+-2.05], p< 0.05 and 855 ml [+-330] vs 1491 ml [+-495], p<
0.05, respectively). Stratified analysis revealed statistically
significant association between D-dimers and blood loss (p< 0.01). An
increase in D-dimers indicated an increase in blood loss (rho=0.343).
CONCLUSIONS. These results suggest that DDAVP must always be given
concomitantly with TXA for maximum depression of fibrinolysis and minimum
blood loss during and after CABG.

<99>
Accession Number
624863946
Title
Prevalence of early mobilization and its effects within the intensive care
unit.
Source
Intensive Care Medicine Experimental. Conference: 31st European Society of
Intensive Care Medicine Annual Congress, ESICM 2018. France. 6 (Supplement
2) (no pagination), 2018. Date of Publication: October 2018.
Author
Marques Filho P.R.; Scorssato Boeira M.; Rodrigues C.; Leaes C.; Sant'anna
MacHado A.; Stormovski De Andrade J.M.; Krann Motta L.; Silva Bellolli
L.F.; Becker D.; Andrighetto Barbosa R.
Institution
(Marques Filho, Scorssato Boeira, Rodrigues, Leaes, Sant'anna MacHado,
Stormovski De Andrade, Krann Motta, Silva Bellolli, Becker, Andrighetto
Barbosa) Hospital Ernesto Dornelles, Porto Alegre, Brazil
Publisher
SpringerOpen
Abstract
INTRODUCTION. Patients admitted to the Intensive Care Unit (ICU) are often
subject to deleterious effects caused by long periods of immobilization.
Early mobilization has stood out, for it helps the functional recovery, is
able to reduce days in mechanical ventilation(MV) and ICU length of stay
(LoS). OBJECTIVES. To evaluate the prevalence of patients who underwent
early mobilization, and its effects on mechanical ventilation and ICU
length of stay. METHODS. 255 patients of both sexes were enrolled, with a
total of 941 physical therapy sessions. Patients were separated in two
randomized groups: group 1 patients were submitted to physical therapy
care within 12 hours of ICU admission; and group 2 underwent physical
therapy care after 12 hours of ICU admission. Physical therapy protocol
consisted of the aplication of four levels of mobilization: passive
exercise (N1), active exercise (N2), orthostastism (N3) and deambulation
(N4).Prevalence data were collected and the effects of early mobilization
on the MV time and LoS were evaluated. Data were described in percentiles
and average + standard deviation; in order to evaluate difference between
groups, Student's t test was used. A p< 0,05 was considered to be
statiscally significant. RESULTS. 52,2% of patients were male, 58,4% were
under mechanical ventilation and 39,9% were using vasoactive drugs. Main
causes for ICU admission were abdominal surgery (19,2%), cardiac surgery
(18%), and sepsis (16,5%). 62,3% of patients were moved from the bed;
Concerning levels of mobilization, 48,6% were able to perform active
exercises and 13,2% to deambulate. There were no difference of SAPS-3
scores between groups; however, in the group that was mobilized earlier a
reduction of both MV time (p< 0,05) and LoS (p< 0,05) was observed.
CONCLUSIONS. This study demonstrates that early mobilization, within a
time-frame under 24 hours of admission, has helped to reduce the duration
of mechanical ventilation and hospital length of stay, thus showing its
potential to improve outcomes in the Intensive Care Unit.

<100>
Accession Number
624863769
Title
Analysis of the transfusion savings guided by tromboelastography (TEG)
prior to invasive techniques in septic patients.
Source
Intensive Care Medicine Experimental. Conference: 31st European Society of
Intensive Care Medicine Annual Congress, ESICM 2018. France. 6 (Supplement
2) (no pagination), 2018. Date of Publication: October 2018.
Author
Rovira Valles Y.; Triginer Roig S.; Bielsa Berrocal L.; Sanchez Satorra
M.; Roig Pineda R.; Alonso Nogues E.; Grifols Ronda J.R.; Marcos Neira P.
Institution
(Rovira Valles, Triginer Roig, Bielsa Berrocal, Sanchez Satorra, Roig
Pineda, Marcos Neira) Hospital Universitari Germans Trias i Pujol,
Intensive Care Unit, Badalona, Spain
(Alonso Nogues, Grifols Ronda) Hospital Universitari Germans Trias i
Pujol, Banc de Sang i Teixits, Badalona, Spain
Publisher
SpringerOpen
Abstract
INTRODUCTION. Thromboelastography (TEG) is a global test of coagulation
which analyzes the whole coagulation process. TEG is popular in trauma,
liver transplant, and cardiac surgeries, but studies in sepsis are limited
(1). OBJECTIVES. To estimate transfusion savings prior to invasive
techniques in septic patients when guiding transfusion by TEG in
comparison with transfusion guided by the Spanish ICU transfusion
recommendations based on conventional coagulation tests. METHODS. Not
blinded randomized observational study. Inclusion criteria: septic
patients admitted in the ICU (apr-dec 2017). Exclusion criteria: absence
of informed consent. Randomization: TEG group (prophylactic transfusion
guided by TEG) or control group (prophylactic transfusion guided by
conventional coagulation tests) prior to an invasive technique. We
analysed clinical variables (var), coagulation and need of transfusion.
Analysis: description of quantitative var in means or medians (CI95%)
according to Shapiro test and qualitative var in proportions. Bivariate
analysis of qualitative var with Chi-squared test and quantitative var
with Mann-Whitney U test. Significance p< 0.05. RESULT(S): n=43.
Males were 67% (CI95%:51-81), age 62.4y (CI95%:58.4-66.5), APACHE II 28.1
(CI95%:24.7-31.5), SOFA 8.3 (CI95%:7.2-9.4), ICU length of stay (LOS) 9
days (CI95%:7-18), ICU mortality 17.5% (CI95%:83-33%), and in-hospital
mortality 25% (CI95%:14-41%). 55% of the patients were randomized in
control group and 45% in TEG group. Incorrect transfusion was found in
21.7% of the patients in the control group and in 6.9% patients in TEG
group (p=0.04). No haemorrhagic complications were found in any group.
Fresh frozen plasma (FFP) transfusion in control group was 437mL
(CI95%:280-550) vs 286mL (CI95%:284-290) in TEG group (p=0.4) and platelet
transfusion in control group was 550mL (CI95%:447-625) vs 265mL
(CI95%:256-275) in TEG group (p=0.08). TEG results were: normal (43%),
hypercoagulable (HyperC) (43%), hypocoagulable (HypoC) (14%). 45.5% of
patients with INR>=1.3 had a normal TEG, 45.5% hyperC TEG and 9% hypoC
TEG. 75% of the patients with APTTr>=1.3 had normal TEG, and 25% hypoC
TEG. 60% of patients with high fibrinogen levels and no one with normal
fibrinogen had an hyperC TEG (p=0.03); all patients with high platelet
count and 10% of patients with low platelet count had an hyperC TEG
(p=0.01). CONCLUSIONS. TEG previous to realization of invasive techniques
in septic patients optimizes transfusion. INR and APTTr in septic patients
do not relate with patients coagulation capacity. TEG prior to invasive
techniques in septic patients can save transfusion. TEG better reflects
the coagulation state in septic patients than the conventional coagulation
tests (INR and APTTr).

<101>
Accession Number
624863701
Title
Effect of transfusion on hemodynamic and oxygen variables: Systematic
review and meta-analysis.
Source
Intensive Care Medicine Experimental. Conference: 31st European Society of
Intensive Care Medicine Annual Congress, ESICM 2018. France. 6 (Supplement
2) (no pagination), 2018. Date of Publication: October 2018.
Author
Cavalcante Dos Santos E.; Orbegozo D.; Mongkolpun W.; Galfo V.; Gouvea
Bogossian E.; Nan W.; Taccone F.S.; Creteur J.; Vincent J.-L.
Institution
(Cavalcante Dos Santos, Orbegozo, Mongkolpun, Galfo, Gouvea Bogossian,
Nan, Taccone, Creteur, Vincent) Erasme Hospital,Universite Libre de
Bruxelles, Intensive Care Unit, Brussels, Belgium
Publisher
SpringerOpen
Abstract
INTRODUCTION. Anemia is a common problem in the intensive care unit (ICU).
Red blood cell transfusion (RBCT) can increase oxygen availability to the
tissues and help correct the mismatch between oxygen delivery and oxygen
consumption in this setting. However, studies evaluating the effects of
RBCT on tissue oxygenation have provided conflicting results, with some
showing improvement and others not. OBJECTIVES. To systematically review
the effects of blood transfusion on hemodynamics and oxygen variables.
METHODS. We performed a systematic review of all prospective,
retrospective, observational and interventional studies that included ICU
patients who had RBCT without active bleeding. The PubMed database was
searched for relevant studies from inception until the end of March 2017.
We excluded animal studies and all studies where cardiac output was
maintained constant before and after transfusion. We also excluded studies
that did not have sufficient data to enable calculation of the change in
hemoglobin concentration and at least one of the following variables after
RBCT: cardiac index/cardiac output, mixed venous oxygen saturation/central
venous oxygen saturation (SvO<inf>2</inf>/ScvO<inf>2</inf>), oxygen
delivery (DO<inf>2</inf>), oxygen consumption (VO<inf>2</inf>) and oxygen
extraction ratio (O<inf>2</inf>ER). We also collected heart rate (HR) and
blood lactate levels before and after RBCT. Studies were considered
according to the patient population included: sepsis, acute respiratory
failure, cardiac surgery, non-cardiac surgery, trauma, neurologic and
mixed. A meta-analysis and a meta-regression analysis were performed for
each hemodynamic and oxygenation variable to explore whether any baseline
pre-transfusion variable could predict an increase in VO<inf>2</inf> after
blood transfusion. All analyses were conducted using Comprehensive
Meta-analysis Software V2. The statistical significance alpha
level was 0.05. RESULTS. Of 2441 eligible studies, 37 met the inclusion
criteria: sepsis (n=17), acute respiratory failure (n=4), cardiac surgery
(n=5), non-cardiac surgery (n=3), neurologic (n=1), trauma (n=1) or mixed
(n=6). Cardiac index did not change after RBCT (k=19; diff means=-0.03;
95%CI,-0.10 to 0.04; p=0.444), HR decreased (k=19; diff means=-1.09;
95%CI,-1.86 to-0.32; p=0.005), SvO<inf>2</inf>/ScvO<inf>2</inf> increased
(k=29; diff means= 2.90; 95%CI, 2.16 to 3.63; p< 0.001), O<inf>2</inf>ER
decreased (k=22; diff means=-3.35; 95%CI,-4.55 to-2.16; p< 0.001),
DO<inf>2</inf> increased (k=22; diff means= 90.56; 95% CI, 68.59 to
112.53; p< 0.001) and VO<inf>2</inf> increased (k=22; diff means= 2.87;
95%CI, 0.35 to 5.38; p=0.025). Blood lactate concentration was the only
variable that predicted an increase in VO<inf>2</inf> after transfusion:
for every 1 mEq/L increase in blood lactate, VO<inf>2</inf> increased by
6.2 mL/min/m (p=0.006). CONCLUSIONS. We observed variable effects of RBCT
on systemic hemodynamics in heterogeneous cohorts of critically ill
patients. Elevated lactate level before RBCT is the only predictor of an
increase in VO<inf>2</inf> after transfusion.

<102>
Accession Number
624831386
Title
Immunomodulatory and Kidney-Protective Effects of the Human Chorionic
Gonadotropin Derivate EA-230.
Source
Nephron. 140 (2) (pp 148-151), 2018. Date of Publication: 2018.
Author
van Groenendael R.; Kox M.; van Eijk L.T.; Pickkers P.
Institution
(van Groenendael, Kox, van Eijk, Pickkers) Department of Intensive Care
Medicine, Radboud University Medical Center, Nijmegen, Netherlands
(van Groenendael, Kox, van Eijk, Pickkers) Radboud Institute for Molecular
Life Sciences, Radboud Center for Infectious Diseases (RCI), Nijmegen,
Netherlands
(van Groenendael, van Eijk) Department of Anesthesiology, Pain and
Palliative Medicine, Radboud University Medical Center, Nijmegen,
Netherlands
(van Groenendael, van Eijk) Radboud institute of Molecular Life Sciences
(RIMLS), Nijmegen, Netherlands
Publisher
NLM (Medline)
Abstract
The systemic inflammatory response following infectious or non-infectious
insults is related to morbidity (including acute kidney injury) and
mortality. Pregnancy is associated with immunotolerance and an increased
glomerular filtration rate. EA-230, a linear tetrapeptide
(Alanine-Glutamine-Glycine-Valine), derived from the beta-chain of the
human chorionic gonadotropin hormone, has shown immunomodulatory and
renoprotective properties in several pre-clinical animal models of
systemic inflammation. Furthermore, an excellent safety profile of EA-230
was observed in phase 1 studies in humans, and the immunomodulatory
effects of EA-230 were recently demonstrated in a phase IIa study during
human experimental endotoxemia. A prospective double-blind
placebo-controlled randomized trial in 180 patients undergoing elective
CABG-surgery with or without valve surgery is currently conducted to
investigate the immunomodulatory and renoprotective properties of
EA-230. Copyright © 2018 The Author(s) Published by S. Karger AG,
Basel.

<103>
Accession Number
624868504
Title
Valve durability after transcatheter aortic valve implantation.
Source
Journal of Thoracic Disease. 10 (Supplement30) (pp S3629-S3636), 2018.
Date of Publication: 01 Nov 2018.
Author
Kataruka A.; Otto C.M.
Institution
(Kataruka, Otto) Division of Cardiology, University of Washington, Box
356422, 1959 NE Pacific Street, HSB AA522, Seattle, WA 98195-6422, United
States
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Transcatheter aortic valve implantation (TAVI) is a minimally invasive
procedure to treat severe symptomatic aortic stenosis. While the TAVI
procedure can be performed safely and provide excellent 5-year results,
little is known about long-term durability. TAVI valves are composed of
bioprosthetic leaflets are prone to deterioration, which are categorized
as structural valve deterioration (SVD) and non-SVD. SVD refers to an
intrinsic pathology of the leaflets or stent structure with mechanisms
that include leaflet calcification, leaflet tear, stent fracture, or stent
creep. Non-SVD processes include valve thrombosis, infective endocarditis
and patient prosthesis mismatch. TAVI valves degenerate by similar
mechanisms as bioprosthetic surgical aortic valves. Unique mechanisms that
contribute to TAVI degeneration include valve crimpling, balloon
expansion, stent under-expansion and valve thrombosis. The absence of a
universally accepted definition of SVD poses a challenge in estimating
valve durability. Traditional surgical bioprosthetic aortic valves have
demonstrated excellent durability with clinically relevant SVD of 6.6% at
10-year follow up. Long-term durability of TAVI valves, however, remain
poorly defined. From meta-analysis TAVI trials, SVD was estimated at 7% at
5 years. With iterative improvements in TAVI valve construction and
deployment techniques, long-term durability may improve. Until long-term
outcomes are better understood, TAVI should be used with caution in
younger patients. Copyright © Journal of Thoracic Disease. All
rights reserved.

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