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<1>
Accession Number
620649618
Title
Hybrid coronary revascularization: Time for a new comparator?.
Source
Catheterization and Cardiovascular Interventions. 91 (2) (pp 213-214),
2018. Date of Publication: 01 Feb 2018.
Author
Misumida N.; Moliterno D.J.
Institution
(Misumida, Moliterno) Gill Heart Institute and Division of Cardiovascular
Medicine, University of Kentucky, Lexington, KY, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
The present meta-analysis found no significant difference between hybrid
coronary revascularization (HCR) and bypass surgery (CABG) regarding
intermediate-term major adverse cardiac and cerebrovascular events. HCR is
feasible, historically with higher revascularization rates but less
perioperative morbidity With a comparable frequency of repeat
revascularization between current-generation drug-eluting stents and CABG,
future trials of HCR are considering multi-vessel PCI as the new
comparator. Copyright © 2018 Wiley Periodicals, Inc.

<2>
Accession Number
620649608
Title
Deferred or immediate stent implantation for primary percutaneous coronary
intervention: A meta-analysis of randomized trials.
Source
Catheterization and Cardiovascular Interventions. 91 (2) (pp 260-264),
2018. Date of Publication: 01 Feb 2018.
Author
Mahmoud A.N.; Saad M.; Elgendy A.Y.; Mentias A.; Elgendy I.Y.
Institution
(Mahmoud, Elgendy, Elgendy) Division of Cardiovascular Medicine,
Department of Medicine, University of Florida, Gainesville, FL, United
States
(Saad) Department of Medicine, University of Arkansas, Little Rock, AR,
United States
(Mentias) Department of Medicine, University of Iowa, Iowa City, IA,
United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To perform a meta-analysis of randomized trials comparing a
deferred versus immediate stenting strategy for primary percutaneous
coronary intervention (PCI). Background(s): Deferred stent
implantation has emerged as a potential strategy aiming to reduce the
thrombus burden and improve micro-vascular reperfusion during primary PCI.
 Method(s): Electronic databases were searched for randomized trials
that compared a deferred stent implantation versus immediate stent
implantation strategy in patients undergoing primary PCI. Random effects
risk ratios (RR) were estimated for the outcomes of interest.
 Result(s): Four trials with 1,570 patients were included. A deferred
stent implantation strategy was associated with a lower incidence of
no-/slow reflow (RR 0.49, 95% confidence interval [CI] 0.24-0.96), and
improved myocardial blush grade 3 (RR 1.42, 95% CI 1.14-1.77). At a mean
follow up of 34 +/- 15 months, both strategies were associated with a
similar risk of all-cause mortality (RR 0.85, 95% CI 0.58-1.24),
cardiovascular mortality (RR 0.84, 95% CI 0.48-1.45), reinfarction (RR
1.54, 95% CI 0.43-5.49), and stent thrombosis (RR = 0.35, 95% CI
0.04-3.35, P = 0.36). Conclusion(s): In patients undergoing primary
PCI, deferred stent implantation is associated with improvement in
surrogate outcomes, but does not appear to improve clinical outcomes.
Future randomized trials are encouraged to identify the patient population
who might benefit from a deferred stent implantation strategy (e.g., high
thrombus burden). Copyright © 2017 Wiley Periodicals, Inc.

<3>
Accession Number
620649592
Title
Comparison of local versus general anesthesia in patients undergoing
transcatheter aortic valve replacement: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 91 (2) (pp 330-342),
2018. Date of Publication: 01 Feb 2018.
Author
Villablanca P.A.; Mohananey D.; Nikolic K.; Bangalore S.; Slovut D.P.;
Mathew V.; Thourani V.H.; Rode's-Cabau J.; Nunez-Gil I.J.; Shah T.; Gupta
T.; Briceno D.F.; Garcia M.J.; Gutsche J.T.; Augoustides J.G.; Ramakrishna
H.
Institution
(Villablanca, Slovut, Gupta, Briceno, Garcia) Division of Cardiovascular
Diseases, Montefiore Medical Center/Albert Einstein College of Medicine,
New York, NY, United States
(Mohananey) Department of Hospital Medicine, Cleveland Clinic, Cleveland,
OH, United States
(Nikolic, Ramakrishna) Department of Anesthesiology, Mayo Clinic,
Scottsdale, AZ, United States
(Bangalore) New York University School of Medicine, New York, NY, United
States
(Slovut) Department of Cardiothoracic and Vascular Surgery, Montefiore
Medical Center/Albert Einstein College of Medicine, New York, NY, United
States
(Mathew) Division of Cardiology, Loyola University Stritch School of
Medicine, Maywood, IL, United States
(Thourani) Division of Cardiothoracic Surgery, Emory University School of
Medicine, Atlanta, GA, United States
(Rode's-Cabau) Quebec Heart and Lung Institute, Quebec City, QC, Canada
(Nunez-Gil) Instituto Cardiovascular Hospital Clinico San Carlos, Madrid,
Spain
(Shah) Department of Internal Medicine, Montefiore Medical Center/Albert
Einstein College of Medicine, New York, NY, United States
(Gutsche, Augoustides) Department of Anesthesiology and Critical Care,
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,
United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is typically
performed under general anesthesia (GA). However, there is increasing data
supporting the safety of performing TAVR under local anesthesia/conscious
sedation (LA). We performed a meta-analysis to gain better understanding
of the safety and efficacy of LA versus GA in patients with severe aortic
stenosis undergoing TAVR. Methods and Results: We comprehensively
searched EMBASE, PubMed, and Web of Science. Effect sizes were summarized
using risk ratios (RRs) difference of the mean (DM), and 95% CIs
(confidence intervals) for dichotomous and continuous variables
respectively. Twenty-six studies and 10,572 patients were included in the
meta-analysis. The use of LA for TAVR was associated with lower overall
30-day mortality (RR, 0.73; 95% CI, 0.57-0.93; P = 0.01), use of
inotropic/vasopressor drugs (RR, 0.45; 95% CI, 0.28-0.72; P < 0.001),
hospital length of stay (LOS) (DM, -2.09; 95% CI, -3.02 to -1.16; P <
0.001), intensive care unit LOS (DM, -0.18; 95% CI, -0.31 to -0.04; P =
0.01), procedure time (DM, -25.02; 95% CI, -32.70 to -17.35; P < 0.001);
and fluoroscopy time (DM, -1.63; 95% CI, -3.02 to -0.24; P = 0.02). No
differences were observed between LA and GA for stroke, cardiovascular
mortality, myocardial infarction, permanent pacemaker implantation, acute
kidney injury, paravalvular leak, vascular complications, major bleeding,
procedural success, conduction abnormalities, and annular rupture.
 Conclusion(s): Our meta-analysis suggests that use of LA for TAVR is
associated with a lower 30-day mortality, shorter procedure time,
fluoroscopy time, ICU LOS, hospital length of stay, and reduced need for
inotropic support. Copyright © 2017 Wiley Periodicals, Inc.

<4>
Accession Number
616523419
Title
Late Incomplete stent apposition is associated with late/very late stent
thrombosis: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 91 (3) (pp 365-375),
2018. Date of Publication: 15 Feb 2018.
Author
Sethi A.; Singbal Y.; Rastogi U.; Prasad V.S.
Institution
(Sethi, Rastogi) Department of Interventional Cardiology, Icahn School of
Medicine at Mount Sinai, NY, United States
(Singbal) Department of Cardiology, University of Queensland, Brisbane,
Australia
(Prasad) Department of Cardiology, Loma Linda University, CA, United
States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: There is a lingering controversy in the current literature
about the impact of late incomplete stent apposition (LISA) on clinical
outcomes, especially stent thrombosis (ST). Therefore, we aimed to
synthesize the available evidence evaluating the association between LISA
and adverse clinical outcomes. Method(s): We systematically searched
electronic databases for studies reporting clinical outcomes in patients
with and without LISA. Relevant study characteristics and clinical
outcomes were extracted. Incidence rate ratios (IRR) and 95% Confidence
Interval (CI) were computed. Sensitivity analyses were done.
 Result(s): Sixteen studies with 4,946 patients; 666 patients with
20,035 patient-months follow up with LISA and 4,280 patients with 121,855
patient-months follow up without LISA were included. The estimated
prevalence of LISA at follow up was 16% (95% CI 12-20%). The incidences of
late/very late ST (IRR = 4.81, 95% CI 2.68-8.62) and myocardial infarction
(MI) (IRR = 3.09, 95% CI 1.72-5.55) were significantly higher in the LISA
group compared to patients without LISA. Subset analysis of studies
reporting Academic Research Consortium definitive/probable ST (IRR = 4.98;
95% CI 2.51-9.89) and acquired LISA (IRR = 3.67, 95% CI 1.5-9.0) similarly
showed increased risk of late/very late ST. The results of sensitivity
analyses were consistent. There was no difference in cardiac death and
target lesion revascularization. Conclusion(s): The presence of LISA
at a follow up of 6-18 months after stent implantation is associated with
a higher risk of late/very late ST and MI. Additional studies are required
to establish a cause and effect, and inform the management strategy.
© 2017 Wiley Periodicals, Inc.

<5>
Accession Number
618106868
Title
A systematic review of reported cases of combined transcatheter aortic and
mitral valve interventions.
Source
Catheterization and Cardiovascular Interventions. 91 (1) (pp 124-134),
2018. Date of Publication: 01 Jan 2018.
Author
Ando T.; Takagi H.; Briasoulis A.; Telila T.; Slovut D.P.; Afonso L.;
Grines C.L.; Schreiber T.
Institution
(Ando, Telila, Grines, Schreiber) Division of Cardiology, Wayne State
University, Detroit Medical Center, Detroit, MI, United States
(Takagi) Division of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Briasoulis) Division of Heart Failure, Mayo Clinic, Rochester, MN, United
States
(Slovut) Division of Cardiothoracic Surgery and Cardiology, Montefiore
Medical Center, Bronx, NY, United States
(Afonso) Division of Cardiology, Wayne State University, Detroit, MI,
United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To summarize the published data of combined transcatheter
aortic and mitral valve intervention (CTAMVI). Background(s): CTAMVI,
a combination of either transcatheter aortic valve replacement (TAVR) or
transcatheter aortic valve-in-valve (TAViV) and transcatheter mitral valve
replacement (TMVR), transcatheter mitral valve-in-valve/valve-in-ring
(TMViV/ViR), or percutaneous mitral valve repair (PMVR) is an attractive
alternative in high-surgical risk patients with combined aortic and mitral
valve disease. However, its procedural details and clinical outcomes have
not been well described. Method(s): We performed a systematic review
of all the published articles from PUBMED and EMBASE. Result(s): A
total of 37 studies with 60 patients were included. The indication for
CTAMVI was high or inoperable surgical risk and symptomatic severe aortic
stenosis (92%) or severe aortic regurgitation (8%) combined with moderate
to severe/severe mitral stenosis (30%) or moderate/severe mitral
regurgitation (65%) or both (5%). In majority of the cases, aortic valve
intervention was performed prior to the mitral valve. Mortality rate were
25% for TAVR + TMVR (range 42 days to 10 months), 17% for TAVR + TMViV/ViR
(range 13 days to 6 months), 0% for TAViV + TMViV/ViR (range 6-365 days),
and 15% for TAVR/ViV + PMVR (range 17 days to 419 days). Significant (more
than moderate) paravalvular regurgitation post-procedure was rare.
 Conclusion(s): CTAMVI appears to confer reasonable clinical outcome.
Further large study is warranted to clarify the optimal strategy,
procedural details and clinical outcomes in the future. Copyright
© 2017 Wiley Periodicals, Inc.

<6>
Accession Number
618550969
Title
Does mild paravalvular regurgitation post transcatheter aortic valve
implantation affect survival? A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 91 (1) (pp 135-147),
2018. Date of Publication: 01 Jan 2018.
Author
Ando T.; Briasoulis A.; Telila T.; Afonso L.; Grines C.L.; Takagi H.
Institution
(Ando, Telila, Afonso) Division of Cardiology, Wayne State University,
Harper Hospital, Detroit, MI, United States
(Ando, Takagi) ALICE (All-Literature Investigation Cardiovascular
Evidence) group, United States
(Briasoulis) Division of Heart Failure, Mayo Clinic, Rochester, MN, United
States
(Grines) Division of Cardiology, Detroit Medical Center, Detroit, MI,
United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: To assess the impact of post transcatheter aortic valve
implantation (TAVI) mild paravalvular regurgitation (PVR) on mortality.
More than moderate PVR after TAVI has decreased with the advent of
new-generation prosthetic valves. However, mild PVR remains common and its
clinical impact has been inconsistent. We aimed to assess the impact of
mild PVR through meta-analysis. Methods and Results: A systematic
literature search was conducted through PUBMED and EMBSE. Manuscripts that
reported hazard ratio (HR) with 95% confidence interval (CI) for clinical
outcome of interest (all-cause and cardiac mortality) has been included.
Random-effects model was used for calculation of HR. A total of 25
articles including total of 21,018 patients were finally included for
quantitative synthesis (meta-analysis). Our pooled analysis demonstrated
higher all-cause mortality in patients with mild PVR compared to
none/trivial PVR (HR 1.26, 95%CI 1.11-1.43, I2=45%, p < 0.001)
(follow up duration range 6 months to 5 years). Significant heterogeneity
among studies was observed (p for heterogeneity = 0.005). Egger's test
showed no evidence of publication bias. Cardiovascular mortality was
increased in patients with mild PVR compared with none/trivial PVR (HR
1.28, 95%CI 1.05-1.57, I2=8%, p = 0.02) (follow up duration
range 1-3 years). Conclusion(s): Mild PVR was associated with
increased all-cause and cardiovascular mortality after TAVI. Whether
further interventions in mild PVR is of benefit, has yet to be
determined. Copyright © 2017 Wiley Periodicals, Inc.

<7>
Accession Number
617329777
Title
TIcaGrEloR and Absorb bioresorbable vascular scaffold implantation for
recovery of vascular function after successful chronic total occlusion
recanalization (TIGER-BVS trial): Rationale and study design.
Source
Catheterization and Cardiovascular Interventions. 91 (1) (pp 1-6), 2018.
Date of Publication: 01 Jan 2018.
Author
Brugaletta S.; Gomez-Lara J.; Caballero J.; Ortega-Paz L.; Teruel L.;
Jimenez Fernandez M.; Romaguera R.; Alcalde Martinez V.; Nato M.; Molina
Navarro E.; Gomez-Hospital J.-A.; Correa Vilches C.; Joyera M.; Cequier
A.; Sabate M.
Institution
(Brugaletta, Ortega-Paz, Sabate) Cardiovascular Institute, Hospital
Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
(Gomez-Lara, Teruel, Romaguera, Nato, Gomez-Hospital, Cequier) Heart
Disease Institute, Bellvitge Universitari Hospital, Universitari of
Barcelona, IDIBELL, Barcelona, Spain
(Caballero, Jimenez Fernandez, Alcalde Martinez, Molina Navarro, Correa
Vilches) Hospitales Universitarios San Cecilio y Virgen de las Nieves,
Granada, Spain
(Joyera) Hospital Clinic, Barcelona, Spain
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To explore the role of ticagrelor versus clopidogrel in
coronary blood flow normalization immediately after chronic coronary total
occlusion (CTO) recanalization. Background(s): Coronary vascular
function of a CTO immediately after recanalization is demonstrated to be
poor. Method(s): The TIGER BVS is a prospective, double-randomized,
open-label, two parallel-group controlled clinical trial to evaluate
efficacy of ticagrelor versus clopidogrel in improving vascular function
of coronary segment distal to CTO immediately after CTO recanalization. A
total of 50 patients who receive CTO PCI will be randomized 1:1 to receive
ticagrelor versus clopidogrel at least 3 days before the procedure.
Immediately after CTO recanalization with Absorb BVS implantation, a
specific study of vascular function under adenosine infusion will be
performed. Patients will be therefore randomized 1:1 to receive
angiographic follow-up with vascular function and optical coherence
tomography analyses at 1- or 3-year follow-up. This study is registered on
ClinicalTrials.gov with number NCT02211066. Conclusion(s): The TIGER
BVS trial will provide the first randomized comparison between ticagrelor
versus clopidogrel in recovering vascular function in CTO patients. It
will also provide important data on vascular restoration therapy of Absorb
BVS in this scenario. Copyright © 2017 Wiley Periodicals, Inc.

<8>
Accession Number
616039972
Title
Hybrid coronary revascularization versus coronary artery bypass grafting
in patients with multivessel coronary artery disease: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 91 (2) (pp 203-212),
2018. Date of Publication: 01 Feb 2018.
Author
Sardar P.; Kundu A.; Bischoff M.; Chatterjee S.; Owan T.; Nairooz R.; Giri
J.; Halkos M.E.; Liberman H.; Douglas J.S.; Mukherjee D.
Institution
(Sardar, Owan) Division of Cardiovascular Medicine, University of Utah,
Salt Lake City, UT, United States
(Kundu) Department of Medicine, University of Massachusetts Medical
School, Worcester, MA, United States
(Bischoff) Department of Medicine, University of Utah, Salt Lake City, UT,
United States
(Chatterjee) Division of Cardiovascular Medicine, Temple University School
of Medicine, Philadelphia, PA, United States
(Nairooz) Division of Cardiovascular Medicine, University of Arkansas for
Medical Sciences, Little Rock, AR, United States
(Giri) Cardiovascular Division, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Halkos) Division of Cardiothoracic Surgery, Emory University School of
Medicine, Atlanta, GA, United States
(Liberman, Douglas) Clinical Research Unit, Division of Cardiology, Emory
University School of Medicine, Atlanta, United States
(Mukherjee) Division of Cardiovascular Medicine, Texas Tech University
Health Sciences Center, El Paso, TX, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: This meta-analysis evaluated the effectiveness of hybrid
coronary revascularization (HCR) compared to coronary artery bypass
grafting (CABG) for the treatment of multivessel coronary artery disease
(MVCAD). Background(s): HCR involves a combination of surgical and
percutaneous techniques, which in selected patients may present an
alternative to conventional CABG. Method(s): Databases were searched
through June 30, 2016, and studies comparing HCR with CABG for treatment
of MVCAD were selected. We calculated summary odds ratios (ORs) and 95%
CIs with the random-effects model. The primary outcome of interest was the
occurrence of major adverse cardiac and cerebrovascular events (MACCE),
defined as a composite of all cause mortality, myocardial infarction, and
stroke. Result(s): The analysis included 2,245 patients from 8
studies (1 randomized controlled trial and 7 observational studies). The
risk of MACCE with HCR and CABG were 3.6% and 5.4%, respectively (OR,
0.53; 95% CI, 0.24-1.16). Compared to CABG group, patients in HCR group
had similar risk of all cause mortality (OR, 0.85; 95% CI, 0.38-1.88),
myocardial infarction (OR, 0.72; 95% CI, 0.31-1.64), stroke (OR, 0.53; 95%
CI, 0.23-1.20), and repeat revascularization (OR, 1.28; 95% CI,
0.58-2.83). The need for postoperative blood transfusions (OR, 0.29; 95%
CI, 0.14-0.59) and hospital stay (weighted mean difference -1.20 days; 95%
CI -1.52 to -0.88 days) was significantly lower in the HCR group.
 Conclusion(s): HCR appears to be safe, and has similar outcomes when
compared with conventional CABG. HCR can be a suitable alternative to
conventional CABG in select patients with MVCAD. © 2017 Wiley
Periodicals, Inc.

<9>
Accession Number
613961578
Title
Thromboelastography (TEG) or rotational thromboelastometry (ROTEM) to
monitor haemostatic treatment in bleeding patients: a systematic review
with meta-analysis and trial sequential analysis.
Source
Anaesthesia. 72 (4) (pp 519-531), 2017. Date of Publication: 01 Apr 2017.
Author
Wikkelso A.; Wetterslev J.; Moller A.M.; Afshari A.
Institution
(Wikkelso) Department of Anaesthesia and Intensive Care Medicine, Hvidovre
Hospital, Copenhagen University Hospital, Hvidovre, Denmark
(Wetterslev) Copenhagen Trial Unit, Centre for Clinical Intervention
Research, University of Copenhagen, Copenhagen, Denmark
(Moller) Department of Anaesthesia and Intensive Care Medicine, Herlev
Hospital, Herlev, Denmark
(Afshari) Department of Paediatric and Obstetric Anaesthesia, Juliane
Marie Center, Copenhagen University Hospital, Copenhagen, Denmark
Publisher
Blackwell Publishing Ltd
Abstract
Coagulopathy and severe bleeding are associated with high mortality. We
evaluated haemostatic treatment guided by the functional viscoelastic
haemostatic assays, thromboelastography or rotational thromboelastometry
in bleeding patients. We searched for randomised, controlled trials
irrespective of publication status, publication date, blinding status,
outcomes published or language from date of inception to 5 January 2016 in
six bibliographic databases. We included 17 trials (1493 participants),
most involving cardiac surgery. Thromboelastography or rotational
thromboelastometry seemed to reduce overall mortality compared to any of
our comparisons (3.9% vs. 7.4%, RR (95% CI) 0.52 (0.28-0.95);
I2 = 0%, 8 trials, 717 participants). However, the quality of
evidence is graded as low due to the high risk of bias, heterogeneity,
imprecision and low event rate. Thromboelastography or rotational
thromboelastometry significantly reduced the proportion of patients
transfused with red blood cells (RR (95% CI) 0.86 (0.79-0.94);
I2 = 0%, 10 trials, 832 participants), fresh frozen plasma (RR
(95% CI) 0.57 (0.33-0.96); I2 = 86%, 10 trials, 832
participants) and platelets (RR (95% CI) 0.73 (0.60-0.88); I2 =
0%, 10 studies, 832 participants). There was no difference in proportion
needing surgical re-interventions (RR (95% CI) 0.75 (0.50-1.10);
I2 = 0%, 9 trials, 887 participants). Trial sequential analysis
of mortality suggests that only 54% of the required information size has
been reached so far. Transfusion strategies guided by thromboelastography
or rotational thromboelastometry may reduce the need for blood products in
patients with bleeding, but the results are mainly based on trials of
elective cardiac surgery involving cardiopulmonary bypass, with
low-quality evidence. Copyright © 2017 The Association of
Anaesthetists of Great Britain and Ireland

<10>
Accession Number
614924738
Title
Long-term outcomes and cost effectiveness of high-dose dexamethasone for
cardiac surgery: a randomised trial.
Source
Anaesthesia. 72 (6) (pp 704-713), 2017. Date of Publication: June 2017.
Author
Dieleman J.M.; de Wit G.A.; Nierich A.P.; Rosseel P.M.; van der Maaten
J.M.; Hofland J.; Diephuis J.C.; de Lange F.; Boer C.; Neslo R.E.; Moons
K.G.; van Herwerden L.A.; Tijssen J.G.; Kalkman C.J.; van Dijk D.
Institution
(Dieleman, Kalkman, van Dijk) Department of Anesthesiology and Intensive
Care, University Medical Center, Utrecht, Netherlands
(de Wit, Neslo, Moons) Julius Center for Health Sciences and Primary Care,
University Medical Center, Utrecht, Netherlands
(Nierich) Department of Cardiothoracic Anesthesia, Isala Klinieken,
Zwolle, Netherlands
(Rosseel) Department of Cardiothoracic Anesthesia, Amphia Ziekenhuis,
Breda, Netherlands
(van der Maaten) Department of Anesthesiology, University Medical Center,
Groningen, Netherlands
(Hofland) Department of Cardiothoracic Anesthesia, Erasmus Medical Center,
Rotterdam, Netherlands
(Diephuis) Department of Cardiothoracic Anesthesia, Medisch Spectrum
Twente, Enschede, Netherlands
(de Lange) Department of Cardiothoracic Anesthesia, Medical Center,
Leeuwarden, Netherlands
(Boer) Department of Anesthesiology, Vrije Universiteit University Medical
Center, Amsterdam, Netherlands
(van Herwerden) Department of Cardiothoracic Surgery, University Medical
Center, Utrecht, Netherlands
(Tijssen) Department of Cardiology, Academic Medical Center, Amsterdam,
Netherlands
Publisher
Blackwell Publishing Ltd
Abstract
Prophylactic intra-operative administration of dexamethasone may improve
short-term clinical outcomes in cardiac surgical patients. The purpose of
this study was to evaluate long-term clinical outcomes and cost
effectiveness of dexamethasone versus placebo. Patients included in the
multicentre, randomised, double-blind, placebo-controlled DExamethasone
for Cardiac Surgery (DECS) trial were followed up for 12 months after
their cardiac surgical procedure. In the DECS trial, patients received a
single intra-operative dose of dexamethasone 1 mg.kg-1 (n =
2239) or placebo (n = 2255). The effects on the incidence of major
postoperative events were evaluated. Also, overall costs for the 12-month
postoperative period, and cost effectiveness, were compared between
groups. Of 4494 randomised patients, 4457 patients (99%) were followed up
until 12 months after surgery. There was no difference in the incidence of
major postoperative events, the relative risk (95%CI) being 0.86
(0.72-1.03); p = 0.1. Treatment with dexamethasone reduced costs per
patient by 921 [1084] (95%CI -1672 to -137; p = 0.02), mainly through
reduction of postoperative respiratory failure and duration of
postoperative hospital stay. The probability of dexamethasone being cost
effective compared with placebo was 97% at a threshold value of 17,000
[20,000] per quality-adjusted life year. We conclude that intra-operative
high-dose dexamethasone did not have an effect on major adverse events at
12 months after cardiac surgery, but was associated with a reduction in
costs. Routine dexamethasone administration is expected to be cost
effective at commonly accepted threshold levels for cost
effectiveness. Copyright © 2017 The Association of Anaesthetists
of Great Britain and Ireland

<11>
Accession Number
612422315
Title
Microvascular reactivity and endothelial glycocalyx degradation when
administering hydroxyethyl starch or crystalloid during off-pump coronary
artery bypass graft surgery: a randomised trial.
Source
Anaesthesia. 72 (2) (pp 204-213), 2017. Date of Publication: 01 Feb 2017.
Author
Kim T.K.; Nam K.; Cho Y.J.; Min J.J.; Hong Y.J.; Park K.U.; Hong D.M.;
Jeon Y.
Institution
(Kim, Cho, Min, Hong, Jeon) Department of Anaesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul, South Korea
(Nam) Cheoncheon Public Health Subcentre, Jangsu Health Centre and County
Hospital, Jangsu, Jeollabuk-do, South Korea
(Hong, Park) Department of Laboratory Medicine, Seoul National University
Bundang Hospital, Seongnam, Gyeongi-do, South Korea
Publisher
Blackwell Publishing Ltd
Abstract
The infusion of fluids to patients may affect tissue microcirculation and
the endothelial glycocalyx. However, the effects of hydroxyethyl starch
and crystalloid on endothelial glycocalyx degradation and microvascular
reactivity have not been evaluated in detail. We hypothesised that
hydroxyethyl starch may cause less endothelial glycocalyx degradation and
better microvascular reactivity than that caused by crystalloid. We
randomly allocated 120 patients undergoing off-pump coronary artery bypass
graft surgery to receive up to 20 ml.kg-1 of either
hydroxyethyl starch 670/0.75 or crystalloid for intra-operative fluid
resuscitation. Crystalloid was then infused to meet ongoing fluid
requirements. During the peri-operative period, vascular occlusion tests
were performed to assess microvascular reactivity, and serum syndecan-1
was measured as an index of endothelial glycocalyx degradation. The median
(IQR [range]) fluid infused during surgery was significantly less in the
hydroxyethyl starch group than the crystalloid group; 2800 (2150-3550
[1400-7300]) vs. 3925 (3100-4725 [1900-6700]) ml, respectively, p < 0.001.
Vascular occlusion test parameters, including tissue oxygen saturation,
occlusion and recovery slope did not differ significantly between the
groups. Peri-operative changes in syndecan-1 were not significantly
different between the groups. We conclude that, in patients undergoing
off-pump coronary artery bypass graft surgery, compared with crystalloid,
the use of hydroxyethyl starch 670/0.75 did not result in significant
differences in microvascular reactivity or endothelial glycocalyx
degradation. Copyright © 2016 The Association of Anaesthetists of
Great Britain and Ireland

<12>
Accession Number
2001161926
Title
Meta-Analysis Comparing Outcomes of Drug Eluting Stents Versus Single and
Multiarterial Coronary Artery Bypass Grafting.
Source
American Journal of Cardiology. 122 (12) (pp 2018-2025), 2018. Date of
Publication: 15 December 2018.
Author
Gaudino M.; Rahouma M.; Abouarab A.; Tam D.Y.; Di Franco A.; Leonard J.;
Benedetto U.; Iannaccone M.; D'Ascenzo F.; Biondi-Zoccai G.; Vallely M.;
Girardi L.N.; Fremes S.E.; Taggart D.P.
Institution
(Gaudino, Rahouma, Abouarab, Di Franco, Leonard, Girardi) Department of
Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United
States
(Tam, Fremes) Schulich Heart Centre, Sunnybrook Health Science, University
of Toronto, Toronto, Ontario, Canada
(Benedetto) School of Clinical Sciences, Bristol Heart Institute,
University of Bristol, Bristol, United Kingdom
(Iannaccone, D'Ascenzo) Citta della Scienza e della Salute, Department of
Cardiology, University of Turin, Torino, Italy
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University, Rome, Italy
(Biondi-Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed,
Pozzilli, Italy
(Vallely) Sydney Medical School, The University of Sydney, Sydney, New
South Wales, Australia
(Taggart) University of Oxford, Oxford, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Relative benefits of coronary artery bypass (CABG) using single and
multiple arterial grafting (SAG, MAG) and drug eluting stent (DES) in
multivessel coronary disease remain uncertain. We compared SAG, MAG, and
DES in a pairwise and network meta-analysis. Randomized trials and
adjusted observational studies comparing CABG versus DES were included
(primary end point: long-term mortality; secondary end points: operative
mortality, perioperative stroke, and follow-up repeated revascularization
[RR]). Studies with >=1.7 arterial grafts and/or patient were classified
as MAG. Bayesian network meta-analyses and random-model pairwise
meta-analyses were performed. A total of 53,239 patients (8 randomized, 17
observational studies) were included (26,306 DES; 26,933 CABG). In
pairwise comparison (mean follow-up: 5.42 years), CABG (MAG + SAG) was
associated with lower long-term mortality (incident rate ratio [IRR] 0.77,
95% confidence interval [CI] 0.66 to 0.90), lower RR (IRR 0.37, 95% CI
0.27 to 0.51), increased perioperative stroke (odds ratio [OR] 3.18, 95%
CI 1.70 to 5.97), and similar operative mortality (OR 1.04, 95% CI 0.64 to
1.70) compared with DES. There was a nonsignificant trend toward lower
long-term mortality for studies with higher mean number of arterial
grafts. In network meta-analyses, compared with DES, MAG was associated
with lower long-term mortality (IRR 0.72, 95% credible interval [CrI] 0.57
to 0.92) and late RR (IRR 0.32, 95% CrI 0.21 to 0.49), SAG was associated
with lower long-term mortality and RR (IRR 0.80, 95% CrI 0.66 to 0.97 and
IRR 0.42, 95% CrI 0.29 to 0.61, respectively). In conclusion, CABG was
associated with reduced 5-year mortality and need for RR compared with
DES. MAG was ranked as the best treatment for the primary and all
secondary outcomes. Copyright © 2018

<13>
Accession Number
625147410
Title
The impact of applying both a critical statistical and a critical clinical
appraisal to the randomised trials that form the cardiology
revascularization guidelines: Implications for clinical practice.
Source
BMJ Evidence-Based Medicine. Conference: 7th Evidence Live Conference.
United Kingdom. 23 (Supplement 1) (pp A23-A24), 2018. Date of Publication:
June 2018.
Author
Dobies D.; Barber K.
Institution
(Dobies) Regional Cardiology Associates, Grand Blanc, United States
(Barber) Genesys Office of Research, Grand Blanc, United States
Publisher
BMJ Publishing Group
Abstract
Objectives Randomised trials and guidelines are used by physicians,
administrators, patients, and policy makers to make medical decisions. The
assumption is that the randomised trial conclusions and the guideline
recommendations are accurate and have been properly vetted. Furthermore,
the randomised trial conclusions and guideline recommendations are used
for certification examinations. Therefore, a critical appraisal should be
performed. Both a critical statistical and a critical clinical evaluation
should be performed. Method The 5 Year Syntax and the Freedom Trials were
evaluated. These trials compared percutaneous coronary artery intervention
(PCI) utilising drug eluting stents to coronary artery bypass (CABG). In
both trials patients with multi-vessel coronary disease were studied.
These two trials form the basis on the cardiology guidelines. Both trials
reported a highly significant result favouring CABG over PCI for patients
with mult-vessel coronary artery disease. Both a critical statistical and
a critical clinical evaluation of these two trials was performed. From a
statistical standpoint, a sensitivity analysis was performed that included
Forest plots. Also, the number needed to treat vs the number needed to
harm was calculated. From a clinical standpoint, the definition of a
myocardial infarction was evaluated along with the clinical impact. Both
trials had significant limitations due to missing data. Results The actual
statistical findings of both the 5 Year Syntax Trial and the Freedom Trial
demonstrated no difference in major adverse cardiovascular and
cerebrovascular events (MACCE). The critical statistical analysis of the
Syntax Trial differed significantly from the reported trial results
because the effect of missing data was accounted for. The reported results
counted all missing data as non-events. The missing data was calculated as
non-events, study event average, and as having events. The clinical
evaluation focused on the definition of a myocardial infarction that was
the biggest component of the MACCE rate. The definition was different for
the CABG patients compared to the PCI patients. The Freedom Trial reported
results were severely limited by the calculation of ratio at risk, a high
differential loss, and a high overall attrition rate. When these
limitations are corrected for the actual results show no difference
between PCI and CABG. Conclusions The reported results of both the 5 Year
Syntax Trial and The Freedom Trial differed significantly from the actual
trial findings since either subjects were excluded or missing data was
only calculated as non-events. Both trial conclusions were severely
compromised. From a clinical standpoint, the definition of a myocardial
infarction was study dependent, a newer generation of stents are used
which are safer, and newer and more effective anti-platelet medications
are used in current practice. Given the concern over the accuracy of
reported conclusions of randomised trials, guideline committees should
utilise independent statisticians for accurate analysis.

<14>
Accession Number
625132930
Title
Intraoperative hypotension is not associated with postoperative cognitive
dysfunction in elderly patients undergoing general anesthesia for surgery:
results of a randomized controlled pilot trial.
Source
Journal of clinical anesthesia. 52 (pp 111-118), 2019. Date of
Publication: 01 Feb 2019.
Author
Langer T.; Santini A.; Zadek F.; Chiodi M.; Pugni P.; Cordolcini V.;
Bonanomi B.; Rosini F.; Marcucci M.; Valenza F.; Marenghi C.; Inglese S.;
Pesenti A.; Gattinoni L.
Institution
(Langer, Valenza, Pesenti, Gattinoni) Department of Pathophysiology and
Transplantation, University of Milan, Milan, Italy; Department of
Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda
Ospedale Maggiore Policlinico, Milan, Italy
(Santini, Marenghi) Department of Anesthesia, Critical Care and Emergency,
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
(Zadek, Chiodi, Pugni, Cordolcini) Department of Pathophysiology and
Transplantation, University of Milan, Milan, Italy
(Bonanomi) Geriatric Unit, Department of Medical Sciences and Community
Health, University of Milan, Italy
(Rosini, Inglese) Geriatric Unit, Department of Medical Sciences and
Community Health, University of Milan, Italy; Fondazione IRCCS Ca' Granda
Ospedale Maggiore Policlinico, Milan, Italy
(Marcucci) Geriatric Unit, Department of Medical Sciences and Community
Health, University of Milan, Italy; Department of Health Research Methods,
Evidence, and Impact, McMaster University, Hamilton, ON, Canada;
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Publisher
NLM (Medline)
Abstract
STUDY OBJECTIVE: To assess the effect of different intraoperative blood
pressure targets on the development of POCD and test the feasibility of a
larger trial. DESIGN: Randomized controlled pilot trial. SETTING:
Perioperative care in a tertiary care teaching hospital with outpatient
follow-up. PATIENTS: One hundred one patients aged >=75years with ASA
physical status <4, undergoing elective, non-cardiac surgery under general
anesthesia and 33 age-matched healthy controls. INTERVENTIONS:
Randomization to a personalized intraoperative blood pressure target, mean
arterial pressure (MAP)>=90% of preoperative values (Target group), or to
a more liberal intraoperative blood pressure management (No-Target group).
Strategies to reach intraoperative blood pressure target were at
discretion of anesthesiologists. MEASUREMENTS: An experienced
neuropsychologist performed a validated battery of neurocognitive tests
preoperatively and 3months after surgery. Incidence of POCD at three
months and postoperative delirium were assessed. Intraoperative time spent
with MAP>=90% of preoperative values, recruitment and drop-out rate at
3months were feasibility outcomes. MAIN RESULTS: The Target group spent a
higher percentage of intraoperative time with MAP >=90% of preoperative
values (65+/-25% vs. 49+/-28%, p<0.01). Incidence of POCD (11% vs. 7%,
relative risk 1.52; 95% CI, 0.41 to 6.3; p=0.56) and delirium (6% vs. 14%,
relative risk, 0.44; 95% CI, 0.12 to 1.60; p=0.21) did not differ between
groups. No correlation was found between intraoperative hypotension and
postoperative cognitive performance (p=0.75) or delirium (p=0.19).
Recruitment rate was of 6patients/month (95% confidential interval (CI), 5
to 7) and drop-out rate at 3months was 24% (95% CI, 14 to 33%).
 CONCLUSION(S): Intraoperative hypotension did not correlate with
postoperative cognitive dysfunction or delirium occurrence in elderly
patients undergoing general anesthesia for non-cardiac surgery. A
multicenter randomized controlled trial is needed in order to confirm the
effect of intraoperative blood pressure on the development of POCD. TRIAL
REGISTRATION NUMBER: NCT02428062www.clinicaltrials.gov. Copyright
© 2018 Elsevier Inc. All rights reserved.

<15>
Accession Number
625132381
Title
Levosimendan use in patients with preoperative low ejection fraction
undergoing cardiac surgery: A systematic review with meta-analysis and
trial sequential analysis.
Source
Journal of clinical anesthesia. 52 (pp 37-47), 2019. Date of Publication:
01 Feb 2019.
Author
Ng K.T.; Chan X.L.; Tan W.; Wang C.Y.
Institution
(Ng, Wang) Department of Anaesthesiology, Faculty of Medicine, University
of Malaya, Jalan Universiti, Kuala Lumpur 50603, Malaysia
(Chan, Tan) School of Medicine, University of Bristol, Bristol, United
Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Patients with preoperative low left ventricular ejection
fraction (LVEF) are known to be associated with high morbidities and
mortality in cardiac surgery. The primary aim of this review was to
examine the clinical outcomes of levosimendan versus placebo in patients
with preoperative low LVEF<=50% undergoing cardiac surgery. DATA SOURCES:
MEDLINE, EMBASE, PubMed and CENTRAL were searched systematically from
their inception until June 2018. REVIEW METHODS: All the randomised
clinical trials (RCTs) were included. RESULT(S): Twelve trials were
eligible (n=1867) for inclusion in the data synthesis. In comparison to
the placebo cohort, the levosimendan cohort showed a significant reduction
in mortality (TSA=inconclusive; rho=0.002; I2=0%; FEM: OR 0.56; 95% CI
0.39, 0.80), especially in the subgroups of preoperative severe low
LVEF<=30% (rho=0.003; OR 0.33; 95% CI 0.16, 0.69), preoperative
administering of levosimendan (rho=0.001; OR 0.46; 95% CI 0.29, 0.74) and
patients who had bolus followed by infusion of levosimendan (rho=0.005; OR
0.50; 95% CI 0.30, 0.81). However, the effect on mortality was not
significant in the subgroup analysis of high quality trials (rho=0.14; OR
0.73; 95% CI 0.47, 1.12). The levosimendan cohort showed a significantly
lower incidence of low-cardiac-output-syndrome (rho<0.001; OR 0.58; 95% CI
0.46, 0.74) and lesser need for mechanical support of cardiac assist
devices (rho=0.02; OR 0.39; 95% CI 0.18, 0.86). CONCLUSION(S): Given
the low level of evidence and inconclusive TSA, the results of this
meta-analysis neither support nor oppose the use of levosimendan in
cardiac patients with preoperative low LVEF<=50%. Therefore, multi-centre,
adequately powered, randomised controlled trials are warranted. PROSPERO
REGISTRATION: CRD42017067572. Copyright © 2018 Elsevier Inc. All
rights reserved.

<16>
Accession Number
625135073
Title
Polyvascular disease, type 2 diabetes, and long-term vascular risk: a
secondary analysis of the IMPROVE-IT trial.
Source
The lancet. Diabetes & endocrinology. 6 (12) (pp 934-943), 2018. Date of
Publication: 01 Dec 2018.
Author
Bonaca M.P.; Gutierrez J.A.; Cannon C.; Giugliano R.; Blazing M.; Park
J.-G.; White J.; Tershakovec A.; Braunwald E.
Institution
(Bonaca, Cannon, Giugliano, Park, Braunwald) Cardiovascular Division,
Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine,
Harvard Medical School, Boston, MA, USA
(Gutierrez, Blazing, White) Duke Clinical Research Institute, Duke
University School of Medicine, Durham, NC, United States
(Tershakovec) Merck, Kenilworth, NJ, USA
Publisher
NLM (Medline)
Abstract
BACKGROUND: Polyvascular disease and type 2 diabetes are each associated
with increased cardiovascular risk, but whether these risks are additive
is unknown. In this exploratory analysis of a randomised trial, we
explored the long-term cardiovascular risk associated with polyvascular
disease, type 2 diabetes, and their combination in patients with acute
coronary syndrome, and assessed the effect of ezetimibe given on top of
statin therapy in patients with these concomitant conditions.
 METHOD(S): IMPROVE-IT was a multicentre, double-blind, randomised,
placebo-controlled trial assessing the effect of ezetimibe added to statin
therapy after acute coronary syndrome. Recruitment was from Oct 26, 2005,
to July 8, 2010, and the trial was done at 1158 sites in 39 countries. 18
144 patients aged 50 years and older who had been stabilised after an
acute coronary syndrome were randomly assigned to 40 mg per day
simvastatin plus either 10 mg per day ezetimibe or matched placebo, for a
median duration of 6 years. In this post-hoc exploratory analysis, we
assessed the prespecified endpoints of the trial, including the primary
composite endpoint (cardiovascular death, a major coronary event
[non-fatal myocardial infarction, documented unstable angina requiring
hospital admission, or coronary revascularisation occurring at least 30
days after randomisation], or stroke [ischaemic or haemorrhagic]) by
concomitant polyvascular disease at baseline (peripheral artery disease or
previous stroke or transient ischaemic attack) and stratified by
concomitant type 2 diabetes. Efficacy analyses were done according to
intention to treat and event rates. IMPROVE-IT is registered with
ClinicalTrials.gov, number NCT00202878. FINDINGS: 1005 patients (6%) had
peripheral artery disease and 1071 (6%) had stroke or transient ischaemic
attack at baseline. Of these, 388 (39%) and 409 (38%) also had concomitant
type 2 diabetes, respectively. At 7 years, patients with either
polyvascular disease or type 2 diabetes had similar rates of the primary
endpoint (39.8% and 39.9%, respectively), which were higher than patients
without polyvascular disease or diabetes (29.6%). Polyvascular disease
with concomitant type 2 diabetes was associated with further heightened
risk (60.0% 7-year Kaplan-Meier rate, adjusted hazard ratio versus those
with polyvascular disease 1.60, 95% CI 1.38-1.85; p<0.0001). Ezetimibe
reduced cardiovascular risk consistently across groups with greater
numerical absolute risk reductions in the highest-risk subgroups.
INTERPRETATION: In patients with coronary artery disease, concomitant
polyvascular disease or type 2 diabetes are associated with increased
long-term cardiovascular risk. The combination of polyvascular disease and
diabetes is additive, resulting in very high risk. The benefit of
ezetimibe is consistent in patients with and without polyvascular disease
and type 2 diabetes; however, by nature of their higher risk patients with
one, or especially both, of these diseases might derive the greatest
absolute benefits.Merck. Copyright © 2018 Elsevier Ltd. All
rights reserved.

<17>
Accession Number
2001319128
Title
Intracranial Actinomycosis Manifesting as a Parenchymal Mass Lesion: A
Case Report and Review of Literature.
Source
World Neurosurgery. 122 (pp 190-194), 2019. Date of Publication: February
2019.
Author
Mishra A.; Prabhuraj A.R.; Bhat D.; Nandeesh B.N.; Mhatre R.
Institution
(Mishra, Prabhuraj, Bhat) Department of Neurosurgery, National Institute
of Mental Health and Neurosciences, Bengaluru, India
(Nandeesh, Mhatre) Department of Neuropathology, National Institute of
Mental Health and Neurosciences, Bengaluru, India
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Intracranial actinomycosis is a rare bacterial infection with
no characteristic clinical or radiologic diagnostic features. The usual
presentation is similar to pyogenic brain abscess or osteomyelitis with or
without pachymeningitis. Intracranial actinomycosis rarely manifests as a
parenchymal mass lesion. A high index of suspicion is warranted in a
patient with immunosuppression or predisposing factors, such as dental
procedure, sinusitis, cardiac septal defect, craniofacial trauma, cranial
surgery, lung infection, or abdominopelvic infection. Case Description: A
young woman presented with a right parietal parenchymal lesion with
involvement of the calvaria and pericranium. She had no predisposing
factors for intracranial actinomycosis. She underwent complete
microsurgical excision of the lesion followed by prolonged antibiotic
therapy. She experienced a good functional recovery. Conclusion(s):
Intracranial actinomycosis manifesting as a parenchymal mass lesion is
extremely rare compared with abscess and pachymeningitis. Histopathologic
examination remains the mainstay of definitive diagnosis, as culture may
be negative in significant number of cases. Aggressive surgical excision
with prolonged antibiotic therapy enhances the chances of a good
functional outcome. Copyright © 2018 Elsevier Inc.

<18>
Accession Number
625146036
Title
Reduction in subtypes and sizes of myocardial infarction with ticagrelor
in PEGASUS-TIMI 54.
Source
Journal of the American Heart Association. 7 (22) (no pagination), 2018.
Article Number: e009260. Date of Publication: 01 Nov 2018.
Author
Bonaca M.P.; Wiviott S.D.; Morrow D.A.; Steg P.G.; Hamm C.; Bhatt D.L.;
Storey R.F.; Cohen M.; Kuder J.; Im K.; Magnani G.; Budaj A.; Nicolau
J.C.; Parkhomenko A.; Sendon J.L.; Dellborg M.; Diaz R.; Werf F.V.D.;
Corbalan R.; Goudev A.; Jensen E.C.; Johanson P.; Braunwald E.; Sabatine
M.S.
Institution
(Bonaca, Wiviott, Morrow, Bhatt, Kuder, Im, Braunwald, Sabatine) TIMI
Study Group, Brigham and Women's Hospital, Boston, MA, United States
(Steg) FACT, DHU FIRE, Hopital Bichat, Assistance Publique-Hopitaux de
Paris, Paris, France
(Hamm) Department of Medicine, Kerckhoff Heart Center, BadNauheim, Germany
(Storey) Department of Medicine, University of Sheffield, United Kingdom
(Cohen) Newark Beth Israel Medical Center, Rutgers-New Jersey Medical
School, Newark, NJ, United States
(Magnani) UniversitatsSpital Zurich (USZ) & Zurich Heart House, University
Hospital of Zurich, Switzerland
(Budaj) Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
(Nicolau) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Parkhomenko) Department of Medicine, Institute of Cardiology, Kiev,
Ukraine
(Sendon) Department of Medicine, Hosp Univrio La Paz, Madrid, Spain
(Dellborg) Sahlgrenska Acad, University of Gothenburg, Sweden
(Diaz) Department of Medicine, ECLA (Estudios Clinicos Latino America),
Rosario, Argentina
(Werf) Department of Medicine, University of Leuven, Belgium
(Corbalan) Department of Medicine, Pontificia Univ Catolica de Chile,
Santiago, Chile
(Goudev) Medical University of Sofia, Queen Ioanna University Hospital,
Sofia, Bulgaria
(Jensen, Johanson) AstraZeneca, Molndal, Sweden
Publisher
American Heart Association Inc.
Abstract
Background--Ticagrelor reduced cardiovascular death, myocardial infarction
(MI), or stroke in patients with prior MI in PEGASUSTIMI 54 (Prevention of
Cardiovascular Events [eg, Death From Heart or Vascular Disease, Heart
Attack, or Stroke] in Patients With Prior Heart Attack Using Ticagrelor
Compared to Placebo on a Background of Aspirin). MI can occur in diverse
settings and with varying severity; therefore, understanding the types and
sizes of MI events prevented is of clinical importance. Methods and
Results--MIs were adjudicated by a blinded clinical events committee and
categorized by subtype and fold elevation of peak cardiac troponin over
the upper limit of normal. A total of 1042 MIs occurred in 898 of the 21
162 randomized patients over a median follow-up of 33 months. The majority
of the MIs (76%) were spontaneous (Type 1), with demand MI (Type 2) and
stent thrombosis (Type 4b) accounting for 13% and 9%, respectively; sudden
death (Type 3), percutaneous coronary intervention-related (Type 4a) and
coronary artery bypass graft-related (Type 5) each accounted for <1%. Half
of MIs (520, 50%) had a peak troponin >=10x upper limit of normal and 21%
of MIs (220) had a peak troponin >=1009 upper limit of normal. A total of
21% (224) were ST-segment-elevation MI STEMI. Overall ticagrelor reduced
MI (4.47% versus 5.25%, hazard ratio 0.83, 95% confidence interval
0.72-0.95, P=0.0055). The benefit was consistent among the subtypes,
including a 31% reduction in MIs with a peak troponin >=1009 upper limit
of normal (hazard ratio 0.69, 95% confidence interval 0.53-0.92, P=0.0096)
and a 40% reduction in ST-segment elevation MI (hazard ratio 0.60, 95%
confidence interval 0.46-0.78, P=0.0002). Conclusions--In stable
outpatients with prior MI, the majority of recurrent MIs are spontaneous
and associated with a high biomarker elevation. Ticagrelor reduces the MI
consistently among subtypes and sizes including large MIs and ST-segment
elevation MI. Clinical Trial Registration-URL:
https://www.clinicaltrials.gov. Unique identifier:
NCT01225562. Copyright © 2018 The Authors.

<19>
Accession Number
625044093
Title
Impact of dexmedetomidine infusion during general anaesthesia on incidence
of postoperative delirium in elderly patients after major non-cardiac
surgery: Study protocol of a randomised, double-blinded and
placebo-controlled trial.
Source
BMJ Open. 8 (4) (no pagination), 2018. Article Number: e019549. Date of
Publication: 01 Apr 2018.
Author
Wang B.-J.; Li C.-J.; Hu J.; Li H.-J.; Guo C.; Wang Z.-H.; Zhang Q.-C.; Mu
D.-L.; Wang D.-X.
Institution
(Wang, Li, Hu, Li, Guo, Zhang, Mu, Wang) Department of Anesthesiology and
Critical Care Medicine, Peking University First Hospital, Beijing, China
(Wang) Department of Anesthesiology, Dongping People's Hospital, Dongping,
China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Delirium is a common complication in the elderly after
surgery and is associated with worse outcomes. Multiple risk factors are
related with postoperative delirium, such as exposure to general
anaesthetics, pain and postoperative inflammatory response. Preclinical
and clinical studies have shown that dexmedetomidine attenuated
neurotoxicity induced by general anaesthetics, improved postoperative
analgesia and inhibited inflammatory response after surgery. Several
studies found that intraoperative use of dexmedetomidine can prevent
postoperative delirium, but data were inconsistent. This study was
designed to investigate the impact of dexmedetomidine administered during
general anaesthesia in preventing delirium in the elderly after major
non-cardiac surgery. Methods and analysis: This is a randomised,
double-blinded and placebo-controlled trial. 620 elderly patients (age
>=60 years) who are scheduled to undertake elective major non-cardiac
surgery (with an expected duration >=2 hours) are randomly divided into
two groups. For patients in the dexmedetomidine group, a loading dose
dexmedetomidine (0.6 mug/kg) will be administered 10 min before
anaesthesia induction, followed by a continuous infusion at a rate of 0.5
mug/kg/hour until 1 hour before the end of surgery. For patients in the
control group, normal saline will be administered with an identical rate
as in the dexmedetomidine group. The primary endpoint is the incidence of
delirium during the first five postoperative days. The secondary endpoints
include pain intensity, cumulative opioid consumption and subjective sleep
quality during the first three postoperative days, as well as the
incidence of non-delirium complications and all-cause mortality within 30
days after surgery. Ethics and dissemination: The study protocol was
approved by the Clinical Research Ethics Committee of Peking University
First Hospital (2015-987) and registered at Chinese Clinical Trial
Registry (http://www.chictr.org.cn) with identifier ChiCTR-IPR-15007654.
The results of the study will be presented at academic conferences and
submitted to peer-reviewed journals. Copyright © 2018 Article
author(s).

<20>
Accession Number
625142584
Title
Cerebral embolic protection systems for transcatheter aortic valve
replacement.
Source
Journal of Interventional Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Author
Gasior T.; Mangner N.; Bijoch J.; Wojakowski W.
Institution
(Gasior, Wojakowski) Division of Cardiology and Structural Heart Diseases,
Medical University of Silesia, Katowice, Poland
(Mangner) Technical University of Dresden, Heart Center Dresden,
Department of Internal Medicine and Cardiology, Dresden, Germany
(Bijoch) SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
In the recent years, ischemic brain injury related to embolization after
transcatheter aortic valve replacement (TAVR) has received increased
attention as new embolic protection strategies emerged to protect the
brain. Diverse cerebral protection devices have been developed to reduce
cerebral embolization during TAVR. These devices work through various
mechanisms and are in different stages of clinical translation. This
review provides the evidence-based review of peri-procedural stroke
prevention during TAVR and summarizes currently available cerebral embolic
protection devices. Copyright © 2018 Wiley Periodicals, Inc.

<21>
Accession Number
2001110854
Title
Intraoperative hypotension is not associated with postoperative cognitive
dysfunction in elderly patients undergoing general anesthesia for surgery:
results of a randomized controlled pilot trial.
Source
Journal of Clinical Anesthesia. 52 (pp 111-118), 2019. Date of
Publication: February 2019.
Author
Langer T.; Santini A.; Zadek F.; Chiodi M.; Pugni P.; Cordolcini V.;
Bonanomi B.; Rosini F.; Marcucci M.; Valenza F.; Marenghi C.; Inglese S.;
Pesenti A.; Gattinoni L.
Institution
(Langer, Zadek, Chiodi, Pugni, Cordolcini, Valenza, Pesenti, Gattinoni)
Department of Pathophysiology and Transplantation, University of Milan,
Milan, Italy
(Langer, Santini, Valenza, Marenghi, Pesenti, Gattinoni) Department of
Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda
Ospedale Maggiore Policlinico, Milan, Italy
(Bonanomi, Rosini, Marcucci, Inglese) Geriatric Unit, Department of
Medical Sciences and Community Health, University of Milan, Italy
(Marcucci) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada
(Rosini, Marcucci, Inglese) Fondazione IRCCS Ca' Granda Ospedale Maggiore
Policlinico, Milan, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: To assess the effect of different intraoperative blood
pressure targets on the development of POCD and test the feasibility of a
larger trial. Design(s): Randomized controlled pilot trial.
 Setting(s): Perioperative care in a tertiary care teaching hospital
with outpatient follow-up. Patient(s): One hundred one patients aged
>=75 years with ASA physical status <4, undergoing elective, non-cardiac
surgery under general anesthesia and 33 age-matched healthy controls.
 Intervention(s): Randomization to a personalized intraoperative blood
pressure target, mean arterial pressure (MAP) >= 90% of preoperative
values (Target group), or to a more liberal intraoperative blood pressure
management (No-Target group). Strategies to reach intraoperative blood
pressure target were at discretion of anesthesiologists. Measurements: An
experienced neuropsychologist performed a validated battery of
neurocognitive tests preoperatively and 3 months after surgery. Incidence
of POCD at three months and postoperative delirium were assessed.
Intraoperative time spent with MAP >= 90% of preoperative values,
recruitment and drop-out rate at 3 months were feasibility outcomes.
 Main Result(s): The Target group spent a higher percentage of
intraoperative time with MAP >=90% of preoperative values (65 +/- 25% vs.
49 +/- 28%, p < 0.01). Incidence of POCD (11% vs. 7%, relative risk 1.52;
95% CI, 0.41 to 6.3; p = 0.56) and delirium (6% vs. 14%, relative risk,
0.44; 95% CI, 0.12 to 1.60; p = 0.21) did not differ between groups. No
correlation was found between intraoperative hypotension and postoperative
cognitive performance (p = 0.75) or delirium (p = 0.19). Recruitment rate
was of 6 patients/month (95% confidential interval (CI), 5 to 7) and
drop-out rate at 3 months was 24% (95% CI, 14 to 33%). Conclusion(s):
Intraoperative hypotension did not correlate with postoperative cognitive
dysfunction or delirium occurrence in elderly patients undergoing general
anesthesia for non-cardiac surgery. A multicenter randomized controlled
trial is needed in order to confirm the effect of intraoperative blood
pressure on the development of POCD. Trial registration number:
NCT02428062 www.clinicaltrials.gov. Copyright © 2018

<22>
Accession Number
2001065927
Title
Levosimendan use in patients with preoperative low ejection fraction
undergoing cardiac surgery: A systematic review with meta-analysis and
trial sequential analysis.
Source
Journal of Clinical Anesthesia. 52 (pp 37-47), 2019. Date of Publication:
February 2019.
Author
Ng K.T.; Chan X.L.; Tan W.; Wang C.Y.
Institution
(Ng, Wang) Department of Anaesthesiology, Faculty of Medicine, University
of Malaya, Jalan Universiti, Kuala Lumpur 50603, Malaysia
(Chan, Tan) School of Medicine, University of Bristol, Bristol, United
Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: Patients with preoperative low left ventricular ejection
fraction (LVEF) are known to be associated with high morbidities and
mortality in cardiac surgery. The primary aim of this review was to
examine the clinical outcomes of levosimendan versus placebo in patients
with preoperative low LVEF <= 50% undergoing cardiac surgery. Data
sources: MEDLINE, EMBASE, PubMed and CENTRAL were searched systematically
from their inception until June 2018. Review methods: All the randomised
clinical trials (RCTs) were included. Result(s): Twelve trials were
eligible (n = 1867) for inclusion in the data synthesis. In comparison to
the placebo cohort, the levosimendan cohort showed a significant reduction
in mortality (TSA = inconclusive; rho = 0.002; I2 = 0%; FEM: OR
0.56; 95% CI 0.39, 0.80), especially in the subgroups of preoperative
severe low LVEF <= 30% (rho = 0.003; OR 0.33; 95% CI 0.16, 0.69),
preoperative administering of levosimendan (rho = 0.001; OR 0.46; 95% CI
0.29, 0.74) and patients who had bolus followed by infusion of
levosimendan (rho = 0.005; OR 0.50; 95% CI 0.30, 0.81). However, the
effect on mortality was not significant in the subgroup analysis of high
quality trials (rho = 0.14; OR 0.73; 95% CI 0.47, 1.12). The levosimendan
cohort showed a significantly lower incidence of
low-cardiac-output-syndrome (rho < 0.001; OR 0.58; 95% CI 0.46, 0.74) and
lesser need for mechanical support of cardiac assist devices (rho = 0.02;
OR 0.39; 95% CI 0.18, 0.86). Conclusion(s): Given the low level of
evidence and inconclusive TSA, the results of this meta-analysis neither
support nor oppose the use of levosimendan in cardiac patients with
preoperative low LVEF <= 50%. Therefore, multi-centre, adequately powered,
randomised controlled trials are warranted. PROSPERO registration:
CRD42017067572. Copyright © 2018 Elsevier Inc.

<23>
Accession Number
624103523
Title
Reassessing Coronary Artery Bypass Surgery Versus Percutaneous Coronary
Intervention in Patients with Type 2 Diabetes Mellitus: A Brief Updated
Analytical Report (2015-2017).
Source
Diabetes Therapy. 9 (5) (pp 2163-2171), 2018. Date of Publication: 01 Oct
2018.
Author
Dai X.; Luo Z.-C.; Zhai L.; Zhao W.-P.; Huang F.
Institution
(Dai, Zhai, Zhao) Department of Endocrinology, The First Affiliated
Hospital of Guangxi Medical University, Guangxi, China
(Luo) Department of Internal Medicine Education, The First Affiliated
Hospital of Guangxi Medical University, Guangxi, China
(Huang) Institute of Cardiovascular Diseases and Guangxi Key Laboratory
Base of Precision Medicine in Cardio-cerebrovascular Disease Control and
Prevention and Guangxi Clinical Research Center for Cardio-cerebrovascular
Diseases, The First Affiliated Hospital of Guangxi Medical University,
Guangxi, China
Publisher
Springer Healthcare (E-mail: kathleen.burke@springer.com)
Abstract
Introduction: In this analysis, we aimed to systematically compare
percutaneous coronary intervention (PCI) versus coronary artery bypass
surgery (CABG) in terms of adverse outcomes utilizing data from a recent
(2015-2017) population of patients with type 2 diabetes mellitus (T2DM).
 Method(s): An electronic search of recent studies (2015-2017) was
carried out using 'diabetes mellitus,' 'coronary artery bypass surgery,'
and 'percutaneous coronary intervention' as the main search terms.
Uncomplicated T2DM patients with stable coronary artery disease (CAD),
left main CAD, and multi-vessel disease were included. RevMan software
(version 5.3) was used to calculate odds ratios (OR) and 95% confidence
intervals (CIs). Result(s): Among a total of 13,114 T2DM patients,
CABG and PCI patients did not differ significantly in their rates of
mortality (OR 0.90, 95% CI 0.61-1.31; P = 0.57) and cardiac death (OR
1.00, 95% CI 0.78-1.30; P = 0.98). However, rates of major adverse events,
repeat revascularization, and myocardial infarction were significantly
higher in the PCI group. Stroke rates did not significantly differ between
the two groups. Conclusion(s): Mortality (1-5 years) did not
significantly differ between the CABG and PCI patients with T2DM. However,
rates of other major adverse events were significantly higher in the PCI
patients, suggesting that CABG is more advantageous than PCI in patients
with T2DM. Copyright © 2018, The Author(s).

<24>
Accession Number
621761102
Title
Effects of glargine insulin on glycemic control in patients with diabetes
mellitus type II undergoing off-pump coronary artery bypass graft.
Source
Annals of Cardiac Anaesthesia. 21 (2) (pp 167-172), 2018. Date of
Publication: April-June 2018.
Author
Gandhi H.; Sarvaia A.; Malhotra A.; Acharya H.; Shah K.; Rajavat J.
Institution
(Gandhi, Sarvaia, Rajavat) Department of Cardiac Anesthesia, U N Mehta
Institute of Cardiology and Research Center, Ahmedabad, Gujarat 380 016,
India
(Malhotra) Department of Cardio Vascular and Thoracic Surgery, U N Mehta
Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
(Acharya, Shah) Department of Research, U N Mehta Institute of Cardiology
and Research Center, Ahmedabad, Gujarat, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: The prevalence of diabetes mellitus in patients requiring
coronary artery bypass grafting (CABG) is noticeably high (20%-30%). These
patients have inferior perioperative outcome, reduced long-term survival,
and high risk of recurrent episodes of angina. To improve perioperative
outcome surgical unit defined satisfactory glycemic control is desired
during this period. Hence, the aim of our study is to compare the efficacy
of glargine insulin combination with continuous human insulin infusion for
perioperative glycemic control in patients with diabetes undergoing CABG.
 Material(s) and Method(s): Fifty Patients, who were posted for
off-pump CABG with diabetes mellitus type II, were randomized in two
group, Group I normal saline + human insulin infusion during the
perioperative period, Group II (glargine group): Glargine + human insulin
infusion during perioperative period. Result(s): During surgery and
in the postoperative period, random blood sugar and human insulin
requirement are significantly higher in control group than glargine group.
Other infection, step-up antibiotics, intensive care unit (ICU) stay, and
hospital stay were significantly higher in control groups in postoperative
period. Conclusion(s): Our study results suggest that glargine
effectively manages blood glucose level with significantly greater control
over postoperative morbidity. Copyright © 2018 Annals of Cardiac
Anaesthesia Published by Wolters Kluwer - Medknow.

<25>
Accession Number
621761084
Title
Assessment of the effect of two regimens of milrinone infusion in
pediatric patients undergoing fontan procedure: A randomized study.
Source
Annals of Cardiac Anaesthesia. 21 (2) (pp 134-140), 2018. Date of
Publication: April-June 2018.
Author
Soliman R.; Ragheb A.
Institution
(Soliman) Department of Anesthesia, Cairo University, Egypt
(Soliman, Ragheb) Prince Sultan Cardiac Centre, Riyadh, Al-Hassa, Saudi
Arabia
(Ragheb) National Heart Institute, Cairo, Egypt
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Objective: The aim of the study was to compare the effect of two different
regimens of milrinone on hemodynamics and oxygen saturation in pediatric
patients undergoing Fontan procedure. Design(s): This was a
randomized study. Setting(s): Cardiac centers. Patient(s): This
study included 116 patients undergoing Fontan procedure. Material(s)
and Method(s): Group E: Milrinone was started as infusion 0.5 mug/kg/min
without a loading dose at the beginning of cardiopulmonary bypass (CPB)
followed by infusion 0.5-0.75 mug/kg/min in the pediatric cardiac surgical
intensive care unit (PSICU). Group L: Milrinone was started as a loading
dose 50 mug/kg over 10 min before weaning from CPB followed by infusion
0.5-0.75 mug/kg/min in the PSICU. Measurements: Heart rate, mean arterial
blood pressure, central venous pressure, transpulmonary pressure, cardiac
index, pharmacological support, lactate level, urine output, oxygen
saturation, ICU, and hospital length of stay. Main Result(s): There
were no changes in the heart rate and mean arterial blood pressure (P >
0.05). The increase in the postoperative central venous pressure,
transpulmonary pressure and lactate level was lower in Group E than Group
L (P < 0.05). The increase in the postoperative cardiac index, oxygen
saturation, and urine output was higher in Group E than Group L (P <
0.05). The requirement for pharmacological support was lower in the Group
E (P < 0.05). The ICU and hospital length of stay were shorter in the
Group E than Group L (P < 0.05). Conclusion(s): Early use of
milrinone during Fontan procedure facilitated the weaning from CPB,
decreased the elevation in the central venous pressure, transpulmonary
gradient pressure, and the requirement for pharmacological support.
Furthermore, it increased the cardiac index and arterial oxygen
saturation. Copyright © 2018 Annals of Cardiac Anaesthesia 
Published by Wolters Kluwer - Medknow.

<26>
Accession Number
621761074
Title
Prophylactic preoperative levosimendan for off-pump coronary artery bypass
grafting in patients with left ventricular dysfunction: Single-centered
randomized prospective study.
Source
Annals of Cardiac Anaesthesia. 21 (2) (pp 123-128), 2018. Date of
Publication: April-June 2018.
Author
Desai P.M.; Sarkar M.S.; Umbarkar S.R.
Institution
(Desai, Sarkar, Umbarkar) Department of Anesthesiology, Seth GS Medical
College and KEM Hospital, A703, Noopur Apartments, PG Rood, Malad West,
Mumbai, Maharashtra 400 064, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: Off-pump coronary artery bypass surgery (OPCAB) is often
complicated by hemodynamic instability, especially in patients with prior
left ventricular (LV) dysfunction and appropriate choice of inotrope plays
a vital role in perioperative management of these patients. Aim and
Objective: To study hemodynamic effects and immediate outcome of
prophylactic infusion of levosimendan in patients with the LV dysfunction
undergoing OPCAB surgery and whether this strategy helps in successful
conduct of OPCAB surgery. Material(s) and Method(s): After
Institutional Ethics Committee approval, 60 patients posted for elective
OPCAB surgery were randomly divided into two groups (n = 30 each).
Patients with the LV ejection fraction <30% were included. Study group was
started on injection levosimendan (@ 0.1 mug/kg/min) in the previous night
before surgery and continued for 24 h including intraoperative period.
Hemodynamic monitoring included heart rate, invasive blood pressure,
cardiac index (CI), pulmonary capillary wedge pressure (PCWP), pulse
oximetry, and arterial blood gases with serum lactates at as T0
(baseline), T1 (15 min after obtuse marginal and/or PDA anastomoses), T2
(at end of surgery), T3 (6 h after surgery in Intensive Care Unit [ICU]),
T4 (12 h after surgery), and T5 (24 h after surgery in ICU). Vasopressor
was added to maintain mean arterial pressure >60 mmHg. Chi-square/Fisher's
exact/Mid P exact test and Student's t-tests were applied for categorical
and continuous data. Result(s): CI was greater and PCWP reduced
significantly in Group L during intraoperative and early postoperative
period. Serum lactate concentration was lower in patients pretreated with
levosimendan. Incidence of postoperative atrial fibrillation (POAF) (36.6
vs. 6.6%; P = 0.01), low cardiac output syndrome (LCOS) (30% vs. 6%; P =
0.02), and acute kidney injury (23.3% vs. 6.7%; P = 0.04) was less in
Group L. Three patients (10%) in control group required conversion to
cardiopulmonary bypass (CPB) as compared to none in the study group. There
was no difference regarding ICU or hospital stay and mortality in both
groups. Conclusion(s): Preoperative levosimendan helps in successful
conduct of OPCAB and reduces the incidence of LCOS, POAF, conversion to
CPB, and requirement of intra-aortic balloon pump. Copyright ©
2018 Annals of Cardiac Anaesthesia Published by Wolters Kluwer -
Medknow.

<27>
Accession Number
622736154
Title
Should kissing balloon inflation after main vessel stenting be routine in
the one-stent approach? A systematic review and meta-analysis of
randomized trials.
Source
PLoS ONE. 13 (6) (no pagination), 2018. Article Number: e0197580. Date of
Publication: June 2018.
Author
Zhong M.; Tang B.; Zhao Q.; Cheng J.; Jin Q.; Fu S.
Institution
(Zhong, Tang, Zhao, Cheng, Jin, Fu) Department of Cardiology, Jinhua
Municipal General Hospital, Jinhua, Zhejiang, China
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
The KBI (kissing balloon inflation) technique is considered the default
strategy for the two-stent approach in real world practice. Studies
comparing KBI and No-KBI in patients undergoing the one-stent approach
have reported conflicting results. The meta-analysis was performed to
compare the clinical outcomes of the KBI strategy and the No-KBI strategy
for coronary bifurcation lesions in the one-stent approach. Five
randomized studies were included, and a total of 1264 patients were
involved in the meta-analysis. The primary outcome was cardiac death. The
secondary end points were stent thrombosis, MI (myocardial infarction),
target lesion revascularization (TLR), target vessel revascularization
(TVR), and main vessel and side branch restenosis. Compared with the
No-KBI strategy, the KBI strategy was associated with a significant
reduction in side branch restenosis (OR: 0.44, 95% CI: 0.30-0.64,
p<0.001). A high risk of main vessel restenosis was found in the KBI group
(OR: 2.96, 95% CI: 1.74-5.01, p<0.001). There were no significant
differences in rates of cardiac death (OR: 1.89, 95% CI: 0.60-5.95, p =
0.28), stent thrombosis (OR: 0.98, 95% CI: 0.19-4.94, p = 0.98), MI (OR:
0.68, 95% CI: 0.33-1.44, p = 0.30), TLR (OR 1.14, 95% CI 0.68-1.90, p =
0.62), or TVR (OR 1.27, 95% CI 0.75-2.16, p = 0.38). Compared with the
No-KBI strategy, the KBI strategy reduced the incidence of side branch
restenosis and increased the risk of main branch restenosis in the
one-stent approach. However, the clinical outcomes were similar between
the KBI and No-KBI groups. Copyright © 2018 Zhong et al. This is
an open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<28>
Accession Number
2001031886
Title
A randomized clinical trial evaluating negative pressure therapy to
decrease vascular groin incision complications.
Source
Journal of Vascular Surgery. 68 (6) (pp 1744-1752), 2018. Date of
Publication: December 2018.
Author
Kwon J.; Staley C.; McCullough M.; Goss S.; Arosemena M.; Abai B.;
Salvatore D.; Reiter D.; DiMuzio P.
Institution
(Kwon, Staley, McCullough, Goss, Arosemena, Abai, Salvatore, Reiter,
DiMuzio) Division of Vascular and Endovascular Surgery, Thomas Jefferson
University Hospital, Philadelphia, Pa, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Vascular groin incision complications contribute significantly
to patients' morbidity and rising health care costs. Negative pressure
therapy over the closed incision decreases the infection rate in cardiac
and orthopedic procedures. This study prospectively evaluated negative
pressure therapy as a means to decrease wound complications and associated
health care costs. Method(s): This was a randomized, prospective,
single-institution study of 119 femoral incisions closed primarily after
elective vascular surgery including both inflow (eg, aortofemoral) and
outflow (eg, femoral-popliteal bypass) procedures. Incisions were
categorized as high risk for wound complications on the basis of body mass
index >30 kg/m2, pannus, reoperation, prosthetic graft, poor
nutrition, immunosuppression, or hemoglobin A<inf>1c</inf> >8% and
randomized 1:1 to standard gauze (n = 60) dressing vs negative pressure
therapy (Prevena [Acelity, San Antonio, Tex], n = 59). Wound complication
rate, length of stay (LOS), reoperation, readmission, and variable
hospital costs were determined during 30 days. Statistical analysis was
performed using chi2 test along with a two-sample unpaired
t-test for continuous variables. Result(s): There were no significant
demographic differences (age, sex, risk factors for wound complication)
between the two high-risk groups. In low-risk controls, the major wound
complication rate was 4.8% (involving one infection in 21 incisions),
resulting in a 3.8-day LOS, 4.8% reoperation, 4.8% readmission rate, and
$17,599 in average variable cost. For high-risk controls, there was a
significant increase in major wound complications to 25% (including all 12
infections in 60 incisions), LOS (10.6 days), reoperation (18.3%),
readmission (16.7%), and costs ($36,537). Finally, negative pressure
therapy significantly reduced major wound complications to 8.5% (including
five of six infections in 59 incisions; P <.001), reoperation (8.5%; P
<.05), and readmission (6.8%; P <.04) but not LOS (10.6 days). The average
variable cost was reduced ($30,492), yielding an average savings of $6045
per patient (P =.11). Conclusion(s): This study suggests that
negative pressure therapy significantly reduces the major wound
complication, reoperation, and readmission rates for patients at high risk
for groin wound complications. Furthermore, this therapy may lead to a
reduction in hospital costs. Negative pressure therapy for all groin
incisions considered at high risk for wound complications is
recommended. Copyright © 2018 Society for Vascular Surgery

<29>
Accession Number
624737206
Title
One-year outcomes after PCI strategies in cardiogenic shock.
Source
New England Journal of Medicine. 379 (18) (pp 1699-1710), 2018. Date of
Publication: 01 Nov 2018.
Author
Thiele H.; Akin I.; Sandri M.; De Waha-Thiele S.; Meyer-Saraei R.; Fuernau
G.; Eitel I.; Nordbeck P.; Geisler T.; Landmesser U.; Skurk C.; Fach A.;
Jobs A.; Lapp H.; Piek J.J.; Noc M.; Goslar T.; Felix S.B.; Maier L.S.;
Stepinska J.; Oldroyd K.; Serpytis P.; Montalescot G.; Barthelemy O.;
Huber K.; Windecker S.; Hunziker L.; Savonitto S.; Torremante P.; Vrints
C.; Schneider S.; Zeymer U.; Desch S.
Institution
(Thiele, Sandri, Jobs) Heart Center Leipzig, University of Leipzig,
Department of Internal Medicine-Cardiology, Strumpellstr. 39, Leipzig
04289, Germany
(Akin, De Waha-Thiele) Universitatsmedizin Mannheim, Mannheim, Germany
(De Waha-Thiele, Meyer-Saraei, Fuernau, Eitel) University Heart Center
Lubeck, Lubeck, Germany
(Akin, De Waha-Thiele, Meyer-Saraei, Fuernau, Eitel, Landmesser, Skurk,
Jobs, Felix, Desch) German Center for Cardiovascular Research, Germany
(Landmesser, Skurk) Universitatsklinikum Charite, Campus Benjamin
Franklin, Germany
(Nordbeck) Berlin, Universitatsklinikum Wurzburg, Wurzburg, Germany
(Geisler) Klinikum der Eberhard, Karls-Universitat Tubingen, Tubingen,
Germany
(Fach) Klinikum Links der Weser, Bremen, Germany
(Lapp) Helios Klinik Erfurt, Erfurt, Germany
(Felix) Ernst-Moritz-Arndt-Universitat, Greifswald, Germany
(Maier) Universitares Herzzentrum Regensburg, Regensburg, Germany
(Schneider, Zeymer) Institut fur Herzinfarktforschung, Germany
(Zeymer) Klinikum Ludwigshafen, Germany
(Piek, Goslar) Academic Medical Center, Amsterdam, Netherlands
(Noc) University Medical Center Ljubljana, Ljubljana, Slovenia
(Stepinska) Institute of Cardiology, Warsaw, Poland
(Oldroyd) Golden Jubilee National Hospital, Glasgow, United Kingdom
(Serpytis) Vilnius University, Hospital Santaros Klinikos, Faculty of
Medicine, Vilnius University, Vilnius, Lithuania
(Montalescot, Barthelemy) Sorbonne Universite Paris 6, ACTION Study Group,
Centre Hospitalier Universi-taire Pitie-Salpetriere, Germany
(Torremante) Applied Research, Technology Transfer, Industrial
Collaboration, Societe par Actions Simplifiee, Germany
(Huber) Department of Cardiology, Sigmund Freud University, Medical
School, Vienna, Austria
(Windecker, Hunziker) Department of Cardiology, Inselspital Bern,
University of Bern, Bern, Switzerland
(Savonitto) Manzoni Hospital, Lecco, Italy
(Vrints) Universitair Ziekenhuis Antwerp, Antwerp, Belgium
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Among patients with acute myocardial infarction, cardiogenic
shock, and multivessel coronary artery disease, the risk of a composite of
death from any cause or severe renal failure leading to renal-replacement
therapy at 30 days was found to be lower with percutaneous coronary
intervention (PCI) of the culprit lesion only than with immediate
multivessel PCI. We evaluated clinical outcomes at 1 year. METHOD(S):
We randomly assigned 706 patients to either culprit-lesion-only PCI or
immediate multivessel PCI. The results for the primary end point of death
or renal-replacement therapy at 30 days have been reported previously.
Prespecified secondary end points at 1 year included death from any cause,
recurrent myocardial infarction, repeat revascularization,
rehospitalization for congestive heart failure, the composite of death or
recurrent infarction, and the composite of death, recurrent infarction, or
rehospitalization for heart failure. RESULT(S): As reported
previously, at 30 days, the primary end point had occurred in 45.9% of the
patients in the culprit-lesion-only PCI group and in 55.4% in the
multivessel PCI group (P=0.01). At 1 year, death had occurred in 172 of
344 patients (50.0%) in the culprit-lesion-only PCI group and in 194 of
341 patients (56.9%) in the multivessel PCI group (relative risk, 0.88;
95% confidence interval [CI], 0.76 to 1.01). The rate of recurrent
infarction was 1.7% with culprit-lesion-only PCI and 2.1% with multivessel
PCI (relative risk, 0.85; 95% CI, 0.29 to 2.50), and the rate of a
composite of death or recurrent infarction was 50.9% and 58.4%,
respectively (relative risk, 0.87; 95% CI, 0.76 to 1.00). Repeat
revascularization occurred more frequently with culprit-lesion-only PCI
than with multivessel PCI (in 32.3% of the patients vs. 9.4%; relative
risk, 3.44; 95% CI, 2.39 to 4.95), as did rehospitalization for heart
failure (5.2% vs. 1.2%; relative risk, 4.46; 95% CI, 1.53 to 13.04).
 CONCLUSION(S): Among patients with acute myocardial infarction and
cardiogenic shock, the risk of death or renal-replacement therapy at 30
days was lower with culprit-lesion-only PCI than with immediate
multivessel PCI, and mortality did not differ significantly between the
two groups at 1 year of follow-up. Copyright © 2018 Massachusetts
Medical Society.

<30>
Accession Number
617647937
Title
Routine use of viscoelastic blood tests for diagnosis and treatment of
coagulopathic bleeding in cardiac surgery: Updated systematic review and
meta-analysis.
Source
British Journal of Anaesthesia. 118 (6) (pp 823-833), 2017. Date of
Publication: 01 Jun 2017.
Author
Serraino G.F.; Murphy G.J.
Institution
(Serraino, Murphy) Department of Cardiovascular Sciences, National
Institute for Health Research, Leicester Biomedical Research Unit in
Cardiovascular Medicine, University of Leicester, Clinical Sciences Wing,
Glenfield General Hospital, Leicester LE3 9QP, United Kingdom
Publisher
Oxford University Press
Abstract
Viscoelastic point-of-care tests are commonly used to provide prompt
diagnosis of coagulopathy and allow targeted treatments in bleeding
patients. We updated existing meta-analyses that have evaluated the
clinical effectiveness of viscoelastic point-of-care tests vs the current
standard of care for the management of cardiac surgery patients at risk of
coagulopathic bleeding. Randomized controlled trials comparing
viscoelastic point-of-care diagnostic testing with standard care in
cardiac surgery patients were sought. All-cause mortality, blood loss,
reoperation, blood transfusion, major morbidity, and intensive care unit
and hospital length of stay were analysed using random-effects modelling.
Fifteen trials that randomized a total of 8737 participants were included
for the analysis. None of the trials was classified as low risk of bias.
The use of thromboelastography-(TEG ) or thromboelastometry (ROTEM
)-guided algorithms did not reduce mortality [risk ratio (RR) 0.55, 95%
confidence interval (CI) 0.28-1.10] without heterogeneity (I2
=1%), reoperation for bleeding, stroke, ventilation time, or hospital
length of stay compared with standard care. Use of TEG or ROTEM resulted
in reductions in the frequency of red blood cell (Risk Ratio 0.88, 95%
Confidence Interval 0.79-0.97; I2 =43%) and platelet
transfusion (Risk Ratio 0.78, 95% Confidence Interval 0.66-0.93;
I2 =0%). Group Reading Assessment and Diagnostic Evaluation
(GRADE) assessment demonstrated that the quality of the evidence was low
or very low for all estimated outcomes. Routine use of viscoelastic
point-of-care tests did not improve important clinical outcomes beyond
transfusion in adults undergoing cardiac surgery. Copyright ©
2017 The Author.

<31>
Accession Number
617647927
Title
Oesophageal Doppler guided goal-directed haemodynamic therapy in thoracic
surgery-a single centre randomized parallel-arm trial.
Source
British Journal of Anaesthesia. 118 (6) (pp 852-861), 2017. Date of
Publication: 01 Jun 2017.
Author
Kaufmann K.B.; Stein L.; Bogatyreva L.; Ulbrich F.; Kaifi J.T.; Hauschke
D.; Loop T.; Goebel U.
Institution
(Kaufmann, Stein, Ulbrich, Loop, Goebel) Department of Anaesthesiology and
Critical Care, Institute of Medical Biometry and Statistics, University of
Freiburg, Freiburg, Germany
(Bogatyreva, Hauschke) IMBI, Institute of Medical Biometry and Statistics,
University of Freiburg, Freiburg, Germany
(Kaifi) Department of Thoracic Surgery, Medical Centre-University of
Freiburg, Faculty of Medicine, Freiburg, Germany
Publisher
Oxford University Press
Abstract
Background: Postoperative pulmonary and renal complications are frequent
in patients undergoing lung surgery. Hyper-and hypovolaemia may contribute
to these complications. We hypothesized that goal-directed haemodynamic
management based on oesophageal Doppler monitoring would reduce
postoperative pulmonary complications in a randomized clinical
parallel-arm trial. Method(s): One hundred patients scheduled for
thoracic surgery were randomly assigned to either standard haemodynamic
management (control group) or goal-directed therapy (GDT group) guided by
an oesophageal Doppler monitoring-based algorithm. The primary endpoint
was postoperative pulmonary complications, including spirometry. Secondary
endpoints included haemodynamic variables, renal, cardiac, and
neurological complications, and length of hospital stay. The investigator
assessing outcomes was blinded to group assignment. Result(s):
Forty-eight subjects of each group were analysed. Compared to the control
group, fewer subjects in the GDT group developed postoperative pulmonary
complications (6 vs. 15 patients; P = 0.047), while spirometry did not
differ between groups. Compared to the control group, patients of the GDT
group showed higher cardiac index (2.9 vs. 2.1 [l min-1
m-2]; P < 0.001) and stroke volume index (43 vs. 34 [ml
m2]; P < 0.001) during surgery. Renal, cardiac and neurological
complications did not differ between groups. Length of hospital stay was
shorter in the GDT compared to the control group (9 vs. 11 days; P =
0.005). Conclusion(s): Compared to standard haemodynamic management,
oesophageal Doppler monitor-guided GDT was associated with fewer
postoperative pulmonary complications and a shorter hospital
stay. Copyright © 2017 The Author.

<32>
Accession Number
2000793724
Title
Early or late fresh frozen plasma administration in newborns and small
infants undergoing cardiac surgery: the APPEAR randomized trial.
Source
British Journal of Anaesthesia. 118 (5) (pp 788-796), 2017. Date of
Publication: May 2017.
Author
Bianchi P.; Cotza M.; Beccaris C.; Silvetti S.; Isgro G.; Pome G.;
Giamberti A.; Ranucci M.
Institution
(Bianchi, Cotza, Beccaris, Isgro, Ranucci) Department of Cardiothoracic,
Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, Via
Morandi 30, 20097 San Donato Milanese, Milan, Italy
(Silvetti) Department of Cardiac Anaesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Pome, Giamberti) Department of Congenital Heart Surgery, IRCCS
Policlinico San Donato, Milan, Italy
Publisher
Elsevier Ltd
Abstract
Background: In newborns and small infants undergoing cardiac surgery with
cardiopulmonary bypass (CPB) and blood priming, it is unclear whether
there is reduced blood loss if fresh frozen plasma (FFP) is added to the
CPB priming volume. This single-centre, randomized trial tested the
hypothesis that the administration of FFP after CPB (late FFP group) is
superior to FFP priming (early FFP group) in terms of postoperative
bleeding and overall red blood cell (RBC) transfusion. Method(s):
Seventy-three infants weighing <10 kg were randomly allocated to receive
FFP to supplement RBCs in the CPB priming solution (n=36) or immediately
after CPB (n=37). The primary endpoint was a difference in postoperative
blood loss; secondary endpoints included the amount of RBCs and FFP
transfused through the first 48 postoperative hours. Result(s): All
patients were included in the analysis. Patients in the late FFP arm had
greater postoperative mean blood loss than patients in the early FFP arm
[33.1 (SD 20.6) vs 24.1 (12.9) ml kg-1; P=0.028], but no
differences in transfusions were found. The subgroup of cyanotic heart
disease patients had comparable results, but with greater use of RBCs in
the late FFP group. Conclusion(s): In infants undergoing cardiac
surgery, FFP in the priming solution appears slightly superior to late
administration in terms of postoperative bleeding. Clinical trial
registration: www.ClinicalTrials.gov, NCT02738190. Copyright ©
2017 The Author(s)

<33>
Accession Number
2000793241
Title
Randomized trial of red cell washing for the prevention of
transfusion-associated organ injury in cardiac surgery.
Source
British Journal of Anaesthesia. 118 (5) (pp 689-698), 2017. Date of
Publication: May 2017.
Author
Wozniak M.J.; Sullo N.; Qureshi S.; Dott W.; Cardigan R.; Wiltshire M.;
Morris T.; Nath M.; Bittar N.; Bhudia S.K.; Kumar T.; Goodall A.H.; Murphy
G.J.
Institution
(Wozniak, Sullo, Qureshi, Dott, Nath, Kumar, Goodall, Murphy) Department
of Cardiovascular Sciences and NIHR Cardiovascular Biomedical Research
Unit, University of Leicester, Glenfield Hospital, Leicester LE3 9QP,
United Kingdom
(Cardigan, Wiltshire) National Health Service Blood and Transplant,
Cambridge CB2 0PT, United Kingdom
(Morris) Leicester Clinical Trials Unit, Leicester Diabetes Centre,
Leicester General Hospital, Leicester LE5 4PW, United Kingdom
(Bittar) Blackpool Victoria Hospital NHS Trust, Blackpool, Lancashire FY3
8NR, United Kingdom
(Bhudia) University Hospitals Coventry and Warwickshire NHS Trust,
Clifford Bridge Road, Coventry CV2 2DX, United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: Experimental studies suggest that mechanical cell washing to
remove pro-inflammatory components that accumulate in the supernatant of
stored donor red blood cells (RBCs) might reduce inflammation and organ
injury in transfused patients. Method(s): Cardiac surgery patients at
increased risk of large-volume RBC transfusion were eligible. Participants
were randomized to receive either mechanically washed allogenic RBCs or
standard care RBCs. The primary outcome was serum interleukin-8 measured
at baseline and at four postsurgery time points. A mechanism substudy
evaluated the effects of washing on stored RBCs in vitro and on markers of
platelet, leucocyte, and endothelial activation in trial subjects.
 Result(s): Sixty adult cardiac surgery patients at three UK cardiac
centres were enrolled between September 2013 and March 2015. Subjects
received a median of 3.5 (interquartile range 2-5.5) RBC units, stored for
a mean of 21 (SD 5.2) days, within 48 h of surgery. Mechanical washing
reduced concentrations of RBC-derived microvesicles but increased
cell-free haemoglobin concentrations in RBC supernatant relative to
standard care RBC supernatant. There was no difference between groups with
respect to perioperative serum interleukin-8 values [adjusted mean
difference 0.239 (95% confidence intervals -0.231, 0.709), P=0.318] or
concentrations of plasma RBC microvesicles, platelet and leucocyte
activation, plasma cell-free haemoglobin, endothelial activation, or
biomarkers of heart, lung, or kidney injury. Conclusion(s): These
results do not support a hypothesis that allogenic red blood cell washing
has clinical benefits in cardiac surgery. Clinical trial registration:
ISRCTN 27076315. Copyright © 2017 The Author(s)

<34>
Accession Number
2000792419
Title
Efficacy and safety of inhaled anaesthetic for postoperative sedation
during mechanical ventilation in adult cardiac surgery patients: a
systematic review and meta-analysis.
Source
British Journal of Anaesthesia. 118 (5) (pp 658-669), 2017. Date of
Publication: May 2017.
Author
Spence J.; Belley-Cote E.; Ma H.K.; Donald S.; Centofanti J.; Hussain S.;
Gupta S.; Devereaux P.J.; Whitlock R.
Institution
(Spence, Belley-Cote, Ma, Donald, Centofanti) Department of Anaesthesia
and Critical Care, McMaster University, Population Health Research
Institute, Hamilton, ON, Canada
(Spence, Devereaux, Whitlock) Department of Clinical Epidemiology and
Biostatistics, McMaster University, Population Health Research Institute,
Hamilton, ON, Canada
(Belley-Cote) Department of Medicine (Cardiology), McMaster University,
Population Health Research Institute, Hamilton, ON, Canada
(Hussain) Department of Surgery, Division of Cardiac Surgery, McGill
University, Montreal, PQ, Canada
(Gupta, Whitlock) Department of Surgery, Division of Cardiac Surgery,
Population Health Research Institute, Hamilton, ON, Canada
(Devereaux) Department of Medicine, Division of Cardiology, Population
Health Research Institute, Hamilton, ON, Canada
(Spence, Belley-Cote, Hussain, Devereaux, Whitlock) Population Health
Research Institute, Hamilton, ON, Canada
Publisher
Elsevier Ltd
Abstract
The aim was to evaluate the efficacy and safety of volatile anaesthetic
for postoperative sedation in adult cardiac surgery patients through a
systematic review and meta-analysis. We retrieved randomized controlled
trials from MEDLINE, EMBASE, CENTRAL, Web of Science, clinical trials
registries, conference proceedings, and reference lists of included
articles. Independent reviewers extracted data, including patient
characteristics, type of intraoperative anaesthesia, inhaled anaesthetic
used, comparator sedation, and outcomes of interest, using pre-piloted
forms. We assessed risk of bias using the Cochrane Tool and evaluated the
strength of the evidence using the GRADE approach. Eight studies enrolling
610 patients were included. Seven had a high and one a low risk of bias.
The times to extubation after intensive care unit (ICU) admission and
sedation discontinuation were, respectively, 76 [95% confidence interval
(CI) -150 to - 2, I2=79%] and 74 min (95% CI - 126 to - 23,
I2=96%) less in patients who were sedated using volatile
anaesthetic. There was no difference in ICU or hospital length of stay.
Patients who received volatile anaesthetic sedation had troponin
concentrations that were 0.71 ng ml-1 (95% CI 0.23-1.2) lower
than control patients. Reporting on other outcomes was varied and not
suitable for meta-analysis. Volatile anaesthetic sedation may be
associated with a shorter time to extubation after cardiac surgery but no
change in ICU or hospital length of stay. It is associated with a
significantly lower postoperative troponin concentration, but the impact
of this on adverse cardiovascular outcomes is uncertain. Blinded
randomized trials using intention-to-treat analysis are required. PROSPERO
registry number: 2016:CRD42016033874. Available from
http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016033874.Copyright © 2017 The Author(s)

<35>
Accession Number
617839605
Title
Association between delirium and cognitive change after cardiac surgery.
Source
British Journal of Anaesthesia. 119 (2) (pp 308-315), 2017. Date of
Publication: 01 Aug 2017.
Author
Sauer A.C.; Veldhuijzen D.S.; Ottens T.H.; Slooter A.J.C.; Kalkman C.J.;
Van Dijk D.
Institution
(Sauer, Veldhuijzen, Ottens, Kalkman) Department of Anesthesiology,
University Medical Center Utrecht, PO Box 85500, GA Utrecht 3508,
Netherlands
(Veldhuijzen) Institute of Psychology, Health, Medical, and
Neuropsychology Unit, Faculty of Social Sciences, Leiden University, PO
Box 9555, RB, Leiden 2300, Netherlands
(Slooter, Van Dijk) Department of Intensive Care Medicine, University
Medical Center Utrecht, PO Box 85500, Utrecht 3508 GA, Netherlands
Publisher
Oxford University Press
Abstract
Previous studies provide inconsistent data on whether postoperative
delirium (POD) is a risk factor for postoperative cognitive decline
(POCD). We thus investigated the relationship between POD and cognitive
change after cardiac surgery and assessed the relationship between
preoperative cognitive domain scores and POD. Methods. Postoperative
deliriumwas assessed with the Confusion Assessment Method (CAM) adapted
for the intensive care unit and the conventional CAM accompanied by chart
review. Cognitive function was assessed with a neuropsychological test
battery before elective cardiac surgery and 1 month and 1 yr afterwards.
Cognitive change was calculated using the Reliable Change Index (RCI).
Multiple linear regression was used to adjust for confounding. Results. Of
the 184 patients who completed baseline assessment, 23 (12.5%) developed
POD. At 1 month, the decline in cognitive performance was worse in
patients with POD [median composite RCI 1.00, interquartile range (IQR)
1.67 to 0.28] than in patients without POD (RCI 0.04, IQR 0.70 to 0.63,
P0.02). At 1 yr, both groups showed cognitive improvement on average
compared with baseline (POD patients median composite RCI 0.25, IQR 0.42
to 1.31, vs non-POD patients RCI 0.92, IQR 0.18-1.53; P0.08). Correction
for differences in age and level of education did not change the results.
Patients with POD performed less well than patients without POD on the
preoperative Trailmaking test part A (P0.03). Conclusions. Postoperative
delirium is independently associated with cognitive decline 1 month after
surgery, but cognitive performance generally recovers in 1 yr. Patients
with a predisposition to POD can be identified before surgery by worse
performance in an attention task. Copyright © The Author 2017.
Published by Oxford University Press.

<36>
Accession Number
624997287
Title
Nitric oxide decreases acute kidney injury and stage 3 chronic kidney
disease after cardiac surgery.
Source
American Journal of Respiratory and Critical Care Medicine. 198 (10) (pp
1279-1287), 2018. Date of Publication: 15 Nov 2018.
Author
Lei C.; Berra L.; Rezoagli E.; Yu B.; Dong H.; Yu S.; Hou L.; Chen M.;
Chen W.; Wang H.; Zheng Q.; Shen J.; Jin Z.; Chen T.; Zhao R.; Christie
E.; Sabbisetti V.S.; Nordio F.; Bonventre J.V.; Xiong L.; Zapol W.M.
Institution
(Lei, Dong, Hou, Chen, Shen, Xiong) Department of Anesthesiology and
Perioperative Medicine, Xijing Hospital, Fourth Military Medical
University, 127 West Changle Road, Xi'an, Shaanxi 710032, China
(Berra, Rezoagli, Yu, Zapol) Department of Anesthesia, Critical Care and
Pain Medicine, Massachusetts General Hospital, Harvard Medical School,
Boston, MA, United States
(Rezoagli) School of Medicine and Surgery, University of Milan-Bicocca,
Monza, Italy
(Yu, Chen, Wang, Zheng, Jin, Chen, Zhao) Department of Cardiovascular
Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an,
Shaanxi, China
(Christie, Sabbisetti, Bonventre) Division of Renal Medicine, Department
of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston,
MA, United States
(Nordio) Division of Cardiovascular Medicine, Department of Medicine,
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United
States
Publisher
American Thoracic Society (E-mail: malexander@thoracic.org)
Abstract
Rationale: No medical intervention has been identified that decreases
acute kidney injury and improves renal outcome at 1 year after cardiac
surgery. Objective(s): To determine whether administration of nitric
oxide reduces the incidence of postoperative acute kidney injury and
improves long-term kidney outcomes after multiple cardiac valve
replacement requiring prolonged cardiopulmonary bypass. Method(s):
Two hundred and forty-four patients undergoing elective, multiple valve
replacement surgery, mostly due to rheumatic fever, were randomized to
receive either nitric oxide (treatment) or nitrogen (control). Nitric
oxide and nitrogen were administered via the gas exchanger during
cardiopulmonary bypass and by inhalation for 24 hours postoperatively.
 Measurements and Main Results: The primary outcome was as follows:
oxidation of ferrous plasma oxyhemoglobin to ferric methemoglobin was
associated with reduced postoperative acute kidney injury from 64%
(control group) to 50% (nitric oxide group) (relative risk [RR], 0.78; 95%
confidence interval [CI], 0.62-0.97; P = 0.014). Secondary outcomes were
as follows: at 90 days, transition to stage 3 chronic kidney disease was
reduced from 33% in the control group to 21% in the treatment group (RR,
0.64; 95% CI, 0.41-0.99; P = 0.024) and at 1 year, from 31% to 18% (RR,
0.59; 95% CI, 0.36-0.96; P = 0.017). Nitric oxide treatment reduced the
overall major adverse kidney events at 30 days (RR, 0.40; 95% CI,
0.18-0.92; P = 0.016), 90 days (RR, 0.40; 95% CI, 0.17-0.92; P = 0.015),
and 1 year (RR, 0.47; 95% CI, 0.20-1.10; P = 0.041). Conclusion(s):
In patients undergoing multiple valve replacement and prolonged
cardiopulmonary bypass, administration of nitric oxide decreased the
incidence of acute kidney injury, transition to stage 3 chronic kidney
disease, and major adverse kidney events at 30 days, 90 days, and 1
year. Copyright © 2018 by the American Thoracic Society.

<37>
Accession Number
625077871
Title
Platelet indices and function response to two types of high intensity
interval exercise and comparison with moderate intensity continuous
exercise among men after coronary artery bypass graft: A randomized trial.
Source
ARYA Atherosclerosis. 14 (5) (pp 188-195), 2018. Date of Publication:
2018.
Author
Sobhani V.; Taghizadeh M.; Moshkani-Farahani M.
Institution
(Sobhani, Taghizadeh) Exercise Physiology Research Center, Life Style
Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Moshkani-Farahani) Atherosclerosis Research Center, Baqiyatallah
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Isfahan University of Medical Sciences(IUMS) (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
BACKGROUND: It has been indicated that the acute exercise increases the
thrombotic events that stem from platelet hyper-reactivity. The present
randomized controlled trial study was carried out with the aim to compare
high-intensity interval exercise (HIIE) with moderate intensity continuous
exercise (MICE) in terms of platelet indices and function in patients who
had undergone post coronary artery bypass graft (CABG). METHOD(S): 30
men with a history of CABG were recruited and divided into 3 groups (MICE,
HIIE-1, and HIIE-2). The MICE protocol consisted of running for 40 minutes
with 65% of maximal heart rate (HR<inf>max</inf>). Subjects in HIIE-1
group performed an interval exercise with work to rest ratio of 1:1 in
which 10 rounds of running (95% HR<inf>max</inf>) were followed by active
recovery (35% HR<inf>max</inf>). HIIE-2 subjects performed an interval
exercise with work to rest ratio of 2:1 in which 7 rounds of running (85%
HR<inf>max</inf>) were followed by active recovery (45% HR<inf>max</inf>).
Before and immediately after the exercise protocols, blood samples were
taken from subjects and analyzed to measure the variables. RESULT(S):
Although platelet count (PLT) and hematocrit (HCT) were increased
significantly after HIIE-1 and HIIE-2 in comparison to MICE (P < 0.050),
the other platelet indices [mean platelet volume (MPV), platelet
distribution width (PDW), plateletcrit (PCT)] were not significantly
changed among groups (P > 0.050). The platelet aggregation and fibrinogen
were further increased after HIIE-1 and HIIE-2 as compared with MICE;
however, such increment were significant between HIIE-2 and MICE (P <
0.050). CONCLUSION(S): It seems that HIIE, regardless of the type,
has higher thrombotic potentials compared with MICE. Accordingly, MICE is
safer than HIIE for rehabilitation in patients undergoing
CABG. Copyright © 2018, Isfahan University of Medical
Sciences(IUMS). All rights reserved.

<38>
Accession Number
624898842
Title
Systematic review of incretin therapy during peri-operative and intensive
care 11 Medical and Health Sciences 1103 Clinical Sciences.
Source
Critical Care. 22 (1) (no pagination), 2018. Article Number: 299. Date of
Publication: 14 Nov 2018.
Author
Hulst A.H.; Plummer M.P.; Hollmann M.W.; Devries J.H.; Preckel B.; Deane
A.M.; Hermanides J.
Institution
(Hulst, Hollmann, Preckel, Hermanides) Department of Anaesthesiology,
Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Postbus 22660,
Amsterdam 1105 AZ, Netherlands
(Plummer, Deane) Intensive Care Unit, Royal Melbourne Hospital, 300
Grattan Street, Parkville, VIC 3050, Australia
(Devries) Department of Endocrinology, Amsterdam UMC, University of
Amsterdam, Meibergdreef 9, Postbus 22660, Amsterdam 1105 AZ, Netherlands
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Glucagon-like peptide 1 (GLP-1) and glucose-dependent
insulinotropic peptide (GIP) are incretin hormones. By lowering blood
glucose in a glucose-dependent manner, incretin-based therapies represent
a novel and promising intervention to treat hyperglycaemia in hospital
settings. We performed a systematic review of the literature for all
current applications of incretin-based therapies in the peri-operative and
critical care settings. Method(s): We searched MEDLINE, the Cochrane
Library, and Embase databases for all randomised controlled trials using
exogenous GLP-1, GLP-1 receptor agonists, exogenous GIP and dipeptidyl
peptidase IV inhibitors in the setting of adult peri-operative care or
intensive care. We defined no comparator treatment. Outcomes of interest
included blood glucose, frequency of hypoglycaemia and insulin
administration. Result(s): Of the 1190 articles identified during the
initial literature search, 38 fulfilled criteria for full-text review, and
19 single-centre studies were subsequently included in the qualitative
review. Of the 18 studies reporting glycaemic control, improvement was
reported in 15, defined as lower glucose concentrations in 12 and as
reduced insulin administration (with similar glucose concentrations) in 3.
Owing to heterogeneity, meta-analysis was possible only for the outcome of
hypoglycaemia. This revealed an incidence of 7.4% in those receiving
incretin-based therapies and 6.8% in comparator groups (P = 0.94).
 Conclusion(s): In small, single-centre studies, incretin-based
therapies lowered blood glucose and reduced insulin administration without
increasing the incidence of hypoglycaemia. Trial registration: PROSPERO,
CRD42017071926. Copyright © 2018 The Author(s).

<39>
[Use Link to view the full text]
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

<40>
[Use Link to view the full text]
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.

<41>
Accession Number
625135398
Title
Effect of magnesium on arrhythmia incidence in patients undergoing
coronary artery bypass grafting.
Source
ANZ journal of surgery. 88 (6) (pp 612-615), 2018. Date of Publication: 01
Jun 2018.
Author
Mohammadzadeh A.; Towfighi F.; Jafari N.
Institution
(Mohammadzadeh, Towfighi, Jafari) Department of Cardiothoracic, Imam
Khomeini Hospital, Ardabil University of Medical Sciences, Ardabil, Iran,
Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiac arrhythmia after coronary artery bypass grafting
(CABG) surgery is a common complication of cardiac surgery. The effect of
serum magnesium, hypomagnesaemia treatment and prophylactic administration
of magnesium in the development and prevention of arrhythmias is
controversial and there are many different ideas. This study evaluates the
therapeutic effects of magnesium in cardiac arrhythmia after CABG surgery.
 METHOD(S): The clinical trial enrolled 250 patients who underwent
CABG. Based on the initial serum levels of magnesium, patients were
divided into two groups: hypomagnesium and normomagnesium. Based on
bioethics committee requirements, patients in the hypo-magnesium group
received magnesium treatments until they attained normal magnesium blood
levels. Both groups underwent CABG with normal blood levels of magnesium.
After surgery, each group was randomly divided into two subgroups: one
subgroup received a bolus dose of magnesium sulphate (30 mg/kg in 5 min)
and the other subgroup received a placebo. Subgroups were under
observation in the intensive care unit for 3 days and arrhythmias were
recorded. Data from all four subgroups were analysed statistically and
interpreted. RESULT(S): The results of this study showed that the
occurrence of arrhythmia was not significantly different among subgroups
(P > 0.05). There was no significant relationship between blood levels of
magnesium and arrhythmia during the 3 days post-surgery (P > 0.05).
 CONCLUSION(S): The results of this study showed that magnesium
sulphate administration did not significantly improve the incidence of
arrhythmias in hypo- and normo-magnesium patients after CABG. There was no
significant correlation between post-operative serum levels of magnesium
and arrhythmia during 3 days. Copyright © 2017 Royal Australasian
College of Surgeons.

<42>
Accession Number
625119148
Title
Timing of Loading Dose of Atorvastatin in Patients Undergoing Percutaneous
Coronary Intervention for Acute Coronary Syndromes: Insights From the
SECURE-PCI Randomized Clinical Trial.
Source
JAMA cardiology. 3 (11) (pp 1113-1118), 2018. Date of Publication: 01 Nov
2018.
Author
Lopes R.D.; de Barros E Silva P.G.M.; de Andrade Jesuino I.; Santucci
E.V.; Barbosa L.M.; Damiani L.P.; Nakagawa Santos R.H.; Laranjeira L.N.;
Dall Orto F.T.C.; Beraldo de Andrade P.; de Castro Bienert I.R.; Alexander
J.H.; Granger C.B.; Berwanger O.
Institution
(Lopes, de Barros E Silva, Barbosa) Brazilian Clinical Research Institute,
Sao Paulo, Brazil
(Lopes, Alexander, Granger) Duke Clinical Research Institute, Durham, NC,
United States
(de Barros E Silva, de Andrade Jesuino, Santucci, Damiani, Nakagawa
Santos, Laranjeira, Berwanger) Research Institute-Heart Hospital, Sao
Paulo, Brazil
(Dall Orto) Hospital do Coracao de Pocos de Caldas, Pocos de Caldas,
Brazil
(Beraldo de Andrade) Santa Casa de Marilia, Marilia, Brazil
(de Castro Bienert) Hospital das Clinicas da Faculdade de Medicina de
Marilia, Marilia, Brazil
Publisher
NLM (Medline)
Abstract
Importance: Loading doses of atorvastatin did not show reduction on
clinical outcomes in the overall population of patients with acute
coronary syndrome (ACS) enrolled in the Statins Evaluation in Coronary
Procedures and Revascularization (SECURE-PCI) trial, but a potential
benefit was identified in patients who subsequently underwent percutaneous
coronary intervention (PCI). Objective(s): To determine whether
periprocedural loading doses of atorvastatin are associated with decreased
30-day major adverse cardiovascular events (MACE) in patients with ACS
undergoing PCI according to type of ACS and timing of atorvastatin
administration before PCI. Design, Setting, and Participant(s):
Secondary analysis of a multicenter, double-blind, placebo-controlled,
randomized clinical trial conducted at 53 sites that enrolled 4191
patients with ACS intended to be treated with PCI between April 18, 2012,
and October 06, 2017. Intervention(s): Patients were randomized to 2
loading doses of 80 mg of atorvastatin or matching placebo before and 24
hours after a planned PCI. By protocol, all patients (regardless of
treatment group) received 40 mg of atorvastatin for 30 days starting 24
hours after the second dose of study medication. Main Outcomes and
Measures: The primary outcome was MACE through 30 days, composed by
all-cause mortality, myocardial infarction, stroke, and unplanned coronary
revascularization. Cox regression models adjusting for key baseline
characteristics were used to assess the association between atorvastatin
and MACE in patients undergoing PCI. Result(s): From the overall
trial population, 2710 (64.7%) underwent PCI (650 women [24.0%]; mean [SD]
age, 62 [11.3] years). Loading atorvastatin was associated with reduced
MACE at 30 days by 28% in the PCI group (adjusted hazard ratio [HR], 0.72;
95% CI 0.54-0.97; P=.03). Loading dose of atorvastatin was administered
less than 12 hours before PCI in 2548 patients (95.3%) (45.1%<2 hours and
54.3% between 2 and 12 hours). There was no significant interaction
between treatment effect and timing of study drug administration. The
treatment effect of loading atorvastatin was more pronounced in patients
with ST-segment elevation myocardial infarction than in patients with
non-ST-segment elevation ACS (adjusted HR, 0.59; 95% CI, 0.38-0.92; P=.02;
HR, 0.85; 95% CI, 0.58-1.27; P=.43, respectively). Conclusions and
Relevance: In patients with ACS undergoing PCI, periprocedural loading
doses of atorvastatin appeared to reduce the rate of MACE at 30 days, most
clearly in patients with ST-segment elevation myocardial infarction. This
beneficial effect seemed to be preserved and consistent, irrespective of
the timing of atorvastatin administration, including within 2 hours before
PCI. Trial Registration: clinicaltrials.gov Identifier: NCT01448642.

<43>
Accession Number
625136229
Title
Interatrial Shunting for Heart Failure: Early and Late Results From the
First-in-Human Experience With the V-Wave System.
Source
JACC. Cardiovascular interventions. 11 (22) (pp 2300-2310), 2018. Date of
Publication: 26 Nov 2018.
Author
Rodes-Cabau J.; Bernier M.; Amat-Santos I.J.; Ben Gal T.; Nombela-Franco
L.; Garcia Del Blanco B.; Kerner A.; Bergeron S.; Del Trigo M.; Pibarot
P.; Shkurovich S.; Eigler N.; Abraham W.T.
Institution
(Rodes-Cabau, Bernier, Bergeron, Del Trigo, Pibarot) Quebec Heart and Lung
Institute, Quebec City, QC, Canada
(Amat-Santos) Hospital Clinico Universitario de Valladolid, Valladolid,
Spain
(Ben Gal) Rabin Medical Center, Petah Tikva, Israel
(Nombela-Franco) Instituto Cardiovascular, Hospital Clinico San Carlos,
Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos
(IdISSC), Madrid, Spain
(Garcia Del Blanco) Hospital Universitari Vall d' Hebron, Barcelona, Spain
(Kerner) Rambam Medical Center, Haifa, Israel
(Shkurovich, Eigler) V-Wave, Caesarea, Israel
(Abraham) Ohio State University Medical Center, Columbus, OH, United
States
Publisher
NLM (Medline)
Abstract
OBJECTIVES: This was a first-in-human study to assess the feasibility,
safety, and exploratory efficacy of interatrial shunting for treating
high-risk heart failure (HF) in patients with reduced and preserved
ejection fraction. METHOD(S): A single-arm open-label study of
patients with New York Heart Association functional class III or IV HF on
optimal therapy was performed at 6 centers. The V-Wave shunt, an
hourglass-shaped implant containing a 1-way bioprosthetic valve, was
implanted by transseptal catheterization. Clinical, functional,
echocardiographic, and hemodynamic evaluations were performed at baseline,
3 and 12 months, and annually (clinical follow-up) thereafter (median
follow-up 28 months; interquartile range: 21 to 31 months).
 RESULT(S): A total of 38 patients were enrolled (30 with HF with
reduced ejection fraction and 8 with HF with preserved ejection fraction;
mean age 66 +/- 9 years; 97% and 3% in New York Heart Association
functional classes III and IV, respectively), and the shunt device was
successfully implanted in all cases without periprocedural mortality. The
rate of major device- or procedure-related complications during the first
12 months was 2.6% (periprocedural cardiac tamponade in 1 patient). At 3-
and 12-month follow-up, there were improvements in New York Heart
Association functional class (classes I and II in 78% and 60% of patients,
respectively), quality of life (improvements >=5 points in 74% and 73% of
patients, respectively), and 6-min walk distance (mean increases of 41 +/-
63 m and 28 +/- 83 m, respectively) (p < 0.02 for all, data available for
36 patients), without changes in objective measures of left- or
right-sided function. All shunts were patent at 3 months, but 5 of 36
(14%) had occluded, and another 13 of 36 (36%) were stenotic at the valve
by 12 months. Patients with widely patent shunts had lower long-term rates
of death, left ventricular assist device placement or heart
transplantation (p = 0.001), and HF hospitalization (p = 0.008), along
with a reduction of pulmonary capillary wedge pressure (from 23.3 +/- 5.4
mm Hg at baseline to 18.0 +/- 4.0 mm Hg at 12 months; p = 0.011).
 CONCLUSION(S): Interatrial shunting with the V-Wave system was
feasible and safe in patients with HF with reduced and preserved ejection
fraction. Improvements in clinical and functional status were observed
early and at 12 months despite attenuation of shunt patency in one-half of
the patients. Patients with preserved shunt patency tended to maintain
clinical benefit during longer term follow-up. Device modification that
improves the durability of patency is likely worthwhile before
confirmation of these findings in a randomized trial. Copyright ©
2018 American College of Cardiology Foundation. Published by Elsevier Inc.
All rights reserved.

<44>
Accession Number
625117341
Title
Single versus Dual Antiplatelet Therapy after Transcatheter Aortic Valve
Implantation: A Systematic Review and Meta-Analysis.
Source
Cardiology. 141 (1) (pp 52-65), 2018. Date of Publication: 2018.
Author
Hu X.; Yang F.-Y.; Wang Y.; Zhang Y.; Chen M.
Institution
(Hu, Yang, Wang, Zhang) West China School of Medicine, West China
Hospital, Sichuan University, Chengdu, China
(Chen) Department of Cardiology, West China Hospital, Sichuan University,
Chengdu, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Although dual antiplatelet therapy (DAPT) with aspirin and
clopidogrel is currently recommended in patients after transcatheter
aortic valve implantation (TAVI), this practice is not supported by
sufficient evidence. This study was performed to compare DAPT to single
antiplatelet therapy (SAPT). METHOD(S): An electronic search was
completed of PubMed, Embase, Ovid Medline, Web of Science, and Cochrane
Central Register of Controlled Trials. Studies comparing DAPT versus SAPT
in patients undergoing TAVI were included. RESULT(S): Seven studies
incorporating 1,445 patients were eligible for the present meta-analysis.
There were no significant differences on 30-day all-cause mortality (OR
1.19, 95% CI 0.63-2.25, p = 0.593), 6-month all-cause mortality (OR 1.11,
95% CI 0.49-2.53, p = 0.796), or 1-year all-cause mortality (OR 1.19, 95%
CI 0.63- 2.25, p = 0.593). DAPT was associated with an increased risk for
30-day (OR 2.91, 95% CI 1.85-4.58, p < 0.01), 6-month (OR 2.54, 95% CI
1.26-5.10, p < 0.001), and 1-year major and lethal bleeding (OR 2.65, 95%
CI 1.04-6.77, p = 0.041) based on 896, 337, and 583 patients,
respectively, compared to SAPT. CONCLUSION(S): Compared to SAPT, DAPT
was not shown to be superior in reducing thrombotic events, but presented
an increased risk of major/life-threatening bleeding. More randomized
controlled trials are needed to provide further evidence. Copyright
© 2018 S. Karger AG, Basel.

<45>
Accession Number
625048080
Title
Goal-directed fluid therapy based on noninvasive cardiac output monitor
reduces postoperative complications in elderly patients after
gastrointestinal surgery: A randomized controlled trial.
Source
Pakistan Journal of Medical Sciences. 34 (6) (pp 1320-1325), 2018. Date of
Publication: November-December 2018.
Author
Yin K.; Ding J.; Wu Y.; Peng M.
Institution
(Yin, Ding, Wu, Peng) Department of Anesthesiology, Yongchuan Hospital of
Chongqing Medical University, Chongqing 402160, China
Publisher
Professional Medical Publications (Raja Ghazanfar Ali Road, Saddar,
Karachi, Pakistan)
Abstract
Objective: Goal-directed fluid therapy (GDFT) was associated with improved
outcomes after surgery. Noninvasive Cardiac Output Monitoring (NICOM) has
proved to be a good choice for guiding GDFT. This study evaluated the
effect of GDFT based on NICOM on prognosis in elderly patients undergoing
resection of gastrointestinal tumor. Method(s): Fifty patients
scheduled for elective laparoscopic radical resection for stomach, colon
or rectal cancer in Yongchuan Hospital of Chongqing Medical University
between November 2014 and December 2015 were included and randomly divided
into two groups: conventional fluid therapy (group C, n=25) and
goal-directed fluid therapy (group G, n=25). The primary outcome was
moderate or severe postoperative complications within 30 days.
 Result(s): Finally, 45 patients successfully completed the study
(group G, n=22; group C, n=23). There were no difference of the duration
of surgery, the requirement of vasoactive agents and the bleeding volume
between two groups (P>0.05). Total fluids infused were 2956+/-629 ml
(group C) and 2259+/-454 ml (group G) (P<0.05), while the requirement of
colloid was increased in group G (1103+/-285ml vs 855+/-226ml) (P<0.05).
The MAP and the mean CI were higher in group G (P<0.05). Compared with
group C, the time when the patients passed the flatus and the length of
hospital stay after operation were shortened in group G (12.6+/-2.4 day
vs17.2+/-2.6 day), the incidence of postoperative complications were
significantly lower in group G (P<0.05). Conclusion(s): Goal-directed
fluid therapy based on NICOM was significantly associated with improvement
of prognosis in elderly patients undergoing resection of gastrointestinal
tumor which reduced postoperative complications. Copyright ©
2018, Professional Medical Publications. All rights reserved.

<46>
Accession Number
625044051
Title
Cardiac implant registries 2006-2016: A systematic review and summary of
global experiences.
Source
BMJ Open. 8 (4) (no pagination), 2018. Article Number: e019039. Date of
Publication: 01 Apr 2018.
Author
Zhang S.; Gaiser S.; Kolominsky-Rabas P.L.
Institution
(Zhang, Kolominsky-Rabas) Interdisciplinary Centre for Health Technology
Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander-University
of Erlangen-Nurnberg, Erlangen, Germany
(Zhang, Kolominsky-Rabas) National Leading-Edge Cluster Medical
Technologies medical Valley EMN, Erlangen, Germany
(Gaiser) St Jude Medical Coordination Center BVBA, Zaventem, Belgium
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives The importance of Cardiac Implant Registry (CIR) for ensuring a
long-term follow-up in postmarket surveillance has been recognised and
approved, but there is lack of consensus standards on how to establish a
CIR. The aim of this study is to investigate the structure and key
elements of CIRs in the past decade (2006-2016) and to provide
recommendations on 'best practice' approaches. Settings and participants A
systematic search on CIR was employed in line with the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses guidelines. The following
databases were searched: The PubMed (Medline), ScienceDirect and the
Scopus database, EMBASE. After identifying the existing CIRs, an
aggregative approach will be used to explore key elements emerging in the
identified registries. Results The following 82 registries were
identified: 18 implantable cardioverterdefibrillator (ICD) registries, 7
cardiac resynchronisation therapy (CRT) registries, 5 pacemaker registries
and 6 cardiovascular implantable electronic device registries which
combined ICD, pacemaker and CRT implantation data; as well as 22 coronary
stent registries and 24 transcatheteraortic heart valve implantation
registries. While 71 national or local registries are from a single
country, 44 are from European countries and 9 are located in USA. The
following criteria have been summarised from the identified registries,
including: Registry working group, ethic issues, transparency, research
objective, inclusion criteria, compulsory participation, endpoint, sample
size, data collection basement, data collection methods, data entry, data
validation and statistical analysis. Conclusions Registries provide a
'real-world' picture for patients, physicians, manufacturers, payers,
decision-makers and other stakeholders. CIRs are important for regulatory
decisions concerning the safety and therefore approval issues of the
medical device; for payers CIRs provide evidence on the medical device
benefit and drive the decision whether the product should be reimbursed or
not; for hospitals CIRs' data are important for sound procurement
decisions, and CIRs also help patients and their physicians to joint
decision-making which of the products is the most
appropriate. Copyright © 2018 Article author(s).

<47>
Accession Number
2001310570
Title
Costs Five Years After Off-Pump or On-Pump Coronary Artery Bypass Surgery.
Source
Annals of Thoracic Surgery. (no pagination), 2018. Date of Publication:
2018.
Author
Wagner T.H.; Hattler B.; Bakaeen F.G.; Collins J.F.; Almassi G.H.; Quin
J.A.; Grover F.L.; Bishawi M.; Shroyer A.L.W.
Institution
(Wagner) VA Palo Alto Health Economics Resource Center, Menlo Park, CA,
United States
(Wagner) Department of Surgery, Stanford University, Palo Alto, CA, United
States
(Hattler, Grover, Shroyer) Eastern Colorado Health Care System, Department
of Veterans Affairs, Denver, CO, United States
(Hattler, Grover) University of Colorado School of Medicine at the
Anschutz Medical Campus, Aurora, CO, United States
(Bakaeen) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Collins) Cooperative Studies Program Coordinating Center, Veterans
Affairs Medical Center, Perry Point, MD, United States
(Almassi) Veterans Affairs Medical Center, Milwaukee, WI, United States
(Almassi) Department of Cardiothoracic Surgery, Medical College of
Wisconsin, Milwaukee, WI, United States
(Quin) VA Boston Healthcare System, West Roxbury, MA, United States
(Bishawi) Division of Cardiovascular and Thoracic Surgery, Duke University
Medical Center, Durham, NC, United States
(Shroyer) Northport VA Medical Center, Northport, NY, United States
Publisher
Elsevier USA
Abstract
Background: Coronary artery bypass grafting (CABG) is a common surgical
treatment for ischemic heart disease. Little is known about the long-term
costs of conducting the surgery on-pump or off-pump. Method(s): As
part of the Randomized On/Off Bypass follow-up study, we followed 2,203
participants randomized to on-pump (n = 1,099) and off-pump (n = 1,104)
CABG for 5 years using Department of Veterans Affairs and Medicare
administrative data. We examined annual costs through 5 years,
standardized to 2016 dollars, using multivariate regression models,
controlling for site and baseline patient factors. Result(s): In the
first year, including the CABG surgery, annual average costs were $66,599
(SE, $1,946) for the on-pump group and $70,552 (SE, $1,954) for the
off-pump group. In years 2 to 5, average costs ranged from $15,000 to
$20,000 per year. There was no significant difference between on-pump and
off-pump across the 5 years. We explored differences among high-risk
subgroups (diabetes, chronic obstructive pulmonary disease, peripheral
vascular disease, cerebrovascular disease, renal dysfunction, ejection
fraction < 35%, over age 70 years), and found no treatment assignment by
time interactions, except for a nonsignificant trend in patients with
diabetes. Conclusion(s): At 5 years, the average costs of off-pump
and on-pump CABG patients did not statistically differ. Costs do not favor
one approach and the decision should be based on clinical risks,
especially in subgroups. Future research is warranted to examine post-CABG
costs and outcomes for diabetic patients over time. Copyright ©
2018 The Society of Thoracic Surgeons

<48>
Accession Number
2001306417
Title
Meta-Analysis Comparing Mitral Valve Repair Versus Replacement for
Degenerative Mitral Regurgitation Across All Ages.
Source
American Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Author
Jung J.C.; Jang M.-J.; Hwang H.Y.
Institution
(Jung, Hwang) Department of Thoracic and Cardiovascular Surgery, Seoul
National University Hospital, Seoul National University College of
Medicine, Seoul, South Korea
(Jang) Medical Research Collaborating Center, Seoul National University
Hospital, Seoul National University College of Medicine, Seoul, South
Korea
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Although current guidelines recommend mitral valve repair (MVr) over
mitral valve replacement (MVR) for patients with mitral regurgitation
(MR), it is unclear if it should be also recommended in elderly patients
with limited life expectancy. This study was conducted to compare the
results of MVr with those of MVR to determine the optimal treatment option
for patients with degenerative MR, particularly according to the patient's
age. A literature search of 5 electronic databases was performed. The
primary outcome was all-cause mortality. The secondary outcomes included
early mortality and freedom from reoperation. A metaregression analysis
and subgroup analysis were performed according to the mean age of the
study population. Twelve retrospective studies (2,950 and 1,252 patients
in the MVr and MVR groups, respectively) were selected. Pooled analyses
demonstrated that the risk of all-cause mortality was significantly higher
in the MVR group than in the MVr group both in all studies and in studies
presenting adjusted results (hazard ratio[95% confidence interval] =
1.57[1.39 to 1.77] and 1.53[1.34 to 1.74], respectively). This benefit was
similar across all ages when the metaregression analysis and the subgroup
analysis were performed (p = 0.879 and 0.123, respectively). Early
mortality and risk of reoperation were also higher in the MVR group than
in the MVr group (risk ratio[95% confidence interval] = 4.51[3.12 to 6.51]
and hazard ratio[95% confidence interval] = 1.47[1.09 to 1.98],
respectively). In conclusion, this study indicates that MVr is beneficial
compared with MVR in patients with degenerative MR regardless of patients'
age in terms of all-cause mortality. Copyright © 2018 Elsevier
Ltd

<49>
Accession Number
625122150
Title
Relationship of mildly increased albuminuria and coronary artery
revascularization outcomes in patients with diabetes.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2018.
Date of Publication: 2018.
Author
Siddique A.; Murphy T.P.; Naeem S.S.; Siddiqui E.U.; Pencina K.M.;
McEnteggart G.E.; Sellke F.W.; Dworkin L.D.
Institution
(Siddique, Siddiqui, McEnteggart) Department of Diagnostic Imaging, Rhode
Island Hospital, The Warren Alpert Medical School of Brown University,
Providence, RI, United States
(Murphy) Department of Diagnostic Imaging, The Warren Alpert Medical
School of Brown University, Providence, RI, United States
(Naeem, Sellke) Division of Cardiothoracic Surgery, Rhode Island Hospital,
Warren Alpert Medical School of Brown University, Providence, RI, United
States
(Pencina) Brigham and Women's, Harvard Medical School, Boston, MA, United
States
(Dworkin) Department of Medicine, University of Toledo, Toledo, OH, United
States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: The aim of this study was to examine the relationship of
albuminuria to cardiovascular disease outcomes in diabetic patients
undergoing treatment for stable coronary artery disease. Methods and
Results: We analyzed data from 2176 participants of the Bypass Angioplasty
Revascularization Investigation in type-2 diabetes (BARI-2D) trial, a
randomized clinical trial comparing Percutaneous coronary
intervention/Coronary artery bypass grafting (PCI/CABG) to medical therapy
for people with diabetes. The population was stratified by baseline spot
urine albumin-creatinine ratio (uACR) into normal (uACR <10 mg/g), mildly
(uACR >=10 mg/g < 30 mg/g), moderately (uACR >=30 mg/g < 300 mg/g) and
severely increased (uACR >=300 mg/g) groups, and outcomes compared between
groups. Death, myocardial infarction (MI) and/or stroke were experienced
by 489 patients at a mean follow-up of 4.3 +/- 1.5 years. Compared with
normal uACR, mildly increased uACR was associated with a 1.4 times (P =
0.042) increase in all-cause mortality. Additionally, nonwhites with
type-II diabetes and stable coronary artery disease who had mildly
increased albuminuria had a Hazard ratio (HR) of 3.3 times (P = 0.028) for
cardiovascular death, 3.1 times for (P = 0.002) all-cause mortality, and
two times for (P = 0.015) MI during follow-up. Conclusion(s): Mildly
increased albuminuria is a significant predictor of all-cause mortality in
those with type-II diabetes mellitus and stable coronary artery disease,
as well as for cardiovascular events those who are
nonwhites. Copyright © 2018 Wiley Periodicals, Inc.

<50>
Accession Number
625122037
Title
Preventing Postoperative Delirium After Major Noncardiac Thoracic
Surgery-A Randomized Clinical Trial.
Source
Journal of the American Geriatrics Society. (no pagination), 2018. Date of
Publication: 2018.
Author
Khan B.A.; Perkins A.J.; Campbell N.L.; Gao S.; Khan S.H.; Wang S.;
Fuchita M.; Weber D.J.; Zarzaur B.L.; Boustani M.A.; Kesler K.
Institution
(Khan, Khan, Fuchita, Boustani) Department of Medicine, School of
Medicine, Indiana University, Indianapolis, IN, United States
(Khan, Campbell, Boustani) Department of Medicine, Center for Aging
Research, Indiana University, Indianapolis, IN, United States
(Khan, Campbell, Boustani) Department of Medicine, Regenstrief Institute,
Inc., Indianapolis, IN, United States
(Khan, Campbell, Boustani) Department of Medicine, Center for Health
Innovation and Implementation Science, Indiana Clinical and Translational
Sciences Institute, Indiana University, Indianapolis, IN, United States
(Perkins, Gao) Department of Statistics, School of Medicine, Indiana
University, Indianapolis, IN, United States
(Campbell) Eskenazi Health, Indianapolis, IN, United States
(Campbell) Department of Pharmacy Practice, College of Pharmacy, Purdue
University, West Lafayette, IN, United States
(Wang) Department of Psychiatry, School of Medicine, Indiana University,
Indianapolis, IN, United States
(Weber) Department of Surgery, University of California, San Francisco,
San Francisco, CA, United States
(Zarzaur, Kesler) Department of Surgery, School of Medicine, Indiana
University, Indianapolis, IN, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To assess the efficacy of haloperidol in reducing
postoperative delirium in individuals undergoing thoracic surgery.
 Design(s): Randomized double-blind placebo-controlled trial.
 Setting(s): Surgical intensive care unit (ICU) of tertiary care
center. Participant(s): Individuals undergoing thoracic surgery
(N=135). Intervention(s): Low-dose intravenous haloperidol (0.5 mg
three times daily for a total of 11 doses) administered postoperatively.
Measurements: The primary outcome was delirium incidence during
hospitalization. Secondary outcomes were time to delirium, delirium
duration, delirium severity, and ICU and hospital length of stay. Delirium
was assessed using the Confusion Assessment Method for the ICU and
delirium severity using the Delirium Rating Scale-Revised. Result(s):
Sixty-eight participants were randomized to receive haloperidol and 67
placebo. No significant differences were observed between those receiving
haloperidol and those receiving placebo in incident delirium (n=15 (22.1%)
vs n=19 (28.4%); p =.43), time to delirium (p =.43), delirium duration
(median 1 day, interquartile range (IQR) 1-2 days vs median 1 day, IQR 1-2
days; p =.71), delirium severity, ICU length of stay (median 2.2 days, IQR
1-3.3 days vs median 2.3 days, IQR 1-4 days; p =.29), or hospital length
of stay (median 10 days, IQR 8-11.5 days vs median 10 days, IQR 8-12 days;
p =.41). In the esophagectomy subgroup (n = 84), the haloperidol group was
less likely to experience incident delirium (n=10 (23.8%) vs n=17 (40.5%);
p =.16). There were no differences in time to delirium (p =.14), delirium
duration (median 1 day, IQR 1-2 days vs median 1 day, IQR 1-2 days; p
=.71), delirium severity, or hospital length of stay (median 11 days, IQR
10-12 days vs median days 11, IQR 10-15 days; p =.26). ICU length of stay
was significantly shorter in the haloperidol group (median 2.8 days, IQR
1.1-3.8 days vs median 3.1 days, IQR 2.1-5.1 days; p =.03). Safety events
were comparable between the groups. Conclusion(s): Low-dose
postoperative haloperidol did not reduce delirium in individuals
undergoing thoracic surgery but may be efficacious in those undergoing
esophagectomy. © 2018, Copyright the Authors Journal compilation
© 2018, The American Geriatrics Society

<51>
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.

<52>
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.

<53>
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.

<54>
Accession Number
624362802
Title
A meta-analysis of >=5-year mortality in randomized controlled trials of
off-pump versus on-pump coronary artery bypass grafting.
Source
Journal of Cardiac Surgery. 33 (11) (pp 716-724), 2018. Date of
Publication: November 2018.
Author
Takagi H.; Hari Y.; Mitta S.; Kawai N.; Ando T.
Institution
(Takagi, Hari, Mitta, Kawai) Department of Cardiovascular Surgery,
Shizuoka Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: We sought to determine whether off-pump coronary artery bypass
grafting (CABG) increases long-term mortality, by performing a
meta-analysis of randomized controlled trials (RCTs) of off-pump versus
on-pump CABG with >=5-year follow-up. Method(s): MEDLINE and EMBASE,
and the Cochrane Central Register of Controlled Trials were searched
through July 2018. Hazard, risk, or odds ratios (HRs, RRs, or ORs) of
long-term (>=5-year) mortality for off-pump versus on-pump CABG were
extracted from each individual trial. Study-specific estimates were
combined using inverse variance-weighted averages of logarithmic HRs in
the random-effects model. Result(s): Our search identified eight
medium- to large-size RCTs at low risk of bias with long-term follow-up of
off-pump versus on-pump CABG enrolling a total of 8780 patients. Combining
four RCTs reporting actual HRs generated a statistically significant
result favoring on-pump CABG (HR, 1.21; P = 0.02). A pooled analysis of
all eight RCTs demonstrated a statistically significant increase in
mortality with off-pump CABG (HR/RR, 1.19; P = 0.01). There was no
evidence of significant publication bias in the meta-analysis of all eight
RCTs. In a sensitivity analysis, extracting RRs or ORs from all eight RCTs
and pooling them demonstrated a statistically significant increase in
mortality with off-pump CABG (RR, 1.17; P = 0.01; OR, 1.20; P = 0.007).
Eliminating 2 RRs and combining six HRs still generated a statistically
significant result favoring on-pump CABG (HR, 1.19; P = 0.05).
 Conclusion(s): Off-pump CABG increases long-term (>=5-year) mortality
compared with on-pump CABG. Copyright © 2018 Wiley Periodicals,
Inc.

<55>
Accession Number
620929942
Title
Red blood cells treated with the amustaline (S-303) pathogen reduction
system: a transfusion study in cardiac surgery.
Source
Transfusion. 58 (4) (pp 905-916), 2018. Date of Publication: April 2018.
Author
Brixner V.; Kiessling A.-H.; Madlener K.; Muller M.M.; Leibacher J.;
Dombos S.; Weber I.; Pfeiffer H.-U.; Geisen C.; Schmidt M.; Henschler R.;
North A.; Huang N.; Mufti N.; Erickson A.; Ernst C.; Rico S.; Benjamin
R.J.; Corash L.M.; Seifried E.
Institution
(Brixner, Muller, Leibacher, Dombos, Weber, Pfeiffer, Geisen, Schmidt,
Seifried) Institute for Transfusion Medicine and Immunohematology of
Johann Wolfgang Goethe University and German Red Cross Blood Donor
Service, Frankfurt am Main, Germany
(Kiessling) Department of Thoracic and Cardiovascular Surgery, Johann
Wolfgang Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
(Madlener) Department of Haemostaseology and Transfusion Medicine,
Kerckhoff-Klinik, Bad Nauheim, Germany
(Henschler) Blood Center Zurich, Swiss Red Cross, Schlieren, Switzerland
(Henschler) Red Cross Blood Service Graubunden, Chur, Switzerland
(North, Huang, Mufti, Erickson, Ernst, Rico, Benjamin, Corash) Cerus
Corporation, Concord, CA, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Nucleic acid-targeted pathogen inactivation technology using
amustaline (S-303) and glutathione (GSH) was developed to reduce the risk
of transfusion-transmitted infectious disease and transfusion-associated
graft-versus-host disease with red blood cell (RBC) transfusion. STUDY
DESIGN AND METHODS: A randomized, double-blind, controlled study was
performed to assess the in vitro characteristics of amustaline-treated
RBCs (test) compared with conventional (control) RBCs and to evaluate
safety and efficacy of transfusion during and after cardiac surgery. The
primary device efficacy endpoint was the postproduction hemoglobin (Hb)
content of RBCs. Exploratory clinical outcomes included renal and hepatic
failure, the 6-minute walk test (a surrogate for cardiopulmonary
function), adverse events (AEs), and the immune response to
amustaline-treated RBCs. RESULT(S): A total of 774 RBC unis were
produced. Mean treatment difference in Hb content was -2.27 g/unit (95%
confidence interval, -2.61 to -1.92 g/unit), within the prespecified
equivalence margins (+/-5 g/unit) to declare noninferiority.
Amustaline-treated RBCs met European guidelines for Hb content,
hematocrit, and hemolysis. Fifty-one (25 test and 26 control) patients
received study RBCs. There were no significant differences in RBC usage or
other clinical outcomes. Observed AEs were within the spectrum expected
for patients of similar age undergoing cardiovascular surgery requiring
RBCs transfusion. No patients exhibited an immune response specific to
amustaline-treated RBCs. CONCLUSION(S): Amustaline-treated RBCs
demonstrated equivalence to control RBCs for Hb content, have appropriate
characteristics for transfusion, and were well tolerated when transfused
in support of acute anemia. Renal impairment was characterized as a
potential efficacy endpoint for pivotal studies of RBC transfusion in
cardiac surgery. Copyright © 2018 The Authors Transfusion
published by Wiley Periodicals, Inc. on behalf of AABB

<56>
Accession Number
620505875
Title
Image quality of prospectively ECG-triggered coronary CT angiography in
heart transplant recipients.
Source
American Journal of Roentgenology. 210 (2) (pp 314-319), 2018. Date of
Publication: February 2018.
Author
Bartykowszki A.; Kolossvary M.; Jermendy A.L.; Karady J.; Szilveszter B.;
Karolyi M.; Balogh O.; Sax B.; Merkely B.; Maurovich-Horvat P.
Institution
(Bartykowszki, Kolossvary, Jermendy, Karady, Szilveszter, Karolyi, Sax,
Merkely, Maurovich-Horvat) MTA-SE Cardiovascular Imaging Research Group,
Heart and Vascular Center, Semmelweis University, 68 Varosmajor St,
Budapest H-1122, Hungary
(Balogh) Department of Cardiology, Gottsegen Gyorgy National Cardiology
Institute, Budapest, Hungary
Publisher
American Roentgen Ray Society
Abstract
OBJECTIVE. Cardiac allograft vasculopathy (CAV) is among the top causes of
death 1 year after heart transplantation (HTx). Coronary CT angiography
(CTA) is a potential alternative to invasive imaging in the diagnosis of
CAV. However, the higher heart rate (HR) of HTx recipients prompts the use
of retrospective ECG-gating, which is associated with higher radiation
dose, a major concern in this patient population. Therefore, we sought to
evaluate the feasibility and image quality of low-radiation-dose
prospectively ECG-triggered coronary CTA in HTx recipients. MATERIALS AND
METHODS. In total, 1270 coronary segments were evaluated in 50 HTx
recipients and 50 matched control subjects who did not undergo HTx. The
control subjects were selected from our clinical database and were matched
for age, sex, body mass index, HR, and coronary dominance. Scans were
performed using 256-MDCT with prospective ECG-triggering. The degree of
motion artifacts was evaluated on a per-segment basis on a 4-point
Likert-type scale. RESULTS. The median HR was 74.0 beats/min
(interquartile range [IQR], 67.8-79.3 beats/min) in the HTx group and 73.0
beats/min (IQR, 68.5-80.0 beats/min) in the matched control group (p =
0.58). In the HTx group, more segments had diagnostic image quality
compared with the control group (624/662 [94.3%] vs 504/608 [82.9%]; p <
0.001). The mean effective radiation dose was low in both groups (3.7 mSv
[IQR, 2.4-4.3 mSv] in the HTx group vs 4.3 mSv [IQR, 2.6-4.3 mSv] in the
control group; p = 0.24). CONCLUSION. Prospectively ECG-triggered coronary
CTA examinations of HTx recipients yielded diagnostic image quality with
low radiation dose. Coronary CTA is a promising noninvasive alternative to
routine catheterization during follow-up of HTx recipients to diagnose
CAV. Copyright © American Roentgen Ray Society.

<57>
Accession Number
617639333
Title
Outcome after percutaneous edge-to-edge mitral repair for functional and
degenerative mitral regurgitation: A systematic review and meta-analysis.
Source
Heart. 104 (4) (pp 306-312), 2018. Date of Publication: 01 Feb 2018.
Author
Chiarito M.; Pagnesi M.; Martino E.A.; Pighi M.; Scotti A.; Biondi-Zoccai
G.; Latib A.; Landoni G.; Mario C.D.; Margonato A.; Maisano F.; Feldman
T.; Alfieri O.; Colombo A.; Godino C.
Institution
(Chiarito) Interventional Cardiology Unit, Humanitas Clinical and Research
Center, Rozzano, Italy
(Pagnesi, Scotti, Latib, Margonato, Colombo, Godino) Interventional
Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina 60,
Milan 20132, Italy
(Martino, Landoni) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Pighi, Mario) Department of Cardiology, NIHR Biomedical Research Unit,
Royal Brompton Hospital, London, United Kingdom
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Roma, Department of
AngioCardioNeurology, Pozzilli, Latina, Italy
(Latib, Colombo) Interventional Cardiology Unit, EMO-GVM Centro Cuore
Columbus, Milan, Italy
(Landoni, Margonato, Alfieri, Colombo) Vita-Salute San Raffaele
University, Milan, Italy
(Maisano) Universitats Spital Zurich, University Heart Center, Zurich,
Switzerland
(Feldman) NorthShore University HealthSystem, Evanston, IL, United States
(Alfieri) Cardiac Surgery Unit, San Raffaele Hospital, Milan, Italy
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives Differences in terms of safety and efficacy of percutaneous
edge-to-edge mitral repair between patients with functional and
degenerative mitral regurgitation (MR) are not well established. We
performed a systematic review and meta-analysis to clarify these
differences. Methods PubMed, EMBASE, Google scholar database and
international meeting abstracts were searched for all studies about
MitraClip. Studies with <25 patients or where 1-year results were not
delineated between MR aetiology were excluded. This study is registered
with PROSPERO. Results A total of nine studies investigating the mid-term
outcome of percutaneous edge-to-edge repair in patients with functional
versus degenerative MR were included in the meta-analysis (n=2615). At 1
year, there were not significant differences among groups in terms of
patients with MR grade<=2 (719/1304 vs 295/504; 58% vs 54%; risk ratio
(RR) 1.12; 95% CI: 0.86 to 1.47; p=0.40), while there was a significantly
lower rate of mitral valve re-intervention in patients with functional MR
compared with those with degenerative MR (77/1770 vs 80/818; 4% vs 10%; RR
0.60; 95% CI: 0.38 to 0.97; p=0.04). One-year mortality rate was 16%
(408/2498) and similar among groups (RR 1.26; 95% CI: 0.90 to 1.77;
p=0.18). Functional MR group showed significantly higher percentage of
patients in New York Heart Association class III/IV (234/1480 vs 49/583;
16% vs 8%; p<0.01) and re-hospitalisation for heart failure (137/605 vs
31/220; 23% vs 14%; p=0.03). No differences were found in terms of single
leaflet device attachment (25/969 vs 20/464; 3% vs 4%; p=0.81) and device
embolisation (no events reported in both groups) at 1 year. Conclusions
This meta-analysis suggests that percutaneous edge-to-edge repair is
likely to be an efficacious and safe option in patients with both
functional and degenerative MR. Large, randomised studies are ongoing and
awaited to fully assess the clinical impact of the procedure in these two
different MR aetiologies. Copyright © Article author(s) (or their
employer(s) unless otherwise stated in the text of the article) 2018.

<58>
Accession Number
621052369
Title
Optimizing the Safety Profile of Everolimus by Delayed Initiation in de
Novo Heart Transplant Recipients: Results of the Prospective Randomized
Study EVERHEART.
Source
Transplantation. 102 (3) (pp 493-501), 2018. Date of Publication: 01 Mar
2018.
Author
Potena L.; Pellegrini C.; Grigioni F.; Amarelli C.; Livi U.; MacCherini
M.; Masciocco G.; Faggian G.; Lilla Della Monica P.; Gerosa G.; Marraudino
N.; Corda M.; Boffini M.; De Santo L.S.; Tona F.; Poggio D.; Savini C.;
Ambrogi F.; Bernazzali S.; D'Armini A.M.; Mattiucci G.; Rinaldi M.;
Ribezzo M.; Porcu M.; Musumeci F.; Gambino A.; Maiello C.; Frigerio M.;
Guzzi G.; Forni A.; Capone G.
Institution
(Potena, Grigioni, Savini) Heart and Lung Transplant Program,
Cardiovascular Department, Academic Hospital S. Orsola-Malpighi, Building
21, via Massarenti, 9, Bologna 40138, Italy
(Pellegrini, D'Armini, Mattiucci) Cardiac Surgery Department, University
of Pavia-Hospital Policlinico, San Matteo, Pavia, Italy
(Amarelli, Maiello) Transplant Surgery Department, Hospitals
Colli-Monaldi, Naples, Italy
(Livi, Guzzi) Cardiothoracic Surgery Department, Academic Hospital S.
Maria della Misericordia, Udine, Italy
(MacCherini, Bernazzali) Heart Transplant Surgery Unit, Academic Hospital
Senese, Siena, Italy
(Masciocco, Frigerio) Cardiology 2-Cardiac Insufficiency and
Transplantation Department, Academic Hospital Niguarda, Milan, Italy
(Faggian, Forni) Cardiac Surgery Unit, Academic Hospital Civile Maggiore,
Verona, Italy
(Lilla Della Monica, Musumeci) Cardiac Surgery Unit, Hospital San Camillo
Forlanini, Rome, Italy
(Gerosa, Poggio, Gambino) Cardiac Surgery Unit, Academic Hospital of
Padova, Padua, Italy
(Marraudino, Capone) Cardiac Surgery Unit, Hospital of Bari, Bari, Italy
(Corda, Porcu) Cardiology Unit, Hospital G. Brotzu, San Michele, Cagliari,
Italy
(Boffini, Rinaldi, Ribezzo) Cardiac Surgery Unit, Hospital Molinette,
Turin, Italy
(De Santo) Hospital Monaldi, Naples, Italy
(Tona) Hospital of Monza, Monza, Italy
(Ambrogi) University of Milan, Milan, Italy
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background Although everolimus potentially improves long-term heart
transplantation (HTx) outcomes, its early postoperative safety profile had
raised concerns and needs optimization. Methods This 6-month, open-label,
multicenter randomized trial was designed to compare the cumulative
incidence of a primary composite safety endpoint comprising wound healing
delays, pericardial effusion, pleural effusion needing drainage, and renal
insufficiency events (estimated glomerular filtration rate <=30/mL/min per
1.73 m2) in de novo HTx recipients receiving immediate
everolimus (EVR-I) (<=144 hours post-HTx) or delayed everolimus (EVR-D)
(4-6 weeks post-HTx with mycophenolate mofetil as a bridge) with
reduced-dose cyclosporine A. Cumulative incidence of biopsy-proven
rejection >= 2R, rejection with hemodynamic compromise, graft loss, or
death was the secondary composite efficacy endpoint. Results Overall, 181
patients were randomized to the EVR-I (n = 89) or EVR-D (n = 92) arms.
Incidence of primary safety endpoint was higher for EVR-I than EVR-D arm
(44.9% vs 32.6%; P = 0.191), mainly driven by a higher rate of pericardial
effusion (33.7% vs 19.6%; P = 0.04); wound healing delays, acute renal
insufficiency events, and pleural effusion occurred at similar frequencies
in the study arms. Efficacy failure was not significantly different in
EVR-I arm versus EVR-D arm (37.1% vs 28.3%; P = 0.191). Three patients in
the EVR-I arm and 1 in the EVR-D arm died. Incidence of clinically
significant adverse events leading to discontinuation was higher in EVR-I
arm versus EVR-D arm (P = 0.02). Conclusions Compared with immediate
initiation, delayed everolimus initiation appeared to provide a clinically
relevant early safety benefit in de novo HTx recipients, without
compromising efficacy. Copyright © 2017 The Author(s). Published
by Wolters Kluwer Health, Inc.

<59>
Accession Number
624898850
Title
Is goal-directed fluid therapy based on dynamic variables alone sufficient
to improve clinical outcomes among patients undergoing surgery? A
meta-analysis 11 Medical and Health Sciences.
Source
Critical Care. 22 (1) (no pagination), 2018. Article Number: 298. Date of
Publication: 14 Nov 2018.
Author
Deng Q.-W.; Tan W.-C.; Zhao B.-C.; Wen S.-H.; Shen J.-T.; Xu M.
Institution
(Deng, Wen, Shen, Xu) Department of Anesthesiology, First Affiliated
Hospital, Sun Yat-sen University, No.58, Zhongshan 2nd Road, Guangzhou
510080, China
(Tan) Department of Endoscopy, Sun Yat-sen University Cancer Center, No.
651, Dongfeng East Road, Guangzhou 510060, China
(Zhao) Department of Anesthesiology, Nanfang Hospital, Southern Medical
University, No. 1838, Guangzhou Avenue North, Guangzhou 510515, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Whether goal-directed fluid therapy based on dynamic
predictors of fluid responsiveness (GDFTdyn) alone improves clinical
outcomes in comparison with standard fluid therapy among patients
undergoing surgery remains unclear. Method(s): PubMed, EMBASE, the
Cochrane Library and ClinicalTrials.gov were searched for relevant
studies. Studies comparing the effects of GDFTdyn with that of standard
fluid therapy on clinical outcomes among adult patients undergoing surgery
were considered eligible. Two analyses were performed separately: GDFTdyn
alone versus standard fluid therapy and GDFTdyn with other optimization
goals versus standard fluid therapy. The primary outcomes were short-term
mortality and overall morbidity, while the secondary outcomes were serum
lactate concentration, organ-specific morbidity, and length of stay in the
intensive care unit (ICU) and in hospital. Result(s): We included 37
studies with 2910 patients. Although GDFTdyn alone lowered serum lactate
concentration (mean difference (MD) - 0.21 mmol/L, 95% confidence interval
(CI) (- 0.39, - 0.03), P = 0.02), no significant difference was found
between groups in short-term mortality (odds ratio (OR) 0.85, 95% CI
(0.32, 2.24), P = 0.74), overall morbidity (OR 1.03, 95% CI (0.31, 3.37),
P = 0.97), organ-specific morbidity, or length of stay in the ICU and in
hospital. Analysis of trials involving the combination of GDFTdyn and
other optimization goals (mainly cardiac output (CO) or cardiac index
(CIx)) showed a significant reduction in short-term mortality (OR 0.45,
95% CI (0.24, 0.85), P = 0.01), overall morbidity (OR 0.41, 95% CI (0.28,
0.58), P < 0.00001), serum lactate concentration (MD - 0.60 mmol/L, 95% CI
(- 1.04, - 0.15), P = 0.009), cardiopulmonary complications (cardiac
arrhythmia (OR 0.58, 95% CI (0.37, 0.92), P = 0.02), myocardial infarction
(OR 0.35, 95% CI (0.16, 0.76), P = 0.008), heart failure/cardiovascular
dysfunction (OR 0.31, 95% CI (0.14, 0.67), P = 0.003), acute lung
injury/acute respiratory distress syndrome (OR 0.13, 95% CI (0.02, 0.74),
P = 0.02), pneumonia (OR 0.4, 95% CI (0.24, 0.65), P = 0.0002)), length of
stay in the ICU (MD - 0.77 days, 95% CI (- 1.07, - 0.46), P < 0.00001) and
in hospital (MD - 1.18 days, 95% CI (- 1.90, - 0.46), P = 0.001).
 Conclusion(s): It was not the optimization of fluid responsiveness by
GDFTdyn alone but rather the optimization of tissue and organ perfusion by
GDFTdyn and other optimization goals that benefited patients undergoing
surgery. Patients managed with the combination of GDFTdyn and CO/CI goals
might derive most benefit. Copyright © 2018 The Author(s).

<60>
Accession Number
2001284590
Title
Validation of a claims-based algorithm identifying eligible study subjects
in the ADAPTABLE pragmatic clinical trial.
Source
Contemporary Clinical Trials Communications. 12 (pp 154-160), 2018. Date
of Publication: December 2018.
Author
Fishman E.; Barron J.; Dinh J.; Jones W.S.; Marshall A.; Merkh R.;
Robertson H.; Haynes K.
Institution
(Fishman, Barron, Dinh, Marshall, Merkh, Haynes) HealthCore, Inc.,
Wilmington, DE, United States
(Jones, Robertson) Duke Clinical Research Institute, Durham, NC, United
States
Publisher
Elsevier Inc
Abstract
Objective: Validate an algorithm that uses administrative claims data to
identify eligible study subjects for the ADAPTABLE (Aspirin Dosing: A
Patient-centric Trial Assessing Benefits and Long-Term Effectiveness)
pragmatic clinical trial (PCT). Material(s) and Method(s): This study
used medical records from a random sample of patients identified as
eligible for the ADAPTABLE trial. The inclusion criteria for ADAPTABLE
were a history of acute myocardial infarction (AMI) or percutaneous
coronary intervention (PCI) or coronary artery bypass grafting (CABG), or
other coronary artery disease (CAD), plus at least one of several
risk-enrichment factors. Exclusion criteria included a history of bleeding
disorders or aspirin allergy. Using a claims-based algorithm, based on
International Classification of Diseases, 9th Edition, Clinical
Modification (ICD-9-CM) and 10th Edition (ICD-10) codes and Current
Procedural Terminology (CPT) codes, we identified patients eligible for
the PCT. The primary outcome was the positive predictive value (PPV) of
the identification algorithm: the proportion of sampled patients whose
medical records confirmed their ADAPTABLE study eligibility. Exact 95%
confidence limits for binomial random variables were calculated for the
PPV estimates. Result(s): Of the 185 patients whose medical records
were reviewed, 168 (90.8%; 95% Confidence Interval: 85.7%, 94.6%) were
confirmed study eligible. This proportion did not differ between patients
identified with codes for AMI and patients identified with codes for PCI
or CABG. Conclusion(s): The estimated PPV was similar to those in
claims-based identification of drug safety surveillance events, indicating
that administrative claims data can accurately identify study-eligible
subjects for pragmatic clinical trials. Copyright © 2018 The
Authors

<61>
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.
 Method(s): 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).
 Result(s): 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). Conclusion(s): 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

<62>
Accession Number
624873222
Title
Efficacy of dexmedetomidine in coronary artery bypass graft surgery under
cardiopulmonary bypass: A randomized, double-blind clinical trial.
Source
Iranian Red Crescent Medical Journal. 20 (8) (no pagination), 2018.
Article Number: e67738. Date of Publication: August 2018.
Author
Sedighinejad A.; Jouryabi A.M.; Imantalab V.; Mirmansouri A.; Sheikhani
N.N.; Atrkarroushan Z.; Biazar G.; Chaibakhsh Y.
Institution
(Sedighinejad, Jouryabi, Imantalab, Mirmansouri, Biazar) Anesthesiology
Research Center, Guilan University of Medical Sciences (GUMS), Rasht,
Iran, Islamic Republic of
(Sheikhani) Department of Cardiac Surgery, Guilan University of Medical
Sciences, Rasht, Iran, Islamic Republic of
(Atrkarroushan, Chaibakhsh) Guilan University of Medical Sciences(GUMS),
Rasht, Iran, Islamic Republic of
Publisher
Kowsar Medical Publishing Company (E-mail: editor@anesthpain.com)
Abstract
Background: In patients undergoing Cardiopulmonary Bypass (CPB) with
extracorporeal circulation, the rapid restoration of blood flow to the
ischemic tissue induces cardiac damage termed as myocardial Ischemic
Reperfusion (I/R) injury. Objective(s): In the current study, the
researchers hypothesized that Dexmedetomidine (DEX) modulates I/R injury
in Coronary Artery Bypass Graft Surgery (CABG) with Cardiopulmonary Bypass
(CPB). Method(s): This randomized, double-blind, clinical trial took
place in a university affiliated Hospital, Gilan, Iran. From April 2016 to
March 2017, 114 eligible patients undergoing elective and isolated CABG
were randomized to receive either DEX infusion 0.3 to 0.5
micro g/kg/hour before induction of anesthesia till 12 hours
postoperatively (group D) or normal saline as placebo (group C). The
endpoints were used to assess creatinine phosphokinase-MB (CKMB) and
cardiac troponin I (CTnI) levels at four measurement time points,
including baseline (T<inf>0</inf>) and 6, 12, 24, and 48 hours after the
operation (T<inf>0</inf>-T<inf>4</inf>). Result(s): Overall, 114
patients' data were analyzed; group D (n = 58) and group C (n = 56). No
significant differences were found between the two groups, in view of
baseline characteristics. Following CPB, a marked increase in CKMB and
CTnI plasma levels was observed in both groups compared with baseline (P =
0.0001). Serum CKMB levels increased from 2.27 +/- 0.59 to 7.81 +/- 1.39,
and 2.22 +/- 0.64 to 7.46 +/- 1.25 and CTnI levels from 10.22 +/- 0.17 to
4.89 +/- 1.1, and 0.27 +/- 0.28 to 4.5 +/- 1.4 in groups C and D,
respectively (P = 0.0001). According to CKMB, there was a significant
difference between the two groups at T<inf>2</inf> (P = 0.002) and
T<inf>3</inf> (P = 0.0001), and based on CTnI at T<inf>2</inf> (P = 0.004)
and T<inf>3</inf> (P = 0.0001). However, no significant difference was
observed at the other measurement point times. No adverse effect was
recorded due to this intervention. Conclusion(s): Perioperative DEX
in cardiac surgery appears safe, with properties to alleviate I/R injury.
Obviously, future standard trials are required to find optimal
intervention strategies. Copyright © 2018, Author(s).

<63>
Accession Number
624873208
Title
Comparative analysis of the effects of vasoperssin and norepinephrine on
the renal function in patients undergoing CABG; A randomized clinical
trial.
Source
Iranian Red Crescent Medical Journal. 20 (8) (no pagination), 2018.
Article Number: e67026. Date of Publication: August 2018.
Author
Hasanpour Dargah M.; Samadi N.; Vakili J.; Isazadefar K.; Kebar S.M.; Zade
A.R.M.; Vakili M.R.
Institution
(Hasanpour Dargah, Vakili) Department of Anesthesiology, Faculty of
Medicine, Ardabil University of Medical Sciences, Ardabil, Iran, Islamic
Republic of
(Samadi) School of Nursing and Midwifery, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Samadi) Department of Medical-Surgical Nursing, School of Nursing and
Midwifery, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Isazadefar) Social Determinants of Health Research Center (SDH), Ardabil
University of Medical Sciences, Ardabil, Iran, Islamic Republic of
(Kebar) Department of Internal Medicine, Faculty of Medicine, Ardabil
University of Medical Sciences, Ardabil, Iran, Islamic Republic of
(Zade) Department of Cardiovascular Diseases, Faculty of Medicine, Ardabil
University of Medical Sciences, Ardabil, Iran, Islamic Republic of
(Vakili) Department of Surgery, Faculty of Medicine, Ardabil University of
Medical Sciences, Ardabil, Iran, Islamic Republic of
Publisher
Kowsar Medical Publishing Company (E-mail: editor@anesthpain.com)
Abstract
Background: Coronary artery bypass grafting (CABG) is one the most common
heart operations, in which blood vessels from other parts of the body,
like the saphenous vein, are grafted to the blocked arteries. Due to the
widespread use of vasoactive drugs in the course of surgery, and renal
complications of these drugs, we aimed to determine the effect of
norepinephrine on the renal function of patients with CABG, visiting the
cardiac surgery ward of a university affiliated hospital in Ardabil, Iran,
with the purpose of maintaining renal perfusion and preventing renal
dysfunction in patients undergoing CABG. Objective(s): This research
aimed to determine and compare the effects of vasopressin and
norepinephrine on the renal function of patients undergoing CABG.
 Method(s): This study was a randomized clinical trial. A total of 120
candidates for CABG in a governmental hospital, Iran, during years
2016-2017, were randomly assigned into two groups. The patients'
conditions across the two groups were compared regarding hemodynamics
during surgery and post-surgical complications, e.g., renal function (Bun,
Cr, and CLCr), using a researcher made questionnaire. Result(s): The
results of our study showed that according to repeated measures test,
there was no statistically significant difference during the intervention
(P value > 0.05). However, the Independent t-test revealed a statistically
significant difference between groups following CABG, which related to the
clearance creatinine level. It indicated higher clearance creatinine level
in the norepinephrine group (72.83 +/- 25.03 and 78.16 +/- 27.31) than the
vasopressin group (64.33 +/- 17.47 and 86.33 +/- 30.54) (P < 0.05),
however, the groups did not vary significantly from each other in other
items. Conclusion(s): According to the results of the study, it could
be stated that probable renal complications during operation can be
reduced to some extent in patients undergoing CABG using inotrope and
vasopressor drugs such as norepinephrine. Copyright © 2018,
Author(s).

<64>
Accession Number
624872227
Title
The effect of remote ischemic preconditioning on the incidence of acute
kidney injury in patients undergoing coronary artery bypass graft surgery:
A randomized controlled trial.
Source
Iranian Journal of Medical Sciences. 43 (6) (pp 587-595), 2018. Date of
Publication: November 2018.
Author
Bagheri S.; Shahbazi S.; Shafa M.; Borhani-Haghighi A.; Kiani M.; Sagheb
M.M.
Institution
(Bagheri, Kiani, Sagheb) Shiraz Nephro-Urology Research Center, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Shahbazi) Anesthesiology and Critical Care Research Center, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Shafa) Department of Cardiac Surgery, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Borhani-Haghighi) Clinical Neurology Research Center, Shiraz University
of Medical Sciences, Shiraz, Iran, Islamic Republic of
Publisher
Shiraz University of Medical Sciences (E-mail: ijms@sums.ac.ir)
Abstract
Background: Remote ischemic preconditioning (RIPC) protects other organs
from subsequent lethal ischemic injury, but uncertainty remains. We
investigated if RIPC could prevent acute kidney injury (AKI) in patients
undergoing coronary artery bypass graft (CABG) surgery. Method(s):
This parallel-group, double-blind, randomized, controlled trial was done
on adults undergoing elective or urgent on-pump CABG surgery from 2013 to
2017 in Shiraz, Iran. Patients were allocated to RIPC or control groups
through permuted blocking. The patients in the RIPC group received three
cycles of 5 min ischemia and 5 min reperfusion in the upper arm after
induction of anesthesia. We placed an uninflated cuff on the arm for 30
min in the control group. The study primary endpoint was an incidence of
AKI. Secondary endpoints included short-term clinical outcomes. We
compared categorical and continuous variables using Pearson
chi2 and unpaired t tests, respectively. P<0.05 was considered
significant. Result(s): Of the 180 patients randomized to RIPC (n=90)
and control (n=90) groups, 87 patients in the RIPC and 90 patients in the
control group were included in the analysis. There was no significant
difference in the incidence of AKI between the groups (38 patients [43.7%]
in the RIPC group and 41 patients [45.6%] in the control group; relative
risk, 0.96; 95% confidence interval, 0.69 to 1.33; P=0.80). No significant
differences were seen regarding secondary endpoints such as postoperative
liver function, atrial fibrillation, and inpatient mortality.
 Conclusion(s): RIPC did not reduce the incidence of AKI, neither did
it improve short-term clinical outcomes in patients undergoing on-pump
CABG surgery. Copyright © 2018, Shiraz University of Medical
Sciences. All rights reserved.

<65>
Accession Number
624836590
Title
Perioperative use of levosimendan improves clinical outcomes in patients
after cardiac surgery: A systematic review and meta-analysis.
Source
Journal of Cardiovascular Pharmacology. 72 (1) (pp 11-18), 2018. Date of
Publication: 2018.
Author
Qiang H.; Luo X.; Huo J.-H.; Wang Z.-Q.
Institution
(Qiang, Huo) Department of Cardiovascular Medicine, First Affiliated
Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
(Luo, Wang) Department of Hematology, Tongji Hospital, Tongji University
School of Medicine, Shanghai, China
(Wang) Department of Cardiology, Xinhua Hospital, School of Medicine,
Shanghai Jiao Tong University, 1665 Kongjiang Rd, Shanghai 200092, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Severe postoperative complications can affect cardiac surgery patients.
Levosimendan is a novel calcium sensitizer commonly administered after
cardiac surgery. However, the patient benefits are controversial. PubMed,
Embase, and the Cochrane library were systematically searched for
randomized controlled trials comparing levosimendan with control in adult
cardiac surgery patients. Twenty-five studies (3247 patients) were
included. Pooled data indicated that levosimendan reduced mortality after
cardiac surgery [odds ratio (OR) 0.63, 95% confidence interval (CI):
0.47-0.84, P = 0.001]. However, this reduction was restricted to patients
with low (<50%) left ventricular ejection fraction (OR 0.49, 95% CI:
0.35-0.70, P = 0.0001). It significantly reduced the incidence of
postoperative acute kidney injury (OR 0.55, 95% CI: 0.41-0.74, P < 0.0001)
and renal replacement therapy use (OR 0.56, 95% CI: 0.39-0.80, P = 0.002).
Moreover, levosimendan significantly shortened the duration of the
intensive care unit stay (weighted mean differences 20.49 day, 95% CI:
20.75 to 20.24, P = 0.0002) and mechanical ventilation use (weighted mean
differences 22.30 hours, 95% CI: 23.76 to 20.84, P = 0.002). In
conclusion, levosimendan reduced the mortality in patients with low left
ventricular ejection fraction and decreased the incidence of acute renal
injury and renal replacement therapy use. In addition, it shortened the
duration of the intensive care unit stay and mechanical ventilation
use. Copyright © 2018 Wolters Kluwer Health, Inc. All rights
reserved.

<66>
Accession Number
624903597
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.; O'Loughlin E.; Chan M.T.; Leslie K.;
Forbes A.; Paech M.; Myles P.
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, Victoria, 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, Victoria, Australia
(Leslie) Anaesthesia, Perioperative and Pain Medicine Unit, and Department
of Pharmacology and Therapeutics, University of Melbourne, Melbourne,
Victoria, Australia
(Myles) Department of Anaesthesia and Perioperative Medicine, Alfred
Hospital, Melbourne, Victoria, Australia
Publisher
NLM (Medline)
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. METHOD(S): 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. RESULT(S): 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(S): 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 © 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
624786043
Title
Single versus dual antiplatelet therapy after transcatheter aortic valve
implantation: A systematic review and meta-analysis.
Source
Cardiology (Switzerland). (pp 52-65), 2018. Date of Publication: 2018.
Author
Hu X.; Yang F.-Y.; Wang Y.; Zhang Y.; Chen M.
Institution
(Hu, Yang, Wang, Zhang) West China School of Medicine, West China
Hospital, Sichuan University, Chengdu 610041, China
(Chen) Department of Cardiology, West China Hospital, Sichuan University,
Chengdu, China
Publisher
S. Karger AG
Abstract
Objectives: Although dual antiplatelet therapy (DAPT) with aspirin and
clopidogrel is currently recommended in patients after transcatheter
aortic valve implantation (TAVI), this practice is not supported by
sufficient evidence. This study was performed to compare DAPT to single
antiplatelet therapy (SAPT). Method(s): An electronic search was
completed of PubMed, Embase, Ovid Medline, Web of Science, and Cochrane
Central Register of Controlled Trials. Studies comparing DAPT versus SAPT
in patients undergoing TAVI were included. Result(s): Seven studies
incorporating 1,445 patients were eligible for the present meta-analysis.
There were no significant differences on 30-day all-cause mortality (OR
1.19, 95% CI 0.63-2.25, p = 0.593), 6-month all-cause mortality (OR 1.11,
95% CI 0.49-2.53, p = 0.796), or 1-year all-cause mortality (OR 1.19, 95%
CI 0.63-2.25, p = 0.593). DAPT was associated with an increased risk for
30-day (OR 2.91, 95% CI 1.85-4.58, p < 0.01), 6-month (OR 2.54, 95% CI
1.26-5.10, p < 0.001), and 1-year major and lethal bleeding (OR 2.65, 95%
CI 1.04-6.77, p = 0.041) based on 896, 337, and 583 patients,
respectively, compared to SAPT. Conclusion(s): Compared to SAPT, DAPT
was not shown to be superior in reducing thrombotic events, but presented
an increased risk of major/life-threatening bleeding. More randomized
controlled trials are needed to provide further evidence. Copyright
© 2018 S. Karger AG, Basel.

<68>
Accession Number
2001012917
Title
Current Readings: Single vs Bilateral Internal Mammary Artery in Coronary
Artery Bypass Grafting.
Source
Seminars in Thoracic and Cardiovascular Surgery. 30 (4) (pp 398-405),
2018. Date of Publication: Winter 2018.
Author
Ejiofor J.I.; Kaneko T.; Aranki S.F.
Institution
(Ejiofor, Kaneko, Aranki) Division of Cardiac Surgery, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
Publisher
W.B. Saunders
Abstract
There is strong retrospective data demonstrating that bilateral internal
mammary artery (BIMA) grafting leads to better long-term survival as
compared to left internal mammary artery grafting. However, this survival
advantage was not corroborated by the interim results of the Arterial
Revascularization Trial. Today, there are barriers to widespread adoption
of BIMA grafting. One of the main disadvantages of the use of BIMA grafts
is the higher risk of deep sternal wound infection. Deep sternal wound
infections can be minimized by skeletonized harvesting of the internal
mammary artery grafts, which preserve blood flow to the sternum. Also,
utilizing the BIMA graft as a "Y" graft may lead to more complete
revascularization compared to its in situ use. BIMA grafting on average
takes 25 minutes longer operating time with a higher in-hospital costs. We
eagerly await the 10-year results of the Arterial Revascularization Trial
to determine the truly unbiased randomized long-term effectiveness of BIMA
grafting. Copyright © 2018 Elsevier Ltd

<69>
Accession Number
624045517
Title
Timing of Loading Dose of Atorvastatin in Patients Undergoing Percutaneous
Coronary Intervention for Acute Coronary Syndromes: Insights from the
SECURE-PCI Randomized Clinical Trial.
Source
JAMA Cardiology. (no pagination), 2018. Date of Publication: 2018.
Author
Lopes R.D.; De Barros E Silva P.G.M.; De Andrade Jesuino I.; Santucci
E.V.; Barbosa L.M.; Damiani L.P.; Nakagawa Santos R.H.; Laranjeira L.N.;
Dall Orto F.T.C.; Beraldo De Andrade P.; De Castro Bienert I.R.; Alexander
J.H.; Granger C.B.; Berwanger O.
Institution
(Lopes, De Barros E Silva, Barbosa) Brazilian Clinical Research Institute,
Sao Paulo, Brazil
(Lopes, Alexander, Granger) Duke Clinical Research Institute, Durham, NC,
United States
(De Barros E Silva, De Andrade Jesuino, Santucci, Damiani, Nakagawa
Santos, Laranjeira, Berwanger) Research Institute-Heart Hospital, Sao
Paulo, Brazil
(Dall Orto) Hospital Do Coracao de Pocos de Caldas, Pocos de Caldas,
Brazil
(Beraldo De Andrade) Santa Casa de Marilia, Marilia, Brazil
(De Castro Bienert) Hospital das Clinicas da Faculdade de Medicina de
Marilia, Marilia, Brazil
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Loading doses of atorvastatin did not show reduction on
clinical outcomes in the overall population of patients with acute
coronary syndrome (ACS) enrolled in the Statins Evaluation in Coronary
Procedures and Revascularization (SECURE-PCI) trial, but a potential
benefit was identified in patients who subsequently underwent percutaneous
coronary intervention (PCI). Objective(s): To determine whether
periprocedural loading doses of atorvastatin are associated with decreased
30-day major adverse cardiovascular events (MACE) in patients with ACS
undergoing PCI according to type of ACS and timing of atorvastatin
administration before PCI. Design, Setting, and Participant(s):
Secondary analysis of a multicenter, double-blind, placebo-controlled,
randomized clinical trial conducted at 53 sites that enrolled 4191
patients with ACS intended to be treated with PCI between April 18, 2012,
and October 06, 2017. Intervention(s): Patients were randomized to 2
loading doses of 80 mg of atorvastatin or matching placebo before and 24
hours after a planned PCI. By protocol, all patients (regardless of
treatment group) received 40 mg of atorvastatin for 30 days starting 24
hours after the second dose of study medication. Main Outcomes and
Measures: The primary outcome was MACE through 30 days, composed by
all-cause mortality, myocardial infarction, stroke, and unplanned coronary
revascularization. Cox regression models adjusting for key baseline
characteristics were used to assess the association between atorvastatin
and MACE in patients undergoing PCI. Result(s): From the overall
trial population, 2710 (64.7%) underwent PCI (650 women [24.0%]; mean [SD]
age, 62 [11.3] years). Loading atorvastatin was associated with reduced
MACE at 30 days by 28% in the PCI group (adjusted hazard ratio [HR], 0.72;
95% CI 0.54-0.97; P =.03). Loading dose of atorvastatin was administered
less than 12 hours before PCI in 2548 patients (95.3%) (45.1% < 2 hours
and 54.3% between 2 and 12 hours). There was no significant interaction
between treatment effect and timing of study drug administration. The
treatment effect of loading atorvastatin was more pronounced in patients
with ST-segment elevation myocardial infarction than in patients with
non-ST-segment elevation ACS (adjusted HR, 0.59; 95% CI, 0.38-0.92; P
=.02; HR, 0.85; 95% CI, 0.58-1.27; P =.43, respectively). Conclusions
and Relevance: In patients with ACS undergoing PCI, periprocedural loading
doses of atorvastatin appeared to reduce the rate of MACE at 30 days,
primarily in patients with ST-segment elevation myocardial infarction.
This beneficial effect seemed to be preserved and consistent, regardless
of timing of atorvastatin administration, including within 2 hours before
PCI. Trial Registration: clinicaltrials.gov Identifier:
NCT01448642. Copyright © 2018 American Medical Association. All
rights reserved.

<70>
Accession Number
624408421
Title
Relationship between intra-operative vein graft treatment with DuraGraft
or saline and clinical outcomes after coronary artery bypass grafting.
Source
Expert Review of Cardiovascular Therapy. 16 (12) (pp 963-970), 2018. Date
of Publication: 02 Dec 2018.
Author
Haime M.; McLean R.R.; Kurgansky K.E.; Emmert M.Y.; Kosik N.; Nelson C.;
Gaziano M.J.; Cho K.; Gagnon D.R.
Institution
(Haime, Gaziano, Cho) VA Boston Healthcare System, Harvard Medical School,
West Roxbury, MA, United States
(McLean) Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA,
United States
(McLean) Department of Medicine, Beth Israel Deaconess Medical Center and
Harvard Medical School, Boston, MA, United States
(McLean, Kurgansky, Kosik, Nelson, Gaziano, Cho) Massachusetts Veterans
Epidemiology Research and Information Center (MAVERIC), VA Boston
Healthcare System, Boston, MA, United States
(Emmert) Clinic for Cardiovascular Surgery, University Hospital of Zurich,
Zurich, Switzerland
(Gaziano, Cho, Gagnon) Division of Aging, Brigham and Women's Hospital,
Boston, MA, United States
(Gagnon) Department of Biostatistics, Boston University School of Public
Health, Boston, MA, United States
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Background: Saphenous vein grafts (SVGs) remain the most often used
conduits for coronary bypass grafting (CABG). Progressive intimal
hyperplasia contributes to vein-graft disease and vein-graft failure
(VGF). We compared the impact of intraoperative preservation of SVGs in a
storage solution (DuraGraft) versus heparinized saline on VGF-related
outcomes after CABG. Method(s): From 1996 to 2004, 2436 patients
underwent isolated CABG with >= 1 SVG. SVGs were consecutively treated
with DuraGraft in 1036 patients (2001-2004) and heparinized saline in 1400
patients (1996-1999). Short- (< 30 days) and long-term (>= 1000 days)
outcomes were assessed using repeat revascularization (primary end point),
and major adverse cardiac events (MACE) consisting of the composite of
death, nonfatal myocardial infarction, or repeat revascularization.
 Result(s): Mean follow-up in the DuraGraft group was 8.5 +/- 4.2
years and 9.9 +/- 5.6 years in controls. Short-term event rates were low
and generally did not differ between groups. DuraGraft was associated with
a 45% lower occurrence of nonfatal myocardial infarction after 1000 days
(hazard ratio 0.55, 95% CI 0.41-0.74; P < 0.0001). There was 35% and 19%
lower long-term risk for revascularization (HR 0.65, 95% CI 0.44-0.97; P =
0.037) and MACE (HR 0.81, 95% CI 0.70-0.94; P = 0.0051), respectively,
after DuraGraft. Mortality was comparable between both groups at 1, 5, and
10 years. There was no statistically significant association between
DuraGraft exposure and time to death starting at 30 or 1000 days (HR 0.91,
95% CI 0.76-1.09; P = 0.29). Conclusion(s): In this study,
intraoperative treatment of SVGs with DuraGraft was associated with a
lower risk of long-term adverse events suggesting that efficient
intraoperative SVG treatment may reduce VGF-related complications
post-CABG. These data warrant randomized clinical trials to validate these
findings. Copyright © 2018, © 2018 Informa UK Limited,
trading as Taylor & Francis Group.

<71>
Accession Number
625081116
Title
Radial versus femoral artery access in patients undergoing PCI for left
main coronary artery disease: Analysis from the EXCEL trial.
Source
EuroIntervention. 14 (10) (pp 1104-1111), 2018. Date of Publication:
November 2018.
Author
Chen S.; Redfors B.; Liu Y.; Ben-Yehuda O.; Morice M.-C.; Leon M.B.;
Kandzari D.E.; Mehran R.; Lembo N.J.; Banning A.P.; Merkely B.; Kappetein
A.P.; Sabik J.F.; Serruys P.W.; Stone G.W.
Institution
(Chen, Redfors, Liu, Ben-Yehuda, Leon, Mehran, Lembo, Stone) Columbia
University Medical Center, Cardiovascular Research Foundation, 1700
Broadway, 9th Floor, New York, NY 10019, United States
(Ben-Yehuda, Leon, Lembo, Stone) New York-Presbyterian Hospital, Columbia
University Medical Center, New York, NY, United States
(Morice) Ramsay Generale de Sante, Institut Cardiovasculaire Paris Sud,
Paris, France
(Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Mehran) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, New York, NY, United States
(Banning) John Radcliffe Hospital, Oxford, United Kingdom
(Merkely) Heart and Vascular Center, Semmelweis University, Budapest,
Hungary
(Kappetein) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
Publisher
EuroPCR
Abstract
Aims: We sought to compare clinical outcomes and procedural
characteristics with transradial access (TRA) versus transfemoral access
(TFA) in patients who were treated with PCI for left main (LM) coronary
artery disease. Methods and Results: The EXCEL trial was a
prospective, international, open-label, multicentre trial that randomised
1,905 patients with LM disease and SYNTAX scores <=32 to PCI with
everolimus-eluting stents versus coronary artery bypass grafting. The
present analysis cohort consisted of 931 patients undergoing PCI with TRA
or TFA, but not both. The primary endpoint was a composite of death,
myocardial infarction (MI), or stroke at three years. Multivariable Cox
proportional hazards regression was used to adjust for differences in
baseline covariates. PCI in EXCEL was performed exclusively with TRA in
248 (26.6%) patients and with TFA in 683 (73.4%) patients. TRA patients
were younger and less likely to have hypertension and chronic kidney
disease. The mean number of vessels and lesions treated was higher in TFA
patients, although the SYNTAX score was similar in both groups. Patients
undergoing TRA and TFA had similar 30-day rates of TIMI major or minor
bleeding (2.4% versus 3.8%, respectively, p=0.30). At three years, TRA and
TFA patients had similar rates of the primary endpoint (15.7% versus
14.8%, adjusted HR 1.11, 95% CI: 0.73-1.69, p=0.64), as well as the
individual rates of death, MI, stroke, ischaemia-driven revascularisation
and stent thrombosis. Conclusion(s): In the EXCEL trial, PCI of LM
disease with TRA was associated with comparable early and late clinical
outcomes to TFA. Copyright © Europa Digital & Publishing 2018.
All rights reserved.

<72>
Accession Number
625108569
Title
Off-versus on-pump coronary surgery and the effect of follow-up length and
surgeons' experience: A meta-analysis.
Source
Journal of the American Heart Association. 7 (21) (no pagination), 2018.
Article Number: e010034. Date of Publication: 01 Nov 2018.
Author
Gaudino M.; Benedetto U.; Bakaeen F.; Rahouma M.; Tam D.Y.; Abouarab A.;
Di Franco A.; Leonard J.; Elmously A.; Puskas J.D.; Angelini G.D.; Girardi
L.N.; Fremes S.E.; Taggart D.P.
Institution
(Gaudino, Rahouma, Abouarab, Di Franco, Leonard, Elmously, Girardi)
Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York
City, NY, United States
(Benedetto, Angelini) Bristol Heart Institute, School of Clinical
Sciences, University of Bristol, United Kingdom
(Bakaeen) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Tam, Fremes) Schulich Heart Centre, Sunnybrook Health Science, University
of Toronto, Canada
(Puskas) Department of Cardiovascular Surgery, Icahn School of Medicine at
Mount Sinai, New York City, NY, United States
(Taggart) Nuffield Department of Surgical Sciences, University of Oxford,
United Kingdom
Publisher
American Heart Association Inc.
Abstract
Background-The debate on the relative benefits of off-pump and on-pump
coronary artery bypass surgery (OPCABG and ONCABG) is still open. We aimed
to provide an updated and complete summary of the evidence on the
differences between OPCABG and ONCABG and to explore whether the length of
the follow-up and the surgeons' experience in OPCABG modify the
comparative results. Methods and Results-All randomized clinical trials
comparing OPCABG and ONCABG were included. Primary outcome was followup
mortality. Secondary outcomes were operative mortality, perioperative
stroke, perioperative myocardial infarction, and late repeated
revascularization. Subgroup analyses were performed based on the length of
the follow-up and the percentage of crossover from the OPCABG group (used
as a surrogate of surgeon experience with OPCABG). One hundred four trials
were included (20 627 patients, OPCABG: 10 288; ONCABG: 10 339). Weighted
mean follow-up time was 3.7 years (range 1-7.5 years). OPCABG was
associated with a higher risk of follow-up mortality (incidence rate ratio
1.11, 95% confidence interval 1.00-1.23, P=0.05). The difference was
significant only for trials with mean follow-up of >=3 years and for
studies with a crossover rate of >=10%. There was a trend toward lower
risk of perioperative stroke and higher need for late repeated
revascularization in the OPCABG arm. Conclusions-OPCABG is associated with
a higher incidence of incomplete revascularization, an increased need for
repeated revascularization, and decreased midterm survival compared with
ONCABG. Surgeon inexperience in OPCABG is associated with late
mortality. Copyright © 2018 The Authors.

<73>
Accession Number
625096611
Title
Switching from ticagrelor to clopidogrel in patients with ST-segment
elevation myocardial infarction undergoing successful percutaneous
coronary intervention in real-world China: Occurrences, reasons, and
long-term clinical outcomes.
Source
Clinical Cardiology. (no pagination), 2018. Date of Publication: 2018.
Author
Li X.-Y.; Su G.-H.; Wang G.-X.; Hu H.-Y.; Fan C.-J.
Institution
(Li, Su, Wang, Hu, Fan) Department of Cardiology, Jinan Central Hospital
Affiliated to Shandong University, Shangdong, China
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Although switching between ticagrelor and clopidogrel is
common in clinical practice, the efficacy and safety of this de-escalation
remain controversial. Hypothesis: We assessed the occurrences, reasons,
and outcomes of switching from ticagrelor to clopidogrel in patients with
ST-segment elevation myocardial infarction (STEMI) undergoing successful
primary percutaneous coronary intervention (PCI). Method(s): A total
of 653 patients with STEMI were randomly assigned to receive loading dose
of ticagrelor or clopidogrel before PCI and then received maintenance
dose, respectively, for 12 months follow-up. The primary outcome was major
adverse cardiac events (MACE), including cardiovascular death, nonfatal
myocardial infarction, and stroke. The secondary outcome included
unexpected rehospitalization for angina, coronary revascularization, and
stent thrombosis. The safety outcome was bleeding described by the
Bleeding Academic Research Consortium (BARC) criteria. Result(s): A
total of 602 participants completed the study. The rate of switching from
ticagrelor to clopidogrel was 48.6% and the main reason was financial
burden. The rate of secondary ischemic events in the de-escalation group
was higher than that in the ticagrelor group (15.1% vs 5.6%, P = 0.008),
but lower than that in the clopidogrel group (15.1% vs 24.6%, P = 0.03),
while there were no significant differences in MACE among the three groups
(P = 0.16). De-escalation, ticagrelor, and clopidogrel did not cause
significant differences in the rates of major bleeding among the three
groups (BARC >= 2, P = 0.34). Conclusion(s): Switching from
ticagrelor to clopidogrel is very common in patients with STEMI in China.
De-escalation might be safe but associated with high risk of ischemic
events as compared to ticagrelor. Copyright © 2018 Wiley
Periodicals, Inc.

<74>
Accession Number
620596463
Title
Midterm clinical outcomes with everolimus-eluting bioresorbable scaffolds
versus everolimus-eluting metallic stents for percutaneous coronary
interventions: A metaanalysis of randomised trials.
Source
EuroIntervention. 13 (13) (pp 1565-1573), 2018. Date of Publication:
January 2018.
Author
Cassese S.; Byrne R.A.; Juni P.; Wykrzykowska J.J.; Puricel S.; Ndrepepa
G.; Schunkert H.; Fusaro M.; Cook S.; Kimura T.; Henriques J.P.S.; Serruys
P.W.; Windecker S.; Kastrati A.
Institution
(Cassese, Byrne, Ndrepepa, Schunkert, Fusaro, Kastrati) Deutsches
Herzzentrum Munchen, Technische Universitat Munchen, Lazarettstrasse, 36,
Munich 80636, Germany
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St. Michael's Hospital, Department of Medicine, University of Toronto,
Toronto, Canada
(Wykrzykowska, Henriques) AMC Heartcenter, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Puricel, Cook) Department of Cardiology, University and Hospital
Fribourg, Fribourg, Switzerland
(Schunkert, Kastrati) DZHK (German Centre for Cardiovascular Research),
Munich Heart Alliance, Munich, Germany
(Kimura) Department of Cardiovascular Medicine, Kyoto University Hospital,
Kyoto, Japan
(Serruys) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Windecker) Department of Cardiology, Bern University Hospital, University
of Bern, Bern, Switzerland
Publisher
EuroPCR
Abstract
Aims: The aim of this meta-analysis was to compare the midterm clinical
outcomes of patients treated with an everolimus-eluting bioresorbable
vascular scaffold (BVS) versus an everolimus-eluting metallic stent (EES)
for percutaneous coronary interventions. Methods and Results: We
performed a meta-analysis of aggregate data by searching Medline, EMBASE,
Cochrane databases and proceedings of international meetings for
randomised trials reporting the clinical outcomes beyond one year of
patients treated with BVS versus EES. The primary efficacy and safety
outcomes were target lesion failure (TLF) and definite/probable stent
(scaffold) thrombosis (ST), respectively. Secondary outcomes were the
individual components of the primary efficacy outcome (cardiac death,
target vessel myocardial infarction [MI], and ischaemia-driven target
lesion revascularisation [ID-TLR]). A total of 5,583 patients randomly
received BVS (n=3,261) or EES (n=2,322) in seven trials. Weighted median
follow-up was 26.6 months. Patients treated with BVS versus EES showed a
higher risk of TLF (odds ratio [OR] 1.35, 95% confidence interval [CI]:
1.11-1.65; p=0.0028) due to a higher risk of target vessel MI (OR 1.68,
95% CI: 1.21-2.33; p=0.008) and ID-TLR (OR 1.42, 95% CI: 1.10-1.84;
p=0.007) though the risk for cardiac death was not statistically different
(OR 0.89, 95% CI: 0.55-1.43; p=0.56). Patients treated with BVS versus EES
showed a higher risk of definite/probable ST (OR 3.24, 95% CI: 1.92-5.49;
p<0.0001), particularly in the period beyond one year after implantation
(OR 4.03, 95% CI: 1.49-10.87; p=0.006). Conclusion(s): At midterm
follow-up, patients treated with BVS as compared to those treated with EES
display a higher risk of target lesion failure and scaffold
thrombosis. Copyright © Europa Digital & Publishing 2018.

<75>
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(s): The benefit of PCI in CTOs
is still controversial. Method(s): 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. Result(s): 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). Conclusion(s): 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

<76>
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. Method(s): 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. Finding(s): 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(s): 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(s):
Bayer AG. Copyright © 2018 Elsevier Ltd

<77>
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). CONCLUSION(S): 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.

<78>
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). CONCLUSION(S):
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.

<79>
Accession Number
619543098
Title
Intensive versus standard blood pressure control in SPRINTE-ligible
participants of ACCORD-BP.
Source
Diabetes Care. 40 (12) (pp 1733-1738), 2017. Date of Publication: 01 Dec
2017.
Author
Buckley L.F.; Dixon D.L.; Wohlford G.F.; Wijesinghe D.S.; Baker W.L.; Van
Tassell B.W.
Institution
(Buckley, Dixon, Wohlford, Wijesinghe, Van Tassell) Department of
Pharmacotherapy and Outcomes Science, Virginia Commonwealth University,
Richmond, VA, United States
(Baker) Department of Pharmacy Practice, School of Pharmacy, University of
Connecticut, Storrs, CT, United States
Publisher
American Diabetes Association Inc. (E-mail: membership@diabetes.org)
Abstract
Objective: We sought to determine the effect of intensive blood pressure
(BP) control on cardiovascular outcomes in participants with type 2
diabetes mellitus (T2DM) and additional risk factors for cardiovascular
disease (CVD). Research Design and Methods: This study was a post hoc,
multivariate, subgroup analysis of ACCORD-BP (Action to Control
Cardiovascular Risk in Diabetes Blood Pressure) participants.
Participantswere eligible for the analysis if they were in the standard
glucose control arm of ACCORD-BP and also had the additional CVD risk
factors required for SPRINT (Systolic Blood Pressure Intervention Trial)
eligibility. We used a Cox proportional hazards regression model to
compare the effect of intensive versus standard BP control on CVD
outcomes. The "SPRINT-eligible" ACCORD-BP participantswere pooledwith
SPRINT participants to determine whether the effects of intensive BP
control interacted with T2DM. Result(s): The mean baseline Framingham
10-year CVD risk scores were 14.5% and 14.8%, respectively, in the
intensive and standard BP control groups. The mean achieved systolic BP
values were 120 and 134 mmHg in the intensive and standard BP control
groups (P <= 0.001). Intensive BP control reduced the composite of CVD
death, nonfatal myocardial infarction (MI), nonfatal stroke, any
revascularization, and heart failure (hazard ratio 0.79; 95% CI 0.65-0.96;
P = 0.02). Intensive BP control also reduced CVD death, nonfatal MI, and
nonfatal stroke (hazard ratio 0.69; 95% CI 0.51-0.93; P = 0.01).
Treatment-related adverse events occurred more frequently in participants
receiving intensive BP control (4.1% vs. 2.1%; P = 0.003). The effect of
intensive BP control on CVD outcomes did not differ between patients with
and without T2DM (P > 0.62). Conclusion(s): Intensive BP control
reduced CVD outcomes in a cohort of participants with T2DM and additional
CVD risk factors. Copyright © 2017 by the American Diabetes
Association.

<80>
[Use Link to view the full text]
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.

<81>
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.

<82>
Accession Number
613696739
Title
Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention
in Patients with Left Ventricular Systolic Dysfunction.
Source
Angiology. 68 (1) (pp 19-28), 2017. Date of Publication: 01 Jan 2017.
Author
Zhang D.; Lyu S.; Song X.; Yuan F.; Xu F.; Zhang M.
Institution
(Zhang, Lyu, Song, Yuan, Xu, Zhang, Zhang) Department of Cardiology,
Beijing Institute of Heart, Lung and Blood Vessel Disease, Capital Medical
University, Beijing Anzhen Hospital, Anzhenli Avenue, Chao Yang District,
Beijing 100029, China
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
The optimal method of coronary revascularization for patients with
coronary artery disease (CAD) and left ventricular (LV) systolic
dysfunction is unclear. The purpose of this meta-analysis was to compare
coronary artery bypass grafting (CABG) and percutaneous coronary
intervention (PCI) in these patients. Two investigators independently
searched PubMed, EMBASE, and the Cochrane Controlled Trials Register
databases for relevant studies. Four prospective and 5 retrospective
studies, published before March 2015, involving 6082 patients were
included. Compared with PCI, CABG was significantly associated with lower
long-term death (odds ratio [OR]: 0.82, 95% confidence interval [CI]:
0.70-0.96, P =.01, I 2 = 0%), myocardial infarction (OR: 0.58,
95% CI: 0.36-0.95, P =.03, I 2 = 44%), and repeat
revascularization (OR: 0.17, 95% CI: 0.14-0.22, P <.001, I 2 =
32%). The short-term death rate was comparable between CABG and PCI (OR:
2.09, 95% CI: 0.80-5.45, P =.13, I 2 = 9%). Coronary artery
bypass grafting has long-term benefits compared with PCI in patients with
CAD and LV dysfunction. Copyright © The Author(s) 2016.

<83>
Accession Number
621774603
Title
Comparison of local versus general anesthesia in patients undergoing
transcatheter aortic valve replacement: An updated meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 92 (5) (pp 1018-1019),
2018. Date of Publication: 01 Nov 2018.
Author
Villablanca P.A.; Mohananey D.; Ramakrishna H.
Institution
(Villablanca) Department of Cardiovascular Medicine, New York University,
New York, NY, United States
(Mohananey) Department of Hospital Medicine, Cleveland Clinic, Cleveland,
OH, United States
(Ramakrishna) Department of Anesthesiology, Mayo Clinic, Scottsdale, AZ,
United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)

<84>
Accession Number
625063339
Title
Transubclavian approach: A competitive access for transcatheter aortic
valve implantation as compared to transfemoral.
Source
Catheterization and Cardiovascular Interventions. 92 (5) (pp 935-944),
2018. Date of Publication: 01 Nov 2018.
Author
Amat-Santos I.J.; Rojas P.; Gutierrez H.; Vera S.; Castrodeza J.; Tobar
J.; Goncalves-Ramirez L.R.; Carrasco M.; Catala P.; San Roman J.A.
Institution
(Amat-Santos, Gutierrez, San Roman) CIBER CV, Cardiology Department,
Hospital Clinico Universitario, Valladolid, Spain
(Amat-Santos, Rojas, Gutierrez, Vera, Castrodeza, Tobar,
Goncalves-Ramirez, Carrasco, Catala, San Roman) Cardiology Department,
Hospital Clinico Universitario, Valladolid, Spain
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Aims: Empirically, transfemoral (TF) approach is the first choice for
transcatheter aortic valve implantation (TAVI). We aimed to investigate
whether transubclavian (TSc) and TF approaches present comparable major
outcomes according to current evidence. Method(s): We systematically
searched PubMed, EMBASE, and Cochrane database for studies with
symptomatic aortic stenosis patients who underwent TAVI through TF or
TSc/axillary access from January/2006 to January/2017. Searched terms
were: ("aortic stenosis" OR "transcatheter aortic" OR "TAVI" OR "TAVR")
and ("transfemoral" OR "transaxillary" OR "transubclavian"). Major
outcomes according to Valve Academic Research Consortium-2 criteria were
gathered. The odds ratio (OR) was used as a summary statistic. A
random-effects model was used. A fully percutaneous TSc TAVI case from our
institution illustrates minimalist approach. Result(s): Final
analysis was made with six studies including 4,504 patients (3,886 TF and
618 TSc). Baseline characteristics of compared groups in individual
studies were similar, with the exception of a higher logistic EuroSCORE in
the TSc group (23.7 +/- 1.92 vs. 21.17 +/- 3.51, P = 0.04) and higher
prevalence of coronary and peripheral artery disease with OR = 0.67 [95%
CI: 0.54-0.83] (P = 0.0003) and OR = 0.08 [95% CI: 0.05-0.12] (P <
0.00001), respectively. TSc group presented comparable 30-day mortality
(OR = 1.37; [95%CI: 0.85-2.21]; P = 0.20). There were no differences for
procedural success, 30-day stroke rate, need for new pacemaker
implantation, major vascular complications, and acute kidney injury
requiring dialysis. Also, no differences were found concerning 1-year
mortality. Conclusion(s): Our study suggests that TSc approach may
be, not only an alternative route to TF approach for TAVI, but even a
competitive one in certain patients with increased risk of femoral
injury. Copyright © 2018 Wiley Periodicals, Inc.

<85>
Accession Number
625050642
Title
Predictors of successful chronic total occlusion percutaneous coronary
interventions: a systematic review and meta-analysis.
Source
Heart (British Cardiac Society). 104 (6) (pp 517-524), 2018. Date of
Publication: 01 Mar 2018.
Author
Wang N.; Fulcher J.; Abeysuriya N.; Adams M.; Lal S.
Institution
(Wang, Fulcher, Adams, Lal) University of Sydney, Sydney, NSW, Australia
(Wang, Fulcher, Adams, Lal) Royal Prince Alfred Hospital, Sydney, NSW,
Australia
(Abeysuriya) University of Queensland, Brisbane, Australia
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The aim of this study was to identify positive and negative
predictors of technical and clinical success for percutaneous coronary
intervention (PCI) of chronic total occlusions (CTO). METHOD(S): We
conducted a systematic review and meta-analysis of studies published
between 2000 and 2016 analysing rates of CTO PCI success with respect to
demographic and angiographic characteristics. Crude ORs and 95% CIs for
each predictor were calculated using a random effects model. Predictors of
technical and clinical success were assessed among 28 demographic and 31
angiographic variables. Clinical success was defined as technical success
without major adverse cardiac events. RESULT(S): A total of 61
studies, totalling 69886 patients were included in this analysis. The
major demographic characteristics associated with a 20% or greater
reduction in the odds of technical and clinical success were a history of
myocardial infarction, PCI, coronary artery bypass grafting,
stroke/transient ischaemic attack and peripheral vascular disease.
Angiographic factors were generally stronger predictors of reduced
technical and clinical success. Those associated with >20% odds reduction
included non-left anterior descending CTOs, multivessel disease, presence
of bridging collaterals, moderate-to-severe calcification, >45degree
vessel bending, tortuous vessel, blunt stump and ostial lesions. Of these,
novel predictors included prior PCI, prior stroke, peripheral vascular
disease, presence of multivessel disease and bridging collaterals.
 CONCLUSION(S): The present study has identified strong negative
predictors for clinical success for CTO PCI, which will aid in patient
selection for this procedure. Copyright © Article author(s) (or
their employer(s) unless otherwise stated in the text of the article)
2018. All rights reserved. No commercial use is permitted unless otherwise
expressly granted.

<86>
Accession Number
625057208
Title
The use of viscoelastic haemostatic assays in non-cardiac surgical
settings: a systematic review and meta-analysis.
Source
Blood transfusion = Trasfusione del sangue. 16 (3) (pp 235-243), 2018.
Date of Publication: 01 May 2018.
Author
Franchini M.; Mengoli C.; Cruciani M.; Marietta M.; Marano G.; Vaglio S.;
Pupella S.; Veropalumbo E.; Masiello F.; Liumbruno G.M.
Institution
(Franchini, Mengoli, Marano, Vaglio, Pupella, Veropalumbo, Masiello,
Liumbruno) Italian National Blood Centre, National Institute of Health,
Rome, Italy
(Franchini) Department of Haematology and Transfusion Medicine, "Carlo
Poma" Hospital, Mantua, Italy
(Cruciani) Infection Control Committee, Verona, Italy
(Marietta) Department of Oncology, Hematology and Respiratory Diseases,
University Hospital, Modena, Italy
(Vaglio) Department of Clinical and Molecular Medicine, "La Sapienza"
University of Rome, Rome, Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: Thrombelastography (TEG) and rotational thromboelastometry
(ROTEM) are viscoelastic haemostatic assays (VHA) which exploit the
elastic properties of clotting blood. The aim of this systematic review
and meta-analysis was to evaluate the usefulness of these tests in
bleeding patients outside the cardiac surgical setting. MATERIALS AND
METHODS: We searched the Cochrane Library, MEDLINE, EMBASE and SCOPUS. We
also searched clinical trial registries for ongoing and unpublished
studies, and checked reference lists to identify additional studies.
 RESULT(S): We found 4 randomised controlled trials (RCTs) that met
our inclusion criteria with a total of 229 participants. The sample size
was small (from 28 to 111 patients) and the follow-up periods very
heterogenous (from 4 weeks to 3 years). Pooled data from the 3 trials
reporting on mortality (199 participants) do not show any effect of the
use of TEG on mortality as compared to standard monitoring (based on the
average treatment effect from a fixed-effects model): Risk Ratio (RR)
0.71; 95% Confidence Interval (CI): 0.43 to 1.16. Likewise, the use of VHA
does not reduce the need for red blood cells (mean difference -0.64; 95%
CI: -1.51 to 0.23), platelet concentrates (mean difference -1.12; 95% CI:
-3.25 to 1.02), and fresh frozen plasma (mean difference -0.91; 95% CI:
-2.02 to 0.19) transfusion. The evidence on mortality and other outcomes
was uncertain (very low-certainty evidence, down-graded due to risk of
biases, imprecision, and inconsistency). CONCLUSION(S): Overall, the
certainty of the evidence provided by the trials was too low for us to be
certain of the benefits and harms of viscoelastic haemostatic assay in
non-cardiac surgical settings. More, larger, and better-designed RCTs
should be carried out in this area.

<87>
Accession Number
625057096
Title
Updated clinical indications for transcatheter aortic valve implantation
in patients with severe aortic stenosis: expert opinion of the Italian
Society of Cardiology and GISE.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 19 (5) (pp 197-210),
2018. Date of Publication: 01 May 2018.
Author
Indolfi C.; Bartorelli A.L.; Berti S.; Golino P.; Esposito G.; Musumeci
G.; Petronio S.; Tamburino C.; Tarantini G.; Ussia G.; Vassanelli C.;
Spaccarotella C.; Violini R.; Mercuro G.; Romeo F.
Institution
(Indolfi) Cattedra di Cardiologia, Universita degli Studi Magna Graecia,
Catanzaro, Italy
Publisher
NLM (Medline)
Abstract
: The introduction of percutaneous treatment of severe aortic stenosis
with transcatheter aortic valve implantation (TAVI) remains one of the
greatest achievements of interventional cardiology. In fact, TAVI emerged
as a better option than either medical therapy or balloon aortic
valvuloplasty for patients who cannot undergo surgical aortic valve
replacement (SAVR) or are at high surgical risk. Recently, increased
operator experience and improved device systems have led to a worldwide
trend toward the extension of TAVI to low-risk or intermediate-risk
patients. In this expert opinion paper, we first discuss the basic
pathophysiology of aortic stenosis in different settings then the key
results of recent clinical investigations on TAVI in intermediate-risk
aortic stenosis patients are summarized. Particular emphasis is placed on
the results of the nordic aortic valve intervention, placement of aortic
transcatheter valves (PARTNER) 2 and Surgical Replacement and
Transcatheter Aortic Valve Implantation Randomized trials. The PARTNER 2
was the first large randomized trial that evaluated the outcome of TAVI in
patients at intermediate risk. The PARTNER 2 data demonstrated that TAVI
is a feasible and reasonable alternative to surgery in intermediate-risk
patients (Society of Thoracic Surgeons 4-8%), especially if they are
elderly or frail. There was a significant interaction between TAVI
approach and mortality, with transfemoral TAVI showing superiority over
SAVR. Moreover, we examine the complementary results of the recently
concluded Surgical Replacement and Transcatheter Aortic Valve Implantation
trial. This prospective randomized trial demonstrated that TAVI is
comparable with surgery (primary end point 12.6% in the TAVI group vs.
14.0% in the SAVR group) in severe aortic stenosis patients deemed to be
at intermediate risk. We review the most relevant clinical evidence
deriving from nonrandomized studies and meta-analyses. Altogether,
clinical outcome available data suggest that TAVI with a newer generation
device might be the preferred treatment option in this patient subgroup.
Finally, the differences between the latest European and American
Guidelines on TAVI were reported and discussed. The conclusion of this
expert opinion article is that TAVI, if feasible, is the treatment of
choice in patients with prohibitive or high surgical risk and may lead to
similar or lower early and midterm mortality rates compared with SAVR in
intermediate-risk patients with severe aortic stenosis.

<88>
Accession Number
625049924
Title
Prevalence of subclinical cardiac abnormalities in patients with
metal-on-metal hip replacements.
Source
International journal of cardiology. 271 (pp 274-280), 2018. Date of
Publication: 15 Nov 2018.
Author
Lodge F.; Khatun R.; Lord R.; John A.; Fraser A.G.; Yousef Z.
Institution
(Lodge, Khatun) Cardiology Department, University Hospital of Wales,
Cardiff, United Kingdom
(Lord) Cardiff School of Sport, Cardiff Metropolitan University, Cardiff,
United Kingdom
(John) Consultant in Trauma and Orthopaedics, University Hospital of
Wales, Cardiff, United Kingdom
(Fraser) Emeritus Professor of Cardiology, Cardiff University, Cardiff,
United Kingdom
(Yousef) Consultant Cardiologist, University Hospital of Wales, Cardiff,
United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: Metal-on-metal (MOM) hip prostheses have a higher failure rate
than conventional prostheses and leaching of cobalt and chromium has been
linked to cardiomyopathy. We screened MOM subjects to evaluate if cobalt
and chromium are related to subclinical cardiac dysfunction.
 METHOD(S): A single centre, non-randomised, observational study using
echocardiography in 95 patients who had undergone MOM hip prostheses, and
15 age matched controls with non-MOM hip replacement. Serial plasma cobalt
and chromium levels were recorded, and data compared by tertiles of cobalt
exposure. RESULT(S): Indexed left ventricular (LV) end-diastolic and
end-systolic volumes (EDVi and ESVi) increased with tertile of cobalt
(omnibus p=0.003 for EDVi and ESVi), as did indexed left atrial (LA)
volumes (p=0.003). MOM subjects had 25% larger EDVi than controls, 32%
larger ESVi (40ml vs. 32ml, and 15ml vs. 11ml, p=0.003 for both) and 28%
larger indexed LA (23ml vs. 18ml, p=0.002). There were no differences in
LV systolic or diastolic function, including ejection fraction, tissue
velocity and mitral E/e'. Estimated glomerular filtration rate was 18%
lower in the highest tertile compared with the lowest (p=0.01) and
correlated inversely with LA volume (r=-0.36, p<0.001) and LV EDV
(r=-0.24, p=0.02). CONCLUSION(S): No correlations between sensitive
measures of systolic or diastolic cardiac function or serum
cobalt/chromium levels were observed in this study. However, there was a
relationship between increasing left ventricular and left atrial volumes
and declining renal function with high cobalt levels which requires
further evaluation in MOM patients. Crown Copyright © 2018.
Published by Elsevier B.V. All rights reserved.

<89>
Accession Number
625053085
Title
The Efficacy of Inpatient vs. Home-Based Physiotherapy Following Coronary
Artery Bypass Grafting.
Source
International journal of environmental research and public health. 15 (11)
(no pagination), 2018. Date of Publication: 17 Nov 2018.
Author
Szylinska A.; Listewnik M.; Rotter I.; Ryl A.; Kotfis K.; Mokrzycki K.;
Kuligowska E.; Walerowicz P.; Brykczynski M.
Institution
(Szylinska, Rotter, Ryl) Department of Medical Rehabilitation and Clinical
Physiotherapy, Pomeranian Medical University in Szczecin, ul. Zolnierska
54, Szczecin 70-204, Poland
(Listewnik) Department of Cardiac Surgery, Pomeranian Medical University
in Szczecin, al. Powstancow Wlkp. 72, Szczecin 70-111, Poland
(Kotfis) Department of Anesthesiology, Pomeranian Medical University in
Szczecin, al. Powstancow Wlkp. 72, Szczecin 70-111, Poland
(Mokrzycki) Department of Cardiac Surgery, Pomeranian Medical University
in Szczecin, al. Powstancow Wlkp. 72, Szczecin 70-111, Poland
(Kuligowska, Walerowicz) Department of Cardiac Surgery, Pomeranian Medical
University in Szczecin, al. Powstancow Wlkp. 72, Szczecin 70-111, Poland
(Brykczynski) Department of Cardiac Surgery, Pomeranian Medical University
in Szczecin, al. Powstancow Wlkp. 72, Szczecin 70-111, Poland
Publisher
NLM (Medline)
Abstract
Background: Intensive post-operative physiotherapy after cardiac surgery
helps to reduce the number of complications, accelerating convalescence
and decreasing peri-operative mortality. Cardiac rehabilitation is aimed
at regaining lost function and sustaining the effect of cardiac surgery.
The aim of this study was to compare the efficacy of inpatient and
home-based phase II physiotherapy following coronary artery bypass
grafting, and inpatient phase II post-operative physiotherapy based on the
analysis of the spirometry results. Method(s): A prospective
observational study included 104 adult patients of both sexes undergoing
planned coronary artery bypass grafting and were randomized to one of the
two groups-inpatients (InPhysio) and home-based (HomePhysio) at a 1:1
ratio. All patients had undergone spirometry testing prior to surgery (S1)
and on the fifth day after the operation (S2), i.e., on the day of
completion of the first phase (PI) of physiotherapy. Both the study group
(InPhysio) and the control group (HomePhysio) performed the same set of
exercises in the second phase (PII) of cardiac physiotherapy, either in
the hospital or at home, respectively, according to the program obtained
in the hospital. Both groups have undergone spirometry testing (S3) at 30
days after the operation. Result(s): The demographic and
peri-operative data for both groups were comparable and showed no
statistically significant differences. An analysis of gradients between
the results of spirometry tests before surgery and at 30 days after the
surgery showed a smaller decrease in forced vital capacity (FVC) in the
study group than in the control group (p < 0.001). The results at five and
30 days after the surgery showed a greater increase in FVC in the study
group than in the control group (680 mL vs. 450 mL, p = 0.009). There were
no statistically significant differences in other parameters studied.
 Conclusion(s): The advantage of inpatient over home-based
physiotherapy was evidenced by much smaller decreases in FVC between the
initial and final tests, and greater increases between the fifth day after
surgery and the final test. Our analysis showed greater efficacy of
inpatient physiotherapy as compared with home-based exercises and raises
concerns about patient adherence.

<90>
Accession Number
625057742
Title
Long-term performance of an external stent for saphenous vein grafts: the
VEST IV trial.
Source
Journal of cardiothoracic surgery. 13 (1) (pp 117), 2018. Date of
Publication: 19 Nov 2018.
Author
Taggart D.P.; Webb C.M.; Desouza A.; Yadav R.; Channon K.M.; De Robertis
F.; Di Mario C.
Institution
(Taggart) Nuffield Department of Surgery, University of Oxford, John
Radcliffe Hospital, Oxford, United Kingdom
(Webb) National Heart & Lung Institute, Imperial College London, London,
United Kingdom
(Webb, Di Mario) Department of Cardiology, Royal Brompton Hospital, Sydney
Street, London SW3 6NP, United Kingdom
(Desouza, Yadav) Department of Cardiothoracic Surgery, Royal Brompton
Hospital, Sydney Street, London, United Kingdom
(Channon) Department of Cardiovascular Medicine, University of Oxford,
John Radcliffe Hospital, Oxford, United Kingdom
(De Robertis) Department of Cardiothoracic Surgery, Harefield Hospital,
Middlesex, London, UK
Publisher
NLM (Medline)
Abstract
BACKGROUND: Externally stenting saphenous vein grafts reduces intimal
hyperplasia, improves lumen uniformity and reduces oscillatory shear
stress 1 year following surgery. The present study is the first to present
the longer-term (4.5 years) performance and biomechanical effects of
externally stented saphenous vein grafts. METHOD(S): Thirty patients
previously implanted with the VEST external stent in the randomized,
within-patient-controlled VEST I study were followed up for adverse
events; 21 of these were available to undergo coronary angiography and
intravascular ultrasound. RESULT(S): Twenty-one stented and 29
nonstented saphenous vein grafts were evaluated by angiography and
ultrasound at 4.5+/-0.3 years. Vein graft failure rates were comparable
between stented and nonstented grafts (30 and 23% respectively; p=0.42).
All failures were apparent at 1 year except for one additional nonstented
failure at 4.5 years. In patent vein grafts, Fitzgibbon perfect patency
remained significantly higher in the stented versus nonstented vein grafts
(81 and 48% respectively, p=0.002), while intimal hyperplasia area (4.27
mm2+/-1.27 mm2 and 5.23 mm2+/-1.83 mm2 respectively, p<0.001) and
thickness (0.36 mm+/-0.09 mm and 0.42 mm+/-0.11 mm respectively, p<0.001)
were significantly reduced. Intimal hyperplasia proliferation correlated
with lumen uniformity and with the distance between the stent and the
lumen (p=0.04 and p<0.001 respectively). CONCLUSION(S): External
stenting mitigates saphenous vein graft remodeling and significantly
reduces diffuse intimal hyperplasia and the development of lumen
irregularities 4.5 years after coronary artery bypass surgery. Close
conformity of the stent to the vessel wall appears to be an important
factor. TRIAL REGISTRATION: NCT01415245 . Registered 11 August 2011.

<91>
Accession Number
625055990
Title
Evolution of the pericardiocentesis technique.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 19 (6) (pp 267-273),
2018. Date of Publication: 01 Jun 2018.
Author
Maggiolini S.; De Carlini C.C.; Imazio M.
Institution
(Maggiolini, De Carlini) Cardiology Division, Cardiovascular Department,
San L. Mandic Hospital, Merate, Italy
(Imazio) Cardiology, Cardiovascular and Thoracic Department, AOU Citta
della Salute e della Scienza di Torino, Torino, Italy
Publisher
NLM (Medline)
Abstract
: Pericardiocentesis is a valuable technique for the diagnosis and
treatment of patients with pericardial effusion and cardiac tamponade,
although it may be associated with potentially serious complications.
Through the years, many different imaging approaches have been described
to reduce the complication rate of the procedure. This systematic review
provides a focused overview of the different techniques developed in
recent years to reduce the procedural complications and to increase the
related success rate.

<92>
Accession Number
2001289028
Title
Fractional Flow Reserve Versus Angiographically-Guided Coronary Artery
Bypass Grafting.
Source
Journal of the American College of Cardiology. 72 (22) (pp 2732-2743),
2018. Date of Publication: 4 December 2018.
Author
Thuesen A.L.; Riber L.P.; Veien K.T.; Christiansen E.H.; Jensen S.E.;
Modrau I.; Andreasen J.J.; Junker A.; Mortensen P.E.; Jensen L.O.
Institution
(Thuesen, Veien, Junker, Jensen) Department of Cardiology, Odense
University Hospital, Odense, Denmark
(Riber, Mortensen) Department of Cardiothoracic Surgery, Odense University
Hospital, Odense, Denmark
(Christiansen) Department of Cardiology, Aarhus University Hospital,
Skejby, Denmark
(Jensen) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
(Modrau) Department of Cardiothoracic Surgery, Aarhus University Hospital,
Skejby, Denmark
(Andreasen) Department of Cardiothoracic Surgery, Aalborg University
Hospital, Aalborg, Denmark
(Andreasen) Department of Clinical Medicine, Aalborg University, Aalborg,
Denmark
Publisher
Elsevier USA
Abstract
Background: The value of fractional flow reserve (FFR) evaluation of
coronary artery stenosis in coronary artery bypass grafting (CABG) is
uncertain, and stenosis assessments usually rely on visual estimates of
lesion severity. Objective(s): This randomized clinical trial
evaluated graft patency and clinical outcome after FFR-guided CABG versus
angiography-guided CABG. Method(s): A total of 100 patients referred
for CABG were randomly assigned to FFR-guided or angiography-guided CABG.
Based on the coronary angiogram, a heart team made a graft plan for all
patients, and FFR evaluations were performed. In FFR-guided CABG, coronary
lesions with FFR >0.80 were deferred, and a new graft plan was designed
accordingly, whereas the surgeon was blinded to the FFR values in patients
who underwent angiography-guided CABG. The primary endpoint was graft
failure in the percentage of all grafts after 6 months. Result(s):
Angiographic follow-up at 6 months was available for 72 patients (39 vs.
33 in the FFR-guided and angiography-guided groups, respectively). Graft
failures of all grafts were similar in both groups (16% vs. 12%; p =
0.97). Rates of death, myocardial infarction, and stroke were also similar
in the study groups, and no difference was seen in revascularization
before angiographic follow-up. After 6 months, deferred lesions (n = 24)
showed a significant reduction in mean FFR from index to follow-up (0.89
+/- 0.05 vs. 0.81 +/- 0.11; p = 0.002). Index FFR did not influence graft
patency. Conclusion(s): FFR-guided CABG had similar graft failure
rates and clinical outcomes as angiography-guided CABG. However, FFR was
reduced significantly after 6 months in deferred lesions. (Fractional Flow
Reserve Versus Angiography Randomization for Graft Optimization [FARGO];
NCT02477371) Copyright © 2018 American College of Cardiology
Foundation

<93>
Accession Number
2001302089
Title
A Randomized Controlled Trial of Liposomal Bupivacaine Parasternal
Intercostal Block for Sternotomy.
Source
Annals of Thoracic Surgery. (no pagination), 2018. Date of Publication:
2018.
Author
Lee C.Y.; Robinson D.A.; Johnson C.A.; Zhang Y.; Wong J.; Joshi D.J.; Wu
T.-T.; Knight P.A.
Institution
(Lee, Robinson, Johnson, Wong, Joshi, Knight) Division of Cardiac Surgery,
Department of Surgery, University of Rochester Medical Center, Rochester,
NY, United States
(Zhang, Wu) Department of Biostatistics and Computational Biology,
University of Rochester, Rochester, NY, United States
Publisher
Elsevier USA
Abstract
Background: Optimal pain control continues to be a concern in cardiac
surgery. Current strategies for postoperative pain management often yield
suboptimal results. The superiority of Exparel (Pacira Pharmaceuticals,
Inc, Parsippany, NJ) in providing postoperative pain control and opioid
sparing is equivocal. This prospective, randomized, double-blind study
examines the efficacy of Exparel as a novel single-dose application
parasternal nerve block in postoperative pain control and opioid sparing.
 Method(s): This single-surgeon study included 79 patients undergoing
median sternotomy for coronary revascularization. Study participants were
randomized to either the drug or a control arm. Each participant received
Exparel or normal saline placebo administered as a parasternal nerve
block. Postoperative pain was rated according to the nonverbal pain scale
or numeric rating scale. Total amount of narcotic pain medication used and
patients' pain scores within the first 72 hours postoperatively were
compared. Secondary outcomes compared the intensive care unit length of
stay, hospital length of stay, time to extubation, time to return of bowel
function, and time to return to work or daily activities. Result(s):
The primary endpoint of pain levels between the two groups demonstrated no
significant difference when analyzing the individual time points
postoperatively. However, overall pain levels were significantly lower in
the study drug group (p = 0.04). There was no significant difference in
the amount of analgesics required postoperatively or in secondary
endpoints between the groups. Conclusion(s): Exparel does not provide
an opioid-sparing benefit or any secondary outcome benefit compared with
placebo. Exparel may be associated with a marginal decrease in
postoperative pain levels. (Parasternal Nerve Bock in Cardiac Patients;
NCT01826851.) Copyright © 2018 The Society of Thoracic Surgeons

<94>
Accession Number
2000701390
Title
Safety of intermediate left main stenosis revascularization deferral based
on fractional flow reserve and intravascular ultrasound: A systematic
review and meta-regression including 908 deferred left main stenosis from
12 studies.
Source
International Journal of Cardiology. 271 (pp 42-48), 2018. Date of
Publication: 15 November 2018.
Author
Cerrato E.; Echavarria-Pinto M.; D'Ascenzo F.; Gonzalo N.; Quadri G.;
Quiros A.; de la Torre Hernandez J.M.; Tomassini F.; Barbero U.;
Nombela-Franco L.; Nunez-Gil I.; Biondi-Zoccai G.; Macaya C.; Varbella F.;
Escaned J.
Institution
(Cerrato, Quadri, Tomassini, Varbella) Interventional Cardiology, San
Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital,
Rivoli, Turin, Italy
(Echavarria-Pinto) Department of Cardiology, Hospital General ISSSTE,
Queretaro, Mexico
(D'Ascenzo) Division of Cardiology, Citta della Salute e della Scienza,
University of Turin, Turin, Italy
(Gonzalo, Nombela-Franco, Nunez-Gil, Macaya, Escaned) Interventional
Cardiology, Hospital Clinico San Carlos, Madrid, Spain
(Quiros) Statistical Department, Univeristy of Leon, Leon, Spain
(de la Torre Hernandez) Interventional Cardiology, Hospital Universitario
Marques de Valdecilla, Valdecilla, Santander, Spain
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Department of
AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
(Barbero) Division of Cardiology, Santissima Annunziata Hospital,
Savigliano, Italy
(Barbero) Cardiovascular Research Unit, Royal Brompton Hospital, London,
United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: Current guidelines recommend intravascular ultrasound (IVUS)
or fractional flow reserve (FFR) to decide upon ambiguous left main (LM)
disease. However, no study has compared the safety of LM revascularization
deferral based on FFR or IVUS. Method(s): MEDLINE/PubMed was
systematically screened for studies reporting on deferred treatment of
angiographically ambiguous LM based upon FFR or IVUS evaluation. Baseline,
angiographic and outcome data were appraised and pooled separately for
each strategy according to random-effect models with inverse-variance
weighting. Result(s): A total of 908 LM stenoses from 7 FFR and 5
IVUS studies were included with median follow-up of 29.0 and 31.5 months
respectively. Per year of follow-up occurrence of overall MACE were 5.1%
in FFR group and 6.4% in IVUS group while death, myocardial infarction, LM
revascularization were respectively 2.6%, 1.5% and 1.8% vs. 3.0%, 0.5% and
2.2%. Meta-regression analysis suggested the influence of a distal LM
stenosis on MACE in FFR group (beta = 0.06, p = 0.01) and age in IVUS
group (beta = 0.4, p = 0.001). In individual studies several independent
predictors of MACE were identified including use of lower doses of
intracoronary adenosine (OR 1.39, p = 0.04) in FFR group and plaque burden
(OR 1.34, p = 0.025), number of other diseased vessels (OR 1.39, p = 0.04)
and any untreated stenosis (OR 3.80; p = 0.037) in IVUS- studies.
 Conclusion(s): Deferring LM intermediate stenosis on the basis of FFR
or IVUS showed an acceptable and similar risk of events in a mid-term
follow-up. Conversely, several different variables related to each
technique showed an interaction on outcome. Copyright © 2018
Elsevier B.V.

<95>
Accession Number
622901049
Title
Radial Versus Femoral Approach for Percutaneous Coronary Intervention:
MACE Outcomes at Long-Term Follow-up.
Source
Journal of Invasive Cardiology. 30 (7) (pp 262-268), 2018. Date of
Publication: July 2018.
Author
Campelo-Parada F.; Carrie D.; Bartorelli A.L.; Namiki A.; Hovasse T.;
Kimura T.; Serra-Penaranda A.; Varenne O.; Lalmand J.; Kadota K.; Ikari
Y.; Tobaru T.; Fujii K.; Nakamura S.; Saito S.; Wijns W.
Institution
(Campelo-Parada, Bartorelli) Hopital Rangueil, CHU Toulouse, 1 Avenue Jean
Poulhes, Toulouse 31059, France
(Carrie) Centro Cardiologico Monzino, University of Milan, Italy
(Namiki) Kanto Rosai Hospital, Japan
(Hovasse) Hopital Prive Jacques Cartier (ICPS), Massy, France
(Kimura) Kyoto University Graduate School of Medicine, Japan
(Serra-Penaranda) Hospital de la Santa Creu i Sant Pau, Spain
(Varenne) Hopital Cochin, Paris, France
(Lalmand) CHU Charleroi, Belgium
(Kadota) Kurashiki Central Hospital, Japan
(Ikari) Tokai University Hospital, Japan
(Tobaru) Sakakibara Heart Institute, Japan
(Fujii) Sakurabashi Watanabe Hospital, Japan
(Nakamura) Kyoto Katsura Hospital, Japan
(Saito) Shonan Kamakura General Hospital, Japan
(Wijns) Cardiovascular Research Center, OLV Hospital, Aalst, Belgium
(Wijns) Lambe Institute for Translational Medicine and Curam, National
University of Ireland, Galway, Ireland
Publisher
HMP Communications
Abstract
Objective: To compare the main outcomes of radial versus femoral access at
long-term follow-up. Background(s): Little is known about the
long-term major cardiovascular events and bleeding complications of
patients undergoing percutaneous coronary intervention (PCI) with radial
vs femoral approach. Method(s): A total of 1107 patients from the
CENTURY II trial were included. To minimize baseline differences between
radial and femoral groups, we applied propensity-score matching for this
comparison. Result(s): In this multicenter study, the radial approach
was used in 73.4% of patients. After propensity-score matching, baseline
and procedural characteristics were comparable between both groups.
Procedural success was high and similar in radial and femoral approaches
(98.2% vs 97.5%; P=.47) while radial access was associated with a shorter
hospital stay (1.69 +/- 1.92 days vs 2.08 +/- 1.98 days; P<.01). The
short-term bleeding and vascular complication rates were significantly
lower in the radial group (1.7% vs 6.2% [P<.001 in-hospital] and 2.7% vs
9.6% [P<.001 at 1-month follow-up]). At 3-year follow-up, radial access
was associated with lower rates of all-cause mortality (3.9 vs 6.9%;
P=.04) and cardiovascular death (2.1 vs 4.9%; P=.02). The composite of
all-cause mortality, myocardial infarction, and revascularization showed
no differences between groups (18.2 vs 21.1%; P=.29). Conclusion(s):
Compared to the femoral approach, the radial approach is associated with
significantly lower long-term all-cause mortality rate as well as lower
in-hospital and short-term bleeding rates. These results suggest
additional long-term benefits of radial access for PCI, but should be
interpreted within the context of the current study and further verified
in future studies. Copyright © 2018 HMP Communications. All
rights reserved.

<96>
Accession Number
622083325
Title
Evolution of the pericardiocentesis technique.
Source
Journal of Cardiovascular Medicine. 19 (6) (pp 267-273), 2018. Date of
Publication: 01 Jun 2018.
Author
Maggiolini S.; De Carlini C.C.; Imazio M.
Institution
(Maggiolini, De Carlini) Cardiology Division, Cardiovascular Department,
San L. Mandic Hospital, Largo Mandic 1, Merate 23807, Italy
(Imazio) Cardiology, Cardiovascular and Thoracic Department, AOU
Cittadella Salute e della Scienza di Torino, Torino, Italy
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Pericardiocentesis is a valuable technique for the diagnosis and treatment
of patients with pericardial effusion and cardiac tamponade, although it
may be associated with potentially serious complications. Through the
years, many different imaging approaches have been described to reduce the
complication rate of the procedure. This systematic review provides a
focused overview of the different techniques developed in recent years to
reduce the procedural complications and to increase the related success
rate. Copyright © 2018 Italian Federation of Cardiology. All
rights reserved.

<97>
Accession Number
623038817
Title
Coronary artery disease in heart transplantation: new concepts for an old
disease.
Source
Transplant International. 31 (8) (pp 787-827), 2018. Date of Publication:
August 2018.
Author
Langstraat M.; Musters K.J.S.; Manintveld O.; Masetti M.; Potena L.
Institution
(Langstraat, Musters) School of Medicine, Erasmus MC, Rotterdam,
Netherlands
(Manintveld) Department of Cardiology, Thorax Center, Rotterdam,
Netherlands
(Masetti, Potena) Heart and Lung Transplant Program, Bologna University
Hospital, Bologna, Italy
Publisher
Blackwell Publishing Ltd
Abstract
Cardiac allograft vasculopathy (CAV) remains one of the main long-term
complications after heart transplantation. We performed a systematic
review focused on articles published in the previous 6 years to reappraise
the novel evidences supporting risk factors, pathology, prevention, and
treatment of CAV. We identified a search string for a literature search on
PubMed. We excluded articles specifically focused on
diagnosis/biomarkers/imaging only or complications of other diseases. We
included 98 studies out of our search. Forty-eight articles describe risk
factors for CAV, 13 pathology, 24 prevention, and 13 treatment for CAV.
While confirming known concepts, we found supportive evidence that CAV
pathophysiology may vary according to the time post-transplant and the
prevalence of metabolic versus immune-mediated risk factors. Selective
revascularization of focal lesions in patients with CAV may result in some
clinical benefit, but CAV prevention, rather than treatment, by
controlling risk factors and by using targeted immunosuppressive therapies
is the most evidence-based approach to reduce disease
progression. Copyright © 2018 Steunstichting ESOT

<98>
Accession Number
2000922101
Title
Statin therapy improved long-term prognosis in patients with major
non-cardiac vascular surgeries: a systematic review and meta-analysis.
Source
Vascular Pharmacology. 109 (pp 1-16), 2018. Date of Publication: October
2018.
Author
Yu W.; Wang B.; Zhan B.; Li Q.; Li Y.; Zhu Z.; Yan Z.
Institution
(Yu, Wang, Li, Li, Zhu, Yan) The Center for Hypertension and Metabolic
Diseases, Department of Hypertension and Endocrinology, Daping Hospital,
Third Military Medical University, Chongqing Institute of Hypertension,
Chongqing 400042, China
(Yu, Zhan) The Thirteenth People's Hospital of Chongqing, The Chongqing
Geriatric Hospital, Chongqing 400053, China
(Wang) Department of Nephrology, Chinese PLA General Hospital, Chinese PLA
Institute of Nephrology, Beijing Key Laboratory of Kidney Disease,
National Clinical Research Center for Kidney Diseases, Fuxing Road 28,
Beijing 100853, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: To investigate whether statin intervention will improve the
long-term prognosis of patients undergoing major non-cardiac vascular
surgeries. Method(s): Major database searches for clinical trials
enrolling patients undergoing major non-cardiac vascular surgeries,
including lower limb revascularization, carotid artery surgeries,
arteriovenous fistula, and aortic surgeries, were performed. Subgroup
analyses, stratified by surgical types or study types, were employed to
obtain statistical results regarding survival, patency rates, amputation,
and cardiovascular and stroke events. Odds ratio (ORs) and 95% confidence
intervals (CIs) were calculated by Review Manager 5.3. Sensitivity
analysis, publication bias and meta-regression were conducted by Stata
14.0. Result(s): In total, 34 observational studies, 8 prospective
cohort studies and 4 randomized controlled clinical trials (RCTs) were
enrolled in the present analysis. It was demonstrated that statin usage
improved all-cause mortality in lower limb, carotid, aortic and mixed
types of vascular surgery subgroups compared with those in which statins
were not used. Additionally, the employment of statins efficiently
enhanced the primary and secondary patency rates and significantly
decreased the amputation rates in the lower limb revascularization
subgroup. Furthermore, for other complications, statin intervention
decreased cardiovascular events in mixed types of vascular surgeries and
stroke incidence in the carotid surgery subgroup. No significant
publication bias was observed. The meta-regression results showed that the
morbidity of cardiovascular disease or the use of aspirin might affect the
overall estimates in several subgroups. Conclusion(s): This
meta-analysis demonstrated that statin therapy was associated with
improved survival rates and patency rates and with reduced cardiovascular
or stroke morbidities in patients who underwent non-cardiac vascular
surgeries. Copyright © 2018 Elsevier Inc.

<99>
Accession Number
621948971
Title
The use of viscoelastic haemostatic assays in non-cardiac surgical
settings: A systematic review and meta-analysis.
Source
Blood Transfusion. 16 (3) (pp 235-243), 2018. Date of Publication: 2018.
Author
Franchini M.; Mengoli C.; Cruciani M.; Marietta M.; Marano G.; Vaglio S.;
Pupella S.; Veropalumbo E.; Masiello F.; Liumbruno G.M.
Institution
(Franchini, Mengoli, Marano, Vaglio, Pupella, Veropalumbo, Masiello,
Liumbruno) Italian National Blood Centre, National Institute of Health,
Rome, Italy
(Franchini) Department of Haematology and Transfusion Medicine, Carlo Poma
Hospital, Strada Lago Paiolo 1, Mantua 46100, Italy
(Cruciani) Infection Control Committee, AULSS9 Scaligera, Verona, Italy
(Marietta) Department of Oncology, Hematology and Respiratory Diseases,
University Hospital, Modena, Italy
(Vaglio) Department of Clinical and Molecular Medicine, La Sapienza
University of Rome, Rome, Italy
Publisher
Edizioni SIMTI (E-mail: luisa.stea@bloodtransfusion.it)
Abstract
Background: Thrombelastography (TEG) and rotational thromboelastometry
(ROTEM) are viscoelastic haemostatic assays (VHA) which exploit the
elastic properties of clotting blood. The aim of this systematic review
and meta-analysis was to evaluate the usefulness of these tests in
bleeding patients outside the cardiac surgical setting. Material(s)
and Method(s): We searched the Cochrane Library, MEDLINE, EMBASE and
SCOPUS. We also searched clinical trial registries for ongoing and
unpublished studies, and checked reference lists to identify additional
studies. Result(s): We found 4 randomised controlled trials (RCTs)
that met our inclusion criteria with a total of 229 participants. The
sample size was small (from 28 to 111 patients) and the follow-up periods
very heterogenous (from 4 weeks to 3 years). Pooled data from the 3 trials
reporting on mortality (199 participants) do not show any effect of the
use of TEG on mortality as compared to standard monitoring (based on the
average treatment effect from a fixed-effects model): Risk Ratio (RR)
0.71; 95% Confidence Interval (CI): 0.43 to 1.16. Likewise, the use of VHA
does not reduce the need for red blood cells (mean difference -0.64; 95%
CI: -1.51 to 0.23), platelet concentrates (mean difference -1.12; 95% CI:
-3.25 to 1.02), and fresh frozen plasma (mean difference -0.91; 95% CI:
-2.02 to 0.19) transfusion. The evidence on mortality and other outcomes
was uncertain (very low-certainty evidence, down-graded due to risk of
biases, imprecision, and inconsistency). Conclusion(s): Overall, the
certainty of the evidence provided by the trials was too low for us to be
certain of the benefits and harms of viscoelastic haemostatic assay in
non-cardiac surgical settings. More, larger, and better-designed RCTs
should be carried out in this area. Copyright © SIMTI Servizi
Srl.

<100>
Accession Number
621948966
Title
The use of viscoelastic haemostatic assays in non-cardiac surgical
settings: A systematic review and meta-analysis.
Source
Blood Transfusion. 16 (3) (pp 224-226), 2018. Date of Publication: 2018.
Author
De Cristofaro R.
Institution
(De Cristofaro) Institute of Internal Medicine and Geriatrics, Haemostasis
and Thrombosis Centre, Fondazione Policlinico Universitario Agostino
Gemelli, Area of Haematological Sciences, Catholic University of the
Sacred Heart, School of Medicine, Largo Francesco Vito 1, Rome 00168,
Italy
Publisher
Edizioni SIMTI (E-mail: luisa.stea@bloodtransfusion.it)

<101>
Accession Number
620964248
Title
Predictors of successful chronic total occlusion percutaneous coronary
interventions: A systematic review and meta-analysis.
Source
Heart. 104 (6) (pp 517-524), 2018. Date of Publication: March 2018.
Author
Wang N.; Fulcher J.; Abeysuriya N.; Adams M.; Lal S.
Institution
(Wang, Fulcher, Adams, Lal) University of Sydney, Sydney, Camperdown, NSW
2006, Australia
(Wang, Fulcher, Adams, Lal) Royal Prince Alfred Hospital, Sydney, NSW,
Australia
(Abeysuriya) University of Queensland, Brisbane, Australia
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective The aim of this study was to identify positive and negative
predictors of technical and clinical success for percutaneous coronary
intervention (PCI) of chronic total occlusions (CTO). Methods We conducted
a systematic review and meta-analysis of studies published between 2000
and 2016 analysing rates of CTO PCI success with respect to demographic
and angiographic characteristics. Crude ORs and 95% CIs for each predictor
were calculated using a random effects model. Predictors of technical and
clinical success were assessed among 28 demographic and 31 angiographic
variables. Clinical success was defined as technical success without major
adverse cardiac events. Results A total of 61 studies, totalling 69 886
patients were included in this analysis. The major demographic
characteristics associated with a 20% or greater reduction in the odds of
technical and clinical success were a history of myocardial infarction,
PCI, coronary artery bypass grafting, stroke/transient ischaemic attack
and peripheral vascular disease. Angiographic factors were generally
stronger predictors of reduced technical and clinical success. Those
associated with >20% odds reduction included non-left anterior descending
CTOs, multivessel disease, presence of bridging collaterals,
moderate-to-severe calcification, >45 degree vessel bending, tortuous
vessel, blunt stump and ostial lesions. Of these, novel predictors
included prior PCI, prior stroke, peripheral vascular disease, presence of
multivessel disease and bridging collaterals. Conclusion The present study
has identified strong negative predictors for clinical success for CTO
PCI, which will aid in patient selection for this procedure. Copyright
© Article author(s) (or their employer(s) unless otherwise stated in
the text of the article) 2018. All rights reserved.

<102>
Accession Number
2001102320
Title
Meta-Analysis Comparing Complete or Culprit Only Revascularization in
Patients With Multivessel Disease Presenting With Cardiogenic Shock.
Source
American Journal of Cardiology. 122 (10) (pp 1661-1669), 2018. Date of
Publication: 15 November 2018.
Author
Bertaina M.; Ferraro I.; Omede P.; Conrotto F.; Saint-Hilary G.; Cavender
M.A.; Claessen B.E.; Henriques J.P.S.; Frea S.; Usmiani T.; Grosso Marra
W.; Pennone M.; Moretti C.; D'Amico M.; D'Ascenzo F.
Institution
(Bertaina, Ferraro, Omede, Conrotto, Frea, Usmiani, Grosso Marra, Pennone,
Moretti, D'Amico, D'Ascenzo) Department of Cardiology, Citta della Salute
e della Scienza, Molinette Hospital, Turin, Italy
(Saint-Hilary) Department of Mathematical Sciences "G. L. Lagrange,",
Politecnico di Torino, Turin, Italy
(Cavender) Department of Medicine, Division of Cardiology, University of
North Carolina, Chapel Hill, NC, United States
(Claessen, Henriques) Department of Cardiology, Academic Medical Center,
Amsterdam, Netherlands
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The optimal strategy for patients with an acute myocardial infarction (MI)
and multivessel (MV) coronary artery disease complicated by cardiogenic
shock (CS) remains unknown. We conducted a meta-analysis of all randomized
controlled trials and observational studies that reported adjusted effect
measures to evaluate the association of MV-PCI (percutaneous coronary
intervention), compared with culprit only (C)-PCI, with cardiovascular
events in patients admitted for CS and MV disease. We identified 12
studies (n = 1 randomized controlled trials, n = 11 observational) that
included 7,417 patients (n = 1,809 treated with MV-PCI and n = 5,608 with
C-PCI). When compared with C-PCI, MV-PCI was not associated with an
increased risk of short-term death (odds ratio [OR] 1.14, 95% confidence
interval [CI] 0.87 to 1.48, p = 0.35 and adjusted OR [OR<inf>adj</inf>]
1.00, 95% CI 0.70 to 1.43, p = 1.00). In-hospital and/or short-term
mortality tended to be higher with MV-PCI, when compared with C-PCI, for
CS patients needing dialysis (s 0.12, 95% CI from 0.049 to 0.198; p=
0.001), whereas MV-PCI was associated with lower in-hospital and/or
short-term mortality in patients with an anterior MI (s -0.022, 95% CI
-0.03 to -0.01; p <0.001). MV-PCI strategy was associated with a more
frequent need for dialysis or contrast-induced nephropathy after
revascularization (OR 1.36, 95% CI 1.06 to 1.75, p = 0.02). In conclusion,
MV-PCI seems not to increase risk of death during short- or long-term
follow-up when compared with C-PCI in patients admitted for MV coronary
artery disease and MI complicated by CS. Furthermore, it appears a more
favorable strategy in patients with anterior MI, whereas the increased
risk for AKI and its negative prognostic impact should be considered in
decision-making process. Further studies are needed to confirm our
hypothesis on in these subpopulations of CS patients. Copyright ©
2018

<103>
Accession Number
2001101575
Title
Meta-Analysis Comparing Percutaneous Coronary Revascularization Using
Drug-Eluting Stent Versus Coronary Artery Bypass Grafting in Patients With
Left Ventricular Systolic Dysfunction.
Source
American Journal of Cardiology. 122 (10) (pp 1670-1676), 2018. Date of
Publication: 15 November 2018.
Author
Cui K.; Zhang D.; Lyu S.; Song X.; Yuan F.; Xu F.; Zhang M.
Institution
(Cui, Zhang, Lyu, Song, Yuan, Xu, Zhang) Department of Cardiology, Beijing
Anzhen Hospital, Capital Medical University and Beijing Institute of
Heart, Lung and Blood Vessel Diseases, Beijing, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The relative safety and efficacy of percutaneous coronary intervention
(PCI) with drug-eluting stent (DES) and coronary artery bypass grafting
(CABG) in patients with left ventricular (LV) systolic dysfunction remains
controversial; therefore we conducted this meta-analysis to identify the
optimal strategy for such cohorts. A comprehensive search of the
electronic databases including PubMed, EMBASE, and Cochrane Library from
January 1, 2003 to March 1, 2018 was performed to identify the eligible
adjusted observational studies. The primary end point was all-cause death
during the longest follow-up, and the generic inverse variance
random-effect model was used to estimate the pooled hazard ratios (HRs)
with 95% confidence intervals (CIs). Eight adjusted observational studies
involving 10,268 patients were included. Compared with CABG, PCI with DES
was associated with higher risk of all-cause mortality (HR 1.36, 95% CI
1.16 to 1.60), cardiac mortality (HR 2.20, 95% CI 1.63 to 2.95),
myocardial infarction (HR 1.69, 95% CI 1.28 to 2.24), and repeat
revascularization (HR 4.95, 95% CI 3.28 to 7.46) in patients with coronary
artery disease and LV systolic dysfunction. Besides, separate analysis of
patients with LV ejection fraction <35% or left main and/or multivessel
disease obtained similar results compared with the overall analysis.
However, DES and CABG shared similar rates of stroke (HR 0.92, 95% CI 0.67
to 1.26). In conclusion, CABG appears to be superior to PCI with DES for
patients with coronary artery disease and LV systolic dysfunction,
particularly in patients with severe LV systolic dysfunction or those with
left main and/or multivessel disease. Copyright © 2018

<104>
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).

<105>
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).

<106>
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. Method(s): 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. Result(s): 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. Conclusion(s): 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).

<107>
Accession Number
623948724
Title
Viscoelastic testing: It's not the measurement, it's what you do with it!.
Source
Canadian Journal of Anesthesia. 65 (12) (pp 1283-1287), 2018. Date of
Publication: 01 Dec 2018.
Author
Sniecinski R.M.
Institution
(Sniecinski) Department of Anesthesiology, Emory University School of
Medicine, 1364 Clifton Rd, NE, Atlanta, GA 30322, United States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)

<108>
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. Method(s): 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. Result(s): 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). Conclusion(s): 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

<109>
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

<110>
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.

<111>
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.

<112>
[Use Link to view the full text]
Accession Number
625042833
Title
Building biorepository for cardiovascular research: The Vanderbilt human
heart and tissue biobank.
Source
Biopreservation and Biobanking. Conference: International Society of
Biological and Environmental Repositories Annual Meeting, ISBER 2018.
United States. 16 (3) (pp A35-A36), 2018. Date of Publication: June 2018.
Author
Su Y.; Tomasek K.; Fulmer C.; Groark C.; Absi T.; Shah A.; Wang T.
Institution
(Su, Tomasek, Fulmer, Groark, Wang) Medicine, Vanderbilt University
Medical Center, Nashville, TN, United States
(Absi, Shah) Cardic Surgery, Vanderbilt University Medical Center,
Nashville, TN, United States
Publisher
Mary Ann Liebert Inc.
Abstract
Background: Cardiovascular disease (CVD) is the leading cause of mortality
in the United States. Tennessee is among the 13 states that have the
highest cardiovascular death rate. To provide a platform for the discovery
of molecular mechanisms of cardiovascular disease and to promote
investigations on clinical outcome, pharmacogenomics, and translational
cardiovascular research, we have established the Vanderbilt Heart and
Tissue Bank/Biorepository. Method(s): In the past eight years, in
collaboration with both pediatric and adult cardiac surgeons, we have
established infrastructure and Standard Operating Procedures (SOPs) to
build a well-characterized human heart and vascular tissue biorepository
along with plasma/DNA collection for biomarker discovery and genetic
studies. Patients' clinical information associated with these biological
specimens was collected into an electronic database, the Research
Electronic Data Capture (RedCap). Result(s): To date, more than 300
explanted hearts including normal unmatched donor hearts and tissue
specimens from both adult and pediatric patients undergoing cardiac
surgery have been collected and stored in the Biobank. Samples collected
range from mitral and aortic valves; apex from patients with an implanted
Left Ventricular Assistant Device; specimens from Norwood, Ross, and TOF
repair surgical procedures; carotid artery with atherosclerotic plaques;
and various tissues of the explanted heart. We have also initiated an iPSC
shared resource and generated patient specific iPSC lines for studying
rare and congenital heart disease. With these resources, we have supported
many principle investigators on their cardiovascular translational
research projects at Vanderbilt University Medical Center.
 Conclusion(s): We have established a well-characterized human heart
tissue Biobank supplemented with clinical information. The Heart Tissue
Biobank becomes an invaluable resource for cardiovascular translational
research.

<113>
Accession Number
625043705
Title
High-sensitivity cardiac troponin I (HS-cTnI) detects postoperative
myocardial damage after elective knee or hip replacement.
Source
Clinical Chemistry. Conference: 69th American Association for Clinical
Chemistry Annual Scientific Meeting and Clinical Lab Expo, AACC 2017.
United States. 63 (Supplement 1) (pp S35), 2017. Date of Publication:
2017.
Author
Tesfazghi M.T.; Bass A.R.; Gage B.F.; Eby C.F.; Anderson J.L.; Stevens
S.M.; Woller S.C.; Scott M.G.
Institution
(Tesfazghi, Gage, Eby, Scott) Washington University, School of Medicine,
St. Louis, MO, United States
(Bass) Weill Cornell Medical College, New York City, NY, United States
(Anderson) Intermountain Healthcare, Salt Lake City, UT, United States
(Stevens, Woller) University of Utah, School of Medicine, Murray, UT,
United States
Publisher
American Association for Clinical Chemistry Inc.
Abstract
Background: More than 200 million patients worldwide undergo non-cardiac
surgery every year. Despite the benefits of treating disease and improving
quality of life, non-cardiac surgery is associated with a risk of vascular
complications including myocardial injury (JAMA. 2012; 307:2295). The VINO
trial showed that preoperative high sensitivity troponin T (hs-cTnT)
levels predicted both postoperative myocardial infarction (MI) and
long-term mortality (Am Heart J. 2013;166:325). Objective(s): The aim
of this study was to examine the change from pre- to postoperative day 2
(POD 2) plasma concentrations of cardiac troponin I (hs-cTnI) among
elderly patients undergoing elective knee or hip replacement.
 Method(s): This was an ancillary study to a randomized controlled
trial, the Genetics- InFormatics Trial (GIFT) (Pharmacogenomics J.
2012;12:417.). We measured hscTnI using the Abbott Architect assay on
pre-operative and POD 2 plasma samples from 791 subjects that underwent
elective hip or knee replacement. At 26 pg/mL (the overall 99th percentile
for this method) the coefficient of variation was 4%. We quantified how
many patients had a delta hs-cTnI > 10 pg/mL, a common (but conservative)
delta for ruling in/out MI at 3 hours in an emergency setting. We also
examined whether in patients with a delta hs-cTnI > 10 pg/mL, the delta
exceeded the short-term biological variability of hs-cTnI (Reference
change value = 50 - 60%). Result(s): Before surgery, 10/791 patients
had hs-cTnI values > 26 pg/ml (range 27- 217) but only one of these
patients exhibited > 10 pg/mL delta at POD 2. Ninety-nine patients (12.5%)
had a delta > 10 pg/ml (range 10 -8901 pg/mL, median 29 pg/mL) rise in
hs-cTnI levels at POD 2. Of these, only one had a pre-operative hs-cTnI >
26 pg/mL (99th%). Of the 99 patients with a > 10 pg/dL delta, 60 also had
a POD 2 above 26 pg/mL (range 27- 8906 pg/mL, median 62 pg/mL). All but
two of the patients with a > 10 pg/mL rise had a percent delta change >
100% (median 992%). Six patients had a clinical diagnosis of MI during
this trial. Conclusion(s): In this study of elderly patients
undergoing elective arthroplasty, 12.5% of patients showed a biologically
significant (> 10 pg/mL) rise in hs-cTnI at POD 2. In contrast, <1% of
patients had a clinical diagnosis of MI. The clinical significance of the
rise in hs-cTnI after elective non-cardiac surgery requires further study.

<114>
Accession Number
625037527
Title
2018 Korean guideline of atrial fibrillation management.
Source
Korean Circulation Journal. 48 (12) (pp 1033-1080), 2018. Date of
Publication: December 2018.
Author
Joung B.; Lee J.M.; Lee K.H.; Kim T.-H.; Choi E.-K.; Lim W.-H.; Kang
K.-W.; Shim J.; Lim H.E.; Park J.; Lee S.-R.; Lee Y.S.; Kim J.-B.
Institution
(Joung) Division of Cardiology, Department of Internal Medicine, Yonsei
University College of Medicine, Yonsei Cardiovascular Hospital, 50,
Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
(Lee, Kim, Kim) Division of Cardiology, Department of Internal Medicine,
Kyung Hee University Medical College, Seoul, South Korea
(Lee) Department of Cardiology, Chonnam National University Hospital,
Gwangju, South Korea
(Choi, Lim) Department of Internal Medicine, Seoul National University
College of Medicine, Seoul, South Korea
(Kang) Division of Cardiology, Eulji University College of Medicine,
Daejeon, South Korea
(Shim, Lim) Division of Cardiology, Department of Internal Medicine, Korea
University College of Medicine, Seoul, South Korea
(Park) Department of Cardiology, Ewha Woman University, Seoul, South Korea
(Lee) Division of Cardiology, Department of Internal Medicine, Soon Chun
Hyang University Hospital, Seoul, South Korea
(Lee) Division of Cardiology, Department of Internal Medicine, Daegu
Catholic University, Daegu, South Korea
Publisher
Korean Society of Circulation (E-mail: herz4@circulation.or.kr)
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia
in the general population. The Korean Heart Rhythm Society organized a
Korean AF Management Guideline Committee and analyzed all available
studies regarding the management of AF, including studies on Korean
patients. This guideline is based on recent data of the Korean population
and the recent guidelines of the European Society of Cardiology, European
Association for Cardio-Thoracic Surgery, American Heart Association, and
Asia Pacific Heart Rhythm Society. Expert consensus or guidelines for the
optimal management of Korean patients with AF were achieved after a
systematic review with intensive discussion. This article provides general
principles for appropriate risk stratification and selection of
anticoagulation therapy in Korean patients with AF. This guideline deals
with optimal stroke prevention, screening, rate and rhythm control, risk
factor management, and integrated management of AF. Copyright ©
2018 Korean Society of Circulation. All rights reserved.

<115>
Accession Number
2001290921
Title
Tranexamic acid in coronary artery surgery: One-year results of the
Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Author
Myles P.S.; Smith J.A.; Kasza J.; Marasco S.; Esmore D.; Krum H.; Tonkin
A.; Buxton B.; Heritier S.; Merry A.; Liew D.; McNeil J.; Forbes A.;
Cooper D.J.; Wallace S.; Meehan A.; Myles P.; Galagher W.; Farrington C.;
Ditoro A.; Wutzlhofer L.; Story D.; Peyton P.; Baulch S.; Sidiropoulos S.;
Potgieter D.; Baker R.A.; Pesudovs B.; O'Loughlin J Wells E.; Coutts P.;
Bolsin S.; Osborne C.; Ives K.; Smith J.; Hulley A.; Christie-Taylor G.;
Painter T.; Lang S.; Mackay H.; Cokis C.; March S.; Bannon P.G.; Wong C.;
Turner L.; Scott D.; Silbert B.; Said S.; Corcoran P.; de Prinse L.;
Bussieres J.S.; Gagne N.; Lamy A.; Semelhago L.; Chan M.T.V.; Underwood
M.; Choi G.S.Y.; Fung B.; Landoni G.; Lembo R.; Monaco F.; Simeone F.;
Marianello D.; Alvaro G.; De Vuono G.; van Dijk D.; Dieleman J.; Numan S.;
McGuinness S.; Parke R.; Raudkivi P.; Gilder E.; Byrne K.; Dunning J.;
Termaat J.; Mans G.; Jayarajah M.; Alderton J.; Waugh D.; Platt M.J.; Pai
A.; Sevillano A.; Lal A.; Sinclair C.; Kunst G.; Knighton A.; Cubas G.M.;
Saravanan P.; Millner R.; Vasudevan V.; Patteril M.; Lopez E.; Basu R.; Lu
J.
Institution
(Myles, Cooper, Marasco, Wallace) Department of Anaesthesia and
Perioperative Medicine, Alfred Hospital, Melbourne, Australia
(Myles, Smith, Kasza, Cooper, Marasco, McNeil, Wallace, Forbes) Department
of Anaesthesia and Perioperative Medicine, Monash University, Melbourne,
Australia
(Smith) Department of Cardiothoracic Surgery, Monash Medical Centre,
Clayton, Australia
(Silbert) Department of Anaesthesia, St Vincent's Hospital, Fitzroy,
Australia
(Jayarajah) Department of Cardiothoracic Anaesthesia and Cardiac Critical
Care, South West Cardiac Centre, Derriford Hospital, Plymouth, United
Kingdom
(Painter) Royal Adelaide Hospital and Discipline of Acute Care Medicine,
University of Adelaide, Adelaide, Australia
(Bussieres) Department of Anesthesiology, Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Quebec City, Quebec, Canada
(McGuinness) Department of Cardiothoracic & Vascular Intensive Care Unit,
Auckland City Hospital, Auckland, New Zealand
(Byrne) Department of Anaesthesia, Waikato Hospital, New Zealand
(Chan) Department of Anesthesiology and Intensive Care, The Chinese
University of Hong Kong, Hong Kong
(Landoni) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Tranexamic acid reduces blood loss and transfusion
requirements in cardiac surgery but may increase the risk of coronary
graft thrombosis. We previously reported the 30-day results of a trial
evaluating tranexamic acid for coronary artery surgery. Here we report the
1-year clinical outcomes. Method(s): Using a factorial design, we
randomly assigned patients undergoing coronary artery surgery to receive
aspirin or placebo and tranexamic acid or placebo. The results of the
tranexamic acid comparison are reported here. The primary 1-year outcome
was death or severe disability, the latter defined as living with a
modified Katz activities of daily living score of less than 8. Secondary
outcomes included a composite of myocardial infarction, stroke, and death
from any cause through to 1 year after surgery. Result(s): The rate
of death or disability at 1 year was 3.8% in the tranexamic acid group and
4.4% in the placebo group (relative risk, 0.85; 95% confidence interval,
0.64-1.13; P = .27), and this did not significantly differ according to
aspirin exposure at the time of surgery (interaction P = .073). The
composite rate of myocardial infarction, stroke, and death up to 1 year
after surgery was 14.3% in the tranexamic acid group and 16.4% in the
placebo group (relative risk, 0.87; 95% CI, 0.76-1.00; P = .053).
 Conclusion(s): In this trial of patients having coronary artery
surgery, tranexamic acid did not affect death or severe disability through
to 1 year after surgery. Further work should be done to explore possible
beneficial effects on late cardiovascular events. Copyright ©
2018 The American Association for Thoracic Surgery

<116>
Accession Number
2001284374
Title
Impact of remote ischemic preconditioning preceding coronary artery bypass
grafting on inducing neuroprotection.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Author
Gasparovic H.; Kopjar T.; Anticevic A.; Rados M.; Malojcic B.; Ivancan V.;
Fabijanic T.; Cikes M.; Milicic D.; Gasparovic V.; Biocina B.
Institution
(Gasparovic, Kopjar, Ivancan, Fabijanic, Biocina) Department of Cardiac
Surgery, University Hospital Center Zagreb, University of Zagreb, Zagreb,
Croatia
(Rados) Department of Radiology, University Hospital Center Zagreb,
University of Zagreb, Zagreb, Croatia
(Malojcic) Department of Neurology, University Hospital Center Zagreb,
University of Zagreb, Zagreb, Croatia
(Cikes, Milicic, Gasparovic) Departments of Cardiology and Internal
Medicine, University Hospital Center Zagreb, University of Zagreb, Zagreb,
Croatia
(Rados) Center of Excellence for Basic, Clinical and Translational
Neuroscience, Croatian Institute for Brain Research, School of Medicine,
University of Zagreb, Zagreb, Croatia
(Anticevic) Departments of Psychiatry and Psychology, Yale University
School of Medicine, New Haven, Conn, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Neurological complications after coronary artery bypass
grafting (CABG) reduce quality of life, increase mortality, and inflate
resource utilization. The risk of postoperative neurological complications
parallels the increasing risk burden of the contemporary patient
population. We evaluated the efficacy of remote ischemic preconditioning
(RIPC) on inducing neuroprotection. Method(s): Seventy patients
undergoing first-time CABG were randomly assigned to RIPC or a sham
procedure. Structural brain magnetic resonance imaging (MRI) was
complemented with functional connectivity MRI to gain a whole-brain global
connectivity analysis. Paired neurocognitive and MRI data were acquired
pre- and postoperatively. The primary end point was a composite of new
ischemic brain lesions and neurocognitive impairment. Secondary end points
included brain connectivity profiles, pooled ischemic volumes, and
individual components of the primary outcome. The Shapiro-Wilk test was
used to determine whether a data set followed a normal distribution. The
Fisher exact test was used to calculate the measures of association for
categorical variables, whereas continuous data were tested with either the
Mann-Whitney U test or the Student t test. Result(s): There was no
between-group difference in the incidence of the primary end point (9
[27%] in the RIPC group vs 8 [24%] in the control group, odds ratio, 1.17
[95% confidence interval, 0.34-4.06]; P = 1.0). Although RIPC did not
reduce the incidence of brain ischemia (8/33 [24%] vs 7/33 [21%]; P =
1.0), the pooled ischemic volume was lower in the RIPC group (157
[interquartile range, 125-231] vs 777 [interquartile range, 564-965]
mm3; P = .004). Postoperative neurocognition was marginally
superior in the RIPC group as evidenced by a lower absolute number of
abnormal neurocognitive tests in the RIPC group (7/99 [7%] vs 16/99 [16%];
odds ratio, 0.40 [95% confidence interval, 0.14-1.09]; P = .074). Robust
reductions of functional connectivity profiles for the associative
thalamus were documented in both groups, irrespective of RIPC (RIPC group,
t = 3.31; P < .01; and the control group, t = 3.52; P < .01).
 Conclusion(s): Silent brain ischemia occurs frequently after CABG.
RIPC did not reduce the incidence of the primary outcome. However, RIPC
significantly reduced the pooled volume of ischemic brain lesions. Surgery
adversely affected global brain connectivity, with RIPC conferring no
demonstrable protection. The association of RIPC with superior
neurocognitive test scores failed to cross the threshold for
significance. Copyright © 2018

<117>
Accession Number
2001283379
Title
Haemodynamic profiles of etomidate vs propofol for induction of
anaesthesia: a randomised controlled trial in patients undergoing cardiac
surgery.
Source
British Journal of Anaesthesia. (no pagination), 2018. Date of
Publication: 2018.
Author
Hannam J.A.; Mitchell S.J.; Cumin D.; Frampton C.; Merry A.F.; Moore M.R.;
Kruger C.J.
Institution
(Hannam) Department of Pharmacology and Clinical Pharmacology, Faculty of
Medical and Health Sciences, University of Auckland, Auckland, New Zealand
(Hannam, Mitchell, Cumin, Merry, Moore) Department of Anaesthesiology,
Faculty of Medical and Health Sciences, University of Auckland, Auckland,
New Zealand
(Mitchell) Department of Anaesthesia, Auckland City Hospital, Auckland,
New Zealand
(Frampton) Department of Medicine, Christchurch School of Medicine and
Health Sciences, University of Otago, Dunedin, New Zealand
(Merry, Kruger) Department of Cardiothoracic and ORL Anaesthesia, Auckland
City Hospital, Auckland, New Zealand
Publisher
Elsevier Ltd
Abstract
Background: Etomidate is frequently selected over propofol for induction
of anaesthesia because of a putatively favourable haemodynamic profile,
but data confirming this perception are limited. Method(s): Patients
undergoing cardiac surgery were randomised to induction of anaesthesia
with propofol or etomidate. Phase I (n=75) was conducted as open-label,
whereas Phase II (n=75) was double blind. Mean arterial blood pressure
(MAP) and boluses of vasopressor administered after induction were
recorded. The primary endpoint was the area under the curve below baseline
MAP (MAP-time integral) during the 10 min after induction. Secondary
endpoints were the use of vasopressors over the same period, and the
effect of blinding on the aforementioned endpoints. Groups were compared
using regression models with phase and anaesthetist as factors.
 Result(s): The mean difference between etomidate and propofol in the
MAP-time integral below baseline was 2244 mm Hg s (95% confidence
interval, 581-3906; P=0.009), representing a 34% greater reduction with
propofol. Overall, vasopressors were used in 10/75 patients in the
etomidate group vs 21/75 in the propofol group (P=0.38), and in 20/74
patients during the blinded phase vs 11/76 during the open-label phase
(P=0.31). The interaction between randomisation and phase (open-labelled
or blinded) was not significant for either primary (P=0.73) or secondary
endpoints (P=0.90). Conclusion(s): Propofol caused a 34% greater
reduction in MAP-time integral from baseline after induction of
anaesthesia than etomidate, despite more frequent use of vasopressors with
propofol, confirming the superior haemodynamic profile of etomidate in
this context. The proportion of patients receiving vasopressors increased
slightly, albeit not significantly, in both groups in the blinded phase.
Clinical trial registration: Australian and New Zealand Clinical Trials
Registry, ACTRN12614000717651. Copyright © 2018 British Journal
of Anaesthesia

<118>
Accession Number
2001281375
Title
Nitric oxide provides myocardial protection when added to the
cardiopulmonary bypass circuit during cardiac surgery: Randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Author
Kamenshchikov N.O.; Mandel I.A.; Podoksenov Y.K.; Svirko Y.S.; Lomivorotov
V.V.; Mikheev S.L.; Kozlov B.N.; Shipulin V.M.; Nenakhova A.A.;
Anfinogenova Y.J.
Institution
(Kamenshchikov, Podoksenov, Svirko, Kozlov, Shipulin, Nenakhova,
Anfinogenova) Cardiology Research Institute, Tomsk National Research
Medical Center, Russian Academy of Sciences, Tomsk, Russian Federation
(Mandel) Federal State Autonomous Educational Institution of Higher
Education I. M. Sechenov First Moscow State Medical University of the
Ministry of Health of the Russian Federation (Sechenov University),
Moscow, Russian Federation
(Mandel) Federal Research and Clinical Center for Specialized Medical Care
and Medical Technologies, Federal Medico-Biological Agency, Moscow,
Russian Federation
(Podoksenov, Svirko, Kozlov, Shipulin) Siberian State Medical University,
Tomsk, Russian Federation
(Lomivorotov) E. Meshalkin National Medical Research Center, Novosibirsk,
Russian Federation
(Mikheev) Federal State Autonomous Institution "Treatment and
Rehabilitation Center" of the Ministry of Healthcare of the Russian
Federation, Moscow, Russian Federation
(Anfinogenova) National Research Tomsk Polytechnic University, Tomsk,
Russian Federation
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: The aim of this pilot study was to elucidate the effects of
exogenous nitric oxide (NO) supply to the extracorporeal circulation
circuit for cardioprotection against ischemia-reperfusion injury during
coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).
 Method(s): A total of 60 patients with coronary artery disease
scheduled for CABG with CPB were enrolled in a prospective randomized
study. Patients were allocated randomly to receive treatment according to
standard or modified CPB protocol where 40-ppm NO was added to the CPB
circuit during cardiac surgery. The primary endpoint was the measurement
of cardiac troponin I (cTnI). The secondary end points consisted in the
measurements of creatine kinase-muscle/brain fraction (CK-MB) and
vasoactive inotropic score (VIS). Result(s): NO delivered into the
CPB circuit had a cardioprotective effect. The level of cTnI was
significantly lower in NO-treated group compared with the control group 6
hours after surgery: 1.79 +/- 0.39 ng/mL versus 2.41 +/- 0.55 ng/mL,
respectively (P = .001). The CK-MB value was significantly lower in
NO-treated group compared with the control group 24 hours after surgery:
47.69 +/- 8.08 U/L versus 62.25 +/- 9.78 U/L, respectively (P = .001); and
the VIS was significantly lower in the NO-treated group 6 hours after the
intervention. Conclusion(s): NO supply to the CPB circuit during CABG
exerted a cardioprotective effect and was associated with lower levels of
VIS and cardiospecific blood markers cTnI and CK-MB. Copyright ©
2018 The American Association for Thoracic Surgery

<119>
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.

<120>
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.
 Method(s): 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.
 Result(s): 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. Conclusion(s):
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

<121>
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).

<122>
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.
 Method(s): 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. Result(s): 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(s): 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.

<123>
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.

<124>
Accession Number
2001262560
Title
Blinded outcomes and angina assessment of coronary bioresorbable
scaffolds: 30-day and 1-year results from the ABSORB IV randomised trial.
Source
The Lancet. 392 (10157) (pp 1530-1540), 2018. Date of Publication: 27
October - 2 November 2018.
Author
Stone G.W.; Ellis S.G.; Gori T.; Metzger D.C.; Stein B.; Erickson M.;
Torzewski J.; Williams J.; Lawson W.; Broderick T.M.; Kabour A.; Piegari
G.; Cavendish J.; Bertolet B.; Choi J.W.; Marx S.O.; Genereux P.;
Kereiakes D.J.
Institution
(Stone, Marx) NewYork-Presbyterian Hospital/Columbia University Medical
Center, New York, NY, United States
(Stone, Genereux) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Ellis) Cleveland Clinic, Cleveland, OH, United States
(Gori) Kardiologie I University Medical Center and Deutsches Zentrum fur
Herz-Kreislaufforschung, Rhein-Main, Mainz, Germany
(Metzger) Ballad Health Systems CVA Heart Institute, Kingsport, TN, United
States
(Stein) Morton Plant Hospital, Clearwater, FL, United States
(Erickson) Royal Perth Hospital, Perth, WA, Australia
(Torzewski) Kliniken Oberallgau, Immenstadt, Germany
(Williams) Presbyterian Hospital, Charlotte, NC, United States
(Lawson) Stony Brook University Medical Center, Stony Brook, NY, United
States
(Broderick, Kereiakes) The Carl and Edyth Lindner Research Center at The
Christ Hospital, Cincinnati, OH, United States
(Kabour) Mercy St Vincent Medical Center, Toledo, OH, United States
(Piegari) St Joseph Medical Center, Wyomissing, PA, United States
(Cavendish) Scripps Memorial Hospital La Jolla, La Jolla, CA, United
States
(Bertolet) North Mississippi Medical Center, Tupelo, MS, United States
(Choi) Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas,
TX, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Previous studies showed more adverse events with coronary
bioresorbable vascular scaffolds (BVS) than with metallic drug-eluting
stents (DES), although in one randomised trial angina was reduced with
BVS. However, these early studies were unmasked, lesions smaller than
intended for the scaffold were frequently enrolled, implantation technique
was suboptimal, and patients with myocardial infarction, in whom BVS might
be well suited, were excluded. Method(s): In the active-controlled,
blinded, multicentre, randomised ABSORB IV trial, patients with stable
coronary artery disease or acute coronary syndromes aged 18 years or older
were recruited from 147 hospitals in five countries (the USA, Germany,
Australia, Singapore, and Canada). Enrolled patients were randomly
assigned (1:1) to receive polymeric everolimus-eluting BVS (Absorb; Abbott
Vascular, Santa Clara, CA, USA) with optimised implantation technique or
cobalt-chromium everolimus-eluting stents (EES; Xience; Abbott Vascular,
Santa Clara, CA, USA). Randomisation was stratified by diabetic status,
whether patients would have been eligible for enrolment in the previous
ABSORB III trial, and site. Patients and clinical assessors were masked to
randomisation. The primary endpoint was target lesion failure (cardiac
death, target vessel myocardial infarction, or ischaemia-driven target
lesion revascularisation) at 30 days, tested for non-inferiority with a
2.9% margin for the risk difference. Analysis was by intention to treat.
The trial is registered with ClinicalTrials.gov, number NCT02173379, and
is closed to accrual. Finding(s): Between Aug 15, 2014, and March 31,
2017, we screened 18 722 patients for eligibility, 2604 of whom were
enrolled. 1296 patients were assigned to BVS, and 1308 patients were
assigned to EES. Follow-up data at 30 days and 1 year, respectively, were
available for 1288 and 1254 patients with BVS and for 1303 and 1272
patients with EES. Biomarker-positive acute coronary syndromes were
present in 622 (24%) of 2602 patients, and, by angiographic core
laboratory analysis, 78 (3%) of 2893 of lesions were in very small
vessels. Target lesion failure at 30 days occurred in 64 (5.0%) patients
assigned to BVS and 48 (3.7%) patients assigned to EES (difference 1.3%,
upper 97.5% confidence limit 2.89; one-sided
p<inf>non-inferiority</inf>=0.0244). Target lesion failure at 1 year
occurred in 98 (7.8%) patients assigned to BVS and 82 (6.4%) patients
assigned to EES (difference 1.4%, upper 97.5% confidence limit 3.4;
one-sided p<inf>non-inferiority</inf>=0.0006). Angina, adjudicated by a
central events committee at 1 year, occurred in 270 (20.3%) patients
assigned to BVS and 274 (20.5%) patients assigned to EES (difference
-0.3%, 95% CI -3.4% to 2.9%; one-sided p<inf>non-inferiority</inf>=0.0008;
two-sided p<inf>superiority</inf>=0.8603). Device thrombosis within 1 year
occurred in nine (0.7%) patients assigned to BVS and four (0.3%) patients
assigned to EES (p=0.1586). Interpretation(s): Polymeric BVS
implanted with optimised technique in an expanded patient population
resulted in non-inferior 30-day and 1-year rates of target lesion failure
and angina compared with metallic DES. Funding(s): Abbott
Vascular. Copyright © 2018 Elsevier Ltd

<125>
Accession Number
624985063
Title
Meta-analysis of Prevalence and Risk Factors for Delirium After
Transcatheter Aortic Valve Implantation.
Source
The American journal of cardiology. 122 (11) (pp 1917-1923), 2018. Date of
Publication: 01 Dec 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, SA, Australia
(Psaltis) School of Medicine, University of Adelaide, Adelaide, South
Australia, Australia; 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, SA, Australia
(Kim) Vascular Research Centre, Heart Health Theme, South Australian
Health and Medical Research Institute, SAHMRI, Adelaide, South Australia,
Australia; Flinders Centre for Epidemiology and Biostatistics, College of
Medicine and Public Health, Flinders University
Publisher
NLM (Medline)
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. Published by
Elsevier Inc.

<126>
Accession Number
625026435
Title
Feasibility and safety of combined percutaneous coronary intervention
among high-risk patients with severe aortic stenosis undergoing
transcatheter aortic valve implantation: a systematic review and
meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 54 (6) (pp 1052-1059),
2018. Date of Publication: 01 Dec 2018.
Author
Bao L.; Gao Q.; Chen S.; Chen Y.; Elhmidi Y.; Shehada S.-E.; Wang S.; Ma
C.
Institution
(Bao) Department of Cardiac Surgery, Aerospace Center Hospital, Beijing,
China
(Gao, Chen, Chen) Department of Cardiac Surgery, Peking University
People's Hospital, Beijing, China
(Elhmidi, Ma) Department of Cardiovascular Surgery, German Heart Centre
Munich, Technische Universitat Munchen, Munich, Germany
(Shehada) Department of Thoracic and Cardiovascular Surgery, West German
Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
(Wang) Department of Cardiovascular Surgery, Henan Provincial People's
Hospital, Zhengzhou, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Recent reports indicated that percutaneous coronary
intervention (PCI) may be correlated with increased mortality in patients
undergoing transcatheter aortic valve implantation (TAVI). Therefore, we
performed a meta-analysis to determine the feasibility and safety of
combined PCI in high-risk patients with severe aortic stenosis undergoing
TAVI. METHOD(S): A comprehensive literature search was performed
using PubMed, Embase and the Cochrane Central Register of Controlled
trials through June 2016. RESULT(S): Five clinical trials including
1634 patients were identified. The pooled analysis revealed no significant
differences in 30-day all-cause mortality [odds ratio (OR) 1.25, 95%
confidence interval (CI) 0.52-3.05; P=0.62], 30-day cardiovascular
mortality rate (OR 1.59, 95% CI 0.52-4.88; P=0.41) and 1-year mortality
rate (OR 1.16, 95% CI 0.85-1.59; P=0.34) among the patients assigned to
TAVI and those undergoing TAVI+PCI. The incidence of myocardial infarction
(OR 2.96, 95% CI 1.03-8.45; P=0.04) was slightly higher in the TAVI+PCI
group. Other complications, such as stroke, kidney injury, bleeding and
vascular complications, were not significantly increased in the TAVI+PCI
group. Patients treated with a staged procedure of TAVI and PCI but not
simultaneous TAVI+PCI showed higher 30-day all-cause mortality as compared
to those undergoing isolated TAVI. CONCLUSION(S): Combined TAVI+PCI
showed similar rates of death from any cause at 30days and 1year as
compared to isolated TAVI. Except for myocardial infarction, the rate of
operative complications in the TAVI+PCI group was not detrimental as
compared to the isolated TAVI group. The simultaneous treatment of
significant coronary artery lesions may be preferred in selected patients
undergoing TAVI.

<127>
Accession Number
625025656
Title
The Effect of Interactive Therapeutic Play Education Program on Anxiety
Levels of Children Undergoing Cardiac Surgery and Their Mothers.
Source
Journal of perianesthesia nursing : official journal of the American
Society of PeriAnesthesia Nurses. 33 (6) (pp 781-789), 2018. Date of
Publication: 01 Dec 2018.
Author
Coskunturk A.E.; Gozen D.
Publisher
NLM (Medline)
Abstract
PURPOSE: This study was conducted to determine the effect of Interactive
Therapeutic Play Education Program applied in preparing pediatric cardiac
patients for surgery on the postoperative anxiety levels of such children
and their mothers. DESIGN: This was a randomized controlled experimental
trial. METHOD(S): The study was conducted on children aged 6 to 12
years, who underwent surgery for congenital heart disease, and their
mothers (N = 43). FINDINGS: Anxiety levels of the children and their
mothers were similar in the preoperative period, whereas postoperative
anxiety levels were lower in the experimental group than in the control
group (P < .05). CONCLUSION(S): As a result of this study it was
determined that education provided using therapeutic play to preoperative
patients aged 6 to 12 years to undergo surgery reduced the anxiety levels
of children and their mothers in the postoperative period. Copyright
© 2017 American Society of PeriAnesthesia Nurses. Published by
Elsevier Inc. All rights reserved.

<128>
[Use Link to view the full text]
Accession Number
625025407
Title
Effectiveness of the Thoracic Pedicle Screw Placement Using the Virtual
Surgical Training System: A Cadaver Study.
Source
Operative neurosurgery (Hagerstown, Md.). 15 (6) (pp 677-685), 2018. Date
of Publication: 01 Dec 2018.
Author
Hou Y.; Lin Y.; Shi J.; Chen H.; Yuan W.
Institution
(Hou, Shi, Chen, Yuan) Department of Orthopaedic Surgery, Changzheng
Hospital, Second Military Medical University, Shanghai, China
(Lin) School of Mechanical Engineering, State Key Laboratory of Mechanical
System and Vibration, Institute of Biomedical Manufacturing and Life
Quality Engineering, Shanghai, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The virtual simulation surgery has initially exhibited its
promising potentials in neurosurgery training. OBJECTIVE(S): To
evaluate effectiveness of the Virtual Surgical Training System (VSTS) on
novice residents placing thoracic pedicle screws in a cadaver study.
 METHOD(S): A total of 10 inexperienced residents participated in this
study and were randomly assigned to 2 groups. The group using VSTS to
learn thoracic pedicle screw fixation was the simulation training (ST)
group and the group receiving an introductory teaching session was the
control group. Ten fresh adult spine specimens including 6 males and 4
females with a mean age of 58.5 yr (range: 33-72) were collected and
randomly allocated to the 2 groups. After exposing anatomic structures of
thoracic spine, the bilateral pedicle screw placement of T6-T12 was
performed on each cadaver specimen. The postoperative computed tomography
scan was performed on each spine specimen, and experienced observers
independently reviewed the placement of the pedicle screws to assess the
incidence of pedicle breach. RESULT(S): The screw penetration rates
of the ST group (7.14%) was significantly lower in comparison to the
control group (30%, P < .05). Statistically significant difference in
acceptable rates of screws also occurred between the ST (100%) and control
(92.86%) group (P < .05). In addition, the average screw penetration
distance in control group (2.37 mm +/- 0.23 mm) was significantly greater
than ST group (1.23 mm +/- 0.56 mm, P < .05). CONCLUSION(S): The
virtual reality surgical training of thoracic pedicle screw
instrumentation effectively improves surgical performance of novice
residents compared to those with traditional teaching method, and can help
new beginners to master the surgical technique within shortest period of
time.

<129>
Accession Number
625012389
Title
Cerebral Small Vessel, But Not Large Vessel Disease, Is Associated With
Impaired Cerebral Autoregulation During Cardiopulmonary Bypass: A
Retrospective Cohort Study.
Source
Anesthesia and analgesia. 127 (6) (pp 1314-1322), 2018. Date of
Publication: 01 Dec 2018.
Author
Nomura Y.; Faegle R.; Hori D.; Al-Qamari A.; Nemeth A.J.; Gottesman R.;
Yenokyan G.; Brown C.; Hogue C.W.
Institution
(Nomura, Hori) From the Division of Cardiac Surgery, Department of Surgery
and, Canada
(Faegle, Gottesman) Department of Neurology, Johns Hopkins University
School of Medicine, Baltimore, MD, United States
(Al-Qamari, Hogue) Anesthesiology and the Bluhm Cardiovascular Institute
and
(Nemeth) Radiology, Division of Neuroradiology, Northwestern University
Feinberg School of Medicine, Chicago, IL, United States
(Nemeth) Department of Neurology, Northwestern University Feinberg School
of Medicine, Chicago, IL, United States
(Yenokyan) Bloomberg School of Public Health, Johns Hopkins University,
Baltimore, MD, United States
(Brown) Department of Anesthesiology & Critical Care Medicine, Johns
Hopkins University School of Medicine, Baltimore, MD, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Impaired cerebral blood flow (CBF) autoregulation during
cardiopulmonary bypass (CPB) is associated with stroke and other adverse
outcomes. Large and small arterial stenosis is prevalent in patients
undergoing cardiac surgery. We hypothesize that large and/or small vessel
cerebral arterial disease is associated with impaired cerebral
autoregulation during CPB. METHOD(S): A retrospective cohort analysis
of data from 346 patients undergoing cardiac surgery with CPB enrolled in
an ongoing prospectively randomized clinical trial of autoregulation
monitoring were evaluated. The study protocol included preoperative
transcranial Doppler (TCD) evaluation of major cerebral artery flow
velocity by a trained vascular technician and brain magnetic resonance
imaging (MRI) between postoperative days 3 and 5. Brain MRI images were
evaluated for chronic white matter hyperintensities (WMHI) by a vascular
neurologist blinded to autoregulation data. "Large vessel" cerebral
vascular disease was defined by the presence of characteristic TCD changes
associated with stenosis of the major cerebral arteries. "Small vessel"
cerebral vascular disease was defined based on accepted scoring methods of
WMHI. All patients had continuous TCD-based autoregulation monitoring
during surgery. RESULT(S): Impaired autoregulation occurred in 32.4%
(112/346) of patients. Preoperative TCD demonstrated moderate-severe large
vessel stenosis in 67 (25.2%) of 266 patients with complete data. In
adjusted analysis, female sex (odds ratio [OR], 0.46; 95% confidence
interval [CI], 0.25-0.86; P = .014) and higher average temperature during
CPB (OR, 1.23; 95% CI, 1.02-1.475; P = .029), but not moderate-severe
large cerebral arterial stenosis (P = .406), were associated with impaired
autoregulation during CPB. Of the 119 patients with available brain MRI
data, 42 (35.3%) demonstrated WMHI. The presence of small vessel cerebral
vascular disease was associated with impaired CBF autoregulation (OR,
3.25; 95% CI, 1.21-8.71; P = .019) after adjustment for age, history of
peripheral vascular disease, preoperative hemoglobin level, and
preoperative treatment with calcium channel blocking drugs.
 CONCLUSION(S): These data confirm that impaired CBF autoregulation is
prevalent during CPB predisposing affected patients to brain hypoperfusion
or hyperperfusion with low or high blood pressure, respectively. Small
vessel, but not large vessel, cerebral vascular disease, male sex, and
higher average body temperature during CPB appear to be associated with
impaired autoregulation.

<130>
Accession Number
625010555
Title
Aprotinin Impacts 8-Isoprostane after Coronary Artery Bypass Grafting.
Source
Scandinavian journal of surgery : SJS : official organ for the Finnish
Surgical Society and the Scandinavian Surgical Society. 107 (4) (pp
329-335), 2018. Date of Publication: 01 Dec 2018.
Author
Toikkanen V.; Rinne T.; Nieminen R.; Moilanen E.; Laurikka J.; Porkkala
H.; Tarkka M.; Mennander A.A.
Institution
(Toikkanen, Laurikka, Tarkka, Mennander) Department of Cardiothoracic
Surgery, SDSKIR Heart Center, Tampere University Hospital, University of
Tampere, Tampere, Finland
(Rinne, Porkkala) Division of Cardiac Anesthesia, Heart Center, Tampere
University Hospital, University of Tampere, Tampere, Finland
(Nieminen, Moilanen) The Immunopharmacology Research Group, Faculty of
Medicine and Life Sciences, University of Tampere and Tampere University
Hospital, Tampere, Finland
Publisher
NLM (Medline)
Abstract
BACKGROUND AND AIMS:: The lungs participate in the modulation of the
circulating inflammatory factors induced by coronary artery bypass
grafting. We investigated whether aprotinin-which has been suggested to
interact with inflammation-influences lung passage of key inflammatory
factors after coronary artery bypass grafting. MATERIAL AND METHODS:: A
total of 40 patients undergoing coronary artery bypass grafting were
randomized into four groups according to aprotinin dose: (1) high dose,
(2) early low dose, (3) late low dose, and (4) without aprotinin.
Pulmonary artery and radial artery blood samples were collected for the
evaluation of calculated lung passage (pulmonary artery/radial artery) of
the pro-inflammatory factors interleukin 6 and interleukin 8,
8-isoprostane, myeloperoxidase and the anti-inflammatory interleukin 10
immediately after induction of anesthesia (T1), 1min after releasing
aortic cross clamp (T2), 15min after releasing aortic cross clamp (T3), 1h
after releasing aortic cross clamp (T4), and 20h after releasing aortic
cross clamp (T5). RESULT(S):: Pulmonary artery/radial artery
8-isoprostane increased in patients with high aprotinin dose as compared
with lower doses (1.1 range 0.97 vs 0.9 range 1.39, p=0.001). The main
effect comparing high aprotinin dose with lower doses was significant
(F(1, 38)=7.338, p=0.01, partial eta squared=0.16) further supporting
difference in the effectiveness of high aprotinin dose for pulmonary
artery/radial artery 8-isoprostane. CONCLUSION(S):: According to the
pulmonary artery/radial artery equation, the impact of aprotinin on
8-isoprostane after coronary artery bypass grafting is dose dependent.
Aprotinin may aid the lung passage of circulating factors toward a
beneficial anti-inflammatory milieu.

<131>
Accession Number
625008740
Title
Ambulation capacity and functional outcome in patients undergoing
neuromuscular electrical stimulation after cardiac valve surgery: A
randomised clinical trial.
Source
Medicine. 97 (46) (pp e13012), 2018. Date of Publication: 01 Nov 2018.
Author
Fontes Cerqueira T.C.; Cerqueira Neto M.L.; Cacau L.A.P.; Oliveira G.U.;
Silva Junior W.M.D.; Carvalho V.O.; Mendonca J.T.; Santana Filho V.J.
Institution
(Fontes Cerqueira) Department of Physiotherapy, Universidade Federal de
Sergipe, Lagarto, Brazil
(Cerqueira Neto, Carvalho, Santana Filho) Department of Physiotherapy,
Universidade Federal de Sergipe, Sao
(Cacau) Department of Physiotherapy, Universidade Tiradentes, Aracaju,
Brazil
(Oliveira) Universidade Federal de Sergipe, Aracaju, Brazil
(Silva Junior) Department of Physiotherapy, Universidade Federal de
Sergipe, Sao Cristovao, Brazil
(Mendonca) Department of Medicine, Universidade Federal de Sergipe, SE,
Sao Cristovao, Brazil
Publisher
NLM (Medline)
Abstract
BACKGROUND: Early mobilization and physical exercise are considered
fundamental components in cardiovascular surgery rehabilitation; however,
occasionally they are inadequate for inhibiting functional decline.
Neuromuscular electrical stimulation (NMES) is a promising tool in
cardiovascular rehabilitation; however, to date, no randomized clinical
trial has measured the effects of NMES on functional capacity and quality
of life in patients who undergo routine cardiac surgery with a short
intensive care unit (ICU) stay. Therefore, we aimed to investigate the
effects of NMES on walking ability, muscle strength, functional
independence, and quality of life in cardiac valve surgery patients in the
immediate postoperative period. METHOD(S): A randomized, parallel,
controlled, 2-arm clinical trial with assessor blinding was conducted.
Fifty-nine adult patients in the preoperative period after cardiac valve
reconstruction and/or replacement were randomly assigned to a control or
intervention group. The intervention group underwent NMES in the
quadriceps and gastrocnemius, bilaterally, for 60 minutes, for up to 10
sessions. The primary outcome was ambulation ability, assessed through the
Six-Minute Walk Test and Walking Speed Test at postoperative day 5 (5PO).
Secondary outcomes were muscular strength (assessed through the Medical
Research Council scale), functional independence measure (assessed through
the Functional Independence Measurement Questionnaire), and quality of
life (assessed through the Nottingham Health Profile) at baseline
(preoperative) and at postoperative days 3 and 5. RESULT(S): The
baseline characteristics were similar in both groups, except for body mass
index. There was no statistically significant difference, with a small
effect size, between both groups regarding the distance walked (95% CI,
-64.87 to 65.97) and walking speed (95% CI, -0.55 to 0.57). There was a
statistically significant difference in upper-limb muscle strength loss
and decline in mobility at postoperative day 3, which had a tendency to
recover to initial values at 5PO, in both groups. No significant
between-group difference was noted for muscle strength, functional
independence, and quality of life. CONCLUSION(S): The use of NMES had
no effect on walking ability, strength, quality of life, or functional
outcome in the postoperative period for patients that underwent regular
valve replacement.

<132>
Accession Number
625008672
Title
Comprehensive preoperative regime of selective gut decontamination in
combination with probiotics, and smectite for reducing endotoxemia and
cytokine activation during cardiopulmonary bypass: A pilot randomized,
controlled trial.
Source
Medicine. 97 (46) (pp e12685), 2018. Date of Publication: 01 Nov 2018.
Author
Liu W.-C.; Zhan Y.-P.; Wang X.-H.; Hou B.-C.; Huang J.; Chen S.-B.
Institution
(Liu) Department of Anesthesiology, First Affiliated Hospital of Nanchang
University, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Both selective digestive decontamination (SDD) and probiotics
have been reported to reduce endotoxemia. However, the available results
are conflicting and few studies have investigated the combined effect of
SDD and probiotics. This study aimed to examine the effectiveness of a
comprehensive preoperative regimen of SDD in combination with probiotics
and smectite on perioperative endotoxemia and cytokine activation in
patients who underwent elective cardiac surgery with cardiopulmonary
bypass (CPB) in a pilot, prospective, randomized, controlled trial.
 METHOD(S): Patients who underwent elective Aortic Valve Replacement
or Mitral Valve Replacement surgery from July 2010 to March 2015 were
included. In total, 30 eligible patients were randomly assigned to receive
either the comprehensive preoperative regimen (n = 15) (a combination of
preoperative SDD, probiotics, and smectite) or the control group (n = 15)
who did not receive this treatment. The levels of endotoxin, IL-6, and
procalcitonin were measured at the time before anesthesia induction,
immediately after cardiopulmonary bypass (CPB), 24 hours after CPB, and 48
hours after CPB. The primary outcomes were changes in endotoxin, IL-6, and
procalcitonin concentrations after CPB. RESULT(S): The mean levels of
change in endotoxin levels after CPB in patients receiving the
comprehensive preoperative regimen was marginally significantly lower than
those in control group (F = 4.0, P = .0552) but was not significantly
different for procalcitonin (F = .14, P = .7134). An interaction between
group and time for IL-6 was identified (F = 4.35, P = .0231). The increase
in IL-6 concentration immediately after CPB in the comprehensive
preoperative group was significantly lower than that in the control group
(P = .0112). The changes in IL-6 concentration at 24 hours and 48 hours
after CPB were not significant between the comprehensive preoperative
group and control group. CONCLUSION(S): The present pilot,
prospective, randomized, controlled study in patients undergoing cardiac
surgery with CPB demonstrated that 3 days of a comprehensive preoperative
regime of SDD in combination with probiotics and smectite may reduce the
endotoxin and IL-6 levels after CPB compared with the control group.

<133>
Accession Number
624983264
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: 01 Nov
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) Duke University Medical Center, Durham, NC, United States
(Leon, Hahn, Kodali, Finn, Alu, Smith) New York Presbyterian Hospital,
Columbia University Medical Center, NY, United States
(Mack) Baylor Scott & 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,
Quebec, Canada
(Weissman) MedStar Washington Hospital Center, WA, United States
(Miller) Stanford University, Stanford, CA, United States
(Herrmann) University of Pennsylvania Health System, Philadelphia, United
States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Thourani, Lerakis) Emory University, Atlanta, Georgia France
Publisher
NLM (Medline)
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(s):
To determine the midterm hemodynamic performance of balloon-expandable
transcatheter heart valves. Design, Setting, and Participant(s): 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. Intervention(s):
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.
 Result(s): 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.

<134>
Accession Number
624996007
Title
Effects of tranexamic acid on short-term and long-term outcomes of on-pump
coronary artery bypass grafting: Randomized trial and 7-year follow-up.
Source
Cardiovascular Therapeutics. (no pagination), 2018. Article Number:
e12472. Date of Publication: 2018.
Author
Zhang Y.; Gao X.; Yuan S.; Guo J.; Lv H.; Zhou Y.; Wang Y.; Ji H.; Wang
G.; Li L.; Shi J.
Institution
(Zhang, Yuan, Guo, Lv, Zhou, Wang, Ji, Wang, Li, Shi) Department of
Anesthesiology, State Key Laboratory of Cardiovascular Diseases, National
Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical
College and Chinese Academy of Medical Sciences, Beijing, China
(Gao) Department of Transfusion, State Key Laboratory of Cardiovascular
Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital,
Peking Union Medical College and Chinese Academy of Medical Sciences,
Beijing, China
Publisher
Blackwell Publishing Ltd
Abstract
Aims: Safety evaluations of tranexamic acid (TXA) remain sparse,
especially with respect to its impact on long-term outcomes in patients
undergoing on-pump coronary artery bypass grafting (CABG). We hypothesized
that the effects of TXA on perioperative bleeding and allogeneic
transfusion and its impact on long-term clinical outcomes of patients
receiving on-pump CABG are superior to those in the control group.
 Method(s): In this prospective, randomized, placebo-controlled trial,
210 patients undergoing primary and isolated on-pump CABG were randomly
assigned to receive TXA or a corresponding volume of saline solution.
Randomly assigned patients were followed up at 1, 3, 5, and 7 years after
hospital discharge. Finally, 163 patients fulfilled the 7-year follow-up.
The primary outcome was allogeneic red blood cell (RBC) transfusion.
Long-term mortality and morbidity were also evaluated. Result(s):
Compared with placebo, TXA reduced the allogeneic RBC requirement in terms
of the volume transfused (4.20 +/- 4.06 vs 6.25 +/- 4.86 units; P < 0.01),
ratio exposed (52.0% vs 71.6%; P < 0.01), and blood loss volume (879.0 +/-
392.5 vs 1154.0 +/- 582.8 mL; P < 0.01). Except for myocardial infarction,
there were no significant differences in mortality or morbidity between
the two groups during the 7-year follow-up. The TXA group had a lower rate
of myocardial infarction than did the placebo group (0.0% vs 4.9% at 84
months; P = 0.03). Conclusion(s): Tranexamic acid significantly
decreased postoperative bleeding and allogeneic transfusion in patients
undergoing on-pump CABG. The 7-year follow-up suggested that the use of
TXA was safe and might play a potential role in the prevention of
long-term myocardial infarction. Copyright © 2018 John Wiley &
Sons Ltd

<135>
Accession Number
624995494
Title
Atrial fibrillation following heart transplantation: A systematic review
and meta-analysis of observational studies.
Source
Journal of Evidence-Based Medicine. (no pagination), 2018. Date of
Publication: 2018.
Author
Chokesuwattanaskul R.; Bathini T.; Thongprayoon C.; Preechawat S.;
O'Corragain O.A.; Pachariyanon P.; Ungprasert P.; Cheungpasitporn W.
Institution
(Chokesuwattanaskul, Preechawat) Faculty of Medicine, Division of
Cardiology, Department of Medicine, Chulalongkorn University and King
Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
(Bathini) Department of Internal Medicine, University of Arizona, Tucson,
AZ, United States
(Thongprayoon) Department of Internal Medicine, Mayo Clinic, Rochester,
MN, United States
(O'Corragain) Department of Internal Medicine, Temple University,
Philadelphia, PA, United States
(Pachariyanon) Department of Internal Medicine, Texas Tech University
Health Sciences Center, Lubbock, TX, United States
(Ungprasert) Clinical Epidemiology Unit, Faculty of Medicine Siriraj
Hospital, Department of Research and Development, Mahidol University,
Bangkok, Thailand
(Cheungpasitporn) Division of Nephrology, Department of Medicine,
University of Mississippi Medical Center, MS, United States
Publisher
Blackwell Publishing
Abstract
Objective: Previous studies have suggested a high incidence of atrial
fibrillation (AF) in heart transplant recipients. However, incidence
trends of AF in heart transplant recipients remain unclear. The study's
aims were (1) to investigate the pooled incidence/incidence trends of AF
following heart transplantation and (2) to assess the mortality risk of
heart transplant recipients with AF. Method(s): A literature search
for studies that reported the incidence of AF following heart
transplantation was conducted using MEDLINE, EMBASE, and The Cochrane
Database from inception through March 2018. Pooled incidence and odds
ratios (OR) with 95%CI were calculated using a random-effects model.
 Result(s): Eighteen studies (2 cohorts from clinical trials and 16
cohort studies) with 5393 heart transplant recipients were enrolled. The
pooled estimated incidence of AF in heart transplant was 10.1% (95%CI:
7.6%-13.2%). Meta-analysis based on the type of anastomotic technique
demonstrated a pooled estimated incidence of AF following heart
transplantation of 18.7% (95%CI: 10.3%-31.5%) and 11.1% (95%CI:
6.5%-18.4%) by biatrial and bicaval techniques, respectively. There was a
significant association between AF following a heart transplant and
increased mortality risk with a pooled OR of 2.86 (95%CI: 2.08-3.93).
Meta-regression analyses showed no significant correlations between the
year of study and incidence of AF (P = 0.47) or mortality risk of AF after
heart transplantation (P = 0.99). Conclusion(s): The overall
estimated incidence of AF following heart transplantation is 10.1%. There
is a significant association between AF and increased mortality after
transplantation. Furthermore, incidence and mortality risk of AF following
heart transplant does not seem to decrease over time. Copyright ©
2018 Chinese Cochrane Center, West China Hospital of Sichuan University
and John Wiley & Sons Australia, Ltd

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