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<1>
Accession Number
2000758454
Title
A meta-analysis of reduced leaflet motion for surgical and transcatheter
aortic valves: Relationship to cerebrovascular events and valve
degeneration.
Source
Cardiovascular Revascularization Medicine. Part B. 19 (7) (pp 868-873),
2018. Date of Publication: October - November 2018.
Author
Makki N.; Shreenivas S.; Kereiakes D.; Lilly S.
Institution
(Makki, Lilly) Department of Cardiology, Ohio State University Wexner
Medical Center, Columbus, OH 43210, United States
(Shreenivas, Kereiakes) Department Cardiology, The Christ Hospital,
Cincinnati, OH 45219, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Reduced leaflet motion (RLM) of transcatheter aortic valves
(TAV) is observed in up to 4% of cases with similar frequency in surgical
valves, with an overall incidence that differs based on prosthesis type
and size. This phenomenon likely represents subclinical leaflet
thrombosis. Herein we sought to analyze the existing reported literature
to assess whether or not RLM is associated with subsequent valve
degeneration or cerebrovascular events. Methods and Results: We
searched PubMed, and EMBASE (2008-2017) to identify relevant studies.
Studies with <1-year follow-up, studies not evaluating RLM, and/or
clinical outcomes were excluded. Our co-primary endpoints were the
incidence of cerebrovascular events (stroke and/or transient ischemic
attack-TIA) or structural valvular degeneration defined as moderate or
greater regurgitation and/or a mean gradient >=20 mm Hg. The literature
search yielded 30 potential studies. Of these, six observational studies
with a total population of 1704 patients met our selection criteria. RLM
was associated with an increased risk of stroke or TIA (adjusted OR 2.60,
95% CI 1.56 to 4.34, p = 0.004). At one year, RLM was associated with an
increased risk of structural valve degeneration (adjusted OR 2.51, 95% CI
1.47 to 4.30, p = 0.006). The association between RLM and clinical
endpoints remained even after limiting analysis to transcatheter aortic
valve replacement (TAVR) patients only. Conclusion(s): In patients
with bio prosthetic aortic valve, presence of RLM is associated with
increased risk of stroke or TIA as well as structural valvular
degeneration. These findings support ongoing surveillance efforts and
evaluation of pharmacotherapies to address RLM in effort to minimize
subsequent clinical events. Copyright © 2018 Elsevier Inc.

<2>
Accession Number
623774886
Title
Evaluation of patient and staff exposure with state of the art X-ray
technology in cardiac catheterization: A randomized controlled trial.
Source
Journal of Interventional Cardiology. 31 (6) (pp 807-814), 2018. Date of
Publication: December 2018.
Author
Buytaert D.; Eloot L.; Mauti M.; Drieghe B.; Gheeraert P.; Taeymans Y.;
Bacher K.
Institution
(Buytaert, Eloot, Bacher) Department of Basic Medical Sciences, Ghent
University, Ghent, Belgium
(Mauti) Philips Healthcare, Best, Netherlands
(Drieghe, Gheeraert, Taeymans) Heart Centre, Ghent University Hospital,
Ghent, Belgium
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Introduction: Cardiac catheterization procedures result in high patient
radiation exposure and corresponding staff doses are reported to be among
the highest for medical staff. The purpose of current randomized
controlled study was to quantify the potential radiation dose reduction
for both patient and staff, enabled by recent X-ray technology. This
technology is equipped with advanced image processing algorithms,
real-time dose monitoring, and an acquisition chain optimized for cardiac
catheterization applications. Method(s): A total of 122 adult
patients were randomly assigned to one of two cath labs, either the
reference X-ray modality (Allura Xper FD10, Philips Healthcare, the
Netherlands) or the new X-ray system (AlluraClarity FD20/10 Philips
Healthcare, the Netherlands). Exposure parameters and staff dosimeter
readings were recorded for each exposure. Technical measurements were
performed to define the radiation scatter behavior. Result(s): With
the newer equipment, patient radiation dose is reduced (as total dose-area
product) by 67% based on geometric means with 95%CI of 53%, 77% for
diagnostic and interventional procedures. The C-arm and leg dosimeter
readings were both reduced with 65% (P < 0.001), while for the collar and
chest dosimeter readings no statistically significant reduction was
noticed. Conclusion(s): The new x-ray and image processing
technology, significantly reduces patient dose in coronary angiographies,
and PCIs by 67%. In general, scatter dose was also reduced, yet for some
dosimeters the reduction was limited and not statistically significant.
This study clearly indicates that the scatter behavior is highly dependent
on C-arm rotation, operator movement and height, dosimeter position, beam
filtration, clinical procedure type and system geometry. Copyright
© 2018 Wiley Periodicals, Inc.

<3>
Accession Number
624327165
Title
A meta-analysis of valve-in-valve and valve-in-ring transcatheter mitral
valve implantation.
Source
Journal of Interventional Cardiology. 31 (6) (pp 899-906), 2018. Date of
Publication: December 2018.
Author
Takagi H.; Hari Y.; Kawai N.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
Japan
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: We performed a meta-analysis of transcatheter mitral valve
implantation (TMVI) for deteriorated bioprosthetic valves (valve-in-valve
[VIV]-TMVI) and/or failed annuloplasty rings (valve-in-ring [VIR]-TMVI),
comparing observed early (30-day) mortality with predicted operative
mortality. Background(s): It remains unclear whether VIV/VIR-TMVI
reduces mortality as compared with redo MVS. Method(s): MEDLINE and
EMBASE were searched current through 24 July 2018 using Web-based search
engines (PubMed and OVID) to identify studies including >=10 patients
undergoing VIV/VIR-TMVI. For each study, data regarding observed 30-day
mortality and predicted operative mortality (Society of Thoracic Surgeons
Predicted Risk of Mortality [STS-PROM]) were used to generate risk ratios
(RRs) and 95% confidence intervals (CIs). Study-specific estimates were
combined using the inverse variance-weighted average of logarithmic RRs in
the random-effects model. One-group meta-analyses of 30-day/late
(including 30-day) mortality rates were also performed in the
random-effects model. Result(s): Of 270 potentially relevant articles
screened initially, 17 eligible studies including a total of 1017 patients
undergoing VIV/VIR-TMVI were identified. In all but four studies, the
STS-PROM was available and varied from 7.7% to 22.0% (weighted mean,
11.5%). Pooled analyses of all VIV/VIR-TMVI studies demonstrated the
30-day mortality rate of 5.4% (95%CI, 4.0-6.8%), the midterm (1- to
5-year) mortality rate of 13.7% (95%CI, 9.0-18.5%), and significantly
lower observed 30-day mortality than predicted operative mortality (RR,
0.67; 95%CI, 0.49-0.91; P = 0.01). Conclusion(s): VIV/VIR-TMVI
brought about relatively low early and midterm (1- to 5-year) mortality,
and observed 30-day mortality was significantly lower than predicted
operative mortality. Copyright © 2018 Wiley Periodicals, Inc.

<4>
Accession Number
625345807
Title
Triglyceride glucose index for predicting cardiovascular outcomes in
patients with coronary artery disease.
Source
Journal of Thoracic Disease. 10 (11) (pp 6137-6146), 2018. Date of
Publication: 01 Nov 2018.
Author
Jin J.-L.; Cao Y.-X.; Wu L.-G.; You X.-D.; Guo Y.-L.; Wu N.-Q.; Zhu C.-G.;
Gao Y.; Dong Q.-T.; Zhang H.-W.; Sun D.; Liu G.; Dong Q.; Li J.-J.
Institution
(Jin, Cao, Guo, Wu, Zhu, Gao, Dong, Zhang, Sun, Liu, Dong, Li) Division of
Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing
100037, China
(Wu, You) Department of Cardiology, TangXian People's Hospital, Baoding
072350, China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Triglyceride glucose (TyG) index is a novel marker for
metabolic disorders and recently it has been reported to be associated
with cardiovascular disease (CVD) risk in apparently healthy individuals.
However, the prognostic value of TyG index in patients with stable
coronary artery disease (CAD) is not determined. Method(s): We
conducted a nested case-control study among 3,745 patients with stable
CAD. Patients were followed up for 11,235 person-years. The cardiovascular
events (CVEs) were defined as all-cause death, non-fatal myocardial
infarction (MI), stroke and post-discharge revascularization [percutaneous
coronary intervention (PCI) coronary artery bypass grafting (CABG)]. In
total, 290 (7.7%) patients with CVEs and 1,450 controls were matched
according to age, gender, previous history of PCI or CABG and the duration
of follow-up. TyG index was calculated as formula: ln[fasting
triglycerides (mg/dL) x fasting plasma glucose (mg/dL)/2]. Result(s):
Multivariable Cox proportional hazards models revealed that TyG index was
positively associated with CVEs risk (hazard ratio: 1.364, 95% confidence
interval: 1.100-1.691, P=0.005). The Kaplan-Meier analysis indicated that
patients within the highest quartile of TyG index presented the lowest
event-free survival (P=0.029). Moreover, a 1-standard deviation (SD)
increment in TyG index was associated with 23.2% [hazard ratio (HR):
1.232, 95% confidence interval (95% CI): 1.084-1.401] higher risk of CVEs,
which was superior to other triglyceride or glycemic related markers.
 Conclusion(s): The present study, firstly, showed that TyG index was
positively associated with future CVEs, suggesting that TyG may be a
useful marker for predicting clinical outcomes in patients with
CAD. Copyright © Journal of Thoracic Disease.

<5>
Accession Number
2001217197
Title
Randomized Controlled Trial of Heparin Versus Bivalirudin Anticoagulation
in Acyanotic Children Undergoing Open Heart Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (6) (pp 2633-2640),
2018. Date of Publication: December 2018.
Author
Hasija S.; Talwar S.; Makhija N.; Chauhan S.; Malhotra P.; Chowdhury U.K.;
Krishna N.S.; Sharma G.
Institution
(Hasija, Makhija, Chauhan, Malhotra, Krishna) Department of Cardiac
Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
(Talwar, Chowdhury) Department of Cardiothoracic Vascular Surgery, All
India Institute of Medical Sciences, New Delhi, India
(Sharma) Department of Perfusion Technology, All India Institute of
Medical Sciences, New Delhi, India
Publisher
W.B. Saunders
Abstract
Objective: To determine the safety and efficacy of bivalirudin as an
anticoagulant for pediatric open heart surgery (OHS) and to determine its
appropriate dosage for this purpose. Design(s): Prospective,
randomized controlled trial. Setting(s): Tertiary care hospital.
 Participant(s): Fifty acyanotic children aged 1-12 years undergoing
OHS. Intervention(s): The children were randomized to receive either
4 mg/kg of heparin (n = 25, group H) or 1 mg/kg of bivalirudin bolus
followed by 2.5 mg/kg/h infusion (n = 25, group B) as the anticoagulant.
The doses were adjusted to maintain activated clotting time (ACT) above
480 seconds. At the conclusion of surgery, protamine (1.3 mg/100 U of
heparin) was administered to children in group H. Measurements and
Main Results: The children were comparable in both groups with regard to
demographic characteristics. The mean age and weight were 51.5 months and
13.4 kg in group H, and 59.3 months and 13.4 kg in group B. The dose of
anticoagulant required was 4.0 +/- 0.2 mg/kg in group H and 1.7 +/- 0.2
mg/kg followed by 3.0 +/- 0.7 mg/kg/h infusion in group B (p < 0.001). One
child in group H required an additional dose compared to 13 (54.2%)
children in group B. Intraoperatively, the ACT achieved was higher in
group H compared to group B (p < 0.05). The ACT returned to baseline value
after protamine administration in group H, but it remained elevated for 2
hours after termination of cardiopulmonary bypass (CPB) in group B (p <
0.01). The ACT was higher in group B compared to group H for 6 hours after
termination of CPB (p < 0.05). Heparin prolonged the onset of clotting,
decreased the rate and strength of thrombus formation, and inhibited
platelet function to a greater extent than bivalirudin on viscoelastic
coagulation testing. The total duration of surgery was prolonged in group
B. The postoperative chest tube drainage was similar in group B (4.9
mL/kg) as in group H (5.9 mL/kg) in spite of higher ACT. The transfusion
requirements were similar. No adverse event occurred in any patient.
 Conclusion(s): Bivalirudin is a safe and effective anticoagulant for
pediatric OHS. Though it is not suitable as a routine anticoagulant for
this purpose, it may be used as a heparin alternative in instances when
heparin cannot be used. The dose required to maintain ACT for more than
480 seconds was 1.7 +/- 0.2 mg/kg followed by 3.0 +/- 0.7 mg/kg/h
infusion. The ACT remained elevated for 2 hours after stopping the
infusion. Bivalirudin did not increase postoperative bleeding and
transfusion requirement. Copyright © 2018 Elsevier Inc.

<6>
Accession Number
625244566
Title
Intermittent systemic hypoxic-hyperoxic training for myocardial protection
in patients undergoing coronary artery bypass surgery: First results from
a single-centre, randomised controlled trial.
Source
Open Heart. 5 (2) (no pagination), 2018. Article Number: e000891. Date of
Publication: 01 Nov 2018.
Author
Tuter D.S.; Kopylov P.Y.; Syrkin A.L.; Glazachev O.S.; Komarov R.N.;
Katkov A.I.; Severova L.P.; Ivanova E.V.; Zhang Y.; Saner H.
Institution
(Tuter, Kopylov, Syrkin, Glazachev, Komarov, Katkov, Severova, Ivanova,
Saner) IE Sechenov First Moscow State Medical University, Moscow, Russian
Federation
(Zhang) Harbin Medical University, Harbin, China
(Saner) University Clinic for Cardiology, University Hospital,
Inselspital, Bern, Switzerland
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background Although remote ischaemic preconditioning (RIP) provides
protection against myocardial ischaemia and reperfusion injury during
cardiac surgery, it is not widely used. Systemic intermittent
hypoxic-hyperoxic training (IHHT) may be a suitable alternative. Methods
This is a prospective, single-centre, randomised controlled trial. 127
patients with ischaemic heart disease and indication for coronary artery
bypass graft (CABG) surgery from the Cardiology Clinic IM Sechenov First
Moscow State Medical University were randomly assigned to IHHT,
IHHT-control or RIP. Primary endpoint was serum concentration of troponin
I and lactate 2 and 24 hours after surgery. Results Median value for
troponin I 24 hours after surgery was 1.068 (0.388-1.397) ng/mL in the
IHHT group and was significantly lower compared with IHHT-controls with
1.980 (1.068-3.239) ng/mL (p=0.012) and to the RIP group with 1.762
(1.288-2.186) ng/mL (p=0.029), while there was no significant difference
between RIP and the IHHT-control. Serum lactate after surgery was 1.74
(1.23-2.04) mmol/L in the IHHT group and was also significantly lower
compared with IHHT-controls with 2.10 (1.80-2.29) mmol/L (p=0.045) and RIP
with 2.12 (1.91-2.33) mmol/L (p=0.032). No significant complications or
serious adverse events were observed during IHHT. Intraoperative and early
postoperative complications did not differ significantly between groups.
Conclusions The results of this first trial using IHHT for myocardial
protection against perioperative ischaemic myocardial injury in patients
undergoing CABG surgery are promising and further larger trials should be
done with adequate power to detect clinical rather than surrogate marker
benefits. Copyright © Author(s) (or their employer(s)) 2018.
Re-use permitted under CC BY-NC. No commercial re-use. See rights and
permissions. Published by BMJ.

<7>
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. 3 (11) (pp 1113-1118), 2018. Date of Publication:
November 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, Box 3850,
2400 Pratt St., Durham, NC 27705, 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, 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, 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. Copyright © 2018 American Medical Association. All
rights reserved.

<8>
Accession Number
623271009
Title
Association of comorbid burden with clinical outcomes after transcatheter
aortic valve implantation.
Source
Heart. 104 (24) (pp 2058-2066), 2018. Date of Publication: 01 Dec 2018.
Author
Bagur R.; Martin G.P.; Nombela-Franco L.; Doshi S.N.; George S.;
Toggweiler S.; Sponga S.; Cotton J.M.; Khogali S.S.; Ratib K.; Kinnaird
T.; Anderson R.A.; Chu M.W.A.; Kiaii B.; Biagioni C.; Schofield-Kelly L.;
Loretz L.; Torracchi L.; Sekar B.; Kwok C.S.; Sperrin M.; Ludman P.F.;
Mamas M.A.
Institution
(Bagur, Chu, Kiaii) Heart Team, London Health Sciences Centre, London, ON
N6A 5A5, Canada
(Bagur) Department of Epidemiology and Biostatistics, Schulich School of
Medicine and Dentistry, Western University, London, ON, Canada
(Bagur, Ratib, Kwok, Mamas) Keele Cardiovascular Research Group, Centre
for Prognosis Research, Institute for Primary Care and Health Sciences,
Keele University, Stoke-on-Trent, United Kingdom
(Martin, Sperrin, Mamas) Farr Institute, Faculty of Biology, Medicine and
Health, University of Manchester, Manchester Academic Health Science
Centre, Manchester, United Kingdom
(Nombela-Franco, Biagioni) Cardiovascular Institute, Hospital Clinico San
Carlos, Madrid, Spain
(Doshi, George, Ludman) Cardiology Department, Queen Elizabeth Hospital,
Birmingham, United Kingdom
(Toggweiler, Loretz) Cardiology Division, Heart Center Lucerne, Lucerne,
Switzerland
(Sponga, Torracchi) Cardiothoracic Department, University Hospital of
Udine, Udine, Italy
(Cotton, Khogali, Schofield-Kelly) Heart and Lung Centre, Royal
Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
(Kinnaird, Anderson, Sekar) Department of Cardiology, University Hospital
of Wales, Cardiff, United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives To investigate the association of the CharlsonComorbidity Index
(CCI) with clinical outcomes after transcatheter aortic valve implantation
(TAVI). Background Patients undergoing TAVI have high comorbid burden;
however, there is limited evidence of its impact on clinical outcomes.
Methods Data from 1887 patients from the UK, Canada, Spain, Switzerland
and Italy were collected between 2007 and 2016. The association of CCI
with 30-day mortality, Valve Academic Research Consortium-2 (VARC-2)
composite early safety, long-term survival and length of stay (LoS) was
calculated using logistic regression and Cox proportional hazard models,
as a whole cohort and at a country level, through a two-stage individual
participant data (IPD) random effect meta-analysis. Results Most (60%) of
patients had a CCI >=3. A weak correlation was found between the total CCI
and four different preoperative risks scores (p =0.16 to 0.29), and
approximately 50% of patients classed as low risk from four risk
prediction models still presented with a CCI >=3. Per-unit increases in
total CCI were not associated with increased odds of 30-day mortality (OR
1.09, 95% CI 0.96 to 1.24) or VARC-2 early safety (OR 1.04, 95% CI 0.96 to
1.14) but were associated with increased hazard of long-term mortality (HR
1.10, 95% CI 1.05 to 1.16). The two-stage IPD meta-analysis indicated that
CCI was not associated with LoS (HR 0.97, 95% CI 0.93 to 1.02). Conclusion
In this multicentre international study, patients undergoing TAVI had
significant comorbid burden. We found a weak correlation between the CCI
and well-established preoperative risks scores. The CCI had a moderate
association with long-term mortality up to 5 years
post-TAVI. Copyright © 2018 Author(s).

<9>
Accession Number
2001368229
Title
Left Main Percutaneous Coronary Intervention Versus Coronary Artery Bypass
Grafting in Patients With Prior Cerebrovascular Disease: Results From the
EXCEL Trial.
Source
JACC: Cardiovascular Interventions. 11 (24) (pp 2441-2450), 2018. Date of
Publication: 24 December 2018.
Author
Diamond J.; Madhavan M.V.; Sabik J.F.; Serruys P.W.; Kappetein A.P.; Leon
M.B.; Taggart D.P.; Berland J.; Morice M.-C.; Gersh B.J.; Kandzari D.E.;
Dressler O.; Stone G.W.
Institution
(Diamond, Madhavan, Leon, Stone) NewYork-Presbyterian Hospital/Columbia
University Medical Center, New York, NY, United States
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Leon, Dressler, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Taggart) John Radcliffe Hospital, Oxford, United Kingdom
(Berland) Clinique Saint Hilaire, Rouen, France
(Morice) Ramsay Generale de Sante - Institut Cardiovasculaire Paris Sud,
Massy, France
(Gersh) Mayo Clinic College of Medicine, Rochester, MN, United States
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to determine whether high-risk
patients with left main coronary artery disease (LMCAD) and prior
cerebrovascular disease (CEVD) preferentially benefit from
revascularization by percutaneous coronary intervention (PCI) compared
with coronary artery bypass grafting (CABG). Background(s): Patients
with known CEVD requiring revascularization are often referred to PCI
rather than CABG. There is a paucity of data regarding the impact of CEVD
in patients with LMCAD undergoing revascularization. Method(s): In
the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for
Effectiveness of Left Main Revascularization) trial, patients with LMCAD
and low or intermediate SYNTAX (Synergy Between PCI with Taxus and Cardiac
Surgery) scores were randomized to PCI with everolimus-eluting stents
versus CABG. The effects of prior CEVD, defined as prior stroke, transient
ischemic attack, or carotid artery disease, on 30-day and 3-year event
rates were assessed. Result(s): Prior CEVD was present in 233 of
1,898 patients (12.3%). These patients were older and had higher rates of
comorbidities, including hypertension, diabetes, peripheral vascular
disease, anemia, chronic kidney disease, and prior PCI, compared with
those without prior CEVD. Patients with prior CEVD had higher rates of
stroke at 30 days (2.2% vs. 0.8%; p = 0.05) and 3 years (6.4% vs. 2.2%; p
= 0.0003) and higher 3-year rates of the primary endpoint of all-cause
death, stroke, or myocardial infarction (25.0% vs. 13.6%; p < 0.0001). The
relative effects of PCI versus CABG on the 30-day and 3-year rates of
stroke (p<inf>interaction</inf> = 0.65 and 0.16, respectively) and the
3-year rates of the primary composite endpoint (p<inf>interaction</inf> =
0.14) were consistent in patients with and those without prior CEVD.
 Conclusion(s): Patients with LMCAD and prior CEVD compared with those
without CEVD have higher rates of stroke and reduced event-free survival
after revascularization. Data from the EXCEL trial do not a priori support
a preferential role of PCI over CABG in patients with known
CEVD. Copyright © 2018 American College of Cardiology Foundation

<10>
Accession Number
2001369150
Title
Radial artery versus saphenous vein as the second conduit for coronary
artery bypass surgery: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Author
Gaudino M.; Rahouma M.; Abouarab A.; Leonard J.; Kamel M.; Di Franco A.;
Demetres M.; Tam D.Y.; Tranbaugh R.; Girardi L.N.; Fremes S.E.
Institution
(Gaudino, Rahouma, Abouarab, Leonard, Kamel, Di Franco, Tranbaugh,
Girardi) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New
York, NY, United States
(Demetres) Samuel J. Wood Library & C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY, United States
(Tam, Fremes) Schulich Heart Centre, Sunnybrook Health Sciences Centre,
University of Toronto, Toronto, Ontario, Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Individual studies may be limited by sample size to detect
differences in late survival between radial artery (RA) or saphenous vein
graft (SVG) as a second conduit for coronary artery bypass surgery. Here
we undertook a meta-analysis of the best evidence available on the
comparison of early and late clinical outcomes of the RA and the SVG.
 Method(s): MEDLINE and EMBASE were searched for studies comparing use
of the RA versus SVG for isolated coronary artery bypass surgery.
Time-to-event outcomes for long-term mortality, repeat revascularization,
and myocardial infarction (MI) were extracted as incidence rate ratios
(IRR) with 95%confidence intervals (95% CI). Odds ratios (OR) were
extracted for perioperative mortality, stroke, and MI. A random effects
meta-analysis was performed. Sensitivity analyses included
leave-one-out-analyses and meta-regression. Result(s): Among 1201
articles, 14 studies (20,931 patients) were included (mean follow-up: 6.6
years). Operative mortality was 1.25% in the RA versus 1.33% in the SVG
group (OR, 0.93; 95% CI, 0.68-1.28). No difference in perioperative MI
(OR, 0.96; 95% CI, 0.59-1.56) or stroke (OR, 0.70; 95% CI, 0.43-1.13) was
found between RA and SVG. Long-term mortality (mean follow-up 6.6 years)
was 24.5% in RA versus 34.2% in SVG group (IRR, 0.74; 95% CI, 0.63-0.87, P
<.001). No difference in follow-up MI or repeat revascularization was
found (IRR, 0.76; 95% CI, 0.42-1.36 and IRR, 0.68; 95% CI, 0.42-1.09
respectively). At meta-regression, RA survival advantage was independent
of age, sex, diabetes, and ventricular function. Conclusion(s):
Compared with the SVG, using the RA as the second conduit is associated
with a 26% relative risk reduction in mortality at 6.6-year
follow-up. Copyright © 2018 The American Association for Thoracic
Surgery

<11>
Accession Number
625380758
Title
Introducing off-the-job training to cardiovascular surgical residency
training: a new era of developing competent cardiovascular surgeons.
Source
Surgery Today. (no pagination), 2018. Date of Publication: 2018.
Author
Yokoyama H.
Institution
(Yokoyama) Department of Cardiovascular Surgery, Fukushima Medical
University, 1 Hikarigaoka, Fukushima City, Fukushima 960-8072, Japan
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Purpose: This review summarizes the recent progress made in understanding
the skill acquisition process of achieving expert status in various fields
that require fine motor skills. We discuss the attempts to apply this
progress to develop competent surgeons. Method(s): We reviewed the
existing literature, using the keywords "surgical training", "skill
acquisition", and "simulator-based training", using Medline, as well as
recent books and chapters related to these issues. We also summarized the
role of simulator-based training in basic skill acquisition through
deliberate practice. Other aspects of surgical skills, such as steps taken
to improve motor skills, technical skill in the operating room, and
competency level from novice to expert, were reviewed. Result(s): The
common element of practice to develop top-ranking experts in various
fields is deliberate practice. Long-term repetitive practice is supported
by the individual's mental attitude: guts, resilience, initiative, tenancy
(GRIT). GRIT can be imparted using a teaching method that supports a
"growth mindset". Conclusion(s): Recent theoretical advances in skill
acquisition can be applied to surgical residency training, while intense
efforts are being made to improve the curriculum and training
environment. Copyright © 2018, Springer Nature Singapore Pte Ltd.

<12>
Accession Number
625344847
Title
Cardiac rehabilitation for patients having cardiac surgery: A systematic
review.
Source
Journal of Cardiovascular Surgery. 59 (6) (pp 817-829), 2018. Date of
Publication: December 2018.
Author
Blokzijl F.; Dieperink W.; Keus F.; Reneman M.F.; Mariani M.A.; Van Der
Horst I.C.
Institution
(Blokzijl, Mariani) Department of Cardiothoracic Surgery, University of
Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box
30001, Groningen 9700 RB, Netherlands
(Dieperink, Keus, Van Der Horst) Department of Critical Care, University
of Groningen, University Medical Center Groningen, Groningen, Netherlands
(Reneman) Department of Rehabilitation Medicine University of Groningen,
University Medical Center Groningen, Groningen, Netherlands
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: Cardiac rehabilitation (CR) is recommended for all cardiac
patients including patients after cardiac surgery. Since the effect of CR
after cardiac surgery has not been well established yet, we conducted a
systematic review on the effects of CR for patients after cardiac surgery
compared to treatment as usual. EVIDENCE ACQUISITION: A systematic review
of randomized clinical trials (RCTs), quasi-randomized and prospective
observational studies in The Cochrane Library, PubMed/MEDLINE and EMBASE
was undertaken until October 18th, 2017. Adults after any kind of cardiac
surgery were included. Primary outcome was all-cause mortality, other
outcomes were serious adverse events, health-related quality of life, work
participation, functioning and costs/cost-effectiveness. Risk of bias was
evaluated, and the quality of evidence was assessed by the Grading of
Recommendations, Assessment, Development and Evaluation (GRADE) criteria.
EVIDENCE SYNTHESIS: Eighteen RCTs and 15 observational studies were
included. Low risk of bias was only observed in one observational study.
Meta-analysis of RCTs suggested no significant difference of CR compared
to control on mortality (random-effects relative risk (RR) 0.93 (95% CI:
0.40-1.81), while observational studies suggested statistically
significant beneficial effect associated with CR (random-effects RR=0.49,
95% CI: 0.35 - 0.68). CR did not significantly affect any of the other
outcomes. Due to the limited data TSA could not be performed.
 CONCLUSION(S): The body of evidence does not allow us to reach any
reliable conclusions about the effectiveness of CR following cardiac
surgery. Future trials need to be conducted with low risks of bias and
clearly defined outcomes. Copyright © 2018 Edizioni Minerva
Medica.

<13>
Accession Number
622947957
Title
Lower on-treatment platelet reactivity during everolimus-eluting stent
implantation contributes to the resolution of post-procedural intra-stent
thrombus: serial OCT observation in the PRASFIT-Elective study.
Source
Heart and Vessels. 33 (12) (pp 1423-1433), 2018. Date of Publication: 01
Dec 2018.
Author
Konishi A.; Iwasaki M.; Shinke T.; Otake H.; Nakagawa M.; Hariki H.; Osue
T.; Inoue T.; Taniguchi Y.; Nishio R.; Kinutani H.; Hiranuma N.; Kuroda
M.; Hirata K.-I.; Saito S.; Nakamura M.; Shite J.; Akasaka T.
Institution
(Konishi, Iwasaki, Shinke, Otake, Nakagawa, Hariki, Osue, Inoue,
Taniguchi, Nishio, Kinutani, Hiranuma, Kuroda, Hirata) Division of
Cardiovascular Medicine, Department of Internal Medicine, Kobe University
Graduate School of Medicine, Kobe, Japan
(Saito) Division of Cardiology, Shonan Kamamura General Hospital,
Kamakura, Japan
(Nakamura) Division of Cardiovascular Medicine, Ohashi Medical Center,
Toho University, Tokyo, Japan
(Shite) Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka,
Japan
(Akasaka) Department of Cardiovascular Medicine, Wakayama Medical
University, Wakayama, Japan
(Shinke) Department of Cardiology, Kobe University Graduate School of
Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Intra-stent thrombus (IS-Th) formed immediately after percutaneous
coronary intervention (PCI) is associated with subsequent adverse coronary
events. However, the impact of on-treatment platelet reactivity on IS-Th
is unknown. PRASFIT-Elective is a multicenter study of PCI patients
receiving prasugrel (20/3.75 mg, loading/maintenance dose) or clopidogrel
(300/75 mg), with aspirin (100 mg). Among the 742 study patients, 111 were
pre-specified for the OCT sub-study. Of these, 82 underwent OCT
immediately after PCI to assess IS-Th and at an 8-month follow-up to
evaluate the fate of the IS-Th. Lesions were considered resolved when
IS-Th were detected after PCI but not on the follow-up or persistent when
IS-Th were observed on both scans. The P2Y12 Reactive Unit (PRU) value was
determined at the initial PCI and 4 and 48 weeks post-PCI. In 76 patients
(86 lesions), we detected 230 IS-Th initially, and 196 IS-Th (85.2%) were
resolved at the 8-month OCT. At PCI, but not 4 or 48 weeks after, the
resolved IS-Th group had a lower PRU than the persistent IS-Th group (199
+/- 101 vs. 266 +/- 102, p = 0.008). Multivariate logistic regression
analyses revealed that lower PRU at PCI and less calcified lesions were
independent predictive factors for the resolution of IS-Th. Local
lesion-related factors and lower on-treatment platelet reactivity at the
time of PCI may contribute to the resolution of IS-Th after EES
implantation, potentially improving clinical outcome. Copyright ©
2018, Springer Japan KK, part of Springer Nature.

<14>
Accession Number
624326601
Title
Rivaroxaban versus Warfarin in Patients with Mechanical Heart Valve:
Rationale and Design of the RIWA Study.
Source
Drugs in R and D. 18 (4) (pp 303-308), 2018. Date of Publication: 01 Dec
2018.
Author
Duraes A.R.; de Souza Lima Bitar Y.; Filho J.A.L.; Schonhofen I.S.; Camara
E.J.N.; Roever L.; Cardoso H.E.D.P.; Akrami K.M.
Institution
(Duraes, Filho, Schonhofen, Cardoso) General Hospital Roberto Santos,
Salvador, Bahia, Brazil
(Duraes, de Souza Lima Bitar, Camara) Federal University of Bahia, Medical
School-UFBA/FAMEB, XV de novembro Square, s/n-Largo do Terreiro de Jesus,
Salvador, BA 40025-010, Brazil
(Roever) Federal University of Uberlandia, Uberlandia, Minas Gerais,
Brazil
(Akrami) Division of Infectious Disease, Department of Medicine,
University of California, San Diego, San Diego, CA, United States
Publisher
Springer International Publishing
Abstract
Introduction: Mechanical heart valves (MHV) are extremely durable, but
they require permanent use of anticoagulation to prevent thromboembolic
events. The only approved therapeutic options are vitamin K antagonists
(VKAs), such as warfarin. As a drug class, clinical management is
difficult, therefore new alternatives need to be evaluated.
 Method(s): RIWA is a phase II/III, prospective, open-label,
randomized, pilot study designed to investigate oral rivaroxaban 15 mg
twice daily compared with dose-adjusted warfarin for the prevention of
stroke (ischemic or hemorrhagic) and systemic embolism in patients with
MHV, from August 2018 to December 2019. Patients will undergo
transesophageal echocardiography at the beginning and the end of the study
(follow-up time 90 days). On an explanatory basis, all events will be
analyzed, including stroke, peripheral systemic embolism, valve
thrombosis, significant bleeding and death. Discussion(s): Warfarin
and similar VKAs are standard therapy for patients with an MHV. Even with
the appropriate use of therapy, the incidence of thromboembolic events is
high at 1-4% per year. Furthermore, bleeding risk is significant, ranging
from 2 to 9% per year. The new frontier to be overcome in relation to use
of the new oral anticoagulants is undoubtedly in patients with MHV. A
significant portion of people with MHV worldwide will benefit if
noninferiority of these new agents is confirmed. Trial Registration:
ClinicalTrials.gov identifier: NCT03566303. Recruitment Status:
Recruiting. First Posted: 25 June 2018. Last Update Posted: 25 June
2018. Copyright © 2018, The Author(s).

<15>
Accession Number
623952028
Title
The prevalence of computed tomography-defined leaflet thrombosis in intra-
versus supra-annular transcatheter aortic valve prostheses.
Source
Catheterization and Cardiovascular Interventions. 92 (7) (pp 1414-1416),
2018. Date of Publication: 01 Dec 2018.
Author
Rashid H.N.; Nasis A.; Gooley R.P.; Cameron J.D.; Brown A.J.
Institution
(Rashid, Nasis, Gooley, Cameron, Brown) Monash Cardiovascular Research
Centre, MonashHEART, Monash Health, and Monash University, Clayton, VIC,
Australia
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Introduction: Leaflet thrombosis (LT) defined by computed tomography (CT)
following transcatheter aortic valve replacement (TAVR) has been shown to
increase cerebrovascular events. The neo-sinus plays an important role in
the development of LT. Intra-annular valves (IAV) have a larger neo-sinus
when compared to supra-annular valves (SAV), and has been associated with
larger thrombus burden. The prevalence of LT with IAV and SAV in a larger,
diverse cohort is unknown. Method(s): We performed a systematic
review to assess the prevalence of LT in IAV versus SAV TAVR prostheses.
Inclusion criteria were (1) reported CT-defined LT following TAVR, (2)
comparison between LT and non-LT cohort, (3) separate registry/database,
and (4) fully published status. A total of 2,013 citations were reviewed
and 7 studies were included. Result(s): Overall, 1,644 patients were
included from 7 observational studies and the prevalence of LT following
TAVR was 12.8%. The Portico valve system (IAV) had the highest prevalence
of LT with 35.2%, followed by Symetis Acurate Neo (SAV) at 15.4% and the
Lotus valve system (IAV) at 14.5%. LT occurred more frequently in IAV than
SAV (13.5% vs. 7%, P = 0.02). Subanalysis of IAV versus SAV with the
exclusion of the Portico valve was performed to ensure results were not
influenced by this valve system and revealed IAV still had higher rates of
LT (12.1% vs. 7%, P = 0.05). Conclusion(s): In summary, IAV
prostheses appear to be associated with higher rates of LT when compared
with SAV. Copyright © 2018 Wiley Periodicals, Inc.

<16>
Accession Number
623266566
Title
Transcatheter valve-in-valve versus redo surgical aortic valve replacement
for the treatment of degenerated bioprosthetic aortic valve: A systematic
review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 92 (7) (pp 1404-1411),
2018. Date of Publication: 01 Dec 2018.
Author
Tam D.Y.; Vo T.X.; Wijeysundera H.C.; Dvir D.; Friedrich J.O.; Fremes S.E.
Institution
(Tam, Fremes) Division of Cardiac Surgery, Department of Surgery, Schulich
Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto,
Toronto, Canada
(Tam, Wijeysundera, Fremes) Institute of Health Policy, Management and
Evaluation, University of Toronto, Toronto, Canada
(Vo) Division of Cardiac Surgery, Department of Surgery, University of
Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
(Wijeysundera) Division of Cardiology, Department of Medicine, Schulich
Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto,
Toronto, Canada
(Dvir) Division of Cardiology Department of Medicine, University of
Washington Medical Centre, Seattle, WA, United States
(Friedrich) Critical Care and Medicine Departments, St. Michael's Hospital
University of Toronto, Toronto, Canada
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: To determine the safety and efficacy of valve-in-valve
transcatheter aortic valve replacement (ViV) versus redo surgical aortic
valve replacement (SAVR) for the treatment of previously failed aortic
bioprostheses. Background(s): Valve-in-valve has emerged as a
treatment option for patients with a failed aortic bioprosthesis. Evidence
for safety and efficacy remains limited to small studies. Method(s):
Medline and Embase were searched to 2017 for studies that directly
compared ViV to redo SAVR. A random effects meta-analysis was performed.
 Result(s): Four unadjusted (n = 298) and two propensity-matched (n =
200) observational studies were included. Valve-in-valve patients were
2.85-years older (P = 0.03) and were 23% higher in predicted mortality
risk (ratio of means: 1.23, 95% confidence interval (95%CI): 1.02-1.48).
There was no difference in peri-operative mortality (4.4% vs. 5.7%, P =
0.83;I2 = 0%) or late mortality, reported at median one year
follow-up (incident rate ratio (IRR) 0.93, 95%CI: 0.74-1.16, P = 0.51,
I2 = 0%) between ViV and redo SAVR. The incidence of permanent
pacemaker implantation (8.3% vs 14.6%; P = 0.05;I2 = 0%) and
dialysis (3.2% vs. 10.3%; P = 0.03; I2 = 0%) were lower in ViV.
There was a reduction in the incidence of severe patient-prosthesis
mismatch (3.3% vs 13.5%; P = 0.03; I2 = 0%) and mild or greater
paravalvular leak (5.5% vs 21.1%; P = 0.03; I2 = 37%) in the
redo SAVR group compared to ViV. Conclusion(s): Despite higher
predicted surgical risk of ViV patients, there was no difference in
mortality but less permanent pacemaker implantation and dialysis compared
to redo SAVR. Choice of treatment must be individualized for both
anatomical and patient risk factors; in high risk patients with favorable
previous prosthesis size, valve-in-valve may be preferred. Copyright
© 2018 Wiley Periodicals, Inc.

<17>
Accession Number
624252536
Title
Impact of Atrial Fibrillation on the Outcomes after MitraClip: A
Meta-Analysis.
Source
Structural Heart. 2 (6) (pp 531-537), 2018. Date of Publication: 02 Nov
2018.
Author
Megaly M.; Abraham B.; Saad M.; Omer M.; Elbadawi A.; Tawadros M.; Khalil
C.; Nairoz R.; Almomani A.; Sengupta J.; Kalra A.; Brilakis E.; Gafoor S.
Institution
(Megaly, Sengupta, Brilakis) Minneapolis Heart Institute, Abbott
Northwestern Hospital, Minneapolis, MN, United States
(Megaly) Division of Cardiology, Department of Medicine, Hennepin County
Medical Center, Minneapolis, MN, United States
(Abraham) Department of Medicine, St. John Providence Hospital, Detroit,
MI, United States
(Saad, Almomani) Department of Cardiovascular Medicine, University of
Arkansas, Little Rock, AR, United States
(Saad) Division of Cardiology, Ain Shams University, Cairo, Egypt
(Omer) Cardiology Division, Saint Luke's Hospital, Kansas City, MO, United
States
(Elbadawi) Division of Cardiology, Rochester General Hospital, Rochester,
NY, United States
(Tawadros) Department of Cardiology, Ain Shams University Medical School,
Cairo, Egypt
(Khalil) Department of Internal Medicine, University of Buffalo, Buffalo,
NY, United States
(Nairoz) Division of Cardiology, University of South California, Los
Angeles, CA, United States
(Kalra) Division of Cardiology, Case Western Reserve University School of
Medicine, Cleveland, OH, United States
(Gafoor) Division of Cardiology, Swedish Medical Center, Seattle, WA,
United States
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: Atrial fibrillation (AF) has been associated with worse
outcomes in patients undergoing mitral valve surgery for mitral
regurgitation. The impact of preexisting AF on the outcomes after
transcatheter mitral valve repair with MitraClip (Abbott Vascular, Santa
Clara, CA, USA) has not been well studied. Method(s): An electronic
search was performed until December 2017 for studies reporting outcomes
after MitraClip in patients with AF versus those with no AF. Outcomes of
interest included all-cause mortality, stroke and major adverse
cardiovascular events (MACE) defined as the composite outcome of death,
stroke, and myocardial infarction at the longest follow-up reported.
 Result(s): A total of four studies including 1473 patients (AF n =
697; no AF n = 776) were included. There was no difference in procedural
success or procedural time between patients with AF versus those without
AF. AF was associated with increased mortality after MitraClip compared
with patients with no AF (OR 1.54, 95% CI (1.16, 2.04), p = 0.003,
I2 = 0%) over a mean follow-up period of 10.2 months. In a
sensitivity analysis excluding early postoperative (30-day) outcomes, AF
remained associated with higher mortality (OR 1.53, 95% CI (1.15, 2.03), p
= 0.003, I2 = 19%). AF was associated with a higher incidence
of MACE after MitraClip (OR 1.46, 95% CI (1.03, 2.07), p = 0.03,
I2 = 13%). No difference was observed in the risk of stroke
between patients with versus without AF after MitraClip (OR 1.13, 95%CI
(0.36, 3.56), p = 0.84, I2 = 37%). Conclusion(s): Compared
with patients without AF, patients with preexisting AF are at higher risk
of death and MACE after MitraClip. Copyright © 2018, © 2018
Cardiovascular Research Foundation.

<18>
Accession Number
624532513
Title
A Meta-Analysis of Clinical Outcomes of Transcatheter Aortic Valve
Replacement in Patients with End-Stage Renal Disease.
Source
Structural Heart. 2 (6) (pp 548-556), 2018. Date of Publication: 02 Nov
2018.
Author
Amione-Guerra J.; Mattathil S.; Prasad A.
Institution
(Amione-Guerra, Mattathil, Prasad) Department of Medicine, Division of
Cardiology, University of Texas Health Science Center at San Antonio, San
Antonio, TX, United States
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: End-stage renal disease (ESRD) is associated with an increased
incidence of severe aortic stenosis (AS). For these patients the usual
care has been surgical aortic valve replacement (SAVR). ESRD patients are
at increased surgical risk. Trans-aortic valve replacement (TAVR) may be
an alternative to SAVR for these patients. However, TAVR trials have
excluded patients with ESRD. Method(s): MEDLINE, OMBASE and Cochrane
databases were queried for relevant studies. A meta-analysis was performed
on the selected studies. Primary outcome was early all-cause mortality;
secondary outcomes included 1-year mortality, bleeding, neurological
deficits, vascular complications, pacemaker requirement, and myocardial
infarction. Result(s): A total of 16 studies included 3,499 patients.
Most patients were high risk as demonstrated by Society of Thoracic
Surgeons (STS) scores > 10 in most studies. Post-TAVR early and 1-year
mortality were 10% (95%CI: 7.8-10.5%) and 33% (95%CI: 24.1-36.8%)
respectively. Most common post-procedure complications were bleeding 17%
(95%CI: 14.8-20.8%), pacemaker implant 14% (95%CI: 11.6-17.5%) and
vascular complications 7% (95%CI: 4.3-9.9%). Neurological deficits and
myocardial infarction were less common both at 1.2% (95%CI: 0.4-2.4%,
0.3-2.5% respectively). Three studies with 2,545 patients compared TAVR
versus SAVR, there was no difference in early mortality (~ 10%, RR:1.0,
95%CI 0.60-1.64, p = 0.9). TAVR was associated with decreased risk of
vascular complications (RR:0.58 95%CI: 0.3-0.8, p = 0.03).
 Conclusion(s): These results suggest that TAVR outcomes in ESRD
patients are comparable to those patients considered extreme surgical
risk. Compared to SAVR, there was no difference in early mortality, but
fewer vascular complications. As the ESRD population continues to grow,
future prospective studies should focus on this particular patient
population. Copyright © 2018, © 2018 Cardiovascular Research
Foundation.

<19>
Accession Number
624531623
Title
Impact of Transcatheter Mitral Valve Repair on Left Ventricular Remodeling
in Secondary Mitral Regurgitation: A Meta-Analysis.
Source
Structural Heart. 2 (6) (pp 541-547), 2018. Date of Publication: 02 Nov
2018.
Author
Megaly M.; Khalil C.; Abraham B.; Saad M.; Tawadros M.; Stanberry L.;
Kalra A.; Goldsmith S.R.; Bart B.; Bae R.; Brilakis E.S.; Gossl M.;
Sorajja P.
Institution
(Megaly, Stanberry, Bae, Brilakis, Gossl, Sorajja) Valve Science Center,
Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital,
Minneapolis, MN, United States
(Megaly, Goldsmith, Bart) Division of Cardiology, Department of Medicine,
Hennepin Healthcare, Minneapolis, MN, United States
(Khalil) Department of Medicine, University at Buffalo, Buffalo, NY,
United States
(Abraham) St. John Hospital and Medical Center, Detroit, MI, United States
(Saad) Department of Cardiovascular Medicine, University of Arkansas for
Medical Sciences, Little Rock, AR, United States
(Saad) Department of Cardiology, Ain Shams University, Cairo, Egypt
(Tawadros) Faculty of Medicine, Ain Shams University, Cairo, Egypt
(Kalra) Division of Cardiology, Case Western Reserve University School of
Medicine, Cleveland, OH, United States
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: Secondary mitral regurgitation (MR) arises from left
ventricular (LV) dilatation and remodeling, and commonly is treated with
transcatheter mitral valve repair. We examined the impact of MitraClip on
reverse cardiac remodeling in patients with severe, symptomatic secondary
MR. Method(s):: An electronic search was performed through January
2018 for studies that reported cardiac chamber dimensions prior to and
after treatment with MitraClip in patients with secondary MR. The mean
difference (MD) with 95% CI was calculated using fixed or random inverse
variance models. Outcomes of interest were changes in LV end-systolic and
end-diastolic volumes (LVESV, LVEDV) and dimensions (LVESD, LVEDD).
Secondary outcomes included left atrial (LA) volume, systolic pulmonary
artery pressure (sPAP) and LV ejection fraction (LVEF). Result(s): A
total of 16 studies with 1,266 patients were included in the present
analysis. The weighted mean follow-up period (+/-SD) was 11.5 +/- 7.2
months. MitraClip was associated with significant reduction in LVEDV
(-14.24 ml, 95% CI [-22.53, -5.94], p = 0.0008), LVESV (-7.67 ml, CI
[-12.30, -3.03], p = 0.001), LVEDD (-2.92 mm [-3.65, -2.19 mm], p <
0.00001), and LVESD (-1.92 mm [-2.92, -0.92], p = 0.0002). MitraClip was
also associated with reduction in LA volume (-16.36 ml [23.23, -9.49 ml],
p < 0.00001) and sPAP (-6.93 mmHg [-8.76, -5.10], p < 0.00001), and a
significant increase in LVEF (+ 2.78% [0.91, 4.66], p = 0.004).
 Conclusion(s): In patients with severe symptomatic secondary MR,
MitraClip is associated with modest, but favorable LV and LA reverse
remodeling. The impact of these changes on clinical outcomes deserves
further study. Copyright © 2018, © 2018 Cardiovascular
Research Foundation.

<20>
Accession Number
625142969
Title
Positive end-expiratory pressure (PEEP) level to prevent expiratory flow
limitation during cardiac surgery: Study protocol for a randomized
clinical trial (EFLcore study).
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 654. Date of
Publication: 26 Nov 2018.
Author
Bignami E.; Spadaro S.; Saglietti F.; Di Lullo A.; Corte F.D.; Guarnieri
M.; De Simone G.; Giambuzzi I.; Zangrillo A.; Volta C.A.
Institution
(Bignami, Saglietti, Di Lullo, Guarnieri, De Simone, Zangrillo) Department
of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute,
Via Olgettina 60, Milan 20132, Italy
(Spadaro, Corte, Volta) Department of Morphology, Surgery and Experimental
Medicine, Section of Anesthesia and Intensive Care, University of Ferrara,
Via Aldo Moro 8, Ferrara 44121, Italy
(Giambuzzi) Department of Cardiac Surgery, IRCCS San Raffaele Scientific
Institute, Via Olgettina 60, Milan 20132, Italy
(Bignami) Anesthesiology, Critical Care and Pain Medicine Division,
Department of Medicine and Surgery, University of Parma, Viale Gramsci 14,
Parma 43126, Italy
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Lung dysfunction commonly occurs after cardiopulmonary bypass
(CPB). Randomized evidence suggests that the presence of expiratory flow
limitation (EFL) in major abdominal surgery is associated with
postoperative pulmonary complications. Appropriate lung recruitment and a
correctly set positive end-expiratory pressure (PEEP) level may prevent
EFL. According to the available data in the literature, an adequate
ventilation strategy during cardiac surgery is not provided. The aim of
this study is to assess whether a mechanical ventilation strategy based on
optimal lung recruitment with a best PEEP before and after CPB and with a
continuous positive airway pressure (CPAP) during CPB would reduce the
incidence of respiratory complications after cardiac surgery.
Methods/design: This will be a single-center, single-blind,
parallel-group, randomized controlled trial. Using a 2-by-2 factorial
design, high-risk adult patients undergoing elective cardiac surgery will
be randomly assigned to receive either a best PEEP (calculated with a PEEP
test) or zero PEEP before and after CPB and CPAP (equal to the best PEEP)
or no ventilation (patient disconnected from the circuit) during CPB. The
primary endpoint will be a composite endpoint of the incidence of EFL
after the weaning from CPB and postoperative pulmonary complications.
 Discussion(s): This study will help to establish a correct
ventilatory strategy before, after, and during CPB. The main purpose is to
establish if a ventilation based on a simple and feasible respiratory test
may preserve lung function in cardiac surgery. Trial registration:
ClinicalTrials.gov, ID: NCT02633423. Registered on 6 December
2017. Copyright © 2018 The Author(s).

<21>
Accession Number
625290456
Title
Role of magnesium as analgesic sparing adjuvant to ropivacaine in thoracic
paravertebral block for breast cancer surgery: A prospective,
double-blinded randomised controlled study.
Source
Journal of Clinical and Diagnostic Research. 12 (12) (pp 1-5), 2018. Date
of Publication: 01 Dec 2018.
Author
Roybasunia S.; Das A.; Mitra T.; Mayur N.; Biswas H.; Mukherjee A.;
Bhattacharyya C.; Mandal S.
Institution
(Roybasunia) Department of Anaesthesiology, Midnapore Medical College,
Midnapore, West Bengal, India
(Das, Mayur, Biswas, Mandal) Department of Anaesthesiology, College of
Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
(Mitra) Department of Anaesthesiology, Murshidabad Medical College,
Berhampore, West Bengal, India
(Mukherjee) Department of Anaesthesiology, N.R.S Medical College, Kolkata,
West Bengal, India
(Bhattacharyya) Department of Anaesthesiology, I.P.G.M.E & R, Kolkata,
West Bengal, India
Publisher
Journal of Clinical and Diagnostic Research (No 3, 1/9 Roop Nagar,GT
Karnal Road, Delhi 110007, India)
Abstract
Introduction: Thoracic surgeries are often associated with intractable
pain leading to postoperative pulmonary complications. To alleviate this
pain in intraoperative and postoperative period, Thoracic Paravertebral
Block (TPVB) has been proven as an effective mean. Various adjuvants and
their mixtures have been tried to prolong the duration of TPVB. Aim: In
this randomised controlled study, we have evaluated the analgesic sparing
efficacy of magnesium sulfate; a NMDA receptor antagonist, administered
along with ropivacaine for TPVB for breast cancer surgery patients.
 Material(s) and Method(s): Eighty breast cancer surgery patients,
undergoing General Anaesthesia (GA), were randomly divided into group RP
and group RM (n=40 each) receiving preoperative TPVB at T<inf>3-5</inf>
level with 0.5% ropivacaine solution admixture with normal saline and
magnesium sulphate, respectively. Intraoperative fentanyl and propofol
requirement was compared. Visual Analogue Scale (VAS) was used for
postoperative pain assessment. Total dose and mean time to administration
of first rescue analgesic paracetamol was noted. Side effects and
haemodynamic parameters were also noted. Results: Intraoperative fentanyl
(153.86 vs. 138.49 micro g), propofol requirement (150.34 vs. 134.23
mg) was significantly less in test (magnesium) group. The requirement of
paracetamol was also significantly less (1592.09 vs. 1149.23 mg) and later
(8.44 vs. 13.34 hour) in group RM than group RP. Haemodynamics and side
effects were comparable among two groups. Conclusion(s): Magnesium
provided better intraoperative as well as postoperative analgesia than
placebo when administered with ropivacaine in TPVB prior to breast cancer
surgery patients. It also renders a lesser analgesic requirement without
major haemodynamic alteration and side effects. Copyright © 2018,
Journal of Clinical and Diagnostic Research. All rights reserved.

<22>
Accession Number
625374244
Title
Outcomes of Patients with Significant Obesity Undergoing TAVR or SAVR in
the Randomized PARTNER 2A Trial.
Source
Structural Heart. 2 (6) (pp 500-511), 2018. Date of Publication: 02 Nov
2018.
Author
Chen S.; Redfors B.; Ben-Yehuda O.; Crowley A.; Dvir D.; Hahn R.T.;
Pibarot P.; Jaber W.A.; Webb J.G.; Yoon S.-H.; Makkar R.R.; Alu M.C.;
Thourani V.H.; Tuzcu E.M.; Mack M.J.; George I.; Nazif T.; Kodali S.K.;
Leon M.B.
Institution
(Chen, Redfors, Ben-Yehuda, Crowley, Leon) Cardiovascular Research
Foundation, New York, NY, United States
(Dvir) Division of Cardiology, University of Washington, Seattle, WA,
United States
(Hahn, Alu, George, Nazif, Kodali, Leon) Structural Heart & Valve Center,
Columbia University Irving Medical Center, New York, NY, United States
(Pibarot) Quebec Heart & Lung Institute, Laval University, QC, Canada
(Jaber, Tuzcu) Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH,
United States
(Webb) Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver,
BC, Canada
(Yoon, Makkar) Department of Medicine, Cedars-Sinai Medical Center, Los
Angeles, CA, United States
(Thourani) Medstar Heart & Vascular Institute, Washington Hospital Center,
Washington, DC, United States
(Mack) Baylor Scott & White Health, Plano, TX, United States
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: Patients with severe aortic stenosis (AS) at intermediate
surgical risk, treated with transcatheter aortic valve replacement (TAVR)
or surgical aortic valve replacement (SAVR) have similar 2-year survival.
Significant obesity (SigOb), defined as body mass index (BMI) >= 35
kg/m2, has been associated with increased surgical risk and
post-operative complications. There are no data comparing clinical
outcomes after SAVR versus TAVR in patients with SigOb. Method(s): In
the PARTNER 2A trial, 2032 patients with severe AS and intermediate
surgical risk were randomized to TAVR with the SAPIEN XT valve or SAVR.
After excluding 32 patients who had very low BMI < 18.5 kg/m2,
the remaining 2000 patients were categorized based on BMI at baseline to
SigOb or not SigOb, and compared in regards to 2-year risk of adverse
cardiovascular events. Result(s): A total of 250 patients (12.5%)
were SigOb and were younger, more often female, and more frequently
diabetic. The 30-day and 2-year rates of the primary composite endpoint
death and disabling stroke as well as the risks of its components, were
similar for patients with versus without SigOb. However, the 2-year
relative risk of cardiovascular death was lower with TAVR versus SAVR for
SigOb patients (5.7% vs 15.4%, p = 0.02; HR 0.36, 95% CI 0.15-0.88) but
not for not SigOb patients (10.6% vs 10.7%, p = 0.91; HR 0.98, 95% CI
0.73-1.32; p<inf>interaction</inf> = 0.03). These results remained
consistent after multivariable adjustment. Conclusion(s): In the
PARTNER 2A Trial, intermediate-risk patients with severe AS and BMI >= 35
kg/m2 undergoing TAVR experienced significantly lower
cardiovascular mortality than similar patients undergoing
SAVR. Copyright © 2018, © 2018 Cardiovascular Research
Foundation.

<23>
Accession Number
2001366467
Title
Meta-Analysis Comparing the Incidence of Infective Endocarditis Following
Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve
Replacement.
Source
American Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Author
Ando T.; Ashraf S.; Villablanca P.A.; Telila T.A.; Takagi H.; Grines C.L.;
Afonso L.; Briasoulis A.
Institution
(Ando, Ashraf, Afonso) Department of Medicine Division of Cardiology,
Wayne State University/Detroit Medical Center, Detroit, MI, United States
(Ando, Takagi) ALICE (All-Literature Investigation of Cardiovascular
Evidence) Group, United States
(Villablanca) Department of Medicine, Division of Cardiology, Henry Ford
Hospital, Detroit, MI, United States
(Telila) Piedmont Heart Institute, Atlanta, Georgia, Georgia
(Takagi) Department of Medicine Division of Cardiovascular Surgery,
Shizuoka Medical Center, Shizuoka, Japan
(Grines) Department of Medicine Division of Cardiology, North Shore
University Hospital, Hofstra Northwell School of Medicine, Manhasset, NY,
United States
(Briasoulis) Department of Medicine Division of Cardiovascular Medicine,
University of Iowa Hospitals and Clinics, Iowa, IA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Infective endocarditis (IE) after transcatheter aortic valve implantation
(TAVI) and surgical aortic valve replacement (SAVR) is a rare but
life-threatening complication. Paravalvular regurgitation, compression of
native leaflets, and space between transcatheter valve prosthesis and
native valves could dispose TAVI recipients at increased risk of IE
compared with SAVR. To assess the comparative risk of IE between TAVI and
SAVR, we performed a systematic review and meta-analysis. A literature
search of PUBMED and EMBASE was performed to identify randomized
controlled trials that reported the event rate of IE in both TAVI and
SAVR. A Mantel-Haenszel method and a random-effects model was used to
calculate the odds ratio (OR) and 95% confidence interval (CI). The
studied outcomes were early (at 1-year), late (>1-year), and overall IE
(postprocedure to longest follow-up) in TAVI versus SAVR. We performed
subgroup analysis based on valve-type (self or balloon-expandable) and
surgical risk (high or intermediate). A total of 4 studies with 3,761
(1,895 TAVI and 1,866 SAVR) patients were included. The incidence of early
IE, (3 studies, 0.86% vs 0.73%, OR 1.17, 95% CI 0.51 to 2.65, p = 0.71,
I2 = 0%), late IE (mean follow-up 2.0 years) (3 studies, 1.3%
vs 0.6%, OR 1.85, 95% CI 0.81 to 4.20, p = 0.42, I2 = 0%), and
overall IE (mean follow-up 3.4 years) (4 studies, 2.0% vs 1.3%, OR 1.44,
95% CI 0.85 to 2.43, p = 0.18, I2 = 0%) was similar between
TAVI and SAVR. Subgroup analysis suggested that in intermediate surgical
risk cohort, there was a trend toward increased risk of overall IE in TAVI
(2.3% in TAVI and 1.2% in SAVR, OR 1.92, 95% CI 0.99 to 3.72, p = 0.05
I2 = 0%). In this meta-analysis, we did not find an increased
risk of IE in TAVI compared with SAVR. Appropriate preventative measure
and early recognition of IE in these cohorts are important. Copyright
© 2018

<24>
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.

<25>
Accession Number
52015679
Title
The effects of lowering LDL cholesterol with statin therapy in people at
low risk of vascular disease: Meta-analysis of individual data from 27
randomised trials.
Source
The Lancet. 380 (9841) (pp 581-590), 2012. Date of Publication: 01 Aug
2012.
Author
Mihaylova B.; Voysey M.; Gray A.; Baigent C.; De Lemos J.; Blazing M.;
Downs J.R.; Gotto A.; Clearfield M.; Gordon D.; Davis B.; Koren M.; Dahlof
B.; Poulter N.; Sever P.; Knopp R.H.; Fellstrom B.; Holdaas H.; Jardine
A.; Schmieder R.; Zannad F.; Goldbourt U.; Kaplinsky E.; Colhoun H.M.;
Betteridge D.J.; Durrington P.N.; Hitman G.A.; Fuller J.; Neil A.; Wanner
C.; Krane V.; Sacks F.; Moye L.; Pfeffer M.; Hawkins C.M.; Wedel H.;
Wikstrand J.; Barter P.; Tavazzi L.; Marchioli R.; Tognoni G.; Franzosi
M.G.; Maggioni A.; Bloomfield H.; Robins S.; Pedersen T.R.; Ridker P.M.;
Holman R.; Meade T.; MacMahon S.; Tonkin A.; Shaw J.; Serruys P.W.;
Nakamura H.; Knatterud G.; Furberg C.; Byington R.; Murphy M.; Blauw G.J.;
Packard C.; Kjekshus J.; Pedersen T.; Wilhelmsen L.; Braunwald E.; Cannon
C.; Murphy S.; Armitage J.; Bowman L.; Parish S.; Peto R.; Sleight P.;
Landray M.; La Rosa J.; Rossouw J.; Probstfi Eld J.; Shepherd J.; Cobbe
S.; MacFarlane P.; Ford I.; Flather M.; Kastelein J.; Newman C.; Shear C.;
Tobert J.; Varigos J.; White H.; Yusuf S.; Mellies M.; McGovern M.;
Barclay J.; Belder R.; Mitchel M.Y.; Musliner T.; Ansquer J.-C.; Llewellyn
B.M.; Pharma N.; Bortolini M.; Brandrup-Wognsen G.; Bryzinski B.; Olsson
G.; Pears J.; DeMicco D.; Barnes E.H.; Baxter A.; Bhala N.; Blackwell L.;
Buck G.; Collins R.; Emberson J.; Herrington W.G.; Holland L.E.; Kearney
P.M.; Keech A.; Kirby A.; Lewis D.A.; Marschner I.; Pollicino C.; Reith
C.; Simes J.; Sourjina T.
Institution
(Baigent, Barnes, Baxter, Bhala, Blackwell, Buck, Collins, Emberson,
Herrington, Holland, Kearney, Keech, Kirby, Lewis, Marschner, Pollicino,
Reith, Simes, Sourjina) National Health and Medical Research Council
(NHMRC), Clinical Trial Centre, University of Sydney, Mallett Street
Campus M02, NSW 2006, Australia
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Statins reduce LDL cholesterol and prevent vascular events, but
their net effects in people at low risk of vascular events remain
uncertain. Methods This meta-analysis included individual participant data
from 22 trials of statin versus control (n=134 537; mean LDL cholesterol
difference 1.08 mmol/L; median follow-up 4.8 years) and five trials of
more versus less statin (n=39 612; difference 0.51 mmol/L; 5.1 years).
Major vascular events were major coronary events (ie, non-fatal myocardial
infarction or coronary death), strokes, or coronary revascularisations.
Participants were separated into five categories of baseline 5-year major
vascular event risk on control therapy (no statin or low-intensity statin)
(<5%, >=5% to <10%, >=10% to <20%, >=20% to <30%, >=30%); in each, the
rate ratio (RR) per 1.0 mmol/L LDL cholesterol reduction was estimated.
Findings Reduction of LDL cholesterol with a statin reduced the risk of
major vascular events (RR 0.79, 95% CI 0.77-0.81, per 1.0 mmol/L
reduction), largely irrespective of age, sex, baseline LDL cholesterol or
previous vascular disease, and of vascular and all-cause mortality. The
proportional reduction in major vascular events was at least as big in the
two lowest risk categories as in the higher risk categories (RR per 1.0
mmol/L reduction from lowest to highest risk: 0.62 [99% CI 0.47-0.81],
0.69 [99% CI 0.60-0.79], 0.79 [99% CI 0.74-0.85], 0.81 [99% CI 0.77-0.86],
and 0.79 [99% CI 0.74-0.84]; trend p=0.04), which reflected significant
reductions in these two lowest risk categories in major coronary events
(RR 0.57, 99% CI 0.36-0.89, p=0.0012, and 0.61, 99% CI 0.50-0.74,
p<0.0001) and in coronary revascularisations (RR 0.52, 99% CI 0.35-0.75,
and 0.63, 99% CI 0.51-0.79; both p<0.0001). For stroke, the reduction in
risk in participants with 5-year risk of major vascular events lower than
10% (RR per 1.0 mmol/L LDL cholesterol reduction 0.76, 99% CI 0.61-0.95,
p=0.0012) was also similar to that seen in higher risk categories (trend
p=0.3). In participants without a history of vascular disease, statins
reduced the risks of vascular (RR per 1.0 mmol/L LDL cholesterol reduction
0.85, 95% CI 0.77-0.95) and all-cause mortality (RR 0.91, 95% CI
0.85-0.97), and the proportional reductions were similar by baseline risk.
There was no evidence that reduction of LDL cholesterol with a statin
increased cancer incidence (RR per 1.0 mmol/L LDL cholesterol reduction
1.00, 95% CI 0.96-1.04), cancer mortality (RR 0.99, 95% CI 0.93-1.06), or
other non-vascular mortality. Interpretation In individuals with 5-year
risk of major vascular events lower than 10%, each 1 mmol/L reduction in
LDL cholesterol produced an absolute reduction in major vascular events of
about 11 per 1000 over 5 years. This benefi t greatly exceeds any known
hazards of statin therapy. Under present guidelines, such individuals
would not typically be regarded as suitable for LDL-lowering statin
therapy. The present report suggests, therefore, that these guidelines
might need to be reconsidered.

<26>
Accession Number
2001226742
Title
Bibliometric Analysis of the Top 100 Most Cited Articles in the First 50
Years of Heart Transplantation.
Source
American Journal of Cardiology. 123 (1) (pp 175-186), 2019. Date of
Publication: 1 January 2019.
Author
Kolkailah A.A.; Fugar S.; Vondee N.; Hirji S.A.; Okoh A.K.; Ayoub A.;
Al-Ogaili A.; Paz Rios L.H.; Kumar S.K.; Camacho M.T.; Rich J.D.; Golzar
Y.
Institution
(Kolkailah, Ayoub, Al-Ogaili, Paz Rios) Department of Medicine, John H.
Stroger, Jr. Hospital of Cook County, Chicago, IL, United States
(Fugar) Division of Cardiology, Rush University Medical Center, Chicago,
IL, United States
(Vondee) Department of Medicine, St. Vincent Charity Medical Center,
Cleveland, OH, United States
(Hirji) Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Okoh, Camacho) Cardiology and Cardiac Surgery Research Unit, Newark Beth
Israel Medical Center, Newark, NJ, United States
(Kumar) Division of Advanced Heart Failure and Transplant Cardiology,
Tampa General Hospital, Tampa, FL, United States
(Rich) Division of Advanced Heart Failure and Transplant Cardiology,
Northwestern Memorial Hospital, Chicago, IL, United States
(Golzar) Division of Cardiology, John H. Stroger, Jr. Hospital of Cook
County, Chicago, IL, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The world celebrates over 50 years since the first human-to-human heart
transplant. Bibliometric analysis is a statistical concept that has
recently evolved, enabling scientists to study citation patterns and
identify characteristics of highly cited scholarly work in different
fields. Although it has been widely utilized, such analyses have not been
conducted to date on heart transplant literature. We sought to assess the
characteristics of the top 100 most referenced citations in the field of
heart transplantation. We searched the Scopus database (www.scopus.com) to
identify all articles relating to heart transplantation. The articles were
arranged in descending order from most cited to least cited and selected
articles were scrutinized for data extraction. One hundred articles were
included in the final list. Of the total 40,660 citations identified,
3,210 (8.0%) were self-citations, which impacted the final rank order. The
articles were published in 25 different journals between 1960 and 2013.
The most productive 5-year time period was between 2000 and 2005, when 24
of the 100 most cited publications were produced. There was no correlation
between the journals' impact factors and the number of articles produced
per journal. The presence and type of funding were not associated with the
number of citations. Over 85% of first and senior investigators were men.
In conclusion, our study highlights key features of the most highly cited
scientific literature on heart transplantation and provides insights into
trends of published work in this field. Additionally, this work may serve
as a useful guide to researchers and funding bodies by highlighting the
most prolific areas of cardiac transplant research to date. Copyright
© 2018

<27>
Accession Number
625162541
Title
Ezetimibe for the prevention of cardiovascular disease and all-cause
mortality events.
Source
Cochrane Database of Systematic Reviews. 2018 (11) (no pagination), 2018.
Article Number: CD012502. Date of Publication: 19 Nov 2018.
Author
Zhan S.; Tang M.; Liu F.; Xia P.; Shu M.; Wu X.
Institution
(Zhan, Tang, Liu, Xia) First Affiliated Hospital of Third Military Medical
University (Army Medical University), Pharmacy Department, 30 Gaotanyan
Street, Chongqing, Shapingba District 400038, China
(Shu) First Affiliated Hospital of Third Military Medical University (Army
Medical University), Cardiovascular Department, Chongqing, China
(Wu) Third Military Medical University (Army Medical University),
Department of Health Statistics, College of Preventive Medicine,
Chongqing, China
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Cardiovascular disease (CVD) remains an important cause of
mortality and morbidity, and high levels of blood cholesterol are thought
to be the major modifiable risk factors for CVD. The use of statins is the
preferred treatment strategy for the prevention of CVD, but some people at
high-risk for CVD are intolerant to statin therapy or unable to achieve
their treatment goals with the maximal recommended doses of statin.
Ezetimibe is a selective cholesterol absorption inhibitor, whether it has
a positive effect on CVD events remains uncertain. Results from clinical
studies are inconsistent and a thorough evaluation of its efficacy and
safety for the prevention of CVD and mortality is necessary.
 Objective(s): To assess the efficacy and safety of ezetimibe for the
prevention of CVD and all-cause mortality. Search Method(s): We
searched the CENTRAL, MEDLINE, Embase and Web of Science on 27 June 2018,
and two clinical trial registry platforms on 11 July 2018. We checked
reference lists from primary studies and review articles for additional
studies. No language restrictions were applied. Selection Criteria:
We included randomised controlled trials (RCTs) that compared ezetimibe
versus placebo or ezetimibe plus other lipid-modifying drugs versus other
lipid-modifying drugs alone in adults, with or without CVD, and which had
a follow-up of at least 12 months. Data Collection and Analysis: Two
review authors independently selected studies for inclusion, extracted
data, assessed risk of bias and contacted trialists to obtain missing
data. We performed statistical analyses according to the Cochrane Handbook
for Systematic Reviews of Interventions and used the GRADE to assess the
quality of evidence. Main Result(s): We included 26 RCTs randomising
23,499 participants. All included studies assessed effects of ezetimibe
plus other lipid-modifying drugs compared with other lipid-modifying drugs
alone or plus placebo. Our findings were driven by the largest study
(IMPROVE-IT), which had weights ranging from 41.5% to 98.4% in the
different meta-analyses. Ezetimibe with statins probably reduces the risk
of major adverse cardiovascular events compared with statins alone (risk
ratio (RR) 0.94, 95% confidence interval (CI) 0.90 to 0.98; a decrease
from 284/1000 to 267/1000, 95% CI 256 to 278; 21,727 participants; 10
studies; moderate-quality evidence). Trials reporting all-cause mortality
used ezetimibe with statin or fenofibrate and found they have little or no
effect on this outcome (RR 0.98, 95% CI 0.91 to 1.05; 21,222 participants;
8 studies; high-quality evidence). Adding ezetimibe to statins probably
reduces the risk of non-fatal myocardial infarction (MI) (RR 0.88, 95% CI
0.81 to 0.95; a decrease from 105/1000 to 92/1000, 95% CI 85 to 100;
21,145 participants; 6 studies; moderate-quality evidence) and non-fatal
stroke (RR 0.83, 95% CI 0.71 to 0.97; a decrease 32/1000 to 27/1000, 95%
CI 23 to 31; 21,205 participants; 6 studies; moderate-quality evidence).
Trials reporting cardiovascular mortality added ezetimibe to statin or
fenofibrate, probably having little or no effect on this outcome (RR 1.00,
95% CI 0.89 to 1.12; 19457 participants; 6 studies; moderate-quality
evidence). The need for coronary revascularisation might be reduced by
adding ezetimibe to statin (RR 0.94, 95% CI 0.89 to 0.99; a decrease from
196/1000 to 184/1000, 95% 175 to 194; 21,323 participants; 7 studies);
however, no difference in coronary revascularisation rate was observed
when a sensitivity analysis was limited to studies with a low risk of
bias. In terms of safety, adding ezetimibe to statins may make little or
no difference in the risk of hepatopathy (RR 1.14, 95% CI 0.96 to 1.35;
20,687 participants; 4 studies; low-quality evidence). It is uncertain
whether ezetimibe increase or decrease the risk of myopathy (RR 1.31, 95%
CI 0.72 to 2.38; 20,581 participants; 3 studies; very low-quality
evidence) and rhabdomyolysis, given the wide CIs and low event rate.
Little or no difference in the risk of cancer, gallbladder-related disease
and discontinuation due to adverse events were observed between treatment
groups. For serum lipids, adding ezetimibe to statin or fenofibrate might
further reduce the low-density lipoprotein cholesterol (LDL-C), total
cholesterol and triglyceride levels and likely increase the high-density
lipoprotein cholesterol levels; however, substantial heterogeneity was
detected in most analyses. None of the included studies reported on
health-related quality of life. Authors' conclusions: Moderate- to
high-quality evidence suggests that ezetimibe has modest beneficial
effects on the risk of CVD endpoints, primarily driven by a reduction in
non-fatal MI and non-fatal stroke, but it has little or no effect on
clinical fatal endpoints. The cardiovascular benefit of ezetimibe might
involve the reduction of LDL-C, total cholesterol and triglycerides. There
is insufficient evidence to determine whether ezetimibe increases the risk
of adverse events due to the low and very low quality of the evidence. The
evidence for beneficial effects was mainly obtained from individuals with
established atherosclerotic cardiovascular disease (ASCVD, predominantly
with acute coronary syndrome) administered ezetimibe plus statins.
However, there is limited evidence regarding the role of ezetimibe in
primary prevention and the effects of ezetimibe monotherapy in the
prevention of CVD, and these topics thus requires further
investigation. Copyright © 2018 The Cochrane Collaboration.

<28>
Accession Number
625044228
Title
Protocol for a phase III, non-inferiority, randomised comparison of a new
fibrinogen concentrate versus cryoprecipitate for treating acquired
hypofibrinogenaemia in bleeding cardiac surgical patients: The FIBRES
trial.
Source
BMJ Open. 8 (4) (no pagination), 2018. Article Number: e020741. Date of
Publication: 01 Apr 2018.
Author
Karkouti K.; Callum J.; Rao V.; Heddle N.; Farkouh M.E.; Crowther M.A.;
Scales D.C.
Institution
(Karkouti) Department of Anesthesia, Institute of Health Policy,
Management and Evaluation, University of Toronto, Toronto, ON, Canada
(Karkouti, Rao) Peter Munk Cardiac Centre, Toronto General Research
Institute, Toronto General Hospital, University Health Network, University
of Toronto, Toronto, ON, Canada
(Callum) Department of Clinical Pathology, Sunnybrook Health Sciences
Centre, University of Toronto, Toronto, ON, Canada
(Callum) Department of Laboratory Medicine and Pathobiology, University of
Toronto, Toronto, ON, Canada
(Rao) Division of Cardiovascular Surgery, University of Toronto, Toronto,
ON, Canada
(Heddle) Department of Medicine, Faculty of Health Sciences, McMaster
University, Hamilton, ON, Canada
(Farkouh) Peter Munk Cardiac Centre, Heart and Stroke Richard Lewar
Centre, University of Toronto, Toronto, ON, Canada
(Crowther) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, ON, Canada
(Scales) Department of Critical Care Medicine, Sunnybrook Health Sciences
Centre, University of Toronto, Toronto, ON, Canada
(Scales) Interdepartmental Division of Critical Care, Department of
Medicine, University of Toronto, Toronto, ON, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Coagulopathic bleeding is a serious complication of cardiac
surgery to which an important contributor is acquired hypofibrinogenaemia
(plasma fibrinogen <1.5-2.0 g/L). The standard intervention for acquired
hypofibrinogenaemia is cryoprecipitate, but purified fibrinogen
concentrates are also available. There is little comparative data between
the two therapies and randomised trials are needed. Methods and analysis
FIBrinogen REplenishment in Surgery (FIBRES) is a multicentre, randomised
(1:1), active-control, single-blinded, phase III trial in adult cardiac
surgical patients experiencing clinically significant bleeding related to
acquired hypofibrinogenaemia. The primary objective is to demonstrate that
fibrinogen concentrate (Octafibrin/Fibryga; Octapharma) is non-inferior to
cryoprecipitate. All patients for whom fibrinogen supplementation is
ordered by the clinical team within 24 hours of cardiopulmonary bypass
will receive 4 g of fibrinogen concentrate or 10 units of cryoprecipitate
(dose-equivalent to 4 g), based on random allocation and deferred consent.
The primary outcome is total red cell, platelet and plasma transfusions
administered within 24 hours of bypass. Secondary outcomes include major
bleeding, fibrinogen levels and adverse events within 28 days. Enrolment
of 1200 patients will provide >90% power to demonstrate non-inferiority.
One preplanned interim analysis will include 600 patients. The pragmatic
design and treatment algorithm align with standard practice, aiding
adherence and generalisability. Ethics and dissemination The study is
approved by the local research ethics board and will be conducted in
accordance with the Declaration of Helsinki, Good Clinical Practice
guidelines and regulatory requirements. Patient consent prior to treatment
is waived, as per criteria in the Tri-Council Policy Statement. Results
will be published in the scientific/medical literature, and at
international congresses. Non-inferiority of purified fibrinogen
concentrate would support its use in acquired hypofibrinogenaemia. The
results are likely to improve care for cardiac surgical patients
experiencing significant bleeding, an understudied yet high-risk
population. Copyright © 2018 Article author(s).

<29>
Accession Number
2001348031
Title
Deferred vs Immediate Stenting in Primary Percutaneous Coronary
Intervention: A Collaborative Meta-analysis of Randomized Trials With
Cardiac Magnetic Resonance Imaging Data.
Source
Canadian Journal of Cardiology. 34 (12) (pp 1573-1580), 2018. Date of
Publication: December 2018.
Author
Cassese S.; Belle L.; Ndrepepa G.; Bosson J.L.; Lonborg J.; Ahtarovski
K.A.; Kelbaek H.; Fusaro M.
Institution
(Cassese, Ndrepepa, Fusaro) Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Munich, Germany
(Belle) Departments of Cardiology and Radiology, Centre Hospitalier
Annecy-Genevois, Annecy, France
(Bosson) Clinical Investigation Centre, University Hospital of Grenoble,
Grenoble, France
(Fusaro) Department of Diagnostic and Interventional Radiology, Santa
Maria di Ca' Foncello Hospital, Treviso, Italy
(Lonborg) Department of Cardiology, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Ahtarovski, Kelbaek) Department of Cardiology, Zealand University
Hospital, Roskilde, Denmark
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The role of deferred vs immediate stenting during primary
percutaneous coronary intervention (PCI) for patients with ST-segment
elevation myocardial infarction (STEMI) remains controversial.
 Method(s): We undertook a collaborative meta-analysis of study-level
data by searching electronic scientific databases for investigations of
primary PCI patients randomized to deferred or immediate stenting and
subsequent cardiac magnetic resonance imaging. Primary angiographic and
imaging outcomes were slow/no-reflow and microvascular obstruction (MVO),
respectively. Main secondary outcome was recurrent ischemia.
 Result(s): Among 4 trials, a total of 1570 patients with STEMI were
assigned to primary PCI with either deferred (n = 779) or immediate
stenting (n = 791). Of these, 797 participants had analyzable cardiac
magnetic resonance imaging examinations. Median clinical follow-up was 9
months. Patients treated with deferred stenting showed a lower risk of
developing slow/no-reflow in the culprit vessel (risk ratio [RR], 0.54
[95% confidence interval (CI), 0.41-0.72]; P < 0.001), a similar risk for
MVO (RR, 0.93 [95% CI, 0.76-1.14]; P = 0.51), and trended higher in the
risk of recurrent ischemia (RR, 2.42 [95% CI, 0.88-6.63]; P = 0.09)
compared with those treated with immediate stenting. The treatment effect
for slow/no-reflow and MVO correlated with a thrombus score grade > 3 at
the baseline angiography and with the total stent length implanted in the
culprit artery. Conclusion(s): A strategy of deferred stenting during
primary PCI improves angiographic but not imaging or clinical outcomes
compared with immediate stenting. The potential lower risk for myocardial
injury by deferred stenting in primary PCI patients with STEMI and high
thrombus burden requires a confirmation in adequately sized randomized
trials. Copyright © 2018 Canadian Cardiovascular Society

<30>
Accession Number
2001348018
Title
The Effect of Cardiac Rehabilitation Attendance on Sexual Activity
Outcomes in Cardiovascular Disease Patients: A Systematic Review.
Source
Canadian Journal of Cardiology. 34 (12) (pp 1590-1599), 2018. Date of
Publication: December 2018.
Author
Boothby C.A.; Dada B.R.; Rabi D.M.; Campbell T.S.; Tang K.L.
Institution
(Boothby, Dada, Rabi, Tang) Department of Community Health Sciences,
University of Calgary, Calgary, Alberta, Canada
(Rabi, Tang) Department of Medicine, University of Calgary, Calgary,
Alberta, Canada
(Rabi) Department of Cardiac Sciences, University of Calgary, Calgary,
Alberta, Canada
(Campbell) Department of Psychology, University of Calgary, Calgary,
Alberta, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Decreased sexual activity (SA) is a common problem in patients
with cardiovascular disease (CVD). Although there is evidence that cardiac
rehabilitation (CR) is effective in improving physical outcomes and
overall quality of life, its effects on SA remain unclear. In this
systematic review we assessed the association between CR attendance and SA
outcomes in adults with CVD. Method(s): Electronic databases
(MEDLINE, PsycINFO, EMBASE, CINAHL) were systematically searched in
January 2018. Original studies that compared attendance to CR vs no
attendance to CR in adults 18 years and older with diagnosed CVD that also
reported on SA outcomes were included. A narrative synthesis was conducted
because the data did not permit meta-analysis. Result(s): Fourteen
studies were identified: 6 randomized controlled trials, 5 nonrandomized
controlled trials, and 3 prospective cohort studies. All CR programs
included an exercise-based component and 4 included an SA-specific
component. Seven studies reported a significant benefit in SA outcomes in
the CR group, 1 study reported significant harm, and 11 studies reported a
nonsignificant difference. Conclusion(s): The effect of CR on SA
outcomes was generally reported to be equivocal or positive. CR showed
some promise in improving sexual functioning and frequency, with mixed
results with regard to sexual resumption and satisfaction. In conclusion,
it remains uncertain if CR consistently improves sexual outcomes in adults
with CVD but these data suggest that further exploration might be
justified. Copyright © 2018 Canadian Cardiovascular Society

<31>
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.

<32>
Accession Number
624575453
Title
Comparative pharmacokinetics of tacrolimus in de novo pediatric transplant
recipients randomized to receive immediate- or prolonged-release
tacrolimus.
Source
Pediatric Transplantation. 22 (8) (no pagination), 2018. Article Number:
e13289. Date of Publication: December 2018.
Author
Vondrak K.; Dhawan A.; Parisi F.; Grenda R.; Debray D.; Marks S.D.; Webb
N.J.A.; Lachaux A.; Kazeem G.; Undre N.
Institution
(Vondrak) Department of Pediatrics, University Hospital Motol, Second
School of Medicine, Charles University, Prague, Czech Republic
(Dhawan) Paediatric Liver GI and Nutrition Center, King's College
Hospital, London, United Kingdom
(Parisi) Department of Pediatric Cardiology and Cardiac Surgery, Thoracic
Transplant Unit, Osp Pediatrico Bambino Gesu, Rome, Italy
(Grenda) Department of Nephrology and Kidney Transplantation, The
Children's Memorial Health Institute, Warsaw, Poland
(Debray) Pediatric Hepatology Unit, APHP-Hopital Universitaire
Necker-Enfants Malades, Paris, France
(Marks) Department of Paediatric Nephrology, Great Ormond Street Hospital
for Children, NHS Foundation Trust, London, United Kingdom
(Webb) Department of Paediatric Nephrology, Royal Manchester Children's
Hospital, Manchester University Foundation Trust, Manchester, United
Kingdom
(Lachaux) Service d'Hepatologie Pediatrique, Universite Lyon 1 et Hospices
Civils de Lyon, HFME, Bron Cedex, France
(Kazeem, Undre) Astellas Pharma Europe Ltd, Chertsey, United Kingdom
(Kazeem) BENKAZ Consulting Ltd, Cambridge, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Phase 2, parallel-group, multicenter, open-label, 4-week study, comparing
PK of PR-T vs IR-T in de novo pediatric patients undergoing primary
kidney, liver, or heart transplantation. Patients randomized 1:1 to
receive once daily, PR-T-, or twice-daily, IR-T-based regimens; dose
adjustments permitted after Day 1. Twenty-four-hour PK profiles collected
on Days 1, 7, and 28. Primary endpoint: tacrolimus AUC<inf>24</inf>.
Secondary end points included tacrolimus C<inf>24</inf> and
C<inf>max</inf>. Endpoints compared between PR-T and IR-T on Days 1, 7,
and 28. Predefined similarity interval for CIs of LSM ratios: 80%-125%. PK
analysis set comprised 33 patients (PR-T, n = 15; IR-T, n = 18). Overall,
AUC<inf>24</inf> and C<inf>max</inf> were lower on Day 1 vs 7 and 28.
Geometric LSM ratios of PR-T:IR-T on Days 1, 7, and 28 were 66.3%, 92.5%,
99.9%, respectively, for AUC<inf>24</inf>; 66.3%, 82.2%, 90.9% for
C<inf>24</inf>; and 77.3%, 120.3%, 92.2% for C<inf>max</inf>.
AUC<inf>24</inf> 90% CI within predefined similarity interval on Day 28;
other 90% CIs fell outside. Linear relationship was similar between
AUC<inf>24</inf> and C<inf>24</inf>, and between tacrolimus formulations,
suggesting that the same therapeutic drug monitoring method can be used
with both formulations in de novo pediatric allograft
recipients. Copyright © 2018 The Authors. Pediatric
Transplantation published by Wiley Periodicals, Inc

<33>
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.

<34>
Accession Number
623657393
Title
Single-dose intravenous diclofenac for acute postoperative pain in adults.
Source
Cochrane Database of Systematic Reviews. 2018 (8) (no pagination), 2018.
Article Number: CD012498. Date of Publication: 28 Aug 2018.
Author
Mcnicol E.D.; Ferguson M.C.; Schumann R.
Institution
(Mcnicol, Schumann) Tufts Medical Center, Department of Anesthesiology and
Perioperative Medicine, Boston, MA, United States
(Mcnicol) Tufts Medical Center, Department of Pharmacy, Boston, MA, United
States
(Mcnicol) Tufts University School of Medicine, Pain Research, Education
and Policy (PREP) Program, Department of Public Health and Community
Medicine, Boston, MA, United States
(Ferguson) Southern Illinois University Edwardsville, Pharmacy Practice,
Edwardsville, United States
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Postoperative administration of non-steroidal
anti-inflammatory drugs (NSAIDs) reduces patient opioid requirements and,
in turn, reduces the incidence and severity of opioid-induced adverse
events (AEs). Objective(s): To assess the analgesic efficacy and
adverse effects of single-dose intravenous diclofenac, compared with
placebo or an active comparator, for moderate to severe postoperative pain
in adults. Search Method(s): We searched the following databases
without language restrictions: the Cochrane Central Register of Controlled
Trials (Cochrane Register of Studies Online), MEDLINE, and Embase on 22
May 2018. We checked clinical trials registers and reference lists of
retrieved articles for additional studies. Selection Criteria: We
included randomized trials that compared a single postoperative dose of
intravenous diclofenac with placebo or another active treatment, for
treating acute postoperative pain in adults following any surgery.
 Data Collection and Analysis: We used standard methodological
procedures expected by Cochrane. Two review authors independently
considered trials for review inclusion, assessed risk of bias, and
extracted data. Our primary outcome was the number of participants in each
arm achieving at least 50% pain relief over a four- and six-hour period.
Our secondary outcomes were time to, and number of participants using
rescue medication; withdrawals due to lack of efficacy, AEs, and for any
cause; and number of participants experiencing any AE, serious AEs (SAEs),
and NSAID-related AEs. We performed a post hoc analysis of opioid-related
AEs, to enable indirect comparisons with other analyses of postoperative
analgesics. For subgroup analysis, we planned to analyze different doses
and formulations of parenteral diclofenac separately. We assessed the
overall quality of the evidence for each outcome using GRADE and created
two 'Summary of findings' tables. Main Result(s): We included eight
studies, involving 1756 participants undergoing various surgeries (dental,
mixed minor, abdominal, and orthopedic), with 20 to 175 participants
receiving intravenous diclofenac in each study. Mean study population ages
ranged from 24.5 years to 54.5 years. Intravenous diclofenac doses varied
among and within studies, ranging from 3.75 mg to 75 mg. Five studies
assessed newer formulations of parenteral diclofenac that could be
administered as an undiluted intravenous bolus. Most studies had an
unclear risk of bias for several domains and a high risk of bias due to
small sample size. The overall quality of evidence for each outcome was
generally low for reasons including unclear risk of bias in studies,
imprecision, and low event numbers. Primary outcome Three studies (277
participants) produced a number needed to treat for an additional
beneficial outcome (NNTB) for at least 50% of maximum pain relief versus
placebo of 2.4 (95% confidence interval (CI) 1.9 to 3.1) over four hours
(low-quality evidence). Four studies (436 participants) produced an NNTB
of 3.8 versus placebo (95% CI 2.9 to 5.9) over six hours (low-quality
evidence). No studies provided data for the comparison of intravenous
diclofenac with another NSAID over four hours. At six hours there was no
difference between intravenous diclofenac and another NSAID (low-quality
evidence). Secondary outcomes For secondary efficacy outcomes, intravenous
diclofenac was generally superior to placebo and similar to other NSAIDs.
For time to rescue medication, comparison of intravenous diclofenac versus
placebo demonstrated a median of 226 minutes for diclofenac versus 80
minutes for placebo (5 studies, 542 participants, low-quality evidence).
There were insufficient data for pooled analysis for comparisons of
diclofenac with another NSAID (very low-quality evidence). For the number
of participants using rescue medication, two studies (235 participants)
compared diclofenac with placebo. The number needed to treat to prevent
one additional harmful event (NNTp) (here, the need for rescue medication)
compared with placebo was 3.0 (2.2 to 4.5, low-quality evidence). The
comparison of diclofenac with another NSAID included only one study (98
participants). The NNTp was 4.5 (2.5 to 33) for ketorolac versus
diclofenac (very low-quality evidence). The numbers of participants
withdrawing were generally low and inconsistently reported (very
low-quality evidence). Participant withdrawals were: 6% (8/140) diclofenac
versus 5% (7/128) placebo, and 9% (8/87) diclofenac versus 7% (6/82)
another NSAID for lack of efficacy; 2% (4/211) diclofenac versus 0%
(0/198) placebo, and 3% (4/138) diclofenac versus 2% (2/129) another NSAID
due to AEs; and 11% (21/191) diclofenac versus 17% (30/179) placebo, and
18% (21/118) diclofenac versus 15% (17/111) another NSAID for any cause.
Overall adverse event rates were similar between intravenous diclofenac
and placebo (71% in both groups, 2 studies, 296 participants) and between
intravenous diclofenac and another NSAID (55% and 58%, respectively, 2
studies, 265 participants) (low-quality evidence for both comparisons).
Serious and specific AEs were rare, preventing meta-analysis. There were
sufficient data for a dose-effect analysis for our primary outcome for
only one alternative dose, 18.75 mg. Analysis of the highest dose employed
in each study demonstrated a relative benefit compared with placebo of 1.9
(1.4 to 2.4), whereas for the group receiving 18.75 mg, the relative
benefit versus placebo was 1.6 (1.2 to 2.1, 2 studies). Compared to
another NSAID, the high-dose analysis demonstrated a relative benefit of
0.9 (0.8 to 1.1), for the group receiving 18.75 mg, the relative benefit
was 0.78 (0.65 to 0.93). For direct comparison of high dose versus 18.75
mg, the proportion of participants with at least 50% pain relief was 66%
(90/137) for the high-dose arm versus 57% (77/135) in the low-dose arm.
There were insufficient data for subgroup meta-analysis of different
diclofenac formulations. Authors' conclusions: The amount and quality of
evidence for the use of intravenous diclofenac as a treatment for
postoperative pain is low. The available evidence indicates that
postoperative intravenous diclofenac administration offers good pain
relief for the majority of patients, but further research may impact this
estimate. Adverse events appear to occur at a similar rate to other
NSAIDs. Insufficient information is available to assess whether
intravenous diclofenac has a different rate of bleeding, renal
dysfunction, or cardiovascular events versus other NSAIDs. There was
insufficient information to evaluate the efficacy and safety of newer
versus traditional formulations of intravenous diclofenac. There was a
lack of studies in major and cardiovascular surgeries and in elderly
populations, which may be at increased risk for adverse
events. Copyright © 2018 The Cochrane Collaboration.

<35>
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.

<36>
Accession Number
623824303
Title
Risk of heart failure in a population with type 2 diabetes versus a
population without diabetes with and without coronary heart disease.
Source
Diabetes, Obesity and Metabolism. 21 (1) (pp 112-119), 2019. Date of
Publication: January 2019.
Author
Chen H.-F.; Ho C.-A.; Li C.-Y.
Institution
(Chen) Department of Endocrinology, Far Eastern Memorial Hospital, New
Taipei City, Taiwan (Republic of China)
(Chen) School of Medicine, Fujen Catholic University, New Taipei City,
Taiwan (Republic of China)
(Ho) Department of Surgery, Catholic Mercy Hospital, Hsinchu County,
Taiwan (Republic of China)
(Li) Department of Public Health, College of Medicine, National Cheng Kung
University, Tainan City, Taiwan (Republic of China)
(Li) Department of Public Health, College of Public Health, China Medical
University, Taichung City, Taiwan (Republic of China)
Publisher
Blackwell Publishing Ltd
Abstract
Aims: To conduct a population-based study comparing age- and sex-specific
risk estimates of heart failure (HF) between people with type 2 diabetes
and people without diabetes, and to investigate the risks of HF in
association with type 2 diabetes in people with various coronary heart
diseases (CHDs). Material(s) and Method(s): We used a nationally
representative sample (one million people) selected from Taiwan's National
Health Insurance (NHI) system. A total of 34 291 patients with type 2
diabetes were identified from ambulatory care claims in 2000, and the same
number of age- and sex-matched controls were randomly selected from the
registry of NHI beneficiaries in the same year. All study subjects were
linked to inpatient claims (2000-2013) to identify the possible admissions
for HF. Using a Cox proportional hazard regression model, we compared the
relative hazards of HF in relation to type 2 diabetes according to various
age and sex stratifications. We also compared the relative hazard of HF
between type 2 diabetes and controls, with and without histories of
various CHDs and coronary revascularization procedures. Result(s):
Compared with absence of diabetes (control group), type 2 diabetes was
significantly associated with an increased hazard of HF (adjusted hazard
ratio [aHR] 1.47, 95% confidence interval [CI] 1.40-1.54]. In both sexes,
those with type 2 diabetes aged <45 years had the highest increased hazard
of HF, with an aHR of 2.54 (95% CI 1.62-3.98) and 4.12 (95% CI 2.35-7.23)
for men and women, respectively. Compared with the control subjects
without any CHD, people with type 2 diabetes without prior CHD had
increased hazards of HF (aHR 1.54, 95% CI 1.41-1.68, in men and aHR 1.56,
95% CI 1.43-1.71, in women), which were similar to the aHRs for people
without diabetes who had histories of heart diseases (aHR 1.60 and 1.55
for men and women, respectively). Conclusion(s): Diabetes mellitus
may increase the risk of HF in both men and women, as well as in all age
groups, especially in young people. People with type 2 diabetes without
CHD had a similarly increased risk of HF to that of control subjects with
CHD. Certain coronary revascularization procedures and CHDs, including
percutaneous transluminal coronary angiography, coronary artery bypass
surgery and acute myocardial infarction, were found to greatly increase
risk of HF in people with type 2 diabetes. Copyright © 2018 John
Wiley & Sons Ltd

<37>
Accession Number
616643553
Title
Standardized uptake values in FDG PET/CT for prosthetic heart valve
endocarditis: a call for standardization.
Source
Journal of Nuclear Cardiology. 25 (6) (pp 2084-2091), 2018. Date of
Publication: 15 Dec 2018.
Author
Scholtens A.M.; Swart L.E.; Kolste H.J.; Budde R.P.J.; Lam M.G.E.H.;
Verberne H.J.
Institution
(Scholtens) Department of Nuclear Medicine, Meander Medical Center,
Maatweg 3, Amersfoort 3813TZ, Netherlands
(Swart, Budde) Department of Radiology and Nuclear Medicine, Erasmus
Medical Center, Rotterdam, Netherlands
(Kolste) Department of Cardiology, VU Medical Center, Amsterdam,
Netherlands
(Lam) Department of Radiology and Nuclear Medicine, University Medical
Center, Utrecht, Netherlands
(Verberne) Department of Radiology and Nuclear Medicine, Academic Medical
Center, Amsterdam, Netherlands
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: The significance of and threshold values for the standardized
uptake value (SUV) in FDG PET/CT to diagnose prosthetic heart valve (PHV)
endocarditis (PVE) are unclear at present. Method(s): A literature
search was performed in the PubMed and EMBASE medical databases,
comprising the following terms: (FDG OR *fluorode* OR *fluoro-de*) AND
(endocarditis OR prosthetic heart valve OR valve replacement). Studies
reporting SUVs correlated to the diagnosis of PVE were selected for
analysis. Result(s): 8 studies were included, with a total of 330
PHVs assessed. SUVs for PVE varied substantially across studies due to
differences in acquisition, reconstruction, and measurement protocols,
with median SUVmax values for rejected PVE ranging from 0.5 to 4.9 and for
definite PVE ranging from 4.2 to 7.4. Conclusion(s): Reported SUV
values for PVE are not interchangeable between sites, and further
standardization of quantification is desirable. To this end, optimal
protocols for patient preparation, image acquisition, and reconstruction
and measurement methods need to be standardized across
centers. Copyright © 2017, The Author(s).

<38>
Accession Number
625344046
Title
The outcome of checkpoint inhibitor therapy in patients with cancer and
solid organ transplant: A systematic review of the literature.
Source
Journal of Clinical Oncology. Conference: 2018 ASCO-SITC Clinical
Immuno-Oncology Symposium. United States. 36 (5 Supplement 1) (no
pagination), 2018. Date of Publication: February 2018.
Author
Hassan N.A.; Abudayyeh A.; Shah M.; Johnson D.H.; Suarez-Almazor M.E.;
Diab A.
Institution
(Hassan, Abudayyeh, Shah, Johnson, Suarez-Almazor, Diab) MD Anderson
Cancer Center, Houston, TX; The University of Texas MD Anderson Cancer
Center, Division of Internal Medicine, Section of Nephrology, Houston, TX;
The University of Texas MD Anderson Cancer Center, Houston, TX; LSU Health
Sciences Center in New Orleans Department of Hematology Oncology, New
Orleans, LA
Publisher
American Society of Clinical Oncology
Abstract
Background: Solid organ transplant recipients have been excluded from
Checkpoint inhibitors (CPI) clinical trials because of the concern of
allo-immunity and possible organ rejection. Method(s): We searched 5
databases through September 2017. Studies describing the use of CPI to
treat cancer in solid organ transplant Patients (pts), and provided
detailed description of each case were included. Result(s): Sixteen
publications met inclusion criteria, reporting on 19 cases. Median age of
pts was 59 (14-77) yrs and 74% were male. Cancer types included melanoma
(n=11), cutaneous squamous cell carcinoma (ca) (n=3), non-small cell lung
ca and hepatocellular ca (n=2 each), and duodenal ca (n=1). Median time to
start CPI after organ transplant was 11 (1-25) yrs. Nivolumab (nivo) was
used in 53%, ipilimumab (ipi) in 26%, and pembrolizumab (pem) in 21%. Most
pts were maintained on low dose prednisone (<= 10 mg), mTOR inhibitors,
and other immunosuppressives prior to initiating CPI. Graft rejection
occurred in 10 of 19 pts (7/12 kidney, 2/5 liver, and 1/2 heart
transplants), 90% after receiving anti PD-1, and CPI was discontinued.
Median time to rejection was 21 (5-60) days, and obtained biopsies were
suggestive of a T-cell mediated rejection process. Only a cardiac
transplant recipient with a bioposy proven cellular rejection after nivo,
had improved ejection fraction after pulse steroids. Aside from rejection
no other immune related adverse events (irAEs) reported. Nivo re-challenge
was recommended for a kidney recipient 12 weeks after the rejection
process, and the pt had partial tumor response but remained on
hemodialysis. Of the 9 pts who had no rejection, 4 had irAEs (hepatitis,
colitis, pneumonitis, and dermatitis), including 3 who required high-dose
steroids with subsequent improvement, and the remaining 5 pts did not
experience any irAEs. Clinical benefit rate was 57% of all pts. Two pts
with liver transplants died within 1 month of nivo treatment secondary to
acute liver rejection, and 2 others died because of progressive cancer.
 Conclusion(s): CPI seem to be associated with high rate of rejection.
Multi-institutional collaborative studies are warranted to enhance our
understanding of the pathogenesis and plan optiomal therapy that maintain
graft tolerance without dampening antitumor clinical benefits.

<39>
Accession Number
625357028
Title
Hybrid Coronary Revascularization vs Complete Coronary Artery Bypass
Grafting for Multivessel Coronary Artery Disease: A Systematic Review and
Meta-Analysis.
Source
Journal of Invasive Cardiology. 30 (12) (pp E131-E149), 2018. Date of
Publication: December 2018.
Author
Nolan S.; Filion K.B.; Atallah R.; Moss E.; Reynier P.; Eisenberg M.J.
Institution
(Nolan, Filion, Atallah, Reynier, Eisenberg) Centre for Clinical
Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill
University, 3755 Cote Ste-Catherine Road, Montreal, QC H3T 1E2, Canada
(Nolan, Filion, Moss, Eisenberg) Faculty of Medicine, McGill University,
Montreal, QC, Canada
(Filion, Eisenberg) Department of Epidemiology, Biostatistics and
Occupational Health, McGill University, Montreal, QC, Canada
(Filion) Department of Medicine, McGill University, Montreal, QC, Canada
(Moss) Division of Cardiac Surgery, Jewish General Hospital, McGill
University, Montreal, QC, Canada
(Eisenberg) Division of Cardiology, Jewish General Hospital, McGill
University, Montreal, QC, Canada
Publisher
HMP Communications
Abstract
BACKGROUND: Hybrid coronary revascularization (HCR) has emerged as a
potential alternative to complete coronary artery bypass graft (CABG)
surgery. However, the efficacy and safety of HCR vs CABG remain unclear.
We therefore conducted a systematic review and meta-analysis to compare
these interventions. Methods. We systematically searched PubMed, MEDLINE
(via Ovid), EMBASE (via Ovid), Cochrane Library of Clinical Trials, and
the Web of Science for studies comparing HCR to CABG in patients with
multivessel coronary artery disease. The primary outcome was major adverse
cardiovascular and cerebrovascular events (MACCE) and its components
(myocardial infarction, stroke, mortality, and target-vessel
revascularization [TVR]) at >=1 year. Secondary outcomes included MACCE at
<=30 days, its components, and postoperative safety outcomes (renal
failure, blood transfusion, new-onset atrial fibrillation, and infection).
 RESULT(S): One randomized controlled trial and 9 cohort studies were
included in our systematic review. Pooled results indicate that HCR is
associated with a lower risk for postoperative blood transfusion (odds
ratio [OR], 0.43; 95% confidence interval [CI], 0.27-0.68) and infection
(OR, 0.19; 95% CI, 0.04-0.98), and a shorter hospital stay (6.0 days for
HCR vs 7.8 days for CABG) and intensive care unit (ICU) stay (25.4 hours
for HCR vs 45.7 hours for CABG). Long-term outcome data showed an
association between HCR and long-term TVR (OR, 3.10; 95% CI, 1.39-6.90).
 CONCLUSION(S): Our results suggest that compared to CABG, HCR is
associated with a lower risk of postoperative blood transfusion and
infection, as well as a shorter ICU stay and hospital stay. HCR was also
associated with a higher risk of long-term TVR. Copyright © 2018
HMP Communications.

<40>
Accession Number
2001363600
Title
Effects of Perioperative Dexmedetomidine on Postoperative Mortality and
Morbidity: A Systematic Review and Meta-analysis.
Source
Clinical Therapeutics. (no pagination), 2018. Date of Publication: 2018.
Author
Peng K.; Ji F.-H.; Liu H.-Y.; Zhang J.; Chen Q.-C.; Jiang Y.-H.
Institution
(Peng, Ji, Liu, Zhang, Chen, Jiang) Departments of Anesthesiology,
Intensive Care Medicine, and Pain Medicine, First Affiliated Hospital of
Soochow University, Suzhou, China
Publisher
Excerpta Medica Inc.
Abstract
Purpose: Major postoperative complications translate into increased health
care resource utilization, prolonged hospital stays, and increased
mortality. We aimed to assess the effects of perioperative dexmedetomidine
use on postoperative mortality and the prevalence of major complications
after cardiac and noncardiac surgery. Method(s): We searched the
PubMed, EMBASE, and Cochrane databases to analyze all published evidence
from randomized controlled trials (RCTs) and cohort studies comparing
perioperative dexmedetomidine use versus no dexmedetomidine use in adult
patients undergoing cardiac and noncardiac surgery. The primary outcome
was postoperative mortality. Secondary outcomes were the durations of
mechanical ventilation, intensive care unit (ICU) stay, and hospital stay,
and the prevalence of major complications. Finding(s): Twenty-three
studies in cardiac surgery (n = 7635) and 8 studies in noncardiac surgery
(n = 1805) were included. In cardiac surgery, dexmedetomidine use reduced
postoperative 30-day mortality (risk ratio [RR], 0.35 [95% CI, 0.24 to
0.51]); durations of mechanical ventilation (mean difference [MD], -1.56 h
[-2.52 to -0.60]), ICU stay (MD, -0.22 day [-0.35 to -0.08]), and hospital
stay (MD, -0.65 day [-1.12 to -0.18]); and the prevalences of delirium
(RR, 0.50 [0.36 to 0.69]), atrial fibrillation (RR, 0.74 [0.57 to 0.97]),
and cardiac arrest (RR, 0.34 [0.13 to 0.87]). In noncardiac surgery,
dexmedetomidine use was associated with decreases in the durations of
mechanical ventilation and hospital stay, with a trend toward a lower
prevalence of delirium (RR, 0.57 [0.32 to 1.01]). The prevalence of
bradycardia was increased in dexmedetomidine-treated patients undergoing
cardiac surgery (RR, 1.70 [1.19 to 2.44]) and noncardiac surgery (RR, 1.64
[1.05 to 2.58]). Implications: Dexmedetomidine use may help to reduce
postoperative 30-day mortality, durations of mechanical ventilation, ICU
stay, and hospital stay, and the prevalences of delirium, atrial
fibrillation, and cardiac arrest in patients who undergo cardiac surgery.
The majority of the benefits of dexmedetomidine were not significant in
patients undergoing noncardiac surgery. An increased risk for bradycardia
should be taken into consideration when prescribing dexmedetomidine.
International Prospective Register of Systematic Reviews identifier:
CRD42017070791. Copyright © 2018

<41>
Accession Number
625353670
Title
Dopamine in critically ill patients with cardiac dysfunction: A systematic
review with meta-analysis and trial sequential analysis.
Source
Acta Anaesthesiologica Scandinavica. (no pagination), 2018. Date of
Publication: 2018.
Author
Hiemstra B.; Koster G.; Wetterslev J.; Gluud C.; Jakobsen J.C.; Scheeren
T.W.L.; Keus F.; van der Horst I.C.C.
Institution
(Hiemstra, Koster, Keus, van der Horst) Department of Critical Care,
University of Groningen, University Medical Center Groningen, Groningen,
Netherlands
(Wetterslev, Gluud, Jakobsen) The Copenhagen Trial Unit (CTU), Centre for
Clinical Intervention Research, Copenhagen, Denmark
(Jakobsen) Department of Cardiology, Holbaek Hospital, Holbaek, Denmark
(Scheeren) Department of Anesthesiology, University of Groningen,
University Medical Center Groningen, Groningen, Netherlands
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Dopamine has been used in patients with cardiac dysfunction
for more than five decades. Yet, no systematic review has assessed the
effects of dopamine in critically ill patients with cardiac dysfunction.
 Method(s): This systematic review was conducted following The
Cochrane Handbook for Systematic Reviews of Interventions. We searched for
trials including patients with observed cardiac dysfunction published
until 19 April 2018. Risk of bias was evaluated and Trial Sequential
Analyses were conducted. The primary outcome was all-cause mortality at
longest follow-up. Secondary outcomes were serious adverse events,
myocardial infarction, arrhythmias, and renal replacement therapy. We used
GRADE to assess the certainty of the evidence. Result(s): We
identified 17 trials randomising 1218 participants. All trials were at
high risk of bias and only one trial used placebo. Dopamine compared with
any control treatment was not significantly associated with relative risk
of mortality (60/457 [13%] vs 90/581 [15%]; RR 0.91; 95% confidence
interval 0.68-1.21) or any other patient-centred outcomes. Trial
Sequential Analyses of all outcomes showed that there was insufficient
information to confirm or reject our anticipated intervention effects.
There were also no statistically significant associations for any of the
outcomes in subgroup analyses by type of comparator (inactive compared to
potentially active), dopamine dose (low compared to moderate dose), or
setting (cardiac surgery compared to heart failure). Conclusion(s):
Evidence for dopamine in critically ill patients with cardiac dysfunction
is sparse, of low quality, and inconclusive. The use of dopamine for
cardiac dysfunction can neither be recommended nor refuted. Copyright
© 2018 The Authors. Acta Anaesthesiologica Scandinavica published by
John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica
Foundation.

<42>
Accession Number
625341084
Title
Efficacy and safety of intravenous esmolol for cardiac protection in
non-cardiac surgery. A systematic review and meta-analysis.
Source
Annals of Medicine. (no pagination), 2018. Date of Publication: 2018.
Author
Ollila A.; Vikatmaa L.; Sund R.; Pettila V.; Wilkman E.
Institution
(Ollila, Vikatmaa, Pettila, Wilkman) Department of Perioperative,
Intensive Care and Pain Medicine, University of Helsinki and Helsinki
University Hospital, Helsinki, Finland
(Sund) Institute of Clinical Medicine, University of Eastern Finland,
Kuopio, Finland
(Sund) Faculty of Social Sciences, Centre for Research Methods, University
of Helsinki, Helsinki, Finland
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Haemodynamic instability predisposes patients to cardiac complications in
non-cardiac surgery. Esmolol, a short-acting cardioselective
beta-adrenergic blocker might be efficient in perioperative cardiac
protection, but could affect other vital organs, such as the kidneys, and
post-discharge survival. We performed a systematic review on the use of
esmolol for perioperative cardiac protection. We searched PubMed, Ovid
Medline and Cochrane Central Register for Controlled trials. Eligible
randomized controlled studies (RCTs) reported a perioperative esmolol
intervention with at least one of the primary (major cardiac or renal
complications during the first 30 postoperative days) or secondary
(postoperative adverse effects and all-cause mortality) outcomes. We
included 196 adult patients from three RCTs. Esmolol significantly reduced
postoperative myocardial ischaemia, RR =0.43 [95% confidence interval, CI:
0.21-0.88], p =.02. No association with clinically significant bradycardia
and hypotension compared to patients receiving control treatment could be
confirmed (RR =7.4 [95% CI: 0.29-139.81], p =.18 and RR =2.21 [95% CI:
0.34-14.36], p =.41, respectively). No differences regarding other
outcomes were observed. No study reported postoperative renal outcomes.
Esmolol seems promising for the prevention of perioperative myocardial
ischaemia. However, the association with bradycardia and hypotension
remains unclear. Randomized trials investigating the effect of
beta1-selective blockade on clinically relevant outcomes and non-cardiac
vital organs are warranted.Key messages Short-acting cardioselective
esmolol seems efficient in the prevention of perioperative myocardial
ischaemia. The possibly increased risk of bradycardia and hypotension with
short-acting intravenous beta blockade could not be confirmed or refuted
by available data. Future adequately powered trials investigating the
effect of beta1-selective blockade on clinically relevant outcomes and
non-cardiac vital organs are warranted. Copyright © 2018, ©
2018 Informa UK Limited, trading as Taylor & Francis Group.

<43>
Accession Number
619929424
Title
Nine-month results of the BIOHELIX-I clinical trial study: Evaluation of
the PRO-Kinetic Energy cobalt chromium bare-metal stent system.
Source
Catheterization and Cardiovascular Interventions. 92 (6) (pp 1030-1039),
2018. Date of Publication: 15 Nov 2018.
Author
Michael T.T.; Richardt G.; Lansky A.; Carney R.J.; Khan M.A.; Shehadeh A.;
Zeymer U.; Gupta S.
Institution
(Michael) Department of Cardiovascular Sciences, University of South
Florida, Tampa, FL, United States
(Richardt) Heart Center, Department of Cardiology, Segeberger Kliniken,
Bad Segeberg, Germany
(Lansky) Heart and Vascular Clinical Research Program, Yale School of
Medicine, New Haven, CT, United States
(Lansky) Device Research, William Harvey Research Institute, Barts Heart
Center, Queen Mary University, United Kingdom
(Carney) Tyler Cardiovascular Consultants, Tyler, TX, United States
(Khan) North Dallas Research Associates, Cardiac Center of Texas,
McKinney, TX, United States
(Shehadeh) Department of Cardiovascular Research, Saint Michael's Medical
Center, Newark, NJ, United States
(Zeymer) Medizinische Klinik B, Klinikum der Stadt Ludwigshafen am Rhein,
Ludwigshafen, Germany
(Gupta) St Charles Hospital, Bend, OR, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To evaluate the safety and efficacy of the PRO-Kinetic Energy
(PKE) Cobalt Chromium Coronary Stent System (BIOTRONIK AG, Switzerland).
 Background(s): Percutaneous coronary intervention is a mainstay
treatment for symptomatic coronary artery disease (CAD). While
drug-eluting stents constitute a majority of implants, bare-metal stents
(BMS) remain important for a subset of patients. Newer generation BMS
offer advantages due to stent design improvements. Method(s): The
BIOHELIX-I study was a prospective, multicenter, non-randomized, single
arm clinical trial designed to evaluate the safety and efficacy of the PKE
bare metal stent. Thirty-three study centers (US, Columbia, Europe)
enrolled 329 patients for treatment of one target lesion (<=31 mm).
Eligible patients received a PKE stent(s), at least one month of dual
antiplatelet therapy and were followed for 36-months. The primary endpoint
was the 9-month rate of target vessel failure (TVF) compared with a
prespecified performance goal of 18.7% derived from prior BMS trials.
 Result(s): The mean patient age was 69 years, 28.6% with diabetes.
The mean lesion length was 13.7 +/- 6.0 mm. The 9-month TVF rate was 9.06%
and met the primary endpoint (P < 0.001). The TVF component rates were
0.95% cardiac death, 1.58% myocardial infarction, and 7.26%
ischemia-driven target vessel revascularization (TVR). The ischemia-driven
target lesion revascularization rate at 9-months was 6.62%.
 Conclusion(s): The 9-month TVF rate of the PKE stent was comparable
to other BMS and is a viable option for treating CAD. The low observed
rate of ischemia-driven TVR supports the safety and efficacy of the novel
BMS design. Copyright © 2017 Wiley Periodicals, Inc.

<44>
Accession Number
621165023
Title
Incidence and predictors of target lesion failure in a multiethnic Asian
population receiving the SYNERGY coronary stent: A prospective all-comers
registry.
Source
Catheterization and Cardiovascular Interventions. 92 (6) (pp 1097-1103),
2018. Date of Publication: 15 Nov 2018.
Author
Ananthakrishna R.; Kristanto W.; Liu L.; Chan S.-P.; Loh P.H.; Tay E.L.;
Chan K.H.; Chan M.Y.; Lee C.-H.; Low A.F.; Tan H.C.; Loh J.P.
Institution
(Ananthakrishna, Kristanto, Liu, Chan, Loh, Tay, Chan, Chan, Lee, Low,
Tan, Loh) Department of Cardiology, National University Heart Centre,
Singapore, Singapore
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To evaluate the target lesion failure (TLF) rate of the
SYNERGY stent in all-comers, multiethnic Asian population.
 Background(s): Currently, most drug eluting stents deliver
anti-proliferative drugs from a durable polymer which is associated with a
risk of late stent thrombosis. The novel everolimus-eluting, platinum
chromium SYNERGY stent is coated with a bioabsorbable abluminal polymer
that resolves within 4 months. Method(s): This was a prospective,
single center registry of consecutive patients treated with the SYNERGY
stent between December 2012 and April 2015. The primary outcome was the
incidence of TLF, defined as the combination of cardiac death, target
vessel myocardial infarction, or clinically driven target lesion
revascularization (TLR) at 1 year. Result(s): A total of 807 patients
received the SYNERGY stent during the study period. One-year clinical
outcome data was available for 765 patients (94.8%) and were considered
for statistical analysis. The mean age was 60.7 +/- 10.8 years, and 83.4%
were males. Patients with acute myocardial infarction consisted of 50.3%
(ST-segment elevation myocardial infarction: 23.0%, Non-ST-segment
elevation myocardial infarction: 27.3%) of the study population. The
treated lesions were complex (ACC/AHA type B2/C: 72.7%). The primary end
point of TLF at 1 year was 5.8%. Rates of cardiac mortality, target vessel
myocardial infarction, and TLR were 4.2, 1.0, and 1.3%, respectively, at 1
year. Predictors of the incidence and time to early TLF were female
gender, Malay ethnicity, diabetes mellitus, acute myocardial infarction at
presentation, a prior history of coronary artery bypass surgery and the
presence of lesion calcification. The incidence of definite stent
thrombosis was 0.4% at 1 year. Conclusion(s): In this registry, the
use of the SYNERGY stent was associated with low rates of TLF at 1
year. Copyright © 2018 Wiley Periodicals, Inc.

<45>
Accession Number
624079113
Title
Safety and Efficacy of Adult Stem Cell Therapy for Acute Myocardial
Infarction and Ischemic Heart Failure (SafeCell Heart): A Systematic
Review and Meta-Analysis.
Source
Stem Cells Translational Medicine. 7 (12) (pp 857-866), 2018. Date of
Publication: December 2018.
Author
Lalu M.M.; Mazzarello S.; Zlepnig J.; Dong Y.Y.R.; Montroy J.; McIntyre
L.; Devereaux P.J.; Stewart D.J.; David Mazer C.; Barron C.C.; McIsaac
D.I.; Fergusson D.A.
Institution
(Lalu, McIsaac) Department of Anesthesiology and Pain Medicine, The Ottawa
Hospital, Ottawa, ON, Canada
(Lalu, Mazzarello, Montroy, McIntyre, McIsaac, Fergusson) Blueprint
Translational Research Group, Clinical Epidemiology Program, Ottawa
Hospital Research Institute, Ottawa, ON, Canada
(Lalu, Stewart) Regenerative Medicine Program, Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(Zlepnig, Dong, Fergusson) Faculty of Medicine, University of Ottawa,
Ottawa, ON, Canada
(McIntyre) Division of Critical Care, The Ottawa Hospital, Ottawa, ON,
Canada
(Devereaux) Population Health Research Institute, David Braley Cardiac,
Vascular, and Stroke Research Institute, Departments of Medicine and
Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON,
Canada
(Lalu, Stewart) Department of Cellular and Molecular Medicine, University
of Ottawa, Ottawa, ON, Canada
(David Mazer) Department of Anesthesia, Li Ka Shing Knowledge Institute of
St. Michael's Hospital, University of Toronto, Department of Physiology,
Toronto, ON, Canada
(Barron) Department of Medicine, McMaster University, Hamilton, ON, Canada
Publisher
John Wiley and Sons Ltd. (E-mail: contentdelivery@wiley.com)
Abstract
Preclinical and clinical evidence suggests that mesenchymal stem cells
(MSCs) may be beneficial in treating both acute myocardial infarction
(AMI) and ischemic heart failure (IHF). However, the safety profile and
efficacy of MSC therapy is not well-known. We conducted a systematic
review of clinical trials that evaluated the safety or efficacy of MSCs
for AMI or IHF. Embase, PubMed/Medline, and Cochrane Central Register of
Controlled Trials were searched from inception to September 27, 2017.
Studies that examined the use of MSCs administered to adults with AMI or
IHF were eligible. The Cochrane risk of bias tool was used to assess bias
of included studies. The primary outcome was safety assessed by adverse
events and the secondary outcome was efficacy which was assessed by
mortality and left ventricular ejection fraction (LVEF). A total of 668
citations were reviewed and 23 studies met eligibility criteria. Of these,
11 studies evaluated AMI and 12 studies evaluated IHF. There was no
association between MSCs and acute adverse events. There was a significant
improvement in overall LVEF in patients who received MSCs (SMD 0.73, 95%
CI 0.24-1.21). No significant difference in mortality was noted (Peto OR
0.68, 95% CI 0.38-1.22). Results from our systematic review suggest that
MSC therapy for ischemic heart disease appears to be safe. There is a need
for a well-designed adequately powered randomized control trial (with
rigorous adverse event reporting and evaluations of cardiac function) to
further establish a clear risk-benefit profile of MSCs. Stem Cells
Translational Medicine 2018;7:857-866. Copyright © 2018 The
Authors. Stem Cells Translational Medicine published by Wiley Periodicals,
Inc. on behalf of AlphaMed Press

<46>
[Use Link to view the full text]
Accession Number
625046067
Title
Early post-operative cognitive dysfunction after closed-loop versus manual
target controlled-infusion of propofol and remifentanil in patients
undergoing elective major non-cardiac surgery Protocol of the randomized
controlled single-blind POCD-ELA trial.
Source
Medicine (United States). 97 (40) (no pagination), 2018. Article Number:
e12558. Date of Publication: 2018.
Author
Besch G.; Vettoretti L.; Claveau M.; Boichut N.; Mahr N.; Bouhake Y.; Liu
N.; Chazot T.; Samain E.; Pili-Floury S.
Institution
(Liu, Chazot) Department of Anesthesia, Foch Hospital, Suresnes, France
(Liu, Chazot) Outcomes Research Consortium, Cleveland Clinic, Cleveland,
OH, United States
(Besch, Vettoretti, Claveau, Boichut, Mahr, Bouhake, Samain, Pili-Floury)
Department of Anesthesiology and Intensive Care Medicine, University
Hospital of Besancon, 3 Boulevard Alexandre Fleming, Besancon 25030,
France
(Vettoretti) Centre Hospitalier Universitaire de Besancon, besancon,
France
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Introduction: Post-operative cognitive dysfunction (POCD) is frequent in
patients older than 60 years undergoing major noncardiac surgery, and
increases both morbidity and mortality. Anesthetic drugs may exert
neurotoxic effects and contribute to the genesis of POCD. The hypothesis
of the POCD-ELA trial was that closed-loop target-controlled infusion of
propofol and remifentanil could reduce the occurrence of POCD by
decreasing the risk of excessive depth of anesthesia and the dose of
anesthetic drugs. Methods and analysis: We designed a single-center,
single-blind, randomized, controlled, parallel trial and aim to include
204 patients aged >60 years undergoing elective major non-cardiac surgery.
Patients will be randomized to receive closed-loop versus manual
target-controlled infusion of propofol and remifentanil guided by
bispectral index monitoring. Cognitive assessment will be performed the
day before surgery (baseline) and within 72 hours after surgery, using a
battery of validated neuropsychological tests. The primary outcome is the
incidence of POCD within 72 hours after surgery. POCD is defined as a
Z-score value > 1.96 for at least 2 different tests or a Z-score composite
value >1.96. The calculation of the Z-score is based on data from an
age-matched control population who did not undergo surgery or general
anesthesia. Ethics and dissemination: This study was approved by the
Ethics Committee (Comite de Protection des Personnes Est-II) and
authorized by the French Health Products Agency (Agence Nationale de
Securite des Medicaments, Saint-Denis, France). The University Hospital of
Besancon is the trial sponsor and the holder of all data and publication
rights. Results of the study will be submitted for publication in a
peer-review international medical journal and for presentation in abstract
(oral or poster) in international peer-reviewed congresses. Registration:
The trial is registered with ClinicalTrials.gov (Identifier: NCT02841423,
principal investigator: Prof Emmanuel Samain, date of registration: July
22, 2016). Last amendment of protocol: version 8.0 April 2018.
Abbreviations: ASA = American Society of Anesthesiologists, BIS =
bispectral index, POCD = Post-Operative Cognitive Dysfunction, SD =
standard deviation. Copyright © 2018 the Author(s). Published by
Wolters Kluwer Health, Inc.

<47>
Accession Number
625259015
Title
Surgical left atrial appendage occlusion during cardiac surgery: A
systematic review and meta-analysis.
Source
World Journal of Cardiology. 10 (11) (pp 242-249), 2018. Date of
Publication: 01 Nov 2018.
Author
Atti V.; Anantha-Narayanan M.; Turagam M.K.; Koerber S.; Rao S.;
Viles-Gonzalez J.F.; Suri R.M.; Velagapudi P.; Lakkireddy D.; Benditt D.G.
Institution
(Atti) Department of Medicine, Michigan State University-Sparrow Hospital,
East Lansing, MI 48912, United States
(Anantha-Narayanan, Benditt) Division of Cardiovascular Diseases,
Department of Medicine, University of Minnesota, Minneapolis, MN 55455,
United States
(Turagam) Helmsley Electrophysiology Center, Icahn School of medicine at
Mount Sinai, New York City, NY 10029, United States
(Koerber) Department of Cardiac Electrophysiology, Medical University of
South Carolina, Charleston, SC 29425, United States
(Rao) Department of Cardiovascular Diseases, Genesys Heart Institute,
Ascension Genesys Hospital, Grand Blanc, MI, United States
(Viles-Gonzalez) Baptist Health South Florida, Department of Medicine,
Wertheim College of Medicine, Miami, FL 33176, United States
(Suri) Cleveland Clinic Foundation, Cleveland Clinic Abu Dhabi, Department
of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH
44195, United States
(Velagapudi) Structural Heart and Valve Center, Center for Interventional
Vascular Therapy, Division of Cardiology, Columbia University Medical
Center, New York City, NY 10027, United States
(Lakkireddy) Kansas City Heart Rhythm Institute and Research Foundation,
Kansas City, MO 64132, United States
Publisher
Baishideng Publishing Group Co (7901 Stoneridge Drive, Suite 501,
Pleasanton, California 94588, United States. E-mail: bpg@baishideng.com)
Abstract
AIM To evaluate the safety and efficacy of surgical left atrial appendage
occlusion (s-LAAO) during concomitant cardiac surgery. METHODS We
performed a comprehensive literature search through May 31st 2018 for all
eligible studies comparing s-LAAO vs no occlusion in patients undergoing
cardiac surgery. Clinical outcomes during follow-up included: embolic
events, stroke, all-cause mortality, atrial fibrillation (AF), reoperation
for bleeding and postoperative complications. We further stratified the
analysis based on propensity matched studies and AF predominance. RESULTS
Twelve studies (n = 40107) met the inclusion criteria. s-LAAO was
associated with lower risk of embolic events (OR: 0.63, 95%CI: 0.53-0.76;
P < 0.001) and stroke (OR: 0.68, 95%CI: 0.57-0.82; P < 0.0001). Stratified
analysis demonstrated this association was more prominent in the AF
predominant strata. There was no significant difference in the incidence
risk of all-cause mortality, AF, and reoperation for bleeding and
postoperative complications. CONCLUSION Concomitant s-LAAO during cardiac
surgery was associated with lower risk of follow-up thromboembolic events
and stroke, especially in those with AF without significant increase in
adverse events. Further randomized trials to evaluate long-term benefits
of s-LAAO are warranted. Copyright © The Author(s) 2018.
Published by Baishideng Publishing Group Inc. All rights reserved.

<48>
Accession Number
625233900
Title
How to treat severe symptomatic structural valve deterioration of aortic
surgical bioprosthesis: Transcatheter valve-in-valve implantation or redo
valve surgery?.
Source
European Journal of Cardio-thoracic Surgery. 54 (6) (pp 1-9), 2018. Date
of Publication: 2018.
Author
Attias D.; Nejjari M.; Nappi F.; Dreyfus J.; Eleid M.F.; Rihal C.S.
Institution
(Attias, Nejjari, Dreyfus) Department of Cardiology, Centre Cardiologique
du Nord, 32-36 rue des Moulins Gemeaux, Saint Denis 93200, France
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord, Saint
Denis, France
(Eleid, Rihal) Department of Cardiovascular Diseases and Cardiovascular
Surgery, Mayo Clinic, Rochester, MN, United States
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
The optimal management of aortic surgical bioprosthesis presenting with
severe symptomatic structural valve deterioration is currently a matter of
debate. Over the past 20 years, the number of implanted bioprostheses
worldwide has been rapidly increasing at the expense of mechanical
prostheses. A large proportion of patients, however, will require
intervention for bioprosthesis structural valve deterioration. Current
options for older patients who often have severe comorbidities include
either transcatheter valve-in-valve (TVIV) implantation or redo valve
surgery. The emergence of TVIV implantation, which is perceived to be less
invasive than redo valve surgery, offers an effective alternative to
surgery for these patients with proven safety and efficacy in high-risk
patient groups including elderly and frail patients. A potential caveat to
this strategy is that results of long-term follow-up after TVIV
implantation are limited. Redo surgery is sometimes preferable, especially
for young patients with a smaller-sized aortic bioprosthesis. With the
emergence of TVIV implantation and the long experience of redo valve
surgery, we currently have 2 complementary treatment modalities, allowing
a tailor-made and patient-orientated intervention. In the heart team, the
decision-making should be based on several factors including type of
bioprosthesis failure, age, comorbidities, operative risk, anatomical
factors, anticipated risks and benefits of each alternative, patient's
choice and local experience. The aim of this review is to provide a
framework for individualized optimal treatment strategies in patients with
failed aortic surgical bioprosthesis. Copyright © The Author(s)
2018.

<49>
Accession Number
621269533
Title
5-Year clinical follow-up of the COBRA (complex coronary bifurcation
lesions: Randomized comparison of a strategy using a dedicated
self-expanding biolimus A9-eluting stent vs. a culotte strategy using
everolimus-eluting stents) study.
Source
Catheterization and Cardiovascular Interventions. 92 (6) (pp E375-E380),
2018. Date of Publication: 15 Nov 2018.
Author
Bennett J.; Adriaenssens T.; McCutcheon K.; Dens J.; Desmet W.; Sinnaeve
P.; Vrolix M.; Dubois C.
Institution
(Bennett, Adriaenssens, McCutcheon, Desmet, Sinnaeve, Dubois) Department
of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
(Adriaenssens, Desmet, Sinnaeve, Dubois) Department of Cardiovascular
Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
(Dens, Vrolix) Department of Cardiology, Oost-Limburg Hospital, Genk,
Belgium
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We evaluated healing responses with optical coherence
tomography, and long-term clinical outcomes after treatment with a
dedicated stent versus a conventional culotte technique.
 Background(s): Dedicated bifurcation stents have been proposed as an
alternative treatment for coronary bifurcation lesions. The long-term
performance of dedicated stents versus conventional dual-stent techniques
for the treatment of complex coronary bifurcation lesions is unknown.
 Method(s): Forty patients with true coronary bifurcation lesions were
randomized to treatment with a dedicated Axxess bifurcation stent in the
proximal main vessel and additional Biomatrix stents in branches versus
culotte stenting using Xience stents. Result(s): The percentage of
uncovered struts in each bifurcation segment at 9 months (primary
endpoint) was similar between groups. Five-year clinical follow-up was
available for all patients and included major adverse cardiac events
[MACE; a composite of cardiac death, myocardial infarction (MI) and
ischemia-driven target lesion revascularization (TLR)], target-vessel
(TVR) and non-target-vessel revascularization (non-TVR), non-TLR and stent
thrombosis. At 5 years, in the culotte group, one patient had undergone
TLR and another suffered a clinical MI, resulting in 10% MACE versus none
in the Axxess group. TVR (5% vs. 10%, P = 0.54) and non-TVR (5% vs. 20%, P
= 0.39) rates were similar between the Axxess and culotte groups,
respectively. There was no stent thrombosis. Conclusion(s): Compared
with culotte stenting with Xience, complex coronary bifurcation stenting
using a dedicated strategy combining the Axxess and Biomatrix stents
results in similar stent strut coverage at 9 months, and excellent
clinical outcomes at 5 years. Copyright © 2018 Wiley Periodicals,
Inc.

<50>
Accession Number
624271718
Title
Cardiopulmonary exercise testing for evaluation of a randomized exercise
training intervention following aortic valve replacement.
Source
Clinical Physiology and Functional Imaging. 39 (1) (pp 103-110), 2019.
Date of Publication: January 2019.
Author
Nilsson H.; Nylander E.; Borg S.; Tamas E.; Hedman K.
Institution
(Nilsson, Nylander, Hedman) Department of Clinical Physiology and
Department of Medical and Health Sciences, Linkoping University,
Linkoping, Sweden
(Borg) Department of Cardiology and Department of Medical and Health
Sciences, Linkoping University, Linkoping, Sweden
(Tamas) Department of Cardiothoracic and Vascular Surgery and Department
of Cardiovascular Medicine, Linkoping University, Linkoping, Sweden
Publisher
Blackwell Publishing Ltd
Abstract
Aortic valve surgery is the definitive treatment for aortic stenosis (AS).
No specific recommendation is available on how exercise training should be
conducted and evaluated after aortic valve replacement (AVR). This study
aimed to examine the effect of aerobic exercise training on exercise
capacity following AVR. In addition to our primary outcome variable, peak
oxygen uptake (peakVO<inf>2</inf>), the effect on submaximal
cardiopulmonary variables including oxygen uptake kinetics (tau), oxygen
uptake efficiency slope (OUES) and ventilatory efficiency
(VE/VCO<inf>2</inf> slope) was evaluated. Following AVR due to AS, 12
patients were randomized to either a group receiving 12 weeks of
supervised aerobic exercise training (EX) or a control group (CON).
Exercise capacity was assessed by a maximal cardiopulmonary exercise test
(CPET). There was a significant increase in peak load (+28%, P = 0.031)
and in peakVO<inf>2</inf> (+23%, P = 0.031) in EX, corresponding to an
increase in achieved percentage of predicted peakVO<inf>2</inf> from 88 to
104% (P = 0.031). For submaximal variables, there were only
non-statistically significant trends in improvement between CPETs in EX.
In CON, there were no significant differences in any maximal or submaximal
variable between CPETs. We conclude that 12 weeks of supervised aerobic
exercise training induces significant adaptations in cardiopulmonary
function following AVR, especially in regard to maximal variables
including peakVO<inf>2</inf>. In addition, we provide novel data on the
effect on several submaximal variables following exercise training in this
group of patients. Copyright © 2018 The Authors. Clinical
Physiology and Functional Imaging published by John Wiley & Sons Ltd on
behalf of Scandinavian Society of Clinical Physiology and Nuclear Medicine

<51>
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. 41 (11) (pp 1446-1454), 2018. Date of Publication:
November 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.

<52>
Accession Number
625097102
Title
Superior renal function with CNI-free everolimus over standard CNI-based
regimen: 18 months data from the randomized, multi-center mandela trial in
de novo heart transplant recipients.
Source
Transplant International. Conference: 27th Annual Meeting of the German
Transplantation Society. Germany. 31 (Supplement 5) (pp 11), 2018. Date of
Publication: November 2018.
Author
Barten M.; Hirt S.; Bara C.; Garbade J.; Doesch A.; Knosalla C.;
Grinninger C.; Stypmann J.; Sieder C.; Junge M.; Schulz U.
Institution
(Barten, Hirt, Bara, Garbade, Doesch, Knosalla, Grinninger, Stypmann,
Schulz) Mandela Study Group, Germany
(Sieder, Junge) Novartis Pharma GmbH, Germany
Publisher
Blackwell Publishing Ltd
Abstract
Purpose: The MANDELA study (NCT00862979) was designed to assess the
benefit on renal function of either a CNI-free or CNI-minimized everolimus
[EVR]-based regimen after early conversion of de novo heart transplant
recipients (HTxR). Method(s): MANDELA is a multi-center, randomized,
controlled, open-label, 12 month study. In total 232 de novo HTxR were
enrolled 3 months [M] post Tx, of whom 162 could be randomized (1:1) to
receive either EVR (C0-h 5-10 ng/mL) with reduced CNI (TAC C0-h 3-8 ng/mL
or CsA C0-h 50-150 ng/mL) + steroids (<=0.3 mg/kg) or EVR (C0-h 5-10
ng/mL) with mycophenolic acid (EC-MPS max. 2880 mg/day or MMF max. 3
g/day) + steroids (<=0.3 mg/kg). The primary objective was renal function
[eGFR; MDRD] 12 M after randomization for assessment of superiority in
CNI-free over CNI-reduced EVR group. Key secondary objectives included
efficacy (composite of BPAR ISHLT1990 grade>=3A/ISHLT2004 grade>=2R, graft
loss/re-transplant, death or loss to follow-up) and safety profiles
including infections. Result(s): Primary endpoint for superior renal
function in CNI-free EVR arm was met with high significance: a difference
of +11.3 mL/min in favor of CNIfree EVR group versus CNI-reduced group (p
< 0.001) in full analysis set; per protocol analysis showed a difference
of +16.8 mL/min in favor of CNI-free EVR arm (p < 0.001) [eGFR (ml/min)
from MDRD formula; LS-mean from ANCOVA model]. Rate of MACE and BPAR was
in line with international standards and the safety profile according to
the patient set and drugs investigated herein. Data from full analysis
will be presented at DTG2018 meeting. Conclusion(s): MANDELA study
showed improved renal function can be achieved by early conversion to an
everolimus-based CNI-free regimen in HTxR without compromising safety and
efficacy.

<53>
Accession Number
2001308766
Title
Effect of two pedometer-based walking interventions on long-term health
outcomes: a study using routine primary care data.
Source
The Lancet. Conference: Public Health Science: A National Conference
Dedicated to New Research in UK Public Health. United Kingdom. 392
(Supplement 2) (pp S42), 2018. Date of Publication: November 2018.
Author
Harris T.; Limb E.; Hosking F.; Carey I.; DeWilde S.; Furness C.; Wahlich
C.; Ahmad S.; Kerry S.; Whincup P.; Victor C.; Ussher M.; Iliffe S.;
Ekelund U.; Fox-Rushby J.; Ibison J.; Cook D.
Institution
(Harris, Limb, Hosking, Carey, DeWilde, Furness, Wahlich, Ahmad, Whincup,
Ussher, Cook) Population Health Research Institute, St George's University
of London, London, United Kingdom
(Ibison) Institute of Medical and Biomedical Education, St George's
University of London, London, United Kingdom
(Kerry) Pragmatic Clinical Trials Unit, Queen Mary's University of London,
London, United Kingdom
(Victor) Gerontology and Health Services Research Unit, Brunel University,
London, United Kingdom
(Iliffe) Research Department of Primary Care & Population Health,
University College London, London, United Kingdom
(Ekelund) Department of Sport Medicine, Norwegian School of Sport
Sciences, Oslo, Norway
(Fox-Rushby) Department of Population Science, King's College London,
London, United Kingdom
Publisher
Lancet Publishing Group
Abstract
Background: Data are lacking from physical activity (PA) trials with
long-term follow-up of both objectively measured PA levels and robust
health outcomes. Two primary care 12-week pedometer-based walking
interventions in adults and older adults (PACE-UP and PACE-Lift) found
sustained objectively measured PA increases at 3 and 4 years,
respectively. Using routine primary care data, we aimed to evaluate
intervention effects on long-term health outcomes relevant to walking
interventions. Method(s): We downloaded primary care data for trial
participants who gave written informed consent, for 4-year periods after
their randomisation from the 7 general practices in the PACE-UP trial and
3 general practices in the PACE-Lift trial (PACE-UP from Oct 23, 2012, to
Nov 11, 2017; PACE-Lift from Oct 12, 2011, to Oct 11, 2016). The following
new events were counted masked to intervention status for all
participants, including those with pre-existing diseases (apart from
diabetes, where existing cases were excluded): cardiovascular (myocardial
infarction, coronary artery bypass graft, angioplasty, and stroke or
transient ischaemic attack), diabetes cases, depression episodes,
fractures, and falls. We modelled the effect of the interventions on
outcomes using Cox and Poisson regression models, adjusting for age, sex,
and practice. Finding(s): Data were downloaded for 1297 (98%) of 1321
trial participants. Event rates were low (<20 per group) for outcomes,
apart from fractures and falls. Cox hazard ratios for time-to-first event
after randomisation for interventions versus controls were: cardiovascular
0.24 (95% CI 0.07-0.77), diabetes 0.77 (0.43-1.38), depression 0.98
(0.46-2.07), and fractures 0.56 (0.35-0.90). Poisson incident rate ratio
for falls was 1.09 (95% CI 0.83-1.43). Interpretation(s): Short-term
primary care PA interventions led to long-term PA increases in the
intervention groups, associated with significant decreases in new
cardiovascular events and fractures at 4 years. Though no significant
differences between intervention and control groups were demonstrated for
other events, direction of effect for diabetes was protective, but our
trials were underpowered to find differences in low frequency outcomes.
Our study also demonstrates the potential for using routine data to
evaluate the outcome of large-scale primary care walking interventions,
avoiding expensive objective accelerometry assessment or inaccurate
self-report PA data. Funding(s): Supported by the National Institute
for Health Research (NIHR). Copyright © 2018 Elsevier Ltd

<54>
Accession Number
623221401
Title
On-pump and off-pump in coronary artery bypass surgery, postoperative
neurocognitive disorders.
Source
American Journal of Cardiology. Conference: 14th International Congress of
Update in Cardiology and Cardiovascular Surgery, UCCVS. Turkey. 121 (8
Supplement 1) (pp e48-e49), 2018. Date of Publication: April 2018.
Author
Keskin G.; Yildirim G.O.; Aktekin E.; Ay N.D.
Institution
(Keskin, Yildirim, Aktekin) Ege University Ataturk Health Services
Vocational School, Izmir, Turkey
(Ay) Dokuz Eylul University Medical Faculty Hospital, Izmir, Turkey
Publisher
Elsevier Inc.
Abstract
Objective: The principles of intensive care treatment, which develop
parallel to the progression of coronary artery disease, have significantly
increased the life span after open heart surgery. Despite advanced
technological advances, however, frequent cerebral complications are
responsible for the development of cognitive deficits following the
posthoc. In this review study, it was aimed to evaluate postoperative
neurocognitive changes in on-pump and off-pump cases in coronary artery
bypass surgery. Method(s): A systematic literature search was
conducted on academic databases like Pubmed, EBSCO, Science Direct by
using the keywords "cardiopulmonary bypass, coronary artery bypass
grafting, off-pump coronary artery bypass grafting, on-pump coronary
artery bypass grafting, neuro-cognitive ". Between the period of
2012-2018, 2,262 articles were found; and since 2013-2018, 530 articles
were indicated Results: Postoperative cognitive dysfunction (POKD) is a
well-known complication of coronary artery bypass grafting (CABG). The
cardiopulmonary bypass is associated with systemic inflammatory responses
and has positive effects on hemostatic dysfunction and myocardial injury.
Of pump coronary artery bypass is a revascularization technique and does
not require cardiopulmonary bypass; the reduced risk of perioperative
stroke and neurocognitive decline with reduced aortic manipulation in this
fashion. It has been stated in the literature that the use of pump and
on-pump coronary artery bypass grafting techniques may cause different
mortality and morbidity, especially in high-risk patient groups. It is
also known that the on-pump method reduces the perioperative morbidity
especially in the studies of the pump method, which is a method that can
be used safely with regard to coronary revascularization. Studies show
that the off-pump group experiences lower depression and anxiety. Some
studies in the 1990's have pointed to a fall in post-pump psychological
functioning. Conclusion(s): These twotechniques showed different
morbidity rates, especially in postoperative cognitive impairment,
incidence of renal insufficiency, blood loss, prolonged mechanical
ventilation, and stay in hospital and intensive care unit.

<55>
Accession Number
623221271
Title
Comparison rheumatic fever (RF) and rheumatic heart disease (RHD) in
Afghanistan and world wide.
Source
American Journal of Cardiology. Conference: 14th International Congress of
Update in Cardiology and Cardiovascular Surgery, UCCVS. Turkey. 121 (8
Supplement 1) (pp e105), 2018. Date of Publication: April 2018.
Author
Naebkhil A.
Institution
(Naebkhil) Kateb Medical School-Kateb University, Kabul, Afghanistan
Publisher
Elsevier Inc.
Abstract
Rheumatic fever and rheumatic heart disease nowadays in Afghanistan taking
life of young generation of Afghanistan which in world sin world stage
Afghanistan is number one regarding incidence and turkey is number 4th
after in ranking regarding incidence of this disease. we reached to
appoint to organize a concerted effort of national and international
agencies to work to gather with strong links to support clinical and
public health infrastructure,and advocacy and funding support from
international community to fucus on good prospect for contriving RF and
RHD over next few years. RF and RHD recent years become mostly is a
regional and need world wide efforts tackle Rf and RH. these disease
related to poverty specially countries affected by war or internal
conflicts and specially affected life of young people in third world
countries we now stand at a critical junction of RF and RHd. This brings
real opportunities to make dramatic progress in the next few years,if we
miss these opportunities these disease may reached to an endemic point in
the third world countries Research is the base to find out the severity of
the disease and incidence and prevalence and we must organize a global
solution to control the spreared of RF and RHD. With concreted efforts
mixture of basic,applied and implementation science-strong links to
clinical and public health infrastructure,advocacy and funding support
from international community and same efforts as going on to tackle
Polio,Malaria and Tuberculosis. to tackle the disease we have plan
solution for the following chalnges 1-chalnge-1st new approaches to
integrating centralized control research program 2-chalange 2th clinical
trial and basics research to understand new phases-to tackle and reduce
the incidence 3-chalange 3th To find a vaccination to prevent the
disease-to identify people with with RF in first stages-and specific
research regarding effecient medical treatment and surgical treatment
before heart failure occur.

<56>
Accession Number
623221179
Title
Is Pulmonary hypertension a risk factor of postoperative atrial
fibrillation in patients undergone coronary artery bypass grafting?.
Source
American Journal of Cardiology. Conference: 14th International Congress of
Update in Cardiology and Cardiovascular Surgery, UCCVS. Turkey. 121 (8
Supplement 1) (pp e21), 2018. Date of Publication: April 2018.
Author
Akca B.; Erdil N.; Battaloglu B.
Institution
(Akca, Erdil, Battaloglu) Inonu University, Malatya, Turkey
Publisher
Elsevier Inc.
Abstract
Objective: This study aimed to establish whether pulmonary hypertension is
one of the risk factors in the etiology of postoperative atrial
fibrillation (AF) after coronary artery bypass grafting (CABG).
 Method(s): 698 patients who underwent isolated coronary artery bypass
graft operation with preoperative echocardiography and pulmonary pressure
measurement were included in the study. Five hundred and ninetyfour of
these patients did not have anyAF (Non-AF Group) and the other one hundred
and four had AF (AF Group). A retrospective study was performed for
patient, disease and treatment related factors and multivariate analysis
was used to identify independent clinical predictors of postoperative AF.
 Result(s): Patients with AF were significantly older and had
significantly higher additive EuroSCORE score as compared with patients
without AF. According to the multivariate regression analysis, mean
pulmonary artery pressure (OR 1.027, 95% CI 1.005-1.050, p = 0.018); and
pulmonary hypertension (mean pulmonary pressure >= 30 mm Hg) (OR 1.800,
95% CI 1.151-2.814, p = 0.009) were independent risk factors for
postoperative AF. COPD, advanced age, and mean duration of ventilation (OR
1.831, 2.992, 1.082, respectively) were also identified as risk factors
for postoperative atrial fibrillation. Conclusion(s): Analysis of our
data reveals that, patient's age, additive EuroSCORE score, and prolonged
ventilation, increased pulmonary pressures are predictors of postoperative
AF. Recognition of risk factors will guide us for better prevention of
this complication and its potential consequences. Nevertheless,
prospective randomized controlled trials needed to support this research
and obtain more reliable evidence.

<57>
Accession Number
623221171
Title
Effect of plasma level of Vitamin D on postoperative atrial fibrillation
in patients undergoing isolated coronary artery bypass grafting.
Source
American Journal of Cardiology. Conference: 14th International Congress of
Update in Cardiology and Cardiovascular Surgery, UCCVS. Turkey. 121 (8
Supplement 1) (pp e43), 2018. Date of Publication: April 2018.
Author
Ozsin K.K.; Kahraman N.
Institution
(Ozsin, Kahraman) University of Health Sciences, Bursa Yuksek Ihtisas
Research and Trainning Hospital, Bursa, Turkey
Publisher
Elsevier Inc.
Abstract
Objective: Postoperative atrial fibrillation (PoAF) is a common
complication after coronary artery bypass grafting (CABG). The aim of this
study was to evaluate the relationship between development of PoAF and
Vitamin D levels in patients undergoing isolated CABG. Method(s):
This prospective randomized clinical trial was conducted on isolated CABG
patients. The study was terminated after reaching 50 patients in both
PoAF(+) group and PoAF(-) group.We assessed the development of AF until
discharge period. While, the level of Vitamin D was measured immediately
after development AF, it was measured on the day discharged from the
hospital in patients without PoAF. Predictive values of the independent
variables were measured for the development of PoAF. Result(s): The
groups were separated as PoAF(-) group (66% male, mean age 58.18 +/- 10.98
years) and PoAF(+) group (74% male, mean age 61.94 +/- 10.88 years).
25(OH) Vitamin D level (OR = 0.855, 95% CI: 0.780-0.938, p = 0.001) and be
age = 65 years (OR = 3.525, 95% CI: 1.310-9.483, p = 0.013) were
identified as an independent predictor of postoperative AF after CABG
surgery in multivariate analysis. It was determined a cut-off level of
7.65 for 25(OH) Vitamin D level for predicting PoAF with a sensitivity of
60 % and a specificity of 64 % (area under the curve: 0.679, p = 0.002).
 Conclusion(s): In this study, we found that Vitamin D level was an
independent predictor of the development of PoAF. Low Vitamin D levels may
be one of the reasons for PoAF development.

<58>
Accession Number
623221166
Title
Application of titanium plate fixation in sternal dehiscence after cardiac
surgery.
Source
American Journal of Cardiology. Conference: 14th International Congress of
Update in Cardiology and Cardiovascular Surgery, UCCVS. Turkey. 121 (8
Supplement 1) (pp e26-e27), 2018. Date of Publication: April 2018.
Author
Atay M.; Toz H.; Acikgoz B.; Turkyilmaz S.; Kavala A.A.
Institution
(Atay, Toz, Acikgoz, Turkyilmaz, Kavala) Bakirkoy Dr. Sadi Konuk Egitim Ve
Arastirma Hastanesi, Istanbul, Turkey
Publisher
Elsevier Inc.
Abstract
Objective: Sternal dehiscence which occurs 0,4-5,1% after cardiac surgery
is a risk factor for morbidity and mortality. Steel wire, steel cable,
titanium clips and titanium plates can be used for sternal repair.We aim
to present our results of titanium plate fixation in the patients with
sternal dehiscence after cardiac surgery. Method(s): We
retrospectively reviewed 14 patients who underwent sternal dehiscence
repair with titanium plate after cardiac surgery between January
2017-December 2017 in our department. Age, gender, comorbid diseases, body
mass index (BMI), number of reoperations, hospital stay and mortality was
assessed. Result(s): Mean BMI was 30,6 +/- 3,4 kg/m2. Seven patients
had diabetes while 2 patients scheduled for dialysis due to chronic kidney
disease. Infection was detected in 5 patients who had sternal drainage and
they immediately scheduled for antibiotherapy. Vacuum assisted closure
(VAC) was also planned in this group of patients. Mean hospital stay for
all patients was 39.2 +/- 33,5 days. Conclusion(s): Sternal
stabilization can be done using different application methods in the
sternal dehiscence after cardiac surgery. Titanium plate fixation can be
the treatment of choice especially in obese patients. However, we conclude
that randomized controlled studies should be done to assess the treatment
modalities.

<59>
Accession Number
623221143
Title
Does ankle brachial index predict postoperative acute renal failure in
open heart surgery patients?.
Source
American Journal of Cardiology. Conference: 14th International Congress of
Update in Cardiology and Cardiovascular Surgery, UCCVS. Turkey. 121 (8
Supplement 1) (pp e27), 2018. Date of Publication: April 2018.
Author
Dagli M.; Yilmaz I.S.; Cicek M.C.; Altynbas O.; Baysal A.N.; Kalender M.
Institution
(Dagli, Yilmaz, Cicek, Altynbas, Baysal) University of Healty Sciences,
Konya Education and Research Hospital, Konya, Turkey
(Kalender) University of Healty Sciences, Derince Education and Research
Hospital, Kocaeli, Turkey
Publisher
Elsevier Inc.
Abstract
Acute kidney injury (AKI) after open heart surgery is an important
perioperative complication that increases patient mortality and morbidity.
Ankle brachial index (ABI), which directly indicates atherosclerotic
disease in the lower extremity, indirectly indicates atherosclerosis in
other vascular systems. ABI is a powerful predictor of cardiovascular
disease and a strong predictor of cardiovascular events and mortality. Our
aim is to determine the role of ABI in predicting AKI in patients who will
undergo open heart surgery. 141 of 257 patients who had undergone open
heart surgery during the last 2 years were included. Exclusion criteria
are; emergency operation, low EF < 50%, and impaired renal function before
surgery. 58 of these 141 patients (23 women)had valve replacement and 83
of them (45 women) were CABG. Mean age is 68 +/- 11. Preoperative ABI,
demographic data, laboratory data, cross-clamp time, pump duration, and
postoperative day 1 and day 2 laboratory data were recorded for all
patients. Independent variables of postoperative creatinine elevation in
our study were ABI, hypertension, advanced age, cross-clamp time and
duration of the pump. The group developing AKI was hypertensive and had a
lowABI (<0,9). The presence of hypertension is an independent risk factor
in terms of post-operative AKI development. Low (<0.9) and high (>1,3) ABI
score are that Atherosclerotic vascular disease is an independent risk
factor in patient groups as well as mortality and morbidity. We found
statistically significant improvement in acute renal failure in patients
with low ABI in our study (p < 0.045). We observed that AKI was more
frequent in patients with high ABI values, although this was not
statistically significant. Diabetes mellitus was present in 58% of
patients (82/141). We observed that the incidence of AKI was even faster,
although not statistically significant, in patients with diabetes
mellitus. Patients who underwent valve operation as a subgroup study were
group 1; patients undergoing coronary surgery were classified as group
2.We did not find a statistically significant difference in the incidence
of AKI when comparing ABI values between 2 groups. The ABI score has been
shown to be associated with increased prevalence of both microvascular and
macrovascular complications in high diabetic patients, macroalbuminuria
and chronic renal disease. ABI score is not only a risk indicator for PAH
but also a general indicator for all pathologies with atherosclerosis and
endothelial damage. In our study, the cross and pump duration were
determined as independent risk factors for postoperative AKI. In
conclusion, ABI, which is accepted as open vessel surgery predictor in a
relatively low risk patient population in terms of AKI, with normal renal
function and open heart surgery, is an independent indicator of
postoperative renal function change. The results need to be supported by
the results of controlled trials involving more patients with high and
lowABI values.

<60>
Accession Number
623221095
Title
Comparison of left atriotomy and superior transseptal approaches in mitral
valve surgery.
Source
American Journal of Cardiology. Conference: 14th International Congress of
Update in Cardiology and Cardiovascular Surgery, UCCVS. Turkey. 121 (8
Supplement 1) (pp e96), 2018. Date of Publication: April 2018.
Author
Turkyilmaz S.
Institution
(Turkyilmaz) Bakirkoy Dr. Sadi Konuk Egitim Ve Arastirma Hastanesi,
Istanbul, Turkey
Publisher
Elsevier Inc.
Abstract
Purpose: To compare the operative and post-operative outcomes of mitral
valve surgery (MVS) with a superior transseptal (STS) approach and a left
atriotomy (LA) approach. Method(s): In two tertiary academic centers,
the charts of patients who underwent MVS between 2012 and 2016 were
analyzed retrospectively. A total of 135 patients underwent MVS. Forty
patients who underwent MVS with the STS approach were enrolled in the
study as Group 1. In the same period, we selected 40 patients who
underwent MVS with the LA approach to serve as the control group (Group
2). To minimize the bias related to the lack of randomization in this
observational study, Group 2 patients were selected using propensity score
matching. Result(s): According to the study design, the preoperative
characteristics of gender, age, mitral valve stenosis and mitral valve
insufficiency were matched (p = 0.368, p = 0.920, p = 0.250 and p = 0.057,
respectively). The cardiopulmonary bypass time was 91.2 +/- 12.1 minutes
in the superior transseptal group and 72.8 +/- 6.4 minutes in the left
atriotomy group (p<0.001). Additionally, duration of clamp time was
significantly shorter in the left atriotomy group (p<0.001). Hemorrhage
was significantly less in patients with a left atriotomy (535.8 ml vs
658.0 ml, p<0.001). Duration of intensive care unit stay and
hospitalization time were significantly longer in patients who underwent
the superior transseptal approach compared to patients who underwent left
atriotomy (p<0.001 vs p<0.001, respectively). Post-operative dysrhythmia
rate and mortality rate were similar between the groups.
 Conclusion(s): Our study demonstrated that MVS with LA decreased
cardiopulmonary bypass time, duration of clamp time, amount of hemorrhage,
duration of intensive care unit stay and hospitalization time compared to
MVS with STS.

<61>
Accession Number
623203775
Title
Building biorepository for cardiovascular research: The Vanderbilt human
heart and tissue biobank.
Source
Biopreservation and Biobanking. Conference: Annual Meeting of the
International Society of Biological and Environmental Repositories and
Exhibits, ISBER 2018. United States. 16 (3) (pp A35-A36), 2018. Date of
Publication: 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.

<62>
Accession Number
625285291
Title
Efficacy and safety of nicorandil on perioperative myocardial injury in
patients undergoing elective percutaneous coronary intervention: Results
of the PENMIPCI trial.
Source
Drug Design, Development and Therapy. 12 (pp 2591-2599), 2018. Date of
Publication: 2018.
Author
Ye Z.; Lu H.; Su Q.; Long M.; Li L.
Institution
(Ye, Su, Long, Li) Department of Cardiology, The First Affiliated Hospital
of Guangxi Medical University, Nanning, Guangxi, China
(Lu) Department of Orthodontics, The Affiliated Dental Hospital of Guangxi
Medical University, Nanning, Guangxi, China
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background: Previous studies have indicated that nicorandil can reduce
perioperative myocardial injury (PMI) in patients undergoing elective
percutaneous coronary intervention (ePCI), but this conclusion is still
controversial. Additionally, studies reporting on the safety of nicorandil
are lacking. Therefore, we performed this prospective study to evaluate
the efficacy and safety of nicorandil on PMI in patients undergoing ePCI.
 Method(s): One hundred and forty-six patients with coronary heart
disease (CHD) scheduled to undergo ePCI were randomly assigned to the
nicorandil group (n=74) or control group (n=72). The primary outcomes were
the change in cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB) at
12 and 24 hours after surgery. The secondary outcome was the incidence of
major adverse cardiac events (MACE), which was a composite of cardiac
death, nonfatal myocardial infarction, new heart failure or coronary
revascularization. Result(s): There was no difference in age
(54.76+/-5.93 vs 56.35+/-5.22) between the nicorandil group and the
control group. In addition, no differences were observed in the cTnT and
CK-MB levels between the two groups at admission (all P>0.05). Compared
with those in the control group, the cTnT (0.15+/-0.12 vs 0.12+/-0.10 at
12 hours and 0.17+/-0.12 vs 0.13+/-0.10 at 24 hours) and CK-MB
(15.35+/-8.23 vs 12.31+/-7.93 at 12 hours and 13.63+/-8.87 vs 11.13+/-5.71
at 24 hours) levels in the nicorandil group were significantly decreased
after surgery (all P<0.05). Furthermore, nicorandil did not increase the
incidence of MACE in the nicorandil group compared with the control group
(12.16% vs 12.50%). Conclusion(s): Nicorandil can reduce PMI in
patients undergoing ePCI and does not increase the incidence of
MACE. Copyright © 2018 Ye et al.

<63>
Accession Number
2001352697
Title
Optimal Position of Inferior Vena Cava Cannula in Pediatric Cardiac
Surgery: A Prospective, Randomized, Controlled, Double-Blind Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Author
Seino Y.; Ohashi N.; Imai H.; Baba H.
Institution
(Seino, Ohashi, Imai, Baba) Division of Anesthesiology, Niigata University
Graduate School of Medical and Dental Sciences, Asahimachi, Niigata, Japan
Publisher
W.B. Saunders
Abstract
Objective: To examine the authors' hypothesis that during the
cardiopulmonary bypass (CPB) in children, the inferior vena cava cannula
tip placed proximal to the right hepatic vein orifice would produce a
higher venous drainage compared with that placed distally. Design(s):
A prospective, randomized, controlled, double-blind study.
 Setting(s): Single university hospital. Participant(s):
Thirty-two patients aged <6 years, scheduled for elective cardiac surgery
using CPB for congenital heart disease. Intervention(s): Participants
were randomized to 2 groups: the proximal group with the cannula tip
placed proximally within 1 cm of the right hepatic vein orifice and the
distal group with the cannula placed distally within 1 cm of the right
hepatic vein orifice. Measurements and Main Results: The primary
outcome of this study was the perfusion flow rate at the time of
establishment of total CPB with cardioplegia. The authors initially
planned to enroll 60 patients, but before reaching the target sample size,
the authors terminated this study owing to patient safety, and 18 patients
in the proximal group and 14 patients in the distal group finally were
analyzed. No significant differences in patient characteristics were
observed between the 2 groups. The mean perfusion flow rate in the
proximal group was significantly greater (2.55 +/- 0.27
L/min/m2) than that in the distal group (2.37 +/- 0.20
L/min/m2, p = 0.04). Conclusion(s): The inferior vena cava
cannula tip placed in the proximal position was clinically superior,
compared with a distal placement, in producing higher perfusion flow in
children. Copyright © 2018 Elsevier Inc.

<64>
Accession Number
614951242
Title
Randomized Evaluation of the Effects of Anacetrapib through
Lipid-modification (REVEAL)-A large-scale, randomized, placebo-controlled
trial of the clinical effects of anacetrapib among people with established
vascular disease: Trial design, recruitment, and baseline characteristics.
Source
American Heart Journal. 187 (pp 182-190), 2017. Date of Publication: 01
May 2017.
Author
Bowman L.; Chen F.; Sammons E.; Stevens W.; Valdes-Marquez E.; Wiviott S.;
Cannon C.P.; Braunwald E.; Collins R.; Landray M.J.; Hopewell J.C.; Jiang
L.; Armitage J.; Haynes R.; Maggioni A.P.; Ertl G.; Angermann C.E.;
Pedersen T.; Goto S.; Teramoto T.; Gray A.; Mihaylova B.; Baigent C.;
Barter P.; Chen Y.; Chen Z.; Tobert J.; Sleight P.; Blaustein R.; DeLucca
P.; Mitchel Y.; van Leijenhorst G.; Sandercock P.; DeMets D.; Kjekshus J.;
Neuberger J.; Tonkin A.; Emberson J.; Granger C.; Colhoun H.; Wallendszus
K.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Patients with prior vascular disease remain at high risk for
cardiovascular events despite intensive statin-based treatment. Inhibition
of cholesteryl ester transfer protein by anacetrapib reduces low-density
lipoprotein (LDL) cholesterol by around 25% to 40% and more than doubles
high-density lipoprotein (HDL) cholesterol. However, it is not known if
these apparently favorable lipid changes translate into reductions in
cardiovascular events. Methods The REVEAL study is a randomized,
double-blind, placebo-controlled clinical trial that is assessing the
efficacy and safety of adding anacetrapib to effective LDL-lowering
treatment with atorvastatin for an average of at least 4 years among
patients with preexisting atherosclerotic vascular disease. The primary
assessment is an intention-to-treat comparison among all randomized
participants of the effects of allocation to anacetrapib on major coronary
events (defined as the occurrence of coronary death, myocardial
infarction, or coronary revascularization). Results Between August 2011
and October 2013, 30,449 individuals in Europe, North America, and China
were randomized to receive anacetrapib 100 mg daily or matching placebo.
Mean (SD) age was 67 (8) years, 84% were male, 88% had a history of
coronary heart disease, 22% had cerebrovascular disease, and 37% had
diabetes mellitus. At the randomization visit (after at least 8 weeks on a
protocol-defined atorvastatin regimen), mean plasma LDL cholesterol was 61
(15) mg/dL and HDL cholesterol was 40 (10) mg/dL. Interpretation The
REVEAL trial will provide a robust evaluation of the clinical efficacy and
safety of adding anacetrapib to an effective statin regimen. Results are
anticipated in 2017. Copyright © 2017 The Authors

<65>
Accession Number
2001289022
Title
Endocarditis After Transcatheter Pulmonary Valve Replacement.
Source
Journal of the American College of Cardiology. 72 (22) (pp 2717-2728),
2018. Date of Publication: 4 December 2018.
Author
McElhinney D.B.; Sondergaard L.; Armstrong A.K.; Bergersen L.; Padera
R.F.; Balzer D.T.; Lung T.-H.; Berger F.; Zahn E.M.; Gray R.G.;
Hellenbrand W.E.; Kreutzer J.; Eicken A.; Jones T.K.; Ewert P.
Institution
(McElhinney) Lucile Packard Children's Hospital Stanford, Palo Alto, CA,
United States
(Sondergaard) The Heart Center, Rigshospitalet, University of Copenhagen,
Copenhagen, Denmark
(Armstrong) Nationwide Children's Hospital, Columbus, OH, United States
(Bergersen) Boston Children's Hospital, Boston, MA, United States
(Padera) Brigham and Women's Hospital, Children's Hospital Boston and
Harvard Medical School, Boston, MA, United States
(Balzer) St. Louis Children's Hospital, St. Louis, MO, United States
(Lung) Medtronic, Santa Rosa, CA, United States
(Berger) Deutsches Herzzentrum Berlin, Berlin, Germany
(Zahn) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Gray) University of Utah, Salt Lake City, UT, United States
(Hellenbrand) Yale School of Medicine, New Haven, CT, United States
(Kreutzer) Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA,
United States
(Eicken, Ewert) German Heart Center Munich, Munich, Germany
(Jones) Seattle Children's Hospital, Seattle, WA, United States
Publisher
Elsevier USA
Abstract
Background: Endocarditis has emerged as one of the most concerning adverse
outcomes in patients with congenital anomalies involving the right
ventricular outflow tract (RVOT) and prosthetic valves. Objective(s):
The aim of this study was to evaluate rates and potential risk factors for
endocarditis after transcatheter pulmonary valve replacement in the
prospective Melody valve trials. Method(s): All patients in whom a
transcatheter pulmonary valve (TPV) was implanted in the RVOT as part of 3
prospective multicenter studies comprised the analytic cohort. The
diagnosis of endocarditis and involvement of the TPV were determined by
the implanting investigator. Result(s): A total of 309 patients
underwent transcatheter pulmonary valve replacement (TPVR) and were
discharged with a valve in place. The median follow-up duration was 5.1
years, and total observation until study exit was 1,660.3 patient-years.
Endocarditis was diagnosed in 46 patients (median 3.1 years after TPVR),
and a total of 35 patients were reported to have TPV-related endocarditis
(34 at the initial diagnosis, 1 with a second episode). The annualized
incidence rate of endocarditis was 3.1% per patient-year and of
TPV-related endocarditis was 2.4% per patient-year. At 5 years post-TPVR,
freedom from a diagnosis of endocarditis was 89% and freedom from
TPV-related endocarditis was 92%. By multivariable analysis, age <=12
years at implant (hazard ratio: 2.3; 95% confidence interval: 1.2 to 4.4;
p = 0.011) and immediate post-implant peak gradient >=15 mm Hg (2.7; 95%
confidence interval: 1.4 to 4.9; p = 0.002) were associated with
development of endocarditis and with development of TPV-related
endocarditis (age <=12 years: 2.8; 95% confidence interval: 1.3 to 5.7; p
= 0.006; gradient >=15 mm Hg: 2.6; 95% confidence interval: 1.3 to 5.2; p
= 0.008). Conclusion(s): Endocarditis is an important adverse outcome
following TVPR in children and adults with post-operative congenital heart
disease involving the RVOT. Ongoing efforts to understand, prevent, and
optimize management of this complication are paramount in making the best
use of TPV therapy. (Melody Transcatheter Pulmonary Valve [TPV] Study:
Post Approval Study of the Original Investigational Device Exemption [IDE]
Cohort; NCT00740870; Melody Transcatheter Pulmonary Valve Post-Approval
Study; NCT01186692; and Melody Transcatheter Pulmonary Valve [TPV]
Post-Market Surveillance Study; NCT00688571) Copyright © 2018
American College of Cardiology Foundation

<66>
Accession Number
625195334
Title
Levosimendan versus placebo in cardiac surgery: A systematic review and
meta-Analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (5) (pp 677-685),
2018. Date of Publication: 01 Nov 2018.
Author
Tena M.; Urso S.; Gonzalez J.M.; Santana L.; Sadaba R.; Juarez P.;
Gonzalez L.; Portela F.
Institution
(Tena, Urso, Portela) Department of Cardiac Surgery, Hospital
Universitario Dr. Negrin, Barranco de la Ballena, s/n, Las Palmas de Gran
Canaria 35010, Spain
(Gonzalez) Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de
Gran Canaria, Spain
(Santana) Department of Anesthesiology, Hospital Universitario Dr. Negrin,
Las Palmas de Gran Canaria, Spain
(Sadaba) Department of Cardiac Surgery, Complejo Hospitalario de Navarra,
Pamplona, Spain
(Juarez, Gonzalez) Intensive Care Unit, Hospital Universitario Dr. Negrin,
Las Palmas de Gran Canaria, Spain
Publisher
Oxford University Press
Abstract
The aim of this meta-Analysis was to review all published randomized
clinical trials comparing levosimendan versus placebo in patients
undergoing cardiac surgery. PubMed, EMBASE and the Cochrane library
database of clinical trials were searched for prospective randomized
clinical trials investigating the perioperative use of levosimendan versus
placebo in patients undergoing adult cardiac surgery from 1 May 2000 to 10
April 2017. Binary outcomes from individual studies were analysed to
compute individual and pooled risk ratios (RRs) with pertinent 95%
confidence intervals (CIs). Fourteen randomized clinical trials with a
total of 2243 patients were included in this review. Overall meta-Analysis
results demonstrated that levosimendan was associated with a significant
reduction in 30-day mortality (RR = 0.71, 95% CI = 0.53-0.95; P = 0.023).
Subgroup analysis showed that this benefit was confined to the moderate
and low ejection fraction studies (RR = 0.44, 95% CI = 0.27-0.70; P <
0.001), whereas no benefit was observed in the preserved ejection fraction
studies (RR = 1.06, 95% CI = 0.72-1.56; P = 0.78). Levosimendan also
reduced the risk of renal replacement therapy (RR = 0.66, 95% CI =
0.47-0.92; P = 0.015) and low cardiac output (RR = 0.40, 95% CI =
0.22-0.73; P = 0.003). No significant differences were detected, between
the levosimendan group and the placebo group, in terms of risk of
myocardial injury (RR = 0.90, 95% CI = 0.69-1.17; P = 0.44), intensive
care unit stay (weighted mean differences =-0.57, 95% CI =-1.15 to 0.01; P
= 0.055) and the use of ventricular assist device (RR = 0.42, 95% CI =
0.07-2.63; P = 0.35). In conclusion, levosimendan was associated with a
reduced risk of mortality, renal replacement therapy and low cardiac
output syndrome in patients undergoing cardiac surgery. Copyright
© The Author(s) 2018. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<67>
Accession Number
2001325769
Title
Transcatheter Versus Surgical Aortic Valve Replacement in Patients With
Prior Cardiac Surgery in the Randomized PARTNER 2A Trial.
Source
JACC: Cardiovascular Interventions. 11 (21) (pp 2207-2216), 2018. Date of
Publication: 12 November 2018.
Author
Chen S.; Redfors B.; Ben-Yehuda O.; Crowley A.; Greason K.L.; Alu M.C.;
Finn M.T.; Vahl T.P.; Nazif T.; Thourani V.H.; Suri R.M.; Svensson L.;
Webb J.G.; Kodali S.K.; Leon M.B.
Institution
(Chen, Redfors, Ben-Yehuda, Crowley, Leon) Cardiovascular Research
Foundation, New York, NY, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Greason) Department of Cardiovascular Surgery, Mayo Clinic, Rochester,
MN, United States
(Alu, Finn, Vahl, Nazif, Kodali, Leon) Columbia University Medical
Center/NewYork-Presbyterian Hospital, New York, NY, United States
(Thourani) Medstar Heart & Vascular Institute, Washington, District of
Columbia, United States
(Suri, Svensson) Cleveland Clinic, Cleveland, OH, United States
(Webb) St. Paul's Hospital, University of British Columbia, Vancouver,
British Columbia, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to further evaluate clinical
outcomes in patients with and without PCS. Background(s): Prior
cardiac surgery (PCS) is associated with increased surgical risk and
post-operative complications following surgical aortic valve replacement
(SAVR), but whether this risk is similar in transcatheter aortic valve
replacement (TAVR) is unclear. Method(s): In the PARTNER 2A
(Placement of Aortic Transcatheter Valve) trial, 2,032 patients with
severe aortic stenosis at intermediate surgical risk were randomized to
TAVR with the SAPIEN XT valve or SAVR. Adverse clinical outcomes at 30
days and 2 years were compared using Kaplan-Meier event rates and
multivariate Cox proportional hazards regression models. The primary
endpoint of the PARTNER 2 trial was all-cause death and disabling stroke.
 Result(s): Five hundred nine patients (25.1%) had PCS, mostly (98.2%)
coronary artery bypass grafting. There were no significant differences
between TAVR and SAVR in patients with or without PCS in the rates of the
primary endpoint at 30 days or 2 years. Nevertheless, an interaction was
observed between PCS and treatment arm; whereas no-PCS patients treated
with TAVR had higher rates of 30-day major vascular complications than
patients treated with SAVR (adjusted hazard ratio: 2.66; 95% confidence
interval: 1.68 to 4.22), the opposite was true for patients with PCS
(adjusted hazard ratio: 0.27; 95% confidence interval: 0.11 to 0.66)
(p<inf>interaction</inf> <0.0001). A similar interaction was observed for
life-threatening or disabling bleeding. Conclusion(s): In the PARTNER
2A trial of intermediate-risk patients with severe aortic stenosis
undergoing SAVR versus TAVR, the relative risk for 2-year adverse clinical
outcomes was similar between TAVR and SAVR in patients with or without
PCS. Copyright © 2018 American College of Cardiology Foundation

<68>
Accession Number
625195663
Title
Is surgical Apgar score an effective assessment tool for the prediction of
postoperative complications in patients undergoing oesophagectomy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (5) (pp 686-691),
2018. Date of Publication: 01 Nov 2018.
Author
Li S.; Zhou K.; Li P.; Che G.
Institution
(Li, Zhou, Li, Che) Department of Thoracic Surgery, West China Hospital,
Sichuan University, Guoxue Alley No.37, Chengdu 610041, China
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether the surgical Apgar
score (SAS) was an effective assessment tool for the prediction of
postoperative complications in patients undergoing oesophagectomy. In
total, 7 papers were identified using the reported search, of which 6
cohort studies represented the best evidence to answer the clinical
question. The authors, journal, date and country of publication, patient
group studied, study type, relevant outcomes and results of these papers
are tabulated. Five of 6 cohort studies demonstrated that a low SAS was
significantly associated with more postoperative complications in patients
undergoing oesophagectomy. The rates of major individual complications in
patients with a lower SAS were commonly higher than those in patients with
a higher SAS. Two cohort studies further reported that a low SAS was
significantly associated with the prolonged length of stay. The cut-off
value of the SAS that had the discriminative power for patients who were
considered at high morbidity risk, however, was not defined but was more
likely to be 6 or less. Current available evidence suggests that the SAS
system may serve as an effective assessment tool for the prediction of
morbidity risk after oesophagectomy. Copyright © The Author(s)
2018. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<69>
Accession Number
2000717740
Title
The predictive value of baseline pulmonary hypertension in early and long
term cardiac and all-cause mortality after transcatheter aortic valve
implantation for patients with severe aortic valve stenosis: A systematic
review and meta-analysis.
Source
Cardiovascular Revascularization Medicine. Part B. 19 (7) (pp 859-867),
2018. Date of Publication: October - November 2018.
Author
Kokkinidis D.G.; Papanastasiou C.A.; Jonnalagadda A.K.; Oikonomou E.K.;
Theochari C.A.; Palaiodimos L.; Karvounis H.I.; Armstrong E.J.; Faillace
R.T.; Giannakoulas G.
Institution
(Kokkinidis, Palaiodimos, Faillace) Department of Medicine, Jacobi Medical
Center, Albert Einstein College of Medicine, Bronx, NY, United States
(Kokkinidis, Armstrong) Division of Cardiology, Denver VA Medical Center
and University of Colorado, Denver, United States
(Papanastasiou, Karvounis, Giannakoulas) 1st Cardiology Department, AHEPA
University Hospital, Aristotle University of Thessaloniki, Thessaloniki,
Greece
(Jonnalagadda) Division of Cardiology, Medstar, Washington Hospital
Center, DC, United States
(Oikonomou, Theochari) Cardiology Working Group, Society of Junior
Doctors, Athens, Greece
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is a safe and
effective alternative to surgical aortic valve replacement (SAVR) for the
treatment of severe aortic valve stenosis (AS). The impact of concomitant
baseline elevated pulmonary artery pressures on outcomes after TAVI has
not been established, since different studies used different definitions
of pulmonary hypertension (PH). Objective(s): To determine the
association of PH with early and late cardiac and all-cause mortality
after TAVI. Method(s): We performed a meta-analysis of studies
comparing patients with elevated pulmonary artery pressures (defined as
pulmonary hypertension or not) versus patients without elevated pulmonary
artery pressures undergoing TAVI. We first performed stratified analyses
based on the different PH cut-off values utilized by the included studies
and subsequently pooled the studies irrespective of their cut-off values.
We used a random effects model for the meta-analysis and assessed
heterogeneity with I-square. Separate meta-analyses were performed for
studies reporting outcomes as hazards ratios (HRs) and relative risks
(RRs). Subgroup analyses were performed for studies published before and
after 2013. Meta-regression analysis in order to assess the effect of
chronic obstructive pulmonary disease and mitral regurgitation were
performed. Result(s): In total 22 studies were included in this
systematic review. Among studies presenting results as HR, PH was
associated with increased late cardiac mortality (HR: 1.8. 95% CI:
1.3-2.3) and late all-cause mortality (HR: 1.56; 95% CI: 1.1-2). The PH
cut-off value that was most likely to be associated with worst outcomes
among the different endpoints was pulmonary artery systolic pressure of 60
mm Hg (HR: 1.8; 95% CI: 1.3-2.3; I2 = 0, for late cardiac
mortality and HR: 1.52; 95% CI: 1-2.1; I2 = 85% for late
all-cause mortality). Conclusion(s): This systematic review and
meta-analysis emphasizes the importance of baseline PH in predicting
mortality outcomes after TAVI. Additional studies are needed to clarify
the association between elevated baseline pulmonary artery pressures and
outcomes after TAVI. Copyright © 2018 Elsevier Inc.

<70>
Accession Number
620728255
Title
A Trial of Two Anesthetic Regimes for Minimally Invasive Mitral Valve
Repair.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (6) (pp 2562-2569),
2018. Date of Publication: December 2018.
Author
Moscarelli M.; Terrasini N.; Nunziata A.; Punjabi P.; Angelini G.; Solinas
M.; Buselli A.; Sarto P.D.; Haxhiademi D.
Institution
(Moscarelli) GVM Care & Research, Anthea Hospital, Bari, Italy
(Terrasini, Nunziata, Sarto, Haxhiademi) Operative Unit of Anesthesiology,
G. Pasquinucci Heart Hospital, Fondazione Toscana G. Monasterio, Massa,
Italy
(Punjabi) Imperial College of London, Hammersmith Hospital, London, United
Kingdom
(Angelini) Bristol Heart Institute, University of Bristol, School of
Clinical Sciences, Bristol, United Kingdom
(Solinas) Operative Unit of Cardiac Surgery, G. Pasquinucci Heart
Hospital, Fondazione Toscana G. Monasterio, Massa, Italy
(Buselli) Perfusion Department, G. Pasquinucci Heart Hospital, Fondazione
Toscana G. Monasterio, Massa, Italy
Publisher
W.B. Saunders
Abstract
Objective: Minimally invasive mitral valve repair may be associated with
prolonged cardioplegic arrest times and ischemic reperfusion injury.
Intravenous (propofol) and volatile (sevoflurane) anesthesia are used
routinely during cardiac surgery and are thought to provide
cardioprotection; however, the individual contribution of each regimen to
cardioprotection is unknown. Therefore, the authors sought to compare the
cardioprotective effects of propofol and sevoflurane anesthesia in
patients undergoing minimally invasive mitral valve repair.
 Design(s): A single-center single-blind randomized controlled trial.
 Setting(s): A specialized regional cardiac surgery center in Italy.
 Participant(s): The study enrolled 62 adults undergoing elective
isolated minimally invasive mitral valve repair for degenerative disease.
Exclusion criteria included secondary mitral regurgitation, previously
treated coronary artery disease, diabetes mellitus, chronic renal failure
requiring dialysis, atrial fibrillation, and documented allergy to either
propofol or sevoflurane. Intervention(s): All patients received
video-assisted minimally invasive right minithoracotomy. Patients were
randomized to receive propofol or sevoflurane anesthesia in a 1:1 ratio.
 Measurements and Main Results: Cardiac troponin I release was
measured over the first 72 hours postoperatively. Operative, cross-clamp,
and total bypass times were similar between groups. Cardiac troponin I
release was reduced nonsignificantly in the propofol group (p = 0.62), and
peak troponin I release was correlated with cross-clamp time in both
groups. There were no differences in terms of intraoperative lactate
release and blood pH between groups. Conclusion(s): Propofol and
sevoflurane anesthesia were associated with similar degrees of myocardial
injury, indicating comparable cardioprotection. Myocardial injury was
related directly to the duration of cardioplegic arrest. Copyright
© 2018 Elsevier Inc.

<71>
Accession Number
624144220
Title
Clinical complete response after chemoradiotherapy for carcinoma of
thoracic esophagus: Is esophagectomy always necessary? A systematic review
and meta-analysis.
Source
Thoracic Cancer. 9 (12) (pp 1638-1647), 2018. Date of Publication:
December 2018.
Author
Wang J.; Qin J.; Jing S.; Liu Q.; Cheng Y.; Wang Y.; Cao F.
Institution
(Wang, Jing, Liu, Cheng, Wang, Cao) Department of Radiation Oncology, The
Fourth Hospital of Hebei Medical University, Shijiazhuang, China
(Qin) Department of Thoracic Surgery, Cancer Hospital of Chinese Academy
of Medical Sciences, Beijing, China
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Although a clinical complete response (cCR) after
chemoradiotherapy (CRT) could lead to a better prognosis, the choice of a
following strategy, such as surgical or non-surgical approach, remains
controversial. Method(s): All articles relevant to a comparison of
surgical and non-surgical treatment (including further definitive
chemoradiotherapy or active surveillance) for esophageal carcinoma
patients with a cCR after CRT were retrieved for meta-analysis. The final
date for data retrieval was 30 June 2018. Result(s): Four
retrospective studies including 648 patients met the inclusion criteria:
620 with squamous cell carcinoma and 28 with adenocarcinoma. The CRT +
surgery group had an advantage over the non-surgery group in regard to
two-year disease-free survival (DFS); however, the two groups showed
similar results in five-year DFS. The CRT + surgery group had an advantage
over the non-surgery group in two-year overall survival (OS);
nevertheless, the two groups showed similar results in five-year OS.
 Conclusion(s): Based on the available evidence, the addition of
surgery to thoracic locally advanced esophageal carcinoma patients with a
cCR after neoadjuvant CRT provided no advantage to long-term survival. As
an exception, the two-year DFS and OS could be improved. This research
conclusion might be more suitable to patients with squamous cell
carcinoma. Copyright © 2018 The Authors. Thoracic Cancer
published by China Lung Oncology Group and John Wiley & Sons Australia,
Ltd

<72>
Accession Number
2000715217
Title
The Effects of an Open-Lung Approach During One-Lung Ventilation on
Postoperative Pulmonary Complications and Driving Pressure: A Descriptive,
Multicenter National Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (6) (pp 2665-2672),
2018. Date of Publication: December 2018.
Author
Belda J.; Ferrando C.; Garutti I.
Institution
(Belda, Ferrando) Hospital Clinico de Valencia, Valencia, Spain, Spain
(Ferrando) CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos
III, Madrid, Spain, Spain
(Garutti) Hospital Gregorio Maranon de Madrid, Madrid, Spain, Spain
Publisher
W.B. Saunders
Abstract
Objective: Thoracic surgical procedures are associated with an increased
risk of postoperative pulmonary complications (PPCs), which seem to be
related directly to intraoperative driving pressure. The authors conducted
this study to describe the incidence of PPCs in patients in whom an
individualized open-lung approach was applied during one-lung ventilation.
 Design(s): This was a prospective, multicenter, national descriptive
study. Setting(s): Thoracic surgery patients undergoing one-lung
ventilation. Participant(s): Eligible participants were included
consecutively from October 1, 2016, to September 30, 2017. A total of 690
patients were included. Intervention(s): An individualized open-lung
approach that consisted of an alveolar recruitment maneuver followed by a
positive end-expiratory pressure adjusted to best respiratory system
compliance was performed in all patients. Measurements and Main
Results: Preoperative and intraoperative data were recorded; the primary
outcome was a description of the incidence of PPCs in these patients
during the first 7 postoperative days. The patients were mainly male, and
half of them had a high risk of PPCs (ARISCAT score exceeding 44). Eleven
percent of participants developed a PPC within the first postoperative
week. The mean open lung positive end-expiratory pressure was 8 +/- 3
cmH<inf>2</inf>O. When compared with pre-open lung approach values, the
open-lung approach significantly decreased the driving pressure (14 +/- 4
cmH<inf>2</inf>O v 11 +/- 3 cmH<inf>2</inf>O; p < 0.001) and increased
dynamic compliance (30 +/- 10 mL/cmH<inf>2</inf>O v 43 +/-15
mL/cmH<inf>2</inf>O; p < 0.001). Conclusion(s): The low incidence of
PPCs in patients who underwent an open-lung approach during one-lung
ventilation compared with that reported for other thoracic surgery series
and the decrease in the driving pressure in these patients justify an
additional randomized controlled trial to compare the open-lung approach
with the standard protective strategy of low tidal volume and low positive
end-expiratory pressure. Copyright © 2018 Elsevier Inc.

<73>
Accession Number
2000705146
Title
Nitric Oxide in Cardiac Surgery: A Meta-Analysis of Randomized Controlled
Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (6) (pp 2512-2519),
2018. Date of Publication: December 2018.
Author
Sardo S.; Osawa E.A.; Finco G.; Gomes Galas F.R.B.; de Almeida J.P.;
Cutuli S.L.; Frassanito C.; Landoni G.; Hajjar L.A.
Institution
(Sardo, Finco) Department of Medical Sciences and Public Health,
University of Cagliari, Monserrato, Italy, Italy
(Osawa) Intensive Care Unit, Instituto do Cancer, Hospital das Clinicas da
Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil,
Brazil
(Gomes Galas, de Almeida, Hajjar) Heart Institute, University of Sao
Paulo, Sao Paulo, Brazil, Brazil
(Cutuli) Department of Anesthesiology and Intensive Care, Universita
Cattolica del Sacro Cuore, Rome, Italy, Italy
(Frassanito, Landoni) IRCCS San Raffaele Scientific Institute, Milan,
Italy, Italy
(Landoni) Vita-Salute San Raffaele University of Milan, Milan, Italy,
Italy
Publisher
W.B. Saunders
Abstract
Objectives: To investigate the efficacy and safety of perioperative
administration of nitric oxide in cardiac surgery. Design(s):
Meta-analysis of randomized controlled trials (RCTs). Participant(s):
Cardiac surgery patients. Intervention(s): A search of Cochrane
Central Register of Controlled Trials (CENTRAL), Embase, and MEDLINE for
RCTs that compared nitric oxide with placebo or other comparators.
 Measurements and Main Results: The primary outcome was intensive care
unit (ICU) stay, and secondary outcomes were mortality, duration of
mechanical ventilation, and reduction of mean pulmonary artery pressure.
The study included 18 RCTs comprising 958 patients. The authors calculated
the pooled odds ratio (OR) and the mean difference (MD) with
random-effects model. Quantitative synthesis of data demonstrated a
clinically negligible reduction in the length of ICU stay (MD -0.38 days,
confidence interval CI [-0.65 to -0.11]; p = 0.005) and mechanical
ventilation duration (MD -4.81 hours, CI [-7.79 to -1.83]; p = 0.002)
compared with all control interventions with no benefit on mortality.
 Conclusion(s): Perioperative delivery of inhaled nitric oxide
resulted to be of no or minimal benefit in patients with pulmonary
hypertension undergoing cardiac surgery. Large, randomized trials are
needed to further assess its effect on major clinical outcomes and its
cost-effectiveness. Copyright © 2018 Elsevier Inc.

<74>
Accession Number
2000822273
Title
Dobutamine and Nitroglycerin Versus Milrinone for Perioperative Management
of Pulmonary Hypertension in Mitral Valve Surgery. A Randomized Controlled
Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (6) (pp 2540-2546),
2018. Date of Publication: December 2018.
Author
Eskandr A.M.; Metwally A.A.; Abu Elkassem M.S.; Sadik S.A.; Elmiligy A.E.;
Mourad M.; Hussein L.
Institution
(Eskandr, Metwally, Abu Elkassem, Sadik, Elmiligy) Anesthesia, ICU, and
Pain Therapy, Faculty of Medicine, Menoufiya University, Shibin El-koom,
Egypt
(Mourad, Hussein) Cardiothoracic Anesthesia and ICU, National Heart
Institute, Cairo, Egypt
Publisher
W.B. Saunders
Abstract
Objective: To compare the effects of dobutamine and nitroglycerin to
milrinone in young patients with severe pulmonary hypertension undergoing
mitral valve replacement. Design(s): A prospective randomized,
double-blinded, controlled study. Setting(s): Single university
hospital. Participant(s): Forty patients had systolic pulmonary
arterial pressure >=60 mmHg and were scheduled for elective mitral valve
replacement. The patients were divided randomly into 2 equal groups
according to the drugs given during the study. Intervention(s): The
patients in group I received 5 to 20 micro g/kg/min of dobutamine and
0.5 to 3 micro g/kg/min of nitroglycerin, and patients in group II
received a loading dose of milrinone, 50 micro g/kg over 10 minutes,
followed by a maintenance dose of 0.25 to 0.75 micro g/kg/min.
 Measurements and Main Results: The primary outcome was the effects of
interventional drugs on mean pulmonary artery pressure. The secondary
outcomes were the effects of interventional drugs on systemic and
pulmonary hemodynamic parameters measured from induction of anesthesia
until the first 12 hours in the intensive care unit stay. There was a more
significant decrease in mean pulmonary artery pressure, pulmonary
capillary wedge pressure, and central venous pressure in group II than
group I at all time points after cardiopulmonary bypass. There were more
significant increases in heart rate, mean arterial pressure, cardiac
output, and mixed venous oxygen tension in group I than group II, which
became more obvious in time. In both groups, there was a significant
decrease in systemic vascular resistance and pulmonary vascular resistance
at all times. Conclusion(s): Milrinone provides adequate cardiac
performance, causing a greater reduction in pulmonary artery pressure and
pulmonary capillary wedge pressure. Copyright © 2018 Elsevier
Inc.

<75>
Accession Number
2000598963
Title
A Randomized Controlled Trial of Intra-Aortic Adenosine Infusion Before
Release of the Aortic Cross-Clamp During Coronary Artery Bypass Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (6) (pp 2520-2527),
2018. Date of Publication: December 2018.
Author
Ammar A.; Mahmoud K.; Elkersh A.; Kasemy Z.
Institution
(Ammar, Mahmoud, Elkersh, Kasemy) Faculty of Medicine, Minoufiya
University, Minoufiya, Egypt, Egypt
Publisher
W.B. Saunders
Abstract
Objectives: To assess the feasibility, safety, and potential useful effect
of adenosine as a postconditioning agent in patients undergoing coronary
artery bypass grafting surgeries. Design(s): Prospective randomized
controlled study. Setting(s): University hospital.
 Participant(s): The study comprised 60 patients scheduled for
coronary artery bypass grafting surgery. Intervention(s): Adenosine
(postconditioning group) or placebo (control group). Adenosine infusion
(150 micro g/kg/min) for 10 minutes via a cardioplegia needle into the
aortic root was started 10 minutes before aortic cross-clamp removal.
 Measurements and Main Results: Compared with the control group,
ejection fraction, fractional shortening, cardiac index (2.9 +/- 0.3 v 2.2
+/- 0.3 L/min/m2, p = 0.032 at 60 min postbypass) and diastolic
function indices were significantly better in the postconditioning group
at most time points in the postbypass period. Cardiac troponin I and
creatine kinase-MB release and the inotropic score were significantly
lower in the postconditioning group at most time points in the
postoperative period. The need for intra-aortic balloon and epicardial
pacing were comparable in both groups, whereas incidence of arrhythmia,
duration of postoperative mechanical ventilation, and intensive care unit
and total hospital stays were significantly lower in the postconditioning
group. Conclusion(s): Adenosine postconditioning provided cardiac
protection as evidenced by a favorable outcome on systolic and diastolic
function indices, less cardiac troponin I and creatine kinase-MB release,
lower incidence of arrhythmia, lower inotropic score, and shorter duration
of postoperative mechanical ventilation and intensive care unit
stay. Copyright © 2017 Elsevier Inc.

<76>
Accession Number
2001252336
Title
Different protocols for early cardiac rehabilitation modulate the vascular
function of individuals undergoing coronary artery bypass grafting:
Randomized clinical trial.
Source
Artery Research. Conference: ARTERY 18. Portugal. 24 (pp 102), 2018. Date
of Publication: December 2018.
Author
Eibel B.; Waclawovsky G.; Boll L.; Barbosa E.; Irigoyen M.C.; Lehnen A.
Institution
(Eibel, Waclawovsky, Boll, Barbosa, Irigoyen, Lehnen) Instituto de
Cardiologia/Fundacao Universitaria de Cardiologia, ARtery DIsease (ARDI)
Group, Porto Alegre, RS, Brazil
Publisher
Elsevier Ltd
Abstract
Background: Cardiac rehabilitation with aerobic exercises is the first
strategy as a non-pharmacological treatment in the postoperative period of
individuals undergoing coronary artery bypass grafting (CABG) to improve
functional capacity and vascular health. However, other exercise
modalities remain uncertain as to the same benefits. Purpose(s): To
evaluate the effect of different modalities of exercise, such as early
cardiac rehabilitation, on subjects submitted to CABG on the percentage of
flow-mediated dilatation (FMD) of the brachial artery and vascular
resistance. Method(s): A randomized clinical trial in which 15
patients (62.7+/-6.5 years) underwent CABG were randomly assigned to the
following groups: isometric (IG, Handgrip Jamar O), ventilatory muscle
training (VG, PowerBreathe O) and control (CG, conventional respiratory
and motor physiotherapy). All patients received physical attendance twice
a day (20 minutes/session) for a consecutive week after the CABG (hospital
admission). Endothelial function was assessed through the technique FMD
before and after (~7 days) admission to CABG. The doppler ultrasound
videos were analyzed by CardiovascularSuite O software to measure %FMD.
Statistics: Generalized estimation equation, followed by Bonferroni
post-hoc (p < 0.05). Result(s): Systolic, diastolic and mean arterial
pressure (SBP/DBP/MAP, respectively) was of 133, 76, 95 mmHg. The groups
presented %FMD before and after intervention of: IG 9,2 - 2,7% p = 0,71;
VG 9,7 - 10,9% p = 0,82; CG 10,4 - 2,9% p = 0,15 and medium flow of: IG
245,5 - 207,6 mL/min p = 0,84; VG 83,7 - 58,7 mL/min p = 0,04; CG 94,6 -
101,2 mL/min p = 0,89. Conclusion(s): Different protocols for early
cardiac rehabilitation modulate the vascular function of individuals
undergoing CABG. Copyright © 2018

<77>
Accession Number
2001350556
Title
Meta-analysis design and results in real life: Problem solvers or detour
to maze. A critical review of meta-analysis of DAPT randomized controlled
trials.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2018. Date of
Publication: 2018.
Author
Nunez Gil I.J.; Elizondo A.; Gradari S.; Villablanca P.A.; Bueno H.;
Feltes G.; Quiros A.; Ramakrishna H.; Boshra L.; Fernandez-Ortiz A.
Institution
(Nunez Gil, Fernandez-Ortiz) Cardiovascular Institute, Hospital Clinico
San Carlos, Madrid, Spain
(Elizondo) Medical Department Astrazeneca, Spain
(Gradari) Biochemistry Department, Faculty of Medicine, Universidad
Autonoma, Madrid, Spain
(Villablanca) Department of Medicine, Division of Cardiology, Montefiore
Medical Center, New York, United States
(Bueno) i+12 Research Institute and Cardiology Department, Hospital 12 de
Octubre, Madrid, Spain
(Bueno, Fernandez-Ortiz) Spanish National Centre for Cardiovascular
Research (CNIC), Madrid, Spain
(Bueno, Fernandez-Ortiz) Faculty of Medicine, Universidad Complutense de
Madrid, Spain
(Feltes) Cardiology Department, Hospital Virgen del Mar, Madrid, Spain
(Quiros) Biostatistics, Leon University, Leon, Spain
(Ramakrishna, Boshra) Department of Anesthesiology and Cardiology, Mayo
Clinic, Phoenix, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Therapeutic strategies - such as duration of dual antiplatelet
therapy after coronary artery stenting - usually generate a large quantity
of meta-analyses. The meta-analyses that include the same randomized
clinical trials should produce similar results. Our aim in the study is to
analyze the quality and to compare the results of meta-analyses focused on
a controversial topic such as dual antiplatelet therapy after percutaneous
coronary intervention. Method(s): We searched all published
meta-analyses published up to November 2015 (near DAPT trial publication)
selecting those that included the same randomized clinical trials
comparing patterns of briefer versus longer-term double antiplatelet
therapy. Result(s): Seventeen meta-analyses achieved our selection
criteria. Of the seventeen analyzed, we identified seven (41.1%) based on
the same ten randomized clinical trials (RCTs), yet their results varied
widely. Many of the meta-analyses differed in only some minor aspect of
the design (i.e. eligible studies, length of comparators and statistical
methods used). Some authors differed in the number of patients
participating in RCTs and even, despite reviewing the same underlying
trials, only 2 of the 7 meta-analyses included the same number of
patients. Conclusion(s): Meta-analyses around cardiovascular,
all-cause or non-cardiovascular death differ frequently. In the DAPT
duration setting, several meta-analyses have been recently published based
on the same data, presenting several issues making it difficult to
determine clear recommendations on certain points. Copyright ©
2018 Elsevier Inc.

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