EPICORE Embase Updates: EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
624272167
Title
Postoperative Delirium in Individuals Undergoing Transcatheter Aortic
Valve Replacement: A Systematic Review and Meta-Analysis.
Source
Journal of the American Geriatrics Society. 66 (12) (pp 2417-2424), 2018.
Date of Publication: December 2018.
Author
Abawi M.; Pagnesi M.; Agostoni P.; Chiarito M.; van Jaarsveld R.C.; van
Dongen C.S.; Slooter A.J.C.; Colombo A.; Kooistra N.H.M.; Doevendans
P.A.F.M.; Latib A.; Stella P.R.
Institution
(Abawi, Agostoni, van Jaarsveld, van Dongen, Kooistra, Doevendans, Stella)
Department of Cardiology, University Medical Center Utrecht, Utrecht
University, Utrecht, Netherlands
(Pagnesi, Colombo, Latib) Interventional Cardiology Unit San Raffaele
Scientific Institute, Milan, Italy
(Agostoni) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Chiarito) Cardio Center Humanitas Research Hospital, Rozzano Milan, Italy
(Slooter) Department of Intensive Care Medicine and Brain Center Rudolf
Magnus, University Medical Center Utrecht, Utrecht University, Utrecht,
Netherlands
(Doevendans) Netherlands Heart Institute, Utrecht, Netherlands
(Colombo, Latib) Interventional Cardiology Unit EMO-GVM Centro Cuore
Columbus, Milan, Italy
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To evaluate the incidence of in-hospital postoperative
delirium (IHPOD) after transcatheter aortic valve replacement (TAVR).
 Design(s): Systematic review and meta-analysis. Setting(s):
Elective procedures. Participant(s): Individuals undergoing TAVR.
Measurements: A literature search was conducted in PubMed, Embase,
BioMedCentral, Google Scholar, and the Cochrane Central Register of
Controlled Trials (up to December 2017). All observational studies
reporting the incidence of IHPOD after TAVR (sample size > 25) were
included in our meta-analysis. The reported incidence rates were weighted
to obtain a pooled estimate rate with 95% confidence interval (CI).
 Result(s): Of 96 potentially relevant articles, 31 with a total of
32,389 individuals who underwent TAVR were included in the meta-analysis.
The crude incidence of IHPOD after TAVR ranged from 0% to 44.6% in
included studies, with a pooled estimate rate of 8.1% (95% CI=6.7-9.4%);
heterogeneity was high (Q = 449; I = 93%; p<inf>heterogeneity</inf>
<.001). The pooled estimate rate of IHPOD was 7.2% (95% CI=5.4-9.1%) after
transfemoral (TF) TAVR and 21.4% (95% CI=10.3-32.5%) after non-TF TAVR.
 Conclusion(s): Delirium occurs frequently after TAVR and is more
common after non-TF than TF procedures. Recommendations are made with the
aim of standardizing future research to reduce heterogeneity between
studies on this important healthcare problem. J Am Geriatr Soc
66:2417-2424, 2018. © 2018, Copyright the Authors Journal
compilation © 2018, The American Geriatrics Society

<2>
Accession Number
2001022620
Title
Genetic association between HLA-G 14-bp polymorphism and diseases: A
systematic review and meta-analysis.
Source
Human Immunology. 79 (10) (pp 724-735), 2018. Date of Publication: October
2018.
Author
de Almeida B.S.; Muniz Y.C.N.; Prompt A.H.; Castelli E.C.; Mendes-Junior
C.T.; Donadi E.A.
Institution
(de Almeida, Donadi) Divisao de Imunologia Clinica, Departamento de
Clinica Medica, Faculdade de Medicina de Ribeirao Preto (FMRP),
Universidade de Sao Paulo (USP), Ribeirao Preto, SP 14049-900, Brazil
(de Almeida) Laboratorio Multiusuario de Estudos em Biologia, Centro de
Ciencias Biologicas, Universidade Federal de Santa Catarina (UFSC),
Florianopolis, Brazil
(Muniz, Prompt) Departamento de Biologia Celular, Embriologia e Genetica,
Centro de Ciencias Biologicas, Universidade Federal de Santa Catarina
(UFSC), Florianopolis, Brazil
(Castelli) Departamento de Patologia, Faculdade de Medicina de Botucatu,
Unesp - Univ. Estadual Paulista, Botucatu, SP 18618-970, Brazil
(Mendes-Junior) Faculdade de Filosofia Ciencias e Letras de Ribeirao Preto
(FFCLRP), Universidade de Sao Paulo (USP), Ribeirao Preto, SP 14049-900,
Brazil
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: HLA-G is an immune checkpoint molecule. Since a differential
molecule expression has been reported even for healthy individuals, many
studies have focused on polymorphisms at HLA-G regulatory regions,
particularly the 3' untranslated region (3'UTR). The presence/absence of a
14-bp sequence was the first polymorphism described and it is the most
studied in association between HLA-G and disorders. Method(s): In
this study, we performed a systematic review and meta-analysis of all
association studies published regarding the HLA-G 14-bp. Result(s):
We verified association between 14-bp alleles and diseases in the
following situations: (1) presence of 14-bp (insertion) conferred
susceptibility to preeclampsia (child alleles evaluated) and systemic
lupus erythematosus (OR = 1.42; 95%CI = 1.04-1.93; p = 0.026 and OR =
1.13; 95%CI = 1.01-1.27, p = 0.028); (2) 14-bp absence (deletion) was
associated with increased risk to breast cancer (OR = 1.23; 95%CI =
1.06-1.43; p = 0.006) and human Cytomegalovirus infection (OR = 2.06;
95%CI = 1.60-2.64; p < 0.0001); and (3) a risk association was observed
between the group of reproductive disorders and the 14-bp insertion (OR =
1.12; 95%CI = 1.01-1.24; p = 0.034). Conclusion(s): Considering that
others 14-bp associations were inconclusive and that other variation sites
observed at HLA-G 3'UTR exhibit a proven role on post-transcriptional
regulation of HLA-G expression, the complete 3'UTR segment should be
analyzed in terms of disease susceptibility, instead of a single
polymorphism. Copyright © 2018

<3>
Accession Number
624327081
Title
Cognitive Outcomes After Heart Valve Surgery: A Systematic Review and
Meta-Analysis.
Source
Journal of the American Geriatrics Society. 66 (12) (pp 2327-2334), 2018.
Date of Publication: December 2018.
Author
Oldham M.A.; Vachon J.; Yuh D.; Lee H.B.
Institution
(Oldham, Lee) Department of Psychiatry, University of Rochester Medical
Center, Rochester, NY, United States
(Vachon) Oncology Department, Ingram School of Nursing, McGill University,
Montreal, QC, Canada
(Yuh) Department of Surgery, Stamford Hospital, Stamford, CT, United
States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To summarize evidence on cognitive outcomes after heart valve
surgery; secondary aim, to examine whether aortic and mitral valve surgery
are associated with different cognitive outcomes. Design(s):
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
systematic review and meta-analysis. Setting(s): Cardiac surgery.
 Participant(s): Individuals undergoing heart valve surgery.
Measurements: We searched MEDLINE, EMBASE, and PsycINFO for peer-reviewed
reports of individuals undergoing heart valve surgery who underwent pre-
and postoperative cognitive assessment. Our initial search returned 1,475
articles, of which 12 were included. Postoperative cognitive results were
divided into those from 1 week to 1 month (early outcomes,
n<inf>pooled</inf> = 450) and from 2 to 6 months (intermediate outcomes;
n<inf>pooled</inf> = 722). No studies with longer-term outcomes were
identified. Result(s): Subjects had moderate early cognitive decline
from baseline (Becker mean gain effect size (ES)=-0.39 +/- 0.27) that
improved slightly by 2 to 6 months (ES=-0.25 +/- 0.38). Individuals
undergoing aortic valve surgery-who were older on average than those
undergoing mitral valve surgery (68 vs 57)-had greater early cognitive
decline than those undergoing mitral valve surgery (ES=-0.68 vs -0.12),
but both cohorts had similar decline 2 to 6 months postoperatively
(ES=-0.27 vs -0.20). Conclusion(s): Heart valve surgery is associated
with cognitive decline over the 6 months after surgery, but outcomes
beyond 6 months are unclear. These findings highlight the cognitive
vulnerability of this population, especially older adults with aortic
stenosis. © 2018 American Geriatrics Society and Wiley Periodicals,
Inc. J Am Geriatr Soc 66:2327-2334, 2018. © 2018, Copyright the
Authors Journal compilation © 2018, The American Geriatrics Society

<4>
Accession Number
2001028524
Title
Intensive versus moderate statin therapy and early graft occlusion after
coronary bypass surgery: The Aggressive Cholesterol Therapy to Inhibit
Vein Graft Events randomized clinical trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (1) (pp 151-161.e1),
2019. Date of Publication: January 2019.
Author
Kulik A.; Abreu A.M.; Boronat V.; Ruel M.
Institution
(Kulik, Abreu, Boronat) Lynn Heart and Vascular Institute, Boca Raton
Regional Hospital, Charles E. Schmidt College of Medicine, Florida
Atlantic University, Boca Raton, Fla, United States
(Ruel) University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Statins prevent saphenous vein graft (SVG) disease and improve
outcomes after coronary artery bypass graft surgery. However, the optimal
postoperative statin dose remains unclear. The Aggressive Cholesterol
Therapy to Inhibit Vein Graft Events trial was undertaken to evaluate
whether early postoperative high-dose statin therapy reduces SVG occlusion
compared with conventional moderate-dose therapy. Method(s): In this
pilot, multicenter, double-blind randomized trial, 173 patients who had
coronary artery bypass graft surgery with SVG were randomized to receive
10 mg or 80 mg atorvastatin daily for 1 year. The primary outcome was SVG
occlusion at 1 year. Secondary outcomes were SVG stenosis and major
adverse cardiovascular events. Result(s): During trial enrollment,
patients randomized to 80 mg atorvastatin achieved significantly lower
low-density lipoprotein cholesterol levels (P <.00001). One-year graft
assessment was performed in 145 patients (83.8%). The primary outcome, SVG
occlusion at 1 year, did not significantly differ between the 2 groups
(12.9% vs 11.4% for 10 mg atorvastatin vs 80 mg atorvastatin; P =.85). The
incidence of vein graft stenosis also did not significantly differ between
the groups (P =.54). However, there was a trend toward fewer patients
developing vein graft disease (either occlusion or stenosis) in the 80 mg
atorvastatin group (29.2% vs 19.2%, 10 mg atorvastatin vs 80 mg
atorvastatin; P =.18). Freedom from major adverse cardiovascular events at
1 year was similar between the groups (P =.27). Conclusion(s):
Compared with 10 mg atorvastatin, 80 mg atorvastatin did not significantly
reduce vein graft occlusion 1 year after coronary artery bypass graft
surgery in this pilot trial. Copyright © 2018 The American
Association for Thoracic Surgery

<5>
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.

<6>
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.

<7>
Accession Number
2001020237
Title
Serotonin Toxicity and Urinary Analgesics: A Case Report and Systematic
Literature Review of Methylene Blue-Induced Serotonin Syndrome.
Source
Psychosomatics. 59 (6) (pp 539-546), 2018. Date of Publication: November
2018.
Author
Zuschlag Z.D.; Warren M.W.; K. Schultz S.
Institution
(Zuschlag, Warren, K. Schultz) James A. Haley Veterans' Hospital, Mental
Health and Behavioral Sciences Service, University of South Florida,
Psychiatry and Behavioral Neurosciences, Tampa, FL, United States
(K. Schultz) University of Iowa Roy J and Lucille A Carver College of
Medicine, Psychiatry, Tampa, FL, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Serotonin syndrome (SS) is a potentially serious side effect
of serotonergic drugs. Cases of SS have been reported from the
administration of methylene blue (MB), an agent with monoamine oxidase
inhibiting properties. To date, the reported cases of MB-induced SS have
all been with MB given parenterally. We report a case induced by the
initiation of a MB-containing oral agent. Method(s): A case of SS
felt to be induced by the initiation of an MB-containing
orally-administered urinary analgesic, started in a patient concurrently
treated with multiple serotonergic drugs, is presented. A systematic
literature review of MB-induced SS follows. The review consisted of
searches in MEDLINE databases using the key terms "methylene blue" and
"serotonin syndrome". The authors read all abstracts, and articles related
to MB and serotonin toxicity; non-associated articles were discarded.
Results are summarized. Result(s): 23 manuscripts were identified,
resulting in 50 unique cases of MB-induced SS. The majority of cases were
related to peri-operative use of MB in parathyroidectomies or for the
treatment of vasoplegic shock. All cases were associated with MB given
parenterally. Concurrent treatment with serotonergic antidepressants was
described in all 50 cases. Symptoms of SS ranged from mild to severe. One
fatality was reported. Conclusion(s): Methylene blue can induce SS,
felt to be secondary to MAOI properties. Although previous reports have
exclusively been associated with MB given via parental administration, our
case suggests that SS can be induced by oral administration of
MB-containing agents. Copyright © 2018

<8>
Accession Number
625412272
Title
Safety of carotid endarterectomy early after percutaneous coronary
interventions.
Source
Italian Journal of Vascular and Endovascular Surgery. 25 (4) (pp 283-287),
2018. Date of Publication: December 2018.
Author
Borioni R.; Tomai F.; De Persio G.; Fratticci L.; Tesori M.C.; Paciotti
C.; Garofalo M.
Institution
(Borioni, Fratticci, Tesori, Paciotti, Garofalo) Department of Vascular
Surgery, Aurelia Hospital, via Telesilla 15, Rome 00124, Italy
(Tomai, De Persio) Department of Cardiology, Aurelia Hospital, Rome, Italy
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: Large published studies regarding the outcome of carotid
endarterctomy (CEA) in patients recently treated with percutaneous
coronary interventions (PCI) and on dual antiplatelet therapy (DAPT) are
lacking. This study sought to evaluate the safety of CEA in this clinical
setting. METHOD(S): Between January 2012 and December 2017, 52
consecutive patients were treated with CEA after recent (<=40 days) PCI
and enrolled in this prospective registry. Forty-one consecutive patients
with a history of coronary artery disease and non-recent PCI undergoing
CEA in the same period of time were identified as control group. The
primary endpoint of the study was the 30-day incidence of major adverse
cardiac and cerebrovascular events (MACCE), including any death,
myocardial infarction, or stroke. Secondary endpoints were cervical
complications, defined as major bleeding and cranial nerve injuries.
 RESULT(S): The majority of patients undergoing CEA was treated with
drug-eluting stent implantation (92.3%) 21.4+/-11.5 days before (range 1
to 40 days) and was on DAPT. The incidence of the primary endpoint at 30
days was 3.8% (95% confidence interval [CI]: 2 to 9.6). The rate of death,
myocardial infarction, and stroke was 0%, 1.9% and 3.8% respectively. The
incidence of major bleedings and cranial nerve injuries were 1.9% and 3.8%
respectively. The control group resulted comparable in terms of age,
gender and risk factors, and exhibited similar outcome. Specifically, the
incidence of MACCE, major bleedings and nerve injuries at 30 days was
4.8%, 2.4% and 2.4%, respectively (all P>0.05). CONCLUSION(S): In
this early investigation, CEA performed in patients recently treated with
PCI and on DAPT is safe with low incidence of bleedings. These results, if
confirmed in larger and multicentric studies, may help to simplify the
treatment strategy of patients with severe carotid obstructive disease and
concomitant coronary artery disease. Copyright © 2018 EDIZIONI
MINERVA MEDICA.

<9>
Accession Number
625391869
Title
CTCA for detection of significant coronary artery disease in routine TAVI
work-up: A systematic review and meta-analysis.
Source
Netherlands Heart Journal. 26 (12) (pp 591-599), 2018. Date of
Publication: 01 Dec 2018.
Author
van den Boogert T.P.W.; Vendrik J.; Claessen B.E.P.M.; Baan J.; Beijk
M.A.; Limpens J.; Boekholdt S.A.M.; Hoek R.; Planken R.N.; Henriques J.P.
Institution
(van den Boogert, Vendrik, Claessen, Baan, Beijk, Boekholdt, Hoek,
Henriques) Heart Centre, Academic Medical Centre, part of the Amsterdam
Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands
(Limpens) Medical Library, Academic Medical Centre, University of
Amsterdam, Amsterdam, Netherlands
(Planken) Department of Radiology and Nuclear Medicine, Academic Medical
Centre, University of Amsterdam, Amsterdam, Netherlands
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Transcatheter aortic valve implantation (TAVI) has evolved to standard
treatment of severe aortic stenosis in patients with an intermediate to
high surgical risk. Computed tomography coronary angiography (CTCA) could
partially replace invasive coronary angiography to diagnose significant
coronary artery disease in the work-up for TAVI. A literature search was
performed in MEDLINE and EMBASE for papers comparing CTCA and coronary
angiography in TAVI candidates. The primary endpoint was the diagnostic
accuracy of CTCA, compared to coronary angiography, for detection of
significant (>50% diameter stenosis) coronary artery disease, measured as
sensitivity, specificity, positive-(PPV) and negative predictive value
(NPV). Seven studies were included, with a cumulative sample size of 1,275
patients. The patient-based pooled sensitivity, specificity, PPV and NPV
were 95, 65, 71 and 94% respectively. Quality assessment revealed
excellent and good quality in terms of applicability and risk of bias
respectively, with the main concern being patient selection. In
conclusion, on the basis of a significance cut-off value of 50% diameter
stenosis, CTCA provides acceptable diagnostic accuracy for the exclusion
of coronary artery disease in patients referred for TAVI. Using the
routinely performed preoperative computed tomography scans as a gatekeeper
for coronary angiography could decrease additional coronary angiographies
by 37% in this high-risk and fragile population. Copyright ©
2018, The Author(s).

<10>
Accession Number
624061380
Title
Efficacy of dexmedetomidine in prevention of junctional ectopic
tachycardia and acute kidney injury after pediatric cardiac surgery: A
meta-analysis.
Source
Congenital Heart Disease. 13 (5) (pp 799-807), 2018. Date of Publication:
September/October 2018.
Author
Li X.; Zhang C.; Dai D.; Liu H.; Ge S.
Institution
(Li, Zhang, Dai, Liu, Ge) Department of Cardiovascular Surgery, The First
Affiliated Hospital of Anhui Medical University, Hefei, China
Publisher
Blackwell Publishing Ltd
Abstract
Objective: We conducted a meta-analysis to evaluate the effects of
prophylactic perioperative dexmedetomidine administration on postoperative
junctional ectopic tachycardia (JET) and acute kidney injury (AKI) in
pediatric patients having undergone cardiac surgery. Design(s): This
systematic review was registered with PROSPERO (CRD42017083880). Databases
including PubMed, Cochrane Central Register of Controlled Trials, and Web
of Science were searched for randomized controlled trials (RCTs) and
observational cohort studies from its inception to March 2018. Two
reviewers independently screened literature, extracted data, and assessed
the quality of included studies using the Jadad scale and Newcastle-Ottawa
score. Meta-analysis was then conducted by RevMan 5.3 and Stata 12.0
software. P value <.05 was considered significant. Result(s): A total
of nine eligible studies (5 RCTs and 4 observational studies) comprising
1851 patients were selected for the final analysis. The results of
meta-analysis showed that dexmedetomidine significantly reduced the
incidence of postoperative JET (OR =0.35, 95% CI: 0.22 to 0.53, P
<.00001), but there was no significant difference between groups in AKI
(OR =0.44, 95% CI: 0.19 to 1.04, P =.06) and all-cause mortality (OR
=0.87, 95% CI: 0.35 to 2.14, P =.77). Conclusion(s): The
administration of perioperative dexmedetomidine effectively prevents JET
in pediatric patients undergoing cardiac surgery but has no significant
effect on postoperative renal function. However, the quality of evidence
for these findings is low; thus, future larger scale randomized studies
are needed to verify the real clinical effects of dexmedetomidine
prophylaxis in pediatric patients. Copyright © 2018 Wiley
Periodicals, Inc.

<11>
Accession Number
625480423
Title
A pilot study comparing anti- inflammatory effects of tranexamic acid and
epsilon aminocaproic acid in pediatric congenital heart surgery.
Source
Arteriosclerosis, Thrombosis, and Vascular Biology. Conference: American
Heart Association's Arteriosclerosis, Thrombosis and Vascular
Biology/Peripheral Vascular Disease 2017 Scientific Sessions, ATVB/PVD
2017. United States. 37 (Supplement 1) (no pagination), 2017. Date of
Publication: May 2017.
Author
Parashar N.; Nafee T.; Lefaiver C.; Steffensen C.; Rizzo V.; Kumar V.;
ElZein C.; Van Bergen A.
Institution
(Parashar, Nafee, Lefaiver, Steffensen, Rizzo, Kumar, ElZein, Van Bergen)
Advocate Children's Hosp, Oak Lawn, IL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Antifibrinolytic agents are frequently used during pediatric
heart surgery with cardiopulmonary bypass (CPB) to reduce transfusions.
There are no studies comparing anti-inflammatory effects of
antifibrinolytic agents, tranexamic acid (TXA) and Epsilon Aminocaproic
acid (EACA). We compared the two agents in pediatric patients undergoing
redo sternotomy with CPB. Aim(s): To compare anti-inflammatory
effects of tranexamic acid versus aminocaproic acid in pediatric patients
undergoing redo sternotomy and cardiopulmonary bypass. Method(s): We
conducted a randomized, double blind pilot study, comparing 10 subjects in
each group receiving EACA and TXA. A cytokine panel was used to measure 13
inflammatory markers in pre, immediate post and 24 hours post-CPB period.
Between group comparisons were tested with Mann-Whitney U tests and within
group comparisons with Friedman tests. Result(s): Sample
characteristics were comparable in both groups. Post CPB, plasma levels of
7 markers increased significantly (p<0.05) in both groups, including
MCP-1; 3 increased significantly (p<0.03) in the EACA group alone,
including GM-CSF; and 3 did not change over time (Table 1). No difference
was found between groups for markers except for IL-10, which was
significantly higher in EACA group post CPB. While absolute values of
markers, chest tube output and volume of blood product needs were lower in
TXA group the differences were not statistically significant.
 Conclusion(s): There was no significant difference in
anti-inflammatory profiles between EACA and TXA in this pilot study.
GM-CSF and MCP-1 were increased in our study post CBP which has not been
described in previous studies.

<12>
Accession Number
625464317
Title
Association of Renin-Angiotensin Inhibitor Treatment with Mortality and
Heart Failure Readmission in Patients with Transcatheter Aortic Valve
Replacement.
Source
JAMA - Journal of the American Medical Association. 320 (21) (pp
2231-2240), 2018. Date of Publication: 04 Dec 2018.
Author
Inohara T.; Manandhar P.; Kosinski A.S.; Matsouaka R.A.; Kohsaka S.; Mentz
R.J.; Thourani V.H.; Carroll J.D.; Kirtane A.J.; Bavaria J.E.; Cohen D.J.;
Kiefer T.L.; Gaca J.G.; Kapadia S.R.; Peterson E.D.; Vemulapalli S.
Institution
(Inohara, Manandhar, Kosinski, Matsouaka, Mentz, Kiefer, Gaca, Peterson,
Vemulapalli) Duke Clinical Research Institute, Duke University Medical
Center, 2400 Pratt St., Durham, NC 27705, United States
(Inohara, Kohsaka) Department of Cardiology, Keio University School of
Medicine, Tokyo, Japan
(Thourani) Department of Cardiac Surgery, MedStar Heart and Vascular
Institute, Georgetown University School of Medicine, Washington, DC,
United States
(Carroll) Division of Cardiology, Department of Medicine, University of
Colorado, Aurora, United States
(Kirtane) Department of Medicine, Columbia University Medical Center, New
York Presbyterian Hospital, New York, NY, United States
(Bavaria) Division of Cardiovascular Surgery, University of Pennsylvania,
Philadelphia, United States
(Cohen) Department of Medicine, Saint Luke's Mid America Heart Institute,
Kansas City, MO, United States
(Cohen) Department of Medicine, University of Missouri-Kansas City School
of Medicine, Kansas City, United States
(Kapadia) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, OH, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance Data are lacking on the effect of a renin-angiotensin system
(RAS) inhibitor prescribed after transcatheter aortic valve replacement
(TAVR). Treatment with a RAS inhibitor may reverse left ventricular
remodeling and improve function. Objective To investigate the association
of prescription of a RAS inhibitor and outcomes after TAVR. Design,
Setting, and Participants Retrospective cohort study of TAVR procedures
performed in the United States (using the Society of Thoracic
Surgeons/American College of Cardiology Transcatheter Valve Therapies
Registry) between July 2014 and January 2016 that were linked to Medicare
claims data (final date of follow-up: March 31, 2017). To account for
differences in demographics, echocardiographic findings, and in-hospital
complications, 1:1 propensity matching was performed. Exposures Initial
hospital discharge prescription of a RAS inhibitor after TAVR. Main
Outcomes and Measures Primary outcomes were all-cause death and
readmission due to heart failure at 1 year after discharge, which were
considered separately. The secondary outcome was health status assessed by
the Kansas City Cardiomyopathy Questionnaire (KCCQ; score range: 0-100,
with a higher score indicating less symptom burden and better quality of
life; a small effect size was defined as 5 points) at 1 year. Results
Among 21312 patients who underwent TAVR at 417 US sites, 8468 patients
(39.7%) were prescribed a RAS inhibitor at hospital discharge. After
propensity matching, 15896 patients were included (mean [SD] age, 82.4
[6.8] years; 48.1% were women; mean [SD] left ventricular ejection
fraction [LVEF], 51.9% [11.5%]). Patients with a prescription for a RAS
inhibitor vs those with no prescription had lower mortality rates at 1
year (12.5% vs 14.9%, respectively; absolute risk difference [ARD], -2.4%
[95% CI, -3.5% to -1.4%]; hazard ratio [HR], 0.82 [95% CI, 0.76 to 0.90])
and lower heart failure readmission rates at 1 year (12.0% vs 13.8%; ARD,
-1.8% [95% CI, -2.8% to -0.7%]; HR, 0.86 [95% CI, 0.79 to 0.95]). When
stratified by LVEF, having a prescription for a RAS inhibitor vs no
prescription was associated with lower 1-year mortality among patients
with preserved LVEF (11.1% vs 13.9%, respectively; ARD, -2.81% [95% CI,
-3.95% to -1.67%]; HR, 0.78 [95% CI, 0.71 to 0.86]), but not among those
with reduced LVEF (18.8% vs 19.5%; ARD, -0.68% [95% CI, -3.52% to 2.20%];
HR, 0.95 [95% CI, 0.81 to 1.12]) (P =.04 for interaction). Of 15896
matched patients, 4837 (30.4%) were included in the KCCQ score analysis
and improvements at 1 year were greater in patients with a prescription
for a RAS inhibitor vs those with no prescription (median, 33.3
[interquartile range, 14.2 to 51.0] vs 31.3 [interquartile range, 13.5 to
51.1], respectively; difference in improvement, 2.10 [95% CI, 0.10 to
4.06]; P <.001), but the effect size was not clinically meaningful.
Conclusions and Relevance Among patients who underwent TAVR, receiving a
prescription for a RAS inhibitor at hospital discharge compared with no
prescription was significantly associated with a lower risk of mortality
and heart failure readmission. However, due to potential selection bias,
this finding requires further investigation in randomized
trials. © Copyright 2018 American Medical Association. All Rights
Reserved.

<13>
Accession Number
625402346
Title
Bariatric surgery among patients with heart failure: A systematic review
and meta-analysis.
Source
Open Heart. 5 (2) (no pagination), 2018. Article Number: e000910. Date of
Publication: 01 Dec 2018.
Author
Berger S.; Meyre P.; Blum S.; Aeschbacher S.; Ruegg M.; Briel M.; Conen D.
Institution
(Berger, Meyre, Blum, Aeschbacher, Conen) Cardiology Division, Department
of Medicine, University Hospital of Basel, Basel, Switzerland
(Berger, Meyre, Blum, Aeschbacher, Ruegg, Conen) Cardiovascular Research
Institute Basel, University Hospital of Basel, Basel, Switzerland
(Briel) Basel Institute for Clinical Epidemiology and Biostatistics,
Department of Clinical Research, University Hospital of Basel, University
of Basel, Basel, Switzerland
(Briel) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada
(Conen) Population Health Research Institute, McMaster University,
Hamilton, ON, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background: Bariatric surgery reduces cardiovascular risk in obese
patients. Heart failure (HF) is associated with an increased perioperative
risk following bariatric surgery. This systematic review aimed to assemble
the evidence on bariatric surgery in patients with known HF and the
potential effect of bariatric surgery on incident HF in obese patients
without prevalent HF. Method(s): We performed a comprehensive
literature search up to 30 September 2017 and included studies comparing
bariatric surgery to non-surgical treatment in patients with known
presurgical HF. To assess whether bariatric surgery has any effect on
incident HF, we also assembled studies looking at new-onset HF among
patients without HF prior to surgery. Result(s): We found five
observational studies (0 randomised trials) comparing bariatric surgery
with non-surgical treatment in patients with a diagnosis of HF prior to
surgery. A review of the available studies (n=676 patients) suggested
reduced admission rates for HF exacerbation and increased left ventricular
ejection fraction after bariatric surgery. No meta-analysis was possible
due to the heterogeneous nature of these studies. Seven studies (one
randomised trial) reported data on new-onset HF in obese patients without
HF prior to bariatric surgery (n=111 127 patients). When comparing
surgical to non-surgical treatment groups, the pooled univariable and
multivariable HRs for incident HF were 0.28 (95% CI 0.13 to 0.55) and 0.44
(95% CI 0.36 to 0.55), respectively. Conclusion(s): In this
systematic review, no randomised trial assessed the benefits and risks of
bariatric surgery in obese patients with concomitant HF. Available studies
do, however, show that surgery might prevent incident HF. Copyright
© 2018 Author.

<14>
Accession Number
2001384178
Title
Heparin-Induced Thrombocytopenia and Cardiac Surgery.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Author
Solanki J.; Shenoy S.; Downs E.; Palkimas S.; Goldman S.; Sharma A.M.
Institution
(Solanki) Department of Medicine, University of Virginia, Charlottesville,
VA, United States
(Shenoy) Division of Cardiovascular Medicine, University of Arizona,
Tuscan, AZ, United States
(Downs) Department of Surgery, University of Virginia, Charlottesville,
VA, United States
(Palkimas, Goldman) Department of Pharmacy, University of Virginia,
Charlottesville, VA, United States
(Sharma) Division of Cardiovascular Medicine, University of Virginia,
Charlottesville, VA, United States
Publisher
W.B. Saunders
Abstract
Heparin-induced thrombocytopenia (HIT) is an immune-mediated condition
characterized by thrombocytopenia with possible arterial and/or venous
thrombosis. The overall incidence of HIT is low but ranges from 0.1% to
5%.1,2 The incidence can be as high as 3% in patients
undergoing cardiac surgery. The use of unfractionated heparin (UFH) is
ubiquitous in patients who undergo cardiac procedures and carries a
10-fold higher incidence of HIT over low molecular weight heparin.
Patients undergoing cardiac surgery thus form a unique group that warrants
specific attention to this clinicopathologic entity considering the
relatively high incidence and associated morbidity and mortality with a
delay in diagnosis. In this article, we will discuss 5 clinical aspects
pertinent to the diagnosis and management of HIT in cardiac surgery
patients and review the current literature. Copyright © 2018

<15>
Accession Number
2001157263
Title
Comparison of the Efficacy of Ultrasound-Guided Serratus Anterior Plane
Block, Pectoral Nerves II Block, and Intercostal Nerve Block for the
Management of Postoperative Thoracotomy Pain After Pediatric Cardiac
Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Author
Kaushal B.; Chauhan S.; Saini K.; Bhoi D.; Bisoi A.K.; Sangdup T.; Khan
M.A.
Institution
(Kaushal, Chauhan) Department of Cardiac Anesthesiology, Cardio and
Neurosciences Center, AIIMS, New Delhi, India
(Saini, Bhoi) Department of Anesthesiology, Pain Medicine and Critical
Care, AIIMS, New Delhi, India
(Bisoi, Sangdup) Department of Cardiothoracic and Vascular Surgery, Cardio
and Neurosciences Center, AIIMS, New Delhi, India
(Khan) Department of Biostatistics, AIIMS, New Delhi, India
Publisher
W.B. Saunders
Abstract
Objective: The aim of this study was to compare the relative efficacy of
ultrasound-guided serratus anterior plane block (SAPB), pectoral nerves
(Pecs) II block, and intercostal nerve block (ICNB) for the management of
post-thoracotomy pain in pediatric cardiac surgery. Design(s): A
prospective, randomized, single-blind, comparative study. Setting(s):
Single-institution tertiary referral cardiac center. Participant(s):
The study comprised 108 children with congenital heart disease requiring
surgery through a thoracotomy. Intervention(s): Children were
allocated randomly to 1 of the 3 groups: SAPB, Pecs II, or ICNB. All
participants received 3 mg / kg of 0.2% ropivacaine for ultrasound-guided
block after induction of anesthesia. Postoperatively, intravenous
paracetamol was used for multimodal and fentanyl was used for rescue
analgesia. Measurements and Main Results: A modified objective pain
score (MOPS) was evaluated at 1, 2, 4, 6, 8, 10, and 12 hours
post-extubation. The early mean MOPS at 1, 2, and 4 hours was similar in
the 3 groups. The late mean MOPS was significantly lower in the SAPB group
compared with that of the ICNB group (p < 0.001). The Pecs II group also
had a lower MOPS compared with the ICNB group at 6, 8, and 10 hours (p <
0.001), but the MOPS was comparable at hour 12 (p = 0.301). The
requirement for rescue fentanyl was significantly higher in ICNB group in
contrast to the SAPB and Pecs II groups. Conclusion(s): SAPB and Pecs
II fascial plane blocks are equally efficacious in post-thoracotomy pain
management compared with ICNB, but they have the additional benefit of
being longer lasting and are as easily performed as the traditional
ICNB. Copyright © 2018

<16>
Accession Number
2001155484
Title
Continuous Ropivacaine Infusion Offers No Benefit in Treating
Postoperative Pain After Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Author
Florkiewicz P.; Musialowicz T.; Hippelainen M.; Lahtinen P.
Institution
(Florkiewicz, Musialowicz, Lahtinen) Department of Anesthesia and
Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland
(Hippelainen) Heart Center, Kuopio University Hospital, Kuopio, Finland
Publisher
W.B. Saunders
Abstract
Objective: One multimodal pain management method for reducing
postoperative opioid need after cardiac surgery is to continuously infuse
local anesthetic into a median sternotomy wound. Previous studies have
shown contradictory results with this method; therefore, no consensus
exists on its effectiveness. The authors tested the effectiveness of
continuous 0.2% ropivacaine infusion into a sternotomy wound after cardiac
surgery. Design(s): Prospective, randomized, double-blinded,
placebo-controlled trial. Setting(s): Single-institution,
tertiary-level, university hospital. Participant(s): Total of 90
patients undergoing coronary artery bypass grafting or heart valve
surgery. Intervention(s): Patients were assigned randomly to receive
0.2% ropivacaine or placebo into a sternotomy wound for 48 hours
postoperatively. Pain was controlled with standardized oxycodone boluses
after surgery and patient-controlled analgesia oxycodone after extubation;
total oxycodone consumption was recorded. Pain was assessed 3 times daily,
at rest and during deep breathing, with the visual analogue scale.
 Measurements and Main Results: Forty-seven patients were assigned to
receive ropivacaine and 43 to receive placebo infusion. Cumulative
oxycodone consumption was 97 +/- 27 mg with ropivacaine and 96 +/- 29 mg
with placebo (p = 0.813). Pain scores were similar between groups, both at
rest (p = 0.630) and during deep breathing (p = 0.793). Adverse event
incidences and surgical wound infection rates were similar between groups.
 Conclusion(s): Continuous 0.2% ropivacaine infusions at the median
sternotomy wound did not reduce postoperative pain or opioid consumption
during the first 48 hours after cardiac surgery. This technique apparently
was not beneficial for post-sternotomy pain treatment. Copyright
© 2018 Elsevier Inc.

<17>
Accession Number
2001149356
Title
Intravenous and Inhaled Milrinone in Adult Cardiac Surgery Patients: A
Pairwise and Network Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Author
Rong L.Q.; Rahouma M.; Abouarab A.; Di Franco A.; Calautti N.M.;
Fitzgerald M.M.; Arisha M.J.; Ibrahim D.A.; Girardi L.N.; Pryor K.O.;
Gaudino M.
Institution
(Rong, Calautti, Fitzgerald, Arisha, Ibrahim, Pryor) Department of
Anesthesiology, Weill Cornell Medicine, New York, NY, United States
(Rahouma, Abouarab, Di Franco, Girardi, Gaudino) Department of
Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY, United
States
Publisher
W.B. Saunders
Abstract
Objective: To summarize the evidence on the hemodynamic,
echocardiographic, and clinical effects of inhaled and intravenous
milrinone (iMil and IvMil) in adult cardiac surgery patients.
 Design(s): Systematic review, pairwise and network meta-analysis.
 Setting(s): Multi-institutional. Participant(s): Adult cardiac
surgery patients. Intervention(s): Comparison between iMil and IvMil
versus other agents or placebo. Measurements and Main Results: The
primary endpoints were mean pulmonary artery pressure (MPAP) and
peripheral vascular resistance (PVR). Secondary endpoints included the
following: (1) mean arterial pressure, heart rate, and cardiac index (CI);
(2) echocardiographic data; and (3) clinical outcomes. Random model,
leave-one-out-analysis, and meta-regression were used. Thirty studies (6
iMil and 24 IvMil) were included for a total of 1,438 patients (194 iMil
and 521 IvMil). IvMil was associated with a lower MPAP, lower PVR, and
higher CI compared to placebo (standardized mean difference [SMD] = -0.22
[95% CI = -0.48 to 0.05], SMD = -0.49 [95% CI = -0.71 to -0.27], and SMD =
0.94 [95% CI = 0.51 to 1.37]). No difference in any outcome was found
between iMil and placebo. At network meta-analysis, significantly lower
PVR and shorter hospital length of stay were found for IvMil compared to
iMil (SMD = -0.82 [95% CI = -1.53 to -0.10] and SMD = -0.50 [95% CI =
-0.95 to -0.05], respectively). Conclusion(s): These results support
the clinical use of IvMil in cardiac surgery patients. No evidence at
present supports the adoption of iMil. Copyright © 2018 Elsevier
Inc.

<18>
[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.

<19>
Accession Number
625266952
Title
Effect of continuous local anesthetic in post-cardiac surgery patients: A
systematic review.
Source
Pain Medicine (United States). 19 (5) (pp 1077-1090), 2018. Date of
Publication: 01 May 2018.
Author
Hong S.S.; Milross M.A.; Alison J.A.
Institution
(Hong, Milross, Alison) Physiotherapy Department, Liverpool Hospital,
Sydney, NSW 2170, Australia
(Hong) Discipline of Physiotherapy and Discipline of Physiotherapy,
Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
(Alison) Physiotherapy Department, Royal Prince Alfred Hospital, Sydney,
NSW, Australia
Publisher
Oxford University Press
Abstract
Objective. The purpose of this review was to determine the effect of CLA
infusion post cardiac surgery on pain, time to ambulation, severe adverse
events, patient satisfaction, time to extubation, length of stay in the
intensive care unit and in the hospital, total narcotic consumption, and
pulmonary function. Design. Systematic review with meta-Analysis (PROSPERO
CRD42014010188). Methods. We searched the following electronic databases:
The Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE;
EMBASE; CINAHL; Allied and Complementary Medicine (AMED); and PsycINFO; as
well as hand-searching cardiothoracic surgery and anesthetic journals and
meeting abstracts. Results. Ten eligible trials with a total of 546
participants were identified. Meta-Analyses showed that CLA infusion
significantly reduced the total mean visual analog pain score at 72 hours
(mean difference [MD] 5 ?14.31mm, 95% confidence interval [CI] 5 ?25.59 to
?3.03); time to ambulation (MD 5 ?2.81 hours, 95% CI 5 ?5.23 to ?0.4);
morphine requirement (MD 5 ?10.19 mg, 95% CI 5 ?11.80 to ?8.58) but did
not reduce time to ambulate to chair (MD 5 ?1.65 hours, 95% CI 5 ?4.04 to
0.74); time to extubation (MD 5 ?0.18 hours, 95% CI 5 ?1.24 to 0.89);
length of ICU stay (MD50.9 hours, 95% CI 5 ?2.96 to 4.75); and hospital
length of stay (MD 5 ?0.59 days, 95% CI 5 ?1.24 to 0.07). There were
insufficient data to perform a meta-Analysis on severe adverse events,
patient satisfaction, or pulmonary function. Conclusions. CLA infusion
after cardiac surgery reduces pain score at 72 hours, shortens time to
ambulation, and reduces morphine consumption at 48 hours. Copyright
© 2018 Oxford University Press. All Rights Reserved.

<20>
Accession Number
2001322828
Title
SYNTAX Score in Patients With Diabetes Undergoing Coronary
Revascularization in the FREEDOM Trial.
Source
Journal of the American College of Cardiology. Part A. 72 (23) (pp
2826-2837), 2018. Date of Publication: 11 December 2018.
Author
Esper R.B.; Farkouh M.E.; Ribeiro E.E.; Hueb W.; Domanski M.; Hamza T.H.;
Siami F.S.; Godoy L.C.; Mathew V.; French J.; Fuster V.
Institution
(Esper, Ribeiro, Hueb, Godoy) Heart Institute of the University of Sao
Paulo Medical School, Sao Paulo, Brazil
(Esper) Prevent Senior Institute, Sao Paulo, Brazil
(Farkouh, Godoy) Peter Munk Cardiac Centre and the Heart and Stroke
Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada
(Domanski) Department of Medicine, Mount Sinai Medical Center, New York,
NY, United States
(Hamza, Siami) New England Research Institutes, Watertown, MA, United
States
(Mathew) Division of Cardiology, Loyola University Stritch School of
Medicine, Maywood, IL, United States
(French) Department of Cardiology, University of New South Wales,
Liverpool Hospital, Sydney, New South Wales, Australia
(Fuster) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Fuster) Centro Nacional de Investigaciones Cardiovasculares, Madrid,
Spain
Publisher
Elsevier USA
Abstract
Background: Diabetes mellitus (DM) is associated with complex coronary
artery disease (CAD), which in turn results in increased morbidity and
mortality from cardiovascular disease. Objective(s): This study
sought to evaluate the utility of SYNTAX score (SS) for predicting future
cardiovascular events in patients with DM and complex CAD undergoing
either coronary artery bypass grafting (CABG) or percutaneous coronary
intervention (PCI). Method(s): The FREEDOM (Future REvascularization
Evaluation in patients with Diabetes mellitus: Optimal management of
Multivessel disease) trial randomized patients with DM and multivessel CAD
to undergo either PCI with drug-eluting stents or CABG. The SS was
calculated retrospectively by a core laboratory. The endpoint of hard
cardiovascular events (HCE) was a composite of death from any cause,
nonfatal myocardial infarction, and nonfatal stroke, while the endpoint of
major adverse cardiac and cerebrovascular events (MACCE) was a composite
of HCE and repeat revascularization. Result(s): A total of 1,900
patients were randomized to PCI (n = 953) or CABG (n = 947). The SS was
considered an independent predictor of 5-year MACCE (hazard ratio per unit
of SS: 1.02; 95% confidence interval: 1.00 to 1.03; p = 0.014) and HCE
(hazard ratio per unit of SS: 1.03; 95% confidence interval: 1.01 to 1.04;
p = 0.002) in the PCI cohort, but not in the CABG group. There was a
higher incidence of MACCE in PCI patients with low, intermediate, and high
SS compared with those who underwent CABG (36.6% vs. 25.9%, p = 0.02;
43.9% vs. 26.8%, p < 0.001; 48.7% vs. 29.7%, p = 0.003, respectively).
 Conclusion(s): In DM patients with multivessel CAD, the complexity of
CAD evaluated by the SS is an independent risk factor for MACCE and HCE
only in patients undergoing PCI. The SS should not be utilized to guide
the choice of coronary revascularization in patients with DM and
multivessel CAD. (Comparison of Two Treatments for Multivessel Coronary
Artery Disease in Individuals With Diabetes [FREEDOM];
NCT00086450) Copyright © 2018

<21>
Accession Number
625397345
Title
Prevention of Early Postoperative Decline (PEaPoD): Protocol for a
randomized, controlled feasibility trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 676. Date of
Publication: 11 Dec 2018.
Author
O'Gara B.; Marcantonio E.R.; Pascual-Leone A.; Shaefi S.; Mueller A.;
Banner-Goodspeed V.; Talmor D.; Subramaniam B.
Institution
(O'Gara, Shaefi, Mueller, Banner-Goodspeed, Talmor, Subramaniam)
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel
Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave,
Boston, MA 02215, United States
(Marcantonio) Division of General Medicine and Primary Care, Beth Israel
Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave,
Boston, MA 02215, United States
(Pascual-Leone) Division of Neurology, Beth Israel Deaconess Medical
Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215,
United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Delirium is associated with a significantly increased risk of
postoperative morbidity and mortality. Furthermore, delirium has been
associated with an increased risk of prolonged cognitive deficits and
accelerated long-term cognitive decline. To date, experimental
interventions for delirium have mainly focused on alternative
pharmacologic and behavioral strategies in the postoperative period. Few
studies have examined whether proactive strategies started before surgery
can prevent delirium or reduce its sequelae. Neurocognitive training
programs such as Lumosity have been shown to be effective in increasing
cognitive performance in both elderly healthy volunteers and patients
suffering from a myriad of acute and chronic medical conditions. When
initiated in the preoperative period, such training programs may serve as
interesting and novel patient-led interventions for the prevention of
delirium and postoperative cognitive decline (POCD). We hypothesize that
perioperative neurocognitive training is feasible in the older cardiac
surgical population and are testing this hypothesis using a randomized
controlled design. Method(s): The Prevention of Early Postoperative
Decline (PEaPoD) study is a randomized, controlled trial with a target
enrollment of 45 elderly cardiac surgical patients. Subjects will be
randomized in a 1:1 ratio to undergo either at least 10 days of
preoperative neurocognitive training, continued for 4 weeks
postoperatively, or usual care control. The primary outcome, feasibility,
will be assessed by study recruitment and adherence to protocol. Secondary
outcomes will include potential differences in the incidence of
postoperative in-hospital delirium and POCD up to 6 months, as determined
by the Confusion Assessment Method and the Montreal Cognitive Assessment.
 Discussion(s): PEaPoD will be the first trial investigating the use
of perioperative cognitive training to potentially reduce delirium and
POCD in the cardiac surgical population. Information gleaned from this
feasibility study will prove valuable in designing future efficacy studies
aimed at determining whether this low-risk, patient-led intervention can
reduce serious postoperative morbidity. Trial registration:
ClinicalTrials.gov, NCT02908464. Registered on 21 September
2016. Copyright © 2018 The Author(s).

<22>
Accession Number
625354268
Title
Management of post-myocardial infarction ventricular septal defects: A
critical assessment.
Source
Journal of Interventional Cardiology. 31 (6) (pp 939-948), 2018. Date of
Publication: December 2018.
Author
Omar S.; Morgan G.L.; Panchal H.B.; Thourani V.; Rihal C.S.; Patel R.;
Kherada N.; Egbe A.C.; Beohar N.
Institution
(Omar, Morgan, Patel, Kherada, Beohar) Mount Sinai Medical Center,
Columbia University Division of Cardiology, Miami Beach, FL, United States
(Panchal) Division of Cardiology, Department of Internal Medicine, East
Tennessee State University, Johnson City, TN, United States
(Thourani) Division of Cardiothoracic Surgery, Medstar Heart and Vascular
Institute, Washington Hospital Center, Washington, DC, United States
(Rihal, Egbe) Division of Cardiovascular Medicine, Mayo Clinic, Rochester,
MN, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Post-myocardial infarction (MI) ventricular septal defects
(PIVSD) are an uncommon but life-threatening complication of acute MI.
Although surgical closure has been the standard of care, mortality, and
recurrence of VSD remain high even after emergent surgery. Transcatheter
VSD closure (TCC) devices have become an alternative or adjunct to
surgical closure. Method(s): Online database search was performed for
studies that included adults with PIVSD who underwent medical treatment
(MT) alone, surgical closure (SC) (early or late), and TCC (early, late,
or for post-surgical residual VSD). Result(s): Twenty-six studies
were included with a total of 737 patients who underwent either MT (N =
100), SC (early (n = 167), late (n = 100)), and TCC (early (n = 176), late
(n = 115), or post-surgical residual VSD (n = 79)). The 30-day mortality
among MT group was 92 +/- 6.3%, among SC was 61 +/- 22.5% (early 56 +/-
23%, late 41 +/- 30%), and for all TCC patients was 33 +/- 24% (early 54
+/- 32.7%, late 16 +/- 26%), and TCC for post-surgical residual VSD 11 +/-
34.9%. The mortality among overall SC, overall TCC and early TCC groups
was significantly lower as compared with the MT (P < 0.001 for all
comparisons). The overall mortality among all TCC, and late TCC groups was
significantly lower when compared with the late SC (P < 0.0001, P <
0.0001, respectively). Conclusion(s): Closure of PIVSD decreases
mortality as compared with MT alone and should be attempted as early as
possible after diagnosis. Selection of TCC versus SC should be based on
factors including complexity of the defect, availability of closure
devices, expertise of the operator, and clinical condition of
patient. Copyright © 2018 Wiley Periodicals, Inc.

<23>
[Use Link to view the full text]
Accession Number
625311440
Title
MicroRNA-155 amplifies nitric oxide/cGMP signaling and impairs vascular
angiotensin II reactivity in septic shock.
Source
Critical Care Medicine. 46 (9) (pp E945-E954), 2018. Date of Publication:
2018.
Author
Vasques-Novoa F.; Laundos T.L.; Cerqueira R.J.; Quina-Rodrigues C.;
Soares-dos-Reis R.; Baganha F.; Ribeiro S.; Mendonca L.; Goncalves F.;
Reguenga C.; Verhesen W.; Carneiro F.; Paiva J.A.; Schroen B.;
Castro-Chaves P.; Pinto-do-o P.; Nascimento D.S.; Heymans S.;
Leite-Moreira A.F.; Roncon-Albuquerque R.
Institution
(Vasques-Novoa, Cerqueira, Quina-Rodrigues, Baganha, Ribeiro, Mendonca,
Goncalves, Castro-Chaves, Leite-Moreira, Roncon-Albuquerque) Department of
Surgery and Physiology, Faculty of Medicine, University of Porto, Porto,
Portugal
(Vasques-Novoa, Castro-Chaves) Department of Internal Medicine, Sao Joao
Hospital Center, Porto, Portugal
(Vasques-Novoa, Paiva, Castro-Chaves) Department of Medicine, Faculty of
Medicine of Porto, Porto, Portugal
(Vasques-Novoa, Laundos, Soares-dos-Reis, Reguenga, Carneiro, Pinto-Do-O,
Nascimento) Instituto de Investigacao e Inovacao em Saude (i3S),
University of Porto, Porto, Portugal
(Vasques-Novoa, Laundos, Pinto-do-o, Nascimento) Instituto de Engenharia
Biomedica (INEB), University of Porto, Porto, Portugal
(Laundos, Pinto-do-o) Instituto de Ciencias Biomedicas Abel Salazar
(ICBAS), University of Porto, Porto, Portugal
(Cerqueira, Leite-Moreira) Department of Cardiothoracic Surgery, Sao Joao
Hospital Center, Porto, Portugal
(Quina-Rodrigues) Department of Cardiology, Hospital de Braga, Braga,
Portugal
(Soares-dos-Reis, Reguenga) Department of Biomedicine-Experimental Biology
Unit, Faculty of Medicine, University of Porto, Porto, Portugal
(Soares-dos-Reis, Reguenga) Instituto de Biologia Molecular e Celular
(IBMC), University of Porto, Porto, Portugal
(Verhesen, Schroen, Heymans) Center for Heart Failure Research,
Cardiovascular Research Institute Maastricht (CARIM), Maastricht
University, Netherlands
(Carneiro) Department of Pathology, Sao Joao Hospital Center, Porto,
Portugal
(Carneiro) Institute of Molecular Pathology and Immunology, University of
Porto (IPATIMUP), Porto, Portugal
(Paiva, Roncon-Albuquerque) Department of Emergency and Intensive Care
Medicine, Sao Joao Hospital Center, Porto, Portugal
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: Septic shock is a life-threatening clinical situation
associated with acute myocardial and vascular dysfunction, whose
pathophysiology is still poorly understood. Herein, we investigated
microRNA-155-dependent mechanisms of myocardial and vascular dysfunction
in septic shock. Design(s): Prospective, randomized controlled
experimental murine study and clinical cohort analysis. Setting(s):
University research laboratory and ICU at a tertiary-care center.
 Patient(s): Septic patients, ICU controls, and healthy controls.
Postmortem myocardial samples from septic and nonseptic patients. Ex vivo
evaluation of arterial rings from patients undergoing coronary artery
bypass grafting. Subjects: C57Bl/6J and genetic background-matched
microRNA-155 knockout mice. Intervention(s): Two mouse models of
septic shock were used. Genetic deletion and pharmacologic inhibition of
microRNA-155 were performed. Ex vivo myographic studies were performed
using mouse and human arterial rings.Measurements and Main Results: We
identified microRNA-155 as a highly up-regulated multifunctional mediator
of sepsisassociated cardiovascular dysfunction. In humans, plasma and
myocardial microRNA-155 levels correlate with sepsis-related mortality and
cardiac injury, respectively, whereas in murine models, microRNA-155
deletion and pharmacologic inhibition attenuate sepsis-associated
cardiovascular dysfunction and mortality. MicroRNA-155 up-regulation in
septic myocardium was found to be mostly supported by microvascular
endothelial cells. This promoted myocardial microvascular permeability and
edema, bioenergetic deterioration, contractile dysfunction,
proinflammatory, and nitric oxide-cGMP-protein kinase G signaling
overactivation. In isolate cardiac microvascular endothelial cells,
microRNA-155 up-regulation significantly contributes to LPSinduced
proinflammatory cytokine up-regulation, leukocyte adhesion, and nitric
oxide overproduction. Furthermore, we identified direct targeting of CD47
by microRNA-155 as a novel mechanism of myocardial and vascular
contractile depression in sepsis, promoting microvascular endothelial cell
and vascular insensitivity to thrombospondin-1-mediated inhibition of
nitric oxide production and nitric oxide-mediated vasorelaxation,
respectively. Additionally, microRNA-155 directly targets angiotensin type
1 receptor, decreasing vascular angiotensin II reactivity. Deletion of
microRNA-155 restored angiotensin II and thrombospondin-1 vascular
reactivity in LPS-exposed arterial rings. Conclusion(s): Our study
demonstrates multiple new microRNA- 155-mediated mechanisms of
sepsis-associated cardiovascular dysfunction, supporting the translational
potential of microRNA-155 inhibition in human septic shock. Copyright
© IAEME Publication

<24>
Accession Number
625122037
Title
Preventing Postoperative Delirium After Major Noncardiac Thoracic
Surgery-A Randomized Clinical Trial.
Source
Journal of the American Geriatrics Society. 66 (12) (pp 2289-2297), 2018.
Date of Publication: December 2018.
Author
Khan B.A.; Perkins A.J.; Campbell N.L.; Gao S.; Khan S.H.; Wang S.;
Fuchita M.; Weber D.J.; Zarzaur B.L.; Boustani M.A.; Kesler K.
Institution
(Khan, Khan, Fuchita, Boustani) Department of Medicine, School of
Medicine, Indiana University, Indianapolis, IN, United States
(Khan, Campbell, Boustani) Department of Medicine, Center for Aging
Research, Indiana University, Indianapolis, IN, United States
(Khan, Campbell, Boustani) Department of Medicine, Regenstrief Institute,
Inc., Indianapolis, IN, United States
(Khan, Campbell, Boustani) Department of Medicine, Center for Health
Innovation and Implementation Science, Indiana Clinical and Translational
Sciences Institute, Indiana University, Indianapolis, IN, United States
(Perkins, Gao) Department of Statistics, School of Medicine, Indiana
University, Indianapolis, IN, United States
(Campbell) Eskenazi Health, Indianapolis, IN, United States
(Campbell) Department of Pharmacy Practice, College of Pharmacy, Purdue
University, West Lafayette, IN, United States
(Wang) Department of Psychiatry, School of Medicine, Indiana University,
Indianapolis, IN, United States
(Weber) Department of Surgery, University of California, San Francisco,
San Francisco, CA, United States
(Zarzaur, Kesler) Department of Surgery, School of Medicine, Indiana
University, Indianapolis, IN, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To assess the efficacy of haloperidol in reducing
postoperative delirium in individuals undergoing thoracic surgery.
 Design(s): Randomized double-blind placebo-controlled trial.
 Setting(s): Surgical intensive care unit (ICU) of tertiary care
center. Participant(s): Individuals undergoing thoracic surgery
(N=135). Intervention(s): Low-dose intravenous haloperidol (0.5 mg
three times daily for a total of 11 doses) administered postoperatively.
Measurements: The primary outcome was delirium incidence during
hospitalization. Secondary outcomes were time to delirium, delirium
duration, delirium severity, and ICU and hospital length of stay. Delirium
was assessed using the Confusion Assessment Method for the ICU and
delirium severity using the Delirium Rating Scale-Revised. Result(s):
Sixty-eight participants were randomized to receive haloperidol and 67
placebo. No significant differences were observed between those receiving
haloperidol and those receiving placebo in incident delirium (n=15 (22.1%)
vs n=19 (28.4%); p =.43), time to delirium (p =.43), delirium duration
(median 1 day, interquartile range (IQR) 1-2 days vs median 1 day, IQR 1-2
days; p =.71), delirium severity, ICU length of stay (median 2.2 days, IQR
1-3.3 days vs median 2.3 days, IQR 1-4 days; p =.29), or hospital length
of stay (median 10 days, IQR 8-11.5 days vs median 10 days, IQR 8-12 days;
p =.41). In the esophagectomy subgroup (n = 84), the haloperidol group was
less likely to experience incident delirium (n=10 (23.8%) vs n=17 (40.5%);
p =.16). There were no differences in time to delirium (p =.14), delirium
duration (median 1 day, IQR 1-2 days vs median 1 day, IQR 1-2 days; p
=.71), delirium severity, or hospital length of stay (median 11 days, IQR
10-12 days vs median days 11, IQR 10-15 days; p =.26). ICU length of stay
was significantly shorter in the haloperidol group (median 2.8 days, IQR
1.1-3.8 days vs median 3.1 days, IQR 2.1-5.1 days; p =.03). Safety events
were comparable between the groups. Conclusion(s): Low-dose
postoperative haloperidol did not reduce delirium in individuals
undergoing thoracic surgery but may be efficacious in those undergoing
esophagectomy. J Am Geriatr Soc 66:2289-2297, 2018. © 2018,
Copyright the Authors Journal compilation © 2018, The American
Geriatrics Society

<25>
Accession Number
625455197
Title
Ventricular tachycardia ablation: Single centre experience.
Source
Europace. Conference: Heart Rhythm Congress, HRC 2018. United Kingdom. 20
(Supplement 4) (pp iv60), 2018. Date of Publication: October 2018.
Author
Adlan A.M.; Arujuna A.; Dowd R.; Panikker S.; Hayat S.; Foster W.; Yusuf
S.; Osman F.; Dhanjal T.
Institution
(Adlan, Arujuna, Dowd, Panikker, Hayat, Osman, Dhanjal) University
Hospital Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
(Yusuf) Good Hope Hospital, Sutton Coldfield, United Kingdom
(Foster) Worcestershire Acute Hospitals NHS Trust, Worcester, MA, United
States
Publisher
Oxford University Press
Abstract
Background: Ventricular tachycardia (VT) is associated with increased
morbidity and in patients with previous myocardial infarction there is an
increased risk of sudden death. There is growing evidence for the
effectiveness of catheter ablation over medications in improving morbidity
in patients with recurrent VT and ischaemic cardiomyopathy (ICM). As a
result the threshold for referring for VT ablation has fallen over recent
years and this has led to increasing numbers of cases being performed.
Given the paucity of real world data since the emergence of distinct
patient selection criteria we sought to present our single centre
experience. Method(s): VT ablation cases performed at University
Hospital Coventry were prospectively recorded into a registry. Follow up
data were obtained from review of medical electronic records. The primary
endpoint for normal heart VT was death, cardiovascular (CV)
hospitalisation and VT recurrence (spontaneous VT or holter evidence of
premature ventricular complex burden>1% with symptoms, or>10% if
asymptomatic). The primary endpoint for non-normal heart VT was arrhythmic
death, VT storm (more than 3 episodes in 24 hours) or appropriate shocks.
 Result(s): Forty seven patients underwent a total of 53 catheter
ablations for VT from January 2012 to January 2018. Mean age+/-SD was
57+/-15 yrs, 68% male, 81% Caucasian, 66% elective. Aetiology of VT
included normal heart (49%), ICM (36%), dilated cardiomyopathy (9%),
hypertrophic cardiomyopathy (4%) and valvular heart disease (2%). Normal
heart VT was predominantly of right ventricular outflow tract origin
(85%). Medications at baseline included betablockers (91%), amiodarone
(43%), verapamil (8%), flecainide (4%) and anticoagulation (60%). Cases
were mostly performed with conscious sedation (89%). Median procedural
time was 200 mins (interquartile range [IQR] 141-241), fluoroscopy time 27
mins (IQR 19-34) and radiofrequency ablation time 22 mins (IQR 11-48).
Catheter ablation was acutely successful in 91% of procedures and there
were 6 major procedural complications in total (11%). These included 3
pericardial effusions that required no intervention, 1 case of pericardial
tamponade requiring pericardiocentesis, 1 case of cardiac perforation
requiring surgical correction and 1 groin haematoma managed
conservatively. In 46 patients followed up after a median of 200 days (IQR
94-571), the composite outcome occurred in 28% of patients. There were 2
non-arrhythmic deaths in total (4%) and 6 CV hospitalisations (13%). This
cohort included 19 ICM (36%) with acute procedural success of 95%. At
median Follow-up of 152 days (IQR 102-254) the primary outcome occurred in
22% of patients while further VT storm/appropriate shocks occurred in 3
patients (17%). Conclusion(s): Our real world data shows that
catheter ablation for normal and structural heart VT is safe, associated
with a high rate of acute procedural success and long-term success rates
comparable to randomized controlled studies.

<26>
Accession Number
625455028
Title
His resynchronization therapy vs. biventricular pacing for heart failure
with LBBB: A within-patient comparison of effects on acute haemodynamic
function and ventricular activation.
Source
Europace. Conference: Heart Rhythm Congress, HRC 2018. United Kingdom. 20
(Supplement 4) (pp iv25), 2018. Date of Publication: October 2018.
Author
Arnold A.D.; Shun-Shin M.J.; Keene D.; Howard J.P.; Afzal Sohaib S.M.;
Wright I.J.; Cole G.D.; Qureshi N.A.; Lefroy D.C.; Koa-Wing M.; Linton
N.W.F.; Boon Lim P.; Peters N.S.; Davies D.W.; Muthumala A.; Tanner M.;
Ellenbogen K.A.; Kanagaratnam P.; Francis D.P.; Whinnett Z.I.
Institution
(Arnold, Shun-Shin, Keene, Howard, Afzal Sohaib, Wright, Cole, Qureshi,
Lefroy, Koa-Wing, Linton, Boon Lim, Peters, Davies, Tanner, Kanagaratnam,
Francis, Whinnett) National Heart and Lung Institute, Imperial College
London, London, United Kingdom
(Muthumala) St Bartholomew's Hospital, London, United Kingdom
(Ellenbogen) Division of Cardiac Electrophysiology, Virginia Commonwealth
University, Richmond, VA, United States
Publisher
Oxford University Press
Abstract
Background: Biventricular pacing improves outcomes in heart failure with
left bundle branch block but many patients do not respond and even in
responders morbidity and mortality remain high. His bundle pacing is a new
method for delivering cardiac (Table presented) resynchronization. We
performed a head-to-head acute crossover comparison between His bundle
pacing and biventricular pacing, measuring effects on ventricular
activation and acute haemodynamic function. Method(s): 23 patients
with left bundle branch block referred for biventricular device
implantation based on standard clinical criteria were recruited. Using
high precision, beat-by-beat assessment of acute systolic blood pressure,
we compared haemodynamic responses to temporary His bundle pacing and
biventricular pacing. This is a reproducible acute measure of cardiac
function: acute changes in systolic blood pressure correlate closely with
changes in cardiac output. We simultaneously assessed ventricular
activation time and dyssynchrony index using non-invasive epicardial
mapping (ECGI). To avoid bias, analysis was automated. Result(s): In
17 patients, temporary His bundle pacing reduced activation time and the
full haemodynamic and ventricular activation dataset was successfully
acquired. Both His bundle pacing and biventricular pacing shortened
12-lead QRS duration (-33.7ms, 95% CI-46.1 to-21.3 ms, P<0.001;-17 ms, 95%
CI-27.3 to-7.1 ms, p=0.002), left ventricular activation time (-43.3 ms,
95% CI-51.7 to-34.8 ms, p<0.001;-16.7ms, 95% CI-29.1 to-4.4 ms, p=0.01)
and left ventricular dyssynchrony index (-17.0ms, 95% CI-21.9 to-12.0 ms,
p<0.001;-5.73 ms, 95% CI-11.1 to-0.3 ms, p=0.04). Both His bundle pacing
and biventricular pacing improved acute systolic blood pressure (12.4mmHg,
95% CI 8.6 to 16.2, p<0.001; 7.8 mmHg, 95% CI 4.2 to 11.4, p<0.001
respectively) compared with the unpaced QRS complex (AAI pacing). When
comparing the within-patient responses with His bundle pacing to
biventricular pacing, His bundle pacing was more effective in delivering
ventricular resynchronization; it delivered significantly greater
reductions in QRS duration (-18.6 ms, 95% CI-31.6 to-5.7, p=0.007), left
ventricular activation time (-26ms 95% CI-41 to-21, p=0.002) and left
ventricular dyssynchrony index (-11.2ms, 95% CI-16.8 to-5.6 ms, p<0.001).
This translated into a significantly greater acute systolic blood pressure
response (4.6 mmHg, 95% CI 0.2 to 9.1, p=0.04). Changes in activation time
showed a close correlation with changes in acute systolic blood pressure
(R2=0.49, p=0.04). LV activation pattern was more physiological with His
bundle pacing than biventricular pacing (Figure 1). Conclusion(s):
His bundle pacing delivers better ventricular resynchronization and
improved haemodynamic function, compared with biventricular pacing in
patients with heart failure and LBBB. Randomised controlled trials are now
justified, to determine if these findings translate to long-term clinical
outcomes; Our high-precision haemodynamic measurements facilitate sample
size and power estimation.

<27>
Accession Number
625454985
Title
Outcomes of transcatheter aortic valve replacement in patients with
chronic kidney disease.
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: American
Heart Association Quality of Care and Outcomes Research Scientific
Sessions, QCOR 2018. United States. 11 (Supplement 1) (no pagination),
2018. Date of Publication: April 2018.
Author
Jou S.; Zhang R.; El-Hajjar M.; Nappi A.; Lyubarova R.; Sidhu M.; Torosoff
M.
Institution
(Jou, Zhang) Albany Med College, Albany, NY, United States
(El-Hajjar, Nappi, Lyubarova, Sidhu, Torosoff) Albany Med Cntr, Albany,
NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is an
alternative form of treatment for patients with aortic valve disease who
are otherwise considered a high risk candidate for surgical aortic valve
replacement (SAVR). Chronic kidney disease (CKD) is known to adversely
affect the outcomes of cardiac surgery including SAVR. We aimed to
determine the outcomes of TAVR in patients with CKD, which has not been
widely reported. Method(s): A retrospective observational study was
conducted on 241 consecutive TAVR patients (81.6 +/- 8.1 years old, 58%
females (140 of 241)) treated between January 2011 and April 2015 at a
single academic institution. CKD was defined as glomerular filtration rate
(GFR) below 60 mL/min. Result(s): Ninety-five out of 241 (39.42%)
TAVR recipients had CKD. Patients with CKD had a significantly higher
Society of Thoracic Surgeons (STS) score (13.8% +/- 9.5, vs. 9.3% +/-
5.013; p-value <0.001), but there was no difference in age, left
ventricular ejection fraction, or aortic valve area prior to TAVR.
Patients with CKD had a longer intensive care unit stay (149.4 +/- 188.9
vs. 105.5 +/- 87.1 hours; p = 0.037) and hospital stay (14.4 +/- 11.7 vs.
11.5 +/- 7.5 days; p = 0.036). Postoperative worsening of kidney
dysfunction (20% (19 of 95) vs. 6.9% (9 of 131); p = 0.003) and vascular
complications (7.4% (7 of 95) vs 1.5% (2 of 131); p = 0.027) were more
frequent in CKD patients. There were trends towards increased inhospital
mortality (3.16% (3 of 95) vs. 2.27% (3 of 132); p = 0.68) and 1-year
mortality (9.47% (9 of 95) vs. 4.55% (6 of 132); p = 0.14) in CKD
patients. When adjusted for significant comorbidities (i.e. diabetes
coronary artery disease, congestive heart failure and pulmonary
hypertension), CKD was not associated with increased in-hospital
mortality, but the risk of 1-year mortality was significantly increased
(adjusted odds ratio 3.2, 95% confidence interval 1.01-9.96; p = 0.048).
 Conclusion(s): A significant proportion of TAVR recipients suffer
from chronic kidney disease. These patients were more likely to experience
vascular complications and worsening of renal dysfunction, a prolonged
intensive care unit and hospital length of stay, and an increased one-year
mortality. Additional prospective randomized studies of this important
patient population are warranted.

<28>
Accession Number
2000733758
Title
Defining Staged Procedures for Percutaneous Coronary Intervention Trials:
A Guidance Document.
Source
JACC: Cardiovascular Interventions. 11 (9) (pp 823-832), 2018. Date of
Publication: 14 May 2018.
Author
Spitzer E.; McFadden E.; Vranckx P.; de Vries T.; Ren B.; Collet C.; Onuma
Y.; Garcia-Garcia H.M.; Lopes R.D.; Stone G.W.; Cutlip D.E.; Serruys P.W.
Institution
(Spitzer, McFadden, de Vries, Ren, Onuma) Cardialysis Core Laboratories
and Clinical Trial Management, Rotterdam, Netherlands
(Spitzer, Ren) Department of Cardiology, Thoraxcenter, Erasmus University
Medical Center, Rotterdam, Netherlands
(McFadden) Department of Cardiology, Cork University Hospital, Cork,
Ireland
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Faculty of Medicine and Life Sciences Hasselt
University, Hasselt, Belgium
(Collet) Department of Cardiology, Academic Medical Center, Amsterdam,
Netherlands
(Garcia-Garcia) Department of Cardiology, MedStar Washington Hospital
Center, Washington, DC, United States
(Lopes) Division of Cardiology, Duke University Medical Center/Duke
Clinical Research Institute, Durham, North Carolina, United States
(Stone) Clinical Trials Center, Cardiovascular Research Foundation and
Division of Cardiology, Columbia University Medical Center, New York, New
York, United States
(Cutlip) Baim Institute for Clinical Research, Boston, Massachusetts,
United States
(Cutlip) Beth Israel Deaconess Medical Center, Boston, Massachusetts,
United States
(Serruys) International Centre for Circulatory Health, NHLI, Imperial
College London, London, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients in coronary intervention trials may require more than 1 procedure
to complete the intended revascularization strategy. However, these staged
interventions are not consistently defined. Standardized definitions are
needed to allow meaningful comparisons of this outcome among trials. This
document provides guidance on relevant parameters involving staged
procedures, including minimum data collection and consistent
classification of coronary procedures initially identified as staged; the
aim is to achieve consistency among clinical trialists, sponsors, health
authorities, and regulators. Definitions were developed jointly among
representatives of academic institutions and clinical research
organizations based on clinical trial experience and published literature.
Reasons for staged procedures were identified and include baseline kidney
function, contrast load and radiation exposure, lesion complexity, and
patient or operator fatigue. Moreover, nonclinical reasons include
procedure scheduling and reimbursement. Management of staged procedures
should be a standalone section in clinical trial protocols and clinical
events committee charters. These documents should clearly define a time
window for staged procedures that allows latitude for local policies,
while respecting accepted clinical guidelines, and consistency with study
objectives. Investigators should document in the case report form the
intent to stage a procedure, the lesions to be treated, and the reasons
for staging, preferably before randomization. Ideally, all
reinterventions, or at least all procedures performed after the
recommended time window, those in which data suggest an anticipated
procedure due to a worsening condition and those where a revascularization
is attempted in the target vessel, should be reviewed by an independent
clinical events committee. Copyright © 2018 American College of
Cardiology Foundation

<29>
Accession Number
2001382906
Title
Systematic preoperative CT scan is associated with reduced risk of stroke
in minimally invasive mitral valve surgery: A meta-analysis.
Source
International Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Author
Leonard J.R.; Henry M.; Rahouma M.; Khan F.M.; Wingo M.; Hameed I.; Di
Franco A.; Guy T.S.; Girardi L.N.; Gaudino M.
Institution
(Leonard, Henry, Rahouma, Khan, Wingo, Hameed, Di Franco, Guy, Girardi,
Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New
York City, NY, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Minimally invasive mitral valve surgery (MIMVS) is performed
with increasing frequency. However, patients undergoing MIMVS might be at
increased risk of perioperative stroke, mainly due to retrograde aortic
embolization during femoral cardio-pulmonary bypass. Pre-operative
computed tomography (CT) screening allows visualization of the aorta and
femoro-iliac vessels and individualization of the surgical approach. In
this meta-analysis, we aim to determine if systematic pre-operative CT
screening is associated with decreased incidence of post-operative stroke
and other complications following MIMVS. Method(s): A comprehensive
review was performed in PubMed (inception-May 2018). Eligible studies
included those which reported on MIMVS (mini-thoracotomy, port access or
robotic approach) with retrograde arterial perfusion. Studies were
separated into two subgroups: systematic pre-operative CT screening
(CT-group) and no CT screening (Non-CT). Pooled event rates (PER) for
operative mortality, post-operative stroke, perioperative myocardial
infarction (MI), and new onset renal failure requiring dialysis were
estimated and inter-group comparisons were performed. Result(s): Data
from 57 studies (13,731 patients) were analyzed (19 CT-group, 38 Non-CT).
PER for post-operative stroke was 2.0% with a statistically significant
difference between the groups (CT-group: 1.5% versus Non-CT: 2.2%, P =
0.03). PER for new dialysis was 1.9%, significantly lower in the CT-group
(0.8% versus 2.3% in the Non-CT group, P = 0.02). PER for operative
mortality was 1.4% with a trend towards better outcomes in the CT-group
(0.8% versus 1.6% in the Non-CT group, P = 0.05). Conclusion(s):
Systematic pre-operative CT screening is associated with lower risk of
post-operative stroke and need for dialysis and a trend toward lower
operative mortality after MIMVS. Copyright © 2018 Elsevier B.V.

<30>
Accession Number
2001380210
Title
Postoperative Pain Management Strategies and Delirium After Transapical
Aortic Valve Replacement: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Author
Strike E.; Arklina B.; Stradins P.; Cusimano R.J.; Osten M.; Horlick E.;
Styra R.; Poonawala H.; Carroll J.; Djaiani G.
Institution
(Strike, Arklina) Department of Anesthesiology, Paula Stradina University
Hospital, Riga, Latvia
(Stradins) Department of Cardiac Surgery, Paula Stradina University
Hospital, Riga, Latvia
(Cusimano) Division of Cardiovascular Surgery, Toronto General Hospital,
Toronto, Canada
(Osten, Horlick) Department of Interventional Cardiology, Toronto General
Hospital, Toronto, Canada
(Styra) Department of Psychiatry, Toronto General Hospital, Toronto,
Canada
(Poonawala, Carroll, Djaiani) Department of Anesthesia and Pain
Management, Toronto General Hospital, Toronto, Canada
Publisher
W.B. Saunders
Abstract
Objective(s): This study was designed to compare 2 different perioperative
analgesia strategies with respect to the incidence of postoperative
delirium after a transapical approach for transcatheter aortic valve
replacement (TAVR). The authors hypothesized that perioperative thoracic
paravertebral analgesia with a local anesthetic would decrease opioid
consumption and in turn reduce the incidence of postoperative delirium
when compared with systemic opioid-based analgesia after a transapical
TAVR procedure. Design(s): Prospective, randomized controlled
clinical trial. Setting(s): Tertiary referral center, university
hospital. Participant(s): The study comprised 44 patients undergoing
a transapical TAVR procedure. Patients with a history of serious mental
illness, delirium, and severe dementia and/or patients with
contraindications to regional anesthesia were excluded.
 Intervention(s): Patients were randomly assigned to either the
paravertebral group (perioperative continuous thoracic paravertebral block
with local anesthetic) or the patient-controlled analgesia group
(systemically administered opioids) using a computer-generated
randomization code in blocks of four patients. Measurements and Main
Results: Assessment of postoperative delirium was performed by trained
research staff using the confusion assessment method for intensive care
unit preoperatively and postoperatively every 12 hours or more often if
needed according to the patient's condition during the first 7
postoperative days or until discharge. Pain was assessed with a 10 cm
Visual Analog Scale pain score system during the 48 hours postoperatively.
The sedation level was assessed using the Sedation Agitation Scale during
the same period. Overall postoperative delirium was detected in 12/44
(27%) patients, with 7/22 (32%) in the patient-controlled analgesia and
5/22 (23%) in the paravertebral groups, respectively (p = 0.73). Both
groups were similar with respect to demographic data, preoperative
medications, and comorbidities. Paravertebral analgesia was associated
with an opioid-sparing effect during surgery and during the 48-hour
postoperative period. Sedation and pain scores were similar between the 2
groups. In addition, paravertebral analgesia was associated with earlier
extubation times; however, the overall morbidity and mortality were
similar between the 2 groups. Conclusion(s): Paravertebral analgesia
in patients undergoing transapical TAVR procedures appears to have an
opioid-sparing effect. However, it did not translate into a statistically
significant decrease in the rate of postoperative delirium. Copyright
© 2018 Elsevier Inc.

<31>
Accession Number
625448685
Title
Permanent pacemaker implantation and paravalvular leak rates following
sutureless aortic valve operations.
Source
Journal of Cardiac Surgery. (no pagination), 2018. Date of Publication:
2018.
Author
Lazkani M.; Yerasi C.; Prakash S.; Pershad A.; Fang K.
Institution
(Lazkani) University of Colorado Health, Medical Center of the Rockies,
Loveland, CO, United States
(Yerasi) St. Joseph's Medical Center, Phoenix, AZ, United States
(Prakash, Pershad, Fang) University of Arizona, Banner University Medical
Center, Phoenix, AZ, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Permanent pacemaker (PPM) implantation and paravalvular leak
(PVL) rates after sutureless aortic valve replacement (SuAVR) vary widely.
The aim of this meta-analysis was to examine the incidence of new PPM
implantation and PVL after SuAVR. Method(s): Studies evaluating PPM
implantation and PVL rates after SuAVR were searched in Medline/PubMed,
Ovid Journals, Clinicaltrials.gov, Cochrane central register of controlled
trials and database. Studies with a sample size >=10 were included in this
analysis. Pooled proportions were calculated using both the fixed and
random-effects models. The heterogeneity among studies was tested using
I2 statistic. The study design was written in accordance with
PRISMA guidelines. Result(s): Thirty studies involving 3993 patients
with a median follow-up of 12 months were included. The median age was 77
years and males constituted 50%. There was a history of stroke and
coronary artery disease in 6% and 31% of the population. Pooled
proportions demonstrate a cumulative postoperative PPM rate of 8.5% (95%
confidence interval [CI] 7.6-9.5%, I2 = 68.8%) and the overall
rate of any PVL was 4.2% (95%CI 3.4-5%, I2 = 76.1%) across all
major SuAVR devices. The rate of severe PVL was only 0.4% (95%CI 0.2-0.7%,
I2 = 0%) at discharge and 0.5% (95%CI 0.2-0.9%, I2 =
0%) at 12 months. Conclusion(s): In SuAVR prostheses implanted in
this meta-analysis, the postoperative permanent pacemaker rate was higher
(8.5%) than reported for non-SuAVR prosthesis. While the overall PVL rate
was 4.2%, the incidence of severe PVL was only 0.4% at discharge and
remained stable at 0.5% at 12 months. Copyright © 2018 Wiley
Periodicals, Inc.

<32>
Accession Number
625447359
Title
Newer-generation of Edwards transcatheter aortic valve systems: SAPIEN 3,
Centera, and SAPIEN 3 Ultra.
Source
Expert Review of Medical Devices. (no pagination), 2018. Date of
Publication: 2018.
Author
Solomonica A.; Choudhury T.; Bagur R.
Institution
(Solomonica, Choudhury, Bagur) London Health Sciences Centre, London,
Canada
(Bagur) Keele Cardiovascular Research Group, Centre for Prognosis
Research, Institute of Primary Care and Health Sciences, University of
Keele, Stoke-on-Trent, United Kingdom
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) has become
the standard of care for patients with severe symptomatic aortic stenosis
at moderate to high surgical risk. Newer devices are now available and
broader indications are expected in the near future. Areas covered: The
Placement of Aortic Transcatheter Valves (PARTNER) trials initially proved
the efficacy of TAVI with the balloon-expandable Edwards SAPIEN valve in
patients deemed in-operable and at high-risk, and later on in
intermediate-risk patients using the balloon-expandable SAPIEN-XT valve.
These trials had laid the groundwork for advancements incorporated in the
balloon-expandable SAPIEN-3 system such as the introduction of the
anti-leak skirt and improved delivery system. In this review, we summarize
the available data on the SAPIEN-3 transcatheter heart valve system and we
highlight the special features of the newly designed self-expanding
Edwards CENTERA valve, and the latest generation of balloon-expanable
SAPIEN-3 UltraTM system. A detailed literature search on these devices was
undertaken using Ovid, PubMed, and Web of Science. Expert commentary: Data
from clinical trials show that TAVI with newer-generation of Edwards
transcatheter heart valve systems have shown significant improvement in
terms of reduced paravalvular leak and have been associated with extremely
good clinical outcomes. Copyright © 2018, © 2018 Informa UK
Limited, trading as Taylor & Francis Group.

<33>
Accession Number
625447318
Title
Innominate artery cannulation in aortic surgery: A systematic review.
Source
Journal of Cardiac Surgery. (no pagination), 2018. Date of Publication:
2018.
Author
Harky A.; Wong C.H.M.; Chan J.S.K.; Zaki S.; Froghi S.; Bashir M.
Institution
(Harky, Zaki) Department of Vascular Surgery, Countess of Chester
Hospital, Chester, United Kingdom
(Wong, Chan) Faculty of Medicine, The Chinese University of Hong Kong,
Shatin, New Territories, Hong Kong
(Froghi) Department of Surgery, Imperial College NHS Trust, Hammersmith
Hospital, London, United Kingdom
(Bashir) Department of Aortovascular Surgery, Manchester Royal Infirmary,
Manchester, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: The innominate artery is considered an alternative site for
establishing cardiopulmonary bypass in surgical procedures involving the
thoracic aorta. This systematic review examines the use of innominate
artery cannulation in aortic surgery. Method(s): A systematic
literature search was undertaken among the four major databases (PubMed,
Embase, Scopus, and Ovid) to identify all studies that utilized innominate
artery cannulation for establishing cardiopulmonary bypass and providing
cerebral perfusion in thoracic aortic surgery. The data were reviewed up
to September 2018. Result(s): Acute type A aortic dissection
contributed to 36% (n = 818) of the total 2,290 patients. 31.5% (n = 719)
underwent surgery on the aortic root only; 54.5% (n = 1246) had ascending
and hemi-arch replacement, while 11.5% had total aortic arch replacement
and 2.5% had a frozen elephant trunk inserted. Postoperative stroke rate
was 1.25% (n = 28), temporary neurological deficit was 4.8% (n = 111).
All-cause 30-day mortality rate was 2.7% (n = 61). Conclusion(s):
Innominate artery cannulation is a safe technique in patients who undergo
thoracic aortic surgery. It can be utilized, in selected cases, as a
reliable route for establishing cardiopulmonary bypass and maintaining
cerebral perfusion. Copyright © 2018 Wiley Periodicals, Inc.

<34>
Accession Number
621295616
Title
Treatment effects of systematic two-stent and provisional stenting
techniques in patients with complex coronary bifurcation lesions:
Rationale and design of a prospective, randomised and multicentre
DEFINITION II trial.
Source
BMJ Open. 8 (3) (no pagination), 2018. Article Number: e020019. Date of
Publication: 01 Mar 2018.
Author
Zhang J.-J.; Gao X.-F.; Han Y.-L.; Kan J.; Tao L.; Ge Z.; Tresukosol D.;
Lu S.; Ma L.-K.; Li F.; Yang S.; Zhang J.; Munawar M.; Li L.; Zhang R.-Y.;
Zeng H.-S.; Santoso T.; Xie P.; Jin Z.-N.; Han L.; Yin W.-H.; Qian X.-S.;
Li Q.-H.; Hong L.; Paiboon C.; Wang Y.; Liu L.-J.; Zhou L.; Wu X.-M.; Wen
S.-Y.; Lu Q.-H.; Yuan J.-Q.; Chen L.-L.; Lavarra F.; Rodriguez A.E.; Zhou
L.-M.; Ding S.-Q.; Vichairuangthum K.; Zhu Y.-S.; Yu M.-Y.; Chen C.;
Sheiban I.; Xia Y.; Tian Y.-L.; Shang Z.-L.; Jiang Q.; Zhen Y.-H.; Wang
X.; Ye F.; Tian N.-L.; Lin S.; Liu Z.-Z.; Chen S.-L.
Institution
(Zhang, Gao, Ge, Ye, Tian, Lin, Liu, Chen) Department of Cardiology,
Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu,
China
(Han) Department of Cardiology, General Hospital of Shenyang Military,
Shenyang, China
(Kan, Chen) Department of Cardiology, Nanjing Heart Center, Nanjing, China
(Tao) Department of Cardiology, Xijing Hospital, 4th Military Medical
University, Xi'an, China
(Tresukosol) Department of Cardiology, Medicine Siriraj Hospital, Mahidol
University, Bangkok, Thailand
(Lu) Department of Cardiology, Taicang People's Hospital, Taicang, China
(Ma) Department of Cardiology, Anhui Provincial Hospital, Hefei, Anhui,
China
(Li) Department of Cardiology, Huainan Eastern Hospital, Huainan, China
(Yang) Department of Cardiology, Yixin People's Hospital, Yixing, China
(Zhang) Department of Cardiology, Cangzhou Central Hospital, Cangzhou,
China
(Munawar) Department of Cardiology, Binawaluya Cardiac Center, Jakarta,
Indonesia
(Li) Department of Cardiology, Guangzhou Red Cross Hospital, Guangzhou,
Guangdong, China
(Zhang) Department of Cardiology, Shanghai Ruijin Hospital, Shanghai,
China
(Zeng) Department of Cardiology, Tongji Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
(Santoso) Department of Cardiology, Medistra Hospital, University of
Indonesia, Jakarta, Indonesia
(Xie) Department of Cardiology, Gansu Provincial Hospital, Lanzhou, China
(Jin) Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Han) Department of Cardiology, Changshu First People's Hospital,
Changshu, China
(Yin) Department of Cardiology, Cheng-Hsin General Hospital, Taipei,
Taiwan (Republic of China)
(Qian) Department of Cardiology, Zhangjiagang First People's Hospital,
Zhangjiagang, China
(Li) Department of Cardiology, Changzhou Hospital of Traditional Chinese
Medicine, Changzhou, China
(Hong) Department of Cardiology, Jiangxi Provincial People's Hospital,
Nanchang, Jiangxi, China
(Paiboon) Department of Cardiology, Bangkok General Hospital, Bangkok,
Thailand
(Wang) Department of Cardiology, Xia'Men Zhongshan Hospital, Xia'men,
China
(Liu) Department of Cardiology, Huainan First People's Hospital, Huainan,
China
(Zhou) Department of Cardiology, Jintan People's Hospital, Jintan, China
(Wu) Department of Cardiology, Wuxi Third People's Hospital, Wuxi, China
(Wen) Department of Cardiology, Daqing Oil General Hospital, Daqing, China
(Lu) Department of Cardiology, Second Hospital of Shandong University,
Ji'nan, China
(Yuan) Department of Cardiology, Xinyang Central Hospital, Xinyang, Henan,
China
(Chen) Department of Cardiology, Fujian Union Hospital, Fuzhou, China
(Lavarra) Department of Cardiology, Jilin Heart Hospital, Changchun, China
(Rodriguez) Department of Cardiology, Otamendi Hospital, Buenos Aires,
Argentina
(Zhou) Department of Cardiology, Chuzhou First People's Hospital, Chuzhou,
China
(Ding) Department of Cardiology, Huainan Xinhua Hospital, Huainan, China
(Vichairuangthum) Department of Cardiology, Bangplee Hospital, Bangkok,
Thailand
(Zhu) Department of Cardiology, Huai'an Second People's Hospital, Huai'an,
China
(Yu) Department of Cardiology, Qingdao Fuwai Hospital, Qingdao, China
(Chen) Department of Cardiology, Affiliated Hospital of Guangdong Medical
University, Guangzhou, China
(Sheiban) Department of Cardiology, University of Turin, Turin, Italy
(Xia) Department of Cardiology, Affiliated Hospital of Xuzhou Medical
University, Xuzhou, China
(Tian) Department of Cardiology, Xuyi People's Hospital, Xuyi, China
(Shang) Department of Cardiology, Wuxi Huishan District People's Hospital,
Wuxi, China
(Jiang) Department of Cardiology, Anqing First People's Hospital, Anqing,
China
(Zhen) Department of Cardiology, Liyang Hospital of Traditional Chinese
Medicine, Liyang, China
(Wang) Department of Cardiology, Lianyungang Hospital of Traditional
Chinese Medicine, Lianyungang, China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Provisional stenting (PS) for simple coronary bifurcation
lesions is the mainstay of treatment. A systematic two-stent approach is
widely used for complex bifurcation lesions (CBLs). However, a randomised
comparison of PS and two-stent techniques for CBLs has never been studied.
Accordingly, the present study is designed to elucidate the benefits of
two-stent treatment over PS in patients with CBLs. Methods and analysis
This DEFINITION II study is a prospective, multinational, randomised,
endpoint-driven trial to compare the benefits of the two-stent technique
with PS for CBLs. A total of 660 patients with CBLs will be randomised in
a 1:1 fashion to receive either PS or the two-stent technique. The primary
endpoint is the rate of 12-month target lesion failure defined as the
composite of cardiac death, target vessel myocardial infarction (MI) and
clinically driven target lesion revascularisation. The major secondary
endpoints include all causes of death, MI, target vessel
revascularisation, in-stent restenosis, stroke and each individual
component of the primary endpoints. The safety endpoint is the occurrence
of definite or probable stent thrombosis. Ethics and dissemination The
study protocol and informed consent have been approved by the
Institutional Review Board of Nanjing First Hospital, and accepted by each
participating centre. Written informed consent was obtained from all
enrolled patients. Findings of the study will be published in a
peer-reviewed journal and disseminated at conferences. Copyright
© 2018 Article author(s) (or their employer(s) unless otherwise
stated in the text of the article). All rights reserved.

<35>
Accession Number
2001335190
Title
Patient-Reported Outcomes in Cardiothoracic Surgery.
Source
Annals of Thoracic Surgery. 107 (1) (pp 294-301), 2019. Date of
Publication: January 2019.
Author
Subramanian M.; Kozower B.D.; Brown L.M.; Khullar O.V.; Fernandez F.G.
Institution
(Subramanian, Kozower) Division of Cardiothoracic Surgery, Washington
University School of Medicine, St. Louis, MO, United States
(Brown) Division of Cardiothoracic Surgery, University of California Davis
Health, Davis, CA, United States
(Khullar, Fernandez) Section of Cardiothoracic Surgery, Emory University
School of Medicine, Atlanta, Georgia
Publisher
Elsevier USA
Abstract
Background: Current studies in cardiothoracic clinical research frequently
fail to use end points that are most meaningful to patients, including
measures associated with quality of life. Patient-reported outcomes (PROs)
represent an underused but important component of high-quality
patient-centered care. Our objective was to highlight important principles
of PRO measurement, describe current use in cardiothoracic operations, and
discuss the potential for and challenges associated with integration of
PROs into large clinical databases. Method(s): We performed a
literature review by using the PubMed/EMBASE databases. Clinical articles
that focused on the use of PROs in cardiothoracic surgical outcomes
measurement or clinical research were included in this review.
 Result(s): PROs measure the outcomes that matter most to patients and
facilitate the delivery of patient-centered care. When effectively used,
PRO measures have provided detailed and nuanced quality-of-life data for
comparative effectiveness research. However, further steps are needed to
better integrate PROs into routine clinical care. Conclusion(s):
Incorporation of PROs into routine clinical practice is essential for
delivering high-quality patient-centered care. Future integration of PROs
into prospectively collected registries and databases, including that The
Society of Thoracic Surgeons National Database, has the potential to
enrich comparative effectiveness research in cardiothoracic
surgery. Copyright © 2019 The Society of Thoracic Surgeons

<36>
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).

<37>
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.

<38>
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.

<39>
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.

<40>
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.

<41>
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.

<42>
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.

<43>
Accession Number
2001335975
Title
Off-Pump Versus On-Pump Impact: Diabetic Patient 5-Year Coronary Artery
Bypass Clinical Outcomes.
Source
Annals of Thoracic Surgery. 107 (1) (pp 92-98), 2019. Date of Publication:
January 2019.
Author
Shroyer A.L.W.; Quin J.A.; Wagner T.H.; Carr B.M.; Collins J.F.; Almassi
G.H.; Bishawi M.; Grover F.L.; Hattler B.
Institution
(Shroyer, Carr, Bishawi) Research and Development Office, Northport
Veterans Affairs Medical Center, Northport, NY, United States
(Shroyer, Grover, Hattler) Research and Development Office, Eastern
Colorado Health Care System, Department of Veterans Affairs, Denver, CO,
United States
(Quin) Department of Surgery, VA Boston Healthcare System, West Roxbury,
MA, United States
(Wagner) Department of Veterans Affairs Health Economics Resource Center,
Palo Alto, CA, United States
(Wagner) Department of Surgery, Stanford University, Palo Alto, CA, United
States
(Carr) Department of Emergency Medicine, Mayo Clinic, Rochester, MN,
United States
(Collins) Cooperative Studies Program Coordinating Center, VA Medical
Center, Perry Point, MD, United States
(Almassi) Department of Surgery, Zablocki VA Medical Center, Milwaukee,
WI, United States
(Almassi) Department of Surgery, Medical College of Wisconsin, Milwaukee,
WI, United States
(Bishawi) Department of Surgery, Duke University Medical Center, Durham,
NC, United States
(Grover) Department of Surgery, University of Colorado School of Medicine,
Aurora, CO, United States
(Hattler) Department of Medicine, University of Colorado School of
Medicine, Aurora, CO, United States
Publisher
Elsevier USA
Abstract
Background: For diabetic patients who require coronary artery bypass graft
(CABG) operation, controversy persists whether an off-pump or an on-pump
approach may be advantageous. This US-based, multicenter, randomized,
controlled trial, Department of Veterans Affairs Randomization On versus
Off Bypass Follow-up Study, compared diabetic patients' 5-year clinical
outcomes for off-pump versus on-pump procedures. Method(s): From 2002
to 2008, 835 medically treated (ie, oral hypoglycemic agent or insulin)
diabetic patients underwent either off-pump (n = 402) or on-pump (n = 433)
CABG. Five-year primary end points included all-cause death and major
adverse cardiovascular events (MACE; composite included all-cause death,
myocardial infarction, or repeat revascularization). Secondary 5-year end
points included cardiac death and MACE-related components. With baseline
risk factors balanced, outcomes were evaluated by using a p value less
than or equal to 0.01; nonsignificant trends were reported for p values
greater than 0.01 and less than or equal to 0.15. Result(s):
Five-year all-cause death rates were 20.2% off pump versus 14.1% on pump
(p = 0.0198). No differences were seen in MACE (32.6% off-pump approach
versus 28.6% on-pump approach, p = 0.216), repeat revascularization (12.4%
off-pump approach versus 11.8% on-pump approach, p = 0.770), and nonfatal
myocardial infarction (12.7% off-pump approach versus 10.4% on-pump
approach, p = 0.299). Cardiac death trended worse with off-pump CABG
(9.0%) than with on-pump CABG (6.25%, p = 0.137). Sensitivity analyses
that removed conversions confirmed these findings. Conclusion(s):
With a 6.1% absolute difference, a strong trend toward improved 5-year
survival was observed with on-pump CABG for medically treated diabetic
patients. No off-pump advantage was found for any 5-year end points. A
future clinical trial now appears warranted to rigorously compare off-pump
versus on-pump longer term outcomes for diabetic patients. Copyright
© 2019

<44>
Accession Number
2001310570
Title
Costs Five Years After Off-Pump or On-Pump Coronary Artery Bypass Surgery.
Source
Annals of Thoracic Surgery. 107 (1) (pp 99-105), 2019. Date of
Publication: January 2019.
Author
Wagner T.H.; Hattler B.; Bakaeen F.G.; Collins J.F.; Almassi G.H.; Quin
J.A.; Grover F.L.; Bishawi M.; Shroyer A.L.W.
Institution
(Wagner) VA Palo Alto Health Economics Resource Center, Menlo Park, CA,
United States
(Wagner) Department of Surgery, Stanford University, Palo Alto, CA, United
States
(Hattler, Grover, Shroyer) Eastern Colorado Health Care System, Department
of Veterans Affairs, Denver, CO, United States
(Hattler, Grover) University of Colorado School of Medicine at the
Anschutz Medical Campus, Aurora, CO, United States
(Bakaeen) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Collins) Cooperative Studies Program Coordinating Center, Veterans
Affairs Medical Center, Perry Point, MD, United States
(Almassi) Veterans Affairs Medical Center, Milwaukee, WI, United States
(Almassi) Department of Cardiothoracic Surgery, Medical College of
Wisconsin, Milwaukee, WI, United States
(Quin) VA Boston Healthcare System, West Roxbury, MA, United States
(Bishawi) Division of Cardiovascular and Thoracic Surgery, Duke University
Medical Center, Durham, NC, United States
(Shroyer) Northport VA Medical Center, Northport, NY, United States
Publisher
Elsevier USA
Abstract
Background: Coronary artery bypass grafting (CABG) is a common surgical
treatment for ischemic heart disease. Little is known about the long-term
costs of conducting the surgery on-pump or off-pump. Method(s): As
part of the Randomized On/Off Bypass follow-up study, we followed 2,203
participants randomized to on-pump (n = 1,099) and off-pump (n = 1,104)
CABG for 5 years using Department of Veterans Affairs and Medicare
administrative data. We examined annual costs through 5 years,
standardized to 2016 dollars, using multivariate regression models,
controlling for site and baseline patient factors. Result(s): In the
first year, including the CABG surgery, annual average costs were $66,599
(SE, $1,946) for the on-pump group and $70,552 (SE, $1,954) for the
off-pump group. In years 2 to 5, average costs ranged from $15,000 to
$20,000 per year. There was no significant difference between on-pump and
off-pump across the 5 years. We explored differences among high-risk
subgroups (diabetes, chronic obstructive pulmonary disease, peripheral
vascular disease, cerebrovascular disease, renal dysfunction, ejection
fraction < 35%, over age 70 years), and found no treatment assignment by
time interactions, except for a nonsignificant trend in patients with
diabetes. Conclusion(s): At 5 years, the average costs of off-pump
and on-pump CABG patients did not statistically differ. Costs do not favor
one approach and the decision should be based on clinical risks,
especially in subgroups. Future research is warranted to examine post-CABG
costs and outcomes for diabetic patients over time. Copyright ©
2019 The Society of Thoracic Surgeons

<45>
Accession Number
2001302089
Title
A Randomized Controlled Trial of Liposomal Bupivacaine Parasternal
Intercostal Block for Sternotomy.
Source
Annals of Thoracic Surgery. 107 (1) (pp 128-134), 2019. Date of
Publication: January 2019.
Author
Lee C.Y.; Robinson D.A.; Johnson C.A.; Zhang Y.; Wong J.; Joshi D.J.; Wu
T.-T.; Knight P.A.
Institution
(Lee, Robinson, Johnson, Wong, Joshi, Knight) Division of Cardiac Surgery,
Department of Surgery, University of Rochester Medical Center, Rochester,
NY, United States
(Zhang, Wu) Department of Biostatistics and Computational Biology,
University of Rochester, Rochester, NY, United States
Publisher
Elsevier USA
Abstract
Background: Optimal pain control continues to be a concern in cardiac
surgery. Current strategies for postoperative pain management often yield
suboptimal results. The superiority of Exparel (Pacira Pharmaceuticals,
Inc, Parsippany, NJ) in providing postoperative pain control and opioid
sparing is equivocal. This prospective, randomized, double-blind study
examines the efficacy of Exparel as a novel single-dose application
parasternal nerve block in postoperative pain control and opioid sparing.
 Method(s): This single-surgeon study included 79 patients undergoing
median sternotomy for coronary revascularization. Study participants were
randomized to either the drug or a control arm. Each participant received
Exparel or normal saline placebo administered as a parasternal nerve
block. Postoperative pain was rated according to the nonverbal pain scale
or numeric rating scale. Total amount of narcotic pain medication used and
patients' pain scores within the first 72 hours postoperatively were
compared. Secondary outcomes compared the intensive care unit length of
stay, hospital length of stay, time to extubation, time to return of bowel
function, and time to return to work or daily activities. Result(s):
The primary endpoint of pain levels between the two groups demonstrated no
significant difference when analyzing the individual time points
postoperatively. However, overall pain levels were significantly lower in
the study drug group (p = 0.04). There was no significant difference in
the amount of analgesics required postoperatively or in secondary
endpoints between the groups. Conclusion(s): Exparel does not provide
an opioid-sparing benefit or any secondary outcome benefit compared with
placebo. Exparel may be associated with a marginal decrease in
postoperative pain levels. (Parasternal Nerve Bock in Cardiac Patients;
NCT01826851.) Copyright © 2019 The Society of Thoracic Surgeons

<46>
Accession Number
625375114
Title
Rare cause of superior vena cava syndrome: A giant bulla.
Source
BMJ Case Reports. 11 (1) (no pagination), 2018. Article Number: e226477.
Date of Publication: 2018.
Author
Batihan G.; Usluer O.; Kaya S.O.
Institution
(Batihan, Usluer, Kaya) Department of Thoracic Surgery, University of
Health Sciences, Dr Suat Seren Chest Diseases and Surgery, Medical
Practice and Research Center, Izmir, Turkey
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Superior vena cava syndrome (SVCS) is a group of symptoms caused by
obstruction of superior vena cava. External compression caused by benign
or malign processes is the most common physiopathology. We aim to present
a 29-year-old man with non-productive cough, facial plethora and venous
distention of the neck. Right apical tense bulla which was compress
superior vena cava was detected and video-assisted thoracoscopic surgery
applied. Our extensive search found out that only one report of SVCS
secondary to bulla is available on Medline. Copyright © BMJ
Publishing Group Limited 2018. No commercial re-use. See rights and
permissions. Published by BMJ.

<47>
Accession Number
2001374431
Title
A randomized controlled trial evaluating general endotracheal anesthesia
versus monitored anesthesia care and the incidence of sedation-related
adverse events during ERCP in high-risk patients.
Source
Gastrointestinal Endoscopy. (no pagination), 2018. Date of Publication:
2018.
Author
Smith Z.L.; Mullady D.K.; Lang G.D.; Das K.K.; Hovis R.M.; Patel R.S.;
Hollander T.G.; Elsner J.; Ifune C.; Kushnir V.M.
Institution
(Smith, Mullady, Lang, Das, Patel, Hollander, Elsner, Kushnir) Division of
Gastroenterology, Washington University School of Medicine, St Louis, MO,
United States
(Hovis, Ifune) Department of Anesthesiology, Washington University School
of Medicine, St Louis, MO, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background and Aims: ERCP is a complex procedure and often performed in
patients at high risk for sedation-related adverse events (SRAEs).
However, there is no current standard of care with regard to mode of
sedation and airway management during ERCP. The aim of this study was to
assess the safety of general endotracheal anesthesia (GEA) versus
propofol-based monitored anesthesia care (MAC) without endotracheal
intubation in patients undergoing ERCP at high risk for SRAEs.
 Method(s): Consecutive patients undergoing ERCP at high risk for
SRAEs at a single center were invited to participate in this randomized
controlled trial comparing GEA and MAC. Inclusion criteria were STOP-BANG
score >=3, abdominal ascites, body mass index >=35, chronic lung disease,
American Society of Anesthesiologists class >3, Mallampati class 4 airway,
and moderate to heavy alcohol use. Exclusion criteria were preceding EUS,
emergent ERCP, tracheostomy, unstable airway, gastric outlet obstruction
or delayed gastric emptying, and altered foregut anatomy. The primary
endpoint was composite incidence of SRAEs: hypoxemia, use of airway
maneuvers, hypotension requiring vasopressors, sedation-related procedure
interruption, cardiac arrhythmia, and respiratory failure. Secondary
outcomes included procedure duration, cannulation success, in-room time,
and immediate adverse events. Result(s): Two hundred patients (mean
age, 61.1 +/- 13.6 years; 36.5% women) were randomly assigned to GEA (n =
101) or MAC (n = 99) groups. Composite SRAEs were significantly higher in
the MAC group compared with the GEA group (51.5% vs 9.9%, P < .001). This
was primarily driven by the frequent need for airway maneuvers in the MAC
group. Additionally, ERCP was interrupted in 10.1% of patients in the MAC
group to convert to GEA because of respiratory instability refractory to
airway maneuvers (n = 8) or significant retained gastric contents (n = 2).
There were no statistically significant differences in cannulation,
in-room, procedure, or fluoroscopy times between the 2 groups. All
patients undergoing GEA were successfully extubated in the procedure room
at completion of ERCP, and Aldrete scores in recovery did not differ
between the 2 groups. There were no immediate adverse events.
 Conclusion(s): In patients at high risk for SRAEs undergoing ERCP,
sedation with GEA is associated with a significantly lower incidence of
SRAEs, without impacting procedure duration, success, recovery, or in-room
time. These data suggest that GEA should be used for ERCP in patients at
high risk for SRAEs (Clinical trial registration number:
NCT02850887.) Copyright © 2018

<48>
Accession Number
625422931
Title
Impact of Patient and Lesion Characteristics on Drug-Coated Balloon
Angioplasty in the Femoropopliteal Artery: A Pooled Analysis of Four
Randomized Controlled Multicenter Trials.
Source
CardioVascular and Interventional Radiology. (no pagination), 2018. Date
of Publication: 2018.
Author
Albrecht T.; Ukrow A.; Werk M.; Tepe G.; Zeller T.; Meyer D.-R.; Kutschera
M.; Speck U.; Waliszewski M.
Institution
(Albrecht, Ukrow) Department of Radiology and Interventional Therapy,
Vivantes Klinikum Neukolln, Berlin, Germany
(Werk) Department of Radiology, Martin-Luther-Hospital, Berlin, Germany
(Tepe) Department of Radiology, RoMed Klinikum Rosenheim, Rosenheim,
Germany
(Zeller) Department of Angiology, Herzzentrum Bad Krozingen, Bad
Krozingen, Germany
(Meyer) Department of Diagnostic and Interventional Radiology, Hubertus
Hospital, Berlin, Germany
(Kutschera, Speck) Experimental Radiology, Department of Radiology,
Charite, Berlin, Germany
(Waliszewski) Medical Scientific Affairs, B.Braun Melsungen AG, Berlin,
Germany
(Waliszewski) Department of Internal Medicine and Cardiology, Charite -
Universitatsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
(Albrecht) Institut fur Radiologie und Interventionelle Therapie, Vivantes
Klinikum Neukolln, Rudower Str. 48, Berlin 12351, Germany
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Objectives: The principal objective of this pooled analysis was to
investigate various patient and lesion characteristics on late lumen loss
(LLL) after drug-coated balloon (DCB) angioplasty. Background(s):
Four randomized controlled trials (THUNDER, FEMPAC, PACIFIER, CONSEQUENT)
were pooled to investigate the influence of various patient and lesion
characteristics on DCB angioplasty and on plain old balloon angioplasty
(POBA) in patients with femoropopliteal artery disease. Method(s):
Angiographic data from 355 patients were pooled to assess the impact of
patient (demographics, cardiovascular risk factors, cardiovascular
co-morbidities, Rutherford stages) and lesion-/procedure-related
(location, occlusion, length, restenosis, calcification, subintimal
crossing, post-dilatation, dissection, stenting) characteristics on LLL.
Linear regression models were utilized with LLL as the dependent variable
to determine the predictive value of cardiovascular and
lesion-/procedure-related factors. Result(s): Observational
statistics revealed that LLL was lower in the DCB group as compared to
POBA independent of all tested patient variables. LLL after DCB was also
independent of most lesion and procedural characteristics except for
lesion length and bailout stenting. LLL increased with lesion length in
both treatment groups. Bailout stenting did not improve LLL in the DCB
group but did so in the POBA group (0.74 +/- 1.07 mm vs. 1.22 +/- 1.36 mm,
p = 0.043). Conclusion(s): DCB was superior to POBA for all tested
patient subgroups and lesion subgroups. Our results suggest that all
patients and lesions benefit to a similar degree from the use of DCB.
DCB-PTA should therefore be preferred to POBA in all patients with
steno-occlusive femoropopliteal lesions. Copyright © 2018,
Springer Science+Business Media, LLC, part of Springer Nature and the
Cardiovascular and Interventional Radiological Society of Europe (CIRSE).

<49>
Accession Number
625422665
Title
Steroids in cardiac surgery trial: a substudy of surgical site infections.
Source
Canadian Journal of Anesthesia. (no pagination), 2018. Date of
Publication: 2018.
Author
McClure G.R.; Belley-Cote E.P.; Harlock J.; Lamy A.; Stacey M.; Devereaux
P.J.; Whitlock R.P.
Institution
(McClure) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(McClure, Belley-Cote, Devereaux, Whitlock) Department of Clinical
Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
(Belley-Cote, Devereaux) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Belley-Cote) Department of Medicine, Universite de Sherbrooke,
Sherbrooke, QC, Canada
(Belley-Cote, Lamy, Devereaux, Whitlock) Population Health Research
Institute, Hamilton, ON, Canada
(Harlock, Stacey) Division of Vascular Surgery, McMaster University,
Hamilton, ON, Canada
(Lamy, Whitlock) Division of Cardiac Surgery, McMaster University,
Hamilton, ON, Canada
(Whitlock) David Braley Cardiac, Vascular and Stroke Research Institute,
Room 1C1-5B, 237 Barton St. E, Hamilton, ON L8L 2X2, Canada
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Postoperative infection, particularly in cardiac surgery, results
in significant morbidity, mortality, and healthcare cost. Identification
of novel predictors of postoperative infection can target high-risk
populations for prophylactic intervention. Method(s): Steroids in
cardiac surgery (SIRS) was a multi-centre randomized-controlled trial
assessing intraoperative administration of methylprednisone during cardiac
surgery, which enrolled 7,507 patients across 80 centres in 18 countries.
It demonstrated that administration of steroids had no effect on mortality
or major morbidity after cardiac surgery. Our primary objective was to
identify risk factors for postoperative surgical site infections using
SIRS participants as a cohort. We excluded patients who did not undergo
surgery, died intraoperatively, or died within 48 hr of the operation.
Patients were assessed for development of "surgical site infection" over
the first 30 days postoperatively. Using theoretical and previously
identified risk factors, we used forward stepwise entry to create a binary
logistic regression model. Result(s): Follow-up at 30 days was
complete for all patients; 7,406 were included in the cohort. Surgical
site infection occurred in 180 (4.8%) and 184 (5.0%) of patients in the
placebo and steroid arms respectively. Significant risk factors (P < 0.05
level) included: diabetes managed with insulin (adjusted odds ratio [aOR]:
1.55; 95% confidence interval [CI] 1.13 to 2.12), oral hypoglycemics (aOR
1.60; 95% CI 1.18 to 2.16), or diet (aOR 1.81; 95% CI 1.16 to 2.83),
female sex (aOR 1.34; 95% CI 1.05 to 1.71), renal failure with (aOR 2.03;
95% CI 1.06 to 3.91), and without (aOR 1.50; 95% CI 1.04 to 2.14)
dialysis, > 96 min cardiopulmonary bypass (CPB) time (aOR 1.84; 95% CI
1.44 to 2.35), body mass index (BMI) < 22.3 (aOR 0.44; 95% CI 0.28 to
0.71) or > 30 (aOR 1.49; 95% CI 1.17 to 1.89), peak intensive care unit
blood glucose (aOR 1.02 per mmol.L-1; 95% CI 1.00 to 1.04), and
coronary artery bypass grafting (CABG) operation type (aOR 2.59; 95% CI
1.87 to 3.59). Conclusion(s): Patients undergoing CABG, requiring
longer CPB, with higher BMI, or with diabetes, are at elevated risk of
surgical site infection. Strategies to mitigate this risk warrant further
investigation. Copyright © 2018, Canadian Anesthesiologists'
Society.

<50>
Accession Number
625422278
Title
Remote ischaemic preconditioning increases serum extracellular vesicle
concentrations with altered micro-RNA signature in CABG patients.
Source
Acta Anaesthesiologica Scandinavica. (no pagination), 2018. Date of
Publication: 2018.
Author
Frey U.H.; Klaassen M.; Ochsenfarth C.; Murke F.; Thielmann M.; Kottenberg
E.; Kleinbongard P.; Klenke S.; Engler A.; Heusch G.; Giebel B.; Peters J.
Institution
(Frey, Klaassen, Ochsenfarth, Kottenberg, Klenke, Engler, Peters) Klinik
fur Anasthesiologie und Intensivmedizin, Universitatsklinikum Essen,
Universitat Duisburg-Essen, Essen, Germany
(Frey, Ochsenfarth) Klinik fur Anasthesiologie, operative Intensivmedizin,
Schmerz- und Palliativmedizin, Marien Hospital Herne, Universitatsklinikum
der Ruhr-Universitat Bochum, Bochum, Germany
(Murke, Giebel) Institut fur Transfusionsmedizin, Universitatsklinikum,
Universitat Duisburg-Essen, Essen, Essen, Germany
(Thielmann) Klinik fur Thorax- und kardiovaskulare Chirurgie,
Universitatsklinikum Essen, Universitat Duisburg-Essen, Essen, Germany
(Kleinbongard, Heusch) Institut fur Pathophysiologie, Westdeutsches Herz-
und Gefaszentrum, Universitatsklinikum Essen, Universitat Duisburg-Essen,
Essen, Germany
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Remote ischaemic preconditioning (RIPC) can attenuate
myocardial ischaemia/reperfusion injury but its underlying mechanisms
remain largely unknown. Recently, extracellular vesicles (EVs) containing
microRNAs (miRNAs) were shown to mediate distant intercellular
communication that may be involved in cardioprotection. We tested the
hypothesis that RIPC in anaesthetized patients undergoing coronary artery
bypass (CABG) surgery results in the release of EVs from the
ischaemic/reperfused arm into the blood stream harbouring cardioprotective
miRNAs. Method(s): In 58 patients randomised to RIPC (three 5/5
minutes episodes of left arm ischaemia/reperfusion by suprasystolic blood
pressure cuff inflations/deflations) or Sham, a subprotocol comprising of
parallel right radial artery and regional (left subclavian) venous blood
sampling before (awake) and 5 and 60 minutes after RIPC/Sham during
isoflurane/sufentanil anaesthesia could be completed. EVs were extracted
by polymer-based precipitation methods, their concentrations measured, and
their miRNA signature analysed. Result(s): Five minutes after RIPC,
regional venous EV concentrations downstream from the cuff increased and
arterial concentrations increased after 60 minutes (fold change [fc]:
RIPC: 1.33 +/- 0.5, Sham: 0.91 +/- 0.31; P = 0.003 for interaction).
Already 5 minutes after RIPC, expression of 26 miRNAs (threshold fc: 3.0,
P < 0.05) isolated from EVs including the cardioprotective miR-21 had
increased. RIPC also decreased postoperative Troponin I concentrations
(AUC RIPC: 336 ng/mL x 72 hours +/- 306 vs Sham: 713 +/- 1013; P = 0.041).
 Conclusion(s): Remote ischaemic preconditioning increases serum EV
concentrations, most likely by early EV release from the patients' left
(RIPC) arm, alters their miRNA signature, and is associated with
myocardial protection. Thus, an increased EV concentration with an altered
miR-signature may mediate the RIPC effect. Copyright © 2018 The
Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley &
Sons Ltd

<51>
Accession Number
625421751
Title
Contemporary Management of Heart Failure in the Elderly.
Source
Drugs and Aging. (no pagination), 2018. Date of Publication: 2018.
Author
Osmanska J.; Jhund P.S.
Institution
(Osmanska, Jhund) British Heart Foundation Cardiovascular Research Centre,
Institute of Cardiovascular and Medical Sciences, University of Glasgow,
126 University Place, Glasgow G12 8TA, United Kingdom
Publisher
Springer International Publishing
Abstract
The foundation of the treatment of heart failure with reduced ejection
fraction is a number of pharmacotherapies shown to reduce morbidity and
mortality in large randomised multinational clinical trials. These include
angiotensin converting enzyme inhibitors, angiotensin receptor blockers,
beta-blockers, mineralocorticoid receptor antagonists, and more recently,
a combined angiotensin receptor blocker neprilysin inhibitor,
sacubitril/valsartan. In select cases, digoxin, ivabradine and hydralazine
with isosorbide dinitrate have a role to play in the treatment of heart
failure with reduced ejection fraction. On this foundation, other more
advanced treatments such as implantable cardioverter defibrillators and
cardiac resynchronisation therapy are recommended in guidelines for the
treatment of heart failure with reduced ejection fraction (i.e. an
ejection fraction of <= 40%) and for a select few there remains the option
of mechanical circulatory support and cardiac transplantation. The
efficacy of pharmacotherapy does not vary by age and each of these
therapies should be considered in all patients, irrespective of age. Other
factors such as co-morbidities like renal dysfunction may limit the use of
some of these drugs in the elderly. Decision making with regard to device
therapy is more complex; the likelihood of competing non-cardiovascular
causes of death and life expectancy need to be considered. Despite
multiple treatment options for heart failure with reduced ejection
fraction, the options for heart failure with preserved ejection fraction
are limited. In the absence of robust outcomes data from a large
randomised trial, a mineralocorticoid receptor antagonist is a reasonable
therapy to reduce the risk of hospitalisation for heart failure in
patients with heart failure with preserved ejection
fraction. Copyright © 2018, Springer Nature Switzerland AG.

<52>
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.

<53>
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.

<54>
Accession Number
623986311
Title
Efficacy of Different Types of Exercise-Based Cardiac Rehabilitation on
Coronary Heart Disease: a Network Meta-analysis.
Source
Journal of General Internal Medicine. 33 (12) (pp 2201-2209), 2018. Date
of Publication: 01 Dec 2018.
Author
Xia T.-L.; Huang F.-Y.; Peng Y.; Huang B.-T.; Pu X.-B.; Yang Y.; Chai H.;
Chen M.
Institution
(Xia, Huang, Peng, Huang, Pu, Yang, Chai, Chen) Department of Cardiology,
West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041,
China
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Exercise-based cardiac rehabilitation (CR) has been recognized
as an essential component of the treatment for coronary heart disease
(CHD). Determining the efficacy of modern alternative treatment methods is
the key to developing exercise-based CR programs. Method(s): Studies
published through June 6, 2016, were identified using MEDLINE, EMBASE, and
the Cochrane Library. English-language articles regarding the efficacy of
different modes of CR in patients with CHD were included in this analysis.
Two investigators independently reviewed abstracts and full-text articles
and extracted data from the studies. According to the categories described
by prior Cochrane reviews, exercise-based CR was classified into
center-based CR, home-based CR, tele-based CR, and combined CR for this
analysis. Outcomes included all-cause mortality, cardiovascular death,
recurrent fatal and/or nonfatal myocardial infarction, recurrent cardiac
artery bypass grafting, recurrent percutaneous coronary intervention
(PCI), and hospital readmissions. Result(s): Sixty randomized
clinical trials (n = 19,411) were included in the analysis. Network
meta-analysis (NMA) demonstrated that only center-based CR significantly
reduced all-cause mortality (center-based: RR = 0.76 [95% CI 0.64-0.90], p
= 0.002) compared to usual care. Other modes of CR were not significantly
different from usual care with regard to their ability to reduce
mortality. Treatment ranking indicated that combined CR exhibited the
highest probability (86.9%) of being the most effective mode, but this
finding was not statistically significant due to the small sample size
(combined: RR = 0.50 [95% CI 0.20-1.27], p = 0.146). Conclusion(s):
Current evidence suggests that center-based CR is acceptable for patients
with CHD. As home- and tele-based CR can save time, money, effort, and
resources and may be preferred by patients, their efficacy should be
investigated further in subsequent studies. Copyright © 2018,
Society of General Internal Medicine.

<55>
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.

<56>
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.

<57>
Accession Number
625285219
Title
Optimal timing of complete revascularization in patients with st-segment
elevation myocardial infarction and multivessel disease: A pairwise and
network meta-analysis.
Source
Clinical Epidemiology. 10 (pp 1037-1051), 2018. Date of Publication: 2018.
Author
Guo W.-Q.; Li L.; Su Q.; Sun Y.-H.; Wang X.-T.; Dai W.-R.; Li H.-Q.
Institution
(Guo, Li, Su, Sun, Wang, Dai, Li) Department of Cardiology, the First
Affiliated Hospital of Guangxi Medical University, Nanning, China
Publisher
Dove Medical Press Ltd (PO Box 300-008, Albany, 44 Corinthian Drive,
Albany,Auckland 0752, New Zealand. E-mail: angela@dovepress.com)
Abstract
Introduction: The optimal revascularization strategy for patients with
ST-segment elevation myocardial infarction and multivessel disease is
unclear. In this study, we performed a meta-analysis to determine the
optimal revascularization strategy for treating these patients.
 Method(s): Searches of PubMed, the Cochrane Library,
clinicaltrial.gov, and the reference lists of relevant papers were
performed covering the period between the year 2000 and March 20, 2017. A
pairwise analysis and a Bayesian network meta-analysis were performed to
compare the effectiveness of early complete revascularization (CR) during
the index hospitalization, delayed CR, and culprit only revascularization
(COR). The primary endpoint was the incidence of major adverse cardiac
events (MACE), which were defined as the composite of recurrent myocardial
infarction (MI), repeat revascularization, and all-cause mortality. The
secondary endpoints were the rates of all-cause mortality, recurrent MI,
and repeat revascularization. This study is registered at PROSPERO under
registration number CRD42017059980. Result(s): Eleven randomized
controlled trials including a total of 3,170 patients were identified. A
pairwise meta-analysis showed that compared with COR, early CR was
associated with significantly decreased risks of MACE (relative risk [RR]
0.47, 95% CI 0.39-0.56), MI (RR 0.55, 95% CI 0.37-0.83), and repeat
revascularization (RR 0.35, 95% CI 0.27-0.46) but not of all-cause
mortality (RR 0.78, 95% CI 0.52-1.16). These results were confirmed by
trial sequential analysis. The network meta-analysis showed that early CR
had the highest probability of being the first treatment option during
MACE (89.2%), MI (83.3%), and repeat revascularization (80.4%).
 Conclusion(s): Early CR during the index hospitalization was markedly
superior to COR with respect to reducing the risk of MACE, as CR
significantly decreased the risks of MI and repeat revascularization
compared with COR. However, further study is warranted to determine
whether CR during the index hospitalization can improve survival in
patients with concurrent ST-segment elevation myocardial infarction and
multivessel disease. The optimal timing of CR remains inconclusive
considering the small number of studies and patients included in the
analysis comparing early and delayed CR. Copyright © 2018 Guo et
al.

<58>
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.

<59>
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.

<60>
Accession Number
2001376035
Title
A Prospective Randomized Study Comparing Ultrasound- Versus
Fluoroscopic-Guided Femoral Arterial Access in Noncardiac Vascular
Patients.
Source
Journal of Vascular Surgery. Conference: 2019 Southern Association for
Vascular Surgery Annual Meeting. United States. 69 (1) (pp e14-e15), 2019.
Date of Publication: January 2019.
Author
Stone P.A.; Campbell J.E.; AbuRahma Z.; Thompson S.N.
Institution
(Stone) Vanderbilt University Medical Center, Nashville, Tenn, United
States
(Campbell) Charleston Division, West Virginia University, Charleston, WV,
United States
(AbuRahma, Thompson) Charleston Area Medical Center, Charleston, WV,
United States
Publisher
Mosby Inc.
Abstract
Objective: The aim of our prospective, randomized study was to compare the
procedural outcomes and complication rates of ultrasound (US)-guided
common femoral artery (CFA) access to fluoroscopic guidance in noncardiac
procedures. Randomized studies comparing CFA access techniques and
resultant complications have been almost exclusively performed in patients
undergoing cardiac procedures. Differences between peripheral vascular
disease and coronary artery disease patient populations and percutaneous
techniques warrant US-guided femoral cannulation to be examined
independently in procedures for peripheral vascular disease.
 Method(s): We randomized 631 patients undergoing femoral access for
noncardiac diagnostic or interventional procedures 1:1 to receive either
fluoroscopic or US-guided access. The primary end point of the study was
successful CFA cannulation. Secondary end points included first-pass
success rate, time to sheath insertion, and accidental venipunctures rate.
Both short-term (24 hours) and mid-term (30-90 days after the procedure)
access complications were assessed by midlevel practitioners blinded to
patient randomization group. Result(s): Successful CFA cannulation
occurred in 88% of US guided procedures compared with 81% of
fluoroscopy-guided access (P = .02). US guidance associated with increased
rates of first-attempt success (78% vs 46%; P < .001), fewer inadvertent
venipunctures (2% vs 10 %; P < .001), and a decreased median time to
cannulation (median time, 1.3 minutes vs 1.7 minutes; P < .001) compared
with fluoroscopy. When access was performed by vascular surgery trainees
(residents and fellows), US guidance retained superior rates of successful
CFA cannulation compared with fluoroscopy guided access (n = 298 [92%] vs
83%; P = .04). Trainees' time to achieve CFA cannulation was similar to
attendings' when using US guidance (1.3 minutes vs 1.3 minutes; P = .77);
however, with fluoroscopy, trainees' times were significantly longer than
those of attendings (2.2 minutes vs 1.5 minutes; P = .001). Rates of
complications did not differ at 24 hours (1.5% vs 1.9%; P = .90) or 30 to
90 days (5% vs 2.2%; P = .24) between the two guidance techniques.
 Conclusion(s): In comparison with fluoroscopy, US-guided CFA
cannulation had a higher rate of success, faster cannulation, and fewer
venipunctures in the absence of increased complications. Furthermore, US
guidance may be especially beneficial in the training of vascular
residents and fellows. Copyright © 2018

<61>
Accession Number
625413596
Title
Safety and efficacy of aerobic exercise commenced early after cardiac
surgery: A systematic review and meta-analysis.
Source
European Journal of Preventive Cardiology. 26 (1) (pp 36-45), 2019. Date
of Publication: 01 Jan 2019.
Author
Doyle M.P.; Indraratna P.; Tardo D.T.; Peeceeyen S.C.S.; Peoples G.E.
Institution
(Doyle, Peoples) School of Medicine, University of Wollongong, Wollongong,
Australia
(Doyle, Peeceeyen) Department of Cardiothoracic Surgery, St George
Hospital, Sydney, Australia
(Indraratna, Tardo) Department of Cardiology, St George Hospital, Sydney,
Australia
(Indraratna) Faculty of Medicine, University of New South Wales, Sydney,
Australia
(Tardo) School of Medicine, University of Notre Dame, Sydney, Australia
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Aerobic exercise is a critical component of cardiac
rehabilitation following cardiac surgery. Aerobic exercise is
traditionally commenced 2-6 weeks following hospital discharge and most
commonly includes stationary cycling or treadmill walking. The initiation
of aerobic exercise within this early postoperative period not only
introduces the benefits associated with aerobic activity sooner, but also
ameliorates the negative effects of immobilization associated with the
early postoperative period. Method(s): A systematic review identified
all studies reporting safety and efficacy outcomes of aerobic exercise
commenced within two weeks of cardiac surgery. A meta-analysis was
performed comparing functional, aerobic and safety outcomes in patients
receiving early postoperative aerobic exercise compared with usual
postoperative care. Result(s): Six-minute walk test distance at
hospital discharge was 419 +/- 88 m in early aerobic exercise patients
versus 341 +/- 81 m in those receiving usual care (mean difference 69.5 m,
95% confidence interval (CI) 39.2-99.7 m, p < 0.00001). Peak aerobic power
was 18.6 +/- 3.8 ml.kg-1.min-1 in those receiving
early exercise versus 15.0 +/- 2.1 ml.kg-1.min-1 in
usual care (mean difference 3.20 ml.kg-1.min-1, 95%
CI 1.45-4.95, p = 0.0003). There was no significant difference in adverse
events rates between the two groups (odds ratio 0.41, 95% CI 0.12-1.42, p
= 0.16). Conclusion(s): Aerobic exercise commenced early after
cardiac surgery significantly improves functional and aerobic capacity
following cardiac surgery. While adverse event rates did not differ
significantly, patients included were very low risk. Further studies are
required to adequately assess safety outcomes of aerobic exercise
commenced early after cardiac surgery. Copyright © The European
Society of Cardiology 2018.

<62>
Accession Number
625375415
Title
Laryngeal mask airway versus endotracheal tube for percutaneous
dilatational tracheostomy in critically ill adults.
Source
Cochrane Database of Systematic Reviews. 2018 (11) (no pagination), 2018.
Article Number: CD009901. Date of Publication: 15 Nov 2018.
Author
Strametz R.; Bergold M.N.; Weberschock T.
Institution
(Strametz) RheinMain University of Applied Science, Wiesbaden Business
School, Bleichstr. 44, Wiesbaden 65183, Germany
(Bergold) Evangelisches Krankenhaus Oldenburg - European Medical School,
Department of Anesthesiology, Intensive Care Medicine and Pain Therapy,
Steinweg 13-17, Oldenburg D-26122, Germany
(Weberschock) Johann Wolfgang Goethe-University Hospital, Department of
Dermatology, Venereology and Allergology, Theodor-Stern-Kai 7, Frankfurt
am Main 60590, Germany
(Weberschock) Goethe University, Evidence-Based Medicine Frankfurt,
Institute for General Practice, Theodor Stern Kai 7, Frankfurt 60590,
Germany
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Percutaneous dilatational tracheostomy (PDT) is one of the
most common bedside surgical procedures performed in critically ill
adults, on intensive care units (ICUs), who require long-term ventilation.
PDT is associated with relevant life-threatening complications: Cuff
rupture or accidental extubation may lead to hypoxia, aspiration or loss
of airway. Puncture of the oesophagus, or creating a false passage during
dilatation or replacement of the tracheostomy tube, can lead to
pneumothorax or emphysema. Wound infections may occur which can cause
mediastinits, especially after creation of false passage or in early
tracheotomized post-sternotomy patients after cardiac surgery. During the
procedure, the patient's airway can be secured with an endotracheal tube
(ETT) or a laryngeal mask airway (LMA). This is an updated version of the
review first published in 2014. Objective(s): To assess the safety
and effectiveness of LMA versus ETT in critically ill adults undergoing
PDT on the ICU. Search Method(s): We searched the following databases
to 9 January 2018: Cochrane Central Register of Controlled Trials
(CENTRAL), MEDLINE and Embase. We searched for reports of ongoing trials
in the metaRegister of Controlled Trials (mRCT). We handsearched for
relevant studies in conference proceedings of five relevant annual
congresses. We contacted study authors and experts concerning unpublished
data and ongoing trials. We searched for further relevant studies in the
reference lists of all included trials and of relevant systematic reviews.
 Selection Criteria: We included randomized controlled trials (RCTs)
that compared use of laryngeal mask airways versus endotracheal tubes in
critically ill adults undergoing elective PDT in the ICU, without injuries
to or diseases of the face or neck. We imposed no restrictions with regard
to language, timing or technique of PDT performed. Data Collection
and Analysis: Two review authors independently assessed the eligibility
and methodological quality of each study and carried out data extraction.
Our primary outcomes were all-cause mortality, procedure-related mortality
and tally of participants with one or more serious adverse events. Where
possible, we combined homogeneous studies for meta-analysis. We used
Cochrane's 'Risk of bias' tool and used GRADE to assess the quality of
evidence for key outcomes. Main Result(s): We included nine RCTs in
this review involving 517 participants. Studies had a high or unclear risk
of bias. The main reason for this was low methodological quality or
missing data, even after study authors were contacted. Study size was
generally small, with a minimum of 40, and a maximum of 73 participants.
In one study (40 participants), three deaths in the LMA group and two
deaths in the ETT group were reported, although none of the deaths were
related to the procedure (very low-quality evidence). Five studies (281
participants) reported on procedure-related deaths, stating that no
procedure-related death occurred at all (very low-quality evidence). It is
uncertain whether there is a difference in the number of people
experiencing one or more serious adverse event(s) between LMA and ETT
(risk ratio (RR) 0.86, 95% confidence interval (CI) 0.41 to 1.80; 467
participants, 8 studies, very low-quality evidence). The duration of the
procedure may be shorter in the LMA group (mean difference (MD) -1.46
minutes, 95% CI -1.92 to -1.01 minutes; 6 studies, 324 participants,
low-quality evidence). However failure of procedure, as allocated by
randomization, requiring conversion to any other procedure, may be higher
in the LMA group (RR 2.82, 95% CI 1.22 to 6.52; 8 studies, 439
participants, low-quality evidence). We did not find any clear evidence of
a difference between ETT and LMA groups for all other outcomes. Only one
study provided follow-up data for late complications related to the
intervention, showing no clear evidence of benefit for any treatment
group. Authors' conclusions: Evidence on the safety of LMA for PDT is too
limited to allow conclusions to be drawn on either its efficacy or safety
compared with ETT. Although the LMA procedure may shorten the period
during which the airway is insecure, it may also lead to higher conversion
rates. Also, late complications have not been investigated sufficiently.
These results are primarily based on single-centre trials with small
sample sizes, and therefore the level of evidence remains low. Studies
with low risk of bias focusing on late complications and relevant
patient-related outcomes are necessary for definitive conclusions on
safety issues related to this procedure. The dependency of the successful
placement of a LMA on the type of LMA used should also be further
assessed. There are two studies awaiting classification that may alter the
conclusions once assessed. Copyright © 2018 The Cochrane
Collaboration.

<63>
Accession Number
625415470
Title
Transcatheter Aortic Valve Replacement for Pure Native Aortic Valve
Regurgitation: A Systematic Review.
Source
Cardiology (Switzerland). (pp 132-140), 2018. Date of Publication: 2018.
Author
Jiang J.; Liu X.; He Y.; Xu Q.; Zhu Q.; Jaiswal S.; Wang L.; Hu P.; Gao
F.; Sun Y.; Liu C.; Lin X.; Liang J.; Ren K.; Wang J.
Institution
(Jiang, Liu, He, Xu, Zhu, Jaiswal, Wang, Hu, Gao, Liu, Lin, Liang, Ren,
Wang) Department of Cardiology, Second Affiliated Hospital, Zhejiang
University School of Medicine, Hangzhou 310009, China
(Sun) Department of Cardiology, Guangdong People's Hospital, Guangdong,
China
Publisher
S. Karger AG
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is a recent and
an effective treatment option for high- or extreme-surgical-risk patients
with symptomatic severe aortic stenosis. However, pure severe native
aortic valve regurgitation (NAVR) without aortic stenosis remains a
contraindication to TAVR. The aim of our systemic review analysis was to
evaluate TAVR in patients with pure NAVR. Method(s): We searched the
published articles in the PubMed and Web of Science databases (2002-2017)
using the Boolean operators for studies of NAVR patients undergoing TAVR.
Reference lists of all returned articles were searched recursively for
other relevant citations. Pooled estimates were calculated using a
random-effects meta-analysis. Result(s): Finally, a total of 10
studies were included in this analysis. The CoreValve was more frequently
used with a lower rate of device success and a higher rate of residual
aortic regurgitation. The new-generation transcatheter heart valves (THVs)
performed a significantly higher rate with less residual aortic
regurgitation and a success rate close to 100%. The 30-day all-cause
mortality rates ranged from 0 to 30% with an estimate summary rate of 9%
(95% CI: 5-15%; I2 = 33%). Cerebrovascular events, major or
life-threatening bleeding, major vascular complications, acute kidney
disease, and new permanent pacemaker implantation occurred similarly in
both the new- and old-generation THV devices. Conclusion(s): Aortic
regurgitation remains a challenging pathology for TAVR. TAVR is a feasible
and reasonable option for carefully selected patients with pure aortic
regurgitation. Copyright © 2018 S. Karger AG, Basel.

<64>
Accession Number
601554983
Title
Efficacy and safety of LDL-lowering therapy among men and women:
Meta-analysis of individual data from 174 000 participants in 27
randomised trials.
Source
The Lancet. 385 (9976) (pp 1397-1405), 2015. Date of Publication: 2015.
Author
Fulcher J.; O'Connell R.; Voysey M.; Mihaylova B.; Colhoun H.; Keech A.;
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.; Marschner I.; 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.;
Probstfield 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.; Barnes E.H.; Keech A.C.; Kirby A.; Marschner I.C.; Simes J.; Baigent
C.; Blackwell L.; Collins R.; Emberson J.; Herrington W.G.; Holland L.E.;
Reith C.
Institution
(Barnes, Keech, Kirby, Marschner, Simes) CTC, University of Sydney,
Australia
(Mihaylova, Baigent, Blackwell, Collins, Emberson, Herrington, Holland,
Reith) CTSU, University of Oxford, United Kingdom
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Whether statin therapy is as effective in women as in men is
debated, especially for primary prevention. We undertook a meta-analysis
of statin trials in the Cholesterol Treatment Trialists' (CTT)
Collaboration database to compare the effects of statin therapy between
women and men. Method(s): We performed meta-analyses on data from 22
trials of statin therapy versus control (n=134 537) and five trials of
more-intensive versus less-intensive statin therapy (n=39 612). Effects on
major vascular events, major coronary events, stroke, coronary
revascularisation and mortality were weighted per 1.0 mmol/L reduction in
LDL cholesterol and effects in men and women compared with a Cox model
that adjusted for non-sex differences. For subgroup analyses, we used 99%
CIs to make allowance for the multiplicity of comparisons. Findings 46 675
(27%) of 174 149 randomly assigned participants were women. Allocation to
a statin had similar absolute effects on 1 year lipid concentrations in
both men and women (LDL cholesterol reduced by about 1.1 mmol/L in statin
vs control trials and roughly 0.5 mmol/L for more-intensive vs
less-intensive therapy). Women were generally at lower cardiovascular risk
than were men in these trials. The proportional reductions per 1.0 mmol/L
reduction in LDL cholesterol in major vascular events were similar overall
for women (rate ratio [RR] 0.84, 99% CI 0.78-0.91) and men (RR 0.78, 99%
CI 0.75-0.81, adjusted p value for heterogeneity by sex=0.33) and also for
those women and men at less than 10% predicted 5 year absolute
cardiovascular risk (adjusted heterogeneity p=0.11). Likewise, the
proportional reductions in major coronary events, coronary
revascularisation, and stroke did not differ significantly by sex. No
adverse effect on rates of cancer incidence or non-cardiovascular
mortality was noted for either sex. These net benefits translated into
all-cause mortality reductions with statin therapy for both women (RR
0.91, 99% CI 0.84-0.99) and men (RR 0.90, 99% CI 0.86-0.95; adjusted
heterogeneity p=0.43). Interpretation In men and women at an equivalent
risk of cardiovascular disease, statin therapy is of similar effectiveness
for the prevention of major vascular events.

<65>
Accession Number
51141585
Title
Efficacy and safety of more intensive lowering of LDL cholesterol: A
meta-analysis of data from 170 000 participants in 26 randomised trials.
Source
The Lancet. 376 (9753) (pp 1670-1681), 2010. Date of Publication: 13 Nov
2010.
Author
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.; 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.; Probstfield 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 Y.; Musliner T.; Ansquer J.-C.; Llewellyn
M.; Bortolini M.; Brandrup-Wognsen G.; Bryzinski B.; Olsson G.; Pears J.;
De Micco D.; Baxter A.; Baigent C.; Barnes E.H.; 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
(De Lemos, Braunwald, Blazing, Murphy) Phase Z, United States
(Downs, Gotto, Clearfield) AFCAPS/TEXCAPS (AirForce/Texas Coronary
Atherosclerosis Prevention Study), United States
(Holdaas) ALERT (Assessment of Lescol in Transplantation), United States
(Gordon, Davis) ALLHAT (Antihypertensive Lipid Lowering Heart Attack
Trial), United States
(Koren) ALLIANCE (Aggressive Lipid-Lowering Initiation Abates New Cardiac
Events), United States
(Dahlof, Poulter, Sever) ASCOT (Anglo-Scandinavian Cardiac Outcomes
Trial), United States
(Knopp) ASPEN, United States
(Fellstrom, Holdaas, Jardine, Schmieder, Zannad) AURORA, United States
(Goldbourt, Kaplinsky) BIP (Bezafibrate Infarction Prevention Study),
United States
(Colhoun, Betteridge, Durrington, Hitman, Fuller, Neil) CARDS
(Collaborative Atorvastatin Diabetes Study), United States
(Wanner, Krane) 4D (Die Deutsche Diabetes Dialyse Study), United States
(Sacks, Moye, Pfeffer) CARE (Cholesterol and Recurrent Events Study),
United States
(Keech, Barter) FIELD (Fenofibrate Intervention and Event Lowering in
Diabetes), United States
(Tavazzi, Maggioni) GISSI (Gruppo Italiano per Lo Studio della
Sopravvivenza nell'Infarto Miocardico)-Heart Failure, Italy
(Marchioli, Tognoni, Franzosi, Maggioni) GISSI-Prevention, Italy
(Bloomfield, Robins) HIT (Veteran Administration Low HDL Intervention
Trial), United States
(Keech, Collins, Armitage, Parish, Peto, Sleight) HPS (Heart Protection
Study), United States
(Pedersen) IDEAL (Incremental Decrease in Endpoints Through Aggressive
Lipid-lowering), United States
(Ridker) JUPITER, United States
(Holman) LDS (Lipids in Diabetes Study), United States
(Meade) LEADER (Lower Extremity Arterial Disease Event Reduction Trial),
United States
(Keech, Simes, MacMahon, Marschner, Tonkin, Shaw) LIPID (Long-term
Intervention with Pravastatin in Ischaemic Disease), United States
(Serruys) LIPS (Lescol Intervention Prevention Study), United States
(Nakamura) MEGA (Management of Elevated Cholesterol in the Primary
Prevention Group of Adult Japanese), United States
(Knatterud) Post-CABG (Post- Coronary Artery Bypass Graft Study), United
States
(Furberg, Byington) PPP (Pravastatin Pooling Project), United States
(Macfarlane, Cobbe, Ford, Murphy, Blauw, Packard, Shepherd) PROSPER
(Prospective Study of Pravastatin in the Elderly at Risk), United States
(Kjekshus, Pedersen, Wilhelmsen) 4S (Scandinavian Simvastatin Survival
Study), United States
(Braunwald, Cannon, Murphy) PROVE-IT (Pravastatin or Atorvastatin
Evaluation and Infection Therapy), United States
(Collins, Armitage, Bowman, Parish, Peto, Sleight) SEARCH (Study of
Effectiveness of Additional Reductions in Cholesterol and Homocysteine),
United States
(Baigent, Baxter, Collins, Landray) SHARP (Study of Heart and Renal
Protection), United States
(La Rosa) TNT (Testing New Targets), United States
(Rossouw, Probstfield) WHI (Women's Health Initiative), United States
(Shepherd, Cobbe, Macfarlane, Ford) WOSCOPS (West of Scotland Coronary
Prevention Study), United Kingdom
(Mellies, McGovern, Barclay, Belder) Bristol-Myers Squibb, United States
(Mitchel, Musliner) Merck, United States
(Ansquer) Laboratoires Fournier, United States
(Llewellyn) Bayer, United States
(Bortolini) Novartis Pharma, United States
(Brandrup-Wognsen, Bryzinski, Olsson, Pears) AstraZeneca, United States
(De Micco) Pfizer, United States
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Lowering of LDL cholesterol with standard statin regimens reduces the risk
of occlusive vascular events in a wide range of individuals. We aimed to
assess the safety and efficacy of more intensive lowering of LDL
cholesterol with statin therapy. We undertook meta-analyses of individual
participant data from randomised trials involving at least 1000
participants and at least 2 years' treatment duration of more versus less
intensive statin regimens (five trials; 39 612 individuals; median
follow-up 5.1 years) and of statin versus control (21 trials; 129 526
individuals; median follow-up 4.8 years). For each type of trial, we
calculated not only the average risk reduction, but also the average risk
reduction per 1.0 mmol/L LDL cholesterol reduction at 1 year after
randomisation. In the trials of more versus less intensive statin therapy,
the weighted mean further reduction in LDL cholesterol at 1 year was 0.51
mmol/L. Compared with less intensive regimens, more intensive regimens
produced a highly significant 15 (95 CI 11-18; p<0.0001) further reduction
in major vascular events, consisting of separately significant reductions
in coronary death or non-fatal myocardial infarction of 13 (95 CI 7-19;
p<0.0001), in coronary revascularisation of 19 (95 CI 15-24; p<0.0001),
and in ischaemic stroke of 16 (95 CI 5-26; p=0.005). Per 1.0 mmol/L
reduction in LDL cholesterol, these further reductions in risk were
similar to the proportional reductions in the trials of statin versus
control. When both types of trial were combined, similar proportional
reductions in major vascular events per 1.0 mmol/L LDL cholesterol
reduction were found in all types of patient studied (rate ratio [RR]
0.78, 95 CI 0.76-0.80; p<0.0001), including those with LDL cholesterol
lower than 2 mmol/L on the less intensive or control regimen. Across all
26 trials, all-cause mortality was reduced by 10 per 1.0 mmol/L LDL
reduction (RR 0.90, 95 CI 0.87-0.93; p<0.0001), largely reflecting
significant reductions in deaths due to coronary heart disease (RR 0.80,
99 CI 0.74-0.87; p<0.0001) and other cardiac causes (RR 0.89, 99 CI
0.81-0.98; p=0.002), with no significant effect on deaths due to stroke
(RR 0.96, 95 CI 0.84-1.09; p=0.5) or other vascular causes (RR 0.98, 99 CI
0.81-1.18; p=0.8). No significant effects were observed on deaths due to
cancer or other non-vascular causes (RR 0.97, 95 CI 0.92-1.03; p=0.3) or
on cancer incidence (RR 1.00, 95 CI 0.96- 1.04; p=0.9), even at low LDL
cholesterol concentrations. Further reductions in LDL cholesterol safely
produce definite further reductions in the incidence of heart attack, of
revascularisation, and of ischaemic stroke, with each 1.0 mmol/L reduction
reducing the annual rate of these major vascular events by just over a
fifth. There was no evidence of any threshold within the cholesterol range
studied, suggesting that reduction of LDL cholesterol by 2-3 mmol/L would
reduce risk by about 40-50. UK Medical Research Council, British Heart
Foundation, European Community Biomed Programme, Australian National
Health and Medical Research Council, and National Heart
Foundation. Copyright © 2010 Elsevier Ltd.

<66>
Accession Number
624533683
Title
A prospective, observational study of cerebrovascular autoregulation and
its association with delirium following cardiac surgery.
Source
Anaesthesia. 74 (1) (pp 33-44), 2019. Date of Publication: January 2019.
Author
Chan B.; Aneman A.
Institution
(Chan) Faculty of Medicine, University of New South Wales, Sydney, NSW,
Australia
(Aneman) Intensive Care Unit, Liverpool Hospital, Liverpool, NSW,
Australia
Publisher
Blackwell Publishing Ltd
Abstract
This aim of this prospective observational cohort study was to evaluate
any association between postoperatively impaired cerebrovascular
autoregulation and the onset of delirium following cardiac surgery.
Previous studies have shown that impaired intra-operative cerebrovascular
autoregulation during cardiopulmonary bypass is associated with delirium.
However, postoperative changes in cerebrovascular autoregulation and its
association with delirium have not been investigated. One-hundred and
eight consecutive adult cardiac surgical patients without baseline
cognitive dysfunction or aphasia were included in the study.
Cerebrovascular autoregulation was assessed by the Pearson correlation
between near-infrared spectroscopy-derived cerebral tissue oxygen
saturation and mean arterial pressure to derive the tissue oximetry index.
Cerebrovascular autoregulation was monitored for a minimum of 90 min on
postoperative day 0 and postoperative day 1. Delirium was assessed
throughout intensive care unit admission using the confusion assessment
method for the intensive care unit. We observed delirium in 24 of the 108
patients studied. The mean (SD) tissue oximetry index was higher in
delirious patients on postoperative day 0 compared with non-delirious
patients; 0.270 (0.199) vs. 0.180 (0.142), p = 0.044, but not on
postoperative day 1; 0.130 (0.160) vs. 0.150 (0.130), p = 0.543. All
patients showed improvement in tissue oximetry index on postoperative day
1 compared with postoperative day 0. Logistic regression analysis
demonstrated tissue oximetry index on postoperative day 0 to be
independently associated with delirium; odds ratio 1.05 (95%CI 1.01-1.10),
p = 0.043. In conclusion, we found an association between impaired
cerebrovascular autoregulation, measured by near-infrared spectroscopy,
and delirium in the early postoperative period. Copyright © 2018
Association of Anaesthetists

<67>
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.

<68>
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

<69>
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.

<70>
Accession Number
625395478
Title
Outcome postponement as a potential patient centred measure of therapeutic
benefit: examples in cardiovascular medicine.
Source
Acta Cardiologica. (no pagination), 2018. Date of Publication: 2018.
Author
Ennezat P.V.; Le Jemtel T.; Cosgrove S.; Hallas J.; Hansen M.R.
Institution
(Ennezat) Centre Hospitalier Regional Universitaire Grenoble-Alpes,
Service de Cardiologie, Grenoble, France
(Le Jemtel) Tulane School of Medicine, Tulane University Heart and
Vascular Institute, New Orleans, LA, United States
(Cosgrove) Mater Misericordiae University Hospital, Dublin, Ireland
(Hallas, Hansen) Department of Clinical Pharmacology and Pharmacy,
University of Southern Denmark, Odense, Denmark
(Hallas, Hansen) Department of Clinical Biochemistry and Pharmacology,
Odense University Hospital, Odense, Denmark
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Background: The impact of randomised controlled trials (RCTs) depends
heavily on the presentation of the findings. Objective(s):
Classically, RCT findings are presented in the form of absolute risk
reduction (ARR), number needed to treat (NNT) to prevent one adverse
outcome, and relative risk reduction (RRR) or hazard ratio (the most
favourable means for drug marketing). However, the estimation of average
survival gain (i.e. outcome postponement between a trial intervention and
comparator) is an alternative and informative means of presenting the
findings of RCTs. Study selection: Recent cardiovascular RCTs evaluating
ezetimibe added to simvastatin, evolocumab, canakinumab, ticagrelor,
rivaroxaban, ivabradine, LCZ 696 (sacubitril/valsartan), and transfemoral
aortic valve replacement are analysed and discussed. Finding(s): The
average survival gains ranged between 4.9 days on a composite end point
with ticagrelor versus clopidogrel in randomised patients with acute
coronary syndrome and 117 days of life expectancy obtained with TAVR
versus standard therapy in patients with severe aortic stenosis deemed
ineligible for surgery. Conclusion(s): Using outcome postponement as
an additional measure of treatment effect is likely to be more easily
understood than hazard ratio or RRR by both patients and physicians and
could help when evaluating drugs. Copyright © 2018, © 2018
Belgian Society of Cardiology.

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