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<1>
Accession Number
620795999
Title
The Future of Biomarker-Guided Therapy for Heart Failure After the Guiding
Evidence-Based Therapy Using Biomarker Intensified Treatment in Heart
Failure (GUIDE-IT) Study.
Source
Current Heart Failure Reports. 15 (2) (pp 37-43), 2018. Date of
Publication: 01 Apr 2018.
Author
Ibrahim N.E.; Januzzi J.L.
Institution
(Ibrahim, Januzzi) Cardiology Division, Massachusetts General Hospital, 55
Fruit Street, GRB-800, Boston, MA 02114, United States
(Ibrahim, Januzzi) Harvard Medical School, Boston, MA, United States
(Januzzi) Baim Institute for Clinical Research, Boston, MA, United States
Publisher
Current Science Inc. (E-mail: info@current-reports.com)
Abstract
Purpose of Review: Biomarker-guided management of patients with chronic
heart failure with reduced ejection fraction (HFrEF) remains
controversial. Recent Findings: Biomarkers have established roles for
diagnosis and prognostication in HF. Pilot data suggested that use of
natriuretic peptides might be helpful to guide HF care. The recent Guiding
Evidence-Based Therapy Using Biomarker Intensified Treatment in Heart
Failure (GUIDE-IT) randomized-controlled trial did not find therapy guided
by NT-proBNP to be more effective than usual care in improving the primary
endpoint of HF hospitalization or cardiovascular mortality amongst
patients with chronic HFrEF. Patients in GUIDE-IT received similar care
and had similar NT-proBNP lowering regardless of treatment allocation.
 Summary: Though biomarkers retain important standing for diagnosis
and prognosis in HF, the GUIDE-IT trial results suggest carefully managed
patients may not benefit from a biomarker-guided strategy. Future studies
focusing this intervention on patients treated in a more real-world
setting are needed. Copyright © 2018, Springer Science+Business
Media, LLC, part of Springer Nature.

<2>
Accession Number
620597915
Title
Bioprosthetic aortic valve leaflet thrombosis detected by multidetector
computed tomography is associated with adverse cerebrovascular events: A
meta-analysis of observational studies.
Source
EuroIntervention. 13 (15) (pp e1748-e1755), 2018. Date of Publication:
February 2018.
Author
Rashid H.N.; Gooley R.P.; Nerlekar N.; Ihdayhid A.R.; McCormick L.M.;
Nasis A.; Cameron J.D.; Brown A.J.
Institution
(Rashid, Gooley, Nerlekar, Ihdayhid, McCormick, Nasis, Cameron, Brown)
Monash Cardiovascular Research Centre, Monash University and MonashHeart,
Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia
Publisher
EuroPCR
Abstract
Aims: Leaflet thrombosis (LT) has become increasingly recognised following
transcatheter and surgical aortic bioprosthetic valve (ABV) replacement
and can be reliably identified by multidetector computed tomography
(MDCT). However, it is an ongoing debate whether MDCT-defined LT is
associated with adverse cerebrovascular outcomes. We sought to perform a
systematic review and meta-analysis in order to assess the incidence and
clinical outcomes associated with MDCT-defined leaflet thrombosis
following (ABV) replacement. Methods and Results: Electronic
databases were searched for studies that performed mandatory MDCT imaging
following ABV replacement. The primary endpoint was the incidence of
cerebrovascular events, defined as a composite of stroke or transient
ischaemic attack (TIA). Secondary endpoints included major adverse
cerebrovascular and cardiovascular events (MACCE), stroke, TIA, death or
myocardial infarction. In total, six studies met the inclusion criteria
with 11.6% (198/1,704) of patients having MDCT-defined LT. The prevalence
of LT following transcatheter and surgical ABV replacement was 13.2% and
3.6%, respectively. Cerebrovascular events were significantly increased in
patients with LT (odds ratio [OR] 3.38, 95% CI: 1.78-6.41, p<0.001). The
risk of MACCE (OR 2.10, 95% CI: 1.21-3.64, p<0.001) and TIA (OR 5.86, 95%
CI: 2.05-16.75, p<0.001) was also increased in patients with LT, although
there were no differences in the incidence of stroke (OR 2.43, 95% CI:
1.00-5.93, p=0.05), death (OR 0.92, 95% CI: 0.42-2.03, p=0.84) or
myocardial infarction (OR 1.72, 95% CI: 0.34-9.78, p=0.54) between groups.
 Conclusion(s): MDCT-defined LT following ABV replacement is
associated with a significantly increased risk of adverse cerebrovascular
events. Further prospective studies are required to ascertain whether LT
can be prevented or treated with pharmacological strategies. Copyright
© Europa Digital & Publishing 2018. All rights reserved.

<3>
Accession Number
624326601
Title
Rivaroxaban versus Warfarin in Patients with Mechanical Heart Valve:
Rationale and Design of the RIWA Study.
Source
Drugs in R and D. 18 (4) (pp 303-308), 2018. Date of Publication: 01 Dec
2018.
Author
Duraes A.R.; de Souza Lima Bitar Y.; Filho J.A.L.; Schonhofen I.S.; Camara
E.J.N.; Roever L.; Cardoso H.E.D.P.; Akrami K.M.
Institution
(Duraes, Filho, Schonhofen, Cardoso) General Hospital Roberto Santos,
Salvador, Bahia, Brazil
(Duraes, de Souza Lima Bitar, Camara) Federal University of Bahia, Medical
School-UFBA/FAMEB, XV de novembro Square, s/n-Largo do Terreiro de Jesus,
Salvador, BA 40025-010, Brazil
(Roever) Federal University of Uberlandia, Uberlandia, Minas Gerais,
Brazil
(Akrami) Division of Infectious Disease, Department of Medicine,
University of California, San Diego, San Diego, CA, United States
Publisher
Springer International Publishing
Abstract
Introduction: Mechanical heart valves (MHV) are extremely durable, but
they require permanent use of anticoagulation to prevent thromboembolic
events. The only approved therapeutic options are vitamin K antagonists
(VKAs), such as warfarin. As a drug class, clinical management is
difficult, therefore new alternatives need to be evaluated.
 Method(s): RIWA is a phase II/III, prospective, open-label,
randomized, pilot study designed to investigate oral rivaroxaban 15 mg
twice daily compared with dose-adjusted warfarin for the prevention of
stroke (ischemic or hemorrhagic) and systemic embolism in patients with
MHV, from August 2018 to December 2019. Patients will undergo
transesophageal echocardiography at the beginning and the end of the study
(follow-up time 90 days). On an explanatory basis, all events will be
analyzed, including stroke, peripheral systemic embolism, valve
thrombosis, significant bleeding and death. Discussion(s): Warfarin
and similar VKAs are standard therapy for patients with an MHV. Even with
the appropriate use of therapy, the incidence of thromboembolic events is
high at 1-4% per year. Furthermore, bleeding risk is significant, ranging
from 2 to 9% per year. The new frontier to be overcome in relation to use
of the new oral anticoagulants is undoubtedly in patients with MHV. A
significant portion of people with MHV worldwide will benefit if
noninferiority of these new agents is confirmed. Trial Registration:
ClinicalTrials.gov identifier: NCT03566303. Recruitment Status:
Recruiting. First Posted: 25 June 2018. Last Update Posted: 25 June
2018. Copyright © 2018, The Author(s).

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

<5>
Accession Number
622002880
Title
Repetitive levosimendan for a LION's heart?.
Source
European Journal of Heart Failure. 20 (7) (pp 1137-1138), 2018. Date of
Publication: July 2018.
Author
Altenberger J.; Polzl G.
Institution
(Altenberger) Cardiac Rehabilitation Center Grossgmain,
Pensionsversicherungsanstalt, Teaching Hospital of Paracelsus Medical
Private University, Salzburg, Austria
(Polzl) Medical University Innsbruck, Department of Internal Medicine III,
Innsbruck, Austria
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)

<6>
Accession Number
619086026
Title
Optimal duration of dual antiplatelet therapy after drug eluting stent
implantation: A network meta-analysis.
Source
Anatolian Journal of Cardiology. 18 (4) (pp 251-260), 2017. Date of
Publication: October 2017.
Author
Gajulapalli R.D.; Dias S.; Pattanshetty D.J.; Athappan G.
Institution
(Gajulapalli) Department of Medicine, Cleveland Clinic, Cleveland, OH,
United States
(Dias) School of Social and Community Medicine, University of Bristol,
Bristol, United Kingdom
(Pattanshetty) Case Western University, Metro Health, Cleveland, OH,
United States
(Athappan) Department of Interventional Cardiology, Temple University
Hospital, Philadelphia-PA, United States
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: There has been much debate regarding the optimal duration of
dual antiplatelet therapy (DAPT) cover after drug eluting stent (DES)
implantation. We aimed to assess the relative benefits of shorter and
longer durations of DAPT coverage. Method(s): We performed a network
meta-analysis (NMA) of all the randomized clinical trials (RCT) comparing
different time durations of DAPT cover. Result(s): We included 11
unique trials with a total of 33,458 patients; the longest duration of
follow-up was 48 months and the shortest was 3 months. NMA results
demonstrated that compared with 12 months, longer DAPT of 30 months
reduced the hazard ratio (HR) of stent thrombosis (HR, 0.29; 95% CrI,
0.17-0.49). There was no difference in mortality between shorter and
longer durations of DAPT except for 30 vs. 48 months (HR, 0.48; 95% CrI,
0.23-0.98). Compared with 12 months, longer DAPT of 30 months reduced the
risk of myocardial infarction (HR, 0.47; 95% CrI, 0.37-0.61). Results also
demonstrated that compared with 12 months, a shorter-term DAPT reduced the
risk of major bleeding (6 months: HR, 0.53; 95% CrI, 0.29-0.98), whereas
longer-term DAPT increased the risk of major bleeding (30 months: HR,
1.61; 95% CrI, 1.21-2.15). Conclusion(s): As expected, bleeding was
less in the shorter duration regimens, whereas the ischemic outcomes were
better in the longer duration ones. Copyright © 2017 by Turkish
Society of Cardiology.

<7>
Accession Number
625382107
Title
Systematic review with meta-analysis: the risk of gastrointestinal
bleeding in patients taking third-generation P2Y<inf>12</inf> inhibitors
compared with clopidogrel.
Source
Alimentary Pharmacology and Therapeutics. 49 (1) (pp 7-19), 2019. Date of
Publication: January 2019.
Author
Guo C.-G.; Chen L.; Chan E.W.; Cheung K.S.; Isshiki T.; Wong I.C.K.; Leung
W.K.
Institution
(Guo, Chen, Cheung, Leung) Department of Medicine, Li Ka Shing Faculty of
Medicine, University of Hong Kong, Hong Kong
(Chan, Wong) Department of Pharmacology and Pharmacy, Li Ka Shing Faculty
of Medicine, University of Hong Kong, Hong Kong
(Isshiki) Cardiovascular Center, Ageo Central General Hospital, Ageo,
Saitama, Japan
Publisher
Blackwell Publishing Ltd
Abstract
Background: Ticagrelor and prasugrel are third-generation oral
P2Y<inf>12</inf>receptor antagonists with rapid onset and pronounced
platelet inhibition. However, higher overall bleeding rates have been
reported for these agents when compared with clopidogrel. Aim(s): To
compare the risk of gastrointestinal bleeding (GIB) among users of
third-generation P2Y<inf>12</inf> inhibitors with clopidogrel.
 Method(s): We systematically searched for published randomised
controlled trials of ticagrelor or prasugrel versus clopidogrel until
September 2018. The primary outcome was the risk of GIB among users of
third-generation P2Y<inf>12</inf>inhibitors when compared to clopidogrel,
expressed as risk ratio (RR) and 95% confidence interval (CI). The rates
of non-coronary artery bypass graft (CABG) major bleeding,
life-threatening bleeding, fatal bleeding, and intracranial bleeding were
analysed as secondary outcomes. Result(s): Forty-one studies were
included in the analysis of non-CABG major bleeding, of which 12 were
included in the analysis of GIB including 58 678 patients.
Third-generation P2Y<inf>12</inf> inhibitors were associated with higher
risk of GIB as compared with clopidogrel (RR 1.28, 95% CI 1.13-1.46). The
findings were consistent for upper (RR 1.32, 95% CI 1.05-1.67) and
unspecified GIB (RR 1.25, 95% CI 1.01-1.53), but not lower GIB (RR 1.25,
95% CI 0.95-1.65). Subgroup analysis showed higher GIB risk in prasugrel
studies (RR 1.40, 95% CI 1.10-1.77) than in ticagrelor studies (RR 1.15,
95% CI 0.94-1.39). Third-generation P2Y<inf>12</inf> inhibitors also
increased the risk of non-CABG major bleeding (RR 1.18, 95% CI 1.08-1.28).
 Conclusion(s): Third-generation P2Y<inf>12</inf> inhibitors were
associated with increased risk of GIB and non-CABG major bleeding when
compared with clopidogrel. Copyright © 2018 John Wiley & Sons Ltd

<8>
Accession Number
625460938
Title
Perioperative administration of buffered versus non-buffered crystalloid
intravenous fluid to improve outcomes following adult surgical procedures:
A Cochrane systematic review.
Source
Perioperative Medicine. 7 (1) (no pagination), 2018. Article Number: 27.
Date of Publication: 13 Dec 2018.
Author
Odor P.M.; Bampoe S.; Dushianthan A.; Bennett-Guerrero E.; Cro S.; Gan
T.J.; Grocott M.P.W.; James M.F.M.; Mythen M.G.; O'Malley C.M.N.; Roche
A.M.; Rowan K.; Burdett E.
Institution
(Odor, Mythen) Department of Anaesthesia and Critical Care, University
College London, Gower St, London WC1E 6BT, United Kingdom
(Bampoe) Centre for Anaesthesia and Perioperative Medicine, University
College London, London, United Kingdom
(Dushianthan) General Intensive Care Unit, University Hospital Southampton
NHS Foundation Trust, Southampton, United Kingdom
(Bennett-Guerrero, Gan) Department of Anesthesiology, Stony Brook
Medicine, Stony Brook, NY, United States
(Cro) Medical Research Council Clinical Trials Unit, London, United
Kingdom
(Grocott) Critical Care Group, Clinical and Experimental Sciences, Faculty
of Medicine, University of Southampton, Southampton, United Kingdom
(James) Department of Anaesthesia, University of Cape Town, Cape Town,
South Africa
(O'Malley) Department of Anaesthesia, St James's Hospital, Dublin, Ireland
(Roche) Department of Anesthesiology and Pain Medicine, University of
Washington, Seattle, WA, United States
(Rowan) Intensive Care National Audit and Research Centre, London, United
Kingdom
(Burdett) Department of Anaesthesia, UCL, Centre for Anaesthesia, London,
United Kingdom
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Buffered intravenous fluid preparations contain substrates to
maintain acid-base status. The objective of this systematic review was to
compare the effects of buffered and non-buffered fluids administered
during the perioperative period on clinical and biochemical outcomes.
 Method(s): We searched MEDLINE, EMBASE, CINAHL and the Cochrane
Library until May 2017 and included all randomised controlled trials that
evaluated buffered versus non-buffered fluids, whether crystalloid or
colloid, administered to surgical patients. We assessed the selected
studies for risk of bias and graded the level of evidence in accordance
with Cochrane recommendations. Result(s): We identified 19
publications of 18 randomised controlled trials, totalling 1096
participants. Mean difference (MD) in postoperative pH was 0.05 units
lower immediately following surgery in the non-buffered group (12 studies
of 720 participants; 95% confidence interval (CI) 0.04 to 0.07; I
2 = 61%). This difference did not persist on postoperative day
1. Serum chloride concentration was higher in the non-buffered group at
the end of surgery (10 trials of 530 participants; MD 6.77 mmol/L, 95% CI
3.38 to 10.17). This effect persisted until postoperative day 1 (5 trials
of 258 participants; MD 8.48 mmol/L, 95% CI 1.08 to 15.88). Quality of
this evidence was moderate. We identified variable protocols for fluid
administration and total volumes of fluid administered to patients
intraoperatively. Outcome data was variably reported at disparate time
points and with heterogeneous patient groups. Consequently, the effect
size and overall confidence interval was reduced, despite the relatively
low inherent risk of bias. There was insufficient evidence on the effect
of fluid composition on mortality and organ dysfunction. Confidence
intervals of this outcome were wide and the quality of evidence was low (3
trials of 276 participants for mortality; odds ratio (OR) 1.85, 95% CI
0.37 to 9.33; I 2 = 0%). Conclusion(s): Small effect sizes
for biochemical outcomes and lack of correlated clinical follow-up data
mean that robust conclusions on major morbidity and mortality associated
with buffered versus non-buffered perioperative fluid choices are still
lacking. Buffered fluid may have biochemical benefits, including a
significant reduction in postoperative hyperchloraemia and metabolic
acidosis. Copyright © 2018 The Author(s).

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

<10>
Accession Number
2001243140
Title
Meta-Analysis of Impact of Anemia and Hemoglobin Level on Survival After
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Author
Takagi H.; Hari Y.; Kawai N.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
To establish evidence whether baseline anemia and decreases in baseline
hemoglobin levels affect survival after transcatheter aortic valve
implantation (TAVI), we performed a meta-analysis of available studies.
Studies considered for inclusion met the following criteria: the design
was a comparative study of patients with baseline anemia versus those
without baseline anemia or a cohort study investigating baseline anemia
(as a dichotomous variable) or baseline hemoglobin levels (as a continuous
variable) as one of prognostic factors of mortality; the study population
was patients who underwent TAVI; and main outcomes included early (30-day
or in-hospital) or late (including early) all-cause mortality.
Study-specific estimates were combined in the random-effects model. Our
search identified 15 eligible studies including a total of 11,657 TAVI
patients. Pooled analysis demonstrated that baseline anemia was associated
with a statistically significant increase in early (p = 0.003) and midterm
mortality (p < 0.0001) and that incremental decreases in baseline
hemoglobin levels were associated with a statistically significant
increase in midterm mortality (p < 0.00001). Pooled analysis of only
adjusted estimates indicated that anemia was independently associated with
a statistically significant increase in early (p = 0.02) and midterm
mortality (p < 0.0001) and that incremental decreases in baseline
hemoglobin levels were independently associated with a statistically
significant increase in midterm mortality (p < 0.00001). In conclusion,
baseline anemia and lower baseline hemoglobin levels may be associated
with increased early and midterm mortality after TAVI. Copyright
© 2018 Elsevier Inc.

<11>
Accession Number
2001385418
Title
Acute Cellular Rejection and Infection Rates in Alemtuzumab vs Traditional
Induction Therapy Agents for Lung and Heart Transplantation: A Systematic
Review and Meta-analysis.
Source
Transplantation Proceedings. 50 (10) (pp 3739-3747), 2018. Date of
Publication: December 2018.
Author
Li K.H.C.; Ho J.C.S.; Recaldin B.; Gong M.; Ho J.; Li G.; Liu T.; Wu
W.K.K.; Wong M.C.S.; Xia Y.; Dong M.; Tse G.
Institution
(Li, Recaldin) Faculty of Medicine, Newcastle University, United Kingdom
(Li, Ho, Tse) Department of Medicine and Therapeutics, Faculty of
Medicine, Chinese University of Hong Kong, Hong Kong, Hong Kong
(Li, Tse) Li Ka Shing Institute of Health Sciences, Faculty of Medicine,
Chinese University of Hong Kong, Hong Kong, Hong Kong
(Gong, Li, Liu) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Ho) Department of Anesthesia and Intensive Care, Faculty of Medicine, The
Chinese University of Hong Kong, Shatin, Hong Kong, Hong Kong
(Wu, Wong) The Jockey Club School of Public Health and Primary Care,
Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong
Kong
(Xia) Department of Cardiology, First Affiliated Hospital of Dalian
Medical University, Dalian, China
(Dong) Department of Cardiology, Yantai Yuhuangding Hospital Affiliated to
Qingdao University, Yantai, Shandong Province, China
Publisher
Elsevier USA
Abstract
Background and objectives: Heart and lung transplantation is a high-risk
procedure, requiring intensive immunosuppressive therapy for preventing
organ rejection. Alemtuzumab, a CD52-specific monoclonal antibody, is
increasingly used for induction therapy compared with conventional agents.
However, there has been no systematic review comparing its efficacy with
traditional therapeutic drugs. Method(s): PubMed and EMBASE were
searched to October 1, 2017, for articles on alemtuzumab in cardiothoracic
transplant surgery. Of the 433 studies retrieved, 8 were included in the
final meta-analysis. Result(s): In lung transplantation, alemtuzumab
use was associated with lower odds of acute cellular rejection compared
with antithymocyte globulin (odds ratio [OR], 0.21; 95% CI, 0.11-0.40; P
<.001), lower acute rejection rates (OR, 0.12; 95% CI, 0.03-0.55; P <.01),
and lower infection rates (OR, 0.69; 95% CI, 0.35-1.36; P =.33) when
compared with basiliximab. Multivariate meta-regression analysis found
that mean age, male sex, single lung transplant, double lung transplant,
cytomegalovirus or Epstein-Barr virus status, idiopathic pulmonary
fibrosis, cystic fibrosis, and mean ischemic time did not significantly
influence acute rejection outcomes. For heart transplantation, alemtuzumab
use was associated with lower acute rejection rates when compared with
tacrolimus (OR, 0.44; 95% CI, 0.30-0.66; P <.001). Conclusion(s):
Alemtuzumab use was associated with lower rejection rates when compared
with conventional induction therapy agents (antithymocyte globulin,
basiliximab, and tacrolimus) in heart and lung transplantation. However,
this was based on observational studies. Randomized controlled trials are
needed to verify its clinical use. Copyright © 2018

<12>
Accession Number
2001385383
Title
Acute Cellular Rejection and Infection Rates in Alemtuzumab vs Traditional
Induction Therapy Agents for Lung and Heart Transplantation: A Systematic
Review and Meta-analysis.
Source
Transplantation Proceedings. 50 (10) (pp 3723-3731), 2018. Date of
Publication: December 2018.
Author
Li K.H.C.; Ho J.C.S.; Recaldin B.; Gong M.; Ho J.; Li G.; Liu T.; Wu
W.K.K.; Wong M.C.S.; Xia Y.; Dong M.; Tse G.
Institution
(Li, Recaldin) Faculty of Medicine, Newcastle University, Newcastle Upon
Tyne, United Kingdom
(Li, Ho, Liu, Tse) Department of Medicine and Therapeutics, Faculty of
Medicine, Chinese University of Hong Kong, Hong Kong, Hong Kong
(Li, Tse) Li Ka Shing Institute of Health Sciences, Faculty of Medicine,
Chinese University of Hong Kong, Hong Kong, Hong Kong
(Gong, Li) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular Disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Ho) Department of Anesthesia and Intensive Care, Faculty of Medicine, The
Chinese University of Hong Kong, Shatin, Hong Kong, Hong Kong
(Wu, Wong) The Jockey Club School of Public Health and Primary Care,
Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong
Kong
(Xia) Department of Cardiology, First Affiliated Hospital of Dalian
Medical University, Dalian, China
(Dong) Department of Cardiology, Yantai Yuhuangding Hospital Affiliated to
Qingdao University, Yantai, Shandong Province, China
Publisher
Elsevier USA
Abstract
Background and Objectives: Heart and lung transplantation is a high-risk
procedure requiring intensive immunosuppressive therapy for preventing
organ rejection. Alemtuzumab, a CD52-specific monoclonal antibody, is
increasingly used for induction therapy compared with conventional agents.
However, there has been no systematic review comparing its efficacy with
traditional therapeutic drugs. Method(s): PubMed and EMBASE were
searched to October 1, 2017, for articles on alemtuzumab in cardiothoracic
transplant surgery. Of the 433 studies retrieved, 8 were included in the
final meta-analysis. Result(s): In lung transplantation, alemtuzumab
use was associated with lower odds of acute cellular rejection compared
with antithymocyte globulin (odds ratio [OR], 0.21; 95% CI, 0.11-0.40; P
<.001), lower acute rejection rates (OR, 0.12; 95% CI, 0.03-0.55; P <.01),
and infection rates (OR, 0.69; 95% CI, 0.35-1.36; P =.33) when compared
with basiliximab. Multivariate meta-regression analysis found that mean
age, male sex, single lung transplant, double lung transplant,
cytomegalovirus or Epstein-Barr virus status, idiopathic pulmonary
fibrosis, cystic fibrosis, and mean ischemic time did not significantly
influence acute rejection outcomes. For heart transplantation, alemtuzumab
use was associated with lower acute rejection rates when compared with
tacrolimus (OR, 0.44; 95% CI, 0.30-0.66; P <.001). Conclusion(s):
Alemtuzumab use was associated with lower rejection rates when compared
with conventional induction therapy agents (antithymocyte globulin,
basiliximab, and tacrolimus) in heart and lung transplantation. However,
this was based on observational studies. Randomized controlled trials are
needed to verify its clinical use. Copyright © 2018 Elsevier Inc.

<13>
Accession Number
625438051
Title
Transcatheter mitral-valve repair in patients with heart failure.
Source
New England Journal of Medicine. 379 (24) (pp 2307-2318), 2018. Date of
Publication: 13 Dec 2018.
Author
Stone G.W.; Lindenfeld J.A.; Abraham W.T.; Kar S.; Lim D.S.; Mishell J.M.;
Whisenant B.; Grayburn P.A.; Rinaldi M.; Kapadia S.R.; Rajagopal V.;
Sarembock I.J.; Brieke A.; Marx S.O.; Cohen D.J.; Weissman N.J.
Institution
(Stone) Columbia University Medical Center, Cardiovascular Research
Foundation, 1700 Broadway, 8th Fl., New York, NY 10019, United States
(Stone) New York-Presbyterian Hospital, Cardiovascular Research
Foundation, United States
(Stone, Marx) Columbia University Medical Center, New York, United States
(Lindenfeld) Advanced Heart Failure, Vanderbilt Heart and Vascular
Institute, Nashville, United States
(Abraham) Departments of Medicine, Physiology, and Cell Biology, Division
of Cardiovascular Medicine, Davis, United States
(Abraham) Heart and Lung Research Institute, Ohio State University,
Columbus, United States
(Kapadia) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, United States
(Sarembock) Christ Hospital, Cincinnati, OH, United States
(Kar) Smidt Heart In-stitute, Cedars-Sinai Medical Center, Los Angeles,
United States
(Mishell) Kaiser Permanente-San Francisco Hospital, San Francisco, CA,
United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville,
United States
(Whisenant) Intermountain Medical Center, Murray, UT, United States
(Grayburn) Baylor University Medical Center, Baylor Heart and Vascular
Institute, United States
(Rinaldi) Carolinas Medical Center, Charlotte, NC, United States
(Rajagopal) Piedmont Hospital, Atlanta, United States
(Brieke) University of Colorado Hospital, Aurora, United States
(Cohen) Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, School of Medicine, Kansas City, United States
(Weissman) MedStar Health Research Institute, Hyattsville, MD, United
States
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Among patients with heart failure who have mitral regurgitation
due to left ventricular dysfunction, the prognosis is poor. Transcatheter
mitral-valve repair may improve their clinical outcomes. METHODS At 78
sites in the United States and Canada, we enrolled patients with heart
failure and moderate-to-severe or severe secondary mitral regurgitation
who remained symptomatic despite the use of maximal doses of
guideline-directed medical therapy. Patients were randomly assigned to
transcatheter mitral-valve repair plus medical therapy (device group) or
medical therapy alone (control group). The primary effectiveness end point
was all hospitalizations for heart failure within 24 months of follow-up.
The primary safety end point was freedom from device-related complications
at 12 months; the rate for this end point was compared with a prespecified
objective performance goal of 88.0%. RESULTS Of the 614 patients who were
enrolled in the trial, 302 were assigned to the device group and 312 to
the control group. The annualized rate of all hospitalizations for heart
failure within 24 months was 35.8% per patient-year in the device group as
compared with 67.9% per patient-year in the control group (hazard ratio,
0.53; 95% confidence interval [CI], 0.40 to 0.70; P<0.001). The rate of
freedom from device-related complications at 12 months was 96.6% (lower
95% confidence limit, 94.8%; P<0.001 for comparison with the performance
goal). Death from any cause within 24 months occurred in 29.1% of the
patients in the device group as compared with 46.1% in the control group
(hazard ratio, 0.62; 95% CI, 0.46 to 0.82; P<0.001). CONCLUSIONS Among
patients with heart failure and moderate-to-severe or severe secondary
mitral regurgitation who remained symptomatic despite the use of maximal
doses of guideline-directed medical therapy, transcatheter mitral-valve
repair resulted in a lower rate of hospitalization for heart failure and
lower all-cause mortality within 24 months of follow-up than medical
therapy alone. The rate of freedom from device-related complications
exceeded a prespecified safety threshold. Copyright © 2018
Massachusetts Medical Society.

<14>
Accession Number
623897589
Title
Impact of Concomitant Mitral Valve Surgery With LVAD Placement: Systematic
Review and Meta-Analysis.
Source
Artificial Organs. (no pagination), 2018. Date of Publication: 2018.
Author
Choi J.H.; Luc J.G.Y.; Moncho Escriva E.; Phan K.; Rizvi S.S.A.; Patel S.;
Entwistle J.W.; Morris R.J.; Massey H.T.; Tchantchaleishvili V.
Institution
(Choi, Rizvi, Patel, Entwistle, Morris, Massey, Tchantchaleishvili)
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia,
PA, United States
(Luc) Division of Cardiovascular Surgery, Department of Surgery,
University of British Columbia, Vancouver, BC, Canada
(Moncho Escriva) Department of Statistics, University of Granada, Granada,
Spain
(Phan) Faculty of Medicine, University of New South Wales, Sydney, NSW,
Australia
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
The aim of this systematic review and meta-analysis was to evaluate the
outcomes of concomitant mitral valve surgery for significant preexisting
mitral regurgitation (MR) in patients undergoing continuous-flow left
ventricular assist device (CF-LVAD) implantation. Electronic search was
performed to identify all studies in the English literature examining
concurrent mitral valve surgery in patients with CF-LVAD implantation.
Identified articles were systematically assessed for inclusion and
exclusion criteria. Of 2319 studies identified, 8 studies were included.
Among 445 patients with moderate to severe or severe MR, 113 (25.4%)
patients received concurrent mitral valvular intervention during CF-LVAD
implantation. There were no significant differences in cardiopulmonary
bypass time (MR Surgery 154 min vs. no MR Surgery 119 min, P = 0.64) or
hospital length of stay (MR Surgery 21 days vs. no MR Surgery 18 days, P =
0.93). On follow-up, there were no significant differences in freedom from
greater than moderate MR (MR Surgery 100% vs. no MR Surgery 74%, P = 0.12)
or left ventricular end-diastolic diameter (MR Surgery: 60 mm vs. no MR
Surgery 65 mm, P = 0.51). Survival was comparable at 6-months (MR Surgery
77% vs. no MR Surgery 81%, P = 0.75), 1-year (MR Surgery 72% vs. no MR
Surgery 80%, P = 0.36), and 2-years of follow-up (MR Surgery 65% vs. no MR
Surgery 70%, P = 0.56). The results of our systematic review and
meta-analysis of 8 studies consisting of 445 patients demonstrates that
the addition of mitral valve intervention to CF-LVAD implantation appears
to be safe with comparable survival to those undergoing CF-LVAD
implantation alone. Large prospective randomized clinical trials are
needed to elucidate whether concomitant mitral valve intervention during
CF-LVAD implantation in patients with severe MR is
necessary. Copyright © 2018 International Center for Artificial
Organs and Transplantation and Wiley Periodicals, Inc.

<15>
Accession Number
625615959
Title
Bioprosthetic Valve Performance After Transcatheter Aortic Valve
Replacement With Self-Expanding Versus Balloon-Expandable Valves in Large
Versus Small Aortic Valve Annuli: Insights From the CHOICE Trial and the
CHOICE-Extend Registry.
Source
JACC. Cardiovascular interventions. 11 (24) (pp 2507-2518), 2018. Date of
Publication: 24 Dec 2018.
Author
Abdelghani M.; Mankerious N.; Allali A.; Landt M.; Kaur J.; Sulimov D.S.;
Merten C.; Sachse S.; Mehilli J.; Neumann F.-J.; Frerker C.; Kurz T.;
El-Mawardy M.; Richardt G.; Abdel-Wahab M.
Institution
(Abdelghani) The Heart Center, Segeberger Kliniken (Academic Teaching
Hospital of the Universities of Kiel, Lubeck, and Hamburg), Bad Segeberg,
Germany; Cardiology Department, The Academic Medical Center, University of
Amsterdam, Amsterdam, the Netherlands
(Mankerious, Allali, Landt, Kaur, Sulimov, Merten, Sachse, Richardt) The
Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the
Universities of Kiel, Lubeck, and Hamburg), Bad Segeberg, Germany
(Mehilli) Munich University Center, Ludwig-Maximilians University, German
Centre for Cardiovascular Research (DZHK), partner site Munich Heart
Alliance, Munich, Germany
(Neumann) Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
(Frerker) Cardiology Department, Asklepios Clinic St. Georg, Hamburg,
Germany
(Kurz) Cardiology Department, Lubeck University Hospital, Lubeck, Germany
(El-Mawardy) Cardiology Department, Vivantes Wenckebach Hospital, Berlin,
Germany
(Abdel-Wahab) The Heart Center, Segeberger Kliniken (Academic Teaching
Hospital of the Universities of Kiel, Lubeck, and Hamburg), Bad Segeberg,
Germany; Cardiology Department, Heart Center Leipzig - University
Hospital, Leipzig, Germany
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The aim of this study was to compare self-expanding and
balloon-expandable transcatheter heart valves (THVs) in large versus small
aortic valve annuli. BACKGROUND: The degree of THV oversizing varies
according to annular size, and this can modify the hemodynamic performance
of self-expanding and balloon-expandable THVs. METHOD(S): Patients
undergoing transcatheter aortic valve replacement in the randomized CHOICE
(Comparison of Transcatheter Heart Valves in High Risk Patients With
Severe Aortic Stenosis: Medtronic CoreValve vs Edwards SAPIEN XT) trial
(CoreValve [CV], n = 120; SAPIEN XT [SXT], n = 121) and the nonrandomized
CHOICE-Extend registry (Evolut R [ER], n = 100; SAPIEN 3 [S3], n = 334)
were compared for THV performance by echocardiography (in all patients)
and by cardiac magnetic resonance imaging (MRI) regurgitant fraction (RF)
(in a subgroup of patients). Patients were stratified according to aortic
valve annular mean diameter into those with large (>23 mm) or small (<=23
mm) annuli. RESULT(S): THV percentage oversizing was 19.1 +/- 6.4%
with the CV, 11.4 +/- 7.0% with the SXT, 18.8 +/- 4.8% with the ER, and
3.7 +/- 5.5% with the S3. Transvalvular mean pressure gradient was lower
with the CV and ER than with the SXT and S3 in both the large and small
annulus groups. In the randomized CHOICE trial, moderate to severe
prosthetic valve regurgitation (PVR) was more with the CV than the SXT in
large annuli (15.1% vs. 0.0%; p = 0.002; MRI RF: 10.5 +/- 10.2% vs. 4.4
+/- 4.5%; p = 0.036) but not in small annuli (0.0% vs. 5.7%; p = 0.50; MRI
RF: 4.0 +/- 4.1% vs. 4.0 +/- 3.4%; p = 0.98). In the CHOICE-Extend
registry, moderate to severe PVR occurred in 2 patients, and any PVR was
not significantly different between the ER and the S3 in large (41.7% vs.
32.5%; p = 0.24) or small (47.1% vs. 43.8%; p = 0.84) annuli. MRI RF was
not different in large annuli (5.0 +/- 3.8% vs. 5.0 +/- 6.1%; p = 0.99)
but was significantly lower with the ER than the S3 in small annuli (2.9
+/- 2.3% vs. 4.8 +/- 3.7%; p = 0.023). On multivariate analysis,
transcatheter aortic valve replacement with the ER in small annuli was
associated with a lower rate of prosthesis-patient mismatch than with the
S3, with no increased risk for PVR. CONCLUSION(S): Older-generation
balloon-expandable THVs were associated with less PVR than self-expanding
THVs in patients with large but not small annuli. The next-generation
self-expanding THV has improved sealing in patients with large annuli and
may have potential advantages in patients with small annuli. Copyright
© 2018 American College of Cardiology Foundation. Published by
Elsevier Inc. All rights reserved.

<16>
Accession Number
625616460
Title
Ultrathin Bioresorbable Polymer Sirolimus-Eluting Stents Versus Thin
Durable Polymer Everolimus-Eluting Stents.
Source
Journal of the American College of Cardiology. 72 (25) (pp 3287-3297),
2018. Date of Publication: 25 Dec 2018.
Author
Kandzari D.E.; Koolen J.J.; Doros G.; Massaro J.J.; Garcia-Garcia H.M.;
Bennett J.; Roguin A.; Gharib E.G.; Cutlip D.E.; Waksman R.
Institution
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia France
(Koolen) Catharina Hospital, Eindhoven, Netherlands
(Doros) Department of Biostatistics and Epidemiology, Boston University
School of Public Health, Baim Institute for Clinical Research, Boston, MA,
United States
(Massaro) Department of Biostatistics and Epidemiology, Boston University
School of Public Health, Boston, MA, United States
(Garcia-Garcia, Waksman) Division of Interventional Cardiology, MedStar
Cardiovascular Research Network, MedStar Washington Hospital Center, WA,
United States
(Bennett) Department of Cardiovascular Medicine, University Hospitals
Leuven, Leuven, Belgium
(Roguin) Department of Cardiology, Rambam Medical Center, Haifa, Israel
(Gharib) Charleston Area Medical Center, Charleston, WV, United States
(Cutlip) Beth Israel Deaconess Medical Center, Baim Institute for Clinical
Research, Boston, MA, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Coronary drug-eluting stent development has introduced new
metal alloys, changes in stent architecture, and bioresorbable polymers.
Whether these advancements improve long-term clinical safety and efficacy
has been inconsistent in prior studies. OBJECTIVE(S): The authors
sought to compare late-term clinical outcomes among patients treated with
an ultrathin strut (60 mum) bioresorbable polymer sirolimus-eluting stent
(BP SES) and a thin strut (81 mum) durable polymer everolimus-eluting
stent (DP EES) in a large randomized trial. METHOD(S): BIOFLOW V
(Biotronik Prospective Randomized Multicenter Study to Assess the Safety
and Effectiveness of the Orsiro Sirolimus Eluting Coronary Stent System in
the Treatment of Subjects with Up to Three De Novo or Restenotic Coronary
Artery Lesions V) was an international randomized trial comparing coronary
revascularization with BP SES and DP EES regarding the primary endpoint of
12-month target lesion failure (TLF). Analysis of pre-specified 2-year
clinical outcomes was performed. RESULT(S): Among 1,334 patients
randomized to treatment with BP SES (n = 884) or DP EES (n = 450), the
2-year TLF rate was 7.5% for BP SES and 11.9% for DP EES (-4.33% treatment
difference; 95% confidence interval: -8.16% to -0.91%; p = 0.015), driven
by differences in target vessel myocardial infarction (MI) (5.3% vs. 9.5%;
p = 0.01) and ischemia-driven target lesion revascularization (2.6% vs.
4.9%; p = 0.04). Rates of cardiac death or MI were 7.0% versus 10.4% for
BP SES and DP EES, respectively (p = 0.047). Late/very late definite stent
thrombosis was statistically lower for BP SES compared with DP EES (0.1%
vs. 1.0%; p = 0.045). CONCLUSION(S): In a large randomized trial,
significant differences in both TLF and target vessel-related MI persisted
through 2 years, favoring treatment with BP SES over DP EES. Significantly
lower cumulative target lesion revascularization and late/very late stent
thrombosis were also observed with BP SES. (Safety and Effectiveness of
the Orsiro Sirolimus Eluting Coronary Stent System in Subjects With
Coronary Artery Lesions [BIOFLOW-V]; NCT02389946). Copyright ©
2018 The Authors. Published by Elsevier Inc. All rights reserved.

<17>
[Use Link to view the full text]
Accession Number
625616343
Title
B-Type Natriuretic Peptide Assessment in Patients Undergoing
Revascularization for Left Main Coronary Artery Disease.
Source
Circulation. 138 (5) (pp 469-478), 2018. Date of Publication: 31 Jul 2018.
Author
Redfors B.; Chen S.; Crowley A.; Ben-Yehuda O.; Gersh B.J.; Lembo N.J.;
Brown W.M.; Banning A.P.; Taggart D.P.; Serruys P.W.; Kappetein A.P.;
Sabik J.F.; Stone G.W.
Institution
(Redfors, Chen, Crowley, Ben-Yehuda, Stone) Clinical Trials Center,
Cardiovascular Research Foundation, New York, NY (B.R., S.C., A.C.,
O.B.-Y., G.W.S.)
(Ben-Yehuda, Lembo, Stone) New York-Presbyterian Hospital/Columbia
University Medical Center, NY, United States
(Gersh) Department of Cardiovascular Medicine, Mayo Clinic College of
Medicine, Rochester, United Kingdom
(Brown) Piedmont Heart Institute, Atlanta, United States
(Banning, Taggart) John Radcliffe Hospital, United Kingdom (A.P.B.,
Oxford, Canada
(Serruys) Imperial College of Science, Technology and Medicine, United
Kingdom (P.W.S.), London, Canada
(Kappetein) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Sabik) Department of Surgery, University Hospitals Cleveland Medical
Center
Publisher
NLM (Medline)
Abstract
BACKGROUND: Elevated B-type natriuretic peptide (BNP) is reflective of
impaired cardiac function and is associated with worse prognosis among
patients with coronary artery disease (CAD). We sought to assess the
association between baseline BNP, adverse outcomes, and the relative
efficacy of percutaneous coronary intervention (PCI) versus coronary
artery bypass grafting (CABG) in patients with left main CAD.
 METHOD(S): The EXCEL trial (Evaluation of XIENCE Versus Coronary
Artery Bypass Surgery for Effectiveness of Left Main Revascularization)
randomized patients with left main CAD and low or intermediate SYNTAX
scores (Synergy Between PCI With TAXUS and Cardiac Surgery) to PCI with
everolimus-eluting stents versus CABG. The primary end point was the
composite of all-cause death, myocardial infarction, or stroke. We used
multivariable Cox proportional hazards regression to assess the
associations between normal versus elevated BNP (>=100 pg/mL), randomized
treatment, and the 3-year risk of adverse events. RESULT(S): BNP at
baseline was elevated in 410 of 1037 (39.5%) patients enrolled in EXCEL.
Patients with elevated BNP levels were older and more frequently had
additional cardiovascular risk factors and lower left ventricular ejection
fraction than those with normal BNP, but had similar SYNTAX scores.
Patients with elevated BNP had significantly higher 3-year rates of the
primary end point (18.6% versus 11.7%; adjusted hazard ratio [HR], 1.62;
95% confidence interval [CI], 1.16-2.28; P=0.005) and higher mortality
(11.5% versus 3.9%; adjusted HR, 2.49; 95% CI, 1.48-4.19; P=0.0006), both
from cardiovascular and noncardiovascular causes. In contrast, there were
no significant differences in the risks of myocardial infarction, stroke,
ischemia-driven revascularization, stent thrombosis, graft occlusion, or
major bleeding. A significant interaction ( Pinteraction=0.03) was present
between elevated versus normal BNP and treatment with PCI versus CABG for
the adjusted risk of the primary composite end point at 3 years among
patients with elevated BNP (adjusted HR for PCI versus CABG, 1.54; 95% CI,
0.96-2.47) versus normal BNP (adjusted HR, 0.74; 95% CI, 0.46-1.20). This
interaction was stronger when log(BNP) was modeled as a continuous
variable ( Pinteraction=0.002). CONCLUSION(S): In the EXCEL trial,
elevated baseline BNP levels in patients with left main CAD undergoing
revascularization were independently associated with long-term mortality
but not nonfatal adverse ischemic or bleeding events. The relative
long-term outcomes after PCI versus CABG for revascularization of left
main CAD may be conditioned by the baseline BNP level. CLINICAL TRIAL
REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier:
NCT01205776.

<18>
Accession Number
625602337
Title
Effects of patient-controlled analgesia with hydromorphone or sufentanil
on postoperative pulmonary complications in patients undergoing thoracic
surgery: a quasi-experimental study.
Source
BMC anesthesiology. 18 (1) (pp 192), 2018. Date of Publication: 19 Dec
2018.
Author
Yan G.; Chen J.; Yang G.; Duan G.; Du Z.; Yu Z.; Peng J.; Liao W.; Li H.
Institution
(Yan, Chen, Yang, Duan, Du, Peng, Liao) Department of Anesthesiology,
Anesthesiology of Xinqiao Hospital of Third Military Medical University,
Shapingba District, Chongqing 400037, China
(Yu) Department of Anesthesiology, Xinqiao Hospital, Thoracic Surgery of
Xinqiao Hospital of Third Military Medical University, Shapingba District,
Chongqing 400037, China
(Li) Department of Anesthesiology, Anesthesiology of Xinqiao Hospital of
Third Military Medical University, Shapingba District, Chongqing 400037,
China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To compare the analgesic effects of patient-controlled
intravenous analgesia (PCA) with hydromorphone and sufentanil after
thoracic surgery on postoperative pulmonary complications (PPCs).
 METHOD(S): A total of 142 patients who were scheduled for thoracic
surgery were randomly allocated to receive PCA with hydromorphone (group
A: experimental group): hydromorphone 0.2mg/kg+dezocine
0.5mg/kg+ramosetron 0.6mg diluted with normal saline to 200mL; or with
sufentanil (group B: control group): sufentanil 3.0mug/kg+dezocine
0.5mg/kg+ramosetron 0.6mg diluted with normal saline to 200mL. The
parameters of intravenous analgesia pump were set as background dose
4ml/h, PCA dose 1mL, locking time 15min. Pain NRS (numerical rating
scale), Ramsay sedation score, nausea or vomiting score were evaluated at
0h, 6h, 12h, 24h, 48h after operation. The cases of PPCs (atelectasis,
pulmonary infection, respiratory failure), CRP (C-reaction protein) and
inflammatory cells (white cell count and percentage of neutrophils) and
blood gas analysis at 12h after operation, length of ICU and postoperative
stay were recorded for each patient. RESULT(S): Data of 136 patients
were analyzed. Compared with group B (4[IQR:2,2]), the pain NRS in group A
(2[IQR:4,4]) was significantly lower at 6h after operation (P=0.000). The
CRP in group A (69.79+/-32.13mg/L) were lower than group B
(76.76+/-43.42mg/L) after operation, but the difference was not
significant (P=0.427). No difference of nausea or vomiting was found
between group A (7.3%) and group B (5.8%) postoperatively (P=0.999). The
PPCs were happened in 11 patients in group A (16.2%) and 22 patients in
group B (32.4%) and the difference between two groups was significant
(P=0.027). Seven patients in group A (10.3%) and eighteen patients in
group B (26.5%) had clinical evidence of pneumonia and the difference
between two groups was significant (P=0.014). The length of ICU and
postoperative stay in group A were 2.73h and 1.82days less than group B
respectively but the differences were not significant (P=0.234, P=0.186
respectively). CONCLUSION(S): Compared with sufentanil, hydromorphone
may provide better postoperative analgesic effect with less pulmonary
complications for patients undergoing thoracic surgery, and it may
accelerate patients' rehabilitation. TRIAL REGISTRATION: Randomized
Controlled Trials ChiCTR1800014282c . Registered 3 January 2018.

<19>
Accession Number
2001243295
Title
Rationale and design of the randomized prospective ATLAS study: Avoid
Transvenous Leads in Appropriate Subjects.
Source
American Heart Journal. 207 (pp 1-9), 2019. Date of Publication: January
2019.
Author
Mondesert B.; Bashir J.; Philippon F.; Dubuc M.; Amit G.; Exner D.; Joza
J.; Birnie D.H.; Lane C.; Tsang B.; Korley V.; Spears D.; Ling A.; Djuric
A.; Crystal E.; Hruczkowski T.; Roux J.-F.; Carroll S.; Essebag V.; Krahn
A.D.; Healey J.S.
Institution
(Mondesert, Dubuc) Department of Medicine, Montreal Heart Institute,
Universite de Montreal, Montreal, Quebec, Canada
(Bashir, Krahn) University of British Columbia, Vancouver, British
Columbia, Canada
(Philippon) Institut Universitaire de cardiologie et de pneumologie de
Quebec, Laval University, Quebec City, Quebec, Canada
(Amit, Ling, Djuric, Carroll, Healey) Population Health Research
Institute, McMaster University, Hamilton, Ontario, Canada
(Exner) Libin Cardiovascular Institute of Alberta, Calgary, Alberta,
Canada
(Joza, Essebag) McGill University Health Centre, Montreal, Quebec, Canada
(Birnie) University of Ottawa Heart Institute, Ottawa, Ontario, Canada
(Lane) Royal Jubilee Hospital, Victoria, British Columbia, Canada
(Tsang) Southlake Regional Health Centre, Newmarket, Ontario, Canada
(Korley) Division of Cardiology, Department of Medicine, St Michael's
Hospital, University of Toronto, Toronto, Ontario, Canada
(Spears) Peter Munk Cardiac Center Toronto General Hospital, University
Health Network, Toronto, Canada
(Crystal) Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health
Sciences Centre, University of Toronto, Toronto, Ontario, Canada
(Hruczkowski) Department of Medicine, Division of Cardiology, University
of Alberta, Edmonton, Canada
(Roux) Cardiology Service, Medicine department, Medicine and Health
sciences university, Sherbrooke university, Sherbrooke, Quebec, Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The defibrillator lead is the weakest part of the transvenous
(TV) implantable cardioverter defibrillation (ICD) system and a frequent
cause of morbidity. Lead dislodgement, cardiac perforation,
insertion-related trauma including pneumothorax and vascular injury, are
common early complications of TV-ICD implantation. Venous occlusion,
tricuspid valve dysfunction, lead fracture and lead insulation failure are
additional, later complications. The introduction of a totally
sub-cutaneous ICD (S-ICD) may reduce these lead-related issues, patient
morbidity, hospitalizations and costs. However, such benefits compared to
the TV-ICD have not been demonstrated in a randomized trial.
 Design(s): ATLAS (Avoid Transvenous Leads in Appropriate Subjects) is
a multi-centered, randomized, open-label, parallel group trial. Patients
younger than 60 years are eligible. If older than 60 years, patients are
eligible if they have an inherited heart rhythm disease, or risk factors
for ICD-related complication, such as hemodialysis, a history of ICD or
pacemaker infection, heart valve replacement, or severe pulmonary disease.
This study will determine if using an S-ICD compared to a TV-ICD reduces a
primary composite outcome of perioperative complications including
pulmonary or pericardial perforation, lead dislodgement or dysfunction,
tricuspid regurgitation and ipsilateral venous thrombosis. Five hundred
patients will be enrolled from 14 Canadian hospitals, and data collected
to both early- (at 6 months) and mid-term complications (at 24 months) as
well as mortality and ICD shock efficacy. The ATLAS randomized trial is
comparing early- and mid-term vascular and lead-related complications
among S-ICD versus TV-ICD recipients who are younger or at higher risk of
ICD-related complications. Copyright © 2018 Elsevier Inc.

<20>
Accession Number
2001307535
Title
Correlates and outcomes of alcohol use after single solid organ
transplantation: A systematic review and meta-analysis.
Source
Transplantation Reviews. 33 (1) (pp 17-28), 2019. Date of Publication:
January 2019.
Author
Dobbels F.; Denhaerynck K.; Klem M.L.; Sereika S.M.; De Geest S.; De
Simone P.; Berben L.; Binet I.; Burkhalter H.; Drent G.; Duerinckx N.;
Engberg S.J.; Glass T.; Gordon E.; Kirsch M.; Kugler C.; Lerret S.;
Rossmeissl A.; Russell C.; Schmidt-Trucksass A.; de Almeida S.S.
Institution
(Berben) Institute of Nursing Science, University of Basel, Switzerland
(Binet) Nephrology and Transplantation Medicine, Cantonal Hospital St.
Gallen, Switzerland
(Burkhalter) Centre of Sleep Medicine, Hirslanden Group Zurich,
Switzerland
(Drent) Department of Gastroenterology and Hepatology, University Medical
center Groningen, Groningen, Netherlands
(Duerinckx) Academic Centre for Nursing and Midwifery, KU Leuven, Leuven,
Belgium
(Duerinckx) Heart Transplantation Program, University Hospitals Leuven,
Leuven, Belgium
(Sereika, Engberg) School of Nursing, University of Pittsburgh, United
States
(Glass) Department of Biostatistics, Swiss Tropical and Public Health
Institute, University of Basel, Basel, Switzerland
(Gordon) Department of Surgery, Center for Healthcare Studies, Center for
Bioethics and Medical Humanities, Northwestern University Feinberg School
of Medicine, Chicago, United States
(Kirsch) Department of Anaesthesiology, University Hospital of Basel,
Switzerland
(Kugler) Nursing Science, University of Witten/Herdecke, Germany
(Lerret) Department of Pediatric Gastroenterology and Transplant Surgery,
Medical College of Wisconsin, United States
(Rossmeissl) Departement fur Sport, Bewegung und Gesundheit, University
Hospital of Basel, Basel, Switzerland
(Russell) School of Nursing and Health Studies, University of Missouri
Kansas City, United States
(Schmidt-Trucksass) Departement fur Sport, Bewegung und Gesundheit,
University Hospital of Basel, Switzerland
(de Almeida) Transplantation program, Hospital Israelita Albert Einstein,
Sao Paulo, Brazil
(Dobbels, De Geest) Academic Centre for Nursing and Midwifery KU, Leuven,
Belgium
(Dobbels, Denhaerynck, De Geest) Institute of Nursing Science, Department
of Public Health, University of Basel, Switzerland
(Klem) Health Sciences Library System, University of Pittsburgh, United
States
(De Simone) Hepatobiliary surgery and liver Transplantation, University of
Pisa Medical School Hospital, Italy
Publisher
W.B. Saunders
Abstract
Background: Reviews on alcohol use in transplant recipients focus on liver
recipients and their risk of post-transplant rejection, but do not assess
alcohol use in kidney, heart, or lung transplant recipients. This
systematic review and meta-analysis aims to synthesize the evidence on
correlates and outcomes of any alcohol use and at-risk drinking after
solid organ transplantation (Tx). Method(s): We searched 4 databases
for quantitative studies in adult heart, liver, kidney and lung Tx
recipients, investigating associations between post-Tx alcohol use and
correlates and/or clinical, economic or quality of life outcomes. Paper
selection, data extraction and quality assessment were performed by 2
reviewers independently. A pooled odds ratio (OR) was computed for each
correlate/outcome reported >=5 times. Result(s): Of the 5331 studies
identified, 76 were included in this systematic review (93.3% on liver Tx;
mean sample size 148.9 (SD = 160.2); 71.9% male; mean age 48.9 years (SD =
6.5); mean time post-Tx 57.7 months (SD = 23.1)). On average, 23.6% of
patients studied used alcohol post-transplant. Ninety-three correlates of
any post-Tx alcohol use were identified, and 9 of the 19 pooled ORs were
significantly associated with a higher odds for any post-Tx alcohol use:
male gender, being employed post-transplant, smoking pre-transplant,
smoking post-transplant, a history of illicit drug use, having
first-degree relatives who have alcohol-related problems, sobriety <6
months prior to transplant, a history of psychiatric illness, and having
received treatment for alcohol-related problems pre-transplant. On average
15.1% of patients had at-risk drinking. A pooled OR was calculated for 6
of the 47 correlates of post-Tx at risk drinking investigated, of which
pre-transplant smoking was the only correlate being significantly
associated with this behavior. None of the outcomes investigated were
significantly associated with any use or at-risk drinking.
 Conclusion(s): Correlates of alcohol use remain under-investigated in
solid organ transplant recipients other than liver transplantation.
Further research is needed to determine whether any alcohol use or at-risk
drinking is associated with poorer post-transplant outcomes. Our
meta-analysis highlights avenues for future research of higher
methodological quality and improved clinical care. Protocol
Registration: PROSPERO protocol CRD42015003333 Copyright © 2018
Elsevier Inc.

<21>
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

<22>
Accession Number
2001341456
Title
Arterial Switch Operation: Operative Approach and Outcomes.
Source
Annals of Thoracic Surgery. 107 (1) (pp 302-310), 2019. Date of
Publication: January 2019.
Author
Fricke T.A.; Konstantinov I.E.
Institution
(Fricke, Konstantinov) Department of Cardiac Surgery, Royal Children's
Hospital, Melbourne, Australia
(Fricke, Konstantinov) Department of Pediatrics, University of Melbourne,
Melbourne, Australia
(Fricke, Konstantinov) Murdoch Children's Research Institute, Melbourne,
Australia
(Konstantinov) Melbourne Children's Centre for Cardiovascular Genomics and
Regenerative Medicine, Melbourne, Australia
Publisher
Elsevier USA
Abstract
The arterial switch operation has excellent early outcomes. Although the
majority of patients are growing into healthy adults, a small subset
require reoperation for pulmonary stenosis as well as neoaortic root
dilatation and neoaortic valve regurgitation, especially as follow-up
increases. Challenging subgroups include patients with anomalous coronary
anatomy, concomitant aortic arch obstruction, Taussig-Bing anomaly,
ventricular septal defect, and low operative weight, and patients with an
intact interventricular septum who present late. Copyright © 2019
The Society of Thoracic Surgeons

<23>
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

<24>
[Use Link to view the full text]
Accession Number
620568177
Title
Diagnostic Accuracy of Coronary Computed Tomography before Aortic Valve
Replacement: Systematic Review and Meta-Analysis.
Source
Journal of Thoracic Imaging. 33 (4) (pp 207-216), 2018. Date of
Publication: 01 Jul 2018.
Author
Chaikriangkrai K.; Jhun H.Y.; Shantha G.P.S.; Abdulhak A.B.; Tandon R.;
Alqasrawi M.; Klappa A.; Pancholy S.; Deshmukh A.; Bhama J.; Sigurdsson G.
Institution
(Chaikriangkrai, Shantha, Abdulhak, Tandon, Alqasrawi, Klappa, Bhama,
Sigurdsson) Heart and Vascular Center, University of Iowa Hospitals and
Clinics, 200 Hawkins Dr, Iowa City, IA 52242, United States
(Jhun) Department of Medicine, University of Kansas Medical Center, Kansas
City, KS, United States
(Pancholy) Wright Center for Graduate Medical Education, Scranton, PA,
United States
(Deshmukh) Mayo Clinic, Rochester, MN, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: In aortic stenosis patients referred for surgical and
transcatheter aortic valve replacement (AVR), the evidence of diagnostic
accuracy of coronary computed tomography angiography (CCTA) has been
limited. The objective of this study was to investigate the diagnostic
accuracy of CCTA for significant coronary artery disease (CAD) in patients
referred for AVR using invasive coronary angiography (ICA) as the gold
standard. Material(s) and Method(s): We searched databases for all
diagnostic studies of CCTA in patients referred for AVR, which reported
diagnostic testing characteristics on patient-based analysis required to
pool summary sensitivity, specificity, positive-likelihood ratio, and
negative-likelihood ratio. Significant CAD in both CCTA and ICA was
defined by >50% stenosis in any coronary artery, coronary stent, or bypass
graft. Result(s): Thirteen studies evaluated 1498 patients (mean age,
74 y; 47% men; 76% transcatheter AVR). The pooled prevalence of
significant stenosis determined by ICA was 43%. Hierarchical summary
receiver-operating characteristic analysis demonstrated a summary area
under curve of 0.96. The pooled sensitivity, specificity, and
positive-likelihood and negative-likelihood ratios of CCTA in identifying
significant stenosis determined by ICA were 95%, 79%, 4.48, and 0.06,
respectively. In subgroup analysis, the diagnostic profiles of CCTA were
comparable between surgical and transcatheter AVR. Conclusion(s):
Despite the higher prevalence of significant CAD in patients with aortic
stenosis than with other valvular heart diseases, our meta-analysis has
shown that CCTA has a suitable diagnostic accuracy profile as a gatekeeper
test for ICA. Our study illustrates a need for further study of the
potential role of CCTA in preoperative planning for AVR. Copyright
© 2018 Wolters Kluwer Health, Inc. All rights reserved.

<25>
Accession Number
620743485
Title
Baseline and postoperative levels of C-reactive protein and interleukins
as inflammatory predictors of atrial fibrillation following cardiac
surgery: A systematic review and meta-analysis.
Source
Kardiologia Polska. 76 (2) (pp 440-451), 2018. Date of Publication: 16 Feb
2018.
Author
Weymann A.; Popov A.-F.; Sabashnikov A.; Ali-Hasan-Al-Saegh S.; Ryazanov
M.; Tse G.; Mirhosseini S.J.; Liu T.; Lotfaliani M.; Sedaghat M.; Baker
W.L.; Ghanei A.; Yavuz S.; Zeriouh M.; Izadpanah P.; Dehghan H.; Testa L.;
Nikfard M.; De Oliveira Sa M.P.B.; Mashhour A.; Nombela-Franco L.;
Rezaeisadrabadi M.; D'Ascenzo F.; Zhigalov K.; Benedetto U.; Najafi S.A.;
Szczechowicz M.; Roever L.; Meng L.; Gong M.; Deshmukh A.J.; Palmerini T.;
Linde C.; Filipiak K.J.; Stone G.W.; Biondi-Zoccai G.; Calkins H.
Institution
(Weymann, Mashhour, Zhigalov, Szczechowicz) Department of Cardiac Surgery,
University Hospital Oldenburg, European Medical School
Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg,
Germany
(Popov, Sabashnikov, Zeriouh) Department of Cardiothoracic Transplantation
and Mechanical Circulatory Support, Royal Brompton and Harefield NHS
Foundation Trust, Harefield Hospital, Harefield-Middlesex, United Kingdom
(Popov) Department of Thoracic and Cardiovascular Surgery, University
Hospital, Goethe University Frankfurt, Frankfurt, Germany
(Sabashnikov, Zeriouh) Department of Cardiothoracic Surgery, University
Hospital of Cologne, Cologne, Germany
(Ali-Hasan-Al-Saegh, Mirhosseini) Cardiovascular Research Centre, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Ali-Hasan-Al-Saegh, Mirhosseini, Dehghan) Consult. Ctr. for Secdry. Res.,
Data Mining, and Knowledge Transfer in Health and Medical Sciences, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Ryazanov) CVS Centre at Nizhny Novgorod, Nizhny Novgorod, Russian
Federation
(Tse) Department of Medicine and Therapeutics, Li Ka Shing Institute of
Health Sciences, Faculty of Medicine, Chinese University of Hong Kong,
Shatin, Hong Kong
(Liu, Meng, Gong) Department of Cardiology, Tianjin Key Laboratory of
Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Lotfaliani) Faculty of Pharmacy, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
(Sedaghat, Ghanei, Rezaeisadrabadi) Department of Internal Medicine,
Shahid Beheshti University of Medical Sciences, Yazd, Tehran, Iran,
Islamic Republic of
(Baker) University of Connecticut, Hartford Hospital Evidence-Based
Practice Centre, Hartford, CT, United States
(Yavuz) Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas
Training and Research Hospital, Bursa, Turkey
(Izadpanah) Department of Interventional Cardiology, Cardiovascular
Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran,
Islamic Republic of
(Dehghan) Department of Health Technology Assessment, Shahid Sadoughi
University of Medical Sciences and Health Services, Yazd, Iran, Islamic
Republic of
(Testa) Department of Cardiology, IRCCS Pol. S. Donato, S. Donato
Milanese, Milan, Italy
(Nikfard) International Relations Office, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran, Islamic Republic of
(De Oliveira Sa) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco - PROCAPE, Recife, Brazil
(De Oliveira Sa) University of Pernambuco - UPE, Recife, Brazil
(De Oliveira Sa) Nucleus of Postgrad. and Res. in Hlth. Sci. of Fac. of
Med. Sci. and Biol. Sci. Institute (FCM/ICB), Recife, Brazil
(Nombela-Franco) Instituto Cardiovascular, Hospital Universitario Clinico
San Carlos, Madrid, Spain
(D'Ascenzo) Division of Cardiology, Department of Medical Sciences, Citta
della Salute e della Scienza Hospital, University of Turin, Turin, Italy
(Benedetto) Bristol Heart Institute, University of Bristol, School of
Clinical Sciences, Bristol, United Kingdom
(Najafi) Department of Cardiology and Internal Medicine, Sankt Katharinen
Hospital, Frankfurt am Main, Germany
(Roever) Department of Clinical Research, Federal University of
Uberlandia, Uberlandia, Brazil
(Deshmukh) Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Mayo
Clinic, Rochester, MN, United States
(Palmerini) Dipartimento Cardio-Toraco-Vascolare, University of Bologna,
Italy
(Linde) Department of Cardiology, Karolinska University Hospital,
Karolinska Institute, Stockholm, Sweden
(Filipiak) Department of Cardiology, Medical University of Warsaw, Warsaw,
Poland
(Stone) New York Presbyterian Hospital, Columbia University Medical
Centre, New York, NY, United States
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed,
Pozzilli, Italy
(Calkins) Department of Cardiology, Johns Hopkins Medical Institutions,
Baltimore, MD, United States
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Postoperative atrial fibrillation (POAF) is a leading
arrhythmia with high incidence and serious clinical implications after
cardiac surgery. Cardiac surgery is associated with systemic inflammatory
response including increase in cytokines and activation of endothelial and
leukocyte responses. Aim This systematic review and meta-analysis aimed to
determine the strength of evidence for evaluating the association of
inflammatory markers, such as C-reactive protein (CRP) and interleukins
(IL), with POAF following isolated coronary artery bypass grafting (CABG),
isolated valvular surgery, or a combination of these procedures.
 Method(s): We conducted a meta-analysis of studies evaluating
measured baseline (from one week before surgical procedures) and
postoperative levels (until one week after surgical procedures) of
inflammatory markers in patients with POAF. A comprehensive search was
performed in electronic medical databases (Medline/PubMed, Web of Science,
Embase, Science Direct, and Google Scholar) from their inception through
May 2017 to identify relevant studies. A comprehensive subgroup analysis
was performed to explore potential sources of heterogeneity.
 Result(s): A literature search of all major databases retrieved 1014
studies. After screening, 42 studies were analysed including a total of
8398 patients. Pooled analysis showed baseline levels of CRP (standard
mean difference [SMD] 0.457 mg/L, p < 0.001), baseline levels of IL-6 (SMD
0.398 pg/mL, p < 0.001), postoperative levels of CRP (SMD 0.576 mg/L, p <
0.001), postoperative levels of IL-6 (SMD 1.66 pg/mL, p < 0.001),
postoperative levels of IL-8 (SMD 0.839 pg/mL, p < 0.001), and
postoperative levels of IL-10 (SMD 0.590 pg/mL, p < 0.001) to be relevant
inflammatory parameters significantly associated with POAF.
 Conclusion(s): Perioperative inflammation is proposed to be involved
in the pathogenesis of POAF. Therefore, perioperative assessment of CRP,
IL-6, IL-8, and IL-10 can help clinicians in terms of predicting and
monitoring for POAF. © Copyright 2018 Polskie Towarzystwo
Kardiologiczne.

<26>
Accession Number
2001266142
Title
Randomised trial comparing forced-air warming to the upper or lower body
to prevent hypothermia during thoracoscopic surgery in the lateral
decubitus position.
Source
British Journal of Anaesthesia. 120 (3) (pp 555-562), 2018. Date of
Publication: March 2018.
Author
Min S.-H.; Yoon S.; Yoon S.-H.; Bahk J.-H.; Seo J.-H.
Institution
(Min, Yoon, Yoon, Bahk, Seo) Department of Anaesthesiology and Pain
Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu,
Seoul 03080, South Korea
Publisher
Elsevier Ltd
Abstract
Background: In the supine position, forced-air warming is more effective
on the lower body than on the upper body to prevent intraoperative
hypothermia. However, it is unknown in the lateral decubitus position. We
thus compared forced-air warming on the upper and lower bodies in the
lateral position. Method(s): Patients (n=123) were randomised to
receive forced-air warming on the upper body or lower body during
thoracoscopic surgery in the lateral position. We measured the
nasopharyngeal temperature at 0, 30, 60, 90, and 120 min after lateral
positioning during surgery and the infrared tympanic membrane temperature
at 0, 30, 60, 90, and 120 min after surgery. Patients received both upper
and lower body warming at a temperature of <35.5degreeC. The primary
outcome was the incidence of intraoperative hypothermia with a temperature
of <36.0degreeC. Result(s): Intraoperative hypothermia was less
frequent with the upper body warming than with the lower body warming
{21/62 vs 35/61, risk ratio [95% confidence interval (CI)] 0.6 (0.4-0.9),
P=0.011}. The intraoperative temperature was higher with the upper body
warming than with the lower body warming at 30 (P=0.002), 60 (P<0.001),
and 90 (P<0.001) min after lateral positioning, and the postoperative
temperature was higher at 0 (P<0.001) and 30 (P=0.001) min after surgery.
Fewer patients received both upper and lower body warming in the upper
body warming group than in the lower body warming group during surgery (1
vs 7, P=0.032). Conclusion(s): Forced-air warming was more effective
on the upper body than on the lower body to prevent hypothermia during
thoracoscopic surgery in the lateral decubitus position. Clinical trial
registration: NCT02993666. Copyright © 2017 British Journal of
Anaesthesia

<27>
[Use Link to view the full text]
Accession Number
623482539
Title
The society of thoracic surgeons, the society of cardiovascular
anesthesiologists, and the American society of extracorporeal technology:
Clinical practice guidelines - Anticoagulation during cardiopulmonary
bypass.
Source
Anesthesia and Analgesia. 126 (2) (pp 413-424), 2018. Date of Publication:
2018.
Author
Shore-Lesserson L.; Baker R.A.; Ferraris V.A.; Greilich P.E.; Fitzgerald
D.; Roman P.; Hammon J.W.
Institution
(Shore-Lesserson) Department of Anesthesiology, Northshore University
Hospital, 300 Community Dr, Manhasset, NY 11030, United States
(Baker) Cardiac Surgery Research and Perfusion, Flinders University and
Flinders Medical Center, Adelaide, SA, Australia
(Ferraris) Division of Cardiovascular and Thoracic Surgery, University of
Kentucky, Lexington, KY, United States
(Greilich) Department of Anesthesiology and Pain Management, University of
Texas-Southwestern Medical Center, Dallas, TX, United States
(Fitzgerald) Division of Cardiovascular Perfusion, Medical University of
South Carolina, Charleston, SC, United States
(Roman) Department of Anesthesiology, Saint Anthony Hospital, Lakewood,
CO, United States
(Hammon) Department of Cardiothoracic Surgery, Wake Forest University
School of Medicine, Winston-Salem, NC, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Despite more than a half century of "safe" cardiopulmonary bypass (CPB),
the evidence base surrounding the conduct of anticoagulation therapy for
CPB has not been organized into a succinct guideline. For this and other
reasons, there is enormous practice variability relating to the use and
dosing of heparin, monitoring heparin anticoagulation, reversal of
anticoagulation, and the use of alternative anticoagulants. To address
this and other gaps, The Society of Thoracic Surgeons, the Society of
Cardiovascular Anesthesiologists, and the American Society of
Extracorporeal Technology developed an Evidence Based Workgroup. This was
a group of interdisciplinary professionals gathered to summarize the
evidence and create practice recommendations for various aspects of CPB.
To date, anticoagulation practices in CPB have not been standardized in
accordance with the evidence base. This clinical practice guideline was
written with the intent to fill the evidence gap and to establish best
practices in anticoagulation therapy for CPB using the available
evidence.To identify relevant evidence, a systematic review was outlined
and literature searches were conducted in PubMed using standardized
medical subject heading (MeSH) terms from the National Library of Medicine
list of search terms. Search dates were inclusive of January 2000 to
December 2015. The search yielded 833 abstracts, which were reviewed by
two independent reviewers. Once accepted into the full manuscript review
stage, two members of the writing group evaluated each of 286 full papers
for inclusion eligibility into the guideline document. Ninety-six
manuscripts were included in the final review. In addition, 17 manuscripts
published before 2000 were included to provide method, context, or
additional supporting evidence for the recommendations as these papers
were considered sentinel publications. Members of the writing group wrote
and developed recommendations based on review of the articles obtained and
achieved more than two thirds agreement on each recommendation. The
quality of information for a given recommendation allowed assessment of
the level of evidence as recommended by the American College of Cardiology
Foundation/American Heart Association Task Force on Practice Guidelines.
Recommendations were written in the three following areas: (1) heparin
dosing and monitoring for initiation and maintenance of CPB; (2) heparin
contraindications and heparin alternatives; and (3) reversal of
anticoagulation during cardiac operations. It is hoped that this guideline
will serve as a resource and will stimulate investigators to conduct more
research and to expand on the evidence base on the topic of
anticoagulation therapy for CPB. Copyright © 2017 International
Anesthesia Research Society.

<28>
Accession Number
2000878287
Title
Efficacy of perioperative dexmedetomidine on postoperative delirium:
systematic review and meta-analysis with trial sequential analysis of
randomised controlled trials.
Source
British Journal of Anaesthesia. 121 (2) (pp 384-397), 2018. Date of
Publication: August 2018.
Author
Duan X.; Coburn M.; Rossaint R.; Sanders R.D.; Waesberghe J.V.; Kowark A.
Institution
(Duan) Department of Anaesthesiology, The Affiliated Hospital of Southwest
Medical University, LuZhou, China
(Duan, Coburn, Rossaint, Waesberghe, Kowark) Department of
Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
(Sanders) Department of Anesthesiology, School of Medicine and Public
Health, University of Wisconsin, Madison, WI, United States
Publisher
Elsevier Ltd
Abstract
Background: The influence of dexmedetomidine on postoperative delirium
(POD) in adult surgical patients remains controversial. We aimed to
analyse whether dexmedetomidine use could decrease POD incidence in this
population and its relation to timing of dexmedetomidine administration
and patient age. Method(s): We used random-effects modelled
meta-analysis, trial sequential analysis, and followed Cochrane
methodology with Grading of Recommendations Assessment, Development, and
Evaluation (GRADE). PubMed and Cochrane library were searched up to July
2017 for randomised controlled trials that analysed POD incidence of adult
surgical patients (age >=18 yr) after dexmedetomidine administration.
 Result(s): Eighteen studies (comprising 3309 patients) were included.
There was decreased risk of POD with dexmedetomidine use for the entire
adult surgical population [odds ratio (OR) 0.35; 95% confidence interval
(CI) 0.24-0.51)], with firm evidence from trial sequential analysis.
Pre-specified subgroup analyses confirmed this result with firm evidence
for cardiac and non-cardiac surgical patients, (OR 0.41; 95% CI 0.26-0.63)
and (OR 0.33; 95% CI 0.18-0.59), respectively. We also found firm evidence
for reduction of POD if dexmedetomidine is administered during the
postoperative period (OR 0.30; 95% CI 0.21-0.44), in patients aged <65 yr
(OR 0.19; 95% CI 0.10-0.36) or >=65 yr (OR 0.44; 95% CI 0.30-0.65).
Evidence for dexmedetomidine's influence on secondary outcomes
(in-hospital mortality, intensive care unit and hospital length of stay,
bradycardia, and hypotension) is thus far insufficient to draw
conclusions. Conclusion(s): Dexmedetomidine can reduce POD incidence
for adult cardiac and non-cardiac surgical patients. The optimal dose and
timing of dexmedetomidine and influence on other outcomes or particular
patient populations with risk factors warrants further studies. Clinical
trial registration: PROSPERO: CRD42017072380. Copyright © 2018
British Journal of Anaesthesia

<29>
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.

<30>
Accession Number
621079995
Title
Evaluation and Management of Aortic Stenosis for the Emergency Clinician:
An Evidence-Based Review of the Literature.
Source
Journal of Emergency Medicine. 55 (1) (pp 34-41), 2018. Date of
Publication: July 2018.
Author
Gottlieb M.; Long B.; Koyfman A.
Institution
(Gottlieb) Department of Emergency Medicine, Rush University Medical
Center, Chicago, Illinois, United States
(Long) Department of Emergency Medicine, San Antonio Military Medical
Center, Fort Sam Houston, Texas, United States
(Koyfman) Department of Emergency Medicine, The University of Texas
Southwestern Medical Center, Dallas, Texas, United States
Publisher
Elsevier USA
Abstract
Introduction: Aortic stenosis is a common condition among older adults
that can be associated with dangerous outcomes, due to both the disease
itself and its influence on other conditions. Objective(s): This
review provides an evidence-based summary of the current emergency
department (ED) evaluation and management of aortic stenosis.
 Discussion(s): Aortic stenosis refers to significant narrowing of the
aortic valve and can be caused by calcific disease, congenital causes, or
rheumatic valvular disease. Symptoms of advanced disease include angina,
dyspnea, and syncope. Patients with these symptoms have a much higher
mortality rate than asymptomatic patients. Initial evaluation should
include an electrocardiogram, complete blood count, basic metabolic
profile, coagulation studies, troponin, brain natriuretic peptide, type
and screen, and a chest radiograph. Transthoracic echocardiogram is the
test of choice, but point-of-care ultrasound has been found to have good
accuracy when a formal echocardiogram is not feasible. Initial management
should begin with restoring preload and ensuring a normal heart rate, as
both bradycardia and tachycardia can lead to clinical decompensation. For
patients with high blood pressure and heart failure symptoms, nitrate
agents may be reasonable, but hypotension should be avoided. Dobutamine
can increase inotropy. For hypotensive patients, vasopressors should be
used at the lowest effective dose. The treatment of choice is valve
replacement, but extracorporeal membrane oxygenation and percutaneous
balloon dilatation of the aortic valve have been described as temporizing
measures. Conclusion(s): Aortic stenosis is an important condition
that can lead to dangerous outcomes and requires prompt recognition and
disease-specific management in the ED. Copyright © 2018

<31>
Accession Number
2000567409
Title
Steroids in cardiac surgery: a systematic review and meta-analysis.
Source
British Journal of Anaesthesia. 120 (4) (pp 657-667), 2018. Date of
Publication: April 2018.
Author
Dvirnik N.; Belley-Cote E.P.; Hanif H.; Devereaux P.J.; Lamy A.; Dieleman
J.M.; Vincent J.; Whitlock R.P.
Institution
(Dvirnik, Belley-Cote, Devereaux, Lamy, Whitlock) Department of Clinical
Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario,
Canada
(Dvirnik, Hanif, Lamy, Whitlock) Division of Cardiac Surgery, McMaster
University, Hamilton, Ontario, Canada
(Devereaux) Department of Medicine, McMaster University, Hamilton,
Ontario, Canada
(Devereaux, Lamy, Vincent, Whitlock) Population Health Research Institute,
Hamilton, Ontario, Canada
(Dieleman) Division of Anaesthesiology, Intensive Care, and Emergency
Medicine, University Medical Center Utrecht, Netherlands
(Dieleman) Department of Anaesthesia and Perioperative Medicine, Monash
University, Melbourne, Australia
Publisher
Elsevier Ltd
Abstract
Background: Cardiopulmonary bypass (CPB) induces a systemic inflammatory
reaction that may contribute to postoperative complications. Preventing
this reaction with steroids may improve outcomes. We performed a
systematic review to evaluate the impact of prophylactic steroids on
clinical outcomes in patients undergoing on-pump cardiac surgery.
 Method(s): We searched MEDLINE, EMBASE, and Cochrane CENTRAL for
randomised controlled trials (RCTs) comparing perioperative corticosteroid
administration with a control group in adults undergoing CPB. Outcomes of
interest included mortality, myocardial infarction, and new onset atrial
fibrillation. We assessed the quality of evidence using the Grading of
Recommendations Assessment, Development and Evaluation approach.
 Result(s): Fifty-six RCTs published between 1977 and 2015 were
included in this meta-analysis. Mortality was not significantly different
between groups [3.0% (215/7258 patients) in the steroid group and 3.5%
(252/7202 patients) in the placebo group; relative risk (RR), 0.85; 95%
confidence interval (CI), 0.71-1.01; P=0.07; I2 = 0%].
Myocardial injury was more frequent in the steroid group [8.0% (560/6989
patients), compared with 6.9% (476/6929 patients); RR, 1.17, 95% CI,
1.04-1.31; P=0.008; I2=0%]. New onset atrial fibrillation was
lower in the steroid group [25.7% (1792/6984 patients) compared with 28.3%
(1969/6964 patients), RR, 0.91, 95% CI, 0.86-0.96, P=0.0005,
I2=43%]; this beneficial effect was limited to small trials (P
for interaction <0.00001). Conclusion(s): After randomising 16 013
patients, steroid administration at the time of cardiac surgery had an
unclear impact on mortality, increased the risk of myocardial injury, and
the impact on atrial fibrillation should be viewed with caution given that
large trials showed no effect. Copyright © 2018 British Journal
of Anaesthesia

<32>
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

<33>
Accession Number
621112482
Title
Multielectrode vs. point-by-point mapping for ventricular tachycardia
substrate ablation: A randomized study.
Source
Europace. 20 (3) (pp 512-519), 2018. Date of Publication: 01 Mar 2018.
Author
Acosta J.; Penela D.; Andreu D.; Cabrera M.; Carlosena A.; Vassanelli F.;
Alarcon F.; Soto-Iglesias D.; Korshunov V.; Borras R.; Linhart M.;
Martinez M.; Fernandez-Armenta J.; Mont L.; Berruezo A.
Institution
(Acosta, Penela, Andreu, Cabrera, Carlosena, Vassanelli, Alarcon,
Soto-Iglesias, Korshunov, Borras, Linhart, Martinez, Fernandez-Armenta,
Mont, Berruezo) Arrhythmia Section, Cardiology Department, Thorax
Institute, Hospital Clinic and IDIBAPS, Institut d'Investigacio Agusti Pi
i Sunyer, Barcelona, Catalonia, Spain
Publisher
Oxford University Press
Abstract
Aims Ventricular tachycardia (VT) substrate ablation is based on detailed
electroanatomical maps (EAM). This study analyses whether high-density
multielectrode mapping (MEM) is superior to conventional point-by-point
mapping (PPM) in guiding VT substrate ablation procedures. Methods and
results This was a randomized controlled study (NCT02083016). Twenty
consecutive ischemic patients undergoing VT substrate ablation were
randomized to either group A [n = 10; substrate mapping performed first by
PPM (Navistar) and secondly by MEM (PentaRay) ablation guided by PPM] or
group B [n = 10; substrate mapping performed first by MEM and second by
PPM ablation guided by MEM]. Ablation was performed according to the
scardechanneling technique. Late potential (LP) pairs were defined as a
Navistar-LP and a PentaRay-LP located within a three-dimensional distance
of <= 3 mm. Data obtained from EAM, procedure time, radiofrequency time,
and postablation VT inducibility were compared between groups. Larger
bipolar scar areas were obtained with MEM (55.7+/-31.7 vs. 50.5+/-26.6
cm2; P = 0.017). Substrate mapping time was similar with MEM (19.7+/-7.9
minutes) and PPM (25+/-9.2 minutes); P = 0.222. No differences were
observed in the number of LPs identified within the scar by MEM vs. PPM
(73+/-50 vs. 76+/-52 LPs per patient, respectively; P = 0.965). A total of
1104 LP pairs were analysed. Using PentaRay, far-field/LP ratio was
significantly lower (0.58+/-0.4 vs. 1.64+/-1.1; P = 0.01) and
radiofrequency time was shorter [median (interquartile range) 12 (7-20)
vs. 22 (17-33) minutes; P = 0.023]. No differences were observed in VT
inducibility after procedure. Conclusion MEM with PentaRay catheter
provided better discrimination of LPs due to a lower sensitivity for
far-field signals. Ablation guided by MEM was associated with a shorter
radiofrequency time. Copyright © The Author 2017.

<34>
Accession Number
2000733845
Title
Predictive value of cell cycle arrest biomarkers for cardiac
surgery-associated acute kidney injury: a meta-analysis.
Source
British Journal of Anaesthesia. 121 (2) (pp 350-357), 2018. Date of
Publication: August 2018.
Author
Su L.-J.; Li Y.-M.; Kellum J.A.; Peng Z.-Y.
Institution
(Su, Li, Peng) Department of Critical Care Medicine, Zhongnan Hospital of
Wuhan University, Wuhan, Hubei Province, China
(Kellum, Peng) Center of Critical Care Nephrology, Department of Critical
Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA,
United States
Publisher
Elsevier Ltd
Abstract
Background: A biomarker test based on a combination of urine tissue
inhibitor of metalloproteinases 2 (TIMP-2) and insulin-like growth factor
binding protein 7 (IGFBP7) has been used as a potential biomarker of acute
kidney injury (AKI). This meta-analysis aimed to evaluate the predictive
value of this biomarker for cardiac surgery-associated acute kidney injury
(CSA-AKI). Method(s): We searched MEDLINE, PubMed, Cochrane, and
EMBASE for studies. We evaluated the methodological quality of each
included study using the Quality Assessment of Diagnostic Accuracy Studies
2 criteria. Meta-DiSc and STATA were used for statistical analyses.
 Result(s): A total of 10 studies (747 patients) were included in this
meta-analysis. Pooled sensitivity and specificity with corresponding 95%
confidence intervals (CI) were 0.77 (95% CI: 0.70-0.83,
I2=40.7%) and 0.76 (95% CI: 0.72-0.79, I2=69.1%),
respectively. Pooled positive likelihood ratio (LR), negative LR, and
diagnostic odds ratio were 3.26 (95% CI: 2.51-4.23, I2=50.7%),
0.32 (95% CI: 0.24-0.41, I2=6.7%), and 10.08 (95% CI:
6.85-14.84, I2=6.7%), respectively. The area under the curve
estimated by summary receiver operating characteristics was 0.83 [standard
error (SE) 0.023] with a Q* value of 0.759 (SE 0.021). There was no
heterogeneity amongst the 10 studies from both threshold and non-threshold
effects. Subgroup analysis showed that the diagnostic value was related to
the severity of AKI and time measurement. Conclusion(s): Urinary
[TIMP-2].[IGFBP7] is an effective predictive test for cardiac surgery
associated acute kidney injury with good diagnostic accuracy within 24 h.
Studies examining use of biomarker-guided care bundles are
indicated. Copyright © 2018 British Journal of Anaesthesia

<35>
Accession Number
616322435
Title
Cost analysis of pulmonary lobectomy procedure: Comparison of stapler
versus precision dissection and sealant.
Source
ClinicoEconomics and Outcomes Research. 9 (pp 201-206), 2017. Date of
Publication: 03 Apr 2017.
Author
Droghetti A.; Marulli G.; Vannucci J.; Giovanardi M.; Bottoli M.C.; Ragusa
M.; Muriana G.
Institution
(Droghetti, Giovanardi, Bottoli, Muriana) Thoracic Surgery Division, Carlo
Poma Hospital, Mantova, Italy
(Marulli) Thoracic Surgery Division, University of Padova, Padova, Italy
(Vannucci, Ragusa) Thoracic Surgery Division, University of Perugia,
Perugia, Italy
Publisher
Dove Medical Press Ltd (PO Box 300-008, Albany, 44 Corinthian Drive,
Albany,Auckland 0752, New Zealand. E-mail: angela@dovepress.com)
Abstract
Objective: We aimed to evaluate the direct costs of pulmonary lobectomy
hospitalization, comparing surgical techniques for the division of
interlobar fissures: stapler (ST) versus electrocautery and hemostatic
sealant patch (ES). Method(s): The cost comparison analysis was based
on the clinical pathway and drawn up by collecting the information
available from the Thoracic Surgery Division medical team at Mantova
Hospital. Direct resource consumption was derived from a previous
randomized controlled trial including 40 patients. Use and maintenance of
technology, equipment and operating room; administrative plus general
costs; and 30-day use of postsurgery hospital resources were considered.
The analysis was conducted from the hospital perspective. Result(s):
On the average, a patient submitted to pulmonary lobectomy costs 9,744.29.
This sum could vary from 9,027 (using ES) to 10,460 (using ST). The
overall lower incidence (50% vs 95%, P=0.0001) and duration of air leakage
(1.7 days vs 4.5 days, P=0.0001) in the ES group significantly affects the
mean time of hospital stay (11.0 days vs 14.3 days) and costs. Cost saving
in the ES group was also driven by the lower incidence of complications.
The main key cost driver was staff employment (42%), then consumables
(34%) and operating room costs (12%). Conclusion(s): There is an
overall saving of around 1,432.90 when using ES patch for each pulmonary
lobectomy. Among patients undergoing this surgical procedure, ES can
significantly reduce air leakage incidence and duration, as well as
decrease hospitalization rates. However, further multicenter research
should be developed considering different clinical and managerial
settings. Copyright © 2017 Droghetti et al.

<36>
[Use Link to view the full text]
Accession Number
617717434
Title
Thoracic paravertebral block for postoperative pain management after renal
surgery: A randomised controlled trial.
Source
European Journal of Anaesthesiology. 34 (9) (pp 596-601), 2017. Date of
Publication: 01 Sep 2017.
Author
Copik M.; Bialka S.; Daszkiewicz A.; Misiolek H.
Institution
(Copik, Bialka, Daszkiewicz, Misiolek) Department of Anaesthesiology and
Critical Care, School of Medicine, Division of Dentistry, Medical
University of Silesia, Zabrze, Poland
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background: Thoracic paravertebral block (ThPVB) combined with general
anaesthesia is used in thoracic and general surgery. It provides effective
analgesia, reduces surgical stress response and the incidence of chronic
postoperative pain. Objective(s): To assess the efficacy of ThPVB in
reducing opioid requirements and decreasing the intensity of pain after
renal surgery. Design(s): A randomised, open label study.
 Setting(s): A single university hospital. Study conducted from August
2013 to February 2014. Participant(s): In total, 68 patients
scheduled for elective renal surgery (open nephrectomy or open
nephron-sparing surgery). Intervention(s): Preoperative ThPVB with
0.5% bupivacaine combined with general anaesthesia, followed by
postoperative oxycodone combined with nonopioid analgesics as rescue
drugs. Follow-up period: 48 h. Main Outcome Measure(s): Total dose of
postoperative oxycodone required, pain intensity, occurrence of opioid
related adverse events, ThPVB-related adverse events and patient
satisfaction. Result(s): A total of 68 patients were randomised into
two groups and, of these, 10 were subsequently excluded from analysis.
Patients in group paravertebral block (PVB; n = 27) had general
anaesthesia and ThPVB, and those in group general (anaesthesia) (GEN) (n =
31) formed a control group receiving general anaesthesia only. Compared
with patients in group GEN, patients who received ThPVB required 39% less
i.v. oxycodone over the first 48 h and had less pain at rest (P < 0.01)
throughout the first 24 h. Group PVB patients also experienced fewer
opioid-related adverse events and were less sedated during the first 12
postoperative hours. Patients in the PVB group had higher satisfaction
scores at 48 h compared with the control group. There were no serious
adverse events. Conclusion(s): In our study, preoperative ThPVB was
an effective part of a multimodal analgesia regimen for reducing opioid
consumption and pain intensity. Methods and drugs used in both groups were
well tolerated with no serious adverse events. Compared with the control
group, patients in the ThPVB group reported increased
satisfaction. Copyright © 2017 European Society of
Anaesthesiology. All rights reserved.

<37>
Accession Number
2001390849
Title
Polymer-free versus durable polymer drug-eluting stents in patients with
coronary artery disease: A meta-analysis.
Source
Annals of Medicine and Surgery. 38 (pp 13-21), 2019. Date of Publication:
February 2019.
Author
Wu J.J.; Way J.A.H.; Kritharides L.; Brieger D.
Institution
(Wu, Way, Kritharides, Brieger) Sydney Medical School, The University of
Sydney, Camperdown, Australia
(Wu, Kritharides, Brieger) Department of Cardiology, Concord Repatriation
General Hospital, Concord, Australia
Publisher
Elsevier Ltd
Abstract
Background: Polymer-free drug-eluting stents (PF-DES) were introduced with
the aim of reducing the risk of stent thrombosis associated with durable
polymer drug-eluting stents (DP-DES). The comparison of safety and
efficacy profiles between these two stent platforms remains unclear.
 Material(s) and Method(s): We conducted electronic database searches
for randomized controlled trials (RCTs) comparing patients treated with
either PF-DES or DP-DES. Outcomes included definite or probable stent
thrombosis (ST), myocardial infarction (MI), cardiac death, all-cause
death, target lesion revascularization (TLR), and target vessel
revascularization (TVR). A random-effects model was used to derive risk
ratios (RRs) with 95% confidence intervals (CIs). Subgroup analyses based
on different variables were also performed. After screening a total of
1026 articles, the present meta-analysis included 13 RCTs comprising 8021
patients. Result(s): No significant differences were found for the
risks of definite or probable ST (RR, 0.94; 95% CI, 0.62-1.43; P = 0.77),
MI (RR, 1.06; 95% CI, 0.85-1.33; P = 0.61), cardiac death (RR, 0.98; 95%
CI, 0.80-1.21; P = 0.88), all-cause death (RR, 0.87; 95% CI, 0.76-1.00; P
= 0.06), TLR (RR, 1.12; 95% CI, 0.94-1.33; P = 0.22), and TVR (RR, 1.18;
95% CI, 0.87-1.61; P = 0.29). Similarly, no significant differences were
found for all outcomes regardless of anti-proliferative drug, except for
an increased risk of TLR for polymer-free paclitaxel-eluting stents
compared with DP-DES (RR, 2.32, 95% CI, 1.30-4.14; P = 0.005).
 Conclusion(s): Our findings showed that PF-DES and DP-DES confer
equivalent safety and efficacy profiles, with similar rates of stent
thrombosis. Copyright © 2018

<38>
Accession Number
623824565
Title
A randomized clinical trial of age and genotype-guided tacrolimus dosing
after pediatric solid organ transplantation.
Source
Pediatric Transplantation. 22 (7) (no pagination), 2018. Article Number:
e13285. Date of Publication: November 2018.
Author
Min S.; Papaz T.; Lafreniere-Roula M.; Nalli N.; Grasemann H.; Schwartz
S.M.; Kamath B.M.; Ng V.; Parekh R.S.; Manlhiot C.; Mital S.
Institution
(Min, Papaz, Lafreniere-Roula, Grasemann, Kamath, Parekh, Mital)
Department of Pediatrics, Hospital for Sick Children, University of
Toronto, Toronto, ON, Canada
(Nalli) Department of Pharmacy, Hospital for Sick Children, University of
Toronto, Toronto, ON, Canada
(Schwartz) Department of Cardiac Critical Care Medicine, Hospital for Sick
Children, University of Toronto, Toronto, ON, Canada
(Ng) Transplant and Regenerative Medicine Centre, Department of
Pediatrics, Hospital for Sick Children, University of Toronto, Toronto,
ON, Canada
(Parekh) Division of Nephrology, Department of Medicine, University Health
Network and University of Toronto, Toronto, ON, Canada
(Parekh) Child Health Evaluative Sciences Program, SickKids Research
Institute, Toronto, ON, Canada
(Manlhiot) Cardiovascular Data Management Centre (CVDMC) Hospital for Sick
Children, University of Toronto, Toronto, ON, Canada
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Tacrolimus pharmacokinetics are influenced by age and CYP3A5
genotype with CYP3A5 expressors (CYP3A5*1/*1 or *1/*3) being fast
metabolizers. However, the benefit of genotype-guided dosing in pediatric
solid organ transplantation has been understudied. Objective(s): To
determine whether age and CYP3A5 genotype-guided starting dose of
tacrolimus result in earlier attainment of therapeutic drug
concentrations. Setting(s): Single hospital-based transplant center.
 Method(s): This was a randomized, semi-blinded, 30-day pilot trial.
Between 2012 and 2016, pediatric patients listed for solid organ
transplant were consented and enrolled into the study. Participants were
categorized as expressors, CYP3A5*1/*1 or CYP3A5*1/*3, and nonexpressors,
CYP3A5*3/*3. Patients were stratified by age (<= or > 6 years) and
randomized (2:1) after transplant to receive genotype-guided (n = 35) or
standard (n = 18) starting dose of tacrolimus for 36-48 hours and were
followed for 30 days. Result(s): Median age at transplant in the
randomized cohort was 2.1 (0.75-8.0) years; 24 (45%) were male.
Participants in the genotype-guided arm achieved therapeutic
concentrations earlier at a median (IQR) of 3.4 (2.5-6.6) days compared to
those in the standard dosing arm of 4.7 (3.5-8.6) days (P = 0.049), and
had fewer out-of-range concentrations [OR (95% CI) = 0.60 (0.44, 0.83), P
= 0.002] compared to standard dosing, with no difference in frequency of
adverse events between the two groups. Conclusion(s): CYP3A5
genotype-guided dosing stratified by age resulted in earlier attainment of
therapeutic tacrolimus concentrations and fewer out-of-range
concentrations. Copyright © 2018 The Authors. Pediatric
Transplantation Published by Wiley Periodicals, Inc.

<39>
Accession Number
620964248
Title
Predictors of successful chronic total occlusion percutaneous coronary
interventions: A systematic review and meta-analysis.
Source
Heart. 104 (6) (pp 517-524), 2018. Date of Publication: March 2018.
Author
Wang N.; Fulcher J.; Abeysuriya N.; Adams M.; Lal S.
Institution
(Wang, Fulcher, Adams, Lal) University of Sydney, Sydney, Camperdown, NSW
2006, Australia
(Wang, Fulcher, Adams, Lal) Royal Prince Alfred Hospital, Sydney, NSW,
Australia
(Abeysuriya) University of Queensland, Brisbane, Australia
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective The aim of this study was to identify positive and negative
predictors of technical and clinical success for percutaneous coronary
intervention (PCI) of chronic total occlusions (CTO). Methods We conducted
a systematic review and meta-analysis of studies published between 2000
and 2016 analysing rates of CTO PCI success with respect to demographic
and angiographic characteristics. Crude ORs and 95% CIs for each predictor
were calculated using a random effects model. Predictors of technical and
clinical success were assessed among 28 demographic and 31 angiographic
variables. Clinical success was defined as technical success without major
adverse cardiac events. Results A total of 61 studies, totalling 69 886
patients were included in this analysis. The major demographic
characteristics associated with a 20% or greater reduction in the odds of
technical and clinical success were a history of myocardial infarction,
PCI, coronary artery bypass grafting, stroke/transient ischaemic attack
and peripheral vascular disease. Angiographic factors were generally
stronger predictors of reduced technical and clinical success. Those
associated with >20% odds reduction included non-left anterior descending
CTOs, multivessel disease, presence of bridging collaterals,
moderate-to-severe calcification, >45 degree vessel bending, tortuous
vessel, blunt stump and ostial lesions. Of these, novel predictors
included prior PCI, prior stroke, peripheral vascular disease, presence of
multivessel disease and bridging collaterals. Conclusion The present study
has identified strong negative predictors for clinical success for CTO
PCI, which will aid in patient selection for this procedure. Copyright
© Article author(s) (or their employer(s) unless otherwise stated in
the text of the article) 2018. All rights reserved.

<40>
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.

<41>
Accession Number
625462429
Title
High-sensitivity troponin T is a prognostic marker of hemodynamic
instability in patients undergoing valve surgery.
Source
Biomarkers in Medicine. 12 (12) (pp 1303-1309), 2018. Date of Publication:
December 2018.
Author
Duchnowski P.; Hryniewiecki T.; Kozma M.; Mariusz K.; Piotr S.
Institution
(Duchnowski, Hryniewiecki, Kozma, Piotr) Department of Acquired Cardiac
Defects, Institute of Cardiology, Warsaw, Poland
(Mariusz) Department of Cardiosurgery and Transplantology, Institute of
Cardiology, Warsaw, Poland
Publisher
Future Medicine Ltd. (E-mail: info@futuremedicine.com)
Abstract
Aim: The usefulness of high-sensitivity troponin T (hs-TnT) as a predictor
of perioperative hemodynamic instability is currently unknown.
 Method(s): A prospective study was conducted on a group of 708
consecutive patients with significant valvular heart disease that
underwent elective valve surgery. The primary end point was postoperative
hemodynamic instability. The secondary end point was death from all causes
in patients with perioperative hemodynamic instability. Result(s):
The postoperative hemodynamic instability occurred in 131 patients. At
multivariate analysis hs-TnT measured immediately after surgery and New
York Heart Association classes remained independent predictors of the
primary end point. Age and hs-TnT measured immediately after surgery were
associated with an increased risk of death. Conclusion(s): Elevated
postoperative hs-TnT was associated with a higher risk of postoperative
hemodynamic instability and death. Copyright © 2018 2018 Future
Medicine Ltd.

<42>
Accession Number
2000552881
Title
Safety of Stenting and Endarterectomy for Asymptomatic Carotid Artery
Stenosis: A Meta-Analysis of Randomised Controlled Trials.
Source
European Journal of Vascular and Endovascular Surgery. 55 (5) (pp
614-624), 2018. Date of Publication: May 2018.
Author
Cui L.; Han Y.; Zhang S.; Liu X.; Zhang J.
Institution
(Cui, Zhang) Department of Vascular and Thyroid Surgery, The First
Hospital of China Medical University, Shenyang, China
(Han, Liu) Department of General Surgery, Shengjing Hospital of China
Medical University, Shenyang, China
(Zhang) Department of Endovascular Surgery, The First Hospital of
Zhengzhou University, Zhengzhou, China
Publisher
W.B. Saunders Ltd
Abstract
Objective/Background: A meta-analysis of recently published randomised
controlled trials (RCTs) was performed to evaluate the safety of carotid
artery stenting (CAS) versus carotid endarterectomy (CEA) for asymptomatic
carotid stenosis with average risk. Method(s): The MEDLINE, Embase,
and Cochrane Library databases were systematically searched for RCTs that
compared CAS with CEA for asymptomatic carotid stenosis. These
publications reported clinical outcomes after revascularisation in
patients with asymptomatic carotid stenosis during their primary
intervention. Trials published in English were searched for on 31 May
2017. End points (composite of ipsilateral stroke, any stroke, major
stroke, minor stroke, myocardial infarction [MI], and death during the
post-procedural period) were extracted from the publications by two
reviewers. The pooled odds ratios (ORs) and 95% confidence intervals (CIs)
were calculated for peri-operative outcomes following CAS and CEA using a
fixed effects model. Result(s): Five studies involving 3901 patients
(1585 with CEA; 2316 with CAS) were included in the meta-analysis. The
risk of any stroke during the peri-procedural period was significantly
lower in patients who underwent CEA than CAS (OR 0.53; 95% CI 0.29-0.96).
The difference between CAS and CEA in the rate of stroke could be driven
by minor stroke (OR 0.50; 95% CI 0.25-1.00). The risk of death, major
stroke, ipsilateral stroke, and MI were not significantly different
between the two interventions (peri-procedural death: OR 1.49 [95% CI
0.26-8.68]; peri-procedural major stroke: OR 0.69 [95% CI 0.20-2.35];
peri-procedural ipsilateral stroke: OR 0.63 [95% CI 0.27-1.47];
peri-procedural MI: OR 1.75 [95% CI 0.84-3.65]). No robust conclusion
could be drawn regarding mid to long-term complications because of the
heterogeneity of the reported data. The different outcomes precluded any
further analysis being conducted. Conclusion(s): Among patients with
asymptomatic carotid stenosis, stenting has a significantly higher rate of
any peri-procedural stroke and peri-procedural minor stroke than CEA, and
similar risk of peri-procedural major stroke, peri-procedural ipsilateral
stroke, or MI. Copyright © 2018 European Society for Vascular
Surgery

<43>
Accession Number
625444719
Title
Continued vs. interrupted direct oral anticoagulants at the time of device
surgery, in patients with moderate to high risk of arterial
thrombo-embolic events (BRUISE CONTROL-2).
Source
European Heart Journal. 39 (44) (pp 3973-3979), 2018. Date of Publication:
21 Nov 2018.
Author
Birnie D.H.; Healey J.S.; Wells G.A.; Ayala-Paredes F.; Coutu B.; Sumner
G.L.; Becker G.; Verma A.; Philippon F.; Kalfon E.; Eikelboom J.; Sandhu
R.K.; Nery P.B.; Lellouche N.; Connolly S.J.; Sapp J.; Essebag V.
Institution
(Birnie, Wells, Nery) Department of Medicine, University of Ottawa,
University of Ottawa Heart Institute, 40 Ruskin St., Ottawa, ON K1Y 4W7,
Canada
(Healey, Eikelboom, Connolly) Hamilton Health Sciences, Population Health
Research Institute, McMaster University, 237 Barton St. East, Hamilton, ON
L8L 2X2, Canada
(Ayala-Paredes) Hopital Fleurimont, Universite de Sherbrooke, 3001 12e Ave
Nord, Sherbrooke, QC J1H 5N4, Canada
(Coutu) Centre Hospitalier de l'Universite de Montreal, Hopital
Hotel-Dieu, 850 St-Denis St., Montreal, QC H2X 0A9, Canada
(Sumner) Libin Cardiovascular Institute, Foothills Medical Centre,
University of Calgary, 1403 29th St. NW, Calgary, AB T2N 2T9, Canada
(Becker, Essebag) Hopital du Sacre-Coeur de Montreal, 5400 boul Gouin
Ouest, Montreal, QC H4J 1C5, Canada
(Verma) Southlake Regional Health Center, 581 Davis Dr, Newmarket, ON L3Y
2P9, Canada
(Philippon) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Laval University, 2725 chemin, Ste-Foy, QC G1V 4G5, Canada
(Kalfon) Galilee Medical Center, 1 Ben Tzvi Blvd, Nahariya 22100, Israel
(Sandhu) University of Alberta, 8440 112 St, Edmonton, AB T6G 2B7, Canada
(Lellouche) Service de Cardiologie, Hopital Henri Mondor, APHP, Creteil,
France
(Sapp) QEII Health Sciences Centre, Dalhousie University, Halifax, NS,
Canada
(Essebag) McGill University Health Center, McGill University, Hopital
Sacre-Coeur de Montreal, Montreal, QC, Canada
Publisher
Oxford University Press
Abstract
Aims Guidelines recommend warfarin continuation rather than heparin
bridging for pacemaker and defibrillator surgery, after the BRUISE CONTROL
trial demonstrated an 80% reduction in device pocket haematoma with this
approach. However, direct oral anticoagulants (DOACs) are now used to
treat the majority of patients with atrial fibrillation. We sought to
understand the best strategy to manage the DOACs at the time of device
surgery and specifically hypothesized that performing device surgery
without DOAC interruption would result in a reduced haematoma rate.
Methods and results We randomly assigned patients with atrial fibrillation
and CHA2DS2-VASc score 2, to continued vs. interrupted DOAC (dabigatran,
rivaroxaban, or apixaban). The primary outcome was blindly evaluated,
clinically significant device pocket haematoma: resulting in re-operation,
interruption of anticoagulation, or prolonging hospital stay. In the
continued arm, the median time between pre- and post-operative DOAC doses
was 12 h; in the interrupted arm the median time was 72 h. Clinically
significant haematoma occurred in of 7 of 328 (2.1%; 95% CI 0.94.3)
patients in the continued DOAC arm and 7 of 334 (2.1%; 95% CI 0.94.3)
patients in the interrupted DOAC arm (P = 0.97). Complications were
uncommon, and included one stroke and one symptomatic pericardial effusion
in each arm. Conclusions These results suggest that, dependent on the
clinical scenario, either management strategy (continued DOAC or
interrupted DOAC) might be reasonable, at least for patients similar to
those enrolled in our trial. Copyright © 2018 Oxford University
Press.

<44>
Accession Number
623034410
Title
Ticagrelor versus clopidogrel in patients with symptomatic peripheral
artery disease and prior coronary artery disease: Insights from the EUCLID
trial.
Source
Vascular Medicine (United Kingdom). 23 (6) (pp 523-530), 2018. Date of
Publication: 01 Dec 2018.
Author
Berger J.S.; Abramson B.L.; Lopes R.D.; Heizer G.; Rockhold F.W.;
Baumgartner I.; Fowkes F.G.R.; Held P.; Katona B.G.; Norgren L.; Jones
W.S.; Millegard M.; Blomster J.; Reist C.; Hiatt W.R.; Patel M.R.;
Mahaffey K.W.
Institution
(Berger) Departments of Medicine and Surgery, New York University School
of Medicine, New York, NY, United States
(Abramson) University of Toronto, Toronto, ON, Canada
(Lopes, Heizer, Rockhold, Jones, Reist, Patel) Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC, United States
(Baumgartner) Swiss Cardiovascular Center, Inselspital, Bern University
Hospital, University of Bern, Bern, Switzerland
(Fowkes) Usher Institute of Population Health Sciences and Informatics,
University of Edinburgh, Edinburgh, United Kingdom
(Held, Millegard, Blomster) AstraZeneca Gothenburg, Molndal, Sweden
(Katona) AstraZeneca Gaithersburg, Gaithersburg, MD, United States
(Norgren) Faculty of Medicine and Health, Orebro University, Orebro,
Sweden
(Hiatt) University of Colorado School of Medicine and CPC Clinical
Research, Aurora, CO, United States
(Mahaffey) Stanford Center for Clinical Research, Stanford University
School of Medicine, Stanford, CA, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Patients with peripheral artery disease (PAD) are at heightened risk of
cardiovascular morbidity and mortality. We sought to evaluate the risk of
concomitant coronary artery disease (CAD) in patients with symptomatic PAD
versus PAD without diagnosed CAD, and whether ticagrelor was superior to
clopidogrel in reducing that risk. The EUCLID trial randomized 13,885
patients with PAD to antithrombotic monotherapy with ticagrelor or
clopidogrel. CAD was defined as prior myocardial infarction (MI),
percutaneous coronary intervention (PCI), or coronary artery bypass graft
(CABG) surgery. Median follow-up was 30 months. Among 4032 (29%) patients
with PAD and CAD, 63% had prior MI, 54% prior PCI, and 38% prior CABG.
After adjustment for baseline characteristics, patients with PAD and CAD
had significantly higher rates of the primary endpoint (cardiovascular
death/MI/stroke, 15.3% vs 8.9%, hazard ratio (HR) 1.50, 95% CI: 1.13-1.99;
p=0.005), but no statistically significant increase in acute limb ischemia
(HR 1.28, 95% CI: 0.57-2.85; p=0.55) or major bleeding (HR 1.10, 95% CI:
0.49-2.48; p=0.81) versus PAD without CAD. Among patients with PAD and
CAD, there was no differential treatment effect between ticagrelor versus
clopidogrel for the primary efficacy endpoint (HR 1.02, 95% CI: 0.87-1.19;
p=0.84), acute limb ischemia (HR 1.03, 95% CI: 0.63-1.69; p=0.89), or
major bleeding (HR 1.06, 95% CI: 0.66-1.69; p=0.81). There was a
statistically significant interaction between prior coronary stent
placement and study treatment (p=0.03) with a numerical reduction in the
primary efficacy endpoint with ticagrelor versus clopidogrel (13.8% vs
16.8%, HR 0.82, 95% CI: 0.65-1.03; p=0.09). Patients with PAD and prior
CAD had higher composite rates of cardiovascular death, MI, and ischemic
stroke versus PAD without diagnosed CAD. There were no significant
differences between ticagrelor and clopidogrel in cardiovascular events or
major bleeding. ClinicalTrials.gov Identifier: NCT01732822. Copyright
© The Author(s) 2018.

<45>
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.

<46>
Accession Number
621803933
Title
Risks of restrictive red blood cell transfusion strategies in patients
with cardiovascular disease (CVD): a meta-analysis.
Source
Transfusion Medicine. 28 (5) (pp 335-345), 2018. Date of Publication:
October 2018.
Author
Cortes-Puch I.; Wiley B.M.; Sun J.; Klein H.G.; Welsh J.; Danner R.L.;
Eichacker P.Q.; Natanson C.
Institution
(Cortes-Puch, Wiley, Sun, Danner, Eichacker, Natanson) Critical Care
Medicine Department, Clinical Center, National Institutes of Health,
Bethesda, MD, United States
(Wiley) Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN,
United States
(Klein) Department of Transfusion Medicine, Clinical Center, National
Institutes of Health, Bethesda, MD, United States
(Welsh) National Institutes of Health Library, National Institutes of
Health, Bethesda, MD, United States
Publisher
Blackwell Publishing Ltd
Abstract
Aim: To evaluate the risks of restrictive red blood cell transfusion
strategies (haemoglobin 7-8 g dL-1) in patients with and
without known cardiovascular disease (CVD). Background(s): Recent
guidelines recommend restrictive strategies for CVD patients hospitalised
for non-CVD indications, patients without known CVD and patients
hospitalised for CVD corrective procedures. Methods/Materials: Database
searches were conducted through December 2017 for randomised clinical
trials that enrolled patients with and without known CVD, hospitalised
either for CVD-corrective procedures or non-cardiac indications, comparing
effects of liberal with restrictive strategies on major adverse coronary
events (MACE) and death. Result(s): In CVD patients not undergoing
cardiac interventions, a liberal strategy decreased (P = 0.01) the
relative risk (95% CI) (RR) of MACE [0.50 (0.29-0.86)] (I2 =
0%). Among patients without known CVD, the incidence of MACE was lower
(1.7 vs 3.9%), and the effect of a liberal strategy on MACE [0.79,
(0.39-1.58)] was smaller and non-significant but not different from CVD
patients (P = 0.30). Combining all CVD and non-CVD patients, a liberal
strategy decreased MACE [0.59, (0.39-0.91); P = 0.02]. Conversely, among
studies reporting mortality, a liberal strategy decreased mortality in CVD
patients (11.7% vs.13.3%) but increased mortality (19.2% vs 18.0%) in
patients without known CVD [interaction P = 0.05; ratio of RR 0.73,
(0.53-1.00)]. A liberal strategy also did not benefit patients undergoing
cardiac surgery; data were insufficient for percutaneous cardiac
procedures. Conclusion(s): In patients hospitalised for non-cardiac
indications, liberal transfusion strategies are associated with a
decreased risk of MACE in both those with and without known CVD. However,
this only provides a survival benefit to CVD patients not admitted for
CVD-corrective procedures. Copyright Published 2018. This article is a
U.S. Government work and is in the public domain in the USA

<47>
Accession Number
621627348
Title
Ticagrelor in Peripheral Artery Disease Endovascular Revascularization
(TI-PAD): Challenges in clinical trial execution.
Source
Vascular Medicine (United Kingdom). 23 (6) (pp 513-522), 2018. Date of
Publication: 01 Dec 2018.
Author
Rogers R.K.; Hiatt W.R.; Patel M.R.; Shishehbor M.H.; White R.; Khan N.D.;
Bhalla N.P.; Jones W.S.; Low Wang C.C.
Institution
(Rogers, Hiatt) Department of Medicine, Division of Cardiology, University
of Colorado School of Medicine, Aurora, CO, United States
(Hiatt, White, Low Wang) CPC Clinical Research, Aurora, CO, United States
(Patel, Jones) Duke University Health System and Duke Clinical Research
Institute, Durham, NC, United States
(Shishehbor) Harrington Heart & Vascular Institute, University Hospitals
of Cleveland, Cleveland, OH, United States
(Khan, Bhalla) AstraZeneca, Wilmington, DE, United States
(Low Wang) Department of Medicine, Division of Endocrinology, University
of Colorado School of Medicine, Aurora, CO, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
There is limited evidence to guide clinical decision-making for
antiplatelet therapy in peripheral artery disease (PAD) in the setting of
lower extremity endovascular treatment. The Ticagrelor in Peripheral
Artery Disease Endovascular Revascularization Study (TI-PAD) evaluated the
role of ticagrelor versus aspirin as monotherapy in the management of
patients following lower extremity endovascular revascularization. The
trial failed to recruit the targeted number of patients, likely due to
aspects of the design including the lack of option for dual antiplatelet
therapy, and inability to identify suitable patients at study sites. In
response, the protocol underwent amendments, but these changes did not
adequately stimulate recruitment, and thus TI-PAD was prematurely
terminated. This article describes the rationale for TI-PAD and challenges
in trial design, subject recruitment and trial operations to better inform
the conduct of future trials in PAD revascularization. ClinicalTrials.gov
Identifier: NCT02227368 Copyright © The Author(s) 2018.

<48>
Accession Number
613961578
Title
Thromboelastography (TEG) or rotational thromboelastometry (ROTEM) to
monitor haemostatic treatment in bleeding patients: a systematic review
with meta-analysis and trial sequential analysis.
Source
Anaesthesia. 72 (4) (pp 519-531), 2017. Date of Publication: 01 Apr 2017.
Author
Wikkelso A.; Wetterslev J.; Moller A.M.; Afshari A.
Institution
(Wikkelso) Department of Anaesthesia and Intensive Care Medicine, Hvidovre
Hospital, Copenhagen University Hospital, Hvidovre, Denmark
(Wetterslev) Copenhagen Trial Unit, Centre for Clinical Intervention
Research, University of Copenhagen, Copenhagen, Denmark
(Moller) Department of Anaesthesia and Intensive Care Medicine, Herlev
Hospital, Herlev, Denmark
(Afshari) Department of Paediatric and Obstetric Anaesthesia, Juliane
Marie Center, Copenhagen University Hospital, Copenhagen, Denmark
Publisher
Blackwell Publishing Ltd
Abstract
Coagulopathy and severe bleeding are associated with high mortality. We
evaluated haemostatic treatment guided by the functional viscoelastic
haemostatic assays, thromboelastography or rotational thromboelastometry
in bleeding patients. We searched for randomised, controlled trials
irrespective of publication status, publication date, blinding status,
outcomes published or language from date of inception to 5 January 2016 in
six bibliographic databases. We included 17 trials (1493 participants),
most involving cardiac surgery. Thromboelastography or rotational
thromboelastometry seemed to reduce overall mortality compared to any of
our comparisons (3.9% vs. 7.4%, RR (95% CI) 0.52 (0.28-0.95);
I2 = 0%, 8 trials, 717 participants). However, the quality of
evidence is graded as low due to the high risk of bias, heterogeneity,
imprecision and low event rate. Thromboelastography or rotational
thromboelastometry significantly reduced the proportion of patients
transfused with red blood cells (RR (95% CI) 0.86 (0.79-0.94);
I2 = 0%, 10 trials, 832 participants), fresh frozen plasma (RR
(95% CI) 0.57 (0.33-0.96); I2 = 86%, 10 trials, 832
participants) and platelets (RR (95% CI) 0.73 (0.60-0.88); I2 =
0%, 10 studies, 832 participants). There was no difference in proportion
needing surgical re-interventions (RR (95% CI) 0.75 (0.50-1.10);
I2 = 0%, 9 trials, 887 participants). Trial sequential analysis
of mortality suggests that only 54% of the required information size has
been reached so far. Transfusion strategies guided by thromboelastography
or rotational thromboelastometry may reduce the need for blood products in
patients with bleeding, but the results are mainly based on trials of
elective cardiac surgery involving cardiopulmonary bypass, with
low-quality evidence. Copyright © 2017 The Association of
Anaesthetists of Great Britain and Ireland

<49>
Accession Number
614924738
Title
Long-term outcomes and cost effectiveness of high-dose dexamethasone for
cardiac surgery: a randomised trial.
Source
Anaesthesia. 72 (6) (pp 704-713), 2017. Date of Publication: June 2017.
Author
Dieleman J.M.; de Wit G.A.; Nierich A.P.; Rosseel P.M.; van der Maaten
J.M.; Hofland J.; Diephuis J.C.; de Lange F.; Boer C.; Neslo R.E.; Moons
K.G.; van Herwerden L.A.; Tijssen J.G.; Kalkman C.J.; van Dijk D.
Institution
(Dieleman, Kalkman, van Dijk) Department of Anesthesiology and Intensive
Care, University Medical Center, Utrecht, Netherlands
(de Wit, Neslo, Moons) Julius Center for Health Sciences and Primary Care,
University Medical Center, Utrecht, Netherlands
(Nierich) Department of Cardiothoracic Anesthesia, Isala Klinieken,
Zwolle, Netherlands
(Rosseel) Department of Cardiothoracic Anesthesia, Amphia Ziekenhuis,
Breda, Netherlands
(van der Maaten) Department of Anesthesiology, University Medical Center,
Groningen, Netherlands
(Hofland) Department of Cardiothoracic Anesthesia, Erasmus Medical Center,
Rotterdam, Netherlands
(Diephuis) Department of Cardiothoracic Anesthesia, Medisch Spectrum
Twente, Enschede, Netherlands
(de Lange) Department of Cardiothoracic Anesthesia, Medical Center,
Leeuwarden, Netherlands
(Boer) Department of Anesthesiology, Vrije Universiteit University Medical
Center, Amsterdam, Netherlands
(van Herwerden) Department of Cardiothoracic Surgery, University Medical
Center, Utrecht, Netherlands
(Tijssen) Department of Cardiology, Academic Medical Center, Amsterdam,
Netherlands
Publisher
Blackwell Publishing Ltd
Abstract
Prophylactic intra-operative administration of dexamethasone may improve
short-term clinical outcomes in cardiac surgical patients. The purpose of
this study was to evaluate long-term clinical outcomes and cost
effectiveness of dexamethasone versus placebo. Patients included in the
multicentre, randomised, double-blind, placebo-controlled DExamethasone
for Cardiac Surgery (DECS) trial were followed up for 12 months after
their cardiac surgical procedure. In the DECS trial, patients received a
single intra-operative dose of dexamethasone 1 mg.kg-1 (n =
2239) or placebo (n = 2255). The effects on the incidence of major
postoperative events were evaluated. Also, overall costs for the 12-month
postoperative period, and cost effectiveness, were compared between
groups. Of 4494 randomised patients, 4457 patients (99%) were followed up
until 12 months after surgery. There was no difference in the incidence of
major postoperative events, the relative risk (95%CI) being 0.86
(0.72-1.03); p = 0.1. Treatment with dexamethasone reduced costs per
patient by 921 [1084] (95%CI -1672 to -137; p = 0.02), mainly through
reduction of postoperative respiratory failure and duration of
postoperative hospital stay. The probability of dexamethasone being cost
effective compared with placebo was 97% at a threshold value of 17,000
[20,000] per quality-adjusted life year. We conclude that intra-operative
high-dose dexamethasone did not have an effect on major adverse events at
12 months after cardiac surgery, but was associated with a reduction in
costs. Routine dexamethasone administration is expected to be cost
effective at commonly accepted threshold levels for cost
effectiveness. Copyright © 2017 The Association of Anaesthetists
of Great Britain and Ireland

<50>
Accession Number
2000793724
Title
Early or late fresh frozen plasma administration in newborns and small
infants undergoing cardiac surgery: the APPEAR randomized trial.
Source
British Journal of Anaesthesia. 118 (5) (pp 788-796), 2017. Date of
Publication: May 2017.
Author
Bianchi P.; Cotza M.; Beccaris C.; Silvetti S.; Isgro G.; Pome G.;
Giamberti A.; Ranucci M.
Institution
(Bianchi, Cotza, Beccaris, Isgro, Ranucci) Department of Cardiothoracic,
Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, Via
Morandi 30, 20097 San Donato Milanese, Milan, Italy
(Silvetti) Department of Cardiac Anaesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Pome, Giamberti) Department of Congenital Heart Surgery, IRCCS
Policlinico San Donato, Milan, Italy
Publisher
Elsevier Ltd
Abstract
Background: In newborns and small infants undergoing cardiac surgery with
cardiopulmonary bypass (CPB) and blood priming, it is unclear whether
there is reduced blood loss if fresh frozen plasma (FFP) is added to the
CPB priming volume. This single-centre, randomized trial tested the
hypothesis that the administration of FFP after CPB (late FFP group) is
superior to FFP priming (early FFP group) in terms of postoperative
bleeding and overall red blood cell (RBC) transfusion. Method(s):
Seventy-three infants weighing <10 kg were randomly allocated to receive
FFP to supplement RBCs in the CPB priming solution (n=36) or immediately
after CPB (n=37). The primary endpoint was a difference in postoperative
blood loss; secondary endpoints included the amount of RBCs and FFP
transfused through the first 48 postoperative hours. Result(s): All
patients were included in the analysis. Patients in the late FFP arm had
greater postoperative mean blood loss than patients in the early FFP arm
[33.1 (SD 20.6) vs 24.1 (12.9) ml kg-1; P=0.028], but no
differences in transfusions were found. The subgroup of cyanotic heart
disease patients had comparable results, but with greater use of RBCs in
the late FFP group. Conclusion(s): In infants undergoing cardiac
surgery, FFP in the priming solution appears slightly superior to late
administration in terms of postoperative bleeding. Clinical trial
registration: www.ClinicalTrials.gov, NCT02738190. Copyright ©
2017 The Author(s)

<51>
Accession Number
2000793241
Title
Randomized trial of red cell washing for the prevention of
transfusion-associated organ injury in cardiac surgery.
Source
British Journal of Anaesthesia. 118 (5) (pp 689-698), 2017. Date of
Publication: May 2017.
Author
Wozniak M.J.; Sullo N.; Qureshi S.; Dott W.; Cardigan R.; Wiltshire M.;
Morris T.; Nath M.; Bittar N.; Bhudia S.K.; Kumar T.; Goodall A.H.; Murphy
G.J.
Institution
(Wozniak, Sullo, Qureshi, Dott, Nath, Kumar, Goodall, Murphy) Department
of Cardiovascular Sciences and NIHR Cardiovascular Biomedical Research
Unit, University of Leicester, Glenfield Hospital, Leicester LE3 9QP,
United Kingdom
(Cardigan, Wiltshire) National Health Service Blood and Transplant,
Cambridge CB2 0PT, United Kingdom
(Morris) Leicester Clinical Trials Unit, Leicester Diabetes Centre,
Leicester General Hospital, Leicester LE5 4PW, United Kingdom
(Bittar) Blackpool Victoria Hospital NHS Trust, Blackpool, Lancashire FY3
8NR, United Kingdom
(Bhudia) University Hospitals Coventry and Warwickshire NHS Trust,
Clifford Bridge Road, Coventry CV2 2DX, United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: Experimental studies suggest that mechanical cell washing to
remove pro-inflammatory components that accumulate in the supernatant of
stored donor red blood cells (RBCs) might reduce inflammation and organ
injury in transfused patients. Method(s): Cardiac surgery patients at
increased risk of large-volume RBC transfusion were eligible. Participants
were randomized to receive either mechanically washed allogenic RBCs or
standard care RBCs. The primary outcome was serum interleukin-8 measured
at baseline and at four postsurgery time points. A mechanism substudy
evaluated the effects of washing on stored RBCs in vitro and on markers of
platelet, leucocyte, and endothelial activation in trial subjects.
 Result(s): Sixty adult cardiac surgery patients at three UK cardiac
centres were enrolled between September 2013 and March 2015. Subjects
received a median of 3.5 (interquartile range 2-5.5) RBC units, stored for
a mean of 21 (SD 5.2) days, within 48 h of surgery. Mechanical washing
reduced concentrations of RBC-derived microvesicles but increased
cell-free haemoglobin concentrations in RBC supernatant relative to
standard care RBC supernatant. There was no difference between groups with
respect to perioperative serum interleukin-8 values [adjusted mean
difference 0.239 (95% confidence intervals -0.231, 0.709), P=0.318] or
concentrations of plasma RBC microvesicles, platelet and leucocyte
activation, plasma cell-free haemoglobin, endothelial activation, or
biomarkers of heart, lung, or kidney injury. Conclusion(s): These
results do not support a hypothesis that allogenic red blood cell washing
has clinical benefits in cardiac surgery. Clinical trial registration:
ISRCTN 27076315. Copyright © 2017 The Author(s)

<52>
Accession Number
2000792419
Title
Efficacy and safety of inhaled anaesthetic for postoperative sedation
during mechanical ventilation in adult cardiac surgery patients: a
systematic review and meta-analysis.
Source
British Journal of Anaesthesia. 118 (5) (pp 658-669), 2017. Date of
Publication: May 2017.
Author
Spence J.; Belley-Cote E.; Ma H.K.; Donald S.; Centofanti J.; Hussain S.;
Gupta S.; Devereaux P.J.; Whitlock R.
Institution
(Spence, Belley-Cote, Ma, Donald, Centofanti) Department of Anaesthesia
and Critical Care, McMaster University, Population Health Research
Institute, Hamilton, ON, Canada
(Spence, Devereaux, Whitlock) Department of Clinical Epidemiology and
Biostatistics, McMaster University, Population Health Research Institute,
Hamilton, ON, Canada
(Belley-Cote) Department of Medicine (Cardiology), McMaster University,
Population Health Research Institute, Hamilton, ON, Canada
(Hussain) Department of Surgery, Division of Cardiac Surgery, McGill
University, Montreal, PQ, Canada
(Gupta, Whitlock) Department of Surgery, Division of Cardiac Surgery,
Population Health Research Institute, Hamilton, ON, Canada
(Devereaux) Department of Medicine, Division of Cardiology, Population
Health Research Institute, Hamilton, ON, Canada
(Spence, Belley-Cote, Hussain, Devereaux, Whitlock) Population Health
Research Institute, Hamilton, ON, Canada
Publisher
Elsevier Ltd
Abstract
The aim was to evaluate the efficacy and safety of volatile anaesthetic
for postoperative sedation in adult cardiac surgery patients through a
systematic review and meta-analysis. We retrieved randomized controlled
trials from MEDLINE, EMBASE, CENTRAL, Web of Science, clinical trials
registries, conference proceedings, and reference lists of included
articles. Independent reviewers extracted data, including patient
characteristics, type of intraoperative anaesthesia, inhaled anaesthetic
used, comparator sedation, and outcomes of interest, using pre-piloted
forms. We assessed risk of bias using the Cochrane Tool and evaluated the
strength of the evidence using the GRADE approach. Eight studies enrolling
610 patients were included. Seven had a high and one a low risk of bias.
The times to extubation after intensive care unit (ICU) admission and
sedation discontinuation were, respectively, 76 [95% confidence interval
(CI) -150 to - 2, I2=79%] and 74 min (95% CI - 126 to - 23,
I2=96%) less in patients who were sedated using volatile
anaesthetic. There was no difference in ICU or hospital length of stay.
Patients who received volatile anaesthetic sedation had troponin
concentrations that were 0.71 ng ml-1 (95% CI 0.23-1.2) lower
than control patients. Reporting on other outcomes was varied and not
suitable for meta-analysis. Volatile anaesthetic sedation may be
associated with a shorter time to extubation after cardiac surgery but no
change in ICU or hospital length of stay. It is associated with a
significantly lower postoperative troponin concentration, but the impact
of this on adverse cardiovascular outcomes is uncertain. Blinded
randomized trials using intention-to-treat analysis are required. PROSPERO
registry number: 2016:CRD42016033874. Available from
http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016033874.Copyright © 2017 The Author(s)

<53>
Accession Number
613755853
Title
Are preoperative experimental pain assessments correlated with clinical
pain outcomes after surgery? A systematic review.
Source
Scandinavian Journal of Pain. 15 (pp 44-52), 2017. Date of Publication: 01
Apr 2017.
Author
Sangesland A.; Storen C.; Vaegter H.B.
Institution
(Sangesland, Storen, Vaegter) Department of Clinical Research, Faculty of
Health Sciences, University of Southern Denmark, Denmark
(Vaegter) Pain Research Group, Pain Center South, Odense University
Hospital, Odense, Denmark
Publisher
Elsevier B.V. (E-mail: peter.golla@degruyter.com)
Abstract
Background Pain after surgery is not uncommon with 30% of patients
reporting moderate to severe postoperative pain. Early identification of
patients prone to postoperative pain may be a step forward towards
individualized pain medicine providing a basis for improved clinical
management through treatment strategies targeting relevant pain mechanisms
in each patient. Assessment of pain processing by quantitative sensory
testing (QST) prior to surgery has been proposed as a method to identify
patients at risk for postoperative pain, although results have been
conflicting. Since the last systematic review, several studies
investigating the association between postoperative pain and more dynamic
measures of pain processing like temporal summation of pain and
conditioned pain modulation have been conducted. Objectives According to
the PRISMA guidelines, the aim of this systematic review was to evaluate
whether assessment of experimental pain processing including measures of
central pain mechanisms prior to surgery was associated with pain
intensity after surgery. Methods Systematic database searches in PubMed
and EMBASE with the following search components: QST, association, and
postoperative pain, for studies that assessed the association between QST
and pain after surgery were performed. Two authors independently reviewed
all titles and abstracts to assess their relevance for inclusion. Studies
were included if (1) QST was performed prior to surgery, (2) pain was
assessed after surgery, and (3) the association between QST and pain after
surgery was investigated. Forty-four unique studies were identified, with
30 studies on 2738 subjects meeting inclusion criteria. The methodological
quality of the include studies was assessed and data extraction included
study population, type of surgery, QST variables, clinical pain outcome
measure and main result. Results Most studies showed moderate to high risk
of bias. Type of surgery investigated include 7 studies on total knee
replacement, 5 studies on caesarean section, 4 studies on thoracic
surgery, 2 studies on herniotomy, 2 studies on hysterectomy/myomectomy, 1
study on tubal ligation, 1 study on gynecologic laparoscopy, 1 study on
arthroscopic knee surgery, 1 study on shoulder surgery, 1 study on disc
herniation surgery, 1 study on cholecystectomy, 1 study on percutaneous
nephrolithotomy, 1 study on molar surgery, 1 study on abdominal surgery,
and 1 study on total knee replacement and total hip replacement. The
majority of the preoperative QST variables showed no consistent
association with pain intensity after surgery. Thermal heat pain above the
pain threshold and temporal summation of pressure pain were the QST
variables, which showed the most consistent association with acute or
chronic pain after surgery. Conclusions QST before surgery does not
consistently predict pain after surgery. High quality studies
investigating the presence of different QST variables in combination or
along with other pain-related psychosocial factors are warranted to
confirm the clinical relevance of QST prior to surgery. Implications
Although preoperative QST does not show consistent results, future studies
in this area should include assessment of central pain mechanisms like
temporal summation of pressure pain, conditioned pain modulation, and
responses to pain above the pain threshold since these variables show
promising associations to pain after surgery. Copyright © 2016
Scandinavian Association for the Study of Pain

<54>
Accession Number
625551530
Title
Hybrid versus traditional cardiac rehabilitation models: A systematic
review and meta-analysis.
Source
Kardiologia Polska. 76 (12) (pp 1717-1724), 2018. Date of Publication:
2018.
Author
Wu C.; Li Y.; Chen J.
Institution
(Wu, Chen) Department of Healthcare Centre, People's Hospital of Hainan
Province, 43 Renmin Ave, Meilan Qu, Haikou Shi, Hainan Sheng, China
(Li) Department of Emergency Medicine, Orthopaedics, and Diabetes,
Hospital of Haikou City, Haikou, China
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: The common drawbacks of standard cardiac rehabilitation (CR)
models include low participation rate, high cost, and dependence on
on-site exercise sessions. Therefore, hybrid CR protocols have been
developed. Aim(s): We aimed to test whether hybrid CR models are
superior or equivalent to the traditional CR models in patients after
myocardial infarction, heart failure, and cardiac surgery, using a
meta-analysis framework. Method(s): Data from relevant original
studies indexed in the Medline, Scopus, Cochrane Central, and Web of
Science databases were extracted and analysed. The standardised mean
difference (SMD) was used as a summary effect estimate, along with 95%
confidence interval (CI). Result(s): Based on data from 1195
patients, the summary effect size showed similar improvement in functional
capacity in hybrid and standard CR programmes (SMD = -0.04, 95% CI -0.18
to 0.09, p = 0.51). No significant difference was detected between the two
models in terms of changes in exercise duration (SMD = -0.14, 95% CI -0.51
to 0.24, p = 0.47), systolic (SMD = -0.01, 95% CI -0.14 to 0.12, p =
0.91), and diastolic (SMD = -0.03, 95% CI -0.16 to 0.11, p = 0.7) blood
pressure, or health-related quality of life (SMD = -0.08, 95% CI -0.23 to
0.07, p = 0.27). In terms of blood lipids, no significant difference was
noted between hybrid and traditional CR models in all assessed lipid
profile parameters, except for triglycerides (favouring the traditional CR
model). Conclusion(s): Hybrid CR protocols showed comparable efficacy
to the traditional model. Further well-designed studies are required to
validate these findings, especially regarding the long-term
outcomes. Kardiologia Polska Copyright © Polish Cardiac Society
2018.

<55>
Accession Number
625468090
Title
Prevention of post-operative complications by using a HMG-CoA reductase
inhibitor in patients undergoing one-lung ventilation for non-cardiac
surgery: Study protocol for a randomised controlled trial 11 Medical and
Health Sciences 1103 Clinical Sciences 11 Medical and Health Sciences 1102
Cardiorespiratory Medicine and Haematology.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 690. Date of
Publication: 18 Dec 2018.
Author
Shyamsundar M.; O'Kane C.; Perkins G.D.; Kennedy G.; Campbell C.; Agus A.;
Phair G.; McAuley D.
Institution
(Shyamsundar, O'Kane, McAuley) Centre for Experimental Medicine, Queen's
University Belfast, Belfast BT9 7BL, United Kingdom
(Perkins) Warwick Trials Unit, University of Warwick, Coventry CV4 7AL,
United Kingdom
(Kennedy, Campbell, Agus, Phair) Northern Ireland Clinical Trials Unit,
Royal Hospitals, 1st Floor Elliott Dynes Building, Belfast BT12 6BA,
United Kingdom
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative pulmonary complications (PPC) and peri-operative
myocardial infarction (MI) have a significant impact on the long-term
mortality of surgical patients. Patients undergoing one-lung ventilation
(OLV) for surgery are at a high risk of developing these complications.
These complications could be associated with intensive care unit (ICU)
admissions and longer hospital stay with associated resource and economic
burden. Simvastatin, a HMG-CoA reductase enzyme inhibitor has been shown
to have pleiotropic anti-inflammatory effects as well as being endothelial
protective. The benefits of statins have been shown in various
observational studies and in small proof-of-concept studies. There is an
urgent need for a well-designed, large clinical trial powered to detect
clinical outcomes. The Prevention HARP 2 trial will test the hypothesis
'simvastatin 80 mg when compared to placebo will reduce cardiac and
pulmonary complications in patients undergoing elective oesophagectomy,
lobectomy or pneumonectomy'. Methods/design: The Prevention HARP 2 trial
is a UK multi-centre, randomised, double-blind, placebo-controlled trial.
Adult patients undergoing elective oesophagectomy, lobectomy or
pneumonectomy will be eligible. Patients who are already on statins will
be excluded from this trial. Patients will be randomised to receive
simvastatin 80 mg or matched placebo for 4 days pre surgery and for up to
7 days post surgery. The primary outcome is a composite outcome of PPC and
MI within 7 days post surgery. Various secondary outcome measures
including clinical outcomes, safety outcomes and health economic outcomes
will be collected. The study aims to recruit 452 patients in total across
12 UK sites. Discussion(s): The results of the Prevention HARP 2
trial should add to our understanding of the benefits of peri-operative
statins and influence clinical decision-making. Analysis of blood and
urine samples from the patients will provide insight into the mechanism of
simvastatin action. Trial registration: International Standard Randomised
Controlled Trials registry, ID: ISRCTN48095567. Registered on 11 November
2016. Copyright © 2018 The Author(s).

<56>
Accession Number
625593447
Title
Innovations in cardiac surgery: Techniques and applications of 3D
printing.
Source
Journal of 3D Printing in Medicine. 2 (4) (pp 179-186), 2018. Date of
Publication: December 2018.
Author
Wang J.; Coles-Black J.; Matalanis G.; Chuen J.
Institution
(Wang, Coles-Black, Chuen) Department of Vascular Surgery, Austin Health,
145 Studley Road, Heidelberg, Melbourne, VIC 3084, Australia
(Wang, Coles-Black, Chuen) 3D Medical Printing Laboratory, Austin Health,
145 Studley Road, Heidelberg, Melbourne, VIC 3084, Australia
(Matalanis) Department of Cardiac Surgery, Austin Health, 145 Studley
Road, Heidelberg, Melbourne, VIC 3084, Australia
Publisher
Future Medicine Ltd. (E-mail: info@futuremedicine.com)
Abstract
Aim: The 3D printing is a developing technology which has begun to
flourish in fields where the ability to visualize complex anatomy in novel
ways can aid interventions. This paper reviews the literature on 3D
printing in cardiac surgery. Method(s): We performed a literature
search in three databases using appropriate search terms to capture
publications pertaining to 3D printing in cardiac surgery. Result(s):
Our search demonstrated a paucity of literature in this area, with 27
relevant publications identified since 1980. The majority of articles
pertained to the utility of 3D printing in presurgical planning, but its
application in other areas was largely unexplored. Conclusion(s):
There is enormous potential for growth of 3D printing in cardiac surgery,
which can drastically change the way, we practice medicine. Copyright
© 2018 Future Medicine Ltd.

<57>
[Use Link to view the full text]
Accession Number
625597027
Title
Survival, Quality of Life, and Functional Status Following Prolonged ICU
Stay in Cardiac Surgical Patients: A Systematic Review.
Source
Critical care medicine. 47 (1) (pp e52-e63), 2019. Date of Publication: 01
Jan 2019.
Author
Trivedi V.; Bleeker H.; Kantor N.; Visintini S.; McIsaac D.I.; McDonald B.
Institution
(Trivedi, McIsaac, McDonald) Department of Anesthesiology and Pain
Medicine, University of Ottawa, Ottawa, ON, Canada
(Trivedi, Bleeker, Kantor, McIsaac, McDonald) Faculty of Medicine,
University of Ottawa, Ottawa, ON, Canada
(Trivedi, Visintini, McDonald) Division of Cardiac Anesthesiology,
University of Ottawa Heart Institute, Ottawa, ON, Canada
(McIsaac) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(McIsaac) School of Epidemiology and Public Health, University of Ottawa,
Ottawa, ON, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Compared with noncardiac critical illness, critically ill
postoperative cardiac surgical patients have different underlying
pathophysiologies, are exposed to different processes of care, and thus
may experience different outcome trajectories. Our objective was to
systematically review the outcomes of cardiac surgical patients requiring
prolonged intensive care with respect to survival, residential status,
functional recovery, and quality of life in both hospital and long-term
follow-up. DATA SOURCES: MEDLINE, Embase, CINAHL, Web of Science, and
Dissertations and Theses Global up to July 21, 2017. STUDY SELECTION:
Studies were included if they assessed hospital or long-term survival
and/or patient-centered outcomes in adult patients with prolonged ICU
stays following major cardiac surgery. After screening 10,159 citations,
114 articles were reviewed in full; a final 34 articles met criteria for
data extraction. DATA EXTRACTION: Two reviewers independently extracted
data and assessed risk of bias using the National Institutes of Health
Quality Assessment Tool for Observational Studies. Extracted data included
the used definition of prolonged ICU stay, number and characteristics of
prolonged ICU stay patients, and any comparator short stay group, length
of follow-up, hospital and long-term survival, residential status,
patient-centered outcome measure used, and relevant score. DATA SYNTHESIS:
The definition of prolonged ICU stay varied from 2 days to greater than 14
days. Twenty-eight studies observed greater in-hospital mortality among
all levels of prolonged ICU stay. Twenty-five studies observed greater
long-term mortality among all levels of prolonged ICU stay. Multiple tools
were used to assess patient-centered outcomes. Long-term health-related
quality of life and function was equivalent or worse with prolonged ICU
stay. CONCLUSION(S): We found consistent evidence that patients with
increases in ICU length of stay beyond 48 hours have significantly
increasing risk of hospital and long-term mortality. The significant
heterogeneity in exposure and outcome definitions leave us unable to
precisely quantify the risk of prolonged ICU stay on mortality and
patient-centered outcomes.

<58>
Accession Number
625598980
Title
Effectiveness of reflexology on anxiety of patients undergoing
cardiovascular interventional procedures: A systematic review and
meta-analysis of randomized controlled trials.
Source
Journal of advanced nursing. 75 (1) (pp 43-53), 2019. Date of Publication:
01 Jan 2019.
Author
Chandrababu R.; Rathinasamy E.L.; Suresh C.; Ramesh J.
Institution
(Chandrababu) Manipal College of Nursing, Manipal Academy of Higher
Education, Manipal, Karnataka, India
(Rathinasamy) Department of Adult Health and Critical Care, College of
Nursing, Sultan Qaboos University, Muscat, Oman
(Suresh) Department of Physical and Health Sciences, SRM Institute of
Science and Technology, Chennai, TN, India
(Ramesh) Udupi College of Nursing, Sri Krishna Educational Trust, Manipal,
Karnataka, India
Publisher
NLM (Medline)
Abstract
AIM: To appraise the evidence concerning the effect of reflexology on the
anxiety in patients undergoing cardiovascular interventional procedures.
BACKGROUND: Anxiety, fear, and other unpleasant emotional experiences are
common among patients before and after cardiovascular interventional
procedures. The higher anxiety may affect prognosis and recovery of
patients. DESIGN: A systematic review and meta-analysis. DATA SOURCES: The
MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health
Literature), Cochrane Central Register of Controlled Trials (Cochrane
Library), EMBASE, PsycINFO, and Web of Science were searched between
2001-2017. REVIEW METHODS: Randomized controlled trials evaluated the
effectiveness of reflexology on anxiety among patients undergoing
cardiovascular interventional procedures were included. Meta-analysis was
done using Revman 5.3. RESULT(S): Ten trials, representing 760
patients with the mean age of 59, fulfilled the inclusion criteria.
Reflexology significantly decreased the anxiety of patients undergoing
cardiovascular interventional procedures in the treatment group compared
with the control group. CONCLUSION(S): Reflexology has some positive
effects on anxiety among patients undergoing cardiovascular procedures. It
may be a useful complementary therapy and further research is necessary to
create reliable evidence. Copyright © 2018 John Wiley & Sons Ltd.

<59>
Accession Number
625597144
Title
Comparison of the Efficacy of Oral versus Intravascular Magnesium in the
Prevention of Hypomagnesemia and Arrhythmia after CABG.
Source
Brazilian journal of cardiovascular surgery. 33 (5) (pp 448-453), 2018.
Date of Publication: 01 Sep 2018.
Author
Jannati M.; Shahbazi S.; Eshaghi L.
Institution
(Jannati) Cardiovascular Surgery Ward, Faghihi Hospital, Shiraz University
of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Shahbazi) Department of Anesthesiology, Shiraz Anesthesiology and
Critical and Care Research Center, Nemazee Hospital, Shiraz University of
Medical Sciences, Shiraz, Iran, Islamic Republic of
(Eshaghi) Department of Anesthesiology, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Cardiac arrhythmias are a common challenge following open-heart
surgeries. Hypomagnesemia is believed to be correlated with this
condition. Prophylactic intravenous magnesium supplementation has been
practiced for a long time in patients undergoing CABG. This study was
designed in an attempt to compare the efficacy of oral versus intravenous
routes in the prevention of hypomagnesemia and arrhythmia. METHOD(S):
In this interventional clinical study, 82 patients were randomly assigned
to 2 groups. All patients were evaluated for baseline serum magnesium
level and arrhythmias. One group received 1,600 mg of oral magnesium
hydroxide through nasogastric (NG) tube prior to surgery, while the other
group received 2 g of magnesium sulfate during the induction of
anesthesia. The serum magnesium level was monitored for 48 hours after the
operation. The difference in preoperative hypomagnesemia was
non-significant (Sig: 0.576). RESULT(S): During the operation, the
serum magnesium level peaked around 4 mg/dL, and no hypomagnesemia was
detected in any patient. Although the curve of oral group declined
parallel and below that of intravenous (IV) group, no significant
differences were detected during postoperative monitoring. In addition, a
prevalence of arrhythmia of 13.9% and 6.5% was noticed in IV and oral
groups, respectively (OR: 0.428). CONCLUSION(S): Providing 1,600 mg
of oral magnesium supplement to patients is as effective as 2,000 mg of
magnesium sulfate IV in preventing hypomagnesemia and arrhythmia after
CABG. Thus, the authors introduce this treatment regimen as a promising
and cost-effective method.

<60>
Accession Number
625597622
Title
Selenium, Vitamin C and N-Acetylcysteine do not Reduce the Risk of Acute
Kidney Injury after Off-Pump CABG: a Randomized Clinical Trial.
Source
Brazilian journal of cardiovascular surgery. 33 (2) (pp 129-134), 2018.
Date of Publication: 01 Mar 2018.
Author
Amini S.; Robabi H.N.; Tashnizi M.A.; Vakili V.
Institution
(Amini) Department of Anesthesia, Faculty of Medicine, Mashhad University
of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Robabi) Department of Anesthesiology and Critical Care, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Tashnizi) Department of Cardiac Surgery, Mashhad University of Medical
Sciences, Mashhad, Iran, Islamic Republic of
(Vakili) Department of Community Medicine, Mashhad University of Medical
Sciences, Mashhad, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The aim of this study was to investigate the impact of
perioperative administration of N-acetylcysteine, selenium and vitamin C
on the incidence and outcomes of acute kidney injury after off-pump
coronary bypass graft surgery. METHOD(S): 291 patients requiring
elective off-pump coronary bypass graft surgery were randomized to receive
either N-acetylcysteine, vitamin C and selenium 600 mg, 1500 mg, 0.5 mg,
and nothing orally twice a day, respectively, from the day before to 2
days after surgery. They were assessed for the development of acute kidney
injury using Acute Kidney Injury Network criteria, time of onset, its
severity and duration, duration of mechanical ventilation, intensive care
unit and hospital length of stay, and in-hospital mortality.
 RESULT(S): 272 patients completed the study. The total incidence of
acute kidney injury was 22.1% (n=60) with 14 (20.9%), 15 (22.1%), 21
(31.8%), and 10 (14.1%) patients in the vitamin C, NAC, selenium, and
control groups, respectively (P=0.096). We did not register significant
differences in the incidence, the time of occurrence, the severity and the
duration of acute kidney injury, as well as the duration of mechanical
ventilation, the intensive care unit and hospital length of stay, and the
in-hospital mortality among the four groups. CONCLUSION(S): We found
that perioperative administration of N-acetylcysteine, vitamin C and
selenium were not effective in preventing acute kidney injury and
associated morbidity and mortality after off-pump coronary bypass graft
surgery.

<61>
[Use Link to view the full text]
Accession Number
625595446
Title
Early Versus Standard Care Invasive Examination and Treatment of Patients
With Non-ST-Segment Elevation Acute Coronary Syndrome.
Source
Circulation. 138 (24) (pp 2741-2750), 2018. Date of Publication: 11 Dec
2018.
Author
Kofoed K.F.; Kelbaek H.; Hansen P.R.; Torp-Pedersen C.; Hofsten D.;
Klovgaard L.; Holmvang L.; Helqvist S.; Jorgensen E.; Galatius S.;
Pedersen F.; Bang L.; Saunamaki K.; Clemmensen P.; Linde J.J.; Heitmann
M.; Wendelboe Nielsen O.; Raymond I.E.; Kristiansen O.P.; Svendsen I.H.;
Bech J.; Dominguez Vall-Lamora M.H.; Kragelund C.; Hansen T.F.; Dahlgaard
Hove J.; Jorgensen T.; Fornitz G.G.; Steffensen R.; Jurlander B.; Abdulla
J.; Lyngbaek S.; Elming H.; Therkelsen S.K.; Abildgaard U.; Jensen J.S.;
Gislason G.; Kober L.V.; Engstrom T.
Institution
(Kofoed, Hofsten, Klovgaard, Holmvang, Helqvist, Jorgensen, Pedersen,
Bang, Saunamaki, Clemmensen, Linde, Kober, Engstrom) Department of
Cardiology, Heart Centre, F.P., P.C., University of Copenhagen, S.H, K.S,
Denmark
(Kelbaek, Elming, Therkelsen) Department of Cardiology, Zealand University
Hospital, Roskilde, H.E, Germany
(Hansen, Torp-Pedersen, Galatius, Bech, Kragelund, Hansen, Abildgaard,
Jensen, Gislason) Department of Cardiology, Herlev and Gentofte Hospitals
(P.R.H., C.T.-P., S.G., C.K., U.A., University of Copenhagen, Denmark
(Heitmann, Wendelboe Nielsen, Raymond, Kristiansen, Svendsen, Dominguez
Vall-Lamora) Department of Cardiology, Bispebjerg and Frederiksberg
Hospitals (M.H., I.E.R., I.H.S., University of Copenhagen, Denmark
(Dahlgaard Hove, Jorgensen, Fornitz) Department of Cardiology, Hvidovre
and Amager Hospitals (J.D.H., University of Copenhagen, Denmark
(Steffensen, Jurlander) Department of Cardiology, Hillerod Hospital (R.S.,
University of Copenhagen, Denmark
(Abdulla, Lyngbaek) Department of Cardiology, Glostrup Hospital (J.A.,
University of Copenhagen, Denmark
Publisher
NLM (Medline)
Abstract
BACKGROUND: The optimal timing of invasive coronary angiography (ICA) and
revascularization in patients with non-ST-segment elevation acute coronary
syndrome is not well defined. We tested the hypothesis that a strategy of
very early ICA and possible revascularization within 12 hours of diagnosis
is superior to an invasive strategy performed within 48 to 72 hours in
terms of clinical outcomes. METHOD(S): Patients admitted with
clinical suspicion of non-ST-segment elevation acute coronary syndrome in
the Capital Region of Copenhagen, Denmark, were screened for inclusion in
the VERDICT trial (Very Early Versus Deferred Invasive Evaluation Using
Computerized Tomography) ( ClinicalTrials.gov NCT02061891). Patients with
ECG changes indicating new ischemia or elevated troponin, in whom ICA was
clinically indicated and deemed logistically feasible within 12 hours,
were randomized 1:1 to ICA within 12 hours or standard invasive care
within 48 to 72 hours. The primary end point was a combination of
all-cause death, nonfatal recurrent myocardial infarction, hospital
admission for refractory myocardial ischemia, or hospital admission for
heart failure. RESULT(S): A total of 2147 patients were randomized;
1075 patients allocated to very early invasive evaluation had ICA
performed at a median of 4.7 hours after randomization, whereas 1072
patients assigned to standard invasive care had ICA performed 61.6 hours
after randomization. Among patients with significant coronary artery
disease identified by ICA, coronary revascularization was performed in
88.4% (very early ICA) and 83.1% (standard invasive care). Within a median
follow-up time of 4.3 (interquartile range, 4.1-4.4) years, the primary
end point occurred in 296 (27.5%) of participants in the very early ICA
group and 316 (29.5%) in the standard care group (hazard ratio, 0.92; 95%
CI, 0.78-1.08). Among patients with a GRACE risk score (Global Registry of
Acute Coronary Events) >140, a very early invasive treatment strategy
improved the primary outcome compared with the standard invasive treatment
(hazard ratio, 0.81; 95% CI, 0.67-1.01; P value for interaction=0.023).
 CONCLUSION(S): A strategy of very early invasive coronary evaluation
does not improve overall long-term clinical outcome compared with an
invasive strategy conducted within 2 to 3 days in patients with
non-ST-segment elevation acute coronary syndrome. However, in patients
with the highest risk, very early invasive therapy improves long-term
outcomes. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov
. Unique identifier: NCT02061891.

<62>
[Use Link to view the full text]
Accession Number
625595266
Title
The Ross Procedure: A Systematic Review, Meta-Analysis, and
Microsimulation.
Source
Circulation. Cardiovascular quality and outcomes. 11 (12) (pp e004748),
2018. Date of Publication: 01 Dec 2018.
Author
Etnel J.R.G.; Grashuis P.; Huygens S.A.; Pekbay B.; Papageorgiou G.;
Helbing W.A.; Roos-Hesselink J.W.; Bogers A.J.J.C.; Mokhles M.M.;
Takkenberg J.J.M.
Institution
(Etnel, Grashuis, Huygens, Pekbay, Papageorgiou, Bogers, Mokhles,
Takkenberg) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, B.P., G.P., M.M.M., Rotterdam, Netherlands
(Huygens) Erasmus School of Health Policy & Management
(Papageorgiou) Department of Biostatistics, Erasmus University Medical
Center, Rotterdam, Netherlands
(Helbing) Division of Cardiology, Department of Pediatrics, Erasmus
University Medical Center, Sophia Children's Hospital, Rotterdam,
Netherlands
(Roos-Hesselink) Department of Cardiology, Erasmus University Medical
Center, Rotterdam, Netherlands
Publisher
NLM (Medline)
Abstract
BACKGROUND: To support decision-making in aortic valve replacement in
children and adults, we provide a comprehensive overview of outcome after
the Ross procedure. METHODS AND RESULTS: A systematic search was conducted
for publications reporting clinical outcome after the Ross procedure,
published between January 1, 2000, and November 22, 2017. Reported event
rates and time-to-event data were pooled and entered into a
microsimulation model to calculate life expectancy and lifetime event
risk. Ninety-nine publications were included (13 129 patients; total
follow-up: 93 408 patient-years, pooled mean follow-up: 7.9+/-5.3 years).
Pooled mean age at surgery was 9.4+/-5.5 years for children and
41.9+/-11.4 for adults. For children and adults, respectively, pooled
early mortality risk was 4.19% (95% CI, 3.21-5.46) and 2.01% (95% CI,
1.44-2.82), late mortality rate was 0.54%/y (95% CI, 0.42-0.70) and
0.59%/y (95% CI, 0.46-0.76), autograft reintervention 1.28%/y (95% CI,
0.99-1.66) and 0.83%/y (95% CI, 0.68-1.01), and right ventricular outflow
tract reintervention 1.97%/y (95% CI, 1.64-2.36) and 0.47%/y (95% CI,
0.37-0.59). Pooled thromboembolism and bleeding rates were low and
comparable to the general population. Lifetime risks of autograft and
right ventricular outflow tract reintervention were, respectively, 94% and
100% for children and 49% and 19% for a 45-year-old. Estimated life
expectancy after surgery was 59 years for children (general population: 64
years) and 30 years for a 45 years old (general population: 31 years).
 CONCLUSION(S): Through excellent survival and avoidance of the burden
of anticoagulation, the Ross procedure provides a unique opportunity for
patients whose preferences do not align with the outcome provided by
mechanical valve replacement and for growing children who also benefit
from autograft diameter increase along with somatic growth. On the
downside, almost all pediatric and many adult Ross patients will require a
reintervention in their lifetime.

<63>
Accession Number
625596143
Title
A new Percutaneous technique for effective vascular Access Site closure in
patients undergoing Transfemoral aortic valve implantation and
thoraco-abdominal aortic aneurysm rEpair: the PASTE study.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
14 (12) (pp e1278-e1285), 2018. Date of Publication: 20 Dec 2018.
Author
Sorropago G.; Singh G.; Sorropago A.; Sole A.; Rossi J.; Tolva V.S.;
Stabile E.; Scalise F.
Institution
(Sorropago) Department of Interventional Cardiology, Policlinico di Monza,
Monza, Italy
Publisher
NLM (Medline)
Abstract
AIMS: The success of transfemoral transcatheter aortic valve implantation
(TAVI) and thoraco-abdominal aneurysm repair (TAAR) depends on haemostatic
control of the access site, which is usually obtained with suture-based
closure devices (Prostar or two ProGlide). A single ProGlide/Glubran
technique, involving a suture placement on the vessel wall followed by
tissue glue injection around the vessel wall, has not been previously
investigated in this clinical setting. Our aim was to study the
feasibility and safety of a single ProGlide/Glubran technique for vascular
access-site closure after transfemoral TAVI and TAAR. METHODS AND RESULTS:
This technique was used in 250 patients from 2012 to 2017. The primary
endpoint was the success of the technique, defined as access-site
haemostasis without complications and not requiring any additional
intervention within 30 days of the index procedure. Patients had a mean
age of 82.4+/-1.93 years, with a logistic EuroSCORE of 20.2+/-2.32. A
total of 218 TAVI and 32 TAAR procedures were performed with a mean sheath
size of 18.09+/-1.55 Fr. The mean sheath to femoral artery ratio was
1.04+/-0.16, with mean femoral artery minimal lumen diameter 6.65+/-0.64
mm. The overall success rate of this technique was 98.4%. Four patients
(1.6%) developed critical stenosis of the femoral artery requiring balloon
dilatation. No major VARC-2 vascular complications were observed.
Thirty-day mortality was 0.4% (non-cardiovascular). CONCLUSION(S):
The results of this study suggest that the single ProGlide/Glubran
technique is a safe and effective method of closing the arterial access
site after transfemoral TAVI and TAAR. The results of our study need to be
confirmed in a randomised controlled trial before being adopted in routine
clinical practice.

<64>
Accession Number
625598556
Title
Effect of Plasma Level of Vitamin D on Postoperative Atrial Fibrillation
in Patients Undergoing Isolated Coronary Artery Bypass Grafting.
Source
Brazilian journal of cardiovascular surgery. 33 (3) (pp 217-223), 2018.
Date of Publication: 01 May 2018.
Author
Ozsin K.K.; Sanri U.S.; Toktas F.; Kahraman N.; Yavuz S.
Institution
(Ozsin, Sanri, Toktas, Kahraman, Yavuz) Department of Cardiovascular
Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, University
of Health Sciences, Turkey
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Postoperative atrial fibrillation (PoAF) is a common
complication after coronary artery bypass grafting (CABG). The aim of the
present study was to evaluate the association between development of PoAF
and vitamin D levels in patients undergoing isolated CABG. METHOD(S):
This prospective randomized clinical trial was conducted on the patients
with isolated CABG. The study was terminated when 50 patients in both
PoAF(+) group and PoAF(-) group were reached. Development of AF until
discharge period was assessed. Vitamin D level was measured immediately
after AF; it was measured on the discharge day for the patients without
PoAF. Predictive values of the independent variables were measured for the
development of PoAF. RESULT(S): The groups were separated as PoAF(-)
group (66% male, mean age 58.18+/-10.98 years) and PoAF(+) group (74%
male, mean age 61.94+/-10.88 years). 25(OH) vitamin D level (OR=0.855, 95%
CI: 0.780-0.938, P=0.001) and > 65 years (OR=3.525, 95% CI: 1.310-9.483,
P=0.013) were identified as an independent predictor of postoperative AF
after CABG surgery in multivariate analysis. The cut-off level for 25(OH)
vitamin D level in receiver-operating characteristic curve analysis was
determined as 7.65 with sensitivity of 60% and specificity of 64% for
predicting PoAF (area under the curve: 0.679, P=0.002).
 CONCLUSION(S): Vitamin D level is considered an independent predictor
for development of PoAF. Lower vitamin D levels may be one of the reasons
for PoAF.

<65>
Accession Number
625598253
Title
The Effect of Dexmedetomidine on the Acute Pain After Cardiothoracic
Surgeries: A Systematic Review.
Source
Brazilian journal of cardiovascular surgery. 33 (4) (pp 404-417), 2018.
Date of Publication: 01 Jul 2018.
Author
Habibi V.; Kiabi F.H.; Sharifi H.
Institution
(Habibi) Department of Cardiac Surgery, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Kiabi) Department of Anesthesiology, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Sharifi) Department of Medical Surgical Nursing, Faculty of Nursing,
Iranshahr University of Medical Sciences, Iranshahr, Iran, Islamic
Republic of
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Acute post-operative pain remains a troublesome complication
of cardiothoracic surgeries. Several randomized controlled trials have
examined the efficacy of dexmedetomidine as a single or as an adjuvant
agent before, during and after surgery. However, no evidence-based
conclusion has been reached regarding the advantages of dexmedetomidine
over the other analgesics. OBJECTIVE(S): To review the effect of
dexmedetomidine on acute post-thoracotomy/sternotomy pain. METHOD(S):
Medline, SCOPUS, Web of Science, and Cochrane databases were used to
search for randomized controlled trials that investigated the analgesia
effect of dexmedetomidine on post-thoracotomy/sternotomy pain in adults'
patients. The outcomes were postoperative pain intensity or incidence,
postoperative analgesia duration, and the number of postoperative
analgesic requirements. RESULT(S): From 1789 citations, 12 trials
including 804 subjects met the inclusion criteria. Most studies showed
that pain score was significantly lower in the dexmedetomidine group up to
24 hours after surgery. Two studies reported the significant lower
postoperative analgesia requirements and one study reported the
significant lower incidence of acute pain after surgery in dexmedetomidine
group. Ten studies found that the total consumption of narcotics was
significantly lower in the dexmedetomidine group. The most reported
complications of dexmedetomidine were nausea/vomiting, bradycardia and
hypotension. CONCLUSION(S): Dexmedetomidine can be used as a safe and
efficient analgesic agent for reducing the postoperative pain and
analgesic requirements up to 24 hours after cardiothoracic surgeries.
However, further well-designed trials are needed to find the optimal
dosage, route, time, and duration of dexmedetomidine administration.

<66>
Accession Number
625598841
Title
Extended-time of Noninvasive Positive Pressure Ventilation Improves Tissue
Perfusion after Coronary Artery Bypass Surgery: a Randomized Clinical
Trial.
Source
Brazilian journal of cardiovascular surgery. 33 (3) (pp 250-257), 2018.
Date of Publication: 01 May 2018.
Author
Nasrala M.L.S.; Bolzan D.W.; Lage Y.G.; Prado F.S.; Arena R.; Lima P.R.L.;
Feguri G.; Silva A.M.C.; Marcondi N.O.; Hossne N.; Guizilini S.; Gomes
W.J.
Institution
(Nasrala, Bolzan, Marcondi, Hossne, Guizilini, Gomes) Cardiology and
Cardiovascular Surgery Disciplines, Escola Paulista de Medicina,
Universidade Federal de Sao Paulo (EPM-UNIFESP), Sao Paulo, SP, Brazil
(Nasrala, Lage, Prado, Lima, Feguri) Physical Therapy Department, Hospital
Santa Rosa, Cuiaba, MT, Brazil
(Lage, Prado, Lima, Feguri) Physical Therapy Department, Hospital Sao
Mateus, Cuiaba, MT, Brazil
(Arena) Department of Physical Therapy, College of Applied Health
Sciences, University of Illinois Chicago, Chicago, IL, United States
(Silva) Public Health Department, Universidade Federal do Mato Grosso
(UFMT), Cuiaba, MT, Brazil
(Guizilini) Department of the Human Movement Sciences, Universidade
Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To compare the effects of extended- versus short-time
noninvasive positive pressure ventilation on pulmonary function, tissue
perfusion, and clinical outcomes in the early postoperative period
following coronary artery bypass surgery in patients with preserved left
ventricular function. METHOD(S): Patients were randomized into two
groups according to noninvasive positive pressure ventilation intensity:
short-time noninvasive positive pressure ventilation n=20 (S-NPPV) and
extended-time noninvasive positive pressure ventilation n=21 (E-NPPV).
S-NPPV was applied for 60 minutes during immediate postoperative period
and 10 minutes, twice daily, from postoperative days 1-5. E-NPPV was
performed for at least six hours during immediate postoperative period and
60 minutes, twice daily, from postoperative days 1-5. As a primary
outcome, tissue perfusion was determined by central venous oxygen
saturation and blood lactate level measured after anesthetic induction,
immediately after extubation and following noninvasive positive pressure
ventilation protocols. As a secondary outcome, pulmonary function tests
were performed preoperatively and in the postoperative days 1, 3, and 5;
clinical outcomes were recorded. RESULT(S): Significant drop in blood
lactate levels and an improvement in central venous oxygen saturation
values in the E-NPPV group were observed when compared with S-NPPV group
after study protocol (P<0.01). The E-NPPV group presented higher
preservation of postoperative pulmonary function as well as lower
incidence of respiratory events and shorter postoperative hospital stay
(P<0.05). CONCLUSION(S): Prophylactic E-NPPV administered in the
early postoperative period of coronary artery bypass surgery resulted in
greater improvements in tissue perfusion, pulmonary function and clinical
outcomes than S-NPPV, in patients with preserved left ventricular
function. TRIAL REGISTRATION: Brazilian Registry of Clinical trial -
RBR7sqj78 - http://www.ensaiosclinicos.gov.br.

<67>
Accession Number
625598071
Title
Thrombocytopenia After Aortic Valve Replacement: Comparison Between
Sutureless Perceval S Valve and Perimount Magna Ease Bioprosthesis.
Source
Brazilian journal of cardiovascular surgery. 33 (2) (pp 169-175), 2018.
Date of Publication: 01 Mar 2018.
Author
Mujtaba S.S.; Ledingham S.; Shah A.R.; Schueler S.; Clark S.; Pillay T.
Institution
(Mujtaba, Ledingham, Shah, Schueler, Clark, Pillay) Department of
Cardiothoracic Surgery, Freeman Hospital, United Kingdom of Great Britain
and Northern Ireland, Freeman Road
Publisher
NLM (Medline)
Abstract
INTRODUCTION: The incidence of postoperative thrombocytopenia after aortic
valve replacement (AVR) with the Perceval S Sutureless bioprosthesis
remains unclear. The aim of this study was to report thrombocytopenia
associated with the use of sutureless AVR. METHOD(S): The data was
collected retrospectively for patients who had isolated AVR with
sutureless Perceval S valve (Group A: 72 patients) and was compared with
patients who underwent isolated sutured AVR with Perimount Magna Ease
Bioprosthesis (Group B: 101 patients) in our institution between June 2014
and January 2017. RESULT(S): Cardiopulmonary bypass and cross-clamp
time were significantly shorter in group A. Maximum drop in platelet count
was 58% mean (day 2.3) in group A versus 44% mean (day 1.7) in group B
(P=0.0001). Absolute platelet count on postoperative day 1-6 in group A
was significantly less than in group B (P<=0.05). Platelet count recovered
to preoperative value in 44% patients in group B versus only in 26%
patients in group A at discharge (P=0.018). Moderate thrombocytopenia
occurs more often in group A (41% vs. 26%) (P=0.008) while severe
thrombocytopenia (<50 x 109) was observed in 6% in group A but never in
group B. Platelets (P=0.007) and packed red blood cells (P=0.009)
transfusion was significantly higher in the group A. CONCLUSION(S):
The implantation of sutureless Perceval aortic valves was associated with
a significant drop in platelet count postoperatively with slow recovery
and higher platelets and packed red blood cells transfusion requirements.
A prospective randomised trial is needed to confirm our findings.

<68>
Accession Number
625598030
Title
Effects of High-Intensity Inspiratory Muscle Training Associated with
Aerobic Exercise in Patients Undergoing CABG: Randomized Clinical Trial.
Source
Brazilian journal of cardiovascular surgery. 33 (4) (pp 376-383), 2018.
Date of Publication: 01 Jul 2018.
Author
Miozzo A.P.; Stein C.; Marcolino M.Z.; Sisto I.R.; Hauck M.; Coronel C.C.;
Plentz R.D.M.
Institution
(Miozzo, Stein, Marcolino, Sisto, Hauck, Coronel, Plentz) Universidade
Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, Brazil
(Miozzo, Stein, Marcolino, Sisto, Hauck, Coronel, Plentz) Instituto de
Cardiologia, Porto Alegre, RS, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Evaluate the interaction between high-intensity inspiratory
muscle training (IMT) and aerobic exercise on physical capacity,
respiratory muscle strength, peripheral muscle strength, and quality of
life of patients who underwent coronary artery bypass grafting (CABG).
 METHOD(S): Twenty-four patients underwent CABG were randomized into
two groups. During 36 sessions, one group received IMT associated with
aerobic exercise and the other group received only aerobic exercise.
Primary outcome was the distance in the six-minute walk distance (6MWD)
test. Secondary outcomes included respiratory muscle strength, peripheral
muscle strength, and quality of life. Measures were taken at the baseline,
at the 12th session, the 24th session, and 36th session. RESULT(S):
Baseline characteristics were similar between the groups. There was no
statistically significant difference between the two groups in any outcome
[6MWD - P=0.935; peak oxygen consumption (PeakVO2) - P=0.853; maximal
inspiratory pressure (MIP) - P=0.243; maximal expiratory pressure (MEP) -
P=0.268; sitting-rising test (SRT) - P=0.212], but there was interaction
in MIP (P=0.000) and all outcomes improved in the two groups (6MWD -
P=0.000; PeakVO2 - P=0.000; MIP - P=0.000; MEP - P=0.000; SRT - P=0.000).
 CONCLUSION(S): There was an improvement of all outcomes in both
groups, but IMT was not able to provide additional benefits. The use of
this combination should be used with caution to not generate higher costs
in the rehabilitation process of these patients.

<69>
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

<70>
Accession Number
623266566
Title
Transcatheter valve-in-valve versus redo surgical aortic valve replacement
for the treatment of degenerated bioprosthetic aortic valve: A systematic
review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 92 (7) (pp 1404-1411),
2018. Date of Publication: 01 Dec 2018.
Author
Tam D.Y.; Vo T.X.; Wijeysundera H.C.; Dvir D.; Friedrich J.O.; Fremes S.E.
Institution
(Tam, Fremes) Division of Cardiac Surgery, Department of Surgery, Schulich
Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto,
Toronto, Canada
(Tam, Wijeysundera, Fremes) Institute of Health Policy, Management and
Evaluation, University of Toronto, Toronto, Canada
(Vo) Division of Cardiac Surgery, Department of Surgery, University of
Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
(Wijeysundera) Division of Cardiology, Department of Medicine, Schulich
Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto,
Toronto, Canada
(Dvir) Division of Cardiology Department of Medicine, University of
Washington Medical Centre, Seattle, WA, United States
(Friedrich) Critical Care and Medicine Departments, St. Michael's Hospital
University of Toronto, Toronto, Canada
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: To determine the safety and efficacy of valve-in-valve
transcatheter aortic valve replacement (ViV) versus redo surgical aortic
valve replacement (SAVR) for the treatment of previously failed aortic
bioprostheses. Background(s): Valve-in-valve has emerged as a
treatment option for patients with a failed aortic bioprosthesis. Evidence
for safety and efficacy remains limited to small studies. Method(s):
Medline and Embase were searched to 2017 for studies that directly
compared ViV to redo SAVR. A random effects meta-analysis was performed.
 Result(s): Four unadjusted (n = 298) and two propensity-matched (n =
200) observational studies were included. Valve-in-valve patients were
2.85-years older (P = 0.03) and were 23% higher in predicted mortality
risk (ratio of means: 1.23, 95% confidence interval (95%CI): 1.02-1.48).
There was no difference in peri-operative mortality (4.4% vs. 5.7%, P =
0.83;I2 = 0%) or late mortality, reported at median one year
follow-up (incident rate ratio (IRR) 0.93, 95%CI: 0.74-1.16, P = 0.51,
I2 = 0%) between ViV and redo SAVR. The incidence of permanent
pacemaker implantation (8.3% vs 14.6%; P = 0.05;I2 = 0%) and
dialysis (3.2% vs. 10.3%; P = 0.03; I2 = 0%) were lower in ViV.
There was a reduction in the incidence of severe patient-prosthesis
mismatch (3.3% vs 13.5%; P = 0.03; I2 = 0%) and mild or greater
paravalvular leak (5.5% vs 21.1%; P = 0.03; I2 = 37%) in the
redo SAVR group compared to ViV. Conclusion(s): Despite higher
predicted surgical risk of ViV patients, there was no difference in
mortality but less permanent pacemaker implantation and dialysis compared
to redo SAVR. Choice of treatment must be individualized for both
anatomical and patient risk factors; in high risk patients with favorable
previous prosthesis size, valve-in-valve may be preferred. Copyright
© 2018 Wiley Periodicals, Inc.

<71>
Accession Number
620572051
Title
Psychological interventions for coronary heart disease: Cochrane
systematic review and meta-analysis.
Source
European Journal of Preventive Cardiology. 25 (3) (pp 247-259), 2018. Date
of Publication: 01 Feb 2018.
Author
Richards S.H.; Anderson L.; Jenkinson C.E.; Whalley B.; Rees K.; Davies
P.; Bennett P.; Liu Z.; West R.; Thompson D.R.; Taylor R.S.
Institution
(Richards) Leeds Institute of Health Sciences, University of Leeds, Leeds,
United Kingdom
(Richards, Jenkinson) Primary Care, University of Exeter Medical School,
Exeter, United Kingdom
(Anderson, Taylor) Institute of Health Research, University of Exeter
Medical School, Exeter, United Kingdom
(Whalley) School of Psychology, University of Plymouth, Plymouth, United
Kingdom
(Rees) Division of Health Sciences, Warwick Medical School, University of
Warwick, Coventry, United Kingdom
(Davies) School of Social and Community Medicine, University of Bristol,
Bristol, United Kingdom
(Bennett) Department of Psychology, University of Swansea, Swansea, United
Kingdom
(Liu) Nuffield Department of Population Health, University of Oxford,
Oxford, United Kingdom
(West) Wales Heart Research Institute, Cardiff University, Cardiff, United
Kingdom
(Thompson) School of Nursing & Midwifery, Queen's University, Belfast,
United Kingdom
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Although psychological interventions are recommended for the
management of coronary heart disease (CHD), there remains considerable
uncertainty regarding their effectiveness. Design(s): Systematic
review and meta-analysis of randomised controlled trials (RCTs) of
psychological interventions for CHD. Method(s): The Cochrane Central
Register of Controlled Trials, MEDLINE, EMBASE, CINAHL and PsycINFO were
searched to April 2016. Retrieved papers, systematic reviews and trial
registries were hand-searched. We included RCTs with at least 6 months of
follow-up, comparing the direct effects of psychological interventions to
usual care for patients following myocardial infarction or
revascularisation or with a diagnosis of angina pectoris or CHD defined by
angiography. Two authors screened titles for inclusion, extracted data and
assessed risk of bias. Studies were pooled using random effects
meta-analysis and meta-regression was used to explore study-level
predictors. Result(s): Thirty-five studies with 10,703 participants
(median follow-up 12 months) were included. Psychological interventions
led to a reduction in cardiovascular mortality (rfcelative risk 0.79, 95%
confidence interval [CI] 0.63 to 0.98), although no effects were observed
for total mortality, myocardial infarction or revascularisation.
Psychological interventions improved depressive symptoms (standardised
mean difference [SMD] -0.27, 95% CI -0.39 to -0.15), anxiety (SMD -0.24,
95% CI -0.38 to -0.09) and stress (SMD -0.56, 95% CI -0.88 to -0.24)
compared with controls. Conclusion(s): We found that psychological
intervention improved psychological symptoms and reduced cardiac mortality
for people with CHD. However, there remains considerable uncertainty
regarding the magnitude of these effects and the specific techniques most
likely to benefit people with different presentations of
CHD. Copyright © 2017, © The European Society of Cardiology
2017.

<72>
Accession Number
621102322
Title
Cerebral autoregulation in cardiopulmonary bypass surgery: A systematic
review.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (3) (pp 494-503),
2018. Date of Publication: 01 Mar 2018.
Author
Caldas J.R.; Haunton V.J.; Panerai R.B.; Hajjar L.A.; Robinson T.G.
Institution
(Caldas, Hajjar) Department of Anesthesia, Heart Institute, University of
Sao Paulo, Surgical Intensive Care, Av. Dr. Eneas de Carvalho Aguiar 44,
Sao Paulo 05403-000, Brazil
(Caldas) Hospital Sao Rafael, Salvador, Bahia, Brazil
(Haunton, Panerai, Robinson) Department of Cardiovascular Sciences,
University of Leicester, Leicester, United Kingdom
(Panerai, Robinson) NIHR Leicester Biomedical Research Centre, University
of Leicester, Leicester, United Kingdom
(Hajjar) Department of Cardiopneumology, Heart Institute, University of
Sao Paulo, Brazil
Publisher
Oxford University Press
Abstract
Cardiopulmonary bypass surgery is associated with a high incidence of
neurological complications, including stroke, delirium and cognitive
impairment. The development of strategies to reduce the incidence of such
neurological events has been hampered by the lack of a clear understanding
of their pathophysiology. Cerebral autoregulation (CA), which describes
the ability of the brain to maintain a stable cerebral blood flow over a
wide range of cerebral perfusion pressures despite changes in blood
pressure, is known to be impaired in various neurological disorders.
Therefore, we aimed to systematically review studies reporting indices of
CA in cardiopulmonary bypass surgery. Databases such as MEDLINE, Web of
Science, Cochrane Database of Systematic Reviews and EMBASE were searched
for relevant articles. Titles, abstracts and full texts of articles were
scrutinized according to predefined selection criteria. Two independent
reviewers undertook the methodological quality screening nd data
extraction of the included studies. Twenty of 2566 identified studies were
relevant. Studies showed marked heterogeneity and weaknesses in key
methodological criteria (e.g. population size and discussion of
limitations). All but 3 of the 20 studies described impairments of CA with
cardiac surgery. Eleven studies investigated clinical outcomes, and 9 of
these found a significant relationship between these and impaired CA.
There is a general agreement that cardiac surgery is associated with
changes in CA and that clinical outcomes appear to be significantly
related to impaired CA. Further studies are now needed to determine
prognostic significance and to inform future therapeutic
strategies. Copyright © The Author 2017.

<73>
Accession Number
621102309
Title
The effect on cardiopulmonary function after thoracoplasty in pectus
carinatum: A systematic literature review.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (3) (pp 474-479),
2018. Date of Publication: 01 Mar 2018.
Author
Sigl S.; Del Frari B.; Harasser C.; Schwabegger A.H.
Institution
(Sigl, Del Frari, Harasser, Schwabegger) Department of Plastic,
Reconstructive and Aesthetic Surgery, Medical University Innsbruck,
Anichstrasse 35, Innsbruck 6020, Austria
Publisher
Oxford University Press
Abstract
OBJECTIVES: Creating an aesthetically appealing result using
thoracoplasty, especially when correcting extensive deformities, but only
causing low morbidity, is challenging. The frequency of thoracoplasties in
cases of pectus carinatum (PC) has increased due to improved experience
and modified surgical techniques, resulting in low morbidity and low
complication rates. The indications for surgical treatment are still
controversial and, in most cases, remain aesthetic or psychological rather
than physiological. However, whether cardiopulmonary function changes
after surgical repair remains a matter of controversy. We sought to
investigate and shed light on published knowledge regarding this question.
 METHOD(S): We searched MEDLINE and PubMed databases, using various
defined search phrases and inclusion criteria, to identify articles on
pre- and postoperative cardiopulmonary evaluation and outcomes.
 RESULT(S): Six studies met the inclusion criteria: 5 studies
evaluated patients with PC for cardiopulmonary outcomes after chest wall
surgery and 1 did so following conservative compression treatment. In
these studies, surgical and conservative orrection of PC did not reduce
absolute lung volumes and spirometric measurements and consequently had no
pathogenic effect on cardiopulmonary function. CONCLUSION(S): The
results of this systematic review suggest that surgical correction of PC
has no symptomatic pathogenic effect on cardiopulmonary function. The
results, however, revealed both heterogeneity in the examinations used and
inconsistent methods within each study. Further prospective trials with a
stronger methodological design are necessary to objectively confirm that
surgical correction of PC does not impair cardiopulmonary
function. Copyright © The Author 2017.

<74>
Accession Number
621102293
Title
Incidence of postoperative atrial fibrillation recurrence in patients
discharged in sinus rhythm after cardiac surgery: A systematic review and
meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (3) (pp 504-511),
2018. Date of Publication: 01 Mar 2018.
Author
Lowres N.; Mulcahy G.; Jin K.; Gallagher R.; Neubeck L.; Freedman B.
Institution
(Lowres, Freedman) Heart Research Institute, University of Sydney,
Building D17, Sydney, NSW 2006, Australia
(Lowres, Mulcahy, Freedman) Charles Perkins Centre, University of Sydney,
Sydney, Australia
(Jin, Gallagher, Neubeck) Sydney Nursing School, University of Sydney,
Sydney, Australia
(Neubeck) School of Health and Social Care, Edinburgh Napier University,
Edinburgh, United Kingdom
(Neubeck) School of Nursing and Midwifery, Faculty of Medicine, Nursing,
and Health Sciences, Flinders University, Adelaide, Australia
Publisher
Oxford University Press
Abstract
Postoperative atrial fibrillation (POAF) is associated with increased
stroke risk and mortality post-discharge. POAF is often considered
transient; however, recurrence is likely under-recognized as symptoms are
an unreliable guide. Surveillance post-discharge may identify asymptomatic
POAF recurrences in patients discharged in sinus rhythm. Therefore, we
performed a systematic review and meta-analysis of studies investigating
POAF recurrence post-discharge, in patients with new-onset POAF following
cardiac surgery who reverted to sinus rhythm prior to discharge. Two
independent reviewers searched medical databases, clinical trial
registries, reference lists and the Internet. After screening from 6525
studies, 8 studies were identified (n = 1157 participants, mean age 66 +/-
10 years and 73% men). Monitoring methods included the following:
telemetry during twice-daily exercise sessions (n = 2), continuous
telemetry for 3 weeks (n = 1), daily 20-s electrocardiography (ECG) using
wearable event recorder (n = 1), 30-s single-lead ECG, 4 times/day (n = 1)
and implanted continuous monitoring (n = 2). The incidence rate of POAF
recurrence identified through non-invasive monitoring in the first 4 weeks
post-discharge was 28.3% [confidence interval (CI) 23.0-33.6%]; recurring
12 +/- 5 days (mean +/- SD) post-surgery. The incidence rate identified
through implanted continuous monitoring was 61-100% within 2 years.
Between 40% and 93% of episodes were asymptomatic. In one small study
reporting stroke risk, 8 of 10 patients with recurrence were
guideline-indicated (CHA2DS2-VASc score >2) for oral anticoagulation for
stroke prevention. Monitoring for POAF recurrence post-hospital discharge
identifies significant numbers of early asymptomatic recurrences in
patients at high risk of stroke who may benefit from anticoagulation for
stroke prevention. More intense monitoring is more likely to identify POAF
recurrence. Future research is required to investigate the prognostic
significance of POAF recurrence, especially stroke and mortality
risk. Copyright © The Author 2017.

<75>
Accession Number
2000953084
Title
Transradial access for coronary diagnostic and interventional procedures:
Consensus statement and recommendations for India: Advancing Complex
CoronariES Sciences through TransRADIAL intervention in India - ACCESS
RADIALTM: Clinical consensus recommendations in collaboration with
Cardiological Society of India (CSI).
Source
Indian Heart Journal. 70 (6) (pp 922-933), 2018. Date of Publication:
November - December 2018.
Author
Goel P.K.; Menon A.; Mullasari A.S.; Valaparambil A.K.; Pinto B.;
Pahlajani D.; Gunasekaran S.; Trehan V.K.; Abhaichand R.K.; Chugh S.K.;
Hiremath M.S.
Institution
(Goel) Department of Cardiology, Sanjay Gandhi Post Graduate Institute of
Medical Sciences (SGPGI), India
(Menon) Department of Cardiology, Lilavati Hospital & Research Centre,
India
(Mullasari) Department of Cardiology, Madras Medical Mission, India
(Valaparambil) Department of Cardiology, Sree Chitra Tirunal Institute,
India
(Pinto) Department of Cardiology, Holy Family Hospital, India
(Pahlajani) Department of Cardiology, Beach Candy Hospital, India
(Hiremath) Department of Cardiology, Ruby Hall Clinic, India
(Gunasekaran) Department of Cardiology, Apollo Hospital, India
(Trehan) Department of Cardiology, G.B. Pant Hospital (GIPMER), India
(Abhaichand) Department of Cardiology, G.K.N.M. Hospital, India
(Chugh) Department of Cardiology, Jaipur National University Hospital,
India
Publisher
Elsevier B.V.
Abstract
Radial access for cardiac catheterization and intervention in India has
been growing steadily over the last decade with favorable clinical
outcomes. However, its usage by interventional cardiologists varies
greatly among Indian operators and hospitals due to large geographic
disparities in health care delivery systems and practice patterns. It also
remains unclear whether the advantages, as well as limitations of
transradial (TR) intervention (as reported in the western literature), are
applicable to developing countries like India or not. An evidence-based
review involving various facets of radial procedure for cardiac
catheterization, including practical, patient-related and technical issues
was conducted by an expert committee that formed a part of Advancing
Complex CoronariES Sciences through TransRADIAL intervention (ACCESS
RADIALTM) Advisory Board. Emerging challenges in redefining TR management
based on evidence supporting practices were discussed to formulate these
final recommendations through consensus. Copyright © 2018

<76>
Accession Number
625517946
Title
Transcatheter mitral valve replacement for mitral regurgitation-A
meta-analysis.
Source
Journal of Cardiac Surgery. 33 (12) (pp 827-835), 2018. Date of
Publication: December 2018.
Author
Takagi H.; Hari Y.; Kawai N.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: We performed a meta-analysis to determine the outcomes in
patients undergoing transcatheter mitral valve replacement (TMVR) for
mitral regurgitation (MR). Method(s): Databases including MEDLINE and
EMBASE were searched through April 2018 using Web-based search engines
(PubMed and OVID) to identify single-arm observational (case series)
studies of TMVR enrolling >=5 patients with MR. For each study, data
regarding observed 30-day mortality and predicted operative mortality
(Society of Thoracic Surgeons Predicted Risk of Mortality) were used to
generate risk ratios (RRs) and 95% confidence intervals (CIs).
Study-specific estimates were combined using the inverse variance-weighted
average of logarithmic RRs in the random-effects model. One-group
meta-analyses of 30-day and >30-day (including 30-day) mortality were also
performed in the random-effects model. Result(s): Of 222 potentially
relevant articles screened initially, nine eligible studies enrolling a
total of 146 patients with MR undergoing TMVR were identified. In all but
two studies, STS-PROM was available and varied from 3.3% to 15.4%
(arithmetic mean, 7.6%). Pooled analyses demonstrated 30-day mortality of
20.4% (95%CI, 9.6-31.2%), >30-day mortality of 32.0% (95%CI, 19.8-44.2%),
and non-significantly higher observed 30-day mortality than predicted
operative mortality (RR, 1.70; 95%CI, 0.85-3.42; P = 0.14). There was no
evidence of significant publication bias. Conclusion(s): TMVR for
patients with MR results in increased early and late
mortality. Copyright © 2018 Wiley Periodicals, Inc.

<77>
Accession Number
625456211
Title
Prevention of Infections in Cardiac Surgery study (PICS): Study protocol
for a pragmatic cluster-randomized factorial crossover pilot trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 688. Date of
Publication: 17 Dec 2018.
Author
Van Oostveen R.B.; Romero-Palacios A.; Whitlock R.; Lee S.F.; Connolly S.;
Carignan A.; Mazer C.D.; Loeb M.; Mertz D.
Institution
(Van Oostveen, Whitlock, Lee, Connolly, Mertz) Population Health Research
Institute (PHRI), Hamilton Health Sciences, Hamilton, ON, Canada
(Romero-Palacios, Whitlock, Connolly, Loeb, Mertz) McMaster University,
Hamilton, ON, Canada
(Carignan) Department of Microbiology and Infectious Diseases, Universite
de Sherbrooke, Sherbrooke, QC, Canada
(Carignan) Centre de Recherche du Centre Hospitalier Universitaire de
Sherbrooke, Sherbrooke, QC, Canada
(Mazer) Li Ka Shing Knowledge Institute, St. Michael's Hospital,
University of Toronto, Toronto, ON, Canada
(Mertz) Juravinski Hospital and Cancer Center, 711 Concession Street,
Hamilton, ON L8V 1C3, Canada
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: A wide range of prophylactic antibiotic regimens are used for
patients undergoing open-heart cardiac surgery. This reflects clinical
equipoise in choice and duration of antibiotic agents. Although
individual-level randomized control trials (RCT) are considered the gold
standard when evaluating the efficacy of an intervention, this approach is
highly resource intensive and a cluster RCT can be more appropriate for
testing clinical effectiveness in a real-world setting. Methods/design: We
are conducting a factorial cluster-randomized crossover pilot trial in
cardiac surgery patients to evaluate the feasibility of this design for a
definite trial to evaluate the optimal duration and choice of
perioperative antibiotic prophylaxis. Specifically, we will evaluate: (a)
the non-inferiority of a single preoperative dose compared to prolonged
prophylaxis and (b) the potential superiority of adding vancomycin to
routine cefazolin in terms of preventing deep and organ/space sternal
surgical site infections (s-SSIs). There are four strategies: (i)
short-term cefazolin, (ii) long-term cefazolin, (iii) short-term cefazolin
+ vancomycin, and (iv) long-term cefazolin + vancomycin. These strategies
are delivered in a different order in each health-care center
participating in the trial. The centers are randomized to an order, and
the current strategy becomes the standard operating procedure in that
center during the study. The three feasibility outcomes include: (1) the
proportion of patients receiving preoperative, intra-operative, and
postoperative antibiotics according to the study protocol, (2) the
proportion of completed follow-up assessments, and (3) a full and final
assessment of the incidence of s-SSIs by the outcome adjudication
committee. Discussion(s): We believe that a cluster-randomized
factorial crossover trial is an effective and feasible design for these
research questions, allowing an evaluation of the clinical effectiveness
in a real-world setting. A waiver of individual informed consent was
considered appropriate by the research ethics boards in each participating
site in Canada as long as an information letter with an opt-out option was
provided. However, a waiver of consent was not approved at two sites in
Germany and Switzerland, respectively. Trial registration:
Clinicaltrials.gov, NCT02285140. Registered on 15 October
2015. Copyright © 2018 The Author(s).

<78>
Accession Number
625448685
Title
Permanent pacemaker implantation and paravalvular leak rates following
sutureless aortic valve operations.
Source
Journal of Cardiac Surgery. 33 (12) (pp 808-817), 2018. Date of
Publication: December 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.

<79>
Accession Number
625447318
Title
Innominate artery cannulation in aortic surgery: A systematic review.
Source
Journal of Cardiac Surgery. 33 (12) (pp 818-825), 2018. Date of
Publication: December 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.

<80>
Accession Number
624544263
Title
Does No-Touch Technique Better than Conventional or Intermediate Saphenous
Vein Harvest Techniques for Coronary Artery Bypass Graft Surgery: a
Systematic Review and Meta-analysis.
Source
Journal of Cardiovascular Translational Research. 11 (6) (no pagination),
2018. Date of Publication: 01 Dec 2018.
Author
Elshafay A.; Bendary A.H.; Vuong H.T.; Ahmed A.R.; Mokhtar M.A.; Soliman
A.L.; Vuong N.L.; bestawi I.A.E.; Abdallah N.A.; Vu V.T.; Hirayama K.; Huy
N.T.
Institution
(Elshafay, Bendary, Soliman, bestawi) Faculty of Medicine, Al-Azhar
University, Cairo 11884, Egypt
(Vuong) Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho
Chi Minh City 700000, Vietnam
(Ahmed) Faculty of Pharmacy, Tanta University, Gharbia 13741, Egypt
(Mokhtar) Faculty of Medicine, Sohag University, Sohag 82738, Egypt
(Vuong) Department of Cardiovascular and Thoracic Surgery, Faculty of
Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi
Minh City 70000, Vietnam
(Vuong) Department of Medical statistic and Informatics, Faculty of Public
Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi
Minh City 70000, Vietnam
(Abdallah) Faculty of Medicine, Aswan University, Aswan 81543, Egypt
(Vu) Faculty of Public Health, University of Medicine and Pharmacy at Ho
Chi Minh City, Ho Chi Minh City 700000, Vietnam
(Hirayama) Department of Immunogenetics, Institute of Tropical Medicine
(NEKKEN), Graduate School of Biomedical Sciences, Nagasaki University,
1-12-4 Sakamoto, Nagasaki 852-8523, Japan
(Huy) Evidence Based Medicine Research Group & Faculty of Applied
Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam
(Huy) Department of Clinical Product Development, Institute of Tropical
Medicine (NEKKEN), School of Tropical Medicine and Global Health, Nagasaki
University, Nagasaki, Japan
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Saphenous vein (SV) is a common graft being used in coronary artery bypass
grafting (CABG). Conventional (CON), intermediate (I), and no-touch (NT)
are the most common harvesting techniques of SV for CABG. The aim of this
study is to systematically review the NT versus CON and I techniques in
harvesting SV for CABG. Twelve databases were searched for randomized
controlled trials comparing the CON, I, and NT techniques in harvesting SV
for CABG. Twelve reports of six RCTs were included. Our meta-analysis
showed that with NT technique, patency rate was significantly higher when
compared to I technique up to 18-month follow-up duration. In contrast,
this significant difference was not maintained in terms of minor
complications of leg wounds with both techniques. The NT has significantly
higher patency rate compared to I vein harvesting technique. However, more
RCTs are warranted to confirm these results. Copyright © 2018,
Springer Science+Business Media, LLC, part of Springer Nature.

<81>
Accession Number
625565910
Title
Costs and benefits of Papacarie in pediatric dentistry: a randomized
clinical trial.
Source
Scientific reports. 8 (1) (pp 17908), 2018. Date of Publication: 17 Dec
2018.
Author
Bottega F.; Bussadori S.K.; Battisti I.D.E.; Vieira E.P.; Pompeo T.S.;
Winkelmann E.R.
Institution
(Bottega, Vieira, Pompeo) Regional University of the Northwestern of Rio
Grande do Sul (UNIJUI), Ijui, RS, Brazil
(Bussadori) Rehabilitation Sciences and Biophotonics Applied to Heath
Science, University of Nove of Julho (UNINOVE), Sao Paulo, SP, Brazil
(Battisti) Federal University of Fronteira Sul (UFFS), Cerro Largo, RS,
Brazil
(Winkelmann) Regional University of the Northwestern of Rio Grande do Sul
(UNIJUI), Ijui, RS, Brazil
Publisher
NLM (Medline)
Abstract
Papacarie gel is an agent that eliminates the need for local anesthesia
and reduces the need for using a drill. However, there is no information
regarding the cost per procedure. Therefore we analyzed the cost, per
procedure, of Papacarie gel compared to the traditional method (drilling),
and performed a comparison between these methods of carious tissue
removal. A randomized clinical trial was performed with 24 children with
an average age of 5.9 years old. Of these children, 12 were boys and 12
were girls, which resulted in a total of 46 restorations. Patients were
separated into: Papacarie group (caries removal with the
chemical-mechanical method - Papacarie gel) and Drill group (caries
removal with the traditional method - drilling). Values of the materials
used in the procedures, heart rate (before, 5minutes during, and after
dental treatment), and the total consultation duration were recorded. A
level of significance of 5% was adopted. Papacarie had a lower cost per
procedure ($ 0.91) when compared to the traditional method ($ 1.58).
Papacarie provided a cost reduction of 42% compared to the traditional
method. Using local anesthesia ($ 2.17), the cost reduction increased to
58%. In the procedure using drill+Papacarie ($ 1.37), the cost reduction
was 33%. Heart rate, consultation duration, and number of restorations
were not statistically different. Papacarie shows an excellent cost
benefit for minimally invasive removal of carious tissue and is a feasible
alternative for public health care.

<82>
Accession Number
625565801
Title
Precision-Exercise-Prescription in patients with lung cancer undergoing
surgery: rationale and design of the PEP study trial.
Source
BMJ open. 8 (12) (pp e024672), 2018. Date of Publication: 16 Dec 2018.
Author
Ulrich C.M.; Himbert C.; Boucher K.; Wetter D.W.; Hess R.; Kim J.;
Lundberg K.; Ligibel J.A.; Barnes C.A.; Rushton B.; Marcus R.; Finlayson
S.R.G.; LaStayo P.C.; Varghese T.K.
Institution
(Ulrich, Himbert, Boucher, Wetter, Kim, Rushton) Huntsman Cancer
Institute, Salt Lake City, UT, United States
(Ulrich, Himbert, Wetter, Hess) Department of Population Health Sciences,
University of Utah, Salt Lake City, UT, United States
(Boucher) Division of Epidemiology, University of Utah, Salt Lake City,
UT, United States
(Hess) Division of General Internal Medicine, University of Utah, Salt
Lake City, UT, United States
(Kim) Department of Health and Kinesiology, University of Utah, Salt Lake
City, UT, United States
(Lundberg) Department of Psychiatry, University of Utah, Salt Lake City,
UT, United States
(Ligibel) Dana-Farber Cancer Institute, Harvard Medical School, Boston,
MA, United States
(Barnes, Marcus, LaStayo) Department of Physical Therapy and Athletic
Training, University of Utah, Salt Lake City, UT, United States
(Finlayson, Varghese) Department of Surgery, University of Utah, Salt Lake
City, UT, United States
(Varghese) Division of Cardiothoracic Surgery, University of Utah, Salt
Lake City, UT, United States
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Lung cancer is a significant burden on societies worldwide,
and the most common cause of death in patients with cancer overall.
Exercise intervention studies in patients with lung cancer have
consistently shown benefits with respect to physical and emotional
functioning. However, to date, exercise training has not been consistently
implemented into clinical practice given that interventions have been
costly and not aligned with clinical care. METHODS/DESIGN: The
Precision-Exercise-Prescription (PEP) study is a prospective randomised
controlled trial comparing the effectiveness and feasibility of a
personalised intervention exercise programme among patients with lung
cancer undergoing surgery. Two-hundred patients who are diagnosed with
stage primary or secondary lung cancer and are eligible to undergo
surgical treatment at Huntsman Cancer Institute comprise the target
population. Patients are randomised to either the (1) outpatient
precision-exercise intervention group or (2) delayed intervention group.
The intervention approach uses Motivation and Problem Solving, a hybrid
behavioural treatment based on motivational interviewing and practical
problem solving. The dosage of the exercise intervention is personalised
based on the individual's Activity Measure for Post-Acute-Care outpatient
basic mobility score, and incorporates four exercise modes: mobility,
callisthenics, aerobic and resistance. Exercise is implemented by physical
therapists at study visits from presurgery until 6 months postsurgery. The
primary endpoint is the level of physical function assessed by 6min walk
distance at 2 months postsurgery. Secondary outcomes include
patient-reported outcomes (eg, quality of life, fatigue and self-efficacy)
and other clinical outcomes, including length of stay, complications,
readmission, pulmonary function and treatment-related costs up to 6 months
postsurgery. ETHICS/DISSEMINATION: The PEP study will test the clinical
effectiveness and feasibility of a personalised exercise intervention in
patients with lung cancer undergoing surgery. Outcomes of this clinical
trial will be presented at national and international conferences and
symposia and will be published in international, peer-reviewed journals.
Ethics approval was obtained at the University of Utah (IRB 00104671).
TRIAL REGISTRATION NUMBER: NCT03306992. Copyright © Author(s) (or
their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial
re-use. See rights and permissions. Published by BMJ.

<83>
Accession Number
625552697
Title
Management of Atrial Fibrillation in Patients Undergoing Coronary Artery
Bypass Grafting: Review of the Literature.
Source
Innovations (Philadelphia, Pa.). 13 (6) (pp 383-390), 2018. Date of
Publication: 01 Nov 2018.
Author
Khiabani A.J.; Adademir T.; Schuessler R.B.; Melby S.J.; Moon M.R.;
Damiano R.J.
Institution
(Khiabani) From the Division of Cardiothoracic Surgery, Department of
Surgery, Washington University School of Medicine, Barnes-Jewish Hospital,
St. Louis
Publisher
NLM (Medline)
Abstract
Untreated atrial fibrillation is associated with an increased risk of
all-cause mortality and morbidity. Despite the current guidelines
recommending surgical ablation of atrial fibrillation at the time of
coronary artery bypass surgery, most patients with concomitant atrial
fibrillation and coronary artery disease do not receive surgical ablation
for their atrial fibrillation. This review reports the efficacy of
different surgical ablation techniques used for the treatment of atrial
fibrillation during coronary artery bypass. PubMed was systematically
searched for studies reporting outcomes of concomitant surgical ablation
in coronary artery bypass patients between January 2002 and March 2018.
Data were independently extracted and analyzed by two investigators.
Twenty-four studies were included. Twelve studies exclusively reported
outcomes of surgical ablation in patients undergoing coronary artery
bypass, whereas the remaining 12 reported outcomes of concomitant cardiac
surgery with subgroup analysis. Only four studies performed the
concomitant Cox-Maze procedure. Freedom from atrial tachyarrhythmia was
reported as high as 98% at 1 year and 76% at 5 years with Cox-Maze
procedure, whereas lesser lesion sets had more variable outcomes, ranging
from 35% to 93%. In most studies, the addition of surgical ablation was
not associated with increased morbidity and mortality. Although the
Cox-Maze procedure had the greatest short- and long-term success rates,
most studies comprising the evidence documenting the safety and efficacy
of adding surgical ablation were of low or moderate quality. There was a
great deal of heterogeneity among study populations, follow-up times,
methods, and definition of failure. To establish a consensus regarding a
surgical ablation technique for atrial fibrillation in coronary artery
bypass population, larger multicenter randomized controlled studies need
to be designed.

<84>
Accession Number
625552665
Title
Robotic Thoracic Surgery Training for Residency Programs: A Position Paper
for an Educational Curriculum.
Source
Innovations (Philadelphia, Pa.). 13 (6) (pp 417-422), 2018. Date of
Publication: 01 Nov 2018.
Author
Raad W.N.; Ayub A.; Huang C.-Y.; Guntman L.; Rehmani S.S.; Bhora F.Y.
Institution
(Huang) Department of General Surgery, Brookdale University Hospital and
Medical Center, Brooklyn, Australia
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Robotic-assisted surgery is increasingly being used in thoracic
surgery. Currently, the Integrated Thoracic Surgery Residency Program
lacks a standardized curriculum or requirement for training residents in
robotic-assisted thoracic surgery. In most circumstances, because of the
lack of formal residency training in robotic surgery, hospitals are
requiring additional training, mentorship, and formal proctoring of cases
before granting credentials to perform robotic-assisted surgery.
Therefore, there is necessity for residents in Integrated Thoracic Surgery
Residency Program to have early exposure and formal training on the
robotic platform. We propose a curriculum that can be incorporated into
such programs that would satisfy both training needs and hospital
credential requirements. METHOD(S): We surveyed all 26 Integrated
Thoracic Surgery Residency Program Directors in the United States. We also
performed a PubMed literature search using the key word "robotic surgery
training curriculum." We reviewed various robotic surgery training
curricula and evaluation tools used by urology, obstetrics gynecology, and
general surgery training programs. We then designed a proposed curriculum
geared toward thoracic Integrated Thoracic Surgery Residency Program
adopted from our credentialing experience, literature review, and survey
consensus. RESULT(S): Of the 26 programs surveyed, we received 17
responses. Most Integrated Thoracic Surgery Residency Program directors
believe that it is important to introduce robotic surgery training during
residency. Our proposed curriculum is integrated during postgraduate years
2 to 6. In the preclinical stage postgraduate years 2 to 3, residents are
required to complete introductory online modules, virtual reality
simulator training, and in-house workshops. During clinical stage
(postgraduate years 4-6), the resident will serve as a supervised bedside
assistant and progress to a console surgeon. Each case will have defined
steps that the resident must demonstrate competency. Evaluation will be
based on standardized guidelines. CONCLUSION(S): Expansion and
utilization of robotic assistance in thoracic surgery have increased. Our
proposed curriculum aims to enable Integrated Thoracic Surgery Residency
Program residents to achieve competency in robotic-assisted thoracic
surgery and to facilitate the acquirement of hospital privileges when they
enter practice.

<85>
Accession Number
625553255
Title
Stented Versus Stentless Aortic Valve Replacement in Patients With Small
Aortic Root: A Systematic Review and Meta-Analysis.
Source
Innovations (Philadelphia, Pa.). 13 (6) (pp 404-416), 2018. Date of
Publication: 01 Nov 2018.
Author
Harky A.; Wong C.H.M.; Hof A.; Froghi S.; Ahmad M.U.; Howard C.; Rimmer
L.; Bashir M.
Institution
(Wong) Faculty of Medicine, Chinese University of Hong Kong, Hong Kong,
China
(Hof, Froghi) Department of Cardiovascular Surgery,
Heinrich-Heine-University, Medical Faculty, Germany
(Ahmad, Howard, Rimmer) School of Medicine, University of Liverpool,
Liverpool, United Kingdom
(Bashir) Manchester Royal Infirmary, Manchester, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The aim of the study was to compare hemodynamic and
perioperative outcomes of stented against stentless aortic valve
replacement in patients with small aortic root (21 mm or less).
 METHOD(S): A comprehensive search was undertaken among the four major
databases (PubMed, Embase, Scopus, and Ovid) to identify all randomized
and nonrandomized controlled trials comparing stentless to stented
bioprosthetic valves in small aortic root patients. Odds ratios, weighted
mean differences, or standardized mean differences and their 95%
confidence intervals were analyzed. RESULT(S): A total of seven
studies with a total of 965 patients fulfilled the inclusion criteria.
There was no significant difference in preoperative baselines including
mean age between both groups (P = 0.08), peak aortic valve gradient (P =
0.06), and effective orifice area (P = 0.28), whereas higher mean aortic
valve gradient in the stented group (P = 0.007). No difference in
cardiopulmonary bypass time (P = 0.74), aortic cross-clamp times (P =
0.88), intensive care unit stay (P = 0.13), and stroke rate (P = 0.56)
were noted. However, stented group of patients showed higher rate of
patient prosthesis mismatch (P = 0.0001) and longer total hospital stay (P
= 0.002). Postoperatively, stentless group showed lower peak and mean
aortic valve gradient (P = 0.003 and P = 0.008, respectively) with a
better effective orifice area (P < 0.00001) at 6 months of follow-up.
Mortality rates while in-hospital and at 1 year were similar in both
groups (P = 0.94 and P = 0.86, respectively). CONCLUSION(S):
Stentless aortic valves offer superior short-term hemodynamic outcomes in
patients with small aortic root when compared with stented aortic valves.
Although both groups have similar perioperative complications rates,
stentless valves bring about a shorter hospital stay. A further large
multicenter randomized controlled trial should address the longer-term
benefit of stentless aortic valve over stented valve.

<86>
Accession Number
625564041
Title
Survival Advantage of MitraClip Over Medical Treatment in Patients with
Mitral Regurgitation: A Meta-Analysis.
Source
The Journal of heart valve disease. 26 (6) (pp 651-658), 2017. Date of
Publication: 01 Nov 2017.
Author
Benito-Gonzalez T.; Estevez-Loureiro R.; Iglesias-Garriz I.; Gualis J.;
Perez de Prado A.; Garrote C.; Swaans M.J.; S Van der Heyden J.A.; Feldman
T.; Giannini C.; Alonso D.; Rodriguez-Santamarta M.; Castano M.;
Fernandez-Vazquez F.
Institution
(Benito-Gonzalez, Estevez-Loureiro, Iglesias-Garriz, Perez de Prado,
Garrote, Alonso, Rodriguez-Santamarta, Fernandez-Vazquez) Department of
Cardiology, University Hospital of Leon, Leon, Spain
(Gualis, Castano) Department of Cardiac Surgery, University Hospital of
Leon, Leon, Spain
(Swaans, S Van der Heyden) Department of Cardiology, St. Antonius
Hospital, Nieuwegein, Netherlands
(Feldman) Cardiology Division, Evanston Hospital, NorthShore University
Health System, Evanston, IL, United States
(Giannini) Cardiac, Thoracic and Vascular Department, Azienda
Ospedaliero-Universitaria, Pisa, Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: The MitraClip system is a percutaneous treatment for mitral
regurgitation (MR) that has shown promising results in patients who are
inoperable or at high risk for mitral surgery. Data on the efficacy of the
system over optimal medical therapy, above all in patients with functional
MR, are scarce. The study aim was to assess the effect of MitraClip on the
survival of patients with moderate/severe or severe MR compared to medical
therapy, using meta-analytical techniques. METHOD(S): Independently,
reviewers searched electronically for relevant articles based on
predefined criteria and end-points. Only articles with a comparison
between MitraClip and conservative therapy were included. Standard
meta-analysis techniques were used. The primary outcomes were 30-day and
one-year mortalities. RESULT(S): Five observational reports were
included that enrolled a total of 1,271 patients: 720 patients underwent
percutaneous mitral valve repair (PMVR) with the MitraClip device, and 551
were managed conservatively. A total of 49 all-cause mortality events was
reported at 30 days: 3.05% (22/720) in the PMVR arm, and 4.90% (27/510) in
the conservative group, with no significant differences in all-cause
mortality (OR 0.64; 95% CI 0.36-1.14). A total of 269 all-cause mortality
events at one year was reported: 15.14% (109/720) in the PMVR arm, and
29.04% (160/551) in the conservative group. A significant difference
favoring PMVR with the MitraClip system over medical therapy alone was
observed (OR 0.44; 95% CI 0.30-0.64, p <0.0001). Neither significance
between study heterogeneity (p = 0.18) nor publication bias was detected
(p = 0.3). CONCLUSION(S): PMVR with the MitraClip system may be
associated with an improvement in one-year survival compared to
stand-alone medical management.

<87>
Accession Number
625574201
Title
Comparing the conventional 15 cm and the C-length approaches for central
venous catheter placement.
Source
Journal of Cardiovascular and Thoracic Research. 10 (4) (pp 221-226),
2018. Date of Publication: 2018.
Author
Jarineshin H.; Sharifi M.; Kashani S.
Institution
(Jarineshin, Sharifi, Kashani) Anesthesiology, Critical Care and Pain
Management Research Center, Hormozgan University of Medical Sciences,
Bandar Abbas, Iran, Islamic Republic of
Publisher
Tabriz University of Medical Sciences (E-mail: tmj@taibahu.edu.sa)
Abstract
Introduction: The present guidelines recommend placing the catheter tip in
the superior vena cava (SVC) above the pericardial cephalic reflection.
The aim of this study was to compare the accuracy of two different
approaches in locating the tip of the Central venous catheter (CVC) at the
suggested vascular zone. Method(s): This was an interventional study
on two hundred patients undergoing Coronary artery bypass surgery (CABG)
operation who required a central venous cannulation. They were randomly
assigned into two groups. in the first group catheter placement was
applied through using the conventional 15 cm method. in the second group a
C-length method was applied for measuring the depth of catheter tip
placement from the preoperative chest radiographs. For statistical
analysis Chi-square test and T-test were used. Result(s): in the
first group (15 cm) 100% of the patients had their catheters placed below
the C-line (Carina line) and the average distance between the catheter tip
and the C-line was +4.22+/-2.10 cm. in the second (C-Length) group 52% of
the catheters were below C-line with an average distance of +0.77+/-0.5
cm. There was a meaningful difference between the two groups in respect to
the catheter location depth and zone of placement (P<0.001).
 Conclusion(s): The C-Length approach in comparison to the
conventional 15 cm approach resulted in a considerable higher number of
catheters above the recommended C-line, thus it can provide a more
reliable and safe mode for CVC placement in the SVC. Copyright ©
2018 The Author (s).

<88>
Accession Number
625573701
Title
Influence of arm position during infraclavicular subclavian vein
catheterization in coronary artery bypass graft surgery.
Source
Journal of Cardiovascular and Thoracic Research. 10 (4) (pp 192-196),
2018. Date of Publication: 2018.
Author
Tarbiat M.; Davoudi M.; Salimbahrami S.A.
Institution
(Tarbiat, Davoudi, Salimbahrami) Clinical Research Development Unit of
Farshchian Heart Center, Department of Anesthesiology, School of Medicine,
Hamadan University of Medical Sciences, Hamadan, Iran, Islamic Republic of
Publisher
Tabriz University of Medical Sciences (E-mail: tmj@taibahu.edu.sa)
Abstract
Introduction: Percutaneous subclavian vein catheterization via
infraclavicular approach is one of the most widely used cannulation
techniques for inserting catheters into a central vein. The aim of this
study was to evaluate influence of arm position during infraclavicular
subclavian vein catheterization with landmark-based technique in coronary
artery bypass graft (CABG) surgery. Method(s): Between September 2017
and June 2018, this prospective randomized clinical trial was performed in
320 patients. The patients were randomly assigned to the Neutral group
(the arms kept by the side) or Abduction group (the arm was abducted to
90degree). The success and complication rates were compared in the two
groups. The data were analyzed using SPSS software. Result(s): in the
first attempt of subclavian vein cannulation, the success rate had no
significant difference between the two groups (P= 0.185). in the second
attempt of catheterization, the success rate in Abduction group (40.5%)
was lower than Neutral group (81.2%). The overall success rate in two
attempts were (84.4%) in the Abduction group and (96.2%) in the Neutral
group. There was a significant difference between two groups in the second
and overall success rates (P= 0.0001). In 34 (10.6%) patients, subclavian
artery puncture occurred, 30 (18.8%) in the Abduction group and 4 (2.5%)
in the Neutral group. There was a significant difference between two
groups (P= 0.0001). Pneumothorax was occurred in 15 (9.4%) in the
Abduction group and 3 (1.9%) in the Neutral group. There was also a
significant difference between two groups (P= 0.004). The differences in
other complications on two groups were statistically insignificant.
 Conclusion(s): Compared with Abduction group, the Neutral group
resulted in higher success rate and fewer subclavian artery puncture and
pneumothorax. The incidences of other complications were similar on both
groups. Copyright © 2018 The Author (s).

<89>
Accession Number
2001399799
Title
Quadruple valve infective endocarditis presenting with suspected Austrian
syndrome: a case report and a case series of quadruple valve infective
endocarditis.
Source
Diagnostic Microbiology and Infectious Disease. (no pagination), 2018.
Date of Publication: 2018.
Author
Zheng S.; Soh J.X.J.; Shafi H.
Institution
(Zheng) Department of Infectious Diseases, Singapore General Hospital,
Outram Road, Singapore 169608, South Africa
(Soh) Department of General Medicine, Sengkang General Hospital, 110
Sengkang E Way, Singapore 544886, South Africa
(Shafi) Division of Infectious Diseases, Changi General Hospital, 2 Simei
Street 3, Singapore 529889, South Africa
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: Austrian syndrome comprises the triad of pneumonia,
meningitis, and endocarditis secondary to Streptococcus pneumonia. We
present what we believe to be the first reported case of Austrian syndrome
with quadruple heart valve involvement and review the literature detailing
cases of quadruple valve infective endocarditis. Case presentation and
results: A case is presented of a patient with radiographic evidence of a
left lower lobe pneumonia. Sequential transthoracic followed by
transesophageal echocardiogram done to evaluate the presence of a cardiac
murmur revealed the presence of quadruple valve vegetations. Multiple
blood cultures were persistently negative. The patient went on to develop
seizures secondary to proven meningitis. Microbiological diagnosis was
eventually established through positive Streptococcus pneumoniae antigen
(Alere BinaxNOW) from cerebrospinal fluid, establishing a presumptive
clinical diagnosis of Austrian syndrome. A computerized PubMed search for
reports of quadruple valve infective endocarditis and their references was
collated. A total of 22 patients were found, including our patient. The
median age of presentation was 47.5 years. Five patients had a history of
intravenous drug abuse, another 5 had underlying congenital heart disease,
and 1 had both. Two patients (9.1%) had 2 microorganisms isolated.
Staphylococcus aureus and Streptococcus viridans (3 cases, 13.6% each)
were the most commonly implicated microorganism. Heart failure was the
commonest complication, afflicting 11 patients (50.0%). Ten patients
(45.5%) underwent surgery. Overall case fatality rate was 50.0%. Cardiac
surgery was of statistical significance in predicting survival (P =
0.009). Conclusion(s): Quadruple valve endocarditis is associated
with a high mortality rate, and cardiac surgery may be
protective. Copyright © 2018 Elsevier Inc.

<90>
Accession Number
2001397683
Title
ECMO support for late presenting arterial switch operation; case report
and review of literature.
Source
Egyptian Journal of Critical Care Medicine. (no pagination), 2018. Date of
Publication: 2018.
Author
Kabbani M.S.; Hamadah H.K.
Institution
(Kabbani, Hamadah) Division of Pediatric Cardiac Intensive Care, Cardiac
Science Department, King Abdulaziz Medical City, Ministry of National
Guard Health Affairs, Riyadh, Saudi Arabia
(Kabbani) King Saud Bin Abdulaziz University for Health Sciences, Riyadh,
Saudi Arabia
Publisher
Egyptian College Of Critical Care Physicians
Abstract
Infants presenting for late arterial switch operation are at risk of
myocardial depression and cardiac arrest due left ventricle
deconditioning. In this report we present a female infant diagnosed to
have transposition of great arteries (TGA) with intact septum who
presented at 3 months of age for late arterial switch operation. Prior to
surgery, the left ventricle size and mass index appeared to be
satisfactory in term of muscular size and function. She underwent late
arterial switch operation (ASO). Soon after surgery, the infant developed
myocardial depression with hemodynamic instability and high left atrial
pressure associated with left atrial dilatation. ECMO was deployed and
patient stayed 10 days on ECMO until left cardiac function recovered. The
infant was decannulated successfully and was subsequently discharged home
with acceptable cardiac function. In conclusion, patients presenting for
late arterial switch operation are at risk for left ventricular
deconditioning and pulmonary hypertension. Deconditioned left ventricle
may fail post repair with inability to handle systemic circulation. Among
limited options for these challenging cases primary ASO with integrated
ECMO support can be used to allow deconditioned left ventricle to recover
its function and ability to handle systemic circulation. Copyright
© 2018

<91>
Accession Number
2001391669
Title
Moderate-to-high intensity inspiratory muscle training improves the
effects of combined training on exercise capacity in patients after
coronary artery bypass graft surgery: A randomized clinical trial.
Source
International Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Author
dos Santos T.D.; Pereira S.N.; Portela L.O.C.; Cardoso D.M.; Lago P.D.;
dos Santos Guarda N.; Moresco R.N.; Pereira M.B.; de Albuquerque I.M.
Institution
(dos Santos, Pereira, de Albuquerque) Functional Rehabilitation Graduate
Program, Department of Physiotherapy and Rehabilitation, Universidade
Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
(Pereira) Cardiology Service of Hospital Universitario de Santa Maria
(HUSM), Empresa Brasileira de Servicos Hospitalares (EBSERH), Santa Maria,
Rio Grande do Sul, Brazil
(Portela) Laboratory of Performance in Simulated Environment, Department
of Collective Sports, Universidade Federal de Santa Maria (UFSM), Santa
Maria, Rio Grande do Sul, Brazil
(Cardoso) Pneumological Sciences Graduate Program, Universidade Federal do
Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
(Lago) Research Group on Cardiopulmonary Interaction (GPIC), Health
Sciences Graduate Program, Universidade Federal de Ciencias da Saude de
Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
(dos Santos Guarda, Moresco) Laboratory of Clinical Biochemistry,
Department of Clinical and Toxicological Analysis, Universidade Federal de
Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
(Pereira) Hospital Universitario de Santa Maria (HUSM), Empresa Brasileira
de Servicos Hospitalares (EBSERH), Santa Maria, Rio Grande do Sul, Brazil
Publisher
Elsevier Ireland Ltd
Abstract
Background: The effects of adding moderate-to-high intensity inspiratory
muscle training (IMT) to short-term aerobic and resistance exercise
(combined training [CT]), after coronary artery bypass grafting (CABG) are
not established. This study aimed to determine the effects of
moderate-to-high intensity IMT + CT on exercise capacity, respiratory
muscle strength, inspiratory muscle endurance, quality of life (QoL), and
laboratory biomarkers in patients after CABG who were participants of a
phase II cardiac rehabilitation program. Method(s): Twenty-four
patients were randomly assigned to either the IMT + CT group (n = 12), who
performed moderate-to-high intensity IMT with CT or the sham-IMT + CT
group (n = 12). Patients completed two sessions per week for 12 weeks.
Each patient underwent a cardiopulmonary exercise test, six-minute walk
test (6MWT), respiratory muscle strength and endurance evaluation, QoL
questionnaire, and serum advanced oxidation protein products, ferric
reducing antioxidant power [FRAP], nitrate/nitrate, and high-sensitivity
C-reactive protein, before and after the 12-week intervention.
 Result(s): The IMT + CT group showed significantly greater
improvements in peak oxygen uptake (1.3
mL.kg-1.min-1; 95% confidence interval [95% CI], 0.5
to 2.2), distance covered during the 6MWT (78.8 m; 95% CI, 28.1 to 129.5),
maximal inspiratory pressure (23.0 cmH<inf>2</inf>O; 95% CI, 9.3 to 36.7),
QoL (-15.1 points; 95% CI, -26.9 to -3.3), and FRAP (83.7 mumol/L; 95% CI,
20.2 to 147.1) compared to the sham-IMT + CT group as a result of the
intervention. Conclusion(s): Short-term moderate-to-high intensity
IMT with CT provided additional benefits in exercise capacity, inspiratory
muscle strength, QoL, and antioxidant profile in patients after CABG.
Trial Registration clinicaltrials.gov Identifier:
NCT02885077 Copyright © 2018 Elsevier B.V.

<92>
Accession Number
625571944
Title
GLP1 Receptor Agonist Liraglutide Is an Effective Therapeutic Option for
Perioperative Glycemic Control in Type 2 Diabetes within Enhanced Recovery
after Surgery (ERAS) Protocols.
Source
European Surgical Research. (pp 349-360), 2018. Date of Publication: 2018.
Author
Kaneko S.; Ueda Y.; Tahara Y.
Institution
(Kaneko, Ueda, Tahara) Division of
Diabetes/Endocrinology/Lifestyle-Related Disease, Takatsuki Red Cross
Hospital, 1-1-1 Abuno, Takatsuki, Osaka 562-1045, Japan
Publisher
S. Karger AG
Abstract
Background: Enhanced Recovery After Surgery (ERAS) protocols are
multimodal perioperative care pathways designed to achieve early recovery
after surgical procedures by maintaining preoperative organ function and
reducing profound stress responses following surgery [Wilmore and Kehlet:
BMJ 2001; 322(7284): 473-6]. Glucagon-like peptide-1 receptor agonists
(GLP-1RAgs), such as liraglutide, have recently been widely used as
antidiabetic agents in patients with type 2 diabetes (T2D) because they
maintain blood glucose at an ideal level throughout the day, including
during postprandial periods, thereby improving hypoglycemia and body
weight more than insulin therapies. Additionally, the administration of
liraglutide may exert cardiovascular, renal, and cerebral protective
effects in T2D patients. The use of GLP-1RAgs for perioperative glycemic
control is sometimes considered to be controversial. Method(s): The
efficacy and safety of liraglutide therapy during perioperative glycemic
control in elective surgery patients within ERAS protocols were compared
with those of insulin therapy. Ninety adult T2D patients scheduled to
undergo elective surgery within ERAS protocols were randomized and
analyzed. Forty-nine subjects were prescribed liraglutide and 41 insulin
therapy. Procedures comprised orthopedic, thoracic, urological,
otolaryngological, hepatic resection, and gynecological breast surgeries.
 Result(s): Liraglutide was shown to be a more effective option than
insulin therapy because (1) glycemic levels were more stable; (2) the
number of patients requiring additional insulin according to the insulin
sliding scale was significantly smaller (Fisher's exact test, p = 0.005);
(3) the insulin dosage required on the day of surgery was significantly
smaller (Fisher's exact, p = 0.004); (4) the additional insulin volume
required was significantly less for patients throughout the perioperative
period (Fisher's exact test, p = 0.001); and (5) while lean body mass
remained the same, body fat measurements, particularly visceral fat,
tended to decrease. Conclusion(s): Based on the results of the
present study and a recent large-scale clinical study showing
cardiovascular and renal protective effects in T2D patients, we consider
the administration of liraglutide within ERAS protocols for T2D patients
to represent a more comprehensive suite of patient protection measures as
a perioperative non-insulin agent, particularly in patients with limited
exercise ability and those at risk of hypoglycemia. Copyright ©
2018 S. Karger AG, Basel.

<93>
Accession Number
625544649
Title
Glycaemic efficacy and safety of linagliptin compared to a basal-bolus
insulin regimen in patients with type 2 diabetes undergoing non-cardiac
surgery: A multicentre randomized clinical trial.
Source
Diabetes, Obesity and Metabolism. (no pagination), 2018. Date of
Publication: 2018.
Author
Vellanki P.; Rasouli N.; Baldwin D.; Alexanian S.; Anzola I.; Urrutia M.;
Cardona S.; Peng L.; Pasquel F.J.; Umpierrez G.E.; Bakhtiari H.; Wang
C.L.; Jones J.; Modzelewski K.; Ensminger E.; Haw J.S.; Fayfman M.; Ramos
C.; Gomez P.
Institution
(Vellanki, Anzola, Urrutia, Cardona, Pasquel, Umpierrez) Division of
Endocrinology, Metabolism and Lipids, Department of Medicine, Emory
University School of Medicine, Atlanta, GA, United States
(Rasouli) Division of Endocrinology, Metabolism and Diabetes, Department
of Medicine, University of Colorado-Denver, Denver, CO, United States
(Baldwin) Division of Endocrinology, Department of Medicine, Rush
University Medical Center, Chicago, IL, United States
(Alexanian) Division of Endocrinology, Diabetes and Nutrition, Department
of Medicine, Boston University, Boston, MA, United States
(Peng) Department of Biostatistics, Rollins School of Public Health, Emory
University, Atlanta, GA, United States
(Bakhtiari, Wang) University of Colorado, Division of Endocrinology,
United States
(Jones) Rush University, Division of Endocrinology, United States
(Modzelewski, Ensminger) Boston University, Division of Endocrinology,
United States
(Haw, Fayfman, Ramos, Gomez) Emory University, Division of Endocrinology,
Metabolism and Lipids, United States
Publisher
Blackwell Publishing Ltd
Abstract
Aims: The use of incretin-based therapy, rather than or complementary to,
insulin therapy is an active area of research in hospitalized patients
with type 2 diabetes (T2D). We determined the glycaemic efficacy and
safety of linagliptin compared to a basal-bolus insulin regimen in
hospitalized surgical patients with T2D. Material(s) and Method(s):
This prospective open-label multicentre study randomized T2D patients
undergoing non-cardiac surgery with admission blood glucose (BG) of 7.8 to
22.2 mmol/L who were under treatment with diet, oral agents or total
insulin dose (TDD) <= 0.5 units/kg/day to either linagliptin (n = 128)
daily or basal-bolus (n = 122) with glargine once daily and rapid-acting
insulin before meals. Both groups received supplemental insulin for BG >
7.8 mmol/L. The primary endpoint was difference in mean daily BG between
groups. Result(s): Mean daily BG was higher in the linagliptin group
compared to the basal-bolus group (9.5 +/- 2.6 vs 8.8 +/- 2.3 mmol/L/dL, P
= 0.03) with a mean daily BG difference of 0.6 mmol/L (95% confidence
interval 0.04, 1.2). In patients with randomization BG < 11.1 mmol/L (63%
of cohort), mean daily BG was similar in the linagliptin and basal-bolus
groups (8.9 +/- 2.3 vs 8.7 +/- 2.3 mmol/L, P = 0.43); however, patients
with BG >= 11.1 mmol/L who were treated with linagliptin had higher BG
compared to the basal-bolus group (10.9 +/- 2.6 vs 9.2 +/- 2.2 mmol/L, P <
0.001). Linagliptin resulted in fewer hypoglycaemic events (1.6% vs 11%, P
= 0.001; 86% relative risk reduction), with similar supplemental insulin
and fewer daily insulin injections (2.0 +/- 3.3 vs 3.1 +/- 3.3, P < 0.001)
compared to the basal-bolus group. Conclusion(s): For patients with
T2D undergoing non-cardiac surgery who presented with mild to moderate
hyperglycaemia (BG < 11.1 mmol/L), daily linagliptin is a safe and
effective alternative to multi-dose insulin therapy, resulting in similar
glucose control with lower hypoglycaemia. Copyright © 2018 John
Wiley & Sons Ltd

<94>
Accession Number
625543899
Title
A Systematic Review of Caudal Anesthesia and Postoperative Outcomes in
Pediatric Cardiac Surgery Patients.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Author
Maharramova M.; Taylor K.
Institution
(Maharramova, Taylor) Hospital for Sick Children, Toronto, ON, Canada
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objectives. In pediatric cardiac surgery, does caudal anesthesia promote
early extubation, reduce pain scores, reduce stress responses, and length
of stay (LOS)? Design. A systematic review. Participants. Inclusion
criteria included cardiac surgical procedures (with or without
cardiopulmonary bypass) in any subject between the ages of full-term
newborn and 18 years receiving caudal anesthesia of any medication
combination. Searches were conducted with assistance of an Academic
librarian from 1947 to July 2017. Methods. Relevant studies selected were
randomized trials or cohort studies. Results. The total number of patients
was 2159 in 17 studies. There were 8 prospective randomized clinical
trials and 9 cohort studies. Caudal medications included dexmedetomidine,
bupivacaine, sufentanil, morphine, fentanyl, and neostigmine. Nine studies
reported earlier extubation in patients with caudal anesthesia.
Cardiopulmonary bypass and surgical duration mitigated early extubation
anesthetic strategies. Three of 5 studies showed reduced pain scores and
need for opiates, 2 studies showed no difference. Two of 3 studies showed
a reduction in stress response. Hemodynamic assessments were improved in 2
studies and unchanged in 3 studies. Four studies showed reduced hospital
LOS. Studies are difficult to interpret because of the comparative
techniques used. Conclusions. The data quality in this review is too poor
to make recommendations regarding incorporation of caudal anesthesia into
clinical practice. Caudal anesthesia may be favorable for early
extubation, improved pain, and hemodynamics and reduced LOS. There are
many other anesthetic alternatives to facilitate early extubation. Our
review is limited by heterogeneous populations, variable pain measurement
scales, and absent definitions of extubation indicators. Copyright
© The Author(s) 2018.

<95>
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

<96>
Accession Number
620004534
Title
The association between hope, marital status, depression and persistent
pain in men and women following cardiac surgery.
Source
BMC Women's Health. 18 (1) (no pagination), 2018. Article Number: 2. Date
of Publication: 02 Jan 2018.
Author
Bjornnes A.K.; Parry M.; Lie I.; Falk R.; Leegaard M.; Rustoen T.
Institution
(Bjornnes, Rustoen) Oslo University Hospital, Ulleval, Department of
Research and Development, Division of Emergencies and Critical Care,
Nydalen, P.O Box 4956, Oslo 0424, Norway
(Bjornnes, Parry) University of Toronto, Lawrence S. Bloomberg Faculty of
Nursing, 155 College Street, Suite 130, Toronto, ON M5T 1P8, Canada
(Lie) Oslo University Hospital, Ulleval, Center for patient centered
heart- and lung research, Department of Cardiothoracic Surgery, Division
of Cardiovascular and Pulmonary Diseases, Nydalen, P.O Box 4956, Oslo
0424, Norway
(Falk) Oslo University Hospital, Ulleval, Oslo Centre for Biostatistics
and Epidemiology, Research Support Services, Nydalen, P.O Box 4956, Oslo
0424, Norway
(Leegaard) Oslo and Akershus University College of Applied Sciences,
Faculty of Health Sciences, Institute of Nursing, St. Olavs Plass, P.O Box
4, Oslo N-0130, Norway
(Rustoen) Oslo University Hospital, Ulleval, Institute of Health and
Society, Nydalen, P.O Box 4956, Oslo 0424, Norway
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Cardiac surgery is a major life event, and outcomes after
surgery are associated with men's and women's ability to self-manage and
cope with their cardiac condition in everyday life. Hope is suggested to
impact cardiac health by having a positive effect on how adults cope with
and adapt to illness and recommended lifestyle changes. Method(s): We
did a secondary analysis of 416 individuals (23% women) undergoing
elective coronary artery bypass graft and/or valve surgery between March
2012 and September 2013 enrolled in randomized controlled trial. Hope was
assessed using The Herth Hope Index (HHI) at three, six and 12 months
following cardiac surgery. Linear mixed model analyses were performed to
explore associations after cardiac surgery between hope, marital status,
depression, persistent pain, and surgical procedure. Result(s): For
the total sample, no statistically significant difference between global
hope scores from 3 to 12 months was observed (ranging from 38.3 +/- 5.1 at
3 months to 38.7 +/- 5.1 at 12 months), and no differences between men and
women were observed at any time points. However, 3 out of 12 individual
items on the HHI were associated with significantly lower scores in women:
#1) I have a positive outlook toward life, #3) I feel all alone, and #6) I
feel scared about my future. Over the study period, diminished hope was
associated with older age, lower education, depression prior to surgery,
and persistent pain at all measurement points. Isolated valve surgery was
positively associated with hope. While neither sex nor marital status, as
main effects, demonstrated significant associations with hope, women who
were divorced/widowed/single were significantly more likely to have lower
hope scores over the study period. Conclusion(s): Addressing pain and
depression, and promoting hope, particularly for women living alone may be
important targets for interventions to improve outcomes following cardiac
surgery. Trial registration: Clinical Trials gov Identifier: NCT01976403.
Date of registration: November 28, 2011. Copyright © 2017 The
Author(s).

<97>
Accession Number
2001348031
Title
Deferred vs Immediate Stenting in Primary Percutaneous Coronary
Intervention: A Collaborative Meta-analysis of Randomized Trials With
Cardiac Magnetic Resonance Imaging Data.
Source
Canadian Journal of Cardiology. 34 (12) (pp 1573-1580), 2018. Date of
Publication: December 2018.
Author
Cassese S.; Belle L.; Ndrepepa G.; Bosson J.L.; Lonborg J.; Ahtarovski
K.A.; Kelbaek H.; Fusaro M.
Institution
(Cassese, Ndrepepa, Fusaro) Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Munich, Germany
(Belle) Departments of Cardiology and Radiology, Centre Hospitalier
Annecy-Genevois, Annecy, France
(Bosson) Clinical Investigation Centre, University Hospital of Grenoble,
Grenoble, France
(Fusaro) Department of Diagnostic and Interventional Radiology, Santa
Maria di Ca' Foncello Hospital, Treviso, Italy
(Lonborg) Department of Cardiology, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Ahtarovski, Kelbaek) Department of Cardiology, Zealand University
Hospital, Roskilde, Denmark
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The role of deferred vs immediate stenting during primary
percutaneous coronary intervention (PCI) for patients with ST-segment
elevation myocardial infarction (STEMI) remains controversial.
 Method(s): We undertook a collaborative meta-analysis of study-level
data by searching electronic scientific databases for investigations of
primary PCI patients randomized to deferred or immediate stenting and
subsequent cardiac magnetic resonance imaging. Primary angiographic and
imaging outcomes were slow/no-reflow and microvascular obstruction (MVO),
respectively. Main secondary outcome was recurrent ischemia.
 Result(s): Among 4 trials, a total of 1570 patients with STEMI were
assigned to primary PCI with either deferred (n = 779) or immediate
stenting (n = 791). Of these, 797 participants had analyzable cardiac
magnetic resonance imaging examinations. Median clinical follow-up was 9
months. Patients treated with deferred stenting showed a lower risk of
developing slow/no-reflow in the culprit vessel (risk ratio [RR], 0.54
[95% confidence interval (CI), 0.41-0.72]; P < 0.001), a similar risk for
MVO (RR, 0.93 [95% CI, 0.76-1.14]; P = 0.51), and trended higher in the
risk of recurrent ischemia (RR, 2.42 [95% CI, 0.88-6.63]; P = 0.09)
compared with those treated with immediate stenting. The treatment effect
for slow/no-reflow and MVO correlated with a thrombus score grade > 3 at
the baseline angiography and with the total stent length implanted in the
culprit artery. Conclusion(s): A strategy of deferred stenting during
primary PCI improves angiographic but not imaging or clinical outcomes
compared with immediate stenting. The potential lower risk for myocardial
injury by deferred stenting in primary PCI patients with STEMI and high
thrombus burden requires a confirmation in adequately sized randomized
trials. Copyright © 2018 Canadian Cardiovascular Society

<98>
Accession Number
2001348018
Title
The Effect of Cardiac Rehabilitation Attendance on Sexual Activity
Outcomes in Cardiovascular Disease Patients: A Systematic Review.
Source
Canadian Journal of Cardiology. 34 (12) (pp 1590-1599), 2018. Date of
Publication: December 2018.
Author
Boothby C.A.; Dada B.R.; Rabi D.M.; Campbell T.S.; Tang K.L.
Institution
(Boothby, Dada, Rabi, Tang) Department of Community Health Sciences,
University of Calgary, Calgary, Alberta, Canada
(Rabi, Tang) Department of Medicine, University of Calgary, Calgary,
Alberta, Canada
(Rabi) Department of Cardiac Sciences, University of Calgary, Calgary,
Alberta, Canada
(Campbell) Department of Psychology, University of Calgary, Calgary,
Alberta, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Decreased sexual activity (SA) is a common problem in patients
with cardiovascular disease (CVD). Although there is evidence that cardiac
rehabilitation (CR) is effective in improving physical outcomes and
overall quality of life, its effects on SA remain unclear. In this
systematic review we assessed the association between CR attendance and SA
outcomes in adults with CVD. Method(s): Electronic databases
(MEDLINE, PsycINFO, EMBASE, CINAHL) were systematically searched in
January 2018. Original studies that compared attendance to CR vs no
attendance to CR in adults 18 years and older with diagnosed CVD that also
reported on SA outcomes were included. A narrative synthesis was conducted
because the data did not permit meta-analysis. Result(s): Fourteen
studies were identified: 6 randomized controlled trials, 5 nonrandomized
controlled trials, and 3 prospective cohort studies. All CR programs
included an exercise-based component and 4 included an SA-specific
component. Seven studies reported a significant benefit in SA outcomes in
the CR group, 1 study reported significant harm, and 11 studies reported a
nonsignificant difference. Conclusion(s): The effect of CR on SA
outcomes was generally reported to be equivocal or positive. CR showed
some promise in improving sexual functioning and frequency, with mixed
results with regard to sexual resumption and satisfaction. In conclusion,
it remains uncertain if CR consistently improves sexual outcomes in adults
with CVD but these data suggest that further exploration might be
justified. Copyright © 2018 Canadian Cardiovascular Society

<99>
Accession Number
621755580
Title
Percutaneous Versus Surgical Revascularization for Left Main or
Multivessel Coronary Artery Disease: Results From a Large-Scale
Meta-Analysis in the Era of Drug-Eluting Stents.
Source
Angiology. 69 (9) (pp 812-824), 2018. Date of Publication: 01 Oct 2018.
Author
Verdoia M.; Barbieri L.; Kedhi E.; Suryapranata H.; De Luca G.
Institution
(Verdoia, Barbieri, De Luca) Division of Cardiology, Azienda
Ospedaliera-Universitaria "Maggiore della Carita," Eastern Piedmont
University, Novara, Italy
(Barbieri) Presidio Ospedaliero S. Andrea, Vercelli, Italy
(Kedhi) Department of Cardiology, Isala Hospital, Zwolle, Netherlands
(Kedhi, Suryapranata) UMC St Radboud, Nijmegen, Netherlands
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
The best treatment options for left main (LM) or multivessel coronary
disease (MVD) are still debated. We performed a meta-analysis of
randomized trials comparing percutaneous versus surgical revascularization
for LM or MVD. Primary end point was overall mortality. Secondary end
points were major adverse cardiovascular events, recurrent myocardial
infarction, repeated revascularization, or stroke. A total of 8 randomized
trials were included, involving 8694 patients, 50% undergoing percutaneous
coronary intervention (PCI). At a mean follow-up of 39.7 months, mortality
was 8.2% with no difference for PCI versus coronary artery bypass grafting
(CABG; odds ratio [OR] 95% confidence interval [CI] = 1.18 [0.90-1.55]; P
=.24, P for heterogeneity [P<inf>het</inf>] =.01). However, CABG was
slightly favored for MVD (OR [95% CI] = 1.54 [1.12-2.13]; P =.008,
P<inf>het</inf> =.14 for PCI) whereas noninferior for LM disease (OR [95%
CI] = 0.88 [0.60-1.29]; P =.50, P<inf>het</inf> =.10, P interaction =.03).
A similar benefit with CABG was also observed in terms of repeated
coronary revascularization, whereas PCI significantly reduced stroke. This
meta-analysis shows that surgical coronary revascularization still offers
advantages in survival and recurrent ischemic events compared to PCI using
drug-eluting stents (DES) in MVD although burdened by an increased risk of
stroke. In LM disease, CABG did not provide outcome benefits but was
associated with a higher risk of stroke compared to PCI. Additional
randomized trials are certainly needed with new-generation
DES. Copyright © The Author(s) 2018.

<100>
Accession Number
621159517
Title
Preventive Effects of Alprostadil Against Contrast-Induced Nephropathy
Inpatients With Renal Insufficiency Undergoing Percutaneous Coronary
Intervention.
Source
Angiology. 69 (5) (pp 393-399), 2018. Date of Publication: 01 May 2018.
Author
Yang S.-C.; Fu N.-K.; Zhang J.; Liang M.; Cong H.-L.; Lin W.-H.; Tian
F.-S.; Lu C.-Z.; Sun T.-T.; Zhang W.-Y.; Ma Z.-H.
Institution
(Yang, Liang, Sun, Zhang, Ma) Tianjin Medical University, Tianjin, China
(Fu, Zhang, Cong) Department of Cardiology, Tianjin Chest Hospital,
Tianjin, China
(Lin) Department of Cardiology, Taida International Cardiovascular
Hospital, Tianjin, China
(Tian) Department of Cardiology, Tianjin Fourth Central Hospital, Tianjin,
China
(Lu) Department of Cardiology, Tianjin First Central Hospital, Tianjin,
China
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
We investigated the preventive effect of alprostadil on contrast-induced
nephropathy (CIN) in patients with renal insufficiency undergoing
percutaneous coronary intervention (PCI). A total of 300 patients with
creatinine clearance (crCl) <=60 mL/min undergoing PCI were randomly
assigned to alprostadil or a control group. The primary end point was the
incidence of CIN defined as an increase in serum creatinine (Scr) levels
by >=0.5 mg/dL or>= 25% after administration of the contrast media within
72 hours. The secondary end points were (1) changes in Scr and crCl within
72 hours and (2) the incidence of major adverse events during
hospitalization. The incidence of CIN was 2.7% (4/150) in the alprostadil
group, and 8.7% (13/150) in the control group (chi2 = 5.05, P
=.043).There was no difference regarding the incidence of major adverse
events during hospitalization between the alprostadil group and control
groups (2.7% vs 4.0%, P =.750). Multivariate logistic regression analysis
showed that alprostadil was an independent protective factor for CIN (odds
ratio = 0.136, 95% confidence interval: 0.020-0.944, P =.044).
Prophylactic administration of alprostadil may prevent CIN in patients
with renal insufficiency undergoing PCI. Copyright © 2017, ©
The Author(s) 2017.

<101>
Accession Number
2001191425
Title
Rationale and design of the Pemafibrate to Reduce Cardiovascular Outcomes
by Reducing Triglycerides in Patients with Diabetes (PROMINENT) study.
Source
American Heart Journal. 206 (pp 80-93), 2018. Date of Publication:
December 2018.
Author
Pradhan A.D.; Paynter N.P.; Everett B.M.; Glynn R.J.; Amarenco P.; Elam
M.; Ginsberg H.; Hiatt W.R.; Ishibashi S.; Koenig W.; Nordestgaard B.G.;
Fruchart J.-C.; Libby P.; Ridker P.M.
Institution
(Pradhan) Division of Cardiovascular Medicine, VA Boston Medical Center,
Boston, MA, United States
(Pradhan, Paynter, Everett, Glynn, Ridker) Division of Preventive
Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston,
MA, United States
(Amarenco) Paris-Diderot Sorbonne University, Paris, France
(Elam) Division of Cardiovascular Medicine, VA Memphis Medical Center,
Memphis, TN, United States
(Ginsberg) Columbia University Vagellos College of Physicians and
Surgeons, New York, NY, United States
(Hiatt) University of Colorado School of Medicine, Division of Cardiology
and CPC Clinical Research, Aurora, CO, United States
(Ishibashi) Division of Endocrinology and Metabolism, Department of
Internal Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen and
German Centre for Cardiovascular Research, Partner Site Munich Heart
Alliance, Munich, Germany
(Nordestgaard) Herlev and Gentofte Hospital, Copenhagen University
Hospital, University of Copenhagen, Copenhagen, Denmark
(Fruchart) The R3i Foundation, Basel, Switzerland
(Everett, Libby, Ridker) Division of Cardiovascular Medicine Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Observational, genetic, and experimental data indicate that triglyceride
rich lipoproteins (TRLs) likely participate causally in atherothrombosis.
Yet, robust clinical trial evidence that triglyceride (TG) lowering
therapy reduces cardiovascular events remains elusive. The selective
peroxisome proliferator-activated receptor alpha modulator (SPPARM-alpha),
pemafibrate, will be used to target residual cardiovascular risk remaining
after treatment to reduce low-density lipoprotein cholesterol (LDL-C) in
individuals with the dyslipidemia of type 2 diabetes mellitus (T2). The
PROMINENT study will randomly allocate approximately 10,000 participants
with T2D, mild-to-moderate hypertriglyceridemia (TG: 200- 499 mg/dl; 2.26-
5.64 mmol/l) and low high-density lipoprotein cholesterol levels (HDL-C:
<=40 mg/dl; 1.03 mmol/l) to either pemafibrate (0.2 mg twice daily) or
matching placebo with an average expected follow-up period of 3.75 years
(total treatment phase 5 years; 24 countries). At study entry,
participants must be receiving either moderate-to-high intensity statin
therapy or meet specified LDL-C criteria. The study population will be
one-third primary and two-thirds secondary prevention (established
cardiovascular disease). The primary endpoint is a composite of nonfatal
myocardial infarction, nonfatal ischemic stroke, hospitalization for
unstable angina requiring urgent coronary revascularization, and
cardiovascular death. This event-driven study will complete when 1092
adjudicated primary endpoints have accrued with at least 200 occurring in
women. Statistical power is at least 90% to detect an 18% reduction in the
primary endpoint. Pre-specified secondary and tertiary endpoints include
all-cause mortality, hospitalization for heart failure, new or worsening
peripheral artery disease, new or worsening diabetic retinopathy and
nephropathy, and change in biomarkers including select lipid and non-lipid
biomarkers, inflammatory and glycemic parameters. Copyright ©
2018

<102>
Accession Number
2001191290
Title
The East-West late lumen loss study: Comparison of angiographic late lumen
loss between Eastern and Western drug-eluting stent study cohorts.
Source
American Heart Journal. 206 (pp 61-71), 2018. Date of Publication:
December 2018.
Author
Harrison R.W.; Radhakrishnan V.; Allen J.C.; Lam P.S.; Allocco D.J.; Brar
S.; Fahy M.; Zhang Z.; Fisher R.; Ikeno F.; Genereux P.; Kimura T.; Liu
M.; Lye W.K.; Nagai H.; Suzuki Y.; White R.; Krucoff M.W.
Institution
(Harrison, Radhakrishnan, Fisher, White, Krucoff) Duke University Medical
Center/Duke Clinical Research Institute, Durham, NC, United States
(Allen, Lye) Duke-NUS Medical School Singapore, Singapore
(Lam, Allocco) Boston Scientific Corporation, Marlborough, MA, United
States
(Brar, Fahy, Liu) Medtronic, Inc., Santa Rosa, CA, United States
(Zhang) Abbott Vascular, Santa Clara, CA, United States
(Ikeno) Stanford University, Stanford, CA, United States
(Genereux) Cardiovascular Research Foundation, New York, NY, United States
(Kimura) Kyoto University, Kyoto, Japan
(Nagai) Terumo Corporation, Tokyo, Japan
(Suzuki) Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Regulatory decisions approving new coronary drug-eluting stent
(DES) require mechanistic observations of angiographic late lumen loss
(LLL). Patient safety and device approval times could be enhanced if
angiographic follow-up data were found to be generalizable across
jurisdictions and geographies. The objectives were to assess the
comparability of in-segment LLL in Eastern and Western DES populations
using the world's largest compilation of follow-up quantitative coronary
angiography data. Method(s): Data from 4 manufacturers involving 29
DES clinical trials in Eastern and Western hemispheres were compiled.
"East" and "West" cohorts were defined by trial location. Independent core
laboratories quantified in-segment LLL for all studies. East and West were
compared before and after adjustment for clinical and anatomic covariates
known to correlate with LLL via conditioning on propensity score
quintiles. An international panel of experts and regulators prospectively
established a clinically meaningful difference between East and West mean
in-segment LLL of +/-0.40 mm. Result(s): The data set comprised 2,047
East and 4,456 West patients. Unadjusted mean +/- SD for West and East
in-segment LLL (mm) was 0.25 +/- 0.46 and 0.12 +/- 0.42, respectively
(difference 0.13 mm; 95% CI 0.11-0.16). Propensity score-adjusted
in-segment LLL East and West least squares means were 0.11 and 0.26 mm,
respectively (difference 0.15 mm; 95% CI 0.13-0.18). Conclusion(s):
In the world's largest compilation of DES protocol 8- to 13-month
angiographic follow-up data, clinically meaningful comparability of
in-segment LLL by independent core laboratory quantitative coronary
angiography in East and West cohorts was demonstrated in both unadjusted
and adjusted comparisons. These findings suggest that DES LLL, once
characterized, could be generalized across regulatory jurisdictions over
the course of global registration efforts. Copyright © 2018
Elsevier Inc.

<103>
Accession Number
623952028
Title
The prevalence of computed tomography-defined leaflet thrombosis in intra-
versus supra-annular transcatheter aortic valve prostheses.
Source
Catheterization and Cardiovascular Interventions. 92 (7) (pp 1414-1416),
2018. Date of Publication: 01 Dec 2018.
Author
Rashid H.N.; Nasis A.; Gooley R.P.; Cameron J.D.; Brown A.J.
Institution
(Rashid, Nasis, Gooley, Cameron, Brown) Monash Cardiovascular Research
Centre, MonashHEART, Monash Health, and Monash University, Clayton, VIC,
Australia
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Introduction: Leaflet thrombosis (LT) defined by computed tomography (CT)
following transcatheter aortic valve replacement (TAVR) has been shown to
increase cerebrovascular events. The neo-sinus plays an important role in
the development of LT. Intra-annular valves (IAV) have a larger neo-sinus
when compared to supra-annular valves (SAV), and has been associated with
larger thrombus burden. The prevalence of LT with IAV and SAV in a larger,
diverse cohort is unknown. Method(s): We performed a systematic
review to assess the prevalence of LT in IAV versus SAV TAVR prostheses.
Inclusion criteria were (1) reported CT-defined LT following TAVR, (2)
comparison between LT and non-LT cohort, (3) separate registry/database,
and (4) fully published status. A total of 2,013 citations were reviewed
and 7 studies were included. Result(s): Overall, 1,644 patients were
included from 7 observational studies and the prevalence of LT following
TAVR was 12.8%. The Portico valve system (IAV) had the highest prevalence
of LT with 35.2%, followed by Symetis Acurate Neo (SAV) at 15.4% and the
Lotus valve system (IAV) at 14.5%. LT occurred more frequently in IAV than
SAV (13.5% vs. 7%, P = 0.02). Subanalysis of IAV versus SAV with the
exclusion of the Portico valve was performed to ensure results were not
influenced by this valve system and revealed IAV still had higher rates of
LT (12.1% vs. 7%, P = 0.05). Conclusion(s): In summary, IAV
prostheses appear to be associated with higher rates of LT when compared
with SAV. Copyright © 2018 Wiley Periodicals, Inc.

<104>
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

<105>
Accession Number
2001226742
Title
Bibliometric Analysis of the Top 100 Most Cited Articles in the First 50
Years of Heart Transplantation.
Source
American Journal of Cardiology. 123 (1) (pp 175-186), 2019. Date of
Publication: 1 January 2019.
Author
Kolkailah A.A.; Fugar S.; Vondee N.; Hirji S.A.; Okoh A.K.; Ayoub A.;
Al-Ogaili A.; Paz Rios L.H.; Kumar S.K.; Camacho M.T.; Rich J.D.; Golzar
Y.
Institution
(Kolkailah, Ayoub, Al-Ogaili, Paz Rios) Department of Medicine, John H.
Stroger, Jr. Hospital of Cook County, Chicago, IL, United States
(Fugar) Division of Cardiology, Rush University Medical Center, Chicago,
IL, United States
(Vondee) Department of Medicine, St. Vincent Charity Medical Center,
Cleveland, OH, United States
(Hirji) Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Okoh, Camacho) Cardiology and Cardiac Surgery Research Unit, Newark Beth
Israel Medical Center, Newark, NJ, United States
(Kumar) Division of Advanced Heart Failure and Transplant Cardiology,
Tampa General Hospital, Tampa, FL, United States
(Rich) Division of Advanced Heart Failure and Transplant Cardiology,
Northwestern Memorial Hospital, Chicago, IL, United States
(Golzar) Division of Cardiology, John H. Stroger, Jr. Hospital of Cook
County, Chicago, IL, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The world celebrates over 50 years since the first human-to-human heart
transplant. Bibliometric analysis is a statistical concept that has
recently evolved, enabling scientists to study citation patterns and
identify characteristics of highly cited scholarly work in different
fields. Although it has been widely utilized, such analyses have not been
conducted to date on heart transplant literature. We sought to assess the
characteristics of the top 100 most referenced citations in the field of
heart transplantation. We searched the Scopus database (www.scopus.com) to
identify all articles relating to heart transplantation. The articles were
arranged in descending order from most cited to least cited and selected
articles were scrutinized for data extraction. One hundred articles were
included in the final list. Of the total 40,660 citations identified,
3,210 (8.0%) were self-citations, which impacted the final rank order. The
articles were published in 25 different journals between 1960 and 2013.
The most productive 5-year time period was between 2000 and 2005, when 24
of the 100 most cited publications were produced. There was no correlation
between the journals' impact factors and the number of articles produced
per journal. The presence and type of funding were not associated with the
number of citations. Over 85% of first and senior investigators were men.
In conclusion, our study highlights key features of the most highly cited
scientific literature on heart transplantation and provides insights into
trends of published work in this field. Additionally, this work may serve
as a useful guide to researchers and funding bodies by highlighting the
most prolific areas of cardiac transplant research to date. Copyright
© 2018

<106>
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.

<107>
Accession Number
618484830
Title
Sevoflurane-induced cardioprotection in coronary artery bypass graft
surgery: Randomised trial with clinical and ex-vivo endpoints.
Source
Anaesthesia Critical Care and Pain Medicine. 37 (3) (pp 217-223), 2018.
Date of Publication: June 2018.
Author
Lemoine S.; Zhu L.; Gerard J.-L.; Hanouz J.-L.
Institution
(Lemoine, Zhu, Gerard, Hanouz) Department of Anaesthesiology and Intensive
Care, Universite Caen-Normandie, Centre Hospitalier Universitaire de Caen,
Caen 14033, France
(Hanouz) EA 4650, Universite Caen-Normandie, Centre Hospitalier
Universitaire de Caen, Caen 14033, France
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background: Myocardial ischaemia reperfusion injury following cardiac
surgery with cardiopulmonary bypass (CPB) increases postoperative
mortality. Setting techniques to protect the heart during this critical
period therefore represents a considerable challenge. Method(s): A
randomised controlled study in Caen University Hospital Centre,
investigated whether the clinical cardio protective effects of
administration sevoflurane before cardiopulmonary bypass during coronary
artery bypass graft surgery (CABG) could translate into protected atrial
trabeculae contractility against hypoxia-reoxygenation in vitro. Patients
undergoing elective on-pump CABG surgery were allocated to receive either
sevoflurane (n = 24) or no halogenated volatile anaesthetic (n = 21).
 Main Outcome Measure(s): the relationship between sevoflurane
exposure before CPB and the incidence of major adverse cardiac events,
with primary endpoint: the postoperative troponin I peak level, and
secondary endpoints: the inotropic support, and the duration of stay in
intensive unit and in-hospital stay were chosen as study endpoints. The
right atrial was collected at the beginning of bypass surgery for the in
vitro experimentation. Isometrically contracting isolated human right
atrial trabeculae obtained from the two groups were exposed to 30-min
hypoxia followed by 60-min reoxygenation. Result(s): The patients
receiving sevoflurane prior to aortic clamping significantly exhibited
less cardiac Troponin I (1.39 [0.34-2.97] vs. 2.80 [2.54-3.64]
ng.mL-1 in Control; P = 0.03) and required a reduced inotropic
drug support (P < 0.001). Isolated trabeculae from patients receiving
sevoflurane enhanced the recovery of force after reoxygenation compared to
the Control group (79 +/- 5% vs. 53 +/- 8% of baseline in Control; P <
0.001). Conclusion(s): Administration of sevoflurane before CPB
induced cardioprotection in patients undergoing CABG and preconditioned
human myocardium against hypoxia-reoxygenation in vitro. Copyright
© 2018 Societe francaise d'anesthesie et de reanimation (Sfar)

<108>
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).

<109>
Accession Number
624713826
Title
Graduated compression stockings for prevention of deep vein thrombosis.
Source
Cochrane Database of Systematic Reviews. 2018 (11) (no pagination), 2018.
Article Number: CD001484. Date of Publication: 03 Nov 2018.
Author
Sachdeva A.; Dalton M.; Lees T.
Institution
(Sachdeva) Newcastle University, Wellcome Centre for Mitochondrial
Research, Cookson Building, Medical School, Framlington Place, Newcastle
upon Tyne NE2 4HH, United Kingdom
(Dalton) Royal Victoria Infirmary, Department of Anaesthetics, Queen
Victoria Road, Newcastle upon Tyne, Tyne and Wear NE1 4LP, United Kingdom
(Lees) NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Hospitalised patients are at increased risk of developing deep
vein thrombosis (DVT) in the lower limb and pelvic veins, on a background
of prolonged immobilisation associated with their medical or surgical
illness. Patients with DVT are at increased risk of developing a pulmonary
embolism (PE). The use of graduated compression stockings (GCS) in
hospitalised patients has been proposed to decrease the risk of DVT. This
is an update of a Cochrane Review first published in 2000, and last
updated in 2014. Objective(s): To evaluate the effectiveness and
safety of graduated compression stockings in preventing deep vein
thrombosis in various groups of hospitalised patients. Search
Method(s): For this review the Cochrane Vascular Information Specialist
searched the Cochrane Vascular Specialised Register, the Cochrane Central
Register of Controlled Trials (CENTRAL), and trials registries on 21 March
2017; and the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE
Ovid, Embase Ovid, CINAHL Ebsco, AMED Ovid , and trials registries on 12
June 2018. Selection Criteria: Randomised controlled trials (RCTs)
involving GCS alone, or GCS used on a background of any other DVT
prophylactic method. We combined results from both of these groups of
trials. Data Collection and Analysis: Two review authors (AS, MD)
assessed potentially eligible trials for inclusion. One review author (AS)
extracted the data, which a second review author (MD) cross-checked and
authenticated. Two review authors (AS, MD) assessed the methodological
quality of trials with the Cochrane 'Risk of bias' tool. Any disagreements
were resolved by discussion with the senior review author (TL). For
dichotomous outcomes, we calculated the Peto odds ratio and corresponding
95% confidence interval. We pooled data using a fixed-effect model. We
used the GRADE system to evaluate the overall quality of the evidence
supporting the outcomes assessed in this review. Main Result(s): We
included 20 RCTs involving a total of 1681 individual participants and
1172 individual legs (2853 analytic units). Of these 20 trials, 10
included patients undergoing general surgery; six included patients
undergoing orthopaedic surgery; three individual trials included patients
undergoing neurosurgery, cardiac surgery, and gynaecological surgery,
respectively; and only one trial included medical patients. Graduated
compression stockings were applied on the day before surgery or on the day
of surgery and were worn up until discharge or until the participants were
fully mobile. In the majority of the included studies DVT was identified
by the radioactive I125 uptake test. Duration of follow-up
ranged from seven to 14 days. The included studies were at an overall low
risk of bias. We were able to pool the data from 20 studies reporting the
incidence of DVT. In the GCS group, 134 of 1445 units developed DVT (9%)
in comparison to the control group (without GCS), in which 290 of 1408
units developed DVT (21%). The Peto odds ratio (OR) was 0.35 (95%
confidence interval (CI) 0.28 to 0.43; 20 studies; 2853 units;
high-quality evidence), showing an overall effect favouring treatment with
GCS (P < 0.001). Based on results from eight included studies, the
incidence of proximal DVT was 7 of 517 (1%) units in the GCS group and 28
of 518 (5%) units in the control group. The Peto OR was 0.26 (95% CI 0.13
to 0.53; 8 studies; 1035 units; moderate-quality evidence) with an overall
effect favouring treatment with GCS (P < 0.001). Combining results from
five studies, all based on surgical patients, the incidence of PE was 5 of
283 (2%) participants in the GCS group and 14 of 286 (5%) in the control
group. The Peto OR was 0.38 (95% CI 0.15 to 0.96; 5 studies; 569
participants; low-quality evidence) with an overall effect favouring
treatment with GCS (P = 0.04). We downgraded the quality of the evidence
for proximal DVT and PE due to low event rate (imprecision) and lack of
routine screening for PE (inconsistency). We carried out subgroup analysis
by speciality (surgical or medical patients). Combining results from 19
trials focusing on surgical patients, 134 of 1365 (9.8%) units developed
DVT in the GCS group compared to 282 of 1328 (21.2%) units in the control
group. The Peto OR was 0.35 (95% CI 0.28 to 0.44; high-quality evidence),
with an overall effect favouring treatment with GCS (P < 0.001). Based on
results from seven included studies, the incidence of proximal DVT was 7
of 437 units (1.6%) in the GCS group and 28 of 438 (6.4%) in the control
group. The Peto OR was 0.26 (95% CI 0.13 to 0.53; 875 units;
moderate-quality evidence) with an overall effect favouring treatment with
GCS (P < 0.001). We downgraded the evidence for proximal DVT due to low
event rate (imprecision). Based on the results from one trial focusing on
medical patients admitted following acute myocardial infarction, 0 of 80
(0%) legs developed DVT in the GCS group and 8 of 80 (10%) legs developed
DVT in the control group. The Peto OR was 0.12 (95% CI 0.03 to 0.51;
low-quality evidence) with an overall effect favouring treatment with GCS
(P = 0.004). None of the medical patients in either group developed a
proximal DVT, and the incidence of PE was not reported. Limited data were
available to accurately assess the incidence of adverse effects and
complications with the use of GCS as these were not routinely
quantitatively reported in the included studies. Authors' conclusions:
There is high-quality evidence that GCS are effective in reducing the risk
of DVT in hospitalised patients who have undergone general and orthopaedic
surgery, with or without other methods of background thromboprophylaxis,
where clinically appropriate. There is moderate-quality evidence that GCS
probably reduce the risk of proximal DVT, and low-quality evidence that
GCS may reduce the risk of PE. However, there remains a paucity of
evidence to assess the effectiveness of GCS in diminishing the risk of DVT
in medical patients. Copyright © 2018 The Cochrane Collaboration.

<110>
Accession Number
621629656
Title
Randomized Controlled Trial on the Influence of Intraoperative
Remifentanil versus Fentanyl on Acute and Chronic Pain after Cardiac
Surgery.
Source
Pain Practice. 18 (4) (pp 443-451), 2018. Date of Publication: April 2018.
Author
de Hoogd S.; Ahlers S.J.G.M.; van Dongen E.P.A.; van de Garde E.M.W.;
Daeter E.J.; Dahan A.; Tibboel D.; Knibbe C.A.J.
Institution
(de Hoogd, Ahlers, van de Garde, Knibbe) Department of Clinical Pharmacy,
St. Antonius Hospital, Nieuwegein, Netherlands
(van Dongen) Department of Anesthesiology and Intensive Care, St. Antonius
Hospital, Nieuwegein, Netherlands
(Daeter) Department of Cardiothoracic Surgery, St. Antonius Hospital,
Nieuwegein, Netherlands
(Dahan) Department of Anesthesiology, Leiden University Medical Center,
Leiden, Netherlands
(Tibboel, Knibbe) Intensive Care and Department of Pediatric Surgery,
Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
(Knibbe) Division of Pharmacology, Leiden Academic Centre for Drug
Research, Leiden University, Leiden, Netherlands
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Remifentanil has been associated with increased acute and
potentially chronic postoperative pain. The objective of this prospective
randomized controlled trial was to investigate the influence of
intraoperative remifentanil on acute and chronic postoperative pain after
cardiac surgery. Method(s): Patients (N = 126) receiving standardized
anesthesia with propofol and intermittent intravenous fentanyl at
predetermined times for cardiac surgery were randomized to
intraoperatively receive either a continuous remifentanil infusion or
additional intermittent intraoperative fentanyl as needed. The primary
endpoint was chronic thoracic pain at 12 months after surgery. Secondary
endpoints were pain at 3 and 6 months after surgery and analgesic
requirements and pain levels in the first 72 hours. Result(s): There
was no significant difference in incidence of chronic thoracic pain
between the remifentanil and fentanyl groups, respectively (20% vs. 18%; P
= 0.817). At 3 months, however, significantly more patients in the
remifentanil group reported chronic thoracic pain (51% vs. 33%; P =
0.047). This effect was more pronounced in younger patients and in
patients receiving a higher dose of remifentanil (both P < 0.05). The
first 24 and 48 hours postoperatively, morphine consumption in the
remifentanil group was significantly higher than in the fentanyl group
(34.3 mg [interquartile range (IQR) 25.3 to 48.2] vs. 30.2 mg [IQR 19.2 to
38.1], P = 0.028; and 46.8 mg [IQR 33.8 to 59.2] vs. 39.0 mg [IQR 6.2 to
51.4], P = 0.047, respectively). Conclusion(s): Intraoperative use of
remifentanil during cardiac surgery does not impact chronic postoperative
pain 1 year after surgery. Nevertheless, remifentanil increases analgesic
requirements and thoracic pain until 3 months after surgery, and its use
is therefore less favorable during cardiac surgery. Copyright ©
2017 The Authors. Pain Practice published by Wiley Periodicals, Inc. on
behalf of World Institute of Pain

<111>
Accession Number
619886352
Title
Turkey's top publications in cardiovascular medicine in the past 25 years:
Evaluation of its impact.
Source
Anatolian Journal of Cardiology. 18 (6) (pp 417-424), 2017. Date of
Publication: December 2017.
Author
Onat A.
Institution
(Onat) Department of Cardiology, Cerrahpasa Medical Faculty, Istanbul
University, Istanbul, Turkey
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: To identify "genuine" publications from Turkey's institutions
since 1992 that have cumulatively contributed the most to global
cardiovascular medicine. Method(s): Based on data from the Web of
Science, 146 publications from Turkey were identified having received >=50
citations as of late July, 2017. Papers with more than a minor share by
international authors were excluded. Result(s): Hundred and ten
primary authors generated 147 medical papers which received >=50
(interquartile range, 54; 86) citations. These articles corresponded in
quality to the top 12% global papers. Half of the articles were published
from 2002 to late 2007, with a median exposure period of 12 years. Peak
performance was reached in 2004-'07, with a mean of 15-20 papers annually,
which then regressed to five papers in 2008-'13, representing an estimated
50% decline. Cardiology generated 105 articles (20 in collaboration with
other branches), cardiovascular surgery generated 27 articles, and
pediatric cardiology generated 5 articles. Publications arose from 26
medical faculties, Gulhane Military Academy, and 9 hospitals not which
were not academically affiliated. The performance of many related Turkish
institutions was disappointing. Conclusion(s): Turkey's contribution
to cardiovascular medicine has further declined slightly in the current
assessment, particularly since 2007. To prevent a further gap in Turkey's
contribution to the field, an undelayed return is needed by building an
environment that allows focusing on research with a potential to
contribute to medicine. Copyright © 2017 by Turkish Society of
Cardiology.

<112>
Accession Number
625508898
Title
Effect of TENS on Postoperative Pain and Pulmonary Function in Patients
Undergoing Coronary Artery Bypass Surgery.
Source
Pain management nursing : official journal of the American Society of Pain
Management Nurses. 19 (4) (pp 408-414), 2018. Date of Publication: 01 Aug
2018.
Author
Jahangirifard A.; Razavi M.; Ahmadi Z.H.; Forozeshfard M.
Institution
(Jahangirifard) Tracheal Diseases Research Center, NRITLD, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Razavi) Nursing Care Research Center, Semnan University of Medical
Sciences, Semnan, Iran; PhD Candidate in Nursing, Department of Medical
Surgical Nursing, School of Nursing and Midwifery, Hamadan University of
Medical Sciences, Hamadan, Iran
(Ahmadi) Masih Daneshvari Hospital, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Forozeshfard) Cancer Research Center and Department of Anesthesiology,
Semnan University of Medical Sciences, Semnan, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: The aim of this study was to determine the effect of
electrical nerve stimulation on pain intensity and pulmonary function in
patients undergoing coronary artery bypass surgery. MATERIALS AND METHODS:
In a randomized clinical trial, a total of 100 patients undergoing
coronary artery bypass surgery at Masih Daneshvari Hospital, Tehran, Iran,
from February to May 2014, were divided into two groups. In the
intervention group (n = 50), patients received routine care along with
transcutaneous electrical nerve stimulation (TENS) immediately after
admission to the intensive care unit (ICU). In the placebo group (n = 50),
patients only received routine care. The pain intensity was measured using
a visual analog scale (VAS) every 6 hours for 72 hours after surgery in
two conditions of rest and coughing. Pulmonary function was assessed
through forced expiratory volume in 1 second (FEV1) and forced volume
capacity (FVC) at 24, 48, and 72 hours after surgery. Age, gender, body
mass index, narcotic consumption, ICU length of stay, and requests for
chest radiographs were recorded. The statistical level of significance was
set at p < .05. RESULT(S): There were no significant differences
between the two groups in terms of age, gender, and body mass index (p >
.05). Pain intensity was significantly lower in the TENS group than the
placebo group in both resting and coughing condition (p < .05). FVC and
FEV1 were significantly better and faster in the TENS group than in the
placebo group at 24, 48, and 72 hours after surgery (p < .05). Patients in
the TENS group had significantly lower narcotic use and requests for chest
radiographs compared with placebo group. CONCLUSION(S): TENS may
reduce postoperative pain in resting and coughing conditions, improve
pulmonary function, and reduce narcotic use in patients undergoing
coronary artery bypass surgery. Copyright © 2017 American Society
for Pain Management Nursing. Published by Elsevier Inc. All rights
reserved.

<113>
Accession Number
625526763
Title
Effect of Oral Alfacalcidol on Clinical Outcomes in Patients Without
Secondary Hyperparathyroidism Receiving Maintenance Hemodialysis: The
J-DAVID Randomized Clinical Trial.
Source
JAMA. 320 (22) (pp 2325-2334), 2018. Date of Publication: 11 Dec 2018.
Author
Shoji T.; Inaba M.; Fukagawa M.; Ando R.; Emoto M.; Fujii H.; Fujimori A.;
Fukui M.; Hase H.; Hashimoto T.; Hirakata H.; Honda H.; Hosoya T.; Ikari
Y.; Inaguma D.; Inoue T.; Isaka Y.; Iseki K.; Ishimura E.; Itami N.; Ito
C.; Kakuta T.; Kawai T.; Kawanishi H.; Kobayashi S.; Kumagai J.; Maekawa
K.; Masakane I.; Minakuchi J.; Mitsuiki K.; Mizuguchi T.; Morimoto S.;
Murohara T.; Nakatani T.; Negi S.; Nishi S.; Nishikawa M.; Ogawa T.; Ohta
K.; Ohtake T.; Okamura M.; Okuno S.; Shigematsu T.; Sugimoto T.; Suzuki
M.; Tahara H.; Takemoto Y.; Tanaka K.; Tominaga Y.; Tsubakihara Y.;
Tsujimoto Y.; Tsuruya K.; Ueda S.; Watanabe Y.; Yamagata K.; Yamakawa T.;
Yano S.; Yokoyama K.; Yorioka N.; Yoshiyama M.; Nishizawa Y.
Institution
(Shoji) Department of Vascular Medicine, Osaka City University Graduate
School of Medicine, Japan
(Shoji, Inaba) Vascular Science Center for Translational Research, Osaka
City University Graduate School of Medicine, Japan
(Inaba, Emoto) Department of Metabolism, Endocrinology, Molecular
Medicine, Osaka City University Graduate School of Medicine, Japan
(Fukagawa) Division of Nephrology, Endocrinology, Metabolism, Tokai
University School of Medicine, Kanagawa, Japan
(Ando) Department of Nephrology, Musashino Red Cross Hospital, Tokyo,
Japan
(Fujii) Department of Drug and Food Evaluation, Osaka City University
Graduate School of Medicine, Japan
(Fujimori) Blood Purification and Kidney Center, Konan Hospital, Hyogo,
Japan
(Fukui) Laboratory of Statistics, Osaka City University Graduate School of
Medicine, Japan
(Hase) Department of Nephrology, Toho University School of Medicine,
Tokyo, Japan
(Hashimoto) Department of Urology, Tojinkai Hospital, Kyoto, Japan
(Hirakata) Division of Nephrology, Fukuoka Renal Clinic, Fukuoka, Japan
(Honda) Division of Nephrology, Department of Medicine, Showa University
Koto Toyosu Hospital, Tokyo, Japan
(Hosoya) Department of Pathophysiology and Therapy in Chronic Kidney
Disease, Jikei University School of Medicine, Tokyo, Japan
(Ikari) Department of Cardiology, Tokai University School of Medicine,
Kanagawa, Japan
(Inaguma) Department of Nephrology, Fujita Health University School of
Medicine, Aichi, Japan
(Inoue) OsakaJapan
(Isaka) Department of Nephrology, Osaka University Graduate School of
Medicine, Japan
(Iseki) Clinical Research Support Center, Tomishiro Central Hospital,
Japan
(Ishimura) Department of Nephrology, Osaka City University Graduate School
of Medicine, Japan
(Itami) Department of Nephrology, Hokkaido, Japan
(Ito) Department of Internal Medicine, Haga Red Cross Hospital, Tochigi,
Japan
(Kakuta) Division of Nephrology, Endocrinology, Metabolism, Tokai
University Hachioji Hospital, Tokyo, Japan
(Kawai) Medical Corporation Chuou Naika Clinic, Hiroshima, Japan
(Kawanishi) Department of Artificial Organs, Tsuchiya General Hospital,
Hiroshima, Japan
(Kobayashi, Ohtake) Department of Kidney Disease and Transplant Center,
Shonan Kamakura General Hospital, Kanagawa, Japan
(Kumagai) Akane Foundation Omachi Tsuchiya Clinic, Hiroshima, Japan
(Maekawa) OsakaJapan
(Masakane) Nephrology, Yamagata, Japan
(Minakuchi) Department of Kidney Disease, Kawashima Hospital, Tokushima,
Japan
(Mitsuiki) Nephrology and Dialysis Center, Japanese Red Cross Fukuoka
Hospital, Japan
(Mizuguchi) Department of Hematology, Dialysis, Diabetes Mellitus,
Kochi-Takasu Hospital, Kochi, Japan
(Morimoto) Department of Medicine, Endocrinology, Hypertension, Tokyo
Women's Medical University, Japan
(Murohara) Department of Cardiology, Nagoya University Graduate School of
Medicine, Aichi, Japan
(Nakatani, Takemoto) Department of Urology, Osaka City University Graduate
School of Medicine, Japan
(Negi, Shigematsu) Department of Nephrology, Wakayama Medical University,
Wakayama, Japan
(Nishi) Division of Nephrology and Kidney Center, Kobe University Graduate
School of Medicine, Hyogo, Japan
(Nishikawa) Meisei Memorial Hospital, Osaka, Japan
(Ogawa) Department of Medicine, Tokyo Women's Medical University Medical
Center East, Tokyo, Japan
(Ohta) Department of Urology, Kochi Takasu Hospital, Kochi, Japan
(Okamura) Department of Internal Medicine, Kayashima Ikuno Hospital,
Osaka, Japan
(Okuno) Department of Internal Medicine, Kidney Center, Shirasagi
Hospital, Osaka, Japan
(Sugimoto) Department of Internal Medicine, Shimane University Faculty of
Medicine, Shimane, Japan
(Suzuki) Department of Nephrology, Shinraku-En Hospital, Niigata, Japan
(Tahara) OsakaJapan
(Tanaka) Department of Internal Medicine, Suiyukai Clinic, Nara, Japan
(Tominaga) Department of Transplant and Endocrine Surgery, Nagoya 2nd Red
Cross Hospital Japan
(Tsubakihara) Department of Safety Management in Health Care Sciences,
Graduate School of Health Care Sciences, Jikei Institute, Osaka, Japan
(Tsujimoto) Department of Internal Medicine, Inoue Hospital, Osaka, Japan
(Tsuruya) Department of Nephrology, Nara Medical University, Japan
(Ueda) Department of Clinical Pharmacology and Therapeutics, University of
the Ryukyus Graduate School of Medicine, Okinawa, Japan
(Watanabe) Kasugai Municipal Hospital, Aichi, Japan
(Yamagata) Department of Nephrology, Faculty of Medicine, University of
Tsukuba, Ibaraki, Japan
(Yamakawa) Kidney Center, Shirasagi Hospital, Osaka, Japan
(Yano) Department of Laboratory Medicine, Shimane University Faculty of
Medicine, Japan
(Yokoyama) Division of Nephrology and Hypertension, Department of Internal
Medicine, Jikei University School of Medicine, Tokyo, Japan
(Yorioka) Hiroshima Kidney Organization, Japan
(Yoshiyama) Department of Cardiovascular Medicine, Osaka City University
Graduate School of Medicine, Japan
(Nishizawa) Hemodialysis Center, Inoue Hospital, Soryu Medical
Corporation, Osaka, Japan
Publisher
NLM (Medline)
Abstract
Importance: Patients with chronic kidney disease have impaired vitamin D
activation and elevated cardiovascular risk. Observational studies in
patients treated with hemodialysis showed that the use of active vitamin D
sterols was associated with lower risk of all-cause mortality, regardless
of parathyroid hormone levels. Objective(s): To determine whether
vitamin D receptor activators reduce cardiovascular events and mortality
in patients without secondary hyperparathyroidism undergoing hemodialysis.
 Design, Setting, and Participant(s): Randomized, open-label, blinded
end point multicenter study of 1289 patients in 207 dialysis centers in
Japan. The study included 976 patients receiving maintenance hemodialysis
with serum intact parathyroid hormone levels less than or equal to 180
pg/mL. The first and last participants were enrolled on August 18, 2008,
and January 26, 2011, respectively. The final date of follow-up was April
4, 2015. Intervention(s): Treatment with 0.5 mug of oral alfacalcidol
per day (intervention group; n=495) vs treatment without vitamin D
receptor activators (control group; n=481). Main Outcomes and
Measures: The primary outcome was a composite measure of fatal and
nonfatal cardiovascular events, including myocardial infarctions,
hospitalizations for congestive heart failure, stroke, aortic
dissection/rupture, amputation of lower limb due to ischemia, and cardiac
sudden death; coronary revascularization; and leg artery revascularization
during 48 months of follow-up. The secondary outcome was all-cause death.
 Result(s): Among 976 patients who were randomized from 108 dialysis
centers, 964 patients were included in the intention-to-treat analysis
(median age, 65 years; 386 women [40.0%]), and 944 (97.9%) completed the
trial. During follow-up (median, 4.0 years), the primary composite outcome
of cardiovascular events occurred in 103 of 488 patients (21.1%) in the
intervention group and 85 of 476 patients (17.9%) in the control group
(absolute difference, 3.25% [95% CI, -1.75% to 8.24%]; hazard ratio, 1.25
[95% CI, 0.94-1.67]; P=.13). There was no significant difference in the
secondary outcome of all-cause mortality between the groups (18.2% vs
16.8%, respectively; hazard ratio, 1.12 [95% CI, 0.83-1.52]; P=.46). Of
the 488 participants in the intervention group, 199 (40.8%) experienced
serious adverse events that were classified as cardiovascular, 64 (13.1%)
experienced adverse events classified as infection, and 22 (4.5%)
experienced malignancy-related serious adverse events. Of 476 participants
in the control group, 191 (40.1%) experienced cardiovascular-related
serious adverse events, 63 (13.2%) experienced infection-related serious
adverse events, and 21 (4.4%) experienced malignancy-related adverse
events. Conclusions and Relevance: Among patients without secondary
hyperparathyroidism undergoing maintenance hemodialysis, oral alfacalcidol
compared with usual care did not reduce the risk of a composite measure of
select cardiovascular events. These findings do not support the use of
vitamin D receptor activators for patients such as these. Trial
Registration: UMIN-CTR Identifier: UMIN000001194.

<114>
Accession Number
625515382
Title
Independent impact of extent of coronary artery disease and percutaneous
revascularisation on 30-day and one-year mortality after TAVI: A
meta-analysis of adjusted observational results.
Source
EuroIntervention. 14 (11) (pp E1169-EE1177), 2018. Date of Publication:
December 2018.
Author
D'Ascenzo F.; Verardi R.; Visconti M.; Conrotto F.; Scacciatella P.;
Dziewierz A.; Stefanini G.G.; Paradis J.-M.; Omede P.; Kodali S.; D'Amico
M.; Rinaldi M.; Salizzoni S.
Institution
(D'Ascenzo, Verardi, Visconti, Conrotto, Scacciatella, Omede, D'Amico)
Division of Cardiology, Department of Internal Medicine, Citta della
Salute e della Scienza, Corso Bramante n 88, Turin 10126, Italy
(Dziewierz) Second Department of Cardiology, Jagiellonian University
Medical College, Krakow, Poland
(Stefanini) Department of Biomedical Sciences, Humanitas University, Pieve
Emanuele, Milan, Italy
(Paradis, Kodali) Cardiovascular Research Foundation, New York, NY, United
States
(Paradis) Quebec Heart and Lung Institute, Quebec, Canada
(Rinaldi, Salizzoni) Division of Cardiac Surgery, Citta della Salute e
della Scienza, Turin, Italy
Publisher
EuroPCR
Abstract
Aims: The impact of the severity of coronary artery disease (CAD) and
percutaneous coronary interventions (PCI) on outcomes after transcatheter
aortic valve implantation (TAVI) remains a matter of debate. We therefore
performed a meta-analysis to evaluate the impact of CAD, of its severity
and of PCI on mortality after TAVI. Methods and Results: All
published studies evaluating the impact of CAD on 30-day and one-year
mortality after TAVI at multivariable analysis were included. The primary
endpoint was the impact of CAD severity (assessed with the SYNTAX score
[SS]) on one-year mortality by pooling with logarithmic transformation
results of multivariable adjusted effect estimates from each individual
study. Secondary endpoints were the impact of the presence of CAD on
30-day and one-year mortality at multivariable analysis and the impact of
residual SYNTAX score (rSS) on one-year mortality at multivariable
analysis. A total of 8,334 patients with a median age of 81.3 (81-82)
years and STS score of 6.2% (IQR 6.0-6.7) from 13 studies were included.
Patients with an SS >22 showed higher one-year mortality at multivariable
analysis (OR 1.71 [1.24-2.36]). The presence of CAD did not impact on
30-day and one-year mortality at multivariable analysis (respectively, OR
1.57 [0.71-3.46] and OR 1.25 [0.74-2.11]). Regarding PCI, patients with
rSS <8 showed lower one-year mortality (OR 0.34 [0.012-0.93]).
 Conclusion(s): The risk of death after TAVI is closely related to the
complexity of CAD. Patients with an SS >22 present higher mortality. SS
may represent a useful tool to select patients undergoing TAVI who could
benefit from coronary revascularisation. In this regard, reaching an rSS
<8 reduced one-year mortality. Randomised controlled trials are needed to
confirm these results. Copyright © Europa Digital & Publishing
2018. All rights reserved.

<115>
Accession Number
625454338
Title
Extended Use of the Wearable Cardioverter-Defibrillator: Which Patients
Are Most Likely to Benefit?.
Source
Cardiology Research and Practice. 2018 (no pagination), 2018. Article
Number: 7373610. Date of Publication: 2018.
Author
Kovacs B.; Reek S.; Krasniqi N.; Eriksson U.; Duru F.
Institution
(Kovacs, Duru) Arrhythmias and Electrophysiology Unit, Department of
Cardiology, University Heart Center Zurich, University Hospital Zurich,
Ramistrasse 100, Zurich 8091, Switzerland
(Krasniqi, Eriksson) Department of Cardiology, Regional Hospital Wetzikon,
Spitalstrasse 66, Wetzikon 8620, Switzerland
(Reek) Rain 34, Aarau 5000, Switzerland
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Background. Wearable cardioverter-defibrillators (WCD, LifeVest, ZOLL) can
protect from sudden cardiac death bridging a vulnerable period until a
decision on implantable cardioverter-defibrillator (ICD) implantation can
be reached. WCD is commonly used for 3 months or less. It is unknown,
which patients use WCD longer and which patients are most likely to
benefit from it. Hypothesis. Extended use of WCD is reasonable in selected
cases based on underlying heart disease and overall patient risk profile.
Methods. We conducted a systematic and comprehensive research of all
published clinical studies on PubMed reporting on the use of the WCD. Only
original articles reporting on wear times and time to appropriate shocks
were included in our analysis. Results. The search resulted in 127
publications. 14 parameters were reported necessary for inclusion in our
analysis. Median wear times ranged from 16 to 394 days. The median wear
time was especially long for patients suffering from nonischemic
cardiomyopathy (NICM) (range: 50-71 days) and specifically peripartum
cardiomyopathy (PPCM) (120 days) and for heart transplant candidates.
There was a large variation of appropriate shocks according to indication
for WCD use. In contrast to NICM in general, the number of appropriate
shocks was particularly high in patients with PPCM (0 in 254 patients and
5 in 49 patients, respectively). The median and maximal time periods to
the first appropriate shock were longest in patients with PPCM (median
time to the first appropriate shock: 68 days). Conclusions. Prolonged use
of WCD is not uncommon in available literature. Patients suffering from
NICM and specifically PPCM seem most likely to have longer therapy
duration with WCD with success. Careful patient selection for prolonged
use may decrease the need for ICD implantation in the future; however,
prospective data are needed to confirm this hypothesis. Copyright
© 2018 Boldizsar Kovacs et al.

<116>
Accession Number
2001390378
Title
Long-term outcomes of mechanical versus biological aortic valve
prosthesis: Systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Author
Diaz R.; Hernandez-Vaquero D.; Alvarez-Cabo R.; Avanzas P.; Silva J.;
Moris C.; Pascual I.
Institution
(Diaz, Hernandez-Vaquero, Alvarez-Cabo, Avanzas, Silva, Moris, Pascual)
Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
(Diaz, Hernandez-Vaquero, Avanzas, Moris, Pascual) Instituto de
Investigacion Sanitaria del Principado de Asturias, Oviedo, Spain
(Silva, Moris) Department of Medicine, University of Oviedo, Oviedo, Spain
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: In recent years, the use of surgically implanted biological
aortic valves has been favored over mechanical prosthesis in patients
between 50 and 70 years of age. However, outcomes on long-term survival
are contradictory. The objective of this study was to determine if
patients with mechanical valves have worse long-term survival than
patients with biological prostheses. Method(s): We systematically
searched published studies that: (1) were propensity score-matched or
randomized controlled trials; (2) provided survival data with a minimum
follow-up of 5 years; and (3) included patients older than 50 and younger
than 70 years of age. Review articles, case reports, and editorials were
excluded. We conducted a meta-analysis on the basis of 2 types of
analysis. A reconstruction of the database of each study to simulate a
patient-level meta-analysis was performed. Log rank test of Kaplan-Meier
curves was recalculated. Hazard ratio (HR) was calculated using a
univariate Cox regression. In addition, we calculated a pooled HR using
the fixed-effect inverse variance method. Result(s): Four propensity
score-matched studies and 1 randomized controlled trial met the inclusion
criteria. Data of 4686 patients were analyzed. Survival rates for
mechanical versus biological valves at 10 and 15 years of follow-up were:
76.78% (95% confidence interval [CI], 74.72%-78.69%) versus 74.09% (95%
CI, 71.96%-76.08%), and 61.58% (95% CI, 58.29%-64.69%) versus 58.04% (95%
CI, 54.57%-61.35%). Log rank test was statistically significant (P =.012)
and the pooled HR was 0.86 (95% CI, 0.76-0.97; P =.01).
 Conclusion(s): Compared with biological aortic valves, mechanical
valves are associated with a long-term survival benefit for patients
between 50 and 70 years. Copyright © 2018 The American
Association for Thoracic Surgery

<117>
Accession Number
2001389912
Title
Pregnancy outcomes and mid-term prognosis in women after arterial switch
operation for dextro-transposition of the great arteries - Tertiary
hospital experiences and review of literature.
Source
Journal of Cardiology. (no pagination), 2018. Date of Publication: 2018.
Author
Horiuchi C.; Kamiya C.A.; Ohuchi H.; Miyoshi T.; Tsuritani M.; Iwanaga N.;
Neki R.; Niwa K.; Kurosaki K.; Ichikawa H.; Ikeda T.; Yoshimatsu J.
Institution
(Horiuchi, Kamiya, Tsuritani, Iwanaga, Neki, Yoshimatsu) Departments of
Perinatology and Gynecology, National Cerebral and Cardiovascular Center,
Suita, Osaka, Japan
(Horiuchi, Miyoshi, Ikeda) Departments of Obstetrics and Gynecology, Mie
University School of Medicine, Mie, Japan
(Ohuchi, Kurosaki) Departments of Pediatric Cardiology, National Cerebral
and Cardiovascular Center, Suita, Osaka, Japan
(Niwa) Cardiovascular Center, St. Luke's International Hospital, Tokyo,
Japan
(Ichikawa) Departments of Pediatric Cardiovascular Surgery, National
Cerebral and Cardiovascular Center, Suita, Osaka, Japan
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Objective: Arterial switch operation (ASO) for dextro-transposition of the
great arteries (d-TGA) has gradually replaced the atrial switch operation
and has become the standard operation. To date, the outcomes of pregnant
women with d-TGA after this new operation have not been investigated. In
this study, we investigated the impact of ASO on pregnant outcomes and
mid-term prognosis in women with d-TGA and compared with the atrial switch
operation through the literature review. Methods and Results: There
were 20 pregnancies in 10 women with d-TGA after ASO and 6 resulted in
abortion. Among 14 successful pregnancies in 10 women, 11 pregnancies
achieved the term delivery and 3 pregnancies, including 1 twin pregnancy,
resulted in preterm labor. Maternal cardiovascular events occurred in 4
(heart failure and arrhythmias in 3 and arrhythmia in 1), and all were
controllable with medications. Risk factors for the peripartum cardiac
events were older age at ASO and delivery, and higher concentration of
brain natriuretic peptide (BNP) at first trimester (p < 0.05). In 7-60
month-follow-up after delivery, no case showed deterioration of functional
class and systemic ventricular function. According to the literature
review, women after ASO demonstrated a better prognosis than those after
the atrial switch operation. Conclusion(s): The majority of women
with d-TGA after ASO tolerated pregnancy and delivery well. The older age
at ASO, an elderly pregnancy, and higher BNP levels at the first trimester
were possibly risk factors of peripartum cardiovascular events among the
group. The literature reviews and this study may indicate the advantage of
systemic left ventricle compared with systemic right ventricle in
long-term outcomes after delivery. Copyright © 2018 Japanese
College of Cardiology

<118>
Accession Number
2001387632
Title
Trans-catheter aortic valve replacement and surgical aortic valve
replacement outcomes in patients with dialysis: Systematic review and
meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2018. Date of
Publication: 2018.
Author
Vindhyal M.R.; Ndunda P.; Khayyat S.; Boppana V.S.; Fanari Z.
Institution
(Vindhyal, Ndunda, Khayyat, Boppana, Fanari) Internal Medicine, University
of Kansas School of Medicine - Wichita, 1010 N Kansas, Wichita, KS 67214,
United States
(Boppana, Fanari) Cardiology, Heartland Cardiology/Wesley Medical Center,
550 N Hillside, Wichita, KS 67214, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Dialysis is associated with higher rate of aortic valve
calcification and higher cardiovascular mortality. Transcatheter aortic
valve replacement (TAVR) is an established alternative for surgical aortic
valve replacement (SAVR) in patients with higher and intermediate
co-morbidities including dialysis. Method(s): Two independent
investigators systematically searched Medline, Cochrane, and Web of
Science. The ROBINS-I tool was used to analyze and assess the bias from
the selected studies. Result(s): The search resulted in 4
observational studies with a total of 966 patients. TAVR in dialysis
patients was associated with no significant difference in in-hospital
mortality [8.1% vs 10.3%; OR (95% CI) 0.74 (0.35, 1.60), I2 = 50%, P =
0.45], risk-of-strokes at 30 days [2% vs 4.4%; OR (95% CI) 0.49 (0.22,
1.09), I2 = 0%, P = 0.08], vascular complications [12.7% vs 13.2%; OR (95%
CI) 0.96 (0.55, 1.67), I2 = 0%, P = 0.89], need of blood transfusion
[43.1% vs 66.4%; OR (95% CI) 0.27 (0.05, 1.39), I2 = 89%, P = 0.12], or
bleeding risk [5.6% vs 6.8%; OR (95% CI) 0.91 (0.18, 4.64), I2 = 5%, P =
0.91] when compared to SAVR. TAVR was associated with significantly
shorter length of stay [8.5 days vs 14.2 days; mean difference (95% CI)
-5.89 (-9.13, -2.64), I2 = 76%, P < 0.0001] and higher pacemaker
implantation [11.4% vs 6.8%; OR (95% CI) 1.74 (1.07, 2.81), I2 = 5%, P =
0.02]. Conclusion(s): TAVR outcomes were comparable to SAVR but had a
significantly shorter length of stay and a higher pacemaker implantation
rate in dialysis patients. Copyright © 2018 Elsevier Inc.

<119>
Accession Number
625518472
Title
Incidence, Characteristics, and Outcomes of Myocardial Infarction in
Patients with Peripheral Artery Disease: Insights from the EUCLID Trial.
Source
JAMA Cardiology. (no pagination), 2018. Date of Publication: 2018.
Author
Olivier C.B.; Mulder H.; Hiatt W.R.; Jones W.S.; Fowkes F.G.R.; Rockhold
F.W.; Berger J.S.; Baumgartner I.; Held P.; Katona B.G.; Norgren L.;
Blomster J.; Patel M.R.; Mahaffey K.W.
Institution
(Olivier, Mahaffey) Stanford Center for Clinical Research, Department of
Medicine, Stanford University, School of Medicine, Stanford, CA, United
States
(Mulder, Jones, Rockhold, Patel) Duke Clinical Research Institute, Duke
University, School of Medicine, Durham, NC, United States
(Hiatt) Division of Cardiology, University of Colorado, School of
Medicine, Aurora, United States
(Hiatt) CPC Clinical Research, University of Colorado, School of Medicine,
Aurora, United States
(Fowkes) Usher Institute of Population Health Sciences and Informatics,
University of Edinburgh, Edinburgh, United Kingdom
(Berger) Department of Medicine, New York University, School of Medicine,
NY, United States
(Berger) Department of Surgery, New York University, School of Medicine,
NY, United States
(Baumgartner) Swiss Cardiovascular Center, Inselspital, University of
Bern, Bern, Switzerland
(Held) AstraZeneca Gothenburg, Molndal, Sweden
(Katona) AstraZeneca Gaithersburg, Gaithersburg, MD, United States
(Norgren) Faculty of Medicine and Health, Orebro University, Orebro,
Sweden
(Blomster) Turku University Hospital, Turku, Finland
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Patients with peripheral artery disease (PAD) are at high risk
for myocardial infarction (MI). Objective(s): To characterize the
incidence and types of MI in a PAD population, identify factors associated
with MI, and determine the association of MI with cardiovascular mortality
and acute limb ischemia. Design, Setting, and Participant(s): The
Study Comparing Cardiovascular Effects of Ticagrelor and Clopidogrel in
Patients With Peripheral Artery Disease (EUCLID) was a double-blind
randomized clinical trial conducted at 811 sites in 28 countries that
randomized 13885 patients with symptomatic PAD to monotherapy with
ticagrelor or clopidogrel. Participants had an ankle-brachial index (ABI)
of 0.80 or less or previous lower extremity revascularization. Median
follow-up was 30 months. For these analyses, patients were evaluated for
MI occurrence during follow-up irrespective of treatment. Data were
analyzed from June 2017 to September 2018. Main Outcomes and
Measures: An adjudication clinical events committee classified MI as type
1 (spontaneous), type 2 (secondary), type 3 (sudden cardiac death), type
4a (less than 48 hours after percutaneous coronary intervention), type 4b
(definite stent thrombosis), or type 5 (less than 72 hours after coronary
artery bypass graft). A multivariate regression model was developed by
stepwise selection to identify factors associated with MI, and a
time-dependent multivariate Cox regression analysis was performed to
determine the association of MI with cardiovascular death and acute limb
ischemia requiring hospitalization. Result(s): Of the 13885 patients
included in this analysis, 9997 (72.0%) were male, and the median
(interquartile range) age was 66 (60-73) years. Myocardial infarction
occurred in 683 patients (4.9%; 2.4 events per 100 patient-years) during a
median follow-up of 30 months. Patients experiencing MI were older (median
[interquartile range] age, 69 [62-75] vs 66 [60-72] years), more likely to
have diabetes (349 of 683 [51.1%] vs 4996 of 13202 [37.8%]) or a previous
lower extremity revascularization (466 of 683 [68.2%] vs 7409 of 13202
[56.1%]), and had a lower ABI (if included by ABI) compared with censored
patients. Of the 683 patients with MI during follow-up, the most common MI
type was type 1 (405 [59.3%]), followed by type 2 (236 [34.6%]), type 4a
(14 [2.0%]), type 3 (12 [1.8%]), type 4b (11 [1.6%]), and type 5 (5
[0.7%]). Postrandomization MI was independently associated with
cardiovascular death (adjusted hazard ratio, 9.0; 95% CI, 7.3-11.2; P
<.001) and acute limb ischemia requiring hospitalization (adjusted hazard
ratio, 2.5; 95% CI, 1.3-5.0; P =.008). Conclusions and Relevance:
Approximately 5% of patients with symptomatic PAD had an MI during a
median follow-up of 30 months. Type 1 MI (spontaneous) was the most common
MI type; however, one-third of MIs were type 2 MI (secondary). More
research is needed to identify therapies to reduce the risk of MI in
patients with PAD and to improve management of type 2 MI. Trial
Registration: ClinicalTrials.gov Identifier: NCT01732822. Copyright
© 2018 American Medical Association. All rights reserved.

<120>
Accession Number
625513473
Title
Low-level laser therapy versus trunk stabilization exercises on sternotomy
healing after coronary artery bypass grafting: a randomized clinical
trial.
Source
Lasers in Medical Science. (no pagination), 2018. Date of Publication:
2018.
Author
Helmy Z.M.; Mehani S.H.M.; El-Refaey B.H.; Al-Salam E.H.A.; Felaya
E.-S.E.E.-S.
Institution
(Helmy, El-Refaey, Felaya) Department of Physical Therapy for Internal
Medicine, Faculty of Physical Therapy, Cairo University, Giza, Egypt
(Mehani) Department of Physical Therapy for Internal Medicine, Faculty of
Physical Therapy, Beni-Suef University, Benisuef Elgadata, Street No. 18,
Beni-Suef governorate 62511, Egypt
(Al-Salam) Department of Diagnostic Imaging, National Heart Institute,
Giza, Egypt
Publisher
Springer London
Abstract
The aim of this study was to investigate the effects of low-level laser
therapy (LLLT) versus trunk stabilization exercises on sternotomy healing
following coronary artery bypass grafting (CABG) surgery. Forty-five male
patients who had acute sternal instability post-CABG surgery in the age
range of 45-65 years were divided randomly into three equal groups (n =
15). The laser group received LLLT, while the exercise group received
trunk stabilization exercises. The control group only received a routine
cardiac rehabilitation programme, which was also provided to both the
laser and the exercise groups. All groups were offered 12 sessions over 4
weeks. Sternal separation, median sternotomy photographic analysis, pain
and activities of daily living (ADL) performance were evaluated pre- and
post-treatment. Statistical significance was set at P < 0.05. There was a
significant decrease among the laser group in upper-sternal separation,
while the exercise and control groups showed a non-significant decrease.
In terms of mid-sternal separation, laser and exercise groups showed a
significant decrease while the control group showed a non-significant
decrease. In terms of lower-sternal separation, the exercise group showed
a significant decrease, while the laser and control groups showed a
non-significant decrease. Post-treatment between-groups analysis showed a
significant difference only among the laser and control groups with regard
to upper-sternal separation, while analysis of the laser, exercise and
control groups in the case of upper-sternal separation and the
between-groups comparison in terms of mid- and lower-sternal separation
revealed no significant differences. LLLT and trunk stabilization
exercises were found to be the most effective methods for sternotomy
healing post-CABG surgery, with LLLT offering superior performance in the
case of the upper sternum while trunk stabilization exercises were more
effective for the lower sternum. Copyright © 2018,
Springer-Verlag London Ltd., part of Springer Nature.

<121>
Accession Number
625512844
Title
Optimal medical therapy vs. coronary revascularization for patients
presenting with chronic total occlusion: A meta-analysis of randomized
controlled trials and propensity score adjusted studies.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2018.
Date of Publication: 2018.
Author
Iannaccone M.; D'ascenzo F.; Piazza F.; De Benedictis M.; Doronzo B.;
Behnes M.; Garbo R.; Mashayekhi K.
Institution
(Iannaccone, Piazza, De Benedictis, Doronzo) SS. Annunziata Hospital, ASL
CN 1, Savigliano, Italy
(D'ascenzo) Department of Cardiology, Citta della Scienza e dalla Salute
Hospital, University of Turin, Turin, Italy
(Behnes) First Department of Medicine, University Medical Center Mannheim,
University of Heidelberg, Mannheim, Germany
(Behnes) DZHK (German Center for Cardiovascular Research) Partner Site,
Mannheim, Germany
(Garbo) S.G. Bosco Hospital, Turin, Italy
(Mashayekhi) Department of Cardiology and Angiology II, University Heart
Center Freiburg, Bad Krozingen, Germany
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Introduction: The optimal management of patients with coronary chronic
total occlusions (CTO) remains controversial. This meta-analysis aims to
compare percutaneous coronary intervention of CTO (CTO-PCI) versus optimal
medical therapy (OMT) in CTO patients. Method(s): A literature search
with highly specific terms was conducted using MEDLINE, EMBASE, and Web of
Science to identify most relevant randomized controlled trials (RCTs) and
observational studies with propensity score matching (PSM) evaluating
differences in between CTO-PCI versus OMT. The primary endpoint was the
incidence of major adverse cardiac events (MACEs, composite of
cardiovascular death, acute coronary syndrome, and repeat PCI, re-PCI)
while its single components were defined as secondary endpoints.
 Result(s): A total of eight studies was included, four RCTs and four
PSMs. 3,971 patients were included in the analysis (2,050 CTO-PCI versus
1,921 OMT) with a mean follow-up of 3 years. No significant differences
were found regarding overall MACE, re-PCI and AMI. Regarding CV-death,
CTO-PCI was associated with a better outcome compared with OMT driven by
PSMs (OR 0.52, 0.0.81, P < 0.01). Conclusion(s): As compared to OMT,
CTO-PCI was associated with similar MACE rate; however, CTO-PCI may be
associated with reduced CV death, mainly due to PSMs effect. Copyright
© 2018 Wiley Periodicals, Inc.

<122>
Accession Number
621756065
Title
Oropharyngeal and nasopharyngeal decontamination with chlorhexidine
gluconate in lung cancer surgery: a randomized clinical trial.
Source
Intensive Care Medicine. 44 (5) (pp 578-587), 2018. Date of Publication:
01 May 2018.
Author
D'Journo X.B.; Falcoz P.-E.; Alifano M.; Le Rochais J.-P.; D'Annoville T.;
Massard G.; Regnard J.F.; Icard P.; Marty-Ane C.; Trousse D.; Doddoli C.;
Orsini B.; Edouard S.; Million M.; Lesavre N.; Loundou A.; Baumstarck K.;
Peyron F.; Honore S.; Dizier S.; Charvet A.; Leone M.; Raoult D.; Papazian
L.; Thomas P.A.
Institution
(D'Journo, Trousse, Doddoli, Orsini, Thomas) Service de Chirurgie
Thoracique, Chemin des Bourrely, Hopital Nord, Assistance Publique
Hopitaux de Marseille, Aix-Marseille University, Marseille cedex 20 13915,
France
(Falcoz, Massard) Service de Chirurgie Thoracique, Nouvel Hopital Civil,
Strasbourg University, Strasbourg, France
(Alifano, Regnard) Service de Chirurgie Thoracique, Hopital Cochin,
Assistance Publique Hopitaux de Paris, Paris Descartes University, Paris,
France
(Le Rochais, Icard) Service de Chirurgie Thoracique, Hopital de la cote de
Nacre, Caen University, Caen, France
(D'Annoville, Marty-Ane) Service de Chirurgie Thoracique, Hopital Arnaud
de Villeneuve, Montpellier University, Montpellier, France
(D'Journo, Doddoli, Edouard, Million, Leone, Raoult, Thomas) Unite de
Recherche sur les Maladies Infectieuses et Tropicales Emergentes
(URMITE),UM63, CNRS 7278, IRD 198 INSERM U1095, Institut
Hospitalo-Universitaire Mediterranee Infection, Marseille Aix-Marseille
Univ., Marseille, France
(Lesavre, Leone) Centre d'Investigation Clinique, Hopital Nord, Assistance
Publique Hopitaux de Marseille, Aix-Marseille University, Marseille,
France
(Loundou, Baumstarck) Unite d'aide methodologique, Assistance Publique
Hopitaux de Marseille, Aix-Marseille University, Marseille, France
(Peyron, Honore) Service Clinique de Pharmacologie, Assistance Publique
Hopitaux de Marseille, Aix-Marseille University, Marseille, France
(Dizier, Charvet, Leone) Service d'Anesthesie-Reanimation, Hopital Nord,
Assistance Publique Hopitaux de Marseille, Aix-Marseille University,
Marseille, France
(Papazian) Reanimation des Detresses Respiratoires et Infections Severes,
Hopital Nord, Assistance Publique Hopitaux de Marseille, Aix-Marseille
University, Marseille, France
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Respiratory complications are the leading causes of morbidity and
mortality after lung cancer surgery. We hypothesized that oropharyngeal
and nasopharyngeal decontamination with chlorhexidine gluconate (CHG)
would be an effective method to reduce these complications as reported in
cardiac surgery. Method(s): In this multicenter parallel-group
randomized double-blind placebo-controlled trial, we enrolled consecutive
adults scheduled for anatomical pulmonary resection for lung cancer.
Perioperative decontamination consisted in oropharyngeal rinse solution
(0.12% CHG) and nasopharyngeal soap (4% CHG) or a placebo. The primary
outcome measure was the proportion of patients requiring postoperative
invasive and/or noninvasive mechanical ventilation (MV). Secondary outcome
measures included occurrence of respiratory and non-respiratory
healthcare-associated infections (HAIs) and outcomes within 90 days.
 Result(s): Between July 2012 and April 2015, 474 patients were
randomized. Of them, 24 had their surgical procedure cancelled or withdrew
consent. The remaining 450 patients were included in a modified
intention-to-treat analysis: 226 were allocated to CHG and 224 to the
placebo. Proportions of patients requiring postoperative MV were not
significantly different [CHG 14.2%; placebo 15.2%; relative risks (RRs)
0.93; 95% confidence interval (CI) 0.59-1.45; P = 0.76]. Neither of the
proportions of patients with respiratory HAIs were different (CHG 13.7%;
placebo 12.9%; RRs 1.06; 95% CI 0.66-1.69; P = 0.81). The CHG group had
significantly decreased incidence of bacteremia, surgical-site infection
and overall Staphylococcus aureus infections. However, there were no
significant between-group differences for hospital stay length, change in
tracheal microbiota, postoperative antibiotic utilization and outcomes by
day 90. Conclusion(s): CHG decontamination decreased neither MV
requirements nor respiratory infections after lung cancer surgery.
Additionally, CHG did not change tracheal microbiota or postoperative
antibiotic utilization. Trial Registration: This study is registered on
ClinicalTrials.gov, number NCT01613365. Copyright © 2018,
Springer-Verlag GmbH Germany, part of Springer Nature and ESICM.

<123>
[Use Link to view the full text]
Accession Number
622901361
Title
Homograft Versus Conventional Prosthesis for Surgical Management of Aortic
Valve Infective Endocarditis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 13 (3) (pp 163-170), 2018. Date of Publication: 01 May 2018.
Author
Yanagawa B.; Mazine A.; Tam D.Y.; Juni P.; Bhatt D.L.; Spindel S.; Puskas
J.D.; Verma S.; Friedrich J.O.
Institution
(Yanagawa, Mazine, Tam, Verma) Division of Cardiac Surgery, St Michael's
Hospital, University of Toronto, Division of Cardiac Surgery, 30 Bond
Street, 8th Floor, Bond Wing, Toronto, ON M5B 1W8, Canada
(Juni) Applied Health Research Centre, St Michael's Hospital, University
of Toronto, Toronto, ON, Canada
(Juni, Friedrich) Li Ka Shing Knowledge Institute, St Michael's Hospital,
University of Toronto, Toronto, ON, Canada
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Spindel, Puskas) Department of Cardiothoracic Surgery, Mount Sinai
Hospital, New York, NY, United States
(Friedrich) Department of Critical Care and Medicine, St Michael's
Hospital, University of Toronto, Toronto, ON, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective Surgical management of aortic valve infective endocarditis (IE)
with cryopreserved homograft has been associated with lower risk of
recurrent IE, but there is equipoise with regard to the optimal
prosthesis. This systematic review and meta-analysis were performed to
compare outcomes between homograft and conventional prosthesis for aortic
valve IE. Methods We searched MEDLINE database to September 2017 for
studies comparing homograft versus conventional prosthesis. The main
outcomes were all-cause mortality, recurrent IE, and reoperation. Results
There were 18 included comparative observational studies with 2232
patients (median follow up = 5 [interquartile range: 2-7] years, 30%
prosthetic valve endocarditis); four studies were adjusted for baseline
differences. There were no differences in perioperative mortality or
stroke despite a greater proportion of staphylococcal endocarditis,
abscess, and root replacements but less multivalve involvement in the
homograft group. Long-term outcomes of all-cause mortality [incidence rate
ratio (IRR) = 1.03, 95% confidence interval (CI) = 0.81-1.31, P = 0.83,
for unmatched, and IRR = 0.82, 95% CI = 0.36-1.84, P = 0.63, for matched
studies], recurrent endocarditis (IRR = 1.01, 95% CI = 0.53-1.93, P =
0.96, for unmatched, and IRR = 1.04, 95% CI = 0.49-2.19, P = 0.92, for
matched studies), and reoperation (IRR = 1.60, 95% CI = 0.80-3.21, P =
0.18, for unmatched, and IRR = 3.17, 95% CI = 0.52-19.44, P = 0.21, for
matched studies) were not different comparing homograft versus
conventional prosthesis. There was a significantly increased need for
reoperation with homograft versus mechanical prosthetic valves, but this
comparison was based on limited data. Conclusions Homografts and
conventional prostheses offer similar survival and freedom from recurrent
endocarditis and reoperation for aortic valve IE. Homografts may be
associated with greater risk of reoperation compared with mechanical
valves. Copyright © 2018 by the International Society for
Minimally Invasive Cardiothoracic Surgery.

<124>
[Use Link to view the full text]
Accession Number
622901359
Title
Three-Year Survival Comparison between Transcatheter and Surgical Aortic
Valve Replacement for Intermediate- and Low-Risk Patients.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 13 (3) (pp 153-162), 2018. Date of Publication: 01 May 2018.
Author
Siordia J.A.; Loera J.M.; Scanlon M.; Evans J.; Knight P.A.
Institution
(Siordia, Loera, Scanlon, Evans, Knight) Department of Cardiac Surgery,
University of Rochester Medical Center, 7796 Victor Mendon Rd, Victor,
Rochester, NY 14564, United States
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Transcatheter aortic valve implantation is a suitable therapeutic
intervention for patients deemed inoperable or high risk for surgical
aortic valve replacement. Current investigations question whether it is a
suitable alternative to surgery for intermediate- and low-risk patients.
The following meta-analysis presents a comparison between transcatheter
versus surgical aortic valve replacement in patients that are intermediate
and low risk for surgery. Articles were collected via an electronic search
using Google Scholar and PubMed. Articles of interest included studies
comparing the survival of intermediate- and low-risk patients undergoing
transcatheter aortic valve implantation to those undergoing surgical
aortic valve replacement. Primary end points included 1-, 2-, and 3-year
survival. Secondary end points included postintervention thromboembolic
events, stroke, transient ischemic attacks, major vascular complications,
permanent pacemaker implantation, life-threatening bleeding, acute kidney
injury, atrial fibrillation, and moderate-to-severe aortic regurgitation.
Six studies met the criteria for the meta-analysis. One- and two-year
survival comparisons showed no difference between the two interventions.
Surgical aortic valve replacement, however, presented with favorable
3-year survival compared with the transcatheter approach. Transcatheter
aortic valve implantation had more major vascular complications, permanent
pacemaker implantation, and moderate-to-severe aortic regurgitation rates
compared with surgery. Surgical aortic valve replacement presented more
life-threatening bleeding, acute kidney injury, and atrial fibrillation
compared with a transcatheter approach. There was no statistical
difference between the two approaches in terms of thromboembolic events,
strokes, or transient ischemic attack rates. Surgical aortic valve
replacement presents favorable 3-year survival rates compared with
transcatheter aortic valve implantation. Copyright © 2018 by the
International Society for Minimally Invasive Cardiothoracic Surgery.

<125>
Accession Number
625413756
Title
Editor's presentation.
Source
European Journal of Preventive Cardiology. 26 (1) (pp 3-5), 2019. Date of
Publication: 01 Jan 2019.
Author
Piepoli M.F.
Institution
(Piepoli) Heart Failure Unit, Cardiology, G da Saliceto Hospital, Romagna,
Italy
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)

<126>
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.

<127>
Accession Number
625391909
Title
Influence of permanent pacemaker implantation after transcatheter aortic
valve implantation with new-generation devices.
Source
Netherlands Heart Journal. 26 (12) (pp 620-627), 2018. Date of
Publication: 01 Dec 2018.
Author
Gonska B.; Kessler M.; Wohrle J.; Rottbauer W.; Seeger J.
Institution
(Gonska, Kesler, Wohrle, Rottbauer, Seeger) Department of Internal
Medicine II, University of Ulm, Ulm, Germany
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Objective: Permanent pacemaker implantation (PPMI) after transcatheter
aortic valve implantation (TAVI) is the most common complication after the
procedure. PPMI rates remain high with the new-generation TAVI devices
despite improved outcomes concerning paravalvular aortic regurgitation and
vascular access complications. However, the impact of PPMI on mortality
and clinical outcome is still a matter of debate, and data with
new-generation devices on this matter are scarce. Therefore, we sought to
analyse the influence of PPMI in patients treated with the new-generation
devices on one-year outcome. Method(s): We enrolled 612 consecutive
patients without prior pacemaker undergoing transfemoral TAVI with the
new-generation devices. Patients with or without PPMI were compared with
respect to clinical outcome within one year. Result(s): PPMI was
performed in 168 patients (24.4% of the overall study population). There
was no significant difference in one-year outcome concerning all-cause
mortality (PPMI vs. no-PPMI: 12.2% vs. 12.5%, p= 0.94), rate of major
adverse events including cardiac, cerebral or valve-related events and
bleeding complications (22.1% vs. 24.5%, p= 0.55) or need for
rehospitalisation due to cardiac symptoms (16.1% vs. 18.1%, p= 0.63). In
patients with reduced ejection fraction (<45%) there was also no impact of
PPMI on one-year mortality (14.3% vs. 15.7%, p= 0.86). Furthermore,
multivariate analysis did not reveal PPMI to be independently associated
with one-year mortality (odds ratio 0.94, 95% confidence interval
0.50-1.74, p= 0.83). Conclusion(s): In this large all-comers TAVI
population with new-generation devices the need for postprocedural PPMI
did not show a statistical significant impact on survival or combined
endpoint of major adverse events within one year. Copyright ©
2018, The Author(s).

<128>
Accession Number
624248631
Title
Cost-effectiveness analysis of single use negative pressure wound therapy
dressings (sNPWT) compared to standard of care in reducing surgical site
complications (SSC) in patients undergoing coronary artery bypass grafting
surgery.
Source
Journal of cardiothoracic surgery. 13 (1) (pp 103), 2018. Date of
Publication: 03 Oct 2018.
Author
Nherera L.M.; Trueman P.; Schmoeckel M.; Fatoye F.A.
Institution
(Nherera, Trueman) Smith & Nephew Advanced Wound Management, Global Market
Access, 101 Hessle Road, Hull HU3 2BN, United Kingdom
(Schmoeckel) Vascular and Diabetic Centre Department of Heart Surgery,
Asklepios Klinik St. Georg Cardiac, Lohmuhlenstr 5, Hamburg 20099, Germany
(Fatoye) Department of Health Professions, Manchester Metropolitan
University, Manchester, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: There is a growing interest in using negative pressure wound
therapy in closed surgical incision to prevent wound complications which
continue to persist following surgery despite advances in infection
measures. OBJECTIVE(S): To estimate the cost-effectiveness of single
use negative pressure wound therapy (sNPWT) compared to standard of care
in patients following coronary artery bypass grafting surgery (CABG)
procedure to reduce surgical site complications (SSC) defined as
dehiscence and sternotomy infections. METHOD(S): A decision analytic
model was developed from the Germany Statutory Health Insurance payer's
perspective over a 12-week time horizon. Baseline data on SSC, revision
operations, length of stay, and readmissions were obtained from a
prospective observational study of 2621 CABG patients in Germany.
Effectiveness data for sNPWT was taken from a randomised open label trial
conducted in Poland which randomised 80 patients to treatment with either
sNPWT or standard care. Cost data (in Euros) were taken from the relevant
diagnostic related groups and published literature. RESULT(S): The
clinical study reported an increase in wounds that healed without
complications 37/40 (92.5%) in the sNPWT compared to 30/40 (75%) patients
in the SC group p=0.03. The model estimated sNPWT resulted in 0.989
complications avoided compared to 0.952 and the estimated quality adjusted
life years were 0.8904 and 0.8593 per patient compared to standard care.
The estimated mean cost per patient was 19,986 for sNPWT compared to
20,572 for SC resulting in cost-saving of 586. The findings were robust to
a range of sensitivity analyses. CONCLUSION(S): The sNPWT can be
considered a cost saving intervention that reduces surgical site
complications following CABG surgery compared to standard care. We however
recommend that additional economic studies should be conducted as new
evidence on the use of sNPWT in CABG patients becomes available to
validate the results of this economic analysis.

<129>
Accession Number
623737388
Title
Donor derived Mycobacterium tuberculosis infection after solid-organ
transplantation: A comprehensive review.
Source
Transplant Infectious Disease. 20 (5) (no pagination), 2018. Article
Number: e12971. Date of Publication: October 2018.
Author
Abad C.L.R.; Razonable R.R.
Institution
(Abad) Section of Infectious Diseases, Department of Medicine, Philippine
General Hospital, University of the Philippines-Manila, Manila,
Philippines
(Razonable) Division of Infectious Diseases, Department of Medicine, The
William J Von Liebig Center for Transplantation and Clinical Regeneration,
Mayo Clinic College of Medicine and Sciences, Rochester, MN, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Mycobacterium tuberculosis may be transmitted via the
allograft to cause a morbid and potentially fatal infection after solid
organ transplantation (SOT). We reviewed all reported cases of
donor-derived tuberculosis (DDTB) to provide an update on its
epidemiology, clinical course, and outcome after SOT. Method(s):
MEDLINE, OVID, and EMBASE were reviewed from its inception until December
31, 2016 using key words donor-derived infection, tuberculosis and solid
organ transplant or transplantation. Result(s): We retrieved 36 cases
of proven (n = 17), probable (n = 8), and possible (n = 11) DDTB among 16
lung, 13 kidney, 6 liver, and 1 heart recipients. Most patients were male
(21/35, 60%) with median age of 48 (range 23-68) years. Median time to
clinical presentation or diagnosis was 2.7 months (range 0.2-29). The most
common donor risk factor was residence in a TB-endemic area (13/28,
46.4%). Fever was the most frequent presenting symptom (20/36, 56.5%).
Diagnosis of tuberculosis was mostly made via AFB smear or mycobacterial
culture (30/36, 83.3%). Allograft involvement was expectedly common; there
were almost equal proportions of pulmonary (36%), extra-pulmonary (28%)
and disseminated (36%) cases. All cases of pulmonary TB were identified
only among lung transplant recipients. The median duration of TB treatment
was 10.5 (range 3-24) months. Graft loss occurred in four (4/22, 18.2%)
patients. All-cause mortality was 25% (9/36); four of nine deaths were
attributed to TB. Conclusion(s): Donor-derived TB presents early
after SOT, most commonly as fever, and carries a high mortality risk.
Donors should be screened, with particular attention to TB risk factors.
Fever during the early post-operative period should prompt a thorough
evaluation for DDTB in endemic regions and among patients with "at-risk"
donors. Copyright © 2018 John Wiley & Sons A/S. Published by John
Wiley & Sons Ltd

<130>
Accession Number
624127331
Title
Efficacy of forced-air warming for preventing perioperative hypothermia
and related complications in patients undergoing laparoscopic surgery: A
randomized controlled trial.
Source
International journal of nursing practice. 24 (5) (pp e12660), 2018. Date
of Publication: 01 Oct 2018.
Author
Su S.-F.; Nieh H.-C.
Institution
(Su) Department of Nursing, National Taichung University of Science and
Technology, Taichung, Taiwan (Republic of China)
(Nieh) Department of Nursing, Taichung Veterans General Hospital,
Taichung, Taiwan (Republic of China)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Perioperatively, unexpected hypothermia may cause adverse
surgical outcomes. However, few studies have explored the efficacy of
forced-air warming in patients undergoing laparoscopic surgery.
AIM/OBJECTIVE: To determine the efficacy of forced-air warming for
preventing perioperative hypothermia and complications in patients
undergoing laparoscopic surgery. METHOD(S): A total of 127
participants undergoing laparoscopic thoracic or abdominal surgery were
recruited between January and November 2015. Participants were randomly
allocated to intervention (forced-air warming, n = 64) and control groups
(passive insulation, n = 63). Oesophageal core temperature was measured
during surgery, whilst tympanic core temperature was measured every 30
minutes preoperatively and in the postanaesthesia care unit. Levels of
shivering and pain, amount of bleeding, and adverse cardiac events were
measured before the transfer from the postanaesthesia care unit. The
generalized estimating equation was used for data analysis.
 RESULT(S): The intervention group had better warming efficacy than
the control group between 90 and 330 minutes during surgery. The
intervention group had fewer complications than the control group in terms
of intraoperative bleeding, time to rewarm to 36degreeC, pain levels, and
shivering levels in the postanaesthesia care unit. CONCLUSION(S):
Forced-air warming can increase warming efficacy and reduce complications
of perioperative hypothermia in patients undergoing laparoscopic
surgery. Copyright © 2018 John Wiley & Sons Australia, Ltd.

<131>
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

<132>
Accession Number
625427617
Title
Long-term adverse outcomes associated with drug-eluting stents and
bare-metal stent in patients with small coronary artery disease: A
systematic review and meta-analysis.
Source
Nepalese Heart Journal. 15 (1) (pp 1-7), 2018. Date of Publication: 2018.
Author
Chaudhary N.; Bundhun P.K.; Shrestha S.; Yan H.
Institution
(Chaudhary, Shrestha) Department of Cardiology, Grande International
Hospital, Dhapasi, Kathmandu, Nepal
(Bundhun, Yan) Department of Geriatrics Cardiology, First Affiliated
Hospital, Guangxi Medical University, Nanning, Guangxi, China
Publisher
Cardiac Society of Nepal
Abstract
Objective: The main purpose of this meta-analysis was to compare the
long-term adverse outcomes associated with drug-eluting stents (DES) and
bare-metal stent (BMS) in patients with small coronary artery disease
(CAD). Method(s): Randomized Controlled Trials (RCTs) and
observational studies comparing the adverse outcomes such as mortality,
major adverse cardiovascular events (MACE), myocardial infarction (MI),
stent thrombosis (ST), target lesion revascularization (TLR), target
vessel revascularization (TVR), and restenosis in small CAD patients
receiving DES and BMS were searched from Embase, PubMed, and Cochrane
Library databases. Odds ratios (ORs) with 95% confidence intervals (CIs)
were calculated and the pooled analyses were performed with RevMan 5.3.
 Result(s): A total number of 4,106 patients with small CAD (2,123
patients received DES and 1,983 patients received BMS) have been included
in this meta-analysis. Pool-analysis demonstrated that the risk of
mortality, MACE, MI, ST, TLR, TVR, and restenosis were significantly lower
in DES group, with OR 0.77(95%CI 0.59-0.99, P=0.04), 0.48(95%CI 0.41-0.56,
P<0.00001), 0.74(95%CI 0.55-0.98, P=0.04), 0.51(95%CI: 0.26-0.98, P=0.04),
0.24(95%CI: 0.16-0.37, P<0.00001), 0.47(95%CI: 0.38-0.59, P<0.00001), and
0.24 (95%CI 0.14-0.43, P<0.00001), respectively. Conclusion(s):
Compared with BMS, DES had lower rates of adverse clinical outcomes, and
restenosis during long-term follow-up. Copyright © 2018 CSIC.

<133>
Accession Number
625142969
Title
Positive end-expiratory pressure (PEEP) level to prevent expiratory flow
limitation during cardiac surgery: Study protocol for a randomized
clinical trial (EFLcore study).
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 654. Date of
Publication: 26 Nov 2018.
Author
Bignami E.; Spadaro S.; Saglietti F.; Di Lullo A.; Corte F.D.; Guarnieri
M.; De Simone G.; Giambuzzi I.; Zangrillo A.; Volta C.A.
Institution
(Bignami, Saglietti, Di Lullo, Guarnieri, De Simone, Zangrillo) Department
of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute,
Via Olgettina 60, Milan 20132, Italy
(Spadaro, Corte, Volta) Department of Morphology, Surgery and Experimental
Medicine, Section of Anesthesia and Intensive Care, University of Ferrara,
Via Aldo Moro 8, Ferrara 44121, Italy
(Giambuzzi) Department of Cardiac Surgery, IRCCS San Raffaele Scientific
Institute, Via Olgettina 60, Milan 20132, Italy
(Bignami) Anesthesiology, Critical Care and Pain Medicine Division,
Department of Medicine and Surgery, University of Parma, Viale Gramsci 14,
Parma 43126, Italy
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Lung dysfunction commonly occurs after cardiopulmonary bypass
(CPB). Randomized evidence suggests that the presence of expiratory flow
limitation (EFL) in major abdominal surgery is associated with
postoperative pulmonary complications. Appropriate lung recruitment and a
correctly set positive end-expiratory pressure (PEEP) level may prevent
EFL. According to the available data in the literature, an adequate
ventilation strategy during cardiac surgery is not provided. The aim of
this study is to assess whether a mechanical ventilation strategy based on
optimal lung recruitment with a best PEEP before and after CPB and with a
continuous positive airway pressure (CPAP) during CPB would reduce the
incidence of respiratory complications after cardiac surgery.
Methods/design: This will be a single-center, single-blind,
parallel-group, randomized controlled trial. Using a 2-by-2 factorial
design, high-risk adult patients undergoing elective cardiac surgery will
be randomly assigned to receive either a best PEEP (calculated with a PEEP
test) or zero PEEP before and after CPB and CPAP (equal to the best PEEP)
or no ventilation (patient disconnected from the circuit) during CPB. The
primary endpoint will be a composite endpoint of the incidence of EFL
after the weaning from CPB and postoperative pulmonary complications.
 Discussion(s): This study will help to establish a correct
ventilatory strategy before, after, and during CPB. The main purpose is to
establish if a ventilation based on a simple and feasible respiratory test
may preserve lung function in cardiac surgery. Trial registration:
ClinicalTrials.gov, ID: NCT02633423. Registered on 6 December
2017. Copyright © 2018 The Author(s).

<134>
Accession Number
617647927
Title
Oesophageal Doppler guided goal-directed haemodynamic therapy in thoracic
surgery-a single centre randomized parallel-arm trial.
Source
British Journal of Anaesthesia. 118 (6) (pp 852-861), 2017. Date of
Publication: 01 Jun 2017.
Author
Kaufmann K.B.; Stein L.; Bogatyreva L.; Ulbrich F.; Kaifi J.T.; Hauschke
D.; Loop T.; Goebel U.
Institution
(Kaufmann, Stein, Ulbrich, Loop, Goebel) Department of Anaesthesiology and
Critical Care, Institute of Medical Biometry and Statistics, University of
Freiburg, Freiburg, Germany
(Bogatyreva, Hauschke) IMBI, Institute of Medical Biometry and Statistics,
University of Freiburg, Freiburg, Germany
(Kaifi) Department of Thoracic Surgery, Medical Centre-University of
Freiburg, Faculty of Medicine, Freiburg, Germany
Publisher
Oxford University Press
Abstract
Background: Postoperative pulmonary and renal complications are frequent
in patients undergoing lung surgery. Hyper-and hypovolaemia may contribute
to these complications. We hypothesized that goal-directed haemodynamic
management based on oesophageal Doppler monitoring would reduce
postoperative pulmonary complications in a randomized clinical
parallel-arm trial. Method(s): One hundred patients scheduled for
thoracic surgery were randomly assigned to either standard haemodynamic
management (control group) or goal-directed therapy (GDT group) guided by
an oesophageal Doppler monitoring-based algorithm. The primary endpoint
was postoperative pulmonary complications, including spirometry. Secondary
endpoints included haemodynamic variables, renal, cardiac, and
neurological complications, and length of hospital stay. The investigator
assessing outcomes was blinded to group assignment. Result(s):
Forty-eight subjects of each group were analysed. Compared to the control
group, fewer subjects in the GDT group developed postoperative pulmonary
complications (6 vs. 15 patients; P = 0.047), while spirometry did not
differ between groups. Compared to the control group, patients of the GDT
group showed higher cardiac index (2.9 vs. 2.1 [l min-1
m-2]; P < 0.001) and stroke volume index (43 vs. 34 [ml
m2]; P < 0.001) during surgery. Renal, cardiac and neurological
complications did not differ between groups. Length of hospital stay was
shorter in the GDT compared to the control group (9 vs. 11 days; P =
0.005). Conclusion(s): Compared to standard haemodynamic management,
oesophageal Doppler monitor-guided GDT was associated with fewer
postoperative pulmonary complications and a shorter hospital
stay. Copyright © 2017 The Author.

<135>
Accession Number
617839605
Title
Association between delirium and cognitive change after cardiac surgery.
Source
British Journal of Anaesthesia. 119 (2) (pp 308-315), 2017. Date of
Publication: 01 Aug 2017.
Author
Sauer A.C.; Veldhuijzen D.S.; Ottens T.H.; Slooter A.J.C.; Kalkman C.J.;
Van Dijk D.
Institution
(Sauer, Veldhuijzen, Ottens, Kalkman) Department of Anesthesiology,
University Medical Center Utrecht, PO Box 85500, GA Utrecht 3508,
Netherlands
(Veldhuijzen) Institute of Psychology, Health, Medical, and
Neuropsychology Unit, Faculty of Social Sciences, Leiden University, PO
Box 9555, RB, Leiden 2300, Netherlands
(Slooter, Van Dijk) Department of Intensive Care Medicine, University
Medical Center Utrecht, PO Box 85500, Utrecht 3508 GA, Netherlands
Publisher
Oxford University Press
Abstract
Previous studies provide inconsistent data on whether postoperative
delirium (POD) is a risk factor for postoperative cognitive decline
(POCD). We thus investigated the relationship between POD and cognitive
change after cardiac surgery and assessed the relationship between
preoperative cognitive domain scores and POD. Methods. Postoperative
deliriumwas assessed with the Confusion Assessment Method (CAM) adapted
for the intensive care unit and the conventional CAM accompanied by chart
review. Cognitive function was assessed with a neuropsychological test
battery before elective cardiac surgery and 1 month and 1 yr afterwards.
Cognitive change was calculated using the Reliable Change Index (RCI).
Multiple linear regression was used to adjust for confounding. Results. Of
the 184 patients who completed baseline assessment, 23 (12.5%) developed
POD. At 1 month, the decline in cognitive performance was worse in
patients with POD [median composite RCI 1.00, interquartile range (IQR)
1.67 to 0.28] than in patients without POD (RCI 0.04, IQR 0.70 to 0.63,
P0.02). At 1 yr, both groups showed cognitive improvement on average
compared with baseline (POD patients median composite RCI 0.25, IQR 0.42
to 1.31, vs non-POD patients RCI 0.92, IQR 0.18-1.53; P0.08). Correction
for differences in age and level of education did not change the results.
Patients with POD performed less well than patients without POD on the
preoperative Trailmaking test part A (P0.03). Conclusions. Postoperative
delirium is independently associated with cognitive decline 1 month after
surgery, but cognitive performance generally recovers in 1 yr. Patients
with a predisposition to POD can be identified before surgery by worse
performance in an attention task. Copyright © The Author 2017.
Published by Oxford University Press.

<136>
[Use Link to view the full text]
Accession Number
625482407
Title
Effectiveness of nurse-led cardiac rehabilitation programs following
coronary artery bypass graft surgery: a systematic review.
Source
JBI database of systematic reviews and implementation reports. 16 (12) (pp
2304-2329), 2018. Date of Publication: 01 Dec 2018.
Author
Mares M.A.; McNally S.; Fernandez R.S.
Institution
(Mares, McNally) School of Nursing and Midwifery, Western Sydney
University, Parramatta, Australia
(Mares) Centre for Applied Nursing Research, Liverpool, Australia
(Mares, McNally) The New South Wales Centre for Evidence Based Health
Care: a Joanna Briggs Institute Centre of Excellence, France
(Mares) Ingham Institute for Applied Medical Research, Liverpool,
Australia
(Fernandez) School of Nursing, University of Wollongong, Wollongong,
Australia
(Fernandez) Centre for Research in Nursing and Health, St George Hospital,
Kogarah, Australia
(Fernandez) Centre for Evidence Based Initiatives in Health Care: a Joanna
Briggs Institute Centre of Excellence
Publisher
NLM (Medline)
Abstract
REVIEW OBJECTIVE: The objective of this review was to investigate the
effectiveness of nurse-led cardiac rehabilitation programs following
coronary artery bypass graft surgery on patients' health-related quality
of life and hospital readmission. INTRODUCTION: Coronary heart disease is
a major cause of death and disability worldwide, putting a great strain on
healthcare resources. For the past two decades, population-wide primary
prevention and individual healthcare approaches have resulted in a
dramatic decline in overall cardiac mortality. Over the intervening years,
surgical techniques in cardiology have also improved substantially. As a
result, long-term outcomes in patients treated with coronary artery bypass
graft surgery have established the treatment's effectiveness and survival
benefit. Furthermore, participating in cardiac rehabilitation following
coronary artery bypass graft surgery has also demonstrated a significant
decrease in all-cause cardiac mortality in these patients. INCLUSION
CRITERIA: This review included studies with participants aged 18 years and
over, post coronary artery bypass graft surgery that evaluated nurse-led
cardiac rehabilitation (CR) programs compared with usual care or other
forms of CR. The outcomes of interest were the health-related quality of
life and hospital readmissions following coronary artery bypass graft
surgery and measured using validated scales. Randomized controlled trials
reported in English between 2000 to June 2017 were considered for
inclusion. METHOD(S): The search strategy aimed to find both
published and unpublished studies using a three-step search strategy. An
initial search of MEDLINE, CINAHL and Scopus was undertaken, followed by a
search for unpublished studies including Dissertation Abstracts
International, ProQuest Dissertations and Theses, Google Scholar, MedNar
and ClinicalTrials.gov. Papers selected for retrieval were assessed by two
independent reviewers for methodological validity prior to inclusion in
the review using the standardized critical appraisal tools from the Joanna
Briggs Institute System for the Unified Management, Assessment and Review
of Information (JBI SUMARI). Quantitative data was extracted from papers
included in the review using the standardized data extraction tool from
JBI-SUMARI. No meta-analysis was undertaken due to heterogeneity of the
outcome measures. All results were subject to double data entry. Effect
sizes expressed as risk ratio (for categorical data) and weighted mean
differences (for continuous data) and their 95% confidence intervals were
calculated for analysis. RESULT(S): Three trials involving 329
patients were included in the final review. The trials that investigated
the effect of home based cardiac rehabilitation programs compared to usual
care at six weeks, three months and six months follow-up demonstrated no
statistically significant difference in health-related quality of life at
any of the follow-up periods. However, one study demonstrated
significantly higher scores related to health-related quality of life
among those who received nurse-led home based cardiac rehabilitation
(154.93 +/- 4.6) compared to those who received usual care (134.20 +/-
8.2) at two months follow-up. No trials were identified that compared the
effectiveness of nurse-led cardiac rehabilitation programs following
coronary artery bypass graft surgery on readmissions to hospital.
 CONCLUSION(S): There is not enough evidence to support or discourage
nurse-led cardiac rehabilitation programs on health-related quality of
life in patients following coronary artery bypass graft surgery. However,
the sparse data available suggests improvements in health-related quality
of life at two months follow-up among those who received a nurse-led
program. Further large-scale multicenter trials with standardized
methodology are needed to determine the effect of nurse-led cardiac
rehabilitation programs on health-related quality of life and rates of
readmission to hospital following coronary artery bypass graft surgery.

<137>
Accession Number
2001386254
Title
Motivational interviewing to support LDL-C therapeutic goals and
lipid-lowering therapy compliance in patients with acute coronary
syndromes (IDEAL-LDL) study: rationale and design.
Source
Hellenic Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Author
Boulmpou A.; Kartas A.; Farmakis I.; Zafeiropoulos S.; Nevras V.;
Papadimitriou I.; Tampaki A.; Vlachou A.; Lillis L.; Koutsakis A.;
Karvounis H.; Giannakoulas G.
Institution
(Boulmpou, Kartas, Farmakis, Zafeiropoulos, Nevras, Papadimitriou,
Tampaki, Vlachou, Lillis, Koutsakis, Karvounis, Giannakoulas) Department
of Cardiology, AHEPA University Hospital, Aristotle University of
Thessaloniki, St. Kiriakidi 1, Thessaloniki 54636, Greece
Publisher
Hellenic Cardiological Society
Abstract
Background: Achieving low-density lipoprotein cholesterol (LDL-C) target
levels after an acute coronary syndrome (ACS) is of paramount importance,
and is often burdened by undertreatment and medication or lifestyle
non-adherence issues. Objective(s): We examined the effect of a
patient-centered, physician-led motivational intervention following ACS on
relevant secondary prevention aspects. Methods-design: The IDEAL-LDL is a
single-center, randomized controlled clinical trial, conducted among
patients hospitalized due to an ACS. Following discharge, all patients
undergo a baseline assessment of lipid profile. Patients in the
intervention group receive an in-person educational session and an
informative leaflet, and also undergo two phone-based, motivational
interviewing sessions at 1 and 6 months. These interventions emphasize on
LDL-C goals, adherence to lipid-lowering medication, and healthy
dietary-lifestyle habits, and are not provided to patients in the control
group, who receive usual care. At 12 months after each patient's
discharge, an in-person interview and lipid profile reassessment are
performed. The primary outcomes are the assessment of LDL-C goal
achievement (<70 mg/dL or >50% reduction from baseline levels) from
baseline to 1 year and changes in medication adherence. Secondary outcomes
relate to the incidence of the composite outcome of cardiovascular death,
nonfatal myocardial infarction/stroke, need for myocardial
revascularization, and recurrent hospitalization during the follow-up
period. Discussion(s): This paper describes the protocol, design, and
rationale for key methodology for an ongoing clinical trial featuring a
simple and feasible intervention. Similar adherence efficacy trials have
not led to sufficient improvements, and there remains a gap regarding how
adherence interventions should be implemented into clinical
care. Copyright © 2018 Hellenic Society of Cardiology

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