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<1>
Accession Number
2001262560
Title
Blinded outcomes and angina assessment of coronary bioresorbable
scaffolds: 30-day and 1-year results from the ABSORB IV randomised trial.
Source
The Lancet. 392 (10157) (pp 1530-1540), 2018. Date of Publication: 27
October - 2 November 2018.
Author
Stone G.W.; Ellis S.G.; Gori T.; Metzger D.C.; Stein B.; Erickson M.;
Torzewski J.; Williams J.; Lawson W.; Broderick T.M.; Kabour A.; Piegari
G.; Cavendish J.; Bertolet B.; Choi J.W.; Marx S.O.; Genereux P.;
Kereiakes D.J.
Institution
(Stone, Marx) NewYork-Presbyterian Hospital/Columbia University Medical
Center, New York, NY, United States
(Stone, Genereux) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Ellis) Cleveland Clinic, Cleveland, OH, United States
(Gori) Kardiologie I University Medical Center and Deutsches Zentrum fur
Herz-Kreislaufforschung, Rhein-Main, Mainz, Germany
(Metzger) Ballad Health Systems CVA Heart Institute, Kingsport, TN, United
States
(Stein) Morton Plant Hospital, Clearwater, FL, United States
(Erickson) Royal Perth Hospital, Perth, WA, Australia
(Torzewski) Kliniken Oberallgau, Immenstadt, Germany
(Williams) Presbyterian Hospital, Charlotte, NC, United States
(Lawson) Stony Brook University Medical Center, Stony Brook, NY, United
States
(Broderick, Kereiakes) The Carl and Edyth Lindner Research Center at The
Christ Hospital, Cincinnati, OH, United States
(Kabour) Mercy St Vincent Medical Center, Toledo, OH, United States
(Piegari) St Joseph Medical Center, Wyomissing, PA, United States
(Cavendish) Scripps Memorial Hospital La Jolla, La Jolla, CA, United
States
(Bertolet) North Mississippi Medical Center, Tupelo, MS, United States
(Choi) Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas,
TX, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Previous studies showed more adverse events with coronary
bioresorbable vascular scaffolds (BVS) than with metallic drug-eluting
stents (DES), although in one randomised trial angina was reduced with
BVS. However, these early studies were unmasked, lesions smaller than
intended for the scaffold were frequently enrolled, implantation technique
was suboptimal, and patients with myocardial infarction, in whom BVS might
be well suited, were excluded. <br/>Method(s): In the active-controlled,
blinded, multicentre, randomised ABSORB IV trial, patients with stable
coronary artery disease or acute coronary syndromes aged 18 years or older
were recruited from 147 hospitals in five countries (the USA, Germany,
Australia, Singapore, and Canada). Enrolled patients were randomly
assigned (1:1) to receive polymeric everolimus-eluting BVS (Absorb; Abbott
Vascular, Santa Clara, CA, USA) with optimised implantation technique or
cobalt-chromium everolimus-eluting stents (EES; Xience; Abbott Vascular,
Santa Clara, CA, USA). Randomisation was stratified by diabetic status,
whether patients would have been eligible for enrolment in the previous
ABSORB III trial, and site. Patients and clinical assessors were masked to
randomisation. The primary endpoint was target lesion failure (cardiac
death, target vessel myocardial infarction, or ischaemia-driven target
lesion revascularisation) at 30 days, tested for non-inferiority with a
2.9% margin for the risk difference. Analysis was by intention to treat.
The trial is registered with ClinicalTrials.gov, number NCT02173379, and
is closed to accrual. <br/>Finding(s): Between Aug 15, 2014, and March 31,
2017, we screened 18 722 patients for eligibility, 2604 of whom were
enrolled. 1296 patients were assigned to BVS, and 1308 patients were
assigned to EES. Follow-up data at 30 days and 1 year, respectively, were
available for 1288 and 1254 patients with BVS and for 1303 and 1272
patients with EES. Biomarker-positive acute coronary syndromes were
present in 622 (24%) of 2602 patients, and, by angiographic core
laboratory analysis, 78 (3%) of 2893 of lesions were in very small
vessels. Target lesion failure at 30 days occurred in 64 (5.0%) patients
assigned to BVS and 48 (3.7%) patients assigned to EES (difference 1.3%,
upper 97.5% confidence limit 2.89; one-sided
p<inf>non-inferiority</inf>=0.0244). Target lesion failure at 1 year
occurred in 98 (7.8%) patients assigned to BVS and 82 (6.4%) patients
assigned to EES (difference 1.4%, upper 97.5% confidence limit 3.4;
one-sided p<inf>non-inferiority</inf>=0.0006). Angina, adjudicated by a
central events committee at 1 year, occurred in 270 (20.3%) patients
assigned to BVS and 274 (20.5%) patients assigned to EES (difference
-0.3%, 95% CI -3.4% to 2.9%; one-sided p<inf>non-inferiority</inf>=0.0008;
two-sided p<inf>superiority</inf>=0.8603). Device thrombosis within 1 year
occurred in nine (0.7%) patients assigned to BVS and four (0.3%) patients
assigned to EES (p=0.1586). <br/>Interpretation(s): Polymeric BVS
implanted with optimised technique in an expanded patient population
resulted in non-inferior 30-day and 1-year rates of target lesion failure
and angina compared with metallic DES. <br/>Funding(s): Abbott
Vascular.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<2>
Accession Number
2001289036
Title
Echocardiographic Screening for Pulmonary Hypertension in Congenital Heart
Disease: JACC Review Topic of the Week.
Source
Journal of the American College of Cardiology. 72 (22) (pp 2778-2788),
2018. Date of Publication: 4 December 2018.
Author
Dimopoulos K.; Condliffe R.; Tulloh R.M.R.; Clift P.; Alonso-Gonzalez R.;
Bedair R.; Chung N.A.Y.; Coghlan G.; Fitzsimmons S.; Frigiola A.; Howard
L.S.; Jenkins P.; Kenny D.; Li W.; MacDonald S.T.; McCabe C.; Oliver J.J.;
Spence M.S.; Szantho G.V.; von Klemperer K.; Wilson D.G.; Wort S.J.
Institution
(Dimopoulos, Alonso-Gonzalez, Li) Adult Congenital Heart Centre and Centre
for Pulmonary Hypertension, Royal Brompton Hospital and Imperial College
London, London, United Kingdom
(Condliffe) Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital,
Sheffield, United Kingdom
(Tulloh, Bedair) Bristol Heart Institute, University Hospitals Bristol,
Bristol, United Kingdom
(Clift) Department of Cardiology, Queen Elizabeth Hospital Birmingham,
Birmingham, United Kingdom
(Chung, Frigiola) Adult Congenital Heart Disease Service, Guy's and St
Thomas' Hospital, London, United Kingdom
(Coghlan) National Pulmonary Hypertension Service, Royal Free Hospital,
London, United Kingdom
(Fitzsimmons) Adult Congenital Heart Disease Unit, Southampton University
Hospital, Southampton, United Kingdom
(Howard) National Pulmonary Hypertension Service, Hammersmith Hospital,
Imperial College Healthcare NHS Trust, London, United Kingdom
(Jenkins) Adult Congenital Heart Disease Unit, Manchester Royal Infirmary,
Manchester, United Kingdom
(Kenny) Our Lady's Children's Hospital and Mater Hospital, Dublin, Ireland
(MacDonald) East Midlands Congenital Heart Centre, Leicester
Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester,
United Kingdom
(McCabe, Wort) Department of Pulmonary Hypertension, Royal Brompton
Hospital, London, United Kingdom
(Oliver) Leeds Congenital Heart Unit, Leeds Teaching Hospitals, Leeds,
United Kingdom
(Spence) Department of Cardiology, Royal Victoria Hospital, Belfast,
Northern Ireland, United Kingdom
(Szantho, Wilson) Cardiology Department, University Hospital of Wales,
Cardiff, United Kingdom
(von Klemperer) Grown-up Congenital Heart Disease Service, Barts Heart
Centre, St. Bartholomew's Hospital, London, United Kingdom
Publisher
Elsevier USA
Abstract
Echocardiography is the mainstay in screening for pulmonary hypertension
(PH). International guidelines suggest echocardiographic parameters for
suspecting PH, but these may not apply to many adults with congenital
heart disease (ACHD). PH is relatively common in ACHD patients and can
significantly affect their exercise capacity, quality of life, and
prognosis. Identification of patients who have developed PH and who may
benefit from further investigations (including cardiac catheterization)
and treatment is thus extremely important. A systematic review and survey
of experts from the United Kingdom and Ireland were performed to assess
current knowledge and practice on echocardiographic screening for PH in
ACHD. This paper presents the findings of the review and expert statements
on the optimal approaches when using echocardiography to assess ACHD
patients for PH, with particular focus on major subgroups: patients with
right ventricular outflow tract obstruction, patients with systemic right
ventricles, patients with unrepaired univentricular circulation, and
patients with tetralogy of Fallot with pulmonary atresia.<br/>Copyright
&#xa9; 2018 The Authors

<3>
Accession Number
2001289028
Title
Fractional Flow Reserve Versus Angiographically-Guided Coronary Artery
Bypass Grafting.
Source
Journal of the American College of Cardiology. 72 (22) (pp 2732-2743),
2018. Date of Publication: 4 December 2018.
Author
Thuesen A.L.; Riber L.P.; Veien K.T.; Christiansen E.H.; Jensen S.E.;
Modrau I.; Andreasen J.J.; Junker A.; Mortensen P.E.; Jensen L.O.
Institution
(Thuesen, Veien, Junker, Jensen) Department of Cardiology, Odense
University Hospital, Odense, Denmark
(Riber, Mortensen) Department of Cardiothoracic Surgery, Odense University
Hospital, Odense, Denmark
(Christiansen) Department of Cardiology, Aarhus University Hospital,
Skejby, Denmark
(Jensen) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
(Modrau) Department of Cardiothoracic Surgery, Aarhus University Hospital,
Skejby, Denmark
(Andreasen) Department of Cardiothoracic Surgery, Aalborg University
Hospital, Aalborg, Denmark
(Andreasen) Department of Clinical Medicine, Aalborg University, Aalborg,
Denmark
Publisher
Elsevier USA
Abstract
Background: The value of fractional flow reserve (FFR) evaluation of
coronary artery stenosis in coronary artery bypass grafting (CABG) is
uncertain, and stenosis assessments usually rely on visual estimates of
lesion severity. <br/>Objective(s): This randomized clinical trial
evaluated graft patency and clinical outcome after FFR-guided CABG versus
angiography-guided CABG. <br/>Method(s): A total of 100 patients referred
for CABG were randomly assigned to FFR-guided or angiography-guided CABG.
Based on the coronary angiogram, a heart team made a graft plan for all
patients, and FFR evaluations were performed. In FFR-guided CABG, coronary
lesions with FFR >0.80 were deferred, and a new graft plan was designed
accordingly, whereas the surgeon was blinded to the FFR values in patients
who underwent angiography-guided CABG. The primary endpoint was graft
failure in the percentage of all grafts after 6 months. <br/>Result(s):
Angiographic follow-up at 6 months was available for 72 patients (39 vs.
33 in the FFR-guided and angiography-guided groups, respectively). Graft
failures of all grafts were similar in both groups (16% vs. 12%; p =
0.97). Rates of death, myocardial infarction, and stroke were also similar
in the study groups, and no difference was seen in revascularization
before angiographic follow-up. After 6 months, deferred lesions (n = 24)
showed a significant reduction in mean FFR from index to follow-up (0.89
+/- 0.05 vs. 0.81 +/- 0.11; p = 0.002). Index FFR did not influence graft
patency. <br/>Conclusion(s): FFR-guided CABG had similar graft failure
rates and clinical outcomes as angiography-guided CABG. However, FFR was
reduced significantly after 6 months in deferred lesions. (Fractional Flow
Reserve Versus Angiography Randomization for Graft Optimization [FARGO];
NCT02477371)<br/>Copyright &#xa9; 2018 American College of Cardiology
Foundation

<4>
Accession Number
2001082783
Title
The value of Coronary Artery computed Tomography as the first-line
anatomical test for stable patients with indications for invasive
angiography due to suspected Coronary Artery Disease: CAT-CAD randomized
trial.
Source
Journal of Cardiovascular Computed Tomography. 12 (6) (pp 472-479), 2018.
Date of Publication: November - December 2018.
Author
Rudzinski P.N.; Kruk M.; Kepka C.; Schoepf U.J.; Duguay T.; Dzielinska Z.;
Pregowski J.; Witkowski A.; Ruzyllo W.; Demkow M.
Institution
(Rudzinski, Kruk, Kepka, Dzielinska, Pregowski, Witkowski, Ruzyllo,
Demkow) Institute of Cardiology in Warsaw, Poland
(Schoepf, Duguay) Division of Cardiovascular Imaging, Department of
Radiology and Radiological Science, Medical University of South Carolina,
Charleston, SC, United States
(Schoepf) Division of Cardiology, Department of Medicine, Medical
University of South Carolina, Charleston, SC, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The aim of this prospective, randomized trial was to evaluate
whether the use of coronary computed tomography angiography (CCTA) as the
first-line anatomical test in patients with suspected significant coronary
artery disease (CAD) may reduce the number of coronary invasive
angiographies (ICA), and expand the use of CCTA in patients currently
diagnosed invasively. <br/>Method(s): 120 patients (age:60.6 +/- 7.9
years, 35% female) with indications to ICA were randomized 1:1 to undergo
CCTA versus direct ICA. Outcomes were evaluated during the diagnostic and
therapeutic periods. <br/>Result(s): The number of invasively examined
patients was reduced by 64.4% in the CCTA group as compared to the direct
ICA group (21vs59,p < 0.0001). The number of patients with ICAs not
followed by coronary intervention was reduced by 88.1% with the CCTA
strategy (5vs42,p < 0.0001). Over the diagnostic and therapeutic course
there were no significant differences regarding the median volume of
contrast (CCTA 80.3 ml[65.0-165.0] vs ICA 90.0 ml[55.0-100.0], p = 0.099),
while a non-significant trend towards higher radiation dose in the CCTA
group was observed (9.9 mSv[7.0-22.1] vs 9.4 mSv[5.2-14.0], p = 0.05).
There were no acute cardiovascular events. <br/>Conclusion(s): CCTA may
hypothetically act as an effective 'gatekeeper' to the catheterization
laboratory in the diagnosis of stable patients with current indications
for ICA. This strategy may result in non-invasive, outpatient-based triage
of two thirds of individuals without actionable CAD, obviating unnecessary
invasive examinations. However, the longer follow-up is indispensable.
ClinicalTrials.gov number: NCT02591992 The aim of our trial was to
evaluate the clinical value of coronary computed tomography angiography
(CCTA) as the first-line anatomical test in the diagnosis of stable
patients with indications for invasive coronary angiography (ICA) due to
suspected significant coronary artery disease (CAD). This is the first
study triaging this group of patients with CT and the results of this
randomized trial are promising in terms of safety and
efficacy.<br/>Copyright &#xa9; 2018 Society of Cardiovascular Computed
Tomography

<5>
Accession Number
623655565
Title
Methods used to assess the performance of biomarkers for the diagnosis of
acute kidney injury: a systematic review and meta-analysis.
Source
Biomarkers. 23 (8) (pp 766-772), 2018. Date of Publication: 17 Nov 2018.
Author
Codorniu A.; Lemasle L.; Legrand M.; Blet A.; Mebazaa A.; Gayat E.
Institution
(Codorniu, Lemasle, Legrand, Blet, Mebazaa, Gayat) Department of
Anesthesiology, Intensive Care and Burn Unit, University Hospital Saint
Louis-Lariboisiere, Paris, France
(Codorniu, Lemasle, Legrand, Blet, Mebazaa, Gayat) Biomarkers in
CArdio-Neuro-VAScular Diseases (BioCANVAS), Paris, France
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Purpose: Methods used to explore biomarkers for acute kidney injury (AKI)
might have a major impact on the results and the use of these biomarkers.
We evaluated the methods used to investigate biomarkers of AKI.
<br/>Material(s) and Method(s): A systematic review and meta-analysis were
performed using a computerized search of the MEDLINE and the EMBASE
databases (PROSPERO CRD42017059618). Articles reporting biomarker's
performance to diagnose AKI were included. The outcome included a
description of the methods used to assess the performance of biomarkers to
diagnose AKI. <br/>Result(s): Among the 295 included studies, assessment
of biomarkers was the primary endpoint in 284 with sample size calculation
in only 8% of cases. Eighty-five percent of the studies summarized the
performance of biomarkers with receiver operating characteristic (ROC)
curves; however, 74 studies (25%) did not provide the threshold,
sensibility or specificity. A total of 176 studies evaluated more than one
biomarker, and only 25% combined biomarkers to increase diagnostic
performance. We determined that the definition of AKI and study design
impacted the diagnostic performance using uNGAL (urinary neutrophil
gelatinase-associated lipocalin) as an example. Major publication bias was
identified. <br/>Conclusion(s): Most articles that reported biomarkers of
AKI performance present methodological weaknesses. Basic rules should be
provided to increase the quality of reporting in this area.<br/>Copyright
&#xa9; 2018, &#xa9; 2018 Informa UK Limited, trading as Taylor & Francis
Group.

<6>
Accession Number
2000856609
Title
Prospective Comparison of FFR Derived From Coronary CT Angiography With
SPECT Perfusion Imaging in Stable Coronary Artery Disease: The ReASSESS
Study.
Source
JACC: Cardiovascular Imaging. 11 (11) (pp 1640-1650), 2018. Date of
Publication: November 2018.
Author
Sand N.P.R.; Veien K.T.; Nielsen S.S.; Norgaard B.L.; Larsen P.; Johansen
A.; Hess S.; Deibjerg L.; Husain M.; Junker A.; Thomsen K.K.; Rohold A.;
Jensen L.O.
Institution
(Sand, Deibjerg, Husain, Thomsen, Rohold) Department of Cardiology,
Hospital of Southwest Denmark, Esbjerg, Denmark
(Sand) Institute of Regional Health Research, University of Southern
Denmark, Odense, Denmark
(Veien, Junker, Jensen) Department of Cardiology, Odense University
Hospital, Odense, Denmark
(Nielsen) Department of Nuclear Medicine, Aalborg University Hospital,
Aalborg, Denmark
(Norgaard) Department of Cardiology, Aarhus University Hospital, Skejby,
Aarhus, Denmark
(Larsen) Department of Epidemiology, Biostatistics and Bioinformatics,
University of Southern Denmark, Odense, Denmark
(Johansen) Department of Nuclear Medicine, Odense University Hospital,
Odense, Denmark
(Hess) Department of Radiology and Nuclear Medicine, Hospital of Southwest
Denmark, Esbjerg, Denmark
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to compare the per-patient diagnostic
performance of coronary computed tomography angiography (CTA)-derived
fractional flow reserve (FFR<inf>CT</inf>) with that of single-photon
emission computed tomography (SPECT), using a fractional flow reserve
(FFR) value of <=0.80 as the reference for diagnosing at least 1
hemodynamically significant stenosis in a head-to-head comparison of
patients with intermediate coronary stenosis as determined by coronary
CTA. <br/>Background(s): No previous study has prospectively compared the
diagnostic performance of FFR<inf>CT</inf> and myocardial perfusion
imaging by SPECT in symptomatic patients with intermediate range coronary
artery disease (CAD). <br/>Method(s): This study was conducted at a
single-center as a prospective study in patients with stable angina
pectoris (N = 143). FFR<inf>CT</inf> and SPECT analyses were performed by
core laboratories and were blinded for the personnel responsible for
downstream patient management. FFR<inf>CT</inf> <=0.80 distally in at
least 1 coronary artery with a diameter >=2 mm classified patients as
having ischemia. Ischemia by SPECT was encountered if a reversible
perfusion defect (summed difference score >=2) or transitory ischemic
dilation of the left ventricle (ratio >1.19) were found. <br/>Result(s):
The per-patient diagnostic performance for identifying ischemia (95%
confidence interval [CI]), FFR<inf>CT</inf> versus SPECT, were sensitivity
of 91% (95% CI: 81% to 97%) versus 41% (95% CI: 29% to 55%; p < 0.001);
specificity of 55% (95% CI: 44% to 66%) versus 86% (95% CI: 77% to 93%; p
< 0.001); negative predictive value of 90% (95% CI: 82% to 98%) versus 68%
(95% CI: 59% to 77%; p = 0.001); positive predictive value of 58% (95% CI:
48% to 68%) versus 67% (95% CI: 51% to 82%; p = NS); and accuracy of 70%
(95% CI: 62% to 77%) versus 68% (95% CI: 60% to 75%; p = NS) respectively.
<br/>Conclusion(s): In patients with stable chest pain and CAD as
determined by coronary CTA, the overall diagnostic accuracy levels of
FFR<inf>CT</inf> and SPECT were identical in assessing hemodynamically
significant stenosis. However, FFR<inf>CT</inf> demonstrated a
significantly higher diagnostic sensitivity than SPECT.<br/>Copyright
&#xa9; 2018 The Authors

<7>
Accession Number
622093305
Title
Sex disparities in acute myocardial infarction care and outcomes.
Source
Catheterization and Cardiovascular Interventions. 92 (5) (pp E341-E347),
2018. Date of Publication: 01 Nov 2018.
Author
Gul B.; Kozuma K.; Haimi I.; Zhao W.; Simonton C.; Ying S.-W.; Buda A.;
Mehta S.; Baumbach A.; Lansky A.
Institution
(Gul, Haimi, Buda, Baumbach, Lansky) Division of Cardiovascular Medicine,
Department of Internal Medicine, Yale School of Medicine, New Haven, CT,
United States
(Kozuma) Division of Cardiovascular Medicine, Teikyo University, Tokyo,
Japan
(Zhao, Simonton, Ying) Abbott Vascular, Santa Clara, CA, United States
(Mehta) Lumen Global and LATIN, Miami, FL, United States
(Baumbach, Lansky) Department of Cardiology, St Bartholomew's Hospital,
London, United Kingdom
(Baumbach, Lansky) William Harvey Research Institute and Queen Mary
University of London, London, United Kingdom
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Aim: We investigated sex-based and regional outcomes after contemporary
percutaneous coronary intervention (PCI) with the Xience V stent in
patients with acute myocardial infarction (AMI). <br/>Methods and Results:
This patient level pooled analysis includes three multi-center,
prospective post-market registries performed in the US, Japan, and China.
A total of 1,938 patients treated with Xience V stents in the setting of
AMI were enrolled. Compared to men, women had higher major adverse cardiac
events (MACE) (14.1% vs. 9.8% P < 0.01, RR 1.4, 95% CI 1.1-1.4) and
all-cause mortality (10% vs. 6.2% P < 0.01, RR 1.61, 95% CI 1.14-2.27) at
one year, without any significant difference in device specific outcomes
of target vessel failure (TVF). US patients compared to the patients from
China and Japan had increased MACE (female: 18% vs. 7.1%, P = 0.0012,
male: 15.7% vs. 4.1%, P < 0.0001). Multivariable analysis demonstrated
that major bleeding was the strongest predictor of MACE (OR 10.51, 95%CI
4.01-27.50, P < 0.0001), MI (OR 4.26, 95%CI 1.37-13.29, P = 0.012), and
all-cause death (OR 5.3, 95%CI 2.32-12.13, P < 0.0001).
<br/>Conclusion(s): Women with AMI who underwent PCI with XIENCE DES have
higher all-cause mortality at one year in compared to men. Region based
outcomes demonstrated increased MACE among US patients compared to the
patients from China and Japan. After adjusting for differences in
demographics, major bleeding, rather than female sex, predicted the higher
observed all-cause mortality.<br/>Copyright &#xa9; 2018 Wiley Periodicals,
Inc.

<8>
Accession Number
624056769
Title
Amiodarone plus Ranolazine for Conversion of Post-Cardiac Surgery Atrial
Fibrillation: Enhanced Effectiveness in Reduced Versus Preserved Ejection
Fraction Patients.
Source
Cardiovascular Drugs and Therapy. 32 (6) (pp 559-565), 2018. Date of
Publication: 01 Dec 2018.
Author
Simopoulos V.; Hevas A.; Hatziefthimiou A.; Dipla K.; Skoularigis I.;
Tsilimingas N.; Aidonidis I.
Institution
(Simopoulos, Hevas, Tsilimingas) Department of Thoracic & Cardiovascular
Surgery, University Hospital of Larissa, Larissa, Greece
(Hatziefthimiou, Aidonidis) Department of Physiology, School of Medicine,
University of Thessaly, Larissa Medical School, Larissa 41500, Greece
(Dipla) Department of Physical Education and Sports Science at Serres,
Aristotle University of Thessaloniki, Thessaloniki, Greece
(Skoularigis) Department of Cardiology, University General Hospital of
Larissa, Larissa, Greece
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Ranolazine (RAN) added to amiodarone (AMIO) has been shown to
accelerate termination of postoperative atrial fibrillation (POAF)
following coronary artery bypass surgery in patients without heart failure
(HF). This study aimed to investigate if treatment efficacy with AMIO or
AMIO + RAN differs between patients with concomitant HF with reduced or
preserved ejection fraction (HFrEF or HFpEF). <br/>Method(s): Patients
with POAF and HFrEF (n = 511, 446 males; 65 +/- 9 years) and with HFpEF (n
= 301, 257 males; 66 +/- 10 years) were enrolled. Onset of AF occurred
2.15 +/- 1.0 days after cardiac surgery, and patients within each group
were randomly assigned to receive either AMIO monotherapy (300 mg in 30
min + 1125 mg in 36 h iv) or AMIO+RAN combination (500 mg po + 375 mg,
after 6 h and 375 mg twice daily thereafter). Primary endpoint was the
time to conversion of POAF within 36 h after initiation of treatment.
<br/>Result(s): AMIO restored sinus rhythm earlier in HFrEF vs. in HFpEF
patients (24.3 +/- 4.6 vs. 26.8 +/- 2.8 h, p < 0.0001). AMIO + RAN
converted POAF faster than AMIO alone in both HFrEF and HFpEF groups, with
conversion times 10.4 +/- 4.5 h in HFrEF and 12.2 +/- 1.1 h in HFpEF
patients (p < 0.0001). Left atrial diameter was significantly greater in
HFrEF vs. HFpEF patients (48.2 +/- 2.6 vs. 35.2 +/- 2.9 mm, p < 0.0001).
No serious adverse drug effects were observed during AF or after
restoration to sinus rhythm in any of the patients enrolled.
<br/>Conclusion(s): AMIO alone or in combination with RAN converted POAF
faster in patients with reduced EF than in those with preserved EF. Thus,
AMIO + RAN seems to be a valuable alternative treatment for terminating
POAF in HFrEF patients.<br/>Copyright &#xa9; 2018, Springer
Science+Business Media, LLC, part of Springer Nature.

<9>
Accession Number
619963102
Title
Comprehensive Cardiac CT With Myocardial Perfusion Imaging Versus
Functional Testing in Suspected Coronary Artery Disease: The Multicenter,
Randomized CRESCENT-II Trial.
Source
JACC: Cardiovascular Imaging. 11 (11) (pp 1625-1636), 2018. Date of
Publication: November 2018.
Author
Lubbers M.; Coenen A.; Kofflard M.; Bruning T.; Kietselaer B.; Galema T.;
Kock M.; Niezen A.; Das M.; van Gent M.; van den Bos E.-J.; van Woerkens
L.; Musters P.; Kooij S.; Nous F.; Budde R.; Hunink M.; Nieman K.
Institution
(Lubbers, Coenen, Galema, Musters, Nieman) Department of Cardiology,
Erasmus University Medical Center, Rotterdam, Netherlands
(Lubbers, Coenen, Nous, Budde, Hunink, Nieman) Department of Radiology,
Erasmus University Medical Center, Rotterdam, Netherlands
(Kofflard, van Gent, van den Bos, van Woerkens) Department of Cardiology,
Albert Schweitzer Ziekenhuis, Dordrecht, Netherlands
(Bruning) Department of Cardiology, Maasstad Ziekenhuis, Rotterdam,
Netherlands
(Kietselaer) Department of Cardiology, Maastricht University Medical
Center, Maastricht, Netherlands
(Kock, Kooij) Department of Radiology, Albert Schweitzer Ziekenhuis,
Dordrecht, Netherlands
(Niezen) Department of Radiology, Maasstad Ziekenhuis, Rotterdam,
Netherlands
(Das) Department of Radiology, Maastricht University Medical Center,
Maastricht, Netherlands
(Nieman) Stanford Cardiovascular Institute, Stanford University, Palo
Alto, CA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to assess the effectiveness, efficiency, and
safety of a tiered, comprehensive cardiac computed tomography (CT)
protocol in comparison with functional testing. <br/>Background(s):
Although CT angiography accurately rules out coronary artery disease
(CAD), incorporation of CT myocardial perfusion imaging as part of a
tiered diagnostic approach could improve the clinical value and efficiency
of cardiac CT in the diagnostic work-up of patients with angina pectoris.
<br/>Method(s): Between July 2013 and November 2015, 268 patients (mean
age 58 years; 49% female) with stable angina (mean pre-test probability
54%) were prospectively randomized between cardiac CT and standard
guideline-directed functional testing (95% exercise electrocardiography).
The tiered cardiac CT protocol included a calcium scan, followed by CT
angiography if calcium was detected. Patients with >=50% stenosis on CT
angiography underwent CT myocardial perfusion imaging. <br/>Result(s): By
6 months, the primary endpoint, the rate of invasive coronary angiograms
without a European Society of Cardiology class I indication for
revascularization, was lower in the CT group than in the functional
testing group (2 of 130 [1.5%] vs. 10 of 138 [7.2%]; p = 0.035), whereas
the proportion of invasive angiograms with a revascularization indication
was higher (88% vs. 50%; p = 0.017). The median duration until the final
diagnosis was 0 (0 of 0) days in the CT group and 0 (0 of 17) in the
functional testing group (p < 0.001). Overall, 13% of patients randomized
to CT required further testing, compared with 37% in the functional
testing group (p < 0.001). The adverse event rate was similar (3% vs. 3%;
p = 1.000), although the median cumulative radiation dose was higher for
the CT group (3.1 mSv [interquartile range: 1.6 to 7.8] vs. 0 mSv
[interquartile range: 0.0 to 7.1]; p < 0.001). <br/>Conclusion(s): In
patients with suspected stable CAD, a tiered cardiac CT protocol with
dynamic perfusion imaging offers a fast and efficient alternative to
functional testing. (Comprehensive Cardiac CT Versus Exercise Testing in
Suspected Coronary Artery Disease 2 [CRESCENT2];
NCT02291484)<br/>Copyright &#xa9; 2018 American College of Cardiology
Foundation

<10>
Accession Number
619963099
Title
Value of Myocardial Perfusion Assessment With Coronary Computed Tomography
Angiography in Patients With Recent Acute-Onset Chest Pain.
Source
JACC: Cardiovascular Imaging. 11 (11) (pp 1611-1621), 2018. Date of
Publication: November 2018.
Author
Sorgaard M.H.; Linde J.J.; Kuhl J.T.; Kelbaek H.; Hove J.D.; Fornitz G.G.;
Jorgensen T.B.S.; Heitmann M.; Kragelund C.; Hansen T.F.; Abdulla J.;
Engstrom T.; Jensen J.S.; Wiegandt Y.T.; Hofsten D.E.; Kober L.V.; Kofoed
K.F.
Institution
(Sorgaard, Linde, Engstrom, Wiegandt, Hofsten, Kober, Kofoed) Department
of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen,
Copenhagen, Denmark
(Kuhl, Heitmann) Department of Cardiology, Bispebjerg Hospital, University
of Copenhagen, Copenhagen, Denmark
(Kelbaek) Department of Cardiology, Zealand University Hospital, Roskilde,
Denmark
(Hove) Department of Cardiology, Hvidovre Hospital, University of
Copenhagen, Copenhagen, Denmark
(Fornitz, Jorgensen) Department of Cardiology, Amager Hospital,
Copenhagen, University of Copenhagen, Copenhagen, Denmark
(Kragelund) Department of Cardiology, Herlev Hospital, University of
Copenhagen, Copenhagen, Denmark
(Hansen, Jensen) Department of Cardiology, Gentofte Hospital, University
of Copenhagen, Copenhagen, Denmark
(Abdulla) Department of Medicine, Division of Cardiology, Glostrup
Hospital, University of Copenhagen, Copenhagen, Denmark
(Kofoed) Department of Radiology, The Diagnostic Centre, Rigshospitalet,
University of Copenhagen, Copenhagen, Denmark
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The authors sought to perform a randomized controlled trial to
evaluate the clinical efficacy of combined examination with coronary
computed tomography angiography (CTA) and computed tomography perfusion
imaging (CTP) compared to coronary CTA alone. <br/>Background(s): Stress
myocardial CTP may increase diagnostic specificity when added to coronary
CTA in patients suspected of having ischemic heart disease.
<br/>Method(s): Patients recently hospitalized for acute-onset chest pain,
who had acute coronary syndrome had been ruled out by normal
electrocardiograms, normal troponin levels, and relief of symptoms, and
who had a clinical indication for outpatient noninvasive testing, were
screened for inclusion in the CATCH-2 (CArdiac cT in the treatment of
acute CHest pain 2) trial (NCT02014311). Patients were randomized 1:1 to
examination with coronary CTA or coronary CTA+CTP. The primary endpoint
was the frequency of coronary revascularization among patients referred
for invasive coronary angiography (ICA) based on index computed tomography
evaluation. Secondary endpoints were invasive procedural complications at
index-related ICA, post-index cardiac death, hospital admittance because
of recurrence of chest pain, unstable angina pectoris, or acute myocardial
infarction, ICA, and revascularization. <br/>Result(s): Among 300 patients
allocated to the coronary CTA+CTP group, 41 (14%) were referred for ICA
compared with 89 (30%) allocated to coronary CTA (p < 0.0001). The primary
endpoint occurred in 50% of coronary CTA+CTP patients versus 48% of
invasively examined patients (p = 0.85). The total number of
revascularizations was significantly lower in the coronary CTA+CTP group
compared to the coronary CTA group (n = 20 [7%] vs. n = 42 [14%]; p =
0.0045). At median follow-up of 1.5 years, the occurrence of secondary
endpoints was similar in the 2 groups. <br/>Conclusion(s): A
post-discharge diagnostic strategy of coronary CTA+CTP safely reduces the
need for invasive examination and treatment in patients suspected of
having ischemic heart disease. (CArdiac cT in the treatment of acute CHest
pain 2-Myocardial CT Perfusion [CATCH2]; NCT02014311)<br/>Copyright &#xa9;
2018 American College of Cardiology Foundation

<11>
Accession Number
622003862
Title
Improved stent expansion with prolonged compared with short balloon
inflation: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 92 (5) (pp 873-880),
2018. Date of Publication: 01 Nov 2018.
Author
Saad M.; Bavineni M.; Uretsky B.F.; Vallurupalli S.
Institution
(Saad, Uretsky, Vallurupalli) Division of Cardiology, University of
Arkansas for Medical Sciences, Little Rock, AR, United States
(Saad) Division of Cardiovascular Medicine, Ain Shams University, Cairo,
Egypt, United States
(Bavineni) Division of Hospital Medicine, University of Arkansas for
Medical Sciences, Little Rock, AR, United States
(Uretsky, Vallurupalli) Division of Cardiology, Central Arkansas Veterans
Healthcare System, Little Rock, AR, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Despite evidence from individual studies suggesting that
prolonged inflation improves coronary stent expansion, relatively shorter
inflation times are commonly employed in clinical practice.
<br/>Method(s): We performed an electronic search of PubMed, Web of
Science, Cochrane, and CINAHL databases to retrieve outcome studies
comparing prolonged versus short inflation times during stent deployment.
Outcomes studied included minimal stent diameter (MSD) and minimal stent
area (MSA). Standardized mean difference (SMD) was used to estimate the
effect sizes for these continuous variables. <br/>Result(s): Seven studies
with a total of 341 patients (415 lesions; mean age 67.6 years; 82% male)
were included. Drug-eluting stents were used in 89 +/- 15% of coronary
lesions. Prolonged stent inflation was associated with increased minimal
stent diameter (2.93 +/- 0.34 mm vs. 2.72 +/- 0.28 mm; SMD = 0.42; 95% CI
0.25-0.59; P < 0.001) and minimal stent area (5.99 +/- 1.21 mm²
vs. 5.17 +/- 0.87 mm²; SMD = 0.46; 95% CI 0.19-0.73; P = 0.001)
compared with shorter duration stent inflation. This difference remained
significant in sensitivity analyses that excluded studies with very
prolonged inflation duration or multiple stent balloon inflations.
<br/>Conclusion(s): Despite differences in duration and methodology,
prolonged stent inflation is associated with improved expansion compared
with shorter duration. The effect of this optimization recommends
randomized trials to determine whether long-term outcomes can be improved
by this simple technical modification.<br/>Copyright &#xa9; 2018 Wiley
Periodicals, Inc.

<12>
Accession Number
624575453
Title
Comparative pharmacokinetics of tacrolimus in de novo pediatric transplant
recipients randomized to receive immediate- or prolonged-release
tacrolimus.
Source
Pediatric Transplantation. 22 (8) (no pagination), 2018. Article Number:
e13289. Date of Publication: December 2018.
Author
Vondrak K.; Dhawan A.; Parisi F.; Grenda R.; Debray D.; Marks S.D.; Webb
N.J.A.; Lachaux A.; Kazeem G.; Undre N.
Institution
(Vondrak) Department of Pediatrics, University Hospital Motol, Second
School of Medicine, Charles University, Prague, Czech Republic
(Dhawan) Paediatric Liver GI and Nutrition Center, King's College
Hospital, London, United Kingdom
(Parisi) Department of Pediatric Cardiology and Cardiac Surgery, Thoracic
Transplant Unit, Osp Pediatrico Bambino Gesu, Rome, Italy
(Grenda) Department of Nephrology and Kidney Transplantation, The
Children's Memorial Health Institute, Warsaw, Poland
(Debray) Pediatric Hepatology Unit, APHP-Hopital Universitaire
Necker-Enfants Malades, Paris, France
(Marks) Department of Paediatric Nephrology, Great Ormond Street Hospital
for Children, NHS Foundation Trust, London, United Kingdom
(Webb) Department of Paediatric Nephrology, Royal Manchester Children's
Hospital, Manchester University Foundation Trust, Manchester, United
Kingdom
(Lachaux) Service d'Hepatologie Pediatrique, Universite Lyon 1 et Hospices
Civils de Lyon, HFME, Bron Cedex, France
(Kazeem, Undre) Astellas Pharma Europe Ltd, Chertsey, United Kingdom
(Kazeem) BENKAZ Consulting Ltd, Cambridge, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Phase 2, parallel-group, multicenter, open-label, 4-week study, comparing
PK of PR-T vs IR-T in de novo pediatric patients undergoing primary
kidney, liver, or heart transplantation. Patients randomized 1:1 to
receive once daily, PR-T-, or twice-daily, IR-T-based regimens; dose
adjustments permitted after Day 1. Twenty-four-hour PK profiles collected
on Days 1, 7, and 28. Primary endpoint: tacrolimus AUC<inf>24</inf>.
Secondary end points included tacrolimus C<inf>24</inf> and
C<inf>max</inf>. Endpoints compared between PR-T and IR-T on Days 1, 7,
and 28. Predefined similarity interval for CIs of LSM ratios: 80%-125%. PK
analysis set comprised 33 patients (PR-T, n = 15; IR-T, n = 18). Overall,
AUC<inf>24</inf> and C<inf>max</inf> were lower on Day 1 vs 7 and 28.
Geometric LSM ratios of PR-T:IR-T on Days 1, 7, and 28 were 66.3%, 92.5%,
99.9%, respectively, for AUC<inf>24</inf>; 66.3%, 82.2%, 90.9% for
C<inf>24</inf>; and 77.3%, 120.3%, 92.2% for C<inf>max</inf>.
AUC<inf>24</inf> 90% CI within predefined similarity interval on Day 28;
other 90% CIs fell outside. Linear relationship was similar between
AUC<inf>24</inf> and C<inf>24</inf>, and between tacrolimus formulations,
suggesting that the same therapeutic drug monitoring method can be used
with both formulations in de novo pediatric allograft
recipients.<br/>Copyright &#xa9; 2018 The Authors. Pediatric
Transplantation published by Wiley Periodicals, Inc

<13>
Accession Number
625300263
Title
Cardiac rehabilitation for patients having cardiac surgery: a systematic
review.
Source
The Journal of cardiovascular surgery. 59 (6) (pp 817-829), 2018. Date of
Publication: 01 Dec 2018.
Author
Blokzijl F.; Dieperink W.; Keus F.; Reneman M.F.; Mariani M.A.; van der
Horst I.C.
Institution
(Blokzijl) Department of Cardiothoracic Surgery, University of Groningen,
University Medical Center Groningen, Groningen, Netherlands
(Dieperink, Keus, van der Horst) Department of Critical Care, University
of Groningen, University Medical Center Groningen, Groningen, Netherlands
(Reneman) Department of Rehabilitation Medicine University of Groningen,
University Medical Center Groningen, Groningen, Netherlands
(Mariani) Department of Cardiothoracic Surgery, University of Groningen,
University Medical Center Groningen, Groningen, Netherlands
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Cardiac rehabilitation (CR) is recommended for all cardiac
patients including patients after cardiac surgery. Since the effect of CR
after cardiac surgery has not been well established yet, we conducted a
systematic review on the effects of CR for patients after cardiac surgery
compared to treatment as usual. EVIDENCE ACQUISITION: A systematic review
of randomized clinical trials (RCTs), quasi-randomized and prospective
observational studies in The Cochrane Library, PubMed/MEDLINE and EMBASE
was undertaken until October 18th, 2017. Adults after any kind of cardiac
surgery were included. Primary outcome was all-cause mortality, other
outcomes were serious adverse events, health-related quality of life, work
participation, functioning and costs/cost-effectiveness. Risk of bias was
evaluated, and the quality of evidence was assessed by the Grading of
Recommendations, Assessment, Development and Evaluation (GRADE) criteria.
EVIDENCE SYNTHESIS: Eighteen RCTs and 15 observational studies were
included. Low risk of bias was only observed in one observational study.
Meta-analysis of RCTs suggested no significant difference of CR compared
to control on mortality (random-effects relative risk (RR) 0.93 (95% CI:
0.40-1.81), while observational studies suggested statistically
significant beneficial effect associated with CR (random-effects RR=0.49,
95% CI: 0.35 - 0.68). CR did not significantly affect any of the other
outcomes. Due to the limited data TSA could not be performed.
<br/>CONCLUSION(S): The body of evidence does not allow us to reach any
reliable conclusions about the effectiveness of CR following cardiac
surgery. Future trials need to be conducted with low risks of bias and
clearly defined outcomes.

<14>
Accession Number
625306712
Title
5-Year Outcomes of Self-Expanding Transcatheter Versus Surgical Aortic
Valve Replacement in High-Risk Patients.
Source
Journal of the American College of Cardiology. 72 (22) (pp 2687-2696),
2018. Date of Publication: 04 Dec 2018.
Author
Gleason T.G.; Reardon M.J.; Popma J.J.; Deeb G.M.; Yakubov S.J.; Lee J.S.;
Kleiman N.S.; Chetcuti S.; Hermiller J.B.; Heiser J.; Merhi W.; Zorn G.L.;
Tadros P.; Robinson N.; Petrossian G.; Hughes G.C.; Harrison J.K.; Conte
J.V.; Mumtaz M.; Oh J.K.; Huang J.; Adams D.H.
Institution
(Gleason, Lee) Departments of Cardiothoracic Surgery and Cardiology,
University of Pittsburgh Medical Center, Pittsburgh, PA, United States
(Reardon, Kleiman) Departments of Cardiothoracic Surgery and
Interventional Cardiology, Houston-Methodist-Debakey Heart and Vascular
Center, Houston, TX, United States
(Popma) Department of Interventional Cardiology, Beth Israel Deaconess
Medical Center, Boston, MA, United States
(Deeb, Chetcuti) Departments of Cardiac Surgery and Interventional
Cardiology, University of Michigan Hospitals, Ann Arbor, MI, United States
(Yakubov) Department of Interventional Cardiology, Riverside
Methodist-Ohio Health, Columbus, OH, United States
(Hermiller) Department of Interventional Cardiology, St. Vincent's Medical
Center, Indianapolis, IN, United States
(Heiser, Merhi) Departments of Cardiothoracic Surgery and Interventional
Cardiology, Spectrum Health Hospitals, Grand Rapids, MI, United States
(Zorn, Tadros) Departments of Thoracic Surgery and Interventional
Cardiology, University of Kansas Hospital, Kansas City, KS, United States
(Robinson, Petrossian) Departments of Cardiothoracic Surgery and
Interventional Cardiology, St. Francis Hospital, Roslyn, NY, United States
(Hughes, Harrison) Departments of Cardiothoracic Surgery and
Interventional Cardiology, Duke University Medical Center, Durham, NC,
United States
(Conte) University of Pittsburgh Medical Center-Pinnacle, PA, United
States
(Mumtaz) Department of Cardiothoracic Surgery, Johns Hopkins Hospital,
Baltimore, MD, United States
(Oh) Division of Cardiology, Mayo Clinic, Rochester, MN, United States
(Huang) Statistical Services, Medtronic, Minneapolis, MN, United States
(Adams) Department of Cardiothoracic Surgery, Mount Sinai Medical Center,
NY, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: The CoreValve U.S. Pivotal High Risk Trial was the first
randomized trial to show superior 1-year mortality of transcatheter aortic
valve replacement (TAVR) compared with surgical aortic valve replacement
(SAVR) among high operative mortality-risk patients. <br/>OBJECTIVE(S):
The authors sought to compare TAVR to SAVR for mid-term 5-year outcomes of
safety, performance, and durability. <br/>METHOD(S): Surgical high-risk
patients were randomized (1:1) to TAVR with the self-expanding
bioprosthesis or SAVR. VARC-1 (Valve Academic Research Consortium I)
definitions were applied. Severe hemodynamic structural valve
deterioration was defined as a mean gradient >=40 mm Hg or a change in
gradient >=20 mm Hg or new severe aortic regurgitation. Five-year
follow-up was planned. <br/>RESULT(S): A total of 797 patients were
randomized at 45 U.S. centers, of whom 750 underwent an attempted implant
(TAVR = 391, SAVR = 359). The overall mean age was 83 years, and the STS
score was 7.4%. All-cause mortality rates at 5 years were 55.3% for TAVR
and 55.4% for SAVR. Subgroup analysis showed no differences in mortality.
Major stroke rates were 12.3% for TAVR and 13.2% for SAVR. Mean aortic
valve gradients were 7.1 +/- 3.6 mm Hg for TAVR and 10.9 +/- 5.7 mm Hg for
SAVR. No clinically significant valve thrombosis was observed. Freedom
from severe SVD was 99.2% for TAVR and 98.3% for SAVR (p = 0.32), and
freedom from valve reintervention was 97.0% for TAVR and 98.9% for SAVR (p
= 0.04). A permanent pacemaker was implanted in 33.0% of TAVR and 19.8% of
SAVR patients at 5 years. <br/>CONCLUSION(S): This study shows similar
mid-term survival and stroke rates in high-risk patients following TAVR or
SAVR. Severe structural valve deterioration and valve reinterventions were
uncommon. (Safety and Efficacy Study of the Medtronic CoreValve System in
the Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very
High Risk Subjects Who Need Aortic Valve Replacement;
NCT01240902).<br/>Copyright &#xa9; 2018 American College of Cardiology
Foundation. Published by Elsevier Inc. All rights reserved.

<15>
Accession Number
625288499
Title
Effects of a prolonged intervention of breathing exercises after cardiac
surgery - a randomised controlled trial.
Source
European Journal of Physiotherapy. (no pagination), 2018. Date of
Publication: 2018.
Author
Carlsson M.; Berthelsen O.; Fagevik Olsen M.
Institution
(Carlsson, Berthelsen, Fagevik Olsen) Department of Physical Therapy,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Carlsson, Fagevik Olsen) Department of Physiotherapy, Institute of
Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Objectives: To evaluate the effect of a prolonged intervention of
breathing exercises with Inspiratory Resistance Positive Expiratory
Pressure for one month after open cardiac surgery concerning lung
function, respiratory movements and postoperative pulmonary complications.
<br/>Method(s): A randomised controlled trial comparing the effect of
home-based breathing exercise after discharge from the hospital or stop at
discharge. Eighty patients were randomly assigned to an intervention group
or control group. Forced vital capacity, forced expiratory volume in the
first second, peak expiratory flow, respratory movements and saturation
were measured at discharge and after the intervention. At follow-up
self-reported pulmonary complications were also recorded. <br/>Result(s):
A significant increase in forced vital capacity (p =.04) was found in the
intervention group compared with the control group, and there were a
tendency towards significant differences also in forced expiratory volume
in the first second and saturation (p =.06). Respiratory movements
increased significantly after one month but there were no significant
differences between groups. None of the patients reported being treated
for pneumonia. <br/>Conclusion(s): A prolonged intervention of breathing
exercise for one month after open cardiac surgery significantly increases
forced vital capacity and may accelerate recovery after cardiac surgery.
Clinical registration number: FoU in Sweden no 76141.<br/>Copyright &#xa9;
2018, &#xa9; 2018 Informa UK Limited, trading as Taylor & Francis Group.

<16>
Accession Number
625287564
Title
Transcatheter aortic valve replacement in patients with pure native aortic
valve regurgitation: A systematic review and meta-analysis.
Source
Clinical Cardiology. (no pagination), 2018. Date of Publication: 2018.
Author
Haddad A.; Arwani R.; Altayar O.; Sawas T.; Murad M.H.; de Marchena E.
Institution
(Haddad) Division of Cardiology, Temple University Lewis Katz School of
Medicine, Philadelphia, Pennsylvania. Harvard T.H Chan School of Public
Health, Boston, MA, United States
(Arwani) Ain Shams University-Faculty of Medicine, Cairo, Egypt
(Altayar) Department of Medicine, Washington University School of
Medicine, St. Louis, MO, United States
(Sawas) Department of Medicine, Mayo Clinic, Rochester, MN, United States
(Murad) Evidence-based Practice Center, Mayo Clinic Robert D. and Patricia
E. Kern Center for the Science of Health Care Delivery, Mayo Clinic,
Rochester, MN, United States
(de Marchena) Division of Cardiology, University of Miami-Miller School of
Medicine, Miami, FL, United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
This systematic review and meta-analysis sought to summarize the available
evidence on the use of transcatheter aortic valve replacement (TAVR) in
patients with Native Aortic Valve Regurgitation (NAVR) and compare
outcomes between first and second generation valves. Owing to the
improvements in transcatheter heart valve design and procedural success,
TAVR has become increasingly performed in broader aortic valve
pathologies. We searched Medline, Embase, Cochrane, and Scopus databases
from 2007 to 2018 and performed a systematic review on reports with at
least 10 patients with aortic valve regurgitation undergoing TAVR
procedure. The main outcome of interest was all-cause mortality at 30
days. A total of 638 patients across 12 studies were included. Mean age
ranged from 68 to 84. Society of Thoracic Surgeons score ranged from 5.4%
to 13.1% and Logistic EuroSCORE ranged from 18.2% to 33%. The incidence
rate of all-cause mortality at 30 days was found to be 11% (95% CI 7%-16%;
I² = 20.86%). All-cause mortality at 30 days for first
generation valves had an incidence rate of 15% (95% CI 10%-20%;
I² = 10%) compared to 7% (95% CI 3%-13%; I² = 37%)
in second generation valves with subgroup interaction analysis P = 0.059.
Device success incidence rate in second generation valves was 92% (95% CI
83%-99%; I² = 67%) vs 68% (95% CI 59%-77%; I² = 53%)
in first generation valves with P = 0.001. TAVR appears to be a feasible
treatment choice for NAVR patients at high risk for surgical valve
replacement. Second generation valves show promising results in terms of
short-term outcomes.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<17>
Accession Number
623428402
Title
A review of combination antimicrobial therapy for enterococcus faecalis
bloodstream infections and infective endocarditis.
Source
Clinical Infectious Diseases. 67 (2) (pp 303-309), 2018. Date of
Publication: 02 Jul 2018.
Author
Beganovic M.; Luther M.K.; Rice L.B.; Arias C.A.; Rybak M.J.; Laplante
K.L.
Institution
(Beganovic, Luther, Laplante) College of Pharmacy, University of Rhode
Island, 7 Greenhouse Rd, Ste 295A, Kingston, RI 02881, United States
(Beganovic, Luther, Laplante) Infectious Diseases Research Program,
Providence Veterans Affairs Medical Center, Providence, RI, United States
(Luther, Laplante) Center of Innovation in Long-Term Services and
Supports, Providence Veterans Affairs Medical Center, Providence, RI,
United States
(Rice) Rhode Island Hospital, Providence, Rhode Island, Providence, RI,
United States
(Rice, Laplante) Warren Alpert Medical School of Brown University,
Division of Infectious Diseases, Providence, RI, United States
(Arias) Center for Antimicrobial Resistance and Microbial Genomics,
Division of Infectious Diseases, Department of Internal Medicine,
Department of Microbiology and Molecular Genetics, University of Texas
Health Science Center at Houston (UTHealth), McGovern Medical School,
Bogota, Colombia
(Arias) Center for Infectious Diseases, UTHealth School of Public Health,
Bogota, Colombia
(Arias) Molecular Genetics and Antimicrobial Resistance Unit,
International Center for Microbial Genomics, Universidad El Bosque,
Bogota, Colombia
(Rybak) Anti-Infective Research Laboratory, Department of Pharmacy
Practice, Eugene Applebaum College of Pharmacy and Health Sciences,
Michigan, United States
(Rybak) Department of Medicine, Division of Infectious Diseases, School of
Medicine, Wayne State University, Michigan, United States
(Rybak) Department of Pharmacy Services, Detroit Receiving Hospital,
Michigan, United States
Publisher
Oxford University Press
Abstract
Enterococci, one of the most common causes of hospital-associated
infections, are responsible for substantial morbidity and mortality.
Enterococcus faecalis, the more common and virulent species, causes
serious high-inoculum infections, namely infective endocarditis, that are
associated with cardiac surgery and mortality rates that remained
unchanged for the last 30 years. The best cures for these infections are
observed with combination antibiotic therapy; however, optimal treatment
has not been fully elucidated. It is the purpose of this review to
highlight treatment options and their limitations, and provide direction
for future investigative efforts to aid in the treatment of these severe
infections. While ampicillin plus ceftriaxone has emerged as a preferred
treatment option, mortality rates continue to be high, and from a safety
standpoint, ceftriaxone, unlike other cephalosporins, promotes
colonization with vancomycin resistant-enterococci due to high biliary
concentrations. More research is needed to improve patient outcomes from
this high-mortality disease.<br/>Copyright &#xa9; Published by Oxford
University Press for the Infectious Diseases Society of America 2018.

<18>
Accession Number
622037763
Title
Amaze: A double-blind, multicentre randomised controlled trial to
investigate the clinical effectiveness and cost-effectiveness of adding an
ablation device-based maze procedure as an adjunct to routine cardiac
surgery for patients with pre-existing atrial fibrillation.
Source
Health Technology Assessment. 22 (19) (no pagination), 2018. Date of
Publication: April 2018.
Author
Sharples L.; Everett C.; Singh J.; Mills C.; Spyt T.; Abu-Omar Y.; Fynn
S.; Thorpe B.; Stoneman V.; Goddard H.; Fox-Rushby J.; Nashef S.
Institution
(Sharples) Department of Medical Statistics, London School of Hygiene &
Tropical Medicine, London, United Kingdom
(Everett, Thorpe) Leeds Institute of Clinical Trials Research, University
of Leeds, Leeds, United Kingdom
(Singh) Health Economics Research Group (HERG), Brunel University London,
London, United Kingdom
(Mills, Stoneman, Goddard) Papworth Trials Unit Collaboration, Papworth
Hospital, Cambridge, United Kingdom
(Spyt) Department of Cardiac Surgery, Glenfield Hospital, Leicester,
United Kingdom
(Abu-Omar, Fynn, Nashef) Department of Cardiology and Department of
Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom
(Fox-Rushby) Department of Population Science, King's College London,
London, United Kingdom
Publisher
NIHR Journals Library (NETSCCAlpha HouseUniversity of Southampton, Science
Park, Southampton SO167NS, United Kingdom)
Abstract
Background: Atrial fibrillation (AF) can be treated using a maze procedure
during planned cardiac surgery, but the effect on clinical patient
outcomes, and the cost-effectiveness compared with surgery alone, are
uncertain. <br/>Objective(s): To determine whether or not the maze
procedure is safe, improves clinical and patient outcomes and is
cost-effective for the NHS in patients with AF. <br/>Design(s):
Multicentre, Phase III, pragmatic, double-blind, parallel-arm randomised
controlled trial. Patients were randomised on a 1: 1 basis using random
permuted blocks, stratified for surgeon and planned procedure.
<br/>Setting(s): Eleven acute NHS specialist cardiac surgical centres.
<br/>Participant(s): Patients aged >= 18 years, scheduled for elective or
in-house urgent cardiac surgery, with a documented history (> 3 months) of
AF. <br/>Intervention(s): Routine cardiac surgery with or without an
adjunct maze procedure administered by an AF ablation device. <br/>Main
Outcome Measure(s): The primary outcomes were return to sinus rhythm (SR)
at 12 months and quality-adjusted life-years (QALYs) over 2 years after
randomisation. Secondary outcomes included return to SR at 2 years,
overall and stroke-free survival, drug use, quality of life (QoL),
cost-effectiveness and safety. <br/>Result(s): Between 25 February 2009
and 6 March 2014, 352 patients were randomised to the control (n = 176) or
experimental (n = 176) arms. The odds ratio (OR) for return to SR at 12
months was 2.06 [95% confidence interval (CI) 1.20 to 3.54; p = 0.0091].
The mean difference (95% CI) in QALYs at 2 years between the two trial
arms (maze/control) was -0.025 (95% CI 0.129 to 0.078; p = 0.6319). The OR
for SR at 2 years was 3.24 (95% CI 1.76 to 5.96). The number of patients
requiring anticoagulant drug use was significantly lower in the maze arm
from 6 months after the procedure. There were no significant differences
between the two arms in operative or overall survival, stroke-free
survival, need for cardioversion or permanent pacemaker implants, New York
Heart Association Functional Classification (for heart failure), EuroQol-5
Dimensions, three-level version score and Short Form questionnaire-36
items score at any time point. Sixty per cent of patients in each trial
arm had a serious adverse event (p = 1.000); most events were mild, but 71
patients (42.5%) in the maze arm and 84 patients (45.5%) in the control
arm had moderately severe events; 31 patients (18.6%) in the maze arm and
38 patients (20.5%) in the control arm had severe events. The mean
additional cost of the maze procedure was 3533 (95% CI 1321 to 5746); the
mean difference in QALYs was -0.022 (95% CI -0.1231 to 0.0791). The maze
procedure was not cost-effective at 30,000 per QALY over 2 years in any
analysis. In a small substudy, the active left atrial ejection fraction
was smaller than that of the control patients (mean difference of -8.03,
95% CI -12.43 to -3.62), but within the predefined clinically equivalent
range. <br/>Limitation(s): Low recruitment, early release of trial
summaries and intermittent resource-use collection may have introduced
bias and imprecise estimates. <br/>Conclusion(s): Ablation can be
practised safely in routine NHS cardiac surgical settings and increases
return to SR rates, but not survival or QoL up to 2 years after surgery.
Lower anticoagulant drug use and recovery of left atrial function support
anticoagulant drug withdrawal provided that good atrial function is
confirmed.<br/>Copyright &#xa9; Queen's Printer and Controller of HMSO
2018.

<19>
Accession Number
623770577
Title
Efficacy and safety of further lowering of low-density lipoprotein
cholesterol in patients starting with very low levels: A meta-analysis.
Source
JAMA Cardiology. 3 (9) (pp 823-828), 2018. Date of Publication: September
2018.
Author
Sabatine M.S.; Wiviott S.D.; Im K.; Murphy S.A.; Giugliano R.P.
Institution
(Sabatine, Wiviott, Im, Murphy, Giugliano) TIMI Study Group, Division of
Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical
School, Hale Bldg for Transformative Medicine, 60 Fenwood Rd, Boston, MA
02115, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE In the Cholesterol Treatment Trialists Collaboration (CTTC), in
patients starting with low-density lipoprotein cholesterol (LDL-C) levels
of approximately 3.4 mmol/L (131.5mg/dL), there was a 22%reduction in
major vascular events per 1-mmol/L (38.7-mg/dL) lowering of LDL-C. The
magnitude of clinical benefit of further LDL-C lowering in patients
already with very low LDL-C levels remains debated. OBJECTIVE To evaluate
efficacy and safety of further lowering LDL-C levels in patient
populations presenting with median LDL-C levels of 1.8 mmol/L (70mg/dL) or
less. DATA SOURCES AND STUDY SELECTION The CTTCwas used for statin data.
For nonstatin therapy, Medline database was searched (2015-April 2018).
Key inclusion criteria were a randomized, double-blind, controlled
cardiovascular outcome trial of LDL-C lowering with data in populations
starting with LDL-C levels averaging 1.8 mmol/L (70mg/dL) or less. DATA
EXTRACTION AND SYNTHESIS Two authors independently extracted data into
standardized data sheets, and data were analyzed using meta-analysis. MAIN
OUTCOMES AND MEASURES The risk ratio (RR) of major vascular events (a
composite of coronary heart death,myocardial infarction, ischemic stroke,
or coronary revascularization) per 1-mmol/L (38.7-mg/dL) reduction in
LDL-C level. RESULTS In the subgroup of patients from the CTTC
meta-analysis of statins with a mean LDL-C in the control arm of 1.7
mmol/L (65.7mg/dL), 1922 major vascular events occurred and the RR for
major vascular events per 1-mmol/L (38.7-mg/dL) reduction in LDL-C was
0.78 (95%CI, 0.65-0.94). For 3 trials of nonstatin LDL-C-lowering
therapies added to statins, there were 50 627 patients, the median LDL-C
in the control arms ranged from 1.6 mmol/L to 1.8 mmol/L (63mg/dL to
70mg/dL), and 9570 major vascular events occurred. Nonstatin therapy
lowered LDL-C by 0.3 to 1.2 mmol/L (11mg/dL to 45mg/dL), and the RR for
major vascular events per 1-mmol/L (38.7-mg/dL) reduction in LDL-C was
0.79 (95%CI, 0.70-0.88). For statins and nonstatins combined, the RR was
0.79 (95%CI, 0.71-0.87; P < .001). Low-density lipoprotein cholesterol
lowering was not associated with an increased risk of serious adverse
events,myalgias and/ormyositis, elevation in the level of
aminotransferases, new-onset diabetes, hemorrhagic stroke, or cancer.
CONCLUSIONS AND RELEVANCE There is a consistent relative risk reduction in
major vascular events per change in LDL-C in patient populations starting
as low as a median of 1.6 mmol/L (63mg/dL) and achieving levels as low as
a median of 0.5 mmol/L (21mg/dL), with no observed offsetting adverse
effects. These data suggest further lowering of LDL-C beyond the lowest
current targets would further reduce cardiovascular risk.<br/>Copyright
&#xa9; 2018 American Medical Association. All rights reserved.

<20>
Accession Number
620867720
Title
Genomic analysis in patients with myxomatous mitral valve prolapse:
Current state of knowledge.
Source
BMC Cardiovascular Disorders. 18 (1) (no pagination), 2018. Article
Number: 41. Date of Publication: 27 Feb 2018.
Author
Gasser S.; Reichenspurner H.; Girdauskas E.
Institution
(Gasser, Reichenspurner, Girdauskas) Department of Cardiovascular Surgery,
University Heart Centre Hamburg, Martinistrasse 52, Hamburg 20251, Germany
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Myxomatous mitral valve prolapse is a common cardiac
abnormality. Morbus Barlow is characterized by excess myxomatous leaflet
tissue, bileaflet prolapse or billowing, chordae elongation and annular
dilatation with or without calcification. Extensive myxoid degeneration
with destruction of the normal three-layered leaflet tissue architecture
is observed histologically in such patients. Autosomal dominant
inheritance with an age and sex-dependent expression has long been
recognised. This review explores the current understanding of the genetics
of bileaflet prolapse, with a focus on genetic analysis and the role for
echocardiographical screening of the first degree relatives of affected
patients. <br/>Method(s): Systematic literature searches were performed
using PubMed and Embase up to September 2017. In Disse et al.'s study
(study one) first degree relatives of 25 patients with Morbus Barlow who
underwent mitral valve repair were screened for bileaflet valve prolapse.
In Nesta et al.'s study one family with three living generations of 43
individuals with 9 confirmed cases of MVP was screened. Genotyping was
performed in four families for 344 microsatellite markers from Chromosome
1 to 16. <br/>Result(s): In study one, autosomal dominant inheritance was
shown in four pedigrees. Genome-wide linkage analysis of the most
informative pedigree (24 individuals, three generations) showed a
significant linkage for markers mapping to chromosome 16p. Linkage to this
locus was confirmed in a second family within the same study, but was
excluded in the remaining two pedigrees. In study two an autosomal
dominant locus was mapped to chromosome 13. 8 of the 9 individuals
affected were found to suffer from bileaflet prolapse. <br/>Conclusion(s):
Barlow's disease is a heritable trait but the genetic causes remain
largely elusive. Ch16p11.2-p12.1 is the only locus proven to be associated
with bileaflet prolapse. Locus 13.q31.3-q32.1 was shown to cause bileaflet
as well as posterior leaflet prolapse. This review intends to make
physicians aware of genetic causes of myxomatous mitral valve prolapse,
thereby emphasising the importance of cardiological examination of
first-degree relatives of patients with Morbus Barlow. Integrated and more
comprehensive studies are needed for identification of genes involved in
this heterogenic disease. Further genomic studies may facilitate more
individualised and accurate risk assessment and may help to develop
possible preventive stategies for patients in the future.<br/>Copyright
&#xa9; 2018 The Author(s).

<21>
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.<br/>Copyright &#xa9; 2018 The Authors.

<22>
Accession Number
625044093
Title
Impact of dexmedetomidine infusion during general anaesthesia on incidence
of postoperative delirium in elderly patients after major non-cardiac
surgery: Study protocol of a randomised, double-blinded and
placebo-controlled trial.
Source
BMJ Open. 8 (4) (no pagination), 2018. Article Number: e019549. Date of
Publication: 01 Apr 2018.
Author
Wang B.-J.; Li C.-J.; Hu J.; Li H.-J.; Guo C.; Wang Z.-H.; Zhang Q.-C.; Mu
D.-L.; Wang D.-X.
Institution
(Wang, Li, Hu, Li, Guo, Zhang, Mu, Wang) Department of Anesthesiology and
Critical Care Medicine, Peking University First Hospital, Beijing, China
(Wang) Department of Anesthesiology, Dongping People's Hospital, Dongping,
China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Delirium is a common complication in the elderly after
surgery and is associated with worse outcomes. Multiple risk factors are
related with postoperative delirium, such as exposure to general
anaesthetics, pain and postoperative inflammatory response. Preclinical
and clinical studies have shown that dexmedetomidine attenuated
neurotoxicity induced by general anaesthetics, improved postoperative
analgesia and inhibited inflammatory response after surgery. Several
studies found that intraoperative use of dexmedetomidine can prevent
postoperative delirium, but data were inconsistent. This study was
designed to investigate the impact of dexmedetomidine administered during
general anaesthesia in preventing delirium in the elderly after major
non-cardiac surgery. Methods and analysis: This is a randomised,
double-blinded and placebo-controlled trial. 620 elderly patients (age
>=60 years) who are scheduled to undertake elective major non-cardiac
surgery (with an expected duration >=2 hours) are randomly divided into
two groups. For patients in the dexmedetomidine group, a loading dose
dexmedetomidine (0.6 mug/kg) will be administered 10 min before
anaesthesia induction, followed by a continuous infusion at a rate of 0.5
mug/kg/hour until 1 hour before the end of surgery. For patients in the
control group, normal saline will be administered with an identical rate
as in the dexmedetomidine group. The primary endpoint is the incidence of
delirium during the first five postoperative days. The secondary endpoints
include pain intensity, cumulative opioid consumption and subjective sleep
quality during the first three postoperative days, as well as the
incidence of non-delirium complications and all-cause mortality within 30
days after surgery. Ethics and dissemination: The study protocol was
approved by the Clinical Research Ethics Committee of Peking University
First Hospital (2015-987) and registered at Chinese Clinical Trial
Registry (http://www.chictr.org.cn) with identifier ChiCTR-IPR-15007654.
The results of the study will be presented at academic conferences and
submitted to peer-reviewed journals.<br/>Copyright &#xa9; 2018 Article
author(s).

<23>
Accession Number
625108569
Title
Off-versus on-pump coronary surgery and the effect of follow-up length and
surgeons' experience: A meta-analysis.
Source
Journal of the American Heart Association. 7 (21) (no pagination), 2018.
Article Number: e010034. Date of Publication: 01 Nov 2018.
Author
Gaudino M.; Benedetto U.; Bakaeen F.; Rahouma M.; Tam D.Y.; Abouarab A.;
Di Franco A.; Leonard J.; Elmously A.; Puskas J.D.; Angelini G.D.; Girardi
L.N.; Fremes S.E.; Taggart D.P.
Institution
(Gaudino, Rahouma, Abouarab, Di Franco, Leonard, Elmously, Girardi)
Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York
City, NY, United States
(Benedetto, Angelini) Bristol Heart Institute, School of Clinical
Sciences, University of Bristol, United Kingdom
(Bakaeen) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Tam, Fremes) Schulich Heart Centre, Sunnybrook Health Science, University
of Toronto, Canada
(Puskas) Department of Cardiovascular Surgery, Icahn School of Medicine at
Mount Sinai, New York City, NY, United States
(Taggart) Nuffield Department of Surgical Sciences, University of Oxford,
United Kingdom
Publisher
American Heart Association Inc.
Abstract
Background-The debate on the relative benefits of off-pump and on-pump
coronary artery bypass surgery (OPCABG and ONCABG) is still open. We aimed
to provide an updated and complete summary of the evidence on the
differences between OPCABG and ONCABG and to explore whether the length of
the follow-up and the surgeons' experience in OPCABG modify the
comparative results. Methods and Results-All randomized clinical trials
comparing OPCABG and ONCABG were included. Primary outcome was followup
mortality. Secondary outcomes were operative mortality, perioperative
stroke, perioperative myocardial infarction, and late repeated
revascularization. Subgroup analyses were performed based on the length of
the follow-up and the percentage of crossover from the OPCABG group (used
as a surrogate of surgeon experience with OPCABG). One hundred four trials
were included (20 627 patients, OPCABG: 10 288; ONCABG: 10 339). Weighted
mean follow-up time was 3.7 years (range 1-7.5 years). OPCABG was
associated with a higher risk of follow-up mortality (incidence rate ratio
1.11, 95% confidence interval 1.00-1.23, P=0.05). The difference was
significant only for trials with mean follow-up of >=3 years and for
studies with a crossover rate of >=10%. There was a trend toward lower
risk of perioperative stroke and higher need for late repeated
revascularization in the OPCABG arm. Conclusions-OPCABG is associated with
a higher incidence of incomplete revascularization, an increased need for
repeated revascularization, and decreased midterm survival compared with
ONCABG. Surgeon inexperience in OPCABG is associated with late
mortality.<br/>Copyright &#xa9; 2018 The Authors.

<24>
Accession Number
624995494
Title
Atrial fibrillation following heart transplantation: A systematic review
and meta-analysis of observational studies.
Source
Journal of Evidence-Based Medicine. 11 (4) (pp 261-271), 2018. Date of
Publication: November 2018.
Author
Chokesuwattanaskul R.; Bathini T.; Thongprayoon C.; Preechawat S.;
O'Corragain O.A.; Pachariyanon P.; Ungprasert P.; Cheungpasitporn W.
Institution
(Chokesuwattanaskul, Preechawat) Faculty of Medicine, Division of
Cardiology, Department of Medicine, Chulalongkorn University and King
Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
(Bathini) Department of Internal Medicine, University of Arizona, Tucson,
AZ, United States
(Thongprayoon) Department of Internal Medicine, Mayo Clinic, Rochester,
MN, United States
(O'Corragain) Department of Internal Medicine, Temple University,
Philadelphia, PA, United States
(Pachariyanon) Department of Internal Medicine, Texas Tech University
Health Sciences Center, Lubbock, TX, United States
(Ungprasert) Clinical Epidemiology Unit, Faculty of Medicine Siriraj
Hospital, Department of Research and Development, Mahidol University,
Bangkok, Thailand
(Cheungpasitporn) Division of Nephrology, Department of Medicine,
University of Mississippi Medical Center, MS, United States
Publisher
Blackwell Publishing
Abstract
Objective: Previous studies have suggested a high incidence of atrial
fibrillation (AF) in heart transplant recipients. However, incidence
trends of AF in heart transplant recipients remain unclear. The study's
aims were (1) to investigate the pooled incidence/incidence trends of AF
following heart transplantation and (2) to assess the mortality risk of
heart transplant recipients with AF. <br/>Method(s): A literature search
for studies that reported the incidence of AF following heart
transplantation was conducted using MEDLINE, EMBASE, and The Cochrane
Database from inception through March 2018. Pooled incidence and odds
ratios (OR) with 95%CI were calculated using a random-effects model.
<br/>Result(s): Eighteen studies (2 cohorts from clinical trials and 16
cohort studies) with 5393 heart transplant recipients were enrolled. The
pooled estimated incidence of AF in heart transplant was 10.1% (95%CI:
7.6%-13.2%). Meta-analysis based on the type of anastomotic technique
demonstrated a pooled estimated incidence of AF following heart
transplantation of 18.7% (95%CI: 10.3%-31.5%) and 11.1% (95%CI:
6.5%-18.4%) by biatrial and bicaval techniques, respectively. There was a
significant association between AF following a heart transplant and
increased mortality risk with a pooled OR of 2.86 (95%CI: 2.08-3.93).
Meta-regression analyses showed no significant correlations between the
year of study and incidence of AF (P = 0.47) or mortality risk of AF after
heart transplantation (P = 0.99). <br/>Conclusion(s): The overall
estimated incidence of AF following heart transplantation is 10.1%. There
is a significant association between AF and increased mortality after
transplantation. Furthermore, incidence and mortality risk of AF following
heart transplant does not seem to decrease over time.<br/>Copyright &#xa9;
2018 Chinese Cochrane Center, West China Hospital of Sichuan University
and John Wiley & Sons Australia, Ltd

<25>
Accession Number
623845505
Title
Post-operative cardiovascular complications and time to recurrence in
meningioma patients treated with versus without pre-operative
embolization: a retrospective cohort study of 741 patients.
Source
Journal of Neuro-Oncology. 140 (3) (pp 659-667), 2018. Date of
Publication: 15 Dec 2018.
Author
Wirsching H.-G.; Richter J.K.; Sahm F.; Morel C.; Krayenbuehl N.; Rushing
E.J.; von Deimling A.; Valavanis A.; Weller M.
Institution
(Wirsching, Morel, Weller) Department of Neurology, University Hospital
and University of Zurich, Frauenklinikstrasse 26, Zurich 8091, Switzerland
(Richter, Valavanis) Department of Neuroradiology, University Hospital and
University of Zurich, Zurich, Switzerland
(Krayenbuehl) Department of Neurosurgery, University Hospital and
University of Zurich, Zurich, Switzerland
(Rushing) Department of Neuropathology, University Hospital and University
of Zurich, Zurich, Switzerland
(Sahm, von Deimling) Department of Neuropathology, University Hospital
Heidelberg, Heidelberg, Germany
(Sahm, von Deimling) Clinical Cooperation Unit Neuropathology, German
Consortium for Translational Cancer Research (DKTK), German Cancer
Research Center (DKFZ), Heidelberg, Germany
(Richter) Department of Diagnostic, Interventional and Pediatric
Radiology, Inselspital and University of Bern, Bern, Switzerland
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Preoperative embolization of radiographically suspected
meningiomas is often performed to facilitate tumor resection. Its effects
on the subsequent disease course of meningioma patients have not been
studied in detail and randomized trials are lacking. The purpose of this
study was to explore associations of preoperative meningioma embolization
with postoperative outcome. <br/>Patients and Methods: Patients undergoing
resection of an intracranial meningioma at the University Hospital Zurich
2000-2013 (N = 741) were reviewed for the inclusion of pre-operative
embolization in the management strategy. Annotations included
demographics, radiographic, surgical, histological and hematological
parameters, cardiovascular risk factors, pre- and postoperative
neurological function and gene methylation-based classification. Binary
regression and Cox proportional hazards models were applied to determine
factors associated with outcome. <br/>Result(s): Pre-operative
embolization was performed in 337 patients (42%). Cardiovascular events
after surgery comprised mostly deep vein thrombosis (N = 39) and pulmonary
embolisms (N = 64). On multivariate analyses of post-operative
cardiovascular adverse events controlling for established risk factors,
there were associations with embolization (OR 2.38, 95% CI 1.37-4.00), and
with female gender (OR 2.18, 95% CI 1.17-4.08). Recurrence-free survival
(RFS) of embolized patients was less favorable among patients with WHO
grade II or grade III meningiomas (median RFS: 4.3 vs. 7.0 years, P =
0.029) or in patients with intermediate or malignant gene methylation
subtype meningiomas (median RFS: 2.0 vs. 8.2 years, P = 0.005).
<br/>Conclusion(s): Pre-operative meningioma embolization may cause
adverse outcomes. Randomized trials to determine benefit-risk ratios are
warranted to clarify the role of pre-operative embolization for the
treatment of meningioma patients.<br/>Copyright &#xa9; 2018, Springer
Science+Business Media, LLC, part of Springer Nature.

<26>
Accession Number
625048840
Title
The efficacy of inpatient vs. Home-based physiotherapy following coronary
artery bypass grafting.
Source
International Journal of Environmental Research and Public Health. 15 (11)
(no pagination), 2018. Article Number: 2572. Date of Publication: 17 Nov
2018.
Author
Szylinska A.; Listewnik M.; Rotter I.; Ryl A.; Kotfis K.; Mokrzycki K.;
Kuligowska E.; Walerowicz P.; Brykczynski M.
Institution
(Szylinska, Rotter, Ryl) Department of Medical Rehabilitation and Clinical
Physiotherapy, Pomeranian Medical University in Szczecin, ul. Zolnierska
54, Szczecin 70-204, Poland
(Listewnik, Mokrzycki, Kuligowska, Walerowicz, Brykczynski) Department of
Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstancow
Wlkp. 72, Szczecin 70-111, Poland
(Kotfis) Department of Anesthesiology, Intensive Therapy and Acute
Intoxications, Pomeranian Medical University in Szczecin, al. Powstancow
W, lkp. 72, Szczecin 70-111, Poland
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Background: Intensive post-operative physiotherapy after cardiac surgery
helps to reduce the number of complications, accelerating convalescence
and decreasing peri-operative mortality. Cardiac rehabilitation is aimed
at regaining lost function and sustaining the effect of cardiac surgery.
The aim of this study was to compare the efficacy of inpatient and
home-based phase II physiotherapy following coronary artery bypass
grafting, and inpatient phase II post-operative physiotherapy based on the
analysis of the spirometry results. <br/>Method(s): A prospective
observational study included 104 adult patients of both sexes undergoing
planned coronary artery bypass grafting and were randomized to one of the
two groups-inpatients (InPhysio) and home-based (HomePhysio) at a 1:1
ratio. All patients had undergone spirometry testing prior to surgery (S1)
and on the fifth day after the operation (S2), i.e., on the day of
completion of the first phase (PI) of physiotherapy. Both the study group
(InPhysio) and the control group (HomePhysio) performed the same set of
exercises in the second phase (PII) of cardiac physiotherapy, either in
the hospital or at home, respectively, according to the program obtained
in the hospital. Both groups have undergone spirometry testing (S3) at 30
days after the operation. <br/>Result(s): The demographic and
peri-operative data for both groups were comparable and showed no
statistically significant differences. An analysis of gradients between
the results of spirometry tests before surgery and at 30 days after the
surgery showed a smaller decrease in forced vital capacity (FVC) in the
study group than in the control group (p < 0.001). The results at five and
30 days after the surgery showed a greater increase in FVC in the study
group than in the control group (680 mL vs. 450 mL, p = 0.009). There were
no statistically significant differences in other parameters studied.
<br/>Conclusion(s): The advantage of inpatient over home-based
physiotherapy was evidenced by much smaller decreases in FVC between the
initial and final tests, and greater increases between the fifth day after
surgery and the final test. Our analysis showed greater efficacy of
inpatient physiotherapy as compared with home-based exercises and raises
concerns about patient adherence.<br/>Copyright &#xa9; 2018, MDPI AG. All
rights reserved.

<27>
Accession Number
625260618
Title
Position paper for the evaluation and management of oral status in
patients with valvular disease: Groupe de Travail Valvulopathies de la
Societe Francaise de Cardiologie, Societe Francaise de Chirurgie Orale,
Societe Francaise de Parodontologie et d'Implantologie Orale, Societe
Francaise d'Endodontie et Societe de Pathologie Infectieuse de Langue
Francaise.
Source
Archives of cardiovascular diseases. 110 (8-9) (pp 482-494), 2017. Date of
Publication: 01 Aug 2017.
Author
Millot S.; Lesclous P.; Colombier M.-L.; Radoi L.; Messeca C.; Ballanger
M.; Charrier J.-L.; Tramba P.; Simon S.; Berrebi A.; Doguet F.; Lansac E.;
Tribouilloy C.; Habib G.; Duval X.; Iung B.
Institution
(Millot) Department of oral surgery, Montpellier university hospital,
34295 Montpellier, France; Inserm 1149, 75018 Paris, France
(Lesclous) Department of oral surgery, Nantes hospital, university of
Nantes, Inserm U791, LIOAD, Nantes 44093, France
(Colombier) Department of periodontology, Louis-Mourier hospital, AP-HP,
university of Paris Descartes, Colombes 92700, France
(Radoi) Department of oral surgery, Louis-Mourier hospital, AP-HP,
university of Paris Descartes, Inserm U1018, Colombes 92700, France
(Messeca) Odontology department, Bichat hospital, AP-HP, Paris 75018,
France
(Ballanger) Department of oral surgery, Pitie-Salpetriere hospital, AP-HP,
university of Paris Descartes, Paris 75013, France
(Charrier) Department of oral surgery, Bretonneau hospital, AP-HP,
university of Paris Descartes, Paris 75018, France
(Tramba) Department of implantology and prosthetics, Pitie Salpetriere
hospital, AP-HP, university of Paris Descartes, Paris 75013, France
(Simon) Endodontics department, Pitie-Salpetriere hospital, AP-HP,
Paris-Diderot university, Paris 75013, France
(Berrebi) Department of cardiology, Georges Pompidou european hospital,
AP-HP, institut mutualiste Montsouris, Paris 75014, France
(Doguet) Department of thoracic and cardiovascular surgery, Rouen
university hospital, Inserm U1096, Rouen 76000, France
(Lansac) Department of cardiac surgery, institut mutualiste Montsouris,
Paris 75014, France
(Tribouilloy) Department of cardiology, university hospital of Amiens,
Inserm U1088, Jules-Verne university of Picardie, Amiens 80480, France
(Habib) Department of cardiology, La Timone hospital, Aix-Marseille
university, Marseille 13385, France
(Duval) Centre of clinical investigations, Bichat hospital, AP-HP,
Paris-Diderot university, Inserm U1137, Paris 75018, France
(Iung) Department of cardiology, Bichat hospital, AP-HP, DHU FIRE,
Paris-Diderot university, Paris 75018, France
Publisher
NLM (Medline)
Abstract
Oral health is of particular importance in patients with heart valve
diseases because of the risk of infective endocarditis. Recommendations
for antibiotic prophylaxis before dental procedures have been restricted,
but the modalities of oral evaluation and dental care are not detailed in
guidelines. Therefore, a multidisciplinary working group reviewed the
literature to propose detailed approaches for the evaluation and
management of buccodental status in patients with valvular disease. Simple
questions asked by a non-dental specialist may draw attention to
buccodental diseases. Besides clinical examination, recent imaging
techniques are highly sensitive for the detection of inflammatory bone
destruction directly related to oral or dental infection foci. The
management of buccodental disease before cardiac valvular surgery should
be adapted to the timing of the intervention. Simple therapeutic
principles can be applied even before urgent intervention. Restorative
dentistry and endodontic and periodontal therapy can be performed before
elective valvular intervention and during the follow-up of patients at
high risk of endocarditis. The detection and treatment of buccodental foci
of infection should follow specific rules in patients who present with
acute endocarditis. Implant placement is no longer contraindicated in
patients at intermediate risk of endocarditis, and can also be performed
in selected high-risk patients. The decision for implant placement should
follow an analysis of general and local factors increasing the risk of
implant failure. The surgical and prosthetic procedures should be
performed in optimal safety conditions. It is therefore now possible to
safely decrease the number of contraindicated dental procedures in
patients at risk of endocarditis.<br/>Copyright &#xa9; 2017 Elsevier
Masson SAS. All rights reserved.

<28>
[Use Link to view the full text]
Accession Number
625046067
Title
Early post-operative cognitive dysfunction after closed-loop versus manual
target controlled-infusion of propofol and remifentanil in patients
undergoing elective major non-cardiac surgery Protocol of the randomized
controlled single-blind POCD-ELA trial.
Source
Medicine (United States). 97 (40) (no pagination), 2018. Article Number:
e12558. Date of Publication: 2018.
Author
Besch G.; Vettoretti L.; Claveau M.; Boichut N.; Mahr N.; Bouhake Y.; Liu
N.; Chazot T.; Samain E.; Pili-Floury S.
Institution
(Liu, Chazot) Department of Anesthesia, Foch Hospital, Suresnes, France
(Liu, Chazot) Outcomes Research Consortium, Cleveland Clinic, Cleveland,
OH, United States
(Besch, Vettoretti, Claveau, Boichut, Mahr, Bouhake, Samain, Pili-Floury)
Department of Anesthesiology and Intensive Care Medicine, University
Hospital of Besancon, 3 Boulevard Alexandre Fleming, Besancon 25030,
France
(Vettoretti) Centre Hospitalier Universitaire de Besancon, besancon,
France
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Introduction: Post-operative cognitive dysfunction (POCD) is frequent in
patients older than 60 years undergoing major noncardiac surgery, and
increases both morbidity and mortality. Anesthetic drugs may exert
neurotoxic effects and contribute to the genesis of POCD. The hypothesis
of the POCD-ELA trial was that closed-loop target-controlled infusion of
propofol and remifentanil could reduce the occurrence of POCD by
decreasing the risk of excessive depth of anesthesia and the dose of
anesthetic drugs. Methods and analysis: We designed a single-center,
single-blind, randomized, controlled, parallel trial and aim to include
204 patients aged >60 years undergoing elective major non-cardiac surgery.
Patients will be randomized to receive closed-loop versus manual
target-controlled infusion of propofol and remifentanil guided by
bispectral index monitoring. Cognitive assessment will be performed the
day before surgery (baseline) and within 72 hours after surgery, using a
battery of validated neuropsychological tests. The primary outcome is the
incidence of POCD within 72 hours after surgery. POCD is defined as a
Z-score value > 1.96 for at least 2 different tests or a Z-score composite
value >1.96. The calculation of the Z-score is based on data from an
age-matched control population who did not undergo surgery or general
anesthesia. Ethics and dissemination: This study was approved by the
Ethics Committee (Comite de Protection des Personnes Est-II) and
authorized by the French Health Products Agency (Agence Nationale de
Securite des Medicaments, Saint-Denis, France). The University Hospital of
Besancon is the trial sponsor and the holder of all data and publication
rights. Results of the study will be submitted for publication in a
peer-review international medical journal and for presentation in abstract
(oral or poster) in international peer-reviewed congresses. Registration:
The trial is registered with ClinicalTrials.gov (Identifier: NCT02841423,
principal investigator: Prof Emmanuel Samain, date of registration: July
22, 2016). Last amendment of protocol: version 8.0 April 2018.
Abbreviations: ASA = American Society of Anesthesiologists, BIS =
bispectral index, POCD = Post-Operative Cognitive Dysfunction, SD =
standard deviation.<br/>Copyright &#xa9; 2018 the Author(s). Published by
Wolters Kluwer Health, Inc.

<29>
Accession Number
625044228
Title
Protocol for a phase III, non-inferiority, randomised comparison of a new
fibrinogen concentrate versus cryoprecipitate for treating acquired
hypofibrinogenaemia in bleeding cardiac surgical patients: The FIBRES
trial.
Source
BMJ Open. 8 (4) (no pagination), 2018. Article Number: e020741. Date of
Publication: 01 Apr 2018.
Author
Karkouti K.; Callum J.; Rao V.; Heddle N.; Farkouh M.E.; Crowther M.A.;
Scales D.C.
Institution
(Karkouti) Department of Anesthesia, Institute of Health Policy,
Management and Evaluation, University of Toronto, Toronto, ON, Canada
(Karkouti, Rao) Peter Munk Cardiac Centre, Toronto General Research
Institute, Toronto General Hospital, University Health Network, University
of Toronto, Toronto, ON, Canada
(Callum) Department of Clinical Pathology, Sunnybrook Health Sciences
Centre, University of Toronto, Toronto, ON, Canada
(Callum) Department of Laboratory Medicine and Pathobiology, University of
Toronto, Toronto, ON, Canada
(Rao) Division of Cardiovascular Surgery, University of Toronto, Toronto,
ON, Canada
(Heddle) Department of Medicine, Faculty of Health Sciences, McMaster
University, Hamilton, ON, Canada
(Farkouh) Peter Munk Cardiac Centre, Heart and Stroke Richard Lewar
Centre, University of Toronto, Toronto, ON, Canada
(Crowther) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, ON, Canada
(Scales) Department of Critical Care Medicine, Sunnybrook Health Sciences
Centre, University of Toronto, Toronto, ON, Canada
(Scales) Interdepartmental Division of Critical Care, Department of
Medicine, University of Toronto, Toronto, ON, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Coagulopathic bleeding is a serious complication of cardiac
surgery to which an important contributor is acquired hypofibrinogenaemia
(plasma fibrinogen <1.5-2.0 g/L). The standard intervention for acquired
hypofibrinogenaemia is cryoprecipitate, but purified fibrinogen
concentrates are also available. There is little comparative data between
the two therapies and randomised trials are needed. Methods and analysis
FIBrinogen REplenishment in Surgery (FIBRES) is a multicentre, randomised
(1:1), active-control, single-blinded, phase III trial in adult cardiac
surgical patients experiencing clinically significant bleeding related to
acquired hypofibrinogenaemia. The primary objective is to demonstrate that
fibrinogen concentrate (Octafibrin/Fibryga; Octapharma) is non-inferior to
cryoprecipitate. All patients for whom fibrinogen supplementation is
ordered by the clinical team within 24 hours of cardiopulmonary bypass
will receive 4 g of fibrinogen concentrate or 10 units of cryoprecipitate
(dose-equivalent to 4 g), based on random allocation and deferred consent.
The primary outcome is total red cell, platelet and plasma transfusions
administered within 24 hours of bypass. Secondary outcomes include major
bleeding, fibrinogen levels and adverse events within 28 days. Enrolment
of 1200 patients will provide >90% power to demonstrate non-inferiority.
One preplanned interim analysis will include 600 patients. The pragmatic
design and treatment algorithm align with standard practice, aiding
adherence and generalisability. Ethics and dissemination The study is
approved by the local research ethics board and will be conducted in
accordance with the Declaration of Helsinki, Good Clinical Practice
guidelines and regulatory requirements. Patient consent prior to treatment
is waived, as per criteria in the Tri-Council Policy Statement. Results
will be published in the scientific/medical literature, and at
international congresses. Non-inferiority of purified fibrinogen
concentrate would support its use in acquired hypofibrinogenaemia. The
results are likely to improve care for cardiac surgical patients
experiencing significant bleeding, an understudied yet high-risk
population.<br/>Copyright &#xa9; 2018 Article author(s).

<30>
Accession Number
625044188
Title
Minimizing ICU Neurological Dysfunction with Dexmedetomidine-induced Sleep
(MINDDS): Protocol for a randomised, double-blind, parallel-arm,
placebo-controlled trial.
Source
BMJ Open. 8 (4) (no pagination), 2018. Article Number: e020316. Date of
Publication: 01 Apr 2018.
Author
Shelton K.T.; Qu J.; Bilotta F.; Brown E.N.; Cudemus G.; D'Alessandro
D.A.; Deng H.; Dibiasio A.; Gitlin J.A.; Hahm E.Y.; Hobbs L.E.; Houle
T.T.; Ibala R.; Loggia M.; Pavone K.J.; Shaefi S.; Tolis G.; Westover
M.B.; Akeju O.
Institution
(Shelton, Qu, Brown, Cudemus, Deng, Gitlin, Hahm, Hobbs, Houle, Ibala,
Pavone, Akeju) Department of Anesthesiology, Critical Care and Pain
Medicine, Massachusetts General Hospital, Boston, MA, United States
(Bilotta) Department of Anaesthesia and Critical Care Medicine, Sapienza
University of Rome, Rome, Italy
(Brown) Institute for Medical Engineering and Sciences, Massachusetts
Institute of Technology, Cambridge, MA, United States
(D'Alessandro, Tolis) Department of Surgery, Division of Cardiac Surgery,
Massachusetts General Hospital, Boston, MA, United States
(Dibiasio) Department of Pharmacy, Massachusetts General Hospital, Boston,
MA, United States
(Loggia) Athinoula A. Martinos Center for Biomedical Imaging, Department
of Radiology, Massachusetts General Hospital, Boston, MA, United States
(Shaefi) Department of Anesthesia and Critical Care, Beth Israel Deaconess
Medical Center, Boston, MA, United States
(Westover) Department of Neurology, Massachusetts General Hospital,
Boston, MA, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Delirium, which is prevalent in postcardiac surgical
patients, is an acute brain dysfunction characterised by disturbances in
attention, awareness and cognition not explained by a pre-existing
neurocognitive disorder. The pathophysiology of delirium remains poorly
understood. However, basic science and clinical studies suggest that sleep
disturbance may be a modifiable risk factor for the development of
delirium. Dexmedetomidine is a alpha-2A adrenergic receptor agonist
medication that patterns the activity of various arousal nuclei similar to
sleep. A single night-time loading dose of dexmedetomidine promotes
non-rapid eye movement sleep stages N2 and N3 sleep. This trial
hypothesises dexmedetomidine-induced sleep as pre-emptive therapy for
postoperative delirium. Methods and analysis The MINDDS (Minimizing ICU
Neurological Dysfunction with Dexmedetomidine-induced Sleep) trial is a
370-patient block-randomised, placebo-controlled, double-blinded,
single-site, parallel-arm superiority trial. Patients over 60 years old,
undergoing cardiac surgery with planned cardiopulmonary bypass, will be
randomised to receive a sleep-inducing dose of dexmedetomidine or placebo.
The primary outcome is the incidence of delirium on postoperative day 1,
assessed with the Confusion Assessment Method by staff blinded to the
treatment assignment. To ensure that the study is appropriately powered
for the primary outcome measure, patients will be recruited and randomised
into the study until 370 patients receive the study intervention on
postoperative day 0. Secondary outcomes will be evaluated by in-person
assessments and medical record review for in-hospital end points, and by
telephone interview for 30-day, 90-day and 180-day end points. All trial
outcomes will be evaluated using an intention-to-treat analysis plan.
Hypothesis testing will be performed using a two-sided significance level
(type I error) of alpha=0.05. Sensitivity analyses using the actual
treatment received will be performed and compared with the
intention-to-treat analysis results. Additional sensitivity analyses will
assess the potential impact of missing data due to loss of follow-up.
Ethics and dissemination The Partners Human Research Committee approved
the MINDDS trial. Recruitment began in March 2017. Dissemination plans
include presentations at scientific conferences, scientific publications
and popular media. Trial registration number NCT02856594.<br/>Copyright
&#xa9; Article author(s) (or their employer(s) unless otherwise stated in
the text of the article) 2018. All rights reserved. No commercial use is
permitted unless otherwise expressly granted.

<31>
Accession Number
625266952
Title
Effect of continuous local anesthetic in post-cardiac surgery patients: A
systematic review.
Source
Pain Medicine (United States). 19 (5) (pp 1077-1090), 2018. Date of
Publication: 01 May 2018.
Author
Hong S.S.; Milross M.A.; Alison J.A.
Institution
(Hong, Milross, Alison) Physiotherapy Department, Liverpool Hospital,
Sydney, NSW 2170, Australia
(Hong) Discipline of Physiotherapy and Discipline of Physiotherapy,
Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
(Alison) Physiotherapy Department, Royal Prince Alfred Hospital, Sydney,
NSW, Australia
Publisher
Oxford University Press (E-mail: subscrip@blackwellpub.com)
Abstract
Objective. The purpose of this review was to determine the effect of CLA
infusion post cardiac surgery on pain, time to ambulation, severe adverse
events, patient satisfaction, time to extubation, length of stay in the
intensive care unit and in the hospital, total narcotic consumption, and
pulmonary function. Design. Systematic review with meta-Analysis (PROSPERO
CRD42014010188). Methods. We searched the following electronic databases:
The Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE;
EMBASE; CINAHL; Allied and Complementary Medicine (AMED); and PsycINFO; as
well as hand-searching cardiothoracic surgery and anesthetic journals and
meeting abstracts. Results. Ten eligible trials with a total of 546
participants were identified. Meta-Analyses showed that CLA infusion
significantly reduced the total mean visual analog pain score at 72 hours
(mean difference [MD] 5 ?14.31mm, 95% confidence interval [CI] 5 ?25.59 to
?3.03); time to ambulation (MD 5 ?2.81 hours, 95% CI 5 ?5.23 to ?0.4);
morphine requirement (MD 5 ?10.19 mg, 95% CI 5 ?11.80 to ?8.58) but did
not reduce time to ambulate to chair (MD 5 ?1.65 hours, 95% CI 5 ?4.04 to
0.74); time to extubation (MD 5 ?0.18 hours, 95% CI 5 ?1.24 to 0.89);
length of ICU stay (MD50.9 hours, 95% CI 5 ?2.96 to 4.75); and hospital
length of stay (MD 5 ?0.59 days, 95% CI 5 ?1.24 to 0.07). There were
insufficient data to perform a meta-Analysis on severe adverse events,
patient satisfaction, or pulmonary function. Conclusions. CLA infusion
after cardiac surgery reduces pain score at 72 hours, shortens time to
ambulation, and reduces morphine consumption at 48 hours.<br/>Copyright
&#xa9; 2018 Oxford University Press. All Rights Reserved.

<32>
Accession Number
625162541
Title
Ezetimibe for the prevention of cardiovascular disease and all-cause
mortality events.
Source
Cochrane Database of Systematic Reviews. 2018 (11) (no pagination), 2018.
Article Number: CD012502. Date of Publication: 19 Nov 2018.
Author
Zhan S.; Tang M.; Liu F.; Xia P.; Shu M.; Wu X.
Institution
(Zhan, Tang, Liu, Xia) First Affiliated Hospital of Third Military Medical
University (Army Medical University), Pharmacy Department, 30 Gaotanyan
Street, Chongqing, Shapingba District 400038, China
(Shu) First Affiliated Hospital of Third Military Medical University (Army
Medical University), Cardiovascular Department, Chongqing, China
(Wu) Third Military Medical University (Army Medical University),
Department of Health Statistics, College of Preventive Medicine,
Chongqing, China
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Cardiovascular disease (CVD) remains an important cause of
mortality and morbidity, and high levels of blood cholesterol are thought
to be the major modifiable risk factors for CVD. The use of statins is the
preferred treatment strategy for the prevention of CVD, but some people at
high-risk for CVD are intolerant to statin therapy or unable to achieve
their treatment goals with the maximal recommended doses of statin.
Ezetimibe is a selective cholesterol absorption inhibitor, whether it has
a positive effect on CVD events remains uncertain. Results from clinical
studies are inconsistent and a thorough evaluation of its efficacy and
safety for the prevention of CVD and mortality is necessary.
<br/>Objective(s): To assess the efficacy and safety of ezetimibe for the
prevention of CVD and all-cause mortality. <br/>Search Method(s): We
searched the CENTRAL, MEDLINE, Embase and Web of Science on 27 June 2018,
and two clinical trial registry platforms on 11 July 2018. We checked
reference lists from primary studies and review articles for additional
studies. No language restrictions were applied. <br/>Selection Criteria:
We included randomised controlled trials (RCTs) that compared ezetimibe
versus placebo or ezetimibe plus other lipid-modifying drugs versus other
lipid-modifying drugs alone in adults, with or without CVD, and which had
a follow-up of at least 12 months. <br/>Data Collection and Analysis: Two
review authors independently selected studies for inclusion, extracted
data, assessed risk of bias and contacted trialists to obtain missing
data. We performed statistical analyses according to the Cochrane Handbook
for Systematic Reviews of Interventions and used the GRADE to assess the
quality of evidence. <br/>Main Result(s): We included 26 RCTs randomising
23,499 participants. All included studies assessed effects of ezetimibe
plus other lipid-modifying drugs compared with other lipid-modifying drugs
alone or plus placebo. Our findings were driven by the largest study
(IMPROVE-IT), which had weights ranging from 41.5% to 98.4% in the
different meta-analyses. Ezetimibe with statins probably reduces the risk
of major adverse cardiovascular events compared with statins alone (risk
ratio (RR) 0.94, 95% confidence interval (CI) 0.90 to 0.98; a decrease
from 284/1000 to 267/1000, 95% CI 256 to 278; 21,727 participants; 10
studies; moderate-quality evidence). Trials reporting all-cause mortality
used ezetimibe with statin or fenofibrate and found they have little or no
effect on this outcome (RR 0.98, 95% CI 0.91 to 1.05; 21,222 participants;
8 studies; high-quality evidence). Adding ezetimibe to statins probably
reduces the risk of non-fatal myocardial infarction (MI) (RR 0.88, 95% CI
0.81 to 0.95; a decrease from 105/1000 to 92/1000, 95% CI 85 to 100;
21,145 participants; 6 studies; moderate-quality evidence) and non-fatal
stroke (RR 0.83, 95% CI 0.71 to 0.97; a decrease 32/1000 to 27/1000, 95%
CI 23 to 31; 21,205 participants; 6 studies; moderate-quality evidence).
Trials reporting cardiovascular mortality added ezetimibe to statin or
fenofibrate, probably having little or no effect on this outcome (RR 1.00,
95% CI 0.89 to 1.12; 19457 participants; 6 studies; moderate-quality
evidence). The need for coronary revascularisation might be reduced by
adding ezetimibe to statin (RR 0.94, 95% CI 0.89 to 0.99; a decrease from
196/1000 to 184/1000, 95% 175 to 194; 21,323 participants; 7 studies);
however, no difference in coronary revascularisation rate was observed
when a sensitivity analysis was limited to studies with a low risk of
bias. In terms of safety, adding ezetimibe to statins may make little or
no difference in the risk of hepatopathy (RR 1.14, 95% CI 0.96 to 1.35;
20,687 participants; 4 studies; low-quality evidence). It is uncertain
whether ezetimibe increase or decrease the risk of myopathy (RR 1.31, 95%
CI 0.72 to 2.38; 20,581 participants; 3 studies; very low-quality
evidence) and rhabdomyolysis, given the wide CIs and low event rate.
Little or no difference in the risk of cancer, gallbladder-related disease
and discontinuation due to adverse events were observed between treatment
groups. For serum lipids, adding ezetimibe to statin or fenofibrate might
further reduce the low-density lipoprotein cholesterol (LDL-C), total
cholesterol and triglyceride levels and likely increase the high-density
lipoprotein cholesterol levels; however, substantial heterogeneity was
detected in most analyses. None of the included studies reported on
health-related quality of life. Authors' conclusions: Moderate- to
high-quality evidence suggests that ezetimibe has modest beneficial
effects on the risk of CVD endpoints, primarily driven by a reduction in
non-fatal MI and non-fatal stroke, but it has little or no effect on
clinical fatal endpoints. The cardiovascular benefit of ezetimibe might
involve the reduction of LDL-C, total cholesterol and triglycerides. There
is insufficient evidence to determine whether ezetimibe increases the risk
of adverse events due to the low and very low quality of the evidence. The
evidence for beneficial effects was mainly obtained from individuals with
established atherosclerotic cardiovascular disease (ASCVD, predominantly
with acute coronary syndrome) administered ezetimibe plus statins.
However, there is limited evidence regarding the role of ezetimibe in
primary prevention and the effects of ezetimibe monotherapy in the
prevention of CVD, and these topics thus requires further
investigation.<br/>Copyright &#xa9; 2018 The Cochrane Collaboration.

<33>
Accession Number
2001340088
Title
Outcome of pump assisted beating mitral valve replacement in patients with
chronic severe mitral regurgitation and left ventricular dysfunction "A
clinical randomized trial".
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. (no
pagination), 2018. Date of Publication: 2018.
Author
Elghany Elsherif M.A.; Salama Ayyad M.A.K.; Elsawy H.; Elwahab A.A.
Institution
(Elghany Elsherif, Elsawy) National Heart Institute, Cairo, Egypt
(Salama Ayyad, Elwahab) Assiut University, Cardiothoracic Surgery
Department, Egypt
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: As a natural extension of warm heart surgery, beating heart
valve surgery was born. The fundamental question was posed: why arrest the
heart if technically adequate valve procedures could be accomplished with
continuous warm perfusion? So this study was carried out to evaluate the
results of mitral valve replacement on beating heart in patients with
chronic severe mitral regurgitation and left ventricular dysfunction.
<br/>Method(s): Sixty patients underwent surgical correction of mitral
insufficiency were prospectively randomized to 30 patients (group 1)
mitral valve replacement using warm blood cardioplegia, and 30 patients
(group II) mitral valve replacement using beating heart technique.
<br/>Result(s): Preoperatively, there was no significant difference
between the two examined groups in age, sex, NYHA and echocardiographic
data. The mitral surgical time (from beginning of opening of the left
atrium till finishing left atrial closure) was significantly longer in the
beating (group II) compared to the control (group I). However, the total
bypass time was not significantly longer in the beating (group II)
compared to the control (group I). The beating (group II) patients had
shorter ventilation time and ICU stays time than in the control (group I).
P value (0.003 and 0.049 respectively). Also (group II) patients had less
incidence of low cardiac output status after surgery than the control
(group I) (p value 0.007). The postoperative echocardiographic results
showed a significant difference on LV myocardial function in favor of the
beating technique (group II) over the cardioplegic technique (group I).
<br/>Conclusion(s): Beating heart mitral valve replacement has proven in
our study to be associated with better LV function early postoperatively
than mitral valve replacement using warm bloody cardioplegic arrest. This
together with the absence of related perioperative mortality and the major
complications suggests that it is safe and beneficial to LV
function.<br/>Copyright &#xa9; 2018

<34>
Accession Number
2001335975
Title
Off-Pump Versus On-Pump Impact: Diabetic Patient 5-Year Coronary Artery
Bypass Clinical Outcomes.
Source
Annals of Thoracic Surgery. (no pagination), 2018. Date of Publication:
2018.
Author
Shroyer A.L.W.; Quin J.A.; Wagner T.H.; Carr B.M.; Collins J.F.; Almassi
G.H.; Bishawi M.; Grover F.L.; Hattler B.
Institution
(Shroyer, Carr, Bishawi) Research and Development Office, Northport
Veterans Affairs Medical Center, Northport, NY, United States
(Shroyer, Grover, Hattler) Research and Development Office, Eastern
Colorado Health Care System, Department of Veterans Affairs, Denver, CO,
United States
(Quin) Department of Surgery, VA Boston Healthcare System, West Roxbury,
MA, United States
(Wagner) Department of Veterans Affairs Health Economics Resource Center,
Palo Alto, CA, United States
(Wagner) Department of Surgery, Stanford University, Palo Alto, CA, United
States
(Carr) Department of Emergency Medicine, Mayo Clinic, Rochester, MN,
United States
(Collins) Cooperative Studies Program Coordinating Center, VA Medical
Center, Perry Point, MD, United States
(Almassi) Department of Surgery, Zablocki VA Medical Center, Milwaukee,
WI, United States
(Almassi) Department of Surgery, Medical College of Wisconsin, Milwaukee,
WI, United States
(Bishawi) Department of Surgery, Duke University Medical Center, Durham,
NC, United States
(Grover) Department of Surgery, University of Colorado School of Medicine,
Aurora, CO, United States
(Hattler) Department of Medicine, University of Colorado School of
Medicine, Aurora, CO, United States
Publisher
Elsevier USA
Abstract
Background: For diabetic patients who require coronary artery bypass graft
(CABG) operation, controversy persists whether an off-pump or an on-pump
approach may be advantageous. This US-based, multicenter, randomized,
controlled trial, Department of Veterans Affairs Randomization On versus
Off Bypass Follow-up Study, compared diabetic patients' 5-year clinical
outcomes for off-pump versus on-pump procedures. <br/>Method(s): From 2002
to 2008, 835 medically treated (ie, oral hypoglycemic agent or insulin)
diabetic patients underwent either off-pump (n = 402) or on-pump (n = 433)
CABG. Five-year primary end points included all-cause death and major
adverse cardiovascular events (MACE; composite included all-cause death,
myocardial infarction, or repeat revascularization). Secondary 5-year end
points included cardiac death and MACE-related components. With baseline
risk factors balanced, outcomes were evaluated by using a p value less
than or equal to 0.01; nonsignificant trends were reported for p values
greater than 0.01 and less than or equal to 0.15. <br/>Result(s):
Five-year all-cause death rates were 20.2% off pump versus 14.1% on pump
(p = 0.0198). No differences were seen in MACE (32.6% off-pump approach
versus 28.6% on-pump approach, p = 0.216), repeat revascularization (12.4%
off-pump approach versus 11.8% on-pump approach, p = 0.770), and nonfatal
myocardial infarction (12.7% off-pump approach versus 10.4% on-pump
approach, p = 0.299). Cardiac death trended worse with off-pump CABG
(9.0%) than with on-pump CABG (6.25%, p = 0.137). Sensitivity analyses
that removed conversions confirmed these findings. <br/>Conclusion(s):
With a 6.1% absolute difference, a strong trend toward improved 5-year
survival was observed with on-pump CABG for medically treated diabetic
patients. No off-pump advantage was found for any 5-year end points. A
future clinical trial now appears warranted to rigorously compare off-pump
versus on-pump longer term outcomes for diabetic patients.<br/>Copyright
&#xa9; 2018

<35>
Accession Number
623337475
Title
Meta-analysis of the impact of successful chronic total occlusion
percutaneous coronary intervention on left ventricular systolic function
and reverse remodeling.
Source
Journal of Interventional Cardiology. 31 (5) (pp 562-571), 2018. Date of
Publication: October 2018.
Author
Megaly M.; Saad M.; Tajti P.; Burke M.N.; Chavez I.; Gossl M.; Lips D.;
Mooney M.; Poulose A.; Sorajja P.; Traverse J.; Wang Y.; Kohl L.P.;
Bradley S.M.; Brilakis E.S.
Institution
(Megaly, Tajti, Burke, Chavez, Gossl, Lips, Mooney, Poulose, Sorajja,
Traverse, Wang, Bradley, Brilakis) Minneapolis Heart Institute, Abbott
Northwestern Hospital, Minneapolis, MN, United States
(Megaly, Kohl) Division of Cardiology, Department of Medicine, Hennepin
County Medical Center, Minneapolis, MN, United States
(Saad) Department of Cardiovascular Medicine, University of Arkansas,
Little Rock, AR, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: We sought to examine the impact of coronary chronic total
occlusion (CTO) percutaneous coronary intervention (PCI) on left
ventricular (LV) function. <br/>Method(s): We performed a systematic
review and meta-analysis of studies published between January 1980 and
November 2017 on the impact of successful CTO PCI on LV function.
<br/>Result(s): A total of 34 observational studies including 2735
patients were included in the meta-analysis. Over a weighted mean
follow-up of 7.9 months, successful CTO PCI was associated with an
increase in LV ejection fraction by 3.8% (95%CI 3.0-4.7, P < 0.0001,
I² = 45%). In secondary analysis of 15 studies (1248 patients)
that defined CTOs as occlusions of at least 3-month duration and reported
follow-up of at least 3-months after the procedure, successful CTO PCI was
associated with improvement in LV ejection fraction by 4.3% (95%CI [3.1,
5.6], P < 0.0001). In the 10 studies (502 patients) that reported LV
end-systolic volume, successful CTO PCI was associated with a decrease in
LV end-systolic volume by 4 mL, (95%CI -6.0 to -2.1, P < 0.0001,
I² = 0%). LV end-diastolic volume was reported in 9 studies
with 403 patients and did not significantly change after successful CTO
PCI (-2.3 mL, 95%CI -5.7 to 1.2 mL, P = 0.19, I² = 0%).
<br/>Conclusion(s): Successful CTO PCI is associated with a statistically
significant improvement in LV ejection fraction and decrease in LV
end-systolic volume, that may reflect a beneficial effect of CTO
recanalization on LV remodeling. The clinical implications of these
findings warrant further investigation.<br/>Copyright &#xa9; 2018 Wiley
Periodicals, Inc.

<36>
Accession Number
622333460
Title
Polymer-free versus permanent polymer-coated drug eluting stents for the
treatment of coronary artery disease: A meta-analysis of randomized
trials.
Source
Journal of Interventional Cardiology. 31 (5) (pp 608-616), 2018. Date of
Publication: October 2018.
Author
Nogic J.; Baey Y.-W.; Nerlekar N.; Ha F.J.; Cameron J.D.; Nasis A.; West
N.E.J.; Brown A.J.
Institution
(Nogic, Baey, Nerlekar, Ha, Cameron, Nasis, Brown) Monash Cardiovascular
Research Centre, Monash University and Monash Heart, Monash Health,
Melbourne, VIC, Australia
(West) Department of Interventional Cardiology, Papworth Hospital NHS
Trust, Cambridge, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Polymer-free drug eluting stents (PF-DES) were developed, in
part, to overcome risk of late ischemic events observed with permanent
polymer-coated DES (PP-DES). However, trial results are inconsistent with
longer-term safety and efficacy of PF-DES remaining unknown. We performed
a meta-analysis of randomized trials assessing outcomes of patients
receiving PF-DES versus PP-DES for treatment of coronary artery disease
(CAD). <br/>Method(s): Electronic searches were performed for randomized
trials comparing outcomes between PF-DES and PP-DES. Trials reporting
major adverse cardiovascular events (MACE), myocardial infarction (MI),
stent thrombosis (ST), all-cause death, target lesion/vessel
revascularization (TLR/TVR), and late lumen loss (LLL) were included.
Analyses were performed at longest follow-up and landmarked beyond 1-year.
<br/>Result(s): Twelve trials (6,943 patients) were included. There was no
significant difference in MACE between PF-DES and PP-DES at longest
follow-up (Odds Ratio [OR] 0.96, 95%CI 0.85-1.10, P = 0.59) or landmark
analysis beyond 1-year (OR 0.96, 95%CI 0.76-1.20, P = 0.70). Although
PF-DES were associated with a significant reduction in all-cause death (OR
0.85, 95%CI 0.72-1.00, P < 0.05), this effect was not present on landmark
analysis beyond 1-year (OR 0.89, 95%CI 0.73-1.10, P = 0.30). There were no
differences observed for MI (OR 1.00, 95%CI 0.77-1.28, P = 0.99) or ST (OR
0.95, 95%CI 0.54-1.68, P = 0.86), with similar efficacy outcomes including
TVR (OR 1.07, 95%CI 0.91-1.26, P = 0.42), TLR (OR 1.03, 95%CI 0.88-1.21, P
= 0.68) and angiographic LLL (pooled mean difference 0.01 mm, 95%CI -0.08
to 0.11, P = 0.76). <br/>Conclusion(s): PF-DES are as safe and efficacious
as PP-DES for the treatment of patients with CAD, but do not significantly
reduce late ischemic complications.<br/>Copyright &#xa9; 2018 Wiley
Periodicals, Inc.

<37>
Accession Number
617243710
Title
Telmisartan decreases microalbuminuria in patients with type 2 diabetes
mellitus following coronary artery bypass grafting.
Source
Cardiovascular Journal of Africa. 28 (3) (pp 191-195), 2017. Date of
Publication: May 2017.
Author
Furat C.; Dogan R.; Ilhan G.; Bayar E.; Ozpak B.; Kara H.; Bozok S.
Institution
(Furat, Dogan) Department of Cardiovascular Surgery, Faculty of Medicine,
Hacettepe University, Ankara, Turkey
(Ilhan) Department of Cardiovascular Surgery, Faculty of Medicine, Recep
Tayyip Erdogan University, Rize, Turkey
(Bayar) Department of Cardiovascular Surgery, Zonguldak Ataturk State
Hospital, Zonguldak, Turkey
(Ozpak) Department of Cardiovascular Surgery, Faculty of Medicine, Katip
Celebi University, Turkey
(Kara) Department of Cardiovascular Surgery, Ada Hospital, Giresun, Turkey
(Bozok) Department of Cardiovascular Surgery, Faculty of Medicine,
Bahcesehir University, Istanbul, Turkey
Publisher
Clinics Cardive Publishing (PTY)Ltd (PO Box 1013, Durbanville 7551, South
Africa)
Abstract
Objective: This prospective study aimed to investigate the effects of the
selective angiotensin receptor antagonist, telmisartan, on
microalbuminuria after coronary artery bypass surgery in patients with
diabetes mellitus. <br/>Method(s): Patients were divided into two groups
with block randomisation, using the sealed envelope technique: group T
(telmisartan group) consisted of patients who received the angiotensin
receptor blocking agent telmisartan 80 mg daily for at least six months in
the pre-operative period; group N-T (non-Telmisartan group) consisted of
patients who received no telmisartan treatment. Clinical and demographic
characteristics, operative and postoperative features, microalbuminuria
and high-sensitivity C-reactive protein levels were compared.
<br/>Result(s): Forty patients met the eligibility criteria for the study.
The groups did not differ with regard to clinical and demographic
characteristics, and operative and postoperative features.
Microalbuminuria levels between the groups differed significantly in the
pre-operative period, first hour postoperatively and fifth day
postoperatively. C-reactive protein levels between the groups differed
significantly on the fifth day postoperatively. <br/>Conclusion(s):
Telmisartan was useful for decreasing systemic inflammation and levels of
urinary albumin excretion in patients who had type 2 diabetes mellitus and
had undergone coronary artery bypass surgery.

<38>
Accession Number
616842262
Title
Position paper for the evaluation and management of oral status in
patients with valvular disease: Groupe de Travail Valvulopathies de la
Societe Francaise de Cardiologie, Societe Francaise de Chirurgie Orale,
Societe Francaise de Parodontologie et d'Implantologie Orale, Societe
Francaise d'Endodontie et Societe de Pathologie Infectieuse de Langue
Francaise.
Source
Archives of Cardiovascular Diseases. 110 (8-9) (pp 482-494), 2017. Date of
Publication: August 2017.
Author
Millot S.; Lesclous P.; Colombier M.-L.; Radoi L.; Messeca C.; Ballanger
M.; Charrier J.-L.; Tramba P.; Simon S.; Berrebi A.; Doguet F.; Lansac E.;
Tribouilloy C.; Habib G.; Duval X.; Iung B.
Institution
(Millot) Department of oral surgery, Montpellier university hospital,
Montpellier 34295, France
(Millot) Inserm 1149, Paris 75018, France
(Lesclous) Department of oral surgery, Nantes hospital, university of
Nantes, Inserm U791, LIOAD, Nantes 44093, France
(Colombier) Department of periodontology, Louis-Mourier hospital, AP-HP,
university of Paris Descartes, Colombes 92700, France
(Radoi) Department of oral surgery, Louis-Mourier hospital, AP-HP,
university of Paris Descartes, Inserm U1018, Colombes 92700, France
(Messeca) Odontology department, Bichat hospital, AP-HP, Paris 75018,
France
(Ballanger) Department of oral surgery, Pitie-Salpetriere hospital, AP-HP,
university of Paris Descartes, Paris 75013, France
(Charrier) Department of oral surgery, Bretonneau hospital, AP-HP,
university of Paris Descartes, Paris 75018, France
(Tramba) Department of implantology and prosthetics, Pitie Salpetriere
hospital, AP-HP, university of Paris Descartes, Paris 75013, France
(Simon) Endodontics department, Pitie-Salpetriere hospital, AP-HP,
Paris-Diderot university, Paris 75013, France
(Berrebi) Department of cardiology, Georges Pompidou european hospital,
AP-HP, institut mutualiste Montsouris, Paris 75014, France
(Doguet) Department of thoracic and cardiovascular surgery, Rouen
university hospital, Inserm U1096, Rouen 76000, France
(Lansac) Department of cardiac surgery, institut mutualiste Montsouris,
Paris 75014, France
(Tribouilloy) Department of cardiology, university hospital of Amiens,
Inserm U1088, Jules-Verne university of Picardie, Amiens 80480, France
(Habib) Department of cardiology, La Timone hospital, Aix-Marseille
university, Marseille 13385, France
(Duval) Centre of clinical investigations, Inserm 1425, Bichat hospital,
AP-HP, Paris-Diderot university, Inserm U1137, AEPEI, Paris 75018, France
(Iung) Department of cardiology, Bichat hospital, AP-HP, DHU FIRE,
Paris-Diderot university, 46, rue Henri-Huchard, Paris 75018, France
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Oral health is of particular importance in patients with heart valve
diseases because of the risk of infective endocarditis. Recommendations
for antibiotic prophylaxis before dental procedures have been restricted,
but the modalities of oral evaluation and dental care are not detailed in
guidelines. Therefore, a multidisciplinary working group reviewed the
literature to propose detailed approaches for the evaluation and
management of buccodental status in patients with valvular disease. Simple
questions asked by a non-dental specialist may draw attention to
buccodental diseases. Besides clinical examination, recent imaging
techniques are highly sensitive for the detection of inflammatory bone
destruction directly related to oral or dental infection foci. The
management of buccodental disease before cardiac valvular surgery should
be adapted to the timing of the intervention. Simple therapeutic
principles can be applied even before urgent intervention. Restorative
dentistry and endodontic and periodontal therapy can be performed before
elective valvular intervention and during the follow-up of patients at
high risk of endocarditis. The detection and treatment of buccodental foci
of infection should follow specific rules in patients who present with
acute endocarditis. Implant placement is no longer contraindicated in
patients at intermediate risk of endocarditis, and can also be performed
in selected high-risk patients. The decision for implant placement should
follow an analysis of general and local factors increasing the risk of
implant failure. The surgical and prosthetic procedures should be
performed in optimal safety conditions. It is therefore now possible to
safely decrease the number of contraindicated dental procedures in
patients at risk of endocarditis.<br/>Copyright &#xa9; 2017 Elsevier
Masson SAS

<39>
Accession Number
617433519
Title
Evaluation of flow after transcatheter aortic valve replacement in
patients with low-flow aortic stenosis: A secondary analysis of the
PARTNER randomized clinical trial.
Source
JAMA Cardiology. 1 (5) (pp 584-592), 2016. Date of Publication: August
2016.
Author
Anjan V.Y.; Herrmann H.C.; Pibarot P.; Stewart W.J.; Kapadia S.; Tuzcu
E.M.; Babaliaros V.; Thourani V.H.; Szeto W.Y.; Bavaria J.E.; Kodali S.;
Hahn R.T.; Williams M.; Miller D.C.; Douglas P.S.; Leon M.B.
Institution
(Anjan, Herrmann) Cardiovascular Division, Hospital of the University of
Pennsylvania, 9038 Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104,
United States
(Pibarot) Department of Medicine, Laval University, Quebec City, QC,
Canada
(Stewart, Kapadia, Tuzcu) Department of Cardiovascular Medicine, Cleveland
Clinic, Cleveland, OH, United States
(Babaliaros) Department of Medicine, Emory University, Atlanta, GA, United
States
(Thourani) Department of Surgery, Emory University, Atlanta, GA, United
States
(Szeto, Bavaria) Division of Cardiothoracic Surgery, University of
Pennsylvania, Philadelphia, PA, United States
(Kodali, Hahn, Leon) Department of Medicine, Columbia University Medical
Center, New York, NY, United States
(Williams) Division of Cardiac Surgery, New York University Langone
Medical Center, New York, NY, United States
(Miller) Department of Cardiothoracic Surgery, Stanford University,
Stanford, CA, United States
(Douglas) Department of Medicine, Duke Clinical Research Institute, Duke
University Medical Center, Durham, NC, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Low-flow (LF) severe aortic stenosis (AS) is an independent
predictor of mortality in patients undergoing aortic valve replacement
(AVR). Little is known about improvement in flow after AVR and its effects
on survival. <br/>Objective(s): To determine whether higher flow
(left-ventricular stroke volume index [LVSVI]) after transcatheter AVR
(TAVR) would indicate better clinical outcomes in this at-risk population.
<br/>Design, Setting, and Participant(s): A substudy analysis of data from
the Placement of Aortic Transcatheter Valves (PARTNER) randomized clinical
trial and continued-access registry was conducted. A total of 984
participants with evaluable echocardiograms and baseline LF AS (LVSVI<=35
mL/m²) were included. The trial was conducted at 26 sites in
the United States and Canada. Patients were stratified after TAVR into
tertiles by discharge LVSVI status (severe low flow [SLF], moderate low
flow [MLF], and normal flow [(NF]). The present study was conducted from
May 11, 2007, to January 9, 2012, with data analysis performed from April
25, 2014, to January 21, 2016. <br/>Main Outcomes and Measures: The
primary end pointwas all-cause mortality at 1 year. <br/>Result(s):
Baseline characteristics of 984 patients with LF AS included mean (SD)
age, 84 (7) years; 582 (59.1%) men; mean Society of Thoracic Surgeons
(STS) score, 11.4%(4.0%); and mean LVSVI, 27.6 (5.0) mL/m². The
discharge LVSVI values by group were SLF, 23.1 (3.5) mL/m²;
MLF, 31.7 (2.2) mL/m²; and NF, 43.1 (7.0). All-cause mortality
at 1 year was SLF, 26.5%; MLF, 20.1%; and NF, 19.6%(P = .045). Mean LVSVI
normalized by 6 months in the MLF (35.9 [9.3] mL/m²) and NF
(38.8 [11.1] mL/m²) groups, but remained low in the SLF group
at 6 months and 1 year (31.4 [8.4] and 33.0 [8.3] mL/m²],
respectively) (P < .001 for all groups). Reported as multivariate hazard
ratio, mortality at 1 year was higher in the SLF group compared with the
other groups (1.61; 95%CI, 1.17-2.23; P = .004). In addition to SLF, sex
(1.59; 95%CI, 1.18-2.13; P = .002), presence of atrial fibrillation (1.41;
95%CI, 1.06-1.87; P = .02), STS score (1.03; 95%CI, 1.01-1.06; P = .02),
presence of moderate or severe mitral regurgitation at discharge (1.65;
95%CI, 1.21-2.26; P = .001), pre-TAVR mean transvalvular gradient (0.98;
95%CI, 0.97-0.99; P = .004), and effective orifice area index (1.87;
95%CI, 1.09-3.19; P = .02) were independent predictors of 1-year
mortality. <br/>Conclusions and Relevance: Severe LF at discharge is
associated with an increased risk of mortality following TAVR in patients
with severe AS and preexisting LF. The identification of remedial causes
of persistent LF after TAVR may represent an opportunity to improve the
outcome of these patients.<br/>Copyright &#xa9; 2016 American Medical
Association. All rights reserved.

<40>
Accession Number
618422321
Title
Safety of preoperative use of ticagrelor with or without aspirin compared
with aspirin alone in patients with acute coronary syndromes undergoing
coronary artery bypass grafting.
Source
JAMA Cardiology. 1 (8) (pp 921-928), 2016. Date of Publication: November
2016.
Author
Gherli R.; Mariscalco G.; Dalen M.; Onorati F.; Perrotti A.; Chocron S.;
Verhoye J.P.; Gulbins H.; Reichart D.; Svenarud P.; Faggian G.; Santarpino
G.; Fischlein T.; Maselli D.; Dominici C.; Musumeci F.; Rubino A.S.;
Mignosa C.; De Feo M.; Bancone C.; Gatti G.; Maschietto L.; Santini F.;
Nicolini F.; Gherli T.; Zanobini M.; Kinnunen E.-M.; Ruggieri V.G.; Rosato
S.; Biancari F.
Institution
(Gherli, Musumeci) Department of Cardiovascular Sciences, Cardiac Surgery
Unit, San Camillo Forlanini Hospital, Rome, Italy
(Mariscalco) Department of Cardiovascular Sciences, Clinical Sciences
Wing, University of Leicester, Glenfield Hospital, Groby Rd, Leicester LE3
9QP, United Kingdom
(Dalen, Svenarud, Faggian) Department of Molecular Medicine and Surgery,
Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
(Dalen, Svenarud, Faggian) Department of Cardiothoracic Surgery and
Anesthesiology, Karolinska Institutet, Karolinska University Hospital,
Stockholm, Sweden
(Onorati) Division of Cardiovascular Surgery, Verona University Hospital,
Verona, Italy
(Perrotti, Chocron) Department of Thoracic and Cardiovascular Surgery,
University Hospital Jean Minjoz, Besancon, France
(Verhoye, Ruggieri) Division of Cardiothoracic and Vascular Surgery,
Pontchaillou University Hospital, Rennes, France
(Gulbins, Reichart) Hamburg University Heart Center, Hamburg, Germany
(Santarpino, Fischlein) Cardiovascular Center, Paracelsus Medical
University, Nuremberg, Germany
(Maselli, Dominici) Department of Cardiac Surgery, St Anna Hospital,
Catanzaro, Italy
(Rubino, Mignosa) Centro Cuore Morgagni, Pedara, Italy
(De Feo, Bancone) Division of Cardiac Surgery, Department of
Cardiothoracic Sciences, Second University of Naples, Naples, Italy
(Gatti, Maschietto) Division of Cardiac Surgery, Ospedali Riuniti,
Trieste, Italy
(Santini) Division of Cardiac Surgery, University of Genoa, Genoa, Italy
(Nicolini, Gherli) Division of Cardiac Surgery, University of Parma,
Parma, Italy
(Zanobini) Department of Cardiac Surgery, Centro Cardiologico-Fondazione
Monzino, Istituto di Ricovero e Cura A Carattere Scientifico, University
of Milan, Milan, Italy
(Kinnunen, Biancari) Department of Surgery, Oulu University Hospital,
Oulu, Finland
(Rosato) National Institute of Health, Rome, Italy
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE The optimal timing of discontinuation of ticagrelor before
cardiac surgery is controversial. OBJECTIVE To evaluate the safety of
preoperative use of ticagrelor with or without aspirin in patients with
acute coronary syndromes (ACS) undergoing isolated coronary artery bypass
grafting (CABG) compared with aspirin alone. DESIGN, SETTING, AND
PARTICIPANTS This prospective, multicenter clinical trialwas performed at
15 European centers of cardiac surgery. Participants were patients with
ACS undergoing isolated CABG from the European Multicenter Study on
Coronary Artery Bypass Grafting (E-CABG) registry between January and
September 2015. EXPOSURES Before surgery, patients received ticagrelor
with or without aspirin or aspirin alone. MAIN OUTCOMES AND MEASURES
Severe bleeding as defined by the Universal Definition of Perioperative
Bleeding (UDPB) and E-CABG bleeding classification criteria. A propensity
score-matched analysis was performed to adjust for differences in baseline
and operative covariates. RESULTS Of 2482 patients from the E-CABG
registry, the study cohort included 786 (31.7%) consecutive patients with
ACS (mean [SD] age, 67.1 [9.3] years; range, 32-88 years), and 132 (16.8%)
were female. One-to-one propensity score matching provided 215 pairs,
whose baseline and operative covariates had a standardized difference of
less than 10%. Preoperative use of ticagrelor was associated with a
similar risk of bleeding according to the UDPB and E-CABG bleeding
classifications, but the incidence of platelet transfusion was higher in
the ticagrelor group (13.5%[29 of 215] vs 6.0% [13 of 215]. Compared with
those receiving aspirin alone, continuing ticagrelor up to the time of
surgery or discontinuing its use less than 2 days before surgery was
associated with a higher risk of platelet transfusion (22.7%[5 of 22] vs
6.4%[12 of 187]) and E-CABG bleeding grades 2 and 3 (18.2%[4 of 22] vs
5.9% [11 of 187]) and tended to have an increased risk of UDPB grades 3
and 4 (22.7%[5 of 22] vs 9.6%[18 of 187]). Among patients in whom
antiplatelet drug use was discontinued at least 2 days before surgery, the
incidence of platelet transfusion was 12.4%(24 of 193) in the ticagrelor
group and 3.6%(1 of 28) in the aspirin-alone group. CONCLUSIONS AND
RELEVANCE In propensity score-matched analyses among patients with ACS
undergoing CABG, the use of preoperative ticagrelor with or without
aspirin compared with aspirin alone was associated with more platelet
transfusion but similar degree of bleeding; in patients receiving
ticagrelor 1 day before or up until surgery, there was an increased rate
of severe bleeding.<br/>Copyright 2016 American Medical Association. All
rights reserved.

<41>
Accession Number
2000932679
Title
Surgical closure of a ventricular septal defect in early childhood leads
to altered pulmonary function in adulthood: A long-term follow-up.
Source
International Journal of Cardiology. 274 (pp 100-105), 2019. Date of
Publication: 1 January 2019.
Author
Rex C.E.; Eckerstrom F.; Heiberg J.; Maagaard M.; Rubak S.; Redington A.;
Hjortdal V.E.
Institution
(Rex, Eckerstrom, Heiberg, Maagaard, Hjortdal) Dept. of Cardiothoracic and
Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard
99, Aarhus N 8200, Denmark
(Rubak) Dept. of Child and Adolescent Health, Danish Center of Pediatric
Pulmonology and Allergology, Aarhus University Hospital, Palle
Juul-Jensens Boulevard 99, Aarhus N 8200, Denmark
(Rex, Eckerstrom, Heiberg, Maagaard, Rubak, Hjortdal) Dept. of Clinical
Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99,
Aarhus N 8200, Denmark
(Redington) Dept. of Pediatrics, Cincinnati Children's Hospital, OH,
United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: The long-term outlook after surgical closure of ventricular
septal defect (VSD) has traditionally been considered benign. However,
there is an increasing awareness of not only late cardiac dysfunction, but
also pulmonary abnormalities. The primary aim of this study was to
describe pulmonary function in adults with a surgically repaired VSD, and
secondarily to determine the effects of salbutamol on the potential
abnormalities. <br/>Method(s): All patients (operated for a VSD in early
childhood) and controls (age- and gender-matched) underwent static and
dynamic spirometry, impulse oscillometry, multiple breath washout,
diffusion capacity for carbon monoxide, and cardiopulmonary exercise
testing. In a double-blinded, cross-over study, participants were
randomized to inhalation of either 900 mug of salbutamol or placebo. The
primary outcome was forced expiratory volume in 1 s. <br/>Result(s): In
total, 30 participants with a surgically closed VSD and 30 healthy
controls were included. The VSD participants had a lower forced expiratory
volume in 1 s (99 +/- 13% vs. 111 +/- 13%), p < 0.001, impaired forced
vital capacity, (106 +/- 12% vs. 118 +/- 13%), p < 0.001, and lower peak
expiratory flow, (95 +/- 18% vs. 118 +/- 19%), p < 0.001, than the control
group. Also, the VSD group had a lower alveolar volume than the control
group, (92 +/- 10% vs. 101 +/- 11%), p < 0.001, but there were no
differences in the remaining pulmonary function parameters. Salbutamol
reduced airway resistances in both groups, but exercise performance was
not improved by salbutamol, however. <br/>Conclusion(s): Adults who have
undergone surgical closure of a VSD in early childhood have reduced
pulmonary function compared with controls, which is unaffected by
inhalation of salbutamol.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<42>
Accession Number
624786043
Title
Single versus dual antiplatelet therapy after transcatheter aortic valve
implantation: A systematic review and meta-analysis.
Source
Cardiology (Switzerland). 141 (1) (pp 52-65), 2018. Date of Publication:
01 Nov 2018.
Author
Hu X.; Yang F.-Y.; Wang Y.; Zhang Y.; Chen M.
Institution
(Hu, Yang, Wang, Zhang) West China School of Medicine, West China
Hospital, Sichuan University, Chengdu, China
(Chen) Department of Cardiology, West China Hospital, Sichuan University,
37 Guoxue Street, Chengdu 610041, China
Publisher
S. Karger AG
Abstract
Objectives: Although dual antiplatelet therapy (DAPT) with aspirin and
clopidogrel is currently recommended in patients after transcatheter
aortic valve implantation (TAVI), this practice is not supported by
sufficient evidence. This study was performed to compare DAPT to single
antiplatelet therapy (SAPT). <br/>Method(s): An electronic search was
completed of PubMed, Embase, Ovid Medline, Web of Science, and Cochrane
Central Register of Controlled Trials. Studies comparing DAPT versus SAPT
in patients undergoing TAVI were included. <br/>Result(s): Seven studies
incorporating 1,445 patients were eligible for the present meta-analysis.
There were no significant differences on 30-day all-cause mortality (OR
1.19, 95% CI 0.63-2.25, p = 0.593), 6-month all-cause mortality (OR 1.11,
95% CI 0.49-2.53, p = 0.796), or 1-year all-cause mortality (OR 1.19, 95%
CI 0.63- 2.25, p = 0.593). DAPT was associated with an increased risk for
30-day (OR 2.91, 95% CI 1.85-4.58, p < 0.01), 6-month (OR 2.54, 95% CI
1.26-5.10, p < 0.001), and 1-year major and lethal bleeding (OR 2.65, 95%
CI 1.04-6.77, p = 0.041) based on 896, 337, and 583 patients,
respectively, compared to SAPT. <br/>Conclusion(s): Compared to SAPT, DAPT
was not shown to be superior in reducing thrombotic events, but presented
an increased risk of major/life-threatening bleeding. More randomized
controlled trials are needed to provide further evidence.<br/>Copyright
&#xa9; 2018 S. Karger AG, Basel.

<43>
Accession Number
625081254
Title
Optical coherence tomography substudy of a prospective multicentre
randomised post-market trial to assess the safety and effectiveness of the
Firehawk cobalt-chromium coronary stent (rapamycin target-eluting) system
for the treatment of atherosclerotic lesions: TARGET All Comers.
Source
EuroIntervention. 14 (10) (pp 1121-1128), 2018. Date of Publication:
November 2018.
Author
Baumbach A.; Lansky A.J.; Onuma Y.; Asano T.; Johnson T.; Anderson R.;
Kiemeneij F.; Zheng M.; Van Royen N.; Slagboom T.; Vlachojannis G.; Xu B.;
Serruys P.W.; Wijns W.
Institution
(Baumbach, Lansky) Barts Heart Centre, University College London, Queen
Mary University of London, London, United Kingdom
(Baumbach, Lansky) Yale University School of Medicine, 135 College Street,
Suite 101, New Haven, CT 06510, United States
(Onuma, Asano, Serruys) Cardialysis, Rotterdam, Netherlands
(Johnson) University Hospitals Bristol, Bristol, United Kingdom
(Anderson) Cardiff and Vale University Health Board, Heath Park, Cardiff,
United Kingdom
(Kiemeneij) VU University Medical Center, Amsterdam, Netherlands
(Zheng) MicroPort, Shanghai, China
(Van Royen) Radboud University Medical Centre Nijmegen, Nijmegen,
Netherlands
(Slagboom) Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
(Vlachojannis) Maasstad Ziekenhuis, Rotterdam, Netherlands
(Xu) Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese
Academy of Medical Sciences, Beijing, China
(Wijns) Lambe Institute for Translational Medicine, Curam, Saolta
University Healthcare Group, National University of Ireland Galway,
Galway, Ireland
Publisher
EuroPCR
Abstract
Aims: Durable polymer drug-eluting stents (DP-DES) may contribute to
persistent inflammation, delayed endothelial healing and subsequent late
DES thrombosis. The aim of this optical coherence tomography (OCT)
substudy was to compare healing and neointimal coverage of a novel
bioabsorbable polymer sirolimus-eluting stent (Firehawk) (BP-DES) versus
the DP-DES (XIENCE) at 90 days in an all-comers patient population.
<br/>Methods and Results: The TARGET All Comers study is a prospective
multicentre randomised post-market trial of 1,656 patients randomised 1: 1
to Firehawk or XIENCE at 21 centres in 10 European countries. The TARGET
OCT substudy enrolled 36 consecutive patients with 52 lesions at six
centres proficient in OCT. Follow-up OCT was performed at three months or
prior to revascularisation when occurring before the three-month window.
The substudy was designed for non-inferiority of the primary endpoint of
neointimal thickness. At follow-up, the mean neointimal thickness by OCT
(52 lesions: Firehawk, n=24; XIENCE, n=28), was not significantly
different between groups (Firehawk 75.5 mum vs. XIENCE V 82.3 mum) meeting
the primary endpoint of non-inferiority (p<inf>noninferiority</inf>
<0.001). The percentage of stent strut coverage was high in both groups
(strut level: 99.9+/-0.3% vs. 100+/-0.1%, p=0.26), and the proportion of
malapposed struts (1.0+/-1.6% vs. 1.2+/-2.0%, p=0.51) was low in both
groups. <br/>Conclusion(s): Based on OCT, the Firehawk BP-DES has a
similar healing response three months after implantation compared to the
DP-DES, with near complete strut coverage, moderate neointima formation
and minimal strut malapposition.<br/>Copyright &#xa9; Europa Digital &
Publishing 2018. All rights reserved.

<44>
Accession Number
625081116
Title
Radial versus femoral artery access in patients undergoing PCI for left
main coronary artery disease: Analysis from the EXCEL trial.
Source
EuroIntervention. 14 (10) (pp 1104-1111), 2018. Date of Publication:
November 2018.
Author
Chen S.; Redfors B.; Liu Y.; Ben-Yehuda O.; Morice M.-C.; Leon M.B.;
Kandzari D.E.; Mehran R.; Lembo N.J.; Banning A.P.; Merkely B.; Kappetein
A.P.; Sabik J.F.; Serruys P.W.; Stone G.W.
Institution
(Chen, Redfors, Liu, Ben-Yehuda, Leon, Mehran, Lembo, Stone) Columbia
University Medical Center, Cardiovascular Research Foundation, 1700
Broadway, 9th Floor, New York, NY 10019, United States
(Ben-Yehuda, Leon, Lembo, Stone) New York-Presbyterian Hospital, Columbia
University Medical Center, New York, NY, United States
(Morice) Ramsay Generale de Sante, Institut Cardiovasculaire Paris Sud,
Paris, France
(Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Mehran) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, New York, NY, United States
(Banning) John Radcliffe Hospital, Oxford, United Kingdom
(Merkely) Heart and Vascular Center, Semmelweis University, Budapest,
Hungary
(Kappetein) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
Publisher
EuroPCR
Abstract
Aims: We sought to compare clinical outcomes and procedural
characteristics with transradial access (TRA) versus transfemoral access
(TFA) in patients who were treated with PCI for left main (LM) coronary
artery disease. <br/>Methods and Results: The EXCEL trial was a
prospective, international, open-label, multicentre trial that randomised
1,905 patients with LM disease and SYNTAX scores <=32 to PCI with
everolimus-eluting stents versus coronary artery bypass grafting. The
present analysis cohort consisted of 931 patients undergoing PCI with TRA
or TFA, but not both. The primary endpoint was a composite of death,
myocardial infarction (MI), or stroke at three years. Multivariable Cox
proportional hazards regression was used to adjust for differences in
baseline covariates. PCI in EXCEL was performed exclusively with TRA in
248 (26.6%) patients and with TFA in 683 (73.4%) patients. TRA patients
were younger and less likely to have hypertension and chronic kidney
disease. The mean number of vessels and lesions treated was higher in TFA
patients, although the SYNTAX score was similar in both groups. Patients
undergoing TRA and TFA had similar 30-day rates of TIMI major or minor
bleeding (2.4% versus 3.8%, respectively, p=0.30). At three years, TRA and
TFA patients had similar rates of the primary endpoint (15.7% versus
14.8%, adjusted HR 1.11, 95% CI: 0.73-1.69, p=0.64), as well as the
individual rates of death, MI, stroke, ischaemia-driven revascularisation
and stent thrombosis. <br/>Conclusion(s): In the EXCEL trial, PCI of LM
disease with TRA was associated with comparable early and late clinical
outcomes to TFA.<br/>Copyright &#xa9; Europa Digital & Publishing 2018.
All rights reserved.

<45>
Accession Number
625112699
Title
Lung protection strategies during cardiopulmonary bypass affect the
composition of blood electrolytes and metabolites-A randomized controlled
trial.
Source
Journal of Clinical Medicine. 7 (11) (no pagination), 2018. Article
Number: 462. Date of Publication: 21 Nov 2018.
Author
Buggeskov K.B.; Maltesen R.G.; Rasmussen B.S.; Hanifa M.A.; Lund M.A.V.;
Wimmer R.; Ravn H.B.
Institution
(Buggeskov, Ravn) Department of Cardiothoracic Anesthesiology,
Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark
(Maltesen, Rasmussen, Hanifa) Department of Anesthesia and Intensive Care,
Aalborg University Hospital, Aalborg 9000, Denmark
(Rasmussen, Hanifa) Department of Clinical Medicine, School of Medicine
and Health, Aalborg University, Aalborg 9000, Denmark
(Lund) Department of Biomedical Sciences, University of Copenhagen,
Copenhagen 2100, Denmark
(Wimmer) Department of Chemistry and Bioscience, Aalborg University,
Aalborg 9220, Denmark
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Cardiac surgery with cardiopulmonary bypass (CPB) causes an acute lung
ischemia-reperfusion injury, which can develop to pulmonary dysfunction
postoperatively. This sub-study of the Pulmonary Protection Trial aimed to
elucidate changes in arterial blood gas analyses, inflammatory protein
interleukin-6, and metabolites of 90 chronic obstructive pulmonary disease
patients following two lung protective regimens of pulmonary artery
perfusion with either hypothermic histidine-tryptophan-ketoglutarate (HTK)
solution or normothermic oxygenated blood during CPB, compared to the
standard CPB with no pulmonary perfusion. Blood was collected at six time
points before, during, and up to 20 hours post-CPB. Blood gas analysis,
enzyme-linked immunosorbent assay, and nuclear magnetic resonance
spectroscopy were used, and multivariate and univariate statistical
analyses were performed. All patients had decreased gas exchange,
augmented inflammation, and metabolite alteration during and after CPB.
While no difference was observed between patients receiving oxygenated
blood and standard CPB, patients receiving HTK solution had an excess of
metabolites involved in energy production and detoxification of reactive
oxygen species. Also, patients receiving HTK suffered a transient isotonic
hyponatremia that resolved within 20 hours post-CPB. Additional studies
are needed to further elucidate how to diminish lung ischemia-reperfusion
injury during CPB, and thereby, reduce the risk of developing severe
postoperative pulmonary dysfunction.<br/>Copyright &#xa9; 2018 by the
authors. Licensee MDPI, Basel, Switzerland.

<46>
Accession Number
625227815
Title
Energy-enriched formula use after congenital heart surgery-a randomized
trial.
Source
Journal of Pediatric Gastroenterology and Nutrition. Conference: North
American Society for Pediatric Gastroenterology, Hepatology and Nutrition
Annual Meeting, NASPGHAN 2018. United States. 67 (Supplement 1) (pp
S385-S386), 2018. Date of Publication: November 2018.
Author
Scheeffer V.; Silveira T.; Ricachinevsky C.; Brondani T.; Salamon F.;
Freitas A.; Feijo F.; Sutil A.
Institution
(Scheeffer, Silveira) Gstroentorology, Hospital da Crianca Santo Antonio,
Canoas, Rio Grande do Sul, Brazil
(Ricachinevsky, Brondani) Intensive Care Unit, Hospital da Crianca Santo
Antonio, Porto Alegre, Brazil
(Salamon, Freitas) Nutrition, Universidade Federal de Ciencias da Saude de
Porto Alegre, Porto Alegre, Brazil
(Feijo) Nutrition, Hospital da Crianca Santo Antonio, Porto Alegre, Brazil
(Sutil) Cardiology, Hospital da Crianca Santo Antonio, Porto Alegre,
Brazil
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: To investigate the effect of energy-enriched formula use
compared to normocaloric formula during the first 30 days after congenital
heart disease surgery. <br/>Method(s): Randomized clinical trial with
consecutive sampling of patients undergoing heart surgery in a reference
hospital in southern Brazil, from March to December 2017. Patients were
randomized into intervention group, which received energy-enriched formula
(caloric density of 1 kcal/ml) and control group, which received
normocaloric formula (0,67kcal/ml). The researcher in charge of
anthropometric evaluation was blinded to the randomization.
<br/>Result(s): 59 patients were included, 30 in control group and 29 in
intervention group. The median age was 4.8 months (IQR 1.08 to 9.76).
Nutritional evaluation showed a statistically significant decrease in Z
score (ZS) of weight for age, length for age and weight for length between
birth and before surgery (p<0.001), suggesting a state of failure to
thrive in this population. There were no statistically significant
differences between groups regarding age, gender, anthropometry (weight,
ZS of weight and height to age) and surgical risk classification after
randomization. There was statistically significant difference in ZS of
weight for age between groups after intervention, where control group
showed a ZS of -2.69 (before intervention was 1.69) while intervention
group showed a ZS of -1.57 (before intervention was 1.53) (p=0.042). The
analysis of variance showed a statically significant difference of weight
gain variation rate between groups during the intervention period (figure
1) (p=0,03). Antibiotic use was less frequent in intervention group
(p=0,047). Hospital length of stay was lower in intervention group, with a
borderline significance (p=0,057); after logarithmic transformation, we
found a decrease in hospital stay of 28,67% (CI -49,7 a 0,01). General
gastrointestinal side effects were similar between groups (p=0,594), while
diarrhea was statistically significant more frequent in intervention group
(p=0,01). However, this side effect was limited and had spontaneous
resolution in 5 out of 6 cases. <br/>Conclusion(s): This study
demonstrates that energy-enriched formula use after heart surgery of
patients with congenital heart disease is safe and can promote better
outcomes with limited side effects.

<47>
Accession Number
625228284
Title
Single versus dual antiplatelet therapy effect on short term graft patency
post CABG using multidetector computed tomography coronary angiography.
Source
European Heart Journal Cardiovascular Imaging. Conference: International
Conference on Nuclear Cardiology and Cardiac CT, ICNC 2017. Austria. 18
(Supplement 1) (pp i90-i91), 2017. Date of Publication: May 2017.
Author
Ekhlas H.; Khedr M.H.M.D.
Institution
(Ekhlas, Khedr) Zagazig University Hospitals, Cardiology, Zagazig, Egypt
Publisher
Oxford University Press
Abstract
Introduction: There is a high prevalence of venous graft closure within 3
months after coronary artery bypass grafting (CABG) surgery . The main
mechanism at this stage is graft thrombosis, which sets the stage for
graft stenosis and occlusion. Multidetector computed tomography coronary
angiography (CTA) has become an important imaging modality for non
invasive assessment of CAD including patients post CABG . In 5% to 10% of
patients with CAD aspirin therapy fail to arouse a complete antiplatelet
response . Clopidogrel is used to reduce ischemic events and mortality in
patients with CAD. <br/>Objective(s): Our study aimed to evaluate the
effect of dual antiplatelet therapy using aspirin plus clopidogrel vs
aspirin alone on the short term patency of venous and arterial grafts post
CABG. <br/>Method(s):50 patients post CABG were randomized into two groups
: group A(25 patients) received aspirin 150 mg/d and group B(25 patients)
received aspirin 150 mg/d plus clopidogrel 75 mg/d. All patients underwent
multislice detector computed tomography angiography (MDCTA ) 3 months post
CABG using 128-dual source Siemens Flash definition scanner. All the scan
were ECG gated. Each graft was classified as patent (flow visible),
occluded, or not analyzable (e.g., because the graft was obscured by a
metal ligature clip or because the image quality was poor).
<br/>Result(s):Total number of 119 grafts were scanned divided into 25
arterial grafts in group A and 24 arterial grafts in group B , 35 SVGs in
group A (out of which there were 2 sequential grafts) and 31 SVGs in group
B (out of which there were 2 sequential grafts). For the venous grafts,
the MDCTA scanning showed 7 occluded SVGs out of 35 SVGs in group A (9%)
and +/- occluded SVGs out of 31 SVGs in group B (8.5%) [p-value = 0.767,
95% CI (-0.105 to 0.123)] .For the arterial grafts, the MDCTA scanning
showed patent all arterial grafts in both groups. <br/>Conclusion(s): Dual
antiplatelet therapy with aspirin plus clopidogrel are not superior over
aspirin alone in the patency of venous and arterial grafts post CABG
during short term follow up.

<48>
[Use Link to view the full text]
Accession Number
625257402
Title
Effect of Complementary Therapies in Patients Following Cardiac Surgery: A
Narrative Review.
Source
Holistic nursing practice. 31 (5) (pp 315-324), 2017. Date of Publication:
01 Sep 2017.
Author
Chandrababu R.; Nayak B.S.; Pai V.B.; Patil N.T.; George A.; George L.S.;
Devi E.S.
Institution
(Chandrababu) Manipal College of Nursing (Mr Chandrababu and Drs Nayak, L.
S. George, Devi) and Kasturba Medical Colleges, Manipal University,
Manipal, India
Publisher
NLM (Medline)
Abstract
Cardiovascular diseases are increasing rapidly and have become a major
health problem worldwide. The incidence and prevalence of cardiovascular
disease are increasing rapidly, predominantly in the developing countries.
Patients with cardiovascular disease who do not respond to routine medical
treatment will have to follow cardiac surgical procedures. The objective
of this study was to apprise the evidence of the effect of various
complementary therapies on postoperative outcomes among patients
undergoing cardiac surgery. A comprehensive literature search was made on
PubMed-Medline, CINAHL, Science Direct, Scopus, Web of Science, and the
Cochrane Library databases for original research studies published between
2000 and 2015. Original articles that reported the effect of complementary
therapies in patients undergoing cardiac surgery were included.
Twenty-eight studies were analyzed, and they have produced conflicting
results. Most of the studies (n = 25) have documented the effects of
complementary therapies on improving postoperative outcomes of patients,
whereas other studies (n = 3) found no evidence of improvement. Although
methods varied considerably, most of the studies included in this review
reported positive results. Therefore, there is some evidence that
complementary therapies can lead to positive postoperative outcomes.
Evidence of the efficacy of complementary therapies in cardiac surgical
patients remains inconclusive. Additional research is needed to provide a
strong evidence base for the use of complementary therapies to improve
postoperative outcomes and recovery in patients undergoing cardiac
surgery.

<49>
Accession Number
625259015
Title
Surgical left atrial appendage occlusion during cardiac surgery: A
systematic review and meta-analysis.
Source
World Journal of Cardiology. 10 (11) (pp 242-249), 2018. Date of
Publication: 01 Nov 2018.
Author
Atti V.; Anantha-Narayanan M.; Turagam M.K.; Koerber S.; Rao S.;
Viles-Gonzalez J.F.; Suri R.M.; Velagapudi P.; Lakkireddy D.; Benditt D.G.
Institution
(Atti) Department of Medicine, Michigan State University-Sparrow Hospital,
East Lansing, MI 48912, United States
(Anantha-Narayanan, Benditt) Division of Cardiovascular Diseases,
Department of Medicine, University of Minnesota, Minneapolis, MN 55455,
United States
(Turagam) Helmsley Electrophysiology Center, Icahn School of medicine at
Mount Sinai, New York City, NY 10029, United States
(Koerber) Department of Cardiac Electrophysiology, Medical University of
South Carolina, Charleston, SC 29425, United States
(Rao) Department of Cardiovascular Diseases, Genesys Heart Institute,
Ascension Genesys Hospital, Grand Blanc, MI, United States
(Viles-Gonzalez) Baptist Health South Florida, Department of Medicine,
Wertheim College of Medicine, Miami, FL 33176, United States
(Suri) Cleveland Clinic Foundation, Cleveland Clinic Abu Dhabi, Department
of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH
44195, United States
(Velagapudi) Structural Heart and Valve Center, Center for Interventional
Vascular Therapy, Division of Cardiology, Columbia University Medical
Center, New York City, NY 10027, United States
(Lakkireddy) Kansas City Heart Rhythm Institute and Research Foundation,
Kansas City, MO 64132, United States
Publisher
Baishideng Publishing Group Co (7901 Stoneridge Drive, Suite 501,
Pleasanton, California 94588, United States. E-mail: bpg@baishideng.com)
Abstract
AIM To evaluate the safety and efficacy of surgical left atrial appendage
occlusion (s-LAAO) during concomitant cardiac surgery. METHODS We
performed a comprehensive literature search through May 31st 2018 for all
eligible studies comparing s-LAAO vs no occlusion in patients undergoing
cardiac surgery. Clinical outcomes during follow-up included: embolic
events, stroke, all-cause mortality, atrial fibrillation (AF), reoperation
for bleeding and postoperative complications. We further stratified the
analysis based on propensity matched studies and AF predominance. RESULTS
Twelve studies (n = 40107) met the inclusion criteria. s-LAAO was
associated with lower risk of embolic events (OR: 0.63, 95%CI: 0.53-0.76;
P < 0.001) and stroke (OR: 0.68, 95%CI: 0.57-0.82; P < 0.0001). Stratified
analysis demonstrated this association was more prominent in the AF
predominant strata. There was no significant difference in the incidence
risk of all-cause mortality, AF, and reoperation for bleeding and
postoperative complications. CONCLUSION Concomitant s-LAAO during cardiac
surgery was associated with lower risk of follow-up thromboembolic events
and stroke, especially in those with AF without significant increase in
adverse events. Further randomized trials to evaluate long-term benefits
of s-LAAO are warranted.<br/>Copyright &#xa9; The Author(s) 2018.
Published by Baishideng Publishing Group Inc. All rights reserved.

<50>
Accession Number
2001335190
Title
Patient-Reported Outcomes in Cardiothoracic Surgery.
Source
Annals of Thoracic Surgery. (no pagination), 2018. Date of Publication:
2018.
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. <br/>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.
<br/>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. <br/>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.<br/>Copyright &#xa9; 2018

<51>
Accession Number
625223968
Title
Impact of concurrent tricuspid regurgitation on mortality after
transcatheter aortic-valve implantation.
Source
Catheterization and Cardiovascular Interventions. (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
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To determine whether concomitant tricuspid regurgitation (TR)
is associated with increased mortality in patients with severe aortic
stenosis (AS) undergoing transcatheter aortic-valve implantation (TAVI),
we performed a meta-analysis of currently available studies.
<br/>Method(s): MEDLINE and EMBASE were searched through May 2018. We
included comparative or cohort studies enrolling patients with AS
undergoing TAVI and reporting early (in-hospital or 30-day) and late
(including early) all-cause mortality in patients stratified by baseline
TR grade. An odds ratio (OR) of early mortality and a hazard ratio (HR) of
late mortality with its 95% CI for significant versus non-significant
(typically, >=moderate versus <moderate) TR was extracted. Study-specific
estimates were combined in the random-effects model. <br/>Result(s): Our
search identified 12 eligible studies enrolling a total of 41,485 TAVI
patients. The meta-analysis for early mortality combining 3 ORs
demonstrated a significant 1.80-fold increase in mortality with
significant TR (OR, 1.80; 95% CI, 1.01 to 3.19; P = 0.05). The primary
meta-analysis for midterm (6-month to 30-month) mortality combining all
the 12 HRs/ORs indicated a significant 1.96-fold increase in mortality
(HR/OR, 1.96; 95% CI, 1.35 to 2.85; P = 0.0004). The secondary
meta-analysis for midterm mortality combining 7 homogeneous HRs (adjusted
HRs for >=moderate versus <moderate TR) showed a significant 2.25-fold
increase in mortality (HR, 2.25; 95% CI, 1.20-4.24; P = 0.01).
<br/>Conclusion(s): Concurrent significant (typically, >=moderate) TR is
associated with an approximately two-fold increase in both early and
midterm all-cause mortality in patients with AS undergoing
TAVI.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<52>
Accession Number
621919035
Title
Pooled diagnostic accuracy of resting distal to aortic coronary pressure
referenced to fractional flow reserve: The importance of resting coronary
physiology.
Source
Journal of Interventional Cardiology. 31 (5) (pp 588-598), 2018. Date of
Publication: October 2018.
Author
Maini R.; Moscona J.; Sidhu G.; Katigbak P.; Fernandez C.; Irimpen A.;
Mogabgab O.; Ward C.; Samson R.; LeJemtel T.
Institution
(Maini, Moscona, Katigbak, Irimpen, Mogabgab, Ward, Samson, LeJemtel)
Division of Cardiology, Department of Medicine, Tulane University, New
Orleans, LA, United States
(Sidhu) The Wright Center for Graduate Medical Education, Scranton, PA,
United States
(Fernandez) Division of Precision Medicine, HeartGEN Institute, Boston,
MA, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Introduction: Both resting and hyperemic physiologic methods to guide
coronary revascularization improve cardiovascular outcomes compared with
angiographic guidance alone. Fractional flow reserve (FFR) remains
underutilized due to concerns regarding hyperemia, prompting study of
resting distal to aortic coronary pressure (Pd/Pa). Pd/Pa is a
vasodilator-free resting index unlike FFR. While Pd/Pa is similar to
another resting index, instantaneous wave-free ratio (iFR), it is a
whole-cycle measurement not limited to the wave-free diastolic period.
Pd/Pa is not validated clinically although multiple accuracy studies have
been performed. Our meta-analysis examines the overall diagnostic accuracy
of Pd/Pa referenced to FFR, the accepted invasive standard of ischemia.
<br/>Method(s): We searched PubMed, EMBASE, Central, ProQuest, and Web of
Science databases for full text articles published through August 9, 2017
addressing the diagnostic accuracy of Pd/Pa referenced to FFR < 0.80. The
following keywords were used: "distal coronary artery pressure" OR "Pd/Pa"
AND "fractional flow reserve" OR "FFR.". <br/>Result(s): In total, 14
studies comprising 7004 lesions were identified. Pooled diagnostic
accuracy estimates of Pd/Pa versus FFR < 0.80 were: sensitivity, 0.77 (95%
CI, 0.75-0.78); specificity, 0.82 (0.81-0.83); positive likelihood ratio,
4.7 (3.3-6.6); negative likelihood ratio, 0.29 (0.24-0.34); diagnostic
odds ratio, 18.1 (14.4-22.6); area under the summary receiver-operating
characteristic curve of 0.88; and diagnostic accuracy of 0.80 (0.76-0.83).
<br/>Conclusion(s): Pd/Pa shows adequate agreement with FFR as a resting
index of coronary stenosis severity without the undesired effects and cost
of hyperemic agents. Pd/Pa has the potential to guide coronary
revascularization with easier application and availability compared with
iFR and FFR.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<53>
Accession Number
622321968
Title
Valve in valve transcatheter aortic valve implantation (ViV-TAVI) versus
redo-Surgical aortic valve replacement (redo-SAVR): A systematic review
and meta-analysis.
Source
Journal of Interventional Cardiology. 31 (5) (pp 661-671), 2018. Date of
Publication: October 2018.
Author
Nalluri N.; Atti V.; Munir A.B.; Karam B.; Patel N.J.; Kumar V.; Vemula
P.; Edla S.; Asti D.; Paturu A.; Gayam S.; Spagnola J.; Barsoum E.;
Maniatis G.A.; Tamburrino F.; Kandov R.; Lafferty J.; Kliger C.
Institution
(Nalluri, Munir, Karam, Spagnola, Barsoum, Maniatis, Tamburrino, Kandov,
Lafferty) Department of Cardiology, Staten Island University Hospital,
Northwell Health, Staten Island, New York City, NY, United States
(Atti) Department of Internal Medicine, Michigan State University, Sparrow
Hospital, East Lansing, MI, United States
(Patel) Department of Cardiology, University of Miami, Jackson Memorial
Hospital, Miami, FL, United States
(Kumar) Department of Cardiology, Mount Sinai St. Luke's Roosevelt
Hospital, New York City, NY, United States
(Vemula) Department of Internal Medicine, Sparrow Health System, Lansing,
MI, United States
(Edla) Department of Cardiology, St. John Hospital and Medical Center,
Detroit, MI, United States
(Asti, Kliger) Department of Interventional Cardiology, Lenox Hill
Hospital, Northwell Health, Manhattan, New York City, NY, United States
(Paturu) Department of Internal Medicine, NRI Medical College, Guntur,
India
(Gayam) Department of Internal Medicine, KVG Medical College, Sullia,
Karnataka, India
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Bioprosthetic (BP) valves have been increasingly used for
aortic valve replacement over the last decade. Due to their limited
durability, patients presenting with failed BP valves are rising. Valve in
Valve - Transcatheter Aortic Valve Implantation (ViV-TAVI) emerged as an
alternative to the gold standard redo-Surgical Aortic Valve Replacement
(redo-SAVR). However, the utility of ViV-TAVI is poorly understood.
<br/>Method(s): A systematic electronic search of the scientific
literature was done in PubMed, EMBASE, SCOPUS, Google Scholar, and
ClinicalTrials.gov. Only studies which compared the safety and efficacy of
ViV-TAVI and redo-SAVR head to head in failed BP valves were included.
<br/>Result(s): Six observational studies were eligible and included 594
patients, of whom 255 underwent ViV- TAVI and 339 underwent redo-SAVR.
There was no significant difference between ViV-TAVI and redo- SAVR for
procedural, 30 day and 1 year mortality rates. ViV-TAVI was associated
with lower risk of permanent pacemaker implantation (PPI) (OR: 0.43, CI:
0.21-0.89; P = 0.02) and a trend toward increased risk of paravalvular
leak (PVL) (OR: 5.45, CI: 0.94-31.58; P = 0.06). There was no significant
difference for stroke, major bleeding, vascular complications and
postprocedural aortic valvular gradients more than 20 mm-hg.
<br/>Conclusion(s): Our results reiterate the safety and feasibility of
ViV-TAVI for failed aortic BP valves in patients deemed to be at high risk
for surgery. VIV-TAVI was associated with lower risk of permanent
pacemaker implantation with a trend toward increased risk of paravalvular
leak.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<54>
Accession Number
622526446
Title
Antiplatelet therapy for patients undergoing coronary artery bypass
surgery.
Source
Kardiologia Polska. 76 (6) (pp 945-952), 2018. Date of Publication: 11 Jun
2018.
Author
DeStephan C.M.; Schneider D.J.
Institution
(DeStephan, Schneider) Department of Medicine, Cardiovascular Research
Institute, University of Vermont, 308 S. Park Drive, Colchester, VT 05446,
United States
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Considerable variation in the use and duration of antiplatelet medications
during the perioperative and postoperative care of patients undergoing
coronary artery bypass grafting (CABG) reflects the limited number of
studies focused directly on these patients as well as the variation in the
results reported. In this review we highlight the incidence and mechanisms
of graft closure as well as the evidence in support of antiplatelet
therapy that is balanced by the impact of antiplatelet therapy on the risk
of bleeding to provide recommendations for the use of this therapy in
patients undergoing CABG. Low-dose acetylsalicylic acid (ASA; <= 160 mg
daily) reduces the incidence of perioperative myocardial infarction, acute
renal injury, and mortality without increasing the risk of bleeding and so
is recommended both before and after CABG. The use of dual antiplatelet
therapy with ASA plus a P2Y12 antagonist adds a greater risk of bleeding.
While additional studies are required, we can make the following
recommendations: Because of increased bleeding and mortality when patients
are treated with clopidogrel preoperatively, CABG should be delayed for
five days. Because of increased bleeding when patients are treated with
ticagrelor preoperatively, CABG should be delayed for three days. Because
of increased bleeding when patients are treated with prasugrel
preoperatively, CABG should be delayed for seven days. For patients who
had a coronary stent placed preoperatively or had an acute coronary
syndrome preoperatively, resumption of therapy with their P2Y12 antagonist
postoperatively for 12 months reduces the subsequent incidence of
cardiovascular events.<br/>Copyright &#xa9; Polish Cardiac Society 2018.

<55>
Accession Number
623386398
Title
Benefits of Using High-Volume-Low-Pressure Tracheal Tube in Children
Undergoing Congenital Cardiac Surgery: Evidence From a Prospective
Randomized Study.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 22 (3) (pp 300-305),
2018. Date of Publication: 01 Sep 2018.
Author
Chand R.; Roy Chowdhury S.; Rupert E.; Mandal C.K.; Narayan P.
Institution
(Chand, Roy Chowdhury, Rupert, Mandal, Narayan) NH Rabindranath Tagore
International Institute of Cardiac Sciences, Kolkata, India
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background. In the past 2 decades, usage of high-volume-low-pressure
microcuffed tracheal tubes in smaller children has increased. However,
there is paucity of evidence of its usage in smaller children undergoing
congenital cardiac surgery. The aim of this study was to assess if
microcuff endotracheal tubes in neonates and younger children undergoing
congenital cardiac surgery is associated with better outcomes than
uncuffed tubes. Methods. We carried out this single-center, prospective,
randomized study between June and November 2016. Eighty patients were
randomized into those receiving microcuff tracheal tubes and conventional
uncuffed tubes. Primary outcome was stridor postextubation. Secondary
outcomes measured included number of tube changes, volume of anesthetic
gases required, and cost incurred. Results. The 2 groups were comparable
in terms of baseline characteristics and duration of intubation. Incidence
of stridor was significantly higher in conventional uncuffed tubes (12
[30%] vs 4 [10%]; P =.04) and so was the number of tube changes required
(17/40 [42.5%] vs 2/40 [5%]; P <=.001). Tube change was associated with
more than 3-fold risk of stridor (odds ratio = 3.92; 95% confidence
interval = 1.23-12.43). Isoflurane (29.14 +/- 7.01 mL vs19.2 +/- 4.81 mL;
P <.0001) and oxygen flow requirement (P <.0001) and the resultant cost
(7.46 +/- 1.4 vs 5.77 +/- 1.2 US$; P <.0001) were all significantly higher
in the conventional uncuffed group. Conclusion. Microcuff pediatric
tracheal tube is associated with significantly lower incidence of stridor,
tube changes, and anesthetic gas requirement. This leads to significant
cost reduction that offsets the higher costs associated with usage of a
microcuff tracheal tube.<br/>Copyright &#xa9; The Author(s) 2018.

<56>
Accession Number
622125360
Title
Impact of ultra-thin struts on restenosis after chronic total occlusion
recanalization: Insights from the randomized PRISON IV trial.
Source
Journal of Interventional Cardiology. 31 (5) (pp 580-587), 2018. Date of
Publication: October 2018.
Author
Zivelonghi C.; Teeuwen K.; Agostoni P.; van der Schaaf R.J.; Ribichini F.;
Adriaenssens T.; Kelder J.C.; Tijssen J.G.P.; Henriques J.P.S.; Suttorp
M.J.
Institution
(Zivelonghi, Agostoni, Kelder, Suttorp) Department of Cardiology, Sint
Antonius Ziekenhuis, Nieuwegein, Netherlands
(Zivelonghi, Ribichini) Department of Cardiology, University of Verona,
Verona, Italy
(Teeuwen) Department of Cardiology, Catharina Hospital, Eindhoven,
Netherlands
(van der Schaaf) Department of Cardiology, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
(Adriaenssens) Department of Cardiology, University Hospital Leuven,
Belgium
(Tijssen, Henriques) Department of Cardiology, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: The PRISON-IV trial showed inferior outcome in patients with
chronic total occlusions (CTOs) treated with the ultrathin-struts (60 mum
for stent diameter <=3 mm, 81mum >3 mm) hybrid-sirolimus eluting stents
(SES) compared with everolimus eluting stents (EES, 81 mum). The aim of
this study is to investigate if the use of smaller stents (<=3 mm) was
responsible for the inferior outcome reported in the trial.
<br/>Method(s): In the PRISON-IV trial 330 patients with CTO lesion were
randomized 1:1 to receive either hybrid-SES or EES. The hybrid-SES failed
to reach the non-inferiority primary endpoint of in-segment late lumen
loss (LLL) at 9-month angiographic follow-up. In this sub-analysis, we
divided the population according to the different size of stents implanted
in those receiving only stents with diameter <=3 mm (Group-A, 178
patients), only stents >3 mm (Group-B, 59 patients), and those receiving
stents of both sizes (Group-C, 93 patients). <br/>Result(s): Baseline and
procedural characteristics were comparable in the three groups. At
angiographic follow-up, most of the adverse outcomes occurred in Group A,
with higher incidence of binary restenosis in the Hybrid-SES versus EES
(10.3% vs 1.3%, P = 0.03) and augmented in-stent diameter stenosis (26.04
+/- 18.59% vs 21.24 +/- 12.84, P = 0.06). Similarly, optical coherence
tomography (OCT), which was performed in 60 patients at follow-up,
documented a mild trend toward lower values of minimum in stent area in
Hybrid-SES arm of Group A (4.4 +/- 1.02mm² vs 5.0 +/- 1.28mm2,
respectively, P = 0.16). <br/>Conclusion(s): The present analysis suggests
that the inferior performance of the ultra-thin hybrid-SES in CTO-PCI is
particularly pronounced when smaller stent (<=3 mm diameter) are adopted,
if compared with EES.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<57>
Accession Number
624440895
Title
Non-invasive screening for coronary artery disease in asymptomatic
diabetic patients: A systematic review and meta-analysis of randomised
controlled trials.
Source
European Heart Journal Cardiovascular Imaging. 19 (8) (pp 838-846), 2018.
Date of Publication: 2018.
Author
Clerc O.F.; Fuchs T.A.; Stehli J.; Benz D.C.; Grani C.; Messerli M.;
Giannopoulos A.A.; Buechel R.R.; Luscher T.F.; Pazhenkottil A.P.; Kaufmann
P.A.; Gaemperli O.
Institution
(Clerc, Fuchs, Stehli, Benz, Grani, Messerli, Giannopoulos, Buechel,
Luscher, Pazhenkottil, Kaufmann, Gaemperli) University Heart Centre,
University Hospital Zurich, Raemistrasse 100, Zurich CH-8091, Switzerland
Publisher
Oxford University Press
Abstract
It is unclear whether non-invasive screening of asymptomatic diabetic
patients for coronary artery disease (CAD) may improve cardiac outcomes.
Thus, we performed a systematic literature review and meta-analysis of
randomised controlled trials (RCT's) on this topic. We searched
appropriate RCT's in five online databases (PubMed/MEDLINE, Cochrane
Library, Embase, Scopus, and Web of Science) from January 2000 to November
2017 and in 41 recent reviews. Two investigators independently extracted
and assessed study data using standardised forms. Additional unpublished
data were obtained from trial authors. The primary endpoint 'any cardiac
event' was a composite of cardiac death, non-fatal myocardial infarction
(MI), unstable angina (UA), or heart failure (HF) hospitalisation. We
performed a meta-analysis of relative risks (RRs) with 95% confidence
intervals (CI) using the Mantel-Haenszel method. We included five RCT's
with 3299 patients, of which 189 (5.7%) experienced any cardiac event on
follow-up (weighted mean 4.1 years). Non-invasive CAD screening
significantly reduced any cardiac event by 27% [RR 0.73 (95% CI
0.55-0.97), P = 0.028, number needed to screen 56]. This result was driven
by important, albeit non-significant decreases in non-fatal MI [RR 0.65
(95% CI 0.41-1.02), P = 0.062] and HF hospitalisation [RR 0.61 (95% CI
0.33-1.10), P = 0.100]. Non-invasive CAD screening did not significantly
affect cardiac death [RR 0.92 (95% CI 0.53-1.60), P = 0.77] and UA [RR
0.73 (95% CI 0.41-1.31), P = 0.29]. Compared with the standard care,
non-invasive CAD screening reduced cardiac events by 27% in asymptomatic
diabetic patients, largely through reductions in non-fatal MIs, and HF
hospitalisations. The present results justify larger, appropriately
powered trials to potentially revisit current
recommendations.<br/>Copyright Published on behalf of the European Society
of Cardiology. All rights reserved. VC The Author(s) 2018.

<58>
Accession Number
623906721
Title
Evaluation of pain and patient satisfaction by music therapy in patients
with endoscopy/colonoscopy.
Source
Turkish Journal of Gastroenterology. 29 (5) (pp 574-579), 2018. Date of
Publication: September 2018.
Author
Bashiri M.; Akcali D.; Coskun D.; Cindoruk M.; Dikmen A.; Cifdaloz B.U.
Institution
(Bashiri, Akcali, Coskun) Department of Anesthesiology and Reanimation,
Gazi University School of Medicine, Ankara, Turkey
(Cindoruk) Department of Gastroenterology, Gazi University School of
Medicine, Ankara, Turkey
(Dikmen) Department of Public Health, Gazi University School of Medicine,
Ankara, Turkey
(Cifdaloz) Department of Musicology, Gazi University Turkish Music
National Conservatory, Ankara, Turkey
Publisher
AVES Ibrahim KARA (105/9 Buyukdere Cad, Mecidiyekoy,Sisli, Istanbul 34394,
Turkey)
Abstract
Background/Aims: Endoscopy and colonoscopy are frequently performed
procedures to evaluate the gastrointestinal system. These procedures are
sometimes disturbing and painful for the patient. In gastrointestinal
suits, endoscopy and colonoscopy may be performed on awake or sedated
patients. Music therapy is a common and non-pharmacological treatment for
various medical conditions, pain, and anxiety. The aim of the present
study was to add music therapy to sedation administered during endoscopy
and colonoscopy. The effect of music treatment on drug consumption,
anxiety, and pain was investigated. <br/>Material(s) and Method(s):
American Anesthesiologist Association I-III adult patients scheduled for
endo/colonoscopy were randomized to music treatment and no music treatment
groups. Patients with endoscopic ultrasound and endoscopic retrograde
colangiopancreaticography were excluded from the study. Anxiety score and
pain severity were evaluated before and after the procedure. Heart rate,
mean arterial pressure, and oxygen saturation were recorded before,
during, and after the procedure. Total drug consumption was recorded.
Patient satisfaction and desire for the same protocol for recurrent
procedures were investigated. <br/>Result(s): Music therapy added to deep
sedation administered by anesthesiologists provided decreased anxiety
score and propofol consumption. Patient satisfaction was increased, and
patients reported a desire for the same protocol for recurrent procedures.
<br/>Conclusion(s): The present study may serve as the beginning of using
music therapy for pain treatment in gastroenterology procedures in our
hospital with/without sedation. Music and other non-pharmacological
treatment methods must be remembered to increase patient comfort during
enco/colonoscopies and other painful procedures.<br/>&#xa9; Copyright 2018
by The Turkish Society of Gastroenterology * Available online at
www.turkjgastroenterol.org

<59>
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.<br/>Copyright &#xa9; 2016
Scandinavian Association for the Study of Pain

<60>
Accession Number
615452596
Title
Cardiovascular efficacy and safety of bococizumab in high-risk patients.
Source
New England Journal of Medicine. 376 (16) (pp 1527-1539), 2017. Date of
Publication: 20 Apr 2017.
Author
Ridker P.M.; Revkin J.; Amarenco P.; Brunell R.; Curto M.; Civeira F.;
Flather M.; Glynn R.J.; Gregoire J.; Jukema J.W.; Karpov Y.; Kastelein
J.J.P.; Koenig W.; Lorenzatti A.; Manga P.; Masiukiewicz U.; Miller M.;
Mosterd A.; Murin J.; Nicolau J.C.; Nissen S.; Ponikowski P.; Santos R.D.;
Schwartz P.F.; Soran H.; White H.; Wright R.S.; Vrablik M.; Yunis C.;
Shear C.L.; Tardif J.-C.
Institution
(Ridker, Glynn) Center for Cardiovascular Disease Prevention, Brigham and
Women's Hospital, Harvard Medical School, 900 Commonwealth Ave., Boston,
MA 02215, United States
(Revkin, Brunell, Curto, Masiukiewicz, Schwartz, Yunis, Shear) Pfizer, New
York, United States
(Amarenco) Paris-Diderot Sorbonne Paris Cite University, Paris, France
(Civeira) Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain
(Flather) University of East Anglia, Norwich, United Kingdom
(Soran) Central Manchester University Hospital, Manchester, United Kingdom
(Gregoire, Tardif) Montreal Heart Institute, Universite de Montreal,
Montreal, Canada
(Jukema) Leiden University Medical Center, Leiden, Netherlands
(Kastelein) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Mosterd) Meander Medical Center, Amersfoort, Netherlands
(Karpov) Russian Cardiology Research and Production Center, Moscow,
Russian Federation
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich Heart Alliance, Munich, Germany
(Lorenzatti) Cordoba Hospital, Cordoba, Argentina
(Manga) University of the Witwatersrand, Johannesburg, South Africa
(Miller) University of Maryland, Baltimore, United States
(Murin) University of Comenius, Bratislava, Slovakia
(Nicolau) Heart Institute, University of Sao Paulo Medical School, Sao
Paulo, Brazil
(Santos) Lipid Clinic Heart Institute, University of Sao Paulo Medical
School Hospital, Sao Paulo, Brazil
(Nissen) Cleveland Clinic Foundation, Cleveland, United States
(Ponikowski) Wroclaw Medical University, Wroclaw, Poland
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Wright) Mayo Clinic, Rochester, MN, United States
(Vrablik) First Faculty of Medicine, Charles University, Prague, Czech
Republic
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Bococizumab is a humanized monoclonal antibody that inhibits
proprotein convertase subtilisin- kexin type 9 (PCSK9) and reduces levels
of low-density lipoprotein (LDL) cholesterol. We sought to evaluate the
efficacy of bococizumab in patients at high cardiovascular risk. METHODS
In two parallel, multinational trials with different entry criteria for
LDL cholesterol levels, we randomly assigned the 27,438 patients in the
combined trials to receive bococizumab (at a dose of 150 mg)
subcutaneously every 2 weeks or placebo. The primary end point was
nonfatal myocardial infarction, nonfatal stroke, hospitalization for
unstable angina requiring urgent revascularization, or cardiovascular
death; 93% of the patients were receiving statin therapy at baseline. The
trials were stopped early after the sponsor elected to discontinue the
development of bococizumab owing in part to the development of high rates
of antidrug antibodies, as seen in data from other studies in the program.
The median follow-up was 10 months. RESULTS At 14 weeks, patients in the
combined trials had a mean change from baseline in LDL cholesterol levels
of -56.0% in the bococizumab group and +2.9% in the placebo group, for a
between-group difference of -59.0 percentage points (P<0.001) and a median
reduction from baseline of 64.2% (P<0.001). In the lower-risk,
shorter-duration trial (in which the patients had a baseline LDL
cholesterol level of >=70 mg per deciliter [1.8 mmol per liter] and the
median follow-up was 7 months), major cardiovascular events occurred in
173 patients each in the bococizumab group and the placebo group (hazard
ratio, 0.99; 95% confidence interval [CI], 0.80 to 1.22; P = 0.94). In the
higher-risk, longer-duration trial (in which the patients had a baseline
LDL cholesterol level of >=100 mg per deciliter [2.6 mmol per liter] and
the median follow-up was 12 months), major cardiovascular events occurred
in 179 and 224 patients, respectively (hazard ratio, 0.79; 95% CI, 0.65 to
0.97; P = 0.02). The hazard ratio for the primary end point in the
combined trials was 0.88 (95% CI, 0.76 to 1.02; P = 0.08). Injection-site
reactions were more common in the bococizumab group than in the placebo
group (10.4% vs. 1.3%, P<0.001). CONCLUSIONS In two randomized trials
comparing the PCSK9 inhibitor bococizumab with placebo, bococizumab had no
benefit with respect to major adverse cardiovascular events in the trial
involving lower-risk patients but did have a significant benefit in the
trial involving higher-risk patients.<br/>Copyright &#xa9; 2017
Massachusetts Medical Society. All rights reserved.

<61>
Accession Number
620034557
Title
Introducing TOPMAST, the first double-blind randomized clinical trial
specifically dedicated to perioperative maintenance fluid therapy in
adults.
Source
Anaesthesiology Intensive Therapy. 49 (5) (pp 366-372), 2017. Date of
Publication: 28 Dec 2017.
Author
Hendrickx S.; Van Vlimmeren K.; Baar I.; Verbrugghe W.; Dams K.; Van
Cromphaut S.; Roelant E.; Embrecht B.; Wittock A.; Mertens P.; Hendriks
J.M.; Lauwers P.; Van Schil P.E.; Van Craenenbroeck A.H.; Van Den Wyngaert
T.; Jorens P.G.; Van Regenmortel N.
Institution
(Hendrickx, Van Vlimmeren, Baar, Verbrugghe, Dams, Van Cromphaut, Jorens,
Van Regenmortel) Department of Intensive Care Medicine, Antwerp University
Hospital, Wilrijkstraat 10, Edegem B2640, Belgium
(Hendrickx, Van Vlimmeren, Embrecht, Wittock, Mertens) Department of
Anesthesiology, Antwerp University Hospital, Antwerp, Belgium
(Roelant) Clinical Trial Center (CTC), Antwerp University Hospital,
University of Antwerp, Antwerp, Belgium
(Hendriks, Lauwers, Van Schil) Department of Thoracic and Vascular
Surgery, Antwerp University Hospital, Antwerp, Belgium
(Van Craenenbroeck) Department of Nephrology, Antwerp University Hospital,
Antwerp, Belgium
(Van Den Wyngaert) Department of Nuclear Medicine, Antwerp University
Hospital, Antwerp, Belgium
(Van Den Wyngaert, Jorens) Faculty of Medicine and Health Sciences,
University of Antwerp, Antwerp, Belgium
(Van Regenmortel) Department of Intensive Care Medicine, Ziekenhuis
Netwerk Antwerpen, Campus Stuivenberg, Antwerp, Belgium
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Although prescribed to every patient undergoing surgery,
maintenance fluid therapy is a poorly researched part of perioperative
fluid therapy. The tonicity of the chosen solutions, could be an important
cause of morbidity, with hyponatremia being a potential side effect of
hypotonic solutions, where isotonic solution could lead to fluid overload.
<br/>Method(s): The TOPMAST-trial is an ongoing prospective single-center
double-blind randomized trial comparing an isotonic and a hypotonic
maintenance fluid strategy during and after surgery in patients undergoing
different types of major thoracic surgery. Patients receive NaCl 0.9% in
glucose 5% with an added 40 mmol L^-1 of potassium chloride or a
premixed solution containing 54 mmol L^-1 sodium, 55 mmol
L^-1 chloride and 26 mmol of potassium at a rate of 27 mL per kg
of body weight per day. The primary hypothesis is that isotonic
maintenance solutions cause a more positive perioperative fluid balance
than hypotonic fluids. Different secondary safety endpoints will be
explored, especially the effect of the study treatments on the occurrence
electrolyte disturbances (e.g. hyponatremia, hyperchloremia) and a set of
clinical endpoints. Efficacy endpoints include the need for resuscitation
fluids and assessment of renal and hormonal adaptive mechanisms. An
anticipated 68 patients will be included between March 2017 and January
2018. <br/>Discussion(s): The study will provide the most comprehensive
evaluation of clinically important outcomes associated with the choice of
perioperative maintenance fluid therapy.

<62>
Accession Number
365300092
Title
Basal insulin and cardiovascular and other outcomes in dysglycemia.
Source
New England Journal of Medicine. 367 (4) (pp 319-328), 2012. Date of
Publication: 26 Jul 2012.
Author
Gerstein H.C.; Bosch J.; Dagenais G.R.; Diaz R.; Jung H.; Maggioni A.P.;
Pogue J.; Probstfield J.; Ramachandran A.; Riddle M.C.; Ryden L.E.; Yusuf
S.
Institution
(Gerstein, Yusuf) Department of Medicine, Population Health Research
Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON,
Canada
(Bosch) Population Health Research Institute and School of Rehabilitation
Science, McMaster University and Hamilton Health Sciences, Hamilton, ON,
Canada
(Dagenais) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec, QC, Canada
(Diaz) Estudios Clinicos Latino America, Rosario, Argentina
(Jung) McMaster University and Hamilton Health Sciences, Hamilton, ON,
Canada
(Maggioni) Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO)
Research Center, Florence, Italy
(Pogue) Population Health Research Institute, McMaster University and
Hamilton Health Sciences, Hamilton, ON, Canada
(Probstfield) University of Washington, Seattle, United States
(Ramachandran) India Diabetes Research Foundation, Chennai, India
(Riddle) Oregon Health and Science University, Portland, United States
(Ryden) Department of Medicine, Karolinska Institute, Stockholm, Sweden
Publisher
Massachussetts Medical Society
Abstract
Background: The provision of sufficient basal insulin to normalize fasting
plasma glucose levels may reduce cardiovascular events, but such a
possibility has not been formally tested. <br/>Method(s): We randomly
assigned 12,537 people (mean age, 63.5 years) with cardiovascular risk
factors plus impaired fasting glucose, impaired glucose tolerance, or type
2 diabetes to receive insulin glargine (with a target fasting blood
glucose level of <=95 mg per deciliter [5.3 mmol per liter]) or standard
care and to receive n-3 fatty acids or placebo with the use of a 2-by-2
factorial design. The results of the comparison between insulin glargine
and standard care are reported here. The coprimary outcomes were nonfatal
myocardial infarction, nonfatal stroke, or death from cardiovascular
causes and these events plus revascularization or hospitalization for
heart failure. Microvascular outcomes, incident diabetes, hypoglycemia,
weight, and cancers were also compared between groups. <br/>Result(s): The
median follow-up was 6.2 years (interquartile range, 5.8 to 6.7). Rates of
incident cardiovascular outcomes were similar in the insulin-glargine and
standard-care groups: 2.94 and 2.85 per 100 person-years, respectively,
for the first coprimary outcome (hazard ratio, 1.02; 95% confidence
interval [CI], 0.94 to 1.11; P = 0.63) and 5.52 and 5.28 per 100
person-years, respectively, for the second coprimary outcome (hazard
ratio, 1.04; 95% CI, 0.97 to 1.11; P = 0.27). New diabetes was diagnosed
approximately 3 months after therapy was stopped among 30% versus 35% of
1456 participants without baseline diabetes (odds ratio, 0.80; 95% CI,
0.64 to 1.00; P = 0.05). Rates of severe hypoglycemia were 1.00 versus
0.31 per 100 person-years. Median weight increased by 1.6 kg in the
insulin-glargine group and fell by 0.5 kg in the standard-care group.
There was no significant difference in cancers (hazard ratio, 1.00; 95%
CI, 0.88 to 1.13; P = 0.97). <br/>Conclusion(s): When used to target
normal fasting plasma glucose levels for more than 6 years, insulin
glargine had a neutral effect on cardiovascular outcomes and cancers.
Although it reduced new-onset diabetes, insulin glargine also increased
hypoglycemia and modestly increased weight.<br/>Copyright &#xa9; 2012
Massachusetts Medical Society.

<63>
Accession Number
2001162502
Title
Outcomes of Acute Myocardial Infarction in Heart Transplant Recipients.
Source
American Journal of Cardiology. 122 (12) (pp 2080-2085), 2018. Date of
Publication: 15 December 2018.
Author
Enezate T.; Omran J.; P. Chang P.; Patel M.; Chien C.; Bacon R.R.; Adler
E.
Institution
(Enezate) Division of Cardiovascular Medicine, University of Missouri
School of Medicine, Columbia, MO, United States
(Omran, Patel, Adler) Sulpizio Cardiovascular Center, University of
California at San Diego, San Diego, CA, United States
(P. Chang, Chien) University of North Carolina, Chapel Hill, NC, United
States
(Bacon) Department of Information Technology, University of Missouri,
Columbia, MO, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Heart transplantation (HT) recipients represent a growing patient
population. Although mechanisms might differ, coronary artery disease is
an important cause of morbidity in this group. Limited data are available
on the outcomes of acute myocardial infarction (AMI) in HT in comparison
to general population (non-HT). The study population was extracted from
the National Readmissions Data 2014 using International Classification of
Diseases, Ninth Revision, Clinical Modification codes for AMI and HT. The
study outcomes included in-hospital all-cause mortality, length of
hospital stay (LOS), cardiogenic shock, acute kidney injury, the
likelihood of receiving invasive left-sided cardiac catheterization with
and/or without percutaneous coronary intervention (PCI) and 30-day
readmission rates. A total of 259,794 discharges with a principal
diagnosis of AMI were identified, in which 789 had a history of HT. In
comparison to non-HT, HT group was associated with longer LOS (5.9 vs 4.9
days, p <0.01), more cardiogenic shock (8.8% vs 6.4%, p <0.01), more acute
kidney injury (26.2% vs 17.6%, p <0.01), less catheterization (59.7% vs
75.1%, p <0.01), less use of PCI (35.2% vs 50.0%, p <0.01), and higher
30-day readmission rate (21.3% vs 14.4%, p <0.01). However, there was no
statistically significant difference in all-cause mortality (6.8% vs 5.4%,
p = 0.07). In conclusion, compared with non-HT, HT with AMI was associated
with longer LOS, more in-hospital morbidity, lower likelihood of receiving
invasive treatment (including PCI), and higher 30-day readmission rates.
There was no significant difference in all-cause mortality.<br/>Copyright
&#xa9; 2018

<64>
Accession Number
619411693
Title
Anesthesia and sleep apnea.
Source
Sleep Medicine Reviews. 40 (pp 79-92), 2018. Date of Publication: August
2018.
Author
Tamisier R.; Fabre F.; O'Donoghue F.; Levy P.; Payen J.-F.; Pepin J.-L.
Institution
(Tamisier, O'Donoghue, Levy, Pepin) Laboratoire HP2, Inserm 1042,
Universitee Grenoble Alpes, Grenoble F-38042, France
(Tamisier, Levy, Pepin) Laboratoire EFCR et Sommeil, Pole Thorax et
Vaisseaux, Grenoble Alpes University Hospital, Grenoble 38043, France
(Fabre, Payen) Pole Anesthesie-reanimation - Hopital Michallon, Grenoble
Alpes University Hospital, Grenoble F-38000, France
(O'Donoghue) Institute for Breathing and Sleep, Austin Health, Heidelberg,
Victoria 3084, Australia
(O'Donoghue) The University of Melbourne, Parkville, Victoria 3010,
Australia
(Payen) Grenoble Institut des Neurosciences, Univ. Grenoble Alpes,
Grenoble F-38000, France
(Payen) INSERM, U1216, Grenoble F-38000, France
Publisher
W.B. Saunders Ltd
Abstract
Due to its low rate of diagnosis, in the general population over half of
those experiencing obstructive sleep apnea (OSA) are unaware that they
have the condition. However, any acute medical event may exacerbate OSA
and could have serious health consequences. In this context the management
of the perioperative period, from anesthesia through the surgery itself
and into the postoperative period, is more problematic for patients with
sleep disordered breathing than for others. There is prolific literature
in this area although large randomized trials are few due to the high
sample size needed and possible ethical difficulties of withholding OSA
treatment in the perioperative period. In 2014 the American Society of
Anesthesiologists published an updated set of recommendations to guide OSA
management during the perioperative period. In this present review we
provide an overview of the different issues that practitioners face with
regard to OSA, from the initial consultation with the anesthesiologist to
the extended post-operative period. There is considerable evidence that
OSA patients are at high risk of perioperative complications, though the
inherent risks from OSA per se and its comorbidities remain difficult to
discern. Nevertheless, appropriate screening and management allow
clinicians to minimize OSA associated risk.<br/>Copyright &#xa9; 2017
Elsevier Ltd

<65>
Accession Number
624529204
Title
Do selective serotonin reuptake inhibitors increase the risk of bleeding
or mortality following coronary artery bypass graft surgery? A
meta-analysis of observational studies.
Source
Perfusion. 33 (6) (pp 415-422), 2018. Date of Publication: 01 Sep 2018.
Author
Eckersley M.J.; Sepehripour A.H.; Casula R.; Punjabi P.; Athanasiou T.
Institution
(Eckersley, Sepehripour, Casula, Punjabi, Athanasiou) Department of
Surgery and Cancer, Imperial College London, London, United Kingdom
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Depressive illness has a high prevalence in patients
undergoing coronary artery bypass graft surgery (CABG). The first line
treatment for depression are selective serotonin reuptake inhibitors
(SSRIs) which inhibit serotonin reuptake in the presynaptic neuronal
membrane and uptake by platelets, inhibiting subsequent serotonin-mediated
platelet activation. This presents a theoretically increased risk of
bleeding and subsequent postoperative mortality. This review aims to
investigate the effects of SSRIs on postoperative bleeding, defined as the
need for transfusions and re-operation for bleeding, as well as 30-day
mortality in patients undergoing CABG. <br/>METHOD(S): Four hundred and
thirty-seven papers were screened with seven meeting the full inclusion
criteria. <br/>RESULT(S): Meta-analysis demonstrated that SSRI use
increased the risk of red blood cell transfusion (odds ratio (OR) = 1.15;
95% confidence interval (CI): 1.06-1.26), but resulted in no difference in
the rate of re-operation for bleeding (OR = 1.07; 95% CI: 0.66-1.74). SSRI
use had no effect on the rates of platelet (OR = 0.93; 95% CI: 0.79-1.09)
or fresh frozen plasma (OR = 0.96; 95% CI: 0.74-1.24) transfusion nor on
the mortality rate (OR =1.03; 95 CI: 0.90-1.17). <br/>CONCLUSION(S): This
review demonstrates that SSRIs are largely safe in cardiac surgery as no
increase in mortality was observed. However, there is a significantly
raised chance of red blood cell transfusion. The heterogeneous nature of
the current evidence base highlights the need for further research into
SSRIs and whether any effect on patient outcomes in cardiac surgery
occurs.

<66>
Accession Number
624522092
Title
Is the use of hydroxyethyl starch as priming solution during cardiac
surgery advisable? A randomized, single-center trial.
Source
Perfusion. 33 (6) (pp 483-489), 2018. Date of Publication: 01 Sep 2018.
Author
Svendsen OS.; Farstad M.; Mongstad A.; Haaverstad R.; Husby P.; Kvalheim
V.L.
Institution
(Svendsen, Farstad, Husby) Department of Anesthesia and Intensive Care,
Haukeland University Hospital, Bergen, Norway
(Mongstad, Haaverstad, Kvalheim) Section for Cardiothoracic Surgery,
Department for Heart Disease, Haukeland University Hospital, Bergen,
Norway
(Haaverstad, Kvalheim) Department of Clinical Science, Faculty of
Medicine, University of Bergen, Bergen, Norway
(Husby) Department of Clinical Medicine, Faculty of Medicine, University
of Bergen, Bergen, Norway
Publisher
NLM (Medline)
Abstract
INTRODUCTION: The use of cardiopulmonary bypass (CPB) leads to increased
fluid filtration and edema. The use of artificial colloids to counteract
fluid extravasation during cardiac surgery is controversial. Beneficial
effects on global fluid loading, leading to better cardiac performance and
hemodynamics, have been claimed. However, renal function and coagulation
may be adversely affected, with unfavorable impact on outcome following
cardiac surgery. <br/>METHOD(S): Forty patients were randomly allocated to
study groups receiving either acetated Ringer's solution (CT group) or
hydroxyethyl starch (HES group, Tetraspan) as CPB priming solution. Fluid
balance, bleeding and hemodynamics, including cardiac output, were
followed postoperatively. The occurrence of acute kidney injury was
closely registered. <br/>RESULT(S): Two patients were excluded from
further analyzes due to surgical complications. Fluid accumulation was
attenuated in the HES group (3374 (883) ml) compared with the CT group
(4328 (1469) ml) (p=0.024). The reduced perioperative fluid accumulation
was accompanied by an increased cardiac index immediately after surgery
(2.7 (0.4) L/min/m2 in the HES group and 2.1 (0.3) L/min/m2 in the CT
group (p<0.001)). No increase in bleeding could be demonstrated in the HES
group. Three patients, all of them in the HES group, experienced acute
kidney injury postoperatively. <br/>CONCLUSION(S): CPB priming with HES
solution lowers fluid loading during bypass and improves cardiac function
in the early postoperative period. The manifestation of acute kidney
injury exclusively in the HES group of patients raises doubts about the
use of HES products in conjunction with cardiac surgery. (
https://clinicaltrials.gov/ct2/show/NCT01511120 ).

<67>
Accession Number
2001166034
Title
Patient-Centered Decision-Making of Revascularization Strategy for Left
Main or Multivessel Coronary Artery Disease.
Source
American Journal of Cardiology. 122 (12) (pp 2005-2013), 2018. Date of
Publication: 15 December 2018.
Author
Kim C.; Hong S.-J.; Ahn C.-M.; Kim J.-S.; Kim B.-K.; Ko Y.-G.; Choi D.;
Jang Y.; Hong M.-K.
Institution
(Kim, Hong, Ahn, Kim, Kim, Ko, Choi, Jang, Hong) Division of Cardiology,
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul,
South Korea
(Kim, Kim, Ko, Choi, Jang, Hong) Cardiovascular Research Institute, Yonsei
University College of Medicine, Seoul, South Korea
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patient preference plays an important role in daily practice; however, its
implication has not been well investigated regarding treatment strategy
for complex coronary artery disease. We prospectively evaluated a trend of
patient-centered decision-making of revascularization strategy in patients
with multivessel or unprotected left main coronary artery disease. A
standardized protocol that favors coronary artery bypass graft surgery
(CABG) as the primary treatment of choice, rather than percutaneous
coronary intervention, was adopted. According to the protocol, patients
decided whether or not they received CABG. Among the 763 consecutively
enrolled patients, 293 patients (38%) consented to receive CABG. Fifty-six
percent of patients with a high Synergy between PCI with Taxus and Cardiac
Surgery (SYNTAX) score chose CABG. SYNTAX score was independently
correlated with consent to receive CABG in each patient SYNTAX score
stratum. In-stent restenosis was an independent predictor of choosing CABG
in patients with low and intermediate SYNTAX scores. Unprotected left main
coronary artery disease was negatively correlated with the decision to
choose CABG in patients with intermediate SYNTAX score. Reasons for
declining CABG included refusal of open-heart surgery in 318 patients
(68%), mild presentation of angina symptoms in 132 patients (28%), low
self-confidence to expect long-term survival in 120 patients (26%), and
economic factors in 10 patients (2%). Short-term major adverse cardiac and
cerebrovascular events occurred in about 1% of patients without
significant differences between the 2 groups. In conclusion, despite the
preferred use of the CABG protocol, more than half of the patients
declined CABG. Patient-centered decision-making as well as heart team
approach should be considered in real-world practice
situations.<br/>Copyright &#xa9; 2018

<68>
Accession Number
624920437
Title
Dabigatran in patients with myocardial injury after non-cardiac surgery
(MANAGE): an international, randomised, placebo-controlled trial.
Source
Lancet (London, England). 391 (10137) (pp 2325-2334), 2018. Date of
Publication: 09 Jun 2018.
Author
Devereaux P.J.; Duceppe E.; Guyatt G.; Tandon V.; Rodseth R.; Biccard
B.M.; Xavier D.; Szczeklik W.; Meyhoff C.S.; Vincent J.; Franzosi M.G.;
Srinathan S.K.; Erb J.; Magloire P.; Neary J.; Rao M.; Rahate P.V.;
Chaudhry N.K.; Mayosi B.; de Nadal M.; Iglesias P.P.; Berwanger O.; Villar
J.C.; Botto F.; Eikelboom J.W.; Sessler D.I.; Kearon C.; Pettit S.; Sharma
M.; Connolly S.J.; Bangdiwala S.I.; Rao-Melacini P.; Hoeft A.; Yusuf S.
Institution
(Devereaux) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada; Department of Medicine,
McMaster University, Hamilton, ON, Canada; Population Health Research
Institute, Hamilton, ON, Canada. Electronic address: philipj@mcmaster.ca
(Duceppe) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada; Department of Medicine,
University of Montreal, Montreal, QC, Canada
(Guyatt, Kearon) Department of Health Research Methods, Evidence, and
Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine,
McMaster University, Hamilton, ON, Canada
(Tandon, Magloire, Neary, Eikelboom) Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Rodseth) Department of Anaesthesia, University of KwaZulu-Natal,
Pietermaritzburg, South Africa
(Biccard) Department of Anaesthesia and Perioperative Medicine, Groote
Schuur Hospital and University of Cape Town, Cape Town, South Africa
(Xavier, Rao) Department of Pharmacology, St John's Medical College and
Research Institute, Bangalore, India
(Szczeklik) Department of Intensive Care and Perioperative Medicine,
Jagiellonian University Medical College, Krakow, Poland
(Meyhoff) Department of Anaesthesia and Intensive Care, Bispebjerg and
Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
(Vincent, Pettit, Rao-Melacini) Population Health Research Institute,
Hamilton, ON, Canada
(Franzosi) Department of Cardiovascular Research, IRCCS Istituto di
Ricerche Farmacologiche Mario Negri, Milan, Italy
(Srinathan) Department of Surgery, University of Manitoba, Winnipeg, MB,
Canada
(Erb) Department of Anesthesiology and Perioperative Medicine, Queen's
University, Kingston, ON, Canada
(Rahate) Department of Surgery, Rahate Surgical Hospital, Nagpur, India
(Chaudhry) Department of Surgery, Christian Medical College Hospital,
Ludhiana, India
(Mayosi) Department of Medicine, Groote Schuur Hospital and University of
Cape Town, Cape Town, South Africa
(de Nadal) Department of Anesthesiology, Hospital Universitari Vall
d'Hebron, Barcelona, Spain
(Iglesias) Department of Anesthesiology, Hospital de la Santa Creu i Sant
Pau, Barcelona, Spain
(Berwanger) Instituto de Ensino e Pesquisa do Hospital do Coracao
(IEP-HCor), Sao Paulo, Brazil
(Villar) Departamento de Investigaciones, Fundacion
Cardioinfantil-Instituto de Cardiologia (Bogota) and Facultad de Ciencias
de la Salud, Universidad Autonoma de Bucaramanga, Colombia
(Botto) Estudios Clinicos Latinoamerica (ECLA), Rosario and Hospital
Austral, Pilar, Argentina
(Sessler) Department of Outcomes Research, Cleveland Clinic,
Anesthesiology Institute, Cleveland, OH, United States
(Sharma, Connolly) Department of Medicine, McMaster University, Hamilton,
ON, Canada; Population Health Research Institute, Hamilton, ON, Canada
(Bangdiwala) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada; Population Health Research
Institute, Hamilton, ON, Canada
(Hoeft) Department of Anesthesiology and Intensive Care Medicine,
University Hospital Bonn, Bonn, Germany
(Yusuf) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada; Department of Medicine,
McMaster University, Hamilton, ON, Canada; Population Health Research
Institute, Hamilton, ON, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Myocardial injury after non-cardiac surgery (MINS) increases
the risk of cardiovascular events and deaths, which anticoagulation
therapy could prevent. Dabigatran prevents perioperative venous
thromboembolism, but whether this drug can prevent a broader range of
vascular complications in patients with MINS is unknown. The MANAGE trial
assessed the potential of dabigatran to prevent major vascular
complications among such patients. <br/>METHOD(S): In this international,
randomised, placebo-controlled trial, we recruited patients from 84
hospitals in 19 countries. Eligible patients were aged at least 45 years,
had undergone non-cardiac surgery, and were within 35 days of MINS.
Patients were randomly assigned (1:1) to receive dabigatran 110 mg orally
twice daily or matched placebo for a maximum of 2 years or until
termination of the trial and, using a partial 2-by-2 factorial design,
patients not taking a proton-pump inhibitor were also randomly assigned
(1:1) to omeprazole 20 mg once daily, for which results will be reported
elsewhere, or matched placebo to measure its effect on major upper
gastrointestinal complications. Research personnel randomised patients
through a central 24 h computerised randomisation system using block
randomisation, stratified by centre. Patients, health-care providers, data
collectors, and outcome adjudicators were masked to treatment allocation.
The primary efficacy outcome was the occurrence of a major vascular
complication, a composite of vascular mortality and non-fatal myocardial
infarction, non-haemorrhagic stroke, peripheral arterial thrombosis,
amputation, and symptomatic venous thromboembolism. The primary safety
outcome was a composite of life-threatening, major, and critical organ
bleeding. Analyses were done according to the intention-to-treat
principle. This trial is registered with ClinicalTrials.gov, number
NCT01661101. FINDINGS: Between Jan 10, 2013, and July 17, 2017, we
randomly assigned 1754 patients to receive dabigatran (n=877) or placebo
(n=877); 556 patients were also randomised in the omeprazole partial
factorial component. Study drug was permanently discontinued in 401 (46%)
of 877 patients allocated to dabigatran and 380 (43%) of 877 patients
allocated to placebo. The composite primary efficacy outcome occurred in
fewer patients randomised to dabigatran than placebo (97 [11%] of 877
patients assigned to dabigatran vs 133 [15%] of 877 patients assigned to
placebo; hazard ratio [HR] 0.72, 95% CI 0.55-0.93; p=0.0115). The primary
safety composite outcome occurred in 29 patients (3%) randomised to
dabigatran and 31 patients (4%) randomised to placebo (HR 0.92, 95% CI
0.55-1.53; p=0.76). INTERPRETATION: Among patients who had MINS,
dabigatran 110 mg twice daily lowered the risk of major vascular
complications, with no significant increase in major bleeding. Patients
with MINS have a poor prognosis; dabigatran 110 mg twice daily has the
potential to help many of the 8 million adults globally who have MINS to
reduce their risk of a major vascular complication [corrected]. FUNDING:
Boehringer Ingelheim and Canadian Institutes of Health
Research.<br/>Copyright &#xa9; 2018 Elsevier Ltd. All rights reserved.

<69>
[Use Link to view the full text]
Accession Number
625008740
Title
Ambulation capacity and functional outcome in patients undergoing
neuromuscular electrical stimulation after cardiac valve surgery: A
randomised clinical trial.
Source
Medicine. 97 (46) (pp e13012), 2018. Date of Publication: 01 Nov 2018.
Author
Fontes Cerqueira T.C.; Cerqueira Neto M.L.; Cacau L.A.P.; Oliveira G.U.;
Silva Junior W.M.D.; Carvalho V.O.; Mendonca J.T.; Santana Filho V.J.
Institution
(Fontes Cerqueira) Department of Physiotherapy, Universidade Federal de
Sergipe, Lagarto, Brazil
(Cerqueira Neto, Carvalho, Santana Filho) Department of Physiotherapy,
Universidade Federal de Sergipe, Sao
(Cacau) Department of Physiotherapy, Universidade Tiradentes, Aracaju,
Brazil
(Oliveira) Universidade Federal de Sergipe, Aracaju, Brazil
(Silva Junior) Department of Physiotherapy, Universidade Federal de
Sergipe, Sao Cristovao, Brazil
(Mendonca) Department of Medicine, Universidade Federal de Sergipe, SE,
Sao Cristovao, Brazil
Publisher
NLM (Medline)
Abstract
BACKGROUND: Early mobilization and physical exercise are considered
fundamental components in cardiovascular surgery rehabilitation; however,
occasionally they are inadequate for inhibiting functional decline.
Neuromuscular electrical stimulation (NMES) is a promising tool in
cardiovascular rehabilitation; however, to date, no randomized clinical
trial has measured the effects of NMES on functional capacity and quality
of life in patients who undergo routine cardiac surgery with a short
intensive care unit (ICU) stay. Therefore, we aimed to investigate the
effects of NMES on walking ability, muscle strength, functional
independence, and quality of life in cardiac valve surgery patients in the
immediate postoperative period. <br/>METHOD(S): A randomized, parallel,
controlled, 2-arm clinical trial with assessor blinding was conducted.
Fifty-nine adult patients in the preoperative period after cardiac valve
reconstruction and/or replacement were randomly assigned to a control or
intervention group. The intervention group underwent NMES in the
quadriceps and gastrocnemius, bilaterally, for 60 minutes, for up to 10
sessions. The primary outcome was ambulation ability, assessed through the
Six-Minute Walk Test and Walking Speed Test at postoperative day 5 (5PO).
Secondary outcomes were muscular strength (assessed through the Medical
Research Council scale), functional independence measure (assessed through
the Functional Independence Measurement Questionnaire), and quality of
life (assessed through the Nottingham Health Profile) at baseline
(preoperative) and at postoperative days 3 and 5. <br/>RESULT(S): The
baseline characteristics were similar in both groups, except for body mass
index. There was no statistically significant difference, with a small
effect size, between both groups regarding the distance walked (95% CI,
-64.87 to 65.97) and walking speed (95% CI, -0.55 to 0.57). There was a
statistically significant difference in upper-limb muscle strength loss
and decline in mobility at postoperative day 3, which had a tendency to
recover to initial values at 5PO, in both groups. No significant
between-group difference was noted for muscle strength, functional
independence, and quality of life. <br/>CONCLUSION(S): The use of NMES had
no effect on walking ability, strength, quality of life, or functional
outcome in the postoperative period for patients that underwent regular
valve replacement.

<70>
[Use Link to view the full text]
Accession Number
625008672
Title
Comprehensive preoperative regime of selective gut decontamination in
combination with probiotics, and smectite for reducing endotoxemia and
cytokine activation during cardiopulmonary bypass: A pilot randomized,
controlled trial.
Source
Medicine. 97 (46) (pp e12685), 2018. Date of Publication: 01 Nov 2018.
Author
Liu W.-C.; Zhan Y.-P.; Wang X.-H.; Hou B.-C.; Huang J.; Chen S.-B.
Institution
(Liu) Department of Anesthesiology, First Affiliated Hospital of Nanchang
University, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Both selective digestive decontamination (SDD) and probiotics
have been reported to reduce endotoxemia. However, the available results
are conflicting and few studies have investigated the combined effect of
SDD and probiotics. This study aimed to examine the effectiveness of a
comprehensive preoperative regimen of SDD in combination with probiotics
and smectite on perioperative endotoxemia and cytokine activation in
patients who underwent elective cardiac surgery with cardiopulmonary
bypass (CPB) in a pilot, prospective, randomized, controlled trial.
<br/>METHOD(S): Patients who underwent elective Aortic Valve Replacement
or Mitral Valve Replacement surgery from July 2010 to March 2015 were
included. In total, 30 eligible patients were randomly assigned to receive
either the comprehensive preoperative regimen (n = 15) (a combination of
preoperative SDD, probiotics, and smectite) or the control group (n = 15)
who did not receive this treatment. The levels of endotoxin, IL-6, and
procalcitonin were measured at the time before anesthesia induction,
immediately after cardiopulmonary bypass (CPB), 24 hours after CPB, and 48
hours after CPB. The primary outcomes were changes in endotoxin, IL-6, and
procalcitonin concentrations after CPB. <br/>RESULT(S): The mean levels of
change in endotoxin levels after CPB in patients receiving the
comprehensive preoperative regimen was marginally significantly lower than
those in control group (F = 4.0, P = .0552) but was not significantly
different for procalcitonin (F = .14, P = .7134). An interaction between
group and time for IL-6 was identified (F = 4.35, P = .0231). The increase
in IL-6 concentration immediately after CPB in the comprehensive
preoperative group was significantly lower than that in the control group
(P = .0112). The changes in IL-6 concentration at 24 hours and 48 hours
after CPB were not significant between the comprehensive preoperative
group and control group. <br/>CONCLUSION(S): The present pilot,
prospective, randomized, controlled study in patients undergoing cardiac
surgery with CPB demonstrated that 3 days of a comprehensive preoperative
regime of SDD in combination with probiotics and smectite may reduce the
endotoxin and IL-6 levels after CPB compared with the control group.

<71>
Accession Number
2001325769
Title
Transcatheter Versus Surgical Aortic Valve Replacement in Patients With
Prior Cardiac Surgery in the Randomized PARTNER 2A Trial.
Source
JACC: Cardiovascular Interventions. 11 (21) (pp 2207-2216), 2018. Date of
Publication: 12 November 2018.
Author
Chen S.; Redfors B.; Ben-Yehuda O.; Crowley A.; Greason K.L.; Alu M.C.;
Finn M.T.; Vahl T.P.; Nazif T.; Thourani V.H.; Suri R.M.; Svensson L.;
Webb J.G.; Kodali S.K.; Leon M.B.
Institution
(Chen, Redfors, Ben-Yehuda, Crowley, Leon) Cardiovascular Research
Foundation, New York, NY, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Greason) Department of Cardiovascular Surgery, Mayo Clinic, Rochester,
MN, United States
(Alu, Finn, Vahl, Nazif, Kodali, Leon) Columbia University Medical
Center/NewYork-Presbyterian Hospital, New York, NY, United States
(Thourani) Medstar Heart & Vascular Institute, Washington, District of
Columbia, United States
(Suri, Svensson) Cleveland Clinic, Cleveland, OH, United States
(Webb) St. Paul's Hospital, University of British Columbia, Vancouver,
British Columbia, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to further evaluate clinical
outcomes in patients with and without PCS. <br/>Background(s): Prior
cardiac surgery (PCS) is associated with increased surgical risk and
post-operative complications following surgical aortic valve replacement
(SAVR), but whether this risk is similar in transcatheter aortic valve
replacement (TAVR) is unclear. <br/>Method(s): In the PARTNER 2A
(Placement of Aortic Transcatheter Valve) trial, 2,032 patients with
severe aortic stenosis at intermediate surgical risk were randomized to
TAVR with the SAPIEN XT valve or SAVR. Adverse clinical outcomes at 30
days and 2 years were compared using Kaplan-Meier event rates and
multivariate Cox proportional hazards regression models. The primary
endpoint of the PARTNER 2 trial was all-cause death and disabling stroke.
<br/>Result(s): Five hundred nine patients (25.1%) had PCS, mostly (98.2%)
coronary artery bypass grafting. There were no significant differences
between TAVR and SAVR in patients with or without PCS in the rates of the
primary endpoint at 30 days or 2 years. Nevertheless, an interaction was
observed between PCS and treatment arm; whereas no-PCS patients treated
with TAVR had higher rates of 30-day major vascular complications than
patients treated with SAVR (adjusted hazard ratio: 2.66; 95% confidence
interval: 1.68 to 4.22), the opposite was true for patients with PCS
(adjusted hazard ratio: 0.27; 95% confidence interval: 0.11 to 0.66)
(p<inf>interaction</inf> <0.0001). A similar interaction was observed for
life-threatening or disabling bleeding. <br/>Conclusion(s): In the PARTNER
2A trial of intermediate-risk patients with severe aortic stenosis
undergoing SAVR versus TAVR, the relative risk for 2-year adverse clinical
outcomes was similar between TAVR and SAVR in patients with or without
PCS.<br/>Copyright &#xa9; 2018 American College of Cardiology Foundation

<72>
Accession Number
623271009
Title
Association of comorbid burden with clinical outcomes after transcatheter
aortic valve implantation.
Source
Heart. (no pagination), 2018. Date of Publication: 20 Jul 2018.
Author
Bagur R.; Martin G.P.; Nombela-Franco L.; Doshi S.N.; George S.;
Toggweiler S.; Sponga S.; Cotton J.M.; Khogali S.S.; Ratib K.; Kinnaird
T.; Anderson R.A.; Chu M.W.A.; Kiaii B.; Biagioni C.; Schofield-Kelly L.;
Loretz L.; Torracchi L.; Sekar B.; Kwok C.S.; Sperrin M.; Ludman P.F.;
Mamas M.A.
Institution
(Bagur, Chu, Kiaii) Heart Team, London Health Sciences Centre, London, ON,
Canada
(Bagur) Department of Epidemiology and Biostatistics, Schulich School of
Medicine and Dentistry, Western University, London, ON, Canada
(Bagur, Ratib, Kwok, Mamas) Keele Cardiovascular Research Group, Centre
for Prognosis Research, Institute for Primary Care and Health Sciences,
Keele University, Stoke-on-Trent, United Kingdom
(Martin, Sperrin, Mamas) Farr Institute, Faculty of Biology, Medicine and
Health, University of Manchester, Manchester Academic Health Science
Centre, Manchester, United Kingdom
(Nombela-Franco, Biagioni) Cardiovascular Institute, Hospital Clinico San
Carlos, Madrid, Spain
(Doshi, George, Ludman) Cardiology Department, Queen Elizabeth Hospital,
Birmingham, United Kingdom
(Toggweiler, Loretz) Cardiology Division, Heart Center Lucerne, Lucerne,
Switzerland
(Sponga, Torracchi) Cardiothoracic Department, University Hospital of
Udine, Udine, Italy
(Cotton, Khogali, Schofield-Kelly) Heart and Lung Centre, Royal
Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
(Kinnaird, Anderson, Sekar) Department of Cardiology, University Hospital
of Wales, Cardiff, United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives: To investigate the association of the CharlsonComorbidity
Index (CCI) with clinical outcomes after transcatheter aortic valve
implantation (TAVI). <br/>Background(s): Patients undergoing TAVI have
high comorbid burden; however, there is limited evidence of its impact on
clinical outcomes. <br/>Method(s): Data from 1887 patients from the UK,
Canada, Spain, Switzerland and Italy were collected between 2007 and 2016.
The association of CCI with 30-day mortality, Valve Academic Research
Consortium-2 (VARC-2) composite early safety, long-term survival and
length of stay (LoS) was calculated using logistic regression and Cox
proportional hazard models, as a whole cohort and at a country level,
through a two-stage individual participant data (IPD) random effect
meta-analysis. <br/>Result(s): Most (60%) of patients had a CCI >=3. A
weak correlation was found between the total CCI and four different
preoperative risks scores (=0.16 to 0.29), and approximately 50% of
patients classed as low risk from four risk prediction models still
presented with a CCI >=3. Per-unit increases in total CCI were not
associated with increased odds of 30-day mortality (OR 1.09, 95% CI 0.96
to 1.24) or VARC-2 early safety (OR 1.04, 95% CI 0.96 to 1.14) but were
associated with increased hazard of long-term mortality (HR 1.10, 95% CI
1.05 to 1.16). The two-stage IPD meta-analysis indicated that CCI was not
associated with LoS (HR 0.97, 95% CI 0.93 to 1.02). <br/>Conclusion(s): In
this multicentre international study, patients undergoing TAVI had
significant comorbid burden. We found a weak correlation between the CCI
and well-established preoperative risks scores. The CCI had a moderate
association with long-term mortality up to 5 years
post-TAVI.<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2018. No
commercial re-use. See rights and permissions. Published by BMJ.

<73>
Accession Number
625195334
Title
Levosimendan versus placebo in cardiac surgery: A systematic review and
meta-Analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (5) (pp 677-685),
2018. Date of Publication: 01 Nov 2018.
Author
Tena M.; Urso S.; Gonzalez J.M.; Santana L.; Sadaba R.; Juarez P.;
Gonzalez L.; Portela F.
Institution
(Tena, Urso, Portela) Department of Cardiac Surgery, Hospital
Universitario Dr. Negrin, Barranco de la Ballena, s/n, Las Palmas de Gran
Canaria 35010, Spain
(Gonzalez) Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de
Gran Canaria, Spain
(Santana) Department of Anesthesiology, Hospital Universitario Dr. Negrin,
Las Palmas de Gran Canaria, Spain
(Sadaba) Department of Cardiac Surgery, Complejo Hospitalario de Navarra,
Pamplona, Spain
(Juarez, Gonzalez) Intensive Care Unit, Hospital Universitario Dr. Negrin,
Las Palmas de Gran Canaria, Spain
Publisher
Oxford University Press
Abstract
The aim of this meta-Analysis was to review all published randomized
clinical trials comparing levosimendan versus placebo in patients
undergoing cardiac surgery. PubMed, EMBASE and the Cochrane library
database of clinical trials were searched for prospective randomized
clinical trials investigating the perioperative use of levosimendan versus
placebo in patients undergoing adult cardiac surgery from 1 May 2000 to 10
April 2017. Binary outcomes from individual studies were analysed to
compute individual and pooled risk ratios (RRs) with pertinent 95%
confidence intervals (CIs). Fourteen randomized clinical trials with a
total of 2243 patients were included in this review. Overall meta-Analysis
results demonstrated that levosimendan was associated with a significant
reduction in 30-day mortality (RR = 0.71, 95% CI = 0.53-0.95; P = 0.023).
Subgroup analysis showed that this benefit was confined to the moderate
and low ejection fraction studies (RR = 0.44, 95% CI = 0.27-0.70; P <
0.001), whereas no benefit was observed in the preserved ejection fraction
studies (RR = 1.06, 95% CI = 0.72-1.56; P = 0.78). Levosimendan also
reduced the risk of renal replacement therapy (RR = 0.66, 95% CI =
0.47-0.92; P = 0.015) and low cardiac output (RR = 0.40, 95% CI =
0.22-0.73; P = 0.003). No significant differences were detected, between
the levosimendan group and the placebo group, in terms of risk of
myocardial injury (RR = 0.90, 95% CI = 0.69-1.17; P = 0.44), intensive
care unit stay (weighted mean differences =-0.57, 95% CI =-1.15 to 0.01; P
= 0.055) and the use of ventricular assist device (RR = 0.42, 95% CI =
0.07-2.63; P = 0.35). In conclusion, levosimendan was associated with a
reduced risk of mortality, renal replacement therapy and low cardiac
output syndrome in patients undergoing cardiac surgery.<br/>Copyright
&#xa9; The Author(s) 2018. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<74>
Accession Number
625194170
Title
The clinical impact of RBC storage age: Findings from clinical trials.
Source
Hematology. Conference: 36th World Congress of the International Society
of Hematology and 56th Annual Scientific Meeting of the British Society
for Haematology. United Kingdom. 21 (1 Supplement 1) (pp 35-36), 2016.
Date of Publication: March 2016.
Author
Fergusson D.
Institution
(Fergusson) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Centre for Practice-Changing Research, Ottawa, ON, Canada
Publisher
Taylor and Francis Ltd.
Abstract
Transfusion of red blood cells is oneof the most common medical
interventionsadministered in hospitalized patients. In NorthAmerica,
donated red blood cells can be stored forup to 42 days. It has been
suggested that prolongedstorage of red blood cells may explain adverse
consequences associated with transfusion. Until recently,the clinical
impact of prolonged red blood cellstorage has not been firmly established.
Reportedadverse consequences of prolonged storage have beenattributed to
the generation of cytokines in thestorage medium. Changes to red cell
membranes thatalter deformability of red cells and an inability to
scavenge nitric oxide and biochemical changes such asdecreased levels of
2,3 DPG, may be even more important than the generation of cytokines as
they impairthe ability of red cells to deliver oxygen to meettissue needs.
In vulnerable patients such as the critically ill, transfusing older red
blood cells may resultin higher rates of organ dysfunction and
morbiditybecause of the deleterious oxygen deficits, or the
proinflammatory effects of bioactive materials thataccumulate during red
cell storage. Laboratory evidence, including animal studies, supports the
hypothesis that prolonged storage may be deleterious.1 Interms of human
studies, a number of observationalstudies suggest that prolonged storage
affects clinicaloutcomes such as mortality and risk of infection.
Asystematic review of observational studies found thatthe transfusion of
older red-cell units was associatedwith a 16 percent increase in
mortality.2 Yet, observational studies assessing the association of
storage agehave major shortcomings such as the ability toaccount for
multiple transfusions of varying storageages and confounding by indication
whereby sickerpatients receive more transfusions.3 Properly conceived and
conducted, large clinical trials overcomethese limitations by their
ability to randomize patientsto distinct red cell storage age
interventions (e.g."fresh" vs "older") and achieve a balance of knownand
unknown confounders between groups. Recently,large randomized clinical
trials addressing storageage have been published. Two trials conducted in
theneonatal (ARIPI) and adult (ABLE) intensive carepopulations compared
red blood cells stored for 7days or less to standard issue.4,5 The RECESS
trialin cardiac surgery patients compared red blood cellsstored for 10
days or less to those stored for 21 daysor more.6 The ARIPI, ABLE, &RECESS
trials allsuggest no benefit of "fresh" red cells compared toeither
standard issue or "older" red blood cells interms of major morbidities and
mortality. Additionallarge trials conducted in all hospitalized patients,
critical care, and cardiac surgery, are nearing completion.Current
evidence suggests that transfusion of fresh redblood cells does not
improve clinical outcomes, therefore changes to current storage time
practice policy isunwarranted. Results to date also suggest that
thedemonstrated changes to red cells or the storagemedium documented in
numerous laboratory studieshave limited clinical impact.

<75>
Accession Number
625207455
Title
Quality of life is not improved after mitral valve surgery combined with
epicardial left atrial cryoablation as compared with mitral valve surgery
alone: a substudy of the double blind randomized SWEDish Multicentre
Atrial Fibrillation study (SWEDMAF).
Source
Europace : European pacing, arrhythmias, and cardiac electrophysiology :
journal of the working groups on cardiac pacing, arrhythmias, and cardiac
cellular electrophysiology of the European Society of Cardiology. 20 (FI3)
(pp f343-f350), 2018. Date of Publication: 01 Nov 2018.
Author
Bagge L.; Probst J.; Jensen S.M.; Blomstrom P.; Thelin S.; Holmgren A.;
Blomstrom-Lundqvist C.
Institution
(Bagge, Probst, Blomstrom, Blomstrom-Lundqvist) Departments of Cardiology
and Medical Science, Uppsala University, Sweden
(Jensen) Faculty of Medicine, Department of Public Health and Clinical
Medicine (Heart centre) Umea University, SE-901 87 Umea, Sweden
(Thelin) Department of Cardiothoracic Surgery, Uppsala University, Uppsala
SE-751 85, Sweden
(Holmgren) Faculty of Medicine, Department of Public Health and Clinical
Medicine, Cardiology, Umea University, SE-901 87 Umea, Sweden
Publisher
NLM (Medline)
Abstract
Aims: Concomitant surgical ablation of atrial fibrillation (AF) in
patients undergoing mitral valve surgery (MVS) has almost become routine
despite lack of convincing information about improved quality-of-life
(QOL) and clinical benefit. Quality-of-life was therefore assessed after
MVS with or without epicardial left atrial cryoablation. <br/>Methods and
Results: Sixty-five patients with permanent AF randomized to MVS with or
without left atrial cryoablation, in the double-blinded multicentre
SWEDMAF trial, replied to the Short Form 36 QOL survey at 6 and 12months
follow-up. The QOL scores at 12month follow-up did not differ
significantly between patients undergoing MVS combined with cryoablation
vs. those undergoing MVS alone regarding Physical Component Summary mean
42.8 (95% confidence interval 38.3-47.3) vs. mean 44.0 (40.1-47.7),
P=0.700 or Mental Component Summary mean 53.1 (49.7-56.4) vs. mean 48.4
(44.6-52.2), P=0.075. All patients, irrespective of allocated procedure,
reached the same QOL after surgery as an age-matched Swedish general
population. The Physical Component Summary in patients with sinus rhythm
did also not differ from those in AF at 12months; mean 45.4 (42.0-48.7)
vs. mean 40.5 (35.5-45.6), P=0.096) nor was there a difference in Mental
Component Summary; mean 51.0 (48.0-54.1) vs. mean 49.6 (44.6-54.5),
P=0.581). <br/>Conclusion(s): Left atrial cryoablation added to MVS does
not improve health-related QOL in patients with permanent AF, a finding
that raises concerns regarding recommendations made for this combined
procedure.

<76>
Accession Number
625214915
Title
Should pre-hospital resuscitative thoracotomy be reserved only for
penetrating chest trauma?.
Source
European journal of trauma and emergency surgery : official publication of
the European Trauma Society. 44 (6) (pp 811-818), 2018. Date of
Publication: 01 Dec 2018.
Author
Nevins E.J.; Moori P.L.; Smith-Williams J.; Bird N.T.E.; Taylor J.V.;
Misra N.
Institution
(Nevins, Bird, Taylor, Misra) Emergency General Surgery and Trauma Unit,
University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, United
Kingdom
(Moori, Taylor, Misra) University of Liverpool Medical School, Liverpool,
United Kingdom
(Smith-Williams) Department of Anaesthesia, Royal Liverpool University
Hospital, Liverpool, United Kingdom
Publisher
NLM (Medline)
Abstract
PURPOSE: The indications for pre-hospital resuscitative thoracotomy (PHRT)
remain undefined. The aim of this paper is to explore the variation in
practice for PHRT in the UK, and review the published literature.
<br/>METHOD(S): MEDLINE and PUBMED search engines were used to identify
all relevant articles and 22 UK Air Ambulance Services were sent an
electronic questionnaire to assess their PHRT practice. <br/>RESULT(S):
Four European publications report PHRT survival rates of 9.7, 18.3, 10.3
and 3.0% in 31, 71, 39 and 33 patients, respectively. All patients
sustained penetrating chest injury. Six case reports also detail survivors
of PHRT, again all had sustained penetrating thoracic injury. One Japanese
paper presents 34 cases of PHRT following blunt trauma, of which 26.4%
survived to the intensive therapy unit but none survived to discharge. A
UK population reports a single survivor of PHRT following blunt trauma but
the case details remain unpublished. Ten (45%) air ambulance services
responded, each service reported different indications for PHRT. All
perform PHRT for penetrating chest trauma, however, length of allowed
pre-procedure down time varied, ranging from 10 to 20 min. Seventy percent
perform PHRT for blunt traumatic cardiac arrest, a procedure which is
likely to require aggressive concurrent circulatory support, despite this
only 5/10 services carry pre-hospital blood products. <br/>CONCLUSION(S):
Current indications for PHRT vary amongst different geographical
locations, across the UK, and worldwide. Survivors are likely to have
sustained penetrating chest injury with short down time. There is only one
published survivor of PHRT following blunt trauma, despite this, PHRT is
still being performed in the UK for this indication.

<77>
Accession Number
625210754
Title
American Society of Hematology 2018 guidelines for management of venous
thromboembolism: heparin-induced thrombocytopenia.
Source
Blood advances. 2 (22) (pp 3360-3392), 2018. Date of Publication: 27 Nov
2018.
Author
Cuker A.; Arepally G.M.; Chong B.H.; Cines D.B.; Greinacher A.; Gruel Y.;
Linkins L.A.; Rodner S.B.; Selleng S.; Warkentin T.E.; Wex A.; Mustafa
R.A.; Morgan R.L.; Santesso N.
Institution
(Cuker, Cines) Department of Medicine and, Canada
(Cuker, Cines) Department of Pathology and Laboratory Medicine, Perelman
School of Medicine, University of Pennsylvania, Philadelphia, PA, United
States
(Arepally) Department of Medicine, Duke University Medical Center, Durham,
NC, United States
(Chong) Department of Haematology, University of New South Wales, Sydney,
NSW, Australia
(Greinacher) Institute of Immunology and Transfusion Medicine, University
of Greifswald, Greifswald, Germany
(Gruel) Department of Haematology-Haemostasis, Trousseau Hospital, Tours,
France
(Linkins, Warkentin) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Rodner) New York, NY
(Selleng) Department of Anaesthesiology, University of Greifswald,
Greifswald, Germany
(Warkentin) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, ON, Canada
(Wex) ColumbusOHUnited States
(Mustafa, Morgan, Santesso) Department of Health Research Methods,
Evidence and Impact, McMaster University, Hamilton, ON, Canada; and
(Mustafa) Department of Medicine, University of Missouri-Kansas City,
Kansas City, MO, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Heparin-induced thrombocytopenia (HIT) is an adverse drug
reaction mediated by platelet-activating antibodies that target complexes
of platelet factor 4 and heparin. Patients are at markedly increased risk
of thromboembolism. <br/>OBJECTIVE(S): These evidence-based guidelines of
the American Society of Hematology (ASH) are intended to support patients,
clinicians, and other health care professionals in their decisions about
diagnosis and management of HIT. <br/>METHOD(S): ASH formed a
multidisciplinary guideline panel balanced to minimize potential bias from
conflicts of interest. The McMaster University GRADE Centre supported the
guideline development process, including updating or performing systematic
evidence reviews. The panel prioritized clinical questions and outcomes
according to their importance for clinicians and patients. The Grading of
Recommendations Assessment, Development and Evaluation (GRADE) approach
was used to assess evidence and make recommendations, which were subject
to public comment. <br/>RESULT(S): The panel agreed on 33 recommendations.
The recommendations address screening of asymptomatic patients for HIT,
diagnosis and initial management of patients with suspected HIT, treatment
of acute HIT, and special situations in patients with acute HIT or a
history of HIT, including cardiovascular surgery, percutaneous
cardiovascular intervention, renal replacement therapy, and venous
thromboembolism prophylaxis. <br/>CONCLUSION(S): Strong recommendations
include use of the 4Ts score rather than a gestalt approach for estimating
the pretest probability of HIT and avoidance of HIT laboratory testing and
empiric treatment of HIT in patients with a low-probability 4Ts score.
Conditional recommendations include the choice among non-heparin
anticoagulants (argatroban, bivalirudin, danaparoid, fondaparinux, direct
oral anticoagulants) for treatment of acute HIT.<br/>Copyright &#xa9; 2018
by The American Society of Hematology.

<78>
Accession Number
625177553
Title
The effect of the timing and dose of dexmedetomidine on postoperative
delirium in elderly patients after laparoscopic major non-cardiac surgery:
A double blind randomized controlled study.
Source
Journal of clinical anesthesia. 47 (pp 27-32), 2018. Date of Publication:
01 Jun 2018.
Author
Lee C.; Lee C.H.; Lee G.; Lee M.; Hwang J.
Institution
(Lee, Lee, Lee) Department of Anesthesiology and Pain Medicine, Wonkwang
University School of Medicine, South Korea
(Lee) Department of Anesthesiology and Pain Medicine, Konkuk University
School of Medicine, South Korea
(Hwang) Department of Orthopaedic Surgery, Hallym University Kangnam
Sacred Heart Hospital, Seoul, South Korea
Publisher
NLM (Medline)
Abstract
STUDY OBJECTIVE: There were few clinical data dosing and timing regimen
for preventing postoperative delirium. The present study aimed to
investigate the effect of the timing and dose of dexmedetomidine on
postoperative delirium in elderly patients after laparoscopic major
non-cardiac surgery. PATIENTS AND INTERVENTIONS: A total of 354 patients
>65years of age undergoing laparoscopic major non-cardiac surgery under
general anesthesia received a dexmedetomidine 1mug/kg bolus followed by
0.2-0.7mug/kg/h infusion from induction of anesthesia to the end of
surgery [group D1]); a dexmedetomidine (1mug/kg bolus [group D2]); or
saline (group S) 15min before the end of surgery. MEASUREMENTS: The
incidence and duration of delirium for 5days after surgery and the
cytokine (tumor necrosis factor-alpha TNFalpha, interleukin [IL]-1 beta,
IL-2, IL-6, IL-8, and IL-10) and cortisol levels were measured 1h and 24h
after surgery. MAIN RESULTS: Group D1 reduced incidence and duration of
delirium and group D2 decreased its duration in patients with delirium
compared to group S. IL-6 levels were significantly lower at 1h and 24h
after surgery in group D1 than in group S, and lower at 24h after surgery
than in group D2. IL-6 levels in group D2 were significantly lower only at
1h after surgery than in group S. However, IL-6 levels in delirious
patients in group D2 were significantly lower at 1h and 24h after surgery
than those in group S. Cortisol levels 1h after surgery were significantly
lower in groups D1 and D2 than in group S. <br/>CONCLUSION(S): The dose
and timing of dexmedetomidine appeared to be important in preventing
delirium. The reduced incidence and duration of delirium by
dexmedetomidine was associated with reduced levels of IL-6 24h after
surgery.<br/>Copyright &#xa9; 2018. Published by Elsevier Inc.

<79>
Accession Number
2001331845
Title
Effect of Perioperative Neuromuscular Electrical Stimulation in Patients
Undergoing Cardiovascular Surgery: A Pilot Randomized Controlled Trial.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Author
Kitamura H.; Yamada S.; Adachi T.; Shibata K.; Tamaki M.; Okawa Y.; Usui
A.
Institution
(Kitamura, Tamaki, Okawa) Department of Cardiovascular Surgery, Nagoya
Heart Center, Nagoya, Japan
(Yamada) Department of Health Science, Nagoya University Graduate School
of Medicine, Nagoya, Japan
(Adachi, Shibata) Program in Physical and Occupational Therapy, Nagoya
University Graduate School of Medicine, Nagoya, Japan
(Shibata) Department of Cardiac Rehabilitation, Nagoya Heart Center,
Nagoya, Japan
(Usui) Department of Cardiac Surgery, Nagoya University Graduate School of
Medicine, Nagoya, Japan
Publisher
W.B. Saunders
Abstract
A randomized, controlled trial was conducted to examine the effects of
perioperative neuromuscular electrical stimulation on muscle proteolysis
and physical function using blinded assessment of physical function.
Consecutive patients undergoing cardiovascular surgery were screened for
eligibility as study subjects. Participants were randomly assigned to
receive either neuromuscular electrical stimulation or the usual
postoperative mobilization program. The intervention group received
neuromuscular electrical stimulation on bilateral legs 8 times before and
after surgery. The primary outcomes were the mean 3-methylhistidine
concentration corrected for urinary creatinine content from baseline to
postoperative day 6, and knee extensor isometric muscle strength on
postoperative day 7. Secondary outcomes were usual walking speed and grip
strength. Physical therapists blinded to patient allocation performed
measurements of physical function. Of 498 consecutive patients screened
for eligibility, 119 participants (intervention group, n = 60; control
group, n = 59) were enrolled. In the overall subjects, there were no
differences in any outcomes between the intervention and control groups.
The results demonstrated no significant effects of neuromuscular
electrical stimulation on muscle proteolysis and physical function after
cardiovascular surgery, suggesting the need to explore indications for
neuromuscular electrical stimulation and to clarify the effects in terms
of the dose-response relationship.<br/>Copyright &#xa9; 2018

<80>
Accession Number
2001331607
Title
A comparative study of preemptive effect of pregabalin and gabapentin on
postoperative pain after coronary artery bypass graft surgery: A clinical
randomized trial.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. (no
pagination), 2018. Date of Publication: 2018.
Author
Hanoura S.; Sharaa M.; Refaie M.; Singh R.
Institution
(Hanoura) Department of Anesthesia and Intensive Care, Al-Azhar
University, Egypt
(Sharaa) Department of Cardiothoracic Surgery, Faculty of Medicine,
AL-Azhar University, Cairo, Egypt
(Refaie, Singh) Department of Cardiology Medical Research, Hamad Medical
Corporation, Doha, Qatar
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Pain that pursues coronary artery bypass graft (CABG) surgery
is usually associated with increased both recovery duration and hospital
stay. Patient outcome could be worsened owing to large doses of opioids
for pain control through over sedation, and prolonged mechanical
ventilation. This study was designed to evaluate the effect of preemptive
gabapentinoids on post CABG surgery pain control. <br/>Method(s): Sixty
patients subjected to CABG were randomized blindly to receive either
pregabalin, gabapentine or placebo 2 h before the surgery. The former
group included 20 patients who received 150 mg pregabalin, whereas the
later group included another 20 patients who received 600 mg gabapentin.
Finally, the placebo group with number of 20 patients received identical
capsule. The postoperative pain was assessed with critical care pain
observation tool (CPOT) and Numeric rate score (NRS). Total administered
of patient controlled analgesia (PCA) with morphine as well as any rescue
doses were registered and patient satisfaction was recorded.
<br/>Result(s): Out of the 60 eligible patients, 56 patients were enrolled
in the study (with male predominance 51: 5). Enrollment at gabapentin,
pregabalin and placebo groups was (19, 18 and 19 respectively).
Post-operative patient satisfaction was better in the pregabalin group
with value 8.1 +/- 1.1 compared to 7.9 +/- 1 in the gabapentin group, and
6.7 +/- 1.2 in the placebo group (P < 0.001). The amount of post-operative
morphine PCA was lowest in the pregabalin group 22.4 +/- 6 versus 27.1 +/-
5.1 in the gabapentin group; with the highest was in the placebo
controlled group 31 +/- 5.1 (p < 0.001). <br/>Conclusion(s): Both
pregabalin and gabapentin were effective for reduction of post CABG
morphine consumption and had better patient satisfaction if given
preemptively as a single dose preoperatively.<br/>Copyright &#xa9; 2018

<81>
Accession Number
2000537654
Title
The effect of the timing and dose of dexmedetomidine on postoperative
delirium in elderly patients after laparoscopic major non-cardiac surgery:
A double blind randomized controlled study.
Source
Journal of Clinical Anesthesia. 47 (pp 27-32), 2018. Date of Publication:
June 2018.
Author
Lee C.; Lee C.H.; Lee G.; Lee M.; Hwang J.
Institution
(Lee, Lee, Lee) Department of Anesthesiology and Pain Medicine, Wonkwang
University School of Medicine, Iksang, South Korea
(Lee) Department of Anesthesiology and Pain Medicine, Konkuk University
School of Medicine, South Korea
(Hwang) Department of Orthopaedic Surgery, Hallym University Kangnam
Sacred Heart Hospital, Seoul, South Korea
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: There were few clinical data dosing and timing regimen
for preventing postoperative delirium. The present study aimed to
investigate the effect of the timing and dose of dexmedetomidine on
postoperative delirium in elderly patients after laparoscopic major
non-cardiac surgery. Patients and interventions: A total of 354 patients
>65 years of age undergoing laparoscopic major non-cardiac surgery under
general anesthesia received a dexmedetomidine 1 mug/kg bolus followed by
0.2-0.7 mug/kg/h infusion from induction of anesthesia to the end of
surgery [group D1]); a dexmedetomidine (1 mug/kg bolus [group D2]); or
saline (group S) 15 min before the end of surgery. Measurements: The
incidence and duration of delirium for 5 days after surgery and the
cytokine (tumor necrosis factor-alpha TNFalpha interleukin [IL]-1 beta
IL-2, IL-6, IL-8, and IL-10) and cortisol levels were measured 1 h and 24
h after surgery. <br/>Main Result(s): Group D1 reduced incidence and
duration of delirium and group D2 decreased its duration in patients with
delirium compared to group S. IL-6 levels were significantly lower at 1 h
and 24 h after surgery in group D1 than in group S, and lower at 24 h
after surgery than in group D2. IL-6 levels in group D2 were significantly
lower only at 1 h after surgery than in group S. However, IL-6 levels in
delirious patients in group D2 were significantly lower at 1 h and 24 h
after surgery than those in group S. Cortisol levels 1 h after surgery
were significantly lower in groups D1 and D2 than in group S.
<br/>Conclusion(s): The dose and timing of dexmedetomidine appeared to be
important in preventing delirium. The reduced incidence and duration of
delirium by dexmedetomidine was associated with reduced levels of IL-6 24
h after surgery.<br/>Copyright &#xa9; 2018

<82>
Accession Number
620158187
Title
Perioperative management of antiplatelet therapy in patients undergoing
non-cardiac surgery following coronary stent placement: A systematic
review.
Source
Systematic Reviews. 7 (1) (no pagination), 2018. Article Number: 4. Date
of Publication: 10 Jan 2018.
Author
Childers C.P.; Maggard-Gibbons M.; Ulloa J.G.; MacQueen I.T.; Miake-Lye
I.M.; Shanman R.; Mak S.; Beroes J.M.; Shekelle P.G.
Institution
(Childers, Maggard-Gibbons, MacQueen) David Geffen School of Medicine at
UCLA, Department of Surgery, 10833 Le Conte Ave., CHS 72-247, Los Angeles,
CA 90095, United States
(Childers, Mak) UCLA Fielding School of Public Health, Department of
Health Policy and Management, Los Angeles, CA, United States
(Maggard-Gibbons, Ulloa, MacQueen, Miake-Lye, Mak, Beroes, Shekelle)
Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA,
United States
(Ulloa) UCSF School of Medicine, Department of Surgery, San Francisco, CA,
United States
(Shanman) RAND Corporation, Santa Monica, CA, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The correct perioperative management of antiplatelet therapy
(APT) in patients undergoing non-cardiac surgery (NCS) is often debated by
clinicians. American College of Cardiology (ACC) and American Heart
Association (AHA) guidelines recommend postponing elective NCS at least 3
months after stent implantation. Regardless of the timing of surgery,
ACC/AHA guidelines recommend continuing at least ASA throughout the
perioperative period and ideally continuing dual APT (DAPT) therapy
"unless surgery demands discontinuation." The objective of this review was
to ascertain the risks and benefits of APT in the perioperative period, to
assess how these risks and benefits vary by APT management, and the
significance of length of time since stent implantation before operative
intervention. <br/>Method(s): PubMed, Web of Science, and Scopus were
searched from inception through October 2017. Articles were included if
patients were post PCI with stent placement (bare metal [BMS] or drug
eluting [DES]), underwent elective NCS, and had rates of major adverse
cardiac events (MACE) or bleeding events associated with pre and
perioperative APT therapy. <br/>Result(s): Of 4882 screened articles, we
included 16 studies in the review (1 randomized controlled trial and 15
observational studies). Studies were small (< 50: n = 5, 51-150: n = 5,
>150: n = 6). All studies included DES with 7 of 16 also including BMS.
Average time from stent to NCS was variable (< 6 months: n = 3, 6-12
months: n = 1, > 12 months: n = 6). At least six different APT strategies
were described. Six studies further utilized bridging protocols using
three different pharmacologic agents. Studies typically included multiple
surgical fields with varying degrees of invasiveness. Across all APT
strategies, rates of MACE/bleeding ranged from 0 to 21% and 0 to 22%.
There was no visible trend in MACE/bleeding rates within a given APT
strategy. Stratifying the articles by type of surgery, timing of
discontinuation of APT therapy, bridging vs. no bridging, and time since
stent placement did not help explain the heterogeneity.
<br/>Conclusion(s): Evidence regarding perioperative APT management in
patients with cardiac stents undergoing NCS is insufficient to guide
practice. Other clinical factors may have a greater impact than
perioperative APT management on MACE and bleeding events. Systematic
review registration: PROSPERO CRD42016036607.<br/>Copyright &#xa9; 2018
The Author(s).

<83>
Accession Number
622635366
Title
Catheter ablation of incisional atrial tachycardia using remote magnetic
navigation in patients after heart surgery: Comparison between acquired
and congenital heart disease.
Source
Europace. 20 (Supplement 2) (pp ii33-ii39), 2018. Date of Publication: 01
May 2018.
Author
Liu X.-Y.; Jacobsen P.K.; Pehrson S.; Chen X.
Institution
(Liu) Department of Cardiology, Wuxi People's Hospital Affiliated to
Nanjing Medical University, No 299, Qingyang Road, Wuxi 214023, China
(Liu, Jacobsen, Pehrson, Chen) Department of Cardiology, Heart Centre,
Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen
2100, Denmark
Publisher
Oxford University Press
Abstract
Aims The objectives of this study were to assess the acute and long-term
outcomes of catheter ablation in incisional atrial tachycardia (IAT) using
remote magnetic navigation (RMN) in patients after heart surgery. Methods
and results A total of 46 patients with IAT after heart surgery who
underwent catheter ablation using RMN were included. Of these patients, 22
patients had acquired heart disease (AHD) and the remaining 24 patients
had various types of congenital heart disease (CHD). In these 46 patients,
57 re-entry circuits were found in 56 procedures. The re-entry circuits
were mainly distributed in right atrium (RA). Acute success of first
ablation reached in 42 of 46 (91%) patients. Mean procedure duration was
115 +/- 39 min, ablation duration was 678 (920.5) s, X-ray time was 4
(4.8) min, and X-ray dose was 3 (6.0) gy cm 2. After a mean follow-up of
28 +/- 19 months, 39 of 46 (85%) patients were free from IAT. No major
complications were observed. There were no significant differences in
procedure durations (AHD 113 +/- 40 min vs. CHD 119 +/- 38 min), ablation
durations [AHD 643 (1027) s vs. CHD 712 (929) s], X-ray time [AHD 4 (4.5)
min vs. CHD 4 (5.0) min], circuits in RA (AHD 85% vs. CHD 86%), acute
success rates (AHD 91% vs. CHD 92%), and long-term success rates (AHD 86%
vs. CHD 83%) between the two groups (P > 0.05). Conclusion Catheter
ablation of IAT in patients after heart surgery using RMN is safe and
effective. No significant differences related to success rates and
procedure characteristics were found between patients with AHD and
CHD.<br/>Copyright &#xa9; The Author(s) 2018.

<84>
Accession Number
622994754
Title
Revascularization strategies in STEMI with multivessel disease: When and
how.
Source
Minerva Cardioangiologica. 66 (4) (pp 429-441), 2018. Date of Publication:
August 2018.
Author
D'Amico G.; Basile M.; Tarantini G.; Marchese A.
Institution
(D'Amico, Tarantini) Unit of Cardiology, Department of Cardiac, Thoracic,
and Vascular Sciences, University of Padua Medical School, Gallucci Heart
Center, Clinic of Cardiology, Via Giustiniani 2, Padua 35128, Italy
(Basile, Marchese) Unit of Cardiology, GVM Care and Research, Anthea
Hospital, Bari, Italy
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Acute ST-segment elevation myocardial infarction (STEMI) typically arises
from total occlusion of an epicardial coronary artery, most often due to
atherosclerotic plaque rupture/erosion and subsequent thrombus formation.
Granted this, important angiographic information for patients presenting
with STEMI is not only about the status of infarct-related artery (IRA)
but also about the atherosclerotic disease burden and disease severity of
non-IRA vessels. Previous studies have reported that multivessel coronary
artery disease is found in approximately 50% of patients with STEMI
undergoing primary percutaneous coronary intervention (PCI). Primary PCI
is now considered the gold standard in the treatment for patients with
STEMI; however, the optimal reperfusion strategy in patients with STEMI
and multivessel disease (MVD) remains uncertain. In this review, we
summarize the available evidence on treatment options for patients with
STEMI and MVD and highlight current guideline recommendations on this
topic.<br/>Copyright &#xa9; 2018 EDIZIONI MINERVA MEDICA.

<85>
Accession Number
2001161926
Title
Meta-Analysis Comparing Outcomes of Drug Eluting Stents Versus Single and
Multiarterial Coronary Artery Bypass Grafting.
Source
American Journal of Cardiology. 122 (12) (pp 2018-2025), 2018. Date of
Publication: 15 December 2018.
Author
Gaudino M.; Rahouma M.; Abouarab A.; Tam D.Y.; Di Franco A.; Leonard J.;
Benedetto U.; Iannaccone M.; D'Ascenzo F.; Biondi-Zoccai G.; Vallely M.;
Girardi L.N.; Fremes S.E.; Taggart D.P.
Institution
(Gaudino, Rahouma, Abouarab, Di Franco, Leonard, Girardi) Department of
Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United
States
(Tam, Fremes) Schulich Heart Centre, Sunnybrook Health Science, University
of Toronto, Toronto, Ontario, Canada
(Benedetto) School of Clinical Sciences, Bristol Heart Institute,
University of Bristol, Bristol, United Kingdom
(Iannaccone, D'Ascenzo) Citta della Scienza e della Salute, Department of
Cardiology, University of Turin, Torino, Italy
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University, Rome, Italy
(Biondi-Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed,
Pozzilli, Italy
(Vallely) Sydney Medical School, The University of Sydney, Sydney, New
South Wales, Australia
(Taggart) University of Oxford, Oxford, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Relative benefits of coronary artery bypass (CABG) using single and
multiple arterial grafting (SAG, MAG) and drug eluting stent (DES) in
multivessel coronary disease remain uncertain. We compared SAG, MAG, and
DES in a pairwise and network meta-analysis. Randomized trials and
adjusted observational studies comparing CABG versus DES were included
(primary end point: long-term mortality; secondary end points: operative
mortality, perioperative stroke, and follow-up repeated revascularization
[RR]). Studies with >=1.7 arterial grafts and/or patient were classified
as MAG. Bayesian network meta-analyses and random-model pairwise
meta-analyses were performed. A total of 53,239 patients (8 randomized, 17
observational studies) were included (26,306 DES; 26,933 CABG). In
pairwise comparison (mean follow-up: 5.42 years), CABG (MAG + SAG) was
associated with lower long-term mortality (incident rate ratio [IRR] 0.77,
95% confidence interval [CI] 0.66 to 0.90), lower RR (IRR 0.37, 95% CI
0.27 to 0.51), increased perioperative stroke (odds ratio [OR] 3.18, 95%
CI 1.70 to 5.97), and similar operative mortality (OR 1.04, 95% CI 0.64 to
1.70) compared with DES. There was a nonsignificant trend toward lower
long-term mortality for studies with higher mean number of arterial
grafts. In network meta-analyses, compared with DES, MAG was associated
with lower long-term mortality (IRR 0.72, 95% credible interval [CrI] 0.57
to 0.92) and late RR (IRR 0.32, 95% CrI 0.21 to 0.49), SAG was associated
with lower long-term mortality and RR (IRR 0.80, 95% CrI 0.66 to 0.97 and
IRR 0.42, 95% CrI 0.29 to 0.61, respectively). In conclusion, CABG was
associated with reduced 5-year mortality and need for RR compared with
DES. MAG was ranked as the best treatment for the primary and all
secondary outcomes.<br/>Copyright &#xa9; 2018

<86>
Accession Number
625167586
Title
Canadian Association of Cardiovascular Prevention and Rehabilitation 2018
Fall Conference Abstracts.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. Conference: 2018
Fall Conference of the Canadian Association of Cardiovascular Prevention
and Rehabilitation, CACPR 2018. Canada. 38 (6) (no pagination), 2018. Date
of Publication: November 2018.
Author
Anonymous
Publisher
Lippincott Williams and Wilkins
Abstract
The proceedings contain 23 papers. The topics discussed include: does
cardiac rehabilitation enhance mental and physical health in those with
atrial fibrillation? a matched case-control study; improvement of
functional capacity and quality of life in heart transplant recipients
after exercise training: a quasi-experimental study; nurses' mental
health: findings from the Champlain nurses' study; hemodynamic responses
to inspiratory muscle exercise in untreated hypertensive individuals: a
preliminary study; effectiveness of coronary heart disease self-management
after coronary intervention in an older patient population; do women and
men differ in baseline smoking characteristics and quit rates following
treatment with smoking cessation medications? a secondary analysis of the
flex study; what support needs do patients have after elective coronary
intervention?; the effectiveness of exercise on cognitive performance in
individuals with known vascular disease: a systematic review; effects of
home based exercise training on functional capacity and quality of life in
group 1 pulmonary hypertension: a sub-analysis from a randomized trial;
acute effect of inspiratory muscle exercise on cardiac autonomic control
in untreated hypertensive patients: does it appear to be safe?; importance
of completing hybrid cardiac rehabilitation for long-term outcomes: a
real-world evaluation; mind the heart: tracking men's mental health after
a cardiac event; and differences in cardiac rehabilitation outcomes
between complete and incomplete revascularization in post-PCI patients
with multivessel coronary artery disease.

<87>
Accession Number
625167505
Title
Promoting patient utilization of cardiac rehabilitation: Cochrane
systematic review and meta-analysis of randomized controlled trials.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. Conference: 2018
Fall Conference of the Canadian Association of Cardiovascular Prevention
and Rehabilitation, CACPR 2018. Canada. 38 (6) (pp E23), 2018. Date of
Publication: November 2018.
Author
Santiago Pio C.; Chaves G.S.S.; Davies P.; Taylor R.S.; Grace S.L.
Institution
(Santiago Pio, Grace) School of Kinesiology and Health Science, York
University, Toronto, ON, Canada
(Chaves) Rehabilitation Science Program, Federal University of Minas
Gerais, Belo Horizonte, Brazil
(Santiago Pio, Davies) School of Social and Community Medicine, University
of Bristol, Bristol, United Kingdom
(Taylor) Institute of Health Research, University of Exeter Medical
School, Exeter, United Kingdom
(Grace) Toronto Rehabilitation Institute, University Health Network,
University of Toronto, ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Background: International clinical practice guidelines routinely recommend
that cardiac patients participate in cardiac rehabilitation (CR) for
comprehensive secondary prevention. However, only approximately 30% of
patients utilize CR, despite its' proven benefits. We updated the previous
Cochrane review assessing interventions to increase patient enrolment,
adherence and completion of CR. <br/>Method(s): A search was performed in
April 2017 to identify studies published since the previous review. The
Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and
CINAHL, among other sources, were searched. Randomized controlled trials
in adults with myocardial infarction, angina, having coronary artery
bypass graft surgery, percutaneous coronary intervention, valve
procedures, heart failure (including transplant), or with rhythm disorders
or devices were included. Interventions had to aim to increase utilization
of comprehensive phase II CR. Two authors independently performed all
stages of citation processing. Outcomes were pooled using random-effects
meta-analysis, and meta-regression was undertaken to explore the impact of
pre-specified study characteristics. <br/>Result(s): 25 studies with 4985
(20.0% women) participants were included. The majority of studies were
assessed as having low risk of bias. There was a significant effect of
interventions in increasing program enrolment (19 arms; risk ratio [RR]
1.27, 95% confidence interval [CI] = 1.13-1.42). Meta-regression showed
that the intervention deliverer (nurse or allied healthcare provider, p =
.02) and delivery format (face-to-face, p = .01) were influential in
increasing enrolment. Interventions to increase adherence were also found
to be effective (4 trials; standard mean difference [SMD] 0.40, 95% CI =
0.13-0.67), particularly where remotely offered (SMD 0.73, 95% CI =
0.33-1.14). Interventions to increase program completion were also
significant (8 arms; RR = 1.13, 95% CI 1.02-1.25), but no effect modifiers
were identified. There was a moderate level of statistical heterogeneity
for each outcome (I2 = 61%, 57%, 47%, respectively). There was no evidence
of small study bias for any of the outcomes (Egger's p = 0.24, p = 0.68, p
= 0.97, respectively). Using GRADE, the quality of evidence was rated
moderate for all 3 outcomes. <br/>Conclusion(s): There is evidence that
interventions to increase utilization of CR are effective, however the
quality of evidence and the heterogeneity of approaches is moderate in
some cases. Enrolment interventions should target healthcare providers,
training nurses or allied healthcare providers to intervene face-to-face,
which could be feasibly achieved with inpatients at the bedside; adherence
interventions should contrarily be offered remotely, such as an online
intervention. More research is needed to understand specifically how to
increase completion, and to establish specific, implementable intervention
materials and protocols.

<88>
Accession Number
625176182
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) (pp 654), 2018. 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
(Bignami) Anesthesiology, Critical Care and Pain Medicine Division,
Department of Medicine and Surgery, University of Parma, Viale Gramsci 14,
Parma 43126, 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
Publisher
NLM (Medline)
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: 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.

<89>
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. <br/>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). <br/>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. <br/>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).
<br/>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)<br/>Copyright &#xa9; 2018

<90>
Accession Number
2001326374
Title
Antiplatelet effects of ticagrelor versus clopidogrel after coronary
artery bypass graft surgery: A single-center randomized controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Author
Xu F.; Feng W.; Zhou Z.; Zhang Y.; Diao X.; Hu S.; Zheng Z.
Institution
(Xu, Feng, Hu, Zheng) Department of Cardiovascular Surgery, Fuwai
Hospital, Chinese Academy of Medical Sciences, Peking Union Medical
College, Beijing, China
(Zhou, Zhang) Center of Laboratory Medicine, Beijing Key Laboratory for
Molecular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences,
Peking Union Medical College, Beijing, China
(Diao) Biostatistical Unit, Fuwai Hospital, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing, China
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The study objective was to compare the onset of platelet
inhibition (inhibition of platelet aggregation) between ticagrelor 90 mg
twice per day and clopidogrel 75 mg once per day in patients receiving
coronary artery bypass grafting. <br/>Method(s): In a single-center,
randomized, open-label study, 140 patients receiving coronary artery
bypass grafting were randomly assigned to the aspirin + ticagrelor group
or the aspirin + clopidogrel group in a 1:1 ratio. Participants in the
aspirin + ticagrelor group took aspirin 100 mg once per day and ticagrelor
90 mg twice per day. Participants in the aspirin + clopidogrel group took
aspirin 100 mg once per day and clopidogrel 75 mg once per day. Platelet
function was determined before study treatment (0 hours); at 2 hours, 8
hours, 24 hours, and 72 hours after medication; and during follow-up at 30
days after surgery. <br/>Result(s): Inhibition of platelet aggregation at
2 hours after the first drug administration was greater for the aspirin +
ticagrelor group than for the aspirin + clopidogrel group (34.2%
[interquartile range, 9.1-66.0] vs 5.3% [interquartile range, -14.3-22.0],
P <.001) and at all times in the study period (P <.001). More patients
reached inhibition of platelet aggregation maximum within 24 hours in the
aspirin + ticagrelor group than in the aspirin + clopidogrel group (52.9%
vs 27.5%, P =.006). The average inhibition of platelet aggregation maximum
from 2 to 24 hours was still greater in the aspirin + ticagrelor group
than in the aspirin + clopidogrel group (72.3% +/- 15.4% vs 49.2% +/-
46.8%, P <.001). There were no differences in terms of bleeding or major
adverse cardiac events between the 2 groups. <br/>Conclusion(s): In
patients receiving coronary artery bypass grafting, the onset of action
was faster and the peak inhibition of platelet aggregation was higher with
ticagrelor than with clopidogrel.<br/>Copyright &#xa9; 2018 The American
Association for Thoracic Surgery

<91>
Accession Number
2001326361
Title
Bioprosthetic aortic valve replacement in elderly patients: Meta-analysis
and microsimulation.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Author
Huygens S.A.; Etnel J.R.G.; Hanif M.; Bekkers J.A.; Bogers A.J.J.C.;
Rutten-van Molken M.P.M.H.; Takkenberg J.J.M.
Institution
(Huygens, Etnel, Hanif, Bekkers, Bogers, Takkenberg) Department of
Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam,
Netherlands
(Huygens, Rutten-van Molken) Institute for Medical Technology Assessment,
Rotterdam/Erasmus School of Health Policy and Management, Erasmus
University, Rotterdam, Netherlands
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: To support decision-making in aortic valve replacement (AVR) in
elderly patients, we provide a comprehensive overview of outcome after AVR
with bioprostheses. <br/>Method(s): A systematic review was conducted of
studies reporting clinical outcome after AVR with bioprostheses in elderly
patients (mean age >=70 years; minimum age >=65 years) published between
January 1, 2000, to January 9, 2016. Reported event rates and
time-to-event data were pooled and entered into a microsimulation model to
calculate life expectancy and lifetime event risks. <br/>Result(s):
Forty-two studies reporting on 34 patient cohorts were included,
encompassing a total of 12,842 patients with 55,437 patient-years of
follow-up (pooled mean follow-up 5.0 +/- 3.3 years). Pooled mean age was
76.5 +/- 5.5 years. Pooled early mortality risk was 5.42% (95% confidence
interval [CI], 4.49-6.55), thromboembolism rate was 1.83%/year (95% CI,
1.28-3.61), and bleeding rate was 0.75%/year (95% CI, 0.50-1.11).
Structural valve deterioration (SVD) was based on pooled time to SVD data
(Gompertz; shape: 0.124, rate: 0.003). For a 75-year-old patient, this
translated to an estimated life expectancy of 9.8 years (general
population: 10.2 years) and lifetime risks of bleeding of 7%,
thromboembolism of 17%, and reintervention of 9%. <br/>Conclusion(s): The
low risks of SVD and reintervention support the use of bioprostheses in
elderly patients in need of AVR. The estimated life expectancy after AVR
was comparable with the general population. The results of this study
inform patients and clinicians about the expected outcomes after
bioprosthetic AVR and thereby support treatment decision-making.
Furthermore, our results can be used as a benchmark for long-term outcomes
after transcatheter aortic valve implantation in patients who were
eligible for surgery and other (future) alternative treatments (eg,
tissue-engineered heart valves).<br/>Copyright &#xa9; 2018 The American
Association for Thoracic Surgery