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<1>
Accession Number
625723464
Title
Effect of intracoronary (IC) tirofiban following aspiration thrombectomyon
infarct size, in patients with large anterior ST segment elevation
myocardial infarction (STEMI) undergoing primary PCI.
Source
European Heart Journal Cardiovascular Imaging. Conference: 15th
International Congress on Cardiovascular Magnetic Resonance, EuroCMR 2017.
Czech Republic. 18 (Supplement 2) (pp ii78), 2017. Date of Publication:
May 2017.
Author
Basuoni A.; El-Naggar W.; Mahdy M.; Al-Kaffas S.
Institution
(Basuoni, El-Naggar, Mahdy, Al-Kaffas) Cairo university Hospitals,
Cardiology Department, Giza, Egypt
Publisher
Oxford University Press
Abstract
Objectives: To evaluate the effect of Intra-coronary delivery of bolus
Tirofiban following Aspiration Thrombectomy on reduction of infarct size
using cardiac magnetic resonance imaging (cMRI) in patients with large
anterior STEMI undergoing primary percutaneous coronary intervention
(PCI). Method(s): A Prospective single-blind randomized controlled
trial was conducted between August, 2014 and November, 2015. 50 patients
with large anterior STEMI were screened at 2 sites in one country (Egypt).
Aspiration Thrombectomy was performed in all patients using a 6 F
aspirationcatheter. Patients were randomized to ICT irofiban (Study
group)and no IC Tirofiban (control group). To ensure high intra-thrombus
drug concentrations, a 25mcg/kg bolus of Tirofiban was administered
locally at the site of the infarct lesion via the aspiration catheter
after flushing of the aspiration catheter well. Primary end point: Infarct
Size at 30 Days measured by cMRI. Secondary end point: Myocardial blush
grade at the end of the PCI procedure. Major Adverse Cardiac and
Cerebrovascular events (MACCE) at 30 days defined as re-infarction,
stroke, severe heart failure and death. Result(s): Evaluable MRI
results at 30 days where present in only 40 of 50 patients (80%), with the
most common reasons for missing data being patient re-infarction prior to
30 days and inability to tolerate the procedure. Patients randomized to IC
Tirofiban compared with no IC Tirofiban had a significant reduction at 30
days infarct size (median, 15451 mm3 - IQR, 17404 mm3 - n=20) vs (median,
43828 mm3 - IQR, 49599 mm3 - n=20) P value= 0.002. myocardial blush grade
results at the end of the PCI where present in 50 patients, randomized to
IC Tirofiban compared with no IC Tirofiban had no significant difference
(P value= 0.67). There is no significant difference in MACCE at 30 days
between patients received bolus IC Tirofiban and patients who did not
receive (P value= 0.723). Conclusion(s): In patients with large
anterior STEMI presenting early after symptom onset and undergoing primary
PCI, infarct size at 30 days was significantly reduced by bolus IC
Tirofiban delivered to the infarct lesion site following manual Aspiration
Thrombectomy.

<2>
Accession Number
625723181
Title
MRI vs. stress-echocardiography with dobutamine: In search of a better
method of diagnosis myocardial viability.
Source
European Heart Journal Cardiovascular Imaging. Conference: 15th
International Congress on Cardiovascular Magnetic Resonance, EuroCMR 2017.
Czech Republic. 18 (Supplement 2) (pp ii154), 2017. Date of Publication:
May 2017.
Author
Rustamova Y.A.; Azizov V.; Maximkin D.; Faibushevich A.
Institution
(Rustamova, Azizov) Azerbaijan Medical University, Baku, Azerbaijan
(Maximkin, Faibushevich) RUDN University, Moscow, Russian Federation
Publisher
Oxford University Press
Abstract
Objectives: to reveal the significance and efficiency of different
diagnostic methods of myocardial viability. Method(s): 214 patients
are included in study. Inclusion criteria: stable angina class
II-III(CCS): occlusion or subtotal stenosis of one or more coronary
arteries by angiography. Patients with acute coronary syndrome,
multivessel disease (SYNTAX score=>32) were excluded of the study. All
patients are randomized in 3 (three) groups. At1group (n =76) we used
cardiac magnetic resonance (CMR) with delayed enhancement imaging, at 2
group (n =78) - two-dimensional low dose Dobutamine stress
echocardiography (LDDSE), at III group (n-60) both of methods. Coronary
revascularization was performed to all patients with vcombined o assess
viable myocardium (VM) in the patients with previous myocardial infarction
(OMI) associated with congestive heart failure (CHF). Late follow-up of
intervention was planned for 18 months. Result(s): The mass of
hibernating myocardium was able to identify only in groups I and III,
where in indicators was 36 and 44% accordingly (p >0.05). Late follow-up
were done in 193 of 214 patients, from which 70 included in I group, 68 -
II group, 55 - III group. Control methods matched to initials. Summary of
cardiovascular complications was 2.8, 8.8 and 5,45% according to groups (p
<0,5), but by frequency of non-fatal MI wasn't revealed any significantly
differs, but repeated intervention on stented segment of arteries differs
at I and II groups (1,4 and 5.9% accordingly; p <0.05). To the end of
observation dynamic of recovery of wall motion abnormality was more
significant at I and III groups, nearly more than 30% compared to the II
group (p <0.05). Positive myocardial remodeling and significant increasing
of EF was marked in all groups. Strong positive correlation between
duration of myocardium hibernation and its function's recovery time was
revealed (r =0.54, p <0.05). I and III groups patient's hibernating
myocardium mass was significantly decrease to 37 and 34% accordingly (p
<0.05) Conclusion(s): CMR with delayed enhancements safe and
effective method of detection of myocardial viability, compared to low
dose Dobutamine stress-echocardiography allows significantly better
estimate dynamic functional recovery of hibernating myocardium and it's
remodeling after coronary revascularization. (Table Presented) .

<3>
Accession Number
623387581
Title
Epicardial left atrial appendage AtriClip occlusion reduces the incidence
of stroke in patients with atrial fibrillation undergoing cardiac surgery.
Source
Europace. 20 (7) (pp e105-e114), 2018. Date of Publication: 01 Jul 2018.
Author
Caliskan E.; Sahin A.; Yilmaz M.; Seifert B.; Hinzpeter R.; Alkadhi H.;
Cox J.L.; Holubec T.; Reser D.; Falk V.; Grunenfelder J.; Genoni M.;
Maisano F.; Salzberg S.P.; Emmert M.Y.
Institution
(Caliskan, Sahin, Yilmaz, Holubec, Reser, Genoni, Maisano, Emmert) Clinic
for Cardiovascular Surgery, University Hospital Zurich, University of
Zurich, Raemistrasse 100, Zurich, Switzerland
(Caliskan, Falk) Department of Cardiovascular Surgery, Charite
Universitatsmedizin Berlin, Chariteplatz 1, Berlin, Germany
(Caliskan, Falk) Department of Cardiothoracic and Vascular Surgery, German
Heart Institute Berlin, Augustenburger Platz 1, Berlin, Germany
(Seifert) Department of Biostatistics, Epidemiology, Biostatistics and
Prevention Institute, University of Zurich, Hirschengraben 84, Zurich,
Switzerland
(Hinzpeter, Alkadhi) Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich, Raemistrasse 100,
Zurich, Switzerland
(Cox) Feinberg School of Medicine, Northwestern University, Arthur J.
Rubloff Building, 420 East Superior Street, Chicago, IL, United States
(Grunenfelder, Salzberg) HeartClinic, Hirslanden Hospital,
Witellikerstrasse 40, Zurich, Switzerland
Publisher
Oxford University Press
Abstract
Aims Left atrial appendage (LAA) occlusion has emerged as an interesting
alternative to oral anticoagulation (OAC) for stroke prevention in
patients with atrial fibrillation (AF). We report the safety, efficacy,
and durability of concomitant device-enabled epicardial LAA occlusion
during open-heart surgery. In addition to long-term follow-up, we evaluate
the impact on stroke risk in this selected population. Methods and results
A total of 291 AtriClip devices were deployed epicardially in patients
(mean CHA2DS2-VASc-Score: 3.1+/- 1.5) undergoing open-heart surgery
(including isolated coronary artery bypass grafting, valve, or combined
procedures) comprising of forty patients from a first-in-man device trial
(NCT00567515) and 251 patients from a consecutive institutional registry
thereafter. In all patients (n= 291), the LAA was successfully excluded
and overall mean follow-up (FU) was 36+/- 23months (range: 1?97months). No
device-related complications were detected throughout the FU period.
Longterm imaging work-up (computed tomography) in selected patients
>5years post-implant (range: 5.1?8.1 years) displayed complete LAA
occlusion with no signs of residual reperfusion or significant LAA stumps.
Subgroup analysis of patients with discontinued OAC during FU (n= 166)
revealed a relative risk reduction of 87.5% with an observed ischaemic
stroke-rate of 0.5/100 patient-years compared with what would have been
expected in a group of patients with similar CHA2DS2-VASc scores (expected
rate of 4.0/100 patient-years). No strokes occurred in the subgroup with
OAC. Conclusion The long-term results from our first-in-man prospective
human trial plus our institutional registry of epicardial LAA occlusion
with the AtriClip in patients with AF undergoing cardiac surgery
demonstrate the safety and durability of the procedure. In addition, our
data are suggestive for the potential efficacy of LAA occlusion in
reducing the incidence of stroke. If validated in future large randomized
trials, routine LAA occlusion in patients undergoing cardiac surgery (with
contraindications to treatment with oral anticoagulants) may represent a
reasonable adjunct procedure to reduce the risk of future
stroke. Copyright ©The Author(s) 2018.

<4>
Accession Number
616643553
Title
Standardized uptake values in FDG PET/CT for prosthetic heart valve
endocarditis: a call for standardization.
Source
Journal of Nuclear Cardiology. 25 (6) (pp 2084-2091), 2018. Date of
Publication: 15 Dec 2018.
Author
Scholtens A.M.; Swart L.E.; Kolste H.J.; Budde R.P.J.; Lam M.G.E.H.;
Verberne H.J.
Institution
(Scholtens) Department of Nuclear Medicine, Meander Medical Center,
Maatweg 3, Amersfoort 3813TZ, Netherlands
(Swart, Budde) Department of Radiology and Nuclear Medicine, Erasmus
Medical Center, Rotterdam, Netherlands
(Kolste) Department of Cardiology, VU Medical Center, Amsterdam,
Netherlands
(Lam) Department of Radiology and Nuclear Medicine, University Medical
Center, Utrecht, Netherlands
(Verberne) Department of Radiology and Nuclear Medicine, Academic Medical
Center, Amsterdam, Netherlands
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: The significance of and threshold values for the standardized
uptake value (SUV) in FDG PET/CT to diagnose prosthetic heart valve (PHV)
endocarditis (PVE) are unclear at present. Method(s): A literature
search was performed in the PubMed and EMBASE medical databases,
comprising the following terms: (FDG OR *fluorode* OR *fluoro-de*) AND
(endocarditis OR prosthetic heart valve OR valve replacement). Studies
reporting SUVs correlated to the diagnosis of PVE were selected for
analysis. Result(s): 8 studies were included, with a total of 330
PHVs assessed. SUVs for PVE varied substantially across studies due to
differences in acquisition, reconstruction, and measurement protocols,
with median SUVmax values for rejected PVE ranging from 0.5 to 4.9 and for
definite PVE ranging from 4.2 to 7.4. Conclusion(s): Reported SUV
values for PVE are not interchangeable between sites, and further
standardization of quantification is desirable. To this end, optimal
protocols for patient preparation, image acquisition, and reconstruction
and measurement methods need to be standardized across
centers. Copyright © 2017, The Author(s).

<5>
Accession Number
619490713
Title
The ratio of circulating regulatory cluster of differentiation 4 T cells
to endothelial progenitor cells predicts clinically significant acute
rejection after heart transplantation.
Source
Journal of Heart and Lung Transplantation. 37 (4) (pp 496-502), 2018. Date
of Publication: April 2018.
Author
Choi D.-H.; Chmura S.A.; Ramachandran V.; Dionis-Petersen K.Y.; Kobayashi
Y.; Nishi T.; Luikart H.; Dimbil S.; Kobashigawa J.; Khush K.; Lewis D.B.;
Fearon W.F.
Institution
(Choi, Kobayashi, Nishi, Luikart, Khush, Fearon) Division of
Cardiovascular Medicine, Stanford University Medical Center, Stanford,
California, United States
(Choi) Department of Internal Medicine, Chosun University School of
Medicine, Gwangju, South Korea
(Chmura, Ramachandran, Dionis-Petersen, Lewis) Division of Allergy,
Immunology, and Rheumatology, Department of Pediatrics, Stanford
University School of Medicine, Stanford, California, United States
(Dimbil, Kobashigawa) Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, California, United States
Publisher
Elsevier USA
Abstract
Background: The aim of this study was to determine the value of the ratio
of the percentage of circulating regulatory cluster of differentiation 4 T
cells (%Tregs) to the percentage of endothelial progenitor cells (%EPCs;
Treg/EPC ratio) for predicting clinically significant acute rejection.
 Method(s): Peripheral blood %Tregs and %EPCs were quantified in 91
cardiac transplant recipients using flow cytometry at a mean of 42 +/- 13
days after transplant. The primary end point was clinically significant
acute rejection, defined as an event that led to an acute augmentation of
immunosuppression in conjunction with an International Society for Heart
and Lung Transplantation grade >= 2R in a right ventricular endomyocardial
biopsy specimen or non-cellular rejection (specimen-negative rejection)
with hemodynamic compromise (decrease in left ventricular ejection
fraction by > 25%). Result(s): Significant rejection occurred in 27
recipients (29.7%) during a median of 49.4 months (interquartile range,
37.0-62.0 months). The mean %Tregs and %EPCs were not significantly
different between those with and without an episode of significant
rejection, but the mean Treg/EPC ratio was significantly lower in
recipients with significant rejection (44.9 vs 106.7, p = 0.001). Receiver
operating characteristic curve analysis showed an area under the curve
value for significant rejection for a Treg/EPC ratio of 0.712. The best
cutoff value of the Treg/EPC ratio that distinguished between those with
or without significant rejection was <= 18 by receiver operating
characteristic curve analysis. Kaplan-Meier analysis revealed that
patients with a Treg/EPC ratio of <= 18 had a significantly higher rate of
rejection than those with a Treg/EPC ratio > 18 (61.5% vs 16.9%, log-rank
p < 0.0001). A low Treg/EPC ratio was an independent predictor of
significant rejection. Conclusion(s): A low Treg/EPC ratio measured
soon after heart transplantation is an independent predictor of acute
rejection. The Treg/EPC ratio has potential as an early biomarker after
heart transplantation for predicting acute rejection. Copyright ©
2018

<6>
Accession Number
2001260983
Title
Meta-analysis Comparing Culprit Vessel Only Versus Multivessel
Percutaneous Coronary Intervention in Patients With Acute Myocardial
Infarction and Cardiogenic Shock.
Source
American Journal of Cardiology. 123 (2) (pp 218-226), 2019. Date of
Publication: 15 January 2019.
Author
Khan M.S.; Siddiqi T.J.; Usman M.S.; Riaz H.; Khan A.R.; Murad M.H.; Kalra
A.; Figueredo V.M.; Bhatt D.L.
Institution
(Khan) Department of Internal Medicine, John H. Stroger Jr. Hospital of
Cook County, Chicago, IL, United States
(Siddiqi, Usman) Department of Internal Medicine, Dow University of Health
Sciences, Karachi, Pakistan
(Riaz) Department of Cardiology, Cleveland Clinic, Cleveland, OH, United
States
(Khan) Department of Cardiology, University of Louisville, Louisville,
Kentucky, United Kingdom
(Murad) Evidence-Based Practice Center, Mayo Clinic, Rochester, NY, United
States
(Kalra) Harrington Heart & Vascular Institute, University Hospitals
Cleveland Medical Center, Division of Cardiovascular Medicine, Department
of Medicine, Case Western Reserve University School of Medicine,
Cleveland, OH, United States
(Figueredo) Department of Cardiology, Institute for Heart & Vascular
Health, Einstein Medical Center, Philadelphia, PA, United States
(Figueredo) Department of Medicine, Sidney Kimmel College of Medicine,
Thomas Jefferson University, Philadelphia, PA, United States
(Bhatt) Department of Cardiology, Brigham and Women's Hospital Heart &
Vascular Center, Harvard Medical School, Boston, MA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Cardiogenic shock (CS) after a myocardial infarction continues to be
associated with high mortality. Whether percutaneous coronary intervention
(PCI) of noninfarct coronary arteries (multivessel intervention [MVI])
improves outcomes in CS after acute myocardial infarction (AMI) remains
controversial. MEDLINE, Cochrane CENTRAL, and Scopus databases were
searched for original studies comparing MVI with culprit-vessel
intervention (CVI) in AMI patients with multivessel disease and CS. Risk
ratios (RRs) and 95% confidence intervals were calculated and pooled using
a random effects model. Thirteen studies, consisting of 7,906 patients
(n<inf>MVI</inf> = 1,937; n<inf>CVI</inf> = 5,969), were included in this
meta-analysis. Overall, the MVI and CVI groups did not differ
significantly in the risk of short-term mortality (RR: 1.06 [0.91, 1.23];
p = 0.45; I2 = 75.82%), long-term mortality (RR: 0.93 [0.78,
1.11]; p = 0.37; I2 = 67.92%), reinfarction (RR: 1.16 [0.75,
1.79]; p = 0.50; I2 = 0%), revascularization (RR: 0.84 [0.48,
1.47]; p = 0.54; I2 = 83.01%), bleeding (RR: 1.15 [0.96, 1.38];
p = 0.09, I2 = 0%), or stroke (RR: 1.29 [0.86, 1.94]; p = 0.80,
I2 = 0%). However, significantly increased risk of renal
failure was seen in the MVI group (RR: 1.35 [1.10, 1.66]; p = 0.004;
I2 = 0%). On subgroup analysis, it was seen that results from
retrospective studies showed higher short-term mortality in the MVI group
in comparison with prospective studies (p = 0.003). The certainty in
estimates is low due to the largely observational nature of the evidence.
In conclusion, MVI provides no additional reduction in short- or long-term
mortality in AMI patients with multivessel disease and CS. Additionally,
the risk of renal failure may be higher with the use of MVI. Copyright
© 2018

<7>
Accession Number
625580520
Title
Coronary CTA reduced risk for coronary events at 5 years in patients with
stable chest pain.
Source
Annals of Internal Medicine. 169 (12) (pp JC70), 2018. Date of
Publication: 18 Dec 2018.
Author
Newby D.E.; Hudson M.P.
Institution
(Newby) University of Edinburgh, Edinburgh, United Kingdom
(Hudson) Henry Ford Hospital, Detroit, MI, United States
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<8>
Accession Number
625580513
Title
In patients with chest pain, HEART Pathway-guided and usual care did not
differ for MACE or health care use.
Source
Annals of Internal Medicine. 169 (12) (pp JC69), 2018. Date of
Publication: 18 Dec 2018.
Author
Stopyra J.P.; Limkakeng A.T.; Granger C.B.
Institution
(Stopyra) Wake Forest School of Medicine, Winston-Salem, NC, United States
(Limkakeng, Granger) Duke University, Durham, NC, United States
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<9>
Accession Number
625580493
Title
Changing to oral antibiotics was noninferior to continuing IV antibiotics
in left-sided infective endocarditis.
Source
Annals of Internal Medicine. 169 (12) (pp JC65), 2018. Date of
Publication: 18 Dec 2018.
Author
Bundgaard H.; Zar F.A.
Institution
(Bundgaard) Copenhagen University Hospital, Copenhagen, Denmark
(Zar) University of Illinois at Chicago, Chicago, IL, United States
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<10>
Accession Number
625468090
Title
Prevention of post-operative complications by using a HMG-CoA reductase
inhibitor in patients undergoing one-lung ventilation for non-cardiac
surgery: Study protocol for a randomised controlled trial 11 Medical and
Health Sciences 1103 Clinical Sciences 11 Medical and Health Sciences 1102
Cardiorespiratory Medicine and Haematology.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 690. Date of
Publication: 18 Dec 2018.
Author
Shyamsundar M.; O'Kane C.; Perkins G.D.; Kennedy G.; Campbell C.; Agus A.;
Phair G.; McAuley D.
Institution
(Shyamsundar, O'Kane, McAuley) Centre for Experimental Medicine, Queen's
University Belfast, Belfast BT9 7BL, United Kingdom
(Perkins) Warwick Trials Unit, University of Warwick, Coventry CV4 7AL,
United Kingdom
(Kennedy, Campbell, Agus, Phair) Northern Ireland Clinical Trials Unit,
Royal Hospitals, 1st Floor Elliott Dynes Building, Belfast BT12 6BA,
United Kingdom
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative pulmonary complications (PPC) and peri-operative
myocardial infarction (MI) have a significant impact on the long-term
mortality of surgical patients. Patients undergoing one-lung ventilation
(OLV) for surgery are at a high risk of developing these complications.
These complications could be associated with intensive care unit (ICU)
admissions and longer hospital stay with associated resource and economic
burden. Simvastatin, a HMG-CoA reductase enzyme inhibitor has been shown
to have pleiotropic anti-inflammatory effects as well as being endothelial
protective. The benefits of statins have been shown in various
observational studies and in small proof-of-concept studies. There is an
urgent need for a well-designed, large clinical trial powered to detect
clinical outcomes. The Prevention HARP 2 trial will test the hypothesis
'simvastatin 80 mg when compared to placebo will reduce cardiac and
pulmonary complications in patients undergoing elective oesophagectomy,
lobectomy or pneumonectomy'. Methods/design: The Prevention HARP 2 trial
is a UK multi-centre, randomised, double-blind, placebo-controlled trial.
Adult patients undergoing elective oesophagectomy, lobectomy or
pneumonectomy will be eligible. Patients who are already on statins will
be excluded from this trial. Patients will be randomised to receive
simvastatin 80 mg or matched placebo for 4 days pre surgery and for up to
7 days post surgery. The primary outcome is a composite outcome of PPC and
MI within 7 days post surgery. Various secondary outcome measures
including clinical outcomes, safety outcomes and health economic outcomes
will be collected. The study aims to recruit 452 patients in total across
12 UK sites. Discussion(s): The results of the Prevention HARP 2
trial should add to our understanding of the benefits of peri-operative
statins and influence clinical decision-making. Analysis of blood and
urine samples from the patients will provide insight into the mechanism of
simvastatin action. Trial registration: International Standard Randomised
Controlled Trials registry, ID: ISRCTN48095567. Registered on 11 November
2016. Copyright © 2018 The Author(s).

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

<12>
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Accession Number
625705834
Title
Short- and long-term impact of remifentanil on thermal detection and pain
thresholds after cardiac surgery: A randomised controlled trial.
Source
European journal of anaesthesiology. 36 (1) (pp 32-39), 2019. Date of
Publication: 01 Jan 2019.
Author
de Hoogd S.; Valkenburg A.J.; van Dongen E.P.A.; Daeter E.J.; van Rosmalen
J.; Dahan A.; Tibboel D.; Knibbe C.A.J.
Institution
(de Hoogd) From the Department of Clinical Pharmacy, St. Antonius
Hospital, Nieuwegein (SdH, CAJK), Intensive Care and Department of
Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam
(AJV, DT, CAJK), Department of Anaesthesiology and Intensive Care (EPAvD),
Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein
(EJD), Department of Biostatistics, Erasmus MC, Rotterdam (JvR),
Department of Anaesthesiology, Leiden University Medical Centre (AD) and
Division of Pharmacology, Leiden Academic Centre for Drug Research, Leiden
University, Leiden, The Netherlands (CAJK)
Publisher
NLM (Medline)
Abstract
BACKGROUND: The clinical relevance of the suggested hyperalgesic effects
of remifentanil is still unclear, especially in the long term.
 OBJECTIVE(S): The current study evaluated the impact of remifentanil
on thermal thresholds 3 days and 12 months after surgery, measured with
Quantitative Sensory Testing. DESIGN: A single-blind, randomised
controlled trial. SETTING: A tertiary care teaching hospital in The
Netherlands, from 2014 to 2016. PATIENTS: A total of 126 patients aged
between 18 and 85 years, undergoing cardiothoracic surgery via sternotomy
(coronary artery bypass grafts and/or valve replacement) were included.
Exclusion criteria were BMI above 35 kg m, history of cardiac surgery,
chronic pain conditions, neurological conditions, allergy to opioids or
paracetamol, language barrier and pregnancy. INTERVENTIONS: Patients were
allocated randomly to receive intra-operatively either a continuous
remifentanil infusion or intermittent intra-operative fentanyl as needed
in addition to standardised anaesthesia with propofol and intermittent
intravenous fentanyl at predetermined time points. MAIN OUTCOME MEASURES:
Warm and cold detection and pain thresholds 3 days and 12 months after
surgery. In addition the use of remifentanil, presence of postoperative
chronic pain, age, opioid consumption and pre-operative quality of life
were tested as a predictor for altered pain sensitivity 12 months after
surgery. RESULT(S): Both warm and cold detection, and pain
thresholds, were not significantly different between the remifentanil and
fentanyl groups 3 days and 12 months after surgery (P > 0.05). No
significant predictors for altered pain sensitivity were identified.
 CONCLUSION(S): Earlier reports of increased pain sensitivity 1 year
after the use of remifentanil could not be confirmed in this randomised
study using Quantitative Sensory Testing. This indicates that remifentanil
plays a minor role in the development of chronic thoracic pain. Still, the
relatively high incidence of chronic thoracic pain and its accompanying
impact on quality of life remain challenging problems. TRIAL REGISTRATION:
The study was registered at EudraCT (ref: 2013-000201-23) and
ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT02031016).

<13>
Accession Number
623313980
Title
Inhaled levosimendan versus intravenous levosimendan in patients with
pulmonary hypertension undergoing mitral valve replacement.
Source
Annals of Cardiac Anaesthesia. 21 (3) (pp 328-332), 2018. Date of
Publication: July-September 2018.
Author
Kundra T.S.; Nagaraja P.S.; Bharathi K.S.; Kaur P.; Manjunatha N.
Institution
(Kundra, Nagaraja, Bharathi, Manjunatha) Department of Cardiac
Anaesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and
Research, Bengaluru, Karnataka, India
(Kaur) Department of Critical Care, Sir Ganga Ram Hospital, New Delhi,
India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Context: Inhaled levosimendan may act as selective pulmonary vasodilator
and avoid systemic side effects of intravenous levosimendan, which include
decrease in systemic vascular resistance (SVR) and systemic hypotension,
but with same beneficial effect on pulmonary artery pressure (PAP) and
right ventricular (RV) function. Aim(s): The aim of this study was to
compare the effect of inhaled levosimendan with intravenous levosimendan
in patients with pulmonary hypertension undergoing mitral valve
replacement. Settings and Design: The present prospective randomized
comparative study was conducted in a tertiary care hospital. Subjects and
Methods: Fifty patients were randomized into two groups (n = 25). Group A:
Levosimendan infusion was started immediately after coming-off of
cardiopulmonary bypass and continued for 24 h at 0.1 mcg/kg/min. Group B:
Total dose of levosimendan which would be given through intravenous route
over 24 h was calculated and then divided into four equal parts and
administered through inhalational route 6th hourly over 24 h.
Hemodynamic profile (pulse rate, mean arterial pressure, pulmonary artery
systolic pressure [PASP], SVR) and RV function were assessed immediately
after shifting, at 1, 8, 24, and 36 h after shifting to recovery.
Statistical Analysis Used: Intragroup analysis was done using paired
student t-test, and unpaired student t-test was used for analysis between
two groups. Result(s): PASP and RV-fractional area change (RV-FAC)
were comparable in the two groups at different time intervals. There was a
significant reduction in PASP and significant improvement in RV-FAC with
both intravenous and inhalational levosimendan. SVR was significantly
decreased with intravenous levosimendan, but no significant decrease in
SVR was observed with inhalational levosimendan. Conclusion(s):
Inhaled levosimendan is a selective pulmonary vasodilator. It causes
decrease in PAP and improvement in RV function, without having a
significant effect on SVR. Copyright © 2018 Medknow Publications.
All rights reserved.

<14>
Accession Number
623313977
Title
Comparison of continuous thoracic epidural analgesia with bilateral
erector spinae plane block for perioperative pain management in cardiac
surgery.
Source
Annals of Cardiac Anaesthesia. 21 (3) (pp 323-327), 2018. Date of
Publication: July-September 2018.
Author
Nagaraja P.S.; Ragavendran S.; Singh N.G.; Asai O.; Bhavya G.; Manjunath
N.; Rajesh K.
Institution
(Nagaraja, Ragavendran, Singh, Asai, Bhavya, Manjunath) Departments of
Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences
and Research, Bengaluru, Karnataka, India
(Rajesh) CTVS, Sri Jayadeva Institute of Cardiovascular Sciences and
Research, Bengaluru, Karnataka, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Objective: Continuous thoracic epidural analgesia (TEA) is compared with
erector spinae plane (ESP) block for the perioperative pain management in
patients undergoing cardiac surgery for the quality of analgesia,
incentive spirometry, ventilator duration, and intensive care unit (ICU)
duration. Methodology: A prospective, randomized comparative clinical
study was conducted. A total of 50 patients were enrolled, who were
randomized to either Group A: TEA (n = 25) or Group B: ESP block (n = 25).
Visual analog scale (VAS) was recorded in both the groups during rest and
cough at the various time intervals postextubation. Both the groups were
also compared for incentive spirometry, ventilator, and ICU duration.
Statistical analysis was performed using the independent Student's t-test.
A value of P < 0.05 was considered statistically significant.
 Result(s): C omparable VAS scores were revealed at 0 h, 3 h, 6 h, and
12 h (P > 0.05) at rest and during cough in both the groups. Group A had a
statistically significant VAS score than Group B (P <= 0.05) at 24 h, 36
h, and 48 h but mean VAS in either of the Group was <=4 both at rest and
during cough. Incentive spirometry, ventilator, and ICU duration were
comparable between the groups. Conclusion(s): ESP block is easy to
perform and can serve as a promising alternative to TEA in optimal
perioperative pain management in cardiac surgery. Copyright ©
2018 Medknow Publications. All rights reserved.

<15>
Accession Number
623313928
Title
Sedation effects by dexmedetomidine versus propofol in decreasing duration
of mechanical ventilation after open heart surgery.
Source
Annals of Cardiac Anaesthesia. 21 (3) (pp 235-242), 2018. Date of
Publication: July-September 2018.
Author
Elgebaly A.S.; Sabry M.
Institution
(Elgebaly) Department of Anesthesia and PSIC, Faculty of Medicine, Tanta
University, Tanta, Gharbia 31111, Egypt
(Sabry) Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta
University Hospital, Tanta, Gharbia 31111, Egypt
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Objective: The objective of this study was to compare the suitability
(efficacy and safety) of dexmedetomidine versus propofol for patients
admitted to the intensive care unit (ICU) after the cardiovascular surgery
for the postoperative sedation before weaning from mechanical ventilation.
 Background(s): Sedation is prescribed in patients admitted to the ICU
after cardiovascular surgery to reduce the patient discomfort, ventilator
asynchrony, to make mechanical ventilation tolerable, prevent accidental
device removal, and to reduce metabolic demands during respiratory and
hemodynamic instability. Careful drug selection for sedation by the ICU
team, postcardiovascular surgery should be done so that patients can be
easily weaned from mechanical ventilation after sedation is stopped to
achieve a shorter duration of mechanical ventilation and decreased the
length of stay in ICU. Method(s): A total of 50 patients admitted to
the ICU after cardiovascular surgery, aged from 18 to 55 years and
requiring mechanical ventilation on arrival to the ICU were enrolled in a
prospective and comparative study. They were randomly divided into two
groups as follows: Group D patients (n = 25) received dexmedetomidine in a
maintenance infusion dose of 0.8 mug/kg/h and Group P patients (n = 25)
received propofol in a maintenance infusion dose of 1.5 mg/kg/h. The
patients were assessed for 12 h postoperatively, and dosing of the study
drug was adjusted based on sedation assessment performed with the Richmond
Agitation-Sedation Scale (RASS). The patients were required to be within
the RASS target range of -2 to +1 at the time of study drug initiation. At
every 4 h, the following information was recorded from each patient such
as heart rate (HR), mean arterial pressure (MAP), arterial blood gases
(ABG), tidal volume (TV), exhaled TV, maximum inspiratory pressure,
respiratory rate and the rapid shallow breathing index, duration of
mechanical ventilation, midazolam and fentanyl dose requirements, and
financial costs. Result(s): The study results showed no statistically
significant difference between both groups with regard to age and body
mass index. Group P patients were more associated with lower MAP and HR
than Group D patients. There was no statistically significant difference
between groups with regard to ABG findings, oxygenation, ventilation, and
respiratory parameters. There was significant difference between both the
groups in midazolam and fentanyl dose requirement and financial costs with
a value of P < 0.05. Conclusion(s): Dexmedetomidine is safer and
equally effective agent for the sedation of mechanically ventilated
patients admitted to the ICU after cardiovascular surgery compared to the
patients receiving propofol, with good hemodynamic stability, and equally
rapid extubation time. Copyright © 2018 Medknow Publications. All
rights reserved.

<16>
Accession Number
2001156838
Title
Open-labeled randomized controlled trial to evaluate the 1-year clinical
outcomes of polymer-free sirolimus-eluting coronary stents as compared
with biodegradable polymer-based sirolimus-eluting coronary stents.
Source
Indian Heart Journal. 70 (Supplement 3) (pp S323-S328), 2018. Date of
Publication: December 2018.
Author
Viswanathan S.; Gopinath K.; Koshy G.; Gupta P.N.; Velappan P.
Institution
(Viswanathan, Gopinath, Koshy, Gupta, Velappan) Department of Cardiology,
Government Medical College and Hospital, Thiruvananthapuram, Kerala
695011, India
Publisher
Elsevier B.V.
Abstract
Background: Head to head trials of clinical outcomes of sirolimus eluting
polymer free vs. biodegradable polymer stents are lacking. Method(s):
Single centre prospective open labeled randomised controlled clinical
trial. Basis for sample size calculation was the rate of MACE from the
ISAR TEST 3 trial in which the absolute difference was 10.25% with a
standard deviation of 0.24. Assuming null hypothesis, 80% power and 5%
alpha error, to detect a 10% difference, adjusting for 10% loss of follow
up, sample size was 204. Inclusion criteria: Patients with stable coronary
artery disease or recent acute coronary syndrome (>1 week from the date of
STEMI), being taken up for elective angioplasty. End points: Primary end
point was MACE at 1 year and secondary end points at the end of 1 year
were cardiac death, urgent target lesion revascularization, acute coronary
syndrome, stroke and in-stent re-stenosis. Result(s): 204 patients
were enrolled between January 2013 to July 2014, 91 in the polymer-free
group and 113 in the biodegradable polymer group. Baseline characteristics
were comparable between both groups. 21 patients (10.29%), were lost to
follow up. MACE at 1 year were comparable in both the groups 3 of
85(3.52%) in the polymer-free group and 3 of 98(3.06%) in the
biodegradable polymer group, p = 0.859. The secondary end points were also
comparable between the two groups- Death- 1 of 85(1.17%) vs. 2 of
98(2.04%), p = 0.646, Stroke 0 of 85 vs. 2 of 98(2.04%), p = 0.185 and
acute coronary syndrome - 2 of 85(2.35%) vs. 1 of 98(1.02%), p = 0.204.
There were no instances of urgent target lesion re-vascularisation or
definite stent thrombosis in either groups. In stent re-stenosis was found
in 7 of 85(8.2%) in the polymer-free group vs. 6 of 98(6.12%) in the
biodegradable polymer group. Conclusion(s): The 1 year MACE rates are
comparable in patients who underwent elective coronary revascularization
using sirolimus eluting polymer-free and biodegradable polymer
stents. Copyright © 2018 Cardiological Society of India

<17>
Accession Number
2001410228
Title
Polyvascular disease, type 2 diabetes, and long-term vascular risk: a
secondary analysis of the IMPROVE-IT trial.
Source
The Lancet Diabetes and Endocrinology. 6 (12) (pp 934-943), 2018. Date of
Publication: December 2018.
Author
Bonaca M.P.; Gutierrez J.A.; Cannon C.; Giugliano R.; Blazing M.; Park
J.-G.; White J.; Tershakovec A.; Braunwald E.
Institution
(Bonaca, Cannon, Giugliano, Park, Braunwald) Cardiovascular Division,
Brigham and Women's Hospital, Boston, MA, United States
(Bonaca, Cannon, Giugliano, Park, Braunwald) Department of Medicine,
Harvard Medical School, Boston, MA, United States
(Gutierrez, Blazing, White) Duke Clinical Research Institute, Duke
University School of Medicine, Durham, NC, United States
(Tershakovec) Merck, Kenilworth, NJ, United States
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Polyvascular disease and type 2 diabetes are each associated
with increased cardiovascular risk, but whether these risks are additive
is unknown. In this exploratory analysis of a randomised trial, we
explored the long-term cardiovascular risk associated with polyvascular
disease, type 2 diabetes, and their combination in patients with acute
coronary syndrome, and assessed the effect of ezetimibe given on top of
statin therapy in patients with these concomitant conditions.
 Method(s): IMPROVE-IT was a multicentre, double-blind, randomised,
placebo-controlled trial assessing the effect of ezetimibe added to statin
therapy after acute coronary syndrome. Recruitment was from Oct 26, 2005,
to July 8, 2010, and the trial was done at 1158 sites in 39 countries. 18
144 patients aged 50 years and older who had been stabilised after an
acute coronary syndrome were randomly assigned to 40 mg per day
simvastatin plus either 10 mg per day ezetimibe or matched placebo, for a
median duration of 6 years. In this post-hoc exploratory analysis, we
assessed the prespecified endpoints of the trial, including the primary
composite endpoint (cardiovascular death, a major coronary event
[non-fatal myocardial infarction, documented unstable angina requiring
hospital admission, or coronary revascularisation occurring at least 30
days after randomisation], or stroke [ischaemic or haemorrhagic]) by
concomitant polyvascular disease at baseline (peripheral artery disease or
previous stroke or transient ischaemic attack) and stratified by
concomitant type 2 diabetes. Efficacy analyses were done according to
intention to treat and event rates. IMPROVE-IT is registered with
ClinicalTrials.gov, number NCT00202878. Finding(s): 1005 patients
(6%) had peripheral artery disease and 1071 (6%) had stroke or transient
ischaemic attack at baseline. Of these, 388 (39%) and 409 (38%) also had
concomitant type 2 diabetes, respectively. At 7 years, patients with
either polyvascular disease or type 2 diabetes had similar rates of the
primary endpoint (39.8% and 39.9%, respectively), which were higher than
patients without polyvascular disease or diabetes (29.6%). Polyvascular
disease with concomitant type 2 diabetes was associated with further
heightened risk (60.0% 7-year Kaplan-Meier rate, adjusted hazard ratio
versus those with polyvascular disease 1.60, 95% CI 1.38-1.85; p<0.0001).
Ezetimibe reduced cardiovascular risk consistently across groups with
greater numerical absolute risk reductions in the highest-risk subgroups.
 Interpretation(s): In patients with coronary artery disease,
concomitant polyvascular disease or type 2 diabetes are associated with
increased long-term cardiovascular risk. The combination of polyvascular
disease and diabetes is additive, resulting in very high risk. The benefit
of ezetimibe is consistent in patients with and without polyvascular
disease and type 2 diabetes; however, by nature of their higher risk
patients with one, or especially both, of these diseases might derive the
greatest absolute benefits. Funding(s): Merck. Copyright ©
2018 Elsevier Ltd

<18>
Accession Number
2001410130
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: 4 December 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, Indiana, India
(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, The 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, Wormleysburg,
PA, United States
(Mumtaz) Department of Cardiothoracic Surgery, The 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,
New York, NY, United States
Publisher
Elsevier USA
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. Objective(s):
The authors sought to compare TAVR to SAVR for mid-term 5-year outcomes of
safety, performance, and durability. 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. 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. 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) Copyright © 2018 American College of Cardiology
Foundation

<19>
Accession Number
2001348350
Title
Outcomes following surgical closure of secundum atrial septal defect in
children < 15 kg - A dual center experience.
Source
Archives of Cardiovascular Diseases Supplements. Conference: 29th European
Days of the French Society of Cardiology. France. 11 (1) (pp 134-135),
2019. Date of Publication: January 2019.
Author
Pilard C.; Jalal Z.; Villemain O.; Roubertie F.; Bonnet D.; Thambo J.
Institution
(Pilard, Jalal, Roubertie, Thambo) Department of Paediatric and Adult
Congenital Cardiology, Bordeaux University Hospital (CHU), France
(Jalal, Thambo) Electrophysiology and Heart Modeling Institute, fondation
Bordeaux Universite, IHU Liryc, Pessac, France
(Villemain, Bonnet) Unite medico-chirurgicale de cardiologie congenitale
et pediatrique, AP-HP, Hopital Necker-Enfants-Malades, Paris, France
Publisher
Elsevier Masson SAS
Abstract
Introduction: In children with a body weight < 15 kg, secundum ASD closure
is usually achieved through a surgical approach as their low weight may
expose them to a higher risk of complications associated with percutaneous
closure. However, reports about the outcome following surgical ASD closure
in children < 15 kg are scarce. Method(s): Medical records of all
children < 15 kg who underwent isolated secundum ASD surgical closure
between 2010 and 2017 in 2 French tertiary centers (Bordeaux University
Hospital, Necker Hospital, Paris, France) were reviewed retrospectively.
 Result(s): Fifty-six children were included (mean age 19 +/- 10
months and mean weight 9 +/- 3 kg at time of surgery). The mean ASD size
was 17 +/- 4 mm. Indications for surgical closure were the right heart
enlargement (56/56, 100%), failure to thrive (26/56, 46.4%), dyspnea
(18/56, 32.1%) and recurrent respiratory infections (7/56, 12.5%).
Thirteen children (23%) underwent cardiac catheterization before surgery
which showed a mean Qp/Qs of 2.3 +/- 0.7 and mean RVPi of 1.3 +/- 0.8
UW.m2. The surgical approach was sternotomy in 83.9% of cases
(mean duration of extracorporeal circulation = 61 +/- 3 and aortic
cross-clamping = 23 +/- 8 minutes). The mean duration of hospital stay was
7 +/- 5 days. No complications were observed during the perioperative
period. After discharge, 54/56 (96.4%) were asymptomatic in the first
month. After a median follow-up of 8 months (range: 0-90), no long-term
complications were noted. Conclusion(s): Surgical closure of a
secundum ASD in children < 15 kg of body weight is a safe technique which
allows clinical improvement of patients. Randomized and comparative
studies between surgery and catheterization are needed to assess the value
of percutaneous closure in this population. Copyright © 2018

<20>
Accession Number
2001348121
Title
Platelet function monitoring for the prediction of clinical outcomes: A
pooled analysis of the randomized ARCTIC and ANTARCTIC trials.
Source
Archives of Cardiovascular Diseases Supplements. Conference: 29th European
Days of the French Society of Cardiology. France. 11 (1) (pp 13), 2019.
Date of Publication: January 2019.
Author
Lattuca B.; Yan Y.; Kerneis M.; Cuisset T.; Silvain J.; Range G.; Elhadad
S.; Pouillot C.; Leclercq F.; Manzo-Silberman S.; Bellemain-Appaix A.;
Vicaut E.; Cayla G.; Collet J.P.; Montalescot G.
Institution
(Lattuca, Cayla) CHU Caremeau, departement de cardiologie, Nimes, France
(Lattuca, Yan, Kerneis, Silvain, Collet, Montalescot) Sorbonne University,
Paris 06 (UPMC), ACTION Study Group, Inserm UMRS 1166, Cardiology
Institute, Pitie-Salpetriere, University Hospital, AP-HP, Paris, France
(Cuisset) ACTION Study Group, Aix-Marseille University, Cardiology
department, Inserm UMR1062, INRA UMR1260, Centre Hospitalier Universitaire
La Timone, Marseille, France
(Range) Cardiology department, Chartres Hospital, Chartres, France
(Elhadad) Cardiology department, Lagny-Marne la Vallee hospital, Jossigny,
France
(Pouillot) Cardiology department, Clinique Sainte-Clotilde,
Saint-Clotilde, France
(Leclercq) Montpellier university, cardiology department, centre
hospitalier universitaire de Montpellier, Montpellier, France
(Manzo-Silberman) Cardiology department, centre hospitalier universitaire
Lariboisiere, AP-HP, Paris, France
(Bellemain-Appaix) Cardiology department, Antibes hospital, Antibes,
France
(Vicaut) ACTION Study Group, Epidemiology and Clinic Research Unit,
Lariboisiere University Hospital, Paris, France
Publisher
Elsevier Masson SAS
Abstract
Background: Platelet function testing offers the possibility to
individualize antiplatelet therapy in coronary artery disease patients but
failed to improve clinical outcomes in randomized trials. However,
high-on-treatment platelet reactivity (HPR) remains a risk factor for
recurrent ischemic events and low-on-treatment platelet reactivity (LPR)
is a risk factor for bleedings. Method(s): We collected data of
patients assigned to the monitoring arm of the randomized ARCTIC and
ANTARCTIC trials that evaluated the platelet reactivity by the VerifyNow
P2Y12 test two weeks after coronary stenting. HPR was defined by PRU >=
208, LPR by PRU <= 85 and optimal platelet reactivity (OPR) by 85.
 Result(s): Among the 1418 patients included, HPR was present in 269
patients (18.9%), OPR was reached in 681 patients (48.0%) and LPR in 468
patients (33.0%). The primary composite endpoint occurred in 9.7%, 11.5%
and 14.3% respectively. There was no significant difference in the net
clinical benefit between HPR and OPR patients (adjusted HR:
0.91(0.48-1.72); P = 0.77) and between LPR and OPR patients (adjusted HR:
1.13 (0.67-1.90); P = 0.64). There were no difference in the individual
clinical endpoints between the three groups. ROC curve analysis
demonstrated that PRU when used for treatment adjustment has a limited
ability to discriminate net clinical benefit, ischemic or bleeding
complications (curve-c index = 0.55, 0.51 or 0.59, respectively).
 Conclusion(s): Two weeks after stenting, an optimal platelet
reactivity was obtained in less than half of the population. The net
clinical benefit of these patients was not different from that of patients
with HPR and LPR who had treatment adjustment. Copyright © 2018

<21>
Accession Number
625670379
Title
Incidence and timing of thromboembolic events after the norwood procedure
in the single ventricle reconstruction clinical trial of the pediatric
heart network (PHN).
Source
Congenital Heart Disease. Conference: American Academy of Pediatrics
Section on Cardiology and Cardiac Surgery, SOCCS 2018. United States. 13
(5) (pp 815-817), 2018. Date of Publication: September - October 2018.
Author
White M.H.; Kelleman M.; Sidonio R.F.; Kochilas L.; Patel K.N.
Institution
(White) Emory University, Atlanta, GA, United States
(Kelleman) Emory University School of Medicine, Atlanta, GA, United States
(Sidonio, Patel) Aflac Cancer and Blood Disorders Center, Emory
University, Children's Healthcare of Atlanta, Atlanta, GA, United States
(Kochilas) Sibley Heart Center Cardiology, Department of Pediatrics, Emory
University, Atlanta, GA, United States
Publisher
Blackwell Publishing Ltd
Abstract
Purpose Thromboembolic events are a common cause of increased morbidity
and mortality in infants who undergo staged surgeries for single ventricle
congenital heart disease (CHD). However, previously reported rates vary,
from 1 to 46%, due to limitations from small sample size, retrospective
study design, heterogeneity of patient population, and single center
experience. We used the public dataset of the PHN Single Ventricle
Reconstruction (SVR) randomized clinical trial to determine the incidence,
timing of, and factors associated with thromboembolic events following the
Norwood procedure.Methods The SVR trial spans from 2005 to 2009 and
includes infants diagnosed with hypoplastic left heart physiology who
underwent randomization to the Norwood procedure with modified
Blalock-?Taussig shunt (mBTS) or right ventricle to pulmonary artery shunt
(RVPAS). Univariate analysis was performed using demographic, clinical,
and surgical factors available from this study to determine association
with thrombosis. Comparisons between groups were made using Wilcoxon
rank-?sum tests for continuous variables and chi-?square tests for
categorical variables. Time to thrombosis was evaluated using survival
analysis.Table 1. Patient characteristics and univariate factors
associated with thrombosisValues reported as Median (IQR 25th -? 75th) or
N (%). +DHCA: deep hypothermic circulatory arrestFigure 1.
Thrombosis-?free survival following the Norwood procedureResultOf the 549
infants included in the SVR trial, the majority were term (88%) white
(64%) males (62%) with a median birth weight of 3.10 kg and predominant
anatomic diagnosis of HLHS (86%) (Table 1). Thirty-?five (6%) patients had
thrombosis during Norwood hospitalization, with the majority (33/35)
developing thrombosis in the first 30 days following the Norwood (Figure
1). Median time to first thromboembolic event was 23 days. There was no
difference in the rate of thrombosis based on shunt types (mBTS vs.
RVPAS). Factors associated with thrombosis were male sex (P=.0052), longer
duration of cardiopulmonary bypass (P=.045), and aprotinin use (P=.033).
Gestational age, race, anatomic diagnosis, ECMO use, and need for CPR were
not associated with thrombosis. Development of thrombosis during Norwood
hospitalization was associated with prolonged median ICU stay and length
of hospital stay; 27 vs. 13 days (IQR 13-?46 days vs. 9-?25 days, P<.001)
and 36 vs. 23 days (IQR 26-?58 days vs. 15-?38 days, P<.001),
respectively.Conclusion In this largest reported prospective cohort of
infants undergoing single ventricle reconstruction, the cumulative
incidence of thrombosis during the Norwood hospitalization was 6.4%.
Aprotinin use and male sex were associated with risk of thrombosis and
this risk was highest within 30 days post Norwood. Thrombosis is
associated with longer length of ICU and hospital stays. Further studies
are needed to investigate the utility of modification of current
management practices, including targeted thromboprophylaxis during this
high risk period following the Norwood procedure.

<22>
Accession Number
625666468
Title
2018 CAS Annual Meeting Abstracts.
Source
Canadian Journal of Anesthesia. Conference: 2018 Annual Meeting of the
Canadian Anesthesiologists' Society, CAS 2018. Canada. 65 (1 Supplement 1)
(no pagination), 2018. Date of Publication: June 2018.
Author
Anonymous
Publisher
Springer New York LLC
Abstract
the proceedings contain 74 papers. The topics discussed include: sedation
during vitreoretinal surgery: current practice patterns; evaluation of the
dimensions of the retromolar space using putty molds for retromolar
intubation feasibility; AASN index: a new clinical test to predict
difficult laryngoscopy and intubation in obstetric patients; airway cuff
pressures: prospective observational multicentre study with a Canada
wide-survey; effect of patient information leaflet on working pattern and
patient satisfaction level in a day care theater complex; association
between difficult airway and OSA in patients undergoing surgery: a
Bayesian meta-analysis; use of prothrombin complex concentrate versus
frozen plasma for bleeding after cardiac surgery; and cardioprotective
effect of L-glutamine preconditioning in the isolated rat heart.

<23>
Accession Number
625666403
Title
Transversus thoracis muscle plane block in cardiac surgery: A prospective
feasibility pilot study.
Source
Canadian Journal of Anesthesia. Conference: 2018 Annual Meeting of the
Canadian Anesthesiologists' Society, CAS 2018. Canada. 65 (1 Supplement 1)
(pp S122-S123), 2018. Date of Publication: June 2018.
Author
Roche M.; Fujii S.; Vissa D.; Sato K.; Bainbridge D.; Jones P.; Zhou J.
Institution
(Roche) Schulich School of Medicine and Dentistry, Western University,
Canada
(Fujii, Vissa, Sato, Bainbridge, Jones, Zhou) Western University, Canada
Publisher
Springer New York LLC
Abstract
Introduction Cardiac surgery patients often experience significant pain
after median sternotomy, and standard parenteral and enteral analgesics
are not always adequate.[1-3] The transversus thoracis muscle plane (TTP)
block is a newly-developed, single-shot nerve block technique that
provides analgesia for the anterior chest wall.[4-6] In this double-blind
pilot study, we assessed the feasibility of performing this novel block as
an analgesic adjunct following cardiac surgery. Methods Following Research
Ethics Board approval, patients were recruited into the study with written
informed consent. All patients aged 18-90 undergoing elective cardiac
surgery by median sternotomy and not meeting exclusion criteria were
eligible. Patients were randomized to the block or standard care control
group upon admission to the intensive care unit (ICU) after surgery. Under
ultrasound guidance, patients in the block group received the TTP block
with 20 mL of either 0.3% or 0.5% ropivacaine bilaterally, based on
weight. The control group underwent ultrasound assessment of the
transversus thoracis plane without any injections. All blocks were
performed by a single anesthesiologist, and data collection was performed
by blinded assessors. The primary feasibility outcomes of this pilot study
were rate of recruitment, adherence, and adverse events. The rate of
recruitment was defined as the ratio of consented to approached eligible
patients. Secondary outcomes included 12- and 24-hour VAS pain scores,
24-hour hydromorphone-equivalent requirements, and patient and health care
provider satisfaction. Results Twenty patients were enrolled in this study
with 10 patients in each group. The recruitment rate was 95% of all
approached eligible patients. The adherence rate to treatment group was
95%. There were no block-related adverse events. The mean (SD) VAS pain
scores were 3.3 (3.2) in the block group vs 5.6 (3.2) in the control group
at 12 hours. At 24 hours, the pain scores were 5.4 (3.7) vs 5.5 (3.9) in
the block and control group, respectively. The mean (SD) 24-hour
hydromorphone-equivalent requirement was 1.89 (1.1) mg in the block group
vs 1.75 (0.9) mg in the control group. Patients, ICU staff, and cardiac
surgeons reported a high degree of satisfaction with this procedure.
Discussion The TTP block is a novel pain management strategy
post-sternotomy. To the best of our knowledge, this feasibility study is
the first reported investigation of the transversus thoracis muscle plane
block in cardiac surgery. The results reveal a high patient recruitment,
adherence, and satisfaction rate, and provide some preliminary data
supporting safety. This pilot study demonstrates the feasibility of using
the TTP block in the cardiac surgical population, and will enable future
controlled studies examining safety and analgesic efficacy.

<24>
Accession Number
625666112
Title
Benzodiazepine-free cardiac anesthesia for reduction of delirium (BFREE):
A pilot cluster crossover trial.
Source
Canadian Journal of Anesthesia. Conference: 2018 Annual Meeting of the
Canadian Anesthesiologists' Society, CAS 2018. Canada. 65 (1 Supplement 1)
(pp S25-S26), 2018. Date of Publication: June 2018.
Author
Spence J.; Belley-Cote E.; Jacobsohn E.; Bangdiwala S.; Lee S.F.; Whitlock
R.; Syed S.; Sarkaria A.; Arora R.; Kavosh M.; Girling L.; Sarah M.; Fast
I.; Connolly S.; Devereaux P.J.; Lamy A.; LeManach Y.; Long S.; Lengyel A.
Institution
(Spence, Belley-Cote, Whitlock, Syed, Devereaux, Lamy, LeManach, Long)
McMaster University, Canada
(Jacobsohn, Arora, Girling) University of Manitoba, Canada
(Bangdiwala, Lee, Sarah, Lengyel) Population Health Research Institute,
Canada
(Sarkaria) Queen's University, Canada
(Kavosh) St. Boniface General Hospital, Canada
(Fast) St. Boniface Hospital, Canada
(Connolly) Population Health Institute, Canada
Publisher
Springer New York LLC
Abstract
Background: Postoperative delirium affects 15-30% of adult cardiac surgery
patients and is associated with adverse outcomes. Intensive care unit
(ICU) trial data suggests that avoiding benzodiazepine use lowers
patients'; risk of delirium; however, no trial has evaluated the effect of
avoiding benzodiazepine use during surgery. Purpose(s): We sought to
determine the feasibility of a multicentre, randomized cluster-crossover
trial evaluating whether an institutional policy of avoiding
intraoperative benzodiazepine usage (B-Free) during adult cardiac surgery
was associated with a decrease in the incidence of postoperative delirium,
when compared with a policy of 'ad libitum'; intraoperative benzodiazepine
administration. Method(s): We conducted a pilot randomized cluster
crossover trial in two-centres using four-four week crossover periods. We
obtained research ethics board approval for waiver of individual patient
consent in both sites; all patients who underwent cardiac surgery during
the pilot period were included. Each site was randomized to either the
B-Free or ad libitum policy and then alternated between intervention arms
during the remaining 3 crossover periods. Our feasibility outcomes were
to: 1) obtain at least one Confusion Assessment Method (CAM) delirium
evaluation in 95% of patients, 2) obtain at least one CAM per 24 hours in
ICU in 90% of patients, and 3) achieve adherence to each of the
intervention arm policies in 80% of patients. In a single site, we
evaluated the incidence of intraoperative awareness using serial Brice
questionnaires and blinded adjudication, with the objective to demonstrate
an incidence of intraoperative awareness during the B-Free period of no
more than 2%. Result(s): 800 patients were included in this trial,
and 362 of 388 patients (93.3%) managed during the ad libitum periods and
365 of 412 patients (88.6%) managed during the B-Free periods were managed
according to the appropriate randomized allocation. We obtained outcome
data on 750 of 800 patients (93.8%); the remaining patients are still
being entered into administrative databases. Of these 750 patients, 735
(98.0%) had >=1 CAM recorded, and 692 patients (92.3%) had >=1 CAM per 24
hours in the ICU. Among the 540 patients at the site that undertook
assessment for intraoperative awareness, 521 patients (96.5%) were
screened and 19 patients (3.5%) were not screened for intraoperative
awareness. Patients were not screened because of intraoperative death,
transfer or death prior to extubation, or communication barrier.
Adjudication determined that 1 of 521 patients (0.2%) had intraoperative
awareness. This patient participated in the B-Free period but had received
benzodiazepine. Conclusion(s): This pilot trial demonstrates the
feasibility of conducting a multicentre, randomized, cluster-crossover
trial evaluating whether an institutional policy of avoiding
intraoperative benzodiazepine use during adult cardiac surgery is
associated with a decrease in the incidence of postoperative delirium,
when compared with a policy of 'ad libitum'; intraoperative benzodiazepine
use.

<25>
Accession Number
625665982
Title
Use of prothrombin complex concentrate versus frozen plasma for bleeding
after cardiac surgery.
Source
Canadian Journal of Anesthesia. Conference: 2018 Annual Meeting of the
Canadian Anesthesiologists' Society, CAS 2018. Canada. 65 (1 Supplement 1)
(pp S15-S16), 2018. Date of Publication: June 2018.
Author
Lenihan M.; Fitzgerald J.; Callum J.; McCluskey S.; Srinivas C.; Karkouti
K.
Institution
(Lenihan, McCluskey, Srinivas, Karkouti) Toronto General Hospital, Canada
(Fitzgerald) Dept of Anesthesia and Intensive Care, Toronto General
Hospital, Canada
(Callum) Sunnybrook Health Sciences Centre, Canada
Publisher
Springer New York LLC
Abstract
Introduction Coagulopathy is a common complication of cardiac surgery with
cardiopulmonary bypass (CPB). The aetiology is multifactorial but impaired
thrombin generation is an important contributor (1). In vitro studies
suggest that Prothrombin Concentrate Complex (PCC) may be more effective
in enhancing thrombin generation compared with plasma alone (2) with
potentially a lower risk profile. PCC is increasingly used to supplement
or supplant plasma at our institution. Thus, we conducted this study to
determine if the correction of coagulopathy with PCC vs plasma is
associated with reduced transfusion requirements and major bleeding in
cardiac surgery. Methods In this retrospective observational study, we
analyzed data collected on cardiac surgery patients operated from 1
January 2012 to 30 December 2017 at our institution. After approval from
the institutional research ethics board, patient data were obtained from
institutional databases. Management of post-CPB coagulopathy was guided by
point-of-care tests (ROTEM and Plateletworks) conducted during CPB, and
standard laboratory tests (CBC, PT, PTT, and fibrinogen level) conducted
after reversal of heparin with protamine. Administration of plasma
(usually 10 - 15 ml/kg in 2 - 4 unit increments) and PCC (Octaplex,
Octapharma, Toronto, usually 20 IU/kg in 1000 IU increments) was guided by
the clotting time (measured by the EXTEM assay of ROTEM), the INR, or
both. Patients were categorized into two groups: those who received only
plasma (FFP group) or those who received PCC with or without plasma (PCC
group). Chi-square or Fisher's exact chi-square and Wilcoxon two-sample
tests were used to compare patient characteristics, risk status, and
outcomes between groups. Propensity score methods were used to obtain
balance with respect to measured confounders and predictors of measured
outcomes. Results Of the 6362 cardiac surgery patients, 1151 (18.2%)
received plasma alone and 204 (3.2%) received PCC. Patient risk-profile
was higher in the PCC group and they more frequently underwent complex
procedures requiring longer CPB durations. In a well-balanced match of 234
patients (n = 117 per group), transfusion outcomes were favorable in the
PCC group, where odds of red cell avoidance was 2.4-fold (95% CI 1.2 -
4.8) higher than the FFP group. They also had reduced major bleeding
(23.9% vs 1815.4%, p-value 0.05) and refractory bleeding (18.8% vs 10.3%,
p-value 0.06). Conclusions There is limited comparative clinical data, but
our findings suggest that PCCs may have a role in the management of
post-CPB coagulopathic bleeding beyond their approved indication for
reversal of warfarin. Adequately powered randomized trials are required to
determine the role of PCC for management of coagulopathy in cardiac
surgery.

<26>
[Use Link to view the full text]
Accession Number
625680183
Title
Use of Closed-Incision Negative-Pressure Therapy in Aesthetic Surgery.
Source
Plastic and reconstructive surgery. S. 143 (1 Management of Surgical
Incisions Utilizing ClosedIncision NegativePressure Therapy) (pp 11S-14S),
2019. Date of Publication: 01 Jan 2019.
Author
Singh D.; Lobach V.; Holton T.
Institution
(Singh) Md. From AAMG Plastic Surgery, Anne Arundel Medical Center,
Annapolis, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Recently published studies have demonstrated clinical
effectiveness of closed-incision negative-pressure therapy (ciNPT) in many
fields of surgery including vascular, cardiac, colorectal, orthopedic, and
reconstructive surgery. A review of current literature was conducted to
determine whether the application of negative-pressure therapy to closed
incisions post aesthetic procedures was beneficial. METHOD(S): The
PubMed/MEDLINE databases were searched for preclinical and clinical
studies published through June 2018. Higher quality publications that met
the following criteria were included: adult patients undergoing aesthetic
or body contouring procedures, comparison of ciNPT with conventional
dressings, and documentation of wound complications and/or incision
quality. RESULT(S): One animal and multiple small, retrospective
comparison articles are discussed. Scientific mechanism of action and
economic analysis are also discussed. There are no level 1 randomized
prospective controlled trials that directly evaluate the effects of ciNPT
dressings in cosmetic patients. CONCLUSION(S): For patients
undergoing certain cosmetic procedures, preliminary data support the idea
that ciNPT dressings provide aesthetic benefit, but more research is
clearly needed.

<27>
Accession Number
2001411722
Title
Assessment of Platelet REACtivity After Transcatheter Aortic Valve
Replacement: The REAC-TAVI Trial.
Source
JACC: Cardiovascular Interventions. 12 (1) (pp 22-32), 2019. Date of
Publication: 14 January 2019.
Author
Jimenez Diaz V.A.; Tello-Montoliu A.; Moreno R.; Cruz Gonzalez I.; Baz
Alonso J.A.; Romaguera R.; Molina Navarro E.; Juan Salvadores P.; Paredes
Galan E.; De Miguel Castro A.; Bastos Fernandez G.; Ortiz Saez A.;
Fernandez Barbeira S.; Raposeiras Roubin S.; Ocampo Miguez J.; Serra
Penaranda A.; Valdes Chavarri M.; Cequier Fillat A.; Calvo Iglesias F.;
Iniguez Romo A.
Institution
(Jimenez Diaz, Baz Alonso, Paredes Galan, De Miguel Castro, Bastos
Fernandez, Ortiz Saez, Fernandez Barbeira, Raposeiras Roubin, Ocampo
Miguez, Calvo Iglesias, Iniguez Romo) Cardiology Department, Hospital
Alvaro Cunqueiro, University Hospital of Vigo, Vigo, Spain
(Jimenez Diaz, Juan Salvadores) Cardiovascular Research Unit, Cardiology
Department, Hospital Alvaro Cunqueiro, University Hospital of Vigo, Vigo,
Spain
(Tello-Montoliu, Valdes Chavarri) Cardiology Department, Hospital
Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
(Tello-Montoliu, Cruz Gonzalez, Valdes Chavarri, Cequier Fillat, Iniguez
Romo) Centro de Investigacion en Red de Enfermedades Cardiovasculares
(Network Research Center for Cardiovascular Diseases), CIBER-CV, Madrid,
Spain
(Moreno) Cardiology Department, Hospital Universitario La Paz, Madrid,
Spain
(Cruz Gonzalez) Cardiology Department, Hospital Universitario de
Salamanca, Salamanca, Spain
(Romaguera, Cequier Fillat) Cardiology Department, Hospital Universitario
de Bellvitge, Barcelona, Spain
(Molina Navarro) Cardiology Department, Hospital Universitario Virgen de
las Nieves, Granada, Spain
(Juan Salvadores) Cardiovascular Research Group, Galicia Sur Health
Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
(Serra Penaranda) Cardiology Department, Hospital Universitario San Pau,
Barcelona, Spain
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The REAC-TAVI (Assessment of platelet REACtivity after
Transcatheter Aortic Valve Implantation) trial enrolled patients with
aortic stenosis (AS) undergoing transcatheter aortic valve replacement
(TAVR) pre-treated with aspirin + clopidogrel, aimed to compare the
efficacy of clopidogrel and ticagrelor in suppressing high platelet
reactivity (HPR) after TAVI. Background(s): Current recommendations
support short-term use of aspirin + clopidogrel for patients with severe
AS undergoing TAVR despite the lack of compelling evidence.
 Method(s): This was a prospective, randomized, multicenter
investigation. Platelet reactivity was measured at 6 different time points
with the VerifyNow assay (Accriva Diagnostics, San Diego, California). HPR
was defined as (P2Y<inf>12</inf> reaction units (PRU) >=208. Patients with
HPR before TAVR were randomized to either aspirin + ticagrelor or aspirin
+ clopidogrel for 3 months. Patients without HPR continued with aspirin +
clopidogrel (registry cohort). The primary endpoint was non-HPR status
(PRU <208) in >=70% of patients treated with ticagrelor at 90 days
post-TAVR. Result(s): A total of 68 patients were included. Of these,
48 (71%) had HPR (PRU 273 +/- 09) and were randomized to aspirin +
ticagrelor (n = 24, PRU 277 +/- 08) or continued with aspirin +
clopidogrel (n = 24, PRU 269 +/- 49). The remaining 20 patients (29%)
without HPR (PRU 133 +/- 12) were included in the registry. Overall,
platelet reactivity across all the study time points after TAVR was lower
in patients randomized to ticagrelor compared with those treated with
clopidogrel, including those enrolled in the registry (p < 0.001). The
primary endpoint was achieved in 100% of patients with ticagrelor compared
with 21% with clopidogrel (p < 0.001). Interestingly, 33% of clopidogrel
responder patients at baseline developed HPR status during the first month
after TAVR. Conclusion(s): HPR to clopidogrel is present in a
considerable number of patients with AS undergoing TAVR. Ticagrelor
achieves a better and faster effect, providing sustained suppression of
HPR to these patients. (Platelet Reactivity After TAVI: A Multicenter
Pilot Study [REAC-TAVI]; NCT02224066) Copyright © 2019 The
Authors

<28>
Accession Number
625573701
Title
Influence of arm position during infraclavicular subclavian vein
catheterization in coronary artery bypass graft surgery.
Source
Journal of Cardiovascular and Thoracic Research. 10 (4) (pp 192-196),
2018. Date of Publication: 2018.
Author
Tarbiat M.; Davoudi M.; Salimbahrami S.A.
Institution
(Tarbiat, Davoudi, Salimbahrami) Clinical Research Development Unit of
Farshchian Heart Center, Department of Anesthesiology, School of Medicine,
Hamadan University of Medical Sciences, Hamadan, Iran, Islamic Republic of
Publisher
Tabriz University of Medical Sciences (E-mail: tmj@taibahu.edu.sa)
Abstract
Introduction: Percutaneous subclavian vein catheterization via
infraclavicular approach is one of the most widely used cannulation
techniques for inserting catheters into a central vein. The aim of this
study was to evaluate influence of arm position during infraclavicular
subclavian vein catheterization with landmark-based technique in coronary
artery bypass graft (CABG) surgery. Method(s): Between September 2017
and June 2018, this prospective randomized clinical trial was performed in
320 patients. The patients were randomly assigned to the Neutral group
(the arms kept by the side) or Abduction group (the arm was abducted to
90degree). The success and complication rates were compared in the two
groups. The data were analyzed using SPSS software. Result(s): in the
first attempt of subclavian vein cannulation, the success rate had no
significant difference between the two groups (P= 0.185). in the second
attempt of catheterization, the success rate in Abduction group (40.5%)
was lower than Neutral group (81.2%). The overall success rate in two
attempts were (84.4%) in the Abduction group and (96.2%) in the Neutral
group. There was a significant difference between two groups in the second
and overall success rates (P= 0.0001). In 34 (10.6%) patients, subclavian
artery puncture occurred, 30 (18.8%) in the Abduction group and 4 (2.5%)
in the Neutral group. There was a significant difference between two
groups (P= 0.0001). Pneumothorax was occurred in 15 (9.4%) in the
Abduction group and 3 (1.9%) in the Neutral group. There was also a
significant difference between two groups (P= 0.004). The differences in
other complications on two groups were statistically insignificant.
 Conclusion(s): Compared with Abduction group, the Neutral group
resulted in higher success rate and fewer subclavian artery puncture and
pneumothorax. The incidences of other complications were similar on both
groups. Copyright © 2018 The Author (s).

<29>
Accession Number
625573250
Title
Outcomes following transcatheter transseptal versus transapical mitral
valve-in-valve and valve-in-ring procedures.
Source
Journal of Cardiovascular and Thoracic Research. 10 (4) (pp 182-186),
2018. Date of Publication: 2018.
Author
Nazir S.; Lohani S.; Tachamo N.; Khan M.S.; Timilsina B.; Luni F.K.;
Donato A.
Institution
(Nazir, Lohani, Tachamo, Khan, Timilsina) Department of Medicine, Reading
Hospital-Tower Health System, West Reading, PA, United States
(Luni) Division of Cardiology, Mercy Saint Vincent Medical Center, Toledo,
OH, United States
(Donato) Sidney Kimmel Medical College at Thomas Jefferson University,
Philadelphia, PA, United States
Publisher
Tabriz University of Medical Sciences (E-mail: tmj@taibahu.edu.sa)
Abstract
Introduction: Transcatheter mitral valve-in-valve (ViV) & valve-in-ring
(ViR) are relatively novel therapeutic alternatives for patients with
degenerated bioprostheses or failed annuloplasty rings whose reoperative
risk is too high. The predominant procedural access for both procedures is
transapical or transseptal. However, whether there are differences in
outcomes of this procedure using transseptal versus transapical access has
not yet been defined. Method(s): We conducted a systematic review of
all published articles from MEDLINE and EMBASE to explore the outcomes of
these two procedural approaches. Result(s): A total of 55 studies
including 183 patients (154 ViV and 29 ViR) were included. Patients that
underwent ViV (101 transapical and 53 transseptal) using the transseptal
approach required more iatrogenic atrial septal defect (ASD) closure (19%
versus 0.0 %; P< 0.001) and hence had a lower device success rate (68%
versus 89%; P= 0.001). However, there was no significant difference
between the two groups in procedural success and all-cause mortality at 30
days. Overall severe bleeding complications (major or life threatening)
were not different the two groups (3.7% versus 7.9%; P= 0.321). in the ViR
group (19 transapical and 10 transseptal), no difference in procedural
success, device success or 30-day outcomes were identified between
transseptal and transapical groups, although sample size was small.
 Conclusion(s): In conclusion, mitral ViV and ViR using the two
different procedural approaches appear to confer equal and reasonable
30-day outcomes. Copyright © 2018 The Author (s).

<30>
Accession Number
625122211
Title
Effect of warfarin education on patient knowledge and anticoagulation
control: a randomised controlled trial.
Source
Journal of Pharmacy Practice and Research. 48 (6) (pp 516-521), 2018. Date
of Publication: December 2018.
Author
Bhatt S.; McCurdy C.E.; Liew D.; Russell D.M.
Institution
(Bhatt, Russell) Department of General Medicine, The Royal Melbourne
Hospital, Melbourne, Australia
(McCurdy) Western Health, Melbourne, Australia
(Liew) Monash Centre of Cardiovascular Research and Education in
Therapeutics, Monash University, Melbourne, Australia
(Russell) Department of Medicine, University of Melbourne, Melbourne,
Australia
Publisher
Wiley-Blackwell (E-mail: info@wiley.com)
Abstract
Background: Patient education is a key component of management in the
anticoagulated patient. Aim(s): The aim of this study was to
establish whether reiteration of warfarin education in the outpatient
setting affects patients' knowledge of warfarin and anticoagulation
control. Method(s): The study was a randomised prospective trial.
Participants newly commenced on warfarin at The Royal Melbourne Hospital
were randomised to either standard inpatient education (n = 19) or to
receive an additional comprehensive warfarin education session (n = 21).
The primary outcome was warfarin knowledge as assessed by the Oral
Anticoagulation Knowledge (OAK) test. Secondary outcomes were time in
therapeutic range (TTR) and complications. The duration of follow-up was 6
weeks. Result(s): There were no significant differences between the
intervention and control groups in OAK test scores (16.3/20 vs 14.4/20,
respectively; p = 0.07), TTR (56.9% vs 59.3%, respectively; p = 0.09) or
in the incidence of complications. Conclusion(s): Within the
limitations of a single-centre, underpowered study, we did not detect any
significant additional benefit to patient knowledge from further
outpatient warfarin education. Current standard inpatient education at our
centre compared favourably with other such designed interventions outlined
in previous studies. Nevertheless, it is possible that certain subsets of
the population may benefit from additional education, such as those with
mild cognitive impairment and those from non-English-speaking backgrounds;
however, a much greater sample size would be required to study these
groups. Copyright © 2018 The Society of Hospital Pharmacists of
Australia

<31>
Accession Number
2001373880
Title
Biatrial maze procedure versus pulmonary vein isolation for atrial
fibrillation during mitral valve surgery: New analytical approaches and
end points.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (1) (pp 234-243.e9),
2019. Date of Publication: January 2019.
Author
Chang H.L.; Rajeswaran J.; Ishwaran H.; Li L.; Ehrlinger J.; Mack M.J.;
Miller M.A.; Taddei-Peters W.C.; Buxton D.; Connolly A.; Geller N.L.;
Gordon D.; Jeffries N.O.; Lee A.; Moy C.S.; Gombos I.K.; Ralph J.; Weisel
R.; Gardner T.J.; O'Gara P.T.; Rose E.A.; Gelijns A.C.; Parides M.K.;
Ascheim D.D.; Moskowitz A.J.; Bagiella E.; Moquete E.; Chang H.; Chase M.;
Goldfarb S.; Gupta L.; Kirkwood K.; Kumbarce E.; Levitan R.; O'Sullivan
K.; Overbey J.; Santos M.; Weglinski M.; Williams P.; Wood C.; Ye X.; Mack
M.; Adame T.; Settele N.; Adams J.; Ryan W.; Smith R.L.; Grayburn P.; Chen
F.Y.; Nohria A.; Cohn L.; Shekar P.; Aranki S.; Couper G.; Davidson M.;
Bolman R.M.; Burgess A.; Conboy D.; Blackwell R.; Kerzner R.; Banbury M.;
Squire A.M.; Gillinov A.M.; Blackstone E.H.; Lytle B.; Mihaljevic T.;
Lackner P.; Berroteran L.; Dolney D.; Fleming S.; Palumbo R.; Whitman C.;
Sankovic K.; Sweeney D.K.; Pattakos G.; Argenziano M.; Williams M.;
Goldsmith L.; Smith C.R.; Naka Y.; Stewart A.; Schwartz A.; Bell D.; Van
Patten D.; Sreekanth S.; Smith P.K.; Alexander J.H.; Milano C.A.; Glower
D.D.; Mathew J.P.; Harrison J.K.; Welsh S.; Ferguson T.B.; Kypson A.P.;
Rodriguez E.; Harris M.; Akers B.; O'Neal A.; Puskas J.D.; Thourani V.H.;
Guyton R.; Baer J.; Baio K.; Neill A.A.; Voisine P.; Senechal M.; Dagenais
F.; O'Connor K.; Dussault G.; Ballivian T.; Keilani S.; Michler R.E.;
D'Alessandro D.A.; DeRose J.J.; Goldstein D.J.; Bello R.; Jakobleff W.;
Garcia M.; Taub C.; Spevack D.; Swayze R.; Sookraj N.; Perrault L.P.;
Basmadjian A.-J.; Bouchard D.; Carrier M.; Cartier R.; Pellerin M.;
Tanguay J.F.; El-Hamamsy I.; Denault A.; Lacharite J.; Robichaud S.; Adams
D.H.; Varghese R.; Mandel-Portnoy Y.; Horvath K.A.; Corcoran P.C.;
Siegenthaler M.P.; Murphy M.; Iraola M.; Greenberg A.; Sai-Sudhakar C.;
Hasan A.; McDavid A.; Kinn B.; Mullen J.C.; Choy J.; Meyer S.; Kuurstra
E.; Gammie J.S.; DeFilippi C.R.; Gaetani D.T.; Young C.A.; Beach D.;
Collins J.; Bolling S.F.; Pagani F.D.; Bloem C.; Acker M.A.; Woo Y.J.;
Mayer M.L.; Bavaria J.E.; Szeto W.Y.; Margulies K.; Keane M.; Glassberg
H.; Jagasia D.; Kirkpatrick J.; Kron I.L.; Ailawadi G.; Johnston K.; Dent
J.M.; Kern J.; Keim J.; Burks S.; Gahring K.; Mangi A.; Akar J.; Yuh D.;
Wilson L.; Bull D.A.; Desvigne-Nickens P.; Dixon D.O.; Haigney M.;
Holubkov R.; Jacobs A.; Miller F.; Murkin J.M.; Spertus J.; Wechsler A.S.;
Sellke F.; McDonald C.L.; Byington R.; Dickert N.; Ikonomidis J.S.;
Williams D.O.; Yancy C.W.; Canty J.M.; Fang J.C.; Giannetti N.;
Richenbacher W.; Rao V.; Furie K.L.; Miller R.; Pinney S.; Roberts W.C.;
Walsh M.N.; Hung J.; Zeng X.; Couderc J.-P.; Balda D.; Bowen W.; Wilson
M.; Schering A.
Institution
(Blackstone, Gillinov) Department of Thoracic and Cardiovascular Surgery,
Cleveland Clinic, Cleveland, OH, United States
(Blackstone, Rajeswaran, Ehrlinger) Department of Quantitative Health
Sciences, Cleveland Clinic, Cleveland, OH, United States
(Chang, Parides, Gelijns, Moskowitz) Department of Population Health
Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY,
United States
(Ishwaran) Department of Public Health Sciences, Division of
Biostatistics, University of Miami, Miami, Fla, United States
(Li) Department of Biostatistics, The University of Texas MD Anderson
Cancer Center, Houston, Tex, United States
(Argenziano) Division of Cardiothoracic Surgery, Department of Surgery,
College of Physicians and Surgeons, Columbia University, New York, NY,
United States
(DeRose) Department of Cardiovascular and Thoracic Surgery,
Montefiore-Einstein Heart Center, Bronx, NY, United States
(Couderc) Heart Research Follow-Up Program, Cardiology Department,
University of Rochester Medical Center, Rochester, NY, United States
(Balda) Medicomp, Inc., Melbourne, Fla, United States
(Dagenais) Department of Cardiac Surgery, Institut Universitaire de
Cardiologie de Quebec, Hopital Laval, Quebec City, Quebec, Canada
(Mack) Department of Cardiothoracic Surgery, Baylor Research Institute,
Baylor Health Care System, Plano, Tex, United States
(Ailawadi) Division of Thoracic and Cardiovascular Surgery, University of
Virginia School of Medicine, Charlottesville, Va, United States
(Smith) Division of Cardiovascular and Thoracic Surgery, Department of
Surgery, Duke University Medical Center, Durham, NC, United States
(Acker) Department of Surgery, Division of Cardiovascular Surgery,
University of Pennsylvania School of Medicine, Philadelphia, Pa, United
States
(O'Gara) Cardiovascular Medicine Division, Brigham and Women's Hospital,
Boston, Mass, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: To use novel statistical methods for analyzing the effect of
lesion set on (long-standing) persistent atrial fibrillation (AF) in the
Cardiothoracic Surgical Trials Network trial of surgical ablation during
mitral valve surgery (MVS). Method(s): Two hundred sixty such
patients were randomized to MVS + surgical ablation or MVS alone. Ablation
was randomized between pulmonary vein isolation and biatrial maze. During
12 months postsurgery, 228 patients (88%) submitted 7949 transtelephonic
monitoring (TTM) recordings, analyzed for AF, atrial flutter (AFL), or
atrial tachycardia (AT). As previously reported, more ablation than
MVS-alone patients were free of AF or AF/AFL at 6 and 12 months (63% vs
29%; P <.001) by 72-hour Holter monitoring, without evident difference
between lesion sets (for which the trial was underpowered).
 Result(s): Estimated freedom from AF/AFL/AT on any transmission
trended higher after biatrial maze than pulmonary vein isolation (odds
ratio, 2.31; 95% confidence interval, 0.95-5.65; P =.07) 3 to 12 months
postsurgery; estimated AF/AFL/AT load (ie, proportion of TTM strips
recording AF/AFL/AT) was similar (odds ratio, 0.90; 95% confidence
interval, 0.57-1.43; P =.6). Within 12 months, estimated prevalence of
AF/AFL/AT by TTM was 58% after MVS alone, and 36% versus 23% after
pulmonary vein isolation versus biatrial maze (P <.02).
 Conclusion(s): Statistical modeling using TTM recordings after MVS in
patients with (long-standing) persistent AF suggests that a biatrial maze
is associated with lower AF/AFL/AT prevalence, but not a lower load,
compared with pulmonary vein isolation. The discrepancy between AF/AFL/AT
prevalence assessed at 2 time points by Holter monitoring versus weekly
TTM suggests the need for a confirmatory trial, reassessment of
definitions for failure after ablation, and validation of statistical
methods for assessing atrial rhythms longitudinally. Copyright ©
2018 The American Association for Thoracic Surgery

<32>
Accession Number
2001243140
Title
Meta-Analysis of Impact of Anemia and Hemoglobin Level on Survival After
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 123 (2) (pp 306-314), 2019. Date of
Publication: 15 January 2019.
Author
Takagi H.; Hari Y.; Kawai N.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
To establish evidence whether baseline anemia and decreases in baseline
hemoglobin levels affect survival after transcatheter aortic valve
implantation (TAVI), we performed a meta-analysis of available studies.
Studies considered for inclusion met the following criteria: the design
was a comparative study of patients with baseline anemia versus those
without baseline anemia or a cohort study investigating baseline anemia
(as a dichotomous variable) or baseline hemoglobin levels (as a continuous
variable) as one of prognostic factors of mortality; the study population
was patients who underwent TAVI; and main outcomes included early (30-day
or in-hospital) or late (including early) all-cause mortality.
Study-specific estimates were combined in the random-effects model. Our
search identified 15 eligible studies including a total of 11,657 TAVI
patients. Pooled analysis demonstrated that baseline anemia was associated
with a statistically significant increase in early (p = 0.003) and midterm
mortality (p < 0.0001) and that incremental decreases in baseline
hemoglobin levels were associated with a statistically significant
increase in midterm mortality (p < 0.00001). Pooled analysis of only
adjusted estimates indicated that anemia was independently associated with
a statistically significant increase in early (p = 0.02) and midterm
mortality (p < 0.0001) and that incremental decreases in baseline
hemoglobin levels were independently associated with a statistically
significant increase in midterm mortality (p < 0.00001). In conclusion,
baseline anemia and lower baseline hemoglobin levels may be associated
with increased early and midterm mortality after TAVI. Copyright
© 2018 Elsevier Inc.

<33>
Accession Number
623636185
Title
A comparison of haemostatic biomarkers during low-risk patients undergoing
cardiopulmonary bypass using either conventional centrifugal cell salvage
or the HemoSep device.
Source
Perfusion (United Kingdom). 34 (1) (pp 76-83), 2019. Date of Publication:
01 Jan 2019.
Author
Boyle G.; Kuffel A.; Parmar K.; Gibson K.; Smith M.; Grehan A.; Hunt B.J.;
Chambers D.J.
Institution
(Boyle, Grehan) Clinical Perfusion Department, Guy's and St Thomas' NHS
Foundation Trust, St Thomas' Hospital, United Kingdom
(Kuffel, Parmar, Hunt) Thrombosis & Vascular Biology Group, The Rayne
Institute, United Kingdom
(Gibson, Smith) Cardiovascular Research, Guy's and St Thomas' NHS
Foundation Trust, St Thomas' Hospital, United Kingdom
(Hunt) Thrombosis & Haemophilia, Guy's & St Thomas' NHS Foundation Trust,
St Thomas' Hospital, United Kingdom
(Chambers) Cardiothoracic Surgery/Cardiac Surgical Research, The Rayne
Institute, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital,
United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Cardiac surgery using cardiopulmonary bypass (CPB) is
associated with a coagulopathy due to haemodilution, thrombocytopenia and
platelet dysfunction and the activation of coagulation and fibrinolysis,
despite the use of large doses of unfractionated heparin. Conventional red
cell salvage may exacerbate post-operative bleeding as plasma containing
haemostatic factors is discarded. We hypothesized that a novel cell
salvage device (HemoSep) may attenuate haemostatic changes associated with
red cell salvage. We studied haemostatic markers following autologous
transfusion from conventional cell salvage or the HemoSep device.
 Method(s): This randomised, controlled trial compared haemostatic
markers in patients undergoing coronary artery bypass grafting or aortic
valve replacement who received autologous blood returned from cell salvage
(control) or HemoSep (study). Blood samples were taken pre-operatively,
end of CPB, post-transfusion of salvaged blood and 3 hours
post-operatively and analysed for full blood count (FBC), prothrombin time
(PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer
and endogenous thrombin potential (ETP). Result(s): Fifty-four
patients were recruited (n=28 control, n=26 study). Processed blood volume
for transfusion was significantly (p<0.001) higher in the HemoSep group.
In the HemoSep group, the PT was shorter (18.7+/-0.3 vs 19.9+/-0.3 sec;
p<0.05) post-operatively and the aPTT was longer (48.6+/-3.8 vs 37.3+/-1.0
sec; p<0.01) following autologous transfusion. In the control group,
D-dimer and ETP levels were higher (1903+/-424 vs.1088+/-151; p<0.05 and
739+/-46 vs. 394+/-60; p<0.001, respectively) following autologous
transfusion. Conclusion(s): Although centrifuged cell salvage is
known to adequately haemoconcentrate and remove unwanted substrates and
bacteriological contamination, the process can exacerbate coagulopathy.
The HemoSep device demonstrated some increase in haemostatic markers when
used in low-risk cardiac surgery patients. Copyright © The
Author(s) 2018.

<34>
Accession Number
625662288
Title
14th Annual Complex Cardiovascular Catheter Therapeutics (C3): Advanced
Endovascular and Coronary Intervention Global Summit.
Source
Journal of Invasive Cardiology. Conference: 14th Annual Complex
Cardiovascular Catheter Therapeutics, C3 Conference. United States. 30 (9)
(no pagination), 2018. Date of Publication: September 2018.
Author
Anonymous
Publisher
HMP Communications
Abstract
the proceedings contain 31 papers. The topics discussed include:
successful management of coronary artery aneurysm with a covered stent
implantation; prognostic value of SYNTAX score II in patients with non-ST
elevation myocardial infarction and multi-vessel disease undergoing
percutaneous coronary intervention; orthostatic hypertension is
underappreciated phenomenon; transcatheter or surgical aortic valve
replacement in patients with advanced kidney disease: a propensity-score
matched analysis; the risk of pulmonary embolism and deep vein thrombosis
in patients with obstructive sleep apnea; comparison of outcomes of
percutaneous transluminal septal myocardial ablation (PTSMA) vs surgical
myomectomy (SM) for the treatment of hypertrophic obstructive
cardiomyopathy, a meta-analysis; and coronary artery thrombus leading to
acute myocardial infarction in an HIV patient: a case report and review of
literature.

<35>
Accession Number
625580055
Title
Transfusion of red blood cells stored for shorter versus longer duration
for all conditions.
Source
Cochrane Database of Systematic Reviews. 2018 (12) (no pagination), 2018.
Article Number: CD010801. Date of Publication: 22 Dec 2018.
Author
Shah A.; Brunskill S.J.; Desborough M.J.; Doree C.; Trivella M.; Stanworth
S.J.
Institution
(Shah) University of Oxford, Radcliffe Department of Medicine, Oxford,
United Kingdom
(Brunskill, Doree) NHS Blood and Transplant, Systematic Review Initiative,
Level 2, John Radcliffe Hospital, Headington, Oxford, Oxon OX3 9BQ, United
Kingdom
(Desborough) NHS Blood and Transplant, Haematology/Transfusion Medicine,
Oxford, United Kingdom
(Trivella) University of Oxford, Centre for Statistics in Medicine, Botnar
Research Centre, Windmill Road, Oxford OX3 7LD, United Kingdom
(Stanworth) Oxford University Hospitals NHS Foundation Trust and
University of Oxford, National Institute for Health Research (NIHR) Oxford
Biomedical Research Centre, John Radcliffe Hospital, Headley Way,
Headington, Oxford OX3 9BQ, United Kingdom
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Red blood cell (RBC) transfusion is a common treatment for
anaemia in many conditions. The safety and efficacy of transfusing RBC
units that have been stored for different durations before a transfusion
is a current concern. The duration of storage for a RBC unit can be up to
42 days. If evidence from randomised controlled trials (RCT) were to
indicate that clinical outcomes are affected by storage duration, the
implications for inventory management and clinical practice would be
significant. Objective(s): To assess the effects of using red blood
cells (RBCs) stored for a shorter versus a longer duration, or versus RBCs
stored for standard practice duration, in people requiring a RBC
transfusion. Search Method(s): We searched the Cochrane Central
Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, PubMed
(for epublications), LILACS, Transfusion Evidence Library, Web of Science
CPCI-S and four international clinical trial registries on 20 November
2017. Selection Criteria: We included RCTs that compared transfusion
of RBCs of shorter versus longer storage duration, or versus standard
practice storage duration. Data Collection and Analysis: We used
standard Cochrane methods. Main Result(s): We included 22 trials
(42,835 participants) in this review. The GRADE quality of evidence ranged
from very low to moderate for our primary outcome of in-hospital and
short-term mortality reported at different time points. Transfusion of
RBCs of shorter versus longer storage duration Eleven trials (2249
participants) compared transfusion of RBCs of shorter versus longer
storage duration. Two trials enrolled low birth weight neonates, two
enrolled children with severe anaemia secondary to malaria or sickle cell
disease, and eight enrolled adults across a range of clinical settings
(intensive care, cardiac surgery, major elective surgery, hospitalised
in-patients, haematology outpatients). We judged only two trials to be at
low risk of bias across all domains; most trials had an unclear risk for
multiple domains. Transfusion of RBCs of shorter versus longer storage
duration probably leads to little or no difference in mortality at
seven-day follow-up (risk ratio (RR) 1.42, 95% confidence interval (CI)
0.66 to 3.06; 1 trial, 3098 participants; moderate quality evidence) or
30-day follow-up (RR 0.85, 95%CI 0.50 to 1.45; 2 trials, 1121
participants; moderate quality evidence) in adults undergoing major
elective cardiac or non-cardiac surgery. For neonates, no studies reported
on the primary outcome of in-hospital or short-term mortality. At 40 weeks
gestational age, the effect of RBCs of shorter versus longer storage
duration on the risk of death was uncertain, as the quality of evidence is
very low (RR 0.90, 95% CI 0.41 to 1.85; 1 trial, 52 participants). The
effect of RBCs of shorter versus longer storage duration on the risk of
death in children with severe anaemia was also uncertain within 24 hours
of transfusion (RR 1.50, 95% CI 0.43 to 5.25; 2 trials, 364 participants;
very low quality evidence), or at 30-day follow-up (RR 1.40, 95% CI 0.45
to 4.31; 1 trial, 290 participants; low quality evidence). Only one trial,
in children with severe anaemia (290 participants), reported adverse
transfusion reactions. Only one child in each arm experienced an adverse
reaction within 24 hours of transfusion. Transfusion of RBCs of shorter
versus standard practice storage duration Eleven trials (40,588
participants) compared transfusion of RBCs of shorter versus standard
practice storage duration. Three trials enrolled critically ill term
neonates; two of these enrolled very low birth weight neonates. There were
no trials in children. Eight trials enrolled critically ill and
non-critically ill adults, with most being hospitalised. We judged four
trials to be at low risk of bias across all domains with the others having
an unclear risk of bias across multiple domains. Transfusion of RBCs of
shorter versus standard practice storage duration probably leads to little
or no difference in adult in-hospital mortality (RR 1.05, 95% CI 0.97 to
1.14; 4 trials, 25,704 participants; moderate quality evidence), ICU
mortality (RR 1.06, 95% CI 0.98 to 1.15; 3 trials, 13,066 participants;
moderate quality evidence), or 30-day mortality (RR 1.04, 95% CI 0.96 to
1.13; 4 trials, 7510 participants;moderate quality evidence). Two of the
three trials that enrolled neonates reported that there were no adverse
transfusion reactions. One trial reported an isolated case of
cytomegalovirus infection in participants assigned to the standard
practice storage duration group. Two trials in critically ill adults
reported data on transfusion reactions: one observed no difference in
acute transfusion reactions between arms (RR 0.67, 95% CI 0.19 to 2.36,
2413 participants), but the other observed more febrile nonhaemolytic
reactions in the shorter storage duration arm (RR 1.48, 95% CI 1.13 to
1.95, 4919 participants). Trial sequential analysis showed that we may now
have sufficient evidence to reject a 5% relative risk increase or decrease
of death within 30 days when transfusing RBCs of shorter versus longer
storage duration across all patient groups. Authors' conclusions: The
effect of storage duration on clinically important outcomes has now been
investigated in large, high quality RCTs, predominantly in adults. There
appears to be no evidence of an effect on mortality that is related to
length of storage of transfused RBCs. However, the quality of evidence in
neonates and children is low. The current practice in blood banks of using
the oldest available RBCs can be continued safely. Additional RCTs are not
required, but research using alternative study designs, should focus on
particular subgroups (e.g. those requiring multiple RBC units) and on
factors affecting RBC quality. Copyright © 2018 The Cochrane
Collaboration.

<36>
Accession Number
625510847
Title
Cost-utility of surgical sutureless bioprostheses vs TAVI in aortic valve
replacement for patients at intermediate and high surgical risk.
Source
ClinicoEconomics and Outcomes Research. 10 (pp 733-745), 2018. Date of
Publication: 2018.
Author
Povero M.; Miceli A.; Pradelli L.; Ferrarini M.; Pinciroli M.; Glauber M.
Institution
(Povero, Pradelli) AdRes Health Economics and Outcomes Research, Turin,
Italy
(Miceli, Ferrarini, Glauber) Minimally Invasive Cardiothoracic Department,
Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan,
Italy
(Miceli) Bristol Heart Institute, University of Bristol, Bristol, United
Kingdom
(Pinciroli) LivaNova, Milan, Italy
Publisher
Dove Medical Press Ltd (PO Box 300-008, Albany, 44 Corinthian Drive,
Albany,Auckland 0752, New Zealand. E-mail: angela@dovepress.com)
Abstract
Background: Meta-analyses of studies comparing transcatheter aortic valve
implants (TAVIs) and sutureless aortic valve replacement (SU-AVR) show
differing effectiveness and safety profiles. The approaches also differ in
their surgical cost (including operating room and device).
 Objective(s): The objective of this study was to assess the
incremental cost-utility of SU-AVR vs TAVIs for the treatment of
intermediate-to high-risk patients in the US, Germany, France, Italy, UK,
and Australia. Method(s): A patient-level simulation compares
in-hospital pathways of patients undergoing SU-AVR or TAVIs; later,
patient history is modeled at the cohort level. Hospital outcomes for
TAVIs reproduce data from recent series; in SU-AVR patients, outcomes are
obtained by applying relative efficacy estimates in a recent meta-analysis
on 1,462 patients. After discharge, survival depends on the development of
paravalvular leak and the need for dialysis. A comprehensive third-party
payer perspective encompassing both in-hospital and long-term costs was
adopted. Result(s): Due to lower in-hospital (4.1% vs 7.0%) and
overall mortality, patients treated with SU-AVR are expected to live an
average of 1.25 years more compared with those undergoing TAVIs, with a
mean gain of 1.14 quality-adjusted life-years. Both in-hospital and
long-term costs were lower for SU-AVR than for TAVIs with total savings
ranging from $4,158 (France) to $20,930 (US). Conclusion(s): SU-AVR
results dominant when compared to TAVIs in intermediate-to high-risk
patients. Both in-hospital and long-term costs are lower for SU-AVR than
for TAVI patients, with concomitant significant gains in life expectancy,
both raw and adjusted for the quality of life. Copyright © 2018
Povero et al.

<37>
Accession Number
2001408918
Title
Systematic Review of Endovascular, Surgical, and Conservative Options for
Infectious Intracranial Aneurysms and Cardiac Considerations.
Source
Journal of Stroke and Cerebrovascular Diseases. (no pagination), 2018.
Date of Publication: 2018.
Author
Ragulojan R.; Grupke S.; Fraser J.F.
Institution
(Ragulojan) UK College of Medicine, University of Kentucky, Lexington,
Kentucky, United Kingdom
(Grupke, Fraser) Department of Neurosurgery, College of Medicine,
University of Kentucky, Lexington, Kentucky, United Kingdom
(Grupke, Fraser) Department of Radiology, College of Medicine, University
of Kentucky, Lexington, Kentucky, United Kingdom
(Fraser) Department of Neurology, College of Medicine, University of
Kentucky, Lexington, Kentucky, United Kingdom
(Fraser) Department of Neuroscience, College of Medicine, University of
Kentucky, Lexington, Kentucky, United Kingdom
Publisher
W.B. Saunders
Abstract
Introduction: With rising rates of intravenous drug use, Infectious
Intracranial aneurysms (IIAs) are a relevant topic for investigation. We
performed a systematic review to better understand current practice
patterns and limits of current published literature. Method(s): 131
publications with a total of 499 patients (665 aneurysms) were included.
Of the 499 patients, 83 were single case reports, and 20.5% of the total
had multiple aneurysms. 35.8% of all aneurysms were ruptured. Of those
reporting treatment, options included conservative antibiotic therapy
(30.0%), open surgical intervention (31.1%), and endovascular occlusion
(31.8%). Chronologically, publication of IIAs has increased. Usage of
endovascular therapies has grown, while conservative and surgical
management have declined in the literature. Overall, 56.2% of aneurysms
for which conservative therapy was initiated eventually either underwent
intervention or death of patient occurred. Result(s): The issue of
cardiac valve surgery in relationship to aneurysm therapy was discussed in
20.8% (80 patients) of all 384 infectious endocarditis patients; of which
15.0% (12) underwent valve surgery before aneurysm treatment and 85.0
patients (68)% underwent valve surgery after aneurysm treatment. For 51 of
the patients where valve surgery followed aneurysm management, the
corresponding aneurysm treatment modality could be determined; 58.8% (30)
of whom were managed endovascularly. 32.7% (26) of all cases reporting
cardiac surgery details underwent cardiac surgery during their admission
with the IIA. Conclusion(s): Overall, increasing trend of
endovascular management of IIAs is evident, and a strong temporal
preference exhibited by providers to perform cardiac surgery subsequently
to IIA management. Copyright © 2018 National Stroke Association

<38>
Accession Number
2001408332
Title
Disparities in death rates in women with peripartum cardiomyopathy between
advanced and developing countries: A systematic review and meta-analysis.
Source
Archives of Cardiovascular Diseases. (no pagination), 2018. Date of
Publication: 2018.
Author
Kerpen K.; Koutrolou-Sotiropoulou P.; Zhu C.; Yang J.; Lyon J.-A.; Lima
F.V.; Stergiopoulos K.
Institution
(Kerpen, Stergiopoulos) Division of Cardiovascular Medicine, Department of
Medicine, Stony Brook University Medical Center, State University of New
York, Stony Brook, Nichols road, NY 11794, United States
(Koutrolou-Sotiropoulou) Division of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN 55905, United States
(Zhu) Department of Applied Mathematics and Statistics, Stony Brook
University, Stony Brook, NY 11794, United States
(Yang) Department of Family, Population and Preventive Medicine, Stony
Brook University Medical Center, Stony Brook, NY 11794, United States
(Lyon) Library Services, Children's Mercy Kansas City, Kansas City, MO
64108, United States
(Lima) Department of Medicine, Brown University, Rhode Island Hospital,
Providence, RI 02903, United States
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
There is limited information about differences in maternal deaths from
peripartum cardiomyopathy (PPCM) between advanced and developing
countries. To review the literature to define the global prevalence of
death from PPCM, and to determine the differences in PPCM mortality rates
and risk factors between advanced and developing countries. Studies in the
English language reporting mortality data on patients with PPCM were
included from searches of MEDLINE, Embase, CINAHL, the Cochrane Library,
the Web of Science Core Collection and Scopus from 01 January 2000 to 11
May 2016. Of the 4294 articles identified, 1.07% were included. The
primary outcome was death; rates of heart transplant, acute myocardial
infarction, heart failure, arrhythmia, cerebrovascular events, embolism
and cardiac arrest were recorded. Studies were categorized as having been
conducted in advanced or developing countries. Data from 46 studies, 4925
patients and 13 countries were included. There were 22 studies from
advanced countries (n = 3417) and 24 from developing countries (n = 1508);
mean follow-up was 2.6 (range 0-8.6) years. Overall mortality prevalence
was 9% (95% confidence interval [CI] 6-11%). The mortality rate in
developing countries (14%, 95% CI 10-18%) was significantly higher than
that in advanced countries (4%, 95% CI 2-7%). There was no difference in
the prevalence of risk factors (chronic hypertension, African descent,
multiple gestation and multiparity) between advanced and developing
countries. Studies with a higher prevalence of women of African descent
had higher death rates (correlation coefficient 0.29, 95% CI 0.13-0.52).
The risk of death in women with PPCM was higher in developing countries
than in advanced countries. Women of African descent had an increased risk
of death. Copyright © 2018 Elsevier Masson SAS

<39>
Accession Number
2000953084
Title
Transradial access for coronary diagnostic and interventional procedures:
Consensus statement and recommendations for India: Advancing Complex
CoronariES Sciences through TransRADIAL intervention in India - ACCESS
RADIALTM: Clinical consensus recommendations in collaboration with
Cardiological Society of India (CSI).
Source
Indian Heart Journal. 70 (6) (pp 922-933), 2018. Date of Publication:
November - December 2018.
Author
Goel P.K.; Menon A.; Mullasari A.S.; Valaparambil A.K.; Pinto B.;
Pahlajani D.; Gunasekaran S.; Trehan V.K.; Abhaichand R.K.; Chugh S.K.;
Hiremath M.S.
Institution
(Goel) Department of Cardiology, Sanjay Gandhi Post Graduate Institute of
Medical Sciences (SGPGI), India
(Menon) Department of Cardiology, Lilavati Hospital & Research Centre,
India
(Mullasari) Department of Cardiology, Madras Medical Mission, India
(Valaparambil) Department of Cardiology, Sree Chitra Tirunal Institute,
India
(Pinto) Department of Cardiology, Holy Family Hospital, India
(Pahlajani) Department of Cardiology, Beach Candy Hospital, India
(Hiremath) Department of Cardiology, Ruby Hall Clinic, India
(Gunasekaran) Department of Cardiology, Apollo Hospital, India
(Trehan) Department of Cardiology, G.B. Pant Hospital (GIPMER), India
(Abhaichand) Department of Cardiology, G.K.N.M. Hospital, India
(Chugh) Department of Cardiology, Jaipur National University Hospital,
India
Publisher
Elsevier B.V.
Abstract
Radial access for cardiac catheterization and intervention in India has
been growing steadily over the last decade with favorable clinical
outcomes. However, its usage by interventional cardiologists varies
greatly among Indian operators and hospitals due to large geographic
disparities in health care delivery systems and practice patterns. It also
remains unclear whether the advantages, as well as limitations of
transradial (TR) intervention (as reported in the western literature), are
applicable to developing countries like India or not. An evidence-based
review involving various facets of radial procedure for cardiac
catheterization, including practical, patient-related and technical issues
was conducted by an expert committee that formed a part of Advancing
Complex CoronariES Sciences through TransRADIAL intervention (ACCESS
RADIALTM) Advisory Board. Emerging challenges in redefining TR management
based on evidence supporting practices were discussed to formulate these
final recommendations through consensus. Copyright © 2018

<40>
Accession Number
622002880
Title
Repetitive levosimendan for a LION's heart?.
Source
European Journal of Heart Failure. 20 (7) (pp 1137-1138), 2018. Date of
Publication: July 2018.
Author
Altenberger J.; Polzl G.
Institution
(Altenberger) Cardiac Rehabilitation Center Grossgmain,
Pensionsversicherungsanstalt, Teaching Hospital of Paracelsus Medical
Private University, Salzburg, Austria
(Polzl) Medical University Innsbruck, Department of Internal Medicine III,
Innsbruck, Austria
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)

<41>
Accession Number
625146036
Title
Reduction in subtypes and sizes of myocardial infarction with ticagrelor
in PEGASUS-TIMI 54.
Source
Journal of the American Heart Association. 7 (22) (no pagination), 2018.
Article Number: e009260. Date of Publication: 01 Nov 2018.
Author
Bonaca M.P.; Wiviott S.D.; Morrow D.A.; Steg P.G.; Hamm C.; Bhatt D.L.;
Storey R.F.; Cohen M.; Kuder J.; Im K.; Magnani G.; Budaj A.; Nicolau
J.C.; Parkhomenko A.; Sendon J.L.; Dellborg M.; Diaz R.; Werf F.V.D.;
Corbalan R.; Goudev A.; Jensen E.C.; Johanson P.; Braunwald E.; Sabatine
M.S.
Institution
(Bonaca, Wiviott, Morrow, Bhatt, Kuder, Im, Braunwald, Sabatine) TIMI
Study Group, Brigham and Women's Hospital, Boston, MA, United States
(Steg) FACT, DHU FIRE, Hopital Bichat, Assistance Publique-Hopitaux de
Paris, Paris, France
(Hamm) Department of Medicine, Kerckhoff Heart Center, BadNauheim, Germany
(Storey) Department of Medicine, University of Sheffield, United Kingdom
(Cohen) Newark Beth Israel Medical Center, Rutgers-New Jersey Medical
School, Newark, NJ, United States
(Magnani) UniversitatsSpital Zurich (USZ) & Zurich Heart House, University
Hospital of Zurich, Switzerland
(Budaj) Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
(Nicolau) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Parkhomenko) Department of Medicine, Institute of Cardiology, Kiev,
Ukraine
(Sendon) Department of Medicine, Hosp Univrio La Paz, Madrid, Spain
(Dellborg) Sahlgrenska Acad, University of Gothenburg, Sweden
(Diaz) Department of Medicine, ECLA (Estudios Clinicos Latino America),
Rosario, Argentina
(Werf) Department of Medicine, University of Leuven, Belgium
(Corbalan) Department of Medicine, Pontificia Univ Catolica de Chile,
Santiago, Chile
(Goudev) Medical University of Sofia, Queen Ioanna University Hospital,
Sofia, Bulgaria
(Jensen, Johanson) AstraZeneca, Molndal, Sweden
Publisher
American Heart Association Inc.
Abstract
Background--Ticagrelor reduced cardiovascular death, myocardial infarction
(MI), or stroke in patients with prior MI in PEGASUSTIMI 54 (Prevention of
Cardiovascular Events [eg, Death From Heart or Vascular Disease, Heart
Attack, or Stroke] in Patients With Prior Heart Attack Using Ticagrelor
Compared to Placebo on a Background of Aspirin). MI can occur in diverse
settings and with varying severity; therefore, understanding the types and
sizes of MI events prevented is of clinical importance. Methods and
Results--MIs were adjudicated by a blinded clinical events committee and
categorized by subtype and fold elevation of peak cardiac troponin over
the upper limit of normal. A total of 1042 MIs occurred in 898 of the 21
162 randomized patients over a median follow-up of 33 months. The majority
of the MIs (76%) were spontaneous (Type 1), with demand MI (Type 2) and
stent thrombosis (Type 4b) accounting for 13% and 9%, respectively; sudden
death (Type 3), percutaneous coronary intervention-related (Type 4a) and
coronary artery bypass graft-related (Type 5) each accounted for <1%. Half
of MIs (520, 50%) had a peak troponin >=10x upper limit of normal and 21%
of MIs (220) had a peak troponin >=1009 upper limit of normal. A total of
21% (224) were ST-segment-elevation MI STEMI. Overall ticagrelor reduced
MI (4.47% versus 5.25%, hazard ratio 0.83, 95% confidence interval
0.72-0.95, P=0.0055). The benefit was consistent among the subtypes,
including a 31% reduction in MIs with a peak troponin >=1009 upper limit
of normal (hazard ratio 0.69, 95% confidence interval 0.53-0.92, P=0.0096)
and a 40% reduction in ST-segment elevation MI (hazard ratio 0.60, 95%
confidence interval 0.46-0.78, P=0.0002). Conclusions--In stable
outpatients with prior MI, the majority of recurrent MIs are spontaneous
and associated with a high biomarker elevation. Ticagrelor reduces the MI
consistently among subtypes and sizes including large MIs and ST-segment
elevation MI. Clinical Trial Registration-URL:
https://www.clinicaltrials.gov. Unique identifier:
NCT01225562. Copyright © 2018 The Authors.

<42>
Accession Number
625464317
Title
Association of Renin-Angiotensin Inhibitor Treatment with Mortality and
Heart Failure Readmission in Patients with Transcatheter Aortic Valve
Replacement.
Source
JAMA - Journal of the American Medical Association. 320 (21) (pp
2231-2240), 2018. Date of Publication: 04 Dec 2018.
Author
Inohara T.; Manandhar P.; Kosinski A.S.; Matsouaka R.A.; Kohsaka S.; Mentz
R.J.; Thourani V.H.; Carroll J.D.; Kirtane A.J.; Bavaria J.E.; Cohen D.J.;
Kiefer T.L.; Gaca J.G.; Kapadia S.R.; Peterson E.D.; Vemulapalli S.
Institution
(Inohara, Manandhar, Kosinski, Matsouaka, Mentz, Kiefer, Gaca, Peterson,
Vemulapalli) Duke Clinical Research Institute, Duke University Medical
Center, 2400 Pratt St., Durham, NC 27705, United States
(Inohara, Kohsaka) Department of Cardiology, Keio University School of
Medicine, Tokyo, Japan
(Thourani) Department of Cardiac Surgery, MedStar Heart and Vascular
Institute, Georgetown University School of Medicine, Washington, DC,
United States
(Carroll) Division of Cardiology, Department of Medicine, University of
Colorado, Aurora, United States
(Kirtane) Department of Medicine, Columbia University Medical Center, New
York Presbyterian Hospital, New York, NY, United States
(Bavaria) Division of Cardiovascular Surgery, University of Pennsylvania,
Philadelphia, United States
(Cohen) Department of Medicine, Saint Luke's Mid America Heart Institute,
Kansas City, MO, United States
(Cohen) Department of Medicine, University of Missouri-Kansas City School
of Medicine, Kansas City, United States
(Kapadia) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, OH, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance Data are lacking on the effect of a renin-angiotensin system
(RAS) inhibitor prescribed after transcatheter aortic valve replacement
(TAVR). Treatment with a RAS inhibitor may reverse left ventricular
remodeling and improve function. Objective To investigate the association
of prescription of a RAS inhibitor and outcomes after TAVR. Design,
Setting, and Participants Retrospective cohort study of TAVR procedures
performed in the United States (using the Society of Thoracic
Surgeons/American College of Cardiology Transcatheter Valve Therapies
Registry) between July 2014 and January 2016 that were linked to Medicare
claims data (final date of follow-up: March 31, 2017). To account for
differences in demographics, echocardiographic findings, and in-hospital
complications, 1:1 propensity matching was performed. Exposures Initial
hospital discharge prescription of a RAS inhibitor after TAVR. Main
Outcomes and Measures Primary outcomes were all-cause death and
readmission due to heart failure at 1 year after discharge, which were
considered separately. The secondary outcome was health status assessed by
the Kansas City Cardiomyopathy Questionnaire (KCCQ; score range: 0-100,
with a higher score indicating less symptom burden and better quality of
life; a small effect size was defined as 5 points) at 1 year. Results
Among 21312 patients who underwent TAVR at 417 US sites, 8468 patients
(39.7%) were prescribed a RAS inhibitor at hospital discharge. After
propensity matching, 15896 patients were included (mean [SD] age, 82.4
[6.8] years; 48.1% were women; mean [SD] left ventricular ejection
fraction [LVEF], 51.9% [11.5%]). Patients with a prescription for a RAS
inhibitor vs those with no prescription had lower mortality rates at 1
year (12.5% vs 14.9%, respectively; absolute risk difference [ARD], -2.4%
[95% CI, -3.5% to -1.4%]; hazard ratio [HR], 0.82 [95% CI, 0.76 to 0.90])
and lower heart failure readmission rates at 1 year (12.0% vs 13.8%; ARD,
-1.8% [95% CI, -2.8% to -0.7%]; HR, 0.86 [95% CI, 0.79 to 0.95]). When
stratified by LVEF, having a prescription for a RAS inhibitor vs no
prescription was associated with lower 1-year mortality among patients
with preserved LVEF (11.1% vs 13.9%, respectively; ARD, -2.81% [95% CI,
-3.95% to -1.67%]; HR, 0.78 [95% CI, 0.71 to 0.86]), but not among those
with reduced LVEF (18.8% vs 19.5%; ARD, -0.68% [95% CI, -3.52% to 2.20%];
HR, 0.95 [95% CI, 0.81 to 1.12]) (P =.04 for interaction). Of 15896
matched patients, 4837 (30.4%) were included in the KCCQ score analysis
and improvements at 1 year were greater in patients with a prescription
for a RAS inhibitor vs those with no prescription (median, 33.3
[interquartile range, 14.2 to 51.0] vs 31.3 [interquartile range, 13.5 to
51.1], respectively; difference in improvement, 2.10 [95% CI, 0.10 to
4.06]; P <.001), but the effect size was not clinically meaningful.
Conclusions and Relevance Among patients who underwent TAVR, receiving a
prescription for a RAS inhibitor at hospital discharge compared with no
prescription was significantly associated with a lower risk of mortality
and heart failure readmission. However, due to potential selection bias,
this finding requires further investigation in randomized
trials. © Copyright 2018 American Medical Association. All Rights
Reserved.

<43>
Accession Number
2001368229
Title
Left Main Percutaneous Coronary Intervention Versus Coronary Artery Bypass
Grafting in Patients With Prior Cerebrovascular Disease: Results From the
EXCEL Trial.
Source
JACC: Cardiovascular Interventions. 11 (24) (pp 2441-2450), 2018. Date of
Publication: 24 December 2018.
Author
Diamond J.; Madhavan M.V.; Sabik J.F.; Serruys P.W.; Kappetein A.P.; Leon
M.B.; Taggart D.P.; Berland J.; Morice M.-C.; Gersh B.J.; Kandzari D.E.;
Dressler O.; Stone G.W.
Institution
(Diamond, Madhavan, Leon, Stone) NewYork-Presbyterian Hospital/Columbia
University Medical Center, New York, NY, United States
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Leon, Dressler, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Taggart) John Radcliffe Hospital, Oxford, United Kingdom
(Berland) Clinique Saint Hilaire, Rouen, France
(Morice) Ramsay Generale de Sante - Institut Cardiovasculaire Paris Sud,
Massy, France
(Gersh) Mayo Clinic College of Medicine, Rochester, MN, United States
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to determine whether high-risk
patients with left main coronary artery disease (LMCAD) and prior
cerebrovascular disease (CEVD) preferentially benefit from
revascularization by percutaneous coronary intervention (PCI) compared
with coronary artery bypass grafting (CABG). Background(s): Patients
with known CEVD requiring revascularization are often referred to PCI
rather than CABG. There is a paucity of data regarding the impact of CEVD
in patients with LMCAD undergoing revascularization. Method(s): In
the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for
Effectiveness of Left Main Revascularization) trial, patients with LMCAD
and low or intermediate SYNTAX (Synergy Between PCI with Taxus and Cardiac
Surgery) scores were randomized to PCI with everolimus-eluting stents
versus CABG. The effects of prior CEVD, defined as prior stroke, transient
ischemic attack, or carotid artery disease, on 30-day and 3-year event
rates were assessed. Result(s): Prior CEVD was present in 233 of
1,898 patients (12.3%). These patients were older and had higher rates of
comorbidities, including hypertension, diabetes, peripheral vascular
disease, anemia, chronic kidney disease, and prior PCI, compared with
those without prior CEVD. Patients with prior CEVD had higher rates of
stroke at 30 days (2.2% vs. 0.8%; p = 0.05) and 3 years (6.4% vs. 2.2%; p
= 0.0003) and higher 3-year rates of the primary endpoint of all-cause
death, stroke, or myocardial infarction (25.0% vs. 13.6%; p < 0.0001). The
relative effects of PCI versus CABG on the 30-day and 3-year rates of
stroke (p<inf>interaction</inf> = 0.65 and 0.16, respectively) and the
3-year rates of the primary composite endpoint (p<inf>interaction</inf> =
0.14) were consistent in patients with and those without prior CEVD.
 Conclusion(s): Patients with LMCAD and prior CEVD compared with those
without CEVD have higher rates of stroke and reduced event-free survival
after revascularization. Data from the EXCEL trial do not a priori support
a preferential role of PCI over CABG in patients with known
CEVD. Copyright © 2018 American College of Cardiology Foundation

<44>
Accession Number
620597915
Title
Bioprosthetic aortic valve leaflet thrombosis detected by multidetector
computed tomography is associated with adverse cerebrovascular events: A
meta-analysis of observational studies.
Source
EuroIntervention. 13 (15) (pp e1748-e1755), 2018. Date of Publication:
February 2018.
Author
Rashid H.N.; Gooley R.P.; Nerlekar N.; Ihdayhid A.R.; McCormick L.M.;
Nasis A.; Cameron J.D.; Brown A.J.
Institution
(Rashid, Gooley, Nerlekar, Ihdayhid, McCormick, Nasis, Cameron, Brown)
Monash Cardiovascular Research Centre, Monash University and MonashHeart,
Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia
Publisher
EuroPCR
Abstract
Aims: Leaflet thrombosis (LT) has become increasingly recognised following
transcatheter and surgical aortic bioprosthetic valve (ABV) replacement
and can be reliably identified by multidetector computed tomography
(MDCT). However, it is an ongoing debate whether MDCT-defined LT is
associated with adverse cerebrovascular outcomes. We sought to perform a
systematic review and meta-analysis in order to assess the incidence and
clinical outcomes associated with MDCT-defined leaflet thrombosis
following (ABV) replacement. Methods and Results: Electronic
databases were searched for studies that performed mandatory MDCT imaging
following ABV replacement. The primary endpoint was the incidence of
cerebrovascular events, defined as a composite of stroke or transient
ischaemic attack (TIA). Secondary endpoints included major adverse
cerebrovascular and cardiovascular events (MACCE), stroke, TIA, death or
myocardial infarction. In total, six studies met the inclusion criteria
with 11.6% (198/1,704) of patients having MDCT-defined LT. The prevalence
of LT following transcatheter and surgical ABV replacement was 13.2% and
3.6%, respectively. Cerebrovascular events were significantly increased in
patients with LT (odds ratio [OR] 3.38, 95% CI: 1.78-6.41, p<0.001). The
risk of MACCE (OR 2.10, 95% CI: 1.21-3.64, p<0.001) and TIA (OR 5.86, 95%
CI: 2.05-16.75, p<0.001) was also increased in patients with LT, although
there were no differences in the incidence of stroke (OR 2.43, 95% CI:
1.00-5.93, p=0.05), death (OR 0.92, 95% CI: 0.42-2.03, p=0.84) or
myocardial infarction (OR 1.72, 95% CI: 0.34-9.78, p=0.54) between groups.
 Conclusion(s): MDCT-defined LT following ABV replacement is
associated with a significantly increased risk of adverse cerebrovascular
events. Further prospective studies are required to ascertain whether LT
can be prevented or treated with pharmacological strategies. Copyright
© Europa Digital & Publishing 2018. All rights reserved.

<45>
Accession Number
620795999
Title
The Future of Biomarker-Guided Therapy for Heart Failure After the Guiding
Evidence-Based Therapy Using Biomarker Intensified Treatment in Heart
Failure (GUIDE-IT) Study.
Source
Current Heart Failure Reports. 15 (2) (pp 37-43), 2018. Date of
Publication: 01 Apr 2018.
Author
Ibrahim N.E.; Januzzi J.L.
Institution
(Ibrahim, Januzzi) Cardiology Division, Massachusetts General Hospital, 55
Fruit Street, GRB-800, Boston, MA 02114, United States
(Ibrahim, Januzzi) Harvard Medical School, Boston, MA, United States
(Januzzi) Baim Institute for Clinical Research, Boston, MA, United States
Publisher
Current Science Inc. (E-mail: info@current-reports.com)
Abstract
Purpose of Review: Biomarker-guided management of patients with chronic
heart failure with reduced ejection fraction (HFrEF) remains
controversial. Recent Findings: Biomarkers have established roles for
diagnosis and prognostication in HF. Pilot data suggested that use of
natriuretic peptides might be helpful to guide HF care. The recent Guiding
Evidence-Based Therapy Using Biomarker Intensified Treatment in Heart
Failure (GUIDE-IT) randomized-controlled trial did not find therapy guided
by NT-proBNP to be more effective than usual care in improving the primary
endpoint of HF hospitalization or cardiovascular mortality amongst
patients with chronic HFrEF. Patients in GUIDE-IT received similar care
and had similar NT-proBNP lowering regardless of treatment allocation.
 Summary: Though biomarkers retain important standing for diagnosis
and prognosis in HF, the GUIDE-IT trial results suggest carefully managed
patients may not benefit from a biomarker-guided strategy. Future studies
focusing this intervention on patients treated in a more real-world
setting are needed. Copyright © 2018, Springer Science+Business
Media, LLC, part of Springer Nature.

<46>
Accession Number
625402346
Title
Bariatric surgery among patients with heart failure: A systematic review
and meta-analysis.
Source
Open Heart. 5 (2) (no pagination), 2018. Article Number: e000910. Date of
Publication: 01 Dec 2018.
Author
Berger S.; Meyre P.; Blum S.; Aeschbacher S.; Ruegg M.; Briel M.; Conen D.
Institution
(Berger, Meyre, Blum, Aeschbacher, Conen) Cardiology Division, Department
of Medicine, University Hospital of Basel, Basel, Switzerland
(Berger, Meyre, Blum, Aeschbacher, Ruegg, Conen) Cardiovascular Research
Institute Basel, University Hospital of Basel, Basel, Switzerland
(Briel) Basel Institute for Clinical Epidemiology and Biostatistics,
Department of Clinical Research, University Hospital of Basel, University
of Basel, Basel, Switzerland
(Briel) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada
(Conen) Population Health Research Institute, McMaster University,
Hamilton, ON, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background: Bariatric surgery reduces cardiovascular risk in obese
patients. Heart failure (HF) is associated with an increased perioperative
risk following bariatric surgery. This systematic review aimed to assemble
the evidence on bariatric surgery in patients with known HF and the
potential effect of bariatric surgery on incident HF in obese patients
without prevalent HF. Method(s): We performed a comprehensive
literature search up to 30 September 2017 and included studies comparing
bariatric surgery to non-surgical treatment in patients with known
presurgical HF. To assess whether bariatric surgery has any effect on
incident HF, we also assembled studies looking at new-onset HF among
patients without HF prior to surgery. Result(s): We found five
observational studies (0 randomised trials) comparing bariatric surgery
with non-surgical treatment in patients with a diagnosis of HF prior to
surgery. A review of the available studies (n=676 patients) suggested
reduced admission rates for HF exacerbation and increased left ventricular
ejection fraction after bariatric surgery. No meta-analysis was possible
due to the heterogeneous nature of these studies. Seven studies (one
randomised trial) reported data on new-onset HF in obese patients without
HF prior to bariatric surgery (n=111 127 patients). When comparing
surgical to non-surgical treatment groups, the pooled univariable and
multivariable HRs for incident HF were 0.28 (95% CI 0.13 to 0.55) and 0.44
(95% CI 0.36 to 0.55), respectively. Conclusion(s): In this
systematic review, no randomised trial assessed the benefits and risks of
bariatric surgery in obese patients with concomitant HF. Available studies
do, however, show that surgery might prevent incident HF. Copyright
© 2018 Author.

<47>
Accession Number
625456211
Title
Prevention of Infections in Cardiac Surgery study (PICS): Study protocol
for a pragmatic cluster-randomized factorial crossover pilot trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 688. Date of
Publication: 17 Dec 2018.
Author
Van Oostveen R.B.; Romero-Palacios A.; Whitlock R.; Lee S.F.; Connolly S.;
Carignan A.; Mazer C.D.; Loeb M.; Mertz D.
Institution
(Van Oostveen, Whitlock, Lee, Connolly, Mertz) Population Health Research
Institute (PHRI), Hamilton Health Sciences, Hamilton, ON, Canada
(Romero-Palacios, Whitlock, Connolly, Loeb, Mertz) McMaster University,
Hamilton, ON, Canada
(Carignan) Department of Microbiology and Infectious Diseases, Universite
de Sherbrooke, Sherbrooke, QC, Canada
(Carignan) Centre de Recherche du Centre Hospitalier Universitaire de
Sherbrooke, Sherbrooke, QC, Canada
(Mazer) Li Ka Shing Knowledge Institute, St. Michael's Hospital,
University of Toronto, Toronto, ON, Canada
(Mertz) Juravinski Hospital and Cancer Center, 711 Concession Street,
Hamilton, ON L8V 1C3, Canada
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: A wide range of prophylactic antibiotic regimens are used for
patients undergoing open-heart cardiac surgery. This reflects clinical
equipoise in choice and duration of antibiotic agents. Although
individual-level randomized control trials (RCT) are considered the gold
standard when evaluating the efficacy of an intervention, this approach is
highly resource intensive and a cluster RCT can be more appropriate for
testing clinical effectiveness in a real-world setting. Methods/design: We
are conducting a factorial cluster-randomized crossover pilot trial in
cardiac surgery patients to evaluate the feasibility of this design for a
definite trial to evaluate the optimal duration and choice of
perioperative antibiotic prophylaxis. Specifically, we will evaluate: (a)
the non-inferiority of a single preoperative dose compared to prolonged
prophylaxis and (b) the potential superiority of adding vancomycin to
routine cefazolin in terms of preventing deep and organ/space sternal
surgical site infections (s-SSIs). There are four strategies: (i)
short-term cefazolin, (ii) long-term cefazolin, (iii) short-term cefazolin
+ vancomycin, and (iv) long-term cefazolin + vancomycin. These strategies
are delivered in a different order in each health-care center
participating in the trial. The centers are randomized to an order, and
the current strategy becomes the standard operating procedure in that
center during the study. The three feasibility outcomes include: (1) the
proportion of patients receiving preoperative, intra-operative, and
postoperative antibiotics according to the study protocol, (2) the
proportion of completed follow-up assessments, and (3) a full and final
assessment of the incidence of s-SSIs by the outcome adjudication
committee. Discussion(s): We believe that a cluster-randomized
factorial crossover trial is an effective and feasible design for these
research questions, allowing an evaluation of the clinical effectiveness
in a real-world setting. A waiver of individual informed consent was
considered appropriate by the research ethics boards in each participating
site in Canada as long as an information letter with an opt-out option was
provided. However, a waiver of consent was not approved at two sites in
Germany and Switzerland, respectively. Trial registration:
Clinicaltrials.gov, NCT02285140. Registered on 15 October
2015. Copyright © 2018 The Author(s).

<48>
Accession Number
2000733772
Title
Complete Revascularization During Primary Percutaneous Coronary
Intervention Reduces Death and Myocardial Infarction in Patients With
Multivessel Disease: Meta-Analysis and Meta-Regression of Randomized
Trials.
Source
JACC: Cardiovascular Interventions. 11 (9) (pp 833-843), 2018. Date of
Publication: 14 May 2018.
Author
Pasceri V.; Patti G.; Pelliccia F.; Gaudio C.; Speciale G.; Mehran R.;
Dangas G.D.
Institution
(Pasceri, Speciale) San Filippo Neri Hospital, Rome, Italy
(Pasceri, Pelliccia, Gaudio, Speciale) La Sapienza University, Rome, Italy
(Patti) Campus Bio-Medico University, Rome, Italy
(Mehran, Dangas) Zena and Michael A. Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, New York, New York, United States
(Mehran, Dangas) Cardiovascular Research Foundation, New York, New York,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to compare complete
revascularization with a culprit-only strategy in patients presenting with
ST-segment elevation myocardial infarction (MI) and multivessel disease by
a meta-analysis of randomized trials. Background(s): Although several
trials have compared complete with culprit-only revascularization in
ST-segment elevation MI, it remains unclear whether complete
revascularization may lead to improvement in hard endpoints (death and
MI). Method(s): Randomized trials comparing complete
revascularization with culprit-only revascularization in patients with
ST-segment elevation MI without cardiogenic shock were identified by a
systematic search of published research. Random-effects meta-analysis was
performed, comparing clinical outcomes in the 2 groups. Result(s):
Eleven trials were identified, including a total of 3,561 patients.
Compared with a culprit-only strategy, complete revascularization
significantly reduced risk for death or MI (relative risk [RR]: 0.76; 95%
confidence interval [CI]: 0.58 to 0.99; p = 0.04). Meta-regression showed
that performing complete revascularization at the time of primary
percutaneous coronary intervention (PCI) was associated with better
outcomes (p = 0.016). The 6 trials performing complete revascularization
during primary PCI (immediate revascularization) were associated with a
significant reduction in risk for both total mortality (RR: 0.62; 95% CI:
0.39 to 0.97; p = 0.03) and MI (RR: 0.40; 95% CI: 0.25 to 0.66; p <
0.001), whereas the 5 trials performing only staged revascularization did
not show any significant benefit in either total mortality (RR: 1.02; 95%
CI: 0.65 to 1.62; p = 0.87) or MI (RR: 1.04; 95% CI: 0.48 to 1.68; p =
0.86). Conclusion(s): When feasible, complete revascularization with
PCI can significantly reduce the combined endpoint of death and MI.
Complete revascularization performed during primary PCI was also
associated with significant reductions in both total mortality and MI,
whereas staged revascularization did not improve these
outcomes. Copyright © 2018 American College of Cardiology
Foundation

<49>
Accession Number
624326601
Title
Rivaroxaban versus Warfarin in Patients with Mechanical Heart Valve:
Rationale and Design of the RIWA Study.
Source
Drugs in R and D. 18 (4) (pp 303-308), 2018. Date of Publication: 01 Dec
2018.
Author
Duraes A.R.; de Souza Lima Bitar Y.; Filho J.A.L.; Schonhofen I.S.; Camara
E.J.N.; Roever L.; Cardoso H.E.D.P.; Akrami K.M.
Institution
(Duraes, Filho, Schonhofen, Cardoso) General Hospital Roberto Santos,
Salvador, Bahia, Brazil
(Duraes, de Souza Lima Bitar, Camara) Federal University of Bahia, Medical
School-UFBA/FAMEB, XV de novembro Square, s/n-Largo do Terreiro de Jesus,
Salvador, BA 40025-010, Brazil
(Roever) Federal University of Uberlandia, Uberlandia, Minas Gerais,
Brazil
(Akrami) Division of Infectious Disease, Department of Medicine,
University of California, San Diego, San Diego, CA, United States
Publisher
Springer International Publishing
Abstract
Introduction: Mechanical heart valves (MHV) are extremely durable, but
they require permanent use of anticoagulation to prevent thromboembolic
events. The only approved therapeutic options are vitamin K antagonists
(VKAs), such as warfarin. As a drug class, clinical management is
difficult, therefore new alternatives need to be evaluated.
 Method(s): RIWA is a phase II/III, prospective, open-label,
randomized, pilot study designed to investigate oral rivaroxaban 15 mg
twice daily compared with dose-adjusted warfarin for the prevention of
stroke (ischemic or hemorrhagic) and systemic embolism in patients with
MHV, from August 2018 to December 2019. Patients will undergo
transesophageal echocardiography at the beginning and the end of the study
(follow-up time 90 days). On an explanatory basis, all events will be
analyzed, including stroke, peripheral systemic embolism, valve
thrombosis, significant bleeding and death. Discussion(s): Warfarin
and similar VKAs are standard therapy for patients with an MHV. Even with
the appropriate use of therapy, the incidence of thromboembolic events is
high at 1-4% per year. Furthermore, bleeding risk is significant, ranging
from 2 to 9% per year. The new frontier to be overcome in relation to use
of the new oral anticoagulants is undoubtedly in patients with MHV. A
significant portion of people with MHV worldwide will benefit if
noninferiority of these new agents is confirmed. Trial Registration:
ClinicalTrials.gov identifier: NCT03566303. Recruitment Status:
Recruiting. First Posted: 25 June 2018. Last Update Posted: 25 June
2018. Copyright © 2018, The Author(s).

<50>
Accession Number
619086026
Title
Optimal duration of dual antiplatelet therapy after drug eluting stent
implantation: A network meta-analysis.
Source
Anatolian Journal of Cardiology. 18 (4) (pp 251-260), 2017. Date of
Publication: October 2017.
Author
Gajulapalli R.D.; Dias S.; Pattanshetty D.J.; Athappan G.
Institution
(Gajulapalli) Department of Medicine, Cleveland Clinic, Cleveland, OH,
United States
(Dias) School of Social and Community Medicine, University of Bristol,
Bristol, United Kingdom
(Pattanshetty) Case Western University, Metro Health, Cleveland, OH,
United States
(Athappan) Department of Interventional Cardiology, Temple University
Hospital, Philadelphia-PA, United States
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: There has been much debate regarding the optimal duration of
dual antiplatelet therapy (DAPT) cover after drug eluting stent (DES)
implantation. We aimed to assess the relative benefits of shorter and
longer durations of DAPT coverage. Method(s): We performed a network
meta-analysis (NMA) of all the randomized clinical trials (RCT) comparing
different time durations of DAPT cover. Result(s): We included 11
unique trials with a total of 33,458 patients; the longest duration of
follow-up was 48 months and the shortest was 3 months. NMA results
demonstrated that compared with 12 months, longer DAPT of 30 months
reduced the hazard ratio (HR) of stent thrombosis (HR, 0.29; 95% CrI,
0.17-0.49). There was no difference in mortality between shorter and
longer durations of DAPT except for 30 vs. 48 months (HR, 0.48; 95% CrI,
0.23-0.98). Compared with 12 months, longer DAPT of 30 months reduced the
risk of myocardial infarction (HR, 0.47; 95% CrI, 0.37-0.61). Results also
demonstrated that compared with 12 months, a shorter-term DAPT reduced the
risk of major bleeding (6 months: HR, 0.53; 95% CrI, 0.29-0.98), whereas
longer-term DAPT increased the risk of major bleeding (30 months: HR,
1.61; 95% CrI, 1.21-2.15). Conclusion(s): As expected, bleeding was
less in the shorter duration regimens, whereas the ischemic outcomes were
better in the longer duration ones. Copyright © 2017 by Turkish
Society of Cardiology.

<51>
Accession Number
619892770
Title
Emergency coronary bypass surgery in patients under the influence of dual
antiplatelet therapy: Effects of tranexamic acid and desmopressin acetate.
Source
Turkish Journal of Medical Sciences. 47 (6) (pp 1708-1714), 2017. Date of
Publication: 2017.
Author
Altun G.; Hemsinli D.; Pulathan Z.; Civelek A.
Institution
(Altun, Pulathan) Department of Cardiovascular Surgery, Karadeniz
Technical University, Faculty of Medicine, Trabzon, Turkey
(Hemsinli) Department of Cardiovascular Surgery, Kanuni Education and
Research Hospital, Trabzon, Turkey
(Civelek) Department of Cardiovascular Surgery, Medical Park Hospital,
Ordu, Turkey
Publisher
Turkiye Klinikleri Journal of Medical Sciences (Talapapa Bulvary no. 102,
Hamammonu 1 06230, Turkey)
Abstract
Background/aim: Bleeding in patients undergoing coronary artery bypass
grafting (CABG) while using dual antiplatelet therapy (DAPT) is a cause of
significant morbidity and mortality. The aim of this study is to examine
the perioperative hemostatic effects of tranexamic acid (TnX-A) and
desmopressin acetate (Des) in these patients. Material(s) and
Method(s): This clinical study was planned in a prospective and randomized
manner. Fifty-four patients were enrolled and classified into 4 different
groups. They were compared in terms of various bleeding and transfusion
parameters. Result(s): No significant differences were observed
between the groups in pre/intraoperative data apart from closure times.
Plasmin/alpha-2 antiplasmin complex values in the TnX-A and control groups
were significantly higher than those in the Des and TnX-A+Des groups at
the end of postoperative drug infusion. Mean duration of closure times,
first 3-h and total postoperative amounts of drainage, administered
volumes of erythrocyte suspension/fresh frozen plasma, cost of blood
products, length of intubation, length of stay in the intensive care unit,
and time to discharge were also significantly higher in the Des and
control groups. Conclusion(s): Des had no significant effect on
bleeding control and even delayed the hemostatic efficacy of TnX-A. Use of
TnX-A infusion alone in these patient groups had a positive effect on
hemostasis-related data. Copyright © TUBITAK.

<52>
Accession Number
2000744045
Title
Off-Pump Versus On-Pump Coronary Artery Bypass Grafting-A Systematic
Review and Analysis of Clinical Outcomes.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (1) (pp 232-244),
2019. Date of Publication: January 2019.
Author
Shaefi S.; Mittel A.; Loberman D.; Ramakrishna H.
Institution
(Shaefi) Divisions of Cardiac Anesthesia and Critical Care, Department of
Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA, United States
(Mittel) Cardiothoracic Anesthesiology, New York-Presbyterian Hospital,
Columbia University Medical Center, New York, NY, United States
(Loberman) Division of Cardiac Surgery, Brigham and Women's Hospital,
Boston, MA, United States
(Loberman) Department of Surgery, Harvard Medical School, Boston, MA,
United States
(Ramakrishna) Division of Cardiovascular and Thoracic Anesthesiology,
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic in
Arizona, Phoenix, AZ, United States
Publisher
W.B. Saunders
Abstract
Surgical coronary artery bypass grafting (CABG) is the standard of care
for revascularization of left main or three-vessel coronary artery
disease. The off-pump coronary artery bypass graft (OPCAB) procedure
avoids the use of cardiopulmonary bypass. Theoretically, OPCAB may improve
long-term outcomes by reducing the rates of perioperative myocardial
injury, stroke, neurocognitive impairment, and cardiac-related mortality.
Several high-quality clinical trials have been conducted since OPCAB
became popular in the 1990s and have demonstrated no benefit of OPCAB over
traditional CABG with respect to these outcomes despite favorable
short-term reductions in transfusion requirements and other postoperative
complications. Ultimately, OPCAB is associated with less effective
myocardial revascularization and does not entirely prevent complications
traditionally associated with cardiopulmonary bypass. This article reviews
major high-quality trials of OPCAB versus traditional CABG with respect to
both short- and long-term clinical outcomes. Copyright © 2018
Elsevier Inc.

<53>
Accession Number
624544263
Title
Does No-Touch Technique Better than Conventional or Intermediate Saphenous
Vein Harvest Techniques for Coronary Artery Bypass Graft Surgery: a
Systematic Review and Meta-analysis.
Source
Journal of Cardiovascular Translational Research. 11 (6) (pp 483-494),
2018. Date of Publication: 01 Dec 2018.
Author
Elshafay A.; Bendary A.H.; Vuong H.T.; Ahmed A.R.; Mokhtar M.A.; Soliman
A.L.; Vuong N.L.; bestawi I.A.E.; Abdallah N.A.; Vu V.T.; Hirayama K.; Huy
N.T.
Institution
(Elshafay, Bendary, Soliman, bestawi) Faculty of Medicine, Al-Azhar
University, Cairo 11884, Egypt
(Vuong) Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho
Chi Minh City 700000, Vietnam
(Ahmed) Faculty of Pharmacy, Tanta University, Gharbia 13741, Egypt
(Mokhtar) Faculty of Medicine, Sohag University, Sohag 82738, Egypt
(Vuong) Department of Cardiovascular and Thoracic Surgery, Faculty of
Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi
Minh City 70000, Vietnam
(Vuong) Department of Medical statistic and Informatics, Faculty of Public
Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi
Minh City 70000, Vietnam
(Abdallah) Faculty of Medicine, Aswan University, Aswan 81543, Egypt
(Vu) Faculty of Public Health, University of Medicine and Pharmacy at Ho
Chi Minh City, Ho Chi Minh City 700000, Vietnam
(Hirayama) Department of Immunogenetics, Institute of Tropical Medicine
(NEKKEN), Graduate School of Biomedical Sciences, Nagasaki University,
1-12-4 Sakamoto, Nagasaki 852-8523, Japan
(Huy) Evidence Based Medicine Research Group & Faculty of Applied
Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam
(Huy) Department of Clinical Product Development, Institute of Tropical
Medicine (NEKKEN), School of Tropical Medicine and Global Health, Nagasaki
University, Nagasaki, Japan
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Saphenous vein (SV) is a common graft being used in coronary artery bypass
grafting (CABG). Conventional (CON), intermediate (I), and no-touch (NT)
are the most common harvesting techniques of SV for CABG. The aim of this
study is to systematically review the NT versus CON and I techniques in
harvesting SV for CABG. Twelve databases were searched for randomized
controlled trials comparing the CON, I, and NT techniques in harvesting SV
for CABG. Twelve reports of six RCTs were included. Our meta-analysis
showed that with NT technique, patency rate was significantly higher when
compared to I technique up to 18-month follow-up duration. In contrast,
this significant difference was not maintained in terms of minor
complications of leg wounds with both techniques. The NT has significantly
higher patency rate compared to I vein harvesting technique. However, more
RCTs are warranted to confirm these results. Copyright © 2018,
Springer Science+Business Media, LLC, part of Springer Nature.

<54>
Accession Number
623897589
Title
Impact of Concomitant Mitral Valve Surgery With LVAD Placement: Systematic
Review and Meta-Analysis.
Source
Artificial Organs. 42 (12) (pp 1139-1147), 2018. Date of Publication:
December 2018.
Author
Choi J.H.; Luc J.G.Y.; Moncho Escriva E.; Phan K.; Rizvi S.S.A.; Patel S.;
Entwistle J.W.; Morris R.J.; Massey H.T.; Tchantchaleishvili V.
Institution
(Choi, Rizvi, Patel, Entwistle, Morris, Massey, Tchantchaleishvili)
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia,
PA, United States
(Luc) Division of Cardiovascular Surgery, Department of Surgery,
University of British Columbia, Vancouver, BC, Canada
(Moncho Escriva) Department of Statistics, University of Granada, Granada,
Spain
(Phan) Faculty of Medicine, University of New South Wales, Sydney, NSW,
Australia
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
The aim of this systematic review and meta-analysis was to evaluate the
outcomes of concomitant mitral valve surgery for significant preexisting
mitral regurgitation (MR) in patients undergoing continuous-flow left
ventricular assist device (CF-LVAD) implantation. Electronic search was
performed to identify all studies in the English literature examining
concurrent mitral valve surgery in patients with CF-LVAD implantation.
Identified articles were systematically assessed for inclusion and
exclusion criteria. Of 2319 studies identified, 8 studies were included.
Among 445 patients with moderate to severe or severe MR, 113 (25.4%)
patients received concurrent mitral valvular intervention during CF-LVAD
implantation. There were no significant differences in cardiopulmonary
bypass time (MR Surgery 154 min vs. no MR Surgery 119 min, P = 0.64) or
hospital length of stay (MR Surgery 21 days vs. no MR Surgery 18 days, P =
0.93). On follow-up, there were no significant differences in freedom from
greater than moderate MR (MR Surgery 100% vs. no MR Surgery 74%, P = 0.12)
or left ventricular end-diastolic diameter (MR Surgery: 60 mm vs. no MR
Surgery 65 mm, P = 0.51). Survival was comparable at 6-months (MR Surgery
77% vs. no MR Surgery 81%, P = 0.75), 1-year (MR Surgery 72% vs. no MR
Surgery 80%, P = 0.36), and 2-years of follow-up (MR Surgery 65% vs. no MR
Surgery 70%, P = 0.56). The results of our systematic review and
meta-analysis of 8 studies consisting of 445 patients demonstrates that
the addition of mitral valve intervention to CF-LVAD implantation appears
to be safe with comparable survival to those undergoing CF-LVAD
implantation alone. Large prospective randomized clinical trials are
needed to elucidate whether concomitant mitral valve intervention during
CF-LVAD implantation in patients with severe MR is
necessary. Copyright © 2018 International Center for Artificial
Organs and Transplantation and Wiley Periodicals, Inc.

<55>
Accession Number
2001385383
Title
Acute Cellular Rejection and Infection Rates in Alemtuzumab vs Traditional
Induction Therapy Agents for Lung and Heart Transplantation: A Systematic
Review and Meta-analysis.
Source
Transplantation Proceedings. 50 (10) (pp 3723-3731), 2018. Date of
Publication: December 2018.
Author
Li K.H.C.; Ho J.C.S.; Recaldin B.; Gong M.; Ho J.; Li G.; Liu T.; Wu
W.K.K.; Wong M.C.S.; Xia Y.; Dong M.; Tse G.
Institution
(Li, Recaldin) Faculty of Medicine, Newcastle University, Newcastle Upon
Tyne, United Kingdom
(Li, Ho, Liu, Tse) Department of Medicine and Therapeutics, Faculty of
Medicine, Chinese University of Hong Kong, Hong Kong, Hong Kong
(Li, Tse) Li Ka Shing Institute of Health Sciences, Faculty of Medicine,
Chinese University of Hong Kong, Hong Kong, Hong Kong
(Gong, Li) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular Disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Ho) Department of Anesthesia and Intensive Care, Faculty of Medicine, The
Chinese University of Hong Kong, Shatin, Hong Kong, Hong Kong
(Wu, Wong) The Jockey Club School of Public Health and Primary Care,
Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong
Kong
(Xia) Department of Cardiology, First Affiliated Hospital of Dalian
Medical University, Dalian, China
(Dong) Department of Cardiology, Yantai Yuhuangding Hospital Affiliated to
Qingdao University, Yantai, Shandong Province, China
Publisher
Elsevier USA
Abstract
Background and Objectives: Heart and lung transplantation is a high-risk
procedure requiring intensive immunosuppressive therapy for preventing
organ rejection. Alemtuzumab, a CD52-specific monoclonal antibody, is
increasingly used for induction therapy compared with conventional agents.
However, there has been no systematic review comparing its efficacy with
traditional therapeutic drugs. Method(s): PubMed and EMBASE were
searched to October 1, 2017, for articles on alemtuzumab in cardiothoracic
transplant surgery. Of the 433 studies retrieved, 8 were included in the
final meta-analysis. Result(s): In lung transplantation, alemtuzumab
use was associated with lower odds of acute cellular rejection compared
with antithymocyte globulin (odds ratio [OR], 0.21; 95% CI, 0.11-0.40; P
<.001), lower acute rejection rates (OR, 0.12; 95% CI, 0.03-0.55; P <.01),
and infection rates (OR, 0.69; 95% CI, 0.35-1.36; P =.33) when compared
with basiliximab. Multivariate meta-regression analysis found that mean
age, male sex, single lung transplant, double lung transplant,
cytomegalovirus or Epstein-Barr virus status, idiopathic pulmonary
fibrosis, cystic fibrosis, and mean ischemic time did not significantly
influence acute rejection outcomes. For heart transplantation, alemtuzumab
use was associated with lower acute rejection rates when compared with
tacrolimus (OR, 0.44; 95% CI, 0.30-0.66; P <.001). Conclusion(s):
Alemtuzumab use was associated with lower rejection rates when compared
with conventional induction therapy agents (antithymocyte globulin,
basiliximab, and tacrolimus) in heart and lung transplantation. However,
this was based on observational studies. Randomized controlled trials are
needed to verify its clinical use. Copyright © 2018 Elsevier Inc.

<56>
Accession Number
2001402655
Title
ECONOMIC BURDEN ASSOCIATED WITH SECONDARY CARDIOVASCULAR (CV) EVENTS - A
SYSTEMATIC LITERATURE REVIEW.
Source
Value in Health. Conference: ISPOR Europe 2018: New Perspectives for
Improving 21st Century Health Systems. Spain. 21 (Supplement 3) (pp S103),
2018. Date of Publication: October 2018.
Author
Cholasamudram S.; Yenamandra J.; Jindal R.; Cristino J.
Institution
(Cholasamudram, Yenamandra, Jindal) Novartis Healthcare Pvt. Ltd.,
Hyderabad, India
(Cristino) Novartis Pharma AG, Basel, Switzerland
Publisher
Elsevier Ltd
Abstract
Objectives: Significant burden incurred during first CV event occurrence
has been widely observed. This review aimed to identify economic burden
associated with subsequent CV events in patients with a prior myocardial
infarction (MI) or broader cardiovascular diseases. Method(s): A
systematic search was undertaken in Embase, MEDLINE and the Cochrane
library to identify relevant English publications of last 10 years
(2008-2017). Studies providing data on cost and resource use associated
with secondary CV events (MI/revascularisation/stroke/unstable angina
[UA]) were included. Result(s): Sixteen studies (20 publications) met
the inclusion criteria. Of these, 12 studies were conducted in US, two in
Asia and one each in UK and Sweden. Data sources for studies included
claims database (N=13), national registers, data warehouse and survey (one
each). Overall, patients were aged 53.5-75.3 years and the proportion of
females varied from 15.8%-54.0%. Higher cost and resource utilization were
observed with secondary events compared to the first event (%increase in
costs [UK] for MI, UA and stroke - 1-6 months: 9%, 25%, 28%; 7-36 months:
65%, 37%, 14%). However, the US study suggested that the sequence of the
event had little bearing on the overall cost. Coronary Artery Bypass Graft
was associated with higher costs among all secondary CV events, followed
by MI. Across all the events, direct costs and associated resource
utilization were higher during the first year compared to subsequent
years. CV-related costs generally decrease after the acute period,
however, two studies observed that costs remained higher than pre-CV event
costs for a longer duration (3 years). Length of hospital stay (LOS) was
observed as the major cost driver and presence of diabetes the important
predictor for higher costs. Conclusion(s): Secondary CV events pose a
significant burden on patients with history of CVD, mainly due to longer
LOS. Additional evidence in patients with a prior MI is
required. Copyright © 2018

<57>
Accession Number
2001402557
Title
A SYSTEMATIC LITERATURE REVIEW (SLR) ON HEALTH STATE UTILITIES ASSOCIATED
WITH ANGINA AND REVASCULARISATION.
Source
Value in Health. Conference: ISPOR Europe 2018: New Perspectives for
Improving 21st Century Health Systems. Spain. 21 (Supplement 3) (pp
S115-S116), 2018. Date of Publication: October 2018.
Author
Natani H.; Gogna S.; Jindal R.; Laires P.A.; Cristino J.
Institution
(Natani, Gogna, Jindal) Novartis Healthcare Pvt. Ltd., Hyderabad, India
(Laires) Novartis Farma, Porto Salvo, Portugal
(Cristino) Novartis Pharma AG, Basel, Switzerland
Publisher
Elsevier Ltd
Abstract
Objectives: Cost-utility analyses for secondary cardiovascular prevention
require health state utility values in order to calculate quality-adjusted
life-years (QALYs) for each health state. This review aimed to identify
and describe the utility values associated with unspecified/unstable
angina and revascularisation reported in the available literature.
 Method(s): An SLR was conducted to identify English publications in
Embase, MEDLINE and the grey literature published in the last 10 years
(2008-2017). Two reviewers independently conducted the screening, data
abstraction, and the quality assessment with a third reviewer consulted in
case of any discrepancies. All types of original research studies
reporting utilities data associated with angina/revascularisation were
included. Studies providing utility values only for stable angina were
excluded. Result(s): Twenty-seven studies (sample size: 49 to 18,017)
met the inclusion criteria (revascularisation: 17 studies; angina: 10
studies). Majority of them used EQ-5D assessment method (N=22;
revascularisation: 16; angina: 6) and were conducted in Europe (N=12;
revascularisation: 9; angina: 3) and North America (N=6;
revascularisation: 3; angina: 3). In general, utility values as per type
of revascularisation (either percutaneous coronary intervention [PCI] or
coronary artery bypass graft [CABG]) did not show significant differences,
particularly within same studies. However, the mean values widely varied
across the included studies (overall [N=17]: 0.33-0.90; PCI [N=10]:
0.33-0.86; CABG [N=9]: 0.69-0.90). Majority of the studies reported
improvement in utility values over time (6/8 studies). Utility values for
angina, irrespective of geographical location, ranged from 0.51 to 0.81
(EQ-5D [N=6]: 0.51-0.81; SF-6D [N=2]: 0.62-0.78; other scales [N=2]:
0.66-0.74). Severity of angina was associated with lower utility values.
 Conclusion(s): Overall, angina and revascularisation have a negative
impact on the reported health utilities. Careful interpretation of
published values is advised, given the heterogeneity of methodologies,
patient populations and timing of utilities assessment reported in the
available literature. Nevertheless, our results can be a valuable resource
for future cost-utility analyses. Copyright © 2018

<58>
Accession Number
2001401640
Title
THE INCIDENCE OF SURGICAL SITE INFECTION IN POLAND.
Source
Value in Health. Conference: ISPOR Europe 2018: New Perspectives for
Improving 21st Century Health Systems. Spain. 21 (Supplement 3) (pp S223),
2018. Date of Publication: October 2018.
Author
Przekopinska B.; Macioch T.; Niewada M.
Institution
(Przekopinska) HealthQuest, Warsaw, Poland
(Macioch, Niewada) Department of Experimental & Clinical Pharmacology,
Medical University of Warsaw, Warsaw, Poland
Publisher
Elsevier Ltd
Abstract
Objectives: World Health Organization data shows surgical site infection
(SSI) is the second most frequent type of healthcare-associated infection
in Europe. Thus, it concerns a major clinical but also an economical
problem due to the prolonged hospital stay and antibiotic treatment. Our
aim was to review most current incidence data on SSI in Polish hospitals.
 Method(s): Medline, Polish Medical Bibliography (PBL) and Google
Scholar were searched for studies that describe the incidence of SSI in
Polish Hospitals. Epidemiological data were categorized into 7 categories
based on a type of surgery department i.e.: general surgery,
cardiovascular, neurosurgery, urology, laryngology, orthopedics and
gynecology. Result(s): We have identified 9 original publication that
describes the incidence of SSI in Polish surgery wards. The incidence of
SSI differs between the type of surgery ward and type of surgery. In
general surgery, the highest rate of SSI was noted in abdominal cavity
surgery, especially in oncology surgery where SSI occurred in 12,54% of
colorectal cancer surgery. Surprisingly, SSI incidence was low in thoracic
surgery (1,3%). In vascular surgery incidence rate varied from 1,3% to
5,6% and in the head and neck thyroid gland surgery had SSI incidence rate
more than 3-fold higher than for craniotomy (8,7% vs 2,4%). The incidence
of SSI was reported at a very similar level in all identified sources
(2,4%-3,3%). In contrary, SSI incidence reported in orthopedic ward differ
a lot being low for musculoskeletal intervention and bone fractures
(1,2%-1,3%) and relatively high for endoprosthesis implantation (up to
7,5%). In the gynecological ward, SSI incidence was very similar to those
observed for abdominal surgery i.e. 3,7%-4,7% for cesarean section and
5,4% for other abdominal cavity surgery. SSI due to maternity intervention
was rare (0,8%). Conclusion(s): Our review showed that incidence of
SSI in Poland is high but still comparable to SSI rate in other European
countries. Copyright © 2018

<59>
Accession Number
2001401584
Title
REAL-WORLD DATA COLLECTION ON MEDICAL DEVICES IN THE ERA OF VALUE-BASED
HEALTHCARE: A LITERATURE REVIEW.
Source
Value in Health. Conference: ISPOR Europe 2018: New Perspectives for
Improving 21st Century Health Systems. Spain. 21 (Supplement 3) (pp S206),
2018. Date of Publication: October 2018.
Author
Rizzo E.; Buseghin G.; Greco T.; Murphy J.; Pinciroli M.; Mordenti G.
Institution
(Rizzo) LivaNova, PLC, Milano, Italy, Italy
(Buseghin, Pinciroli, Mordenti) LivaNova PLC, Milan, Italy, Italy
(Greco) LivaNova PLC, Milan, MI, Italy, Italy
(Murphy) LivaNova PLC, London, UK, United Kingdom
Publisher
Elsevier Ltd
Abstract
Objectives: To analyze the role of real world evidence in Value Based
Health Care of medical devices. Method(s): A literature search
(research string released on 2nd April, 2018) was performed on PubMed
including the following as main keywords: medical devices, real-world data
and value-based healthcare. No restrictions on language, year of
publications, and type of reference were imputed. Result(s):
Fifty-eight papers were identified and scrutinized. 2 additional
references were identified through other sources. 27 were included. The
records were published between 2004 and 2018. Once plotted against the
year of publication, an upward trend was visible starting from 1 (4%)
publications in 2004 up to 4 (15%) in 2016 and 5 (19%) in 2018. 81% of the
records reported evidence in cardiology and cardiac surgery area; 7% in
neurology. Most data came from registries (63%) and administrative
databases (33%). The sponsors were healthcare industry (4%), academia
(93%), health authorities (4%). Conclusion(s): Value based healthcare
has become a hot topic both for policy makers and for the medical devices
industry. The constantly increasing production of real world evidence and
analyses based on observational data, registry and administrative
databases confirms the increasing interest in this research area. The
clinical practice may substantially differ from controlled trials; the use
of real world data not only completes the body of evidence on a specific
therapy, but also may drive the updates of clinical guidelines. Both the
technological progress and the production of real world evidence have
become so fast that an adequate way to timely develop guidelines should be
sought. Alongside, the use of real world evidence may play a relevant role
when policy makers need to measure the value of a medical
technology. Copyright © 2018

<60>
Accession Number
2001401527
Title
EARLY HEALTH TECHNOLOGY ASSESSMENT OF TISSUE-ENGINEERED HEART VALVES IN
THE AORTIC POSITION IN ELDERLY PATIENTS.
Source
Value in Health. Conference: ISPOR Europe 2018: New Perspectives for
Improving 21st Century Health Systems. Spain. 21 (Supplement 3) (pp S108),
2018. Date of Publication: October 2018.
Author
Huygens S.; Corro Ramos I.; Bouten C.; Kluin J.; Takkenberg H.; Rutten-van
Molken M.
Institution
(Huygens, Takkenberg) Erasmus MC, Rotterdam, Netherlands
(Corro Ramos) Erasmus University Rotterdam, Rotterdam, Netherlands
(Bouten) Eindhoven University of Technology, Eindhoven, Netherlands
(Kluin) Amsterdam Medical Centre, Amsterdam Zuidoost, Netherlands
(Rutten-van Molken) Erasmus School of Health Policy & Management (ESHPM),
Rotterdam, Netherlands
Publisher
Elsevier Ltd
Abstract
Objectives: Tissue-engineered heart valves (TEHV) are foreseen to have
important advantages over currently used heart valve substitutes. In
elderly patients, these include reduction of reinterventions due to
degeneration of biological heart valve substitutes. Our objective was to
perform early Health Technology Assessment of TEHV in elderly patients
(>=70 years) requiring aortic valve replacement. Method(s): Using a
patient-level simulation model, the cost-effectiveness of TEHV compared to
surgical (SAVR) or transcatheter aortic valve replacement (TAVI) with
currently used heart valve substitutes was assessed from a societal
perspective. Clinical input parameters were derived from registries or
meta-analyses. Health-related quality of life was expressed in utilities
obtained from patient-reported EQ-5D-5L-questionnaires corrected for
utilities during events based on literature. Costs included healthcare
costs extracted from health insurance claims databases, and costs of
informal care and productivity loss of unpaid work based on
patient-reported questionnaires. Improvements in long-term performance of
TEHV, divided in durability, thrombogenicity, and infection resistance,
were explored separately and combined in scenario analyses to estimate the
maximum QALY gain, cost reduction and headroom. Result(s): Durability
of TEHV had the highest impact on QALY gain and costs. Perfect(no
prosthetic valve-related events)/improved(50% of current prosthetic
valve-related events) TEHV performance resulted in a maximum lifetime QALY
gain of 0.098/0.055 QALYs compared to SAVR and 0.028/0.019 QALYs compared
to TAVI, a maximum cost reduction of 412/446 compared to SAVR and
1,730/939 compared to TAVI, translating to a headroom of 2,382/1,548
compared to SAVR and 3,125/1,874 compared to TAVI. When the durability of
TEHV was 50% less, but thrombogenicity and infection resistance were 50%
improved, the QALY loss was 0.035/0.062 and cost increase was 2,935/2,541
compared to SAVR or TAVI, respectively. Conclusion(s): Considering
the high impact on lifetime QALYs and costs, the focus of TEHV developers
to create durable, lifelong lasting valves is crucial to further improve
current heart valve substitutes. Copyright © 2018

<61>
Accession Number
2001401455
Title
COST-UTILITY OF SURGICAL SUTURELESS BIOPROSTHESES VS. TAVI IN AORTIC VALVE
REPLACEMENT FOR PATIENTS AT INTERMEDIATE AND HIGH SURGICAL RISK.
Source
Value in Health. Conference: ISPOR Europe 2018: New Perspectives for
Improving 21st Century Health Systems. Spain. 21 (Supplement 3) (pp S262),
2018. Date of Publication: October 2018.
Author
Povero M.; Pradelli L.; Pinciroli M.
Institution
(Povero, Pradelli) AdRes HEOR, Torino, Italy
(Pinciroli) LivaNova PLC, Milan, Italy
Publisher
Elsevier Ltd
Abstract
Objectives: Transcatheter aortic valve implantations (TAVI) and sutureless
aortic valve replacement (SU-AVR) have been compared in several clinical
trials or meta-analyses, indicating differing effectiveness and safety
profiles. The approaches also differ in their surgical cost (operating
room and device). These results could lead to lower costs and increase in
quality of life with SU-AVR. Aim of this work is to assess the incremental
cost-utility of SU-AVR versus TAVI for the treatment of
intermediate-to-high risk patients in US, Germany, France, Italy, UK and
Australia. Method(s): A patient-level discrete event simulation was
developed to compare in-hospital pathways of patients undergoing SU-AVR or
TAVI; after discharge, lifetime evolution was modeled using a cohort
Markov model. Hospital outcomes for TAVI reproduce data from recent
series; in SU-AVR patients, outcomes are obtained by applying relative
efficacy estimates from Meco et al. meta-analysis. After discharge,
survival depends on the development of para-valvular leak and need for
dialysis. A comprehensive third-party payer perspective encompassing both
in-hospital and long-term costs was adopted. All costs were expressed as
2017 US dollars. Result(s): In-hospital mortality for SU-AVR resulted
lower than TAVI (4.1% vs 7.0%) with an analogous improvement in the
lifetime survival (5.51 vs 4.26 LYs); patients with SU-AVR lived 1.25
years more than patients undergoing TAVI (IQR 1.03-1.44) with a mean gain
of 1.14 QALYs (IQR 0.98-1.31). Both hospital and long-term costs resulted
lower for SU-AVR than TAVI with total savings ranging from about $ 4,160,
for France, to almost $ 21,000, for US. Conclusion(s): SU-AVR results
dominant when compared to TAVI in intermediate-to-high risk patients. Both
in-hospital and long-term costs are lower for SU-AVR than for TAVI
patients, with concomitant significant gains in life expectancy, both raw
and adjusted for quality of life. Copyright © 2018

<62>
Accession Number
2001401356
Title
DISCRETE CHOICE EXPERIMENTS TO MEASURE PATIENTS' PREFERENCES FOR CORONARY
REVASCULARIZATION.
Source
Value in Health. Conference: ISPOR Europe 2018: New Perspectives for
Improving 21st Century Health Systems. Spain. 21 (Supplement 3) (pp
S274-S275), 2018. Date of Publication: October 2018.
Author
Magliano C.A.
Institution
(Magliano) Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
Publisher
Elsevier Ltd
Abstract
Objectives: Angioplasty and open surgery represent the available
revascularization treatment options. An important trade-off between them
is the less invasive profile of angioplasty, which comes with a higher
risk of the need to repeat the revascularization. Recently, the new stents
generation significantly reduced the need to redo treatment from more than
30% to approximately 12%. Patients' preferences are poorly explored in
this scenario so using a Discrete Choice Experiment, we elicited patients'
relative preferences between these treatments. Method(s): We used
hypothetical labelled scenarios (angioplasty and surgery) considering four
attributes previously selected through a systematic review and patients
interviews: perioperative death, death within five years, myocardial
infarction within five years and the need to repeat the revascularization
treatment within five years. A conditional logit model was used to
estimate the coefficients that were used as the relative preference
weights. Result(s): A total of 160 patients completed the experiment.
The majority of respondents (73%) preferred surgery and on average,
patients valued a 1% increased risk of death within five years in the same
way as a 2.8% risk of nonfatal myocardial infarction (MI), 1.1% risk of
perioperative death, and 4.2% increased risk to redo the procedure.
 Conclusion(s): In this sample, most patients preferred surgery
instead of angioplasty when facing realistic levels of risks and benefits.
The coefficients ratios indicate that patients do not value all attributes
similarly, highlighting the limitation of using composite endpoints.
Patients valued 1%-increased risk of perioperative death in the same way
as a 3.9% risk of repeat revascularization. Based on the 3.1% difference
between perioperative mortality from angioplasty and surgery in Brazil,
patients would prefer angioplasty as long as the risk of needing to redo
the treatment is under 12.1% suggesting the necessity to incorporate the
second-generation stents in the Brazilian public health
system. Copyright © 2018

<63>
Accession Number
625629240
Title
Can definitive chemoradiotherapy be an alternative to surgery for
early-stage oesophageal cancer?.
Source
Interactive cardiovascular and thoracic surgery. 28 (1) (pp 37-40), 2019.
Date of Publication: 01 Jan 2019.
Author
Deng H.-Y.; Li G.; Luo J.; Alai G.
Institution
(Deng, Li, Luo, Alai) Lung Cancer Center, West China Hospital, Sichuan
University, Chengdu, China
(Deng) Department of Thoracic Surgery, West China Hospital, Sichuan
University, Chengdu, China
Publisher
NLM (Medline)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was: Can definitive
chemoradiotherapy (CRT) be an alternative to surgery for early-stage
oesophageal cancer? A total of 622 papers were found using the reported
search, of which 5 cohort studies represented the best evidence to answer
the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. Three cohort studies with very
limited sample size reported that definitive CRT yielded comparable
overall survival to surgery, whereas the other 2 studies with large sample
size reported that definitive CRT yielded worse survival than surgery. Two
of the cohort studies also reported that definitive CRT was associated
with significantly higher rates of recurrence than surgery. The available
evidence, while both scarce and of poor quality, suggests that definitive
CRT for early-stage oesophageal cancer resulted in worse overall survival
and more recurrence when compared to surgery. Therefore, we would
recommend that surgery still remains the standard treatment for patients
with early-stage oesophageal cancer, whereas definitive CRT could be an
alternative to surgery for patients unfit for surgery, although with
slightly inferior outcomes.

<64>
Accession Number
625628155
Title
Cardioplegia in paediatric cardiac surgery: a systematic review of
randomized controlled trials.
Source
Interactive cardiovascular and thoracic surgery. 28 (1) (pp 144-150),
2019. Date of Publication: 01 Jan 2019.
Author
Drury N.E.; Yim I.; Patel A.J.; Oswald N.K.; Chong C.-R.; Stickley J.;
Jones T.J.
Institution
(Drury, Yim, Patel, Oswald, Stickley, Jones) Department of Paediatric
Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United
Kingdom
(Drury) Institute of Cardiovascular Sciences, University of Birmingham,
Birmingham, United Kingdom
(Chong) Department of Physiology, Anatomy and Genetics, University of
Oxford, Oxford, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Cardioplegia is the primary method for myocardial protection
during cardiac surgery. We conducted a systematic review of randomized
controlled trials of cardioplegia in children to evaluate the current
evidence base. METHOD(S): We searched MEDLINE, CENTRAL and LILACS and
manually screened retrieved references and systematic reviews to identify
all randomized controlled trials comparing cardioplegia solutions or
additives in children undergoing cardiac surgery published in any
language; secondary publications and those reporting inseparable adult
data were excluded. Two or more reviewers independently screened studies
for eligibility and extracted data; the Cochrane Risk of Bias tool was
used to assess for potential biases. RESULT(S): We identified 26
trials randomizing 1596 children undergoing surgery; all were
single-centre, Phase II trials, recruiting few patients (median 48,
interquartile range 30-99). The most frequent comparison was blood versus
crystalloid in 10 (38.5%) trials, and the most common end points were
biomarkers of myocardial injury (17, 65.4%), inotrope requirements (15,
57.7%) and length of stay in the intensive care unit (11, 42.3%). However,
the heterogeneity of patients, interventions and reported outcome measures
prohibited meta-analysis. Overall risk of bias was high in 3 (11.5%)
trials, unclear in 23 (88.5%) and low in none. CONCLUSION(S): The
current literature on cardioplegia in children contains no late phase
trials. The small size, inconsistent use of end points and low quality of
reported trials provide a limited evidence base to inform practice. A core
outcome set of clinically important, standardized, validated end points
for assessing myocardial protection in children should be developed to
facilitate the conduct of high-quality, multicentre trials. PROSPERO
registration: CRD42017080205.

<65>
[Use Link to view the full text]
Accession Number
625619925
Title
The impact of preoperative frailty status on outcomes after transcatheter
aortic valve replacement: An update of systematic review and
meta-analysis.
Source
Medicine. 97 (51) (pp e13475), 2018. Date of Publication: 01 Dec 2018.
Author
Huang L.; Zhou X.; Yang X.; Yu H.
Institution
(Huang, Zhou, Yu) Department of Anesthesiology, West China Hospital, China
(Yang) Department of Obstetrics and Gynecology, West China Second
University Hospital, Sichuan University, Chengdu, Sichuan, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Frailty is a syndrome of impaired physiologic reserve and
decreased resistance to stressors and can often be seen in high-risk
patients undergoing transcatheter aortic valve replacement (TAVR).
Preoperative frailty status is thought to be related to adverse outcomes
after TAVR. We conducted this systematic review and meta-analysis to
determine the impact of preoperative frailty status on outcomes among
patients after TAVR. METHOD(S): PubMed, Embase, and the Cochrane
Library were searched for relevant studies through January 2018. Fourteen
articles (n = 7489) meeting the inclusion criteria were finally included.
Possible effects were calculated using meta-analysis. RESULT(S): The
pooled risk ratios (RRs) of late mortality (>6 months) and acute kidney
injury after TAVR in frail group were 2.81 (95% confidence interval (CI)
1.90-4.15, P < .001, I = 84%) and 1.41 (95% CI 1.02-1.94, P = .04, I =
24%), respectively. Compared with non-frail group, significantly higher
incidence of 30-day mortality (RR 2.03, 95% CI 1.63-2.54, P < .001, I =
0%) and life threatening or major bleeding after TAVR (RR 1.48, 95% CI
1.20-1.82, P < .001, I = 14%) was found in frail group. There was no
significant association between frailty and incidence of stroke after TAVR
(RR 0.93, 95% CI 0.53-1.63, P = .80, I = 0%). CONCLUSION(S):
Preoperative frailty status is proved to be significantly associated with
poor outcomes after TAVR. Our findings may remind doctors in the field of
a more comprehensive preoperative evaluation for TAVR candidates. More
well-designed and large-sample sized prospective studies are further
needed to figure out the best frailty assessment tool for patients
undergoing TAVR.

<66>
[Use Link to view the full text]
Accession Number
625621376
Title
Letter by Lema Regarding Article, "High-Target Versus Low-Target Blood
Pressure Management During Cardiopulmonary Bypass to Prevent Cerebral
Injury in Cardiac Surgery Patients: A Randomized Controlled Trial".
Source
Circulation. 138 (21) (pp 2442), 2018. Date of Publication: 20 Nov 2018.
Author
Lema G.
Institution
(Lema) Pontificia Universidad Catolica de Chile, Santiago, Chile
Publisher
NLM (Medline)

<67>
[Use Link to view the full text]
Accession Number
625622670
Title
Periprocedural Myocardial Injury Predicts Short- and Long-Term Mortality
in Patients Undergoing Transcatheter Aortic Valve Replacement.
Source
Circulation. Cardiovascular interventions. 11 (11) (pp e007106), 2018.
Date of Publication: 01 Nov 2018.
Author
Michail M.; Cameron J.N.; Nerlekar N.; Ihdayhid A.R.; McCormick L.M.;
Gooley R.; Niccoli G.; Crea F.; Montone R.A.; Brown A.J.
Institution
(Michail, Nerlekar, Ihdayhid, McCormick, Gooley, Brown) Monash
Cardiovascular Research Centre and MonashHeart, A.R.I., L.M.M., Monash
Health, Melbourne, Australia
(Michail) Institute of Cardiovascular Science, University College London,
United Kingdom (M.M.)
(Cameron) St George's University of London, United Kingdom (J.N.C.)
(Niccoli, Crea, Montone) Department of Cardiovascular and Thoracic
Sciences, Catholic University of the Sacred Heart, F.C., Rome, Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: The aim was to assess whether periprocedural myocardial injury
(PPMI) predicts outcomes in patients undergoing transcatheter aortic valve
replacement (TAVR). PPMI is a strong predictor of outcomes following
coronary intervention, but its impact in the context of TAVR remains
unclear. We performed a systematic review and meta-analysis to ascertain
the association between PPMI and short- or long-term outcomes. METHODS AND
RESULTS: Electronic searches identified studies reporting PPMI following
TAVR. Primary end point was 30-day all-cause mortality, with secondary end
points, including 1-year all-cause mortality, neurological events,
post-TAVR pacemaker implantation, and aortic regurgitation. Analyses were
performed using random effects modeling and reported as summary odds ratio
(OR) with 95% CI. Nine studies comprising 3442 patients (mean age
81.0+/-6.6 years, 51.2% female) were included. PPMI occurred in 25.5% of
patients following TAVR. The pooled all-cause mortality at 30-days and
1-year was 5.2% and 18.6%, respectively. The occurrence of PPMI following
TAVR was associated with significantly increased risk of both 30-day (OR,
4.23; CI, 1.95-9.19; P<0.001) and 1-year all-cause mortality (OR, 1.77;
CI, 1.05-2.99; P<0.001). Similarly, PPMI was associated with post-TAVR
neurological events (OR, 2.72; CI, 1.69-4.37; P<0.001) and post-TAVR
permanent pacing (OR, 1.43; CI, 1.02-2.00; P=0.04) but not with a
statistically significant increase in aortic regurgitation post-TAVR (OR,
1.39; CI, 0.93-2.08; P=0.11). CONCLUSION(S): PPMI is common following
TAVR and is strongly associated with 30-day and 1-year mortality.
Detection of PPMI has potential to identify TAVR patients at highest risk
of subsequent adverse events.

<68>
Accession Number
625645627
Title
Dose adjustment of immunosuppressants during co-administration of
posaconazole: a systematic review.
Source
Clinical and investigative medicine. Medecine clinique et experimentale.
41 (1) (pp E5-E15), 2018. Date of Publication: 27 Mar 2018.
Author
Fu C.; Chen J.; Xu Y.; Wu D.
Institution
(Fu) Department of Hematology, First Affiliated Hospital of Soochow
University, Jiangsu Institute of Hematology, 188# Shizi Street, Suzhou,
China
Publisher
NLM (Medline)
Abstract
PURPOSE: The purpose of this retrospective study was to analyze the dose
adjustment of immunosuppressants (cyclosporine, tacrolimus and sirolimus)
for the patients with allogeneic hematopoietic stem cell and solid-organ
(heart/lung) transplantation during co-administration of posaconazole.
 METHOD(S): MEDLINE, EMBASE and Cochrane Library were searched from
January 1, 2000 to June 30, 2017 for clinical reports of patients who
received allogeneic hematopoietic stem cell and organ transplantation and
were co-administered posaconazole and immunosuppressants (cyclosporine,
tacrolimus or sirolimus). RESULT(S): Seven studies were included in
the systematic review with a total of 215 patients. Five studies involved
hematopoietic stem cell transplant, one heart transplant and one lung
transplant. In general, the co-administration of posaconazole with
sirolimus, tacrolimus or cyclosporine necessitated immunosuppressant dose
reductions to maintain the levels of the drug in the optimal therapeutic
range. Reported dose reductions were 50%-68% for sirolimus, 75% for
tacrolimus and 14%-49% for cyclosporine. The findings were similar for
hematopoietic stem cell, heart or lung transplantation studies.
 CONCLUSION(S): Our findings indicate that, when posaconazole is
co-administered, the dosage of sirolimus and tacrolimus should be reduced
by 60%-70% and for cyclosporine and by 30%-40% following allogeneic
hematopoietic stem cell and solid-organ transplantation.

<69>
[Use Link to view the full text]
Accession Number
625621245
Title
Letter by Jha Regarding Article, "High-Target Versus Low-Target Blood
Pressure Management During Cardiopulmonary Bypass to Prevent Cerebral
Injury in Cardiac Surgery Patients: A Randomized Controlled Trial".
Source
Circulation. 138 (21) (pp 2443-2444), 2018. Date of Publication: 20 Nov
2018.
Author
Jha A.K.
Institution
(Jha) Department of Anesthesiology and Critical Care, Jawaharlal Institute
of Postgraduate Medical Education and Research, Puducherry, India
Publisher
NLM (Medline)

<70>
[Use Link to view the full text]
Accession Number
625621182
Title
Response by Vedel et al to Letters Regarding Article, "High-Target Versus
Low-Target Blood Pressure Management During Cardiopulmonary Bypass to
Prevent Cerebral Injury in Cardiac Surgery Patients: A Randomized
Controlled Trial".
Source
Circulation. 138 (21) (pp 2447-2448), 2018. Date of Publication: 20 Nov
2018.
Author
Vedel A.G.; Rasmussen L.S.; Holmgaard F.; Nilsson J.C.
Institution
(Vedel, Holmgaard, Nilsson) Department of Cardiothoracic Anesthesia, Heart
Center (A.G.V., F.H., Rigshospitalet, University of Copenhagen, Denmark
(Vedel, Rasmussen) Department of Anesthesia, Center of Head and
Orthopedics (A.G.V., Rigshospitalet, University of Copenhagen, Denmark
Publisher
NLM (Medline)

<71>
[Use Link to view the full text]
Accession Number
625621114
Title
Letter by Ge and Kong Regarding Article, "High-Target Versus Low-Target
Blood Pressure Management During Cardiopulmonary Bypass to Prevent
Cerebral Injury in Cardiac Surgery Patients: A Randomized Controlled
Trial".
Source
Circulation. 138 (21) (pp 2445-2446), 2018. Date of Publication: 20 Nov
2018.
Author
Ge H.-W.; Kong F.-J.
Institution
(Ge, Kong) Department of Urology, Affiliated Hangzhou First People's
Hospital, Zhejiang University School of Medicine, China (H.W.-G. and
F.J.-K.)
Publisher
NLM (Medline)

<72>
[Use Link to view the full text]
Accession Number
625622139
Title
Transcarotid Compared With Other Alternative Access Routes for
Transcatheter Aortic Valve Replacement.
Source
Circulation. Cardiovascular interventions. 11 (11) (pp e006388), 2018.
Date of Publication: 01 Nov 2018.
Author
Chamandi C.; Abi-Akar R.; Rodes-Cabau J.; Blanchard D.; Dumont E.;
Spaulding C.; Doyle D.; Pagny J.-Y.; DeLarochelliere R.; Lafont A.;
Paradis J.-M.; Puri R.; Karam N.; Maes F.; Rodriguez-Gabella T.; Chassaing
S.; Le Page O.; Kalavrouziotis D.; Mohammadi S.
Institution
(Chamandi, Rodes-Cabau, Dumont, DeLarochelliere, Paradis, Puri, Maes,
Rodriguez-Gabella, Kalavrouziotis, Mohammadi) Department of Cardiac
Surgery and Cardiology, Quebec Heart and Lung Institute, Laval University,
Canada (C.C., J.R.-C., E.D., D.D., R.D., J.-M.P., R.P., F.M., T.R.-G.,
D.K., S.M.)
(Abi-Akar, Blanchard, Spaulding, Pagny, Lafont, Karam) Department of
Cardiac Surgery and Cardiology, Hopital Europeen Georges Pompidou,
Assistance Publique Hopitaux de Paris, Universite Paris Descartes, France
(R.A.-A., D.B., C.S., J.-Y.P., A.L., N.K.)
(Doyle, Chassaing, Le Page) Department of Cardiac Surgery and Cardiology,
Clinique St Gatien, Tours, S.C, United States
Publisher
NLM (Medline)
Abstract
Background The optimal access for patients undergoing transcatheter aortic
valve replacement (TAVR) who are not candidates for a transfemoral
approach has not been elucidated. The purpose of this study was to compare
the safety, feasibility, and early clinical outcomes of transcarotid TAVR
compared with thoracic approaches. Methods and Results From a multicenter
consecutive cohort of 329 alternative-access TAVR patients (2012-2017), we
identified 101 patients who underwent transcarotid TAVR and 228 patients
who underwent a transapical or transaortic TAVR. Preprocedural success and
30-day clinical outcomes were compared using multivariable propensity
score analysis to account for between-group differences in baseline
characteristics. All transcarotid cases were performed under general
anesthesia, mainly using the left common carotid artery (97%).
Propensity-matched groups had similar rates of 30-day all-cause mortality
(2.1% versus 4.6%; P=0.37), stroke (2.1% versus 3.5%; P=0.67; transcarotid
versus transapical/transaortic, respectively), new pacemaker implantation,
and major vascular complications. Transcarotid TAVR was associated with
significantly less new-onset atrial fibrillation (3.2% versus 19.0%;
P=0.002), major or life-threatening bleeding (4.3% versus 19.9%; P=0.002),
acute kidney injury (none versus 12.1%; P=0.002), and shorter median
length of hospital stay (6 versus 8 days; P<0.001). Conclusions
Transcarotid vascular access for TAVR is safe and feasible and is
associated with encouraging short-term clinical outcomes. Our data suggest
a clinical benefit of transcarotid TAVR with respect to atrial
fibrillation, major bleeding, acute kidney injury, and length of stay
compared with the more invasive transapical or transaortic strategies.
Randomized studies are required to ascertain whether transcarotid TAVR
yields equivalent results to other alternative vascular access routes.

<73>
Accession Number
625642537
Title
The Safe Addition of Nitric Oxide into the Sweep Gas of the Extracorporeal
Circuit during Cardiopulmonary Bypass and Extracorporeal Life Support.
Source
The journal of extra-corporeal technology. 50 (4) (pp 260-264), 2018. Date
of Publication: 01 Dec 2018.
Author
Bennett M.; Thuys C.; Augustin S.; Schultz B.; Bottrell S.; Horton A.;
Bednarz A.; Horton S.
Institution
(Bennett, Thuys, Augustin, Schultz, Bottrell, Horton, Horton) Department
of Cardiac Surgery, Perfusion Unit, Royal Children's Hospital, Parkville,
Victoria, Australia
(Bednarz) Department of Biomedical Engineering, Royal Children's Hospital,
Parkville, Victoria, Australia
(Horton) Faculty of Medicine, Department of Paediatrics, The University of
Melbourne, Parkville, Victoria, Australia; and
(Horton) Murdoch Children's Research Institute, Parkville, Victoria,
Australia
Publisher
NLM (Medline)
Abstract
Low cardiac output syndrome and the systemic inflammatory response are
consequences of the cardiac surgical perioperative course. The mechanisms
responsible are multifactorial, but recent studies have shown that nitric
oxide (NO) may be a key component in mitigating some of these processes.
Following on from literature reports detailing the use of inhaled NO added
to the gas phase of the extracorporeal circuit, we set about developing a
technique to perform this addition safely and efficiently. In the setting
of cardiopulmonary bypass, the technique was validated in a randomized
prospective trial looking at 198 children. The benefits observed in this
trial then stimulated the incorporation of NO into all extracorporeal life
support (ECLS) circuits. This required additional hardware modifications
all of which were able to be performed safely. Initial results from the
first series of ECLS patients using NO also appear promising.

<74>
[Use Link to view the full text]
Accession Number
625621581
Title
Fish Oil and Perioperative Bleeding.
Source
Circulation. Cardiovascular quality and outcomes. 11 (11) (pp e004584),
2018. Date of Publication: 01 Nov 2018.
Author
Akintoye E.; Sethi P.; Harris W.S.; Thompson P.A.; Marchioli R.; Tavazzi
L.; Latini R.; Pretorius M.; Brown N.J.; Libby P.; Mozaffarian D.
Institution
(Akintoye) Division of Cardiovascular Medicine, University of Iowa
Hospitals and Clinics (E.A.)
(Sethi, Harris, Thompson) Department of Internal Medicine, Sanford School
of Medicine, University of South Dakota, United States
(Harris) OmegaQuant, LLC, Sioux Falls, United States
(Marchioli) Cardiovascular Renal Metabolic Therapeutic Area, Medical
Strategy and Science, Therapeutic Science and Strategy Unit, Milan, United
States
(Tavazzi) Maria Cecilia Hospital, GVM Care & Research, Cotignola
(Latini) Department of Cardiovascular Research, IRCCS Istituto di Ricerche
Farmacologiche "Mario Negri", Milan, United States
(Pretorius) Division of Cardiothoracic Anesthesiology, Department of
Anesthesiology, Vanderbilt University Medical Center, Nashville, United
States
(Brown) Department of Pharmacology (N.B.) and Department of Medicine
(N.B.), Vanderbilt University School of Medicine, Nashville, TN, United
States
(Libby) Division of Cardiovascular Medicine, Department of Medicine,
Brigham and Women's Hospital, Harvard Medical School, Boston, United
Kingdom
(Mozaffarian) Friedman School of Nutrition Science and Policy, Tufts
University, Boston, United Kingdom
Publisher
NLM (Medline)
Abstract
Background Fish oil is among the most common natural supplements for
treatment of hypertriglyceridemia or prevention of cardiovascular disease.
However, concerns about theoretical bleeding risk have led to
recommendations that patients should stop taking fish oil before surgery
or delay in elective procedures for patients taking fish oil by some
health care professionals. Methods and Results We tested the effect of
fish oil supplementation on perioperative bleeding in a multinational,
placebo-controlled trial involving 1516 patients who were randomized to
perioperative fish oil (eicosapentaenoic acid+docosahexaenoic acid; 8-10 g
for 2-5 days preoperatively, and then 2 g/d postoperatively) or placebo.
Primary outcome was major perioperative bleeding as defined by the
Bleeding Academic Research Consortium. Secondary outcomes include
perioperative bleeding per thrombolysis in myocardial infarction and
International Society on Thrombosis and Hemostasis definitions, chest tube
output, and total units of blood transfused. Participants' mean (SD) age
was 63 (13) years, and planned surgery included coronary artery bypass
graft (52%) and valve surgery (50%). The primary outcome occurred in 92
patients (6.1%). Compared with placebo, risk of Bleeding Academic Research
Consortium bleeding was not higher in the fish oil group: odds ratio,
0.81; 95% CI, 0.53-1.24; absolute risk difference, 1.1% lower (95% CI,
-3.0% to 1.8%). Similar findings were seen for secondary bleeding
definitions. The total units of blood transfused were significantly lower
in the fish oil group compared with placebo (mean, 1.61 versus 1.92;
P<0.001). Evaluating achieved plasma phospholipid omega-3 polyunsaturated
fatty acids levels with supplementation (on the morning of surgery),
higher levels were associated with lower risk of Bleeding Academic
Research Consortium bleeding, with substantially lower risk in the third
(odds ratio, 0.30 [95% CI, 0.11-0.78]) and fourth (0.36 [95% CI,
0.15-0.87]) quartiles, compared with the lowest quartile. Conclusions Fish
oil supplementation did not increase perioperative bleeding and reduced
the number of blood transfusions. Higher achieved n-3-PUFA levels were
associated with lower risk of bleeding. These novel findings support the
need for reconsideration of current recommendations to stop fish oil or
delay procedures before cardiac surgery. Clinical Trial Registration URL:
https://www.clinicaltrials.gov . Unique identifier: NCT00970489.

<75>
[Use Link to view the full text]
Accession Number
625618946
Title
The efficacy of thoracic paravertebral block for thoracoscopic surgery: A
meta-analysis of randomized controlled trials.
Source
Medicine. 97 (51) (pp e13771), 2018. Date of Publication: 01 Dec 2018.
Author
Hu Z.; Liu D.; Wang Z.-Z.; Wang B.; Dai T.
Institution
(Hu, Wang, Wang, Dai) Department of Thoracic Surgery, Austria
(Liu) Department of Respiratory and Critical Care Medicine, Affiliated
Hospital of Southwest Medical University, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The efficacy of thoracic paravertebral block for thoracoscopic
surgery remains controversial. We conduct a systematic review and
meta-analysis to explore the impact of thoracic paravertebral block on
thoracoscopic surgery. METHOD(S): We search PubMed, EMbase, Web of
science, EBSCO, and Cochrane library databases through August 2018 for
randomized controlled trials (RCTs) assessing the effect of thoracic
paravertebral block on thoracoscopic surgery. This meta-analysis is
performed using the random-effect model. RESULT(S): Six RCTs
involving 300 patients are included in the meta-analysis. Overall,
compared with control group for thoracoscopic surgery, thoracic
paravertebral block results in significantly reduced pain scores within 6
hours (Std. MD = -2.15; 95% CI = -3.67 to -0.62; P = .006), postoperative
anesthesia consumption during 48 hours (Std. MD = -1.81; 95% CI = -3.05 to
-0.58; P = .004), and hospital stay (Std. MD = -1.19; 95% CI = -2.13 to
-0.26; P = .01), but has no important impact on pain scores at 24 hours
(Std. MD = -1.10; 95% CI = -2.77-0.57; P = .20), and 48 hours (Std. MD =
-1.25; 95% CI = -2.86-0.36; P = .13). CONCLUSION(S): Thoracic
paravertebral block can substantially enhance pain management for
thoracoscopic surgery.

<76>
Accession Number
2001406141
Title
Moderate Aortic Stenosis and Heart Failure With Reduced Ejection Fraction:
Can Imaging Guide Us to Therapy?.
Source
JACC: Cardiovascular Imaging. 12 (1) (pp 172-184), 2019. Date of
Publication: January 2019.
Author
Pibarot P.; Messika-Zeitoun D.; Ben-Yehuda O.; Hahn R.T.; Burwash I.G.;
Van Mieghem N.M.; Spitzer E.; Leon M.B.; Bax J.; Otto C.M.
Institution
(Pibarot) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec/Quebec Heart & Lung Institute, Universite Laval, Quebec, Canada
(Messika-Zeitoun, Burwash) University of Ottawa Heart Institute, Ottawa,
Ontario, Canada
(Ben-Yehuda, Hahn, Leon) Columbia University Medical Center/New
York-Presbyterian Hospital, New York, NY, United States
(Ben-Yehuda, Hahn) Cardiovascular Research Foundation, New York, NY,
United States
(Van Mieghem, Spitzer) Department of Cardiology, Thoraxcenter, Erasmus
University Medical Center, Rotterdam, Netherlands
(Spitzer) Cardialysis, Rotterdam, Netherlands
(Bax) Department of Cardiology Leiden University Medical Centre, Leiden,
Netherlands
(Otto) Division of Cardiology, University of Washington School of
Medicine, Seattle, WA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Clinical management of patients with only moderate aortic stenosis (AS)
but symptoms of heart failure with a reduced left ventricular ejection
fraction (HFrEF) is challenging. Current guidelines recommend clinical
surveillance with multimodality imaging; aortic valve replacement (AVR) is
deferred until the stenosis becomes severe. Given the known benefits of
afterload reduction in management of patients with HFrEF, it has been
hypothesized that AVR may be beneficial in patients with only moderate AS
who present with HFrEF. In this article, we first review the current
approach for management of patients with moderate AS and HFrEF based on
close clinical and imaging surveillance with AVR delayed until AS is
severe. We then discuss the case for transcatheter AVR (TAVR) earlier in
the disease course, when AS is moderate, based on stress echocardiographic
data. We conclude with a detailed summary of the TAVR UNLOAD
(Transcatheter Aortic Valve Replacement to UNload the Left Ventricle in
Patients With ADvanced Heart Failure) trial, in which patients with
moderate AS and HFrEF are randomized to guideline-directed heart failure
therapy alone versus guideline-directed heart failure therapy plus
TAVR. Copyright © 2019 American College of Cardiology Foundation

<77>
Accession Number
625557083
Title
Comparison of totally laparoscopic and open approach in total gastrectomy
with D2 lymphadenectomy - systematic review and meta-analysis.
Source
Cancer Management and Research. 10 (pp 6705-6714), 2018. Date of
Publication: 2018.
Author
Malczak P.; Torbicz G.; Rubinkiewicz M.; Gajewska N.; Sajuk N.; Rozmus K.;
Wysocki M.; Major P.; Budzynski A.; Pedziwiatr M.
Institution
(Malczak, Torbicz, Rubinkiewicz, Gajewska, Sajuk, Rozmus, Wysocki, Major,
Budzynski, Pedziwiatr) Department of General Surgery, Jagiellonian
University Medical College, Krakow, Poland
(Malczak, Wysocki, Major, Budzynski, Pedziwiatr) Centre for Research,
Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
Publisher
Dove Medical Press Ltd (PO Box 300-008, Albany, 44 Corinthian Drive,
Albany,Auckland 0752, New Zealand. E-mail: angela@dovepress.com)
Abstract
Introduction: Gastric cancer is a worldwide health concern, being one of
the five most common malignant neoplasms worldwide. Currently, an open
approach is the gold standard for surgical treatment. Incorporation of
laparoscopy as a method of choice for gastric resections remains
controversial because of limited evidence of eligibility. To date, there
are no high-quality randomized quality trials on totally laparoscopic D2
total gastrectomies. Aim(s): The aim of this study was to assess
currently available literature and provide meta-analysis on acquired data
regarding short-term outcomes with a subgroup analysis of western and
eastern studies. Material(s) and Method(s): We performed a systematic
review and meta-analysis according to the PRISMA guidelines. The primary
outcomes of interest were morbidity and short-term complications.
 Result(s): An initial reference search yielded 3,073 articles.
Finally, we chose eight studies covering 1,582 patients that we included
in the quantitative analysis. We did not find statistical differences
regarding operative time, anastomotic leakage, surgical site infection,
cardiac complications, pulmonary complications, or number of harvested
lymph nodes. We found significant differences regarding length of hospital
stay and morbidity in the Asian population. Conclusion(s): This
systematic review indicates that a laparoscopic approach for D2 total
gastrectomy does not increase morbidity. Furthermore, it allows for a
shorter hospital stay. However, more randomized controlled trials are
required to fully assess this approach because available data are of
limited quality. Copyright © 2018 Malczak et al.

<78>
Accession Number
2001403276
Title
Meta-Analysis of Impact of Baseline N-TerminalPro-Brain Natriuretic
Peptide Levels on SurvivalAfter Transcatheter Aortic Valve Implantation
for Aortic Stenosis.
Source
American Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Author
Takagi H.; Hari Y.; Kawai N.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
We performed a meta-analysis of currently available studies investigating
impact of baseline N-terminal pro-brain natriuretic peptide (NT-proBNP) on
mortality after transcatheter aortic valve implantation (TAVI) for aortic
stenosis (AS). MEDLINE and EMBASE were searched through August 2018 using
PubMed and OVID. Studies considered for inclusion met the following
criteria: the design was a study researching impact of baseline NT-proBNP
levels on survival; the study population was patients underwent TAVI for
AS; outcomes included all-cause mortality. For each study, we directly
extracted odds ratio (ORs) or hazard ratios (HRs) of mortality (for high
vs low baseline NT-proBNP); and generated ORs using mortality rates in
both patients with high and low levels of baseline NT-proBNP.
Study-specific estimates were combined using inverse variance-weighted
averages of logarithmic ORs/HRs in the random-effects model. We identified
16 eligible studies including a total of 3,679 patients underwent TAVI for
AS. Pooled analyses demonstrated that high levels of baseline NT-proBNP
were associated with a statistically nonsignificant increase in early
(30-day or 2-month) mortality (pooled OR, 1.60; 95% confidence interval,
0.84 to 3.04; p = 0.15) and a statistically significant increase in
midterm (6-month to 4-year) mortality (pooled OR/HR, 1.88; 95% confidence
interval, 1.54 to 2.28; p < 0.00001). Although funnel-plot asymmetry
suggesting publication bias was detected, adjusting for funnel-plot
asymmetry indicated an association of high levels of baseline NT-proBNP
with a still significant increase in midterm mortality. In conclusion,
high levels of baseline NT-proBNP predict increased midterm, not early,
mortality after TAVI for AS. Copyright © 2018 Elsevier Inc.

<79>
Accession Number
625633979
Title
Comment on "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
Shoar S.; Naderan M.; Hosseini F.; Shoar N.
Institution
(Shoar) Clinical Research Scholar and Scientist, ScientificWriting
Corporation, Houston, TX, United States
(Shoar, Naderan) Faculty of Medicine, Tehran University of Medical
Science, Tehran, Iran, Islamic Republic of
(Hosseini) School of Medicine, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
(Shoar) Faculty of Medicine, Kashan University of Medical Sciences,
Kashan, Iran, Islamic Republic of
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)

<80>
Accession Number
625632253
Title
Impact of tricuspid regurgitation and right ventricular dysfunction on
outcomes after transcatheter aortic valve replacement: A systematic review
and meta-analysis.
Source
Clinical Cardiology. (no pagination), 2018. Date of Publication: 2018.
Author
Fan J.; Liu X.; Yu L.; Sun Y.; Jaiswal S.; Zhu Q.; Chen H.; He Y.; Wang
L.; Ren K.; Wang J.
Institution
(Fan, Jaiswal, Zhu, Wang) Zhejiang University School of Medicine,
Hangzhou, China
(Liu, Chen, He, Wang, Ren, Wang) Department of Cardiology, Second
Affiliated Hospital Zhejiang University School of Medicine, Hangzhou,
China
(Yu) Department of Echocardiography, The Second Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou, China
(Sun) Department of Cardiology, Guangdong People's Hospital, Guangzhou,
China
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Far less attention has been paid to the prognostic effect of right-side
heart disease on outcomes after transcatheter aortic valve replacement
(TAVR) when compared with the left side. Therefore, we performed a
systematic review and meta-analysis on the impact of tricuspid
regurgitation (TR) and right ventricular (RV) dysfunction on outcomes
after TAVR. We hypothesized that TR and RV dysfunction may have a
deleterious effect on outcomes after TAVR. Article revealing the
prognostic effect of TR and RV dysfunction on outcomes after TAVR were
being integrated. Random or fixed effect model was adopted in accordance
with the heterogeneity. There were nine studies with a total of 6466
patients enrolled after a comprehensive literature search of the
MEDLINE/PubMed, EMBASE, ISI Web of Science, and Cochrane databases. The
overall analysis revealed that moderate or severe TR at baseline increased
all-cause mortality after TAVR (HR = 1.79, CI 95% 1.52-2.11, P < 0.001).
Both baseline RV dysfunction (HR = 1.53, CI 95% 1.27-1.83, P < 0.001) and
presence of RV dilation (HR = 1.83, CI 95% 1.47-2.27, P < 0.001) were
associated with all-cause mortality. Both baseline moderate or severe TR
and RV dysfunction worsen prognosis after TAVR and careful assessment of
right heart function should be done for clinical decision by the heart
team before the TAVR procedure. Copyright © 2018 The Authors.
Clinical Cardiology published by Wiley Periodicals, Inc.

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