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<1>
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Accession Number
615007679
Title
Laparoscopic Lavage Versus Primary Resection for Acute Perforated
Diverticulitis: Review and Meta-analysis.
Source
Annals of Surgery. 267 (2) (pp 252-258), 2018. Date of Publication: 01 Feb
2018.
Author
Penna M.; Markar S.R.; Mackenzie H.; Hompes R.; Cunningham C.
Institution
(Penna, Markar, Mackenzie) Department of Surgery and Cancer, Imperial
College London, London, United Kingdom
(Penna, Hompes, Cunningham) Department of Colorectal Surgery, Churchill
Hospital, University Hospitals of Oxford, Old Road, Oxford OX3 7LE, United
Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: To compare clinical outcomes after laparoscopic lavage (LL) or
colonic resection (CR) for purulent diverticulitis. Background(s):
Laparoscopic lavage has been suggested as an alternative treatment for
traditional CR. Comparative studies to date have shown conflicting
results. Method(s): Electronic searches of Embase, Medline, Web of
Science, and Cochrane databases were performed. Weighted mean differences
(WMD) were calculated for effect size of continuous variables and pooled
odds ratios (POR) calculated for discrete variables. Result(s): A
total of 589 patients recruited from 3 randomized controlled trials (RCTs)
and 4 comparative studies were included; 85% as Hinchey III. LL group had
younger patients with higher body mass index and lower ASA grades, but
comparable Hinchey classification and previous diverticulitis rates. No
significant differences were noted for mortality, 30-day reoperations and
unplanned readmissions. LL had higher rates of intraabdominal abscesses
(POR = 2.85; 95% confidence interval, CI, 1.52-5.34; P = 0.001),
peritonitis (POR = 7.80; 95% CI 2.12-28.69; P = 0.002), and increased
long-term emergency reoperations (POR = 3.32; 95% CI 1.73-6.38; P <
0.001). Benefits of LL included shorter operative time, fewer cardiac
complications, fewer wound infections, and shorter hospital stay. Overall,
90% had stomas after CR, of whom 74% underwent stoma reversal within
12-months. Approximately, 14% of LL patients required a stoma; 48%
obtaining gut continuity within 12-months, whereas 36% underwent elective
sigmoidectomy. Conclusion(s): The preservation of diseased bowel by
LL is associated with approximately 3 times greater risk of persistent
peritonitis, intraabdominal abscesses and the need for emergency surgery
compared with CR. Future studies should focus on developing composite
predictive scores encompassing the wide variation in presentations of
diverticulitis and treatment tailored on case-by-case basis. ©
Copyright 2017 Wolters Kluwer Health, Inc. All rights reserved.

<2>
Accession Number
622518909
Title
Self-efficacy and quality of life among people with cardiovascular
diseases: A meta-analysis.
Source
Rehabilitation Psychology. 63 (2) (pp 295-312), 2018. Date of Publication:
May 2018.
Author
Banik A.; Schwarzer R.; Knoll N.; Czekierda K.; Luszczynska A.
Institution
(Banik, Czekierda, Luszczynska) Psychology Department in Wroclaw, SWPS
University of Social Sciences and Humanities, Poland
(Schwarzer, Knoll) Department of Education and Psychology, Freie
Universitat Berlin, Germany
(Luszczynska) Trauma, Health, and Hazards Center, University of Colorado,
Colorado Springs, United States
Publisher
American Psychological Association Inc. (E-mail: journals@apa.org)
Abstract
Purpose/Objective: Self-efficacy forms key modifiable personal resources
influencing illness management, rehabilitation participation, and their
outcomes such as perceived health-related quality of life (HRQOL) among
people with a cardiovascular disease (CVD). Yet, an overarching research
synthesis of the selfefficacy- HRQOL association in the CVD context is
missing. This systematic review and meta-analysis of research on the
self-efficacy-HRQOL relationship among people with CVD investigates
whether the strength of associations depends on conceptualizations of
self-efficacy and HRQOL (general vs. specific), presence of cardiovascular
surgery, the type of CVD diagnosis, and patients' age (up to 60 vs. older
than 60). Research Method/Design: We searched the following databases:
PsycINFO, PsycARTICLES, Academic Search Complete, Health Source:
Nursing/Academic Edition, and MEDLINE. This search resulted in 17 original
studies (k = 18 samples) included in the meta-analysis. Result(s):
Findings suggested that stronger self-efficacy was associated with better
HRQOL (r = .37; 95% CI [.29, .44]). Moderator analyses indicated stronger
associations when HRQOL was measured in a general way (compared to
CVD-specific) and when selfefficacy was measured in a general or
exercise-specific way (as opposed to CVD symptom-specific).
Self-efficacy-HRQOL associations were similar in strength across age
groups, regardless of presence of cardiovascular surgery, and among
patients diagnosed with different forms of CVD. Conclusions/ Implications:
General and exercise-specific self-efficacy are moderately related with
HRQOL among people with CVD after surgery or during rehabilitation.
Results need to be interpreted with caution due to heterogeneity of
original research and the dominance of cross-sectional
designs. Copyright © 2018 American Psychological Association.

<3>
Accession Number
623324833
Title
Platelet storage duration and its clinical and transfusion outcomes: A
systematic review.
Source
Critical Care. 22 (1) (no pagination), 2018. Article Number: 185. Date of
Publication: 05 Aug 2018.
Author
Aubron C.; Flint A.W.J.; Ozier Y.; McQuilten Z.
Institution
(Aubron) Centre Hospitalier et Universitaire de Brest - Universite de
Bretagne Occidentale, The Medical Intensive Care Unit, Bvd Tanguy Prigent,
Brest Cedex 29609, France
(Aubron, Flint, McQuilten) Monash University, The Australian and New
Zealand Intensive Care Research Centre, Department of Epidemiology and
Preventive Medicine, Melbourne, Australia
(McQuilten) Monash University, The Transfusion Research Unit, Department
of Epidemiology and Preventive Medicine, Melbourne, Australia
(Flint) Royal Australian Navy, Australian Defence Force, Canberra,
Australia
(Ozier) Centre Hospitalier et Universitaire de Brest - Universite de
Bretagne Occidentale, The Department of Anesthesiology, Brest, France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Platelets (PLTs) are usually stored for up to 5days prior to
transfusion, although in some blood services the storage period is
extended to 7days. During storage, changes occur in both PLT and storage
medium, which may lead to PLT activation and dysfunction. The clinical
significance of these changes remains uncertain. Method(s): We
performed a systematic review to assess the association between PLT
storage time and clinical or transfusion outcomes in patients receiving
allogeneic PLT transfusion. We searched studies published in English
between January 2000 and July 2017 identified from MEDLINE, Embase, PubMed
and the Cochrane Libraries. Result(s): Of the 18 studies identified,
five included 4719 critically ill patients (trauma, post-cardiac surgery
and a heterogeneous population of critically ill patients) and 13 included
8569 haematology patients. The five studies in critically ill patients
were retrospective and did not find any association between PLT storage
time when PLTs were stored for up to 5days and mortality. There was also
no association between older PLTs and sepsis in the two largest studies
(n=4008 patients). Of the 13 studies in haematology patients, seven
analysed prolonged storage time up to 6.5 or 7days. Administration of
fresh PLTs (less than 2 or 3days) was associated with a significant
increase in corrected count increment (CCI) compared to older PLTs in
seven of the eight studies analysing this outcome. One single centre
retrospective study found an increase in bleeding events in patients
receiving older PLTs. Conclusion(s): PLT storage time does not appear
to be associated with clinical outcomes, including bleeding, sepsis or
mortality, in critically ill patients or haematology patients. The
freshest PLTs (less than 3days) were associated with a better CCI,
although there was no impact on bleeding events, questioning the clinical
significance of this association. However, there is an absence of evidence
to draw definitive conclusions, especially in critically ill
patients. Copyright © 2018 The Author(s).

<4>
Accession Number
620625700
Title
Cardiac rehabilitation after percutaneous coronary intervention: Results
from a nationwide survey.
Source
European Journal of Cardiovascular Nursing. 17 (3) (pp 273-279), 2018.
Date of Publication: 01 Mar 2018.
Author
Olsen S.J.S.; Schirmer H.; Bonaa K.H.; Hanssen T.A.
Institution
(Olsen) Division of Internal Medicine, University Hospital of North
Norway, Norway
(Olsen, Schirmer, Hanssen) Cardiovascular Research Group, The Arctic
University of Norway, Norway
(Schirmer, Hanssen) Department of Heart Disease, University Hospital of
North Norway, Norway
(Bonaa) Department of Community Medicine, The Arctic University of Norway,
Norway
(Bonaa) Department of Public Health and Nursing, Norwegian University of
Science and Technology, Norway
(Bonaa) Clinic for Heart Disease, St. Olavs University Hospital,
Trondheim, Norway
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Aim: The purpose of this study was to estimate the proportion of Norwegian
coronary heart disease patients participating in cardiac rehabilitation
programmes after percutaneous coronary intervention, and to determine
predictors of cardiac rehabilitation participation. Method(s):
Participants were patients enrolled in the Norwegian Coronary Stent Trial.
We assessed cardiac rehabilitation participation in 9013 of these patients
who had undergone their first percutaneous coronary intervention during
2008-2011. Of these, 7068 patients (82%) completed a self-administered
questionnaire on cardiac rehabilitation participation within three years
after their percutaneous coronary intervention. Result(s):
Twenty-eight per cent of the participants reported engaging in cardiac
rehabilitation. Participation rate differed among the four regional health
authorities in Norway, varying from 20%-31%. Patients undergoing
percutaneous coronary intervention for an acute coronary syndrome were
more likely to participate in cardiac rehabilitation than patients with
stable angina (odds ratio 3.2; 95% confidence interval 2.74-3.76). A
multivariate statistical model revealed that men had a 28% lower
probability (p<0.001) of participating in cardiac rehabilitation, and the
odds of attending cardiac rehabilitation decreased with increasing age
(p<0.001). Contributors to higher odds of cardiac rehabilitation
participation were educational level >12 years (odds ratio 1.50; 95%
confidence interval 1.32-1.71) and body mass index>25 (odds ratio 1.19;
95% confidence interval 1.05-1.36). Prior coronary artery bypass graft was
associated with lower odds of cardiac rehabilitation participation (odds
ratio 0.47; 95% confidence interval 0.32-0.70) Conclusion(s): The
estimated cardiac rehabilitation participation rate among patients
undergoing first-time percutaneous coronary intervention is low in Norway.
The typical participant is young, overweight, well-educated, and had an
acute coronary event. These results varied by geographical
region. Copyright © 2017, © The European Society of
Cardiology 2017.

<5>
Accession Number
620560223
Title
Quality of life in patients with implantable cardioverter-defibrillator:
systematic review of randomized controlled trials.
Source
European Journal of Cardiovascular Nursing. 17 (3) (pp 196-206), 2018.
Date of Publication: 01 Mar 2018.
Author
da Silva K.R.; Costa R.; Rodrigues C.G.; Schasechter A.; Nobre M.C.;
Passman R.; Mark D.B.
Institution
(da Silva, Costa, Nobre) Heart Institute (InCor), Hospital das Clinicas,
Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
(Rodrigues) Global Research and Innovation Network (GRINN), Porto Alegre,
Brazil
(Schasechter, Passman) Northwestern University, Feinberg School of
Medicine, Chicago, IL, United States
(Mark) Duke Clinical Research Institute, Durham, NC, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Implantable cardioverter-defibrillator (ICD) therapy
significantly improves the survival of patients who are at high risk for
sudden cardiac death. However, it is unclear whether this survival is
accompanied by impairment on quality of life (QoL). Objective(s):
This systematic review sought to describe whether ICD therapy, as compared
with standard treatment, can have an impact on QoL outcomes.
 Method(s): Extensive literature searches were carried out in PubMed,
EMBASE, LILACS and Cochrane Library. Eligible studies were randomized
controlled trials (RCTs) of ICD versus medical therapy that reported valid
and reliable measures of QoL. Included studies were reviewed to determine
baseline patient characteristics, mean duration of follow-up,
questionnaires used to assess QoL and association between QoL scores and
ICD shock therapy. Result(s): Seven studies, enrolling a total of
5,701 patients, were included in this review. The analyzed trials showed
conflicting results about the impact of ICD on QoL outcomes. Among the
secondary prevention studies, CIDS reported a clear benefit from ICD and
AVID showed no difference between ICD and amiodarone groups. Of the
primary prevention trials, AMIOVIRT, MADIT II, DEFINITE, and SCD-HeFT
found no evidence of impaired QoL in patients with an ICD. Evidence for an
association between ICD shocks and QoL was mixed and seemed to depend on
the interval between shocks and QoL assessment. Conclusion(s): There
was no evidence of impaired QoL in patients with an ICD. However, ICD
patients must be educated of all possible risks and benefits, including
transitory declines in QoL after ICD shocks. Copyright © 2017,
© The European Society of Cardiology 2017.

<6>
Accession Number
624732967
Title
A double-blind randomized controlled trial of the local application of
vancomycin versus ampicillin powder into the operative field for thoracic
and/or lumbar fusions.
Source
Journal of Neurosurgery: Spine. 29 (5) (pp 553-559), 2018. Date of
Publication: November 2018.
Author
Takeuchi M.; Wakao N.; Kamiya M.; Hirasawa A.; Murotani K.; Takayasu M.
Institution
(Takeuchi, Wakao, Kamiya, Hirasawa, Takayasu) Spine Center, Aichi Medical
University Hospital, Nagakute, Japan
(Takeuchi, Takayasu) Department of Neurological Surgery, Aichi Medical
University Hospital, Nagakute, Japan
(Wakao, Kamiya, Hirasawa) Department of Orthopedics Surgery, Aichi Medical
University Hospital, Nagakute, Japan
(Murotani) Division of Biostatistics, Clinical Research Center, Aichi
Medical University Hospital, Nagakute, Japan
(Takeuchi) Department of Spine Surgery, Aichi Spine Hospital, Inuyama,
Aichi, Japan
Publisher
American Association of Neurological Surgeons
Abstract
OBJECTIVE Retrospective studies have reported that the local application
of vancomycin (VCM) powder into the operative field decreases the
incidence of surgical site infection (SSI) in thoracic and/or lumbar
fusion. Authors of the present study prospectively evaluated the effects
of VCM in patients undergoing thoracic and/or lumbar fusion. METHODS In
this randomized double-blind trial, 230 patients undergoing thoracic
and/or lumbar fusion were randomly assigned to the local administration of
VCM (interventional group, 1 g) or ampicillin (AMP; control group, 1 g)
into the surgical field. The primary outcome was SSI results within 1 year
of surgery. RESULTS The trial was prematurely stopped according to
predetermined rules. The results showed one superficial infection (0.9%,
Staphylococcus aureus) and one deep infection (0.9%, S. aureus) in the VCM
group and two superficial infections (1.8%, Staphylococcus epidermidis and
culture negative) and one deep infection (0.9%, methicillin-resistant S.
aureus) in the AMP group. No significant differences in infection rates
were observed between the groups (p = 0.8). CONCLUSIONS This double-blind
randomized controlled trial demonstrated that the local application of VCM
or AMP powder into the operative field in short thoracic and/or lumbar
fusion procedures resulted in a similar incidence of SSI. CLASSIFICATION
OF EVIDENCE Type of question: therapeutic; study design: randomized
controlled trial; evidence: class III. Clinical trial registration no.:
UMIN000009377 (umin.ac.jp/ctr). Copyright © AANS 2018.

<7>
Accession Number
618464567
Title
Randomized trial of near-infrared spectroscopy for personalized
optimization of cerebral tissue oxygenation during cardiac surgery.
Source
British Journal of Anaesthesia. 119 (3) (pp 384-393), 2017. Date of
Publication: 2017.
Author
Rogers C.A.; Stoica S.; Ellis L.; Stokes E.A.; Wordsworth S.; Dabner L.;
Clayton G.; Downes R.; Nicholson E.; Bennett S.; Angelini G.D.; Reeves
B.C.; Murphy G.J.
Institution
(Rogers, Ellis, Dabner, Clayton, Reeves) Clinical Trials and Evaluation
Unit, School of Clinical Sciences, University of Bristol, Bristol Royal
Infirmary, Bristol BS2 8HW, United Kingdom
(Stoica, Downes, Nicholson, Angelini) Bristol Heart Institute, National
Institute for Health Research Bristol Biomedical Research Unit in
Cardiovascular Medicine, University Hospitals Bristol NHS Foundation
Trust, Bristol Royal Infirmary, Bristol BS2 8HW, United Kingdom
(Stokes, Wordsworth) Health Economics Research Centre, Nuffield Department
of Population Health, University of Oxford, Old Road Campus, Old Road,
Headington, Oxford OX3 7LF, United Kingdom
(Bennett) Cardiac Anaesthesia and Intensive Care, King Faisal Cardiac
Center, NGHA, Jeddah, Saudi Arabia
(Murphy) Department of Cardiovascular Sciences, National Institute for
Health Research Leicester Biomedical Research Unit in Cardiovascular
Medicine, University of Leicester, Clinical Sciences Wing, Glenfield
General Hospital, Leicester LE3 9QP, United Kingdom
Publisher
Oxford University Press
Abstract
Background. We assessed whether a near-infrared spectroscopy (NIRS)-based
algorithm for the personalized optimization of cerebral oxygenation during
cardiopulmonary bypass combined with a restrictive red cell transfusion
threshold would reduce perioperative injury to the brain, heart, and
kidneys. Methods. In a randomized controlled trial, participants in three
UK centres were randomized with concealed allocation to a NIRS (INVOS
5100; Medtronic Inc., Minneapolis, MN, USA)-based patient-specific'
algorithm that included a restrictive red cell transfusion threshold
(haematocrit 18%) or to a generic' non-NIRS-based algorithm (standard
care). The NIRS algorithm aimed to maintain cerebral oxygenation at an
absolute value of > 50% or at > 70% of baseline values. The primary
outcome for the trial was cognitive function measured up to 3 months
postsurgery. Results. The analysis population comprised eligible
randomized patients who underwent valve or combined valve surgery and
coronary artery bypass grafts using cardiopulmonary bypass between
December 2009 and January 2014 (n=98 patient-specific algorithm; n=106
generic algorithm). There was no difference between the groups for the
three core cognitive domains (attention, verbal memory, and motor
coordination) or for the non-core domains psychomotor speed and
visuo-spatial skills. The NIRS group had higher scores for verbal fluency;
mean difference 3.73 (95% confidence interval 1.50, 5.96). Red cell
transfusions, biomarkers of brain, kidney, and myocardial injury, adverse
events, and health-care costs were similar between the groups.
Conclusions. These results do not support the use of NIRS-based algorithms
for the personalized optimization of cerebral oxygenation in adult cardiac
surgery. Clinical trial registration.http://www.controlled-trials.com,
ISRCTN 23557269. Copyright © 2017 The Author.

<8>
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.

<9>
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

<10>
Accession Number
625551530
Title
Hybrid versus traditional cardiac rehabilitation models: A systematic
review and meta-analysis.
Source
Kardiologia Polska. 76 (12) (pp 1717-1724), 2018. Date of Publication:
2018.
Author
Wu C.; Li Y.; Chen J.
Institution
(Wu, Chen) Department of Healthcare Centre, People's Hospital of Hainan
Province, 43 Renmin Ave, Meilan Qu, Haikou Shi, Hainan Sheng, China
(Li) Department of Emergency Medicine, Orthopaedics, and Diabetes,
Hospital of Haikou City, Haikou, China
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: The common drawbacks of standard cardiac rehabilitation (CR)
models include low participation rate, high cost, and dependence on
on-site exercise sessions. Therefore, hybrid CR protocols have been
developed. Aim(s): We aimed to test whether hybrid CR models are
superior or equivalent to the traditional CR models in patients after
myocardial infarction, heart failure, and cardiac surgery, using a
meta-analysis framework. Method(s): Data from relevant original
studies indexed in the Medline, Scopus, Cochrane Central, and Web of
Science databases were extracted and analysed. The standardised mean
difference (SMD) was used as a summary effect estimate, along with 95%
confidence interval (CI). Result(s): Based on data from 1195
patients, the summary effect size showed similar improvement in functional
capacity in hybrid and standard CR programmes (SMD = -0.04, 95% CI -0.18
to 0.09, p = 0.51). No significant difference was detected between the two
models in terms of changes in exercise duration (SMD = -0.14, 95% CI -0.51
to 0.24, p = 0.47), systolic (SMD = -0.01, 95% CI -0.14 to 0.12, p =
0.91), and diastolic (SMD = -0.03, 95% CI -0.16 to 0.11, p = 0.7) blood
pressure, or health-related quality of life (SMD = -0.08, 95% CI -0.23 to
0.07, p = 0.27). In terms of blood lipids, no significant difference was
noted between hybrid and traditional CR models in all assessed lipid
profile parameters, except for triglycerides (favouring the traditional CR
model). Conclusion(s): Hybrid CR protocols showed comparable efficacy
to the traditional model. Further well-designed studies are required to
validate these findings, especially regarding the long-term
outcomes. Kardiologia Polska Copyright © Polish Cardiac Society
2018.

<11>
Accession Number
2001331607
Title
A comparative study of preemptive effect of pregabalin and gabapentin on
postoperative pain after coronary artery bypass graft surgery: A clinical
randomized trial.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 26 (4) (pp
245-251), 2018. Date of Publication: December 2018.
Author
Hanoura S.; Sharaa M.; Refaie M.; Singh R.
Institution
(Hanoura) Department of Anesthesia and Intensive Care, Al-Azhar
University, Egypt
(Sharaa) Department of Cardiothoracic Surgery, Faculty of Medicine,
AL-Azhar University, Cairo, Egypt
(Refaie, Singh) Department of Cardiology Medical Research, Hamad Medical
Corporation, Doha, Qatar
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Pain that pursues coronary artery bypass graft (CABG) surgery
is usually associated with increased both recovery duration and hospital
stay. Patient outcome could be worsened owing to large doses of opioids
for pain control through over sedation, and prolonged mechanical
ventilation. This study was designed to evaluate the effect of preemptive
gabapentinoids on post CABG surgery pain control. Method(s): Sixty
patients subjected to CABG were randomized blindly to receive either
pregabalin, gabapentine or placebo 2 h before the surgery. The former
group included 20 patients who received 150 mg pregabalin, whereas the
later group included another 20 patients who received 600 mg gabapentin.
Finally, the placebo group with number of 20 patients received identical
capsule. The postoperative pain was assessed with critical care pain
observation tool (CPOT) and Numeric rate score (NRS). Total administered
of patient controlled analgesia (PCA) with morphine as well as any rescue
doses were registered and patient satisfaction was recorded.
 Result(s): Out of the 60 eligible patients, 56 patients were enrolled
in the study (with male predominance 51: 5). Enrollment at gabapentin,
pregabalin and placebo groups was (19, 18 and 19 respectively).
Post-operative patient satisfaction was better in the pregabalin group
with value 8.1 +/- 1.1 compared to 7.9 +/- 1 in the gabapentin group, and
6.7 +/- 1.2 in the placebo group (P < 0.001). The amount of post-operative
morphine PCA was lowest in the pregabalin group 22.4 +/- 6 versus 27.1 +/-
5.1 in the gabapentin group; with the highest was in the placebo
controlled group 31 +/- 5.1 (p < 0.001). Conclusion(s): Both
pregabalin and gabapentin were effective for reduction of post CABG
morphine consumption and had better patient satisfaction if given
preemptively as a single dose preoperatively. Copyright © 2018
The Egyptian Society of Cardio-thoracic Surgery

<12>
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.

<13>
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.

<14>
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

<15>
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.

<16>
Accession Number
2001340088
Title
Outcome of pump assisted beating mitral valve replacement in patients with
chronic severe mitral regurgitation and left ventricular dysfunction "A
clinical randomized trial".
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 26 (4) (pp
257-263), 2018. Date of Publication: December 2018.
Author
Elghany Elsherif M.A.; Salama Ayyad M.A.K.; Elsawy H.; Elwahab A.A.
Institution
(Elghany Elsherif, Elsawy) National Heart Institute, Cairo, Egypt
(Salama Ayyad, Elwahab) Assiut University, Cardiothoracic Surgery
Department, Egypt
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: As a natural extension of warm heart surgery, beating heart
valve surgery was born. The fundamental question was posed: why arrest the
heart if technically adequate valve procedures could be accomplished with
continuous warm perfusion? So this study was carried out to evaluate the
results of mitral valve replacement on beating heart in patients with
chronic severe mitral regurgitation and left ventricular dysfunction.
 Method(s): Sixty patients underwent surgical correction of mitral
insufficiency were prospectively randomized to 30 patients (group 1)
mitral valve replacement using warm blood cardioplegia, and 30 patients
(group II) mitral valve replacement using beating heart technique.
 Result(s): Preoperatively, there was no significant difference
between the two examined groups in age, sex, NYHA and echocardiographic
data. The mitral surgical time (from beginning of opening of the left
atrium till finishing left atrial closure) was significantly longer in the
beating (group II) compared to the control (group I). However, the total
bypass time was not significantly longer in the beating (group II)
compared to the control (group I). The beating (group II) patients had
shorter ventilation time and ICU stays time than in the control (group I).
P value (0.003 and 0.049 respectively). Also (group II) patients had less
incidence of low cardiac output status after surgery than the control
(group I) (p value 0.007). The postoperative echocardiographic results
showed a significant difference on LV myocardial function in favor of the
beating technique (group II) over the cardioplegic technique (group I).
 Conclusion(s): Beating heart mitral valve replacement has proven in
our study to be associated with better LV function early postoperatively
than mitral valve replacement using warm bloody cardioplegic arrest. This
together with the absence of related perioperative mortality and the major
complications suggests that it is safe and beneficial to LV
function. Copyright © 2018

<17>
Accession Number
623882850
Title
Outcome measures for pediatric laryngotracheal reconstruction:
International consensus statement.
Source
Laryngoscope. (no pagination), 2018. Date of Publication: 2018.
Author
Balakrishnan K.; Sidell D.R.; Bauman N.M.; Bellia-Munzon G.F.; Boesch
R.P.; Bromwich M.; Cofer S.A.; Daines C.; de Alarcon A.; Garabedian N.;
Hart C.K.; Ida J.B.; Leboulanger N.; Manning P.B.; Mehta D.K.; Monnier P.;
Myer C.M.; Prager J.D.; Preciado D.; Propst E.J.; Rahbar R.; Russell J.;
Rutter M.J.; Thierry B.; Thompson D.M.; Torre M.; Varela P.; Vijayasekaran
S.; White D.R.; Wineland A.M.; Wood R.E.; Wootten C.T.; Zur K.; Cotton
R.T.
Institution
(Balakrishnan, Cofer) Department of Otorhinolaryngology and Mayo Clinic
Children's Center, Rochester, MN, United States
(Boesch) Department of Pediatric and Adolescent Medicine and Mayo Clinic
Children's Center, Mayo Clinic, Rochester, MN, United States
(Sidell) Department of Otolaryngology-Head and Neck Surgery, Stanford
University, Palo Alto, CA, United States
(Bauman, Preciado) Division of Otolaryngology, Children's National Health
System, Washington, DC, United States
(Daines) Department of Pediatrics, University of Arizona Health Sciences,
Tucson, AZ, United States
(de Alarcon, Hart, Myer, Rutter, Cotton) Division of Pediatric
Otolaryngology and Aerodigestive and Esophageal Center, Cincinnati
Children's Hospital Medical Center and University of Cincinnati College of
Medicine, Cincinnati, OH, United States
(Wood) Division of Pulmonary Medicine, Cincinnati Children's Hospital,
Cincinnati, OH, United States
(Ida, Thompson) Department of Otolaryngology, Head and Neck Surgery,
Northwestern University Feinberg School of Medicine, Chicago, IL, United
States
(Manning) Section of Pediatric Cardiothoracic Surgery, St. Louis
Children's Hospital and Washington University School of Medicine, St.
Louis, MO, United States
(Mehta) Department of Pediatric Otolaryngology, Texas Children's Hospital,
Houston, TX, United States
(Prager) Department of Otolaryngology, University of Colorado, Aurora, CO,
United States
(Rahbar) Department of Otolaryngology, Boston Children's Hospital, Harvard
Medical School, Boston, MA, United States
(White) Department of Otolaryngology-Head and Neck Surgery, Medical
University of South Carolina, Charleston, SC, United States
(Wineland) University of Arkansas School for Medical Sciences, Department
of Otolaryngology-Head & Neck Surgery, Arkansas Children's Hospital,
Little Rock, AR, United States
(Wootten) Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville,
TN, United States
(Zur) Center for Pediatric Airway Disorders, Children's Hospital of
Philadelphia, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, United States
(Bellia-Munzon) Department of Pediatric Surgery, General Hospital of
Children Pedro de Elizalde, Buenos Aires, Argentina
(Bromwich) Department of Otorhinolaryngology, University of Ottawa,
Ottawa, Canada
(Propst) Department of Otolaryngology-Head & Neck Surgery, Hospital for
Sick Children, University of Toronto, Toronto, ON, Canada
(Garabedian, Leboulanger, Thierry) Department of Otorhinolaryngology,
Hopital Universitaire Necker-Enfants Malades, Paris, France
(Monnier) Department of Otolaryngology, Head and Neck Surgery, University
Hospital of Lausanne (CHUV), Lausanne, Switzerland
(Russell) Department of Paediatric Otolaryngology, Our Lady's Hospital for
Sick Children, Dublin, Ireland
(Torre) Airway Team and Surgical Department, Instituto Giannina Gaslini,
Genoa, Italy
(Varela) Pediatric Surgery Department, University of Chile, Clinical Las
Condes Medical Center, Santiago, Chile
(Vijayasekaran) Department of Otolaryngology, Head and Neck Surgery,
Princess Margaret Hospital for Children, Perth, Australia
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: Develop multidisciplinary and international consensus on
patient, disease, procedural, and perioperative factors, as well as key
outcome measures and complications, to be reported for pediatric airway
reconstruction studies. Method(s): Standard Delphi methods were
applied. Participants proposed items in three categories: 1)
patient/disease characteristics, 2)
procedural/intraoperative/perioperative factors, and 3) outcome measures
and complications. Both general and anatomic site-specific measures were
elicited. Participants also suggested specific operations to be
encompassed by this project. We then used iterative ranking and review to
develop consensus lists via a priori Delphi consensus criteria.
 Result(s): Thirty-three pediatric airway experts from eight countries
in North and South America, Europe, and Australia participated,
representing otolaryngology (including International Pediatric
Otolaryngology Group members), pulmonology, general surgery, and
cardiothoracic surgery. Consensus led to inclusion of 19 operations
comprising open expansion, resection, and slide procedures of the larynx,
trachea, and bronchi as well as three endoscopic procedures. Consensus was
achieved on multiple patient/comorbidity (10), disease/stenosis (7),
perioperative-/intraoperative-/procedure-related (16) factors. Consensus
was reached on multiple outcome and complication measures, both general
and site-specific (8 general, 13 supraglottic, 15 glottic, 17 subglottic,
8 cervical tracheal, 12 thoracic tracheal). The group was able to clarify
how each outcome should be measured, with specific instruments defined
where applicable. Conclusion(s): This consensus statement provides a
framework to communicate results consistently and reproducibly,
facilitating meta-analyses, quality improvement, transfer of information,
and surgeon self-assessment. It also clarifies expert opinion on which
patient, disease, procedural, and outcome measures may be important to
consider in any pediatric airway reconstruction patient. Level of
Evidence: 5. Laryngoscope, 2018. Copyright © 2018 The American
Laryngological, Rhinological and Otological Society, Inc.

<18>
Accession Number
2000888513
Title
Perioperative dexmedetomidine reduces delirium after cardiac surgery: A
meta-analysis of randomized controlled trials.
Source
Journal of Clinical Anesthesia. 50 (pp 33-42), 2018. Date of Publication:
November 2018.
Author
Wu M.; Liang Y.; Dai Z.; Wang S.
Institution
(Wu, Liang, Dai, Wang) Department of anesthesiology, The Affiliated
Hospital of Qingdao University, 16 Jiangsu Road, Qingdao 266071, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: To evaluate the efficiency of dexmedetomidine on the
incidence of delirium in patients after cardiac surgery. Design(s):
Meta-analysis of randomized controlled trials. Setting(s): Operating
room and Intensive Care Unit (ICU). Patient(s): Ten trials with a
total of 1387 patients undergoing cardiac surgery met the inclusion
criteria. Intervention(s): Randomized controlled trials (RCTs)
comparing the effect of dexmedetomidine versus non-treatment of
dexmedetomidine (normal saline (NS), propofol and other anesthetic drugs)
on delirium in patients undergoing cardiac surgery were retrieved from
PubMed/Medline, Embase, the Cochrane Library and Web of science. The
primary outcome was the incidence of delirium. The secondary outcomes were
the rate of bradycardia and hypotension, the duration of mechanical
ventilation and the length of ICU and hospital stay. Main Result(s):
Compared with the control group, Dexmedetomidine significantly decreased
the incidence of postoperative delirium, (risk ratio 0.46; 95% confidence
intervals, 0.34 to 0.62; P < 0.00001), while the incidence of bradycardia
was increased in dexmedetomidine group (risk ratio 1.86; 95% confidence
intervals, 1.16 to 2.99; P = 0.01). There was no significant difference
between groups with regarding to the occurrence of hypotension (risk ratio
0.90; 95% confidence intervals, 0.59 to 1.38; P = 0.63), the duration of
mechanical ventilation (Mean Difference 0.21; 95% confidence intervals,
-0.70 to 1.12; P = 0.65), and the length of ICU (Standard Mean Difference
- 0.07; 95% confidence intervals, -0.19 to 0.06; P = 0.3) and hospital
stay (Mean Difference - 0.13; 95% confidence intervals, -0.56 to 0.30; P =
0.56). Conclusion(s): Perioperative dexmedetomidine administration
decreased the incidence of delirium in patients after cardiac surgery, but
might increase the rate of bradycardia. Furthermore, we did not observe
significant differences in the incidence of hypotension, the duration of
mechanical ventilation and length of ICU and hospital stay between groups.
Future studies are needed to ascertain the effect of dexmedetomidine on
the incidence of delirium after coronary artery bypass grafting (CABG) and
in patient with cognitive disorder at baseline, whether intraoperative
dexmedetomidine infusion could reduce postoperative delirium and the
optimal dose of dexmedetomidine. Copyright © 2018 Elsevier Inc.

<19>
Accession Number
625792268
Title
Single versus (vs) double chest tube drainage following lobectomy; do we
still need to debate this or is it a 'no brainer'?.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2017. Italy. 50 (Supplement 61) (no
pagination), 2017. Date of Publication: September 2017.
Author
Hardavella G.; Bhaskaran P.; Karampinis I.; Anastasiou N.
Institution
(Hardavella, Karampinis, Anastasiou) Department of Thoracic Surgery,
General Oncology Hospital 'Agioi Anargyroi', Athens, Greece
(Bhaskaran) Department of Thoracic Surgery, Royal Brompton and Harefield
Hospitals, NHS Fpundation Trust, London, United Kingdom
Publisher
European Respiratory Society
Abstract
Introduction: Chest tube drainage is a standard of care for patients
undergoing lobectomy. Most surgical teams use double chest tube drainage
as it is believed to achieve better fluid evacuation however it is linked
with increased patient pain and hospital stay. Aim(s): To assess the
efficacy and safety of double vs single chest tube drainage following
thoracotomy and lobectomy in a pragmatic clinical setting (tertiary
thoracic surgery service). Material(s) and Method(s): Prospective
randomised controlled trial (October 2015-October 2016)for patients
undergoing therapeutic lobectomies for non small cell lung cancer; group A
had single chest tube drainage and group B had double chest tube post
operatively. Data was collected for post-operative pain (numerical pain
scale NPS), patient controlled analgesia (PCA), drain age, hospital stay,
morbidity. SPSS v.22 was used for statistical analysis. Result(s):
119 patients were enrolled;72 male, 47 female, mean age 67.3 years. Group
A had 60 patients and group B 59 patients. Mean NPS score in group A was 3
vs 8 in group B (p=0.001) and PCA was significantly less used in group A
than in group B (p=0.002). Mean chest tube drain age was 3.4 days in group
A vs 4.8 days in group B (p=0.02). Among all patients, re-insertion of
chest tube drainage was only needed for one(group A). Mean hospital stay
was 4.5 days (group A) vs 6.3 days in group B (p=0.025). Morbidity was
similar in both groups(p=0.1). Conclusion(s):Single chest tube
drainage is an efficient and safe post-operative option for patients
undergoing lobectomies. It can efficiently achieve prompt fluid evacuation
while minimising post-operative pain, use of PCA and hospital stay.

<20>
Accession Number
625790083
Title
The REACH study, a randomized controlled trial assessing the safety and
effectiveness of the Spiration Valve System endobronchial therapy for
severe emphysema: 12 month follow-up results.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2017. Italy. 50 (Supplement 61) (no
pagination), 2017. Date of Publication: September 2017.
Author
Wang G.; Li S.; Wang C.; Gao X.; Jin F.; Yang H.; Han B.; Zhou R.; Chen
C.; Chen L.; Bai C.; Shen H.; Zhong N.
Institution
(Wang) Peking University, First Hospital, Beijing, China
(Li, Zhong) First Affiliated Hospital, Guangzhou Medical College,
Guangzhou, China
(Wang) Shanghai No. 10 People's Hospital, Shanghai, China
(Gao) Guangdong General Hospital, Guangzhou, China
(Jin) Tangdu Hospital, Second Teaching Hospital, Fourth Military Medical
University, Xi'an, China
(Yang) Xiangya Hospital, Central South University, Changsha, China
(Han) Shanghai Chest Hospital Affiliated to, Shanghai Jiaotong University,
Shanghai, China
(Zhou) Second Xiangya Hospital, Central South University, Changsha, China
(Chen) First Affiliated Hospital, Wenzhou Hospital, Wenzhou, China
(Chen) General Hospital of Chinese People's Liberation Army (301),
Beijing, China
(Bai) Zhongshan Hospital, Fudan University, Shanghai, China
(Shen) Second Affiliated Hospital, Zhejiang University, School of
Medicine, Hangzhou, China
Publisher
European Respiratory Society
Abstract
The REACH study is the first multicenter randomized controlled trial
conducted in China assessing the safety and effectiveness of endobronchial
valve treatment for severe emphysema patients with complete fissures. The
study objectives were target lobe volume reduction (TLVR) and significant
improvement in lung function. 101 subjects, 66 treatment and 35 control,
were enrolled at 12 study sites. Target lobe selection, based on visual
HRCT identified an upper lobe in 55% and a lower lobe in 45% of patients.
Treatment consisted of target lobe occlusion utilizing the Spiration Valve
System (Olympus, USA). The control group received optimal medical
management. 64.6% of patients at 12 months showed evidence of significant
(TLVR at 350 ml MCID). Mean TLVR in treatment patients was 781 ml at 12
months. Compared to control, the treatment group achieved a significant
and clinically meaningful improvement in FEV1 at the 1, 3, 6 and 12 month
visits (16.8%, 14.2%, 20.7%, 22.8%) with a responder rate of approximately
39.8% at 12 months. Significant improvements were also observed for
quality of life measures and 6MWT. Between the 6 and 12 month follow-up
visits, there were 8 serious adverse events in the treatment group
consisting primarily of acute COPD exacerbations (6), lung abscess (1) and
pneumothorax (1). There was one control and no treatment group deaths. In
conclusion, this is the first multicenter study comparing endobronchial
valve therapy to medical arm control that has demonstrated 12 month
sustained clinically meaningful benefit with acceptable adverse events for
severe emphysema patients selected only by HRCT.

<21>
Accession Number
625788627
Title
The effects of aerobic exercise training on spirometric parameters,
respiratory muscle strength and functional capacity in patients after
coronary artery bypass surgery.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2017. Italy. 50 (Supplement 61) (no
pagination), 2017. Date of Publication: September 2017.
Author
Ozyilmaz S.; Gurses N.; Zeren M.; Cetin G.
Institution
(Ozyilmaz, Gurses, Zeren) Bezmialem Vakif University, Faculty of Health
Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
(Cetin) Istanbul University, Institute of Cardiology, Department of
Cardiovascular Surgery, Istanbul, Turkey
Publisher
European Respiratory Society
Abstract
Objective: The aim of this study was to examine the effects of aerobic
exercise on spirometric parameters, respiratory muscle strength and
functional capacity in patients after coronary artery bypass surgery.
 Method(s): Twenty six patients were included in the study. All
patients received pre and post-op chest physiotherapy and post-op
inpatient early mobilization program and they were educated for risk
factors and lifestyle modifications and daily physical activity before
discharge. One month after the surgery, patients were assessed with
spirometry, maximum inspiratory (MIP) and expiratory (MEP) pressure
measurements and six-minute walk test (6MWT) and were randomized into
training (TG) or control (CG) group. TG received aerobic exercise training
on a treadmill with the intensity of 75-85% of maximum heart rate for
30-40 minutes, 3 days in a week and for 8 weeks. CG received no aerobic
exercise training but was asked to continue their chest physiotherapy and
daily physical activity program at home as TG. There was a dropout of 1
patient in TG. Remaining 25 patients were assessed again after 8 weeks.
 Result(s): There were significant improvements in FVC and FEV1
(p<0.001), FEF%50, MIP, MEP and 6MWT (p<0.01) in TG. There were also
significant improvements in FVC (p<0.05), FEV1, FEF50%, MIP, MEP and 6MWT
(p<0.01) in CG. Improvements in FVC, FEV1 and FEF%50 were significantly
higher in TG compared to CG (p<0.05). Conclusion(s): Compared to CG,
aerobic exercise training further improves the spirometric parameters in
patients after coronary artery bypass surgery.

<22>
Accession Number
625777312
Title
Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease.
Source
The New England journal of medicine. 380 (1) (pp 33-44), 2019. Date of
Publication: 03 Jan 2019.
Author
Manson J.E.; Cook N.R.; Lee I.-M.; Christen W.; Bassuk S.S.; Mora S.;
Gibson H.; Gordon D.; Copeland T.; D'Agostino D.; Friedenberg G.; Ridge
C.; Bubes V.; Giovannucci E.L.; Willett W.C.; Buring J.E.
Institution
(Manson, Cook, Lee, Christen, Bassuk, Mora, Gibson, Gordon, Copeland,
D'Agostino, Friedenberg, Ridge, Bubes, Giovannucci, Willett, Buring) From
the Department of Medicine, Brigham and Women's Hospital and Harvard
Medical School (J.E.M., N.R.C., I.-M.L., W.C., S.S.B., S.M., H.G., D.G.,
T.C., D.D., G.F., C.R., V.B., E.L.G., W.C.W., J.E.B.), and the Departments
of Epidemiology (J.E.M., N.R.C., I.-M.L., W.C.W., J.E.B.) and Nutrition
(E.L.G., W.C.W.), Harvard T.H. Chan School of Public Health - all in
Boston
Publisher
NLM (Medline)
Abstract
BACKGROUND: It is unclear whether supplementation with vitamin D reduces
the risk of cancer or cardiovascular disease, and data from randomized
trials are limited. METHOD(S): We conducted a nationwide, randomized,
placebo-controlled trial, with a two-by-two factorial design, of vitamin
D3 (cholecalciferol) at a dose of 2000 IU per day and marine n-3 (also
called omega-3) fatty acids at a dose of 1 g per day for the prevention of
cancer and cardiovascular disease among men 50 years of age or older and
women 55 years of age or older in the United States. Primary end points
were invasive cancer of any type and major cardiovascular events (a
composite of myocardial infarction, stroke, or death from cardiovascular
causes). Secondary end points included site-specific cancers, death from
cancer, and additional cardiovascular events. This article reports the
results of the comparison of vitamin D with placebo. RESULT(S): A
total of 25,871 participants, including 5106 black participants, underwent
randomization. Supplementation with vitamin D was not associated with a
lower risk of either of the primary end points. During a median follow-up
of 5.3 years, cancer was diagnosed in 1617 participants (793 in the
vitamin D group and 824 in the placebo group; hazard ratio, 0.96; 95%
confidence interval [CI], 0.88 to 1.06; P=0.47). A major cardiovascular
event occurred in 805 participants (396 in the vitamin D group and 409 in
the placebo group; hazard ratio, 0.97; 95% CI, 0.85 to 1.12; P=0.69). In
the analyses of secondary end points, the hazard ratios were as follows:
for death from cancer (341 deaths), 0.83 (95% CI, 0.67 to 1.02); for
breast cancer, 1.02 (95% CI, 0.79 to 1.31); for prostate cancer, 0.88 (95%
CI, 0.72 to 1.07); for colorectal cancer, 1.09 (95% CI, 0.73 to 1.62); for
the expanded composite end point of major cardiovascular events plus
coronary revascularization, 0.96 (95% CI, 0.86 to 1.08); for myocardial
infarction, 0.96 (95% CI, 0.78 to 1.19); for stroke, 0.95 (95% CI, 0.76 to
1.20); and for death from cardiovascular causes, 1.11 (95% CI, 0.88 to
1.40). In the analysis of death from any cause (978 deaths), the hazard
ratio was 0.99 (95% CI, 0.87 to 1.12). No excess risks of hypercalcemia or
other adverse events were identified. CONCLUSION(S): Supplementation
with vitamin D did not result in a lower incidence of invasive cancer or
cardiovascular events than placebo. (Funded by the National Institutes of
Health and others; VITAL ClinicalTrials.gov number, NCT01169259 .).

<23>
Accession Number
625777232
Title
Marine n-3 Fatty Acids and Prevention of Cardiovascular Disease and
Cancer.
Source
The New England journal of medicine. 380 (1) (pp 23-32), 2019. Date of
Publication: 03 Jan 2019.
Author
Manson J.E.; Cook N.R.; Lee I.-M.; Christen W.; Bassuk S.S.; Mora S.;
Gibson H.; Albert C.M.; Gordon D.; Copeland T.; D'Agostino D.; Friedenberg
G.; Ridge C.; Bubes V.; Giovannucci E.L.; Willett W.C.; Buring J.E.
Institution
(Manson, Cook, Lee, Christen, Bassuk, Mora, Gibson, Albert, Gordon,
Copeland, D'Agostino, Friedenberg, Ridge, Bubes, Giovannucci, Willett,
Buring) From the Department of Medicine, Brigham and Women's Hospital and
Harvard Medical School (J.E.M., N.R.C., I-M.L., W.C., S.S.B., S.M., H.G.,
C.M.A., D.G., T.C., D.D., G.F., C.R., V.B., E.L.G., W.C.W., J.E.B.), and
the Departments of Epidemiology (J.E.M., N.R.C., I.-M.L., W.C.W., J.E.B.)
and Nutrition (E.L.G., W.C.W.), Harvard T.H. Chan School of Public Health
- all in Boston
Publisher
NLM (Medline)
Abstract
BACKGROUND: Higher intake of marine n-3 (also called omega-3) fatty acids
has been associated with reduced risks of cardiovascular disease and
cancer in several observational studies. Whether supplementation with n-3
fatty acids has such effects in general populations at usual risk for
these end points is unclear. METHOD(S): We conducted a randomized,
placebo-controlled trial, with a two-by-two factorial design, of vitamin
D3 (at a dose of 2000 IU per day) and marine n-3 fatty acids (at a dose of
1 g per day) in the primary prevention of cardiovascular disease and
cancer among men 50 years of age or older and women 55 years of age or
older in the United States. Primary end points were major cardiovascular
events (a composite of myocardial infarction, stroke, or death from
cardiovascular causes) and invasive cancer of any type. Secondary end
points included individual components of the composite cardiovascular end
point, the composite end point plus coronary revascularization (expanded
composite of cardiovascular events), site-specific cancers, and death from
cancer. Safety was also assessed. This article reports the results of the
comparison of n-3 fatty acids with placebo. RESULT(S): A total of
25,871 participants, including 5106 black participants, underwent
randomization. During a median follow-up of 5.3 years, a major
cardiovascular event occurred in 386 participants in the n-3 group and in
419 in the placebo group (hazard ratio, 0.92; 95% confidence interval
[CI], 0.80 to 1.06; P=0.24). Invasive cancer was diagnosed in 820
participants in the n-3 group and in 797 in the placebo group (hazard
ratio, 1.03; 95% CI, 0.93 to 1.13; P=0.56). In the analyses of key
secondary end points, the hazard ratios were as follows: for the expanded
composite end point of cardiovascular events, 0.93 (95% CI, 0.82 to 1.04);
for total myocardial infarction, 0.72 (95% CI, 0.59 to 0.90); for total
stroke, 1.04 (95% CI, 0.83 to 1.31); for death from cardiovascular causes,
0.96 (95% CI, 0.76 to 1.21); and for death from cancer (341 deaths from
cancer), 0.97 (95% CI, 0.79 to 1.20). In the analysis of death from any
cause (978 deaths overall), the hazard ratio was 1.02 (95% CI, 0.90 to
1.15). No excess risks of bleeding or other serious adverse events were
observed. CONCLUSION(S): Supplementation with n-3 fatty acids did not
result in a lower incidence of major cardiovascular events or cancer than
placebo. (Funded by the National Institutes of Health and others; VITAL
ClinicalTrials.gov number, NCT01169259 .).

<24>
Accession Number
625777785
Title
Cardiovascular Risk Reduction with Icosapent Ethyl for
Hypertriglyceridemia.
Source
The New England journal of medicine. 380 (1) (pp 11-22), 2019. Date of
Publication: 03 Jan 2019.
Author
Bhatt D.L.; Steg P.G.; Miller M.; Brinton E.A.; Jacobson T.A.; Ketchum
S.B.; Doyle R.T.; Juliano R.A.; Jiao L.; Granowitz C.; Tardif J.-C.;
Ballantyne C.M.
Institution
(Bhatt, Steg, Miller, Brinton, Jacobson, Ketchum, Doyle, Juliano, Jiao,
Granowitz, Tardif, Ballantyne) From Brigham and Women's Hospital Heart and
Vascular Center and Harvard Medical School, Boston (D.L.B.); FACT (French
Alliance for Cardiovascular Trials), Departement Hospitalo-Universitaire
FIRE (Fibrose, Inflammation, and Remodeling), Assistance Publique-Hopitaux
de Paris, Hopital Bichat, Universite Paris-Diderot, INSERM Unite 1148,
Paris (P.G.S.); National Heart and Lung Institute, Imperial College, Royal
Brompton Hospital, London (P.G.S.); the Department of Medicine, University
of Maryland School of Medicine, Baltimore (M.M.); the Utah Lipid Center,
Salt Lake City (E.A.B.); the Office of Health Promotion and Disease
Prevention, Department of Medicine, Emory University School of Medicine,
Atlanta (T.A.J.); Amarin Pharma, Bedminster, NJ (S.B.K., R.T.D.J., R.A.J.,
L.J., C.G.); Montreal Heart Institute, Universite de Montreal, Montreal
(J.-C.T.); and the Department of Medicine, Baylor College of Medicine, and
the Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart
and Vascular Center, Houston (C.M.B.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients with elevated triglyceride levels are at increased
risk for ischemic events. Icosapent ethyl, a highly purified
eicosapentaenoic acid ethyl ester, lowers triglyceride levels, but data
are needed to determine its effects on ischemic events. METHOD(S): We
performed a multicenter, randomized, double-blind, placebo-controlled
trial involving patients with established cardiovascular disease or with
diabetes and other risk factors, who had been receiving statin therapy and
who had a fasting triglyceride level of 135 to 499 mg per deciliter (1.52
to 5.63 mmol per liter) and a low-density lipoprotein cholesterol level of
41 to 100 mg per deciliter (1.06 to 2.59 mmol per liter). The patients
were randomly assigned to receive 2 g of icosapent ethyl twice daily
(total daily dose, 4 g) or placebo. The primary end point was a composite
of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke,
coronary revascularization, or unstable angina. The key secondary end
point was a composite of cardiovascular death, nonfatal myocardial
infarction, or nonfatal stroke. RESULT(S): A total of 8179 patients
were enrolled (70.7% for secondary prevention of cardiovascular events)
and were followed for a median of 4.9 years. A primary end-point event
occurred in 17.2% of the patients in the icosapent ethyl group, as
compared with 22.0% of the patients in the placebo group (hazard ratio,
0.75; 95% confidence interval [CI], 0.68 to 0.83; P<0.001); the
corresponding rates of the key secondary end point were 11.2% and 14.8%
(hazard ratio, 0.74; 95% CI, 0.65 to 0.83; P<0.001). The rates of
additional ischemic end points, as assessed according to a prespecified
hierarchical schema, were significantly lower in the icosapent ethyl group
than in the placebo group, including the rate of cardiovascular death
(4.3% vs. 5.2%; hazard ratio, 0.80; 95% CI, 0.66 to 0.98; P=0.03). A
larger percentage of patients in the icosapent ethyl group than in the
placebo group were hospitalized for atrial fibrillation or flutter (3.1%
vs. 2.1%, P=0.004). Serious bleeding events occurred in 2.7% of the
patients in the icosapent ethyl group and in 2.1% in the placebo group
(P=0.06). CONCLUSION(S): Among patients with elevated triglyceride
levels despite the use of statins, the risk of ischemic events, including
cardiovascular death, was significantly lower among those who received 2 g
of icosapent ethyl twice daily than among those who received placebo.
(Funded by Amarin Pharma; REDUCE-IT ClinicalTrials.gov number, NCT01492361
.).

<25>
Accession Number
625776509
Title
Transcatheter aortic valve replacement in low risk patients.
Source
Minerva cardioangiologica. 67 (1) (pp 19-38), 2019. Date of Publication:
01 Feb 2019.
Author
Junquera L.; Ferreira-Neto A.; Guimaraes L.; Asmarats L.; Del Val D.;
Wintzer-Wehekind J.; Muntane-Carol G.; Freitas-Ferraz A.; Rodes-Cabau J.
Institution
(Junquera, Ferreira-Neto, Guimaraes, Asmarats, Del Val, Wintzer-Wehekind,
Muntane-Carol, Freitas-Ferraz) Quebec Heart and Lung Institute, Laval
University, Quebec City, QC, Canada
(Rodes-Cabau) Quebec Heart and Lung Institute, Laval University, Quebec
City, QC, Canada
Publisher
NLM (Medline)
Abstract
Transcatheter aortic valve replacement (TAVR) is a relatively new
technology that has grown exponentially over the past decade. Although it
was initially restricted to elderly patients at very high or prohibitive
surgical risk, it is currently being evaluated as a treatment option in
younger and lower risk patients. The increasing experience of the Heart
Teams, along with the continued refinement of transcatheter valve
technology has resulted in TAVR achieving results comparable to those of
surgery for treating intermediate-risk patients. Furthermore, promising
preliminary results have been obtained from observational and propensity
matched studies in low risk patients, and a small randomized trial showed
the non-inferiority of TAVR vs. SAVR regarding early and late (up to 6
years) outcomes. Three ongoing randomized trials will provide the definite
response about the safety and efficacy of TAVR for treating low risk
patients with severe aortic stenosis in the near future. The (expected)
positive results of these studies would establish the basis for TAVR as
the preferred treatment for the majority of patients with aortic stenosis.
However, continuous research efforts for better determining valve
durability among TAVR recipients, as well as reducing some of the genuine
and frequent complications of TAVR (e.g. conduction disturbances) are
important in this final effort for making TAVR the default treatment for
aortic stenosis.

<26>
Accession Number
625774287
Title
Hypoglossal Nerve Stimulation and Heart Rate Variability: Analysis of STAR
Trial Responders.
Source
Otolaryngology--head and neck surgery : official journal of American
Academy of Otolaryngology-Head and Neck Surgery. 160 (1) (pp 165-171),
2019. Date of Publication: 01 Jan 2019.
Author
Dedhia R.C.; Shah A.J.; Bliwise D.L.; Quyyumi A.A.; Strollo P.J.; Li Q.;
Da Poian G.; Clifford G.D.
Institution
(Dedhia) Department of Otolaryngology, School of Medicine, Emory
University, Atlanta, GA, United States
(Dedhia, Bliwise) Emory Sleep Center, Emory Healthcare, Atlanta, GA,
United States
(Shah) Department of Epidemiology, Rollins School of Public Health, Emory
University, Atlanta, GA, United States
(Quyyumi) Division of Cardiology, Department of Medicine, School of
Medicine, Emory University, Atlanta, GA, United States
(Strollo) Division of Pulmonary, Allergy and Critical Care Medicine,
School of Medicine, University of Pittsburgh, Pittsburgh, PA, United
States
(Li, Da Poian, Clifford) Department of Biomedical Informatics, Emory
University, Atlanta, GA, United States
(Li, Da Poian, Clifford) Department of Biomedical Engineering, Georgia
Institute of Technology, Atlanta, GA, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Hypoglossal nerve stimulation represents a novel therapy for
the treatment of moderate-severe obstructive sleep apnea; nonetheless, its
cardiovascular effects are not known. We examine the effects of
hypoglossal nerve stimulation on heart rate variability, a measure of
autonomic function. STUDY DESIGN: Substudy of the STAR trial (Stimulation
Therapy for Apnea Reduction): a multicenter prospective single-group
cohort. SETTING: Academic and private practice centers in the United
States and Europe. SUBJECTS AND METHODS: A subset of responder
participants (n = 46) from the STAR trial was randomized to therapy
withdrawal or therapy maintenance 12 months after surgery. Heart rate
variability analysis included standard deviation of the R-R interval
(SDNN), low-frequency power of the R-R interval, and high-frequency power
of the R-R interval. Analysis was performed by sleep with 5-minute sliding
window epochs during baseline, 12 months, and the maintenance/withdrawal
period. RESULT(S): A significant improvement from baseline to 12
months in heart rate variability was seen for SDNN and low frequency
across all sleep stages. SDNN analysis demonstrated no change in the wake
period (mean +/- SD: 0.042 +/- 0.01 vs 0.077 +/- 0.07, P = .19). Reduction
in SDNN was correlated to improvement in apnea-hypopnea index ( r = 0.39,
P = .03). In the therapy withdrawal group, no significant changes in SDNN
were seen for N1/N2, N3, or rapid eye movement sleep. CONCLUSION(S):
Hypoglossal nerve stimulation therapy appears to reduce heart rate
variability during sleep. This reduction was not affected by a 1-week
withdrawal period. Larger prospective studies are required to better
understand the effect of hypoglossal nerve stimulation on autonomic
dysfunction in obstructive sleep apnea.

<27>
Accession Number
625078936
Title
Influence of staged repair and primary repair on outcomes in patients with
complete atrioventricular septal defect and tetralogy of Fallot: a
systematic review and meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. 26 (1) (pp 98-105), 2018.
Date of Publication: 01 Jan 2018.
Author
Lenko E.; Kulyabin Y.; Zubritskiy A.; Gorbatykh Y.; Naberukhin Y.; Nichay
N.; Bogachev-Prokophiev A.; Karaskov A.
Institution
(Lenko, Kulyabin, Zubritskiy, Gorbatykh, Naberukhin, Nichay,
Bogachev-Prokophiev, Karaskov) Department of Congenital Heart Surgery,
Siberian Biomedical Research Center, Novosibirsk, Russian Federation
Abstract
OBJECTIVES: Complete atrioventricular septal defect with tetralogy of
Fallot is a rare congenital heart disease. The combination of these
lesions occurs in about 1% of all patients with atrioventricular canal
defects and in 5-6% of patients with tetralogy of Fallot. To assess the
influence of surgical strategy on the survival and reintervention rate for
the left atrioventricular valve and right ventricular outflow tract.
 METHOD(S): We analyzed all related studies since 1986. Thirty-eight
articles were initially retrieved via PubMed/MEDLINE, Cochrane Central
Register of Controlled Trials and Google Scholar, from which 18
retrospective studies were included in the systematic review and 8 studies
in the meta-analysis. RESULT(S): There was no significant difference
in the 6-year survival between staged repair and primary repair [80
patients in the primary group and 81 patients in the staged group; I2=0%;
time-to-event data Peto odds ratio 0.66, 95% confidence interval (CI)
0.3-1.5, P=0.31; hazard ratio 0.66, 95% CI 0.3-1.3, P=0.23]. Both groups
had an equal reintervention rate for the left atrioventricular valve [75
patients in the primary group and 71 patients in the staged group;
I2=0.26%; the Mantel-Haenszel odds ratio 0.60, 95% CI 0.22-1.68, P=0.33],
but patients who received an initial palliation had a higher rate of
reoperation on the right ventricular outflow tract [I2=0%; the
Mantel-Haenszel odds ratio 0.27, 95% CI 0.27-0.9988, P=0.05].
 CONCLUSION(S): Results of this meta-analysis reveal no difference in
6-year survival and reoperation rate for the left atrioventricular valve;
however, patients who underwent staged repair had a higher rate of
reintervention for the right ventricular outflow tract, which could be
related to initially poor pulmonary bed anatomy. Therefore, both the
primary repair and the staged repair are acceptable options for repair of
complete atrioventricular septal defect with tetralogy of Fallot. The
choice of surgical strategy must consider the anatomy of the pulmonary
bed, patient condition and associated anomalies, which could affect
surgical risk. Copyright © The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<28>
Accession Number
625774472
Title
N-Acetylcysteine for Preventing of Acute Kidney Injury in Chronic Kidney
Disease Patients Undergoing Cardiac Surgery: A Metaanalysis.
Source
The heart surgery forum. 21 (6) (pp E513-E521), 2018. Date of Publication:
19 Dec 2018.
Author
He G.; Li Q.; Li W.; Wang L.; Yang J.; Zeng F.
Institution
(He) Department of Respiratory Medicine, First College of Clinical Medical
Sciences, Yichang Central People's Hospital, China Three Gorges
University, Yichang, Hubei province, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The aim of this study was to determine whether N-acetylcysteine
(NAC) has an effect on acute kidney injury (AKI) in chronic kidney disease
patients undergoing cardiac surgery. METHOD(S): We reviewed
literature through PubMed, Medline through PubMed and OVID, The Cochrane
Library, Wan Fang Database, China Biology Medicine Database, Chinese
Periodical Database, China Knowledge Resource Integrated Database, and
Chinese Clinical Trial Registry (1980 to July 10, 2018). Two investigators
independently collected the data and assessed the quality of each study.
RevMan 5.3 was used for the present metaanalysis. RESULT(S): A total
of 5 RCTs (N = 678 participants) were included in the primary analysis.
Pooled analysis showed that intravenous infusion of NAC significantly
reduced the incidence of AKI (RR = 0.77, 95% = 0.63 to 0.94, P < .01) and
that NAC could decrease the adverse cardiac events (RR = 0.83, 95% = 0.70
to 0.97, P < .05), but that it may increase the length of stay in the ICU
(mean difference [MD] = 2.1, 95% CI = 1.61 to 2.60, P < .01). There were
no statistically significant differences between the 2 groups in the
requirement for renal replacement therapy(RRT) (RR = 1.33, 95% = 0.63 to
2.81, P = .45) and all-cause mortality (RR = 0.51, 95% = 0.25 to 1.06, P =
.07). CONCLUSION(S): Our study shows that intravenous infusion of NAC
could prevent postoperative AKI in preexisting-renal-failure patients
undergoing cardiac surgery.

<29>
Accession Number
625774782
Title
Oral Anticoagulation.
Source
Deutsches Arzteblatt international. 115 (46) (pp 776-783), 2018. Date of
Publication: 16 Nov 2018.
Author
Altiok E.; Marx N.
Institution
(Altiok) Department of Cardiology, Angiology and Intensive Care Medicine
(Department of Internal Medicine I), University Hospital Aachen, RWTH
Aachen University, Aachen, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: Much new evidence on oral anticoagulation has come to light in
recent years. Non-vitamin-K-dependent oral anti- coagulants (NOAC) have
been developed and have been introduced into clinical practice. In this
review, we present the current state of the evidence on anticoagulation
for various indications with vitamin K antagonists (VKA) and with NOAC.
 METHOD(S): This review is based on pertinent articles retrieved by a
selective search in PubMed (search terms: anticoagulation, atrial
fibrillation, prosthetic valve, thrombosis, pulmonary embolism) and on
specialty society recommendations and relevant guidelines from the years
2000-2018. RESULT(S): The main indications for oral anticoagulation
are atrial fibrillation, venous thromboembolism, and status post heart
valve replacement. In patients with atrial fibrillation and without
valvular heart disease, anticoagulation is recommended for men with a
CHA2DS2-VASc score >= 1 and for women with a score >= 2. NOAC for this
indication are associated with a marginally lower rate of stroke than VKA
(3.5% vs. 3.8%, number needed to treat [NNT] = 333) as well as a lower
rate of major hemorrhage (5.1% vs. 6.2%, NNT = 91). NOAC are
contraindicated for patients with mechanical heart valves. Anticoagulation
with VKA can be predictably antagonized. Among the various types of NOAC,
the anticoagulant effect of dabigatran can be safely antagonized with an
antidote; no specific antidote is yet available for apixaban, rivaroxaban,
or edoxaban. CONCLUSION(S): The evidence base for anticoagulation
over a time frame of several years is inadequate at present, and direct
comparative data for the different types of NOAC are not yet available.

<30>
Accession Number
625778378
Title
Effects of Aortic Valve Replacement on Severe Aortic Stenosis and
Preserved Systolic Function: Systematic Review and Network Meta-analysis.
Source
Scientific reports. 7 (1) (pp 5092), 2017. Date of Publication: 11 Jul
2017.
Author
Zheng Q.; Djohan A.H.; Lim E.; Ding Z.P.; Ling L.H.; Shi L.; Chan E.S.-Y.;
Chin C.W.L.
Institution
(Zheng, Shi, Chan) Department of Epidemiology, Singapore Clinical Research
Institute, Singapore
(Zheng, Shi, Chan) Cochrane Singapore, Singapore
(Djohan) Department of Internal Medicine, National University Hospital,
Singapore
(Lim, Ding, Shi, Chan, Chin) Duke-NUS Medical School, Singapore
(Ding, Chin) Department of Cardiovascular Medicine, National Heart Centre,
Singapore
(Ling) Department of Cardiology, National University Heart Center,
Singapore
(Ling) Yong Loo Lin School of Medicine, National University of Singapore,
Singapore
Publisher
NLM (Medline)
Abstract
The survival benefits of aortic valve replacement (AVR) in the different
flow-gradient states of severe aortic stenosis (AS) is not known. A
comprehensive search in PubMed/MEDLINE, Embase, Cochrane Library, CNKI and
OpenGrey were conducted to identify studies that investigated the
prognosis of severe AS (effective orifice area <=1.0cm2) and left
ventricular ejection fraction >=50%. Severe AS was stratified by mean
pressure gradient [threshold of 40mmHg; high-gradient (HG) and
low-gradient (LG)] and stroke volume index [threshold of 35ml/m2;
normal-flow (NL) and low-flow (LF)]. Network meta-analysis was conducted
to assess all-cause mortality among each AS sub-type with rate ratio (RR)
reported. The effects of AVR on prognosis were examined using network
meta-regression. In the pooled analysis (15 studies and 9,737 patients),
LF states (both HG and LG) were associated with increased mortality rate
(LFLG: RR 1.88; 95% CI: 1.43-2.46; LFHG: RR: 1.77; 95% CI: 1.16-2.70)
compared to moderate AS; and NF states in both HG and LG had similar
prognosis as moderate AS (NFLG: RR 1.11; 95% CI: 0.81-1.53; NFHG: RR 1.16;
95% CI: 0.82-1.64). AVR conferred different survival benefits: it was most
effective in NFHG (RR with AVR /RR without AVR : 0.43; 95% CI: 0.22-0.82)
and least in LFLG (RR with AVR /RR without AVR : 1.19; 95% CI: 0.74-1.94).

<31>
Accession Number
625202357
Title
Percutaneous Coronary Intervention, Coronary Artery Bypass Surgery and the
SYNTAX score: A systematic review and meta-analysis.
Source
Scientific reports. 7 (pp 43801), 2017. Date of Publication: 02 Mar 2017.
Author
Bundhun P.K.; Yanamala C.M.; Huang F.
Institution
(Bundhun, Huang) Institute of Cardiovascular Diseases, First Affiliated
Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
(Yanamala) Department of Internal Medicine, EALING Hospital, University of
Buckingham, Uxbridge road, Southall, UB1 3HW, London, United Kingdom
Abstract
The SYNTAX [Synergy Between percutaneous coronary intervention (PCI) With
Taxus and coronary artery bypass surgery (CABG)] score is a
decision-making tool in interventional cardiology. However, several facts
still remain to be addressed: What about PCI or CABG with a low versus a
high score respectively? And what about PCI with a low score versus CABG
with a high score? Electronic databases were carefully searched for
relevant publications. Odds ratios (OR) with 95% confidence intervals
(CIs) were calculated and the analysis was carried out by RevMan 5.3.
Eleven studies with a total number of 11,037 patients were included. In
terms of clinical outcomes, this analysis showed PCI to have significantly
favored patients with a low versus a high SYNTAX score. In patients who
were re-vascularized by CABG, mortality and major adverse cardiac events
were significantly lower with a low SYNTAX score. However, when PCI with a
low SYNTAX score was compared with CABG with a high SYNTAX score, no
significant difference in mortality and combined death/stroke/myocardial
infarction were observed. In conclusion, the SYNTAX score might be
considered useful in interventional cardiology. Nevertheless, the fact
that it has limitations when compared to newer tools should also not be
ignored.

<32>
Accession Number
625465228
Title
Precision-Exercise-Prescription in patients with lung cancer undergoing
surgery: Rationale and design of the PEP study trial.
Source
BMJ Open. 8 (12) (no pagination), 2018. Article Number: e024672. Date of
Publication: 01 Dec 2018.
Author
Ulrich C.M.; Himbert C.; Boucher K.; Wetter D.W.; Hess R.; Kim J.;
Lundberg K.; Ligibel J.A.; Barnes C.A.; Rushton B.; Marcus R.; Finlayson
S.R.G.; LaStayo P.C.; Varghese T.K.
Institution
(Ulrich, Himbert, Boucher, Wetter, Kim, Rushton) Huntsman Cancer
Institute, Salt Lake City, UT, United States
(Ulrich, Himbert, Wetter, Hess) Department of Population Health Sciences,
University of Utah, Salt Lake City, UT, United States
(Boucher) Division of Epidemiology, University of Utah, Salt Lake City,
UT, United States
(Hess) Division of General Internal Medicine, University of Utah, Salt
Lake City, UT, United States
(Kim) Department of Health and Kinesiology, University of Utah, Salt Lake
City, UT, United States
(Lundberg) Department of Psychiatry, University of Utah, Salt Lake City,
UT, United States
(Ligibel) Dana-Farber Cancer Institute, Harvard Medical School, Boston,
MA, United States
(Barnes, Marcus, LaStayo) Department of Physical Therapy and Athletic
Training, University of Utah, Salt Lake City, UT, United States
(Finlayson, Varghese) Department of Surgery, University of Utah, Salt Lake
City, UT, United States
(Varghese) Division of Cardiothoracic Surgery, University of Utah, Salt
Lake City, UT, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Lung cancer is a significant burden on societies worldwide,
and the most common cause of death in patients with cancer overall.
Exercise intervention studies in patients with lung cancer have
consistently shown benefits with respect to physical and emotional
functioning. However, to date, exercise training has not been consistently
implemented into clinical practice given that interventions have been
costly and not aligned with clinical care. Methods/design: The
Precision-Exercise-Prescription (PEP) study is a prospective randomised
controlled trial comparing the effectiveness and feasibility of a
personalised intervention exercise programme among patients with lung
cancer undergoing surgery. Two-hundred patients who are diagnosed with
stage primary or secondary lung cancer and are eligible to undergo
surgical treatment at Huntsman Cancer Institute comprise the target
population. Patients are randomised to either the (1) outpatient
precision-exercise intervention group or (2) delayed intervention group.
The intervention approach uses Motivation and Problem Solving, a hybrid
behavioural treatment based on motivational interviewing and practical
problem solving. The dosage of the exercise intervention is personalised
based on the individual's Activity Measure for Post-Acute-Care outpatient
basic mobility score, and incorporates four exercise modes: mobility,
callisthenics, aerobic and resistance. Exercise is implemented by physical
therapists at study visits from presurgery until 6 months postsurgery. The
primary endpoint is the level of physical function assessed by 6 min walk
distance at 2 months postsurgery. Secondary outcomes include
patient-reported outcomes (eg, quality of life, fatigue and self-efficacy)
and other clinical outcomes, including length of stay, complications,
readmission, pulmonary function and treatment-related costs up to 6 months
postsurgery. Ethics/dissemination: The PEP study will test the clinical
effectiveness and feasibility of a personalised exercise intervention in
patients with lung cancer undergoing surgery. Outcomes of this clinical
trial will be presented at national and international conferences and
symposia and will be published in international, peer-reviewed journals.
Ethics approval was obtained at the University of Utah (IRB
00104671). Copyright © 2018 Author(s).

<33>
Accession Number
625786707
Title
Estimating the additional costs per life saved due to transcatheter aortic
valve replacement: a secondary data analysis of electronic health records
in Germany.
Source
European Journal of Health Economics. (no pagination), 2019. Date of
Publication: 2019.
Author
Kaier K.; von zur Muhlen C.; Zirlik A.; Bothe W.; Hehn P.; Zehender M.;
Bode C.; Stachon P.
Institution
(Kaier, Hehn) Institute of Medical Biometry and Statistics, Faculty of
Medicine and Medical Center, University of Freiburg, Freiburg, Germany
(Kaier, von zur Muhlen, Zirlik, Zehender, Bode, Stachon) Department of
Cardiology and Angiology I, Heart Center Freiburg, Faculty of Medicine,
University of Freiburg, Hugstetter Str. 55, Freiburg 79104, Germany
(Bothe) Department of Cardiac and Vascular Surgery, Heart Center Freiburg,
Faculty of Medicine, University of Freiburg, Freiburg, Germany
(Zirlik) Department of Cardiology, Medical University of Graz, Graz,
Austria
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Aortic stenosis (AS) is the most common valvular heart disease, with a
dismal prognosis when untreated. Recommended therapy is surgical (SAVR) or
transcatheter (TAVR) aortic valve replacement. Based on a retrospective
cohort of isolated SAVR and TAVR procedures performed in Germany in 2015
(N = 17,826), we examine the impact of treatment selection on in-hospital
mortality and total in-hospital costs for a variety of at-risk
populations. Since patients were not randomized to the two treatment
options, the two endpoints in-hospital mortality and reimbursement are
analyzed using logistic and linear regression models with 20 predefined
patient characteristics as potential confounders. Incremental
cost-effectiveness ratios were calculated as a ratio of the risk-adjusted
reimbursement and mortality differences with 95% confidence intervals
obtained by Fieller's theorem. Our study shows that TF-TAVR is more costly
that SAVR and that cost differences between the procedures vary little
between patient groups. Results regarding in-hospital mortality are mixed.
SAVR is the predominant procedure among younger patients. For patients
older than 85 years or at intermediate and higher pre-operative risk
TF-TAVR seems to be the treatment of choice. Incremental
cost-effectiveness ratios (ICER) are most favorable for patients older
than 85 years (ICER 154,839, 95% CI 89,163-302,862), followed by patients
at higher pre-operative risk (ICER 413,745, 95% CI 258,027-952,273). A
hypothetical shift from SAVR towards TF-TAVR among patients at
intermediate pre-operative risk is associated with a less favorable ICER
(1,486,118, 95% CI 764,732-23,692,323), as the risk-adjusted mortality
benefit is relatively small (- 0.97% point), while the additional
reimbursement is still eminent (+14,464). From a German healthcare system
payer's perspective, the additional costs per life saved due to TAVR are
most favorable for patients older than 85 and/or at higher pre-operative
risk. Copyright © 2019, Springer-Verlag GmbH Germany, part of
Springer Nature.

<34>
Accession Number
368100868
Title
Additive effect of phosphodiesterase inhibitors in control of pulmonary
hypertension after congenital cardiac surgery in children.
Source
Iranian Journal of Pediatrics. 23 (1) (pp 19-26), 2013. Date of
Publication: February 2013.
Author
Farah P.; Ahmad-Ali A.; Hanane G.; Abbas E.
Institution
(Farah, Hanane) Department of Pediatrics, Islamic Azad University, Kazerun
Branch, Kazerun, Iran, Islamic Republic of
(Ahmad-Ali) Department of Surgery, Division of Cardiovascular Surgery,
Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Abbas) Department of Medicine, New York Medical College, Valhalla, NY,
United States
Publisher
Kowsar Medical Publishing Company
Abstract
Objective: Control of residual pulmonary arterial hypertension (PAH) after
closure of left to right shunts in children is still a challenging issue.
The purpose of this study was to compare the effect of two
phosphodiesterase inhibitors in pediatric cardiac surgical patients.
 Method(s): A total of 48 postoperative children were enrolled in the
study between 2008 and 2010. Patients were stratified based upon choice of
pulmonary vasodilator into three equal groups (n=16); Milrinone group
received intravenous milrinone (0.75 mu/kg/min), Sildenafil group received
oral sildenafil (0.3 mg/kg every 3 hours) and the Combination group
received both medications. Finding(s): Demographic variables and
types of congenital anomalies were not different among the 3 groups.
Patients in the Combination group had higher preoperative pulmonary artery
to aortic (PA/AO) pressure ratios compared to other two groups (P=0.001).
Postoperatively, patients in Milrinone group incurred lower systolic PA
and PA/AO pressures compared to Sildenafil group (P=0.014, 0.003), but it
was the same in Sildenafil and Combination group (P=0.2; 0.330
respectively). Pulmonary hypertensive crisis was noted in 6 patients in
Sildenafil group, and 3 patients in Combination group (P=0.02).
Significant rise in PA pressure was noticed after discontinuation of drug
in Milrinone group (P=0.001), which was not observed in the Combination
group (P= 0.6). No mortality was noticed in any of the groups.
 Conclusion(s): Intravenous milrinone is more effective than oral
sildenafil in control of postoperative PAH and elimination of pulmonary
hypertensive crisis. Combination of two drugs reduces the risk of rebound
pulmonary arterial hypertension after discontinuation of milrinone. ©
2013 by Pediatrics Center of Excellence, Children's Medical Center, Tehran
University of Medical Sciences, All rights reserved.

<35>
Accession Number
365863684
Title
Platelets in pulmonary hypertension: A causative role or a simple
association?.
Source
Iranian Journal of Pediatrics. 22 (2) (pp 145-157), 2012. Date of
Publication: June 2012.
Author
Zanjani K.S.
Institution
(Zanjani) Pediatric Center of Excellence, Children's Medical Center,
Tehran University of Medical Sciences, No 62, Dr Gharib St, 14194 Tehran,
Iran, Islamic Republic of
Publisher
Kowsar Medical Publishing Company
Abstract
Pathophysiology of pulmonary arterial hypertension is based on three basic
mechanisms: thrombotic pulmonary vascular lesions, vasoconstriction and
vascular remodeling. Platelets are related to all of these mechanisms by
their aggregation, production, storage and release of several mediators.
The role of platelets is more prominent in some types of pulmonary
arterial hypertension, including those which are secondary to inflammatory
and infectious diseases, hemoglobinopathies, essential thrombocythemia,
drugs, thromboembolism, and cardiac surgery. Most pulmonary
antihypertensive drugs have a negative effect on platelets. In this
review, the mechanisms of platelets association with pulmonary arterial
hypertension, those types of pulmonary arterial hypertension with greatest
platelet contribution to their pathophysiology, and the effects of
pulmonary antihypertensive drugs on platelets are summarized. © 2012
by Pediatrics Center of Excellence, Children's Medical Center, Tehran
University of Medical Sciences.

<36>
Accession Number
622125360
Title
Impact of ultra-thin struts on restenosis after chronic total occlusion
recanalization: Insights from the randomized PRISON IV trial.
Source
Journal of Interventional Cardiology. 31 (5) (pp 580-587), 2018. Date of
Publication: October 2018.
Author
Zivelonghi C.; Teeuwen K.; Agostoni P.; van der Schaaf R.J.; Ribichini F.;
Adriaenssens T.; Kelder J.C.; Tijssen J.G.P.; Henriques J.P.S.; Suttorp
M.J.
Institution
(Zivelonghi, Agostoni, Kelder, Suttorp) Department of Cardiology, Sint
Antonius Ziekenhuis, Nieuwegein, Netherlands
(Zivelonghi, Ribichini) Department of Cardiology, University of Verona,
Verona, Italy
(Teeuwen) Department of Cardiology, Catharina Hospital, Eindhoven,
Netherlands
(van der Schaaf) Department of Cardiology, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
(Adriaenssens) Department of Cardiology, University Hospital Leuven,
Belgium
(Tijssen, Henriques) Department of Cardiology, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: The PRISON-IV trial showed inferior outcome in patients with
chronic total occlusions (CTOs) treated with the ultrathin-struts (60 mum
for stent diameter <=3 mm, 81mum >3 mm) hybrid-sirolimus eluting stents
(SES) compared with everolimus eluting stents (EES, 81 mum). The aim of
this study is to investigate if the use of smaller stents (<=3 mm) was
responsible for the inferior outcome reported in the trial.
 Method(s): In the PRISON-IV trial 330 patients with CTO lesion were
randomized 1:1 to receive either hybrid-SES or EES. The hybrid-SES failed
to reach the non-inferiority primary endpoint of in-segment late lumen
loss (LLL) at 9-month angiographic follow-up. In this sub-analysis, we
divided the population according to the different size of stents implanted
in those receiving only stents with diameter <=3 mm (Group-A, 178
patients), only stents >3 mm (Group-B, 59 patients), and those receiving
stents of both sizes (Group-C, 93 patients). Result(s): Baseline and
procedural characteristics were comparable in the three groups. At
angiographic follow-up, most of the adverse outcomes occurred in Group A,
with higher incidence of binary restenosis in the Hybrid-SES versus EES
(10.3% vs 1.3%, P = 0.03) and augmented in-stent diameter stenosis (26.04
+/- 18.59% vs 21.24 +/- 12.84, P = 0.06). Similarly, optical coherence
tomography (OCT), which was performed in 60 patients at follow-up,
documented a mild trend toward lower values of minimum in stent area in
Hybrid-SES arm of Group A (4.4 +/- 1.02mm2 vs 5.0 +/- 1.28mm2,
respectively, P = 0.16). Conclusion(s): The present analysis suggests
that the inferior performance of the ultra-thin hybrid-SES in CTO-PCI is
particularly pronounced when smaller stent (<=3 mm diameter) are adopted,
if compared with EES. Copyright © 2018 Wiley Periodicals, Inc.

<37>
Accession Number
620733772
Title
Three-dimensional printing in congenital heart disease: A systematic
review.
Source
Journal of Medical Radiation Sciences. 65 (3) (pp 226-236), 2018. Date of
Publication: September 2018.
Author
Lau I.; Sun Z.
Institution
(Lau, Sun) Department of Medical Radiation Sciences, Curtin University,
Perth, Australia
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Three-dimensional (3D) printing has shown great promise in medicine with
increasing reports in congenital heart disease (CHD). This systematic
review aims to analyse the main clinical applications and accuracy of 3D
printing in CHD, as well as to provide an overview of the software tools,
time and costs associated with the generation of 3D printed heart models.
A search of different databases was conducted to identify studies
investigating the application of 3D printing in CHD. Studies based on
patient's medical imaging datasets were included for analysis, while
reports on in vitro phantom or review articles were excluded from the
analysis. A total of 28 studies met selection criteria for inclusion in
the review. More than half of the studies were based on isolated case
reports with inclusion of 1-12 cases (61%), while 10 studies (36%) focused
on the survey of opinion on the usefulness of 3D printing by healthcare
professionals, patients, parents of patients and medical students, and the
remaining one involved a multicentre study about the clinical value of 3D
printed models in surgical planning of CHD. The analysis shows that
patient-specific 3D printed models accurately replicate complex cardiac
anatomy, improve understanding and knowledge about congenital heart
diseases and demonstrate value in preoperative planning and simulation of
cardiac or interventional procedures, assist surgical decision-making and
intra-operative orientation, and improve patient-doctor communication and
medical education. The cost of 3D printing ranges from USD 55 to USD 810.
This systematic review shows the usefulness of 3D printed models in
congenital heart disease with applications ranging from accurate
replication of complex cardiac anatomy and pathology to medical education,
preoperative planning and simulation. The additional cost and time
required to manufacture the 3D printed models represent the limitations
which need to be addressed in future studies. Copyright © 2018
The Authors. Journal of Medical Radiation Sciences published by John Wiley
& Sons Australia, Ltd on behalf of Australian Society of Medical Imaging
and Radiation Therapy and New Zealand Institute of Medical Radiation
Technology.

<38>
Accession Number
2000646002
Title
Totally endoscopic coronary artery bypass surgery: A meta-analysis of the
current evidence.
Source
International Journal of Cardiology. 261 (pp 42-46), 2018. Date of
Publication: 15 June 2018.
Author
Leonard J.R.; Rahouma M.; Abouarab A.A.; Schwann A.N.; Scuderi G.; Lau C.;
Guy T.S.; Demetres M.; Puskas J.D.; Taggart D.P.; Girardi L.N.; Gaudino M.
Institution
(Leonard, Rahouma, Abouarab, Schwann, Scuderi, Lau, Guy, Girardi, Gaudino)
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York,
NY, United States
(Demetres) Samuel J. Wood Library & C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY, United States
(Puskas) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Taggart) Department of Cardiovascular Surgery, University of Oxford,
United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: Totally endoscopic coronary artery bypass (TECAB) has emerged
as an alternative to other minimally invasive techniques. However, limited
TECAB results are available to date. The purpose of this systematic review
is to examine the existing literature to give an objective estimate of the
outcomes of TECAB using a meta-analytical approach. Method(s): A
comprehensive online review was performed in Ovid MEDLINE Ovid EMBASE and
The Cochrane Library from 2000 to July 2017. Eligible studies included
single arm TECAB studies as well as comparative studies (TECAB vs
minimally invasive direct coronary artery bypass (MIDCAB)). Pooled event
rates and odds ratios (ORs) for operative mortality, perioperative
myocardial infarction (MI), perioperative stroke, graft patency and repeat
revascularization were estimated. Single arm and pairwise comparisons were
performed. Result(s): Seventeen single arm TECAB articles (3721
patients, weighted mean follow-up 3.3 years) were included. The pooled
event rate was 0.80% (95%CI: 0.60-1.2%) for operative mortality, 2.28%
(95%CI: 1.7-3%) for perioperative MI, 1.50% (95%CI: 1.1-2.0%) for
perioperative stroke, 2.99% (95%CI: 1.6-5.4%) for repeat revascularization
and 94.8% (95%CI: 89.3-97.5%) for early graft patency (weighted mean
follow-up 10.1 months). On pairwise meta-analysis 376 patients (263 TECAB
and 113 MIDCAB) were included. No difference in operative mortality (OR =
0.25, 95%CI: 0.02-2.83), perioperative MI (OR = 3.09, 95%CI: 0.37-26.12)
or perioperative stroke (OR = 1.33, 95%CI: 0.17-10.26) was found between
the two techniques. Conclusion(s): TECAB has an acceptably low
operative risk and a good early patency rate. The incidence of
perioperative MI requires further investigation. The dearth of data
comparing TECAB to open approaches compels the need for future comparative
trials. Copyright © 2017 Elsevier Ireland Ltd

<39>
Accession Number
2000825445
Title
Dabigatran in patients with myocardial injury after non-cardiac surgery
(MANAGE): an international, randomised, placebo-controlled trial.
Source
The Lancet. 391 (10137) (pp 2325-2334), 2018. Date of Publication: 9 - 15
June 2018.
Author
Rahate P.V.; Chaudhry N.K.; Iglesias P.P.; Eikelboom J.W.; Connolly S.J.;
Devereaux P.J.; Duceppe E.; Bangdiwala S.I.; Connolly S.; Eikelboom J.;
Guyatt G.; Kearon C.; Pettit S.; Pogue J.; Rodseth R.; Sessler D.I.;
Vincent J.; Yusuf S.; Di Diodato S.; Gasic Z.; Mastrangelo L.J.; Molnar
S.H.; Swanson J.L.; Tosh M.L.; Wells J.R.; Botto F.; Diaz R.; Chow C.K.;
Berwanger O.; Gonzales B.; Tandon V.; Villar J.C.; Vasquez S.; Jansky P.;
Dusek R.; Meyhoff C.S.; Coriat P.; Hoeft A.; Wittmann M.; Yonga G.; Xavier
D.; Rao M.; Mathur N.; Franzosi M.G.; Seletti E.; Malaga G.;
Tumanan-Mendoza B.A.; Tagle M.P.A.; Szczeklik W.; Biccard B.M.;
Alonso-Coello P.; Popova E.; Shields M.; Le Manach Y.; Moayyedi P.; van
Zanten S.; Fleischmann E.; Garg A.; Karaye K.; McFalls E.; Sigamani A.;
Belley-Cote E.; Biedron G.; Borges F.; Frosi Stella S.; Haarmark Nielsen
C.; Leong D.P.; Spence J.; Tran A.; Wawrzycka-Adamczyk K.; Yang S.S.; Yung
T.; Wyse D.G.; Cheng D.; Johnstone D.E.; Wells G.A.; Joseph P.; Patel A.;
Gregus K.; Lawrence K.; Doharris L.; Conen D.; Cheung J.; Douketis J.;
Wright D.; Wikkerink S.; Dechert W.; Panju M.; Azzam K.; Rapanos T.; Van
Helder T.; Shroff A.; Hare J.; Kidane B.; Nguyen T.; Leydier L.; Bayaraa
V.; Parlow J.; DuMerton D.A.; Thakrar A.; Shelley J.; Deligne B.; Carling
R.D.; Mrkobrada M.; Dresser G.K.; Jacka M.J.; Hornstein D.; Winkelaar
G.B.; Haider Z.H.; Lanjewar P.P.; Varughese V.; Calton R.; Ahuja H.;
George P.; Sharma A.; Bhatt K.S.; Mangukiya D.O.; Nandaniya K.V.; Parekh
V.V.; Pillai A.B.; Menon V.P.; Desai S.C.; Sidhu R.S.; Gupta S.K.; George
R.K.; Gurunath T.R.; Drummond L.W.; Torborg A.M.; Kusel B.S.; Naidoo P.;
Naidoo D.P.; Rajah C.; Farina Z.; von Rahden R.P.; Gumede S.; Chishala C.;
Coetzee E.; Dyer R.A.; Diedericks J.; Bielanski P.; Kaczmarek B.;
Studzinska D.; Zaniewski M.; Libura M.J.; Zacharias-Nalichowski T.M.; Sega
A.A.S.; Salwa J.; Kozka M.; Gorka J.; Wludarczyk A.; Nowak-Kozka I.;
Grudzien P.S.; Gucwa J.W.; Slowiaczek M.P.; Dobosz P.P.D.; Gogenur I.;
Eriksen J.R.; Borup T.; Kirkegaard T.; Isbye D.; Sonne A.; Rasmussen L.S.;
Troensegaard H.; Duus C.L.; Halle B.M.; Gundel O.N.; Bernholm K.F.;
Martinsen K.R.; Pedersen S.; Itenov T.S.; Camio E.; Vazquez C.; Matarin
S.; Cano E.; Alvarez-Garcia J.; India I.; Gonzalez-Osuna A.; Vives M.;
Rossello E.; Serrano A.B.; Turiel M.; Drago L.; Colombo C.; Marra F.; Mos
L.; Arteni F.; Lembo R.; Ortalda A.; Passarani S.; Mokini Z.; Figueiredo
E.L.; Werner G.F.; Petriz J.L.; Maia L.N.; Bergo R.R.; Precoma D.B.;
Saraiva J.F.K.; Vilamajo O.G.; Allegrini E.; Benzadon M.; Parody M.L.;
Duronto E.A.; Ingaramo A.C.; Parra G.A.; Novoa D.; Miller S.A.; Thomas S.;
Karlapudi S.P.; Bourji M.H.; Banerjee S.; Gupta A.; Opole I.O.; Fischer
M.; Mendoza V.L.; Reyes E.B.; Pierson R.J.; Shields M.O.; Piriou V.;
Zacharowski K.; Rotta-Rotta A.; Paper M.; Srinathan S.K.; Erb J.; Magloire
P.; Neary J.; Rahate P.; Chaudhry N.; Mayosi B.; de Nadal M.; Paniagua
Iglesias P.; Sharma M.; Rao-Melacini P.
Institution
(Devereaux, Duceppe, Guyatt, Kearon, Bangdiwala, Yusuf) Department of
Health Research Methods, Evidence, and Impact, McMaster University,
Hamilton, ON, Canada
(Devereaux, Guyatt, Tandon, Magloire, Neary, Eikelboom, Kearon, Sharma,
Connolly, Yusuf) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Devereaux, Vincent, Pettit, Sharma, Connolly, Bangdiwala, Rao-Melacini,
Yusuf) Population Health Research Institute, Hamilton, ON, Canada
(Duceppe) Department of Medicine, University of Montreal, Montreal, QC,
Canada
(Rodseth) Department of Anaesthesia, University of KwaZulu-Natal,
Pietermaritzburg, South Africa
(Biccard) Department of Anaesthesia and Perioperative Medicine, Groote
Schuur Hospital and University of Cape Town, Cape Town, South Africa
(Mayosi) Department of Medicine, Groote Schuur Hospital and University of
Cape Town, Cape Town, South Africa
(Xavier, Rao) Department of Pharmacology, St John's Medical College and
Research Institute, Bangalore, India
(Szczeklik) Department of Intensive Care and Perioperative Medicine,
Jagiellonian University Medical College, Krakow, Poland
(Meyhoff) Department of Anaesthesia and Intensive Care, Bispebjerg and
Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
(Franzosi) Department of Cardiovascular Research, IRCCS Istituto di
Ricerche Farmacologiche Mario Negri, Milan, Italy
(Srinathan) Department of Surgery, University of Manitoba, Winnipeg, MB,
Canada
(Erb) Department of Anesthesiology and Perioperative Medicine, Queen's
University, Kingston, ON, Canada
(Rahate) Department of Surgery, Rahate Surgical Hospital, Nagpur, India
(Chaudhry) Department of Surgery, Christian Medical College Hospital,
Ludhiana, India
(de Nadal) Department of Anesthesiology, Hospital Universitari Vall
d'Hebron, Barcelona, Spain
(Iglesias) Department of Anesthesiology, Hospital de la Santa Creu i Sant
Pau, Barcelona, Spain
(Berwanger) Instituto de Ensino e Pesquisa do Hospital do Coracao
(IEP-HCor), Sao Paulo, Brazil
(Villar) Departamento de Investigaciones, Fundacion
Cardioinfantil-Instituto de Cardiologia (Bogota) and Facultad de Ciencias
de la Salud, Universidad Autonoma de Bucaramanga, Colombia
(Botto) Estudios Clinicos Latinoamerica (ECLA), Rosario and Hospital
Austral, Pilar, Argentina
(Sessler) Department of Outcomes Research, Cleveland Clinic,
Anesthesiology Institute, Cleveland, OH, United States
(Hoeft) Department of Anesthesiology and Intensive Care Medicine,
University Hospital Bonn, Bonn, Germany
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Myocardial injury after non-cardiac surgery (MINS) increases
the risk of cardiovascular events and deaths, which anticoagulation
therapy could prevent. Dabigatran prevents perioperative venous
thromboembolism, but whether this drug can prevent a broader range of
vascular complications in patients with MINS is unknown. The MANAGE trial
assessed the potential of dabigatran to prevent major vascular
complications among such patients. Method(s): In this international,
randomised, placebo-controlled trial, we recruited patients from 84
hospitals in 19 countries. Eligible patients were aged at least 45 years,
had undergone non-cardiac surgery, and were within 35 days of MINS.
Patients were randomly assigned (1:1) to receive dabigatran 110 mg orally
twice daily or matched placebo for a maximum of 2 years or until
termination of the trial and, using a partial 2-by-2 factorial design,
patients not taking a proton-pump inhibitor were also randomly assigned
(1:1) to omeprazole 20 mg once daily, for which results will be reported
elsewhere, or matched placebo to measure its effect on major upper
gastrointestinal complications. Research personnel randomised patients
through a central 24 h computerised randomisation system using block
randomisation, stratified by centre. Patients, health-care providers, data
collectors, and outcome adjudicators were masked to treatment allocation.
The primary efficacy outcome was the occurrence of a major vascular
complication, a composite of vascular mortality and non-fatal myocardial
infarction, non-haemorrhagic stroke, peripheral arterial thrombosis,
amputation, and symptomatic venous thromboembolism. The primary safety
outcome was a composite of life-threatening, major, and critical organ
bleeding. Analyses were done according to the intention-to-treat
principle. This trial is registered with ClinicalTrials.gov, number
NCT01661101. Finding(s): Between Jan 10, 2013, and July 17, 2017, we
randomly assigned 1754 patients to receive dabigatran (n=877) or placebo
(n=877); 556 patients were also randomised in the omeprazole partial
factorial component. Study drug was permanently discontinued in 401 (46%)
of 877 patients allocated to dabigatran and 380 (43%) of 877 patients
allocated to placebo. The composite primary efficacy outcome occurred in
fewer patients randomised to dabigatran than placebo (97 [11%] of 877
patients assigned to dabigatran vs 133 [15%] of 877 patients assigned to
placebo; hazard ratio [HR] 0.72, 95% CI 0.55-0.93; p=0.0115). The primary
safety composite outcome occurred in 29 patients (3%) randomised to
dabigatran and 31 patients (4%) randomised to placebo (HR 0.92, 95% CI
0.55-1.53; p=0.76). Interpretation(s): Among patients who had MINS,
dabigatran 110 mg twice daily lowered the risk of major vascular
complications, with no significant increase in major bleeding. Patients
with MINS have a poor prognosis; dabigatran 100 mg twice daily has the
potential to help many of the 8 million adults globally who have MINS to
reduce their risk of a major vascular complication. Funding(s):
Boehringer Ingelheim and Canadian Institutes of Health
Research. Copyright © 2018 Elsevier Ltd

<40>
Accession Number
623881396
Title
Rationale and design of the Virginia Commonwealth University-Anakinra
Remodeling Trial-3 (VCU-ART3): A randomized, placebo-controlled,
double-blinded, multicenter study.
Source
Clinical Cardiology. 41 (8) (pp 1004-1008), 2018. Date of Publication:
August 2018.
Author
Van Tassell B.W.; Lipinski M.J.; Appleton D.; Roberts C.S.; Kontos M.C.;
Abouzaki N.; Melchior R.; Mueller G.; Garnett J.; Canada J.; Carbone S.;
Buckley L.F.; Wohlford G.; Kadariya D.; Trankle C.R.; Oddi Erdle C.;
Sculthorpe R.; Puckett L.; DeWilde C.; Shah K.; Angiolillo D.J.; Vetrovec
G.; Biondi-Zoccai G.; Arena R.; Abbate A.
Institution
(Van Tassell, Roberts, Kontos, Abouzaki, Melchior, Mueller, Canada,
Carbone, Kadariya, Trankle, Oddi Erdle, Shah, Vetrovec, Abbate) VCU Pauley
Heart Center, Virginia Commonwealth University, Richmond, VA, United
States
(Van Tassell, Buckley, Wohlford) Department of Pharmacotherapy and
Outcomes Science, Virginia Commonwealth University, Richmond, VA, United
States
(Van Tassell, Puckett, DeWilde, Abbate) VCU Johnson Center for Pulmonary
and Critical Care Research, Virginia Commonwealth University, Richmond,
VA, United States
(Lipinski) Medstar Heart and Vascular Institute, MedStar Washington
Hospital Center, Washington, DC, United States
(Appleton, Melchior, Mueller, Garnett, Puckett) Virginia Cardiovascular
Specialists, Richmond, United States
(Canada) Department of Kinesiology and Health Sciences, Virginia
Commonwealth University, Richmond, VA, United States
(Sculthorpe) Investigational Pharmacy, Virginia Commonwealth University,
Richmond, VA, United States
(Biondi-Zoccai) Department of Medical and Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, and Department of
AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
(Arena) Department of Physical Therapy, College of Applied Health
Sciences, University of Illinois at Chicago, Chicago, IL, United States
(Angiolillo) Division of Cardiology, University of Florida, Jacksonville,
FL, United States
(Abbate) Kenneth and Dianne Wright Center for Clinical and Translational
Research, Virginia Commonwealth University, Richmond, VA, United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
There is clear association between the intensity of the acute inflammatory
response during acute myocardial infarction (AMI) and adverse prognosis
after AMI. Interleukin-1 (IL-1) is a pro-inflammatory cytokine released
during AMI and involved in adverse remodeling and heart failure (HF). We
describe a study to evaluate the safety and efficacy of IL-1 blockade
using an IL-1 receptor antagonist (anakinra) during the acute phase of
ST-segment elevation myocardial infarction (STEMI). The Virginia
Commonwealth University-Anakinra Remodeling Trial-3 (VCU-ART3;
http://www.ClinicalTrials.gov NCT01950299) is a phase 2, multicenter,
double-blinded, randomized, placebo-controlled clinical trial comparing
anakinra 100 mg once or twice daily vs matching placebo (1:1:1) for 14
days in 99 patients with STEMI. Patients who present to the hospital with
STEMI within 12 hours of symptom onset will be eligible for enrollment.
Patients will be excluded for a history of HF (functional class III-IV),
severe valvular disease, severe kidney disease (stage 4-5), active
infection, recent use of immunosuppressive drugs, active malignancy, or
chronic autoimmune/auto-inflammatory diseases. We will measure the
difference in the area under the curve for C-reactive protein between
admission and day 14, separately comparing each of the anakinra groups
with the placebo group. The P value will be considered significant if
<0.025 to adjust for multiple comparisons. Patients will also be followed
for up to 12 months from enrollment to evaluate cardiac remodeling
(echocardiography), cardiac function (echocardiography), and major adverse
cardiovascular outcomes (cardiovascular death, MI, revascularization, and
new onset of HF). Copyright © 2018 Wiley Periodicals, Inc.

<41>
Accession Number
624089161
Title
Cerebral monitoring of anaesthesia on reducing cognitive dysfunction and
postoperative delirium: a systematic review.
Source
Journal of International Medical Research. 46 (10) (pp 4100-4110), 2018.
Date of Publication: 01 Oct 2018.
Author
Luo C.; Zou W.
Institution
(Luo) Department of Neurology, The People's Hospital of Yongchuan
District, Chongqing, China
(Zou) Department of Neurology, Yongchuan Hospital of Traditional Chinese
Medicine, Chongqing, China
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: To assess the efficacy of cerebrally monitoring the depth of
anaesthesia in reducing postoperative cognitive dysfunction and
postoperative delirium (POD). Method(s): MEDLINE, EMBASE, and
Cochrane Library databases were searched following PRISMA statement
guidelines. We included randomized clinical trials (RCTs) comparing
electroencephalogram-based and routine care-guided titration of
anaesthesia in a systematic review. The risk estimate from each RCT was
pooled in a meta-analysis. The primary outcome was POD and long-term
cognitive dysfunction. Subgroup analyses were conducted for the subtypes
of intervention group and surgery. We identified five RCTs with a total
sample size of 2,868 and with bispectral index (BIS) or auditory evoked
potential (AEP) as interventions. Result(s): The odds ratio (OR) for
POD and long-term cognitive decline was 0.51 (95%CI: 0.35-0.76) and 0.69
(95%CI: 0.49-0.97), respectively. Significant heterogeneity was identified
in the POD data. There was no significant difference between BIS- and
AEP-based titration of anaesthesia in reducing the risk of POD. Extensive
heterogeneity for cardiac and thoracic surgery was identified in the study
population, and significant publication bias was found among the POD
results. Conclusion(s): BIS- and AEP-guided anaesthesia are
associated with significantly reduced risk of POD and long-term cognitive
dysfunction. Copyright © The Author(s) 2018.

<42>
Accession Number
623337475
Title
Meta-analysis of the impact of successful chronic total occlusion
percutaneous coronary intervention on left ventricular systolic function
and reverse remodeling.
Source
Journal of Interventional Cardiology. 31 (5) (pp 562-571), 2018. Date of
Publication: October 2018.
Author
Megaly M.; Saad M.; Tajti P.; Burke M.N.; Chavez I.; Gossl M.; Lips D.;
Mooney M.; Poulose A.; Sorajja P.; Traverse J.; Wang Y.; Kohl L.P.;
Bradley S.M.; Brilakis E.S.
Institution
(Megaly, Tajti, Burke, Chavez, Gossl, Lips, Mooney, Poulose, Sorajja,
Traverse, Wang, Bradley, Brilakis) Minneapolis Heart Institute, Abbott
Northwestern Hospital, Minneapolis, MN, United States
(Megaly, Kohl) Division of Cardiology, Department of Medicine, Hennepin
County Medical Center, Minneapolis, MN, United States
(Saad) Department of Cardiovascular Medicine, University of Arkansas,
Little Rock, AR, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: We sought to examine the impact of coronary chronic total
occlusion (CTO) percutaneous coronary intervention (PCI) on left
ventricular (LV) function. Method(s): We performed a systematic
review and meta-analysis of studies published between January 1980 and
November 2017 on the impact of successful CTO PCI on LV function.
 Result(s): A total of 34 observational studies including 2735
patients were included in the meta-analysis. Over a weighted mean
follow-up of 7.9 months, successful CTO PCI was associated with an
increase in LV ejection fraction by 3.8% (95%CI 3.0-4.7, P < 0.0001,
I2 = 45%). In secondary analysis of 15 studies (1248 patients)
that defined CTOs as occlusions of at least 3-month duration and reported
follow-up of at least 3-months after the procedure, successful CTO PCI was
associated with improvement in LV ejection fraction by 4.3% (95%CI [3.1,
5.6], P < 0.0001). In the 10 studies (502 patients) that reported LV
end-systolic volume, successful CTO PCI was associated with a decrease in
LV end-systolic volume by 4 mL, (95%CI -6.0 to -2.1, P < 0.0001,
I2 = 0%). LV end-diastolic volume was reported in 9 studies
with 403 patients and did not significantly change after successful CTO
PCI (-2.3 mL, 95%CI -5.7 to 1.2 mL, P = 0.19, I2 = 0%).
 Conclusion(s): Successful CTO PCI is associated with a statistically
significant improvement in LV ejection fraction and decrease in LV
end-systolic volume, that may reflect a beneficial effect of CTO
recanalization on LV remodeling. The clinical implications of these
findings warrant further investigation. Copyright © 2018 Wiley
Periodicals, Inc.

<43>
Accession Number
621919035
Title
Pooled diagnostic accuracy of resting distal to aortic coronary pressure
referenced to fractional flow reserve: The importance of resting coronary
physiology.
Source
Journal of Interventional Cardiology. 31 (5) (pp 588-598), 2018. Date of
Publication: October 2018.
Author
Maini R.; Moscona J.; Sidhu G.; Katigbak P.; Fernandez C.; Irimpen A.;
Mogabgab O.; Ward C.; Samson R.; LeJemtel T.
Institution
(Maini, Moscona, Katigbak, Irimpen, Mogabgab, Ward, Samson, LeJemtel)
Division of Cardiology, Department of Medicine, Tulane University, New
Orleans, LA, United States
(Sidhu) The Wright Center for Graduate Medical Education, Scranton, PA,
United States
(Fernandez) Division of Precision Medicine, HeartGEN Institute, Boston,
MA, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Introduction: Both resting and hyperemic physiologic methods to guide
coronary revascularization improve cardiovascular outcomes compared with
angiographic guidance alone. Fractional flow reserve (FFR) remains
underutilized due to concerns regarding hyperemia, prompting study of
resting distal to aortic coronary pressure (Pd/Pa). Pd/Pa is a
vasodilator-free resting index unlike FFR. While Pd/Pa is similar to
another resting index, instantaneous wave-free ratio (iFR), it is a
whole-cycle measurement not limited to the wave-free diastolic period.
Pd/Pa is not validated clinically although multiple accuracy studies have
been performed. Our meta-analysis examines the overall diagnostic accuracy
of Pd/Pa referenced to FFR, the accepted invasive standard of ischemia.
 Method(s): We searched PubMed, EMBASE, Central, ProQuest, and Web of
Science databases for full text articles published through August 9, 2017
addressing the diagnostic accuracy of Pd/Pa referenced to FFR < 0.80. The
following keywords were used: "distal coronary artery pressure" OR "Pd/Pa"
AND "fractional flow reserve" OR "FFR.". Result(s): In total, 14
studies comprising 7004 lesions were identified. Pooled diagnostic
accuracy estimates of Pd/Pa versus FFR < 0.80 were: sensitivity, 0.77 (95%
CI, 0.75-0.78); specificity, 0.82 (0.81-0.83); positive likelihood ratio,
4.7 (3.3-6.6); negative likelihood ratio, 0.29 (0.24-0.34); diagnostic
odds ratio, 18.1 (14.4-22.6); area under the summary receiver-operating
characteristic curve of 0.88; and diagnostic accuracy of 0.80 (0.76-0.83).
 Conclusion(s): Pd/Pa shows adequate agreement with FFR as a resting
index of coronary stenosis severity without the undesired effects and cost
of hyperemic agents. Pd/Pa has the potential to guide coronary
revascularization with easier application and availability compared with
iFR and FFR. Copyright © 2018 Wiley Periodicals, Inc.

<44>
Accession Number
622994754
Title
Revascularization strategies in STEMI with multivessel disease: When and
how.
Source
Minerva Cardioangiologica. 66 (4) (pp 429-441), 2018. Date of Publication:
August 2018.
Author
D'Amico G.; Basile M.; Tarantini G.; Marchese A.
Institution
(D'Amico, Tarantini) Unit of Cardiology, Department of Cardiac, Thoracic,
and Vascular Sciences, University of Padua Medical School, Gallucci Heart
Center, Clinic of Cardiology, Via Giustiniani 2, Padua 35128, Italy
(Basile, Marchese) Unit of Cardiology, GVM Care and Research, Anthea
Hospital, Bari, Italy
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Acute ST-segment elevation myocardial infarction (STEMI) typically arises
from total occlusion of an epicardial coronary artery, most often due to
atherosclerotic plaque rupture/erosion and subsequent thrombus formation.
Granted this, important angiographic information for patients presenting
with STEMI is not only about the status of infarct-related artery (IRA)
but also about the atherosclerotic disease burden and disease severity of
non-IRA vessels. Previous studies have reported that multivessel coronary
artery disease is found in approximately 50% of patients with STEMI
undergoing primary percutaneous coronary intervention (PCI). Primary PCI
is now considered the gold standard in the treatment for patients with
STEMI; however, the optimal reperfusion strategy in patients with STEMI
and multivessel disease (MVD) remains uncertain. In this review, we
summarize the available evidence on treatment options for patients with
STEMI and MVD and highlight current guideline recommendations on this
topic. Copyright © 2018 EDIZIONI MINERVA MEDICA.

<45>
Accession Number
623386398
Title
Benefits of Using High-Volume-Low-Pressure Tracheal Tube in Children
Undergoing Congenital Cardiac Surgery: Evidence From a Prospective
Randomized Study.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 22 (3) (pp 300-305),
2018. Date of Publication: 01 Sep 2018.
Author
Chand R.; Roy Chowdhury S.; Rupert E.; Mandal C.K.; Narayan P.
Institution
(Chand, Roy Chowdhury, Rupert, Mandal, Narayan) NH Rabindranath Tagore
International Institute of Cardiac Sciences, Kolkata, India
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background. In the past 2 decades, usage of high-volume-low-pressure
microcuffed tracheal tubes in smaller children has increased. However,
there is paucity of evidence of its usage in smaller children undergoing
congenital cardiac surgery. The aim of this study was to assess if
microcuff endotracheal tubes in neonates and younger children undergoing
congenital cardiac surgery is associated with better outcomes than
uncuffed tubes. Methods. We carried out this single-center, prospective,
randomized study between June and November 2016. Eighty patients were
randomized into those receiving microcuff tracheal tubes and conventional
uncuffed tubes. Primary outcome was stridor postextubation. Secondary
outcomes measured included number of tube changes, volume of anesthetic
gases required, and cost incurred. Results. The 2 groups were comparable
in terms of baseline characteristics and duration of intubation. Incidence
of stridor was significantly higher in conventional uncuffed tubes (12
[30%] vs 4 [10%]; P =.04) and so was the number of tube changes required
(17/40 [42.5%] vs 2/40 [5%]; P <=.001). Tube change was associated with
more than 3-fold risk of stridor (odds ratio = 3.92; 95% confidence
interval = 1.23-12.43). Isoflurane (29.14 +/- 7.01 mL vs19.2 +/- 4.81 mL;
P <.0001) and oxygen flow requirement (P <.0001) and the resultant cost
(7.46 +/- 1.4 vs 5.77 +/- 1.2 US$; P <.0001) were all significantly higher
in the conventional uncuffed group. Conclusion. Microcuff pediatric
tracheal tube is associated with significantly lower incidence of stridor,
tube changes, and anesthetic gas requirement. This leads to significant
cost reduction that offsets the higher costs associated with usage of a
microcuff tracheal tube. Copyright © The Author(s) 2018.

<46>
Accession Number
618954521
Title
An updated meta-analysis of novel oral anticoagulants versus vitamin K
antagonists for uninterrupted anticoagulation in atrial fibrillation
catheter ablation.
Source
Heart Rhythm. 15 (1) (pp 107-115), 2018. Date of Publication: January
2018.
Author
Cardoso R.; Knijnik L.; Bhonsale A.; Miller J.; Nasi G.; Rivera M.; Blumer
V.; Calkins H.
Institution
(Cardoso, Bhonsale, Miller, Calkins) Division of Cardiology, Department of
Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, United
States
(Knijnik, Nasi, Rivera, Blumer) Division of Cardiology, Department of
Medicine, University of Miami-Jackson Memorial Hospital, Miami, Florida,
United States
Publisher
Elsevier B.V.
Abstract
Background: Catheter ablation is recommended as a first- or second-line
rhythm control therapy for selected patients with atrial fibrillation
(AF). There is a wide variability in the periprocedural management of oral
anticoagulation in patients undergoing AF ablation. Objective(s): We
aimed to perform an updated meta-analysis of novel oral anticoagulants
(NOACs) vs vitamin K antagonists (VKAs) as uninterrupted anticoagulation
in patients undergoing AF ablation. Method(s): Databases and
conference abstracts were searched. Studies were excluded if oral
anticoagulants were held at any periprocedural period. The primary
outcomes were stroke or transient ischemic attack (TIA) and major
bleeding. Result(s): Twelve studies and 4962 patients were included.
Stroke or TIA was rare (NOAC, 0.08%; VKA, 0.16%) and not different between
groups (odds ratio [OR] 0.66; 95% confidence interval [CI] 0.19-2.30). The
incidence of silent cerebral embolic events was also not significantly
different between NOACs (8%) and VKAs (9.6%) (OR 0.86; 95% CI 0.42-1.76).
Major bleeding was significantly reduced in the NOAC group (0.9%) as
compared with VKA-treated patients (2%) (OR 0.50; 95% CI 0.30-0.84; P
<.01). This finding was confirmed in a subgroup analysis of randomized and
cohort studies with matched controls (OR 0.45; 95% CI 0.24-0.83; P =.01).
There was no significant difference in the outcomes of individual NOACs
and VKAs, although these analyses may have been underpowered to detect
minor differences in such rare outcomes. Conclusion(s): In patients
undergoing AF ablation, uninterrupted periprocedural NOACs are associated
with a low incidence of stroke or TIA and a significant reduction in major
bleeding as compared with uninterrupted VKAs. Copyright © 2017
Heart Rhythm Society

<47>
Accession Number
622526446
Title
Antiplatelet therapy for patients undergoing coronary artery bypass
surgery.
Source
Kardiologia Polska. 76 (6) (pp 945-952), 2018. Date of Publication: 11 Jun
2018.
Author
DeStephan C.M.; Schneider D.J.
Institution
(DeStephan, Schneider) Department of Medicine, Cardiovascular Research
Institute, University of Vermont, 308 S. Park Drive, Colchester, VT 05446,
United States
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Considerable variation in the use and duration of antiplatelet medications
during the perioperative and postoperative care of patients undergoing
coronary artery bypass grafting (CABG) reflects the limited number of
studies focused directly on these patients as well as the variation in the
results reported. In this review we highlight the incidence and mechanisms
of graft closure as well as the evidence in support of antiplatelet
therapy that is balanced by the impact of antiplatelet therapy on the risk
of bleeding to provide recommendations for the use of this therapy in
patients undergoing CABG. Low-dose acetylsalicylic acid (ASA; <= 160 mg
daily) reduces the incidence of perioperative myocardial infarction, acute
renal injury, and mortality without increasing the risk of bleeding and so
is recommended both before and after CABG. The use of dual antiplatelet
therapy with ASA plus a P2Y12 antagonist adds a greater risk of bleeding.
While additional studies are required, we can make the following
recommendations: Because of increased bleeding and mortality when patients
are treated with clopidogrel preoperatively, CABG should be delayed for
five days. Because of increased bleeding when patients are treated with
ticagrelor preoperatively, CABG should be delayed for three days. Because
of increased bleeding when patients are treated with prasugrel
preoperatively, CABG should be delayed for seven days. For patients who
had a coronary stent placed preoperatively or had an acute coronary
syndrome preoperatively, resumption of therapy with their P2Y12 antagonist
postoperatively for 12 months reduces the subsequent incidence of
cardiovascular events. Copyright © Polish Cardiac Society 2018.

<48>
Accession Number
624089140
Title
Cognitive function in patients with coronary artery disease: A literature
review.
Source
Journal of International Medical Research. 46 (10) (pp 4019-4031), 2018.
Date of Publication: 01 Oct 2018.
Author
Burkauskas J.; Lang P.; Bunevicius A.; Neverauskas J.;
Buciute-Jankauskiene M.; Mickuviene N.
Institution
(Burkauskas, Neverauskas, Buciute-Jankauskiene, Mickuviene) Behavioral
Medicine Institute, Lithuanian University of Health Sciences, Vyduno Str.
4/J. Sliupo Str. 7, Palanga LT-00135, Lithuania
(Lang) Harvard Medical School, Laboratory of Clinical & Experimental
Psychopathology, Dr. John C. Corrigan Mental Health Center, Harvard
Medical School, 49 Hillside Street, Fall River, MA 02720, United States
(Bunevicius) Laboratory of Clinical Research, Neuroscience Institute,
Lithuanian University of Health Sciences, Eiveniu st. 4, Kaunas LT-50161,
Lithuania
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: Cognitive function impairment is a well-documented complication
of cerebrovascular disease (CBVD). Less is known about what factors affect
the deterioration of cognitive function in patients with coronary artery
disease (CAD). The aim of this review is to explore recent studies
investigating factors associated with cognitive function in patients with
CAD. Method(s): Studies published from 2010 to 2016 were identified
through a systematic search of MEDLINE/PubMed and were included if they
addressed factors affecting cognitive function in the CAD population.
 Result(s): Of the 227 publications identified, 32 were selected for
the review. Five factors tentatively affecting cognitive function in
patients with CAD were identified: coronary artery bypass grafting (CABG)
surgery, apolipoprotein E4 (APOE4) genotype, left ventricular ejection
fraction (LVEF), medication use, and various hormones and biomarkers.
 Conclusion(s): New techniques in CABG surgery have proven to
alleviate postoperative cognitive decline. Researchers are still debating
the effects of APOE4 genotype, LVEF, and the use of cardiovascular
medications on cognitive function. Thyroid hormones and biomarkers are
associated with cognitive function, but the exact nature of the
association is debatable. Longitudinal studies should clarify those
associations. In addition, cross-sectional studies addressing other causes
of cognitive decline in patients with CAD are warranted. Copyright
© The Author(s) 2018.

<49>
Accession Number
623738041
Title
The incremental predictive value of frailty measures in elderly patients
undergoing cardiac surgery: A systematic review.
Source
Clinical Cardiology. 41 (8) (pp 1103-1110), 2018. Date of Publication:
August 2018.
Author
Li Z.; Ding X.
Institution
(Li) Department of Epidemiology & Biostatistics, Western University,
London, ON, Canada
(Ding) Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing, China
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Emerging evidence demonstrates that frailty measures can predict adverse
outcomes after cardiac procedures. Our objectives were to examine whether
the inclusion of frailty measures adds incremental predictive value to
existing surgical risk prediction models in patients undergoing cardiac
surgery and to evaluate the reporting and methods of studies that
investigated the prediction of frailty measures in cardiology. The
inclusion of frailty measures adds incremental predictive value on
existing perioperative risk-scoring systems. We systematically searched
the EMBASE, MEDLINE, and Web of Science databases for relevant studies.
Studies were included according to predefined inclusion criteria. The
quality of included studies was appraised using the QUADAS-2 tool. Data
were extracted and synthesized according to predefined methods. Twelve
studies were included in the analysis. Included studies demonstrated the
incremental predictive value of frailty measures on existing surgical risk
models for mortality, but the predictive value of frailty measures alone
was not consistent across literature. Few studies that investigated the
predictive ability of frailty measures reported all important model
performance measures. When comparing the predictive value of frailty
measures with existing models, few studies reported if the frailty
measurement was separately performed from the existing perioperative risk
assessment. The addition of frailty measures to the existing perioperative
risk models improved the prediction performance for mortality, but the
incorporation of frailty assessment into perioperative risk assessment
requires further evidence before making health policy
recommendations. Copyright © 2018 Wiley Periodicals, Inc.

<50>
Accession Number
621761102
Title
Effects of glargine insulin on glycemic control in patients with diabetes
mellitus type II undergoing off-pump coronary artery bypass graft.
Source
Annals of Cardiac Anaesthesia. 21 (2) (pp 167-172), 2018. Date of
Publication: April-June 2018.
Author
Gandhi H.; Sarvaia A.; Malhotra A.; Acharya H.; Shah K.; Rajavat J.
Institution
(Gandhi, Sarvaia, Rajavat) Department of Cardiac Anesthesia, U N Mehta
Institute of Cardiology and Research Center, Ahmedabad, Gujarat 380 016,
India
(Malhotra) Department of Cardio Vascular and Thoracic Surgery, U N Mehta
Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
(Acharya, Shah) Department of Research, U N Mehta Institute of Cardiology
and Research Center, Ahmedabad, Gujarat, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: The prevalence of diabetes mellitus in patients requiring
coronary artery bypass grafting (CABG) is noticeably high (20%-30%). These
patients have inferior perioperative outcome, reduced long-term survival,
and high risk of recurrent episodes of angina. To improve perioperative
outcome surgical unit defined satisfactory glycemic control is desired
during this period. Hence, the aim of our study is to compare the efficacy
of glargine insulin combination with continuous human insulin infusion for
perioperative glycemic control in patients with diabetes undergoing CABG.
 Material(s) and Method(s): Fifty Patients, who were posted for
off-pump CABG with diabetes mellitus type II, were randomized in two
group, Group I normal saline + human insulin infusion during the
perioperative period, Group II (glargine group): Glargine + human insulin
infusion during perioperative period. Result(s): During surgery and
in the postoperative period, random blood sugar and human insulin
requirement are significantly higher in control group than glargine group.
Other infection, step-up antibiotics, intensive care unit (ICU) stay, and
hospital stay were significantly higher in control groups in postoperative
period. Conclusion(s): Our study results suggest that glargine
effectively manages blood glucose level with significantly greater control
over postoperative morbidity. Copyright © 2018 Annals of Cardiac
Anaesthesia Published by Wolters Kluwer - Medknow.

<51>
Accession Number
621761084
Title
Assessment of the effect of two regimens of milrinone infusion in
pediatric patients undergoing fontan procedure: A randomized study.
Source
Annals of Cardiac Anaesthesia. 21 (2) (pp 134-140), 2018. Date of
Publication: April-June 2018.
Author
Soliman R.; Ragheb A.
Institution
(Soliman) Department of Anesthesia, Cairo University, Egypt
(Soliman, Ragheb) Prince Sultan Cardiac Centre, Riyadh, Al-Hassa, Saudi
Arabia
(Ragheb) National Heart Institute, Cairo, Egypt
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Objective: The aim of the study was to compare the effect of two different
regimens of milrinone on hemodynamics and oxygen saturation in pediatric
patients undergoing Fontan procedure. Design(s): This was a
randomized study. Setting(s): Cardiac centers. Patient(s): This
study included 116 patients undergoing Fontan procedure. Material(s)
and Method(s): Group E: Milrinone was started as infusion 0.5 mug/kg/min
without a loading dose at the beginning of cardiopulmonary bypass (CPB)
followed by infusion 0.5-0.75 mug/kg/min in the pediatric cardiac surgical
intensive care unit (PSICU). Group L: Milrinone was started as a loading
dose 50 mug/kg over 10 min before weaning from CPB followed by infusion
0.5-0.75 mug/kg/min in the PSICU. Measurements: Heart rate, mean arterial
blood pressure, central venous pressure, transpulmonary pressure, cardiac
index, pharmacological support, lactate level, urine output, oxygen
saturation, ICU, and hospital length of stay. Main Result(s): There
were no changes in the heart rate and mean arterial blood pressure (P >
0.05). The increase in the postoperative central venous pressure,
transpulmonary pressure and lactate level was lower in Group E than Group
L (P < 0.05). The increase in the postoperative cardiac index, oxygen
saturation, and urine output was higher in Group E than Group L (P <
0.05). The requirement for pharmacological support was lower in the Group
E (P < 0.05). The ICU and hospital length of stay were shorter in the
Group E than Group L (P < 0.05). Conclusion(s): Early use of
milrinone during Fontan procedure facilitated the weaning from CPB,
decreased the elevation in the central venous pressure, transpulmonary
gradient pressure, and the requirement for pharmacological support.
Furthermore, it increased the cardiac index and arterial oxygen
saturation. Copyright © 2018 Annals of Cardiac Anaesthesia 
Published by Wolters Kluwer - Medknow.

<52>
Accession Number
621761074
Title
Prophylactic preoperative levosimendan for off-pump coronary artery bypass
grafting in patients with left ventricular dysfunction: Single-centered
randomized prospective study.
Source
Annals of Cardiac Anaesthesia. 21 (2) (pp 123-128), 2018. Date of
Publication: April-June 2018.
Author
Desai P.M.; Sarkar M.S.; Umbarkar S.R.
Institution
(Desai, Sarkar, Umbarkar) Department of Anesthesiology, Seth GS Medical
College and KEM Hospital, A703, Noopur Apartments, PG Rood, Malad West,
Mumbai, Maharashtra 400 064, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: Off-pump coronary artery bypass surgery (OPCAB) is often
complicated by hemodynamic instability, especially in patients with prior
left ventricular (LV) dysfunction and appropriate choice of inotrope plays
a vital role in perioperative management of these patients. Aim and
Objective: To study hemodynamic effects and immediate outcome of
prophylactic infusion of levosimendan in patients with the LV dysfunction
undergoing OPCAB surgery and whether this strategy helps in successful
conduct of OPCAB surgery. Material(s) and Method(s): After
Institutional Ethics Committee approval, 60 patients posted for elective
OPCAB surgery were randomly divided into two groups (n = 30 each).
Patients with the LV ejection fraction <30% were included. Study group was
started on injection levosimendan (@ 0.1 mug/kg/min) in the previous night
before surgery and continued for 24 h including intraoperative period.
Hemodynamic monitoring included heart rate, invasive blood pressure,
cardiac index (CI), pulmonary capillary wedge pressure (PCWP), pulse
oximetry, and arterial blood gases with serum lactates at as T0
(baseline), T1 (15 min after obtuse marginal and/or PDA anastomoses), T2
(at end of surgery), T3 (6 h after surgery in Intensive Care Unit [ICU]),
T4 (12 h after surgery), and T5 (24 h after surgery in ICU). Vasopressor
was added to maintain mean arterial pressure >60 mmHg. Chi-square/Fisher's
exact/Mid P exact test and Student's t-tests were applied for categorical
and continuous data. Result(s): CI was greater and PCWP reduced
significantly in Group L during intraoperative and early postoperative
period. Serum lactate concentration was lower in patients pretreated with
levosimendan. Incidence of postoperative atrial fibrillation (POAF) (36.6
vs. 6.6%; P = 0.01), low cardiac output syndrome (LCOS) (30% vs. 6%; P =
0.02), and acute kidney injury (23.3% vs. 6.7%; P = 0.04) was less in
Group L. Three patients (10%) in control group required conversion to
cardiopulmonary bypass (CPB) as compared to none in the study group. There
was no difference regarding ICU or hospital stay and mortality in both
groups. Conclusion(s): Preoperative levosimendan helps in successful
conduct of OPCAB and reduces the incidence of LCOS, POAF, conversion to
CPB, and requirement of intra-aortic balloon pump. Copyright ©
2018 Annals of Cardiac Anaesthesia Published by Wolters Kluwer -
Medknow.

<53>
Accession Number
623038817
Title
Coronary artery disease in heart transplantation: new concepts for an old
disease.
Source
Transplant International. 31 (8) (pp 787-827), 2018. Date of Publication:
August 2018.
Author
Langstraat M.; Musters K.J.S.; Manintveld O.; Masetti M.; Potena L.
Institution
(Langstraat, Musters) School of Medicine, Erasmus MC, Rotterdam,
Netherlands
(Manintveld) Department of Cardiology, Thorax Center, Rotterdam,
Netherlands
(Masetti, Potena) Heart and Lung Transplant Program, Bologna University
Hospital, Bologna, Italy
Publisher
Blackwell Publishing Ltd
Abstract
Cardiac allograft vasculopathy (CAV) remains one of the main long-term
complications after heart transplantation. We performed a systematic
review focused on articles published in the previous 6 years to reappraise
the novel evidences supporting risk factors, pathology, prevention, and
treatment of CAV. We identified a search string for a literature search on
PubMed. We excluded articles specifically focused on
diagnosis/biomarkers/imaging only or complications of other diseases. We
included 98 studies out of our search. Forty-eight articles describe risk
factors for CAV, 13 pathology, 24 prevention, and 13 treatment for CAV.
While confirming known concepts, we found supportive evidence that CAV
pathophysiology may vary according to the time post-transplant and the
prevalence of metabolic versus immune-mediated risk factors. Selective
revascularization of focal lesions in patients with CAV may result in some
clinical benefit, but CAV prevention, rather than treatment, by
controlling risk factors and by using targeted immunosuppressive therapies
is the most evidence-based approach to reduce disease
progression. Copyright © 2018 Steunstichting ESOT

<54>
Accession Number
622333460
Title
Polymer-free versus permanent polymer-coated drug eluting stents for the
treatment of coronary artery disease: A meta-analysis of randomized
trials.
Source
Journal of Interventional Cardiology. 31 (5) (pp 608-616), 2018. Date of
Publication: October 2018.
Author
Nogic J.; Baey Y.-W.; Nerlekar N.; Ha F.J.; Cameron J.D.; Nasis A.; West
N.E.J.; Brown A.J.
Institution
(Nogic, Baey, Nerlekar, Ha, Cameron, Nasis, Brown) Monash Cardiovascular
Research Centre, Monash University and Monash Heart, Monash Health,
Melbourne, VIC, Australia
(West) Department of Interventional Cardiology, Papworth Hospital NHS
Trust, Cambridge, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Polymer-free drug eluting stents (PF-DES) were developed, in
part, to overcome risk of late ischemic events observed with permanent
polymer-coated DES (PP-DES). However, trial results are inconsistent with
longer-term safety and efficacy of PF-DES remaining unknown. We performed
a meta-analysis of randomized trials assessing outcomes of patients
receiving PF-DES versus PP-DES for treatment of coronary artery disease
(CAD). Method(s): Electronic searches were performed for randomized
trials comparing outcomes between PF-DES and PP-DES. Trials reporting
major adverse cardiovascular events (MACE), myocardial infarction (MI),
stent thrombosis (ST), all-cause death, target lesion/vessel
revascularization (TLR/TVR), and late lumen loss (LLL) were included.
Analyses were performed at longest follow-up and landmarked beyond 1-year.
 Result(s): Twelve trials (6,943 patients) were included. There was no
significant difference in MACE between PF-DES and PP-DES at longest
follow-up (Odds Ratio [OR] 0.96, 95%CI 0.85-1.10, P = 0.59) or landmark
analysis beyond 1-year (OR 0.96, 95%CI 0.76-1.20, P = 0.70). Although
PF-DES were associated with a significant reduction in all-cause death (OR
0.85, 95%CI 0.72-1.00, P < 0.05), this effect was not present on landmark
analysis beyond 1-year (OR 0.89, 95%CI 0.73-1.10, P = 0.30). There were no
differences observed for MI (OR 1.00, 95%CI 0.77-1.28, P = 0.99) or ST (OR
0.95, 95%CI 0.54-1.68, P = 0.86), with similar efficacy outcomes including
TVR (OR 1.07, 95%CI 0.91-1.26, P = 0.42), TLR (OR 1.03, 95%CI 0.88-1.21, P
= 0.68) and angiographic LLL (pooled mean difference 0.01 mm, 95%CI -0.08
to 0.11, P = 0.76). Conclusion(s): PF-DES are as safe and efficacious
as PP-DES for the treatment of patients with CAD, but do not significantly
reduce late ischemic complications. Copyright © 2018 Wiley
Periodicals, Inc.

<55>
Accession Number
622321968
Title
Valve in valve transcatheter aortic valve implantation (ViV-TAVI) versus
redo-Surgical aortic valve replacement (redo-SAVR): A systematic review
and meta-analysis.
Source
Journal of Interventional Cardiology. 31 (5) (pp 661-671), 2018. Date of
Publication: October 2018.
Author
Nalluri N.; Atti V.; Munir A.B.; Karam B.; Patel N.J.; Kumar V.; Vemula
P.; Edla S.; Asti D.; Paturu A.; Gayam S.; Spagnola J.; Barsoum E.;
Maniatis G.A.; Tamburrino F.; Kandov R.; Lafferty J.; Kliger C.
Institution
(Nalluri, Munir, Karam, Spagnola, Barsoum, Maniatis, Tamburrino, Kandov,
Lafferty) Department of Cardiology, Staten Island University Hospital,
Northwell Health, Staten Island, New York City, NY, United States
(Atti) Department of Internal Medicine, Michigan State University, Sparrow
Hospital, East Lansing, MI, United States
(Patel) Department of Cardiology, University of Miami, Jackson Memorial
Hospital, Miami, FL, United States
(Kumar) Department of Cardiology, Mount Sinai St. Luke's Roosevelt
Hospital, New York City, NY, United States
(Vemula) Department of Internal Medicine, Sparrow Health System, Lansing,
MI, United States
(Edla) Department of Cardiology, St. John Hospital and Medical Center,
Detroit, MI, United States
(Asti, Kliger) Department of Interventional Cardiology, Lenox Hill
Hospital, Northwell Health, Manhattan, New York City, NY, United States
(Paturu) Department of Internal Medicine, NRI Medical College, Guntur,
India
(Gayam) Department of Internal Medicine, KVG Medical College, Sullia,
Karnataka, India
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Bioprosthetic (BP) valves have been increasingly used for
aortic valve replacement over the last decade. Due to their limited
durability, patients presenting with failed BP valves are rising. Valve in
Valve - Transcatheter Aortic Valve Implantation (ViV-TAVI) emerged as an
alternative to the gold standard redo-Surgical Aortic Valve Replacement
(redo-SAVR). However, the utility of ViV-TAVI is poorly understood.
 Method(s): A systematic electronic search of the scientific
literature was done in PubMed, EMBASE, SCOPUS, Google Scholar, and
ClinicalTrials.gov. Only studies which compared the safety and efficacy of
ViV-TAVI and redo-SAVR head to head in failed BP valves were included.
 Result(s): Six observational studies were eligible and included 594
patients, of whom 255 underwent ViV- TAVI and 339 underwent redo-SAVR.
There was no significant difference between ViV-TAVI and redo- SAVR for
procedural, 30 day and 1 year mortality rates. ViV-TAVI was associated
with lower risk of permanent pacemaker implantation (PPI) (OR: 0.43, CI:
0.21-0.89; P = 0.02) and a trend toward increased risk of paravalvular
leak (PVL) (OR: 5.45, CI: 0.94-31.58; P = 0.06). There was no significant
difference for stroke, major bleeding, vascular complications and
postprocedural aortic valvular gradients more than 20 mm-hg.
 Conclusion(s): Our results reiterate the safety and feasibility of
ViV-TAVI for failed aortic BP valves in patients deemed to be at high risk
for surgery. VIV-TAVI was associated with lower risk of permanent
pacemaker implantation with a trend toward increased risk of paravalvular
leak. Copyright © 2018 Wiley Periodicals, Inc.

<56>
Accession Number
618389896
Title
Percutaneous coronary intervention vs. coronary artery bypass grafting for
left main revascularization: An updated meta-analysis.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 3 (3) (pp
173-182), 2017. Date of Publication: 2017.
Author
Bajaj N.S.; Patel N.; Kalra R.; Marogil P.; Bhardwaj A.; Arora G.; Arora
P.
Institution
(Bajaj) Division of Cardiovascular Medicine, Department of Radiology,
Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United
States
(Bajaj, Patel, Bhardwaj, Arora, Arora) Division of Cardiovascular
Diseases, Department of Medicine, University of Alabama at Birmingham,
1900 University Boulevard Birmingham, AL 35233, United States
(Kalra) Cardiovascular Division, University of Minnesota, 420 Delaware St
SE, Minneapolis, MN 55455, United States
(Marogil) Department of Internal Medicine, Brookwood Baptist Health, 2010
Brookwood Medical Center Drive Birmingham, AL 35209, United States
(Arora) Section of Cardiology, Birmingham Veterans Affairs Medical Center,
700 19th St S, Birmingham, AL 35233, United States
Publisher
Oxford University Press
Abstract
Aims The optimal revascularization strategy for left main coronary artery
disease (LMD) remains controversial, especially with two recent randomized
controlled trials showing conflicting results. We sought to address this
controversy with our analysis. Methods and results Comprehensive
literature search was performed. We compared percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG) for LMD
revascularization using standard meta-analytic techniques. A 21% higher
risk of long-term major adverse cardiac and cerebrovascular event [MACCE;
composite of death, myocardial infarction (MI), stroke, and repeat
revascularization] was observed in patients undergoing PCI in comparison
with CABG [risk ratio (RR) 1.21, 95% confidence interval (CI) 1.05-1.40].
This risk was driven by higher rate of repeat revascularization in those
undergoing PCI (RR 1.61, 95% CI 1.34-1.95). On the contrary, MACCE rates
at 30 days were lower in PCI when compared with CABG (RR 0.55, 95% CI
0.39-0.76), which was driven by lower rates of stroke in the PCI arm (RR
0.41, 95% CI 0.17-0.98). At 1 year, lower stroke rates (RR 0.21, 95% CI
0.08-0.59) in the PCI arm were balanced by higher repeat revascularization
rates in those undergoing PCI (RR 1.78, 95% CI 1.33-2.37), resulting in a
clinical equipoise in MACCE rates between the two revascularization
strategies. There was no difference in death or MI between PCI when
compared with CABG at any time point. Conclusion Outcomes of CABG vs. PCI
for LMD revascularization vary over time. Therefore, individualized
decisions need to be made for LMD revascularization using the heart team
approach. Copyright © 2017 The Author.

<57>
Accession Number
620034557
Title
Introducing TOPMAST, the first double-blind randomized clinical trial
specifically dedicated to perioperative maintenance fluid therapy in
adults.
Source
Anaesthesiology Intensive Therapy. 49 (5) (pp 366-372), 2017. Date of
Publication: 28 Dec 2017.
Author
Hendrickx S.; Van Vlimmeren K.; Baar I.; Verbrugghe W.; Dams K.; Van
Cromphaut S.; Roelant E.; Embrecht B.; Wittock A.; Mertens P.; Hendriks
J.M.; Lauwers P.; Van Schil P.E.; Van Craenenbroeck A.H.; Van Den Wyngaert
T.; Jorens P.G.; Van Regenmortel N.
Institution
(Hendrickx, Van Vlimmeren, Baar, Verbrugghe, Dams, Van Cromphaut, Jorens,
Van Regenmortel) Department of Intensive Care Medicine, Antwerp University
Hospital, Wilrijkstraat 10, Edegem B2640, Belgium
(Hendrickx, Van Vlimmeren, Embrecht, Wittock, Mertens) Department of
Anesthesiology, Antwerp University Hospital, Antwerp, Belgium
(Roelant) Clinical Trial Center (CTC), Antwerp University Hospital,
University of Antwerp, Antwerp, Belgium
(Hendriks, Lauwers, Van Schil) Department of Thoracic and Vascular
Surgery, Antwerp University Hospital, Antwerp, Belgium
(Van Craenenbroeck) Department of Nephrology, Antwerp University Hospital,
Antwerp, Belgium
(Van Den Wyngaert) Department of Nuclear Medicine, Antwerp University
Hospital, Antwerp, Belgium
(Van Den Wyngaert, Jorens) Faculty of Medicine and Health Sciences,
University of Antwerp, Antwerp, Belgium
(Van Regenmortel) Department of Intensive Care Medicine, Ziekenhuis
Netwerk Antwerpen, Campus Stuivenberg, Antwerp, Belgium
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Although prescribed to every patient undergoing surgery,
maintenance fluid therapy is a poorly researched part of perioperative
fluid therapy. The tonicity of the chosen solutions, could be an important
cause of morbidity, with hyponatremia being a potential side effect of
hypotonic solutions, where isotonic solution could lead to fluid overload.
 Method(s): The TOPMAST-trial is an ongoing prospective single-center
double-blind randomized trial comparing an isotonic and a hypotonic
maintenance fluid strategy during and after surgery in patients undergoing
different types of major thoracic surgery. Patients receive NaCl 0.9% in
glucose 5% with an added 40 mmol L-1 of potassium chloride or a
premixed solution containing 54 mmol L-1 sodium, 55 mmol
L-1 chloride and 26 mmol of potassium at a rate of 27 mL per kg
of body weight per day. The primary hypothesis is that isotonic
maintenance solutions cause a more positive perioperative fluid balance
than hypotonic fluids. Different secondary safety endpoints will be
explored, especially the effect of the study treatments on the occurrence
electrolyte disturbances (e.g. hyponatremia, hyperchloremia) and a set of
clinical endpoints. Efficacy endpoints include the need for resuscitation
fluids and assessment of renal and hormonal adaptive mechanisms. An
anticipated 68 patients will be included between March 2017 and January
2018. Discussion(s): The study will provide the most comprehensive
evaluation of clinically important outcomes associated with the choice of
perioperative maintenance fluid therapy.

<58>
Accession Number
619544490
Title
The relationship between preoperative frailty and outcomes following
transcatheter aortic valve implantation: A systematic review and
meta-analysis.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 3 (2) (pp
123-132), 2017. Date of Publication: 01 Apr 2017.
Author
Anand A.; Harley C.; Visvanathan A.; Shah A.S.V.; Cowell J.; MacLullich
A.; Shenkin S.; Mills N.L.
Institution
(Anand, Shah, Mills) BHF Centre for Cardiovascular Science, University of
Edinburgh, Room SU305, Chancellor's Building, Edinburgh EH16 4SB, United
Kingdom
(Harley, Visvanathan, Cowell) Department of Geriatric Medicine, NHS
Lothian, Edinburgh, United Kingdom
(MacLullich, Shenkin) Edinburgh Delirium Research Group, Geriatric
Medicine, University of Edinburgh, Edinburgh, United Kingdom
Publisher
Oxford University Press
Abstract
Aims Transcatheter aortic valve implantation (TAVI) is an increasingly
common intervention for patients with aortic stenosis deemed high risk for
major cardiac surgery, but identifying those who will benefit can be
challenging. Frailty reflects physiological reserve and may be a useful
prognostic marker in this population. We performed a systematic review and
meta-analysis of the association between frailty and outcomes after TAVI.
Methods and results Five databases were searched between January 2000 and
May 2015. From 2623 articles screened, 54 were assessed for eligibility.
Ten cohort studies (n = 4592) met the inclusion criteria of reporting a
measure of frailty with early (=30 days) or late (>30 days) mortality and
procedural complications following TAVI as defined by the Valve Academic
Research Consortium (VARC). Frailty was associated with increased early
mortality in four studies (n = 1900) (HR 2.35, 95% CI 1.78-3.09, P <
0.001) and increased late mortality in seven studies (n = 3159) (HR 1.63,
95% CI 1.34-1.97, P < 0.001). Objective frailty tools identified an even
higher risk group for late mortality (HR 2.63, 95% CI 1.87-3.70, P <
0.001). Frail individuals undergoing TAVI have a mortality rate of 34
deaths per 100 patient years, compared with 19 deaths per 100 patient
years in non-frail patients. There was limited reporting of VARC
procedural outcomes in relation to frailty, preventing meta-analysis.
Conclusion Frailty assessment in an already vulnerable TAVI population
identifies individuals at even greater risk of poor outcomes. Use of
objective frailty tools may inform patient selection, but this requires
further assessment in large prospective registries. Copyright ©
The Author 2016.

<59>
Accession Number
611972454
Title
Oral Anticoagulation in the Elderly: New Oral Anticoagulants-Innovative
Solution for an Old Problem?.
Source
American Journal of Therapeutics. (no pagination), 2016. Date of
Publication: 29 Aug 2016.
Author
Barbosa M.; Menezes Falcao L.
Institution
(Barbosa) 1Emergency Department, Vila Franca de Xira Hospital and Internal
Medicine Department of the CUF Torres Vedras Hospital, Torres Vedras,
Portugal; and 2Department of Internal Medicine, Santa Maria Hospital,
Lisbon University of Medicine, Lisboa, Portugal.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Direct oral anticoagulants emerge as the most innovative and promising
drug toward preventing and treating cardiovascular disease, raising great
interest among the scientific community. Numerous studies and
meta-analysis generated much data clarifying clinicians' doubts; however,
uncertainties remain regarding their use in particular groups such as
patients with prosthetic valves, in valvular atrial fibrillation (defined
as atrial fibrillation related to mitral rheumatic heart disease or
prosthetic heart valves), among the elderly, in paraneoplastic
thromboembolism, in pulmonary embolism with hemodynamic compromise, and
scarcity of specific antidotes. This review article intends to condense
the vast scientific production addressing new oral anticoagulants by
focusing on their advantages and disadvantages when used on the
elderly. Copyright © 2016 Wolters Kluwer Health, Inc. All rights
reserved.

<60>
Accession Number
2001427456
Title
Rivaroxaban, Aspirin, or Both to Prevent Early Coronary Bypass Graft
Occlusion: The COMPASS-CABG Study.
Source
Journal of the American College of Cardiology. 73 (2) (pp 121-130), 2019.
Date of Publication: 22 January 2019.
Author
Lamy A.; Eikelboom J.; Sheth T.; Connolly S.; Bosch J.; Fox K.A.A.; Zhu
J.; Lonn E.; Dagenais G.; Widimsky P.; Branch K.R.H.; Bhatt D.L.; Zheng
Z.; Straka Z.; Dagenais F.; Kong Y.; Marsden T.; Lee S.F.; Copland I.;
Yusuf S.
Institution
(Lamy, Eikelboom, Sheth, Connolly, Bosch, Lonn, Marsden, Lee, Copland,
Yusuf) Population Health Research Institute, McMaster University,
Hamilton, Ontario, Canada
(Lamy) CADENCE Research Group, Hamilton Health Sciences, Hamilton,
Ontario, Canada
(Lamy) Department of Surgery, McMaster University, Hamilton, Ontario,
Canada
(Lamy, Lonn, Yusuf) Department of Health Research Methods, Evidence, and
Impact, McMaster University, Hamilton, Ontario, Canada
(Eikelboom, Sheth, Connolly, Lonn, Yusuf) Department of Medicine, McMaster
University, Hamilton, Ontario, Canada
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, United Kingdom
(Zhu, Zheng) FuWai Hospital, Beijing, China
(Dagenais) Institut Universitaire de Cardiologie et de Pnemologie de
Quebec, Quebec City, Quebec, Canada
(Widimsky, Straka) Cardiocenter, University Hospital Kralovske Vinohrady
and Third Faculty of Medicine, Charles University, Prague, Czech Republic
(Branch) University of Washington Medical Center, Seattle, WA, United
States
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Dagenais) Quebec Heart and Lung University Institute, Laval University,
Quebec City, Quebec, Canada
(Kong) Shanghai Chest Hospital Affiliated with Shanghai Jiao Tong
University, Shanghai, China
Publisher
Elsevier USA
Abstract
Background: Patients with recent coronary artery bypass graft (CABG)
surgery are at risk for early graft failure, which is associated with a
risk of myocardial infarction and death. In the COMPASS (Cardiovascular
OutcoMes for People Using Anticoagulation StrategieS) trial, rivaroxaban
2.5 mg twice daily plus aspirin 100 mg once daily compared with aspirin
100 mg once daily reduced the primary major adverse cardiovascular events
(MACE) outcome of cardiovascular death, stroke, or myocardial infarction.
Rivaroxaban 5 mg twice daily alone did not significantly reduce MACE.
 Objective(s): This pre-planned substudy sought to determine whether
the COMPASS treatments are more effective than aspirin alone for
preventing graft failure and MACE after CABG surgery. Method(s): The
substudy randomized 1,448 COMPASS trial patients 4 to 14 days after CABG
surgery to receive the combination of rivaroxaban plus aspirin,
rivaroxaban alone, or aspirin alone. The primary outcome was graft
failure, diagnosed by computed tomography angiogram 1 year after surgery.
 Result(s): The combination of rivaroxaban and aspirin and the regimen
of rivaroxaban alone did not reduce the graft failure rates compared with
aspirin alone (combination vs. aspirin: 113 [9.1%] vs. 91 [8.0%] failed
grafts; odds ratio [OR]: 1.13; 95% confidence interval [CI]: 0.82 to 1.57;
p = 0.45; rivaroxaban alone vs. aspirin: 92 [7.8%] vs. 92 [8.0%] failed
grafts; OR: 0.95; 95% CI: 0.67 to 1.33; p = 0.75). Compared with aspirin,
the combination was associated with fewer MACE (12 [2.4%] vs. 16 [3.5%];
hazard ratio [HR]: 0.69; 95% CI: 0.33 to 1.47; p = 0.34), whereas
rivaroxaban alone was not (16 [3.3%] vs. 16 [3.5%]; HR: 0.99, CI: 0.50 to
1.99; p = 0.98). There was no fatal bleeding or tamponade within 30 days
of randomization. Conclusion(s): The combination of rivaroxaban 2.5
mg twice daily plus aspirin or rivaroxaban 5 mg twice daily alone compared
with aspirin alone did not reduce graft failure in patients with recent
CABG surgery, but the combination of rivaroxaban 2.5 mg twice daily plus
aspirin was associated with similar reductions in MACE, as observed in the
larger COMPASS trial. (Cardiovascular OutcoMes for People Using
Anticoagulation StrategieS [COMPASS]; NCT01776424) Copyright ©
2019 American College of Cardiology Foundation

<61>
Accession Number
625556086
Title
Effects of patient-controlled analgesia with hydromorphone or sufentanil
on postoperative pulmonary complications in patients undergoing thoracic
surgery: A quasi-experimental study 11 Medical and Health Sciences 1103
Clinical Sciences.
Source
BMC Anesthesiology. 18 (1) (no pagination), 2018. Article Number: 192.
Date of Publication: 19 Dec 2018.
Author
Yan G.; Chen J.; Yang G.; Duan G.; Du Z.; Yu Z.; Peng J.; Liao W.; Li H.
Institution
(Yan, Chen, Yang, Duan, Du, Peng, Liao, Li) Department of Anesthesiology,
Anesthesiology of Xinqiao Hospital of Third Military Medical University,
Shapingba District, Chongqing 400037, China
(Yu) Department of Anesthesiology, Xinqiao Hospital, Thoracic Surgery of
Xinqiao Hospital of Third Military Medical University, Shapingba District,
Chongqing 400037, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Objective: To compare the analgesic effects of patient-controlled
intravenous analgesia (PCA) with hydromorphone and sufentanil after
thoracic surgery on postoperative pulmonary complications (PPCs).
 Method(s): A total of 142 patients who were scheduled for thoracic
surgery were randomly allocated to receive PCA with hydromorphone (group
A: experimental group): hydromorphone 0.2 mg/kg + dezocine 0.5 mg/kg +
ramosetron 0.6 mg diluted with normal saline to 200 mL; or with sufentanil
(group B: control group): sufentanil 3.0mug/kg + dezocine 0.5 mg/kg +
ramosetron 0.6 mg diluted with normal saline to 200 mL. The parameters of
intravenous analgesia pump were set as background dose 4 ml/h, PCA dose 1
mL, locking time 15 min. Pain NRS (numerical rating scale), Ramsay
sedation score, nausea or vomiting score were evaluated at 0 h, 6 h, 12 h,
24 h, 48 h after operation. The cases of PPCs (atelectasis, pulmonary
infection, respiratory failure), CRP (C-reaction protein) and inflammatory
cells (white cell count and percentage of neutrophils) and blood gas
analysis at 12 h after operation, length of ICU and postoperative stay
were recorded for each patient. Result(s): Data of 136 patients were
analyzed. Compared with group B (4[IQR:2,2]), the pain NRS in group A
(2[IQR:4,4]) was significantly lower at 6 h after operation (P = 0.000).
The CRP in group A (69.79 +/- 32.13 mg/L) were lower than group B (76.76
+/- 43.42 mg/L) after operation, but the difference was not significant (P
= 0.427). No difference of nausea or vomiting was found between group A
(7.3%) and group B (5.8%) postoperatively (P = 0.999). The PPCs were
happened in 11 patients in group A (16.2%) and 22 patients in group B
(32.4%) and the difference between two groups was significant (P = 0.027).
Seven patients in group A (10.3%) and eighteen patients in group B (26.5%)
had clinical evidence of pneumonia and the difference between two groups
was significant (P = 0.014). The length of ICU and postoperative stay in
group A were 2.73 h and 1.82 days less than group B respectively but the
differences were not significant (P = 0.234, P = 0.186 respectively).
 Conclusion(s): Compared with sufentanil, hydromorphone may provide
better postoperative analgesic effect with less pulmonary complications
for patients undergoing thoracic surgery, and it may accelerate patients'
rehabilitation. Trial registration: Randomized Controlled Trials
ChiCTR1800014282c. Registered 3 January 2018. Copyright © 2018
The Author(s).

<62>
Accession Number
2000873413
Title
A double-blind, randomized controlled trial of gabapentin vs. placebo for
acute pain management in critically ill patients with rib fractures.
Source
Injury. 49 (9) (pp 1693-1698), 2018. Date of Publication: September 2018.
Author
Moskowitz E.E.; Garabedian L.; Harden K.; Perkins-Pride E.; Asfaw M.;
Preslaski C.; Liasia K.N.; Lawless R.; Burlew C.C.; Pieracci F.
Institution
(Moskowitz, Garabedian, Harden, Perkins-Pride, Asfaw, Preslaski, Liasia,
Lawless, Burlew, Pieracci) Denver Health Medical Center, University of
Colorado School of Medicine, United States
Publisher
Elsevier Ltd
Abstract
Introduction: Achieving adequate pain control for rib fractures remains
challenging; prescription of alternatives to narcotics is imperative to
curtail the current opioid epidemic. Although gabapentin has shown promise
following elective thoracic procedures, its efficacy in patients with rib
fractures remains unstudied. We hypothesized that gabapentin, as compared
to placebo, would both improve acute pain control and decrease narcotic
use among critically ill patients with rib fractures. Material(s) and
Method(s): Adult patients admitted to the trauma surgery service from
November 2016 - November 2017 at an urban, Level I trauma center with one
or more rib fractures were randomized to either gabapentin 300 mg thrice
daily or placebo for one month following their injury. Daily numeric pain
scores, opioid consumption, oxygen requirement, respiratory rate, and
incentive spirometry recordings during the index admission, as well as and
one-month quality of life survey data were abstracted. Result(s):
Forty patients were randomized. The groups were well matched with respect
to age, gender, prior narcotic use, tobacco use, and prior respiratory
disease. Although the median RibScore did not differ between groups, the
gabapentin group had a higher median number of ribs fractured as compared
to the placebo group (7 vs. 5, respectively). Degree of pulmonary
contusion and injury severity score were similar between groups. Use of
loco-regional anesthetic modalities did not differ between groups. Daily
numeric pain scores, opioid consumption, oxygen requirement, respiratory
rate, and incentive spirometry recordings were similar between both
groups. No benefit was observed when adding gabapentin to a multi-modal
analgesic regimen for rib fractures. There were no instances of pneumonia,
respiratory failure, or mortality in either group. Hospital and intensive
care unit length of stay were similar between groups. Both overall and
chest-specific quality of life was equivalent between groups at one month
follow-up. Conclusion(s): In this group of critically ill patients
with rib fractures, gabapentin did not improve acute outcomes for up to
one month of treatment. Copyright © 2018 Elsevier Ltd

<63>
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.

<64>
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.

<65>
Accession Number
622684080
Title
Factors associated with non-participation in and dropout from cardiac
rehabilitation programmes: a systematic review of prospective cohort
studies.
Source
European Journal of Cardiovascular Nursing. 18 (1) (pp 38-47), 2019. Date
of Publication: 01 Jan 2019.
Author
Resurreccion D.M.; Moreno-Peral P.; Gomez-Herranz M.; Rubio-Valera M.;
Pastor L.; Caldas de Almeida J.M.; Motrico E.
Institution
(Resurreccion, Motrico) Departamento de Psicologia, Universidad Loyola
Andalucia, Spain
(Moreno-Peral, Motrico) SAMSERAP Group, Primary Care Prevention and Health
Promotion Research Network (RedIAPP), Spain
(Moreno-Peral) SAMSERAP Group, Instituto de Investigacion Biomedica de
Malaga (IBIMA), Spain
(Gomez-Herranz) Departamento de psicologia experimental, Universidad de
Sevilla, Spain
(Rubio-Valera) Research and Development Unit, Institut de Recerca Sant
Joan de Deu, Spain
(Rubio-Valera) Grupo PRISMA, Centro de Investigacion Biomedica en Red
Epidemiologia y Salud Publica, Spain
(Pastor) Unidad Clinica de Cardiologia, Hospital Nuestra Senora de Valme,
Spain
(Caldas de Almeida) Mental Health Department, Universidade Nova de Lisboa,
Portugal
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Although evidence exists for the efficacy of cardiac
rehabilitation programmes to reduce morbidity and mortality among patients
with cardiovascular disease, cardiac rehabilitation programmes are
underused. We aimed systematically to review the evidence from prospective
cohort studies on factors associated with non-participation in and/or
dropping out from cardiac rehabilitation programmes. Method(s):
MedLine, Embase, Scopus, Open Grey and Cochrane Database were searched for
relevant publications from inception to February 2018. Search terms
included (a) coronary heart disease and other cardiac conditions; (b)
cardiac rehabilitation and secondary prevention; and (c) non-participation
in and/or dropout. Databases were searched following the PRISMA statement.
Study selection, data extraction and the assessment of study quality were
performed in duplicate. Result(s): We selected 43 studies with a
total of 63,425 patients from 10 different countries that met the
inclusion criteria. Factors associated with non-participation in and
dropout from cardiac rehabilitation were grouped into six broad
categories: intrapersonal factors, clinical factors, interpersonal
factors, logistical factors, cardiac rehabilitation programme factors and
health system factors. We found that clinical factors, logistical factors
and health system factors were the main factors assessed for
non-participation in cardiac rehabilitation. We also found differences
between the factors associated with non-participation and dropout.
 Conclusion(s): Several factors were determinant for non-participation
in and dropout from cardiac rehabilitation. These findings could be useful
to clinicians and policymakers for developing interventions aimed at
improving participation and completion of cardiac rehabilitation, such as
E-health or home-based delivery programmes. Trial Registration:
International Prospective Register of Systematic Reviews (PROSPERO)
identifier: CRD42016032973. Copyright © The European Society of
Cardiology 2018.

<66>
Accession Number
621493019
Title
Do selective serotonin reuptake inhibitors increase the risk of bleeding
or mortality following coronary artery bypass graft surgery? A
meta-analysis of observational studies.
Source
Perfusion (United Kingdom). 33 (6) (pp 415-422), 2018. Date of
Publication: 01 Sep 2018.
Author
Eckersley M.J.; Sepehripour A.H.; Casula R.; Punjabi P.; Athanasiou T.
Institution
(Eckersley, Sepehripour, Casula, Punjabi, Athanasiou) Department of
Surgery and Cancer, Imperial College London, London, United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: Depressive illness has a high prevalence in patients
undergoing coronary artery bypass graft surgery (CABG). The first line
treatment for depression are selective serotonin reuptake inhibitors
(SSRIs) which inhibit serotonin reuptake in the presynaptic neuronal
membrane and uptake by platelets, inhibiting subsequent serotonin-mediated
platelet activation. This presents a theoretically increased risk of
bleeding and subsequent postoperative mortality. This review aims to
investigate the effects of SSRIs on postoperative bleeding, defined as the
need for transfusions and re-operation for bleeding, as well as 30-day
mortality in patients undergoing CABG. Method(s): Four hundred and
thirty-seven papers were screened with seven meeting the full inclusion
criteria. Result(s): Meta-analysis demonstrated that SSRI use
increased the risk of red blood cell transfusion (odds ratio (OR) = 1.15;
95% confidence interval (CI): 1.06-1.26), but resulted in no difference in
the rate of re-operation for bleeding (OR = 1.07; 95% CI: 0.66-1.74). SSRI
use had no effect on the rates of platelet (OR = 0.93; 95% CI: 0.79-1.09)
or fresh frozen plasma (OR = 0.96; 95% CI: 0.74-1.24) transfusion nor on
the mortality rate (OR =1.03; 95 CI: 0.90-1.17). Conclusion(s): This
review demonstrates that SSRIs are largely safe in cardiac surgery as no
increase in mortality was observed. However, there is a significantly
raised chance of red blood cell transfusion. The heterogeneous nature of
the current evidence base highlights the need for further research into
SSRIs and whether any effect on patient outcomes in cardiac surgery
occurs. Copyright © The Author(s) 2018.

<67>
Accession Number
625448685
Title
Permanent pacemaker implantation and paravalvular leak rates following
sutureless aortic valve operations.
Source
Journal of Cardiac Surgery. 33 (12) (pp 808-817), 2018. Date of
Publication: December 2018.
Author
Lazkani M.; Yerasi C.; Prakash S.; Pershad A.; Fang K.
Institution
(Lazkani) University of Colorado Health, Medical Center of the Rockies,
Loveland, CO, United States
(Yerasi) St. Joseph's Medical Center, Phoenix, AZ, United States
(Prakash, Pershad, Fang) University of Arizona, Banner University Medical
Center, Phoenix, AZ, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Permanent pacemaker (PPM) implantation and paravalvular leak
(PVL) rates after sutureless aortic valve replacement (SuAVR) vary widely.
The aim of this meta-analysis was to examine the incidence of new PPM
implantation and PVL after SuAVR. Method(s): Studies evaluating PPM
implantation and PVL rates after SuAVR were searched in Medline/PubMed,
Ovid Journals, Clinicaltrials.gov, Cochrane central register of controlled
trials and database. Studies with a sample size >=10 were included in this
analysis. Pooled proportions were calculated using both the fixed and
random-effects models. The heterogeneity among studies was tested using
I2 statistic. The study design was written in accordance with
PRISMA guidelines. Result(s): Thirty studies involving 3993 patients
with a median follow-up of 12 months were included. The median age was 77
years and males constituted 50%. There was a history of stroke and
coronary artery disease in 6% and 31% of the population. Pooled
proportions demonstrate a cumulative postoperative PPM rate of 8.5% (95%
confidence interval [CI] 7.6-9.5%, I2 = 68.8%) and the overall
rate of any PVL was 4.2% (95%CI 3.4-5%, I2 = 76.1%) across all
major SuAVR devices. The rate of severe PVL was only 0.4% (95%CI 0.2-0.7%,
I2 = 0%) at discharge and 0.5% (95%CI 0.2-0.9%, I2 =
0%) at 12 months. Conclusion(s): In SuAVR prostheses implanted in
this meta-analysis, the postoperative permanent pacemaker rate was higher
(8.5%) than reported for non-SuAVR prosthesis. While the overall PVL rate
was 4.2%, the incidence of severe PVL was only 0.4% at discharge and
remained stable at 0.5% at 12 months. Copyright © 2018 Wiley
Periodicals, Inc.

<68>
Accession Number
625447318
Title
Innominate artery cannulation in aortic surgery: A systematic review.
Source
Journal of Cardiac Surgery. 33 (12) (pp 818-825), 2018. Date of
Publication: December 2018.
Author
Harky A.; Wong C.H.M.; Chan J.S.K.; Zaki S.; Froghi S.; Bashir M.
Institution
(Harky, Zaki) Department of Vascular Surgery, Countess of Chester
Hospital, Chester, United Kingdom
(Wong, Chan) Faculty of Medicine, The Chinese University of Hong Kong,
Shatin, New Territories, Hong Kong
(Froghi) Department of Surgery, Imperial College NHS Trust, Hammersmith
Hospital, London, United Kingdom
(Bashir) Department of Aortovascular Surgery, Manchester Royal Infirmary,
Manchester, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: The innominate artery is considered an alternative site for
establishing cardiopulmonary bypass in surgical procedures involving the
thoracic aorta. This systematic review examines the use of innominate
artery cannulation in aortic surgery. Method(s): A systematic
literature search was undertaken among the four major databases (PubMed,
Embase, Scopus, and Ovid) to identify all studies that utilized innominate
artery cannulation for establishing cardiopulmonary bypass and providing
cerebral perfusion in thoracic aortic surgery. The data were reviewed up
to September 2018. Result(s): Acute type A aortic dissection
contributed to 36% (n = 818) of the total 2,290 patients. 31.5% (n = 719)
underwent surgery on the aortic root only; 54.5% (n = 1246) had ascending
and hemi-arch replacement, while 11.5% had total aortic arch replacement
and 2.5% had a frozen elephant trunk inserted. Postoperative stroke rate
was 1.25% (n = 28), temporary neurological deficit was 4.8% (n = 111).
All-cause 30-day mortality rate was 2.7% (n = 61). Conclusion(s):
Innominate artery cannulation is a safe technique in patients who undergo
thoracic aortic surgery. It can be utilized, in selected cases, as a
reliable route for establishing cardiopulmonary bypass and maintaining
cerebral perfusion. Copyright © 2018 Wiley Periodicals, Inc.

<69>
[Use Link to view the full text]
Accession Number
621052369
Title
Optimizing the Safety Profile of Everolimus by Delayed Initiation in de
Novo Heart Transplant Recipients: Results of the Prospective Randomized
Study EVERHEART.
Source
Transplantation. 102 (3) (pp 493-501), 2018. Date of Publication: 01 Mar
2018.
Author
Potena L.; Pellegrini C.; Grigioni F.; Amarelli C.; Livi U.; MacCherini
M.; Masciocco G.; Faggian G.; Lilla Della Monica P.; Gerosa G.; Marraudino
N.; Corda M.; Boffini M.; De Santo L.S.; Tona F.; Poggio D.; Savini C.;
Ambrogi F.; Bernazzali S.; D'Armini A.M.; Mattiucci G.; Rinaldi M.;
Ribezzo M.; Porcu M.; Musumeci F.; Gambino A.; Maiello C.; Frigerio M.;
Guzzi G.; Forni A.; Capone G.
Institution
(Potena, Grigioni, Savini) Heart and Lung Transplant Program,
Cardiovascular Department, Academic Hospital S. Orsola-Malpighi, Building
21, via Massarenti, 9, Bologna 40138, Italy
(Pellegrini, D'Armini, Mattiucci) Cardiac Surgery Department, University
of Pavia-Hospital Policlinico, San Matteo, Pavia, Italy
(Amarelli, Maiello) Transplant Surgery Department, Hospitals
Colli-Monaldi, Naples, Italy
(Livi, Guzzi) Cardiothoracic Surgery Department, Academic Hospital S.
Maria della Misericordia, Udine, Italy
(MacCherini, Bernazzali) Heart Transplant Surgery Unit, Academic Hospital
Senese, Siena, Italy
(Masciocco, Frigerio) Cardiology 2-Cardiac Insufficiency and
Transplantation Department, Academic Hospital Niguarda, Milan, Italy
(Faggian, Forni) Cardiac Surgery Unit, Academic Hospital Civile Maggiore,
Verona, Italy
(Lilla Della Monica, Musumeci) Cardiac Surgery Unit, Hospital San Camillo
Forlanini, Rome, Italy
(Gerosa, Poggio, Gambino) Cardiac Surgery Unit, Academic Hospital of
Padova, Padua, Italy
(Marraudino, Capone) Cardiac Surgery Unit, Hospital of Bari, Bari, Italy
(Corda, Porcu) Cardiology Unit, Hospital G. Brotzu, San Michele, Cagliari,
Italy
(Boffini, Rinaldi, Ribezzo) Cardiac Surgery Unit, Hospital Molinette,
Turin, Italy
(De Santo) Hospital Monaldi, Naples, Italy
(Tona) Hospital of Monza, Monza, Italy
(Ambrogi) University of Milan, Milan, Italy
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background Although everolimus potentially improves long-term heart
transplantation (HTx) outcomes, its early postoperative safety profile had
raised concerns and needs optimization. Methods This 6-month, open-label,
multicenter randomized trial was designed to compare the cumulative
incidence of a primary composite safety endpoint comprising wound healing
delays, pericardial effusion, pleural effusion needing drainage, and renal
insufficiency events (estimated glomerular filtration rate <=30/mL/min per
1.73 m2) in de novo HTx recipients receiving immediate
everolimus (EVR-I) (<=144 hours post-HTx) or delayed everolimus (EVR-D)
(4-6 weeks post-HTx with mycophenolate mofetil as a bridge) with
reduced-dose cyclosporine A. Cumulative incidence of biopsy-proven
rejection >= 2R, rejection with hemodynamic compromise, graft loss, or
death was the secondary composite efficacy endpoint. Results Overall, 181
patients were randomized to the EVR-I (n = 89) or EVR-D (n = 92) arms.
Incidence of primary safety endpoint was higher for EVR-I than EVR-D arm
(44.9% vs 32.6%; P = 0.191), mainly driven by a higher rate of pericardial
effusion (33.7% vs 19.6%; P = 0.04); wound healing delays, acute renal
insufficiency events, and pleural effusion occurred at similar frequencies
in the study arms. Efficacy failure was not significantly different in
EVR-I arm versus EVR-D arm (37.1% vs 28.3%; P = 0.191). Three patients in
the EVR-I arm and 1 in the EVR-D arm died. Incidence of clinically
significant adverse events leading to discontinuation was higher in EVR-I
arm versus EVR-D arm (P = 0.02). Conclusions Compared with immediate
initiation, delayed everolimus initiation appeared to provide a clinically
relevant early safety benefit in de novo HTx recipients, without
compromising efficacy. Copyright © 2017 The Author(s). Published
by Wolters Kluwer Health, Inc.

<70>
Accession Number
617639333
Title
Outcome after percutaneous edge-to-edge mitral repair for functional and
degenerative mitral regurgitation: A systematic review and meta-analysis.
Source
Heart. 104 (4) (pp 306-312), 2018. Date of Publication: 01 Feb 2018.
Author
Chiarito M.; Pagnesi M.; Martino E.A.; Pighi M.; Scotti A.; Biondi-Zoccai
G.; Latib A.; Landoni G.; Mario C.D.; Margonato A.; Maisano F.; Feldman
T.; Alfieri O.; Colombo A.; Godino C.
Institution
(Chiarito) Interventional Cardiology Unit, Humanitas Clinical and Research
Center, Rozzano, Italy
(Pagnesi, Scotti, Latib, Margonato, Colombo, Godino) Interventional
Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina 60,
Milan 20132, Italy
(Martino, Landoni) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Pighi, Mario) Department of Cardiology, NIHR Biomedical Research Unit,
Royal Brompton Hospital, London, United Kingdom
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Roma, Department of
AngioCardioNeurology, Pozzilli, Latina, Italy
(Latib, Colombo) Interventional Cardiology Unit, EMO-GVM Centro Cuore
Columbus, Milan, Italy
(Landoni, Margonato, Alfieri, Colombo) Vita-Salute San Raffaele
University, Milan, Italy
(Maisano) Universitats Spital Zurich, University Heart Center, Zurich,
Switzerland
(Feldman) NorthShore University HealthSystem, Evanston, IL, United States
(Alfieri) Cardiac Surgery Unit, San Raffaele Hospital, Milan, Italy
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives Differences in terms of safety and efficacy of percutaneous
edge-to-edge mitral repair between patients with functional and
degenerative mitral regurgitation (MR) are not well established. We
performed a systematic review and meta-analysis to clarify these
differences. Methods PubMed, EMBASE, Google scholar database and
international meeting abstracts were searched for all studies about
MitraClip. Studies with <25 patients or where 1-year results were not
delineated between MR aetiology were excluded. This study is registered
with PROSPERO. Results A total of nine studies investigating the mid-term
outcome of percutaneous edge-to-edge repair in patients with functional
versus degenerative MR were included in the meta-analysis (n=2615). At 1
year, there were not significant differences among groups in terms of
patients with MR grade<=2 (719/1304 vs 295/504; 58% vs 54%; risk ratio
(RR) 1.12; 95% CI: 0.86 to 1.47; p=0.40), while there was a significantly
lower rate of mitral valve re-intervention in patients with functional MR
compared with those with degenerative MR (77/1770 vs 80/818; 4% vs 10%; RR
0.60; 95% CI: 0.38 to 0.97; p=0.04). One-year mortality rate was 16%
(408/2498) and similar among groups (RR 1.26; 95% CI: 0.90 to 1.77;
p=0.18). Functional MR group showed significantly higher percentage of
patients in New York Heart Association class III/IV (234/1480 vs 49/583;
16% vs 8%; p<0.01) and re-hospitalisation for heart failure (137/605 vs
31/220; 23% vs 14%; p=0.03). No differences were found in terms of single
leaflet device attachment (25/969 vs 20/464; 3% vs 4%; p=0.81) and device
embolisation (no events reported in both groups) at 1 year. Conclusions
This meta-analysis suggests that percutaneous edge-to-edge repair is
likely to be an efficacious and safe option in patients with both
functional and degenerative MR. Large, randomised studies are ongoing and
awaited to fully assess the clinical impact of the procedure in these two
different MR aetiologies. Copyright © Article author(s) (or their
employer(s) unless otherwise stated in the text of the article) 2018.

<71>
Accession Number
625700087
Title
Caudal and epidural blocks in infants and small children: Historical
perspective and ultrasound-guided approaches.
Source
Korean Journal of Anesthesiology. 71 (6) (pp 430-439), 2018. Date of
Publication: December 2018.
Author
Kil H.K.
Institution
(Kil) Department of Anesthesiology and Pain Medicine, Severance Hospital,
Yonsei University Health System, Seoul, South Korea
Publisher
Korean Society of Anesthesiologists
Abstract
In infants and small children, ultrasound (US) guidance provides ample
anatomical information to perform neuraxial blocks. We can measure the
distance from the skin to the epidural space in the US image and can refer
to it during needle insertion. We may also visualize the needle or a
catheter during real-time US-guided epidural catheterization. In cases
where direct needle or catheter visualization is difficult, US allows
predicting successful puncture and catheterization using surrogate
markers, such as dura mater displacement, epidural space widening due to
drug injection, or mass movement of the drug within the caudal space.
Although many experienced anesthesiologists still prefer to use
conventional techniques, prospective randomized controlled trials using US
guidance are providing increasing evidence of its advantages. The use of
US-guided regional block will gradually become widespread in infants and
children. Copyright © The Korean Society of Anesthesiologists,
2018.

<72>
Accession Number
620309141
Title
An Invasive vs a Conservative Approach in Elderly Patients with
Non-ST-Segment Elevation Myocardial Infarction: Systematic Review and
Meta-Analysis.
Source
Canadian Journal of Cardiology. 34 (3) (pp 330-332), 2018. Date of
Publication: March 2018.
Author
Saraswat A.; Rahman A.; Singh K.
Institution
(Saraswat, Rahman, Singh) Department of Cardiology, Gold Coast University
Hospital, Gold Coast, Queensland, Australia
(Rahman, Singh) Department of Medicine, Griffith University, Gold Coast,
Queensland, Australia
(Singh) Department of Medicine, University of Adelaide, Adelaide, South
Australia, Australia
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Elderly (>= 75 years) patients form a large sub-group of
non-ST-segment elevation myocardial infarction (NSTEMI) population but are
vastly under-represented in trials. Thus, the benefits of an early
angiography in the elderly remain unclear. In this systematic review, we
compared outcomes of "invasive" and "conservative" strategies of NSTEMI
management in elderly patients. Method(s): A comprehensive search of
major databases was performed. We included comparative studies of any
design that enrolled patients >= 75 years, and where outcomes of both
strategies of NSTEMI management were available. Result(s): Among the
included studies (3 randomized and 6 observational), there were 6340
patients in the "invasive" group and 13,358 patients in the "conservative"
group. The 12-month mortality rate (odds ration [OR], 0.45; p < 0.00001),
the 30-day mortality (OR, 0.50; p = 0.0009), and events of stroke (OR,
0.42; p < 0.00001) were significantly lower in the invasive group. Major
bleeding was higher in the invasive cohort (OR, 1.63; p = 0.03). Analysis
of randomised studies showed lower reinfarction with invasive approach at
12 months (p = 0.0001). Significant heterogeneity was noted among studies
according to study design. Conclusion(s): The overall benefit with
invasive strategy comes from the data of observational studies that are
prone to selection bias. We believe that there is a need for a large
randomized study in the elderly patients regarding management of
NSTEMI. Copyright © 2017 Canadian Cardiovascular Society

<73>
Accession Number
622736154
Title
Should kissing balloon inflation after main vessel stenting be routine in
the one-stent approach? A systematic review and meta-analysis of
randomized trials.
Source
PLoS ONE. 13 (6) (no pagination), 2018. Article Number: e0197580. Date of
Publication: June 2018.
Author
Zhong M.; Tang B.; Zhao Q.; Cheng J.; Jin Q.; Fu S.
Institution
(Zhong, Tang, Zhao, Cheng, Jin, Fu) Department of Cardiology, Jinhua
Municipal General Hospital, Jinhua, Zhejiang, China
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
The KBI (kissing balloon inflation) technique is considered the default
strategy for the two-stent approach in real world practice. Studies
comparing KBI and No-KBI in patients undergoing the one-stent approach
have reported conflicting results. The meta-analysis was performed to
compare the clinical outcomes of the KBI strategy and the No-KBI strategy
for coronary bifurcation lesions in the one-stent approach. Five
randomized studies were included, and a total of 1264 patients were
involved in the meta-analysis. The primary outcome was cardiac death. The
secondary end points were stent thrombosis, MI (myocardial infarction),
target lesion revascularization (TLR), target vessel revascularization
(TVR), and main vessel and side branch restenosis. Compared with the
No-KBI strategy, the KBI strategy was associated with a significant
reduction in side branch restenosis (OR: 0.44, 95% CI: 0.30-0.64,
p<0.001). A high risk of main vessel restenosis was found in the KBI group
(OR: 2.96, 95% CI: 1.74-5.01, p<0.001). There were no significant
differences in rates of cardiac death (OR: 1.89, 95% CI: 0.60-5.95, p =
0.28), stent thrombosis (OR: 0.98, 95% CI: 0.19-4.94, p = 0.98), MI (OR:
0.68, 95% CI: 0.33-1.44, p = 0.30), TLR (OR 1.14, 95% CI 0.68-1.90, p =
0.62), or TVR (OR 1.27, 95% CI 0.75-2.16, p = 0.38). Compared with the
No-KBI strategy, the KBI strategy reduced the incidence of side branch
restenosis and increased the risk of main branch restenosis in the
one-stent approach. However, the clinical outcomes were similar between
the KBI and No-KBI groups. Copyright © 2018 Zhong et al. This is
an open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<74>
Accession Number
620649618
Title
Hybrid coronary revascularization: Time for a new comparator?.
Source
Catheterization and Cardiovascular Interventions. 91 (2) (pp 213-214),
2018. Date of Publication: 01 Feb 2018.
Author
Misumida N.; Moliterno D.J.
Institution
(Misumida, Moliterno) Gill Heart Institute and Division of Cardiovascular
Medicine, University of Kentucky, Lexington, KY, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
The present meta-analysis found no significant difference between hybrid
coronary revascularization (HCR) and bypass surgery (CABG) regarding
intermediate-term major adverse cardiac and cerebrovascular events. HCR is
feasible, historically with higher revascularization rates but less
perioperative morbidity With a comparable frequency of repeat
revascularization between current-generation drug-eluting stents and CABG,
future trials of HCR are considering multi-vessel PCI as the new
comparator. Copyright © 2018 Wiley Periodicals, Inc.

<75>
Accession Number
620775591
Title
Self-Management Interventions for Women With Cardiac Pain: A Systematic
Review and Meta-analysis.
Source
Canadian Journal of Cardiology. 34 (4) (pp 458-467), 2018. Date of
Publication: April 2018.
Author
Parry M.; Bjornnes A.K.; Victor J.C.; Ayala A.P.; Lenton E.; Clarke H.;
Harvey P.; Lalloo C.; McFetridge-Durdle J.; McGillion M.H.; Price J.;
Stinson J.; Watt-Watson J.
Institution
(Parry, Bjornnes, Stinson, Watt-Watson) Lawrence S Bloomberg Faculty of
Nursing, University of Toronto, Toronto, Ontario, Canada
(Bjornnes) Institute of Nursing and Health Promotion, Oslo and Akershus
University College of Applied Sciences, Oslo, Norway
(Victor) Institute of Health Policy, Management and Evaluation, University
of Toronto, Toronto, Ontario, Canada
(Ayala, Lenton) Gerstein Science Information Centre, University of
Toronto, Toronto, Ontario, Canada
(Clarke) Pain Research Unit, University Health Network, Toronto, Ontario,
Canada
(Harvey) Department of Medicine, Women's College Hospital, Toronto,
Ontario, Canada
(Lalloo, Stinson) The Hospital for Sick Children, The Peter Gilgan Centre
for Research and Learning, Toronto, Ontario, Canada
(McFetridge-Durdle) College of Nursing, Florida State University,
Tallahassee, Florida, United States
(McGillion) School of Nursing, McMaster University, Hamilton, Ontario,
Canada
(Price) Women's College Research Institute, Women's College Hospital,
Toronto, Ontario, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Cardiac pain is considered the primary indicator of coronary
artery disease (CAD). Existing reviews lack appropriate numbers of women
or sex-based subgroup analyses, or both; thus, the benefits of
self-management (women with cardiac pain actively participating in their
own care and treatment) remain uncertain. Method(s): Using methods
described by the Evidence for Policy and Practice Information and
Co-ordinating Centre at the Institute of Education, 7 databases were
systematically searched to examine and synthesize the evidence on
self-management interventions for women with cardiac pain and cardiac pain
equivalents, such as fatigue, dyspnea, and exhaustion. Result(s): Our
search yielded 22,402 article titles and abstracts. Of these, 57
randomized controlled trials were included in a final narrative synthesis,
comprising data from 13,047 participants, including 5299 (41%) women.
Self-management interventions targeting cardiac pain in women compared
with a control population reduced (1) cardiac pain frequency and cardiac
pain proportion (obstructive and nonobstructive CAD), (2) fatigue at 12
months, and (3) dyspnea at 2 months. There was no evidence of group
differences in postprocedural (percutaneous coronary intervention or
cardiac surgery) pain. Results indicated that self-management
interventions for cardiac pain were more effective if they included a
greater proportion of women (standardized mean difference [SMD], -0.01;
standard error, 0.003; P = 0.02), goal setting (SMD, -0.26; 95% confidence
interval [CI], -0.49 to -0.03), and collaboration/support from health care
providers (SMD, -0.57; 95% CI, -1.00 to -0.14). Conclusion(s): The
results of this review suggest that self-management interventions reduce
cardiac pain and cardiac pain equivalents. Copyright © 2017
Canadian Cardiovascular Society

<76>
Accession Number
621948966
Title
The use of viscoelastic haemostatic assays in non-cardiac surgical
settings: A systematic review and meta-analysis.
Source
Blood Transfusion. 16 (3) (pp 224-226), 2018. Date of Publication: 2018.
Author
De Cristofaro R.
Institution
(De Cristofaro) Institute of Internal Medicine and Geriatrics, Haemostasis
and Thrombosis Centre, Fondazione Policlinico Universitario Agostino
Gemelli, Area of Haematological Sciences, Catholic University of the
Sacred Heart, School of Medicine, Largo Francesco Vito 1, Rome 00168,
Italy
Publisher
Edizioni SIMTI (E-mail: luisa.stea@bloodtransfusion.it)

<77>
Accession Number
616834912
Title
Intraoperative dexamethasone does not increase the risk of postoperative
wound infection: A propensity score-matched post hoc analysis of the
ENIGMA-II trial (EnDEX).
Source
British Journal of Anaesthesia. 118 (2) (pp 190-199), 2017. Date of
Publication: 01 Feb 2017.
Author
Corcoran T.; Kasza J.; Short T.G.; Chan M.T.V.; Forbes A.; Myles P.;
Wallace S.; Galagher W.; Farrington C.; Ditoro A.; Peyton P.; Baulch S.;
Sidiropoulos S.; Bulach R.; Bryant D.; O'Loughlin E.; Mitteregger V.;
Bolsin S.; Osborne C.; McRae R.; Backstrom M.; Leslie K.; Cotter R.; Paech
M.; March S.; Silbert B.; Said S.; Halliwell R.; Cope J.; Fahlbusch D.;
Crump D.; Thompson G.; Jefferies A.; McCulloch T.; Reeves M.; Buckley N.;
Tidyl T.; Schricker T.; Lattermann R.; Iannuzzi D.; Beattie S.; Carroll
J.; Jacka M.; Bryden C.; Badner N.; Chan M.; Tsang M.; Cheng B.; Fong A.;
Chu L.; Koo E.; Mohd N.; Ming L.E.; Yin Wang C.; Campbell D.; McAllister
D.; Walker S.; Olliff S.; Kennedy R.; Eldawlatly A.; Alzahrani T.; Chua
N.; Haller G.; Pichon I.; Sneyd R.; McMillan H.; Parkinson I.; Rousseau
G.; Brennan A.; Balaji P.; Cupitt J.; Nightingale J.; Kunst G.; Dickinson
M.; Saran T.; Subramaniam B.; Banner-Godspeed V.; Sessler D.; Liu J.; Kurz
A.; Hesler B.; Fu A.; Egan C.; Fiffick A.; Hutcherson M.; Turan A.; Naylor
A.; Obal D.; Cooke E.
Institution
(Corcoran, Paech) Department of Anaesthesia and Pain Medicine, Royal Perth
Hospital, Perth, WA, Australia
(Corcoran, O'Loughlin, Paech) School of Medicine and Pharmacology,
University of Western Australia, Perth, WA, Australia
(Corcoran) Western Australia Health Department, Perth, WA, Australia
(Corcoran, Kasza, Leslie, Forbes, Myles) Department of Epidemiology and
Preventive Medicine, Monash University, Melbourne, VIC, Australia
(Short) Department of Anaesthesia, Auckland City Hospital, Park Road,
Grafton, Auckland, New Zealand
(O'Loughlin) Department of Anaesthesia and Pain Medicine, Fiona Stanley
Hospital, Perth, WA, Australia
(Chan) Department of Anaesthesia and Intensive Care, Chinese University of
Hong Kong, Hong Kong Special Administrative Region, China
(Leslie) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, VIC, Australia
(Leslie) Anaesthesia Perioperative and Pain Medicine Unit, Department of
Pharmacology and Therapeutics, University of Melbourne, Melbourne, VIC,
Australia
(Myles) Department of Anaesthesia and Perioperative Medicine, Alfred
Hospital, Melbourne, VIC, Australia
(Wallace, Galagher, Farrington, Ditoro) AustinAustralia
(Peyton, Baulch, Sidiropoulos) DandenongAustralia
(Bulach, Bryant) Fremantle, Australia
(O'Loughlin, Mitteregger) Geelong Hospital, Australia
(Bolsin, Osborne) Monash Medical Centre, Australia
(McRae, Backstrom) Royal Melbourne Hospital, Australia
(Leslie, Cotter) Royal Perth Hospital, Australia
(Paech, March) St Vincent's Hospital, Australia
(Silbert, Said) Westmead Hospital, Australia
(Halliwell, Cope) Calvary WakefieldAustralia
(Fahlbusch, Crump) Peter MacCallum Cancer Centre, Australia
(Thompson) Western Hospital, Australia
(Jefferies) Royal Prince Alfred, Australia
(McCulloch) North West Regional Hosptial, Australia
(Reeves) McMaster University, Canada
(Buckley, Tidyl) Royal Victoria Hospital, Canada
(Schricker, Lattermann, Iannuzzi) Toronto General Hospital, Canada
(Beattie, Carroll) University of Alberta Hospital, Canada
(Jacka, Bryden) London Health Sciences, Canada
(Badner) Prince of Wales, Hong Kong
(Chan) ANZCA Trials Group Member, Hong Kong
(Tsang) Tuen Mun Hospital, Hong Kong
(Cheng, Fong) ACM Fong, Hong Kong
(Chu, Koo) Nethersole Eastern Hospital, Hong Kong
(Mohd, Ming) Hospital Kuala Lumpur, Malaysia
(Yin Wang) Malaya Medical Centre, Malaysia
(Campbell, McAllister) Auckland Hospital, New Zealand
(Walker, Olliff) Middlemore Hospital, New Zealand
(Kennedy) Christchurch Hospital, New Zealand
(Eldawlatly, Alzahrani) King Saud University Hospital, Saudi Arabia
(Chua) Tan Tock Seng Hospital, Singapore
(Haller, Pichon) Geneva University Hospital, Switzerland
(Sneyd, McMillan) Plymouth NHS Trust, France
(Parkinson) Royal Lancaster Infirmary, United Kingdom
(Rousseau) North Devon District Hospital, United Kingdom
(Brennan) Bradford Teaching Hospital, United Kingdom
(Balaji) Hull Royal Infirmary, United Kingdom
(Cupitt) Blackpool Victoria Hospital, United Kingdom
(Nightingale) Portsmouth Hospital, United Kingdom
(Kunst) King's College Hospital, United Kingdom
(Dickinson) Royal Surrey County Hospital, United Kingdom
(Saran) University Hospitals, Coventry and Warwickshire, United Kingdom
(Subramaniam, Banner-Godspeed) Beth Israel Deaconess Medical Center,
United States
(Sessler, Liu, Kurz, Hesler, Fu, Egan, Fiffick, Hutcherson, Turan, Naylor)
Cleveland Clinic, United States
(Obal, Cooke) Louisville Medical Centre, United States
Publisher
Oxford University Press
Abstract
Background. In a post hoc analysis of the ENIGMA-II trial, we sought to
determine whether intraoperative dexamethasone was associated with adverse
safety outcomes. Methods. Inverse probability weighting with estimated
propensity scores was used to determine the association of dexamethasone
administration with postoperative infection, quality of recovery, and
adverse safety outcomes for 5499 of the 7112 non-cardiac surgery subjects
enrolled in ENIGMA-II. Results. Dexamethasone was administered to 2178
(40%) of the 5499 subjects included in this analysis and was not
associated with wound infection [189 (8.7%) vs 275 (8.3%); propensity
score-adjusted relative risk (RR) 1.10; 95% confidence interval (CI)
0.89-1.34; P=0.38], severe postoperative nausea and vomiting on day 1 [242
(7.3%) vs 189 (8.7%); propensity score-adjusted RR 1.06; 95% CI 0.86-1.30;
P=0.59], quality of recovery score [median 14, interquartile range (IQR)
12-15, vs median 14, IQR 12-16, P=0.10), length of stay in the
postanaesthesia care unit [propensity score-adjusted median (IQR) 2.0
(1.3, 2.9) vs 1.9 (1.3, 3.1), P=0.60], or the primary outcome of the main
trial. Dexamethasone administration was associated with a decrease in
fever on days 1-3 [182 (8.4%) vs 488 (14.7%); RR 0.61; 95% CI 0.5-0.74;
P<0.001] and shorter lengths of stay in hospital [propensity
score-adjusted median (IQR) 5.0 (2.9, 8.2) vs 5.3 (3.1, 9.1), P<0.001].
Neither diabetes mellitus nor surgical wound contamination status altered
these outcomes. Conclusion. Dexamethasone administration to high-risk
non-cardiac surgical patients did not increase the risk of postoperative
wound infection or other adverse events up to day 30, and appears to be
safe in patients either with or without diabetes mellitus. Clinical trial
registration. NCT00430989. Copyright © 2017 The Author.

<78>
Accession Number
2001212006
Title
Does the position of the drains after open heart surgery make a
difference?"A clinical randomized trial".
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 26 (4) (pp
281-286), 2018. Date of Publication: December 2018.
Author
Refat A.M.; Abdelsayed A.
Institution
(Refat, Abdelsayed) Department of Cardiothoracic Surgery, Faculty of
Medicine, Zagazig University, Sharqia, Egypt
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Pericardial effusion remains a common clinical problem after
cardiac surgery. Adequate postoperative drainage can be obtained by
posterior pericardial drainage through a posterior tube, along with
conventional drainage of the anterior mediastinum. Method(s): Three
hundred patients, who underwent cardiac surgery, were enrolled in a
prospectively randomized study. Group A (150 patients) had two
retrosternal drains and group B (150 patients) had two retrosternal
drains, one retrosternal and one retro-cardiac. Result(s): Early
pericardial effusion developed in 5 (3.4%) patients in group A and 2
(2.9%) in group B (P = 0.76). Early posterior pericardial effusion
occurred in 5 (3.4%) patients of group A whereas no patients had early
posterior pericardial effusion in Group B (P = 0.024). Fourteen (9.5%)
patients from group A had late posterior pericardial effusion, compared to
1 (0.7%) patient from group B (P = 0.001). Three patients from group A had
late posterior cardiac tamponade whereas no patients from group B had late
posterior cardiac tamponade (P = 0.013). Conclusion(s): The use of a
drain placed in the posterior pericardial cavity is simple and safe and
appears to be sufficient for posterior drainage. This reduces not only the
high incidence of late significant pericardial effusion but also reduce
early pericardial effusion and tamponade. Copyright © 2018 The
Egyptian Society of Cardio-thoracic Surgery

<79>
Accession Number
2001424632
Title
Bioprosthetic Valve Performance After Transcatheter Aortic Valve
Replacement With Self-Expanding Versus Balloon-Expandable Valves in Large
Versus Small Aortic Valve Annuli: Insights From the CHOICE Trial and the
CHOICE-Extend Registry.
Source
JACC: Cardiovascular Interventions. 11 (24) (pp 2507-2518), 2018. Date of
Publication: 24 December 2018.
Author
Abdelghani M.; Mankerious N.; Allali A.; Landt M.; Kaur J.; Sulimov D.S.;
Merten C.; Sachse S.; Mehilli J.; Neumann F.-J.; Frerker C.; Kurz T.;
El-Mawardy M.; Richardt G.; Abdel-Wahab M.
Institution
(Abdelghani, Mankerious, Allali, Landt, Kaur, Sulimov, Merten, Sachse,
Richardt, Abdel-Wahab) The Heart Center, Segeberger Kliniken (Academic
Teaching Hospital of the Universities of Kiel, Lubeck, and Hamburg), Bad
Segeberg, Germany
(Abdelghani) Cardiology Department, The Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Mehilli) Munich University Center, Ludwig-Maximilians University and
German Centre for Cardiovascular Research (DZHK), partner site Munich
Heart Alliance, Munich, Germany
(Neumann) Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
(Frerker) Cardiology Department, Asklepios Clinic St. Georg, Hamburg,
Germany
(Kurz) Cardiology Department, Lubeck University Hospital, Lubeck, Germany
(El-Mawardy) Cardiology Department, Vivantes Wenckebach Hospital, Berlin,
Germany
(Abdel-Wahab) Cardiology Department, Heart Center Leipzig - University
Hospital, Leipzig, Germany
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to compare self-expanding and
balloon-expandable transcatheter heart valves (THVs) in large versus small
aortic valve annuli. Background(s): The degree of THV oversizing
varies according to annular size, and this can modify the hemodynamic
performance of self-expanding and balloon-expandable THVs. Method(s):
Patients undergoing transcatheter aortic valve replacement in the
randomized CHOICE (Comparison of Transcatheter Heart Valves in High Risk
Patients With Severe Aortic Stenosis: Medtronic CoreValve vs Edwards
SAPIEN XT) trial (CoreValve [CV], n = 120; SAPIEN XT [SXT], n = 121) and
the nonrandomized CHOICE-Extend registry (Evolut R [ER], n = 100; SAPIEN 3
[S3], n = 334) were compared for THV performance by echocardiography (in
all patients) and by cardiac magnetic resonance imaging (MRI) regurgitant
fraction (RF) (in a subgroup of patients). Patients were stratified
according to aortic valve annular mean diameter into those with large (>23
mm) or small (<=23 mm) annuli. Result(s): THV percentage oversizing
was 19.1 +/- 6.4% with the CV, 11.4 +/- 7.0% with the SXT, 18.8 +/- 4.8%
with the ER, and 3.7 +/- 5.5% with the S3. Transvalvular mean pressure
gradient was lower with the CV and ER than with the SXT and S3 in both the
large and small annulus groups. In the randomized CHOICE trial, moderate
to severe prosthetic valve regurgitation (PVR) was more with the CV than
the SXT in large annuli (15.1% vs. 0.0%; p = 0.002; MRI RF: 10.5 +/- 10.2%
vs. 4.4 +/- 4.5%; p = 0.036) but not in small annuli (0.0% vs. 5.7%; p =
0.50; MRI RF: 4.0 +/- 4.1% vs. 4.0 +/- 3.4%; p = 0.98). In the
CHOICE-Extend registry, moderate to severe PVR occurred in 2 patients, and
any PVR was not significantly different between the ER and the S3 in large
(41.7% vs. 32.5%; p = 0.24) or small (47.1% vs. 43.8%; p = 0.84) annuli.
MRI RF was not different in large annuli (5.0 +/- 3.8% vs. 5.0 +/- 6.1%; p
= 0.99) but was significantly lower with the ER than the S3 in small
annuli (2.9 +/- 2.3% vs. 4.8 +/- 3.7%; p = 0.023). On multivariate
analysis, transcatheter aortic valve replacement with the ER in small
annuli was associated with a lower rate of prosthesis-patient mismatch
than with the S3, with no increased risk for PVR. Conclusion(s):
Older-generation balloon-expandable THVs were associated with less PVR
than self-expanding THVs in patients with large but not small annuli. The
next-generation self-expanding THV has improved sealing in patients with
large annuli and may have potential advantages in patients with small
annuli. Copyright © 2018 American College of Cardiology
Foundation

<80>
Accession Number
2001424395
Title
Ultrathin Bioresorbable Polymer Sirolimus-Eluting Stents Versus Thin
Durable Polymer Everolimus-Eluting Stents.
Source
Journal of the American College of Cardiology. 72 (25) (pp 3287-3297),
2018. Date of Publication: 25 December 2018.
Author
Kandzari D.E.; Koolen J.J.; Doros G.; Massaro J.J.; Garcia-Garcia H.M.;
Bennett J.; Roguin A.; Gharib E.G.; Cutlip D.E.; Waksman R.
Institution
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Koolen) Catharina Hospital, Eindhoven, Netherlands
(Doros) Department of Biostatistics and Epidemiology, Boston University
School of Public Health, Baim Institute for Clinical Research, Boston, MA,
United States
(Massaro) Department of Biostatistics and Epidemiology, Boston University
School of Public Health, Boston, MA, United States
(Garcia-Garcia, Waksman) Division of Interventional Cardiology, MedStar
Cardiovascular Research Network, MedStar Washington Hospital Center,
Washington, DC, United States
(Bennett) Department of Cardiovascular Medicine, University Hospitals
Leuven, Leuven, Belgium
(Roguin) Department of Cardiology, Rambam Medical Center, Haifa, Israel
(Gharib) Charleston Area Medical Center, Charleston, WV, United States
(Cutlip) Beth Israel Deaconess Medical Center, Baim Institute for Clinical
Research, Boston, MA, United States
Publisher
Elsevier USA
Abstract
Background: Coronary drug-eluting stent development has introduced new
metal alloys, changes in stent architecture, and bioresorbable polymers.
Whether these advancements improve long-term clinical safety and efficacy
has been inconsistent in prior studies. Objective(s): The authors
sought to compare late-term clinical outcomes among patients treated with
an ultrathin strut (60 mum) bioresorbable polymer sirolimus-eluting stent
(BP SES) and a thin strut (81 mum) durable polymer everolimus-eluting
stent (DP EES) in a large randomized trial. Method(s): BIOFLOW V
(Biotronik Prospective Randomized Multicenter Study to Assess the Safety
and Effectiveness of the Orsiro Sirolimus Eluting Coronary Stent System in
the Treatment of Subjects with Up to Three De Novo or Restenotic Coronary
Artery Lesions V) was an international randomized trial comparing coronary
revascularization with BP SES and DP EES regarding the primary endpoint of
12-month target lesion failure (TLF). Analysis of pre-specified 2-year
clinical outcomes was performed. Result(s): Among 1,334 patients
randomized to treatment with BP SES (n = 884) or DP EES (n = 450), the
2-year TLF rate was 7.5% for BP SES and 11.9% for DP EES (-4.33% treatment
difference; 95% confidence interval: -8.16% to -0.91%; p = 0.015), driven
by differences in target vessel myocardial infarction (MI) (5.3% vs. 9.5%;
p = 0.01) and ischemia-driven target lesion revascularization (2.6% vs.
4.9%; p = 0.04). Rates of cardiac death or MI were 7.0% versus 10.4% for
BP SES and DP EES, respectively (p = 0.047). Late/very late definite stent
thrombosis was statistically lower for BP SES compared with DP EES (0.1%
vs. 1.0%; p = 0.045). Conclusion(s): In a large randomized trial,
significant differences in both TLF and target vessel-related MI persisted
through 2 years, favoring treatment with BP SES over DP EES. Significantly
lower cumulative target lesion revascularization and late/very late stent
thrombosis were also observed with BP SES. (Safety and Effectiveness of
the Orsiro Sirolimus Eluting Coronary Stent System in Subjects With
Coronary Artery Lesions [BIOFLOW-V]; NCT02389946) Copyright ©
2018 The Authors

<81>
Accession Number
625744319
Title
Methylene blue as an adjunct to treat vasoplegia in patients undergoing
cardiac surgery requiring cardiopulmonary bypass: A literature review.
Source
AANA Journal. 86 (6) (pp 455-463), 2018. Date of Publication: 01 Dec 2018.
Author
Arevalo V.N.; Bullerwell M.L.
Institution
(Arevalo) Department of Anesthesiology, Baylor College of Medicine, United
States
(Arevalo) Texas Children's Hospital, Houston, TX, United States
(Bullerwell) Nursing Practice-Nurse Anesthesia Program, Baylor College of
Medicine, United States
(Bullerwell) Ben Taub Hospital, Houston, TX, United States
Publisher
AANA Publishing Inc. (E-mail: llacey@aana.com )
Abstract
The term vasoplegia describes hypotension refractory to vasopressor
therapy, a common finding related to cardiac surgery requiring
cardiopulmonary bypass. High doses of vasoactive agents are associated
with adverse effects such as peripheral and mesenteric ischemia. Databases
were systematically searched for literature on methylene blue as an
adjunct therapy to treat vasoplegia. Fifteen articles were selected. The
quality of the studies was evaluated using the US Preventive Services Task
Force (USPSTF) grading tool, and a chart was created to present the
components of each study. Preoperative, intraoperative, and postoperative
administration of methylene blue has been shown to increase systemic
vascular resistance and mean arterial pressure, with the period after
surgery being the most common time for use of this therapy. Decreased
vasopressor requirements have also been consistently demonstrated after
methylene blue administration. This catecholamine-sparing effect prevents
vasopressor-related injury. Its favorable safety profile as well as
hemodynamic effects have made methylene blue a valuable adjunct in the
setting of vasoplegia. Methylene blue is an effective treatment of
refractory hypotension related to cardiac surgery requiring
cardiopulmonary bypass. Larger, randomized controlled trials are needed to
strengthen the state of the evidence and to define specific
doses. Copyright © 2018 AANA Publishing Inc. All rights reserved.

<82>
Accession Number
625742819
Title
The Accuracy of Urinary TIMP-2 and IGFBP7 for the Diagnosis of Cardiac
Surgery-Associated Acute Kidney Injury: A Systematic Review and
Meta-Analysis.
Source
Journal of Intensive Care Medicine. (no pagination), 2018. Date of
Publication: 2018.
Author
Tai Q.; Yi H.; Wei X.; Xie W.; Zeng O.; Zheng D.; Sun J.; Wang G.; Wang
S.; Liu G.
Institution
(Tai, Xie, Zheng, Sun, Wang, Wang, Liu) Intensive Care Unit, The First
Affiliated Hospital, Sun Yat-sen University, Guangdong Province, China
(Yi, Wei) Surgical Intensive Care Unit, The Third Affiliated Hospital of
Sun Yat-sen University, Guangdong Province, China
(Zeng) Department of Cardiology Intensive Care Unit, First People's
Hospital of Chenzhou, Hunan Province, China
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Tissue inhibitor of metalloproteinase 2 (TIMP-2) and
insulin-like growth factor binding protein 7 (IGFBP7) are recent promising
markers for identification of cardiac surgery-associated acute kidney
injury (CSA-AKI). The aim of this study was systematically and
quantitatively to evaluate the accuracy of urinary TIMP-2 and IGFBP7 for
the diagnosis of CSA-AKI. Method(s): Three databases including
PubMed, ISI web of knowledge, and Embase were systematically searched from
inception to March 2018. Two investigators conducted the processes of
literature search study selection, data extraction, and quality evaluation
independently. Meta-DiSc and STATA were used for all statistical analyses.
 Result(s): A total of 8 studies comprising 552 patients were included
in this meta-analysis. Pooled sensitivity and specificity with
corresponding 95% confidence intervals (CIs) were 0.79 (95% CI, 0.71-0.86,
I2 = 74.2%) and 0.76 (95% CI, 0.72-0.80, I2 =
80.8%), respectively. Pooled positive likelihood ratio (LR), negative LR,
and diagnostic odds ratio were 3.49 (95% CI, 2.44-5.00, I2 =
61.5%), 0.31(95% CI, 0.19-0.51, I2 = 51.8%), and 14.89 (95% CI,
7.31-30.32, I2 = 27.9%), respectively. The area under curve
estimated by summary receiver operating characteristic was 0.868 (standard
error [SE] 0.032) with a Q* value of 0.799 (SE 0.032). Sensitivity
analysis demonstrated that one study notably affected the stability of
pooled results. One of the subgroups investigated-AKI threshold-could
account for partial heterogeneity. Conclusion(s): Urinary TIMP-2 and
IGFBP7 is a helpful biomarker for early diagnosis of CSA-AKI. And, the
potential of this biomarker with a broader spectrum of clinical settings
may be the focus of future studies. Copyright © The Author(s)
2018.

<83>
Accession Number
623265249
Title
Comparing outcomes after transcatheter aortic valve replacement in
patients with stenotic bicuspid and tricuspid aortic valve: A systematic
review and meta-analysis.
Source
Clinical Cardiology. 41 (7) (pp 896-902), 2018. Date of Publication: July
2018.
Author
Kanjanahattakij N.; Horn B.; Vutthikraivit W.; Biso S.M.; Ziccardi M.R.;
Lu M.L.R.; Rattanawong P.
Institution
(Kanjanahattakij, Horn, Biso, Ziccardi, Lu) Department of Medicine,
Einstein Medical Center, Philadelphia, PA, United States
(Vutthikraivit) Department of Medicine, Texas Tech University Health
Sciences Center, Lubbock, TX, United States
(Rattanawong) University of Hawaii Internal Medicine Residency Program,
Honolulu, HI, United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has become an
alternative treatment to surgery in patients with severe aortic stenosis.
However, patients with bicuspid aortic stenosis (BAV) are usually excluded
from major TAVR studies. The aim of this study is to reexamine current
evidence of TAVR in patients with severe aortic stenosis and BAV compared
with tricuspid aortic valve (TAV). Hypothesis: There might be differences
in outcomes post TAVR between patients with BAV comparing to TAV.
 Method(s): Databases were systematically searched for relevant
articles featuring cohort studies that included patients with BAV and TAV
who underwent TAVR studies, of which reported outcomes of interest
included mortality and complications in both groups. Pooled effect size
was calculated with a random-effect model and weighted for the inverse of
variance, to compare outcomes post-TAVR between BAV and TAV.
 Result(s): Nine studies were included in the meta-analysis. There was
no difference in 30-day mortality rate in patients with BAV compared with
TAV (OR: 1.27, 95% CI: 0.84-1.93, I2 = 0). Patients with BAV
were more likely to have a moderate to severe paravalvular leak (9
studies; OR: 1.42, 95% CI: 1.08-1.87, I2 = 0) and conversion to
surgery (5 studies; OR: 5.48, 95% CI: 1.74-17.27, I2 = 0), and
less likely to have device success compared with patients with TAV (5
studies; OR: 0.57, 95% CI: 0.40-0.81, I2 = 0%).
 Conclusion(s): There was no difference in mortality post-TAVR in
patients with BAV compared with TAV. Further randomized studies should be
done in newer-generation prostheses to assess this
association. Copyright © 2018 Wiley Periodicals, Inc.

<84>
Accession Number
624459567
Title
Antiplatelet Effect of Ketorolac in Children After Congenital Cardiac
Surgery.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 9 (6) (pp
651-658), 2018. Date of Publication: 01 Nov 2018.
Author
Kim J.S.; Kaufman J.; Patel S.S.; Manco-Johnson M.; Di Paola J.; da Cruz
E.M.
Institution
(Kim, Kaufman, Patel, da Cruz) Department of Pediatrics, Heart Institute,
Children's Hospital Colorado, University of Colorado Denver School of
Medicine, Aurora, CO, United States
(Manco-Johnson, Di Paola) Department of Pediatrics, Hemophilia and
Thrombosis Center, Children's Hospital Colorado, University of Colorado
Denver School of Medicine, Aurora, CO, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Ketorolac is used for pediatric analgesia after surgery
despite its known platelet inhibition via the arachidonic acid (AA)
pathway. The degree of platelet inhibitory effect after cardiac surgery is
not well characterized. Thromboelastography with platelet mapping (TEG-PM)
is emerging as a frequently used test to evaluate platelet inhibition via
the AA pathway. Method(s): Post hoc analysis of a data set collected
in a prospective observational cohort study evaluating platelet inhibition
in children after congenital heart surgery with cardiopulmonary bypass
(CPB). Categorization into two groups: (1) received ketorolac and (2) did
not receive ketorolac for analgesia after surgery. The TEG-PM was
evaluated at two time points (prior to surgery and 12-48 hours after CPB).
 Result(s): Fifty-three children were studied; mean age was 6.6
(range: 0.07-16.7) years and 45% (n = 24) were female. Participants were
distributed into two groups by ketorolac use, 41 within the ketorolac
group and 12 in the no ketorolac group. All 41 participants who received
ketorolac had platelet inhibition and 11 (91.7%) of 12 participants who
did not receive ketorolac had normal platelet function after surgery (P
<.0001). There was no difference in patient characteristics or clinical
data between the two groups. Conclusion(s): Ketorolac use in a cohort
of children after congenital cardiac surgery was associated with platelet
inhibition via the AA pathway when evaluated by TEG-PM. Copyright
© The Author(s) 2018.

<85>
[Use Link to view the full text]
Accession Number
622083325
Title
Evolution of the pericardiocentesis technique.
Source
Journal of Cardiovascular Medicine. 19 (6) (pp 267-273), 2018. Date of
Publication: 01 Jun 2018.
Author
Maggiolini S.; De Carlini C.C.; Imazio M.
Institution
(Maggiolini, De Carlini) Cardiology Division, Cardiovascular Department,
San L. Mandic Hospital, Largo Mandic 1, Merate 23807, Italy
(Imazio) Cardiology, Cardiovascular and Thoracic Department, AOU
Cittadella Salute e della Scienza di Torino, Torino, Italy
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Pericardiocentesis is a valuable technique for the diagnosis and treatment
of patients with pericardial effusion and cardiac tamponade, although it
may be associated with potentially serious complications. Through the
years, many different imaging approaches have been described to reduce the
complication rate of the procedure. This systematic review provides a
focused overview of the different techniques developed in recent years to
reduce the procedural complications and to increase the related success
rate. Copyright © 2018 Italian Federation of Cardiology. All
rights reserved.

<86>
Accession Number
618813138
Title
Coronary artery bypass grafting versus percutaneous coronary intervention
in patients with noninsulin treated type 2 diabetes mellitus: A
meta-analysis of randomized controlled trials.
Source
Diabetes/Metabolism Research and Reviews. 34 (1) (no pagination), 2018.
Article Number: e2951. Date of Publication: January 2018.
Author
Wang Y.; Wen M.; Zhou J.; Chen Y.; Zhang Q.
Institution
(Wang, Wen, Zhou, Chen, Zhang) Department of Cardiology, West China
Hospital, Sichuan University, Chengdu, China
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: The outcomes and prognosis of revascularization by either
coronary artery bypass grafting (CABG) surgery or percutaneous coronary
intervention (PCI) in patients with noninsulin-treated type 2 diabetes
mellitus (NITDM) have not yet been well established. Method(s):
Randomized controlled trials (RCTs) were identified by searching Pubmed,
EMBASE, and Cochrane library from inception until May 2016. Heterogeneity
was evaluated, and the pooled hazard ratio (HR) was calculated by using a
fixed-effect model. A random-effect model was used when statistically
significant heterogeneity was observed (I2 >= 50%). All data
analyses were carried out by using RevMan 5.3 and STATA software 12.0.
 Result(s): A total of 4 RCTs involving 5 studies, consisting of 2270
patients with noninsulin-treated type 2 diabetes mellitus, were
identified. Compared with CABG-treated patients, PCI-treated patients had
significantly higher all-cause mortality (HR 1.39; 95% CI 1.01 to 1.91; P
=.04), myocardial infarction (HR 2.14; 95% CI 1.40 to 3.27; P =.0004),
repeated revascularization (HR 2.52; 95% CI 1.77 to 3.57; P <.00001), and
major adverse cardiovascular and cerebrovascular events (HR 1.50; 95% CI
1.20-1.87; P =.0004). However, PCI was associated with lower incidence of
stoke (HR 0.47; 95% CI 0.24 to 0.90; P =.02). Conclusion(s): In NITDM
patients, our study suggests that CABG surgery is associated with reduced
risk of mortality and morbidity, although with increased incidence of
stroke compared with percutaneous coronary intervention. The decision if
to have percutaneous coronary intervention or CABG surgery should factor
the risk for stroke of the patients when considering CABG over
percutaneous coronary intervention. Adequately powered RCTs are needed to
confirm the results of this meta-analysis. Copyright © 2017 John
Wiley & Sons, Ltd.

<87>
Accession Number
621614120
Title
Critical developments of 2017: a review of the literature from selected
topics in transfusion. A committee report from the AABB Clinical
Transfusion Medicine Committee.
Source
Transfusion. 58 (4) (pp 1065-1075), 2018. Date of Publication: April 2018.
Author
Friedman D.F.; Goel R.; Heddle N.M.; Hopkins C.K.; Karp J.K.; Pagano M.B.;
Perumbeti A.; Ramsey G.; Roback J.D.; Schwartz J.; Shaz B.H.; Spinella
P.C.; Cohn C.S.; Cushing M.M.; Kelley J.; Klapper E.
Institution
(Cushing, Goel, Cushing) Department of Pathology, Weill Cornell Medicine,
New York, NY, United States
(Kelley, Kelley) Department of Laboratory Medicine, The University of
Texas MD Anderson Cancer Center, Houston, TX, United States
(Klapper, Klapper) Department of Pathology and Laboratory Medicine,
Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Friedman) Blood Bank and Transfusion Medicine Department, Children's
Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA,
United States
(Heddle) McMaster Center for Transfusion Research, McMaster University,
Hamilton, ON, Canada
(Hopkins) Blood Systems Inc., Scottsdale, AZ, United States
(Karp) Department of Pathology, Anatomy, and Cell Biology, Thomas
Jefferson University Hospitals, Philadelphia, PA, United States
(Pagano) Transfusion Medicine Division, Department of Laboratory Medicine,
University of Washington, Seattle, WA, United States
(Perumbeti) Department of Pathology and Laboratory Medicine, Children's
Hospital Los Angeles, Los Angeles, CA, United States
(Ramsey) Department of Pathology, Feinberg School of Medicine,
Northwestern University, Chicago, IL, United States
(Roback) Department of Pathology and Laboratory Medicine, Emory University
School of Medicine, Atlanta, GA, United States
(Schwartz) Department of Pathology and Cell Biology, Columbia University
Medical Center and the New York-Presbyterian Hospital, United States
(Shaz) New York Blood Center, New York, NY, United States
(Spinella) Department of Pediatrics, Division of Pediatric Critical Care,
Washington University School of Medicine, St Louis, MO, United States
(Cohn, Cohn) Department of Laboratory Medicine and Pathology, University
of Minnesota, Minneapolis, MN, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: The AABB compiles an annual synopsis of the published
literature covering important developments in the field of Transfusion
Medicine. For the first time, an abridged version of this work is being
made available in TRANSFUSION, with the full-length report available as an
Appendix S1 (available as supporting information in the online version of
this paper). STUDY DESIGN AND METHODS: Papers published in 2016 and early
2017 are included, as well as earlier papers cited for background.
Although this synopsis is comprehensive, it is not exhaustive, and some
papers may have been excluded or missed. RESULT(S): The following
topics are covered: duration of red blood cell storage and clinical
outcomes, blood donor characteristics and patient outcomes, reversal of
bleeding in hemophilia and for patients on direct oral anticoagulants,
transfusion approach to hemorrhagic shock, pathogen inactivation,
pediatric transfusion medicine, therapeutic apheresis, and extracorporeal
support. CONCLUSION(S): This synopsis may be a useful educational
tool. Copyright © 2018 AABB

<88>
Accession Number
620929942
Title
Red blood cells treated with the amustaline (S-303) pathogen reduction
system: a transfusion study in cardiac surgery.
Source
Transfusion. 58 (4) (pp 905-916), 2018. Date of Publication: April 2018.
Author
Brixner V.; Kiessling A.-H.; Madlener K.; Muller M.M.; Leibacher J.;
Dombos S.; Weber I.; Pfeiffer H.-U.; Geisen C.; Schmidt M.; Henschler R.;
North A.; Huang N.; Mufti N.; Erickson A.; Ernst C.; Rico S.; Benjamin
R.J.; Corash L.M.; Seifried E.
Institution
(Brixner, Muller, Leibacher, Dombos, Weber, Pfeiffer, Geisen, Schmidt,
Seifried) Institute for Transfusion Medicine and Immunohematology of
Johann Wolfgang Goethe University and German Red Cross Blood Donor
Service, Frankfurt am Main, Germany
(Kiessling) Department of Thoracic and Cardiovascular Surgery, Johann
Wolfgang Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
(Madlener) Department of Haemostaseology and Transfusion Medicine,
Kerckhoff-Klinik, Bad Nauheim, Germany
(Henschler) Blood Center Zurich, Swiss Red Cross, Schlieren, Switzerland
(Henschler) Red Cross Blood Service Graubunden, Chur, Switzerland
(North, Huang, Mufti, Erickson, Ernst, Rico, Benjamin, Corash) Cerus
Corporation, Concord, CA, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Nucleic acid-targeted pathogen inactivation technology using
amustaline (S-303) and glutathione (GSH) was developed to reduce the risk
of transfusion-transmitted infectious disease and transfusion-associated
graft-versus-host disease with red blood cell (RBC) transfusion. STUDY
DESIGN AND METHODS: A randomized, double-blind, controlled study was
performed to assess the in vitro characteristics of amustaline-treated
RBCs (test) compared with conventional (control) RBCs and to evaluate
safety and efficacy of transfusion during and after cardiac surgery. The
primary device efficacy endpoint was the postproduction hemoglobin (Hb)
content of RBCs. Exploratory clinical outcomes included renal and hepatic
failure, the 6-minute walk test (a surrogate for cardiopulmonary
function), adverse events (AEs), and the immune response to
amustaline-treated RBCs. RESULT(S): A total of 774 RBC unis were
produced. Mean treatment difference in Hb content was -2.27 g/unit (95%
confidence interval, -2.61 to -1.92 g/unit), within the prespecified
equivalence margins (+/-5 g/unit) to declare noninferiority.
Amustaline-treated RBCs met European guidelines for Hb content,
hematocrit, and hemolysis. Fifty-one (25 test and 26 control) patients
received study RBCs. There were no significant differences in RBC usage or
other clinical outcomes. Observed AEs were within the spectrum expected
for patients of similar age undergoing cardiovascular surgery requiring
RBCs transfusion. No patients exhibited an immune response specific to
amustaline-treated RBCs. CONCLUSION(S): Amustaline-treated RBCs
demonstrated equivalence to control RBCs for Hb content, have appropriate
characteristics for transfusion, and were well tolerated when transfused
in support of acute anemia. Renal impairment was characterized as a
potential efficacy endpoint for pivotal studies of RBC transfusion in
cardiac surgery. Copyright © 2018 The Authors Transfusion
published by Wiley Periodicals, Inc. on behalf of AABB

<89>
Accession Number
2000542159
Title
Changes in resting pulmonary function testing over time after the Nuss
procedure: A systematic review and meta-analysis.
Source
Journal of Pediatric Surgery. 53 (11) (pp 2299-2306), 2018. Date of
Publication: November 2018.
Author
Wang Q.; Fan S.; Wu C.; Jin X.; Pan Z.; Hong D.
Institution
(Wang, Wu, Jin, Pan) Cardiothoracic surgery of hildren's Hospital of
Chongqing Medical University; Ministry of Education Key Laboratory of
Child Development and Disorders; China international Science and
Technology Cooperation base of Child development and Critical Disorders;
Chongqing Key Laboratory of Pediatrics, Chongqing, China
(Fan, Hong) Renal Division and Institute of Nephrology, Sichuan Academy of
Medical Science & Sichuan Provincial People's Hospital, School of
Medicine, University of Electronic Science and Technology of China,
Chengdu, China
(Hong) ChengduChina
Publisher
W.B. Saunders
Abstract
Background: Pectus excavatum, the most common congenital chest wall
deformity in pediatric patients, leads to pulmonary dysfunction. There is
no consensus regarding the effectiveness of the Nuss procedure for
recovering pulmonary function. In this meta- analysis, we focused on the
changes that occur in pulmonary function after the Nuss procedure.
 Method(s): We performed a literature search in the MEDLINE, Embase,
Cochrane library and PubMed databases. The included studies were required
to contain pulmonary function tests with results adjusted to predicted
values both before and after the Nuss procedure. The key outcomes of
interest in this analysis were pulmonary function measured as forced
expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). Subgroup
analyses were performed based on time since surgery and the mean ages of
the patients when they underwent surgery by forest plots and
meta-regressions. Result(s): Thirteen studies involving 465
participants were included in this review. The standard mean difference
(SMD) observed in FEV1 and FVC after surgery were 0.17 (95% CI, 0.01-0.33,
p = 0.04) and - 0.18 (95% CI, - 0.41-0.06, p = 0.14), respectively. The
overall meta-regression SMD of FEV1 and FVC by time since surgery were
1.21 (95% CI, 1.04-1.41, p = 0.020) and 1.38 (95% CI, 1.05-1.83, p =
0.027), respectively. We found evidence of a temporal relationship between
time at which pulmonary function tests were performed after surgery and
predicted FEV1 and FVC values. The SMD of FEV1 (0.26, p = 0.012) was
slightly higher in group evaluated more than 2 year after initial surgery.
 Conclusion(s): Abnormal resting pulmonary functions tests performed
prior to surgery showed an initial depression after surgery. The FEV1 of
patients slightly increased at 2 year post surgery compared with the
baseline. Further studies with longer term follow-up are still needed to
determine if pulmonary function could improve to normal after surgery.
Levels of Evidence: Level of evidence: 4 (based on lowest level of article
analyzed in meta-analysis/systematic review). Copyright © 2018

<90>
Accession Number
620405045
Title
Remote Ischaemic PrEconditioning of Human Myocardium (RIPE): Study
protocol for a double-blinded randomised controlled trial.
Source
Kardiologia Polska. 76 (1) (pp 136-143), 2018. Date of Publication: 2018.
Author
Deja M.A.; Wiaderkiewicz R.; Czekaj P.; Czech E.; Malinowski M.; Machej
L.; Weglarzy A.; Kowalowka A.; Piekarska M.; Szurlej B.; Latusek T.
Institution
(Deja, Malinowski, Kowalowka, Piekarska, Szurlej, Latusek) Department of
Cardiac Surgery, School of Medicine in Katowice, Medical University of
Silesia, Katowice, Poland
(Deja, Malinowski, Kowalowka, Piekarska) Department of Cardiac Surgery,
Upper-Silesian Heart Centre, Katowice, Poland
(Wiaderkiewicz, Czekaj, Czech) Department of Histology and Embryology,
School of Medicine in Katowice, Medical University of Silesia, ul. Medykow
18, Katowice 40-752, Poland
(Machej) Department of Anaesthesia and Intensive Care Nursing, School of
Health Sciences, Medical University of Silesia, Katowice, Poland
(Weglarzy) Department of Cardiac Anaesthesia, Upper-Silesian Heart Centre,
Katowice, Poland
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Remote preconditioning has been shown to be a potent
protective phenomenon in many animals. Several studies aimed to
demonstrate it was feasible in humans by trying to show its protective
effect during cardiac surgery. Of these, some small studies and one larger
trial were positive while two other bigger studies showed no effectiveness
of remote preconditioning as assessed by levels of postoperatively
released cardiac markers. Recently, two large clinical trials also failed
to prove the benefit of remote preconditioning in cardiac surgery. No
study showed that remote preconditioning actually increases resistance of
human myocardium to standardised ischaemic and reperfusion stimulus in
experimental settings. In animal studies, remote preconditioning was shown
to improve mitochondrial function and structure, but such data on human
myocardium are scarce. Aim(s): The aim of the study is to determine
whether remote preconditioning protects human myocardium against
ischaemia-reperfusion injury in both in vivo and in vitro conditions.
 Method(s): The trial is designed as a single-centre, double-blinded,
sham-controlled trial of 120 patients. We randomise (1:1) patients
referred for coronary artery bypass grafting for stable coronary artery
disease to remote preconditioning or "sham" intervention. The remote
preconditioning is obtained by three cycles of 5 min inflation and 5 min
deflation of a blood pressure cuff on the right arm. Postoperative course
including myocardial enzymes profile will be analysed. Moreover, in the
in-vitro arm the clinically preconditioned myocardium will be assessed for
function, mitochondria structure, and mitochondria-dependent apoptosis.
The informed consent of all patients is obtained before enrolment into the
study by the investigator. The study conforms to the spirit and the letter
of the declaration of Helsinki. Result(s) and Conclusion(s): In case
the effect of remote preconditioning is not measurable in ex-vivo
assessment, any future attempt at implementing this phenomenon in clinical
practice may be futile and should not be continued until the effect can be
confirmed in a controlled experimental setting. The study might therefore
indicate future directions in trials of clinical implementation of remote
preconditioning. Trial Registration: Clinical Trials Register
(Clinicaltrials.gov) identifier: NCT01994707. The study was approved by
Institutional Review Board of the Medical University of Silesia
(KNW/0022/KB1/160/12). Copyright © Polskie Towarzystwo
Kardiologiczne 2018.

<91>
Accession Number
620405039
Title
Haematological indices as predictors of atrial fibrillation following
isolated coronary artery bypass grafting, valvular surgery, or combined
procedures: A systematic review with meta-analysis.
Source
Kardiologia Polska. 76 (1) (pp 107-118), 2018. Date of Publication: 2018.
Author
Weymann A.; Ali-Hasan-Al-Saegh S.; Popov A.-F.; Sabashnikov A.;
Mirhosseini S.J.; Liu T.; Tse G.; Lotfaliani M.; Ghanei A.; Testa L.;
D'Ascenzo F.; Benedetto U.; Dehghan H.; Roever L.; De Oliveira Sa M.P.B.;
Baker W.L.; Yavuz S.; Zeriouh M.; Mashhour A.; Nombela-Franco L.; Jang
J.-S.; Meng L.; Gong M.; Deshmukh A.J.; Palmerini T.; Linde C.; Filipiak
K.J.; Biondi-Zoccai G.; Calkins H.; Stone G.W.
Institution
(Weymann, Mashhour) Department of Cardiac Surgery, University Hospital
Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky
University Oldenburg, Oldenburg, Germany
(Weymann, Popov, Sabashnikov) Department of Cardiothoracic Transplantation
and Mechanical Circulatory Support, Royal Brompton and Harefield NHS
Foundation Trust, Harefield Hospital, Harefield Middlesex, United Kingdom
(Ali-Hasan-Al-Saegh, Popov, Sabashnikov, Mirhosseini) Cardiovascular
Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd,
Iran, Islamic Republic of
(Popov, Sabashnikov) Department of Thoracic and Cardiovascular Surgery,
University Hospital Goethe University Frankfurt, Frankfurt, Germany
(Sabashnikov) Department of Cardiothoracic Surgery, University Hospital of
Cologne, Cologne, Germany
(Liu, Meng, Gong) 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
(Tse) Department of Medicine and Therapeutics, Li Ka Shing Institute of
Health Sciences, Faculty of Medicine, Chinese University of Hong Kong,
Shatin, Hong Kong
(Lotfaliani) Faculty of Pharmacy, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
(Ghanei) Department of Internal Medicine, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran, Islamic Republic of
(Testa) Department of Cardiology, IRCCS Pol. S. Donato, S. Donato
Milanese, Milan, Italy
(D'Ascenzo) Division of Cardiology, Department of Medical Sciences, Citta
della Salute e della Scienza Hospital, University of Turin, Turin, Italy
(Benedetto) Bristol Heart Institute, University of Bristol, School of
Clinical Sciences, Bristol, United Kingdom
(Dehghan) Department of Health Technology Assessment, Shahid Sadoughi
University of Medical Sciences and Health Services, Yazd, Iran, Islamic
Republic of
(Roever) Department of Clinical Research, Federal University of
Uberlandia, Uberlandia, Brazil
(De Oliveira Sa) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco (PROCAPE), Recife, Brazil
(De Oliveira Sa) University of Pernambuco (UPE), Recife, Brazil
(De Oliveira Sa) Nucleus of Postgraduate and Research in Health Sciences
of Faculty of Medical Sciences and Biological Sciences Institute
(FCM/ICB), Recife, Brazil
(Baker) University of Connecticut/Hartford Hospital Evidence-Based
Practice Centre, Hartford, CT, United States
(Yavuz) Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas
Training and Research Hospital, Bursa, Turkey
(Nombela-Franco) Instituto Cardiovascular, Hospital Universitario Clinico
San Carlos, Madrid, Spain
(Jang) Department of Cardiology, Busan Paik Hospital, Inje University
College of Medicine, Jin-gu, Busan, South Korea
(Deshmukh) Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Mayo
Clinic, Rochester, MN, United States
(Palmerini) Dipartimento Cardio-Toraco-Vascolare, University of Bologna,
Bologna, Italy
(Linde) Department of Cardiology, Karolinska University Hospital,
Karolinska Institutet, Stockholm, Sweden
(Filipiak) 1st Department of Cardiology, Medical University of Warsaw,
Warsaw, Poland
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed,
Pozzilli, Italy
(Calkins) Department of Cardiology, Johns Hopkins Medical Institutions,
Baltimore, MD, United States
(Stone) New York Presbyterian Hospital, Columbia University Medical
Centre, New York, NY, United States
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: New postoperative atrial fibrillation (POAF) is one of the
most critical and common complications after cardiovascular surgery
precipitating early and late morbidities. Complete blood count (CBC) is an
imperative blood test in clinical practice, routinely used in the
examination of cardiovascular diseases. Aim(s): This systematic
review with meta-analysis aimed to determine the strength of evidence for
evaluating the association of haematological indices in CBC tests with
atrial fibrillation following isolated coronary artery bypass graft
(CABG), isolated valvular surgery, or a combination of these treatments.
 Method(s): We conducted a meta-analysis of studies evaluating pre-
and postoperative haematological indices in patients with POAF. A
comprehensive subgroup analysis was performed to explore potential sources
of heterogeneity. Result(s): A literature search of all major
databases retrieved 732 studies. After screening, 22 studies were analysed
including a total of 6098 patients. Pooled analysis showed preoperative
platelet count (PC) (weighted mean difference [WMD] = -7.07 x
109/L and p < 0.001), preoperative mean platelet volume (MPV)
(WMD = 0.53 FL and p < 0.001), preoperative white blood cell count (WBC)
(WMD = 0.130 x 109/L and p < 0.001), preoperative
neutrophil-to-lymphocyte ratio (NLR) (WMD = 0.33 and p < 0.001),
preoperative red blood cell distribution width (RDW) (WMD = 0.36% and p <
0.001), postoperative WBC (WMD = 1.36 x 109/L and p < 0.001),
and postoperative NLR (WMD = 0.74 and p < 0.001) as associated factors
with POAF. Conclusion(s): Haematological indices may predict the risk
of POAF before surgery. These easily-performed tests should definitely be
taken into account in patients undergoing isolated CABG, valvular surgery,
or combined procedures. Copyright © Polskie Towarzystwo
Kardiologiczne 2018.

<92>
Accession Number
620405038
Title
The effect of intravenous N-acetylcysteine on prevention of atrial
fibrillation after coronary artery bypass graft surgery: A double-blind,
randomised, placebo-controlled trial.
Source
Kardiologia Polska. 76 (1) (pp 99-106), 2018. Date of Publication: 2018.
Author
Soleimani A.; Habibi M.R.; Kiabi F.H.; Alipour A.; Habibi V.; Azizi S.;
Zeydi A.E.; Sohrabi F.B.
Institution
(Soleimani, Habibi, Kiabi) Department of Anaesthesiology, Imam Khomeini
Hospital, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Alipour) Department of Epidemiology, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Habibi) Department of Cardiac Surgery, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Azizi) Department of Pathology, Faculty of Paramedicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Zeydi) Department of Medical-Surgical Nursing, Faculty of Nursing and
Midwifery, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Sohrabi) Mazandaran Heart Centre, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Atrial fibrillation (AF) is one of the most frequently
occurring dysrhythmias after coronary artery bypass graft (CABG) surgery.
 Aim(s): The aim of this study was to evaluate the effect of
intravenous N-acetylcysteine (NAC) on the prevention of AF after CABG
surgery. Method(s): In a double-blind, randomised controlled trial, a
total of 150 patients who were scheduled for on-pump CABG surgery were
randomly assigned into two groups. In group A, patients received an
intravenous NAC infusion (50 mg/kg) after induction of anaesthesia. These
patients additionally received two intravenous doses of NAC on
postoperative days 1 and 2. Patients in group B received normal saline (as
a placebo) with the same volume, during the same time interval. During the
first three days after surgery, postoperative AF (POAF) was assessed by
continuous electrocardiogram monitoring; serum high-sensitivity C-reactive
protein (hsCRP) level was also assessed before and three days after
surgery. Result(s): During follow-up, 17 patients (17/141, 12.1%)
developed POAF. POAF occurred in four (5.6%) patients in the NAC group and
13 (18.8%) patients in the placebo group (OR 0.23; 95% CI 0.08-0.82; p =
0.02). In the multivariable logistic regression analysis, the only
predictor of AF after CABG surgery was the use of NAC (OR 0.21; 95% CI
0.06-0.73; p = 0.01). Also, the hsCRP level trend in the NAC group was
different from the trend in the control group (group time interaction or
interaction effect) (p < 0.001). Conclusion(s): It seems that
perioperative intravenous NAC therapy can be effectively used to reduce
inflammation and the incidence of POAF after CABG surgery. Copyright
© Polskie Towarzystwo Kardiologiczne 2018.

<93>
Accession Number
622640220
Title
Sex-Specific Outcomes after Transcatheter Aortic Valve Replacement: FDA
Patient-Level Meta-Analysis of Premarket Clinical Trials.
Source
Journal of Women's Health. 27 (6) (pp 808-814), 2018. Date of Publication:
June 2018.
Author
Zusterzeel R.; Mishra N.K.; Beydoun H.; Laschinger J.; Wu C.; Dong L.M.;
Marinac-Dabic D.; Strauss D.G.; Canos D.A.
Institution
(Zusterzeel, Mishra, Beydoun, Laschinger, Wu, Dong, Marinac-Dabic,
Strauss, Canos) U.S. Food and Drug Administration, 10903 New Hampshire
Avenue 64-2014, Silver Spring, MD 20993, United States
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is a less
invasive alternative approach to surgery. Individual randomized clinical
trials evaluating the safety and efficacy of TAVR were mostly underpowered
for conducting separate analyses for women and men. We pooled data from
premarket TAVR clinical trials comparing short (30 days)- and long-term
(~2 years) outcomes by sex. Method(s): Patient-level data from the
TAVR arms of six clinical trials were pooled (2515 patients).
Random-effects models for time-to-event outcomes (odds ratios [ORs] for
30-day outcomes and hazard ratios [HRs] for complete follow-up for
mortality, ischemic stroke, kidney injury, major bleeding, myocardial
infarction, and device migration) and dichotomous outcomes (ORs for
reintervention, rehospitalization, and pacemaker implantation) were then
fit to directly compare outcomes between women and men. Result(s):
Overall, the pattern of individual comorbidities was more severe in men.
There was no difference in mortality risk at 30 days (female-to-male OR =
1.00 [0.69-1.46]); however, at follow-up completion (~2 years post-TAVR),
women had a 24% lower mortality risk than men (HR = 0.76 [95% CI:
0.65-0.89]). Women also had a 30% lower risk of kidney injury at 30 days
(OR = 0.70 [0.49-0.98]), which increased to 33% over the complete
follow-up period (HR = 0.67 [0.51-0.87]). Major bleeding was more common
in women compared to men at both 30 days (OR = 1.44 [1.19-1.76]) and
long-term follow-up (HR = 1.22 [1.04-1.43]). For dichotomous outcomes,
women had a 68% lower risk for reinterventions (OR = 0.32 [0.18-0.58]). We
did not observe any difference in the risk of ischemic stroke, myocardial
infarction, device migration, rehospitalizations, or pacemaker
implantations between sexes. Conclusion(s): This patient-level data
meta-analysis of six premarket clinical trials found that women who
received TAVR had fewer comorbidities at baseline. Acute outcomes (30 day)
with respect to mortality were similar. Women were observed to have a
lower risk of kidney injury, but higher risk of major bleeding compared to
men receiving TAVR at 30 days. At complete follow-up, statistically
significant advantages for women emerged in improved survival and lower
reintervention risk. No differences in ischemic stroke, pacemaker
implantation, or rehospitalization were observed. That women are healthier
at baseline and develop fewer postprocedural complications than men may
explain their higher survival. © Copyright 2018, Mary Ann
Liebert, Inc. 2018.

<94>
Accession Number
625044228
Title
Protocol for a phase III, non-inferiority, randomised comparison of a new
fibrinogen concentrate versus cryoprecipitate for treating acquired
hypofibrinogenaemia in bleeding cardiac surgical patients: The FIBRES
trial.
Source
BMJ Open. 8 (4) (no pagination), 2018. Article Number: e020741. Date of
Publication: 01 Apr 2018.
Author
Karkouti K.; Callum J.; Rao V.; Heddle N.; Farkouh M.E.; Crowther M.A.;
Scales D.C.
Institution
(Karkouti) Department of Anesthesia, Institute of Health Policy,
Management and Evaluation, University of Toronto, Toronto, ON, Canada
(Karkouti, Rao) Peter Munk Cardiac Centre, Toronto General Research
Institute, Toronto General Hospital, University Health Network, University
of Toronto, Toronto, ON, Canada
(Callum) Department of Clinical Pathology, Sunnybrook Health Sciences
Centre, University of Toronto, Toronto, ON, Canada
(Callum) Department of Laboratory Medicine and Pathobiology, University of
Toronto, Toronto, ON, Canada
(Rao) Division of Cardiovascular Surgery, University of Toronto, Toronto,
ON, Canada
(Heddle) Department of Medicine, Faculty of Health Sciences, McMaster
University, Hamilton, ON, Canada
(Farkouh) Peter Munk Cardiac Centre, Heart and Stroke Richard Lewar
Centre, University of Toronto, Toronto, ON, Canada
(Crowther) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, ON, Canada
(Scales) Department of Critical Care Medicine, Sunnybrook Health Sciences
Centre, University of Toronto, Toronto, ON, Canada
(Scales) Interdepartmental Division of Critical Care, Department of
Medicine, University of Toronto, Toronto, ON, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Coagulopathic bleeding is a serious complication of cardiac
surgery to which an important contributor is acquired hypofibrinogenaemia
(plasma fibrinogen <1.5-2.0 g/L). The standard intervention for acquired
hypofibrinogenaemia is cryoprecipitate, but purified fibrinogen
concentrates are also available. There is little comparative data between
the two therapies and randomised trials are needed. Methods and analysis
FIBrinogen REplenishment in Surgery (FIBRES) is a multicentre, randomised
(1:1), active-control, single-blinded, phase III trial in adult cardiac
surgical patients experiencing clinically significant bleeding related to
acquired hypofibrinogenaemia. The primary objective is to demonstrate that
fibrinogen concentrate (Octafibrin/Fibryga; Octapharma) is non-inferior to
cryoprecipitate. All patients for whom fibrinogen supplementation is
ordered by the clinical team within 24 hours of cardiopulmonary bypass
will receive 4 g of fibrinogen concentrate or 10 units of cryoprecipitate
(dose-equivalent to 4 g), based on random allocation and deferred consent.
The primary outcome is total red cell, platelet and plasma transfusions
administered within 24 hours of bypass. Secondary outcomes include major
bleeding, fibrinogen levels and adverse events within 28 days. Enrolment
of 1200 patients will provide >90% power to demonstrate non-inferiority.
One preplanned interim analysis will include 600 patients. The pragmatic
design and treatment algorithm align with standard practice, aiding
adherence and generalisability. Ethics and dissemination The study is
approved by the local research ethics board and will be conducted in
accordance with the Declaration of Helsinki, Good Clinical Practice
guidelines and regulatory requirements. Patient consent prior to treatment
is waived, as per criteria in the Tri-Council Policy Statement. Results
will be published in the scientific/medical literature, and at
international congresses. Non-inferiority of purified fibrinogen
concentrate would support its use in acquired hypofibrinogenaemia. The
results are likely to improve care for cardiac surgical patients
experiencing significant bleeding, an understudied yet high-risk
population. Copyright © 2018 Article author(s).

<95>
Accession Number
2000922101
Title
Statin therapy improved long-term prognosis in patients with major
non-cardiac vascular surgeries: a systematic review and meta-analysis.
Source
Vascular Pharmacology. 109 (pp 1-16), 2018. Date of Publication: October
2018.
Author
Yu W.; Wang B.; Zhan B.; Li Q.; Li Y.; Zhu Z.; Yan Z.
Institution
(Yu, Wang, Li, Li, Zhu, Yan) The Center for Hypertension and Metabolic
Diseases, Department of Hypertension and Endocrinology, Daping Hospital,
Third Military Medical University, Chongqing Institute of Hypertension,
Chongqing 400042, China
(Yu, Zhan) The Thirteenth People's Hospital of Chongqing, The Chongqing
Geriatric Hospital, Chongqing 400053, China
(Wang) Department of Nephrology, Chinese PLA General Hospital, Chinese PLA
Institute of Nephrology, Beijing Key Laboratory of Kidney Disease,
National Clinical Research Center for Kidney Diseases, Fuxing Road 28,
Beijing 100853, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: To investigate whether statin intervention will improve the
long-term prognosis of patients undergoing major non-cardiac vascular
surgeries. Method(s): Major database searches for clinical trials
enrolling patients undergoing major non-cardiac vascular surgeries,
including lower limb revascularization, carotid artery surgeries,
arteriovenous fistula, and aortic surgeries, were performed. Subgroup
analyses, stratified by surgical types or study types, were employed to
obtain statistical results regarding survival, patency rates, amputation,
and cardiovascular and stroke events. Odds ratio (ORs) and 95% confidence
intervals (CIs) were calculated by Review Manager 5.3. Sensitivity
analysis, publication bias and meta-regression were conducted by Stata
14.0. Result(s): In total, 34 observational studies, 8 prospective
cohort studies and 4 randomized controlled clinical trials (RCTs) were
enrolled in the present analysis. It was demonstrated that statin usage
improved all-cause mortality in lower limb, carotid, aortic and mixed
types of vascular surgery subgroups compared with those in which statins
were not used. Additionally, the employment of statins efficiently
enhanced the primary and secondary patency rates and significantly
decreased the amputation rates in the lower limb revascularization
subgroup. Furthermore, for other complications, statin intervention
decreased cardiovascular events in mixed types of vascular surgeries and
stroke incidence in the carotid surgery subgroup. No significant
publication bias was observed. The meta-regression results showed that the
morbidity of cardiovascular disease or the use of aspirin might affect the
overall estimates in several subgroups. Conclusion(s): This
meta-analysis demonstrated that statin therapy was associated with
improved survival rates and patency rates and with reduced cardiovascular
or stroke morbidities in patients who underwent non-cardiac vascular
surgeries. Copyright © 2018 Elsevier Inc.

<96>
Accession Number
624362802
Title
A meta-analysis of >=5-year mortality in randomized controlled trials of
off-pump versus on-pump coronary artery bypass grafting.
Source
Journal of Cardiac Surgery. 33 (11) (pp 716-724), 2018. Date of
Publication: November 2018.
Author
Takagi H.; Hari Y.; Mitta S.; Kawai N.; Ando T.
Institution
(Takagi, Hari, Mitta, 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
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: We sought to determine whether off-pump coronary artery bypass
grafting (CABG) increases long-term mortality, by performing a
meta-analysis of randomized controlled trials (RCTs) of off-pump versus
on-pump CABG with >=5-year follow-up. Method(s): MEDLINE and EMBASE,
and the Cochrane Central Register of Controlled Trials were searched
through July 2018. Hazard, risk, or odds ratios (HRs, RRs, or ORs) of
long-term (>=5-year) mortality for off-pump versus on-pump CABG were
extracted from each individual trial. Study-specific estimates were
combined using inverse variance-weighted averages of logarithmic HRs in
the random-effects model. Result(s): Our search identified eight
medium- to large-size RCTs at low risk of bias with long-term follow-up of
off-pump versus on-pump CABG enrolling a total of 8780 patients. Combining
four RCTs reporting actual HRs generated a statistically significant
result favoring on-pump CABG (HR, 1.21; P = 0.02). A pooled analysis of
all eight RCTs demonstrated a statistically significant increase in
mortality with off-pump CABG (HR/RR, 1.19; P = 0.01). There was no
evidence of significant publication bias in the meta-analysis of all eight
RCTs. In a sensitivity analysis, extracting RRs or ORs from all eight RCTs
and pooling them demonstrated a statistically significant increase in
mortality with off-pump CABG (RR, 1.17; P = 0.01; OR, 1.20; P = 0.007).
Eliminating 2 RRs and combining six HRs still generated a statistically
significant result favoring on-pump CABG (HR, 1.19; P = 0.05).
 Conclusion(s): Off-pump CABG increases long-term (>=5-year) mortality
compared with on-pump CABG. Copyright © 2018 Wiley Periodicals,
Inc.

<97>
Accession Number
620799646
Title
The impact of prehabilitation on post-surgical complications in patients
undergoing non-urgent cardiovascular surgical intervention: Systematic
review and meta-analysis.
Source
European Journal of Preventive Cardiology. 25 (4) (pp 404-417), 2018. Date
of Publication: 01 Mar 2018.
Author
Marmelo F.; Rocha V.; Goncalves D.
Institution
(Marmelo, Rocha, Goncalves) Department of Surgery and Physiology of the
Faculty of Medicine of Porto, Porto, Portugal
(Rocha) Sao Martinho Hospital, Valongo, Portugal
(Goncalves) Ave Valley Superior School of Health, Famalicao, Portugal
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Introduction: Cardiac surgery is an aggressive procedure, inducing a great
level of stress and disturbance to the homeostasis of the organism and
underlying several postoperative complications. Surgical prehabilitation
comprises pre-operative physical conditioning designed to improve the
physiological and functional capacities of the individual, prepare the
organism for surgical stress and reduce the risk of postoperative
morbidity. Aim(s): This systematic review and meta-analysis is aimed
at evaluating the ability of prehabilitation to prevent post-surgical
complications in cardiac patients. Method(s): We selected studies
conducted among patients who were waiting for non-urgent cardiac surgical
procedures, where a comparison between prehabilitation and standard
treatment was made. A total of 3650 possible studies were researched, of
which eight were selected for inclusion. Result(s): A reduction in
the number of complications in the groups submitted to prehabilitation
(odds ratio = 0.41; 95% confidence interval (CI): 0.28-0.62; p < 0.001;
I2= 0%) was observed, as well as a significant increase in
maximal inspiratory pressure (standard mean difference (SMD) = 0.66; 95%
CI: 0.35-0.96; p < 0.001; I2= 58%), a non-significant decrease
in the length of stay (SMD = -0.56; 95% CI: -1.13, 0.01; p = 0.05;
I2= 93%), a non-significant increase in the distance walked by
the intervention group in the six-minute walk test (SMD = 0.89; 95% CI
-0.06, 1.84; p = 0.07) and a lack of effect on mechanical ventilation time
(SMD = -0.03; 95% CI: -0.22, 0.16; p = 0.75; I2= 0%).
 Conclusion(s): Prehabilitation reduces the number of post-surgical
complications and increases maximal inspiratory pressure; a reduction in
the length of stay and an improvement of functional capacities are also
probable. Copyright © 2018, © The European Society of
Cardiology 2018.

<98>
Accession Number
625052238
Title
Prenatal diagnosis of total and partial anomalous pulmonary venous
connection: multicenter cohort study and meta-analysis.
Source
Ultrasound in obstetrics & gynecology : the official journal of the
International Society of Ultrasound in Obstetrics and Gynecology. 52 (1)
(pp 24-34), 2018. Date of Publication: 01 Jul 2018.
Author
Paladini D.; Pistorio A.; Wu L.H.; Meccariello G.; Lei T.; Tuo G.;
Donarini G.; Marasini M.; Xie H.-N.
Institution
(Paladini, Meccariello, Donarini) Fetal Medicine & Surgery Unit, Istituto
Giannina Gaslini, Genoa, Italy
(Pistorio) Unit of Epidemiology and Biostatistics, Istituto Giannina
Gaslini, Genoa, Italy
(Wu, Lei, Xie) Department of Ultrasonic Medicine, Fetal Medical Center,
First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
(Tuo, Marasini) Department of Pediatric Cardiology and Cardiac Surgery,
Istituto Giannina Gaslini, Genoa, Italy
Abstract
OBJECTIVES: The aims of this study were to review systematically
literature on and describe the sonographic features and associated
anomalies of total (TAPVC) and partial (PAPVC) anomalous pulmonary venous
connection and scimitar syndrome (SS). METHOD(S): A retrospective
cohort study was carried out of cases of TAPVC, PAPVC and SS that
underwent comprehensive ultrasound examination, seen over a 20-year period
at two tertiary referral centers. Assessed variables included TAPVC
subtype, gestational age at diagnosis, area behind the left atrium,
ventricular disproportion, vertical vein, pulmonary venous obstruction,
mode of diagnosis, association with cardiac and extracardiac conditions,
and pregnancy and fetoneonatal outcomes. The outcome was considered
favorable if the individual was alive and well (no functional impairment
from surgery or cardiac or extracardiac conditions). Cases associated with
right isomerism were excluded from the analysis, as TAPVC in these cases
was only one of several major cardiac anomalies affecting sonographic
signs. A systematic review was performed in order to obtain a synthesis of
characteristics associated with TAPVC, PAPVC and SS. The literature search
of PubMed and EMBASE (1970-2016) included reviews, case series and case
reports. A meta-analysis was conducted only for TAPVC. Random-effects
models were used to obtain pooled estimates of the frequencies of clinical
characteristics and sonographic features. RESULT(S): For TAPVC, a
total of 15 studies involving 71 patients (including 13 from the current
cohort study) were included in the systematic review and meta-analysis.
The pooled estimate for the association of TAPVC with congenital heart
disease was 28.3% (95% CI, 18.1-41.3%) and with extracardiac anomalies it
was 18.5% (95% CI, 10.5-30.6%). Of TAPVC cases, obstructed venous return
was observed in 34.1% (95% CI, 22.7-47.7%), a favorable outcome in 43.8%
(95% CI, 24.0-65.8%), ventricular disproportion in 59.2% (95% CI,
45.1-72.0%), increased area behind the left atrium in 58.1% (95% CI,
41.1-73.5%) and a vertical vein in 59.3% (95% CI, 41.1-75.3%). Diagnosis
was established by using color or power Doppler in 84.9% (95% CI,
67.3-93.9%) of cases. For SS, there were only three studies describing
eight cases, to which the current study added another five. Ventricular
disproportion was present in three out of nine SS cases for which data
were available, but for two of these, there was a concurrent heart
anomaly. Color Doppler was used for all SS diagnoses, and four-dimensional
echocardiography was useful in two out of six cases in which it was used.
Outcome for SS cases was generally good. For PAPVC, there were only five
studies describing five cases, to which the current study added another
two. Major cardiac anomalies were associated in four out of seven of these
cases, and extracardiac anomalies in three out of six cases for which data
were available. CONCLUSION(S): TAPVC can be associated with other
cardiac and extracardiac anomalies in a significant percentage of cases.
Leading sonographic signs are ventricular disproportion, increased area
behind the left atrium and the finding of a vertical vein. Color/power
Doppler is the key mode for diagnosis of TAPVC. Obstructed venous return
can be expected in roughly one-third of cases of TAPVC and outcome is
favorable in less than half of cases. Data for SS and PAPVC are too few to
synthesize. Copyright © 2017 ISUOG. Published by John Wiley & Sons
Ltd.

<99>
Accession Number
622901049
Title
Radial Versus Femoral Approach for Percutaneous Coronary Intervention:
MACE Outcomes at Long-Term Follow-up.
Source
Journal of Invasive Cardiology. 30 (7) (pp 262-268), 2018. Date of
Publication: July 2018.
Author
Campelo-Parada F.; Carrie D.; Bartorelli A.L.; Namiki A.; Hovasse T.;
Kimura T.; Serra-Penaranda A.; Varenne O.; Lalmand J.; Kadota K.; Ikari
Y.; Tobaru T.; Fujii K.; Nakamura S.; Saito S.; Wijns W.
Institution
(Campelo-Parada, Bartorelli) Hopital Rangueil, CHU Toulouse, 1 Avenue Jean
Poulhes, Toulouse 31059, France
(Carrie) Centro Cardiologico Monzino, University of Milan, Italy
(Namiki) Kanto Rosai Hospital, Japan
(Hovasse) Hopital Prive Jacques Cartier (ICPS), Massy, France
(Kimura) Kyoto University Graduate School of Medicine, Japan
(Serra-Penaranda) Hospital de la Santa Creu i Sant Pau, Spain
(Varenne) Hopital Cochin, Paris, France
(Lalmand) CHU Charleroi, Belgium
(Kadota) Kurashiki Central Hospital, Japan
(Ikari) Tokai University Hospital, Japan
(Tobaru) Sakakibara Heart Institute, Japan
(Fujii) Sakurabashi Watanabe Hospital, Japan
(Nakamura) Kyoto Katsura Hospital, Japan
(Saito) Shonan Kamakura General Hospital, Japan
(Wijns) Cardiovascular Research Center, OLV Hospital, Aalst, Belgium
(Wijns) Lambe Institute for Translational Medicine and Curam, National
University of Ireland, Galway, Ireland
Publisher
HMP Communications
Abstract
Objective: To compare the main outcomes of radial versus femoral access at
long-term follow-up. Background(s): Little is known about the
long-term major cardiovascular events and bleeding complications of
patients undergoing percutaneous coronary intervention (PCI) with radial
vs femoral approach. Method(s): A total of 1107 patients from the
CENTURY II trial were included. To minimize baseline differences between
radial and femoral groups, we applied propensity-score matching for this
comparison. Result(s): In this multicenter study, the radial approach
was used in 73.4% of patients. After propensity-score matching, baseline
and procedural characteristics were comparable between both groups.
Procedural success was high and similar in radial and femoral approaches
(98.2% vs 97.5%; P=.47) while radial access was associated with a shorter
hospital stay (1.69 +/- 1.92 days vs 2.08 +/- 1.98 days; P<.01). The
short-term bleeding and vascular complication rates were significantly
lower in the radial group (1.7% vs 6.2% [P<.001 in-hospital] and 2.7% vs
9.6% [P<.001 at 1-month follow-up]). At 3-year follow-up, radial access
was associated with lower rates of all-cause mortality (3.9 vs 6.9%;
P=.04) and cardiovascular death (2.1 vs 4.9%; P=.02). The composite of
all-cause mortality, myocardial infarction, and revascularization showed
no differences between groups (18.2 vs 21.1%; P=.29). Conclusion(s):
Compared to the femoral approach, the radial approach is associated with
significantly lower long-term all-cause mortality rate as well as lower
in-hospital and short-term bleeding rates. These results suggest
additional long-term benefits of radial access for PCI, but should be
interpreted within the context of the current study and further verified
in future studies. Copyright © 2018 HMP Communications. All
rights reserved.

<100>
[Use Link to view the full text]
Accession Number
623482539
Title
The society of thoracic surgeons, the society of cardiovascular
anesthesiologists, and the American society of extracorporeal technology:
Clinical practice guidelines - Anticoagulation during cardiopulmonary
bypass.
Source
Anesthesia and Analgesia. 126 (2) (pp 413-424), 2018. Date of Publication:
2018.
Author
Shore-Lesserson L.; Baker R.A.; Ferraris V.A.; Greilich P.E.; Fitzgerald
D.; Roman P.; Hammon J.W.
Institution
(Shore-Lesserson) Department of Anesthesiology, Northshore University
Hospital, 300 Community Dr, Manhasset, NY 11030, United States
(Baker) Cardiac Surgery Research and Perfusion, Flinders University and
Flinders Medical Center, Adelaide, SA, Australia
(Ferraris) Division of Cardiovascular and Thoracic Surgery, University of
Kentucky, Lexington, KY, United States
(Greilich) Department of Anesthesiology and Pain Management, University of
Texas-Southwestern Medical Center, Dallas, TX, United States
(Fitzgerald) Division of Cardiovascular Perfusion, Medical University of
South Carolina, Charleston, SC, United States
(Roman) Department of Anesthesiology, Saint Anthony Hospital, Lakewood,
CO, United States
(Hammon) Department of Cardiothoracic Surgery, Wake Forest University
School of Medicine, Winston-Salem, NC, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Despite more than a half century of "safe" cardiopulmonary bypass (CPB),
the evidence base surrounding the conduct of anticoagulation therapy for
CPB has not been organized into a succinct guideline. For this and other
reasons, there is enormous practice variability relating to the use and
dosing of heparin, monitoring heparin anticoagulation, reversal of
anticoagulation, and the use of alternative anticoagulants. To address
this and other gaps, The Society of Thoracic Surgeons, the Society of
Cardiovascular Anesthesiologists, and the American Society of
Extracorporeal Technology developed an Evidence Based Workgroup. This was
a group of interdisciplinary professionals gathered to summarize the
evidence and create practice recommendations for various aspects of CPB.
To date, anticoagulation practices in CPB have not been standardized in
accordance with the evidence base. This clinical practice guideline was
written with the intent to fill the evidence gap and to establish best
practices in anticoagulation therapy for CPB using the available
evidence.To identify relevant evidence, a systematic review was outlined
and literature searches were conducted in PubMed using standardized
medical subject heading (MeSH) terms from the National Library of Medicine
list of search terms. Search dates were inclusive of January 2000 to
December 2015. The search yielded 833 abstracts, which were reviewed by
two independent reviewers. Once accepted into the full manuscript review
stage, two members of the writing group evaluated each of 286 full papers
for inclusion eligibility into the guideline document. Ninety-six
manuscripts were included in the final review. In addition, 17 manuscripts
published before 2000 were included to provide method, context, or
additional supporting evidence for the recommendations as these papers
were considered sentinel publications. Members of the writing group wrote
and developed recommendations based on review of the articles obtained and
achieved more than two thirds agreement on each recommendation. The
quality of information for a given recommendation allowed assessment of
the level of evidence as recommended by the American College of Cardiology
Foundation/American Heart Association Task Force on Practice Guidelines.
Recommendations were written in the three following areas: (1) heparin
dosing and monitoring for initiation and maintenance of CPB; (2) heparin
contraindications and heparin alternatives; and (3) reversal of
anticoagulation during cardiac operations. It is hoped that this guideline
will serve as a resource and will stimulate investigators to conduct more
research and to expand on the evidence base on the topic of
anticoagulation therapy for CPB. Copyright © 2017 International
Anesthesia Research Society.

<101>
[Use Link to view the full text]
Accession Number
625733541
Title
Regional Analgesia Added to General Anesthesia Compared With General
Anesthesia Plus Systemic Analgesia for Cardiac Surgery in Children: A
Systematic Review and Meta-analysis of Randomized Clinical Trials.
Source
Anesthesia and analgesia. 128 (1) (pp 130-136), 2019. Date of Publication:
01 Jan 2019.
Author
Monahan A.; Guay J.; Hajduk J.; Suresh S.
Institution
(Monahan, Hajduk, Suresh) From the Department of Pediatric Anesthesiology,
Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United
States
(Guay) Department of Anesthesio logy and Critical Care, Faculty of
Medicine, Laval University, Quebec City, QC, Canada
(Guay) Department of Anesthesiology, Faculty of Medicine, QC, Canada
(Guay) Teaching and Research Unit, Health Sciences, University of Quebec
in Abitibi-Temiscamingue, QC, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: The aim of this systematic review was to compare the effects
of regional analgesic (RA) techniques with systemic analgesia on
postoperative pain, nausea and vomiting, resources utilization,
reoperation, death, and complications of the analgesic techniques in
children undergoing cardiac surgery. METHOD(S): A search was done in
May 2018 in PubMed, Embase, and the Cochrane Central Register of
Controlled Trials for randomized controlled trials comparing RA techniques
with systemic analgesia. Risks of bias of included trials were judged with
the Cochrane tool. Data were analyzed with fixed- (I < 25%) or
random-effects models (I >= 25%). The quality of evidence was graded
according to the Grading of Recommendations Assessment, Development, and
Evaluation working group scale. RESULT(S): We included 14 randomized
controlled trials with 605 participants (312 to RA and 293 to the
comparator). RA reduces pain up to 24 hours after surgery. At 6-8 hours
after surgery, the standardized mean difference was -0.81 (95% confidence
interval [CI], -1.22 to -0.40; low-quality evidence). We did not find a
difference for nausea and vomiting (risk ratio [RR], 0.89; 95% CI,
0.61-1.31; very low-quality evidence), duration of tracheal intubation
(standardized mean difference, -0.18; 95% CI, -0.40 to 0.05; low-quality
evidence), intensive care unit length of stay (mean difference, -0.10
hours; 95% CI, -1.31 to 1.12 hours; low-quality evidence), hospital length
of stay (mean difference, -0.02 days; 95% CI, -1.16 to 1.12 days;
low-quality evidence), reoperation (RR, 0.76; 95% CI, 0.17-3.28;
low-quality evidence), death (RR, 0.50; 95% CI, 0.05-4.94; low-quality
evidence), and respiratory depression (RR, 2.06; 95% CI, 0.20-21.68; very
low-quality evidence). No trial reported signs of local anesthetic
toxicity or lasting neurological or infectious complications related to
the RA techniques. One trial reported 1 transient ipsilateral episode of
diaphragmatic paralysis with intrapleural analgesia that resolved with
cessation of local anesthetic administration. CONCLUSION(S): Compared
to systemic analgesia, RA techniques reduce postoperative pain up to 24
hours in children undergoing cardiac surgery. Currently, there is no
evidence that RA for pediatric cardiac surgery has any impact on major
morbidity and mortality. These results should be interpreted cautiously
because they represent a meta-analysis of small and heterogeneous studies.
Further studies are needed.

<102>
Accession Number
625733426
Title
Congress of Neurological Surgeons Systematic Review and Evidence-Based
Guidelines on the Evaluation and Treatment of Patients With Thoracolumbar
Spine Trauma: Novel Surgical Strategies.
Source
Neurosurgery. 84 (1) (pp E59-E62), 2019. Date of Publication: 01 Jan 2019.
Author
Chi J.H.; Eichholz K.M.; Anderson P.A.; Arnold P.M.; Dailey A.T.; Dhall
S.S.; Harrop J.S.; Hoh D.J.; Qureshi S.; Rabb C.H.; Raksin P.B.; Kaiser
M.G.; O'Toole J.E.
Institution
(Chi) Department of Neurosurgery, Harvard Medical School, Brigham and
Women's Hospital, Boston, MA, United States
(Eichholz) St. Louis Minimally Invasive Spine Center, St. Louis, MO,
United States
(Anderson) Department of Orthopedics and Rehabilitation, University of
Wisconsin, Madison, WI, United States
(Arnold) Department of Neurosurgery, University of Kansas School of
Medicine, Kansas City, KS, United States
(Dailey, Rabb) Department of Neurosurgery, University of Utah, Salt Lake
City, UT, United States
(Dhall) Department of Neurological Surgery, University of California, San
Francisco, CA, United States
(Harrop) Departments of Neurological Surgery and Orthopedic Surgery,
Thomas Jefferson University, Philadelphia, PA, United States
(Hoh) Lillian S. Wells Department of Neurological Surgery, University of
Florida, Gainesville, FL, United States
(Qureshi) Department of Orthopaedic Surgery, Weill Cornell Medical
College, NY, United States
(Raksin) Division of Neurosurgery, John H. Stroger, Jr Hospital of Cook
County and Department of Neurological Surgery, Rush University Medical
Center, Chicago, IL, United States
(Kaiser) Department of Neurosurgery, Columbia University, NY, United
States
(O'Toole) Department of Neurological Surgery, Rush University Medical
Center, Chicago, IL, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Treatment of thoracolumbar burst fractures has traditionally
involved spinal instrumentation with fusion performed with standard open
surgical techniques. Novel surgical strategies, including instrumentation
without fusion and percutaneous instrumentation alone, have been
considered less invasive and more efficient treatments. OBJECTIVE(S):
To review the current literature and determine the role of fusion in
instrumented fixation, as well as the role of percutaneous
instrumentation, in the treatment of patients with thoracolumbar burst
fractures. METHOD(S): The task force members identified search
terms/parameters and a medical librarian implemented the literature
search, consistent with the literature search protocol (see Appendix I),
using the National Library of Medicine PubMed database and the Cochrane
Library for the period from January 1, 1946 to March 31, 2015.
 RESULT(S): A total of 906 articles were identified and 38 were
selected for full-text review. Of these articles, 12 articles met criteria
for inclusion in this systematic review. CONCLUSION(S): There is
grade A evidence for the omission of fusion in instrumented fixation for
thoracolumbar burst fractures. There is grade B evidence that percutaneous
instrumentation is as effective as open instrumentation for thoracolumbar
burst fractures. QUESTION: Does the addition of arthrodesis to
instrumented fixation improve outcomes in patients with thoracic and
lumbar burst fractures? RECOMMENDATION: It is recommended that in the
surgical treatment of patients with thoracolumbar burst fractures,
surgeons should understand that the addition of arthrodesis to
instrumented stabilization has not been shown to impact clinical or
radiological outcomes, and adds to increased blood loss and operative
time. Strength of Recommendation: Grade A. QUESTION: How does the use of
minimally invasive techniques (including percutaneous instrumentation)
affect outcomes in patients undergoing surgery for thoracic and lumbar
fractures compared to conventional open techniques? RECOMMENDATION:
Stabilization using both open and percutaneous pedicle screws may be
considered in the treatment of thoracolumbar burst fractures as the
evidence suggests equivalent clinical outcomes. Strength of
Recommendation: Grade B The full version of the guideline can be reviewed
at:
https://www.cns.org/guideline-chapters/congress-neurological-surgeons-syst
ematic-review-evidence-based-guidelines/chapter_12.

<103>
Accession Number
625733260
Title
ERS/EACTS statement on the management of malignant pleural effusions.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 55 (1) (pp 116-132),
2019. Date of Publication: 01 Jan 2019.
Author
Bibby A.C.; Dorn P.; Psallidas I.; Porcel J.M.; Janssen J.; Froudarakis
M.; Subotic D.; Astoul P.; Licht P.; Schmid R.; Scherpereel A.; Rahman
N.M.; Maskell N.A.; Cardillo G.
Institution
(Bibby, Maskell) Academic Respiratory Unit, University of Bristol Medical
School Translational Health Sciences, Bristol, United Kingdom
(Bibby, Maskell) North Bristol Lung Centre, North Bristol NHS Trust,
Bristol, United Kingdom
(Dorn, Schmid) Division of Thoracic Surgery, University Hospital Bern,
Bern, Switzerland
(Psallidas, Rahman) Oxford Respiratory Trials Unit, University of Oxford,
Oxford, United Kingdom
(Porcel) Pleural Medicine Unit, Arnau de Vilanova University Hospital, IRB
Lleida, Lleida, Spain
(Janssen) Department of Pulmonary Diseases, Canisius Wilhelmina Hospital,
Nijmegen, Netherlands
(Froudarakis) Department of Respiratory Medicine, Medical School of
Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
(Subotic) Clinic for Thoracic Surgery, Clinical Center of Serbia,
Belgrade, Serbia
(Astoul) Department of Thoracic Oncology, Pleural Diseases and
Interventional Pulmonology, Hospital North Aix-Marseille University,
Marseille, France
(Licht) Department of Cardiothoracic Surgery, Odense University Hospital,
Odense, Denmark
(Scherpereel) Pulmonary and Thoracic Oncology Department, Hospital of the
University (CHU) of Lille, Lille, France
(Rahman) Oxford Centre for Respiratory Medicine, NHS Foundation Trust,
University Hospitals, Oxford, United Kingdom
(Maskell, Cardillo) Task force chairperson France
(Cardillo) Department of Thoracic Surgery, Carlo Forlanini Hospital,
Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
Publisher
NLM (Medline)
Abstract
Malignant pleural effusions (MPE) are a common pathology, treated by
respiratory physicians and thoracic surgeons alike. In recent years,
several well-designed randomized clinical trials have been published that
have changed the landscape of MPE management. The European Respiratory
Society (ERS) and the European Association for Cardio-Thoracic Surgery
(EACTS) established a multidisciplinary collaboration of clinicians with
expertise in the management of MPE with the aim of producing a
comprehensive review of the scientific literature. Six areas of interest
were identified, including the optimum management of symptomatic MPE,
management of trapped lung in MPE, management of loculated MPE, prognostic
factors in MPE, whether there is a role for oncological therapies prior to
intervention for MPE and whether a histological diagnosis is always
required in MPE. The literature revealed that talc pleurodesis and
indwelling pleural catheters effectively manage the symptoms of MPE. There
was limited evidence regarding the management of trapped lung or loculated
MPE. The LENT score was identified as a validated tool for predicting
survival in MPE, with Brims' prognostic score demonstrating utility in
mesothelioma prognostication. There was no evidence to support the use of
oncological therapies as an alternative to MPE drainage, and the
literature supported the use of tissue biopsy as the gold standard for
diagnosis and treatment planning.Management options for malignant pleural
effusions have advanced over the past decade, with high-quality randomized
trial evidence informing practice in many areas. However, uncertainties
remain and further research is required http://ow.ly/rNt730jOxOS.

<104>
Accession Number
625733696
Title
Guidelines for enhanced recovery after lung surgery: recommendations of
the Enhanced Recovery After Surgery (ERAS) Society and the European
Society of Thoracic Surgeons (ESTS).
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 55 (1) (pp 91-115),
2019. Date of Publication: 01 Jan 2019.
Author
Batchelor T.J.P.; Rasburn N.J.; Abdelnour-Berchtold E.; Brunelli A.;
Cerfolio R.J.; Gonzalez M.; Ljungqvist O.; Petersen R.H.; Popescu W.M.;
Slinger P.D.; Naidu B.
Institution
(Batchelor) Department of Thoracic Surgery, University Hospitals Bristol
NHS Foundation Trust, Bristol, United Kingdom
(Rasburn) Department of Anaesthesia, University Hospitals Bristol NHS
Foundation Trust, Bristol, United Kingdom
(Abdelnour-Berchtold, Gonzalez) Division of Thoracic Surgery, Centre
Hospitalier Universitaire Vaudois, Lausanne, Switzerland
(Brunelli) Department of Thoracic Surgery, St. James's University
Hospital, Leeds, United Kingdom
(Cerfolio) Department of Cardiothoracic Surgery, New York University
Langone Health, New York, NY, USA
(Ljungqvist) Department of Surgery, Faculty of Medicine and Health, Orebro
University, Orebro, Sweden
(Petersen) Department of Thoracic Surgery, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Popescu) Department of Anesthesiology, Yale University School of
Medicine, New Haven, CT, United States
(Slinger) Department of Anesthesia, University Health Network - Toronto
General Hospital, Toronto, ON, Canada
(Naidu) Department of Thoracic Surgery, Heart of England NHS Foundation
Trust, Birmingham, United Kingdom
Publisher
NLM (Medline)
Abstract
Enhanced recovery after surgery is well established in specialties such as
colorectal surgery. It is achieved through the introduction of multiple
evidence-based perioperative measures that aim to diminish postoperative
organ dysfunction while facilitating recovery. This review aims to present
consensus recommendations for the optimal perioperative management of
patients undergoing thoracic surgery (principally lung resection). A
systematic review of meta-analyses, randomized controlled trials, large
non-randomized studies and reviews was conducted for each protocol
element. Smaller prospective and retrospective cohort studies were
considered only when higher-level evidence was unavailable. The quality of
the evidence base was graded by the authors and used to form consensus
recommendations for each topic. Development of these recommendations was
endorsed by the Enhanced Recovery after Surgery Society and the European
Society for Thoracic Surgery. Recommendations were developed for a total
of 45 enhanced recovery items covering topics related to preadmission,
admission, intraoperative care and postoperative care. Most are based on
good-quality studies. In some instances, good-quality data were not
available, and subsequent recommendations are generic or based on data
extrapolated from other specialties. In other cases, no recommendation can
currently be made because either equipoise exists or there is a lack of
available evidence. Recommendations are based not only on the quality of
the evidence but also on the balance between desirable and undesirable
effects. Key recommendations include preoperative counselling, nutritional
screening, smoking cessation, prehabilitation for high-risk patients,
avoidance of fasting, carbohydrate loading, avoidance of preoperative
sedatives, venous thromboembolism prophylaxis, prevention of hypothermia,
short-acting anaesthetics to facilitate early emergence, regional
anaesthesia, nausea and vomiting control, opioid-sparing analgesia,
euvolemic fluid management, minimally invasive surgery, early chest drain
removal, avoidance of urinary catheters and early mobilization after
surgery. These guidelines outline recommendations for the perioperative
management of patients undergoing lung surgery based on the best available
evidence. As the recommendation grade for most of the elements is strong,
the use of a systematic perioperative care pathway has the potential to
improve outcomes after surgery.

<105>
Accession Number
625733608
Title
Effects of Massage in Reducing the Pain and Anxiety of the Cardiac Surgery
Critically Ill-a Randomized Controlled Trial.
Source
Pain medicine (Malden, Mass.). 19 (12) (pp 2556-2569), 2018. Date of
Publication: 01 Dec 2018.
Author
Boitor M.; Martorella G.; Maheu C.; Laizner A.M.; Gelinas C.
Institution
(Boitor, Maheu, Laizner, Gelinas) Ingram School of Nursing, McGill
University, 680 Sherbrooke West, Montreal, Quebec, Canada
(Martorella) College of Nursing, Florida State University, 104F - Vivian
M. Duxbury Hall, FL, United States
Publisher
NLM (Medline)
Abstract
Objective: To evaluate the effectiveness of hand massage on the pain and
anxiety of the cardiac surgery critically ill. Design(s): A three-arm
randomized controlled trial. Setting(s): This study was conducted in
a medical-surgical intensive care unit in Canada. Subjects: Adult patients
who underwent elective cardiac surgery, who were able to speak
French/English and to self-report symptoms, without a high risk of
postoperative complications were eligible. Method(s): Patients were
randomly allocated to standard care plus either two 20-minute hand
massages (experimental), two 20-minute hand holdings (active control), or
two 20-minute rest periods (passive control/standard care). Pain
intensity, pain unpleasantness, anxiety, muscle tension, and vital signs
were evaluated before, after, and 30minutes later for each intervention.
 Result(s): From the 83 patients recruited, 60 were randomized (20
massage, 19 hand holding, 21 standard care). After controlling for
baseline scores, the massage group reported significantly lower pain
intensity, pain unpleasantness, and anxiety for the first data collection
set compared with both hand holding and standard care (analysis of
covariance, P<0.02), with an average decrease of two points on a 0-10
scale. No statistically significant differences were noted between hand
holding and standard care for any of the symptoms. Similar results were
observed for the second data collection set (N=43). Patients had decreased
muscle tension post massage. Vital signs did not differ significantly
between groups. Conclusion(s): Findings suggest that a 20-minute hand
massage in addition to routine postoperative pain management can
concomitantly reduce pain intensity, pain unpleasantness, and anxiety by
two points on average on a 0-10 scale.

<106>
Accession Number
625728440
Title
Vasopressin therapy in cardiac surgery.
Source
Journal of Cardiac Surgery. (no pagination), 2018. Date of Publication:
2018.
Author
Kunkes J.H.; Baker W.L.; Hammond J.A.; Gluck J.
Institution
(Kunkes, Hammond, Gluck) Hartford Hospital, Hartford, CT, United States
(Kunkes, Hammond, Gluck) University of Connecticut School of Medicine,
Farmington, CT, United States
(Baker) University of Connecticut School of Pharmacy, Storrs, CT, United
States
(Hammond, Gluck) Heart and Vascular Institute, Hartford Healthcare,
Hartford, CT, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Arginine vasopressin (AVP) is a naturally occurring peptide
with diverse effects mediated through selective V1 and V2 receptors. About
10% of patients undergoing cardiopulmonary bypass develop postoperative
vasodilatory shock requiring high-dose catecholamines. We sought to
examine the role of AVP therapy in cardiac surgery. Method(s): A
search of Medline was conducted through September 2018 using key words and
medical subject headings (MeSH) relating to AVP, copeptin, and cardiac
surgery. A systematic review was performed on articles as they pertained
to AVP for use as a vasopressor after cardiovascular surgery complicated
by vasodilatory shock. Result(s): A relative or absolute deficiency
of Arginine vasopressin is associated with vasodilatory shock after
cardiopulmonary bypass. Physiologic replacement with exogenous Arginine
vasopressin results in significant increases in systemic vascular
resistance and mean arterial pressure with decreased requirements of
catecholamines. At doses of <0.1 U/min Arginine vasopressin is safe with
very few adverse effects. Conclusion(s): Post-cardiopulmonary bypass
vasodilatory shock is largely due to a relative deficiency of Arginine
vasopressin. Exogenous administration of low-dose Arginine vasopressin
alone or in combination with traditional catecholamines is a safe and
effective way to manage this type of vasodilatory shock. Copyright
© 2018 Wiley Periodicals, Inc.

<107>
Accession Number
625728550
Title
Spontaneous leaflet fracture resulting in embolization from mechanical
valve prostheses.
Source
Journal of Cardiac Surgery. (no pagination), 2018. Date of Publication:
2018.
Author
van Steenbergen G.G.J.; Tsang Q.H.Y.; van der Heide S.M.; Verkroost
M.W.A.; Li W.W.L.; Morshuis W.J.
Institution
(van Steenbergen, Tsang, van der Heide, Verkroost, Li, Morshuis)
Department of Cardiothoracic Surgery at Radboudumc, Nijmegen, Netherlands
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Spontaneous leaflet fracture of mechanical heart valve prostheses is very
rare. We describe a case of spontaneous leaflet embolization 31 years
after aortic valve replacement with an Edwards-Duromedics prosthesis
(Baxter Healthcare Corp., Edwards Division, Santa Ana, CA). We review the
literature on this subject to increase awareness and recognition for this
potentially life-threatening complication. Copyright © 2018 The
Authors. Journal of Cardiac Surgery Published by Wiley Periodicals, Inc.

<108>
[Use Link to view the full text]
Accession Number
624732755
Title
Serum Uric Acid and Atrial Fibrillation: Meta-analysis.
Source
Critical Pathways in Cardiology. 17 (3) (pp 161-166), 2018. Date of
Publication: 01 Sep 2018.
Author
Pak S.; Yatsynovich Y.; Valencia D.; Chen T.
Institution
(Pak, Yatsynovich, Valencia) Department of Medicine, Kettering Medical
Center, Kettering, OH 45429, United States
(Chen) Department of Mathematics and Statistics, Toledo University,
Toledo, OH, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Hyperuricemia has been recently speculated to be associated with the
development of atrial fibrillation (AF). A meta-analysis of observational
studies was conducted to explore the relationship between serum uric acid
(SUA) and AF. We searched the MEDLINE, EMBASE, and CINAHL databases and
performed extensive bibliography search to identify studies with mean SUA
level for patients with and without AF. Key search terms were "atrial
fibrillation" and "uric acid." Under the random-effects model, the pooled
standardized difference in means between patients with and without AF was
calculated. A total of 24 studies with 30,609 patients were included for
quantitative analyzation of the difference in SUA levels between the
patients with and without AF. The SUA level of patients with atrial AF was
found to be significantly higher compared with those without AF
(standardized difference in means = 0.66; 95% confidence interval,
0.43-0.88; P < 0.0001). The mean SUA level of patients with AF
significantly is higher than those without AF. Copyright © 2018
Wolters Kluwer Health, Inc. All rights reserved.

<109>
Accession Number
618528277
Title
Comparison of Iodixanol and Iopromide in Patients with Renal Insufficiency
and Congestive Heart Failure Undergoing Coronary Angiography by
Hemodynamic Monitoring.
Source
Angiology. 68 (10) (pp 907-913), 2017. Date of Publication: 01 Nov 2017.
Author
Qian G.; Yang Y.-Q.; Dong W.; Cao F.; Chen Y.-D.
Institution
(Qian, Yang, Dong, Cao, Chen) Department of Cardiology, Chinese People's
Liberation Army General Hospital, Beijing, China
(Chen) Chinese People's Liberation Army General Hospital, 28# Fuxing
Street, Haidian District, Beijing 100853, China
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
We investigated the impact of contrast media (CM) with different
osmolality on cardiac preload in patients with chronic kidney disease
(CKD) and congestive heart failure (CHF). Patients with CKD and CHF were
equally randomized to receive either iso-osmolar contrast media (IOCM)
iodixanol or low-osmolar contrast media iopromide. We measured cardiac
preload indexes by invasive hemodynamic monitoring before and after CM
injection. Major adverse cardiac events postprocedures were recorded.
Increase in extravascular lung water index was only seen in the iopromide
group (P <.001), while global end diastolic index and central venous
pressure were all significantly increased from baseline in the both groups
(P <.001, respectively), and the increase in cardiac preload indexes was
significantly greater in the iopromide group than in the iodixanol group
(P < 0.001). The overall incidence of acute heart failure was more
frequently observed in the iopromide group (P = 0.027). Low-osmolar
contrast media iopromide significantly increased cardiac preload in
patients with CKD and CHF undergoing cardiac catheterization procedures
compared with IOCM iodixanol. Copyright © The Author(s) 2017.

<110>
Accession Number
621584814
Title
Effect of continuous positive airway pressure on long-term cardiovascular
outcomes in patients with coronary artery disease and obstructive sleep
apnea: A systematic review and meta-analysis.
Source
Respiratory Research. 19 (1) (no pagination), 2018. Article Number: 61.
Date of Publication: 10 Apr 2018.
Author
Wang X.; Zhang Y.; Dong Z.; Fan J.; Nie S.; Wei Y.
Institution
(Wang, Fan, Nie) Capital Medical University, Emergency and Critical Care
Center, Beijing Anzhen Hospital, 2 Anzhen Road, Beijing, Chaoyang District
100029, China
(Zhang, Dong) Capital Medical University, Cardiovascular Center, Beijing
Tongren Hospital, Beijing, China
(Wei) Beijing Anzhen Hospital, Capital Medical University, Department of
Otolaryngology Head and Neck Surgery, 2 Anzhen Road, Beijing, Chaoyang
District 100029, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Obstructive sleep apnea (OSA) is highly prevalent in patients
with coronary artery disease (CAD) and is associated with recurrent
cardiovascular risk. However, whether treatment with continuous positive
airway pressure (CPAP) reduces this risk remains unclear. We performed a
systematic review and meta-analysis to assess the effect of CPAP on
long-term cardiovascular outcomes in patients with concomitant CAD and
OSA. Method(s): We searched the PubMed, EMBASE, and Cochrane library
from their inceptions to October 7, 2017. We included observational
studies and randomized controlled trials (RCTs) that described the
association of CPAP treatment with cardiovascular events in patients with
CAD and OSA. The primary outcome of interest was major adverse
cardiovascular event (MACE), including all-cause or cardiovascular death,
myocardial infarction, stroke, repeat revascularization, or
hospitalization for heart failure. Outcomes data were pooled using random
effects models and heterogeneity assessed with the I2
statistic. Result(s): We identified 9 studies (2 RCTs and 7
observational studies) with 1430 participants. The median follow-up
duration was from 36 to 86.5 months. Treatment with CPAP was associated
with a significantly lower risk of MACE in 6 observational studies (RR
0.61, 95% CI: 0.39-0.94, P = 0.02), but this was not reproduced in 2 RCTs
(RR 0.57, 95% CI: 0.32-1.02, P = 0.06). Similarly, CPAP significantly
reduced the risk of all-cause death (4 observational studies) and
cardiovascular death (3 observational studies), which were also not
confirmed in RCTs. Conclusion(s): The use of CPAP in patients with
CAD and OSA might prevent subsequent cardiovascular events, which was only
demonstrated in observational studies, but not in RCTs. The value of CPAP
therapy as second prevention for CAD needs further
investigation. Copyright © 2018 The Author(s).

<111>
Accession Number
620609218
Title
Effect of Remote Ischemic Preconditioning on Intestinal
Ischemia-Reperfusion Injury in Adults Undergoing On-Pump CABG Surgery: A
Randomized Controlled Pilot Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (3) (pp 1243-1247),
2018. Date of Publication: June 2018.
Author
Struck R.; Wittmann M.; Muller S.; Meybohm P.; Muller A.; Bagci S.
Institution
(Struck, Wittmann, Muller) Department of Anesthesiology and Intensive Care
Medicine, University Hospital Bonn, Bonn, Germany
(Muller) Department of Anesthesiology and Intensive Care and Emergency
Medicine and Pain Therapy Kemperhof Koblenz, Gemeinschaftsklinikum
Mittelrhein, Koblenz, Germany
(Meybohm) Department of Anesthesiology, Intensive Care Medicine and Pain
Therapy, University Hospital Frankfurt, Frankfurt, Germany
(Muller, Bagci) Neonatology and Pediatric Intensive Care, Children's
Hospital, University of Bonn, Bonn, Germany
Publisher
W.B. Saunders
Abstract
Objective: Cardiopulmonary bypass (CPB) surgery commonly threatens the
heart and remote organs with ischemia-reperfusion injury. Transient
episodes of ischemia to nonvital tissue, known as remote ischemic
preconditioning (RIPC), is thought to help local and remote vital organs
to withstand subsequent ischemic insults. Design(s): Prospective,
randomized, double-blinded control trial. Setting(s): Tertiary
referral academic teaching hospital. Participant(s): Thirty patients
undergoing elective CPB surgery Intervention: RIPC was achieved via three
5-minute cycles of upper limb ischemia using a blood pressure cuff or
control (sham cuff). Measurements and Main Results: Primary outcome
was the occurrence of intestinal injury, as measured by an increase in
intestinal fatty acid binding protein (I-FABP). Secondary outcomes
included incidence of gastrointestinal complications and duration of
intensive care unit (ICU) stay. RIPC did not affect serum IFABP levels at
the end of surgery and on the first postoperative day (p = 0.697 and p =
0.461, respectively). For all patients, mean I-FABP levels significantly
increased at the end of surgery and decreased to under baseline levels on
the first postoperative day (from a mean [+/- standard deviation] baseline
value of 764 +/- 492 pg/mL to 2,002 +/- 974 pg/mL and decreased to 568 +/-
319 pg/mL, p < 0.001). All patients remained clinically absent of
gastrointestinal complications until hospital discharge. Duration of ICU
stay was not correlated with I-FABP levels at the end of surgery. Neither
duration of CPB nor duration of aortic clamping significantly correlated
with postoperative I-FABP levels. Conclusion(s): These findings
suggest that RIPC does not affect intestinal injury in patients undergoing
CPB surgery. In patients undergoing cardiac surgery, intestinal injury
appears to be moderate and transient without any clinical relevant
complication. Copyright © 2017 Elsevier Inc.

<112>
Accession Number
623717234
Title
Computed tomography-guided pericardiocentesis: a systematic review
concerning contemporary evidence and future perspectives.
Source
Therapeutic Advances in Cardiovascular Disease. 12 (11) (pp 299-307),
2018. Date of Publication: 01 Nov 2018.
Author
Vilela E.M.; Ruivo C.; Guerreiro C.E.; Silva M.P.; Ladeiras-Lopes R.;
Caeiro D.; Morais G.P.; Primo J.; Braga P.; Ferreira N.; Nunes J.P.L.;
Ribeiro V.G.
Institution
(Vilela) Cardiology Department, Vila Nova de Gaia / Espinho Hospital
Center EPE, Rua Conceicao Fernandes, Vila Nova de Gaia 4434-520, Portugal
(Ruivo) Leiria Hospital Center, Leiria, Portugal
(Guerreiro, Silva, Ladeiras-Lopes, Caeiro, Morais, Primo, Braga, Ferreira,
Ribeiro) Cardiology Department, Vila Nova de Gaia / Espinho Hospital
Center, Gaia, Portugal
(Nunes) Sao Joao Hospital Center, Porto, Portugal
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Pericardial effusion (PE) can develop in several pathological
scenarios, and is often initially evaluated by means of echocardiography.
Computed tomography (CT) has been used as an aid in the management of
patients presenting with PE, in selected cases. The role of CT-guided
pericardiocentesis in contemporary practice, however, remains not fully
ascertained. We aimed at presenting a systematic review concerning the
state-of-the-art of this technique. Method(s): A systematic review of
published data on the use of CT for guiding pericardiocentesis was carried
out (search performed on PubMed, ISI Web of Knowledge and Scopus
databases). Result(s): From title and abstract analysis, 14 articles
were included that met the prespecified criteria. After full-text
analysis, six articles were excluded. The eight articles under analysis
included a total of 635 procedures performed in 571 patients. CT guidance
was mostly used in a postoperative setting (364 procedures). Most
procedures were done mainly for therapeutic purposes (528 procedures).
Success rates ranged from 94% to 100%. Complications ranged from 0% to
7.8%. Conclusion(s): CT-guided pericardiocentesis is a useful
technique in the approach to PE, in several clinical scenarios. Its use
can be especially relevant in the postoperative period, as well as in
individuals with suboptimal image quality (as assessed by
echocardiography, for the moment the first choice in the approach to most
cases of PE). Copyright © The Author(s), 2018.

<113>
Accession Number
623805068
Title
Cardiac rehabilitation and its effects on cognition in patients with
coronary artery disease and heart failure.
Source
Expert Review of Cardiovascular Therapy. 16 (9) (pp 645-652), 2018. Date
of Publication: 02 Sep 2018.
Author
Alagiakrishnan K.; Mah D.; Gyenes G.
Institution
(Alagiakrishnan, Mah, Gyenes) Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, Canada
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Cardiac rehabilitation program is an evidence-based
intervention and established model of exercise delivery following
myocardial infarction and heart failure. Although it forms an important
part of recovery and helps to prevent future events and complications,
there has been little focus on its potential cognitive benefits. Areas
covered: Coronary artery disease and heart failure are common heart
problems associated with significant morbidity and mortality, and
cognitive decline is commonly seen in affected individuals. Cognitive
impairment may influence patient self-management by reducing medication
adherence, rendering patients unable to make lifestyle modifications and
causing missed healthcare visits. Cognitive assessment in cardiac
rehabilitation as an outcome measure has the potential to improve
clinical, functional and behavioral domains as well as help to reduce gaps
in the quality of care in these patients. Expert commentary: Limited
evidence at present has shown that cardiac rehabilitation and exercise has
potential in preventing cognitive decline. Cardiac prehabilitation, a
rehabilitation-like program delivered before cardiac surgery, may also
play a role in preventing postoperative cognitive dysfunction, but needs
future research studies to support it. Copyright © 2018, ©
2018 Informa UK Limited, trading as Taylor & Francis Group.

<114>
[Use Link to view the full text]
Accession Number
615007272
Title
Ventilation with High or Low Tidal Volume with PEEP Does Not Influence
Lung Function after Spinal Surgery in Prone Position: A Randomized
Controlled Trial.
Source
Journal of Neurosurgical Anesthesiology. 30 (3) (pp 237-245), 2018. Date
of Publication: 2018.
Author
Soh S.; Shim J.-K.; Ha Y.; Kim Y.-S.; Lee H.; Kwak Y.-L.
Institution
(Soh, Shim, Kwak) Department of Anesthesiology and Pain Medicine,
Anesthesia and Pain Research Institut, Yonsei University College of
Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
(Shim, Kwak) Anesthesia and Pain Research Institute, Severance
Cardiovascular Hospital, United States
(Ha) Departments of and Neurosurgery, United States
(Kim) Internal Medicine, United States
(Lee) Anesthesiology and Pain Medicine, United States
(Ha) Spine and Spinal Cord Institute, Yonsei University College of
Medicine, Seoul, South Korea
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Spinal surgery in the prone position is accompanied by
increased intrathoracic pressure and decreased respiratory compliance.
This study investigated whether intraoperative lung protective mechanical
ventilation improved lung function evaluated with pulmonary function tests
in patients at risk of postoperative pulmonary complications (PPCs) after
major spinal surgery in the prone position. Method(s): Seventy-eight
patients at potential risk of PPCs were randomly assigned to the
protective group (tidal volume; 6 mL/kg predicted body weight, 6 cm H 2 O
positive end-expiratory pressure with recruitment maneuvers) or the
conventional group (10 mL/kg predicted body weight, no positive
end-expiratory pressure). The primary efficacy variables were assessed by
pulmonary function tests, performed before surgery, and 3 and 5 days
afterward. Result(s): Postoperative forced vital capacity (2.17+/-0.1
L vs. 1.91+/-0.1 L, P=0.213) and forced expiratory volume in 1 second
(1.73+/-0.08 L vs. 1.59+/-0.08 L, P=0.603) at postoperative day (POD) 3 in
the protective and conventional groups, respectively, were similar. Trends
of a postoperative decrease in forced vital capacity (P=0.586) and forced
expiratory volume in 1 second (P=0.855) were similar between the groups.
Perioperative blood-gas analysis variables were comparable between the
groups. Patients in the protective and conventional groups showed similar
rates of clinically significant PPCs (8% vs. 10%, P>0.999).
 Conclusion(s): In patients at potential risk of developing PPCs
undergoing major spinal surgery, we did not find evidence indicating any
difference between the lung protective and conventional ventilation in
postoperative pulmonary function and oxygenation. Copyright ©
2017 Wolters Kluwer Health, Inc. All rights reserved.

<115>
Accession Number
622383195
Title
Antiarrhythmic effects of ranolazine used both alone for prevention of
atrial fibrillation and as an add-on to intravenous amiodarone for its
pharmacological cardioversion: A meta-Analysis.
Source
Minerva Cardioangiologica. 66 (3) (pp 349-359), 2018. Date of Publication:
June 2018.
Author
De Vecchis R.; Ariano C.; Giasi A.; Cioppa C.
Institution
(De Vecchis, Ariano, Giasi, Cioppa) Unit of Cardiology, Presidio Sanitario
Intermedio Elena D'Aosta, ASL Napoli 1 Centro, Via P. Gaurico 21, Naples
80125, Italy
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: Recent evidence from relatively small randomized controlled
trials would seem to support a useful role of ranolazine for the
prevention and treatment of atrial fibrillation (AF). The present study is
aimed at providing information about the possible beneficial
anti-Arrhythmic properties of ranolazine. In particular, the meta-Analysis
carried out in this study focuses on the application of ranolazine to
prophylaxis and treatment of atrial fibrillation. EVIDENCE ACQUISITION:
Both methods randomized controlled trials (RCTs) and non-randomized
observational studies concerning the effects of ranolazine on AF were
included in the meta-Analysis. In each of the considered studies, a
comparison was made between a group of patients taking ranolazine and a
second group treated instead with another antiarrhythmic therapy, or
assigned to placebo. Efficacy outcomes were the risk of new-onset AF, the
probability of conversion to sinus rhythm of patients with recent
occurrence (>=48 h) of AF and the time to conversion to sinus rhythm.
Safety endpoints were death, adverse events, QTc prolongation and
hypotension. EVIDENCE SYNTHESIS: Ten studies (8 RCTs and 2 nonrandomized
observational studies) were gathered on the whole. Ranolazine was
effective in preventing the occurrence of AF when compared to controls
(RR=0.60; 95% CI: 0.43-0.83; P=0.002). Subgroup analysis showed a more
pronounced preventive effect of ranolazine against AF in the postoperative
setting of coronary artery bypass grafting (CABG) surgery (RR=0.39; 95%
CI: 0.18-0.83; P=0.02) when compared to non-postoperative AF (RR=0.76; 95%
CI: 0.63-0.92; P=0.04). Ranolazine enhanced the chances of successful
cardioversion when added to intravenous amiodarone compared to amiodarone
alone (RR 1.18; 95% CI: 1.05-1.33; P=0.004) and significantly decreased
the time to cardioversion (SMD=-10.35 h; 95% CI:-18.13 hours to-2.57
hours; P<0.001). Overall risks of death, adverse events, and QTc
prolongation were shown to be similar in the comparison between patients
treated with ranolazine and controls. CONCLUSION(S): Ranolazine given
orally at appropriate doses showed the property to significantly quicken
the conversion of AF to sinus rhythm when combined with the IV amiodarone,
compared to IV amiodarone alone. Furthermore, in patients in sinus rhythm,
ranolazine proved to reduce the frequency of new onset AF as well as of
its recurrences, especially in patients undergone CABG surgery, known to
be at high risk of developing postoperative AF. In addition, ranolazine
use seems to be safe and associated with relatively few adverse
events. Copyright © 2017 EDIZIONI MINERVA MEDICA.

<116>
Accession Number
622441087
Title
Acute chest pain evaluation using coronary computed tomography angiography
compared with standard of care: A meta-analysis of randomised clinical
trials.
Source
Heart. 104 (3) (pp 215-221), 2018. Date of Publication: 01 Feb 2018.
Author
Gongora C.A.; Bavishi C.; Uretsky S.; Argulian E.
Institution
(Gongora, Bavishi, Argulian) Mount Sinai Heart, Mount Sinai St Luke's
Hospital, Icahn School of Medicine, Division of Cardiology, New York
10019, United States
(Uretsky) Department of Cardiovascular Medicine, Morristown Medical
Center, Gagnon Cardiovascular Institute, Morristown, NJ, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Coronary CT angiography (CCTA) has certain advantages compared
with stress testing including greater accuracy in identifying obstructive
coronary disease. The aim of the study was to perform a systematical
review and meta-analysis comparing CCTA with other standard-of-care (SOC)
approaches in evaluation of patients with acute chest pain. Methods
Electronic databases were systematically searched to identify randomised
clinical trials of patients with acute chest pain comparing CCTA with SOC
approaches. We examined the following end points: mortality, major adverse
cardiac events (MACE), myocardial infarction (MI), invasive coronary
angiography (ICA) and revascularisation. Pooled risk ratios (RR) and their
95% CIs were calculated using random-effects models. Results Ten trials
with 6285 patients were included. The trials used different definitions
and implementation for SOC but all used physiologic testing. The clinical
follow-up ranged from 1 to 19 months. There were no significant
differences in all-cause mortality (RR 0.48, 95% CI 0.17 to 1.36, p=0.17),
MI (RR 0.82, 95% CI 0.49 to 1.39, p=0.47) or MACE (RR 0.98, 95% CI 0.67 to
1.43, p=0.92) between the groups. However, significantly higher rates of
ICA (RR 1.32, 95% CI 1.07 to 1.63, p=0.01) and revascularisation (RR 1.77,
95% CI 1.35 to 2.31, p<0.0001) were observed in the CCTA arm. Conclusions
Compared with other SOC approaches use of CCTA is associated with similar
major adverse cardiac events but higher rates of revascularisation in
patients with acute chest pain. Copyright © 2018 Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article). All rights reserved.

<117>
Accession Number
622441081
Title
Diagnostic and prognostic benefits of computed tomography coronary
angiography using the 2016 National Institute for Health and Care
Excellence guidance within a randomised trial.
Source
Heart. 104 (3) (pp 207-214), 2018. Date of Publication: 01 Feb 2018.
Author
Adamson P.D.; Hunter A.; Williams M.C.; Shah A.S.V.; McAllister D.A.;
Pawade T.A.; Dweck M.R.; Mills N.L.; Berry C.; Boon N.A.; Clark E.;
Flather M.; Forbes J.; McLean S.; Roditi G.; Van Beek E.J.R.; Timmis A.D.;
Newby D.E.
Institution
(Adamson, Hunter, Williams, Shah, Pawade, Dweck, Mills, Boon, Clark, Van
Beek, Newby) BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh EH16 4SB, United Kingdom
(Williams, Van Beek) Edinburgh Imaging, Queens Medical Research Institute,
University of Edinburgh, Edinburgh, United Kingdom
(McAllister) Institute of Health and Wellbeing, University of Glasgow,
Glasgow, United Kingdom
(Berry, Roditi) Institute of Clinical Sciences, University of Glasgow,
Glasgow, United Kingdom
(Flather) Norwich Medical School, University of East Anglia, Norwich,
United Kingdom
(Forbes) Health Research Institute, University of Limerick, Limerick,
Ireland
(McLean) National Health Service, Fife, United Kingdom
(Timmis) William Harvey Research Institute, Queen Mary University of
London, London, United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives To evaluate the diagnostic and prognostic benefits of CT
coronary angiography (CTCA) using the 2016 National Institute for Health
and Care Excellence (NICE) guidelines for the assessment of suspected
stable angina. Methods Post hoc analysis of the Scottish COmputed
Tomography of the HEART (SCOT-HEART) trial of 4146 participants with
suspected angina randomised to CTCA. Patients were dichotomised into NICE
guideline-defined possible angina and non-anginal presentations. Primary
(diagnostic) endpoint was diagnostic certainty of angina at 6 weeks and
prognostic endpoint comprised fatal and non-fatal myocardial infarction
(MI). Results In 3770 eligible participants, CTCA increased diagnostic
certainty more in those with possible angina (relative risk (RR) 2.22 (95%
CI 1.91 to 2.60), p<0.001) than those with non-anginal symptoms (RR 1.30
(1.11 to 1.53), p=0.002; p interaction <0.001). In the possible angina
cohort, CTCA did not change rates of invasive angiography (p=0.481) but
markedly reduced rates of normal coronary angiography (HR 0.32 (0.19 to
0.52), p<0.001). In the non-anginal cohort, rates of invasive angiography
increased (HR 1.82 (1.13 to 2.92), p=0.014) without reducing rates of
normal coronary angiography (HR 0.78 (0.30 to 2.05), p=0.622). At 3.2
years of follow-up, fatal or non-fatal MI was reduced in patients with
possible angina (3.2% to 1.9%%; HR 0.58 (0.34 to 0.99), p=0.045) but not
in those with non-anginal symptoms (HR 0.65 (0.25 to 1.69), p=0.379).
Conclusions NICE-guided patient selection maximises the benefits of CTCA
on diagnostic certainty, use of invasive coronary angiography and
reductions in fatal and non-fatal myocardial infarction. Patients with
non-anginal chest pain derive minimal benefit from CTCA and increase the
rates of invasive investigation. Trial registration number
ClinicalTrials.gov: NCT01149590;post results. Copyright © Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2018. All rights reserved. No commercial use is permitted unless
otherwise expressly granted.

<118>
Accession Number
625438051
Title
Transcatheter mitral-valve repair in patients with heart failure.
Source
New England Journal of Medicine. 379 (24) (pp 2307-2318), 2018. Date of
Publication: 13 Dec 2018.
Author
Stone G.W.; Lindenfeld J.A.; Abraham W.T.; Kar S.; Lim D.S.; Mishell J.M.;
Whisenant B.; Grayburn P.A.; Rinaldi M.; Kapadia S.R.; Rajagopal V.;
Sarembock I.J.; Brieke A.; Marx S.O.; Cohen D.J.; Weissman N.J.
Institution
(Stone) Columbia University Medical Center, Cardiovascular Research
Foundation, 1700 Broadway, 8th Fl., New York, NY 10019, United States
(Stone) New York-Presbyterian Hospital, Cardiovascular Research
Foundation, United States
(Stone, Marx) Columbia University Medical Center, New York, United States
(Lindenfeld) Advanced Heart Failure, Vanderbilt Heart and Vascular
Institute, Nashville, United States
(Abraham) Departments of Medicine, Physiology, and Cell Biology, Division
of Cardiovascular Medicine, Davis, United States
(Abraham) Heart and Lung Research Institute, Ohio State University,
Columbus, United States
(Kapadia) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, United States
(Sarembock) Christ Hospital, Cincinnati, OH, United States
(Kar) Smidt Heart In-stitute, Cedars-Sinai Medical Center, Los Angeles,
United States
(Mishell) Kaiser Permanente-San Francisco Hospital, San Francisco, CA,
United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville,
United States
(Whisenant) Intermountain Medical Center, Murray, UT, United States
(Grayburn) Baylor University Medical Center, Baylor Heart and Vascular
Institute, United States
(Rinaldi) Carolinas Medical Center, Charlotte, NC, United States
(Rajagopal) Piedmont Hospital, Atlanta, United States
(Brieke) University of Colorado Hospital, Aurora, United States
(Cohen) Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, School of Medicine, Kansas City, United States
(Weissman) MedStar Health Research Institute, Hyattsville, MD, United
States
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Among patients with heart failure who have mitral regurgitation
due to left ventricular dysfunction, the prognosis is poor. Transcatheter
mitral-valve repair may improve their clinical outcomes. METHODS At 78
sites in the United States and Canada, we enrolled patients with heart
failure and moderate-to-severe or severe secondary mitral regurgitation
who remained symptomatic despite the use of maximal doses of
guideline-directed medical therapy. Patients were randomly assigned to
transcatheter mitral-valve repair plus medical therapy (device group) or
medical therapy alone (control group). The primary effectiveness end point
was all hospitalizations for heart failure within 24 months of follow-up.
The primary safety end point was freedom from device-related complications
at 12 months; the rate for this end point was compared with a prespecified
objective performance goal of 88.0%. RESULTS Of the 614 patients who were
enrolled in the trial, 302 were assigned to the device group and 312 to
the control group. The annualized rate of all hospitalizations for heart
failure within 24 months was 35.8% per patient-year in the device group as
compared with 67.9% per patient-year in the control group (hazard ratio,
0.53; 95% confidence interval [CI], 0.40 to 0.70; P<0.001). The rate of
freedom from device-related complications at 12 months was 96.6% (lower
95% confidence limit, 94.8%; P<0.001 for comparison with the performance
goal). Death from any cause within 24 months occurred in 29.1% of the
patients in the device group as compared with 46.1% in the control group
(hazard ratio, 0.62; 95% CI, 0.46 to 0.82; P<0.001). CONCLUSIONS Among
patients with heart failure and moderate-to-severe or severe secondary
mitral regurgitation who remained symptomatic despite the use of maximal
doses of guideline-directed medical therapy, transcatheter mitral-valve
repair resulted in a lower rate of hospitalization for heart failure and
lower all-cause mortality within 24 months of follow-up than medical
therapy alone. The rate of freedom from device-related complications
exceeded a prespecified safety threshold. Copyright © 2018
Massachusetts Medical Society.

<119>
Accession Number
625438048
Title
Percutaneous repair or medical treatment for secondary mitral
regurgitation.
Source
New England Journal of Medicine. 379 (24) (pp 2297-2306), 2018. Date of
Publication: 13 Dec 2018.
Author
Obadia J.-F.; Messika-Zeitoun D.; Leurent G.; Iung B.; Bonnet G.; Piriou
N.; Lefevre T.; Piot C.; Rouleau F.; Carrie D.; Nejjari M.; Ohlmann P.;
Leclercq F.; Saint Etienne C.; Teiger E.; Leroux L.; Karam N.; Michel N.;
Gilard M.; Donal E.; Trochu J.-N.; Cormier B.; Armoiry X.; Boutitie F.;
Maucort-Boulch D.; Barnel C.; Samson G.; Guerin P.; Vahanian A.; Mewton N.
Institution
(Obadia) Hopital Cardiovasculaire Louis Pradel, Chirurgie
Cardio-Vasculaire et Transplantation Cardiaque, 28, Ave. Doyen Lepine,
Bron Cedex 69677, France
(Obadia) Hopital Cardiovasculaire Louis Pradel, Chirurgie
Cardio-Vasculaire et Transplantation Cardiaque, France
(Armoiry) Pharmacy Department, Laboratoire Mateis, France
(Barnel, Samson, Mewton) Hopital Cardiovasculaire Louis Pradel, Clinical
Investigation Center and Heart Failure Department, INSERM 1407, Hospices
Civils de Lyon, Claude Bernard University, Lyon, France
(Messika-Zeitoun, Iung, Vahanian) Assistance Publique-Hopitaux de Paris
(APHP), Hopital Bichat, France
(Karam) APHP, Hopital Europeen Georges Pom-pidou, Paris, France
(Leurent, Donal) Centre Hospitalier Universitaire (CHU) Rennes, Hopital
Pontchaillou, Rennes, France
(Bonnet) Assistance Publique-Hopitaux de Marseille (APHM), Hopital de la
Timone, France
(Michel) Hopital Saint Joseph, Marseille, France
(Piriou, Trochu, Guerin) CHU Nantes, Hopital Guillaume et Rene Laennec,
Nantes, France
(Lefevre, Cormier) Institut Jacques Cartier, Massy, France
(Piot) Clinique du Millenaire, France
(Leclercq) CHU Montpellier, Hopital Arnaud-de-Villeneuve, Montpellier,
France
(Rouleau) CHU Angers, Angers, France
(Carrie) CHU Toulouse, Hopital Rangueil, Toulouse, France
(Nejjari) Centre Cardiologique du Nord, Saint-Denis, France
(Ohlmann) Hopitaux Universitaires de Strasbourg, Nouvel Hopital Civil,
Strasbourg, France
(Saint Etienne) Centre Hospitalier Regional Universitaire (CHRU) de Tours,
Hopital Trousseau, Tours, France
(Teiger) APHP, Hopital Henri Mondor, Creteil, France
(Leroux) CHU Bordeaux, Hopital Haut-Leveque, Pessac, France
(Gilard) CHRU Brest, Hopital de La Cavale Blanche, Brest, France
(Boutitie, Maucort-Boulch) Service de Biostatistique-Bioinformatique, Pole
Sante Publique, Hospices Civils de Lyon, Centre National de la Recherche
Scientifique (CNRS), Laboratoire de Biometrie et Biologie Evolutive,
Equipe Biostatistique-Sante, Villeurbanne, France
(Messika-Zeitoun) University of Ottawa Heart Institute, Division of
Cardiology, Ottawa, Canada
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND In patients who have chronic heart failure with reduced left
ventricular ejection fraction, severe secondary mitral-valve regurgitation
is associated with a poor prognosis. Whether percutaneous mitral-valve
repair improves clinical outcomes in this patient population is unknown.
METHODS We randomly assigned patients who had severe secondary mitral
regurgitation (defined as an effective regurgitant orifice area of >20
mm2 or a regurgitant volume of >30 ml per beat), a left
ventricular ejection fraction between 15 and 40%, and symptomatic heart
failure, in a 1:1 ratio, to undergo percutaneous mitral-valve repair in
addition to receiving medical therapy (intervention group; 152 patients)
or to receive medical therapy alone (control group; 152 patients). The
primary efficacy outcome was a composite of death from any cause or
unplanned hospitalization for heart failure at 12 months. RESULTS At 12
months, the rate of the primary outcome was 54.6% (83 of 152 patients) in
the intervention group and 51.3% (78 of 152 patients) in the control group
(odds ratio, 1.16; 95% confidence interval [CI], 0.73 to 1.84; P=0.53).
The rate of death from any cause was 24.3% (37 of 152 patients) in the
intervention group and 22.4% (34 of 152 patients) in the control group
(hazard ratio, 1.11; 95% CI, 0.69 to 1.77). The rate of unplanned
hospitalization for heart failure was 48.7% (74 of 152 patients) in the
intervention group and 47.4% (72 of 152 patients) in the control group
(hazard ratio, 1.13; 95% CI, 0.81 to 1.56). CONCLUSIONS Among patients
with severe secondary mitral regurgitation, the rate of death or unplanned
hospitalization for heart failure at 1 year did not differ significantly
between patients who underwent percutaneous mitral-valve repair in
addition to receiving medical therapy and those who received medical
therapy alone. Copyright © 2018 Massachusetts Medical Society.

<120>
Accession Number
618297890
Title
Platelet reactivity-adjusted antiplatelet therapy in patients with
percutaneous coronary intervention: a meta-analysis of randomized
controlled trials.
Source
Platelets. 29 (6) (pp 589-595), 2018. Date of Publication: 18 Aug 2018.
Author
Xing Z.; Tang L.; Zhu Z.; Huang J.; Peng X.; Hu X.
Institution
(Xing, Tang, Zhu, Huang, Peng, Hu) Department of Cardiovascular Medicine,
The Second Xiangya Hospital, Central South University, Changsha, Hunan,
China
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Numerous number of evidences show that high on-treatment platelet
reactivity is a well-known risk factor for adverse events in patients
after percutaneous coronary intervention (PCI). Controversial situations
still exist regarding the effectiveness of tailoring antiplatelet therapy
according to platelet function monitoring. The PubMed, Embase, and
Cochrane Central databases were searched for randomized trials comparing
platelet reactivity-adjusted antiplatelet therapy with conventional
antiplatelet therapy in patients undergoing PCI. The primary end point was
all-cause mortality, major adverse cardiac events (MACE) including
cardiovascular (CV) death, nonfatal myocardial infarction (MI),
definite/probable stent thrombosis (ST), revascularization, and stroke or
transient ischemic attack (TIA). The safety end point was defined as major
bleeding events. We derived pooled risk ratios (RRs) with fixed-effect
models. Six studies enrolling 6347 patients were included. Compared with
conventional treatment, tailoring antiplatelet failed to reduce all-cause
mortality (RR: 0.89, 95% confidence interval [CI]: 0.63-1.24, P = 0.48),
MACE (RR: 1.02, 95% CI: 0.92-1.14, P = 0.69), MI (RR: 1.07, 95% CI:
0.95-1.21, P = 0.24), CV death (RR: 0.69, 95% CI: 0.40-1.19, P = 0.09), ST
(RR: 0.83, 95% CI: 0.50-1.38, P = 0.23), stroke or TIA (RR: 1.08, 95% CI:
0.55-2.12, P = 0.83), revascularization (RR: 0.96, 95% CI: 0.69-1.33, P =
0.79), and major bleeding events (RR: 0.79, 95% CI: 0.53-1.17, P = 0.24).
Compared with traditional antiplatelet treatment, tailoring antiplatelet
therapy according to platelet reactivity testing failed to reduce
all-cause mortality, MACE, and major bleeding events in patients
undergoing PCI. Copyright © 2018, © 2018 Taylor & Francis.

<121>
Accession Number
625517946
Title
Transcatheter mitral valve replacement for mitral regurgitation-A
meta-analysis.
Source
Journal of Cardiac Surgery. 33 (12) (pp 827-835), 2018. Date of
Publication: December 2018.
Author
Takagi H.; Hari Y.; Kawai N.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: We performed a meta-analysis to determine the outcomes in
patients undergoing transcatheter mitral valve replacement (TMVR) for
mitral regurgitation (MR). Method(s): Databases including MEDLINE and
EMBASE were searched through April 2018 using Web-based search engines
(PubMed and OVID) to identify single-arm observational (case series)
studies of TMVR enrolling >=5 patients with MR. For each study, data
regarding observed 30-day mortality and predicted operative mortality
(Society of Thoracic Surgeons Predicted Risk of Mortality) were used to
generate risk ratios (RRs) and 95% confidence intervals (CIs).
Study-specific estimates were combined using the inverse variance-weighted
average of logarithmic RRs in the random-effects model. One-group
meta-analyses of 30-day and >30-day (including 30-day) mortality were also
performed in the random-effects model. Result(s): Of 222 potentially
relevant articles screened initially, nine eligible studies enrolling a
total of 146 patients with MR undergoing TMVR were identified. In all but
two studies, STS-PROM was available and varied from 3.3% to 15.4%
(arithmetic mean, 7.6%). Pooled analyses demonstrated 30-day mortality of
20.4% (95%CI, 9.6-31.2%), >30-day mortality of 32.0% (95%CI, 19.8-44.2%),
and non-significantly higher observed 30-day mortality than predicted
operative mortality (RR, 1.70; 95%CI, 0.85-3.42; P = 0.14). There was no
evidence of significant publication bias. Conclusion(s): TMVR for
patients with MR results in increased early and late
mortality. Copyright © 2018 Wiley Periodicals, Inc.

<122>
Accession Number
625515916
Title
Impact of retrograde approach on long-term clinical outcomes of patients
undergoing coronary chronic total occlusion interventions.
Source
EuroIntervention. 14 (11) (pp E1183-E1191), 2018. Date of Publication:
December 2018.
Author
Tanaka H.; Ohya M.; Kubo S.; Miura K.; Otsuru S.; Habara S.; Tada T.; Fuku
Y.; Goto T.; Kadota K.
Institution
(Tanaka, Ohya, Kubo, Miura, Otsuru, Habara, Tada, Fuku, Goto, Kadota)
Division of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki,
Okayama 710-8602, Japan
Publisher
EuroPCR
Abstract
Aims: The aim of the study was to assess the long-term outcomes of
coronary chronic total occlusion (CTO) lesions after retrograde
percutaneous coronary intervention (PCI) in comparison with those after
antegrade PCI alone. Methods and Results: A total of 842 consecutive
patients (928 CTO lesions) undergoing PCI and subsequent follow-up were
classified into two groups: retrograde PCI for at least one CTO (n=302,
retrograde group) and antegrade PCI alone (n=540, antegrade group). The
total procedural success rate was 89.7%. The retrograde group had
significantly higher incidences of periprocedural myocardial infarction
and coronary perforation (7.3% vs. 3.7%, p=0.01; 7.9% vs. 4.4%, p=0.04,
respectively). Median follow-up duration was 7.7 (interquartile range
5.6-8.7) years. Seven-year relative risk comparing the retrograde and
antegrade groups was neutral in all-cause death (adjusted HR [aHR] 1.06,
95% CI: 0.75-1.49; p=0.745), cardiac death (aHR 0.85, 95% CI: 0.47-1.55;
p=0.598), coronary artery bypass grafting (aHR 1.62, 95% CI: 0.74-3.54;
p=0.229), and non-target vessel revascularisation (aHR 0.96, 95% CI:
0.78-1.17; p=0.663). Conclusion(s): Retrograde CTO PCI did not lead
to worse long-term outcomes despite increased risk in periprocedural
myocardial infarction and coronary perforation. Copyright ©
Europa Digital & Publishing 2018. All rights reserved.

<123>
Accession Number
625515382
Title
Independent impact of extent of coronary artery disease and percutaneous
revascularisation on 30-day and one-year mortality after TAVI: A
meta-analysis of adjusted observational results.
Source
EuroIntervention. 14 (11) (pp E1169-EE1177), 2018. Date of Publication:
December 2018.
Author
D'Ascenzo F.; Verardi R.; Visconti M.; Conrotto F.; Scacciatella P.;
Dziewierz A.; Stefanini G.G.; Paradis J.-M.; Omede P.; Kodali S.; D'Amico
M.; Rinaldi M.; Salizzoni S.
Institution
(D'Ascenzo, Verardi, Visconti, Conrotto, Scacciatella, Omede, D'Amico)
Division of Cardiology, Department of Internal Medicine, Citta della
Salute e della Scienza, Corso Bramante n 88, Turin 10126, Italy
(Dziewierz) Second Department of Cardiology, Jagiellonian University
Medical College, Krakow, Poland
(Stefanini) Department of Biomedical Sciences, Humanitas University, Pieve
Emanuele, Milan, Italy
(Paradis, Kodali) Cardiovascular Research Foundation, New York, NY, United
States
(Paradis) Quebec Heart and Lung Institute, Quebec, Canada
(Rinaldi, Salizzoni) Division of Cardiac Surgery, Citta della Salute e
della Scienza, Turin, Italy
Publisher
EuroPCR
Abstract
Aims: The impact of the severity of coronary artery disease (CAD) and
percutaneous coronary interventions (PCI) on outcomes after transcatheter
aortic valve implantation (TAVI) remains a matter of debate. We therefore
performed a meta-analysis to evaluate the impact of CAD, of its severity
and of PCI on mortality after TAVI. Methods and Results: All
published studies evaluating the impact of CAD on 30-day and one-year
mortality after TAVI at multivariable analysis were included. The primary
endpoint was the impact of CAD severity (assessed with the SYNTAX score
[SS]) on one-year mortality by pooling with logarithmic transformation
results of multivariable adjusted effect estimates from each individual
study. Secondary endpoints were the impact of the presence of CAD on
30-day and one-year mortality at multivariable analysis and the impact of
residual SYNTAX score (rSS) on one-year mortality at multivariable
analysis. A total of 8,334 patients with a median age of 81.3 (81-82)
years and STS score of 6.2% (IQR 6.0-6.7) from 13 studies were included.
Patients with an SS >22 showed higher one-year mortality at multivariable
analysis (OR 1.71 [1.24-2.36]). The presence of CAD did not impact on
30-day and one-year mortality at multivariable analysis (respectively, OR
1.57 [0.71-3.46] and OR 1.25 [0.74-2.11]). Regarding PCI, patients with
rSS <8 showed lower one-year mortality (OR 0.34 [0.012-0.93]).
 Conclusion(s): The risk of death after TAVI is closely related to the
complexity of CAD. Patients with an SS >22 present higher mortality. SS
may represent a useful tool to select patients undergoing TAVI who could
benefit from coronary revascularisation. In this regard, reaching an rSS
<8 reduced one-year mortality. Randomised controlled trials are needed to
confirm these results. Copyright © Europa Digital & Publishing
2018. All rights reserved.

<124>
Accession Number
621953266
Title
Augmented reality for the surgeon: Systematic review.
Source
International Journal of Medical Robotics and Computer Assisted Surgery.
14 (4) (no pagination), 2018. Article Number: e1914. Date of Publication:
August 2018.
Author
Yoon J.W.; Chen R.E.; Kim E.J.; Akinduro O.O.; Kerezoudis P.; Han P.K.; Si
P.; Freeman W.D.; Diaz R.J.; Komotar R.J.; Pirris S.M.; Brown B.L.; Bydon
M.; Wang M.Y.; Wharen R.E.; Quinones-Hinojosa A.
Institution
(Yoon, Akinduro, Pirris, Brown, Wharen, Quinones-Hinojosa) Department of
Neurological Surgery, Mayo Clinic, Jacksonville, FL, United States
(Chen) Emory University School of Medicine, Atlanta, GA, United States
(Chen, Han, Si) Georgia Institute of Technology, Atlanta, GA, United
States
(Kim) Baylor College of Medicine, Houston, TX, United States
(Kerezoudis, Bydon) Department of Neurological Surgery, Mayo Clinic,
Rochester, MN, United States
(Freeman) Department of Neurology, Mayo Clinic, Jacksonville, FL, United
States
(Diaz) Department of Neurosurgery and Neurology, Montreal Neurological
Institute and Hospital, McGill University, Montreal, QC, Canada
(Komotar, Wang) Department of Neurological Surgery, University of Miami
Miller School of Medicine, University of Miami Hospital, University of
Miami Brain Tumor Initiative, Miami, FL, United States
(Pirris) St. Vincent's Spine and Brain Institute, Jacksonville, FL, United
States
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Introduction: Since the introduction of wearable head-up displays, there
has been much interest in the surgical community adapting this technology
into routine surgical practice. Method(s): We used the keywords
augmented reality OR wearable device OR head-up display AND surgery using
PubMed, EBSCO, IEEE and SCOPUS databases. After exclusions, 74 published
articles that evaluated the utility of wearable head-up displays in
surgical settings were included in our review. Result(s): Across all
studies, the most common use of head-up displays was in cases of live
streaming from surgical microscopes, navigation, monitoring of vital
signs, and display of preoperative images. The most commonly used head-up
display was Google Glass. Head-up displays enhanced surgeons' operating
experience; common disadvantages include limited battery life, display
size and discomfort. Conclusion(s): Due to ergonomic issues with
dual-screen devices, augmented reality devices with the capacity to
overlay images onto the surgical field will be key features of
next-generation surgical head-up displays. Copyright © 2018 John
Wiley & Sons, Ltd.

<125>
Accession Number
620069745
Title
Comparative Study Between Conventional Fasting Versus Overnight Infusion
of Lipid or Carbohydrate on Insulin and Free Fatty Acids in Obese Patients
Undergoing Elective On-pump Coronary Artery Bypass Grafting. A Prospective
Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (3) (pp 1248-1253),
2018. Date of Publication: June 2018.
Author
Hosny H.; Ibrahim M.; El-Siory W.; Abdel-Monem A.
Institution
(Hosny, Ibrahim, El-Siory, Abdel-Monem) Department of Anesthesia and
Intensive Care, Kasr Al-Ainy Faculty of Medicine, Cairo University, Egypt
(Hosny) Department of Cardiothoracic Anaesthesia, Harefield Hospital,
London, United Kingdom
Publisher
W.B. Saunders
Abstract
Objectives: Postoperative insulin resistance represents a major component
of postoperative metabolic disorder. The authors compared the effects of
preoperative infusion of lipid emulsion or carbohydrate to conventional
preoperative fasting on postoperative insulin and free fatty acid (FFA)
levels. Design(s): A prospective randomized double-blinded study.
 Setting(s): Tertiary university hospital. Participant(s):
Sixty-three patients undergoing coronary artery bypass grafting.
 Intervention(s): Participants were randomized into 3 equal groups.
Group G received 500 mL of glucose 10% (50 g glucose). Group L received
100 mL of 2% lipid emulsion (soybean 30%, medium chain triglycerides (TG)
30%, olive oil 25%, fish oil 15%, and 20 mg vitamin E). Group C fasted
overnight except for clear fluids allowed until 4 hours preoperatively.
Serum insulin at the start of infusion (T<inf>1</inf>), 1-hour
preinduction (T<inf>2</inf>), on admission to the intensive care unit
(T<inf>3</inf>), after 24 hours of admission (T<inf>4</inf>), and after 48
hours of admission (T<inf>5</inf>), and FFA at T<inf>1</inf> and
T<inf>2</inf> were measured. Serum very-low-density lipoprotein (VLDL),
serum TG, and blood sugar were all measured (T<inf>1</inf>-T<inf>4</inf>).
Bypass time, ischemic time, need for inotropic support, and length of
intensive care unit stay also were measured. Measurements and Main
Results: At the end of infusion FFAs were significantly lower in the L
group (1.1 +/- 0.76 mg/dL) compared with G (1.64 +/- 0.85 mg/dL) and C
groups (1.48 +/- 0.76 mg/dL). Insulin levels were significantly lower in
the L group compared with levels in the G and C groups at T<inf>2</inf>,
T<inf>3</inf>, and T<inf>4</inf>. Also, TG, VLDL, and random blood sugar
levels decreased significantly at T<inf>2</inf>, T<inf>3</inf>, and
T<inf>4</inf> in the L group compared with the other 2 groups and compared
with baseline value within the same group. Conclusion(s):
Preoperative lipid infusion lowered postoperative FFA, insulin, TG, VLDL,
and random blood sugar in obese patients undergoing coronary artery bypass
grafting surgeries. Copyright © 2017 Elsevier Inc.

<126>
Accession Number
2001193010
Title
Targeted therapy with a localised abluminal groove, low-dose
sirolimus-eluting, biodegradable polymer coronary stent (TARGET All
Comers): a multicentre, open-label, randomised non-inferiority trial.
Source
The Lancet. 392 (10153) (pp 1117-1126), 2018. Date of Publication: 29
September - 5 October 2018.
Author
Lansky A.; Wijns W.; Xu B.; Kelbaek H.; van Royen N.; Zheng M.; Morel
M.-A.; Knaapen P.; Slagboom T.; Johnson T.W.; Vlachojannis G.; Arkenbout
K.E.; Holmvang L.; Janssens L.; Ochala A.; Brugaletta S.; Naber C.K.;
Anderson R.; Rittger H.; Berti S.; Barbato E.; Toth G.G.; Maillard L.;
Valina C.; Buszman P.; Thiele H.; Schachinger V.; Baumbach A.
Institution
(Lansky, Baumbach) Yale University School of Medicine, New Haven, CT,
United States
(Lansky, Baumbach) Barts Heart Centre, London and Queen Mary University of
London, London, United Kingdom
(Wijns) The Lambe Institute for Translational Medicine and Curam, National
University of Ireland, Galway and Saolta University Healthcare Group,
University College Hospital Galway, Galway, Ireland
(Xu) Fu Wai Hospital, National Centre for Cardiovascular Diseases, Chinese
Academy of Medical Sciences, Beijing, China
(Kelbaek) Department of Cardiology, Roskilde University Hospital,
Roskilde, Denmark
(van Royen, Knaapen) Department of Cardiology, VU University Medical
Centre, Amsterdam, Netherlands
(Zheng) Shanghai MicroPort Medical (Group), Shanghai, China
(Morel) Cardialysis, Rotterdam, Netherlands
(Slagboom) Amsterdam Department of Interventional Cardiolody, Onze Lieve
Vrouwe Gasthuis, Amsterdam, Netherlands
(Johnson) Bristol Heart Institute, University Hospitals Bristol NHS
Foundation Trust, Bristol, United Kingdom
(Vlachojannis) Department of Cardiology, Maasstad Ziekenhuis, Rotterdam,
Netherlands
(Arkenbout) Department of Cardiology, Tergooi Ziekenhuis, Blaricum,
Netherlands
(Holmvang) Department of Cardiology, Rigshospitalet, Copenhagen University
Hospital, Copenhagen, Denmark
(Janssens) Heart Centre, Imelda Ziekenhuis, Bonheiden, Belgium
(Ochala) Department of Invasive Cardiology, Silesian Medical University,
Katowice, Poland
(Brugaletta) Cardiovascular Institute, Hospital Clinic, Institut
d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona,
Spain
(Naber) Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus, Essen,
Germany
(Anderson) Department of Cardiology, University Hospital of Wales,
Cardiff, United Kingdom
(Rittger) Medizinische Klinik I, Klinikum Furth, University of Erlangen,
Furth, Germany
(Berti) UOC Cardiologia Diagnostica ed Interventistica, Fondazione CNR Reg
Toscana G Monasterio, Ospedale del Cuore, Massa, Italy
(Barbato) Cardiovascular Research Centre Aalst, OLV Hospital, Aalst,
Belgium
(Barbato) Department of Advanced Biomedical Sciences, University of Naples
Federico II, Italy
(Toth) Department of Cardiology, Medical University of Graz, Graz, Austria
(Maillard) Service de Cardiologie, Clinique Axium, Aix-en-Provence, France
(Valina) Klinik fur Kardiologie und Angiologie II,
Universitats-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
(Buszman) American Heart of Poland, Katowice, Poland
(Thiele) Herzzentrum Leipzig, Leipzig, Germany
(Schachinger) Medizinische Klinik I, Herz-Thorax Zentrum, Klinikum Fulda,
Fulda, Germany
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: The FIREHAWK is a drug-eluting stent with a fully
biodegradable sirolimus-containing polymer coating localised to recessed
abluminal grooves on the stent surface. We investigated clinical outcomes
with this targeted, low-dose, biodegradable polymer, sirolimus-eluting
stent compared with XIENCE durable polymer, everolimus-eluting stents in
an all-comers population. Method(s): The TARGET All Comers study was
a prospective, multicentre, open-label randomised non-inferiority trial
done at 21 centres in ten European countries. Patients with symptomatic or
asymptomatic coronary artery disease and objective evidence of myocardial
ischaemia who qualified for percutaneous coronary intervention were
randomised 1:1 to undergo implantation of a FIREHAWK or XIENCE.
Randomisation was web-based, with random block allocation and
stratification by centre and ST elevation myocardial infarction. Outcome
assessors were masked to treatment allocation, but treating physicians and
patients were not. The primary endpoint was target lesion failure at 12
months, a composite of cardiac death, target vessel myocardial infarction,
or ischaemia-driven target lesion revascularisation. The control event
rate for XIENCE was assumed to be 7%, the non-inferiority margin was 3.5%,
and the primary analysis was in the intention-to-treat population,
censoring patients who did not have either an event before 365 days or
contact beyond 365 days. Late lumen loss was the primary endpoint of an
angiographic substudy designed to investigate the non-inferiority of the
FIREHAWK compared with the XIENCE stent. This trial is registered with
ClinicalTrials.gov, number NCT02520180. Finding(s): From Dec 17,
2015, to Oct 14, 2016, 1653 patients were randomly assigned to
implantation of the FIREHAWK (n=823) or XIENCE (n=830). 65 patients in the
FIREHAWK group and 66 in the XIENCE group had insufficient follow-up data
and were excluded from the analyses. At 12 months, target lesion failure
occurred in 46 (6.1%) of 758 patients in the FIREHAWK group and in 45
(5.9%) of 764 patients in the XIENCE group (difference 0.2%, 90% CI -1.9
to 2.2, p<inf>non-inferiority</inf>=0.004, 95% CI -2.2 to 2.6,
p<inf>superiority</inf>=0.88). There were no differences in
ischaemia-driven revascularisation or stent thrombosis rates at 12 months.
176 patients were included in the angiographic substudy, in which in-stent
late lumen loss was 0.17 mm (SD 0.48) in the FIREHAWK group and 0.11 mm
(0.52) in the XIENCE group (p=0.48), with an absolute difference of 0.05
mm (95% CI -0.09 to 0.18, p<inf>non-inferiority</inf>=0.024).
 Interpretation(s): In a broad all-comers population of patients
requiring stent implantation for myocardial ischaemia, the FIREHAWK was
non-inferior to the XIENCE as assessed with the primary endpoint of target
lesion failure at 12 months and in-stent late lumen loss at 13 months. The
FIREHAWK is a safe and effective alternative stent to treat patients with
ischaemic coronary artery disease in clinical practice. Funding(s):
Shanghai Microport Medical. Copyright © 2018 Elsevier Ltd

<127>
Accession Number
2001206526
Title
Baseline and on-statin treatment lipoprotein(a) levels for prediction of
cardiovascular events: individual patient-data meta-analysis of statin
outcome trials.
Source
The Lancet. 392 (10155) (pp 1311-1320), 2018. Date of Publication: 13 - 19
October 2018.
Author
Willeit P.; Ridker P.M.; Nestel P.J.; Simes J.; Tonkin A.M.; Pedersen
T.R.; Schwartz G.G.; Olsson A.G.; Colhoun H.M.; Kronenberg F.; Drechsler
C.; Wanner C.; Mora S.; Lesogor A.; Tsimikas S.
Institution
(Willeit) Department of Neurology, Medical University of Innsbruck,
Innsbruck, Austria
(Willeit) Department of Public Health and Primary Care, University of
Cambridge, Cambridge, United Kingdom
(Ridker, Mora) Brigham and Women's Hospital, Harvard Medical School,
Boston, MA, United States
(Nestel) Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
(Simes) NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW,
Australia
(Tonkin) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Vic, Australia
(Pedersen) Oslo University Hospital, Ulleval, and Medical Faculty,
University of Oslo, Oslo, Norway
(Schwartz) Division of Cardiology, VA Medical Center and University of
Colorado School of Medicine, Denver, CO, United States
(Olsson) Department of Medicine and Care, Faculty of Health Sciences,
University of Linkoping, Linkoping, Sweden
(Colhoun) MRC Human Genetics Unit, Centre for Genomic and Experimental
Medicine, MRC Institute of Genetics & Molecular Medicine, Edinburgh,
United Kingdom
(Kronenberg) Division of Genetic Epidemiology, Department of Medical
Genetics, Molecular and Clinical Pharmacology, Medical University of
Innsbruck, Innsbruck, Austria
(Drechsler, Wanner) Division of Nephrology, Department of Internal
Medicine 1 and Comprehensive Heart Failure Centre, University Hospital of
Wurzburg, Wurzburg, Germany
(Lesogor) Novartis Pharma AG, Basel, Switzerland
(Tsimikas) Vascular Medicine Program, Sulpizio Cardiovascular Center,
Division of Cardiology, Department of Medicine, University of California
San Diego, La Jolla, CA, United States
(Tsimikas) Vascular Medicine Program, Sulpizio Cardiovascular Center,
University of California San Diego, La Jolla, CA 92093, United States
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Elevated lipoprotein(a) is a genetic risk factor for
cardiovascular disease in general population studies. However, its
contribution to risk for cardiovascular events in patients with
established cardiovascular disease or on statin therapy is uncertain.
 Method(s): Patient-level data from seven randomised,
placebo-controlled, statin outcomes trials were collated and harmonised to
calculate hazard ratios (HRs) for cardiovascular events, defined as fatal
or non-fatal coronary heart disease, stroke, or revascularisation
procedures. HRs for cardiovascular events were estimated within each trial
across predefined lipoprotein(a) groups (15 to <30 mg/dL, 30 to <50 mg/dL,
and >=50 mg/dL, vs <15 mg/dL), before pooling estimates using multivariate
random-effects meta-analysis. Finding(s): Analyses included data for
29 069 patients with repeat lipoprotein(a) measurements (mean age 62 years
[SD 8]; 8064 [28%] women; 5751 events during 95 576 person-years at risk).
Initiation of statin therapy reduced LDL cholesterol (mean change -39%
[95% CI -43 to -35]) without a significant change in lipoprotein(a).
Associations of baseline and on-statin treatment lipoprotein(a) with
cardiovascular disease risk were approximately linear, with increased risk
at lipoprotein(a) values of 30 mg/dL or greater for baseline
lipoprotein(a) and 50 mg/dL or greater for on-statin lipoprotein(a). For
baseline lipoprotein(a), HRs adjusted for age and sex (vs <15 mg/dL) were
1.04 (95% CI 0.91-1.18) for 15 mg/dL to less than 30 mg/dL, 1.11
(1.00-1.22) for 30 mg/dL to less than 50 mg/dL, and 1.31 (1.08-1.58) for
50 mg/dL or higher; respective HRs for on-statin lipoprotein(a) were 0.94
(0.81-1.10), 1.06 (0.94-1.21), and 1.43 (1.15-1.76). HRs were almost
identical after further adjustment for previous cardiovascular disease,
diabetes, smoking, systolic blood pressure, LDL cholesterol, and HDL
cholesterol. The association of on-statin lipoprotein(a) with
cardiovascular disease risk was stronger than for on-placebo
lipoprotein(a) (interaction p=0.010) and was more pronounced at younger
ages (interaction p=0.008) without effect-modification by any other
patient-level or study-level characteristics. Interpretation(s): In
this individual-patient data meta-analysis of statin-treated patients,
elevated baseline and on-statin lipoprotein(a) showed an independent
approximately linear relation with cardiovascular disease risk. This study
provides a rationale for testing the lipoprotein(a) lowering hypothesis in
cardiovascular disease outcomes trials. Funding(s): Novartis Pharma
AG. Copyright © 2018 Elsevier Ltd

<128>
Accession Number
613254797
Title
Effect of the type of cardiopulmonary bypass pump flow on postoperative
cognitive function in patients undergoing isolated coronary artery
surgery.
Source
Anatolian Journal of Cardiology. 16 (11) (pp 875-880), 2016. Date of
Publication: 2016.
Author
Ozturk S.; Sacar M.; Baltalarli A.; Ozturk I.
Institution
(Ozturk) Department of Cardiovascular Surgery, Dr. Siyami Ersek
Cardiothoracic and Vascular Surgery Education and Research Hospital,
Istanbul, Turkey
(Sacar) Department of Cardiovascular Surgery, 18 Mart Univesity, Faculty
of Medicine, Canakkale, Turkey
(Baltalarli) Department of Cardiovascular Surgery, Pamukkale Univesity,
Faculty of Medicine, Denizli, Turkey
(Ozturk) Department of Anesthesiology, Goztepe Education and Research
Hospital, Istanbul, Turkey
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: Pulsatile flow, generated by a pump during cardiopulmonary
bypass, has been accepted as more physiological in coronary artery bypass
grafting surgery (CABG). Therefore, we aimed to investigate the effects of
pulsatile and nonpulsatile flow on postoperative cognitive function and to
review relationship with the biomarkers S100beta and neuron-specific
enolase (NSE). Method(s): Patients who underwent isolated CABG were
included this prospective, randomized, double-blind study, which was
performed between March 2010 and December 2010. Patients were divided into
two groups: pulsatile (Group I, n=20) and nonpulsatile (Group II, n=20)
flow. Blood samples were collected 1 day before surgery and in the sixth
postoperative hour for the analysis of S100beta and NSE. In addition,
Mini- Mental State Examination (MMSE) was performed during preoperative
period and on third postoperative day. Outcomes were determination of
effects of pump flow type on cognitive function and relationships with
concentrations of S100beta and NSE. Result(s): Forty patients were
included. No differences were observed between the groups with respect to
complications, mortality, S100beta (Group I: 1.9+/-0.2 mu/L; Group II:
2.0+/-0.2 mu/L), NSE (Group I: 12.5+/-0.8 mu/L; Group II: 12.4+/-0.7
mu/L), MMSE scores [Group I: 25 (23-27); Group II: 25 (23-27)], and
postoperative cognitive dysfunction (POCD) (p>0.05). No correlation was
observed between MMSE scores and concentrations of S100beta (r=-0.032) and
NSE (r=-0.423) (p>0.05). Conclusion(s): There was no difference
between types of pump flow for POCD and no relationship between cognitive
dysfunction and S100beta and NSE concentrations. Pump flow type does not
affect NSE concentrations. Copyright © 2016 by Turkish Society of
Cardiology.

<129>
[Use Link to view the full text]
Accession Number
625718867
Title
One-Year Outcomes After MitraClip for Functional Mitral Regurgitation.
Source
Circulation. 139 (1) (pp 37-47), 2019. Date of Publication: 02 Jan 2019.
Author
Ailawadi G.; Lim D.S.; Mack M.J.; Trento A.; Kar S.; Grayburn P.A.; Glower
D.D.; Wang A.; Foster E.; Qasim A.; Weissman N.J.; Ellis J.; Crosson L.;
Fan F.; Kron I.L.; Pearson P.J.; Feldman T.
Institution
(Ailawadi, Kron) Division of Thoracic and Cardiovascular Surgery (G.A.,
University of Virginia, Charlottesville, United States
(Lim) Division of Cardiology (D.S.L.), University of Virginia,
Charlottesville, United States
(Mack) Heart Hospital Baylor Plano, Baylor HealthCare System, Dallas,
United States
(Trento, Kar) Heart Institute, Cedars Sinai Medical Center, Los Angeles,
United States
(Grayburn) Baylor University Medical Center, Baylor Heart and Vascular
Institute, Dallas, United States
(Glower, Wang) Duke University Medical Center, Durham, Canada
(Foster, Qasim) Division of Cardiology, University of California, San
Francisco (E.F.
(Weissman) MedStar Health Research Institute, Hyattsville, United States
(Ellis, Crosson, Fan) Abbott Vascular, L.C., Santa Clara, Cuba
(Pearson, Feldman) Northshore University Health System, Evanston, United
States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Secondary mitral regurgitation (SMR) occurs in the absence of
organic mitral valve disease and may develop as the left ventricle dilates
or remodels or as a result of leaflet tethering with impaired coaptation,
most commonly from apical and lateral distraction of the subvalvular
apparatus, with late annular dilatation. The optimal therapy for SMR is
unclear. This study sought to evaluate the 1-year adjudicated outcomes of
all patients with SMR undergoing the MitraClip procedure in the EVEREST II
(Endovascular Valve Edge-to-Edge Repair Study) Investigational Device
Exemption program, which is comprised of the randomized clinical trial,
the prospective High-Risk Registry, and the REALISM Continued Access
Registry (Multicenter Study of the MitraClip System). METHOD(S):
Patients with 3+/4+ SMR enrolled in EVEREST II were stratified by non-high
surgical risk (non-HR) and high surgical risk (HR) status (defined as
Society of Thoracic Surgeons risk of mortality >=12% or predefined risk
factors). Clinical, echocardiographic, and functional outcomes at 1 year
were evaluated. RESULT(S): A total of 616 patients (482 HR, 134
non-HR; mean age, 73.3+/-10.5 years; Society of Thoracic Surgeons risk,
10.2+/-6.9%) with SMR underwent the MitraClip procedure. At baseline,
80.5% of patients were in New York Heart Association class III/IV. Major
adverse events at 30 days included death (3.6%), stroke (2.3%), and renal
failure (1.5%). At discharge, 88.8% had MR <=2+. At 1 year, there were 139
deaths, and the Kaplan-Meier estimate of freedom from mortality was 76.8%.
The majority of surviving patients (84.7%) remained with MR <=2+ and New
York Heart Association class I/II (83.0%). Kaplan-Meier survival at 1 year
was 74.1% in HR patients and 86.4% in non-HR patients ( P=0.0175). At 1
year, both groups achieved comparable MR reduction (MR <=2+, 84.0% versus
87.0%) and improvement in left ventricular end-diastolic volume (-8.0 mL
versus -12.7 mL), whereas New York Heart Association class I/II was found
in 80.1% versus 91.8% ( P=0.008) of HR and non-HR patients, respectively.
In HR patients, the annualized rate of heart failure hospitalizations
decreased from 0.68 to 0.46 in the 12 months before to 12 months after the
procedure ( P<0.0001). CONCLUSION(S): Transcatheter mitral valve
repair with the MitraClip in patients with secondary MR is associated with
acceptable safety, reduction of MR severity, symptom improvement, and
positive ventricular remodeling. CLINICAL TRIAL REGISTRATION:
https://www.clinicaltrials.gov . Unique identifiers: NCT00209274,
NCT01940120, and NCT01931956.

<130>
[Use Link to view the full text]
Accession Number
625718604
Title
Pharmacologic interventions for preventing delirium in adult patients
after cardiac surgery: Protocol of a systematic review and network
meta-analysis.
Source
Medicine. 97 (52) (pp e13881), 2018. Date of Publication: 01 Dec 2018.
Author
Wen J.; Zeng H.; Li Z.; He G.; Jin Y.
Institution
(Wen) Shanghai University of Traditional Chinese Medicine, Shanghai, China
(Wen, Jin) Shanghai University of Medicine & Health Sciences, Shanghai,
China
(Zeng, Li) Second Clinical College of Guangzhou University of Chinese
Medicine, Guangzhou, China
(He) First Clinical College of Guangzhou University of Chinese Medicine,
Guangzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Delirium is common in adult patients undergoing cardiac
surgery and related to a high morbidity and mortality. Although a variety
of pharmacologic interventions have been applied in delirium prevention,
there is still uncertainty concerning which drug is optimal. Thus, we plan
to conduct a systematic review and network meta-analysis (NMA) of
published studies to assess the efficacy and safety of pharmacologic
interventions for preventing delirium among those patients.
 METHOD(S): A systematic literature search will be conducted in
Embase, PubMed, and the Cochrane Library. The primary outcome will be the
incidence of postoperative delirium. Secondary outcomes will include
all-cause mortality and length of hospital or intensive care unit stay. A
frequentist NMA will be conducted using Stata version 14.0. The
inconsistency between direct and indirect comparisons will be evaluated
using a node splitting method. In addition, surface under the cumulative
ranking area will be used to evaluate superiority of different treatments.
 RESULT(S): The findings of our review will be submitted to a
peer-reviewed publication. CONCLUSION(S): Our study will generate
convincing evidence regarding the effectiveness and safety of different
pharmacologic interventions for delirium prevention in cardiac surgery
patients.

<131>
Accession Number
2001422044
Title
A systematic review of infected descending thoracic aortic grafts and
endografts.
Source
Journal of Vascular Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Kahlberg A.; Grandi A.; Loschi D.; Vermassen F.; Moreels N.; Chakfe N.;
Melissano G.; Chiesa R.
Institution
(Kahlberg, Grandi, Loschi, Melissano, Chiesa) Department of Vascular
Surgery, Vita-Salute University School of Medicine, San Raffaele
Scientific Institute, Milan, Italy
(Vermassen, Moreels) Department of Vascular and Thoracic Surgery, Ghent
University Hospital, Ghent, Belgium
(Chakfe) Department of Vascular Surgery and Kidney Transplantation,
University Hospital of Strasbourg, Strasbourg, France
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The objective of this study was to collect and critically
analyze the current evidence on the modalities and results of treatment of
descending thoracic aortic surgical graft (SG) and endograft (EG)
infection, which represents a rare but dramatic complication after both
surgical and endovascular aortic repair. Method(s): A comprehensive
electronic health database search (PubMed/MEDLINE, Scopus, Google Scholar,
and the Cochrane Library) identified all articles that were published up
to October 2017 reporting on thoracic aortic SG or EG infection.
Observational studies, multicenter reports, single-center series and case
reports, case-control studies, and guidelines were considered eligible if
reporting specific results of treatment of descending thoracic aortic SG
or EG infection. Comparisons of patients presenting with SG or EG
infection and between invasive and conservative treatment were performed.
Odds ratio (OR) meta-analyses were run when comparative data were
available. Result(s): Forty-three studies reporting on 233 patients
with infected SG (49) or EG (184) were included. Four were multicenter
studies including 107 patients, all with EG infection, associated with a
fistula in 91% of cases, with a reported overall survival at 2 years of
16% to 39%. The remaining 39 single-center studies included 49 patients
with SG infection and 77 with EG infection. Association with
aortoesophageal fistula was significantly more common with EG (60% vs 31%;
P =.01). In addition, time interval from index procedure to infection was
significantly shorter with EG (17 +/- 21 months vs 32 +/- 61 months; P
=.03). Meta-analysis showed a trend of increased 1-year mortality in
patients with SG infection compared with EG infection (pooled OR, 3.6; 95%
confidence interval, 0.9-14.7; P =.073). Surgical management with infected
graft explantation was associated with a trend toward lower 1-year
mortality compared with graft preservation (pooled OR, 0.3; 95% confidence
interval, 0.1-1.0; P =.056). Conclusion(s): Thoracic aortic EG
infection is likely to occur more frequently in association with
aortoesophageal fistulas and in a shorter time compared with SG infection.
Survival is poor in both groups, especially in patients with SG infection.
Surgical treatment with graft explantation seems to be the preferable
choice in fit patients. Copyright © 2018 Society for Vascular
Surgery

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