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<1>
Accession Number
623686393
Title
Normal values for Doppler echocardiographic assessment of prosthetic valve
function after transcatheter aortic valve replacement: A systematic review
and meta-analysis.
Source
European Heart Journal Cardiovascular Imaging. 19 (4) (pp 361-368), 2018.
Date of Publication: April 2018.
Author
Winter M.-P.; Zbiral M.; Kietaibl A.; Sulzgruber P.; Kastner J.; Rosenhek
R.; Binder T.; Lang I.M.; Goliasch G.
Institution
(Winter, Zbiral, Kietaibl, Sulzgruber, Kastner, Rosenhek, Binder, Lang,
Goliasch) Department of Internal medicine II, Division of cardiology,
Medical University of Vienna, Waehringerguertel 18-20, Vienna A-1090,
Austria
Publisher
Oxford University Press
Abstract
Transcatheter aortic valve replacement has emerged as valuable treatment
modality for patients with severe aortic stenosis and an unacceptable
risk/benefit ratio for open heart surgery, but particularities specific to
TAVR and a rapidly growing number of available TAVR prosthesis make
post-procedural assessment of valve function challenging. Aim of the
present analysis was to collect and pool all available data currently in
the literature regarding normal doppler values for transcatheter
prosthetic heart valves and to provide a comprehensive overview. A PRISMA
checklist-guided systematic review and meta-analysis of prospective
observational studies or national and device specific registries or
randomized clinical trials was conducted. Studies were identified by
searching PUBMED, SCOPUS, Cochrane Central Register of Controlled Trials
and LILACs from January 2000 to March 2017. Out of 240 abstracts, 155
studies reporting echocardiographic parameter for twelve different valves
prosthesis in a total of 27,159 patients were in included in this
meta-analysis. The means and standard deviations of peak velocity, peak
gradient, mean gradient and effective orifice were extracted and pooled
from the included studies. The pooled means and standard deviations for
all available TAVR prosthesis were classified according to implanted valve
size and time since implantation. The present study firstly describes a
pooled analysis of normal values for all available TAVR prosthesis in
order to empower treating physicians with a reliable tool to perform
follow-up echocardiographic assessment in TAVR patients and to safely
identify patients with prostheses dysfunction.<br/>Copyright &#xa9; The
Author 2017.

<2>
Accession Number
623664113
Title
Long-term use of carvedilol in patients with ST-segment elevation
myocardial infarction treated with primary percutaneous coronary
intervention.
Source
PLoS ONE. 13 (8) (no pagination), 2018. Article Number: e0199347. Date of
Publication: August 2018.
Author
Watanabe H.; Ozasa N.; Morimoto T.; Shiomi H.; Bingyuan B.; Suwa S.;
Nakagawa Y.; Izumi C.; Kadota K.; Ikeguchi S.; Hibi K.; Furukawa Y.; Kaji
S.; Suzuki T.; Akao M.; Inada T.; Hayashi Y.; Nanasato M.; Okutsu M.;
Kametani R.; Sone T.; Sugimura Y.; Kawai K.; Abe M.; Kaneko H.; Nakamura
S.; Kimura T.
Institution
(Watanabe, Ozasa, Shiomi, Bingyuan, Kimura) Department of Cardiovascular
Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
(Morimoto) Department of Clinical Epidemiology, Hyogo College of Medicine,
Hyogo, Japan
(Suwa) Division of Cardiology, Juntendo University Shizuoka Hospital,
Izunokuni, Japan
(Nakagawa, Izumi) Division of Cardiology, Tenri Hospital, Nara, Japan
(Kadota) Division of Cardiology, Kurashiki Central Hospital, Kurashiki,
Japan
(Ikeguchi) Division of cardiology, Shiga General Hospital, Moriyama, Japan
(Hibi) Division of Cardiology, Yokohama City University Medical Center,
Yokohama, Japan
(Furukawa, Kaji) Division of Cardiology, Kobe City Medical Center General
Hospital, Kobe, Japan
(Suzuki) Division of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
(Akao) Department of Cardiology, National Hospital Organization Kyoto
Medical Center, Kyoto, Japan
(Inada) Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
(Hayashi) Division of Cardiology, Tsuchiya General Hospital, Hiroshima,
Japan
(Nanasato) Cardiovascular Center, Nagoya Daini Red Cross Hospital, Nagoya,
Japan
(Okutsu) Division of Cardiology, Nozaki Tokushukai Hospital, Osaka, Japan
(Kametani) Division of Cardiology, Nagoya Tokushukai General Hospital,
Kasugai, Japan
(Sone) Division of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
(Sugimura) Division of Cardiology, Kawakita General Hospital, Tokyo, Japan
(Kawai) Division of Cardiology, Chikamori Hospital, Kochi, Japan
(Abe) Division of Cardiology, Yotsuba Circulation Clinic, Matsuyama, Japan
(Kaneko) Division of Cardiology, Hoshi General Hospital, Koriyama, Japan
(Nakamura) Division of Cardiology, New Tokyo Hospital, Chiba, Japan
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Despite its recommendation by the current guidelines, the role
of long-term oral beta-blocker therapy has never been evaluated by
randomized trials in uncomplicated ST-segment elevation myocardial
infarction (STEMI) patients without heart failure, left ventricular
dysfunction or ventricular arrhythmia who underwent primary percutaneous
coronary intervention (PCI). Methods and results In a multi-center,
open-label, randomized controlled trial, STEMI patients with successful
primary PCI within 24 hours from the onset and with left ventricular
ejection fraction (LVEF) 40% were randomly assigned in a 1-to-1 fashion
either to the carvedilol group or to the no beta-blocker group within 7
days after primary PCI. The primary endpoint is a composite of all-cause
death, myocardial infarction, hospitalization for heart failure, and
hospitalization for acute coronary syndrome. Between August 2010 and May
2014, 801 patients were randomly assigned to the carvedilol group (N =
399) or the no beta-blocker group (N = 402) at 67 centers in Japan. The
carvedilol dose was up-titrated from 3.4+/-2.1 mg at baseline to 6.3
+/-4.3 mg at 1-year. During median follow-up of 3.9 years with 96.4%
follow-up, the cumulative 3-year incidences of both the primary endpoint
and any coronary revascularization were not significantly different
between the carvedilol and no beta-blocker groups (6.8% and 7.9%, P =
0.20, and 20.3% and 17.7%, P = 0.65, respectively). There also was no
significant difference in LVEF at 1-year between the 2 groups (60.9+/-8.4%
and 59.6+/-8.8%, P = 0.06) Conclusion Long-term carvedilol therapy added
on the contemporary evidence-based medications did not seem beneficial in
selected STEMI patients treated with primary PCI. Trial registration
CAPITAL-RCT (Carvedilol Post-Intervention Long-Term Administration in
Large-scale Randomized Controlled Trial) ClinicalTrials.gov.number, NCT
01155635.<br/>Copyright &#xa9; 2018 Watanabe 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.

<3>
Accession Number
623909271
Title
MAGnesium-based bioresorbable scaffold and vasomotor function in patients
with acute ST segment elevation myocardial infarction: The MAGSTEMI trial:
Rationale and design.
Source
Catheterization and Cardiovascular Interventions. 93 (1) (pp 64-70), 2019.
Date of Publication: 01 Jan 2019.
Author
Brugaletta S.; Cequier A.; Alfonso F.; Iniguez A.; Romani S.; Serra A.;
Salinas P.; Goicolea J.; Bordes P.; del Blanco B.G.; Hernandez-Antolin R.;
Pernigotti A.; Gomez-Lara J.; Sabate M.
Institution
(Brugaletta, Pernigotti, Sabate) Department of Cardiology, Institut Clinic
Cardiovascular, Hospital Clinic, Institut d'Investigacions Biomediques
August Pi i Sunyer (IDIBAPS), Barcelona, Spain
(Cequier, Gomez-Lara) Department of Cardiology, Hospital de Bellvitge,
Barcelona, Spain
(Alfonso) Department of Cardiology, Hospital La Princesa, Madrid, Spain
(Iniguez) Department of Cardiology, Hospital Alvaro Cunqueiro, Vigo, Spain
(Romani) Department of Cardiology, Hospital San Pedro de Alcantara,
Caceres, Spain
(Serra) Department of Cardiology, Hospital de Sant Pau, Barcelona, Spain
(Salinas) Department of Cardiology, Hospital Clinico San Carlos, Madrid,
Spain
(Goicolea) Department of Cardiology, Hospital Puerta de
Hierro-Majadahonda, Madrid, Spain
(Bordes) Department of Cardiology, Hospital General de Alicante, Alicante,
Spain
(del Blanco) Department of Cardiology, Hospital Vall d'Hebron, Barcelona,
Spain
(Hernandez-Antolin) Department of Cardiology, Hospital Ramon y Cajal,
Madrid, Spain
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Aim: Use of a Bioresorbable Scaffolds (BRS) either in clinical practice or
in the setting of an acute myocardial infarction (MI) is controversial.
Despite an overall high rate of thrombosis, vascular healing response
following BRS implantation tend to superiority as compared to metallic
drug-eluting stent in ST-segment elevation myocardial infarction (STEMI)
patients. We sought to compare the in-stent/scaffold vasomotion between
metallic BRS and sirolimus eluting stent (SES) at 12-month angiographic
follow-up in the setting of patients with STEMI treated by primary PCI.
Study design: This is an investigator-driven, prospective, multicenter,
randomized, single blind, two-arm, controlled trial (ClinicalTrials.gov
number: NCT03234348). This trial will randomize ~148 patients 1:1 to SES
or BRS. Primary end-point is the in-stent/scaffold change in mean lumen
diameter after nitroglycerin administration at 12-month angiographic
follow-up. Besides, patient-oriented combined endpoint of all-cause death,
any MI, and any revascularization, together with scaffold/stent thrombosis
rate and device-oriented endpoint of cardiac death, target vessel (TV)-MI
and TVR at 1 year will be also evaluated. Clinical follow-up will be
scheduled yearly up to 5 years. <br/>Conclusion(s): This trial will shed
light on the vascular vasomotion following BRS implantation in the complex
scenario of STEMI.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<4>
Accession Number
2001444962
Title
Preoperative Exercise Rehabilitation in Cardiac and Vascular
Interventions.
Source
Journal of Surgical Research. 237 (pp 3-11), 2019. Date of Publication:
May 2019.
Author
Drudi L.M.; Tat J.; Ades M.; Mata J.; Landry T.; MacKenzie K.S.; Steinmetz
O.K.; Gill H.L.
Institution
(Drudi, Tat, Ades, Mata, MacKenzie, Steinmetz, Gill) Division of Vascular
Surgery, Department of Surgery, McGill University, Montreal, Quebec,
Canada
(Landry) Montreal General Hospital Medical Library, Montreal, Quebec,
Canada
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Background: Exercise-based interventions have become part of the standard
of care in rehabilitation programs for cardiovascular risk reduction and
the promotion of a healthy lifestyle. The systematic review describes the
current state of knowledge of the effects of preoperative exercise
training (prehabilitation) on perioperative clinical outcomes in patients
undergoing cardiac and vascular interventions. <br/>Method(s): Studies
were systematically searched within 14 databases from inception to October
2016. Only studies that assessed a preoperative exercise program in adult
patients undergoing cardiac or vascular interventions with clinical or
patient-centered endpoints were included in the review. Two independent
reviewers selected studies for inclusion, extracted data, and assessed
quality using Cochrane Collaboration's tool for
RCTs^{11111111111111111} and ROBINS-I tool for nonrandomized
studies. <br/>Result(s): Nine studies met our inclusion criteria and were
stratified for qualitative analyses by cardiac (n = 7) and vascular (n =
2) procedures. Prehabilitation was associated with decreased length of
stay, reduced postoperative complications, improved objective physical
functioning, and improved subjective quality of life (SF-36 physical and
mental health domains) measures in patients undergoing cardiac and
vascular procedures. Given the amount of heterogeneity that was present in
the designs, populations, and comparators among the included studies, we
were unable to statistically pool data across trials. <br/>Conclusion(s):
Our qualitative findings suggest that prehabilitation may improve clinical
outcomes, physical performance, and health-related quality-of-life
measures in patients undergoing cardiac and vascular surgery
procedures.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<5>
Accession Number
2000953084
Title
Transradial access for coronary diagnostic and interventional procedures:
Consensus statement and recommendations for India: Advancing Complex
CoronariES Sciences through TransRADIAL intervention in India - ACCESS
RADIALTM: Clinical consensus recommendations in collaboration with
Cardiological Society of India (CSI).
Source
Indian Heart Journal. 70 (6) (pp 922-933), 2018. Date of Publication:
November - December 2018.
Author
Goel P.K.; Menon A.; Mullasari A.S.; Valaparambil A.K.; Pinto B.;
Pahlajani D.; Gunasekaran S.; Trehan V.K.; Abhaichand R.K.; Chugh S.K.;
Hiremath M.S.
Institution
(Goel) Department of Cardiology, Sanjay Gandhi Post Graduate Institute of
Medical Sciences (SGPGI), India
(Menon) Department of Cardiology, Lilavati Hospital & Research Centre,
India
(Mullasari) Department of Cardiology, Madras Medical Mission, India
(Valaparambil) Department of Cardiology, Sree Chitra Tirunal Institute,
India
(Pinto) Department of Cardiology, Holy Family Hospital, India
(Pahlajani) Department of Cardiology, Beach Candy Hospital, India
(Hiremath) Department of Cardiology, Ruby Hall Clinic, India
(Gunasekaran) Department of Cardiology, Apollo Hospital, India
(Trehan) Department of Cardiology, G.B. Pant Hospital (GIPMER), India
(Abhaichand) Department of Cardiology, G.K.N.M. Hospital, India
(Chugh) Department of Cardiology, Jaipur National University Hospital,
India
Publisher
Elsevier B.V.
Abstract
Radial access for cardiac catheterization and intervention in India has
been growing steadily over the last decade with favorable clinical
outcomes. However, its usage by interventional cardiologists varies
greatly among Indian operators and hospitals due to large geographic
disparities in health care delivery systems and practice patterns. It also
remains unclear whether the advantages, as well as limitations of
transradial (TR) intervention (as reported in the western literature), are
applicable to developing countries like India or not. An evidence-based
review involving various facets of radial procedure for cardiac
catheterization, including practical, patient-related and technical issues
was conducted by an expert committee that formed a part of Advancing
Complex CoronariES Sciences through TransRADIAL intervention (ACCESS
RADIALTM) Advisory Board. Emerging challenges in redefining TR management
based on evidence supporting practices were discussed to formulate these
final recommendations through consensus.<br/>Copyright &#xa9; 2018

<6>
Accession Number
624534942
Title
Definitions and clinical impact of revascularization completeness.
Source
Minerva Cardioangiologica. 66 (5) (pp 594-599), 2018. Date of Publication:
October 2018.
Author
Aurigemma C.; Burzotta F.; Russo G.; Previ L.; Trani C.
Institution
(Aurigemma, Burzotta, Russo, Previ, Trani) Institute of Cardiology,
Catholic University of the Sacred Heart, Largo A. Gemelli 1, Rome 00168,
Italy
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
The completeness of revascularization in patients with multivessel
coronary artery disease (CAD) remains an unanswered question. Despite 20
years of investigation there are still major doubts in this topic,
reaching as far as to the lack of a standardized definition. The
employment of different definition and the multiplicity of confounding
variables that in general favor patients who receive a complete
revascularization (CR) are the reason of difficult comparisons between
studies. The complexity of coronary anatomy diseases and the clinical
features play important role in the revascularization strategy. However,
the clinical impact of CR is different in particular clinical subsets,
such as diabetes, ST-segment elevation myocardial infarction, cardiogenic
shock, ischemic heart failure. The CR is a desirable objective, but it is
not mandatory and sometimes a reasonable incomplete revascularization (IR)
offers comparable results. Clinical variables, including patient's age,
life expectancy, the severity of symptoms at presentation, comorbidities
(particularly diabetes mellitus), left ventricular function and myocardial
viability, as well as coronary anatomy should be considered in the
decision making whether to attempt CR or to follow a reasonable IR
strategy, for both percutaneous coronary intervention and coronary artery
bypass graft surgery, in patients with multivessel CAD.<br/>Copyright
&#xa9; 2018 EDIZIONI MINERVA MEDICA.

<7>
Accession Number
624534928
Title
High-risk percutaneous coronary intervention: How to define it today?.
Source
Minerva Cardioangiologica. 66 (5) (pp 576-593), 2018. Date of Publication:
October 2018.
Author
De Marzo V.; D'Amario D.; Galli M.; Vergallo R.; Porto I.
Institution
(De Marzo, D'Amario, Galli, Vergallo, Porto) Unit of Interventional
Cardiology, Department of Cardiovascular Sciences, Catholic University of
the Sacred Heart, Rome, Italy
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Before the percutaneous era, the mortality rate of patients with coronary
heart disease not suitable for cardiac surgery was extremely high. This
limit has been progressively exceeded with the advent of minimally
invasive approaches, which, although initially intended exclusively for
low risk scenarios, was then employed in complex patients often too
compromised to undergo cardiac surgery. We are currently witnessing,
however, a sudden expansion in percutaneous coronary interventions (PCI)
in extreme cases, perceived as high-risk by operators, imposing an
important burden of human and economic resources on interventional
cardiology as a whole. In this review, the literature regarding the
current definition of high-risk PCI and its implications has been
reviewed. In summary, all proposed definitions of high risk PCI combine
features related to three main clinical areas: 1) patient risk factors and
comorbidities (incorporating those which preclude surgical or percutaneous
revascularization such as diabetes, chronic obstructive pulmonary disease,
chronic kidney disease, lung disease, frailty, advanced age); 2) location
of the disease and complexity of coronary anatomy (including multi-vessel
disease, left main disease, chronic total occlusion, bifurcations); 3)
hemodynamic clinical status (ventricular dysfunction, concomitant valvular
disease or unstable characteristics). Importantly, encouraging results in
terms of efficacy and gains in health status of PCI in (variously defined)
high-risk, as compared to the low-risks patients, are reported. Thus,
treating high-risk patients is becoming increasingly relevant, to the
point that current guidelines now particularly highlight the
appropriateness of percutaneous interventions in this
setting.<br/>Copyright &#xa9; 2018 EDIZIONI MINERVA MEDICA.

<8>
Accession Number
625827784
Title
Effect of Oral Alfacalcidol on Clinical Outcomes in Patients Without
Secondary Hyperparathyroidism Receiving Maintenance Hemodialysis: The
J-DAVID Randomized Clinical Trial.
Source
JAMA - Journal of the American Medical Association. 320 (22) (pp
2325-2334), 2018. Date of Publication: 11 Dec 2018.
Author
Shoji T.; Inaba M.; Fukagawa M.; Ando R.; Emoto M.; Fujii H.; Fujimori A.;
Fukui M.; Hase H.; Hashimoto T.; Hirakata H.; Honda H.; Hosoya T.; Ikari
Y.; Inaguma D.; Inoue T.; Isaka Y.; Iseki K.; Ishimura E.; Itami N.; Ito
C.; Kakuta T.; Kawai T.; Kawanishi H.; Kobayashi S.; Kumagai J.; Maekawa
K.; Masakane I.; Minakuchi J.; Mitsuiki K.; Mizuguchi T.; Morimoto S.;
Murohara T.; Nakatani T.; Negi S.; Nishi S.; Nishikawa M.; Ogawa T.; Ohta
K.; Ohtake T.; Okamura M.; Okuno S.; Shigematsu T.; Sugimoto T.; Suzuki
M.; Tahara H.; Takemoto Y.; Tanaka K.; Tominaga Y.; Tsubakihara Y.;
Tsujimoto Y.; Tsuruya K.; Ueda S.; Watanabe Y.; Yamagata K.; Yamakawa T.;
Yano S.; Yokoyama K.; Yorioka N.; Yoshiyama M.; Nishizawa Y.
Institution
(Shoji) Department of Vascular Medicine, Osaka City University Graduate
School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
(Shoji, Inaba) Vascular Science Center for Translational Research, Osaka
City University Graduate School of Medicine, Japan
(Inaba, Emoto) Department of Metabolism Endocrinology, and Molecular
Medicine, Osaka City University Graduate School of Medicine, Japan
(Fukagawa) Division of Nephrology Endocrinology, and Metabolism, Tokai
University School of Medicine, Kanagawa, Japan
(Ando) Department of Nephrology, Musashino Red Cross Hospital, Tokyo,
Japan
(Fujii) Department of Drug and Food Evaluation, Osaka City University
Graduate School of Medicine, Japan
(Fujimori) Blood Purification and Kidney Center, Konan Hospital, Hyogo,
Japan
(Fukui) Laboratory of Statistics, Osaka City University Graduate School of
Medicine, Japan
(Hase) Department of Nephrology, Toho University School of Medicine,
Tokyo, Japan
(Hashimoto) Department of Urology, Tojinkai Hospital, Kyoto, Japan
(Hirakata) Division of Nephrology, Fukuoka Renal Clinic, Fukuoka, Japan
(Honda) Division of Nephrology, Department of Medicine, Showa University
Koto Toyosu Hospital, Tokyo, Japan
(Hosoya) Department of Pathophysiology and Therapy in Chronic Kidney
Disease, Jikei University School of Medicine, Tokyo, Japan
(Ikari) Department of Cardiology, Tokai University School of Medicine,
Kanagawa, Japan
(Inaguma) Department of Nephrology, Fujita Health University School of
Medicine, Aichi, Japan
(Inoue) Yuseikai Clinic, Osaka, Japan
(Isaka) Department of Nephrology, Osaka University Graduate School of
Medicine, Japan
(Iseki) Clinical Research Support Center, Tomishiro Central Hospital,
Japan
(Ishimura) Department of Nephrology, Osaka City University Graduate School
of Medicine, Japan
(Itami) Department of Nephrology, Itami Kidney Clinic, Hokkaido, Japan
(Ito) Department of Internal Medicine, Haga Red Cross Hospital, Tochigi,
Japan
(Kakuta) Division of Nephrology Endocrinology, and Metabolism, Tokai
University Hachioji Hospital, Tokyo, Japan
(Kawai) Medical Corporation Chuou Naika Clinic, Hiroshima, Japan
(Kawanishi) Department of Artificial Organs, Tsuchiya General Hospital,
Hiroshima, Japan
(Kobayashi, Ohtake) Department of Kidney Disease and Transplant Center,
Shonan Kamakura General Hospital, Kanagawa, Japan
(Kumagai) Akane Foundation Omachi Tsuchiya Clinic, Hiroshima, Japan
(Maekawa) Hemodialysis, Fujiidera Shirasagi Clinic, Osaka, Japan
(Masakane) Nephrology, Honcho Yabuki Clinic, Yamagata, Japan
(Minakuchi) Department of Kidney Disease, Kawashima Hospital, Tokushima,
Japan
(Mitsuiki) Nephrology and Dialysis Center, Japanese Red Cross Fukuoka
Hospital, Japan
(Mizuguchi) Department of Hematology Dialysis, and Diabetes Mellitus,
Kochi-Takasu Hospital, J-Kochi, Japan
(Morimoto) Department of Medicine Endocrinology, and Hypertension, Tokyo
Women's Medical University, Japan
(Murohara) Department of Cardiology, Nagoya University Graduate School of
Medicine, Aichi, Japan
(Nakatani, Takemoto) Department of Urology, Osaka City University Graduate
School of Medicine, Japan
(Negi, Shigematsu) Department of Nephrology, Wakayama Medical University,
Wakayama, Japan
(Nishi) Division of Nephrology and Kidney Center, Kobe University Graduate
School of Medicine, Hyogo, Japan
(Nishikawa) Meisei Memorial Hospital, Osaka, Japan
(Ogawa) Department of Medicine, Tokyo Women's Medical University Medical
Center East, Tokyo, Japan
(Ohta) Department of Urology, Kochi Takasu Hospital, J-Kochi, Japan
(Okamura) Department of Internal Medicine, Kayashima Ikuno Hospital,
Osaka, Japan
(Okuno) Department of Internal Medicine, Kidney Center, Shirasagi
Hospital, Osaka, Japan
(Sugimoto) Department of Internal Medicine, Shimane University Faculty of
Medicine, Shimane, Japan
(Suzuki) Department of Nephrology, Shinraku-En Hospital, Niigata, Japan
(Tahara) Ikuno-Aiwa Hemodialysis Clinic, Osaka, Japan
(Tanaka) Department of Internal Medicine, Suiyukai Clinic, Nara, Japan
(Tominaga) Department of Transplant and Endocrine Surgery, Nagoya 2nd Red
Cross Hospital, Japan
(Tsubakihara) Department of Safety Management in Health Care Sciences,
Graduate School of Health Care Sciences, Jikei Institute, Osaka, Japan
(Tsujimoto) Department of Internal Medicine, Inoue Hospital, Osaka, Japan
(Tsuruya) Department of Nephrology, Nara Medical University, Japan
(Ueda) Department of Clinical Pharmacology and Therapeutics, University of
the Ryukyus Graduate School of Medicine, Okinawa, Japan
(Watanabe) Kasugai Municipal Hospital, Aichi, Japan
(Yamagata) Department of Nephrology, Faculty of Medicine, University of
Tsukuba, Ibaraki, Japan
(Yamakawa) Kidney Center, Shirasagi Hospital, Osaka, Japan
(Yano) Department of Laboratory Medicine, Shimane University Faculty of
Medicine, Japan
(Yokoyama) Division of Nephrology and Hypertension, Department of Internal
Medicine, Jikei University School of Medicine, Tokyo, Japan
(Yorioka) Hiroshima Kidney Organization, Japan
(Yoshiyama) Department of Cardiovascular Medicine, Osaka City University
Graduate School of Medicine, Japan
(Nishizawa) Hemodialysis Center, Inoue Hospital, Soryu Medical
Corporation, Osaka, Japan
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Patients with chronic kidney disease have impaired vitamin D
activation and elevated cardiovascular risk. Observational studies in
patients treated with hemodialysis showed that the use of active vitamin D
sterols was associated with lower risk of all-cause mortality, regardless
of parathyroid hormone levels. <br/>Objective(s): To determine whether
vitamin D receptor activators reduce cardiovascular events and mortality
in patients without secondary hyperparathyroidism undergoing hemodialysis.
<br/>Design, Setting, and Participant(s): Randomized, open-label, blinded
end point multicenter study of 1289 patients in 207 dialysis centers in
Japan. The study included 976 patients receiving maintenance hemodialysis
with serum intact parathyroid hormone levels less than or equal to 180
pg/mL. The first and last participants were enrolled on August 18, 2008,
and January 26, 2011, respectively. The final date of follow-up was April
4, 2015. <br/>Intervention(s): Treatment with 0.5 mug of oral alfacalcidol
per day (intervention group; n = 495) vs treatment without vitamin D
receptor activators (control group; n = 481). <br/>Main Outcomes and
Measures: The primary outcome was a composite measure of fatal and
nonfatal cardiovascular events, including myocardial infarctions,
hospitalizations for congestive heart failure, stroke, aortic
dissection/rupture, amputation of lower limb due to ischemia, and cardiac
sudden death; coronary revascularization; and leg artery revascularization
during 48 months of follow-up. The secondary outcome was all-cause death.
<br/>Result(s): Among 976 patients who were randomized from 108 dialysis
centers, 964 patients were included in the intention-to-treat analysis
(median age, 65 years; 386 women [40.0%]), and 944 (97.9%) completed the
trial. During follow-up (median, 4.0 years), the primary composite outcome
of cardiovascular events occurred in 103 of 488 patients (21.1%) in the
intervention group and 85 of 476 patients (17.9%) in the control group
(absolute difference, 3.25% [95% CI, -1.75% to 8.24%]; hazard ratio, 1.25
[95% CI, 0.94-1.67]; P =.13). There was no significant difference in the
secondary outcome of all-cause mortality between the groups (18.2% vs
16.8%, respectively; hazard ratio, 1.12 [95% CI, 0.83-1.52]; P =.46). Of
the 488 participants in the intervention group, 199 (40.8%) experienced
serious adverse events that were classified as cardiovascular, 64 (13.1%)
experienced adverse events classified as infection, and 22 (4.5%)
experienced malignancy-related serious adverse events. Of 476 participants
in the control group, 191 (40.1%) experienced cardiovascular-related
serious adverse events, 63 (13.2%) experienced infection-related serious
adverse events, and 21 (4.4%) experienced malignancy-related adverse
events. <br/>Conclusions and Relevance: Among patients without secondary
hyperparathyroidism undergoing maintenance hemodialysis, oral alfacalcidol
compared with usual care did not reduce the risk of a composite measure of
select cardiovascular events. These findings do not support the use of
vitamin D receptor activators for patients such as these. Trial
Registration: UMIN-CTR Identifier: UMIN000001194.<br/>Copyright &#xa9;
2018 American Medical Association. All rights reserved.

<9>
Accession Number
621005723
Title
Association between serum calcium, serum phosphate and aortic stenosis
with implications for prevention.
Source
European Journal of Preventive Cardiology. 25 (5) (pp 551-556), 2018. Date
of Publication: 01 Mar 2018.
Author
Wald D.S.; Bestwick J.P.
Institution
(Wald, Bestwick) Queen Mary University of London, Wolfson Institute of
Preventive Medicine, Barts, The London School of Medicine and Dentistry,
United Kingdom
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Aortic stenosis is the most common cause of valvular heart
disease with no means of prevention. Lowering serum levels of calcium or
phosphate are potential preventive strategies but observational studies on
the associations with aortic stenosis are inconsistent. Design and
methods: A case-control study was conducted in 132 individuals undergoing
echocardiography (63 with aortic stenosis and 69 without) and the results
combined with three other comparable studies (914 individuals overall) to
provide a summary odds ratio of aortic stenosis for a 0.1 mmol/L increase
(approximately one standard deviation) in calcium and phosphate
respectively. The relationship between calcium and phosphate and the
severity of aortic stenosis, according to peak trans-aortic velocity, was
also examined in the case-control study using linear regression.
<br/>Result(s): Both calcium and phosphate were positively associated with
aortic stenosis. The summary odds ratio for a 0.1 mmol/L increase in
calcium was 1.79 (95% confidence interval 1.07-2.99), p = 0.027 and for
phosphate it was 1.47 (1.08-2.01), p = 0.015. Peak trans-aortic velocity
increased with phosphate levels, 9% (4%-14%) per 0.1 mmol/L, p = 0.001,
but not with calcium, p = 0.089. <br/>Conclusion(s): If the associations
are causal and reversible, these results indicate that a small reduction
in calcium or phosphate levels, within the physiological rage, would
translate into a clinically significant reduction in the risk of aortic
stenosis. Randomised trials of calcium and phosphate lowering therapies in
aortic stenosis are needed.<br/>Copyright &#xa9; 2018, &#xa9; The European
Society of Cardiology 2018.

<10>
Accession Number
2001092620
Title
The Role of Colchicine in Treating Postoperative and Post-catheter
Ablation Atrial Fibrillation.
Source
Clinical Therapeutics. 41 (1) (pp 21-29), 2019. Date of Publication:
January 2019.
Author
Deftereos S.G.; Vrachatis D.A.; Angelidis C.; Vrettou A.-R.; Sarri E.K.;
Giotaki S.G.; Varytimiadi E.; Kossyvakis C.; Kotsia E.; Deftereos G.S.;
Doudoumis K.; Giannopoulos G.
Institution
(Deftereos, Angelidis, Vrettou, Varytimiadi) 2nd Department of Cardiology,
Medical School, Attikon Hospital, National and Kapodistrian University of
Athens, Athens, Greece
(Vrachatis, Sarri, Giotaki, Kossyvakis, Kotsia, Deftereos, Doudoumis,
Giannopoulos) Department of Cardiology, "G. Gennimatas" General Hospital
of Athens, Athens, Greece
Publisher
Excerpta Medica Inc.
Abstract
Purpose: The goal of this review was to summarize, analyze, and compare
trials studying the efficacy of colchicine in the prevention of atrial
fibrillation (AF) post-operatively (POAF) and post-catheter ablation.
Ongoing studies and current guidelines are also presented and reviewed.
<br/>Method(s): Published studies on the field were identified through a
literature search of the PubMed and clinicaltrials.gov databases.
<br/>Finding(s): Four original studies regarding POAF, two original
studies regarding post-catheter ablation AF, and six meta-analyses were
identified. In addition, the 3 most recent guidelines/expert consensus
documents were scrutinized. Implications: AF occurs frequently after
cardiac surgery (POAF) and catheter pulmonary vein isolation (postablation
AF) and is associated with increased cardiovascular morbidity. A number of
trials over the last few years have investigated the role of colchicine in
the prevention of POAF and postablation AF targeting the local and
systemic inflammatory process that leads to initiation and maintenance of
AF. Available data imply that colchicine may have a preventive role in
POAF and/or postablation AF. However, certain limitations of these studies
underline the need for further investigation.<br/>Copyright &#xa9; 2018
Elsevier Inc.

<11>
Accession Number
2001363600
Title
Effects of Perioperative Dexmedetomidine on Postoperative Mortality and
Morbidity: A Systematic Review and Meta-analysis.
Source
Clinical Therapeutics. 41 (1) (pp 138-154.e4), 2019. Date of Publication:
January 2019.
Author
Peng K.; Ji F.-H.; Liu H.-Y.; Zhang J.; Chen Q.-C.; Jiang Y.-H.
Institution
(Peng, Ji, Liu, Zhang, Chen, Jiang) Departments of Anesthesiology,
Intensive Care Medicine, and Pain Medicine, First Affiliated Hospital of
Soochow University, Suzhou, China
Publisher
Excerpta Medica Inc.
Abstract
Purpose: Major postoperative complications translate into increased health
care resource utilization, prolonged hospital stays, and increased
mortality. We aimed to assess the effects of perioperative dexmedetomidine
use on postoperative mortality and the prevalence of major complications
after cardiac and noncardiac surgery. <br/>Method(s): We searched the
PubMed, EMBASE, and Cochrane databases to analyze all published evidence
from randomized controlled trials (RCTs) and cohort studies comparing
perioperative dexmedetomidine use versus no dexmedetomidine use in adult
patients undergoing cardiac and noncardiac surgery. The primary outcome
was postoperative mortality. Secondary outcomes were the durations of
mechanical ventilation, intensive care unit (ICU) stay, and hospital stay,
and the prevalence of major complications. <br/>Finding(s): Twenty-three
studies in cardiac surgery (n = 7635) and 8 studies in noncardiac surgery
(n = 1805) were included. In cardiac surgery, dexmedetomidine use reduced
postoperative 30-day mortality (risk ratio [RR], 0.35 [95% CI, 0.24 to
0.51]); durations of mechanical ventilation (mean difference [MD], -1.56 h
[-2.52 to -0.60]), ICU stay (MD, -0.22 day [-0.35 to -0.08]), and hospital
stay (MD, -0.65 day [-1.12 to -0.18]); and the prevalences of delirium
(RR, 0.50 [0.36 to 0.69]), atrial fibrillation (RR, 0.74 [0.57 to 0.97]),
and cardiac arrest (RR, 0.34 [0.13 to 0.87]). In noncardiac surgery,
dexmedetomidine use was associated with decreases in the durations of
mechanical ventilation and hospital stay, with a trend toward a lower
prevalence of delirium (RR, 0.57 [0.32 to 1.01]). The prevalence of
bradycardia was increased in dexmedetomidine-treated patients undergoing
cardiac surgery (RR, 1.70 [1.19 to 2.44]) and noncardiac surgery (RR, 1.64
[1.05 to 2.58]). Implications: Dexmedetomidine use may help to reduce
postoperative 30-day mortality, durations of mechanical ventilation, ICU
stay, and hospital stay, and the prevalences of delirium, atrial
fibrillation, and cardiac arrest in patients who undergo cardiac surgery.
The majority of the benefits of dexmedetomidine were not significant in
patients undergoing noncardiac surgery. An increased risk for bradycardia
should be taken into consideration when prescribing dexmedetomidine.
International Prospective Register of Systematic Reviews identifier:
CRD42017070791.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<12>
Accession Number
625859158
Title
Guided meditation as an adjunct to enhance postoperative recovery after
cardiac surgery: Study protocol for a prospective randomized controlled
feasibility trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 39. Date of
Publication: 11 Jan 2019.
Author
Packiasabapathy S.; Susheela A.T.; Mueller A.; Patxot M.; Gasangwa D.-V.;
O'Gara B.; Shaefi S.; Marcantonio E.R.; Yeh G.Y.; Subramaniam B.
Institution
(Susheela, Mueller, Patxot, Gasangwa, O'Gara, Shaefi, Subramaniam)
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel
Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, United
States
(Susheela, Mueller, O'Gara, Shaefi, Marcantonio, Yeh, Subramaniam) Harvard
Medical School, 25 Shattuck St, Boston, MA 02115, United States
(Marcantonio, Yeh) Division of General Medicine and Primary Care, Beth
Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215,
United States
(Packiasabapathy) Department of Anesthesia, Critical Care and Pain
Medicine, Indiana University School of Medicine, 340 W 10th St #6200,
Indianapolis, IN 46202, United States
(Subramaniam) Beth Israel Deaconess Medical Center, 375 Longwood Avenue,
W/MASCO-414, Boston, MA 02215, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Cardiac surgical procedures are associated with postoperative
neurological complications such as cognitive decline and delirium, which
can complicate recovery and impair quality of life. Perioperative
depression and anxiety may be associated with increased mortality after
cardiac surgeries. Surgical prehabilitation is an emerging concept that
includes preoperative interventions to potentially reduce postoperative
complications. While most current prehabilitation interventions focus on
optimizing physical health, mind-body interventions are an area of growing
interest. Preoperative mind-body interventions such as Isha Kriya
meditation, may hold significant potential to improve postsurgical
outcomes. <br/>Method(s): This is a prospective, randomized controlled
feasibility trial. A total of 40 adult patients undergoing cardiac surgery
will be randomized to one of three study groups. Participants randomized
to either of the two intervention groups will receive meditative
intervention: (1) commencing two weeks before surgery; or (2) commencing
only from the day after surgery. Meditative intervention will last for
four weeks after the surgery in these groups. Participants in the third
control group will receive the current standard of care with no meditative
intervention. All participants will undergo assessments using
neurocognitive, sleep, depression, anxiety, and pain questionnaires at
various time points in the perioperative period. Blood samples will be
collected at baseline, preoperatively, and postoperatively to assess for
inflammatory biomarkers. The primary aim of this trial is to assess the
feasibility of implementing a perioperative meditative intervention
program. Other objectives include studying the effect of meditation on
postoperative pain, sleep, psychological wellbeing, cognitive function,
and delirium. These will be used to calculate effect size to design future
studies. <br/>Discussion(s): This study serves as the first step towards
understanding the feasibility of implementing a mind-body intervention as
a prehabilitative intervention to improve postoperative surgical outcomes
after cardiac surgery. Trial registration: Clinicaltrials.gov,
NCT03198039. Registered on 23 June 2017.<br/>Copyright &#xa9; 2019 The
Author(s).

<13>
Accession Number
625857527
Title
Mortality impact of post-discharge myocardial infarction size after
percutaneous coronary intervention: a patient-level pooled analysis from
the 4 large-scale Japanese studies.
Source
Cardiovascular Intervention and Therapeutics. 34 (1) (pp 47-58), 2019.
Date of Publication: 25 Jan 2019.
Author
Watanabe H.; Morimoto T.; Shiomi H.; Yoshikawa Y.; Kato T.; Saito N.;
Shizuta S.; Ono K.; Yamaji K.; Ando K.; Kaji S.; Furukawa Y.; Akao M.;
Ishikawa T.; Tamura T.; Yamamoto Y.; Muramatsu T.; Suwa S.; Nakagawa Y.;
Kadota K.; Takatsu Y.; Nishikawa H.; Hiasa Y.; Hayashi Y.; Miyazaki S.;
Kimura T.
Institution
(Watanabe, Shiomi, Yoshikawa, Kato, Saito, Shizuta, Ono, Kimura)
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto
University, 54 Shogoin-Kawahara cho, Sakyo-ku, Kyoto 606-8507, Japan
(Morimoto) Department of Clinical Epidemiology, Hyogo College of Medicine,
Nishinomiya, Japan
(Yamaji, Ando) Division of Cardiology, Kokura Memorial Hospital,
Kitakyushu, Japan
(Kaji, Furukawa) Department of Cardiovascular Medicine, Kobe City Medical
Centre General Hospital, Kobe, Japan
(Akao) Division of Cardiology, National Hospital Organization Kyoto
Medical Centre, Kyoto, Japan
(Ishikawa) Division of Cardiology, The Jikei University Kashiwa Hospital,
Kashiwa, Japan
(Tamura) Division of Cardiology, Japanese Red Cross Wakayama Medical
Center, Wakayama, Japan
(Yamamoto) Division of Cardiology, Iwaki Kyoritsu Hospital, Iwaki, Japan
(Muramatsu) Division of Cardiology, Tokyo General Hospital, Tokyo, Japan
(Suwa) Division of Cardiology, Juntendo University Shizuoka Hospital,
Izunokuni, Japan
(Nakagawa) Division of Cardiology, Tenri Hospital, Tenri, Japan
(Kadota) Division of Cardiology, Kurashiki Central Hospital, Kurashiki,
Japan
(Takatsu) Division of Cardiology, Hyogo Prefectural Amagasaki General
Medical Centre, Amagasaki, Japan
(Nishikawa) Division of Cardiology, Mie Heart Centre, Mie, Japan
(Hiasa) Division of Cardiology, Tokushima Red Cross Hospital, Tokushima,
Japan
(Hayashi) Division of Cardiology, Tsuchiya General Hospital, Hiroshima,
Japan
(Miyazaki) Division of Cardiology, Department of Medicine, Faculty of
Medicine, Kindai University, Osakasayama, Japan
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
It is unknown whether there is a threshold of creatine kinase (CK) or
CK-MB affecting the subsequent mortality for post-discharge myocardial
infarction (PDMI) after percutaneous coronary intervention. Current study
sought to evaluate the impact of PDMI. The study population included
30,051 patients with successful coronary stenting and discharged alive in
the pooled patient-level database of 4 Japanese studies (j-Cypher
registry, CREDO-Kyoto PCI/CABG registry cohort-2, RESET, and NEXT). During
4.4 +/- 1.4 year follow-up, 915 patients experienced PDMI (cumulative
5-year incidence of 3.6%). Among 466 patients with available peak CK ratio
(peak CK/upper limit of normal), peak CK ratio (< 3) was present in 21% of
patients, while peak CK ratios (>= 3 and < 5), (>= 5 and < 10), (>= 10 and
< 30), and (>= 30) were present in 17, 25, 30, and 7.3% of patients,
respectively. The excess mortality risk of patients with relative to those
without PDMI for subsequent mortality was significant (adjusted HR 5.12,
95% CI 4.52-5.80, P < 0.001) by the Cox model with PDMI incorporated as
the time-updated covariate. However, the mortality risk of patients in the
smallest peak CK ratio category (< 3) was insignificant (HR 0.85, 95% CI
0.43-1.71, P = 0.65). In conclusion, despite significant overall mortality
risk of PDMI, the mortality risk of small PDMI was similar to that of no
PDMI, suggesting the presence of some threshold about infarct size
influencing mortality. Trial registrations The Randomized Evaluation of
Sirolimus-Eluting Versus Everolimus-Eluting Stent Trial (RESET);
NCT01035450 and NOBORI Biolimus-Eluting Versus XIENCE/PROMUS
Everolimus-Eluting Stent Trial (NEXT); NCT01303640. J-Cypher and
CREDO-Kyoto PCI/CABG registry cohort 2 were not registered into clinical
trial database.<br/>Copyright &#xa9; 2018, Japanese Association of
Cardiovascular Intervention and Therapeutics.

<14>
Accession Number
625856203
Title
Myocardial calcification secondary to toxic shock syndrome: A comparative
review of 17 cases.
Source
BMJ Case Reports. 12 (1) (no pagination), 2019. Article Number: e228054.
Date of Publication: 01 Jan 2019.
Author
Inayat F.; Haq M.; Ahmed T.
Institution
(Ahmed, Haq) University of Maryland Medical Center, Midtown Campus,
Baltimore, MD, United States
(Inayat) Allama Iqbal Medical College, Lahore, Pakistan
(Ahmed) Cleveland Clinic, Fairview Hospital, Cleveland, OH, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Myocardial calcification is a rare and life-threatening condition. It has
been associated with a myriad of causes, including ischaemic heart
disease, cardiac surgery, rheumatic fever, and myocarditis. However, this
entity is less well recognised in the setting of toxic shock syndrome.
Published medical literature is scarce with regard to the pathogenesis and
clinical implications of this potential association. We chronicle here the
case of a patient with myocardial calcification secondary to toxic shock
syndrome from our clinical experience. Furthermore, a systematic
literature search of the medical databases PubMed and Google Scholar was
conducted. A total of 17 cases fulfilled the inclusion criteria. The data
on patients' characteristics, epidemiology, clinical features, comorbid
conditions, diagnosis, clinical course and outcome were collected and
analysed. The present review outlines our current understanding of the
epidemiology of and risk factors for sepsis-related myocardial
calcification, the pathophysiology of this condition and currently
available approaches to diagnosis.<br/>Copyright &#xa9; 2019 BMJ
Publishing Group Limited.

<15>
Accession Number
625893541
Title
The association of depression following percutanous coronary intervention
with adverse cardiovascular events: Protocol for a systematic review and
meta-analysis.
Source
Medicine. 98 (2) (pp e13952), 2019. Date of Publication: 01 Jan 2019.
Author
Zhao Y.; Tian J.; Tong T.; Gao R.; Liu Y.
Institution
(Liu) Graduate School of Beijing University of Chinese Medicine
(Liu, Liu) Cardiovascular diseases center, Xiyuan hospital of China
academy of Chinese medical sciences
(Liu, Gao) Institute of Clinical Pharmacology of Xiyuan Hospital, China
Academy of Chinese Medical Sciences, Beijing, China
(Zhao) School of Chinese Medicine, Li Ka Shing Faculty of Medicine,
University of Hong Kong, Pokfulam, Hong Kong, China
(Tian) Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Tong) Department of Mathematics, Hong Kong Baptist University, Kowloon
Tong, Hong Kong, China
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Percutanous coronary intervention (PCI) has been
increasingly used for patients suffered from severe coronary artery
disease. However, physical trauma and potential adverse events related to
the procedure often result in detrimental psychological stress.
Accumulating evidences have shown that depression is closely related to
coronary artery disease. However, the association of depression following
percutanous coronary intervention with adverse cardiovascular events is
still unknown. <br/>OBJECTIVE(S): This review is designed to assess the
prognostic association of depression following PCI with adverse cardiac
events. METHODS AND ANALYSIS: The following databases will be searched,
PubMed, the EMBASE, CINAHL and Web of Science of English-language
publications from inception to 30 October 2018. Cross-referencing from
retrieved studies will be conducted additionally, and observational
studies were included. Two independent review authors will do the study
selection on the basis of the study eligibility criteria. Extracted data
will be used for quantitative and qualitative evidence synthesis as well
as to assess methodological quality of studies using the Newcastle-Ottawa
checklist. The primary objective of this review is adverse cardiac events,
presented as a composition of myocardial infarction, repeat coronary
revascularization, cardiac readmission, and cardiac death. The accumulated
evidence is evaluated and graded according to Grading of Recommendations,
Assessment, Development and Evaluation (GRADE). RESULTS AND
<br/>CONCLUSION(S): This review will explain the association of depression
following percutanous coronary intervention with adverse cardiovascular
events, and provide physicians with scientific evidence for psychological
intervention in patients after PCI. PROSPERO REGISTRATION NUMBER:
CRD42018112486.

<16>
[Use Link to view the full text]
Accession Number
625892372
Title
Percutaneous coronary intervention or coronary artery bypass graft in left
main coronary artery disease: a comprehensive meta-analysis of adjusted
observational studies and randomized controlled trials.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 19 (10) (pp
554-563), 2018. Date of Publication: 01 Oct 2018.
Author
Bertaina M.; De Filippo O.; Iannaccone M.; Colombo A.; Stone G.; Serruys
P.; Mancone M.; Omede P.; Conrotto F.; Pennone M.; Kimura T.; Kawamoto H.;
Zoccai G.B.; Sheiban I.; Templin C.; Benedetto U.; Cavalcante R.; D'Amico
M.; Gaudino M.; Moretti C.; Gaita F.; D'Ascenzo F.
Institution
(Bertaina, De Filippo, Iannaccone, Omede, Conrotto, Pennone, D'Amico,
Moretti, Gaita, D'Ascenzo) Division of Cardiology, Molinette Hospital,
Citta Della Salute e della Scienza, Turin, Italy
(Colombo, Kawamoto) Interventional Cardiology, Cardio-Thoracic-Vascular
Department, San Raffaele Scientific Institute, Milan, Italy
(Stone) Cardiovascular Research and Education Columbia University Medical
Center, Presbyterian Hospital, NY, United States
(Serruys, Cavalcante) Department of Interventional Cardiology, Erasmus
University Medical Center, Rotterdam, Netherlands
(Mancone) Department of Cardiovascular, Respiratory, Nephrology,
Anesthesiology and Geriatric Sciences, University 'La Sapienza' of Rome,
Rome, Italy
(Kimura) Department of Cardiovascular Medicine, Kyoto University, Japan
(Zoccai) Department of Medico-Surgical Sciences and Biotechnologies,
Sapienza University of Rome, Latina, Italy
(Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli,
Italy
(Sheiban) Cardiology Department, Pederzoli Hospital, Verona, Italy
(Templin) University Heart Center, Department of Cardiology, University
Hospital Zurich, Zurich, Switzerland
(Benedetto, Gaudino) Bristol Heart Institute, University of Bristol,
School of Clinical Sciences, Bristol, United Kingdom
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medical
College, NY, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Treatment of patients with ULMCA (unprotected left main
coronary artery disease) with percutaneous coronary intervention (PCI) has
been compared with coronary artery bypass graft (CABG), without conclusive
results. <br/>METHOD(S): All randomized controlled trials (RCTs) and
observational studies with multivariate analysis comparing PCI and CABG
for ULMCA were included. Major cardiovascular events (MACEs, composite of
all-cause death, MI, definite or probable ST, target vessel
revascularization and stroke) were the primary end points, whereas its
single components were the secondary ones, along with stent thrombosis,
graft occlusion and in-hospital death and stroke. Subgroup analyses were
performed according to Syntax score. <br/>RESULT(S): Six RCTs (4717
patients) and 20 observational studies with multivariate adjustment (14
597 patients) were included. After 5 (3-5.5) years, MACE rate was higher
for PCI [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.07-1.14],
without difference in death, whereas more relevant risk of MI was because
of observational studies. Coronary stenting increased risk of
revascularization (OR 1.52; 95% CI 1.34-1.72). At meta-regression,
performance of PCI was improved by use of intra-coronary imaging and
worsened by first generation stents, whereas two arterial grafts increased
benefit of CABG. For patients with Syntax score less than 22, MACE rates
did not differ, whereas for higher values, CABG reduced MACE because of
lower risk of revascularization. Incidence of graft occlusion was 3.24%
(2.25-4.23), whereas 2.13% (1.28-2.98: all CI 95%) of patients experienced
stent thrombosis. <br/>CONCLUSION(S): Surgical revascularization reduces
risk of revascularization for ULMCA patients, especially for those with
Syntax score greater than 22, with a higher risk of in-hospital death.
Intra-coronary imaging and use of arterial grafts improved performance of
revascularization strategies.

<17>
Accession Number
2001458399
Title
Value of the SYNTAX Score in ST-Elevation Myocardial Infarction Patients
With a Concomitant Chronic Total Coronary Occlusion(from the EXPLORE
Trial).
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
van Dongen I.M.; Elias J.; Garcia-Garcia H.M.; Hoebers L.P.; Ouweneel
D.M.; Scheunhage E.M.; Delewi R.; Ramunddal T.; Eriksen E.; Claessen B.E.;
van der Schaaf R.J.; Henriques J.P.S.
Institution
(van Dongen, Elias, Hoebers, Ouweneel, Scheunhage, Delewi, Claessen,
Henriques) Academic Medical Center, Amsterdam, Netherlands
(van Dongen, van der Schaaf) Onze Lieve Vrouwe Gasthuis, Amsterdam,
Netherlands
(Garcia-Garcia) Medstar Washington hospital, Washington, DC, United States
(Ramunddal) Sahlgrenska University Hospital, Gothenburg, Sweden
(Eriksen) Haukeland University Hospital, Bergen, Norway
(Claessen) The Zena and Michael A. Wiener Cardiovascular Institute, the
Icahn School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
'To analyze the impact of additional coronary artery disease, quantified
by the SYNTAX (SYNergy between PCI with TAXus and cardiac surgery) score,
on left ventricular ejection fraction (LVEF) and long-term outcomes in a
cohort of ST-elevated myocardial infarction (STEMI) patients with a
concomitant chronic total coronary occlusion (CTO). A total of 302 STEMI
patients were randomized to percutaneous coronary intervention of a CTO
(CTO PCI) (n = 148) or conservative CTO treatment (n = 154). SYNTAX scores
were calculated by an independent corelab (Cardialysis BV, Rotterdam) at
two time-points: (1) at baseline, and (2) after primary PCI in the
conservative CTO arm and after CTO PCI in the invasive arm (named
'discharge SYNTAX score'). The population was divided in two groups (below
or equal to the median SYNTAX score preprimary PCI, or above the median).
At 4-month follow-up, the LVEF was significantly lower in patients in the
group with a SYNTAX score above the group median (42.8% vs 48.5%, p =
0.001), and the SYNTAX score was an independent predictor for LVEF at 4
months (beta-0.151 (SE 0.068), p = 0.028). In the group with a SYNTAX
score above the group median the mortality rate was higher (10.1% vs 3.9%,
p = 0.025), and there was a trend towards a higher MACE rate (15.4% vs
8.5%, p = 0.063). In conclusion, in this sub-analysis of the EXPLORE trial
we observed a worse LVEF and a higher mortality rate for patients with a
SYNTAX score above the median. We found that the SYNTAX score is an
independent negative predictor for LVEF and an independent positive
predictor for LVEDV at 4-month follow-up.<br/>Copyright &#xa9; 2019

<18>
Accession Number
2001457854
Title
Intraoperative Use of Nondepolarizing Neuromuscular Blocking Agents During
Cardiac Surgery and Postoperative Pulmonary Complications: A Prospective
Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Gerlach R.M.; Shahul S.; Wroblewski K.E.; Cotter E.K.H.; Perkins B.W.;
Harrison J.-H.; Ota T.; Jeevanandam V.; Chaney M.A.
Institution
(Gerlach, Shahul, Perkins, Harrison, Chaney) Department of Anesthesia and
Critical Care, University of Chicago Medicine, Chicago, IL, United States
(Wroblewski) Department of Public Health Sciences, University of Chicago,
Chicago, IL, United States
(Cotter) Department of Anesthesiology, University of Kansas Medical
Center, Kansas City, KS, United States
(Ota, Jeevanandam) Department of Cardiothoracic Surgery, University of
Chicago Medicine, Chicago, IL, United States
Publisher
W.B. Saunders
Abstract
Objective: Nondepolarizing neuromuscular blocking agents (NMBAs) are
associated with perioperative complications in noncardiac surgery;
however, little is known about their effect on cardiac surgery. This study
assessed the effect of neuromuscular blockade (NMB) on the incidence of
postoperative pulmonary complications (PPCs) after cardiac surgery and
operating conditions. <br/>Design(s): Prospective, randomized clinical
trial with blinded outcomes assessment. <br/>Setting(s): University
hospital, single institution. <br/>Participant(s): Adult patients having
cardiac surgery requiring cardiopulmonary bypass. <br/>Intervention(s):
One hundred patients were randomized to receive succinylcholine (group
SUX) for intubation with no further NMB administered or cisatracurium
(group CIS) for intubation and maintenance NMB. The primary outcome was a
composite incidence of PPCs in the 72 hours after elective cardiac
surgery. PPCs included failure to extubate within 24 hours, need for
reintubation, pneumonia, aspiration, unanticipated need for noninvasive
respiratory support, acute respiratory distress, and mortality from
respiratory arrest. The secondary outcome was the adequacy of operating
conditions as assessed by blinded surgeon survey (including a rating of
surgical conditions on a Likert scale from 1 = poor to 5 = excellent),
anesthesiologist report, and patient questionnaire. <br/>Measurements and
Main Results: The composite incidence of PPCs did not differ between
groups (8 of 50 patients in both groups; 16%). Mean surgeon rating of
surgical conditions was lower in the SUX group (4.65 +/- 0.85 v 4.96 +/-
0.20, p = 0.02). <br/>Conclusion(s): Although avoiding nondepolarizing
NMBA is feasible, doing so worsened operating conditions and did not
reduce the incidence of postoperative pulmonary
complications.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<19>
Accession Number
2001457680
Title
Meta-Analysis of the Role of Cangrelor for Patients Undergoing
Percutaneous Coronary Intervention.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Majmundar M.; Kansara T.; Jain A.; Mithawala P.; Desai R.; Shah P.; Doshi
R.
Institution
(Majmundar, Kansara) Department of Internal Medicine, Metropolitan
Hospital Center, New York Medical College, New York, NY, United States
(Jain) Department of Internal Medicine, Saint Luke's Hospital,
Chesterfield, MO, United States
(Shah) Department of Internal Medicine, S.B.K.S. Medical College,
Sumandeep Vidyapeeth University, Vadodara, India
(Mithawala) Department of Pharmacy, Presbyterian College School of
Pharmacy, Clinton, SC, United States
(Desai) Department of Cardiology, Atlanta VA Medical Center, Decatur,
Georgia, Georgia
(Shah) Department of Cardiology, Phoebe Putney Memorial Hospital, Albany,
Georgia, Georgia
(Doshi) Department of Internal Medicine, University of Nevada Reno School
of Medicine, Reno, NV, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Inhibition of the P2Y12 receptor by an oral P2Y12 inhibitor with loading
doses along with Cyclooxygenase-1 inhibition by aspirin is considered a
first-line treatment strategy in patients with the acute coronary syndrome
and patients undergoing percutaneous coronary intervention (PCI).
Limitations associated with oral P2Y12 receptor inhibitors include a
requirement for in vivo conversion (thienopyridines), delayed onset of
action, suboptimal inhibition, irreversible inhibition (thienopyridines),
and delayed offset. In the acute setting, therapy with potent platelet
inhibitors that have a fast onset and offset is desirable to attenuate
thrombotic complications. Cangrelor, an intravenous agent, is an adenosine
triphosphate analog, selectively and explicitly blocking P2Y12
receptor-mediated platelet activation. Cangrelor has been studied in a
series of CHAMPION trials. A patient-level, meta-analysis of all 3 phase
III trials (24,910 patients), demonstrated that cangrelor significantly
reduced the rate of the composite outcome of death, myocardial infarction,
ischemia-driven revascularization, or stent thrombosis at 48 hours and 30
days compared with clopidogrel, with no significant increase in major
bleeding. It is approved for clinical use in patients undergoing PCI to
reduce the risk of myocardial infarction, repeat revascularization, and
stent thrombosis in patients who have not been treated with a P2Y12
platelet inhibitor and are not being given a
GPII<inf>b</inf>III<inf>a</inf> inhibitor. In conclusion, patients unable
to take oral medications undergoing emergent/urgent PCI and those who had
recent PCI with drug eluting stent in need for urgent cardiac or
noncardiac surgery are potential candidates for cangrelor.<br/>Copyright
&#xa9; 2019 Elsevier Ltd

<20>
Accession Number
2001457219
Title
Fragility of Red Blood Cells Collected Under Different Conditions With a
Cell Saver Device.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Chung Y.S.; Kim H.R.; Kang H.; Ryu C.; Park B.; Hong J.
Institution
(Chung, Park, Hong) Department of Thoracic and Cardiovascular Surgery,
Chung-Ang University Hospital, Seoul, South Korea
(Kim) Department of Laboratory Medicine, Chung-Ang University Hospital,
Seoul, South Korea
(Kang, Ryu) Department of Anesthesiology and Pain Medicine, Chung-Ang
University Hospital, Seoul, South Korea
Publisher
W.B. Saunders
Abstract
Objective: To quantify the degree of lethal and sublethal damage to red
blood cells (RBCs) by cell saver (CS) processing among different
conditions of shed blood in cardiac surgery. <br/>Design(s): Prospective
randomized, double-blinded, controlled study. <br/>Setting(s): Single
university hospital. <br/>Participant(s): Twenty rabbits were divided
randomly into non-heparinized and heparinized groups. Thereafter, each
group was subdivided into non-gauze and gauze groups based on whether the
blood was collected with gauze and squeezed out. <br/>Intervention(s):
Blood from each group was aspirated directly from the heart and underwent
CS processing. Mechanical fragility index (MFI) and percent hemolysis were
measured pre- and post-CS processing. <br/>Measurements and Main Results:
In RBCs after CS processing, the MFI and percent hemolysis were increased
significantly in both the non-heparinized and heparinized groups compared
to pre-CS processing. The MFI was significantly higher in the heparinized
group than in the non-heparinized group (p = 0.002). However, no
differences in percent hemolysis were detected between groups (p = 0.696).
The MFI and percent hemolysis of the non-gauze and gauze groups did not
differ. <br/>Conclusion(s): This study reports the increase in sublethal
and lethal injuries to RBCs from heparinized and non-heparinized blood
after CS processing. CS-processed heparinized blood contained more
sublethally injured RBCs compared to CS-processed non-heparinized blood.
RBCs collected by squeezing blood-saturated gauze did not exhibit
additional trauma. Further investigation is required to determine the
clinical implications of transfusing rescued but injured RBCs using a
CS.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<21>
Accession Number
624777777
Title
Impact of intravenous exenatide infusion for perioperative blood glucose
control on myocardial ischemia-reperfusion injuries after coronary artery
bypass graft surgery: Sub study of the phase II/III ExSTRESS randomized
trial.
Source
Cardiovascular Diabetology. 17 (1) (no pagination), 2018. Article Number:
140. Date of Publication: 01 Nov 2018.
Author
Besch G.; Perrotti A.; Salomon Du Mont L.; Puyraveau M.; Ben-Said X.;
Baltres M.; Barrucand B.; Flicoteaux G.; Vettoretti L.; Samain E.; Chocron
S.; Pili-Floury S.
Institution
(Besch, Ben-Said, Baltres, Barrucand, Flicoteaux, Vettoretti, Samain,
Pili-Floury) Department of Anesthesiology and Intensive Care Medicine,
University Hospital of Besancon, EA3920, SFR-FED 4234 INSERM, University
of Franche-Comte, 3 bvd Alexander Fleming, Besancon 25000, France
(Perrotti) Department of Cardiothoracic Surgery, University of
Franche-Comte, 3 bvd Alexander Fleming, Besancon 25000, France
(Salomon Du Mont) Department of Vascular Surgery, University Hospital of
Besancon, EA3920, University of Franche-Comte, 3 bvd Alexander Fleming,
Besancon 25000, France
(Puyraveau) Clinical Methodology Center, University Hospital of Besancon,
University of Franche-Comte, 3 bvd Alexander Fleming, Besancon 25000,
France
(Chocron) Department of Cardiothoracic Surgery, University Hospital of
Besancon, EA3920, University of Franche-Comte, 3 bvd Alexander Fleming,
Besancon 25000, France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The aim of the study was to investigate whether intravenous
(iv) infusion of exenatide, a synthetic GLP-1 receptor agonist, could
provide a protective effect against myocardial ischemia-reperfusion injury
after coronary artery bypass graft (CABG) surgery. <br/>Method(s): A sub
study analysis of patients > 18 years admitted for elective CABG and
included in the ExSTRESS trial was conducted. Patients were randomized to
receive either iv exenatide (1-h bolus of 0.05 mug min^-1
followed by a constant infusion of 0.025 mug min^-1) (exenatide
group) or iv insulin therapy (control group) for blood glucose control
(target range 100-139 mg dl^-1) during the first 48 h after
surgical incision. All serum levels of troponin I measured during routine
care in the Cardiac Surgery ICU were recorded. The primary outcome was the
highest value of plasma concentration of troponin I measured between 12
and 24 h after ICU admission. The proportion of patients presenting an
echocardiographic left ventricular ejection fraction (LVEF) > 50% at the
follow-up consultation was compared between the two groups.
<br/>Result(s): Finally, 43 and 49 patients were analyzed in the control
and exenatide groups, respectively {age: 69 [61-76] versus 71 [63-75]
years; baseline LVEF < 50%: 6 (14%) versus 16 (32%) patients; on-pump
surgery: 29 (67%) versus 33 (67%) patients}. The primary outcome did not
significantly differ between the two groups (3.34 [1.06-6.19] mug
l^-1 versus 2.64 [1.29-3.85] mug l^-1 in the control
and exenatide groups, respectively; mean difference (MD) [95% confidence
interval (95% CI)] 0.16 [- 0.25; 0.57], p = 0.54). The highest troponin
value measured during the first 72 h in the ICU was 6.34 [1.36-10.90]
versus 5.04 [2.39-7.18] mug l^-1, in the control and exenatide
groups respectively (MD [95% CI] 0.20 [- 0.22; 0.61], p = 0.39). At the
follow-up consultation, 5 (12%) versus 8 (16%) patients presented a LVEF <
50% in the control and in the exenatide groups respectively (relative risk
[95% CI] 0.68 [0.16; 2.59], p = 0.56). <br/>Conclusion(s): Postoperative
iv exenatide did not provide any additional cardioprotective effect
compared to iv insulin in low-risk patients undergoing scheduled CABG
surgery. Trial registration ClinicalTrials.gov Identifier NCT01969149,
date of registration: January 7th, 2015; EudraCT No. 2009-009254-25 A,
date of registration: January 6th, 2009<br/>Copyright &#xa9; 2018 The
Author(s).

<22>
Accession Number
620608858
Title
Effect of cone reconstruction on right ventricular function in patients
with Ebstein's anomaly: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (2) (pp 301-306),
2018. Date of Publication: 01 Feb 2018.
Author
Li D.; Hirata Y.; Zhou X.; Masuzawa A.; Ono M.; An Q.
Institution
(Li, An) Department of Cardiovascular Surgery, West China Hospital,
Sichuan University, No. 37 Guo Xue Xiang, Sichuan 610041, China
(Li, Hirata, Masuzawa, Ono) Department of Cardiac Surgery, University of
Tokyo, Tokyo, Japan
(Zhou) Evidence-Based Medicine Research Center, School of Basic Medical
Sciences, Jiangxi University of Traditional Chinese Medicine, Jiangxi,
China
Publisher
Oxford University Press
Abstract
OBJECTIVES Cone reconstruction (CR) is a novel technique for surgically
treating the tricuspid valve and right ventricle (RV) in patients with
Ebstein's anomaly. However, precise changes in the RV function after CR
remain unclear. This study aimed to evaluate the RV size and New York
Heart Association (NYHA) functional class by conducting a meta-analysis of
reported data. METHODS The MEDLINE, EMBASE, Cochrane Library and China
National Knowledge Infrastructure databases were searched for relevant
studies. The variables were RV measurements, NYHA functional classes and
tricuspid valve regurgitation grades. A fixed/random effects model was
used to summarize the estimates of mean difference with standard error.
Sensitivity analysis was conducted to ascertain the primary origin of the
heterogeneity. RESULTS Nine studies that involved 210 patients were
included. The results demonstrated that after CR, the functional RV volume
significantly decreased, NYHA functional class improved and tricuspid
valve regurgitation grade decreased. CONCLUSIONS Thus, CR appeared to be a
positive approach for Ebstein's anomaly, with good results being obtained
for the RV size and NYHA functional class. Because some limitations could
not be overcome, studies with more data on RV and longer follow-ups are
required to confirm our study results.<br/>Copyright &#xa9; 2017 The
Author.

<23>
Accession Number
620608825
Title
Sutureless aortic valve replacement versus transcatheter aortic valve
implantation: A meta-analysis of comparative matched studies using
propensity score matching.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (2) (pp 207-209),
2018. Date of Publication: 01 Feb 2018.
Author
Meco M.; Miceli A.; Montisci A.; Donatelli F.; Cirri S.; Ferrarini M.; Lio
A.; Glauber M.
Institution
(Meco) Cardiac Centre, Humanitas Gavazzeni Hospital, Bergamo, Italy
(Miceli, Montisci, Donatelli, Cirri, Ferrarini, Lio, Glauber)
Cardiothoracic Center, Istituto Clinico sant'Ambrogio, Gruppo Ospedaliero
San Donato, Via G. Faravelli 16, Milan 20149, Italy
(Miceli) Department of Clinical Science at South Bristol, University of
Bristol, Bristol, United Kingdom
(Donatelli) Department of Cardiac Surgery, University of Milan, Milan,
Italy
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: The aim of this meta-analysis was to compare outcomes of
patients undergoing transcatheter aortic valve implantation (TAVI) with
those undergoing surgical aortic valve replacement using sutureless
valves. <br/>METHOD(S): A systematic review and meta-analysis in
accordance with the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) statement was performed. <br/>RESULT(S): No
randomized controlled trials were identified. Six comparative studies
using propensity score matching met the inclusion criteria. This
meta-analysis identified 1462 patients in that 731 patients underwent
surgical aortic valve replacement using sutureless valves (SU) and 731
patients underwent a TAVI. The 30-day or in-hospital mortality was lower
in the SU group [odds ratio (OR) 0.54, 95% confidence interval (CI)
0.36-0.80; P = 0.003]. In the TAVI group, the incidence of postoperative
stroke was higher (OR 0.36, 95% CI 0.17-0.79; P = 0.01). The incidence of
moderate or severe paravalvular regurgitation was higher in the TAVI group
(OR 0.22, 95% CI 0.14-0.35; P = 0.001). There were neither differences in
the postoperative renal failure (OR 1.44, 95% CI 0.46-4.58; P = 0.53) nor
in the number of patients requiring postoperative pacemaker implantation
(OR 1.06, 95% CI 0.54-2.08; P = 0.86). Patients in the SU group required
more transfusions (OR 4.47, 95% CI 2.77-7.21; P = 0.0001), whereas those
in the TAVI group had higher major vascular complications (OR 0.06, 95% CI
0.01-0.25; P = 0.0001). Intensive care unit stay was not different (mean
difference 0.99, 95% CI-1.22 to 1.40; P = 0.53). One-year survival was
better in the SU group (Peto OR 0.35, 95% CI 0.18-0.67; P = 0.001), as was
the 2-year survival (Peto OR 0.38, 95% CI 0.17-0.86; P = 0.001).
<br/>CONCLUSION(S): Surgical aortic valve replacement using sutureless
valves is associated with better early and mid-term outcomes compared with
TAVI in high-or intermediate-risk patients.<br/>Copyright &#xa9; 2017 The
Author.

<24>
Accession Number
2001266142
Title
Randomised trial comparing forced-air warming to the upper or lower body
to prevent hypothermia during thoracoscopic surgery in the lateral
decubitus position.
Source
British Journal of Anaesthesia. 120 (3) (pp 555-562), 2018. Date of
Publication: March 2018.
Author
Min S.-H.; Yoon S.; Yoon S.-H.; Bahk J.-H.; Seo J.-H.
Institution
(Min, Yoon, Yoon, Bahk, Seo) Department of Anaesthesiology and Pain
Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu,
Seoul 03080, South Korea
Publisher
Elsevier Ltd
Abstract
Background: In the supine position, forced-air warming is more effective
on the lower body than on the upper body to prevent intraoperative
hypothermia. However, it is unknown in the lateral decubitus position. We
thus compared forced-air warming on the upper and lower bodies in the
lateral position. <br/>Method(s): Patients (n=123) were randomised to
receive forced-air warming on the upper body or lower body during
thoracoscopic surgery in the lateral position. We measured the
nasopharyngeal temperature at 0, 30, 60, 90, and 120 min after lateral
positioning during surgery and the infrared tympanic membrane temperature
at 0, 30, 60, 90, and 120 min after surgery. Patients received both upper
and lower body warming at a temperature of <35.5degreeC. The primary
outcome was the incidence of intraoperative hypothermia with a temperature
of <36.0degreeC. <br/>Result(s): Intraoperative hypothermia was less
frequent with the upper body warming than with the lower body warming
{21/62 vs 35/61, risk ratio [95% confidence interval (CI)] 0.6 (0.4-0.9),
P=0.011}. The intraoperative temperature was higher with the upper body
warming than with the lower body warming at 30 (P=0.002), 60 (P<0.001),
and 90 (P<0.001) min after lateral positioning, and the postoperative
temperature was higher at 0 (P<0.001) and 30 (P=0.001) min after surgery.
Fewer patients received both upper and lower body warming in the upper
body warming group than in the lower body warming group during surgery (1
vs 7, P=0.032). <br/>Conclusion(s): Forced-air warming was more effective
on the upper body than on the lower body to prevent hypothermia during
thoracoscopic surgery in the lateral decubitus position. Clinical trial
registration: NCT02993666.<br/>Copyright &#xa9; 2017 British Journal of
Anaesthesia

<25>
Accession Number
624465199
Title
Surgical ablation of atrial fibrillation: A systematic review
andmeta-analysis of randomized controlled trials.
Source
Europace. 20 (9) (pp 1442-1450), 2018. Date of Publication: 2018.
Author
McClure G.R.; Belley-Cote E.P.; Jaffer I.H.; Dvirnik N.; An K.R.; Fortin
G.; Spence J.; Healey J.; Singal R.K.; Whitlock R.P.
Institution
(McClure, An) Michael G. DeGroote School of Medicine, McMaster University,
1280 Main St W, Hamilton, ON L8S 4L8, Canada
(McClure, Belley-Cote, Dvirnik, Spence, Whitlock) Department of Clinical
Epidemiology and Biostatistics, McMaster University, 1280 Main St W,
Hamilton, ON L8S 4L8, Canada
(Belley-Cote, Healey) Department of Medicine, McMaster University, 1280
Main St W, Hamilton, ON L8S 4L8, Canada
(Belley-Cote, Dvirnik, Healey, Whitlock) Population Health Research
Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
(Belley-Cote, Fortin) Department of Medicine, Universite de Sherbrooke,
2500 Boulevard de l'Universite, Sherbrooke, QC J1K 2R1, Canada
(Jaffer) Thrombosis and Atherosclerosis Research Institute (TaARI),
McMaster University, 20 Copeland Ave, Hamilton, ON L8L 2X2, Canada
(Jaffer, Dvirnik, Whitlock) Department of Cardiac Surgery, McMaster
University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
(Spence) Department of Anesthesia, McMaster University, 1280 Main St W,
Hamilton, ON L8S 4L8, Canada
(Singal) Department of Surgery, University of Manitoba, 66 Chancellors
Cir, Winnipeg, MB R3T 2N2, Canada
(Singal) I.H. Asper Clinical Research Institute, St. Boniface General
Hospital, 69 Tache Avenue, Winnipeg, MB R2H 2A6, Canada
Publisher
Oxford University Press
Abstract
Aims: The aim of this review was to assess the effect of concomitant
surgical atrial fibrillation (AF) ablation on postoperative freedom from
AF and patient-important outcomes. <br/>Methods and Results: We searched
Cochrane CENTRAL, MEDLINE, and EMBASE databases from inception to May 2016
for randomized controlled trials (RCTs) evaluating surgical AF ablation
using any lesion set vs. no surgical AF ablation in adults with AF
undergoing cardiac surgery. We performed screening, risk-of-bias
evaluation, and data collection independently and in duplicate. We
evaluated risk of bias with the modified Cochrane tool, quality of
evidence using GRADE framework, and pooled data with a random-effects
model. Of the 23 included studies, only one was considered at low risk of
bias. Surgical AF ablation was associated with more freedom from AF at 12
months [relative risk (RR) = 2.32, 95% confidence interval (CI) 1.92-2.80;
P < 0.001, low quality]. However, no significant difference was seen in
mortality (RR = 1.07, 95% CI 0.72-1.52; P = 0.41, moderate quality),
stroke (RR = 1.19, 95% CI 0.59-2.39; P = 0.63, moderate quality), or
pacemaker implantation (RR = 1.28, 95% CI 0.85-1.95; P = 0.24, high
quality). Comparing biatrial and left-sided lesion sets showed no
difference in mortality (P-interaction = 0.60) or stroke (Pinteraction =
0.12). At 12 months, biatrial procedures led to more freedom from AF (RR =
2.80, 95% CI 2.13-3.68; P < 0.0001) when compared with left-sided ablation
(RR = 2.00, 95% CI 1.68-2.39; P < 0.0001) (P-interaction = 0.04) Biatrial
procedures appear to increase the risk for pacemaker (RR = 2.68, 95% CI
1.41-5.11; P = 0.002) compared with no ablation while left-sided ablation
does not (RR = 1.08, 95% CI 0.67-1.74; P = 0.76) (P-interaction = 0.03).
<br/>Conclusion(s): Surgical AF ablation during cardiac surgery improves
freedom from AF. However, impact on patient-important outcomes including
mortality and stroke has not shown statistical significance in current RCT
evidence. Biatrial compared with left-sided lesion sets showed no
difference in mortality or stroke but were associated with significantly
increased freedom from AF and risk for pacemaker
requirement.<br/>Copyright &#xa9; 2017 The Author(s).

<26>
Accession Number
621726140
Title
Systematic review of the cost-effectiveness of transcatheter interventions
for valvular heart disease.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 4 (2) (pp
81-90), 2018. Date of Publication: 01 Apr 2018.
Author
Gialama F.; Prezerakos P.; Apostolopoulos V.; Maniadakis N.
Institution
(Gialama, Maniadakis) Department of Health Services Management, National
School of Public Health, 196 Alexandras Avenue, Athens 115 21, Greece
(Prezerakos) Department of Nursing Studies, University of Peloponnese,
Efstathiou and Stamatikis Valioti and Plateon, Sparti 23100, Greece
(Apostolopoulos) Administration, Athens Medical Group, Filadelfeos and
Kefalariou 1, Square Kefalariou, Kifisia, Athens 14562, Greece
Publisher
Oxford University Press
Abstract
Transcatheter aortic valve implantation (TAVI) and transcatheter mitral
valve repair (TMVR) are increasingly used for managing patients with
valvular heart disease to whom surgery presents a high-risk. As these are
costly procedures, a systematic review of studies concerned with their
economic assessment was undertaken. The search was performed in PubMed and
the Cochrane Library and followed recommended methodological steps.
Studies were screened and their data were retrieved and were synthesized
using a narrative approach. Twenty-four, good to high quality, evaluations
were identified, representing different viewpoints, modelling techniques
and willingness-topay thresholds. Studies show that in high-risk patients
with symptomatic aortic stenosis, TAVI may be cost-effective compared with
medical management (MM) across many health care settings. In contrast,
studies of TAVI compared with surgical aortic valve replacement (SAVR)
yield conflicting and inconclusive results. The limited data available
show that TMVR may also be cost-effective relative to MM in mitral valve
disease. Existing evidence indicates that transcatheter techniques may be
cost-effective options, relative to MM, in high-risk patients with
valvular disease. Nonetheless, more research is needed to establish their
economic value further, to investigate the drives of cost-effectiveness,
and to evaluate surgical with transcatheter techniques in aortic valvular
disease.<br/>Copyright &#xa9; 2018 The Author(s). Published on behalf of
the European Society of Cardiology. All rights reserved.

<27>
Accession Number
625880483
Title
The role of desmopressin as a blood conservation agent in select patients
undergoing cardiac surgery.
Source
JACCP Journal of the American College of Clinical Pharmacy. Conference:
2018 ACCP Global Conference on Clinical Pharmacy. United States. 1 (2) (pp
140), 2018. Date of Publication: December 2018.
Author
Moose E.; Tatum E.
Institution
(Moose, Tatum) Department of Pharmacy, Novant Health Forsyth Medical
Center, Winston-Salem, NC, United States
Publisher
Wiley-Blackwell Publishing Ltd
Abstract
INTRODUCTION: Blood conservation strategies are implemented during cardiac
surgery to decrease the potential short-term and long-term complications
associated with blood transfusions. RESEARCH QUESTION OR HYPOTHESIS: The
objective of this study was to determine if there was a difference in
transfusion requirements and Factor VIIa use between patients that receive
des-mopressin (DDAVP) and those that do not, that undergo cardiac surgery
for aortic stenosis. STUDY DESIGN: Single-center, retrospective study
approved by the Institutional Review Board. <br/>METHOD(S): Adult patients
undergoing cardiac surgery for aortic stenosis between June 1, 2016 and
August 31, 2017 were included in the study. Patients were excluded for
uremia, the presence of von Willebrand disease or hemophilia A, existing
or prior history of hyponatremia, contraindication or hypersensitivity to
DDAVP, or if anticoagulation or antiplatelet therapies were not held
appropriately prior to surgery. The treatment group received DDAVP 0.3
mcg/kg intravenously post-bypass during protamine administration. The
control group did not receive DDAVP and were randomized based on
cardiothoracic surgeon. In both arms, rates of acute renal failure,
hyponatremia, transfusion requirements, and recombi-nant factor VIIa use
were evaluated postoperatively. <br/>RESULT(S): A total of 59 patients
were included in the final analysis. The primary endpoint showed less
transfusion requirements 6 hours after surgery, 5 patients (19%) in the
DDAVP group and 12 patients (37%) in the control group (P=0.0896). There
was no difference in factor VIIa use, the rates of renal failure, and
hyponatremia between the groups. <br/>CONCLUSION(S): The current body of
literature regarding the use of desmopressin in cardiac surgery is very
limited. DDAVP may have a role in cardiac surgery in patients with aortic
stenosis, but additional research is needed for validation.

<28>
Accession Number
625880469
Title
Impact of postoperative acupuncture on pain, nausea, mood, and medical
outcomes in patients undergoing valve surgery: Design and lessons learned
from the ACU-heart pilot trial.
Source
Global Advances in Health and Medicine. Conference: International Congress
on Integrative Medicine and Health, ICIMH 2018. United States. 7 (pp 143),
2018. Date of Publication: January-December 2018.
Author
Ring M.; Grimone A.; Feingold K.; Moskowitz J.T.; Lin F.; Shafiro T.;
McCarthy P.; Patel R.; Davidson C.
Institution
(Ring) Osher Collaborative for Integrative Medicine, Chicago, IL, United
States
(Grimone, Feingold, Moskowitz, Lin, Shafiro, McCarthy, Patel, Davidson)
ChicagoILUnited States
Publisher
SAGE Publications Ltd
Abstract
Purpose: In addition to pain, nausea, depression, and anxiety,
postoperative atrial fibrillation is a common complication after cardiac
surgery. ACU-Heart is a randomized controlled pilot trial evaluating daily
postoperative acupuncture among patients undergoing valve surgery.
<br/>Result(s): ACU-Heart enrollment and intervention are ongoing (N=70 of
100). The acupuncturists have been successfully trained in delivering
treatment within the restrictions of the intensive care environment as
well as the need to adhere to the research protocol. Factors that
facilitate delivery of daily acupuncture include advanced scheduling and
coordination with nursing staff. Retention has been high, with minimal
refusals for daily acupuncture sessions. Days of floor transfer and
discharge can be more difficult to provide acupuncture given increased
demands on the patient. Patients are eager to be randomized to acupuncture
and have welcomed the sessions to date. Several patients noted that the
acupuncture was the highlight of the hospitalization and surgeons have
received positive feedback from patients. <br/>Conclusion(s): This ongoing
randomized trial is the first to assess the feasibility and acceptability
of delivering daily acupuncture in the hospital setting after open heart
surgery. To date, postoperative acupuncture is proving to be both feasible
and accepted in the hospital setting, including in cardiac intensive care
as early as POD1.

<29>
Accession Number
625877313
Title
Hybrid Minimally Invasive Esophagectomy for Esophageal Cancer.
Source
The New England journal of medicine. 380 (2) (pp 152-162), 2019. Date of
Publication: 10 Jan 2019.
Author
Mariette C.; Markar S.R.; Dabakuyo-Yonli T.S.; Meunier B.; Pezet D.;
Collet D.; D'Journo X.B.; Brigand C.; Perniceni T.; Carrere N.; Mabrut
J.-Y.; Msika S.; Peschaud F.; Prudhomme M.; Bonnetain F.; Piessen G.
Institution
(Mariette, Markar, Dabakuyo-Yonli, Meunier, Pezet, Collet, D'Journo,
Brigand, Perniceni, Carrere, Mabrut, Msika, Peschaud, Prudhomme,
Bonnetain, Piessen) From the Department of Digestive and Oncologic
Surgery, Claude Huriez University Hospital, and INSERM, Centre Hospitalier
Universitaire (CHU) Lille, Unite Mixte de Recherche 1172-JPARC Jean-Pierre
Aubert Research Center, Team "Mucins, epithelial differentiation, and
carcinogenesis," Universite de Lille, Lille (C.M., G.P.), the Epidemiology
and Quality of Life Unit, INSERM Unite 1231, Centre Georges Francois
Leclerc, Dijon (T.S.D.-Y.), the Department of Hepatobiliary and Digestive
Surgery, CHU Rennes, University of Rennes 1, Rennes (B.M.), Universite
Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie
Digestive, Clermont-Ferrand (D.P.), the Department of Digestive Surgery,
Haut Leveque University Hospital, Bordeaux (D.C.), the Department of
Thoracic Surgery, Hopital Nord, Aix-Marseille Universite, Assistance
Publique-Hopitaux de Marseille, Marseille (X.B.D.), the Department of
Digestive Surgery, Strasbourg University, Strasbourg (C.B.), the
Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris
(T.P.), the Department of Digestive Surgery, Purpan Hospital, CHU
Toulouse, Universite Toulouse III, Toulouse (N.C.), the Department of
General Surgery and Liver Transplantation, Hopital de la Croix-Rousse,
Hospices Civils de Lyon, Equipe Mixte de Recherche 3738, Universite Lyon
1, Lyon (J.-Y.M.), the Department of Digestive and General Surgery, CHU
Louis Mourier, Assistance Publique-Hopitaux de Paris (AP-HP), Universite
Paris 7, Denis Diderot, PRES Sorbonne Paris Cite, Colombes (S.M.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative complications, especially pulmonary
complications, affect more than half the patients who undergo open
esophagectomy for esophageal cancer. Whether hybrid minimally invasive
esophagectomy results in lower morbidity than open esophagectomy is
unclear. <br/>METHOD(S): We performed a multicenter, open-label,
randomized, controlled trial involving patients 18 to 75 years of age with
resectable cancer of the middle or lower third of the esophagus. Patients
were randomly assigned to undergo transthoracic open esophagectomy (open
procedure) or hybrid minimally invasive esophagectomy (hybrid procedure).
Surgical quality assurance was implemented by the credentialing of
surgeons, standardization of technique, and monitoring of performance.
Hybrid surgery comprised a two-field abdominal-thoracic operation (also
called an Ivor-Lewis procedure) with laparoscopic gastric mobilization and
open right thoracotomy. The primary end point was intraoperative or
postoperative complication of grade II or higher according to the
Clavien-Dindo classification (indicating major complication leading to
intervention) within 30 days. Analyses were done according to the
intention-to-treat principle. <br/>RESULT(S): From October 2009 through
April 2012, we randomly assigned 103 patients to the hybrid-procedure
group and 104 to the open-procedure group. A total of 312 serious adverse
events were recorded in 110 patients. A total of 37 patients (36%) in the
hybrid-procedure group had a major intraoperative or postoperative
complication, as compared with 67 (64%) in the open-procedure group (odds
ratio, 0.31; 95% confidence interval [CI], 0.18 to 0.55; P<0.001). A total
of 18 of 102 patients (18%) in the hybrid-procedure group had a major
pulmonary complication, as compared with 31 of 103 (30%) in the
open-procedure group. At 3 years, overall survival was 67% (95% CI, 57 to
75) in the hybrid-procedure group, as compared with 55% (95% CI, 45 to 64)
in the open-procedure group; disease-free survival was 57% (95% CI, 47 to
66) and 48% (95% CI, 38 to 57), respectively. <br/>CONCLUSION(S): We found
that hybrid minimally invasive esophagectomy resulted in a lower incidence
of intraoperative and postoperative major complications, specifically
pulmonary complications, than open esophagectomy, without compromising
overall and disease-free survival over a period of 3 years. (Funded by the
French National Cancer Institute; ClinicalTrials.gov number, NCT00937456
.).

<30>
Accession Number
625878390
Title
Randomized Trial of Endoscopic or Open Vein-Graft Harvesting for
Coronary-Artery Bypass.
Source
The New England journal of medicine. 380 (2) (pp 132-141), 2019. Date of
Publication: 10 Jan 2019.
Author
Zenati M.A.; Bhatt D.L.; Bakaeen F.G.; Stock E.M.; Biswas K.; Gaziano
J.M.; Kelly R.F.; Tseng E.E.; Bitondo J.; Quin J.A.; Almassi G.H.; Haime
M.; Hattler B.; DeMatt E.; Scrymgeour A.; Huang G.D.
Institution
(Zenati, Bhatt, Bakaeen, Stock, Biswas, Gaziano, Kelly, Tseng, Bitondo,
Quin, Almassi, Haime, Hattler, DeMatt, Scrymgeour, Huang) From the
Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology
(D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and
Harvard Medical School, the Department of Surgery, Brigham and Women's
Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and
Women's Hospital Heart and Vascular Center and Harvard Medical School
(D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the
Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular
Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh
Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program
Coordinating Center, Office of Research and Development, Department of
Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA
Medical Center and University of Minnesota, Minneapolis (R.F.K.); San
Francisco VA Medical Center and University of California, San Francisco,
San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of
Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System,
Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating
Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the
Cooperative Studies Program Central Office, Office of Research and
Development, Department of Veterans Affairs, Washington, DC (G.D.H.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: The saphenous-vein graft is the most common conduit for
coronary-artery bypass grafting (CABG). The influence of the vein-graft
harvesting technique on long-term clinical outcomes has not been well
characterized. <br/>METHOD(S): We randomly assigned patients undergoing
CABG at 16 Veterans Affairs cardiac surgery centers to either open or
endoscopic vein-graft harvesting. The primary outcome was a composite of
major adverse cardiac events, including death from any cause, nonfatal
myocardial infarction, and repeat revascularization. Leg-wound
complications were also evaluated. <br/>RESULT(S): A total of 1150
patients underwent randomization. Over a median follow-up of 2.78 years,
the primary outcome occurred in 89 patients (15.5%) in the open-harvest
group and 80 patients (13.9%) in the endoscopic-harvest group (hazard
ratio, 1.12; 95% confidence interval [CI], 0.83 to 1.51; P=0.47). A total
of 46 patients (8.0%) in the open-harvest group and 37 patients (6.4%) in
the endoscopic-harvest group died (hazard ratio, 1.25; 95% CI, 0.81 to
1.92); myocardial infarctions occurred in 34 patients (5.9%) in the
open-harvest group and 27 patients (4.7%) in the endoscopic-harvest group
(hazard ratio, 1.27; 95% CI, 0.77 to 2.11), and revascularization occurred
in 35 patients (6.1%) in the open-harvest group and 31 patients (5.4%) in
the endoscopic-harvest group (hazard ratio, 1.14; 95% CI, 0.70 to 1.85).
Leg-wound infections occurred in 18 patients (3.1%) in the open-harvest
group and in 8 patients (1.4%) in the endoscopic-harvest group (relative
risk, 2.26; 95% CI, 0.99 to 5.15). <br/>CONCLUSION(S): Among patients
undergoing CABG, we did not find a significant difference between open
vein-graft harvesting and endoscopic vein-graft harvesting in the risk of
major adverse cardiac events. (Funded by the Cooperative Studies Program,
Office of Research and Development, Department of Veterans Affairs;
REGROUP ClinicalTrials.gov number, NCT01850082 .).

<31>
Accession Number
619944059
Title
Potentially Modifiable Risk Factors for Long-Term Cognitive Impairment
After Critical Illness: A Systematic Review.
Source
Mayo Clinic Proceedings. 93 (1) (pp 68-82), 2018. Date of Publication:
January 2018.
Author
Sakusic A.; O'Horo J.C.; Dziadzko M.; Volha D.; Ali R.; Singh T.D.;
Kashyap R.; Farrell A.M.; Fryer J.D.; Petersen R.; Gajic O.; Rabinstein
A.A.
Institution
(Sakusic) Department of Physiology, Faculty of Medicine, University of
Tuzla, Tuzla, Bosnia and Herzegovina
(Sakusic) University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
(Sakusic, O'Horo, Volha, Ali, Singh, Kashyap, Gajic, Rabinstein)
Multidisciplinary Epidemiology and Translational Research in Intensive
Care (METRIC), Emergency and Perioperative Medicine, Mayo Clinic,
Rochester, MN, United States
(O'Horo) Division of Infectious Diseases, Department of Medicine, Mayo
Clinic, Rochester, MN, United States
(Gajic) Division of Pulmonary and Critical Care Medicine, Department of
Medicine, Mayo Clinic, Rochester, MN, United States
(Dziadzko, Kashyap) Department of Anesthesiology, Mayo Clinic, Rochester,
MN, United States
(Singh, Petersen, Rabinstein) Department of Neurology, Mayo Clinic,
Rochester, MN, United States
(Dziadzko) Department of Anesthesiology, CHU Croix Rousse, Lyon, France
(Fryer) Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United
States
(Farrell) Mayo Clinic Libraries, Rochester, MN, United States
Publisher
Elsevier Ltd
Abstract
Long-term cognitive impairment is common in survivors of critical illness.
Little is known about the etiology of this serious complication. We sought
to summarize current scientific knowledge about potentially modifiable
risk factors during intensive care unit (ICU) treatment that may play a
substantial role in the development of long-term cognitive impairment. All
searches were run on October 1, 2017. The search strategy included Ovid
MEDLINE, Ovid Embase, Ovid CDR, Cochrane Central Register of Controlled
Trials and Database of Abstracts of Reviews of Effect, Scopus, and Web of
Science, and included MeSH headings and keywords related to intensive
care, critical care, and cognitive disorders. Searches were restricted to
adult subjects. Inclusion required follow-up cognitive evaluation at least
2 months after ICU discharge. Studies assessing patients with cardiac
arrest, traumatic brain injury, and cardiac surgery history were excluded.
The search strategy resulted in 3180 studies. Of these, 28 studies (.88%)
met our inclusion criteria and were analyzed. Delirium and duration of
delirium were associated with long-term cognitive impairment after ICU
admission in 6 of 9 studies in which this factor was analyzed. Weaker and
more inconsistent associations have been reported with hypoglycemia,
hyperglycemia, fluctuations in serum glucose levels, and in-hospital acute
stress symptoms. Instead, most of the studies did not find significant
associations between long-term cognitive impairment and mechanical
ventilation; use of sedatives, vasopressors, or analgesic medications;
enteral feeding; hypoxia; extracorporeal membrane oxygenation; systolic
blood pressure; pulse rate; or length of ICU stay. Prolonged delirium may
be a risk factor for long-term cognitive impairment after critical
illness, though this association has not been entirely consistent across
studies. Other potentially preventable factors have not been shown to have
strong or consistent associations with long-term cognitive dysfunction in
survivors of critical illness.<br/>Copyright &#xa9; 2017 Mayo Foundation
for Medical Education and Research

<32>
Accession Number
620255431
Title
Peri-operative chest physiotherapy for paediatric cardiac patients: a
systematic review and meta-analysis.
Source
Physiotherapy (United Kingdom). 104 (3) (pp 251-263), 2018. Date of
Publication: September 2018.
Author
Beningfield A.; Jones A.
Institution
(Beningfield, Jones) Discipline of Physiotherapy, College of Healthcare
Sciences, James Cook University, Townsville, Australia
Publisher
Elsevier Ltd
Abstract
Background: Chest physiotherapy (CPT) is implemented before and after
congenital heart disease (CHD) surgery in paediatrics to prevent and treat
postoperative pulmonary complications (PPC). Currently, there are no
systematic reviews or meta-analyses on the efficacy of CPT in this
population. <br/>Objective(s): To conduct a systematic review and
meta-analysis to determine whether peri-operative CPT is safe and
effective for paediatric patients with CHD. Data sources: A literature
search was conducted on PEDro, MEDLINE, CINAHL, Informit, The Cochrane
Library and Scopus in March and April 2016. Eligibility criteria: English
peer-reviewed articles that utilised CPT before or after cardiac surgery
for paediatric CHD. Systematic reviews were excluded. Data extraction and
synthesis: Completed by two independent researchers using the Crowe
Critical Appraisal Tool. Data were collated using a piloted data
extraction tool. Mix Version 2.0.1.4 was used for meta-analysis, and data
were extracted using an odds ratio (with a random effects model).
<br/>Result(s): Eleven studies met the inclusion criteria for the
systematic review. Variable results were found regarding the effect of CPT
on peripheral oxygen saturation and pain. Meta-analysis showed that CPT
did not prevent pneumonia (odds ratio (OR) 2.01; 95% confidence interval
(CI) 0.80 to 5.05; P = 0.13), and did not prevent or treat atelectasis (OR
1.27; 95% CI 0.18 to 8.87; P = 0.81). <br/>Limitation(s): There was a lack
of high-quality studies. The included studies were comprised of
heterogeneous treatment, limiting external validity. <br/>Conclusion(s):
Active therapies such as mobilisation, deep breathing and incentive
spirometry were more effective than passive treatment. Percussion led to
oxygen desaturation, and percussion, vibration and suctioning increased
the risk of developing atelectasis. Systematic review registration number
CRD42015024768.<br/>Copyright &#xa9; 2017 Chartered Society of
Physiotherapy

<33>
Accession Number
625730707
Title
Patients' preferences for coronary revascularization: A systematic review.
Source
Patient Preference and Adherence. 13 (pp 29-35), 2019. Date of
Publication: 2019.
Author
Magliano C.A.S.; Monteiro A.L.; Rebelo A.R.O.; Pereira C.C.A.
Institution
(Magliano, Rebelo) Instituto Nacional de Cardiologia, INC, Rio de Janeiro,
Brazil
(Monteiro) Department of Pharmacy Systems, Outcomes and Policy, College of
Pharmacy, University of Illinois at Chicago, IL, United States
(Pereira) Escola Nacional de Saude Publica, ENSP, FIOCRUZ, Rio de Janeiro,
Brazil
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Aims: Current recommendations regarding the best treatment option for
coronary revascularization are usually based on composite outcomes that
were not selected or weighed with patients thence they may fail in
representing patients' preferences adequately. This systematic review
aimed to appraise existing literature surrounding stated preference (SP)
regarding coronary revascularization. <br/>Methods and Results: Studies
related to SP regarding coronary revascularization were searched on
Medline, Embase and Lilacs databases. Two reviewers screened all titles
independently, and consensus resolved any disagreements. Of 735 total
citations, six studies were included and qualitatively synthesized.
Notably, the attributes most often cited in these studies coincided with
those already used in clinical trials (death, myocardial infarction,
stroke and redo revascularization). Half of the studies analyzed the use
of composite endpoints and showed the necessity to review this practice
since the attributes are weighed differently, and there is a disagreement
between patients and physicians. Also, a large variety of methods were
used to elicitate and value the attributes such as rating, ranking,
standard gamble, willingness to pay, and discrete choice experiments.
<br/>Conclusion(s): Despite a large number of studies comparing
revascularization treatment efficacy, there are just a few focusing on
patients' preferences. The selection of outcomes to be considered in the
trade-off between treatment options and how to weigh them properly, taking
into consideration patients' preferences, need to be explored in future
trials.<br/>Copyright &#xa9; 2019 Magliano et al.

<34>
[Use Link to view the full text]
Accession Number
2001072974
Title
Impact of Isolyte Versus 0.9% Saline on Postoperative Event of Acute
Kidney Injury Assayed by Urinary [TIMP-2]x[IGFBP7] in Patients Undergoing
Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (2) (pp 348-356),
2019. Date of Publication: February 2019.
Author
Lee N.M.; Deriy L.; Petersen T.R.; Shah V.O.; Hutchens M.P.; Gerstein N.S.
Institution
(Lee, Deriy, Petersen, Gerstein) Department of Anesthesiology and Critical
Care Medicine, University of New Mexico School of Medicine, Albuquerque,
N, United States
(Shah) Department of Internal Medicine, Division of Nephrology, University
of New Mexico School of Medicine, Albuquerque, NM, United States
(Hutchens) Department of Anesthesiology and Perioperative Medicine, Oregon
Health & Science University, Portland, OR, United States
Publisher
W.B. Saunders
Abstract
Objective: Administration of excess chloride in 0.9% normal saline (NS)
decreases renal perfusion and glomerular filtration rate, thereby
increasing the risk for acute kidney injury (AKI). In this study, the
effect of NS versus Isolyte use during cardiac surgery on urinary levels
of tissue inhibitor of metalloproteinase 2 and insulin-like growth
factor-binding protein 7 [TIMP-2] x [IGFBP7] and postoperative risk of AKI
were examined. <br/>Design(s): Prospective, randomized, and single-blinded
trial. <br/>Setting(s): Single university medical center.
<br/>Participant(s): Thirty patients over 18 years without chronic renal
insufficiency or recent AKI undergoing elective cardiac surgery.
<br/>Intervention(s): Subjects were randomized to receive either NS or
Isolyte during the intraoperative period. <br/>Measurements and Main
Results: The primary outcome was the change in urinary levels of [TIMP2] x
[IGFBP7] from before surgery to 24 hours postoperatively. Secondary
outcomes included serum creatinine pre- and postoperatively at 24 and 48
hours, serum chloride pre- and postoperatively at 24 and 48 hours, need
for dialysis prior to discharge, and arterial pH measured 24 hours
postoperatively. Sixteen patients received NS and 14 patients received
Isolyte. Three patients developed AKI within the first 3 postoperative
days, all in the NS group. The authors found increases in [TIMP-2] x
[IGFBP7] in both groups. However, the difference in this increase between
study arms was not significant (p = 0.92; -0.097 to 0.107).
<br/>Conclusion(s): The authors observed no change in urinary [TIMP-] x
[IGFBP7] levels in patients receiving NS versus Isolyte during cardiac
surgery. Future larger studies in patients at higher risk for AKI are
recommended to evaluate the impact of high- versus lower-chloride
solutions on the risk of postoperative AKI after cardiac
surgery.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<35>
Accession Number
2000990084
Title
Effect of Dexmedetomidine Infusion on Sublingual Microcirculation in
Patients Undergoing On-Pump Coronary Artery Bypass Graft Surgery: A
Prospective Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (2) (pp 334-340),
2019. Date of Publication: February 2019.
Author
Mohamed H.; Hosny H.; Tawadros, MD P.; Elayashy, MD, DESA, FCAI M.;
El-Ashmawi, MD H.
Institution
(Mohamed, Hosny, Tawadros, MD, Elayashy, MD, DESA, FCAI, El-Ashmawi, MD)
Department of Anesthesia and Intensive Care, Kasr Al-Ainy Faculty of
Medicine, Cairo University, London, United Kingdom
(Hosny) Department of Cardiothoracic Anaesthesia, Royal Brompton Hospital,
Sydney Street, London, United Kingdom
Publisher
W.B. Saunders
Abstract
Objectives: Cardiac surgery is characterized by attenuation of
microcirculatory perfusion. Dexmedetomidine has been proved to attenuate
the microcirculatory derangements evoked by experimental sepsis. The
authors investigated the effects of dexmedetomidine infusion on sublingual
microcirculation in patients undergoing on-pump coronary artery bypass
graft (CABG) surgery. <br/>Design(s): Prospective, randomized blinded
study. <br/>Setting(s): Tertiary university hospital. <br/>Participant(s):
A total of 70 adults undergoing elective on-pump CABG surgery.
<br/>Intervention(s): After a standard general anesthesia, participants
were allocated randomly to receive either propofol continuous intravenous
infusion, 50 to 70 micro&#32;g/kg/min, or propofol infusion, 50 to 70
micro&#32;g/kg/min plus dexmedetomidine infusion, 0.5 micro&#32;g/kg/h,
during cardiopulmonary bypass. Microcirculation was studied with
side-stream dark field imaging at 3 times: immediately before starting
bypass (T0), 30 minutes after initiation of bypass (T1), and 30 minutes
after weaning from bypass (T2). <br/>Measurements and Main Results:
Microvascular flow index was significantly higher in the dexmedetomidine
group at T2 compared to the control group (2.20 +/- 0.29 and 1.47 +/-
0.30, respectively; p = 0.001). The perfused vessel density was
significantly higher in the dexmedetomidine group at T2 compared to the
control group (6.1 [3-8.9] mm/mm2 and 3.3 [2.2-4.3] mm/mm2 respectively; p
= 0.01). The total vascular density was significantly higher in the
dexmedetomidine group compared to the control group at T1 and T2 (9.9
[7.8-12.6] mm/mm2 v 7.4 [6.1-9] mm/mm2 p = 0.005; and 9.27 +/- 2.27 mm/mm2
v 7.24 +/- 1.66 mm/mm2 p = 0.003, respectively). <br/>Conclusion(s): This
trial demonstrated that dexmedetomidine infusion improved sublingual
microcirculation indices in patients undergoing on-pump CABG
surgery.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<36>
Accession Number
2000988720
Title
Double-Blind, Randomized, Placebo-Controlled Trial Comparing the Effects
of Antithrombin Versus Placebo on the Coagulation System in Infants with
Low Antithrombin Undergoing Congenital Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (2) (pp 396-402),
2019. Date of Publication: February 2019.
Author
Jooste E.H.; Scholl R.; Wu Y.-H.; Jaquiss R.D.B.; Lodge A.J.; Ames W.A.;
Homi H.M.; Machovec K.A.; Greene N.H.; Donahue B.S.; Shah N.; Benkwitz C.
Institution
(Jooste, Scholl, Ames, Homi, Machovec, Greene) Pediatric Anesthesiology,
Department of Anesthesiology, Duke University Medical Center, Durham, NC,
United States
(Wu) Department of Biostatistics and Bioinformatics, Duke University
Medical Center, Durham, NC, United States
(Jaquiss) Department of Cardiovascular and Thoracic Surgery, UT
Southwestern Medical Center and Children's Medical Center, Dallas, TX,
United States
(Lodge) Division of Congenital Cardiac Surgery, Department of
Cardiothoracic Surgery, Duke University Medical Center, Durham, United
Kingdom
(Donahue) Division of Pediatric Cardiac Anesthesiology, Monroe Carell Jr
Children's Hospital, Vanderbilt University Medical Center, Nashville, TN,
United States
(Shah) Division of Pediatric Hematology/Oncology, Duke University Medical
Center, Durham, NC, United States
(Benkwitz) Department of Anesthesia and Perioperative Care, UCSF Benioff
Children's Hospital, San Francisco, CA, United States
Publisher
W.B. Saunders
Abstract
Objectives: To determine whether precardiopulmonary bypass (CPB)
normalization of antithrombin levels in infants to 100% improves heparin
sensitivity and anticoagulation during CPB and has beneficial effects into
the postoperative period. <br/>Design(s): Randomized, double-blinded,
placebo-controlled prospective study. <br/>Setting(s): Multicenter study
performed in 2 academic hospitals. <br/>Participant(s): The study
comprised 40 infants younger than 7 months with preoperative antithrombin
levels <70% undergoing CPB surgery. <br/>Intervention(s): Antithrombin
levels were increased with exogenous antithrombin to 100% functional level
intraoperatively before surgical incision. <br/>Measurements and Main
Results: Demographics, clinical variables, and blood samples were
collected up to postoperative day 4. Higher first post-heparin activated
clotting times (sec) were observed in the antithrombin group despite
similar initial heparin dosing. There was an increase in heparin
sensitivity in the antithrombin group. There was significantly lower
24-hour chest tube output (mL/kg) in the antithrombin group and lower
overall blood product unit exposures in the antithrombin group as a whole.
Functional antithrombin levels (%) were significantly higher in the
treatment group versus placebo group until postoperative day 2. D-dimer
was significantly lower in the antithrombin group than in the placebo
group on postoperative day 4. <br/>Conclusion(s): Supplementation of
antithrombin in infants with low antithrombin levels improves heparin
sensitivity and anticoagulation during CPB without increased rates of
bleeding or adverse events. Beneficial effects may be seen into the
postoperative period, reflected by significantly less postoperative
bleeding and exposure to blood products and reduced generation of
D-dimers.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<37>
Accession Number
2001137503
Title
Shifts of Transfusion Demand in Cardiac Surgery After Implementation of
Rotational Thromboelastometry-Guided Transfusion Protocols: Analysis of
the HEROES-CS (HEmostasis Registry of patiEntS in Cardiac Surgery)
Observational, Prospective Open Cohort Database.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (2) (pp 307-317),
2019. Date of Publication: February 2019.
Author
Kuiper G.J.A.J.M.; van Egmond L.T.; Henskens Y.M.C.; Roekaerts P.M.;
Maessen J.G.; ten Cate H.; Buhre W.F.; Lance M.D.
Institution
(Kuiper, Buhre, Lance) Department of Anaesthesiology and Pain Treatment,
Maastricht University Medical Center, Maastricht, Netherlands
(Kuiper, ten Cate) Laboratory for Clinical Thrombosis and Haemostasis,
Department of Internal Medicine, Cardiovascular Research Institute
Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
(van Egmond, Henskens) Central Diagnostic Laboratory, Cluster for
Haemostasis and Transfusion, Maastricht University Medical Center,
Maastricht, Netherlands
(Roekaerts) Department of Intensive Care Medicine, Maastricht University
Medical Center, Maastricht, Netherlands
(Maessen) Department of Cardiothoracic Surgery, Maastricht University
Medical Center, Maastricht, Netherlands
(ten Cate) Department of Internal Medicine, Maastricht University Medical
Center, Maastricht, Netherlands
Publisher
W.B. Saunders
Abstract
Objectives: Rotational thromboelastometry (ROTEM)-guided transfusion
algorithms in cardiac surgery have been proven to be successful in
reducing blood loss in randomized controlled trials. Using an
institutional hemostasis registry of patients in cardiac surgery
(HEROES-CS), the authors hypothesized that the use of ROTEM-guided
transfusion algorithms would save blood products and overall costs in
cardiac surgery in every day practice. <br/>Design(s): Observational,
prospective open cohort database. <br/>Setting(s): Single-center academic
hospital. <br/>Participant(s): Cardiac surgery patients.
<br/>Intervention(s): Implementation of ROTEM-guided bleeding management.
<br/>Measurements and Main Results: A classical-guided algorithm and a
ROTEM-guided algorithm were used for patient blood management in 2
cohorts. Primary outcome was the use and amount of blood products and
hemostatic medication. Secondary outcomes were amount of rethoracotomies,
length of stay, and 30-day mortality. Finally, costs and savings were
calculated. The classical-guided cohort comprised 204 patients, and
ROTEM-guided cohort comprised 151 patients. Baseline characteristics
showed excellent similarities after propensity score matching of 202
patients. Blood loss was lower after ROTEM guidance (p < 0.001). Absolute
risk reduction was 17% for red blood cells (p = 0.024), 12% for fresh
frozen plasma (p = 0.019), and 4% for thrombocyte concentrates (p =
0.582). More tranexamic acid was given, but not more fibrinogen
concentrate, while desmopressin was given less often. Hospital length of
stay was reduced by an overall median of 2 and a mean of 4 days (p <
0.001). Mortality and rethoracotomy rates were not affected. Potential
savings were about 4,800 ($5,630) per patient. <br/>Conclusion(s):
Implementation of a ROTEM-guided transfusion algorithm in cardiac surgery
patients reduced the use of blood products and hemostatic medication,
hereby saving costs. Reductions in mortality and rethoracotomy rates could
not be found.<br/>Copyright &#xa9; 2018 The Authors

<38>
Accession Number
625825944
Title
Hypoglossal Nerve Stimulation and Heart Rate Variability: Analysis of STAR
Trial Responders.
Source
Otolaryngology - Head and Neck Surgery (United States). 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
SAGE Publications Inc. (E-mail: claims@sagepub.com)
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. <br/>Study Design: Substudy of the STAR trial
(Stimulation Therapy for Apnea Reduction): a multicenter prospective
single-group cohort. <br/>Setting(s): 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. <br/>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. <br/>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.<br/>Copyright &#xa9; American
Academy of Otolaryngology-Head and Neck Surgery Foundation 2018.

<39>
Accession Number
625825859
Title
Bronchoscopic lung cryobiopsy: An Indian association for bronchology
position statement.
Source
Lung India. 36 (1) (pp 48-59), 2019. Date of Publication: January-February
2019.
Author
Dhooria S.; Agarwal R.; Sehgal I.S.; Aggarwal A.N.; Goyal R.; Guleria R.;
Singhal P.; Shah S.P.; Gupta K.B.; Koolwal S.; Akkaraju J.; Annapoorni S.;
Bal A.; Bansal A.; Behera D.; Chhajed P.N.; Dhamija A.; Dhar R.; Garg M.;
Gopal B.; Hibare K.R.; James P.; Jindal A.; Jindal S.K.; Khan A.; Kishore
N.; Koul P.A.; Kumar A.; Kumar R.; Lall A.; Madan K.; Mandal A.; Mehta
R.M.; Mohan A.; Nangia V.; Nath A.; Nayar S.; Patel D.; Pattabhiraman V.;
Raghupati N.; Sarkar P.K.; Singh V.; Sivaramakrishnan M.; Srinivasan A.;
Swarnakar R.; Talwar D.; Thangakunam B.
Institution
(Dhooria, Agarwal, Sehgal, Aggarwal, Goyal, Guleria, Singhal, Shah, Gupta,
Koolwal, Akkaraju, Annapoorni, Bal, Bansal, Behera, Chhajed, Dhamija,
Dhar, Garg, Gopal, Hibare, James, Jindal, Jindal, Khan, Kishore, Koul,
Kumar, Kumar, Lall, Madan, Mandal, Mehta, Mohan, Nangia, Nath, Nayar,
Patel, Pattabhiraman, Raghupati, Sarkar, Singh, Sivaramakrishnan,
Srinivasan, Swarnakar, Talwar, Thangakunam) Departments of Pulmonary
Medicine, Postgraduate Institute of Medical Education and Research,
Chandigarh 160 012, India
(Goyal) Department of Respiratory Medicine, Jaipur Golden Hospital, Rajiv
Gandhi Cancer Institute, India
(Guleria, Madan, Mohan) Department of Pulmonary Medicine and Sleep
Disorders, All India Institute of Medical Sciences, India
(Singhal) Department of Respiratory Medicine, Bombay Hospital and Fortis
Hiranandani Hospital, India
(Shah) Department of Respiratory Medicine, Nanavati Super Speciality
Hospital, India
(Gupta) Department of Respiratory Medicine, Postgraduate Institute of
Medical Sciences, Rohtak, Haryana, India
(Koolwal) Department of Chest Diseases, SMS Medical College, India
(Akkaraju) Department of Respiratory Medicine, Century Hospital,
Hyderabad, Telangana, India
(Annapoorni, Pattabhiraman, Sivaramakrishnan, Srinivasan) Department of
Respiratory Medicine, Royal Care Hospital, Coimbatore, India
(Bal) Departments of Histopathology, Postgraduate Institute of Medical
Education and Research, Chandigarh, India
(Bansal) Department of Respiratory Medicine, Indraprastha Apollo Hospital,
India
(Chhajed) India and Lung Care and Sleep Centre, Institute of Pulmonology,
Medical Research and Development, Mumbai, India
(Dhamija, Kumar) Department of Respiratory Medicine, Sir Ganga Ram
Hospital, India
(Dhar) Department of Respiratory Medicine, Fortis Hospital Anandapur,
Kolkata, West Bengal, India
(Garg) Departments of Radiodiagnosis and Imaging, Postgraduate Institute
of Medical Education and Research, Chandigarh, India
(Gopal) Department of Respiratory Medicine, Maharaja Agrasen Hospital,
India
(Hibare) Department of Respiratory Medicine, Narayana Health City, India
(James, Thangakunam) Department of Pulmonary Medicine, Christian Medical
College, Vellore, India
(Jindal, Jindal) Department of Respiratory Medicine, Jindal Chest Clinic,
Chandigarh, India
(Khan, Nath) Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate
Institute of Medical Sciences, Lucknow, India
(Kishore, Lall) Department of Respiratory Medicine, Max Hospital, India
(Koul) Department of Internal and Pulmonary Medicine, Sher-I-Kashmir
Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
(Kumar) Department of Pulmonary Medicine, Vallabhbhai Patel Chest
Institute, India
(Mandal) Fortis Hospital, Mohali, Punjab, India
(Mehta) Department of Respiratory Medicine, Apollo Hospital, Bengaluru,
Karnataka, India
(Nangia) Department of Respiratory Medicine, Fortis Hospital, India
(Nayar) Department of Respiratory Medicine, BLK Super Speciality Hospital,
New Delhi, India
(Patel) Department of Respiratory Medicine, City Clinic and Bhailal Amin
General Hospital, Vadodara, Gujarat, India
(Raghupati) Department of Respiratory Medicine, Apollo Hospital, Chennai,
Tamil Nadu, India
(Sarkar) Department of Medicine, Pulmonary, Critical Care and Sleep
Medicine, Baylor College of Medicine, Houston, TX, United States
(Singh) Department of Respiratory Medicine, Asthma Bhawan, Jaipur,
Rajasthan, India
(Swarnakar) Department of Respiratory Medicine, Getwell Hospital and
Research Institute, Nagpur, Maharashtra, India
(Talwar) Metro Centre for Respiratory Diseases, Noida, Uttar Pradesh,
India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: Bronchoscopic lung cryobiopsy (BLC) is a novel technique for
obtaining lung tissue for the diagnosis of diffuse parenchymal lung
diseases. The procedure is performed using several different variations of
technique, resulting in an inconsistent diagnostic yield and a variable
risk of complications. There is an unmet need for standardization of the
technical aspects of BLC. Methodology: This is a position statement framed
by a group comprising experts from the fields of pulmonary medicine,
thoracic surgery, pathology, and radiology under the aegis of the Indian
Association for Bronchology. Sixteen questions on various technical
aspects of BLC were framed. A literature search was conducted using PubMed
and EMBASE databases. The expert group discussed the available evidence
relevant to each question through e-mail and a face-to-face meeting, and
arrived at a consensus. <br/>Result(s): The experts agreed that patients
should be carefully selected for BLC after weighing the risks and benefits
of the procedure. Where appropriate, consideration should be given to
perform alternate procedures such as conventional transbronchial biopsy or
subject the patient directly to a surgical lung biopsy. The procedure is
best performed after placement of an artificial airway under
sedation/general anesthesia. Fluoroscopic guidance and occlusion balloon
should be utilized for positioning the cryoprobe to reduce the risk of
pneumothorax and bleeding, respectively. At least four tissue specimens
(with at least two of adequate size, i.e., >=5 mm) should be obtained
during the procedure from different lobes or different segments of a lobe.
The histopathological findings of BLC should be interpreted by an
experienced pulmonary pathologist. The final diagnosis should be made
after a multidisciplinary discussion. Finally, there is a need for
structured training for performing BLC. <br/>Conclusion(s): This position
statement is an attempt to provide practical recommendations for the
performance of BLC in DPLDs.<br/>Copyright &#xa9; 2019 Wolters Kluwer
Medknow Publications. All rights reserved.

<40>
Accession Number
2001157263
Title
Comparison of the Efficacy of Ultrasound-Guided Serratus Anterior Plane
Block, Pectoral Nerves II Block, and Intercostal Nerve Block for the
Management of Postoperative Thoracotomy Pain After Pediatric Cardiac
Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (2) (pp 418-425),
2019. Date of Publication: February 2019.
Author
Kaushal B.; Chauhan S.; Saini K.; Bhoi D.; Bisoi A.K.; Sangdup T.; Khan
M.A.
Institution
(Kaushal, Chauhan) Department of Cardiac Anesthesiology, Cardio and
Neurosciences Center, AIIMS, New Delhi, India
(Saini, Bhoi) Department of Anesthesiology, Pain Medicine and Critical
Care, AIIMS, New Delhi, India
(Bisoi, Sangdup) Department of Cardiothoracic and Vascular Surgery, Cardio
and Neurosciences Center, AIIMS, New Delhi, India
(Khan) Department of Biostatistics, AIIMS, New Delhi, India
Publisher
W.B. Saunders
Abstract
Objective: The aim of this study was to compare the relative efficacy of
ultrasound-guided serratus anterior plane block (SAPB), pectoral nerves
(Pecs) II block, and intercostal nerve block (ICNB) for the management of
post-thoracotomy pain in pediatric cardiac surgery. <br/>Design(s): A
prospective, randomized, single-blind, comparative study. <br/>Setting(s):
Single-institution tertiary referral cardiac center. <br/>Participant(s):
The study comprised 108 children with congenital heart disease requiring
surgery through a thoracotomy. <br/>Intervention(s): Children were
allocated randomly to 1 of the 3 groups: SAPB, Pecs II, or ICNB. All
participants received 3 mg/kg of 0.2% ropivacaine for ultrasound-guided
block after induction of anesthesia. Postoperatively, intravenous
paracetamol was used for multimodal and fentanyl was used for rescue
analgesia. <br/>Measurements and Main Results: A modified objective pain
score (MOPS) was evaluated at 1, 2, 4, 6, 8, 10, and 12 hours
post-extubation. The early mean MOPS at 1, 2, and 4 hours was similar in
the 3 groups. The late mean MOPS was significantly lower in the SAPB group
compared with that of the ICNB group (p < 0.001). The Pecs II group also
had a lower MOPS compared with the ICNB group at 6, 8, and 10 hours (p <
0.001), but the MOPS was comparable at hour 12 (p = 0.301). The
requirement for rescue fentanyl was significantly higher in ICNB group in
contrast to the SAPB and Pecs II groups. <br/>Conclusion(s): SAPB and Pecs
II fascial plane blocks are equally efficacious in post-thoracotomy pain
management compared with ICNB, but they have the additional benefit of
being longer lasting and are as easily performed as the traditional
ICNB.<br/>Copyright &#xa9; 2018

<41>
Accession Number
2001155484
Title
Continuous Ropivacaine Infusion Offers No Benefit in Treating
Postoperative Pain After Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (2) (pp 378-384),
2019. Date of Publication: February 2019.
Author
Florkiewicz P.; Musialowicz T.; Hippelainen M.; Lahtinen P.
Institution
(Florkiewicz, Musialowicz, Lahtinen) Department of Anesthesia and
Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland
(Hippelainen) Heart Center, Kuopio University Hospital, Kuopio, Finland
Publisher
W.B. Saunders
Abstract
Objective: One multimodal pain management method for reducing
postoperative opioid need after cardiac surgery is to continuously infuse
local anesthetic into a median sternotomy wound. Previous studies have
shown contradictory results with this method; therefore, no consensus
exists on its effectiveness. The authors tested the effectiveness of
continuous 0.2% ropivacaine infusion into a sternotomy wound after cardiac
surgery. <br/>Design(s): Prospective, randomized, double-blinded,
placebo-controlled trial. <br/>Setting(s): Single-institution,
tertiary-level, university hospital. <br/>Participant(s): Total of 90
patients undergoing coronary artery bypass grafting or heart valve
surgery. <br/>Intervention(s): Patients were assigned randomly to receive
0.2% ropivacaine or placebo into a sternotomy wound for 48 hours
postoperatively. Pain was controlled with standardized oxycodone boluses
after surgery and patient-controlled analgesia oxycodone after extubation;
total oxycodone consumption was recorded. Pain was assessed 3 times daily,
at rest and during deep breathing, with the visual analogue scale.
<br/>Measurements and Main Results: Forty-seven patients were assigned to
receive ropivacaine and 43 to receive placebo infusion. Cumulative
oxycodone consumption was 97 +/- 27 mg with ropivacaine and 96 +/- 29 mg
with placebo (p = 0.813). Pain scores were similar between groups, both at
rest (p = 0.630) and during deep breathing (p = 0.793). Adverse event
incidences and surgical wound infection rates were similar between groups.
<br/>Conclusion(s): Continuous 0.2% ropivacaine infusions at the median
sternotomy wound did not reduce postoperative pain or opioid consumption
during the first 48 hours after cardiac surgery. This technique apparently
was not beneficial for post-sternotomy pain treatment.<br/>Copyright
&#xa9; 2018 Elsevier Inc.

<42>
Accession Number
2000975905
Title
Bilateral Erector Spinae Plane Block for Acute Post-Surgical Pain in Adult
Cardiac Surgical Patients: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (2) (pp 368-375),
2019. Date of Publication: February 2019.
Author
Krishna S.N.; Chauhan S.; Bhoi D.; Kaushal B.; Hasija S.; Sangdup T.;
Bisoi A.K.
Institution
(Krishna, Chauhan, Kaushal, Hasija) Department of Cardiac Anesthesiology,
Cardio and Neurosciences Center, All India Institute of Medical Sciences,
New Delhi, India
(Bhoi) Department of Anesthesiology, Pain Medicine and Critical Care, All
India Institute of Medical Sciences, New Delhi, India
(Sangdup, Bisoi) Department of Cardiothoracic and Vascular Surgery, Cardio
and Neurosciences Center, All India Institute of Medical Sciences, New
Delhi, India
Publisher
W.B. Saunders
Abstract
Objectives: To examine the analgesic efficacy of bilateral erector spinae
plane (ESP) block compared with conventional treatment for pain after
cardiac surgery in adult patients. <br/>Design(s): A prospective,
randomized, controlled, single-blinded study. <br/>Setting(s):
Single-center tertiary teaching hospital. <br/>Participant(s): One hundred
and six adult patients undergoing elective cardiac surgery with
cardiopulmonary bypass. <br/>Intervention(s): Patients were randomized
into 2 groups. Patients in group 1 (ESP block group, n = 53) received
ultrasound-guided bilateral ESP block with 3 mg/kg of 0.375% ropivacaine
before anesthesia induction at the T6 transverse process level. Patients
in group 2 (paracetamol and tramadol group, n = 53) received paracetamol
(1 gm every 6 hours) and tramadol (50 mg every 8 hours) intravenously in
the postoperative period. The primary study outcome was to evaluate pain
at rest using an 11-point numeric rating scale (NRS). Mann-Whitney U test
was used for comparing NRS scores. <br/>Measurements and Main Results: The
postoperative pain level after extubation and duration of analgesia during
which NRS was < 4 of 10 was compared between the groups. The median pain
score at rest after extubation in group 1 was 0 of 10 until hour 6, 3 of
10 at hour 8, and 4 of 10 at hours 10 and 12 postextubation. These were
significantly less in comparison with group 2 (p = 0.0001). Patients in
group 1 had a significantly higher mean duration of analgesia (8.98 +/-
0.14 hours), during which NRS was < 4 of 10, compared with group 2 (4.60
+/- 0.12 hours) (p = 0.0001). <br/>Conclusion(s): ESP block safely
provided significantly better pain relief at rest for longer duration as
compared to intravenous paracetamol and tramadol.<br/>Copyright &#xa9;
2018 Elsevier Inc.

<43>
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. <br/>Background(s): Current recommendations
support short-term use of aspirin + clopidogrel for patients with severe
AS undergoing TAVR despite the lack of compelling evidence.
<br/>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. <br/>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. <br/>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)<br/>Copyright &#xa9; 2019 The
Authors

<44>
Accession Number
625824043
Title
Effect of dexmedetomidine or propofol sedation on haemodynamic stability
of patients after thoracic surgery.
Source
Anaesthesiology Intensive Therapy. 50 (5) (pp 359-366), 2018. Date of
Publication: 31 Dec 2018.
Author
Bialka S.; Copik M.; Karpe J.; Przybyla M.; Sliwczynska M.; Czyzewski D.;
Misiolek H.
Institution
(Bialka, Copik, Karpe, Przybyla, Sliwczynska, Misiolek) Department of
Anaesthesiology and Intensive Care, School of Medicine, Division of
Dentistry in Zabrze, Medical University of Silesia, 3 Maja 13-15, Zabrze
41-800, Poland
(Czyzewski) Department of Thoracic Surgery, School of Medicine, Division
of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Dexmedetomidine and propofol are commonly used sedative agents
in non-invasive ventilation as they allow for straightforward arousal and
are easily controllable to a relative degree. Moreover, dexmedetomidine is
associated with a low risk of respiratory depression. However, both agents
are associated with significant haemodynamic side effects. The primary aim
of this study is to compare the influence of both drugs on haemodynamic
effects in patients after thoracic surgical procedures receiving
dexmedetomidine or propofol for non-invasive postoperative ventilation.
<br/>Method(s): A prospective, randomised, observational study conducted
in a university hospital. <br/>Intervention(s): Continuous sedation with
dexmedetomidine or propofol for six hours of postoperative non-invasive
ventilation after thoracic surgery, with concomitant use of continuous
epidural analgesia. <br/>Result(s): A total of 38 patients (20 on
dexmedetomidine and 18 on propofol) were included in the analysis. The
primary findings of this study were that although the heart rate, along
with the systolic and mean arterial blood pressure did not differ
significantly between the groups (P = 0.87; P = 0.42; P = 0.13,
respectively), diastolic arterial blood pressure was significantly higher
in the propofol group (P = 0.02). A comparative analysis of epinephrine
usage did not reveal significant differences between the groups. Although
cardiac output (P = 0.36) and cardiac index (P = 0.36) analyses did not
show significant differences between the groups, there is a clear tendency
toward lower values of CO/CI in the group receiving propofol. While we
also observed a similar tendency in the stroke volume index and stroke
volume variation values, these differences did not reach statistical
significance either (P = 0.16; P = 0.64, respectively). Despite systemic
vascular resistance index values being higher in the propofol group,
exceeding reference values, similarly, the difference between the groups
was not significant (P = 0.36). <br/>Conclusion(s): The main finding of
this study is that dexmedetomidine and propofol provide similar advantages
in haemodynamic stability during short-term sedation for non-invasive
ventilation after thoracic surgical procedures in patients receiving
continuous epidural analgesia.<br/>Copyright &#xa9; 2018 Via Medica. All
rights reserved.

<45>
Accession Number
620158187
Title
Perioperative management of antiplatelet therapy in patients undergoing
non-cardiac surgery following coronary stent placement: A systematic
review.
Source
Systematic Reviews. 7 (1) (no pagination), 2018. Article Number: 4. Date
of Publication: 10 Jan 2018.
Author
Childers C.P.; Maggard-Gibbons M.; Ulloa J.G.; MacQueen I.T.; Miake-Lye
I.M.; Shanman R.; Mak S.; Beroes J.M.; Shekelle P.G.
Institution
(Childers, Maggard-Gibbons, MacQueen) David Geffen School of Medicine at
UCLA, Department of Surgery, 10833 Le Conte Ave., CHS 72-247, Los Angeles,
CA 90095, United States
(Childers, Mak) UCLA Fielding School of Public Health, Department of
Health Policy and Management, Los Angeles, CA, United States
(Maggard-Gibbons, Ulloa, MacQueen, Miake-Lye, Mak, Beroes, Shekelle)
Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA,
United States
(Ulloa) UCSF School of Medicine, Department of Surgery, San Francisco, CA,
United States
(Shanman) RAND Corporation, Santa Monica, CA, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The correct perioperative management of antiplatelet therapy
(APT) in patients undergoing non-cardiac surgery (NCS) is often debated by
clinicians. American College of Cardiology (ACC) and American Heart
Association (AHA) guidelines recommend postponing elective NCS at least 3
months after stent implantation. Regardless of the timing of surgery,
ACC/AHA guidelines recommend continuing at least ASA throughout the
perioperative period and ideally continuing dual APT (DAPT) therapy
"unless surgery demands discontinuation." The objective of this review was
to ascertain the risks and benefits of APT in the perioperative period, to
assess how these risks and benefits vary by APT management, and the
significance of length of time since stent implantation before operative
intervention. <br/>Method(s): PubMed, Web of Science, and Scopus were
searched from inception through October 2017. Articles were included if
patients were post PCI with stent placement (bare metal [BMS] or drug
eluting [DES]), underwent elective NCS, and had rates of major adverse
cardiac events (MACE) or bleeding events associated with pre and
perioperative APT therapy. <br/>Result(s): Of 4882 screened articles, we
included 16 studies in the review (1 randomized controlled trial and 15
observational studies). Studies were small (< 50: n = 5, 51-150: n = 5,
>150: n = 6). All studies included DES with 7 of 16 also including BMS.
Average time from stent to NCS was variable (< 6 months: n = 3, 6-12
months: n = 1, > 12 months: n = 6). At least six different APT strategies
were described. Six studies further utilized bridging protocols using
three different pharmacologic agents. Studies typically included multiple
surgical fields with varying degrees of invasiveness. Across all APT
strategies, rates of MACE/bleeding ranged from 0 to 21% and 0 to 22%.
There was no visible trend in MACE/bleeding rates within a given APT
strategy. Stratifying the articles by type of surgery, timing of
discontinuation of APT therapy, bridging vs. no bridging, and time since
stent placement did not help explain the heterogeneity.
<br/>Conclusion(s): Evidence regarding perioperative APT management in
patients with cardiac stents undergoing NCS is insufficient to guide
practice. Other clinical factors may have a greater impact than
perioperative APT management on MACE and bleeding events. Systematic
review registration: PROSPERO CRD42016036607.<br/>Copyright &#xa9; 2018
The Author(s).

<46>
Accession Number
624939850
Title
Anesthesiological risks in mucopolysaccharidoses.
Source
Italian Journal of Pediatrics. 44 (Supplement 2) (no pagination), 2018.
Article Number: 116. Date of Publication: 16 Nov 2018.
Author
Moretto A.; Bosatra M.G.; Marchesini L.; Tesoro S.
Institution
(Moretto, Bosatra) Department of Perioperative Medicine and Intensive
Care, ASST San Gerardo, Via Pergolesi 33, Monza, MB 20900, Italy
(Marchesini, Tesoro) Department of Surgical and Biological Sciences,
Section of Anesthesia, Analgesia and Intensive Care, Perugia University,
Azienda Ospedaliero Universitaria di Perugia, Piazzale Menghini 1,
Perugia, PG 06100, Italy
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Patients suffering from mucopolysaccharidosis are among the
most complex from the anesthesiological point of view, especially
regarding the management of the airway. The evidence base for anesthesia
management is often limited to case reports and small case series.
<br/>Aim(s): To identify useful information about experience with each
subtype of mucopolysaccharidosis reported in the literature and propose a
guide on the best options for airway management to the anesthesiologists
who take care of these patients. <br/>Method(s): A query of the PubMed
database specific for "anesthesia" and "mucopolysaccharidosis" and a
further query specific for "mucopolysaccharidosis and difficult airway
management" was conducted. We looked for those items that offered
practical guidance to anesthesiological management. We did not exclude
case reports, especially those that reported a specific technique, because
of their practical suggestions. <br/>Result(s): We identified 15 reviews,
17 retrospective case series, 5 prospective studies, and 28 case reports
that focused on airway managements in anesthesia or had practical
suggestions for preoperative evaluation and risk assessment. An accurate
preoperative evaluation and the need for an experienced team are
emphasized in all the reviewed articles and for each type of
mucopolysaccharidosis. Many suggestions on how to plan the perioperative
period have been highlighted. Insertion of a laryngeal mask airway
generally improves ventilation and facilitates intubation with a
fiberoptic bronchoscope. Furthermore, the videolaryngoscope is very useful
in making intubation easier and facilitating bronchoscope passage.
<br/>Conclusion(s): Patients with mucopolysaccharidosis are at high risk
for anesthesia-related complications and require a high level of
attention. However, a multidisciplinary approach, combined with expertise
in the use of new techniques and new devices for airway management, makes
anesthesiological management safer. Further research with prospective
studies would be useful.<br/>Copyright &#xa9; 2018 The Author(s).

<47>
Accession Number
624508370
Title
Medical treatment or revascularisation as the best approach for
spontaneous coronary artery dissection: A systematic review and
meta-analysis.
Source
European Heart Journal: Acute Cardiovascular Care. 7 (7) (pp 614-623),
2018. Date of Publication: 01 Oct 2018.
Author
Martins J.L.; Afreixo V.; Santos L.; Costa M.; Santos J.; Goncalves L.
Institution
(Martins, Santos, Santos) Department of Cardiology, Baixo Vouga Hospital
Centre, Portugal
(Afreixo) CIDMA/IBIMED/Department of Mathematics, University of Aveiro,
Portugal
(Costa, Goncalves) Department of Cardiology, Coimbra Hospital and
Universitary Centre - General Unit, Portugal
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Introduction: Patients presenting with spontaneous coronary artery
dissection (SCAD) may receive either conservative medical management or a
revascularisation strategy. There is still a lack of consensus with
respect to the best treatment approach for SCAD. <br/>Objective(s): We
sought to determine whether outcomes differ between the first-line
treatment approaches (conservative versus revascularisation) in patients
with SCAD. <br/>Method(s): We searched Medline, EMBASE and the Cochrane
Library for studies published from January 1990 to November 2016 that
compared first-line treatments for patients with SCAD. We conducted a
pooled risk ratio meta-analysis for four main outcomes: mortality,
myocardial infarction (MI), SCAD recurrence and target vessel
revascularisation (TVR). <br/>Result(s): We identified 11 non-randomised
studies that included a total of 631 patients. A pooled meta-analysis
showed no significant difference between conservative management and
revascularisation approaches in mortality (risk difference [RD] = 0.01;
95% confidence interval [CI] = -0.01 to 0.04; I² = 0%; p = 1),
MI (RD = -0.01; 95% CI = -0.04 to 0.03; I² = 0%; p = 0.5) or
SCAD recurrence (RD = -0.01; 95% CI = -0.06 to 0.05; I² = 0%; p
= 0.74). Revascularisation as an initial first-line approach was
associated with an estimated additional risk of TVR of 6.3% (RD = 0.06;
95% CI = 0.01-0.11; I² = 0%; p = 0.96). <br/>Conclusion(s): The
results demonstrate an increased risk of TVR when revascularisation was
used as the initial first-line treatment approach. The treatment decision
must be individualised and be based on both clinical and angiographic
factors, but conservative therapy should prevail in most
cases.<br/>Copyright &#xa9; The European Society of Cardiology 2017.

<48>
Accession Number
620999453
Title
The role of N-acetylcysteine in platelet aggregation and reperfusion
injury in recent years.
Source
Current Clinical Pharmacology. 12 (2) (pp 83-91), 2017. Date of
Publication: 01 May 2017.
Author
Nikbakht M.; Ahmadi F.; Vaseghi G.; Talasaz A.H.; Eshraghi A.; Naderi J.;
Daneshme M.A.
Institution
(Nikbakht) Department of Pharmacology, Faculty of Medicine, Yasuj
University of Medical Sciences, Yasuj, Iran, Islamic Republic of
(Ahmadi, Daneshme) Department of Medicinal Chemistry, School of
Pharmacy-International Campus, Iran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Vaseghi) Isfahan Cardiovascular Research Center, Cardiovascular Research
Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
(Talasaz) Department of Clinical Pharmacy, School of Pharmacy, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Eshraghi) Department of Clinical Pharmacy, School of
Pharmacy-International Campus, Iran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Naderi) Applied Physiology Research Center, Cardiovascular Research
Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: N-acetylcysteine (NAC) is an amino acid that contains a
cysteine group and is currently used widely in various fields of medical
research especially in cardiology. In this review, potential benefits of
NAC in the aggregation of platelet and reperfusion injury are evaluated.
<br/>Method(s): The available evidence was collected by searching Scopus,
Pub-Med, Medline, Cochrane central register of controlled trials, and
Cochrane database systematic reviews. Our searching was performed without
time limitation and only English language articles were included in this
review. Key words used as search terms included "N-acetylcysteine",
"platelet aggregation", "reperfusion injury". <br/>Result(s): Over the
past decade, several investigations were carried out to ascertain
reperfusion injury and antiplatelet properties of NAC, and in this article
the results of investigations in both models (human and animal) were
addressed in detail. The results revealed that NAC has an important
antiplatelet property in animal models while this effect is not very
significant in human models and needs more investigations. However, its
reperfusion injury in both models is worth noticing. <br/>Conclusion(s):
Due to the limited data about effectiveness of NAC in both human and
animal as antiplatelet agent, more investigation is needed to evaluate NAC
efficacy in platelet aggregation and reperfusion injury especially in
human studies in the future.<br/>Copyright &#xa9; 2017 Bentham Science
Publishers.

<49>
Accession Number
621870186
Title
Perioperative management of hyperlipidemia medications.
Source
Current Clinical Pharmacology. 12 (3) (pp 152-156), 2017. Date of
Publication: 01 Aug 2017.
Author
Renew J.R.
Institution
(Renew) Department of Anesthesiology and Perioperative Medicine, Mayo
Clinic, Jacksonville, FL 32224, United States
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Coronary artery disease is a common comorbidity encountered
during the perioperative period. Whether patients are scheduled for
cardiac or noncardiac surgery, this cardiovascular disease must be
addressed in the preoperative period to decrease the accompanying risks
and potential postoperative problems. Lipid-lowering medications are often
used to treat hyperlipidemia, a risk factor for the development of
atherosclerosis and coronary artery disease. <br/>Objective(s): To discuss
the medications most commonly used to treat hyperlipidemia and to describe
strategies for handling these treatment regimens in the perioperative
period. <br/>Method(s): An online search of studies and review articles
was conducted through PubMed and Medline that addressed pharmacology and
perioperative management of hyperlipidemia medications. <br/>Result(s):
Statins are the most commonly prescribed lipid-lowering agents, with
benefits that extend beyond correcting lipid levels. However, statins can
have clinically significant adverse effects that may necessitate the use
of other lipid-lowering medications with different mechanisms of action.
Alternative medications such as nicotinic acid and omega-3 fatty acids
should be withheld in the preoperative period because these agents have
been associated with hypotension and increased bleeding.
<br/>Conclusion(s): Clinicians must be familiar with the various
lipid-lowering agents because it is very likely they will encounter such
medications during preoperative visits.<br/>Copyright &#xa9; 2017 Bentham
Science Publishers.

<50>
Accession Number
2000856302
Title
Comprehensive Echocardiographic Assessment of Normal Transcatheter Valve
Function.
Source
JACC: Cardiovascular Imaging. (no pagination), 2018. Date of Publication:
2018.
Author
Hahn R.T.; Leipsic J.; Douglas P.S.; Jaber W.A.; Weissman N.J.; Pibarot
P.; Blanke P.; Oh J.K.
Institution
(Hahn) Columbia University Medical Center/New York-Presbyterian Hospital,
New York, New York, United States
(Leipsic, Blanke) University of British Columbia and St. Paul's Hospital,
Vancouver, Canada
(Douglas) Division of Cardiovascular Medicine, Duke University Medical
Center, and Duke Clinical Research Institute, Durham, North Carolina,
United States
(Jaber) Cleveland Clinic Foundation, Cleveland, Ohio, United States
(Weissman) Medstar Health Research Institute, Washington, DC, United
States
(Pibarot) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec/Quebec Heart & Lung Institute, Department of Medicine, Laval
University, Quebec, Canada
(Oh) Mayo Clinic, Rochester, Minnesota, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study aims to establish parameters for identifying normal
function for each of the 3 iterations of balloon-expandable valves and 2
iterations of self-expanding valves. <br/>Background(s): Expected
transthoracic echocardiographic Doppler-derived hemodynamic data for
transcatheter aortic valves inform pre-implant decision-making and
post-implanted monitoring of longitudinal valve function. <br/>Method(s):
We collected the Echocardiography Core Lab measured mean gradients and
effective orifice area (EOA) from discharge or 30-day echocardiograms from
randomized trials; the PARTNER (Placement of Aortic Transcatheter Valves)
trials for the balloon-expandable valves and the Medtronic CoreValve US
Pivotal trial and Medtronic CoreValve Evolut R United States IDE Clinical
Study for the self-expanding valves. <br/>Result(s): For all SAPIEN
(Edwards Lifesciences, Irvine, California) valve sizes, mean EOA = 1.70
+/- 0.49 cm² with mean gradient of 9.36 +/- 4.13 mm Hg. For all
SAPIEN XT valve sizes, mean EOA = 1.67 +/- 0.46 cm² with mean
gradient of 9.52 +/- 3.64 mm Hg. For all SAPIEN 3 valve sizes, the mean
EOA = 1.66 +/- 0.38 cm² with mean gradient of 11.18 +/- 4.35 mm
Hg. For all CoreValve valve sizes, the mean EOA = 1.88 +/- 0.56
cm² with mean gradient of 8.85 +/- 4.14 mm Hg. For all Evolut R
valve sizes, the mean EOA = 2.01 +/- 0.65 cm² with mean
gradient of 7.52 +/- 3.19 mm Hg. The SAPIEN 3 post-implant EOA was
progressively larger for each quintile of baseline annular area by
computed tomography (p < 0.001). Similarly, for the Evolut R valve,
post-implantation EOA was significantly larger for each quintile of
baseline annular perimeter (p < 0.001). <br/>Conclusion(s): Tables of
expected mean transcatheter aortic valve hemodynamics by valve type and
size are essential in evaluating the function of these transcatheter
prosthetic valves. Tables of expected EOA by the native annular anatomy
may be useful for pre-implantation decision making. Criteria for defining
structural valve dysfunction are proposed.<br/>Copyright &#xa9; 2018
American College of Cardiology Foundation

<51>
Accession Number
625845466
Title
Acute Influenza Infection Presenting with Cardiac Tamponade: A Case Report
and Review of Literature.
Source
The Permanente journal. 23 (no pagination), 2019. Date of Publication:
2019.
Author
Pandey Y.; Hasan R.; Joshi K.P.; Habash F.J.; Jagana R.
Institution
(Pandey, Hasan, Habash) University of Arkansas for Medical Sciences
Medical Center, Little Rock, United States
(Joshi) Department of Internal Medicine, University of Arkansas for
Medical Sciences Medical Center, Little Rock, United States
(Jagana) Department of Pulmonary and Critical Care, University of Arkansas
for Medical Sciences Medical Center, Little Rock, United States
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Cardiac complications associated with influenza infection
can occur either via a direct effect of the virus on the heart or through
exacerbation of preexisting cardiovascular disease. We present a case of a
57-year-old man with acute influenza infection complicated by pericardial
effusion and cardiac tamponade. CASE PRESENTATION: A 57-year-old white man
presented to the Emergency Department with sudden onset of severe,
nonexertional, retrosternal, pressure-like chest pain for a few hours and
with fever and muscle aches for 2 days. The patient was initially admitted
because of suspected acute coronary syndrome. The next morning, he
complained of acute-onset shortness of breath and had hypotension and
tachycardia. On examination, his peripheral extremities were cold and
heart sounds were distant. Pulsus paradoxus was 20 mmHg. The
electrocardiogram showed low-voltage QRS complex with electrical
alternans. An urgently performed bedside echocardiogram showed moderate
pericardial effusion with a small right ventricular cavity with diastolic
collapse. Emergent pericardiocentesis was performed, with removal of 250
mL of fluid from the pericardial space. The patient's hemodynamic status
immediately improved. Analyses of pericardial fluid demonstrated no
bacteria, acid-fast bacilli, or malignant cells. The result of a rapid
influenza diagnostic test with polymerase chain reaction was positive for
influenza A virus, with other viral panels yielding normal results. The
patient was treated with oseltamivir for 5 days. DISCUSSION: Pericardial
involvement is a rare and perhaps underreported complication of influenza
infection. Early recognition of cardiac symptoms and appropriate
diagnostic workup in a patient presenting with influenza-like symptoms is
important to avoid life-threatening complications.

<52>
Accession Number
2001446129
Title
Effects of high dose atorvastatin before elective percutaneous coronary
intervention on highly sensitive troponin T and one year major
cardiovascular events; a randomized clinical trial.
Source
IJC Heart and Vasculature. 22 (pp 96-101), 2019. Date of Publication:
March 2019.
Author
Pourhosseini H.; Lashkari R.; Aminorroaya A.; Soltani D.; Jalali A.;
Tajdini M.
Institution
(Pourhosseini, Lashkari, Aminorroaya, Soltani, Jalali) Tehran Heart Center
and School of Medicine, Tehran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Tajdini) Tehran Heart Center, Tehran University of Medical Sciences,
North Kargar Ave., Tehran, Iran, Islamic Republic of
Publisher
Elsevier Ireland Ltd (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Introduction: Some studies have demonstrated that post-PCI elevated
cardiac enzymes are associated with worse outcomes. In this study, we
aimed to determine if high-dose treatment with atorvastatin before planned
elective PCI reduces PMI or MACE at 1-year median follow-up.
<br/>Material(s) and Method(s): Eligible participants were randomly
allocated to group A (80 mg atorvastatin 12 h and 40 mg 2 h before PCI)
and group B (40 mg atorvastatin daily). Blood samples were obtained before
and at 24 h after PCI to measure hsTnT. All patients were followed
regarding MACE (combination of death, re-hospitalizations for ACS, and
unplanned coronary revascularization) during one year after PCI.
<br/>Result(s): 207 patients randomly assigned to Group A (n = 97) or
group B (n = 110). The rate of PMI was lower in group A (5.2%) compared to
group B (10.9%); despite near to 50% lower rate of PMI in group A, binary
logistic regression showed no significant association between atorvastatin
recapture and PMI. The occurrence of MACE in 97 patients of group A was 11
(11.3%), higher than 11 (10%) cases of 110 patients in group B. Cox
proportional hazards regression model shows no significant difference in
MACE of study groups. <br/>Conclusion(s): Pretreatment of patients with
stable angina who were planned to undergo an elective PCI with 120 mg of
atorvastatin before the procedure confer them the same benefit in terms of
PMI and MACE as 40 mg routine daily dosage of this statin
does.<br/>Copyright &#xa9; 2018

<53>
Accession Number
625854676
Title
Effect of Low-Dose Intracoronary Alteplase during Primary Percutaneous
Coronary Intervention on Microvascular Obstruction in Patients with Acute
Myocardial Infarction: A Randomized Clinical Trial.
Source
JAMA - Journal of the American Medical Association. 321 (1) (pp 56-68),
2019. Date of Publication: 01 Jan 2019.
Author
McCartney P.J.; Eteiba H.; Maznyczka A.M.; McEntegart M.; Greenwood J.P.;
Muir D.F.; Chowdhary S.; Gershlick A.H.; Appleby C.; Cotton J.M.; Wragg
A.; Curzen N.; Oldroyd K.G.; Lindsay M.; Rocchiccioli J.P.; Shaukat A.;
Good R.; Watkins S.; Robertson K.; Malkin C.; Martin L.; Gillespie L.;
Ford T.J.; Petrie M.C.; MacFarlane P.W.; Tait R.C.; Welsh P.; Sattar N.;
Weir R.A.; Fox K.A.; Ford I.; McConnachie A.; Berry C.
Institution
(McCartney, Eteiba, Maznyczka, McEntegart, Oldroyd, Lindsay, Rocchiccioli,
Shaukat, Good, Watkins, Robertson, Ford, Petrie, Welsh, Sattar, Berry)
British Heart Foundation Glasgow Cardiovascular Research Centre, Institute
of Cardiovascular and Medical Sciences, University of Glasgow, 126
University Pl, Glasgow G12 8TA, United Kingdom
(McCartney, Eteiba, Maznyczka, McEntegart, Martin, Petrie, Berry) West of
Scotland Heart and Lung Centre, Golden Jubilee National Hospital,
Clydebank, Clydebank, United Kingdom
(Greenwood, Malkin) Leeds University and Leeds Teaching Hospitals NHS
Trust, Leeds, United Kingdom
(Muir) James Cook University Hospital NHS Trust, Middlesbrough, United
Kingdom
(Chowdhary) South Manchester Hospitals NHS Trust, Manchester, United
Kingdom
(Gershlick) Leicester University Hospitals NHS Trust, Leicester, United
Kingdom
(Appleby) Liverpool Heart and Chest Hospital NHS Foundation Trust,
Liverpool, United Kingdom
(Cotton) Royal Wolverhampton University Hospital NHS Trust, Wolverhampton,
United Kingdom
(Wragg) Barts and the London Hospital, London, United Kingdom
(Curzen) University Hospital Southampton Foundation Trust, Southampton,
United Kingdom
(Gillespie) Greater Glasgow and Clyde Health Board, Glasgow, United
Kingdom
(MacFarlane) Electrocardiography Core Laboratory, University of Glasgow,
Glasgow, United Kingdom
(Tait) Department of Haematology, Royal Infirmary, Glasgow, United Kingdom
(Weir) University Hospital Hairmyres, East Kilbride, United Kingdom
(Fox) University of Edinburgh, Edinburgh, United Kingdom
(Ford, McConnachie) Robertson Centre for Biostatistics, Institute of
Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Microvascular obstruction commonly affects patients with acute
ST-segment elevation myocardial infarction (STEMI) and is associated with
adverse outcomes. <br/>Objective(s): To determine whether a therapeutic
strategy involving low-dose intracoronary fibrinolytic therapy with
alteplase infused early after coronary reperfusion will reduce
microvascular obstruction. <br/>Design, Setting, and Participant(s):
Between March 17, 2016, and December 21, 2017, 440 patients presenting at
11 hospitals in the United Kingdom within 6 hours of STEMI due to a
proximal-mid-vessel occlusion of a major coronary artery were randomized
in a 1:1:1 dose-ranging trial design. Patient follow-up to 3 months was
completed on April 12, 2018. <br/>Intervention(s): Participants were
randomly assigned to treatment with placebo (n = 151), alteplase 10 mg (n
= 144), or alteplase 20 mg (n = 145) by manual infusion over 5 to 10
minutes. The intervention was scheduled to occur early during the primary
PCI procedure, after reperfusion of the infarct-related coronary artery
and before stent implant. <br/>Main Outcomes and Measures: The primary
outcome was the amount of microvascular obstruction (% left ventricular
mass) demonstrated by contrast-enhanced cardiac magnetic resonance imaging
(MRI) conducted from days 2 through 7 after enrollment. The primary
comparison was the alteplase 20-mg group vs the placebo group; if not
significant, the alteplase 10-mg group vs the placebo group was considered
a secondary analysis. <br/>Result(s): Recruitment stopped on December 21,
2017, because conditional power for the primary outcome based on a
prespecified analysis of the first 267 randomized participants was less
than 30% in both treatment groups (futility criterion). Among the 440
patients randomized (mean age, 60.5 years; 15% women), the primary end
point was achieved in 396 patients (90%), 17 (3.9%) withdrew, and all
others were followed up to 3 months. In the primary analysis, the mean
microvascular obstruction did not differ between the 20-mg alteplase and
placebo groups (3.5% vs 2.3%; estimated difference, 1.16%; 95% CI, -0.08%
to 2.41%; P =.32) nor in the analysis of 10-mg alteplase vs placebo groups
(2.6% vs 2.3%; estimated difference, 0.29%; 95% CI, -0.76% to 1.35%; P
=.74). Major adverse cardiac events (cardiac death, nonfatal MI, unplanned
hospitalization for heart failure) occurred in 15 patients (10.1%) in the
placebo group, 18 (12.9%) in the 10-mg alteplase group, and 12 (8.2%) in
the 20-mg alteplase group. <br/>Conclusions and Relevance: Among patients
with acute STEMI presenting within 6 hours of symptoms, adjunctive
low-dose intracoronary alteplase given during the primary percutaneous
intervention did not reduce microvascular obstruction. The study findings
do not support this treatment. Trial Registration: ClinicalTrials.gov
Identifier: NCT02257294.<br/>Copyright &#xa9; 2019 American Medical
Association. All rights reserved.

<54>
Accession Number
2001453938
Title
Transcatheter Versus Surgical Aortic Valve Replacement in Patients With
Chronic Kidney Disease: A Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Cheng X.; Hu Q.; Zhao H.; Qin S.; Zhang D.
Institution
(Cheng, Qin, Zhang) Department of Cardiology, The First Affiliated
Hospital of Chongqing Medical University, Chongqing, China
(Hu) Department of Clinical Laboratory, Chongqing General Hospital,
Chongqing, China
(Zhao) Department of Cardiology, People's Hospital of Chongqing Banan,
Chongqing, China
Publisher
W.B. Saunders
Abstract
Objective: The aim of this meta-analysis was to compare the clinical
outcomes of transcatheter aortic valve replacement (TAVR) with those of
surgical aortic valve replacement (SAVR) in patients with chronic kidney
disease (CKD). <br/>Design(s): Meta-analysis of 10 observational studies.
<br/>Setting(s): Hospital. <br/>Participant(s): Patients with CKD (9,619)
undergoing aortic valve replacement. <br/>Intervention(s): None.
<br/>Measurements and Main Results: The Medline, Cochrane Library, and
Embase databases were searched for clinical studies published from January
2000 to October 2018. Studies that fulfilled the predefined inclusion
criteria were included. The primary clinical outcomes included early
all-cause mortality and postoperative stroke. Random-effects modeling was
used to calculate odds ratio (OR) and 95% CI. After a literature search of
the major databases, 10 observational cohort studies with a total of 9,619
patients were identified. Pooled analysis indicated that, when compared
with SAVR, TAVR was associated with a lower risk of early all-cause
mortality (6.1% v 10.2%; OR: 0.71; 95% CI: 0.51-0.98) and stroke (1.1% v
2.2%; OR: 0.53; 95% CI: 0.37-0.75). Although TAVR increased the risk of
pacemaker implantation (OR: 2.06; 95% CI: 1.16-3.66), it reduced the risk
of blood transfusion (OR: 0.50; 95% CI: 0.39-0.65), infection (OR: 0.30;
95% CI: 0.13-0.70), acute kidney injury (AKI) (OR: 0.46; 95% CI:
0.38-0.55), and AKI requiring dialysis (OR: 0.66; 95% CI: 0.58-0.75).
There were not significant differences in the incidence rates of cardiac
tamponade (OR: 0.60; 95% CI: 0.26-1.36) and major vascular damage (OR:
1.12; 95% CI: 0.81-1.55) between the 2 groups. <br/>Conclusion(s):
Transcatheter aortic valve replacement might be a preferable approach to
SAVR in patients with CKD. A large, prospective, randomized controlled
trial is warranted.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<55>
Accession Number
2001446157
Title
The Role of Tolvaptan Administration After Cardiac Surgery: A
Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Bellos I.; Iliopoulos D.C.; Perrea D.N.
Institution
(Bellos, Iliopoulos, Perrea) Laboratory of Experimental Surgery and
Surgical Research N.S. Christeas, Athens University Medical School,
National and KaPOD istrian University of Athens, Athens, Greece
Publisher
W.B. Saunders
Abstract
Objective: To evaluate the efficacy and safety of tolvaptan in fluid
management after cardiac surgery compared with conventional diuretic
treatment. <br/>Design(s): Systematic review of the literature with
meta-analyses. <br/>Setting(s): The Medline, Scopus, Cochrane Central
Register of Controlled Trials, Clinicaltrials.gov, and Google Scholar
databases were searched from inception to July 30, 2018.
<br/>Participant(s): The study comprised 759 patients undergoing cardiac
surgery. <br/>Intervention(s): Tolvaptan administration (n = 397) or
standard diuretic therapy (n = 398). <br/>Measurements and Main Results:
Ten studies were included in the present meta-analysis. Tolvaptan
administration was associated with a significantly faster return to
preoperative body weight (mean difference [MD)] -1.48 d, 95% confidence
interval [CI] -1.92 to 1.03), shorter duration of hospital stay (MD -2.58
d, 95% CI -5.09 to -0.07), lower incidence of acute kidney injury (odds
ratio 0.34, 95% CI 0.16-0.69), and greater urine output (MD 0.47 L/d, 95%
CI 0.25-0.69) and sodium levels (MD 2.85 mEq/L, 95% CI 1.90-3.80). No
significant differences were present regarding duration of intensive care
unit stay (MD -0.09 d, 95% CI -0.33 to 0.15), arrhythmia incidence (odds
ratio 0.58, 95% CI 0.33-1.02), and serum creatinine values (MD -0.08
mg/dL, 95% CI -0.20 to 0.04). <br/>Conclusion(s): The outcomes of the
present meta-analysis suggest the promising role of tolvaptan
administration in the management of fluid retention in patients after
cardiac surgery. Future large-scale clinical trials should be conducted to
fully elucidate its efficacy and to assess the optimal treatment protocol
to be applied in the clinical setting.<br/>Copyright &#xa9; 2018 Elsevier
Inc.

<56>
Accession Number
2001445897
Title
Transcatheter versus surgical aortic valve replacement in low-risk
surgical patients: A meta-analysis of randomized clinical trials.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Kheiri B.; Osman M.; Abubakar H.; Subahi A.; Chahine A.; Ahmed S.; Bachuwa
G.; Alkotob M.L.; Hassan M.; Bhatt D.L.
Institution
(Kheiri, Chahine, Ahmed, Bachuwa) Department of Internal Medicine, Hurley
Medical Center, Michigan State University, Flint, MI, United States
(Osman) Division of Cardiology, West Virginia University School of
Medicine, Morgantown, WV, United States
(Abubakar, Subahi) Department of Internal Medicine, Wayne State
University, Detroit, MI, United States
(Alkotob, Hassan) Division of Cardiology, Hurley Medical Center, Michigan
State University, Flint, MI, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, MA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is a valid
option for patients with high or intermediate surgical risk. However,
clinical outcomes of TAVR in low-risk patients are lacking. Our aim was to
evaluate the efficacy and safety of TAVR versus surgical aortic valve
replacement (SAVR) in low-surgical-risk patients. <br/>Method(s):
Electronic database review was conducted for all randomized clinical
trials (RCTs) that compared TAVR versus SAVR in low-risk patients. We
calculated risk ratios (RRs) and 95% confidence intervals (CIs) using a
random-effects model. <br/>Result(s): We included 3 RCTs totaling 604
patients (310 TAVR and 294 SAVR). Our results showed no significant
difference in mortality between TAVR compared with SAVR (RR = 0.71; 95% CI
= 0.22-2.30; P = 0.56), however, there was a significantly increased risk
of pacemaker implantation (RR = 7.28; 95% CI = 3.94-13.42; P < 0.01) and
moderate/severe paravalvular leakage (PVL) (RR = 6.74; 95% CI =
1.31-34.65; P = 0.02) with TAVR. Nevertheless, TAVR demonstrated a
significantly reduced risk of post-procedural bleeding (RR = 0.40; 95% CI
= 0.30-0.54; P < 0.01) and new-onset atrial fibrillation (RR = 0.36; 95%
CI = 0.27-0.47; P < 0.01). Other clinical outcomes were not significantly
different between the groups and included cardiovascular mortality,
stroke, transient ischemic attack, and myocardial infarction.
<br/>Conclusion(s): Among low-risk patients, TAVR offered comparable
efficacy outcomes and fewer bleeding events compared with SAVR. There were
increased risks of pacemaker implantation and PVL associated with TAVR,
though lower atrial fibrillation risks.<br/>Copyright &#xa9; 2018

<57>
Accession Number
625852891
Title
A systematic review of isolated radial artery harvesting as a conduit for
lower limb bypass grafting.
Source
Vascular. (no pagination), 2018. Date of Publication: 2018.
Author
Wee I.; Choong A.M.T.L.
Institution
(Wee, Choong) SingVaSC, Singapore Vascular Surgical Collaborative,
Singapore
(Wee) Yong Loo Lin School of Medicine, National University of Singapore,
Singapore
(Choong) Cardiovascular Research Institute, National University of
Singapore, Singapore
(Choong) Department of Surgery, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
(Choong) Division of Vascular Surgery, National University Heart Centre,
Singapore
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Whilst autologous vein conduits have been heralded as the
first-line approach for patients undergoing lower limb bypass grafting
procedures, patients with peripheral arterial occlusive disease may have
exhausted venous options given prior use for cardiac surgery, varicose
vein surgery, or lower limb revascularization. Hence, the use of a radial
artery graft may serve as a viable alternative. <br/>Method(s): The
systematic review was performed in accordance to the Preferred Reporting
Items for Systematic Review and Meta-analysis guidelines. An electronic
search was performed on the following databases: Medline (via PubMed);
EMBASE; Cochrane library to search for relevant publications. A narrative
analysis was conducted. <br/>Result(s): Four publications were included in
this review including two retrospective cohort studies, one case series,
and one case report, with a total of 43 patients. The most common
indication for lower limb bypass grafting was critical limb ischemia, and
the radial artery was chosen as graft conduit, most commonly due to the
absence of suitable arm or leg vein. There was one case of 30-day
mortality and 11 reinterventions. <br/>Conclusion(s): Despite the
encouraging results, the paucity of high-quality studies prevents the
establishment of any firm conclusion. This warrants the need for
appropriately conducted randomized controlled trials to compare the radial
artery graft to autologous vein grafts and prosthetic grafts for lower
limb bypass grafting.<br/>Copyright &#xa9; The Author(s) 2018.

<58>
Accession Number
625530954
Title
Evidence for varicose vein treatment: An overview of systematic reviews.
Source
Sao Paulo Medical Journal. 136 (4) (pp 324-332), 2018. Date of
Publication: July-August 2018.
Author
Oliveira R.A.; Mazzucca A.C.P.; Pachito D.V.; Riera R.; Baptista-Silva
J.C.D.C.
Institution
(Oliveira) Universidade Federal de Uberlandia (UFU), Uberlandia, MG,
Brazil
(Oliveira, Mazzucca, Pachito) Universidade Federal de Sao Paulo (UNIFESP),
Discipline of Evidence-Based Health, Sao Paulo, SP, Brazil
(Riera) Discipline of Evidence-based Health, Escola Paulista de Medicina,
Universidade Federal de Sao Paulo (UNIFESP), Brazil
(Baptista-Silva) Discipline of Vascular Surgery, Discipline of
Evidence-Based Health, Universidade Federal de Sao Paulo (UNIFESP), Sao
Paulo, SP, Brazil
Publisher
Associacao Paulista de Medicina (E-mail: revistas@apm.org.br)
Abstract
BACKGROUND: Varicose veins affect nearly 30% of the world's population.
This condition is a social problem and needs interventions to improve
quality of life and reduce risks. Recently, new and less invasive methods
for varicose vein treatment have emerged. There is a need to define the
best treatment options and to reduce the risks and costs. Since there are
cosmetic implications, treatments for which effectiveness remains unproven
present risks to consumers and higher costs for stakeholders. These risks
and costs justify conducting an overview of systematic reviews to
summarize the evidence. DESIGN AND SETTING: Overview of systematic reviews
within the Discipline of Evidence-Based Health, at Universidade Federal de
Sao Paulo (UNIFESP). <br/>METHOD(S): Systematic reviews on clinical or
surgical treatments for varicose veins were included, with no restrictions
on language or publication date. <br/>RESULT(S): 51 reviews fulfilled the
inclusion criteria. Outcomes and comparators were described, and a
narrative review was conducted. Overall, there was no evidence that
compression stockings should be recommended for patients as the initial
treatment or after surgical interventions. There was low to moderate
evidence that minimally invasive therapies (endovenous laser therapy,
radiofrequency ablation or foam sclerotherapy) are as safe and effective
as conventional surgery (ligation and stripping). Among these systematic
reviews, only 18 were judged to present high quality. <br/>CONCLUSION(S):
There was evidence of low to moderate quality that minimally invasive
treatments, including foam sclerotherapy, laser and radiofrequency therapy
are comparable to conventional surgery, regarding effectiveness and safety
for treatment of varicose veins.<br/>Copyright &#xa9; 2018 by Associacao
Paulista de Medicina.

<59>
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. <br/>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.<br/>Copyright &#xa9; 2018 American Psychological Association.

<60>
Accession Number
2001425748
Title
Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent
Implantation: The ULTIMATE Trial.
Source
Journal of the American College of Cardiology. 72 (24) (pp 3126-3137),
2018. Date of Publication: 18 December 2018.
Author
Zhang J.; Gao X.; Kan J.; Ge Z.; Han L.; Lu S.; Tian N.; Lin S.; Lu Q.; Wu
X.; Li Q.; Liu Z.; Chen Y.; Qian X.; Wang J.; Chai D.; Chen C.; Li X.;
Gogas B.D.; Pan T.; Shan S.; Ye F.; Chen S.-L.
Institution
(Zhang, Gao, Kan, Ge, Tian, Lin, Liu, Pan, Shan, Ye, Chen) Department of
Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing,
China
(Han, Wang) Department of Cardiology, Changshu NO.1 People's Hospital,
Changshu, China
(Lu, Chai) Department of Cardiology, The First People's Hospital of
Taicang, Taicang, China
(Lu) Department of Cardiology, The Second Hospital of Shandong University,
Jinan, China
(Wu, Chen) Department of Cardiology, Wuxi Third People's Hospital, Wuxi,
China
(Li, Li) Department of Cardiology, Changzhou Traditional Chinese Medicine
Hospital, Changzhou, China
(Chen) Department of Cardiology, Fuwai Central China Cardiovascular
Hospital, Zhengzhou, China
(Qian) Department of Cardiology, The First People's Hospital of
Zhangjiagang, Zhangjiagang, China
(Gogas) Department of Cardiology, Emory University Hospital, Atlanta,
Georgia
Publisher
Elsevier USA
Abstract
Background: Intravascular ultrasound (IVUS)-guided drug-eluting stent
(DES) implantation is associated with fewer major adverse cardiovascular
events compared with angiography guidance for patients with individual
lesion subset. However, the beneficial effect on major adverse
cardiovascular event outcome of IVUS guidance over angiography guidance in
all-comers who undergo DES implantation still remains understudied.
<br/>Objective(s): This study aimed to determine the benefits of IVUS
guidance over angiography guidance during DES implantation in all-comer
patients. <br/>Method(s): A total of 1,448 all-comer patients who required
DES implantation were randomly assigned (1:1 ratio) to either an IVUS
guidance or angiography guidance group. The primary endpoint was
target-vessel failure (TVF) at 12 months, including cardiac death,
target-vessel myocardial infarction, and clinically driven target-vessel
revascularization (TVR). The procedure was defined as a success if all
IVUS-defined optimal criteria were met. <br/>Result(s): At 12 months
follow-up, 60 TVFs (4.2%) occurred, with 21 (2.9%) in the IVUS group and
39 (5.4%) in the angiography group (hazard ratio [HR]: 0.530; 95%
confidence interval [CI]: 0.312 to 0.901; p = 0.019). In the IVUS group,
TVF was recorded in 1.6% of patients with successful procedures, compared
with 4.4% in patients who failed to achieve all optimal criteria (HR:
0.349; 95% CI: 0.135 to 0.898; p = 0.029). The significant reduction of
clinically driven target-lesion revascularization or definite stent
thrombosis (HR: 0.407; 95% CI: 0.188 to 0.880; p = 0.018) based on
lesion-level analysis by IVUS guidance was not achieved when the
patient-level analysis was performed. <br/>Conclusion(s): The present
study demonstrates that IVUS-guided DES implantation significantly
improved clinical outcome in all-comers, particularly for patients who had
an IVUS-defined optimal procedure, compared with angiography guidance.
(Intravascular Ultrasound Guided Drug Eluting Stents Implantation in
"All-Comers" Coronary Lesions [ULTIMATE]; NCT02215915)<br/>Copyright
&#xa9; 2018 American College of Cardiology Foundation

<61>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<62>
[Use Link to view the full text]
Accession Number
620568177
Title
Diagnostic Accuracy of Coronary Computed Tomography before Aortic Valve
Replacement: Systematic Review and Meta-Analysis.
Source
Journal of Thoracic Imaging. 33 (4) (pp 207-216), 2018. Date of
Publication: 01 Jul 2018.
Author
Chaikriangkrai K.; Jhun H.Y.; Shantha G.P.S.; Abdulhak A.B.; Tandon R.;
Alqasrawi M.; Klappa A.; Pancholy S.; Deshmukh A.; Bhama J.; Sigurdsson G.
Institution
(Chaikriangkrai, Shantha, Abdulhak, Tandon, Alqasrawi, Klappa, Bhama,
Sigurdsson) Heart and Vascular Center, University of Iowa Hospitals and
Clinics, 200 Hawkins Dr, Iowa City, IA 52242, United States
(Jhun) Department of Medicine, University of Kansas Medical Center, Kansas
City, KS, United States
(Pancholy) Wright Center for Graduate Medical Education, Scranton, PA,
United States
(Deshmukh) Mayo Clinic, Rochester, MN, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: In aortic stenosis patients referred for surgical and
transcatheter aortic valve replacement (AVR), the evidence of diagnostic
accuracy of coronary computed tomography angiography (CCTA) has been
limited. The objective of this study was to investigate the diagnostic
accuracy of CCTA for significant coronary artery disease (CAD) in patients
referred for AVR using invasive coronary angiography (ICA) as the gold
standard. <br/>Material(s) and Method(s): We searched databases for all
diagnostic studies of CCTA in patients referred for AVR, which reported
diagnostic testing characteristics on patient-based analysis required to
pool summary sensitivity, specificity, positive-likelihood ratio, and
negative-likelihood ratio. Significant CAD in both CCTA and ICA was
defined by >50% stenosis in any coronary artery, coronary stent, or bypass
graft. <br/>Result(s): Thirteen studies evaluated 1498 patients (mean age,
74 y; 47% men; 76% transcatheter AVR). The pooled prevalence of
significant stenosis determined by ICA was 43%. Hierarchical summary
receiver-operating characteristic analysis demonstrated a summary area
under curve of 0.96. The pooled sensitivity, specificity, and
positive-likelihood and negative-likelihood ratios of CCTA in identifying
significant stenosis determined by ICA were 95%, 79%, 4.48, and 0.06,
respectively. In subgroup analysis, the diagnostic profiles of CCTA were
comparable between surgical and transcatheter AVR. <br/>Conclusion(s):
Despite the higher prevalence of significant CAD in patients with aortic
stenosis than with other valvular heart diseases, our meta-analysis has
shown that CCTA has a suitable diagnostic accuracy profile as a gatekeeper
test for ICA. Our study illustrates a need for further study of the
potential role of CCTA in preoperative planning for AVR.<br/>Copyright
&#xa9; 2018 Wolters Kluwer Health, Inc. All rights reserved.

<63>
Accession Number
624333574
Title
The effect of group-based cognitive behavioral therapy on inflammatory
biomarkers in patients with coronary heart disease-results from the
SUPRIM-trial.
Source
Upsala journal of medical sciences. 123 (3) (pp 167-173), 2018. Date of
Publication: 01 Sep 2018.
Author
Olsson E.M.G.; Norlund F.; Pingel R.; Burell G.; Gulliksson M.; Larsson
A.; Karlsson B.; Svardsudd K.; Held C.
Institution
(Olsson, Norlund, Held) Department of Women's and Children's Health,
Uppsala University, Uppsala, Sweden
(Pingel, Burell, Gulliksson, Karlsson, Svardsudd) Department of Public
Health and Caring Sciences, Uppsala University, Uppsala, Sweden
(Larsson) Department of Medical Sciences, Biomedical Structure and
Function, Uppsala University, Uppsala, Sweden
(Held) Department of Medical Sciences, Cardiology, Uppsala University,
Uppsala, Sweden
Publisher
NLM (Medline)
Abstract
BACKGROUND: The Secondary Prevention in Uppsala Primary Healthcare Project
(SUPRIM) is a prospective randomized controlled trial of a group-based
cognitive behavioral therapy (CBT) stress management program for coronary
heart disease (CHD) patients. The intervention reduced the risk of fatal
or non-fatal first recurrent cardiovascular (CV) events. The aim of the
present study was to analyze if the positive effects of the CBT program on
clinical outcomes could have been mediated by changes in biomarkers for
inflammation. <br/>METHOD(S): Altogether 362 patients with CHD were
randomly assigned to intervention or usual care. The inflammatory
biomarkers (VCAM-1, TNF-R1, TNF-R2, PTX3, and hs-CRP) were serially
assessed at five time points every six months from study start until 24
months later, and analyzed with linear mixed models. <br/>RESULT(S):
Baseline levels of the inflammatory markers were near normal, indicating a
stable phase. The group-based CBT stress management program did not
significantly affect the levels of inflammatory biomarkers in patients
with CHD. Three out of five (VCAM-1, TNF-R2, and PTX3) inflammatory
biomarkers showed a slight increase over time in both study groups, and
all were positively associated with age. <br/>CONCLUSION(S): Group-based
CBT stress management did not affect biomarkers for inflammation in
patients with CHD. It is therefore unlikely that inflammatory processes
including these biomarkers were mediating the effect the CBT program had
on the reduction in CV events. The close to normal baseline levels of the
biomarkers and the lack of elevated psychological distress symptoms
indicate a possible floor effect which may have influenced the results.

<64>
Accession Number
621079995
Title
Evaluation and Management of Aortic Stenosis for the Emergency Clinician:
An Evidence-Based Review of the Literature.
Source
Journal of Emergency Medicine. 55 (1) (pp 34-41), 2018. Date of
Publication: July 2018.
Author
Gottlieb M.; Long B.; Koyfman A.
Institution
(Gottlieb) Department of Emergency Medicine, Rush University Medical
Center, Chicago, Illinois, United States
(Long) Department of Emergency Medicine, San Antonio Military Medical
Center, Fort Sam Houston, Texas, United States
(Koyfman) Department of Emergency Medicine, The University of Texas
Southwestern Medical Center, Dallas, Texas, United States
Publisher
Elsevier USA
Abstract
Introduction: Aortic stenosis is a common condition among older adults
that can be associated with dangerous outcomes, due to both the disease
itself and its influence on other conditions. <br/>Objective(s): This
review provides an evidence-based summary of the current emergency
department (ED) evaluation and management of aortic stenosis.
<br/>Discussion(s): Aortic stenosis refers to significant narrowing of the
aortic valve and can be caused by calcific disease, congenital causes, or
rheumatic valvular disease. Symptoms of advanced disease include angina,
dyspnea, and syncope. Patients with these symptoms have a much higher
mortality rate than asymptomatic patients. Initial evaluation should
include an electrocardiogram, complete blood count, basic metabolic
profile, coagulation studies, troponin, brain natriuretic peptide, type
and screen, and a chest radiograph. Transthoracic echocardiogram is the
test of choice, but point-of-care ultrasound has been found to have good
accuracy when a formal echocardiogram is not feasible. Initial management
should begin with restoring preload and ensuring a normal heart rate, as
both bradycardia and tachycardia can lead to clinical decompensation. For
patients with high blood pressure and heart failure symptoms, nitrate
agents may be reasonable, but hypotension should be avoided. Dobutamine
can increase inotropy. For hypotensive patients, vasopressors should be
used at the lowest effective dose. The treatment of choice is valve
replacement, but extracorporeal membrane oxygenation and percutaneous
balloon dilatation of the aortic valve have been described as temporizing
measures. <br/>Conclusion(s): Aortic stenosis is an important condition
that can lead to dangerous outcomes and requires prompt recognition and
disease-specific management in the ED.<br/>Copyright &#xa9; 2018

<65>
Accession Number
625756754
Title
Impact of Early versus Late Initiation of Renal Replacement Therapy in
Patients with Cardiac Surgery-Associated Acute Kidney Injury:
Meta-Analysis with Trial Sequential Analysis of Randomized Controlled
Trials.
Source
BioMed Research International. 2018 (no pagination), 2018. Article Number:
6942829. Date of Publication: 2018.
Author
Cui J.; Tang D.; Chen Z.; Liu G.
Institution
(Cui) Head and Neck Surgery, Affiliated Cancer Hospital, Institute of
Guangzhou Medical University, Guangdong Province 510095, China
(Tang) Department of General Surgery, Third Xiangya Hospital, Central
South University, Changsha, Hunan Province 410008, China
(Chen) Intensive Care Unit, Shunde Hospital, Southern Medical University,
Foshan, Guangdong Province 528300, China
(Liu) Department of Pathology, Affiliated Cancer Hospital, Institute of
Guangzhou Medical University, Guangzhou, Guangdong Province 510095, China
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Background. Previous studies have examined the effect of the initiation
time of renal replacement therapy (RRT) in patients with cardiac
surgery-associated acute kidney injury (CSA-AKI), but the findings remain
controversial. The aim of this meta-analysis was to systematically and
quantitatively compare the impact of early versus late initiation of RRT
on the outcome of patients with CSA-AKI. Methods. Four databases (PubMed,
the Cochrane Library, ISI Web of Knowledge, and Embase) were
systematically searched from inception to June 2018 for randomized
clinical trials (RCTs). Two investigators independently performed the
literature search, study selection, data extraction, and quality
evaluation. Meta-analysis and trial sequential analysis (TSA) were used to
examine the impact of RRT initiation time on all-cause mortality (primary
outcome). The Grading of Recommendations Assessment Development and
Evaluation (GRADE) was used to evaluate the level of evidence. Results. We
identified 4 RCTs with 355 patients that were eligible for inclusion.
Pooled analyses indicated no difference in mortality for patients
receiving early and late initiation of RRT (relative risk [RR] = 0.61, 95%
confidence interval [CI] = 0.33 to 1.12). However, the results were not
confirmed by TSA. Similarly, early RRT did not reduce the length of stay
(LOS) in the intensive care unit (ICU) (mean difference [MD] = -1.04; 95%
CI = -3.34 to 1.27) or the LOS in the hospital (MD = -1.57; 95% CI = -4.62
to 1.48). Analysis using GRADE indicated the certainty of the body of
evidence was very low for a benefit from early initiation of RRT.
Conclusion. Early initiation of RRT had no beneficial impacts on outcomes
in patients with CSA-AKI. Future larger and more adequately powered
prospective RCTs are needed to verify the benefit of reduced mortality
associated with early initiation of RRT. Trial Registration. This trial is
registered with PROSPERO registration number CRD42018084465, registered on
11 February 2018.<br/>Copyright &#xa9; 2018 Jie Cui et al.

<66>
Accession Number
624162936
Title
Physical Activity after Cardiac EventS (PACES) - A group education
programme with subsequent text-message support designed to increase
physical activity in individuals with diagnosed coronary heart disease:
Study protocol for a randomised controlled trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 537. Date of
Publication: 04 Oct 2018.
Author
Herring L.Y.; Dallosso H.; Chatterjee S.; Bodicoat D.; Schreder S.; Khunti
K.; Yates T.; Seidu S.; Hudson I.; Davies M.J.
Institution
(Herring, Dallosso, Schreder) Leicester Diabetes Centre, University
Hospitals of Leicester, Leicester General Hospital, Leicester LE5 4PR,
United Kingdom
(Chatterjee, Bodicoat, Khunti, Yates, Seidu, Davies) Diabetes Research
Centre, College of Medicine, Biological Sciences and Psychology,
University of Leicester, Leicester LE5 4PW, United Kingdom
(Khunti) NIHR Collaboration for Leadership in Applied Health Research and
Care - East Midlands, University of Leicester, Leicester, United Kingdom
(Yates, Davies) NIHR Leicester Biomedical Research Centre, University of
Leicester, Leicester, United Kingdom
(Hudson) Department of Cardiology, Glenfield Hospital, Leicester LE3 9QP,
United Kingdom
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Coronary heart disease (CHD) represents approximately 13% of
deaths worldwide and is the leading cause of death in the UK with
considerable associated health care costs. After a CHD event, timely
cardiac rehabilitation optimises patient outcomes. However, a high
percentage of these services do not meet necessary performance indicators
such as course length and follow-up attendance. Uptake of such services is
only 50% in UK patients and support provided 12 months after an event is
often limited. To delay and prevent further CHD events leading to
hospitalisation, supplementary self-management strategies such as group
education, are necessary. <br/>Method(s): This is a single-centre,
randomised controlled trial (RCT) recruiting participants (n = 290) aged
>=18 years who are 12 to 48 months post diagnosis of a CHD-related cardiac
event (myocardial infarction, angina and any other acute coronary
syndrome). The study aims to implement a structured education programme,
with text-message support over 12 months, and identify whether delivery of
the programme, to individuals who have a history of a cardiac event, would
be an effective and cost-effective strategy for increasing walking. The
primary outcome, objectively measured average daily physical activity,
specifically step count through walking activity, is assessed using the
wrist-worn GENEActiv accelerometer at baseline, 6 and 12 months. Secondary
outcomes at 12 months include cardiovascular risk factors such as smoking
status, blood pressure, lipid profile, glycated haemoglobin (HbA1c),
obesity, self-efficacy, quality of life, physical activity and physical
function. Participants are randomised to either the control group
receiving standard care and a physical activity information leaflet, or
the intervention group whose partcipants receive the leaflet and are
invited to attend two group-based structured education sessions. These
encourage participants to adopt and maintain healthy behaviours and
self-manage their lifestyle. They are delivered approximately 2 weeks
apart by trained facilitators and reinforced via subsequent text-message
support. <br/>Discussion(s): To our knowledge, this is the first trial
designed to assess the effectiveness of a group education programme 12 to
48 months after a CHD event diagnosis. If successful, the PACES programme
could be translated into effective post-operative cardiac care and
complement the current post-operative services available. Trial
registration: ISRCTN, ID: ISRCTN91163727. The trial was registered on 27
February 2017.<br/>Copyright &#xa9; 2018 The Author(s).

<67>
Accession Number
622002880
Title
Repetitive levosimendan for a LION's heart?.
Source
European Journal of Heart Failure. 20 (7) (pp 1137-1138), 2018. Date of
Publication: July 2018.
Author
Altenberger J.; Polzl G.
Institution
(Altenberger) Cardiac Rehabilitation Center Grossgmain,
Pensionsversicherungsanstalt, Teaching Hospital of Paracelsus Medical
Private University, Salzburg, Austria
(Polzl) Medical University Innsbruck, Department of Internal Medicine III,
Innsbruck, Austria
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)

<68>
Accession Number
613696739
Title
Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention
in Patients with Left Ventricular Systolic Dysfunction.
Source
Angiology. 68 (1) (pp 19-28), 2017. Date of Publication: 01 Jan 2017.
Author
Zhang D.; Lyu S.; Song X.; Yuan F.; Xu F.; Zhang M.
Institution
(Zhang, Lyu, Song, Yuan, Xu, Zhang, Zhang) Department of Cardiology,
Beijing Institute of Heart, Lung and Blood Vessel Disease, Capital Medical
University, Beijing Anzhen Hospital, Anzhenli Avenue, Chao Yang District,
Beijing 100029, China
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
The optimal method of coronary revascularization for patients with
coronary artery disease (CAD) and left ventricular (LV) systolic
dysfunction is unclear. The purpose of this meta-analysis was to compare
coronary artery bypass grafting (CABG) and percutaneous coronary
intervention (PCI) in these patients. Two investigators independently
searched PubMed, EMBASE, and the Cochrane Controlled Trials Register
databases for relevant studies. Four prospective and 5 retrospective
studies, published before March 2015, involving 6082 patients were
included. Compared with PCI, CABG was significantly associated with lower
long-term death (odds ratio [OR]: 0.82, 95% confidence interval [CI]:
0.70-0.96, P =.01, I ² = 0%), myocardial infarction (OR: 0.58,
95% CI: 0.36-0.95, P =.03, I ² = 44%), and repeat
revascularization (OR: 0.17, 95% CI: 0.14-0.22, P <.001, I ² =
32%). The short-term death rate was comparable between CABG and PCI (OR:
2.09, 95% CI: 0.80-5.45, P =.13, I ² = 9%). Coronary artery
bypass grafting has long-term benefits compared with PCI in patients with
CAD and LV dysfunction.<br/>Copyright &#xa9; The Author(s) 2016.

<69>
Accession Number
2001306417
Title
Meta-Analysis Comparing Mitral Valve Repair Versus Replacement for
Degenerative Mitral Regurgitation Across All Ages.
Source
American Journal of Cardiology. 123 (3) (pp 446-453), 2019. Date of
Publication: 1 February 2019.
Author
Jung J.C.; Jang M.-J.; Hwang H.Y.
Institution
(Jung, Hwang) Department of Thoracic and Cardiovascular Surgery, Seoul
National University Hospital, Seoul National University College of
Medicine, Seoul, South Korea
(Jang) Medical Research Collaborating Center, Seoul National University
Hospital, Seoul National University College of Medicine, Seoul, South
Korea
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Although current guidelines recommend mitral valve repair (MVr) over
mitral valve replacement (MVR) for patients with mitral regurgitation
(MR), it is unclear if it should be also recommended in elderly patients
with limited life expectancy. This study was conducted to compare the
results of MVr with those of MVR to determine the optimal treatment option
for patients with degenerative MR, particularly according to the patient's
age. A literature search of 5 electronic databases was performed. The
primary outcome was all-cause mortality. The secondary outcomes included
early mortality and freedom from reoperation. A metaregression analysis
and subgroup analysis were performed according to the mean age of the
study population. Twelve retrospective studies (2,950 and 1,252 patients
in the MVr and MVR groups, respectively) were selected. Pooled analyses
demonstrated that the risk of all-cause mortality was significantly higher
in the MVR group than in the MVr group both in all studies and in studies
presenting adjusted results (hazard ratio[95% confidence interval] =
1.57[1.39 to 1.77] and 1.53[1.34 to 1.74], respectively). This benefit was
similar across all ages when the metaregression analysis and the subgroup
analysis were performed (p = 0.879 and 0.123, respectively). Early
mortality and risk of reoperation were also higher in the MVR group than
in the MVr group (risk ratio[95% confidence interval] = 4.51[3.12 to 6.51]
and hazard ratio[95% confidence interval] = 1.47[1.09 to 1.98],
respectively). In conclusion, this study indicates that MVr is beneficial
compared with MVR in patients with degenerative MR regardless of patients'
age in terms of all-cause mortality.<br/>Copyright &#xa9; 2018 Elsevier
Ltd

<70>
Accession Number
625708457
Title
Epidural Dexmedetomidine Reduces the Requirement of Propofol during Total
Intravenous Anaesthesia and Improves Analgesia after Surgery in Patients
undergoing Open Thoracic Surgery.
Source
Scientific reports. 7 (1) (pp 3992), 2017. Date of Publication: 21 Jun
2017.
Author
Zeng X.; Jiang J.; Yang L.; Ding W.
Institution
(Zeng, Jiang, Yang, Ding) Department of Anaesthesiology, Second Hospital
of Harbin Medical University, 246 Xuefu Road, Harbin, Heilongjiang 150001,
China
Abstract
The aim of this study was to assess the systemic and analgesic effects of
epidural dexmedetomidine in thoracic epidural anaesthesia (TEA) combined
with total intravenous anaesthesia during thoracic surgery. Seventy-one
patients undergoing open thoracotomy were included in this study and
randomly divided into three groups: Control group (Group C): patients
received TEA with levobupivacaine alone and were intravenously infused
with saline; Epidural group (Group E): patients received TEA with
levobupivacaine and dexmedetomidine, and were intravenously infused with
saline; Intravenous group (group V): patients received TEA with
levobupivacaine alone and were intravenously infused with dexmedetomidine.
The doses of propofol used in the induction and maintenance of general
anaesthesia, cardiovascular response, dose and first time of postoperative
analgesia and verbal rating scale were recorded. The induction and
maintenance were significantly lower in the Groups E and V. Verbal rating
scale and postoperative analgesic requirements were significantly lower in
Group E than in Groups C and V. Patients in Group C had more severe
cardiovascular responses, as compared with Groups E and V. Epidural
administration of dexmedetomidine reduced the induction and maintenance of
propofol, and inhibited the cardiovascular response after intubation and
extubation. Moreover, epidural dexmedetomidine provided better analgesia
after open thoracotomy.

<71>
Accession Number
625692274
Title
The efficacy and side effects of dexmedetomidine and morphine in
patient-controlled analgesia method after coronary artery bypass grafting
surgery.
Source
International Journal of Pharmaceutical Research. 10 (1) (pp 251-256),
2018. Date of Publication: January-March 2018.
Author
Anvaripour A.; Ashkpour H.; Marashian M.; Mirzaei K.; Jahangirifard A.
Institution
(Anvaripour) Anesthesiology and Critical Care Department, Bushehr
University of Medical Sciences, Bushehr, Iran, Islamic Republic of
(Ashkpour) Bushehr University of Medical Sciences, Bushehr, Iran, Islamic
Republic of
(Marashian) Chronic Respiratory disease Research Center, National Research
institute of Tuberculosis and Lung disease(NRITLD), Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Mirzaei) Bushehr University of Medical Sciences, Bushehr, Iran, Islamic
Republic of
(Jahangirifard) Lung Transplantation Research Center, National Research
Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Advanced Scientific Research
Abstract
Background: The current study headed to conduct this comparison byusing
PCA to find the final effects of both drugs on pain and other common
complications among patients who suffered CABG surgery in a ICU in
Southwest of Iran. <br/>Method(s): Through a randomized clinical trial
(RCT) 83 patients, 40-80 years of age, who were suitable candidates for
elective CABG surgery enrolled the study. From the patients 42 were in a
group of patients who were administered PCA with 100cc saline in addition
to 200mcgdexmedetomidine and 4mg of ondansetron at the pace of 0.7
mcg/kg/h while 41experienced 100cc saline, 10mg morphine and 4mg
ondansetron by PCA with 0.015 mg/kg/h infusion pace in the first 24 hours
after surgery. Systolic, diastolic, mean blood pressure and heart rate
were checked every 2 hours for a total time of 14 hours after weaning.
Sedation level was checked every 1 hours by the "Ramsay" criteria and
weaning was done considering the criteria. <br/>Result(s): Data showed no
statistical differences in the scores of immediately after extubating and
12 and 24 hours later between the groups. Repeated measure test determined
an improvement in the severity of pain as time went on similarly for both
groups. <br/>Conclusion(s): As dexmedetomidine had similar effects to
morphine on pain and hemodynamic features during first 24 hours of surgery
as well as extubating time, sedation level and additional demand for
analgesics, it would be a perfect alteration for morphine at least
postoperatively. Analysis showed the same frequency of nausea and vomiting
in the two groups of the current study.<br/>Copyright &#xa9; 2019,
Advanced Scientific Research. All rights reserved.

<72>
Accession Number
625834028
Title
The effect of local anesthetic continuous wound infusion for the
prevention of postoperative pneumonia after on-pump cardiac surgery with
sternotomy: the STERNOCAT randomized clinical trial.
Source
Intensive Care Medicine. (no pagination), 2019. Date of Publication: 2019.
Author
Amour J.; Cholley B.; Ouattara A.; Longrois D.; Leprince P.; Fellahi
J.-L.; Riou B.; Hariri S.; Latremouille C.; Remy A.; Provenchere S.;
Carillion A.; Achouh P.; Labrousse L.; Tran Dinh A.; Ait Hamou N.;
Charfeddine A.; Lafourcade A.; Hajage D.; Bougle A.; Puybasset L.;
Margetis D.; Lebreton G.; Laalie M.; Barreda T.; D'Alessandro C.;
Boughenou M.-F.; Bel A.; Jouan J.; Du Puy Montbrun L.; Menasche P.;
Quessard A.
Institution
(Amour, Hariri, Carillion, Ait Hamou, Charfeddine, Bougle) Department of
Anesthesiology and Critical Care Medicine, Pitie-Salpetriere Hospital,
Institut de Cardiologie, Reanimation de Chirurgie Cardiaque, Sorbonne
Universite, UMR INSERM 1166, IHU ICAN, Assistance Publique-Hopitaux de
Paris (AP-HP), 47-83 Boulevard de l'Hopital, Paris 75013, France
(Cholley) Department of Anesthesiology and Critical Care Medicine, Hopital
Europeen Georges Pompidou, Universite Paris-Descartes, Sorbonne Paris
Cite, AP-HP, Paris, France
(Ouattara, Remy) Biology of Cardiovascular Diseases and Department of
Anesthesiology and Critical Care, Magellan Medico-Surgical Center,
University of Bordeaux, INSERM, UMR 1034, Bordeaux, France
(Longrois, Provenchere, Tran Dinh) Department of Anesthesiology and
Critical Care Medicine, Hopital Bichat-Claude Bernard, Unite INSERM U1148
(Laboratory for Vascular Translational Science), Universite Paris-Diderot,
Sorbonne Paris Cite, AP-HP, Paris, France
(Leprince) Department of Cardiovascular and Thoracic Surgery,
Pitie-Salpetriere Hospital, Sorbonne Universite, UMR INSERM 1166, IHU
ICAN, Assistance Publique-Hopitaux de Paris (AP-HP), Paris, France
(Fellahi) Universite Claude Bernard Lyon 1, Inserm U1060, Department of
Anesthesiology and Critical Care Medicine, Hopital Louis Pradel, Hospices
Civils de Lyon, Lyon, France
(Riou) Department of Emergency Medicine and Surgery, Pitie-Salpetriere
Hospital, Sorbonne Universite, UMR INSERM 1166, IHU ICAN, Assistance
Publique-Hopitaux de Paris (AP-HP), Paris, France
(Latremouille, Achouh) Department of Cardiovascular and Thoracic Surgery,
Hopital Europeen Georges Pompidou, Universite Paris-Descartes, Sorbonne
Paris Cite, AP-HP, Paris, France
(Labrousse) Department of Cardiovascular and Thoracic Surgery, Magellan
Medico-Surgical Center, University of Bordeaux, INSERM, UMR 1034,
Bordeaux, France
(Lafourcade, Hajage) Department of Biostatistic, Public Health and Medical
Information, Pitie-Salpetriere Hospital, Sorbonne Universite, Assistance
Publique-Hopitaux de Paris (AP-HP), Paris, France
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Postoperative pain after cardiac surgery, exacerbated by cough
and sternal mobilization, limits clearance of bronchopulmonary secretions
and may predispose to postoperative pneumonia. In this study, we tested
the ability of local anesthetic continuous wound infusion to prevent
pneumonia after cardiac surgery with sternotomy and cardiopulmonary bypass
(CPB) owing to better analgesia and bronchopulmonary drainage.
<br/>Method(s): In this randomized, double-blind, placebo-controlled trial
conducted in five academic centers, patients undergoing cardiac surgery
with sternotomy and CPB were enrolled from February 2012 until November
2014, and were followed over 30 days. Patients were assigned to a 48-h
infusion (10 ml h^-1) of l-bupivacaine (12.5 mg h^-1)
or placebo (saline) via a pre-sternal multiperforated catheter. Anesthesia
and analgesia protocols were standardized. The primary end point was the
incidence of pneumonia during the study period, i.e., until hospital
discharge or 30 days. We hypothesized a 30% reduction in the incidence of
pneumonia. <br/>Result(s): Among 1493 randomized patients, 1439 completed
the trial. Pneumonia occurred in 36/746 patients (4.9%) in the
l-bupivacaine group and in 42/739 patients (5.7%) in the placebo group
(absolute risk difference taking into account center and baseline risk of
postoperative pneumonia, - 1.3% [95% CI - 3.4; 0.8] P = 0.22). In the
predefined subgroup of patients at high risk, l-bupivacaine decreased the
incidence of pneumonia (absolute risk difference, - 5.6% [95% CI - 10.0; -
1.1], P = 0.01). <br/>Conclusion(s): After cardiac surgery with
sternotomy, continuous wound infusion of l-bupivacaine failed to decrease
the incidence of pneumonia. These findings do not support the use of local
anesthetic continuous wound infusion in this indication. Further study
should investigate its effect in high-risk patients. Trial registration:
EudraCT Number: 2011-003292-10; Clinicaltrials.gov Identifier:
NCT01648777.<br/>Copyright &#xa9; 2018, Springer-Verlag GmbH Germany, part
of Springer Nature.

<73>
Accession Number
625833075
Title
Optimization of heart allocation: The transplant risk score.
Source
American Journal of Transplantation. (no pagination), 2018. Date of
Publication: 2018.
Author
Jasseron C.; Legeai C.; Jacquelinet C.; Nubret-Le Coniat K.; Flecher E.;
Cantrelle C.; Audry B.; Bastien O.; Dorent R.
Institution
(Jasseron, Legeai, Jacquelinet, Cantrelle, Audry, Bastien, Dorent) Agence
de la Biomedecine, Direction Prelevement Greffe Organes-Tissus,
Saint-Denis La Plaine, France
(Nubret-Le Coniat) Departement d'Anesthesie-Reanimation II, Centre
Hospitalier Universitaire de Bordeaux, Pessac, France
(Flecher) Service de Chirurgie Cardio-Vasculaire, Centre Hospitalier
Universitaire de Rennes, Rennes, France
Publisher
Blackwell Publishing Ltd
Abstract
The new French heart allocation system is designed to minimize waitlist
mortality and extend the donor pool without a detrimental effect on
posttransplant survival. This study was designed to construct a 1-year
posttransplant graft-loss risk score incorporating recipient and donor
characteristics. The study included all adult first single-organ
recipients transplanted between 2010 and 2014 (N = 1776). This population
was randomly divided in a 2:1 ratio into derivation and validation
cohorts. The association of variables with 1-year graft loss was
determined with a mixed Cox model with center as random effect. The
predictors were used to generate a transplant-risk score (TRS).
Donor-recipient matching was assessed using 2 separate recipient- and
donor-risk scores. Factors associated with 1-year graft loss were
recipient age >50 years, valvular cardiomyopathy and congenital heart
disease, previous cardiac surgery, diabetes, mechanical ventilation,
glomerular filtration rate and bilirubin, donor age >55 years, and donor
sex: female. The C-index of the final model was 0.70. Correlation between
observed and predicted graft loss rate was excellent for the overall
cohort (r = 0.90). Hearts from high-risk donors transplanted to low-risk
recipients had similar survival as those from low-risk donors. The TRS
provides an accurate prediction of 1-year graft-loss risk and allows
optimal donor-recipient matching.<br/>Copyright &#xa9; 2018 The American
Society of Transplantation and the American Society of Transplant Surgeons

<74>
Accession Number
622171559
Title
EQ-5D studies in cardiovascular diseases in eight Central and Eastern
European countries: A systematic review of the literature.
Source
Kardiologia Polska. 76 (5) (pp 860-870), 2018. Date of Publication: 11 May
2018.
Author
Batog P.; Rencz F.; Pentek M.; Gulacsi L.; Filipiak K.J.; Rupel V.P.;
Simon J.; Brodszky V.; Baji P.; Zavada J.; Petrova G.; Rotar A.; Golicki
D.
Institution
(Batog) Department of Experimental and Clinical Pharmacology, Medical
University of Warsaw, Warsaw, Poland
(Rencz, Pentek, Gulacsi, Brodszky, Baji) Corvinus University of Budapest,
Department of Health Economics, Budapest, Hungary
(Rencz) Hungarian Academy of Sciences, Premium Postdoctoral Research
Programme, Budapest, Hungary
(Filipiak) 1st Department of Cardiology, Medical University of Warsaw,
Warsaw, Poland
(Rupel) Institute for Economic Research, Ljubljana, Slovenia
(Simon) Department of Health Economics, Centre for Public Health, Medical
University of Vienna, Vienna, Austria
(Zavada) Institute of Rheumatology, Prague, Czech Republic
(Petrova) Department of Social Pharmacy and Pharmacoeconomics, Faculty of
Pharmacy, Medical University, Sofia, Bulgaria
(Rotar) Department of Social Medicine, University of Amsterdam, Amsterdam,
Netherlands
(Golicki) Department of Experimental and Clinical Pharmacology, Medical
University of Warsaw, ul. Banacha 1B, Warszawa 02-097, Poland
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: The measurement of health-related quality of life (HRQoL) by
validated generic instruments, such as EQ-5D, has become an increasingly
important tool for the assessment of health care in a wide range of
diagnoses. <br/>Aim(s): We aimed to systematically review EQ-5D literature
on cardiovascular diseases in eight Central and Eastern European (CEE)
countries. <br/>Method(s): A structured literature search was conducted in
MEDLINE, EMBASE, Web of Science, CINAHL, PsycINFO, Cochrane Library, and
the EuroQol website up to November 2016. Original cardiovascular-related
studies that reported EQ-5D results were included. <br/>Result(s): Of the
36 papers, 17 reported EQ-5D index scores. Most studies were performed in
Poland (n = 24, 67%). The most common diagnosis regarding the number of
publications and population size was ischaemic heart disease (n = 13, N =
6394), followed by atrial fibrillation (n = 4, N = 1052). The average
EQ-5D index scores ranged from 0.61 to 0.88 and from 0.66 to 0.95 for
patients before and after cardiac procedure/surgery, respectively
(including angioplasty, coronary artery bypass grafting, ablation,
surgical correction of septal defects, transcatheter aortic valve
implantation [TAVI]). In all studies baseline scores were lower than the
repeated assessments after the procedure, with the most substantial
improvement of 0.24 in high-risk elderly patients after TAVI. Studies
which did not assess invasive treatment reported mean EQ-5D index scores
ranging from 0.18 to 0.80. <br/>Conclusion(s): The number of
cardiovascular-related studies reporting HRQoL using EQ-5D has
consistently increased in CEE countries over the past decade and is
outstanding compared with other clinical fields. The EQ-5D index and EQ
VAS scores varied based on the disease severity, patient characteristics,
and treatment protocol.<br/>Copyright &#xa9; Polish Cardiac Society 2018.

<75>
Accession Number
618782328
Title
Peri-operative continuation of metformin does not improve glycaemic
control in patients with type 2 diabetes: A randomized controlled trial.
Source
Diabetes, Obesity and Metabolism. 20 (3) (pp 749-752), 2018. Date of
Publication: March 2018.
Author
Hulst A.H.; Polderman J.A.W.; Ouweneel E.; Pijl A.J.; Hollmann M.W.;
DeVries J.H.; Preckel B.; Hermanides J.
Institution
(Hulst, Polderman, Ouweneel, Hollmann, Preckel, Hermanides) Department of
Anaesthesiology, Academic Medical Centre, University of Amsterdam,
Amsterdam, Netherlands
(Pijl) Department of Anaesthesiology, Medical Centre Slotervaart,
Amsterdam, Netherlands
(DeVries) Department of Internal Medicine, Academic Medical Centre,
University of Amsterdam, Amsterdam, Netherlands
Publisher
Blackwell Publishing Ltd
Abstract
Historically, metformin was withheld before surgery for fear of
metformin-associated lactic acidosis. Currently, however, this risk is
deemed to be low and guidelines have moved towards the continuation of
metformin. We hypothesized that continuing metformin peri-operatively
would lower postoperative serum glucose level without an effect on plasma
lactate levels. We performed a single-blind multicentre randomized
controlled trial in people with type 2 diabetes mellitus scheduled for
non-cardiac surgery and continued (MF+ group) or withheld (MF- group)
metformin before surgery. The main outcome measures were the differences
in peri-operative plasma glucose and lactate levels. We randomized 70
patients (37 MF+ group and 33 MF- group) with type 2 diabetes mellitus.
Postoperative glucose levels were similar in the MF+ and the MF- groups
(8.2 +/- 1.8 vs 8.3 +/- 2.3 mmol/L P =.95) Although preoperative lactate
levels were slightly higher in the MF+ group compared with the MF- group
(1.5 vs 1.2 mmol/L; P =.02), the postoperative lactate levels were not
significantly different (1.2 vs 1.0 mmol/L; P =.18). In conclusion,
continuation of metformin during elective non-cardiac surgery does not
improve glucose control or raise lactate levels to a clinically relevant
degree.<br/>Copyright &#xa9; 2017 John Wiley & Sons Ltd

<76>
Accession Number
620134307
Title
Differences in left ventricular remodelling in patients with aortic
stenosis treated with transcatheter aortic valve replacement with
corevalve prostheses compared to surgery with porcine or bovine biological
prostheses.
Source
European Heart Journal Cardiovascular Imaging. 19 (1) (pp 39-46), 2018.
Date of Publication: 01 Jan 2018.
Author
Ngo A.; Hassager C.; Thyregod H.G.Ho.; Sondergaard L.; Olsen P.S.;
Steinbruchel D.; Hansen P.B.; Kjaergaard J.; Winther-Jensen M.; Ihlemann
N.
Institution
(Ngo) Department of Cardiology, Zealand University Hospital, Roskilde
4000, Denmark
(Hassager, Sondergaard, Kjaergaard, Winther-Jensen, Ihlemann) Department
of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen
2100, Denmark
(Thyregod, Olsen) Department of Cardiothoracic Surgery, Rigshospitalet,
Copenhagen University Hospital, Copenhagen 2100, Denmark
(Steinbruchel) Emergency Department, Nykobing Falster Hospital, Nykobing
Falster 4800, Denmark
(Hansen) Department of Cardiac Anesthesia, Rigshospitalet, Copenhagen
University Hospital, Copenhagen 2100, Denmark
Publisher
Oxford University Press
Abstract
Aims Patients with severe aortic stenosis (AS) can be considered for
treatment with either transcatheter (TAVR) or surgical aortic valve
replacement (SAVR). The purpose of this study was to compare left
ventricular (LV) remodeling in patients with AS after treatment with TAVR
or SAVR. Methods and results This is an echocardiographic substudy of the
NOTION trial, a randomized all-comers trial comparing TAVR with SAVR in
patients above 70 years of age. Transthoracic echocardiograms were
performed at baseline, 3 and 12 months after TAVR and SAVR. About 232
patients were included in the study, 120 were randomized to TAVR and 112
to SAVR. From baseline to 12 months post-procedure, aortic valve area
(AVA) increased in both groups, but with a larger increase in the TAVR
group (0.65 +/- 0.04 cm 2 vs. 1.02 +/- 0.05 cm 2 for SAVR and TAVR group,
P < 0.0001). At 12 months, LV mass regression was more pronounced in the
SAVR group as compared with TAVR (17.5% vs. 7.2%, P < 0.001). In the TAVR
group at 12 months, end diastolic volume (EDV) increased by 10.2 +/- 2.5
ml and, in the SAVR group, EDV decreased by 15.4 +/- 2.6 ml with a
statistically significant difference between the two groups (P < 0.0001).
Paravalvular leakage (PVL) and pacemaker implantations were more common in
patients treated with TAVR, which was associated with an increase in EDV
(P < 0.01). Conclusion Patients undergoing SAVR had a larger LV mass
regression at 1 year compared with patients undergoing TAVR, which may be
due to increasing amounts of PVL and pacemakers in the TAVR group.
Published on behalf of the European Society of Cardiology. All rights
reserved.<br/>Copyright &#xa9; The Author 2017. For permissions, please
email: journals.permissions@oup.com.

<77>
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
Rodseth R.; 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.; 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. <br/>Method(s): In this international,
randomised, placebo-controlled trial, we recruited patients from 84
hospitals in 19 countries. Eligible patients were aged at least 45 years,
had undergone non-cardiac surgery, and were within 35 days of MINS.
Patients were randomly assigned (1:1) to receive dabigatran 110 mg orally
twice daily or matched placebo for a maximum of 2 years or until
termination of the trial and, using a partial 2-by-2 factorial design,
patients not taking a proton-pump inhibitor were also randomly assigned
(1:1) to omeprazole 20 mg once daily, for which results will be reported
elsewhere, or matched placebo to measure its effect on major upper
gastrointestinal complications. Research personnel randomised patients
through a central 24 h computerised randomisation system using block
randomisation, stratified by centre. Patients, health-care providers, data
collectors, and outcome adjudicators were masked to treatment allocation.
The primary efficacy outcome was the occurrence of a major vascular
complication, a composite of vascular mortality and non-fatal myocardial
infarction, non-haemorrhagic stroke, peripheral arterial thrombosis,
amputation, and symptomatic venous thromboembolism. The primary safety
outcome was a composite of life-threatening, major, and critical organ
bleeding. Analyses were done according to the intention-to-treat
principle. This trial is registered with ClinicalTrials.gov, number
NCT01661101. <br/>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). <br/>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. <br/>Funding(s):
Boehringer Ingelheim and Canadian Institutes of Health
Research.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<78>
Accession Number
624784470
Title
Interaction between warfarin and cannabis.
Source
Basic and Clinical Pharmacology and Toxicology. 124 (1) (pp 28-31), 2019.
Date of Publication: January 2019.
Author
Damkier P.; Lassen D.; Christensen M.M.H.; Madsen K.G.; Hellfritzsch M.;
Pottegard A.
Institution
(Damkier, Christensen, Hellfritzsch) Department of Clinical Biochemistry
and Pharmacology, Odense University Hospital, Odense, Denmark
(Damkier, Christensen) Department of Clinical Research, University of
Southern Denmark, Odense, Denmark
(Lassen) Department of Oncology, Aarhus University Hospital, Aarhus,
Denmark
(Christensen) Hospital Pharmacy, Hospital of South West Denmark, Esbjerg,
Denmark
(Madsen) Department of Oncology, Odense University Hospital, Odense,
Denmark
(Madsen, Hellfritzsch, Pottegard) Clinical Pharmacology and Pharmacy,
Department of Public Health, University of Southern Denmark, Odense,
Denmark
Publisher
Blackwell Publishing Ltd
Abstract
Delta-9-tetrahydrocannabinol (THC), the main psychoactive cannabinoid in
cannabis, may inhibit the cytochrome P450 enzyme CYP2C9. Consequently,
cannabis use might infer a risk of drug-drug interaction with substrates
for this enzyme, which includes drugs known to have a narrow therapeutic
window. In this study, we describe a case report of a 27-year-old man
treated with warfarin due to mechanical heart valve replacement who
presented with elevated international normalized ratio (INR) value (INR =
4.6) following recreational cannabis use. We conducted a review of the
available literature, using the PubMed and EMBASE databases while
following PRISMA guidelines. Following screening of 85 articles, three
eligible articles were identified, including one in vitro study and two
case reports. The in vitro study indicated that THC inhibits the
CYP2C9-mediated metabolism of warfarin. One case study reported of a man
who on two occasions of increased marijuana use experienced INR values
above 10 as well as bleeding. The other case study reported of a patient
who initiated treatment with a liquid formulation of cannabidiol for the
management of epilepsy, ultimately necessitating a 30% reduction in
warfarin dose to maintain therapeutic INR values. The available, although
sparse, data suggest that use of cannabinoids increases INR values in
patients receiving warfarin. Until further data are available, we suggest
patients receiving warfarin be warned against cannabis use.<br/>Copyright
&#xa9; 2018 Nordic Association for the Publication of BCPT (former Nordic
Pharmacological Society)

<79>
Accession Number
625530950
Title
Association of L-arginine supplementation with markers of endothelial
function in patients with cardiovascular or metabolic disorders: A
systematic review and meta-analysis.
Source
Nutrients. 11 (1) (no pagination), 2019. Article Number: 15. Date of
Publication: January 2019.
Author
Rodrigues-Krause J.; Krause M.; da Rocha I.M.G.; Umpierre D.; Fayh A.P.T.
Institution
(Rodrigues-Krause) School of Physical Education, Federal University of Rio
Grande do Sul, Felizardo Strees 750, Porto Alegre, RS 90690-200, Brazil
(Krause) Laboratory of Inflammation, Metabolism and Exercise Research
(LAPIMEX) and Laboratory of Cellular Physiology, Department of Physiology,
Institute of Basic Health Sciences, Federal University of Rio Grande do
Sul, Sarmento Leite Street 750, Porto Alegre, RS 90035-190, Brazil
(da Rocha, Fayh) Graduation Program in Nutrition, Federal University of
Rio Grande do Norte, Senador Salgado Filho Street 3000, Natal, RN
59078-970, Brazil
(Umpierre) Department of Public Health, Federal University of Rio Grande
do Sul, Sao Manuel Street S/N, Porto Alegre, RS 90620-110, Brazil
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
L-Arginine supplementation is a potential therapy for treating
cardiovascular and metabolic diseases. However, the use of distinct
L-arginine sources, intervened populations, and treatment regimens may
have yielded confusion about their efficacy. This research constitutes a
systematic review and meta-analysis summarizing the effects of L-arginine
supplementation compared to placebo in individuals with cardiovascular
disease (CVD), obesity, or diabetes. Eligibility criteria included
randomized clinical trials and interventions based on oral supplementation
of L-arginine with a minimum duration of three days; comparison groups
consisted of individuals with the same disease condition receiving an oral
placebo substance. The primary outcome was flow-mediated dilation, and
secondary outcomes were nitrite/nitrate (NOx) rate and asymmetric
dimethylarginine (ADMA). Statistical heterogeneity among studies included
in the meta-analyses was assessed using the inconsistency index (I2).
Fifty-four full-text articles from 3761 retrieved references were assessed
for eligibility. After exclusions, 13 studies were included for data
extraction. There was no difference in blood flow after post-ischemic
hyperemia between the supplementation of L-arginine and placebo groups
before and after the intervention period (standardized mean difference
(SMD) = 0.30; 95% confidence intervals (CIs) = -0.85 to 1.46; I2 = 96%).
Sensitivity analysis showed decreased heterogeneity when the studies that
most favor arginine and placebo were removed, and positive results in
favor of arginine supplementation were found (SMD = 0.59; 95% CIs = 0.10
to 1.08; I2 = 75%). No difference was found in meta-analytical estimates
of NOx and ADMA responses between arginine or placebo treatments. Overall,
the results indicated that oral L-arginine supplementation was not
associated with improvements on selected variables in these patients
(PROSPERO Registration: CRD42017077289).<br/>Copyright &#xa9; 2018 by the
authors. Licensee MDPI, Basel, Switzerland.

<80>
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).
<br/>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. <br/>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).
<br/>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.<br/>Copyright &#xa9; 2018
The Author(s).

<81>
Accession Number
621756065
Title
Oropharyngeal and nasopharyngeal decontamination with chlorhexidine
gluconate in lung cancer surgery: a randomized clinical trial.
Source
Intensive Care Medicine. 44 (5) (pp 578-587), 2018. Date of Publication:
01 May 2018.
Author
D'Journo X.B.; Falcoz P.-E.; Alifano M.; Le Rochais J.-P.; D'Annoville T.;
Massard G.; Regnard J.F.; Icard P.; Marty-Ane C.; Trousse D.; Doddoli C.;
Orsini B.; Edouard S.; Million M.; Lesavre N.; Loundou A.; Baumstarck K.;
Peyron F.; Honore S.; Dizier S.; Charvet A.; Leone M.; Raoult D.; Papazian
L.; Thomas P.A.
Institution
(D'Journo, Trousse, Doddoli, Orsini, Thomas) Service de Chirurgie
Thoracique, Chemin des Bourrely, Hopital Nord, Assistance Publique
Hopitaux de Marseille, Aix-Marseille University, Marseille cedex 20 13915,
France
(Falcoz, Massard) Service de Chirurgie Thoracique, Nouvel Hopital Civil,
Strasbourg University, Strasbourg, France
(Alifano, Regnard) Service de Chirurgie Thoracique, Hopital Cochin,
Assistance Publique Hopitaux de Paris, Paris Descartes University, Paris,
France
(Le Rochais, Icard) Service de Chirurgie Thoracique, Hopital de la cote de
Nacre, Caen University, Caen, France
(D'Annoville, Marty-Ane) Service de Chirurgie Thoracique, Hopital Arnaud
de Villeneuve, Montpellier University, Montpellier, France
(D'Journo, Doddoli, Edouard, Million, Leone, Raoult, Thomas) Unite de
Recherche sur les Maladies Infectieuses et Tropicales Emergentes
(URMITE),UM63, CNRS 7278, IRD 198 INSERM U1095, Institut
Hospitalo-Universitaire Mediterranee Infection, Marseille Aix-Marseille
Univ., Marseille, France
(Lesavre, Leone) Centre d'Investigation Clinique, Hopital Nord, Assistance
Publique Hopitaux de Marseille, Aix-Marseille University, Marseille,
France
(Loundou, Baumstarck) Unite d'aide methodologique, Assistance Publique
Hopitaux de Marseille, Aix-Marseille University, Marseille, France
(Peyron, Honore) Service Clinique de Pharmacologie, Assistance Publique
Hopitaux de Marseille, Aix-Marseille University, Marseille, France
(Dizier, Charvet, Leone) Service d'Anesthesie-Reanimation, Hopital Nord,
Assistance Publique Hopitaux de Marseille, Aix-Marseille University,
Marseille, France
(Papazian) Reanimation des Detresses Respiratoires et Infections Severes,
Hopital Nord, Assistance Publique Hopitaux de Marseille, Aix-Marseille
University, Marseille, France
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Respiratory complications are the leading causes of morbidity and
mortality after lung cancer surgery. We hypothesized that oropharyngeal
and nasopharyngeal decontamination with chlorhexidine gluconate (CHG)
would be an effective method to reduce these complications as reported in
cardiac surgery. <br/>Method(s): In this multicenter parallel-group
randomized double-blind placebo-controlled trial, we enrolled consecutive
adults scheduled for anatomical pulmonary resection for lung cancer.
Perioperative decontamination consisted in oropharyngeal rinse solution
(0.12% CHG) and nasopharyngeal soap (4% CHG) or a placebo. The primary
outcome measure was the proportion of patients requiring postoperative
invasive and/or noninvasive mechanical ventilation (MV). Secondary outcome
measures included occurrence of respiratory and non-respiratory
healthcare-associated infections (HAIs) and outcomes within 90 days.
<br/>Result(s): Between July 2012 and April 2015, 474 patients were
randomized. Of them, 24 had their surgical procedure cancelled or withdrew
consent. The remaining 450 patients were included in a modified
intention-to-treat analysis: 226 were allocated to CHG and 224 to the
placebo. Proportions of patients requiring postoperative MV were not
significantly different [CHG 14.2%; placebo 15.2%; relative risks (RRs)
0.93; 95% confidence interval (CI) 0.59-1.45; P = 0.76]. Neither of the
proportions of patients with respiratory HAIs were different (CHG 13.7%;
placebo 12.9%; RRs 1.06; 95% CI 0.66-1.69; P = 0.81). The CHG group had
significantly decreased incidence of bacteremia, surgical-site infection
and overall Staphylococcus aureus infections. However, there were no
significant between-group differences for hospital stay length, change in
tracheal microbiota, postoperative antibiotic utilization and outcomes by
day 90. <br/>Conclusion(s): CHG decontamination decreased neither MV
requirements nor respiratory infections after lung cancer surgery.
Additionally, CHG did not change tracheal microbiota or postoperative
antibiotic utilization. Trial Registration: This study is registered on
ClinicalTrials.gov, number NCT01613365.<br/>Copyright &#xa9; 2018,
Springer-Verlag GmbH Germany, part of Springer Nature and ESICM.

<82>
Accession Number
620743485
Title
Baseline and postoperative levels of C-reactive protein and interleukins
as inflammatory predictors of atrial fibrillation following cardiac
surgery: A systematic review and meta-analysis.
Source
Kardiologia Polska. 76 (2) (pp 440-451), 2018. Date of Publication: 16 Feb
2018.
Author
Weymann A.; Popov A.-F.; Sabashnikov A.; Ali-Hasan-Al-Saegh S.; Ryazanov
M.; Tse G.; Mirhosseini S.J.; Liu T.; Lotfaliani M.; Sedaghat M.; Baker
W.L.; Ghanei A.; Yavuz S.; Zeriouh M.; Izadpanah P.; Dehghan H.; Testa L.;
Nikfard M.; De Oliveira Sa M.P.B.; Mashhour A.; Nombela-Franco L.;
Rezaeisadrabadi M.; D'Ascenzo F.; Zhigalov K.; Benedetto U.; Najafi S.A.;
Szczechowicz M.; Roever L.; Meng L.; Gong M.; Deshmukh A.J.; Palmerini T.;
Linde C.; Filipiak K.J.; Stone G.W.; Biondi-Zoccai G.; Calkins H.
Institution
(Weymann, Mashhour, Zhigalov, Szczechowicz) Department of Cardiac Surgery,
University Hospital Oldenburg, European Medical School
Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg,
Germany
(Popov, Sabashnikov, Zeriouh) Department of Cardiothoracic Transplantation
and Mechanical Circulatory Support, Royal Brompton and Harefield NHS
Foundation Trust, Harefield Hospital, Harefield-Middlesex, United Kingdom
(Popov) Department of Thoracic and Cardiovascular Surgery, University
Hospital, Goethe University Frankfurt, Frankfurt, Germany
(Sabashnikov, Zeriouh) Department of Cardiothoracic Surgery, University
Hospital of Cologne, Cologne, Germany
(Ali-Hasan-Al-Saegh, Mirhosseini) Cardiovascular Research Centre, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Ali-Hasan-Al-Saegh, Mirhosseini, Dehghan) Consult. Ctr. for Secdry. Res.,
Data Mining, and Knowledge Transfer in Health and Medical Sciences, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Ryazanov) CVS Centre at Nizhny Novgorod, Nizhny Novgorod, Russian
Federation
(Tse) Department of Medicine and Therapeutics, Li Ka Shing Institute of
Health Sciences, Faculty of Medicine, Chinese University of Hong Kong,
Shatin, Hong Kong
(Liu, Meng, Gong) Department of Cardiology, Tianjin Key Laboratory of
Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Lotfaliani) Faculty of Pharmacy, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
(Sedaghat, Ghanei, Rezaeisadrabadi) Department of Internal Medicine,
Shahid Beheshti University of Medical Sciences, Yazd, Tehran, Iran,
Islamic Republic of
(Baker) University of Connecticut, Hartford Hospital Evidence-Based
Practice Centre, Hartford, CT, United States
(Yavuz) Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas
Training and Research Hospital, Bursa, Turkey
(Izadpanah) Department of Interventional Cardiology, Cardiovascular
Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran,
Islamic Republic of
(Dehghan) Department of Health Technology Assessment, Shahid Sadoughi
University of Medical Sciences and Health Services, Yazd, Iran, Islamic
Republic of
(Testa) Department of Cardiology, IRCCS Pol. S. Donato, S. Donato
Milanese, Milan, Italy
(Nikfard) International Relations Office, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran, Islamic Republic of
(De Oliveira Sa) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco - PROCAPE, Recife, Brazil
(De Oliveira Sa) University of Pernambuco - UPE, Recife, Brazil
(De Oliveira Sa) Nucleus of Postgrad. and Res. in Hlth. Sci. of Fac. of
Med. Sci. and Biol. Sci. Institute (FCM/ICB), Recife, Brazil
(Nombela-Franco) Instituto Cardiovascular, Hospital Universitario Clinico
San Carlos, Madrid, Spain
(D'Ascenzo) Division of Cardiology, Department of Medical Sciences, Citta
della Salute e della Scienza Hospital, University of Turin, Turin, Italy
(Benedetto) Bristol Heart Institute, University of Bristol, School of
Clinical Sciences, Bristol, United Kingdom
(Najafi) Department of Cardiology and Internal Medicine, Sankt Katharinen
Hospital, Frankfurt am Main, Germany
(Roever) Department of Clinical Research, Federal University of
Uberlandia, Uberlandia, Brazil
(Deshmukh) Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Mayo
Clinic, Rochester, MN, United States
(Palmerini) Dipartimento Cardio-Toraco-Vascolare, University of Bologna,
Italy
(Linde) Department of Cardiology, Karolinska University Hospital,
Karolinska Institute, Stockholm, Sweden
(Filipiak) Department of Cardiology, Medical University of Warsaw, Warsaw,
Poland
(Stone) New York Presbyterian Hospital, Columbia University Medical
Centre, New York, NY, United States
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed,
Pozzilli, Italy
(Calkins) Department of Cardiology, Johns Hopkins Medical Institutions,
Baltimore, MD, United States
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Postoperative atrial fibrillation (POAF) is a leading
arrhythmia with high incidence and serious clinical implications after
cardiac surgery. Cardiac surgery is associated with systemic inflammatory
response including increase in cytokines and activation of endothelial and
leukocyte responses. Aim This systematic review and meta-analysis aimed to
determine the strength of evidence for evaluating the association of
inflammatory markers, such as C-reactive protein (CRP) and interleukins
(IL), with POAF following isolated coronary artery bypass grafting (CABG),
isolated valvular surgery, or a combination of these procedures.
<br/>Method(s): We conducted a meta-analysis of studies evaluating
measured baseline (from one week before surgical procedures) and
postoperative levels (until one week after surgical procedures) of
inflammatory markers in patients with POAF. A comprehensive search was
performed in electronic medical databases (Medline/PubMed, Web of Science,
Embase, Science Direct, and Google Scholar) from their inception through
May 2017 to identify relevant studies. A comprehensive subgroup analysis
was performed to explore potential sources of heterogeneity.
<br/>Result(s): A literature search of all major databases retrieved 1014
studies. After screening, 42 studies were analysed including a total of
8398 patients. Pooled analysis showed baseline levels of CRP (standard
mean difference [SMD] 0.457 mg/L, p < 0.001), baseline levels of IL-6 (SMD
0.398 pg/mL, p < 0.001), postoperative levels of CRP (SMD 0.576 mg/L, p <
0.001), postoperative levels of IL-6 (SMD 1.66 pg/mL, p < 0.001),
postoperative levels of IL-8 (SMD 0.839 pg/mL, p < 0.001), and
postoperative levels of IL-10 (SMD 0.590 pg/mL, p < 0.001) to be relevant
inflammatory parameters significantly associated with POAF.
<br/>Conclusion(s): Perioperative inflammation is proposed to be involved
in the pathogenesis of POAF. Therefore, perioperative assessment of CRP,
IL-6, IL-8, and IL-10 can help clinicians in terms of predicting and
monitoring for POAF.<br/>&#xa9; Copyright 2018 Polskie Towarzystwo
Kardiologiczne.

<83>
Accession Number
624751005
Title
Effect of physical exercise on weight loss and physical function following
bariatric surgery: A meta-analysis of randomised controlled trials.
Source
BMJ Open. 8 (10) (no pagination), 2018. Article Number: e023208. Date of
Publication: 2018.
Author
Ren Z.-Q.; Lu G.-D.; Zhang T.-Z.; Xu Q.
Institution
(Ren, Zhang, Xu) School of Nursing, Nanjing Medical University, Nanjing,
China
(Lu) Department of Interventional Radiology, First Affiliated Hospital of
Nanjing Medical University, Nanjing, China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives We performed a meta-analysis of all of the available randomised
controlled trials (RCTs) to investigate whether physical exercise
contributes to weight loss or physical function improvement in adults
receiving bariatric surgery. Methods We searched PubMed, Embase, the
Cochrane Library, OVID and the CINAHL up through May 2018. RCTs that
assigned adults with obesity to either an exercise training group or a
no-exercise group after bariatric surgery were included. The primary
outcomes were weight loss and physical function. Study bias was assessed
using the Cochrane risk of bias tool, and the quality of evidence was
assessed using GRADEpro. Results A total of eight studies met the
inclusion criteria (n=347 participants). Most of the studies carried a low
risk of bias due to randomisation and blinding. Compared with those
without exercise intervention after surgery, patients engaging in physical
exercise were associated with greater weight loss (weighted mean
difference (WMD) -1.94 kg; 95% CI -3.18 to -0.69; n=8) and longer 6 min
walk distance (6MWD; WMD29.67 m; 95% CI 25.97 to 33.37; n=2) during
follow-up. By subgroup analyses, the additional weight loss in exercise
group was related to the starting time and type of exercise: patients
engaging in exercise 1 year or more after surgery and patients received
aerobic-resistance exercise experienced more weight loss. Besides,
patients in exercise training group also had lower systolic blood pressure
and resting heart rate after surgery. The quality of evidence for these
outcomes was moderate to very low. Conclusions Physical exercise after
bariatric surgery provides 1.94 kg additional weight loss and 29.67 m
longer 6MWD compared with surgery alone. Moreover, engaging in exercise 1
year or more after surgery, and a combined aerobic and resistance training
programme may result in greater weight loss.<br/>Copyright &#xa9; 2018
Author(s) (or their employer(s)).

<84>
Accession Number
625577857
Title
Magna Ease Versus Trifecta Early Hemodynamics: A Systematic Review and
Meta-analysis.
Source
Innovations (Philadelphia, Pa.). 13 (4) (pp 267-272), 2018. Date of
Publication: 01 Jul 2018.
Author
Yanagawa B.; Tam D.Y.; Hong K.; Mazine A.; Bagai A.; Shahbaz N.K.;
Ouzounian M.; Verma S.
Institution
(Yanagawa, Tam, Hong, Mazine, Shahbaz, Verma) From the Divisions of
Cardiac Surgery and
(Bagai) Cardiology, St Michael's Hospital, University of Toronto, Toronto,
Australia
(Ouzounian) Division of Cardiac Surgery, Toronto General Hospital,
Toronto, Australia
Abstract
OBJECTIVE: This meta-analysis compares the early echocardiographic
outcomes of aortic valve replacement using the two most commonly implanted
stented bioprostheses. <br/>METHOD(S): We searched MEDLINE and EMBASE
databases until 2017 for studies comparing Magna or Magna Ease (Edwards
Lifesciences, Irvine, CA USA) versus Trifecta (St Jude Medical, St. Paul,
MN USA) aortic bioprosthetic valves. A random-effects meta-analysis was
performed for the primary outcome of mean gradient on echocardiography and
secondary outcomes of effective orifice area, indexed effective orifice
area, and in-hospital mortality. <br/>RESULT(S): There were two randomized
controlled trial, three matched, and six unmatched retrospective
observational studies with 2119 patients [median reported follow-up = 6
months (interquartile range = 6 to 12)]. The Magna/Magna Ease valve was
associated with higher early mean gradient (mean difference = 4.09, 95%
confidence interval = 3.48 to 4.69, P < 0.0001) and smaller effective
orifice area (mean difference = 0.30, 95% confidence interval = -0.38 to
-0.22, P < 0.0001). There were no differences in 30-day mortality between
Magna/Magna Ease and Trifecta (relative risk = 1.01, 95% confidence
interval = 0.41 to 2.50, P = 1.0). <br/>CONCLUSION(S): Trifecta may offer
a small hemodynamic advantage compared with the Magna/Magna Ease valve
with no differences in early mortality. Long-term follow-up is required to
determine whether these differences persist and translate into differences
in clinical outcomes.

<85>
Accession Number
625830860
Title
Outcomes of Impella 5.0 in Cardiogenic Shock: A Systematic Review and
Meta-analysis.
Source
Innovations (Philadelphia, Pa.). 13 (4) (pp 254-260), 2018. Date of
Publication: 01 Jul 2018.
Author
Batsides G.; Massaro J.; Cheung A.; Soltesz E.; Ramzy D.; Anderson M.B.
Institution
(Massaro) Department of Biostatistics, Boston University School of Public
Health, Boston, United Kingdom
(Cheung) Saint Paul's Hospital, University of British Columbia, Vancouver,
Canada
(Soltesz) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation, OH USA, Cleveland, Australia
(Ramzy) Division of Cardiac Surgery, Cedars-Sinai Medical Center, Los
Angeles, United States
(Anderson) Division of Cardiothoracic Surgery, Department of Surgery,
Rutgers Robert Wood Johnson Medical School, NB, Canada
Abstract
OBJECTIVE: The aim of the study was to comprehensively summarize the
survival outcomes and complications of Impella 5.0 (Abiomed Inc, Danvers,
MA USA) use in patients with cardiogenic shock (CS). <br/>METHOD(S): We
performed a literature review for relevant studies by searching in
Medline, Medline In-Process, EMBASE, and the CENTRAL bibliographic
databases on April 30, 2017. Nonoverlapping studies with 10 patients or
more supported for cardiogenic shock with Impella 5.0 or Impella left
direct were included. Data on patient characteristics, indication of
support, and outcomes were extracted. A random effect was used to pool the
various outcomes. <br/>RESULT(S): This meta-analysis included six studies
totaling 163 patients (mean +/- SD age = 56.3 +/- 12.0, male 81%).
Indications for support included 88 (54.0%) for acute on chronic
decompensated heart failure, 35 (21.5%) for postcardiotomy cardiogenic
shock, 27 (16.6%) for acute myocardial infarction complicated by
cardiogenic shock, and, 13 (8.0%) for cardiogenic shock due to other
reasons. Survival to next therapy was 73.5% in patients supported for
acute on chronic decompensated heart failure. The survival to device
explant among patients supported for postcardiotomy cardiogenic shock or
acute myocardial infarction complicated by cardiogenic shock was 90.2%,
and of those, myocardial recovery was achieved in 73.8%. The overall
estimated survival to discharge, 30, 180, and 365 days was 73.5%, 72.6%,
62.7%, and 58.4%, respectively. Patients supported for postcardiotomy
cardiogenic shock had the highest heart recovery among survivors to
explant (92.1%) and highest survival at 30 (89.5%) and 365 days (69.5%).
<br/>CONCLUSION(S): Impella 5.0/LD is associated with favorable survival
outcomes and higher rate of myocardial recovery in patients with
cardiogenic shock.

<86>
Accession Number
624971429
Title
A perioperative surgeon-controlled open-lung approach versus conventional
protective ventilation with low positive end-expiratory pressure in
cardiac surgery with cardiopulmonary bypass (PROVECS): Study protocol for
a randomized controlled trial 11 Medical and Health Sciences 1102
Cardiorespiratory Medicine and Haematology.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 624. Date of
Publication: 13 Nov 2018.
Author
Lagier D.; Fischer F.; Fornier W.; Fellahi J.-L.; Colson P.; Cholley B.;
Jaber S.; Baumstarck K.; Guidon C.; Quintana G.; Gaillat F.; Nedir P.;
Duponq R.; Gomert R.; Guinard B.; Heraud F.; Villacorta J.; Degirmenci S.;
Pernoud N.; Samarani G.; Lalande M.; Huynh T.M.; Gros C.; Elmiloudi F.;
Tacquard C.; Bilger A.; Levy F.; Cinca E.; Bongarzone C.; Heger B.; Balvay
V.; Berns M.; Oulehri W.; Ouattara A.
Institution
(Lagier, Guidon) Department of Cardiovascular Anesthesiology and Critical
Care Medicine, La Timone University Hospital, AP-HM, Aix-Marseille
University, 264 rue saint Pierre, Marseille, cedex 5 13005, France
(Fischer) Department of Cardiovascular and Thoracic Anesthesiology, Nouvel
Hopital Civil, Strasbourg, France
(Fornier, Fellahi) Department of Anesthesiology and Critical Care
Medicine, Louis Pradel University Hospital, University Claude Bernard, 28
Avenue du Doyen Lepine, Bron 69677, France
(Colson) Department of Anesthesiology and Critical Care Medicine, Arnaud
de Villeneuve University Hospital, 371 Avenue du Doyen Gaston Giraud,
Montpellier 34295, France
(Cholley) Department of Anesthesiology and Critical Care Medicine, Hopital
Europeen Georges Pompidou, AP-HP, University Paris Descartes-Sorbonne
Paris Cite, 20 Rue Leblanc, Paris 75015, France
(Jaber) Department of Anesthesiology and Critical Care Medicine, Saint
Eloi University Hospital, 80 Avenue Augustin Fliche, Montpellier 34295,
France
(Baumstarck) Unite de Recherche EA3279, Aix-Marseille University, 27 bd
Jean Moulin, Marseille, Marseille, cedex 5 13385, France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative pulmonary complications (PPCs) are frequent
after on-pump cardiac surgery. Cardiac surgery results in a complex
pulmonary insult leading to high susceptibility to perioperative pulmonary
atelectasis. For technical reasons, ventilator settings interact with the
surgical procedure and traditionally, low levels of positive
end-expiratory pressure (PEEP) have been used. The objective is to compare
a perioperative, multimodal and surgeon-controlled open-lung approach with
conventional protective ventilation with low PEEP to prevent PPCs in
patients undergoing cardiac surgery. Methods/design: The perioperative
open-lung protective ventilation in cardiac surgery (PROVECS) trial is a
multicenter, two-arm, randomized controlled trial. In total, 494 patients
scheduled for elective cardiac surgery with cardiopulmonary bypass (CPB)
and aortic cross-clamp will be randomized into one of the two treatment
arms. In the experimental group, systematic recruitment maneuvers and
perioperative high PEEP (8 cmH2O) are associated with ultra-protective
ventilation during CPB. In this group, the settings of the ventilator are
controlled by surgeons in relation to standardized protocol deviations. In
the control group, no recruitment maneuvers, low levels of PEEP (2 cmH2O)
and continuous positive airway pressure during CPB (2 cmH2O) are used. Low
tidal volumes (6-8 mL/kg of predicted body weight) are used before and
after CPB in each group. The primary endpoint is a composite of the single
PPCs evaluated during the first 7 postoperative days. <br/>Discussion(s):
The PROVECS trial will be the first multicenter randomized controlled
trial to evaluate the impact of a perioperative and multimodal open-lung
ventilatory strategy on the occurrence of PPCs after on-pump cardiac
surgery. The trial design includes standardized surgeon-controlled
protocol deviations that guarantee a pragmatic approach. The results will
help anesthesiologists and surgeons aiming to optimize ventilatory
settings during cardiac surgery. Trial registration: Clinical Trials.gov,
NCT 02866578. Registered on 15 August 2016. Last updated 11 July
2017.<br/>Copyright &#xa9; 2018 The Author(s).

<87>
Accession Number
2001441112
Title
Polyether ether ketone (PEEK) and its 3D printed implants applications in
medical field: An overview.
Source
Clinical Epidemiology and Global Health. (no pagination), 2019. Date of
Publication: 2019.
Author
Haleem A.; Javaid M.
Institution
(Haleem, Javaid) Department of Mechanical Engineering, Jamia Millia
Islamia, New Delhi, India
Publisher
Elsevier B.V.
Abstract
Background: Extensively studied research articles on Polyether ether
ketone (PEEK) in "medical" and "PEEK 3D printing in the medical field" to
identify a direction of the development and identify critical applications
in medicine. <br/>Material(s) and Method(s): This is a literature-based
study of research articles listed in Scopus. A literature review &
bibliometric analysis is done to achieve the research objective.
<br/>Result(s): Searching keywords as "PEEK" "medical" through Scopus
identified 426 research articles and searching "PEEK" "medical" "3D
printing" identified ten articles. This study identifies that PEEK is a
suitable material that helps innovation and helps to solve different
surgical and medical problems. Analysis of the Scopus data depicts an
increasing trend in the medical field, especially the application of this
material. Much research is done on PEEK in medical, but there is very less
work reported on PEEK 3D printing in medical. 3D PEEK implants are
preferred in medical for requirements of extensive customisation. This
technology caters well to the manufacturing of prosthetics, artificial
bone, heart & its parts and other human parts. Finally, twelve important
applications areas are identified in medical. <br/>Conclusion(s): PEEK has
somewhat bone like properties. This material can be well used in 3D
printing technologies to help fulfil various challenges of the medical. In
medical, PEEK materials foresee different surgical application as it can
replace titanium and ceramic implants. The need is to explore the use of
PEEK in different surgeries of orthopaedic, spine, maxilla-facial, cranial
and others 3D printing manufactures complex design implants as per
requirement of a patient with an exact match. This material is also
applicable for cardiac surgery like manufacturing of heart valve
prostheses and leaflet heart valves. PEEK material is hard, lightweight,
stiff and is a robust polymer while having satisfactory wear properties
that help implants with an extended life. In dentistry, PEEK implants have
also the potential for use in tooth replacement. It seems somewhat
cost-effective to fulfil innovative medical requirements with comparable
wear and mechanical strength.<br/>Copyright &#xa9; 2019 INDIACLEN

<88>
Accession Number
2001440615
Title
Trifecta has lower gradient and less prosthesis-patient mismatch than
Mosaic Ultra in the aortic position: A prospective randomized study.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Braathen B.; Husebye T.; Lunde I.G.; Tonnessen T.
Institution
(Braathen, Tonnessen) Department of Cardiothoracic Surgery, Oslo
University Hospital, Ulleval, Norway
(Husebye) Department of Cardiology, Oslo University Hospital, Ulleval,
Norway
(Lunde) Institute for Experimental Medical Research and Center for Heart
Failure Research, Oslo, Norway
(Lunde, Tonnessen) University of Oslo, Oslo, Norway
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: When aortic valve replacement is needed, a biological valve is
usually implanted in patients older than age 60 to 65 years. A large
valvular opening area is important to avoid prosthesis-patient mismatch
and facilitate reverse left ventricular remodeling. The Trifecta
biological valve (St Jude Medical, St Paul, Minn) is, because of its
design, believed to reduce transvalvular gradient compared with other
biological valves, especially in smaller annuli. Several retrospective
studies have compared transvalvular gradients of implanted valves
prostheses using the respective manufacturers given size and not the
actual annulus size measured by a metric sizer. This makes comparison of
the hemodynamic properties of different valve brands and sizes difficult.
We therefore performed a prospective randomized study, using the same
metric sizer to measure annulus size, and compared hemodynamic profiles of
the Trifecta to our standard Mosaic Ultra biological valve (Medtronic,
Minneapolis, Minn). <br/>Method(s): Ninety elective patients with small to
medium annulus diameter undergoing aortic valve replacement were
randomized to either Trifecta or Mosaic Ultra. After native valve removal
and decalcification, a Hegar-sizer was used to measure true annulus size.
Then the largest possible valve of either brand was implanted according to
the randomization protocol. Echocardiography was performed 6 months
postoperatively. <br/>Result(s): Baseline parameters of the 2 cohorts were
comparable. There were lower transvalvular gradients in the Trifecta
compared with the Mosaic Ultra group for the given annulus sizes. Severe
prosthesis-patient mismatch was present in 28% of patients in the Mosaic
group and 3% of patients in the Trifecta group. <br/>Conclusion(s):
Trifecta showed lower transvalvular gradients and less severe
prosthesis-patient mismatch compared with Mosaic Ultra for the given
annulus sizes. ClinicalTrials.gov Protocol ID:
2011/2596/REK.<br/>Copyright &#xa9; 2018 The American Association for
Thoracic Surgery

<89>
Accession Number
625820311
Title
Developmental Pharmacokinetics and Age-Appropriate Dosing Design of
Milrinone in Neonates and Infants with Acute Kidney Injury Following
Cardiac Surgery.
Source
Clinical Pharmacokinetics. (no pagination), 2019. Date of Publication:
2019.
Author
Mizuno T.; Gist K.M.; Gao Z.; Wempe M.F.; Alten J.; Cooper D.S.; Goldstein
S.L.; Vinks A.A.
Institution
(Mizuno, Vinks) Division of Clinical Pharmacology, Cincinnati Children's
Hospital Medical Center, 3333 Burnet Avenue, MLC6018, Cincinnati, OH
45229-3039, United States
(Gist) Department of Pediatrics, Children's Hospital Colorado, University
of Colorado, Aurora, CO, United States
(Gao, Alten, Cooper) Heart Institute, Cincinnati Children's Hospital
Medical Center, Cincinnati, OH, United States
(Wempe) Skaggs School of Pharmacy and Pharmaceutical Sciences, University
of Colorado, Aurora, CO, United States
(Goldstein) Division of Nephrology, Cincinnati Children's Hospital Medical
Center, Cincinnati, OH, United States
(Mizuno, Alten, Cooper, Goldstein, Vinks) Department of Pediatrics,
College of Medicine, University of Cincinnati, Cincinnati, OH, United
States
Publisher
Springer International Publishing
Abstract
Background and Objective: Milrinone is used for the prevention of low
cardiac output syndrome in pediatric patients after cardiac surgery.
Milrinone is mainly eliminated by the kidneys; however, there is limited
information on milrinone pharmacokinetics in infants who have acute kidney
injury (AKI). The aim of this study was to develop a milrinone population
pharmacokinetic model in neonates and infants with or without AKI. The
developed milrinone pharmacokinetic model was utilized for a Monte Carlo
simulation analysis to identify age-appropriate dosing regimens in
neonates and infants. <br/>Method(s): Population pharmacokinetic analysis
was performed with a total of 1088 serum milrinone concentrations obtained
from 92 infants as part of a prospective clinical study in neonates and
infants following cardiac surgery (ClinicalTrials.gov identifier
NCT01966237). AKI stages were determined based on the Kidney Injury
Improving Global Outcomes (KDIGO) Clinical Practice Guideline within the
first three postoperative days. <br/>Result(s): A two-compartment model
was found to adequately describe the pharmacokinetic data. Allometrically
scaled body weight, AKI stages, and maturation function were identified as
significant predictors of milrinone clearance. The proposed dosing
regimens for milrinone continuous infusions were determined based on a
target concentration attainment of simulated steady-state concentration
and covered three age groups across 0-12 months of age for each AKI stage.
<br/>Conclusion(s): This study provides a milrinone population
pharmacokinetic model in neonates and infants and captures the
developmental changes in clearance. Age-appropriate dosing regimens were
determined based on the simulation analysis with the developed
pharmacokinetic model. The findings will facilitate model-informed
precision dosing of milrinone in infants with or without
AKI.<br/>Copyright &#xa9; 2019, Springer Nature Switzerland AG.

<90>
Accession Number
2000822243
Title
Anticoagulation and Antiplatelet Strategies After On-X Mechanical Aortic
Valve Replacement.
Source
Journal of the American College of Cardiology. 71 (24) (pp 2717-2726),
2018. Date of Publication: 19 June 2018.
Author
Puskas J.D.; Yanagawa B.; Ely J.; Puskas J.; Gerdisch M.; Nichols D.;
Graeve A.; Fermin L.; Rhenman B.; Kapoor D.; Copeland J.; Quinn R.; Hughes
G.C.; Azar H.; McGrath M.; Wait M.; Kong B.; Martin T.; Douville E.C.;
Meyer S.; Jamieson W.R.E.; Ye J.; Landvater L.; Trotter T.; Armitage J.;
Askew J.; Accola K.; Levy P.; Duncan D.; Sethi G.; Razi A.; Hagberg R.;
Hamman B.; Swistel D.; Shoukfeh M.F.; Tutuska P.; Sai-Sudhakar C.B.;
Damiano R.; Pettersson G.; Campbell M.; Gregoric I.; Cameron D.; Blackwell
R.; Allen K.
Institution
(Puskas) Icahn School of Medicine at Mount Sinai, New York, New York,
United States
(Gerdisch) Franciscan St. Francis Health, Indianapolis, Indiana, United
States
(Nichols, Graeve) Multicare Tacoma General, Tacoma, Washington, United
States
(Fermin, Rhenman, Kapoor) Southern Arizona Veterans Affairs Hospital,
Tucson, Arizona, United States
(Copeland) University of Arizona, Tucson, Arizona, United States
(Quinn) Maine Medical, Portland, Maine, United States
(Hughes) Duke University, Durham, North Carolina, United States
(Azar, McGrath) Sentara Norfolk General, Norfolk, Virginia, United States
(Wait) University of Texas Southwestern, Dallas, Texas, United States
(Kong) St. Joseph Mercy Hospital, Ann Arbor, Michigan, United States
(Martin) University of Florida, Gainesville, Florida, United States
(Douville) Providence Portland, Portland, Oregon, United States
(Meyer) University of Alberta, Edmonton, Alberta, Canada
(Ye) St. Paul's Hospital, Vancouver, British Columbia, Canada
(Jamieson) Vancouver General Hospital, Vancouver, British Columbia, Canada
(Landvater) Carolina Cardiovascular, Raleigh, North Carolina, United
States
(Hagberg) Hartford Hospital, Hartford, Connecticut, United States
(Trotter) Oklahoma City VA, Oklahoma City, Oklahoma, United States
(Armitage, Askew) Mary Washington, Fredericksburg, Virginia, United States
(Accola) Florida Hospital, Orlando, Florida, United States
(Levy) New Mexico Heart Institute, Albuquerque, New Mexico, United States
(Duncan) Novant Health Forsyth Medical Center, Winston-Salem, North
Carolina, United States
(Yanagawa) St. Michael's Hospital, Toronto, Ontario, Canada
(Ely) On-X Life Technologies, Austin, Texas, United States
Publisher
Elsevier USA
Abstract
Background: The burden oral anticoagulation is a limitation of mechanical
valve prostheses. <br/>Objective(s): The aim of this study was to test
whether patients could be safely managed with dual-antiplatelet therapy
(DAPT) (aspirin 325 mg and clopidogrel 75 mg) or lower warfarin after On-X
mechanical aortic valve replacement (mAVR). <br/>Method(s): PROACT
(Prospective Randomized On-X Anticoagulation Trial) (n = 576) is a
multicenter (41 sites) noninferiority trial. From June 2006 through
February 2014, 201 patients >=18 years of age without thromboembolic risk
factors undergoing mAVR were randomized to receive DAPT (n = 99) or
standard warfarin plus aspirin (n = 102) 3 months after mAVR (low-risk
arm). From June 2006 through October 2009, 375 patients with 1 or more
thromboembolic risk factors were also randomized to lower intensity
warfarin plus aspirin (international normalized ratio 1.5 to 2.0; n = 185)
or standard warfarin plus aspirin (international normalized ratio 2.0 to
3.0; n = 190) 3 months after mAVR (high-risk arm). <br/>Result(s): The
low-risk arm was terminated for excess cerebral thromboembolic events
(3.12% per patient-year vs. 0.29% per patient-year, p = 0.02) in the DAPT
group at up to 8.8-year follow-up (631.6 patient-years), with no
differences in bleeding or all-cause mortality. High-risk arm patients
experienced significantly lower major (1.59% per patient-year vs. 3.94%
per patient-year, p = 0.002) and minor (1.27% per patient-year vs. 3.49%
per patient-year, p = 0.002) bleeding up to 8.7-year follow-up (2,035.2
patient-years), with no differences in thromboembolism (0.42% per
patient-year vs. 0.09% per patient-year, p = 0.20) and all-cause
mortality. <br/>Conclusion(s): DAPT was associated with higher rates of
thromboembolism and valve thrombosis compared with control in the low-risk
arm. International normalized ratios were safely maintained at 1.5 to 2.0
in high-risk patients, without differences in mortality or thromboembolic
complications. (Randomized On-X Anticoagulation Trial [PROACT];
NCT00291525)<br/>Copyright &#xa9; 2018

<91>
Accession Number
622850255
Title
Pre-operative use of aspirin in patients undergoing coronary artery bypass
grafting: A systematic review and updated metaanalysis.
Source
Journal of Thoracic Disease. 10 (6) (pp 3444-3459), 2018. Date of
Publication: 01 Jun 2018.
Author
Solo K.; Lavi S.; Choudhury T.; Martin J.; Nevis I.F.; Kwok C.S.;
Kotronias R.A.; Nishina N.; Sponga S.; Ayan D.; Mamas M.A.; Bagur R.
Institution
(Solo, Martin, Bagur) Department of Epidemiology and Biostatistics,
Schulich School of Medicine and Dentistry, Western University, London, ON,
Canada
(Lavi, Choudhury, Ayan, Bagur) London Health Sciences Centre, London, ON,
Canada
(Martin) Department of Anesthesia and Perioperative Medicine, Centre for
Medical Evidence, Decision Integrity and Clinical Impact (MEDICI),
Schulich School of Medicine and Dentistry, Western University, London, ON,
Canada
(Nevis) Health Quality Ontario, Toronto, ON, Canada
(Kwok, Mamas, Bagur) Keele Cardiovascular Research Group, Institute for
Applied Clinical Science and Centre for Prognosis Research, Institute of
Primary Care and Health Sciences, University of Keele, Stoke-on-Trent,
United Kingdom
(Kotronias) Oxford University Clinical Academic Graduate School, Oxford
University, Oxford, United Kingdom
(Nishina) Faculty of International Communication, Gunma Prefectural
Women's University, Tamamura, Gunma, Japan
(Sponga) Cardiothoracic Department, University Hospital of Udine, Udine,
Italy
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Aspirin therapy improves saphenous vein graft (SVG) patency in
patients undergoing coronary artery bypass graft (CABG), however, its use
in the pre-operative period remains controversial. Therefore, we conducted
a systematic review and meta-analysis of randomized-controlled trials
(RCTs) to update the evidence about risk and benefits of pre-operative
aspirin therapy in patients undergoing CABG. <br/>Method(s): Electronic
databases (Medline, Embase, PubMed, Cochrane Library, and Scopus) were
searched to identify RCTs evaluating the effect of aspirin versus
placebo/control before CABG. Two investigators independently and in
duplicate screened citations and extracted data and rated the risk of
bias. The strength of evidence was appraised using the Grading of
Recommendation Assessment, Development, and Evaluation (GRADE) approach.
Meta-analysis was performed using a random-effects model. The main
outcomes of interest were 30-day mortality, peri-operative myocardial
infarction (MI), chest tube drainage and SVG occlusion. <br/>Result(s): A
total of 13 RCTs involving 4,377 participants (2,266/2,111 pre-operative
aspirin/control) met the inclusion criteria. Pre-operative aspirin reduced
the risk of SVG occlusion [risk ratio (RR): 0.69, 95% confidence interval
(CI): 0.49-0.97, P=0.03, I²=16%], but no differences in
mortality (RR: 1.41, 95% Cl: 0.73-2.74, I²=0%) and MI (RR:
0.84, 95% CI: 0.69-1.03, I²=0%) were found. However,
pre-operative aspirin increased chest tube drainage (MD: 100.40 mL, 95%
CI: 24.32-176.47 mL, P=0.01, I²=84%) and surgical reexploration
(RR: 1.52, 95% CI: 1.02-2.27, P=0.04, I²=8%), with no
significant difference in RBC transfusion (RR: 1.06, 95% CI: 0.90-1.25,
I²=35%). <br/>Conclusion(s): Based on trials where the rated
body of evidence was of low to very-low quality, preoperative aspirin
improves SVG patency but increases chest tube drainage and need for
surgical reexploration.<br/>Copyright &#xa9; Journal of Thoracic Disease.

<92>
Accession Number
623488501
Title
Intravenous ivabradine versus placebo in patients with low cardiac output
syndrome treated by dobutamine after elective coronary artery bypass
surgery: A phase 2 exploratory randomized controlled trial.
Source
Critical Care. 22 (1) (no pagination), 2018. Article Number: 193. Date of
Publication: 17 Aug 2018.
Author
Nguyen L.S.; Squara P.; Amour J.; Carbognani D.; Bouabdallah K.; Thierry
S.; Apert-Verneuil C.; Moyne A.; Cholley B.
Institution
(Nguyen, Squara) Critical Care Medicine, CMC Ambroise Pare,
Neuilly-sur-Seine, France
(Amour) Hopital de la Pitie-Salpetriere, AP-HP, Universite Pierre et Marie
Curie, Anesthesiology and Critical Care Medicine, Paris, France
(Carbognani, Bouabdallah) Institut Mutualiste Monsouris, Anesthesiology
and Critical Care Medicine, Paris, France
(Thierry) Centre Cardiologique du Nord, Anesthesiology and Critical Care
Medicine, Saint-Denis, France
(Apert-Verneuil, Moyne) Institut de Recherches Internationales Servier,
Suresnes, France
(Cholley) Hopital Europeen Georges Pompidou, AP-HP, Universite Paris
Descartes-Sorbonne Paris Cite, Anesthesiology and Critical Care Medicine
Department, Paris, France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Low cardiac output syndrome (LCOS) is a severe condition which
can occur after cardiac surgery, especially among patients with
pre-existing left ventricular dysfunction. Dobutamine, its first-line
treatment, is associated with sinus tachycardia. This study aims to assess
the ability of intravenous ivabradine to decrease sinus tachycardia
associated with dobutamine infused for LCOS after coronary artery bypass
graft (CABG) surgery. <br/>Method(s): In a phase 2, multi-center,
single-blind, randomized controlled trial, patients with left ventricular
ejection fraction below 40% presenting sinus tachycardia of at least 100
beats per minute (bpm) following dobutamine infusion for LCOS after CABG
surgery received either intravenous ivabradine or placebo (three
ivabradine for one placebo). Treatment lasted until dobutamine weaning or
up to 48 h. The primary endpoint was the proportion of patients achieving
a heart rate (HR) in the 80- to 90-bpm range. Secondary endpoints were
invasive and non-invasive hemodynamic parameters and arrhythmia events.
<br/>Result(s): Nineteen patients were included. More patients reached the
primary endpoint in the ivabradine than in the placebo group (13 (93%)
versus 2 (40%); P = 0.04). Median times to reach target HR were 1.0 h in
the ivabradine group and 5.7 h in the placebo group. Ivabradine decreased
HR (112 to 86 bpm, P <0.001) while increasing cardiac index (P = 0.02),
stroke volume (P <0.001), and systolic blood pressure (P = 0.03). In the
placebo group, these parameters remained unchanged from baseline. In the
ivabradine group, five patients (36%) developed atrial fibrillation (AF)
and one (7%) was discontinued for sustained AF; two (14%) were
discontinued for bradycardia. <br/>Conclusion(s): Intravenous ivabradine
achieved effective and rapid correction of sinus tachycardia in patients
who received dobutamine for LCOS after CABG surgery. Simultaneously,
stroke volume and systolic blood pressure increased, suggesting a
beneficial effect of this treatment on tissue perfusion.<br/>Copyright
&#xa9; 2018 The Author(s).

<93>
Accession Number
623636185
Title
A comparison of haemostatic biomarkers during low-risk patients undergoing
cardiopulmonary bypass using either conventional centrifugal cell salvage
or the HemoSep device.
Source
Perfusion (United Kingdom). 34 (1) (pp 76-83), 2019. Date of Publication:
01 Jan 2019.
Author
Boyle G.; Kuffel A.; Parmar K.; Gibson K.; Smith M.; Grehan A.; Hunt B.J.;
Chambers D.J.
Institution
(Boyle, Grehan) Clinical Perfusion Department, Guy's and St Thomas' NHS
Foundation Trust, St Thomas' Hospital, United Kingdom
(Kuffel, Parmar, Hunt) Thrombosis & Vascular Biology Group, The Rayne
Institute, United Kingdom
(Gibson, Smith) Cardiovascular Research, Guy's and St Thomas' NHS
Foundation Trust, St Thomas' Hospital, United Kingdom
(Hunt) Thrombosis & Haemophilia, Guy's & St Thomas' NHS Foundation Trust,
St Thomas' Hospital, United Kingdom
(Chambers) Cardiothoracic Surgery/Cardiac Surgical Research, The Rayne
Institute, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital,
United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Cardiac surgery using cardiopulmonary bypass (CPB) is
associated with a coagulopathy due to haemodilution, thrombocytopenia and
platelet dysfunction and the activation of coagulation and fibrinolysis,
despite the use of large doses of unfractionated heparin. Conventional red
cell salvage may exacerbate post-operative bleeding as plasma containing
haemostatic factors is discarded. We hypothesized that a novel cell
salvage device (HemoSep) may attenuate haemostatic changes associated with
red cell salvage. We studied haemostatic markers following autologous
transfusion from conventional cell salvage or the HemoSep device.
<br/>Method(s): This randomised, controlled trial compared haemostatic
markers in patients undergoing coronary artery bypass grafting or aortic
valve replacement who received autologous blood returned from cell salvage
(control) or HemoSep (study). Blood samples were taken pre-operatively,
end of CPB, post-transfusion of salvaged blood and 3 hours
post-operatively and analysed for full blood count (FBC), prothrombin time
(PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer
and endogenous thrombin potential (ETP). <br/>Result(s): Fifty-four
patients were recruited (n=28 control, n=26 study). Processed blood volume
for transfusion was significantly (p<0.001) higher in the HemoSep group.
In the HemoSep group, the PT was shorter (18.7+/-0.3 vs 19.9+/-0.3 sec;
p<0.05) post-operatively and the aPTT was longer (48.6+/-3.8 vs 37.3+/-1.0
sec; p<0.01) following autologous transfusion. In the control group,
D-dimer and ETP levels were higher (1903+/-424 vs.1088+/-151; p<0.05 and
739+/-46 vs. 394+/-60; p<0.001, respectively) following autologous
transfusion. <br/>Conclusion(s): Although centrifuged cell salvage is
known to adequately haemoconcentrate and remove unwanted substrates and
bacteriological contamination, the process can exacerbate coagulopathy.
The HemoSep device demonstrated some increase in haemostatic markers when
used in low-risk cardiac surgery patients.<br/>Copyright &#xa9; The
Author(s) 2018.

<94>
Accession Number
619197730
Title
Drug-Eluting Stents Versus Coronary Artery Bypass Grafts for Left Main
Coronary Disease: A Meta-Analysis and Review of Randomised Controlled
Trials.
Source
Heart Lung and Circulation. 27 (12) (pp 1437-1445), 2018. Date of
Publication: December 2018.
Author
Moore P.; Burrage M.; Garrahy P.; Lim R.; McCann A.; Camuglia A.
Institution
(Moore, Burrage, Garrahy, Lim, McCann, Camuglia) Department of Cardiology,
Princess Alexandra Hospital, Brisbane, Qld, Australia
(Moore, Burrage, Garrahy, Lim, McCann, Camuglia) School of Medicine,
University of Queensland, Brisbane, Qld, Australia
Publisher
Elsevier Ltd
Abstract
Background: Revascularisation of left main coronary artery (LMCA) disease
can be potentially managed with percutaneous coronary intervention (PCI)
or coronary artery bypass graft surgery (CABG). Recent randomised
controlled trial (RCT) data have added to the literature on this subject
and this meta-analysis aims to assess the state of the data to assist in
guiding patient treatment decisions. <br/>Method(s): A systematic
literature search of Cochrane Library, EMBASE, OVID, and PubMed Medline
was performed. Randomised controlled trials of patients with LMCA disease
undergoing PCI with drug eluting stents or CABG were included. Clinical
outcomes and adverse events were assessed and analysed. <br/>Result(s):
Four suitable RCTs of adequate quality and follow-up were identified. The
incidence of major adverse cardiac and cerebrovascular events (MACCE) at 3
to 5 years of follow-up was significantly increased with PCI compared to
CABG (23.3% vs 18.2%, OR 1.37; 95% CI: 1.18-1.58; p = < 0.0001;
I² = 0%) and was largely driven by more repeat
revascularisation procedures among patients treated with PCI. There was no
statistically significant difference in rates of mortality, myocardial
infarction or stroke (either individually or when these outcomes were
combined as a composite endpoint). <br/>Conclusion(s): Coronary artery
bypass grafting and PCI both represent reasonable treatment modalities for
LMCA disease in appropriately selected patients. However, where CABG is
feasible it offers superior long-term freedom from repeat
revascularisation. Longer-term follow-up is required to further clarify
the durability of mortality outcomes, especially in patients treated with
PCI.<br/>Copyright &#xa9; 2017 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<95>
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. <br/>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. <br/>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. <br/>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). <br/>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)<br/>Copyright &#xa9;
2018 The Authors

<96>
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. <br/>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. <br/>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). <br/>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.<br/>Copyright &#xa9; 2018 The
Egyptian Society of Cardio-thoracic Surgery

<97>
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.
<br/>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. <br/>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].
<br/>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.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<98>
[Use Link to view the full text]
Accession Number
624926079
Title
The effect of dexmedetomidine on the perioperative hemodynamics and
postoperative cognitive function of elderly patients with hypertension:
Study protocol for a randomized controlled trial.
Source
Medicine. 97 (43) (pp e12851), 2018. Date of Publication: 01 Oct 2018.
Author
Du X.; Yu J.; Mi W.
Institution
(Du, Mi) Department of Anesthesiology, Chinese PLA Medical School/Chinese
PLA General Hospital, Beijing, China
(Yu) Department of Anesthesiology, Affiliated Hospital of Inner Mongolia
Medical University, Hohhot, China
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Cognitive dysfunction after surgery, a common clinical
manifestation of postoperative psychonosema. It usually occurs after heart
surgery, hip replacement, mandibular fractures, and other major
operations. Dexmedetomidine can exert sedative, analgesic, anxiolytic
effect, inhibits the sympathetic activity, maintains hemodynamic balance,
helps reduce the amount of anesthetic agents, and relatively slightly
depresses respiration. Preoperative administration of dexmedetomidine for
sedation has been reported to reduce the incidence of acute postoperative
delirium. But currently there is no study on the effect of dexmedetomidine
on the postoperative cognitive function of elderly patients with essential
hypertension. METHODS/DESIGN: This study is a prospective, single-center,
double-blind controlled clinical trial. Elderly patients aged between 60
and 80 years old, diagnosed with primary hypertension for 1 year or longer
will be included, and randomized into 2 groups. Patients in observational
group will be given a loading dose of dexmedetomidine at 0.8 mug/kg,
pumped for over 10 minutes. Although patients in control group will be
pumped of the same volume of normal saline within 10 minutes, before the
induction of anesthesia. Minimental state examination and levels of
interleukin-6, tumor necrosis factor alpha, and C-reactive protein will be
set as primary endpoints. Baseline characteristics of patients will be
summarized by groups and compared using Chi-square or Fisher exact tests
for categorical variables and 2-sample t tests or Wilcoxon rank sum test
for the continuous variables. Repeated measurement analysis of covariance
model will also be used for the comparison of endpoints between 2 groups.
<br/>CONCLUSION(S): The present study is designed to investigate the
effect of the application of dexmedetomidine on postoperative myocardial
injury and postoperative cognitive dysfunction, also to explore the
association between inflammatory factors and postoperative cognitive
function. With this study, we are expecting to find out an appropriate
anesthesia method for elderly people with hypertension to alleviate the
postoperative adverse effects caused by medical treatments. TRIALS
REGISTRATION: This study was registered on Chinese Clinical Trial Registry
(http://www.chictr.org.cn/) with the ID ChiCTR-IPR-16009156.

<99>
[Use Link to view the full text]
Accession Number
624909547
Title
Pharmacologic prevention of postoperative delirium after on-pump cardiac
surgery: A meta-analysis of randomized trials.
Source
Medicine. 97 (43) (pp e12771), 2018. Date of Publication: 01 Oct 2018.
Author
Tao R.; Wang X.-W.; Pang L.-J.; Cheng J.; Wang Y.-M.; Gao G.-Q.; Liu Y.;
Wang C.
Institution
(Tao, Pang, Cheng, Wang, Gao, Liu, Wang) Department of Substance-Related
Disorders, Division of Psychiatry, Hefei No.4 People's Hospital, Anhui
Mental Health Center, China
(Tao, Pang, Cheng, Wang, Wang) Mental Health Clinical College of Anhui
Medical University, Hefei, China
(Wang) Department of Cardiothoracic Surgery, First Affiliated Hospital of
Chongqing Medical University, Chongqing, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative delirium is a prevalent and disabling mental
disorder in patients undergoing on-pump cardiac surgery. There is some
evidence that the use of pharmacological interventions may reduce the risk
of developing of postoperative delirium. Therefore, the aim of this
meta-analysis was to determine the effect of pharmacologic agents for the
prevention postoperative delirium after cardiac surgery. <br/>METHOD(S):
Randomized controlled trials (RCTs) were identified through a systematic
literature search of electronic databases and article references up to
October 2016. End points included incidence of postoperative delirium,
severity of postoperative delirium, cognitive disturbances of
postoperative delirium, duration of postoperative delirium, length of stay
in intensive care unit (ICU) and hospital, and short-term mortality.
<br/>RESULT(S): A total of 14 RCTs with an aggregate of 14,139 patients
were included. The results of the present meta-analysis show that
pharmacologic agents significantly decrease postoperative delirium
[relative risk (RR), 0.83; 95% confidence interval (95% CI), 0.75-0.91, P
< .00001] and duration of postoperative delirium (RR = -0.37, 95% CI =
-0.47 to -0.27, P < .00001) after on-pump cardiac surgery. In addition,
subgroup analysis shows that dexamethasone and dexamethasone were
associated with a trend toward a reduction in postoperative delirium (RR,
0.45; 95% CI, 0.30-0.66, P < .0001; RR, 0.80; 95% CI, 0.68-0.93, P = .003,
respectively). However, our results fail to support the assumption that
pharmacologic prophylaxis is associated with a positively reduction in
short-term mortality, length of ICU, or hospital stay. <br/>CONCLUSION(S):
This meta-analysis suggests that the perioperative use of pharmacologic
agents can prevent postoperative delirium development in patients
undergoing cardiac surgery. However, there remain important gaps in the
evidence base on a few small studies with multiple limitations. Further
large-scale, high-quality RCTs are needed in this area.

<100>
Accession Number
620505875
Title
Image quality of prospectively ECG-triggered coronary CT angiography in
heart transplant recipients.
Source
American Journal of Roentgenology. 210 (2) (pp 314-319), 2018. Date of
Publication: February 2018.
Author
Bartykowszki A.; Kolossvary M.; Jermendy A.L.; Karady J.; Szilveszter B.;
Karolyi M.; Balogh O.; Sax B.; Merkely B.; Maurovich-Horvat P.
Institution
(Bartykowszki, Kolossvary, Jermendy, Karady, Szilveszter, Karolyi, Sax,
Merkely, Maurovich-Horvat) MTA-SE Cardiovascular Imaging Research Group,
Heart and Vascular Center, Semmelweis University, 68 Varosmajor St,
Budapest H-1122, Hungary
(Balogh) Department of Cardiology, Gottsegen Gyorgy National Cardiology
Institute, Budapest, Hungary
Publisher
American Roentgen Ray Society
Abstract
OBJECTIVE. Cardiac allograft vasculopathy (CAV) is among the top causes of
death 1 year after heart transplantation (HTx). Coronary CT angiography
(CTA) is a potential alternative to invasive imaging in the diagnosis of
CAV. However, the higher heart rate (HR) of HTx recipients prompts the use
of retrospective ECG-gating, which is associated with higher radiation
dose, a major concern in this patient population. Therefore, we sought to
evaluate the feasibility and image quality of low-radiation-dose
prospectively ECG-triggered coronary CTA in HTx recipients. MATERIALS AND
METHODS. In total, 1270 coronary segments were evaluated in 50 HTx
recipients and 50 matched control subjects who did not undergo HTx. The
control subjects were selected from our clinical database and were matched
for age, sex, body mass index, HR, and coronary dominance. Scans were
performed using 256-MDCT with prospective ECG-triggering. The degree of
motion artifacts was evaluated on a per-segment basis on a 4-point
Likert-type scale. RESULTS. The median HR was 74.0 beats/min
(interquartile range [IQR], 67.8-79.3 beats/min) in the HTx group and 73.0
beats/min (IQR, 68.5-80.0 beats/min) in the matched control group (p =
0.58). In the HTx group, more segments had diagnostic image quality
compared with the control group (624/662 [94.3%] vs 504/608 [82.9%]; p <
0.001). The mean effective radiation dose was low in both groups (3.7 mSv
[IQR, 2.4-4.3 mSv] in the HTx group vs 4.3 mSv [IQR, 2.6-4.3 mSv] in the
control group; p = 0.24). CONCLUSION. Prospectively ECG-triggered coronary
CTA examinations of HTx recipients yielded diagnostic image quality with
low radiation dose. Coronary CTA is a promising noninvasive alternative to
routine catheterization during follow-up of HTx recipients to diagnose
CAV.<br/>Copyright &#xa9; American Roentgen Ray Society.

<101>
Accession Number
2000733845
Title
Predictive value of cell cycle arrest biomarkers for cardiac
surgery-associated acute kidney injury: a meta-analysis.
Source
British Journal of Anaesthesia. 121 (2) (pp 350-357), 2018. Date of
Publication: August 2018.
Author
Su L.-J.; Li Y.-M.; Kellum J.A.; Peng Z.-Y.
Institution
(Su, Li, Peng) Department of Critical Care Medicine, Zhongnan Hospital of
Wuhan University, Wuhan, Hubei Province, China
(Kellum, Peng) Center of Critical Care Nephrology, Department of Critical
Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA,
United States
Publisher
Elsevier Ltd
Abstract
Background: A biomarker test based on a combination of urine tissue
inhibitor of metalloproteinases 2 (TIMP-2) and insulin-like growth factor
binding protein 7 (IGFBP7) has been used as a potential biomarker of acute
kidney injury (AKI). This meta-analysis aimed to evaluate the predictive
value of this biomarker for cardiac surgery-associated acute kidney injury
(CSA-AKI). <br/>Method(s): We searched MEDLINE, PubMed, Cochrane, and
EMBASE for studies. We evaluated the methodological quality of each
included study using the Quality Assessment of Diagnostic Accuracy Studies
2 criteria. Meta-DiSc and STATA were used for statistical analyses.
<br/>Result(s): A total of 10 studies (747 patients) were included in this
meta-analysis. Pooled sensitivity and specificity with corresponding 95%
confidence intervals (CI) were 0.77 (95% CI: 0.70-0.83,
I²=40.7%) and 0.76 (95% CI: 0.72-0.79, I²=69.1%),
respectively. Pooled positive likelihood ratio (LR), negative LR, and
diagnostic odds ratio were 3.26 (95% CI: 2.51-4.23, I²=50.7%),
0.32 (95% CI: 0.24-0.41, I²=6.7%), and 10.08 (95% CI:
6.85-14.84, I²=6.7%), respectively. The area under the curve
estimated by summary receiver operating characteristics was 0.83 [standard
error (SE) 0.023] with a Q* value of 0.759 (SE 0.021). There was no
heterogeneity amongst the 10 studies from both threshold and non-threshold
effects. Subgroup analysis showed that the diagnostic value was related to
the severity of AKI and time measurement. <br/>Conclusion(s): Urinary
[TIMP-2].[IGFBP7] is an effective predictive test for cardiac surgery
associated acute kidney injury with good diagnostic accuracy within 24 h.
Studies examining use of biomarker-guided care bundles are
indicated.<br/>Copyright &#xa9; 2018 British Journal of Anaesthesia

<102>
Accession Number
625534090
Title
Bioactive scaffolds in stem-cell-based therapies for cardiac repair:
Protocol for a meta-analysis of randomized controlled preclinical trials
in animal myocardial infarction models 11 Medical and Health Sciences 1102
Cardiorespiratory Medicine and Haematology.
Source
Systematic Reviews. 7 (1) (no pagination), 2018. Article Number: 225. Date
of Publication: 05 Dec 2018.
Author
Khan K.; Gasbarrino K.; Mahmoud I.; Makhoul G.; Yu B.; Dufresne L.;
Daskalopoulou S.S.; Schwertani A.; Cecere R.
Institution
(Khan, Makhoul, Yu, Dufresne, Schwertani, Cecere) Division of Cardiology
and Cardiac Surgery, McGill University Health Centre, Montreal, QC, Canada
(Gasbarrino, Daskalopoulou) Division of Experimental Medicine, Department
of Medicine, Faculty of Medicine, McGill University Health Centre,
Montreal, QC, Canada
(Mahmoud) McConnell Resource Centre, McGill University Health Centre,
Montreal, QC, Canada
(Cecere) Glen Campus-The Royal Victoria Hospital, 1001 Decarie Blvd,
Montreal, QC H4A 3J1, Canada
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Acute myocardial infarction (MI) remains one of the leading
causes of death worldwide with no curative therapy available. Stem cell
therapies have been gaining interest as a means to repair the cardiac
tissue after MI and prevent the onset of heart failure. Many in vivo
reports suggest that the use of stem cells is promising, yet clinical
trials suggest that the cells fail to integrate into the native tissue,
resulting in limited improvements in cardiac function and repair. To
battle this limitation, the combination of using stem cells embedded in a
bioactive scaffold that promotes cell retention is growing in interest.
Yet, a systematic review of the literature on the use of stem cells
embedded in bioactive scaffolds for cardiac repair has not yet been
performed. In this protocol, we outline a systematic review and
meta-analysis of preclinical trials in animal MI models that utilize stem
cell-embedded scaffolds for cardiac repair and compare their effects to
stem cell-treated animals without the use of a scaffold. Methods/design:
We will search the following electronic databases: Cochrane Library,
MEDLINE, Embase, PubMed, Scopus and Web of Science, and gray literature:
Canadian Agency for Drugs and Technologies in Health and Google Scholar.
We will only include randomly controlled preclinical trials that have
directly investigated the effects of stem cells embedded in a scaffold for
cardiac repair in an animal MI model. Two investigators will independently
review each article included in the final analysis. The primary endpoint
that will be investigated is left ventricular ejection fraction. Secondary
endpoints will include infarct size, end systolic volume, end diastolic
volume, fractional shortening and left ventricular wall thickness. Pooled
analyses will be conducted using the DerSimonian-Laird random effects and
Mantel-Haenszel fixed-effect models. Between-studies heterogeneity will be
quantified and determined using the Tau² and I ²
statistics. Publication bias will be assessed using visual inspection of
funnel plots and complemented by Begg's and Egger's statistical tests.
Possible sources of heterogeneity will be assessed using subgroup-meta
analysis and meta-regression. <br/>Discussion(s): To date, the use of
scaffolds in myocardial repair has not yet been systematically reviewed.
The results of this meta-analysis will aid in determining the efficacy of
stem cell-embedded scaffolds for cardiac repair and help bring this
therapy to the clinic.<br/>Copyright &#xa9; 2018 The Author(s).

<103>
Accession Number
2000878287
Title
Efficacy of perioperative dexmedetomidine on postoperative delirium:
systematic review and meta-analysis with trial sequential analysis of
randomised controlled trials.
Source
British Journal of Anaesthesia. 121 (2) (pp 384-397), 2018. Date of
Publication: August 2018.
Author
Duan X.; Coburn M.; Rossaint R.; Sanders R.D.; Waesberghe J.V.; Kowark A.
Institution
(Duan) Department of Anaesthesiology, The Affiliated Hospital of Southwest
Medical University, LuZhou, China
(Duan, Coburn, Rossaint, Waesberghe, Kowark) Department of
Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
(Sanders) Department of Anesthesiology, School of Medicine and Public
Health, University of Wisconsin, Madison, WI, United States
Publisher
Elsevier Ltd
Abstract
Background: The influence of dexmedetomidine on postoperative delirium
(POD) in adult surgical patients remains controversial. We aimed to
analyse whether dexmedetomidine use could decrease POD incidence in this
population and its relation to timing of dexmedetomidine administration
and patient age. <br/>Method(s): We used random-effects modelled
meta-analysis, trial sequential analysis, and followed Cochrane
methodology with Grading of Recommendations Assessment, Development, and
Evaluation (GRADE). PubMed and Cochrane library were searched up to July
2017 for randomised controlled trials that analysed POD incidence of adult
surgical patients (age >=18 yr) after dexmedetomidine administration.
<br/>Result(s): Eighteen studies (comprising 3309 patients) were included.
There was decreased risk of POD with dexmedetomidine use for the entire
adult surgical population [odds ratio (OR) 0.35; 95% confidence interval
(CI) 0.24-0.51)], with firm evidence from trial sequential analysis.
Pre-specified subgroup analyses confirmed this result with firm evidence
for cardiac and non-cardiac surgical patients, (OR 0.41; 95% CI 0.26-0.63)
and (OR 0.33; 95% CI 0.18-0.59), respectively. We also found firm evidence
for reduction of POD if dexmedetomidine is administered during the
postoperative period (OR 0.30; 95% CI 0.21-0.44), in patients aged <65 yr
(OR 0.19; 95% CI 0.10-0.36) or >=65 yr (OR 0.44; 95% CI 0.30-0.65).
Evidence for dexmedetomidine's influence on secondary outcomes
(in-hospital mortality, intensive care unit and hospital length of stay,
bradycardia, and hypotension) is thus far insufficient to draw
conclusions. <br/>Conclusion(s): Dexmedetomidine can reduce POD incidence
for adult cardiac and non-cardiac surgical patients. The optimal dose and
timing of dexmedetomidine and influence on other outcomes or particular
patient populations with risk factors warrants further studies. Clinical
trial registration: PROSPERO: CRD42017072380.<br/>Copyright &#xa9; 2018
British Journal of Anaesthesia

<104>
Accession Number
621755580
Title
Percutaneous Versus Surgical Revascularization for Left Main or
Multivessel Coronary Artery Disease: Results From a Large-Scale
Meta-Analysis in the Era of Drug-Eluting Stents.
Source
Angiology. 69 (9) (pp 812-824), 2018. Date of Publication: 01 Oct 2018.
Author
Verdoia M.; Barbieri L.; Kedhi E.; Suryapranata H.; De Luca G.
Institution
(Verdoia, Barbieri, De Luca) Division of Cardiology, Azienda
Ospedaliera-Universitaria "Maggiore della Carita," Eastern Piedmont
University, Novara, Italy
(Barbieri) Presidio Ospedaliero S. Andrea, Vercelli, Italy
(Kedhi) Department of Cardiology, Isala Hospital, Zwolle, Netherlands
(Kedhi, Suryapranata) UMC St Radboud, Nijmegen, Netherlands
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
The best treatment options for left main (LM) or multivessel coronary
disease (MVD) are still debated. We performed a meta-analysis of
randomized trials comparing percutaneous versus surgical revascularization
for LM or MVD. Primary end point was overall mortality. Secondary end
points were major adverse cardiovascular events, recurrent myocardial
infarction, repeated revascularization, or stroke. A total of 8 randomized
trials were included, involving 8694 patients, 50% undergoing percutaneous
coronary intervention (PCI). At a mean follow-up of 39.7 months, mortality
was 8.2% with no difference for PCI versus coronary artery bypass grafting
(CABG; odds ratio [OR] 95% confidence interval [CI] = 1.18 [0.90-1.55]; P
=.24, P for heterogeneity [P<inf>het</inf>] =.01). However, CABG was
slightly favored for MVD (OR [95% CI] = 1.54 [1.12-2.13]; P =.008,
P<inf>het</inf> =.14 for PCI) whereas noninferior for LM disease (OR [95%
CI] = 0.88 [0.60-1.29]; P =.50, P<inf>het</inf> =.10, P interaction =.03).
A similar benefit with CABG was also observed in terms of repeated
coronary revascularization, whereas PCI significantly reduced stroke. This
meta-analysis shows that surgical coronary revascularization still offers
advantages in survival and recurrent ischemic events compared to PCI using
drug-eluting stents (DES) in MVD although burdened by an increased risk of
stroke. In LM disease, CABG did not provide outcome benefits but was
associated with a higher risk of stroke compared to PCI. Additional
randomized trials are certainly needed with new-generation
DES.<br/>Copyright &#xa9; The Author(s) 2018.

<105>
Accession Number
620676488
Title
Is the use of hydroxyethyl starch as priming solution during cardiac
surgery advisable? A randomized, single-center trial.
Source
Perfusion (United Kingdom). 33 (6) (pp 483-489), 2018. Date of
Publication: 01 Sep 2018.
Author
Svendsen O.S.; Farstad M.; Mongstad A.; Haaverstad R.; Husby P.; Kvalheim
V.L.
Institution
(Svendsen, Farstad, Husby) Department of Anesthesia and Intensive Care,
Haukeland University Hospital, Bergen, Norway
(Mongstad, Haaverstad, Kvalheim) Section for Cardiothoracic Surgery,
Department for Heart Disease, Haukeland University Hospital, Bergen,
Norway
(Haaverstad, Kvalheim) Department of Clinical Science, Faculty of
Medicine, University of Bergen, Bergen, Norway
(Husby) Department of Clinical Medicine, Faculty of Medicine, University
of Bergen, Bergen, Norway
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: The use of cardiopulmonary bypass (CPB) leads to increased
fluid filtration and edema. The use of artificial colloids to counteract
fluid extravasation during cardiac surgery is controversial. Beneficial
effects on global fluid loading, leading to better cardiac performance and
hemodynamics, have been claimed. However, renal function and coagulation
may be adversely affected, with unfavorable impact on outcome following
cardiac surgery. <br/>Method(s): Forty patients were randomly allocated to
study groups receiving either acetated Ringer's solution (CT group) or
hydroxyethyl starch (HES group, Tetraspan) as CPB priming
solution. Fluid balance, bleeding and hemodynamics, including cardiac
output, were followed postoperatively. The occurrence of acute kidney
injury was closely registered. <br/>Result(s): Two patients were excluded
from further analyzes due to surgical complications. Fluid accumulation
was attenuated in the HES group (3374 (883) ml) compared with the CT group
(4328 (1469) ml) (p=0.024). The reduced perioperative fluid accumulation
was accompanied by an increased cardiac index immediately after surgery
(2.7 (0.4) L/min/m² in the HES group and 2.1 (0.3)
L/min/m² in the CT group (p<0.001)). No increase in bleeding
could be demonstrated in the HES group. Three patients, all of them in the
HES group, experienced acute kidney injury postoperatively.
<br/>Conclusion(s): CPB priming with HES solution lowers fluid loading
during bypass and improves cardiac function in the early postoperative
period. The manifestation of acute kidney injury exclusively in the HES
group of patients raises doubts about the use of HES products in
conjunction with cardiac surgery.
(https://clinicaltrials.gov/ct2/show/NCT01511120).<br/>Copyright &#xa9;
The Author(s) 2017.

<106>
Accession Number
2001022620
Title
Genetic association between HLA-G 14-bp polymorphism and diseases: A
systematic review and meta-analysis.
Source
Human Immunology. 79 (10) (pp 724-735), 2018. Date of Publication: October
2018.
Author
de Almeida B.S.; Muniz Y.C.N.; Prompt A.H.; Castelli E.C.; Mendes-Junior
C.T.; Donadi E.A.
Institution
(de Almeida, Donadi) Divisao de Imunologia Clinica, Departamento de
Clinica Medica, Faculdade de Medicina de Ribeirao Preto (FMRP),
Universidade de Sao Paulo (USP), Ribeirao Preto, SP 14049-900, Brazil
(de Almeida) Laboratorio Multiusuario de Estudos em Biologia, Centro de
Ciencias Biologicas, Universidade Federal de Santa Catarina (UFSC),
Florianopolis, Brazil
(Muniz, Prompt) Departamento de Biologia Celular, Embriologia e Genetica,
Centro de Ciencias Biologicas, Universidade Federal de Santa Catarina
(UFSC), Florianopolis, Brazil
(Castelli) Departamento de Patologia, Faculdade de Medicina de Botucatu,
Unesp - Univ. Estadual Paulista, Botucatu, SP 18618-970, Brazil
(Mendes-Junior) Faculdade de Filosofia Ciencias e Letras de Ribeirao Preto
(FFCLRP), Universidade de Sao Paulo (USP), Ribeirao Preto, SP 14049-900,
Brazil
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: HLA-G is an immune checkpoint molecule. Since a differential
molecule expression has been reported even for healthy individuals, many
studies have focused on polymorphisms at HLA-G regulatory regions,
particularly the 3' untranslated region (3'UTR). The presence/absence of a
14-bp sequence was the first polymorphism described and it is the most
studied in association between HLA-G and disorders. <br/>Method(s): In
this study, we performed a systematic review and meta-analysis of all
association studies published regarding the HLA-G 14-bp. <br/>Result(s):
We verified association between 14-bp alleles and diseases in the
following situations: (1) presence of 14-bp (insertion) conferred
susceptibility to preeclampsia (child alleles evaluated) and systemic
lupus erythematosus (OR = 1.42; 95%CI = 1.04-1.93; p = 0.026 and OR =
1.13; 95%CI = 1.01-1.27, p = 0.028); (2) 14-bp absence (deletion) was
associated with increased risk to breast cancer (OR = 1.23; 95%CI =
1.06-1.43; p = 0.006) and human Cytomegalovirus infection (OR = 2.06;
95%CI = 1.60-2.64; p < 0.0001); and (3) a risk association was observed
between the group of reproductive disorders and the 14-bp insertion (OR =
1.12; 95%CI = 1.01-1.24; p = 0.034). <br/>Conclusion(s): Considering that
others 14-bp associations were inconclusive and that other variation sites
observed at HLA-G 3'UTR exhibit a proven role on post-transcriptional
regulation of HLA-G expression, the complete 3'UTR segment should be
analyzed in terms of disease susceptibility, instead of a single
polymorphism.<br/>Copyright &#xa9; 2018

<107>
[Use Link to view the full text]
Accession Number
625008740
Title
Ambulation capacity and functional outcome in patients undergoing
neuromuscular electrical stimulation after cardiac valve surgery: A
randomised clinical trial.
Source
Medicine. 97 (46) (pp e13012), 2018. Date of Publication: 01 Nov 2018.
Author
Fontes Cerqueira T.C.; Cerqueira Neto M.L.; Cacau L.A.P.; Oliveira G.U.;
Silva Junior W.M.D.; Carvalho V.O.; Mendonca J.T.; Santana Filho V.J.
Institution
(Fontes Cerqueira) Department of Physiotherapy, Universidade Federal de
Sergipe, Lagarto, Brazil
(Cerqueira Neto, Carvalho, Santana Filho) Department of Physiotherapy,
Universidade Federal de Sergipe, Sao
(Cacau) Department of Physiotherapy, Universidade Tiradentes, Aracaju,
Brazil
(Oliveira) Universidade Federal de Sergipe, Aracaju, Brazil
(Silva Junior) Department of Physiotherapy, Universidade Federal de
Sergipe, Sao Cristovao, Brazil
(Mendonca) Department of Medicine, Universidade Federal de Sergipe, SE,
Sao Cristovao, Brazil
Publisher
NLM (Medline)
Abstract
BACKGROUND: Early mobilization and physical exercise are considered
fundamental components in cardiovascular surgery rehabilitation; however,
occasionally they are inadequate for inhibiting functional decline.
Neuromuscular electrical stimulation (NMES) is a promising tool in
cardiovascular rehabilitation; however, to date, no randomized clinical
trial has measured the effects of NMES on functional capacity and quality
of life in patients who undergo routine cardiac surgery with a short
intensive care unit (ICU) stay. Therefore, we aimed to investigate the
effects of NMES on walking ability, muscle strength, functional
independence, and quality of life in cardiac valve surgery patients in the
immediate postoperative period. <br/>METHOD(S): A randomized, parallel,
controlled, 2-arm clinical trial with assessor blinding was conducted.
Fifty-nine adult patients in the preoperative period after cardiac valve
reconstruction and/or replacement were randomly assigned to a control or
intervention group. The intervention group underwent NMES in the
quadriceps and gastrocnemius, bilaterally, for 60 minutes, for up to 10
sessions. The primary outcome was ambulation ability, assessed through the
Six-Minute Walk Test and Walking Speed Test at postoperative day 5 (5PO).
Secondary outcomes were muscular strength (assessed through the Medical
Research Council scale), functional independence measure (assessed through
the Functional Independence Measurement Questionnaire), and quality of
life (assessed through the Nottingham Health Profile) at baseline
(preoperative) and at postoperative days 3 and 5. <br/>RESULT(S): The
baseline characteristics were similar in both groups, except for body mass
index. There was no statistically significant difference, with a small
effect size, between both groups regarding the distance walked (95% CI,
-64.87 to 65.97) and walking speed (95% CI, -0.55 to 0.57). There was a
statistically significant difference in upper-limb muscle strength loss
and decline in mobility at postoperative day 3, which had a tendency to
recover to initial values at 5PO, in both groups. No significant
between-group difference was noted for muscle strength, functional
independence, and quality of life. <br/>CONCLUSION(S): The use of NMES had
no effect on walking ability, strength, quality of life, or functional
outcome in the postoperative period for patients that underwent regular
valve replacement.

<108>
[Use Link to view the full text]
Accession Number
625008672
Title
Comprehensive preoperative regime of selective gut decontamination in
combination with probiotics, and smectite for reducing endotoxemia and
cytokine activation during cardiopulmonary bypass: A pilot randomized,
controlled trial.
Source
Medicine. 97 (46) (pp e12685), 2018. Date of Publication: 01 Nov 2018.
Author
Liu W.-C.; Zhan Y.-P.; Wang X.-H.; Hou B.-C.; Huang J.; Chen S.-B.
Institution
(Liu) Department of Anesthesiology, First Affiliated Hospital of Nanchang
University, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Both selective digestive decontamination (SDD) and probiotics
have been reported to reduce endotoxemia. However, the available results
are conflicting and few studies have investigated the combined effect of
SDD and probiotics. This study aimed to examine the effectiveness of a
comprehensive preoperative regimen of SDD in combination with probiotics
and smectite on perioperative endotoxemia and cytokine activation in
patients who underwent elective cardiac surgery with cardiopulmonary
bypass (CPB) in a pilot, prospective, randomized, controlled trial.
<br/>METHOD(S): Patients who underwent elective Aortic Valve Replacement
or Mitral Valve Replacement surgery from July 2010 to March 2015 were
included. In total, 30 eligible patients were randomly assigned to receive
either the comprehensive preoperative regimen (n = 15) (a combination of
preoperative SDD, probiotics, and smectite) or the control group (n = 15)
who did not receive this treatment. The levels of endotoxin, IL-6, and
procalcitonin were measured at the time before anesthesia induction,
immediately after cardiopulmonary bypass (CPB), 24 hours after CPB, and 48
hours after CPB. The primary outcomes were changes in endotoxin, IL-6, and
procalcitonin concentrations after CPB. <br/>RESULT(S): The mean levels of
change in endotoxin levels after CPB in patients receiving the
comprehensive preoperative regimen was marginally significantly lower than
those in control group (F = 4.0, P = .0552) but was not significantly
different for procalcitonin (F = .14, P = .7134). An interaction between
group and time for IL-6 was identified (F = 4.35, P = .0231). The increase
in IL-6 concentration immediately after CPB in the comprehensive
preoperative group was significantly lower than that in the control group
(P = .0112). The changes in IL-6 concentration at 24 hours and 48 hours
after CPB were not significant between the comprehensive preoperative
group and control group. <br/>CONCLUSION(S): The present pilot,
prospective, randomized, controlled study in patients undergoing cardiac
surgery with CPB demonstrated that 3 days of a comprehensive preoperative
regime of SDD in combination with probiotics and smectite may reduce the
endotoxin and IL-6 levels after CPB compared with the control group.

<109>
[Use Link to view the full text]
Accession Number
622901361
Title
Homograft Versus Conventional Prosthesis for Surgical Management of Aortic
Valve Infective Endocarditis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 13 (3) (pp 163-170), 2018. Date of Publication: 01 May 2018.
Author
Yanagawa B.; Mazine A.; Tam D.Y.; Juni P.; Bhatt D.L.; Spindel S.; Puskas
J.D.; Verma S.; Friedrich J.O.
Institution
(Yanagawa, Mazine, Tam, Verma) Division of Cardiac Surgery, St Michael's
Hospital, University of Toronto, Division of Cardiac Surgery, 30 Bond
Street, 8th Floor, Bond Wing, Toronto, ON M5B 1W8, Canada
(Juni) Applied Health Research Centre, St Michael's Hospital, University
of Toronto, Toronto, ON, Canada
(Juni, Friedrich) Li Ka Shing Knowledge Institute, St Michael's Hospital,
University of Toronto, Toronto, ON, Canada
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Spindel, Puskas) Department of Cardiothoracic Surgery, Mount Sinai
Hospital, New York, NY, United States
(Friedrich) Department of Critical Care and Medicine, St Michael's
Hospital, University of Toronto, Toronto, ON, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective Surgical management of aortic valve infective endocarditis (IE)
with cryopreserved homograft has been associated with lower risk of
recurrent IE, but there is equipoise with regard to the optimal
prosthesis. This systematic review and meta-analysis were performed to
compare outcomes between homograft and conventional prosthesis for aortic
valve IE. Methods We searched MEDLINE database to September 2017 for
studies comparing homograft versus conventional prosthesis. The main
outcomes were all-cause mortality, recurrent IE, and reoperation. Results
There were 18 included comparative observational studies with 2232
patients (median follow up = 5 [interquartile range: 2-7] years, 30%
prosthetic valve endocarditis); four studies were adjusted for baseline
differences. There were no differences in perioperative mortality or
stroke despite a greater proportion of staphylococcal endocarditis,
abscess, and root replacements but less multivalve involvement in the
homograft group. Long-term outcomes of all-cause mortality [incidence rate
ratio (IRR) = 1.03, 95% confidence interval (CI) = 0.81-1.31, P = 0.83,
for unmatched, and IRR = 0.82, 95% CI = 0.36-1.84, P = 0.63, for matched
studies], recurrent endocarditis (IRR = 1.01, 95% CI = 0.53-1.93, P =
0.96, for unmatched, and IRR = 1.04, 95% CI = 0.49-2.19, P = 0.92, for
matched studies), and reoperation (IRR = 1.60, 95% CI = 0.80-3.21, P =
0.18, for unmatched, and IRR = 3.17, 95% CI = 0.52-19.44, P = 0.21, for
matched studies) were not different comparing homograft versus
conventional prosthesis. There was a significantly increased need for
reoperation with homograft versus mechanical prosthetic valves, but this
comparison was based on limited data. Conclusions Homografts and
conventional prostheses offer similar survival and freedom from recurrent
endocarditis and reoperation for aortic valve IE. Homografts may be
associated with greater risk of reoperation compared with mechanical
valves.<br/>Copyright &#xa9; 2018 by the International Society for
Minimally Invasive Cardiothoracic Surgery.

<110>
[Use Link to view the full text]
Accession Number
622901359
Title
Three-Year Survival Comparison between Transcatheter and Surgical Aortic
Valve Replacement for Intermediate- and Low-Risk Patients.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 13 (3) (pp 153-162), 2018. Date of Publication: 01 May 2018.
Author
Siordia J.A.; Loera J.M.; Scanlon M.; Evans J.; Knight P.A.
Institution
(Siordia, Loera, Scanlon, Evans, Knight) Department of Cardiac Surgery,
University of Rochester Medical Center, 7796 Victor Mendon Rd, Victor,
Rochester, NY 14564, United States
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Transcatheter aortic valve implantation is a suitable therapeutic
intervention for patients deemed inoperable or high risk for surgical
aortic valve replacement. Current investigations question whether it is a
suitable alternative to surgery for intermediate- and low-risk patients.
The following meta-analysis presents a comparison between transcatheter
versus surgical aortic valve replacement in patients that are intermediate
and low risk for surgery. Articles were collected via an electronic search
using Google Scholar and PubMed. Articles of interest included studies
comparing the survival of intermediate- and low-risk patients undergoing
transcatheter aortic valve implantation to those undergoing surgical
aortic valve replacement. Primary end points included 1-, 2-, and 3-year
survival. Secondary end points included postintervention thromboembolic
events, stroke, transient ischemic attacks, major vascular complications,
permanent pacemaker implantation, life-threatening bleeding, acute kidney
injury, atrial fibrillation, and moderate-to-severe aortic regurgitation.
Six studies met the criteria for the meta-analysis. One- and two-year
survival comparisons showed no difference between the two interventions.
Surgical aortic valve replacement, however, presented with favorable
3-year survival compared with the transcatheter approach. Transcatheter
aortic valve implantation had more major vascular complications, permanent
pacemaker implantation, and moderate-to-severe aortic regurgitation rates
compared with surgery. Surgical aortic valve replacement presented more
life-threatening bleeding, acute kidney injury, and atrial fibrillation
compared with a transcatheter approach. There was no statistical
difference between the two approaches in terms of thromboembolic events,
strokes, or transient ischemic attack rates. Surgical aortic valve
replacement presents favorable 3-year survival rates compared with
transcatheter aortic valve implantation.<br/>Copyright &#xa9; 2018 by the
International Society for Minimally Invasive Cardiothoracic Surgery.

<111>
Accession Number
621159517
Title
Preventive Effects of Alprostadil Against Contrast-Induced Nephropathy
Inpatients With Renal Insufficiency Undergoing Percutaneous Coronary
Intervention.
Source
Angiology. 69 (5) (pp 393-399), 2018. Date of Publication: 01 May 2018.
Author
Yang S.-C.; Fu N.-K.; Zhang J.; Liang M.; Cong H.-L.; Lin W.-H.; Tian
F.-S.; Lu C.-Z.; Sun T.-T.; Zhang W.-Y.; Ma Z.-H.
Institution
(Yang, Liang, Sun, Zhang, Ma) Tianjin Medical University, Tianjin, China
(Fu, Zhang, Cong) Department of Cardiology, Tianjin Chest Hospital,
Tianjin, China
(Lin) Department of Cardiology, Taida International Cardiovascular
Hospital, Tianjin, China
(Tian) Department of Cardiology, Tianjin Fourth Central Hospital, Tianjin,
China
(Lu) Department of Cardiology, Tianjin First Central Hospital, Tianjin,
China
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
We investigated the preventive effect of alprostadil on contrast-induced
nephropathy (CIN) in patients with renal insufficiency undergoing
percutaneous coronary intervention (PCI). A total of 300 patients with
creatinine clearance (crCl) <=60 mL/min undergoing PCI were randomly
assigned to alprostadil or a control group. The primary end point was the
incidence of CIN defined as an increase in serum creatinine (Scr) levels
by >=0.5 mg/dL or>= 25% after administration of the contrast media within
72 hours. The secondary end points were (1) changes in Scr and crCl within
72 hours and (2) the incidence of major adverse events during
hospitalization. The incidence of CIN was 2.7% (4/150) in the alprostadil
group, and 8.7% (13/150) in the control group (chi² = 5.05, P
=.043).There was no difference regarding the incidence of major adverse
events during hospitalization between the alprostadil group and control
groups (2.7% vs 4.0%, P =.750). Multivariate logistic regression analysis
showed that alprostadil was an independent protective factor for CIN (odds
ratio = 0.136, 95% confidence interval: 0.020-0.944, P =.044).
Prophylactic administration of alprostadil may prevent CIN in patients
with renal insufficiency undergoing PCI.<br/>Copyright &#xa9; 2017, &#xa9;
The Author(s) 2017.

<112>
Accession Number
624061380
Title
Efficacy of dexmedetomidine in prevention of junctional ectopic
tachycardia and acute kidney injury after pediatric cardiac surgery: A
meta-analysis.
Source
Congenital Heart Disease. 13 (5) (pp 799-807), 2018. Date of Publication:
September/October 2018.
Author
Li X.; Zhang C.; Dai D.; Liu H.; Ge S.
Institution
(Li, Zhang, Dai, Liu, Ge) Department of Cardiovascular Surgery, The First
Affiliated Hospital of Anhui Medical University, Hefei, China
Publisher
Blackwell Publishing Ltd
Abstract
Objective: We conducted a meta-analysis to evaluate the effects of
prophylactic perioperative dexmedetomidine administration on postoperative
junctional ectopic tachycardia (JET) and acute kidney injury (AKI) in
pediatric patients having undergone cardiac surgery. <br/>Design(s): This
systematic review was registered with PROSPERO (CRD42017083880). Databases
including PubMed, Cochrane Central Register of Controlled Trials, and Web
of Science were searched for randomized controlled trials (RCTs) and
observational cohort studies from its inception to March 2018. Two
reviewers independently screened literature, extracted data, and assessed
the quality of included studies using the Jadad scale and Newcastle-Ottawa
score. Meta-analysis was then conducted by RevMan 5.3 and Stata 12.0
software. P value <.05 was considered significant. <br/>Result(s): A total
of nine eligible studies (5 RCTs and 4 observational studies) comprising
1851 patients were selected for the final analysis. The results of
meta-analysis showed that dexmedetomidine significantly reduced the
incidence of postoperative JET (OR =0.35, 95% CI: 0.22 to 0.53, P
<.00001), but there was no significant difference between groups in AKI
(OR =0.44, 95% CI: 0.19 to 1.04, P =.06) and all-cause mortality (OR
=0.87, 95% CI: 0.35 to 2.14, P =.77). <br/>Conclusion(s): The
administration of perioperative dexmedetomidine effectively prevents JET
in pediatric patients undergoing cardiac surgery but has no significant
effect on postoperative renal function. However, the quality of evidence
for these findings is low; thus, future larger scale randomized studies
are needed to verify the real clinical effects of dexmedetomidine
prophylaxis in pediatric patients.<br/>Copyright &#xa9; 2018 Wiley
Periodicals, Inc.

<113>
Accession Number
2000567409
Title
Steroids in cardiac surgery: a systematic review and meta-analysis.
Source
British Journal of Anaesthesia. 120 (4) (pp 657-667), 2018. Date of
Publication: April 2018.
Author
Dvirnik N.; Belley-Cote E.P.; Hanif H.; Devereaux P.J.; Lamy A.; Dieleman
J.M.; Vincent J.; Whitlock R.P.
Institution
(Dvirnik, Belley-Cote, Devereaux, Lamy, Whitlock) Department of Clinical
Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario,
Canada
(Dvirnik, Hanif, Lamy, Whitlock) Division of Cardiac Surgery, McMaster
University, Hamilton, Ontario, Canada
(Devereaux) Department of Medicine, McMaster University, Hamilton,
Ontario, Canada
(Devereaux, Lamy, Vincent, Whitlock) Population Health Research Institute,
Hamilton, Ontario, Canada
(Dieleman) Division of Anaesthesiology, Intensive Care, and Emergency
Medicine, University Medical Center Utrecht, Netherlands
(Dieleman) Department of Anaesthesia and Perioperative Medicine, Monash
University, Melbourne, Australia
Publisher
Elsevier Ltd
Abstract
Background: Cardiopulmonary bypass (CPB) induces a systemic inflammatory
reaction that may contribute to postoperative complications. Preventing
this reaction with steroids may improve outcomes. We performed a
systematic review to evaluate the impact of prophylactic steroids on
clinical outcomes in patients undergoing on-pump cardiac surgery.
<br/>Method(s): We searched MEDLINE, EMBASE, and Cochrane CENTRAL for
randomised controlled trials (RCTs) comparing perioperative corticosteroid
administration with a control group in adults undergoing CPB. Outcomes of
interest included mortality, myocardial infarction, and new onset atrial
fibrillation. We assessed the quality of evidence using the Grading of
Recommendations Assessment, Development and Evaluation approach.
<br/>Result(s): Fifty-six RCTs published between 1977 and 2015 were
included in this meta-analysis. Mortality was not significantly different
between groups [3.0% (215/7258 patients) in the steroid group and 3.5%
(252/7202 patients) in the placebo group; relative risk (RR), 0.85; 95%
confidence interval (CI), 0.71-1.01; P=0.07; I² = 0%].
Myocardial injury was more frequent in the steroid group [8.0% (560/6989
patients), compared with 6.9% (476/6929 patients); RR, 1.17, 95% CI,
1.04-1.31; P=0.008; I²=0%]. New onset atrial fibrillation was
lower in the steroid group [25.7% (1792/6984 patients) compared with 28.3%
(1969/6964 patients), RR, 0.91, 95% CI, 0.86-0.96, P=0.0005,
I²=43%]; this beneficial effect was limited to small trials (P
for interaction <0.00001). <br/>Conclusion(s): After randomising 16 013
patients, steroid administration at the time of cardiac surgery had an
unclear impact on mortality, increased the risk of myocardial injury, and
the impact on atrial fibrillation should be viewed with caution given that
large trials showed no effect.<br/>Copyright &#xa9; 2018 British Journal
of Anaesthesia

<114>
Accession Number
619411693
Title
Anesthesia and sleep apnea.
Source
Sleep Medicine Reviews. 40 (pp 79-92), 2018. Date of Publication: August
2018.
Author
Tamisier R.; Fabre F.; O'Donoghue F.; Levy P.; Payen J.-F.; Pepin J.-L.
Institution
(Tamisier, O'Donoghue, Levy, Pepin) Laboratoire HP2, Inserm 1042,
Universitee Grenoble Alpes, Grenoble F-38042, France
(Tamisier, Levy, Pepin) Laboratoire EFCR et Sommeil, Pole Thorax et
Vaisseaux, Grenoble Alpes University Hospital, Grenoble 38043, France
(Fabre, Payen) Pole Anesthesie-reanimation - Hopital Michallon, Grenoble
Alpes University Hospital, Grenoble F-38000, France
(O'Donoghue) Institute for Breathing and Sleep, Austin Health, Heidelberg,
Victoria 3084, Australia
(O'Donoghue) The University of Melbourne, Parkville, Victoria 3010,
Australia
(Payen) Grenoble Institut des Neurosciences, Univ. Grenoble Alpes,
Grenoble F-38000, France
(Payen) INSERM, U1216, Grenoble F-38000, France
Publisher
W.B. Saunders Ltd
Abstract
Due to its low rate of diagnosis, in the general population over half of
those experiencing obstructive sleep apnea (OSA) are unaware that they
have the condition. However, any acute medical event may exacerbate OSA
and could have serious health consequences. In this context the management
of the perioperative period, from anesthesia through the surgery itself
and into the postoperative period, is more problematic for patients with
sleep disordered breathing than for others. There is prolific literature
in this area although large randomized trials are few due to the high
sample size needed and possible ethical difficulties of withholding OSA
treatment in the perioperative period. In 2014 the American Society of
Anesthesiologists published an updated set of recommendations to guide OSA
management during the perioperative period. In this present review we
provide an overview of the different issues that practitioners face with
regard to OSA, from the initial consultation with the anesthesiologist to
the extended post-operative period. There is considerable evidence that
OSA patients are at high risk of perioperative complications, though the
inherent risks from OSA per se and its comorbidities remain difficult to
discern. Nevertheless, appropriate screening and management allow
clinicians to minimize OSA associated risk.<br/>Copyright &#xa9; 2017
Elsevier Ltd

<115>
Accession Number
623657393
Title
Single-dose intravenous diclofenac for acute postoperative pain in adults.
Source
Cochrane Database of Systematic Reviews. 2018 (8) (no pagination), 2018.
Article Number: CD012498. Date of Publication: 28 Aug 2018.
Author
Mcnicol E.D.; Ferguson M.C.; Schumann R.
Institution
(Mcnicol, Schumann) Tufts Medical Center, Department of Anesthesiology and
Perioperative Medicine, Boston, MA, United States
(Mcnicol) Tufts Medical Center, Department of Pharmacy, Boston, MA, United
States
(Mcnicol) Tufts University School of Medicine, Pain Research, Education
and Policy (PREP) Program, Department of Public Health and Community
Medicine, Boston, MA, United States
(Ferguson) Southern Illinois University Edwardsville, Pharmacy Practice,
Edwardsville, United States
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Postoperative administration of non-steroidal
anti-inflammatory drugs (NSAIDs) reduces patient opioid requirements and,
in turn, reduces the incidence and severity of opioid-induced adverse
events (AEs). <br/>Objective(s): To assess the analgesic efficacy and
adverse effects of single-dose intravenous diclofenac, compared with
placebo or an active comparator, for moderate to severe postoperative pain
in adults. <br/>Search Method(s): We searched the following databases
without language restrictions: the Cochrane Central Register of Controlled
Trials (Cochrane Register of Studies Online), MEDLINE, and Embase on 22
May 2018. We checked clinical trials registers and reference lists of
retrieved articles for additional studies. <br/>Selection Criteria: We
included randomized trials that compared a single postoperative dose of
intravenous diclofenac with placebo or another active treatment, for
treating acute postoperative pain in adults following any surgery.
<br/>Data Collection and Analysis: We used standard methodological
procedures expected by Cochrane. Two review authors independently
considered trials for review inclusion, assessed risk of bias, and
extracted data. Our primary outcome was the number of participants in each
arm achieving at least 50% pain relief over a four- and six-hour period.
Our secondary outcomes were time to, and number of participants using
rescue medication; withdrawals due to lack of efficacy, AEs, and for any
cause; and number of participants experiencing any AE, serious AEs (SAEs),
and NSAID-related AEs. We performed a post hoc analysis of opioid-related
AEs, to enable indirect comparisons with other analyses of postoperative
analgesics. For subgroup analysis, we planned to analyze different doses
and formulations of parenteral diclofenac separately. We assessed the
overall quality of the evidence for each outcome using GRADE and created
two 'Summary of findings' tables. <br/>Main Result(s): We included eight
studies, involving 1756 participants undergoing various surgeries (dental,
mixed minor, abdominal, and orthopedic), with 20 to 175 participants
receiving intravenous diclofenac in each study. Mean study population ages
ranged from 24.5 years to 54.5 years. Intravenous diclofenac doses varied
among and within studies, ranging from 3.75 mg to 75 mg. Five studies
assessed newer formulations of parenteral diclofenac that could be
administered as an undiluted intravenous bolus. Most studies had an
unclear risk of bias for several domains and a high risk of bias due to
small sample size. The overall quality of evidence for each outcome was
generally low for reasons including unclear risk of bias in studies,
imprecision, and low event numbers. Primary outcome Three studies (277
participants) produced a number needed to treat for an additional
beneficial outcome (NNTB) for at least 50% of maximum pain relief versus
placebo of 2.4 (95% confidence interval (CI) 1.9 to 3.1) over four hours
(low-quality evidence). Four studies (436 participants) produced an NNTB
of 3.8 versus placebo (95% CI 2.9 to 5.9) over six hours (low-quality
evidence). No studies provided data for the comparison of intravenous
diclofenac with another NSAID over four hours. At six hours there was no
difference between intravenous diclofenac and another NSAID (low-quality
evidence). Secondary outcomes For secondary efficacy outcomes, intravenous
diclofenac was generally superior to placebo and similar to other NSAIDs.
For time to rescue medication, comparison of intravenous diclofenac versus
placebo demonstrated a median of 226 minutes for diclofenac versus 80
minutes for placebo (5 studies, 542 participants, low-quality evidence).
There were insufficient data for pooled analysis for comparisons of
diclofenac with another NSAID (very low-quality evidence). For the number
of participants using rescue medication, two studies (235 participants)
compared diclofenac with placebo. The number needed to treat to prevent
one additional harmful event (NNTp) (here, the need for rescue medication)
compared with placebo was 3.0 (2.2 to 4.5, low-quality evidence). The
comparison of diclofenac with another NSAID included only one study (98
participants). The NNTp was 4.5 (2.5 to 33) for ketorolac versus
diclofenac (very low-quality evidence). The numbers of participants
withdrawing were generally low and inconsistently reported (very
low-quality evidence). Participant withdrawals were: 6% (8/140) diclofenac
versus 5% (7/128) placebo, and 9% (8/87) diclofenac versus 7% (6/82)
another NSAID for lack of efficacy; 2% (4/211) diclofenac versus 0%
(0/198) placebo, and 3% (4/138) diclofenac versus 2% (2/129) another NSAID
due to AEs; and 11% (21/191) diclofenac versus 17% (30/179) placebo, and
18% (21/118) diclofenac versus 15% (17/111) another NSAID for any cause.
Overall adverse event rates were similar between intravenous diclofenac
and placebo (71% in both groups, 2 studies, 296 participants) and between
intravenous diclofenac and another NSAID (55% and 58%, respectively, 2
studies, 265 participants) (low-quality evidence for both comparisons).
Serious and specific AEs were rare, preventing meta-analysis. There were
sufficient data for a dose-effect analysis for our primary outcome for
only one alternative dose, 18.75 mg. Analysis of the highest dose employed
in each study demonstrated a relative benefit compared with placebo of 1.9
(1.4 to 2.4), whereas for the group receiving 18.75 mg, the relative
benefit versus placebo was 1.6 (1.2 to 2.1, 2 studies). Compared to
another NSAID, the high-dose analysis demonstrated a relative benefit of
0.9 (0.8 to 1.1), for the group receiving 18.75 mg, the relative benefit
was 0.78 (0.65 to 0.93). For direct comparison of high dose versus 18.75
mg, the proportion of participants with at least 50% pain relief was 66%
(90/137) for the high-dose arm versus 57% (77/135) in the low-dose arm.
There were insufficient data for subgroup meta-analysis of different
diclofenac formulations. Authors' conclusions: The amount and quality of
evidence for the use of intravenous diclofenac as a treatment for
postoperative pain is low. The available evidence indicates that
postoperative intravenous diclofenac administration offers good pain
relief for the majority of patients, but further research may impact this
estimate. Adverse events appear to occur at a similar rate to other
NSAIDs. Insufficient information is available to assess whether
intravenous diclofenac has a different rate of bleeding, renal
dysfunction, or cardiovascular events versus other NSAIDs. There was
insufficient information to evaluate the efficacy and safety of newer
versus traditional formulations of intravenous diclofenac. There was a
lack of studies in major and cardiovascular surgeries and in elderly
populations, which may be at increased risk for adverse
events.<br/>Copyright &#xa9; 2018 The Cochrane Collaboration.

<116>
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.<br/>Copyright &#xa9; 2017 The Author.

<117>
Accession Number
617647937
Title
Routine use of viscoelastic blood tests for diagnosis and treatment of
coagulopathic bleeding in cardiac surgery: Updated systematic review and
meta-analysis.
Source
British Journal of Anaesthesia. 118 (6) (pp 823-833), 2017. Date of
Publication: 01 Jun 2017.
Author
Serraino G.F.; Murphy G.J.
Institution
(Serraino, 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
Viscoelastic point-of-care tests are commonly used to provide prompt
diagnosis of coagulopathy and allow targeted treatments in bleeding
patients. We updated existing meta-analyses that have evaluated the
clinical effectiveness of viscoelastic point-of-care tests vs the current
standard of care for the management of cardiac surgery patients at risk of
coagulopathic bleeding. Randomized controlled trials comparing
viscoelastic point-of-care diagnostic testing with standard care in
cardiac surgery patients were sought. All-cause mortality, blood loss,
reoperation, blood transfusion, major morbidity, and intensive care unit
and hospital length of stay were analysed using random-effects modelling.
Fifteen trials that randomized a total of 8737 participants were included
for the analysis. None of the trials was classified as low risk of bias.
The use of thromboelastography-(TEG ) or thromboelastometry (ROTEM
)-guided algorithms did not reduce mortality [risk ratio (RR) 0.55, 95%
confidence interval (CI) 0.28-1.10] without heterogeneity (I²
=1%), reoperation for bleeding, stroke, ventilation time, or hospital
length of stay compared with standard care. Use of TEG or ROTEM resulted
in reductions in the frequency of red blood cell (Risk Ratio 0.88, 95%
Confidence Interval 0.79-0.97; I² =43%) and platelet
transfusion (Risk Ratio 0.78, 95% Confidence Interval 0.66-0.93;
I² =0%). Group Reading Assessment and Diagnostic Evaluation
(GRADE) assessment demonstrated that the quality of the evidence was low
or very low for all estimated outcomes. Routine use of viscoelastic
point-of-care tests did not improve important clinical outcomes beyond
transfusion in adults undergoing cardiac surgery.<br/>Copyright &#xa9;
2017 The Author.

<118>
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.

<119>
Accession Number
625814495
Title
Prospective, randomized trial of bioresorbable scaffolds vs.
everolimus-eluting stents in patients undergoing coronary stenting for
myocardial infarction: the Intracoronary Scaffold Assessment a Randomized
evaluation of Absorb in Myocardial Infarction (ISAR-Absorb MI) trial.
Source
European heart journal. 40 (2) (pp 167-176), 2019. Date of Publication: 07
Jan 2019.
Author
Byrne R.A.; Alfonso F.; Schneider S.; Maeng M.; Wiebe J.; Kretov E.;
Bradaric C.; Rai H.; Cuesta J.; Rivero F.; Hoppmann P.; Schlichtenmaier
J.; Christiansen E.H.; Cassese S.; Joner M.; Schunkert H.; Laugwitz K.-L.;
Kastrati A.
Institution
(Byrne, Wiebe, Rai, Cassese, Joner, Schunkert, Kastrati) Department of
Cardiovascular Diseases, Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Lazarettstrasse 36, Munich, Germany
(Byrne, Joner, Schunkert, Laugwitz, Kastrati) DZHK (German Centre for
Cardiovascular Research), Partner Site Munich Heart Alliance, Munich,
Germany
(Alfonso, Cuesta, Rivero) Cardiac Department, Hospital Universitario de La
Princesa Madrid, Madrid, Spain
(Schneider, Bradaric, Hoppmann, Schlichtenmaier, Laugwitz) Clinic and
Policlinic Internal Medicine I (Cardiology and Angiology), Klinikum rechts
der Isar, Technische Universitat Munchen, Munich, Germany
(Maeng, Christiansen) Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark
(Kretov) E.N. Meshalkin National Medical Research Center, Novosibirsk,
Russian Federation
Publisher
NLM (Medline)
Abstract
Aims: Bioresorbable scaffolds (BRS) provide short-term coronary artery
scaffolding and drug delivery. Although prior trials showed a higher rate
of device failure compared with conventional drug-eluting stents (DES),
only a single trial investigated patients undergoing percutaneous coronary
intervention (PCI) for acute myocardial infarction (MI). We aimed to
compare outcomes with BRS vs. DES in patients undergoing PCI for MI.
<br/>Methods and Results: We did a prospective, randomized, multicentre,
non-inferiority, clinical trial of everolimus-eluting BRS vs. durable
polymer everolimus-eluting stents (EES) in patients with acute MI.
Patients were eligible for enrolment if they presented with ST-elevation
MI, or non-ST-elevation MI with thrombosis visual at angiography and were
randomly allocated to treatment with BRS or EES in 2:1 proportion.
Angiographic follow-up was scheduled at 6-8months and clinical follow-up
was done at 12months. The primary endpoint was percentage diameter
stenosis in-segment at follow-up. A total of 262 patients were enrolled
and were allocated to BRS (n=173) or EES (n=89). Angiographic follow-up
was available for 213 (81.3%) patients. Mean diameter stenosis was
24.6+/-12.2% with BRS vs. 27.3+/-11.7% with EES (mean difference -2.7%,
upper limit of one-sided 97.5% confidence limit 0.7%, pre-specified margin
of non-inferiority 5%, Pnon-inferiority <0.001). The rate of the
device-oriented composite of cardiac death/target vessel MI/target lesion
revascularization [BRS: 12 (7.0%) vs. EES: 6 (6.7%), hazard ratio (HR)
1.04, 95% confidence interval (CI) 0.39-2.78] and definite/probable stent
thrombosis [3 (1.7%) vs. 2 (2.3%), HR 0.76, 95% CI 0.13-4.56] were
comparable in both groups. <br/>Conclusion(s): In patients undergoing PCI
for acute MI BRS were non-inferior to EES for percentage diameter stenosis
at angiographic follow-up. Rates of clinical events were comparable
between the treatment groups, although the study was not powered to detect
differences in clinical outcomes. Clinical trial registration: The trial
was registered at www.clinicaltrials.gov (NCT01942070).

<120>
Accession Number
625806118
Title
Additional filtering of blood from a cell salvage device is not likely to
show important additional benefits in outcome in cardiac surgery.
Source
Transfusion. (no pagination), 2019. Date of Publication: 2019.
Author
de Vries A.J.; Vermeijden W.J.; van Pelt L.J.; van den Heuvel E.R.; van
Oeveren W.
Institution
(de Vries) Department of Anesthesiology, University Medical Center
Groningen, Groningen, Netherlands
(Vermeijden) Department of Critical Care, Medisch Spectrum Twente,
Enschede, Netherlands
(van Pelt) Department of Laboratory Medicine, University Medical Center
Groningen, Groningen, Netherlands
(van den Heuvel) Department of Mathematics & Computer Science, Eindhoven
University of Technology, Eindhoven, Netherlands
(van Oeveren) Haemoscan b.v, Groningen, Netherlands
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Several authors and manufacturers of cell salvage devices
recommend additional filtering of processed blood before transfusion.
There is no evidence to support this practice. Therefore, we compared the
clinical outcome and biochemical effects of cell salvage with or without
additional filtering. STUDY DESIGN AND METHODS: The patients, scheduled
for coronary artery bypass grafting, valve replacement, or combined
procedures were part of our randomized multicenter factorial study of cell
salvage and filter use on transfusion requirements (ISRCTN 58333401). They
were randomized to intraoperative cell salvage or cell salvage plus
additional WBC depletion filter. We compared the occurrence of major
adverse events (combined death/stroke/myocardial infarction) as primary
outcome and minor adverse events (renal function disturbances, infections,
delirium), ventilation time, and length of stay in the intensive care unit
and hospital. We also measured biochemical markers of organ injury and
inflammation. <br/>RESULT(S): One hundred eighty-nine patients had cell
salvage, and 175 patients had cell salvage plus filter and completed the
study. Demographic data, surgical procedures, and amount of salvaged blood
were not different between the groups. There was no difference in the
primary outcome with a risk of 6.3% (95% confidence interval [CI],
3.34-11.25) in the cell salvage plus filter group versus 5.8% (95% CI,
3.09-10.45) in the cell salvage group, a relative risk of 1.08 (95% CI,
0.48- 2.43]. There were no differences in minor adverse events and
biochemical markers between the groups. <br/>CONCLUSION(S): The routine
use of an additional filter for transfusion of salvaged blood is unlikely
to show important additional benefits.<br/>Copyright &#xa9; 2019 AABB

<121>
Accession Number
2001438005
Title
Postoperative Outcomes in SAVR/TAVR Patients With Cognitive Impairment: A
Systematic Review.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Luan Erfe B.M.; Erfe J.M.; Brovman E.Y.; Boehme J.; Bader A.M.; Urman R.D.
Institution
(Luan Erfe, Bader) Harvard Medical School, Boston, MA, United States
(Erfe) Yale School of Medicine, New Haven, CT, United States
(Brovman, Boehme, Bader, Urman) Department of Anesthesiology,
Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA,
United States
Publisher
W.B. Saunders
Abstract
To assess the predictive value of preoperative cognitive impairment on
postoperative in-hospital, short-term, and mid-term outcomes among
patients undergoing surgical or transcatheter aortic valve replacement.
The review was conducted according to PRISMA guidelines. Articles were
identified in EMBASE, Medline, and PubMed. Eligible articles compared the
outcomes of patients with and without preoperative cognitive impairment
who underwent aortic valve replacement and were published in English
between January 1, 1997 and November 1, 2017. The quality of included
observational studies was evaluated using the Newcastle-Ottawa scale. The
strength of the body of evidence was also assessed. A total of 6163
abstracts were screened by 2 independent reviewers and 31 full-text
articles were reviewed. Eight studies met inclusion criteria. The studies
included 1 case-control, 5 prospective cohort, and 2 retrospective cohort
studies. Given the paucity and heterogeneity of studies, meta-analysis was
not possible. Five studies were of good quality. Preoperative cognitive
impairment is a risk factor for postoperative delirium in 2 studies,
increased mid-term mortality in 2 studies, and increased length of stay,
risk of discharge to a health-care facility or progressive disability in 1
study. However, given the paucity and methodological flaws of the included
studies, the body of evidence on the predictive value of preoperative
cognitive impairment on postoperative outcomes remains weak. This
systematic review highlights the need for more good quality studies to
provide evidence regarding the incidence of cognitive impairment and
associations with poor outcomes after aortic valve
replacement.<br/>Copyright &#xa9; 2018