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<1>
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Accession Number
624068468
Title
Hyperinsulinemic Normoglycemia during Cardiac Surgery Reduces a Composite
of 30-day Mortality and Serious In-hospital Complications: A Randomized
Clinical Trial.
Source
Anesthesiology. 128 (6) (pp 1125-1139), 2018. Date of Publication: 01 Jun
2018.
Author
Duncan A.E.; Sessler D.I.; Sato H.; Sato T.; Nakazawa K.; Carvalho G.;
Hatzakorzian R.; Codere-Maruyama T.; Abd-Elsayed A.; Bose S.; Said T.;
Mendoza-Cuartas M.; Chowdary H.; Mascha E.J.; Yang D.; Gillinov A.M.;
Schricker T.
Institution
(Duncan) Departments of Cardiothoracic Anesthesia and Outcomes Research,
Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave-J4, Cleveland,
OH 44195, United States
(Sessler, Abd-Elsayed, Bose, Said, Mendoza-Cuartas, Chowdary, Mascha,
Yang) Outcomes Research, United States
(Mascha, Yang) Quantitative Health Sciences, United States
(Gillinov) Thoracic and Cardiovascular Surgery, Cleveland Clinic,
Cleveland, OH, United States
(Sato, Sato, Nakazawa, Carvalho, Hatzakorzian, Codere-Maruyama, Schricker)
Department of Anesthesia, Royal Victoria Hospital, McGill University,
Montreal, Canada
(Abd-Elsayed) Department of Anesthesiology, University of Wisconsin,
School of Medicine and Public Health, Madison, WI, United States
(Bose) Department of Anesthesia and Critical Care, Beth Israel Deaconess
Medical Center, Boston, MA, United States
(Said) Departments of Family Medicine and Geriatric Medicine, Metro Health
Medical Center, Cleveland, OH, United States
(Mendoza-Cuartas) Southern Arizona Anesthesia, Tucson, AZ, United States
(Chowdary) Department of Anesthesiology, University of Cincinnati,
Cincinnati, OH, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Hyperinsulinemic normoglycemia augments myocardial glucose
uptake and utilization. We tested the hypothesis that hyperinsulinemic
normoglycemia reduces 30-day mortality and morbidity after cardiac
surgery. Method(s): This dual-center, parallel-group, superiority
trial randomized cardiac surgical patients between August 2007 and March
2015 at the Cleveland Clinic, Cleveland, Ohio, and Royal Victoria
Hospital, Montreal, Canada, to intraoperative glycemic management with (1)
hyperinsulinemic normoglycemia, a fixed high-dose insulin and concomitant
variable glucose infusion titrated to glucose concentrations of 80 to 110
mg . dl-1; or (2) standard glycemic management, low-dose
insulin infusion targeting glucose greater than 150 mg . dl-1.
The primary outcome was a composite of 30-day mortality, mechanical
circulatory support, infection, renal or neurologic morbidity. Interim
analyses were planned at each 12.5% enrollment of a maximum 2,790
patients. Result(s): At the third interim analysis (n = 1,439;
hyperinsulinemic normoglycemia, 709, standard glycemic management, 730;
52% of planned maximum), the efficacy boundary was crossed and study
stopped per protocol. Time-weighted average glucose concentration (means
+/- SDs) with hyperinsulinemic normoglycemia was 108 +/- 20 versus 150 +/-
33 mg . dl-1 with standard glycemic management, P < 0.001. At
least one component of the composite outcome occurred in 49 (6.9%)
patients receiving hyperinsulinemic normoglycemia versus 82 (11.2%)
receiving standard glucose management (P < efficacy boundary 0.0085);
estimated relative risk (95% interim-adjusted CI) 0.62 (0.39 to 0.97), P =
0.0043. There was a treatment-by-site interaction (P = 0.063); relative
risk for the composite outcome was 0.49 (0.26 to 0.91, P = 0.0007, n =
921) at Royal Victoria Hospital, but 0.96 (0.41 to 2.24, P = 0.89, n =
518) at the Cleveland Clinic. Severe hypoglycemia (less than 40 mg .
dl-1) occurred in 6 (0.9%) patients. Conclusion(s):
Intraoperative hyperinsulinemic normoglycemia reduced mortality and
morbidity after cardiac surgery. Providing exogenous glucose while
targeting normoglycemia may be preferable to simply normalizing glucose
concentrations. Copyright © 2018, the American Society of
Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved.

<2>
Accession Number
2001534861
Title
Long-Term Survival Following Multivessel Revascularization in Patients
With Diabetes: The FREEDOM Follow-On Study.
Source
Journal of the American College of Cardiology. 73 (6) (pp 629-638), 2019.
Date of Publication: 19 February 2019.
Author
Farkouh M.E.; Domanski M.; Dangas G.D.; Godoy L.C.; Mack M.J.; Siami F.S.;
Hamza T.H.; Shah B.; Stefanini G.G.; Sidhu M.S.; Tanguay J.-F.; Ramanathan
K.; Sharma S.K.; French J.; Hueb W.; Cohen D.J.; Fuster V.; Zazif T.N.;
Thai H.; Burton J.R.; Schampaert E.; Escobedo J.; Dubois-Rande J.-L.;
Macaya C.; Carrie D.; Richardt G.; Roguin A.; Lotan C.; Kornowski R.;
Presbitero P.; Sousa J.E.; Velasquez J.G.; Rodriguez A.; Devlin G.; French
J.K.; Kaul U.
Institution
(Farkouh, Godoy) Peter Munk Cardiac Centre and the Heart and Stroke
Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada
(Domanski) University of Maryland School of Medicine, Baltimore, MD,
United States
(Dangas, Sharma, Fuster) Zena and Michael Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, New York, NY, United States
(Godoy, Hueb) Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP,
Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
(Mack) Baylor Scott & White Health, Dallas, TX, United States
(Siami, Hamza) New England Research Institutes, Watertown, MA, United
States
(Shah) VA New York Harbor Healthcare System, New York University School of
Medicine, New York, NY, United States
(Stefanini) Humanitas Research Hospital, Milan, Italy
(Sidhu) Albany Medical Center, Albany, NY, United States
(Tanguay) Division of Medicine, Montreal Heart Institute, Universite de
Montreal, Montreal, Quebec, Canada
(Ramanathan) University of British Columbia, Vancouver, British Columbia,
Canada
(French) Cardiology Department, Liverpool Hospital, Sydney, New South
Wales, Australia
(Cohen) Saint-Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City, MO, United States
(Fuster) Centro Nacional de Investigaciones Cardiovasculares Carlos III,
Madrid, Spain
Publisher
Elsevier USA
Abstract
Background: The FREEDOM (Future Revascularization Evaluation in Patients
with Diabetes Mellitus: Optimal Management of Multivessel Disease) trial
demonstrated that for patients with diabetes mellitus (DM) and multivessel
coronary disease (MVD), coronary artery bypass grafting (CABG) is superior
to percutaneous coronary intervention with drug-eluting stents (PCI-DES)
in reducing the rate of major adverse cardiovascular and cerebrovascular
events after a median follow-up of 3.8 years. It is not known, however,
whether CABG confers a survival benefit after an extended follow-up
period. Objective(s): The purpose of this study was to evaluate the
long-term survival of DM patients with MVD undergoing coronary
revascularization in the FREEDOM trial. Method(s): The FREEDOM trial
randomized 1,900 patients with DM and MVD to undergo either PCI with
sirolimus-eluting or paclitaxel-eluting stents or CABG on a background of
optimal medical therapy. After completion of the trial, enrolling centers
and patients were invited to participate in the FREEDOM Follow-On study.
Survival was evaluated using Kaplan-Meier analysis, and Cox proportional
hazards models were used for subgroup and multivariate analyses.
 Result(s): A total of 25 centers (of 140 original centers) agreed to
participate in the FREEDOM Follow-On study and contributed a total of 943
patients (49.6% of the original cohort) with a median follow-up of 7.5
years (range 0 to 13.2 years). Of the 1,900 patients, there were 314
deaths during the entire follow-up period (204 deaths in the original
trial and 110 deaths in the FREEDOM Follow-On). The all-cause mortality
rate was significantly higher in the PCI-DES group than in the CABG group
(24.3% [159 deaths] vs. 18.3% [112 deaths]; hazard ratio: 1.36; 95%
confidence interval: 1.07 to 1.74; p = 0.01). Of the 943 patients with
extended follow-up, the all-cause mortality rate was 23.7% (99 deaths) in
the PCI-DES group and 18.7% (72 deaths) in the CABG group (hazard ratio:
1.32; 95% confidence interval: 0.97 to 1.78; p = 0.076).
 Conclusion(s): In patients with DM and MVD, coronary
revascularization with CABG leads to lower all-cause mortality than with
PCI-DES in long-term follow-up. (Comparison of Two Treatments for
Multivessel Coronary Artery Disease in Individuals With Diabetes
[FREEDOM]; NCT00086450) Copyright © 2019

<3>
Accession Number
2001534855
Title
Drug-Eluting Stent Versus Drug-Coated Balloon Revascularization in
Patients With Femoropopliteal Arterial Disease.
Source
Journal of the American College of Cardiology. 73 (6) (pp 667-679), 2019.
Date of Publication: 19 February 2019.
Author
Bausback Y.; Wittig T.; Schmidt A.; Zeller T.; Bosiers M.; Peeters P.;
Brucks S.; Lottes A.E.; Scheinert D.; Steiner S.
Institution
(Bausback, Wittig, Schmidt, Scheinert, Steiner) Division of Angiology,
Department of Internal Medicine, Neurology and Dermatology, University
Hospital Leipzig, Leipzig, Germany
(Zeller) Department of Angiology, Universitats-Herzzentrum Freiburg, Bad
Krozingen, Germany
(Bosiers) Department of Vascular Surgery, AZ St.-Blasius, Dendermonde,
Belgium
(Peeters) Department of Cardiovascular Surgery, Imelda Hospital,
Bonheiden, Belgium
(Brucks) Angiologikum Hamburg, Hamburg, Germany
(Lottes) Cook Research Incorporated, West Lafayette, Indiana, India
Publisher
Elsevier USA
Abstract
Background: Randomized trials of drug-eluting stents (DES) and drug-coated
balloons (DCB) for femoropopliteal interventions reported superior patency
rates for both strategies compared to standard balloon angioplasty. To
date, head-to-head comparisons are missing. Objective(s): The authors
sought to compare DES versus DCB for femoropopliteal lesions through 36
months. Method(s): Within a multicenter, randomized trial, 150
patients with symptomatic femoropopliteal disease were randomly assigned
to primary DES implantation or DCB angioplasty with bailout stenting after
stratification for lesion length (<=10 cm, >10 cm to <=20 cm, and >20 cm
to <=30 cm). The primary effectiveness endpoint was primary patency at 12
months assessed by Kaplan-Meier. Secondary endpoints comprised major
adverse events including death, major amputations, and clinically driven
target lesion revascularization, and clinical outcomes. Result(s):
More than one-half of lesions were total occlusions, and the stenting rate
was 25.3% in the DCB group. Kaplan-Meier estimates of primary patency were
79% and 80% for DES and DCB at 12 months (p = 0.96) but decreased to 54%
and 38% through 36 months (p = 0.17), respectively. Freedom from
clinically driven target lesion revascularization was >90% at 12 months
but dropped to around 70% at 36 months in both groups. Overall, the
mortality rate through 36 months was 7.3%, with 1 procedure-related death
in the DCB group. Improvement of clinical outcomes was sustained through
36 months. Conclusion(s): Patency rates at 12 months suggest
comparable effectiveness and safety of DES versus DCB plus bailout
stenting in femoropopliteal interventions; a trend in favor of the DES was
observed up to 36 months. (Randomized Evaluation of the Zilver PTX Stent
vs. Paclitaxel-Eluting Balloons for Treatment of Symptomatic Peripheral
Artery Disease of the Femoropopliteal Artery [REAL PTX];
NCT01728441) Copyright © 2019 The Authors

<4>
Accession Number
626347713
Title
A prescription support-tool for chronic management of oral antithrombotic
combinations in adults based on a systematic review of international
guidelines.
Source
PLoS ONE. 14 (2) (no pagination), 2019. Article Number: e0211695. Date of
Publication: February 2019.
Author
Zerah L.; Bun R.-S.; Guillo S.; Collet J.-P.; Bonnet-Zamponi D.; Tubach F.
Institution
(Zerah, Bun, Guillo, Bonnet-Zamponi, Tubach) Sorbonne Universite, INSERM,
Institut Pierre Louis d'Epidemiologie et de Sante Publique, AP-HP, Hopital
Pitie-Salpetriere, Departement Biostatistique Sante Publique et
Information Medicale, Unite de Recherche Clinique, PSL-CFX, Centre de
Pharmacoepidemiologie (Cephepi), Paris, France
(Collet) Sorbonne Universite, INSERM, AP-HP, Hopital Pitie-Salpetriere,
Departement de Cardiologie, Paris, France
(Bonnet-Zamponi) Observatoire du Medicament des Dispositifs Medicaux et de
l'Innovation Therapeutique Ile de France (OMEDIT), Paris, France
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Oral antithrombotic (AT) drugs, which include antiplatelet and
anticoagulant therapies, are widely implicated in serious preventable
bleeding events. Avoiding inappropriate oral AT combinations is a major
concern. Numerous practical guidelines have been released; a document to
enhance prescriptions of oral AT combinations for adults would be of great
help. Objective To synthesize guidelines on the prescription of oral AT
combinations in adults and to create a prescription support-tool for
clinicians about chronic management ( one month) of oral AT combinations.
Methods A systematic review of guidelines published between January 2012
and April 2017, in English or in French, from Trip database, Guideline
International Network and PubMed, dealing with the prescription of oral
ATs in adults was conducted. In-hospital management of ATs, bridging
therapy and switches of ATs were not considered. Some specific topics
requiring specialized follow-up (cancer, auto-immune disease, haemophilia,
HIV, paediatrics and pregnancy) were excluded. Last update was made in
November 2018. Results A total of 885 guidelines were identified and 70
met the eligibility criteria. A prescription support-tool summarizing
medical conditions requiring chronic management of oral AT combinations in
adults with drug types, dosage and duration, on a double-sided page, was
provided and tested by an external committee of physicians. The lack of
specific guidelines for old people (age 75 years and older) is questioned
considering the specific vulnerability of this age group to serious
bleedings. Conclusions Recommendations on prescriptions about chronic
management of oral AT combinations in adults were mainly consensual but
dispersed in numerous guidelines according to the medical indication. We
provide a prescription support-tool for clinicians. Further studies are
needed to assess the impact of this tool on appropriate prescribing and
the prevention of serious adverse drug events. Copyright © 2019
Zerah 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.

<5>
Accession Number
624183007
Title
Amaze: A randomized controlled trial of adjunct surgery for atrial
fibrillation.
Source
European Journal of Cardio-thoracic Surgery. 54 (4) (pp 729-737), 2018.
Date of Publication: 01 Oct 2018.
Author
Nashef S.A.M.; Fynn S.; Abu-Omar Y.; Spyt T.J.; Mills C.; Everett C.C.;
Fox-Rushby J.; Singh J.; Dalrymple-Hay M.; Sudarshan C.; Codispoti M.;
Braidley P.; Wells F.C.; Sharples L.D.
Institution
(Nashef, Abu-Omar, Sudarshan, Codispoti, Wells) Department of Surgery,
Papworth Hospital, Cambridge CB23 3RE, United Kingdom
(Fynn) Department of Cardiology, Papworth Hospital, Cambridge, United
Kingdom
(Spyt) Department of Cardiothoracic Surgery, Glenfield Hospital,
Leicester, United Kingdom
(Mills) Research and Development, Papworth Hospital, Cambridge, United
Kingdom
(Everett) Clinical Trials Unit, University of Leeds, Leeds, United Kingdom
(Fox-Rushby, Singh) Department of Health Economics, Brunel University,
London, United Kingdom
(Dalrymple-Hay) Department of Cardiothoracic Surgery, Plymouth Hospital,
Derriford Hospital, Plymouth, United Kingdom
(Braidley) Department of Cardiothoracic Surgery, Northern General
Hospital, Sheffield, United Kingdom
(Sharples) Department of Medical Statistics, London School of Hygiene and
Tropical Medicine, London, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES Atrial fibrillation (AF) reduces survival and quality of life
(QoL). It can be treated at the time of major cardiac surgery using
ablation procedures ranging from simple pulmonary vein isolation to a full
maze procedure. The aim of this study is to evaluate the impact of adjunct
AF surgery as currently performed on sinus rhythm (SR) restoration,
survival, QoL and cost-effectiveness. METHODS In a multicentre, Phase III,
pragmatic, double-blinded, parallel-armed randomized controlled trial, 352
cardiac surgery patients with >3 months of documented AF were randomized
to surgery with or without adjunct maze or similar AF ablation between
2009 and 2014. Primary outcomes were SR restoration at 1 year and
quality-adjusted life years at 2 years. Secondary outcomes included SR at
2 years, overall and stroke-free survival, medication, QoL,
cost-effectiveness and safety. RESULTS More ablation patients were in SR
at 1 year [odds ratio (OR) 2.06, 95% confidence interval (CI) 1.20-3.54; P
= 0.009]. At 2 years, the OR increased to 3.24 (95% CI 1.76-5.96).
Quality-adjusted life years were similar at 2 years (ablation - control
-0.025, P = 0.6319). Significantly fewer ablation patients were
anticoagulated from 6 months postoperatively. Stroke rates were 5.7%
(ablation) and 9.1% (control) (P = 0.3083). There was no significant
difference in stroke-free survival [hazard ratio (HR) = 0.99, 95% CI
0.64-1.53; P = 0.949] nor in serious adverse events, operative or overall
survival, cardioversion, pacemaker implantation, New York Heart
Association, EQ-5D-3L and SF-36. The mean additional ablation cost per
patient was 3533 (95% CI 1321-5746). Cost-effectiveness was not
demonstrated at 2 years. CONCLUSIONS Adjunct AF surgery is safe and
increases SR restoration and costs but not survival or QoL up to 2 years.
A continued follow-up will provide information on these outcomes in the
longer term. Study registration ISRCTN82731440 (project number
07/01/34). Copyright © The Author(s) 2018. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.

<6>
Accession Number
624182982
Title
Left ventricular assist device implantation with and without concomitant
tricuspid valve surgery: A systematic review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 54 (4) (pp 644-651), 2018.
Date of Publication: 01 Oct 2018.
Author
Veen K.M.; Muslem R.; Soliman O.I.; Caliskan K.; Kolff M.E.A.; Dousma D.;
Manintveld O.C.; Birim O.; Bogers A.J.J.C.; Takkenberg J.J.M.
Institution
(Veen, Muslem, Kolff, Dousma, Birim, Bogers, Takkenberg) Thoraxcenter,
Department of Cardiothoracic Surgery, Erasmus University Medical Centre,
Rotterdam, Netherlands
(Muslem, Soliman, Caliskan, Manintveld) Thoraxcenter, Department of
Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES Moderate-to-severe tricuspid regurgitation is common in
end-stage heart disease and is associated with an impaired survival after
left ventricular assist device (LVAD) surgery. Controversy remains whether
concomitant tricuspid valve surgery (TVS) during LVAD implantation is
beneficial. We aimed to provide a contemporary overview of outcomes in
patients who underwent LVAD surgery with or without concomitant TVS.
METHODS A systematic literature search was performed for articles
published between January 2005 and March 2017. Studies comparing patients
undergoing isolated LVAD implantation and LVAD + TVS were included. Early
outcomes were pooled in risk ratios using random effects models, and late
survival was visualized by a pooled Kaplan-Meier curve. RESULTS Eight
publications were included in the meta-analysis, including 562 undergoing
isolated LVAD implantation and 303 patients with LVAD + TVS. Patients
undergoing LVAD + TVS had a higher tricuspid regurgitation grade, central
venous pressure and bilirubin levels at baseline and were more often
female. We found no significant differences in early mortality and late
mortality, early right ventricular failure and late right ventricular
failure, acute kidney failure, early right ventricular assist device
implantation or length of hospital stay. Cardiopulmonary bypass time was
longer in patients undergoing additional TVS [mean difference +35 min 95%
confidence interval (16-55), P = 0.001]. CONCLUSIONS Adding TVS during
LVAD implantation is not associated with worse outcome. Adding TVS,
nevertheless, may be beneficial, as baseline characteristics of patients
undergoing LVAD + TVS were suggestive of a more progressive underlying
disease, but with comparable short-term outcome and long-term outcome with
patients undergoing isolated LVAD. Copyright © The Author(s)
2018. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<7>
Accession Number
624182978
Title
Systematic bilateral internal mammary artery grafting: Lessons learned
from the CATHolic University EXtensive BIMA Grafting Study.
Source
European Journal of Cardio-thoracic Surgery. 54 (4) (pp 702-707), 2018.
Date of Publication: 01 Oct 2018.
Author
Gaudino M.; Glieca F.; Luciani N.; Pragliola C.; Tsiopoulos V.; Bruno P.;
Farina P.; Bonalumi G.; Pavone N.; Nesta M.; Cammertoni F.; Munjal M.; Di
Franco A.; Massetti M.
Institution
(Gaudino, Glieca, Luciani, Pragliola, Tsiopoulos, Bruno, Farina, Bonalumi,
Pavone, Nesta, Cammertoni, Di Franco, Massetti) Department of
Cardiovascular Sciences, Catholic University, Rome, Italy
(Munjal) Department of Cardiothoracic Surgery, Cornell Medicine, New York,
NY, United States
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES Despite claims of feasibility, to date no study has examined
the effect of systematic bilateral internal mammary artery (BIMA) use in a
large cohort of real-world unselected patients. The CATHolic University
EXtensive BIMA Grafting Study (CATHEXIS) registry was designed to assess
the feasibility and safety of systematic BIMA grafting. METHODS The
CATHEXIS was a single-centre, prospective, observational,
propensity-matched study. The study was supposed to include 2 arms of 500
patients each: a prospective arm and a retrospective arm. The prospective
arm included almost all patients referred for coronary artery bypass
grafting (CABG) at our institution after the start of the CATHEXIS with
very few exceptions. BIMA would have been used in all these patients. The
retrospective arm included patients submitted to CABG before the start of
the CATHEXIS and propensity matched to the prospective group (average BIMA
use 50%; the radial artery was extensively used). Safety analyses were
scheduled after enrolment of 200, 300 and 400 BIMA patients. RESULTS After
the first 226 patients, the BIMA use percentage was 88.5% (200 of 226). In
178 (89%) patients, mammary arteries were used as Y graft. Postoperative
mortality was 2%, and incidence of perioperative myocardial infarction,
graft failure and sternal complications were 3.5%, 3% and 5.5%,
respectively. No perioperative stroke occurred. The incidence of major
adverse cardiac events (particularly graft failure and sternal
complications) in the BIMA arm were significantly higher than those in the
propensity-matched cohort; the study was stopped for safety. CONCLUSIONS
In a real world setting the systematic use of BIMA was associated with a
higher incidence of perioperative adverse events (particularly sternal
complications). Individualization of the revascularization strategy and
use of alternative arterial conduits are probably preferable to systematic
use of BIMA. Copyright © The Author(s) 2018. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<8>
Accession Number
624182891
Title
Prospective multicentre evaluation of a novel, low-profile transapical
delivery system for self-expandable transcatheter aortic valve
implantation: 6-month outcomes.
Source
European Journal of Cardio-thoracic Surgery. 54 (4) (pp 762-767), 2018.
Date of Publication: 01 Oct 2018.
Author
Conradi L.; Hilker M.; Kempfert J.; Borgermann J.; Treede H.; Holzhey
D.M.; Schrofel H.; Kim W.-K.; Schaefer U.; Walther T.
Institution
(Conradi) Department of Cardiovascular Surgery, University Heart Center
Hamburg, Hamburg 20251, Germany
(Hilker) Department of Cardiothoracic Surgery, University Medical Center
Regensburg, Regensburg, Germany
(Kempfert) Department of Cardiac Surgery, German Heart Center, Berlin,
Germany
(Borgermann) Clinic for Thoracic and Cardiovascular Surgery, Heart and
Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
(Treede) Department of Cardiac Surgery, Mid-German Heart Center,
University Hospital Halle, Halle, Germany
(Holzhey) Department of Cardiac Surgery, Heart Center Leipzig University,
Leipzig, Germany
(Schrofel) Department of Cardiovascular Surgery, Heart Center Freiburg,
Bad Krozingen, Germany
(Kim) Department of Cardiology, Kerckhoff Heart and Lung Center, Bad
Nauheim, Germany
(Kim, Walther) Department of Cardiac Surgery, Kerckhoff Heart and Lung
Center, Bad Nauheim, Germany
(Schaefer) Department of Cardiology, University Heart Center Hamburg,
Hamburg, Germany
(Walther) Department of Thoracic and Cardiovascular Surgery, University
Hospital Frankfurt, Frankfurt am Main, Germany
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES We assessed the safety and efficacy of a novel low-profile,
22-Fr transapical delivery system together with the ACURATE neoTM
resheathable transcatheter heart valve. METHODS This prospective,
single-arm, multicentre study enrolled 60 patients with severe symptomatic
aortic stenosis and high surgical risk ineligible for transfemoral access.
Primary end points were 6-month mortality and procedural success. RESULTS
The mean age of patients was 79.8 +/- 4.7 years, and the patients had
severe comorbidities including coronary artery disease (71.7%), diabetes
(38.3%), atrial fibrillation (30.0%) and chronic obstructive pulmonary
disease (21.7%); logistic EuroSCORE-I, -II and the Society of Thoracic
Surgeons (STS) scores were 20.9 +/- 8.9%, 6.1 +/- 5.0% and 4.3 +/- 2.9%,
respectively. A non-rib spreading approach using soft tissue retractors
only was used in 88.3% of patients (n = 53). Resheathing and repositioning
of transcatheter heart valve were performed in 6.7% of cases (n = 4); the
device implantation time was 3 +/- 2 min. Apical access site complications
occurred in 1.7% (n = 1). Procedural success was 98.3% (n = 59), and
procedural success in the absence of major adverse cardiac and
cerebrovascular events at 30 days was 90.0% (n = 54). At 30 days,
cardiovascular and overall mortality were 8.3% (n = 5), stroke rate was
1.7% (n = 1), and 17.2% of patients (n = 10) received a permanent
pacemaker implant. No paravalvular leakage >=2+ was observed, and the mean
transvalvular gradient was 5.9 +/- 2.7 mmHg. At 6 months, survival was
84.3% with sustained haemodynamic results. CONCLUSIONS This study
indicates safety and efficacy of transapical aortic valve implantation
using a novel low-profile delivery system. High procedural success, short
implantation times and a low rate of apical access site complications
underline the favourable safety profile and ease of use. Clinical trial
registration ClinicalTrials.gov: NCT02950428. Copyright © The
Author(s) 2018. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<9>
Accession Number
626012636
Title
Comparison between blood and non-blood cardioplegia in tetralogy of
Fallot.
Source
Asian Cardiovascular and Thoracic Annals. 27 (2) (pp 75-79), 2019. Date of
Publication: 01 Feb 2019.
Author
Romolo H.; Hernisa L.; Fakhri D.; Rachmat J.; Dwi Mulia D.; Rahmat B.
Institution
(Romolo, Hernisa, Fakhri, Rachmat, Rahmat) Department of Pediatric Cardiac
Surgery, Rumah Sakit Jantung dan Pembuluh Darah Nasional Harapan Kita,
Jakarta, Indonesia
(Dwi Mulia) Department of Surgery, Rumah Sakit Cipto Mangunkusumo, Faculty
of Medicine, Universitas Indonesia, Jakarta, Indonesia
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Cardioplegia is an integral part of myocardial protection. The
superiority of blood cardioplegia in adult patients has been reported.
However, this is yet to be studied in cyanotic pediatric patients.
 Method(s): A randomized open-label trial was conducted in 70 patients
with tetralogy of Fallot. They were divided into two groups: 35 patients
had crystalloid cardioplegia (controls), and 35 had blood cardioplegia.
Lactate and coronary oxygen extraction in arterial blood and the coronary
sinus were measured immediately after cessation of cardiopulmonary bypass,
15 and 30 min later. Postoperative mortality, major adverse cardiac
events, mechanical ventilation time, inotrope administration, arrhythmias,
right ventricular function, intensive care unit and hospital length of
stay were observed. Result(s): There were no significant differences
in clinical outcomes or lactate levels. There was a significant difference
in coronary oxygen extraction immediately and 15 min after cessation of
cardiopulmonary bypass (p = 0.038, p = 0.015). Conclusion(s): Blood
cardioplegia gave a better postoperative oxygen extraction value but there
were no differences in myocardial damage or clinical outcome between the
two groups. Copyright © The Author(s) 2018.

<10>
Accession Number
623717497
Title
Cardioplegia practice in paediatric cardiac surgery: a UK & Ireland
survey.
Source
Perfusion (United Kingdom). 34 (2) (pp 125-129), 2019. Date of
Publication: 01 Mar 2019.
Author
Drury N.E.; Horsburgh A.; Bi R.; Willetts R.G.; Jones T.J.
Institution
(Drury, Horsburgh, Bi, Willetts, Jones) Department of Paediatric Cardiac
Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
(Drury) Institute of Cardiovascular Sciences, University of Birmingham,
Birmingham, United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: Many techniques are available for cardioplegic arrest in
children, but there is a lack of late phase clinical trials to guide
practice. We surveyed paediatric cardiac surgeons and perfusionists to
establish current practice and willingness to change within a clinical
trial. Method(s): An online survey was sent to all consultant
paediatric cardiac surgeons and chief perfusionists in paediatric centres
in the UK and Ireland. Information was sought on cardioplegia type,
composition, temperature, topical cooling, dosing for induction and
maintenance, interval between doses, whether practice changed with patient
age or complexity and whether respondents would be willing and able to use
different cardioplegia solutions within a randomised trial.
 Result(s): Responses were obtained from 32 (78.0%) surgeons and 12
(100%) perfusionists. Twenty-seven (84.4%) surgeons use blood cardioplegia
in infants, with St. Thomas' Harefield preparation the most popular (19,
59.4%), used routinely in eight (66.7%) centres. Twenty-two (68.8%)
administer at 4-6degreeC, 18 (56.3%) use topical cooling, 18 (56.3%) give
30 ml/kg induction and 15 ml/kg maintenance, with 23 (71.9%) re-dosing
every 20-25 minutes. Thirty (93.8%) surgeons were open to randomising
patients in a trial, with del Nido (29, 90.6%) the most popular.
 Conclusion(s): This survey demonstrates heterogeneity in cardioplegia
practice. Whilst most surgeons use blood cardioplegia, there is variation
in type, temperature, topical cooling, dosing and intervals. Combined with
a lack of evidence from late phase trials, our findings support the
presence of clinical equipoise. Surgeons are willing to change practice,
suggesting that a pragmatic, multi-centre, randomised, controlled trial of
cardioplegia in children is feasible. Copyright © The Author(s)
2018.

<11>
Accession Number
2001537578
Title
Uniportal Lung Cancer Surgery: State of the Evidence.
Source
Annals of Thoracic Surgery. 107 (3) (pp 962-972), 2019. Date of
Publication: March 2019.
Author
Sihoe A.D.L.
Institution
(Sihoe) Department of Surgery, Li Ka Shing Faculty of Medicine, The
University of Hong Kong, Hong Kong, Hong Kong
(Sihoe) Division of Thoracic Surgery, The University of Hong Kong Shenzhen
Hospital, Shenzhen, China
(Sihoe) Department of Thoracic Surgery, Tongji University Shanghai
Pulmonary Hospital, Shanghai, China
Publisher
Elsevier USA
Abstract
Background: Uniportal video-assisted thoracic surgery (VATS) has generated
much attention in recent years, but questions remain regarding the
adequacy of evidence to support its use in lung cancer surgery. This
review aims to explore what the currently published literature suggests
the role of the uniportal approach may be and to critically appraise that
literature. Method(s): A systematic review was conducted using the
Ovid Medline database to identify articles related to uniportal VATS.
Articles were selected for review on the basis of ability to provide
original clinical data on the role of uniportal VATS for lung cancer
surgery. Result(s): The literature search revealed that only some
publications on uniportal VATS provided original clinical data. Twenty-two
articles were selected for review, including 9 case series and 13
comparative studies. No concerns about the safety of the uniportal VATS
were noted. Some but not all comparative studies provided data suggesting
that uniportal VATS may hold advantages over multiportal VATS in some
simple clinical outcomes (such as reduced lengths of stay and
postoperative pain). However, the quantity and quality of evidence thus
far are limited. Conclusion(s): It remains premature to declare
superiority for uniportal VATS in lung cancer surgery. A higher level of
evidence is needed, especially in investigating objective benefits and
treatment efficacy of the single-incision approach. Copyright ©
2019 The Society of Thoracic Surgeons

<12>
Accession Number
624573416
Title
A prospective, single-center, randomized study to assess whether automated
coregistration of optical coherence tomography with angiography can reduce
geographic miss.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2018.
Date of Publication: 2018.
Author
Koyama K.; Fujino A.; Maehara A.; Yamamoto M.H.; Alexandru D.; Jennings
J.; Krug P.; Santiago L.M.; Murray M.; Bongiovanni L.; Lee T.; Kim S.-Y.;
Wang X.; Lin Y.; Matsumura M.; Ali Z.A.; Sosa F.; Haag E.; Mintz G.S.;
Shlofmitz R.A.
Institution
(Koyama, Fujino, Maehara, Yamamoto, Lee, Kim, Wang, Lin, Ali) Division of
Cardiology, Department of Medicine, Columbia University Medical Center,
New York, NY, United States
(Koyama, Fujino, Maehara, Yamamoto, Lee, Kim, Wang, Lin, Matsumura, Ali,
Mintz) Clinical Trials Center, Cardiovascular Research Foundation, New
York, NY, United States
(Alexandru, Jennings, Krug, Santiago, Murray, Bongiovanni, Haag,
Shlofmitz) Department of Cardiology, St. Francis Hospital, Roslyn, NY,
United States
(Wang) Beijing Anzhen Hospital, Capital Medical University, Beijing, China
(Lin) Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen
University, Guangzhou, China
(Sosa) Abbott Vascular, Santa Clara, CA, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: We sought to evaluate whether automated coregistration of
optical coherence tomography (OCT) with angiography reduces geographic
miss (GM) during coronary stenting. Background(s): Previous
intravascular ultrasound or OCT studies have showed that residual disease
at the stent edge or stent edge dissection was associated with stent
thrombosis or edge restenosis. This has been termed GM. Method(s):
Two hundred de novo coronary lesions were randomized in a 1:1 ratio to
OCT-guided percutaneous coronary intervention (PCI) with versus without
automated coregistration of OCT with angiography. GM, the primary
endpoint, was defined as angiographic >=type B dissection or diameter
stenosis >50% or OCT minimum lumen area <4.0 mm2 with
significant residual disease or dissection (dissection flap >60degree)
within 5 mm from the stent edge. Result(s): The prevalence of GM was
not different comparing OCT-guided PCI with versus without automated
coregistration (27.6% vs 34.0%, P = 0.33). However, there was a trend
toward a reduced prevalence of significant distal stent edge dissection in
lesions with automated coregistration (11.1% vs 20.8%, P = 0.07). The
discrepancy in the distance between planned versus actual implanted stent
location with automated coregistration was significantly shorter than
without coregistration (1.9 +/- 1.6 mm vs 2.6 +/- 2.7 mm, P = 0.03),
especially the prevalence of >=5 mm discrepancy that was less frequent
with automated coregistration. Conclusion(s): Automated
coregistration of OCT with angiography did not reduce the primary endpoint
of GM after stent implantation. Copyright © 2018 Wiley
Periodicals, Inc.

<13>
Accession Number
2001589904
Title
Minimally Invasive coronary surgery compared to STernotomy coronary artery
bypass grafting: The MIST trial.
Source
Contemporary Clinical Trials. 78 (pp 140-145), 2019. Date of Publication:
March 2019.
Author
Guo M.H.; Wells G.A.; Glineur D.; Fortier J.; Davierwala P.M.; Kikuchi K.;
Lemma M.G.; Mishra Y.K.; McGinn J.; Ramchandani M.; Rabindra P.; Nambala
S.; Chiu K.M.; Kiaii B.; Gibson S.; Ruel M.
Institution
(Guo, Glineur, Fortier, Gibson, Ruel) Division of cardiac surgery,
University of Ottawa Heart Institute, Ottawa, Canada
(Wells) Department of Epidemiology, University of Ottawa, Ottawa, Canada
(Davierwala) Division of cardiovascular surgery, Herzzentrum Leipzig,
Leipzig, Germany
(Kikuchi) Division of cardiac surgery, Wuhan Asian Heart Hospital, Wuhan,
China
(Lemma) Division of cardiac surgery, Jilin Heart Hospital, Jilin, China
(Mishra) Division of cardiac surgery, Fortis Escorts Heart Institute, New
Delhi, India
(McGinn) Division of cardiothoracic surgery, Carolinas Medical Center,
Charlotte, United States
(Ramchandani) Division of cardiothoracic surgery, Houston Methodist,
Houston, United States
(Rabindra) Division of cardiothoracic surgery, Gundersen Lutheran Medical
Center, La Crosse, United States
(Nambala) Division of cardiac surgery, Apollo Hospital, Bangalore, India
(Chiu) Division of cardiac surgery, Far Eastern Memorial Hospital, Taipei,
Taiwan (Republic of China)
(Kiaii) Division of cardiac surgery, London Health Sciences Center,
London, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Rationale: Minimally invasive cardiac surgery has emerged as a safe
alternative to standard cardiac surgery. Minimally invasive coronary
surgery (MICS CABG) was developed to allow adequate exposure and complete
revascularization in CABG from a small thoracotomy incision without
cardiopulmonary bypass. Multiple studies have reported significant shorter
length of hospital stay and earlier postoperative physical recovery for
MICS CABG patients when compared to sternotomy CABG patients. However,
there have been no convincing clinical trials that demonstrate improvement
in post-operative quality of life for patients who undergo MICS CABG.
Study design: The Minimally Invasive Coronary Surgery compared to
Sternotomy Coronary Artery Bypass Grafting (MIST) trial is a
multi-centered, prospective randomized controlled trial that compares the
quality of life and recovery in the early post-operative period between
patients undergoing MICS CABG versus patients undergoing sternotomy CABG.
Patients will be randomized either to the MICS CABG group or the
sternotomy CABG group, and the target enrollment is 88 patients per group.
The primary outcome is quality of life assessment performed by SF-36
questionnaire at 1 month. Conclusion(s): The MIST trial is the first
prospective study that compares the quality of life between MICS CABG and
sternotomy CABG patients. The results of this trial may enhance the
procedural desirability of MICS CABG by patients and provide an incentive
for surgeons and institutions to increase the availability of MICS CABG in
suitable patients. Copyright © 2019 Elsevier Inc.

<14>
[Use Link to view the full text]
Accession Number
626393308
Title
PREPARED Study: A Study of Shared Decision-Making for Coronary Artery
Disease.
Source
Circulation. Cardiovascular quality and outcomes. 12 (2) (pp e005244),
2019. Date of Publication: 01 Feb 2019.
Author
Doll J.A.; Jones W.S.; Lokhnygina Y.; Culpepper S.; Parks R.L.; Calhoun
C.; Au D.H.; Patel M.R.
Institution
(Doll) Section of Cardiology (J.A.D.), VA Puget Sound Health Care System,
Seattle, WA, United States
(Doll) Division of Cardiology, Department of Medicine, University of
Washington, Australia
(Jones, Lokhnygina, Patel) Division of Cardiology, Department of Medicine,
Duke University School of Medicine, Durham, Canada
(Jones, Culpepper, Patel) Duke Clinical Research Institute, Durham, S.C,
United States
(Parks, Calhoun) Healthwise, Inc, Boise, United States
(Au) Center of Innovation for Veteran-Centered and Value-Driven Care
(D.H.A.), VA Puget Sound Health Care System, Seattle, WA, United States
Publisher
NLM (Medline)
Abstract
Background Guidelines recommend patient engagement in shared
decision-making regarding coronary revascularization, but studies
demonstrate poor patient understanding of risks, benefits, and
alternatives. Effective strategies are needed to integrate informed
patient preferences into clinical care, particularly for patients
undergoing diagnostic coronary angiography. Methods and Results We
developed a web-based decision aid to educate patients and survey their
treatment preferences before angiography. We compared knowledge,
attitudes, and preferences of 203 patients with and without use of the
decision aid. In a pilot cluster-randomized study, cardiologists were
assigned to receive versus not receive patient preferences, with
subsequent assessment of treatment decisions. The median age of
participants was 64 years, 62% were men, 74% were white, and a similar
number had acute presentation (49% non-ST-segment-elevation myocardial
infarction or unstable angina) and stable presentation (51% stable angina
or atypical symptoms). Most patients preferred treatment with percutaneous
coronary intervention compared with either medical therapy alone (63%
versus 21%) or coronary artery bypass graft surgery (81% versus 7%). The
decision aid was associated with improved performance on a 6-item
knowledge scale (mean, 2.7 versus 2.2 questions correct; P<0.01) and
greater interest in shared decision-making but not an overall change in
patient preferences. The pilot cluster-randomized study demonstrated the
feasibility of integrating patient preference information into clinical
care, although providing preferences to the clinicians did not improve
concordance between preference and treatment. Conclusions A web-based
decision aid was associated with improved patient knowledge and greater
desire to participate in shared decision-making for coronary
revascularization. Most patients preferred percutaneous coronary
intervention to either medical therapy alone or coronary artery bypass
graft surgery. Further investigation is needed to determine the impact of
patient preferences on clinical decision-making and outcomes. Clinical
Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier:
NCT02272062.

<15>
Accession Number
626053671
Title
Antiplatelet Therapy versus Anticoagulation after Surgical Bioprosthetic
Aortic Valve Replacement: A Systematic Review and Meta-Analysis.
Source
Thrombosis and Haemostasis. 119 (2) (pp 328-339), 2019. Date of
Publication: 2019.
Author
An K.R.; Belley-Cote E.P.; Um K.J.; Gupta S.; McClure G.R.; Jaffer I.H.;
Pandey A.; Spence J.; Van Der Wall S.J.; Eikelboom J.W.; Whitlock R.P.
Institution
(An, Um, McClure) Michael G. DeGroote School of Medicine, McMaster
University, Hamilton, ON, Canada
(Belley-Cote, Gupta, Jaffer, Spence, Whitlock) Department of Clinical
Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
(Belley-Cote) Division of Cardiology, McMaster University, Hamilton, ON,
Canada
(Belley-Cote, Jaffer, Eikelboom, Whitlock) Population Health Research
Institute, Hamilton, ON, Canada
(Gupta, Jaffer, Whitlock) Division of Cardiac Surgery, McMaster
University, Hamilton, ON, Canada
(Pandey) Faculty of Health Sciences, McMaster University, Hamilton, ON,
Canada
(Spence) Department of Anesthesia, McMaster University, Hamilton, ON,
Canada
(Van Der Wall) Department of Thrombosis and Hemostasis, Leiden University
Medical Centre, Leiden University, Leiden, Netherlands
(Eikelboom) Division of Hematology and Thromboembolism, McMaster
University, Hamilton, ON, Canada
(Whitlock) David Braley Cardiac, Vascular, Stroke Research Institute, 237
Barton Street East, Hamilton, ON L8L 2X2, Canada
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background The optimal antithrombotic therapy after surgical bioprosthetic
aortic valve replacement (BAVR) is uncertain. We conducted a systematic
review and meta-analysis of observational studies and randomized
controlled trials (RCTs) comparing antiplatelet therapy and
anticoagulation in patients with surgical BAVR. Methods We searched
Cochrane CENTRAL, MEDLINE and EMBASE from inception to 3 November 2017 for
studies evaluating antiplatelet therapy versus anticoagulation early after
surgical BAVR. We performed title and abstract screening, full-text
review, risk of bias evaluation and data collection independently and in
duplicate. We evaluated overall quality of evidence using the Grading of
Recommendations Assessment, Development and Evaluation framework, and
pooled data using a random effects model. Results We identified 2 RCTs (n
= 397) and 5 observational studies (n = 2,012) meeting our eligibility
criteria. The mean follow-up for all outcomes was 3 months in RCTs, and 10
months for observational studies. Antiplatelet compared with anticoagulant
therapy demonstrated a trend towards fewer major bleeds in RCTs (relative
risk [RR], 0.34; 95% confidence interval [CI], 0.11-1.04, p = 0.06, I
2 = 0%, low quality evidence), and significantly fewer major
bleeds in observational studies (RR, 0.34; 95% CI, 0.20-0.58, p <= 0.0001,
I 2 = 0%, very low quality evidence), but stroke,
thromboembolism and mortality did not show a significant difference in
either RCTs or observational studies. Conclusion Antiplatelet therapy
demonstrated reduced bleeding risk with no negative effects on stroke,
thromboembolism or mortality compared with anticoagulation therapy after
surgical BAVR. Our confidence in the results is reduced by the low quality
of the available evidence. Copyright © 2019 Georg Thieme Verlag
KG Stuttgart New York.

<16>
Accession Number
2001580530
Title
Interval From Initiation of Prasugrel to Coronary Angiography in Patients
With Non-ST-Segment Elevation Myocardial Infarction.
Source
Journal of the American College of Cardiology. 73 (8) (pp 906-914), 2019.
Date of Publication: 5 March 2019.
Author
Silvain J.; Rakowski T.; Lattuca B.; Liu Z.; Bolognese L.; Goldstein P.;
Hamm C.; Tanguay J.-F.; ten Berg J.; Widimsky P.; Miller D.; Portal J.-J.;
Collet J.-P.; Vicaut E.; Montalescot G.; Dudek D.
Institution
(Silvain, Lattuca, Collet, Montalescot) Sorbonne University, ACTION Study
Group, INSERM UMRS 1166, ICAN, Institut de Cardiologie, Hopital
Pitie-Salpetriere (AP-HP), Paris, France
(Rakowski, Dudek) Institute of Cardiology, Jagiellonian University Medical
College, Krakow, Poland
(Lattuca) Service de Cardiologie, Centre Hospitalier Universitaire Nimes,
ACTION Study Group, Universite Montpellier, Montpellier, France
(Liu) Department of Cardiology, Peking Union Medical College Hospital,
Beijing, China
(Bolognese) Cardiovascular and Neurological Department, Azienda
Ospedaliera, Arezzo, Italy
(Goldstein) SAMU and Emergency Department, Lille University Hospital,
Lille, France
(Hamm) Kerckhoff Heart and Thorax Center, Bad Nauheim and Medical Clinic
I, University of Giessen, Giessen, Germany
(Tanguay) Montreal Heart Institute, Montreal University, Montreal, Quebec,
Canada
(ten Berg) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Widimsky) Third Medical Faculty of Charles University and University
Hospital Royal Vineyards, Prague, Czech Republic
(Miller) Eli Lilly and Company, Indianapolis, Indiana, India
(Portal, Vicaut) Methodology and Statistical Unit, Centre Hospitalier
Universitaire Lariboisiere (ACTION Study Group, AP-HP, Universite Paris
7), Paris, France
Publisher
Elsevier USA
Abstract
Background: In the ACCOAST (A Comparison of Prasugrel at PCI or Time of
Diagnosis of Non-ST Elevation Myocardial Infarction) trial, the prasugrel
pre-treatment strategy versus placebo was associated with excess bleeding
complications and no improved ischemic outcome in non-ST-segment elevation
myocardial infarction (MI). Whether patients with the longest
pre-treatment duration had an ischemic benefit is unknown.
 Objective(s): This pre-specified analysis of the ACCOAST trial aimed
to assess the effect of pre-treatment duration with prasugrel (time from
randomization to angiography) on outcomes. Method(s): Within the
4,033 patients randomized in the ACCOAST trial, pre-treatment duration was
available in 4,001 patients (99.2%). The population of the trial was
divided into quartiles of pre-treatment duration (0.1 to 2.5 h, 2.5 to 3.9
h, 3.9 to 13.6 h, and >13.6 h) with an evaluation of the primary efficacy
endpoint of cardiovascular death, MI, stroke, urgent revascularization or
glycoprotein IIb/IIIa inhibitor bailout use. Secondary efficacy outcomes
including cardiovascular death, MI, or stroke; all-cause death; stent
thrombosis and safety outcomes (all coronary artery bypass graft [CABG] or
non-CABG TIMI [Thrombolysis In Myocardial Infarction] major bleeding) were
also evaluated at 7 days. Result(s): The primary efficacy outcome of
cardiovascular death, MI, stroke, urgent revascularization or glycoprotein
IIb/IIIa inhibitor bailout use did not differ between the quartiles of
pre-treatment duration in the trial population (p = 0.17 for interaction).
None of the secondary efficacy outcomes were found to be dependent on
pre-treatment duration. The safety outcome of all CABG or non-CABG TIMI
major bleeding did not differ between the quartiles of pre-treatment
duration (p = 0.37 for interaction). Conclusion(s): In non-ST-segment
elevation MI patients, the excess risk of bleeding and the absence of
ischemic benefit were consistent across the quartiles of increasing
duration of prasugrel pre-treatment. (A Comparison of Prasugrel at PCI or
Time of Diagnosis of Non-ST Elevation Myocardial Infarction [ACCOAST];
NCT01015287) Copyright © 2019 American College of Cardiology
Foundation

<17>
Accession Number
2001528394
Title
Modified ultrafiltration in coronary artery bypass grafting: A randomized,
double-blinded, controlled clinical trial.
Source
Iranian Red Crescent Medical Journal. 20 (5) (no pagination), 2018.
Article Number: e66187. Date of Publication: 01 May 2018.
Author
Tabaei A.S.; Mortazian M.; Yaghoubi A.; Manesh S.A.; Totonchi Z.;
Baharestani B.; Mehrabanian M.; Pazoki-Toroudi H.; Kaveh H.; Toloueitabar
Y.; Ghanbari A.; Gorjipour F.
Institution
(Tabaei, Yaghoubi, Gorjipour, Totonchi, Baharestani, Kaveh, Toloueitabar,
Ghanbari) Rajaie Cardiovascular Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Mortazian) Department of Cardiology, AJA University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Manesh) Department of Radiology, Qom University of Medical Sciences and
Health Services, Qom, Iran, Islamic Republic of
(Mehrabanian) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Pazoki-Toroudi, Gorjipour) Physiology Research Center, Iran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Kowsar Medical Publishing Company (E-mail: info@anesthpain.com)
Abstract
Background: Modified Ultrafiltration (MUF) has been used in
Cardiopulmonary Bypass (CPB) operations to prevent hemodilution and remove
pro-inflammatory cytokines. It has been studied in pediatric operation
settings. However, evidence exists regarding its application in adults'
Coronary Artery Bypass Grafting (CABG) operation. Objective(s): The
present study investigated MUF and its effects on inflammatory cytokine
response, hemodilution and rotational thromboelastometry outcomes in
adults' CABG operation. Method(s): In a randomized controlled trial,
56 elective CABG patients that had referred to the Rajaie Cardiovascular
Medical and Research Center (Tehran, Iran) during year 2017 were randomly
assigned to two groups, including control and MUF groups. Preoperative and
postoperative clinical parameters were recorded. Serum level of
inflammatory cytokines after clamp removal, after Cardiopulmonary Bypass
(CPB) (MUF in the MUF group) and 24 hours after Intensive Care Unit (ICU)
entrance, and Rotational Thrombo-elastometry (ROTEM) indices,
pre-operation, and post-operation, were measured. Result(s): The two
groups were similar in clinical perioperative parameters, including
hemodynamics, transfusions, ROTEM indices, mechanical ventilation and CPB
time, and ICU stay. The levels of inflammatory mediators were
significantly increased after CPB in both groups. Interleukin (IL)-6,-8
and-10 measures were equal between the two groups in all trial measurement
points. The MUF group demonstrated a significantly lower level of Tumor
Necrosis Factor (TNF)-alpha compared with the control group after CPB
(1.55 +/- 0.29 versus 1.77 +/- 0.35 log10 pg/mL, respectively; P = 0.031).
Hemoglobin (9.55 +/- 0.96 versus 8.29 +/- 0.57 g/dl, P < 0.001) and
hematocrit % (29.96 +/- 3.23 and 24.72 +/- 1.62, P < 0.001) levels were
significantly higher in the MUF group compared with the control, after
CPB. Conclusion(s): Modified Ultrafiltration eliminates extra liquids
and TNF-alpha from circulation in adults CABG operation, without affecting
the hemostatic indices and improves hemoglobin level. It does not remove
anti-inflammatory cytokine IL-10 from circulation. Copyright ©
2018, Author(s).

<18>
Accession Number
626044987
Title
Post-TAVI follow-up with MDCT of the valve prosthesis: Technical
application, regular findings and typical local post-interventional
complications.
Source
RoFo Fortschritte auf dem Gebiet der Rontgenstrahlen und der Bildgebenden
Verfahren. 190 (6) (pp 521-530), 2018. Date of Publication: 2018.
Author
Soschynski M.; Capilli F.; Ruile P.; Neumann F.-J.; Langer M.; Krauss T.
Institution
(Soschynski, Capilli, Langer, Krauss) Department of Radiology, Medical
Center, University of Freiburg, Faculty of Medicine, University of
Freiburg, Germany, Hugstetter Strase 55, Freiburg 79106, Germany
(Ruile, Neumann) Department of Cardiology and Angiology II, University
Heart Center Freiburg-Bad Krozingen, Germany
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has evolved
into an alternative procedure to surgical valve replacement for high-risk
patients with aortic valve stenosis. Despite technical innovations, there
is still a risk of complications during and after the intervention. After
a TAVI procedure, ECG-gated multidetector computed tomography (MDCT) plays
an important role in the early diagnosis of local complications. In this
article, we explain for the first time how the technical acquisition of
MDCT in the region of the aortic root is performed as post-interventional
control of the TAVI prosthesis. In the second part normal
post-interventional findings of different prosthetic valves as well as
classic and uncommon complications in the implant area will be illustrated
in several case studies. Method(s): In this review the current
literature from PubMed about ECG-gated MDCT after TAVI is summarized and
structured. It is supplemented by several case studies from our
institution. Results and Conclusion(s): Using retrospectively
ECG-gated MDCT, an aortic valve prosthesis after TAVI can be visualized
with high spatial resolution in several phases of the cardiac cycle.
Images of the implanted aortic valve at all time points of the cardiac
cycle enable a functional analysis of prosthetic leaflets similar to
echocardiography. MDCT is superior to transthoracic echocardiography with
respect to the direct detection of prosthetic leaflet thrombosis. The
position of the device in relation to the coronary ostia and correct
unfolding of the stent frame need to be evaluated. There are different
types of stents carrying the valve leaflets with distinct ideal positions.
Any stent should cover the left ventricular outflow tract (LVOT) along its
whole circumference. Life-threatening complications in the implant area,
such as annulus rupture, can be diagnosed reliably with CT. Copyright
© 2018 Georg Thieme Verlag KG, Stuttgart.

<19>
Accession Number
2001581983
Title
Impact of Heparin- or Nonheparin-Coated Circuits on Platelet Function in
Pediatric Cardiac Surgery.
Source
Annals of Thoracic Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Giorni C.; Pezzella C.; Bojan M.; Ricci Z.; Pouard P.; Raisky O.; Tourneur
L.; La Salvia O.; Favia I.; Borgel D.; Cogo P.; Carotti A.; Lasne D.
Institution
(Giorni, Pezzella, Ricci, La Salvia, Favia, Cogo, Carotti) Pediatric
Intensive Care, Cardiac Surgery and Perfusion Unit, Bambino Gesu
Children's Hospital, Rome, Italy
(Bojan, Pouard) Department of Anesthesiology and Critical Care, Assistance
Publique-Hopitaux de Paris, Hopital Necker-Enfants Malades, Paris, France
(Raisky, Tourneur) Department of Pediatric Cardiac Surgery, Assistance
Publique-Hopitaux de Paris, Hopital Necker-Enfants Malades, Paris, France
(Borgel, Lasne) Hematology Laboratory, Assistance Publique-Hopitaux de
Paris, Hopital Necker-Enfants Malades, Paris, France
(Borgel, Lasne) Hemostase Inflammation Thrombose, Unite Mixte de Recherche
-S1176, Institut National de la Sante et de la Recherche Medicale,
University Paris-Sud, Universite Paris-Saclay, Le Kremlin-Bicetre, France
Publisher
Elsevier USA
Abstract
Background: Extracorporeal circuit coating has been shown to improve
coagulation derangements during pediatric cardiopulmonary bypass (CPB).
This study compared platelet function and hemostasis activation in
pediatric cardiac surgery conducted with nonheparin coating (Balance;
Medtronic, Minneapolis, MN) versus heparin-based coating (Carmeda;
Medtronic) circuits. Method(s): A prospective, randomized,
double-center trial was conducted in children older than 1 month
undergoing congenital heart disease treatment. Blood samples were
collected at baseline (T0), 15 minutes after the start of CPB (T1), and 15
minutes (T2) and 1 hour after the conclusion of CPB (T3). The primary end
point of the study was to detect potential differences in
beta-thromboglobulin levels between the two groups at T2. Other
coagulation and platelet function indicators were analyzed as secondary
end points. Result(s): The concentration of beta-thromboglobulin
increased significantly at T2 in both groups. However, there was no
significant difference between the groups across all time points. There
was no difference in the secondary end points between the groups.
 Conclusion(s): The two circuits showed similar biological effects on
platelet function and coagulation. This observation may be useful in
optimizing the conduct of CPB and in rationalizing its cost for the
treatment of congenital heart disease. Copyright © 2019 The
Society of Thoracic Surgeons

<20>
Accession Number
620258769
Title
Randomized comparison of novel biodegradable polymer and durable
polymer-coated cobalt-chromium sirolimus-eluting stents: Three-Year
Outcomes of the I-LOVE-IT 2 Trial.
Source
Catheterization and Cardiovascular Interventions. 91 (Supplement 1) (pp
608-616), 2018. Date of Publication: 15 Feb 2018.
Author
Song L.; Li J.; Guan C.; Jing Q.; Lu S.; Yang L.; Xu K.; Yang Y.; Xu B.;
Han Y.
Institution
(Song, Yang) Department of Cardiology, Fu Wai Hospital, National Center
for Cardiovascular Diseases, Beijing, China
(Li, Jing, Xu, Han) Department of Cardiology, General Hospital of Shenyang
Military Region, Shenyang, China
(Guan, Xu) Catheterization Laboratory, Fu Wai Hospital, National Center
for Cardiovascular Diseases, Beijing, China
(Lu) Department of Cardiology, Affiliated Anzhen Hospital of Capital
Medical University, Beijing, China
(Yang) Department of Cardiology, Kunming General Hospital of Chengdu
Military Region, Kunming, China
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We aimed to compare the long-term outcomes of the novel
biodegradable polymer cobalt-chromium sirolimus-eluting stent (BP-SES)
versus the durable polymer sirolimus-eluting stent (DP-SES) in the
I-LOVE-IT2 trial. Background(s): Comparisons of the long-term safety
and efficiency of the BP-DES versus the DP-DES are limited.
 Method(s): A total of 2,737 patients eligible for coronary stenting
were randomized to the BP-SES or DP-SES group at a 2:1 ratio. The primary
endpoint of target lesion failure (TLF) was defined as a composite of
cardiac death, target vessel myocardial infarction (MI), or clinically
indicated target lesion revascularization. Result(s): A three-year
clinical follow-up period was available for 2,663 (97.3%) patients. There
were no significant differences in TLF (8.9% vs. 8.6%, P = 0.81),
patient-oriented composite endpoint (PoCE) (15.2% vs.14.5%, P = 0.63), or
individual components between the BP-SES and DP-SES. Definite/probable
stent thrombosis (ST) was low and similar at 3 years (0.8% vs. 1.0%, P =
0.64). Landmark analysis of 1-3 years showed that the TLF (2.7% vs. 2.6%,
P = 0.81), PoCE (6.2% vs. 5.1%, P = 0.28), and definite/probable ST (0.4%
vs. 0.4%, P = 1.00) were comparable between the 2 arms.
 Conclusion(s): In this prospective randomized trial, the BP-SES
showed similar clinical results versus the DP-SES in terms of safety and
efficacy outcomes over a 3-year follow-up period. Copyright ©
2018 Wiley Periodicals, Inc.

<21>
Accession Number
621249026
Title
Induction immunosuppressive therapy in cardiac transplantation: a
systematic review and meta-analysis.
Source
Heart Failure Reviews. 23 (5) (pp 641-649), 2018. Date of Publication: 01
Sep 2018.
Author
Briasoulis A.; Inampudi C.; Pala M.; Asleh R.; Alvarez P.; Bhama J.
Institution
(Briasoulis, Inampudi, Pala, Alvarez, Bhama) Division of Cardiovascular
Diseases, Section of Heart Failure and Transplant, University of Iowa
Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242, United States
(Asleh) Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN,
United States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Approximately 50% of heart transplant programs currently employ a strategy
of induction therapy (IT) with either interleukin-2 receptor antagonists
(IL2RA) or polyclonal anti-thymocyte antibodies (ATG) during the early
postoperative period. However, the overall utility of such therapy is
uncertain and data comparing induction protocols are limited. The authors
searched PubMed, the Cochrane Central Register of Controlled Trials, and
ClinicalTrials.gov through January 2018 for randomized controlled trials
(RCTs) or observational controlled studies of IT vs no IT and IL2RA vs
ATG. Inverse variance fixed effects models with odds ratio (OR) as the
effect measure were used for primary analyses. Main outcomes include
moderate and severe rejection, all-cause mortality, infection, and cancer.
The authors' search retrieved 2449 studies, of which 11 met criteria for
inclusion (8 RCTs and 3 observational case-control studies). Quality of
evidence for RCTs was moderate to high. Overall, patients receiving IT had
similar risk of moderate-to-severe rejection, all-cause death, infection,
and cancer with patients who did not receive IT. The use of IL2RA was
associated with significantly higher risk of moderate-to-severe rejection
than ATG (OR 3.4; 95% CI 1.4 to 8.1), but similar risk of death,
infections, and cancer. The use of IT was not associated with any benefits
or harms compared with no IT. Moderate-to-severe rejection may be reduced
by ATG compared with IL2RA. Copyright © 2018, Springer
Science+Business Media, LLC, part of Springer Nature.

<22>
Accession Number
623831954
Title
Risk stratification and role for additional diagnostic testing in patients
with acute chest pain and normal high-sensitivity cardiac troponin levels.
Source
PLoS ONE. 13 (9) (no pagination), 2018. Article Number: e0203506. Date of
Publication: September 2018.
Author
Smulders M.W.; Bekkers S.C.A.M.; van Cauteren Y.J.M.; Liefhebber A.;
Vermeer J.R.; Vervuurt J.; Van Dieijen-Visser M.P.; Mingels A.M.A.; Rocca
H.-P.B.-L.; Dagnelie P.C.; Wildberger J.E.; Crijns H.J.G.M.; Kietselaer
B.L.J.H.
Institution
(Smulders, Bekkers, van Cauteren, Liefhebber, Vermeer, Vervuurt, Rocca,
Crijns, Kietselaer) Department of Cardiology, Maastricht University
Medical Center, Maastricht, Netherlands
(Smulders, Bekkers, van Cauteren, Van Dieijen-Visser, Mingels, Rocca,
Dagnelie, Wildberger, Crijns, Kietselaer) Cardiovascular Research
Institute Maastricht (CARIM), Maastricht University, Maastricht,
Netherlands
(Bekkers, van Cauteren, Wildberger, Kietselaer) Department of Radiology,
Maastricht University Medical Center, Maastricht, Netherlands
(Van Dieijen-Visser, Mingels) Department of Clinical Chemistry, Maastricht
University Medical Center, Maastricht, Netherlands
(Dagnelie) Department of Epidemiology, Maastricht University, Maastricht,
Netherlands
(Dagnelie) School for Public Health and Primary Care (CAPHRI), Maastricht
University, Maastricht, Netherlands
(Kietselaer) Department of Cardiology, Zuyderland Medical Center7,
Heerlen, Netherlands
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Normal high sensitivity cardiac troponin (hs-cTn) assays rule
out acute myocardial infarction (AMI) with great accuracy, but additional
non-invasive testing is frequently ordered. This observational study
evaluates whether clinical characteristics can contribute to risk
stratification and could guide referral for additional testing. Methods
918 serial patients with acute chest pain and normal hs-cTnT levels were
prospectively included. Major adverse cardiac events (MACE) and
non-invasive test results were assessed during one-year follow-up.
Patients were classified as low and high risk based on clinical
characteristics. Results MACE occurred in 6.1% of patients and mainly
comprised revascularizations (86%). A recent abnormal stress test,
suspicious history, a positive family history and higher baseline hs-cTnT
levels were independent predictors of MACE with odds ratios of 16.00 (95%
CI:6.25-40.96), 16.43 (6.36-42.45), 2.33 (1.22-4.42) and 1.10 (1.01-1.21),
respectively. Absence of both recent abnormal stress test and suspicious
history identified 86% of patients. These patients were at very low risk
for MACE (0.4% in 30-days and 2.3% in one-year). Despite this, the
majority (287/345 = 83%) of additional tests were performed in low risk
patients, with <10% abnormal test findings. The diagnostic yield was
significantly higher in the remaining higher risk patients, 40% abnormal
test findings and a positive predictive value of 70% for MACE. Similar
results were observed in patients without known coronary artery disease.
Conclusions Clinical characteristics can be used to identify low risk
patients with acute chest pain and normal hs-cTnT levels. Current
strategies in the emergency department result in numerous additional
tests, which are mostly ordered in patients at very low risk and have a
low diagnostic yield. Copyright © 2018 Smulders 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.

<23>
Accession Number
618953020
Title
Meta-analysis of transfemoral TAVR versus surgical aortic valve
replacement.
Source
Catheterization and Cardiovascular Interventions. 91 (4) (pp 806-812),
2018. Date of Publication: 01 Mar 2018.
Author
Arora S.; Vaidya S.R.; Strassle P.D.; Misenheimer J.A.; Rhodes J.A.; Ramm
C.J.; Wheeler E.N.; Caranasos T.G.; Cavender M.A.; Vavalle J.P.
Institution
(Arora, Misenheimer, Ramm, Cavender, Vavalle) Division of Cardiology,
University of North Carolina, Chapel Hill, NC 27599-7075, United States
(Vaidya) Division of Internal Medicine, Cape Fear Valley Medical Center,
Fayetteville, NC 28304, United States
(Strassle) Department of Epidemiology, Gillings School of Global Public
Health, University of North Carolina, Chapel Hill, NC 27599-7400, United
States
(Strassle, Caranasos) Department of Surgery, UNC School of Medicine,
Chapel Hill, NC 27599-7050, United States
(Misenheimer) Division of Cardiology, The Medical College of Georgia at
Augusta University, Augusta, GA 30912, United States
(Rhodes, Wheeler) Campbell University School of Osteopathic Medicine,
Lillington, NC 27546, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: In the recently concluded PARTNER 2 trial, TF-TAVR cohort was
shown to have lower risks of death or disabling strokes as compared to
SAVR, whereas the outcomes with transthoracic TAVR were comparable with
SAVR. Method(s): We searched PubMed, EMBASE, Web of Science, and
Google Scholar for all comparison studies between TAVR and SAVR and
mortality as an outcome, irrespective of surgical risk. Randomized
controlled trials and propensity-score-matched cohort studies that used a
transfemoral approach exclusively or stratified results by route of access
and reported data for TF-TAVR patients were eligible for inclusion.
Outcomes of interest included 30-day and 1-year mortality, and 30-day
complications. If significant heterogeneity was found in the random
effects meta-analyses, a sensitivity analysis which individually removed
each study was conducted. Result(s): Seven studies reported results
on TF-TAVR. Compared with SAVR, TF-TAVR had comparable 30-day mortality
(RR 0.79, 95% CI 0.58, 1.06), 1-year mortality (RR 0.91, 95% CI 0.78,
1.08) and 30-day risk of bleeding (RR 0.70, 95% CI 0.31, 1.57). However,
TF-TAVR was associated with lower 30-day risks of atrial fibrillation (RR
0.28, 95% CI 0.17, 0.45), acute kidney injury (RR 0.38, 95% CI 0.20,
0.71), and myocardial infarction (RR 0.41, 95% CI 0.23, 0.75) at a cost of
higher incidences of vascular complications (RR 6.10, 95% CI 2.92, 12.73)
and pacemaker implantations (RR 3.29, 95% CI 1.41, 7.65).
 Conclusion(s): TF-TAVR is associated with lower 30-day risks of
myocardial infarction compared to SAVR. Further studies are required to
investigate the role of myocardial injury on overall TF-TAVR
outcomes. Copyright © 2017 Wiley Periodicals, Inc.

<24>
Accession Number
622077222
Title
Comparison of the analgesic effects of modified continuous intercostal
block and paravertebral block under surgeon's direct vision after
video-assisted thoracic surgery: a randomized clinical trial.
Source
General Thoracic and Cardiovascular Surgery. 66 (7) (pp 425-431), 2018.
Date of Publication: 01 Jul 2018.
Author
Kadomatsu Y.; Mori S.; Ueno H.; Uchiyama M.; Wakai K.
Institution
(Kadomatsu) Department of Thoracic Surgery, Nagoya University Graduate
School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
(Mori, Ueno, Uchiyama) Department of Thoracic Surgery, Japanese Red Cross
Nagoya Daiichi Hospital, Mitishita-cho 3-35, Nakamura-ku, Nagoya 453-8511,
Japan
(Kadomatsu, Wakai) Department of Preventive Medicine, Nagoya University
Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550,
Japan
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Objective: Clinical evidence comparing paravertebral (PVB) and continuous
intercostal nerve (ICB) blocks for pain management post video-assisted
thoracic surgery (VATS) is limited. This study confirms the analgesic
effect of ICB using two catheters is not inferior to that of PVB under
direct vision. Method(s): Fifty patients who underwent VATS lobectomy
from July 2015 to March 2016 were prospectively recruited and randomly
assigned to PVB and ICB groups. Postoperative pain was assessed using the
visual analog scale (VAS). VAS score at rest at 24 h was the primary
endpoint. Data on time required for catheter insertion, adverse effects,
and frequency of additional analgesics as secondary endpoints were also
collected. Noninferiority was assessed by adding a VAS margin of 15 mm to
the PVB group. Result(s): No significant differences were observed
between the VAS scores of the two groups except at 48 h after surgery,
with a margin noted for the PVB group. No significant differences were
detected in the frequency of additional analgesics and occurrence of
adverse effects. Conclusion(s): Our results could not clearly
establish noninferiority of ICB to PVB. Improvements in ICB may be
necessary for it to be used as an alternative method to PVB. Copyright
© 2018, The Japanese Association for Thoracic Surgery.

<25>
Accession Number
626283949
Title
Effects of traditional Chinese exercise on cardiac rehabilitation after
percutaneous coronary intervention: Study protocol for network
meta-analysis of randomised controlled trials.
Source
BMJ Open. 9 (2) (no pagination), 2019. Article Number: e023096. Date of
Publication: 2019.
Author
Luo C.; Wen J.; Sun W.; Li T.; Yu X.; Zhang T.; Zhou X.; Wu W.; Li R.
Institution
(Luo, Zhou, Wu, Li) Department of Cardiovascular Disease, First Affiliated
Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, China
(Wen, Sun, Li, Zhang) Guangzhou University of Chinese Medicine, Guangzhou,
China
(Yu) Department of Rehabilitation Center, First Affiliated Hospital of
Guangzhou, University of Chinese Medicine, Guangzhou, China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Coronary heart disease (CHD) is the most common cause of
death worldwide. Percutaneous coronary intervention (PCI) has been shown
to reduce mortality in patients with CHD. However, there are still
recurrences of cardiovascular events after PCI. Cardiac rehabilitation
(CR) in patients with established CHD is associated with reductions in
cardiovascular mortality and hospital admissions, as well as improved
quality of life. More and more clinical trials suggest that traditional
Chinese exercise (TCE) plays a positive role in patients post-PCI. The
primary purposes of the current study are to conduct a network
meta-analysis of randomised trials to determine the effects of TCE in
patients after PCI, and to separately compare the effects of tai chi,
baduanjin and yijinjing on CR after PCI. Methods and analysis Studies will
be retrieved from the following databases: PubMed, Embase, Cochrane
Library, Chinese National Knowledge Infrastructure, Wanfang Data, Chinese
BioMedical Database and Chinese Science and Technology Periodicals
Database, from inception to December 2018. We will include randomised
controlled trials that are related to the effects of TCE therapies in
patients after PCI. The primary outcomes will be all-cause mortality,
revascularisations, health-related quality of life and hospitalisations.
Two reviewers will independently select eligible articles. For each
included article, two reviewers will independently extract the data and
assess the risk of bias by using the Cochrane risk of bias tool. Bayesian
network meta-analyses will be conducted to pool all treatment effects. The
ranking probabilities for the optimal intervention of various treatments
(tai chi, baduanjin or yijinjing) will be estimated by the mean ranks and
surface under the cumulative ranking curve. The Grading of Recommendations
Assessment, Development and Evaluation System will be used to assess the
quality of evidence. Ethics and dissemination The results will be
disseminated through peer-reviewed publications. They will provide
consolidated evidence to inform clinicians on the potential functions of
TCE in CR, and to provide reliable evidence for the application of TCE.
Trial registration number CRD42018088415. Copyright © Author(s)
(or their employer(s)) 2019. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ.

<26>
Accession Number
2001564218
Title
Impact of Short-Term Complications on Mortality and Quality of Life After
Transcatheter Aortic Valve Replacement.
Source
JACC: Cardiovascular Interventions. 12 (4) (pp 362-369), 2019. Date of
Publication: 25 February 2019.
Author
Arnold S.V.; Zhang Y.; Baron S.J.; McAndrew T.C.; Alu M.C.; Kodali S.K.;
Kapadia S.; Thourani V.H.; Miller D.C.; Mack M.J.; Leon M.B.; Cohen D.J.
Institution
(Arnold, Baron, Cohen) Saint Luke's Mid America Heart Institute and
University of Missouri-Kansas City, Kansas City, MO, United States
(Zhang, McAndrew, Alu, Kodali, Leon) Columbia-Presbyterian Hospital, New
York, NY, United States
(Kapadia) Cleveland Clinic Foundation, Cleveland, OH, United States
(Thourani) Medstar Washington Hospital Center/Georgetown University,
Washington, DC, United States
(Miller) Stanford University Medical School, Stanford, CA, United States
(Mack) Baylor Scott and White Health, Plano, TX, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to examine the independent
association of short-term complications of transcatheter aortic valve
replacement (TAVR) with survival and quality of life at 1 year.
 Background(s): Prior studies have examined the mortality and cost
implications of various complications of TAVR. However, many of these
complications may primarily affect patients' quality of life after TAVR,
which has not been previously studied. Method(s): Among patients at
intermediate or high surgical risk who underwent TAVR as part of the
PARTNER (Placement of Aortic Transcatheter Valve) 2 studies and survived
30 days, the association between complications within the 30 days after
TAVR and mortality and quality of life at 1 year was examined. Quality of
life was assessed using the Kansas City Cardiomyopathy Questionnaire and
the Short-Form 12. Complications assessed included major and minor stroke,
life-threatening and major bleeding, vascular injury, stage 3 acute kidney
injury, new pacemaker implantation, and mild and moderate or severe
paravalvular leak (PVL). Multivariable models that included all
complications as well as baseline clinical factors were used to examine
the independent association of each complication with outcomes.
 Result(s): Among 3,763 TAVR patients, major stroke and stage 3 acute
kidney injury were associated with markedly increased risk for 1-year
mortality, with adjusted hazard ratios of 5.4 (95% confidence interval
[CI]: 3.1 to 9.5) and 4.9 (95% CI: 2.7 to 8.8), respectively, as well as
poorer quality of life among survivors (reductions in 1-year Kansas City
Cardiomyopathy Questionnaire overall summary score of 15.1 points [95% CI:
24.8 to 5.3 points] and 14.7 points [95% CI: 25.6 to 3.8 points],
respectively). Moderate or severe PVL, life-threatening bleeding, and
major bleeding were each associated with a more modest increase in
mortality and decrement in quality of life, whereas mild PVL was
associated with a small decrease in quality of life. After adjusting for
baseline characteristics and other complications, need for a new
pacemaker, minor stroke, and vascular injury were not independently
associated with poor outcomes. Conclusion(s): Among patients
undergoing TAVR, similar events are associated with increased mortality
and impaired quality of life at 1 year. These results suggest that despite
considerable progress, efforts to further reduce stroke, acute kidney
injury, bleeding, and moderate or severe PVL are likely to yield important
clinical benefits and remain key targets for device iteration and
procedural improvement. Copyright © 2019 American College of
Cardiology Foundation

<27>
Accession Number
2001511372
Title
Effects of platelet-rich plasmapheresis during cardiovascular surgery: A
meta-analysis of randomized controlled clinical trials.
Source
Journal of Clinical Anesthesia. 56 (pp 88-97), 2019. Date of Publication:
September 2019.
Author
Zhai Q.; Wang Y.; Yuan Z.; Zhang R.; Tian A.
Institution
(Zhai, Wang, Yuan, Tian) Department of Anesthesiology, the First
Affiliated Hospital of China Medical University (CMU), Shenyang, Liaoning,
China
(Zhang) Department of Gerontology and Geriatrics, the First Affiliated
Hospital of China Medical University (CMU), Shenyang, Liaoning, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: This study aimed to explore the effects of platelet-rich
plasmapheresis (PRP) on the amount of postoperative blood loss and the
requirements for allogeneic fresh frozen plasma (FFP) and red blood cell
(RBC) transfusions during cardiovascular surgery. Method(s): A
literature search of 7 online databases was conducted. Randomized control
trials (RCT) comparing intraoperative PRP or appropriate control groups
were considered suitable for this current study. Result(s): Fifteen
RCTs enrolling a total of 1002 patients, including 501 patients who
received PRP and 501 control patients. Meta-analysis of the data from
these trials showed that PRP reduced the total volume of postoperative
blood loss (standardized mean difference [SMD], -0.74; 95% confidence
interval [CI], -1.18 to -0.31; P < 0.05), reduced postoperative fresh
frozen plasma (FFP) transfusion (SMD, -0.38; 95%CI, -0.69 to -0.08; P <
0.05), reduced postoperative RBCs transfusion (SMD, -0.44; 95%CI, -0.77 to
-0.10; P < 0.05), and reduced the proportion of patients receiving
postoperative allogeneic RBC transfusions (relative risk [RR], 0.44;
95%CI, 0.21-0.91, P < 0.05) during cardiovascular surgery.
 Conclusion(s): Conducting PRP before cardiopulmonary bypass (CPB) and
transfusing autologous platelet-rich plasma (aPRP) after reversal of
heparin could reduce postoperative blood loss, the requirements for blood
products transfusion during cardiovascular surgery. A higher mean platelet
count in aPRP may improve the final outcome. However, there was a high
degree of undetermined heterogeneity among the analyzed trials, and larger
and more precise RCTs are needed to confirm these
conclusions. Copyright © 2019 Elsevier Inc.

<28>
Accession Number
625728509
Title
B-type natriuretic peptide is associated with remodeling and exercise
capacity after transcatheter aortic valve replacement for aortic stenosis.
Source
Clinical Cardiology. 42 (2) (pp 270-276), 2019. Date of Publication:
Februaryy 2019.
Author
Sato K.; Kumar A.; Krishnaswamy A.; Mick S.; Desai M.Y.; Griffin B.P.;
Kapadia S.R.; Popovic Z.B.
Institution
(Sato, Kumar, Krishnaswamy, Mick, Desai, Griffin, Kapadia, Popovic)
Department of Cardiovascular Medicine, Heart and Vascular Institute,
Cleveland Clinic, Cleveland, OH, United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: We aimed to assess longitudinal changes of B-type natriuretic
peptide (BNP) in aortic stenosis (AS) patients treated by transcatheter
aortic valve replacement (TAVR). Method(s): From our TAVR database,
we identified 193 consecutive patients with severe symptomatic AS who
underwent TAVR and were prospectively followed using serial BNP levels and
echocardiography. Patients were divided into subgroups according to type
of left ventricular (LV) remodeling as having normal LV mass and relative
wall thickness, or showing concentric remodeling (CR), concentric
hypertrophy (CH), and eccentric hypertrophy (EH). Result(s): At
baseline, 30 patients (16%) had EH, 115 (60%) had CH, 37 (19%) had CR, and
11 (6%) had normal LV geometry. After TAVR, BNP decreased in the first 30
days, with further improvement during follow-up. Patients with EH had
higher BNP at baseline (P < 0.01) and a greater subsequent decrease (P <
0.001). During the median follow-up of 1331 days (interquartile range:
632-1678), 119 (62%) patients died. BNP showed a time-dependent
association with all-cause mortality both in a univariable (hazards ratio
[HR] 1.24, 95% confidence interval [CI]: 1.04-1.47, P = 0.017), and in a
multivariable model with Society of Thoracic Surgeons score and baseline
BNP forced into the analysis (HR 1.32, 95% CI: 1.001-1.73, P = 0.049).
Elevated BNP was associated with a larger LV end-diastolic volume index (P
< 0.001) and shorter 6-minute walk test distance (P = 0.013) throughout
follow-up. Conclusion(s): In patients with AS, BNP was associated
with LV remodeling phenotypes and functional status before and after TAVR.
Elevated BNP levels were associated with poor prognosis. Copyright
© 2018 The Authors. Clinical Cardiology published by Wiley
Periodicals, Inc.

<29>
Accession Number
2000570319
Title
Management of Patients With Aortic Valve Stenosis.
Source
Mayo Clinic Proceedings. 93 (4) (pp 488-508), 2018. Date of Publication:
April 2018.
Author
Kanwar A.; Thaden J.J.; Nkomo V.T.
Institution
(Kanwar) Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA,
United States
(Kanwar) Mayo Clinic College of Medicine and Science, Rochester, MN,
United States
(Thaden, Nkomo) Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN, United States
Publisher
Elsevier Ltd
Abstract
With increased life expectancy and aging of the population, aortic
stenosis is now one of the most common valvular heart diseases. Early
recognition and management of aortic stenosis are of paramount importance
because untreated symptomatic severe disease is universally fatal. The
advent of transcather aortic valve replacement technologies provides
exciting avenues of care to patients with this disease in whom traditional
surgical procedures could not be performed or were associated with high
risk. This review for clinicians offers an overview of aortic stenosis and
updated information on the current status of various treatment strategies.
An electronic literature search of PubMed, MEDLINE, EMBASE, and Scopus was
performed from conception July 1, 2016, through November 30, 2017, using
the terms aortic stenosis, aortic valve replacement, transcatheter aortic
valve replacement (TAVR), transcatheter aortic valve insertion (TAVI),
surgical aortic valve replacement, aortic stenosis flow-gradient patterns,
low-flow aortic valve stenosis, natural history, stress testing,
pathophysiology, bicuspid aortic valve, and congenital aortic valve
disease. Copyright © 2018 Mayo Foundation for Medical Education
and Research

<30>
Accession Number
617911834
Title
Clinical Impact of Changes in Hemodynamic Indices of Contractile Function
During Treatment of Acute Decompensated Heart Failure.
Source
Journal of Cardiac Failure. 24 (1) (pp 43-50), 2018. Date of Publication:
January 2018.
Author
Bilchick K.C.; Mejia-Lopez E.; McCullough P.; Breathett K.; Kennedy J.L.;
Tallaj J.; Bergin J.; Pamboukian S.; Abuannadi M.; Mazimba S.
Institution
(Bilchick, Mejia-Lopez, Kennedy, Bergin, Abuannadi, Mazimba) University of
Virginia Health System, Charlottesville, Virginia, United States
(McCullough) Baylor Heart and Vascular Institute, Dallas, Texas, United
States
(Breathett) University of Colorado, Denver, Colorado, United States
(Tallaj, Pamboukian) University of Alabama, Birmingham, Alabama, United
States
Publisher
Churchill Livingstone Inc.
Abstract
Background The objective of this work was to determine the impact of
improving right ventricular versus left ventricular stroke work indexes
(RVSWI vs LVSWI) during therapy for acute decompensated heart failure
(ADHF). Methods and Results Cox proportional hazards regression and
logistic regression were used to analyze key factors associated with
outcomes in 175 patients (mean age 56.7 +/- 13.6 years, 29.1% female) with
hemodynamic data from the Evaluation Study of Congestive Heart Failure and
Pulmonary Artery Catheterization Effectiveness trial. In this cohort,
28.6% and 69.7%, respectively, experienced the outcomes of death,
transplantation, or ventricular assist device implantatation (DVADTX) and
DVADTX or HF rehospitalization (DVADTXHF) during 6 months of follow-up.
Increasing RVSWI (DELTARVSWI) from baseline to discharge was associated
with a decrease in DVADTXHF (hazard ratio [HR] 0.923, 95% confidence
interval [CI] 0.871-0.979) per 0.1 mm HgLm-2 increase);
however, increasing LVSWI (DELTALVSWI) had only a nonsignificant
association with decreased DVADTXHF (P =.11) In a multivariable model,
patients with DELTARVSWI <=1.07 mm HgLm-2 and DELTALVSWI <=4.57
mm HgLm-2 had a >2-fold risk of DVADTXHF (HR 2.05, 95% CI
1.23-3.41; P =.006). Conclusion Compared with left ventricular stroke
work, increasing right ventricular stroke work during treatment of ADHF
was associated with better outcomes. The results promise to inform optimal
hemodynamic targets for ADHF. Copyright © 2017 Elsevier Inc.

<31>
Accession Number
617243710
Title
Telmisartan decreases microalbuminuria in patients with type 2 diabetes
mellitus following coronary artery bypass grafting.
Source
Cardiovascular Journal of Africa. 28 (3) (pp 191-195), 2017. Date of
Publication: May 2017.
Author
Furat C.; Dogan R.; Ilhan G.; Bayar E.; Ozpak B.; Kara H.; Bozok S.
Institution
(Furat, Dogan) Department of Cardiovascular Surgery, Faculty of Medicine,
Hacettepe University, Ankara, Turkey
(Ilhan) Department of Cardiovascular Surgery, Faculty of Medicine, Recep
Tayyip Erdogan University, Rize, Turkey
(Bayar) Department of Cardiovascular Surgery, Zonguldak Ataturk State
Hospital, Zonguldak, Turkey
(Ozpak) Department of Cardiovascular Surgery, Faculty of Medicine, Katip
Celebi University, Turkey
(Kara) Department of Cardiovascular Surgery, Ada Hospital, Giresun, Turkey
(Bozok) Department of Cardiovascular Surgery, Faculty of Medicine,
Bahcesehir University, Istanbul, Turkey
Publisher
Clinics Cardive Publishing (PTY)Ltd (PO Box 1013, Durbanville 7551, South
Africa)
Abstract
Objective: This prospective study aimed to investigate the effects of the
selective angiotensin receptor antagonist, telmisartan, on
microalbuminuria after coronary artery bypass surgery in patients with
diabetes mellitus. Method(s): Patients were divided into two groups
with block randomisation, using the sealed envelope technique: group T
(telmisartan group) consisted of patients who received the angiotensin
receptor blocking agent telmisartan 80 mg daily for at least six months in
the pre-operative period; group N-T (non-Telmisartan group) consisted of
patients who received no telmisartan treatment. Clinical and demographic
characteristics, operative and postoperative features, microalbuminuria
and high-sensitivity C-reactive protein levels were compared.
 Result(s): Forty patients met the eligibility criteria for the study.
The groups did not differ with regard to clinical and demographic
characteristics, and operative and postoperative features.
Microalbuminuria levels between the groups differed significantly in the
pre-operative period, first hour postoperatively and fifth day
postoperatively. C-reactive protein levels between the groups differed
significantly on the fifth day postoperatively. Conclusion(s):
Telmisartan was useful for decreasing systemic inflammation and levels of
urinary albumin excretion in patients who had type 2 diabetes mellitus and
had undergone coronary artery bypass surgery.

<32>
Accession Number
616842262
Title
Position paper for the evaluation and management of oral status in
patients with valvular disease: Groupe de Travail Valvulopathies de la
Societe Francaise de Cardiologie, Societe Francaise de Chirurgie Orale,
Societe Francaise de Parodontologie et d'Implantologie Orale, Societe
Francaise d'Endodontie et Societe de Pathologie Infectieuse de Langue
Francaise.
Source
Archives of Cardiovascular Diseases. 110 (8-9) (pp 482-494), 2017. Date of
Publication: August 2017.
Author
Millot S.; Lesclous P.; Colombier M.-L.; Radoi L.; Messeca C.; Ballanger
M.; Charrier J.-L.; Tramba P.; Simon S.; Berrebi A.; Doguet F.; Lansac E.;
Tribouilloy C.; Habib G.; Duval X.; Iung B.
Institution
(Millot) Department of oral surgery, Montpellier university hospital,
Montpellier 34295, France
(Millot) Inserm 1149, Paris 75018, France
(Lesclous) Department of oral surgery, Nantes hospital, university of
Nantes, Inserm U791, LIOAD, Nantes 44093, France
(Colombier) Department of periodontology, Louis-Mourier hospital, AP-HP,
university of Paris Descartes, Colombes 92700, France
(Radoi) Department of oral surgery, Louis-Mourier hospital, AP-HP,
university of Paris Descartes, Inserm U1018, Colombes 92700, France
(Messeca) Odontology department, Bichat hospital, AP-HP, Paris 75018,
France
(Ballanger) Department of oral surgery, Pitie-Salpetriere hospital, AP-HP,
university of Paris Descartes, Paris 75013, France
(Charrier) Department of oral surgery, Bretonneau hospital, AP-HP,
university of Paris Descartes, Paris 75018, France
(Tramba) Department of implantology and prosthetics, Pitie Salpetriere
hospital, AP-HP, university of Paris Descartes, Paris 75013, France
(Simon) Endodontics department, Pitie-Salpetriere hospital, AP-HP,
Paris-Diderot university, Paris 75013, France
(Berrebi) Department of cardiology, Georges Pompidou european hospital,
AP-HP, institut mutualiste Montsouris, Paris 75014, France
(Doguet) Department of thoracic and cardiovascular surgery, Rouen
university hospital, Inserm U1096, Rouen 76000, France
(Lansac) Department of cardiac surgery, institut mutualiste Montsouris,
Paris 75014, France
(Tribouilloy) Department of cardiology, university hospital of Amiens,
Inserm U1088, Jules-Verne university of Picardie, Amiens 80480, France
(Habib) Department of cardiology, La Timone hospital, Aix-Marseille
university, Marseille 13385, France
(Duval) Centre of clinical investigations, Inserm 1425, Bichat hospital,
AP-HP, Paris-Diderot university, Inserm U1137, AEPEI, Paris 75018, France
(Iung) Department of cardiology, Bichat hospital, AP-HP, DHU FIRE,
Paris-Diderot university, 46, rue Henri-Huchard, Paris 75018, France
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Oral health is of particular importance in patients with heart valve
diseases because of the risk of infective endocarditis. Recommendations
for antibiotic prophylaxis before dental procedures have been restricted,
but the modalities of oral evaluation and dental care are not detailed in
guidelines. Therefore, a multidisciplinary working group reviewed the
literature to propose detailed approaches for the evaluation and
management of buccodental status in patients with valvular disease. Simple
questions asked by a non-dental specialist may draw attention to
buccodental diseases. Besides clinical examination, recent imaging
techniques are highly sensitive for the detection of inflammatory bone
destruction directly related to oral or dental infection foci. The
management of buccodental disease before cardiac valvular surgery should
be adapted to the timing of the intervention. Simple therapeutic
principles can be applied even before urgent intervention. Restorative
dentistry and endodontic and periodontal therapy can be performed before
elective valvular intervention and during the follow-up of patients at
high risk of endocarditis. The detection and treatment of buccodental foci
of infection should follow specific rules in patients who present with
acute endocarditis. Implant placement is no longer contraindicated in
patients at intermediate risk of endocarditis, and can also be performed
in selected high-risk patients. The decision for implant placement should
follow an analysis of general and local factors increasing the risk of
implant failure. The surgical and prosthetic procedures should be
performed in optimal safety conditions. It is therefore now possible to
safely decrease the number of contraindicated dental procedures in
patients at risk of endocarditis. Copyright © 2017 Elsevier
Masson SAS

<33>
[Use Link to view the full text]
Accession Number
626380307
Title
Bioprosthetic Aortic Valve Replacement in Nonelderly Adults.
Source
Circulation. Cardiovascular quality and outcomes. 12 (2) (pp e005481),
2019. Date of Publication: 01 Feb 2019.
Author
Etnel J.R.G.; Huygens S.A.; Grashuis P.; Pekbay B.; Papageorgiou G.; Roos
Hesselink J.W.; Bogers A.J.J.C.; Takkenberg J.J.M.
Institution
(Etnel, Huygens, Grashuis, Pekbay, Papageorgiou, Bogers, Takkenberg)
Department of Cardiothoracic Surgery (J.R.G.E., B.P., G.P., Erasmus
University Medical Center, Rotterdam, Netherlands
(Huygens) Erasmus School of Health Policy & Management, Erasmus University
Rotterdam, Rotterdam, Netherlands
(Papageorgiou) Department of Biostatistics (G.P.), Erasmus University
Medical Center, Rotterdam, Netherlands
(Roos Hesselink) Department of Cardiology (J.W.R.H.), Erasmus University
Medical Center, Rotterdam, Netherlands
Publisher
NLM (Medline)
Abstract
Background To support decision-making in aortic valve replacement in
nonelderly adults, we aim to provide a comprehensive overview of reported
outcome after bioprosthetic aortic valve replacement and to translate this
to age-specific patient outcome estimates. Methods and Results A
systematic review was conducted for papers reporting clinical outcome
after aortic valve replacement with currently available bioprostheses in
patients with a mean age <55 years, published between January 1, 2000, and
January 9, 2016. Pooled reported event rates and time-to-event data were
pooled and entered into a microsimulation model to calculate life
expectancy and lifetime event risk for the ages of 25, 35, 45, and 55
years at surgery. Nineteen publications were included, encompassing a
total of 2686 patients with 21117 patient-years of follow-up (pooled mean
follow-up: 7.9+/-4.2 years). Pooled mean age at surgery was 50.7+/-11.0
years. Pooled early mortality risk was 3.30% (95% CI, 2.39-4.55), late
mortality rate was 2.39%/y (95% CI, 1.13-2.94), reintervention 1.82%/y
(95% CI, 1.31-2.52), structural valve deterioration 1.59%/y (95% CI,
1.21-2.10), thromboembolism 0.53%/y (95% CI, 0.42-0.67), bleeding 0.22%/y
(95% CI, 0.16-0.32), endocarditis 0.48%/y (95% CI, 0.37-0.62), and 20-year
pooled actuarial survival was 58.7% and freedom from reintervention was
29.0%. Median time to structural valve deterioration was 17.3 years and
median time to all-cause first reintervention was 16.9 years. For a
45-year-old adult, for example, this translated to a microsimulation-based
estimated life expectancy of 21 years (general population: 32 years) and
lifetime risk of reintervention of 78%, structural valve deterioration
71%, thromboembolism 12%, bleeding 5%, and endocarditis 9%. Conclusions
Aortic valve replacement with bioprostheses in young adults is associated
with high structural valve deterioration and reintervention rates and low,
though not absent, hazards of thromboembolism and bleeding. Foremostly,
most patients will require one or more reinterventions during their
lifetime and survival is impaired in comparison with the age- and
sex-matched general population. Prosthesis durability remains the main
concern in nonelderly patients.

<34>
Accession Number
626381014
Title
Leveraging Cumulative Network Meta-analysis and Value of Information
Analysis to Understand the Evolving Value of Medical Research.
Source
Medical decision making : an international journal of the Society for
Medical Decision Making. 39 (2) (pp 119-129), 2019. Date of Publication:
01 Feb 2019.
Author
Kim D.D.; Trikalinos T.A.; Wong J.B.
Institution
(Kim) Center for the Evaluation of Value and Risk in Health, Institute for
Clinical Research and Health Policy Studies, Tufts Medical Center, Boston,
MA, United States
(Trikalinos) Department of Health Services, Policy & Practice, Brown
University School of Public Health, Brown University, Providence, RI,
United States
(Wong) Division of Clinical Decision Making, Institute for Clinical
Research and Health Policy Studies, Tufts Medical Center, Boston, MA,
United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Leveraging cumulative network meta-analysis (NMA) and value of
information (VOI) analysis, this article aims to understand the evolving
value of medical research and to identify gaps in the evidence for future
research. METHOD(S): As an illustration, we identified 31 randomized
controlled trials (RCT) from 1980 to 2013 that examined a network of 3
interventions for coronary artery disease: medical therapy (MED),
percutaneous coronary intervention (PCI), and coronary artery bypass graft
(CABG) surgery. We conducted Bayesian NMA to combine evidence from a new
RCT with existing knowledge. Then, using the Duke Databank for
Cardiovascular Diseases database, we developed an accelerated failure time
model to estimate the joint effects of patient characteristics and
treatment choices on survival outcomes. With the estimated coefficients
and covariance matrices, we projected survival benefits and its
surrounding uncertainty among 50,000 simulated patients treated with MED,
PCI, or CABG. The value of resolving residual uncertainty from future
trials was quantified through the VOI analysis. We repeated these steps
for each published RCT to estimate dynamic changes in VOI estimates.
 RESULT(S): Our cumulative NMA found that CABG conferred a lower, but
not statistically significant, mortality than PCI (hazard ratio [HR],
0.90; 95% uncertainty interval, 0.80-1.05). MED had a nonsignificantly
higher long-term mortality than PCI (HR, 1.11; 0.98-1.31) but
significantly higher than CABG (HR, 1.07; 1.23-1.41). The greatest
potential gains from future research would come from additional
head-to-head trials between CABG v. PCI with the value of future research
equaling 0.27 life years per patient. CONCLUSION(S): The combination
of cumulative NMA and VOI approaches can improve the efficiency of
comparative effectiveness research by using all of the available evidence
to determine future research priorities.

<35>
[Use Link to view the full text]
Accession Number
626379702
Title
Effects of thoracic epidural anesthesia/analgesia on the stress response,
pain relief, hospital stay, and treatment costs of patients with
esophageal carcinoma undergoing thoracic surgery: A single-center,
randomized controlled trial.
Source
Medicine. 98 (7) (pp e14362), 2019. Date of Publication: 01 Feb 2019.
Author
Li Y.; Dong H.; Tan S.; Qian Y.; Jin W.
Institution
(Li) Department of Anesthesiology, first affiliated hospital of Nanjing
Medical University, Nanjing 210029, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Appropriate postoperative pain management can improve outcomes
in patients with esophageal cancer (EC). OBJECTIVE(S): To compare
different combinations of anesthesia and analgesia techniques in patients
with EC undergoing open thoracotomy. METHOD(S): This randomized,
controlled, open-label trial enrolled 100 patients with EC (aged 40-65
years; American Society of Anesthesiologists [ASA] grade I/II) receiving
elective surgery at Jiangsu Province Hospital (China) between July 2016
and December 2017. Patients were randomized to 4 groups (n = 25 per
group): total intravenous general anesthesia plus patient-controlled
intravenous analgesia (TIVA/PCIA); TIVA plus patient-controlled epidural
analgesia (TIVA/PCEA); thoracic epidural anesthesia with intravenous
general anesthesia plus PCIA (TEA-IVA/PCIA); and TEA-IVA/PCEA (TEA-IVA
plus PCEA). Primary outcomes were plasma cortisol level (measured at
baseline, 2 h after skin incision, surgery completion, and 24 and 48 h
post-surgery) and pain (assessed at 24, 48, and 72 hours post-surgery
using a visual analog scale). Secondary outcomes included time to first
flatus, hospital stay and treatment costs. Postoperative adverse events
(AEs) were analyzed. RESULT(S): Baseline and operative
characteristics were similar between the 4 groups. Plasma cortisol level
increased (P <.05 vs baseline) earlier in the TIVA groups (2 h after skin
incision) than in the TEA-IVA groups (24 h after surgery). At 48 hours
after surgery, plasma cortisol had returned to baseline levels in the PCEA
groups but not in the PCIA groups. VAS pain scores at rest and during
coughing were lower in the PCEA groups than in the PCIA groups (P <.05).
Compared with the PCIA groups, the PCEA groups had shorter time to first
flatus and shorter hospital stay, while use of TEA-IVA lowered the costs
of intraoperative anesthesia (P <.05). However, the PCEA groups had a
higher incidence of nausea, vomiting, and pruritus. CONCLUSION(S):
Thoracic epidural anesthesia/analgesia can reduce the stress response,
improve postoperative recovery and reduce hospital stay and costs for
patients with EC.

<36>
Accession Number
2001580984
Title
Comparison of del Nido and histidine-tryptophan-ketoglutarate cardioplegia
solutions in pediatric patients undergoing open heart surgery: A
prospective randomized clinical trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (3) (pp 1182-1192.e1),
2019. Date of Publication: March 2019.
Author
Talwar S.; Chatterjee S.; Sreenivas V.; Makhija N.; Kapoor P.M.; Choudhary
S.K.; Airan B.
Institution
(Talwar, Chatterjee, Choudhary, Airan) Department of Cardiothoracic and
Vascular Surgery, All India Institute of Medical Sciences, New Delhi,
India
(Sreenivas) Department of Biostatistics, All India Institute of Medical
Sciences, New Delhi, India
(Makhija, Kapoor) Department of Cardiac Anesthesiology, All India
Institute of Medical Sciences, New Delhi, India
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: We conducted a prospective randomized controlled trial to
compare del Nido (DN) and histidine-tryptophan-ketoglutarate (HTK)
cardioplegia solution in pediatric patients undergoing intracardiac
tetralogy of Fallot repair. Method(s): One hundred consecutive
patients 12 years of age or younger, undergoing intracardiac repair of
tetralogy of Fallot were randomized into DN (n = 50) and HTK (n = 50)
groups. Cardioplegia strategy consisted of a single dose of DN (20 mL/kg)
or HTK (6 mL/kg/min for 6 minutes). Primary outcome was cardiac index
(CI). Secondary outcomes were ventricular arrhythmias post cross-clamp
release, time to peripheral rewarming, duration of mechanical ventilation,
inotropic score, intensive care unit and hospital stay, and serum levels
of troponin-I, interleukin-6, and tumor necrosis factor-alpha.
Ultrastructural changes in the myocardium were assessed. Result(s):
CI was significantly higher in the DN group compared with the HTK group at
6 (P =.005) and 24 hours (P <.001) after surgery. It was on an average
0.44 L/min/m2 higher in the DN group at any time point (P
=.004). Time for complete cessation of electrical activity was longer in
the HTK group (P =.01) and more patients in the HTK group had ventricular
arrhythmias post cross-clamp release (P =.03). Duration of mechanical
ventilation (P =.006), intensive care unit stay (P =.05), and hospital
stay (P <.001) were lower in the DN group. Patients in the DN group had
lower troponin I levels 24 hours after cardiopulmonary bypass (P <.001).
Electron microscopic studies showed more myocardial edema (P =.02) and
myofibrillar disarray (P =.04) in the HTK group along with lower glycogen
stores (P =.04). DN cardioplegia was more cost-effective than HTK
cardioplegia (P <.001). Conclusion(s): DN cardioplegia was associated
with better preservation of CI, less duration of mechanical ventilation,
shorter intensive care unit and hospital stays, lower inotropic scores,
and less release of troponin-I. Electron microscopy showed less myocardial
edema and better preservation of the myofibrillar architecture and
glycogen stores in the DN group. Copyright © 2018

<37>
Accession Number
625973756
Title
Allo-immunity and graft rejection after checkpoint inhibitor therapy (CPI)
in solid organ transplant (SOT) recipients.
Source
Journal of Clinical Oncology. Conference: 2018 Annual Meeting of the
American Society of Clinical Oncology, ASCO 2018. United States. 36 (15
Supplement 1) (no pagination), 2018. Date of Publication: May 2018.
Author
Abdel-Wahab N.; Abudayyeh A.; Shah M.; Johnson D.H.; Trinh V.; Abdelrahim
M.; Gaber A.O.; Suarez-Almazor M.E.; Diab A.
Institution
(Abdel-Wahab, Abudayyeh, Shah, Johnson, Trinh, Abdelrahim, Gaber,
Suarez-Almazor, Diab) Section of Rheumatology & Clinical Immunology,
Department of General Internal Medicine, The University of Texas MD
Anderson Cancer Center, Houston, TX; Section of Nephrology, The University
of Texas MD Anderson Cancer Center, Houston, TX; The University of Texas
MD Anderson Cancer Center, Houston, TX; The University of Texas MD
Anderson Cancer Center, Houston, TX; The University of Texas MD Anderson
Cancer Center, Houston, TX; Houston Methodist, Houston, TX; Houston
Methodist, Houston, TX; Section of Rheumatology & Clinical Immunology,
Department of General Internal Medicine, The University of Texas MD
Anderson Cancer Center, Houston, TX; Department of Melanoma Medical
Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX;
Section of Rheumatology & Clinical Immunology, Department of General
Internal Medicine, The University of Texas MD Anderson Cancer Center,
Houston, TX; Section of Nephrology, The University of Texas MD Anderson
Cancer Center, Houston, TX; The University of Texas MD Anderson Cancer
Center, Houston, TX; Houston Methodist, Houston, TX; Department of
Melanoma Medical Oncology, The University of Texas MD Anderson Cancer
Center, Houston, TX
Publisher
American Society of Clinical Oncology
Abstract
Background: The safety of CPI in patients (pts) with prior SOT was never
fully assessed because they were always excluded from clinical trials due
to the risk of allo-immunity and organ rejection, and being on
immunosupresive therapy (IST). Method(s): We identified from pharmacy
records pts who had received CPI between January 2004 and June 2017 at our
institution (n = 4,406). Claims data were obtained for all pts from 6
months prior to first infusion to last follow-up or death. ICD 9 & 10
diagnostic codes were used to identify pts with organ transplant (n =
173). Medical records were reviewed to identify SOT pts. We systematically
reviewed the literature databases through September 2017 to identify
similar pts. Result(s): A total of 24 pts were retrieved, 6 from
institutional databases and 18 from literature. Median age was 61.5
(14-79) years; 75% were male; 67% had metastatic melanoma. Other cancer
types included cutaneous squamous cell, non-small cell lung,
hepatocellular, and duodenal carcinomas. Renal transplant was reported in
67%. Other SOT included liver and heart. Median time to initiation of CPI
after SOT was 8 (1-25) years. Most received anti-PD1 agents (79%). At CPI
initiation, all pts were kept on prednisone (<= 10 mg), mTOR inhibitors,
or other IST to maintain graft tolerance. Graft rejection occured in 50%
of pts (8/16 kidney, 3/6 liver, and 1/2 heart transplants); 92% received
anti-PD1 therapy. Median time to rejection was 21 (5-60) days. In 8 pts
with biopsies, 6 had a T-cell mediated rejection, and 2 had mixed cellular
and antibody infiltrates. Management of rejection included appropriate
IST, and 29% remained dependent on dialysis. CPI was discontinued in all
pts. Among all rejected cases, only one pt with cardiac transplant
recovered. Interestingly, other irAEs occurred mainly in non rejected
cases. They all improved with appropriate IST. In melanoma pts, 27% (4/15)
responded to CPI. In all pts, death was reported in 35% (n = 8), in 4 pts
was due to organ rejection (2 liver and 2 kidney). Conclusion(s):
High rejection rate was evident in SOT pts shortly after CPI and was
associated with high mortality rate. Further studies are needed to
establish the risk-benefit profile in this population.

<38>
Accession Number
626235830
Title
Frailty in patients undergoing transcatheter aortic valve implantation: A
protocol for a systematic review.
Source
BMJ Open. 9 (2) (no pagination), 2019. Article Number: e024163. Date of
Publication: 01 Feb 2019.
Author
Li Z.; Dawson E.; Moodie J.; Martin J.; Bagur R.; Cheng D.; Kiaii B.;
John-Baptiste A.
Institution
(Li, Martin, Bagur, John-Baptiste) Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
(Li, Dawson, Moodie, Martin, Cheng, John-Baptiste) Centre for Medical
Evidence, Decision Integrity and Clinical Impact (MEDICI), Western
University, London, ON, Canada
(Li, Dawson, Moodie, Martin, Cheng, John-Baptiste) Department of
Anesthesia and Perioperative Medicine, Western University, London, ON,
Canada
(Li, Martin, Bagur, Cheng, Kiaii, John-Baptiste) Schulich School of
Medicine and Dentistry, Western University, London, ON, Canada
(Bagur) Division of Cardiology, Department of Medicine, Western
University, London, ON, Canada
(Cheng) Division of Critical Care Medicine, Department of Medicine,
Western University, London, ON, Canada
(Kiaii) Division of Cardiac Surgery, Department of Surgery, Western
University, London, ON, Canada
(John-Baptiste) Interfaculty Program in Public Health, Western University,
London, ON, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Aortic stenosis is a significant cause of morbidity and
mortality in older patients. The advent of transcatheter aortic valve
implantation (TAVI) offers an alternative to surgical aortic valve
replacement for patients with severe symptomatic aortic stenosis who are
at high or intermediate risk of adverse events. Existing evidence
highlights the importance of frailty as a predictor of poor outcomes
post-TAVI. The objective of this study is to review the operationalisation
of frailty instruments for TAVI recipients and determine clinical outcomes
and the change in quality of life in frail patients undergoing TAVI.
Methods and analysis Methods are reported according to the Preferred
Reporting Items for Systematic Review and Meta-Analysis Protocols 2015
checklist. We will search relevant databases to identify published,
completed but unpublished and ongoing studies. We will include studies of
patients with aortic stenosis, diagnosed as frail and who underwent a TAVI
procedure that report mortality, clinical outcomes or health-related
quality of life. Retrospective or prospective cohort studies, randomised
controlled trials and non-randomised controlled trials will be eligible
for inclusion. Two researchers will independently screen articles for
inclusion, with disagreements resolved by a third reviewer. One researcher
will extract data with audit by a second researcher. The risk of bias in
studies will be evaluated using the Quality in Prognosis Studies tool.
Meta-Analysis of mortality, survival curve and the change in quality of
life will be performed if appropriate. Subgroup analysis, sensitivity
analysis and meta-regression will be performed if necessary. Ethics and
dissemination Due to the nature of this study, no ethical issues are
foreseen. We will disseminate the results of our systematic review through
a peer-reviewed journal. Trial registration number
CRD42018090597. Copyright © Author(s) (or their employer(s))
2019.

<39>
Accession Number
626235807
Title
Improving neurodevelopmental outcomes in children with congenital heart
disease: Protocol for a randomised controlled trial of working memory
training.
Source
BMJ Open. 9 (2) (no pagination), 2019. Article Number: e023304. Date of
Publication: 01 Feb 2019.
Author
Calderon J.; Bellinger D.C.; Hartigan C.; Lord A.; Stopp C.; Wypij D.;
Newburger J.W.
Institution
(Calderon) Boston Children's Hospital, Department of Psychiatry, Boston,
MA, United States
(Calderon, Bellinger) Department of Psychiatry, Harvard Medical School,
Boston, MA, United States
(Hartigan, Lord, Stopp, Wypij, Newburger) Department of Cardiology, Boston
Children's Hospital, Boston, MA, United States
(Wypij) Department of Biostatistics, Harvard T.H. Chan School of Public
Health, Boston, MA, United States
(Newburger) Department of Pediatrics, Harvard Medical School, Boston, MA,
United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Executive function (EF) impairments are among the most
prevalent neurodevelopmental morbidities in youth with congenital heart
disease (CHD). To date, no studies have investigated the efficacy of
cognitive interventions to improve EF outcomes in children with CHD.
Methods and analysis This is a single-centre, single-blinded, two-Arm
randomised controlled trial to test the efficacy of Cogmed Working Memory
Training (Cogmed) versus standard of care in children with CHD after
open-heart surgery in infancy. Participants will consist of 100 children
with CHD aged 7-12 years who underwent open-heart surgery before the age
of 12 months. Participants are randomly allocated to either an
intervention group including training on the home-based Cogmed
intervention for a duration of approximately 5 weeks or a control group
who receive the standard of care. We will evaluate the efficacy of Cogmed
at post-Treatment and 3 months after completion of the intervention.
Baseline, post-Treatment and 3-month follow-up assessments will include
specific measures of EF, cognitive and social functioning, and attention
deficit hyperactivity disorder (ADHD) symptoms. The primary outcome of
this study is the change in standardised mean score on the List Sorting
Working Memory test from the National Institutes of Health Toolbox for the
Assessment of Neurological and Behavioral Function. Secondary outcomes
include measures of social skills, inhibitory control, cognitive
flexibility and behavioural EF as well as ADHD symptoms as measured by the
Behavior Rating Inventory of Executive Function, Second Edition, and the
Conners Third Edition. The efficacy of the intervention will be evaluated
by comparing within-subject differences (baseline to post-Treatment,
baseline to 3-month follow-up) between the two groups using an
intention-To-Treat analysis. Ethics and dissemination This study has
received Institutional Review Board (IRB) approval from Boston's
Children's Hospital IRB (P00022440) and the Human Protection Agency from
the US Department of Defense. Trial registration number NCT03023644;
Pre-results. Copyright © Author(s) (or their employer(s)) 2019.

<40>
Accession Number
2001408918
Title
Systematic Review of Endovascular, Surgical, and Conservative Options for
Infectious Intracranial Aneurysms and Cardiac Considerations.
Source
Journal of Stroke and Cerebrovascular Diseases. 28 (3) (pp 838-844), 2019.
Date of Publication: March 2019.
Author
Ragulojan R.; Grupke S.; Fraser J.F.
Institution
(Ragulojan) UK College of Medicine, University of Kentucky, Lexington,
Kentucky, United Kingdom
(Grupke, Fraser) Department of Neurosurgery, College of Medicine,
University of Kentucky, Lexington, Kentucky, United Kingdom
(Grupke, Fraser) Department of Radiology, College of Medicine, University
of Kentucky, Lexington, Kentucky, United Kingdom
(Fraser) Department of Neurology, College of Medicine, University of
Kentucky, Lexington, Kentucky, United Kingdom
(Fraser) Department of Neuroscience, College of Medicine, University of
Kentucky, Lexington, Kentucky, United Kingdom
Publisher
W.B. Saunders
Abstract
Introduction: With rising rates of intravenous drug use, Infectious
Intracranial aneurysms (IIAs) are a relevant topic for investigation. We
performed a systematic review to better understand current practice
patterns and limits of current published literature. Method(s): 131
publications with a total of 499 patients (665 aneurysms) were included.
Of the 499 patients, 83 were single case reports, and 20.5% of the total
had multiple aneurysms. 35.8% of all aneurysms were ruptured. Of those
reporting treatment, options included conservative antibiotic therapy
(30.0%), open surgical intervention (31.1%), and endovascular occlusion
(31.8%). Chronologically, publication of IIAs has increased. Usage of
endovascular therapies has grown, while conservative and surgical
management have declined in the literature. Overall, 56.2% of aneurysms
for which conservative therapy was initiated eventually either underwent
intervention or death of patient occurred. Result(s): The issue of
cardiac valve surgery in relationship to aneurysm therapy was discussed in
20.8% (80 patients) of all 384 infectious endocarditis patients; of which
15.0% (12) underwent valve surgery before aneurysm treatment and 85.0
patients (68)% underwent valve surgery after aneurysm treatment. For 51 of
the patients where valve surgery followed aneurysm management, the
corresponding aneurysm treatment modality could be determined; 58.8% (30)
of whom were managed endovascularly. 32.7% (26) of all cases reporting
cardiac surgery details underwent cardiac surgery during their admission
with the IIA. Conclusion(s): Overall, increasing trend of
endovascular management of IIAs is evident, and a strong temporal
preference exhibited by providers to perform cardiac surgery subsequently
to IIA management. Copyright © 2018 National Stroke Association

<41>
Accession Number
623215729
Title
Does body mass index truly affect mortality and cardiovascular outcomes in
patients after coronary revascularization with percutaneous coronary
intervention or coronary artery bypass graft? A systematic review and
network meta-analysis.
Source
Obesity Reviews. 19 (9) (pp 1236-1247), 2018. Date of Publication:
September 2018.
Author
Ma W.-Q.; Sun X.-J.; Wang Y.; Han X.-Q.; Zhu Y.; Liu N.-F.
Institution
(Ma, Sun, Wang, Han, Zhu, Liu) Department of Cardiology, Zhongda Hospital,
School of Medicine, Southeast University 87 Dingjiaqiao, Nanjing, China
Publisher
Blackwell Publishing Ltd
Abstract
Background: Obesity, a comorbid medical condition, is usually observed in
patients with established coronary artery disease. Paradoxically, patients
with a higher body mass index (BMI) usually have better clinical outcomes
after coronary revascularization. Method(s): We searched five online
databases through December 2017. We identified studies reporting the rate
of all-cause mortality or cardiovascular-related outcomes among patients
after coronary revascularization with percutaneous coronary intervention
or coronary artery bypass graft based on various BMI categories. Network
meta-analysis was performed using Bayesian methods. Result(s):
Sixty-five records involving 865,774 participants were included in our
study. A U-shaped association was observed across BMI categories for
all-cause mortality. Using normal weight as the reference, all-cause
mortality was increased for (relative risk [RR]: 2.4; 95% credibility
interval [CrI]: 2.1-2.7) patients with underweight, whereas it was lowered
in patients with overweight, obese, and severely obese. This association
remained significant in many subgroups. We also observed that the risk of
major adverse cardiovascular events (MACE) was lowest among patients with
overweight. Furthermore, patients with underweight were associated with
greater risks of myocardial infarction (RR: 1.9; 95% CrI: 1.4-2.5),
cardiovascular-related mortality (RR: 2.8; 95% CrI: 1.6-4.7), stroke (RR:
2.0; 95% CrI: 1.3-3.3) and heart failure (RR: 1.7; 95% CrI: 1.1-2.7)
compared with normal weight patients; no significant association was
observed among individuals with higher BMI. Conclusion(s): The
'obesity paradox' does exist in patients after coronary revascularization,
especially for patients with post-percutaneous coronary intervention.
All-cause mortality in patients with high BMI is significantly lower
compared with patients with normal weight. Furthermore, patients with
underweight experience higher rates of cardiovascular outcomes compared
with patients with normal weight. Copyright © 2018 World Obesity
Federation

<42>
Accession Number
619209723
Title
Cerebral oximetry and postoperative delirium after cardiac surgery: a
randomised, controlled trial.
Source
Anaesthesia. 72 (12) (pp 1456-1466), 2017. Date of Publication: December
2017.
Author
Lei L.; Katznelson R.; Fedorko L.; Carroll J.; Poonawala H.; Machina M.;
Styra R.; Rao V.; Djaiani G.
Institution
(Lei, Katznelson, Fedorko, Carroll, Poonawala, Machina, Djaiani)
Departments of Anesthesia and Pain Management, Toronto General Hospital,
University Health Network, University of Toronto, Toronto, ON, Canada
(Styra) Department of Psychiatry, Toronto General Hospital, University
Health Network, University of Toronto, Toronto, ON, Canada
(Rao) Division of Cardiovascular Surgery, Toronto General Hospital,
University Health Network, University of Toronto, Toronto, ON, Canada
Publisher
Blackwell Publishing Ltd
Abstract
Postoperative delirium is associated with increased morbidity and
mortality. We hypothesised that restoration of regional cerebral oxygen
desaturation would reduce the incidence of postoperative delirium in
elderly patients after cardiac surgery. After institutional ethics review
board approval and informed consent, a double-blinded, prospective,
randomised, controlled trial was conducted in patients >= 60 years of age
undergoing cardiac surgery with cardiopulmonary bypass. In the
intervention group, an algorithm was commenced if regional cerebral oxygen
saturation decreased below 75% of baseline value for 1 min or longer. In
the control group, the cerebral oximetry monitor screen was electronically
blinded. Assessment of delirium was performed with confusion assessment
method for intensive care unit or confusion assessment method after
discharge from intensive care unit at 12-h intervals for seven
postoperative days. Postoperative delirium was present in 30 out of 123
(24.4%) and 31 out of 126 (24.6%) patients in the intervention and control
groups, respectively, odds ratio 0.98 (95%CI 0.55-1.76), p = 0.97.
Postoperative delirium was present in 20 (71%) out of 28 and in 41 (18%)
out of 221 patients with baseline regional cerebral oxygen saturation <=
50, or > 50%, respectively, p = 0.0001. Higher baseline regional cerebral
oxygen saturation and body mass index were protective against
postoperative delirium. Restoration of regional cerebral oxygen
desaturation did not result in lower postoperative delirium after cardiac
surgery. Pre-operative regional cerebral oxygen saturation <= 50% was
associated with increased postoperative delirium rates in elderly patients
following cardiac surgery. Copyright © 2017 The Association of
Anaesthetists of Great Britain and Ireland

<43>
Accession Number
618243389
Title
Performance of the Minto model for the target-controlled infusion of
remifentanil during cardiopulmonary bypass.
Source
Anaesthesia. 72 (10) (pp 1196-1205), 2017. Date of Publication: October
2017.
Author
Cho Y.J.; Jo W.Y.; Oh H.; Koo C.-H.; Oh J.; Cho J.-Y.; Yu K.-S.; Jeon Y.;
Kim T.K.
Institution
(Cho, Jo, Oh, Jeon, Kim) Department of Anaesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul, South Korea
(Koo) CHA Bundang Medical Centre, Department of Anaesthesiology and Pain
Medicine, Seongnam-si, South Korea
(Oh, Cho, Yu) Department of Clinical Pharmacology and Therapeutics, Seoul
National University College of Medicine and Hospital, Seoul, South Korea
Publisher
Blackwell Publishing Ltd
Abstract
We studied the predictive performance of the Minto pharmacokinetic model
during cardiopulmonary bypass in patients undergoing cardiac surgery.
Patients received remifentanil target-controlled infusion using the Minto
model during total intravenous anaesthesia with propofol. From 56
patients, 275 arterial blood samples were drawn before, during and after
bypass to determine the plasma concentration of remifentanil, and the
predicted concentrations were recorded at each time. For pooled data, the
median prediction error and median absolute prediction error were 21.3%
and 21.8%, respectively, and 22.1% and 22.3% during bypass. Both were
148.4% during hypothermic circulatory arrest and measured concentrations
were more than three times greater than predicted (26.9 (17.0) vs. 7.1
(1.6) ng.ml-1). The Minto model showed considerable bias but
overall acceptable precision during bypass. The target concentration of
remifentanil should be reduced when using the Minto model during
hypothermic circulatory arrest. Copyright © 2017 The Association
of Anaesthetists of Great Britain and Ireland

<44>
Accession Number
617788567
Title
A randomised trial comparing real-time double-lumen endobronchial tube
placement with the Disposcope with conventional blind
placement.
Source
Anaesthesia. 72 (9) (pp 1097-1106), 2017. Date of Publication: September
2017.
Author
Chen P.T.; Ting C.K.; Lee M.Y.; Cheng H.W.; Chan K.H.; Chang W.K.
Institution
(Chen, Ting, Lee, Cheng, Chan, Chang) Department of Anesthesiology, Taipei
Veterans General Hospital, Taipei, Taiwan (Republic of China)
(Chen, Ting, Chan, Chang) Department of Anesthesiology, School of
Medicine, National Yang-Ming University, Taipei, Taiwan (Republic of
China)
(Chen) School of Nursing, Taipei Medical University, Taipei, Taiwan
(Republic of China)
(Chang) Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan (Republic of
China)
Publisher
Blackwell Publishing Ltd
Abstract
Double-lumen endobronchial tube placement is challenging. This study
compared double-lumen tube placement with the Disposcope, a
wireless videostylet allowing real-time visualisation, with conventional
blind placement. Patients undergoing elective thoracic surgery with normal
airways requiring one-lung ventilation were randomly allocated into two
groups (27 patients in each group). The Disposcope was used to assist
left-sided double-lumen tube placement in one group, and conventional
blind placement was performed in the control group. Placement in both
groups was checked with fibreoptic bronchoscopy. The Disposcope-assisted
group had a shorter total mean (SD) placement time (18.6 (2.5) s vs. 21.4
(2.9) s, p < 0.001), laryngoscopy to end of auscultation time (83.4 (3.0)
s vs. 93.9 (5.7) s, p < 0.001) and total operation time (130.7 (6.1) s vs.
154.5 (6.3) s, p < 0.001). In the Disposcope-assisted group, the
double-lumen tube was inserted in the correct side in all patients
(100.0%), whereas in the conventional group, the double-lumen tube was
placed in the correct side in 25 (92.6%) patients and in the wrong side in
2 (7.4%) patients; the difference was not significant (p = 0.150). In the
Disposcope-assisted group, the double-lumen tube was inserted to the
optimal depth in 24 (88.9%) patients, whereas in the conventional group it
was inserted to the optimal depth in one (4.0%) patient. The Disposcope
increased the success rate of double-lumen tube placement, and shortened
the total operation time when compared with standard placement with
confirmation using fibreoptic bronchoscopy, and may replace the
conventional method. Copyright © 2017 The Association of
Anaesthetists of Great Britain and Ireland

<45>
Accession Number
2000995801
Title
Culprit-Only Versus Complete Coronary Revascularization After ST-Segment
Elevation Myocardial Infarction- A Systematic Review and Analysis of
Clinical Outcomes.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (3) (pp 850-857),
2019. Date of Publication: March 2019.
Author
Lamelas P.; Winter J.; Villablanca P.A.; Mehta S.; Ramakrishna H.
Institution
(Lamelas, Mehta) Population Health Research Institute, McMaster
University, Hamilton, Ontario, Canada
(Lamelas, Winter, Mehta) Interventional Cardiology, McMaster University,
Hamilton, Ontario, Canada
(Villablanca) Division of Cardiology, New York University School of
Medicine, New York, NY, United States
Publisher
W.B. Saunders

<46>
Accession Number
2001043455
Title
Thoracic Epidurals are Associated With Decreased Opioid Consumption
Compared to Surgical Infiltration of Liposomal Bupivacaine Following
Video-Assisted Thoracoscopic Surgery for Lobectomy: A Retrospective Cohort
Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (3) (pp 694-698),
2019. Date of Publication: March 2019.
Author
Sztain J.F.; Gabriel R.A.; Said E.T.
Institution
(Sztain, Gabriel, Said) Department of Anesthesiology, Division of Regional
Anesthesia and Acute Pain, University of California, San Diego, La Jolla,
CA, United States
(Gabriel) Department of Medicine, Division of Biomedical Informatics,
University of California, San Diego, La Jolla, CA, United States
Publisher
W.B. Saunders
Abstract
Objective: Thoracic epidural analgesia (TEA) is considered the gold
standard for postoperative pain control in thoracic surgery, however it is
associated with the undesirable risks of hypotension urinary retention,
and bleeding. Recently, surgical site infiltration with liposomal
bupivicaine (LB) has been suggested as a comparable alternative to TEA.
The authors compared total opioid consumption in patients who received
either TEA or LB undergoing video-assisted thorascopic surgery (VATS) for
lobectomy. Design(s): Retrospective cohort study. Setting(s):
University hospital. Participant(s): Patients undergoing VATS for
lobectomy. Intervention(s): TEA versus LB Measurements and Main
Results: The primary outcome was POD 0 to 2 total opioid requirements,
measured in intravenous morphine equivalents (mg). Wilcoxon rank sum test
was used to calculate the significant differences in the primary outcome.
The 25 - 75% interquartile range (IQR) was reported with each median
value. Forty-five patients were included in the analysis, in which 14
(31.1%) were in the LB group. Between the TEA and LB group, there were no
differences in age, sex, or body mass. The median (25 - 75% IQR) total
opioid consumption during POD 0 - 2 in the TEA and LB group were 28.0 mg
(12.0 - 52.0 mg) and 49.5 mg (35.0 - 70.5 mg), respectively (p = 0.03), in
which the median difference was 22.5 mg (95% CI 0.60 - 38.0 mg).
 Conclusion(s): VATs lobectomy patients consumed 43.4% less opioids on
POD 0-2 with TEA when compared to surgical site infiltration of LB.
Further prospective randomized controlled trials are required to
demonstrate superior analgesia of TEA in this surgical
population. Copyright © 2018 Elsevier Inc.

<47>
Accession Number
2000972670
Title
Effects of Nicorandil Versus Nitroglycerin on Arterial Oxygenation During
Two-Lung Ventilation and One-Lung Ventilation in Patients With Risk
Factors for Myocardial Ischemia: A Prospective, Randomized, Double-Blind
Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (3) (pp 702-709),
2019. Date of Publication: March 2019.
Author
Murakami C.; Kawano H.; Kinoshita M.; Kondo A.; Inoue M.
Institution
(Murakami, Kawano, Kinoshita, Kondo, Inoue) Department of Anesthesiology,
Tokushima Prefectural Central Hospital, Tokushima, Japan
Publisher
W.B. Saunders
Abstract
Objectives: To compare the effects of nicorandil and nitroglycerin on
arterial oxygenation during two-lung ventilation (TLV) and one-lung
ventilation (OLV) in patients with risk factors for myocardial ischemia.
 Design(s): A prospective, randomized, double-blind study.
 Setting(s): A tertiary care hospital. Participant(s): Fifty-six
patients scheduled for elective video-assisted thoracic surgery were
assigned randomly to either the nicorandil group or the nitroglycerin
group. Intervention(s): Patients in the nicorandil group received a
bolus dose of nicorandil, 0.08 mg/kg during induction of anesthesia,
followed by a continuous infusion at a rate of 0.08 mg/kg/h. Patients in
the nitroglycerin group received a continuous infusion of nitroglycerin at
a rate of 1 micro g/kg/min from the induction of anesthesia.
 Measurements and Main Results: Arterial blood gas analysis was
performed at the following points: before induction of anesthesia; during
TLV; at 5, 10, 20, and 30 minutes after the initiation of OLV.
PaO<inf>2</inf> at TLV (479.7 +/- 57.1 v 408.2 +/- 70.9 mmHg, p < 0.001);
and at 5 minutes (344.8 +/- 85.1 v 282.6 +/- 85.8 mmHg, p = 0.012), 20
minutes (215.7 +/- 103.0 v 158.2 +/- 74.5 mmHg, p = 0.027), and 30 minutes
(198.8 +/- 103.5 v 147.5 +/- 64.1 mmHg, p = 0.039) after OLV was
significantly higher in the nicorandil group than in the nitroglycerin
group. Conclusion(s): This study demonstrated that oxygenation during
TLV and OLV was significantly higher in patients receiving nicorandil than
in those receiving nitroglycerin. Copyright © 2018 Elsevier Inc.

<48>
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). Copyright © 2018 by the
authors. Licensee MDPI, Basel, Switzerland.

<49>
Accession Number
624556565
Title
Short version of the S3 guideline on screening, diagnosis, therapy and
follow-up of abdominal aortic aneurysms.
Source
Gefasschirurgie. 24 (Supplement 1) (no pagination), 2019. Date of
Publication: 01 Feb 2019.
Author
Debus E.S.; Heidemann F.; Gross-Fengels W.; Mahlmann A.; Muhl E.; Pfister
K.; Roth S.; Stroszczynski C.; Walther A.; Weiss N.; Wilhelmi M.;
Grundmann R.T.
Institution
(Debus, Heidemann) Klinik und Poliklinik fur Gefasmedizin, Universitares
Herzzentrum Hamburg, Hamburg, Germany
(Gross-Fengels) Abteilung Diagnostische und Interventionelle Radiologie,
Asklepios Klinik Harburg, Hamburg, Germany
(Mahlmann, Weiss) Bereich Angiologie, Universitatsgefascentrum,
Universitatsklinikum "Carl Gustav Carus", Technische Universitat Dresden,
Dresden, Germany
(Muhl) Klinik fur Chirurgie, Campus Lubeck, Universitatsklinikum
Schleswig-Holstein, Lubeck, Germany
(Pfister) Abteilung fur Gefaschirurgie, Endovaskulare Chirurgie,
Universitatsklinikum Regensburg, Regensburg, Germany
(Roth) Klinik fur Gefaschirurgie, St. Marienhospital, Hamm, Germany
(Stroszczynski) Institut fur Rontgendiagnostik, Universitatsklinikum
Regensburg, Regensburg, Germany
(Walther) Klinik fur Anasthesiologie und op. Intensivmedizin, Klinikum
Stuttgart, Katharinenhospital, Stuttgart, Germany
(Wilhelmi) Klinik fur Herz-, Thorax-, Transplantations- und Gefaschirurgie
(HTTG), Medizinische Hochschule Hannover, Hanover, Germany
(Grundmann) Deutsches Institut fur Gefasmedizinische Gesundheitsforschung
(DIGG), Deutsche Gesellschaft fur Gefaschirurgie und Gefasmedizin, Berlin,
Germany
(Grundmann) In den Gruben 144, Burghausen 84489, Germany
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
In this article a brief version of the newly developed S3 guidelines on
screening, diagnosis, therapy and follow-up of abdominal aortic aneurysms
(AAA), which was developed under the auspices of the German Society of
Vascular Surgery and VascularMedicine (DGG) is presented. In addition to
the DGG, participating professional societies were the German Radiological
Society (DRG), German Society for Angiology/Society for Vascular Medicine
(DGA), German Interdisciplinary Association for Intensive Care and
Emergency Medicine (DIVI), German Society for Ultrasound in Medicine
(DEGUM), German Vascular League e.V., German Society for Interventional
Radiology (DEGIR), German Society for Anesthesiology and Intensive Care
Medicine (DGAI), German Society for Thoracic and Cardiovascular Surgery
(DGTHG) and the German Society of Surgery (DGCH). The guidelines are based
on a systematic literature search in Medline (PubMed) for the period from
1 January 2000 to 1 January 2017. Important publications from 2017 were
also considered. The selection of evidence was made by a multilevel
screening process. In addition to the evidence, other criteria were
included in the assessment of the recommendation level, such as the
consistency of the study results, the clinical relevance of the endpoints
and effect sizes, the benefit-risk balance, the applicability of the study
results to the patient target group and the care system, the feasibility
of the recommendations in everyday life, patient preferences and ethical
and legal considerations. All recommendations/findings were approved with
strong consensus (approval of >95% of the participating professional
societies/associations). Thus, the present text version of the S3
guidelines on AAA represents the view of all participating
societies. Copyright © 2018, The Author(s).

<50>
Accession Number
2001149356
Title
Intravenous and Inhaled Milrinone in Adult Cardiac Surgery Patients: A
Pairwise and Network Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (3) (pp 663-673),
2019. Date of Publication: March 2019.
Author
Rong L.Q.; Rahouma M.; Abouarab A.; Di Franco A.; Calautti N.M.;
Fitzgerald M.M.; Arisha M.J.; Ibrahim D.A.; Girardi L.N.; Pryor K.O.;
Gaudino M.
Institution
(Rong, Calautti, Fitzgerald, Arisha, Ibrahim, Pryor) Department of
Anesthesiology, Weill Cornell Medicine, New York, NY, United States
(Rahouma, Abouarab, Di Franco, Girardi, Gaudino) Department of
Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY, United
States
Publisher
W.B. Saunders
Abstract
Objective: To summarize the evidence on the hemodynamic,
echocardiographic, and clinical effects of inhaled and intravenous
milrinone (iMil and IvMil) in adult cardiac surgery patients.
 Design(s): Systematic review, pairwise and network meta-analysis.
 Setting(s): Multi-institutional. Participant(s): Adult cardiac
surgery patients. Intervention(s): Comparison between iMil and IvMil
versus other agents or placebo. Measurements and Main Results: The
primary endpoints were mean pulmonary artery pressure (MPAP) and
peripheral vascular resistance (PVR). Secondary endpoints included the
following: (1) mean arterial pressure, heart rate, and cardiac index (CI);
(2) echocardiographic data; and (3) clinical outcomes. Random model,
leave-one-out-analysis, and meta-regression were used. Thirty studies (6
iMil and 24 IvMil) were included for a total of 1,438 patients (194 iMil
and 521 IvMil). IvMil was associated with a lower MPAP, lower PVR, and
higher CI compared to placebo (standardized mean difference [SMD] = -0.22
[95% CI = -0.48 to 0.05], SMD = -0.49 [95% CI = -0.71 to -0.27], and SMD =
0.94 [95% CI = 0.51 to 1.37]). No difference in any outcome was found
between iMil and placebo. At network meta-analysis, significantly lower
PVR and shorter hospital length of stay were found for IvMil compared to
iMil (SMD = -0.82 [95% CI = -1.53 to -0.10] and SMD = -0.50 [95% CI =
-0.95 to -0.05], respectively). Conclusion(s): These results support
the clinical use of IvMil in cardiac surgery patients. No evidence at
present supports the adoption of iMil. Copyright © 2018 Elsevier
Inc.

<51>
Accession Number
625025407
Title
Effectiveness of the Thoracic Pedicle Screw Placement Using the Virtual
Surgical Training System: A Cadaver Study.
Source
Operative neurosurgery (Hagerstown, Md.). 15 (6) (pp 677-685), 2018. Date
of Publication: 01 Dec 2018.
Author
Hou Y.; Lin Y.; Shi J.; Chen H.; Yuan W.
Institution
(Hou, Shi, Chen, Yuan) Department of Orthopaedic Surgery, Changzheng
Hospital, Second Military Medical University, Shanghai, China
(Lin) School of Mechanical Engineering, State Key Laboratory of Mechanical
System and Vibration, Institute of Biomedical Manufacturing and Life
Quality Engineering, Shanghai, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The virtual simulation surgery has initially exhibited its
promising potentials in neurosurgery training. OBJECTIVE(S): To
evaluate effectiveness of the Virtual Surgical Training System (VSTS) on
novice residents placing thoracic pedicle screws in a cadaver study.
 METHOD(S): A total of 10 inexperienced residents participated in this
study and were randomly assigned to 2 groups. The group using VSTS to
learn thoracic pedicle screw fixation was the simulation training (ST)
group and the group receiving an introductory teaching session was the
control group. Ten fresh adult spine specimens including 6 males and 4
females with a mean age of 58.5 yr (range: 33-72) were collected and
randomly allocated to the 2 groups. After exposing anatomic structures of
thoracic spine, the bilateral pedicle screw placement of T6-T12 was
performed on each cadaver specimen. The postoperative computed tomography
scan was performed on each spine specimen, and experienced observers
independently reviewed the placement of the pedicle screws to assess the
incidence of pedicle breach. RESULT(S): The screw penetration rates
of the ST group (7.14%) was significantly lower in comparison to the
control group (30%, P < .05). Statistically significant difference in
acceptable rates of screws also occurred between the ST (100%) and control
(92.86%) group (P < .05). In addition, the average screw penetration
distance in control group (2.37 mm +/- 0.23 mm) was significantly greater
than ST group (1.23 mm +/- 0.56 mm, P < .05). CONCLUSION(S): The
virtual reality surgical training of thoracic pedicle screw
instrumentation effectively improves surgical performance of novice
residents compared to those with traditional teaching method, and can help
new beginners to master the surgical technique within shortest period of
time.

<52>
Accession Number
622796865
Title
Long-term impact of chronic total occlusion recanalisation in patients
with ST-elevation myocardial infarction.
Source
Heart. 104 (17) (pp 1432-1438), 2018. Date of Publication: 01 Sep 2018.
Author
Elias J.; Van Dongen I.M.; Ramunddal T.; Laanmets P.; Eriksen E.;
Meuwissen M.; Michels H.R.; Bax M.; Ioanes D.; Suttorp M.J.; Strauss B.H.;
Barbato E.; Marques K.M.; Claessen B.E.P.M.; Hirsch A.; Van Der Schaaf
R.J.; Tijssen J.G.P.; Henriques J.P.S.; Hoebers L.P.
Institution
(Elias, Van Dongen, Claessen, Tijssen, Henriques, Hoebers) Department of
Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam
1105 AZ, Netherlands
(Ramunddal, Ioanes) Sahlgrenska University Hospital, Gothenburg, Sweden
(Laanmets) North-Estonia Medical Centre, Talinn, Estonia
(Eriksen) Haukeland University Hospital, Bergen, Norway
(Meuwissen) Department of Cardiology, Amphia Hospital, Breda, Netherlands
(Michels) Catharina Hospital, Eindhoven, Netherlands
(Bax) Department of Cardiology, Haga Teaching Hospital, The Hague,
Netherlands
(Suttorp) Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein,
Netherlands
(Strauss) Sunnybrook Health Sciences Centre, Toronto, Canada
(Barbato) Cardiovascular Center, Onze Lieve Vrouwe Ziekenhuis, Aalst,
Belgium
(Marques) VU University Medical Center, Amsterdam, Netherlands
(Hirsch) Erasmus Medical Center, Rotterdam, Netherlands
(Van Der Schaaf) Department of Cardiology, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background During primary percutaneous coronary intervention (PCI), a
concurrent chronic total occlusion (CTO) is found in 10% of patients with
ST-elevation myocardial infarction (STEMI). Long-term benefits of CTO-PCI
have been suggested; however, randomised data are lacking. Our aim was to
determine mid-term and long-term clinical outcome of CTO-PCI versus CTO-No
PCI in patients with STEMI with a concurrent CTO. Methods The Evaluating
Xience and left ventricular function in PCI on occlusiOns afteR STEMI
(EXPLORE) was a multicentre randomised trial that included 302 patients
with STEMI after successful primary PCI with a concurrent CTO. Patients
were randomised to either CTO-PCI or CTO-No PCI. The primary end point of
the current study was occurrence of major adverse cardiac events (MACE):
cardiac death, coronary artery bypass grafting and MI. Other end points
were 1-year left ventricular function (LVF); LV-ejection fraction and LV
end-diastolic volume and angina status. Results The median long-term
follow-up was 3.9 (2.1-5.0) years. MACE was not significantly different
between both arms (13.5% vs 12.3%, HR 1.03, 95% CI 0.54 to 1.98; P=0.93).
Cardiac death was more frequent in the CTO-PCI arm (6.0% vs 1.0%, P=0.02)
with no difference in all-cause mortality (12.9% vs 6.2%, HR 2.07, 95% CI
0.84 to 5.14; P=0.11). One-year LVF did not differ between both arms.
However, there were more patients with freedom of angina in the CTO-PCI
arm at 1 year (94% vs 87%, P=0.03). Conclusions In this randomised trial
involving patients with STEMI with a concurrent CTO, CTO-PCI was not
associated with a reduction in long-term MACE compared to CTO-No PCI.
One-year LVF was comparable between both treatment arms. The finding that
there were more patients with freedom of angina after CTO-PCI at 1-year
follow-up needs further investigation. Clinical trial registration EXPLORE
trial number NTR1108 www.trialregister.nl. Copyright © Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2018. All rights reserved. No commercial use is permitted unless
otherwise expressly granted.

<53>
Accession Number
624726924
Title
Transcutaneous Electrical Acupoint Stimulation Improves Immunological
Function During the Perioperative Period in Patients With Non-Small Cell
Lung Cancer Undergoing Video-Assisted Thoracic Surgical Lobectomy.
Source
Technology in cancer research & treatment. 17 (pp 1533033818806477), 2018.
Date of Publication: 01 Jan 2018.
Author
Tu Q.; Yang Z.; Gan J.; Zhang J.; Que B.; Song Q.; Wang Y.
Institution
(Tu, Gan) Department of Anesthesiology, Tangshan People's Hospital, North
China University of Science and Technology, Tangshan, China
(Tu) Tangshan, 2 The Graduate School of North China University of Science
and Technology, China
(Tu, Yang) Qing Tu and Zhou Yang contributed equally to this article
(Yang) Sichuan Academy of Medical Sciences, Sichuan Provincial People's
Hospital, 3 Department of Gastrointestinal Surgery, Chengdu, Sichuan,
China
(Zhang) Department of Anesthesiology, Third People's Hospital of Chengdu,
Southwest Jiao Tong University, Chendu, China
(Que) Department of Anesthesiology, Hangzhou Hospital of Traditional
Chinese Medicine, Hangzhou, China
(Song) Department of Cardiology, Tangshan People's Hospital, North China
University of Science and Technology, Tangshan, China
(Wang) Department of Neurology, Tangshan People's Hospital, North China
University of Science and Technology, Tangshan, China
Publisher
NLM (Medline)
Abstract
The immunological function of patients with malignant tumors may be
suppressed during the perioperative period. However, details on the
effects of transcutaneous electrical acupoint stimulation (TEAS) on
immunological function are relatively lacking. We designed this study to
examine the effects of TEAS on the immunological function of patients with
non-small cell lung cancer (NSCLC) during the perioperative period.
Participants (n = 144) were enrolled and randomly assigned into group TEAS
or group sham TEAS. TEAS on bilateral Feishu (BL13), Hegu (L14), and
Zusanli (ST36) was performed continuously throughout the procedure. The
primary outcome was the quantities of natural killer (NK) cells at 30
minutes before induction (T0), 5 minutes after intubation (T1), at the
beginning of the operation (T2), at the beginning of the lobectomy (T3),
at the beginning of the lymphadenectomy (T4), and immediately after
extubation (T5). The secondary outcomes were the serum levels of tumor
necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) at T0 to T5,
the mean arterial pressure (MAP) and heart rate (HR), the intraoperative
consumption of propofol and remifentanil, the incidence of hypoxemia,
postoperative nausea and vomiting (PONV), and the length of hospital stay.
The quantities of NK cells were decreased in group sham TEAS after
intubation compared to that in group TEAS, while the quantities of NK
cells in group TEAS were similar at T0 to T5. Meanwhile, the quantities of
NK cells in group sham TEAS at T1 ( P = .012), T2 ( P < .001), T3 ( P =
.027), T4 ( P = .045), and T5 ( P = .021) were lower than those in group
TEAS. In group TEAS, the serum levels of TNF-alpha were lower at T1 to T5,
while the levels of IL-6 were lower at T2 to T5. Furthermore, the
intraoperative MAP and HR were more stable, the total propofol and
remifentanil consumptions were lower, and the length of hospital stay was
shorter than those in group sham TEAS. The application of TEAS can
effectively reverse the decrease in NK cells, decrease the serum levels of
TNF-alpha and IL-6, maintain hemodynamic stability during the
perioperative period, decrease the consumption of propofol and
remifentanil, and shorten the length of the hospital stay.

<54>
Accession Number
623687180
Title
Perioperative diltiazem or nitroglycerin in on-pump coronary artery
bypass: A systematic review and network meta-analysis.
Source
PLoS ONE. 13 (8) (no pagination), 2018. Article Number: e0203315. Date of
Publication: August 2018.
Author
Hu Y.; Yang X.; Zhang L.; Wu X.; Liu A.Y.; Boscarino J.A.; Kirchner H.L.;
Casale A.S.; Zhang X.
Institution
(Hu, Yang, Kirchner) Biomedical and Translational Informatics, Geisinger
Medical Center, Danville, PA, United States
(Zhang, Wu, Zhang) Division of Anesthesiology, Geisinger Medical Center,
Danville, PA, United States
(Liu) Department of Cell and Systems Biology, University of Toronto,
Toronto, Canada
(Boscarino) Department of Epidemiology and Health Services Research,
Geisinger Medical Center, Danville, PA, United States
(Casale) Geisinger Heart Institute, Geisinger Wyoming Valley Medical
Center, Wilkes Barre, PA, United States
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Arterial graft spasm is a severe complication after coronary
artery bypass graft (CABG). Among numerous potential antispasmodic agents,
systemic application of diltiazem and nitroglycerin had been investigated
most frequently over the past three decades. However, it remains
inconclusive if either or both agents could improve patient outcomes by
preventing graft spasm when applied perioperatively, and, if so, which one
would be a better choice. The current systematic review and network
meta-analysis aims to summarize the data from all available randomized
clinical trials of perioperative continuous intravenous infusion of
diltiazem and/or nitroglycerin in patients undergoing on-pump CABG in
order to define and compare their roles in graft spasm prevention and
their impacts on perioperative outcomes. Methods We searched Ovid Medline,
PubMed, CINAHL, Google Scholar and Cochrane Center for randomized
controlled trials that reported outcome effects of perioperative
continuous intravenous infusion of diltiazem and/or nitroglycerin in
patients undergoing elective on-pump CABG. Conventional meta-analyses were
conducted to evaluate the pairwise comparisons (diltiazem vs. placebo;
nitroglycerin vs. placebo; diltiazem vs. nitroglycerin) on perioperative
outcomes. Network meta-analyses were implemented to compare the three
regimens through direct and indirect comparison. Results Twenty-seven
studies involving 1,660 patients were included. Pairwise and network
meta-analyses found no significant difference in mortality among the
groups. There are four studies that reported blood flow measurements of
internal mammary artery grafts intraopera-tively after dissecting or
immediately after distal anastomosis while patients were on continuous
intravenous infusion of diltiazem and nitroglycerin. Although insufficient
for data synthesis, the measured results from all four studies suggest
that both diltiazem and nitroglycerin significantly increased blood flow
of arterial grafts compared to placebo. For other perioperative outcomes,
compared to diltiazem, patients that received nitroglycerin had higher
odds of postoperative atrial fibrillation (OR = 2.67, 95% CI: 1.15 to
6.24) and higher peak serum cardiac enzymes. Patients that received
placebo had higher odds of atrial fibrillation (OR = 3.00, 95% CI: 1.18 to
7.63) and lower odds of requiring inotrope support (OR = 0.19, 95% CI:
0.04 to 0.73) compared to diltiazem. Data from the network meta-analysis
indicated that diltiazem had significantly lower odds of postoperative
atrial fibrillation compared to nitroglycerin (OR = 0.39, 95% CI: 0.18 to
0.85). In fact, the rank from highest to lowest rates of postoperative
atrial fibrillation was placebo>nitroglycerin>diltiazem. The rank from
highest to lowest odds of requiring inotropic support is nitroglycerin>
diltiazem>pla-cebo. However, placebo had significantly higher odds of
postoperative myocardial infarction than diltiazem (OR = 4.51, 95% CI:
1.34 to 15.25). The rank from highest to lowest odds of postoperative
myocardial infarction, transient cardiac ischemic event and atrial
fibrillation is placebo>nitroglycerin>diltiazem. Conclusion Compared to
nitroglycerin and placebo, perioperative continuous intravenous infusion
of diltiazem had stronger protective effects against postoperative
ischemic cardiac injuries and atrial fibrillation although patients may
need more inotropic support. The increased blood flow from diltiazem use
in arterial grafts may potentially contribute to the drug's outcome
benefits. Copyright © 2018 Hu 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.

<55>
[Use Link to view the full text]
Accession Number
626354528
Title
Impact of Initial Shunt Type on Echocardiographic Indices in Children
After Single Right Ventricle Palliations.
Source
Circulation. Cardiovascular imaging. 12 (2) (pp e007865), 2019. Date of
Publication: 01 Feb 2019.
Author
Frommelt P.C.; Hu C.; Trachtenberg F.; Baffa J.M.; Boruta R.J.; Chowdhury
S.; Cnota J.F.; Dragulescu A.; Levine J.C.; Lu J.; Mercer-Rosa L.; Miller
T.A.; Shah A.; Slesnick T.C.; Stapleton G.; Stelter J.; Wong P.; Newburger
J.W.
Institution
(Frommelt, Stelter) Department of Pediatrics, Division of Pediatric
Cardiology, Children's Hospital of Wisconsin, United States
(Frommelt, Stelter) Department of Pediatrics, Division of Pediatric
Cardiology, Medical College of Wisconsin, Canada
(Hu, Trachtenberg) Department of Pediatrics, Division of Pediatric
Cardiology, New England Research Institutes, Waterford, Ireland
(Baffa) Department of Pediatrics, Division of Pediatric Cardiology,
Nemours Cardiac Center, DE (J.M.B.), Wilmington, United States
(Boruta) Department of Pediatrics, Division of Pediatric Cardiology, Duke
University Hospital, Durham, Canada
(Chowdhury) Department of Pediatrics, Division of Pediatric Cardiology,
Medical University of South Carolina, Switzerland
(Cnota) Department of Pediatrics, Division of Pediatric Cardiology,
Cincinnati Children's Hospital and Medical Center, United States
(Dragulescu) Department of Pediatrics, Division of Pediatric Cardiology,
Hospital of Sick Children, Toronto, Australia
(Levine, Newburger) Department of Pediatrics, Division of Pediatric
Cardiology, Boston Children's Hospital, Harvard Medical School, Australia
(Lu) Department of Pediatrics, Division of Pediatric Cardiology,
University of Michigan Medical School, United States
(Mercer-Rosa) Department of Pediatrics, Division of Pediatric Cardiology,
Children's Hospital of Philadelphia, University of Pennsylvania Medical
School (L.M.-R.)
(Miller) Department of Pediatrics, Division of Pediatric Cardiology,
Primary Children's Medical Center, University of Utah, Canada
(Shah) Department of Pediatrics, Division of Pediatric Cardiology, Morgan
Stanley Children's Hospital of New York-Presbyterian (A.S.)
(Shah) Department of Pediatrics, Division of Pediatric Cardiology,
Columbia College of Physicians and Surgeons, NY, United States
(Slesnick) Department of Pediatrics, Division of Pediatric Cardiology,
Children's Healthcare of Atlanta, Emory University, Atlanta, United States
(Stapleton) Department of Pediatrics, Division of Pediatric Cardiology,
John Hopkins All Children's Health Institute, Baltimore, Canada
(Wong) Department of Pediatrics, Division of Pediatric Cardiology,
Children's Hospital Los Angeles, United States
Publisher
NLM (Medline)
Abstract
Background Heart size and function in children with single right ventricle
(RV) anomalies may be influenced by shunt type at the Norwood procedure.
We sought to identify shunt-related differences during early childhood
after staged surgical palliations using echocardiography. Methods We
compared echocardiographic indices of RV, neoaortic, and tricuspid valve
size and function at 14 months, pre-Fontan, and 6 years in 241 subjects
randomized to a Norwood procedure using either the modified
Blalock-Taussig shunt or RV-to-pulmonary-artery shunt. Results At 6 years,
the shunt groups did not differ significantly in any measure except for
increased indexed neoaortic area in the modified Blalock-Taussig shunt. RV
ejection fraction improved between pre-Fontan and 6 years in the
RV-to-pulmonary artery shunt group but was stable in the modified
Blalock-Taussig shunt group. For the entire cohort, RV diastolic and
systolic size and functional indices were improved at 6 years compared
with earlier measurements, and indexed tricuspid and neoaortic annular
area decreased from 14 months to 6 years. The prevalence of >=moderate
tricuspid and neoaortic regurgitation was uncommon and did not vary by
group or time period. Diminished RV ejection fraction at the 14-month
study was predictive of late death/transplant; the hazard of late
death/transplant when RV ejection fraction was <40% was tripled (hazard
ratio, 3.18; 95% CI, 1.41-7.17). Conclusions By 6 years after staged
palliation, shunt type has not impacted RV size and function, and RV and
valvar size and function show beneficial remodeling. Poor RV systolic
function at 14 months predicts worse late survival independent of the
initial shunt type. Clinical Trial Registration URL:
https://www.clinicaltrials.gov . Unique identifier: NCT00115934.

<56>
[Use Link to view the full text]
Accession Number
626377735
Title
Driving Pressure during Thoracic Surgery: A Randomized Clinical Trial.
Source
Anesthesiology. 130 (3) (pp 385-393), 2019. Date of Publication: 01 Mar
2019.
Author
Park M.; Ahn H.J.; Kim J.A.; Yang M.; Heo B.Y.; Choi J.W.; Kim Y.R.; Lee
S.H.; Jeong H.; Choi S.J.; Song I.S.
Institution
(Park) From the Department of Anesthesiology and Pain Medicine, Samsung
Medical Center, Sungkyunkwan University School of Medicine in Seoul,
J.W.C., S.H.L., S.J.C., I.S.S.) Kangwon National University School of
Graduate Medicine in Chuncheon
Publisher
NLM (Medline)
Abstract
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Driving pressure (plateau minus
end-expiratory airway pressure) is a target in patients with acute
respiratory distress syndrome, and is proposed as a target during general
anesthesia for patients with normal lungs. It has not been reported for
thoracic anesthesia where isolated, inflated lungs may be especially at
risk. WHAT THIS ARTICLE TELLS US THAT IS NEW: In a double-blinded,
randomized trial (292 patients), minimized driving pressure compared with
standard protective ventilation was associated with less postoperative
pneumonia or acute respiratory distress syndrome. BACKGROUND: Recently,
several retrospective studies have suggested that pulmonary complication
is related with driving pressure more than any other ventilatory
parameter. Thus, the authors compared driving pressure-guided ventilation
with conventional protective ventilation in thoracic surgery, where lung
protection is of the utmost importance. The authors hypothesized that
driving pressure-guided ventilation decreases postoperative pulmonary
complications more than conventional protective ventilation.
 METHOD(S): In this double-blind, randomized, controlled study, 292
patients scheduled for elective thoracic surgery were included in the
analysis. The protective ventilation group (n = 147) received conventional
protective ventilation during one-lung ventilation: tidal volume 6ml/kg of
ideal body weight, positive end-expiratory pressure (PEEP) 5cm H2O, and
recruitment maneuver. The driving pressure group (n = 145) received the
same tidal volume and recruitment, but with individualized PEEP which
produces the lowest driving pressure (plateau pressure-PEEP) during
one-lung ventilation. The primary outcome was postoperative pulmonary
complications based on the Melbourne Group Scale (at least 4) until
postoperative day 3. RESULT(S): Melbourne Group Scale of at least 4
occurred in 8 of 145 patients (5.5%) in the driving pressure group, as
compared with 18 of 147 (12.2%) in the protective ventilation group (P =
0.047, odds ratio 0.42; 95% CI, 0.18 to 0.99). The number of patients who
developed pneumonia or acute respiratory distress syndrome was less in the
driving pressure group than in the protective ventilation group (10/145
[6.9%] vs. 22/147 [15.0%], P = 0.028, odds ratio 0.42; 95% CI, 0.19 to
0.92). CONCLUSION(S): Application of driving pressure-guided
ventilation during one-lung ventilation was associated with a lower
incidence of postoperative pulmonary complications compared with
conventional protective ventilation in thoracic surgery.

<57>
Accession Number
626370946
Title
A model-based cost-effectiveness analysis of Patient Blood Management.
Source
Blood Transfusion. 17 (1) (pp 16-26), 2019. Date of Publication:
January-February 2019.
Author
Kleineruschkamp A.; Meybohm P.; Straub N.; Zacharowski K.; Choorapoikayil
S.
Institution
(Kleineruschkamp, Meybohm, Zacharowski, Choorapoikayil) Department of
Anaesthesiology, Intensive Care Medicine and Pain Therapy, University
Hospital Frankfurt, Theodor Stern Kai 7, Frankfurt 60590, Germany
(Straub) Institute of Market Research, Statistics and Prognosis, Munich,
Germany
Publisher
Edizioni SIMTI (E-mail: luisa.stea@bloodtransfusion.it)
Abstract
Background. Patient blood management (PBM) is a multidisciplinary concept
focused on the management of anaemia, minimisation of iatrogenic blood
loss and rational use of allogeneic blood products. The aims of this study
were: (i) to analyse post-operative outcome in patients with liberal vs
restrictive exposure to allogeneic blood products and (ii) to evaluate the
cost-effectiveness of PBM in patients undergoing surgery. Materials and
methods. A systematic literature review and meta-analysis were performed
to compare post-operative complications in predominantly non-transfused
patients (restrictive transfusion group) and patients who received one to
three units of red blood cells (liberal transfusion group). Outcome
measures included sepsis with/without pneumonia, acute renal failure,
acute myocardial infarction and acute stroke. In a second step, a health
economic model was developed to calculate cost-effectiveness of PBM
(PBM-arm vs control-arm) for simulated cohorts of 10,000 cardiac and
non-cardiac surgical patients based on the results of the meta-analysis
and costs. Results. Out of 478 search results, 22 studies were analysed in
the meta-analysis. The pooled relative risk of any complication in the
restrictive transfusion group was 0.43 for non-cardiac and 0.34 for
cardiac surgical patients. In the simulation model, PBM was related to
reduced complications (1,768 vs 1,245) and complication-related deaths
(411 vs 304) compared to standard care. PBM-related costs of therapy
exceeded costs of the control arm by 150 per patient. However, total
costs, including hospitalisation, were higher in the control-arm for both
non-cardiac ( 2,885.11) and cardiac surgery patients ( 1,760.69). The
incremental cost-effectiveness ratio including hospitalisation showed
savings of 30,458 (non-cardiac and cardiac surgery patients) for
preventing one complication and 128,023 (non-cardiac and cardiac surgery
patients) for prevention of one complication-related death in the PBM-arm.
Discussion. Our results indicate that PBM may be associated with fewer
adverse clinical outcomes compared to control management and may, thereby,
be cost-effective. Copyright © SIMTIPRO Srl

<58>
Accession Number
626370610
Title
Congress of neurological surgeons systematic review and evidence-based
guidelines on the evaluation and treatment of patients with thoracolumbar
spine trauma: Novel surgical strategies.
Source
Clinical Neurosurgery. 84 (1) (pp E59-E62), 2019. Date of Publication: 01
Jan 2019.
Author
Chi J.H.; Eichholz K.M.; Anderson P.A.; Arnold P.M.; Dailey A.T.; Dhall
S.S.; Harrop J.S.; Hoh D.J.; Qureshi S.; Rabb C.H.; Raksin P.B.; Kaiser
M.G.; O'Toole J.E.
Institution
(Chi) Department of Neurosurgery, Harvard Medical School, Brigham and
Women's Hospital, Boston, MA, United States
(Eichholz) St. Louis Minimally Invasive Spine Center, St. Louis, MO,
United States
(Anderson) Department of Orthopedics and Rehabilitation, University of
Wisconsin, Madison, WI, United States
(Arnold) Department of Neurosurgery, University of Kansas, School of
Medicine, Kansas City, KS, United States
(Dailey, Rabb) Department of Neurosurgery, University of Utah, Salt Lake
City, UT, United States
(Dhall) Department of Neurological Surgery, University of California, San
Francisco, San Francisco, CA, United States
(Harrop) Departments of Neurological Surgery and Orthopedic Surgery,
Thomas Jefferson University, Philadelphia, PA, United States
(Hoh) Lillian S. Wells Department of Neurological Surgery, University of
Florida, Gainesville, FL, United States
(Qureshi) Department of Orthopaedic Surgery, Weill Cornell Medical
College, New York, NY, United States
(Raksin) Division of Neurosurgery, John H. Stroger Jr Hospital of Cook
County, Rush University Medical Center, Chicago, IL, United States
(Kaiser) Department of Neurosurgery, Columbia University, New York, NY,
United States
(O'Toole) Department of Neurological Surgery, Rush University Medical
Center, Chicago, IL, United States
Publisher
Oxford University Press
Abstract
BACKGROUND: Treatment of thoracolumbar burst fractures has traditionally
involved spinal instrumentation with fusion performed with standard open
surgical techniques. Novel surgical strategies, including instrumentation
without fusion and percutaneous instrumentation alone, have been
considered less invasive and more efficient treatments. OBJECTIVE(S):
To review the current literature and determine the role of fusion in
instrumented fixation, as well as the role of percutaneous
instrumentation, in the treatment of patients with thoracolumbar burst
fractures. METHOD(S): The task force members identified search
terms/parameters and a medical librarian implemented the literature
search, consistent with the literature search protocol (see Appendix I),
using the National Library of Medicine PubMed database and the Cochrane
Library for the period from January 1, 1946 to March 31, 2015.
 RESULT(S): A total of 906 articles were identified and 38 were
selected for full-text review. Of these articles, 12 articles met criteria
for inclusion in this systematic review. CONCLUSION(S): There is
grade A evidence for the omission of fusion in instrumented fixation for
thoracolumbar burst fractures. There is grade B evidence that percutaneous
instrumentation is as effective as open instrumentation for thoracolumbar
burst fractures. RECOMMENDATIONS: QUESTION: Does the addition of
arthrodesis to instrumented fixation improve outcomes in patients with
thoracic and lumbar burst fractures? RECOMMENDATION: It is recommended
that in the surgical treatment of patients with thoracolumbar burst
fractures, surgeons should understand that the addition of arthrodesis to
instrumented stabilization has not been shown to impact clinical or
radiological outcomes, and adds to increased blood loss and operative
time. Strength of Recommendation: Grade A QUESTION: How does the use of
minimally invasive techniques (including percutaneous instrumentation)
affect outcomes in patients undergoing surgery for thoracic and lumbar
fractures compared to conventional open techniques? RECOMMENDATION:
Stabilization using both open and percutaneous pedicle screwsmay be
considered in the treatment of thoracolumbar burst fractures as the
evidence suggests equivalent clinical outcomes. Copyright © 2018
by the Congress of Neurological Surgeons.

<59>
Accession Number
626315478
Title
Bisystolic vertebral artery: Critical finding or can be ignored?.
Source
Journal of Clinical Imaging Science. 9 (1) (no pagination), 2019. Article
Number: 2. Date of Publication: 01 Jan 2019.
Author
Sharma P.; Kochar P.; Soin P.; Cohen S.
Institution
(Soin) Department of Pathology and Laboratory Medicine, Weil Cornell
College of Medicine, New York, United States
(Sharma, Kochar, Cohen) Department of Radiology, Yale New Haven Health at
Bridgeport Hospital, Bridgeport, CT, United States
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
The carotid Doppler imaging findings in three adults presenting with
vertigo, transient speech difficulty and for cardiac prebypass graft
surgery revealing two systolic peaks in one of the vertebral arteries. In
presteal situations, vertebral artery waveform shows two systolic peaks
with sharp first and rounded second systolic peak or two systolic peaks
with a deep cleft between the two peaks with antegrade flow. With increase
in stenosis to more than 80% there is bidirectional flow and later flow
reversal. We discuss the types of presteal vertebral artery waveforms, its
clinical implications and brief review of literature. Copyright ©
2019 Journal of Clinical Imaging Science.

<60>
Accession Number
626372663
Title
Effect of iloprost inhalation on postoperative outcome in high-risk
cardiac surgical patients: a prospective randomized-controlled multicentre
trial (ILOCARD).
Source
Canadian Journal of Anesthesia. (no pagination), 2019. Date of
Publication: 2019.
Author
Winterhalter M.; Rex S.; Stoppe C.; Kienbaum P.; Muller H.-H.; Kaufmann
I.; Kuppe H.; Dongas A.; Zwissler B.
Institution
(Winterhalter) Klinik fur Anasthesiologie und Schmerztherapie, Klinikum
Bremen-Mitte gGmbH, Bremen, Germany
(Winterhalter, Kienbaum) Klinik fur Anasthesiologie, Universitatsklinikum
Dusseldorf, Dusseldorf, Germany
(Rex) Department of Anesthesiology & Department of Cardiovascular
Sciences, University Hospitals Leuven, KU Leuven, Herestraat 49, Leuven
3000, Belgium
(Rex, Stoppe) Klinik fur Anasthesiologie, Universitatsklinikum der RWTH
Aachen, Aachen, Germany
(Muller) Klinische Forschung, IBE - Institut fur Medizinische
Informationsverarbeitung, Biometrie und Epidemiologie,
Ludwig-Maximilians-Universitat Munchen, Munich, Germany
(Muller) Institut fur Medizinische Biometrie und Epidemiologie,
Philipps-Universitat Marburg, Marburg, Germany
(Kaufmann, Zwissler) Klinik fur Anasthesiologie, LMU Klinikum der
Universitat Munchen, Munich, Germany
(Kaufmann) Klinik fur Anasthesiologie, Operative Intensivmedizin und
Schmerztherapie, Stadtisches Klinikum Munchen, Neuperlach, Munich, Germany
(Kuppe) Institut fur Anasthesiologie, Deutsches Herzzentrum Berlin,
Berlin, Germany
(Dongas) Institut fur Anasthesiologie, Herz- und Diabeteszentrum NRW,
Ruhr-Universitat Bochum, Bad Oeynhausen, Germany
(Dongas) Klinik fur Anasthesiologie und operative Intensivmedizin,
Franziskus Hospital Bielefeld, Bielefeld, Germany
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Perioperative right ventricular (RV) failure due to pressure
overload from pulmonary hypertension (PH) worsens postoperative outcomes
after cardiac surgery. Inhaled iloprost is a potent pulmonary vasodilator
improving RV performance, ameliorating myocardial and pulmonary
ischemia-reperfusion injury and attenuating inflammation. We hypothesized
that the prophylactic inhalation of iloprost would reduce postoperative
ventilation times after cardiac surgery. Method(s): In this phase
III, multicentre, randomized, double-blind, placebo-controlled trial, we
randomly assigned 253 cardiac surgical patients at high risk of
perioperative RV failure to the prophylactic inhalation of 20 micro g
iloprost or placebo before and during weaning from extracorporeal
circulation. The primary endpoint was the duration of postoperative
ventilation. Secondary endpoints included perioperative hemodynamics,
intensive care unit and hospital length of stay, and 90-day mortality.
Safety was assessed by the incidence of adverse events. Result(s):
Iloprost had no significant effect on the median [interquartile range]
duration of postoperative ventilation compared with placebo (720
[470-1170] min vs 778 [541-1219] min, respectively; median decrease, 65
min; 95% confidence interval [CI], - 77 to 210; P = 0.37). While the
nebulization of iloprost decreased RV afterload and improved cardiac
index, major secondary endpoints were not significantly affected.
Ninety-day mortality occurred in 14% of the iloprost patients compared
with 14% of the placebo patients (hazard ratio, 0.97; 95% CI, 0.50 to
1.89; P = 0.93). The incidence of adverse events was comparable in both
groups. Conclusion(s): The prophylactic inhalation of iloprost did
not meaningfully improve the outcome in high-risk cardiac surgical
patients. Trial registration: www.clinicaltrials.gov (NCT00927654);
registered 25 June, 2009. Copyright © 2019, Canadian
Anesthesiologists' Society.

<61>
Accession Number
626360116
Title
Intravascular ultrasound guidance reduces cardiac death and coronary
revascularization in patients undergoing drug-eluting stent implantation:
results from a meta-analysis of 9 randomized trials and 4724 patients.
Source
International Journal of Cardiovascular Imaging. (no pagination), 2019.
Date of Publication: 2019.
Author
Gao X.-F.; Wang Z.-M.; Wang F.; Gu Y.; Ge Z.; Kong X.-Q.; Zuo G.-F.; Zhang
J.-J.; Chen S.-L.
Institution
(Gao, Wang, Wang, Gu, Ge, Kong, Zuo, Zhang, Chen) Department of
Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68
Changle Road, Nanjing 210006, China
(Gao, Zhang, Chen) Department of Cardiology, Nanjing Heart Centre,
Nanjing, China
Publisher
Springer Netherlands (E-mail: rbk@louisiana.edu)
Abstract
Intravascular ultrasound (IVUS) guidance is not routinely performed in
real-word clinical practice partly because the benefit of IVUS guidance is
not well established. This updated meta-analysis aims to compare
IVUS-guided and angiography-guided drug-eluting stent (DES) implantation,
simultaneously stressing the value of an optimal IVUS-defined procedure.
Medline, Scopus, Google Scholar, and Cochrane Controlled Trials Registry
were searched for the randomized trials comparing IVUS-guided and
angiography-guided DES implantation. Nine eligible randomized trials
including 4,724 patients were identified. At a mean follow-up of 16.7
months, IVUS guidance was associated with a significant lower risk of
major adverse cardiovascular events (MACE) [5.4% vs. 9.0%; relative risks
(RR): 0.61, 95% confident interval (CI) 0.49-0.74, p < 0.001], cardiac
death (0.6% vs. 1.2%; RR: 0.49, 95% CI 0.26-0.92, p = 0.03), target vessel
revascularization (3.5% vs.6.1%; RR: 0.58, 95% CI 0.42-0.80, p = 0.001),
target lesion revascularization (3.1% vs. 5.2%; RR: 0.59, 95% CI
0.44-0.80, p = 0.001), and definite/probable stent thrombosis (0.5%
vs.1.1%; RR: 0.45, 95% CI 0.23-0.87, p = 0.02) compared with angiography
guidance. No significant differences in all cause death and myocardial
infarction were noted between the two groups. Subgroup analysis showed
that patients who met the optimal criteria had a lower rate of MACE than
those with IVUS-defined suboptimal procedure (RR: 0.33, 95% CI 0.06-0.60,
p = 0.02). The present meta-analysis with the largest sample size to date
demonstrates that IVUS-guided DES implantation significantly reduces
cardiac death, coronary revascularization and stent thrombosis,
particularly for patients with IVUS-defined optimal procedures compared
with angiography guidance. Copyright © 2019, Springer Nature B.V.

<62>
Accession Number
626359973
Title
A randomized trial comparing triiodothyronine (T3) with thyroxine (T4) for
hemodynamically unstable brain-dead organ donors.
Source
Clinical Transplantation. (no pagination), 2019. Article Number: e13486.
Date of Publication: 2019.
Author
Dhar R.; Stahlschmidt E.; Yan Y.; Marklin G.
Institution
(Dhar) Division of Neurocritical Care, Department of Neurology, Washington
University in St. Louis School of Medicine, Saint Louis, MO, United States
(Stahlschmidt, Marklin) Mid-America Transplant, St. Louis, MO, United
States
(Yan) Division of Public Health Sciences, Department of Surgery,
Washington University in St. Louis School of Medicine, St. Louis, MO,
United States
Publisher
Blackwell Publishing Ltd
Abstract
Rationale: Brain-dead (BD) organ donors frequently exhibit hemodynamic
instability and/or reversible cardiac dysfunction. Retrospective studies
have suggested that thyroid hormone may stabilize hemodynamics and enhance
myocardial recovery. Intravenous levothyroxine (T4) is most frequently
utilized but studies have suggested that triiodothyronine (T3) may be
superior. We performed a randomized comparative-effectiveness trial to
address this uncertainty in donor management. Method(s): All
heart-eligible donors managed at a single OPO underwent standardized fluid
resuscitation. If not weaned off vasopressors, donors underwent
echocardiography (within 12 hours of BD) and were randomized to T3 or T4
infusion for eight hours. Result(s): A total of 37 BD donors were
randomized (16 T3 vs 21 T4). Baseline ejection fraction (EF) was
comparable (median 38% vs 45%, P = 0.87) as was vasopressor dosage (6 vs
12 mug/min of norepinephrine, NE, P = 0.12). Reduction in NE dose and
proportion weaned off vasopressors was similar and LVEF improved in both
groups (repeat EF: 50% vs 52.5%, P = 0.38) with almost half attaining EF
>=55%. Although more hearts were transplanted in the T3 group (10/16 vs
6/21, P = 0.04), this difference did not persist after adjusting for
baseline imbalances in age and PF ratio. Conclusion(s): Infusion of
T3 does not appear to confer significant hemodynamic or cardiac benefits
over T4 for hemodynamic unstable BD organ donors. Copyright ©
2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

<63>
Accession Number
626300338
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:
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
Oxford University Press
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.
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 6-8 months and clinical follow-up
was done at 12 months. 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%,
prespecified 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. Conclusion 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). Copyright © The Author(s) 2018.

<64>
Accession Number
2001001361
Title
What are the clinical, quality-of-life, and cost consequences of 30years
of excellent vs. poor glycemic control in type 1 diabetes?.
Source
Journal of Diabetes and its Complications. 32 (10) (pp 911-915), 2018.
Date of Publication: October 2018.
Author
Herman W.H.; Braffett B.H.; Kuo S.; Lee J.M.; Brandle M.; Jacobson A.M.;
Prosser L.A.; Lachin J.M.
Institution
(Herman) Departments of Internal Medicine and Epidemiology, University of
Michigan, Ann Arbor, MI, United States
(Braffett, Lachin) The Biostatistics Center, George Washington University,
Washington, DC, United States
(Kuo) Department of Internal Medicine, University of Michigan, Ann Arbor,
MI, United States
(Lee) Pediatric Endocrinology, Child Health Evaluation and Research Unit,
University of Michigan, Ann Arbor, MI, United States
(Brandle) Division of Endocrinology and Diabetes, Kantonsspital St.
Gallen, Sankt Gallen, SG, Switzerland
(Jacobson) Winthrop-University Hospital, Mineola, NY, United States
(Prosser) Department of Pediatrics, University of Michigan, Ann Arbor, MI,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: The Diabetes Control and Complications Trial (DCCT)
demonstrated that intensive therapy for type 1 diabetes delayed the
development of microvascular and neuropathic complications compared to
conventional therapy. At the end of DCCT, all participants were trained in
intensive therapy, care was transferred to community providers, and the
difference in HbA1c between treatment groups narrowed and disappeared. Our
objective was to describe the outcomes and the quality-of-life and costs
associated with those outcomes in participants who maintained excellent
vs. poor glycemic control over 30 years. Research design and methods: We
assessed the incidence of retinopathy, nephropathy, neuropathy,
cardiovascular disease, acute metabolic complications, death,
quality-of-life, and costs in the tertile of DCCT intensive therapy
participants who achieved a mean updated HbA1c of <7.2% (55 mmol/mol) and
the tertile of DCCT conventional therapy participants (n = 240) who
achieved a mean updated HbA1c of >8.8% (73 mmol/mol) over 30 years.
 Result(s): Thirty years of excellent vs. poor glycemic control
substantially reduced the incidence of retinopathy requiring laser therapy
(5% vs. 45%), end-stage renal disease (0% vs. 5%), clinical neuropathy
(15% vs. 50%), myocardial infarction (3% vs. 5%), stroke (0.4% vs. 2%),
and death (6% vs. 20%). It also resulted in a gain of ~1.62
quality-adjusted life-years and averted ~$90,900 in costs of complications
per participant. Conclusion(s): Thirty years of excellent vs. poor
glycemic control for T1DM can substantially reduce the incidence of
complications, comorbidities, and death, improve quality-of-life, and
reduce costs. These estimates represent the benefits that may be achieved
with excellent glycemic control. Copyright © 2018 Elsevier Inc.

<65>
Accession Number
2001149927
Title
Transcatheter aortic valve replacement outcomes in bicuspid compared to
trileaflet aortic valves.
Source
Cardiovascular Revascularization Medicine. 20 (1) (pp 50-56), 2019. Date
of Publication: January 2019.
Author
Nagaraja V.; Suh W.; Fischman D.L.; Banning A.; Martinez S.C.; Potts J.;
Kwok C.S.; Ratib K.; Nolan J.; Bagur R.; Mamas M.A.
Institution
(Nagaraja, Potts, Kwok, Ratib, Nolan, Bagur, Mamas) Keele Cardiovascular
Research Group, Centre for Prognosis Research, Institute of Primary Care
and Health Sciences, Keele University, United Kingdom
(Nagaraja, Potts, Ratib, Nolan, Bagur, Mamas) Academic Dept of Cardiology,
Royal Stoke Hospital, United Kingdom
(Nagaraja) Department of Cardiology, Prince of Wales Hospital and
Community Health Services, Randwick, New South Wales, Australia
(Suh) Division of Cardiology, University of California Los Angeles Medical
Center, David Geffen School of Medicine at UCLA, United States
(Fischman) Department of Medicine (Cardiology), Thomas Jefferson
University Hospital, Philadelphia, PA, United States
(Banning) Oxford Heart Centre, Oxford University Hospitals NHS Trust
Foundation, Oxford, United Kingdom
(Martinez) Division of Cardiology, Providence St. Peter Hospital, Olympia,
WA, United States
(Kwok) Department of Cardiology, University Hospital of North Midlands,
United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Aim: TAVR in patients with bicuspid aortic valves (BAV) is more
challenging compared to individuals with trileaflet aortic valves (TAV).
BAV have been excluded from the large randomized clinical trials assessing
transcatheter aortic valve replacements (TAVR) and has been considered as
a relative contraindication to TAVR. To report the outcomes of TAVR in BAV
and compare them to TAV in the National Inpatient Sample (NIS).
 Methods and Results: TAVR procedures were identified between 2011 and
2014 in the NIS dataset. Endpoints assessed included in-hospital
mortality, periprocedural complications, length of stay and cost. Of
40,604 identified TAVR procedures, 407 (1%) were BAV and the 40,197 (99%)
were TAV. Patients with BAV were younger and had a lower comorbidity
burden. In hospital mortality (4.89% vs 4.17%, OR: 1.71, 95%CI: 0.57-5.12,
P = 0.21), AMI (3.49% vs 3.58%, OR: 1.12, 95%CI: 0.36-3.54, P = 0.85),
stroke and TIA (2.49% vs 3.55%, OR: 0.75, 95%CI: 0.18-3.16, P = 0.70),
vascular complications (2.39% vs 5.58%, OR:0.47, 95%CI: 0.11-1.93, P =
0.29), major bleeding (16.96% vs 23.50%, OR: 0.63, 95%CI: 0.34-1.17, P =
0.15) and rates of permanent pacemaker (PPM) (9.88% vs 10.88%, OR: 1.19,
95%CI: 0.57-2.51, P = 0.64) were similar in both cohorts.
 Conclusion(s): With multimodality imaging and further improvement in
technology, our study demonstrates off-label TAVR should not be considered
prohibitive and can be successfully performed for BAV with similar
peri-procedural outcomes compared to those with TAV. However, there is a
need for robust large prospective studies. Copyright © 2018
Elsevier Inc.

<66>
Accession Number
2000737452
Title
An updated meta-analysis of TAVR in patients at intermediate risk for
SAVR.
Source
Cardiovascular Revascularization Medicine. 20 (1) (pp 57-69), 2019. Date
of Publication: January 2019.
Author
Lazkani M.; Singh N.; Howe C.; Patel N.; Colon M.J.; Tasset M.; Amabile
O.; Morris M.; Fang H.K.; Pershad A.
Institution
(Lazkani, Patel, Colon, Tasset, Amabile, Morris, Fang, Pershad) University
of Arizona, Banner University Medical Center - Phoenix, United States
(Singh, Howe) University of Arizona, Banner University Medical Center,
Tuscon, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has been
approved for use in patients with severe aortic stenosis at intermediate,
high and extreme surgical risk. This meta-analysis was performed to assess
the safety and efficacy of TAVR compared to surgical aortic valve
replacement (SAVR) in intermediate risk patients. Method(s): We
searched PubMed, EMBASE, Web of science, and the Cochrane Central Register
of Controlled Trials databases for studies comparing TAVR versus SAVR in
patients at intermediate surgical risk, with a mean Society of Thoracic
Surgeon score of 3-8% or a mean logistic European risk score of 10-20%.
The primary endpoint was to assess the efficacy of TAVR compared to SAVR,
defined as all-cause and cardiovascular mortality at 30-days, 1-year, and
>=2 years of follow-up. Secondary endpoints were the safety profile,
comprising of cerebrovascular events, myocardial infarctions, permanent
pacemaker placement, new onset atrial fibrillation, aortic regurgitation,
vascular complications, major bleeding and acute kidney injury.
 Result(s): This is the largest and most contemporary meta-analysis of
5647 intermediate risk patients in eleven studies published to date. There
were no statistically significant differences in all-cause and cardiac
mortality at 30 days, 1- year and >2-years of follow up. Acute kidney
injury and atrial fibrillation occurred more frequently in patients
treated with SAVR and permanent pacemaker implantation and aortic
insufficiency were more frequent in patients treated with TAVR.
 Conclusion(s): This meta-analysis suggests that for intermediate risk
patients with severe aortic stenosis, TAVR has similar efficacy as SAVR
but with a different adverse event profile. Copyright © 2018
Elsevier Inc.

<67>
Accession Number
624650464
Title
Effects of bone marrow mononuclear cells delivered through a graft vessel
in patients with previous myocardial infarction and chronic heart failure:
An echocardiographic study of left ventricular dyssynchrony.
Source
Journal of clinical ultrasound : JCU. 46 (8) (pp 512-518), 2018. Date of
Publication: 01 Oct 2018.
Author
Qi Z.; Liu S.; Duan F.
Institution
(Qi) Department of Ultrasound, Beijing Hospital of Traditional Chinese
Medicine, Capital Medical University, Beijing, China
(Liu) Department of Cardiovascular Surgery, Fuwai Hospital &
Cardiovascular Institute, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences & Tsinghua University, Peking Union
Medical College, Beijing, China
(Duan) Department of Echocardiography, Fuwai Hospital & Cardiovascular
Institute, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences & Tsinghua University, Peking Union Medical College,
Beijing, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Several trials are investigating the delivery of stem cells to
treat ischemic cardiomyopathy. The aim of this study was the
echocardiographic evaluation of the effectiveness of isolated coronary
artery bypass graft (CABG) combined with bone marrow mononuclear cells
(BMMNC) delivered through the graft vessels to improve left ventricular
dyssynchrony in patients with previous myocardial infarction and chronic
heart failure. METHOD(S): 42 patients with previous myocardial
infarction and chronic heart failure were randomly allocated to either the
CABG only group (n=18) or the CABG with BMMNC graft group (n=24group). We
used 2D strain imaging to measure the absolute difference in time-to-peak
radial strain between the earliest and the latest activated segments on LV
short-axis images at the apical (RSTa), at the mitral annulus (RSTb), and
at the papillary muscle (RSTm) level. RESULT(S): The effective rate
of LV dyssynchrony improvement was significantly higher in the CABG+BMMNC
than in the CABG only group (RSTb: 91.7% vs 50%, P<.05; RSTm: 78.6% vs
35.7%, P<.05; RSTa: 92.3% vs 50%, P<.05). The deterioration rate of LV
synchrony was significantly lower in the CABG+BMMNC than in the CABG only
group for RSTb (8.3% vs 70%, P<.05;) and RSTm (0 vs 50%, P<.05), but not
for RSTa (18.2% vs 37.5%, P>.05). CONCLUSION(S): Combining CABG with
BMMNC delivering provided a better improvement of left ventricular
dyssynchrony than CABG only. Copyright © 2018 Wiley Periodicals,
Inc.

<68>
Accession Number
2001569043
Title
Depth of anesthesia measured by bispectral index and postoperative
mortality: A meta-analysis of observational studies.
Source
Journal of Clinical Anesthesia. 56 (pp 119-125), 2019. Date of
Publication: September 2019.
Author
Liu Y.-H.; Qiu D.-J.; Jia L.; Tan J.-T.; Kang J.-M.; Xie T.; Xu H.-M.
Institution
(Liu, Qiu, Jia, Tan, Kang, Xie, Xu) Department of Anesthesiology, Fourth
Hospital of Hebei Medical University, Shijiazhuang 050000, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Introduction: Whether anesthesia depth affects postoperative mortality
remains uncertain. Measurements: Several databases were systematically
searched to identify all articles studying the relationship between depth
of anesthesia and postoperative mortality. Post hoc subgroup analyses were
conducted for follow-up period (30 days vs. longer than 90 days) and type
of surgery. Main Result(s): The analysis included 38,722 patients
from nine studies. We observed a significant relationship between low
bispectral index (BIS) and mortality (pooled aHR, 1.22;95% CI, 1.08 to
1.38; P = 0.001; I2 = 85.4%). Post hoc subgroup analyses
indicated low BIS to be linked with significantly elevated mortality risk
in patients with >=90 days follow-up (pooled adjusted hazard ratio [aHR],
1.09; 95% CI, 1.00-1.19; P = 0.01; I2 = 79.4%), but this
association did not achieve significance in those with a 30 day follow-up
duration (pooled aHR, 1.52; 95% CI, 0.97-2.38; P = 0.28; I2 =
79.0%). In addition, this link between postoperative mortality and low BIS
was significant in those who had undergone cardiac surgery (pooled aHR,
1.30; 95% CI, 1.14 to 1.49; P < 0.001; I2 = 0.0%), but not in
patients that had received other forms of surgery (pooled aHR, 1.06; 95%
CI, 0.98 to 1.14; P = 0.14; I2 = 73.2%). Conclusion(s): We
observed a significant relationship between deep anesthesia and long-term
mortality, though this was not significant 30 days following surgery. In
patients who had received cardiac surgery, deep anesthesia may increase
mortality. However, this trend was not observed in patients who had
undergone other forms of surgery. Copyright © 2019 Elsevier Inc.

<69>
[Use Link to view the full text]
Accession Number
626338525
Title
Cost-Effectiveness of Transcatheter Versus Surgical Aortic Valve
Replacement in Patients With Severe Aortic Stenosis at Intermediate Risk.
Source
Circulation. 139 (7) (pp 877-888), 2019. Date of Publication: 12 Feb 2019.
Author
Baron S.J.; Wang K.; House J.A.; Magnuson E.A.; Reynolds M.R.; Makkar R.;
Herrmann H.C.; Kodali S.; Thourani V.H.; Kapadia S.; Svensson L.; Mack
M.J.; Brown D.L.; Russo M.J.; Smith C.R.; Webb J.; Miller C.; Leon M.B.;
Cohen D.J.
Institution
(Baron, Wang, Magnuson, Cohen) Saint Luke's Mid America Heart Institute,
University of Missouri-Kansas City (S.J.B.
(House) Premier Research Services Inc, Charlotte, United States
(Reynolds) Lahey Hospital and Medical Center, Burlington, Canada
(Makkar) Cedars-Sinai Medical Center, Los Angeles, United States
(Herrmann) Hospital of University of Pennsylvania, United States
(Kodali, Smith) Columbia University Medical Center, United States
(Thourani) MedStar Heart and Vascular Institute/Georgetown University, WA,
United States
(Kapadia, Svensson) Cleveland Clinic, Canada
(Mack, Brown) Baylor Scott and White Healthcare, Plano, United States
(Russo) RWJ Barnabas Health, West Orange, United States
(Webb) St. Paul's Hospital, Vancouver, BC, Canada
(Miller) Stanford Medical Center, Palo Alto, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: In patients with severe aortic stenosis (AS) at intermediate
surgical risk, treatment with transcatheter aortic valve replacement
(TAVR) or surgical aortic valve replacement (SAVR) results in similar
rates of death or stroke at 2 years. Whether TAVR is cost-effective
compared with SAVR for intermediate-risk patients remains uncertain.
 METHOD(S): Between 2011 and 2014, 3110 intermediate-risk AS patients
were treated with TAVR or SAVR in the PARTNER 2 trial (Placement of Aortic
Transcatheter Valves 2). A total of 2032 patients were randomized to
receive TAVR using the SAPIEN XT valve (XT-TAVR) or SAVR in the PARTNER 2A
trial, whereas the PARTNER S3i registry included an additional 1078
patients treated with TAVR using the SAPIEN 3 valve (S3-TAVR), which
offers a lower delivery profile and sealing skirt designed to reduce
paravalvular regurgitation compared with XT-TAVR. Procedural costs were
estimated using measured resource utilization. Other in-trial costs were
assessed by linkage of trial data with Medicare claims (n=2333) or by
linear regression models for unlinked patients (n=682). Health utilities
were estimated using the EQ-5D at baseline and 1, 12, and 24 months. Using
a Markov model informed by in-trial costs, utilities, and survival data,
lifetime cost-effectiveness from the perspective of the US healthcare
system was estimated in terms of cost per quality-adjusted life-year
gained. RESULT(S): Although procedural costs were =$20000 higher with
TAVR than SAVR, total cost differences for the index hospitalization were
only $2888 higher with XT-TAVR ( P=0.014) and were $4155 lower with
S3-TAVR ( P<0.001) owing to reductions in length of stay with TAVR.
Follow-up costs were significantly lower with XT-TAVR (DELTA=-$9304;
P<0.001) and S3-TAVR (DELTA=-$11377; P<0.001) than with SAVR. Over a
lifetime horizon, TAVR was projected to lower total costs by $8000 to
$10000 and to increase quality-adjusted survival by 0.15 to 0.27 years.
XT-TAVR and S3-TAVR were found to be economically dominant compared with
SAVR in 84% and 97% of bootstrap replicates, respectively.
 CONCLUSION(S): Among intermediate-risk AS patients, TAVR is projected
to be economically dominant from the perspective of the US healthcare
system by providing both greater quality-adjusted life expectancy and
lower long-term costs than SAVR. If long-term data demonstrate comparable
late mortality with TAVR and SAVR, these findings suggest that TAVR might
be the preferred treatment strategy for intermediate-risk AS patients
based on both clinical and economic considerations. CLINICAL TRIAL
REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier:
NCT01314313.

<70>
Accession Number
626345183
Title
Cost-effectiveness analysis of the SAPIEN 3 TAVI valve compared with
surgery in intermediate-risk patients.
Source
Journal of Medical Economics. (no pagination), 2019. Date of Publication:
2019.
Author
Goodall G.; Lamotte M.; Ramos M.; Maunoury F.; Pejchalova B.; de
Pouvourville G.
Institution
(Goodall, Pejchalova) Edwards Lifesciences S.A., Nyon, Switzerland
(Lamotte, Ramos) IQVIA, Corporate village, Zaventem, Belgium
(Maunoury) Statesia, Le Mans, France
(de Pouvourville) ESSEC Business School, Cergy Pontoise, France
Publisher
Taylor and Francis Ltd
Abstract
Objective: Transcatheter aortic valve implantation (TAVI) has become the
therapy of choice for treating severe aortic stenosis in patients at
high-risk for surgery or where it is considered too risky to attempt. This
uptake varies across geographies however, and its cost or value has
frequently been cited as the reason for this. We sought to evaluate the
potential cost and clinical impact of TAVI in intermediate risk patients
from a French collective perspective. Material(s) and Method(s): The
analysis was performed using a novel Markov model with data derived from
the PARTNER II randomized controlled trial for survival, clinical event
rates, and quality-of-life. The simulated time horizon was 15 years, costs
were from French sources and presented in 2016 Euros. Discounting of all
outcomes was at 4% annually and the effect of uncertainty in model
parameters was explored by deterministic and probabilistic sensitivity
analysis (PSA). Result(s): In comparison to surgery, TAVI resulted in
improved clinical outcomes (life expectancy and quality-adjusted life
expectancy) and lower costs over a lifetime time horizon. The base case
results showed increases of 0.42 years and 0.41 QALYs with lifetime cost
savings of 439 for TAVI compared to surgery. PSA results showed a >50%
likelihood of cost-effectiveness at 0 willingness-to-pay and a 100%
likelihood at ~15,000. Limitation(s): Clinically, survival
projections are based on limited follow-up data and introduce uncertainty
into the outcomes from the model. Economically, procedure costs are
derived from a heterogeneous mix of patient risk groups, although this is
much more likely to bias against TAVI and under-estimate overall cost
savings. Conclusion(s): In our analyses of intermediate risk
patients, TAVI is associated with superior clinical outcomes compared to
surgery and is cost saving. It could be expected that cost savings are
conservative and likely to increase over time. Copyright © 2019,
© 2019 Informa UK Limited, trading as Taylor & Francis Group.

<71>
Accession Number
624048641
Title
Effects of Cilostazol-Based Triple Antiplatelet Therapy Versus Dual
Antiplatelet Therapy After Coronary Drug-Eluting Stent Implantation: An
Updated Meta-Analysis of the Randomized Controlled Trials.
Source
Clinical Drug Investigation. 39 (1) (no pagination), 2019. Date of
Publication: 31 Jan 2019.
Author
Zhao S.; Zhong Z.; Qi G.; Shi L.; Tian W.
Institution
(Zhao, Qi, Shi, Tian) Department of Geriatric Cardiology, First Affiliated
Hospital, China Medical University, No. 155 Nanjingbei Street, 110001
Heping District, Shenyang, China
(Zhong) Department of Respiratory, Central Hospital, Shenyang Medical
College, Shenyang, China
Publisher
Springer International Publishing
Abstract
Background and Objective: The results of studies on cilostazol-based
triple antiplatelet therapy (TAT) after drug-eluting stent (DES)
implantation were inconsistent. To assess the effects of TAT compared with
dual antiplatelet therapy (DAT) after DES/second-generation DES
implantation, we performed a meta-analysis of randomized controlled trials
(RCTs). Method(s): All relevant studies evaluated were identified by
searching the PubMed, EMBASE, Cochrane Library, and ISI Web of Science
databases without time and language limitation. Subgroup analyses were
performed to evaluate the efficacy and safety of TAT after
second-generation DES implantation. Result(s): Eleven RCTs involving
a total of 4684 patients were included. The meta-analysis showed TAT was
associated with significant beneficial effects on angiographic findings of
in-stent restenosis [risk ratio (RR) 0.645, 95% confidence interval (CI)
0.470-0.885; P = 0.007], in-segment restenosis (RR 0.606, 95% CI
0.450-0.817; P = 0.001), in-stent late loss (RR - 0.095, 95% CI - 0.136 to
- 0.054; P < 0.0001), in-segment late loss (RR - 0.100, 95% CI - 0.139 to
- 0.061; P < 0.0001), target lesion revascularization (TLR) (RR 0.570, 95%
CI 0.430-0.755; P < 0.0001), and target vessel revascularization (TVR) (RR
0.523, 95% CI 0.380-0.719; P < 0.0001). No significant difference was
found in outcomes of all-cause death, cardiac death, definite/probable
stent thrombosis (ST), non-fatal myocardial infarction (MI), overall
bleeding, and major bleeding between the two groups, as well as some minor
adverse effects including palpitations, thrombocytopenia, neutropenia, and
hepatic dysfunction. However, the incidence rate of rash, gastrointestinal
disorders, and headache was significantly higher in TAT. The
second-generation DES subgroup showed similar results, except for the
indicators of all-cause death (RR 2.161, 95% CI 1.007-4.635; P = 0.048)
and hepatic dysfunction (RR 0.176, 95% CI 0.031-0.995; P = 0.049).
 Conclusion(s): Compared with DAT, cilostazol-based TAT can
significantly improve the angiographic findings of in-stent and in-segment
late loss, in-stent and in-segment restenosis, TLR, and TVR after
DES/second-generation DES implantation. However, no benefits were observed
in outcomes of all-cause death, cardiac death, ST, and MI. Copyright
© 2018, Springer Nature Switzerland AG.

<72>
Accession Number
623699218
Title
Solid organ transplantation following allogeneic haematopoietic cell
transplantation: experience from a referral organ transplantation center
and systematic review of literature.
Source
Bone Marrow Transplantation. 54 (2) (pp 190-203), 2019. Date of
Publication: 01 Feb 2019.
Author
Brockmann J.G.; Broering D.C.; Raza S.M.; Rasheed W.; Hashmi S.K.;
Chaudhri N.; Nizami I.Y.; Alburaiki J.A.H.; Shagrani M.A.; Ali T.; Aljurf
M.
Institution
(Brockmann, Broering, Raza) Department of Surgery, Organ Transplant
Center, All King Faisal Specialist Hospital and Research Center, Riyadh,
Saudi Arabia
(Rasheed, Hashmi, Chaudhri, Aljurf) Department of Medical Oncology, All
King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
(Nizami) Organ Transplant Centre, Lung Transplant Medicine, All King
Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
(Alburaiki) Department of Cardiology, All King Faisal Specialist Hospital
and Research Center, Riyadh, Saudi Arabia
(Shagrani) Organ Transplant Center, Department of Paediatric Transplant
Hepatology, Organ Transplant Center, All King Faisal Specialist Hospital
and Research Center, Riyadh, Saudi Arabia
(Ali) Organ Transplant Center, Department of Kidney and Pancreas
Transplant Nephrology, Organ Transplant Center, All King Faisal Specialist
Hospital and Research Center, Riyadh, Saudi Arabia
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
Solid organ transplantation (SOT) following haematopoietic cell
transplantation (HCT) is a rare event. Uncertainty exists whether such
recipients are at higher risk of relapse of underlying haematological
disease or at increased risk of developing infectious or immunological
complications and malignancies following SOT. The experience at our
referral organ transplantation center and the present literature of SOT (n
= 198) in recipients following previous HCT was systematically reviewed.
Outcome analysis of 206 SOT recipients following HCT challenges the
validity of the frequently stated comparable outcome with recipients
without prior HCT. SOT recipients after HCT are younger and have a higher
mortality and morbidity in comparison with "standard" recipients.
Rejection rates for SOT recipients following HCT appear to be lower for
all organs, except for liver transplantation. In the setting of liver
transplantation following HCT, mortality for recipients of deceased donor
grafts appears to be exceptionally high, although experience with grafts
of living donors are favourable. Morbidity was mostly associated with
infectious and malignant complications. Of note some SOT recipients who
received solid organ donation from the same HCT donor were able to achieve
successful withdrawal of immune suppression. Despite limited follow-up,
recipients with prior HCT show a different course after SOT, necessitating
attention and closer follow-up. Copyright © 2018, Macmillan
Publishers Limited, part of Springer Nature.

<73>
Accession Number
2001541737
Title
C-reactive protein and prognosis after percutaneous coronary intervention
and bypass graft surgery for left main coronary artery disease: Analysis
from the EXCEL trial.
Source
American Heart Journal. 210 (pp 49-57), 2019. Date of Publication: April
2019.
Author
Kosmidou I.; Redfors B.; Chen S.; Crowley A.; Lembo N.J.; Karmpaliotis D.;
Brown W.M.; Maupas E.; Durrleman N.; Shah A.; Reardon M.J.; Dressler O.;
Ben-Yehuda O.; Kappetein A.P.; Sabik J.F.; Serruys P.W.; Stone G.W.
Institution
(Kosmidou, Redfors, Chen, Crowley, Lembo, Karmpaliotis, Dressler,
Ben-Yehuda, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Kosmidou, Lembo, Karmpaliotis, Ben-Yehuda, Stone) NewYork-Presbyterian
Hospital/Columbia University Medical Center, New York, NY, United States
(Brown) Piedmont Heart Institute, Atlanta, GA, United States
(Maupas, Durrleman) Hopital Prive Les Franciscaines, Nimes, France
(Shah, Reardon) Houston Methodist Hospital, Houston, TX, United States
(Kappetein) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The prognostic impact of high-sensitivity C-reactive protein
(CRP) levels in patients with left main coronary artery disease (LMCAD)
treated with percutaneous coronary intervention (PCI) and coronary artery
bypass grafting (CABG) is unknown. We sought to determine the effect of
elevated baseline CRP levels on the 3-year outcomes after LMCAD
revascularization and to examine whether CRP influenced the relative
outcomes of PCI versus CABG. Method(s): In the EXCEL trial, patients
with LMCAD and Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX)
scores <=32 were randomized to PCI versus CABG. The primary composite
outcome of death, myocardial infarction (MI), or stroke was analyzed
according to baseline CRP levels. Result(s): Among 999 patients with
available CRP levels, median CRP was 3.10 mg/L (interquartile range
1.12-6.40 mg/L). The rate of the primary composite end point of death, MI,
or stroke at 3 years steadily increased with greater baseline CRP levels.
The adjusted relationship between the 3-year composite rate of death, MI,
or stroke and baseline CRP modeled as a continuous log-transformed
variable demonstrated steadily increasing event rates with greater CRP
levels (adjusted hazard ratio, 1.26, 95% CI 1.10-1.44, P =.0008).
Similarly, patients with CRP >=10 mg/L had a 3-fold higher risk of the
3-year primary end point compared to patients with lower CRP levels
(adjusted hazard ratio 2.92, 95% CI 1.88-4.54, P <.0001). The association
between an elevated CRP level and the adjusted 3-year risk of the primary
composite end point did not differ according to revascularization strategy
(P<inf>interaction</inf> =.75). Conclusion(s): In patients with LMCAD
undergoing revascularization, elevated baseline CRP levels were strongly
associated with subsequent death, MI, and stroke at 3 years, irrespective
of the mode of revascularization. Further studies are warranted to
determine whether anti-inflammatory therapies may improve the prognosis of
high-risk patients with LMCAD following revascularization. Copyright
© 2019 Elsevier Inc.

<74>
[Use Link to view the full text]
Accession Number
625257402
Title
Effect of Complementary Therapies in Patients Following Cardiac Surgery: A
Narrative Review.
Source
Holistic nursing practice. 31 (5) (pp 315-324), 2017. Date of Publication:
01 Sep 2017.
Author
Chandrababu R.; Nayak B.S.; Pai V.B.; Patil N.T.; George A.; George L.S.;
Devi E.S.
Institution
(Chandrababu) Manipal College of Nursing (Mr Chandrababu and Drs Nayak, L.
S. George, Devi) and Kasturba Medical Colleges, Manipal University,
Manipal, India
Publisher
NLM (Medline)
Abstract
Cardiovascular diseases are increasing rapidly and have become a major
health problem worldwide. The incidence and prevalence of cardiovascular
disease are increasing rapidly, predominantly in the developing countries.
Patients with cardiovascular disease who do not respond to routine medical
treatment will have to follow cardiac surgical procedures. The objective
of this study was to apprise the evidence of the effect of various
complementary therapies on postoperative outcomes among patients
undergoing cardiac surgery. A comprehensive literature search was made on
PubMed-Medline, CINAHL, Science Direct, Scopus, Web of Science, and the
Cochrane Library databases for original research studies published between
2000 and 2015. Original articles that reported the effect of complementary
therapies in patients undergoing cardiac surgery were included.
Twenty-eight studies were analyzed, and they have produced conflicting
results. Most of the studies (n = 25) have documented the effects of
complementary therapies on improving postoperative outcomes of patients,
whereas other studies (n = 3) found no evidence of improvement. Although
methods varied considerably, most of the studies included in this review
reported positive results. Therefore, there is some evidence that
complementary therapies can lead to positive postoperative outcomes.
Evidence of the efficacy of complementary therapies in cardiac surgical
patients remains inconclusive. Additional research is needed to provide a
strong evidence base for the use of complementary therapies to improve
postoperative outcomes and recovery in patients undergoing cardiac
surgery.

<75>
Accession Number
626328701
Title
Antifibrinolytic agents for paediatric scoliosis surgery: a systematic
review and meta-analysis.
Source
European Spine Journal. (no pagination), 2019. Date of Publication: 2019.
Author
Karimi S.; Lu V.M.; Nambiar M.; Phan K.; Ambikaipalan A.; Mobbs R.J.
Institution
(Karimi) Faculty of Medicine, Melbourne School of Medicine, Melbourne
University, Melbourne, VIC, Australia
(Karimi) Department of Orthopaedic Surgery, Westmead Hospital, Westmead,
Sydney, NSW 2145, Australia
(Lu, Phan) Faculty of Medicine, University of Sydney, Sydney, NSW,
Australia
(Nambiar) Department of Surgery, The University of Melbourne, Melbourne,
VIC, Australia
(Nambiar, Ambikaipalan) Department of Orthopaedic Surgery, Box Hill
Hospital, Melbourne, Australia
(Phan, Mobbs) NeuroSpine Surgery Research Group, Prince of Wales Private
Hospital, Randwick, Sydney, NSW, Australia
(Phan, Mobbs) Department of Neurosurgery, Prince of Wales Public Hospital,
Randwick, Sydney, NSW, Australia
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Study design: Systematic review and meta-analysis of randomised controlled
trials. Objective(s): The purpose of this study is to perform a
systematic review and meta-analysis of antifibrinolytic agents for
paediatric spine surgery. Background(s): Bleeding is an important
consideration in paediatric scoliosis surgery; blood loss leads directly
to higher morbidity and mortality. Antifibrinolytics are an attractive
non-invasive method of reducing bleeding as evidenced in arthroplasty,
cardiac surgery and adult scoliosis surgery. Method(s): A thorough
database search of Medline, PubMed, EMBASE and Cochrane was performed
according to PRISMA guidelines, and a systematic review was performed.
 Result(s): Five randomised controlled trials were identified in this
meta-analysis, consisting of a total of 285 spine surgery patients with
subgroups of tranexamic acid (n = 101), epsilon aminocaproic acid (n = 61)
and control (n = 123). This meta-analysis found that antifibrinolytics
lead to statistically significant reductions in peri-operative blood loss
(MD - 379.16, 95% CI [- 579.76, - 178.57], p < 0.001), intra-operative
blood loss (MD - 516.42, 95% CI [- 1055.58, 22.74], p < 0.001), reduced
fresh frozen plasma requirements (MD - 307.77, 95% CI [- 369.66, -
245.88], p < 0.001) and reduced post-operative blood loss (MD - 185.95,
95% CI [- 336.04, - 35.87], p = 0.02). Conclusion(s): This
meta-analysis concludes that antifibrinolytics lead to statistically
significant reductions in peri-operative blood loss, intra-operative blood
loss, reduced fresh frozen plasma requirements and reduced post-operative
blood loss with TXA. Graphical abstract: These slides can be retrieved
under Electronic Supplementary Material.[Figure not available: see
fulltext.]. Copyright © 2019, Springer-Verlag GmbH Germany, part
of Springer Nature.

<76>
Accession Number
626328282
Title
Pharmacological interventions for the prevention of acute kidney injury
after pediatric cardiac surgery: a network meta-analysis.
Source
Clinical and Experimental Nephrology. (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 Kapodistrian University of Athens, 15B, Ag. Thoma str.,
Athens 115 27, Greece
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Background: Acute kidney injury constitutes a major complication of
cardiac surgery in pediatric patients. The present meta-analysis aims to
accumulate current literature and assess the efficacy of pharmacological
interventions in preventing postoperative renal dysfunction after
congenital heart surgery. Method(s): Literature search was conducted
using Medline (1966-2018), Scopus (2004-2018), Cochrane Central Register
of Controlled Trials CENTRAL (1999-2018), Clinicaltrials.gov (2008-2018),
and Google Scholar (2004-2018) databases. Statistical analysis was
performed with Review Manager 5.3 and R 3.4.3. Result(s):
Meta-analysis included 14 studies, with a total of 2,625 patients. AKI
incidence was significantly lower in the dexmedetomidine (OR 0.49, 95% CI
[0.28-0.87]) and acetaminophen (OR 0.43, 94% CI [0.28-0.67]) groups, while
no difference was present in patients receiving corticosteroid (OR 1.16,
95% CI [0.69-1.95]), fenoldopam (OR 0.47, 95% CI [0.22-1.02]), or
aminophylline (OR 0.98, 95% CI [0.29-3.34]). Network meta-analysis
proposed that dexmedetomidine had the greatest probability (44.5%) to rank
first, although significant overlap with the other treatments was
observed. Conclusion(s): The present meta-analysis suggests that no
firm evidence exists about the protective role of pharmacological
interventions in the pediatric population. Future randomized controlled
trials should clarify the effectiveness of dexmedetomidine and
acetaminophen and indicate the optimal protocol to be applied, to protect
renal function in the perioperative setting. Copyright © 2019,
Japanese Society of Nephrology.

<77>
Accession Number
626327954
Title
Diagnostic accuracy of dobutamine stress echocardiography in the detection
of cardiac allograft vasculopathy in heart transplant recipients: A
systematic review and meta-analysis study.
Source
Echocardiography. (no pagination), 2019. Date of Publication: 2019.
Author
Elkaryoni A.; Abu-Sheasha G.; Altibi A.M.; Hassan A.; Ellakany K.; Nanda
N.C.
Institution
(Elkaryoni, Hassan) Division of Internal Medicine, University of Missouri
Kansas City, Kansas City, MO, United States
(Abu-Sheasha) Division of Biomedical Statistics and Medical Informatics,
Medical Research Institute, Alexandria University, Alexandria, Egypt
(Altibi) Division of Internal Medicine, Henry Ford Allegiance Health,
Jackson, MI, United States
(Ellakany) Division of Cardiovascular Disease, University of Alexandria
School of medicine, Alexandria, Egypt
(Nanda) Division of Cardiovascular Disease, University of Alabama at
Birmingham, Birmingham, AL, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Dobutamine stress echocardiography (DSE) is a well-established
imaging modality used to screen patients with mild-to-moderate risk for
coronary artery disease. In heart transplantation recipients, cardiac
allograft vasculopathy (CAV) is a common and lethal complication. The use
of DSE to detect CAV showed promising results initially, but later studies
showed limitation in its use to detect CAV. It is unclear if this cohort
of patients derives benefit from DSE. Method(s): We searched PubMed,
Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and
Scopus from inception through March 2018 for studies examining the
accuracy of DSE in correlation to coronary angiography (CA) or
intravascular ultrasound (IVUS) to detect CAV. Original studies comparing
the ability of DSE to detect CAV in comparison with CA or IVUS were
included. Relevant data were extracted and hierarchical summary receiver
operating characteristic analysis was conducted to test the overall
diagnostic accuracy of DSE for patients with CAV. Result(s): Eleven
studies (749 participants) met the inclusion criteria. The sensitivity of
DSE varied from 1.7% to 93.8%, and specificity, from 54.8% to 98.8%.
Pooled sensitivity was 60.2% (95% confidence interval (CI), 33.0%-82.3%)
and specificity 85.7% (95% CI, 73.8%-92.7%). DSE had an overall diagnostic
odds ratio (OR) of 9.1 (95% CI, 4.6-17.8), positive likelihood ratio (LR+)
of 4.1 (95% CI, 2.8-6.1), negative likelihood ratio (LR-) of 0.47 (95% CI:
0.23-0.73), and area under curve (AUC) of 0.73 (95% CI, 0.72-0.75).
Heterogeneity among studies was not statistically significant
(tau2= 0.32, Cochran's Q = 9.5, P = 0.483). Conclusion(s):
Dobutamine stress echocardiography has a limited sensitivity to detect
early CAV but its specificity is much higher. There remains a need for an
alternative noninvasive modality which will have both high sensitivity and
high specificity for detecting CAV. Copyright © 2019 Wiley
Periodicals, Inc.

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