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<1>
Accession Number
2001465654
Title
Catheter Ablation of Ventricular Tachycardia in Patients With a
Ventricular Assist Device: A Systematic Review of Procedural
Characteristics and Outcomes.
Source
JACC: Clinical Electrophysiology. 5 (1) (pp 39-51), 2019. Date of
Publication: January 2019.
Author
Anderson R.D.; Lee G.; Virk S.; Bennett R.G.; Hayward C.S.; Muthiah K.;
Kalman J.; Kumar S.
Institution
(Anderson, Lee, Kalman) Department of Cardiology, Royal Melbourne
Hospital, Faculty of Medicine, Dentistry, and Health Science, University
of Melbourne, Melbourne, Australia
(Virk, Kumar) Department of Cardiology, Westmead Hospital, Westmead,
Australia
(Bennett) Bristol Heart Institute, Bristol Royal Infirmary, Bristol,
United Kingdom
(Hayward, Muthiah) Heart Failure and Transplant Unit, Department of
Cardiology, St. Vincent's Hospital, Darlinghurst, Australia
(Kumar) Department of Cardiology, Westmead Applied Research Centre,
University of Sydney, Westmead, Australia
Publisher
Elsevier Inc
Abstract
Objectives: This is a systematic review summarizing the procedural
characteristics and outcomes of ventricular assist device (VAD)-related
ventricular tachycardia (VT) ablation. <br/>Background(s): Drug-refractory
VT refractory commonly develops post-VAD implantation. Procedural and
outcome data come from small series or case reports. <br/>Method(s): An
electronic search was performed using major databases. Primary outcomes
were VT recurrence, mortality, and cardiac transplantation. Secondary
endpoints were acute procedural success and procedural complications.
<br/>Result(s): Eighteen studies were included, with a total of 110
patients (mean age 59.6 +/- 11 years, 89% men; VT storm 34%). Scar-related
re-entry was the predominant mechanism of VT (90.3%) and cannula-related
VT in 19.3% cases. Electroanatomical mapping interference occurred in 1.8%
of cases; there were no reports of catheter entrapment. Noninducibility of
clinical VT was achieved in 77.9%; procedural complications occurred in
9.4%. At a mean follow-up of 263.5 +/- 267.0 days, VT recurred in 43.6%,
23.4% underwent cardiac transplant, and 48.1% died. There were no
procedural-related deaths and no death was directly related to ventricular
arrhythmia. In follow-up, there was a significant reduction in implantable
cardioverter-defibrillator therapies or shocks (57.1% vs. 23.8%). Ablation
allowed VT storm termination in 90% of patients. <br/>Conclusion(s):
VAD-related VT is predominantly related to pre-existing intrinsic
myocardial scar rather than inflow cannula site insertion. Catheter
ablation is a reasonable treatment strategy, albeit with expectedly high
rate of recurrence, transplantation, and mortality related to severe
underlying disease.<br/>Copyright &#xa9; 2019

<2>
Accession Number
2001382906
Title
Systematic preoperative CT scan is associated with reduced risk of stroke
in minimally invasive mitral valve surgery: A meta-analysis.
Source
International Journal of Cardiology. 278 (pp 300-306), 2019. Date of
Publication: 1 March 2019.
Author
Leonard J.R.; Henry M.; Rahouma M.; Khan F.M.; Wingo M.; Hameed I.; Di
Franco A.; Guy T.S.; Girardi L.N.; Gaudino M.
Institution
(Leonard, Henry, Rahouma, Khan, Wingo, Hameed, Di Franco, Guy, Girardi,
Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New
York City, NY, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Minimally invasive mitral valve surgery (MIMVS) is performed
with increasing frequency. However, patients undergoing MIMVS might be at
increased risk of perioperative stroke, mainly due to retrograde aortic
embolization during femoral cardio-pulmonary bypass. Pre-operative
computed tomography (CT) screening allows visualization of the aorta and
femoro-iliac vessels and individualization of the surgical approach. In
this meta-analysis, we aim to determine if systematic pre-operative CT
screening is associated with decreased incidence of post-operative stroke
and other complications following MIMVS. <br/>Method(s): A comprehensive
review was performed in PubMed (inception-May 2018). Eligible studies
included those which reported on MIMVS (mini-thoracotomy, port access or
robotic approach) with retrograde arterial perfusion. Studies were
separated into two subgroups: systematic pre-operative CT screening
(CT-group) and no CT screening (Non-CT). Pooled event rates (PER) for
operative mortality, post-operative stroke, perioperative myocardial
infarction (MI), and new onset renal failure requiring dialysis were
estimated and inter-group comparisons were performed. <br/>Result(s): Data
from 57 studies (13,731 patients) were analyzed (19 CT-group, 38 Non-CT).
PER for post-operative stroke was 2.0% with a statistically significant
difference between the groups (CT-group: 1.5% versus Non-CT: 2.2%, P =
0.03). PER for new dialysis was 1.9%, significantly lower in the CT-group
(0.8% versus 2.3% in the Non-CT group, P = 0.02). PER for operative
mortality was 1.4% with a trend towards better outcomes in the CT-group
(0.8% versus 1.6% in the Non-CT group, P = 0.05). <br/>Conclusion(s):
Systematic pre-operative CT screening is associated with lower risk of
post-operative stroke and need for dialysis and a trend toward lower
operative mortality after MIMVS.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<3>
Accession Number
2001214205
Title
Systematic review of native and graft-related aortic infection outcome
managed with orthotopic xenopericardial grafts.
Source
Journal of Vascular Surgery. 69 (2) (pp 614-618), 2019. Date of
Publication: February 2019.
Author
Hostalrich A.; Ozdemir B.A.; Sfeir J.; Solovei L.; Alric P.; Canaud L.
Institution
(Hostalrich, Ozdemir, Sfeir, Solovei, Alric, Canaud) Department of
Thoracic and Vascular Surgery, Hopital A de Villeneuve, Montpellier,
France
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Limited data are available on the use of xenopericardium in the
treatment of native and graft-related aortic infections. The aim of this
review was to assess outcomes of neoaortic reconstruction using
xenopericardium in this challenging group of patients. <br/>Method(s):
Studies involving xenopericardial graft reconstruction to treat native and
aortic graft infections were systematically searched and reviewed (Embase,
Medline, and Cochrane databases) for the period of January 2007 to
December 2017. <br/>Result(s): A total of 4 studies describing 71 patients
treated for aortic graft (n = 54) and native aortic (n = 17) infections
were included; 25 patients (35%) were operated on in an acute setting. The
technical success rate was 100%. The mean 30-day mortality was 25% (range,
7.7%-31%). Only one death (1.4%) was linked to the operator-made
pericardial tube graft (acute postoperative bleeding from proximal
anastomosis). Septic multiorgan failure was the most common cause of
perioperative death (72% [13/18]). Among the 53 patients who survived,
only 3 presented with recurrent infection (5.7%), so 70.4% of patients
were alive after intervention without evidence of infection (50/71).
During follow-up, 2 false aneurysms (3.7% [2/53]), 1 early rupture (1.4%
[1/71]), and 2 cases (3.7% [2/53]) of late rupture were reported. Other
causes of late deaths unrelated to the aortic xenopericardial repair were
not reported in the different series. The early reintervention rate was
1.4% (1/71), treated by open repair for rupture. The late reintervention
rate was 7.5% (4/53) with thoracic endovascular aortic repair in three
patients (one false aneurysm and two ruptures) and open repair in one
patient (one false aneurysm). There were no cases of early or late graft
thrombosis. One-year mortality rate was 38% but only 4.2% were related to
the aortic repair using orthotopic xenopericardium (one early and two late
ruptures). <br/>Conclusion(s): These data confirm the high morbidity of
native and graft-related aortic infections and provide insight into the
results of orthotopic xenografts as a treatment alternative. Larger series
and longer follow-up will be required to compare the role of operator-made
pericardial tube graft with other treatment options in infected
fields.<br/>Copyright &#xa9; 2018 Society for Vascular Surgery

<4>
Accession Number
2001285620
Title
Long-term clinical outcomes of valsartan in patients with a systemic right
ventricle: Follow-up of a multicenter randomized controlled trial.
Source
International Journal of Cardiology. 278 (pp 84-87), 2019. Date of
Publication: 1 March 2019.
Author
van Dissel A.C.; Winter M.M.; van der Bom T.; Vliegen H.W.; van Dijk
A.P.J.; Pieper P.G.; Sieswerda G.T.; Roos-Hesselink J.W.; Zwinderman A.H.;
Mulder B.J.M.; Bouma B.J.
Institution
(van Dissel, Winter, van der Bom, Mulder, Bouma) Department of Cardiology,
Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam,
Netherlands
(van Dissel, Mulder) Netherlands Heart Institute, Utrecht, Netherlands
(Vliegen) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(van Dijk) Department of Cardiology, Radboud University Medical Center,
Nijmegen, Netherlands
(Pieper) Department of Cardiology, University Medical Center Groningen,
Groningen, Netherlands
(Sieswerda) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Roos-Hesselink) Department of Cardiology, Erasmus Medical Center,
Rotterdam, Netherlands
(Zwinderman) Department of Clinical Epidemiology, Biostatistics and
Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam,
Netherlands
Publisher
Elsevier Ireland Ltd
Abstract
Objectives: In the VAL-SERVE (Valsartan in Systemic Right Ventricle)
trial, three-year valsartan treatment improved systemic ventricular
function only in symptomatic patients with congenitally or with an atrial
switch corrected transposition of the great arteries. The aim of the
current study was to investigate the longer-term clinical outcomes after
valsartan treatment. <br/>Method(s): From 2006 to 2009, 88 adults were
randomly allocated 1:1 to either valsartan or placebo for three
consecutive years. Endpoints were defined as overall survival and freedom
from clinical events (arrhythmia, heart failure, tricuspid valve surgery,
death). <br/>Result(s): Cardiac drug use and median follow-up after trial
close-out (8.3 years) was similar between the randomization groups. Six
patients (valsartan n = 3, placebo n = 3) died in 364 and 365 person-years
(P = 0.999). No difference in the composite or separate clinical endpoints
was found between the randomization groups, with corresponding long-term
event-free survival rates of 50% and 34%. Nevertheless, in symptomatic
patients valsartan significantly reduced the risk for events compared to
placebo (HR 0.37, 95% CI 0.17-0.92). Analysis for repeated events and
on-treatment analysis with any
renin-angiotensin-aldosterone-system-inhibitor did not alter these
results. <br/>Conclusion(s): Valsartan treatment in systemic RV patients
did not result in improved survival at longer-term follow-up, but was
associated with decreased risk of events in symptomatic
patients.<br/>Copyright &#xa9; 2018

<5>
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Accession Number
624837963
Title
Del Nido cardioplegia for myocardial protection in adult cardiac surgery:
A systematic review and meta-analysis.
Source
ASAIO Journal. 64 (3) (pp 360-367), 2018. Date of Publication: 2018.
Author
Li Y.; Lin H.; Zhao Y.; Li Z.; Liu D.; Wu X.; Ji B.; Gao B.
Institution
(Li, Lin, Zhao, Liu, Wu) Department of Cardiac Surgery, Lanzhou University
Second Hospital, Lanzhou University, Lanzhou, China
(Li) Department of Cardiopulmonary Bypass, State Key Laboratory of
Cardiovascular Medicine, Fuwai Hospital, National Center for
Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union
Medical College, Beijing, China
(Li) Department of Cardiopulmonary Bypass, Lanzhou University Second
Hospital, Lanzhou University, Lanzhou, China
(Ji) Department of Cardiopulmonary Bypass, State Key Laboratory of
Cardiovascular Medicine, Fuwai Hospital, National Center for
Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union
Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 10010,
China
(Gao) Department of Cardiac Surgery, Lanzhou University Second Hospital,
No. 80, Cuiyingmen, Chengguan District, Lanzhou 730030, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Cardioplegia is an important strategy for myocardial protection during
cardiac surgery. This meta-analysis was to compare the effects of del Nido
and conventional cardioplegia in adult patients. Systematic searches were
performed to identify studies using PubMed, Embase, the Cochrane Library,
and the International Clinical Trials Registry Platform. A total of nine
studies were included. Cardiopulmonary bypass and cross-clamp time were
significantly shorter in the del Nido than conventional cardioplegia (mean
difference [MD]: -7.52, 95% confidence interval [95% CI]: -14.76 to -0.29,
p = 0.04; MD: -5.74, 95% CI: -10.14 to -1.34, p = 0.01). During the
operation, cardioplegia volume and blood glucose level were lower in the
del Nido group (MD: -522.53, 95% CI: -926.68 to -118.37, p = 0.01;
standardized mean difference [SMD]: -1.11, 95% CI: -1.74 to -0.48, p =
0.0006). Ventilation time and length of intensive care unit were decreased
significantly with del Nido cardioplegia (MD: -1.05, 95% CI: -1.79 to
-0.31, p = 0.006; MD: -0.65, 95% CI: -0.92 to -0.38, p < 0.00001). There
were no differences in myocardial enzyme, postoperative inotropic support,
atrial fibrillation, hospital, and mortality between the two groups. In
adult cardiac surgery, myocardial protection used with the del Nido or
conventional cardioplegia solution yield similar short-term clinical
outcomes. ASAIO Journal 2018; 64:360-367.<br/>Copyright &#xa9; 2017 by the
ASAIO

<6>
[Use Link to view the full text]
Accession Number
624014832
Title
Individualized Biventricular Epicardial Augmentation Technology in a
Drug-Induced Porcine Failing Heart Model.
Source
ASAIO Journal. 64 (4) (pp 480-488), 2018. Date of Publication: 2018.
Author
Jagschies L.; Hirschvogel M.; Matallo J.; Maier A.; Mild K.; Brunner H.;
Hinkel R.; Gee M.W.; Radermacher P.; Wildhirt S.M.; Hafner S.
Institution
(Jagschies, Hirschvogel, Gee) Mechanics and High Performance Computing
Group, Technical University of Munich, Garching, Germany
(Maier, Wildhirt) AdjuCor GmbH, Garching, Germany
(Mild, Brunner) Klinik fur Diagnostische und Interventionelle Radiologie,
Universitatsklinikum Ulm, Ulm, Germany
(Hinkel) Institute for Cardiovascular Prevention (IPEK), LMU, Munich,
Germany
(Hinkel) . Medizinische Klinik, Klinikum Rechts der Isar, TUM, Munich,
Germany
(Hinkel) DZHK (German Center for Cardiovascular Research), Partner Site
Munich Heart Alliance, Munich, Germany
(Hafner) Klinik fur Anasthesiologie, Universitatsklinikum Ulm, Ulm,
Germany
(Matallo, Hafner) Institut fur Anasthesiologische Pathophysiologie und
Verfahrensentwicklung, Universitatsklinikum Ulm, Helmholtzstrasse 8-1, Ulm
89081, Germany
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
For treatment of advanced heart failure, current strategies include
cardiac transplantation or blood-contacting pump technology associated
with complications, including stroke and bleeding. This study investigated
an individualized biventricular epicardial augmentation technology in a
drug-induced porcine failing heart model. A total of 11 pigs were used,
for the assessment of hemodynamics and cardiac function under various
conditions of support pressures and support durations (n = 4), to assess
device positioning and function by in vivo computer tomographic imaging (n
= 3) and to investigate a minimally invasive implantation on the beating
heart (n = 4). Support pressures of 20-80 mm Hg gradually augmented
cardiac function parameters in this animal model as indicated by increased
left ventricular stroke volume, end-systolic pressures, and decreased
end-diastolic pressures. Strong evidence was found regarding the necessity
of mechanical synchronization of support end with the isovolumetric
relaxation phase of the heart. In addition, the customized,
self-expandable implant enabled a marker-guided minimally invasive
implantation through a 4 cm skin incision using fluoroscopy. Correct
positioning was confirmed in computer tomographic images. Continued
long-term survival investigations will deliver preclinical evidence for
further development of this concept. ASAIO Journal 2018;
64:480-488.<br/>Copyright &#xa9; 2017 by the ASAIO.

<7>
Accession Number
619944647
Title
Clinical impact of culture-positive preservation fluid on solid organ
transplantation: A systematic review and meta-analysis.
Source
Transplantation Reviews. 32 (2) (pp 85-91), 2018. Date of Publication:
April 2018.
Author
Oriol I.; Sabe N.; Tebe C.; Veroux M.; Boin I.F.S.F.; Carratala J.
Institution
(Oriol, Sabe, Carratala) Infectious Disease Department, Hospital
Universitari de Bellvitge - IDIBELL, Spanish Network for Research in
Infectious Diseases (REIPI), and Clinical Science Department, Faculty of
Medicine, University of Barcelona, Barcelona, Spain
(Tebe) Statistical Assessment Service at Bellvitge Biomedical Research
Institute (IDIBELL) and Department of Basic Sciences, Universitat Rovira I
Virgili, Spain
(Veroux) Organ Transplant Unit, Department of Medical and Surgical
Sciences and Advanced Technologies, Gf. Ingrassia University of Catania,
Catania, Italy
(Boin) Unit of Liver Transplantation, State University of Campinas, Sao
Paulo, Brazil
Publisher
W.B. Saunders
Abstract
Contamination of the preservation fluid (PF) used for donated organs is a
potential source of post-transplant infection. However, the information on
this issue is scarce. We therefore conducted a systematic review and
meta-analysis to assess the incidence of culture-positive PF and its
impact on solid organ transplant (SOT) recipients. Seventeen studies were
identified and included. The overall incidence of culture-positive PF was
37% (95% CI: 27% to 49%), and the incidence of PF-related infections among
SOT recipients with PF cultures that grew pathogenic microorganisms was
10% (95% CI: 7% to 15%). There were differences in the rates of infections
due to pathogenic microorganisms between SOT recipients who received
pre-emptive treatment and those who did not, but without statistical
significance. The mortality rate among SOT recipients with PF-related
infection was 35% (95% CI: 21% to 53%). In conclusion, although
contamination of the PF of donated organs is frequent, the incidence of
PF-related infection is relatively low. A closely clinical and
microbiologic monitoring of the SOT recipient in case of culture-positive
PF, regardless of the type of microorganism isolated might be do in order
to establish a prompt diagnosis of PF-related infection.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<8>
Accession Number
617376205
Title
Pulse on Spontaneous Coronary Artery Dissections: Experience-Based Survey.
Source
JACC: Cardiovascular Interventions. 10 (14) (pp 1469-1471), 2017. Date of
Publication: 24 Jul 2017.
Author
Buccheri D.; Zambelli G.; Alfonso F.; Cortese B.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<9>
Accession Number
614848100
Title
Valvular Heart Disease Patients on Edoxaban or Warfarin in the ENGAGE
AF-TIMI 48 Trial.
Source
Journal of the American College of Cardiology. 69 (11) (pp 1372-1382),
2017. Date of Publication: 21 Mar 2017.
Author
De Caterina R.; Renda G.; Carnicelli A.P.; Nordio F.; Trevisan M.; Mercuri
M.F.; Ruff C.T.; Antman E.M.; Braunwald E.; Giugliano R.P.
Institution
(De Caterina, Renda) Institute of Cardiology and Center of Excellence on
Aging, G. d'Annunzio University, Chieti, Italy
(Carnicelli, Nordio, Trevisan, Ruff, Antman, Braunwald, Giugliano)
Cardiovascular Medicine Division, Brigham and Women's Hospital, Boston,
Massachusetts, United States
(Mercuri) Pharma Development, Daiichi-Sankyo, Parsippany, New Jersey,
United States
Publisher
Elsevier USA
Abstract
Background The use of non-vitamin K antagonist oral anticoagulants (NOACs)
instead of vitamin K antagonists (VKAs) in patients with atrial
fibrillation (AF) and coexisting valvular heart disease (VHD) is of
substantial interest. Objectives This study explored outcomes in patients
with AF with and without VHD in the ENGAGE AF-TIMI 48 (Effective
Anticoagulation with factor Xa Next Generation in Atrial
Fibrillation-Thrombolysis In Myocardial Infarction 48) trial, comparing
edoxaban with warfarin. Methods Valvular heart disease was defined as
history or baseline echocardiography evidence of at least moderate
aortic/mitral regurgitation, aortic stenosis, or prior valve surgery
(bioprosthesis replacement, valve repair, valvuloplasty). Patients with
moderate to severe mitral stenosis or mechanical heart valves were
excluded from the trial. Comparisons were made of rates of stroke/systemic
embolic event (SSEE), major bleeding, additional efficacy and safety
outcomes, as well as net clinical outcomes, in patients with or without
VHD treated with edoxaban or warfarin, using adjusted Cox proportional
hazards. Results After adjustment for multiple baseline characteristics,
compared with no-VHD patients (n = 18,222), VHD patients (n = 2,824) had a
similar rate of SSEE but higher rates of death (hazard ratio [HR]: 1.40;
95% confidence interval [CI]:1.26 to 1.56; p <0.001), major adverse
cardiovascular events (HR: 1.29; 95% CI: 1.16 to 1.43; p <0.001), and
major bleeding (HR: 1.21; 95% CI: 1.03 to 1.42; p = 0.02). Higher-dose
edoxaban regimen had efficacy similar to warfarin in the presence of VHD
(for SSEE, HR: 0.69; 95% CI: 0.44 to 1.07, in patients with VHD, and HR:
0.91; 95% CI: 0.77 to 1.07, in patients without VHD; p interaction
[p<inf>int</inf>] = 0.26; and for less major bleeding, HR: 0.74; 95% CI:
0.53 to 1.02 in patients with VHD, and HR: 0.82; 95% CI: 0.71 to 0.94, in
patients with no VHD; p<inf>int</inf> = 0.57). Conclusions The presence of
VHD increased the risk of death, major adverse cardiovascular events, and
major bleeding but did not affect the relative efficacy or safety of
higher-dose edoxaban versus warfarin in AF. (Global Study to Assess the
Safety and Effectiveness of Edoxaban (DU-176b) vs. Standard Practice of
Dosing With Warfarin in Patients With Atrial Fibrillation [ENGAGE AF-TIMI
48]; NCT00781391)<br/>Copyright &#xa9; 2017 The Authors

<10>
Accession Number
626115861
Title
Effect of Listening to Music on Patient Anxiety and Pain Perception during
Urodynamic Study: Randomized Controlled Trial.
Source
LUTS: Lower Urinary Tract Symptoms. 11 (1) (pp 39-42), 2019. Date of
Publication: January 2019.
Author
Ozturk E.; Hamidi N.; Yikilmaz T.N.; Ozcan C.; Basar H.
Institution
(Ozturk, Yikilmaz, Basar) Department of Urology, Dr Abdurrahman Yurtaslan
Training and Research Hospital, Ankara, Turkey
(Hamidi) Deparment of Urology, Ataturk Training and Research Hospital,
Ankara, Turkey
(Ozcan) Deparment of Urology, Gulhane Training and Research Hospital,
Ankara, Turkey
Publisher
Blackwell Publishing
Abstract
Objective: Urodynamic studies (UDS) include assessments of the physics and
physiology of the lower urinary tract (LUT). It is an invasive test and
patients can feel fear and anxiety, especially at the beginning of the
test. The aim of this study was to determine whether listening to music
during urodynamic study decreases patient anxiety and pain.
<br/>Method(s): Sixty-two patients who underwent urodynamic study were
randomized into the following groups: no music (group 1, n = 30) or
classical music (group 2, n = 32) during the procedure. Patient anxiety
levels were quantified using the State-Trait Anxiety Inventory (STAI) and
Beck's Anxiety Inventory (BAI). A visual analog scale (VAS) was used for
self-assessment of discomfort and willingness among patients to have a
repeat urodynamic study. <br/>Result(s): Demographic characteristics, mean
age, duration of procedure, systolic and diastolic blood pressure (SBP and
DBP) and heart rate before procedure were statistically significantly
similar between the two groups. Statistically significant differences were
detected between the two groups in the mean pain score on VAS (4.1 +/- 1.4
vs 2.6 +/- 1.8), mean post-procedural STAI score (46 +/- 5.8 vs 37.3 +/-
5) and mean BAI score (14.2 +/- 1.7 vs 3.5 +/- 0.7). SBP and DBP and heart
rate were similar between the groups. <br/>Conclusion(s): Music is a
cheap, safe and effective intervention that has gained increasing
recognition as an effective tool to reduce pain and anxiety. Listening to
music during urodynamic study reduced patient pain and
anxiety.<br/>Copyright &#xa9; 2017 John Wiley & Sons Australia, Ltd

<11>
Accession Number
2001283379
Title
Haemodynamic profiles of etomidate vs propofol for induction of
anaesthesia: a randomised controlled trial in patients undergoing cardiac
surgery.
Source
British Journal of Anaesthesia. 122 (2) (pp 198-205), 2019. Date of
Publication: February 2019.
Author
Hannam J.A.; Mitchell S.J.; Cumin D.; Frampton C.; Merry A.F.; Moore M.R.;
Kruger C.J.
Institution
(Hannam) Department of Pharmacology and Clinical Pharmacology, Faculty of
Medical and Health Sciences, University of Auckland, Auckland, New Zealand
(Hannam, Mitchell, Cumin, Merry, Moore) Department of Anaesthesiology,
Faculty of Medical and Health Sciences, University of Auckland, Auckland,
New Zealand
(Mitchell) Department of Anaesthesia, Auckland City Hospital, Auckland,
New Zealand
(Frampton) Department of Medicine, Christchurch School of Medicine and
Health Sciences, University of Otago, Dunedin, New Zealand
(Merry, Kruger) Department of Cardiothoracic and ORL Anaesthesia, Auckland
City Hospital, Auckland, New Zealand
Publisher
Elsevier Ltd
Abstract
Background: Etomidate is frequently selected over propofol for induction
of anaesthesia because of a putatively favourable haemodynamic profile,
but data confirming this perception are limited. <br/>Method(s): Patients
undergoing cardiac surgery were randomised to induction of anaesthesia
with propofol or etomidate. Phase I (n=75) was conducted as open-label,
whereas Phase II (n=75) was double blind. Mean arterial blood pressure
(MAP) and boluses of vasopressor administered after induction were
recorded. The primary endpoint was the area under the curve below baseline
MAP (MAP-time integral) during the 10 min after induction. Secondary
endpoints were the use of vasopressors over the same period, and the
effect of blinding on the aforementioned endpoints. Groups were compared
using regression models with phase and anaesthetist as factors.
<br/>Result(s): The mean difference between etomidate and propofol in the
MAP-time integral below baseline was 2244 mm Hg s (95% confidence
interval, 581-3906; P=0.009), representing a 34% greater reduction with
propofol. Overall, vasopressors were used in 10/75 patients in the
etomidate group vs 21/75 in the propofol group (P=0.38), and in 20/74
patients during the blinded phase vs 11/76 during the open-label phase
(P=0.31). The interaction between randomisation and phase (open-labelled
or blinded) was not significant for either primary (P=0.73) or secondary
endpoints (P=0.90). <br/>Conclusion(s): Propofol caused a 34% greater
reduction in MAP-time integral from baseline after induction of
anaesthesia than etomidate, despite more frequent use of vasopressors with
propofol, confirming the superior haemodynamic profile of etomidate in
this context. The proportion of patients receiving vasopressors increased
slightly, albeit not significantly, in both groups in the blinded phase.
Clinical trial registration: Australian and New Zealand Clinical Trials
Registry, ACTRN12614000717651.<br/>Copyright &#xa9; 2018 British Journal
of Anaesthesia

<12>
Accession Number
625764777
Title
Vitamin D supplements and prevention of cancer and cardiovascular disease.
Source
New England Journal of Medicine. 380 (1) (pp 33-44), 2019. Date of
Publication: 03 Jan 2019.
Author
Manson J.E.; Cook N.R.; Lee I.-M.; Christen W.; Bassuk S.S.; Mora S.;
Gibson H.; Gordon D.; Copeland T.; D'Agostino D.; Friedenberg G.; Ridge
C.; Bubes V.; Giovannucci E.L.; Willett W.C.; Buring J.E.
Institution
(Manson, Cook, Lee, Christen, Bassuk, Mora, Gibson, Gordon, Copeland,
D'Agostino, Friedenberg, Ridge, Bubes, Giovannucci, Willett, Buring)
Department of Medicine, Brigham and Women's Hospital, Harvard Medical
School, 900 Commonwealth Ave., Boston, MA 02215, United States
(Manson, Cook, Lee, Willett, Buring) Department of Epidemiology, Harvard
T.H. Chan School of Public Health, Boston, MA, United States
(Giovannucci, Willett) Department of Nutrition, Harvard T.H. Chan School
of Public Health, Boston, MA, United States
Publisher
Massachussetts Medical Society
Abstract
Background: It is unclear whether supplementation with vitamin D reduces
the risk of cancer or cardiovascular disease, and data from randomized
trials are limited. <br/>Method(s): We conducted a nationwide, randomized,
placebo-controlled trial, with a two-by-two factorial design, of vitamin
D3 (cholecalciferol) at a dose of 2000 IU per day and marine n-3 (also
called omega-3) fatty acids at a dose of 1 g per day for the prevention of
cancer and cardiovascular disease among men 50 years of age or older and
women 55 years of age or older in the United States. Primary end points
were invasive cancer of any type and major cardiovascular events (a
composite of myocardial infarction, stroke, or death from cardiovascular
causes). Secondary end points included site-specific cancers, death from
cancer, and additional cardiovascular events. This article reports the
results of the comparison of vitamin D with placebo. <br/>Result(s): A
total of 25,871 participants, including 5106 black participants, underwent
randomization. Supplementation with vitamin D was not associated with a
lower risk of either of the primary end points. During a median follow-up
of 5.3 years, cancer was diagnosed in 1617 participants (793 in the
vitamin D group and 824 in the placebo group; hazard ratio, 0.96; 95%
confidence interval [CI], 0.88 to 1.06; P = 0.47). A major cardiovascular
event occurred in 805 participants (396 in the vitamin D group and 409 in
the placebo group; hazard ratio, 0.97; 95% CI, 0.85 to 1.12; P = 0.69). In
the analyses of secondary end points, the hazard ratios were as follows:
for death from cancer (341 deaths), 0.83 (95% CI, 0.67 to 1.02); for
breast cancer, 1.02 (95% CI, 0.79 to 1.31); for prostate cancer, 0.88 (95%
CI, 0.72 to 1.07); for colorectal cancer, 1.09 (95% CI, 0.73 to 1.62); for
the expanded composite end point of major cardiovascular events plus
coronary revascularization, 0.96 (95% CI, 0.86 to 1.08); for myocardial
infarction, 0.96 (95% CI, 0.78 to 1.19); for stroke, 0.95 (95% CI, 0.76 to
1.20); and for death from cardiovascular causes, 1.11 (95% CI, 0.88 to
1.40). In the analysis of death from any cause (978 deaths), the hazard
ratio was 0.99 (95% CI, 0.87 to 1.12). No excess risks of hypercalcemia or
other adverse events were identified. <br/>Conclusion(s): Supplementation
with vitamin D did not result in a lower incidence of invasive cancer or
cardiovascular events than placebo.<br/>Copyright &#xa9; 2018
Massachusetts Medical Society.

<13>
Accession Number
2001489265
Title
How effective is reflexology on physiological parameters and weaning time
from mechanical ventilation in patients undergoing cardiovascular
surgery?.
Source
European Journal of Integrative Medicine. 26 (pp 43-49), 2019. Date of
Publication: February 2019.
Author
Kandemir D.; Oztekin S.D.
Institution
(Kandemir) Maltepe University, School of Nursing, Istanbul 34857, Turkey
(Oztekin) Istanbul University, Florence Nightingale Nursing Faculty,
Istanbul 34857, Turkey
Publisher
Elsevier GmbH
Abstract
Introduction: Cardiovascular disease is one of the leading causes of
morbidity and mortality in both developed and developing countries. The
present research was designed to determine the effects of reflexology on
physiological parameters and mechanical weaning (MV) weaning time.
<br/>Method(s): In this non-randomized controlled clinical trial, 85
patients who underwent open heart surgery were allocated into either an
experimental group (n = 42) or aut control group (n = 43) using
convenience sampling. The participants were informed about the study and a
written and oral informed consent was obtained from each patient. Along
with the study, a twenty-thirty-minute foot reflexology and routine care
treatments were applied to the patients in the experimental group and
control group, respectively in the post-operative period. In this context,
physiological parameters and mechanical ventilation weaning time of the
patients were examined at certain intervals. <br/>Result(s): According to
the values obtained before reflexology for experimental and control group,
the pulse rate (p = 0.013) and diastolic blood pressure (p = 0.021) of the
patients in the experimental group at 5 min before reflexology were
significantly higher. Moreover, oxygen saturation values of the patients
in the experimental group at 5 min after extubation were lower (p =
0.012). However, reflexology did not exhibit any significant changes in
other physiological parameters but the mechanical ventilation weaning time
after reflexology was shorter in the experimental group (p = 0.023).
<br/>Conclusion(s): Reflexology did not have a significant effect on
physiological parameters in patients receiving mechanical ventilation
support. Shortening the weaning time from mechanical ventilation suggests
that it might be applied effectively in patients receiving mechanical
ventilation support in intensive care unit.<br/>Copyright &#xa9; 2019
Elsevier GmbH

<14>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright
&#xa9; 2018, The Japanese Association for Thoracic Surgery.

<15>
Accession Number
625448685
Title
Permanent pacemaker implantation and paravalvular leak rates following
sutureless aortic valve operations.
Source
Journal of Cardiac Surgery. 33 (12) (pp 808-817), 2018. Date of
Publication: December 2018.
Author
Lazkani M.; Yerasi C.; Prakash S.; Pershad A.; Fang K.
Institution
(Lazkani) University of Colorado Health, Medical Center of the Rockies,
Loveland, CO, United States
(Yerasi) St. Joseph's Medical Center, Phoenix, AZ, United States
(Prakash, Pershad, Fang) University of Arizona, Banner University Medical
Center, Phoenix, AZ, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Permanent pacemaker (PPM) implantation and paravalvular leak
(PVL) rates after sutureless aortic valve replacement (SuAVR) vary widely.
The aim of this meta-analysis was to examine the incidence of new PPM
implantation and PVL after SuAVR. <br/>Method(s): Studies evaluating PPM
implantation and PVL rates after SuAVR were searched in Medline/PubMed,
Ovid Journals, Clinicaltrials.gov, Cochrane central register of controlled
trials and database. Studies with a sample size >=10 were included in this
analysis. Pooled proportions were calculated using both the fixed and
random-effects models. The heterogeneity among studies was tested using
I² statistic. The study design was written in accordance with
PRISMA guidelines. <br/>Result(s): Thirty studies involving 3993 patients
with a median follow-up of 12 months were included. The median age was 77
years and males constituted 50%. There was a history of stroke and
coronary artery disease in 6% and 31% of the population. Pooled
proportions demonstrate a cumulative postoperative PPM rate of 8.5% (95%
confidence interval [CI] 7.6-9.5%, I² = 68.8%) and the overall
rate of any PVL was 4.2% (95%CI 3.4-5%, I² = 76.1%) across all
major SuAVR devices. The rate of severe PVL was only 0.4% (95%CI 0.2-0.7%,
I² = 0%) at discharge and 0.5% (95%CI 0.2-0.9%, I² =
0%) at 12 months. <br/>Conclusion(s): In SuAVR prostheses implanted in
this meta-analysis, the postoperative permanent pacemaker rate was higher
(8.5%) than reported for non-SuAVR prosthesis. While the overall PVL rate
was 4.2%, the incidence of severe PVL was only 0.4% at discharge and
remained stable at 0.5% at 12 months.<br/>Copyright &#xa9; 2018 Wiley
Periodicals, Inc.

<16>
Accession Number
625447318
Title
Innominate artery cannulation in aortic surgery: A systematic review.
Source
Journal of Cardiac Surgery. 33 (12) (pp 818-825), 2018. Date of
Publication: December 2018.
Author
Harky A.; Wong C.H.M.; Chan J.S.K.; Zaki S.; Froghi S.; Bashir M.
Institution
(Harky, Zaki) Department of Vascular Surgery, Countess of Chester
Hospital, Chester, United Kingdom
(Wong, Chan) Faculty of Medicine, The Chinese University of Hong Kong,
Shatin, New Territories, Hong Kong
(Froghi) Department of Surgery, Imperial College NHS Trust, Hammersmith
Hospital, London, United Kingdom
(Bashir) Department of Aortovascular Surgery, Manchester Royal Infirmary,
Manchester, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: The innominate artery is considered an alternative site for
establishing cardiopulmonary bypass in surgical procedures involving the
thoracic aorta. This systematic review examines the use of innominate
artery cannulation in aortic surgery. <br/>Method(s): A systematic
literature search was undertaken among the four major databases (PubMed,
Embase, Scopus, and Ovid) to identify all studies that utilized innominate
artery cannulation for establishing cardiopulmonary bypass and providing
cerebral perfusion in thoracic aortic surgery. The data were reviewed up
to September 2018. <br/>Result(s): Acute type A aortic dissection
contributed to 36% (n = 818) of the total 2,290 patients. 31.5% (n = 719)
underwent surgery on the aortic root only; 54.5% (n = 1246) had ascending
and hemi-arch replacement, while 11.5% had total aortic arch replacement
and 2.5% had a frozen elephant trunk inserted. Postoperative stroke rate
was 1.25% (n = 28), temporary neurological deficit was 4.8% (n = 111).
All-cause 30-day mortality rate was 2.7% (n = 61). <br/>Conclusion(s):
Innominate artery cannulation is a safe technique in patients who undergo
thoracic aortic surgery. It can be utilized, in selected cases, as a
reliable route for establishing cardiopulmonary bypass and maintaining
cerebral perfusion.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<17>
Accession Number
625517946
Title
Transcatheter mitral valve replacement for mitral regurgitation-A
meta-analysis.
Source
Journal of Cardiac Surgery. 33 (12) (pp 827-835), 2018. Date of
Publication: December 2018.
Author
Takagi H.; Hari Y.; Kawai N.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: We performed a meta-analysis to determine the outcomes in
patients undergoing transcatheter mitral valve replacement (TMVR) for
mitral regurgitation (MR). <br/>Method(s): Databases including MEDLINE and
EMBASE were searched through April 2018 using Web-based search engines
(PubMed and OVID) to identify single-arm observational (case series)
studies of TMVR enrolling >=5 patients with MR. For each study, data
regarding observed 30-day mortality and predicted operative mortality
(Society of Thoracic Surgeons Predicted Risk of Mortality) were used to
generate risk ratios (RRs) and 95% confidence intervals (CIs).
Study-specific estimates were combined using the inverse variance-weighted
average of logarithmic RRs in the random-effects model. One-group
meta-analyses of 30-day and >30-day (including 30-day) mortality were also
performed in the random-effects model. <br/>Result(s): Of 222 potentially
relevant articles screened initially, nine eligible studies enrolling a
total of 146 patients with MR undergoing TMVR were identified. In all but
two studies, STS-PROM was available and varied from 3.3% to 15.4%
(arithmetic mean, 7.6%). Pooled analyses demonstrated 30-day mortality of
20.4% (95%CI, 9.6-31.2%), >30-day mortality of 32.0% (95%CI, 19.8-44.2%),
and non-significantly higher observed 30-day mortality than predicted
operative mortality (RR, 1.70; 95%CI, 0.85-3.42; P = 0.14). There was no
evidence of significant publication bias. <br/>Conclusion(s): TMVR for
patients with MR results in increased early and late
mortality.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<18>
Accession Number
2000707429
Title
Baroreflex activation therapy for the treatment of heart failure with
reduced ejection fraction in patients with and without coronary artery
disease.
Source
International Journal of Cardiology. 266 (pp 187-192), 2018. Date of
Publication: 1 September 2018.
Author
Halbach M.; Abraham W.T.; Butter C.; Ducharme A.; Klug D.; Little W.C.;
Reuter H.; Schafer J.E.; Senni M.; Swarup V.; Wachter R.; Weaver F.A.;
Wilks S.J.; Zile M.R.; Muller-Ehmsen J.
Institution
(Halbach, Reuter) Department of Internal Medicine III, University Hospital
of Cologne, Cologne, Germany
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, OH, United States
(Butter) Department of Cardiology, Immanuel Heart Center Bernau - Medical
School Brandenburg, Bernau, Germany
(Ducharme) Montreal Heart Institute, University of Montreal, Montreal,
Quebec, Canada
(Klug) Department of Cardiology A, University Hospital, Lille, France
(Little) Division of Cardiology, University of Mississippi Medical Center,
Jackson, MS, United States
(Schafer) Department of Statistics, NAMSA, Inc., Minneapolis, MN, United
States
(Senni) Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo,
Italy
(Swarup) Department of Electrophysiology, Arizona Heart Hospital, Phoenix,
AZ, United States
(Wachter) Clinic and Policlinic for Cardiology, University Hospital
Leipzig, Leipzig, Germany
(Weaver) Division of Vascular Surgery and Endovascular Therapy, Keck
School of Medicine, University of Southern California, Los Angeles, CA,
United States
(Wilks) Department of Research, CVRx, Inc., Minneapolis, MN, United States
(Zile) Medical University of South Carolina, Charleston, SC, United States
(Muller-Ehmsen) Department of Medicine, Asklepios Klinik Altona, Hamburg,
Germany
(Zile) Ralph H. Johnson Department of Veterans Affairs Medical Center,
Charleston, SC, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: In a randomized trial, baroreflex activation therapy (BAT)
improved exercise capacity, quality of life and NT-proBNP in patients with
heart failure with reduced ejection fraction (HFrEF). In view of different
mechanisms underlying HFrEF, we performed a post-hoc subgroup analysis of
efficacy and safety of BAT in patients with and without coronary artery
disease (CAD). <br/>Methods and Results: Patients with left ventricular
ejection fraction <35% and NYHA Class III were randomized 1:1 to
guideline-directed medical and device therapy alone or plus BAT. Patients
with a history of CAD, prior myocardial infarction or coronary artery
bypass graft were assigned to the CAD group with all others assigned to
the no-CAD group. Of 71 BAT treated patients, 52 had CAD and 19 had no
CAD. In the control group, 49 of 69 patients had CAD and 20 had no CAD.
The system- or procedure-related major adverse neurological or
cardiovascular event rate was 3.8% in the CAD group vs. 0% in the no-CAD
group (p = 1.0). In the whole cohort, NYHA Class, Minnesota Living with
Heart Failure score, 6-minute hall walk distance and NTproBNP were
improved in BAT treated patients compared with controls. Statistical
analyses revealed no interaction between the presence of CAD and effect of
BAT (all p > 0.05). <br/>Conclusion(s): No major differences were found in
BAT efficacy or safety between patients with and without CAD, indicating
that BAT improves exercise capacity, quality of life and NTproBNP in
patients with ischemic and non-ischemic cardiomyopathy. ClinicalTrials.gov
identifier NCT01471860 and NCT01720160.<br/>Copyright &#xa9; 2018 Elsevier
B.V.

<19>
Accession Number
621629656
Title
Randomized Controlled Trial on the Influence of Intraoperative
Remifentanil versus Fentanyl on Acute and Chronic Pain after Cardiac
Surgery.
Source
Pain Practice. 18 (4) (pp 443-451), 2018. Date of Publication: April 2018.
Author
de Hoogd S.; Ahlers S.J.G.M.; van Dongen E.P.A.; van de Garde E.M.W.;
Daeter E.J.; Dahan A.; Tibboel D.; Knibbe C.A.J.
Institution
(de Hoogd, Ahlers, van de Garde, Knibbe) Department of Clinical Pharmacy,
St. Antonius Hospital, Nieuwegein, Netherlands
(van Dongen) Department of Anesthesiology and Intensive Care, St. Antonius
Hospital, Nieuwegein, Netherlands
(Daeter) Department of Cardiothoracic Surgery, St. Antonius Hospital,
Nieuwegein, Netherlands
(Dahan) Department of Anesthesiology, Leiden University Medical Center,
Leiden, Netherlands
(Tibboel, Knibbe) Intensive Care and Department of Pediatric Surgery,
Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
(Knibbe) Division of Pharmacology, Leiden Academic Centre for Drug
Research, Leiden University, Leiden, Netherlands
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Remifentanil has been associated with increased acute and
potentially chronic postoperative pain. The objective of this prospective
randomized controlled trial was to investigate the influence of
intraoperative remifentanil on acute and chronic postoperative pain after
cardiac surgery. <br/>Method(s): Patients (N = 126) receiving standardized
anesthesia with propofol and intermittent intravenous fentanyl at
predetermined times for cardiac surgery were randomized to
intraoperatively receive either a continuous remifentanil infusion or
additional intermittent intraoperative fentanyl as needed. The primary
endpoint was chronic thoracic pain at 12 months after surgery. Secondary
endpoints were pain at 3 and 6 months after surgery and analgesic
requirements and pain levels in the first 72 hours. <br/>Result(s): There
was no significant difference in incidence of chronic thoracic pain
between the remifentanil and fentanyl groups, respectively (20% vs. 18%; P
= 0.817). At 3 months, however, significantly more patients in the
remifentanil group reported chronic thoracic pain (51% vs. 33%; P =
0.047). This effect was more pronounced in younger patients and in
patients receiving a higher dose of remifentanil (both P < 0.05). The
first 24 and 48 hours postoperatively, morphine consumption in the
remifentanil group was significantly higher than in the fentanyl group
(34.3 mg [interquartile range (IQR) 25.3 to 48.2] vs. 30.2 mg [IQR 19.2 to
38.1], P = 0.028; and 46.8 mg [IQR 33.8 to 59.2] vs. 39.0 mg [IQR 6.2 to
51.4], P = 0.047, respectively). <br/>Conclusion(s): Intraoperative use of
remifentanil during cardiac surgery does not impact chronic postoperative
pain 1 year after surgery. Nevertheless, remifentanil increases analgesic
requirements and thoracic pain until 3 months after surgery, and its use
is therefore less favorable during cardiac surgery.<br/>Copyright &#xa9;
2017 The Authors. Pain Practice published by Wiley Periodicals, Inc. on
behalf of World Institute of Pain

<20>
Accession Number
2001391669
Title
Moderate-to-high intensity inspiratory muscle training improves the
effects of combined training on exercise capacity in patients after
coronary artery bypass graft surgery: A randomized clinical trial.
Source
International Journal of Cardiology. 279 (pp 40-46), 2019. Date of
Publication: 15 March 2019.
Author
dos Santos T.D.; Pereira S.N.; Portela L.O.C.; Cardoso D.M.; Lago P.D.;
dos Santos Guarda N.; Moresco R.N.; Pereira M.B.; de Albuquerque I.M.
Institution
(dos Santos, Pereira, de Albuquerque) Functional Rehabilitation Graduate
Program, Department of Physiotherapy and Rehabilitation, Universidade
Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
(Pereira) Cardiology Service of Hospital Universitario de Santa Maria
(HUSM), Empresa Brasileira de Servicos Hospitalares (EBSERH), Santa Maria,
Rio Grande do Sul, Brazil
(Portela) Laboratory of Performance in Simulated Environment, Department
of Collective Sports, Universidade Federal de Santa Maria (UFSM), Santa
Maria, Rio Grande do Sul, Brazil
(Cardoso) Pneumological Sciences Graduate Program, Universidade Federal do
Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
(Lago) Research Group on Cardiopulmonary Interaction (GPIC), Health
Sciences Graduate Program, Universidade Federal de Ciencias da Saude de
Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
(dos Santos Guarda, Moresco) Laboratory of Clinical Biochemistry,
Department of Clinical and Toxicological Analysis, Universidade Federal de
Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
(Pereira) Hospital Universitario de Santa Maria (HUSM), Empresa Brasileira
de Servicos Hospitalares (EBSERH), Santa Maria, Rio Grande do Sul, Brazil
Publisher
Elsevier Ireland Ltd
Abstract
Background: The effects of adding moderate-to-high intensity inspiratory
muscle training (IMT) to short-term aerobic and resistance exercise
(combined training [CT]), after coronary artery bypass grafting (CABG) are
not established. This study aimed to determine the effects of
moderate-to-high intensity IMT + CT on exercise capacity, respiratory
muscle strength, inspiratory muscle endurance, quality of life (QoL), and
laboratory biomarkers in patients after CABG who were participants of a
phase II cardiac rehabilitation program. <br/>Method(s): Twenty-four
patients were randomly assigned to either the IMT + CT group (n = 12), who
performed moderate-to-high intensity IMT with CT or the sham-IMT + CT
group (n = 12). Patients completed two sessions per week for 12 weeks.
Each patient underwent a cardiopulmonary exercise test, six-minute walk
test (6MWT), respiratory muscle strength and endurance evaluation, QoL
questionnaire, and serum advanced oxidation protein products, ferric
reducing antioxidant power [FRAP], nitrate/nitrate, and high-sensitivity
C-reactive protein, before and after the 12-week intervention.
<br/>Result(s): The IMT + CT group showed significantly greater
improvements in peak oxygen uptake (1.3
mL.kg^-1.min^-1; 95% confidence interval [95% CI], 0.5
to 2.2), distance covered during the 6MWT (78.8 m; 95% CI, 28.1 to 129.5),
maximal inspiratory pressure (23.0 cmH<inf>2</inf>O; 95% CI, 9.3 to 36.7),
QoL (-15.1 points; 95% CI, -26.9 to -3.3), and FRAP (83.7 mumol/L; 95% CI,
20.2 to 147.1) compared to the sham-IMT + CT group as a result of the
intervention. <br/>Conclusion(s): Short-term moderate-to-high intensity
IMT with CT provided additional benefits in exercise capacity, inspiratory
muscle strength, QoL, and antioxidant profile in patients after CABG.
Trial Registration clinicaltrials.gov Identifier:
NCT02885077<br/>Copyright &#xa9; 2018 Elsevier B.V.

<21>
Accession Number
623824864
Title
Sentinel node navigation surgery in esophageal cancer.
Source
Annals of Gastroenterological Surgery. 3 (1) (pp 7-13), 2019. Date of
Publication: January 2019.
Author
Takeuchi H.; Kitagawa Y.
Institution
(Takeuchi) Department of Surgery, Hamamatsu University School of Medicine,
Hamamatsu, Japan
(Kitagawa) Department of Surgery, Keio University School of Medicine,
Tokyo, Japan
Publisher
Wiley-Blackwell Publishing Ltd (E-mail: info@royensoc.co.uk)
Abstract
Over the last 20 years, the sentinel node (SN) concept has been widely
applied to the surgical staging of both breast cancer and melanoma.
However, the validity of this concept has been controversial for
esophageal cancer, because SN mapping for esophageal cancer is not
considered to be technically easy because of the complicated
multidirectional lymphatic networks of the esophagus and mediastinum.
Nevertheless, studies including meta-analyses indicated that SN mapping
may be feasible in early esophageal cancer. Transthoracic esophagectomy
with three-field lymphadenectomy was developed as a potential curative
procedure for thoracic esophageal cancer. However, this highly invasive
procedure might increase morbidity and reduce patients' quality of life
(QOL) after esophagectomy. Although further validation based on
multicenter trials using the standard protocol of SN mapping for
esophageal cancer is required, SN navigation surgery would enable us to
carry out personalized and limited lymph node dissection which might
reduce morbidity and maintain patients' QOL.<br/>Copyright &#xa9; 2018 The
Authors. Annals of Gastroenterological Surgery published by John Wiley &
Sons Australia, Ltd on behalf of The Japanese Society of
Gastroenterological Surgery

<22>
Accession Number
2001173105
Title
Off-pump coronary artery bypass surgery: The long and winding road.
Source
International Journal of Cardiology. 279 (pp 51-55), 2019. Date of
Publication: 15 March 2019.
Author
Farina P.; Gaudino M.; Angelini G.D.
Institution
(Farina) Cardiothoracic Surgery, Mater Misericordiae University Hospital,
Dublin, Ireland
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York, NY, United States
(Angelini) Bristol Heart Institute, Bristol University, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
After more than thirty years, a hundred randomized studies and dozens of
meta-analyses, there is still controversy on the results and benefits of
off-pump coronary artery bypass grafting. The present review summarizes
the most relevant evidence, the relation of outcomes with surgeon's and
institution's experience, addresses regional variations in popularity of
the technique, and the need for structural training.<br/>Copyright &#xa9;
2018 Elsevier B.V.

<23>
Accession Number
625447359
Title
Newer-generation of Edwards transcatheter aortic valve systems: SAPIEN 3,
Centera, and SAPIEN 3 Ultra.
Source
Expert Review of Medical Devices. (no pagination), 2018. Date of
Publication: 2018.
Author
Solomonica A.; Choudhury T.; Bagur R.
Institution
(Solomonica, Choudhury, Bagur) London Health Sciences Centre, London,
Canada
(Bagur) Keele Cardiovascular Research Group, Centre for Prognosis
Research, Institute of Primary Care and Health Sciences, University of
Keele, Stoke-on-Trent, United Kingdom
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) has become
the standard of care for patients with severe symptomatic aortic stenosis
at moderate to high surgical risk. Newer devices are now available and
broader indications are expected in the near future. Areas covered: The
Placement of Aortic Transcatheter Valves (PARTNER) trials initially proved
the efficacy of TAVI with the balloon-expandable Edwards SAPIEN valve in
patients deemed in-operable and at high-risk, and later on in
intermediate-risk patients using the balloon-expandable SAPIEN-XT valve.
These trials had laid the groundwork for advancements incorporated in the
balloon-expandable SAPIEN-3 system such as the introduction of the
anti-leak skirt and improved delivery system. In this review, we summarize
the available data on the SAPIEN-3 transcatheter heart valve system and we
highlight the special features of the newly designed self-expanding
Edwards CENTERA valve, and the latest generation of balloon-expanable
SAPIEN-3 UltraTM system. A detailed literature search on these devices was
undertaken using Ovid, PubMed, and Web of Science. Expert commentary: Data
from clinical trials show that TAVI with newer-generation of Edwards
transcatheter heart valve systems have shown significant improvement in
terms of reduced paravalvular leak and have been associated with extremely
good clinical outcomes.<br/>Copyright &#xa9; 2018, &#xa9; 2018 Informa UK
Limited, trading as Taylor & Francis Group.

<24>
Accession Number
623277154
Title
Effects of lowest-dose vs. highest-dose pitavastatin on coronary
neointimal hyperplasia at 12-month follow-up in type 2 diabetic patients
with non-ST elevation acute coronary syndrome: an optical coherence
tomography analysis.
Source
Heart and Vessels. 34 (1) (no pagination), 2018. Date of Publication: 22
Jan 2019.
Author
Lim J.W.; Jeong H.S.; Hong S.J.; Kim H.J.; Kim Y.C.; Kang B.G.; Jeon S.M.;
Cho J.Y.; Lee S.H.; Joo H.J.; Park J.H.; Yu C.W.
Institution
(Lim, Jeong, Hong, Kim, Kim, Kang, Jeon, Cho, Lee, Joo, Park, Yu)
Department of Cardiology, Cardiovascular Center, Korea University Anam
Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul 136-705, South Korea
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Current ACC/AHA guidelines recommend high-dose statin therapy after
coronary stenting, especially in diabetic patients; however, pitavastatin
4 mg or pitavastatin 1 mg are frequently used after coronary stenting in
Asia, even in patients with acute coronary syndrome. We compared the
effects of highest-dose and lowest-dose pitavastatin therapy on coronary
neointimal hyperplasia at 12-month follow-up in diabetic patients with
non-ST-elevation acute coronary syndrome (NSTE-ACS) using optical
coherence tomography. A total of 72 diabetic patients with NSTE-ACS were
randomized to lowest-dose pitavastatin [1 mg (n = 36)] or highest-dose
pitavastatin [4 mg (n = 36)] after everolimus-eluting stent implantation.
The primary endpoint was to compare the normalized neointimal volume at
12-month follow-up. Normalized neointimal volume was significantly lower
in the pitavastatin 4 mg group (4.00 +/- 2.80 vs. 8.24 +/- 2.83
mm³/mm, p < 0.01) at 12-month follow-up. There was also
significant difference in neointimal area between the pitavastatin 4 mg
group and pitavastatin 1 mg group (0.41 +/- 0.28 vs. 0.74 +/- 0.23
mm², p < 0.01). Improvement of brachial artery flow-mediated
dilation (baFMD) was significantly higher in the pitavastatin 4 mg group
than in pitavastatin 1 mg group (0.15 +/- 0.15 vs. - 0.03 +/- 0.19 mm, p <
0.001). In addition, the improvement of adiponectin levels was
significantly greater in the pitavastatin 4 mg group than in the
pitavastatin 1 mg group (2.97 +/- 3.98 vs. 0.59 +/- 2.80 mug/mL, p <
0.05). Pitavastatin 4 mg significantly improved inflammatory cytokines and
lipid profiles compared to pitavastatin 1 mg during the 12-month
follow-up, contributing to the reduction of neointimal hyperplasia and to
the improvement of baFMD in diabetic patients with NSTE-ACS requiring
coronary stenting. Thus, the administration of pitavastatin 4 mg can be
safely and effectively used in high-risk patients requiring coronary
stenting. Trial registration NCT02545231 (Clinical Trial registration
information:
https://clinicaltrials.gov/ct2/show/NCT02545231).<br/>Copyright &#xa9;
2018, Springer Japan KK, part of Springer Nature.

<25>
Accession Number
626109585
Title
RhoA/rho-kinase, nitric oxide and inflammatory response in LIMA during
OPCABG with isoflurane preconditioning.
Source
Journal of cardiothoracic surgery. 14 (1) (pp 22), 2019. Date of
Publication: 25 Jan 2019.
Author
Zhang L.; Wang C.-B.; Li B.; Lin D.-M.; Ma J.
Institution
(Zhang, Wang, Lin, Ma) Department of Anesthesiology, Beijing Anzhen
Hospital, Capital Medical University-Beijing Institute of Heart Lung and
Blood Vessel Diseases, No.2 Anzhen Road ,Chaoyang District, Beijing
100029, China
(Li) Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital
Medical University-Beijing Institute of Heart Lung and Blood Vessel
Diseases, No.2 Anzhen Road ,Chaoyang District, Beijing 100029, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Grafting vessel with LIMA to the left anterior descending
coronary artery plays a most important role in the long-term prognosis of
OPCABG surgery. The aim of this study was to compare the effects of
isoflurane preconditioning on miRs and mRNAs levels in the left internal
mammary arterie (LIMA) graft with propofol in patients undergoing off-pump
coronary artery bypass surgery (OPCABG). <br/>METHOD(S): Patients were
randomly assigned to receive either propofol (n=15), or interrupted
isoflurane (n=15). In group P, propofol administration was continued at
3-5mg/kg/h intravenous injection for the duration of surgery. Five minutes
prior to incision, patients of the isoflurane group (group Iso) received
2cycles of 1 MAC isoflurane. <br/>RESULT(S): miR-221 were significantly
lower in group Iso (P<0 .05). E-selectin mRNA, RhoA mRNA and ROK mRNA were
significantly lower at specimens of LIMA in group Iso compared with those
in group P patients (P<0 .05). The expression of NOS3 mRNA was
significantly higher in group Iso patients (P<0 .05). <br/>CONCLUSION(S):
Our findings provide some insight that prior interrupted isoflurane
administration could regulate miR-221, and downstream effectors (mRNAs)
and resulted in actual attenuation of inflammation and spasm of LIMA in
patients undergoing OPCABG surgery. TRIAL REGISTRATION: NCT No. (
ClinicalTrials.gov ): NCT02678650; Registration date: January 23, 2016.

<26>
Accession Number
626115914
Title
Optimal Intensity of Warfarin Therapy in Patients With Mechanical Aortic
Valves.
Source
Journal of Pharmacy Practice. 32 (1) (pp 93-98), 2019. Date of
Publication: 01 Feb 2019.
Author
Kido K.; Ball J.
Institution
(Kido, Ball) Department of Pharmacy Practice, South Dakota State
University College of Pharmacy and Allied Health Professions, Sioux Falls,
SD, United States
(Kido) Avera McKennan Hospital, Department of Pharmacy Service, Sioux
Falls, SD, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective: To review the current guidelines and published literature in
order to identify the evidence-based international normalized ratio (INR)
goal in patients with a mechanical aortic valve. <br/>Data Sources:
Medline/PubMed, Cochrane and Google Scholar database searches for relevant
articles from 1946 through March 2017 were executed using the key words
"mechanical aortic valve" and "antithrombotic therapy or anticoagulation
therapy or warfarin." Study Selection and Data Extraction: All
English-language observational and interventional studies assessing INR
goals in patients with a mechanical aortic valve were evaluated.
<br/>Result(s): After low thrombogenic valves became standard in the
practice, the INR goal decreased to 2 to 3 in low-risk recipients with
most of bileaflet mechanical aortic valves. There is a paucity of data to
justify the INR goal of 2 to 3 in high-risk patients. Until further higher
evidence is available, it is reasonable to target an INR range of 2.5 to
3.5 in patients with risk factors for thromboembolism with low
thrombogenic valves, except for On-X valve. The INR goal in high-risk On-X
aortic valve recipients can be managed at 1.5 to 2.5 with low-dose aspirin
3 months after valve implantation. <br/>Conclusion(s): The INR goals of 2
to 3 for low risk and 2.5 to 3.5 for high risk should be considered for
bileaflet mechanical aortic valve recipients. Additionally, a lower INR
goal of 2 to 3 for the first 3 months after valve replacement followed by
an INR goal of 1.5 to 2.5 in both low- and high-risk aortic On-X valve
recipients may be considered.<br/>Copyright &#xa9; The Author(s) 2017.

<27>
Accession Number
626115026
Title
Analysis of the effect of acapella in the rapid rehabilitation of
thoracoscopic lung cancer.
Source
Acta Medica Mediterranea. 35 (1) (pp 205-209), 2019. Date of Publication:
2019.
Author
Zhou Z.; Zhao B.; Zha M.; Meng X.
Institution
(Zhou, Zhao, Zha, Meng) Changshu Hospital, Soochow University, First
People's Hospital of Changshu City, Changshu, Jiangsu Province 215500,
China
Publisher
A. CARBONE Editore
Abstract
Introduction: rapid recovery of lung cancer patients after thoracoscopic
surgery, and to summarize the application experience. <br/>Method(s): A
total of 100 lung cancer patients admitted to the Thoracic Surgery
Department for thoracoscopic surgery from May 2016 to March 2018 in
Changshu No.1 People's Hospital were enrolled in the study. Patients were
randomized into observation group and control group, each with 50 cases.
Both groups received routine perioperative management of lung surgery,
including strict smoking cessation, guidance for effective coughing,
breathing training, posture change in bed, etc. The patients were patted
on the back for sputum excretion, and received aerosol inhalation to
promote expectoration. The observation group was given Acapella
expectoration training on the first postoperative day. The amount of
expectoration, white blood cell count, extubation time, postoperative
hospital stay of the two groups were recorded on first day and the third
day after operation and before discharge. The role of Acapella in
postoperative recovery of lung cancer patients with thoracoscopic surgery
was discussed. <br/>Result(s): The time of chest tube removal and length
of hospital stay were shorter in the observation group than the control
group, and there was statistical significance. Comparison of expectoration
amount between the observation group and the control group before the
operation and on the first postoperative day was not statistically
different. The expectoration amount was higher in the observation group on
the third postoperative day and before discharge, with statistical
significance. The white blood cell count was higher in the observation
group than the control group before operation, but there was no
statistical significance. The white blood cell count was lower in the
observation group on the first and third postoperative day, but there was
no statistical significance. The white blood cell count was lower in the
observation group, with statistical significance. <br/>Conclusion(s):
Acapella can promote early excretion of sputum, shorten the removal time
of chest tube and the length of hospital stay after thoracoscopic surgery,
which has positive significance for patients' rapid postoperative recovery
and is thus worthy of our promotion.<br/>Copyright &#xa9; 2019 A. CARBONE
Editore. All rights reserved.

<28>
Accession Number
626113997
Title
Comparison of propofol versus sevoflurane on the outcomes of patients
undergoing cardiac surgery with cardiopulmonary bypass.
Source
Acta Medica Mediterranea. 35 (1) (pp 369-372), 2019. Date of Publication:
2019.
Author
Tang S.; Yang F.; Zhang K.; Chen W.; Xie T.
Institution
(Tang) Department of Anesthesiology, Renmin Hospital of Wuhan University,
Wuhan, Hubei Province 430060, China
(Yang) Department of Clinical Oncology, Taihe Hospital, Hubei University
of Medicine, Shiyan, Hubei 442000, China
(Xie) Department of Anesthesiology, Jingzhou Central Hospital, Second
Clinical Medical College, Yangtze University, Jingzhou, Hubei 434020,
China
(Chen) Department of Anesthesiology, first people's hospital of Jingzhou,
first Clinical Medical College, Yangtze University, Jingzhou, Hubei
434020, China
Publisher
A. CARBONE Editore
Abstract
Objective: To compare the effects of propofol versus sevoflurane on the
outcomes of patients undergoing cardiac surgery with cardiopulmonary
bypass (CPB). <br/>Method(s): 110 patients who underwent cardiac surgery
with CPB from January 2015 to June 2017 in our hospital were randomly
divided into 2 groups (n=55): A group in which anesthesia was maintained
with sevoflurane and B group in which anesthesia was maintained with
propofol. MMSE score before and after operation, perioperative laboratory
index, the incidence of postoperative cognitive dysfunction (POCD) and the
incidence of adverse events between two groups were compared.
<br/>Result(s): MMSE score was significantly higher in B group than in A
group after anesthesia (p<0.05). Serum levels of brain injury markers
neuron-specific enolase, S100beta and matrix metalloproteinase 9 were
significantly lower in B group than in A group (p<0.05). POCD incidence at
12 h and 24 h after operation was significantly lower in B group than in A
group (p<0.05). There was no significant difference in the incidence of
low cardiac output and thoracotomy bleeding between two groups.
<br/>Conclusion(s): Compared with sevoflurane, the use of propofol during
cardiac surgery with CPB can efficiently improve postoperative cognitive
function without increasing the risk of adverse reactions.<br/>Copyright
&#xa9; 2019 A. CARBONE Editore. All rights reserved.

<29>
Accession Number
2001506668
Title
Durability of Transcatheter and Surgical Bioprosthetic Aortic Valves in
Patients at Lower Surgical Risk.
Source
Journal of the American College of Cardiology. 73 (5) (pp 546-553), 2019.
Date of Publication: 12 February 2019.
Author
Sondergaard L.; Ihlemann N.; Capodanno D.; Jorgensen T.H.; Nissen H.;
Kjeldsen B.J.; Chang Y.; Steinbruchel D.A.; Olsen P.S.; Petronio A.S.;
Thyregod H.G.H.
Institution
(Sondergaard, Ihlemann, Jorgensen) Department of Cardiology, The Heart
Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
(Capodanno) Cardiothoracic and Vascular Department, Azienda Ospedaliero
Universitaria "Policlinico-Vittorio Emanuele, " University of Catania,
Catania, Italy
(Nissen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Kjeldsen) Department of Cardiothoracic and Vascular Surgery, Odense
University Hospital, Odense, Denmark
(Chang) Coronary and Structural Heart Disease Management, Medtronic,
Mounds View, MN, United States
(Steinbruchel, Olsen, Thyregod) Department of Cardiothoracic Surgery, The
Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
(Petronio) Cardiothoracic and Vascular Department, Azienda Ospedaliero
Universitaria Pisana, Pisa, Italy
Publisher
Elsevier USA
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is an
alternative to surgical aortic valve replacement (SAVR) in patients with
severe aortic stenosis and intermediate or high surgical risk.
<br/>Objective(s): The aim of this study was to compare the durability of
transcatheter and surgical bioprosthetic aortic valves using standardized
criteria. <br/>Method(s): In the NOTION (Nordic Aortic Valve Intervention)
trial, all-comer patients with severe aortic stenosis and lower surgical
risk for mortality were randomized 1:1 to TAVR (n = 139) or SAVR (n =
135). Moderate/severe structural valve deterioration (SVD) was defined as
a mean gradient >=20 mm Hg, an increase in mean gradient >=10 mm Hg from 3
months post-procedure, or more than mild intraprosthetic aortic
regurgitation (AR) either new or worsening from 3 months post-procedure.
Nonstructural valve deterioration (NSVD) was defined as moderate/severe
patient-prosthesis mismatch at 3 months or moderate/severe paravalvular
leakage. Bioprosthetic valve failure (BVF) was defined as: valve-related
death, aortic valve reintervention, or severe hemodynamic SVD.
<br/>Result(s): At 6 years, the rates of all-cause mortality were similar
for TAVR (42.5%) and SAVR (37.7%) patients (p = 0.58). The rate of SVD was
higher for SAVR than TAVR (24.0% vs. 4.8%; p < 0.001), whereas there were
no differences in NSVD (57.8% vs. 54.0%; p = 0.52) or endocarditis (5.9%
vs. 5.8%; p = 0.95). BVF rates were similar after SAVR and TAVR through 6
years (6.7% vs. 7.5%; p = 0.89). <br/>Conclusion(s): In the NOTION trial
through 6 years, SVD was significantly greater for SAVR than TAVR, whereas
BVF was low and similar for both groups. Longer-term follow-up of
randomized clinical trials will be necessary to confirm these findings.
(Nordic Aortic Valve Intervention Trial; NCT01057173)<br/>Copyright &#xa9;
2019 American College of Cardiology Foundation

<30>
Accession Number
626044903
Title
Influence of vasoactive infusions on body temperature during off pump
coronary artery bypass grafting.
Source
Journal of Cardiac Critical Care. 2 (1) (pp 19-24), 2018. Date of
Publication: 2018.
Author
Kanchi M.; Menon P.A.
Institution
(Kanchi) Anesthesia and Intensive Care, Narayana Institute of Cardiac
Sciences, Narayana Health City, #258/A, Bommasandra Industrial Area,
Anekal Taluk, Bangalore, Karnataka 560099, India
(Menon) Department of Neuroanaesthesia, National Institute of Mental
Health and Neurosciences, Lakkasandra, Bangalore, India
Publisher
Thieme India
Abstract
Introduction: Unintentional hypothermia in patients undergoing off pump
coronary artery bypass grafting (OPCABG) under general anesthesia (GA) is
a known complication. The wide sternotomy wound as well as low ambient
operating room temperature further promotes heat loss. The changes in
temperature could further be affected by the use of various vasoactive
drugs by affecting the thermoregulatory response. This study is aimed to
detect the temperature changes and the influence of vasoactive infusions
on the temperature in the patients undergoing OPCABG under GA.
<br/>Aim(s): The main purpose of this article is to assess the core and
skin temperature changes during OPCABG surgery and to assess the effect of
vasoactive infusion used intraoperatively on the core temperature Settings
and Design: Single center, nonrandomized, open label, observational study.
Methods and material: After informed consent and ethical clearance from
institutional review board, 151 adult patients undergoing elective OPCABG
surgeries under GA were included in the study. A common anesthetic
protocol and warming strategy was used in all patients. The core
temperature measured with a nasopharyngeal probe and the skin temperature
measured at the palmar surface of the right index finger were recorded at
induction, at 30 minutes intervals thereafter, and at end surgery. The
demographic variables and the duration of surgery were also recorded. The
type and dose of vasoactive agents used intraoperatively were also
recorded. The study population was divided post hoc into groups and
subgroups for further analysis. <br/>Result(s): All the patients showed a
decrease in core temperature at end surgery. The temperature changes
showed an initial exponential decrease in the first hour followed by a
gradual decrease subsequently. The peripheral temperature showed a gradual
increase from induction to end surgery. The temperature gradients showed a
linear decrease with the core temperature and peripheral skin temperature
reaching equilibrium at end surgery. The study population was divided into
four groups depending on the type of vasoactive drugs received
intraoperatively: vasoconstrictor (V), vasodilator (D), mixed
vasoconstrictor and vasodilator (M), and no vasoactive drugs (N) group.
The patients in the vasoconstrictor group had a higher core temperature at
end surgery when compared with vasodilator group. <br/>Conclusion(s):
OPCABG under GA results in decrease in core temperature. The decrease in
temperature is exponential in the initial 1 hour followed by a more
gradual decrease. The temperature changes are possibly affected by the
vasoactive drugs used intraoperatively. The effect of vasoactive drugs on
core temperature is higher when used during the initial exponential
decrease in temperature. However, further adequately powered randomized
controlled trials may be required to establish these
findings.<br/>Copyright &#xa9; 2018 Official Publication of The Simulation
Society (TSS).

<31>
Accession Number
2001210542
Title
Temporary autonomic modulation with botulinum toxin type A to reduce
atrial fibrillation after cardiac surgery.
Source
Heart Rhythm. 16 (2) (pp 178-184), 2019. Date of Publication: February
2019.
Author
Waldron N.H.; Cooter M.; Haney J.C.; Schroder J.N.; Gaca J.G.; Lin S.S.;
Sigurdsson M.I.; Fudim M.; Podgoreanu M.V.; Stafford-Smith M.; Milano
C.A.; Piccini J.P.; Mathew J.P.
Institution
(Waldron, Cooter, Sigurdsson, Podgoreanu, Stafford-Smith, Mathew)
Department of Anesthesiology, Duke University Medical Center, Durham, NC,
United States
(Waldron, Fudim, Podgoreanu, Piccini) Duke Clinical Research Institute,
Durham, NC, United States
(Haney, Schroder, Gaca, Lin, Milano) Department of Surgery (Cardiothoracic
Surgery), Duke University Medical Center, Durham, NC, United States
(Lin) Department of Immunology, Duke University Medical Center, Durham,
NC, United States
(Lin) Department of Pathology, Duke University Medical Center, Durham, NC,
United States
(Fudim, Piccini) Department of Medicine (Cardiology), Duke University
Medical Center, Durham, NC, United States
Publisher
Elsevier B.V.
Abstract
Background: Postoperative atrial fibrillation (POAF) frequently
complicates cardiac surgery and is associated with worse outcomes. The
cardiac autonomic nervous system is implicated in the pathogenesis of
POAF. <br/>Objective(s): The purpose of this study was to determine the
efficacy and safety of selective cardiac autonomic modulation in
preventing POAF. <br/>Method(s): In this randomized, double-blind,
placebo-controlled trial, adults undergoing cardiac surgery were
randomized 1:1 to intraoperative injection of 250 units onabotulinumtoxinA
(botulinum toxin type A [BoNTA]) or placebo into epicardial fat pads. The
study was powered to detect a 40% reduction in relative risk of POAF. Time
to first episode of in-hospital POAF was the primary outcome, evaluated in
patients receiving injection. Additionally, incidence of POAF, length of
stay (LOS), and adverse events were examined. <br/>Result(s): The trial
assigned 145 patients to injection, 15 of whom were dropped before
treatment, leaving 130 patients for analysis. Overall, 36.5% (23/63) of
BoNTA-treated patients developed POAF compared with 47.8% (32/67) of
placebo-treated patients. The time-to-event analysis revealed a hazard
ratio of 0.69 (95% confidence interval 0.41-1.19; P =.18) for the BoNTA vs
placebo arm. There were no significant differences in postoperative
hospital LOS (median [interquartile range] 6.0 [3.4] vs 6.2 [3.7] days; P
=.51) or adverse events prolonging LOS (27/63 [42.9%] vs 30/67 [44.8%]; P
=.83) in patients receiving BoNTA vs placebo. <br/>Conclusion(s):
Epicardial injection of onabotulinumtoxinA was without discernible adverse
effects, but we failed to detect a significant difference in risk of POAF.
Future large-scale studies of epicardial onabotulinumtoxinA injection as a
potential POAF prevention strategy should be designed to study smaller,
but clinically meaningful, treatment effects.<br/>Copyright &#xa9; 2018
Heart Rhythm Society

<32>
Accession Number
2001485298
Title
A prospective 5-year study of exercise performance following Melody valve
implant.
Source
American Heart Journal. 209 (pp 47-53), 2019. Date of Publication: March
2019.
Author
Priromprintr B.; Silka M.J.; Rhodes J.; Batra A.S.
Institution
(Priromprintr, Silka) Children's Hospital Los Angeles, University of
Southern California, Los Angeles, CA, United States
(Priromprintr) Lucile Packard Children's Hospital at Stanford, Stanford
University Medical Center, Palo Alto, CA, United States
(Rhodes) Children's Hospital of Boston, Boston, MA, United States
(Batra) Children's Hospital of Orange County, University of California,
Irvine, CA, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The long-term benefits of Melody valve implant for right
ventricular outflow tract conduit obstruction or insufficiency on exercise
capacity are undefined. <br/>Method(s): As part of the Melody valve
clinical trial, 136 patients with congenital heart disease underwent
serial cardiopulmonary exercise testing prior to, 6 months after, and
annually for up to 5 years postimplant. <br/>Result(s): Mean age at Melody
valve implantation was 22.4 +/- 0.9 years (range 7-53 years). The 95
patients who completed the study protocol provide the basis of this
report. An initial improvement in % predicted workload was present at 6
months postimplant; however, at the final (5 year) follow-up, sustained or
further improvements in workload were not demonstrated for the entire
cohort compared to baseline. By subgroup analysis, age <17 years at
implant and pulmonary regurgitation as the primary lesion were variables
associated with sustained improvement in exercise performance. There were
sustained improvements in the ventilatory equivalents for O<inf>2</inf>
(minute ventilation/O<inf>2</inf> intake, P =.01) and CO<inf>2</inf>
(minute ventilation/CO<inf>2</inf> output, P <.01) at the ventilatory
anaerobic threshold at the study conclusion. Improvements in forced vital
capacity were also observed during the study but not sustained at the
final follow-up. <br/>Conclusion(s): A cautious appraisal of the
cardiovascular benefits of Melody valve implant on sustained improvements
in exercise performance appears warranted. Although the observed changes
in pulmonary function suggest improved restrictive lung physiology and
more efficient gas exchange, after an initial increase in % predicted
performance, neither sustained nor further improvements in exercise
performance were observed, except in specific patient
subgroups.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<33>
Accession Number
2001481642
Title
Handoffs From the Operating Room to the Intensive Care Unit After
Cardiothoracic Surgery: From The Society of Thoracic Surgeons Workforce on
Critical Care.
Source
Annals of Thoracic Surgery. 107 (2) (pp 619-630), 2019. Date of
Publication: February 2019.
Author
Chatterjee S.; Shake J.G.; Arora R.C.; Engelman D.T.; Firstenberg M.S.;
Geller C.M.; Hirose H.; Lonchyna V.A.; Lytle F.T.; Milewski R.K.C.;
Moosdorf R.G.H.; Rabin J.; Sanjanwala R.; Galati M.; Whitman G.J.
Institution
(Chatterjee) Division of General and Cardiothoracic Surgery, Michael E.
DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX,
United States
(Chatterjee) Department of Cardiovascular Surgery, Texas Heart Institute,
Houston, TX, United States
(Shake) Department of Surgery, University of Mississippi School of
Medicine, Jackson, MS, United States
(Arora, Sanjanwala) Department of Surgery, St. Boniface Hospital,
University of Manitoba, Winnipeg, Canada
(Engelman) Department of Surgery, Baystate Medical Center, Springfield,
MA, United States
(Firstenberg) Division of Cardiothoracic Surgery, Department of Surgery,
The Medical Center of Aurora, Aurora, CO, United States
(Geller) Division of Cardiothoracic Surgery, Department of Surgery,
Crozer-Keystone Health System, Drexel University College of Medicine,
Upland, PA, United States
(Hirose) Division of Cardiothoracic Surgery, Department of Surgery, Thomas
Jefferson University, Philadelphia, PA, United States
(Lonchyna) Section of Cardiac and Thoracic Surgery, Department of Surgery,
University of Chicago School of Medicine, Chicago, IL, United States
(Lytle) Division of Critical Care Medicine, Department of Anesthesiology,
Case Western Reserve University, Cleveland, OH, United States
(Milewski) Department of Surgery, University of Pennsylvania School of
Medicine, Philadelphia, PA, United States
(Moosdorf) Department for Cardiovascular Surgery, Phillips University
Marburg, Marburg, Germany
(Rabin) R. Adams Cowley Shock Trauma Center, University of Maryland School
of Medicine, Baltimore, MD, United States
(Galati) Texas Medical Center Library, Houston, TX, United States
(Whitman) Department of Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
Publisher
Elsevier USA

<34>
Accession Number
625834028
Title
The effect of local anesthetic continuous wound infusion for the
prevention of postoperative pneumonia after on-pump cardiac surgery with
sternotomy: the STERNOCAT randomized clinical trial.
Source
Intensive Care Medicine. 45 (1) (pp 33-43), 2019. Date of Publication: 01
Jan 2019.
Author
Amour J.; Cholley B.; Ouattara A.; Longrois D.; Leprince P.; Fellahi
J.-L.; Riou B.; Hariri S.; Latremouille C.; Remy A.; Provenchere S.;
Carillion A.; Achouh P.; Labrousse L.; Tran Dinh A.; Ait Hamou N.;
Charfeddine A.; Lafourcade A.; Hajage D.; Bougle A.; Puybasset L.;
Margetis D.; Lebreton G.; Laalie M.; Barreda T.; D'Alessandro C.;
Boughenou M.-F.; Bel A.; Jouan J.; Du Puy Montbrun L.; Menasche P.;
Quessard A.
Institution
(Amour, Hariri, Carillion, Ait Hamou, Charfeddine, Bougle) Department of
Anesthesiology and Critical Care Medicine, Pitie-Salpetriere Hospital,
Institut de Cardiologie, Reanimation de Chirurgie Cardiaque, Sorbonne
Universite, UMR INSERM 1166, IHU ICAN, Assistance Publique-Hopitaux de
Paris (AP-HP), 47-83 Boulevard de l'Hopital, Paris 75013, France
(Cholley) Department of Anesthesiology and Critical Care Medicine, Hopital
Europeen Georges Pompidou, Universite Paris-Descartes, Sorbonne Paris
Cite, AP-HP, Paris, France
(Ouattara, Remy) Biology of Cardiovascular Diseases and Department of
Anesthesiology and Critical Care, Magellan Medico-Surgical Center,
University of Bordeaux, INSERM, UMR 1034, Bordeaux, France
(Longrois, Provenchere, Tran Dinh) Department of Anesthesiology and
Critical Care Medicine, Hopital Bichat-Claude Bernard, Unite INSERM U1148
(Laboratory for Vascular Translational Science), Universite Paris-Diderot,
Sorbonne Paris Cite, AP-HP, Paris, France
(Leprince) Department of Cardiovascular and Thoracic Surgery,
Pitie-Salpetriere Hospital, Sorbonne Universite, UMR INSERM 1166, IHU
ICAN, Assistance Publique-Hopitaux de Paris (AP-HP), Paris, France
(Fellahi) Universite Claude Bernard Lyon 1, Inserm U1060, Department of
Anesthesiology and Critical Care Medicine, Hopital Louis Pradel, Hospices
Civils de Lyon, Lyon, France
(Riou) Department of Emergency Medicine and Surgery, Pitie-Salpetriere
Hospital, Sorbonne Universite, UMR INSERM 1166, IHU ICAN, Assistance
Publique-Hopitaux de Paris (AP-HP), Paris, France
(Latremouille, Achouh) Department of Cardiovascular and Thoracic Surgery,
Hopital Europeen Georges Pompidou, Universite Paris-Descartes, Sorbonne
Paris Cite, AP-HP, Paris, France
(Labrousse) Department of Cardiovascular and Thoracic Surgery, Magellan
Medico-Surgical Center, University of Bordeaux, INSERM, UMR 1034,
Bordeaux, France
(Lafourcade, Hajage) Department of Biostatistic, Public Health and Medical
Information, Pitie-Salpetriere Hospital, Sorbonne Universite, Assistance
Publique-Hopitaux de Paris (AP-HP), Paris, France
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Postoperative pain after cardiac surgery, exacerbated by cough
and sternal mobilization, limits clearance of bronchopulmonary secretions
and may predispose to postoperative pneumonia. In this study, we tested
the ability of local anesthetic continuous wound infusion to prevent
pneumonia after cardiac surgery with sternotomy and cardiopulmonary bypass
(CPB) owing to better analgesia and bronchopulmonary drainage.
<br/>Method(s): In this randomized, double-blind, placebo-controlled trial
conducted in five academic centers, patients undergoing cardiac surgery
with sternotomy and CPB were enrolled from February 2012 until November
2014, and were followed over 30 days. Patients were assigned to a 48-h
infusion (10 ml h^-1) of l-bupivacaine (12.5 mg h^-1)
or placebo (saline) via a pre-sternal multiperforated catheter. Anesthesia
and analgesia protocols were standardized. The primary end point was the
incidence of pneumonia during the study period, i.e., until hospital
discharge or 30 days. We hypothesized a 30% reduction in the incidence of
pneumonia. <br/>Result(s): Among 1493 randomized patients, 1439 completed
the trial. Pneumonia occurred in 36/746 patients (4.9%) in the
l-bupivacaine group and in 42/739 patients (5.7%) in the placebo group
(absolute risk difference taking into account center and baseline risk of
postoperative pneumonia, - 1.3% [95% CI - 3.4; 0.8] P = 0.22). In the
predefined subgroup of patients at high risk, l-bupivacaine decreased the
incidence of pneumonia (absolute risk difference, - 5.6% [95% CI - 10.0; -
1.1], P = 0.01). <br/>Conclusion(s): After cardiac surgery with
sternotomy, continuous wound infusion of l-bupivacaine failed to decrease
the incidence of pneumonia. These findings do not support the use of local
anesthetic continuous wound infusion in this indication. Further study
should investigate its effect in high-risk patients. Trial registration:
EudraCT Number: 2011-003292-10; Clinicaltrials.gov Identifier:
NCT01648777.<br/>Copyright &#xa9; 2018, Springer-Verlag GmbH Germany, part
of Springer Nature.

<35>
Accession Number
626034122
Title
Aortic stenosis, aortic regurgitation and arterial hypertension.
Source
Current Vascular Pharmacology. 17 (2) (pp 180-190), 2018. Date of
Publication: 2018.
Author
Katsi V.; Georgiopoulos G.; Oikonomou D.; Aggeli C.; Grassos C.;
Papadopoulos D.P.; Thomopoulos C.; Marketou M.; Dimitriadis K.; Toutouzas
K.; Nihoyannopoulos P.; Tsioufis C.; Tousoulis D.
Institution
(Katsi, Georgiopoulos, Aggeli, Dimitriadis, Toutouzas, Nihoyannopoulos,
Tsioufis, Tousoulis) First Department of Cardiology, 'Hippokration'
Hospital, University of Athens, Medical School, Athens, Greece
(Oikonomou) Department of Cardiology, 'Evaggelismos' General Hospital,
Athens, Greece
(Grassos) Department of Cardiology, 'KAT' General Hospital, Athens, Greece
(Papadopoulos) Department of Cardiology, 'Laiko' General Hospital, Athens,
Greece
(Thomopoulos) Department of Cardiology, Helena Venizelou Hospital, Athens,
Greece
(Marketou) Department of Cardiology, Heraklion University Hospital, Crete,
Greece
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Hypertension (HT) is an important risk factor for
cardiovascular disease and might precipitate pathology of the aortic
valve. <br/>Objective(s): To investigate the association of HT with aortic
dysfunction (including both aortic regurgitation and stenosis) and the
impact of antihypertensive treatment on the natural course of underlying
aortic disease. <br/>Method(s): We performed a systematic review of the
literature for all relevant articles assessing the correlation between HT
and phenotype of aortic disease. <br/>Result(s): Co-existence of HT with
aortic stenosis and aortic regurgitation is highly prevalent in
hypertensive patients and predicts a worse prognosis. Certain
antihypertensive agents may improve haemodynamic parameters (aortic jet
velocity, aortic regurgitation volume) and remodeling of the left
ventricle, but there is no strong evidence of benefit regarding clinical
outcomes. Renin-angiotensin system inhibitors, among other vasodilators,
are well-tolerated in aortic stenosis. <br/>Conclusion(s): Several lines
of evidence support a detrimental association between HT and aortic valve
disease. Therefore, HT should be promptly treated in aortic valvulopathy.
Despite conventional wisdom, specific vasodilators can be used with
caution in aortic stenosis.<br/>Copyright &#xa9; 2019 Bentham Science
Publishers.

<36>
Accession Number
624485211
Title
Preferred Revascularization Strategies in Patients with Ischemic Heart
Failure: A Meta-Analysis.
Source
Current medical science. 38 (5) (pp 776-784), 2018. Date of Publication:
01 Oct 2018.
Author
Xiao J.; Xu F.; Yang C.-L.; Chen W.-Q.; Chen X.; Zhang H.; Wei Z.-J.; Liu
J.-P.
Institution
(Xiao, Xu, Chen, Chen, Zhang) Department of Cardiovascular Surgery, Union
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan 430022, China
(Xiao) Department of Cardio-Thoracic Surgery, Ganzhou People's Hospital,
Ganzhou 341000, China
(Yang) Department of Cardiovascular Surgery, Central Hospital of Wuhan,
Wuhan 430022, China
(Wei) Department of Thyroid Surgery, Central Hospital of Wuhan, Wuhan
430022, China
(Liu) Department of Cardiovascular Surgery, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan 430022,
China
Publisher
NLM (Medline)
Abstract
Clinically, coronary artery bypass grafting (CABG) or percutaneous
coronary intervention (PCI) is generally used to treat patients with
ischemic heart failure. However, the optimal treatment strategy remains
unknown. This study examined the efficacy of the two coronary
revascularization strategies for severe ischemic heart failure by using a
meta-analysis. Studies comparing the efficacy of CABG and PCI were
obtained from PubMed, EMBASE, Google Scholar and Cochrane Central Register
of Controlled Trials (CENTRAL). The quality of each eligible article was
evaluated by Newcastle-Ottawa Quality Assessment Scale (NOS), and the
meta-analysis was performed using Stata version 12.0 software. Eventually,
12 studies involving 9248 patients (n=4872 in CABG group; n=4376 in PCI
group) were subject to the meta-analysis for subsequent pooling
calculation. The pooled hazard ratio (HR) [HR=0.83, 95% CI (0.76, 0.90),
P<0.001; heterogeneity, P=0.218, I2=22.9%] of CABG compared with that of
PCI revealed a statistical superiority of CABG to PCI in terms of the
long-term mortality. Furthermore, CABG showed more advantages over PCI
with respect to the incidence of myocardial infarction [HR=0.51, 95% CI
(0.39, 0.67), P<0.001; heterogeneity, P=0.707, I2=0%] and repeat
revascularization [HR=0.40, 95% CI (0.27, 0.59), P<0.001; heterogeneity,
P<0.001, I2=80.1%]. It was concluded that CABG appears to be more
advantageous than PCI for the treatment of ischemic heart failure in the
given clinical setting.

<37>
Accession Number
615136925
Title
Coronary Artery Bypass Surgery in Diffuse Advanced Coronary Artery
Disease: 1-Year Clinical and Angiographic Results.
Source
Thoracic and Cardiovascular Surgeon. 66 (6) (pp 477-482), 2018. Date of
Publication: 18 Feb 2018.
Author
Dourado L.O.C.; Bittencourt M.S.; Pereira A.C.; Poppi N.T.; Dallan L.A.O.;
Krieger J.E.; Cesar L.A.M.; Gowdak L.H.W.
Institution
(Dourado, Pereira, Poppi, Dallan, Krieger, Cesar, Gowdak) Cardiopneumology
Department, Heart Institute (InCor), University of Sao Paulo Medical
School, Sao Paulo, Brazil
(Bittencourt) Division of Internal Medicine, Center for Clinical and
Epidemiological Research, University Hospital, University of Sao Paulo,
Sao Paulo, Brazil
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background Proper treatment of patients with diffuse, severe coronary
artery disease (CAD) is a challenge due to its complexity. Thus, data on
the outcomes after coronary artery bypass graft (CABG) in this population
is scarce. In this study, we aimed to determine the impact of CABG on the
clinical and functional status, as well as graft patency in those
individuals. Methods Patients with severe and diffuse CAD who underwent
incomplete CABG due to complex anatomy or extensive distal coronary
involvement were evaluated preoperatively and 1 year after surgery.
Postoperative coronary angiography was performed to evaluate graft
patency. Graft occlusion was defined as the complete absence of
opacification of the target vessel. Stratified analysis of graft occlusion
was performed by graft type and territories, defined as left anterior
descending artery (LAD), the left circumflex branch, and the right
coronary artery territories; the latter two, grouped, were further
classified as non-LAD territory. Results A total of 57 patients were
included, in whom 131 grafts were placed. There was a significant
improvement in Canadian Cardiovascular Society angina symptom severity (Z
= -6.1; p < 0.001) and maximum oxygen uptake (p < 0.001), with a
corresponding decrease in the use of long-acting nitrates (p < 0.001). The
overall graft occlusion rate was 19.1%, with no significant difference
between LAD and non-LAD territories (p = 0.08). However, a significantly
lower occlusion rate was noted for the internal mammary artery (IMA)
grafts when compared with saphenous vein grafts (p = 0.01), though this
difference was only significant in the LAD territory (p = 0.04). Overall,
the use of venous graft was the only predictor occlusion at 1 year (odds
ratio: 4.03; p = 0.016). Conclusion In patients with diffuse CAD,
incomplete CABG surgery resulted in a significant clinical improvement,
with acceptable graft occlusion rates at 1 year, particularly for IMA
grafts to the LAD territory.<br/>Copyright &#xa9; 2018 Georg Thieme Verlag
KG Stuttgart. New York.

<38>
Accession Number
625287564
Title
Transcatheter aortic valve replacement in patients with pure native aortic
valve regurgitation: A systematic review and meta-analysis.
Source
Clinical Cardiology. 42 (1) (pp 159-166), 2019. Date of Publication:
January 2019.
Author
Haddad A.; Arwani R.; Altayar O.; Sawas T.; Murad M.H.; de Marchena E.
Institution
(Haddad) Division of Cardiology, Temple University Lewis Katz School of
Medicine, Philadelphia, PA, United States
(Haddad) Harvard T.H Chan School of Public Health, Boston, MA, United
States
(Arwani) Ain Shams University-Faculty of Medicine, Cairo, Egypt
(Altayar) Department of Medicine, Washington University School of
Medicine, St. Louis, MO, United States
(Sawas) Department of Medicine, Mayo Clinic, Rochester, MN, United States
(Murad) Evidence-based Practice Center, Mayo Clinic Robert D. and Patricia
E. Kern Center for the Science of Health Care Delivery, Mayo Clinic,
Rochester, MN, United States
(de Marchena) Division of Cardiology, University of Miami-Miller School of
Medicine, Miami, FL, United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
This systematic review and meta-analysis sought to summarize the available
evidence on the use of transcatheter aortic valve replacement (TAVR) in
patients with Native Aortic Valve Regurgitation (NAVR) and compare
outcomes between first and second generation valves. Owing to the
improvements in transcatheter heart valve design and procedural success,
TAVR has become increasingly performed in broader aortic valve
pathologies. We searched Medline, Embase, Cochrane, and Scopus databases
from 2007 to 2018 and performed a systematic review on reports with at
least 10 patients with aortic valve regurgitation undergoing TAVR
procedure. The main outcome of interest was all-cause mortality at 30
days. A total of 638 patients across 12 studies were included. Mean age
ranged from 68 to 84. Society of Thoracic Surgeons score ranged from 5.4%
to 13.1% and Logistic EuroSCORE ranged from 18.2% to 33%. The incidence
rate of all-cause mortality at 30 days was found to be 11% (95% CI 7%-16%;
I² = 20.86%). All-cause mortality at 30 days for first
generation valves had an incidence rate of 15% (95% CI 10%-20%;
I² = 10%) compared to 7% (95% CI 3%-13%; I² = 37%)
in second generation valves with subgroup interaction analysis P = 0.059.
Device success incidence rate in second generation valves was 92% (95% CI
83%-99%; I² = 67%) vs 68% (95% CI 59%-77%; I² = 53%)
in first generation valves with P = 0.001. TAVR appears to be a feasible
treatment choice for NAVR patients at high risk for surgical valve
replacement. Second generation valves show promising results in terms of
short-term outcomes.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<39>
Accession Number
625633979
Title
Comment on "Transcatheter aortic valve replacement in patients with pure
native aortic valve regurgitation: A systematic review and meta-analysis".
Source
Clinical Cardiology. 42 (1) (pp 167-168), 2019. Date of Publication:
January 2019.
Author
Shoar S.; Naderan M.; Hosseini F.; Shoar N.
Institution
(Shoar) Clinical Research Scholar and Scientist, ScientificWriting
Corporation, Houston, TX, United States
(Shoar, Naderan) Faculty of Medicine, Tehran University of Medical
Science, Tehran, Iran, Islamic Republic of
(Hosseini) School of Medicine, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
(Shoar) Faculty of Medicine, Kashan University of Medical Sciences,
Kashan, Iran, Islamic Republic of
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)

<40>
Accession Number
625632253
Title
Impact of tricuspid regurgitation and right ventricular dysfunction on
outcomes after transcatheter aortic valve replacement: A systematic review
and meta-analysis.
Source
Clinical Cardiology. 42 (1) (pp 206-212), 2019. Date of Publication:
January 2019.
Author
Fan J.; Liu X.; Yu L.; Sun Y.; Jaiswal S.; Zhu Q.; Chen H.; He Y.; Wang
L.; Ren K.; Wang J.
Institution
(Fan, Jaiswal, Zhu, Wang) Zhejiang University School of Medicine,
Hangzhou, China
(Liu, Chen, He, Wang, Ren, Wang) Department of Cardiology, Second
Affiliated Hospital Zhejiang University School of Medicine, Hangzhou,
China
(Yu) Department of Echocardiography, The Second Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou, China
(Sun) Department of Cardiology, Guangdong People's Hospital, Guangzhou,
China
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Far less attention has been paid to the prognostic effect of right-side
heart disease on outcomes after transcatheter aortic valve replacement
(TAVR) when compared with the left side. Therefore, we performed a
systematic review and meta-analysis on the impact of tricuspid
regurgitation (TR) and right ventricular (RV) dysfunction on outcomes
after TAVR. We hypothesized that TR and RV dysfunction may have a
deleterious effect on outcomes after TAVR. Article revealing the
prognostic effect of TR and RV dysfunction on outcomes after TAVR were
being integrated. Random or fixed effect model was adopted in accordance
with the heterogeneity. There were nine studies with a total of 6466
patients enrolled after a comprehensive literature search of the
MEDLINE/PubMed, EMBASE, ISI Web of Science, and Cochrane databases. The
overall analysis revealed that moderate or severe TR at baseline increased
all-cause mortality after TAVR (HR = 1.79, CI 95% 1.52-2.11, P < 0.001).
Both baseline RV dysfunction (HR = 1.53, CI 95% 1.27-1.83, P < 0.001) and
presence of RV dilation (HR = 1.83, CI 95% 1.47-2.27, P < 0.001) were
associated with all-cause mortality. Both baseline moderate or severe TR
and RV dysfunction worsen prognosis after TAVR and careful assessment of
right heart function should be done for clinical decision by the heart
team before the TAVR procedure.<br/>Copyright &#xa9; 2018 The Authors.
Clinical Cardiology published by Wiley Periodicals, Inc.

<41>
Accession Number
623220176
Title
The HEART Pathway Randomized Controlled Trial One-year Outcomes.
Source
Academic Emergency Medicine. 26 (1) (pp 41-50), 2019. Date of Publication:
January 2019.
Author
Stopyra J.P.; Riley R.F.; Hiestand B.C.; Russell G.B.; Hoekstra J.W.;
Lefebvre C.W.; Nicks B.A.; Cline D.M.; Askew K.L.; Elliott S.B.;
Herrington D.M.; Burke G.L.; Miller C.D.; Mahler S.A.
Institution
(Stopyra, Hiestand, Hoekstra, Lefebvre, Nicks, Cline, Askew, Elliott,
Miller, Mahler) Department of Emergency Medicine, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Russell, Herrington) Department of Biostatistical Sciences, Wake Forest
School of Medicine, Winston-Salem, NC, United States
(Burke) Department of Internal Medicine, Division of Cardiology, Wake
Forest School of Medicine, Winston-Salem, NC, United States
(Burke) Public Health Sciences, Wake Forest School of Medicine,
Winston-Salem, NC, United States
(Mahler) Departments of Implementation Science and Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United
States
(Riley) The Christ Hospital Heart and Vascular Center and Lindner Center
for Research and Education, Cincinnati, OH, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: The objective was to determine the impact of the HEART Pathway
on health care utilization and safety outcomes at 1 year in patients with
acute chest pain. <br/>Method(s): Adult emergency department (ED) patients
with chest pain (N = 282) were randomized to the HEART Pathway or usual
care. In the HEART Pathway arm, ED providers used the HEART score and
troponin measures (0 and 3 hours) to risk stratify patients. Usual care
was based on American College of Cardiology/American Heart Association
guidelines. Major adverse cardiac events (MACE-cardiac death, myocardial
infarction [MI], or coronary revascularization), objective testing (stress
testing or coronary angiography), and cardiac hospitalizations and ED
visits were assessed at 1 year. Randomization arm outcomes were compared
using Fisher's exact tests. <br/>Result(s): A total of 282 patients were
enrolled, with 141 randomized to each arm. MACE at 1 year occurred in
10.6% (30/282): 9.9% in the HEART Pathway arm (14/141; 10 MIs, four
revascularizations without MI) versus 11.3% in usual care (16/141; one
cardiac death, 13 MIs, two revascularizations without MI; p = 0.85). Among
low-risk HEART Pathway patients, 0% (0/66) had MACE, with a negative
predictive value (NPV) of 100% (95% confidence interval = 93%-100%).
Objective testing through 1 year occurred in 63.1% (89/141) of HEART
Pathway patients compared to 71.6% (101/141) in usual care (p = 0.16).
Nonindex cardiac-related hospitalizations and ED visits occurred in 14.9%
(21/141) and 21.3% (30/141) of patients in the HEART Pathway versus 10.6%
(15/141) and 16.3% (23/141) in usual care (p = 0.37, p = 0.36).
<br/>Conclusion(s): The HEART Pathway had a 100% NPV for 1-year safety
outcomes (MACE) without increasing downstream hospitalizations or ED
visits. Reduction in 1-year objective testing was not
significant.<br/>Copyright &#xa9; 2018 by the Society for Academic
Emergency Medicine

<42>
Accession Number
625571944
Title
GLP1 Receptor Agonist Liraglutide Is an Effective Therapeutic Option for
Perioperative Glycemic Control in Type 2 Diabetes within Enhanced Recovery
after Surgery (ERAS) Protocols.
Source
European Surgical Research. (pp 349-360), 2018. Date of Publication: 2018.
Author
Kaneko S.; Ueda Y.; Tahara Y.
Institution
(Kaneko, Ueda, Tahara) Division of
Diabetes/Endocrinology/Lifestyle-Related Disease, Takatsuki Red Cross
Hospital, 1-1-1 Abuno, Takatsuki, Osaka 562-1045, Japan
Publisher
S. Karger AG
Abstract
Background: Enhanced Recovery After Surgery (ERAS) protocols are
multimodal perioperative care pathways designed to achieve early recovery
after surgical procedures by maintaining preoperative organ function and
reducing profound stress responses following surgery [Wilmore and Kehlet:
BMJ 2001; 322(7284): 473-6]. Glucagon-like peptide-1 receptor agonists
(GLP-1RAgs), such as liraglutide, have recently been widely used as
antidiabetic agents in patients with type 2 diabetes (T2D) because they
maintain blood glucose at an ideal level throughout the day, including
during postprandial periods, thereby improving hypoglycemia and body
weight more than insulin therapies. Additionally, the administration of
liraglutide may exert cardiovascular, renal, and cerebral protective
effects in T2D patients. The use of GLP-1RAgs for perioperative glycemic
control is sometimes considered to be controversial. <br/>Method(s): The
efficacy and safety of liraglutide therapy during perioperative glycemic
control in elective surgery patients within ERAS protocols were compared
with those of insulin therapy. Ninety adult T2D patients scheduled to
undergo elective surgery within ERAS protocols were randomized and
analyzed. Forty-nine subjects were prescribed liraglutide and 41 insulin
therapy. Procedures comprised orthopedic, thoracic, urological,
otolaryngological, hepatic resection, and gynecological breast surgeries.
<br/>Result(s): Liraglutide was shown to be a more effective option than
insulin therapy because (1) glycemic levels were more stable; (2) the
number of patients requiring additional insulin according to the insulin
sliding scale was significantly smaller (Fisher's exact test, p = 0.005);
(3) the insulin dosage required on the day of surgery was significantly
smaller (Fisher's exact, p = 0.004); (4) the additional insulin volume
required was significantly less for patients throughout the perioperative
period (Fisher's exact test, p = 0.001); and (5) while lean body mass
remained the same, body fat measurements, particularly visceral fat,
tended to decrease. <br/>Conclusion(s): Based on the results of the
present study and a recent large-scale clinical study showing
cardiovascular and renal protective effects in T2D patients, we consider
the administration of liraglutide within ERAS protocols for T2D patients
to represent a more comprehensive suite of patient protection measures as
a perioperative non-insulin agent, particularly in patients with limited
exercise ability and those at risk of hypoglycemia.<br/>Copyright &#xa9;
2018 S. Karger AG, Basel.

<43>
Accession Number
626090370
Title
Effect of dexamethasone on postoperative pain scores in a resource-limited
setting: A randomized double blind placebo controlled clinical trial.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society 2018 Annual Meeting and International Science Symposium, IARS
2018. United States. 126 (4 Supplement 1) (pp 611-613), 2018. Date of
Publication: April 2018.
Author
Ayupo N.C.; Ayebale E.; Bulamba F.; Kwizera A.
Institution
(Ayupo) Makere University, Cleveland, OH, United States
(Ayebale, Bulamba, Kwizera) Makerere University, Kampala, Uganda
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Acute pain management in resourcelimited settings remains a
major challenge, despite advancements in treatment modalities
internationally. Patients encounter enormous barriers in accessing
opioids. In an effort to curb abuse, governments have imposed stringent
restrictions deterring health workers from prescribing and administering
opioids, exposing patients to sub-optimally treated postoperative pain.
Dexamethasone, a potent anti-inflammatory drug not subject to government
restrictions, is frequently utilized perioperatively and has been shown to
reduce pain scores and opioid requirements in tonsillectomies and cardiac
surgeries. We therefore studied the effect of dexamethasone on pain scores
and breakthrough analgesic requirements in patients undergoing
mastectomies, thyroidectomies and laparotomies. <br/>METHOD(S): Design:
Randomized double blind placebo controlled trial with block randomization
and sequential allocation. <br/>Setting(s): Operating theaters and
surgical wards of a national referral hospital in a resource limited
setting. Study population: Adult patients undergoing elective
laparotomies, thyroidectomies and mastectomies who met the inclusion
criteria and gave consent. Inclusion criteria: Consented adult patients
scheduled for mastectomies, laparotomies and thyroidectomies who were ASA
I & II. Exclusion criteria: Patients with Cushing's disease, Cushing's
syndrome, diabetes mellitus and systemic infection. Sample size: 180
patients with 90 patients in each arm, calculated using Stuart J.P's
formula. <br/>Intervention(s): Group 1 received 12mg dexamethasone and
group 2 0.9% saline (placebo), given 15 minutes after induction of
anesthesia. <br/>Primary Outcome: Pain scores were assessed in PACU at
baseline, 12 and 24 hours postoperatively using the numerical rating
scale. Secondary outcome: Adverse effects of dexamethasone, including
hypersensitivity reactions, hyperglycemia and hyperthermia, were measured
at baseline, 12 and 24 hours postoperatively. Data entry: EpiData version
3.1. Data analysis: Intention to treat analysis with STATA 12.
<br/>RESULT(S): 309 patients were screened over 8 months. 136 patients
were excluded; 2 withheld consent, 6 were unable to consent due to
language barrier and 128 fit the exclusion criteria. 176 patients were
randomized with 88 patients in each arm. 3 patients in the intervention
arm were lost to followup. Mean pain scores in PACU at baseline, 12 and 24
hours postoperatively were 2.97(2.50) p=0.41, 4.17(2.04) p=0.45 and
3.33(1.91) p=0.63 respectively. No difference existed in the incidence of
adverse outcomes in both groups. Other outcome data is presented in
tables. <br/>CONCLUSION(S): Dexamethasone does not reduce postoperative
pain scores or the amount of breakthrough analgesic in patients undergoing
mastectomies, laparotomies and thyroidectomies in a resource-limited
setting.

<44>
Accession Number
626089108
Title
Resting-state functional connectivity as a marker of delirium in
postoperative cardiac patients.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society 2018 Annual Meeting and International Science Symposium, IARS
2018. United States. 126 (4 Supplement 1) (pp 370-372), 2018. Date of
Publication: April 2018.
Author
Trammel E.R.; Bolzenius J.; Spencer J.W.; Avidan M.; Palanca B.
Institution
(Trammel, Bolzenius, Spencer, Avidan, Palanca) Washington University,
School of Medicine, St. Louis, MO, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Delirium is a neurological complication that is associated
with adverse perioperative outcomes. Patterns of correlated activity
across distributed brain regions, known as functional connectivity (FC),
are putative magnetic resonance imaging (MRI) markers of delirium1. FC
within the default mode network (DMN) and ventral attention network (VAN)
resting-state networks show weakened FC during sevoflurane-induced
unconsciousness2 and other altered states of arousal. Using a
longitudinal, case-controlled trial, we assessed whether DMN or VAN FC
correlates with the presence and severity of delirium. <br/>METHOD(S): As
part of NCT03110185, we recruited 33 English-speaking patients over the
age of 60 undergoing major cardiac surgery requiring cardiopulmonary
bypass. Patients were excluded if they had any of the following: MRI
incompatible implants; concomitant cerebrovascular procedure or
requirement of deep hypothermic circulatory arrest; inability to lay flat
or still for MRI; legal blindness or severe deafness; seizure history;
known focal brain lesion larger than 3 centimeters. Patients were assessed
for delirium using the Confusion Assessment Method (CAM) for three
consecutive days following surgery. Patients then underwent 3T MRI scans
between removal of temporary epicardial pacemaker wires and 30 days after
hospital discharge. An additional CAM assessment was performed on the day
of the MRI to assess that delirium had resolved. Figure 1 demonstrates an
example study timeline. Analyses consisted of data from 15 (6 with
delirium, 9 control) patients. Demographics for patients included in
analyses are provided in Table 1. As described previously2, we carried out
image preprocessing and generated subject-specific CSF and white matter
nuisance regressors. Global signal regression and framewise displacement
indices were used for censoring imaging epochs likely contaminated by
motion artifacts. Average FC maps were generated from Z-transformed
Pearson r values. The multilayer perceptron (MLP) model will be used to
parcellate grey matter voxels into seven resting state networks.
Non-parametric statistical analysis will assess the relationships between
DMN and VAN restingstate FC and delirium outcome measures. <br/>RESULT(S):
Qualitative preliminary analyses of group average maps suggest weaker FC
among regions of the DMN in individuals who developed delirium after
surgery (Figure 2). Additionally, FC among regions of VAN appears to be
weaker in patients who experience postoperative delirium relative to
controls (Figure 2). <br/>CONCLUSION(S): Preliminary analyses suggest
differences in resting-state FC in patients who do and do not develop
delirium. Weakened DMN or VAN FC in patients with recent delirium may
reflect an underlying vulnerability. Further investigation is warranted
into the use of DMN and VAN FC as a biomarker for delirium vulnerability
and recovery. (Figure Presented) .

<45>
Accession Number
626089359
Title
Postoperative delirium and hepatic venous congestion: A prospective study.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society 2018 Annual Meeting and International Science Symposium, IARS
2018. United States. 126 (4 Supplement 1) (pp 126-128), 2018. Date of
Publication: April 2018.
Author
Benkreira A.; Beaubien-Souligny W.; Denault A.; Mailhot T.
Institution
(Benkreira, Mailhot) Montreal Heart Institute, Montreal, Canada
(Beaubien-Souligny, Denault) University of Montreal, Montreal, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Post-operative delirium is a frequent complication after
cardiac surgery. Venous congestion from right ventricular failure and
fluid overload could be an important contributing mechanism1,2. However,
objective signs of congestion have yet to be associated with delirium.
Portal vein pulsatility evaluated by Point-of-Care Doppler ultrasound is a
marker of right heart failure induced hepatic congestion3,4. This
prospective study aimed to determine if an association between portal vein
pulsatility and delirium and associated features is present after cardiac
surgery. <br/>METHOD(S): Following approval from the local research and
ethics committee, cardiac surgery patients were randomly recruited from
August 2016 to August 2017. Patients were excluded if they suffered from a
critical state impeding their ability to consent. From the day prior to
surgery, patients had a brief cognitive evaluation followed by ultrasound
daily for 5 consecutive days. Cognitive dysfunction was defined as a score
of more than 0 on the delirium index scale. Patients were also evaluated
for asterixis and bilateral cerebral oximetry by near infrared
spectroscopy (NIRS) using O3TM Regional Oximeter System (Masimo
Corporation, Irvine CA) values were recorded at the time of cognitive
evaluation. Delirium was defined as an intensive care delirium screening
checklist (ICDSC) more than or equal to 4 by the nursing staff. Portal
pulsatility was defined as a velocity variation ([VMax-VMin]/VMax) of more
than 30% during the cardiac cycle. A generalized estimating equation
analysis was used to assess the relationship between portal pulsatility
and cognitive assessment by the investigators (cognitive dysfunction,
asterixis and cerebral oximetry). A Cox regression analysis with
time-dependant variable was used to assess the association between portal
pulsatility and delirium identified by the nursing staff. <br/>RESULT(S):
145 patients were included. The cohort was composed mostly of men (73.8%)
with a mean age of 66 years (+/-13). Patients identified with an abnormal
cognitive status represented 36.9% of all assessments (139/379). Portal
pulsatility was documented in 42.3% of assessments (237/559). A
significant association was found between the presence of portal
pulsatility and the development of cognitive dysfunction assessed by the
investigators (OR: 2.10 [CI: 1,25-3,53] p=0.005). A significant
association was found between the presence of portal pulsatility and both
the development of asterixis (OR: 2.23 [CI: 1,13-4,41] p=0.02) and a more
than 15% decrease in cerebral oximetry values from pre-operative baseline
(OR: 2.23 [CI:1.12-4.71] p=0.02). An association between portal flow
pulsatility and by the nursing staff delirium (HR: 2,63 CI:1.13-6.11
p=0.025) was also present. <br/>CONCLUSION(S): This data presents for the
rst time an association between an objective sign of portal hypertension
of cardiac origin and delirium in cardiac surgery patients. This suggests
that delirium may have a congestive origin in some patients. (Table
Presented) .

<46>
Accession Number
626089280
Title
The association between angiotensin converting enzyme inhibitors and
angiotensin receptor blocker use and the incidence of delirium in surgical
ICU patients.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society 2018 Annual Meeting and International Science Symposium, IARS
2018. United States. 126 (4 Supplement 1) (pp 377-380), 2018. Date of
Publication: April 2018.
Author
Sheerer C.; Ezell J.; Argalious M.Y.; Esa W.A.S.; Sessler D.I.; Zimmerman
N.; Farag E.
Institution
(Sheerer, Ezell, Argalious, Esa, Sessler, Zimmerman, Farag) Cleveland
Clinic Foundation, Cleveland, OH, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Postoperative delirium is a common neurological complication
especially among the elderly. Delirium is characterized as an acute and
fluctuating disturbance in cognition and attention. Although the
pathophysiology of delirium is not fully understood, inflammation,
neurotransmitter imbalance, and metabolic derangement are proposed as
possible mechanisms. Delirium increases the incidence of subsequent
cognitive impairment and is associated with increased postoperative
morbidity and mortality. Angiotensin converting enzyme inhibitors (ACEIs)
such as captopril or perindopril that are capable of crossing the
bloodbrain barrier have been shown to enhance memory function in patients
with mild-to-moderate Alzheimer's disease. Data from previous clinical
trials showed that use of ACEIs reduced dementia and cognitive decline.
Similarly, candesartan, an angiotensin II receptor 1 (ATR1) antagonist,
diminished the incidence of non-fatal stroke and showed a trend towards
improved cognitive function. Given the aforementioned reported benefits of
ACEIs and ARBs in improving cognitive function, we sought to test the
hypothesis that preoperative use of ACEI and/or ARBs was associated with a
lower incidence of delirium in postsurgical ICU patients. <br/>METHOD(S):
Research design: Retrospective single center trial Research setting:
Cleveland Clinic Main Campus surgical intensive care unit (SICU) Number of
patients enrolled: 1,733 Selection criteria: Any patient who had
non-cardiac surgery who was admitted to the SICU and had at least one
confusion assessment method (CAMICU) assessment during their ICU stay
Outcome variable measurements: compared two groups for the incidence of
delirium during their ICU stay while adjusting for confounding variables
Statistical methods: performed a sensitivity analysis using a
propensity-score matching to control for the potential confounders. A
logistic regression model was used for comparing the matched groups.
Compared the two groups for in-hospital mortality using a multivariable
logistic regression model with a backward model selection procedure.
<br/>RESULT(S): We utilized data from 1,733 patients who met our inclusion
/ exclusion criteria, including 121 patients who were treated with ACEIs
or ARBs in the preoperative period and 1,612 patients who were not. All
patients had at least one CAM-ICU assessment during ICU stay; the median
number of CAM assessments was 10 for patients treated with ACEIs or ARBs
and 9 for patients who were not treated. The incidence of delirium was
42.2% (51/121) for patients who were treated with ACEIs or ARBs in the
preoperative period and 45.5% (733/1612) for patients who were not
(unadjusted P-value = 0.48). The estimated odds ratio of experiencing
delirium during ICU stay was 0.87 (95% CI: 0.57, 1.33) for ACEI / ARBs
patients versus control patients (P = 0.53), after adjusting. No
difference was found in the risk of in-hospital mortality between ACEI /
ARB patients (4.1%, 5/121) and control patients (6.8%, 109/1612).
<br/>CONCLUSION(S): The results of our study show that the use of ACEIs
and ARBs in the preoperative period is not associated with reduction in
the risk of delirium in ICU patients. However, patients who received ACEIs
and ARBs were more prone to developing postoperative delirium as they were
older, had a high ASA physical status grade, had more prolonged surgeries,
and received more opioids. (Figure Presented) .

<47>
Accession Number
626089184
Title
Gender differences in perioperative hormonal and inflammatory stress
response during cardiac surgery: An exploratory data analysis.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society 2018 Annual Meeting and International Science Symposium, IARS
2018. United States. 126 (4 Supplement 1) (pp 118-120), 2018. Date of
Publication: April 2018.
Author
Doney L.; Lazar S.; Subramaniam K.
Institution
(Doney, Lazar) University of Pittsburgh Medical Center, Pittsburgh, PA,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: The natural response to the stress of cardiac surgery and
cardiopulmonary bypass is well known. Included in this response is the
elevation of inflammatory mediators including ACTH, growth hormone,
cortisol and interleukins1. Perioperative stress, hyperglycemia, and
inflammation have been linked to an increased incidence of major adverse
events and mortality in patients undergoing cardiac surgery1,2. This
abstract is an exploratory analysis examining gender differences in stress
mediators during cardiac surgery. Data for this analysis was taken from a
clinical trial at the University of Pittsburgh Medical Center examining
Remifentanil and glycemic response during cardiac surgery (Trial #:
NCT02349152). <br/>METHOD(S): A prospective, randomized clinical trial
took place at UPMC after institutional ethical board review in patients
undergoing cardiac surgery. Potential participants were screened by the
cardiac surgeons and study coordinators and informed consent was obtained.
Eligible participants were randomized to either control (Fentanyl IV
bolus) or intervention (Remifentanil infusion) group. See Table 1 for
inclusion and exclusion criteria. The blood glucose goal during the
perioperative period was between 140-180 mg/dl. A standard insulin
infusion protocol was followed. Upon placement of the arterial line,
desired lab values were obtained. These values were subsequently drawn 30
minutes into cardiopulmonary bypass, at the end of cardiopulmonary bypass,
end of surgery, and 8 hours post-operatively. Perioperative patient data
was obtained from the electronic anesthesia record and Society of Thoracic
Surgeon's Database. Independent samples t-test (SPSS 12.0) was utilized
for analysis of baseline characteristics and inflammatory mediators. Chi
square test evaluated categorical variables. A value of p < 0.05 was
determined to be statistically significant. <br/>RESULT(S): A total of 116
patients were enrolled in the study and 106 patients (72 men and 34 women)
completed the study. Since this abstract focuses on the exploratory
analysis for the relationship between gender and stress response, refer to
the clinical trial #NCT02349152 for information on the primary outcome.
Baseline patient characteristics are included in Table 2. BMI was
significantly higher in men compared to women. Equal proportion of
patients in both genders belonged to the Remifentanil and control group.
Cortisol levels at the end of surgery as well as initial growth hormone
levels were significantly higher in men compared to women. ACTH (8 hours
post-op), growth hormone (CPB-end, end of surgery, 8 hours post-op) and
TNF alpha (8 hours post-op) levels were significantly higher in women
compared to men. See Table 3 for complete data analysis of hormonal and
inflammatory mediators in men and women. <br/>CONCLUSION(S): During the
peri-operative period in patients undergoing cardiac surgery with
cardiopulmonary bypass, it was found that men and women have significant
differences in levels of certain known mediators of stress response
(cortisol, ACTH, growth hormone, TNF alpha). Further research is required
to evaluate gender discrepancies in perioperative stress response and its
relation to outcomes after cardiac surgery. (Table Presented) .

<48>
Accession Number
626089636
Title
The impact of hyperoxia on outcomes after cardiac surgery: A systematic
review.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society 2018 Annual Meeting and International Science Symposium, IARS
2018. United States. 126 (4 Supplement 1) (pp 137), 2018. Date of
Publication: April 2018.
Author
Heinrichs J.; Lodewyks C.; Neilson C.; Abou-Setta A.; Grocott H.P.
Institution
(Heinrichs, Lodewyks, Neilson, Abou-Setta, Grocott) University of
Manitoba, Winnipeg, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Historically, cardiac surgery patients have been managed
with supraphysiologic intraoperative oxygen levels to protect against the
risks of tissue hypoperfusion inherent in the un-physiologic nature of
surgery and cardiopulmonary bypass. This may result in excessive reactive
oxygen species generation and exacerbation of ischemia-reperfusion injury.
In this review, we synthesize all available data from randomized
controlled trials (RCTs) to investigate the impact of hyperoxia on
postoperative organ dysfunction, length of stay, and mortality during
adult cardiac surgery. <br/>METHOD(S): After registering this systematic
review at the International Prospective Register of Systematic Reviews
(CRD42017074712), we searched Medline, Embase, Scopus, and Cochrane
Central Register of Controlled Trials databases using a high-sensitivity
strategy for RCTs that compared oxygenation strategies for adult cardiac
surgery. A search of the grey literature to identify unpublished studies
was also conducted in clincialtrials. gov, the WHO International Clinical
Trials Registry Platform, and Open Grey. Our primary outcome was
postoperative organ dysfunction defined by postoperative increases in
myocardial enzymes, acute kidney injury, and neurological dysfunction.
Secondary outcomes were mortality, ventilator days, and length of stay in
the hospital and intensive care unit. A risk of bias assessment was
performed using the Cochrane Risk of Bias Tool. <br/>RESULT(S): Our
initial database search identified 4421 items. Following screening, we
identified 12 RCTs that met our inclusion criteria. All of the RCTs
included only patients scheduled for elective surgery. Nine of the trials
included patients for coronary artery bypass grafting (CABG) only; one
trial included patients for isolated valvular surgery only; and two trials
included patients for CABG, isolated valvular, as well as combined
procedures. The specific oxygenation strategy used in the normoxia and
hyperoxia arms of each study varied substantially. Six trials used
specific PaO2 targets, ve trials prescribed a set FiO2, and one trial used
a combination of PaO2 and pulse oximetry (SpO2) targets. There was marked
heterogeneity in the timing of the study intervention in these trials,
with ve distinct time periods over which the oxygenation strategy being
evaluated was applied. There were also major differences in authors'
choices of oxygenation thresholds for their normoxic and hyperoxic
treatment arms (Figure 1). The resulting heterogeneity from these
important differences precluded us from conducting a meta-analysis. In
lieu of meta-analysis, a narrative synthesis was performed. Risk of bias
was unclear to high in all but one trial. Reporting quality was generally
poor. The large majority of trials found no difference between hyperoxia
and normoxia for any outcome. Two trials reported reduced postoperative
myocardial enzymes and one trial reported reduced mechanical ventilation
time in the normoxia group. Together these positive trials only contained
108 of the 760 patients included in this review. <br/>CONCLUSION(S):
Hyperoxia has minimal impact on organ dysfunction, length of stay, and
mortality in adult cardiac surgery. However, the current evidence base is
small, heterogeneous, and at risk of bias. There is no universal consensus
of what defines a hyperoxic PaO2 during cardiac surgery. Clinical
equipoise exists for future trials to expose patients to a wide range of
oxygenation strategies. (Figure Presented) .

<49>
Accession Number
626098880
Title
Genome-wide association study of myocardial infarction, atrial
fibrillation, acute stroke, acute kidney injury and delirium after cardiac
surgery - a sub-analysis of the RIPHeart-Study.
Source
BMC cardiovascular disorders. 19 (1) (pp 26), 2019. Date of Publication:
24 Jan 2019.
Author
Westphal S.; Stoppe C.; Gruenewald M.; Bein B.; Renner J.; Cremer J.;
Coburn M.; Schaelte G.; Boening A.; Niemann B.; Kletzin F.; Roesner J.;
Strouhal U.; Reyher C.; Laufenberg-Feldmann R.; Ferner M.; Brandes I.F.;
Bauer M.; Kortgen A.; Stehr S.N.; Wittmann M.; Baumgarten G.; Struck R.;
Meyer-Treschan T.; Kienbaum P.; Heringlake M.; Schoen J.; Sander M.;
Treskatsch S.; Smul T.; Wolwender E.; Schilling T.; Degenhardt F.; Franke
A.; Mucha S.; Tittmann L.; Kohlhaas M.; Fuernau G.; Brosteanu O.;
Hasenclever D.; Zacharowski K.; Meybohm P.
Institution
(Westphal, Strouhal, Reyher, Kohlhaas, Zacharowski, Meybohm) Department of
Anaesthesiology, Intensive Care Medicine and Pain Therapy, University
Hospital Frankfurt, Frankfurt, Germany
(Stoppe, Coburn, Schaelte) Department of Anaesthesiology, Medical Faculty,
RWTH Aachen, University Aachen, Aachen, Germany
(Gruenewald, Bein, Renner) Department of Anaesthesiology and Intensive
Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel,
Germany
(Bein) Department of Anaesthesiology, Intensive Care Medicine, Emergency
Medicine and Pain Therapy, Asklepios Klinik St. Georg, Hamburg, Germany
(Cremer) Department of Cardiovascular Surgery, University Hospital
Schleswig-Holstein, Campus Kiel, Kiel, Germany
(Boening, Niemann) Department of Cardiovascular Surgery, University of
Giessen, Giessen, Germany
(Kletzin) Clinic of Anaesthesiology and Intensive Care Medicine,
University Hospital Rostock, Rostock, Germany
(Roesner) Department of Anaesthesiology and Intensive Care, Suedstadt
Hospital Rostock, Rostock, Germany
(Laufenberg-Feldmann, Ferner) Department of Anesthesiology, Medical Center
of Johannes Gutenberg-University, Mainz, Germany
(Brandes) Department of Anaesthesiology and Intensive Care Medicine,
University Hospital Goettingen, Goettingen, Germany
(Bauer) Department of Anaesthesiology and Intensive Care, Klinikum Region
Hannover, Hannover, Germany
(Kortgen) Department of Anaesthesiology and Intensive Care Medicine and
Center for Sepsis Control and Care, Jena University Hospital, Jena,
Germany
(Stehr) Department of Anesthesiology and Intensive Care Medicine,
University Hospital Leipzig, Leipzig, Germany
(Wittmann, Struck) Department of Anaesthesiology and Intensive Care
Medicine, University Hospital Bonn, Bonn, Germany
(Baumgarten) Department of Anaesthesiology and Intensive Care Medicine,
Johanniter Hospital Bonn, Bonn, Germany
(Meyer-Treschan, Kienbaum) Department of Anaesthesiology and Intensive
Care Medicine, University Hospital Duesseldorf, Duesseldorf, Germany
(Heringlake) Department of Anaesthesiology and Intensive Care Medicine,
University Luebeck, Luebeck, Germany
(Schoen) Department of Anaesthesiology and Intensive Care Medicine,
Hospital Neuruppin, Neuruppin, Germany
(Sander) Department of Anaesthesiology and Intensive Care, University of
Giessen, Giessen, Germany
(Treskatsch) Department of Anaesthesiology and Intensive Care Medicine,
Charite-Universitatsmedizin Berlin ,Campus Charite Mitte, Berlin, Germany
(Smul, Wolwender, Schilling) Department of Anaesthesiology, University
Hospital Wuerzburg, Wuerzburg, Germany
(Degenhardt, Franke, Mucha, Tittmann) Institute of Clinical Molecular
Biology, Kiel University, University Hospital Schleswig-Holstein, Campus
Kiel, Kiel, Germany
(Fuernau) University Heart Center Luebeck, University Hospital
Schleswig-Holstein, Medical Clinic II (Cardiology/Angiology/Intensive Care
Medicine), Luebeck, Germany
(Brosteanu) Clinical Trial Centre, University Leipzig, Leipzig, Germany
(Hasenclever) Institute for Medical Informatics, Statistics and
Epidemiology, University Leipzig, Leipzig, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: The aim of our study was the identification of genetic
variants associated with postoperative complications after cardiac
surgery. <br/>METHOD(S): We conducted a prospective, double-blind,
multicenter, randomized trial (RIPHeart). We performed a genome-wide
association study (GWAS) in 1170 patients of both genders (871 males, 299
females) from the RIPHeart-Study cohort. Patients undergoing non-emergent
cardiac surgery were included. Primary endpoint comprises a binary
composite complication rate covering atrial fibrillation, delirium,
non-fatal myocardial infarction, acute renal failure and/or any new stroke
until hospital discharge with a maximum of fourteen days after surgery.
<br/>RESULT(S): A total of 547,644 genotyped markers were available for
analysis. Following quality control and adjustment for clinical covariate,
one SNP reached genome-wide significance (PHLPP2, rs78064607, p=3.77x10-8)
and 139 (adjusted for all other outcomes) SNPs showed promising
association with p<1x10-5 from the GWAS. <br/>CONCLUSION(S): We identified
several potential loci, in particular PHLPP2, BBS9, RyR2, DUSP4 and HSPA8,
associated with new-onset of atrial fibrillation, delirium, myocardial
infarction, acute kidney injury and stroke after cardiac surgery. TRIAL
REGISTRATION: The study was registered with ClinicalTrials.gov
NCT01067703, prospectively registered on 11 Feb 2010.

<50>
[Use Link to view the full text]
Accession Number
626102871
Title
Application of intrapulmonary wire combined with intrapleural fibrin glue
in preoperative localization of small pulmonary nodules.
Source
Medicine. 98 (4) (pp e14029), 2019. Date of Publication: 01 Jan 2019.
Author
Zhang W.-H.; Bai Y.-Y.; Guo W.; Li M.; Chang G.-X.; Liu W.; Mao Y.
Institution
(Zhang, Guo, Li, Chang, Liu, Mao) Department of Thoracic Surgery, First
Hospital of Hohhot
(Bai) Department of Anesthesiology, First Hospital of Hohhot, Inner
Mongolia, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: This study aims to investigate the accuracy of the preoperative
localization of small nodules by computerized tomography (CT)-guided
placing wire and intrapleural fibrin glue near the nodules at 3 days
before the operation. <br/>METHOD(S): From October 2015 to December 2017,
a total of 79 patients, who received preoperative localization of small
pulmonary nodules and surgical treatment in the Department of Thoracic
Surgery of Hohhot First Hospital, were enrolled into this study. These
patients were randomly divided into 2 groups: methylene blue localization
group (n = 47), and modified localization group (n = 32), where the
patients received preoperative localization of the small nodules by
CT-guided placing wire and intrapleural fibrin glue near the nodule at 3
days before the operation. Localization accuracy, operation time and
difficulty in postoperative seeking for pathological specimens were
compared between these 2 groups. <br/>RESULT(S): In the methylene blue
localization group, 3 patients had localization failure due to the
intrathoracic diffusion of methylene blue, and the success rate was
93.61%. In the modified localization group, all 32 patients succeeded in
the localization, and the success rate was 100%. Operation time and
difficulty of finding the specimen was significantly lower in the modified
localization group than in the methylene blue localization group (P <
.05). <br/>CONCLUSION(S): The application of preoperative localization of
small nodules by placing wire and intrapleural fibrin glue improves the
success rate of resection, reduces operation time and the risk of the
operation, and lowers the difficulty of finding pathological specimens
after the operation. Hence this operative procedure is worthy of
popularization.

<51>
Accession Number
2001290921
Title
Tranexamic acid in coronary artery surgery: One-year results of the
Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (2) (pp 644-652.e9),
2019. Date of Publication: 01 Feb 2019.
Author
Myles P.S.; Smith J.A.; Kasza J.; Silbert B.; Jayarajah M.; Painter T.;
Cooper D.J.; Marasco S.; McNeil J.; Bussieres J.S.; McGuinness S.; Byrne
K.; Chan M.T.V.; Landoni G.; Wallace S.; Forbes A.; Esmore D.; Krum H.;
Tonkin A.; Buxton B.; Heritier S.; Merry A.; Liew D.; Meehan A.; Galagher
W.; Farrington C.; Ditoro A.; Wutzlhofer L.; Story D.; Peyton P.; Baulch
S.; Sidiropoulos S.; Potgieter D.; Baker R.A.; Pesudovs B.; O'Loughlin J
Wells E.; Coutts P.; Bolsin S.; Osborne C.; Ives K.; Hulley A.;
Christie-Taylor G.; Lang S.; Mackay H.; Cokis C.; March S.; Bannon P.G.;
Wong C.; Turner L.; Scott D.; Said S.; Corcoran P.; de Prinse L.; Gagne
N.; Lamy A.; Semelhago L.; Underwood M.; Choi G.S.Y.; Fung B.; Lembo R.;
Monaco F.; Simeone F.; Marianello D.; Alvaro G.; De Vuono G.; van Dijk D.;
Dieleman J.; Numan S.; Parke R.; Raudkivi P.; Gilder E.; Dunning J.;
Termaat J.; Mans G.; Alderton J.; Waugh D.; Platt M.J.; Pai A.; Sevillano
A.; Lal A.; Sinclair C.; Kunst G.; Knighton A.; Cubas G.M.; Saravanan P.;
Millner R.; Vasudevan V.; Patteril M.; Lopez E.; Basu R.; Lu J.
Institution
(Myles, Cooper, Marasco, Wallace) Department of Anaesthesia and
Perioperative Medicine, Alfred Hospital, Melbourne, Australia
(Myles, Smith, Kasza, Cooper, Marasco, McNeil, Wallace, Forbes) Department
of Anaesthesia and Perioperative Medicine, Monash University, Melbourne,
Australia
(Smith) Department of Cardiothoracic Surgery, Monash Medical Centre,
Clayton, Australia
(Silbert) Department of Anaesthesia, St Vincent's Hospital, Fitzroy,
Australia
(Jayarajah) Department of Cardiothoracic Anaesthesia and Cardiac Critical
Care, South West Cardiac Centre, Derriford Hospital, Plymouth, United
Kingdom
(Painter) Royal Adelaide Hospital and Discipline of Acute Care Medicine,
University of Adelaide, Adelaide, Australia
(Bussieres) Department of Anesthesiology, Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Quebec City, Quebec, Canada
(McGuinness) Department of Cardiothoracic & Vascular Intensive Care Unit,
Auckland City Hospital, Auckland, New Zealand
(Byrne) Department of Anaesthesia, Waikato Hospital, New Zealand
(Chan) Department of Anesthesiology and Intensive Care, The Chinese
University of Hong Kong, Hong Kong
(Landoni) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Tranexamic acid reduces blood loss and transfusion
requirements in cardiac surgery but may increase the risk of coronary
graft thrombosis. We previously reported the 30-day results of a trial
evaluating tranexamic acid for coronary artery surgery. Here we report the
1-year clinical outcomes. <br/>Method(s): Using a factorial design, we
randomly assigned patients undergoing coronary artery surgery to receive
aspirin or placebo and tranexamic acid or placebo. The results of the
tranexamic acid comparison are reported here. The primary 1-year outcome
was death or severe disability, the latter defined as living with a
modified Katz activities of daily living score of less than 8. Secondary
outcomes included a composite of myocardial infarction, stroke, and death
from any cause through to 1 year after surgery. <br/>Result(s): The rate
of death or disability at 1 year was 3.8% in the tranexamic acid group and
4.4% in the placebo group (relative risk, 0.85; 95% confidence interval,
0.64-1.13; P =.27), and this did not significantly differ according to
aspirin exposure at the time of surgery (interaction P =.073). The
composite rate of myocardial infarction, stroke, and death up to 1 year
after surgery was 14.3% in the tranexamic acid group and 16.4% in the
placebo group (relative risk, 0.87; 95% CI, 0.76-1.00; P =.053).
<br/>Conclusion(s): In this trial of patients having coronary artery
surgery, tranexamic acid did not affect death or severe disability through
to 1 year after surgery. Further work should be done to explore possible
beneficial effects on late cardiovascular events.<br/>Copyright &#xa9;
2018 The American Association for Thoracic Surgery

<52>
Accession Number
623751668
Title
Preoperative rehabilitation in lung cancer patients: Yoga approach.
Source
Advances in Experimental Medicine and Biology. 1096 (pp 19-29), 2018. Date
of Publication: 2018.
Author
Barassi G.; Bellomo R.G.; Di Iulio A.; Lococo A.; Porreca A.; Di Felice
P.A.; Saggini R.
Institution
(Barassi, Porreca, Di Felice, Saggini) Department of Medical Oral and
Biotechnological Science, "Gabriele d'Annunzio" University,
Chieti-Pescara, Italy
(Bellomo) Department of Biomolecular Sciences, 'Carlo Bo' University,
Urbino, Italy
(Di Iulio, Lococo) Division of Thoracic Surgery, Santo Spirito Hospital of
Pescara, Pescara, Italy
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Lung cancer is one of the leading causes of cancer death worldwide.
Surgical removal remains the best option for most tumors of this type.
Reduction of cigarette consumption in patients with lung cancer candidates
for the surgery could limit the impact of tobacco on postsurgical
outcomes. Breathing exercises appear to help combat cigarette cravings.
Yoga exercise benefits have been studied in lung cancer survivors, rather
than in the preoperative setting. In this study, we have recruited 32
active smokers affected by lung cancer and being candidates for pulmonary
surgery. The patients were randomly assigned to two groups: one treated by
standard breathing and the other treated by yoga breathing (YB). The
groups were evaluated at times T0 (baseline) and T1 (after 7 days of
treatment) to compare the effects of the two breathing treatments on
pulmonary performance in a presurgery setting. Pulmonary and
cardiocirculatory functions have been tested using a self-calibrating
computerized spirometer and a portable pulse oximetry device. The findings
demonstrate appreciable short-term improvement in lung function assessed
by spirometry. We conclude that yoga breathing can be a beneficial
preoperative support for thoracic surgery.<br/>Copyright &#xa9; 2018,
Springer International Publishing AG, part of Springer Nature.

<53>
Accession Number
624377409
Title
Randomized trial of the Carpentier-Edwards supra-annular prosthesis versus
the Medtronic Mosaic aortic prosthesis: 10-year results.
Source
European Journal of Cardio-thoracic Surgery. 54 (2) (pp 281-287), 2018.
Date of Publication: 2018.
Author
Zibdeh O.; Bugg I.; Patel S.; Twine G.; Unsworth-White J.
Institution
(Zibdeh, Bugg, Patel) Plymouth University, Peninsula School of Medicine,
Plymouth, United Kingdom
(Twine, Unsworth-White) South West Cardiothoracic Unit, Derriford
Hospital, Plymouth PL6 8DH, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: We performed a prospective randomized study comparing the
clinical performance of the Carpentier-Edwards supraannular valve (CE-SAV)
(Edwards Lifesciences, Irvine, CA, USA) and the newer Mosaic (Medtronic
Corporation, Minneapolis, MN, USA) porcine bioprostheses in the aortic
position over a 10-year period. <br/>METHOD(S): Between January 2001 and
March 2005, 394 patients undergoing bioprosthetic aortic valve replacement
were randomized to receive either the CE-SAV (n = 191) or the Mosaic (n =
203) prosthesis. The preoperative demographics, EuroSCORE and
intraoperative characteristics concerning cardiopulmonary bypass of the 2
groups were comparable. All patients were followed annually for 10 years.
<br/>RESULT(S): There were 77 (40.3%) deaths in the CE-SAV group and 93
(45.8%) deaths in the Mosaic group. The 10-year survival rate in the 2
groups was 59.7% and 54.2%, respectively (P = 0.27). There were no
statistically significant differences between the 2 groups in terms of
structural valve deterioration (P = 0.08), endocarditis (P = 0.95),
thromboembolism (P = 0.06) and major bleeds (P = 0.09). However, the
incidence of paravalvular leaks and valve-related reoperations were higher
in the Mosaic group, with 5 leaks and 6 reoperations when compared to none
in the CE-SAV group, (P=0.02) and (P = 0.01) respectively.
<br/>CONCLUSION(S): At 10 years after implantation, freedom from
reoperation was greater in the CE-SAV group with no incidences of
paravalvular leaks. There were no other statistically significant
differences between CE-SAV and Mosaic aortic prostheses.<br/>Copyright
&#xa9; The Author(s) 2018.

<54>
Accession Number
624898850
Title
Is goal-directed fluid therapy based on dynamic variables alone sufficient
to improve clinical outcomes among patients undergoing surgery? A
meta-analysis.
Source
Critical Care. 22 (1) (no pagination), 2018. Article Number: 298. Date of
Publication: 14 Nov 2018.
Author
Deng Q.-W.; Tan W.-C.; Zhao B.-C.; Wen S.-H.; Shen J.-T.; Xu M.
Institution
(Deng, Wen, Shen, Xu) Department of Anesthesiology, First Affiliated
Hospital, Sun Yat-sen University, No.58, Zhongshan 2nd Road, Guangzhou
510080, China
(Tan) Department of Endoscopy, Sun Yat-sen University Cancer Center, No.
651, Dongfeng East Road, Guangzhou 510060, China
(Zhao) Department of Anesthesiology, Nanfang Hospital, Southern Medical
University, No. 1838, Guangzhou Avenue North, Guangzhou 510515, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Whether goal-directed fluid therapy based on dynamic
predictors of fluid responsiveness (GDFTdyn) alone improves clinical
outcomes in comparison with standard fluid therapy among patients
undergoing surgery remains unclear. <br/>Method(s): PubMed, EMBASE, the
Cochrane Library and ClinicalTrials.gov were searched for relevant
studies. Studies comparing the effects of GDFTdyn with that of standard
fluid therapy on clinical outcomes among adult patients undergoing surgery
were considered eligible. Two analyses were performed separately: GDFTdyn
alone versus standard fluid therapy and GDFTdyn with other optimization
goals versus standard fluid therapy. The primary outcomes were short-term
mortality and overall morbidity, while the secondary outcomes were serum
lactate concentration, organ-specific morbidity, and length of stay in the
intensive care unit (ICU) and in hospital. <br/>Result(s): We included 37
studies with 2910 patients. Although GDFTdyn alone lowered serum lactate
concentration (mean difference (MD) - 0.21 mmol/L, 95% confidence interval
(CI) (- 0.39, - 0.03), P = 0.02), no significant difference was found
between groups in short-term mortality (odds ratio (OR) 0.85, 95% CI
(0.32, 2.24), P = 0.74), overall morbidity (OR 1.03, 95% CI (0.31, 3.37),
P = 0.97), organ-specific morbidity, or length of stay in the ICU and in
hospital. Analysis of trials involving the combination of GDFTdyn and
other optimization goals (mainly cardiac output (CO) or cardiac index
(CIx)) showed a significant reduction in short-term mortality (OR 0.45,
95% CI (0.24, 0.85), P = 0.01), overall morbidity (OR 0.41, 95% CI (0.28,
0.58), P < 0.00001), serum lactate concentration (MD - 0.60 mmol/L, 95% CI
(- 1.04, - 0.15), P = 0.009), cardiopulmonary complications (cardiac
arrhythmia (OR 0.58, 95% CI (0.37, 0.92), P = 0.02), myocardial infarction
(OR 0.35, 95% CI (0.16, 0.76), P = 0.008), heart failure/cardiovascular
dysfunction (OR 0.31, 95% CI (0.14, 0.67), P = 0.003), acute lung
injury/acute respiratory distress syndrome (OR 0.13, 95% CI (0.02, 0.74),
P = 0.02), pneumonia (OR 0.4, 95% CI (0.24, 0.65), P = 0.0002)), length of
stay in the ICU (MD - 0.77 days, 95% CI (- 1.07, - 0.46), P < 0.00001) and
in hospital (MD - 1.18 days, 95% CI (- 1.90, - 0.46), P = 0.001).
<br/>Conclusion(s): It was not the optimization of fluid responsiveness by
GDFTdyn alone but rather the optimization of tissue and organ perfusion by
GDFTdyn and other optimization goals that benefited patients undergoing
surgery. Patients managed with the combination of GDFTdyn and CO/CI goals
might derive most benefit.<br/>Copyright &#xa9; 2018 The Author(s).

<55>
Accession Number
624898842
Title
Systematic review of incretin therapy during peri-operative and intensive
care.
Source
Critical Care. 22 (1) (no pagination), 2018. Article Number: 299. Date of
Publication: 14 Nov 2018.
Author
Hulst A.H.; Plummer M.P.; Hollmann M.W.; Devries J.H.; Preckel B.; Deane
A.M.; Hermanides J.
Institution
(Hulst, Hollmann, Preckel, Hermanides) Department of Anaesthesiology,
Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Postbus 22660,
Amsterdam 1105 AZ, Netherlands
(Plummer, Deane) Intensive Care Unit, Royal Melbourne Hospital, 300
Grattan Street, Parkville, VIC 3050, Australia
(Devries) Department of Endocrinology, Amsterdam UMC, University of
Amsterdam, Meibergdreef 9, Postbus 22660, Amsterdam 1105 AZ, Netherlands
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Glucagon-like peptide 1 (GLP-1) and glucose-dependent
insulinotropic peptide (GIP) are incretin hormones. By lowering blood
glucose in a glucose-dependent manner, incretin-based therapies represent
a novel and promising intervention to treat hyperglycaemia in hospital
settings. We performed a systematic review of the literature for all
current applications of incretin-based therapies in the peri-operative and
critical care settings. <br/>Method(s): We searched MEDLINE, the Cochrane
Library, and Embase databases for all randomised controlled trials using
exogenous GLP-1, GLP-1 receptor agonists, exogenous GIP and dipeptidyl
peptidase IV inhibitors in the setting of adult peri-operative care or
intensive care. We defined no comparator treatment. Outcomes of interest
included blood glucose, frequency of hypoglycaemia and insulin
administration. <br/>Result(s): Of the 1190 articles identified during the
initial literature search, 38 fulfilled criteria for full-text review, and
19 single-centre studies were subsequently included in the qualitative
review. Of the 18 studies reporting glycaemic control, improvement was
reported in 15, defined as lower glucose concentrations in 12 and as
reduced insulin administration (with similar glucose concentrations) in 3.
Owing to heterogeneity, meta-analysis was possible only for the outcome of
hypoglycaemia. This revealed an incidence of 7.4% in those receiving
incretin-based therapies and 6.8% in comparator groups (P = 0.94).
<br/>Conclusion(s): In small, single-centre studies, incretin-based
therapies lowered blood glucose and reduced insulin administration without
increasing the incidence of hypoglycaemia. Trial registration: PROSPERO,
CRD42017071926.<br/>Copyright &#xa9; 2018 The Author(s).

<56>
Accession Number
2001287657
Title
Treatment of malignant pleural mesothelioma with chemotherapy preceding
versus after surgical resection.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (2) (pp 758-766.e1),
2019. Date of Publication: February 2019.
Author
Verma V.; Ahern C.A.; Berlind C.G.; Lindsay W.D.; Grover S.; Friedberg
J.S.; Simone C.B.
Institution
(Verma) Department of Radiation Oncology, Allegheny General Hospital,
Pittsburgh, Pa, United States
(Ahern, Berlind, Lindsay) Oncora Medical, Philadelphia, Pa, United States
(Grover) Department of Radiation Oncology, University of Pennsylvania,
Philadelphia, Pa, United States
(Friedberg) Division of Thoracic Surgery, Department of Surgery,
University of Maryland Medical Center, Baltimore, Md, United States
(Simone) Department of Radiation Oncology, University of Maryland Medical
Center, Baltimore, Md, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: There are 2 main treatment paradigms recognized by the
National Comprehensive Cancer Network for resectable malignant pleural
mesothelioma (MPM): induction chemotherapy followed by resection (IC/R),
and up-front resection with postoperative chemotherapy (R/PC). These
paradigms are being compared in an accruing randomized phase II trial. In
the absence of such completed trials, in this study we evaluated overall
survival (OS) and postoperative outcomes of IC/R and R/PC. <br/>Method(s):
The National Cancer Database was queried for newly diagnosed
epithelioid/biphasic MPM. Metastatic, node-positive, and/or cT4 disease
was excluded, along with nondefinitive surgery and lack of chemotherapy.
Multivariable logistic regression ascertained factors independently
associated with induction chemotherapy delivery. Kaplan-Meier analysis was
used to evaluate OS between cohorts; multivariable Cox proportional
hazards modeling was used to assess factors associated with OS. Survival
was also evaluated between propensity-matched populations. Last,
postoperative outcomes were assessed between groups. <br/>Result(s):
Overall, 361 patients (182 IC/R, 179 R/PC) were analyzed. Temporal trends
revealed that IC/R is decreasing over time. Survival of the IC/R cohort
was similar to that of R/PC patients (20.9 vs 21.7 months; P =.500); this
persisted after propensity matching (20.8 vs 22.0 months; P =.270).
However, patients who underwent IC/R experienced longer postoperative
hospitalization (median 7 days vs 6 days; P =.001) and higher 30-day
mortality (3.3% vs 0%; P =.020). <br/>Conclusion(s): To our knowledge,
this is the only comparative investigation of the 2 major management
paradigms of operable MPM. IC/R regimens are decreasing over time in the
United States. Although associated with survival similar to R/PC, IC/R
might be associated with worse postoperative outcomes. Careful induction
chemotherapy patient selection is thus highly recommended.<br/>Copyright
&#xa9; 2018 The American Association for Thoracic Surgery

<57>
Accession Number
2001481102
Title
Impact of Chronic Kidney Disease on Outcomes of Myocardial
Revascularization in Patients With Diabetes.
Source
Journal of the American College of Cardiology. 73 (4) (pp 400-411), 2019.
Date of Publication: 5 February 2019.
Author
Farkouh M.E.; Sidhu M.S.; Brooks M.M.; Vlachos H.; Boden W.E.; Frye R.L.;
Hartigan P.; Siami F.S.; Bittner V.A.; Chaitman B.R.; Mancini G.B.J.;
Fuster V.
Institution
(Farkouh) Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar
Centre, University of Toronto, Toronto, Ontario, Canada
(Sidhu) Albany Medical College, Albany, NY, United States
(Brooks, Vlachos) University of Pittsburgh, Pittsburgh, PA, United States
(Boden) Boston University and VA New England Health Care System, Boston,
MA, United States
(Frye) Mayo Clinic, Rochester, MN, United States
(Hartigan) Yale University and VA West Haven, West Haven, CT, United
States
(Siami) New England Research Institutes, Watertown, MA, United States
(Bittner) University of Alabama at Birmingham, Birmingham, AL, United
States
(Chaitman) St. Louis University, St. Louis, MO, United States
(Mancini) University of British Columbia, Vancouver, British Columbia,
Canada
(Fuster) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Fuster) Centro Nacional de Investigaciones Cardiovasculares, Madrid,
Spain
Publisher
Elsevier USA
Abstract
Background: The optimal coronary revascularization strategy in patients
with stable ischemic heart disease (SIHD) who have type 2 diabetes (T2DM)
and chronic kidney disease (CKD) remains unclear. <br/>Objective(s): This
patient-level pooled analysis sought to compare outcomes of 3 large,
federally-funded randomized trials in SIHD patients with T2DM and CKD
(COURAGE [Clinical Outcomes Utilizing Revascularization and Aggressive
Drug Evaluation], BARI 2D [Bypass Angioplasty Revascularization
Investigation 2 Diabetes], and FREEDOM [Future Revascularization
Evaluation in Patients with Diabetes Mellitus: Optimal Management of
Multi-vessel Disease]). <br/>Method(s): The primary endpoint was the
composite of major adverse cardiovascular or cerebrovascular events
(MACCE) including all-cause death, myocardial infarction (MI), or stroke
adjusted for trial and randomization strategy. <br/>Result(s): Of the
4,953 patients with available estimated glomerular filtration rate (eGFR)
at baseline, 1,058 had CKD (21.4%). CKD patients were more likely to be
older, be female, and have a history of heart failure. CKD subjects were
more likely to experience a MACCE (adjusted hazard ratio [HR]: 1.48; 95%
confidence interval [CI]: 1.28 to 1.71; p = 0.0001) during a median
4.5-year follow-up. Both mild (eGFR 45 to 60 ml/min/1.73 m²)
and moderate to severe (eGFR <45 ml/min/1.73 m²) CKD predicted
MACCE (adjusted HRs: 1.25 and 2.26, respectively). For patients without
CKD, coronary artery bypass graft (CABG) surgery combined with optimal
medical therapy (OMT) was associated with lower MACCE rates compared with
percutaneous coronary intervention (PCI) + OMT (adjusted HR: 0.69; 95% CI:
0.55 to 0.86; p = 0.001). For the comparison of CABG + OMT versus PCI +
OMT in the CKD group, there was only a statistically significant
difference in subsequent revascularization rates (HR: 0.25; 95% CI: 0.15
to 0.41; p = 0.0001) but not in MACCE rates. <br/>Conclusion(s): Among
SIHD patients with T2DM and no CKD, CABG + OMT significantly reduced MACCE
compared with PCI + OMT. In subjects with CKD, there was a nonsignificant
trend toward a better MACCE outcome with CABG and a significant reduction
in subsequent revascularization.<br/>Copyright &#xa9; 2019 American
College of Cardiology Foundation

<58>
Accession Number
624513084
Title
Effect of Cricoid Pressure Compared with a Sham Procedure in the Rapid
Sequence Induction of Anesthesia: The IRIS Randomized Clinical Trial.
Source
JAMA Surgery. 154 (1) (pp 9-17), 2019. Date of Publication: January 2019.
Author
Birenbaum A.; Hajage D.; Roche S.; Ntouba A.; Eurin M.; Cuvillon P.; Rohn
A.; Compere V.; Benhamou D.; Biais M.; Menut R.; Benachi S.; Lenfant F.;
Riou B.
Institution
(Birenbaum, Roche) Department of Anesthesiology and Critical Care, Hopital
Pitie-Salpetriere, Assistance Publique-Hopitaux de Paris, Paris, France
(Hajage) Sorbonne Universite, Department of Biostatistics Public Health
and Medical Information, Hopital Pitie-Salpetriere, Assistance
Publique-Hopitaux de Paris, Paris, France
(Ntouba) Universite Jules Verne, Department of Anesthesiology and Critical
Care, CHI Amiens-Picardie, Amiens, France
(Eurin) Department of Anesthesiology and Critical Care, Hopital Beaujon,
Assistance Publique-Hopitaux de Paris, Clichy, France
(Cuvillon) Universite de Montpellier, Department of Anesthesiology and
Critical Care, Hopital Caremeau, Nimes, France
(Rohn) Department of Anesthesiology and Critical Care, Centre Hospitalier
Universitaire Regional de Lille, Lille, France
(Compere) Universite de Haute-Normandie, Department of Anesthesiology and
Critical Care, Hopital, Rouen, France
(Benhamou) Universite Paris-Sud, Department of Anesthesiology and Critical
Care, Hopital Bicetre, Assistance Publique-Hopitaux de Paris, Le
Kremlin-Bicetre, France
(Biais) Universite Victor Segalen, Department of Anesthesiology and
Critical Care, Hopital Pellegrin, Bordeaux, France
(Menut) Universite Toulouse 3-Paul Sabatier, Department of Anesthesiology
and Intensive Care, University Hospital of Toulouse, Toulouse, France
(Benachi) Department of Anesthesiology and Critical Care, Hopital
Avicenne, Assistance Publique-Hopitaux de Paris, Bobigny, France
(Lenfant) Department of Anesthesiology, Centre Hospitalier Simone Veil,
Cannes, France
(Riou) Sorbonne Universite, UMR Inserm, Institut Hospitalo-universitaire
ICAN, Department of Emergency Medicine and Surgery, Hopital
Pitie-Salpetriere, Assistance Publique-Hopitaux de Paris, Paris, France
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: The use of cricoid pressure (Sellick maneuver) during rapid
sequence induction (RSI) of anesthesia remains controversial in the
absence of a large randomized trial. <br/>Objective(s): To test the
hypothesis that the incidence of pulmonary aspiration is not increased
when cricoid pressure is not performed. <br/>Design, Setting, and
Participant(s): Randomized, double-blind, noninferiority trial conducted
in 10 academic centers. Patients undergoing anesthesia with RSI were
enrolled from February 2014 until February 2017 and followed up for 28
days or until hospital discharge (last follow-up, February 8, 2017).
<br/>Intervention(s): Patients were assigned to a cricoid pressure
(Sellick group) or a sham procedure group. <br/>Main Outcomes and
Measures: Primary end point was the incidence of pulmonary aspiration (at
the glottis level during laryngoscopy or by tracheal aspiration after
intubation). It was hypothesized that the sham procedure would not be
inferior to the cricoid pressure. The secondary end points were related to
pulmonary aspiration, difficult tracheal intubation, and traumatic
complications owing to the tracheal intubation or cricoid pressure.
<br/>Result(s): Of 3472 patients randomized, mean (SD) age was 51 (19)
years and 1777 (51%) were men. The primary end point, pulmonary
aspiration, occurred in 10 patients (0.6%) in the Sellick group and in 9
patients (0.5%) in the sham group. The upper limit of the 1-sided 95% CI
of relative risk was 2.00, exceeding 1.50, failing to demonstrate
noninferiority (P =.14). The risk difference was -0.06% (2-sided 95% CI,
-0.57 to 0.42) in the intent-to-treat population and -0.06% (2-sided 95%
CI, -0.56 to 0.43) in the per protocol population. Secondary end points
were not significantly different among the 2 groups (pneumonia, length of
stay, and mortality), although the comparison of the Cormack and Lehane
grade (Grades 3 and 4, 10% vs 5%; P <.001) and the longer intubation time
(Intubation time >30 seconds, 47% vs 40%; P <.001) suggest an increased
difficulty of tracheal intubation in the Sellick group. <br/>Conclusions
and Relevance: This large randomized clinical trial performed in patients
undergoing anesthesia with RSI failed to demonstrate the noninferiority of
the sham procedure in preventing pulmonary aspiration. Further studies are
required in pregnant women and outside the operating room. Trial
Registration: ClinicalTrials.gov Identifier: NCT02080754.<br/>Copyright
&#xa9; 2018 American Medical Association. All rights reserved.

<59>
Accession Number
2001243438
Title
Aspirin in coronary artery surgery: 1-year results of the Aspirin and
Tranexamic Acid for Coronary Artery Surgery trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (2) (pp 633-640),
2019. Date of Publication: February 2019.
Author
Myles P.S.; Smith J.A.; Kasza J.; Silbert B.; Jayarajah M.; Painter T.;
Cooper D.J.; Marasco S.; McNeil J.; Bussieres J.S.; McGuinness S.; Chan
M.T.V.; Wallace S.; Forbes A.
Institution
(Myles, Cooper, Marasco, Wallace) Alfred Hospital, Melbourne, Australia
(Myles, Smith, Kasza, Cooper, Marasco, McNeil, Wallace, Forbes) Monash
University, Melbourne, Australia
(Smith) Monash Medical Centre, Clayton, Australia
(Silbert) St Vincent's Hospital, Fitzroy, Australia
(Jayarajah) South West Cardiac Centre, Derriford Hospital, Plymouth,
United Kingdom
(Painter) Royal Adelaide Hospital and Discipline of Acute Care Medicine,
University of Adelaide, Adelaide, Australia
(Bussieres) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec City, Quebec, Canada
(McGuinness) Auckland City Hospital, Auckland, New Zealand
(Chan) The Chinese University of Hong Kong, Hong Kong, Hong Kong
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Aspirin may reduce the risk of vascular graft thrombosis after
cardiovascular surgery. We previously reported the 30-day results of a
trial evaluating aspirin use before coronary artery surgery. Here we
report the 1-year outcomes evaluating late thrombotic events and
disability-free survival. <br/>Method(s): Using a factorial design, we
randomly assigned patients undergoing coronary artery surgery to receive
aspirin or placebo and tranexamic acid or placebo. The results of the
aspirin comparison are reported here. The primary 1-year outcome was death
or severe disability, the latter defined as living with a modified Katz
activities of daily living score < 8. Secondary outcomes included a
composite of myocardial infarction, stroke and death from any cause
through to 1 year after surgery. <br/>Result(s): Patients were randomly
assigned to aspirin (1059 patients) or placebo (1068 patients). The rate
of death or severe disability was 4.1% in the aspirin group and 3.5% in
the placebo group (relative risk, 1.17; 95% confidence interval,
0.76-1.81; P =.48). There was no significant difference in the rates of
myocardial infarction (P =.11), stroke (P =.086), or death (P =.24), or a
composite of these cardiovascular end points (P =.68). With the exception
of those with a low European System for Cardiac Operative Risk Evaluation
score (P =.03), there were no interaction effects on these outcomes with
tranexamic acid (all tests of interaction P >.10). <br/>Conclusion(s): In
patients undergoing coronary artery surgery, preoperative aspirin did not
reduce death or severe disability, or thrombotic events through to 1 year
after surgery.<br/>Copyright &#xa9; 2018 The American Association for
Thoracic Surgery

<60>
Accession Number
625869364
Title
Randomized trial of endoscopic or open vein-graft harvesting for
coronary-artery bypass.
Source
New England Journal of Medicine. 380 (2) (pp 132-141), 2019. Date of
Publication: 10 Jan 2019.
Author
Zenati M.A.; Bhatt D.L.; Bakaeen F.G.; Stock E.M.; Biswas K.; Michael
Gaziano J.; Kelly R.F.; Tseng E.E.; Bitondo J.; Quin J.A.; Hossein Almassi
G.; Haime M.; Hattler B.; DeMatt E.; Scrymgeour A.; Huang G.D.
Institution
(Zenati, Quin, Haime) Division of Cardiac Surgery, Veterans Affairs Boston
Healthcare System, 1400 VFW Parkway, Boston, MA 02132
(Bhatt, Michael Gaziano) Division of Cardiology, Veterans Affairs (VA)
Boston Healthcare System, Harvard Medical School, Boston
(Zenati, Quin, Haime) Department of Surgery, Brigham and Women's Hospital,
Harvard Medical School, Boston
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston
(Bitondo) Massachusetts General Hospital, Boston
(Bakaeen) Departments of Thoracic and Cardiovascular Surgery, Heart and
Vascular Institute, Cleveland Clinic, Cleveland
(Bakaeen) VA Pittsburgh Healthcare System, Pittsburgh
(Stock, Biswas, DeMatt) Cooperative Studies Program Coordinating Center,
Office of Research and Development, Department of Veterans Affairs, Perry
Point, MD
(Kelly) Minneapolis VA Medical Center, University of Minnesota,
Minneapolis
(Tseng) San Francisco VA Medical Center, University of California, San
Francisco, San Francisco
(Hossein Almassi) Zablocki VA Medical Center, Medical College of
Wisconsin, Milwaukee
(Hattler) VA Eastern Colorado Healthcare System, Denver
(Scrymgeour) Cooperative Studies Program Pharmacy Coordinating Center,
Department of Veterans Affairs, Albuquerque, NM
(Huang) Cooperative Studies Program Central Office, Office of Research and
Development, Department of Veterans Affairs, WA, United States
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND The saphenous-vein graft is the most common conduit for
coronary-artery bypass grafting (CABG). The influence of the vein-graft
harvesting technique on long-term clinical outcomes has not been well
characterized. METHODS We randomly assigned patients undergoing CABG at 16
Veterans Affairs cardiac surgery centers to either open or endoscopic
vein-graft harvesting. The primary outcome was a composite of major
adverse cardiac events, including death from any cause, nonfatal
myocardial infarction, and repeat revascularization. Leg-wound
complications were also evaluated. RESULTS A total of 1150 patients
underwent randomization. Over a median follow-up of 2.78 years, the
primary outcome occurred in 89 patients (15.5%) in the open-harvest group
and 80 patients (13.9%) in the endoscopic-harvest group (hazard ratio,
1.12; 95% confidence interval [CI], 0.83 to 1.51; P=0.47). A total of 46
patients (8.0%) in the open-harvest group and 37 patients (6.4%) in the
endoscopic-harvest group died (hazard ratio, 1.25; 95% CI, 0.81 to 1.92);
myocardial infarc-tions occurred in 34 patients (5.9%) in the open-harvest
group and 27 patients (4.7%) in the endoscopic-harvest group (hazard
ratio, 1.27; 95% CI, 0.77 to 2.11), and revascularization occurred in 35
patients (6.1%) in the open-harvest group and 31 patients (5.4%) in the
endoscopic-harvest group (hazard ratio, 1.14; 95% CI, 0.70 to 1.85).
Leg-wound infections occurred in 18 patients (3.1%) in the open-harvest
group and in 8 patients (1.4%) in the endoscopic-harvest group (relative
risk, 2.26; 95% CI, 0.99 to 5.15). CONCLUSIONS Among patients undergoing
CABG, we did not find a significant difference between open vein-graft
harvesting and endoscopic vein-graft harvesting in the risk of major
adverse cardiac events. (Funded by the Cooperative Studies Program, Office
of Research and Development, Department of Veterans Affairs; REGROUP
ClinicalTrials.gov number, NCT01850082).<br/>Copyright &#xa9; 2018
Massachusetts Medical Society.

<61>
Accession Number
625869356
Title
Hybrid minimally invasive esophagectomy for esophageal cancer.
Source
New England Journal of Medicine. 380 (2) (pp 152-162), 2019. Date of
Publication: 10 Jan 2019.
Author
Mariette C.; Markar S.R.; Dabakuyo-Yonli T.-H.S.; Meunier B.; Pezet D.;
Collet D.; D'Journo X.B.; Brigand C.; Perniceni T.; Carrere N.; Mabrut
J.-Y.; Msika S.; Peschaud F.; Prudhomme M.; Bonnetain F.; Piessen G.
Institution
(Mariette, Piessen) Department of Digestive and Oncologic Surgery, Claude
Huriez University Hospital, Rue Michel Polonovski, Lille F59000, France
(Mariette, Piessen) INSERM, Centre Hospitalier Universitaire (CHU) Lille,
Unite Mixte de Recherche 1172-JPARC Jean-Pierre Aubert Research Center,
Team "Mucins, epithelial differentiation, and carcinogenesis, Universite
de Lille, Lille, France
(Dabakuyo-Yonli) Epidemiology and Quality of Life Unit, INSERM Unite 1231,
Centre Georges Francois Leclerc, Dijon, France
(Meunier) Department of Hepatobiliary and Digestive Surgery, CHU Rennes,
University of Rennes 1, Rennes, France
(Pezet) Universite Clermont Auvergne, INSERM, CHU Clermont-Ferrand,
Service de Chirurgie Digestive, Clermont-Ferrand, France
(Collet) Department of Digestive Surgery, Haut Leveque University
Hospital, Bordeaux, France
(D'Journo) Department of Thoracic Surgery, Hopital Nord, Aix-Marseille
Universite, Assistance Publique-Hopitaux de Marseille, Marseille, France
(Brigand) Department of Digestive Surgery, Strasbourg University,
Strasbourg, France
(Perniceni) Department of Digestive Surgery, Institut Mutualiste
Montsouris, Paris, France
(Carrere) Department of Digestive Surgery, Purpan Hospital, CHU Toulouse,
Universite Toulouse III, Toulouse, France
(Mabrut) Department of General Surgery and Liver Transplantation, Hopital
de la Croix-Rousse, Hospices Civils de Lyon, Equipe Mixte de Recherche
3738, Universite Lyon 1, Lyon, France
(Msika) Department of Digestive and General Surgery, CHU Louis Mourier,
Assistance Publique-Hopitaux de Paris (AP-HP), Universite Paris 7, Denis
Diderot, PRES Sorbonne Paris Cite, Colombes, France
(Peschaud) Department of Surgery and Oncology, Centre Hospitalier
Universitaire Ambroise Pare, AP-HP, Universite de Versailles,
Boulogne-Billancourt, France
(Prudhomme) Department of Digestive Surgery, CHU Nimes, Nimes, France
(Bonnetain) Methodology and Quality of Life Unit in Cancer, INSERM Unite
Mixte de Recherche 1098, University Hospital of Besancon, Besancon, France
(Markar) Department of Surgery and Cancer, Imperial College, London,
United Kingdom
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Postoperative complications, especially pulmonary
complications, affect more than half the patients who undergo open
esophagectomy for esophageal cancer. Whether hybrid minimally invasive
esophagectomy results in lower morbidity than open esophagectomy is
unclear. METHODS We performed a multicenter, open-label, randomized,
controlled trial involving patients 18 to 75 years of age with resectable
cancer of the middle or lower third of the esophagus. Patients were
randomly assigned to undergo transthoracic open esophagectomy (open
procedure) or hybrid minimally invasive esophagectomy (hybrid procedure).
Surgical quality assurance was implemented by the credentialing of
surgeons, standardization of technique, and monitoring of performance.
Hybrid surgery comprised a two-field abdominal-thoracic operation (also
called an Ivor-Lewis procedure) with laparoscopic gastric mobilization and
open right thoracotomy. The primary end point was intraoperative or
postoperative complication of grade II or higher according to the
Clavien-Dindo classification (indicating major complication leading to
intervention) within 30 days. Analyses were done according to the
intention-to-treat principle. RESULTS From October 2009 through April
2012, we randomly assigned 103 patients to the hybrid-procedure group and
104 to the open-procedure group. A total of 312 serious adverse events
were recorded in 110 patients. A total of 37 patients (36%) in the
hybrid-procedure group had a major intraoperative or postoperative
complication, as compared with 67 (64%) in the open-procedure group (odds
ratio, 0.31; 95% confidence interval [CI], 0.18 to 0.55; P<0.001). A total
of 18 of 102 patients (18%) in the hybrid-procedure group had a major
pulmonary complication, as compared with 31 of 103 (30%) in the
open-procedure group. At 3 years, overall survival was 67% (95% CI, 57 to
75) in the hybrid-procedure group, as compared with 55% (95% CI, 45 to 64)
in the open-procedure group; disease-free survival was 57% (95% CI, 47 to
66) and 48% (95% CI, 38 to 57), respectively. CONCLUSIONS We found that
hybrid minimally invasive esophagectomy resulted in a lower incidence of
intraoperative and postoperative major complications, specifically
pulmonary complications, than open esophagectomy, without compromising
overall and disease-free survival over a period of 3 years. (Funded by the
French National Cancer Institute; ClinicalTrials.gov number,
NCT00937456.)<br/>Copyright &#xa9; 2019 Massachusetts Medical Society.

<62>
Accession Number
625728440
Title
Vasopressin therapy in cardiac surgery.
Source
Journal of Cardiac Surgery. 34 (1) (pp 20-27), 2019. Date of Publication:
January 2019.
Author
Kunkes J.H.; Baker W.L.; Hammond J.A.; Gluck J.
Institution
(Kunkes, Hammond, Gluck) Hartford Hospital, Hartford, CT, United States
(Kunkes, Hammond, Gluck) University of Connecticut School of Medicine,
Farmington, CT, United States
(Baker) University of Connecticut School of Pharmacy, Storrs, CT, United
States
(Hammond, Gluck) Heart and Vascular Institute, Hartford Healthcare,
Hartford, CT, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Arginine vasopressin (AVP) is a naturally occurring peptide
with diverse effects mediated through selective V1 and V2 receptors. About
10% of patients undergoing cardiopulmonary bypass develop postoperative
vasodilatory shock requiring high-dose catecholamines. We sought to
examine the role of AVP therapy in cardiac surgery. <br/>Method(s): A
search of Medline was conducted through September 2018 using key words and
medical subject headings (MeSH) relating to AVP, copeptin, and cardiac
surgery. A systematic review was performed on articles as they pertained
to AVP for use as a vasopressor after cardiovascular surgery complicated
by vasodilatory shock. <br/>Result(s): A relative or absolute deficiency
of Arginine vasopressin is associated with vasodilatory shock after
cardiopulmonary bypass. Physiologic replacement with exogenous Arginine
vasopressin results in significant increases in systemic vascular
resistance and mean arterial pressure with decreased requirements of
catecholamines. At doses of <0.1 U/min Arginine vasopressin is safe with
very few adverse effects. <br/>Conclusion(s): Post-cardiopulmonary bypass
vasodilatory shock is largely due to a relative deficiency of Arginine
vasopressin. Exogenous administration of low-dose Arginine vasopressin
alone or in combination with traditional catecholamines is a safe and
effective way to manage this type of vasodilatory shock.<br/>Copyright
&#xa9; 2018 Wiley Periodicals, Inc.

<63>
Accession Number
626010611
Title
Durability Data for Bioprosthetic Surgical Aortic Valve: A Systematic
Review.
Source
JAMA Cardiology. 4 (1) (pp 71-80), 2019. Date of Publication: January
2019.
Author
Fatima B.; Mohananey D.; Khan F.W.; Jobanputra Y.; Tummala R.; Banerjee
K.; Krishnaswamy A.; Mick S.; Tuzcu E.M.; Blackstone E.; Svensson L.;
Kapadia S.
Institution
(Fatima, Mohananey, Jobanputra, Tummala, Banerjee, Krishnaswamy, Tuzcu,
Kapadia) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United
States
(Khan) Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN,
United States
(Mick, Blackstone, Svensson) Department of Cardiothoracic Surgery, Heart
and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Although several studies have reported data on surgical aortic
valve durability, variability in study methodologies and definitions as
well as inadequate follow-up make the interpretation of data from these
studies difficult to interpret. <br/>Objective(s): To review available
data on structural valve deterioration (SVD) of surgical bioprosthetic
aortic valves by examining the published literature as well as data
reported to the US Food and Drug Administration (FDA). Evidence Review: A
systematic review using Preferred Reporting Items for Systematic Review
and Meta-Analysis reporting guidelines to obtain all available data from
preexisting literature on the actuarial freedom from SVD and outcomes of
SVD. Data were collected from database inception to November 2016.
Additionally, data reported to the FDA were obtained. <br/>Finding(s): In
total, 167 studies and 12 FDA reports including 101650 patients and 17
different valve types were analyzed. There were 11 different definitions
of SVD used in the studies. Core laboratory data were available for 11
studies. Mean follow-up ranged from less than 1 year to 14 years.
Kaplan-Meier estimates were reported for up to 30 years of follow-up, with
0% to 37% of patients remaining at risk at maximum follow-up. Food and
Drug Administration-reported data are similarly variable in duration (mean
follow-up range, 1.2 to 7 years) and completeness of follow-up, with final
follow-up of 0.1% to 95%. <br/>Conclusions and Relevance: There is
considerable variability in reporting SVD of surgical aortic valves, with
different definitions and inadequate long-term systematically collected
core laboratory data. Rigorously collected long-term data with
standardized definitions for surgical valves are needed to provide a
benchmark for the durability of rapidly evolving transcatheter
valves.<br/>Copyright &#xa9; 2018 American Medical Association. All rights
reserved.

<64>
Accession Number
625955648
Title
Automated oxygen administration versus conventional oxygen therapy after
major abdominal or thoracic surgery: Study protocol for an international
multicentre randomised controlled study.
Source
BMJ Open. 9 (1) (no pagination), 2019. Date of Publication: 01 Jan 2019.
Author
L'Her E.; Jaber S.; Verzilli D.; Jacob C.; Huiban B.; Futier E.; Kerforne
T.; Pateau V.; Bouchard P.-A.; Gouillou M.; Nowak E.; Lellouche F.
Institution
(L'Her) Medical Intensive Care, CHRU de Brest-La Cavale Blanche, Brest,
France
(L'Her, Pateau) LATIM INSERM UMR 1101, FHU Techsan, Universite de Bretagne
Occidentale, Brest, France
(Jaber, Verzilli) Intensive Care Unit, Department of Anesthesiology B DAR
B CHU de Montpellier, Universite Montpellier 1, Montpellier, France
(Jacob, Huiban) Anesthesiology Department, CHRU de Brest-La Cavale
Blanche, Brest, France
(Futier) Anesthesiology Department, Hopital Estaing, Centre Hospitalier
Universitaire Clermont-Ferrand, Clermont-Ferrand, France
(Kerforne) Anesthesiology Department, CHU de Poitiers, Poitiers Cedex,
France
(Pateau) RandD, Oxynov Inc, Technopole Brest Iroise, Plouzane, France
(Bouchard, Lellouche) Research Laboratory, Centre de Recherche de
l'Institut de Cardiologie et de Pneumologie de Quebec, Quebec, France
(Gouillou, Nowak) Centre d'Investigation Clinique CIC INSERM 1412, CHRU de
Brest-La Cavale Blanche, Brest, France
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Hypoxemia and hyperoxia may occur after surgery with
potential related complications. The FreeO 2 PostOp trial is a
prospective, multicentre, randomised controlled trial that evaluates the
clinical impact of automated O 2 administration versus conventional O 2
therapy after major abdominal or thoracic surgeries. The study is powered
to demonstrate benefits of automated oxygen titration and weaning in term
of oxygenation, which is an important surrogate for complications after
such interventions. Methods and analysis After extubation, patients are
randomly assigned to the Standard (manual O 2 administration) or FreeO 2
group (automated closed-loop O 2 administration). Stratification is
performed for the study centre and a medical history of chronic
obstructive pulmonary disease (COPD). Primary outcome is the percentage of
time spent in the target zone of oxygen saturation, during a 3-day time
frame. In both groups, patients will benefit from continuous oximetry
recordings. The target zone of oxygen saturation is SpO 2 =88%-92% for
patients with COPD and 92%-96% for patients without COPD. Secondary
outcomes are the nursing workload assessed by the number of manual O 2
flow adjustments, the time spent with severe desaturation (SpO 2 <85%) and
hyperoxia area (SpO 2 >98%), the time spent in a hyperoxia area (SpO 2
>98%), the VO 2, the duration of oxygen administration during
hospitalisation, the frequency of use of mechanical ventilation (invasive
or non-invasive), the duration of the postrecovery room stay, the
hospitalisation length of stay and the survival rate. Ethics and
dissemination The FreeO 2 PostOp study is conducted in accordance with the
declaration of Helsinki and was registered on 11 September 2015
(http://www.clinicaltrials.gov). First patient inclusion was performed on
14 January 2016. The results of the study will be presented at academic
conferences and submitted to peer-reviewed journals. Trial registration
number NCT02546830.<br/>Copyright &#xa9; &#xa9; 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.

<65>
Accession Number
2000741576
Title
Vasopressin in Cardiac Surgery: A Meta-analysis of Randomized Controlled
Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2225-2232),
2018. Date of Publication: October 2018.
Author
Dunser M.W.; Bouvet O.; Knotzer H.; Arulkumaran N.; Hajjar L.A.; Ulmer H.;
Hasibeder W.R.
Institution
(Dunser) Department of Anesthesiology and Intensive Care Medicine, Kepler
University Hospital and Johannes Kepler University Linz, Linz, Austria
(Bouvet) Amomed Pharma GmbH, Vienna, Austria
(Knotzer) Department of Anesthesiology and Critical Care Medicine II,
Klinikum Wels, Wels, Austria
(Arulkumaran) Department of Critical Care, University College of London
Hospital, London, United Kingdom
(Hajjar) Department of Cardiopneumology, InCor, University of Sao Paulo,
Sao Paulo, Brazil
(Ulmer) Institute of Medical Statistics, Informatics and Health Economics,
Innsbruck Medical University, Innsbruck, Austria
(Hasibeder) Department of Anesthesiology and Critical Care Medicine,
Krankenhaus St. Vinzenz in Zams, Zams, Austria
Publisher
W.B. Saunders
Abstract
Objective: To summarize the results of randomized controlled trials on the
use of vasopressin as a vasopressor agent in cardiac surgery.
<br/>Design(s): Meta-analysis. <br/>Participant(s):
Six-hundred-twenty-five adult patients undergoing elective or emergency
cardiac surgery. <br/>Intervention(s): Arginine vasopressin infusion (n =
313) or control/standard therapy (n = 312). <br/>Measurements and Main
Results: The rates of perioperative complications and postoperative
mortality were used as primary and secondary endpoints, respectively.
Fixed and/or random effects models were used to compare pooled odds
ratios. Arginine vasopressin reduced the pooled odds ratio (OR) of
perioperative complications (OR, 0.33; 95% confidence interval [CI],
0.2-0.54; p < 0.0001). A sensitivity analysis excluding the largest trial
showed an unchanged reduction in perioperative complications (OR, 0.35;
95% CI, 0.18-0.69; p = 0.002). When analyzing each perioperative
complication separately, vasopressin reduced the pooled OR of vasodilatory
shock (OR, 0.4; 95% CI, 0.16-0.97; p = 0.04) and new-onset atrial
fibrillation (OR, 0.42; 95% CI, 0.21-0.82; p = 0.01). The pooled OR of
postoperative death was not different between patients treated with
arginine vasopressin and those receiving standard therapy or placebo (OR,
0.83; 95% CI, 0.45-1.53; p = 0.55). The funnel plot for the primary
endpoint suggested a relevant publication bias. All included trials
suffered from a high risk of bias. <br/>Conclusion(s): Our meta-analysis
suggests that arginine vasopressin may reduce the rate of perioperative
complications in patients undergoing elective or emergency cardiac
surgery. No difference in postoperative mortality was observed. An
adequately powered multicenter trial is required for reliable estimation
of the effects of arginine vasopressin on perioperative complication rates
and mortality in cardiac surgical patients.<br/>Copyright &#xa9; 2018
Elsevier Inc.

<66>
Accession Number
620844538
Title
Perioperative Management of Cardiovascular Medications.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2289-2302),
2018. Date of Publication: October 2018.
Author
Lomivorotov V.V.; Efremov S.M.; Abubakirov M.N.; Belletti A.; Karaskov
A.M.
Institution
(Lomivorotov, Efremov, Abubakirov) Department of Anaesthesiology and
Intensive Care, E. Meshalkin National Medical Research Center,
Novosibirsk, Russian Federation
(Belletti) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Karaskov) Department of Cardiac Surgery, E. Meshalkin National Medical
Research Center, Novosibirsk, Russian Federation
Publisher
W.B. Saunders

<67>
Accession Number
2000778981
Title
Steroids and Survival in Critically Ill Adult Patients: A Meta-analysis of
135 Randomized Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2252-2260),
2018. Date of Publication: October 2018.
Author
Martino E.A.; Baiardo Redaelli M.; Sardo S.; Lembo R.; Giordano V.F.;
Winterton D.; Ruggeri L.; Hajjar L.A.; Zangrillo A.; Landoni G.
Institution
(Martino, Baiardo Redaelli, Lembo, Giordano, Winterton, Ruggeri,
Zangrillo, Landoni) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Sardo) Department of Medical Sciences "M. Aresu, " University of
Cagliari, Cagliari, Italy
(Hajjar) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Zangrillo, Landoni) Vita-Salute San Raffaele University, Milan, Italy
Publisher
W.B. Saunders
Abstract
Objective: Corticosteroids have important effects on intermediate outcomes
in critically ill patients, but their effect on survival is unknown. The
objective of this meta-analysis was to analyze the effect on mortality of
corticosteroids in critical and perioperative settings. <br/>Design(s): A
meta-analysis of randomized trials. <br/>Setting(s): PubMed, Embase,
BioMed Central, Google Scholar, and the Cochrane Central Register of
Controlled Trials were searched to February 1, 2018, for randomized trials
comparing corticosteroids with placebo or standard care.
<br/>Participant(s): Critically ill or surgical adult patients.
<br/>Intervention(s): Corticosteroids compared with placebo or standard
care. <br/>Measurements and Main Results: A total of 44,553 patients from
135 studies were included. Overall, mortality in the corticosteroid group
and in the control group were similar (16% v 16%; p = 0.9). Subanalyses
identified a beneficial effect of corticosteroids on survival in patients
with respiratory system diseases (9% v 13%; p < 0.001) and bacterial
meningitis (28% v 32%; p= 0.04), and a detrimental effect on survival in
patients with traumatic brain injury (22% v 19%; p < 0.001). No
differences in mortality were found in patients with cardiac diseases (7%
v 6%; p = 0.7), in patients undergoing cardiac surgery (2.8% v 3.2% p =
0.14), and when treatment duration or patient age were considered.
<br/>Conclusion(s): This meta-analysis documents the safety of
corticosteroids in the overall critically ill population with the notable
exception of brain injury patients, a setting where the authors confirmed
their detrimental effect on survival. A possible beneficial effect of
corticosteroids on survival was found among patients with respiratory
diseases and in patients with bacterial meningitis.<br/>Copyright &#xa9;
2018 Elsevier Inc.

<68>
Accession Number
2000571932
Title
Effect of Levosimendan on Renal Outcome in Cardiac Surgery Patients With
Chronic Kidney Disease and Perioperative Cardiovascular Dysfunction: A
Substudy of a Multicenter Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2152-2159),
2018. Date of Publication: October 2018.
Author
Zangrillo A.; Alvaro G.; Belletti A.; Pisano A.; Brazzi L.; Calabro M.G.;
Guarracino F.; Bove T.; Grigoryev E.V.; Monaco F.; Boboshko V.A.;
Likhvantsev V.V.; Scandroglio A.M.; Paternoster G.; Lembo R.; Frassoni S.;
Comis M.; Pasyuga V.V.; Navalesi P.; Lomivorotov V.V.
Institution
(Zangrillo, Belletti, Calabro, Bove, Monaco, Scandroglio, Lembo, Frassoni)
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Zangrillo) Vita-Salute San Raffaele University, Milan, Italy
(Alvaro, Navalesi) Department of Anesthesia and Intensive Care, AOU Mater
Domini Germaneto, Catanzaro, Italy
(Pisano) Division of Cardiac Anesthesia and Intensive Care Unit, AORN dei
Colli - Monaldi Hospital, Naples, Italy
(Brazzi) Department of Anesthesia and Intensive Care, AOU Citta della
Salute e della Scienza, Turin, Italy
(Brazzi) Department of Surgical Sciences, University of Turin, Turin,
Italy
(Guarracino) Division of Cardiothoracic Anesthesia and Intensive Care,
Department of Anesthesia and Critical Care Medicine, AOU Pisana, Pisa,
Italy
(Grigoryev) Department of Anesthesiology and Intensive Care, State
Research Institute for Complex Issues of Cardiovascular Disease, Kemerovo,
Russian Federation
(Boboshko, Lomivorotov) Department of Anesthesiology and Intensive Care,
E. Meshalkin National Medical Research Center, Novosibirsk, Russian
Federation
(Likhvantsev) Department of Anesthesiology and Intensive Care, Moscow
Regional Clinical and Research Institute, Moscow, Russian Federation
(Paternoster) Department of Anesthesia and Intensive Care, San Carlo
Hospital, Potenza, Italy
(Comis) Department of Cardiovascular Anesthesia and Intensive Care, AO
Ordine Mauriziano, Turin, Italy
(Pasyuga) Department of Anesthesiology and Intensive Care, Federal Center
for Cardiovascular Surgery Astrakhan, Astrakhan, Russian Federation
(Navalesi) Department of Medical and Surgical Sciences, Magna Graecia
University, Catanzaro, Italy
Publisher
W.B. Saunders
Abstract
Objective: Acute kidney injury (AKI) occurs frequently after cardiac
surgery. Levosimendan might reduce the incidence of AKI in patients
undergoing cardiac surgery. The authors investigated whether levosimendan
administration could reduce AKI incidence in a high-risk cardiac surgical
population. <br/>Design(s): Post hoc analysis of a multicenter randomized
trial. <br/>Setting(s): Cardiac surgery operating rooms and intensive care
units of 14 centers in 3 countries. <br/>Participant(s): The study
comprised 90 patients who underwent mitral valve surgery with an estimated
glomerular filtration rate <60 mL/min/1.73 m² and perioperative
myocardial dysfunction. <br/>Intervention(s): Patients were assigned
randomly to receive levosimendan (0.025-0.2 mug/kg/min) or placebo in
addition to standard inotropic treatment. <br/>Measurements and Main
Results: Forty-six patients were assigned to receive levosimendan and 44
to receive placebo. Postoperative AKI occurred in 14 (30%) patients in the
levosimendan group versus 23 (52%) in the placebo group (absolute
difference -21.8; 95% confidence interval -41.7 to -1.97; p = 0.035). The
incidence of major complications also was lower (18 [39%]) in the
levosimendan group versus that in the placebo group (29 [66%]) (absolute
difference -26.8 [-46.7 to -6.90]; p = 0.011). A trend toward lower serum
creatinine at intensive care unit discharge was observed in the
levosimendan group (1.18 [0.99-1.49] mg/dL) versus that in the placebo
group (1.39 [1.05-1.76] mg/dL) (95% confidence interval -0.23 [-0.49 to
0.01]; p = 0.07). <br/>Conclusion(s): Levosimendan may improve renal
outcome in cardiac surgery patients with chronic kidney disease undergoing
mitral valve surgery who develop perioperative myocardial dysfunction.
Results of this exploratory analysis should be investigated in future
properly designed randomized controlled trials.<br/>Copyright &#xa9; 2018
Elsevier Inc.

<69>
Accession Number
625957739
Title
Comparison of hemodynamic response and postoperative pain score between
general anaesthesia with intravenous analgesia versus general anesthesia
with caudal analgesia in pediatric patients undergoing open-heart surgery.
Source
Annals of Cardiac Anaesthesia. 22 (1) (pp 35-40), 2018. Date of
Publication: January-March 2019.
Author
Samantaray D.J.; Trehan M.; Chowdhry V.; Reedy S.
Institution
(Samantaray, Chowdhry) Department of Cardiac Anaesthesiology, Care
Hospital, Bhubaneswar, India
(Trehan) Department of Anaesthesiology, Apollo Hospital, Krishna Vihar
Patrapada, Bhubaneswar, Odisha KV?18, India
(Reedy) Department of Anaesthesiology, KK Womens and Children Hospital,
Singapore, Singapore
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Context: Regional anesthesia may attenuate adverse physiological stress
responses associated with cardiothoracic surgery. In this study,
hemodynamic stress response at the different time of surgical stimuli was
compared between patients receiving general anesthesia (GA) along with
caudal epidural analgesia with GA with intravenous analgesia in pediatric
population undergoing open-heart surgery. <br/>Aim(s): This study aims to
compare the hemodynamic response at the different time of surgical stimuli
and postoperative pain score, in pediatric patients undergoing open-heart
procedures. Settings and Design: We designed a prospective randomized
controlled trial to study hemodynamic effects between Group I and Group
II. Fifty patients were randomly allocated equally into Group I (GA +
caudal epidural) and Group II (GA + intravenous analgesia) by sealed
envelope technique. Subjects and Methods: After obtaining approval from
Institutional Ethical Committee, this prospective study was conducted in
50 American Society of Anesthesiologist Classes II and III pediatric
patients aged between 1 and 12 years posted for cardiac surgery in our
institution. Statistical Analysis: ANOVA, two-way ANOVA, and Student's
test. <br/>Result(s): The heart rate, systolic blood pressure, diastolic
blood pressure and mean blood pressure variations were compared between
Groups I and II at different time intervals. The variations were found to
be significantly higher at the time of skin incision and 2 min after skin
incision in Group II as compared to Group I. Pain score was compared
between the groups and was found to be significantly lower with Group I
(2.5 +/- 1.2) as compared to Group II (4.6 +/- 1.7), P = (0.004).
<br/>Conclusion(s): Caudal analgesia with GA (Group I) was found to have
better hemodynamic control and significantly better postoperative pain
relief in the first 24 h after awakening.<br/>Copyright &#xa9; 2019
Wolters Kluwer Medknow Publications. All rights reserved.

<70>
Accession Number
619499363
Title
Effect of Sustained Use of Aspirin until the Time of Surgery on Outcomes
following Coronary Artery Bypass Grafting: A Randomized Clinical Trial.
Source
Thoracic and Cardiovascular Surgeon. 66 (6) (pp 442-451), 2018. Date of
Publication: 24 Nov 2018.
Author
Sharifi M.; Kamali A.; Ghandi Y.
Institution
(Sharifi) Department of Cardiovascular Surgery, Amir-Almomenin Training
and Research Hospital, Arak University of Medical Sciences, Arak
3848176941, Iran, Islamic Republic of
(Kamali) Department of Anesthesiology, Faculty of Medicine, Arak
University of Medical Sciences, Arak, Iran, Islamic Republic of
(Ghandi) Department of Pediatric Cardiology, Faculty of Medicine, Arak
University of Medical Sciences, Arak, Iran, Islamic Republic of
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background The topic of aspirin (acetylsalicylic acid, ASA) use in
coronary artery disease patients planned for coronary artery bypass
grafting during perioperative period is among the most disputed issues in
cardiac surgery. We designed a study to weigh the risks and benefits of
continued ASA ingestion until the time of surgery. Methods In this
randomized double-blind clinical trial, 206 consecutive patients scheduled
for isolated coronary artery bypass surgery (CABG) were randomly
stratified into two groups. In group 1 (104 cases), patients were given 80
mg ASA per day until the day of surgery. In group 2 (102 patients), ASA
(80 mg per day) was stopped 4 days before the operation. Patients in these
two groups were similar in terms of preoperative patient and procedural
characteristics. ASA was resumed 24 hours after the surgery in all
patients. Results The rates of bleeding and reexploration within 24 hours
of surgery were significantly higher in group 1 (824.3 vs. 492.1 mL, p <
0.001 and 5.7% vs. 0, p = 0.0138, respectively). The amount of intra- and
postoperative packed red blood cell (PRBC) transfusion was considerably
greater in group 1 (mean: 1.83 vs. 0.71 units, p < 0.001). The rate of
hospital mortality was similar (1.9% in both the groups, p = 0.98).
Patients in group 1 had significantly longer mean hospital stay than
patients in group 2 (8 vs. 5.1 days, p < 0.001). Again the time interval
between weaning from heart-lung machine and closing the sternum was
strikingly longer in group 1 (mean: 32.1 vs. 14.5 minutes, p < 0.001). The
incidence of adverse postoperative outcomes such as myocardial infarction,
stroke, and renal failure was not statistically different between the two
groups. Conclusion Sustained ASA use until the day of surgery in patients
planned for elective isolated CABG can result in excessive bleeding,
increased rate of reexploration, and need for more PRBC transfusion
without any proven beneficial effect on reducing unfavorable postoperative
outcomes. Hence, we recommend discontinuing ASA between 3 and 5 days
before non-urgent CABG while keeping it on in nonelective
circumstances.<br/>Copyright &#xa9; 2018 Georg Thieme Verlag KG Stuttgart.
New York.

<71>
Accession Number
621200762
Title
To fly as a pilot after cardiac surgery.
Source
European Journal of Cardio-thoracic Surgery. 53 (3) (pp 505-511), 2018.
Date of Publication: 01 Mar 2018.
Author
Syburra T.; Nicol E.; Mitchell S.; Bron D.; Rosendahl U.; Pepper J.
Institution
(Syburra) Department of Cardiac Surgery, Luzerner Kantonsspital, Luzern,
Switzerland
(Nicol) Department of Cardiology, Royal Brompton Hospital, London, United
Kingdom
(Mitchell) Civil Aviation Authority, Gatwick Airport, United Kingdom
(Bron) Aeromedical Centre, Swiss Air Force, Dubendorf, Switzerland
(Rosendahl, Pepper) Department of Cardiothoracic Surgery, Royal Brompton
Hospital, London, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Aircrew are responsible for safe and reliable aircraft operations.
Cardiovascular disease accounts for 50% of all pilot licences declined or
withdrawn for medical reasons in Western Europe and is the most common
cases of sudden incapacitation in flight. Aircrew retirement age is
increasing (up to age 65) in a growing number of airlines and the burden
of subclinical, but potentially significant, coronary atherosclerosis is
unknown in qualified pilots above age 40. Safety considerations are
paramount in aviation medicine, and the most dreaded cardiovascular
complications are thromboembolic events and rhythm disturbances due to
their potential for sudden incapacitation. In aviation, the current
consensus risk threshold for an acceptable level of controlled risk of
acute incapacitation is 1% (for dual pilot commercial operations), a
percentage calculated using engineering principles to ensure the incidence
of a fatal air accident is no greater than 1 per 107 h of flying. This is
known as the '1% safety rule'. To fly as a pilot after cardiac surgery is
possible; however, special attention to perioperative planning is
mandatory. Choice of procedure is crucial for license renewal. Licensing
restrictions are likely to apply and the postoperative follow-up requires
a tight scheduling. The cardiac surgeon should always liaise and
communicate with the pilot's aviation medicine examiner prior to and
following cardiac surgery.<br/>Copyright &#xa9; The Author 2017. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<72>
Accession Number
621200759
Title
Comparative performance of transcatheter aortic valve-in-valve
implantation versus conventional surgical redo aortic valve replacement in
patients with degenerated aortic valve bioprostheses: Systematic review
and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 53 (3) (pp 495-504), 2018.
Date of Publication: 01 Mar 2018.
Author
Gozdek M.; Raffa G.M.; Suwalski P.; Kolodziejczak M.; Anisimowicz L.;
Kubica J.; Navarese E.P.; Kowalewski M.
Institution
(Gozdek, Anisimowicz, Kowalewski) Department of Cardiac Surgery,
Cardiovascular Institute, Dr Antoni Jurasz Memorial University Hospital,
Bydgoszcz, Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy
(Suwalski) Clinical Department of Cardiac Surgery, Central Clinical
Hospital of the Ministry of Interior, Warsaw, Poland
(Suwalski) Pulaski University of Technology and Humanities, Radom, Poland
(Kolodziejczak) Cardiovascular Institute, Collegium Medicum in Bydgoszcz,
University of Nicolaus Copernicus, Torun, Poland
(Kubica) Department of Cardiology and Internal Medicine, Cardiovascular
Institute, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz,
Poland
(Navarese) Inova Center for Thrombosis Research and Drug Development,
Inova Heart and Vascular Institute, Fairfax, VA, United States
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
The objective of this report was to directly compare, by means of a
systematic review and meta-analysis, redo surgical aortic valve
replacement (re-sAVR) with valve-in-valve transcatheter aortic valve
implantation (ViV TAVI) for patients with failed degenerated aortic
bioprostheses. Multiple databases were screened for all available reports
comparing ViV TAVI with re-sAVR in patients with failing degenerated
aortic bioprostheses. The primary outcome was all-cause mortality
determined from the longest available survival data. Five observational
studies (n = 342) were included in the meta-analysis; patients in the ViV
TAVI group were older and had a higher baseline risk compared to those in
the re-sAVR group. Although there was no statistical difference in
procedural mortality [risk ratio (RR) 0.74, 95% confidence interval (CI)
0.18-2.97; P = 0.67], 30-day mortality (RR 1.29, 95% CI 0.44-3.78; P =
0.64) and cardiovascular mortality (RR 0.91, 95% CI 0.30-2.70; P = 0.86)
at a mean follow-up period of 18 months, cumulative survival analysis
favoured surgery with borderline statistical significance (ViV TAVI versus
re-sAVR: hazard ratio 1.91, 95% CI 1.03-3.57; P = 0.039). ViV TAVI was
associated with a significantly lower rate of permanent pacemaker
implantations (RR 0.37, 95% CI 0.20-0.68; P = 0.002) and shorter intensive
care unit (P < 0.001) and hospital stays (P = 0.020). In contrast, re-sAVR
offered superior echocardiographic outcomes: lower incidence of
patient-prosthesis mismatch (P = 0.008), fewer paravalvular leaks (P =
0.023) and lower mean postoperative aortic valve gradients in the
prespecified analysis (P = 0.017). The ViV TAVI approach is a safe and
feasible alternative to re-sAVR that may offer an effective, less invasive
treatment for patients with failed surgical aortic valve bioprostheses who
are inoperable or at high risk. Re-sAVR should remain the standard of
care, particularly in the low-risk population, because it offers superior
haemodynamic outcomes with low mortality rates.<br/>Copyright &#xa9; The
Author 2017. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<73>
Accession Number
619931835
Title
Heart Failure With Preserved Ejection Fraction-A Systematic Review and
Analysis of Perioperative Outcomes.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2423-2434),
2018. Date of Publication: October 2018.
Author
Mohananey D.; Heidari-Bateni G.; Villablanca P.A.; Iturrizaga Murrieta
J.C.; Vlismas P.; Agrawal S.; Bhatia N.; Mookadam F.; Ramakrishna H.
Institution
(Mohananey) Division of Hospital Medicine, Cleveland Clinic, Cleveland,
OH, United States
(Heidari-Bateni) Department of Internal Medicine, Saint Louis University
Hospital, St. Louis, MO, United States
(Villablanca) Division of Cardiovascular Diseases, NYU Langone Medical
Center, New York, NY, United States
(Iturrizaga Murrieta, Vlismas) Department of Internal Medicine, Montefiore
Medical Center, Bronx, NY, United States
(Agrawal) Department of Cardiovascular Medicine, St. Lukes University
Health Network, Bethlehem, PA, United States
(Bhatia) Division of Cardiovascular Medicine, Vanderbilt Heart and
Vascular Institute, Nashville, TN, United States
(Mookadam) Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale,
AZ, United States
(Ramakrishna) Division of Cardiovascular and Thoracic Anesthesiology, Mayo
Clinic, Phoenix, AZ, United States
Publisher
W.B. Saunders

<74>
Accession Number
621224934
Title
Postoperative Vasoplegic Syndrome Is Associated With Impaired Endothelial
Vasomotor Response in Cardiac Surgery: A Prospective, Observational Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2218-2224),
2018. Date of Publication: October 2018.
Author
Abou-Arab O.; Martineau L.; Bar S.; Huette P.; Amar A.B.; Caus T.; Dupont
H.; Kamel S.; Guinot P.-G.; Lorne E.
Institution
(Abou-Arab, Martineau, Bar, Huette, Amar, Dupont, Lorne) Department of
Anaesthesiology and Critical Care Medicine, Amiens Picardy University
Hospital, Amiens, France
(Caus) Department of Cardiac Surgery, Amiens Picardy University Hospital,
Amiens, France
(Kamel) Jules Verne University of Picardy, Amiens, France
(Guinot) Department of Anaesthesiology and Critical Care Medicine, Dijon
University Hospital, Dijon, France
Publisher
W.B. Saunders
Abstract
Objectives: Vasoplegic syndrome (VS) affects up to 30% of cardiac surgery
patients. Onset of VS may be associated with overproduction of nitric
oxide (NO). The response of the brachial artery to NO can be assessed
using flow-mediated vasodilation (FMD). The aim of this study was to
assess brachial artery diameter and FMD response immediately after cardiac
surgery. <br/>Design(s): Prospective, observational study.
<br/>Setting(s): Single-center study in a tertiary teaching hospital.
<br/>Patient(s): Patients older than 18 years undergoing elective cardiac
surgery with cardiopulmonary bypass who provided informed consent.
<br/>Intervention(s): Brachial artery diameter and FMD response were
measured before cardiac surgery and just after surgery on admission to the
intensive care unit. Patients were screened for VS for the following 48
hours. <br/>Result(s): Eleven (39%) of the 28 patients included in the
study developed VS. Brachial artery diameter and FMD differed between VS
and non-VS patients. On intensive care unit admission, mean (+/- standard
deviation) brachial artery diameter was greater in VS patients than in
non-VS patients (3.9 +/- 0.7 mm v 3.0 +/- 0.8 mm, respectively; p =
0.002). Similarly, the FMD response after surgery was greater in VS
patients than in non-VS patients (42% +/- 8% v 31% +/- 1%, respectively; p
= 0.014). Brachial artery diameter and FMD response after surgery were
both predictive of VS, with an area under the curve (95% confidence
interval) of 0.850 (0.705-0.995) (p = 0.002) and 0.755 (0.56-0.95) (p =
0.047), respectively. <br/>Conclusion(s): Cardiac surgery with
cardiopulmonary bypass appears to alter the NO-mediated endothelial
vasomotor response.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<75>
Accession Number
2000669038
Title
Clinical Outcomes of Adult Patients Who Receive Extracorporeal Membrane
Oxygenation for Postcardiotomy Cardiogenic Shock: A Systematic Review and
Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2087-2093),
2018. Date of Publication: October 2018.
Author
Wang L.; Wang H.; Hou X.
Institution
(Wang, Wang, Hou) Center for Cardiac Intensive Care, Capital Medical
University Affiliated Anzhen Hospital, Beijing, China
Publisher
W.B. Saunders
Abstract
Objective: To investigate the clinical outcomes of adult patients
receiving extracorporeal membrane oxygenation (ECMO) for postcardiotomy
cardiogenic shock (PCS). <br/>Design(s): Meta-analysis of 20 observational
studies. <br/>Setting(s): Hospitals that perform cardiac surgery.
<br/>Participant(s): The study included 2,877 PCS patients undergoing ECMO
from 20 observational studies. <br/>Intervention(s): ECMO use.
<br/>Measurements and Main Results: Twenty observational studies were
selected for final analysis. The pooled survival rate to hospital
discharge was 34.0% (30.0%-38.0%) in PCS patients receiving ECMO. The
pooled 1-year survival rate was 24.0% (19.05%-30.0%). The pooled midterm
survival rate was 18.0% (11.0%-27.0%). The pooled rate of leg ischemia was
14.0% (10.0%-20.0%). The pooled rate of redo surgery was 50.0%
(32.0%-68.0%). The pooled rate of renal failure was 57.0% (47.0%-66.0%).
The pooled rate of neurologic complications was 16.0% (13.0%-20.0%). The
pooled rate of infection was 31.0% (22.0%-41.0%). Most of the included
studies commonly revealed that age >65 years, pre-ECMO or post-ECMO blood
lactate, renal insufficiency, a longer duration of ECMO, and neurologic
complications were risk factors of in-hospital mortality in PCS patients
undergoing ECMO. <br/>Conclusion(s): The short-term and midterm survival
rates of PCS patients treated with ECMO were disappointingly low, and
post-ECMO complication rates were relatively high.<br/>Copyright &#xa9;
2018 Elsevier Inc.

<76>
Accession Number
624077339
Title
Six-month outcomes after restrictive or liberal transfusion for cardiac
surgery.
Source
New England Journal of Medicine. 379 (13) (pp 1224-1233), 2018. Date of
Publication: 27 Sep 2018.
Author
Mazer C.D.; Whitlock R.P.; Fergusson D.A.; Belley-Cote E.; Connolly K.;
Khanykin B.; Gregory A.J.; De Medicis E.; Carrier F.M.; McGuinness S.;
Young P.J.; Byrne K.; Villar J.C.; Royse A.; Grocott H.P.; Seeberger M.D.;
Mehta C.; Lellouche F.; Hare G.M.T.; Painter T.W.; Fremes S.; Syed S.;
Bagshaw S.M.; Hwang N.-C.; Royse C.; Hall J.; Dai D.; Mistry N.; Thorpe
K.; Verma S.; Juni P.; Shehata N.
Institution
(Mazer, Hare, Mistry) Department of Anesthesia, St. Michael's Hospital,
University of Toronto, 30 Bond St., Toronto, ON M5B 1W8, Canada
(Verma) Department of Surgery, Division of Cardiac Surgery, Keenan
Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute of
St. Michael's Hospital, Canada
(Mazer, Hare, Thorpe, Verma, Juni) St. Michael's Hospital, Keenan Research
Centre for Biomedical Science, Li Ka Shing Knowledge Institute of St.
Michael's Hospital, Canada
(Hall, Dai, Thorpe, Verma, Juni) Applied Health Research Centre,
University of Toronto, Canadian Blood Services, Toronto, Canada
(Fremes) Sunnybrook Health Sciences Centre, University of Toronto,
Canadian Blood Services, Toronto, Canada
(Shehata) Division of Hematology, Mount Sinai Hospital, University of
Toronto, Canadian Blood Services, Toronto, Canada
(Juni, Shehata) Department of Medicine, University of Toronto, Canadian
Blood Services, Toronto, Canada
(Mazer, Hare) Department of Physiology, University of Toronto, Canadian
Blood Services, Toronto, Canada
(Shehata) Laboratory Medicine and Pathobiology, University of Toronto,
Canadian Blood Services, Toronto, Canada
(Thorpe) Dalla Lana School of Public Health, University of Toronto,
Canadian Blood Services, Toronto, Canada
(Shehata) Institute of Health Policy, Management and Evaluation,
University of Toronto, Canadian Blood Services, Toronto, Canada
(Whitlock, Belley-Cote) Population Health Research Institute, Hamilton,
ON, Canada
(Whitlock, Belley-Cote, Connolly, Syed) Hamilton Health Sciences Center,
Hamilton, ON, Canada
(Whitlock, Belley-Cote, Connolly, Syed) McMaster University, Hamilton, ON,
Canada
(Fergusson) Ottawa Hospital Research Institute, University of Ottawa,
Ottawa, Canada
(Gregory) Cumming School of Medicine, Libin Cardiovascular Institute,
University of Calgary, Calgary, Canada
(Bagshaw) Department of Critical Care Medicine, Faculty of Medicine and
Dentistry, University of Alberta, Edmonton, Canada
(De Medicis) CHUS-Centre Hospitalier Universitaire de Sherbrooke,
Sherbrooke, Canada
(Lellouche) Department of Anesthesiology and Critical Care Medicine,
Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Laval
University, Laval, QC, Canada
(Carrier) Departments of Anesthesia and Medicine, Division of Critical
Care, Centre Hospitalier de L'Universite de Montreal, Montreal, Canada
(Grocott) Department of Anesthesia, Perioperative and Pain Medicine, St.
Boniface Hospital, University of Manitoba, Winnipeg, Canada
(Khanykin) Department of Cardiothoracic Anesthesia, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Canada
(McGuinness, Young) Medical Research Institute of New Zealand, Wellington,
New Zealand
(Byrne) Waikato Hospital, Hamilton, New Zealand
(Villar) Fundacion Cardioinfantil-Instituto de Cardiologia, Universidad
Autonoma de Bucaramanga, Bucaramanga, Colombia
(Royse, Royse) Department of Surgery, University of Melbournel, Melbourne,
VIC, Australia
(Royse) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, VIC, Australia
(Painter) Department of Anaesthesia, Royal Adelaide Hospital, Discipline
of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
(Seeberger) University of Basel, Department of Anesthesia, Surgical
Intensive Care, Prehospital Emergency Medicine and Pain Therapy,
University Hospital Basel, Basel, Switzerland
(Seeberger) Klinik Hirslanden Zurich, Zurich, Switzerland
(Mehta) Heart Care Associates, SAL Hospital, Gujarat, India
(Hwang) Department of Cardiothoracic Anaesthesia, National Heart Center,
Singapore, Singapore
(Hwang) Department of Anaesthesiology, Singapore General Hospital,
Singapore, Singapore
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND We reported previously that, in patients undergoing cardiac
surgery who were at moderate-to-high risk for death, a restrictive
transfusion strategy was noninferior to a liberal strategy with respect to
the composite outcome of death from any cause, myocardial infarction,
stroke, or new-onset renal failure with dialysis by hospital discharge or
28 days after surgery, whichever came first. We now report the clinical
outcomes at 6 months after surgery. METHODS We randomly assigned 5243
adults undergoing cardiac surgery to a restrictive red-cell transfusion
strategy (transfusion if the hemoglobin concentration was <7.5 g per
deciliter intraoperatively or postoperatively) or a liberal red-cell
transfusion strategy (transfusion if the hemoglobin concentration was <9.5
g per deciliter intraoperatively or postoperatively when the patient was
in the intensive care unit [ICU] or was <8.5 g per deciliter when the
patient was in the non-ICU ward). The primary composite outcome was death
from any cause, myocardial infarction, stroke, or newonset renal failure
with dialysis occurring within 6 months after the initial surgery. An
expanded secondary composite outcome included all the components of the
primary outcome as well as emergency department visit, hospital
readmission, or coronary revascularization occurring within 6 months after
the index surgery. The secondary outcomes included the individual
components of the two composite outcomes. RESULTS At 6 months after
surgery, the primary composite outcome had occurred in 402 of 2317
patients (17.4%) in the restrictive-threshold group and in 402 of 2347
patients (17.1%) in the liberal-threshold group (absolute risk difference
before rounding, 0.22 percentage points; 95% confidence interval [CI],
-1.95 to 2.39; odds ratio, 1.02; 95% CI, 0.87 to 1.18; P = 0.006 for
noninferiority). Mortality was 6.2% in the restrictive-threshold group and
6.4% in the liberal-threshold group (odds ratio, 0.95; 95% CI, 0.75 to
1.21). There were no significant between-group differences in the
secondary outcomes. CONCLUSIONS In patients undergoing cardiac surgery who
were at moderate-to-high risk for death, a restrictive strategy for
red-cell transfusion was noninferior to a liberal strategy with respect to
the composite outcome of death from any cause, myocardial infarction,
stroke, or new-onset renal failure with dialysis at 6 months after
surgery.<br/>Copyright &#xa9; 2018 Massachusetts Medical Society.

<77>
Accession Number
620396891
Title
The Society of Thoracic Surgeons, The Society of Cardiovascular
Anesthesiologists, and The American Society of ExtraCorporeal Technology:
Clinical Practice Guidelines *-Anticoagulation During Cardiopulmonary
Bypass.
Source
Annals of Thoracic Surgery. 105 (2) (pp 650-662), 2018. Date of
Publication: February 2018.
Author
Shore-Lesserson L.; Baker R.A.; Ferraris V.A.; Greilich P.E.; Fitzgerald
D.; Roman P.; Hammon J.W.
Institution
(Shore-Lesserson) Department of Anesthesiology, Zucker School of Medicine
at Hofstra Northwell, Hempstead, New York, United States
(Baker) Cardiac Surgery Research and Perfusion, Flinders University and
Flinders Medical Center, Adelaide, South Australia, Australia
(Ferraris) Division of Cardiovascular and Thoracic Surgery, University of
Kentucky, Lexington, Kentucky, United States
(Greilich) Department of Anesthesiology and Pain Management, University of
Texas-Southwestern Medical Center, Dallas, Texas, United States
(Fitzgerald) Division of Cardiovascular Perfusion, Medical University of
South Carolina, Charleston, South Carolina, United States
(Roman) Department of Anesthesiology, Saint Anthony Hospital, Lakewood,
Colorado, United States
(Hammon) Department of Cardiothoracic Surgery, Wake Forest University
School of Medicine, Winston-Salem, North Carolina, United States
Publisher
Elsevier USA
Abstract
Despite more than a half century of "safe" cardiopulmonary bypass (CPB),
the evidence base surrounding the conduct of anticoagulation therapy for
CPB has not been organized into a succinct guideline. For this and other
reasons, there is enormous practice variability relating to the use and
dosing of heparin, monitoring heparin anticoagulation, reversal of
anticoagulation, and the use of alternative anticoagulants. To address
this and other gaps, The Society of Thoracic Surgeons, the Society of
Cardiovascular Anesthesiologists, and the American Society of
Extracorporeal Technology developed an Evidence Based Workgroup. This was
a group of interdisciplinary professionals gathered to summarize the
evidence and create practice recommendations for various aspects of CPB.
To date, anticoagulation practices in CPB have not been standardized in
accordance with the evidence base. This clinical practice guideline was
written with the intent to fill the evidence gap and to establish best
practices in anticoagulation therapy for CPB using the available evidence.
To identify relevant evidence, a systematic review was outlined and
literature searches were conducted in PubMed using standardized medical
subject heading (MeSH) terms from the National Library of Medicine list of
search terms. Search dates were inclusive of January 2000 to December
2015. The search yielded 833 abstracts, which were reviewed by two
independent reviewers. Once accepted into the full manuscript review
stage, two members of the writing group evaluated each of 286 full papers
for inclusion eligibility into the guideline document. Ninety-six
manuscripts were included in the final review. In addition, 17 manuscripts
published before 2000 were included to provide method, context, or
additional supporting evidence for the recommendations as these papers
were considered sentinel publications. Members of the writing group wrote
and developed recommendations based on review of the articles obtained and
achieved more than two thirds agreement on each recommendation. The
quality of information for a given recommendation allowed assessment of
the level of evidence as recommended by the American College of Cardiology
Foundation/American Heart Association Task Force on Practice Guidelines.
Recommendations were written in the three following areas: (1) heparin
dosing and monitoring for initiation and maintenance of CPB; (2) heparin
contraindications and heparin alternatives; and (3) reversal of
anticoagulation during cardiac operations. It is hoped that this guideline
will serve as a resource and will stimulate investigators to conduct more
research and to expand on the evidence base on the topic of
anticoagulation therapy for CPB.<br/>Copyright &#xa9; 2018 The Society of
Thoracic Surgeons, International Anesthesia Research Society, and the
American Society of ExtraCorporeal Technology

<78>
Accession Number
619998937
Title
Bronchial Blocker Versus Left Double-Lumen Endotracheal Tube for One-Lung
Ventilation in Right Video-Assisted Thoracoscopic Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 297-301),
2018. Date of Publication: February 2018.
Author
Lu Y.; Dai W.; Zong Z.; Xiao Y.; Wu D.; Liu X.; Chun Wong G.T.
Institution
(Lu, Dai, Zong, Xiao, Liu) Department of Anesthesiology, First Affiliated
Hospital of Anhui Medical University, Hefei, China
(Wu) Department of Anesthesiology, Affiliated Fuyang Hospital of Anhui
Medical University, Hefei, China
(Chun Wong) Department of Anesthesiology, University of Hong Kong, Hong
Kong SAR, Hong Kong
Publisher
W.B. Saunders
Abstract
Objective: The aim of this study was to compare the quality of lung
deflation of a left-sided double-lumen endotracheal tube (DLT) with a
bronchial blocker (BB) for one-lung ventilation in video-assisted thoracic
surgery (VATS). <br/>Design(s): A prospective, randomized, clinical study.
<br/>Setting(s): A university-affiliated teaching hospital.
<br/>Participant(s): Forty-five adult patients undergoing esophageal tumor
surgery using VATS with right lung deflation. <br/>Intervention(s):
Patients were assigned by a computer-generated randomization sequence to
either the left-sided DLT or BB group. The correct positioning of the
airway device was confirmed using fiberoptic bronchoscopy.
<br/>Measurements and Main Results: The variables assessed included: (1)
time required to correctly place the devices and to achieve lung collapse;
(2) the number of times the device malpositioned; (3) the quality of lung
deflation as rated by the surgeon; (4) blood pressure and heart rate at
baseline (T<inf>1</inf>), immediately before (T<inf>2</inf>) and after
(T<inf>3</inf>) and 1 minute (T<inf>4</inf>) after intubation; (5) the
number of patients with hypoxemia (SpO<inf>2</inf> < 90%) during the
one-lung ventilation (OLV) period; and (6) postoperative hoarseness of
voice, sore throat, or pulmonary infection. Of the 45 patients approached
for the study, 21 patients in the DLT group and 19 patients in the BB
group were analyzed. The time required to place the device in the correct
position was similar between the 2 groups. The time to achieve right lung
collapse in the BB group was significantly longer (mean difference: 3.232,
95% confidence interval [CI]: 1.993-4.471; p = 0.003). The quality of lung
collapse, OLV duration, number of patients with device malposition, and
hypoxemia in both groups were similar. There were more patients suffering
hoarseness (odds ratio [OR]: 4.85, 95% CI: 1.08-21.76; p = 0.034) or sore
throat (OR: 4.29, 95% CI: 1.14-16.18; p = 0.030) in the DLT group, while
no patients developed postoperative lung infection in either group.
Compared to T<inf>1</inf>, systolic blood pressure (sBP), diastolic BP
(dBP), and heart rate (HR) at T<inf>2</inf> in both groups were higher (p
< 0.05) in the DLT group. Then, compared to T<inf>2</inf>, sBP and dBP at
T<inf>3</inf> and T<inf>4</inf> and HR at T<inf>3</inf> in the DLT group
were higher (p < 0.05). <br/>Conclusion(s): The results of this study
showed that BB is an effective alternative for left one-lung ventilation
in right VATS, but requires a longer time to achieve complete lung
collapse. Moreover, the use of BB caused less hemodynamic perturbation and
can reduce postoperative hoarseness and sore throat.<br/>Copyright &#xa9;
2018 Elsevier Inc.

<79>
Accession Number
2001012556
Title
The Effect of Inhaled Milrinone Versus Inhaled Levosimendan in Pulmonary
Hypertension Patients Undergoing Mitral Valve Surgery - A Pilot Randomized
Double-Blind Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2123-2129),
2018. Date of Publication: October 2018.
Author
Kundra T.S.; Prabhakar V.; Kaur P.; Manjunatha N.; Gandham R.
Institution
(Kundra, Prabhakar, Manjunatha) Department of Cardiac Anaesthesia, Sri
Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore,
India, India
(Kaur) Department of Critical Care, Sir Ganga Ram Hospital, New Delhi,
India, India
(Gandham) Department of Anaesthesiology, Apollo Hospital, Vishakhapatnam,
India, India
Publisher
W.B. Saunders
Abstract
Objective: To compare the effects of inhaled milrinone and levosimendan on
pulmonary and systemic hemodynamics in patients with pulmonary
hypertension. <br/>Design(s): Prospective, double-blind, randomized
controlled study. <br/>Setting(s): Tertiary care cardiac institute with
650 beds. <br/>Participant(s): The study comprised 150 adult patients with
pulmonary hypertension undergoing mitral valve surgery.
<br/>Intervention(s): Patients were assigned randomly into 1 of the
following 3 groups: milrinone (M), levosimendan (L), or control (C); n =
50 per group. In group M, inhaled milrinone (50 micro&#32;g/kg); in group
L, inhaled levosimendan (24 micro&#32;g/kg); and in group C, normal saline
was administered when the patient arrived in the recovery room.
Pre-inhalation and post-inhalation hemodynamics (mean arterial pressure
[MAP], pulse rate, and systemic vascular resistance [SVR]) were noted
until 24 hours of inhalation of the drug. The change in pulmonary artery
pressures (pulmonary artery systolic pressure [PASP] and mean pulmonary
artery pressure [MPAP]) and the duration for which they remained decreased
compared with the control group, were noted. <br/>Measurements and Main
Results: MAP, pulse rate, and SVR were comparable in the 3 groups at
various time intervals. PASP and MPAP decreased comparably after
inhalation of levosimendan and milrinone. However, they reached levels
near the control group values after 2.5 to 3 hours in group L and after
0.5 hours in group M. <br/>Conclusion(s): Because inhaled levosimendan
causes a decrease in PASP and MPAP without causing a decrease in SVR and
MAP, the authors conclude that inhaled levosimendan is a selective
pulmonary vasodilator. It is as effective as milrinone in reducing
pulmonary artery pressures. In addition, it has advantage over inhaled
milrinone because it is has a longer duration of action.<br/>Copyright
&#xa9; 2018 Elsevier Inc.

<80>
Accession Number
626063067
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: 01 Feb 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
Publisher
NLM (Medline)
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. <br/>METHOD(S): 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.
<br/>RESULT(S): 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, I2=0%, low quality evidence),
and significantly fewer major bleeds in observational studies (RR, 0.34;
95% CI, 0.20-0.58, p<=0.0001, I2=0%, very low quality evidence), but
stroke, thromboembolism and mortality did not show a significant
difference in either RCTs or observational studies. <br/>CONCLUSION(S):
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.<br/>Copyright
Georg Thieme Verlag KG Stuttgart . New York.

<81>
Accession Number
626061014
Title
Engaging hospitalized patients with personalized health information: a
randomized trial of an inpatient portal.
Source
Journal of the American Medical Informatics Association : JAMIA. 26 (2)
(pp 115-123), 2019. Date of Publication: 01 Feb 2019.
Author
Masterson Creber R.M.; Grossman L.V.; Ryan B.; Qian M.; Polubriaginof
F.C.G.; Restaino S.; Bakken S.; Hripcsak G.; Vawdrey D.K.
Institution
(Masterson Creber) Department of Healthcare Policy & Research, Division of
Health Informatics, Weill Cornell Medicine, NY, United States
(Grossman, Polubriaginof, Hripcsak, Vawdrey) Department of Biomedical
Informatics, Columbia University, NY, United States
(Ryan, Polubriaginof, Vawdrey) Value Institute at NewYork-Presbyterian
Hospital, NY, United States
(Qian) Department of Biostatistics, Columbia University, NY, United States
(Restaino) Columbia University Medical Center, NY, United States
(Bakken) Department of Biomedical Informatics, School of Nursing, Data
Science Institute, Columbia University, NY, United States
Publisher
NLM (Medline)
Abstract
Objective: To determine the effects of an inpatient portal intervention on
patient activation, patient satisfaction, patient engagement with health
information, and 30-day hospital readmissions. Methods and Materials: From
March 2014 to May 2017, we enrolled 426 English- or Spanish-speaking
patients from 2 cardiac medical-surgical units at an urban academic
medical center. Patients were randomized to 1 of 3 groups: 1) usual care,
2) tablet with general Internet access (tablet-only), and 3) tablet with
an inpatient portal. The primary study outcome was patient activation
(Patient Activation Measure-13). Secondary outcomes included all-cause
readmission within 30 days, patient satisfaction, and patient engagement
with health information. <br/>Result(s): There was no evidence of a
difference in patient activation among patients assigned to the inpatient
portal intervention compared to usual care or the tablet-only group.
Patients in the inpatient portal group had lower 30-day hospital
readmissions (5.5% vs. 12.9% tablet-only and 13.5% usual care; P=0.044).
There was evidence of a difference in patient engagement with health
information between the inpatient portal and tablet-only group, including
looking up health information online (89.6% vs. 51.8%; P<0.001).
Healthcare providers reported that patients found the portal useful and
that the portal did not negatively impact healthcare delivery.
<br/>Conclusion(s): Access to an inpatient portal did not significantly
improve patient activation, but it was associated with looking up health
information online and with a lower 30-day hospital readmission rate.
These results illustrate benefit of providing hospitalized patients with
real-time access to their electronic health record data while in the
hospital. Trial Registration: ClinicalTrials.gov Identifier: NCT01970852.

<82>
Accession Number
2001492497
Title
Off- vs. On-Pump Coronary Artery Bypass Grafting Long-Term Survival is
Driven by Incompleteness of Revascularisation.
Source
Heart Lung and Circulation. (no pagination), 2019. Date of Publication:
2019.
Author
Thakur U.; Nerlekar N.; Muthalaly R.G.; Comella A.; Wong N.C.; Cameron
J.D.; Harper R.W.; Smith J.A.; Brown A.J.
Institution
(Thakur, Nerlekar, Muthalaly, Comella, Wong, Cameron, Harper, Smith,
Brown) Monash Cardiovascular Research Centre, Monash University and
MonashHeart, Monash Health, Melbourne, Vic, Australia
(Thakur, Muthalaly, Comella, Wong, Harper, Smith) Department of Surgery
(School of Clinical Sciences at Monash Health], Monash University,
Melbourne, Vic, Australia
Publisher
Elsevier Ltd
Abstract
Background: Off-pump coronary artery bypass grafting (CABG) negates the
requirement for extracorporeal circulation used with the traditional
on-pump approach. However, off-pump CABG is technically more challenging
and may theoretically lead to less complete revascularisation. Recent data
suggests a prognostic benefit for traditional on-pump CABG, but the
mechanism for this remains unclear. We hypothesised that the inferior
outcomes with off-pump CABG could be driven by the need for repeat
revascularisation, with this benefit only becoming clear at long-term
follow-up. We therefore evaluated short, medium and long-term outcomes of
patients undergoing revascularisation with on vs. off-pump CABG.
<br/>Method(s): Electronic databases were searched to identify suitable
randomised controlled trials enrolling >=100 patients in each arm.
Clinical outcomes were extracted at 30-days, 12-months or >4 years. The
primary outcome was long-term all-cause death, while secondary outcomes
included 30-day, 12-month and >4-year cardiac death, stroke, myocardial
infarction or revascularisation. <br/>Result(s): Thirteen studies
comprising 13,234 patients were included. Off-pump CABG was associated
with an increased risk of all-cause death (Odds Ratio (OR) 1.18, 95%
confidence interval (CI) 1.02-1.32, p = 0.01) and repeat bypass surgery
(OR 2.57, 95%CI 1.23-5.39, p = 0.01) at long-term follow-up. A
significant, increased requirement for revascularisation in off-pump was
seen at 12-month follow-up (OR 1.59, 95%CI 1.09-2.33, p = 0.02). No
differences were noted between groups at 30-days, 12-months and >4 years
for myocardial infarction or stroke. <br/>Conclusion(s): Off-pump CABG is
associated with significantly higher rates of all-cause mortality rate at
long-term follow-up. These outcomes demonstrate a temporal relationship
that may be driven by a greater requirement for repeat revascularisation
at 1- and 5-year follow-up. Trial registration:
CRD42018102019.<br/>Copyright &#xa9; 2018 Australian and New Zealand
Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society
of Australia and New Zealand (CSANZ)

<83>
Accession Number
2001490102
Title
Sildenafil for Pulmonary Hypertension in the Early Postoperative Period
After Mitral Valve Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Ram E.; Sternik L.; Klempfner R.; Eldar M.; Goldenberg I.; Peled Y.;
Raanani E.; Kogan A.
Institution
(Ram, Sternik, Raanani, Kogan) Department of Cardiac Surgery, Sheba
Medical Center at Tel Hashomer, Sackler School of Medicine, Tel Aviv
University, Tel Aviv, Israel
(Klempfner, Eldar, Goldenberg, Peled) Heart Institute, Sheba Medical
Center at Tel Hashomer, Sackler School of Medicine, Tel Aviv University,
Tel Aviv, Israel
Publisher
W.B. Saunders
Abstract
Objectives: The phosphodiesterase-5 inhibitor sildenafil was developed for
the treatment of pulmonary hypertension. The authors investigated the
efficacy and safety of sildenafil in the early postoperative period after
mitral valve surgery in patients with pulmonary hypertension.
<br/>Design(s): A double-blind, placebo-controlled randomized trial was
performed. <br/>Setting(s): The trial was performed in a single tertiary
referral center. <br/>Participant(s): Fifty consecutive patients who
experienced pulmonary hypertension and underwent mitral valve surgery.
<br/>Intervention(s): Patients were randomly assigned to the following 2
groups: 25 patients received 20 mg sildenafil every 8 hours, and the
remaining 25 patients received placebo during the same period. Hemodynamic
parameters were studied by using a pulmonary artery catheter at baseline
and every 6 hours up to 36 hours. <br/>Result(s): Patients who received
sildenafil showed a decrease in mean pulmonary pressure, from 32 +/- 7
mmHg at baseline to 26 +/- 3 mmHg after 36 hours, whereas no change was
seen in patients who received placebo (mean pulmonary pressure 34 +/- 6
mmHg at baseline and 35 +/- 5 mmHg after 36 h) (p < 0.001). No significant
changes in systemic hemodynamic and oxygenation were observed. Patients
who received sildenafil compared with those who received placebo had a
median mechanical lung ventilation time of 16 (10-31) hours versus 19
(13-41) hours (p = 0.431), intensive care unit stay of 74 (44-106) hours
versus 91 (66-141) hours (p = 0.410), and a total hospitalization stay of
7 (5-10) days versus 11 (7-15) days (p = 0.009). <br/>Conclusion(s): The
immediate postoperative administration of sildenafil after mitral valve
surgery is safe. Sildenafil demonstrates a favorable decreasing effect on
pulmonary vascular pressure without systemic hypotension and
ventilation-perfusion mismatch.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<84>
Accession Number
2001489272
Title
Intravenous amino acid therapy for kidney protection in cardiac surgery
patients: A pilot randomized controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Pu H.; Doig G.S.; Heighes P.T.; Allingstrup M.J.; Wang A.; Brereton J.;
Pollock C.; Chesher D.; Bellomo R.
Institution
(Pu, Doig, Heighes, Allingstrup) Northern Clinical School Intensive Care
Research Unit, Sydney Medical School, University of Sydney, Sydney,
Australia
(Wang, Brereton, Pollock) Northern Clinical School, Sydney Medical School,
University of Sydney, Sydney, Australia
(Pu) Department of Critical Care Medicine, Sichuan Academy of Medical
Sciences & Sichuan Provincial People's Hospital, Chengdu, China
(Chesher) New South Wales Health, Pathology, St. Leonards, Australia
(Bellomo) Australian and New Zealand Intensive Care Research Centre,
School of Public Health and Preventive Medicine, Monash University,
Melbourne, Australia
(Bellomo) School of Medicine, University of Melbourne, Melbourne,
Australia
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: To determine whether a continuous intravenous infusion of
standard amino acids could preserve kidney function after on-pump cardiac
surgery. <br/>Method(s): Adult patients scheduled to receive cardiac
surgery lasting longer than 1 hour on-pump were randomized to standard
care (n = 36) or an infusion of amino acids initiated immediately after
induction of anesthesia (n = 33). The study's primary outcome measurements
assessed renal function. These assessments included duration of renal
dysfunction, duration and severity of acute kidney injury (AKI), estimated
glomerular filtration rate (eGFR) over time, urine output, and use of
renal-replacement therapy. Complications and other measures of morbidity
were also assessed. <br/>Result(s): Sixty-nine patients (mean age 71.5
[standard deviation 9.2] years; 19 of 69 women) were enrolled and
randomized. Patients received coronary artery bypass graft surgery
(37/69), valve surgery (24/69), coronary artery bypass graft and valve
surgery (6/69), or other procedures (2/69). Mean on-pump time was 268
[standard deviation 136] minutes. Duration of renal dysfunction did not
differ between the groups (relative risk, 0.86; 95% confidence interval
[CI], 0.19-3.79, P =.84). However, patients who received the amino acid
infusion had a reduced duration of AKI (relative risk, 0.02; 95% CI,
0.005-0.11, P <.0001) and greater eGFR (+10.8%; 95% CI, 1.0%-20.8%, P
=.033). Daily mean urine output was also significantly greater in patients
who received the amino acid infusion (1.4 +/- 0.5 vs 1.7 +/- 0.9 L/d; P
=.046). <br/>Conclusion(s): Commencing an infusion of standard amino acids
immediately after the induction of anesthesia did not alter duration of
renal dysfunction; however, other key measures of renal function (duration
of AKI, eGFR and urine output) were significantly improved. These results
warrant replication in multicenter clinical trials.<br/>Copyright &#xa9;
2018 The American Association for Thoracic Surgery

<85>
Accession Number
621112482
Title
Multielectrode vs. point-by-point mapping for ventricular tachycardia
substrate ablation: A randomized study.
Source
Europace. 20 (3) (pp 512-519), 2018. Date of Publication: 01 Mar 2018.
Author
Acosta J.; Penela D.; Andreu D.; Cabrera M.; Carlosena A.; Vassanelli F.;
Alarcon F.; Soto-Iglesias D.; Korshunov V.; Borras R.; Linhart M.;
Martinez M.; Fernandez-Armenta J.; Mont L.; Berruezo A.
Institution
(Acosta, Penela, Andreu, Cabrera, Carlosena, Vassanelli, Alarcon,
Soto-Iglesias, Korshunov, Borras, Linhart, Martinez, Fernandez-Armenta,
Mont, Berruezo) Arrhythmia Section, Cardiology Department, Thorax
Institute, Hospital Clinic and IDIBAPS, Institut d'Investigacio Agusti Pi
i Sunyer, Barcelona, Catalonia, Spain
Publisher
Oxford University Press
Abstract
Aims Ventricular tachycardia (VT) substrate ablation is based on detailed
electroanatomical maps (EAM). This study analyses whether high-density
multielectrode mapping (MEM) is superior to conventional point-by-point
mapping (PPM) in guiding VT substrate ablation procedures. Methods and
results This was a randomized controlled study (NCT02083016). Twenty
consecutive ischemic patients undergoing VT substrate ablation were
randomized to either group A [n = 10; substrate mapping performed first by
PPM (Navistar) and secondly by MEM (PentaRay) ablation guided by PPM] or
group B [n = 10; substrate mapping performed first by MEM and second by
PPM ablation guided by MEM]. Ablation was performed according to the
scardechanneling technique. Late potential (LP) pairs were defined as a
Navistar-LP and a PentaRay-LP located within a three-dimensional distance
of <= 3 mm. Data obtained from EAM, procedure time, radiofrequency time,
and postablation VT inducibility were compared between groups. Larger
bipolar scar areas were obtained with MEM (55.7+/-31.7 vs. 50.5+/-26.6
cm2; P = 0.017). Substrate mapping time was similar with MEM (19.7+/-7.9
minutes) and PPM (25+/-9.2 minutes); P = 0.222. No differences were
observed in the number of LPs identified within the scar by MEM vs. PPM
(73+/-50 vs. 76+/-52 LPs per patient, respectively; P = 0.965). A total of
1104 LP pairs were analysed. Using PentaRay, far-field/LP ratio was
significantly lower (0.58+/-0.4 vs. 1.64+/-1.1; P = 0.01) and
radiofrequency time was shorter [median (interquartile range) 12 (7-20)
vs. 22 (17-33) minutes; P = 0.023]. No differences were observed in VT
inducibility after procedure. Conclusion MEM with PentaRay catheter
provided better discrimination of LPs due to a lower sensitivity for
far-field signals. Ablation guided by MEM was associated with a shorter
radiofrequency time.<br/>Copyright &#xa9; The Author 2017.

<86>
Accession Number
620134307
Title
Differences in left ventricular remodelling in patients with aortic
stenosis treated with transcatheter aortic valve replacement with
corevalve prostheses compared to surgery with porcine or bovine biological
prostheses.
Source
European Heart Journal Cardiovascular Imaging. 19 (1) (pp 39-46), 2018.
Date of Publication: 01 Jan 2018.
Author
Ngo A.; Hassager C.; Thyregod H.G.Ho.; Sondergaard L.; Olsen P.S.;
Steinbruchel D.; Hansen P.B.; Kjaergaard J.; Winther-Jensen M.; Ihlemann
N.
Institution
(Ngo) Department of Cardiology, Zealand University Hospital, Roskilde
4000, Denmark
(Hassager, Sondergaard, Kjaergaard, Winther-Jensen, Ihlemann) Department
of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen
2100, Denmark
(Thyregod, Olsen) Department of Cardiothoracic Surgery, Rigshospitalet,
Copenhagen University Hospital, Copenhagen 2100, Denmark
(Steinbruchel) Emergency Department, Nykobing Falster Hospital, Nykobing
Falster 4800, Denmark
(Hansen) Department of Cardiac Anesthesia, Rigshospitalet, Copenhagen
University Hospital, Copenhagen 2100, Denmark
Publisher
Oxford University Press
Abstract
Aims Patients with severe aortic stenosis (AS) can be considered for
treatment with either transcatheter (TAVR) or surgical aortic valve
replacement (SAVR). The purpose of this study was to compare left
ventricular (LV) remodeling in patients with AS after treatment with TAVR
or SAVR. Methods and results This is an echocardiographic substudy of the
NOTION trial, a randomized all-comers trial comparing TAVR with SAVR in
patients above 70 years of age. Transthoracic echocardiograms were
performed at baseline, 3 and 12 months after TAVR and SAVR. About 232
patients were included in the study, 120 were randomized to TAVR and 112
to SAVR. From baseline to 12 months post-procedure, aortic valve area
(AVA) increased in both groups, but with a larger increase in the TAVR
group (0.65 +/- 0.04 cm 2 vs. 1.02 +/- 0.05 cm 2 for SAVR and TAVR group,
P < 0.0001). At 12 months, LV mass regression was more pronounced in the
SAVR group as compared with TAVR (17.5% vs. 7.2%, P < 0.001). In the TAVR
group at 12 months, end diastolic volume (EDV) increased by 10.2 +/- 2.5
ml and, in the SAVR group, EDV decreased by 15.4 +/- 2.6 ml with a
statistically significant difference between the two groups (P < 0.0001).
Paravalvular leakage (PVL) and pacemaker implantations were more common in
patients treated with TAVR, which was associated with an increase in EDV
(P < 0.01). Conclusion Patients undergoing SAVR had a larger LV mass
regression at 1 year compared with patients undergoing TAVR, which may be
due to increasing amounts of PVL and pacemakers in the TAVR group.
Published on behalf of the European Society of Cardiology. All rights
reserved.<br/>Copyright &#xa9; The Author 2017. For permissions, please
email: journals.permissions@oup.com.

<87>
[Use Link to view the full text]
Accession Number
624384002
Title
Effectiveness of Nurse's Intentional Presence as a Holistic Modality on
Depression, Anxiety, and Stress of Cardiac Surgery Patients.
Source
Holistic nursing practice. 32 (6) (pp 296-306), 2018. Date of Publication:
01 Nov 2018.
Author
Khajian Gelogahi Z.; Aghebati N.; Mazloum S.R.; Mohajer S.
Institution
(Khajian Gelogahi) Evidence-Based Research Center (Dr Aghebati, Medical
Surgical Department (Ms Gelogahi, Dr Aghebati, School of Nursing and
Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
Publisher
NLM (Medline)
Abstract
One of the important aspects of recovering after bypass surgery is mental
disorders of patients. Despite the importance of intentional presence in
interpersonal interactive space in holistic nursing, a few experimental
and clinical trial studies are conducted on this subject. This study
determines the effect of intentional presence of a holistic nurse on
anxiety, stress, and depression in patients undergoing coronary artery
bypass graft surgery. The study used a randomized clinical trial conducted
on 80 patients referred to heart surgery department from March 2016 to
June 2017, who were allocated to the control and intervention groups
randomly. DASS 21 (Depression, Anxiety, Stress scale) questionnaire and a
checklist to determine stressor resources were used to measure the
variables. Four 30- to 45-minute sessions of nursing intentional presence
were conducted for each patient individually in the intervention group.
The results showed homogeneity between 2 groups in demographic variables
(P > .05). But there was heterogeneity between 2 groups (P < .05) for some
stressors. By using analysis of covariance and excluding the effect of
stressors and the first scores before the intervention, statistics
represented a significant decrease in stress, anxiety, and depression
scores in the intervention group compared with the control group (P <
.0001). The results of this study indicated that the intentional presence
of a nurse as an effective nursing procedure can reduce the depression,
stress, and anxiety of the patients undergoing coronary artery bypass
surgery.

<88>
Accession Number
621555172
Title
Repair versus replacement for the surgical correction of tricuspid
regurgitation: A meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 53 (4) (pp 748-755), 2018.
Date of Publication: 01 Apr 2018.
Author
Choi J.W.; Jang M.-J.; Kim K.H.; Hwang H.Y.
Institution
(Choi, Kim, Hwang) Department of Thoracic and Cardiovascular Surgery,
Seoul National University Hospital, Seoul National University College of
Medicine, Seoul, South Korea
(Jang) Medical Research Collaborating Center, Seoul National University
Hospital, Seoul National University College of Medicine, Seoul, South
Korea
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Tricuspid valve repair (TVr) has both a theoretical advantage
in preserving right ventricular function and disadvantages such as a
higher risk of repair failure in the long-term compared with tricuspid
valve replacement (TVR). This study was conducted to compare the results
of TVr with those of TVR to find an optimal treatment option.
<br/>METHOD(S): A literature search of 5 databases was performed. The
primary outcome was all-cause mortality. Secondary outcomes were tricuspid
reoperation and valve-related events. Subgroup analyses were performed
according to the risk of bias, year of publication and proportions of
patients with tricuspid regurgitation Grade >= 3, functional aetiology and
isolated tricuspid valve surgery. Publication bias was explored using the
funnel plot and Egger's test. <br/>RESULT(S): Seventeen retrospective
studies involving 4561 patients (TVr group = 3432 patients and TVR group =
1129 patients) were included. A pooled analysis showed that the risk of
all-cause mortality was significantly higher in the TVR group than in the
TVr group [hazard ratio (95% confidence interval) 1.59 (1.26-2.00)]. There
were no significant differences in tricuspid valve reoperation in 6
studies and valve-related events in 5 studies between the TVR and TVr
groups [hazard ratio (95% confidence interval) 1.30 (0.88-1.91) and 1.47
(0.91- 2.38), respectively]. None of the subgroup analyses demonstrated a
significant difference in the hazard ratio of all-cause mortality. No
publication bias was identified for the primary and secondary outcomes.
<br/>CONCLUSION(S): This meta-analysis indicates that TVr is more
beneficial compared with TVR in terms of all-cause mortality. From the
available data, TVr is not associated with an increased risk of tricuspid
reoperation compared with TVR.<br/>Copyright &#xa9; The Author 2017.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<89>
Accession Number
621555156
Title
Randomized controlled trials in children's heart surgery in the 21st
century: A systematic review.
Source
European Journal of Cardio-thoracic Surgery. 53 (4) (pp 724-731), 2018.
Date of Publication: 01 Apr 2018.
Author
Drury N.E.; Patel A.J.; Oswald N.K.; Chong C.-R.; Stickley J.; Barron
D.J.; Jones T.J.
Institution
(Drury, Patel, Oswald, Stickley, Barron, Jones) Department of Paediatric
Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United
Kingdom
(Drury) Institute of Cardiovascular Sciences, University of Birmingham,
Birmingham, United Kingdom
(Chong) Department of Physiology, Anatomy and Genetics, University of
Oxford, Oxford, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Randomized controlled trials are the gold standard for
evaluating health care interventions, yet are uncommon in children's heart
surgery. We conducted a systematic review of clinical trials in paediatric
cardiac surgery to evaluate the scope and quality of the current
international literature. <br/>METHOD(S): We searched MEDLINE, CENTRAL and
LILACS, and manually screened retrieved references and systematic reviews
to identify all randomized controlled trials reporting the effect of any
intervention on the conduct or outcomes of heart surgery in children
published in any language since January 2000; secondary publications and
those reporting inseparable adult data were excluded. Two reviewers
independently screened studies for eligibility and extracted data; the
Cochrane Risk of Bias tool was used to assess for potential biases.
<br/>RESULT(S): We identified 333 trials from 34 countries randomizing 23
902 children. Most were early phase (313, 94.0%), recruiting few patients
(median 45, interquartile range 28-82), and only 11 (3.3%) directly
evaluated a surgical intervention. One hundred and nine (32.7%) trials
calculated a sample size, 52 (15.6%) reported a CONSORT diagram, 51
(15.3%) were publicly registered and 25 (7.5%) had a Data Monitoring
Committee. The overall risk of bias was low in 22 (6.6%), high in 69
(20.7%) and unclear in 242 (72.7%). <br/>CONCLUSION(S): The recent
literature in children's heart surgery contains few late-phase clinical
trials. Most trials did not conform to the accepted standards of
reporting, and the overall risk of bias was low in few studies. There is a
need for high-quality, multicentre clinical trials to provide a robust
evidence base for contemporary paediatric cardiac surgical
practice.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<90>
Accession Number
623347714
Title
New-onset arrhythmias following transcatheter aortic valve implantation: A
systematic review and meta-analysis.
Source
Heart. 104 (14) (pp 1208-1215), 2018. Date of Publication: 01 Jul 2018.
Author
Siontis G.C.M.; Praz F.; Lanz J.; Vollenbroich R.; Roten L.; Stortecky S.;
Raber L.; Windecker S.; Pilgrim T.
Institution
(Siontis, Praz, Lanz, Vollenbroich, Roten, Stortecky, Raber, Windecker,
Pilgrim) Department of Cardiology, Swiss Cardiovascular Center Bern,
University of Bern, Bern, Switzerland
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: To evaluate the prevalence and clinical impact of new-onset
arrhythmias in patients following transcatheter aortic valve implantation
(TAVI). <br/>Method(s): We systematically identified studies reporting
new-onset arrhythmias after TAVI other than atrioventricular conduction
disturbances. We summarised monitoring strategies, type and prevalence of
arrhythmias and estimated their effect on risk of death or cerebrovascular
events by using random-effects meta-analysis. The study is registered with
International prospective register of systematic reviews (PROSPERO)
(CRD42017058053). <br/>Result(s): Sixty-five studies (43 506 patients)
reported new-onset arrhythmias following TAVI. The method of arrhythmia
detection was specified only in 31 studies (48%). New-onset atrial
fibrillation (NOAF) (2641 patients), bradyarrhythmias (182 patients),
supraventricular arrhythmias (29 patients), ventricular arrhythmias (28
patients) and non-specified major arrhythmias (855 patients) were
reported. In most studies (52 out of 65), new-onset arrhythmia detection
was limited to the first month following TAVI. The most frequently
documented arrhythmia was NOAF with trend of increasing summary prevalence
of 11%, 14%, 14% and 25% during inhospital, 30-day, 1-year and 2-year
follow-ups, respectively (P for trend=0.011). Summary prevalence estimates
of NOAF at 30-day follow-up differ significantly between studies of
prospective and retrospective design (8% and 21%, respectively, P=0.002).
New episodes of bradyarrhythmias were documented with a summary crude
prevalence of 4% at 1-year follow-up. NOAF increased the risk of death
(relative risk 1.61, 95% CI 1.35 to 1.98, I 2 =47%) and cerebrovascular
events (1.79, 95% CI 1.24 to 2.64, I 2 =0%). No study commented on
therapeutic modifications following the detection of new-onset
arrhythmias. <br/>Conclusion(s): Systematic identification of new-onset
arrhythmias following TAVI may have considerable impact on subsequent
therapeutic management and long-term prognosis in this patient
population.<br/>Copyright &#xa9; 2018 Article author(s). All rights
reserved.

<91>
Accession Number
2001214512
Title
Evidence for Cerebral Embolic Prevention in Transcatheter Aortic Valve
Implantation and Thoracic Endovascular Aortic Repair.
Source
Annals of Vascular Surgery. 55 (pp 292-306), 2019. Date of Publication:
February 2019.
Author
Lam H.T.; Kwong J.M.; Lam P.L.; Yeung W.L.; Chan Y.C.
Institution
(Lam, Kwong, Lam, Yeung) Li Ka Shing Faculty of Medicine, University of
Hong Kong, Pokfulam, Hong Kong SAR, Hong Kong
(Chan) Division of Vascular and Endovascular Surgery, Department of
Surgery, University of Hong Kong Medical Centre, Pokfulam, Hong Kong SAR,
Hong Kong
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Embolic stroke is a formidable complication of transcatheter
aortic valve implantation (TAVI) and thoracic endovascular aortic repair
(TEVAR). Mechanical strategies to reduce the risk of ischemic embolic
lesions include embolic protection devices (EPDs) and carbon dioxide
flushing (CDF). This study aims to assess the efficacy for EPD and CDF
uses in TAVI and TEVAR. <br/>Method(s): A literature review was performed
according to the Preferred Reporting Items for Systematic reviews and
Meta-Analysis. All searches were performed via PubMed, OvidSP, MEDLINE,
Web of Science Core Collection, and Cochrane Library. Conference abstracts
and proceedings were included. Those that were out of scope of interest
and review articles were excluded. <br/>Result(s): Eighteen studies
fulfilled the inclusion criteria of the 456 articles searched. Regarding
EPD use in TAVI, systematic review comparing EPD with no-EPD showed
smaller total volume of cerebral lesions and smaller volume per lesion in
patients with EPD in all studies. They also performed better in
postoperative neurocognitive assessments but could not demonstrate
clinical prevention of embolic stroke in all studies. While for EPD use in
TEVAR, capture of embolic debris and absence of early postoperative
neurocognitive deficit were demonstrated in all cases of 2 prospective
pilot studies. Concerning CDF in TEVAR, significant reduction in gaseous
emboli released during stent-graft deployment was shown by 1 in vitro
study. Successful CDF application in all patients, with only 1 case of
postoperative nondisabling stroke, was also demonstrated by 1 cohort
study. <br/>Conclusion(s): This systematic review of medical literature
has demonstrated the safety and feasibility of EPD use in TAVI. Although
improvements in clinical outcomes have yet been demonstrated, there was
level I evidence showing reduced embolic lesions in imaging. The use of
EPD and CDF in TEVAR was suggested, but evidence remained inadequate to
support routine clinical use.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<92>
Accession Number
623175250
Title
Meta-analysis of efficacy and safety of dual antiplatelet therapy versus
aspirin monotherapy after coronary artery bypass grafting.
Source
European Journal of Preventive Cardiology. 26 (2) (pp 215-218), 2019. Date
of Publication: 01 Jan 2019.
Author
Khan S.U.; Talluri S.; Rahman H.; Lekkala M.; Khan M.S.; Riaz H.; Shah H.;
Kaluski E.; Sattur S.
Institution
(Khan, Talluri, Rahman, Lekkala, Shah, Kaluski, Sattur) Guthrie Clinic,
Robert Packer Hospital, United States
(Khan) Cook County Hospital, United States
(Riaz) Cleveland Clinic, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)

<93>
Accession Number
625997810
Title
The Portico transcatheter aortic valve for the treatment of severe aortic
stenosis.
Source
Future Cardiology. 15 (1) (pp 31-37), 2019. Date of Publication: January
2019.
Author
Taramasso M.; Miura M.; Gavazzoni M.; Andreas M.; Saccocci M.; Gulmez G.;
Puri R.; Maisano F.
Institution
(Taramasso, Miura, Gavazzoni, Saccocci, Gulmez, Maisano) Cardiovascular
Surgical Department, Heart Valve Clinic, University of Zurich, Zurich,
Switzerland
(Andreas) Department of Surgery, Division of Cardiac Surgery, Medical
University of Vienna, Vienna, Austria
(Puri) Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland,
OH, United States
Publisher
Future Medicine Ltd. (E-mail: info@futuremedicine.com)
Abstract
The Portico TAVI system (Abbott Vascular, Santa Clara, CA, USA) has been
specifically designed to mitigate some of the complications associated
with first-generation valves. Most of the data generated from randomized
studies comparing transcatheter aortic valve implantation with surgery
stem from reported experiences with first generation transcatheter heart
valve devices. The aim of this review is to describe the repositionable
and retrievable Portico system and its implantation technique, coupled
with our single-center experience and to provide a review of the clinical
results reported so far in the literature.<br/>Copyright &#xa9; 2018 2018
Future Medicine Ltd.

<94>
Accession Number
624995494
Title
Atrial fibrillation following heart transplantation: A systematic review
and meta-analysis of observational studies.
Source
Journal of Evidence-Based Medicine. 11 (4) (pp 261-271), 2018. Date of
Publication: November 2018.
Author
Chokesuwattanaskul R.; Bathini T.; Thongprayoon C.; Preechawat S.;
O'Corragain O.A.; Pachariyanon P.; Ungprasert P.; Cheungpasitporn W.
Institution
(Chokesuwattanaskul, Preechawat) Faculty of Medicine, Division of
Cardiology, Department of Medicine, Chulalongkorn University and King
Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
(Bathini) Department of Internal Medicine, University of Arizona, Tucson,
AZ, United States
(Thongprayoon) Department of Internal Medicine, Mayo Clinic, Rochester,
MN, United States
(O'Corragain) Department of Internal Medicine, Temple University,
Philadelphia, PA, United States
(Pachariyanon) Department of Internal Medicine, Texas Tech University
Health Sciences Center, Lubbock, TX, United States
(Ungprasert) Clinical Epidemiology Unit, Faculty of Medicine Siriraj
Hospital, Department of Research and Development, Mahidol University,
Bangkok, Thailand
(Cheungpasitporn) Division of Nephrology, Department of Medicine,
University of Mississippi Medical Center, MS, United States
Publisher
Blackwell Publishing
Abstract
Objective: Previous studies have suggested a high incidence of atrial
fibrillation (AF) in heart transplant recipients. However, incidence
trends of AF in heart transplant recipients remain unclear. The study's
aims were (1) to investigate the pooled incidence/incidence trends of AF
following heart transplantation and (2) to assess the mortality risk of
heart transplant recipients with AF. <br/>Method(s): A literature search
for studies that reported the incidence of AF following heart
transplantation was conducted using MEDLINE, EMBASE, and The Cochrane
Database from inception through March 2018. Pooled incidence and odds
ratios (OR) with 95%CI were calculated using a random-effects model.
<br/>Result(s): Eighteen studies (2 cohorts from clinical trials and 16
cohort studies) with 5393 heart transplant recipients were enrolled. The
pooled estimated incidence of AF in heart transplant was 10.1% (95%CI:
7.6%-13.2%). Meta-analysis based on the type of anastomotic technique
demonstrated a pooled estimated incidence of AF following heart
transplantation of 18.7% (95%CI: 10.3%-31.5%) and 11.1% (95%CI:
6.5%-18.4%) by biatrial and bicaval techniques, respectively. There was a
significant association between AF following a heart transplant and
increased mortality risk with a pooled OR of 2.86 (95%CI: 2.08-3.93).
Meta-regression analyses showed no significant correlations between the
year of study and incidence of AF (P = 0.47) or mortality risk of AF after
heart transplantation (P = 0.99). <br/>Conclusion(s): The overall
estimated incidence of AF following heart transplantation is 10.1%. There
is a significant association between AF and increased mortality after
transplantation. Furthermore, incidence and mortality risk of AF following
heart transplant does not seem to decrease over time.<br/>Copyright &#xa9;
2018 Chinese Cochrane Center, West China Hospital of Sichuan University
and John Wiley & Sons Australia, Ltd

<95>
Accession Number
623686393
Title
Normal values for Doppler echocardiographic assessment of prosthetic valve
function after transcatheter aortic valve replacement: A systematic review
and meta-analysis.
Source
European Heart Journal Cardiovascular Imaging. 19 (4) (pp 361-368), 2018.
Date of Publication: April 2018.
Author
Winter M.-P.; Zbiral M.; Kietaibl A.; Sulzgruber P.; Kastner J.; Rosenhek
R.; Binder T.; Lang I.M.; Goliasch G.
Institution
(Winter, Zbiral, Kietaibl, Sulzgruber, Kastner, Rosenhek, Binder, Lang,
Goliasch) Department of Internal medicine II, Division of cardiology,
Medical University of Vienna, Waehringerguertel 18-20, Vienna A-1090,
Austria
Publisher
Oxford University Press
Abstract
Transcatheter aortic valve replacement has emerged as valuable treatment
modality for patients with severe aortic stenosis and an unacceptable
risk/benefit ratio for open heart surgery, but particularities specific to
TAVR and a rapidly growing number of available TAVR prosthesis make
post-procedural assessment of valve function challenging. Aim of the
present analysis was to collect and pool all available data currently in
the literature regarding normal doppler values for transcatheter
prosthetic heart valves and to provide a comprehensive overview. A PRISMA
checklist-guided systematic review and meta-analysis of prospective
observational studies or national and device specific registries or
randomized clinical trials was conducted. Studies were identified by
searching PUBMED, SCOPUS, Cochrane Central Register of Controlled Trials
and LILACs from January 2000 to March 2017. Out of 240 abstracts, 155
studies reporting echocardiographic parameter for twelve different valves
prosthesis in a total of 27,159 patients were in included in this
meta-analysis. The means and standard deviations of peak velocity, peak
gradient, mean gradient and effective orifice were extracted and pooled
from the included studies. The pooled means and standard deviations for
all available TAVR prosthesis were classified according to implanted valve
size and time since implantation. The present study firstly describes a
pooled analysis of normal values for all available TAVR prosthesis in
order to empower treating physicians with a reliable tool to perform
follow-up echocardiographic assessment in TAVR patients and to safely
identify patients with prostheses dysfunction.<br/>Copyright &#xa9; The
Author 2017.

<96>
[Use Link to view the full text]
Accession Number
617616595
Title
Letter by Shi et al Regarding Article, "Body Mass Index and Mortality
Among Adults Undergoing Cardiac Surgery: A Nationwide Study With a
Systematic Review and Meta-Analysis".
Source
Circulation. 136 (5) (pp 505-506), 2017. Date of Publication: 01 Aug 2017.
Author
Shi Y.; Yu H.; Yang X.-Y.
Institution
(Shi, Yu) Department of Anesthesiology, West China Hospital, Sichuan
University, Chengdu, China
(Yang) Department of Obstetrics and Gynecology, West China Second
Hospital, Sichuan University, Chengdu, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<97>
Accession Number
2001482174
Title
Proceedings #34: Effect of Spinal Cord Stimulation on Intraoperatively
Recorded EEG in Chronic Pain Patients.
Source
Brain Stimulation. Conference: 3rd International Brain Stimulation
Conference. Canada. 12 (2) (pp e102-e103), 2019. Date of Publication:
March - April 2019.
Author
Telkes I.; Paniccioli S.; Grey R.; Briotte M.; McCarthy K.; Pilitsis J.G.
Institution
(Telkes, Pilitsis) Department of Neuroscience and Experimental
Therapeutics, Albany Medical College, United States
(Paniccioli, Grey, Briotte, McCarthy) Nuvasive Clinical Services, San
Diego, CA, United States
(Pilitsis) Department of Neurosurgery, Albany Medical Center, United
States
Publisher
Elsevier Inc.
Abstract
Introduction: Spinal cord stimulation (SCS) is routinely used, effective
treatment for medically intractable pain syndromes. However, significant
subsets of patients remain sub-optimally treated. Plus, the mechanism of
action of stimulation is still unknown. <br/>Method(s): In order to
further our understanding of the electro-physiological changes with
respect to stimulation, we recorded 10-channel EEG
(electroencephalography) from two chronic pain patients during SCS surgery
by using tonic (60Hz-300mus) and high frequency (HF) stimulation
(10kHz-30mus). We computed subband powers by normalizing to patient's
baseline. <br/>Result(s): Relative subband power distributions showed that
tonic and HF stimulation affect spectral patterns differently compared to
their stimulation OFF states. For example, alpha band power was found
higher in all channels in P1 and almost all channels in P2 with 10 kHz
stimulation while theta band power was only lower in FP1 with tonic
stimulation and partially lower on the right side in P2 with HF
stimulation. <br/>Conclusion(s): Our preliminary results might show an
underlying pathophysiology and its responses to different stimulation
settings in chronic pain patients. 2 Introduction: Chronic pain has been
estimated to affect about 100 million adult Americans. Treatment of
chronic pain remains suboptimal, with 51% of patients reporting having
little to no control over their pain [1]. While SCS can be used
effectively in many patients [2-4], significant subsets of patients remain
sub-optimally treated [3]. In patients, benefit has been shown with higher
frequencies as opposed to continuously given impulses (tonic) [5-6]. We
are unclear how these neuromodulators work to control pain. Further, it
remains to be elucidated whether changing the way the electrical impulse
is delivered can change how pain is felt. Our understanding of the effects
of chronic pain or the different SCS waveforms on EEG patterns are
limited. Chronic pain studies showed higher spectral power in theta and
beta bands [7-8]. The patients who were taking centrally acting pain
medications showed similar patterns to that of non-medication taking
patients. After central lateral thalamotomy, the differences in the theta
bands normalized along with reduction in pain perception [8-9]. It was
also shown that the peak activity in chronic pain patients with spinal
cord injury was in theta range while it was in alpha range in non-pain
patients with spinal cord injury [10]. Here, we explore effects of tonic
and 10kHz-HF stimulation on EEG recordings during surgery. The purpose of
this pilot study is to clarify how this stimulation patterns may affect
electrophysiological activity in the cingulate, prefrontal, motor and
sensory cortex in chronic pain patients with back pain and associated
radicular symptoms. 3 Methods: EEG signals were recorded from 2 patients
with chronic pain who were undergoing thoracic SCS surgery. The
experimental protocol was approved by the Institutional Review Board of
Albany Medical College. Both patients provided written informed consent
for study participation. Surgeries were performed in asleep using total
intravenous anesthesia as done routinely at our center to allow for
intraoperative neuromonitoring (ION). EEG recordings through 10 channels
were collected by using needle electrodes. Data acquisition was performed
with 128 Hz sampling frequency using the Cascade PRO (Cadwell, Kennetwick,
MA) monitoring system. EEG recording started when the optimal current and
the contact pair were determined by gradually increasing current from 0 mA
to 10 mA with 60 Hz frequency and 300 mus pulse width as per our ION
protocol [11]. Then, 1-min baseline was recorded while the stimulation was
OFF. Immediately after, lead was stimulated from the optimal contact pair
for 40 s by using tonic (60Hz-300mus) and HF (10kHz-30mus), respectively.
Each stimulation trial was separated by 30-s OFF period. All data were
analyzed offline in Matlab (Mathworks, Natick, Massachusetts). A modified
Welch periodogram method was used to map the signals to the frequency
domain. Subband power changes relative to baseline were computed in theta
(4-7 Hz), alpha (8-12 Hz), beta (13-30 Hz), and gamma (35-55 Hz) bands.
The relative powers which show the power changes with respect to baseline
were represented in decibel scale (dB). 4 Results: We analyzed 10-channel
EEG data in 2 chronic pain patients, P1 and P2, age 64 and 48 years,
respectively. Both patients were implanted with paddle electrodes placed
over the T9-10 interspace (Nevro Corp, CA). The distribution of relative
EEG powers, including topographical maps, for tonic (blue) and HF (red)
are shown in Fig.1. Theta power in both trials was found increased in
almost all channels in P1 (Fig.1.A). Channel FP1 showed no theta change by
tonic stimulation. HF stimulation increased alpha power in all channels
while tonic stimulation slightly increased the alpha power in F1, FP1,
CP3, CP4, and T8. Considering that the alpha power decreases in chronic
pain patients compared to healthy subjects or medicated pain patients
[7,10], this enhancement induced by HF might be a therapeutic effect. Both
tonic and HF stimulation increased the beta and gamma powers in various
degrees in almost all EEG channels. The highest amount of change was found
on T8 in both trials. Fig.1.B demonstrates the power changes in P2. The
patterns of relative theta power were found different in P2. HF induced a
decrease in theta power mostly on the right side. Unlikely, tonic
stimulation induced no change in theta power on this side. Patterns in
alpha range in response to HF were various. Mostly the frontal regions
showed positive changes in alpha power with stimulation and the increase
was higher with HF. The most dramatic difference between tonic and HF
stimulation was found in beta and gamma band powers in P2. HF increased
beta power in all channels with a similar degree while tonic stimulation
decreased it in various amounts. Similarly, the change in gamma power was
mostly positive in HF and negative in tonic stimulation. [Figure
presented] 5 Discussion and <br/>Conclusion(s): In the current study, we
found the peak activity in P1 at the alpha range with HF stimulation while
it remained at theta range with tonic stimulation. On the other hand, peak
activity in P2 was noted at beta range with HF stimulation. The increased
alpha activity in this patient was noted in the frontal regions with HF
stimulation. It has been shown that a shift towards theta peak frequencies
is a hallmark of chronic pain [8-9]. Thus, the demonstrated shift towards
higher, alpha, frequencies may be the first indicator of pain relief
facilitated by HF stimulation [8]. Additionally, we demonstrated
topographical differences between tonic and HF stimulation over many
different sites indicating pain has diffuse effect and some cortical areas
may be more contributory to these differences [10]. We might speculate
about the effect of anesthesia which characteristically replaces the
faster brain rhythms (alpha and beta) by slower activity (delta and theta)
[12]. However, we investigated the power changes relative to their
baseline and we didn't observe uniform changes in the subband powers in
these patients. Postoperative pain evaluation, 6 weeks following the SCS
surgery, indicated that pain level in P1 was 3/10 while this was 7/10 in
P2 with suboptimal pain relief. Considering the elevated alpha power
indicates a NO/less-pain state, HF-induced positive changes in alpha power
might be correlated to stimulation-responsive pain state in P1. Our
preliminary results support the possibility that different stimulation
patterns affect the electrophysiological activity differently in various
cortical regions. Such differences might account for the variability in
pain suppression in patients with chronic pain treated with SCS. Why do we
see these spectral changes in these locations? What are the major
differences between 60 Hz and 10 kHz stimulation? Why do we observe
asymmetrical responses with some stimulation settings? These questions
need to be studied in detail with larger subject populations. References:
[1] American Pain Foundation. Voices of Chronic Pain. New York: David
Michaelson & Company, LLC 2006. [2]Grabow TS, Tella PK, Raja SN. Spinal
cord stimulation for complex regional pain syndrome: an evidence-based
medicine review of the literature. Clin J Pain 2003;19(6):371-83. [3]
Kumar K, Taylor RS, Jacques L, et al. Spinal cord stimulation versus
conventional medical management for neuropathic pain: A multicenter
randomized controlled trial in patients with failed back surgery syndrome.
Pain 2007;132(1-2):179-88. [4] Johnson S, Ayling H, Sharma M, et al.
External noninvasive peripheral nerve stimulation treatment of neuropathic
pain: a prospective audit. Neuromodulation: Technology at the Neural
Interface 2014; doi: 10.1111/ner.12244 [5] Al-Kaisy A, Van Buyten JP, Smet
I, et al. Sustained effectiveness of 10 kHz high-frequency spinal cord
stimulation for patients with chronic, low back pain: 24-month results of
a prospective multicenter study. Pain Medicine 2013; 5. [6] Perruchoud C,
Eldabe S, Batterham AM, et al. Analgesic efficacy of high-frequency spinal
cord stimulation: a randomized double-blind placebo-controlled study.
Neuromodulation 2013;16(4):363-9. [7]Jensen MP, Sherlin LH, Hakimian S, et
al. Neuromodulatory approaches for chronic pain management: Research
findings and clinical implications. Journal of Neurotherapy 2009; 13(4),
196-213. [8] Sarnthein J, Stern J, Aufenberg C, et al. Increased EEG power
and slowed dominant frequency in patients with neurogenic pain. Brain
2005; 129(1), 55-64. [9] Stern J, Jeanmonod D, and Sarnthein J. Persistent
EEG overactivation in the cortical pain matrix of neurogenic pain
patients. Neuroimage 2006; 31(2), 721-731. [10] Boord P, Siddall PJ, Tran
Y, et al. Electroencephalographic slowing and reduced reactivity in
neuropathic pain following spinal cord injury. Spinal cord 2008; 46(2),
118. [11] Roth SG, Lange S, Haller J, et al. A prospective study of the
intra-and postoperative efficacy of intraoperative neuromonitoring in
spinal cord stimulation. Stereotact Funct Neurosurg 2015; 93(5), 348-354.
[12] Nicolaou N, Hourris S, Alexandrou P, et al. EEG-based automatic
classification of 'awake' versus 'anesthetized' state in general
anesthesia using Granger causality. PloS one. 2012; 7(3):
e33869.<br/>Copyright &#xa9; 2018

<98>
Accession Number
626045394
Title
Patient safety, cost-effectiveness, and quality of life: reduction of
delirium risk and postoperative cognitive dysfunction after elective
procedures in older adults-study protocol for a stepped-wedge cluster
randomized trial (PAWEL Study).
Source
Trials. 20 (1) (pp 71), 2019. Date of Publication: 21 Jan 2019.
Author
Sanchez A.; Thomas C.; Deeken F.; Wagner S.; Kloppel S.; Kentischer F.;
von Arnim C.A.F.; Denkinger M.; Conzelmann L.O.; Biermann-Stallwitz J.;
Joos S.; Sturm H.; Metz B.; Auer R.; Skrobik Y.; Eschweiler G.W.; Rapp
M.A.
Institution
(Sanchez, Deeken, Rapp) Department of Social and Preventive Medicine,
University of Potsdam, Am Neuen Palais 10, Potsdam 14469, Germany
(Thomas) Department of Old Age Psychiatry and Psychotherapy, Klinikum
Stuttgart, Stuttgart, Germany
(Wagner) Department of Anaesthesiology and Intensive Care,
Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
(Kloppel) Center for Geriatrics and Gerontology, University Medical Center
Freiburg, Freiburg, Germany
(Kloppel) University Hospital of Old Age Psychiatry, University of Bern,
Bern, Switzerland
(Kentischer) Department of Surgery, Medical Center-University of Freiburg,
Freiburg, Germany
(von Arnim) Department of Neurology, University Hospital Ulm, Ulm, Germany
(Denkinger) Agaplesion Bethesda Clinic, Geriatric Center Ulm University,
Ulm, Germany
(Conzelmann) Helios Clinic for Heart Surgery, Karlsruhe, Germany
(Biermann-Stallwitz) Institute for Health Care Management and Research,
University Duisburg-Essen, Essen, Germany
(Joos, Sturm) Institute for General Practice and Interprofessional Care,
University Hospital Tubingen, Tubingen, Germany
(Metz) Geriatric Center Karlsruhe, ViDia Christian Clinics Karlsruhe,
Karlsruhe, Germany
(Auer) Allgemeine Ortskrankenkasse (AOK) Baden-Wurttemberg, Stuttgart,
Germany
(Skrobik) Department of Medicine, McGill University Health Center, Glen
Campus, Montreal, QC, Canada
(Eschweiler) Geriatric Center at the University Hospital Tubingen,
Tubingen, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative delirium is a common disorder in older adults
that is associated with higher morbidity and mortality, prolonged
cognitive impairment, development of dementia, higher institutionalization
rates, and rising healthcare costs. The probability of delirium after
surgery increases with patients' age, with pre-existing cognitive
impairment, and with comorbidities, and its diagnosis and treatment is
dependent on the knowledge of diagnostic criteria, risk factors, and
treatment options of the medical staff. In this study, we will investigate
whether a cross-sectoral and multimodal intervention for preventing
delirium can reduce the prevalence of delirium and postoperative cognitive
decline (POCD) in patients older than 70years undergoing elective surgery.
Additionally, we will analyze whether the intervention is cost-effective.
<br/>METHOD(S): The study will be conducted at five medical centers (with
two or three surgical departments each) in the southwest of Germany. The
study employs a stepped-wedge design with cluster randomization of the
medical centers. Measurements are performed at six consecutive points:
preadmission, preoperative, and postoperative with daily delirium
screening up to day 7 and POCD evaluations at 2, 6, and 12months after
surgery. Recruitment goals are to enroll 1500 patients older than 70years
undergoing elective operative procedures (cardiac, thoracic, vascular,
proximal big joints and spine, genitourinary, gastrointestinal, and
general elective surgery procedures). DISCUSSION: Results of the trial
should form the basis of future standards for preventing delirium and POCD
in surgical wards. Key aims are the improvement of patient safety and
quality of life, as well as the reduction of the long-term risk of
conversion to dementia. Furthermore, from an economic perspective, we
expect benefits and decreased costs for hospitals, patients, and
healthcare insurances. TRIAL REGISTRATION: German Clinical Trials
Register, DRKS00013311 . Registered on 10 November 2017.