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<1>
Accession Number
2001403276
Title
Meta-Analysis of Impact of Baseline N-TerminalPro-Brain Natriuretic
Peptide Levels on SurvivalAfter Transcatheter Aortic Valve Implantation
for Aortic Stenosis.
Source
American Journal of Cardiology. 123 (5) (pp 820-826), 2019. Date of
Publication: 1 March 2019.
Author
Takagi H.; Hari Y.; Kawai N.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
We performed a meta-analysis of currently available studies investigating
impact of baseline N-terminal pro-brain natriuretic peptide (NT-proBNP) on
mortality after transcatheter aortic valve implantation (TAVI) for aortic
stenosis (AS). MEDLINE and EMBASE were searched through August 2018 using
PubMed and OVID. Studies considered for inclusion met the following
criteria: the design was a study researching impact of baseline NT-proBNP
levels on survival; the study population was patients underwent TAVI for
AS; outcomes included all-cause mortality. For each study, we directly
extracted odds ratio (ORs) or hazard ratios (HRs) of mortality (for high
vs low baseline NT-proBNP); and generated ORs using mortality rates in
both patients with high and low levels of baseline NT-proBNP.
Study-specific estimates were combined using inverse variance-weighted
averages of logarithmic ORs/HRs in the random-effects model. We identified
16 eligible studies including a total of 3,679 patients who underwent TAVI
for AS. Pooled analyses demonstrated that high levels of baseline
NT-proBNP were associated with a statistically nonsignificant increase in
early (30-day or 2-month) mortality (pooled OR, 1.60; 95% confidence
interval, 0.84 to 3.04; p = 0.15) and a statistically significant increase
in midterm (6-month to 4-year) mortality (pooled OR/HR, 1.88; 95%
confidence interval, 1.54 to 2.28; p < 0.00001). Although funnel-plot
asymmetry suggesting publication bias was detected, adjusting for
funnel-plot asymmetry indicated an association of high levels of baseline
NT-proBNP with a still significant increase in midterm mortality. In
conclusion, high levels of baseline NT-proBNP predict increased midterm,
not early, mortality after TAVI for AS.<br/>Copyright &#xa9; 2018 Elsevier
Ltd

<2>
Accession Number
2001381149
Title
Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention
in Patients With Non-ST-Elevation Myocardial Infarction and Left Main or
Multivessel Coronary Disease.
Source
American Journal of Cardiology. 123 (5) (pp 717-724), 2019. Date of
Publication: 1 March 2019.
Author
Freitas P.; Madeira M.; Raposo L.; Madeira S.; Brito J.; Brizido C.; Gama
F.; Vale N.; Ranchordas S.; Magro P.; Braga A.; Goncalves P.D.A.; Gabriel
H.M.; Nolasco T.; Boshoff S.; Marques M.; Bruges L.; Calquinha J.;
Sousa-Uva M.; Abecasis M.; Almeida M.; Neves J.P.; Mendes M.
Institution
(Freitas, Raposo, Madeira, Brito, Brizido, Gama, Vale, Goncalves, Gabriel,
Almeida, Mendes) Department of Cardiology, Hospital de Santa Cruz, Lisbon,
Portugal
(Madeira, Ranchordas, Magro, Braga, Nolasco, Boshoff, Marques, Bruges,
Calquinha, Sousa-Uva, Abecasis, Neves) Department of Cardiac Surgery,
Hospital de Santa Cruz, Lisbon, Portugal
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Current recommendations on the optimal revascularization strategy in
Non-ST-elevation myocardial infarction (NSTEMI) with left main (LM) or
multivessel coronary disease (MVD) are based upon randomized clinical
trials conducted in stable coronary artery disease. In a real-world
contemporary observational registry, we compared the long-term outcome of
NSTEMI patients with LM/MVD (n = 1,104) submitted to coronary artery
bypass grafting (CABG), percutaneous coronary intervention (PCI), or
optimized medical therapy (OMT). The primary end point was 5-year
all-cause mortality. Results were assessed in the entire population (CABG
289, PCI 399, and OMT 416) and in a propensity score-matched cohort of
CABG (n = 159) and PCI (n = 159). Crude 5-year mortality rates in CABG and
PCI were 25.3% versus 29.6%, respectively (unadjusted hazard ratio [HR]
1.2; 95% confidence intervals [CI] 0.9 to 1.6; p = 0.212); OMT, however,
was associated with a twofold higher risk of mortality when compared with
any revascularization strategy (unadjusted HR 2.0; 95% CI 1.7 to 2.5; p <
0.001). After propensity score-matching and multivariate analysis, there
was a trend toward a higher incidence of the primary end point in patients
who underwent PCI versus CABG (31% vs 21%; adjusted HR 1.52; 95% CI 0.93
to 2.50; p = 0.094). This was a consistent finding over subgroups deemed
clinically relevant, such as in patients with LM or proximal left anterior
descending disease, SYNergy between percutaneous coronary intervention
with TAXus >=23 and left ventricle ejection fraction <40%. In conclusion,
in a real-world cohort of NSTEMI patients with LM/MVD, those selected for
OMT had a dire outcome. Although adjusted 5-year mortality was
statistically similar between revascularization strategies, there was a
trend favoring CABG, which might be the preferred option in LM, proximal
LAD, SYNergy between percutaneous coronary intervention with TAXus >=23,
and left ventricle ejection fraction <40% subgroups.<br/>Copyright &#xa9;
2018

<3>
Accession Number
2001366467
Title
Meta-Analysis Comparing the Incidence of Infective Endocarditis Following
Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve
Replacement.
Source
American Journal of Cardiology. 123 (5) (pp 827-832), 2019. Date of
Publication: 1 March 2019.
Author
Ando T.; Ashraf S.; Villablanca P.A.; Telila T.A.; Takagi H.; Grines C.L.;
Afonso L.; Briasoulis A.
Institution
(Ando, Ashraf, Afonso) Department of Medicine Division of Cardiology,
Wayne State University/Detroit Medical Center, Detroit, MI, United States
(Ando, Takagi) ALICE (All-Literature Investigation of Cardiovascular
Evidence) Group, United States
(Villablanca) Department of Medicine, Division of Cardiology, Henry Ford
Hospital, Detroit, MI, United States
(Telila) Piedmont Heart Institute, Atlanta, Georgia, Georgia
(Takagi) Department of Medicine Division of Cardiovascular Surgery,
Shizuoka Medical Center, Shizuoka, Japan
(Grines) Department of Medicine Division of Cardiology, North Shore
University Hospital, Hofstra Northwell School of Medicine, Manhasset, NY,
United States
(Briasoulis) Department of Medicine Division of Cardiovascular Medicine,
University of Iowa Hospitals and Clinics, Iowa, IA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Infective endocarditis (IE) after transcatheter aortic valve implantation
(TAVI) and surgical aortic valve replacement (SAVR) is a rare but
life-threatening complication. Paravalvular regurgitation, compression of
native leaflets, and space between transcatheter valve prosthesis and
native valves could dispose TAVI recipients at increased risk of IE
compared with SAVR. To assess the comparative risk of IE between TAVI and
SAVR, we performed a systematic review and meta-analysis. A literature
search of PUBMED and EMBASE was performed to identify randomized
controlled trials that reported the event rate of IE in both TAVI and
SAVR. A Mantel-Haenszel method and a random-effects model was used to
calculate the odds ratio (OR) and 95% confidence interval (CI). The
studied outcomes were early (at 1-year), late (>1-year), and overall IE
(postprocedure to longest follow-up) in TAVI versus SAVR. We performed
subgroup analysis based on valve-type (self or balloon-expandable) and
surgical risk (high or intermediate). A total of 4 studies with 3,761
(1,895 TAVI and 1,866 SAVR) patients were included. The incidence of early
IE, (3 studies, 0.86% vs 0.73%, OR 1.17, 95% CI 0.51 to 2.65, p = 0.71,
I² = 0%), late IE (mean follow-up 2.0 years) (3 studies, 1.3%
vs 0.6%, OR 1.85, 95% CI 0.81 to 4.20, p = 0.42, I² = 0%), and
overall IE (mean follow-up 3.4 years) (4 studies, 2.0% vs 1.3%, OR 1.44,
95% CI 0.85 to 2.43, p = 0.18, I² = 0%) was similar between
TAVI and SAVR. Subgroup analysis suggested that in intermediate surgical
risk cohort, there was a trend toward increased risk of overall IE in TAVI
(2.3% in TAVI and 1.2% in SAVR, OR 1.92, 95% CI 0.99 to 3.72, p = 0.05
I² = 0%). In this meta-analysis, we did not find an increased
risk of IE in TAVI compared with SAVR. Appropriate preventative measure
and early recognition of IE in these cohorts are important.<br/>Copyright
&#xa9; 2018

<4>
Accession Number
621655408
Title
Effects of hypertonic saline vs normal saline on lactate clearance after
cardiovascular surgery.
Source
Archivos de Cardiologia de Mexico. 88 (2) (pp 100-106), 2018. Date of
Publication: April-June 2018.
Author
Atehortua-Lopez L.H.; Mendoza-Franco R.; Escobar-Serna J.F.; Urrego L.A.;
Alzate F.; Jaimes F.
Institution
(Atehortua-Lopez, Alzate) Hospital Universitario San Vicente Fundacion,
Medellin, Colombia
(Atehortua-Lopez, Mendoza-Franco, Escobar-Serna, Urrego) Universidad de
Antioquia, Medellin, Colombia
(Jaimes) Universidad de Antioquia, Research Unit Hospital Pablo Tobon
Uribe, Medellin, Colombia
Publisher
Instituto Nacional de Cardiologia Ignazio Chavez (E-mail:
archivos@cardiologia.org.mx)
Abstract
Background: The postoperative care of patients subjected to cardiac
surgery frequently require a complete recovery with intravenous fluids,
but crystalloid solutions like normal saline may increase the interstitial
oedema, and it is also well known that fluid overload increases mortality.
<br/>Objective(s): To compare the effect of 7.5% hypertonic saline (HS)
with 0.9% normal saline (NS) on lactate clearance, as well as the
haemodynamic response of patients during the first day after
cardiovascular bypass surgery. <br/>Method(s): The study included patients
18 years of age and older with coronary artery disease and/or heart valve
disease, and who underwent bypass surgery and/or cardiac valve replacement
and were randomly assigned to receive 4 mL/kg of HS or NS intravenously
for 30 min once they were admitted to the ICU. Lactate, arterial blood
gases, heart rate, central venous pressure, and pulmonary wedge pressure
were measured at 0, 6, 12, and 24 h after being admitted to the ICU. The
analyses were carried out with an intention-to-treat principle.
<br/>Result(s): Out of a total of 494 patients evaluated, 102 were
included and assigned to the HS groups (51 patients) or NS (51 patients).
The mean age of the participants was 59 +/- 14 years, and 59.8% were male.
No statistically significant differences were observed between two groups
in the lactate clearance, or in any of the secondary outcomes.
<br/>Conclusion(s): Our study failed to show a better lactate clearance in
the group on hypertonic saline, and with no evidence of a higher incidence
of adverse effects in that group.<br/>Copyright &#xa9; 2017 Instituto
Nacional de Cardiologia Ignacio Chavez.

<5>
Accession Number
624632544
Title
Heart transplantation for infective endocarditis: Viable option for a
limited few?.
Source
Transplant Infectious Disease. 21 (1) (no pagination), 2019. Article
Number: e13006. Date of Publication: Februaryy 2019.
Author
Murphy K.M.; Vikram H.R.
Institution
(Murphy) Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ,
United States
(Vikram) Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ, United
States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Active infection in the recipient is considered a relative
contraindication for solid organ transplantation. However, heart
transplantation (HT) can be curative in patients with ventricular assist
device infections. For patients with infective endocarditis (IE), valve
replacement is part of the management strategy based on emergent, acute,
or elective indications. HT has been utilized as an uncommon and sporadic
treatment option for carefully selected patients with refractory or
recurrent IE after all other surgical treatment options have been
exhausted or are not feasible. Herein, we review 19 published cases of IE
in whom HT was undertaken in the setting of ongoing active infection with
reported good outcomes. We attempt to propose general criteria for HT in
the setting of IE and discuss challenges and hurdles that clinicians might
encounter when considering HT for active IE in the absence of robust data
or clearly defined criteria.<br/>Copyright &#xa9; 2018 John Wiley & Sons
A/S. Published by John Wiley & Sons Ltd

<6>
Accession Number
624173922
Title
Safety and efficacy of transcatheter aortic valve replacement for native
aortic valve regurgitation: A systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 93 (2) (pp 345-353),
2019. Date of Publication: 01 Feb 2019.
Author
Rawasia W.F.; Khan M.S.; Usman M.S.; Siddiqi T.J.; Mujeeb F.A.; Chundrigar
M.; Kalra A.; Alkhouli M.; Kavinsky C.J.; Bhatt D.L.
Institution
(Rawasia, Alkhouli) Division of Cardiology, School of Medicine, West
Virginia University, Morgantown, WV, United States
(Khan) Department of Internal Medicine, Cook County Hospital, Chicago, IL,
United States
(Usman, Siddiqi, Mujeeb) Department of Internal Medicine, Dow Medical
College, Dow University of Health Sciences, Karachi, Pakistan
(Chundrigar) Department of Internal Medicine, The Aga Khan University -
Medical College, Karachi, Pakistan
(Kalra) Division of Cardiovascular Medicine, Case Western Reserve
University School of Medicine, University Hospitals Cleveland Medical
Center, Cleveland, OH, United States
(Kalra) Department of Medicine, Case Western Reserve University School of
Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH,
United States
(Kavinsky) Division of Cardiology, Rush University Medical Center,
Chicago, IL, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Harvard University, Boston, MA, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: The objective of this study was to analyze the available
literature on using transcatheter aortic valve replacement (TAVR) for
native aortic regurgitation (AR). <br/>Background(s): Surgical aortic
valve replacement is the gold standard therapy for native AR. TAVR has
emerged as an alternative approach in high-risk patients. <br/>Method(s):
MEDLINE, Scopus, and Cochrane CENTRAL were searched for reports of at
least 5 patients undergoing TAVR for native AR. Outcomes included 30-day
mortality, myocardial infarction, stroke, major bleeding, postprocedural
moderate to severe AR, and device success. Pooled estimates were
calculated using a random-effects model. Subgroup analysis and a
meta-regression were performed to study the effects of study level
covariates on outcomes. <br/>Result(s): Nineteen studies (n =998 patients)
were included. The rate of procedural success per Valve Academic Research
Consortium - 2 (VARC-2) criteria was 86.2% (78.8%-92.2%]. Thirty-day
mortality was 11.9% (9.4%-14.7%). Subgroup analysis showed the use of new
generation valves was associated with lower 30-day mortality (P = 0.02)
and higher device success (P = 0.009) compared with early generation
valves. There was no significant difference (P = 0.13) in the rate of
30-day mortality between patients receiving purpose-specific [8.2%
(4.3%-13.1%); I2 = 0%] and nonpurpose specific valves [13.0% (8.2%-18.6%);
I2 = 25%]. However, device success was higher (P = 0.02) in patients who
received purpose-specific valves [96.3% (92.2%-98.9%); I2 = 0%] compared
with nonpurpose specific valves [84.4% (75%-91.9%); I2 =46%].
<br/>Conclusion(s): TAVR for native AR is associated with acceptable
procedural success but increased early mortality. However, the safety and
the efficacy of the procedure increased with newer valves.<br/>Copyright
&#xa9; 2018 Wiley Periodicals, Inc.

<7>
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

<8>
Accession Number
2000570319
Title
Management of Patients With Aortic Valve Stenosis.
Source
Mayo Clinic Proceedings. 93 (4) (pp 488-508), 2018. Date of Publication:
April 2018.
Author
Kanwar A.; Thaden J.J.; Nkomo V.T.
Institution
(Kanwar) Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA,
United States
(Kanwar) Mayo Clinic College of Medicine and Science, Rochester, MN,
United States
(Thaden, Nkomo) Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN, United States
Publisher
Elsevier Ltd
Abstract
With increased life expectancy and aging of the population, aortic
stenosis is now one of the most common valvular heart diseases. Early
recognition and management of aortic stenosis are of paramount importance
because untreated symptomatic severe disease is universally fatal. The
advent of transcather aortic valve replacement technologies provides
exciting avenues of care to patients with this disease in whom traditional
surgical procedures could not be performed or were associated with high
risk. This review for clinicians offers an overview of aortic stenosis and
updated information on the current status of various treatment strategies.
An electronic literature search of PubMed, MEDLINE, EMBASE, and Scopus was
performed from conception July 1, 2016, through November 30, 2017, using
the terms aortic stenosis, aortic valve replacement, transcatheter aortic
valve replacement (TAVR), transcatheter aortic valve insertion (TAVI),
surgical aortic valve replacement, aortic stenosis flow-gradient patterns,
low-flow aortic valve stenosis, natural history, stress testing,
pathophysiology, bicuspid aortic valve, and congenital aortic valve
disease.<br/>Copyright &#xa9; 2018 Mayo Foundation for Medical Education
and Research

<9>
Accession Number
623175183
Title
Study Design of the Graft Patency After FFR-Guided Versus
Angiography-Guided CABG Trial (GRAFFITI).
Source
Journal of Cardiovascular Translational Research. 11 (4) (pp 269-273),
2018. Date of Publication: 01 Aug 2018.
Author
Toth G.G.; De Bruyne B.; Kala P.; Ribichini F.L.; Casselman F.; Ramos R.;
Piroth Z.; Fournier S.; Van Mieghem C.; Penicka M.; Mates M.; Van Praet
F.; Degriek I.; Barbato E.
Institution
(Toth) Department of Cardiology, University Heart Center Graz, Medical
University of Graz, Graz, Austria
(Toth, De Bruyne, Casselman, Fournier, Van Mieghem, Penicka, Van Praet,
Degriek, Barbato) Cardiovascular Research Center Aalst, OLV Clinic, OLV
Hospital, Moorselbaan, 164, Aalst B-9300, Belgium
(Kala) Department of Cardiology and Internal Medicine, University Hospital
Brno and Medical Faculty of Masaryk University, Brno, Czech Republic
(Ribichini) Division of Cardiology, Department of Medicine, University of
Verona, Verona, Italy
(Ramos) Hospital Santa Marta - Centro Hospitalar Lisboa Central, Lisbon,
Portugal
(Piroth) Hungarian Institute of Cardiology, Budapest, Hungary
(Mates) Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic
(Barbato) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University, Naples, Italy
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Clinical benefit of invasive functionally guided revascularization has
been mostly investigated and proven for percutaneous coronary
intervention. It has never been prospectively evaluated whether a
systematic fractional flow reserve (FFR) assessment is also beneficial in
guiding coronary artery bypass graft surgery (CABG). The objective of the
GRAft patency after FFR-guided versus angiography-guIded CABG (GRAFFITI)
trial was to compare an FFR-guided revascularization strategy to the
traditional angiography-guided revascularization strategy for patients
undergoing CABG. Patients were enrolled with significantly diseased left
anterior descending or left main stem and at least one major coronary
artery with angiographically intermediate stenosis (30-90% diameter
stenosis) that was assessed by FFR. Thereafter, while the FFR values were
kept concealed, cardiac surgeons decided their intended procedural
strategy based on the coronary angiography alone. At this point, patients
underwent 1:1 randomization to either an FFR-guided or an
angiography-guided CABG strategy. In case the patient was randomized to
angiography-guided arm, cardiac surgeons kept their intended procedural
strategy, i.e., CABG was guided solely on the basis of the coronary
angiography. In case the patient was randomized to the FFR-guided arm, FFR
values were disclosed to the surgeons who revised the surgical protocol
according to the functional significance of each coronary stenosis. The
primary endpoint of the trial was the rate of graft occlusion at 12
months, assessed by coronary computed tomography or coronary angiography.
The secondary endpoints were (1) length of postoperative hospital stay;
(2) changes in surgical strategy depending upon FFR results (in FFR-guided
group only); and (3) rate of major adverse cardiac and cerebrovascular
events, i.e., composite of death, myocardial infarction, stroke, and any
revascularization during the follow-up period. This study is the first
prospective randomized trial investigating potential clinical benefits,
associated with FFR-guided surgical revascularization. Trial registration:
NCT01810224.<br/>Copyright &#xa9; 2018, Springer Science+Business Media,
LLC, part of Springer Nature.

<10>
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.

<11>
Accession Number
622796865
Title
Long-term impact of chronic total occlusion recanalisation in patients
with ST-elevation myocardial infarction.
Source
Heart. 104 (17) (pp 1432-1438), 2018. Date of Publication: 01 Sep 2018.
Author
Elias J.; Van Dongen I.M.; Ramunddal T.; Laanmets P.; Eriksen E.;
Meuwissen M.; Michels H.R.; Bax M.; Ioanes D.; Suttorp M.J.; Strauss B.H.;
Barbato E.; Marques K.M.; Claessen B.E.P.M.; Hirsch A.; Van Der Schaaf
R.J.; Tijssen J.G.P.; Henriques J.P.S.; Hoebers L.P.
Institution
(Elias, Van Dongen, Claessen, Tijssen, Henriques, Hoebers) Department of
Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam
1105 AZ, Netherlands
(Ramunddal, Ioanes) Sahlgrenska University Hospital, Gothenburg, Sweden
(Laanmets) North-Estonia Medical Centre, Talinn, Estonia
(Eriksen) Haukeland University Hospital, Bergen, Norway
(Meuwissen) Department of Cardiology, Amphia Hospital, Breda, Netherlands
(Michels) Catharina Hospital, Eindhoven, Netherlands
(Bax) Department of Cardiology, Haga Teaching Hospital, The Hague,
Netherlands
(Suttorp) Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein,
Netherlands
(Strauss) Sunnybrook Health Sciences Centre, Toronto, Canada
(Barbato) Cardiovascular Center, Onze Lieve Vrouwe Ziekenhuis, Aalst,
Belgium
(Marques) VU University Medical Center, Amsterdam, Netherlands
(Hirsch) Erasmus Medical Center, Rotterdam, Netherlands
(Van Der Schaaf) Department of Cardiology, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background During primary percutaneous coronary intervention (PCI), a
concurrent chronic total occlusion (CTO) is found in 10% of patients with
ST-elevation myocardial infarction (STEMI). Long-term benefits of CTO-PCI
have been suggested; however, randomised data are lacking. Our aim was to
determine mid-term and long-term clinical outcome of CTO-PCI versus CTO-No
PCI in patients with STEMI with a concurrent CTO. Methods The Evaluating
Xience and left ventricular function in PCI on occlusiOns afteR STEMI
(EXPLORE) was a multicentre randomised trial that included 302 patients
with STEMI after successful primary PCI with a concurrent CTO. Patients
were randomised to either CTO-PCI or CTO-No PCI. The primary end point of
the current study was occurrence of major adverse cardiac events (MACE):
cardiac death, coronary artery bypass grafting and MI. Other end points
were 1-year left ventricular function (LVF); LV-ejection fraction and LV
end-diastolic volume and angina status. Results The median long-term
follow-up was 3.9 (2.1-5.0) years. MACE was not significantly different
between both arms (13.5% vs 12.3%, HR 1.03, 95% CI 0.54 to 1.98; P=0.93).
Cardiac death was more frequent in the CTO-PCI arm (6.0% vs 1.0%, P=0.02)
with no difference in all-cause mortality (12.9% vs 6.2%, HR 2.07, 95% CI
0.84 to 5.14; P=0.11). One-year LVF did not differ between both arms.
However, there were more patients with freedom of angina in the CTO-PCI
arm at 1 year (94% vs 87%, P=0.03). Conclusions In this randomised trial
involving patients with STEMI with a concurrent CTO, CTO-PCI was not
associated with a reduction in long-term MACE compared to CTO-No PCI.
One-year LVF was comparable between both treatment arms. The finding that
there were more patients with freedom of angina after CTO-PCI at 1-year
follow-up needs further investigation. Clinical trial registration EXPLORE
trial number NTR1108 www.trialregister.nl.<br/>Copyright &#xa9; Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2018. All rights reserved. No commercial use is permitted unless
otherwise expressly granted.

<12>
Accession Number
624107209
Title
Treatment of Candida sternal infection following cardiac surgery-a review
of literature.
Source
Infectious Diseases. 51 (1) (pp 1-11), 2019. Date of Publication: 02 Jan
2019.
Author
Arikan A.A.; Omay O.; Kanko M.; Horuz E.; Yagli G.; Kagan E.Y.; Agir H.
Institution
(Arikan) Department of Cardiovascular Surgery, Mus State Hospital, Mus,
Turkey
(Omay, Kanko, Yagli) Kocaeli University Medical Faculty, Department of
Cardiovascular Surgery, Kocaeli, Turkey
(Horuz) Department of Infectious Diseases and Clinical Microbiology,
Zonguldak Hospital for Obstetrics and Pediatric Diseases, Zonguldak,
Turkey
(Kagan) Department of Plastic and Reconstructive Surgery, Kocaeli
University Medical Faculty, Kocaeli, Turkey
(Agir) Department of Plastic and Reconstructive Surgery, Altunizade
Acibadem Hospital, Istanbul, Turkey
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Background:Candida sternal wound infections (SWIs) following cardiac
surgery are rare but are associated with a high mortality rate. Guidelines
on this topic either propose no suggestions for management or offer
recommendations based on a small number of reports. <br/>Method(s): This
paper presents a case of a Candida SWI and its successful treatment with
debridement using a burr, negative pressure vacuum therapy (NPVT) and
dermal grafting. To investigate different methods of treating Candida SWIs
following cardiac surgery, a review was completed using the MEDLINE
database. Reports without English abstracts and without defined outcomes
of therapy for individual patients were excluded. <br/>Result(s):
Seventy-seven cases of Candida SWIs following cardiac surgery were
identified in 20 articles published since 1999, including our case.
Treatment strategies are identified: omentum flap; muscle flap;
debridement and secondary wound healing with or without NPVT; debridement
and primary closure; incision and drainage; only medical therapy. Patients
documented in the articles were classified based on the following
outcomes: cured (n = 41 patients [including the present case]), relapse
infection (n = 25 patients) and death (n = 11 patients). The various
methods used to treat patients were analysed. <br/>Conclusion(s): Delayed
closure reoperation with surgical debridement and NPVT have favourable
outcomes. In the presence of widespread osteomyelitis, the use of omental
flaps is advocated. Treatment with muscle flaps has a high rate of
relapse. Debridement and secondary healing or conservative management with
antifungals alone can be considered in the treatment of relapsing
infection.<br/>Copyright &#xa9; 2018, &#xa9; 2018 Society for Scandinavian
Journal of Infectious Diseases.

<13>
Accession Number
626201185
Title
Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis.
Source
The New England journal of medicine. 380 (5) (pp 415-424), 2019. Date of
Publication: 31 Jan 2019.
Author
Iversen K.; Ihlemann N.; Gill S.U.; Madsen T.; Elming H.; Jensen K.T.;
Bruun N.E.; Hofsten D.E.; Fursted K.; Christensen J.J.; Schultz M.; Klein
C.F.; Fosboll E.L.; Rosenvinge F.; Schonheyder H.C.; Kober L.;
Torp-Pedersen C.; Helweg-Larsen J.; Tonder N.; Moser C.; Bundgaard H.
Institution
(Iversen, Ihlemann, Gill, Madsen, Elming, Jensen, Bruun, Hofsten, Fursted,
Christensen, Schultz, Klein, Fosboll, Rosenvinge, Schonheyder, Kober,
Torp-Pedersen, Helweg-Larsen, Tonder, Moser, Bundgaard) From the
Department of Cardiology, Herlev-Gentofte University Hospital (K.I., M.S.,
C.F.K.), Department of Cardiology, the Heart Center, Rigshospitalet,
Copenhagen University Hospital (N.I., D.E.H., E.L.F., L.K., H.B.), the
Departments of Infectious Diseases (J.H.-L.) and Clinical Microbiology
(C.M.), Rigshospitalet, the Department of Cardiology, Hillerod Hospital
(N.T.), and the Department of Clinical Microbiology, Slagelse Hospital and
Institute of Clinical Medicine (J.J.C.), University of Copenhagen,
Copenhagen, the Departments of Cardiology (S.U.G.) and Clinical
Microbiology (F.R.), Odense University Hospital, Odense, the Departments
of Cardiology (T.M.) and Cardiology and Epidemiology and Biostatistics
(C.T.-P.), Aalborg University Hospital, the Department of Clinical
Microbiology, Aalborg University Hospital, Aalborg University (H.C.S.),
and the Department of Health Science and Technology, Aalborg University
(C.T.-P.), Aalborg, the Department of Cardiology, Zealand University
Hospital, Roskilde (H.E.), the Department of Cardiology, Aarhus University
Hospital, Aarhus (K.T.J.), the Department of Cardiology, University
Hospital of Copenhagen, Gentofte (N.E.B.), and the Department of Bacteria,
Parasites and Fungi, Statens Serum Institut, Copenhagen (K.F.) - all in
Denmark
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients with infective endocarditis on the left side of the
heart are typically treated with intravenous antibiotic agents for up to 6
weeks. Whether a shift from intravenous to oral antibiotics once the
patient is in stable condition would result in efficacy and safety similar
to those with continued intravenous treatment is unknown. <br/>METHOD(S):
In a randomized, noninferiority, multicenter trial, we assigned 400 adults
in stable condition who had endocarditis on the left side of the heart
caused by streptococcus, Enterococcus faecalis, Staphylococcus aureus, or
coagulase-negative staphylococci and who were being treated with
intravenous antibiotics to continue intravenous treatment (199 patients)
or to switch to oral antibiotic treatment (201 patients). In all patients,
antibiotic treatment was administered intravenously for at least 10 days.
If feasible, patients in the orally treated group were discharged to
outpatient treatment. The primary outcome was a composite of all-cause
mortality, unplanned cardiac surgery, embolic events, or relapse of
bacteremia with the primary pathogen, from the time of randomization until
6 months after antibiotic treatment was completed. <br/>RESULT(S): After
randomization, antibiotic treatment was completed after a median of 19
days (interquartile range, 14 to 25) in the intravenously treated group
and 17 days (interquartile range, 14 to 25) in the orally treated group
(P=0.48). The primary composite outcome occurred in 24 patients (12.1%) in
the intravenously treated group and in 18 (9.0%) in the orally treated
group (between-group difference, 3.1 percentage points; 95% confidence
interval, -3.4 to 9.6; P=0.40), which met noninferiority criteria.
<br/>CONCLUSION(S): In patients with endocarditis on the left side of the
heart who were in stable condition, changing to oral antibiotic treatment
was noninferior to continued intravenous antibiotic treatment. (Funded by
the Danish Heart Foundation and others; POET ClinicalTrials.gov number,
NCT01375257 .).

<14>
Accession Number
626200702
Title
Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years.
Source
The New England journal of medicine. 380 (5) (pp 437-446), 2019. Date of
Publication: 31 Jan 2019.
Author
Taggart D.P.; Benedetto U.; Gerry S.; Altman D.G.; Gray A.M.; Lees B.;
Gaudino M.; Zamvar V.; Bochenek A.; Buxton B.; Choong C.; Clark S.; Deja
M.; Desai J.; Hasan R.; Jasinski M.; O'Keefe P.; Moraes F.; Pepper J.;
Seevanayagam S.; Sudarshan C.; Trivedi U.; Wos S.; Puskas J.; Flather M.
Institution
(Taggart, Benedetto, Gerry, Altman, Gray, Lees, Gaudino, Zamvar, Bochenek,
Buxton, Choong, Clark, Deja, Desai, Hasan, Jasinski, O'Keefe, Moraes,
Pepper, Seevanayagam, Sudarshan, Trivedi, Wos, Puskas, Flather) From the
Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T.,
B.L.), the Centre for Statistics in Medicine, Botnar Research Centre
(S.G., D.G.A.), and the Health Economics Research Centre, Nuffield
Department of Population Health (A.M.G.), University of Oxford, Oxford,
the School of Clinical Sciences, University of Bristol, and Bristol Royal
Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal
Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital,
Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman
Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's
College Hospital (J.D.), and Royal Brompton Hospital and Imperial College
London (J. Pepper), London, the Department of Cardiac Surgery, Royal
Infirmary, Manchester (R.H.), the Department of Cardiac Surgery,
University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac
Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School,
University of East Anglia, and Norfolk and Norwich University Hospital,
Norwich (M.F.) - all in the United Kingdom; the Department of
Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian
Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New
York; the Center for Cardiovascular Research and Development, American
Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical
University of Silesia (M.D., S.W.), Katowice, and the Department of
Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) -
all in Poland; the Department of Cardiac Surgery, Austin Health,
Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of
Pernambuco, Recife, Brazil (F.M.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Multiple arterial grafts may result in longer survival than
single arterial grafts after coronary-artery bypass grafting (CABG)
surgery. We evaluated the use of bilateral internal-thoracic-artery grafts
for CABG. <br/>METHOD(S): We randomly assigned patients scheduled for CABG
to undergo bilateral or single internal-thoracic-artery grafting.
Additional arterial or vein grafts were used as indicated. The primary
outcome was death from any cause at 10 years. The composite of death from
any cause, myocardial infarction, or stroke was a secondary outcome.
<br/>RESULT(S): A total of 1548 patients were randomly assigned to undergo
bilateral internal-thoracic-artery grafting (the bilateral-graft group)
and 1554 to undergo single internal-thoracic-artery grafting (the
single-graft group). In the bilateral-graft group, 13.9% of the patients
received only a single internal-thoracic-artery graft, and in the
single-graft group, 21.8% of the patients also received a radial-artery
graft. Vital status was not known for 2.3% of the patients at 10 years. In
the intention-to-treat analysis at 10 years, there were 315 deaths (20.3%
of the patients) in the bilateral-graft group and 329 deaths (21.2%) in
the single-graft group (hazard ratio, 0.96; 95% confidence interval [CI],
0.82 to 1.12; P=0.62). Regarding the composite outcome of death,
myocardial infarction, or stroke, there were 385 patients (24.9%) with an
event in the bilateral-graft group and 425 patients (27.3%) with an event
in the single-graft group (hazard ratio, 0.90; 95% CI, 0.79 to 1.03).
<br/>CONCLUSION(S): Among patients who were scheduled for CABG and had
been randomly assigned to undergo bilateral or single
internal-thoracic-artery grafting, there was no significant between-group
difference in the rate of death from any cause at 10 years in the
intention-to-treat analysis. Further studies are needed to determine
whether multiple arterial grafts provide better outcomes than a single
internal-thoracic-artery graft. (Funded by the British Heath Foundation
and others; Current Controlled Trials number, ISRCTN46552265 .).

<15>
Accession Number
624974595
Title
Immune checkpoint inhibitors in the management of malignancies in
transplant recipients.
Source
Postgraduate Medical Journal. 94 (1118) (pp 704-708), 2018. Date of
Publication: 01 Dec 2018.
Author
Regalla D.K.R.; Williams G.R.; Paluri R.K.
Institution
(Regalla) Internal Medicine, University of Alabama at Birmingham Hospital,
Birmingham, AL, United States
(Williams, Paluri) Hematology-Oncology, University of Alabama, Birmingham
Hospital, Birmingham, AL 35233, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Cancer immunotherapy, an area of active research, has thus far yielded
several exciting breakthroughs in cancer treatment strategies. So far,
immune checkpoint inhibitors have been the most promising method of cancer
immunotherapy. CTLA-4, PD-1 and PD-L1 are the immune checkpoint molecules
against which monoclonal antibodies act against and revolutionised the
treatment of several malignancies. However, it is still unclear whether
using these monoclonal antibodies in patients with malignancy and a
history of transplant is as beneficial as in patients without a history of
transplantation. The reason being, with the therapeutic benefit, also
comes the inherent disadvantage of transplant rejection because of the
activation of T-cells against donor antigens. So, transplant-related
complications limit the usage of the checkpoint blockade therapy to treat
malignancies. Here, we review the data published in this context and
suggest optimal approaches to using the currently available repertoire of
immunotherapies.<br/>Copyright &#xa9; 2019 Author(s).

<16>
Accession Number
2001156838
Title
Open-labeled randomized controlled trial to evaluate the 1-year clinical
outcomes of polymer-free sirolimus-eluting coronary stents as compared
with biodegradable polymer-based sirolimus-eluting coronary stents.
Source
Indian Heart Journal. 70 (Supplement 3) (pp S323-S328), 2018. Date of
Publication: December 2018.
Author
Viswanathan S.; Gopinath K.; Koshy G.; Gupta P.N.; Velappan P.
Institution
(Viswanathan, Gopinath, Koshy, Gupta, Velappan) Department of Cardiology,
Government Medical College and Hospital, Thiruvananthapuram, Kerala
695011, India
Publisher
Elsevier B.V.
Abstract
Background: Head to head trials of clinical outcomes of sirolimus eluting
polymer free vs. biodegradable polymer stents are lacking. <br/>Method(s):
Single centre prospective open labeled randomised controlled clinical
trial. Basis for sample size calculation was the rate of MACE from the
ISAR TEST 3 trial in which the absolute difference was 10.25% with a
standard deviation of 0.24. Assuming null hypothesis, 80% power and 5%
alpha error, to detect a 10% difference, adjusting for 10% loss of follow
up, sample size was 204. Inclusion criteria: Patients with stable coronary
artery disease or recent acute coronary syndrome (>1 week from the date of
STEMI), being taken up for elective angioplasty. End points: Primary end
point was MACE at 1 year and secondary end points at the end of 1 year
were cardiac death, urgent target lesion revascularization, acute coronary
syndrome, stroke and in-stent re-stenosis. <br/>Result(s): 204 patients
were enrolled between January 2013 to July 2014, 91 in the polymer-free
group and 113 in the biodegradable polymer group. Baseline characteristics
were comparable between both groups. 21 patients (10.29%), were lost to
follow up. MACE at 1 year were comparable in both the groups 3 of
85(3.52%) in the polymer-free group and 3 of 98(3.06%) in the
biodegradable polymer group, p = 0.859. The secondary end points were also
comparable between the two groups- Death- 1 of 85(1.17%) vs. 2 of
98(2.04%), p = 0.646, Stroke 0 of 85 vs. 2 of 98(2.04%), p = 0.185 and
acute coronary syndrome - 2 of 85(2.35%) vs. 1 of 98(1.02%), p = 0.204.
There were no instances of urgent target lesion re-vascularisation or
definite stent thrombosis in either groups. In stent re-stenosis was found
in 7 of 85(8.2%) in the polymer-free group vs. 6 of 98(6.12%) in the
biodegradable polymer group. <br/>Conclusion(s): The 1 year MACE rates are
comparable in patients who underwent elective coronary revascularization
using sirolimus eluting polymer-free and biodegradable polymer
stents.<br/>Copyright &#xa9; 2018 Cardiological Society of India

<17>
Accession Number
2001385418
Title
Acute Cellular Rejection and Infection Rates in Alemtuzumab vs Traditional
Induction Therapy Agents for Lung and Heart Transplantation: A Systematic
Review and Meta-analysis.
Source
Transplantation Proceedings. 50 (10) (pp 3739-3747), 2018. Date of
Publication: December 2018.
Author
Li K.H.C.; Ho J.C.S.; Recaldin B.; Gong M.; Ho J.; Li G.; Liu T.; Wu
W.K.K.; Wong M.C.S.; Xia Y.; Dong M.; Tse G.
Institution
(Li, Recaldin) Faculty of Medicine, Newcastle University, United Kingdom
(Li, Ho, Tse) Department of Medicine and Therapeutics, Faculty of
Medicine, Chinese University of Hong Kong, Hong Kong, Hong Kong
(Li, Tse) Li Ka Shing Institute of Health Sciences, Faculty of Medicine,
Chinese University of Hong Kong, Hong Kong, Hong Kong
(Gong, Li, Liu) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Ho) Department of Anesthesia and Intensive Care, Faculty of Medicine, The
Chinese University of Hong Kong, Shatin, Hong Kong, Hong Kong
(Wu, Wong) The Jockey Club School of Public Health and Primary Care,
Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong
Kong
(Xia) Department of Cardiology, First Affiliated Hospital of Dalian
Medical University, Dalian, China
(Dong) Department of Cardiology, Yantai Yuhuangding Hospital Affiliated to
Qingdao University, Yantai, Shandong Province, China
Publisher
Elsevier USA
Abstract
Background and objectives: Heart and lung transplantation is a high-risk
procedure, requiring intensive immunosuppressive therapy for preventing
organ rejection. Alemtuzumab, a CD52-specific monoclonal antibody, is
increasingly used for induction therapy compared with conventional agents.
However, there has been no systematic review comparing its efficacy with
traditional therapeutic drugs. <br/>Method(s): PubMed and EMBASE were
searched to October 1, 2017, for articles on alemtuzumab in cardiothoracic
transplant surgery. Of the 433 studies retrieved, 8 were included in the
final meta-analysis. <br/>Result(s): In lung transplantation, alemtuzumab
use was associated with lower odds of acute cellular rejection compared
with antithymocyte globulin (odds ratio [OR], 0.21; 95% CI, 0.11-0.40; P
<.001), lower acute rejection rates (OR, 0.12; 95% CI, 0.03-0.55; P <.01),
and lower infection rates (OR, 0.69; 95% CI, 0.35-1.36; P =.33) when
compared with basiliximab. Multivariate meta-regression analysis found
that mean age, male sex, single lung transplant, double lung transplant,
cytomegalovirus or Epstein-Barr virus status, idiopathic pulmonary
fibrosis, cystic fibrosis, and mean ischemic time did not significantly
influence acute rejection outcomes. For heart transplantation, alemtuzumab
use was associated with lower acute rejection rates when compared with
tacrolimus (OR, 0.44; 95% CI, 0.30-0.66; P <.001). <br/>Conclusion(s):
Alemtuzumab use was associated with lower rejection rates when compared
with conventional induction therapy agents (antithymocyte globulin,
basiliximab, and tacrolimus) in heart and lung transplantation. However,
this was based on observational studies. Randomized controlled trials are
needed to verify its clinical use.<br/>Copyright &#xa9; 2018

<18>
Accession Number
619950441
Title
The impact of maintaining serum potassium >=3.6 mEq/L vs >=4.5 mEq/L on
the incidence of new-onset atrial fibrillation in the first 120 hours
after isolated elective coronary artery bypass grafting - study protocol
for a randomised feasibility trial for the proposed Tight K randomized
non-inferiority trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 618. Date of
Publication: 28 Dec 2017.
Author
Campbell N.G.; Allen E.; Sanders J.; Swinson R.; Birch S.; Sturgess J.;
Al-Subaie N.; Elbourne D.; Montgomery H.; O'Brien B.
Institution
(Campbell) Manchester University Foundation NHS Trust, Department of
Cardiology, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT,
United Kingdom
(Allen, Swinson, Sturgess, Elbourne) London School of Hygiene and Tropical
Medicine, Clinical Trials Unit, Keppel Street, London WC1E 7HT, United
Kingdom
(Sanders, Birch, O'Brien) St Bartholomew's Hospital, Barts Health NHS
Trust, Barts Heart Centre, West Smithfield, London EC1A 7BE, United
Kingdom
(Al-Subaie) St George's Hospital, Cardiothoracic Intensive Care Unit,
Blackshaw Road, Tooting, London SW17 0QT, United Kingdom
(Montgomery) UCL Division of Medicine, and Institute for Sport, Exercise
and Health, 1st floor, 170 Tottenham Court Road, London W1T 7HA, United
Kingdom
(Sanders, O'Brien) Queen Mary University of London, William Harvey
Research Institute, Charterhouse Square, London EC1M 6BQ, United Kingdom
(O'Brien) Outcomes Research Consortium, Cleveland, OH, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Atrial fibrillation (AF) occurs in approximately one in three
patients after cardiac surgery, and is associated with increased
short-term and long-term mortality, intensive care unit (ICU) and hospital
stay, and increased cost of care. In an attempt to reduce AF incidence in
these patients, serum potassium (K+) levels are commonly maintained at the
high end of normal (4.5-5.5 mEq/L). However, such potassium
supplementation is without proven benefit, and is not without negative
consequences. It carries clinical risk, negatively impacts patient
experience and is both time-consuming and costly. This protocol describes
a randomised controlled pilot trial to assess the feasibility of a
proposed randomised non-inferiority trial to investigate the impact of
maintaining serum potassium >= 3.6 mEq/L vs >= 4.5 mEq/L on the incidence
of new-onset atrial fibrillation in the first 120 hours after isolated
elective coronary artery bypass grafting. <br/>Method(s): Design: this is
a randomized feasibility trial as a pilot for a randomized non-inferiority
trial. <br/>Participant(s): are 160 patients undergoing isolated coronary
artery bypass grafting at two centres. Allocation: patients will be
randomized (1:1) to protocols aiming to maintain serum potassium at either
>= 3.6 mEq/L ("relaxed control") or >= 4.5 mEq/L ("tight control").
Primary analytic aim: was to assess the feasibility and acceptability of
planning and delivering the intervention and trial methods to inform a
full-scale non-inferiority trial. <br/>Outcome(s): the primary indicative
efficacy outcome measures being field-tested are feasibility of
participant recruitment and randomization, maintaining a protocol
violation rate < 10%, and retaining 90% patient follow up 28 days after
surgery. The primary clinical outcome measure of the future full "Tight K
Study" will be incidence of AF after cardiac surgery. <br/>Discussion(s):
The Tight K Pilot will assess the feasibility of conducting the full
trial, which is intended to confirm or refute the efficacy of current
potassium management in preventing AF after cardiac surgery. Trial
registration: ClinicalTrials.gov, NCT03195647. Registered on 23 May 2017.
Last updated 19June 2017.<br/>Copyright &#xa9; 2017 The Author(s).

<19>
Accession Number
626322636
Title
Updates on Minimally Invasive Surgery in Non-Small Cell Lung Cancer.
Source
Current treatment options in oncology. 20 (2) (pp 16), 2019. Date of
Publication: 11 Feb 2019.
Author
Ikeda N.
Institution
(Ikeda) Department of Thoracic Surgery, Tokyo Medical University, 6-7-1
Nishishinjuku ,Shinjuku-ku, Tokyo 160-0023, Japan
Publisher
NLM (Medline)
Abstract
OPINION STATEMENT: Video-assisted thoracic surgery (VATS) has become
widely used since the 1990s and has become a standard treatment approach
mainly for early-stage non-small cell lung cancer. The few randomized
controlled trials providing evidence of the effectiveness of VATS
lobectomy at present are supported by a large number of propensity-matched
studies, several high-quality meta-analyses, and outcome studies. These
studies provide comprehensive data demonstrating the lower morbidity,
shorter chest tube duration, and shorter hospital stay of VATS than
thoracotomy during the postoperative course. Moreover, VATS shows
equivalent oncological outcome as thoracotomy and therefore should be
performed for lobectomy as much as possible. Importantly, VATS has
recently been applied to advanced cases and previously contraindicated
complex procedures such as bronchoplasty and chest wall resection.
Attention has also been paid to reduced port surgery performed by frontier
surgeons. Thus, the indications of VATS have seen a significant expansion.
This major development logically negates any hesitation to change to the
VATS technique as any doubt will likely constrain its wider applications.
Preparation of scientific learning environments is necessary and should be
actively pursued to adopt new skills instead of debating between the
choice of "VATS or open."

<20>
Accession Number
626303803
Title
A prospective randomized controlled double-blind study comparing
auscultation and lung ultrasonography in the assessment of double lumen
tube position in elective thoracic surgeries involving one lung
ventilation at a tertiary care cancer institute.
Source
Korean journal of anesthesiology. 72 (1) (pp 24-31), 2019. Date of
Publication: 01 Feb 2019.
Author
Parab S.Y.; Kumar P.; Divatia J.V.; Sharma K.
Institution
(Parab, Kumar, Divatia, Sharma) Department of Anesthesiology, Critical
Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute,
Mumbai, India
Publisher
NLM (Medline)
Abstract
BACKGROUND: As lung ultrasound (LUS) can be used to identify regional lung
ventilation and collapse, we hypothesize that LUS can be better than
auscultation in assessing lung isolation and determining double lumen tube
(DLT) position. <br/>METHOD(S): A randomized controlled study was
conducted in tertiary care cancer institute from November 2014 to December
2015, including 100 adult patients undergoing elective thoracic surgeries.
Patients with tracheostomy, difficult airway and pleural-based pathologies
were excluded. After anesthesia induction and DLT insertion, patients were
randomized into group A (auscultation) and group B (LUS). Regional
ventilation was assessed by experienced anesthesiologists using the
respective method for each group. Final confirmation of DLT position with
a bronchoscope was performed by a blinded anesthesiologist. Contingency
tables were plotted to determine sensitivity, specificity, positive
predictive value (PPV), negative predictive value (NPV), and accuracy for
each method. <br/>RESULT(S): Data from 91 patients were analyzed (group A
= 47, group B = 44). Compared with auscultation, LUS had significantly
higher sensitivity (94.1% vs. 73.3%, P = 0.010), PPV (57.1% vs. 35.5%, P =
0.044), NPV (93.8% vs. 75.0%, P = 0.018), accuracy (70.5% vs. 48.9%, P =
0.036) and required longer median time (161.5 vs. 114 s, P < 0.001) for
assessment of DLT position. Differences in specificity (55.6% vs. 37.5%, P
= 0.101) and area under curve (0.748; 95% CI: 0.604-0.893 vs. 0.554, 95%
CI: 0.379-0.730; P = 0.109) were not significant. <br/>CONCLUSION(S):
Compared to auscultation, LUS is a superior method for assessing lung
isolation and determining DLT position.

<21>
Accession Number
626303642
Title
Comparison of displacement of polyvinyl chloride and silicone leftsided
double-lumen tubes during lateral positioning.
Source
Korean journal of anesthesiology. 72 (1) (pp 32-38), 2019. Date of
Publication: 01 Feb 2019.
Author
Kwon N.K.; Jung S.M.; Park S.-J.; Han Y.
Institution
(Kwon, Jung, Park, Han) Department of Anesthesiology and Pain Medicine,
Yeungnam University School of Medicine, Daegu, South Korea
Publisher
NLM (Medline)
Abstract
BACKGROUND: Compared to an equivalent sized polyvinyl chloride (PVC)
double-lumen tube (DLT), a silicone DLT has a shorter endobronchial
segment. The aim of this study was to compare the incidence of clinically
significant displacement of left-sided PVC and silicone DLTs after a
positional change to a lateral position from a supine position and
determine its effect on the need for DLT repositioning for successful lung
separation in patients undergoing thoracic surgery. <br/>METHOD(S): One
hundred eight adult patients requiring one-lung ventilation were randomly
divided into group P (PVC DLT, n = 54) and group S (Silicone DLT, n = 54).
The position of the DLT was observed before and after lateral positioning
to assess the effect of the position change. The incidence of clinically
significant displacement (> 10 mm) of DLT was compared between the groups.
<br/>RESULT(S): DLTs were clinically significantly displaced in group P
(17/48, 35.4%) and group S (18/52, 34.6%) after lateral positioning (P =
0.933). A proximal displacement (31.3% [group P] and 25.0% [group S]) was
more common than distal displacement (4.2% [group P] and 9.6% [group S]),
with no significant intergroup difference (P = 0.494). After lateral
positioning, critical malposition of DLT with bronchial herniation to the
right main bronchus was 8.3% (group P) and 7.9% (group S, P = 0.906).
<br/>CONCLUSION(S): Left-sided PVC and silicone DLTs produced comparable
incidences of clinically significant displacement and, consequently,
required similar rates of repositioning for successful lung separation
after lateral positioning.

<22>
[Use Link to view the full text]
Accession Number
626305275
Title
Postoperative outcomes of patients with chronic obstructive pulmonary
disease undergoing coronary artery bypass grafting surgery: A
meta-analysis.
Source
Medicine. 98 (6) (pp e14388), 2019. Date of Publication: 01 Feb 2019.
Author
Zhao H.; Li L.; Yang G.; Gong J.; Ye L.; Zhi S.; Zhang X.; Li J.
Institution
(Zhao, Li, Yang, Gong, Ye, Zhi, Li) Department of Respiratory Medicine,
Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
(Zhang) Department of Plastic Surgery, Plastic Surgery Hospital, Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing,
China
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a frequent
comorbid disease in patients undergoing coronary artery bypass grafting
(CABG) surgery, with an incidence ranging from 4% to 20.5%.
Conventionally, COPD was recognized as a surgical contraindication to
CABG. Because of the recent improvements in surgical techniques,
anesthesia, and postoperative management, CABG has been performed more
commonly in patients with COPD. However, studies have shown the various
effects of COPD on postoperative morbidity and mortality after CABG, and
this remains to be well defined. <br/>OBJECTIVE(S): To compare the
postoperative outcomes after CABG between patients with and those without
COPD. <br/>METHOD(S): A systematic search was conducted in the Cochrane
Library, PubMed, EmBase, and Ovid databases (until May 10, 2018). Studies
comparing perioperative results and mortality outcomes after CABG between
patients with and those without COPD were evaluated independently by 2
reviewers to identify the potentially eligible studies. Review Manager and
STATA software were used for statistical analyses. <br/>RESULT(S): No
significant difference in the mortality rates were found between patients
with and those without COPD. COPD was associated with a higher respiratory
failure rate (odds ratio [OR] = 4.01; 95% CI: 1.19-13.51, P = .03; P <.001
for heterogeneity), higher pneumonia rate (OR = 2.92; 95% CI: 2.37-3.60, P
<.00001; P = .73 for heterogeneity), higher stroke rate (OR = 2.91; 95%
CI: 1.37-6.18, P = .005; P = .60 for heterogeneity), higher renal failure
rate (OR = 1.60; 95% CI: 1.30-1.97, P <.00001; P = .19 for heterogeneity),
and higher wound infection rate (OR = 2.16; 95% CI: 1.21-3.88, P = .01; P
= .53 for heterogeneity) after CABG. <br/>CONCLUSION(S): Patients with
COPD were at higher risks for developing postoperative morbidities,
particularly pneumonia, respiratory failure, stroke, renal failure, and
wound infection. Although COPD was not associated with a higher risk of
mortality, caution should be taken when a patient with COPD is indicated
for CABG, considering the higher odds of postoperative complications
involving the respiratory system and others.

<23>
Accession Number
626235830
Title
Frailty in patients undergoing transcatheter aortic valve implantation: A
protocol for a systematic review.
Source
BMJ Open. 9 (2) (no pagination), 2019. Article Number: e024163. Date of
Publication: 01 Feb 2019.
Author
Li Z.; Dawson E.; Moodie J.; Martin J.; Bagur R.; Cheng D.; Kiaii B.;
John-Baptiste A.
Institution
(Li, Martin, Bagur, John-Baptiste) Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
(Li, Dawson, Moodie, Martin, Cheng, John-Baptiste) Centre for Medical
Evidence, Decision Integrity and Clinical Impact (MEDICI), Western
University, London, ON, Canada
(Li, Dawson, Moodie, Martin, Cheng, John-Baptiste) Department of
Anesthesia and Perioperative Medicine, Western University, London, ON,
Canada
(Li, Martin, Bagur, Cheng, Kiaii, John-Baptiste) Schulich School of
Medicine and Dentistry, Western University, London, ON, Canada
(Bagur) Division of Cardiology, Department of Medicine, Western
University, London, ON, Canada
(Cheng) Division of Critical Care Medicine, Department of Medicine,
Western University, London, ON, Canada
(Kiaii) Division of Cardiac Surgery, Department of Surgery, Western
University, London, ON, Canada
(John-Baptiste) Interfaculty Program in Public Health, Western University,
London, ON, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Aortic stenosis is a significant cause of morbidity and
mortality in older patients. The advent of transcatheter aortic valve
implantation (TAVI) offers an alternative to surgical aortic valve
replacement for patients with severe symptomatic aortic stenosis who are
at high or intermediate risk of adverse events. Existing evidence
highlights the importance of frailty as a predictor of poor outcomes
post-TAVI. The objective of this study is to review the operationalisation
of frailty instruments for TAVI recipients and determine clinical outcomes
and the change in quality of life in frail patients undergoing TAVI.
Methods and analysis Methods are reported according to the Preferred
Reporting Items for Systematic Review and Meta-Analysis Protocols 2015
checklist. We will search relevant databases to identify published,
completed but unpublished and ongoing studies. We will include studies of
patients with aortic stenosis, diagnosed as frail and who underwent a TAVI
procedure that report mortality, clinical outcomes or health-related
quality of life. Retrospective or prospective cohort studies, randomised
controlled trials and non-randomised controlled trials will be eligible
for inclusion. Two researchers will independently screen articles for
inclusion, with disagreements resolved by a third reviewer. One researcher
will extract data with audit by a second researcher. The risk of bias in
studies will be evaluated using the Quality in Prognosis Studies tool.
Meta-Analysis of mortality, survival curve and the change in quality of
life will be performed if appropriate. Subgroup analysis, sensitivity
analysis and meta-regression will be performed if necessary. Ethics and
dissemination Due to the nature of this study, no ethical issues are
foreseen. We will disseminate the results of our systematic review through
a peer-reviewed journal. Trial registration number
CRD42018090597.<br/>Copyright &#xa9; Author(s) (or their employer(s))
2019.

<24>
Accession Number
626235807
Title
Improving neurodevelopmental outcomes in children with congenital heart
disease: Protocol for a randomised controlled trial of working memory
training.
Source
BMJ Open. 9 (2) (no pagination), 2019. Article Number: e023304. Date of
Publication: 01 Feb 2019.
Author
Calderon J.; Bellinger D.C.; Hartigan C.; Lord A.; Stopp C.; Wypij D.;
Newburger J.W.
Institution
(Calderon) Boston Children's Hospital, Department of Psychiatry, Boston,
MA, United States
(Calderon, Bellinger) Department of Psychiatry, Harvard Medical School,
Boston, MA, United States
(Hartigan, Lord, Stopp, Wypij, Newburger) Department of Cardiology, Boston
Children's Hospital, Boston, MA, United States
(Wypij) Department of Biostatistics, Harvard T.H. Chan School of Public
Health, Boston, MA, United States
(Newburger) Department of Pediatrics, Harvard Medical School, Boston, MA,
United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Executive function (EF) impairments are among the most
prevalent neurodevelopmental morbidities in youth with congenital heart
disease (CHD). To date, no studies have investigated the efficacy of
cognitive interventions to improve EF outcomes in children with CHD.
Methods and analysis This is a single-centre, single-blinded, two-Arm
randomised controlled trial to test the efficacy of Cogmed Working Memory
Training (Cogmed) versus standard of care in children with CHD after
open-heart surgery in infancy. Participants will consist of 100 children
with CHD aged 7-12 years who underwent open-heart surgery before the age
of 12 months. Participants are randomly allocated to either an
intervention group including training on the home-based Cogmed
intervention for a duration of approximately 5 weeks or a control group
who receive the standard of care. We will evaluate the efficacy of Cogmed
at post-Treatment and 3 months after completion of the intervention.
Baseline, post-Treatment and 3-month follow-up assessments will include
specific measures of EF, cognitive and social functioning, and attention
deficit hyperactivity disorder (ADHD) symptoms. The primary outcome of
this study is the change in standardised mean score on the List Sorting
Working Memory test from the National Institutes of Health Toolbox for the
Assessment of Neurological and Behavioral Function. Secondary outcomes
include measures of social skills, inhibitory control, cognitive
flexibility and behavioural EF as well as ADHD symptoms as measured by the
Behavior Rating Inventory of Executive Function, Second Edition, and the
Conners Third Edition. The efficacy of the intervention will be evaluated
by comparing within-subject differences (baseline to post-Treatment,
baseline to 3-month follow-up) between the two groups using an
intention-To-Treat analysis. Ethics and dissemination This study has
received Institutional Review Board (IRB) approval from Boston's
Children's Hospital IRB (P00022440) and the Human Protection Agency from
the US Department of Defense. Trial registration number NCT03023644;
Pre-results.<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2019.

<25>
Accession Number
626312121
Title
Percutaneous treatment of saphenous vein graft aneurysm: Contemporary
procedural considerations.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2019.
Date of Publication: 2019.
Author
Khan A.; Brienesse S.; Boyle A.; Collins N.
Institution
(Khan, Brienesse, Boyle, Collins) Cardiovascular Department, John Hunter
Hospital, Newcastle, Australia
(Khan, Brienesse, Boyle) School of Medicine and Public Health, The
University of Newcastle, Newcastle, Australia
(Khan, Boyle) Cardiovascular Research Program, Hunter Medical Research
Institute, Newcastle, Australia
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
While coronary artery bypass grafting remains an essential component of
revascularization therapy, the use of venous conduits in the form of
saphenous vein grafts is associated with a number of late sequelae,
including graft stenosis and occlusion. The recognition of saphenous vein
graft aneurysm, typically a late complication, may be associated with
adverse outcomes. We describe the percutaneous therapy of saphenous vein
graft aneurysm, utilizing contemporary devices, including newer generation
covered stents, and the use of devices more commonly used in peripheral
vascular intervention, reflecting the dilated nature of vein grafts.
Saphenous vein graft aneurysm can be successfully treated with
percutaneous therapy, avoiding the risk of repeat sternotomy and
associated morbidity. The use of new generation covered stents has not
been previously well reported; however, it may have an important role in
the treatment of coronary artery and saphenous vein graft aneurysm.
Awareness of the role of covered stents used in both coronary and
peripheral intervention and the advantages of new generation devices are
essential to allow optimal therapy of this uncommon, late complication.
The role and potential benefits of new generation covered stents are
discussed with a review of the existing literature.<br/>Copyright &#xa9;
2019 Wiley Periodicals, Inc.

<26>
Accession Number
626310170
Title
Transcatheter aortic valve replacement for pure aortic valve
regurgitation: "on-label" versus "off-label" use of TAVR devices.
Source
Clinical Research in Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Wernly B.; Eder S.; Navarese E.P.; Kretzschmar D.; Franz M.; Alushi B.;
Beckhoff F.; Jung C.; Lichtenauer M.; Datz C.; Schulze P.C.; Landmesser
U.; Hoppe U.C.; Falk V.; Lauten A.
Institution
(Wernly, Lichtenauer, Hoppe) Department of Cardiology, Clinic of Internal
Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
(Eder, Datz) Department of Internal Medicine, Hospital Oberndorf, Teaching
Hospital of Paracelsus Medical University Salzburg, Oberndorf, Austria
(Navarese) Interventional Cardiology and Cardiovascular Medicine Research,
Inova Center for Thrombosis Research and Drug Development, Inova Heart and
Vascular Institute, Falls Church, VA, United States
(Navarese) SIRIO MEDICINE Network, Evidence-Based Section, Falls Church,
VA, United States
(Navarese) Cardiovascular Institute, Ludwik Rydygier Collegium Medicum,
Nicolaus Copernicus University, Bydgoszcz, Poland
(Kretzschmar, Franz, Schulze) Department of Cardiology, Clinic of Internal
Medicine I, Universitaetsherzzentrum Thuringen, Friedrich Schiller
University Jena, Jena, Germany
(Alushi, Beckhoff, Landmesser, Lauten) Department of Cardiology,
University Heart Center Berlin and Charite University Medicine Berlin,
Campus Benjamin-Franklin, Berlin, Germany
(Alushi, Beckhoff, Landmesser, Lauten) German Center for Cardiovascular
Research (DZHK), Site Berlin, Berlin, Germany
(Jung) Division of Cardiology, Pulmonology, and Vascular Medicine, Medical
Faculty, University Duesseldorf, Dusseldorf, Germany
(Landmesser) Berlin Institute of Health (BIH), Berlin, Germany
(Falk) Department of Cardiovascular Surgery, Charite Berlin, Berlin,
Germany
(Falk) Department of Cardiothoracic and Vascular Surgery, German Heart
Center Berlin, Berlin, Germany
(Falk) Department of Health Sciences and Technology, ETH Zurich, Zurich,
Switzerland
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) has become the
mainstay of treatment for aortic stenosis in patients with high surgical
risk. Pure aortic regurgitation (PAR) is considered a relative
contraindication for TAVR; however, TAVR is increasingly performed in PAR
patients with unfavorable risk profile. Herein, we aim to summarize
available data on TAVR for PAR with special emphasis on "on-label" versus
"off-label" TAVR devices. <br/>Methods and Results: Pubmed was searched
for studies of patients undergoing TAVR for PAR. Primary outcome was 30
day-mortality. Pooled estimated event rates were calculated. Twelve
studies including a total of 640 patients were identified until December
2017. Among these, 208 (33%) patients were treated with devices with
CE-mark approval for PAR ("on-label"; JenaValve and J valve). Overall, the
procedural success rate was 89.9% (95% CI 81.1-96.1%; I² 80%).
Major bleeding was reported in 6.4% (95% CI 2.9-10.8%; I² 48%).
All-cause mortality at 30 days was 10.4% (95% CI 7.1-14.2%; I²
20%). Stroke occurred in 2.2% (95% CI 0.9-3.9%; I² 0%). A
permanent pacemaker was required in 10.7% (95% CI 7.3-14.6%; I²
23%). At 30 days after TAVR, >= moderate AR post-interventional was
observed in 11.5% (95% CI 2.9-23.6%; I² 90%). In the
"on-label"-group, success rate was 93.0% (95% CI 85.9-98.1%; I²
52%). 30-day-mortality was 9.1% (95% CI 3.7-16.0%; I² 36%).
More than trace AR was present in 2.8% (95% CI 0.1-7.6%; I²
0%). Compared to first-generation devices, second-generation devices were
associated with significantly lower 30-day-mortality (r = - 0.10; p =
0.02), and significantly higher procedural success rates (r = 0.28; p <
0.001). Compared to other second-generation devices, the use of J valve or
JenaValve was not associated with altered mortality (r = 0.04; p = 0.50),
rates of > trace residual AR (r = - 0.05; p = 0.65) but with a
significantly higher procedural success (r = 0.15; p = 0.042).
<br/>Conclusion(s): Based on this summary of available observational data
TAVR for PAR is feasible and safe in patients deemed inoperable.
First-generation TAVR devices are associated with inferior outcome and
should be avoided. The "on-label" use of PAR-certified TAVR devices is
associated with a significantly higher procedural success rate and might
be favorable compared to other second-generation devices.<br/>Copyright
&#xa9; 2019, Springer-Verlag GmbH Germany, part of Springer Nature.

<27>
Accession Number
622247456
Title
Dexmedetomidine improves the outcomes in paediatric cardiac surgery: A
meta-analysis of randomized controlled trials.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (5) (pp 852-858),
2018. Date of Publication: 01 May 2018.
Author
Liu Y.; Bian W.; Liu P.; Zang X.; Gu X.; Chen W.
Institution
(Liu, Bian, Liu, Zang, Gu, Chen) Department of Intensive Care Unit,
Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road,
Haidian District, Beijing 100038, China
Publisher
Oxford University Press
Abstract
OBJECTIVES Dexmedetomidine has been shown to decrease cardiac
complications in adults undergoing cardiac surgery. Results from clinical
trials of dexmedetomidine on outcomes following paediatric cardiac surgery
are controversial. METHODS We searched EMBASE, PubMed and Cochrane CENTRAL
databases for randomized controlled trials comparing the effect of
dexmedetomidine versus placebo or other anaesthetic drugs in paediatric
patients undergoing cardiac surgery. The primary outcome was the duration
of mechanical ventilation. The secondary outcomes were intensive care unit
stay, hospital length of stay (LOS), incidence of junctional ectopic
tachycardia and postoperative deaths. RESULTS Nine trials with a total of
837 patients were selected. Compared with controls, dexmedetomidine
significantly reduced the postoperative duration of mechanical ventilation
[in hours; n = 837; weighted mean difference-2.20, 95% confidence interval
(CI)-3.51 to-0.90; P = 0.001; I 2 = 97%], intensive care unit LOS (in
days; n = 737; weighted mean difference-0.47, 95% CI-0.90 to-0.03; P =
0.03; I 2 = 97%) and hospital LOS (in days; n = 291; weighted mean
difference-1.80, 95% CI-3.36 to-0.25; P = 0.02; I 2 = 96%).
Dexmedetomidine also significantly reduced the incidence of postoperative
junctional ectopic tachycardia (21/292 vs 50/263; risk ratio 0.40, 95% CI
0.25-0.64; P = 0.0001; I 2 = 0.0%), but there was no difference between
groups in postoperative deaths (4/182 vs 6/153; odds ratio 0.54, 95% CI
0.15-1.93; P = 0.34; I 2 = 0.0%). CONCLUSIONS Perioperative administration
of dexmedetomidine to paediatric patients undergoing cardiac surgery may
shorten the duration of mechanical ventilation, LOS in the intensive care
unit and in the hospital and reduce the incidence of junctional ectopic
tachycardia. More high-quality randomized controlled trials are encouraged
to verify the beneficial effect of dexmedetomidine before its clinical
application in paediatric patients undergoing surgery for congenital heart
disease.<br/>Copyright &#xa9; 2018 The Author.

<28>
Accession Number
622247434
Title
Comparison of right ventricular function after ministernotomy and full
sternotomy aortic valve replacement: A randomized study.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (5) (pp 790-797),
2018. Date of Publication: 01 May 2018.
Author
Dalen M.; Da Silva C.O.; Sartipy U.; Winter R.; Franco-Cereceda A.;
Barimani J.; Back M.; Svenarud P.
Institution
(Dalen, Sartipy, Franco-Cereceda, Svenarud) Department of Cardiac Surgery,
Karolinska University Hospital, Stockholm 17176, Sweden
(Dalen, Sartipy, Franco-Cereceda, Svenarud) Department of Molecular
Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
(Da Silva, Winter, Barimani, Back) Department of Cardiology, Karolinska
University Hospital, Stockholm, Sweden
(Back) Department of Medicine, Karolinska Institutet, Stockholm, Sweden
Publisher
Oxford University Press
Abstract
OBJECTIVES Right ventricular (RV) function is impaired after cardiac
surgery, possibly because of the opening of the pericardium. In minimally
invasive aortic valve replacement, the pericardium is only partially
incised. METHODS A randomized trial compared RV function after
ministernotomy versus full sternotomy in 40 adults undergoing aortic valve
replacement at the Karolinska University Hospital. Primary outcomes were
tricuspid annular plane systolic excursion, RV pulsed-wave tissue Doppler
velocity, RV fractional area change and basal and mid-RV transversal
diameters on postoperative Days 4 and 40. RESULTS On postoperative Day 4,
the tricuspid annular plane systolic excursion had decreased in both
groups [ministernotomy: median (Q1-Q3) 25 (21-28) vs 16 (11-18), P <
0.001; sternotomy: 22.5 (22-22.5) vs 8 (7-12) mm, P < 0.001] but was
higher in the ministernotomy group (P < 0.001). Pulsed-wave tissue Doppler
RV velocity decreased significantly in patients who underwent sternotomy
[10.5 (10-12) vs 6.5 (5-8) cm/s, P < 0.001] but did not decrease
significantly in patients who underwent ministernotomy [11.5 (11-12) vs 10
(9-11) cm/s, P = 0.054]. Fractional area change was equally decreased in
both groups [ministernotomy: 46 (39-51) vs 38 (34-44)%, P < 0.001;
sternotomy: 45 (40-49) vs 37 (25-39.5)%, P = 0.003]. RV dimensions did not
change on postoperative Day 4 in both groups. The differences between the
2 groups were similar 40 days postoperatively. CONCLUSIONS RV long-axis
function was reduced after both ministernotomy and full sternotomy aortic
valve replacement, but the reduction was more pronounced in the full
sternotomy group. Global RV function was equally impaired in both groups
postoperatively. Clinical trial registration
http://www.clinicaltrials.gov. Unique identifier:
NCT01972555.<br/>Copyright &#xa9; 2018 The Author.

<29>
Accession Number
623687180
Title
Perioperative diltiazem or nitroglycerin in on-pump coronary artery
bypass: A systematic review and network meta-analysis.
Source
PLoS ONE. 13 (8) (no pagination), 2018. Article Number: e0203315. Date of
Publication: August 2018.
Author
Hu Y.; Yang X.; Zhang L.; Wu X.; Liu A.Y.; Boscarino J.A.; Kirchner H.L.;
Casale A.S.; Zhang X.
Institution
(Hu, Yang, Kirchner) Biomedical and Translational Informatics, Geisinger
Medical Center, Danville, PA, United States
(Zhang, Wu, Zhang) Division of Anesthesiology, Geisinger Medical Center,
Danville, PA, United States
(Liu) Department of Cell and Systems Biology, University of Toronto,
Toronto, Canada
(Boscarino) Department of Epidemiology and Health Services Research,
Geisinger Medical Center, Danville, PA, United States
(Casale) Geisinger Heart Institute, Geisinger Wyoming Valley Medical
Center, Wilkes Barre, PA, United States
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Arterial graft spasm is a severe complication after coronary
artery bypass graft (CABG). Among numerous potential antispasmodic agents,
systemic application of diltiazem and nitroglycerin had been investigated
most frequently over the past three decades. However, it remains
inconclusive if either or both agents could improve patient outcomes by
preventing graft spasm when applied perioperatively, and, if so, which one
would be a better choice. The current systematic review and network
meta-analysis aims to summarize the data from all available randomized
clinical trials of perioperative continuous intravenous infusion of
diltiazem and/or nitroglycerin in patients undergoing on-pump CABG in
order to define and compare their roles in graft spasm prevention and
their impacts on perioperative outcomes. Methods We searched Ovid Medline,
PubMed, CINAHL, Google Scholar and Cochrane Center for randomized
controlled trials that reported outcome effects of perioperative
continuous intravenous infusion of diltiazem and/or nitroglycerin in
patients undergoing elective on-pump CABG. Conventional meta-analyses were
conducted to evaluate the pairwise comparisons (diltiazem vs. placebo;
nitroglycerin vs. placebo; diltiazem vs. nitroglycerin) on perioperative
outcomes. Network meta-analyses were implemented to compare the three
regimens through direct and indirect comparison. Results Twenty-seven
studies involving 1,660 patients were included. Pairwise and network
meta-analyses found no significant difference in mortality among the
groups. There are four studies that reported blood flow measurements of
internal mammary artery grafts intraopera-tively after dissecting or
immediately after distal anastomosis while patients were on continuous
intravenous infusion of diltiazem and nitroglycerin. Although insufficient
for data synthesis, the measured results from all four studies suggest
that both diltiazem and nitroglycerin significantly increased blood flow
of arterial grafts compared to placebo. For other perioperative outcomes,
compared to diltiazem, patients that received nitroglycerin had higher
odds of postoperative atrial fibrillation (OR = 2.67, 95% CI: 1.15 to
6.24) and higher peak serum cardiac enzymes. Patients that received
placebo had higher odds of atrial fibrillation (OR = 3.00, 95% CI: 1.18 to
7.63) and lower odds of requiring inotrope support (OR = 0.19, 95% CI:
0.04 to 0.73) compared to diltiazem. Data from the network meta-analysis
indicated that diltiazem had significantly lower odds of postoperative
atrial fibrillation compared to nitroglycerin (OR = 0.39, 95% CI: 0.18 to
0.85). In fact, the rank from highest to lowest rates of postoperative
atrial fibrillation was placebo>nitroglycerin>diltiazem. The rank from
highest to lowest odds of requiring inotropic support is nitroglycerin>
diltiazem>pla-cebo. However, placebo had significantly higher odds of
postoperative myocardial infarction than diltiazem (OR = 4.51, 95% CI:
1.34 to 15.25). The rank from highest to lowest odds of postoperative
myocardial infarction, transient cardiac ischemic event and atrial
fibrillation is placebo>nitroglycerin>diltiazem. Conclusion Compared to
nitroglycerin and placebo, perioperative continuous intravenous infusion
of diltiazem had stronger protective effects against postoperative
ischemic cardiac injuries and atrial fibrillation although patients may
need more inotropic support. The increased blood flow from diltiazem use
in arterial grafts may potentially contribute to the drug's outcome
benefits.<br/>Copyright &#xa9; 2018 Hu et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<30>
Accession Number
623684675
Title
Cardiovascular magnetic resonance in heart transplant patients: Diagnostic
value of quantitative tissue markers: T2 mapping and extracellular volume
fraction, for acute rejection diagnosis.
Source
Journal of Cardiovascular Magnetic Resonance. 20 (1) (no pagination),
2018. Article Number: 59. Date of Publication: 27 Aug 2018.
Author
Vermes E.; Pantaleon C.; Auvet A.; Cazeneuve N.; Machet M.C.; Delhommais
A.; Bourguignon T.; Aupart M.; Brunereau L.
Institution
(Vermes, Pantaleon, Auvet, Bourguignon, Aupart) Department of
Cardiothoracic Surgery, University Francois Rabelais, Tours, France
(Vermes, Cazeneuve, Delhommais, Brunereau) Department of Radiology,
University Francois Rabelais, Tours, France
(Machet) Department of Anatomopathology, University Francois Rabelais,
Tours, France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The diagnosis of acute rejection in cardiac transplant
recipients requires invasive technique with endomyocardial biopsy (EMB)
which has risks and limitations. Cardiovascular magnetic resonance imaging
(CMR) with T2 and T1 mapping is a promising technique for characterizing
myocardial tissue. The purpose of the study was to evaluate T2, T1 and
extracellular volume fraction (ECV) quantification as novel tissue markers
to diagnose acute rejection. <br/>Method(s): CMR was prospectively
performed in 20 heart transplant patients providing 31 comparisons
EMB-CMR. CMR was performed close to EMB. Images were acquired on a 1.5
Tesla scanner including T2 mapping (T2 prepared balanced steady state free
precession) and T1 mapping (modified Look-Locker inversion recovery
sequences: MOLLI) at basal, mid and apical level in short axis view.
Global and segmental T2 and T1 values were measured before and 15 min (for
T1 mapping) after contrast administration. <br/>Result(s): Acute rejection
was diagnosed in seven patients: six cellular rejections (4 grade IR, 2
grade 2R) and one antibody mediated rejection. Patients with acute
rejection had significantly higher global T2 values at 3 levels: 58.5 ms
[55.0-60.3] vs 51.3 ms [49.5-55.2] (p = 0.007) at basal; 55.7 ms
[54.0-59.7] vs 51.8 ms [50.1-53.6] (p = 0.002) at median and 58.2 ms
[54.0-63.7] vs 53.6 ms [50.8-57.4] (p = 0.026) at apical level. The area
under the curve (AUC) for each level was 0.83, 0.79 and 0.78 respectively.
Patients with acute rejection had significantly higher ECV at basal level:
34.2% [32.8-37.4] vs 27.4% [24.6-30.6] (p = 0.006). The AUC for basal
level was 0.84. The sensitivity, specificity and diagnosis accuracy for
basal T2 (cut off: 57.7 ms) were 71, 96 and 90% respectively; and for
basal ECV: (cut off 32%) were 86, 85 and 85% respectively. Combining basal
T2 and basal ECV allowed diagnosing all acute rejection and avoiding 63%
of EMB. <br/>Conclusion(s): In heart transplant patients, a combined CMR
approach using T2 mapping and ECV quantification provides a high
diagnostic accuracy for acute rejection diagnosis and could potentially
decrease the number of routine EMB.<br/>Copyright &#xa9; 2018 The
Author(s).

<31>
Accession Number
2000715217
Title
The Effects of an Open-Lung Approach During One-Lung Ventilation on
Postoperative Pulmonary Complications and Driving Pressure: A Descriptive,
Multicenter National Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (6) (pp 2665-2672),
2018. Date of Publication: 01 Dec 2018.
Author
Belda J.; Ferrando C.; Garutti I.; Pozo N.; Soro M.; Suarez-Sipmann F.;
Tusman G.; Unzueta C.; Villar J.; Bermejo S.; Callejo A.; Coves S.;
Gallego-Ligorit L.; Granell M.; Jimenez M.J.; Lluch A.; Martinez J.A.; de
la Matta M.; Planas A.; Aguirre P.; Rodriguez A.; Sastre J.A.; Arocas B.;
Barcena E.; Belmonte L.; Carbonell J.; Carrizo J.; Charco P.; Cuervo J.;
Del Rio E.; Florea R.; Gutierrez A.; Jurado A.; Lascorz L.; Navarro J.M.;
Martinez S.; Monleon B.; Parra M.J.; Perez S.; Sancho L.; Serralta F.;
Villena A.; Cruz P.; de la Gala F.; Olmedilla L.; Pineiro P.;
Sanchez-Pedrosa G.; Alday E.; Munoz M.; Ramasco F.; Diaz R.; Parera A.;
Cabrera S.; Guerra E.; Morales L.; Gallart L.; Perez A.; Calderon A.;
Guerrero M.; Kadaoui S.-D.; Levstek M.; Real M.I.; Pintor J.; Barrado P.;
Cotera I.; Izquierdo B.; Lacosta L.; Molinos I.; Rubio B.; Puertolas M.;
Sanjuan-Villareal A.; Valles-Torres J.; Tres E.; Viguera L.; Biosca E.;
Broseta A.; Hernandez J.; Morales J.; Navarro-Ripoll R.; Femenia X.;
Minguez L.; Lopez A.; Esteve I.; Llacer E.; Blanco L.; Ceresuela R.;
Orallo M.A.; Pereira D.; Prieto M.P.; Otero T.
Institution
(Belda, Ferrando) Hospital Clinico de Valencia, Valencia, Spain
(Ferrando) CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos
III, Madrid, Spain
(Garutti) Hospital Gregorio Maranon de Madrid, Madrid, Spain
(Belda, Ferrando, Pozo, Soro) Hospital Clinico de Valencia, Valencia,
Spain
(Ferrando, Suarez-Sipmann, Villar) CIBER de Enfermedades Respiratorias,
Instituto de Salud Carlos III, Madrid, Spain
(Garutti) Hospital Gregorio Maranon de Madrid, Madrid, Spain
(Suarez-Sipmann, Planas) La Princesa de Madrid, Madrid, Spain
(Tusman) Hospital Privado Mar de Plata, La Plata, Argentina
(Unzueta) Hospital San Pau i Santa Creu de Barcelona, Barcelona, Spain
(Villar, Rodriguez) Hospital Dr. Negrin de Las Palmas, Las Palmas, Spain
(Bermejo) Hospital Parc de Salut Mar de Barcelona, Barcelona, Spain
(Callejo) Hospital 12 de Octubre de Madrid, Madrid, Spain
(Coves) Hospital de Vinalopo de Elche, Alicante, Spain
(Gallego-Ligorit) Hospital Miguel Servet de Zaragoza, Zaragoza, Spain
(Granell) Hospital Consorcio General de Valencia, Valencia, Spain
(Jimenez) Hospital Clinic de Barcelona, Barcelona, Spain
(Lluch) Hospital La Fe de Valencia, Valencia, Spain
(Martinez) Hospital Mutua de Terrassa, Terrassa, Spain
(de la Matta) Hospital Virgen del Rocio de Sevilla, Sevilla, Spain
(Aguirre) Hospital Alvaro Cunqueiro de Vigo, Vigo, Spain
(Sastre) Hospital Clinico de Salamanca, Salamanca, Spain
(Ferrando, Arocas, Barcena, Belmonte, Carbonell, Carrizo, Charco, Cuervo,
Del Rio, Florea, Gutierrez, Jurado, Lascorz, Navarro, Martinez, Monleon,
Parra, Perez, Sancho, Serralta, Villena) Hospital Clinico de Valencia,
Spain
(Cruz, de la Gala, Olmedilla, Pineiro, Sanchez-Pedrosa) Hospital Gregorio
Maranon de Madrid, Spain
(Alday, Munoz, Ramasco) Hospital La Princesa de Madrid, Spain
(Diaz, Parera) Hospital Sant Pau i Santa Creu de Barcelona, Spain
(Cabrera, Guerra, Morales) Hospital Dr. Negrin de Las Palmas, Spain
(Gallart, Perez) Hospital Parc de Salut Mar de Barcelona, Spain
(Calderon, Guerrero, Kadaoui, Levstek, Real) Hospital 12 de Octubre de
Madrid, Spain
(Pintor) Hospital de Vinalopo de Elche, Spain
(Barrado, Cotera, Izquierdo, Lacosta, Molinos, Rubio, Puertolas,
Sanjuan-Villareal, Valles-Torres, Tres, Viguera) Hospital Miguel Servet de
Zaragoza, Spain
(Biosca, Broseta, Hernandez, Morales) Hospital Consorcio General de
Valencia, Spain
(Navarro-Ripoll) Hospital Clinic de Barcelona, Spain
(Femenia, Minguez, Lopez) Hospital La Fe de Valencia, Spain
(Esteve, Llacer) Hospital Mutua de Terrassa, Spain
(Blanco, Ceresuela, Orallo, Pereira, Prieto, Otero) Hospital Alvaro
Cunqueiro de Vigo, Spain
Publisher
W.B. Saunders
Abstract
Objective: Thoracic surgical procedures are associated with an increased
risk of postoperative pulmonary complications (PPCs), which seem to be
related directly to intraoperative driving pressure. The authors conducted
this study to describe the incidence of PPCs in patients in whom an
individualized open-lung approach was applied during one-lung ventilation.
<br/>Design(s): This was a prospective, multicenter, national descriptive
study. <br/>Setting(s): Thoracic surgery patients undergoing one-lung
ventilation. <br/>Participant(s): Eligible participants were included
consecutively from October 1, 2016, to September 30, 2017. A total of 690
patients were included. <br/>Intervention(s): An individualized open-lung
approach that consisted of an alveolar recruitment maneuver followed by a
positive end-expiratory pressure adjusted to best respiratory system
compliance was performed in all patients. <br/>Measurements and Main
Results: Preoperative and intraoperative data were recorded; the primary
outcome was a description of the incidence of PPCs in these patients
during the first 7 postoperative days. The patients were mainly male, and
half of them had a high risk of PPCs (ARISCAT score exceeding 44). Eleven
percent of participants developed a PPC within the first postoperative
week. The mean open lung positive end-expiratory pressure was 8 +/- 3
cmH<inf>2</inf>O. When compared with pre-open lung approach values, the
open-lung approach significantly decreased the driving pressure (14 +/- 4
cmH<inf>2</inf>O v 11 +/- 3 cmH<inf>2</inf>O; p < 0.001) and increased
dynamic compliance (30 +/- 10 mL/cmH<inf>2</inf>O v 43 +/-15
mL/cmH<inf>2</inf>O; p < 0.001). <br/>Conclusion(s): The low incidence of
PPCs in patients who underwent an open-lung approach during one-lung
ventilation compared with that reported for other thoracic surgery series
and the decrease in the driving pressure in these patients justify an
additional randomized controlled trial to compare the open-lung approach
with the standard protective strategy of low tidal volume and low positive
end-expiratory pressure.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<32>
Accession Number
622474694
Title
Effect of preoperative warming on intraoperative hypothermia: a
randomized-controlled trial.
Source
Canadian Journal of Anesthesia. 65 (9) (pp 1029-1040), 2018. Date of
Publication: 01 Sep 2018.
Author
Lau A.; Lowlaavar N.; Cooke E.M.; West N.; German A.; Morse D.J.; Gorges
M.; Merchant R.N.
Institution
(Lau, Lowlaavar, Cooke, West, Gorges, Merchant) Department of
Anesthesiology, Pharmacology, & Therapeutics, University of British
Columbia, Vancouver, BC, Canada
(German) Graduate School of Medicine, University of Wollongong,
Wollongong, Australia
(Morse) 3M Infection Prevention Division, 3M Corporation, St. Paul, MN,
United States
(Gorges) Research Institute, BC Children's Hospital, Vancouver, BC, Canada
(Merchant) Department of Anesthesia and Perioperative Medicine, Royal
Columbian Hospital, Fraser Health Authority, New Westminster, BC, Canada
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: The purpose of this study was to evaluate the effects of
preoperative forced-air warming on intraoperative hypothermia.
<br/>Method(s): In this randomized-controlled trial, adult patients
scheduled for elective, non-cardiac surgery under general anesthesia were
stratified by scheduled surgical duration (< 2.5 hr or >= 2.5 hr) and then
randomized to a pre-warming group using a BairPawsTM forced-air warming
system for at least 30 min preoperatively or to a control group with
warmed blankets on request. All patients were warmed intraoperatively via
convective forced-air warming blankets. Perioperative temperature was
measured using the SpotOnTM temperature system consisting of a single-use
disposable sensor applied to the participant's forehead. The primary
outcome was the magnitude of intraoperative hypothermia calculated as the
area under the time-temperature curve for core temperatures < 36degreeC
between induction of general anesthesia and leaving the operating room.
Secondary outcomes included surgical site infections, packed red blood
cell requirements, and 24 hr postoperative opioid consumption.
<br/>Result(s): Two hundred participants were analyzed (101 control; 99
pre-warmed). Pre-warmed participants had a lower median [interquartile
range] magnitude of hypothermia than controls (0.00 [0.00-0.12]
degreeC.hr^-1vs 0.05 [0.00-0.36] degreeC.hr^-1,
respectively; median difference, -0.01degreeC.hr^-1; 95%
confidence interval, -0.04 to 0.00degreeC.hr^-1; P = 0.005).
There were no between-group differences in the secondary outcomes.
<br/>Conclusion(s): A minimum of 30 min of preoperative forced-air
convective warming decreased the overall intraoperative hypothermic
exposure. While redistribution hypothermia still occurs despite pre- and
intraoperative forced-air warming, their combined application results in
greater preservation of intraoperative normothermia compared with
intraoperative forced-air warming alone. Trial registration:
www.clinicaltrials.gov (NCT02177903). Registered 25 June
2014.<br/>Copyright &#xa9; 2018, Canadian Anesthesiologists' Society.

<33>
Accession Number
622602737
Title
Impact of surgical pulmonary valve replacement on ventricular strain and
synchrony in patients with repaired tetralogy of Fallot: A cardiovascular
magnetic resonance feature tracking study.
Source
Journal of Cardiovascular Magnetic Resonance. 20 (1) (no pagination),
2018. Article Number: 37. Date of Publication: 18 Jun 2018.
Author
Balasubramanian S.; Harrild D.M.; Kerur B.; Marcus E.; Del Nido P.; Geva
T.; Powell A.J.
Institution
(Balasubramanian, Harrild, Kerur, Marcus, Geva, Powell) Department of
Cardiology, Boston Children's Hospital, Boston, United States
(Balasubramanian, Harrild, Marcus, Geva, Powell) Department of Pediatrics,
Harvard Medical School, Boston, United States
(Del Nido) Department of Cardiac Surgery, Boston Children's Hospital,
Boston, United States
(Del Nido) Department of Surgery, Boston Children's Hospital, Boston,
United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: In patients with repaired tetralogy of Fallot (TOF), a better
understanding of the impact of surgical pulmonary valve replacement (PVR)
on ventricular mechanics may lead to improved indications and outcomes.
Therefore, we used cardiovascular magnetic resonance (CMR) feature
tracking analysis to quantify ventricular strain and synchrony in repaired
TOF patients before and after PVR. <br/>Method(s): Thirty-six repaired TOF
patients (median age 22.4 years) prospectively underwent CMR a mean of 4.5
+/- 3.8 months before PVR surgery and 7.3 +/- 2.1 months after PVR
surgery. Feature tracking analysis on cine steady-state free precession
images was used to measure right ventricular (RV) and left ventricular
(LV) circumferential strain from short-axis views at basal,
mid-ventricular, and apical levels; and longitudinal strain from 4-chamber
views. Intraventricular synchrony was quantified using the maximum
difference in time-to-peak strain, the standard deviation of the
time-to-peak, and cross correlation delay (CCD) metrics; interventricular
synchrony was assessed using the CCD metric. <br/>Result(s): Following
PVR, RV end-diastolic volume, end-systolic volume, and ejection fraction
declined, and LV end-diastolic volume and end-systolic volume both
increased with no significant change in the LV ejection fraction. LV
global basal and apical circumferential strains, and basal synchrony
improved. RV global circumferential and longitudinal strains were
unchanged, and there was a varied impact on synchrony across the
locations. Interventricular synchrony worsened at the midventricular level
but was unchanged at the base and apex, and on 4-chamber views.
<br/>Conclusion(s): Surgical PVR in repaired TOF patients led to improved
LV global strain and no change in RV global strain. LV and RV synchrony
parameters improved or were unchanged, and interventricular synchrony
worsened at the midventricular level.<br/>Copyright &#xa9; 2018 The
Author(s).

<34>
Accession Number
621323224
Title
Early Outcomes of Hypoplastic Left Heart Syndrome Infants: Meta-Analysis
of Studies Comparing the Hybrid and Norwood Procedures.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 9 (2) (pp
224-233), 2018. Date of Publication: 01 Mar 2018.
Author
Cao J.Y.; Lee S.Y.; Phan K.; Ayer J.; Celermajer D.S.; Winlaw D.S.
Institution
(Cao, Lee, Phan, Ayer, Celermajer, Winlaw) Sydney Medical School,
University of Sydney, Sydney, NSW, Australia
(Phan) NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private
Hospital, Sydney, NSW, Australia
(Ayer, Winlaw) Heart Centre for Children, The Children's Hospital at
Westmead, Sydney, NSW, Australia
(Celermajer) Cardiology, Royal Prince Alfred Hospital, Sydney, NSW,
Australia
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
The hybrid strategy is an alternative to the traditional Norwood procedure
for initial palliation of infants with hypoplastic left heart syndrome
(HLHS) who are deemed to be at high surgical risk. Numerous single-center
studies have compared the two procedures, showing similar early outcomes,
although the cohort sizes are likely insufficiently powered to detect
significant differences. The current meta-analysis aims to explore the
early morbidity and mortality associated with the hybrid compared to the
Norwood procedure. MEDLINE, Cochrane Libraries, and Embase were
systematically searched, and 14 studies were included for statistical
synthesis, comprising 263 hybrid and 426 Norwood patients. Early mortality
was significantly higher in the hybrid patients (relative risk [RR] =
1.54, P <.05, 95% confidence interval [CI]: 1.02-2.34), whereas interstage
mortality was comparable between the two groups (RR = 0.88, P >.05, 95%
CI: 0.46-1.70). Six-month (RR = 0.89, P <.05, 95% CI: 0.80-1.00) and
one-year (RR = 0.88, P <.05, 95% CI: 0.78-1.00) transplant-free survival
was also inferior among the hybrid patients. Furthermore, the hybrid
patients required more reinterventions following initial surgical
palliation (RR = 1.48, P <.05, 95% CI: 1.09-2.01), although the two groups
had comparable length of hospital and intensive care unit stay
postoperatively. In conclusion, our results suggest that the hybrid
procedure is associated with worse early survival compared to the
traditional Norwood when used for initial palliation of infants with HLHS.
However, due to the hybrid being used preferentially for high-risk
patients, definitive conclusions regarding the efficacy of the procedure
cannot be drawn.<br/>Copyright &#xa9; 2018, &#xa9; The Author(s) 2018.

<35>
Accession Number
626288117
Title
Comparison of balloon-expandable vs. self-expandable valves in patients
undergoing transfemoral transcatheter aortic valve implantation: From the
CENTER-collaboration.
Source
European Heart Journal. 40 (5) (pp 456-465), 2019. Date of Publication:
2019.
Author
Vlastra W.; Chandrasekhar J.; Munoz-Garcia A.J.; Tchetche D.; De Brito
F.S.; Barbanti M.; Kornowski R.; Latib A.; D'Onofrio A.; Ribichini F.;
Baan J.; Tijssen J.G.P.; Trillo-Nouche R.; Dumonteil N.; Abizaid A.;
Sartori S.; D'Errigo P.; Tarantini G.; Lunardi M.; Orvin K.; Pagnesi M.;
Del Valle R.; Modine T.; Dangas G.; Mehran R.; Piek J.J.; Delewi R.
Institution
(Vlastra, Chandrasekhar, Baan, Tijssen, Piek, Delewi) Department of
Clinical and Experimental Cardiology, Heart Center, Amsterdam UMC,
University of Amsterdam, Meibergdreef 9, Amsterdam 1105AZ, Netherlands
(Chandrasekhar, Sartori, Dangas, Mehran) Zena and Michael A. Wiener
Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1
Gustave L. Levy Place, New York, NY 10029-6574, United States
(Munoz-Garcia) Department of Cardiology, Hospital Universitario Virgen de
la Victoria, Campus de Teatinos, Malaga 29010, Spain
(Tchetche, Dumonteil) Clinique Pasteur, 45 Avenue de Lombez, Toulouse
31076, France
(De Brito) Heart Institute (InCor), University of Sao Paulo Medical
School, Av. Dr. Eneas Carvalho de Aguiar, Sao Paulo - SP 05403-900, Brazil
(Barbanti) Division of Cardiology, Policlinico-Vittorio Emanuele Hospital,
University of Catania, Via Salvatore Citelli, 6, Catania CT 95123, Italy
(Kornowski, Orvin) Cardiology Department, Rabin Medical Center, Ze'ev
Jabotinsky St 39, Petah Tikva 4941492, Israel
(Latib, Pagnesi) Interventional Cardiology Unit, San Raffaele Scientific
Institute, Via Olgettina Milano, 58, Milano MI 20132, Italy
(D'Onofrio, Tarantini) Department of Cardiac, Thoracic and Vascular
Sciences, Interventional Cardiology Unit, University of Padova, Via Nicolo
Giustiniani, 2, Padova PD 35128, Italy
(Ribichini, Lunardi) Division of Cardiology, Department of Medicine,
University of Verona, Policlinico Gb Rossi, Piazzale L.A. Scuro 10, Verona
37134, Italy
(Trillo-Nouche) Servicio de Cardiologia, Complejo Hospitalario
Universitario de Santiago de Compostela, Santiago de Compostela, Rua da
Choupana, s/n, Santiago de Compostela, A Coruna 15706, Spain
(Abizaid) Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante
Pazzanese, 500 - Vila Mariana, Sao Paulo - SP 04012-909, Brazil
(D'Errigo) National Centre for Global Helath, Istituto Superiore di
Sanita, Viale Regina Elena, 299, Roma RM 00161, Italy
(Del Valle) Hospital Universitario Central de Asturias, Julian Claveria.
S/N, Oviedo, Asturias 33011, Spain
(Modine) Centre Hospitalier Universitaire, 2, avenue Oscar Lambret, Lille
59037, France
(Tchetche, Dumonteil) Clinique Pasteur, Toulouse 31300, France
Publisher
Oxford University Press
Abstract
Aims: The aim of this study was to compare clinical outcomes of patients
undergoing transfemoral transcatheter aortic valve implantation (TAVI)
with balloon-expandable (BE) valves vs. self-expandable (SE) valves.
Transcatheter aortic valve implantation is a minimally invasive and
lifesaving treatment in patients with aortic valve stenosis. Even though
BE-valves and SE-valves are both commonly used on a large scale,
adequately sized trials comparing clinical outcomes in patients with
severe aortic valve stenosis treated with BE-valves compared with
SE-valves are lacking. <br/>Methods and Results: In this
CENTER-collaboration, data from 10 registries or clinical trials, selected
through a systematic search, were pooled and analysed. Propensity score
methodology was used to reduce treatment selection bias and potential
confounding. The primary endpoints were mortality and stroke at 30 days
follow-up in patients treated with BEvalves compared with SE-valves.
Secondary endpoints included clinical outcomes, e.g. bleeding during
hospital admission. All outcomes were split for early-generation BE-valves
compared with early-generation SE-valves and new-generation BE-valves with
new-generation SE-valves. The overall patient population (N= 12 381)
included 6239 patients undergoing TAVI with BE-valves and 6142 patients
with SE-valves. The propensity matched population had a mean age of 81 +/-
7 years and a median STS-PROM score or 6.5% [interquartile range (IQR)
4.0-13.0%]. At 30-day follow-up, the mortality rate was not statistically
different in patients undergoing TAVI with BE-valves compared with
SE-valves [BE: 5.3% vs. SE: 6.2%, relative risk (RR) 0.9; 95% confidence
interval (CI) 0.7-1.0, P = 0.10]. Stroke occurred less frequently in
patients treated with BE-valves (BE: 1.9% vs. SE: 2.6%, RR 0.7; 95% CI
0.5-1.0, P = 0.03). Also, patients treated with BE-valves had a three-fold
lower risk of requiring pacemaker implantation (BE: 7.8% vs. SE: 20.3%, RR
0.4; 95% CI 0.3-0.4, P < 0.001). In contrast, patients treated with
new-generation BE-valves more frequently experienced major and
life-threatening bleedings compared with new-generation SEvalves (BE: 4.8%
vs. SE: 2.1%, RR 2.3; 95% CI 1.6-3.3, P < 0.001). <br/>Conclusion(s): In
this study, which is the largest study to compare valve types in TAVI, we
demonstrated that the incidence of stroke and pacemaker implantation was
lower in patients undergoing transfemoral TAVI with BE-valves compared
with SE-valves. In contrast, patients treated with new-generation
BE-valves more often suffered from major or life-threatening bleedings
than patients with new-generation SE-valves. Mortality at 30-days was not
statistically different in patients treated with BE-valves compared with
SE-valves. This study was a propensity-matched analysis generated from
observational data, accordingly current outcomes will have to be confirmed
in a large scale randomized controlled trial.<br/>Copyright &#xa9; 2018
The Author(s). All rights reserved.

<36>
[Use Link to view the full text]
Accession Number
626207605
Title
Donor-specific Cell-free DNA as a Biomarker in Solid Organ
Transplantation. A Systematic Review.
Source
Transplantation. 103 (2) (pp 273-283), 2019. Date of Publication: 01 Feb
2019.
Author
Knight S.R.; Thorne A.; Lo Faro M.L.
Institution
(Knight, Thorne, Lo Faro) Nuffield Department of Surgical Sciences,
University of Oxford, Oxford, United Kingdom
(Knight) Centre for Evidence in Transplantation, Clinical Effectiveness
Unit, Royal College of Surgeons of England, London, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background There is increasing interest in the use of noninvasive
biomarkers to reduce the risks posed by invasive biopsy for monitoring of
solid organ transplants (SOTs). One such promising marker is the presence
of donor-derived cell-free DNA (dd-cfDNA) in the urine or blood of
transplant recipients. Methods We systematically reviewed the published
literature investigating the use of cfDNA in monitoring of graft health
after SOT. Electronic databases were searched for studies relating cfDNA
fraction or levels to clinical outcomes, and data including measures of
diagnostic test accuracy were extracted. Narrative analysis was performed.
Results Ninety-five articles from 47 studies met the inclusion criteria
(18 kidneys, 7 livers, 11 hearts, 1 kidney-pancreas, 5 lungs, and 5
multiorgans). The majority were retrospective and prospective cohort
studies, with 19 reporting diagnostic test accuracy data. Multiple
techniques for measuring dd-cfDNA were reported, including many not
requiring a donor sample. dd-cfDNA falls rapidly within 2 weeks, with
baseline levels varying by organ type. Levels are elevated in the presence
of allograft injury, including acute rejection and infection, and return
to baseline after successful treatment. Elevation of cfDNA levels is seen
in advance of clinically apparent organ injury. Discriminatory power was
greatest for higher grades of T cell-mediated and antibody-mediated acute
rejection, with high negative predictive values. Conclusions Cell-free DNA
is a promising biomarker for monitoring the health of SOTs. Future studies
will need to define how it can be used in routine clinical practice and
determine clinical benefit with routine prospective
monitoring.<br/>Copyright &#xa9; 2019 Wolters Kluwer Health, Inc. All
rights reserved.

<37>
Accession Number
626249115
Title
Effect of electroencephalography-guided anesthetic administration on
postoperative delirium among older adults undergoing major surgery the
engages randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 321 (5) (pp 473-483),
2019. Date of Publication: 05 Feb 2019.
Author
Wildes T.S.; Mickle A.M.; Abdallah A.B.; Maybrier H.R.; Oberhaus J.;
Budelier T.P.; Kronzer A.; McKinnon S.L.; Park D.; Torres B.A.; Graetz
T.J.; Emmert D.A.; Palanca B.J.; Goswami S.; Jordan K.; Lin N.; Fritz
B.A.; Stevens T.W.; Jacobsohn E.; Schmitt E.M.; Inouye S.K.; Stark S.;
Lenze E.J.; Avidan M.S.
Institution
(Wildes, Mickle, Abdallah, Maybrier, Oberhaus, Budelier, Kronzer,
McKinnon, Park, Torres, Graetz, Emmert, Palanca, Goswami, Jordan, Fritz,
Stevens, Avidan) Department of Anesthesiology, Washington University,
School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, United States
(Lin) Department of Mathematics, Washington University, School of
Medicine, St Louis, MO, United States
(Jacobsohn) Department of Anesthesiology, University of Manitoba,
Winnipeg, Canada
(Schmitt, Inouye) Department of Medicine, Beth Israel-Deaconess Medical
Center, Harvard Medical School, Boston, MA, United States
(Stark) Department of Occupational Therapy, Washington University, School
of Medicine, St Louis, MO, United States
(Lenze) Department of Psychiatry, Washington University, School of
Medicine, St Louis, MO, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Intraoperative electroencephalogram (EEG) waveform suppression,
often suggesting excessive general anesthesia, has been associated with
postoperative delirium. OBJECTIVE To assess whether EEG-guided anesthetic
administration decreases the incidence of postoperative delirium. DESIGN,
SETTING, AND PARTICIPANTS Randomized clinical trial of 1232 adults
aged60years and older undergoing major surgery and receiving general
anesthesia at Barnes-Jewish Hospital in St Louis. Recruitmentwas from
January 2015 toMay 2018, with follow-up until July 2018. INTERVENTIONS
Patients were randomized 1:1 (stratified by cardiac vs noncardiac surgery
and positive vs negative recent fall history) to receive EEG-guided
anesthetic administration (n = 614) or usual anesthetic care (n = 618).
MAIN OUTCOMES AND MEASURES The primary outcomewas incident delirium during
postoperative days 1 through 5. Intraoperative measures included
anesthetic concentration, EEG suppression, and hypotension. Adverse events
included undesirable intraoperative movement, intraoperative awareness
with recall, postoperative nausea and vomiting, medical complications, and
death. RESULTS Of the 1232 randomized patients (median age, 69 years
[range, 60to 95]; 563women [45.7%]), 1213 (98.5%)were assessed for the
primary outcome. Delirium during postoperative days 1 to 5 occurred in 157
of 604patients (26.0%)in the guided group and 140 of 609 patients
(23.0%)in the usual care group (difference, 3.0%[95%CI, -2.0%to 8.0%]; P =
.22). Median end-tidal volatile anesthetic concentrationwas significantly
lower in the guided group than the usual care group (0.69 vs0.80minimum
alveolar concentration; difference, -0.11 [95%CI, -0.13 to -0.10), and
median cumulative time with EEGsuppressionwas significantly less (7 vs 13
minutes; difference, -6.0[95%CI, -9.9 to -2.1]). Therewas no significant
difference between groups in the median cumulative time with mean arterial
pressure below60mmHg (7 vs 7 minutes; difference,0.0[95%CI, -1.7 to 1.7]).
Undesirablemovement occurred in 137 patients (22.3%) in the guided and 95
(15.4%) in the usual care group.Nopatients reported intraoperative
awareness. Postoperative nausea and vomitingwas reported in 48 patients
(7.8%) in the guided and 55 patients (8.9%) in the usual care group.
Serious adverse eventswere reported in 124 patients (20.2%) in the guided
and 130 (21.0%)in the usual care group. Within 30 days of surgery, 4
patients (0.65%) in the guided group and 19 (3.07%) in the usual care
group died. CONCLUSIONS AND RELEVANCE Among older adults undergoing major
surgery, EEG-guided anesthetic administration, compared with usual care,
did not decrease the incidence of postoperative delirium. This finding
does not support the use of EEG-guided anesthetic administration for this
indication.<br/>Copyright &#xa9; 2019 American Medical Association.

<38>
Accession Number
2001500072
Title
Hydrocortisone, vitamin C and thiamine for the treatment of sepsis and
septic shock following cardiac surgery.
Source
Indian Journal of Anaesthesia. 62 (12) (pp 934-939), 2018. Date of
Publication: 01 Dec 2018.
Author
Balakrishnan M.; Gandhi H.; Shah K.; Pandya H.; Patel R.; Keshwani S.;
Yadav N.
Institution
(Balakrishnan, Gandhi, Shah, Pandya, Patel, Keshwani, Yadav) Department of
Cardiac Anesthesia, U.N. Mehta Institute of Cardiology and Research
Center, Ahmadabad, Gujarat, India
Publisher
Indian Society of Anaesthetists (Flat No 12/1A K Point, 68-BAPC Roy Road,
Kolkata 700009, India)
Abstract
Background and Aims: The effect of vitamin C on vasopressor requirement in
critically ill patients have been evaluated previously. We aimed to
evaluate the effect of vitamin C, hydrocortisone and thiamine on
vasopressor requirement and mortality in post-operative adult cardiac
surgical patients with septic shock. <br/>Method(s): About 24 patients
with septic shock were randomised into Group 1 (receiving matching placebo
per day for 4 days) and Group 2 (receiving 6 g vitamin C, 400 mg thiamine
and 200 mg hydrocortisone per day for 4 days). Vasopressor dose over 4
days of therapy was the primary endpoint, whereas in-hospital mortality
was the secondary endpoint. <br/>Result(s): APACHE IV and EUROSCORE II
scores were similar between both the groups. Significant reductions in the
requirement of vasopressin (difference from day 1 - 0.0008 +/- 0.00289 vs
0.0033 +/- 0.00492 units/kg/min; P = 0.019) and noradrenaline (difference
from day 1 - 0.0283 +/- 0.040 vs 0.023 +/- 0.035 micro&#32;g/kg/min; P =
0.006) were observed with vitamin C treatment as compared to control
group. PCT levels on Day 3 (68.11 +/- 33.64 vs 33.2 +/- 27.55 ng/mL; P =
0.0161) and Day 4 (70.03 +/- 29.74 vs 26.3 +/- 23.08 ng/mL; P = 0.0009)
were significantly lower in treatment group as compared to control.
However, there was no difference in the Sepsis-Related Organ Failure
Assessment (SOFA) score and mortality between the studied groups.
<br/>Conclusion(s): Combination of vitamin C, thiamine and hydrocortisone
reduces vasopressor requirement in adult cardiac surgical patients with
septic shock.<br/>Copyright &#xa9; 2018 Indian Journal of Anaesthesia.

<39>
Accession Number
624844334
Title
Clinical efficacy of different side branch protection techniques on
patients receiving coronary intervention and prognostic analysis.
Source
European Review for Medical and Pharmacological Sciences. 22 (20) (pp
6977-6982), 2018. Date of Publication: 2018.
Author
Lai J.-X.; Mo Z.-Q.; Song A.-J.; Tan W.-F.
Institution
(Lai, Mo, Song, Tan) Department of Cardiovascular Medicine, Jiangmen
Central Hospital, Jiangmen, China
Publisher
Verduci Editore s.r.l (E-mail: g.lombardi@verduci.it)
Abstract
OBJECTIVE: To investigate and analyze the clinical efficacy of different
side branch protection techniques on patients receiving coronary
intervention and the patient's prognosis. <br/>PATIENTS AND METHODS: A
total of 80 patients with coronary heart disease treated in Jiangmen
Central Hospital from January 2014 to January 2017 were collected.
According to different side branch protection strategies selected during
operation, they were divided into jailed wire technique (JWT) group
(n=20), jailed balloon technique (JBT) group (n=20), balloon-stent kissing
technique (BSKT) group (n=20), and BSKT+RW group (n=20). The relevant
operation parameters and the prevalence of adverse reactions at 1 month
and 6 months after operation were compared among the four groups.
<br/>RESULT(S): The success rate of operation and relevant operation
parameters in BSKT+RW group were slightly superior to those in other three
groups, but there were no significant differences among the four groups
(p>0.05). Besides, the prevalence rates of adverse reactions at 1 month
and 6 months after the operation had no significant differences among the
four groups, but they were slightly lower in BSKT+RW group than those in
the other three groups. <br/>CONCLUSION(S): There are no significant
differences in the clinical efficacy and postoperative recovery of
patients receiving coronary intervention among the four kinds of different
side branch protection techniques. However, BSKT+RW is slightly superior
to the other three treatment methods, which, therefore, is a preferred
choice if the patient's economic conditions permit.<br/>Copyright &#xa9;
2018 Verduci Editore s.r.l. All rights reserved.

<40>
Accession Number
621102322
Title
Cerebral autoregulation in cardiopulmonary bypass surgery: A systematic
review.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (3) (pp 494-503),
2018. Date of Publication: 01 Mar 2018.
Author
Caldas J.R.; Haunton V.J.; Panerai R.B.; Hajjar L.A.; Robinson T.G.
Institution
(Caldas, Hajjar) Department of Anesthesia, Heart Institute, University of
Sao Paulo, Surgical Intensive Care, Av. Dr. Eneas de Carvalho Aguiar 44,
Sao Paulo 05403-000, Brazil
(Caldas) Hospital Sao Rafael, Salvador, Bahia, Brazil
(Haunton, Panerai, Robinson) Department of Cardiovascular Sciences,
University of Leicester, Leicester, United Kingdom
(Panerai, Robinson) NIHR Leicester Biomedical Research Centre, University
of Leicester, Leicester, United Kingdom
(Hajjar) Department of Cardiopneumology, Heart Institute, University of
Sao Paulo, Brazil
Publisher
Oxford University Press
Abstract
Cardiopulmonary bypass surgery is associated with a high incidence of
neurological complications, including stroke, delirium and cognitive
impairment. The development of strategies to reduce the incidence of such
neurological events has been hampered by the lack of a clear understanding
of their pathophysiology. Cerebral autoregulation (CA), which describes
the ability of the brain to maintain a stable cerebral blood flow over a
wide range of cerebral perfusion pressures despite changes in blood
pressure, is known to be impaired in various neurological disorders.
Therefore, we aimed to systematically review studies reporting indices of
CA in cardiopulmonary bypass surgery. Databases such as MEDLINE, Web of
Science, Cochrane Database of Systematic Reviews and EMBASE were searched
for relevant articles. Titles, abstracts and full texts of articles were
scrutinized according to predefined selection criteria. Two independent
reviewers undertook the methodological quality screening nd data
extraction of the included studies. Twenty of 2566 identified studies were
relevant. Studies showed marked heterogeneity and weaknesses in key
methodological criteria (e.g. population size and discussion of
limitations). All but 3 of the 20 studies described impairments of CA with
cardiac surgery. Eleven studies investigated clinical outcomes, and 9 of
these found a significant relationship between these and impaired CA.
There is a general agreement that cardiac surgery is associated with
changes in CA and that clinical outcomes appear to be significantly
related to impaired CA. Further studies are now needed to determine
prognostic significance and to inform future therapeutic
strategies.<br/>Copyright &#xa9; The Author 2017.

<41>
Accession Number
621102293
Title
Incidence of postoperative atrial fibrillation recurrence in patients
discharged in sinus rhythm after cardiac surgery: A systematic review and
meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (3) (pp 504-511),
2018. Date of Publication: 01 Mar 2018.
Author
Lowres N.; Mulcahy G.; Jin K.; Gallagher R.; Neubeck L.; Freedman B.
Institution
(Lowres, Freedman) Heart Research Institute, University of Sydney,
Building D17, Sydney, NSW 2006, Australia
(Lowres, Mulcahy, Freedman) Charles Perkins Centre, University of Sydney,
Sydney, Australia
(Jin, Gallagher, Neubeck) Sydney Nursing School, University of Sydney,
Sydney, Australia
(Neubeck) School of Health and Social Care, Edinburgh Napier University,
Edinburgh, United Kingdom
(Neubeck) School of Nursing and Midwifery, Faculty of Medicine, Nursing,
and Health Sciences, Flinders University, Adelaide, Australia
Publisher
Oxford University Press
Abstract
Postoperative atrial fibrillation (POAF) is associated with increased
stroke risk and mortality post-discharge. POAF is often considered
transient; however, recurrence is likely under-recognized as symptoms are
an unreliable guide. Surveillance post-discharge may identify asymptomatic
POAF recurrences in patients discharged in sinus rhythm. Therefore, we
performed a systematic review and meta-analysis of studies investigating
POAF recurrence post-discharge, in patients with new-onset POAF following
cardiac surgery who reverted to sinus rhythm prior to discharge. Two
independent reviewers searched medical databases, clinical trial
registries, reference lists and the Internet. After screening from 6525
studies, 8 studies were identified (n = 1157 participants, mean age 66 +/-
10 years and 73% men). Monitoring methods included the following:
telemetry during twice-daily exercise sessions (n = 2), continuous
telemetry for 3 weeks (n = 1), daily 20-s electrocardiography (ECG) using
wearable event recorder (n = 1), 30-s single-lead ECG, 4 times/day (n = 1)
and implanted continuous monitoring (n = 2). The incidence rate of POAF
recurrence identified through non-invasive monitoring in the first 4 weeks
post-discharge was 28.3% [confidence interval (CI) 23.0-33.6%]; recurring
12 +/- 5 days (mean +/- SD) post-surgery. The incidence rate identified
through implanted continuous monitoring was 61-100% within 2 years.
Between 40% and 93% of episodes were asymptomatic. In one small study
reporting stroke risk, 8 of 10 patients with recurrence were
guideline-indicated (CHA2DS2-VASc score >2) for oral anticoagulation for
stroke prevention. Monitoring for POAF recurrence post-hospital discharge
identifies significant numbers of early asymptomatic recurrences in
patients at high risk of stroke who may benefit from anticoagulation for
stroke prevention. More intense monitoring is more likely to identify POAF
recurrence. Future research is required to investigate the prognostic
significance of POAF recurrence, especially stroke and mortality
risk.<br/>Copyright &#xa9; The Author 2017.

<42>
Accession Number
2001554203
Title
Comparison of Coronary Artery Bypass Grafting and Drug-Eluting Stents in
Patients With Chronic Kidney Disease and Left Main Coronary Artery
Disease: A Systematic Review and Meta-Analysis.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2019 Cardiovascular
Research Technologies. United States. 12 (4 Supplement) (pp S18), 2019.
Date of Publication: 25 February 2019.
Author
Barbarawi M.O.; Alkotob L.; Bachuwa G.
Institution
(Barbarawi, Alkotob, Bachuwa) Hurley Medical Center, Flint, MI, United
States
Publisher
Elsevier Inc.
Abstract
Background: Treatment of left main coronary artery disease (LMCAD) in
patients with chronic kidney disease (CKD) with either percutaneous
coronary intervention (PCI) or coronary artery bypass grafting (CABG)
remains controversial. Therefore, we performed a meta-analysis to evaluate
the optimal choice of therapy when treating LMCAD in patients with CKD.
<br/>Method(s): We performed an electronic database search of Pubmed,
Clinicaltrials.gov, and Cochrane Library for all studies that compared PCI
with CABG when treating LMCAD in the setting of CKD. Major adverse cardiac
and cerebrovascular events (MACCE) was the primary outcome. Secondary
outcomes included myocardial infarction (MI), cerebrovascular events,
all-cause mortality, and repeat revascularization. <br/>Result(s): Our
analysis included 4 studies with a total of 998 patients. Follow-up was
variable, between 2.5 and 4.3 years. Our study demonstrated significant
reduction in MACCE for patients treated with CABG when compared with PCI
(odds ratio (OR) 0.68; 95% confidence intervals (CI) 0.51-0.89, P=0.005;
I²=0%). We also found a significant reduction in both MI events
(OR 0.55; 95%CI 0.34-0.87; P=0.01; I²=0%) and repeat
revascularization (OR 0.22; 95% CI 0.10-0.51; P<0.001, I²=63%)
in the CABG group. However, patients who received CABG therapy were
associated with an increased risk of cerebrovascular disease events (OR
2.04; 95% CI 1.02-4.08; P=0.04, I²=0%). <br/>Conclusion(s): In
patients with CKD requiring LMCAD intervention, CABG proved to have a
lower risk of MACCE, MI, and repeat revascularization; however, it was
associated with an increased risk of cerebrovascular accidents when
compared to patients who received PCI therapy. Further RCTs with
sufficient power are required to confirm these findings. [Figure
presented]<br/>Copyright &#xa9; 2019

<43>
Accession Number
2001554202
Title
Freedom from Recurrent Mitral Regurgitation-Is Surgery Really Better than
Mitraclip? A Meta-Analysis.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2019 Cardiovascular
Research Technologies. United States. 12 (4 Supplement) (pp S58), 2019.
Date of Publication: 25 February 2019.
Author
Ashukem M.; Pandya B.; Gulati M.; Biglari D.; Hurst T.; Gramze N.; Agarwal
S.; Ligita C.; Fang K.; Su W.; Butman S.; Kalya A.; Gelbert G.; Abbas F.;
Patel N.; Arabia F.; Pershad A.; Gopalan R.; Verma D.R.
Institution
(Ashukem, Gulati, Biglari, Hurst, Gramze, Agarwal, Ligita, Su, Butman,
Kalya, Gelbert, Abbas, Patel, Arabia, Pershad, Gopalan, Verma) Department
of Cardiology, University of Arizona/Banner University Medical Center,
Phoenix, AZ, United States
(Pandya) Department of Cardiology, Hofstra School of Medicine Staten
Island University Hospital Northwell Health, Staten Island, NY, United
States
(Fang) Department of Cardithorasic Surgery, University of Arizona/Banner
University Medical Center, Phoenix, AZ, United States
Publisher
Elsevier Inc.
Abstract
Background: Long-term freedom from recurrent mitral regurgitation in
patients undergoing MitraClip compared to traditional mitral-valve surgery
is not known. <br/>Method(s): PubMed, EMBASE, and Google Scholar databases
were queried for all trials about MitraClip compared with optimal medical
therapy. <br/>Result(s): Seven trials including 818 patients were analyzed
in this meta-analysis. Data for risk of recurrent mitral regurgitation at
1-year and long-term (>1 year) follow-up for MitraClip vs traditional
mitral valve surgery was collected. At 1-year follow-up, there were 7-fold
higher odds of recurrent mitral regurgitation with MitraClip compared to
mitral valve surgery (OR 7.36, 95% CI 4.43-12.22). At long-term follow up
(> 1 year), the odds of recurrent mitral regurgitation increased to 9
folds (OR 9.13, 95% CI 4.40-18.93). Absolute risk reduction with mitral
valve surgery for recurrent mitral regurgitation was 18.4% at long-term
follow-up. The number needed to treat with mitral surgery to prevent 1
patient from significant recurrent mitral regurgitation at > 1-year follow
up was 5 <br/>Conclusion(s): In this meta-analysis, traditional mitral
valve surgery is more effective in reducing risk of recurrent mitral
regurgitation compared to MitraClip at 1-year and long-term follow-up
[Figure presented]<br/>Copyright &#xa9; 2019

<44>
Accession Number
2001554180
Title
In-Hospital Clinical Outcomes of Transcatheter Aortic Valve Replacement in
Patients with Concomitant Carotid Artery Stenosis: Insights from the Most
Recent National Inpatient Sample.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2019 Cardiovascular
Research Technologies. United States. 12 (4 Supplement) (pp S36), 2019.
Date of Publication: 25 February 2019.
Author
Bandyopadhyay D.; Modi V.A.; Sud K.; Chakraborty S.; Hajra A.; Herzog E.;
Moreno P.R.
Institution
(Bandyopadhyay, Modi, Sud, Herzog, Moreno) Mount Sinai St Luke's
Roosevelt, New York, NY, United States
(Chakraborty) Interfaith Medical Center, New York, NY, United States
(Hajra) IPGMER, Kolkata, West Bengal, India
Publisher
Elsevier Inc.
Abstract
Background: Carotid artery stenosis (CAS) is common in older adults
undergoing transcatheter aortic valve replacement (TAVR). CAS may be
associated with increased risk of periprocedural stroke (PPS) and major
cardiovascular events. Carotid filter protection (sentinel system) systems
are frequently used to reduce PPS during TAVR. However, the risk of having
baseline carotid disease for PPS is unclear. In this National Inpatient
sample (NIS) database analysis, we investigated the risk of PPS in
patients undergoing TAVR with concomitant CAS. <br/>Method(s): In this
retrospective cohort study, we used the recently published 2016 NIS
database using the ICD 10 codes for both TAVR and CAS. I652, I6521, I6522,
I652, and I6529 were the ICD 10 code of CAS. Primary outcomes of interest
were PPS, mortality, cardiogenic shock, cardiac arrest, acute kidney
injury, length of stay, and cost of care. Multivariate logistic regression
was used to adjust for potential confounders. We used STATA 15.1 for
analysis. <br/>Result(s): A total of 33590 patients underwent TAVR of
which 2365 had a concurrent diagnosis of CAS (7%). There was a
significantly higher number of smokers, chronic kidney disease, and
dyslipidemia in the CAS group. We observed no significant difference in
PPS (odds ratio (OR): 1.8 CI: 0.65-4.9, p-value:0.26), mortality (OR:
1.01, CI:0.48-2,p-vale: 0.98), acute kidney injury (OR: 1, CI: 0.73-1.4,
p-value: 0.98), cardiogenic shock (OR: 1.4, CI: 0.91-2.33, p-value: 0.91),
cardiac arrest (OR: 0.97, CI:0.53- 1.8, p-value: 0.93), length of stay,
and cost of care between these two groups. <br/>Conclusion(s): Our finding
would help to stratify the patients regarding selecting treatment options.
Further randomized trials are needed to understand the significance of CAS
on TAVR and the efficacy of embolic protection devices. [Figure
presented]<br/>Copyright &#xa9; 2019

<45>
Accession Number
2001554160
Title
Coronary Intervention After Self-Expanding Transcatheter or Surgical
Aortic Valve Replacement in the SURTAVI Trial.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2019 Cardiovascular
Research Technologies. United States. 12 (4 Supplement) (pp S43), 2019.
Date of Publication: 25 February 2019.
Author
Kleiman N.S.; Popma J.J.; Chetcuti S.J.; Serruys P.W.; Van Mieghem N.M.;
Stoler R.C.; Harrison J.K.; Brecker S.J.
Institution
(Kleiman) Houston Methodist DeBakey Heart & Vascular Center, Houston, TX,
United States
(Popma) Beth Israel Deaconess Medical Center, Harvard Medical School,
Boston, MA, United States
(Chetcuti) University of Michigan Hospitals, Ann Arbor, MI, United States
(Serruys) Research in Interventional Cardiology, Rotterdam, Netherlands
(Van Mieghem) Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands
(Stoler) Baylor Heart and Vascular Hospital, Dallas, TX, United States
(Harrison) Duke University Medical Center, Durham, NC, United States
(Brecker) St. George's Hospital, London, United Kingdom
Publisher
Elsevier Inc.
Abstract
Background: Obstructive coronary artery disease frequently accompanies
severe aortic stenosis. In patients who have undergone transcatheter
aortic valve replacement (TAVR), particularly with a self-expanding
prosthesis, percutaneous coronary intervention (PCI) is frequently viewed
as being more challenging primarily due to the valve frame and
displacement of native leaflets. As TAVR is under study in lower-risk
patients, management of coronary artery disease (CAD) is important for
long-term patient management. Accordingly, we examined the frequency and
outcome of PCI following the index TAVR using the CoreValve or Evolut R in
the SURTAVI trial of patients at intermediate risk of mortality following
surgical aortic valve replacement (SAVR). <br/>Method(s): All patients in
SURTAVI underwent coronary angiography during screening. Randomization was
stratified by the need for revascularization. Of 1660 patients undergoing
aortic valve replacement (AVR) from June 19, 2012, to June 30, 2016, 332
(20%) were stratified to revascularization (169 to TAVR+PCI; 163 to
SAVR+CABG). Among the 864 patients assigned to TAVR, most (86%) were
treated with the early-generation CoreValve bioprosthesis; the remainder
received the Evolut R valve. Post-AVR PCI data were collected routinely
during follow-up. Ease of access was reported via operator survey.
Linearized PCI rates were calculated. Lesion success was defined as a
final diameter stenosis < 30%. <br/>Result(s): Through July 22, 2018, 33
patients (17 TAVR, 16 SAVR) had a PCI procedure post AVR during which 52
lesions (30 TAVR, 22 SAVR) were treated. Of the 17 TAVR patients, 14 were
implanted with the CoreValve and 3 with the Evolut R bioprothesis. The
linearized rates (PCI procedures per patient year after the index
procedure) were 0.007 for TAVR and 0.009 for SAVR. The mean time to first
post-index procedure PCI was 791.4 +/- 368.4 days in TAVR and 822.1 +/-
527.1 days in SAVR patients. Lesion success was documented in 26/29
(89.7%) TAVR and 18/19 (94.7%) SAVR patients. No patients experienced
abrupt closure, flow-limiting dissection, or coronary artery perforation.
Ease of access information in native coronary vessels was available for 34
of the 52 lesions. Of these, it was reported as easy or moderately
difficult in 82.4% of cases. The most frequently used guide catheters were
Judkins, followed by EBU and XB curves. <br/>Conclusion(s): Following
appropriate treatment of coronary artery disease at or around the time of
TAVR, subsequent need for PCI in the intermediate-term is uncommon and can
be performed successfully. Most operators judged the procedures to be easy
or only moderately difficult. These findings may have implications for the
potential extension of the procedure to lower-risk patients with longer
expected survival.<br/>Copyright &#xa9; 2019

<46>
Accession Number
626300338
Title
Prospective, randomized trial of bioresorbable scaffolds vs.
everolimus-eluting stents in patients undergoing coronary stenting for
myocardial infarction: The Intracoronary Scaffold Assessment a Randomized
evaluation of Absorb in Myocardial Infarction (ISAR-Absorb MI) trial.
Source
European Heart Journal. 40 (2) (pp 167-176), 2019. Date of Publication:
2019.
Author
Byrne R.A.; Alfonso F.; Schneider S.; Maeng M.; Wiebe J.; Kretov E.;
Bradaric C.; Rai H.; Cuesta J.; Rivero F.; Hoppmann P.; Schlichtenmaier
J.; Christiansen E.H.; Cassese S.; Joner M.; Schunkert H.; Laugwitz K.-L.;
Kastrati A.
Institution
(Byrne, Wiebe, Rai, Cassese, Joner, Schunkert, Kastrati) Department of
Cardiovascular Diseases, Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Lazarettstrasse 36, Munich, Germany
(Byrne, Joner, Schunkert, Laugwitz, Kastrati) DZHK (German Centre for
Cardiovascular Research), Partner Site Munich Heart Alliance, Munich,
Germany
(Alfonso, Cuesta, Rivero) Cardiac Department, Hospital Universitario de la
Princesa Madrid, Madrid, Spain
(Schneider, Bradaric, Hoppmann, Schlichtenmaier, Laugwitz) Clinic and
Policlinic Internal Medicine i (Cardiology and Angiology), Klinikum Rechts
der Isar, Technische Universitat Munchen, Munich, Germany
(Maeng, Christiansen) Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark
(Kretov) E.N. Meshalkin National Medical Research Center, Novosibirsk,
Russian Federation
Publisher
Oxford University Press
Abstract
Aims Bioresorbable scaffolds (BRS) provide short-Term coronary artery
scaffolding and drug delivery. Although prior trials showed a higher rate
of device failure compared with conventional drug-eluting stents (DES),
only a single trial investigated patients undergoing percutaneous coronary
intervention (PCI) for acute myocardial infarction (MI). We aimed to
compare outcomes with BRS vs. DES in patients undergoing PCI for MI.
Methods and results We did a prospective, randomized, multicentre,
non-inferiority, clinical trial of everolimus-eluting BRS vs. durable
polymer everolimus-eluting stents (EES) in patients with acute MI.
Patients were eligible for enrolment if they presented with ST-elevation
MI, or non-ST-elevation MI with thrombosis visual at angiography and were
randomly allocated to treatment with BRS or EES in 2:1 proportion.
Angiographic follow-up was scheduled at 6-8 months and clinical follow-up
was done at 12 months. The primary endpoint was percentage diameter
stenosis in-segment at follow-up. A total of 262 patients were enrolled
and were allocated to BRS (n = 173) or EES (n = 89). Angiographic
follow-up was available for 213 (81.3%) patients. Mean diameter stenosis
was 24.6 +/- 12.2% with BRS vs. 27.3 +/- 11.7% with EES (mean
difference-2.7%, upper limit of one-sided 97.5% confidence limit 0.7%,
prespecified margin of non-inferiority 5%, Pnon-inferiority <0.001). The
rate of the device-oriented composite of cardiac death/target vessel
MI/target lesion revascularization [BRS: 12 (7.0%) vs. EES: 6 (6.7%),
hazard ratio (HR) 1.04, 95% confidence interval (CI) 0.39-2.78] and
definite/probable stent thrombosis [3 (1.7%) vs. 2 (2.3%), HR 0.76, 95% CI
0.13-4.56] were comparable in both groups. Conclusion In patients
undergoing PCI for acute MI BRS were non-inferior to EES for percentage
diameter stenosis at angiographic follow-up. Rates of clinical events were
comparable between the treatment groups, although the study was not
powered to detect differences in clinical outcomes. Clinical trial
registration The trial was registered at www.clinicaltrials.gov
(NCT01942070).<br/>Copyright &#xa9; The Author(s) 2018.

<47>
Accession Number
2001540461
Title
VEITHsymposium.
Source
Journal of Vascular Surgery. Conference: VEITHsymposium. United States. 68
(5) (pp A1-A24), 2018. Date of Publication: November 2018.
Author
Anonymous
Publisher
Mosby Inc.
Abstract
The proceedings contains 12 papers. The topics discussed include: Statin
Therapy Improved Long-Term Prognosis in Patients With Major Non-Cardiac
Vascular Surgeries: A Systematic Review and Meta-Analysis;Acute Limited
Tears of the Thoracic Aorta;Tips for Pedal Access: Technical Evolution and
Review;Hypogastric Preservation Using Retrograde Endovascular
Bypass;Comparison of Devices Used in Carotid Artery Stenting: A Vascular
Quality Initiative Analysis of Commonly Used Carotid Stents and Embolic
Protection Devices;Early Outcomes After Carotid Endarterectomy and Carotid
Artery Stenting for Carotid Stenosis in the ACS-NSQIP Database;Effect of
More Expedited Carotid Intervention on Recurrent Ischaemic Event Rate: A
National Audit;Meta-analysis of Renal Function Following Infrarenal EVAR
using Suprarenal or Infrarenal Fixation Devices;Aortic Re-operation After
Replacement of the Proximal Aorta: A Systematic Review and
Meta-Analysis;On-Treatment Platelet Reactivity is a Predictor of Adverse
Events in Peripheral Artery Disease Patients Undergoing Percutaneous
Angioplasty;A Randomised Clinical Trial Comparing N-Butyl Cyanoacrylate,
Radiofrequency Ablation and Endovenous Laser Ablation for the Treatment of
Superficial Venous Incompetence: Two Year Follow up Results;Diameter
Criteria Have Limited Value for Prediction of Functional Dialysis Use of
Arteriovenous Fistulas

<48>
Accession Number
624755353
Title
Repetitive levosimendan infusions for patients with advanced chronic heart
failure in the vulnerable post-discharge period.
Source
ESC Heart Failure. 6 (1) (pp 174-181), 2019. Date of Publication:
Februaryy 2019.
Author
Polzl G.; Allipour Birgani S.; Comin-Colet J.; Delgado J.F.; Fedele F.;
Garcia-Gonzales M.J.; Gustafsson F.; Masip J.; Papp Z.; Stork S.; Ulmer
H.; Vrtovec B.; Wikstrom G.; Altenberger J.
Institution
(Polzl, Allipour Birgani) Department of Internal Medicine III, Medical
University Innsbruck, Innsbruck, Austria
(Comin-Colet) Department of Cardiology, Bellvitge University Hospital and
IDIBELL, University of Barcelona Hospitalet de Llobregat, Barcelona, Spain
(Delgado) Department of Cardiology, University Hospital 12 de Octubre,
CIBERCV, Madrid, Spain
(Fedele) Department of Cardiovascular, Respiratory, Nephrology,
Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome,
Italy
(Garcia-Gonzales) Department of Cardiology, University Hospital Canarias,
San Cristobal de La Laguna, Tenerife, Spain
(Gustafsson) Department of Cardiology, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
(Masip) Intensive Care Department, Consorci Sanitari Integral, University
of Barcelona, Barcelona, Spain
(Masip) Cardiology Department, Hospital Sanitas CIMA, Barcelona, Spain
(Papp) Department of Cardiology, Division of Clinical Physiology, Faculty
of Medicine, University of Debrecen, Debrecen, Hungary
(Stork) Department of Internal Medicine and Comprehensive Heart Failure
Center, University Hospital Wurzburg, Wurzburg, Germany
(Ulmer) Department for Medical Statistics, Informatics and Health
Economics, Medical University Innsbruck, Innsbruck, Austria
(Vrtovec) Department of Cardiology, University Medical Center Ljubljana,
Ljubljana, Slovenia
(Wikstrom) Department of Cardiology, Institute of Medical Sciences,
Uppsala University Hospital, Uppsala, Sweden
(Altenberger) Cardiac Rehabilitation Center Grossgmain,
Pensionsversicherungsanstalt, Teaching Hospital of Paracelsus Medical
Private University, Salzburg, Austria
Publisher
Wiley-Blackwell (E-mail: info@wiley.com)
Abstract
Hospitalization for acute heart failure (HF) is associated with a
substantial morbidity burden and with associated healthcare costs and an
increased mortality risk. However, few if any major medical innovations
have been witnessed in this area in recent times. Levosimendan is a
first-in-class calcium sensitizer and potassium channel opener indicated
for the management of acute HF. Experience in several clinical studies has
indicated that administration of intravenous levosimendan in intermittent
cycles may reduce hospitalization and mortality rates in patients with
advanced HF; however, none of those trials were designed or powered to
give conclusive insights into that possibility. This paper describes the
rationale and protocol of LeoDOR (levosimendan infusions for patients with
advanced chronic heart failure), a randomized, double-blind,
placebo-controlled, international, multicentre trial that will explore the
efficacy and safety of intermittent levosimendan therapy, in addition to
optimized standard therapy, in patients following hospitalization for
acute HF. Salient features of LeoDOR include the use of two treatment
regimens, in order to evaluate the effects of different schedules and
doses of levosimendan during a 12 week treatment phase, and the use of a
global rank primary endpoint, in which all patients are ranked across
three hierarchical groups ranging from time to death or urgent heart
transplantation or implantation of a ventricular assist device to time to
rehospitalization and, lastly, time-averaged proportional change in
N-terminal pro-brain natriuretic peptide. Secondary endpoints include
changes in HF symptoms and functional status at 14 weeks.<br/>Copyright
&#xa9; 2018 The Authors. ESC Heart Failure published by John Wiley & Sons
Ltd on behalf of the European Society of Cardiology.

<49>
Accession Number
626191936
Title
Transcatheter, sutureless and conventional aortic-valve replacement: A
network meta-analysis of 16,432 patients.
Source
Journal of Thoracic Disease. 11 (1) (pp 188-199), 2019. Date of
Publication: 01 Jan 2019.
Author
Lloyd D.; Luc J.G.Y.; Indja B.E.; Leung V.; Wang N.; Phan K.
Institution
(Luc) Division of Cardiovascular Surgery, Department of Surgery,
University ofBritish Columbia, Vancouver, BC, Canada
(Indja, Wang, Phan) Faculty of Medicine, University of Sydney, Sydney,
Australia
(Leung, Wang) Department of Cardiology, Royal Prince Alfred Hospital,
Sydney, Australia
(Phan) Collaborative Research (CORE) Group, Macquarie University, Sydney,
Australia
(Lloyd) School of Medicine, University of Notre Dame, Sydney, 160 Oxford
St, Darlinghurst, NSW 2010, Australia
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Minimally invasive surgical techniques pose alternatives to
conventional surgery for the treatment of aortic stenosis (AS). We present
a Bayesian network analysis comparing Valve Academic Research Consortium-2
clinical outcomes between transcatheter aortic valve implantation (TAVI),
sutureless (SL-AVR) and conventional aortic valve replacement (CAVR).
<br/>Method(s): Electronic searches of databases were conducted and seven
two-arm randomized-controlled trials and 25 propensity-score-matched
studies comparing clinical outcomes of TAVI, SL-AVR and CAVR for treatment
of AS were identified. Bayesian Markov chain Monte Carlo modelling was
used to analyze clinical outcomes. <br/>Result(s): The analysis included
16,432 patients who underwent TAVI [7,056], SL-AVR [1,238] or CAVR
[8,138]. Compared to CAVR, TAVI and SL-AVR were associated with reduced
postoperative major bleeding of 59% (OR 0.41, 95% CI: 0.28-0.59) and 44%
(OR 0.56, 95% CI: 0.30-0.99) respectively. TAVI had a 41% reduction in
postoperative myocardial infarction (OR 0.59, 95% CI: 0.40-0.86) and
SL-AVR had a 40% reduction in postoperative acute kidney injury (AKI) (OR
0.62, 95% CI: 0.42-0.86). Compared to TAVI, CAVR and SL-AVR had a
reduction in moderate/severe paravalvular regurgitation of 89% (OR 0.11,
95% CI: 0.07-0.16) and 92% (OR 0.08, 95% CI: 0.03-0.17). CAVR had a 67%
decreased postoperative permanent pacemaker (PPM) implantation compared to
TAVI (OR 0.33, 95% CI: 0.24-0.45) and a 63% reduction compared to SL-AVR
(OR 0.37, 95% CI: 0.22-0.61). There were no differences in 30-day
mortality or postoperative stroke between the groups. <br/>Conclusion(s):
In selected patients, minimally invasive surgical interventions including
TAVI and SL-AVR for severe AS are viable alternatives to conventional
surgery. However, TAVI is associated with increased paravalvular
regurgitation, whereas TAVI and SL-AVR are associated with increased
conduction disturbances compared to CAVR.<br/>Copyright &#xa9; Journal of
Thoracic Disease. All rights reserved.

<50>
Accession Number
625955735
Title
Cardiogenic Necrotizing Enterocolitis: A Clinically Distinct Entity from
Classical Necrotizing Enterocolitis.
Source
European Journal of Pediatric Surgery. 29 (1) (pp 14-22), 2019. Date of
Publication: 2019.
Author
Siano E.; Lauriti G.; Ceccanti S.; Zani A.
Institution
(Siano, Zani) Division of General and Thoracic Surgery, Hospital for Sick
Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
(Lauriti) Department of Pediatric Surgery, Spirito Santo Hospital,
Pescara, G. d'Annunzio University, Chieti-Pescara, Italy
(Ceccanti) Pediatric Surgery Unit, Sapienza University of Rome, Azienda
Policlinico Umberto i, Rome, Italy
(Zani) Department of Surgery, University of Toronto, Toronto, ON, Canada
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Aim The main purpose of this study was to investigate if necrotizing
enterocolitis (NEC) has a different presentation and outcome in patients
with congenital heart defect (CHD) (cardiogenic NEC) from those without
(classical NEC). Materials and Methods A systematic review of the
literature on the characteristics of infants with NEC and CHD was
performed by three independent investigators using a defined strategy
(PubMed, Cochrane, Embase, and Web of Science). A meta-analysis was
conducted on studies comparing NEC in infants with CHD and non-CHD infants
using RevMan 5.3. Results Systematic review: Of 7,291 abstracts screened,
126 full-text articles were analyzed and 51 studies were included. NEC had
an incidence of 5.1% in CHD infants (7,728/151,046, range 0-24%) and 0.8%
in non-CHD infants (26,430/3,256,891, range 0.1-8.9%; p < 0.0001). In very
low birth weight infants, NEC occurred in 6.3% of CHD patients
(6,361/100,454pts) and in 8.9% of non-CHD (23,201/257,794pts; p < 0.0001).
In CHD cases, NEC occurred before cardiac surgery in 48% cases and surgery
for NEC was required in 31% infants (2,037/6,683). Meta-analysis: In eight
comparative studies, the incidence of NEC was higher in CHD infants (6%,
768/13,145) than in infants with no CHD (0.9%, 32,625/3,354,323pts; p <
0.00001, odds ratio [OR] 1.84, 95% confidence interval [CI] 1.7-1.9). The
overall mortality was higher in infants with CHD and NEC (38%, 243/640)
than in those without CHD (27%, 6651/24810; p < 0.00001, OR 3.4, 95% CI
2.8-4.1). Conclusion This is the first evidence-based study showing that
infants with cardiogenic NEC have different demographics and outcomes than
those with classical NEC. The risk of developing NEC and the mortality
rate are higher among infants with CHD than in those without. Conversely,
the need for intestinal surgery is lower in babies with cardiogenic NEC
than in those with classical NEC. Further studies are needed to establish
preventative and management interventions that are specific to infants
with or at risk of developing cardiogenic NEC.<br/>Copyright &#xa9; 2019
Georg Thieme Verlag KG Stuttgart - New York.

<51>
Accession Number
623718506
Title
Smoking cessation after nurse-coordinated referral to a comprehensive
lifestyle programme in patients with coronary artery disease: a substudy
of the RESPONSE-2 trial.
Source
European Journal of Cardiovascular Nursing. 18 (2) (pp 113-121), 2019.
Date of Publication: 01 Feb 2019.
Author
Snaterse M.; Jorstad H.T.; Minneboo M.; Lachman S.; Boekholdt S.M.; ter
Riet G.; Scholte op Reimer W.J.M.; Peters R.J.G.
Institution
(Snaterse, Scholte op Reimer) ACHIEVE Centre of Applied Research,
Amsterdam University of Applied Sciences, Netherlands
(Jorstad, Minneboo, Lachman, Boekholdt, Scholte op Reimer, Peters)
Department of Cardiology, Academic Medical Centre, Netherlands
(ter Riet) Department of General Practice, Academic Medical Centre,
Netherlands
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective: The objective of this study was to investigate the
characteristics of successful quitters, their use of a smoking cessation
programme and the use of other lifestyle interventions to improve
lifestyle-related risk factors, within a nurse-coordinated care programme.
<br/>Method(s): We used data from the multicentre randomised controlled
RESPONSE-2 trial (n=824, The Netherlands). The trial was designed to
assess the efficacy of nurse-coordinated referral to a comprehensive set
of up to three community-based interventions, based on smoking cessation,
healthy food choices and physical activity to improve lifestyle-related
risk factors in coronary artery disease patients, compared to usual care.
Smoking status was assessed using urinary cotinine at baseline and 12
months follow-up. <br/>Result(s): At 12 months follow-up, there was no
statistically significant difference in cessation rates (50% intervention
group vs. 46% usual care group, P=0.45). The majority of successful
quitters in both groups quit immediately after hospitalisation (72%
intervention group vs. 86% usual care group, P=0.29). Only 19% of
successful quitters in the intervention group participated in the smoking
cessation programme. However, successful quitters participated more
frequently in other lifestyle programmes compared with persistent smokers
(65% vs. 37%, P<0.01). <br/>Conclusion(s): The majority of patients who
successfully quit smoking are those who quit immediately after
hospitalisation, without a need to participate in a smoking cessation
programme. Moreover, this programme was attended by only a minority of
successful quitters. Successful quitters were motivated to attend other
lifestyle programmes addressing healthy food choices and physical
activity. Our findings support a tailored, comprehensive approach to
lifestyle interventions in the secondary prevention of coronary artery
disease.<br/>Copyright &#xa9; The European Society of Cardiology 2018.

<52>
Accession Number
624630584
Title
A Systematic Review of Cost-Effectiveness Analyses of Left Ventricular
Assist Devices: Issues and Challenges.
Source
Applied Health Economics and Health Policy. 17 (1) (pp 35-46), 2019. Date
of Publication: 14 Feb 2019.
Author
Schmier J.K.; Patel J.D.; Leonhard M.J.; Midha P.A.
Institution
(Schmier) Exponent Inc, 1800 Diagonal Rd., Suite 500, Alexandria, VA
22314, United States
(Patel, Midha) Exponent Inc, 3440 Market Street, Suite 600, Philadelphia,
PA 19104, United States
(Leonhard) Exponent, Inc, 15375 SE 30th Place, Suite 250, Bellevue, WA
98007, United States
Publisher
Springer International Publishing
Abstract
Background: Advanced heart failure (HF) can be treated conservatively or
aggressively, with left ventricular assist devices (LVADs) and heart
transplant (HT) being the most aggressive strategies. <br/>Objective(s):
The goal of this review was to identify, describe, critique and summarize
published cost-effectiveness analyses on LVADs for adults with HF.
<br/>Method(s): We conducted a literature search using PubMed and ProQuest
DIALOG databases to identify English-language publications from 2006 to
2017 describing cost-effectiveness analyses of LVADs and reviewed them
against inclusion criteria. Those that met criteria were obtained for
full-text review and abstracted if they continued to meet study
requirements. <br/>Result(s): A total of 12 cost-effectiveness studies (13
articles) were identified, all of which described models; they were almost
evenly split between those examining LVADs as destination therapy (DT) or
as bridge to transplant (BTT). Studies were Markov or semi-Markov models
with one- or three-month cycles that followed patients until death. Inputs
came from a variety of sources, with the REMATCH trial and INTERMACS
registry common clinical data sources, although some publications also
used data from studies at their own institutions. Costs were derived from
standard sources in many studies but from individual hospital data in
some. Inputs for health utilities, which were used in 11 of 12 studies,
were generally derived from two studies. None of the studies reported a
societal perspective, that is, included non-medical costs such as
caregiving. <br/>Conclusion(s): No study found LVADs to be cost effective
for DT or BTT with base case assumptions, although incremental
cost-effectiveness ratios met thresholds for cost effectiveness in some
probabilistic analyses. With constant improvements in LVADs and expanding
indications, understanding and re-evaluating the cost effectiveness of
their use will be critical to making treatment decisions.<br/>Copyright
&#xa9; 2018, Springer Nature Switzerland AG.

<53>
Accession Number
626066430
Title
Pharmacokinetics of tacrolimus granules in pediatric de novo liver,
kidney, and heart transplantation: The OPTION study.
Source
Pediatric Transplantation. 23 (1) (no pagination), 2019. Article Number:
e13328. Date of Publication: Februaryy 2019.
Author
Webb N.J.A.; Baumann U.; Camino M.; Frauca E.; Undre N.; Garcia-Guereta
L.; Tonshoff B.; Reding R.; Rubik J.; Di-Filippo S.; Deschenes G.
Institution
(Webb) Department of Paediatric Nephrology and NIHR/Wellcome Trust
Manchester Clinical Research Facility, University of Manchester,
Manchester Academic Health Science Centre, Royal Manchester Children's
Hospital, Manchester, United Kingdom
(Baumann) Division of Paediatric Gastroenterology and Hepatology,
Children's Hospital, Hannover Medical School, Hannover, Germany
(Camino) Hospital Universitario Gregorio Maranon, Madrid, Spain
(Frauca) Hospital Universitario La Paz, Madrid, Spain
(Undre) Astellas Pharma EMEA, Chertsey, Surrey, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Tacrolimus granules were developed for patients who are unable to swallow
capsules. Therapeutic drug monitoring (TDM) is required to optimize
efficacy and safety, which is based on C<inf>trough</inf> for tacrolimus
capsules. Pharmacokinetic (PK) data for tacrolimus granules are required
to establish the basis for TDM in those who are unable to swallow
capsules. In this phase IV study (NCT01371331) of children undergoing
liver, kidney, or heart transplantation, patients received tacrolimus
granules 0.15 mg/kg twice daily; first dose was administered within 24
hours of reperfusion. PK analysis samples were collected after
reperfusion, after first dose of tacrolimus (Day 1), and at steady state
(Day 7; >4 days stable dose). Of the 52 transplant recipients enrolled, 38
had two evaluable PK profiles. Mean AUC<inf>tau</inf> after first dose of
tacrolimus was 211, 97, and 224 hour*ng/mL in liver, kidney, and heart
transplant recipients, respectively; corresponding mean AUC<inf>tau</inf>
at steady state was 195, 208, and 165 hour*ng/mL. C<inf>trough</inf> and
AUC<inf>tau</inf> were positively correlated after first dose of
tacrolimus and at steady state (Pearson's coefficients: r = 0.81 and r =
0.87, respectively). This study demonstrated that C<inf>trough</inf> is a
reliable marker for TDM in pediatric transplant recipients treated with
tacrolimus granules, consistent with TDM for other tacrolimus
formulations.<br/>Copyright &#xa9; 2019 John Wiley & Sons A/S. Published
by John Wiley & Sons Ltd

<54>
Accession Number
626247656
Title
Zingiber officinale roscoe reduces chest pain on patients undergoing
coronary angioplasty: A clinical trial.
Source
Journal of HerbMed Pharmacology. 8 (1) (pp 47-50), 2019. Date of
Publication: 2019.
Author
Hasanvand A.; Ebrahimi Y.; Mohamadi A.; Nazari A.
Institution
(Hasanvand) Lorestan University of Medical Sciences, Khorramabad, Iran,
Islamic Republic of
(Ebrahimi) Department of Cardiology, Lorestan University of Medical
Sciences, Khorramabad, Iran, Islamic Republic of
(Mohamadi) Razi Herbal Medicines Research Center, Lorestan University of
Medical Sciences, Khorramabad, Iran, Islamic Republic of
(Nazari) Department of Physiology and Pharmacology, Lorestan University of
Medical Sciences, Khorramabad, Iran, Islamic Republic of
Publisher
Nickan Research Institute (E-mail: rafieian@skums.ac.ir)
Abstract
Introduction: Evidence from animal studies suggests that Zingiber
officinale (ginger) may help prevent ischemia-reperfusion injury (IRI) in
heart. The aim of the present study was to
investigatetheeffectofgingeroninducingpreconditioningonpatientsundergoinga
ngioplasty. <br/>Method(s): Thirty-four patients, referred for elective
angioplasty, were randomly divided into the control (17 patients) and
ginger groups (17 patients). Subjects in the experimental group were
provided 250 mg ginger powder in Zintoma capsules per day for 10 days,
whereas those in the control group received placebo. The patients
underwent percutaneous transluminal coronary angioplasty (PTCA) (One
45-second balloon inflation and 2 minutes reperfusion). Chest pain scores
were assessed immediately after angioplasty and cardiac injury biomarkers
were assessed 12 hours later. <br/>Result(s): The average pain score
during the balloon inflation in the ginger group was significantly lower
than the control group (2.1+/-1 versus 3.8+/-1.5, P=0.04). Troponin I was
elevated in both groups after angioplasty, but there was not any
significant difference between groups in this regard (P=0.12 and 0.10,
respectively). <br/>Conclusion(s): The use of ginger reduces chest pain
during coronary angioplasty but its effect on the release of biochemical
markers of myocardial damage is obscure.<br/>Copyright &#xa9; 2019 Nickan
Research Institute. All Right Reserved.

<55>
Accession Number
2001534861
Title
Long-Term Survival Following Multivessel Revascularization in Patients
With Diabetes: The FREEDOM Follow-On Study.
Source
Journal of the American College of Cardiology. 73 (6) (pp 629-638), 2019.
Date of Publication: 19 February 2019.
Author
Farkouh M.E.; Domanski M.; Dangas G.D.; Godoy L.C.; Mack M.J.; Siami F.S.;
Hamza T.H.; Shah B.; Stefanini G.G.; Sidhu M.S.; Tanguay J.-F.; Ramanathan
K.; Sharma S.K.; French J.; Hueb W.; Cohen D.J.; Fuster V.; Zazif T.N.;
Thai H.; Burton J.R.; Schampaert E.; Escobedo J.; Dubois-Rande J.-L.;
Macaya C.; Carrie D.; Richardt G.; Roguin A.; Lotan C.; Kornowski R.;
Presbitero P.; Sousa J.E.; Velasquez J.G.; Rodriguez A.; Devlin G.; French
J.K.; Kaul U.
Institution
(Farkouh, Godoy) Peter Munk Cardiac Centre and the Heart and Stroke
Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada
(Domanski) University of Maryland School of Medicine, Baltimore, MD,
United States
(Dangas, Sharma, Fuster) Zena and Michael Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, New York, NY, United States
(Godoy, Hueb) Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP,
Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
(Mack) Baylor Scott & White Health, Dallas, TX, United States
(Siami, Hamza) New England Research Institutes, Watertown, MA, United
States
(Shah) VA New York Harbor Healthcare System, New York University School of
Medicine, New York, NY, United States
(Stefanini) Humanitas Research Hospital, Milan, Italy
(Sidhu) Albany Medical Center, Albany, NY, United States
(Tanguay) Division of Medicine, Montreal Heart Institute, Universite de
Montreal, Montreal, Quebec, Canada
(Ramanathan) University of British Columbia, Vancouver, British Columbia,
Canada
(French) Cardiology Department, Liverpool Hospital, Sydney, New South
Wales, Australia
(Cohen) Saint-Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City, MO, United States
(Fuster) Centro Nacional de Investigaciones Cardiovasculares Carlos III,
Madrid, Spain
Publisher
Elsevier USA
Abstract
Background: The FREEDOM (Future Revascularization Evaluation in Patients
with Diabetes Mellitus: Optimal Management of Multivessel Disease) trial
demonstrated that for patients with diabetes mellitus (DM) and multivessel
coronary disease (MVD), coronary artery bypass grafting (CABG) is superior
to percutaneous coronary intervention with drug-eluting stents (PCI-DES)
in reducing the rate of major adverse cardiovascular and cerebrovascular
events after a median follow-up of 3.8 years. It is not known, however,
whether CABG confers a survival benefit after an extended follow-up
period. <br/>Objective(s): The purpose of this study was to evaluate the
long-term survival of DM patients with MVD undergoing coronary
revascularization in the FREEDOM trial. <br/>Method(s): The FREEDOM trial
randomized 1,900 patients with DM and MVD to undergo either PCI with
sirolimus-eluting or paclitaxel-eluting stents or CABG on a background of
optimal medical therapy. After completion of the trial, enrolling centers
and patients were invited to participate in the FREEDOM Follow-On study.
Survival was evaluated using Kaplan-Meier analysis, and Cox proportional
hazards models were used for subgroup and multivariate analyses.
<br/>Result(s): A total of 25 centers (of 140 original centers) agreed to
participate in the FREEDOM Follow-On study and contributed a total of 943
patients (49.6% of the original cohort) with a median follow-up of 7.5
years (range 0 to 13.2 years). Of the 1,900 patients, there were 314
deaths during the entire follow-up period (204 deaths in the original
trial and 110 deaths in the FREEDOM Follow-On). The all-cause mortality
rate was significantly higher in the PCI-DES group than in the CABG group
(24.3% [159 deaths] vs. 18.3% [112 deaths]; hazard ratio: 1.36; 95%
confidence interval: 1.07 to 1.74; p = 0.01). Of the 943 patients with
extended follow-up, the all-cause mortality rate was 23.7% (99 deaths) in
the PCI-DES group and 18.7% (72 deaths) in the CABG group (hazard ratio:
1.32; 95% confidence interval: 0.97 to 1.78; p = 0.076).
<br/>Conclusion(s): In patients with DM and MVD, coronary
revascularization with CABG leads to lower all-cause mortality than with
PCI-DES in long-term follow-up. (Comparison of Two Treatments for
Multivessel Coronary Artery Disease in Individuals With Diabetes
[FREEDOM]; NCT00086450)<br/>Copyright &#xa9; 2019

<56>
Accession Number
2001534855
Title
Drug-Eluting Stent Versus Drug-Coated Balloon Revascularization in
Patients With Femoropopliteal Arterial Disease.
Source
Journal of the American College of Cardiology. 73 (6) (pp 667-679), 2019.
Date of Publication: 19 February 2019.
Author
Bausback Y.; Wittig T.; Schmidt A.; Zeller T.; Bosiers M.; Peeters P.;
Brucks S.; Lottes A.E.; Scheinert D.; Steiner S.
Institution
(Bausback, Wittig, Schmidt, Scheinert, Steiner) Division of Angiology,
Department of Internal Medicine, Neurology and Dermatology, University
Hospital Leipzig, Leipzig, Germany
(Zeller) Department of Angiology, Universitats-Herzzentrum Freiburg, Bad
Krozingen, Germany
(Bosiers) Department of Vascular Surgery, AZ St.-Blasius, Dendermonde,
Belgium
(Peeters) Department of Cardiovascular Surgery, Imelda Hospital,
Bonheiden, Belgium
(Brucks) Angiologikum Hamburg, Hamburg, Germany
(Lottes) Cook Research Incorporated, West Lafayette, Indiana, India
Publisher
Elsevier USA
Abstract
Background: Randomized trials of drug-eluting stents (DES) and drug-coated
balloons (DCB) for femoropopliteal interventions reported superior patency
rates for both strategies compared to standard balloon angioplasty. To
date, head-to-head comparisons are missing. <br/>Objective(s): The authors
sought to compare DES versus DCB for femoropopliteal lesions through 36
months. <br/>Method(s): Within a multicenter, randomized trial, 150
patients with symptomatic femoropopliteal disease were randomly assigned
to primary DES implantation or DCB angioplasty with bailout stenting after
stratification for lesion length (<=10 cm, >10 cm to <=20 cm, and >20 cm
to <=30 cm). The primary effectiveness endpoint was primary patency at 12
months assessed by Kaplan-Meier. Secondary endpoints comprised major
adverse events including death, major amputations, and clinically driven
target lesion revascularization, and clinical outcomes. <br/>Result(s):
More than one-half of lesions were total occlusions, and the stenting rate
was 25.3% in the DCB group. Kaplan-Meier estimates of primary patency were
79% and 80% for DES and DCB at 12 months (p = 0.96) but decreased to 54%
and 38% through 36 months (p = 0.17), respectively. Freedom from
clinically driven target lesion revascularization was >90% at 12 months
but dropped to around 70% at 36 months in both groups. Overall, the
mortality rate through 36 months was 7.3%, with 1 procedure-related death
in the DCB group. Improvement of clinical outcomes was sustained through
36 months. <br/>Conclusion(s): Patency rates at 12 months suggest
comparable effectiveness and safety of DES versus DCB plus bailout
stenting in femoropopliteal interventions; a trend in favor of the DES was
observed up to 36 months. (Randomized Evaluation of the Zilver PTX Stent
vs. Paclitaxel-Eluting Balloons for Treatment of Symptomatic Peripheral
Artery Disease of the Femoropopliteal Artery [REAL PTX];
NCT01728441)<br/>Copyright &#xa9; 2019 The Authors

<57>
Accession Number
624377360
Title
A systemic review and meta-analysis: Long-term results of the Bentall
versus the David procedure in patients with Marfan syndrome.
Source
European Journal of Cardio-thoracic Surgery. 54 (3) (pp 411-419), 2018.
Date of Publication: 2018.
Author
Burgstaller J.M.; Held U.; Mosbahi S.; Stak D.; Steurer J.; Eckstein F.;
Berdajs D.A.
Institution
(Burgstaller, Held, Steurer) Horten Center for Patient-Oriented Research
and Knowledge Transfer, University of Zurich, Zurich, Switzerland
(Mosbahi) Department of General Surgery, County Hospital Freiburg,
Freiburg im Breisgau, Switzerland
(Stak) Department of Cardiac Surgery, Triemli City Hospital, Zurich,
Switzerland
(Eckstein, Berdajs) Department of Cardiac Surgery, University Hospital
Basel, Spitalstrasse 21, Basel 4031, Switzerland
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
This systemic review of the literature and meta-analysis aimed to evaluate
the current state of the evidence for and against reimplantation of the
aortic valve (RAV) versus the composite valve graft (CVG) intervention in
patients with Marfan syndrome. Random effects metaregression was performed
across the study arms with logit-transformed proportions of in-hospital
deaths as an outcome measure when possible. Results are presented as odds
ratios with 95% confidence intervals (CIs) and P-values. Other outcomes
are summarized with medians, interquartile ranges (IQR) and ranges and the
numbers of patients at risk. Twenty retrospective studies that included a
combined 2156 patients with long-term follow-up were identified for
analysis after a literature search. The in-hospital mortality rate
favoured the RAV procedure with an odds ratio of 0.23 [95% CI 0.09-0.55, P
= 0.001]. The survival rate at mid-term for the RAV cohort was 96.7% (CI
94.2-98.5) vs. 86.4% (CI 82.8-89.6) for the CVG group and 93.1% (CI
66.4-100) for the RAV group vs. 82.6% (CI 74.9-89.2) for the CVG group for
the long term. Freedom from valve-related reintervention (median
percentages) for the long term was 97.6% (CI 90.3-100%) for the RAV
procedure and 88.6% (CI 79.1-95.5) for a CVG. This systematic review of
the literature stresses the advantages of the RAV procedure in patients
with Marfan syndrome in regard to long- and short-term results as the
treatment of choice in aortic root surgery. The RAV procedure reduces
in-hospital as well as long-term deaths and protects against aortic valve
reintervention.<br/>Copyright &#xa9; 2018 The Author(s). Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<58>
Accession Number
620674692
Title
Adherence to Mediterranean and low-fat diets among heart and lung
transplant recipients: A randomized feasibility study.
Source
Nutrition Journal. 17 (1) (no pagination), 2018. Article Number: 22. Date
of Publication: 14 Feb 2018.
Author
Entwistle T.R.; Green A.C.; Fildes J.E.; Miura K.
Institution
(Entwistle, Fildes) Transplant Centre, University Hospital of South
Manchester, Manchester M23 9LT, United Kingdom
(Green, Miura) Cancer and Population Studies Group, QIMR Berghofer Medical
Research Institute, 300 Herston Road, Herston, QLD 4006, Australia
(Green) CRUK Manchester Institute, University of Manchester, Wilmslow
Road, Manchester, United Kingdom
(Fildes) Manchester Collaborative Centre for Inflammation Research,
University of Manchester, Manchester, United Kingdom
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Heart and lung transplant recipients are at a substantially
increased risk of cardiovascular disease (CVD). Since both low-fat and
Mediterranean diets can reduce CVD in immunocompetent people at high risk,
we assessed adherence among thoracic transplant recipients allocated to
one or other of these diets for 12 months. <br/>Method(s): Forty-one
transplant recipients (20 heart; 21 lung) randomized to a Mediterranean or
a low-fat diet for 12 months received diet-specific education at baseline.
Adherence was primarily assessed by questionnaire: 14-point Mediterranean
diet (score 0-14) and 9-point low-fat diet (score 0-16) respectively, high
scores indicating greater adherence. Median scores at baseline, 6 months,
12 months, and 6-weeks post-intervention were compared by dietary group.
We further assessed changes in weight, body mass index (BMI) and serum
triglycerides from baseline to 12 months as an additional indicator of
adherence. <br/>Result(s): In those randomized to a Mediterranean diet,
median scores increased from 4 (range 1-9) at baseline, to 10 (range 6-14)
at 6-months and were maintained at 12 months, and also at 6-weeks
post-intervention (median 10, range 6-14). Body weight, BMI and serum
triglycerides decreased over the 12-month intervention period (mean weight
- 1.8 kg, BMI -0.5 kg/m², triglycerides - 0.17 mmol/L). In the
low-fat diet group, median scores were 11 (range 9-14) at baseline;
slightly increased to 12 (range 9-16) at 6 months, and maintained at 12
months and 6 weeks post-intervention (median 12, range 8-15). Mean changes
in weight, BMI and triglycerides were - 0.2 kg, 0.0 kg/m² and -
0.44 mmol/L, respectively. <br/>Conclusion(s): Thoracic transplant
recipients adhered to Mediterranean and low-fat dietary interventions. The
change from baseline eating habits was notable at 6 months; and this
change was maintained at 12 months and 6 weeks post-intervention in both
Mediterranean diet and low-fat diet groups. Dietary interventions based on
comprehensive, well-supported education sessions targeted to both patients
and their family members are crucial to success. Such nutritional
strategies can help in the management of their substantial CVD risk. Trial
registration: The IRAS trial registry (ISRCTN63500150). Date of
registration 27 July 2016. Retrospectively registered.<br/>Copyright
&#xa9; 2018 The Author(s).

<59>
Accession Number
624430159
Title
Enhanced recovery after surgery pathway for patients undergoing cardiac
surgery: A randomized clinical trial.
Source
European Journal of Cardio-thoracic Surgery. 54 (3) (pp 491-497), 2018.
Date of Publication: 2018.
Author
Li M.; Zhang J.; Gan T.J.; Qin G.; Wang L.; Zhu M.; Zhang Z.; Pan Y.; Ye
Z.; Zhang F.; Chen X.; Lin G.; Huang L.; Luo W.; Guo Q.; Wang E.
Institution
(Li, Zhang, Qin, Wang, Zhu, Zhang, Pan, Ye, Zhang, Guo, Wang) Department
of Anaesthesiology, Xiangya Hospital, Central South University, Changsha,
Hunan 410008, China
(Gan) Department of Anesthesiology, Stony Brook University, Stony Brook,
NY, United States
(Chen, Lin, Huang, Luo) Department of Cardiovascular Surgery, Xiangya
Hospital, Central South University, Changsha, Hunan, China
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Enhanced recovery after surgery (ERAS) pathways have not been
reported in cardiac surgery. The aim of this study was to evaluate the
clinical effectiveness and safety profile of ERAS pathways compared with
routine care for patients undergoing cardiac valvular surgery.
<br/>METHOD(S): A randomized clinical trial was conducted between July
2015 and November 2016. A total of 226 patients who underwent elective
valvular surgery were randomly assigned to the ERAS pathway or routine
care (control) group. The ERAS protocol consisted of an evidence-based
systematic optimization approach for managing perioperative patients. The
control group received routine care. The primary end-point was readiness
for hospital discharge. The secondary outcomes were duration of intensive
care unit (ICU) stay, length of postoperative vasoactive drug support,
duration of mechanical ventilation, time to first bowel movement, removal
of surgical drain, overall medical costs and complication rate.
<br/>RESULT(S): Postoperative time to readiness for discharge was
significantly shorter in the ERAS group (6.0 (2.014.0) days) than the
control group (7.0 (4.016.0) days, P = 0.01), and the duration of ICU stay
and duration of mechanical ventilation were significantly shorter in the
ERAS group (20.9 (13.569.3) h, 7.2 (0.022.3) h, respectively) than the
control group (22.0 (13.4212.3) h, P = 0.001; 8.8 (3.744.9) h,
respectively; P < 0.0001). The overall treatment cost of the ERAS group
(69202 (52089123823) CNY) was significantly lower than that of the control
group (77058 (51390144290) CNY, P = 0.002). <br/>CONCLUSION(S): ERAS
pathways reduce the length of ICU and hospital stay, postoperative
complications and cost for patients undergoing cardiac surgery. Clinical
trial registration: ClinicalTrials.gov: NCT02479581.<br/>Copyright &#xa9;
2018 The Author(s).

<60>
Accession Number
2001149927
Title
Transcatheter aortic valve replacement outcomes in bicuspid compared to
trileaflet aortic valves.
Source
Cardiovascular Revascularization Medicine. 20 (1) (pp 50-56), 2019. Date
of Publication: January 2019.
Author
Nagaraja V.; Suh W.; Fischman D.L.; Banning A.; Martinez S.C.; Potts J.;
Kwok C.S.; Ratib K.; Nolan J.; Bagur R.; Mamas M.A.
Institution
(Nagaraja, Potts, Kwok, Ratib, Nolan, Bagur, Mamas) Keele Cardiovascular
Research Group, Centre for Prognosis Research, Institute of Primary Care
and Health Sciences, Keele University, United Kingdom
(Nagaraja, Potts, Ratib, Nolan, Bagur, Mamas) Academic Dept of Cardiology,
Royal Stoke Hospital, United Kingdom
(Nagaraja) Department of Cardiology, Prince of Wales Hospital and
Community Health Services, Randwick, New South Wales, Australia
(Suh) Division of Cardiology, University of California Los Angeles Medical
Center, David Geffen School of Medicine at UCLA, United States
(Fischman) Department of Medicine (Cardiology), Thomas Jefferson
University Hospital, Philadelphia, PA, United States
(Banning) Oxford Heart Centre, Oxford University Hospitals NHS Trust
Foundation, Oxford, United Kingdom
(Martinez) Division of Cardiology, Providence St. Peter Hospital, Olympia,
WA, United States
(Kwok) Department of Cardiology, University Hospital of North Midlands,
United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Aim: TAVR in patients with bicuspid aortic valves (BAV) is more
challenging compared to individuals with trileaflet aortic valves (TAV).
BAV have been excluded from the large randomized clinical trials assessing
transcatheter aortic valve replacements (TAVR) and has been considered as
a relative contraindication to TAVR. To report the outcomes of TAVR in BAV
and compare them to TAV in the National Inpatient Sample (NIS).
<br/>Methods and Results: TAVR procedures were identified between 2011 and
2014 in the NIS dataset. Endpoints assessed included in-hospital
mortality, periprocedural complications, length of stay and cost. Of
40,604 identified TAVR procedures, 407 (1%) were BAV and the 40,197 (99%)
were TAV. Patients with BAV were younger and had a lower comorbidity
burden. In hospital mortality (4.89% vs 4.17%, OR: 1.71, 95%CI: 0.57-5.12,
P = 0.21), AMI (3.49% vs 3.58%, OR: 1.12, 95%CI: 0.36-3.54, P = 0.85),
stroke and TIA (2.49% vs 3.55%, OR: 0.75, 95%CI: 0.18-3.16, P = 0.70),
vascular complications (2.39% vs 5.58%, OR:0.47, 95%CI: 0.11-1.93, P =
0.29), major bleeding (16.96% vs 23.50%, OR: 0.63, 95%CI: 0.34-1.17, P =
0.15) and rates of permanent pacemaker (PPM) (9.88% vs 10.88%, OR: 1.19,
95%CI: 0.57-2.51, P = 0.64) were similar in both cohorts.
<br/>Conclusion(s): With multimodality imaging and further improvement in
technology, our study demonstrates off-label TAVR should not be considered
prohibitive and can be successfully performed for BAV with similar
peri-procedural outcomes compared to those with TAV. However, there is a
need for robust large prospective studies.<br/>Copyright &#xa9; 2018
Elsevier Inc.

<61>
Accession Number
2001408918
Title
Systematic Review of Endovascular, Surgical, and Conservative Options for
Infectious Intracranial Aneurysms and Cardiac Considerations.
Source
Journal of Stroke and Cerebrovascular Diseases. 28 (3) (pp 838-844), 2019.
Date of Publication: March 2019.
Author
Ragulojan R.; Grupke S.; Fraser J.F.
Institution
(Ragulojan) UK College of Medicine, University of Kentucky, Lexington,
Kentucky, United Kingdom
(Grupke, Fraser) Department of Neurosurgery, College of Medicine,
University of Kentucky, Lexington, Kentucky, United Kingdom
(Grupke, Fraser) Department of Radiology, College of Medicine, University
of Kentucky, Lexington, Kentucky, United Kingdom
(Fraser) Department of Neurology, College of Medicine, University of
Kentucky, Lexington, Kentucky, United Kingdom
(Fraser) Department of Neuroscience, College of Medicine, University of
Kentucky, Lexington, Kentucky, United Kingdom
Publisher
W.B. Saunders
Abstract
Introduction: With rising rates of intravenous drug use, Infectious
Intracranial aneurysms (IIAs) are a relevant topic for investigation. We
performed a systematic review to better understand current practice
patterns and limits of current published literature. <br/>Method(s): 131
publications with a total of 499 patients (665 aneurysms) were included.
Of the 499 patients, 83 were single case reports, and 20.5% of the total
had multiple aneurysms. 35.8% of all aneurysms were ruptured. Of those
reporting treatment, options included conservative antibiotic therapy
(30.0%), open surgical intervention (31.1%), and endovascular occlusion
(31.8%). Chronologically, publication of IIAs has increased. Usage of
endovascular therapies has grown, while conservative and surgical
management have declined in the literature. Overall, 56.2% of aneurysms
for which conservative therapy was initiated eventually either underwent
intervention or death of patient occurred. <br/>Result(s): The issue of
cardiac valve surgery in relationship to aneurysm therapy was discussed in
20.8% (80 patients) of all 384 infectious endocarditis patients; of which
15.0% (12) underwent valve surgery before aneurysm treatment and 85.0
patients (68)% underwent valve surgery after aneurysm treatment. For 51 of
the patients where valve surgery followed aneurysm management, the
corresponding aneurysm treatment modality could be determined; 58.8% (30)
of whom were managed endovascularly. 32.7% (26) of all cases reporting
cardiac surgery details underwent cardiac surgery during their admission
with the IIA. <br/>Conclusion(s): Overall, increasing trend of
endovascular management of IIAs is evident, and a strong temporal
preference exhibited by providers to perform cardiac surgery subsequently
to IIA management.<br/>Copyright &#xa9; 2018 National Stroke Association

<62>
Accession Number
2000737452
Title
An updated meta-analysis of TAVR in patients at intermediate risk for
SAVR.
Source
Cardiovascular Revascularization Medicine. 20 (1) (pp 57-69), 2019. Date
of Publication: January 2019.
Author
Lazkani M.; Singh N.; Howe C.; Patel N.; Colon M.J.; Tasset M.; Amabile
O.; Morris M.; Fang H.K.; Pershad A.
Institution
(Lazkani, Patel, Colon, Tasset, Amabile, Morris, Fang, Pershad) University
of Arizona, Banner University Medical Center - Phoenix, United States
(Singh, Howe) University of Arizona, Banner University Medical Center,
Tuscon, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has been
approved for use in patients with severe aortic stenosis at intermediate,
high and extreme surgical risk. This meta-analysis was performed to assess
the safety and efficacy of TAVR compared to surgical aortic valve
replacement (SAVR) in intermediate risk patients. <br/>Method(s): We
searched PubMed, EMBASE, Web of science, and the Cochrane Central Register
of Controlled Trials databases for studies comparing TAVR versus SAVR in
patients at intermediate surgical risk, with a mean Society of Thoracic
Surgeon score of 3-8% or a mean logistic European risk score of 10-20%.
The primary endpoint was to assess the efficacy of TAVR compared to SAVR,
defined as all-cause and cardiovascular mortality at 30-days, 1-year, and
>=2 years of follow-up. Secondary endpoints were the safety profile,
comprising of cerebrovascular events, myocardial infarctions, permanent
pacemaker placement, new onset atrial fibrillation, aortic regurgitation,
vascular complications, major bleeding and acute kidney injury.
<br/>Result(s): This is the largest and most contemporary meta-analysis of
5647 intermediate risk patients in eleven studies published to date. There
were no statistically significant differences in all-cause and cardiac
mortality at 30 days, 1- year and >2-years of follow up. Acute kidney
injury and atrial fibrillation occurred more frequently in patients
treated with SAVR and permanent pacemaker implantation and aortic
insufficiency were more frequent in patients treated with TAVR.
<br/>Conclusion(s): This meta-analysis suggests that for intermediate risk
patients with severe aortic stenosis, TAVR has similar efficacy as SAVR
but with a different adverse event profile.<br/>Copyright &#xa9; 2018
Elsevier Inc.

<63>
Accession Number
2001111846
Title
Fungal endocarditis after transcatheter aortic valve replacement (TAVR):
Case report and review of literature.
Source
Journal of Infection and Chemotherapy. 25 (3) (pp 215-217), 2019. Date of
Publication: March 2019.
Author
Morioka H.; Tokuda Y.; Oshima H.; Iguchi M.; Tomita Y.; Usui A.; Yagi T.
Institution
(Morioka, Iguchi, Tomita, Yagi) Department of Infectious Diseases, Nagoya
University Hospital, Japan
(Tokuda, Oshima, Usui) Department of Cardiac Surgery, Nagoya University
Hospital, Japan
Publisher
Elsevier B.V.
Abstract
The reported number of transcatheter aortic valve replacement-associated
infective endocarditis (TAVR-IE) cases has been increasing worldwide, but
information about the incidence and clinical features of fungal TAVR-IE is
quite limited. We present a patient who acquired TAVR-IE caused by Candida
parapsilosis four month after TAVR, who was successfully treated
redo-aortic valve replacement and prolonged antifungal
therapy.<br/>Copyright &#xa9; 2018 Japanese Society of Chemotherapy and
The Japanese Association for Infectious Diseases

<64>
Accession Number
622931550
Title
Impact of mean arterial pressure on sublingual microcirculation during
cardiopulmonary bypass-Secondary outcome from a randomized clinical trial.
Source
Microcirculation. 25 (5) (no pagination), 2018. Article Number: e12459.
Date of Publication: July 2018.
Author
Holmgaard F.; Vedel A.G.; Ravn H.B.; Nilsson J.C.; Rasmussen L.S.
Institution
(Holmgaard, Vedel, Ravn, Nilsson) Department of Cardiothoracic Anesthesia,
Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen,
Denmark
(Rasmussen) Department of Anesthesia, Centre of Head and Orthopedics,
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Publisher
Wiley Blackwell (E-mail: info@wiley.com)
Abstract
Objective: In this substudy of a randomized, clinical trial, we explored
the sublingual microcirculation during cardiac surgery at 2 different
levels of blood pressure. We hypothesized that a higher map during CPB
would cause higher MFI. <br/>Method(s): Thirty-six cardiac surgery
patients undergoing CABG were included and randomized to either low (40-50
mm Hg) or high (70-80 mm Hg) MAP during CPB. SDF video images were
recorded from the sublingual mucosa. Recordings were analyzed in a blinded
fashion to quantify microcirculatory variables. <br/>Result(s): MAP during
CPB in the low target group was 45.0 mm Hg (SD: 5.3) vs 67.2 mm Hg (SD:
8.9) in the high target group. We found no significant difference between
the 2 groups in MFI during CPB evaluated for AV: 2.91 vs 2.90 (P =.82).
For sm AV (<20 mum), the corresponding values were 2.87 and 2.85 in the
low and high target groups, respectively (P =.82). <br/>Conclusion(s): We
found no significant difference in sublingual microcirculatory flow
expressed as MFI according to 2 different levels of MAP during
CPB.<br/>Copyright &#xa9; 2018 John Wiley & Sons Ltd

<65>
Accession Number
620649608
Title
Deferred or immediate stent implantation for primary percutaneous coronary
intervention: A meta-analysis of randomized trials.
Source
Catheterization and Cardiovascular Interventions. 91 (2) (pp 260-264),
2018. Date of Publication: 01 Feb 2018.
Author
Mahmoud A.N.; Saad M.; Elgendy A.Y.; Mentias A.; Elgendy I.Y.
Institution
(Mahmoud, Elgendy, Elgendy) Division of Cardiovascular Medicine,
Department of Medicine, University of Florida, Gainesville, FL, United
States
(Saad) Department of Medicine, University of Arkansas, Little Rock, AR,
United States
(Mentias) Department of Medicine, University of Iowa, Iowa City, IA,
United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To perform a meta-analysis of randomized trials comparing a
deferred versus immediate stenting strategy for primary percutaneous
coronary intervention (PCI). <br/>Background(s): Deferred stent
implantation has emerged as a potential strategy aiming to reduce the
thrombus burden and improve micro-vascular reperfusion during primary PCI.
<br/>Method(s): Electronic databases were searched for randomized trials
that compared a deferred stent implantation versus immediate stent
implantation strategy in patients undergoing primary PCI. Random effects
risk ratios (RR) were estimated for the outcomes of interest.
<br/>Result(s): Four trials with 1,570 patients were included. A deferred
stent implantation strategy was associated with a lower incidence of
no-/slow reflow (RR 0.49, 95% confidence interval [CI] 0.24-0.96), and
improved myocardial blush grade 3 (RR 1.42, 95% CI 1.14-1.77). At a mean
follow up of 34 +/- 15 months, both strategies were associated with a
similar risk of all-cause mortality (RR 0.85, 95% CI 0.58-1.24),
cardiovascular mortality (RR 0.84, 95% CI 0.48-1.45), reinfarction (RR
1.54, 95% CI 0.43-5.49), and stent thrombosis (RR = 0.35, 95% CI
0.04-3.35, P = 0.36). <br/>Conclusion(s): In patients undergoing primary
PCI, deferred stent implantation is associated with improvement in
surrogate outcomes, but does not appear to improve clinical outcomes.
Future randomized trials are encouraged to identify the patient population
who might benefit from a deferred stent implantation strategy (e.g., high
thrombus burden).<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<66>
Accession Number
620649592
Title
Comparison of local versus general anesthesia in patients undergoing
transcatheter aortic valve replacement: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 91 (2) (pp 330-342),
2018. Date of Publication: 01 Feb 2018.
Author
Villablanca P.A.; Mohananey D.; Nikolic K.; Bangalore S.; Slovut D.P.;
Mathew V.; Thourani V.H.; Rode's-Cabau J.; Nunez-Gil I.J.; Shah T.; Gupta
T.; Briceno D.F.; Garcia M.J.; Gutsche J.T.; Augoustides J.G.; Ramakrishna
H.
Institution
(Villablanca, Slovut, Gupta, Briceno, Garcia) Division of Cardiovascular
Diseases, Montefiore Medical Center/Albert Einstein College of Medicine,
New York, NY, United States
(Mohananey) Department of Hospital Medicine, Cleveland Clinic, Cleveland,
OH, United States
(Nikolic, Ramakrishna) Department of Anesthesiology, Mayo Clinic,
Scottsdale, AZ, United States
(Bangalore) New York University School of Medicine, New York, NY, United
States
(Slovut) Department of Cardiothoracic and Vascular Surgery, Montefiore
Medical Center/Albert Einstein College of Medicine, New York, NY, United
States
(Mathew) Division of Cardiology, Loyola University Stritch School of
Medicine, Maywood, IL, United States
(Thourani) Division of Cardiothoracic Surgery, Emory University School of
Medicine, Atlanta, GA, United States
(Rode's-Cabau) Quebec Heart and Lung Institute, Quebec City, QC, Canada
(Nunez-Gil) Instituto Cardiovascular Hospital Clinico San Carlos, Madrid,
Spain
(Shah) Department of Internal Medicine, Montefiore Medical Center/Albert
Einstein College of Medicine, New York, NY, United States
(Gutsche, Augoustides) Department of Anesthesiology and Critical Care,
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,
United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is typically
performed under general anesthesia (GA). However, there is increasing data
supporting the safety of performing TAVR under local anesthesia/conscious
sedation (LA). We performed a meta-analysis to gain better understanding
of the safety and efficacy of LA versus GA in patients with severe aortic
stenosis undergoing TAVR. <br/>Methods and Results: We comprehensively
searched EMBASE, PubMed, and Web of Science. Effect sizes were summarized
using risk ratios (RRs) difference of the mean (DM), and 95% CIs
(confidence intervals) for dichotomous and continuous variables
respectively. Twenty-six studies and 10,572 patients were included in the
meta-analysis. The use of LA for TAVR was associated with lower overall
30-day mortality (RR, 0.73; 95% CI, 0.57-0.93; P = 0.01), use of
inotropic/vasopressor drugs (RR, 0.45; 95% CI, 0.28-0.72; P < 0.001),
hospital length of stay (LOS) (DM, -2.09; 95% CI, -3.02 to -1.16; P <
0.001), intensive care unit LOS (DM, -0.18; 95% CI, -0.31 to -0.04; P =
0.01), procedure time (DM, -25.02; 95% CI, -32.70 to -17.35; P < 0.001);
and fluoroscopy time (DM, -1.63; 95% CI, -3.02 to -0.24; P = 0.02). No
differences were observed between LA and GA for stroke, cardiovascular
mortality, myocardial infarction, permanent pacemaker implantation, acute
kidney injury, paravalvular leak, vascular complications, major bleeding,
procedural success, conduction abnormalities, and annular rupture.
<br/>Conclusion(s): Our meta-analysis suggests that use of LA for TAVR is
associated with a lower 30-day mortality, shorter procedure time,
fluoroscopy time, ICU LOS, hospital length of stay, and reduced need for
inotropic support.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<67>
Accession Number
616039972
Title
Hybrid coronary revascularization versus coronary artery bypass grafting
in patients with multivessel coronary artery disease: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 91 (2) (pp 203-212),
2018. Date of Publication: 01 Feb 2018.
Author
Sardar P.; Kundu A.; Bischoff M.; Chatterjee S.; Owan T.; Nairooz R.; Giri
J.; Halkos M.E.; Liberman H.; Douglas J.S.; Mukherjee D.
Institution
(Sardar, Owan) Division of Cardiovascular Medicine, University of Utah,
Salt Lake City, UT, United States
(Kundu) Department of Medicine, University of Massachusetts Medical
School, Worcester, MA, United States
(Bischoff) Department of Medicine, University of Utah, Salt Lake City, UT,
United States
(Chatterjee) Division of Cardiovascular Medicine, Temple University School
of Medicine, Philadelphia, PA, United States
(Nairooz) Division of Cardiovascular Medicine, University of Arkansas for
Medical Sciences, Little Rock, AR, United States
(Giri) Cardiovascular Division, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Halkos) Division of Cardiothoracic Surgery, Emory University School of
Medicine, Atlanta, GA, United States
(Liberman, Douglas) Clinical Research Unit, Division of Cardiology, Emory
University School of Medicine, Atlanta, United States
(Mukherjee) Division of Cardiovascular Medicine, Texas Tech University
Health Sciences Center, El Paso, TX, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: This meta-analysis evaluated the effectiveness of hybrid
coronary revascularization (HCR) compared to coronary artery bypass
grafting (CABG) for the treatment of multivessel coronary artery disease
(MVCAD). <br/>Background(s): HCR involves a combination of surgical and
percutaneous techniques, which in selected patients may present an
alternative to conventional CABG. <br/>Method(s): Databases were searched
through June 30, 2016, and studies comparing HCR with CABG for treatment
of MVCAD were selected. We calculated summary odds ratios (ORs) and 95%
CIs with the random-effects model. The primary outcome of interest was the
occurrence of major adverse cardiac and cerebrovascular events (MACCE),
defined as a composite of all cause mortality, myocardial infarction, and
stroke. <br/>Result(s): The analysis included 2,245 patients from 8
studies (1 randomized controlled trial and 7 observational studies). The
risk of MACCE with HCR and CABG were 3.6% and 5.4%, respectively (OR,
0.53; 95% CI, 0.24-1.16). Compared to CABG group, patients in HCR group
had similar risk of all cause mortality (OR, 0.85; 95% CI, 0.38-1.88),
myocardial infarction (OR, 0.72; 95% CI, 0.31-1.64), stroke (OR, 0.53; 95%
CI, 0.23-1.20), and repeat revascularization (OR, 1.28; 95% CI,
0.58-2.83). The need for postoperative blood transfusions (OR, 0.29; 95%
CI, 0.14-0.59) and hospital stay (weighted mean difference -1.20 days; 95%
CI -1.52 to -0.88 days) was significantly lower in the HCR group.
<br/>Conclusion(s): HCR appears to be safe, and has similar outcomes when
compared with conventional CABG. HCR can be a suitable alternative to
conventional CABG in select patients with MVCAD. &#xa9; 2017 Wiley
Periodicals, Inc.

<68>
Accession Number
623352675
Title
Efficacy of Xuebijing Injection () on Cardiopulmonary Bypass-Associated
Pulmonary Injury: A Prospective, Single-center, Randomized, Double Blinded
Trial.
Source
Chinese Journal of Integrative Medicine. 24 (11) (pp 815-821), 2018. Date
of Publication: 01 Nov 2018.
Author
Gao W.; Li N.; Cui X.-G.
Institution
(Gao, Li, Cui) Department of Anesthesiology, the Second Affiliated
Hospital of Harbin Medical University, Harbin 150081, China
Publisher
Chinese Journal of Integrated Traditional and Western Medicine Press
(E-mail: cjim@jia.net)
Abstract
Objective: To evaluate the efficacy of Xuebijing Injection (, XBJ) on the
lung injury induced by cardiopulmonary bypass (CPB). <br/>Method(s): Fifty
patients undergoing CPB were randomized to either the saline group or XBJ
group according to a random number table (25 cases in each group). The
patients in the saline group received saline and patients in XBJ group
received XBJ at 12 h prior to the operation, at the beginning of the
operation, and at 12 h after the second injection. The
PaO<inf>2</inf>/FiO<inf>2</inf> at extubation 3 days post-operation,
duration of ventilation in the intensive care unit (ICU), and lengths of
stay in the ICU and hospital were recorded. The levels of inflammatory
mediators including interleukin (IL)-1beta, IL-8, IL-10, and C-reactive
protein (CRP) in bronchoalveolar lavage fluid (BALF) and plasma were
measured. The neutrophil count and elastase neutrophil elastase in BALF
were also measured. In addition, adverse events were monitored.
<br/>Result(s): The PaO<inf>2</inf>/FiO<inf>2</inf> in the XBJ group was
higher than that in the saline group from 12 to 72 h post-operation (all
P<0.05). The blood levels of IL-1beta, IL-8, and CRP in the XBJ group from
12 to 72 h were all significantly lower than those in the saline group
(all P<0.05). In contrast, the level of the anti-inflammatory cytokine
IL-10 was significantly higher in the XBJ group than in the saline group
(P<0.05). In addition, 4 patients presented with atelectasis in the saline
group and none in the XBJ group. Ten patients experienced mild acute
respiratory distress syndrome (ARDS) during hospitalization, and 5
patients with mild ARDS were in the XBJ group (P<0.05).
<br/>Conclusion(s): XBJ shows protective potential against lung injury in
patients who undergo CPB surgery, possibly through the downregulation of
inflammatory mediators, reduction in neutrophil infiltration, and
upregulation of IL-10 (Trial registry: ChiCTR-TRC-14004628).<br/>Copyright
&#xa9; 2018, Chinese Association of the Integration of Traditional and
Western Medicine.

<69>
Accession Number
616523419
Title
Late Incomplete stent apposition is associated with late/very late stent
thrombosis: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 91 (3) (pp 365-375),
2018. Date of Publication: 15 Feb 2018.
Author
Sethi A.; Singbal Y.; Rastogi U.; Prasad V.S.
Institution
(Sethi, Rastogi) Department of Interventional Cardiology, Icahn School of
Medicine at Mount Sinai, NY, United States
(Singbal) Department of Cardiology, University of Queensland, Brisbane,
Australia
(Prasad) Department of Cardiology, Loma Linda University, CA, United
States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: There is a lingering controversy in the current literature
about the impact of late incomplete stent apposition (LISA) on clinical
outcomes, especially stent thrombosis (ST). Therefore, we aimed to
synthesize the available evidence evaluating the association between LISA
and adverse clinical outcomes. <br/>Method(s): We systematically searched
electronic databases for studies reporting clinical outcomes in patients
with and without LISA. Relevant study characteristics and clinical
outcomes were extracted. Incidence rate ratios (IRR) and 95% Confidence
Interval (CI) were computed. Sensitivity analyses were done.
<br/>Result(s): Sixteen studies with 4,946 patients; 666 patients with
20,035 patient-months follow up with LISA and 4,280 patients with 121,855
patient-months follow up without LISA were included. The estimated
prevalence of LISA at follow up was 16% (95% CI 12-20%). The incidences of
late/very late ST (IRR = 4.81, 95% CI 2.68-8.62) and myocardial infarction
(MI) (IRR = 3.09, 95% CI 1.72-5.55) were significantly higher in the LISA
group compared to patients without LISA. Subset analysis of studies
reporting Academic Research Consortium definitive/probable ST (IRR = 4.98;
95% CI 2.51-9.89) and acquired LISA (IRR = 3.67, 95% CI 1.5-9.0) similarly
showed increased risk of late/very late ST. The results of sensitivity
analyses were consistent. There was no difference in cardiac death and
target lesion revascularization. <br/>Conclusion(s): The presence of LISA
at a follow up of 6-18 months after stent implantation is associated with
a higher risk of late/very late ST and MI. Additional studies are required
to establish a cause and effect, and inform the management strategy.
&#xa9; 2017 Wiley Periodicals, Inc.

<70>
Accession Number
616160579
Title
The effectiveness of modern cardiac rehabilitation: A systematic review of
recent observational studies in non-attenders versus attenders.
Source
PLoS ONE. 12 (5) (no pagination), 2017. Article Number: e0177658. Date of
Publication: May 2017.
Author
Sumner J.; Harrison A.; Doherty P.
Institution
(Sumner, Harrison, Doherty) University of York, Department of Health
Sciences, York, United Kingdom
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background The beneficial effects of cardiac rehabilitation (CR) have been
challenged in recent years and there is now a need to investigate whether
current CR programmes, delivered in the context of modern cardiology,
still benefit patients. Methods A systematic review of non-randomised
controlled studies was conducted. Electronic searches of Medline, Embase,
CINAHL, science citation index (web of science), CIRRIE and Open Grey were
undertaken. Non-randomised studies investigating the effects of CR were
included when recruitment occurred from the year 2000 onwards in
accordance with significant CR guidance changes from the late 1990's.
Adult patients diagnosed with acute myocardial infarction (AMI) were
included. Non-English articles were considered. Two reviewers
independently screened articles according to pre-defined selection
criteria as reported in the PROSPERO database (CRD42015024021). Results
Out of 2,656 articles, 8 studies involving 9,836 AMI patients were
included. Studies were conducted in 6 countries. CR was found to reduce
the risk of all-cause and cardiac-related mortality and improve
Health-Related Quality of Life (HRQOL) significantly in at least one
domain. The benefits of CR in terms of recurrent MI were inconsistent and
no significant effects were found regarding re-vascularisation or
re-hospitalisation following AMI. Conclusion Recent observational evidence
draws different conclusions to the most current reviews of trial data with
respect to total mortality and re-hospitalisation, questioning the
representativeness of historic data in the modern cardiological era.
Future work should seek to clarify which patient and service level factors
determine the likelihood of achieving improved allcause and cardiac
mortality and reduced hospital re-admissions.<br/>Copyright &#xa9; This is
an open access article, free of all copyright, and may be freely
reproduced, distributed, transmitted, modified, built upon, or otherwise
used by anyone for any lawful purpose. The work is made available under
the Creative Commons CC0 public domain dedication.

<71>
Accession Number
2001554150
Title
Is Surgery Really Better than MitraClip? Meta Analysis Evaluating Short-,
Intermediate-, and Long-Term Mortality in Patients Undergoing MitraClip Vs
Surgery.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2019 Cardiovascular
Research Technologies. United States. 12 (4 Supplement) (pp S59), 2019.
Date of Publication: 25 February 2019.
Author
Ashukem M.; Pandya B.; Gulati M.; Hurst T.; Gramze N.; Biglari D.; Fang
K.; Abbas F.; Agarwal S.; Gellert G.; Patel N.; Ligita C.; Butman S.; Su
W.; Kalya A.; Arabia F.; Pershad A.; Gopalan R.; Verma D.R.
Institution
(Ashukem, Gulati, Hurst, Gramze, Biglari, Fang, Abbas, Agarwal, Gellert,
Patel, Ligita, Su, Kalya, Arabia, Pershad, Gopalan, Verma) University of
Arizona-Phx/Banner University Medical Center, Scottsdale, AZ, United
States
(Pandya) Staten Island University Hospital, Northwell Health, Staten
Island, NY, United States
(Butman) Heart & Vascular Center of Northern Arizona, Cottonwood, AZ,
United States
Publisher
Elsevier Inc.
Abstract
Background: Percutaneous mitral valve repair with MitraClip is a promising
alternative to traditional mitral valve surgery in patients with severe,
symptomatic mitral regurgitation. Impact of MitraClip on survival compared
to mitral valve surgery is not known. <br/>Method(s): PubMed, EMBASE, and
Google Scholar databases were queried for all trials about MitraClip
compared with optimal medical therapy. <br/>Result(s): Ten trials
including 1780 patients were analyzed in this meta-analysis. Survival data
regarding short-, intermediate- (1 year), and long-term (> 1 year) for
MitraClip vs mitral valve surgery was collected. There was no difference
in 30-day mortality (OR 0.74, 95% CI 0.35-1.55) while 1-year and long-term
follow-up showed significant mortality advantage with mitral valve surgery
compared to MitraClip (OR 1.44, 95% CI 1.04-1.99 and OR 1.73, 95% CI
1.30-2.31, respectively). Absolute risk reduction with mitral valve
surgery was 3.4% at 1 year and 12.1% at long-term follow-up. Number needed
to treat with mitral valve surgery to save 1 life at 1-year and at
long-term follow-up was 29 and 8.3, respectively. <br/>Conclusion(s): In
this meta-analysis, mitral valve surgery was associated with survival
benefit at 1-year and long-term follow-up. This analysis supports mitral
valve surgery as the first option for eligible patients. [Figure
presented]<br/>Copyright &#xa9; 2019

<72>
Accession Number
2001554146
Title
Mortality Advantage of Mitraclip in Patients with Heart Failure and Mitral
Regurgitation: An Updated Meta-Analysis.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2019 Cardiovascular
Research Technologies. United States. 12 (4 Supplement) (pp S56), 2019.
Date of Publication: 25 February 2019.
Author
Pandya B.; Ashukem M.; Gulati M.; Hurst T.; Biglari D.; Gramze N.; Butman
S.; Fang K.; Ligita C.; Agarwal S.; Kalya A.; Abbas F.; Patel N.; Su W.;
Gellert G.; Arabia F.; Pershad A.; Gopalan R.; Verma D.R.
Institution
(Pandya) Department of Cardiology Hofstra School of Medicine/Staten Island
University Hospital Northwell Health, Staten Island, NY, United States
(Ashukem, Gulati, Hurst, Biglari, Gramze, Butman, Ligita, Agarwal, Kalya,
Abbas, Patel, Su, Gellert, Arabia, Pershad, Gopalan, Verma) Department of
Cardiology, University of Arizona/Banner University Medical Center,
Phoenix, AZ, United States
(Fang) Department of Cardiothorasic surgery, University of Arizona/Banner
University Medical Center, Phoenix, AZ, United States
Publisher
Elsevier Inc.
Abstract
Background: In patients with symptomatic mitral regurgitation who are
high-risk for surgery, transcatheter mitral valve repair has been shown to
be safe and improve clinical outcomes. However, its impact on survival has
shown conflicting results in recent trials. <br/>Method(s): PubMed,
EMBASE, and Google Scholar databases were queried for all trials about
MitraClip compared with optimal medical therapy Results: This
meta-analysis of 9 trials, including 3099 patients, found that patients
treated with MitraClip compared to optimal medical therapy had similar
30-day mortality (OR 0.64, 95% CI 0.32- 1.28) while at 12-months MitraClip
was associated with significantly lower all-cause mortality (OR 0.50, 95%
CI 0.38- 0.66). Absolute risk reduction was 13.9%, and number needed to
treat to save 1 life at 12 months was 7.2. <br/>Conclusion(s): In this
meta-analysis, transcatheter mitral valve repair with MitraClip was
associated with significantly lower mortality at 12 months of follow-up
[Figure presented]<br/>Copyright &#xa9; 2019

<73>
Accession Number
2001554139
Title
Clinical Outocomes of Percutaneous Mitral Valve Repair with MitraClip for
the Management of Functional Mitral Regurgitation.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2019 Cardiovascular
Research Technologies. United States. 12 (4 Supplement) (pp S57-S58),
2019. Date of Publication: 25 February 2019.
Author
Marmagkiolis K.; Hakeem A.; Ebersole D.G.; Iliescu C.; Ates I.;
Cilingiroglu M.
Institution
(Marmagkiolis) Pepin Heart Institute, Florida Hospital Tampa, Tampa, FL,
United States
(Hakeem) Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ,
Canada
(Ebersole) Watson Clinic LLP, Lakeland, FL, United States
(Iliescu) Division of Cardiology, Department of Medicine, MD Anderson
Cancer Center, University of Texas at Houston, Houston, TX, United States
(Ates) Bahcesehir University, School of Medicine, Istanbul, Turkey
(Cilingiroglu) Bahcesehir University, Istanbul, Turkey
Publisher
Elsevier Inc.
Abstract
Objectives: To evaluate the safety and efficacy of percutaneous mitral
valve repair for the management of functional mitral insufficiency.
<br/>Background(s): Severe functional mitral regurgitation (FMR) is
present in 25-30% of patients with heart failure and is an independent
predictor of mortality and hospitalizations in patients with both ischemic
and non-ischemic cardiomyopathy. MitraClip therapy has been approved for
high-surgical-risk patients with primary mitral regurgitation. Recent
studies, including 2 randomized trials, have yielded conflicting results
in terms of its clinical efficacy and outcomes for FMR. A quantitative
evaluation and synthesis of this information are essential in elucidating
the role of Mitraclip repair for FMR Methods: We performed a literature
search using PubMed, EMBASE, and Cochrane Central Register of Controlled
Trials from September 2008 to September 2018. Studies comparing
percutaneous mitral valve repair using the MitraClip device against
conservative therapy for the management of FMR were included.
<br/>Result(s): Seven studies with 1174 patients in the MitraClip group
and 1015 patients in the medical therapy group met inclusion criteria. The
12-month mortality in the MitraClip group was 18.4% compared with 25.9% in
the medical therapy group (OR 0.65 [0.50, 0.86]; P<0.002). The rate of
readmission at 12 months was 29.9% in the MitraClip group compared with
54.1% in the medical therapy group (OR: 040 [0.32-0.49]; p< 0.0001). The
prognostic efficacy of MitraClip repair appears to be more substantial
over a longer follow-up period over medical therapy alone.
<br/>Conclusion(s): Based on the results of this meta-analysis,
percutaneous mitral valve repair with MitraClip appears to be superior to
medical therapy for symptomatic moderate-to-severe functional mitral
insufficiency.<br/>Copyright &#xa9; 2019

<74>
Accession Number
2001554135
Title
Transcatheter versus Surgical Aortic Valve Replacement in Patients with
Chronic Liver Disease: A Meta-analysis.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2019 Cardiovascular
Research Technologies. United States. 12 (4 Supplement) (pp S50), 2019.
Date of Publication: 25 February 2019.
Author
Ndunda P.M.; Vindhyal M.; Srinivasan S.; Muutu T.; Fanari Z.
Institution
(Ndunda, Vindhyal, Srinivasan, Muutu) University of Kansas School of
Medicine - Wichita, Wichita, KS, United States
(Fanari) Heartland Cardiology/Wesley Medical Center Structural Heart
Program & University of Kansas School of Medicine - Wichita, Wichita, KS,
United States
Publisher
Elsevier Inc.
Abstract
Background: Cirrhosis increases cardiac surgical risk with a 30-day
mortality of 9-52% in Child-Pugh class A and C, respectively. A higher
Model for End-stage Liver Disease excluding International normalized ratio
(MELD-XI) score is associated with higher mortality following
transcatheter aortic valve replacement (TAVR). The objective of this
systematic review and meta-analysis was to compare clinical outcomes in
patients with cirrhosis undergoing either TAVR or surgical aortic valve
replacement (SAVR). <br/>Method(s): Medline, Cochrane Library, Web of
Science, and Google Scholar were searched for relevant studies. Two
investigators independently reviewed studies that were either randomized
controlled trials or controlled observational studies. They also
independently extracted data and assessed the risk of bias of the studies
using the Cochrane Collaboration tools (RoB2.0 and ROBINS-I).
<br/>Result(s): Five studies (5 controlled observational studies) with
2236 patients were included in the quantitative analysis, including 359
TAVR and 1877 SAVR patients. Patients undergoing TAVR had lower rates of
in-hospital mortality [6.6% vs 13.7%; OR 0.46 (95% CI 0.25, 0.85)
I²=0%] blood transfusion [13.4% vs 28.4%; OR 0.35 (95% CI 0.24,
0.52) I²=22%], mean peri-procedural length of hospital stay
[10.9 vs 15.7 days; MD -6.32 (SD -10.28, -2.36) I²=83%], and a
higher proportion of patients discharged home [73.5% vs 58.2%; OR 2.01
(95% CI 1.30, 3.10) I²=19%]. There was no significant
difference in acute kidney injury [10.6% vs 18.1%; OR 0.54 (95% CI 0.29,
1.02) I² = 0%] and cost of hospitalization [$250,386 vs
$257,464; SMD -0.25 (-0.47, 0.03) I² = 96%].
<br/>Conclusion(s): This analysis suggests that TAVR is associated with
better in-hospital outcomes compared to SAVR in patients with cirrhosis.
[Figure presented]<br/>Copyright &#xa9; 2019

<75>
Accession Number
2001554116
Title
In-Hospital Outcomes of Patients with Bicuspid Aortic Valve Undergoing
Transcatheter Aortic Valve Replacement: A Nationwide Analysis.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2019 Cardiovascular
Research Technologies. United States. 12 (4 Supplement) (pp S45), 2019.
Date of Publication: 25 February 2019.
Author
Bandyopadhyay D.; Claessen B.E.; Chakraborty S.; Mehran R.
Institution
(Bandyopadhyay) Mount Sinai St Luke's Roosevelt, New York, NY, United
States
(Claessen, Mehran) Icahn School of Medicine at Mount Sinai, New York, NY,
United States
(Chakraborty) Interfaith Medical Center, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has
revolutionized the treatment of severe symptomatic aortic stenosis (AS).
Traditionally congenital bicuspid aortic valve (BAV) stenosis patients had
been excluded from TAVR studies. Now TAVR is increasingly used in BAV
stenosis. But data regarding the outcome of TAVR in BAV patients is
scarce. Here we analyze the most recent national inpatient sample (NIS) to
investigate the impact of BAV in-hospital outcomes in patients undergoing
TAVR for severe AS. <br/>Method(s): In this retrospective cohort study, we
used the recently published 2016 NIS database using the ICD 10 codes for
both TAVR and BAV. Primary outcomes of interest were mortality,
cardiogenic shock, cardiac arrest, stroke, and acute kidney injury.
Multivariate logistic regression was used to adjust for potential
confounders including age, gender, race, socioeconomic status, diabetes,
hypertension, smoking, alcohol use, chronic kidney disease, obesity, and
dyslipidemia. We used STATA 15.1 for analysis. <br/>Result(s): A total of
33590 patients underwent TAVR, of which 335 patients had a concurrent
diagnosis of BAV. Mean age was lower in patients with BAV (69.5yrs. vs.
80.5 yrs.). Chronic kidney disease was significantly higher in patients
undergoing TAVR without BAV than those with BAV. There was no significant
difference in mortality, stroke, acute kidney injury, cardiac arrest,
cardiogenic shock, length of stay, or cost of care in patients undergoing
TAVR with a concurrent diagnosis of BAV than those without BAV.
<br/>Conclusion(s): In this study, we demonstrated that the presence of
BAV did not significantly impact the in-hospital mortality and morbidity
in patients undergoing TAVR. New-generation devices and increasing
expertise with TAVR might be the reason. Randomized clinical trials are
needed to evaluate the potential of TAVR in BAV patients. [Figure
presented]<br/>Copyright &#xa9; 2019

<76>
Accession Number
2001554114
Title
Usefulness of Skeletal Muscle Area Detected by Computed Tomography to
Predict Mortality in Patients Undergoing Transcatheter Aortic Valve
Replacement: A Meta-Analysis.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2019 Cardiovascular
Research Technologies. United States. 12 (4 Supplement) (pp S51), 2019.
Date of Publication: 25 February 2019.
Author
Soud M.; Alahdab F.; Ho G.; Cejudo-Tejeda M.; Hideo-Kajita A.; Kuku K.;
Garcia-Garcia H.
Institution
(Soud, Ho, Cejudo-Tejeda, Hideo-Kajita, Kuku, Garcia-Garcia) MedStar
Washington Hospital Center, Washington, DC, United States
(Alahdab) Mayo Clinic Evidence-based Practice Center, Rochester, MN,
United States
Publisher
Elsevier Inc.
Abstract
Background: Sarcopenia, which is referred to as low muscle mass measured
from the readily available preoperative computed tomography (CT) images,
has been recently suggested as a predictor of outcomes in patients
undergoing transcatheter aortic valve replacement (TAVR). However, results
of these studies are variable, and therefore, we performed a meta-analysis
of the current literature to evaluate sarcopenia as a predictor of outcome
post TAVR. <br/>Method(s): Using PubMed/Medline, Embase, Scopus database,
and conference abstracts between January 2008 and February 2018, we
identified studies that reported CT-derived skeletal muscle area (SMA) and
survival outcomes post TAVR. Studies were evaluated for the incidence of
early (<= 30 days) and late all-cause mortality (> 30 days) post TAVR.
<br/>Result(s): Seven studies with 1881 patients were included (mean age
of 81.8 years +/- 12 years, 55.9% men). Mean body mass index (BMI) was
28.2 kg/m2 +/- 1.1, mean Society of Thoracic Surgeons risk score was 7.0
+/- 0.6, and mean albumin level was 3.8 g/dL +/- 0.1. (odds ratio [OR]:
0.49, 95% confidence interval [CI]: 0.28 to 0.83, p = 0.049; Figure 1A).
Similarly, short-term mortality after TAVR was reduced in non-sarcopenic
patients; however, it was not statistically significant (OR: 0.72; 95% CI:
0.44-1.18; P = 0.285; Figure 1B). <br/>Conclusion(s): CT-derived skeletal
muscle area provides value in predicting post-TAVR long-term outcomes for
patients undergoing TAVR. This is a simple risk assessment tool that may
help in making treatment decisions and planning for TAVR procedure.
[Figure presented]<br/>Copyright &#xa9; 2019

<77>
Accession Number
2001554112
Title
1-Year Outcomes of Transcatheter Aortic Valve Replacement Versus Surgical
Aortic Valve Replacement in Patients at Intermediate Surgical Risk: A
Propensity-Match Analysis from the SURTAVI Trial.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2019 Cardiovascular
Research Technologies. United States. 12 (4 Supplement) (pp S42-S43),
2019. Date of Publication: 25 February 2019.
Author
Yakubov S.J.; Popma J.J.; Van Mieghem N.M.; Serruys P.W.; Kappetein A.-P.;
Reardon M.J.
Institution
(Yakubov) Riverside Methodist Hospital, Columbus, OH, United States
(Popma) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Van Mieghem) Erasmus Medical Center, Rotterdam, Netherlands
(Serruys) Imperial College London, London, United Kingdom
(Kappetein) Medtronic, Mounds View, MN, United States
(Reardon) Houston Methodist Debakey Heart and Vascular Center, Houston,
TX, United States
Publisher
Elsevier Inc.
Abstract
Background: The SURTAVI trial demonstrated the noninferiority of
transcatheter aortic valve replacement (TAVR) using a self-expanding valve
to surgical aortic valve replacement (SAVR) in patients with severe,
symptomatic aortic stenosis at intermediate risk for surgery. The majority
of TAVR patients in SURTAVI received an early-generation device which is
no longer commercially available. This analysis compares TAVR outcomes in
intermediate-risk patients that received the next-generation recapturable
Evolut R valve to those of similar patients randomized to SAVR in the
SURTAVI trial. <br/>Method(s): The continued access study of SURTAVI
enrolled 290 patients between September 2016 and July 2017 at 59 sites in
the United States. Of them, 252 were implanted with the 23, 26, or 29 mm
Evolut R device. Propensity-score matching between this group and the
SURTAVI SAVR patients with annular diameter of 26 mm or less was based on
22 clinical characteristics, resulting in 196 matched pairs for analysis.
Clinical outcomes to 1 year were compared. <br/>Result(s): After matching,
the mean age for both TAVR and SAVR patients was 79.4 years. The mean
STS-PROM was 4.0 +/- 1.5% for TAVR and 3.9 +/- 1.3% for SAVR. The rate of
1-year all-cause mortality or disabling stroke was statistically
significant in favor of TAVR (3.6% vs. 9.8%; p=0.01). Other 30-day and
1-year Kaplan-Meier clinical event rates for the propensity-matched pairs
are shown (Table 1). <br/>Conclusion(s): Compared to SAVR, TAVR using
Evolut R led to significantly better 1-year outcome in terms of all-cause
mortality or disabling stroke, suggesting that this may be the preferred
treatment for patients with severe, symptomatic aortic stenosis at
intermediate surgical risk. [Figure presented]<br/>Copyright &#xa9; 2019

<78>
Accession Number
2001554099
Title
Long Term Outcomes of Transcatheter Aortic Valve Replacement Among
Patients with Low Gradient Severe Aortic Stenosis: Systematic Review and
Meta-analysis.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2019 Cardiovascular
Research Technologies. United States. 12 (4 Supplement) (pp S48), 2019.
Date of Publication: 25 February 2019.
Author
Osman M.; Ghaffar Y.A.; Foster T.J.; Alqahtani F.; Kheiri B.; Alhamoud H.;
Osman K.; Shah K.; Alkhouli M.
Institution
(Osman, Ghaffar, Foster, Alqahtani, Alhamoud, Shah, Alkhouli) West
Virginia University, Morgantown, WV, United States
(Kheiri) Hurley Medical Center, Flint, MI, United States
(Osman) Michigan Health Specialists, Flint, MI, United States
Publisher
Elsevier Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has emerged as
an effective therapy for patients with severe aortic stenosis. Data are
lacking regarding outcomes of TAVR among patients with low gradient severe
aortic stenosis. <br/>Method(s): We conducted a literature search of
PubMed, Embase, and Cochrane Library from inception through November 2018.
Studies reporting outcomes of TAVR in patients with severe aortic stenosis
and low gradient were included. The primary endpoint was all-cause
mortality. Secondary endpoints included cardiovascular mortality and
periprocedural mortality. <br/>Result(s): 26 studies fulfilled the
inclusion criteria and were included in the analysis. The pooled analysis
included 5.823 patients, mean age 81+/- 2 years and 51% were females.
Long-term all-cause mortality per person years among patients with low
gradient, classical low gradient, and paradoxical low gradient aortic
stenosis was 20.8% (95% CI 17.1%-24.4%) p<0.001, 25.3% (95% CI 19.5%-31%)
p<0.001, and 15.8% (95% CI 12.4%-19.1%) p<0.001, respectively. The 30-day
mortality was 7.6% (95% CI 6.1%9.6%) p<0.001, 11.6% (95 % CI 6.4%-20.1%),
p<0.001, and 7.1% (95% CI 5.4%-9.2%) p<0.001 among patients with low
gradient, classical low gradient, and paradoxical low gradient,
respectively. Long-term cardiovascular mortality per person years was 12%
(95% CI 8.5%-15.1%) p<0.001, 13.8% (95% CI 10%-17.6%) p<0.001, and 8.4%
(95% CI3.5.5%-11.2%) p<0.001 among patients with low gradient, classical
low gradient, and paradoxical low gradient, respectively.
<br/>Conclusion(s): Long-term all-cause, 30-day mortality, and
cardiovascular mortality were higher among patients with classical low
gradient compared to patients with paradoxical low gradient severe aortic
stenosis.<br/>Copyright &#xa9; 2019

<79>
Accession Number
2001554097
Title
Prevalence and Outcomes of Cardiac Amyloidosis in Patients with Aortic
Stenosis Referred for Aortic Valve Replacement: A Systematic Review and
Meta-Analysis.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2019 Cardiovascular
Research Technologies. United States. 12 (4 Supplement) (pp S51-S52),
2019. Date of Publication: 25 February 2019.
Author
Ndunda P.M.; Muutu T.; Vindhyal M.; Khayyat S.; Fanari Z.
Institution
(Ndunda, Muutu, Vindhyal, Khayyat, Fanari) University of Kansas School of
Medicine - Wichita, Wichita, KS, United States
Publisher
Elsevier Inc.
Abstract
Introduction: Studies suggest an association between transthyretin-related
cardiac amyloidosis (ATTR CA) and calcific aortic stenosis (AS). The
prevalence of cardiac amyloidosis in patients undergoing transcatheter
aortic valve replacement (TAVR) and surgical aortic valve replacement
(SAVR) and the clinical outcomes in this population is not clear.
<br/>Method(s): Four databases were searched for both interventional and
observational studies: PubMed, Cochrane Library, Web of Science and Google
Scholar. Two investigators independently screened, selected, and assessed
studies for risk of bias using the Cochrane Collaboration tools.
<br/>Result(s): Thirteen studies were selected for qualitative analysis.
The diagnosis of amyloidosis was made either on biopsy or ^99m
Technetium scintigraphy in 12 studies and cardiac magnetic resonance in 1
study. The mean age ranged from 70-88 years, and the percentage of males
ranged from 50%-92%. Six observational studies reported prevalence of ATTR
CA in patients evaluated for TAVR or SAVR (pooled prevalence 11% [95% CI
6.9%, 15.1%; I² = 73%]). Five studies reported the proportion
of patients with low-flow, low-gradient AS among those with AS and ATTR CA
(pooled proportion 0.685 [0.484, 0.886; I² = 73%]). Low-flow,
low-gradient AS was more common among patients with ATTR CA compared with
those with AS alone (pooled OR 3.17 [95% CI 1.4 - 7.16; I² =
0%]). Two studies compared mortality in AS patients with and without ATTR
amyloidosis (56% vs 20%; HR 2.92 [95% CI 1.09, 7.86]) and (50% vs 5.7%; HR
9.5 [95% CI 2.5, 35.8]) at 1 and 2 years, respectively. One study compared
mortality after any aortic valve replacement with medical therapy (HR 0.29
[0.15,0.58] p <0.001). Another reported mortality at a median follow-up of
33 months: SAVR - 25%, TAVR - 6.2%, medical therapy - 12.5%. One study
showed no difference in 2-year mortality in patients with ATTR amyloidosis
and AS vs ATTR amyloidosis without AS (37% vs 33%; HR 1.22 [0.62 - 2.42] p
= 0.566). <br/>Conclusion(s): The pooled prevalence of ATTR CA in patients
with AS undergoing aortic valve replacement was 11%, and of those, 68.5%
had low-flow, low-gradient AS. ATTR CA is associated with worse outcomes
in patients with AS, but there is a need for more studies to determine the
optimal type of aortic valve replacement.<br/>Copyright &#xa9; 2019

<80>
Accession Number
2001554091
Title
The Percutaneous Approach and Myocardial Revascularization Surgery to Left
Coronary Artery Tron Injury.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2019 Cardiovascular
Research Technologies. United States. 12 (4 Supplement) (pp S16-S17),
2019. Date of Publication: 25 February 2019.
Author
dos Santos C.T.; Macedo T.L.S.; dos Anjos I.L.P.B.; Rebello D.M.; Machado
R.F.S.; Rosa R.B.R.; de Aragao I.P.B.
Institution
(dos Santos, Macedo, dos Anjos, Rebello, Machado, Rosa, de Aragao)
Vassouras University, Vassouras, Brazil
Publisher
Elsevier Inc.
Abstract
Cardiovascular atherosclerotic disease is a major cause of morbidity and
mortality in the world, with 36% of deaths in adults between 50 and 64
years old and 42% in people older than 65 years. Injuries of the left
coronary artery (ILCA) tend to myocardial revascularization surgery (MRS)
as the main therapeutic alternative. As percutaneous techniques evolved,
the frequency of this method has increased in medical practice, being also
adopted as an option for patients with prohibitive surgical risk.Our aim
was to analyse the singularities between the intervention of ILCA by MRS
and percutaneous intervention (PI).A systematic literature review with
meta-analysis was based on seven articles, from 2007 to 2017, based on
Scielo, Lilacs and PubMed. The PRECOMBAT study randomized 600 patients
with injuries greater than 50% in the area to receive the two
interventions. It was observed that PI was not inferior to MRS, presenting
a composite rate of combined primary events of 8.7% and 6.7%, p = 0.001.
The composite events at 24 months had values of 12.2% and 8.1%, p = 0.12
for the respective groups and after that period, the occurrence of stroke,
AMI and death, with rates of 4.4% and 4.7%, p = 0.83 indicating a small
difference. The combined analysis with the SYNTAX trial shows that the
incidence of cerebrovascular and cardiac events at the end of five years
was 23% in MRS and 28.3% in PI. PI was associated with a 67% reduction in
cardiac mortality and 60% in all causes as opposed to surgery. The LEMANS
study with 52 patients with PI and 53 with MRS indicates, at 10 years of
follow-up, higher ejection fraction rates for PI 54.9 +/- 8.3% and 49.8
+/- 10.3%. Mortality is 21.6% and 30.2%. The possibility of 14-year
survival was similar in both groups, with 74.2% and 67.5%, p = 0.34 and
the same was observed with event-free survival, with 34.7% vs. 22.1% p =
0.06. The frequency of heart attacks and strokes, as well as the need for
new revascularizations did not have significant discrepancies, with values
of 8.7% and 10.4%, p = 0.62; 4.3% and 6.3% p = 0.62 and 74.2% and 67.5%, p
= 0.34. Although MRS is more indicated for therapy, the mentioned studies
demonstrate the similarity in results with the percutaneous approach.
Patients with ILCA may have angioplasty as an effective and viable route
compared to long-term surgery, and therefore, it is valid in the
group.<br/>Copyright &#xa9; 2019

<81>
Accession Number
626262180
Title
Isolated right atrial rupture from blunt trauma: a case report with
systematic review of a lethal injury.
Source
Journal of cardiothoracic surgery. 14 (1) (pp 28), 2019. Date of
Publication: 04 Feb 2019.
Author
Maraqa T.; Mohamed M.A.T.; Wilson K.L.; Perinjelil V.; Sachwani-Daswani
G.R.; Mercer L.
Institution
(Maraqa, Perinjelil, Sachwani-Daswani, Mercer) Trauma Department, Hurley
Medical Center, One Hurley Plaza, Flint, MI 48503, United States
(Mohamed) Department of Surgery, Michigan State University College of
Human Medicine, Eyde Building, Suite 600 ,4660 S. Hagadorn Road, East
Lansing, MI 48823, United States
(Wilson) Department of Surgery, University of Chicago, 5841 S. Maryland
Avenue, Chicago, IL 60637, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Isolated right atrial rupture (IRAR) from blunt chest trauma
is rare. There are no physical exam findings and non-invasive testing
specific to the condition, which result in diagnostic delays and poor
outcomes. We present a case of IRAR along with a systematic review of
similar cases in the literature. CASE REPORT: A 23-year-old male presented
following a motor vehicle accident (MVA). He was bradycardic and
hypotensive during transportation; and required intubation. There were
contusions along the right chest wall with clear breath sounds, and no
jugular venous distension, muffled heart sounds. Hemodynamic status
progressively worsened, ultimately leading to his death. However, no
external sources of bleeding or evidence of cardiac tamponade was found.
<br/>METHOD(S): A search of PubMed, Ovid, and the Cochrane Library using:
(Blunt OR Blunt trauma) AND (Laceration OR Rupture OR Tear) AND (Right
Atrium OR Right Atrial). Articles were included if they were original
articles describing cases of IRAR. <br/>RESULT(S): Forty-five reports
comprising seventy-five (n=75) cases of IRAR. <br/>CONCLUSION(S): IRAR
most commonly occurs following MVAs as the result of blunt chest trauma.
Rupture occurs at four distinct sites and is most commonly at the right
atrial appendage. IRAR is a diagnostic challenge and requires a high index
of suspicion, as patients' hemodynamics can rapidly deteriorate. The
presentations vary depending on multiple factors including rupture size,
pericardial integrity, and concomitant injuries. Cardiac tamponade may
have a protective effect by prompting the search for a bleeding source. A
pericardial window can be diagnostic and therapeutic in IRAR. Outcomes are
favourable with timely recognition and prompt surgical intervention.

<82>
Accession Number
626261380
Title
Liberal transfusion strategy to prevent mortality and anaemia-associated,
ischaemic events in elderly non-cardiac surgical patients - the study
design of the LIBERAL-Trial.
Source
Trials. 20 (1) (pp 101), 2019. Date of Publication: 04 Feb 2019.
Author
Meybohm P.; Lindau S.; Treskatsch S.; Francis R.; Spies C.; Velten M.;
Wittmann M.; Gueresir E.; Stoppe C.; Kowark A.; Coburn M.; Selleng S.;
Baschin M.; Jenichen G.; Meersch M.; Ermert T.; Zarbock A.; Kranke P.;
Kredel M.; Helf A.; Laufenberg-Feldmann R.; Ferner M.; Wittenmeier E.;
Gurtler K.-H.; Kienbaum P.; de Abreu M.G.; Sander M.; Bauer M.; Seyfried
T.; Gruenewald M.; Choorapoikayil S.; Mueller M.M.; Seifried E.; Brosteanu
O.; Bogatsch H.; Hasenclever D.; Zacharowski K.
Institution
(Meybohm, Lindau, Choorapoikayil, Zacharowski) Department of
Anaesthesiology, Intensive Care Medicine and Pain Therapy, University
Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
(Treskatsch, Francis, Spies) Department of Anesthesiology, Operative
Intensive Care Medicine, Berlin Institute of Health, Charite -
Universitatsmedizin Berlin, Freie Universitat Berlin, Campus Benjamin
Franklin, Humboldt-Universitat zu Berlin ,Campus Charite Mitte ,Campus
Virchow KlinikumCharite, Berlin, Germany
(Velten, Wittmann) Department of Anaesthesiology and Intensive Care
Medicine, University Hospital Bonn, Bonn, Germany
(Gueresir) Department of Neurosurgery, University Hospital Bonn, Bonn,
Germany
(Stoppe) Department of Intensive Care Medicine, RWTH University Aachen,
Pauwelstrasse 30, Aachen 52074, Germany
(Kowark, Coburn) Department of Anesthesiology, RWTH University Aachen,
Pauwelstrasse 30, Aachen 52074, Germany
(Selleng, Baschin, Jenichen) Department of Anesthesiology, University
Hospital Greifswald, Greifswald, Germany
(Meersch, Ermert, Zarbock) Department of Anaesthesiology, Intensive Care
and Pain Therapy, University Hospital Munster, Munster, Germany
(Kranke, Kredel, Helf) Department of Anaesthesia and Critical Care,
University Hospital of Wurzburg, Wuerzburg, Germany
(Laufenberg-Feldmann, Ferner, Wittenmeier) Department of Anaesthesiology
and Intensive Care Medicine, University Hospital Mainz, Main, Germany
(Gurtler) Department of Anaesthesiology and Intensive Care Medicine,
University Hospital Augsburg, Augsburg, Germany
(Kienbaum) Department of Anaesthesiology and Intensive Care Medicine,
University Hospital Dusseldorf, Dusseldorf, Germany
(de Abreu) Department of Anaesthesiology and Intensive Care Medicine,
University Hospital Dresden, Dresden, Germany
(Sander) Department of Anaesthesiology and Intensive Care Medicine,
University Hospital Giessen-Marburg, Giessen, Germany
(Bauer) Department of Anaesthesiology and Intensive Care Medicine,
University Hospital Jena, Jena, Germany
(Seyfried) Department of Anaesthesiology and Intensive Care Medicine,
University Hospital Regensburg, Regensburg, Germany
(Gruenewald) Department of Anaesthesiology and Intensive Care Medicine,
University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
(Mueller, Seifried) Institute for Transfusion Medicine and
Immunohaematology Frankfurt/ Main, German Red Cross Blood Transfusion
Service Baden-Wuerttemberg - Hessen, Frankfurt, Germany
(Brosteanu, Bogatsch) Clinical Trial Centre Leipzig, University Leipzig,
Leipzig, Germany
(Hasenclever) Institute for Medical Informatics, Statistics and
Epidemiology, University Leipzig, Leipzig, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: Perioperative anaemia leads to impaired oxygen supply with a
risk of vital organ ischaemia. In healthy and fit individuals, anaemia can
be compensated by several mechanisms. Elderly patients, however, have less
compensatory mechanisms because of multiple co-morbidities and age-related
decline of functional reserves. The purpose of the study is to evaluate
whether elderly surgical patients may benefit from a liberal red blood
cell (RBC) transfusion strategy compared to a restrictive transfusion
strategy. <br/>METHOD(S): The LIBERAL Trial is a prospective, randomized,
multicentre, controlled clinical phase IV trial randomising 2470 elderly
(>= 70years) patients undergoing intermediate- or high-risk non-cardiac
surgery. Registered patients will be randomised only if Haemoglobin (Hb)
reaches <=9g/dl during surgery or within 3days after surgery either to the
LIBERAL group (transfusion of a single RBC unit when Hb<=9g/dl with a
target range for the post-transfusion Hb level of 9-10.5g/dl) or the
RESTRICTIVE group (transfusion of a single RBC unit when Hb<=7.5g/dl with
a target range for the post-transfusion Hb level of 7.5-9g/dl). The
intervention per patient will be followed until hospital discharge or up
to 30days after surgery, whichever occurs first. The primary efficacy
outcome is defined as a composite of all-cause mortality, acute myocardial
infarction, acute ischaemic stroke, acute kidney injury (stage III), acute
mesenteric ischaemia and acute peripheral vascular ischaemia within 90days
after surgery. Infections requiring iv antibiotics with re-hospitalisation
are assessed as important secondary endpoint. The primary endpoint will be
analysed by logistic regression adjusting for age, cancer surgery (y/n),
type of surgery (intermediate- or high-risk), and incorporating centres as
random effect. DISCUSSION: The LIBERAL-Trial will evaluate whether a
liberal transfusion strategy reduces the occurrence of major adverse
events after non-cardiac surgery in the geriatric population compared to a
restrictive strategy within 90days after surgery. TRIAL REGISTRATION:
ClinicalTrials.gov (identifier: NCT03369210 ).

<83>
Accession Number
626274575
Title
Comparison of transcatheter aortic valve implantation with other
approaches to treat aortic valve stenosis: a systematic review and
meta-analysis.
Source
Systematic reviews. 8 (1) (pp 44), 2019. Date of Publication: 05 Feb 2019.
Author
Wagner G.; Steiner S.; Gartlehner G.; Arfsten H.; Wildner B.; Mayr H.;
Moertl D.
Institution
(Wagner, Gartlehner) Department for Evidence-based Medicine and Clinical
Epidemiology, Danube University Krems, Dr.-Karl-Dorrek-Strase 30, Krems
3500, Austria
(Steiner) Division of Interventional Angiology, University Hospital
Leipzig, Liebigstrase 20 ,Haus 4, Leipzig 04103, Germany
(Gartlehner) RTI International, 3040 East Cornwallis Road ,PO Box 12194
,Research Triangle Park, NC, United States
(Arfsten) Department of Medicine II, Division of Cardiology, Medical
University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
(Wildner) University Library-Information Retrieval Office, Medical
University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
(Mayr, Moertl) Department of Internal Medicine 3, University Hospital St.
Poelten, Karl Landsteiner University of Health Sciences, St. Poelten 3100,
Austria
(Mayr, Moertl) Institute for Research of Ischaemic Cardiac Disease and
Rhythmology, Karl Landsteiner Society, St. Poelten 3100, Austria
Publisher
NLM (Medline)
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVI) is an
alternative treatment for patients with symptomatic severe aortic stenosis
ineligible for surgical aortic valve replacement (SAVR) or at increased
perioperative risk. Due to continually emerging evidence, we performed a
systematic review and meta-analysis comparing benefits and harms of TAVI,
SAVR, medical therapy, and balloon aortic valvuloplasty. <br/>METHOD(S):
We searched MEDLINE, Embase, and Cochrane CENTRAL from 2002 to June 6,
2017. We dually screened abstracts and full-text articles for randomized
controlled trials (RCTs) and propensity score-matched observational
studies. Two investigators independently rated the risk of bias of
included studies and determined the certainty of evidence using GRADE
(Grading of Recommendations Assessment, Development and Evaluation). If
data permitted, we performed meta-analyses using random- and fixed-effects
models. <br/>RESULT(S): Out of 7755 citations, we included six RCTs (5862
patients) and 13 observational studies (6376 patients). In meta-analyses,
patients treated with SAVR or TAVI had similar risks for mortality at
30days (relative risk [RR] 1.05; 95% confidence interval [CI] 0.82 to
1.33) and 1 year (RR 1.02; 95% CI 0.93 to 1.13). TAVI had significantly
lower risks for major bleeding but increased risks for major vascular
complications, moderate or severe paravalvular aortic regurgitation, and
new pacemaker implantation compared to SAVR. Comparing TAVI to medical
therapy, mortality did not differ at 30days but was significantly reduced
at 1year (RR 0.51; 95% CI 0.34 to 0.77). <br/>CONCLUSION(S): Given similar
mortality risks but different patterns of adverse events, the choice
between TAVI and SAVR remains an individual one.

<84>
Accession Number
2001547957
Title
Patient Phenotypes, Cardiovascular Risk, and Ezetimibe Treatment in
Patients After Acute Coronary Syndromes (from IMPROVE-IT).
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Sharma A.; Sun J.-L.; Lokhnygina Y.; Roe M.T.; Ahmad T.; Desai N.R.;
Blazing M.A.
Institution
(Sharma, Sun, Lokhnygina, Roe, Blazing) Duke Clinical Research Institute,
Duke University School of Medicine, Durham, NC, United States
(Sharma) Division of Cardiology, Stanford University, Palo Alto, CA,
United States
(Sharma) Division of Cardiology, McGill University Health Centre,
Montreal, Quebec, Canada
(Ahmad, Desai) Yale New Haven Hospital, Yale University, New Haven, CT,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Risk prediction following acute coronary syndrome (ACS) remains
challenging. Data-driven machine-learning algorithms can potentially
identify patients at high risk of clinical events. The Improved Reduction
of Outcomes: Vytorin Efficacy International Trial randomized 18,144
post-ACS patients to ezetimibe + simvastatin or placebo + simvastatin. We
performed hierarchical cluster analysis to identify patients at high risk
of adverse events. Associations between clusters and outcomes were
assessed using Cox proportional hazards models. The primary outcome was
cardiovascular death, nonfatal myocardial infarction, nonfatal stroke,
unstable angina hospitalization, or coronary revascularization >=30 days
after randomization. We evaluated ezetimibe's impact on outcomes across
clusters and the ability of the cluster analysis to discriminate for
outcomes compared with the Global Registry of Acute Coronary Events
(GRACE) score. Five clusters were identified. In cluster 1 (n = 13,252),
most patients experienced a non-STEMI (54.8%). Cluster 2 patients (n =
2,719) had the highest incidence of unstable angina (n = 83.3%). Cluster 3
patients (n = 782) all identified as Spanish descent, whereas cluster 4
patients (n = 803) were primarily from South America (56.2%). In cluster 5
(n = 587), all patients had ST elevation. Cluster analysis identified
patients at high risk of adverse outcomes (log-rank p <0.0001); Cluster 2
(vs 1) patients had the highest risk of outcomes (hazards ratio 1.33, 95%
confidence interval 1.24 to 1.43). Compared with GRACE risk, cluster
analysis did not provide superior outcome discrimination. A consistent
ezetimibe treatment effect was identified across clusters (interaction p =
0.882). In conclusion, cluster analysis identified significant difference
in risk of outcomes across cluster groups. Data-driven strategies to
identify patients who may differentially benefit from therapies and for
risk stratification require further evaluation.<br/>Copyright &#xa9; 2019
Elsevier Inc.

<85>
Accession Number
2001546788
Title
Effect of pranayama on anxiety and pain among patients undergoing cardiac
surgery: A non-randomized controlled trial.
Source
Clinical Epidemiology and Global Health. (no pagination), 2019. Date of
Publication: 2019.
Author
Chandrababu R.; Kurup S.B.; Ravishankar N.; Ramesh J.
Institution
(Chandrababu) Manipal College of Nursing, Manipal Academy of Higher
Education, Manipal, Karnataka 576104, India
(Kurup) Sri Ramachandra College of Nursing, Sri Ramachandra Institute of
Higher Education and Research, Porur, Chennai 600116, India
(Ravishankar) Department of Statistics, Prasanna School of Public Health,
Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
(Ramesh) Udupi College of Nursing, Shree Krishna Educational Trust,
Manipal, Karnataka 576104, India
Publisher
Elsevier B.V.
Abstract
Background: Major cardiac surgery could be physically and mentally
stressful. Anxiety and pain are commonly experienced by patients while
undergoing cardiac surgery. Yoga is recognized as the most beneficial
complementary and alternative therapy. <br/>Objective(s): To assess the
effect of alternate nostril breathing exercises (pranayama) on anxiety and
pain among patients undergoing cardiac surgery. <br/>Method(s): A
non-randomized controlled trial was adopted as study design and involved
48 patients undergoing cardiac surgery. The experimental group (n = 24)
received pranayama study intervention while the control group (n = 24)
received routine care of the hospital. Outcomes were state anxiety and
pain, measured with the state anxiety inventory and a visual analogue
scale respectively. Data were analyzed by SPSS version 20.0. Repeated
measures ANOVA was used to test the effect of the intervention.
<br/>Result(s): Study results showed that patients in the experimental
group experienced a significant decrease in anxiety (p < 0.05) than the
control group. There was a decrease in pain scores but was not
statistically significant across different time point measurements at p <
0.05 between the groups. <br/>Conclusion(s): These findings support the
use of pranayama for decreasing anxiety among patients undergoing cardiac
surgery. However, there is a need for randomized controlled trials with
higher sample size to confirm this results. Future trials also should
focus on the estimation of relevant biomarkers such as endorphins to
understand the scientific rationale.<br/>Copyright &#xa9; 2019 INDIACLEN

<86>
Accession Number
621206984
Title
ZipFix Versus Conventional Sternal Closure: One-Year Follow-Up.
Source
Heart Lung and Circulation. 28 (3) (pp 443-449), 2019. Date of
Publication: March 2019.
Author
Nezafati P.; Shomali A.; Kahrom M.; Omidvar Tehrani S.; Dianatkhah M.;
Nezafati M.H.
Institution
(Nezafati) Cardiac Rehabilitation Research Center, Isfahan Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
(Shomali) Javad Al Aemeh Hospital, Mashhad, Iran, Islamic Republic of
(Kahrom, Nezafati) Cardiac Surgery, Ghaem Hospital, Mashhad University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
(Omidvar Tehrani) Student Research Committee, Mashhad University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
(Dianatkhah) Isfahan Cardiovascular Research Center, Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
Publisher
Elsevier Ltd
Abstract
Background: The present study aimed to compare postoperative complications
commonly revealed after sternotomy closure by new sternal ZipFixTM
(Synthes GmbH, Oberdorf, Switzerland) implant and conventional steel wire.
<br/>Method(s): Among the initial 360 subjects, 326 patients enrolled in
this randomised control trial who were candidates for cardiac surgery from
April 2014 to March 2015. After the surgery, the sternal closure was
randomly done with poly-ether-ether-ketone (PEEK) based sternal ZipFix
(ZF) on the sternal body (n = 168) or with conventional wires (CWs) (n =
158). Patients were followed postoperatively as well as 1, 3, 6, and 12
months after discharge regarding postoperative complications such as pain
severity, dehiscence, and infection including incisional infections
(superficial or deep), and organ/space infection (mediastinitis or
osteomyelitis). <br/>Result(s): The mean age of the ZF and CW groups were
63.58 +/- 10.9 and 62.42 +/- 7.1 years, respectively (p = 0.262). In
addition, there was no significant difference between the two groups'
baseline characteristics (p > 0.05). Our study showed higher mean pain
severity score in the conventional closure group compared with ZipFix
closure group at all study time points (p < 0.001). Infection was seen in
2.76% of the overall participants with no significant difference of
incisional and organ infection between the two groups throughout the
study. After 1-month follow-up, five patients in the CW group had sternal
dehiscence whereas no patients in ZF had dehiscence (p < 0.001).
<br/>Conclusion(s): Our trial demonstrates greater clinical advantages in
terms of pain and sternal dehiscence post surgery by using sternal ZipFix
compared to conventional steel wire.<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)

<87>
Accession Number
2001481092
Title
Alirocumab Reduces Total Nonfatal Cardiovascular and Fatal Events: The
ODYSSEY OUTCOMES Trial.
Source
Journal of the American College of Cardiology. 73 (4) (pp 387-396), 2019.
Date of Publication: 5 February 2019.
Author
Szarek M.; White H.D.; Schwartz G.G.; Alings M.; Bhatt D.L.; Bittner V.A.;
Chiang C.-E.; Diaz R.; Edelberg J.M.; Goodman S.G.; Hanotin C.; Harrington
R.A.; Jukema J.W.; Kimura T.; Kiss R.G.; Lecorps G.; Mahaffey K.W.;
Moryusef A.; Pordy R.; Roe M.T.; Tricoci P.; Xavier D.; Zeiher A.M.; Steg
P.G.
Institution
(Szarek) State University of New York, Downstate School of Public Health,
Brooklyn, NY, United States
(White) University of Auckland and Green Lane Cardiovascular Services
Auckland City Hospital, Auckland, New Zealand
(Schwartz) Division of Cardiology, University of Colorado School of
Medicine, Aurora, CO, United States
(Alings) Amphia Ziekenhuis Molengracht, Breda, Netherlands
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center and Harvard
Medical School, Boston, MA, United States
(Bittner) Division of Cardiovascular Disease, University of Alabama at
Birmingham, Birmingham, AL, United States
(Chiang) General Clinical Research Center, Taipei Veterans General
Hospital and National Yang-Ming University, Taipei, Taiwan (Republic of
China)
(Diaz) Estudios Cardiologicos Latinoamerica, Instituto Cardiovascular de
Rosario, Rosario, Argentina
(Edelberg, Moryusef) Sanofi, Bridgewater, NJ, United States
(Goodman) Canadian VIGOUR Centre, University of Alberta, Edmonton,
Alberta, St. Michael's Hospital, University of Toronto, Toronto, Ontario,
Canada
(Hanotin, Lecorps) Sanofi, Paris, France
(Harrington, Mahaffey) Stanford Center for Clinical Research, Department
of Medicine, Stanford University, Stanford, CA, United States
(Jukema) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Kimura) Kyoto University Graduate School of Medicine, Kyoto-shi, Kyoto,
Japan
(Kiss) Magyar Honvedseg Egeszsegugyi Kozpont, Budapest, Hungary
(Pordy) Regeneron Pharmaceuticals Inc., Tarrytown, NY, United States
(Roe) Division of Cardiology, Department of Medicine, Duke University
School of Medicine, Durham, NC, United States
(Roe, Tricoci) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC, United States
(Xavier) Department of Pharmacology and Division of Clinical Research, St.
John's Medical College and Research Institute, Bangalore, India
(Zeiher) Department of Medicine III, Goethe University, Frankfurt am Main,
Germany
(Steg) Assistance Publique-Hopitaux de Paris, Hopital Bichat, Paris and
Paris Diderot University, Sorbonne Paris Cite FACT (French Alliance for
Cardiovascular Trials), INSERM U1148, Paris, France
(Steg) National Heart and Lung Institute, Imperial College, Royal Brompton
Hospital, London, United Kingdom
Publisher
Elsevier USA
Abstract
Background: The ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes
After an Acute Coronary Syndrome During Treatment With Alirocumab) trial
compared alirocumab with placebo, added to high-intensity or
maximum-tolerated statin treatment, after acute coronary syndrome (ACS) in
18,924 patients. Alirocumab reduced the first occurrence of the primary
composite endpoint and was associated with fewer all-cause deaths.
<br/>Objective(s): This pre-specified analysis determined the extent to
which alirocumab reduced total (first and subsequent) nonfatal
cardiovascular events and all-cause deaths in ODYSSEY OUTCOMES.
<br/>Method(s): Hazard functions for total nonfatal cardiovascular events
(myocardial infarction, stroke, ischemia-driven coronary
revascularization, and hospitalization for unstable angina or heart
failure) and death were jointly estimated, linked by a shared frailty
accounting for patient risk heterogeneity and correlated within-patient
nonfatal events. An association parameter also quantified the strength of
the linkage between risk of nonfatal events and death. The model provides
accurate relative estimates of nonfatal event risk if nonfatal events are
associated with increased risk for death. <br/>Result(s): With 3,064 first
and 5,425 total events, 190 fewer first and 385 fewer total nonfatal
cardiovascular events or deaths were observed with alirocumab compared
with placebo. Alirocumab reduced total nonfatal cardiovascular events
(hazard ratio: 0.87; 95% confidence interval: 0.82 to 0.93) and death
(hazard ratio: 0.83; 95% confidence interval: 0.71 to 0.97) in the
presence of a strong association between nonfatal and fatal event risk.
<br/>Conclusion(s): In patients with ACS, the total number of nonfatal
cardiovascular events and deaths prevented with alirocumab was twice the
number of first events prevented. Consequently, total event reduction is a
more comprehensive metric to capture the totality of alirocumab clinical
efficacy after ACS.<br/>Copyright &#xa9; 2019 The Authors

<88>
Accession Number
626076643
Title
Multicentre, open-label, randomised controlled clinical trial to assess
the efficacy and safety of appropriate target values for lipid management
in patients who have mild-to-moderate stenotic lesions with high-risk
plaques in coronary arteries: Study protocol.
Source
BMJ Open. 9 (1) (no pagination), 2019. Article Number: e022843. Date of
Publication: 01 Jan 2019.
Author
Matsuda M.; Kada A.; Saito A.M.; Hasegawa K.
Institution
(Matsuda) Institute for Clinical Research, National Hospital Organization
Kure Medical Center, Kure, Japan
(Matsuda, Kada, Saito) Clinical Research Center, National Hospital
Organization Nagoya Medical Center, Nagoya, Japan
(Hasegawa) Division of Translational Research, National Hospital
Organization Kyoto Medical Center, Kyoto, Japan
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction To detect patients at high risk of developing myocardial
infarction, plaque characteristics as well as the degree of stenosis in
coronary arteries should be evaluated. However, unstable plaque or severe
calcification detected via coronary artery CT (CACT) is not reflected in
risk stratification according to current guidelines. It is hypothesised
that patients with high-risk findings on CACT (even those without proven
history of coronary artery diseases; CAD) should be strictly managed to
lower their low-density lipoprotein cholesterol (LDL-C) levels to targets
of secondary prevention. Currently, however, there is no evidence based on
prospective randomised intervention studies to prove this hypothesis.
Methods and analysis Patients with mild-to-moderate stenotic lesions with
positive remodelling or severe calcification, but without any history of
CAD, will be randomly allocated to group A (reduce LDL-C to <120~160 mg/dL
according to the primary prevention criteria based on the Japan
Atherosclerosis Society (JAS) Guideline for Prevention of Atherosclerotic
Cardiovascular Diseases 2017) and group B (reduce LDL-C to <70 mg/dL
according to the secondary prevention criteria for high risk based on the
JAS Guideline). They will be strictly managed to achieve the LDL-C
targets. We will follow-up and evaluate the composite endpoints consisting
of major cardiovascular events (death from CAD, non-fatal myocardial
infarction, operation for coronary revascularisation and stroke) and
stenosis progression or new stenosis development for 3 years. Ethics and
dissemination The study was approved by the National Hospital Organization
Central Research Ethics Committee. The results of this study are scheduled
to be published within 2 years after study completion via conference
presentation or journal publication.<br/>Copyright &#xa9; 2018 Author(s)
(or their employer(s)).

<89>
Accession Number
2001516901
Title
Efficacy and safety of statin therapy in older people: a meta-analysis of
individual participant data from 28 randomised controlled trials.
Source
The Lancet. 393 (10170) (pp 407-415), 2019. Date of Publication: 2 - 8
February 2019.
Author
Armitage J.; Baigent C.; Barnes E.; Betteridge D.J.; Blackwell L.; Blazing
M.; Bowman L.; Braunwald E.; Byington R.; Cannon C.; Clearfield M.;
Colhoun H.; Collins R.; Dahlof B.; Davies K.; Davis B.; de Lemos J.; Downs
J.R.; Durrington P.; Emberson J.; Fellstrom B.; Flather M.; Ford I.;
Franzosi M.G.; Fulcher J.; Fuller J.; Furberg C.; Gordon D.; Goto S.;
Gotto A.; Halls H.; Harper C.; Hawkins C.M.; Herrington W.; Hitman G.;
Holdaas H.; Holland L.; Jardine A.; Jukema J.W.; Kastelein J.; Kean S.;
Keech A.; Kirby A.; Kjekshus J.; Knatterud (deceased) G.; Knopp (deceased)
R.; Koenig W.; Koren M.; Krane V.; Landray M.J.; LaRosa J.; Lonn E.;
MacFarlane P.; MacMahon S.; Maggioni A.; Marchioli R.; Marschner I.;
Mihaylova B.; Moye L.; Murphy S.; Nakamura H.; Neil A.; Newman C.;
O'Connell R.; Packard C.; Parish S.; Pedersen T.; Peto R.; Pfeffer M.;
Poulter N.; Preiss D.; Reith C.; Ridker P.; Robertson M.; Sacks F.; Sattar
N.; Schmieder R.; Serruys P.; Sever P.; Shaw J.; Shear C.; Simes J.;
Sleight P.; Spata E.; Tavazzi L.; Tobert J.; Tognoni G.; Tonkin A.;
Trompet S.; Varigos J.; Wanner C.; Wedel H.; White H.; Wikstrand J.;
Wilhelmsen L.; Wilson K.; Young R.; Yusuf S.; Zannad F.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Statin therapy has been shown to reduce major vascular events
and vascular mortality in a wide range of individuals, but there is
uncertainty about its efficacy and safety among older people. We undertook
a meta-analysis of data from all large statin trials to compare the
effects of statin therapy at different ages. <br/>Method(s): In this
meta-analysis, randomised trials of statin therapy were eligible if they
aimed to recruit at least 1000 participants with a scheduled treatment
duration of at least 2 years. We analysed individual participant data from
22 trials (n=134 537) and detailed summary data from one trial (n=12 705)
of statin therapy versus control, plus individual participant data from
five trials of more intensive versus less intensive statin therapy (n=39
612). We subdivided participants into six age groups (55 years or younger,
56-60 years, 61-65 years, 66-70 years, 71-75 years, and older than 75
years). We estimated effects on major vascular events (ie, major coronary
events, strokes, and coronary revascularisations), cause-specific
mortality, and cancer incidence as the rate ratio (RR) per 1.0 mmol/L
reduction in LDL cholesterol. We compared proportional risk reductions in
different age subgroups by use of standard chi² tests for
heterogeneity when there were two groups, or trend when there were more
than two groups. <br/>Finding(s): 14 483 (8%) of 186 854 participants in
the 28 trials were older than 75 years at randomisation, and the median
follow-up duration was 4.9 years. Overall, statin therapy or a more
intensive statin regimen produced a 21% (RR 0.79, 95% CI 0.77-0.81)
proportional reduction in major vascular events per 1.0 mmol/L reduction
in LDL cholesterol. We observed a significant reduction in major vascular
events in all age groups. Although proportional reductions in major
vascular events diminished slightly with age, this trend was not
statistically significant (p<inf>trend</inf>=0.06). Overall, statin or
more intensive therapy yielded a 24% (RR 0.76, 95% CI 0.73-0.79)
proportional reduction in major coronary events per 1.0 mmol/L reduction
in LDL cholesterol, and with increasing age, we observed a trend towards
smaller proportional risk reductions in major coronary events
(p<inf>trend</inf>=0.009). We observed a 25% (RR 0.75, 95% CI 0.73-0.78)
proportional reduction in the risk of coronary revascularisation
procedures with statin therapy or a more intensive statin regimen per 1.0
mmol/L lower LDL cholesterol, which did not differ significantly across
age groups (p<inf>trend</inf>=0.6). Similarly, the proportional reductions
in stroke of any type (RR 0.84, 95% CI 0.80-0.89) did not differ
significantly across age groups (p<inf>trend</inf>=0.7). After exclusion
of four trials which enrolled only patients with heart failure or
undergoing renal dialysis (among whom statin therapy has not been shown to
be effective), the trend to smaller proportional risk reductions with
increasing age persisted for major coronary events
(p<inf>trend</inf>=0.01), and remained non-significant for major vascular
events (p<inf>trend</inf>=0.3). The proportional reduction in major
vascular events was similar, irrespective of age, among patients with
pre-existing vascular disease (p<inf>trend</inf>=0.2), but appeared
smaller among older than among younger individuals not known to have
vascular disease (p<inf>trend</inf>=0.05). We found a 12% (RR 0.88, 95% CI
0.85-0.91) proportional reduction in vascular mortality per 1.0 mmol/L
reduction in LDL cholesterol, with a trend towards smaller proportional
reductions with older age (p<inf>trend</inf>=0.004), but this trend did
not persist after exclusion of the heart failure or dialysis trials
(p<inf>trend</inf>=0.2). Statin therapy had no effect at any age on
non-vascular mortality, cancer death, or cancer incidence.
<br/>Interpretation(s): Statin therapy produces significant reductions in
major vascular events irrespective of age, but there is less direct
evidence of benefit among patients older than 75 years who do not already
have evidence of occlusive vascular disease. This limitation is now being
addressed by further trials. <br/>Funding(s): Australian National Health
and Medical Research Council, National Institute for Health Research
Oxford Biomedical Research Centre, UK Medical Research Council, and
British Heart Foundation.<br/>Copyright &#xa9; 2019 The Author(s).
Published by Elsevier Ltd. This is an Open Access article under the CC
BY-NC-ND 4.0 license

<90>
Accession Number
620892214
Title
Transcatheter aortic valve implantation (TAVI) for native aortic valve
regurgitation - A systematic review -.
Source
Circulation Journal. 82 (3) (pp 895-902), 2018. Date of Publication: 2018.
Author
Yousef A.; MacDonald Z.; Simard T.; Russo J.J.; Feder J.; Froeschl M.V.;
Dick A.; Glover C.; Burwash I.G.; Latib A.; Rodes-Cabau J.; Labinaz M.;
Hibbert B.
Institution
(Yousef, MacDonald, Simard, Russo, Feder, Froeschl, Dick, Glover, Burwash,
Latib, Labinaz, Hibbert) CAPITAL Research Group, Division of Cardiology,
University of Ottawa Heart Institute, Ottawa, ON, Canada
(Latib) Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus and
San Raffaele Scientific Institute, Milan, Italy
(Rodes-Cabau) Quebec Heart and Lung Institute, Quebec City, QC, Canada
(Simard, Hibbert) Department of Cellular and Molecular Medicine,
University of Ottawa, Ottawa, ON, Canada
Publisher
Japanese Circulation Society
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has become the
standard of care for management of high-risk patients with aortic
stenosis. Limited data is available regarding the performance of TAVI in
patients with native aortic valve regurgitation (NAVR). <br/>Methods and
Results: We performed a systematic review from 2002 to 2016. The primary
outcome was device success as per VARC-2 criteria. Secondary endpoints
included procedural complications, and 30-day and 1-year mortality rates.
A total of 175 patients were included from 31 studies. Device success was
reported in 86.3% of patients - with device failure driven by moderate
aortic regurgitation (AR >=3+) and/or need for a second device. Procedural
complications were rare, with no procedural deaths, myocardial infarctions
or annular ruptures reported. Procedural safety was acceptable with a low
30-day incidence of stroke (1.5%). The 30-day and 1-year overall mortality
rates were 9.6% and 20.0% (cardiovascular death, 3.8% and 10.1%,
respectively). Patients receiving 2nd-generation valves demonstrated
similar safety profiles with greater device success compared with
1st-generation valves (96.2% vs. 78.4%). This was driven by the higher
incidence of second-valve implantation (23.4% vs. 1.7%) and significant
paravalvular leak (8.3% vs. 0.0%). <br/>Conclusion(s): TAVI demonstrates
acceptable safety and efficacy in high-risk patients with severe NAVR.
Second-generation valves may afford a similar safety profile with improved
device success. Dedicated studies are needed to definitively establish the
efficacy of TAVI in this population.<br/>Copyright &#xa9; 2018, Japanese
Circulation Society. All rights reserved.

<91>
Accession Number
623196340
Title
Efficacy of prophylactic dexmedetomidine in preventing postoperative
junctional ectopic tachycardia in pediatric cardiac surgery patients: A
systematic review and meta-analysis.
Source
Paediatric Anaesthesia. 28 (7) (pp 597-606), 2018. Date of Publication:
July 2018.
Author
Ghimire L.V.; Chou F.-S.
Institution
(Ghimire) Section of Pediatrics and Section of Cardiology, Department of
Medicine, Lakes Region General Hospital, Laconia, NH, United States
(Ghimire) Department of Clinical Pediatrics, University of New England,
Biddeford, ME, United States
(Chou) Division of Neonatology, Children's Mercy Kansas City, Kansas City,
MO, United States
(Chou) Department of Pediatrics, University of Missouri-Kansas City,
Kansas City, MO, United States
(Chou) Department of Pediatrics, University of Kansas Medical Center,
Kansas City, KS, United States
Publisher
Blackwell Publishing Ltd
Abstract
Background: Junctional ectopic tachycardia is a serious tachyarrhythmic
complication following pediatric cardiac surgery. It is difficult to
manage and is associated with significant morbidity and mortality.
Conventional nonpharmacological and pharmacological measures have shown
limited effects. Dexmedetomidine is an alpha2 agonist which has recently
been shown in multiple studies to be effective. <br/>Aim(s): The aim of
this systematic review with meta-analysis was to evaluate the efficacy of
prophylactic dexmedetomidine administration in the prevention of
junctional ectopic tachycardia in pediatric patients following cardiac
surgeries. <br/>Method(s): We searched MEDLINE, EMBASE, Cochrane, Web of
Science, and relevant references published in English before December 20,
2017 and performed meta-analysis on the selected studies, with one group
receiving prophylactic perioperative dexmedetomidine administration and
another group receiving placebo. The primary outcome was the incidence of
junctional ectopic tachycardia, secondary outcomes included bradycardia,
hypotension, intensive care unit stay, total hospital stay, inotropic
scores, and total mechanical ventilation time. Odds ratio or mean
difference with 95% confidence intervals were calculated using a random
effect model. <br/>Result(s): Seven studies (5 prospective randomized
studies and 2 retrospective case-controlled studies) with a total of 1616
patients were analyzed. The incidence of junctional ectopic tachycardia in
the dexmedetomidine group was significantly reduced compared to placebo.
Similarly, intensive care unit stay, inotropic scores, and total
mechanical ventilation time were also significantly decreased in the
dexmedetomidine group. No significant increases in adverse events were
found. Mortality was low in both groups. <br/>Conclusion(s): Prophylactic
dexmedetomidine is effective in reducing the incidence of postoperative
junctional ectopic tachycardia without significant increases in adverse
events in pediatric patients undergoing surgery for congenital heart
diseases.<br/>Copyright &#xa9; 2018 John Wiley & Sons Ltd

<92>
Accession Number
620867720
Title
Genomic analysis in patients with myxomatous mitral valve prolapse:
Current state of knowledge.
Source
BMC Cardiovascular Disorders. 18 (1) (no pagination), 2018. Article
Number: 41. Date of Publication: 27 Feb 2018.
Author
Gasser S.; Reichenspurner H.; Girdauskas E.
Institution
(Gasser, Reichenspurner, Girdauskas) Department of Cardiovascular Surgery,
University Heart Centre Hamburg, Martinistrasse 52, Hamburg 20251, Germany
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Myxomatous mitral valve prolapse is a common cardiac
abnormality. Morbus Barlow is characterized by excess myxomatous leaflet
tissue, bileaflet prolapse or billowing, chordae elongation and annular
dilatation with or without calcification. Extensive myxoid degeneration
with destruction of the normal three-layered leaflet tissue architecture
is observed histologically in such patients. Autosomal dominant
inheritance with an age and sex-dependent expression has long been
recognised. This review explores the current understanding of the genetics
of bileaflet prolapse, with a focus on genetic analysis and the role for
echocardiographical screening of the first degree relatives of affected
patients. <br/>Method(s): Systematic literature searches were performed
using PubMed and Embase up to September 2017. In Disse et al.'s study
(study one) first degree relatives of 25 patients with Morbus Barlow who
underwent mitral valve repair were screened for bileaflet valve prolapse.
In Nesta et al.'s study one family with three living generations of 43
individuals with 9 confirmed cases of MVP was screened. Genotyping was
performed in four families for 344 microsatellite markers from Chromosome
1 to 16. <br/>Result(s): In study one, autosomal dominant inheritance was
shown in four pedigrees. Genome-wide linkage analysis of the most
informative pedigree (24 individuals, three generations) showed a
significant linkage for markers mapping to chromosome 16p. Linkage to this
locus was confirmed in a second family within the same study, but was
excluded in the remaining two pedigrees. In study two an autosomal
dominant locus was mapped to chromosome 13. 8 of the 9 individuals
affected were found to suffer from bileaflet prolapse. <br/>Conclusion(s):
Barlow's disease is a heritable trait but the genetic causes remain
largely elusive. Ch16p11.2-p12.1 is the only locus proven to be associated
with bileaflet prolapse. Locus 13.q31.3-q32.1 was shown to cause bileaflet
as well as posterior leaflet prolapse. This review intends to make
physicians aware of genetic causes of myxomatous mitral valve prolapse,
thereby emphasising the importance of cardiological examination of
first-degree relatives of patients with Morbus Barlow. Integrated and more
comprehensive studies are needed for identification of genes involved in
this heterogenic disease. Further genomic studies may facilitate more
individualised and accurate risk assessment and may help to develop
possible preventive stategies for patients in the future.<br/>Copyright
&#xa9; 2018 The Author(s).

<93>
Accession Number
626245013
Title
The effect of inhalation aromatherapy with rose essential oil on the
anxiety of patients undergoing coronary artery bypass graft surgery.
Source
Complementary therapies in clinical practice. 34 (pp 201-207), 2019. Date
of Publication: 01 Feb 2019.
Author
Fazlollahpour-Rokni F.; Shorofi S.A.; Mousavinasab N.; Ghafari R.;
Esmaeili R.
Institution
(Fazlollahpour-Rokni) Student Research Committee, School of Nursing and
Midwifery, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Shorofi) Traditional and Complementary Medicine Research Center,
Addiction Institute, Mazandaran University of Medical Sciences, Sari,
Iran; Adjunct Research Fellow, Flinders University, Adelaide, Australia
(Mousavinasab) Health Sciences Research Center, Mazandaran University of
Medical Sciences, Sari, Iran, Islamic Republic of
(Ghafari) Department of Cardiac Surgery, School of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Esmaeili) Orthopedic Research Center, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND AND PURPOSE: Anxiety is one of the most common responses of
patients awaiting coronary artery bypass graft (CABG) surgery to stressful
conditions before surgery. This study is intended to examine the effect of
inhalation aromatherapy with rose essential oil on the anxiety of patients
undergoing CABG surgery. MATERIALS AND METHODS: This was a single-blind
randomized clinical trial of 66 patients undergoing CABG surgery. The
experimental group inhaled three drops of 4% rose essential oil for 10
minutes one night and one hour before surgery. The control group did not
receive any intervention from the research team. <br/>RESULT(S): The level
of anxiety was measured before and 30 minutes after the intervention using
the Spielberger's Anxiety Inventory. Prior to surgery, an independent
t-test showed that the mean score of anxiety was not significantly
different between the experimental and control groups (p=0.41).
Aromatherapy with rose essential oil did not cause any significant
differences in state anxiety (P=0.41), trait anxiety (P=0.90), and total
anxiety (P=0.69). <br/>CONCLUSION(S): Our results revealed that inhalation
aromatherapy with rose essential oil could not significantly reduce
anxiety in CABG patients. Future research with larger sample sizes and
using different concentrations of rose essential oil are needed to achieve
more definitive conclusions.<br/>Copyright &#xa9; 2018. Published by
Elsevier Ltd.

<94>
[Use Link to view the full text]
Accession Number
626259818
Title
Early Peritoneal Dialysis and Major Adverse Events After Pediatric Cardiac
Surgery: A Propensity Score Analysis.
Source
Pediatric critical care medicine : a journal of the Society of Critical
Care Medicine and the World Federation of Pediatric Intensive and Critical
Care Societies. 20 (2) (pp 158-165), 2019. Date of Publication: 01 Feb
2019.
Author
Namachivayam S.P.; Butt W.; Millar J.; Konstantinov I.E.; Nguyen C.;
d'Udekem Y.
Institution
(Nguyen) Department of Paediatrics, University of Melbourne, Melbourne,
VIC, Australia
(Nguyen) Clinical Epidemiology and Biostatistics Unit, Murdoch Children's
Research Institute, Melbourne, VIC, Australia
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Early peritoneal dialysis may have a role in modulating the
inflammatory response after cardiopulmonary bypass. This study sought to
test the effect of early peritoneal dialysis on major adverse events after
pediatric cardiac surgery involving cardiopulmonary bypass. DESIGN: In
this observational study, the outcomes in infants post cardiac surgery who
received early peritoneal dialysis (within 6hr of completing
cardiopulmonary bypass) were compared with those who received late
peritoneal dialysis. The primary outcome was a composite of one or more of
cardiac arrest, emergency chest reopening, requirement for extracorporeal
membrane oxygenation, or death. Secondary outcomes included duration of
mechanical ventilation, length of intensive care, and hospital stay. A
propensity score methodology utilizing inverse probability of treatment
weighting was used to minimize selection bias due to timing of peritoneal
dialysis. SETTING: Cardiac ICU, The Royal Children's Hospital, Melbourne,
VIC, Australia. PATIENTS: From 2012 to 2015, infants who were commenced on
peritoneal dialysis after cardiac surgery were included. MEASUREMENTS AND
MAIN RESULTS: Among 239 eligible infants, 56 (23%) were commenced on early
peritoneal dialysis and 183 (77%) on late peritoneal dialysis. At 90 days,
early peritoneal dialysis as compared with late peritoneal dialysis was
associated with a decreased risk of primary outcome (relative risk, 0.16;
95% CI, 0.05-0.47; p < 0.001 and absolute risk difference, -18.1%; 95% CI,
-25.1 to -11.1; p < 0.001). Early peritoneal dialysis was also associated
with a decrease in duration of mechanical ventilation and intensive care
stay. Among infants with a cardiopulmonary bypass greater than 150
minutes, early peritoneal dialysis was also associated with a survival
advantage (relative risk, 0.14; 95% CI, 0.03-0.84; p = 0.03 and absolute
risk difference, -7.8; 95% CI, -13.6 to -2; p = 0.008).
<br/>CONCLUSION(S): Early peritoneal dialysis in infants post cardiac
surgery is associated with a decrease in the rate of major adverse events.
The role of early peritoneal dialysis warrants the conduct of randomized
trials both in high and low-to-middle income countries; any beneficial
effects if confirmed have the potential to strongly influence outcomes for
children born with congenital heart disease.

<95>
Accession Number
2001543550
Title
Trends and Updates on Cardiopulmonary Bypass Setup in Pediatric Cardiac
Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Medikonda R.; Ong C.S.; Wadia R.; Goswami D.; Schwartz J.; Wolff L.;
Hibino N.; Vricella L.; Nyhan D.; Barodka V.; Steppan J.
Institution
(Medikonda) Johns Hopkins School of Medicine, Baltimore, MD, United States
(Ong, Wolff, Hibino, Vricella) Department of Surgery, Johns Hopkins
University, Baltimore, MD, United States
(Wadia, Goswami, Schwartz, Nyhan, Barodka, Steppan) Department of
Anesthesiology and Critical Care Medicine, Johns Hopkins University,
Baltimore, MD, United States
Publisher
W.B. Saunders
Abstract
Perfusion strategies for cardiopulmonary bypass have direct consequences
on pediatric cardiac surgery outcomes. However, inconsistent study results
and a lack of uniform evidence-based guidelines for pediatric
cardiopulmonary bypass management have led to considerable variability in
perfusion practices among, and even within, institutions. Important
aspects of cardiopulmonary bypass that can be optimized to improve
clinical outcomes of pediatric patients undergoing cardiac surgery include
extracorporeal circuit components, priming solutions, and additives. This
review summarizes the current literature on circuit components and priming
solution composition with an emphasis on crystalloid, colloid, and
blood-based primes, as well as mannitol, bicarbonate, and
calcium.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<96>
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

<97>
Accession Number
625422665
Title
Steroids in cardiac surgery trial: a substudy of surgical site infections.
Source
Canadian Journal of Anesthesia. 66 (2) (pp 182-192), 2019. Date of
Publication: 15 Feb 2019.
Author
McClure G.R.; Belley-Cote E.P.; Harlock J.; Lamy A.; Stacey M.; Devereaux
P.J.; Whitlock R.P.
Institution
(McClure) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(McClure, Belley-Cote, Devereaux, Whitlock) Department of Clinical
Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
(Belley-Cote, Devereaux) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Belley-Cote) Department of Medicine, Universite de Sherbrooke,
Sherbrooke, QC, Canada
(Belley-Cote, Lamy, Devereaux, Whitlock) Population Health Research
Institute, Hamilton, ON, Canada
(Harlock, Stacey) Division of Vascular Surgery, McMaster University,
Hamilton, ON, Canada
(Lamy, Whitlock) Division of Cardiac Surgery, McMaster University,
Hamilton, ON, Canada
(Whitlock) David Braley Cardiac, Vascular and Stroke Research Institute,
Room 1C1-5B, 237 Barton St. E, Hamilton, ON L8L 2X2, Canada
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Postoperative infection, particularly in cardiac surgery, results
in significant morbidity, mortality, and healthcare cost. Identification
of novel predictors of postoperative infection can target high-risk
populations for prophylactic intervention. <br/>Method(s): Steroids in
cardiac surgery (SIRS) was a multi-centre randomized-controlled trial
assessing intraoperative administration of methylprednisone during cardiac
surgery, which enrolled 7,507 patients across 80 centres in 18 countries.
It demonstrated that administration of steroids had no effect on mortality
or major morbidity after cardiac surgery. Our primary objective was to
identify risk factors for postoperative surgical site infections using
SIRS participants as a cohort. We excluded patients who did not undergo
surgery, died intraoperatively, or died within 48 hr of the operation.
Patients were assessed for development of "surgical site infection" over
the first 30 days postoperatively. Using theoretical and previously
identified risk factors, we used forward stepwise entry to create a binary
logistic regression model. <br/>Result(s): Follow-up at 30 days was
complete for all patients; 7,406 were included in the cohort. Surgical
site infection occurred in 180 (4.8%) and 184 (5.0%) of patients in the
placebo and steroid arms respectively. Significant risk factors (P < 0.05
level) included: diabetes managed with insulin (adjusted odds ratio [aOR]:
1.55; 95% confidence interval [CI] 1.13 to 2.12), oral hypoglycemics (aOR
1.60; 95% CI 1.18 to 2.16), or diet (aOR 1.81; 95% CI 1.16 to 2.83),
female sex (aOR 1.34; 95% CI 1.05 to 1.71), renal failure with (aOR 2.03;
95% CI 1.06 to 3.91), and without (aOR 1.50; 95% CI 1.04 to 2.14)
dialysis, > 96 min cardiopulmonary bypass (CPB) time (aOR 1.84; 95% CI
1.44 to 2.35), body mass index (BMI) < 22.3 (aOR 0.44; 95% CI 0.28 to
0.71) or > 30 (aOR 1.49; 95% CI 1.17 to 1.89), peak intensive care unit
blood glucose (aOR 1.02 per mmol.L^-1; 95% CI 1.00 to 1.04), and
coronary artery bypass grafting (CABG) operation type (aOR 2.59; 95% CI
1.87 to 3.59). <br/>Conclusion(s): Patients undergoing CABG, requiring
longer CPB, with higher BMI, or with diabetes, are at elevated risk of
surgical site infection. Strategies to mitigate this risk warrant further
investigation.<br/>Copyright &#xa9; 2018, Canadian Anesthesiologists'
Society.

<98>
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. 16 (2) (pp 81-87), 2019. Date of
Publication: 01 Feb 2019.
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.

<99>
Accession Number
624327165
Title
A meta-analysis of valve-in-valve and valve-in-ring transcatheter mitral
valve implantation.
Source
Journal of Interventional Cardiology. 31 (6) (pp 899-906), 2018. Date of
Publication: December 2018.
Author
Takagi H.; Hari Y.; Kawai N.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
Japan
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: We performed a meta-analysis of transcatheter mitral valve
implantation (TMVI) for deteriorated bioprosthetic valves (valve-in-valve
[VIV]-TMVI) and/or failed annuloplasty rings (valve-in-ring [VIR]-TMVI),
comparing observed early (30-day) mortality with predicted operative
mortality. <br/>Background(s): It remains unclear whether VIV/VIR-TMVI
reduces mortality as compared with redo MVS. <br/>Method(s): MEDLINE and
EMBASE were searched current through 24 July 2018 using Web-based search
engines (PubMed and OVID) to identify studies including >=10 patients
undergoing VIV/VIR-TMVI. For each study, data regarding observed 30-day
mortality and predicted operative mortality (Society of Thoracic Surgeons
Predicted Risk of Mortality [STS-PROM]) 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/late
(including 30-day) mortality rates were also performed in the
random-effects model. <br/>Result(s): Of 270 potentially relevant articles
screened initially, 17 eligible studies including a total of 1017 patients
undergoing VIV/VIR-TMVI were identified. In all but four studies, the
STS-PROM was available and varied from 7.7% to 22.0% (weighted mean,
11.5%). Pooled analyses of all VIV/VIR-TMVI studies demonstrated the
30-day mortality rate of 5.4% (95%CI, 4.0-6.8%), the midterm (1- to
5-year) mortality rate of 13.7% (95%CI, 9.0-18.5%), and significantly
lower observed 30-day mortality than predicted operative mortality (RR,
0.67; 95%CI, 0.49-0.91; P = 0.01). <br/>Conclusion(s): VIV/VIR-TMVI
brought about relatively low early and midterm (1- to 5-year) mortality,
and observed 30-day mortality was significantly lower than predicted
operative mortality.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<100>
Accession Number
2001499750
Title
Reevaluating the importance of modified ultrafiltration in contemporary
pediatric cardiac surgery.
Source
Journal of Clinical Medicine. 7 (12) (no pagination), 2018. Article
Number: 498. Date of Publication: 01 Dec 2018.
Author
Milovanovic V.; Bisenic D.; Mimic B.; Ali B.; Cantinotti M.; Soldatovic
I.; Vulicevic I.; Murzi B.; Ilic S.
Institution
(Milovanovic, Bisenic, Vulicevic) Department of Cardiac Surgery,
University Childrens Hospital, Belgrade 11 000, Serbia
(Mimic, Ali) East Midlands Congenital Heart Centre, University Hospitals
of Leicester, Leicester LE39QB, United Kingdom
(Cantinotti) Institute of Clinical Physiology, Fondazione G. Monasterio
CNR-Regione Toscana, Pisa 56100, Italy
(Soldatovic, Ilic) School of Medicine, University of Belgrade, Belgrade 11
000, Serbia
(Murzi) Fondazione G. Monasterio CNR-Regione Toscana, Massa 54100, Italy
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Objective(s): Modified ultrafiltration has gained wide acceptance as a
powerful tool against cardiopulmonary bypass morbidity in pediatric
cardiac surgery. The aim of our study was to assess the importance of
modified ultrafiltration within conditions of contemporary cardiopulmonary
bypass characteristics. <br/>Method(s): Ninety-eight patients (overall
cohort) weighing less than 12 kg undergoing surgical repair with
cardiopulmonary bypass were prospectively enrolled in a randomized
protocol to receive modified and conventional ultrafiltration (MUF group)
or just conventional ultrafiltration (non-MUF group). A special attention
was paid to forty-nine neonates and infants weighing less than 5 kg (lower
weight (LW) cohort). <br/>Result(s): Post-filtration hematocrit was
significantly higher in the MUF group for both cohorts (overall cohort p =
0.001; LW cohort p = 0.04), but not at other time points. During the
postoperative course, patients in the MUF group received fewer packed red
blood cells, (overall cohort p = 0.01; LW cohort p = 0.07), but required
more fresh frozen plasma (overall cohort p = 0.04; LW cohort p = 0.05).
There was no difference between groups in hemodynamic state, chest tube
output, duration of mechanical ventilation, respiratory parameters,
duration of intensive care unit, and hospitalization stay.
<br/>Conclusion(s): If conventional ultrafiltration provides adequate
hemoconcentration modified ultrafiltration does not provide additional
positive benefits except for reduction in blood cell transfusion, This,
however, comes at the cost of needing more fresh frozen plasma. Of
particular importance is that this also applies to infants with weight
bellow 5 kg where modified ultrafiltration was supposed to have the
greatest positive impact.<br/>Copyright &#xa9; 2018 by the authors.
Licensee MDPI, Basel, Switzerland.

<101>
Accession Number
624996007
Title
Effects of tranexamic acid on short-term and long-term outcomes of on-pump
coronary artery bypass grafting: Randomized trial and 7-year follow-up.
Source
Cardiovascular Therapeutics. 36 (6) (no pagination), 2018. Article Number:
e12472. Date of Publication: December 2018.
Author
Zhang Y.; Gao X.; Yuan S.; Guo J.; Lv H.; Zhou Y.; Wang Y.; Ji H.; Wang
G.; Li L.; Shi J.
Institution
(Zhang, Yuan, Guo, Lv, Zhou, Wang, Ji, Wang, Li, Shi) Department of
Anesthesiology, State Key Laboratory of Cardiovascular Diseases, National
Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical
College and Chinese Academy of Medical Sciences, Beijing, China
(Gao) Department of Transfusion, State Key Laboratory of Cardiovascular
Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital,
Peking Union Medical College and Chinese Academy of Medical Sciences,
Beijing, China
Publisher
Blackwell Publishing Ltd
Abstract
Aims: Safety evaluations of tranexamic acid (TXA) remain sparse,
especially with respect to its impact on long-term outcomes in patients
undergoing on-pump coronary artery bypass grafting (CABG). We hypothesized
that the effects of TXA on perioperative bleeding and allogeneic
transfusion and its impact on long-term clinical outcomes of patients
receiving on-pump CABG are superior to those in the control group.
<br/>Method(s): In this prospective, randomized, placebo-controlled trial,
210 patients undergoing primary and isolated on-pump CABG were randomly
assigned to receive TXA or a corresponding volume of saline solution.
Randomly assigned patients were followed up at 1, 3, 5, and 7 years after
hospital discharge. Finally, 163 patients fulfilled the 7-year follow-up.
The primary outcome was allogeneic red blood cell (RBC) transfusion.
Long-term mortality and morbidity were also evaluated. <br/>Result(s):
Compared with placebo, TXA reduced the allogeneic RBC requirement in terms
of the volume transfused (4.20 +/- 4.06 vs 6.25 +/- 4.86 units; P < 0.01),
ratio exposed (52.0% vs 71.6%; P < 0.01), and blood loss volume (879.0 +/-
392.5 vs 1154.0 +/- 582.8 mL; P < 0.01). Except for myocardial infarction,
there were no significant differences in mortality or morbidity between
the two groups during the 7-year follow-up. The TXA group had a lower rate
of myocardial infarction than did the placebo group (0.0% vs 4.9% at 84
months; P = 0.03). <br/>Conclusion(s): Tranexamic acid significantly
decreased postoperative bleeding and allogeneic transfusion in patients
undergoing on-pump CABG. The 7-year follow-up suggested that the use of
TXA was safe and might play a potential role in the prevention of
long-term myocardial infarction.<br/>Copyright &#xa9; 2018 John Wiley &
Sons Ltd

<102>
Accession Number
625354268
Title
Management of post-myocardial infarction ventricular septal defects: A
critical assessment.
Source
Journal of Interventional Cardiology. 31 (6) (pp 939-948), 2018. Date of
Publication: December 2018.
Author
Omar S.; Morgan G.L.; Panchal H.B.; Thourani V.; Rihal C.S.; Patel R.;
Kherada N.; Egbe A.C.; Beohar N.
Institution
(Omar, Morgan, Patel, Kherada, Beohar) Mount Sinai Medical Center,
Columbia University Division of Cardiology, Miami Beach, FL, United States
(Panchal) Division of Cardiology, Department of Internal Medicine, East
Tennessee State University, Johnson City, TN, United States
(Thourani) Division of Cardiothoracic Surgery, Medstar Heart and Vascular
Institute, Washington Hospital Center, Washington, DC, United States
(Rihal, Egbe) Division of Cardiovascular Medicine, Mayo Clinic, Rochester,
MN, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Post-myocardial infarction (MI) ventricular septal defects
(PIVSD) are an uncommon but life-threatening complication of acute MI.
Although surgical closure has been the standard of care, mortality, and
recurrence of VSD remain high even after emergent surgery. Transcatheter
VSD closure (TCC) devices have become an alternative or adjunct to
surgical closure. <br/>Method(s): Online database search was performed for
studies that included adults with PIVSD who underwent medical treatment
(MT) alone, surgical closure (SC) (early or late), and TCC (early, late,
or for post-surgical residual VSD). <br/>Result(s): Twenty-six studies
were included with a total of 737 patients who underwent either MT (N =
100), SC (early (n = 167), late (n = 100)), and TCC (early (n = 176), late
(n = 115), or post-surgical residual VSD (n = 79)). The 30-day mortality
among MT group was 92 +/- 6.3%, among SC was 61 +/- 22.5% (early 56 +/-
23%, late 41 +/- 30%), and for all TCC patients was 33 +/- 24% (early 54
+/- 32.7%, late 16 +/- 26%), and TCC for post-surgical residual VSD 11 +/-
34.9%. The mortality among overall SC, overall TCC and early TCC groups
was significantly lower as compared with the MT (P < 0.001 for all
comparisons). The overall mortality among all TCC, and late TCC groups was
significantly lower when compared with the late SC (P < 0.0001, P <
0.0001, respectively). <br/>Conclusion(s): Closure of PIVSD decreases
mortality as compared with MT alone and should be attempted as early as
possible after diagnosis. Selection of TCC versus SC should be based on
factors including complexity of the defect, availability of closure
devices, expertise of the operator, and clinical condition of
patient.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<103>
Accession Number
624777777
Title
Impact of intravenous exenatide infusion for perioperative blood glucose
control on myocardial ischemia-reperfusion injuries after coronary artery
bypass graft surgery: Sub study of the phase II/III ExSTRESS randomized
trial.
Source
Cardiovascular Diabetology. 17 (1) (no pagination), 2018. Article Number:
140. Date of Publication: 01 Nov 2018.
Author
Besch G.; Perrotti A.; Salomon Du Mont L.; Puyraveau M.; Ben-Said X.;
Baltres M.; Barrucand B.; Flicoteaux G.; Vettoretti L.; Samain E.; Chocron
S.; Pili-Floury S.
Institution
(Besch, Ben-Said, Baltres, Barrucand, Flicoteaux, Vettoretti, Samain,
Pili-Floury) Department of Anesthesiology and Intensive Care Medicine,
University Hospital of Besancon, EA3920, SFR-FED 4234 INSERM, University
of Franche-Comte, 3 bvd Alexander Fleming, Besancon 25000, France
(Perrotti) Department of Cardiothoracic Surgery, University of
Franche-Comte, 3 bvd Alexander Fleming, Besancon 25000, France
(Salomon Du Mont) Department of Vascular Surgery, University Hospital of
Besancon, EA3920, University of Franche-Comte, 3 bvd Alexander Fleming,
Besancon 25000, France
(Puyraveau) Clinical Methodology Center, University Hospital of Besancon,
University of Franche-Comte, 3 bvd Alexander Fleming, Besancon 25000,
France
(Chocron) Department of Cardiothoracic Surgery, University Hospital of
Besancon, EA3920, University of Franche-Comte, 3 bvd Alexander Fleming,
Besancon 25000, France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The aim of the study was to investigate whether intravenous
(iv) infusion of exenatide, a synthetic GLP-1 receptor agonist, could
provide a protective effect against myocardial ischemia-reperfusion injury
after coronary artery bypass graft (CABG) surgery. <br/>Method(s): A sub
study analysis of patients > 18 years admitted for elective CABG and
included in the ExSTRESS trial was conducted. Patients were randomized to
receive either iv exenatide (1-h bolus of 0.05 mug min^-1
followed by a constant infusion of 0.025 mug min^-1) (exenatide
group) or iv insulin therapy (control group) for blood glucose control
(target range 100-139 mg dl^-1) during the first 48 h after
surgical incision. All serum levels of troponin I measured during routine
care in the Cardiac Surgery ICU were recorded. The primary outcome was the
highest value of plasma concentration of troponin I measured between 12
and 24 h after ICU admission. The proportion of patients presenting an
echocardiographic left ventricular ejection fraction (LVEF) > 50% at the
follow-up consultation was compared between the two groups.
<br/>Result(s): Finally, 43 and 49 patients were analyzed in the control
and exenatide groups, respectively {age: 69 [61-76] versus 71 [63-75]
years; baseline LVEF < 50%: 6 (14%) versus 16 (32%) patients; on-pump
surgery: 29 (67%) versus 33 (67%) patients}. The primary outcome did not
significantly differ between the two groups (3.34 [1.06-6.19] mug
l^-1 versus 2.64 [1.29-3.85] mug l^-1 in the control
and exenatide groups, respectively; mean difference (MD) [95% confidence
interval (95% CI)] 0.16 [- 0.25; 0.57], p = 0.54). The highest troponin
value measured during the first 72 h in the ICU was 6.34 [1.36-10.90]
versus 5.04 [2.39-7.18] mug l^-1, in the control and exenatide
groups respectively (MD [95% CI] 0.20 [- 0.22; 0.61], p = 0.39). At the
follow-up consultation, 5 (12%) versus 8 (16%) patients presented a LVEF <
50% in the control and in the exenatide groups respectively (relative risk
[95% CI] 0.68 [0.16; 2.59], p = 0.56). <br/>Conclusion(s): Postoperative
iv exenatide did not provide any additional cardioprotective effect
compared to iv insulin in low-risk patients undergoing scheduled CABG
surgery. Trial registration ClinicalTrials.gov Identifier NCT01969149,
date of registration: January 7th, 2015; EudraCT No. 2009-009254-25 A,
date of registration: January 6th, 2009<br/>Copyright &#xa9; 2018 The
Author(s).

<104>
Accession Number
2001499914
Title
Comparative effectiveness of the core components of cardiac rehabilitation
on mortality and morbidity: A systematic review and network meta-analysis.
Source
Journal of Clinical Medicine. 7 (12) (no pagination), 2018. Article
Number: 514. Date of Publication: 01 Dec 2018.
Author
Kabboul N.N.; Tomlinson G.; Francis T.A.; Grace S.L.; Chaves G.; Rac V.;
Daou-Kabboul T.; Bielecki J.M.; Alter D.A.; Krahn M.
Institution
(Kabboul, Tomlinson, Francis, Rac, Bielecki, Krahn) Toronto Health
Economics and Technology Assessment (THETA) Collaborative, 200 Elizabeth
Street, Toronto, ON M5G 2C4, Canada
(Kabboul, Francis, Rac, Bielecki, Krahn) Faculty of Pharmacy, University
of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada
(Tomlinson, Alter, Krahn) Department of Medicine, University Health
Network, 27 King's College Circle, Toronto, ON M5S 1A1, Canada
(Tomlinson, Alter, Krahn) Institute of Health Policy, Management and
Evaluation (IHPME), University of Toronto, 4th Floor, 155 College St,
Toronto, ON M5T 3M6, Canada
(Tomlinson, Grace, Alter, Krahn) Faculty of Medicine, University of
Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S
1A8, Canada
(Grace, Alter) Toronto Rehabilitation Institute, University Health
Network, University of Toronto, 550 University Ave, Toronto, ON M5G 2A2,
Canada
(Grace) School of Kinesiology and Health Science, York University, 4700
Keele St, Toronto, ON M3J 1P3, Canada
(Chaves) Department of Physical Therapy, Federal University of Minas
Gerais, Av. Pres. Antonio Carlos, 6627-Pampulha, Belo Horizonte, MG
31270-901, Brazil
(Daou-Kabboul) Human Nutrition, Bridgeport University, 126 Park Ave,
Bridgeport, CT 06604, United States
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
A systematic review and network meta-analysis (NMA) of randomized
controlled trials (RCTs) evaluating the core components of cardiac
rehabilitation (CR), nutritional counseling (NC), risk factor modification
(RFM), psychosocial management (PM), patient education (PE), and exercise
training (ET)) was undertaken. Published RCTs were identified from
database inception dates to April 2017, and risk of bias assessed using
Cochrane's tool. Endpoints included mortality (all-cause and
cardiovascular (CV)) and morbidity (fatal and non-fatal myocardial
infarction (MI), coronary artery bypass surgery (CABG), percutaneous
coronary intervention (PCI), and hospitalization (all-cause and CV)).
Meta-regression models decomposed treatment effects into the main effects
of core components, and two-way or all-way interactions between them.
Ultimately, 148 RCTs (50,965 participants) were included. Main effects
models were best fitting for mortality (e.g., for all-cause, specifically
PM (hazard ratio HR = 0.68, 95% credible interval CrI = 0.54-0.85) and ET
(HR = 0.75, 95% CrI = 0.60-0.92) components effective), MI (e.g., for
all-cause, specifically PM (hazard ratio HR = 0.76, 95% credible interval
CrI = 0.57-0.99), ET (HR = 0.75, 95% CrI = 0.56-0.99) and PE (HR = 0.68,
95% CrI = 0.47-0.99) components effective) and hospitalization (e.g.,
all-cause, PM (HR = 0.76, 95% CrI = 0.58-0.96) effective). For
revascularization (including CABG and PCI individually), the full
interaction model was best-fitting. Given that each component, individual
or in combination, was associated with mortality and/or morbidity,
recommendations for comprehensive CR are warranted.<br/>Copyright &#xa9;
2018 by the authors. Licensee MDPI, Basel, Switzerland.

<105>
Accession Number
2001537578
Title
Uniportal Lung Cancer Surgery: State of the Evidence.
Source
Annals of Thoracic Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Sihoe A.D.L.
Institution
(Sihoe) Department of Surgery, Li Ka Shing Faculty of Medicine, The
University of Hong Kong, Hong Kong, Hong Kong
(Sihoe) Division of Thoracic Surgery, The University of Hong Kong Shenzhen
Hospital, Shenzhen, Hong Kong
(Sihoe) Department of Thoracic Surgery, Tongji University Shanghai
Pulmonary Hospital, Shanghai, China
Publisher
Elsevier USA
Abstract
Background: Uniportal video-assisted thoracic surgery (VATS) has generated
much attention in recent years, but questions remain regarding the
adequacy of evidence to support its use in lung cancer surgery. This
review aims to explore what the currently published literature suggests
the role of the uniportal approach may be and to critically appraise that
literature. <br/>Method(s): A systematic review was conducted using the
Ovid Medline database to identify articles related to uniportal VATS.
Articles were selected for review on the basis of ability to provide
original clinical data on the role of uniportal VATS for lung cancer
surgery. <br/>Result(s): The literature search revealed that only some
publications on uniportal VATS provided original clinical data. Twenty-two
articles were selected for review, including 9 case series and 13
comparative studies. No concerns about the safety of the uniportal VATS
were noted. Some but not all comparative studies provided data suggesting
that uniportal VATS may hold advantages over multiportal VATS in some
simple clinical outcomes (such as reduced lengths of stay and
postoperative pain). However, the quantity and quality of evidence thus
far are limited. <br/>Conclusion(s): It remains premature to declare
superiority for uniportal VATS in lung cancer surgery. A higher level of
evidence is needed, especially in investigating objective benefits and
treatment efficacy of the single-incision approach.<br/>Copyright &#xa9;
2019

<106>
Accession Number
626237712
Title
Intraoperative use of dexmedetomidine for the prevention of emergence
agitation and postoperative delirium in thoracic surgery: a
randomized-controlled trial.
Source
Canadian Journal of Anesthesia. (no pagination), 2019. Date of
Publication: 2019.
Author
Kim J.A.; Ahn H.J.; Yang M.; Lee S.H.; Jeong H.; Seong B.G.
Institution
(Kim, Ahn, Yang, Lee, Jeong, Seong) Department of Anesthesiology and Pain
Medicine, Samsung Medical Center, Sungkyunkwan University School of
Medicine, 50 Ilwon-Dong, Gangnam-Gu, Seoul 135-710, South Korea
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: We investigated whether preventive use of dexmedetomidine during
surgery was effective for reducing emergence agitation and postoperative
delirium. <br/>Method(s): In this double-blind randomized-controlled
trial, 143 patients undergoing thoracoscopic lung resection surgery were
randomly assigned to the dexmedetomidine-sevoflurane (DEX-Sevo, n = 73) or
sevoflurane (Sevo, n = 70) groups. Dexmedetomidine or saline
administration was started after inducing anesthesia and continued until
the end of surgery at a fixed dose (0.5
micro&#32;g.kg^-1.hr^-1). The primary endpoint was the
incidence of delirium up until the end of postoperative day 3. Emergence
agitation and postoperative delirium were measured with the Riker sedation
agitation scale and the confusion assessment method, respectively. The
secondary endpoints were serum cytokine and catecholamine levels.
<br/>Result(s): The DEX-Sevo group showed less frequent emergence
agitation than the Sevo group (13% vs 35%, respectively; relative risk,
0.38; 95% confidence interval [CI], 0.18 to 0.79; P = 0.011) but the
incidence of delirium after discharge from the postanesthesia care unit
was not different (25% vs 25%, DEX-Sevo vs Sevo). Both pro- and
anti-inflammatory cytokines were lower in the DEX-Sevo group than in the
Sevo group. Nevertheless, the interleukin (IL)6/IL10 ratio (median
difference, 5.8; 95% CI,1.8 to 10.0; P = 0.012) and IL8/IL10 ratio (median
difference, 0.8; 95% CI, 0.2 to 1.3; P = 0.007) were higher in the
DEX-Sevo group than in the Sevo group, indicating a pro-inflammatory
cytokine balance in the DEX-Sevo group. Norepinephrine and epinephrine
levels were lower in the DEX-Sevo group than in the Sevo group (both, P <
0.001). <br/>Conclusion(s): Intraoperative dexmedetomidine reduced
emergence agitation but not postoperative delirium in patients undergoing
thoracic surgery. Dexmedetomidine seemed to affect emergence agitation
through catecholamines, but not through an anti-inflammatory action. Trial
registration Clinical Research Information Service (KCT 0001877);
registered 7 April, 2016.<br/>Copyright &#xa9; 2019, Canadian
Anesthesiologists' Society.

<107>
Accession Number
626236761
Title
Burden of medical co-morbidities and benefit from surgical
revascularization in patients with ischaemic cardiomyopathy.
Source
European Journal of Heart Failure. (no pagination), 2019. Date of
Publication: 2019.
Author
Ambrosy A.P.; Stevens S.R.; Al-Khalidi H.R.; Rouleau J.L.; Bouabdallaoui
N.; Carson P.E.; Adlbrecht C.; Cleland J.G.F.; Dabrowski R.; Golba K.S.;
Pina I.L.; Sueta C.A.; Roy A.; Sopko G.; Bonow R.O.; Velazquez E.J.
Institution
(Ambrosy) Division of Cardiology, The Permanente Medical Group, San
Francisco, CA, United States
(Ambrosy) Division of Research, Kaiser Permanente Northern California,
Oakland, CA, United States
(Stevens, Al-Khalidi) Department of Biostatistics and Bioinformatics, Duke
Clinical Research Institute, Duke University School of Medicine, Durham,
NC, United States
(Rouleau, Bouabdallaoui) Research Center, Montreal Heart Institute,
Montreal, QC, Canada
(Carson) Department of Cardiology, Washington Veterans Affairs Medical
Center, Washington, DC, United States
(Adlbrecht) 4th Medical Department, Karl Landsteiner Institute for
Cardiovascular and Critical Care Research, Hietzing Hospital, Vienna,
Austria
(Cleland) Robertson Centre for Biostatistics and Clinical Trials,
University of Glasgow, Glasgow, United Kingdom
(Dabrowski) 2nd Department of Coronary Artery Disease, Institute of
Cardiology, Warsaw, Poland
(Golba) Department of Electrocardiology and Heart Failure, School of
Health Sciences, Medical University of Silesia, Katowice, Poland
(Pina) Albert Einstein College of Medicine, Montefiore Medical Center, New
York, NY, United States
(Sueta) Division of Cardiology, University of North Carolina School of
Medicine, Chapel Hill, NC, United States
(Roy) Department of Cardiology, All India Institute of Medical Sciences,
New Delhi, India
(Sopko) Division of Cardiovascular Sciences, National Heart, Lung, and
Blood Institute, National Institutes of Health, Bethesda, MD, United
States
(Bonow) Northwestern University Feinberg School of Medicine, Chicago, IL,
United States
(Velazquez) Section of Cardiovascular Medicine, Department of Internal
Medicine, Yale University School of Medicine, New Haven, CT, United States
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Aims: The landmark STICH trial found that surgical revascularization
compared to medical therapy alone improved survival in patients with heart
failure (HF) of ischaemic aetiology and an ejection fraction (EF) <= 35%.
However, the interaction between the burden of medical co-morbidities and
the benefit from surgical revascularization has not been previously
described in patients with ischaemic cardiomyopathy. <br/>Methods and
Results: The STICH trial (ClinicalTrials.gov Identifier: NCT00023595)
enrolled patients >= 18 years of age with coronary artery disease amenable
to coronary artery bypass grafting (CABG) and an EF <= 35%. Eligible
participants were randomly assigned 1:1 to receive medical therapy (MED)
(n = 602) or MED/CABG (n = 610). A modified Charlson co-morbidity index
(CCI) based on the availability of data and study definitions was
calculated by summing the weighted points for all co-morbid conditions.
Patients were divided into mild/moderate (CCI 1-4) and severe (CCI >= 5)
co-morbidity. Cox proportional hazards models were used to evaluate the
association between CCI and outcomes and the interaction between severity
of co-morbidity and treatment effect. The study population included 349
patients (29%) with a mild/moderate CCI score and 863 patients (71%) with
a severe CCI score. Patients with a severe CCI score had greater
functional limitations based on 6-min walk test and impairments in
health-related quality of life as assessed by the Kansas City
Cardiomyopathy Questionnaire. A total of 161 patients (Kaplan-Meier rate =
50%) with a mild/moderate CCI score and 579 patients (Kaplan-Meier rate =
69%) with a severe CCI score died over a median follow-up of 9.8 years.
After adjusting for baseline confounders, patients with a severe CCI score
were at higher risk for all-cause mortality (hazard ratio 1.44, 95%
confidence interval 1.19-1.74; P < 0.001). There was no interaction
between CCI score and treatment effect on survival (P = 0.756).
<br/>Conclusion(s): More than 70% of patients had a severe burden of
medical co-morbidities at baseline, which was independently associated
with increased risk of death. There was not a differential benefit of
surgical revascularization with respect to survival based on severity of
co-morbidity.<br/>Copyright &#xa9; 2019 The Authors. European Journal of
Heart Failure &#xa9; 2019 European Society of Cardiology