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

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

<3>
Accession Number
622219722
Title
Mitral Valve Interventions in Structural Heart Disease.
Source
Current Cardiology Reports. 20 (6) (no pagination), 2018. Article Number:
49. Date of Publication: 01 Jun 2018.
Author
Saccocci M.; Taramasso M.; Maisano F.
Institution
(Saccocci, Taramasso, Maisano) Heart Center University Hospital of Zurich,
Department of Cardiac Surgery - UniversitatsSpital Zurich, Ramistrasse
100, Zurich 8091, Switzerland
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of review: Analyze the current state of the art and the future
perspectives of mitral interventions in clinical setting. Recent Findings:
A systematic and critical review of the new mitral percutaneous therapies
and imaging technologies is the basis to adopt the right treatment for
each patient according to specific valve dysfunction and clinical
presentation, waiting for definitive guidelines. While surgical mitral
repair will remain the gold standard for low-risk healthy patients with
degenerative mitral regurgitation (DMR), transcatheter mitral valve repair
is becoming first line therapy in high risk patients with functional
mitral regurgitation (FMR). The introduction of transcatheter mitral valve
replacement will expand indications for advanced DMR and FMR in inoperable
patients. Summary: The introduction of transcatheter mitral
interventions is changing the mitral therapy scenario. Mitral
interventionalists might evolve into hybrid professional figures able to
offer a tailored approach for each patient, including surgical and
percutaneous approaches, depending on the anatomo-functional status of the
valve, to clinical conditions, and to the timing of the
intervention. Copyright © 2018, Springer Science+Business Media,
LLC, part of Springer Nature.

<4>
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Accession Number
624836981
Title
Adding sufentanil to ropivacaine in continuous thoracic paravertebral
block fails to improve analgesia after video-assisted thoracic surgery: A
randomised controlled trial.
Source
European Journal of Anaesthesiology. 35 (10) (pp 766-773), 2018. Date of
Publication: 2018.
Author
Bauer C.; Pavlakovic I.; Mercier C.; Maury J.-M.; Koffel C.; Roy P.;
Fellahi J.-L.
Institution
(Bauer, Maury) Hospices Civils de Lyon, Hopital de la Croix Rousse,
Service d'Anesthesie-Reanimation, 103 Grande Rue de la Croix-Rousse, Lyon
69004, France
(Pavlakovic, Koffel, Fellahi) Hospices Civils de Lyon, Hopital
Cardiologique et Pneumologique Louis Pradel, Service
d'Anesthesie-Reanimation, Lyon, France
(Mercier, Roy) Hospices Civils de Lyon, Service de Biostatistique -
Bioinformatique, Lyon, France
(Koffel, Roy, Fellahi) Faculte de Medecine, Universite Claude Bernard Lyon
1, Lyon, France
(Koffel, Roy) CNRS UMR5558, Laboratoire de Biometrie et Biologie
Evolutive, Departement Biostatistiques et Modelisation pour la Sante et
l'Environnement, Equipe Biostatistique-Sante, Lyon, France
(Fellahi) Hospices Civils de Lyon, Hopital Cardiologique et Pneumologique
Louis Pradel, Service de Chirurgie Thoracique, Lyon, France
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND: The benefit of adding opioid to a local anaesthetic for
continuous thoracic paravertebral analgesia after video-assisted thoracic
surgery (VATS) is unclear. OBJECTIVE(S): To analyse the analgesic
efficacy of ropivacaine and sufentanil in combination compared with
ropivacaine alone after VATS. DESIGN: A randomised, double-blinded,
single-centre clinical trial. SETTING: A tertiary university hospital
between March 2010 and April 2014. PATIENTS: Ninety patients were
recruited, two were not included leaving 88 randomised into two groups.
Eighteen patients were excluded from analysis and 70 completed the study.
INTERVENTION: To receive thoracic paravertebral analgesia with either 2 mg
m-1 ropivacaine and 0.25 mug m-1 sufentanil
(ropivacaine R sufentanil group) or 2 mg m-1 ropivacaine alone
(ropivacaine group) for 48 h postoperatively. Infusion rate was set at
0.15 ml kg-1 h-1 in both groups. MAIN OUTCOME
MEASURES: The primary endpoint was the mean total amount of
self-administered morphine by the patients in each group at 48 h
postoperatively. RESULT(S): The mean +/- SD total amount of
self-administered morphine was not significantly different between groups
(53.1+/-27.2mg in the ropivacaine R sufentanil group vs. 58.8+/- 34.3 mg
in the ropivacaine group; P=0.72). No significant differences were found
between the two groups in either pain scores at rest or during movement,
in opioid-related adverse reactions, in patient satisfaction or length of
hospital stay. CONCLUSION(S): Adding 0.25 mugm-1
sufentanil to 2 mg m-1 ropivacaine in continuous thoracic
paravertebral analgesia for VATS did not reduce morphine consumption or
pain scores when compared with ropivacaine alone. We cannot recommend its
use for routine clinical practice. Further studies analysing different
concentrations and infusion rates of sufentanil are needed before a lack
of efficacy can be confirmed. Copyright © 2018 European Society
of Anaesthesiology. All rights reserved.

<5>
Accession Number
622745297
Title
Evaluating the effect of magnesium supplementation and cardiac arrhythmias
after acute coronary syndrome: A systematic review and meta-analysis.
Source
BMC Cardiovascular Disorders. 18 (1) (no pagination), 2018. Article
Number: 129. Date of Publication: 28 Jun 2018.
Author
Salaminia S.; Sayehmiri F.; Angha P.; Sayehmiri K.; Motedayen M.
Institution
(Salaminia) Yasuj University of Medical Science, Department of Cardiac
Surgery, Yasuj, Iran, Islamic Republic of
(Sayehmiri) Shahid Beheshti University of Medical Sciences, Proteomics
Research Center, Tehran, Iran, Islamic Republic of
(Angha) Yasuj University of Medical Sciences, Social Determinants of
Health Research Center, Yasuj, Iran, Islamic Republic of
(Sayehmiri) Ilam University of Medical Sciences, Department of Social
Medicine, School of Medicine, Ilam, Iran, Islamic Republic of
(Motedayen) Zanjan University of Medical Sciences, Department of
Cardiology, Faculty of Medicine, Zanjan, Iran, Islamic Republic of
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Atrial and ventricular cardiac arrhythmias are one of the most
common early complications after cardiac surgery and these serve as a
major cause of mortality and morbidity after cardiac revascularization. We
want to evaluate the effect of magnesium sulfate administration on the
incidence of cardiac arrhythmias after cardiac revascularization by doing
this systematic review and meta-analysis. Method(s): The search
performed in several databases (SID, Magiran, IranDoc, IranMedex, MedLib,
PubMed, EmBase, Web of Science, Scopus, the Cochrane Library and Google
Scholar) for published Randomized controlled trials before December 2017
that have reported the association between Magnesium consumption and the
incidence of cardiac arrhythmias. This relationship measured using odds
ratios (ORs) with a confidence interval of 95% (CIs). Funnel plots and
Egger test used to examine publication bias. STATA (version 11.1) used for
all analyses. Result(s): Twenty-two studies selected as eligible for
this research and included in the final analysis. The total rate of
ventricular arrhythmia was lower in the group receiving magnesium sulfate
than placebo (11.88% versus 24.24%). The same trend obtained for the total
incidence of supraventricular arrhythmia (10.36% in the magnesium versus
23.91% in the placebo group). In general the present meta-analysis showed
that magnesium could decrease ventricular and supraventricular arrhythmias
compared with placebo (OR = 0.32, 95% CI 0.16-0.49; p < 0.001 and OR =
0.42, 95% CI 0.22-0.65; p < 0.001, respectively). Subgroup analysis showed
that the effect of magnesium on the incidence of cardiac arrhythmias was
not affected by clinical settings and dosage of magnesium. Meta-regression
analysis also showed that there was no significant association between the
reduction of ventricular arrhythmias and sample size. Conclusion(s):
The results of this meta-analysis study suggest that magnesium sulfate can
be used safely and effectively and is a cost-effective way in the
prevention of many of ventricular and supraventricular
arrhythmias. Copyright © 2018 The Author(s).

<6>
Accession Number
621585628
Title
Antithrombotic therapy in patients receiving saphenous vein coronary
artery bypass grafts: A protocol for a systematic review and network
metaanalysis.
Source
BMJ Open. 8 (4) (no pagination), 2018. Article Number: e019555. Date of
Publication: 2018.
Author
Solo K.; Martin J.; Lavi S.; Kabali C.; John-Baptiste A.; Nevis I.F.;
Choudhury T.; Mamas M.A.; Bagur R.
Institution
(Solo, Martin, John-Baptiste, Bagur) Department of Epidemiology and
Biostatistics, Schulich School of Medicine and Dentistry, Western
University, London, ON, Canada
(Martin, John-Baptiste) Department of Anesthesia and Perioperative
Medicine, Centre for Medical Evidence, Decision Integrity and Clinical
Impact (MEDICI), Western University, London, ON, Canada
(Lavi, Choudhury, Bagur) Division of Cardiology, London Health Sciences
Centre, London, ON, Canada
(Kabali) Epidemiology Division, University of Toronto, Dalla Lana School
of Public Health, Toronto, ON, Canada
(John-Baptiste) Interfaculty Program in Public Health, Western University,
London, ON, Canada
(Nevis) Health Quality Ontario, London, ON, Canada
(Mamas, Bagur) Keele Cardiovascular Research Group, Institute for Applied
Clinical Science, Centre for Prognosis Research, Institute of Primary Care
and Health Sciences, University of Keele, Keele, United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: The current evidence for the prevention of saphenous vein
graft failure (SVGF) after coronary artery bypass graft (CABG) surgery
consists of direct head-tohead comparison of treatments (including
placebo) in randomised-controlled trials (RCTs) and observational studies.
However, summarising the evidence using traditional pairwise meta-analyses
does not allow the inclusion of data from treatments that have not been
compared head to head. Exclusion of such comparisons could impact the
precision of pooled estimates in a metaanalysis. Hence, to address the
challenge of whether aspirin alone or in addition to another
antithrombotic agent is a more effective regimen to improve SVG patency, a
network meta-analysis (NMA) is necessary. The objectives of this study are
to synthesise the available evidence on antithrombotic agents (or their
combination) and estimate the treatment effects among direct and indirect
treatment comparisons on SVGF and major adverse cardiovascular events, and
to generate a treatment ranking according to their efficacy and safety
outcomes. Method(s): We will perform a systematic review of RCTs
evaluating antithrombotic agents in patients undergoing CABG. A
comprehensive English literature search will be conducted using electronic
databases and grey literature resources to identify published and
unpublished articles. Two individuals will independently and in duplicate
screen potential studies, assess the eligibility of potential studies and
extract data. Risk of bias and quality of evidence will also be evaluated
independently and in duplicate. We will investigate the data to ensure its
suitability for NMA, including adequacy of the outcome data and
transitivity of treatment effects. We plan to estimate the pooled direct,
indirect and the mixed effects for all antithrombotic agents using a NMA.
Ethics and dissemination: Due to the nature of the study, there are no
ethical concerns nor informed consent required. We anticipate that this
NMA will be the first to simultaneously assess the relative effects of
multiple antithrombotic agents in patients undergoing CABG. The results of
this NMA will inform clinicians, patients and guideline developers the
best available evidence on comparative effects benefits of antithrombotic
agents after CABG while considering the side effect profile to support
future clinical decision-making. We will disseminate the results of our
systematic review and NMA through a peerreviewed journal. Copyright
© Article author(s) (or their employer(s) unless otherwise stated in
the text of the article) 2018. All rights reserved.

<7>
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Accession Number
623156245
Title
Adjusted calculation model of heparin management during cardiopulmonary
bypass in obese patients.
Source
European Journal of Anaesthesiology. 35 (8) (pp 613-620), 2018. Date of
Publication: 01 Aug 2018.
Author
Vienne M.; Haas E.; Wipf T.; Grunebaum L.; Levy F.; Sattler L.; Minh T.H.;
Severac F.; Tacquard C.; Collange O.; Mertes P.-M.; Steib A.
Institution
(Vienne, Haas, Wipf, Levy, Tacquard, Collange, Mertes, Steib) Department
of Anesthesiology and Intensive Care, University Hospital, Nouvel Hopital
Civil, 1 Place de L'hopital, Strasbourg Cedex 67091, France
(Grunebaum, Sattler) Laboratory of Haemostasis, University Hospital,
Strasbourg, France
(Minh) Department of Cardiac Surgery, NHC, University Hospital,
Strasbourg, France
(Severac) Department of BioStatistics, Federation de Medecine
Translationelle, University Hospital, Strasbourg, France
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND Anticoagulation during cardiopulmonary bypass (CPB) is usually
adapted to total body weight (TBW). This may be inaccurate in obese
patients and lead to heparin overdose with a risk of bleeding. OBJECTIVES
To validate the efficacy and safety of an adjusted calculation model of
heparin dosing based on ideal body weight (IBW) rather than TBW in obese
CPB patients, with an expected target mean plasma heparin concentration of
4.5IUml -1 after onset of CPB in the experimental group. DESIGN Randomised
controlled study. SETTING University hospital. PATIENTS Sixty obese
patients (BMI>=30kgm -2) scheduled for CPB were included from January to
June 2016. INTERVENTIONS Patients received a bolus dose of unfractionated
heparin of either 300IUkg -1 of TBW or 340IUkg -1 of IBW before onset of
CPB. Additional adjusted boluses were injected to maintain an activated
clotting time (ACT) of at least 400s. MAIN OUTCOME MEASURES Plasma heparin
concentration and ACT were measured at different time points. Total
heparin doses and transfusion requirements were recorded. RESULTS The
target heparin concentration of 4.5IUml -1 was reached in the IBW group at
the onset of CPB and maintained at all time points during CPB. Heparin
concentrations were significantly higher in the TBW group after the bolus
(6.52+/-0.97 vs. 4.54+/-1.13IUml -1, P<0.001) and after cardioplegia
(5.10+/-1.03 vs. 4.31+/-1.00IUml -1, P=0.02). Total heparin doses were
significantly higher in the TBW group. Mean ACT was significantly lower in
the IBW group but remained over 400s during CPB. The correlation between
heparin and ACT was poor. Peri-operative bleeding and transfusion
requirements were comparable. No thrombotic event occurred in the CPB
circuit. CONCLUSION The current IBW-adjusted regimen of heparin
administration may be used efficiently in obese CPB patients, thereby
avoiding overdose which cannot be accurately assessed by ACT monitoring
alone. TRIAL REGISTRATION ClinicalTrials.gov identifier:
NCT02675647. Copyright © 2018 European Society of
Anaesthesiology. All rights reserved.

<8>
Accession Number
625044093
Title
Impact of dexmedetomidine infusion during general anaesthesia on incidence
of postoperative delirium in elderly patients after major non-cardiac
surgery: Study protocol of a randomised, double-blinded and
placebo-controlled trial.
Source
BMJ Open. 8 (4) (no pagination), 2018. Article Number: e019549. Date of
Publication: 01 Apr 2018.
Author
Wang B.-J.; Li C.-J.; Hu J.; Li H.-J.; Guo C.; Wang Z.-H.; Zhang Q.-C.; Mu
D.-L.; Wang D.-X.
Institution
(Wang, Li, Hu, Li, Guo, Zhang, Mu, Wang) Department of Anesthesiology and
Critical Care Medicine, Peking University First Hospital, Beijing, China
(Wang) Department of Anesthesiology, Dongping People's Hospital, Dongping,
China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Delirium is a common complication in the elderly after
surgery and is associated with worse outcomes. Multiple risk factors are
related with postoperative delirium, such as exposure to general
anaesthetics, pain and postoperative inflammatory response. Preclinical
and clinical studies have shown that dexmedetomidine attenuated
neurotoxicity induced by general anaesthetics, improved postoperative
analgesia and inhibited inflammatory response after surgery. Several
studies found that intraoperative use of dexmedetomidine can prevent
postoperative delirium, but data were inconsistent. This study was
designed to investigate the impact of dexmedetomidine administered during
general anaesthesia in preventing delirium in the elderly after major
non-cardiac surgery. Methods and analysis: This is a randomised,
double-blinded and placebo-controlled trial. 620 elderly patients (age
>=60 years) who are scheduled to undertake elective major non-cardiac
surgery (with an expected duration >=2 hours) are randomly divided into
two groups. For patients in the dexmedetomidine group, a loading dose
dexmedetomidine (0.6 mug/kg) will be administered 10 min before
anaesthesia induction, followed by a continuous infusion at a rate of 0.5
mug/kg/hour until 1 hour before the end of surgery. For patients in the
control group, normal saline will be administered with an identical rate
as in the dexmedetomidine group. The primary endpoint is the incidence of
delirium during the first five postoperative days. The secondary endpoints
include pain intensity, cumulative opioid consumption and subjective sleep
quality during the first three postoperative days, as well as the
incidence of non-delirium complications and all-cause mortality within 30
days after surgery. Ethics and dissemination: The study protocol was
approved by the Clinical Research Ethics Committee of Peking University
First Hospital (2015-987) and registered at Chinese Clinical Trial
Registry (http://www.chictr.org.cn) with identifier ChiCTR-IPR-15007654.
The results of the study will be presented at academic conferences and
submitted to peer-reviewed journals. Copyright © 2018 Article
author(s).

<9>
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. 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. 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.
 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. 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. Copyright © 2019 The Author(s).
Published by Elsevier Ltd. This is an Open Access article under the CC
BY-NC-ND 4.0 license

<10>
Accession Number
2001504735
Title
Design and rationale of the Management of High Bleeding Risk Patients Post
Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus
Standard DAPT Regimen (MASTER DAPT) Study.
Source
American Heart Journal. 209 (pp 97-105), 2019. Date of Publication: March
2019.
Author
Frigoli E.; Smits P.; Vranckx P.; Ozaki Y.; Tijssen J.; Juni P.; Morice
M.-C.; Onuma Y.; Windecker S.; Frenk A.; Spaulding C.; Chevalier B.;
Barbato E.; Tonino P.; Hildick-Smith D.; Roffi M.; Kornowski R.; Schultz
C.; Lesiak M.; Iniguez A.; Colombo A.; Alasnag M.; Mullasari A.; James S.;
Stankovic G.; Ong P.J.L.; Rodriguez A.E.; Mahfoud F.; Bartunek J.;
Moschovitis A.; Laanmets P.; Leonardi S.; Heg D.; Sunnaker M.; Valgimigli
M.
Institution
(Frigoli, Heg, Sunnaker) Clinical Trials Unit, University of Bern, Bern,
Switzerland
(Smits) Department of Cardiology, Maasstad Hospital, Rotterdam,
Netherlands
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
(Vranckx) Faculty of Medicine and Life Sciences, Hasselt University,
Hasselt, Belgium
(Ozaki) Department of Cardiology, School of Medicine, Fujita Health
University, Toyoake, Aichi, Japan
(Tijssen) University of Amsterdam, Amsterdam, Netherlands
(Juni) University of Toronto, Applied Health Research Centre, Li Ka Shing
Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
(Morice) Cardiovascular European Research Center (CERC), Massy, France
(Onuma) Thorax Center, Erasmus Medical Center, Rotterdam, Netherlands
(Windecker, Frenk, Moschovitis, Valgimigli) Department of Cardiology, Bern
University Hospital, Bern, Switzerland
(Spaulding) Cardiology department, Hopital Europeen Georges Pompidou,
Assistance Publique Hopitaux de Paris, Sudden Death Expert Center, INSERM
U 970, Paris Descartes Universite, Paris, France
(Chevalier) Ramsay Generale de Sante Interventional Cardiology Department,
Institut Cardiovasculaire Paris Sud, Massy, France
(Barbato, Bartunek) Cardiovascular Research Center Aalst, Aalst, Belgium
(Barbato) Division of Cardiology, Department of Advanced Biomedical
Sciences, University Federico II of Naples, Italy
(Tonino) Department of Cardiology, Catharina Hospital, Eindhoven,
Netherlands
(Hildick-Smith) Brighton and Sussex University Hospitals NHS Trust,
Brighton, United Kingdom
(Roffi) Division of Cardiology, Geneva University Hospitals, Geneva,
Switzerland
(Kornowski) Rabin Medical Center, Sackler School of Medicine, Tel Aviv
University, Tel Aviv, Israel
(Schultz) Department of Cardiology, Royal Perth Hospital Campus,
University of Western Australia, Perth, Australia
(Lesiak) 1st Department of Cardiology, University of Medical Sciences,
Poznan, Poland
(Iniguez) Hospital Alvaro Cunqueiro, Vigo, Spain
(Colombo) Unit of Cardiovascular Interventions, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Alasnag) Department of Cardiology, King Fahad Armed Forces Hospital,
Jeddah, Saudi Arabia
(Mullasari) Madras Medical Mission, Chennai, India
(James) Department of Medical Sciences, Cardiology, Uppsala University,
Uppsala, Sweden
(Stankovic) Department of Cardiology, Clinical Center of Serbia, Faculty
of medicine, University of Belgrade, Belgrade, Serbia
(Ong) Tan Tock Seng Hospital, Singapore, Singapore
(Rodriguez) Cardiac Unit Otamendi Hospital, Buenos Aires School of
Medicine Cardiovascular Research Center (CECI), Buenos Aires, Argentina
(Mahfoud) Saarland University Hospital, Homburg, Germany
(Laanmets) North-Estonia Medical Centre Foundation, Tallinn, Estonia
(Leonardi) Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The optimal duration of antiplatelet therapy in high-bleeding
risk (HBR) patients with coronary artery disease treated with
newer-generation drug-eluting bioresorbable polymer-coated stents remains
unclear. Design(s): MASTER DAPT (clinicaltrial.gov NCT03023020) is an
investigator-initiated, open-label, multicenter, randomized controlled
trial comparing an abbreviated versus a standard duration of antiplatelet
therapy after bioresorbable polymer-coated Ultimaster (TANSEI)
sirolimus-eluting stent implantation in approximately 4,300 HBR patients
recruited from >=100 interventional cardiology centers globally. After a
mandatory 30-day dual-antiplatelet therapy (DAPT) run-in phase, patients
are randomized to (a) a single antiplatelet regimen until study completion
or up to 5 months in patients with clinically indicated oral
anticoagulation (experimental 1-month DAPT group) or (b) continue DAPT for
at least 5 months in patients without or 2 in patients with concomitant
indication to oral anticoagulation, followed by a single antiplatelet
regimen (standard antiplatelet regimen). With a final sample size of 4,300
patients, this study is powered to assess the noninferiority of the
abbreviated antiplatelet regimen with respect to the net adverse clinical
and major adverse cardiac and cerebral events composite end points and if
satisfied for the superiority of abbreviated as compared to standard
antiplatelet therapy duration in terms of major or clinically relevant
nonmajor bleeding. Study end points will be adjudicated by a blinded
Clinical Events Committee. Conclusion(s): The MASTER DAPT study is
the first randomized controlled trial aiming at ascertaining the optimal
duration of antiplatelet therapy in HBR patients treated with
sirolimus-eluting bioresorbable polymer-coated stent
implantation. Copyright © 2018 Elsevier Inc.

<11>
[Use Link to view the full text]
Accession Number
626174140
Title
Comparison of physical fitness and cardiopulmonary exercise test
performance using arm versus leg cycling in patients with cardiovascular
or pulmonary disease-a systematic review and meta-analysis.
Source
Cardiopulmonary Physical Therapy Journal. 29 (4) (pp 154-165), 2018. Date
of Publication: 01 Oct 2018.
Author
Tolstrup Larsen R.; Hermann Tang L.; Keller C.; Christensen J.; Taylor
R.S.; Doherty P.; Langberg H.; Zwisler A.-D.
Institution
(Tolstrup Larsen, Hermann Tang, Taylor, Zwisler) REHPA, Danish Knowledge
Centre for Rehabilitation and Palliative Care, Odense University Hospital,
University of Southern Denmark, Denmark
(Tolstrup Larsen, Christensen, Langberg) CopenRehab, Section of Social
Medicine, Department of Public Health, University of Copenhagen, Henrik
Pontoppidans Vej 6, Copenhagen N DK-2200, Denmark
(Hermann Tang) Department of Rehabilitation and Nutrition, Faculty of
Health and Technology, Metropolitan University College, Copenhagen,
Denmark
(Keller, Christensen) Department of Occupational- A Nd Physiotherapy
Therapy, Copenhagen University Hospital, Copenhagen, Denmark
(Taylor) Institute of Health Research, University of Exeter Medical
School, Exeter, United Kingdom
(Taylor) National Institute of Public Health, University of Southern
Denmark, Copenhagen, Denmark
(Doherty) Department of Health Sciences, University of York, York, United
Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: Alternative modes of cardiopulmonary exercise testing are needed
and an arm cycle (AC) is a promising alternative to the gold standard of
the leg cycle (LC). The aim of this study was to undertake a systematic
review comparing maximal oxygen consumption (VO 2max) obtained from AC and
LC in patient populations with cardiovascular disease (CVD) and pulmonary
disease (PD). Method(s): A systematic review was undertaken with
literature searches on December 5, 2016. Studies were included if they
directly compared aerobic capacity values obtained from AC and LC in
patients with CVD or PD. Results across studies were pooled using random
effects meta-analysis and univariate meta-regression were used to assess
potential associations between variables. Result(s): A total of 14
studies in 411 patients were included. On average, VO 2max of LC exceeded
AC mean difference by 3.48 mL.kg-1 .min-1, (95% confidence interval [CI]:
1.94, 5.03) and a mean AC/LC ratio of 0.83, (95% CI: 0.77, 0.90). VO 2max
differences between AC and LC were similar in patients with CVD compared
with PD but were found to be higher in older individuals and those with
higher VO 2max. Conclusion(s): Although AC offers an important
alternative form of exercise testing for patients with CVD or PD,
clinicians must take into account that VO 2max values obtained from AC are
consistently lower than those obtained on LC. However, the results of this
article offer an evidence-based estimation for the proportional
differences between AC values and LC values for groups with CVD or groups
with PD. Copyright © 2018 Cardiovascular and Pulmonary Section,
APTA.

<12>
[Use Link to view the full text]
Accession Number
626172968
Title
Short physical performance battery can be utilized to evaluate physical
function in patients after cardiac surgery.
Source
Cardiopulmonary Physical Therapy Journal. 29 (2) (pp 88-96), 2018. Date of
Publication: 01 Apr 2018.
Author
Katijjahbe M.A.; Granger C.L.; Denehy L.; Royse A.; Royse C.; Clarke S.;
El-Ansary D.
Institution
(Katijjahbe, Granger, Denehy, El-Ansary) Department of Physiotherapy,
Faculty of Medicine, Dentistry and Health Sciences, University of
Melbourne, Parkville, VIC 3053, Australia
(Katijjahbe) Department of Physiotherapy, Hospital Cancelor Tuaku Mukhriz,
Pusat Perubatan University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
(Granger) Physiotherapy Department, Royal Melbourne Hospital, Parkville,
VIC, Australia
(Royse, Royse) Department of Surgery, University of Melbourne, Parkville,
VIC, Australia
(Royse, Royse) Department of Surgery, Royal Melbourne Hospital, VIC,
Australia
(Clarke) Statistical Consulting Centre, School of Mathematics and
Statistics, University of Melbourne, Australia
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: The Short Physical Performance Battery (SPPB) is a test used to
assess physical function; however, the minimal clinically important
difference (MCID) in patients after cardiac surgery is unknown. The aim of
this study was to determine the MCID of the SPPB after cardiac surgery.
 Method(s): Seventy-two participants performed the SPPB at 4 weeks and
3 months postoperatively. The Short Form-36 version 2 was used to assess
physical function and the Global Rating of Change (GRC) scale was used to
assess patients' perceived change. Distribution-based methods were used to
determine the MCID. Result(s): The mean (95% confidence intervals
[CIs]) change of the SPPB between testing time points was 11.04
(0.67-1.42) points. Ninety-eight percent of patients rated their function
as "changed" on the GRC scale. The MCID calculated using
distribution-based methods ranged from 0.44 points (95% CI [0.191, 0.613])
for the effect size-based estimate to 1.35 points for the standard error
of measurement-based estimate. No participants scored 0/12; however, 45%
and69% of participants scored 12/12 at 4 weeks and 3 months
postoperatively, respectively. Conclusion(s): The MCID for SPPB is
estimated to be between 0.44 and 1.35 points out of 12 for patients in the
early postoperative period. Nearly half of the participants scored the
maximum score at 4 weeks, increasing to two-thirds at 3 months meaning
that the SPPB may be too easy as time from surgery increases and patients
recover. Further research is required to confirm the MCID in patients
closer to surgery where the ceiling effect is likely to be
lower. © Copyright 2018 Cardiovascular and Pulmonary Section,
APTA.

<13>
Accession Number
2001082783
Title
The value of Coronary Artery computed Tomography as the first-line
anatomical test for stable patients with indications for invasive
angiography due to suspected Coronary Artery Disease: CAT-CAD randomized
trial.
Source
Journal of Cardiovascular Computed Tomography. 12 (6) (pp 472-479), 2018.
Date of Publication: November - December 2018.
Author
Rudzinski P.N.; Kruk M.; Kepka C.; Schoepf U.J.; Duguay T.; Dzielinska Z.;
Pregowski J.; Witkowski A.; Ruzyllo W.; Demkow M.
Institution
(Rudzinski, Kruk, Kepka, Dzielinska, Pregowski, Witkowski, Ruzyllo,
Demkow) Institute of Cardiology in Warsaw, Poland
(Schoepf, Duguay) Division of Cardiovascular Imaging, Department of
Radiology and Radiological Science, Medical University of South Carolina,
Charleston, SC, United States
(Schoepf) Division of Cardiology, Department of Medicine, Medical
University of South Carolina, Charleston, SC, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The aim of this prospective, randomized trial was to evaluate
whether the use of coronary computed tomography angiography (CCTA) as the
first-line anatomical test in patients with suspected significant coronary
artery disease (CAD) may reduce the number of coronary invasive
angiographies (ICA), and expand the use of CCTA in patients currently
diagnosed invasively. Method(s): 120 patients (age:60.6 +/- 7.9
years, 35% female) with indications to ICA were randomized 1:1 to undergo
CCTA versus direct ICA. Outcomes were evaluated during the diagnostic and
therapeutic periods. Result(s): The number of invasively examined
patients was reduced by 64.4% in the CCTA group as compared to the direct
ICA group (21vs59,p < 0.0001). The number of patients with ICAs not
followed by coronary intervention was reduced by 88.1% with the CCTA
strategy (5vs42,p < 0.0001). Over the diagnostic and therapeutic course
there were no significant differences regarding the median volume of
contrast (CCTA 80.3 ml[65.0-165.0] vs ICA 90.0 ml[55.0-100.0], p = 0.099),
while a non-significant trend towards higher radiation dose in the CCTA
group was observed (9.9 mSv[7.0-22.1] vs 9.4 mSv[5.2-14.0], p = 0.05).
There were no acute cardiovascular events. Conclusion(s): CCTA may
hypothetically act as an effective 'gatekeeper' to the catheterization
laboratory in the diagnosis of stable patients with current indications
for ICA. This strategy may result in non-invasive, outpatient-based triage
of two thirds of individuals without actionable CAD, obviating unnecessary
invasive examinations. However, the longer follow-up is indispensable.
ClinicalTrials.gov number: NCT02591992 The aim of our trial was to
evaluate the clinical value of coronary computed tomography angiography
(CCTA) as the first-line anatomical test in the diagnosis of stable
patients with indications for invasive coronary angiography (ICA) due to
suspected significant coronary artery disease (CAD). This is the first
study triaging this group of patients with CT and the results of this
randomized trial are promising in terms of safety and
efficacy. Copyright © 2018 Society of Cardiovascular Computed
Tomography

<14>
Accession Number
623774886
Title
Evaluation of patient and staff exposure with state of the art X-ray
technology in cardiac catheterization: A randomized controlled trial.
Source
Journal of Interventional Cardiology. 31 (6) (pp 807-814), 2018. Date of
Publication: December 2018.
Author
Buytaert D.; Eloot L.; Mauti M.; Drieghe B.; Gheeraert P.; Taeymans Y.;
Bacher K.
Institution
(Buytaert, Eloot, Bacher) Department of Basic Medical Sciences, Ghent
University, Ghent, Belgium
(Mauti) Philips Healthcare, Best, Netherlands
(Drieghe, Gheeraert, Taeymans) Heart Centre, Ghent University Hospital,
Ghent, Belgium
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Introduction: Cardiac catheterization procedures result in high patient
radiation exposure and corresponding staff doses are reported to be among
the highest for medical staff. The purpose of current randomized
controlled study was to quantify the potential radiation dose reduction
for both patient and staff, enabled by recent X-ray technology. This
technology is equipped with advanced image processing algorithms,
real-time dose monitoring, and an acquisition chain optimized for cardiac
catheterization applications. Method(s): A total of 122 adult
patients were randomly assigned to one of two cath labs, either the
reference X-ray modality (Allura Xper FD10, Philips Healthcare, the
Netherlands) or the new X-ray system (AlluraClarity FD20/10 Philips
Healthcare, the Netherlands). Exposure parameters and staff dosimeter
readings were recorded for each exposure. Technical measurements were
performed to define the radiation scatter behavior. Result(s): With
the newer equipment, patient radiation dose is reduced (as total dose-area
product) by 67% based on geometric means with 95%CI of 53%, 77% for
diagnostic and interventional procedures. The C-arm and leg dosimeter
readings were both reduced with 65% (P < 0.001), while for the collar and
chest dosimeter readings no statistically significant reduction was
noticed. Conclusion(s): The new x-ray and image processing
technology, significantly reduces patient dose in coronary angiographies,
and PCIs by 67%. In general, scatter dose was also reduced, yet for some
dosimeters the reduction was limited and not statistically significant.
This study clearly indicates that the scatter behavior is highly dependent
on C-arm rotation, operator movement and height, dosimeter position, beam
filtration, clinical procedure type and system geometry. Copyright
© 2018 Wiley Periodicals, Inc.

<15>
Accession Number
2001385383
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 3723-3731), 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, Newcastle Upon
Tyne, United Kingdom
(Li, Ho, Liu, 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) 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. 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. 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 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). 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. Copyright © 2018 Elsevier Inc.

<16>
Accession Number
623347714
Title
New-onset arrhythmias following transcatheter aortic valve implantation: A
systematic review and meta-analysis.
Source
Heart. 104 (14) (pp 1208-1215), 2018. Date of Publication: 01 Jul 2018.
Author
Siontis G.C.M.; Praz F.; Lanz J.; Vollenbroich R.; Roten L.; Stortecky S.;
Raber L.; Windecker S.; Pilgrim T.
Institution
(Siontis, Praz, Lanz, Vollenbroich, Roten, Stortecky, Raber, Windecker,
Pilgrim) Department of Cardiology, Swiss Cardiovascular Center Bern,
University of Bern, Bern, Switzerland
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: To evaluate the prevalence and clinical impact of new-onset
arrhythmias in patients following transcatheter aortic valve implantation
(TAVI). Method(s): We systematically identified studies reporting
new-onset arrhythmias after TAVI other than atrioventricular conduction
disturbances. We summarised monitoring strategies, type and prevalence of
arrhythmias and estimated their effect on risk of death or cerebrovascular
events by using random-effects meta-analysis. The study is registered with
International prospective register of systematic reviews (PROSPERO)
(CRD42017058053). Result(s): Sixty-five studies (43 506 patients)
reported new-onset arrhythmias following TAVI. The method of arrhythmia
detection was specified only in 31 studies (48%). New-onset atrial
fibrillation (NOAF) (2641 patients), bradyarrhythmias (182 patients),
supraventricular arrhythmias (29 patients), ventricular arrhythmias (28
patients) and non-specified major arrhythmias (855 patients) were
reported. In most studies (52 out of 65), new-onset arrhythmia detection
was limited to the first month following TAVI. The most frequently
documented arrhythmia was NOAF with trend of increasing summary prevalence
of 11%, 14%, 14% and 25% during inhospital, 30-day, 1-year and 2-year
follow-ups, respectively (P for trend=0.011). Summary prevalence estimates
of NOAF at 30-day follow-up differ significantly between studies of
prospective and retrospective design (8% and 21%, respectively, P=0.002).
New episodes of bradyarrhythmias were documented with a summary crude
prevalence of 4% at 1-year follow-up. NOAF increased the risk of death
(relative risk 1.61, 95% CI 1.35 to 1.98, I 2 =47%) and cerebrovascular
events (1.79, 95% CI 1.24 to 2.64, I 2 =0%). No study commented on
therapeutic modifications following the detection of new-onset
arrhythmias. Conclusion(s): Systematic identification of new-onset
arrhythmias following TAVI may have considerable impact on subsequent
therapeutic management and long-term prognosis in this patient
population. Copyright © 2018 Article author(s). All rights
reserved.

<17>
Accession Number
2000811503
Title
Sonolysis in risk reduction of symptomatic and silent brain infarctions
during coronary stenting (SONOREDUCE): Randomized, controlled trial.
Source
International Journal of Cardiology. 267 (pp 62-67), 2018. Date of
Publication: 15 September 2018.
Author
Viszlayova D.; Brozman M.; Langova K.; Herzig R.; Skoloudik D.
Institution
(Viszlayova, Brozman) Department of Neurology, Faculty Hospital Nitra and
Constantine Philosopher University, Nitra, Slovakia
(Viszlayova) Department of Neurology, Faculty of Medicine and Dentistry,
Palacky University, Olomouc, Czech Republic
(Viszlayova) Department of Neurology, Charles University Faculty of
Medicine, Hradec Kralove, Czech Republic
(Langova, Skoloudik) Centre for Research and Science, Faculty of Health
Sciences, Palacky University, Olomouc, Czech Republic
(Langova) Department of Biophysics, Faculty of Medicine and Dentistry,
Palacky University, Olomouc, Czech Republic
(Herzig) Department of Neurology, Comprehensive Stroke Center, Charles
University Faculty of Medicine and University Hospital Hradec Kralove,
Hradec Kralove, Czech Republic
Publisher
Elsevier Ireland Ltd
Abstract
Background: Silent brain infarcts can be detected on magnetic resonance
imaging (MRI) in ~22% of patients after coronary angioplasty and stenting
(CS). The effect of periprocedural sonolysis on the risk of new brain
infarcts during CS was examined. Method(s): Patients undergoing
elective CS were allocated randomly to a bilateral sonolysis group (70
patients, 58 men; mean age, 59.9 years) or a control group (74 patients,
45 men; mean age, 65.5 years). Neurologic examination, cognitive function
tests, and brain MRI were performed prior to intervention and at 24 h
after CS. Neurologic examination and cognitive function tests were
repeated at 30 days after CS. Result(s): No significant differences
were observed in the number of patients with new infarcts (25.7 vs. 18.9%,
P = 0.423), the number of lesions (1.3 +/- 1.0 vs. 2.9 +/- 5.3, P =
0.493), lesion volume (0.16 +/- 0.34 vs. 0.28 +/- 0.60 mL, P = 0.143), and
the number of patients with new ischemic lesions in the insonated MCA
territories (18.6vs. 17.6%, P = 0.958) between the sonolysis group and the
control group. There were no cases of stroke, transient ischemic attack,
myocardial infarction, or death in the two groups. Intracranial bleeding
was reported only in 1 patient in the control group (0 vs. 1.4%, P =
0.888). Clock-drawing test scores at 30 days were significantly higher in
the sonolysis group than in the control group (median 3.0 vs. 2.5, P =
0.031). Conclusion(s): Sonolysis does not reduce the risk of new
brain infarcts after CS. The effect of sonolysis on number and volume of
ischemic lesions and cognitive function should be assessed in further
studies. Copyright © 2018 Elsevier B.V.

<18>
Accession Number
620590629
Title
Rationale and design of the Statins Evaluation in Coronary procedUres and
REvascularization: The SECURE-PCI Trial.
Source
American Heart Journal. 198 (pp 129-134), 2018. Date of Publication: April
2018.
Author
Berwanger O.; de Barros e Silva P.G.M.; Dall Orto F.T.C.; de Andrade P.B.;
de Castro Bienert I.R.; Bosso C.E.; Mangione J.; Polanczyk C.A.; Sousa A.;
Kalil R.; de Moura Santos L.; Sposito A.C.; Rech R.L.; Sousa A.C.S.;
Baldissera F.; Nascimento B.R.; de Andrade Jesuino I.; Santucci E.V.;
Damiani L.P.; Laranjeira L.N.; Borges de Oliveira J.A.; Giraldez R.R.;
Cavalcanti A.B.; Pereira S.B.; Mattos L.A.; Armaganijan L.V.; Guimaraes
H.P.; Sousa J.E.; Alexander J.H.; Granger C.B.; Lopes R.D.
Institution
(Berwanger, de Barros e Silva, Dall Orto, de Andrade, de Castro Bienert,
Bosso, Mangione, Polanczyk, Sousa, Kalil, de Moura Santos, Sposito, Rech,
Sousa, Baldissera, Nascimento, de Andrade Jesuino, Santucci, Damiani,
Laranjeira, Borges de Oliveira, Giraldez, Cavalcanti, Pereira, Mattos,
Armaganijan, Guimaraes, Sousa, Alexander, Granger, Lopes) Research
Institute-Heart Hospital (HCor), Rua Abilio Soares 250, 12th floor, Sao
Paulo, SP 04005-000, Brazil
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Previous evidence suggests that acute treatment with statins
reduce atherosclerotic complications, including periprocedural myocardial
infarction, but currently, there are no large, adequately powered studies
to define the effects of early, high-dose statins in patients with acute
coronary syndrome (ACS) and planned invasive management.
 Objective(s): The main goal of Statins Evaluation in Coronary
procedUres and REvascularization (SECURE-PCI) Trial is to determine
whether the early use of a loading dose of 80 mg of atorvastatin before an
intended percutaneous coronary intervention followed by an additional dose
of 80 mg 24 hours after the procedure will be able to reduce the rates of
major cardiovascular events at 30 days in patients with an ACS.
 Design(s): The SECURE-PCI study is a pragmatic, multicenter,
double-blind, placebo-controlled randomized trial planned to enroll around
4,200 patients in 58 different sites in Brazil. The primary outcome is the
rate of major cardiovascular events at 30 days defined as a composite of
all-cause mortality, nonfatal acute myocardial infarction, nonfatal
stroke, and coronary revascularization. The SECURE PCI is a large
randomized trial testing a strategy of early, high-dose statin in patients
with ACS and will provide important information about the acute treatment
of this patient population. Copyright © 2018

<19>
Accession Number
620548208
Title
Preoperative factors associated with worsening in health-related quality
of life following coronary artery bypass grafting in the Randomized On/Off
Bypass (ROOBY) trial.
Source
American Heart Journal. 198 (pp 33-38), 2018. Date of Publication: April
2018.
Author
Bishawi M.; Hattler B.; Almassi G.H.; Spertus J.A.; Quin J.A.; Collins
J.F.; Grover F.L.; Shroyer A.L.
Institution
(Bishawi, Shroyer) Northport VA Medical Center, Northport, NY, United
States
(Bishawi) Duke University Medical Center, Durham, NC, United States
(Hattler, Grover, Shroyer) Eastern Colorado Health Care System, Denver VA
Medical Center, Denver, CO, United States
(Hattler, Grover) University of Colorado School of Medicine, Anschutz
Medical Campus, Aurora, CO, United States
(Almassi) Clement J. Zablocki Veterans Affairs (VA) Medical Center,
Milwaukee, WI, United States
(Almassi) Medical College of Wisconsin, Milwaukee, WI, United States
(Spertus) Saint Luke's Mid America Heart Institute and University of
Missouri, Kansas City, MO, United States
(Collins) Cooperative Studies Program Coordinating Center, Veterans
Affairs Medical Center, Point, Perry, MD, United States
(Quin) VA Boston Healthcare System, West Roxbury, MA and Harvard Medical
School, Boston, MA, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
For advanced coronary disease, coronary artery bypass graft (CABG) surgery
generally improves patients' symptoms and long-term survival.
Unfortunately, some patients experience worse health-related quality of
life (HRQL) after CABG. The objective of this study is to report the
frequency and risk factors associated with 1-year post-CABG HRQL
deterioration. Method(s): From 2002 to 2007, 2203 "Randomized On/Off
Bypass" (ROOBY) trial patients randomly received either off-pump or
on-pump CABG at 18 VA medical centers. Subjects completed both baseline
and 1-year Seattle Angina Questionnaire (SAQ) and the Veterans Rand 36
(VR-36) questionnaires to assess HRQL. Using previously published
criteria, the rates of clinically significant changes were determined for
the SAQ [angina frequency (AF), physical limitation (PL), and quality of
life (QoL)] and VR36 [mental component score (MCS) and physical component
score (PCS)] subscales. Multivariate regression models were then used to
identify pre-CABG patient characteristics associated with worsened 1-year
HRQL status for each subscale. Result(s): Over 80% of patients had an
improvement or no change in SAQ and VR-36 subscale scores 1 year after
CABG. The HRQL scale-specific deterioration rates were 4.5% SAQ-AF, 16.8%
SAQ-PL, 4.9% SAQ-QoL, 19.4% VR36-MCS, and 13.5% VR36-PCS. Predictors of
1-year HRQL deterioration were diabetes and smoking for the SAQ-AF;
diabetes, chronic obstructive pulmonary disease (COPD), and peripheral
vascular disease (PVD) for SAQ-PL; COPD and depression for the SAQ-QoL;
diabetes for VR36-PCS, and history of stroke and depression for VR36-MCS.
The baseline score was an independent predictor for worsening in all the
subscales studied. Conclusion(s): Among VA patients, less than 20%
experienced worse HRQL 1 year after CABG. For patients with low symptom
burden at baseline, diabetes, smoking, depression, PVD, COPD, and a prior
stroke, clinicians should be more cautious in pre-CABG counseling as to
their anticipated HRQL improvements. Copyright © 2018

<20>
Accession Number
2000625675
Title
A narrative overview: Have clinical trials of PCI vs medical therapy
addressed the right question?.
Source
International Journal of Cardiology. 267 (pp 35-40), 2018. Date of
Publication: 15 September 2018.
Author
Morrone D.; Marzilli M.; Panico R.A.; Kolm P.; Weintraub W.S.
Institution
(Morrone, Kolm, Weintraub) Christiana Care Health System, Newark, DE,
United States
(Morrone, Marzilli, Panico) Surgery Pathology, Medical, Molecular and
Critic Area Department-Cardiovascular Disease Section, Pisa University,
Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background: In RCTs about revascularization, the terms "coronary artery
disease" and "ischemic heart disease" are sometimes used interchangeably.
This can create confusion concerning inclusion and exclusion criteria,
which may lead to uncertain results. Objective(s): Our purpose is to
investigate whether the study populations in randomized controlled trials
(RCTs) which compared percutaneous coronary revascularization to medical
therapy for stable ischemic heart disease specifically enrolled patients
with demonstrable ischemia, and how many patients were included in trials
with evidence of coronary atherosclerosis but without evidence of
ischemia. Method(s): Trial published data were obtained from ACME I,
ACME II, RITA I, RITA II, MASS I, MASS II, AVERT, ACIP, COURAGE and FAME2.
Published data were used to calculate the number of patients included in
the trials with a negative stress test but significant coronary artery
stenosis and the number of patients excluded from the trials with a
positive stress test or angina, but without significant coronary artery
stenosis at the time of angiography. Result(s): A total of 196,433
patients were screened between 1998 and 2011. Overall about 30% of
patients were excluded if they did not meet the angiographic criteria,
even though the presence of inducible ischemia or angina, and, about 20%
of patients were included without inducible ischemia. Conclusion(s):
RCTs have contributed to the confusion between coronary artery disease and
ischemic heart disease. This may limit the ability to interpret the
results and apply them in practice. Copyright © 2018 Elsevier
B.V.

<21>
Accession Number
623664113
Title
Long-term use of carvedilol in patients with ST-segment elevation
myocardial infarction treated with primary percutaneous coronary
intervention.
Source
PLoS ONE. 13 (8) (no pagination), 2018. Article Number: e0199347. Date of
Publication: August 2018.
Author
Watanabe H.; Ozasa N.; Morimoto T.; Shiomi H.; Bingyuan B.; Suwa S.;
Nakagawa Y.; Izumi C.; Kadota K.; Ikeguchi S.; Hibi K.; Furukawa Y.; Kaji
S.; Suzuki T.; Akao M.; Inada T.; Hayashi Y.; Nanasato M.; Okutsu M.;
Kametani R.; Sone T.; Sugimura Y.; Kawai K.; Abe M.; Kaneko H.; Nakamura
S.; Kimura T.
Institution
(Watanabe, Ozasa, Shiomi, Bingyuan, Kimura) Department of Cardiovascular
Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
(Morimoto) Department of Clinical Epidemiology, Hyogo College of Medicine,
Hyogo, Japan
(Suwa) Division of Cardiology, Juntendo University Shizuoka Hospital,
Izunokuni, Japan
(Nakagawa, Izumi) Division of Cardiology, Tenri Hospital, Nara, Japan
(Kadota) Division of Cardiology, Kurashiki Central Hospital, Kurashiki,
Japan
(Ikeguchi) Division of cardiology, Shiga General Hospital, Moriyama, Japan
(Hibi) Division of Cardiology, Yokohama City University Medical Center,
Yokohama, Japan
(Furukawa, Kaji) Division of Cardiology, Kobe City Medical Center General
Hospital, Kobe, Japan
(Suzuki) Division of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
(Akao) Department of Cardiology, National Hospital Organization Kyoto
Medical Center, Kyoto, Japan
(Inada) Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
(Hayashi) Division of Cardiology, Tsuchiya General Hospital, Hiroshima,
Japan
(Nanasato) Cardiovascular Center, Nagoya Daini Red Cross Hospital, Nagoya,
Japan
(Okutsu) Division of Cardiology, Nozaki Tokushukai Hospital, Osaka, Japan
(Kametani) Division of Cardiology, Nagoya Tokushukai General Hospital,
Kasugai, Japan
(Sone) Division of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
(Sugimura) Division of Cardiology, Kawakita General Hospital, Tokyo, Japan
(Kawai) Division of Cardiology, Chikamori Hospital, Kochi, Japan
(Abe) Division of Cardiology, Yotsuba Circulation Clinic, Matsuyama, Japan
(Kaneko) Division of Cardiology, Hoshi General Hospital, Koriyama, Japan
(Nakamura) Division of Cardiology, New Tokyo Hospital, Chiba, Japan
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Despite its recommendation by the current guidelines, the role
of long-term oral beta-blocker therapy has never been evaluated by
randomized trials in uncomplicated ST-segment elevation myocardial
infarction (STEMI) patients without heart failure, left ventricular
dysfunction or ventricular arrhythmia who underwent primary percutaneous
coronary intervention (PCI). Methods and results In a multi-center,
open-label, randomized controlled trial, STEMI patients with successful
primary PCI within 24 hours from the onset and with left ventricular
ejection fraction (LVEF) 40% were randomly assigned in a 1-to-1 fashion
either to the carvedilol group or to the no beta-blocker group within 7
days after primary PCI. The primary endpoint is a composite of all-cause
death, myocardial infarction, hospitalization for heart failure, and
hospitalization for acute coronary syndrome. Between August 2010 and May
2014, 801 patients were randomly assigned to the carvedilol group (N =
399) or the no beta-blocker group (N = 402) at 67 centers in Japan. The
carvedilol dose was up-titrated from 3.4+/-2.1 mg at baseline to 6.3
+/-4.3 mg at 1-year. During median follow-up of 3.9 years with 96.4%
follow-up, the cumulative 3-year incidences of both the primary endpoint
and any coronary revascularization were not significantly different
between the carvedilol and no beta-blocker groups (6.8% and 7.9%, P =
0.20, and 20.3% and 17.7%, P = 0.65, respectively). There also was no
significant difference in LVEF at 1-year between the 2 groups (60.9+/-8.4%
and 59.6+/-8.8%, P = 0.06) Conclusion Long-term carvedilol therapy added
on the contemporary evidence-based medications did not seem beneficial in
selected STEMI patients treated with primary PCI. Trial registration
CAPITAL-RCT (Carvedilol Post-Intervention Long-Term Administration in
Large-scale Randomized Controlled Trial) ClinicalTrials.gov.number, NCT
01155635. Copyright © 2018 Watanabe et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<22>
Accession Number
625563806
Title
Valve-Sparing Aortic Root Repair Compared to Composite Aortic Root
Replacement: A Systematic Review and Meta-Analysis.
Source
The Journal of heart valve disease. 26 (6) (pp 632-638), 2017. Date of
Publication: 01 Nov 2017.
Author
Harky A.; Fok M.; Froghi S.; Bilal H.; Bashir M.
Institution
(Harky) Department of Vascular Surgery, Countess of Chester Hospital,
Chester, United Kingdom
(Fok) Department of Surgery, Peterborough City Hospital, Edith Cavell
Campus, Peterborough, United Kingdom
(Froghi) Department of General Surgery, Imperial College Healthcare NHS
Trust, St. Mary's Hospital, London, United Kingdom
(Bilal) Manchester Metropolitan University, Manchester, United Kingdom
(Bashir) Manchester Metropolitan University, United Kingdom. Electronic
correspondence:, Manchester, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: Aortic root aneurysms represent a significant risk of
morbidity and mortality. Composite root replacement is the preferred
practice for repair, although recently valve-sparing replacement has
become a popular alternative. The study aim was to identify comparative
studies that simultaneously analyzed composite root and valve-sparing root
replacement outcomes. METHOD(S): A systematic review of the current
literature was performed through four major databases, from inception
until 2016. All comparative studies of valve-sparing versus composite root
replacement were identified. All studies were assessed by two reviewers
for their applicability and inclusion. RESULT(S): A total of 12
comparative papers was identified encompassing 2,352 patients (700
valve-sparing and 1,652 composite); the mean follow up was 3.7 +/- 1.7
years. Aortic cross-clamp and cardiopulmonary bypass times were lower in
the composite group (p <0.0001 and p<0.00001, respectively). In-hospital
mortality was low, but higher in the composite group (p = 0.002). Only one
study reported long-term follow up. In studies reporting reoperation,
there was slight difference favoring composite over valve-sparing
replacement (p = 0.05). CONCLUSION(S): Valve-sparing and composite
root replacement remain feasible options for replacement of the aortic
root. Long-term data of comparative studies are not yet available to
assess the viability of these procedures.

<23>
Accession Number
626223336
Title
Cardiac Arrest After Cardiac Surgery: An Evidence-Based Resuscitation
Protocol.
Source
Critical care nurse. 39 (1) (pp 15-25), 2019. Date of Publication: 01 Feb
2019.
Author
Michaelis P.; Leone R.J.
Institution
(Michaelis, Leone) Patrick Michaelis is a private consultant in
Bellingham, WA, United States
(Michaelis, Leone) Richard Leone is a cardiothoracic surgeon, Skagit
Regional Health, Mount Vernon, and Kadlec Regional Medical Center,
Richland, Washington
Publisher
NLM (Medline)
Abstract
More than 250 000 cardiac surgical procedures are performed annually in
the United States. Postoperative cardiac arrest rates range from 0.7% to
5.2%. This article reviews current evidence for cardiac arrest
resuscitation after cardiac surgery. The evaluation included resuscitation
guidelines and 22 studies identified through a MEDLINE search.
Evidence-based resuscitation differs from advanced cardiovascular life
support guidelines. European Resuscitation Council guidelines include
correcting reversible causes of arrest, applying defibrillation/pacing
before external cardiopulmonary resuscitation, resternotomy within 5
minutes if electrical therapies fail, and restricting epinephrine use to
avoid rebound hypertension. A 2017 Society of Thoracic Surgeons protocol
derived from European Resuscitation Council guidelines is now standard of
care in the United States. Evidence-based practices can improve survival
and reduce resternotomy rates. This article describes the clinical
implementation of the Society of Thoracic Surgeons
guidelines. Copyright ©2019 American Association of Critical-Care
Nurses.

<24>
Accession Number
626200172
Title
Early physical and psycho-educational rehabilitation in patients with
coronary artery bypass grafting: A randomized controlled trial.
Source
Journal of rehabilitation medicine. 51 (2) (pp 136-143), 2019. Date of
Publication: 01 Feb 2019.
Author
Hojskov I.E.; Moons P.; Egerod I.; Olsen P.S.; Thygesen L.C.; Hansen N.V.;
La Cour S.; Bech K.H.; Borregaard B.; Gluud C.; Winkel P.; Lindschou J.;
Kikkenborg Berg S.
Institution
(Hojskov) Department of Cardiothoracic Surgery/Department of Nursing,
Faculty of Health and Technology, Rigshospitalet, University of
Copenhagen/ Metropolitan University College, Copenhagen 2100, Denmark
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Rehabilitation of patients following coronary artery bypass
grafting (CABG) has been widely studied; however, research into early
rehabilitation after CABG is sparse. The aim of this trial was to assess
the impact of early rehabilitation, compared with usual care in patients
following CABG. DESIGN: Randomized controlled trial. PATIENTS: A total of
326 patients treated with CABG. METHOD(S): Patients treated with CABG
were randomized 1:1 to 4 weeks of comprehensive early rehabilitation or
usual care. The primary outcome was the Six Minute Walk Test (6MWT).
Secondary outcomes were mental health and physical activity (Medical
Outcome Study Short Form; SF-12); anxiety and depression (Hospital Anxiety
and Depression Scale; HADS); physical and emotional scores; sleep
(Pittsburgh Sleep Quality Index; PSQI); pain (Orebro Musculoskeletal
Screening Questionnaire; OMSQ) and muscle endurance (Sit-To-Stand test).
 RESULT(S): Sixteen patients dropped out. No significant differences
between groups in the primary outcome (6MWT) were found after 4 weeks
(p=0.27). For secondary outcomes the odds ratio of HADS-D >=8 decreased in
favour of the experimental intervention (p=0.04). There was non-adherence
to parts of the intervention. Per-protocol analysis showed differences
between groups for the 6MWT (p=0.02) and the Sit-To-Stand test (p=0.046).
 CONCLUSION(S): In general, the intervention had no effect on the
6MWT, or secondary outcomes, except for depressive symptoms. However, in
adherent participants, the intervention had a positive effect for the
primary and several secondary outcomes.

<25>
[Use Link to view the full text]
Accession Number
626211355
Title
Outcomes of patients with and without baseline lipid-lowering therapy
undergoing revascularization for left main coronary artery disease:
analysis from the EXCEL trial.
Source
Coronary artery disease. 30 (2) (pp 143-149), 2019. Date of Publication:
01 Mar 2019.
Author
Chen S.; Redfors B.; Liu Y.; Vrolix M.; Macaya C.; Ben-Yehuda O.;
Kappetein A.P.; Sabik J.F.; Serruys P.W.; Stone G.W.
Institution
(Chen, Redfors, Liu, Ben-Yehuda, Stone) Clinical Trials Center,
Cardiovascular Research Foundation, China
(Redfors) Sahlgrenska University Hospital, Gothenburg, Sweden
(Vrolix) Ziekenhuis Oost Limburg, Genk, Belgium
(Macaya) Hospital Clinico de San Carlos, Madrid, Spain
(Ben-Yehuda, Stone) Division of Cardiology, NewYork-Presbyterian
Hospital/Columbia University Medical Center, NY, United States
(Kappetein) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: There is a paucity of data on the effect of baseline
lipid-lowering therapy (LLT) in patients undergoing revascularization for
left main (LM) coronary artery disease (CAD). We compared outcomes for
patients with LMCAD randomized to percutaneous coronary intervention (PCI)
or coronary artery bypass grafting (CABG) according to the presence of
baseline LLT in the EXCEL trial. PATIENTS AND METHODS: The EXCEL
trial randomized 1905 patients with LMCAD and SYNTAX scores up to 32 to
PCI with everolimus-eluting stents versus CABG. Patients were categorized
according to whether they were medically treated with LLT at baseline, and
their outcomes were examined using multivariable Cox proportional hazards
regression. The primary endpoint was a composite of death, stroke, or
myocardial infarction at 3 years. RESULT(S): Among 1901 patients with
known baseline LLT status, 1331 (70.0%) were medically treated with LLT at
baseline. There were no significant differences between the PCI and CABG
groups in the 3-year rates of the primary endpoint in patients with versus
without baseline LLT (Pinteraction=0.62). Among patients with baseline
LLT, the 3-year rate of ischemia-driven revascularization was higher after
PCI compared with CABG (13.7 vs. 5.3%; adjusted hazard ratio=2.97; 95%
confidence interval: 1.95-4.55; P<0.0001), in contrast to patients without
baseline LLT (9.8 vs. 12.1%; adjusted hazard ratio=0.79; 95% confidence
interval: 0.47-1.33; P=0.39) (Pinteraction=0.0003). CONCLUSION(S): In
the EXCEL trial, 3-year major adverse event rates after PCI versus CABG
for LMCAD were similar and consistent in patients with and without LLT at
baseline; however, revascularization during follow-up was more common
after PCI compared with CABG in patients with baseline LLT, but not in
those without baseline LLT.

<26>
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. 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.
 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).
 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 .).

<27>
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. 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. 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.
 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 .).

<28>
Accession Number
626200012
Title
The periprocedural myocardial damage prevention during elective
percutaneous coronary intervention as a result of pharmacological
preconditioning with an oral form of nicorandil in patients with stable
coronary artery disease. Pilot study.
Source
Terapevticheskii arkhiv. 90 (9) (pp 53-59), 2018. Date of Publication: 20
Sep 2018.
Author
Gostishchev R.V.; Soboleva G.N.; Samko A.N.; Rogoza A.N.; Minasyan A.A.
Institution
(Gostishchev, Soboleva, Samko, Rogoza, Minasyan) Federal State Budgetary
Institution "National Medical Research Center of Cardiology" of the
Ministry of Health of Russia, Moscow, Russian Federation
Publisher
NLM (Medline)
Abstract
AIM: The purpose of the study is to prove the effectiveness of
pharmacological preconditioning caused by nicorandil in patients with
stable coronary heart disease (CHD) during the elective percutaneous
coronary intervention (PCI). MATERIALS AND METHODS: We included 88
patients with a stable form of CHD, who were going to pass the elective
PCI, in the study. As the method of blind randomization envelope method
was used. There were formed two groups or patients: the first group
involved 45 patients - were treated with nicorandil (Cordinic, PIQ-FHARMA
LLC) (the main group) the other group included 43 patients who were
treated by the standard therapy (the comparison group). The basic
antianginal therapy was allowed to use in both groups: beta-blockers,
calcium antagonists, ATE inhibitors / angiotensin II receptor blockers,
statins, acetylsalicylic acid, blockers of P2Y12 receptor platelets. The
admission of prolonged form of nitrates before the PCI was allowed in the
second group. Patients from the 1st group were to take nicorandil 2 days
and 1 day before the PCI at the 30 mg/day dose, then 20 mg orally 2 hours
just before PCI, and one more time 6 hours after the PCI - 10 mg
nicorandil. Highly sensitive troponin (HS-Tp) as a biomarker of
irreversible damage to the myocardium was evaluated before PCI and after
PCI in 24 hours. Were used highly sensitive troponin (HF-Tr) and creatine
phosphokinase-MB as an irreversible myocardial damage biomarkers. The
analysis of which was conducted before PCI and 24 hours after the surgery.
 RESULT(S): The obtained data shows the significant differences of an
increase in hs-Tp in 24 hours after PCI in patients with no admission of
nicorandil (117 ng/l) as compared with the nicorandil group (73 ng/l), p =
0.04. There were significant differences in the 24 hours increment in
hs-Tp in the control group, it was higher (112 ng/l) than in the
nicorandil group (67 ng/l), p = 0.03. There was also a significant
-decrease in CK-MB after 24 hours in the nicorandil group (2.7 ng/L)
compared to the control group (2.0 ng/L), p = 0.008. Also the frequency of
the troponin increase above the UNL(upper normal level) in the nicorandal
group, was significantly (p = 0.03) lower (in 62% of cases compared to 85%
of the control group). CONCLUSION(S): The prevention of the
complications during the percutaneous myocardial revascularization should
be considered with the position of the most suitable pharmacological
support. The appointment of the oral form of nicorandil (Cordinic,
PIQ-FHARMA LLC) for 2 days and 1 day before PCI 30 mg/day, then 20 mg 2
hours before the PCI and 10 mg after 6 hours after the surgery reduces the
risk of intraoperative myocardial damage. The obtained data give an
opportunity to extend the indications for nicorandil's appointment in the
drug support during PCI in patients with stable coronary artery disease.

<29>
Accession Number
626169042
Title
Interventions to promote patient utilisation of cardiac rehabilitation.
Source
Cochrane Database of Systematic Reviews. 2019 (2) (no pagination), 2019.
Article Number: CD007131. Date of Publication: 01 Feb 2019.
Author
Santiago de Araujo Pio C.; Chaves G.S.S.; Davies P.; Taylor R.S.; Grace
S.L.
Institution
(Santiago de Araujo Pio, Grace) York University, School of Kinesiology and
Health Science, 4700 Keele Street, Toronto, ON M4P 2L8, Canada
(Chaves) Federal University of Minas Gerais, Rehabilitation Science
Program, Belo Horizonte, Brazil
(Davies) University of Bristol, Population Health Sciences, Bristol
Medical School, Canynge Hall, Bristol BS8 2PS, United Kingdom
(Taylor) University of Exeter Medical School, Institute of Health
Research, South Cloisters, St Luke's Campus, Heavitree Road, Exeter EX2
4SG, United Kingdom
(Grace) University Health Network, Toronto Rehabilitation Institute,
8e-402 Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, Canada
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: International clinical practice guidelines routinely recommend
that cardiac patients participate in rehabilitation programmes for
comprehensive secondary prevention. However, data show that only a small
proportion of these patients utilise rehabilitation. Objective(s):
First, to assess interventions provided to increase patient enrolment in,
adherence to, and completion of cardiac rehabilitation. Second, to assess
intervention costs and associated harms, as well as interventions intended
to promote equitable CR utilisation in vulnerable patient subpopulations.
 Search Method(s): Review authors performed a search on 10 July 2018,
to identify studies published since publication of the previous systematic
review. We searched the Cochrane Central Register of Controlled Trials
(CENTRAL); the National Health Service (NHS) Centre for Reviews and
Dissemination (CRD) databases (Health Technology Assessment (HTA) and
Database of Abstracts of Reviews of Effects (DARE)), in the Cochrane
Library (Wiley); MEDLINE (Ovid); Embase (Elsevier); the Cumulative Index
to Nursing and Allied Health Literature (CINAHL) (EBSCOhost); and
Conference Proceedings Citation Index - Science (CPCI-S) on Web of Science
(Clarivate Analytics). We checked the reference lists of relevant
systematic reviews for additional studies and also searched two clinical
trial registers. We applied no language restrictions. Selection
Criteria: We included randomised controlled trials (RCTs) in adults with
myocardial infarction, with angina, undergoing coronary artery bypass
graft surgery or percutaneous coronary intervention, or with heart failure
who were eligible for cardiac rehabilitation. Interventions had to aim to
increase utilisation of comprehensive phase II cardiac rehabilitation. We
included only studies that measured one or more of our primary outcomes.
Secondary outcomes were harms and costs, and we focused on equity.
 Data Collection and Analysis: Two review authors independently
screened the titles and abstracts of all identified references for
eligibility, and we obtained full papers of potentially relevant trials.
Two review authors independently considered these trials for inclusion,
assessed included studies for risk of bias, and extracted trial data
independently. We resolved disagreements through consultation with a third
review author. We performed random-effects meta-regression for each
outcome and explored prespecified study characteristics. Main
Result(s): Overall, we included 26 studies with 5299 participants (29
comparisons). Participants were primarily male (64.2%). Ten (38.5%)
studies included patients with heart failure. We assessed most studies as
having low or unclear risk of bias. Sixteen studies (3164 participants)
reported interventions to improve enrolment in cardiac rehabilitation, 11
studies (2319 participants) reported interventions to improve adherence to
cardiac rehabilitation, and seven studies (1567 participants) reported
interventions to increase programme completion. Researchers tested a
variety of interventions to increase utilisation of cardiac
rehabilitation. In many studies, this consisted of contacts made by a
healthcare provider during or shortly after an acute care hospitalisation.
Low-quality evidence shows an effect of interventions on increasing
programme enrolment (19 comparisons; risk ratio (RR) 1.27, 95% confidence
interval (CI) 1.13 to 1.42). Meta-regression revealed that the
intervention deliverer (nurse or allied healthcare provider; P = 0.02) and
the delivery format (face-to-face; P = 0.01) were influential in
increasing enrolment. Low-quality evidence shows interventions to increase
adherence were effective (nine comparisons; standardised mean difference
(SMD) 0.38, 95% CI 0.20 to 0.55), particularly when they were delivered
remotely, such as in home-based programs (SMD 0.56, 95% CI 0.37 to 0.76).
Moderate-quality evidence shows interventions to increase programme
completion were also effective (eight comparisons; RR 1.13, 95% CI 1.02 to
1.25), but those applied in multi-centre studies were less effective than
those given in single-centre studies, leading to questions regarding
generalisability. A moderate level of statistical heterogeneity across
intervention studies reflects heterogeneity in intervention approaches.
There was no evidence of small-study bias for enrolment (insufficient
studies to test for this in the other outcomes). With regard to secondary
outcomes, no studies reported on harms associated with the interventions.
Only two studies reported costs. In terms of equity, trialists tested
interventions designed to improve utilisation among women and older
patients. Evidence is insufficient for quantitative assessment of whether
women-tailored programmes were associated with increased utilisation, and
studies that assess motivating women are needed. For older participants,
again while quantitative assessment could not be undertaken, peer
navigation may improve enrolment. Authors' conclusions: Interventions may
increase cardiac rehabilitation enrolment, adherence and completion;
however the quality of evidence was low to moderate due to heterogeneity
of the interventions used, among other factors. Effects on enrolment were
larger in studies targeting healthcare providers, training nurses, or
allied healthcare providers to intervene face-to-face; effects on
adherence were larger in studies that tested remote interventions. More
research is needed, particularly to discover the best ways to increase
programme completion. Copyright © 2019 The Cochrane
Collaboration.

<30>
Accession Number
626142693
Title
Intramyocardial bone marrow cell injection does not lead to functional
improvement in patients with chronic ischaemic heart failure without
considerable ischaemia.
Source
Netherlands Heart Journal. 27 (2) (pp 81-92), 2019. Date of Publication:
01 Feb 2019.
Author
Mann I.; Tseng C.C.S.; Rodrigo S.F.; Koudstaal S.; van Ramshorst J.;
Beeres S.L.; Dibbets-Schneider P.; de Geus-Oei L.F.; Lamb H.J.; Wolterbeek
R.; Zwaginga J.J.; Fibbe W.E.; Westinga K.; Bax J.J.; Doevendans P.A.;
Schalij M.J.; Chamuleau S.A.J.; Atsma D.E.
Institution
(Mann, Rodrigo, van Ramshorst, Beeres, Bax, Schalij, Atsma) Department of
Cardiology, Leiden University Medical Center, Leiden, Netherlands
(Tseng, Koudstaal, Doevendans, Chamuleau) Department of Cardiology,
University Medical Center Utrecht, Utrecht, Netherlands
(Dibbets-Schneider, de Geus-Oei, Lamb) Department of Radiology, Leiden
University Medical Center, Leiden, Netherlands
(de Geus-Oei) MIRA Institute for Biomedical Technology and Technical
Medicine, University of Twente, Enschede, Netherlands
(Wolterbeek) Department of Medical Statistics and Bioinformatics, Leiden
University Medical Center, Leiden, Netherlands
(Zwaginga, Fibbe) Department of Hematology, Leiden University Medical
Center, Leiden, Netherlands
(Westinga) Department of Cell Therapy Facility, University Medical Center
Utrecht, Utrecht, Netherlands
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Background: It has been suggested that bone marrow cell injection may have
beneficial effects in patients with chronic ischaemic heart disease.
However, previous trials have led to discrepant results of cell-based
therapy in patients with chronic heart failure. The aim of this study was
to evaluate the efficacy of intramyocardial injection of mononuclear bone
marrow cells in patients with chronic ischaemic heart failure with limited
stress-inducible myocardial ischaemia. Methods and Results: This
multicentre, randomised, placebo-controlled trial included 39 patients
with no-option chronic ischaemic heart failure with a follow-up of 12
months. A total of 19 patients were randomised to autologous
intramyocardial bone marrow cell injection (cell group) and 20 patients
received a placebo injection (placebo group). The primary endpoint was the
group difference in change of left ventricular ejection fraction, as
determined by single-photon emission tomography. On follow-up at 3 and 12
months, change of left ventricular ejection fraction in the cell group was
comparable with change in the placebo group (P= 0.47 and P= 0.08,
respectively). Also secondary endpoints, including left ventricle volumes,
myocardial perfusion, functional and clinical parameters did not
significantly change in the cell group as compared to placebo. Neither
improvement was demonstrated in a subgroup of patients with
stress-inducible ischaemia (P= 0.54 at 3-month and P= 0.15 at 12-month
follow-up). Conclusion(s): Intramyocardial bone marrow cell injection
does not improve cardiac function, nor functional and clinical parameters
in patients with severe chronic ischaemic heart failure with limited
stress-inducible ischaemia. Clinical Trial Registration:
NTR2516. Copyright © 2018, The Author(s).

<31>
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.
 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). 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).
 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. Copyright © 2018 Australian
and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the
Cardiac Society of Australia and New Zealand (CSANZ)

<32>
Accession Number
625692274
Title
The efficacy and side effects of dexmedetomidine and morphine in
patient-controlled analgesia method after coronary artery bypass grafting
surgery.
Source
International Journal of Pharmaceutical Research. 10 (1) (pp 251-256),
2018. Date of Publication: January-March 2018.
Author
Anvaripour A.; Ashkpour H.; Marashian M.; Mirzaei K.; Jahangirifard A.
Institution
(Anvaripour) Anesthesiology and Critical Care Department, Bushehr
University of Medical Sciences, Bushehr, Iran, Islamic Republic of
(Ashkpour) Bushehr University of Medical Sciences, Bushehr, Iran, Islamic
Republic of
(Marashian) Chronic Respiratory disease Research Center, National Research
institute of Tuberculosis and Lung disease(NRITLD), Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Mirzaei) Bushehr University of Medical Sciences, Bushehr, Iran, Islamic
Republic of
(Jahangirifard) Lung Transplantation Research Center, National Research
Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Advanced Scientific Research
Abstract
Background: The current study headed to conduct this comparison byusing
PCA to find the final effects of both drugs on pain and other common
complications among patients who suffered CABG surgery in a ICU in
Southwest of Iran. Method(s): Through a randomized clinical trial
(RCT) 83 patients, 40-80 years of age, who were suitable candidates for
elective CABG surgery enrolled the study. From the patients 42 were in a
group of patients who were administered PCA with 100cc saline in addition
to 200mcgdexmedetomidine and 4mg of ondansetron at the pace of 0.7
mcg/kg/h while 41experienced 100cc saline, 10mg morphine and 4mg
ondansetron by PCA with 0.015 mg/kg/h infusion pace in the first 24 hours
after surgery. Systolic, diastolic, mean blood pressure and heart rate
were checked every 2 hours for a total time of 14 hours after weaning.
Sedation level was checked every 1 hours by the "Ramsay" criteria and
weaning was done considering the criteria. Result(s): Data showed no
statistical differences in the scores of immediately after extubating and
12 and 24 hours later between the groups. Repeated measure test determined
an improvement in the severity of pain as time went on similarly for both
groups. Conclusion(s): As dexmedetomidine had similar effects to
morphine on pain and hemodynamic features during first 24 hours of surgery
as well as extubating time, sedation level and additional demand for
analgesics, it would be a perfect alteration for morphine at least
postoperatively. Analysis showed the same frequency of nausea and vomiting
in the two groups of the current study. Copyright © 2019,
Advanced Scientific Research. All rights reserved.

<33>
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. 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. 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). 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. Copyright © 2018, Canadian Anesthesiologists'
Society.

<34>
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. Copyright
© 2018 The Authors. ESC Heart Failure published by John Wiley & Sons
Ltd on behalf of the European Society of Cardiology.

<35>
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. Copyright © 2018 Japanese Society of Chemotherapy and
The Japanese Association for Infectious Diseases

<36>
Accession Number
621102309
Title
The effect on cardiopulmonary function after thoracoplasty in pectus
carinatum: A systematic literature review.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (3) (pp 474-479),
2018. Date of Publication: 01 Mar 2018.
Author
Sigl S.; Del Frari B.; Harasser C.; Schwabegger A.H.
Institution
(Sigl, Del Frari, Harasser, Schwabegger) Department of Plastic,
Reconstructive and Aesthetic Surgery, Medical University Innsbruck,
Anichstrasse 35, Innsbruck 6020, Austria
Publisher
Oxford University Press
Abstract
OBJECTIVES: Creating an aesthetically appealing result using
thoracoplasty, especially when correcting extensive deformities, but only
causing low morbidity, is challenging. The frequency of thoracoplasties in
cases of pectus carinatum (PC) has increased due to improved experience
and modified surgical techniques, resulting in low morbidity and low
complication rates. The indications for surgical treatment are still
controversial and, in most cases, remain aesthetic or psychological rather
than physiological. However, whether cardiopulmonary function changes
after surgical repair remains a matter of controversy. We sought to
investigate and shed light on published knowledge regarding this question.
 METHOD(S): We searched MEDLINE and PubMed databases, using various
defined search phrases and inclusion criteria, to identify articles on
pre- and postoperative cardiopulmonary evaluation and outcomes.
 RESULT(S): Six studies met the inclusion criteria: 5 studies
evaluated patients with PC for cardiopulmonary outcomes after chest wall
surgery and 1 did so following conservative compression treatment. In
these studies, surgical and conservative orrection of PC did not reduce
absolute lung volumes and spirometric measurements and consequently had no
pathogenic effect on cardiopulmonary function. CONCLUSION(S): The
results of this systematic review suggest that surgical correction of PC
has no symptomatic pathogenic effect on cardiopulmonary function. The
results, however, revealed both heterogeneity in the examinations used and
inconsistent methods within each study. Further prospective trials with a
stronger methodological design are necessary to objectively confirm that
surgical correction of PC does not impair cardiopulmonary
function. Copyright © The Author 2017.

<37>
Accession Number
625774472
Title
N-Acetylcysteine for Preventing of Acute Kidney Injury in Chronic Kidney
Disease Patients Undergoing Cardiac Surgery: A Metaanalysis.
Source
The heart surgery forum. 21 (6) (pp E513-E521), 2018. Date of Publication:
19 Dec 2018.
Author
He G.; Li Q.; Li W.; Wang L.; Yang J.; Zeng F.
Institution
(He) Department of Respiratory Medicine, First College of Clinical Medical
Sciences, Yichang Central People's Hospital, China Three Gorges
University, Yichang, Hubei province, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The aim of this study was to determine whether N-acetylcysteine
(NAC) has an effect on acute kidney injury (AKI) in chronic kidney disease
patients undergoing cardiac surgery. METHOD(S): We reviewed
literature through PubMed, Medline through PubMed and OVID, The Cochrane
Library, Wan Fang Database, China Biology Medicine Database, Chinese
Periodical Database, China Knowledge Resource Integrated Database, and
Chinese Clinical Trial Registry (1980 to July 10, 2018). Two investigators
independently collected the data and assessed the quality of each study.
RevMan 5.3 was used for the present metaanalysis. RESULT(S): A total
of 5 RCTs (N = 678 participants) were included in the primary analysis.
Pooled analysis showed that intravenous infusion of NAC significantly
reduced the incidence of AKI (RR = 0.77, 95% = 0.63 to 0.94, P < .01) and
that NAC could decrease the adverse cardiac events (RR = 0.83, 95% = 0.70
to 0.97, P < .05), but that it may increase the length of stay in the ICU
(mean difference [MD] = 2.1, 95% CI = 1.61 to 2.60, P < .01). There were
no statistically significant differences between the 2 groups in the
requirement for renal replacement therapy(RRT) (RR = 1.33, 95% = 0.63 to
2.81, P = .45) and all-cause mortality (RR = 0.51, 95% = 0.25 to 1.06, P =
.07). CONCLUSION(S): Our study shows that intravenous infusion of NAC
could prevent postoperative AKI in preexisting-renal-failure patients
undergoing cardiac surgery.

<38>
Accession Number
620059693
Title
Nonprimary PCI at hospitals without cardiac surgery on-site: Consistent
outcomes for all?.
Source
American Heart Journal. 197 (pp 18-26), 2018. Date of Publication: March
2018.
Author
Czarny M.J.; Miller J.M.; Naiman D.Q.; Hwang C.-W.; Hasan R.K.; Lemmon
C.C.; Aversano T.
Institution
(Czarny, Miller, Hwang, Hasan, Lemmon, Aversano) School of Medicine, Johns
Hopkins University, Baltimore, MD, United States
(Naiman) Department of Applied Mathematics and Statistics, Johns Hopkins
University, Baltimore, MD, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background The CPORT-E trial showed the noninferiority of nonprimary
percutaneous coronary intervention (PCI) at hospitals without cardiac
surgery on-site (SoS) compared with hospitals with SoS for 6-week
mortality and 9-month major adverse cardiac events (MACE). However, target
vessel revascularization (TVR) was increased at non-SoS hospitals.
Therefore, we aimed to determine the consistency of the CPORT-E trial
findings across the spectrum of enrolled patients. Methods Post hoc
subgroup analyses of 6-week mortality and 9-month MACE, defined as the
composite of death, Q-wave myocardial infarction, or TVR, were performed.
Patients with and without 9-month TVR and rates of related outcomes were
compared. Results There was no interaction between SoS status and
clinically relevant subgroups for 6-week mortality or 9-month MACE (P for
any interaction =.421 and.062, respectively). In addition to increased
9-month rates of TVR and diagnostic catheterization at hospitals without
SoS, non-TVR was also increased (2.7% vs 1.9%, P =.002); there was no
difference in myocardial infarction-driven TVR, non-TVR, or diagnostic
catheterization. Predictors of 9-month TVR included intra-aortic balloon
pump use, any index PCI complication, and 3-vessel PCI, whereas predictors
of freedom from TVR included SoS, discharge on a P2Y<inf>12</inf>
inhibitor, and stent implantation. Conclusions The noninferiority of
nonprimary PCI at non-SoS hospitals was consistent across clinically
relevant subgroups. Elective PCI at an SoS hospital conferred a TVR
benefit which may be related to a lower rate of referral for diagnostic
catheterization for reasons other than myocardial
infarction. Copyright © 2017 Elsevier Inc.

<39>
Accession Number
612422315
Title
Microvascular reactivity and endothelial glycocalyx degradation when
administering hydroxyethyl starch or crystalloid during off-pump coronary
artery bypass graft surgery: a randomised trial.
Source
Anaesthesia. 72 (2) (pp 204-213), 2017. Date of Publication: 01 Feb 2017.
Author
Kim T.K.; Nam K.; Cho Y.J.; Min J.J.; Hong Y.J.; Park K.U.; Hong D.M.;
Jeon Y.
Institution
(Kim, Cho, Min, Hong, Jeon) Department of Anaesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul, South Korea
(Nam) Cheoncheon Public Health Subcentre, Jangsu Health Centre and County
Hospital, Jangsu, Jeollabuk-do, South Korea
(Hong, Park) Department of Laboratory Medicine, Seoul National University
Bundang Hospital, Seongnam, Gyeongi-do, South Korea
Publisher
Blackwell Publishing Ltd
Abstract
The infusion of fluids to patients may affect tissue microcirculation and
the endothelial glycocalyx. However, the effects of hydroxyethyl starch
and crystalloid on endothelial glycocalyx degradation and microvascular
reactivity have not been evaluated in detail. We hypothesised that
hydroxyethyl starch may cause less endothelial glycocalyx degradation and
better microvascular reactivity than that caused by crystalloid. We
randomly allocated 120 patients undergoing off-pump coronary artery bypass
graft surgery to receive up to 20 ml.kg-1 of either
hydroxyethyl starch 670/0.75 or crystalloid for intra-operative fluid
resuscitation. Crystalloid was then infused to meet ongoing fluid
requirements. During the peri-operative period, vascular occlusion tests
were performed to assess microvascular reactivity, and serum syndecan-1
was measured as an index of endothelial glycocalyx degradation. The median
(IQR [range]) fluid infused during surgery was significantly less in the
hydroxyethyl starch group than the crystalloid group; 2800 (2150-3550
[1400-7300]) vs. 3925 (3100-4725 [1900-6700]) ml, respectively, p < 0.001.
Vascular occlusion test parameters, including tissue oxygen saturation,
occlusion and recovery slope did not differ significantly between the
groups. Peri-operative changes in syndecan-1 were not significantly
different between the groups. We conclude that, in patients undergoing
off-pump coronary artery bypass graft surgery, compared with crystalloid,
the use of hydroxyethyl starch 670/0.75 did not result in significant
differences in microvascular reactivity or endothelial glycocalyx
degradation. Copyright © 2016 The Association of Anaesthetists of
Great Britain and Ireland

<40>
Accession Number
2001470200
Title
Utility of frozen section in diagnosis of persistent fungal endocarditis -
a case report.
Source
Pathology. Conference: Pathology Update Abstracts 2019. Australia. 51
(Supplement 1) (pp S75-S76), 2019. Date of Publication: February 2019.
Author
Chirchir M.; Marjoniemi V.
Institution
(Chirchir, Marjoniemi) Anatomical Pathology Department, St George
Hospital, Sydney, NSW, Australia
Publisher
Elsevier B.V.
Abstract
Infective fungal endocarditis occurs in less than 10% of all endocarditis
cases, with those affecting native valves even less.1 The
common organisms implicated are Aspergillus, Candida and
Histoplasma.2 Clinically fungal endocarditis is diagnosed by
positive blood cultures from a set of 3 cultures drawn with a 1 hour
difference between the first and last cultures and the presence of
vegetations on imaging with transthoracic echocardiogram (TTE) or
transoesophageal echocardiogram (TOE).2 Tissue culture
diagnosis is rarely implemented and usually only used to detect more
fastidious organisms or post antibiotic administration. We present a
unique and unusual case of the use of frozen section in diagnosing the
persistence of fungal elements post anti-fungal treatment at the time of
mitral valve replacement in a 55-year-old male intravenous (IV) drug user.
A comprehensive literature search failed to demonstrate any published
literature for the diagnosis of fungal endocarditis on frozen section.
References1. Chaudhary SC, Sawlani KK, Arora R, et al. Native aortic valve
fungal endocarditis. BMJ Case Rep 2013; 007144. 2. Ellis ME, Al-Abdely H,
Sanddridge A, et al. Fungal endocarditis: evidence in the world
literature, 1965-1995. Clin Infect Dis 2001; 32: 50. Copyright ©
2018

<41>
Accession Number
2001463103
Title
Transfusion Indications: An Update In 2019.
Source
Pathology. Conference: Pathology Update Abstracts 2019. Australia. 51
(Supplement 1) (pp S42), 2019. Date of Publication: February 2019.
Author
Lin Y.
Institution
(Lin) Department of Laboratory Medicine and Molecular Diagnostics,
Sunnybrook Health Sciences Centre, Department of Laboratory Medicine and
Pathobiology, University of Toronto, Toronto, Canada
Publisher
Elsevier B.V.
Abstract
Transfusion is a core competency for every hematologist. Since the
original red blood cell (RBC) transfusion threshold trial, Transfusion
Requirements in Critical Care published in 1999, data supporting
restrictive RBC transfusion thresholds have been well established in many
populations including orthopaedic surgery, upper gastrointestinal bleeding
and cardiac surgery with the number of randomised trials totalling 37 and
over 19,000 patients enrolled.1 As a result, guidelines have
been established supporting restrictive transfusion thresholds
(haemoglobin less than 70 g/L and in patients with cardiac disease,
haemoglobin less than 80 g/L)2 even in the setting of
haematology patients. Studies in platelet transfusion have also been
conducted. The role of prophylactic platelet transfusion has been affirmed
at a platelet count of 10 x 109/L in acute leukaemia
patients.3 On the other hand, platelet transfusion may cause
harm in the setting of antiplatelet related intracranial bleeding. The key
learning objective of this session is to understand where data exist to
support the role of transfusion and where transfusion may potentially
cause more harm than good. References1. Carson JL, Stanworth SJ, Alexander
JH, et al. Clinical trials evaluating red blood cell transfusion
thresholds: An updated systematic review and with additional focus on
patients with cardiovascular disease. Am Heart J 2018; 200: 96-101. 2.
Carson JL, Guyatt G, Heddle NM, et al. Clinical Practice Guidelines From
the AABB: Red Blood Cell Transfusion Thresholds and Storage. JAMA 2016;
316: 2025-35. 3. Nahirniak S, Slichter SJ, Tanael S, et al. Guidance on
platelet transfusion for patients with hypoproliferative thrombocytopenia.
Transfus Med Rev 2015; 29: 3-13. Copyright © 2018

<42>
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. Copyright © 2019
Georg Thieme Verlag KG Stuttgart - New York.

<43>
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).
 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. 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. 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. Copyright © Journal of
Thoracic Disease. All rights reserved.

<44>
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. 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). 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.
 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. Copyright © 2018 by the authors.
Licensee MDPI, Basel, Switzerland.

<45>
Accession Number
620594411
Title
The effect of a peer support intervention on early recovery outcomes in
men recovering from coronary bypass surgery: A randomized controlled
trial.
Source
European Journal of Cardiovascular Nursing. 17 (5) (pp 408-417), 2018.
Date of Publication: 01 Jun 2018.
Author
Colella T.J.F.; King-Shier K.
Institution
(Colella) University Health Network/Toronto Rehab Cardiovascular
Prevention & Rehabilitation Program, Lawrence S. Bloomberg Faculty of
Nursing, University of Toronto, Toronto, ON, Canada
(King-Shier) Faculty of Nursing, Department of Community Health Sciences,
University of Calgary, AB, Canada
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background and aim: Examine the effect of a professionally-guided
telephone peer support intervention on recovery outcomes including
depression, perceived social support, and health services utilization
after coronary artery bypass graft surgery (CABG). Method(s): A
randomized controlled trial was conducted with post-coronary artery bypass
graft surgery men (N=185) who were randomized before hospital discharge.
The intervention arm received telephone-based peer support through weekly
telephone calls from a peer volunteer over six weeks, initiated within 3-4
days of discharge. Result(s): Although a significant difference was
detected in pre-intervention depression scores at discharge, there were no
differences between groups in changes in depression scores at six weeks
(p=0.08), 12 weeks (0.49) or over time (p=0.51); and no significant
differences in perceived social support scores over time (p=0.94). At 12
weeks, the intervention group had significantly lower incidence of health
services utilization (family physician (p=0.02) and emergency room
(p=0.04)). Conclusion(s): Healthcare providers need to continue to
investigate novel interventions to enhance social support and reduce
depression in cardiac patients. Copyright © 2017, © The
European Society of Cardiology 2017.

<46>
Accession Number
623793281
Title
Resuming anticoagulants after anticoagulation-associated intracranial
haemorrhage: Systematic review and meta-analysis.
Source
BMJ Open. 8 (5) (no pagination), 2018. Article Number: e019672. Date of
Publication: 01 May 2018.
Author
Zhou Z.; Yu J.; Carcel C.; Delcourt C.; Shan J.; Lindley R.I.; Neal B.;
Anderson C.S.; Hackett M.L.
Institution
(Zhou) Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University,
Shanghai, China
(Zhou, Yu, Carcel, Delcourt, Lindley, Neal, Anderson, Hackett) George
Institute for Global Health, Faculty of Medicine, University of New South
Wales, Sydney, NSW, Australia
(Yu) Department of Cardiology, Peking University Third Hospital, Beijing,
China
(Carcel, Delcourt, Anderson) Department of Neurology, Royal Prince Alfred
Hospital, Sydney Health Partners, Sydney, NSW, Australia
(Carcel, Delcourt, Lindley, Hackett) Sydney Medical School, University of
Sydney, Sydney, NSW, Australia
(Shan) Department of Geriatrics, Ren Ji Hospital, Shanghai Jiao Tong
University, Shanghai, China
(Neal) Charles Perkins Centre, University of Sydney, Sydney, NSW,
Australia
(Neal) Department of Epidemiology and Biostatistics, Imperial College
London, London, United Kingdom
(Anderson) George Institute China, Peking University Health Science
Center, Beijing, China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To determine the adverse outcomes following resumption of
anticoagulation in patients with anticoagulation-associated intracranial
haemorrhage (ICH). Design We performed a systematic review and
meta-analysis in this clinical population. The Preferred Reporting Items
for Systemic Reviews and Meta-Analyses statement was followed, and two
authors independently assessed eligibility of all retrieved studies and
extracted data. Data sources Medline, Embase and the Cochrane Central
Register of Controlled Trials, from inception to February 2017.
Eligibility criteria and outcomes Randomised controlled trials or cohort
studies that recruited adults who received oral anticoagulants at the time
of ICH occurrence and survived after the acute phase or hospitalisation
were searched. Primary outcomes, including long-term mortality, recurrent
ICH and thromboembolic events. Secondary outcomes were the frequency of
resuming anticoagulant therapy and related factors. Results We included 12
cohort studies (no clinical trials) involving 3431 ICH participants. The
pooled frequency of resuming anticoagulant therapy was 38% (95% CI 32% to
44%), but this was higher in participants with prosthetic heart valves,
subarachnoid haemorrhage or dyslipidaemia. There was no evidence that
resuming anticoagulant therapy was associated with higher long-term
mortality (pooled relative risk (RR) 0.60, 95% CI 0.30 to 1.19; p=0.14) or
ICH recurrence (pooled RR 1.14, 95% CI 0.72 to 1.80; p=0.57). Resumption
of anticoagulation was associated with significantly fewer thromboembolic
events (pooled RR 0.31, 95% CI 0.23 to 0.42; p<0.001). In a subgroup of
patients with atrial fibrillation, resuming anticoagulant therapy was
associated with fewer long-term mortality (pooled RR 0.27, 95% CI 0.20 to
0.37, p<0.001). Conclusions Based on these observational studies, resuming
anticoagulant therapy after anticoagulation-associated ICH has beneficial
effects on long-term complications. Clinical trials are needed to
substantiate these findings. PROSPERO registration number
CRD42017063827. Copyright © Article author(s) (or their
employer(s) unless otherwise stated in the text of the article) 2018.

<47>
Accession Number
623277154
Title
Effects of lowest-dose vs. highest-dose pitavastatin on coronary
neointimal hyperplasia at 12-month follow-up in type 2 diabetic patients
with non-ST elevation acute coronary syndrome: an optical coherence
tomography analysis.
Source
Heart and Vessels. 34 (1) (pp 62-73), 2019. Date of Publication: 22 Jan
2019.
Author
Lim J.W.; Jeong H.S.; Hong S.J.; Kim H.J.; Kim Y.C.; Kang B.G.; Jeon S.M.;
Cho J.Y.; Lee S.H.; Joo H.J.; Park J.H.; Yu C.W.
Institution
(Lim, Jeong, Hong, Kim, Kim, Kang, Jeon, Cho, Lee, Joo, Park, Yu)
Department of Cardiology, Cardiovascular Center, Korea University Anam
Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul 136-705, South Korea
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Current ACC/AHA guidelines recommend high-dose statin therapy after
coronary stenting, especially in diabetic patients; however, pitavastatin
4 mg or pitavastatin 1 mg are frequently used after coronary stenting in
Asia, even in patients with acute coronary syndrome. We compared the
effects of highest-dose and lowest-dose pitavastatin therapy on coronary
neointimal hyperplasia at 12-month follow-up in diabetic patients with
non-ST-elevation acute coronary syndrome (NSTE-ACS) using optical
coherence tomography. A total of 72 diabetic patients with NSTE-ACS were
randomized to lowest-dose pitavastatin [1 mg (n = 36)] or highest-dose
pitavastatin [4 mg (n = 36)] after everolimus-eluting stent implantation.
The primary endpoint was to compare the normalized neointimal volume at
12-month follow-up. Normalized neointimal volume was significantly lower
in the pitavastatin 4 mg group (4.00 +/- 2.80 vs. 8.24 +/- 2.83
mm3/mm, p < 0.01) at 12-month follow-up. There was also
significant difference in neointimal area between the pitavastatin 4 mg
group and pitavastatin 1 mg group (0.41 +/- 0.28 vs. 0.74 +/- 0.23
mm2, p < 0.01). Improvement of brachial artery flow-mediated
dilation (baFMD) was significantly higher in the pitavastatin 4 mg group
than in pitavastatin 1 mg group (0.15 +/- 0.15 vs. - 0.03 +/- 0.19 mm, p <
0.001). In addition, the improvement of adiponectin levels was
significantly greater in the pitavastatin 4 mg group than in the
pitavastatin 1 mg group (2.97 +/- 3.98 vs. 0.59 +/- 2.80 mug/mL, p <
0.05). Pitavastatin 4 mg significantly improved inflammatory cytokines and
lipid profiles compared to pitavastatin 1 mg during the 12-month
follow-up, contributing to the reduction of neointimal hyperplasia and to
the improvement of baFMD in diabetic patients with NSTE-ACS requiring
coronary stenting. Thus, the administration of pitavastatin 4 mg can be
safely and effectively used in high-risk patients requiring coronary
stenting. Trial registration NCT02545231 (Clinical Trial registration
information:
https://clinicaltrials.gov/ct2/show/NCT02545231). Copyright ©
2018, Springer Japan KK, part of Springer Nature.

<48>
Accession Number
626115026
Title
Analysis of the effect of acapella in the rapid rehabilitation of
thoracoscopic lung cancer.
Source
Acta Medica Mediterranea. 35 (1) (pp 205-209), 2019. Date of Publication:
2019.
Author
Zhou Z.; Zhao B.; Zha M.; Meng X.
Institution
(Zhou, Zhao, Zha, Meng) Changshu Hospital, Soochow University, First
People's Hospital of Changshu City, Changshu, Jiangsu Province 215500,
China
Publisher
A. CARBONE Editore
Abstract
Introduction: rapid recovery of lung cancer patients after thoracoscopic
surgery, and to summarize the application experience. Method(s): A
total of 100 lung cancer patients admitted to the Thoracic Surgery
Department for thoracoscopic surgery from May 2016 to March 2018 in
Changshu No.1 People's Hospital were enrolled in the study. Patients were
randomized into observation group and control group, each with 50 cases.
Both groups received routine perioperative management of lung surgery,
including strict smoking cessation, guidance for effective coughing,
breathing training, posture change in bed, etc. The patients were patted
on the back for sputum excretion, and received aerosol inhalation to
promote expectoration. The observation group was given Acapella
expectoration training on the first postoperative day. The amount of
expectoration, white blood cell count, extubation time, postoperative
hospital stay of the two groups were recorded on first day and the third
day after operation and before discharge. The role of Acapella in
postoperative recovery of lung cancer patients with thoracoscopic surgery
was discussed. Result(s): The time of chest tube removal and length
of hospital stay were shorter in the observation group than the control
group, and there was statistical significance. Comparison of expectoration
amount between the observation group and the control group before the
operation and on the first postoperative day was not statistically
different. The expectoration amount was higher in the observation group on
the third postoperative day and before discharge, with statistical
significance. The white blood cell count was higher in the observation
group than the control group before operation, but there was no
statistical significance. The white blood cell count was lower in the
observation group on the first and third postoperative day, but there was
no statistical significance. The white blood cell count was lower in the
observation group, with statistical significance. Conclusion(s):
Acapella can promote early excretion of sputum, shorten the removal time
of chest tube and the length of hospital stay after thoracoscopic surgery,
which has positive significance for patients' rapid postoperative recovery
and is thus worthy of our promotion. Copyright © 2019 A. CARBONE
Editore. All rights reserved.

<49>
Accession Number
626114859
Title
Meta-analysis of complications in patients undergoing procedures with
uninterrupted anticoagulation compared with bridging anticoagulation.
Source
Acta Medica Mediterranea. 35 (1) (pp 143-154), 2019. Date of Publication:
2019.
Author
Shuhua F.; Xinsheng C.; Na W.; Bing H.
Institution
(Shuhua, Xinsheng, Na) Department of Pharmacy, Zhenjiang First People's
Hospital, Zhenjiang, Jiangsu 212002, China
(Bing) Department of Clinical Pharmacy, Xuzhou Central Hospital, Jiefang
South Road 199th, Xuzhou, Jiangsu 221009, China
Publisher
A. CARBONE Editore
Abstract
Objective: To evaluate the complications of perioperative uninterrupted
anticoagulation (UA) compared with bridging anticoagulation (BA) in
patients undergoing procedures. Method(s): Relevant studies
concerning the complications in patients requiring procedures with UA or
BA were electronically and systematically searched and identified based on
established search strategy and selection criteria. The implications
including major, minor complications, stroke/ TIA/thromboembolism and
death were reassessed by meta-analysis using pooled odds ratios (ORs) and
95% confidence interval (CIs). Result(s): Totally, 58 publications
representing 14 RCTs(randomized controlled trials) and 44 observational
cohort studies were included in the meta-analysis. A significantly
decreased risk of major and minor complications in patients with UA
(OR=0.46, 95%CI=0.35-0.59, p<0.001; OR=0.59, 95%CI=0.42-0.84, p=0.004,
respectively) were shown compared to BA. Similar results were obtained in
extensive subgroup analyses. Meanwhile, no significantly increased risk of
stroke/TIA/thromboembolism and death was observed in UA group compared to
BA group(OR=0.80, 95%CI=0.48-1.34, p=0.4; OR=1.54, 95%CI=0.81-2.93,
p=0.19, respectively). However, a significantly raised risk of death in
patients with UA was found compared to those with BA in randomized studies
(OR=2.03, 95%CI=1.42-2.91, p=0.0001) and in Caucasian population (OR=1.95,
95%CI=1.39-2.72, p=0.0001). Conclusion(s): The complications rate of
perioperative UA strategy seemed lower compared to BA, suggesting a
potentially better option for patients receiving procedures. Copyright
© 2019 A. CARBONE Editore. All rights reserved.

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

<51>
Accession Number
2001354713
Title
A randomized-controlled, double-blind study to evaluate the efficacy of
caudal midazolam, ketamine and neostigmine as adjuvants to bupivacaine on
postoperative analgesic in children undergoing lower abdominal surgery.
Source
Acta Biomedica. 89 (4) (pp 513-518), 2018. Date of Publication: 17 Jan
2018.
Author
Shirmohammadie M.; Soltani A.E.; Arbabi S.; Nasseri K.
Institution
(Shirmohammadie, Nasseri) Department of Anesthesiology, Kurdistan
University of Medical Sciences, Sanandaj, Iran, Islamic Republic of
(Soltani, Arbabi) Tehran Children Medical Center, Tehran University of
medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Mattioli 1885 (E-mail: edit@mattioli1885.com)
Abstract
Background: Caudal epidural is the most commonly used technique for the
management of postoperative pain in children. The aim of the present study
was to assess and compare the efficacy of caudal bupivacaine as a
postoperative analgesic alone or combined with midazolam, ketamine, and
neostigmine in pediatric patients undergoing lower abdominal surgery.
 Method(s): Eighty pediatric patients categorized under the American
Society of Anesthesiologists Physical Status I and II Classification
System, who have been scheduled to undergo lower abdominal surgery were
randomly designated into four groups to receive caudal block with either 1
ml/kg of 0.25% caudal bupivacaine for group B, 1 ml/kg of 0.25% caudal
bupivacaine mixed with 2 mug/kg neostigmine for group BN, 1 ml/kg of 0.25%
caudal bupivacaine mixed with 0.5 mg/kg ketamine for group BK or 1 ml/kg
of 0.25% caudal bupivacaine mixed with 50 mcg/kg midazolam for group BM.
Postoperative analgesia was examined by a blinded anesthetist utilizing a
Revised Faces Pain Scale. Consumption of the total amount of rescue
analgesic each 24 h, postoperative time to requirement of the first dose
and any adverse effects were noted. Result(s): The four groups were
comparable as regards age, sex, weight, duration of surgery, heart rate,
blood pressure and the time from induction of anesthesia to response to
voice. The Revised Faces Pain Scale was 2.6+/-1.5 in group BN, 3.1+/-1.8
in group BM, 4.4+/-2.4 in group BK, and 5.6+/-1.3 in group B (p=0.005).
Postoperative duration of analgesia was 433+/-68 min, 769+/-118 min,
1097+/-126 min and 1254+/-176 min in groups B, BK, BM and BN respectively
(P=0.001). The dose of rescue analgesic within 24 h in group B was
significantly higher than those of the other three groups (P<0.05).
 Conclusion(s): Addition of either neostigmine, midazolam, or ketamine
to caudal bupivacaine extended analgesia time and decreased rescue
analgesic compared to bupivacaine alone in children who underwent lower
abdominal surgery. (www.actabiomedica.it). Copyright © Mattioli
1885.

<52>
Accession Number
2000571905
Title
Levosimendan Following Cardiac Surgery.
Source
Heart Lung and Circulation. 28 (3) (pp e19-e20), 2019. Date of
Publication: March 2019.
Author
Conte S.M.; Florisson D.S.; De Bono J.A.; Davies R.A.; Newcomb A.E.
Institution
(Conte, Florisson, De Bono, Davies, Newcomb) Cardiothoracic Surgery
Department, St Vincent's Hospital Melbourne, Melbourne, Vic, Australia
Publisher
Elsevier Ltd
Abstract
A best evidence topic was written to address if perioperative levosimendan
improves mortality following cardiac surgery. Fourteen papers represented
the best available evidence. An older meta-analysis summarising 11 of
these trials concluded that there were fewer deaths in the levosimendan
group compared to the control group (OR 0.41, p < 0.001) however, this was
driven by the results of three included trials by the same author. Three
larger and more recent randomised controlled trials failed to demonstrate
significant differences in mortality. We conclude that levosimendan lacks
robust evidence to substantiate claims of mortality benefit in cardiac
surgery patients and should not be used routinely in such
patients. Copyright © 2018 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<53>
Accession Number
620719429
Title
GLP-1 Receptor Agonists and Cardiovascular Disease: a Meta-Analysis of
Recent Cardiac Outcome Trials.
Source
Cardiovascular Drugs and Therapy. 32 (1) (pp 65-72), 2018. Date of
Publication: 01 Feb 2018.
Author
Jia X.; Alam M.; Ye Y.; Bajaj M.; Birnbaum Y.
Institution
(Jia, Alam, Birnbaum) The Section of Cardiology, Department of Medicine,
Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United
States
(Ye) The Department of Biochemistry and Molecular Biology, University of
Texas Medical Branch, Galveston, TX, United States
(Bajaj) Endocrinology and Diabetes Division, Department of Medicine,
Baylor College of Medicine, Houston, TX, United States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: The aim of this study is to examine the cardioprotective
properties of Glucagon-like peptide-1 receptor agonist, a class of
antihyperglycemic therapy, via meta-analysis of four recently published
cardiovascular outcomes trials. Method(s): Meta-analysis was
performed pooling data from the ELIXA, LEADER, SUSTAIN-6 and EXSCEL
trials. A random effects model was used to generate risk ratio with 95%
confidence interval for cardiovascular and safety outcomes.
 Result(s): A total of 33,457 patients were included in the
meta-analysis. Based on the study, GLP-1R agonists significantly reduced
all-cause mortality (RR 0.89; 95% CI 0.82 to 0.96) and cardiovascular
mortality (RR 0.88; 95% CI 0.80 to 0.97) when compared to placebo. When
long-acting agents were analyzed alone, reduction in major adverse cardiac
events (RR 0.88; 95% CI 0.81 to 0.97) and non-fatal strokes (RR 0.87; 95%
CI 0.76 to 0.99) also showed significance. Conclusion(s): Overall,
GLP-1R agonists appear to have cardioprotective properties likely via
modification of metabolic parameters such as glycemic control, weight
loss, and improvement in blood pressure. Additional studies are warranted
to compare cardiovascular outcomes among the different
agents. Copyright © 2018, Springer Science+Business Media, LLC,
part of Springer Nature.

<54>
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.
 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. 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). 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. Copyright © 2018 John Wiley &
Sons Ltd

<55>
Accession Number
620004534
Title
The association between hope, marital status, depression and persistent
pain in men and women following cardiac surgery.
Source
BMC Women's Health. 18 (1) (no pagination), 2018. Article Number: 2. Date
of Publication: 02 Jan 2018.
Author
Bjornnes A.K.; Parry M.; Lie I.; Falk R.; Leegaard M.; Rustoen T.
Institution
(Bjornnes, Rustoen) Oslo University Hospital, Ulleval, Department of
Research and Development, Division of Emergencies and Critical Care,
Nydalen, P.O Box 4956, Oslo 0424, Norway
(Bjornnes, Parry) University of Toronto, Lawrence S. Bloomberg Faculty of
Nursing, 155 College Street, Suite 130, Toronto, ON M5T 1P8, Canada
(Lie) Oslo University Hospital, Ulleval, Center for patient centered
heart- and lung research, Department of Cardiothoracic Surgery, Division
of Cardiovascular and Pulmonary Diseases, Nydalen, P.O Box 4956, Oslo
0424, Norway
(Falk) Oslo University Hospital, Ulleval, Oslo Centre for Biostatistics
and Epidemiology, Research Support Services, Nydalen, P.O Box 4956, Oslo
0424, Norway
(Leegaard) Oslo and Akershus University College of Applied Sciences,
Faculty of Health Sciences, Institute of Nursing, St. Olavs Plass, P.O Box
4, Oslo N-0130, Norway
(Rustoen) Oslo University Hospital, Ulleval, Institute of Health and
Society, Nydalen, P.O Box 4956, Oslo 0424, Norway
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Cardiac surgery is a major life event, and outcomes after
surgery are associated with men's and women's ability to self-manage and
cope with their cardiac condition in everyday life. Hope is suggested to
impact cardiac health by having a positive effect on how adults cope with
and adapt to illness and recommended lifestyle changes. Method(s): We
did a secondary analysis of 416 individuals (23% women) undergoing
elective coronary artery bypass graft and/or valve surgery between March
2012 and September 2013 enrolled in randomized controlled trial. Hope was
assessed using The Herth Hope Index (HHI) at three, six and 12 months
following cardiac surgery. Linear mixed model analyses were performed to
explore associations after cardiac surgery between hope, marital status,
depression, persistent pain, and surgical procedure. Result(s): For
the total sample, no statistically significant difference between global
hope scores from 3 to 12 months was observed (ranging from 38.3 +/- 5.1 at
3 months to 38.7 +/- 5.1 at 12 months), and no differences between men and
women were observed at any time points. However, 3 out of 12 individual
items on the HHI were associated with significantly lower scores in women:
#1) I have a positive outlook toward life, #3) I feel all alone, and #6) I
feel scared about my future. Over the study period, diminished hope was
associated with older age, lower education, depression prior to surgery,
and persistent pain at all measurement points. Isolated valve surgery was
positively associated with hope. While neither sex nor marital status, as
main effects, demonstrated significant associations with hope, women who
were divorced/widowed/single were significantly more likely to have lower
hope scores over the study period. Conclusion(s): Addressing pain and
depression, and promoting hope, particularly for women living alone may be
important targets for interventions to improve outcomes following cardiac
surgery. Trial registration: Clinical Trials gov Identifier: NCT01976403.
Date of registration: November 28, 2011. Copyright © 2017 The
Author(s).

<56>
[Use Link to view the full text]
Accession Number
626183490
Title
Ultrasound-guided vs. palpation-guided techniques for radial arterial
catheterisation in infants: A randomised controlled trial.
Source
European journal of anaesthesiology. 36 (3) (pp 200-205), 2019. Date of
Publication: 01 Mar 2019.
Author
Min J.J.; Tay C.K.; Gil N.-S.; Lee J.-H.; Kim S.; Kim C.S.; Yang J.-H.;
Jun T.-G.
Publisher
NLM (Medline)
Abstract
BACKGROUND: The usefulness of ultrasound-guided techniques for radial
arterial catheterisation has been well identified; however, its usefulness
has not been completely evaluated in infants under 12 months of age, who
are generally considered the most difficult group for arterial
catheterisation. OBJECTIVE(S): We evaluated whether ultrasound
guidance would improve success rates and reduce the number of attempts at
radial arterial catheterisation in infants. DESIGN: A randomised,
controlled and patient-blinded study. SETTING: Single-centre trial, study
period from June 2016 to February 2017. PATIENTS: Seventy-four infants
undergoing elective cardiac surgery. INTERVENTION: Patients were allocated
randomly into either ultrasound-guided group (group US) or
palpation-guided group (group P) (each n=37) according to the technique
applied for radial arterial catheterisation. All arterial catheterisations
were performed by one of two experienced anaesthesiologists based on group
assignment and were recorded on video. MAIN OUTCOME MEASURES: The primary
endpoint was the first-pass success. The number of attempts and total
duration of the procedure until successful catheterisation were also
analysed. RESULT(S): The first-pass success rate was significantly
higher in the group US than in the group P (68 vs. 38%, P = 0.019). In
addition, fewer attempts were needed for successful catheterisation in the
group US than in the group P (median 1 [IQR 1 to 2] vs. 2 [1 to 4], P =
0.023). However, the median [IQR] procedural time (s) until successful
catheterisation in the two groups was not significantly different (102 [49
to 394] vs. 218 [73 to 600], P = 0.054). CONCLUSION(S): The current
study demonstrated that the ultrasound-guided technique for radial
arterial catheterisation in infants effectively improved first-pass
success rate and also reduced the number of attempts required. TRIAL
REGISTRATION: ClinicalTrials.gov NCT02795468.

<57>
Accession Number
626168450
Title
Perioperative Bridging With Glycoprotein IIb/IIIa Inhibitors Versus
Cangrelor: Balancing Efficacy and Safety.
Source
Annals of Pharmacotherapy. (no pagination), 2019. Date of Publication:
2019.
Author
Van Tuyl J.S.; Newsome A.S.; Hollis I.B.
Institution
(Van Tuyl) SSM Health St Louis University Hospital, MO, United States
(Van Tuyl) St Louis College of Pharmacy, MO, United States
(Newsome) The University of Georgia College of Pharmacy, Augusta, GA,
United States
(Newsome) Augusta University Medical Center, Augusta, GA, United States
(Hollis) University of North Carolina Medical Center, Chapel Hill, NC,
United States
(Hollis) UNC Eshelman School of Pharmacy, Chapel Hill, NC, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective: To review the efficacy and safety of perioperative
administration of intravenous (IV) antiplatelet agents as a substitute for
oral P2Y<inf>12</inf> inhibitors and to provide clinicians guidance on
optimal and cost-effective use of these medications. Data Sources: A
MEDLINE literature search (1950 to November 2018) was performed using the
key search terms abciximab, bridging, cangrelor, cardiac surgery, coronary
artery bypass surgery, eptifibatide, intravenous antiplatelet agent, and
tirofiban. Additional references were identified from a review of
literature citations. Study Selection and Data Extraction: In all, 18
original research reports and case reports/series were included in the
review. Data Synthesis: Prevention of postoperative bleeding is
critical to decrease morbidity and mortality after cardiac surgery. IV
antiplatelet medications have short half-lives and are frequently used to
substitute for oral P2Y<inf>12</inf> inhibitors to allow platelet function
recovery before procedures. Functional recovery of platelets is delayed
after abciximab discontinuation and increases postoperative bleeding risk.
Eptifibatide and tirofiban have similar pharmacokinetic/pharmacodynamic
properties and comparable efficacy and safety in the setting of
perioperative bridging. Cangrelor may be considered in patients with renal
insufficiency as decreased clearance of eptifibatide or tirofiban may
increase the risk of postoperative bleeding. Relevance to Patient Care and
Clinical Practice: Comparative studies of IV antiplatelet medications have
not been published. Appropriate use of IV antiplatelet medications can
prevent perioperative ischemic events and bleeding. Conclusion(s):
Eptifibatide, tirofiban, and cangrelor are preferred over abciximab as a
perioperative bridge. The choice of agent should be tailored to clinical
characteristics of the patient and institutional acquisition
costs. Copyright © The Author(s) 2019.

<58>
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. Background(s): It remains unclear whether VIV/VIR-TMVI
reduces mortality as compared with redo MVS. 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. 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). 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. Copyright © 2018 Wiley Periodicals, Inc.

<59>
Accession Number
2000731187
Title
Challenges of immunosuppressive and antitrypanosomal drug therapy after
heart transplantation in patients with chronic Chagas disease: A
systematic review of clinical recommendations.
Source
Transplantation Reviews. 32 (3) (pp 157-167), 2018. Date of Publication:
July 2018.
Author
Nogueira S.S.; Felizardo A.A.; Caldas I.S.; Goncalves R.V.; Novaes R.D.
Institution
(Nogueira, Felizardo, Caldas, Novaes) Institute of Biomedical Sciences,
Federal University of Alfenas, Alfenas, Minas Gerais 37130-001, Brazil
(Caldas) Department of Pathology and Parasitology, Federal University of
Alfenas, Alfenas, Minas Gerais 37130-001, Brazil
(Nogueira, Felizardo, Novaes) Department of Structural Biology, Federal
University of Alfenas, Alfenas, Minas Gerais 37130-001, Brazil
(Goncalves) Department of Animal Biology, Federal University of Vicosa,
Vicosa, Minas Gerais 36570-000, Brazil
Publisher
W.B. Saunders
Abstract
Background: Although contraindicated for decades, heart transplantation
(HT) has finally become a feasible therapeutic option for the treatment of
Chagasic patients with end-stage heart failure. Part of the success in
achieving acceptable survival rates after HT is due to the enhancement of
the pharmacological management of allograft rejection and reactivation of
Trypanosoma cruzi infection. Method(s): By using the framework of a
systematic review, we investigated if Chagasic patients who have undergone
a HT are treated with similar immunosuppressive and antitrypanosomal
regimens in endemic and non-endemic countries and exhibits similar T.
cruzi reactivation, allograft rejection and survival rates. From a
structured search in PubMed/Medline, Scopus, and Web of Sciences
databases, 30 clinical studies were reviewed. Result(s) and
Conclusion(s): Although immunosuppressive regimens are variable in endemic
and non-endemic countries, the current evidence supports the
administration of lower doses of corticosteroids, adjusted cyclosporine
levels (100-150 ng/mL) 3 months after HT, and azathioprine rather than
mycophenolate mofetil to reduce the risk of T. cruzi reactivation and
rejection episodes. Antitrypanosomal therapy exclusively based on
benznidazole, nifurtimox, and allopurinol was consistent in endemic and
non-endemic countries, achieving effective results in the control of
infection reactivation. The evidence that supports prophylactic
antitrypanosomal therapy or administration of allopurinol alone is
limited. By highlighting the main sources of research bias, we hope that
our critical analysis can help to expedite clinical research and to reduce
methodological bias, thereby improving the quality of evidence in new
research initiatives. Copyright © 2018 Elsevier Inc.

<60>
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. 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). 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). 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. Copyright © 2018 Wiley Periodicals, Inc.

<61>
Accession Number
618872391
Title
Systematic review and meta-analysis to compare outcomes between
intermediate- and high-risk patients undergoing transcatheter aortic valve
implantation.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 3 (4) (pp
289-295), 2017. Date of Publication: 01 Oct 2017.
Author
Singh K.; Bhalla A.S.; Qutub M.A.; Carson K.; Labinaz M.
Institution
(Singh) Department of Cardiology, Gold Coast University Hospital, 1
Hospital Blvd, Southport, QLD 4215, Australia
(Singh) Griffith University, 58 Parklands Drive, Gold Coast, QLD 4215,
Australia
(Singh, Carson) University of Adelaide, North Terrace, Adelaide, SA 5000,
Australia
(Bhalla) University of Sydney, Sydney, NSW 2006, Australia
(Qutub) Department of Medicine, King Abdulaziz University, Jeddah, Saudi
Arabia
(Labinaz) University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON
K1Y 4W7, Canada
Publisher
Oxford University Press
Abstract
Aims Recent studies have reported non-inferior outcomes for transcatheter
aortic valve implantation (TAVI) compared with surgical aortic valve
replacement (SAVR) in intermediate-risk patients. However, a comparison of
outcomes among TAVI patients depending upon the surgical risk score has
not been performed in a large study. Our aim was to compare the outcomes
of TAVI in low-, intermediate-, and high-risk patients, to ascertain if
the morbidity and mortality is related to the patient's risk profile or
the procedure itself. Methods and results A thorough computer-based search
was performed using Ovid MEDLINE, EMBASE, Google Scholar, and PubMed
databases. We included original research studies reporting data on TAVI in
the low-, intermediate-, and high-risk groups. Patients in
intermediate-risk group were compared to the high-risk cohort for device
success, mortality, and complications. A total of 2414 patients in the
intermediate-risk group were compared with 1597 high-risk patients. On
meta-analysis, intermediate-risk group demonstrated similar device success
[odds ratio (OR) 1.29, 95% confidence interval (CI) 0.87-1.90, I 2 = 0%, P
= 0.2) but a lower 30-day mortality OR 0.54, 95% CI 0.34-0.86, I 2 = 49%,
P = 0.009). There was no difference in the incidence of stroke (OR 1.17,
95% CI 0.80-1.71, I 2 = 36%, P = 0.42) or permanent pacemaker implantation
between the two groups (OR 1.04, 95% CI 0.82-1.32, I 2 = 41%, P = 0.74).
Conclusion Transcatheter aortic valve implantation in intermediate-risk
patients carries a low mortality and high success. Incidence of pacemaker
and stroke remains high in the lower risk group. Published on behalf of
the European Society of Cardiology. All rights reserved. Copyright
© The Author 2017.

<62>
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.
 Objective(s): The aim of this study was to compare the durability of
transcatheter and surgical bioprosthetic aortic valves using standardized
criteria. 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.
 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). 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) Copyright ©
2019 American College of Cardiology Foundation

<63>
Accession Number
625764779
Title
Marine n-3 fatty acids and prevention of cardiovascular disease and
cancer.
Source
New England Journal of Medicine. 380 (1) (pp 23-32), 2019. Date of
Publication: 03 Jan 2019.
Author
Manson J.E.; Cook N.R.; Lee I.-M.; Christen W.; Bassuk S.S.; Mora S.;
Gibson H.; Albert C.M.; Gordon D.; Copeland T.; D'Agostino D.; Friedenberg
G.; Ridge C.; Bubes V.; Giovannucci E.L.; Willett W.C.; Buring J.E.
Institution
(Manson, Cook, Lee, Christen, Bassuk, Mora, Gibson, Albert, Gordon,
Copeland, D'Agostino, Friedenberg, Ridge, Bubes, Giovannucci, Willett,
Buring) Department of Medicine, Brigham and Women's Hospital, Harvard
Medical School, 900 Commonwealth Ave., Boston, MA 02215, United States
(Manson, Cook, Lee, Willett, Buring) Department of Epidemiology, Harvard
T.H. Chan School of Public Health, Boston, MA, United States
(Giovannucci, Willett) Department of Nutrition, Harvard T.H. Chan School
of Public Health, Boston, MA, United States
Publisher
Massachussetts Medical Society
Abstract
Background: Higher intake of marine n-3 (also called omega-3) fatty acids
has been associated with reduced risks of cardiovascular disease and
cancer in several observational studies. Whether supplementation with n-3
fatty acids has such effects in general populations at usual risk for
these end points is unclear. Method(s): We conducted a randomized,
placebo-controlled trial, with a two-by-two factorial design, of vitamin
D3 (at a dose of 2000 IU per day) and marine n-3 fatty acids (at a dose of
1 g per day) in the primary prevention of cardiovascular disease and
cancer among men 50 years of age or older and women 55 years of age or
older in the United States. Primary end points were major cardiovascular
events (a composite of myocardial infarction, stroke, or death from
cardiovascular causes) and invasive cancer of any type. Secondary end
points included individual components of the composite cardiovascular end
point, the composite end point plus coronary revascularization (expanded
composite of cardiovascular events), site-specific cancers, and death from
cancer. Safety was also assessed. This article reports the results of the
comparison of n-3 fatty acids with placebo. Result(s): A total of
25,871 participants, including 5106 black participants, underwent
randomization. During a median follow-up of 5.3 years, a major
cardiovascular event occurred in 386 participants in the n-3 group and in
419 in the placebo group (hazard ratio, 0.92; 95% confidence interval
[CI], 0.80 to 1.06; P = 0.24). Invasive cancer was diagnosed in 820
participants in the n-3 group and in 797 in the placebo group (hazard
ratio, 1.03; 95% CI, 0.93 to 1.13; P = 0.56). In the analyses of key
secondary end points, the hazard ratios were as follows: for the expanded
composite end point of cardiovascular events, 0.93 (95% CI, 0.82 to 1.04);
for total myocardial infarction, 0.72 (95% CI, 0.59 to 0.90); for total
stroke, 1.04 (95% CI, 0.83 to 1.31); for death from cardiovascular causes,
0.96 (95% CI, 0.76 to 1.21); and for death from cancer (341 deaths from
cancer), 0.97 (95% CI, 0.79 to 1.20). In the analysis of death from any
cause (978 deaths overall), the hazard ratio was 1.02 (95% CI, 0.90 to
1.15). No excess risks of bleeding or other serious adverse events were
observed. Conclusion(s): Supplementation with n-3 fatty acids did not
result in a lower incidence of major cardiovascular events or cancer than
placebo. Copyright © 2018 Massachusetts Medical Society.

<64>
Accession Number
625764777
Title
Vitamin D supplements and prevention of cancer and cardiovascular disease.
Source
New England Journal of Medicine. 380 (1) (pp 33-44), 2019. Date of
Publication: 03 Jan 2019.
Author
Manson J.E.; Cook N.R.; Lee I.-M.; Christen W.; Bassuk S.S.; Mora S.;
Gibson H.; Gordon D.; Copeland T.; D'Agostino D.; Friedenberg G.; Ridge
C.; Bubes V.; Giovannucci E.L.; Willett W.C.; Buring J.E.
Institution
(Manson, Cook, Lee, Christen, Bassuk, Mora, Gibson, Gordon, Copeland,
D'Agostino, Friedenberg, Ridge, Bubes, Giovannucci, Willett, Buring)
Department of Medicine, Brigham and Women's Hospital, Harvard Medical
School, 900 Commonwealth Ave., Boston, MA 02215, United States
(Manson, Cook, Lee, Willett, Buring) Department of Epidemiology, Harvard
T.H. Chan School of Public Health, Boston, MA, United States
(Giovannucci, Willett) Department of Nutrition, Harvard T.H. Chan School
of Public Health, Boston, MA, United States
Publisher
Massachussetts Medical Society
Abstract
Background: It is unclear whether supplementation with vitamin D reduces
the risk of cancer or cardiovascular disease, and data from randomized
trials are limited. Method(s): We conducted a nationwide, randomized,
placebo-controlled trial, with a two-by-two factorial design, of vitamin
D3 (cholecalciferol) at a dose of 2000 IU per day and marine n-3 (also
called omega-3) fatty acids at a dose of 1 g per day for the prevention of
cancer and cardiovascular disease among men 50 years of age or older and
women 55 years of age or older in the United States. Primary end points
were invasive cancer of any type and major cardiovascular events (a
composite of myocardial infarction, stroke, or death from cardiovascular
causes). Secondary end points included site-specific cancers, death from
cancer, and additional cardiovascular events. This article reports the
results of the comparison of vitamin D with placebo. Result(s): A
total of 25,871 participants, including 5106 black participants, underwent
randomization. Supplementation with vitamin D was not associated with a
lower risk of either of the primary end points. During a median follow-up
of 5.3 years, cancer was diagnosed in 1617 participants (793 in the
vitamin D group and 824 in the placebo group; hazard ratio, 0.96; 95%
confidence interval [CI], 0.88 to 1.06; P = 0.47). A major cardiovascular
event occurred in 805 participants (396 in the vitamin D group and 409 in
the placebo group; hazard ratio, 0.97; 95% CI, 0.85 to 1.12; P = 0.69). In
the analyses of secondary end points, the hazard ratios were as follows:
for death from cancer (341 deaths), 0.83 (95% CI, 0.67 to 1.02); for
breast cancer, 1.02 (95% CI, 0.79 to 1.31); for prostate cancer, 0.88 (95%
CI, 0.72 to 1.07); for colorectal cancer, 1.09 (95% CI, 0.73 to 1.62); for
the expanded composite end point of major cardiovascular events plus
coronary revascularization, 0.96 (95% CI, 0.86 to 1.08); for myocardial
infarction, 0.96 (95% CI, 0.78 to 1.19); for stroke, 0.95 (95% CI, 0.76 to
1.20); and for death from cardiovascular causes, 1.11 (95% CI, 0.88 to
1.40). In the analysis of death from any cause (978 deaths), the hazard
ratio was 0.99 (95% CI, 0.87 to 1.12). No excess risks of hypercalcemia or
other adverse events were identified. Conclusion(s): Supplementation
with vitamin D did not result in a lower incidence of invasive cancer or
cardiovascular events than placebo. Copyright © 2018
Massachusetts Medical Society.

<65>
Accession Number
625893541
Title
The association of depression following percutanous coronary intervention
with adverse cardiovascular events: Protocol for a systematic review and
meta-analysis.
Source
Medicine. 98 (2) (pp e13952), 2019. Date of Publication: 01 Jan 2019.
Author
Zhao Y.; Tian J.; Tong T.; Gao R.; Liu Y.
Institution
(Liu) Graduate School of Beijing University of Chinese Medicine
(Liu, Liu) Cardiovascular diseases center, Xiyuan hospital of China
academy of Chinese medical sciences
(Liu, Gao) Institute of Clinical Pharmacology of Xiyuan Hospital, China
Academy of Chinese Medical Sciences, Beijing, China
(Zhao) School of Chinese Medicine, Li Ka Shing Faculty of Medicine,
University of Hong Kong, Pokfulam, Hong Kong, China
(Tian) Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Tong) Department of Mathematics, Hong Kong Baptist University, Kowloon
Tong, Hong Kong, China
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Percutanous coronary intervention (PCI) has been
increasingly used for patients suffered from severe coronary artery
disease. However, physical trauma and potential adverse events related to
the procedure often result in detrimental psychological stress.
Accumulating evidences have shown that depression is closely related to
coronary artery disease. However, the association of depression following
percutanous coronary intervention with adverse cardiovascular events is
still unknown. OBJECTIVE(S): This review is designed to assess the
prognostic association of depression following PCI with adverse cardiac
events. METHODS AND ANALYSIS: The following databases will be searched,
PubMed, the EMBASE, CINAHL and Web of Science of English-language
publications from inception to 30 October 2018. Cross-referencing from
retrieved studies will be conducted additionally, and observational
studies were included. Two independent review authors will do the study
selection on the basis of the study eligibility criteria. Extracted data
will be used for quantitative and qualitative evidence synthesis as well
as to assess methodological quality of studies using the Newcastle-Ottawa
checklist. The primary objective of this review is adverse cardiac events,
presented as a composition of myocardial infarction, repeat coronary
revascularization, cardiac readmission, and cardiac death. The accumulated
evidence is evaluated and graded according to Grading of Recommendations,
Assessment, Development and Evaluation (GRADE). RESULTS AND
 CONCLUSION(S): This review will explain the association of depression
following percutanous coronary intervention with adverse cardiovascular
events, and provide physicians with scientific evidence for psychological
intervention in patients after PCI. PROSPERO REGISTRATION NUMBER:
CRD42018112486.

<66>
Accession Number
623034410
Title
Ticagrelor versus clopidogrel in patients with symptomatic peripheral
artery disease and prior coronary artery disease: Insights from the EUCLID
trial.
Source
Vascular Medicine (United Kingdom). 23 (6) (pp 523-530), 2018. Date of
Publication: 01 Dec 2018.
Author
Berger J.S.; Abramson B.L.; Lopes R.D.; Heizer G.; Rockhold F.W.;
Baumgartner I.; Fowkes F.G.R.; Held P.; Katona B.G.; Norgren L.; Jones
W.S.; Millegard M.; Blomster J.; Reist C.; Hiatt W.R.; Patel M.R.;
Mahaffey K.W.
Institution
(Berger) Departments of Medicine and Surgery, New York University School
of Medicine, New York, NY, United States
(Abramson) University of Toronto, Toronto, ON, Canada
(Lopes, Heizer, Rockhold, Jones, Reist, Patel) Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC, United States
(Baumgartner) Swiss Cardiovascular Center, Inselspital, Bern University
Hospital, University of Bern, Bern, Switzerland
(Fowkes) Usher Institute of Population Health Sciences and Informatics,
University of Edinburgh, Edinburgh, United Kingdom
(Held, Millegard, Blomster) AstraZeneca Gothenburg, Molndal, Sweden
(Katona) AstraZeneca Gaithersburg, Gaithersburg, MD, United States
(Norgren) Faculty of Medicine and Health, Orebro University, Orebro,
Sweden
(Hiatt) University of Colorado School of Medicine and CPC Clinical
Research, Aurora, CO, United States
(Mahaffey) Stanford Center for Clinical Research, Stanford University
School of Medicine, Stanford, CA, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Patients with peripheral artery disease (PAD) are at heightened risk of
cardiovascular morbidity and mortality. We sought to evaluate the risk of
concomitant coronary artery disease (CAD) in patients with symptomatic PAD
versus PAD without diagnosed CAD, and whether ticagrelor was superior to
clopidogrel in reducing that risk. The EUCLID trial randomized 13,885
patients with PAD to antithrombotic monotherapy with ticagrelor or
clopidogrel. CAD was defined as prior myocardial infarction (MI),
percutaneous coronary intervention (PCI), or coronary artery bypass graft
(CABG) surgery. Median follow-up was 30 months. Among 4032 (29%) patients
with PAD and CAD, 63% had prior MI, 54% prior PCI, and 38% prior CABG.
After adjustment for baseline characteristics, patients with PAD and CAD
had significantly higher rates of the primary endpoint (cardiovascular
death/MI/stroke, 15.3% vs 8.9%, hazard ratio (HR) 1.50, 95% CI: 1.13-1.99;
p=0.005), but no statistically significant increase in acute limb ischemia
(HR 1.28, 95% CI: 0.57-2.85; p=0.55) or major bleeding (HR 1.10, 95% CI:
0.49-2.48; p=0.81) versus PAD without CAD. Among patients with PAD and
CAD, there was no differential treatment effect between ticagrelor versus
clopidogrel for the primary efficacy endpoint (HR 1.02, 95% CI: 0.87-1.19;
p=0.84), acute limb ischemia (HR 1.03, 95% CI: 0.63-1.69; p=0.89), or
major bleeding (HR 1.06, 95% CI: 0.66-1.69; p=0.81). There was a
statistically significant interaction between prior coronary stent
placement and study treatment (p=0.03) with a numerical reduction in the
primary efficacy endpoint with ticagrelor versus clopidogrel (13.8% vs
16.8%, HR 0.82, 95% CI: 0.65-1.03; p=0.09). Patients with PAD and prior
CAD had higher composite rates of cardiovascular death, MI, and ischemic
stroke versus PAD without diagnosed CAD. There were no significant
differences between ticagrelor and clopidogrel in cardiovascular events or
major bleeding. ClinicalTrials.gov Identifier: NCT01732822. Copyright
© The Author(s) 2018.

<67>
Accession Number
621224479
Title
Rationale, design, and baseline characteristics of the CArdiovascular
safety and Renal Microvascular outcomE study with LINAgliptin
(CARMELINA): A randomized, double-blind, placebo-controlled
clinical trial in patients with type 2 diabetes and high cardio-renal
risk.
Source
Cardiovascular Diabetology. 17 (1) (no pagination), 2018. Article Number:
39. Date of Publication: 14 Mar 2018.
Author
Rosenstock J.; Perkovic V.; Alexander J.H.; Cooper M.E.; Marx N.; Pencina
M.J.; Toto R.D.; Wanner C.; Zinman B.; Baanstra D.; Pfarr E.; Mattheus M.;
Broedl U.C.; Woerle H.-J.; George J.T.; von Eynatten M.; McGuire D.K.
Institution
(Rosenstock) Dallas Diabetes Research Center at Medical City, 7777 Forest
Lane, Suite C-685, Dallas, TX 75230, United States
(Perkovic) University of New South Wales, The George Institute for Global
Health, Faculty of Medicine, Sydney, NSW, Australia
(Alexander, Pencina) Duke Clinical Research Institute, Duke Health,
Durham, NC, United States
(Cooper) Monash University, Head of Diabetes, Melbourne, VIC, Australia
(Marx) RWTH Aachen University, Department of Internal Medicine I,
University Hospital Aachen, Aachen, Germany
(Toto) University of Texas Southwestern Medical Center, Dallas, TX, United
States
(Wanner) Wurzburg Univ Clinic, Dept of Medicine, Wurzburg, Germany
(Zinman) Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute,
Toronto, Canada
(Zinman) University of Toronto, Toronto, Canada
(Baanstra) Boehringer Ingelheim bv, Alkmaar, Netherlands
(Pfarr, Mattheus, Broedl, George, von Eynatten) Boehringer Ingelheim
Pharma GmbH and Co. KG, Ingelheim, Germany
(Woerle) Ulm University, Ulm, Germany
(McGuire) University of Texas Southwestern Medical Center, Division of
Cardiology, Department of Internal Medicine, Dallas, TX, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Cardiovascular (CV) outcome trials in type 2 diabetes (T2D)
have underrepresented patients with chronic kidney disease (CKD), leading
to uncertainty regarding their kidney efficacy and safety. The
CARMELINA trial aims to evaluate the effects of linagliptin, a
DPP-4 inhibitor, on both CV and kidney outcomes in a study population
enriched for cardio-renal risk. Method(s): CARMELINA is a
randomized, double-blind, placebo-controlled clinical trial conducted in
27 countries in T2D patients at high risk of CV and/or kidney events.
Participants with evidence of CKD with or without CV disease and HbA1c
6.5-10.0% (48-86 mmol/mol) were randomized 1:1 to receive linagliptin once
daily or matching placebo, added to standard of care adjusted according to
local guidelines. The primary outcome is time to first occurrence of CV
death, non-fatal myocardial infarction, or non-fatal stroke. The key
secondary outcome is a composite of time to first sustained occurrence of
end-stage kidney disease, >= 40% decrease in estimated glomerular
filtration rate (eGFR) from baseline, or renal death. CV and kidney events
are prospectively adjudicated by independent, blinded clinical event
committees. CARMELINA was designed to continue until at least
611 participants had confirmed primary outcome events. Assuming a hazard
ratio of 1.0, this provides 90% power to demonstrate non-inferiority of
linagliptin versus placebo within the pre-specified non-inferiority margin
of 1.3 at a one-sided alpha-level of 2.5%. If non-inferiority of
linagliptin for the primary outcome is demonstrated, then its superiority
for both the primary outcome and the key secondary outcome will be
investigated with a sequentially rejective multiple test procedure.
 Result(s): Between July 2013 and August 2016, 6980 patients were
randomized and took >= 1 dose of study drug (40.6, 33.1, 16.9, and 9.4%
from Europe, South America, North America, and Asia, respectively). At
baseline, mean +/- SD age was 65.8 +/- 9.1 years, HbA1c 7.9 +/- 1.0%, BMI
31.3 +/- 5.3 kg/m2, and eGFR 55 +/- 25 mL/min/1.73
m2. A total of 5148 patients (73.8%) had prevalent kidney
disease (defined as eGFR < 60 mL/min/1.73 m2 or
macroalbuminuria [albumin-to-creatinine ratio > 300 mg/g]) and 3990
patients (57.2%) had established CV disease with increased albuminuria;
these characteristics were not mutually exclusive. Microalbuminuria (n =
2896 [41.5%]) and macroalbuminuria (n = 2691 [38.6%]) were common.
 Conclusion(s): CARMELINA will add important information
regarding the CV and kidney disease clinical profile of linagliptin by
including an understudied, vulnerable cohort of patients with T2D at
highest cardio-renal risk. Copyright © 2018 The Author(s).

<68>
Accession Number
626057456
Title
Effect of physiotherapy on quality of life after coronary artery bypass
graft surgery: A randomized study.
Source
Journal of Research in Medical Sciences. 23 (1) (no pagination), 2018.
Article Number: 11. Date of Publication: January 2018.
Author
Zolfaghari M.; Mirhosseini S.; Baghbeheshti M.; Afshani A.; Moazzam S.
Institution
(Zolfaghari, Mirhosseini) Health Management and Economics Research Center,
Iran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Mirhosseini) Department of Health Economics, School of Health Management
and Information Sciences, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Baghbeheshti) Department of Community Medicine, Dezful University of
Medical Sciences, Dezful, Iran, Islamic Republic of
(Afshani) Department of Health Administration, School of Management and
Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran,
Islamic Republic of
(Moazzam) Department of Radiation Oncology, Namazi Hospital, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: This study aims to assess the impact that physiotherapy (PT)
has on the quality of life (QoL) of patients who have undergone coronary
artery bypass grafting (CABG) surgery. The objective of this study was to
assess the effect of PT on physical and mental aspects of patients' QoL.
 Material(s) and Method(s): The study population consisted of 50
patients who aged between 60 and 70 years and who had previously undergone
CABG surgery. The patients were randomly allocated to two groups: a PT
group (n = 25) and a control group (n = 25). The physical characteristics
of the participants were recorded at the outset of the study. The patients
who were allocated to the PT group completed 16 sessions of classic PT.
QoL assessments of all participants were performed before and after the
program in the form of a short form-36 health survey. An independent
sample t-test and an ANCOVA were performed for the purpose of statistical
analyses. Result(s): The QoL scores of the patients (mean age = 62.08
years) who underwent PT significantly improved after the intervention (P <
0.001). A significant difference between groups was observed (P < 0.001)
in both the mental component summary and physical component summary
variables. Conclusion(s): PT can help relieve pain, reduce
depression, help patients more effectively perform the tasks of everyday
living, and help ease the symptoms of other disabilities associated with
cardiac surgery. In the current study, the implementation of a PT program
improved the patient's mental health and increased their
QoL. Copyright © 2018 Journal of Pathology Informatics Published
by Wolters Kluwer - Medknow.

<69>
Accession Number
625285291
Title
Efficacy and safety of nicorandil on perioperative myocardial injury in
patients undergoing elective percutaneous coronary intervention: Results
of the PENMIPCI trial.
Source
Drug Design, Development and Therapy. 12 (pp 2591-2599), 2018. Date of
Publication: 2018.
Author
Ye Z.; Lu H.; Su Q.; Long M.; Li L.
Institution
(Ye, Su, Long, Li) Department of Cardiology, The First Affiliated Hospital
of Guangxi Medical University, Nanning, Guangxi, China
(Lu) Department of Orthodontics, The Affiliated Dental Hospital of Guangxi
Medical University, Nanning, Guangxi, China
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background: Previous studies have indicated that nicorandil can reduce
perioperative myocardial injury (PMI) in patients undergoing elective
percutaneous coronary intervention (ePCI), but this conclusion is still
controversial. Additionally, studies reporting on the safety of nicorandil
are lacking. Therefore, we performed this prospective study to evaluate
the efficacy and safety of nicorandil on PMI in patients undergoing ePCI.
 Method(s): One hundred and forty-six patients with coronary heart
disease (CHD) scheduled to undergo ePCI were randomly assigned to the
nicorandil group (n=74) or control group (n=72). The primary outcomes were
the change in cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB) at
12 and 24 hours after surgery. The secondary outcome was the incidence of
major adverse cardiac events (MACE), which was a composite of cardiac
death, nonfatal myocardial infarction, new heart failure or coronary
revascularization. Result(s): There was no difference in age
(54.76+/-5.93 vs 56.35+/-5.22) between the nicorandil group and the
control group. In addition, no differences were observed in the cTnT and
CK-MB levels between the two groups at admission (all P>0.05). Compared
with those in the control group, the cTnT (0.15+/-0.12 vs 0.12+/-0.10 at
12 hours and 0.17+/-0.12 vs 0.13+/-0.10 at 24 hours) and CK-MB
(15.35+/-8.23 vs 12.31+/-7.93 at 12 hours and 13.63+/-8.87 vs 11.13+/-5.71
at 24 hours) levels in the nicorandil group were significantly decreased
after surgery (all P<0.05). Furthermore, nicorandil did not increase the
incidence of MACE in the nicorandil group compared with the control group
(12.16% vs 12.50%). Conclusion(s): Nicorandil can reduce PMI in
patients undergoing ePCI and does not increase the incidence of
MACE. Copyright © 2018 Ye et al.

<70>
Accession Number
2000537654
Title
The effect of the timing and dose of dexmedetomidine on postoperative
delirium in elderly patients after laparoscopic major non-cardiac surgery:
A double blind randomized controlled study.
Source
Journal of Clinical Anesthesia. 47 (pp 27-32), 2018. Date of Publication:
June 2018.
Author
Lee C.; Lee C.H.; Lee G.; Lee M.; Hwang J.
Institution
(Lee, Lee, Lee) Department of Anesthesiology and Pain Medicine, Wonkwang
University School of Medicine, Iksang, South Korea
(Lee) Department of Anesthesiology and Pain Medicine, Konkuk University
School of Medicine, South Korea
(Hwang) Department of Orthopaedic Surgery, Hallym University Kangnam
Sacred Heart Hospital, Seoul, South Korea
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: There were few clinical data dosing and timing regimen
for preventing postoperative delirium. The present study aimed to
investigate the effect of the timing and dose of dexmedetomidine on
postoperative delirium in elderly patients after laparoscopic major
non-cardiac surgery. Patients and interventions: A total of 354 patients
>65 years of age undergoing laparoscopic major non-cardiac surgery under
general anesthesia received a dexmedetomidine 1 mug/kg bolus followed by
0.2-0.7 mug/kg/h infusion from induction of anesthesia to the end of
surgery [group D1]); a dexmedetomidine (1 mug/kg bolus [group D2]); or
saline (group S) 15 min before the end of surgery. Measurements: The
incidence and duration of delirium for 5 days after surgery and the
cytokine (tumor necrosis factor-alpha TNFalpha interleukin [IL]-1 beta
IL-2, IL-6, IL-8, and IL-10) and cortisol levels were measured 1 h and 24
h after surgery. Main Result(s): Group D1 reduced incidence and
duration of delirium and group D2 decreased its duration in patients with
delirium compared to group S. IL-6 levels were significantly lower at 1 h
and 24 h after surgery in group D1 than in group S, and lower at 24 h
after surgery than in group D2. IL-6 levels in group D2 were significantly
lower only at 1 h after surgery than in group S. However, IL-6 levels in
delirious patients in group D2 were significantly lower at 1 h and 24 h
after surgery than those in group S. Cortisol levels 1 h after surgery
were significantly lower in groups D1 and D2 than in group S.
 Conclusion(s): The dose and timing of dexmedetomidine appeared to be
important in preventing delirium. The reduced incidence and duration of
delirium by dexmedetomidine was associated with reduced levels of IL-6 24
h after surgery. Copyright © 2018

<71>
Accession Number
621627348
Title
Ticagrelor in Peripheral Artery Disease Endovascular Revascularization
(TI-PAD): Challenges in clinical trial execution.
Source
Vascular Medicine (United Kingdom). 23 (6) (pp 513-522), 2018. Date of
Publication: 01 Dec 2018.
Author
Rogers R.K.; Hiatt W.R.; Patel M.R.; Shishehbor M.H.; White R.; Khan N.D.;
Bhalla N.P.; Jones W.S.; Low Wang C.C.
Institution
(Rogers, Hiatt) Department of Medicine, Division of Cardiology, University
of Colorado School of Medicine, Aurora, CO, United States
(Hiatt, White, Low Wang) CPC Clinical Research, Aurora, CO, United States
(Patel, Jones) Duke University Health System and Duke Clinical Research
Institute, Durham, NC, United States
(Shishehbor) Harrington Heart & Vascular Institute, University Hospitals
of Cleveland, Cleveland, OH, United States
(Khan, Bhalla) AstraZeneca, Wilmington, DE, United States
(Low Wang) Department of Medicine, Division of Endocrinology, University
of Colorado School of Medicine, Aurora, CO, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
There is limited evidence to guide clinical decision-making for
antiplatelet therapy in peripheral artery disease (PAD) in the setting of
lower extremity endovascular treatment. The Ticagrelor in Peripheral
Artery Disease Endovascular Revascularization Study (TI-PAD) evaluated the
role of ticagrelor versus aspirin as monotherapy in the management of
patients following lower extremity endovascular revascularization. The
trial failed to recruit the targeted number of patients, likely due to
aspects of the design including the lack of option for dual antiplatelet
therapy, and inability to identify suitable patients at study sites. In
response, the protocol underwent amendments, but these changes did not
adequately stimulate recruitment, and thus TI-PAD was prematurely
terminated. This article describes the rationale for TI-PAD and challenges
in trial design, subject recruitment and trial operations to better inform
the conduct of future trials in PAD revascularization. ClinicalTrials.gov
Identifier: NCT02227368 Copyright © The Author(s) 2018.

<72>
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. Copyright © 2018, © 2018 Informa UK
Limited, trading as Taylor & Francis Group.

<73>
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. Copyright © 2018 Author(s)
(or their employer(s)).

<74>
Accession Number
2001511372
Title
Effects of platelet-rich plasmapheresis during cardiovascular surgery: A
meta-analysis of randomized controlled clinical trials.
Source
Journal of Clinical Anesthesia. 56 (pp 88-97), 2019. Date of Publication:
September 2019.
Author
Zhai Q.; Wang Y.; Yuan Z.; Zhang R.; Tian A.
Institution
(Zhai, Wang, Yuan, Tian) Department of Anesthesiology, the First
Affiliated Hospital of China Medical University (CMU), Shenyang, Liaoning,
China
(Zhang) Department of Gerontology and Geriatrics, the First Affiliated
Hospital of China Medical University (CMU), Shenyang, Liaoning, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: This study aimed to explore the effects of platelet-rich
plasmapheresis (PRP) on the amount of postoperative blood loss and the
requirements for allogeneic fresh frozen plasma (FFP) and red blood cell
(RBC) transfusions during cardiovascular surgery. Method(s): A
literature search of 7 online databases was conducted. Randomized control
trials (RCT) comparing intraoperative PRP or appropriate control groups
were considered suitable for this current study. Result(s): Fifteen
RCTs enrolling a total of 1002 patients, including 501 patients who
received PRP and 501 control patients. Meta-analysis of the data from
these trials showed that PRP reduced the total volume of postoperative
blood loss (standardized mean difference [SMD], -0.74; 95% confidence
interval [CI], -1.18 to -0.31; P < 0.05), reduced postoperative fresh
frozen plasma (FFP) transfusion (SMD, -0.38; 95%CI, -0.69 to -0.08; P <
0.05), reduced postoperative RBCs transfusion (SMD, -0.44; 95%CI, -0.77 to
-0.10; P < 0.05), and reduced the proportion of patients receiving
postoperative allogeneic RBC transfusions (relative risk [RR], 0.44;
95%CI, 0.21-0.91, P < 0.05) during cardiovascular surgery.
 Conclusion(s): Conducting PRP before cardiopulmonary bypass (CPB) and
transfusing autologous platelet-rich plasma (aPRP) after reversal of
heparin could reduce postoperative blood loss, the requirements for blood
products transfusion during cardiovascular surgery. A higher mean platelet
count in aPRP may improve the final outcome. However, there was a high
degree of undetermined heterogeneity among the analyzed trials, and larger
and more precise RCTs are needed to confirm these
conclusions. Copyright © 2019 Elsevier Inc.

<75>
Accession Number
2001513448
Title
Moraxella nonliquefaciens septic arthritis in a hematopoietic stem cell
transplant patient a case report and review of the literature.
Source
Journal of Infection and Public Health. (no pagination), 2019. Date of
Publication: 2019.
Author
Khalife M.; Merashli M.; Kanj S.S.
Institution
(Khalife, Kanj) From the Division of Infectious Diseases, Department of
Internal Medicine, American University of Beirut Medical Center, Beirut,
Lebanon
(Merashli) Division of Allergy, Immunology and Rheumatology, Department of
Internal Medicine, American University of Beirut Medical Center, Beirut,
Lebanon
Publisher
Elsevier Ltd
Abstract
Background: Septic arthritis is a common rheumatologic condition with
myriad microbiological causative agents. Moraxella is one of the very rare
causes of septic arthritis. We hereby present the third case of Moraxella
nonliquefaciens septic arthritis and the first case in a hematopoietic
stem cell transplant patient (HSCT) along with a brief review of the
literature. Method(s): We used PubMed with google search engine to
search the literature for reported cases of moraxella septic arthritis.
 Result(s): Information on 19 other cases of moraxella infectious
arthritis was found. M. catarrhalis was the most common species isolated.
Only 2 reports on M. nonliquefaciens were found; the first one in a
multiple myeloma patient and the second one in a diabetic patient on
hemodialysis. Predisposing conditions included inflammatory arthritis,
prosthetic joints, diabetes, Human Immunodeficiency Virus (HIV) infection,
Hepatitis C, hemodialysis, esophageal cancer, valve replacements,
alcoholism and Intravenous (IV) drug use. The age group of the reported
cases ranged from 3 months to 78 years. Conclusion(s): Infectious
arthritis with Moraxella spp. is a very rare entity which can occur in any
age group and in the setting of various underlying medical
conditions. Copyright © 2019 The Authors

<76>
Accession Number
2001513139
Title
Are racial differences in hospital mortality after coronary artery bypass
graft surgery real? A risk-adjusted meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Benedetto U.; Kamel M.K.; Khan F.M.; Angelini G.D.; Caputo M.; Girardi
L.N.; Gaudino M.
Institution
(Benedetto, Angelini, Caputo) Bristol Heart Institute, University of
Bristol, School of Clinical Sciences, Bristol, United Kingdom
(Kamel, Khan, Girardi, Gaudino) Department of Cardiothoracic Surgery,
Weill Cornell Medicine, New York, NY, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Despite several reports, there are still conflicting data on
the influence of ethnicity on mortality rates associated with coronary
artery bypass grafting (CABG). We aimed to get further insights into the
effect of race on mortality following CABG by performing a risk adjusted
meta-analysis. Method(s): Relevant studies were searched on PubMed,
Embase, BioMed Central, and the Cochrane Central register. Pairwise
meta-analysis was used to estimate the relative risk of hospital death of
black, Hispanic, and Asian patients using white patients as reference.
Risk adjusted meta-analytic estimates were obtained using generic inverse
variance methods with random effect model. Result(s): A total of 28
studies were selected for analysis. A total of 21 studies reported on
hospital mortality in black (n = 222,892) versus white (n = 3,884,043)
patients, 7 studies reported on Hispanic (n = 91,256) versus white (n =
1,458,524) and 9 studies reported on Asian (n = 27,820) versus white (n =
1,081,642). When compared with white patients, adjusted risk of hospital
death was significantly greater for black patients (adjusted odds ratio
[OR], 1.25; 95% confidence interval [CI], 1.13-1.39; P <.001), and not
statistically different for Asian (OR, 1.33; 95% CI, 0.99-1.77; P =.05)
and Hispanic patients (adjusted OR, 1.08; 95% CI, 0.94-1.23; P =.26).
Meta-regression showed a significant trend toward lower mortality rates in
most recent series in both black (P =.02) and white (P =.0007) and Asian
(P =.01) but not for Hispanic (P =.41). However, as mortality rates were
lower across the different races, the relative disadvantage between the
study groups persisted, which may explain the lack of interaction between
study period and race effect on mortality for black (adjusted P =.09),
Asian (adjusted P =.63), and Hispanic (adjusted P =.97) patients.
 Conclusion(s): The present meta-analysis showed that despite progress
is being made in lowering in-hospital mortality rates among the major
racial/ethnic groups, ethnical disparities in hospital mortality after
CABG remain. Copyright © 2018 The American Association for
Thoracic Surgery

<77>
Accession Number
626156595
Title
Chronic kidney disease is associated with increased mortality and
procedural complications in transcatheter aortic valve replacement: a
systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2019.
Date of Publication: 2019.
Author
Rattanawong P.; Kanitsoraphan C.; Kewcharoen J.; Riangwiwat T.;
Chongyangyuenvong P.; Vutthikraivit W.; Mannem S.R.; Chung E.H.
Institution
(Rattanawong, Kanitsoraphan, Kewcharoen) Department of Internal Medicine,
University of Hawaii Internal Medicine Residency Program, Honolulu, HI,
United States
(Rattanawong, Chongyangyuenvong) Department of Internal Medicine, Faculty
of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
(Riangwiwat) Geisinger Commonwealth School of Medicine, Scranton, PA,
United States
(Vutthikraivit) Department of Internal Medicine, Texas Tech University
Health Sciences Center, Lubbock, TX, United States
(Mannem) Division of Cardiology, Queen's Medical Center, Honolulu, HI,
United States
(Chung) Department of Internal Medicine, Michigan Medicine, University of
Michigan, Ann Arbor, MI, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: We performed a systematic review and meta-analysis to explore
the association between chronic kidney disease (CKD) and mortality and
procedural complications in transcatheter aortic valve replacement (TAVR).
 Background(s): The impact of varying stages of CKD or end-stage renal
disease (ESRD) on patients receiving TAVR is not clearly identified.
 Method(s): We searched the databases of MEDLINE and EMBASE from
inception to May 2018. Included studies were published TAVR studies that
compared the risk of mortality and procedural complications in CKD
patients compared to control patients. Data from each study were combined
using the random-effects model. Result(s): Twelve studies (42,703 CKD
patients and 51,347 controls) were included. Compared with controls, CKD
patients had a significantly higher risk of 30-day overall mortality (risk
ratio [RR] = 1.56, 95% confidence interval [CI]: 1.34-1.80, I2
= 60.9), long-term cardiovascular mortality (RR = 1.44, 95% CI: 1.22-1.70,
I2 = 36.2%), and long-term overall mortality (RR = 1.66, 95%
CI: 1.45-1.91, I2 = 80.3), as well as procedural complications
including pacemaker requirement (RR = 1.20, 95% CI: 1.03-1.39,
I2 = 56.1%) and bleeding (RR = 1.60, 95% CI: 1.26-2.02,
I2 = 86.0%). Risk of mortality and procedural complications
increased with severity of CKD for stages 3, 4, and 5, respectively, in
terms of long-term overall mortality (RR = 1.28, 1.82, and 2.12), 30-day
overall mortality (RR = 1.26, 1.89, and 1.93), 30-day cardiovascular
mortality (RR = 1.18, 1.75, and 2.50), and 30-day overall bleeding (RR =
1.19, 1.63, and 2.12). Conclusion(s): Our meta-analysis demonstrates
a significant increased risk of mortality and procedural complications in
patients with CKD who underwent TAVR compared to controls. Copyright
© 2019 Wiley Periodicals, Inc.

<78>
Accession Number
626156333
Title
Evaluation of Albumin 25% Use in Critically Ill Patients at a Tertiary
Care Medical Center.
Source
Hospital Pharmacy. (no pagination), 2019. Date of Publication: 2019.
Author
Torbic H.; Bauer S.R.; Militello M.; Welch S.; Udeh C.; Richardson S.
Institution
(Torbic, Bauer, Militello, Welch, Udeh) Cleveland Clinic, OH, United
States
(Richardson) Kaweah Delta Health Care District, Visalia, CA, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Albumin 25% has been studied and has demonstrated benefit in a
limited number of patient populations. The use of albumin 25% is
associated with higher costs compared with crystalloid therapy. The aim of
this study was to describe the prescribing practices of albumin 25% at a
tertiary-care medical center and identify opportunities for restriction
criteria related to its use to help generate cost savings. Method(s):
This evaluation was a retrospective, noninterventional, descriptive study
of albumin 25% use between June 2015 and February 2016. Inclusion criteria
consisted of patients >=18 years old and who received at least one dose of
albumin 25% while admitted to a Cleveland Clinic main campus intensive
care unit (ICU). Inclusion was restricted to 150 randomly selected
patients. Result(s): A total of 539 albumin 25% orders were placed
for the 150 included patients. The cardiovascular ICU more frequently
prescribed albumin 25% compared with the medical, surgical, neurosciences,
and coronary ICUs (51% vs 23% vs 11% vs 9% vs 6%, respectively). Although
the cardiovascular surgery ICU most frequently prescribed albumin 25%
compared with other ICUs, the medical ICU prescribed a larger total
quantity of albumin 25% compared with the cardiovascular, surgical,
neurosciences, and coronary ICUs (8705 g vs 7275 g vs 3205 g vs 2162 g vs
625 g, respectively). The majority of patients (61%) did not have an
indication listed for albumin 25% use and only 9% of patients were
prescribed for indications supported by primary literature. Of the
patients prescribed albumin for other indications not supported by primary
literature (30%), the most common reasons for albumin 25% were
hypotension, acute kidney injury, and volume resuscitation. The median
cost per patient of albumin 25% was $417 with a total cost of $122 164 for
the cohort. Only 19% of the total cost aligned with dosing regimens
evaluated in primary literature. Conclusion(s): Prescribing patterns
of albumin 25% at a tertiary academic medical center do not align with
indications supported by primary literature. These findings identified a
major opportunity for prescriber education and implementation of
restriction criteria to target cost savings. Copyright © The
Author(s) 2019.

<79>
Accession Number
2001283379
Title
Haemodynamic profiles of etomidate vs propofol for induction of
anaesthesia: a randomised controlled trial in patients undergoing cardiac
surgery.
Source
British Journal of Anaesthesia. 122 (2) (pp 198-205), 2019. Date of
Publication: February 2019.
Author
Hannam J.A.; Mitchell S.J.; Cumin D.; Frampton C.; Merry A.F.; Moore M.R.;
Kruger C.J.
Institution
(Hannam) Department of Pharmacology and Clinical Pharmacology, Faculty of
Medical and Health Sciences, University of Auckland, Auckland, New Zealand
(Hannam, Mitchell, Cumin, Merry, Moore) Department of Anaesthesiology,
Faculty of Medical and Health Sciences, University of Auckland, Auckland,
New Zealand
(Mitchell) Department of Anaesthesia, Auckland City Hospital, Auckland,
New Zealand
(Frampton) Department of Medicine, Christchurch School of Medicine and
Health Sciences, University of Otago, Dunedin, New Zealand
(Merry, Kruger) Department of Cardiothoracic and ORL Anaesthesia, Auckland
City Hospital, Auckland, New Zealand
Publisher
Elsevier Ltd
Abstract
Background: Etomidate is frequently selected over propofol for induction
of anaesthesia because of a putatively favourable haemodynamic profile,
but data confirming this perception are limited. Method(s): Patients
undergoing cardiac surgery were randomised to induction of anaesthesia
with propofol or etomidate. Phase I (n=75) was conducted as open-label,
whereas Phase II (n=75) was double blind. Mean arterial blood pressure
(MAP) and boluses of vasopressor administered after induction were
recorded. The primary endpoint was the area under the curve below baseline
MAP (MAP-time integral) during the 10 min after induction. Secondary
endpoints were the use of vasopressors over the same period, and the
effect of blinding on the aforementioned endpoints. Groups were compared
using regression models with phase and anaesthetist as factors.
 Result(s): The mean difference between etomidate and propofol in the
MAP-time integral below baseline was 2244 mm Hg s (95% confidence
interval, 581-3906; P=0.009), representing a 34% greater reduction with
propofol. Overall, vasopressors were used in 10/75 patients in the
etomidate group vs 21/75 in the propofol group (P=0.38), and in 20/74
patients during the blinded phase vs 11/76 during the open-label phase
(P=0.31). The interaction between randomisation and phase (open-labelled
or blinded) was not significant for either primary (P=0.73) or secondary
endpoints (P=0.90). Conclusion(s): Propofol caused a 34% greater
reduction in MAP-time integral from baseline after induction of
anaesthesia than etomidate, despite more frequent use of vasopressors with
propofol, confirming the superior haemodynamic profile of etomidate in
this context. The proportion of patients receiving vasopressors increased
slightly, albeit not significantly, in both groups in the blinded phase.
Clinical trial registration: Australian and New Zealand Clinical Trials
Registry, ACTRN12614000717651. Copyright © 2018 British Journal
of Anaesthesia

<80>
Accession Number
2001481642
Title
Handoffs From the Operating Room to the Intensive Care Unit After
Cardiothoracic Surgery: From The Society of Thoracic Surgeons Workforce on
Critical Care.
Source
Annals of Thoracic Surgery. 107 (2) (pp 619-630), 2019. Date of
Publication: February 2019.
Author
Chatterjee S.; Shake J.G.; Arora R.C.; Engelman D.T.; Firstenberg M.S.;
Geller C.M.; Hirose H.; Lonchyna V.A.; Lytle F.T.; Milewski R.K.C.;
Moosdorf R.G.H.; Rabin J.; Sanjanwala R.; Galati M.; Whitman G.J.
Institution
(Chatterjee) Division of General and Cardiothoracic Surgery, Michael E.
DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX,
United States
(Chatterjee) Department of Cardiovascular Surgery, Texas Heart Institute,
Houston, TX, United States
(Shake) Department of Surgery, University of Mississippi School of
Medicine, Jackson, MS, United States
(Arora, Sanjanwala) Department of Surgery, St. Boniface Hospital,
University of Manitoba, Winnipeg, Canada
(Engelman) Department of Surgery, Baystate Medical Center, Springfield,
MA, United States
(Firstenberg) Division of Cardiothoracic Surgery, Department of Surgery,
The Medical Center of Aurora, Aurora, CO, United States
(Geller) Division of Cardiothoracic Surgery, Department of Surgery,
Crozer-Keystone Health System, Drexel University College of Medicine,
Upland, PA, United States
(Hirose) Division of Cardiothoracic Surgery, Department of Surgery, Thomas
Jefferson University, Philadelphia, PA, United States
(Lonchyna) Section of Cardiac and Thoracic Surgery, Department of Surgery,
University of Chicago School of Medicine, Chicago, IL, United States
(Lytle) Division of Critical Care Medicine, Department of Anesthesiology,
Case Western Reserve University, Cleveland, OH, United States
(Milewski) Department of Surgery, University of Pennsylvania School of
Medicine, Philadelphia, PA, United States
(Moosdorf) Department for Cardiovascular Surgery, Phillips University
Marburg, Marburg, Germany
(Rabin) R. Adams Cowley Shock Trauma Center, University of Maryland School
of Medicine, Baltimore, MD, United States
(Galati) Texas Medical Center Library, Houston, TX, United States
(Whitman) Department of Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
Publisher
Elsevier USA

<81>
[Use Link to view the full text]
Accession Number
621612518
Title
Culprit versus multivessel coronary intervention in ST-segment elevation
myocardial infarction: A meta-analysis of randomized trials.
Source
Coronary Artery Disease. 29 (2) (pp 151-160), 2018. Date of Publication:
2018.
Author
Vaidya S.R.; Qamar A.; Arora S.; Devarapally S.R.; Kondur A.; Kaul P.
Institution
(Vaidya, Arora) Department of Internal Medicine, Cape Fear Valley Medical
Center, Fayetteville, NC 28304, United States
(Devarapally) Division of Cardiology, Davis Regional Medical Center,
Statesville, United States
(Arora, Kaul) Division of Cardiology, University of North Carolina at
Chapel Hill, Chapel Hill, United States
(Vaidya) Department of Internal Medicine, Campbell University School of
Medicine, Lillington, NC, United States
(Kondur) Division of Cardiology, Detroit Medical Center, Wayne State
University, Detroit, MI, United States
(Qamar) Division of Cardiology, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Kaul) Division of Interventional Cardiology, Piedmont Heart Institute,
Atlanta, GA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background The 2015 American College of Cardiology/American Heart
Association update on primary percutaneous coronary intervention (PCI) in
patients with ST-segment elevation myocardial infarction (STEMI)
recommended PCI of the non-infarct-related artery at the time of primary
PCI (class IIb recommendation). Despite evidence supporting complete
revascularization in STEMI, its benefit on mortality rates is uncertain.
Methods We searched all available databases for randomized controlled
trials comparing complete multivessel percutaneous coronary intervention
(CMV PCI) with infarct-artery-only revascularization in patients with
STEMI. Summary risk ratios and 95% confidence intervals (CIs) were
calculated for both the efficacy and safety outcomes. Results Nine
randomized controlled trials fulfilled the inclusion criteria, yielding
2991 patients. Follow-up periods ranged from 6 to 36 months. Compared with
infarct-related artery-only PCI, CMV PCI was associated with significantly
lower rates of major adverse cardiac events [relative risk (RR)=0.54, 95%
CI=0.41-0.71; P<0.00001], cardiovascular mortality (RR=0.48, 95%
CI=0.28-0.80; P=0.005), and repeat revascularization (RR=0.38, 95%
CI=0.30-0.47; P<0.00001). Although, contrast-induced nephropathy and major
bleed rates were comparable between both groups, CMV PCI failed to show
any reduction in all-cause mortality (RR=0.75, 95% CI=0.53-1.07; P=0.11)
and nonfatal myocardial infarction (RR=0.69, 95% CI=0.43-1.10; P=0.12).
Conclusion Our results suggest that in patients with STEMI and multivessel
disease, complete revascularization is safe, and is associated with
reduced risks of major adverse cardiac events and cardiac death along with
a reduced need for repeat revascularization. However, it showed no
beneficial effect on all-cause mortality and nonfatal myocardial
infarction. Copyright © 2018 Wolters Kluwer Health, Inc. All
rights reserved.

<82>
[Use Link to view the full text]
Accession Number
621612483
Title
Long-term darapladib use does not affect coronary plaque composition
assessed using multimodality intravascular imaging modalities: A
randomized-controlled study.
Source
Coronary Artery Disease. 29 (2) (pp 104-113), 2018. Date of Publication:
2018.
Author
Choi W.G.; Prasad M.; Lennon R.; Gulati R.; Prasad A.; Lerman L.O.; Lerman
A.
Institution
(Choi, Prasad, Lennon, Gulati, Prasad, Lerman, Lerman) Department of
Cardiovascular Diseases, United States
(Lerman) Division of Nephrology and Hypertension, Mayo Clinic, 200 First
St SW, Rochester, MN 55905, United States
(Choi) Division of Cardiology, Department of Internal Medicine, Konkuk
University College of Medicine, Chungbuk, South Korea
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background Lipoprotein-associated phospholipase A 2 (Lp-PLA 2) may play a
role in plaque progression and vulnerability. We aimed to define plaque
characteristics on multimodality intravascular imaging in patients with
coronary endothelial dysfunction in response to long-term inhibition of
Lp-PLA2 by darapladib. Patients and methods This is a double-blinded,
randomized study screening 70 patients, and enrolling 54 patients with
suspected ischemia, without obstructive disease on angiography and with
coronary endothelial dysfunction by invasive assessment. Patients were
randomized to receive darapladib or placebo for 6 months. Forty patients
underwent multimodality intravascular imaging at baseline and after 6
months of therapy. Several parameters of plaque vulnerability were
measured, including maximum value of lipid core burden index for any of
the 4-mm segment (maxLCBI 4 mm) by near-infrared spectroscopy.
Microchannels and macrophages were assessed using optical coherence
tomography and necrotic core volume by virtual histology intravascular
ultrasound. Results There was no significant difference in maxLCBI 4 mm
[64.56 (7.74, 128.56) vs. 22.43 (0, 75.63), P=0.522] or in macrophage
images angle [-9.5degree (-25.53degree, 12.68degree) vs.-16.7degree
(-28.6degree,-4.8degree), P=0.489] between groups. There was a trend
toward shorter microchannel length in the darapladib arm [0, (-4.4, 0.2)
mm vs. 0.8 (-0.15, 1.9) mm, P=0.08]. Percentage of necrotic core volume
was not significantly different. Conclusion Thus, long-term inhibition of
endogenous Lp-PLA 2 activity with darapladib was not associated with a
change in plaque progression and vulnerability indices after 6 months of
therapy, and the endogenous Lp-PLA 2 pathway may not play a direct role in
the progression of early atherosclerosis in humans. Copyright ©
2018 Wolters Kluwer Health, Inc. All rights reserved.

<83>
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.
 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.
 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. 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.
 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. Copyright © 2019 The Authors

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

<85>
Accession Number
2001446129
Title
Effects of high dose atorvastatin before elective percutaneous coronary
intervention on highly sensitive troponin T and one year major
cardiovascular events; a randomized clinical trial.
Source
IJC Heart and Vasculature. 22 (pp 96-101), 2019. Date of Publication:
March 2019.
Author
Pourhosseini H.; Lashkari R.; Aminorroaya A.; Soltani D.; Jalali A.;
Tajdini M.
Institution
(Pourhosseini, Lashkari, Aminorroaya, Soltani, Jalali) Tehran Heart Center
and School of Medicine, Tehran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Tajdini) Tehran Heart Center, Tehran University of Medical Sciences,
North Kargar Ave., Tehran, Iran, Islamic Republic of
Publisher
Elsevier Ireland Ltd (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Introduction: Some studies have demonstrated that post-PCI elevated
cardiac enzymes are associated with worse outcomes. In this study, we
aimed to determine if high-dose treatment with atorvastatin before planned
elective PCI reduces PMI or MACE at 1-year median follow-up.
 Material(s) and Method(s): Eligible participants were randomly
allocated to group A (80 mg atorvastatin 12 h and 40 mg 2 h before PCI)
and group B (40 mg atorvastatin daily). Blood samples were obtained before
and at 24 h after PCI to measure hsTnT. All patients were followed
regarding MACE (combination of death, re-hospitalizations for ACS, and
unplanned coronary revascularization) during one year after PCI.
 Result(s): 207 patients randomly assigned to Group A (n = 97) or
group B (n = 110). The rate of PMI was lower in group A (5.2%) compared to
group B (10.9%); despite near to 50% lower rate of PMI in group A, binary
logistic regression showed no significant association between atorvastatin
recapture and PMI. The occurrence of MACE in 97 patients of group A was 11
(11.3%), higher than 11 (10%) cases of 110 patients in group B. Cox
proportional hazards regression model shows no significant difference in
MACE of study groups. Conclusion(s): Pretreatment of patients with
stable angina who were planned to undergo an elective PCI with 120 mg of
atorvastatin before the procedure confer them the same benefit in terms of
PMI and MACE as 40 mg routine daily dosage of this statin
does. Copyright © 2018

<86>
Accession Number
625326671
Title
Alcohol septal ablation vs myectomy for symptomatic hypertrophic
obstructive cardiomyopathy: Systematic review and meta-analysis.
Source
Clinical Cardiology. 42 (1) (pp 190-197), 2019. Date of Publication:
January 2019.
Author
Osman M.; Kheiri B.; Osman K.; Barbarawi M.; Alhamoud H.; Alqahtani F.;
Alkhouli M.
Institution
(Osman, Alhamoud, Alqahtani, Alkhouli) Division of Cardiology, West
Virginia University School of Medicine, Morgantown, WV, United States
(Kheiri, Barbarawi) Hurley Medical Center, Michigan State University,
Flint, MI, United States
(Osman) Michigan Health Specialist, Flint, MI, United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Surgical myectomy (SM) and Alcohol septal ablation (ASA) are
effective therapies for patients with hypertrophic cardiomyopathy who
remain symptomatic despite medical therapy. A plethora of data has
recently emerged on the long-term outcomes of these procedures. We hence
sought to perform an updated meta-analysis comparing both procedures.
 Method(s): Studies reporting long-term (>3-years) outcomes of SM
and/or ASA were included. The primary endpoint was all-cause mortality.
Secondary endpoints included cardiovascular mortality, sudden cardiac
death (SCD), reintervention, and complications including death, pacemaker
implantation, and stroke. Result(s): Twenty-two ASA cohorts (n =
4213; follow-up = 6.6-years) and 23 SM cohorts (n = 4240; follow-up =
6.8-years) were included. Septal myectomy was associated with higher
periprocedural mortality and stroke (2% vs 1.2%, P = 0.009 and 1.5% vs
0.8% P = 0.013, respectively), but ASA was associated with more need of
pacemaker (10% vs 5%, P < 0.001). During long-term follow-up, all-cause
mortality, cardiovascular mortality, and sudden cardiac death rates were
1.5%, 0.4%, and 0.3% per person-year in the ASA group and 1.1%, 0.5%, and
0.3% per person-year in the SM group (P = 0.21, P = 0.53, P = 0.43),
respectively. Repeat septal reduction intervention(s) were more common
after ASA (11% vs 1.5%, P < 0.001). Conclusion(s): Compared with SM,
ASA is associated with lower periprocedural mortality and stroke but
higher rates of pacemaker implantations and reintervention. However, there
was no difference between ASA and SM with regards to long-term all-cause
mortality, cardiovascular mortality, or SCD. Copyright © 2018
Wiley Periodicals, Inc.

<87>
Accession Number
625633979
Title
Comment on "Transcatheter aortic valve replacement in patients with pure
native aortic valve regurgitation: A systematic review and meta-analysis".
Source
Clinical Cardiology. 42 (1) (pp 167-168), 2019. Date of Publication:
January 2019.
Author
Shoar S.; Naderan M.; Hosseini F.; Shoar N.
Institution
(Shoar) Clinical Research Scholar and Scientist, ScientificWriting
Corporation, Houston, TX, United States
(Shoar, Naderan) Faculty of Medicine, Tehran University of Medical
Science, Tehran, Iran, Islamic Republic of
(Hosseini) School of Medicine, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
(Shoar) Faculty of Medicine, Kashan University of Medical Sciences,
Kashan, Iran, Islamic Republic of
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)

<88>
Accession Number
625632253
Title
Impact of tricuspid regurgitation and right ventricular dysfunction on
outcomes after transcatheter aortic valve replacement: A systematic review
and meta-analysis.
Source
Clinical Cardiology. 42 (1) (pp 206-212), 2019. Date of Publication:
January 2019.
Author
Fan J.; Liu X.; Yu L.; Sun Y.; Jaiswal S.; Zhu Q.; Chen H.; He Y.; Wang
L.; Ren K.; Wang J.
Institution
(Fan, Jaiswal, Zhu, Wang) Zhejiang University School of Medicine,
Hangzhou, China
(Liu, Chen, He, Wang, Ren, Wang) Department of Cardiology, Second
Affiliated Hospital Zhejiang University School of Medicine, Hangzhou,
China
(Yu) Department of Echocardiography, The Second Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou, China
(Sun) Department of Cardiology, Guangdong People's Hospital, Guangzhou,
China
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Far less attention has been paid to the prognostic effect of right-side
heart disease on outcomes after transcatheter aortic valve replacement
(TAVR) when compared with the left side. Therefore, we performed a
systematic review and meta-analysis on the impact of tricuspid
regurgitation (TR) and right ventricular (RV) dysfunction on outcomes
after TAVR. We hypothesized that TR and RV dysfunction may have a
deleterious effect on outcomes after TAVR. Article revealing the
prognostic effect of TR and RV dysfunction on outcomes after TAVR were
being integrated. Random or fixed effect model was adopted in accordance
with the heterogeneity. There were nine studies with a total of 6466
patients enrolled after a comprehensive literature search of the
MEDLINE/PubMed, EMBASE, ISI Web of Science, and Cochrane databases. The
overall analysis revealed that moderate or severe TR at baseline increased
all-cause mortality after TAVR (HR = 1.79, CI 95% 1.52-2.11, P < 0.001).
Both baseline RV dysfunction (HR = 1.53, CI 95% 1.27-1.83, P < 0.001) and
presence of RV dilation (HR = 1.83, CI 95% 1.47-2.27, P < 0.001) were
associated with all-cause mortality. Both baseline moderate or severe TR
and RV dysfunction worsen prognosis after TAVR and careful assessment of
right heart function should be done for clinical decision by the heart
team before the TAVR procedure. Copyright © 2018 The Authors.
Clinical Cardiology published by Wiley Periodicals, Inc.

<89>
Accession Number
619592181
Title
A comparison between inhalational (Desflurane) and total intravenous
anaesthesia (Propofol and dexmedetomidine) in improving postoperative
recovery for morbidly obese patients undergoing laparoscopic sleeve
gastrectomy: A double-blinded randomised controlled trial.
Source
Journal of Clinical Anesthesia. 45 (pp 6-11), 2018. Date of Publication:
May 2018.
Author
Elbakry A.-E.; Sultan W.-E.; Ibrahim E.
Institution
(Elbakry, Sultan, Ibrahim) Department of Anaesthesia and Intensive Care,
Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective Laparoscopic sleeve gastrectomy is commonly performed
under total intravenous anaesthesia (TIVA) or balanced anaesthesia using
an intravenous and inhalation agent. It is still unclear which anaesthesia
regimen is better for this group of patients. The present study has been
conducted to compare the use of the inhalation anaesthesia technique using
desflurane with the TIVA technique, using propofol and dexmedetomidine.
Design Prospective, randomised, double-blinded study. Setting Menoufia
Univeristy Hospital. Patients This randomised trial was carried out on 100
morbidly obese patients undergoing laparoscopic sleeve gastrectomy. The
patients were randomised into two equally sized groups; one group received
the inhalation anaesthesia technique and the other received the TIVA
technique. Interventions All patients received general anaesthesia, which
was induced by propofol, remifentanil, and rocuronium. Anaesthesia was
maintained using desflurane in oxygen air mixture in the inhalation group,
whilst anaesthesia was maintained by intravenous infusion of propofol and
dexmedetomidine in the TIVA group. Measurements Intra-operative vital
signs, anaesthesia recovery time, postoperative nausea and vomiting, pain
score, post-anaesthetic care unit (PACU) stay time, total first 24 h
post-operative analgesic needs and the onset of first bowel movement were
recorded. Main results The TIVA group had lower intra-operative heart
rates and mean arterial blood pressure (P < 0.0001). The TIVA group also
had a lower post-operative visual analogue score for pain assessment (VAS)
(P < 0.0001), lower total analgesic requirements (P < 0.0001), a lower
incidence of nausea (P = 0.01) and vomiting (P = 0.03), and shorter PACU
stays (P = 0.01). There was no significant difference between groups with
regard to the onset of bowel movement (P = 0.16). Conclusions TIVA using
propofol and dexmedetomidine is a better anaesthetic regimen than
inhalation anaesthesia using desflurane for laparoscopic sleeve
gastrectomy in morbidly obese patients. The TIVA technique provided better
postoperative recovery with fewer postoperative side effects and analgesic
requirements. Clinical trial registery number NCT03029715. Copyright
© 2017 Elsevier Inc.

<90>
Accession Number
623736705
Title
Clinical pharmacodynamics and long-term efficacy of Talcom vs. Plavix in
patients undergoing coronary stent implantation: a randomized study with
5-year follow-up.
Source
European Journal of Clinical Pharmacology. 74 (11) (pp 1397-1403), 2018.
Date of Publication: 01 Nov 2018.
Author
Li J.; Fan Y.; Zhu T.; Chen J.; Kong D.; Meng H.; Zhang J.; Xu K.; Ye S.;
Ji Y.; Li C.
Institution
(Li, Fan, Meng, Zhang, Xu, Ye, Ji, Li) Department of Cardiology, The First
Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road,
Nanjing, Jiangsu 210029, China
(Li) Department of Cardiology, Suqian Hospital Affiliated of Xuzhou
Medical University, Suqian, Jiangsu 223800, China
(Zhu) Department of Cardiology, The Affiliated Jiangning Hospital of
Nanjing Medical University, Nanjing, Jiangsu 210029, China
(Chen) Department of Cardiology, People's Hospital of Maanshan, Maanshan,
Anhui 243000, China
(Kong) Department of Cardiology, Jining First People's Hospital, Jining,
Shandong 272011, China
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Form II clopidogrel bisulfate (Plavix) has been extensively used
in patients with acute coronary syndrome. However, the efficacy of form I
clopidogrel bisulfate (Talcom) was less investigated. The aim of this
study was to investigate the efficacy and safety of Talcom compared with
Plavix. Method(s): Two hundred and forty-eight patients were
recruited after receiving percutaneous coronary intervention (PCI).
Participants were randomly assigned to Talcom or Plavix group, and
administered with Talcom or Plavix 75 mg od respectively in combination
with aspirin 100 mg od for 12 months. Primary endpoints were set as levels
of adenosine diphosphate-induced platelet aggregation (PL<inf>ADP</inf>)
on the 5th day and at 1 month after randomization. Patients were
followed-up for 5 years. Bleeding events and major adverse cardiovascular
events (MACE) including cardiac death, non-fatal myocardial infarction,
ischemic stroke, target lesion revascularization (TLR), and cardiogenic
re-admission were recorded. Result(s): On the 5th day and at 1 month
after randomization, the antiplatelet effect of Talcom was non-inferior to
that of Plavix [PL<inf>ADP</inf> (5th day): 30% (22%, 43%) vs. 33% (22%,
44%), p = 0.007; PL<inf>ADP</inf> (1 month): 29% (19%, 43%) vs. 31% (22%,
43%), p = 0.005]. A total of 208 patients completed the follow-up, the
incidences of MACE and bleeding were both comparable, and the MACE-free
survival did not differ between the two groups. However, the expenditure
was 32% lower for Talcom compared to Plavix during the treatment period.
 Conclusion(s): The antiplatelet effect of Talcom is non-inferior to
Plavix, and the clinical efficacy and safety of Talcom and Plavix at 5
years were not significantly different in this study. Copyright ©
2018, Springer-Verlag GmbH Germany, part of Springer Nature.

<91>
Accession Number
618550969
Title
Does mild paravalvular regurgitation post transcatheter aortic valve
implantation affect survival? A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 91 (1) (pp 135-147),
2018. Date of Publication: 01 Jan 2018.
Author
Ando T.; Briasoulis A.; Telila T.; Afonso L.; Grines C.L.; Takagi H.
Institution
(Ando, Telila, Afonso) Division of Cardiology, Wayne State University,
Harper Hospital, Detroit, MI, United States
(Ando, Takagi) ALICE (All-Literature Investigation Cardiovascular
Evidence) group, United States
(Briasoulis) Division of Heart Failure, Mayo Clinic, Rochester, MN, United
States
(Grines) Division of Cardiology, Detroit Medical Center, Detroit, MI,
United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: To assess the impact of post transcatheter aortic valve
implantation (TAVI) mild paravalvular regurgitation (PVR) on mortality.
More than moderate PVR after TAVI has decreased with the advent of
new-generation prosthetic valves. However, mild PVR remains common and its
clinical impact has been inconsistent. We aimed to assess the impact of
mild PVR through meta-analysis. Methods and Results: A systematic
literature search was conducted through PUBMED and EMBSE. Manuscripts that
reported hazard ratio (HR) with 95% confidence interval (CI) for clinical
outcome of interest (all-cause and cardiac mortality) has been included.
Random-effects model was used for calculation of HR. A total of 25
articles including total of 21,018 patients were finally included for
quantitative synthesis (meta-analysis). Our pooled analysis demonstrated
higher all-cause mortality in patients with mild PVR compared to
none/trivial PVR (HR 1.26, 95%CI 1.11-1.43, I2=45%, p < 0.001)
(follow up duration range 6 months to 5 years). Significant heterogeneity
among studies was observed (p for heterogeneity = 0.005). Egger's test
showed no evidence of publication bias. Cardiovascular mortality was
increased in patients with mild PVR compared with none/trivial PVR (HR
1.28, 95%CI 1.05-1.57, I2=8%, p = 0.02) (follow up duration
range 1-3 years). Conclusion(s): Mild PVR was associated with
increased all-cause and cardiovascular mortality after TAVI. Whether
further interventions in mild PVR is of benefit, has yet to be
determined. Copyright © 2017 Wiley Periodicals, Inc.

<92>
Accession Number
617329777
Title
TIcaGrEloR and Absorb bioresorbable vascular scaffold implantation for
recovery of vascular function after successful chronic total occlusion
recanalization (TIGER-BVS trial): Rationale and study design.
Source
Catheterization and Cardiovascular Interventions. 91 (1) (pp 1-6), 2018.
Date of Publication: 01 Jan 2018.
Author
Brugaletta S.; Gomez-Lara J.; Caballero J.; Ortega-Paz L.; Teruel L.;
Jimenez Fernandez M.; Romaguera R.; Alcalde Martinez V.; Nato M.; Molina
Navarro E.; Gomez-Hospital J.-A.; Correa Vilches C.; Joyera M.; Cequier
A.; Sabate M.
Institution
(Brugaletta, Ortega-Paz, Sabate) Cardiovascular Institute, Hospital
Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
(Gomez-Lara, Teruel, Romaguera, Nato, Gomez-Hospital, Cequier) Heart
Disease Institute, Bellvitge Universitari Hospital, Universitari of
Barcelona, IDIBELL, Barcelona, Spain
(Caballero, Jimenez Fernandez, Alcalde Martinez, Molina Navarro, Correa
Vilches) Hospitales Universitarios San Cecilio y Virgen de las Nieves,
Granada, Spain
(Joyera) Hospital Clinic, Barcelona, Spain
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To explore the role of ticagrelor versus clopidogrel in
coronary blood flow normalization immediately after chronic coronary total
occlusion (CTO) recanalization. Background(s): Coronary vascular
function of a CTO immediately after recanalization is demonstrated to be
poor. Method(s): The TIGER BVS is a prospective, double-randomized,
open-label, two parallel-group controlled clinical trial to evaluate
efficacy of ticagrelor versus clopidogrel in improving vascular function
of coronary segment distal to CTO immediately after CTO recanalization. A
total of 50 patients who receive CTO PCI will be randomized 1:1 to receive
ticagrelor versus clopidogrel at least 3 days before the procedure.
Immediately after CTO recanalization with Absorb BVS implantation, a
specific study of vascular function under adenosine infusion will be
performed. Patients will be therefore randomized 1:1 to receive
angiographic follow-up with vascular function and optical coherence
tomography analyses at 1- or 3-year follow-up. This study is registered on
ClinicalTrials.gov with number NCT02211066. Conclusion(s): The TIGER
BVS trial will provide the first randomized comparison between ticagrelor
versus clopidogrel in recovering vascular function in CTO patients. It
will also provide important data on vascular restoration therapy of Absorb
BVS in this scenario. Copyright © 2017 Wiley Periodicals, Inc.

<93>
Accession Number
2001262560
Title
Blinded outcomes and angina assessment of coronary bioresorbable
scaffolds: 30-day and 1-year results from the ABSORB IV randomised trial.
Source
The Lancet. 392 (10157) (pp 1530-1540), 2018. Date of Publication: 27
October - 2 November 2018.
Author
Stone G.W.; Ellis S.G.; Gori T.; Metzger D.C.; Stein B.; Erickson M.;
Torzewski J.; Williams J.; Lawson W.; Broderick T.M.; Kabour A.; Piegari
G.; Cavendish J.; Bertolet B.; Choi J.W.; Marx S.O.; Genereux P.;
Kereiakes D.J.
Institution
(Stone, Marx) NewYork-Presbyterian Hospital/Columbia University Medical
Center, New York, NY, United States
(Stone, Genereux) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Ellis) Cleveland Clinic, Cleveland, OH, United States
(Gori) Kardiologie I University Medical Center and Deutsches Zentrum fur
Herz-Kreislaufforschung, Rhein-Main, Mainz, Germany
(Metzger) Ballad Health Systems CVA Heart Institute, Kingsport, TN, United
States
(Stein) Morton Plant Hospital, Clearwater, FL, United States
(Erickson) Royal Perth Hospital, Perth, WA, Australia
(Torzewski) Kliniken Oberallgau, Immenstadt, Germany
(Williams) Presbyterian Hospital, Charlotte, NC, United States
(Lawson) Stony Brook University Medical Center, Stony Brook, NY, United
States
(Broderick, Kereiakes) The Carl and Edyth Lindner Research Center at The
Christ Hospital, Cincinnati, OH, United States
(Kabour) Mercy St Vincent Medical Center, Toledo, OH, United States
(Piegari) St Joseph Medical Center, Wyomissing, PA, United States
(Cavendish) Scripps Memorial Hospital La Jolla, La Jolla, CA, United
States
(Bertolet) North Mississippi Medical Center, Tupelo, MS, United States
(Choi) Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas,
TX, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Previous studies showed more adverse events with coronary
bioresorbable vascular scaffolds (BVS) than with metallic drug-eluting
stents (DES), although in one randomised trial angina was reduced with
BVS. However, these early studies were unmasked, lesions smaller than
intended for the scaffold were frequently enrolled, implantation technique
was suboptimal, and patients with myocardial infarction, in whom BVS might
be well suited, were excluded. Method(s): In the active-controlled,
blinded, multicentre, randomised ABSORB IV trial, patients with stable
coronary artery disease or acute coronary syndromes aged 18 years or older
were recruited from 147 hospitals in five countries (the USA, Germany,
Australia, Singapore, and Canada). Enrolled patients were randomly
assigned (1:1) to receive polymeric everolimus-eluting BVS (Absorb; Abbott
Vascular, Santa Clara, CA, USA) with optimised implantation technique or
cobalt-chromium everolimus-eluting stents (EES; Xience; Abbott Vascular,
Santa Clara, CA, USA). Randomisation was stratified by diabetic status,
whether patients would have been eligible for enrolment in the previous
ABSORB III trial, and site. Patients and clinical assessors were masked to
randomisation. The primary endpoint was target lesion failure (cardiac
death, target vessel myocardial infarction, or ischaemia-driven target
lesion revascularisation) at 30 days, tested for non-inferiority with a
2.9% margin for the risk difference. Analysis was by intention to treat.
The trial is registered with ClinicalTrials.gov, number NCT02173379, and
is closed to accrual. Finding(s): Between Aug 15, 2014, and March 31,
2017, we screened 18 722 patients for eligibility, 2604 of whom were
enrolled. 1296 patients were assigned to BVS, and 1308 patients were
assigned to EES. Follow-up data at 30 days and 1 year, respectively, were
available for 1288 and 1254 patients with BVS and for 1303 and 1272
patients with EES. Biomarker-positive acute coronary syndromes were
present in 622 (24%) of 2602 patients, and, by angiographic core
laboratory analysis, 78 (3%) of 2893 of lesions were in very small
vessels. Target lesion failure at 30 days occurred in 64 (5.0%) patients
assigned to BVS and 48 (3.7%) patients assigned to EES (difference 1.3%,
upper 97.5% confidence limit 2.89; one-sided
p<inf>non-inferiority</inf>=0.0244). Target lesion failure at 1 year
occurred in 98 (7.8%) patients assigned to BVS and 82 (6.4%) patients
assigned to EES (difference 1.4%, upper 97.5% confidence limit 3.4;
one-sided p<inf>non-inferiority</inf>=0.0006). Angina, adjudicated by a
central events committee at 1 year, occurred in 270 (20.3%) patients
assigned to BVS and 274 (20.5%) patients assigned to EES (difference
-0.3%, 95% CI -3.4% to 2.9%; one-sided p<inf>non-inferiority</inf>=0.0008;
two-sided p<inf>superiority</inf>=0.8603). Device thrombosis within 1 year
occurred in nine (0.7%) patients assigned to BVS and four (0.3%) patients
assigned to EES (p=0.1586). Interpretation(s): Polymeric BVS
implanted with optimised technique in an expanded patient population
resulted in non-inferior 30-day and 1-year rates of target lesion failure
and angina compared with metallic DES. Funding(s): Abbott
Vascular. Copyright © 2018 Elsevier Ltd

<94>
Accession Number
618106868
Title
A systematic review of reported cases of combined transcatheter aortic and
mitral valve interventions.
Source
Catheterization and Cardiovascular Interventions. 91 (1) (pp 124-134),
2018. Date of Publication: 01 Jan 2018.
Author
Ando T.; Takagi H.; Briasoulis A.; Telila T.; Slovut D.P.; Afonso L.;
Grines C.L.; Schreiber T.
Institution
(Ando, Telila, Grines, Schreiber) Division of Cardiology, Wayne State
University, Detroit Medical Center, Detroit, MI, United States
(Takagi) Division of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Briasoulis) Division of Heart Failure, Mayo Clinic, Rochester, MN, United
States
(Slovut) Division of Cardiothoracic Surgery and Cardiology, Montefiore
Medical Center, Bronx, NY, United States
(Afonso) Division of Cardiology, Wayne State University, Detroit, MI,
United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To summarize the published data of combined transcatheter
aortic and mitral valve intervention (CTAMVI). Background(s): CTAMVI,
a combination of either transcatheter aortic valve replacement (TAVR) or
transcatheter aortic valve-in-valve (TAViV) and transcatheter mitral valve
replacement (TMVR), transcatheter mitral valve-in-valve/valve-in-ring
(TMViV/ViR), or percutaneous mitral valve repair (PMVR) is an attractive
alternative in high-surgical risk patients with combined aortic and mitral
valve disease. However, its procedural details and clinical outcomes have
not been well described. Method(s): We performed a systematic review
of all the published articles from PUBMED and EMBASE. Result(s): A
total of 37 studies with 60 patients were included. The indication for
CTAMVI was high or inoperable surgical risk and symptomatic severe aortic
stenosis (92%) or severe aortic regurgitation (8%) combined with moderate
to severe/severe mitral stenosis (30%) or moderate/severe mitral
regurgitation (65%) or both (5%). In majority of the cases, aortic valve
intervention was performed prior to the mitral valve. Mortality rate were
25% for TAVR + TMVR (range 42 days to 10 months), 17% for TAVR + TMViV/ViR
(range 13 days to 6 months), 0% for TAViV + TMViV/ViR (range 6-365 days),
and 15% for TAVR/ViV + PMVR (range 17 days to 419 days). Significant (more
than moderate) paravalvular regurgitation post-procedure was rare.
 Conclusion(s): CTAMVI appears to confer reasonable clinical outcome.
Further large study is warranted to clarify the optimal strategy,
procedural details and clinical outcomes in the future. Copyright
© 2017 Wiley Periodicals, Inc.

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

<96>
[Use Link to view the full text]
Accession Number
626149389
Title
Safety of Carotid Revascularization in Patients With a History of Coronary
Heart Disease.
Source
Stroke. 50 (2) (pp 413-418), 2019. Date of Publication: 01 Feb 2019.
Author
Volkers E.J.; Algra A.; Kappelle L.J.; Becquemin J.-P.; de Borst G.J.;
Brown M.M.; Bulbulia R.; Calvet D.; Eckstein H.-H.; Fraedrich G.; Gregson
J.; Halliday A.; Hendrikse J.; Howard G.; Jansen O.; Roubin G.S.; Bonati
L.H.; Brott T.G.; Mas J.-L.; Ringleb P.A.; Greving J.P.
Institution
(Volkers, Algra, Kappelle) From the Department of Neurology and
Neurosurgery, Brain Center Rudolf Magnus (E.J.V., A.A., University Medical
Center Utrecht, Utrecht University, Utrecht, Netherlands
(Volkers, Algra, Greving) Julius Center for Health Sciences and Primary
Care (E.J.V., A.A., University Medical Center Utrecht, Utrecht University,
Utrecht, Netherlands
(Becquemin) Hopital Prive Paul D'Egine, Champigny
(de Borst) Department of Vascular Surgery (G.J.d.B.), University Medical
Center Utrecht, Utrecht University, Utrecht, Netherlands
(Brown, Bonati) Department of Brain Repair and Rehabilitation, UCL
Institute of Neurology, University College London, United Kingdom (M.M.B.
(Bulbulia) MRC Population Health Research Unit, Clinical Trial Service
Unit and Epidemiological Studies Unit, Nuffield Department of Population
Health, University of Oxford, United Kingdom (R.B.)
(Calvet, Mas) Department of Neurology, Hopital Sainte-Anne, DHU Neurovasc
Sorbonne Paris Cite, INSERM U894, Universite Paris-Descartes, Paris,
Canada
(Eckstein) Department of Vascular and Endovascular Surgery/Vascular
Center, Klinikum rechts der Isar, Technical University Munich, Germany
(H.-H.E.)
(Fraedrich) Department of Vascular Surgery, Medical University of
Innsbruck, Australia
(Gregson) Department of Medical Statistics, London School for Hygiene and
Tropical Medicine, United Kingdom (J.G.)
(Halliday) Nuffield Department of Surgical Sciences, John Radcliffe
Hospital, United Kingdom (A.H.), Oxford, Canada
(Hendrikse) Department of Radiology (J.H.), University Medical Center
Utrecht, Utrecht University, Utrecht, Netherlands
(Howard) Department of Biostatistics, UAB School of Public Health, AL
(G.H.), Birmingham, United Kingdom
(Jansen) Clinic for Radiology and Neuroradiology, UKSH Campus Kiel,
Germany (O.J.)
(Roubin) Cardiovascular Associates of the Southeast, AL (G.S.R.),
Birmingham, United Kingdom
(Bonati) Department of Neurology and Stroke Center, Department of Clinical
Research, University Hospital Basel, University of Basel, Austria
(Brott) Department of Neurology, Mayo Clinic, FL (T.G.B.), Jacksonville,
United States
(Ringleb) Department of Neurology, University of Heidelberg Medical
School, Germany (P.A.R.)
Publisher
NLM (Medline)
Abstract
Background and Purpose- We investigated whether procedural stroke or death
risk of carotid artery stenting (CAS) compared with carotid endarterectomy
(CEA) is different in patients with and without history of coronary heart
disease (CHD) and whether the treatment-specific impact of age differs.
Methods- We combined individual patient data of 4754 patients with
symptomatic carotid stenosis from 4 randomized trials (EVA-3S
[Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe
Carotid Stenosis], SPACE [Stent-Protected Angioplasty Versus Carotid
Endarterectomy], ICSS [International Carotid Stenting Study], and CREST
[Carotid Revascularization Endarterectomy Versus Stenting Trial]).
Procedural risk was defined as any stroke or death <=30 days after
treatment. We compared procedural risk between both treatments with Cox
regression analysis, stratified by history of CHD and age (<70, 70-74,
>=75 years). History of CHD included myocardial infarction, angina, or
coronary revascularization. Results- One thousand two hundred ninety-three
(28%) patients had history of CHD. Procedural stroke or death risk was
higher in patients with history of CHD. Procedural risk in patients
treated with CAS compared with CEA was consistent in patients with history
of CHD (8.3% versus 4.6%; hazard ratio [HR], 1.96; 95% CI, 0.67-5.73) and
in those without (6.9% versus 3.6%; HR, 1.93; 95% CI, 1.40-2.65;
Pinteraction=0.89). In patients with history of CHD, procedural risk was
significantly higher after CAS compared with CEA in patients aged >=75
(CAS-to-CEA HR, 2.78; 95% CI, 1.32-5.85), but not in patients aged <70
(HR, 1.71; 95% CI, 0.79-3.71) and 70 to 74 years (HR, 1.09; 95% CI,
0.45-2.65). In contrast, in patients without history of CHD, procedural
risk after CAS was higher in patients aged 70 to 74 (HR, 3.62; 95% CI,
1.80-7.29) and >=75 years (HR, 2.64; 95% CI, 1.52-4.59), but equal in
patients aged <70 years (HR, 1.05; 95% CI, 0.63-1.73; 3-way
Pinteraction=0.09). Conclusions- History of CHD does not modify procedural
stroke or death risk of CAS compared with CEA. CAS might be as safe as CEA
in patients with history of CHD aged <75 years, whereas for patients
without history of CHD, risk after CAS compared with CEA was only equal in
those aged <70 years.

<97>
Accession Number
626148272
Title
Does the use of an in situ or Y-configuration for bilateral internal
thoracic arteries influence long-term survival, patency or repeat
revascularization in coronary bypass surgery?.
Source
Interactive cardiovascular and thoracic surgery. 28 (2) (pp 222-226),
2019. Date of Publication: 01 Feb 2019.
Author
Kelleher R.; Gimpel D.; McCormack D.J.; El-Gamel A.
Institution
(Kelleher) Department of Medicine, School of Medicine, Queens University
Belfast, Belfast, United Kingdom
(Gimpel, McCormack, El-Gamel) Department of Cardiothoracic Surgery,
Waikato Hospital, Hamilton, New Zealand
(Gimpel, McCormack, El-Gamel) Department of Surgery, University of
Auckland, Auckland, New Zealand
Publisher
NLM (Medline)
Abstract
A best evidence topic was constructed according to a structured protocol.
The question addressed was whether the configuration of bilateral internal
thoracic arteries (BITAs) influences survival, patency or repeat
revascularization in patients undergoing coronary artery bypass grafting.
Five hundred and seventy-one papers were found using the reported
searches, of which 8 represented the best evidence to answer the clinical
question. One systematic review, 4 randomized trials and 3 observational
studies were selected. The authors, date, journal, study type, population,
main outcome measures and results are tabulated. All 4 prospective
randomized trials found no significant difference in graft patency or
mortality when comparing Y-graft and in situ configurations. Three of the
4 randomized trials found no difference in major adverse cardiovascular
and cerebrovascular events or repeat revascularization at follow-up. An
exception was Glineur et al. (Bilateral internal thoracic artery
configuration for coronary artery bypass surgery: a prospective randomized
trial. Circ Cardiovasc Interv 2016;9:7), who found that the
Y-configuration resulted in lower rates of major adverse cardiovascular
and cerebrovascular events. All 3 observational studies reviewed found no
alteration in survival, cardiac events or repeat revascularization between
in situ and Y-graft BITA configurations. One systematic review found
similar outcomes with respect to mortality, cardiac events and repeat
revascularization with in situ and composite BITA. In summary, existing
literature demonstrates no difference in clinical outcomes between
composite and in situ graft configurations. Furthermore, the configuration
of BITA does not affect mortality, graft patency or repeat
revascularization.

<98>
[Use Link to view the full text]
Accession Number
626140781
Title
Cyclosporine before Coronary Artery Bypass Grafting Does Not Prevent
Postoperative Decreases in Renal Function: A Randomized Clinical Trial:
Erratum.
Source
Anesthesiology. 130 (2) (pp 360), 2019. Date of Publication: 01 Feb 2019.
Author
Anonymous
Publisher
NLM (Medline)

<99>
Accession Number
626128441
Title
Hammock Mitral Valve Repair in Infancy: Operative Steps Toward a
Customized Reconstruction After Preoperative Planning.
Source
World Journal for Pediatric and Congenital Hearth Surgery. (no
pagination), 2019. Date of Publication: 2019.
Author
VanLoozen D.; Jensen M.A.; Lutin W.A.; Polimenakos A.C.
Institution
(VanLoozen, Lutin) Department of Pediatric Cardiology, Children's Hospital
of Georgia, Augusta University, Augusta, GA, United States
(Jensen) Department of Medical Illustration, College of Allied Health,
Augusta University, Augusta, GA, United States
(Polimenakos) Department of Pediatric Cardiothoracic Surgery, Children's
Hospital of Georgia, Augusta University, Augusta, GA, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Hammock mitral valve (MV) repair is historically technically difficult
with a guarded prognosis. Surgical experience is extremely limited and
variable outcomes are reported. The perioperative strategy and technical
details of hammock MV repair in an infant who presented with severe mitral
stenosis are described and review of the existing literature was
undertaken. Copyright © The Author(s) 2019.

<100>
Accession Number
2001509347
Title
Causes of death in intermediate-risk patients: The Randomized Surgical
Replacement and Transcatheter Aortic Valve Implantation Trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Amrane H.; Deeb G.M.; Popma J.J.; Yakubov S.J.; Gleason T.G.; Van Mieghem
N.M.; Reardon M.J.; Williams M.R.; Mumtaz M.; Kappetein A.P.; Serruys
P.W.; Tadros P.; Zorn G.L.; Boonstra P.W.; van Boven A.
Institution
(Amrane) Department of Cardiac and Thoracic Surgery, Medisch Centrum
Leeuwarden, Netherlands
(Deeb) Department of Cardiac Surgery, University of Michigan Hospitals,
Ann Arbor, Mich, United States
(Popma) Department of Interventional Cardiology, Beth Israel Deaconess
Medical Center, Harvard Medical School, Boston, Mass, United States
(Yakubov) Department of Interventional Cardiology; Riverside
Methodist-Ohio Health, Columbus, OH, United States
(Gleason) Department of Cardiothoracic Surgery, University of Pittsburgh
Medical Center, Pittsburgh, Pa, United States
(Van Mieghem) Department of Interventional Cardiology, Eramus Medical
Center, Rotterdam, Netherlands
(Reardon) Department of Cardiothoracic Surgery, Houston Methodist DeBakey
Heart & Vascular Center, Houston, Tex, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Examine the causes and timing of death in the Surgical
Replacement and Transcatheter Aortic Valve Implantation intermediate-risk
randomized trial for transcatheter aortic valve replacement (TAVR) and
surgical aortic valve replacement (SAVR). Method(s): Causes of death
were adjudicated by an independent clinical event committee and by
post-hoc hierarchical classification. Causes of death were evaluated and
characteristics and procedural parameters compared between patients who
died and survivors for 3 time periods: early (0-30 days), recovery (31-120
days), and late (121-365 days). Result(s): All-cause mortality at 1
year was 6.5% after TAVR and 6.7% after SAVR. There were no differences in
mortality rates between TAVR and SAVR for any of the 3 time periods. Early
mortality was primarily due to technical, procedure-related problems in
TAVR and due to complications in SAVR. For TAVR and SAVR, most deaths
during recovery were caused by complications. Other causes, including
comorbid conditions, accounted for most late deaths. Conclusion(s):
Mortality rates were similar for patients treated with TAVR or SAVR at any
time period including at 1 year. Early cause of death was more commonly
technical failure after TAVR and due to complications after SAVR. Recovery
phase cause of death was dominated by complications from TAVR and SAVR.
Late cause of death appeared to be independent of the procedure in both
groups. Copyright © 2018 The American Association for Thoracic
Surgery

<101>
Accession Number
626131720
Title
In-hospital outcomes after emergency or prophylactic veno-arterial
extracorporeal membrane oxygenation during transcatheter aortic valve
implantation: a comprehensive review of the literature.
Source
Perfusion (United Kingdom). (no pagination), 2019. Date of Publication:
2019.
Author
Raffa G.M.; Kowalewski M.; Meani P.; Follis F.; Martucci G.; Arcadipane
A.; Pilato M.; Maessen J.; Lorusso R.; Turrisi M.; Gandolfo C.; Montalbano
G.; Cannata S.; Coco V.L.; Armaro A.; Stringi V.; Romano G.; Falletta C.;
Delnoij T.; Gilbers M.; Heuts S.; Schreurs R.; Jiritano F.; Matteucci M.;
Fina D.
Institution
(Raffa, Maessen, Lorusso) Cardio-Thoracic Surgery Department, Heart and
Vascular Centre, Maastricht University Medical Centre, Maastricht,
Netherlands
(Raffa, Follis, Martucci, Arcadipane, Pilato) Department for the Treatment
and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation
and Department of Anaesthesia and Intensive Care, IRCCS-ISMETT (Istituto
Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo,
Italy
(Kowalewski) Clinical Department of Cardiac Surgery, Central Clinical
Hospital of the Ministry of Interior in Warsaw, Poland
(Kowalewski) Cardiothoracic Research Centre, Collegium Medicum, Nicolaus
Copernicus University, Bydgoszcz, Poland
(Meani) Intensive Care Unit, Heart and Vascular Centre, Maastricht
University Medical Centre, Maastricht, Netherlands
(Meani) Cardiology Departments, Heart and Vascular Centre, Maastricht
University Medical Centre, Maastricht, Netherlands
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has been used
to deal with life-threatening complications as well as back-up or active
cardiovascular support during high-risk procedures in patients undergoing
transcatheter aortic valve implantation (TAVI). PubMed and MEDLINE
electronic databases were searched in order to identify studies with
emergency or prophylactic V-A ECMO application in association with TAVI
procedures. From November 2012 to November 2017, 14 relevant studies were
identified that included 5,115 TAVI patients of whom 102 (2%) required V-A
ECMO (22 prophylactically, 66 as an emergency and 14 without a reported
indication). The reason for emergency V-A ECMO institution was detailed in
64 patients: left ventricle free wall rupture (n = 14), haemodynamic
instability (n = 12), ventricular arrhythmias (n = 7), aortic annulus
rupture (n = 6), coronary obstruction (n = 6), low left ventricular output
(ejection fraction <35%) (n = 5), uncontrollable bleeding (n = 5), severe
aortic regurgitation (n = 4), prosthesis embolisation (n = 3), aortic
dissection (n = 1) and respiratory failure (n = 1). Femoral arterial and
vein cannulation was the most common access technique for V-A ECMO
institution. Major bleeding (n = 7) and vascular access complications (n =
7) were reported after ECMO institution. The overall in-hospital survival
was 73% (61% in the emergency vs. 100% in the prophylactic group). V-A
ECMO support should be available at any centre performing TAVI and
provides effective mechanical circulatory support in an emergency setting.
We present an algorithm to aid decisions about prophylactic circulatory
assistance with V-A ECMO and it should form part of the heart team
discussion before a TAVI procedure is undertaken. Copyright © The
Author(s) 2019.

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