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<1>
Accession Number
624533683
Title
A prospective, observational study of cerebrovascular autoregulation and
its association with delirium following cardiac surgery.
Source
Anaesthesia. 74 (1) (pp 33-44), 2019. Date of Publication: January 2019.
Author
Chan B.; Aneman A.
Institution
(Chan) Faculty of Medicine, University of New South Wales, Sydney, NSW,
Australia
(Aneman) Intensive Care Unit, Liverpool Hospital, Liverpool, NSW,
Australia
Publisher
Blackwell Publishing Ltd
Abstract
This aim of this prospective observational cohort study was to evaluate
any association between postoperatively impaired cerebrovascular
autoregulation and the onset of delirium following cardiac surgery.
Previous studies have shown that impaired intra-operative cerebrovascular
autoregulation during cardiopulmonary bypass is associated with delirium.
However, postoperative changes in cerebrovascular autoregulation and its
association with delirium have not been investigated. One-hundred and
eight consecutive adult cardiac surgical patients without baseline
cognitive dysfunction or aphasia were included in the study.
Cerebrovascular autoregulation was assessed by the Pearson correlation
between near-infrared spectroscopy-derived cerebral tissue oxygen
saturation and mean arterial pressure to derive the tissue oximetry index.
Cerebrovascular autoregulation was monitored for a minimum of 90 min on
postoperative day 0 and postoperative day 1. Delirium was assessed
throughout intensive care unit admission using the confusion assessment
method for the intensive care unit. We observed delirium in 24 of the 108
patients studied. The mean (SD) tissue oximetry index was higher in
delirious patients on postoperative day 0 compared with non-delirious
patients; 0.270 (0.199) vs. 0.180 (0.142), p = 0.044, but not on
postoperative day 1; 0.130 (0.160) vs. 0.150 (0.130), p = 0.543. All
patients showed improvement in tissue oximetry index on postoperative day
1 compared with postoperative day 0. Logistic regression analysis
demonstrated tissue oximetry index on postoperative day 0 to be
independently associated with delirium; odds ratio 1.05 (95%CI 1.01-1.10),
p = 0.043. In conclusion, we found an association between impaired
cerebrovascular autoregulation, measured by near-infrared spectroscopy,
and delirium in the early postoperative period. Copyright © 2018
Association of Anaesthetists

<2>
[Use Link to view the full text]
Accession Number
617003416
Title
Chest Wall Resection for Recurrent Breast Cancer in the Modern Era.
Source
Annals of Surgery. 267 (4) (pp 646-655), 2018. Date of Publication: 01 Apr
2018.
Author
Wakeam E.; Acuna S.A.; Keshavjee S.
Institution
(Wakeam, Keshavjee) Division of Thoracic Surgery, Toronto General
Hospital, University Health Network, Department of Surgery, University of
Toronto, 200 Elizabeth St, 9N-946, Toronto, ON M5G 2C4, Canada
(Acuna) Institute of Health Policy, Management and Evaluation, University
of Toronto, Toronto, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: To review the literature on chest wall resection for recurrent
breast cancer and evaluate overall survival (OS) and quality-of-life (QOL)
outcomes. Background(s): Full-thickness chest wall resection for
recurrent breast cancer is controversial, as historically these
recurrences have been thought of as a harbinger of systemic disease.
 Method(s): A systematic search in MEDLINE, EMBASE, and Cochrane
CENTRAL identified 48 eligible studies, all retrospective, accounting for
1305 patients. The review is reported following Preferred Reporting Items
for Systematic Reviews and Meta-Analyses guidelines. Primary end points
were patient-centered QOL outcomes and OS; secondary outcomes included
disease-free survival (DFS) and 30-day morbidity. Risk of bias was
assessed using the Methodological Index for Non-Randomized Studies
instrument and the Oxford Centre for Evidence-Based Medicine's levels of
evidence tool. Random-effects meta-analysis was used to create pooled
estimates. Meta-regressions and sensitivity analyses were used to explore
study heterogeneity by age, year of publication, risk of bias, and
surgical intent (curative vs palliative). Result(s): Studies
consistently reported excellent OS and DFS in properly selected patients.
Pooled estimates for 5-year OS in all studies and those from the past 15
years were 40.8% [95% confidence interval (CI) 35.2-46.7) and 43.1% (95%
CI 35.8-50.7), whereas pooled 5-year DFS was 27.1% (95% CI 16.6-41.0).
Eight studies reported excellent outcomes related to QOL. Mortality was
consistently low (<1%) and 30-day pooled morbidity was 20.2% (95% CI
15.3%-26.3%). Study quality varied, and risk of selection bias in included
studies was high. Conclusion(s): Full-thickness chest wall resection
can be performed with excellent survival and low morbidity. Few studies
report on QOL; prospective studies should focus on patient-centered
outcomes in this population. Copyright © 2017 Wolters Kluwer
Health, Inc. All rights reserved.

<3>
Accession Number
2001715176
Title
ST-Elevation Myocardial Infarction Associated With Infective Endocarditis.
Source
American Journal of Cardiology. 123 (8) (pp 1239-1243), 2019. Date of
Publication: 15 April 2019.
Author
Nazir S.; Elgin E.; Loynd R.; Zaman M.; Donato A.
Institution
(Nazir, Loynd) Department of Internal Medicine, Reading Hospital-Tower
Health System, West Reading, Pennsylvania, United Kingdom
(Elgin) Division of Cardiology, Reading Hospital-Tower Health System, West
Reading, Pennsylvania, United Kingdom
(Zaman) Division of Pulmonary and Critical Care, Reading Hospital-Tower
Health System, West Reading, Pennsylvania, United Kingdom
(Donato) Sidney Kimmel Medical College at Thomas Jefferson University,
Philadelphia, PA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
ST-elevation myocardial infarction (STEMI) as a complication of infective
endocarditis (IE) is a rarely reported entity. No clear guidelines exist
with regards to the management of this medical emergency. We sought to
systematically review the clinical presentation and management of this
condition. We searched relevant articles on STEMI associated with IE and
extracted data on demographic variables, key clinical characteristics upon
presentation, treatment strategies, and clinical outcomes. We identified
100 patients from 95 articles. The mean age at presentation was 53 +/- 17
years with male preponderance (n = 63, 63%, p = 0.01). Most patients (63
of 100, 63%) presented with STEMI as their first manifestation of IE, with
others occurring at 15 +/- 17 days after diagnosis of IE. Findings that
suggested possible septic emboli were not consistently present, including
history of prosthetic valve placement (15%), presence of other embolic
disease (27%), fever (42%) increased leukocyte count (80%), and presence
of murmur (88%). Atherosclerotic disease was absent in 95% on cardiac
catheterization. Eleven patients receiving tissue plasminogen activator
fared poorly, with 9 major bleeds; balloon angioplasty was successful in
56% (9 of 16 cases), aspiration thombectomy in 68% (21 of 31 cases), and
coronary stenting in 81% (14 of 16 cases). The 30-day mortality was 43%.
In conclusion, patients with STEMI in the face of recent IE, new
precordial murmur, fever, increased leukocyte count or other embolic
events, septic emboli should be considered as a cause for STEMI. Best
practices for management are not known, but thrombolytics appear to carry
significant bleeding and embolic risks. Copyright © 2019 Elsevier
Inc.

<4>
Accession Number
626360116
Title
Intravascular ultrasound guidance reduces cardiac death and coronary
revascularization in patients undergoing drug-eluting stent implantation:
results from a meta-analysis of 9 randomized trials and 4724 patients.
Source
International Journal of Cardiovascular Imaging. 35 (2) (pp 239-247),
2019. Date of Publication: 15 Feb 2019.
Author
Gao X.-F.; Wang Z.-M.; Wang F.; Gu Y.; Ge Z.; Kong X.-Q.; Zuo G.-F.; Zhang
J.-J.; Chen S.-L.
Institution
(Gao, Wang, Wang, Gu, Ge, Kong, Zuo, Zhang, Chen) Department of
Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68
Changle Road, Nanjing 210006, China
(Gao, Zhang, Chen) Department of Cardiology, Nanjing Heart Centre,
Nanjing, China
Publisher
Springer Netherlands (E-mail: rbk@louisiana.edu)
Abstract
Intravascular ultrasound (IVUS) guidance is not routinely performed in
real-word clinical practice partly because the benefit of IVUS guidance is
not well established. This updated meta-analysis aims to compare
IVUS-guided and angiography-guided drug-eluting stent (DES) implantation,
simultaneously stressing the value of an optimal IVUS-defined procedure.
Medline, Scopus, Google Scholar, and Cochrane Controlled Trials Registry
were searched for the randomized trials comparing IVUS-guided and
angiography-guided DES implantation. Nine eligible randomized trials
including 4,724 patients were identified. At a mean follow-up of 16.7
months, IVUS guidance was associated with a significant lower risk of
major adverse cardiovascular events (MACE) [5.4% vs. 9.0%; relative risks
(RR): 0.61, 95% confident interval (CI) 0.49-0.74, p < 0.001], cardiac
death (0.6% vs. 1.2%; RR: 0.49, 95% CI 0.26-0.92, p = 0.03), target vessel
revascularization (3.5% vs.6.1%; RR: 0.58, 95% CI 0.42-0.80, p = 0.001),
target lesion revascularization (3.1% vs. 5.2%; RR: 0.59, 95% CI
0.44-0.80, p = 0.001), and definite/probable stent thrombosis (0.5%
vs.1.1%; RR: 0.45, 95% CI 0.23-0.87, p = 0.02) compared with angiography
guidance. No significant differences in all cause death and myocardial
infarction were noted between the two groups. Subgroup analysis showed
that patients who met the optimal criteria had a lower rate of MACE than
those with IVUS-defined suboptimal procedure (RR: 0.33, 95% CI 0.06-0.60,
p = 0.02). The present meta-analysis with the largest sample size to date
demonstrates that IVUS-guided DES implantation significantly reduces
cardiac death, coronary revascularization and stent thrombosis,
particularly for patients with IVUS-defined optimal procedures compared
with angiography guidance. Copyright © 2019, Springer Nature B.V.

<5>
Accession Number
620707338
Title
Prognostic Value of Right Ventricular Dysfunction on Clinical Outcomes
After Transcatheter Aortic Valve Replacement.
Source
JACC: Cardiovascular Imaging. 12 (4) (pp 577-587), 2019. Date of
Publication: April 2019.
Author
Asami M.; Stortecky S.; Praz F.; Lanz J.; Raber L.; Franzone A.; Piccolo
R.; Siontis G.C.M.; Heg D.; Valgimigli M.; Wenaweser P.; Roost E.;
Windecker S.; Pilgrim T.
Institution
(Asami, Stortecky, Praz, Lanz, Raber, Franzone, Piccolo, Siontis,
Valgimigli, Wenaweser, Windecker, Pilgrim) Department of Cardiology, Swiss
Cardiovascular Center, Bern University Hospital, Bern, Switzerland
(Heg) Institute of Social and Preventive Medicine and Clinical Trials
Unit, University of Bern, Bern, Switzerland
(Roost) Department of Cardiac Surgery, Swiss Cardiovascular Center, Bern
University Hospital, Bern, Switzerland
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The purpose of this study was to investigate the association
between right ventricular dysfunction (RVD) and cardiovascular death after
transcatheter aortic valve replacement (TAVR). Background(s): There
is conflicting evidence on the effect of RVD on clinical outcomes after
TAVR. Method(s): A total of 1,116 TAVR patients (age 82 +/- 6 years;
51% female) who were consecutively enrolled into a prospective registry
underwent detailed pre-operative assessment of right ventricular (RV)
function and were dichotomized into 2 groups for the purposes of the
present retrospective analysis. RVD was assessed using fractional area
change (<35%), tricuspid annular plane systolic excursion (<1.7 cm), and
systolic movement of the RV lateral wall by tissue Doppler imaging (<9.5
cm/s). RVD was found in 325 (29.1%) patients. The primary outcome was
cardiovascular death at 1 year. Result(s): After adjustment for
comorbidities, patients with RVD had a higher risk of cardiovascular death
at 1 year compared with patients with normal RV function (20.1% vs. 7.1%;
adjusted hazard ratio [HR<inf>adj</inf>]: 2.94; 95% confidence interval
[CI]: 2.02 to 4.27; p < 0.001). The difference emerged within the first 30
days after TAVR (9.0% vs. 2.2%; HR<inf>adj</inf>: 4.62; 95% CI: 2.51 to
8.50; p < 0.001). Normalization of RV function after TAVR was found in
57.4% of patients with RVD at baseline. There was a gradient of increasing
risk of cardiovascular death among patients with normal RV function, RVD
recovery (HR<inf>adj</inf>: 2.16; 95% CI: 1.16 to 4.02), new RVD
(HR<inf>adj</inf>: 3.93; 95% CI: 2.09 to 7.39), and maintained RVD
(HR<inf>adj</inf>: 8.74; 95% CI: 5.33 to 14.3), respectively.
 Conclusion(s): RVD at baseline was associated with a more than 2-fold
increased risk of cardiovascular death at 1 year after TAVR, with a
gradient of risk according to RVD recovery. (Swiss TAVI Registry;
NCT01368250) Copyright © 2019 American College of Cardiology
Foundation

<6>
Accession Number
626885873
Title
High-energy nutrition in paediatric cardiac critical care patients: a
randomized controlled trial.
Source
Nursing in critical care. 24 (2) (pp 97-102), 2019. Date of Publication:
01 Mar 2019.
Author
Zhang H.; Gu Y.; Mi Y.; Jin Y.; Fu W.; Latour J.M.
Institution
(Zhang, Mi, Jin, Fu) Cardiac Intensive Care Unit, Children's Hospital of
Fudan University, Shanghai, China
(Gu, Latour) Nursing Department, Children's Hospital of Fudan University,
Shanghai, China
(Latour) Faculty of Health and Human Sciences, University of Plymouth,
Drake Circus, Plymouth, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: Previous studies have shown that feeding a high-energy formula
(HF) to infants after cardiac surgery increases energy intake, with fewer
side effects on cardiopulmonary function. However, impacts on weight gain
and gastrointestinal function remain unclear. AIMS AND OBJECTIVES: To
determine the impact of HF compared with standard formula on weight gain
and gastrointestinal tolerance in postoperative infants with congenital
heart disease. DESIGN: This was a randomized controlled trial.
 METHOD(S): The setting of the study was at a 20-bed cardiac intensive
care unit at a tertiary children's hospital in China. Study population
included infants <1 year of age who underwent cardiac surgery and were
allocated to the intervention group (n=32) or control group (n=32). The
intervention group received HF (100kcal/100mL), and the control group
received standard formula (67kcal/100mL) for 7 days during the stabilized
postoperative period at the cardiac intensive care unit. Primary outcomes
were weight gain and gastrointestinal intolerance. Secondary outcomes were
energy intake and standard intensive care characteristics. RESULT(S):
Infants who received HF (n=30) showed less weight loss than those who
received standard formula (n=29); -16g [95% confidence interval (CI): -74
to 42] versus -181g (95% CI: -264 to -99), P=0.001. The evaluation of
gastrointestinal intolerance showed that the intervention group had
several side effects, such as abdominal distension (n=1), gastric
retention (n=2) and diarrhoea (n=1), while the control group had no
problems. Enteral energy intake in the intervention group was higher than
the control group from day three. CONCLUSION(S): Infants after
cardiac surgery fed with HF gained more weight but had increased feeding
intolerance. However, the feeding intolerance symptoms could be relieved
by medication and did not affect feeding advancement. RELEVANCE TO
CLINICAL PRACTICE: Paediatric intensive care clinicians should consider
gradually increasing the energy density of the formula during feeding and
assess feeding intolerance signs in some children with malnutrition after
cardiac surgery. Copyright © 2018 British Association of Critical
Care Nurses.

<7>
Accession Number
626887784
Title
Reversal of DIRECT-ACTING Oral Anticoagulants in Urgent Surgery of the
Proximal Aorta: case Series and Review of the literature.
Source
Current pharmaceutical design. 24 (38) (pp 4534-4539), 2018. Date of
Publication: 2018.
Author
Zimmermann E.; Ameer F.; Worku B.; Avgerinos D.
Institution
(Zimmermann) Department of Surgery, NewYork-Presbyterian/Queens, Flushing,
NY, United States
(Ameer) Department of Cardiology, NewYork-Presbyterian/ Queens, Flushing,
NY, United States
(Worku, Avgerinos) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, NewYork Presbyterian, New York, NY, United States
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Proximal aorta interventions impose significant bleeding
risk. Patients on concomitant anticoagulation regimens compound the risk
of bleeding in any surgery, but especially cardiothoracic interventions.
The employment of direct-acting oral anticoagulants (DOAC), namely those
that target clotting factors II or X, has expanded at a precipitous rate
over the last decade. The emergence of their reversal agents has followed
slowly, leaving clinicians with management dilemmas in urgent surgery. We
discuss current reversal strategies based on the available published data
and our experience with proximal aortic surgery in patients taking DOACs.
LITERATURE SEARCH: We performed a review of literature and present three
cases from our experience to offer insight into management strategies that
have been historically successful. A review of literature was conducted
via PubMed with the following search string: (NOAC or DOAC or TSOAC) and
(aorta or aortic or (Stanford and type and a)). CASE PRESENTATION: We
present three case presentations that illustrate the importance of DOAC
identification and offer management strategies in mitigating associated
bleeding risks in urgent or emergent surgeries. CONCLUSION(S):
Treatment teams should be aware of the technical limitations of
identifying and reversing DOACs. In view of the tendency toward publishing
positive outcomes, more scientific rigor is required in the area of
emergency DOAC reversal strategies. Copyright© Bentham Science
Publishers; For any queries, please email at epub@benthamscience.net.

<8>
Accession Number
626903456
Title
Safety assessment of omeprazole use: a review.
Source
Sao Paulo medical journal = Revista paulista de medicina. 136 (6) (pp
557-570), 2018. Date of Publication: 01 Nov 2018.
Author
Forgerini M.; Mieli S.; Mastroianni P.C.
Institution
(Forgerini) BSc. Pharmacist and Master's Student in the Postgraduate
Program on Pharmaceutical Sciences, Universidade Estadual Paulista
(UNESP), Araraquara (SP), Brazil
(Mieli) Undergraduate Pharmacy Student, Universidade Estadual Paulista
(UNESP), Araraquara (SP), Brazil
(Mastroianni) Department of Drugs and Medicines, Universidade Estadual
Paulista (UNESP), Araraquara (SP), Brazil
Publisher
NLM (Medline)
Abstract
BACKGROUND: Risks regarding hospital admission due to adverse drug
reactions and drug interactions from use of omeprazole have been reported.
The question guiding the present review was "Which adverse events occur in
patients using omeprazole in a Food and Drug Administration-approved
and/or off-label manner?" It was also proposed to evaluate the safety of
use of omeprazole. DESIGN AND SETTING: Qualitative narrative review with
critical evaluation, in a public university. METHOD(S): The PubMed,
SCOPUS, LILACS, SciELO, EMBASE and EBSCO databases were searched on July
31, 2018. Studies evaluating adverse events were screened. RESULT(S):
72 articles were included, among which 58 reported on adverse drug events
(47, adverse drug reactions; 5, drug interactions; and 6, situations of
ineffectiveness). 28 adverse drug reactions not described in compendia and
drug leaflets were described in these studies: myocardial infarction (6);
stroke (2); spontaneous abortion (1); proliferative changes (1); chills
(1); heart failure (1); thrombosis (2); and dementia (1), among others.
Severe adverse reactions, for instance cardiac problems, Steven-Johnson
syndrome and proliferative changes, were identified. The antiplatelet
effects of drugs such as clopidogrel, in patients who underwent
heart-related surgery, increased the risk of developing cardiac problems,
such as cardiovascular death, myocardial infarction and stroke. In newly
transplanted patients, decreased absorption of mycophenolate mofetil
occurred, thus leading to rejection of transplanted organs.
 CONCLUSION(S): Use of omeprazole should be monitored primarily in
patients with heart disorders using antiplatelet agents concomitantly, and
in newly transplanted patients using mycophenolic acid, in order to avoid
serious adverse reactions.

<9>
Accession Number
626892025
Title
Guidelines for enhanced recovery after lung surgery: Recommendations of
the Enhanced Recovery after Surgery (ERAS) Society and the
European Society of Thoracic Surgeons (ESTS).
Source
European Journal of Cardio-thoracic Surgery. 55 (1) (pp 91-115), 2019.
Date of Publication: 01 Jan 2019.
Author
Batchelor T.J.P.; Rasburn N.J.; Abdelnour-Berchtold E.; Brunelli A.;
Cerfolio R.J.; Gonzalez M.; Ljungqvist O.; Petersen R.H.; Popescu W.M.;
Slinger P.D.; Naidu B.
Institution
(Batchelor) Department of Thoracic Surgery, University Hospitals Bristol
NHS Foundation Trust, Upper Maudlin Street, Bristol BS28HW, United Kingdom
(Rasburn) Department of Anaesthesia, University Hospitals Bristol NHS
Foundation Trust, Bristol, United Kingdom
(Abdelnour-Berchtold, Gonzalez) Division of Thoracic Surgery, Centre
Hospitalier Universitaire Vaudois, Lausanne, Switzerland
(Brunelli) Department of Thoracic Surgery, St. James's University
Hospital, Leeds, United Kingdom
(Cerfolio) Department of Cardiothoracic Surgery, New York University
Langone Health, New York, NY, United States
(Ljungqvist) Department of Surgery, Faculty of Medicine and Health, Orebro
University, Orebro, Sweden
(Petersen) Department of Thoracic Surgery, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Popescu) Department of Anesthesiology, Yale University School of
Medicine, New Haven, CT, United States
(Slinger) Department of Anesthesia, University Health Network, Toronto
General Hospital, Toronto, ON, Canada
(Naidu) Department of Thoracic Surgery, Heart of England NHS Foundation
Trust, Birmingham, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Enhanced recovery after surgery is well established in specialties such as
colorectal surgery. It is achieved through the introduction of multiple
evidence-based perioperative measures that aim to diminish postoperative
organ dysfunction while facilitating recovery. This review aims to present
consensus recommendations for the optimal perioperative management of
patients undergoing thoracic surgery (principally lung resection). A
systematic review of meta-analyses, randomized controlled trials, large
non-randomized studies and reviews was conducted for each protocol
element. Smaller prospective and retrospective cohort studies were
considered only when higher-level evidence was unavailable. The quality of
the evidence base was graded by the authors and used to form consensus
recommendations for each topic. Development of these recommendations was
endorsed by the Enhanced Recovery after Surgery Society and the European
Society for Thoracic Surgery. Recommendations were developed for a total
of 45 enhanced recovery items covering topics related to preadmission,
admission, intraoperative care and postoperative care. Most are based on
good-quality studies. In some instances, good-quality data were not
available, and subsequent recommendations are generic or based on data
extrapolated from other specialties. In other cases, no recommendation can
currently be made because either equipoise exists or there is a lack of
available evidence. Recommendations are based not only on the quality of
the evidence but also on the balance between desirable and undesirable
effects. Key recommendations include preoperative counselling, nutritional
screening, smoking cessation, prehabilitation for high-risk patients,
avoidance of fasting, carbohydrate loading, avoidance of preoperative
sedatives, venous thromboembolism prophylaxis, prevention of hypothermia,
short-acting anaesthetics to facilitate early emergence, regional
anaesthesia, nausea and vomiting control, opioid-sparing analgesia,
euvolemic fluid management, minimally invasive surgery, early chest drain
removal, avoidance of urinary catheters and early mobilization after
surgery. These guidelines outline recommendations for the perioperative
management of patients undergoing lung surgery based on the best available
evidence. As the recommendation grade for most of the elements is strong,
the use of a systematic perioperative care pathway has the potential to
improve outcomes after surgery. Copyright © 2018 The Author(s).
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<10>
Accession Number
626853169
Title
Radial Artery Versus Saphenous Vein Grafts in Coronary Artery Bypass
Surgery: a Literature Review.
Source
Current Cardiology Reports. 21 (5) (no pagination), 2019. Article Number:
36. Date of Publication: 01 May 2019.
Author
Virk H.U.H.; Lakhter V.; Ahmed M.; O' Murchu B.; Chatterjee S.
Institution
(Virk) Department of Cardiovascular Diseases, Einstein healthcare Network,
Philadelphia, PA, United States
(Lakhter) Division of Cardiology, Department of Medicine, Massachusetts
General Hospital, Boston, MA, United States
(Ahmed) Department of Cardiology, Ochsner Health system, New Orleans, LA,
United States
(O' Murchu) Temple Heart and Vascular Institute, Philadelphia, PA, United
States
(Chatterjee) Division of Cardiology, Hoffman Heart Institute, St Francis
Hospital, Hartford, CT, United States
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: Coronary artery bypass grafting is a preferred strategy
for complete coronary revascularization in patients who have multi-vessel
coronary artery disease, left ventricular dysfunction, and/or diabetes.
Both arterial (internal thoracic artery/radial artery) and venous grafts
are utilized to bypass the obstruction in native vessels. Despite having
radial arterial grafts as a preferred second conduit for bypass, venous
grafts are more commonly used. Recent Findings: We review the existing
literature and report the preferred conduit based on a recently published
meta-analysis of 6 randomized controlled trials. The analysis concluded
that radial artery grafts are associated with fewer adverse cardiac events
and better graft patency at 5 years of follow-up. Summary: Although
saphenous vein grafting is the most commonly used conduit in addition to
ITA, current data suggests that total arterial bypass (using RA conduit in
addition to ITA) may be the better strategy. Both the US and European
consensus guidelines advocate for the use of arterial over SV grafting for
most patients. Copyright © 2019, Springer Science+Business Media,
LLC, part of Springer Nature.

<11>
Accession Number
626893088
Title
Effectiveness of Melatonin for the Prevention of Intensive Care Unit
Delirium.
Source
Pharmacotherapy. 39 (3) (pp 280-287), 2019. Date of Publication: March
2019.
Author
Baumgartner L.; Lam K.; Lai J.; Barnett M.; Thompson A.; Gross K.; Morris
A.
Institution
(Baumgartner, Lam, Lai, Barnett) Touro University California College of
Pharmacy, Vallejo, CA, United States
(Baumgartner, Thompson, Gross, Morris) University of California San
Francisco Medical Center, San Francisco, CA, United States
Publisher
Pharmacotherapy Publications Inc.
Abstract
Study Objective: Intensive care unit (ICU) delirium is an acute brain
dysfunction that has been associated with increased mortality, prolonged
ICU and hospital lengths of stay, and development of post-ICU cognitive
impairment. Melatonin may help to restore sleep and reduce the occurrence
of ICU delirium. The purpose of this study was to evaluate the
effectiveness of melatonin for the prevention of ICU delirium in
critically ill adults. Design(s): Retrospective, observational cohort
study. Setting(s): Large academic medical center. Patient(s): A
total of 232 adults were included who were admitted to the
medical-surgical or cardiac ICUs between 2013 and 2017 who had a negative
Confusion Assessment Method for the ICU (CAM-ICU). Of those, patients who
received melatonin for at least 48 hours were included in the melatonin
group (n=117). Patients were included in the control group if they were
admitted to the ICU for at least 4 days (average time of melatonin
initiation) and did not receive melatonin or antipsychotics within the
first 4 days of their ICU stay (n=115). Measurements and Main
Results: The primary outcome was development of delirium, which was
assessed by using the CAM-ICU twice daily by nursing staff. The
development of delirium was significantly lower in the melatonin group: 9
(7.7%) versus 28 (24.3%) patients (p = 0.001). This finding remained
significant in multivariate logistic models controlling for age, sex,
history of hypertension, need for emergent surgery, Acute Physiology and
Chronic Health Evaluation II score, mechanical ventilation, ICU length of
stay, dexmedetomidine use, and benzodiazepine use. For those patients who
developed delirium, patients in the control group had, on average, 20.9
delirium-free days without coma in 28 days compared with 19.9 days in the
melatonin group (p = 0.72). In the melatonin group, melatonin was used for
a mean +/- SD of 6.3 +/- 7.9 days, with a median dose of 3.5 mg/night
(range: 1-10 mg). Conclusion(s): The development of ICU delirium was
significantly lower in the melatonin group compared with that in the
control group. To our knowledge, this is one of the only studies that has
examined the use of melatonin for the prevention of ICU delirium.
Melatonin may be a promising agent for the prevention of ICU delirium;
however, a randomized study is needed to further validate its
efficacy. Copyright © 2019 Pharmacotherapy Publications, Inc.

<12>
Accession Number
626882745
Title
Comparing everolimus-based immunosuppression with reduction or withdrawal
of calcineurin inhibitor reduction from six months after heart
transplantation: the randomized MANDELA study.
Source
American journal of transplantation : official journal of the American
Society of Transplantation and the American Society of Transplant
Surgeons. (no pagination), 2019. Date of Publication: 18 Mar 2019.
Author
Barten M.J.; Hirt S.W.; Garbade J.; Bara C.; Doesch A.O.; Knosalla C.;
Grinninger C.; Stypmann J.; Sieder C.; Lehmkuhl H.B.; Porstner M.; Schulz
U.
Institution
(Barten) Department of Cardiovascular Surgery, University Heart Center
Hamburg, Martinistrasse 52, Hamburg 20246, Germany
(Hirt) Department of Cardiothoracic Surgery, University Hospital
Regensburg, Franz-Josef-Straus-Allee 11, Regensburg 93053, Germany
(Garbade, Lehmkuhl) University Department of Cardiac Surgery, Leipzig
Heart Center, Germany
(Bara) Division of Cardiovascular, Thoracic and Transplantation Surgery,
Hannover Medical School, Carl-Neuberg-Strase 1, Hannover 30625, Germany
(Doesch) Department of Cardiology, University Hospital Heidelberg, Im
Neuenheimer Feld 400, Heidelberg 69120, Germany
(Knosalla) Department of Cardiothoracic and Vascular Surgery, German Heart
Institute Berlin, DZHK (German Centre for Cardiovascular Research),
partner site Berlin ,Augustenburger Platz 1, Berlin 13353, Germany
(Grinninger) Department of Cardiac Surgery, Munich Transplantation Center,
Klinikum Groshadern LMU, Marchioninistrase 15, Munich 81377, Germany
(Stypmann) Department of Cardiovascular Medicine, Division of Cardiology,
University Hospital Munster, Albert-Schweitzer-Strase 33, Munster 48149,
Germany
(Sieder, Porstner) Novartis Pharma GmbH ,Roonstrase 25, Nuremberg 90429,
Germany
(Schulz) Department of Thoracic and Cardiovascular Surgery, Heart and
Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, Bad
Oeynhausen 32545, Germany
Publisher
NLM (Medline)
Abstract
In the 12-month, open-label MANDELA study, patients were randomized at
month 6 after heart transplantation to (i) convert to calcineurin
inhibitor (CNI)-free immunosuppression with everolimus (EVR), mycophenolic
acid and steroids (CNI-free, n=71), or to (ii) continue reduced-exposure
CNI, with EVR and steroids (EVR/redCNI, n=74). Tacrolimus was administered
in 48.8% of EVR/redCNI patients and 52.6% of CNI-free patients at
radomization. Both strategies improved and stabilized renal function based
on the primary endpoint (estimated GFR at month 18 post-transplant
post-randomization) with superiority of the CNI-free group versus
EVR/redCNI : mean 64.1mL/min/1.73m2 versus 52.9mL/min/1.73m2 ; difference
+11.3mL/min/1.73m2 (p<0.001). By month 18, estimated GFR had increased by
>=10mL/min/1.732 in 31.8% and 55.2% of EVR/redCNI and CNI-free patients,
respectively, and by >=25 mL/min/1.73m2 in 4.5% and 20.9%. Rates of
biopsy-proven acute rejection (BPAR) were 6.8% and 21.1%; all cases were
without hemodynamic compromise. BPAR was less frequent with EVR/redCNI
versus the CNI-free regimen (p=0.015); 6/15 episodes in CNI-free patients
occurred with EVR concentration <5ng/mL. Rates of adverse events and
associated discontinuations were comparable EVR/redCNI from month 6
achieved stable renal function with infrequent BPAR. One-year renal
function can be improved by early conversion to EVR-based CNI-free therapy
but requires close EVR monitoring. This article is protected by copyright.
All rights reserved.

<13>
Accession Number
626882081
Title
Graft Patency after Robotically Assisted Coronary Artery Bypass Surgery.
Source
Innovations (Philadelphia, Pa.). (pp 1556984519836896), 2019. Date of
Publication: 18 Mar 2019.
Author
Kitahara H.; Nisivaco S.; Balkhy H.H.
Institution
(Kitahara, Nisivaco, Balkhy) University of Chicago Medicine, IL, United
States
Publisher
NLM (Medline)
Abstract
OBJECTIVE: With advances in robotic instrumentation and technology, both
robotically assisted minimally invasive direct coronary artery bypass
(RMIDCAB) and totally endoscopic coronary artery bypass (TECAB) have been
widely used over the past 20 years. Graft patency is the most important
outcome in coronary bypass surgery and is associated with long-term
prognosis. In this article we reviewed all experts' studies in the field
of robotic assisted coronary artery bypass and investigated graft patency
in patients who underwent RMIDCAB or TECAB. METHOD(S): We performed a
literature search in PubMed from 1999 to 2018 using the terms "Robotic"
and "Coronary bypass" and/or "Minimally invasive" and/or "Totally
endoscopic." Of the articles found, studies investigating graft patency
were specifically selected. RESULT(S): In 33 articles, a total of
4,000 patients underwent robotic assisted coronary artery bypass surgery
either by a RMIDCAB (2,396) or by a TECAB (1,604) approach. The graft
patency was assessed by invasive angiography or computed tomographic
angiography in all studies. The mean graft patency at early (<1 month),
midterm (<5 years), and long-term (>5 years) follow-up was 97.7%, 96.1%,
and 93.2% in RMIDCAB and 98.8%, 95.8%, and 93.6% in TECAB, respectively.
 CONCLUSION(S): The graft patency of robotic assisted coronary artery
bypass was equivalent to reported outcomes of the conventional approach.
These results should encourage the adoption of robotic approaches in
coronary bypass surgery.

<14>
Accession Number
626881552
Title
Percutaneous left ventricular assist device support during ablation of
ventricular tachycardia: A meta-analysis of current evidence.
Source
Journal of cardiovascular electrophysiology. (no pagination), 2019. Date
of Publication: 07 Mar 2019.
Author
Luni F.K.; Zungsontiporn N.; Farid T.; Malik S.A.; Khan S.; Daniels J.; Wu
R.; Link M.S.; Joglar J.A.
Institution
(Luni, Zungsontiporn, Daniels, Wu, Link, Joglar) Department of Cardiology,
UT Southwestern Medical Center, Dallas, TX, United States
(Farid, Khan) Department of Cardiology, University of Louisville,
Louisville, KY, United States
(Malik) Department of Neurology, University of Michigan, Ann Arbor, MI,
United States
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Catheter ablation of ventricular tachycardia (VT) can be an
effective therapy to reduce VT burden, but often it is limited by the
potential for hemodynamic instability. Percutaneous left ventricular
assist devices (pLVADs) have been used to maintain hemodynamic support
during VT ablation but the evidence regarding its clinical impact has been
inconclusive. METHODS AND RESULTS: We sought to assess the clinical impact
of pLVAD when used in VT ablation by conducting a meta-analysis of the
current evidence. We searched Pubmed and found nine observational studies
that compared clinical outcomes of VT ablation in patients with pLVAD
support to controls with no pLVAD support. The pooled data did not show a
significant difference in mortality between both groups, nor a difference
in acute procedural success or in recurrence of VT. There was also no
difference in the number of patients receiving a cardiac transplant or
being enrolled in the transplant list. Although there was no difference in
the ablation time between the groups, patients in the pLVAD group had a
longer total procedural time and more procedure-related adverse effects.
 CONCLUSION(S): This meta-analysis did not show clinical benefits from
using pLVAD support during VT ablation, whereas it was associated with
longer procedure times and more complications. This study was, however,
limited by the observational nature of the data. In view of these data,
the risk and benefit of pLVAD support during VT ablation should be
considered on an individual basis. Copyright © 2019 Wiley
Periodicals, Inc.

<15>
Accession Number
626880950
Title
Feasibility of planning coronary artery bypass grafting based only on
coronary computed tomography angiography and CT-derived fractional flow
reserve: a pilot survey of the surgeons involved in the randomized SYNTAX
III Revolution trial.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2019.
Date of Publication: 18 Mar 2019.
Author
Sonck J.; Miyazaki Y.; Collet C.; Onuma Y.; Asano T.; Takahashi K.; Kogame
N.; Katagiri Y.; Modolo R.; Serruys P.W.; Bartorelli A.L.; Andreini D.;
Doenst T.; Maureira J.P.; Plass A.; La Meir M.; Pompillio G.
Institution
(Sonck, Collet, La Meir) Department of Cardiology and Cardiovascular
Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
(Sonck) Department of Advanced Biomedical Sciences, University of Naples
Federico II, Naples, Italy
(Miyazaki, Onuma) Department of Interventional Cardiology, Thoraxcenter,
Erasmus University Medical Center, Rotterdam, Netherlands
(Collet, Asano, Takahashi, Kogame, Katagiri, Modolo) Department of
Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Onuma, Serruys) Cardialysis BV, Rotterdam, Netherlands
(Serruys) Department of Cardiology, Imperial College of London, London,
United Kingdom
(Bartorelli) Department of Biomedical and Clinical Sciences "Luigi Sacco",
University of Milan, Milan, Italy
(Bartorelli, Andreini, Pompillio) Centro Cardiologico Monzino, IRCCS,
Milan, Italy
(Andreini, Pompillio) Department of Clinical Sciences and Community
Health, University of Milan, Milan, Italy
(Doenst) Department of Cardiothoracic Surgery, Jena University Hospital,
Friedrich Schiller University of Jena, Jena, Germany
(Maureira) Department of Cardiovascular Surgery, CHRU Nancy, Nancy, France
(Plass) Division of Cardiovascular Surgery, University Hospital Zurich,
Zurich, Switzerland
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Invasive coronary angiography has been the preferred
diagnostic method to guide the decision-making process between coronary
artery bypass grafting (CABG) and percutaneous coronary intervention and
plan a surgical revascularization procedure. Guidelines recommend a heart
team approach and assessment of coronary artery disease (CAD) complexity,
objectively quantified by the anatomical SYNTAX score. Coronary computed
tomography angiography (CCTA) and CT-derived fractional flow reserve
(FFRCT) are emerging technologies in the diagnosis of stable CAD. In this
study, data from patients with left main or 3-vessel CAD who underwent
CABG were evaluated to assess the feasibility of developing a surgical
plan based on CCTA integrated with FFRCT. The primary objective was to
assess the theoretical feasibility of surgical decision-making and
treatment planning based only on non-invasive imaging. METHOD(S):
This study represents a survey of surgeons involved in the SYNTAX III
Revolution trial. In this trial, heart teams were randomized to make
treatment decisions using CTA. CCTAs and FFRCT results of 20 patients were
presented to 5 cardiac surgeons. RESULT(S): Surgical treatment
decision-making based on CCTA with FFRCT was considered feasible by a
panel of surgeons in 84% of the cases with an excellent agreement on the
number of anastomoses to be made in each patient (intraclass correlation
coefficient 0.77, 95% confidence interval 0.35-0.96). CONCLUSION(S):
Using non-invasive imaging only in patients with left main or 3-vessel
CAD, an excellent agreement on treatment planning and the number of
anastomoses was found among cardiac surgeons. Thus, CABG planning based on
non-invasive imaging appears feasible. Further investigation is warranted
to determine the safety and feasibility in clinical
practice. Copyright © The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<16>
Accession Number
626880567
Title
Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac
Surgery.
Source
The New England journal of medicine. (no pagination), 2019. Date of
Publication: 19 Mar 2019.
Author
Landoni G.; Lomivorotov V.V.; Nigro Neto C.; Monaco F.; Pasyuga V.V.;
Bradic N.; Lembo R.; Gazivoda G.; Likhvantsev V.V.; Lei C.; Lozovskiy A.;
Di Tomasso N.; Bukamal N.A.R.; Silva F.S.; Bautin A.E.; Ma J.; Crivellari
M.; Farag A.M.G.A.; Uvaliev N.S.; Carollo C.; Pieri M.; Kunstyr J.; Wang
C.Y.; Belletti A.; Hajjar L.A.; Grigoryev E.V.; Agro F.E.; Riha H.;
El-Tahan M.R.; Scandroglio A.M.; Elnakera A.M.; Baiocchi M.; Navalesi P.;
Shmyrev V.A.; Severi L.; Hegazy M.A.; Crescenzi G.; Ponomarev D.N.; Brazzi
L.; Arnoni R.; Tarasov D.G.; Jovic M.; Calabro M.G.; Bove T.; Bellomo R.;
Zangrillo A.
Institution
(Landoni, Lomivorotov, Nigro Neto, Monaco, Pasyuga, Bradic, Lembo,
Gazivoda, Likhvantsev, Lei, Lozovskiy, Di Tomasso, Bukamal, Silva, Bautin,
Ma, Crivellari, Farag, Uvaliev, Carollo, Pieri, Kunstyr, Wang, Belletti,
Hajjar, Grigoryev, Agro, Riha, El-Tahan, Scandroglio, Elnakera, Baiocchi,
Navalesi, Shmyrev, Severi, Hegazy, Crescenzi, Ponomarev, Brazzi, Arnoni,
Tarasov, Jovic, Calabro, Bove, Bellomo, Zangrillo) From the Department of
Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute
(G.L., F.M., R.L., N.D.T., M.C., M.P., A.B., A.M.S., M.G.C., A.Z.), and
Vita-Salute San Raffaele University (G.L., A.Z.), Milan, Istituto di
Anestesia e Rianimazione, Azienda Ospedaliera di Padova, Padua (C.C.),
Anesthesia and Intensive Care Department, University Campus Bio-Medico of
Rome (F.E.A.), and Anestesia e Rianimazione, Dipartimento Cardiovascolare,
Azienda Ospedaliera San Camillo Forlanini (L.S.), Rome, the Department of
Cardiothoracic and Vascular Anesthesia and Intensive Care, University
Hospital Policlinico S. Orsola, Bologna (M.B.), Dipartimento di Scienze
Mediche e Chirurgiche, Universita Magna Graecia di Catanzaro, Catanzaro
(P.N.), Anestesia e Terapia Intensiva Cardiochirurgica, Istituto Clinico
Humanitas, Rozzano (G.C.), the Department of Anesthesia, Intensive Care
and Emergency, Citta della Salute e della Scienza Hospital, and the
Department of Surgical Sciences, University of Turin, Turin (L.B.), and
the Anesthesiology and Intensive Care Clinic, Department of Medicine,
University of Udine, Udine (T.B.) - all in Italy; the Department of
Anesthesiology and Intensive Care, E. Meshalkin National Medical Research
Center, Novosibirsk (V.V. Lomivorotov, V.A.S., D.N.P.), the Departments of
Anesthesiology and Intensive Care (V.V.P.) and Cardiac Surgery (D.G.T.),
Federal Center for Cardiovascular Surgery Astrakhan, Astrakhan, the
Department of Anesthesia and Intensive Care, First Moscow State Medical
University (V.V.P., V.V. Likhvantsev), and the Department of Intensive
Care, Moscow Regional Clinical and Research Institute (V.V. Likhvantsev),
Moscow, the Department of Anesthesia and Intensive Care, Ural Institute of
Cardiology, Ekaterinburg (A.L.), the Laboratory for Anesthesiology and
Intensive Care
Publisher
NLM (Medline)
Abstract
BACKGROUND: Volatile (inhaled) anesthetic agents have cardioprotective
effects, which might improve clinical outcomes in patients undergoing
coronary-artery bypass grafting (CABG). METHOD(S): We conducted a
pragmatic, multicenter, single-blind, controlled trial at 36 centers in 13
countries. Patients scheduled to undergo elective CABG were randomly
assigned to an intraoperative anesthetic regimen that included a volatile
anesthetic (desflurane, isoflurane, or sevoflurane) or to total
intravenous anesthesia. The primary outcome was death from any cause at 1
year. RESULT(S): A total of 5400 patients were randomly assigned:
2709 to the volatile anesthetics group and 2691 to the total intravenous
anesthesia group. On-pump CABG was performed in 64% of patients, with a
mean duration of cardiopulmonary bypass of 79 minutes. The two groups were
similar with respect to demographic and clinical characteristics at
baseline, the duration of cardiopulmonary bypass, and the number of
grafts. At the time of the second interim analysis, the data and safety
monitoring board advised that the trial should be stopped for futility. No
significant difference between the groups with respect to deaths from any
cause was seen at 1 year (2.8% in the volatile anesthetics group and 3.0%
in the total intravenous anesthesia group; relative risk, 0.94; 95%
confidence interval [CI], 0.69 to 1.29; P=0.71), with data available for
5353 patients (99.1%), or at 30 days (1.4% and 1.3%, respectively;
relative risk, 1.11; 95% CI, 0.70 to 1.76), with data available for 5398
patients (99.9%). There were no significant differences between the groups
in any of the secondary outcomes or in the incidence of prespecified
adverse events, including myocardial infarction. CONCLUSION(S): Among
patients undergoing elective CABG, anesthesia with a volatile agent did
not result in significantly fewer deaths at 1 year than total intravenous
anesthesia. (Funded by the Italian Ministry of Health; MYRIAD
ClinicalTrials.gov number, NCT02105610.). Copyright © 2019
Massachusetts Medical Society.

<17>
Accession Number
2001728271
Title
Antithrombotic Strategies After Bioprosthetic Aortic Valve Replacement: A
Systematic Review.
Source
Annals of Thoracic Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Papak J.N.; Chiovaro J.C.; Noelck N.; Healy L.D.; Freeman M.; Quin J.A.;
Paynter R.; Low A.; Kondo K.; McCarty O.J.T.; Kansagara D.
Institution
(Papak, Chiovaro, Noelck, Kansagara) Department of Medicine, VA Portland
Healthcare System, Portland, OR, United States
(Papak, Chiovaro, Noelck, Kansagara) Department of Medicine, Oregon Health
& Science University, Portland, OR, United States
(Healy, McCarty) Department of Biomedical Engineering, Oregon Health &
Science University, Portland, OR, United States
(Freeman, Paynter, Low, Kondo, Kansagara) Evidence-based Synthesis Program
Center, VA Portland Health Care System, Portland, OR, United States
(Quin) Department of Surgery, VA Boston Health Care System, Boston, MA,
United States
Publisher
Elsevier USA
Abstract
Background: The optimal antithrombotic regimen after bioprosthetic aortic
valve replacement (bAVR) is unclear. We conducted a systematic review of
various anticoagulation strategies following surgical or transcatheter
bAVR (TAVR). Method(s): We searched Medline, PubMed, Embase,
Evidence-Based Medicine Reviews, and gray literature through June 2017 for
controlled clinical trials and cohort studies that directly compared
different antithrombotic strategies in nonpregnant adults who had
undergone bAVR. We assessed risk of bias and graded the strength of the
evidence using established methods. Result(s): Of 4,554 titles
reviewed, 6 clinical trials and 13 cohort studies met inclusion criteria.
We found moderate-strength evidence that mortality, thromboembolic events,
and bleeding rates are similar between aspirin and warfarin after surgical
bAVR. Observational data suggest lower mortality and thromboembolic events
with aspirin combined with warfarin compared with aspirin alone after
surgical bAVR, but the effect size is small and the combination is
associated with a substantial increase in bleeding risk. We found
insufficient evidence for all other treatment comparisons in surgical
bAVR. In TAVR patients, we found moderate-strength evidence that
mortality, stroke, and major cardiac events are similar between dual
antiplatelet therapy and aspirin alone, though a nonsignificantly lower
rate of bleeding occurred with aspirin alone. Conclusion(s):
Treatment with warfarin or aspirin leads to similar outcomes after
surgical bAVR. Combining aspirin with warfarin may lead to a small
decrease in thromboembolism and mortality, but is accompanied by increased
bleeding. For TAVR patients, aspirin is equivalent to dual antiplatelet
therapy for reducing thromboembolism and mortality, with a possible
decrease in bleeding. Copyright © 2019 The Society of Thoracic
Surgeons

<18>
Accession Number
626908581
Title
Effectiveness of protection strategies in reducing radiation exposure
among proceduralists during cardiac catheterization procedures: a
systematic review protocol.
Source
JBI database of systematic reviews and implementation reports. (no
pagination), 2019. Date of Publication: 14 Mar 2019.
Author
Fernandez R.; Ellwood L.; Barrett D.; Weaver J.
Institution
(Fernandez, Ellwood) Centre for Evidence Based Initiatives in Health Care:
a Joanna Briggs Centre of Excellence, Australia
(Fernandez, Ellwood) Centre for Research in Nursing and Health, St George
Hospital, Sydney, Australia
(Fernandez) School of Nursing, University of Wollongong, Sydney, Australia
(Barrett) Interventional Cardiology, St Andrews Private Hospital, Ipswich,
Australia
(Weaver) Cardiology Department, St George Hospital, Sydney, Australia
(Weaver) School of Medicine, University of New South Wales, Sydney,
Australia
Publisher
NLM (Medline)
Abstract
REVIEW QUESTION: What is the effectiveness of radiation protection
strategies on the radiation dose received by the proceduralist during
cardiac catheterization procedures?

<19>
Accession Number
626907798
Title
I-level positive airway pressure ventilation for patients with hypoxemia
after coronary artery bypass grafting.
Source
Journal of biological regulators and homeostatic agents. 33 (2) (no
pagination), 2019. Date of Publication: 20 Mar 2019.
Author
Cai W.W.; Hu J.; Wang H.; Zhu G.J.; Chen S.; Chen X.P.
Institution
(Cai, Hu, Wang, Zhu, Chen) Luoyang Central Hospital Affiliated to
Zhengzhou University, Luoyang, China
(Chen) Luoyang Central Hospital Affiliated to Zhengzhou University,
Luoyang, China
Publisher
NLM (Medline)
Abstract
Coronary artery bypass grafting (CABG) is an effective scheme for
treatment of myocardial ischemia. Hypoxemia is a common complication of
CABG, which can affect surgical effect and prognosis and even induce
multiple organ failure. To explore the clinical efficacy of bi-level
positive airway pressure ventilation in the treatment of CABG-associated
hypoxemia, 216 patients who were admitted to our hospital between August
2015 and April 2017 and developed CABG-associated hypoxemia were selected
and randomly divided into 2 groups, an observation group (n=108) and a
control group (n=108). Patients in the control group were given
conventional treatment including continuous oxygen inhalation through
nasal tube, anti-infection, bronchodilation, phlegm resolving, nutrition
support, analgesia, cardiac function maintenance, coronary dilatation,
anticoagulation and maintenance of stable internal environment, while
patients in the observation group were given positive airway pressure
ventilation via a breathing machine or nasal mask besides the conventional
treatment.

<20>
Accession Number
626907298
Title
Domain-specific cognitive dysfunction after cardiac surgery. A secondary
analysis of a randomized trial.
Source
Acta anaesthesiologica Scandinavica. (no pagination), 2019. Date of
Publication: 19 Mar 2019.
Author
Vedel A.G.; Holmgaard F.; Siersma V.; Langkilde A.; Paulson O.B.; Ravn
H.B.; Nilsson J.C.; Rasmussen L.S.
Institution
(Vedel, Holmgaard, Ravn, Nilsson) Department of Cardiothoracic
Anaesthesiology, Heart Centre, Rigshospitalet, University of Copenhagen,
Copenhagen, Denmark
(Vedel, Rasmussen) Department of Anaesthesia, Centre of Head and
Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Siersma) Research Unit for General Practice and Section of General
Practice, Department of Public Health, University of Copenhagen,
Copenhagen, Denmark
(Langkilde) Department of Radiology, Diagnostic Centre, Rigshospitalet,
University of Copenhagen, Copenhagen, Denmark
(Paulson) Neurobiology Research Unit, Neuroscience Centre, Rigshospitalet,
University of Copenhagen, Copenhagen, Denmark
Publisher
NLM (Medline)
Abstract
BACKGROUND: Brain injury and cognitive dysfunction are serious
complications after cardiac surgery. In the perfusion pressure cerebral
infarcts (PPCI) trial, we allocated cardiac surgery patients to a mean
arterial pressure of either 70-80 mm Hg (high-target) or 40-50 mm Hg
(low-target) during cardiopulmonary bypass. In this secondary analysis, we
aimed to assess potential differences in domain-specific patterns of
cognitive deterioration between allocation groups and to investigate any
associations of postoperative cognitive dysfunction (POCD) with
diffusion-weighted magnetic resonance imaging (DWI)-detected brain
lesions. METHOD(S): Of the 197 patients randomized in the PPCI trial,
89 in the low-target group and 80 in the high-target group had complete
DWI datasets, and 92 and 80 patients had complete data for an evaluation
of cognitive function at discharge respectively. Cognitive function was
assessed prior to surgery, at discharge and at 3 months. DWI was obtained
at baseline and on postoperative days 3 to 6. RESULT(S): We found no
statistically significant differences between the two groups when
comparing the proportion of patients with a domain-specific deterioration
over the pre-defined critical level in seven individual test variables at
discharge. Significant deterioration was most common in tests thought to
assess cognitive flexibility and interference susceptibility and least
common in the memory test. POCD at discharge was more frequent in patients
with DWI-positive brain lesions (OR adjusted for age and group allocation:
2.24 [95% CI 1.48-3.00], P = 0.036). CONCLUSION(S): Domain-specific
patterns of POCD were comparable between groups. A significant association
was seen between DWI-positive brain lesions and POCD. Copyright ©
2019 The Acta Anaesthesiologica Scandinavica Foundation. Published by John
Wiley & Sons Ltd.

<21>
Accession Number
626906700
Title
Prophylactic implantable cardioverter-defibrillator in the very elderly.
Source
Europace : European pacing, arrhythmias, and cardiac electrophysiology :
journal of the working groups on cardiac pacing, arrhythmias, and cardiac
cellular electrophysiology of the European Society of Cardiology. (no
pagination), 2019. Date of Publication: 19 Mar 2019.
Author
Zakine C.; Garcia R.; Narayanan K.; Gandjbakhch E.; Algalarrondo V.;
Lellouche N.; Perier M.-C.; Fauchier L.; Gras D.; Bordachar P.; Piot O.;
Babuty D.; Sadoul N.; Defaye P.; Deharo J.-C.; Klug D.; Leclercq C.;
Extramiana F.; Boveda S.; Marijon E.
Institution
(Zakine, Narayanan, Perier, Marijon) Paris Cardiovascular Research Center,
Paris, France
(Garcia) University Hospital of Poitiers, Poitiers, France
(Narayanan) Maxcure Hospitals, Hyderabad, India
(Gandjbakhch) La Pitie Salpetriere Hospital, Paris, France
(Algalarrondo) Antoine-Beclere Hospital, Paris, France
(Lellouche) Henri Mondor Hospital, Paris, France
(Perier, Marijon) European Georges Pompidou Hospital, Cardiology
Department, Paris, France
(Fauchier, Babuty) Tours University Hospital, Tours, France
(Gras) Hopital prive du Confluent, Nantes, France
(Bordachar) University Hospital od Bordeaux, Bordeaux, France
(Piot) Centre Cardiologique du Nord, Saint Denis, France
(Sadoul) Nancy University Hospital, Nancy, France
(Defaye) University Hospital of Grenoble, Grenoble, France
(Deharo) La Timone University Hospital, Marseille, France
(Klug) Lille University Hospital, Lille, France
(Leclercq) Rennes University Hospital, Universite de Rennes, CIC-IT,
Rennes, France
(Extramiana) Bichat-Claude-Bernard Hospital, Paris, France
(Boveda) Clinique Pasteur, Toulouse, France
(Marijon) Paris Descartes University, Paris, France
Publisher
NLM (Medline)
Abstract
AIMS: Current guidelines do not propose any age cut-off for the primary
prevention implantable cardioverter-defibrillator (ICD). However, the
risk/benefit balance in the very elderly population has not been well
studied. METHODS AND RESULTS: In a multicentre French study assessing
patients implanted with an ICD for primary prevention, outcomes among
patients aged >=80years were compared with <80years old controls matched
for sex and underlying heart disease (ischaemic and dilated
cardiomyopathy). A total of 300 ICD recipients were enrolled in this
specific analysis, including 150 patients >=80years (mean age
81.9+/-2.0years; 86.7% males) and 150 controls (mean age
61.8+/-10.8years). Among older patients, 92 (75.6%) had no more than one
associated comorbidity. Most subjects in the elderly group got an ICD as
part of a cardiac resynchronization therapy procedure (74% vs. 46%,
P<0.0001). After a mean follow-up of 3.0+/-2years, 53 patients (35%) in
the elderly group died, including 38.2% from non cardiovascular causes of
death. Similar proportion of patients received >=1 appropriate therapy
(19.4% vs. 21.6%; P=0.65) in the elderly group and controls, respectively.
There was a trend towards more early perioperative events (P=0.10) in the
elderly, with no significant increase in late complications (P=0.73).
 CONCLUSION(S): Primary prevention ICD recipients >=80years in the
real world had relatively low associated comorbidity. Rates of appropriate
therapies and device-related complications were similar, compared with
younger subjects. Nevertheless, the inherent limitations in interpreting
observational data on this particular competing risk situation call for
randomized controlled trials to provide definitive answers. Meanwhile, a
careful multidisciplinary evaluation is needed to guide patient selection
for ICD implantation in the elderly population. Copyright Published on
behalf of the European Society of Cardiology. All rights reserved. ©
The Author(s) 2019. For permissions, please email:
journals.permissions@oup.com.

<22>
Accession Number
626359973
Title
A randomized trial comparing triiodothyronine (T3) with thyroxine (T4) for
hemodynamically unstable brain-dead organ donors.
Source
Clinical Transplantation. 33 (3) (no pagination), 2019. Article Number:
e13486. Date of Publication: March 2019.
Author
Dhar R.; Stahlschmidt E.; Yan Y.; Marklin G.
Institution
(Dhar) Division of Neurocritical Care, Department of Neurology, Washington
University in St. Louis School of Medicine, Saint Louis, MO, United States
(Stahlschmidt, Marklin) Mid-America Transplant, St. Louis, MO, United
States
(Yan) Division of Public Health Sciences, Department of Surgery,
Washington University in St. Louis School of Medicine, St. Louis, MO,
United States
Publisher
Blackwell Publishing Ltd
Abstract
Rationale: Brain-dead (BD) organ donors frequently exhibit hemodynamic
instability and/or reversible cardiac dysfunction. Retrospective studies
have suggested that thyroid hormone may stabilize hemodynamics and enhance
myocardial recovery. Intravenous levothyroxine (T4) is most frequently
utilized but studies have suggested that triiodothyronine (T3) may be
superior. We performed a randomized comparative-effectiveness trial to
address this uncertainty in donor management. Method(s): All
heart-eligible donors managed at a single OPO underwent standardized fluid
resuscitation. If not weaned off vasopressors, donors underwent
echocardiography (within 12 hours of BD) and were randomized to T3 or T4
infusion for eight hours. Result(s): A total of 37 BD donors were
randomized (16 T3 vs 21 T4). Baseline ejection fraction (EF) was
comparable (median 38% vs 45%, P = 0.87) as was vasopressor dosage (6 vs
12 mug/min of norepinephrine, NE, P = 0.12). Reduction in NE dose and
proportion weaned off vasopressors was similar and LVEF improved in both
groups (repeat EF: 50% vs 52.5%, P = 0.38) with almost half attaining EF
>=55%. Although more hearts were transplanted in the T3 group (10/16 vs
6/21, P = 0.04), this difference did not persist after adjusting for
baseline imbalances in age and PF ratio. Conclusion(s): Infusion of
T3 does not appear to confer significant hemodynamic or cardiac benefits
over T4 for hemodynamic unstable BD organ donors. Copyright ©
2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

<23>
Accession Number
626236761
Title
Burden of medical co-morbidities and benefit from surgical
revascularization in patients with ischaemic cardiomyopathy.
Source
European Journal of Heart Failure. 21 (3) (pp 373-381), 2019. Date of
Publication: March 2019.
Author
Ambrosy A.P.; Stevens S.R.; Al-Khalidi H.R.; Rouleau J.L.; Bouabdallaoui
N.; Carson P.E.; Adlbrecht C.; Cleland J.G.F.; Dabrowski R.; Golba K.S.;
Pina I.L.; Sueta C.A.; Roy A.; Sopko G.; Bonow R.O.; Velazquez E.J.
Institution
(Ambrosy) Division of Cardiology, The Permanente Medical Group, San
Francisco, CA, United States
(Ambrosy) Division of Research, Kaiser Permanente Northern California,
Oakland, CA, United States
(Stevens, Al-Khalidi) Department of Biostatistics and Bioinformatics, Duke
Clinical Research Institute, Duke University School of Medicine, Durham,
NC, United States
(Rouleau, Bouabdallaoui) Research Center, Montreal Heart Institute,
Montreal, QC, Canada
(Carson) Department of Cardiology, Washington Veterans Affairs Medical
Center, Washington, DC, United States
(Adlbrecht) 4th Medical Department, Karl Landsteiner Institute for
Cardiovascular and Critical Care Research, Hietzing Hospital, Vienna,
Austria
(Cleland) Robertson Centre for Biostatistics and Clinical Trials,
University of Glasgow, Glasgow, United Kingdom
(Dabrowski) 2nd Department of Coronary Artery Disease, Institute of
Cardiology, Warsaw, Poland
(Golba) Department of Electrocardiology and Heart Failure, School of
Health Sciences, Medical University of Silesia, Katowice, Poland
(Pina) Albert Einstein College of Medicine, Montefiore Medical Center, New
York, NY, United States
(Sueta) Division of Cardiology, University of North Carolina School of
Medicine, Chapel Hill, NC, United States
(Roy) Department of Cardiology, All India Institute of Medical Sciences,
New Delhi, India
(Sopko) Division of Cardiovascular Sciences, National Heart, Lung, and
Blood Institute, National Institutes of Health, Bethesda, MD, United
States
(Bonow) Northwestern University Feinberg School of Medicine, Chicago, IL,
United States
(Velazquez) Section of Cardiovascular Medicine, Department of Internal
Medicine, Yale University School of Medicine, New Haven, CT, United States
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Aims: The landmark STICH trial found that surgical revascularization
compared to medical therapy alone improved survival in patients with heart
failure (HF) of ischaemic aetiology and an ejection fraction (EF) <= 35%.
However, the interaction between the burden of medical co-morbidities and
the benefit from surgical revascularization has not been previously
described in patients with ischaemic cardiomyopathy. Methods and
Results: The STICH trial (ClinicalTrials.gov Identifier: NCT00023595)
enrolled patients >= 18 years of age with coronary artery disease amenable
to coronary artery bypass grafting (CABG) and an EF <= 35%. Eligible
participants were randomly assigned 1:1 to receive medical therapy (MED)
(n = 602) or MED/CABG (n = 610). A modified Charlson co-morbidity index
(CCI) based on the availability of data and study definitions was
calculated by summing the weighted points for all co-morbid conditions.
Patients were divided into mild/moderate (CCI 1-4) and severe (CCI >= 5)
co-morbidity. Cox proportional hazards models were used to evaluate the
association between CCI and outcomes and the interaction between severity
of co-morbidity and treatment effect. The study population included 349
patients (29%) with a mild/moderate CCI score and 863 patients (71%) with
a severe CCI score. Patients with a severe CCI score had greater
functional limitations based on 6-min walk test and impairments in
health-related quality of life as assessed by the Kansas City
Cardiomyopathy Questionnaire. A total of 161 patients (Kaplan-Meier rate =
50%) with a mild/moderate CCI score and 579 patients (Kaplan-Meier rate =
69%) with a severe CCI score died over a median follow-up of 9.8 years.
After adjusting for baseline confounders, patients with a severe CCI score
were at higher risk for all-cause mortality (hazard ratio 1.44, 95%
confidence interval 1.19-1.74; P < 0.001). There was no interaction
between CCI score and treatment effect on survival (P = 0.756).
 Conclusion(s): More than 70% of patients had a severe burden of
medical co-morbidities at baseline, which was independently associated
with increased risk of death. There was not a differential benefit of
surgical revascularization with respect to survival based on severity of
co-morbidity. Copyright © 2019 The Authors. European Journal of
Heart Failure © 2019 European Society of Cardiology

<24>
Accession Number
2001485298
Title
A prospective 5-year study of exercise performance following Melody valve
implant.
Source
American Heart Journal. 209 (pp 47-53), 2019. Date of Publication: March
2019.
Author
Priromprintr B.; Silka M.J.; Rhodes J.; Batra A.S.
Institution
(Priromprintr, Silka) Children's Hospital Los Angeles, University of
Southern California, Los Angeles, CA, United States
(Priromprintr) Lucile Packard Children's Hospital at Stanford, Stanford
University Medical Center, Palo Alto, CA, United States
(Rhodes) Children's Hospital of Boston, Boston, MA, United States
(Batra) Children's Hospital of Orange County, University of California,
Irvine, CA, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The long-term benefits of Melody valve implant for right
ventricular outflow tract conduit obstruction or insufficiency on exercise
capacity are undefined. Method(s): As part of the Melody valve
clinical trial, 136 patients with congenital heart disease underwent
serial cardiopulmonary exercise testing prior to, 6 months after, and
annually for up to 5 years postimplant. Result(s): Mean age at Melody
valve implantation was 22.4 +/- 0.9 years (range 7-53 years). The 95
patients who completed the study protocol provide the basis of this
report. An initial improvement in % predicted workload was present at 6
months postimplant; however, at the final (5 year) follow-up, sustained or
further improvements in workload were not demonstrated for the entire
cohort compared to baseline. By subgroup analysis, age <17 years at
implant and pulmonary regurgitation as the primary lesion were variables
associated with sustained improvement in exercise performance. There were
sustained improvements in the ventilatory equivalents for O<inf>2</inf>
(minute ventilation/O<inf>2</inf> intake, P =.01) and CO<inf>2</inf>
(minute ventilation/CO<inf>2</inf> output, P <.01) at the ventilatory
anaerobic threshold at the study conclusion. Improvements in forced vital
capacity were also observed during the study but not sustained at the
final follow-up. Conclusion(s): A cautious appraisal of the
cardiovascular benefits of Melody valve implant on sustained improvements
in exercise performance appears warranted. Although the observed changes
in pulmonary function suggest improved restrictive lung physiology and
more efficient gas exchange, after an initial increase in % predicted
performance, neither sustained nor further improvements in exercise
performance were observed, except in specific patient
subgroups. Copyright © 2018 Elsevier Inc.

<25>
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.

<26>
Accession Number
621589228
Title
International Normalized Ratio Targets for Left-Sided Mechanical Valve
Replacement.
Source
Thrombosis and Haemostasis. 118 (5) (pp 906-913), 2018. Article Number:
170712. Date of Publication: 01 May 2018.
Author
Gupta S.; Belley-Cote E.P.; Sarkaria A.; Pandey A.; Spence J.; McClure G.;
Panchal P.; Jaffer I.H.; An K.; Eikelboom J.; Whitlock R.P.
Institution
(Gupta, Jaffer, Whitlock) Department of Surgery, McMaster University,
Hamilton, ON, Canada
(Gupta, Belley-Cote, Spence, McClure, Whitlock) Department of Health
Research Methods, Evidence and Impact, McMaster University, Hamilton, ON,
Canada
(Belley-Cote, Eikelboom) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Belley-Cote, Eikelboom, Whitlock) Perioperative and Surgery Program,
Population Health Research Institute, Hamilton Health Sciences, Hamilton,
ON, Canada
(Sarkaria) Department of Medicine, School of Medicine, Queen's University,
Kingston, ON, Canada
(Pandey, Jaffer) Experimental Thrombosis and Atherosclerosis Program,
Thrombosis and Atherosclerosis Research Institute, Hamilton Health
Sciences, Hamilton, ON, Canada
(Pandey, Panchal) Department of Health Sciences, McMaster University,
Hamilton, ON, Canada
(Spence) Department of Anesthesia, McMaster University, Hamilton, ON,
Canada
(McClure, An) Michael DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(Whitlock) David Braley Cardiac, Vascular and Stroke Research Institute,
237 Barton Street East, Hamilton, ON L8L 2X2, Canada
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background Guidelines recommend higher international normalized ratio
(INR) targets for patients with mechanical valves believed to be at higher
risk for thromboembolism. Higher INR targets are associated with increased
bleeding risk. We performed a systematic review and meta-analysis
assessing effects of lower and higher INR targets on thromboembolic and
bleeding risk in patients with mechanical heart valves. Methods We
searched Cochrane CENTRAL, MEDLINE and EMBASE for randomized controlled
trials (RCTs) evaluating lower versus higher INR targets for adults with
bileaflet mechanical valves. We performed title and abstract screening,
full-text review, risk of bias evaluation and data collection
independently and in duplicate. We pooled data using a random effects
model and used the Grading of Recommendations Assessment, Development and
Evaluation framework to evaluate overall quality of evidence. Results We
identified six RCTs (n = 5,497). Lower INR targets were associated with
significantly less bleeding--22% versus 40% (relative risk [RR]: 0.54, 95%
confidence interval [CI]: 0.31, 0.93, p = 0.03, very low quality). There
was no difference in thromboembolism--2% in both groups (RR: 1.28, 95% CI:
0.88, 1.85, p = 0.20, very low quality) or mortality--5.5% with lower INR
targets versus 8.5% (RR: 1.00, 95% CI: 0.82, 1.21, p = 0.47, moderate
quality). Conclusion In patients with mechanical valves, higher INR
targets are not supported by current evidence, which is of very low
quality. In fact, our systematic review suggests that lower INR targets
offer significantly lower bleeding risks with no significant difference in
thromboembolic risk. Copyright © 2018 Schattauer.

<27>
Accession Number
626772158
Title
Bioresorbable vascular scaffolds for percutaneous treatment of chronic
total coronary occlusions: A meta-analysis.
Source
BMC Cardiovascular Disorders. 19 (1) (no pagination), 2019. Article
Number: 59. Date of Publication: 15 Mar 2019.
Author
Polimeni A.; Anadol R.; Munzel T.; Geyer M.; De Rosa S.; Indolfi C.; Gori
T.
Institution
(Polimeni, Anadol, Munzel, Geyer, Gori) Kardiologie i, Zentrum fur
Kardiologie, University Medical Center Mainz, DZHK Standort Rhein-Main,
Mainz, Germany
(Polimeni, De Rosa, Indolfi) Division of Cardiology, Department of Medical
and Surgical Sciences, Magna Graecia University, Catanzaro 88100, Italy
(Indolfi) URT-CNR, Department of Medicine, Consiglio Nazionale Delle
Ricerche of IFC, Viale Europa S/N, Catanzaro 88100, Italy
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: BRS represent a new approach to treating coronary artery
disease. Beneficial properties of BRS regarding the restoration of
vasomotility after resorption make them attractive devices in CTO
revascularization. However, experience in this setting is limited.
 Method(s): We systematically searched Medline, Scholar, and Scopus
for reports of at least 9 patients with CTO undergoing BRS implantation.
Patients' and procedural characteristics were summarized. The primary
outcome of interest was target lesion revascularization (TLR). Pooled
estimates were calculated using a random-effects meta-analysis. The study
protocol was registered in PROSPERO (CRD42017069322). Result(s):
Thirteen reports for a total of 843 lesions with a median follow-up of 12
months (IQR 6-12) were included in the analysis. At short-term, the
summary estimate rate of TLR was 2.6% (95% CI: 1 to 4%, I2 =
0%, P = 0.887) while at mid to long-term it was 3.8% (95% CI: 2 to 6%,
I2 = 0%, P = 0.803). At long-term follow-up (>=12 months), the
summary estimate rate of cardiac death was 1.1% (95% CI: 0 to 2%,
I2 = 0%, P = 0.887). The summary estimate rates of scaffold
thrombosis and clinical restenosis were respectively 0.9% (95% CI: 0 to
2%, I2 = 0%, P = 0.919) and 1.8% (95% CI: 0 to 4%,
I2 = 0%, P = 0.448). Finally, the summary estimate rate of
target vessel revascularization was 6.6% (95% CI: 0 to 11%, I2
= 0%, P = 0.04). Conclusion(s): Implantation of BRS in a population
with CTO is feasible, although further longer-term outcome studies are
necessary. Copyright © 2019 The Author(s).

<28>
Accession Number
2001675387
Title
High-dose versus low-dose opioid anesthesia in adult cardiac surgery: A
meta-analysis.
Source
Journal of Clinical Anesthesia. 57 (pp 57-62), 2019. Date of Publication:
November 2019.
Author
Rong L.Q.; Kamel M.K.; Rahouma M.; Naik A.; Mehta K.; Abouarab A.A.; Di
Franco A.; Demetres M.; Mustapich T.L.; Fitzgerald M.M.; Pryor K.O.;
Gaudino M.
Institution
(Rong, Mustapich, Fitzgerald, Pryor) Department of Anesthesiology, Weill
Cornell Medicine/New York Presbyterian, NY, NY, United States
(Kamel, Rahouma, Naik, Mehta, Abouarab, Di Franco, Gaudino) Department of
Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, NY,
NY, United States
(Demetres) Samuel J. Wood Library & C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study Objective. We performed a systematic comparison of high-dose and
low-dose opioid anesthesia in cardiac surgery. Design(s): Systematic
review and meta-analysis of randomized controlled trials (RCTs).
 Setting(s): Operating room. Patient(s): 1400 adult patients
undergoing cardiac surgery using general anesthesia. Intervention(s):
All RCTs comparing the effects of various doses of intravenous opioids
(morphine, fentanyl, sufentanil, and remifentanil) during adult cardiac
surgery using general anesthesia published until May 2018 (full-text
English articles reporting data from human subjects) were included.
Measurements: Primary outcome was intensive care unit (ICU) length of stay
(LOS). Secondary outcomes were ventilation time, use of vasopressors,
perioperative myocardial infarction, perioperative stroke, and hospital
LOS. Main Result(s): Eighteen articles were included (1400 patients).
There was no difference in ICU LOS between studies using high or low dose
of opioids (both short-acting and long-acting) (standard mean difference
[SMD]-0.02, 95%CI: -0.15-0.11, P = 0.74). Similarly, there was no
difference in secondary outcomes of ventilation time (SMD-0.27, 95%CI:
-0.63-0.09, P = 0.14), use of vasopressors (OR 0.61, 95%CI: 0.29-1.30, P =
0.20), myocardial infarction (risk difference 0.00, 95% CI: -0.02-0.03, P
= 0.70), stroke (RD 0.00, 95% CI: -0.01-0.01, P = 0.92) and hospital LOS
(SMD 0.03, 95% CI: -0.26-0.33, P = 0.84). At meta-regression, there was no
effect of age, gender, or type of opioid on the difference between groups.
 Conclusion(s): Our data suggest that low-dose opioids, both short
acting and long acting, are safe and effective to use in adult cardiac
surgery patients, independent of the clinical characteristics of the
patients and the type of opioid used. In view of the current opioid
epidemic, low-dose opioid anesthesia should be considered for cardiac
surgery patients. Copyright © 2019 Elsevier Inc.

<29>
Accession Number
2001547957
Title
Patient Phenotypes, Cardiovascular Risk, and Ezetimibe Treatment in
Patients After Acute Coronary Syndromes (from IMPROVE-IT).
Source
American Journal of Cardiology. 123 (8) (pp 1193-1201), 2019. Date of
Publication: 15 April 2019.
Author
Sharma A.; Sun J.-L.; Lokhnygina Y.; Roe M.T.; Ahmad T.; Desai N.R.;
Blazing M.A.
Institution
(Sharma, Sun, Lokhnygina, Roe, Blazing) Duke Clinical Research Institute,
Duke University School of Medicine, Durham, NC, United States
(Sharma) Division of Cardiology, Stanford University, Palo Alto, CA,
United States
(Sharma) Division of Cardiology, McGill University Health Centre,
Montreal, Quebec, Canada
(Ahmad, Desai) Yale New Haven Hospital, Yale University, New Haven, CT,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Risk prediction following acute coronary syndrome (ACS) remains
challenging. Data-driven machine-learning algorithms can potentially
identify patients at high risk of clinical events. The Improved Reduction
of Outcomes: Vytorin Efficacy International Trial randomized 18,144
post-ACS patients to ezetimibe + simvastatin or placebo + simvastatin. We
performed hierarchical cluster analysis to identify patients at high risk
of adverse events. Associations between clusters and outcomes were
assessed using Cox proportional hazards models. The primary outcome was
cardiovascular death, nonfatal myocardial infarction, nonfatal stroke,
unstable angina hospitalization, or coronary revascularization >=30 days
after randomization. We evaluated ezetimibe's impact on outcomes across
clusters and the ability of the cluster analysis to discriminate for
outcomes compared with the Global Registry of Acute Coronary Events
(GRACE) score. Five clusters were identified. In cluster 1 (n = 13,252),
most patients experienced a non-STEMI (54.8%). Cluster 2 patients (n =
2,719) had the highest incidence of unstable angina (n = 83.3%). Cluster 3
patients (n = 782) all identified as Spanish descent, whereas cluster 4
patients (n = 803) were primarily from South America (56.2%). In cluster 5
(n = 587), all patients had ST elevation. Cluster analysis identified
patients at high risk of adverse outcomes (log-rank p <0.0001); Cluster 2
(vs 1) patients had the highest risk of outcomes (hazards ratio 1.33, 95%
confidence interval 1.24 to 1.43). Compared with GRACE risk, cluster
analysis did not provide superior outcome discrimination. A consistent
ezetimibe treatment effect was identified across clusters (interaction p =
0.882). In conclusion, cluster analysis identified significant difference
in risk of outcomes across cluster groups. Data-driven strategies to
identify patients who may differentially benefit from therapies and for
risk stratification require further evaluation. Copyright © 2019
Elsevier Inc.

<30>
Accession Number
625380758
Title
Introducing off-the-job training to cardiovascular surgical residency
training: a new era of developing competent cardiovascular surgeons.
Source
Surgery Today. 49 (4) (pp 300-310), 2019. Date of Publication: 10 Apr
2019.
Author
Yokoyama H.
Institution
(Yokoyama) Department of Cardiovascular Surgery, Fukushima Medical
University, 1 Hikarigaoka, Fukushima City, Fukushima 960-8072, Japan
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Purpose: This review summarizes the recent progress made in understanding
the skill acquisition process of achieving expert status in various fields
that require fine motor skills. We discuss the attempts to apply this
progress to develop competent surgeons. Method(s): We reviewed the
existing literature, using the keywords "surgical training", "skill
acquisition", and "simulator-based training", using Medline, as well as
recent books and chapters related to these issues. We also summarized the
role of simulator-based training in basic skill acquisition through
deliberate practice. Other aspects of surgical skills, such as steps taken
to improve motor skills, technical skill in the operating room, and
competency level from novice to expert, were reviewed. Result(s): The
common element of practice to develop top-ranking experts in various
fields is deliberate practice. Long-term repetitive practice is supported
by the individual's mental attitude: guts, resilience, initiative, tenancy
(GRIT). GRIT can be imparted using a teaching method that supports a
"growth mindset". Conclusion(s): Recent theoretical advances in skill
acquisition can be applied to surgical residency training, while intense
efforts are being made to improve the curriculum and training
environment. Copyright © 2018, Springer Nature Singapore Pte Ltd.

<31>
Accession Number
2001693973
Title
Bacterial infiltration in structural heart valve disease.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Oberbach A.; Friedrich M.; Lehmann S.; Schlichting N.; Kullnick Y.; Graber
S.; Buschmann T.; Hagl C.; Bagaev E.; Gruhle M.; Albert M.; Luehr M.;
Pichlmaier M.; Rodloff A.C.; Reiche K.; Kraft T.; Horn F.
Institution
(Oberbach, Hagl, Bagaev) Department of Cardiac Surgery,
Ludwig-Maximilians-University, Munich, Germany
(Oberbach, Friedrich, Lehmann, Schlichting, Kullnick, Buschmann)
Department of Diagnostics, Fraunhofer Institute for Cell Therapy and
Immunology, Leipzig, Germany
(Oberbach) Division of Gastroenterology and Hepatology, Department of
Medicine, The Johns Hopkins Medical Institutions, Baltimore, Md, United
States
(Friedrich) Institute of Clinical Immunology, University of Leipzig,
Leipzig, Germany
(Lehmann) Department of Internal Medicine, University of Leipzig, Leipzig,
Germany
(Schlichting) Department of Visceral, Transplantation, Thoracic and
Vascular Surgery, Leipzig University Hospital, Leipzig, Germany
(Graber) Institute for Medical Microbiology and Epidemiology of Infectious
Diseases, Leipzig University Hospital, Leipzig, Germany
(Hagl) Munich Heart Alliance, Partner Site German Center for
Cardiovascular Disease (DZHK), Munich, Germany
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: The pathology of structural valvular heart disease (sVHD)
ranges from basic diseases of rheumatologic origin to chronic degenerative
remodeling processes after acute bacterial infections. Molecular genetic
methods allow detection of the complete microbial spectrum in heart valve
tissues independent of microbiological cultivation. In particular,
whole-metagenome analysis is a sensitive and highly specific analytical
method that allows a deeper insight into the pathogenicity of the
diseases. In the present study we assessed the pathogen spectrum in heart
valve tissue from 25 sVHD patients using molecular and microbiological
methods. Method(s): Twenty-five sVHD patients were selected randomly
from an observational cohort study (March 2016 to January 2017). The
explanted native heart valves were examined using microbiological methods
and immunohistological structural analysis. In addition, the bacterial
metagenome of the heart valve tissue was determined using next-generation
sequencing. Result(s): The use of sonication as a pretreatment of
valve tissue from 4 sVHD patients permitted successful detection of
Clostridium difficile, Enterococcus faecalis, Staphylococcus
saccharolyticus, and Staphylococcus haemolyticus using microbial
cultivation. Histological staining revealed intramural localization.
Metagenome analysis identified a higher rate of bacterial infiltration in
52% of cases. The pathogen spectrum included both gram-positive and
gram-negative bacteria. Conclusion(s): Microbiological and molecular
biological studies are necessary to detect the spectrum of bacteria in a
calcified heart valve. Metagenome analysis is a valid method to gain new
insight into the polymicrobial pathophysiology of sVHD. Our results
suggest that an undetected proportion of sVHD might be triggered by
chronic inflammation or influenced by secondary bacterial
infiltration. Copyright © 2019 The American Association for
Thoracic Surgery

<32>
[Use Link to view the full text]
Accession Number
626858343
Title
Comparison between video-assisted thoracoscopic lung cancer resection and
robot-assisted lung cancer resection: Protocol for a systematic review and
meta-analysis.
Source
Medicine. 98 (11) (pp e14790), 2019. Date of Publication: 01 Mar 2019.
Author
Chai T.; Lin Y.; Shen Z.; Chen S.; Zhang Z.; Lin W.; Zhang P.; Kang M.;
Lin J.
Institution
(Chai, Shen, Chen, Zhang, Lin, Zhang, Kang, Lin) Department of Thoracic
Surgery, Fujian Medical University Union Hospital
(Chai, Shen, Zhang) Graduate School of Fujian Medical University
(Lin) School of Stomatology, Fujian Medical University, Fuzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Video-assisted thoracoscopic surgery (VATS) has developed
rapidly and a variety of feasible technical methods have been formed. VATS
is the main way of lung cancer resection nowadays with minor surgical
incision and less bleeding. Robot-assisted thoracic surgery (RATS) is a
revolution in surgical procedures and robotic pulmonary resection has been
put to use by an increasing quantity of hospitals around the world.
However, the widespread adoption of robot-assisted lung cancer resection
is controversial. We aimed to evaluate quality metrics of these 2
different approaches of operation by this review and meta-analysis.
METHODS AND ANALYSIS: We will search Medline, Embase, Pubmed, Google
Scholar, and the Cochrane Central Register of Controlled Trials for
related literature published in any language before February 28, 2019.
Propensity score matched comparative studies, prospective cohort studies;
randomized controlled trials (RCTs) will be included. If sufficient data
are available, we will perform subgroup analysis in different operative
types of lung cancer resection. RESULT(S): The results of this study
will be published in a peer-reviewed journal. CONCLUSION(S): To our
knowledge, this will be the first time to use meta-analysis to assess
quality metrics of video-assisted thoracoscopic lung cancer resection and
robot-assisted lung cancer resection. The results of this study will
provide more proofs for researchers, clinicians, and patients with lung
cancer to choose a suitable surgical procedure. There is not enough
high-quality evidence of RCTs to be included, due to the characteristics
of interventions. We will try to include some non-randomized controlled
trials, small sample trails. Although our team has experience in carrying
out a systematic review and meta-analysis, there may be high heterogeneity
and low reliability of evidence, which is the limitation of this study.

<33>
[Use Link to view the full text]
Accession Number
626858283
Title
Red blood cell transfusion threshold after pediatric cardiac surgery: A
systematic review and meta-analysis.
Source
Medicine. 98 (11) (pp e14884), 2019. Date of Publication: 01 Mar 2019.
Author
Deng X.; Wang Y.; Huang P.; Luo J.; Xiao Y.; Qiu J.; Yang G.
Institution
(Deng, Wang, Huang, Luo, Xiao, Yang) Heart Center, Austria
(Qiu) Department of Emergency Center, Hunan Children's Hospital, Changsha,
China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Restrictive red blood cell transfusion strategy is implemented
to minimize risk following allogeneic blood transfusion in adult cardiac
surgery. However, it is still unclear if it can be applied to pediatric
cardiac patients. The purpose of this systematic review and meta-analysis
was to determine the effect of postoperative restrictive transfusion
thresholds on clinical outcomes based on up-to-date results of randomized
controlled trials (RCTs) and observational studies in pediatric cardiac
surgery. METHOD(S): We searched for RCTs and observational studies in
the following databases: the Cochrane Central Register of Controlled
Trials, MEDLINE, EMBASE, and ClinicalTrials.gov from their inception to
October 26, 2017. We also searched reference lists of published
guidelines, reviews, and relevant articles, as well as conference
proceedings. No language restrictions were applied and no observational
study met the inclusion criteria. RESULT(S): Four RCTs on cardiac
surgery involving 454 patients were included. There were no differences in
the pooled fixed effects of intensive care unit (ICU) stay between the
liberal and restrictive transfusion thresholds (standardized mean
difference SMD, 0.007; 95% confidence interval CI, -0.18-0.19; P = .94).
There were also no differences in the length of hospital stay (SMD,
-0.062; 95% CI, -0.28-0.15; P = .57), ventilation duration (SMD, -0.015;
95% CI, -0.25-0.22; P = .90), mean arterial lactate level (SMD, 0.071; 95%
CI, -0.22-0.36; P = .63), and mortality (risk ratio, 0.49; 95% CI,
0.13-1.94; P = .31). There was no inter-trial heterogeneity for any pooled
analysis. Publication bias was tested using Egger, Begg, or the
trim-and-fill test, and the results indicated no significant publication
bias. CONCLUSION(S): Evidence from RCTs in pediatric cardiac surgery,
though limited, showed non-inferiority of restrictive thresholds over
liberal thresholds in length of ICU stay and other outcomes following red
blood cell transfusion. Further high-quality RCTs are necessary to confirm
the findings.

<34>
Accession Number
626859640
Title
External aortic clamping versus endoaortic balloon occlusion in minimally
invasive cardiac surgery: a systematic review and meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. 27 (2) (pp 208-214),
2018. Date of Publication: 01 Aug 2018.
Author
Khan H.; Hadjittofi C.; Uzzaman M.; Salhiyyah K.; Garg S.; Butt S.; Aya
H.; Chaubey S.
Institution
(Khan, Garg) Department of Cardiothoracic Surgery, Harefield Hospital,
London, United Kingdom
(Hadjittofi) Department of General Surgery, Whipps Cross University
Hospital, London, United Kingdom
(Uzzaman) Department of Cardiothoracic Surgery, University Hospital
Coventry, Coventry, United Kingdom
(Salhiyyah) Department of Cardiothoracic Surgery, Southampton University
Hospital, Southampton, United Kingdom
(Butt, Aya) Department of Cardiothoracic, Kings College Hospital, London,
United Kingdom
(Chaubey) Department of Cardiothoracic Surgery, Hammersmith Hospital,
London, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Minimally invasive cardiac valve surgery is safe, effective
and increasingly popular. It is performed worldwide with the use of either
external aortic clamping or endoaortic balloon occlusion. METHOD(S):
We conducted a literature search using MEDLINE, EMBASE, Scopus and Web of
Science. Primary outcomes included aortic dissection, conversion to
sternotomy, mortality, stroke and cross-clamp time. Secondary outcomes
included atrial fibrillation, acute kidney injury, reoperation for
bleeding, cardiopulmonary bypass times, myocardial infarction, use of
intra-aortic balloon pump and length of hospital stay. The random effects
model was used to calculate the outcomes of both binary and continuous
data. RESULT(S): Thirty retrospective studies were included in the
meta-analysis. The incidence of aortic dissection (pooled odds ratio=3.88,
95% confidence interval=1.06-14.18; P=0.04) and conversion to sternotomy
(pooled odds ratio=3.07, 95% confidence interval=1.33-7.10; P=0.009) was
higher in the endoaortic balloon occlusion group than in the external
aortic clamping group, in whom a direct comparison was possible. The
remaining observational studies did not show any significant differences
in either group. There was no significant difference in 30-day mortality
(P=0.37), stroke (P=0.26), cross-clamp time (P=0.20), atrial fibrillation
(P=0.18), acute kidney injury (P=0.49), reoperation for bleeding (P=0.24),
cardiopulmonary bypass time (P=0.06), myocardial infarction (P=0.74), use
of intra-aortic balloon pump (P=0.11) or length of hospital stay (P=0.47).
 CONCLUSION(S): External aortic clamping may be safer than endoaortic
balloon occlusion with respect to aortic dissection and conversion to
sternotomy. However, mortality, length of stay, stroke, cross-clamp time
and other cardiovascular complication rates were similar between the 2
techniques.

<35>
Accession Number
626773285
Title
Interventions to support return to work for people with coronary heart
disease.
Source
Cochrane Database of Systematic Reviews. 2019 (3) (no pagination), 2019.
Article Number: CD010748. Date of Publication: 14 Mar 2019.
Author
Hegewald J.; EWegewitz U.; Euler U.; Van Dijk J.L.; Adams J.; Fishta A.;
Heinrich P.; Seidler A.
Institution
(Hegewald, Euler, Heinrich, Seidler) Institute and Policlinic of
Occupational and Social Medicine, Faculty of Medicine Carl GustavCarus,
TUDresden, Fetscherstrasse 74, Dresden 01307, Germany
(EWegewitz) Division 3: Work and Health, Federal Institute for
Occupational Safety and Health (BAuA), Berlin, Germany
(Van Dijk) Dutch Institute of Clinical Occupational Medicine, Hilversum,
Netherlands
(Adams) Cardiac Rehabilitation Unit, Baylor Hamilton Heart and Vascular
Hospital, Dallas, TX, United States
(Fishta) Evidence Based Medicine, OH Management, Federal Institute for
Occupational Safety and Health (BAuA), Berlin, Germany
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background People with coronary heart disease (CHD) often require
prolonged absences from work to convalesce after acute disease events like
myocardial infarctions (MI) or revascularisation procedures such as
coronary artery bypass grafting (CABG) or percutaneous coronary
intervention (PCI). Reduced functional capacity and anxiety due to CHD may
further delay or prevent return to work. Objectives To assess the effects
of person- and work-directed interventions aimed at enhancing return to
work in patients with coronary heart disease compared to usual care or no
intervention. Search methods We searched the databases CENTRAL, MEDLINE,
Embase, PsycINFO, NIOSHTIC, NIOSHTIC-2, HSELINE, CISDOC, and LILACS
through 11October 2018.We also searched theUSNational Library ofMedicine
registry, clinicaltrials.gov, to identify ongoing studies. Selection
criteria We included randomised controlled trials (RCTs) examining return
to work among people with CHD who were provided either an intervention or
usual care. Selected studies included only people treated for MI or who
had undergone either a CABG or PCI. At least 80% of the study population
should have been working prior to the CHD and not at the time of the
trial, or study authors had to have considered a return-to-work subgroup.
We included studies in all languages. Two review authors independently
selected the studies and consulted a third review author to resolve
disagreements. Data collection and analysis Two review authors extracted
data and independently assessed the risk of bias. We conducted
meta-analyses of rates of return to work and time until return to work. We
considered the secondary outcomes, health-related quality of life and
adverse events among studies where at least 80% of study participants were
eligible to return to work. Main results We found 39 RCTs (including one
cluster- and four three-armed RCTs). We included the return-to-work
results of 34 studies in the meta-analyses. Person-directed, psychological
counselling versus usual care We included 11 studies considering return to
work following psychological interventions among a subgroup of 615
participants in the meta-analysis. Most interventions used some form of
counselling to address participants' disease-related anxieties and
provided information on the causes and course of CHD to dispel
misconceptions. We do not know if these interventions increase return to
work up to six months (risk ratio (RR) 1.08, 95% confidence interval (CI)
0.84 to 1.40; six studies; very low-certainty evidence) or at six to 12
months (RR 1.24, 95% CI 0.95 to 1.63; seven studies; very low-certainty
evidence). We also do not know if psychological interventions shorten the
time until return to work. Psychological interventions may have little or
no effect on the proportion of participants working between one and five
years (RR 1.09, 95% CI 0.88 to 1.34; three studies; low-certainty
evidence). Person-directed, work-directed counselling versus usual care
Four studies examined work-directed counselling. These counselling
interventions included advising patients when to return to work based on
treadmill testing or extended counselling to include co-workers' fears and
misconceptions regarding CHD. Work-directed counselling may result in
little to no difference in the mean difference (MD) in days until return
to work (MD -7.52 days, 95% CI -20.07 to 5.03 days; four studies;
low-certainty evidence). Work-directed counselling probably results in
little to no difference in cardiac deaths (RR 1.00, 95% CI 0.19 to 5.39;
two studies; moderate-certainty evidence). Person-directed, physical
conditioning interventions versus usual care Nine studies examined the
impact of exercise programmes. Compared to usual care, we do not know if
physical interventions increase return to work up to six months (RR 1.17,
95% CI 0.97 to 1.41; four studies; very low-certainty evidence). Physical
conditioning interventions may result in little to no difference in
return-to-work rates at six to 12 months (RR 1.09, 95% CI 0.99 to 1.20;
five studies; low-certainty evidence), and may also result in little to no
difference on the rates of patients working after one year (RR 1.04, 95%
CI 0.82 to 1.30; two studies; low-certainty evidence). Physical
conditioning interventions may result in little to no difference in the
time needed to return to work (MD -7.86 days, 95% CI -29.46 to 13.74 days;
four studies; low-certainty evidence). Physical conditioning interventions
probably do not increase cardiac death rates (RR 1.00, 95%CI 0.35 to 2.80;
two studies; moderate-certainty evidence). Person-directed, combined
interventions versus usual care We included 13 studies considering return
to work following combined interventions in the meta-analysis. Combined
cardiac rehabilitation programmes may have increased return to work up to
six months (RR 1.56, 95% CI 1.23 to 1.98; number needed to treat for an
additional beneficial outcome (NNTB) 5; four studies; low-certainty
evidence), and may have little to no difference on returnto- work rates at
six to 12 months' follow-up (RR 1.06, 95% CI 1.00 to 1.13; 10 studies;
low-certainty evidence). We do not know if combined interventions
increased the proportions of participants working between one and five
years (RR 1.14, 95% CI 0.96 to 1.37; six studies; very low-certainty
evidence) or at five years (RR 1.09, 95% CI 0.86 to 1.38; four studies;
very low-certainty evidence). Combined interventions probably shortened
the time needed until return to work (MD -40.77, 95% CI -67.19 to -14.35;
two studies; moderate-certainty evidence). Combining interventions
probably results in little to no difference in reinfarctions (RR 0.56, 95%
CI 0.23 to 1.40; three studies; moderate-certainty evidence).
Work-directed, interventions We found no studies exclusively examining
strictly work-directed interventions at the workplace. Authors'
conclusions Combined interventions may increase return to work up to six
months and probably reduce the time away from work. Otherwise, we found no
evidence of either a beneficial or harmful effect of person-directed
interventions. The certainty of the evidence for the various interventions
and outcomes ranged fromvery low to moderate. Return to work was typically
a secondary outcome of the studies, and as such, the results pertaining to
return to work were often poorly reported. Adhering to RCT reporting
guidelines could greatly improve the evidence of future research. A
research gap exists regarding controlled trials of work-directed
interventions, health-related quality of life within the return-to-work
process, and adverse effects. Copyright © 2019 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<36>
Accession Number
626862969
Title
Comparison of anterior, posterior, and anterior combined with posterior
surgical treatment of thoracic and lumbar spinal tuberculosis: a
systematic review.
Source
The Journal of international medical research. (pp 300060519830827), 2019.
Date of Publication: 17 Mar 2019.
Author
Bian Z.; Gui Y.; Feng F.; Shen H.; Lao L.
Institution
(Bian, Gui) Shanghai Jiao Tong University School of Medicine, Shanghai,
China
(Feng, Shen, Lao) Renji Hospital Affiliated to Shanghai Jiao Tong
University School of Medicine, Shanghai, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: This study was performed to compare different surgical
approaches in the treatment of spinal tuberculosis. METHOD(S): We
conducted a literature search to identify and analyze papers published
from January 1966 to April 2018 relevant to comparison of the anterior,
posterior, and anterior combined with posterior approaches in the
treatment of spinal tuberculosis of the thoracic and lumbar regions.
 RESULT(S): Twenty-five studies involving 2295 patients were
identified in this systematic review. The operative time was significantly
longer in the anterior combined with posterior approach than in the other
two approaches. Blood loss was significantly greater in the anterior
combined with posterior approach (1125.0+/-275.5 mL) than in the posterior
approach (710.4+/-192.4 mL). The difference in correction of the kyphosis
angle among the three procedures was not significant. The overall surgical
and transthoracic complications were significantly lower in the posterior
approach. The clinical outcome of all patients improved, but there was no
significant difference among the three procedures. CONCLUSION(S):
Blood loss, overall surgical and transthoracic complications, and the
operative time are different among the three approaches. Therefore,
different factors must be carefully assessed in deciding among the three
procedures.

<37>
Accession Number
626862425
Title
Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in
Low-Risk Patients.
Source
The New England journal of medicine. (no pagination), 2019. Date of
Publication: 17 Mar 2019.
Author
Mack M.J.; Leon M.B.; Thourani V.H.; Makkar R.; Kodali S.K.; Russo M.;
Kapadia S.R.; Malaisrie S.C.; Cohen D.J.; Pibarot P.; Leipsic J.; Hahn
R.T.; Blanke P.; Williams M.R.; McCabe J.M.; Brown D.L.; Babaliaros V.;
Goldman S.; Szeto W.Y.; Genereux P.; Pershad A.; Pocock S.J.; Alu M.C.;
Webb J.G.; Smith C.R.
Institution
(Mack, Leon, Thourani, Makkar, Kodali, Russo, Kapadia, Malaisrie, Cohen,
Pibarot, Leipsic, Hahn, Blanke, Williams, McCabe, Brown, Babaliaros,
Goldman, Szeto, Genereux, Pershad, Pocock, Alu, Webb, Smith) From Baylor
Scott and White Health, Plano, TX (M.J.M., D.L.B.); Columbia University
Irving Medical Center and New York-Presbyterian Hospital (M.B.L., S.K.K.,
R.T.H., M.C.A., C.R.S.) and New York University Langone Medical Center
(M.R.W.) - both in New York; Medstar Heart and Vascular Institute,
Georgetown University, Washington, DC (V.H.T.); Cedars-Sinai Heart
Institute, Los Angeles (R.M.); Robert Wood Johnson Medical School, Rutgers
University, New Brunswick (M.R.), and Gagnon Cardiovascular Institute,
Morristown Medical Center, Morristown (P.G.) - both in New Jersey;
Cleveland Clinic, Cleveland (S.R.K.); Feinberg School of Medicine,
Northwestern University, Chicago (S.C.M.); Saint Luke's Mid America Heart
Institute, Kansas City, MO (D.J.C.); Quebec Heart and Lung Institute,
Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University
of British Columbia, Vancouver (J.L., P.B., J.G.W.) - both in Canada;
University of Washington, Seattle (J.M.M.); Emory University Hospital,
Atlanta (V.B.); Lankenau Medical Center, Wynnewood (S.G.), and the
Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.) - both
in Pennsylvania; Banner University Medical Center, Phoenix, AZ (A.P.); and
the London School of Hygiene and Tropical Medicine, London (S.J.P.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Among patients with aortic stenosis who are at intermediate or
high risk for death with surgery, major outcomes are similar with
transcatheter aortic-valve replacement (TAVR) and surgical aortic-valve
replacement. There is insufficient evidence regarding the comparison of
the two procedures in patients who are at low risk. METHOD(S): We
randomly assigned patients with severe aortic stenosis and low surgical
risk to undergo either TAVR with transfemoral placement of a
balloon-expandable valve or surgery. The primary end point was a composite
of death, stroke, or rehospitalization at 1 year. Both noninferiority
testing (with a prespecified margin of 6 percentage points) and
superiority testing were performed in the as-treated population.
 RESULT(S): At 71 centers, 1000 patients underwent randomization. The
mean age of the patients was 73 years, and the mean Society of Thoracic
Surgeons risk score was 1.9% (with scores ranging from 0 to 100% and
higher scores indicating a greater risk of death within 30 days after the
procedure). The Kaplan-Meier estimate of the rate of the primary composite
end point at 1 year was significantly lower in the TAVR group than in the
surgery group (8.5% vs. 15.1%; absolute difference, -6.6 percentage
points; 95% confidence interval [CI], -10.8 to -2.5; P<0.001 for
noninferiority; hazard ratio, 0.54; 95% CI, 0.37 to 0.79; P=0.001 for
superiority). At 30 days, TAVR resulted in a lower rate of stroke than
surgery (P=0.02) and in lower rates of death or stroke (P=0.01) and
new-onset atrial fibrillation (P<0.001). TAVR also resulted in a shorter
index hospitalization than surgery (P<0.001) and in a lower risk of a poor
treatment outcome (death or a low Kansas City Cardiomyopathy Questionnaire
score) at 30 days (P<0.001). There were no significant between-group
differences in major vascular complications, new permanent pacemaker
insertions, or moderate or severe paravalvular regurgitation.
 CONCLUSION(S): Among patients with severe aortic stenosis who were at
low surgical risk, the rate of the composite of death, stroke, or
rehospitalization at 1 year was significantly lower with TAVR than with
surgery. (Funded by Edwards Lifesciences; PARTNER 3 ClinicalTrials.gov
number, NCT02675114.). Copyright © 2019 Massachusetts Medical
Society.

<38>
Accession Number
626862100
Title
Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in
Low-Risk Patients.
Source
The New England journal of medicine. (no pagination), 2019. Date of
Publication: 17 Mar 2019.
Author
Popma J.J.; Deeb G.M.; Yakubov S.J.; Mumtaz M.; Gada H.; O'Hair D.; Bajwa
T.; Heiser J.C.; Merhi W.; Kleiman N.S.; Askew J.; Sorajja P.; Rovin J.;
Chetcuti S.J.; Adams D.H.; Teirstein P.S.; Zorn G.L.; Forrest J.K.;
Tchetche D.; Resar J.; Walton A.; Piazza N.; Ramlawi B.; Robinson N.;
Petrossian G.; Gleason T.G.; Oh J.K.; Boulware M.J.; Qiao H.; Mugglin
A.S.; Reardon M.J.
Institution
(Popma, Deeb, Yakubov, Mumtaz, Gada, O'Hair, Bajwa, Heiser, Merhi,
Kleiman, Askew, Sorajja, Rovin, Chetcuti, Adams, Teirstein, Zorn, Forrest,
Tchetche, Resar, Walton, Piazza, Ramlawi, Robinson, Petrossian, Gleason,
Oh, Boulware, Qiao, Mugglin, Reardon) From Beth Israel Deaconess Medical
Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor
(G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H.,
W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus
(S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health,
Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh
(T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center,
Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular
Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A.,
P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester
(J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota;
Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health
System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.)
- both in New York; Scripps Clinic and Research Foundation, La Jolla, CA
(P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New
Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France
(D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital,
Melbourne, VIC, Australia (A.W.); McGill University Health Centre,
Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Transcatheter aortic-valve replacement (TAVR) is an
alternative to surgery in patients with severe aortic stenosis who are at
increased risk for death from surgery; less is known about TAVR in
low-risk patients. METHOD(S): We performed a randomized
noninferiority trial in which TAVR with a self-expanding supraannular
bioprosthesis was compared with surgical aortic-valve replacement in
patients who had severe aortic stenosis and were at low surgical risk.
When 850 patients had reached 12-month follow-up, we analyzed data
regarding the primary end point, a composite of death or disabling stroke
at 24 months, using Bayesian methods. RESULT(S): Of the 1468 patients
who underwent randomization, an attempted TAVR or surgical procedure was
performed in 1403. The patients' mean age was 74 years. The 24-month
estimated incidence of the primary end point was 5.3% in the TAVR group
and 6.7% in the surgery group (difference, -1.4 percentage points; 95%
Bayesian credible interval for difference, -4.9 to 2.1; posterior
probability of noninferiority >0.999). At 30 days, patients who had
undergone TAVR, as compared with surgery, had a lower incidence of
disabling stroke (0.5% vs. 1.7%), bleeding complications (2.4% vs. 7.5%),
acute kidney injury (0.9% vs. 2.8%), and atrial fibrillation (7.7% vs.
35.4%) and a higher incidence of moderate or severe aortic regurgitation
(3.5% vs. 0.5%) and pacemaker implantation (17.4% vs. 6.1%). At 12 months,
patients in the TAVR group had lower aortic-valve gradients than those in
the surgery group (8.6 mm Hg vs. 11.2 mm Hg) and larger effective orifice
areas (2.3 cm2 vs. 2.0 cm2). CONCLUSION(S): In patients with severe
aortic stenosis who were at low surgical risk, TAVR with a self-expanding
supraannular bioprosthesis was noninferior to surgery with respect to the
composite end point of death or disabling stroke at 24 months. (Funded by
Medtronic; ClinicalTrials.gov number, NCT02701283.). Copyright ©
2019 Massachusetts Medical Society.

<39>
Accession Number
626861401
Title
Effectiveness of Discharge Education With the Teach-Back Method on 30-Day
Readmission: A Systematic Review.
Source
Journal of patient safety. (no pagination), 2019. Date of Publication: 13
Mar 2019.
Author
Oh E.G.; Lee H.J.; Yang Y.L.; Kim Y.M.
Institution
(Lee, Yang) College of Nursing, .Mo-Im Kim Nursing Research Institute,
Yonsei University
(Kim) College of Nursing, Graduate School, Yonsei University, Seoul, South
Korea
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Teach-back methods are reported to improve patient outcomes by
encouraging patient understanding and participation and are increasingly
being used in various clinical settings. This study attempts to identify
the effectiveness of discharge education using the teach-back method on
30-day readmission. METHOD(S): MEDLINE, CINAHL, Embase, The Cochrane
Library, and Web of Science were used to search experimental studies. The
search terms were "discharged patient," "teach-back," and "30-day
readmission" published in English up until July 2017. Two trained
reviewers performed a critical appraisal of retrieved studies using the
Risk of Bias Assessment tool for Nonrandomized Studies. Data were analyzed
using Cochrane Review Manager (Revman) software 5.2. RESULT(S): A
total of five studies were analyzed (3 studies on heart failure, 1 study
on total joint replacement, and 1 study on a coronary artery bypass
graft). The main content of the teach-back education was to confirm and
reinforce the patients' comprehension of health-related information. Among
the five studies, three studies were included in the meta-analysis. The
odds ratio of 30-day readmission for discharge education with the
teach-back method and usual care was 0.55 (95% confidence interval,
0.34-0.91; P = 0.02). The I score was 0%, which means that the analyzed
studies are homogeneous. CONCLUSION(S): The results indicate that
discharge education with the teach-back method resulted in a 45% reduction
in 30-day readmission. However, only a few studies were included in the
analysis, and they showed a high risk of selection bias. Therefore, we
suggest that well-designed randomized controlled trials be conducted.

<40>
Accession Number
626866403
Title
Meta-Analysis of the Prognostic Role of Late Gadolinium Enhancement and
Global Systolic Impairment in Left Ventricular Noncompaction.
Source
JACC. Cardiovascular imaging. (no pagination), 2019. Date of Publication:
08 Mar 2019.
Author
Grigoratos C.; Barison A.; Ivanov A.; Andreini D.; Amzulescu M.-S.;
Mazurkiewicz L.; De Luca A.; Grzybowski J.; Masci P.G.; Marczak M.;
Heitner J.F.; Schwitter J.; Gerber B.L.; Emdin M.; Aquaro G.D.
Institution
(Grigoratos, Emdin) Fondazione Gabriele Monasterio CNR/Regione Toscana,
Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa,
Italy
(Barison, De Luca, Aquaro) PisaItaly
(Ivanov, Heitner) Department of Cardiology, New York Methodist Hospital,
Brooklyn, NY, United States
(Andreini) Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of
Clinical Sciences and Community Health, Cardiovascular Section, University
of Milan, Milan, Italy
(Amzulescu, Gerber) Division of Cardiology, Department of Cardiovascular
Diseases Cliniques St. Luc and Pole de Recherche Cardiovasculaire,
Institut de Recherche Experimentale et Clinique, Universite Catholique de
Louvain, Brussels, Belgium
(Mazurkiewicz) Department of Cardiomyopathies, Institute of Cardiology,
Warsaw, Poland; CMR Unit, Institute of Cardiology, Warsaw, Poland
(Grzybowski) Department of Cardiomyopathies, Institute of Cardiology,
Warsaw, Poland
(Masci, Schwitter) Division of Cardiology and CMR-Center, University
Hospital Lausanne, Lausanne, Switzerland
(Marczak) CMR Unit, Institute of Cardiology, Warsaw, Poland
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The objective of this meta-analysis was to assess the
predictive value of late gadolinium enhancement (LGE) and global systolic
impairment for future major adverse cardiovascular events in left
ventricular noncompaction (LVNC). BACKGROUND: The prognosis of patients
with LVNC, with and without left ventricular dysfunction and LGE, is still
unclear. METHOD(S): A systematic review of published research and a
meta-analysis reporting a combined endpoint of hard (cardiac death, sudden
cardiac death, appropriate defibrillator firing, resuscitated cardiac
arrest, cardiac transplantation, assist device implantation) and minor
(heart failure hospitalization and thromboembolic events) events was
performed. RESULT(S): Four studies with 574 patients with LVNC and
677 with no LVNC and an average follow-up duration of 5.2 years were
analyzed. In patients with LVNC, LGE was associated with the combined
endpoint (pooled odds ratio: 4.9; 95% confidence interval: 1.63 to 14.6; p
= 0.005) and cardiac death (pooled odds ratio: 9.8; 95% confidence
interval: 2.44 to 39.5; p < 0.001). Preserved left ventricular systolic
function was found in 183 patients with LVNC: 25 with positive LGE and 158
with negative LGE. In LVNC with preserved ejection fraction, positive LGE
was associated with hard cardiac events (odds ratio: 6.1; 95% confidence
interval: 2.1 to 17.5; p < 0.001). No hard cardiac events were recorded in
patients with LVNC, preserved ejection fraction, and negative LGE.
 CONCLUSION(S): Patients with LVNC but without LGE have a better
prognosis than those with LGE. When LGE is negative and global systolic
function is preserved, no hard cardiac events are to be expected.
Currently available criteria allow diagnosis of LVNC, but to further
define the presence and prognostic significance of the disease, LGE and/or
global systolic impairment must be considered for better risk
stratification. Copyright © 2019 American College of Cardiology
Foundation. Published by Elsevier Inc. All rights reserved.

<41>
Accession Number
624320431
Title
Predictors of ischaemic mitral regurgitation recurrence in patients
undergoing combined surgery: Additional value of cardiovascular magnetic
resonance imaging.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (2) (pp 222-228),
2018. Date of Publication: August 2018.
Author
Glaveckaite S.; Uzdavinyte-Gateliene E.; Petrulioniene Z.; Palionis D.;
Valeviciene N.; Kalinauskas G.; Serpytis P.; Laucevicius A.
Institution
(Glaveckaite, Uzdavinyte-Gateliene, Petrulioniene, Serpytis, Laucevicius)
Clinic of Cardiovascular Diseases, Centre of Cardiology and Angiology,
Vilnius University, Vilnius, Lithuania
(Palionis, Valeviciene) Department of Radiology, Nuclear Medicine and
Medical Physics, Centre of Radiology and Nuclear Medicine, Vilnius,
Lithuania
(Kalinauskas) Clinic of Cardiovascular Diseases, Centre of Heart Surgery,
Vilnius University, Vilnius, Lithuania
Publisher
Oxford University Press
Abstract
OBJECTIVES: We aimed to evaluate (i) the effectiveness of combined surgery
(coronary artery bypass grafting with restrictive mitral valve
annuloplasty) and (ii) the late gadolinium enhancement cardiovascular
magnetic resonance-based predictors of ischaemic mitral regurgitation
(IMR) recurrence. METHOD(S): The prospective analysis included 40
patients with multivessel coronary artery disease, IMR >IIdegree and left
ventricular (LV) dysfunction undergoing combined surgery. The degree of
IMR and LV parameters were assessed preoperatively by transthoracic
echocardiography, 3D transoesophageal echocardiography and cardiovascular
magnetic resonance and postoperatively by transthoracic echocardiography.
The effective mitral valve repair group (n = 30) was defined as having
recurrent ischaemic mitral regurgitation (RIMR) <IIdegree at the end of
follow-up (25 +/- 11 months). RESULT(S): The surgery was effective:
freedom from RIMR >IIdegree at 1 and 2 years after surgery was 80% and
75%, respectively. Using multivariable logistic regression, 2 independent
predictors of RIMR >IIdegree were identified: >3 non-viable LV segments
(odds ratio 22, P = 0.027) and >1 non-viable segment in the LV posterior
wall (odds ratio 11, P = 0.026). Using classification trees, the best
combinations of cardiovascular magnetic resonance-based and 3D
transoesophageal echocardiography-based predictors for RIMR >IIdegree were
(i) posterior mitral valve leaflet angle >40degree and LV end-systolic
volume index >45 ml/m2 (sensitivity 100%, specificity 89%) and (ii) scar
transmurality >68% in the inferior LV wall and EuroSCORE II >8
(sensitivity 83%, specificity 78%). CONCLUSION(S): There is a clear
relationship between the amount of non-viable LV segments, especially in
the LV posterior and inferior walls, and the recurrence of IMR after the
combined surgery. Copyright © The Author(s) 2018.

<42>
Accession Number
624513621
Title
Diabetes mellitus is an independent prognostic factor for mid-term and
long-term survival following transcatheter aortic valve implantation: A
systematic review and meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (2) (pp 159-168),
2018. Date of Publication: August 2018.
Author
Lv W.; Li S.; Zhao Z.; Liao Y.; Li Y.; Chen M.; Feng Y.
Institution
(Li) Department of Thoracic Surgery, West China Hospital, Sichuan
University, Chengdu, China
(Lv, Zhao, Liao, Li, Chen, Feng) Department of Cardiology, West China
Hospital, Sichuan University, Guoxue Alley No. 37, Chengdu, China
Publisher
Oxford University Press
Abstract
Prior studies have proposed the unfavourable roles of diabetes mellitus
(DM) in surgical populations. For patients who underwent transcatheter
aortic valve implantation, the prognostic value of DM remains
controversial. This review summarizes the effects of DM on short-term,
mid-term and long-term prognosis in patients who undergo transcatheter
aortic valve implantation. We searched the PubMed database to identify
eligible articles. The odds ratio and hazard ratio with the corresponding
95% confidence interval were adopted for synthesizing short-term and
medium- to long-term survival outcomes, respectively. The heterogeneity
level and publication bias between studies were also estimated. Finally,
20 observational studies enrolling 19 260 patients met the eligibility
criteria and, thus, were included in this review. An overall analysis
identified that DM was significantly associated with the poor medium- to
long-term overall survival (hazard ratio 1.21, 95% confidence interval
1.03-1.41; P = 0.019). However, no significant impact of DM on 30-day
mortality was observed (odds ratio 1.10, 95% confidence interval
0.86-1.41; P = 0.46) in patients undergoing transcatheter aortic valve
implantation. Further subgroup analyses indicated that the prognostic
value of DM for medium- to long-term overall survival Remained significant
in the subgroups of multivariable origins of incorporated data, duration
of follow-ups (1-year/<_2-year follow-up), Western populations and
insulin-dependent diabetes mellitus. This meta-analysis demonstrates that
DM is a strongly independent predictor for poor medium- to long-term
overall survival but shows no significant effect of DM on 30-day
mortality. Our findings need to be further verified and modified by more
worldwide studies. Copyright © The Author(s) 2018.

<43>
Accession Number
626825393
Title
Percutaneous devices for left atrial appendage occlusion: A contemporary
review.
Source
World Journal of Cardiology. 11 (2) (pp 57-70), 2019. Date of Publication:
01 Feb 2019.
Author
Pacha H.M.; Al-khadra Y.; Soud M.; Darmoch F.; Pacha A.M.; Chadi Alraies
M.
Institution
(Pacha, Soud) MedStar Washington Hospital Center, Washington, DC 20010,
United States
(Al-khadra) Cleveland Clinic, Medicine Institute, Cleveland, OH 44195,
United States
(Darmoch) Beth Israel Deaconess Medical center, Harvard Medical School,
Boston, MA 02215, United States
(Pacha) University Hospital of Mainz, Mainz 55122, Germany
(Chadi Alraies) Wayne State University, Detroit Medical Center, Detroit
Heart Hospital, 311 Mack Ave, Detroit, MI 48201, United States
Publisher
Baishideng Publishing Group Co (7901 Stoneridge Drive, Suite 501,
Pleasanton, California 94588, United States. E-mail: bpg@baishideng.com)
Abstract
Patient with atrial fibrillation (AF) are at risk of developing stroke
with the left atrial appendage (LAA) being the most common site for
thrombus formation. If left untreated, AF is associated with 4 to 5 folds
increase in the risk of ischemic stroke in all age groups. About 5% to 15%
of AF patients have atrial thrombi on transesophageal echocardiography,
and 91% of those thrombi are located in the LAA in patient with
nonrheumatic AF. Although oral anticoagulants are the gold-standard
treatment for stroke prevention in patients with non-valvular AF, some
patients are at high risk of bleeding and deemed not candidates for
anticoagulation. Therefore, LAA occlusion (LAAO) has emerged as
alternative approach for stroke prevention in those patients. Surgical
LAAO is associated with high rate of unsuccessful closure and recommended
only in patients with AF and undergoing cardiac surgery. Percutaneous LAAO
uses transvenous access with trans-septal puncture and was first tested
using the PLAATO device. Watchman is the most common and only Food and
Drug Administration (FDA) approved device for LAAO. LAAO using Watchman
device is non-inferior to warfarin therapy in preventing ischemic
stroke/systemic thromboembolism. However, it is associated with lower
rates of hemorrhagic stroke, bleeding and death. Amplatzer is another
successful LAAO device that has CE mark and is waiting for FDA approval.
Optimal antithrombotic therapy post LAAO is still under debate and highly
patient-specific. The aim of this paper is to systematically review the
current literature to evaluate the efficacy and safety of different LAAO
devices. Copyright ©The Author(s) 2019. Published by Baishideng
Publishing Group Inc. All rights reserved.

<44>
Accession Number
2001228443
Title
Intraoperative prediction of cardiac surgery-associated acute kidney
injury using urinary biomarkers of cell cycle arrest.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (4) (pp 1545-1553.e5),
2019. Date of Publication: April 2019.
Author
Cummings J.J.; Shaw A.D.; Shi J.; Lopez M.G.; O'Neal J.B.; Billings F.T.
Institution
(Cummings, Shaw, O'Neal, Billings) Division of Cardiothoracic
Anesthesiology, Department of Anesthesiology, Vanderbilt University
Medical Center, Nashville, Tenn, United States
(Lopez, Billings) Division of Critical Care Medicine, Department of
Anesthesiology, Vanderbilt University Medical Center, Nashville, Tenn,
United States
(Shi) Department of Statistics, Walker Bioscience, Carlsbad, Calif, United
States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Tissue inhibitor of metalloproteinases 2 (TIMP-2) and
insulin-like growth factor-binding protein 7 (IGFBP7) are postoperative
urinary biomarkers of renal stress and acute kidney injury (AKI). We
conducted this study to test the hypothesis that intraoperative
concentrations of urinary [TIMP-2].[IGFBP7] are associated with
postoperative AKI. Method(s): We measured urinary [TIMP-2].[IGFBP7]
at 8 perioperative timepoints in 400 patients who participated in a
randomized controlled trial of atorvastatin for AKI in cardiac surgery. We
compared [TIMP-2].[IGFBP7] between subjects who did and did not develop
KDIGO stage 2 or 3 AKI within 48 hours of surgery, adjusted for AKI risk
factors. Result(s): Fourteen patients (3.5%) met the primary endpoint
of stage 2 or 3 AKI within 48 hours of surgery, and an additional 77
patients (19.3%) developed stage 1 AKI. Patients who developed stage 2 or
3 AKI displayed bimodal elevations of [TIMP-2].[IGFBP7], with a first
elevation (median, 0.45 [ng/mL]2/1000) intraoperatively and a
second elevation (1.45 [ng/mL]2/1000) 6 hours postoperatively.
Patients who did not develop AKI did not have any elevations in
[TIMP-2].[IGFBP7]. Each 10-fold increase in intraoperative
[TIMP-2].[IGFBP7] was independently associated with a 290% increase in the
odds of stage 2 or 3 AKI (P =.01), and each 10-fold increase in the 6
hours postoperative [TIMP-2].[IGFBP7] was independently associated with a
650% increase in the odds of stage 2 or 3 AKI (P <.001). The maximum
[TIMP-2].[IGFBP7] between these 2 timepoints provided an area under the
receiver operating characteristic curve of 0.82 (95% confidence interval
[CI], 0.73-0.90), 100% sensitivity, and 100% negative predictive value
using the >0.3 cutoff to predict stage 2 or 3 AKI. Conclusion(s):
Intraoperative elevations of [TIMP-2].[IGFBP7] can predict moderate or
severe AKI and could provide an opportunity to alter postoperative
management to prevent kidney injury. Copyright © 2018 The
American Association for Thoracic Surgery

<45>
Accession Number
625544649
Title
Glycaemic efficacy and safety of linagliptin compared to a basal-bolus
insulin regimen in patients with type 2 diabetes undergoing non-cardiac
surgery: A multicentre randomized clinical trial.
Source
Diabetes, Obesity and Metabolism. 21 (4) (pp 837-843), 2019. Date of
Publication: April 2019.
Author
Vellanki P.; Rasouli N.; Baldwin D.; Alexanian S.; Anzola I.; Urrutia M.;
Cardona S.; Peng L.; Pasquel F.J.; Umpierrez G.E.; Bakhtiari H.; Wang
C.L.; Jones J.; Modzelewski K.; Ensminger E.; Haw J.S.; Fayfman M.; Ramos
C.; Gomez P.
Institution
(Vellanki, Anzola, Urrutia, Cardona, Pasquel, Umpierrez) Division of
Endocrinology, Metabolism and Lipids, Department of Medicine, Emory
University School of Medicine, Atlanta, GA, United States
(Rasouli) Division of Endocrinology, Metabolism and Diabetes, Department
of Medicine, University of Colorado-Denver, Denver, CO, United States
(Baldwin) Division of Endocrinology, Department of Medicine, Rush
University Medical Center, Chicago, IL, United States
(Alexanian) Division of Endocrinology, Diabetes and Nutrition, Department
of Medicine, Boston University, Boston, MA, United States
(Peng) Department of Biostatistics, Rollins School of Public Health, Emory
University, Atlanta, GA, United States
(Bakhtiari, Wang) University of Colorado, Division of Endocrinology,
United States
(Jones) Rush University, Division of Endocrinology, United States
(Modzelewski, Ensminger) Boston University, Division of Endocrinology,
United States
(Haw, Fayfman, Ramos, Gomez) Emory University, Division of Endocrinology,
Metabolism and Lipids, United States
Publisher
Blackwell Publishing Ltd
Abstract
Aims: The use of incretin-based therapy, rather than or complementary to,
insulin therapy is an active area of research in hospitalized patients
with type 2 diabetes (T2D). We determined the glycaemic efficacy and
safety of linagliptin compared to a basal-bolus insulin regimen in
hospitalized surgical patients with T2D. Material(s) and Method(s):
This prospective open-label multicentre study randomized T2D patients
undergoing non-cardiac surgery with admission blood glucose (BG) of 7.8 to
22.2 mmol/L who were under treatment with diet, oral agents or total
insulin dose (TDD) <= 0.5 units/kg/day to either linagliptin (n = 128)
daily or basal-bolus (n = 122) with glargine once daily and rapid-acting
insulin before meals. Both groups received supplemental insulin for BG >
7.8 mmol/L. The primary endpoint was difference in mean daily BG between
groups. Result(s): Mean daily BG was higher in the linagliptin group
compared to the basal-bolus group (9.5 +/- 2.6 vs 8.8 +/- 2.3 mmol/L/dL, P
= 0.03) with a mean daily BG difference of 0.6 mmol/L (95% confidence
interval 0.04, 1.2). In patients with randomization BG < 11.1 mmol/L (63%
of cohort), mean daily BG was similar in the linagliptin and basal-bolus
groups (8.9 +/- 2.3 vs 8.7 +/- 2.3 mmol/L, P = 0.43); however, patients
with BG >= 11.1 mmol/L who were treated with linagliptin had higher BG
compared to the basal-bolus group (10.9 +/- 2.6 vs 9.2 +/- 2.2 mmol/L, P <
0.001). Linagliptin resulted in fewer hypoglycaemic events (1.6% vs 11%, P
= 0.001; 86% relative risk reduction), with similar supplemental insulin
and fewer daily insulin injections (2.0 +/- 3.3 vs 3.1 +/- 3.3, P < 0.001)
compared to the basal-bolus group. Conclusion(s): For patients with
T2D undergoing non-cardiac surgery who presented with mild to moderate
hyperglycaemia (BG < 11.1 mmol/L), daily linagliptin is a safe and
effective alternative to multi-dose insulin therapy, resulting in similar
glucose control with lower hypoglycaemia. Copyright © 2018 John
Wiley & Sons Ltd

<46>
Accession Number
2001710882
Title
Prothrombin Complex Concentrate in Cardiac Surgery: A Systematic Review
and Meta-Analysis.
Source
Annals of Thoracic Surgery. 107 (4) (pp 1275-1283), 2019. Date of
Publication: April 2019.
Author
Roman M.; Biancari F.; Ahmed A.B.; Agarwal S.; Hadjinikolaou L.; Al-Sarraf
A.; Tsang G.; Oo A.Y.; Field M.; Santini F.; Mariscalco G.
Institution
(Roman, Mariscalco) Department of Cardiovascular Sciences, University of
Leicester, Glenfield Hospital, Leicester, United Kingdom
(Biancari) Heart Center, Turku University Hospital and University of
Turku, Turku, Finland
(Biancari) Department of Surgery, University of Oulu, Oulu, Finland
(Ahmed) Department of Anesthesia and Critical Care, Glenfield Hospital,
University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
(Agarwal) Department of Anesthesia, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
(Hadjinikolaou, Al-Sarraf, Mariscalco) Cardiac Surgery Unit, Glenfield
Hospital, University Hospitals of Leicester NHS Trust, Leicester, United
Kingdom
(Tsang) Cardiac Surgery Unit, University Hospital Southampton NHS
Foundation Trust, Southampton, United Kingdom
(Oo) Department of Cardiac Surgery, Barts Heart Centre, St. Bartholomew's
Hospital, London, United Kingdom
(Field) Department of Cardiac Surgery, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
(Santini) Department of Integrated Surgical and Diagnostic Sciences,
Division of Cardiac Surgery, University of Genoa, Italy
Publisher
Elsevier USA
Abstract
Background: Prothrombin complex concentrate (PCC) has recently emerged as
an effective alternative to fresh frozen plasma (FFP) in treating
excessive perioperative bleeding. This systematic review and meta-analysis
evaluated the safety and efficacy of PCC administration as first-line
treatment for coagulopathy after adult cardiac surgery. Method(s):
PubMed/MEDLINE, EMBASE, and the Cochrane Library were searched from
inception to the end of March 2018 to identify eligible articles. Adult
patients undergoing cardiac surgery and receiving perioperative PCC were
compared with patients receiving FFP. Result(s): A total of 861 adult
patients from four studies were retrieved. No randomized studies were
identified. Pooled odds ratios (ORs) showed that the PCC cohort was
associated with a significant reduction in the risk of RBC transfusion
(OR, 2.22; 95% confidence interval [CI], 1.45 to 3.40) and units of RBC
received (OR, 1.34; 95% CI, 0.78 to 1.90). No differences were observed
between the groups for reexploration for bleeding (OR, 1.09; 95% CI, 0.66
to 1.82), chest drain output at 24 hours (OR, 66.36; 95% CI, -82.40 to
216.11), hospital mortality (OR, 0.94; 95% CI, 0.59 to 1.49), stroke (OR,
0.80; 95% CI, 0.41 to 1.56), and occurrence of acute kidney injury (OR,
0.80; 95% CI, 0.58 to 1.12). A trend toward increased risk of renal
replacement therapy was observed in the PCC group (OR, 0.41; 95% CI, 0.16
to 1.02). Conclusion(s): In patients with significant bleeding after
cardiac surgery, PCC administration seems to be more effective than FFP in
reducing perioperative blood transfusions. No additional risks of
thromboembolic events or other adverse reactions were observed. Randomized
controlled trials are needed to establish the safety of PCC in cardiac
surgery definitively. Copyright © 2019 The Society of Thoracic
Surgeons

<47>
Accession Number
2001408332
Title
Disparities in death rates in women with peripartum cardiomyopathy between
advanced and developing countries: A systematic review and meta-analysis.
Source
Archives of Cardiovascular Diseases. 112 (3) (pp 187-198), 2019. Date of
Publication: March 2019.
Author
Kerpen K.; Koutrolou-Sotiropoulou P.; Zhu C.; Yang J.; Lyon J.-A.; Lima
F.V.; Stergiopoulos K.
Institution
(Kerpen, Stergiopoulos) Division of Cardiovascular Medicine, Department of
Medicine, Stony Brook University Medical Center, State University of New
York, Stony Brook, Nichols road, NY 11794, United States
(Koutrolou-Sotiropoulou) Division of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN 55905, United States
(Zhu) Department of Applied Mathematics and Statistics, Stony Brook
University, Stony Brook, NY 11794, United States
(Yang) Department of Family, Population and Preventive Medicine, Stony
Brook University Medical Center, Stony Brook, NY 11794, United States
(Lyon) Library Services, Children's Mercy Kansas City, Kansas City, MO
64108, United States
(Lima) Department of Medicine, Brown University, Rhode Island Hospital,
Providence, RI 02903, United States
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
There is limited information about differences in maternal deaths from
peripartum cardiomyopathy (PPCM) between advanced and developing
countries. To review the literature to define the global prevalence of
death from PPCM, and to determine the differences in PPCM mortality rates
and risk factors between advanced and developing countries. Studies in the
English language reporting mortality data on patients with PPCM were
included from searches of MEDLINE, Embase, CINAHL, the Cochrane Library,
the Web of Science Core Collection and Scopus from 01 January 2000 to 11
May 2016. Of the 4294 articles identified, 1.07% were included. The
primary outcome was death; rates of heart transplant, acute myocardial
infarction, heart failure, arrhythmia, cerebrovascular events, embolism
and cardiac arrest were recorded. Studies were categorized as having been
conducted in advanced or developing countries. Data from 46 studies, 4925
patients and 13 countries were included. There were 22 studies from
advanced countries (n = 3417) and 24 from developing countries (n = 1508);
mean follow-up was 2.6 (range 0-8.6) years. Overall mortality prevalence
was 9% (95% confidence interval [CI] 6-11%). The mortality rate in
developing countries (14%, 95% CI 10-18%) was significantly higher than
that in advanced countries (4%, 95% CI 2-7%). There was no difference in
the prevalence of risk factors (chronic hypertension, African descent,
multiple gestation and multiparity) between advanced and developing
countries. Studies with a higher prevalence of women of African descent
had higher death rates (correlation coefficient 0.29, 95% CI 0.13-0.52).
The risk of death in women with PPCM was higher in developing countries
than in advanced countries. Women of African descent had an increased risk
of death. Copyright © 2018 Elsevier Masson SAS

<48>
Accession Number
2001211034
Title
Prospective Trial of Low-Fidelity Deliberate Practice of Aortic and
Coronary Anastomoses (TECoG 002).
Source
Journal of Surgical Education. 76 (3) (pp 844-855), 2019. Date of
Publication: May - June 2019.
Author
Spratt J.R.; Brunsvold M.; Joyce D.; Nguyen T.; Antonoff M.; Loor G.
Institution
(Spratt) Department of Surgery, University of Minnesota, Minneapolis, MN,
United States
(Brunsvold) Division of Critical Care/Acute Care Surgery, Department of
Surgery, University of Minnesota, Minneapolis, MN, United States
(Joyce) Division of Cardiothoracic Surgery, Medical College of Wisconsin,
Milwaukee, WI, United States
(Nguyen) Department of Cardiothoracic and Vascular Surgery, University of
Texas Health Science Center at Houston, Houston, TX, United States
(Antonoff) Department of Thoracic and Cardiovascular Surgery, Division of
Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX,
United States
(Loor) Division of Cardiothoracic Surgery, Department of Surgery,
University of Minnesota, Minneapolis, MN, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: We sought to examine the feasibility of a home practice
curriculum of vascular anastomosis in cardiovascular surgery using a
low-fidelity simulation platform and to examine its effectiveness in skill
acquisition in senior surgical trainees. Design(s): We organized a
multicenter prospective randomized study of senior residents and fellows,
who were oriented to a low-fidelity cardiac simulator and an 8-week
curriculum of independent practice of aortic and coronary anastomosis.
"Treatment" trainees received a simulator and the curriculum. Control
trainees received only their usual operative experience. The groups then
crossed over; all were studied for 16 weeks in total. Video skill
assessments were captured at 0, 8, and 16 weeks and were scored by one
blinded investigator using the Joint Council on Thoracic Surgery Education
Assessment tool. A post-hoc survey was distributed to invited participants
following study completion. Setting(s): University of Minnesota
Department of Surgery, Mayo Clinic Department of Cardiovascular Surgery,
and the University of Texas Health Science Center at Houston. Participants
used the simulator in offices, call rooms, and their homes.
 Participant(s): Program participation in the study was solicited
through the Thoracic Education Cooperative Group. Four institutions
expressed interest and a total of 29 trainees were invited to the study
and randomized. Of these, 12 (38%) completed the curriculum and submitted
the requisite 3 sets of videos (6 treatment, 6 control). All were senior
residents and fellows in general and cardiothoracic surgery.
 Result(s): No significant differences were detected in assessment
scores before and after the curriculum nor before or after the control
period in the overall or postgraduate year-stratified populations.
Participant case numbers during the study did not have a significant
effect on assessment scores. Randomized participants reported strong
interest in deliberate practice of technical skills but identified
competing clinical and personal obligations and significant barriers to
simulation. Conclusion(s): Considerable variability in performance
existed among participants who completed the study, but overall, the
curriculum alone was insufficient to improve simulator Joint Council on
Thoracic Surgery Education scores compared to those not undergoing the
curriculum. Among senior residents and fellows, provision of a practice
curriculum and simulator for repeated practice is feasible but clinical
and personal responsibilities were barriers to repetitive
practice. Copyright © 2018 Association of Program Directors in
Surgery

<49>
Accession Number
2001581983
Title
Impact of Heparin- or Nonheparin-Coated Circuits on Platelet Function in
Pediatric Cardiac Surgery.
Source
Annals of Thoracic Surgery. 107 (4) (pp 1241-1247), 2019. Date of
Publication: April 2019.
Author
Giorni C.; Pezzella C.; Bojan M.; Ricci Z.; Pouard P.; Raisky O.; Tourneur
L.; La Salvia O.; Favia I.; Borgel D.; Cogo P.; Carotti A.; Lasne D.
Institution
(Giorni, Pezzella, Ricci, La Salvia, Favia, Cogo, Carotti) Pediatric
Intensive Care, Cardiac Surgery and Perfusion Unit, Bambino Gesu
Children's Hospital, Rome, Italy
(Bojan, Pouard) Department of Anesthesiology and Critical Care, Assistance
Publique-Hopitaux de Paris, Hopital Necker-Enfants Malades, Paris, France
(Raisky, Tourneur) Department of Pediatric Cardiac Surgery, Assistance
Publique-Hopitaux de Paris, Hopital Necker-Enfants Malades, Paris, France
(Borgel, Lasne) Hematology Laboratory, Assistance Publique-Hopitaux de
Paris, Hopital Necker-Enfants Malades, Paris, France
(Borgel, Lasne) Hemostase Inflammation Thrombose, Unite Mixte de Recherche
-S1176, Institut National de la Sante et de la Recherche Medicale,
University Paris-Sud, Universite Paris-Saclay, Le Kremlin-Bicetre, France
Publisher
Elsevier USA
Abstract
Background: Extracorporeal circuit coating has been shown to improve
coagulation derangements during pediatric cardiopulmonary bypass (CPB).
This study compared platelet function and hemostasis activation in
pediatric cardiac surgery conducted with nonheparin coating (Balance;
Medtronic, Minneapolis, MN) versus heparin-based coating (Carmeda;
Medtronic) circuits. Method(s): A prospective, randomized,
double-center trial was conducted in children older than 1 month
undergoing congenital heart disease treatment. Blood samples were
collected at baseline (T0), 15 minutes after the start of CPB (T1), and 15
minutes (T2) and 1 hour after the conclusion of CPB (T3). The primary end
point of the study was to detect potential differences in
beta-thromboglobulin levels between the two groups at T2. Other
coagulation and platelet function indicators were analyzed as secondary
end points. Result(s): The concentration of beta-thromboglobulin
increased significantly at T2 in both groups. However, there was no
significant difference between the groups across all time points. There
was no difference in the secondary end points between the groups.
 Conclusion(s): The two circuits showed similar biological effects on
platelet function and coagulation. This observation may be useful in
optimizing the conduct of CPB and in rationalizing its cost for the
treatment of congenital heart disease. Copyright © 2019 The
Society of Thoracic Surgeons

<50>
Accession Number
626845729
Title
INR targets for mechanical valves: A systematic review and meta-analysis.
Source
BMC Proceedings. Conference: 7th International Conference for Healthcare
and Medical Students, ICHAMS 2018. Ireland. 12 (Supplement 12) (no
pagination), 2018. Date of Publication: November 2018.
Author
Gupta S.; Belley-Cote E.; Sarkaria A.; Pandey A.; Spence J.; McClure G.;
Panchal P.; Jaffer I.; An K.; Eikelboom J.; Whitlock R.
Institution
(Gupta) McMaster University, Population Health Research Institute,
Hamilton General Hospital, Hamilton, ON, Canada
(Gupta, Belley-Cote) Department of Health Research Methods, Evidence, and
Impact, McMaster University, Hamilton, ON, Canada
(Belley-Cote, Jaffer, Whitlock) Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Belley-Cote, Spence, McClure, Whitlock) Population Health Research
Institute, Hamilton, ON, Canada
(Eikelboom) Queen's University Medical School, Kingston, ON, Canada
(Sarkaria, Eikelboom, Whitlock) Thrombosis and Atherosclerosis Research
Institute, Hamilton, ON, Canada
(Panchal, An) Department of Anesthesia, McMaster University, Hamilton, ON,
Canada
(Pandey, Jaffer) Michael DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(Spence) Faculty of Health Sciences, McMaster University, Hamilton, ON,
Canada
Publisher
BioMed Central Ltd.
Abstract
Introduction: Guidelines recommend higher INR targets for patients with
mechanical valves who are believed to be at higher risk for
thromboembolism. Higher INR targets are associated with increased bleeding
risk. We performed a systematic review and meta-analysis assessing effects
of lower and higher INR targets on thromboembolism and bleeding risk in
patients with mechanical heart valves. Method(s): We searched
Cochrane CENTRAL, MEDLINE and EMBASE for randomized controlled trials
(RCTs) and observational studies evaluating lower versus higher INR
targets for adults with bileaflet mechanical valves. We performed title
and abstract screening, full-text review, risk of bias evaluation, and
data collection independently and in duplicate. We evaluated overall
quality of evidence with the GRADE framework, and pooled data using a
random effects model. Result(s): We identified 6 RCTs (n = 5497) and
2 observational studies (n = 1195). In RCTs, lower INR targets were
associated with significantly less bleeding - 22% versus 40% - (RR 0.54,
95%CI 0.31, 0.93, p=0.03, very low quality). There was no difference in
thromboembolism - 2% in both groups (RR 1.28, 95%CI 0.88, 1.85, p=0.20,
very low quality) or mortality - 5.5% with lower INR targets versus 8.5%
(RR 1.00, 95%CI 0.82, 1.21, p=0.47, moderate quality). Observational
studies showed no significant differences in bleeding or thromboembolism,
whereas lower INR targets were associated with lower mortality (RR 0.56,
95%CI 0.49, 0.63, p<0.00001). Discussion(s): In patients with
bi-leaflet mechanical valves, lower INR targets appear to be associated
with lower bleeding risk when compared to higher INR targets without
compromising efficacy.

<51>
Accession Number
626846662
Title
Retained surgical gauze swab migration in a paraplegic patient: A case
report and literature review.
Source
Swiss Medical Weekly. Conference: 77th Annual Meeting of the Swiss
Orthopaedics. Switzerland. 147 (Supplement 223) (pp 66S), 2017. Date of
Publication: June 2017.
Author
Vogel R.; Ladurner A.; Rudin D.
Institution
(Vogel, Ladurner, Rudin) Kantonsspital St. Gallen KSSG, Switzerland
Publisher
EMH Swiss Medical Publishers Ltd.
Abstract
Introduction: Gossypiboma is a serious but uncommon complication of
surgical interventions. Most case reports and reviews refer to abdominal
or thoracic surgery. Retained postoperative foreign bodies in limb or
spine surgery are less commonly encountered. We present a case of
gossypiboma in a paraplegic patient originating from pararectal surgery
and detected 15 years after index surgery for infectious migration to the
left thigh. Method(s): We present an unusual clinical case and
performed a systematic literature review on the subject. Case
presentation: A 56-year-old paraplegic patient with complete sensory
deficit in both legs presented with signs of an infected haematoma at the
left thigh. At the time of surgical evacuation cotton tissue originating
from a surgical gauze swab was retrieved. After a thorough investigation
of the patient's medical history, polytrauma treatment consisting of
emergent laparotomy with abdominal gauze packing in 1986 and surgical
treatment of a fistulating pararectal abscess in 2001 were stated possible
origins of the intraoperative findings. Further surgical interventions
with a more extended approach were necessary. Another gauze tissue
conglomerate was found next to the ischial tuberosity, revealing the
surgical treatment of a pararectal abscess (developed from sacral
decubiti) as the origin of the retained gauze swabs. Conclusion(s):
Retained surgical gauze (RSG) swab is a serious and, due to medicolegal
reasons, underreported complication of surgical intervention. Diagnosis
can be challenging because patients may present with only vague symptoms.
In the presented case the patient remained asymptomatic for 15 years,
mainly due to his paraplegia. Prevention of RSG is far more important than
cure. Awareness of the problem, staff training and the use of preventive
measures as radiopaque labelled gauze swabs or monitored counting should
be mandatory in every surgical intervention.

<52>
Accession Number
2001707101
Title
Interventional Therapy Versus Medical Therapy for Secundum Atrial Septal
Defect: A Systematic Review (Part 2) for the 2018 AHA/ACC Guideline for
the Management of Adults With Congenital Heart Disease: A Report of the
American College of Cardiology/American Heart Association Task Force on
Clinical Practice Guidelines.
Source
Journal of the American College of Cardiology. 73 (12) (pp 1579-1595),
2019. Date of Publication: 2 April 2019.
Author
Oster M.; Bhatt A.B.; Zaragoza-Macias E.; Dendukuri N.; Marelli A.
Publisher
Elsevier USA
Abstract
Secundum atrial septal defect (ASD) is the most common adult congenital
heart defect and can present with wide variation in clinical findings.
With the intention of preventing morbidity and mortality associated with
late presentation of ASD, consensus guidelines have recommended surgical
or percutaneous ASD closure in adults with right heart enlargement, with
or without symptoms. The aim of the present analysis was to determine if
the protective effect of secundum ASD closure in adults could be qualified
by pooling data from published studies. A systematic review and
meta-analysis were performed by using EMBASE, MEDLINE (through PubMed),
and the Cochrane Library databases to assess the effect of secundum ASD
percutaneous or surgical closure in unoperated adults >=18 years of age.
Data were pooled across studies with the DerSimonian-Laird random-effects
model or a Bayesian meta-analysis model. Between-study heterogeneity was
assessed with Cochran's Q test. Bias assessment was performed with the
Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool, and statistical
risk of bias was assessed with Begg and Mazumdar's test and Egger's test.
A total of 11 nonrandomized studies met the inclusion criteria,
contributing 603 patients. Pooled analysis showed a protective effect of
ASD closure on New York Heart Association functional class and on right
ventricular systolic pressure, volumes, and dimensions. Two additional
studies comprising 652 patients were reviewed separately for mortality
outcome and primary outcome of interest because they did not meet the
inclusion criteria. Those studies showed that ASD closure was associated
with a weak protective effect on adjusted mortality rate but no
significant impact on atrial arrhythmias in patients >50 years of age.
Across all studies, there was significant heterogeneity between studies
for nearly all clinical outcomes. The overall body of evidence was limited
to observational cohort studies, the limitations of which make for
low-strength evidence. Even within the parameters of the included studies,
quality of evidence was further diminished by the lack of well-defined
clinical outcomes. In conclusion, pooled data analysis on the impact of
secundum ASD closure in adults was notably limited because of the lack of
randomized controlled trials in patients with only secundum ASD. The few
cohort studies in this population demonstrated improvement in functional
status and right ventricular size and function as shown by echocardiogram.
However, our findings suggest that at the time of this publication,
insufficient data are available to determine the impact of ASD repair on
mortality rate in adults. Copyright © 2019 American Heart
Association, Inc., and the American College of Cardiology Foundation

<53>
Accession Number
2001700472
Title
Effect of methylprednisolone on acute kidney injury in patients undergoing
cardiac surgery with a cardiopulmonary bypass pump: A randomized
controlled trial.
Source
CMAJ. 191 (9) (pp E247-E256), 2019. Date of Publication: 04 Mar 2019.
Author
Garg A.X.; Chan M.T.V.; Cuerden M.S.; Devereaux P.J.; Abbasi S.H.;
Hildebrand A.; Lamontagne F.; Lamy A.; Noiseux N.; Parikh C.R.; Perkovic
V.; Quantz M.; Rochon A.; Royse A.; Sessler D.I.; Shah P.J.; Sontrop J.M.;
Tagarakis G.I.; Teoh K.H.; Vincent J.; Walsh M.; Yared J.-P.; Yusuf S.;
Whitlock R.P.
Institution
(Garg, Cuerden, Sontrop) Division of Nephrology, Department of Medicine,
London Health Sciences Centre, London, ON, Canada
(Chan) Department of Anaesthesia and Intensive Care, Chinese University of
Hong Kong, Hong Kong, Hong Kong
(Devereaux, Walsh) Departments of Health Research Methods, Evidence, and
Impact, Medicine, McMaster University, Hamilton, ON, Canada
(Abbasi) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Hildebrand) Division of Nephrology, Department of Medicine, University of
Alberta, Edmonton, AB, Canada
(Lamontagne) Departement de medecine, Faculte de medecine et des Sciences
de la Sante, Universite de Sherbrooke, Sherbrooke, QC, Canada
(Lamy) Department of Surgery, McMaster University, Hamilton, ON, Canada
(Noiseux) Department of Cardiac Surgery, Universite de Montreal, Montreal,
QC, Canada
(Parikh) Division of Nephrology, Johns Hopkins School of Medicine,
Baltimore, MD, United States
(Perkovic) George Institute for Global Health, Sydney, Australia
(Quantz) Division of Cardiac Surgery, London Health Sciences Centre,
University Hospital, London, ON, Canada
(Rochon) Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
(Royse) Department of Surgery, University of Melbourne, Melbourne,
Australia
(Sessler) Department of Outcomes Research, Cleveland Clinic, Cleveland,
OH, United States
(Shah) Department of Cardiac Surgery, Princess Alexandra Hospital,
Brisbane, Australia
(Sontrop, Tagarakis) Department of Cardiovascular and Thoracic Surgery,
Aristotle University of Thessaloniki, Thessaloniki, Greece
(Teoh) Division of Cardiac Surgery, Southlake Regional Health Centre,
Newmarket, ON, Canada
(Vincent, Whitlock) Population Health Research Institute, Hamilton, ON,
Canada
(Yared) Department of Cardiothoracic Anesthesiology, Cleveland Clinic,
Cleveland, OH, United States
(Yusuf) Division of Cardiology, Department of Medicine, McMaster
University, Hamilton, ON, Canada
Publisher
Canadian Medical Association (1867 Alta Vista Drive, Ottawa KIG5W8,
Canada)
Abstract
BACKGROUND: Perioperative corticosteroid use may reduce acute kidney
injury. We sought to test whether methylprednisolone reduces the risk of
acute kidney injury after cardiac surgery. METHOD(S): We conducted a
prespecified substudy of a randomized controlled trial involving patients
undergoing cardiac surgery with cardiopulmonary bypass (2007-2014);
patients were recruited from 79 centres in 18 countries. Eligibility
criteria included a moderate-to-high risk of perioperative death based on
a preoperative score of 6 or greater on the European System for Cardiac
Operative Risk Evaluation I. Patients (n = 7286) were randomly assigned
(1:1) to receive intravenous methylprednisolone (250 mg at anesthetic
induction and 250 mg at initiation of cardiopulmonary bypass) or placebo.
Patients, caregivers, data collectors and outcome adjudicators were
unaware of the assigned intervention. The primary outcome was
postoperative acute kidney injury, defined as an increase in the serum
creatinine concentration (from the preoperative value) of 0.3 mg/dL or
greater (>= 26.5 micro mol/L) or 50% or greater in the 14-day period
after surgery, or use of dialysis within 30 days after surgery.
 RESULT(S): Acute kidney injury occurred in 1479/3647 patients (40.6%)
in the methylprednisolone group and in 1426/3639 patients (39.2%) in the
placebo group (adjusted relative risk 1.04, 95% confidence interval 0.96
to 1.11). Results were consistent across several definitions of acute
kidney injury and in patients with preoperative chronic kidney disease.
INTERPRETATION: Intraoperative corticosteroid use did not reduce the risk
of acute kidney injury in patients with a moderate-to-high risk of
perioperative death who had cardiac surgery with cardiopulmonary bypass.
Our results do not support the prophylactic use of steroids during
cardiopulmonary bypass surgery. Copyright © 2019 Joule Inc.

<54>
Accession Number
2001716430
Title
Impact of Chronic Kidney Disease on Decision Making and Management in
Transcatheter Aortic Valve Interventions.
Source
Canadian Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Hensey M.; Murdoch D.J.; Sathananthan J.; Wood D.A.; Webb J.G.
Institution
(Hensey, Murdoch, Sathananthan, Wood, Webb) Centre for Heart Valve
Innovation, St Paul's Hospital, University of British Columbia, Vancouver,
British Columbia, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The coexistence of chronic kidney disease (CKD) and severe aortic stenosis
(AS) is common, and the prevalence of both is rising. The 2 conditions are
inherently linked in that significant CKD may accelerate the development
of AS and severe AS may result in deteriorating kidney function. The
volume of and indications for transcatheter aortic valve implantation
(TAVI) procedures are ever-increasing, and there are many challenges that
need to be considered in patients with concomitant severe AS and CKD being
assessed for TAVI. Throughout the process of working these patients up for
definitive management of their valvular heart disease, the presence of CKD
impacts on diagnostic investigations, treatment decisions, and therapeutic
interventions. Herein we review the current literature regarding TAVI in
patients with CKD focusing on the decision-making process and specific
risks involved in TAVI and CKD. We also provide specific practical
strategies to best manage this challenging patient cohort. Copyright
© 2018

<55>
Accession Number
626668069
Title
Cardioplegia in paediatric cardiac surgery: A systematic review of
randomized controlled trials.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (1) (pp 144-150),
2019. Date of Publication: 01 Jan 2019.
Author
Drury N.E.; Yim I.; Patel A.J.; Oswald N.K.; Chong C.-R.; Stickley J.;
Jones T.J.
Institution
(Drury, Yim, Patel, Oswald, Stickley, Jones) Department of Paediatric
Cardiac Surgery, Birmingham Children's Hospital, Steelhouse Lane,
Birmingham B4 6NH, United Kingdom
(Drury) Institute of Cardiovascular Sciences, University of Birmingham,
Birmingham, United Kingdom
(Chong) Department of Physiology, Anatomy and Genetics, University of
Oxford, Oxford, United Kingdom
Publisher
Oxford University Press
Abstract
OBJECTIVES: Cardioplegia is the primary method for myocardial protection
during cardiac surgery. We conducted a systematic review of randomized
controlled trials of cardioplegia in children to evaluate the current
evidence base. METHOD(S): We searched MEDLINE, CENTRAL and LILACS and
manually screened retrieved references and systematic reviews to identify
all randomized controlled trials comparing cardioplegia solutions or
additives in children undergoing cardiac surgery published in any
language; secondary publications and those reporting inseparable adult
data were excluded. Two or more reviewers independently screened studies
for eligibility and extracted data; the Cochrane Risk of Bias tool was
used to assess for potential biases. RESULT(S): We identified 26
trials randomizing 1596 children undergoing surgery; all were
single-centre, Phase II trials, recruiting few patients (median 48,
interquartile range 30-99). The most frequent comparison was blood versus
crystalloid in 10 (38.5%) trials, and the most common end points were
biomarkers of myocardial injury (17, 65.4%), inotrope requirements (15,
57.7%) and length of stay in the intensive care unit (11, 42.3%). However,
the heterogeneity of patients, interventions and reported outcome measures
prohibited metaanalysis. Overall risk of bias was high in 3 (11.5%)
trials, unclear in 23 (88.5%) and low in none. CONCLUSION(S): The
current literature on cardioplegia in children contains no late phase
trials. The small size, inconsistent use of end points and low quality of
reported trials provide a limited evidence base to inform practice. A core
outcome set of clinically important, standardized, validated end points
for assessing myocardial protection in children should be developed to
facilitate the conduct of highquality, multicentre trials. Copyright
© The Author(s) 2018. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<56>
Accession Number
2001693337
Title
Transfusion of standard-issue packed red blood cells induces pulmonary
vasoconstriction in critically ill patients after cardiac surgery-A
randomized, double-blinded, clinical trial.
Source
PLoS ONE. 14 (3) (no pagination), 2019. Article Number: e0213000. Date of
Publication: March 2019.
Author
Baron-Stefaniak J.; Leitner G.C.; Kuntzel N.K.I.; Meyer E.L.; Hiesmayr
M.J.; Ullrich R.; Baron D.M.
Institution
(Baron-Stefaniak, Kuntzel, Hiesmayr, Ullrich, Baron) Department of
Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University
of Vienna, Vienna, Austria
(Leitner) Department of Blood Group Serology and Transfusion Medicine,
Medical University of Vienna, Vienna, Austria
(Meyer) Section for Medical Statistics, Center for Medical Statistics,
Informatics, and Intelligent Systems, Medical University of Vienna,
Vienna, Austria
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Experimental and volunteer studies have reported pulmonary
vasoconstriction during transfusion of packed red blood cells (PRBCs)
stored for prolonged periods. The primary aim of this study was to
evaluate whether transfusion of PRBCs stored over 21 days (standard-issue,
siPRBCs) increases pulmonary artery pressure (PAP) to a greater extent
than transfusion of PRBCs stored for less then 14 days (fresh, fPRBCs) in
critically ill patients following cardiac surgery. The key secondary aim
was to assess whether the pulmonary vascular resistance index (PVRI)
increases after transfusion of siPRBCs to a greater extent than after
transfusion of fPRBCs. Methods The study was performed as a single-center,
double-blinded, parallel-group, randomized clinical trial. Leukoreduced
PRBCs were transfused while continuously measuring hemodynamic parameters.
Systemic concentrations of syndecan-1 were measured to assess glycocalyx
injury. After randomizing 19 patients between January 2014 and June 2016,
the study was stopped due to protracted patient recruitment. Results Of 19
randomized patients, 11 patients were transfused and included in
statistical analyses. Eight patients were excluded prior to transfusion, 6
patients received fPRBCs (10+/-3 storage days), whereas 5 patients
received siPRBCs (33+/-4 storage days). The increase in PAP (7 +/-3 vs.
2+/-2 mmHg, P = 0.012) was greater during transfusion of siPRBCs than
during transfusion of fPRBCs. In addition, the change in PVRI (150+/-89
vs. -4+/-37 dynscm-5m2, P = 0.018) was greater after
transfusion of siPRBCs than after transfusion of fPRBCs. The increase in
PAP correlated with the change of systemic syndecan-1 concentrations at
the end of transfusion (R = 0.64,P = 0.034). Conclusion Although this
study is underpowered and results require verification in larger clinical
trials, our findings suggest that transfusion of siPRBCs increases PAP and
PVRI to a greater extent than transfusion of fPRBCs in critically ill
patients following cardiac surgery. Glycocalyx injury might contribute to
pulmonary vasoconstriction associated with transfusion of stored
blood. Copyright: © 2019 Baron-Stefaniak 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.

<57>
Accession Number
2001374431
Title
A randomized controlled trial evaluating general endotracheal anesthesia
versus monitored anesthesia care and the incidence of sedation-related
adverse events during ERCP in high-risk patients.
Source
Gastrointestinal Endoscopy. 89 (4) (pp 855-862), 2019. Date of
Publication: April 2019.
Author
Smith Z.L.; Mullady D.K.; Lang G.D.; Das K.K.; Hovis R.M.; Patel R.S.;
Hollander T.G.; Elsner J.; Ifune C.; Kushnir V.M.
Institution
(Smith, Mullady, Lang, Das, Patel, Hollander, Elsner, Kushnir) Division of
Gastroenterology, Washington University School of Medicine, St Louis, MO,
United States
(Hovis, Ifune) Department of Anesthesiology, Washington University School
of Medicine, St Louis, MO, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background and Aims: ERCP is a complex procedure often performed in
patients at high risk for sedation-related adverse events (SRAEs).
However, there is no current standard of care with regard to mode of
sedation and airway management during ERCP. The aim of this study was to
assess the safety of general endotracheal anesthesia (GEA) versus
propofol-based monitored anesthesia care (MAC) without endotracheal
intubation in patients undergoing ERCP at high risk for SRAEs.
 Method(s): Consecutive patients undergoing ERCP at high risk for
SRAEs at a single center were invited to participate in this randomized
controlled trial comparing GEA and MAC. Inclusion criteria were STOP-BANG
score >=3, abdominal ascites, body mass index >=35, chronic lung disease,
American Society of Anesthesiologists class >3, Mallampati class 4 airway,
and moderate to heavy alcohol use. Exclusion criteria were preceding EUS,
emergent ERCP, tracheostomy, unstable airway, gastric outlet obstruction
or delayed gastric emptying, and altered foregut anatomy. The primary
endpoint was composite incidence of SRAEs: hypoxemia, use of airway
maneuvers, hypotension requiring vasopressors, sedation-related procedure
interruption, cardiac arrhythmia, and respiratory failure. Secondary
outcomes included procedure duration, cannulation success, in-room time,
and immediate adverse events. Result(s): Two hundred patients (mean
age, 61.1 +/- 13.6 years; 36.5% women) were randomly assigned to GEA (n =
101) or MAC (n = 99) groups. Composite SRAEs were significantly higher in
the MAC group compared with the GEA group (51.5% vs 9.9%, P <.001). This
was primarily driven by the frequent need for airway maneuvers in the MAC
group. Additionally, ERCP was interrupted in 10.1% of patients in the MAC
group to convert to GEA because of respiratory instability refractory to
airway maneuvers (n = 8) or significant retained gastric contents (n = 2).
There were no statistically significant differences in cannulation,
in-room, procedure, or fluoroscopy times between the 2 groups. All
patients undergoing GEA were successfully extubated in the procedure room
at completion of ERCP, and Aldrete scores in recovery did not differ
between the 2 groups. There were no immediate adverse events.
 Conclusion(s): In patients at high risk for SRAEs undergoing ERCP,
sedation with GEA is associated with a significantly lower incidence of
SRAEs, without impacting procedure duration, success, recovery, or in-room
time. These data suggest that GEA should be used for ERCP in patients at
high risk for SRAEs (Clinical trial registration number:
NCT02850887.) Copyright © 2019

<58>
Accession Number
626733921
Title
Comparison of outcomes between fractional-flow-reserve- and
angiography-directed intervention in non-ST elevation acute coronary
syndrome.
Source
Journal of the College of Physicians and Surgeons Pakistan. 29 (3) (pp
268-273), 2019. Date of Publication: 01 Mar 2019.
Author
Jianjun Y.; Xiaohua P.; Xuemei T.; Gang H.; Hailong W.
Institution
(Jianjun, Xiaohua, Xuemei, Hailong) Department of Cardiology, Heart
Center, Chongqing Three Gorges Central Hospital, 165# Xincheng Road,
Wanzhou, Chongqing 404000, China
(Gang) Department of Cardiology, Suining Central Hospital, Suining,
Sichuan 629000, China
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Among the sick patients suffering from non-ST segment elevation acute
coronary syndrome (NSTEACS), the accuracy of fractional flow reserve
(FFR)-directed percutaneous coronary intervention (PCI) or coronary artery
bypass grafting (CABG) is still ambiguous. Studies were obtained from
PubMed, Embase, Wanfang Data, and Cochrane Library electronic statistics
from their initiation up to April 2018, to explore the differences between
the FFR-directed approach and the coronary angiography (CA)/stress
perfusion scintigraphy (SPS)-directed approach in the outcomes of NSTACS
patients. Odds ratio was determined for individual studies, quality
assessments, heterogeneity, and publishing bias analyses. In total, there
were 5 studies involving 1,366 patients (606 FFR patients and 760 CA
patients). Compared with CA, the collection of the studies indicated that
FFR had a lower incidence of myocardial infarction (MI) (OR, 0.61; 95% CI:
0.39-0.96; p <0.05). However, none showed important disparities in main
adverse cardiovascular events (MACE, OR, 0.74; 95% CI: 0.53-1.03; p=0.07),
all-cause death rate (OR, 0.83; 95% CI: 0.45-1.54; p = 0.56), and major
bleeding (OR, 1.00; 95%CI: 0.25-4.03; p=1). The FFR-directed management of
patients with NSTEACS had a close relationship with the serious decrease
in incidence of MI without statistical significance. Future large-scale
research, which is carried out at random and with a control, is needed to
confirm these conclusions. Copyright © 2019 Dustri-Verlag Dr.
Karl Feistle. All Rights Reserved.

<59>
Accession Number
626327954
Title
Diagnostic accuracy of dobutamine stress echocardiography in the detection
of cardiac allograft vasculopathy in heart transplant recipients: A
systematic review and meta-analysis study.
Source
Echocardiography. 36 (3) (pp 528-536), 2019. Date of Publication: March
2019.
Author
Elkaryoni A.; Abu-Sheasha G.; Altibi A.M.; Hassan A.; Ellakany K.; Nanda
N.C.
Institution
(Elkaryoni, Hassan) Division of Internal Medicine, University of Missouri
Kansas City, Kansas City, MO, United States
(Abu-Sheasha) Division of Biomedical Statistics and Medical Informatics,
Medical Research Institute, Alexandria University, Alexandria, Egypt
(Altibi) Division of Internal Medicine, Henry Ford Allegiance Health,
Jackson, MI, United States
(Ellakany) Division of Cardiovascular Disease, University of Alexandria
School of medicine, Alexandria, Egypt
(Nanda) Division of Cardiovascular Disease, University of Alabama at
Birmingham, Birmingham, AL, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Dobutamine stress echocardiography (DSE) is a well-established
imaging modality used to screen patients with mild-to-moderate risk for
coronary artery disease. In heart transplantation recipients, cardiac
allograft vasculopathy (CAV) is a common and lethal complication. The use
of DSE to detect CAV showed promising results initially, but later studies
showed limitation in its use to detect CAV. It is unclear if this cohort
of patients derives benefit from DSE. Method(s): We searched PubMed,
Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and
Scopus from inception through March 2018 for studies examining the
accuracy of DSE in correlation to coronary angiography (CA) or
intravascular ultrasound (IVUS) to detect CAV. Original studies comparing
the ability of DSE to detect CAV in comparison with CA or IVUS were
included. Relevant data were extracted and hierarchical summary receiver
operating characteristic analysis was conducted to test the overall
diagnostic accuracy of DSE for patients with CAV. Result(s): Eleven
studies (749 participants) met the inclusion criteria. The sensitivity of
DSE varied from 1.7% to 93.8%, and specificity, from 54.8% to 98.8%.
Pooled sensitivity was 60.2% (95% confidence interval (CI), 33.0%-82.3%)
and specificity 85.7% (95% CI, 73.8%-92.7%). DSE had an overall diagnostic
odds ratio (OR) of 9.1 (95% CI, 4.6-17.8), positive likelihood ratio (LR+)
of 4.1 (95% CI, 2.8-6.1), negative likelihood ratio (LR-) of 0.47 (95% CI:
0.23-0.73), and area under curve (AUC) of 0.73 (95% CI, 0.72-0.75).
Heterogeneity among studies was not statistically significant
(tau2= 0.32, Cochran's Q = 9.5, P = 0.483). Conclusion(s):
Dobutamine stress echocardiography has a limited sensitivity to detect
early CAV but its specificity is much higher. There remains a need for an
alternative noninvasive modality which will have both high sensitivity and
high specificity for detecting CAV. Copyright © 2019 Wiley
Periodicals, Inc.

<60>
Accession Number
2001645104
Title
Best practice in psychological activities in cardiovascular prevention and
rehabilitation: Position Paper.
Source
Monaldi Archives for Chest Disease. 88 (2) (pp 47-83), 2018. Date of
Publication: 2018.
Author
Sommaruga M.; Angelino E.; Porta P.D.; Abatello M.; Baiardo G.; Balestroni
G.; Bettinardi O.; Callus E.; Ciraci C.; Omodeo O.; Rizza C.; Michielin
P.; Ambrosetti M.; Griffo R.; Pedretti R.F.E.; Pierobon A.
Institution
(Sommaruga) Psychology Unit, Istituti Clinici Scientifici Maugeri IRCCS,
Via Camaldoli 64, Milan 20138, Italy
(Angelino) Psychology Unit, Istituti Clinici Scientifici Maugeri IRCCS,
Turin, Italy
(Porta) FERB Onlus Rehabilitation Center of Cernusco sul Naviglio, Milan,
Italy
(Abatello) Unit of Cardiology, University Health Agency, Trieste, Italy
(Baiardo) Cardiovascular Institute of Camogli, Genova, Italy
(Balestroni) Psychology Unit, Istituti Clinici Scientifici Maugeri IRCCS,
Veruno, Italy
(Bettinardi) Department of Mental Health and Addictive Behavior, Local
Health Authority, Piacenza, Italy
(Callus) Clinical Psychology Service, Polyclinic San Donato IRCCS, San
Donato Milanese, Milan, Italy
(Ciraci) Cardiovascular Prevention and Rehabilitation Unit, Don Carlo
Gnocchi Foundation, Parma, Italy
(Omodeo) Psychology Unit, Istituti Clinici Scientifici Maugeri IRCCS,
Pavia, Italy
(Rizza) Gruppo Multimedica Spa-IRCCS, Milan, Italy
(Michielin) Department of Psychology, University of Padua, Italy
(Ambrosetti) Cardiovascular Rehabilitation Unit, Le Terrazze Clinic,
Cunardo, Italy
(Griffo) Research and Educational Centre GICR-IACPR, Genoa, Italy
(Pedretti) Department of Cardiology, Istituti Clinici Scientifici Maugeri
IRCCS, Pavia, Italy
(Pierobon) Psychology Unit, Istituti Clinici Scientifici Maugeri IRCCS,
Montescano, Italy
Publisher
PAGEPress Publications (E-mail: info@pagepress.org )
Abstract
Recent guidelines on cardiovascular disease prevention suggest multimodal
behavioral interventions for psychosocial risk factors and referral for
psychotherapy in the case of clinically significant symptoms of depression
and anxiety overall. Accordingly, psychologists of the Italian Association
for Cardiovascular Prevention, Rehabilitation and Epidemiology
(GICR-IACPR) have reviewed the key components of psychological activities
in cardiovascular prevention and rehabilitation (CPR). The aim of this
study was to elaborate a position paper on the Non com best practice in
routine psychological activities in CPR based on efficacy, effectiveness
and sustainability. The steps followed were: i) a review of the latest
international guidelines and position papers; ii) analysis of the
evidence-based literature; iii) a qualitative analysis of the
psychological services operating in some reference Italian cardiac
rehabilitation facilities; iv) classification of the psychological
activities in CPR as low or high intensity based on the NICE Guidelines on
psychological interventions on anxiety and depression. We confirm the
existence of an association between depression, anxiety, social factors,
stress, personality and illness onset/outcome and coronary heart disease.
Evidence for an association between depression, social factors and disease
outcome emerges particularly for chronic heart failure. Some positive
psychological variables (e.g., optimism) are associated to illness
outcome. Evidence is reported on the impact of psychological activities on
'new' conditions which are now indicated for cardiac rehabilitation:
pulmonary hypertension, grown-up congenital heart, end-stage heart
failure, implantable cardioverter-defribrillator and mechanical
ventricular assist devices, frail and oldest-old patients, and end-of-life
care. We also report evidence related to caregivers. The Panel divided
evidence-based psychological interventions into: i) low intensity
(counseling, psycho-education, self-care, self-management, telemedicine,
self-help); or ii) high intensity (individual, couples and/or family and
group psychotherapy, such as stress management). The results show that
psychotherapy is consisting of cognitive-behavioral therapy (mainly),
interpersonal therapy, and short term psycho-dinamic therapy. The current
data further refine the working tools available for psychological
activities in CPR, giving clear directions about the choice of
interventions, which should be evidence-based and have at least a minimum
standard. This document provides a comprehensive update on new knowledge
and new paths for psychologists working in the CPR
settings. ©Copyright M. Sommaruga et al., 2018 Tipografia PI-ME
Editrice, Italy

<61>
Accession Number
626823153
Title
A randomized controlled trial to assess operator radiation exposure from
cardiac catheterization procedures using RAD BOARD with standard pelvic
shielding versus standard pelvic shielding alone.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2019.
Date of Publication: 2019.
Author
Suryadevara R.; Brown E.D.; Green S.M.; Scott T.D.; Nordberg C.M.;
Blankenship J.C.
Institution
(Suryadevara) Department of Cardiology, Harton Regional Medical Center,
Tullahoma, TN, United States
(Brown) Department of Cardiology, University of New Mexico, Albuquerque,
NM, United States
(Green, Scott, Blankenship) Department of Cardiology, Geisinger Medical
Center, Danville, PA, United States
(Nordberg) Department of Biomedical and Translational Informatics,
Geisinger Health System, Danville, PA, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: To study radiation exposure to the primary operator during
diagnostic cardiac catheterizations using a radio-dense RAD BOARD radial
access arm board. Background(s): The use of radial access for
catheterization in the United States has increased from 1% in 2007 to 41%
in 2018. Compared to femoral access, operator radiation exposure from
radial access is similar or higher. The RAD BOARD radio-dense radial
access arm board has been marketed as reducing radiation to operators by
44%. Material(s) and Method(s): We randomized 265 patients undergoing
catheterization via right radial access to standard pelvic lead drape
shielding (nonboard group) versus RAD BOARD in addition to pelvic drape
(board group). Operator radiation exposure was measured using Landauer
Microstar nanoDotTM badges worn by the operator. Result(s): Board and
nonboard groups were similar with respect to demographic and procedural
variables. Mean operator dose per case was higher in the board group
(.65mSieverts) than in the nonboard group (.56mSieverts, P < 0.0001). In
sub-group analyses, radiation doses were higher in the board group
compared to the nonboard group in patients across all body mass index
groups (P < 0.03). In multivariate analysis, operator dose correlated with
use of the RAD BOARD more closely than any other variable (P < 0.001).
Post hoc analysis of the table setup with RAD BOARD revealed that use of
RAD BOARD prevented placement of a shield normally inserted into the top
of the standard below-table shield. Conclusion(s): RAD BOARD with the
pelvic shield was associated with higher radiation exposure to the
operator compared with pelvic shield alone, likely due to inability to use
standard radiation shielding along with the RAD BOARD. Copyright
© 2019 Wiley Periodicals, Inc.

<62>
Accession Number
2001408918
Title
Systematic Review of Endovascular, Surgical, and Conservative Options for
Infectious Intracranial Aneurysms and Cardiac Considerations.
Source
Journal of Stroke and Cerebrovascular Diseases. 28 (3) (pp 838-844), 2019.
Date of Publication: March 2019.
Author
Ragulojan R.; Grupke S.; Fraser J.F.
Institution
(Ragulojan) UK College of Medicine, University of Kentucky, Lexington,
Kentucky, United Kingdom
(Grupke, Fraser) Department of Neurosurgery, College of Medicine,
University of Kentucky, Lexington, Kentucky, United Kingdom
(Grupke, Fraser) Department of Radiology, College of Medicine, University
of Kentucky, Lexington, Kentucky, United Kingdom
(Fraser) Department of Neurology, College of Medicine, University of
Kentucky, Lexington, Kentucky, United Kingdom
(Fraser) Department of Neuroscience, College of Medicine, University of
Kentucky, Lexington, Kentucky, United Kingdom
Publisher
W.B. Saunders
Abstract
Introduction: With rising rates of intravenous drug use, Infectious
Intracranial aneurysms (IIAs) are a relevant topic for investigation. We
performed a systematic review to better understand current practice
patterns and limits of current published literature. Method(s): 131
publications with a total of 499 patients (665 aneurysms) were included.
Of the 499 patients, 83 were single case reports, and 20.5% of the total
had multiple aneurysms. 35.8% of all aneurysms were ruptured. Of those
reporting treatment, options included conservative antibiotic therapy
(30.0%), open surgical intervention (31.1%), and endovascular occlusion
(31.8%). Chronologically, publication of IIAs has increased. Usage of
endovascular therapies has grown, while conservative and surgical
management have declined in the literature. Overall, 56.2% of aneurysms
for which conservative therapy was initiated eventually either underwent
intervention or death of patient occurred. Result(s): The issue of
cardiac valve surgery in relationship to aneurysm therapy was discussed in
20.8% (80 patients) of all 384 infectious endocarditis patients; of which
15.0% (12) underwent valve surgery before aneurysm treatment and 85.0
patients (68)% underwent valve surgery after aneurysm treatment. For 51 of
the patients where valve surgery followed aneurysm management, the
corresponding aneurysm treatment modality could be determined; 58.8% (30)
of whom were managed endovascularly. 32.7% (26) of all cases reporting
cardiac surgery details underwent cardiac surgery during their admission
with the IIA. Conclusion(s): Overall, increasing trend of
endovascular management of IIAs is evident, and a strong temporal
preference exhibited by providers to perform cardiac surgery subsequently
to IIA management. Copyright © 2018 National Stroke Association

<63>
Accession Number
2001214512
Title
Evidence for Cerebral Embolic Prevention in Transcatheter Aortic Valve
Implantation and Thoracic Endovascular Aortic Repair.
Source
Annals of Vascular Surgery. 55 (pp 292-306), 2019. Date of Publication:
February 2019.
Author
Lam H.T.; Kwong J.M.; Lam P.L.; Yeung W.L.; Chan Y.C.
Institution
(Lam, Kwong, Lam, Yeung) Li Ka Shing Faculty of Medicine, University of
Hong Kong, Pokfulam, Hong Kong SAR, Hong Kong
(Chan) Division of Vascular and Endovascular Surgery, Department of
Surgery, University of Hong Kong Medical Centre, Pokfulam, Hong Kong SAR,
Hong Kong
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Embolic stroke is a formidable complication of transcatheter
aortic valve implantation (TAVI) and thoracic endovascular aortic repair
(TEVAR). Mechanical strategies to reduce the risk of ischemic embolic
lesions include embolic protection devices (EPDs) and carbon dioxide
flushing (CDF). This study aims to assess the efficacy for EPD and CDF
uses in TAVI and TEVAR. Method(s): A literature review was performed
according to the Preferred Reporting Items for Systematic reviews and
Meta-Analysis. All searches were performed via PubMed, OvidSP, MEDLINE,
Web of Science Core Collection, and Cochrane Library. Conference abstracts
and proceedings were included. Those that were out of scope of interest
and review articles were excluded. Result(s): Eighteen studies
fulfilled the inclusion criteria of the 456 articles searched. Regarding
EPD use in TAVI, systematic review comparing EPD with no-EPD showed
smaller total volume of cerebral lesions and smaller volume per lesion in
patients with EPD in all studies. They also performed better in
postoperative neurocognitive assessments but could not demonstrate
clinical prevention of embolic stroke in all studies. While for EPD use in
TEVAR, capture of embolic debris and absence of early postoperative
neurocognitive deficit were demonstrated in all cases of 2 prospective
pilot studies. Concerning CDF in TEVAR, significant reduction in gaseous
emboli released during stent-graft deployment was shown by 1 in vitro
study. Successful CDF application in all patients, with only 1 case of
postoperative nondisabling stroke, was also demonstrated by 1 cohort
study. Conclusion(s): This systematic review of medical literature
has demonstrated the safety and feasibility of EPD use in TAVI. Although
improvements in clinical outcomes have yet been demonstrated, there was
level I evidence showing reduced embolic lesions in imaging. The use of
EPD and CDF in TEVAR was suggested, but evidence remained inadequate to
support routine clinical use. Copyright © 2018 Elsevier Inc.

<64>
Accession Number
623636185
Title
A comparison of haemostatic biomarkers during low-risk patients undergoing
cardiopulmonary bypass using either conventional centrifugal cell salvage
or the HemoSep device.
Source
Perfusion (United Kingdom). 34 (1) (pp 76-83), 2019. Date of Publication:
01 Jan 2019.
Author
Boyle G.; Kuffel A.; Parmar K.; Gibson K.; Smith M.; Grehan A.; Hunt B.J.;
Chambers D.J.
Institution
(Boyle, Grehan) Clinical Perfusion Department, Guy's and St Thomas' NHS
Foundation Trust, St Thomas' Hospital, United Kingdom
(Kuffel, Parmar, Hunt) Thrombosis & Vascular Biology Group, The Rayne
Institute, United Kingdom
(Gibson, Smith) Cardiovascular Research, Guy's and St Thomas' NHS
Foundation Trust, St Thomas' Hospital, United Kingdom
(Hunt) Thrombosis & Haemophilia, Guy's & St Thomas' NHS Foundation Trust,
St Thomas' Hospital, United Kingdom
(Chambers) Cardiothoracic Surgery/Cardiac Surgical Research, The Rayne
Institute, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital,
United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Cardiac surgery using cardiopulmonary bypass (CPB) is
associated with a coagulopathy due to haemodilution, thrombocytopenia and
platelet dysfunction and the activation of coagulation and fibrinolysis,
despite the use of large doses of unfractionated heparin. Conventional red
cell salvage may exacerbate post-operative bleeding as plasma containing
haemostatic factors is discarded. We hypothesized that a novel cell
salvage device (HemoSep) may attenuate haemostatic changes associated with
red cell salvage. We studied haemostatic markers following autologous
transfusion from conventional cell salvage or the HemoSep device.
 Method(s): This randomised, controlled trial compared haemostatic
markers in patients undergoing coronary artery bypass grafting or aortic
valve replacement who received autologous blood returned from cell salvage
(control) or HemoSep (study). Blood samples were taken pre-operatively,
end of CPB, post-transfusion of salvaged blood and 3 hours
post-operatively and analysed for full blood count (FBC), prothrombin time
(PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer
and endogenous thrombin potential (ETP). Result(s): Fifty-four
patients were recruited (n=28 control, n=26 study). Processed blood volume
for transfusion was significantly (p<0.001) higher in the HemoSep group.
In the HemoSep group, the PT was shorter (18.7+/-0.3 vs 19.9+/-0.3 sec;
p<0.05) post-operatively and the aPTT was longer (48.6+/-3.8 vs 37.3+/-1.0
sec; p<0.01) following autologous transfusion. In the control group,
D-dimer and ETP levels were higher (1903+/-424 vs.1088+/-151; p<0.05 and
739+/-46 vs. 394+/-60; p<0.001, respectively) following autologous
transfusion. Conclusion(s): Although centrifuged cell salvage is
known to adequately haemoconcentrate and remove unwanted substrates and
bacteriological contamination, the process can exacerbate coagulopathy.
The HemoSep device demonstrated some increase in haemostatic markers when
used in low-risk cardiac surgery patients. Copyright © The
Author(s) 2018.

<65>
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.

<66>
Accession Number
2001031886
Title
A randomized clinical trial evaluating negative pressure therapy to
decrease vascular groin incision complications.
Source
Journal of Vascular Surgery. 68 (6) (pp 1744-1752), 2018. Date of
Publication: December 2018.
Author
Kwon J.; Staley C.; McCullough M.; Goss S.; Arosemena M.; Abai B.;
Salvatore D.; Reiter D.; DiMuzio P.
Institution
(Kwon, Staley, McCullough, Goss, Arosemena, Abai, Salvatore, Reiter,
DiMuzio) Division of Vascular and Endovascular Surgery, Thomas Jefferson
University Hospital, Philadelphia, Pa, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Vascular groin incision complications contribute significantly
to patients' morbidity and rising health care costs. Negative pressure
therapy over the closed incision decreases the infection rate in cardiac
and orthopedic procedures. This study prospectively evaluated negative
pressure therapy as a means to decrease wound complications and associated
health care costs. Method(s): This was a randomized, prospective,
single-institution study of 119 femoral incisions closed primarily after
elective vascular surgery including both inflow (eg, aortofemoral) and
outflow (eg, femoral-popliteal bypass) procedures. Incisions were
categorized as high risk for wound complications on the basis of body mass
index >30 kg/m2, pannus, reoperation, prosthetic graft, poor
nutrition, immunosuppression, or hemoglobin A<inf>1c</inf> >8% and
randomized 1:1 to standard gauze (n = 60) dressing vs negative pressure
therapy (Prevena [Acelity, San Antonio, Tex], n = 59). Wound complication
rate, length of stay (LOS), reoperation, readmission, and variable
hospital costs were determined during 30 days. Statistical analysis was
performed using chi2 test along with a two-sample unpaired
t-test for continuous variables. Result(s): There were no significant
demographic differences (age, sex, risk factors for wound complication)
between the two high-risk groups. In low-risk controls, the major wound
complication rate was 4.8% (involving one infection in 21 incisions),
resulting in a 3.8-day LOS, 4.8% reoperation, 4.8% readmission rate, and
$17,599 in average variable cost. For high-risk controls, there was a
significant increase in major wound complications to 25% (including all 12
infections in 60 incisions), LOS (10.6 days), reoperation (18.3%),
readmission (16.7%), and costs ($36,537). Finally, negative pressure
therapy significantly reduced major wound complications to 8.5% (including
five of six infections in 59 incisions; P <.001), reoperation (8.5%; P
<.05), and readmission (6.8%; P <.04) but not LOS (10.6 days). The average
variable cost was reduced ($30,492), yielding an average savings of $6045
per patient (P =.11). Conclusion(s): This study suggests that
negative pressure therapy significantly reduces the major wound
complication, reoperation, and readmission rates for patients at high risk
for groin wound complications. Furthermore, this therapy may lead to a
reduction in hospital costs. Negative pressure therapy for all groin
incisions considered at high risk for wound complications is
recommended. Copyright © 2018 Society for Vascular Surgery

<67>
Accession Number
624713826
Title
Graduated compression stockings for prevention of deep vein thrombosis.
Source
Cochrane Database of Systematic Reviews. 2018 (11) (no pagination), 2018.
Article Number: CD001484. Date of Publication: 03 Nov 2018.
Author
Sachdeva A.; Dalton M.; Lees T.
Institution
(Sachdeva) Newcastle University, Wellcome Centre for Mitochondrial
Research, Cookson Building, Medical School, Framlington Place, Newcastle
upon Tyne NE2 4HH, United Kingdom
(Dalton) Royal Victoria Infirmary, Department of Anaesthetics, Queen
Victoria Road, Newcastle upon Tyne, Tyne and Wear NE1 4LP, United Kingdom
(Lees) NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Hospitalised patients are at increased risk of developing deep
vein thrombosis (DVT) in the lower limb and pelvic veins, on a background
of prolonged immobilisation associated with their medical or surgical
illness. Patients with DVT are at increased risk of developing a pulmonary
embolism (PE). The use of graduated compression stockings (GCS) in
hospitalised patients has been proposed to decrease the risk of DVT. This
is an update of a Cochrane Review first published in 2000, and last
updated in 2014. Objective(s): To evaluate the effectiveness and
safety of graduated compression stockings in preventing deep vein
thrombosis in various groups of hospitalised patients. Search
Method(s): For this review the Cochrane Vascular Information Specialist
searched the Cochrane Vascular Specialised Register, the Cochrane Central
Register of Controlled Trials (CENTRAL), and trials registries on 21 March
2017; and the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE
Ovid, Embase Ovid, CINAHL Ebsco, AMED Ovid , and trials registries on 12
June 2018. Selection Criteria: Randomised controlled trials (RCTs)
involving GCS alone, or GCS used on a background of any other DVT
prophylactic method. We combined results from both of these groups of
trials. Data Collection and Analysis: Two review authors (AS, MD)
assessed potentially eligible trials for inclusion. One review author (AS)
extracted the data, which a second review author (MD) cross-checked and
authenticated. Two review authors (AS, MD) assessed the methodological
quality of trials with the Cochrane 'Risk of bias' tool. Any disagreements
were resolved by discussion with the senior review author (TL). For
dichotomous outcomes, we calculated the Peto odds ratio and corresponding
95% confidence interval. We pooled data using a fixed-effect model. We
used the GRADE system to evaluate the overall quality of the evidence
supporting the outcomes assessed in this review. Main Result(s): We
included 20 RCTs involving a total of 1681 individual participants and
1172 individual legs (2853 analytic units). Of these 20 trials, 10
included patients undergoing general surgery; six included patients
undergoing orthopaedic surgery; three individual trials included patients
undergoing neurosurgery, cardiac surgery, and gynaecological surgery,
respectively; and only one trial included medical patients. Graduated
compression stockings were applied on the day before surgery or on the day
of surgery and were worn up until discharge or until the participants were
fully mobile. In the majority of the included studies DVT was identified
by the radioactive I125 uptake test. Duration of follow-up
ranged from seven to 14 days. The included studies were at an overall low
risk of bias. We were able to pool the data from 20 studies reporting the
incidence of DVT. In the GCS group, 134 of 1445 units developed DVT (9%)
in comparison to the control group (without GCS), in which 290 of 1408
units developed DVT (21%). The Peto odds ratio (OR) was 0.35 (95%
confidence interval (CI) 0.28 to 0.43; 20 studies; 2853 units;
high-quality evidence), showing an overall effect favouring treatment with
GCS (P < 0.001). Based on results from eight included studies, the
incidence of proximal DVT was 7 of 517 (1%) units in the GCS group and 28
of 518 (5%) units in the control group. The Peto OR was 0.26 (95% CI 0.13
to 0.53; 8 studies; 1035 units; moderate-quality evidence) with an overall
effect favouring treatment with GCS (P < 0.001). Combining results from
five studies, all based on surgical patients, the incidence of PE was 5 of
283 (2%) participants in the GCS group and 14 of 286 (5%) in the control
group. The Peto OR was 0.38 (95% CI 0.15 to 0.96; 5 studies; 569
participants; low-quality evidence) with an overall effect favouring
treatment with GCS (P = 0.04). We downgraded the quality of the evidence
for proximal DVT and PE due to low event rate (imprecision) and lack of
routine screening for PE (inconsistency). We carried out subgroup analysis
by speciality (surgical or medical patients). Combining results from 19
trials focusing on surgical patients, 134 of 1365 (9.8%) units developed
DVT in the GCS group compared to 282 of 1328 (21.2%) units in the control
group. The Peto OR was 0.35 (95% CI 0.28 to 0.44; high-quality evidence),
with an overall effect favouring treatment with GCS (P < 0.001). Based on
results from seven included studies, the incidence of proximal DVT was 7
of 437 units (1.6%) in the GCS group and 28 of 438 (6.4%) in the control
group. The Peto OR was 0.26 (95% CI 0.13 to 0.53; 875 units;
moderate-quality evidence) with an overall effect favouring treatment with
GCS (P < 0.001). We downgraded the evidence for proximal DVT due to low
event rate (imprecision). Based on the results from one trial focusing on
medical patients admitted following acute myocardial infarction, 0 of 80
(0%) legs developed DVT in the GCS group and 8 of 80 (10%) legs developed
DVT in the control group. The Peto OR was 0.12 (95% CI 0.03 to 0.51;
low-quality evidence) with an overall effect favouring treatment with GCS
(P = 0.004). None of the medical patients in either group developed a
proximal DVT, and the incidence of PE was not reported. Limited data were
available to accurately assess the incidence of adverse effects and
complications with the use of GCS as these were not routinely
quantitatively reported in the included studies. Authors' conclusions:
There is high-quality evidence that GCS are effective in reducing the risk
of DVT in hospitalised patients who have undergone general and orthopaedic
surgery, with or without other methods of background thromboprophylaxis,
where clinically appropriate. There is moderate-quality evidence that GCS
probably reduce the risk of proximal DVT, and low-quality evidence that
GCS may reduce the risk of PE. However, there remains a paucity of
evidence to assess the effectiveness of GCS in diminishing the risk of DVT
in medical patients. Copyright © 2018 The Cochrane Collaboration.

<68>
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

<69>
Accession Number
620258769
Title
Randomized comparison of novel biodegradable polymer and durable
polymer-coated cobalt-chromium sirolimus-eluting stents: Three-Year
Outcomes of the I-LOVE-IT 2 Trial.
Source
Catheterization and Cardiovascular Interventions. 91 (Supplement 1) (pp
608-616), 2018. Date of Publication: 15 Feb 2018.
Author
Song L.; Li J.; Guan C.; Jing Q.; Lu S.; Yang L.; Xu K.; Yang Y.; Xu B.;
Han Y.
Institution
(Song, Yang) Department of Cardiology, Fu Wai Hospital, National Center
for Cardiovascular Diseases, Beijing, China
(Li, Jing, Xu, Han) Department of Cardiology, General Hospital of Shenyang
Military Region, Shenyang, China
(Guan, Xu) Catheterization Laboratory, Fu Wai Hospital, National Center
for Cardiovascular Diseases, Beijing, China
(Lu) Department of Cardiology, Affiliated Anzhen Hospital of Capital
Medical University, Beijing, China
(Yang) Department of Cardiology, Kunming General Hospital of Chengdu
Military Region, Kunming, China
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We aimed to compare the long-term outcomes of the novel
biodegradable polymer cobalt-chromium sirolimus-eluting stent (BP-SES)
versus the durable polymer sirolimus-eluting stent (DP-SES) in the
I-LOVE-IT2 trial. Background(s): Comparisons of the long-term safety
and efficiency of the BP-DES versus the DP-DES are limited.
 Method(s): A total of 2,737 patients eligible for coronary stenting
were randomized to the BP-SES or DP-SES group at a 2:1 ratio. The primary
endpoint of target lesion failure (TLF) was defined as a composite of
cardiac death, target vessel myocardial infarction (MI), or clinically
indicated target lesion revascularization. Result(s): A three-year
clinical follow-up period was available for 2,663 (97.3%) patients. There
were no significant differences in TLF (8.9% vs. 8.6%, P = 0.81),
patient-oriented composite endpoint (PoCE) (15.2% vs.14.5%, P = 0.63), or
individual components between the BP-SES and DP-SES. Definite/probable
stent thrombosis (ST) was low and similar at 3 years (0.8% vs. 1.0%, P =
0.64). Landmark analysis of 1-3 years showed that the TLF (2.7% vs. 2.6%,
P = 0.81), PoCE (6.2% vs. 5.1%, P = 0.28), and definite/probable ST (0.4%
vs. 0.4%, P = 1.00) were comparable between the 2 arms.
 Conclusion(s): In this prospective randomized trial, the BP-SES
showed similar clinical results versus the DP-SES in terms of safety and
efficacy outcomes over a 3-year follow-up period. Copyright ©
2018 Wiley Periodicals, Inc.

<70>
Accession Number
622602737
Title
Impact of surgical pulmonary valve replacement on ventricular strain and
synchrony in patients with repaired tetralogy of Fallot: A cardiovascular
magnetic resonance feature tracking study.
Source
Journal of Cardiovascular Magnetic Resonance. 20 (1) (no pagination),
2018. Article Number: 37. Date of Publication: 18 Jun 2018.
Author
Balasubramanian S.; Harrild D.M.; Kerur B.; Marcus E.; Del Nido P.; Geva
T.; Powell A.J.
Institution
(Balasubramanian, Harrild, Kerur, Marcus, Geva, Powell) Department of
Cardiology, Boston Children's Hospital, Boston, United States
(Balasubramanian, Harrild, Marcus, Geva, Powell) Department of Pediatrics,
Harvard Medical School, Boston, United States
(Del Nido) Department of Cardiac Surgery, Boston Children's Hospital,
Boston, United States
(Del Nido) Department of Surgery, Boston Children's Hospital, Boston,
United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: In patients with repaired tetralogy of Fallot (TOF), a better
understanding of the impact of surgical pulmonary valve replacement (PVR)
on ventricular mechanics may lead to improved indications and outcomes.
Therefore, we used cardiovascular magnetic resonance (CMR) feature
tracking analysis to quantify ventricular strain and synchrony in repaired
TOF patients before and after PVR. Method(s): Thirty-six repaired TOF
patients (median age 22.4 years) prospectively underwent CMR a mean of 4.5
+/- 3.8 months before PVR surgery and 7.3 +/- 2.1 months after PVR
surgery. Feature tracking analysis on cine steady-state free precession
images was used to measure right ventricular (RV) and left ventricular
(LV) circumferential strain from short-axis views at basal,
mid-ventricular, and apical levels; and longitudinal strain from 4-chamber
views. Intraventricular synchrony was quantified using the maximum
difference in time-to-peak strain, the standard deviation of the
time-to-peak, and cross correlation delay (CCD) metrics; interventricular
synchrony was assessed using the CCD metric. Result(s): Following
PVR, RV end-diastolic volume, end-systolic volume, and ejection fraction
declined, and LV end-diastolic volume and end-systolic volume both
increased with no significant change in the LV ejection fraction. LV
global basal and apical circumferential strains, and basal synchrony
improved. RV global circumferential and longitudinal strains were
unchanged, and there was a varied impact on synchrony across the
locations. Interventricular synchrony worsened at the midventricular level
but was unchanged at the base and apex, and on 4-chamber views.
 Conclusion(s): Surgical PVR in repaired TOF patients led to improved
LV global strain and no change in RV global strain. LV and RV synchrony
parameters improved or were unchanged, and interventricular synchrony
worsened at the midventricular level. Copyright © 2018 The
Author(s).

<71>
Accession Number
620701991
Title
Quality of life, satisfaction and outcomes after ministernotomy versus
full sternotomy isolated aortic valve replacement (QUALITY-AVR): Study
protocol for a randomised controlled trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 114. Date of
Publication: 17 Feb 2018.
Author
Rodriguez-Caulo E.A.; Guijarro-Contreras A.; Otero-Forero J.; Mataro M.J.;
Sanchez-Espin G.; Guzon A.; Porras C.; Such M.; Ordonez A.; Melero-Tejedor
J.M.; Jimenez-Navarro M.
Institution
(Rodriguez-Caulo, Guijarro-Contreras, Otero-Forero, Mataro, Sanchez-Espin,
Guzon, Porras, Such, Melero-Tejedor, Jimenez-Navarro) UGC Area del
Corazon. Servicio de Cirugia Cardiovascular y Cardiologia. Hospital, Univ.
Virgen de Vic de Malaga, Fund. Publica Andaluza para Invest. de Malaga en
Biomedicina y Salud, Universidad de Malaga. Spain. CIBERCV Enfermedades
Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
(Ordonez) UGC Area del Corazon, Servicio de Cirugia Cardiovascular,
Hospital Universitario Virgen del Rocio de Sevilla, Red de Investigacion
Cardiovascular (RIC), Instituto de Salud Carlos III, Madrid, Spain
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: During the last decade, the use of ministernotomy in cardiac
surgery has increased. Quality of life and patient satisfaction after
ministernotomy have never been compared to conventional full sternotomy in
randomised trials. The aim of the study is to determine if this minimally
invasive approach improves quality of life, satisfaction and clinical
morbimortality outcomes. Methods/design: The QUALITY-AVR trial is a
single-blind, single-centre, independent, and pragmatic randomised
clinical trial comparing ministernotomy ("J" shaped upper hemisternotomy
toward right 4th intercostal space) to full sternotomy in patients with
isolated severe aortic stenosis scheduled for elective aortic valve
replacement. One hundred patients will be randomised in a 1:1
computational fashion. Sample size was determined for the primary end
point with alpha error of 0.05 and with power of 90% in detecting
differences between intervention groups of >=0.10 points in change from
baseline quality of life Questionnaire EuroQOL-index (EQ-5D-5L), measured
at 1, 6 or 12months. Secondary endpoints are: the differences in change
from other baseline EQ-5D-5L utilities (visual analogue scale, Health
Index and Severity Index), cardiac surgery specific satisfaction
questionnaire (SATISCORE), a combined safety endpoint of four major
adverse complications at 1month (all-cause mortality, acute myocardial
infarction, neurologic events and acute renal failure), bleeding through
drains within the first 24h, intubation time, postoperative hospital and
intensive care unit length of stay, transfusion needs during the first 72h
and 1-year survival rates. Clinical follow up is scheduled at baseline, 1,
6, and 12months after randomization. All clinical outcomes are recorded
following the Valve Academic Research Consortium 2 criteria.
 Discussion(s): The QUALITY-AVR trial aims to test the hypothesis that
ministernotomy improves quality of life, satisfaction and clinical
outcomes in patients referred for isolated aortic valve replacement.
Statistically significant differences favouring ministernotomy could
modify the surgical "gold standard" for aortic stenosis surgery, and
subsequently the need to change the control group in transcatheter aortic
valve implantation trials. Recruitment started on 18 March 2016. In
November 2017, 75 patients were enrolled. Copyright © 2018 The
Author(s).

<72>
Accession Number
623684675
Title
Cardiovascular magnetic resonance in heart transplant patients: Diagnostic
value of quantitative tissue markers: T2 mapping and extracellular volume
fraction, for acute rejection diagnosis.
Source
Journal of Cardiovascular Magnetic Resonance. 20 (1) (no pagination),
2018. Article Number: 59. Date of Publication: 27 Aug 2018.
Author
Vermes E.; Pantaleon C.; Auvet A.; Cazeneuve N.; Machet M.C.; Delhommais
A.; Bourguignon T.; Aupart M.; Brunereau L.
Institution
(Vermes, Pantaleon, Auvet, Bourguignon, Aupart) Department of
Cardiothoracic Surgery, University Francois Rabelais, Tours, France
(Vermes, Cazeneuve, Delhommais, Brunereau) Department of Radiology,
University Francois Rabelais, Tours, France
(Machet) Department of Anatomopathology, University Francois Rabelais,
Tours, France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The diagnosis of acute rejection in cardiac transplant
recipients requires invasive technique with endomyocardial biopsy (EMB)
which has risks and limitations. Cardiovascular magnetic resonance imaging
(CMR) with T2 and T1 mapping is a promising technique for characterizing
myocardial tissue. The purpose of the study was to evaluate T2, T1 and
extracellular volume fraction (ECV) quantification as novel tissue markers
to diagnose acute rejection. Method(s): CMR was prospectively
performed in 20 heart transplant patients providing 31 comparisons
EMB-CMR. CMR was performed close to EMB. Images were acquired on a 1.5
Tesla scanner including T2 mapping (T2 prepared balanced steady state free
precession) and T1 mapping (modified Look-Locker inversion recovery
sequences: MOLLI) at basal, mid and apical level in short axis view.
Global and segmental T2 and T1 values were measured before and 15 min (for
T1 mapping) after contrast administration. Result(s): Acute rejection
was diagnosed in seven patients: six cellular rejections (4 grade IR, 2
grade 2R) and one antibody mediated rejection. Patients with acute
rejection had significantly higher global T2 values at 3 levels: 58.5 ms
[55.0-60.3] vs 51.3 ms [49.5-55.2] (p = 0.007) at basal; 55.7 ms
[54.0-59.7] vs 51.8 ms [50.1-53.6] (p = 0.002) at median and 58.2 ms
[54.0-63.7] vs 53.6 ms [50.8-57.4] (p = 0.026) at apical level. The area
under the curve (AUC) for each level was 0.83, 0.79 and 0.78 respectively.
Patients with acute rejection had significantly higher ECV at basal level:
34.2% [32.8-37.4] vs 27.4% [24.6-30.6] (p = 0.006). The AUC for basal
level was 0.84. The sensitivity, specificity and diagnosis accuracy for
basal T2 (cut off: 57.7 ms) were 71, 96 and 90% respectively; and for
basal ECV: (cut off 32%) were 86, 85 and 85% respectively. Combining basal
T2 and basal ECV allowed diagnosing all acute rejection and avoiding 63%
of EMB. Conclusion(s): In heart transplant patients, a combined CMR
approach using T2 mapping and ECV quantification provides a high
diagnostic accuracy for acute rejection diagnosis and could potentially
decrease the number of routine EMB. Copyright © 2018 The
Author(s).

<73>
Accession Number
620559023
Title
Guanxinning tablet for patients who switch from dual antiplatelet therapy
to aspirin alone after percutaneous coronary intervention: Study protocol
for a cluster randomized controlled trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 93. Date of
Publication: 07 Feb 2018.
Author
Li J.; Ju J.; Chen Z.; Liu J.; Lu F.; Gao R.; Xu H.
Institution
(Li, Ju) Graduate School, Beijing University of Chinese Medicine, Beijing
100029, China
(Chen, Xu) China Academy of Chinese Medical Sciences, Cardiovascular
Diseases Center, Xiyuan Hospital, XiYuan CaoChang 1, Beijing 100091, China
(Liu) China Academy of Chinese Medical Sciences, Graduate School, Beijing
100700, China
(Lu, Gao) China Academy of Chinese Medical Sciences, Institute of Clinical
Pharmacology, Xiyuan Hospital, XiYuan CaoChang 1, Beijing 100091, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: One-year dual antiplatelet therapy (DAPT), generally aspirin
in combination with a P2Y12 receptor inhibitor, has been a standard
treatment for patients undergoing percutaneous coronary intervention
(PCI). Prolonged DAPT has proven itself effective in further reducing
cardiovascular events, yet with increased risk of bleeding. Thus, it is of
great necessity to find an alternative drug that is as effective but safer
and more economic than the P2Y12 inhibitors after termination of one-year
DAPT. Method(s): We will conduct a cluster randomized controlled
trial in 3600 eligible post-PCI patients from 36 tertiary hospitals (100
patients per hospital) across mainland China. The hospitals served as
clusters are randomized in a 2:1 ratio to Guanxinning tablet (GXNT) plus
aspirin or aspirin alone for 12 months, with other conventional treatment
applied in both groups. After the treatment period, all patients will be
followed up for another 12 months. The primary outcome measure is
composite cardiovascular events including cardiovascular death, non-fatal
myocardial infarction, stent thrombosis, revascularization, ischemic
stroke, and re-admission due to unstable angina. Secondary outcome
measures are all-cause mortality, each individual component of the primary
outcome measure, and stopping or reducing the rate of nitroglycerin
administration. Adverse events, including bleeding, will be closely
monitored during the whole trial period. In addition, a cost-effectiveness
study of GXNT for the study population will be conducted along with this
trial. Discussion(s): This trial aims to determine whether the
addition of GXNT will further improve prognosis without increasing
bleeding risk for patients with coronary artery disease who have switched
from DAPT to aspirin alone after PCI. Completion of this clinical trial
might provide a novel, promising, and safer alternative to P2Y12
inhibitors for prolonged antiplatelet therapy in post-PCI
patients. Copyright © 2018 The Author(s).

<74>
Accession Number
622684681
Title
Jugular vs femoral vein for central venous catheterization in pediatric
cardiac surgery (PRECiSE): Study protocol for a randomized controlled
trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 329. Date of
Publication: 25 Jun 2018.
Author
Silvetti S.; Aloisio T.; Cazzaniga A.; Ranucci M.
Institution
(Silvetti, Aloisio, Cazzaniga, Ranucci) IRCCS Policlinico San Donato,
Department of Cardiovascular Anesthesia and Intensive Care, Via Morandi
30, San Donato Milanese, Milan 20097, Italy
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Placement of central venous catheters (CVCs) is essential and
routine practice in the management of children with congenital heart
disease. The purpose of the present protocol is to evaluate the risk for
infectious complications in terms of catheter colonization, catheter
line-associated bloodstream infections, and catheter-related bloodstream
infections (CRBSIs), and the mechanical complications from different
central venous access sites in infants and newborns undergoing cardiac
surgery. Method(s): One hundred sixty patients under 1 year of age
and scheduled for cardiac surgery will be included in this randomized
controlled trial (RCT); patients will be randomly allocated to the jugular
or femoral vein arms. CVC insertion will be performed by one of three
selected expert operators. Discussion(s): The choice of the insertion
site for central venous catheterization can influence the incidence and
type of infectious complications in adults but this is not unanimously
evidenced in the pediatric setting. The experimental hypothesis of this
RCT is that the jugular insertion site is less likely to induce catheter
colonization and CRBSI than the femoral site. Copyright © 2018
The Author(s).

<75>
Accession Number
619127124
Title
A systematic review of the incidence of and risk factors for postoperative
atrial fibrillation following general surgery.
Source
Anaesthesia. 73 (4) (pp 490-498), 2018. Date of Publication: April 2018.
Author
Chebbout R.; Heywood E.G.; Drake T.M.; Wild J.R.L.; Lee J.; Wilson M.; Lee
M.J.
Institution
(Chebbout) Department of General Surgery, Wishaw General Hospital, Wishaw,
United Kingdom
(Heywood) Department of General Surgery, University of Edinburgh, United
Kingdom
(Drake) Department of Clinical Surgery, University of Edinburgh, United
Kingdom
(Wild) Leeds Teaching Hospitals NHS FT, FT, Leeds, United Kingdom
(Lee) Department of Cardiology, Sheffield Teaching Hospitals NHS FT,
Sheffield, United Kingdom
(Wilson) School of Health and Related Research (ScHARR) University of
Sheffield, Sheffield, United Kingdom
(Lee) Department of General Surgery, Sheffield Teaching Hospitals,
Sheffield, United Kingdom
Publisher
Blackwell Publishing Ltd
Abstract
Atrial fibrillation is a common cardiac arrhythmia and can occur de novo
following a surgical procedure. It is associated with increased inpatient
and long-term mortality. There is limited evidence concerning new-onset
atrial fibrillation following abdominal surgery. This study aimed to
identify the prevalence of and risk factors for postoperative atrial
fibrillation in the general surgical population. A systematic search of
the Embase, MEDLINE and Cochrane (CENTRAL) databases was conducted.
Studies were included in the review if they reported cases of new-onset
atrial fibrillation within 30 days of the index operation. Results were
evaluated qualitatively due to substantial clinical heterogeneity.
Incidence rates were pooled using a weighted random-effects meta-analysis
model. A total of 835 records were initially identified, from which 32
full texts were retrieved. Following review, 13 studies were included that
involved 52,959 patients, of whom 10.94% (95%CI 7.22-15.33) developed
atrial fibrillation. Five studies of patients undergoing oesophagectomy (n
= 376/1923) had a weighted average rate of 17.66% (95%CI 12.16-21.47),
compared with 7.63% (95%CI 4.39-11.98) from eight studies of
non-oesophageal surgery (n = 2927/51,036). Identified risk factors
included: increasing age; history of cardiac disease; postoperative
complications, particularly, sepsis, pneumonia and pleural effusions.
New-onset postoperative atrial fibrillation is common, and is more
frequent after surgery involving the thorax. Future work should focus on
stratifying risk to allow targeted prophylaxis of atrial fibrillation and
other peri-operative complications. Copyright © 2017 The
Association of Anaesthetists of Great Britain and Ireland

<76>
Accession Number
624572139
Title
TRACE (Routine posTsuRgical Anesthesia visit to improve patient outComE):
A prospective, multicenter, stepped-wedge, cluster-randomized
interventional study.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 586. Date of
Publication: 26 Oct 2018.
Author
Smit-Fun V.M.; De Korte-De Boer D.; Posthuma L.M.; Stolze A.; Dirksen
C.D.; Hollmann M.W.; Buhre W.F.; Boer C.
Institution
(Smit-Fun, De Korte-De Boer, Buhre) Department of Anaesthesiology and Pain
Medicine, Maastricht University Medical Centre +, P. Debeyelaan 25,
Maastricht 6229 HX, Netherlands
(Posthuma, Hollmann) Department of Anaesthesiology, Academic Medical
Centre Amsterdam, Meibergdreef 9 H1Z-132, Amsterdam 1105 AZ, Netherlands
(Stolze, Boer) Department of Anesthesiology, VU University Medical Centre,
De Boelelaan 1117, Amsterdam 1081 HV, Netherlands
(Dirksen) Department of Clinical Epidemiology and Medical Technology,
Maastricht University Medical Centre+, Maastricht, Netherlands
(Dirksen) Care and Public Health Research Institute (CAPHRI), Maastricht
University, Maastricht, Netherlands
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Perioperative complications occur in 30-40% of non-cardiac
surgical patients and are the leading cause of early postoperative
morbidity and mortality. Regular visits by trained health professionals
may decrease the incidence of complications and mortality through earlier
detection and adequate treatment of complications. Until now, no studies
have been performed on the impact of routine postsurgical anesthesia
visits on the incidence of postoperative complications and mortality.
 Method(s): TRACE is a prospective, multicenter, stepped-wedge cluster
randomized interventional study in academic and peripheral hospitals in
the Netherlands. All hospitals start simultaneously with a control phase
in which standard care is provided. Sequentially, in a randomized order,
hospitals cross over to the intervention phase in which patients at risk
are routinely followed up by an anesthesia professional at postoperative
days 1 and 3, aiming to detect and prevent or treat postoperative
complications. We aim to include 5600 adult patients who are at high risk
of developing complications. The primary outcome variable is 30-day
postoperative mortality. Secondary outcomes include incidence of
postoperative complications and postoperative quality of life up to one
year following surgery. Statistical analyses will be performed to compare
the control and intervention cohorts with multilevel linear and logistic
regression models, adjusted for temporal trends and for clusters
(hospitals). The time horizon of the economic (cost-effectiveness)
evaluation will be 30 days and one year following surgery.
 Discussion(s): TRACE is the first to study the effects of a routine
postoperative visit by an anesthesia healthcare professional on mortality
and cost-effectiveness of surgical patients. If the intervention proves to
be beneficial for the patient and cost-effective, the stepped-wedge design
ensures direct implementation in the participating hospitals. Trial
registration: Nederlands Trial Register/Netherlands Trial Registration,
NTR5506. Registered on 02 December 2015. Copyright © 2018 The
Author(s).

<77>
Accession Number
619847431
Title
Pilot multi-centre randomised trial of the impact of pre-operative focused
cardiac ultrasound on mortality and morbidity in patients having surgery
for femoral neck fractures (ECHONOF-2 pilot).
Source
Anaesthesia. 73 (4) (pp 428-437), 2018. Date of Publication: April 2018.
Author
Canty D.J.; Heiberg J.; Yang Y.; Royse A.G.; Margale S.; Nanjappa N.;
Scott D.; Maier A.; Sessler D.I.; Chuan A.; Palmer A.; Bucknill A.; French
C.; Royse C.F.
Institution
(Canty, Yang, Royse, Bucknill) Department of Surgery, University of
Melbourne, Australia
(Canty) Royal Melbourne and Monash Hospitals, Melbourne, Australia
(Heiberg, Royse) Department of Anesthesia and Pain Management, Royal
Melbourne Hospital, Melbourne, Australia
(Heiberg) Department of Anesthesia and Intensive Care, Aarhus University
Hospital, Aarhus, Denmark
(Yang, French, Royse) Department of Intensive Care, Western Health,
Melbourne, Australia
(Royse) Department of Cardiothoracic Surgery, Royal Melbourne Hospital,
Melbourne, Australia
(Margale) Northside Clinical School, University of Queensland, Brisbane,
Australia
(Margale) Department of Anaesthesia and Perfusion services, Prince Charles
Hospital, Brisbane, Australia
(Nanjappa) University of Adelaide, Australia
(Nanjappa) Queen Elizabeth Hospital, Adelaide, Australia
(Scott) School of Medicine, University of Melbourne, Australia
(Scott) St. Vincent's Hospital Melbourne, Australia
(Maier) Department of Medicine and Aged Care, Royal Melbourne Hospital,
University of Melbourne, Australia
(Maier) Department of Human Movement Sciences, MOVE Research Institute
Amsterdam, Vrije Universiteit, Amsterdam, Netherlands
(Sessler) Anesthesiology Institute, Cleveland Clinic, Cleveland, OH,
United States
(Chuan) University of New South Wales, Sydney, Australia
(Chuan) Liverpool Hospital, Sydney, Australia
(Palmer) Health Economics Research Unit, Menzies Institute for Medical
Research, University of Tasmania, Hobart, Australia
(Bucknill) Royal Melbourne Hospital, Melbourne, Australia
Publisher
Blackwell Publishing Ltd
Abstract
Hip fracture surgery is common, usually occurs in elderly patients who
have multiple comorbidities, and is associated with high morbidity and
mortality. Pre-operative focused cardiac ultrasound can alter diagnosis
and management, but its impact on outcome remains uncertain. This pilot
study assessed feasibility and group separation for a proposed large
randomised clinical trial of the impact of pre-operative focused cardiac
ultrasound on patient outcome after hip fracture surgery. Adult patients
requiring hip fracture surgery in four teaching hospitals in Australia
were randomly allocated to receive focused cardiac ultrasound before
surgery or not. The primary composite outcome was any death, acute kidney
injury, non-fatal myocardial infarction, cerebrovascular accident,
pulmonary embolism or cardiopulmonary arrest within 30 days of surgery. Of
the 175 patients screened, 100 were included as trial participants
(screening:recruitment ratio 1.7:1), 49 in the ultrasound group and 51 as
controls. There was one protocol failure among those recruited. The
primary composite outcome occurred in seven of the ultrasound group
patients and 12 of the control group patients (relative group separation
39%). Death, acute kidney injury and cerebrovascular accident were
recorded, but no cases of myocardial infarction, pulmonary embolism or
cardiopulmonary arrest ocurred. Focused cardiac ultrasound altered the
management of 17 participants, suggesting an effect mechanism. This pilot
study demonstrated that enrolment and the protocol are feasible, that the
primary composite outcome is appropriate, and that there is a treatment
effect favouring focused cardiac ultrasound - and therefore supports a
large randomised clinical trial. Copyright © 2017 The Association
of Anaesthetists of Great Britain and Ireland

<78>
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).

<79>
Accession Number
625048840
Title
The efficacy of inpatient vs. Home-based physiotherapy following coronary
artery bypass grafting.
Source
International Journal of Environmental Research and Public Health. 15 (11)
(no pagination), 2018. Article Number: 2572. Date of Publication: 17 Nov
2018.
Author
Szylinska A.; Listewnik M.; Rotter I.; Ryl A.; Kotfis K.; Mokrzycki K.;
Kuligowska E.; Walerowicz P.; Brykczynski M.
Institution
(Szylinska, Rotter, Ryl) Department of Medical Rehabilitation and Clinical
Physiotherapy, Pomeranian Medical University in Szczecin, ul. Zolnierska
54, Szczecin 70-204, Poland
(Listewnik, Mokrzycki, Kuligowska, Walerowicz, Brykczynski) Department of
Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstancow
Wlkp. 72, Szczecin 70-111, Poland
(Kotfis) Department of Anesthesiology, Intensive Therapy and Acute
Intoxications, Pomeranian Medical University in Szczecin, al. Powstancow
W, lkp. 72, Szczecin 70-111, Poland
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Background: Intensive post-operative physiotherapy after cardiac surgery
helps to reduce the number of complications, accelerating convalescence
and decreasing peri-operative mortality. Cardiac rehabilitation is aimed
at regaining lost function and sustaining the effect of cardiac surgery.
The aim of this study was to compare the efficacy of inpatient and
home-based phase II physiotherapy following coronary artery bypass
grafting, and inpatient phase II post-operative physiotherapy based on the
analysis of the spirometry results. Method(s): A prospective
observational study included 104 adult patients of both sexes undergoing
planned coronary artery bypass grafting and were randomized to one of the
two groups-inpatients (InPhysio) and home-based (HomePhysio) at a 1:1
ratio. All patients had undergone spirometry testing prior to surgery (S1)
and on the fifth day after the operation (S2), i.e., on the day of
completion of the first phase (PI) of physiotherapy. Both the study group
(InPhysio) and the control group (HomePhysio) performed the same set of
exercises in the second phase (PII) of cardiac physiotherapy, either in
the hospital or at home, respectively, according to the program obtained
in the hospital. Both groups have undergone spirometry testing (S3) at 30
days after the operation. Result(s): The demographic and
peri-operative data for both groups were comparable and showed no
statistically significant differences. An analysis of gradients between
the results of spirometry tests before surgery and at 30 days after the
surgery showed a smaller decrease in forced vital capacity (FVC) in the
study group than in the control group (p < 0.001). The results at five and
30 days after the surgery showed a greater increase in FVC in the study
group than in the control group (680 mL vs. 450 mL, p = 0.009). There were
no statistically significant differences in other parameters studied.
 Conclusion(s): The advantage of inpatient over home-based
physiotherapy was evidenced by much smaller decreases in FVC between the
initial and final tests, and greater increases between the fifth day after
surgery and the final test. Our analysis showed greater efficacy of
inpatient physiotherapy as compared with home-based exercises and raises
concerns about patient adherence. Copyright © 2018, MDPI AG. All
rights reserved.

<80>
Accession Number
622653312
Title
Dexmedetomidine and intravenous acetaminophen for the prevention of
postoperative delirium following cardiac surgery (DEXACET trial): Protocol
for a prospective randomized controlled trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 326. Date of
Publication: 22 Jun 2018.
Author
Shankar P.; Mueller A.; Packiasabapathy S.; Gasangwa D.; Patxot M.; O'Gara
B.; Shaefi S.; Marcantonio E.R.; Subramaniam B.
Institution
(Shankar, Mueller, Packiasabapathy, Gasangwa, Patxot, O'Gara, Shaefi,
Subramaniam) Beth Israel Deaconess Medical Center, Center for Anesthesia
Research Excellence (CARE), Department of Anesthesia, Critical Care and
Pain Medicine, One Deaconess Road, CC-650, Boston, MA 02215, United States
(Mueller, O'Gara, Shaefi, Marcantonio, Subramaniam) Harvard Medical
School, 25 Shattuck Street, Boston, MA 02215, United States
(Marcantonio) Beth Israel Deaconess Medical Center, Harvard Medical
School, Division of General Medicine and Primary Care, 330 Brookline
Avenue, Boston, MA 02215, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative delirium is common in elderly cardiac surgery
patients. It is multifactorial and is influenced by the patient's baseline
status and the nature of the medical and surgical interventions that the
patient receives. Some of these factors are potentially modifiable,
including postoperative sedation and analgesia protocols. This study has
been designed to evaluate the effectiveness of postoperative intravenous
acetaminophen in conjunction with either dexmedetomidine or propofol in
decreasing the incidence of delirium. Method(s): This is a
prospective, randomized, placebo-controlled, double-blinded, factorial
trial that includes patients who are at least 60 years old and who are
undergoing cardiac surgeries involving cardiopulmonary bypass, including
coronary artery bypass graft (CABG) and combined CABG/valve surgeries.
Patients are randomly assigned to receive one of four postoperative
analgesic-sedation regimens: (1) acetaminophen and dexmedetomidine, (2)
acetaminophen and propofol, (3) dexmedetomidine and placebo, or (4)
propofol and placebo. The primary outcome, incidence of delirium, will be
assessed with the Confusion Assessment Method (CAM or CAM-ICU). The
secondary outcome, postoperative cognitive decline, will be assessed with
the Montreal Cognitive Assessment. Additional secondary outcomes,
including duration of delirium, postoperative analgesic requirement,
length of stay, and incidence of adverse events, will also be reported.
Data will be analyzed in 120 randomly assigned patients who received at
least one dose of the study medication(s) on a modified intention-to-treat
basis. Discussion(s): This study has been approved by the
institutional review board at Beth Israel Deaconess Medical Center, and
the trial is currently recruiting. This study will systematically examine
the implications of modification in postoperative sedative/analgesic
protocols after cardiac surgery, specifically for short- and long-term
cognitive outcomes. Any positive outcomes from this study could direct
simple yet effective practice changes aimed to reduce morbidity. Trial
registration: ClinicalTrials.gov Identifier: NCT02546765 , registered
January 13, 2015. Copyright © 2018 The Author(s).

<81>
Accession Number
621918721
Title
Tranexamic Acid versus Placebo to Prevent Blood Transfusion during Radical
Cystectomy for Bladder Cancer (TACT): Study Protocol for a Randomized
Controlled Trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 261. Date of
Publication: 02 May 2018.
Author
Breau R.H.; Lavallee L.T.; Cnossen S.; Witiuk K.; Cagiannos I.; Momoli F.;
Bryson G.; Kanji S.; Morash C.; Turgeon A.; Zarychanski R.; Mallick R.;
Knoll G.; Fergusson D.A.
Institution
(Breau, Lavallee, Cnossen, Witiuk, Momoli, Bryson, Kanji, Mallick,
Fergusson) Ottawa Hospital Research Institute, Ottawa, ON, Canada
(Breau, Lavallee, Cagiannos, Morash, Knoll) Division of Urology,
Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
(Bryson) University of Ottawa and Ottawa Hospital, Department of
Anesthesiology and Pain Medicine, Ottawa, ON, Canada
(Turgeon) CHU de Quebec, Universite Laval, Quebec City, QC, Canada
(Zarychanski) University of Manitoba, Department of Internal Medicine,
Section of Medical Oncology and Haematology, Winnipeg, MB, Canada
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Radical cystectomy for bladder cancer is associated with a
high risk of needing red blood cell transfusion. Tranexamic acid reduces
blood loss during cardiac and orthopedic surgery, but no study has yet
evaluated tranexamic acid use during cystectomy. Method(s): A
randomized, double-blind (surgeon-, anesthesiologist-, patient-,
data-monitor-blinded), placebo-controlled trial of tranexamic acid during
cystectomy was initiated in June 2013. Prior to incision, the intervention
arm participants receive a 10 mg/kg loading dose of intravenously
administered tranexamic acid, followed by a 5 mg/kg/h maintenance
infusion. In the control arm, the patient receives an identical volume of
normal saline that is indistinguishable from the intervention. The primary
outcome is any blood transfusion from the start of surgery up to 30 days
post operative. There are no strict criteria to mandate the transfusion of
blood products. The decision to transfuse is entirely at the discretion of
the treating physicians who are blinded to patient allocation. Physicians
are allowed to utilize all resources to make transfusion decisions,
including serum hemoglobin concentration and vital signs. To date, 147
patients of a planned 354 have been randomized to the study.
 Discussion(s): This protocol reviews pertinent data relating to blood
transfusion during radical cystectomy, highlighting the need to identify
methods for reducing blood loss and preventing transfusion in patients
receiving radical cystectomy. It explains the clinical rationale for using
tranexamic acid to reduce blood loss during cystectomy, and outlines the
study methods of our ongoing randomized controlled trial. Copyright
© 2018 The Author(s).

<82>
Accession Number
625142969
Title
Positive end-expiratory pressure (PEEP) level to prevent expiratory flow
limitation during cardiac surgery: Study protocol for a randomized
clinical trial (EFLcore study).
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 654. Date of
Publication: 26 Nov 2018.
Author
Bignami E.; Spadaro S.; Saglietti F.; Di Lullo A.; Corte F.D.; Guarnieri
M.; De Simone G.; Giambuzzi I.; Zangrillo A.; Volta C.A.
Institution
(Bignami, Saglietti, Di Lullo, Guarnieri, De Simone, Zangrillo) Department
of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute,
Via Olgettina 60, Milan 20132, Italy
(Spadaro, Corte, Volta) Department of Morphology, Surgery and Experimental
Medicine, Section of Anesthesia and Intensive Care, University of Ferrara,
Via Aldo Moro 8, Ferrara 44121, Italy
(Giambuzzi) Department of Cardiac Surgery, IRCCS San Raffaele Scientific
Institute, Via Olgettina 60, Milan 20132, Italy
(Bignami) Anesthesiology, Critical Care and Pain Medicine Division,
Department of Medicine and Surgery, University of Parma, Viale Gramsci 14,
Parma 43126, Italy
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Lung dysfunction commonly occurs after cardiopulmonary bypass
(CPB). Randomized evidence suggests that the presence of expiratory flow
limitation (EFL) in major abdominal surgery is associated with
postoperative pulmonary complications. Appropriate lung recruitment and a
correctly set positive end-expiratory pressure (PEEP) level may prevent
EFL. According to the available data in the literature, an adequate
ventilation strategy during cardiac surgery is not provided. The aim of
this study is to assess whether a mechanical ventilation strategy based on
optimal lung recruitment with a best PEEP before and after CPB and with a
continuous positive airway pressure (CPAP) during CPB would reduce the
incidence of respiratory complications after cardiac surgery.
Methods/design: This will be a single-center, single-blind,
parallel-group, randomized controlled trial. Using a 2-by-2 factorial
design, high-risk adult patients undergoing elective cardiac surgery will
be randomly assigned to receive either a best PEEP (calculated with a PEEP
test) or zero PEEP before and after CPB and CPAP (equal to the best PEEP)
or no ventilation (patient disconnected from the circuit) during CPB. The
primary endpoint will be a composite endpoint of the incidence of EFL
after the weaning from CPB and postoperative pulmonary complications.
 Discussion(s): This study will help to establish a correct
ventilatory strategy before, after, and during CPB. The main purpose is to
establish if a ventilation based on a simple and feasible respiratory test
may preserve lung function in cardiac surgery. Trial registration:
ClinicalTrials.gov, ID: NCT02633423. Registered on 6 December
2017. Copyright © 2018 The Author(s).

<83>
Accession Number
622519495
Title
Intravenous morphine versus intravenous paracetamol after cardiac surgery
in neonates and infants: A study protocol for a randomized controlled
trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 318. Date of
Publication: 13 Jun 2018.
Author
Zeilmaker-Roest G.A.; van Rosmalen J.; van Dijk M.; Koomen E.; Jansen
N.J.G.; Kneyber M.C.J.; Maebe S.; van den Berghe G.; Vlasselaers D.;
Bogers A.J.J.C.; Tibboel D.; Wildschut E.D.
Institution
(Zeilmaker-Roest, van Dijk, Tibboel, Wildschut) Erasmus MC-Sophia
Children's Hospital, Department of Pediatric Intensive Care, Rotterdam,
Netherlands
(Zeilmaker-Roest, Bogers) Department of Cardiothoracic Surgery, Erasmus
MC, Rotterdam, Netherlands
(van Rosmalen) Department of Biostatistics, Erasmus MC, Rotterdam,
Netherlands
(Koomen, Jansen) Wilhelmina Children's Hospital, University Medical Center
Utrecht, Department of Pediatric Intensive Care, Utrecht, Netherlands
(Kneyber) Beatrix Children's Hospital, University Medical Center
Groningen, Department of Pediatrics, division of Pediatric Critical Care
Medicine, Groningen, Netherlands
(Maebe, van den Berghe, Vlasselaers) UZ Leuven, Department of Intensive
Care Medicine, Leuven, Belgium
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Morphine is worldwide the analgesic of first choice after
cardiac surgery in children. Morphine has unwanted hemodynamic and
respiratory side effects. Therefore, post-cardiac surgery patients may
potentially benefit from a non-opioid drug for pain relief. A previous
study has shown that intravenous (IV) paracetamol is effective and
opioid-sparing in children after major non-cardiac surgery. The aim of the
study is to test the hypothesis that intermittent IV paracetamol
administration in children after cardiac surgery will result in a
reduction of at least 30% of the cumulative morphine requirement.
 Method(s): This is a prospective, multi-center, randomized controlled
trial at four level-3 pediatric intensive care units (ICUs) in the
Netherlands and Belgium. Children who are 0-36months old will be randomly
assigned to receive either intermittent IV paracetamol or continuous IV
morphine up to 48h post-operatively. Morphine will be available as rescue
medication for both groups. Validated pain and sedation assessment tools
will be used to monitor patients. The sample size (n=208, 104 per arm) was
calculated in order to detect a 30% reduction in morphine dose; two-sided
significance level was 5% and power was 95%. Discussion(s): This
study will focus on the reduction, or replacement, of morphine by IV
paracetamol in children (0-36months old) after cardiac surgery. The
results of this study will form the basis of a new pain management
algorithm and will be implemented at the participating ICUs, resulting in
an evidence-based guideline on post-operative pain after cardiac surgery
in infants who are 0-36months old. Copyright © 2018 The
Author(s).

<84>
[Use Link to view the full text]
Accession Number
623904071
Title
Meta-analysis of death and myocardial infarction in the DEFINE-FLAIR and
iFR-SWEDEHEART trials.
Source
Circulation. 136 (24) (pp 2389-2391), 2017. Date of Publication: December
2017.
Author
Berry C.; McClure J.D.; Oldroyd K.G.
Institution
(Berry, McClure) British Heart Foundation Glasgow Cardiovascular Research
Centre, Institute of Cardiovascular and Medical Sciences, University of
Glasgow, Scotland, United Kingdom
(Berry, Oldroyd) West of Scotland Heart and Lung Centre, Golden Jubilee
National Hospital, Clydebank, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<85>
Accession Number
617376205
Title
Pulse on Spontaneous Coronary Artery Dissections: Experience-Based Survey.
Source
JACC: Cardiovascular Interventions. 10 (14) (pp 1469-1471), 2017. Date of
Publication: 24 Jul 2017.
Author
Buccheri D.; Zambelli G.; Alfonso F.; Cortese B.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<86>
[Use Link to view the full text]
Accession Number
626379702
Title
Effects of thoracic epidural anesthesia/analgesia on the stress response,
pain relief, hospital stay, and treatment costs of patients with
esophageal carcinoma undergoing thoracic surgery: A single-center,
randomized controlled trial.
Source
Medicine. 98 (7) (pp e14362), 2019. Date of Publication: 01 Feb 2019.
Author
Li Y.; Dong H.; Tan S.; Qian Y.; Jin W.
Institution
(Li) Department of Anesthesiology, first affiliated hospital of Nanjing
Medical University, Nanjing 210029, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Appropriate postoperative pain management can improve outcomes
in patients with esophageal cancer (EC). OBJECTIVE(S): To compare
different combinations of anesthesia and analgesia techniques in patients
with EC undergoing open thoracotomy. METHOD(S): This randomized,
controlled, open-label trial enrolled 100 patients with EC (aged 40-65
years; American Society of Anesthesiologists [ASA] grade I/II) receiving
elective surgery at Jiangsu Province Hospital (China) between July 2016
and December 2017. Patients were randomized to 4 groups (n = 25 per
group): total intravenous general anesthesia plus patient-controlled
intravenous analgesia (TIVA/PCIA); TIVA plus patient-controlled epidural
analgesia (TIVA/PCEA); thoracic epidural anesthesia with intravenous
general anesthesia plus PCIA (TEA-IVA/PCIA); and TEA-IVA/PCEA (TEA-IVA
plus PCEA). Primary outcomes were plasma cortisol level (measured at
baseline, 2 h after skin incision, surgery completion, and 24 and 48 h
post-surgery) and pain (assessed at 24, 48, and 72 hours post-surgery
using a visual analog scale). Secondary outcomes included time to first
flatus, hospital stay and treatment costs. Postoperative adverse events
(AEs) were analyzed. RESULT(S): Baseline and operative
characteristics were similar between the 4 groups. Plasma cortisol level
increased (P <.05 vs baseline) earlier in the TIVA groups (2 h after skin
incision) than in the TEA-IVA groups (24 h after surgery). At 48 hours
after surgery, plasma cortisol had returned to baseline levels in the PCEA
groups but not in the PCIA groups. VAS pain scores at rest and during
coughing were lower in the PCEA groups than in the PCIA groups (P <.05).
Compared with the PCIA groups, the PCEA groups had shorter time to first
flatus and shorter hospital stay, while use of TEA-IVA lowered the costs
of intraoperative anesthesia (P <.05). However, the PCEA groups had a
higher incidence of nausea, vomiting, and pruritus. CONCLUSION(S):
Thoracic epidural anesthesia/analgesia can reduce the stress response,
improve postoperative recovery and reduce hospital stay and costs for
patients with EC.

<87>
Accession Number
626245013
Title
The effect of inhalation aromatherapy with rose essential oil on the
anxiety of patients undergoing coronary artery bypass graft surgery.
Source
Complementary therapies in clinical practice. 34 (pp 201-207), 2019. Date
of Publication: 01 Feb 2019.
Author
Fazlollahpour-Rokni F.; Shorofi S.A.; Mousavinasab N.; Ghafari R.;
Esmaeili R.
Institution
(Fazlollahpour-Rokni) Student Research Committee, School of Nursing and
Midwifery, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Shorofi) Traditional and Complementary Medicine Research Center,
Addiction Institute, Mazandaran University of Medical Sciences, Sari,
Iran; Adjunct Research Fellow, Flinders University, Adelaide, Australia
(Mousavinasab) Health Sciences Research Center, Mazandaran University of
Medical Sciences, Sari, Iran, Islamic Republic of
(Ghafari) Department of Cardiac Surgery, School of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Esmaeili) Orthopedic Research Center, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND AND PURPOSE: Anxiety is one of the most common responses of
patients awaiting coronary artery bypass graft (CABG) surgery to stressful
conditions before surgery. This study is intended to examine the effect of
inhalation aromatherapy with rose essential oil on the anxiety of patients
undergoing CABG surgery. MATERIALS AND METHODS: This was a single-blind
randomized clinical trial of 66 patients undergoing CABG surgery. The
experimental group inhaled three drops of 4% rose essential oil for 10
minutes one night and one hour before surgery. The control group did not
receive any intervention from the research team. RESULT(S): The level
of anxiety was measured before and 30 minutes after the intervention using
the Spielberger's Anxiety Inventory. Prior to surgery, an independent
t-test showed that the mean score of anxiety was not significantly
different between the experimental and control groups (p=0.41).
Aromatherapy with rose essential oil did not cause any significant
differences in state anxiety (P=0.41), trait anxiety (P=0.90), and total
anxiety (P=0.69). CONCLUSION(S): Our results revealed that inhalation
aromatherapy with rose essential oil could not significantly reduce
anxiety in CABG patients. Future research with larger sample sizes and
using different concentrations of rose essential oil are needed to achieve
more definitive conclusions. Copyright © 2018. Published by
Elsevier Ltd.

<88>
Accession Number
625988673
Title
Lack of Benefit on Treating Asymptomatic Bacteriuria Prior to
Cardiovascular Surgery: a Systematic Review and Meta-Analysis.
Source
Brazilian journal of cardiovascular surgery. 33 (6) (pp 641-643), 2018.
Date of Publication: 01 Nov 2018.
Author
Gomez-Ochoa S.A.; Espin-Chico B.B.
Institution
(Gomez-Ochoa) Researcher GERMINA-UIS Group. School of Medicine, Health
Sciences Faculty, Universidad Industrial de Santander, Bucaramanga,
Colombia
(Espin-Chico) Public Health Faculty. Escuela Politecnica Superior de
Chimborazo, Riobamba, Ecuador
Publisher
NLM (Medline)

<89>
Accession Number
2001696797
Title
Intravenous Iron Supplement for Iron Deficiency in Cardiac Transplant
Recipients (IronIC): Rationale and Design of a Randomized, Controlled
Trial.
Source
Journal of Heart and Lung Transplantation. Conference: ISHLT 39th Annual
Meeting and Scientific Sessions. United States. 38 (4 Supplement) (pp
S286), 2019. Date of Publication: April 2019.
Author
Brautaset K.V.; Ostby C.M.; Vartdal T.; Rolid K.; Gude E.; Andreassen
A.K.; Gullestad L.; Broch K.
Institution
(Brautaset, Ostby, Vartdal, Rolid, Gude, Andreassen, Gullestad, Broch)
Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
Publisher
Elsevier USA
Abstract
Purpose: Heart transplant recipients have reduced exercise capacity,
despite preserved graft function. Numerous mechanisms may contribute to
this impaired exercise tolerance, one of which may be iron deficiency
(ID). Among our heart transplant survivors, 48 % have ID defined as serum
ferritin < 100 micro g/l or ferritin between 100 and 300 micro g/l
in combination with a transferrin saturation < 20 %. The IronIC trial
(NCT03662789) is designed to test the hypothesis that intravenous (i.v.)
iron therapy will improve peak oxygen consumption, muscle strength,
cognitive capacity and quality of life in these patients. Method(s):
The IronIC trial is a randomized, controlled trial designed to test the
efficacy and safety of a single bolus of iron isomaltoside in adult,
stable heart transplant recipients with ID. We aim to randomize 100
patients in a 1:1 fashion to receive i.v. iron isomaltoside 20 mg/ kg body
weight, or NaCl, in a double-blind manner. The trial is powered to detect
a 1.5 ml/kg/min between-group difference in the change in peak oxygen
consumption. Secondary objectives are to assess the impact of treatment on
iron stores, hand grip strength, body composition, cognitive function,
quality of life, and safety and tolerability. All participants must
provide written, informed consent. Exclusion criteria include hemoglobin <
100 g/ l, red blood cell disorders, end-stage kidney failure, intolerance
to iron isomaltoside, and ongoing infections or rejections.
 Result(s): All regulatory approvals have been obtained. Recruitment
started April 2018 and is expected to end April 2019, with last follow-up
October 2019. So far, there have been no serious adverse events.
Demographics for the first 41 patients are presented in the Table.
 Conclusion(s): The IronIC trial is an ongoing, randomized,
controlled, double blind study designed to assess the efficacy and safety
of a single, i.v. bolus of iron in heart transplant recipients with ID. We
expect results to be available at the end of 2019. Copyright ©
2019

<90>
Accession Number
2001696751
Title
Continuous-Flow Left Ventricular Assist Devices and Bariatric Surgery in
Patients with Morbid Obesity and Heart Failure - A Systematic Review.
Source
Journal of Heart and Lung Transplantation. Conference: ISHLT 39th Annual
Meeting and Scientific Sessions. United States. 38 (4 Supplement) (pp
S80-S81), 2019. Date of Publication: April 2019.
Author
Challappalli J.; Cross D.; Weber M.P.; Choi J.; Maynes E.J.; Aggarwal R.;
Boyle A.J.; Entwistle J.W.; Massey H.T.; Morris R.J.; Tchantchaleishvili
V.
Institution
(Challappalli) College of Medicine, Drexel University, Philadelphia, PA,
United States
(Cross, Weber, Choi, Maynes, Entwistle, Massey, Morris,
Tchantchaleishvili) Division of Cardiac Surgery, Thomas Jefferson
University, Philadelphia, PA, United States
(Aggarwal) Department of Surgery, Thomas Jefferson University,
Philadelphia, PA, United States
(Boyle) Division of Cardiology, Thomas Jefferson University, Philadelphia,
PA, United States
Publisher
Elsevier USA
Abstract
Purpose: A body mass index (BMI) > 35 kg/m2 is a contraindication to
transplantation in patients with end-stage heart failure. In these
patients, bariatric surgery can be considered either concomitantly with
continuous-flow left ventricular assist device (CF-LVAD) placement, or
staged after CF-LVAD has been placed. We sought to evaluate the outcomes
for these approaches. Method(s): An electronic search was performed
to identify all relevant studies. After assessment for inclusion and
exclusion criteria, eight original studies were pooled for systematic
review and meta-analysis. Result(s): Of 53 patients, 24 (45%)
underwent simultaneous bariatric surgery with CF-LVAD placement while 29
(55%) underwent staged bariatric surgery after CF-LVAD. The average age of
all patients was 43.6 years (95% CI: 36.9-50.2) with 40% female.
Laparoscopic sleeve gastrectomy was performed in 89% (95% CI: 74-96);
gastric banding was performed in the remaining 11% (95% CI: 4-26). Average
time between CF-LVAD implantation and bariatric surgery was 30.0 months
(95% CI: 15.4-44.6) for staged procedures. Mean BMI at recent follow-up
(34.2 kg/m2, 95% CI: 31.4-36.9) was significantly lower than mean
preoperative BMI (45.9 kg/m2, 95% CI: 43.2-48.7) (p=0.01). There was no
significant difference in incidence of postoperative complications
[simultaneous, 17% (95% CI, 2-65) vs staged, 20% (95% CI, 6-51), p=0.89]
or overall survival [simultaneous, 92% (95% CI, 72-98) vs staged, 81% (95%
CI, 62-92), p=0.29] for average follow-up time of 10.6 months (Table).
Surgery resulted in 67% of patients (95% CI: 52-79) being listed for heart
transplantation, including 31% (95% CI: 19-46) who were transplanted.
 Conclusion(s): Both simultaneous and staged approaches have
comparable outcomes, which can allow previously ineligible patients to
undergo heart transplantation. Increased complication rate in both groups
likely reflects the complexity of the patients and not the timing of the
procedure. Copyright © 2019

<91>
Accession Number
2001696675
Title
Effect of Heart Rate on Early Progression of Cardiac Allograft
Vasculopathy: A Prospective Study Using Highly Automated 3-D Optical
Coherence Tomography Analysis.
Source
Journal of Heart and Lung Transplantation. Conference: ISHLT 39th Annual
Meeting and Scientific Sessions. United States. 38 (4 Supplement) (pp
S283), 2019. Date of Publication: April 2019.
Author
Pazdernik M.; Wichterle D.; Chen Z.; Zhang H.; Wahle A.; Kautzner J.;
Melenovsky V.; Malek I.; Karmazin V.; Bedanova H.; Ozabalova E.; Tomasek
A.; Kovarnik T.; Sonka M.
Institution
(Pazdernik, Wichterle, Kautzner, Melenovsky, Malek, Karmazin) IKEM,
Prague, Czech Republic
(Chen, Zhang, Wahle, Sonka) Iowa Institute for Biomedical Imaging,
University of Iowa, Iowa City, IA, United States
(Bedanova, Ozabalova, Tomasek) Cardiovascular and Transplantation Surgery,
Brno, Czech Republic
(Kovarnik) General University Hospital in Prague, Prague, Czech Republic
Publisher
Elsevier USA
Abstract
Purpose: Despite the controversial effect of elevated heart rate on
progression of cardiac allograft vasculopathy (CAV), heart-rate-slowing
agents are frequently prescribed with the assumption that higher heart
rate predicts worse outcomes in cardiovascular disease. Method(s):
This prospective 2-center trial investigated progression of CAV in 116
heart transplant (HTx) patients. Both baseline (1 month after HTx) and
follow-up (12 months after HTx) examinations by coronary optical coherence
tomography (OCT) were analyzed using highly automated 3D graph-based
segmentation software. Mean heart rate was assessed by 24-hour ambulatory
ECG monitoring at baseline and at 12-month follow-ups after HTx.
 Result(s): During the first post-transplant year, significant
reduction in the mean coronary luminal area from 8.9+/-2.4 to 7.8+/-2.3
mm2 (p<0.0001), progression in both mean intimal thickness (IT)
from 105+/-39 to 129+/-52 micro m (p<0.0001) and maximum local
co-registered IT by 79+/-71 micro m (P<0.0001) were observed. Baseline
and follow-up mean heart rates were 80+/-8 and 83+/-8 bpm during the
treatment with beta-blockers in 53% and 75% patients, respectively. No
significant relationship was found between both baseline and follow up
heart rate and coronary narrowing (R = -0.11, p=0.29 and R = -0.09,
p=0.39). No significant relationship was observed between baseline heart
rate and both IT indices (R = 0.02, p=0.82 and R = 0.04, p=0.66). For
follow-up data, corresponding correlations (R = -0.10, p=0.31 and R =
-0.17, p=0.09) revealed a non-significant trend for less pronounced
progression of local intimal changes in patients with higher heart rate.
 Conclusion(s): Heart-rate-slowing treatment in HTx patients may not
be essential because our study did not confirm significant relationships
between the mean heart rate and 12-month progression of CAV. As this was
investigated in HTx patients who were treated by beta-blockers at the
discretion of attending physicians, a randomized study is warranted to
assess the heart rate effect on CAV progression. This work was supported
in part by the grants from the National Institutes of Health
(R01-EB004640), Ministry of Health of the Czech Republic (16-27465A,
16-28525A, 17-28784A - all rights reserved), and IKEM (MH-CZ-DRO-IKEM-IN
00023001). Copyright © 2019

<92>
Accession Number
2001696579
Title
Effect of Donor Simvastatin Treatment on Cardiac Allograft
Ischemia-Reperfusion Injury (IRI) - 1-Year Follow-Up Analysis of a
Randomized Prospective Single-Center Clinical Trial.
Source
Journal of Heart and Lung Transplantation. Conference: ISHLT 39th Annual
Meeting and Scientific Sessions. United States. 38 (4 Supplement) (pp
S273), 2019. Date of Publication: April 2019.
Author
Holmstrom E.; Nykanen A.; Syrjala S.; Tuuminen R.; Jokinen J.; Krebs R.;
Lemstrom K.
Institution
(Holmstrom, Syrjala, Tuuminen, Krebs) Transplantation Laboratory,
University of Helsinki, Helsinki, Finland
(Nykanen, Jokinen, Lemstrom) Cardiac Surgery, Heart and Lung Center,
Helsinki University Hospital, Helsinki, Finland
Publisher
Elsevier USA
Abstract
Purpose: Cardiac allograft IRI may lead to deleterious short- and
long-term effects. Experimental studies show that donor statin treatment
protects heart allograft from both IRI and chronic allograft vasculopathy.
Here, we analyzed the 1-year follow-up data on the effect of donor
simvastatin treatment on cardiac allograft. Method(s): We randomized
84 heart transplant donors to a control group, or to receive simvastatin
80mg at the time of graft acceptance in a single-center clinical trial.
IRI was evaluated by cardiac enzyme release. Patient survival,
biopsy-proven rejections, intravenous rejection treatments and
postoperative proBNP levels have been currently followed up to 1 year.
 Result(s): Plasma TnT and TnI values peaked at 6 hours. Donor
simvastatin treatment decreased plasma troponin T and I (by 34% and 40%,
respectively; both P<0.05) levels 6 hours after reperfusion. Donor
simvastatin also decreased proBNP (by 37%; P<0.05) at 1 week after
transplantation, and the need for intravenous rejection treatments (by
53%; P<0.05) in the first postoperative month. At 1-year, proBNP levels
(2400 vs 3400 ng/L; P=ns) and mortality (93% vs 86%; P=ns) remained
slightly lower in the donor simvastatin treatment arm compared to control
group. Also the need for intravenous rejection treatments (33 vs 16; P=ns)
and the number of biopsy-proven rejections (69 vs 48; P=ns) were lower in
the donor simvastatin group. Conclusion(s): Donor simvastatin
treatment decreased early postoperative IRI and improved early graft
function as measured by plasma troponin and proBNP levels. It also reduced
the need for early rejection treatments. In a 1-year follow-up, these
differences can still be seen, but the difference between groups has
evened to statistically non-significant. Copyright © 2019

<93>
Accession Number
2001696157
Title
Effect of High Intensity Interval Training on Health Related Quality of
Life in De Novo Heart Transplant Recipients-The HITTS Study.
Source
Journal of Heart and Lung Transplantation. Conference: ISHLT 39th Annual
Meeting and Scientific Sessions. United States. 38 (4 Supplement) (pp
S196-S197), 2019. Date of Publication: April 2019.
Author
Rolid K.; Andreassen A.K.; Yardley M.; Gude E.; Bjorkelund E.; Authen
A.R.; Grov I.; Pettersen K.I.; Dall C.H.; Prescott E.; Karason K.;
Gullestad L.; Nytroen K.
Institution
(Rolid, Andreassen, Yardley, Gude, Bjorkelund, Authen, Grov, Pettersen,
Gullestad, Nytroen) Department of Cardiology, Oslo University Hospital,
Rikshospitalet, Oslo, Norway
(Dall, Prescott) Department of Cardiology, Bispebjerg University Hospital,
Copenhagen, Denmark
(Karason) Department of Cardiology, Sahlgrenska University Hospital,
Gothenborg, Sweden
Publisher
Elsevier USA
Abstract
Purpose: A main goal after heart transplantation (HTx) is to achieve good
health related quality of life (HRQoL). Exercise training after heart
transplantation (HTx) is recommended and high-intensity interval training
(HIT) seem to be more effective than moderate continuous training (MICT).
Studies on the effect of HIT vs. MICT on HRQoL is scarce, and no studies
among de novo HTx recipients exist. Method(s): Eighty-one de novo HTx
recipients were included and were randomized 1:1 to either HIT or MICT.
HRQoL was assessed by the Short Form-36 (SF-36v2), the Hospital Anxiety
and Depression Scale (HADS) at baseline (mean 11 weeks after surgery) and
at 1-yr follow- up, additionally, participants reported their overall
health on a numeric visual analouge scale after the intervention period.
SF-36 scores were calculated using norm based values with a standardized
mean of 50+/-10. All patients underwent a clinical examination and
physical tests. Result(s): At 1-yr follow-up 78 patients were
retested. Both groups had significant improvements on the physical
function components of HRQoL the first year after HTx, while mental
health, anxiety and depression scores remain unchanged. There were no
serious adverse events related to exercise in either of the groups during
the intervention period. Mean +/- SD age for the total population was
49+/-13 years, 73% were men. There was no significant difference between
HIT and MICT in seven of the eight SF-36 subscales, in physical component
summary score (PCS) or mental component summary score (MCS). However,
there was a statistical significant positive change in the role emotional
(RE) subscale mean score in the HIT group compared to the MICT group
(Table 1). Conclusion(s): From baseline to 1-yr follow-up HIT vs.
MICT resulted in similar mean changes in HRQoL, except from on the SF-36
RE subscale. Both groups had significant improvements in PF, RP and
PCS,suggesting that exercise training improves some areas of the
multidimensional concept of HRQoL. Copyright © 2019

<94>
Accession Number
2001696052
Title
Late-Breaking Clinical Trial: 10-Year Follow-Up of the Everolimus versus
Azathioprine Multi-National Study.
Source
Journal of Heart and Lung Transplantation. Conference: ISHLT 39th Annual
Meeting and Scientific Sessions. United States. 38 (4 Supplement) (pp
S75), 2019. Date of Publication: April 2019.
Author
Kobashigawa J.A.; Starling R.; Passano E.; Bernhardt P.; Azarbal B.; Cheng
R.; Esmailian F.; Khush K.; Mancini D.; Patel J.; Sato T.; Varnous S.
Institution
(Kobashigawa, Passano, Azarbal, Cheng, Esmailian, Patel, Sato) Smidt Heart
Institute at Cedars-Sinai, Los Angeles, CA, United States
(Starling) Cleveland Clinic, Cleveland, OH, United States
(Bernhardt) Novartis Pharmaceuticals, Basel, Switzerland
(Khush) Stanford University, Palo Alto, CA, United States
(Mancini) Mount Sinai, New York, NY, United States
(Varnous) APHP, Pitie-Salpetriere, Sorbonne University, Paris, France
Publisher
Elsevier USA
Abstract
Purpose: This study is the 10-year follow-up of a randomized double-blind
prospective trial that compared everolimus (1.5 mg or 3 mg) to
azathioprine. In the original study of 634 heart transplant patients,
there were significantly fewer patients on everolimus who reached the 6
month composite endpoint of death, graft loss or re-transplantation, loss
to followup, biopsy-proven acute rejection, or rejection with hemodynamic
compromise (36.4% and 27.0%, compared to 46.0%, p<0.03). Further, a
decrease in the development of cardiac allograft vasculopathy (CAV), as
assessed by intravascular ultrasound (IVUS) at 12 months, was observed in
the everolimus groups compared to those on azathioprine. The purpose of
this study is to assess for the clinical outcome of the early treatment of
everolimus vs azathioprine at 10-years and to assess whether first-year
intravascular ultrasound (IVUS) predicts long-term clinical outcome at
10-years. Method(s): This 10-year follow-up study included 364
patients (57% of the original patients) with 116 and 124 patients assigned
to everolimus 1.5 mg and 3 mg respectively, and 124 patients assigned to
azathioprine. The first analysis includes intent-to-treat by study drug
with 10-year endpoint of freedom from a composite endpoint of death,
re-transplant, experiencing a coronary stent, myocardial infarction, or
development of angiographic CAV. In addition, on-treatment by study drug
at 10-years is analyzed for the composite endpoint, individual components
of the composite endpoint, left ventricular dysfunction and non-fatal
major adverse cardiac events. There were 138 patients with paired IVUS
studies (at baseline and 1-year) with 54 patients having first-year change
in maximal intimal thickness (MIT) >0.5mm and 84 patients without. Study
endpoints for the 2 IVUS groups were the same as above. Further IVUS
analysis is performed by study drug assignment and the presence of
baseline donor disease. Result(s): 10-year survival, freedom from
angiographic CAV or NF-MACE by the intent-to-treat and on-treatment
analyses by study drugs (everolimus vs azathioprine) will be revealed.
Whether the change in first-year IVUS parameters (specifically change in
MIT>0.5mm) can predict 10-year outcome (survival, angiographic CAV or
NF-MACE) will also be revealed. Conclusion(s): Findings with
conclusions will be discussed at the late-breaking session. Copyright
© 2019

<95>
Accession Number
2001695817
Title
Cardiac Surgical Procedures with Concomitant vs. Staged Orthotopic Liver
Transplant.
Source
Journal of Heart and Lung Transplantation. Conference: ISHLT 39th Annual
Meeting and Scientific Sessions. United States. 38 (4 Supplement) (pp
S375-S376), 2019. Date of Publication: April 2019.
Author
Reddy H.G.; Choi J.; Maynes E.J.; Carlson L.A.; Gordon J.; Horan D.P.;
Khan J.; Weber M.P.; Morris R.J.; Massey H.T.; Tchantchaleishvili V.
Institution
(Reddy, Choi, Maynes, Carlson, Gordon, Horan, Khan, Weber, Morris, Massey,
Tchantchaleishvili) Division of Cardiac Surgery, Thomas Jefferson
University, Philadelphia, PA, United States
Publisher
Elsevier USA
Abstract
Purpose: In patients who require orthotopic liver transplant (OLT),
cardiac surgery may be needed to optimize preoperative cardiac status for
OLT. The aim of this systematic review was to evaluate patient
characteristics and outcomes undergoing staged versus concomitant cardiac
procedures with OLT. Method(s): An electronic search was performed to
identify all case reports and series, from which patient-level data was
extracted regarding cardiac procedures associated with OLT. After
assessment for inclusion and exclusion criteria, 26 articles were pooled
for systematic review. Result(s): Overall, 49 patients were included
in the analysis, of whom 12 (24%) underwent staged procedures and 37 (76%)
underwent concomitant procedures. The median age was lower in the staged
group [staged: 51.0 (IQR, 43.8-59.2) years vs. concomitant: 60.0 (IQR,
55.0-64.0) years, p=0.02]. Other baseline characteristics were comparable
between the two groups. For staged procedures, the median time between
heart procedures and OLT was 2 months. The most commonly reported cardiac
procedures were coronary artery bypass graft (CABG) [staged: 4/12 (33.3%)
vs. concomitant: 21/37 (56.8%), p=0.28], aortic valve replacement (AVR)
[staged: 3/12 (25.0%) vs. concomitant: 19/37 (51.2%), p=0.21], and
transcatheter aortic valve replacement (TAVR) [staged: 4/12 (33.3%) vs.
concomitant: 0/37 (0%), p=0.002]. There was a significantly shorter
post-OLT hospital stay for those who had staged procedures versus those
who had concomitant procedures [staged: 8 (IQR, 5-13) days vs.
concomitant: 17 (IQR, 14-24) days, p=0.007]. However, both groups had
similar in-hospital mortality [staged: 1/12 (8.3%) vs. concomitant: 4/37
(10.8%), p=1.0]. Stratified survival between the two groups is shown in
the figure. Conclusion(s): Patients who underwent the staged approach
had a shorter post-transplant hospital stay, but survival appeared
comparable with respect to those who underwent concomitant cardiac
procedures with OLT. Copyright © 2019

<96>
Accession Number
2001695777
Title
Comparative Efficacy of Bortezomib and Carfilzomib Desensitization
Protocols in Highly Sensitized Cardiac Transplant Candidates.
Source
Journal of Heart and Lung Transplantation. Conference: ISHLT 39th Annual
Meeting and Scientific Sessions. United States. 38 (4 Supplement) (pp
S35-S36), 2019. Date of Publication: April 2019.
Author
Sobhanian M.; Saltarrelli J.; Weeks P.; Nathan S.; Radovancevic R.; Kar
B.; Gregoric I.
Institution
(Sobhanian, Weeks) Memorial Hermann Hospital - Texas Medical Center,
Houston, TX, United States
(Saltarrelli, Nathan, Radovancevic, Kar, Gregoric) The University of Texas
Health Science Center at Houston, Houston, TX, United States
Publisher
Elsevier USA
Abstract
Purpose: At our center, patients who are deemed highly sensitized may
undergo a proteasome inhibitor-based desensitization protocol to shorten
organ wait time and improve the probability of finding an acceptable
donor. The purpose of this study is to evaluate the comparative effects on
detectable anti-HLA antibodies between our center's bortezomib-based and
carfilzomib-based protocol in sensitized patients awaiting heart
transplantation. Method(s): This was a retrospective cohort study.
Highly sensitized patients awaiting cardiac transplant who underwent the
desensitization protocol between April 2013 and February 2017 were
included in the study. Protocol included either a bortezomib or
carfilzomib-based regimen with multiple plasmapheresis sessions and a
single dose of rituximab. Efficacy of these two desensitization regimens
was evaluated by comparing trends in pre- and post-protocol positive (mean
fluorescence intensity (MFI) greater than 500) anti-HLA antibody allele
specificities. Result(s): Of the 19 patients who underwent a
desensitization protocol, 8 patients received a bortezomib-based regimen
and 11 patients a carfilzomib-based regimen. When comparing trends in both
HLA class I and class II antibodies pre- and post- desensitization
protocol, patients who received a bortezomib-based regimen experienced a
greater reduction (p<0.0001) in the detection of both class I and class II
alloantibodies compared to those that received carfilzomib (Table 1).
 Conclusion(s): In our observed cohort, bortezomib-based
desensitization protocol was associated with a greater percent reduction
of anti-HLA antibody alleles with MFI>500 compared to the
carfilzomib-based desensitization protocol. Larger, prospective randomized
studies are needed to confirm these results. Copyright © 2019

<97>
Accession Number
2001695732
Title
EVOLVD: Cholesterol Lowering with EVOLocumab to Prevent Cardiac Allograft
Vasculopathy in De-Novo Heart Transplant Recipients: Rationale and Design
of a Randomized, Controlled Trial.
Source
Journal of Heart and Lung Transplantation. Conference: ISHLT 39th Annual
Meeting and Scientific Sessions. United States. 38 (4 Supplement) (pp
S279), 2019. Date of Publication: April 2019.
Author
Broch K.; Gustafsson F.; Radegran G.; Karl L.B.; Eiskjaer H.; Karason K.;
Dellgren G.; Lommi J.; Pentikainen M.; Arora S.; Gude E.; Andreassen A.K.;
Gullestad L.
Institution
(Broch, Arora, Gude, Andreassen, Gullestad) Cardiology, Oslo University
Hospital Rikshospitalet, Oslo, Norway
(Gustafsson) Cardiology, Rigshospitalet, Copenhagen, Denmark
(Radegran) The Section for Heart Failure and Valvular Disease, VO. Heart
and Lung Medicine, Skane University Hospital, Oslo, Sweden
(Karl, Lommi, Pentikainen) Cardiology, Helsinki University Hospital Heart
and Lung Center, Helsinki, Finland
(Eiskjaer) Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
(Karason, Dellgren) Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
Publisher
Elsevier USA
Abstract
Purpose: Cardiac allograft vasculopathy (CAV) is a unique form of
accelerated atherosclerosis that is characterized by a diffuse,
progressive thickening of the arterial intima of the allograft coronaries.
CAV accounts for 30% of deaths occurring beyond the first year after heart
transplantation. It is partly caused by immunological factors, partly
brought about by established risk factors for atherosclerosis, such as
elevated LDL cholesterol levels. Evolocumab is a fully humanized
monoclonal antibody that inhibits the enzyme proprotein convertase
subtilisin-kexin type 9 (PCSK9), thereby reducing LDL cholesterol levels
by as much as 70 %. The EVOLVD trial is designed to test the hypothesis
that treatment with evolocumab can ameliorate CAV in heart transplant
recipients. Method(s): The EVOLVD trial is a randomized, controlled
double-blind trial designed to test the efficacy and safety of one year's
treatment with evolocumab in de novo heart transplant recipients. The
trial will be conducted at the Nordic transplantation sites in Norway,
Denmark, Sweden, and Finland. We aim to randomize 130 recently
transplanted patients in a 1:1 fashion to receive monthly subcutaneous
injections of 420 mg evolocumab or matching placebo supplied by the
manufacturer. The trial is powered to detect a 0.05 mm between-group
difference in the change in the intima thickness as measured by coronary
intravascular ultrasound (IVUS). Secondary objectives are to assess the
impact of treatment on cholesterol levels, renal function, inflammation,
cardiac function as assessed by biomarkers and echocardiography, quality
of life, and safety and tolerability. All participants must provide
written, informed consent. Exclusion criteria include contraindications to
study medication, inability to perform coronary angiography with IVUS, and
an estimated glomerular filtration rate < 20 ml/ min. Result(s):
Applications have been submitted to regulatory authorities. We aim to
recruit patients from November 2018 through December 2020, with last
patient, last visit in January 2022. Conclusion(s): The EVOLVD trial
is a randomized, controlled, double blind study designed to assess the
efficacy and safety of the PCSK9 inhibitor evolocumab in de novo heart
transplant recipients. We expect results to be available in January
2022. Copyright © 2019

<98>
Accession Number
2001695707
Title
Effect of Donor Simvastatin Treatment on Gene Expression Profiles in Human
Cardiac Allografts during Ischemia-Reperfusion Injury.
Source
Journal of Heart and Lung Transplantation. Conference: ISHLT 39th Annual
Meeting and Scientific Sessions. United States. 38 (4 Supplement) (pp
S75-S76), 2019. Date of Publication: April 2019.
Author
Krebs R.; Kankainen M.; Holmstrom E.; Dhaygude K.; Lukac J.; Ojala T.;
Mattila P.; Nykanen A.; Lemstrom K.
Institution
(Krebs, Holmstrom, Dhaygude, Lukac, Nykanen, Lemstrom) Transplantation
Laboratory, University of Helsinki, Helsinki, Finland
(Kankainen, Ojala, Mattila) Institute for Molecular Medicine Finland,
University of Helsinki, Helsinki, Finland
Publisher
Elsevier USA
Abstract
Purpose: Numerous studies have shown that statin therapy initiated early
after heart transplantation has beneficial effects on the development of
cardiac allograft vasculopathy. Recently, we were able to show in a
randomized clinical trial that simvastatin treatment of brain-dead donors
conditions the heart transplant to withstand ischemia-reperfusion injury
and to reduce the need for rejection treatments early after
transplantation. In this study, we analyzed myocardial gene expression
profiles in cardiac allografts after donor simvastatin treatment.
 Method(s): 84 heart transplant donors received 80 mg of simvastatin
via nasogastric tube (n=42), or no treatment (n=42) in a prospective,
double-blinded randomized controlled trial. Transmural Tru-Cut biopsies
were taken from the apex of left ventricle of the donor heart immediately
before reperfusion and 1 hour after reperfusion. 20 heart biopsies from
donors without treatment and 20 heart biopsies from donors with
simvastatin treatment will be analyzed with RNA sequencing.
 Result(s): The preliminary analysis of RNA sequencing data from
myocardial biopsies revealed altogether 137 significantly differentially
expressed genes in all pairwise comparisons. The overall biological
functions of these genes were related to gene ontology terms such as
response to toxic substance, leukocyte migration, neutrophil mediated
immunity, response to lipopolysaccharide, and response to oxidative
stress. At the KEGG pathway level, our results indicated alterations in
IL-17, TNF, MAPK and the AGE-RAGE signaling pathways. Conclusion(s):
We have shown in previous studies that donor simvastatin treatment induces
protective effects against IRI in heart transplant recipients. In this
study, we were able to detect significantly differentially expressed genes
related to effects of simvastatin treatment. In order to single out genes
that show beneficial effects of simvastatin treatment, further analysis
will be conducted by exploring gene expression changes in specific
biological functional categories, such as interleukin signaling and
neutrophil degranulation. The complete analysis will be presented at the
ISHLT 2019 congress. Copyright © 2019

<99>
Accession Number
2001695689
Title
Effect of High-Intensity Interval Training on Progression of Coronary
Artery Vasculopathy in De Novo Heart Transplant Recipients.
Source
Journal of Heart and Lung Transplantation. Conference: ISHLT 39th Annual
Meeting and Scientific Sessions. United States. 38 (4 Supplement) (pp
S280), 2019. Date of Publication: April 2019.
Author
Nytroen K.; Rolid K.; Bjorkelund E.; Karason K.; Gustafsson F.; Solberg
O.; Gullestad L.; Arora S.
Institution
(Nytroen, Rolid, Solberg, Gullestad) Department of Cardiology, Oslo Univ
Hosp Rikshospitalet, Oslo, Norway
(Bjorkelund) Oslo University Hospital, Oslo, Norway
(Karason) Sahlgrenska University Hospital, Gothenburg, Sweden
(Gustafsson) Rigshospitalet University Hospital, Copenhagen, Denmark
(Arora) Oslo University Hospital Rikshospital, Oslo, Norway
Publisher
Elsevier USA
Abstract
Purpose: Coronary artery vasculopathy (CAV) leads to increased morbidity
and mortality in heart transplant (HTx) recipients. We have previously
shown that high-intensity interval training (HIT) in maintenance
recipients significantly reduced CAV progression, as compared to a control
group. Our hypothesis was that HIT compared to moderate intensity,
continuous training (MICT) in de novo HTx recipients would show similar
results. Method(s): 67 HTx recipients (mean +/- SD age 49 +/- 13, 72
(% men) were randomized to either nine months of HIT or MICT at mean 11
weeks (range 7 - 16) post HTx. The effect of training on CAV progression
was assessed by matched intravascular ultrasound (IVUS) examinations at
baseline and 12 months, and analyses were performed to measure change in
Maximal Intimal Thickness (MIT), Percent Atheroma Volume (PAV) and Total
Atheroma Volume (TAV). Result(s): Age and sex were similar between
the groups. Peak oxygen consumption (VO<inf>2peak L/min</inf>) improved
with 12.5 +/- 10.3 % in the HIT group vs. 8.7 +/- 9.3 % in the MICT group
(p=0.022). IVUS analysis revealed a relatively small increase in all the
three main IVUS parameters in both groups: The mean +/- SD increase in MIT
was 0.08 +/- 0.12mm in the HIT group vs. 0.06 +/- 0.10 mm in the MICT
group. The increase in PAV was 4.3 +/- 5.6 % in the HIT group vs. 3.2 +/-
3.9 % in the MICT group, and TAV increased with 20.0 +/- 51.5
mm3in the HIT group vs. 25.7 +/- 44.8mm3 in the MICT
group, but there were no significant differences between the groups (see
Table 1). Furthermore, there were no significant correlations between
VO<inf>2peak</inf> and MIT, PAV or TAV in either of the groups.
 Conclusion(s): The increase in VO2 <inf>peak</inf> was significantly
greater in HIT patients as compared to the MICT group. However, there was
no significant difference in progression of CAV between the two treatment
groups. We await the results from the 3-year follow-up to evaluate
potential long-term effects. Copyright © 2019

<100>
Accession Number
2001695664
Title
Mild Acute Cellular Rejection is Not Associated with Development of
Cardiac Allograft Vasculopathy Assessed by Intravascular Ultrasound and
Coronary Angiography in Heart Transplant Recipients - A Substudy of the
SCHEDULE Trial.
Source
Journal of Heart and Lung Transplantation. Conference: ISHLT 39th Annual
Meeting and Scientific Sessions. United States. 38 (4 Supplement) (pp
S99-S100), 2019. Date of Publication: April 2019.
Author
Nelson L.M.; Andreassen A.K.; Arora S.; Andersson B.; Gude E.; Eiskjaer
H.; Radegran G.; Dellgren G.; Gullestad L.; Gustafsson F.
Institution
(Nelson, Gustafsson) Department of Cardiology, Copenhagen University
Hospital, Rigshospitalet, Copenhagen, Denmark
(Andreassen, Arora, Gude) Department of Cardiology, Oslo University
Hospital, Rikshospitalet, Oslo, Norway
(Andersson) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Eiskjaer) Department of Cardiology, Aarhus University Hospital, Skejby,
Aarhus, Denmark
(Radegran) The Clinic for Heart Failure and Valvular Disease, Skane
University Hospital and Lund University, Lund, Sweden
(Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gullestad) Department of Cardiology, Oslo University Hospital, University
of Oslo, RikshospitaletOslo, Norway
Publisher
Elsevier USA
Abstract
Purpose: The impact of mild (1R) acute cellular rejection (ACR) on the
development of cardiac allograft vasculopathy (CAV) after heart
transplantation (HTx) remains unclear. We aimed to investigate the
association between mild ACR within 1 year of HTx and development of CAV
at 3 years post HTx. Method(s): This is a substudy of the SCHEDULE
trial (n=115) in which de novo HTx recipients were randomized to either
(i) everolimus or (ii) conventional CNI-based immunosuppression. 76
patients (66%) were eligible for inclusion based on matched intravascular
ultrasound (IVUS) examinations at baseline (BL) and 3 years post HTx.
Biopsy proven ACR within year 1 was recorded and graded according to ISHLT
criteria (1R, 2R, 3R). Development of CAV was assessed by IVUS and
coronary angiography at year 3 post HTx. Result(s): Median age was 53
years (45-61) and 71% were male. In 67% of patients ACR was recorded
during year 1 (1R in 63%, 2R in 24%, and 3R in 3% of patients,
respectively). Patients were grouped by rejection profile: no ACR (33%),
only 1R (42%), at least one 2R/3R (25%). At 3 years post HTx 49% of
patients had CAV on IVUS (maximal intimal thickness, MIT >= 0.5 mm) with
no difference in the incidence of IVUS-CAV between groups (p=0.43). Median
MIT<inf>BL-3Y</inf> was 0.09 mm (0.05-0.15) with no significant difference
among groups (p=0.84) (figure 1). At 3 years post HTx angiographic CAV was
present in 26% of patients with no significant between group difference
(no ACR: 40%, only 1R: 24%, at least one 2R/3R: 7%; p=0.06). No
correlation was found between number of 1R and MIT<inf>BL-3Y</inf>
(r=-0.03, p=0.83). Number of 1R did not predict MIT<inf>BL-3Y</inf> in an
adjusted linear regression model (p=0.69). No significant interaction with
treatment regimen (everolimus/CNI) was found (p=0.84). Conclusion(s):
Mild ACR within 1 year of HTx was not associated with development of CAV
assessed by IVUS and coronary angiography at year 3 post
HTx. Copyright © 2019

<101>
[Use Link to view the full text]
Accession Number
626799868
Title
Type 2 Diabetes and Hypertension.
Source
Circulation research. 124 (6) (pp 930-937), 2019. Date of Publication: 15
Mar 2019.
Author
Sun D.; Zhou T.; Heianza Y.; Li X.; Fan M.; Fonseca V.A.; Qi L.
Institution
(Sun, Zhou, Heianza, Li, Qi) From the Department of Epidemiology, School
of Public Health and Tropical Medicine, Tulane University, X.L., New
Orleans, United States
(Zhou) Department of Public Health Laboratory Sciences, West China School
of Public Health, Sichuan University, China (T.Z.), Chengdu, Sichuan
Province, China
(Fan) Department of Epidemiology and Biostatistics, School of Public
Health, Peking University Health Science Center, China (M.F.), Beijing,
China
(Fonseca) Section of Endocrinology and Metabolism, Tulane University
School of Medicine, New Orleans, United States
(Qi) Department of Nutrition, Harvard T.H. Chan School of Public Health,
Boston, United Kingdom
(Qi) Channing Division of Network Medicine, Department of Medicine,
Brigham and Women's Hospital and Harvard Medical School, Boston, United
Kingdom
Publisher
NLM (Medline)
Abstract
RATIONALE: In observational studies, type 2 diabetes mellitus (T2D) has
been associated with an increased risk of hypertension, and vice versa;
however, the causality between these conditions remains to be determined.
 OBJECTIVE(S): This population-based prospective cohort study sought
to investigate the bidirectional causal relations of T2D with
hypertension, systolic and diastolic blood pressure (BP) using Mendelian
randomization (MR) analysis. METHODS AND RESULTS: After exclusion of
participants free of a history of heart failure, cardiovascular disease,
cardiac procedures, and non-T2D diabetes mellitus, a total of 318664
unrelated individuals with qualified genotyping data of European descent
aged 37 to 73 from UK Biobank were included. The genetically instrumented
T2D and hypertension were constructed using 134 and 233 single nucleotide
polymorphisms, respectively. Seven complementary MR methods were applied,
including inverse-variance weighted method, 2 median-based methods (simple
and weighted), MR-Egger, MR-robust adjusted profile scores, MR-Pleiotropy
Residual Sum and Outlier, and multivariate MR. The genetically
instrumented T2D was associated with risk of hypertension (odds ratio,
1.07 [95% CI, 1.04-1.10], P=3.4x10-7), whereas the genetically determined
hypertension showed no relationship with T2D (odds ratio, 0.96
[0.88-1.04], P=0.34). Our MR estimates from T2D to BP showed that the
genetically instrumented T2D was associated with a 0.67 mmHg higher
systolic BP (95% CI, 0.41-0.93, P=5.75x10-7) but not with a higher
diastolic BP. There was no clear evidence showing a causal effect of
elevated systolic BP or diastolic BP on T2D risk. Positive pleiotropic
bias was indicated in the hypertension->T2D relation (odds ratio, of
MR-Egger intercept 1.010 [1.004-1.016], P=0.001) but not from T2D to
hypertension (1.001 [0.998-1.004], P=0.556). CONCLUSION(S): T2D may
causally affect hypertension, whereas the relationship from hypertension
to T2D is unlikely to be causal. These findings suggest the importance of
keeping an optimal glycemic profile in general populations, and BP
screening and monitoring, especially systolic BP, in patients with T2D.

<102>
[Use Link to view the full text]
Accession Number
626804215
Title
Predictors, Incidence, and Outcomes of Patients Undergoing Transfemoral
Transcatheter Aortic Valve Implantation Complicated by Stroke.
Source
Circulation. Cardiovascular interventions. 12 (3) (pp e007546), 2019. Date
of Publication: 01 Mar 2019.
Author
Vlastra W.; Jimenez-Quevedo P.; Tchetche D.; Chandrasekhar J.; de Brito
F.S.; Barbanti M.; Kornowski R.; Latib A.; D'Onofrio A.; Ribichini F.;
Baan J.; Tijssen J.G.P.; De la Torre Hernandez J.M.; Dumonteil N.;
Sarmento-Leite R.; Sartori S.; Rosato S.; Tarantini G.; Lunardi M.; Orvin
K.; Pagnesi M.; Hernandez-Antolin R.; Modine T.; Dangas G.; Mehran R.;
Piek J.J.; Delewi R.
Institution
(Vlastra, Chandrasekhar, Baan, Tijssen, Piek, Delewi) Heart Center,
Amsterdam, Netherlands
(Vlastra, Chandrasekhar, Baan, Tijssen, Piek, Delewi) Department of
Clinical and Experimental Cardiology, University of Amsterdam, Amsterdam
Cardiovascular Sciences
(Jimenez-Quevedo) Cardiovascular Institute, San Carlos University
Hospital, Madrid, Spain
(Tchetche, Dumonteil) Clinique Pasteur, Toulouse, France
(Chandrasekhar, Sartori, Dangas, Mehran) Zena and Michael A. Wiener
Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, S.S.,
G.D., NY, United States
(de Brito) Heart Institute (InCor), University of Sao Paulo Medical School
(Barbanti) Division of Cardiology, Policlinico-Vittorio Emanuele Hospital,
University of Catania, Italy
(Kornowski, Orvin) Cardiology Department, Rabin Medical Center, Petach
Tikva, Canada
(Latib, Pagnesi) Interventional Cardiology Unit, San Raffaele Scientific
Institute, Milan, United States
(D'Onofrio, Tarantini) Interventional Cardiology Unit, Department of
Cardiac, Thoracic and Vascular Sciences, University of Padova, India
(Ribichini, Lunardi) Division of Cardiology, Department of Medicine,
University of Verona, Italy
(De la Torre Hernandez) Hospital Marques de Valdecilla, Servicio de
Cardiologia, Cantabria, Santander, Spain
(Sarmento-Leite) Instituto de Cardiologia do Rio Grando do Sul, France
(Rosato) National Centre for Global Helath, Istituto Superiore di Sanita,
Rome, Italy
(Hernandez-Antolin) Department of Cardiology, University Hospital Ramon y
Cajal, Madrid, Spain
(Modine) Centre Hospitalier Universitaire, Lille, France
Publisher
NLM (Medline)
Abstract
BACKGROUND: Stroke remains one of the most devastating complications of
transcatheter aortic valve implantation (TAVI). The aim of this study was
to identify the incidence, timing, temporal trends, and predictors of
stroke after TAVI and evaluate the outcomes of patients with stroke.
METHODS AND RESULTS: The CENTER-Collaboration is an international
collaboration consisting of 3 national registries and 7 local registries
or prospective clinical trials, selected through a systematic review.
Accordingly, a total of 10982 patients undergoing transfemoral TAVI
between 2007 and 2018 were included in the current patient-level pooled
analyses. A total of 261 patients (2.4%) experienced stroke during the
first month after TAVI. The median time between TAVI and stroke was 1 day
(interquartile range, 0-6 days). The stroke rate was comparable in
procedures performed in the early years of TAVI (2007-2012) to those in
the more recent years of TAVI (2013-2018; both 2.4%; P=1.0). Independent
predictors of stroke at 30 days were a history of cerebrovascular events
(odds ratio, 2.2; 95% CI, 1.4-3.6; P=0.0012) and a glomerular filtration
rate of <30 mL/min per 1.73 m2 (odds ratio, 1.7; 95% CI, 1.0-2.8; P=0.05).
Stroke occurring within the first 30 days after TAVI was associated with a
6-fold increase of 30-day mortality (odds ratio, 6.0; 95% CI, 4.4-8.1;
P<0.001). Moreover, patients with stroke more frequently had documented
new-onset atrial fibrillation (16% versus 3%; P<0.001) and major or
life-threatening bleedings (12% versus 7%; P=0.002) at 30-day follow-up.
 CONCLUSION(S): In this large, global, patient-level analysis, the
incidence of stroke after transfemoral TAVI was 2.4%. Prior
cerebrovascular events and a low glomerular filtration rate independently
predicted the occurrence of stroke after TAVI. The occurrence of stroke
after TAVI was associated with a strikingly 6-fold increase of 30-day
mortality; additionally, there was a 5-fold higher rate of new-onset
atrial fibrillation in patients with stroke. CLINICAL TRIAL REGISTRATION:
URL: https://www.clinicaltrials.gov . Unique identifier: NCT03588247.

<103>
Accession Number
626815385
Title
Outcomes after Ross procedure in adult patients: A meta-analysis and
microsimulation.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Sibilio S.; Koziarz A.; Belley-Cote E.P.; McClure G.R.; MacIsaac S.; Reza
S.J.; Um K.J.; Lengyel A.; Mendoza P.; Alsagheir A.; Alraddadi H.; Gupta
S.; Schneider A.W.; Patel P.M.; Brown J.W.; Chu M.W.A.; Peterson M.D.;
Ouzounian M.; Paparella D.; El-Hamamsy I.; Whitlock R.P.
Institution
(Sibilio) Facolta di Medicina e Chirugia, University of Bari "Aldo Moro",
Bari, Italy
(Koziarz) Faculty of Medicine, University of Toronto, Toronto, ON, Canada
(Koziarz, McClure, MacIsaac, Reza, Lengyel, Mendoza, Alsagheir, Alraddadi,
Gupta, Whitlock) Department of Surgery, Division of Cardiac Surgery,
McMaster University, Hamilton, ON, Canada
(Belley-Cote, Um) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Belley-Cote, McClure, Whitlock) Population Health Research Institute,
Hamilton, ON, Canada
(MacIsaac) School of Medicine, Faculty of Medicine and Health Sciences,
Royal College of Surgeons in Ireland, Dublin, Ireland
(Alsagheir) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada
(Schneider) Department of Cardiothoracic Surgery, Leiden University
Medical Center, Leiden, Netherlands
(Patel) Department of Cardiothoracic Surgery, Emory University, Atlanta,
GA, United States
(Brown) Section of Cardiothoracic Surgery, Indiana University School of
Medicine, Indianapolis, IN, United States
(Chu) Department of Surgery, Division of Cardiac Surgery, London Health
Sciences Centre, Western University, London, ON, Canada
(Peterson) Division of Cardiac Surgery, St. Michael's Hospital, University
of Toronto, Toronto, ON, Canada
(Ouzounian) Division of Cardiac Surgery, Peter Munk Cardiac Center,
University of Toronto, Toronto, ON, Canada
(Paparella) Department of Emergency and Organ Transplant, Division of
Cardiac Surgery and Santa Maria Hospital, GVM Care & Research, University
of Bari "Aldo Moro", Bari, Italy
(El-Hamamsy) Division of Cardiac Surgery, Montreal Heart Institute,
Universite de Montreal, Montreal, QC, Canada
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: We conducted a meta-analysis to estimate the risk of adverse
events, life expectancy, and event-free life expectancy after the Ross
procedure in adults. Method(s): We searched databases for reports
evaluating the Ross procedure in patients aged more than or equal to 16
years of age. A microsimulation model was used to evaluate age- and
gender-specific life expectancy for patients undergoing the Ross
procedure. Result(s): Data were pooled from 63 articles totaling 19
155 patients from 20 countries. Perioperative mortality was 2.5% (95%
confidence interval [CI]: 1.9-3.1; N = 9978). We found a mortality risk of
5.9% (95% CI: 4.8-7.2) at a mean follow-up of 7.2 years (N = 7573). The
rate of perioperative clinically significant bleeding was 1.0% (95% CI:
0.1-3.0); re-exploration for bleeding 4.6% (95% CI: 3.1-6.3);
postoperative clinically significant bleeding from 30 days until a mean of
7.1 years was 0.5% (95% CI: 0.2-1.0). At a mean of 6.9 years of follow-up,
reintervention rate of any operated valve was 7.9% (95% CI: 5.7-10.3). The
risk of valve thrombosis was 0.3% (95% CI: 0.2-0.5) at 7.6 years;
peripheral embolism 0.3% (95% CI: 0.2-0.4) at 6.4 years; stroke 0.9% (95%
CI: 0.7-1.2) at 6.5 years; and endocarditis 2.1% (95% CI: 1.6-2.6) at 8.0
years. Microsimulation reported a 40-year-old undergoing the Ross
procedure to have a life expectancy of 35.4 years and event-free life
expectancy of 26.6 years. Conclusion(s): Ross procedure in nonelderly
adults is associated with low mortality and low risk of adverse events
both at short- and long-term follow-up. The surgical community must
prioritize a large, expertize-based randomized controlled trial to
definitively address the risks and benefits of the Ross procedure compared
to conventional aortic valve replacement. Copyright © 2019 Wiley
Periodicals, Inc.

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